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Home My WebLink About04-0523 INRE: ESTATE OF GLADYS A. : IN THE COURT OF COMMON PLEAS OF GARDNER, late of the : CUMBERLAND COUNTY Township of South Newton, : PENNSYLVANIA Cumberland County, : ORPHANS' COURT DIVISION Pennsylvania, deceased : ESTATE NUMBER 21-04-0523 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Gladys A. Gardner Date of Death: May 12, 2004 Will No. 21-04-0523 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on June 9, 2004: Fred Koser 236 Big Pond Road Shippensburg, P A 17257 Martha Kelly 819 Crescent Drive . -' Shippensburg, P A 17257 d ~ Cleversburg Cemetery Association c.. f: c/o Garnet D. Sturn -~ 45 Cherry Grove Road . -.. Shippensburg, P A 17257 Susan T. Sullivan --~ 244 Big Pond Road Shippensburg, P A 17257 ~ WEIGLE & ASSOCIATES. Pc. ~ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. June 9, 2004 // I ~- Name: Address: Weigle & Associates, P.C. 126 East King Street Shippensburg, P A 17257 Telephone: (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative WEIGLE & ASSOCIATES. P.c. ~ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004243 WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 ACN ASSESSMENT AMOUNT CONTROL NUMBER ___nn_ fold ______un _____n. 101 I $27,000.00 . . ESTATE INFORMATION: SSN: 187.16-5571 I FILE NUMBER: 2104-0523 I DECEDENT NAME: GARDNER GLADYS A I DATE OF PAYMENT: 08/06/2004 I POSTMARK DATE: 08/06/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/12/2004 I I TOTAL AMOUNT PAID: $27,000.00 _... REMARKS: CHECK#109 INITIALS: JA >' SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ Iu~ ~ ~ 1 / r:~7 ~cdr- A. 4~ '#- 7.../-0 'f - () 5: z.. 3 fA ~~ 70JX f~ cd ~ ft Z7r OOtJ.CJCJ WEIGLE & ASSOCIATES, P.C. Attorneys at Law 126 East King Street Shippenaburg. PA 17257 00 g ::0 - .... ::::; rp .(j) ::j ;7 n cr . Co ~I -'" .,~" "'" '-', H? ~ c:' I::' I 0'1 :::g N .j:,;. 0 l>' ~ gJ t'l .... -a. C'l "CI'" t"" ~~>t!!j r;.l"lsl/." " .. ;;l a3=' >- . ~ ~ 00- ~ . ~ 00 = .. 0 ..... ~ ...."'t"rl ... ~ .... '" ~ ~ >, ~ I'D ~ ~..... ~ '" S" .... ~ .. 0 .oJ 0 .. (J ... (J (J 0 .. 0 ~ n n 1;' III 0 H " >-' H OQ ..... rt ..... '" ::r '" >-' 0 rt l1> " l1> '" H 'd l1> 0 > '"" ::e:: ..... ..... >-' - ..., >-' 0 '" ..... ou w -"('j' g ::0 ;;'g ,~ '<tr l1> "" H c: ~~,~~. '0.. r::~:. 1,,,1"1 ",..'" :+ >-' G1 ~ .\1 J) I 1"f'1 " I ,.:~ (~ ;~~:~ ::~::~ ;:::;::, * p.. .J'l - n (I:," >t 0 31 - ", N ""1"""" -Ef. ~ """.,J urnrE: ~. ,I'''""" D '0 m """,,llll11if>..s'';'' ~ 0" ,....."'V'.... - ~""IIII~) \ t ~" "Il~ \ ~ g:", ::; c5I l? m 'II~ ~ "'" o .11 II I c:: ~~) ,J, rl I ,I G1 '-"\ 1\) I-"IJ I 1,IIl"11 0, "I .",.1 "i> .~>, 31 (;, r;:.' ." (t COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004366 SULLlV AN SUSAN T 244 BIG POND ROAD SHIPPENSBURG, PA 17257 ACN ASSESSMENT AMOUNT CONTROL NUMBER ____un fold ---------- -------- 101 I $977.17 ESTATE INFORMATION: SSN: 187-16-5571 I FILE NUMBER: 2104-0523 I DECEDENT NAME: GARDNER GLADYS A I DATE OF PAYMENT: 09/13/2004 I POSTMARK DATE: 09/13/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/12/2004 I I TOTAL AMOUNT PAID: $977.17 REMARKS: GARDNER GLADYS CHECK# 114 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV..1500 EX + (6~O) REV-1500 * COMMONWEALTH OF PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 RESIDENT DECEDENT II 04 0523 HARRISBURG, PA 17128-0601 COUNTY CODE YEAR -~_.._-~ NUMBER ---TDECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I 187-16-5511 l- i Gardner, Gladys A. z W DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 05-12-2004 07-12-1923 REGISTER OF WILLS 0 w (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C ------- - ._._-_._---~-- [J 2. Supplemental Return w I xJ 1. Original Return D 3. Remainder Return (date of death prior to 12-13-82) .... lo::~<II 4. Limited Estate 4a. Future Interest Compromise (date of death after D 5. Federal Estate Tax Return Required uO:lo:: 12-12-82) wll.U ,,00 [)(] 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes 00:-' II.lD II. copy of Will) copy of Trust) c( 9. Litigation Proceeds Received D 10 S:f.ousal (date of death between D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) . 1 -31-91 .... AME COMPLETE MAILING ADDRESS z w _~_e!r)'~. Weiglf:t_, Esquire c z 0 IRM NAME (If applicable) II. 126 East King Street <II Weigle & Associates, P.C. w 0: Shippensburg, PA 17257 0: 0 I ELEPHONE NUMBER 0 .717-532-7388 '1-- 1. Re~~t;te (Schedule A) ~.._--_._-----,_."- (1 ) 78,000.00 OFFICIAL I 2. Stocks and Bonds (Schedule B) (2) None D 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) 1- None .~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 258,738.79 (Schedule E) D Clear Amb:tts z 6. Jointly Owned Property (Schedule F) (6) None Not Suppa ed 0 by Transactions i= Separate Billing Requested -.-to ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None :) (Schedule G or L) I.J Separate Billing Requested l- ii: 8. Total Gross Assets (total Lines 1-7) (8) 336,738.79 <( 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 33,695.25 w a: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 9,561.34 11. Total Deductions (total Lines 9 & 10) (11 ) 43,256.59 12. Net Value of Estate (Line 8 minus Line 11) (12) 293,482.20 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has (13) 97,494.07 not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 195,988.13 _.__._--_._~-".__. - SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) 0.00 or transfers under Sec. 9116(a)(1.2) - ----.-...--...-.. z 0 (16) i= 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 0.00 ~ - ----~,._-_._"._.-.._---- :) a.. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00 ::E 0 0 18. Amount of Line 14 taxable at collateral rate 195,988.13 x .15 (18) 29,398.22 x ~ 19. Tax Due (19) 29,398.22 .~. 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ;;;;;;BE;iSi1JRe:[Q;~Nsw~UE!QUeSmQNS;QN;ReYERsEisIDE.p;ie~He~1<'lM~i:'a~~ Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS 232 Big Pond Road -- - --~---_.--------~- I STATE IZIP CITY Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 29,398.22 ' ---------- 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments 27,000.00. C. Discount 1,421.05 Total Credits (A + 8 + C) (2) 28,421.05 3. InteresUPenalty if applicable D. Interest _~_m'~__. E. Penalty TotallnteresUPenalty (0 + E) (3) -----~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPA YMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 977.17 A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is theBALANCE DUE (58) 977.17 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE 8LOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.............................__...........................m................ 0 [J(] b. retain the right to designate who shall use the property transferred or its income;................................ D Ix1 1..1 c. retain a reversionary interest; or............................ .............................................................. n................ [J lie] d. receive the promise for life of either payments, benefits or care?........................................................... D I-X] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................ ...... ...... ............................... __................... ................................ 0 [xJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D [Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which D I~ contains a beneficiary designation?........ ................... ................................ on............................ n.................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and cO'T1E~e. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. .___ .___ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RE~URN ADDRESS DATE Sus~n T. Sullivan . 1 ;J 244 B;g Pond Road c; /J /;;tj ~dL' ~ Shippensburg, PA 17257 .. . \ - NATURE OF PERSON RESPON IBLE FO IL ADDRESS ..-- --.-------- DATE ~, /--- - -VZ!tJ'j l_ ADDRESS --.---- DATE 126 East King Street Shippensburg, PA 17257 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev.1502 EX+ (6-98) . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller. ne~her being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is jolntly-owned with right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residence at 232 Big Pond Road - Shippensburg, South Newton Township, 78,000.00 Cumberland County, PA - sold 08/27/2004 TOTAL (Also enter on Line 1, Recapitulation) 78,000.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev.1508 EX+ (6.98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 Include the proceeds of litigation and the dale the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Cash on hand at date of death 1.00 2 Tax Prorations at real estate settlement - county tax proration $69.53, school tax 899.92 proration $830.39 3 American Express Mutual Fund - #01142224090-0-002 97,779.27 4 M & T Bank Checking Account #1216185 79,871.65 Accrued income on Item 4 through date of death 17.51 5 M & T Bank Checking Account #97250074 72,367.09 6 2001 Ford Focus 4,756.00 7 Personal Property - proceeds of public sale 08/14/2004 2,596.35 8 Proceeds of individual sales of personal property 450.00 TOTAL (Also enter on Line 5, Recapitulation) 258,738.79 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRA TIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 6,127.00 B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 13,102.00 See continuation schedule(s) attached 2. Attorney's Fees 13,852.00 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 301.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 313.25 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 33,695.25 - Copyright (cl 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev..1502 EX+ (6.98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM DESCRIPTION NUMBER AMOUNT 1 Fogelsanger-Bricker Funeral Home 6,127.00 Subtotal 6,127.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-981 SCHEDULE H-81 PERSONAL REPRESENTATIVE'S COMMISSIONS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM NUMBER DESCRIPTION AMOUNT 1 Susan T. Sullivan - Executrix Commission 13,102.00 Subtotal 13,102.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B1 (Rev. 6-98) Rey.1502 EX+ (6-98) SCHEDULE H-82 A TTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM DESCRIPTION NUMBER AMOUNT 1 Weigle & Associates, P.C. - Attorney Fee 13,852.00 Subtotal 13,852.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-84 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM DESCRIPTION NUMBER AMOUNT 1 Register of Wills, Cumberland County - Letters Testamentary and Short Certificates 301.00 Subtotal 301.00 Cop~Tight (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Rey.1502 EX+ (6-98) SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - advertising Letters Testamentary 75.00 2 Linda K. Klein - notary fees 10.00 3 News Chronicle - advertising Letters Testamentary 84.50 4 Register of Wills, Cumberland County - filing PA Inheritance Tax Return 15.00 5 Register of Wills, Cumberland County - filing Family Settlement Agreement 100.00 6 Weigle & Associates, P.C. - reimbursement for postage, xerox copies, and long 28.75 distance telehone calls Subtotal 313.25 Cop~'right (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 Include unreimbursed medical expenses. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Borough of Shippensburg - water billing 36.43 2 Checks clearing after date of death - drawn on M & T Bank Checking Account 2,952.85 #97250074 3 Fred Koser - lawn mowing, April - June 220.00 4 PPL Electric Utilities - May statement 19.98 5 PPL Electric Utilities - June statement 10.63 6 Real Estate settlement expenses - including document preparation $85.00; 1% 2,068.92 realty transfer tax $780.00; 2004-05 school taxes $984.08; 2004 county taxes $219.84 7 Sprint - 06/01/04 statement, local service 140.10 8 Sprint - 06/04/04 statement long distance 8.39 9 Susan Sullivan - reimbursement for expenses paid for decedent prior to date of 166.04 death 10 Thornwald Home - 04/01/04 statement 3,938.00 TOTAL (Also enter on Line 10, Recapitulation) 9,561.34 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) *' SCHEDULE .J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trusteels) I. TAXABLE DISTRIBUTIONS [include outright seousal aistributions, and ransfers under Sec. 9116(a)(1.2)] 1 Martha Kelly Niece 500.00 819 Crescent Drive Shippensburg, PA 17257 2 Fred Koser Nephew 500.00 236 Big Pond Road Shippensburg, PA 17257 3 Susan T. Sullivan Friend 2/3 of residuary 194,988.13 244 Big Pond Road estate Shippensburg, PA 17257 Total 195,988.13 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 97,494.07 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 97,494.07 - Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE ....IIB CHARITABLE AND GOVERNMENTAL COMMONWEALTH OF PENNSYLVANIA DISTRIBUTIONS INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Gardner, Gladys A. 21-04-0523 ITEM NUMBER DESCRIPTION AMOUNT 1 Cleversburg Cemetery Association 97,494.07 45 Cherry Grove Road Shippensburg, PA 17257 TIN: 75-210221 Subtotal 97,494.07 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ-IIB (Rev. 6-98) .A. Settlement Statement u.s. Department of Housing and Urban Development B. Tvoe of Loan OMS No. 2502-0265 REV. HUD-1 (3/86) 1. [)FHA 2. DFmHA 3, DConv, Un ins, 16. File Number I 7. Loan Number /8. Mortgage Insurance Case Number 4. [)VA 5, DConv. Ins, 041150GARDINER C. Note: .1 nlS orm IS rumlsneo 0 give you a StalemeOl 0 ac ua selllement costs. Amoun s palo 10 ana oy tOe settlement agen are s~own. I TitleExpress Settlement System lIems marked "(p.o.c.)" were paid outside the closing: they are shown here for information purposes a~d ~re not included in the totals. WARNING: II is a crime to knowingly make false statements to the UOIted States on this or an~ other Similar form. Pena/!Ies:upon Printed 08/27/2004 at 15:26 RLH conviction can include a fine and Imorisonment. For details see: Tille 18 U. S. Code Seclion 1 01 and Seclion 1010. 0, NAME OF BORROWER: Lynn E. Brenize and Jamie D. Brenize ADDRESS: 25 Foreman Road. Shippensbura. PA 17257 E. NAME OF SELLER: Estate of Gladys A. Gardner ADDRESS: F. NAME OF LENDER: ADDRESS: G, PROPERTY ADDRESS: 232 Big Pond Road, Shippensburg, PA 17257 \, South Newton Township H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717.532.7387 Fax: 717.532.6552 PUICE OF SETTLEMENT: 126 East King Street Shipoensbura. PA 17257 I. SETTLEMENT DATE: 08/27/2004 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101, Contract sales Drice 78 000.00 401. Contract sales Drice 78.000.00 102. Personal ProDerty 402, Personal Prooerty 103. Settlement charQes to borrower (line 1400\ 1 308.50 403. 104. 404, 105. 405, Adiustments for items paid by seller in advance Adiustments for items paid by seller in advance 107, County taxes 08/27/04 to 12/31/04 69.53 407. County taxes 08/27/04 to 12/31/04 69.53 108. School Taxes 08/27/04 to 06/30/05 830.39 408. School Taxes 08/27/04 to 06/30/05 830.39 109. 409, 110, 410. 111. 411. 112. 412, 120. GROSS AMOUNT DUE FROM BORROWER 80 208.42 420. GROSS AMOUNT DUE TO SELLER 78.899.92 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS INiAMOUNT DUE TO SELLER 201. DeDosit or earnest money 7.800.00 501, Excess DeDosit (SSe instructions) 7.800.00 202. Princioal amount of new loans 502. Settlement charoes to seller (line 1400\ 2.068.92 203, Existino loan(s) taken subiect to 503. Existina loan(s) takim subiect to 204. 504, Payoff of First Mortbaae Loan 205. 505. 206. 506. 207, 507. 208. 508. 209. 509, Adiustments for items unpaid bv seller Adiustments for items unpaid bv seller 213. 513. 214, 514. 215. 515, 216, 516. 217, 517, 218. 518, 219. 519, 220. TOTAL PAID BY/FOR BORROWER 7 800.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 9.868.92 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower !line 120\ 80 208.42 601. Gross amount due to seller (line 420) 78 899.92 302. Less amounts oaid bvlfor borrower !line 220\ 7 800.00 602, Less reduction amount due seller (line 520) 9 868.92 303. CASH FROM BORROWER 72.408.42 603. CASH TO SELLER 69 031.00 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information conlained herein is Important lax Information and is being furnished to t~e Internal Revenue Service. If you are required 10 file a relurn. a negligence penally or other sanclion will be imposed on you if this i1em is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on line 401 above constilutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: If Ihis real estate was your frinciPal residence. file Form 211 g, Sale or Exchange of Princlpat Residence, for any gain, with your tncome tax return; for other transactions, complete Ihe applicable parts of Form 4797, Form 625 and/or Schedule D (Form 1040). You are required by law t.o provide. the selUement agent (Fed. Tax ID No: ) with yourcorrect taxpayer identification numqer. If you do not provide your correcltaxpayer identificalion number. you may be sUbJect to CIVIl or cnmlnal penalties Imposed by law. Under penalhes of pe~ury. I certify that the number shown on this statement is my correcltaxpayer identification number. TIN: / SELLER(S) SIGNATURE(S): J SELLER(S) NEW MAILING ADDRESS: .?ARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 041150GARDINER PAGE 2 . /LEMENT STATEMENT REV, HUD-1 (3/86\ TitleExoress Settlement System Printed 08/27/2004 at 15:26 RLH fLEMENT CHARGES PAID FROM PAID FROM JTAL SALES/BROKER'S COMMISSION based on Drice $78.000.00 @ 0.000 = BORROWER'S SELLER'S division of commission (line 70m as follows: FUNDS AT FUNDS AT /:$ to SETTLEMENT SETTLEMENT 1.. :$ to ~::;ommission oaid at Settlement 'SOO.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. I_oan Orioination Fee % 802. I_oan Discount % 803. Appraisal Fee 804, Credit Report 805. Lender's InsDection Fee 806. Mortoaoe ADnlication Fee 807. AssumDtion Fee . 808. 809, 810, 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to fii)$ /dav 902, Mortoane Insurance Premium for to 903, Hazard Insurance Premium for to 904. 905, 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. fii)$ Imo 1002. Mortoaoe Insurance mo. fii)$ /mo 1003, City Pronertv Tax mo. ((1)$ Imo 1004. County Property Tax mo,~$ 16.65 /mo 1005. School Taxes mo.@$ 82.01 /mo 1009. Aoareoate Analvsis Adjustment 1100. TITLE CHARGES 1101. Settlement or c1osino fee to South Central Home Settlements Inc. 490.00 1102, Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Prenaration to South Central Home Settlements 85.00 1106, Notarv Fees 1107. Attornev's fees (includes above items No: \ 1108. Title Insurance (includes above items No: \ 1109. Lender's Coveraoe $ 1110. Owner's Coveraoe $ 78 000.00 . 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordino Fees Deed $ 38.50 . Mortoane $ , Release $ 38.50 1202. Citv/Countv taxlstamDs Deed $780.00 ' Mortaaoe $ 780.00 1203. State T axlstamps Deed $780.00 : Mortqaqe $ 780.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302, Pest Insnection 1303, 2004-05 School Taxes 10 Patricia J. Minnelli 984.08 1304. 2004 Countv/Township to Patricia J. Minnelli 219.84 1305, 1306. 1307, 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K\ 1.308.50 2 068.92 Hun CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 SeUlement Slatement and 10 the best of my' knowledge and belief, it is a true and accurate statement!of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy t the HUD-1 SeU ement Slatemenl. ''"~C-~ ,,~~b.j)~ Estate of ~ladYS A. Gardner. 'i ( ~~~ff(d!l6tJ 't &bA ~ .&L-~ y: usan . U I n, ecu nx L..- WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Slatement which I have prepared is a true and accurale account of this transaction. UNITED STATES ON THIS OR ANY SIMILAR FORM. PENAL TIES UPON CONVICTION I have caused or will cause the funds to be disbursed in accordance with this slatemenl. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. By: DATE JUL 1 3 200% @ IDS LIFE INSURANCE COMPANY AMERICAN EXPRESS FUNDS AMERICAN EXPRESS CERTIFICATE COMPANY AMERICAN EXPRESS BROKERAGE 70100 AXP Financial Center Minneapolis, MN 55474 July 9, 2004 JERRY WEIGLE WEIGLE AND ASSOCIATES 126 EAST KING ST SHIPPENSBURG, PA 17257-1397 Dear JERRY WEIGLE: Thank you for your recent inquiry regarding GLADYS A GARDNER's accounts. These are the values of the accounts as of 05/1212004. Mutual Funds Account Number Total Value # of shares Asset Value Per Share 011422240900002 $97,779.27 25825.126 3.780 The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Sincerely, Peter Fischer Death Settlements Processing Team 70100 AXP Financial Center Minneapolis, MN 55474 888-723-8476, option 1,3,1 Insurance and annuities are issued by IDS Life Insurance Company, an American Express company. American Express Brokerage is provided by American Express Financial Advisors Inc. American Express Financial Advisors Inc. Member NASD. American Express Company is separate from American Express Financial Advisors Inc. and is not a broker-dealer. mlM&TBank 499 Mitchell Road, Millsboro, DE 19%6 Mail Code 501-120 Phone (302) 934-2909 Fax (302) 934-2955 June 9, 2004 Weigle & Associates Attorneys At Law 126 East King Street Shippensburg, PA 17257-1397 Re: Estate of Gladvs A Gardner Social Securitv: 187-16-5571 Date of Death: }v1av 12.2004 Dear Sir or Madam: Per your inquiry dated June 8, 2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 97250074 Ownership (Names oj) Gladys A Gardner William L Gruver, POA Opening Date 01/28/80 Balance on Date of Death $72,367.09 Accrued Interest $ 0.00 __~_v_________~______________________~_________________ Total $72,367.09 2. Type of Account Savings Account Account Number 21000001216185 Ownership (Names oj) Gladys A Gardner William L Gruver, POA Opening Date 03/30/57 Balance on Date of Death $79,871.65 Accrued Interest $ 17.51 .------------------------------------------------------._-----.----- Total $79,889.16 For further account information, closures and/or reimbursement offunds please call the Walnut Bottom Office at #717-532-2414. We were unable to locate any safe deposit box for the above-mentioned decedent. Edmunds used Ford Focus car appraisal. Used Ford car pricing. Page 1 of2 ISIGN INI edmunds" DEALS SF Financinq As Low As 4.39% APR Compare Leases Free Insurance Quote wl';!re ~mi\r7 ~<J' t:,u!,e'~ sta 't. HOME NEW CARS (ERTlAED CARS USED CARS CAR REVIEWS TIPS & ADVICE FORUMS ~ Sell your car online. Get your car in front of millions of serious shoppers. 2001 Ford Focus 4 Dr LX Sedan View 2001 Styles Other years for this style 12003 .:=:J ~ · Used Ve Consumer Rating 7.7 I IRATE ITI 115 Reviews . Free Re J.D. Power Ratinqs I View all Ratinqs I Editors' Review .Downlo Use the links below to .... .... research this \/ehicle · Search Used Ford Listinqs . Calculate Low Payments · Request a Free Insurance Quote · Free Extended Warrantv Quote ~ · TMV Pricing . Appraise Your Car Used Car Appraiser . Resale Values Back Sele( · Payment Calculators orus" · Vehicle History Report STEP 5 Review Edmunds.com Pricing Report . Certified Program ~ ~ 2001 Ford Focus 4 Dr LX ~ Tr~e !'1arket Value@ II Sedan . Pricing I · True Cost to Own .L~. ' - _ * :J Trade-In Private Dealer Party Retail National Base Price $4,611 $5,541 $6,398 ~ . Standard Features Optional Equipment $0 $0 $0 . Specifications Color Adiustment · Colors Light Blue $-3 $-4 $-5 L . Safety Regional Adiustment $24 $29 $33 . Photos & Video for Zip Code 17257 · Maintenance Mileage Adiustment $-73 $-73 $-73 50,000 miles . Standard Warranty Condition Adiustment $-625 $-737 $-826 Average Total $3,934 $4,756 $5,527 . Editors' Review · Consumer Reviews Certified Used Vehicle N/A . Road Tests & Awards Price Another Vehicle . Ratings Print Private Partv Window Sticker I Print Dealer Window Sticker · Consumer Discussions Next Steps Get a Free Price Quote on a New Car Used Vehicle ListinQs Looking to buy a new car? Get a Free Dealer Price Quote from dealers in your area. Sell Your Car Calculate Monthly Get a Free Quote f .- .. Payments Free Insurance Ouotes . . .-. -" LAST WILL AND TESTAMENT I, GLADYS A. GARDNER, presently residing at 232 Big Pond Road, Shippensburg, Southampton Township, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give and bequeath the sum of Five Hundred Dollars ($500.00) to my nephew, FRED KOSER, on a per stirpes distribution basis. THIRD. I give and bequeath the surn of Five Hundred Dollars ($500.00) to my niece, MARTHA KELLY, on a per stirpes distribution basis. FOURTH. I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, as follows: A. One-third (1/3) of my estate to the CLEVERSBURG CEMETERY ASSOCIATION ofCleversburg, Pennsylvania; and B. Two-thirds (2/3) of my estate to my friend, SUSAN T. SULLIVAN. FIFTH. I nominate, constitute and appoint my friend, SUSAN T. SULLIV AN, presently residing at 244 Big Pond Road, Shippensburg, Pennsylvania 17257, to be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint BRENDA BOYD, presently residing at 20515 Georgia Avenue North, Forest Lake, Minnesota 55025, to be the Executrix of this my Last Will and Testament. SIXTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. SEVENTH. I direct my Executor to retain the services of JERRY A. WEIGLE, ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, Gladys A. Gardner, have hereunto ~and and seal (A. this ~ast Will and Testament, written on one (1) page, this 'day of '1~ , 2004. v Lff . t. . // (/ (SEAL) ,";'^_. <. .J:' . ~ I ',", - c:. ,,_u;,. l.~/,>_., - , v' WEIGLE & ASSOCIATES. p,c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 I . This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. L//rL ( ~i / JalL.... aC. ~ 1..,,). __Ii," {(' e.d-- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, Gladys A. Gardner, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~I/ 4 ./ -';~a. /' L'/-<1/ tL- /!::.1.~<-eh~,~~/ / Sworn or affirmed to and acknowledged before m~ by ~ADYS A. ~~~R, the Testatrix, thIS ~ day of 1J1l& .,..' , 20 ~. i \ / , iL" / C! r " NOTARIAL SEAL Jerry A Weigle, Notary Pub! Shippensburg. PA Cumberland County My Commission ires October 7, 2006 WEIGLE & ASSOCIATES. PC - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 r COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We, LuJ, ( 7.i",6 , and 7?]~ .,." , -];", dO ~' , the witnesse~hose names are signed to the foregoing instrument, being duly qualifie . according to law, do. depose and say that we were present and saw Gladys A. Gardner, the Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~('rU / JYj.-d-rj., Yn, 7:/.. Q~ Sworn or affirmed to and subscribed before me by ~ [;, ~ , / / and NOTARIAL SEAL , . Jerry A Weigle, Notary Public ShlPJ,lenSoorg, PA Cumberland County My Commission Expires October 7, 2006 'i WEIGLE & ASSOCIATES. P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION PO BOX Z80601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 171Z8-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP 109-D4) DATE 11-15-2004 ESTATE OF GARDNER GLADYS A DATE OF DEATH 05-12-2004 FILE NUMBER 21 04-0523 COUNTY CUMBERLAND JERRY A WEIGLE ESQ ACN 101 WEIGLE & ASSOCIATES I Allount Rellitted I 126 EKING ST SHIPPENSBURG PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... REV: i5'4-j-EX-AFP--CoY:oiY-NoYicE--OF-YNHERiTANCE-i"-A'X-A-PPRA-isEi'-ENi'~--Ar:roWAtrCE-(fR------------- ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GARDNER GLADYS A FILE NO. 21 04-0523 ACN 101 DATE 11-15-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 78.000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 258.738.79 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 336,738.79 APPROVED DEDUCTIONS AND EXEMPTIONS: 33,695.25 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 9.561.34 11. Total Deductions (11) 43.256 59 12. Net Value of Tax Return (12) 293,482.20 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 97,494.07 14. Net Value of Estate Subject to Tax (14) 195,988.13 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 195,988.13 X 15 = 29,398.22 19. Principal Tax Due 4; '; \ ~~j (19)= 29,398.22 TAX CREDITS: "\ I"AYMENT l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-06-2004 CD004243 6~; r- t ,'[" 1,~1. 05 27,000.00 09-13-2004 CD004366 :::> '\..' . ,-. .00 977.17 TOTAL TAX CREDIT 29,398.22 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERYATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent efter the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS. AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available online at www.revenue.state.oa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. ADMIN- C) Appeal to the Orphans. Court. ISTRATIYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent.s death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor rm ~ ~ ~-1991 -rrr- 7'mi"ii!DI" Z1iii1 -,r- .1iiiimr 1983 16Z .000438 1992 9Z .000247 2002 6Z .000164 1984 11Z .000301 1993-1994 n .000192 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000247 2004 4Z .000110 1986 10Z .000274 1999 n .000192 1987 10Z .000274 2000 n .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. --, --'-1 ESTATE OF GLADYS A. GARDNER :-j 1 ~, File No. 21-04-0523 ~...-- FAMILY SETTLEMENT AGREEMENT -ciJ '\ ^j ,- THIS AGREEMENT made this' l j day of~t l.U6 ,2005, BETWEEN: GARNET D. STUM, IREASURER OF CLEVERSBURG CEMETERY ASSOCIATION, and SUSAN T. SULLIVAN, being the residuary legatees under the Last Will and Testament of Gladys A. Gardner, late of the Township of South New10n, Cumberland County, Pennsylvania, AND SUSAN T. SULLIVAN, Executrix of the Estate of Gladys A. Gardner, deceased. WHEREAS, Gladys A. Gardner died May 12,2004, testate; and WHEREAS, Letters Testamentary were granted to Susan T. Sullivan on June 3, 2004, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS. all assets of the late Gladys A. Gardner have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said parties hereto desire to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, ^ND FURTHER desire that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. WEIGLE & ASSOCIATES. P.C - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 172571397 NOW, THEREFORE, WITNESSETH, that the parties hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereol~ and the receipt of their distributive shares as therein shown, do mutually bind themselves to the said Distribution and Accounting as sct forth and further mutually release Susan T. Sullivan. Executrix, from all claims and demands whatsoever arising out of settlement of the Estate of Gladys A. Gardner. The parties hereto do further agree that should any liability come due to thc estate ofthe said decedent after the signing of this agreemcnt, wc do hereby covenant and agree with the aforesaid personal representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivcry of this family settlement agreement and final release. IN WITNESS WHEREOF, thc parties have hereunto set their hands and seals the day and year first above written. WITNESS: / / .. iCLEVERSBURG CEMETERY ASSOCIA nON '\.../ C I L/ /L " . (.- ., ' . ..i' l / C iI, !y:. clAL,,-<;-tL,:Sluh (SEAL) I . L )1 ~ Garnet D. Sturn, lreasurer \.0 " /-" r" " ;, ", \ ^'M / ',' . , , . I) ) ~" ' / . ,~ V /1, ~~f //JU<i fl. 11 /. !UC1u'(tJ(.. (SEAL) \ " Susan T. SullIvan \ ! \ , Ii I WEIGLE & ASSOCIATES. Pc. - ATTORNEYS AT LAW - 126 EAST KING STREET - SH1PPENSBURG, PA 17257 1397 SUMMARY OF ACCOUNT Estate of Gladys A. Gardner, Deceased For the period of Mav 12. 2004 throullh Januarv 6. 2005 Fiduciary Current Acquisition Proposed Distributions Palle Value Value to Beneficiaries 10 163,172.46 163,172.46 PRINCIPAL Receipts: This Account 1 336,738.79 Net Gain (or Loss) on Sales 2 or Other Dispositions 2,208.06 Less Disbursements: 338,946.85 Debts of Decedent 3 9,570.66 Funeral Expenses 3 6,127.00 Administration Expenses 3-4 614.25 Federal and State Taxes 4 27,977.17 Commissions 4 13,102.00 Fees 4 13,852.00 Family Exemption 0.00 71,243.08 Balance Before Distributions 267,703.77 Transfer from (to) Income Distributions to Beneficiaries 5 104,931.00 Principal Balance on Hand 6 162,772.77 For Information: Investments Made Changes in Investment Holdings 7 INCOME Receipts: This Account 8 399.69 Net Gain (or Loss) on Sales 0.00 or Other Dispositions 399.69 Less Disbursements 0.00 Balance Before Distributions 399.69 Transfer from (to) Principal Distributions to Beneficiaries 0.00 Income Balance on Hand 9 399.69 For Information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND 163,172.46 SCHEDULE A RECEIPTS OF PRINCIPAL Fiduciary Acquisition Value Cash 05/12/2004 American Express Mutual Fund - 97,779.27 #01142224090-0-002,25,825.126 shares 05/12/2004 Cash on hand at date of death 1.00 05/12/2004 M & T Bank Checking Account #1216185 79,871.65 05/12/2004 Accrued income on above item through date of 17.51 death 05/12/2004 M & T Bank Checking Account #97250074 72,367.09 250,036.52 Personal Property 05/12/2004 2001 Ford Focus 4,756.00 08/14/2004 Personal Property - proceeds of public sale 2,596.35 08/14/2004 05/12/2004 Proceeds of individual sales of personal 450.00 property 7,802.35 Real Estate in PA 08/27/2004 Residence at 232 Big Pond Road - 78,000.00 Shippensburg, South Newton Township, Cumberland County, PA - sold 08/27/2004 78,000.00 Subseauent Principal Receipts 08/27/2004 Tax Prorations at real estate settlement - county 899.92 tax proration $69.53, school tax proration $830.39 899.92 Total Receipts of Principal 336,738.79 1 SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL Gain Loss 07/27/2004 American Express Mutual Fund Net Proceeds 99,987.33 Fiduciary Acquisition Value -97,779.27 2,208.06 TOTAL GAINS AND LOSSES/PRINCIPAL 2,208.06 LESS LOSS NET GAIN OR LOSS 2,208.06 2 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Debts of Decedent 06/14/2004 Checks clearing after date of death - drawn on M 2,952.85 & T Bank Checking Account #97250074 06/15/2004 Sprint - 06/01/04 statement, local service 140.10 06/15/2004 PPL Electric Utilities - May statement 19.98 06/15/2004 Susan Sullivan - reimbursement for expenses 166.04 paid for decedent prior to date of death 06/23/2004 Sprint - 06/04/04 statement long distance 8.39 06/23/2004 PPL Electric Utilities - June statement 10.63 06/29/2004 Fred Koser - lawn mowing, April - June 220.00 06/29/2004 Thornwald Home - 04/01/04 statement 3,938.00 07/27/2004 08/27/2004 Real Estate settlement expenses - including 2,068.92 document preparation $85.00; 1% realty transfer tax $780.00; 2004-05 school taxes $984.08; 2004 county taxes $219.84 08/31/2004 Borough of Shippensburg - water billing 36.43 Total Debts of Decedent 9,570.66 Funeral Expenses 06/15/2004 Fogelsanger-Bricker Funeral Home 6,127.00 Total Funeral Expenses 6,127.00 Miscellaneous Administration Expenses 06/15/2004 Register of Wills, Cumberland County - Letters 301.00 Testamentary and Short Certificates 06/15/2004 Cumberland Law Journal - advertising Letters 75.00 Testamentary 07/16/2004 News Chronicle - advertising Letters 84.50 Testamentary 09/01/2004 Register of Wills, Cumberland County - filing PA 15.00 Inheritance Tax Return 01/06/2005 Register of Wills, Cumberland County - filing 100.00 Family Settlement Agreement 3 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued 01/06/2005 Weigle & Associates, P.C. - reimbursement for 28.75 postage, xerox copies, and long distance telehone calls 01/06/2005 Linda K. Klein - notary fees 10.00 Total Miscellaneous Administrative Expenses 614.25 Taxes 08/05/2004 Register of Wills, Cumberland County - PA 27,000.00 Inheritance Tax payment at discount 09/0212004 Register of Wills, Cumberland County - PA 977.17 Inheritance Tax balance due Total Taxes 27,977.17 Commissions 09/01/2004 Susan T. Sullivan. Executrix Commission 13,102.00 Total Commissions 13,102.00 Fees 09/01/2004 Weigle & Associates, P.C. - Attorney Fee 13,852.00 Total Fees 13,852.00 TOTAL DISBURSEMENTS OF PRINCIPAL 71,243.08 4 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL Cleversburq Cemetery Association 06/30/2004 Partial Distribution 33,000.00 33,000.00 Fred Koser 06/30/2004 Specific Bequest 500.00 500.00 Martha Kellv 06/3012004 Specific Bequest 500.00 500.00 Susan T. Sullivan 06/15/2004 2001 Ford Focus 4,756.00 06/30/2004 Partial Distribution 66,000.00 10/27/2004 Cash 175.00 70,931.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 104,931.00 5 PRINCIPAL BALANCE ON HAND Current Value Fiduciary 01/06/2005 Acquisition # Units Description or as Noted Value Cash Orrstown Bank Estate Checking Acc 152,772.77 162,772.77 Total Cash 162,772.77 162,772.77 162,772.77 162,772.77 6 SCHEDULE F CHANGE IN INVESTMENT HOLDINGS - PRINCIPAL # Units Cost 2001 Ford Focus 05/12/2004 Inventoried 4,756.00 06/15/2004 Distributed -4,756.00 0.00 American Express Mutual Fund 05/12/2004 Inventoried 97,779.27 07/27/2004 Sold -97,779.27 0.00 Total 0.00 7 SCHEDULE G RECEIPTS OF INCOME Dividends American Express Mutual Fund OS/27/2004 301.85 301.85 Interest/Bank M & T Bank CheckinQ Account #1216185 06/14/2004 15.32 15.32 Orrstown Bank Estate CheckinQ Account #103.005054 07/11/2004 13,00 08/10/2004 9.94 09/10/2004 18.94 10/11/2004 19.70 11/11/2004 20.94 82.52 TOTAL RECEIPTS OF INCOME 399.69 8 INCOME BALANCE ON HAND Current Value Fiduciary 01/06/2005 Acquisition # Units Desc ri ptio n or as Noted Value Cash Orrstown Bank Estate Checking Acc 399.69 399.69 Total Cash 399.69 399.69 399.69 399.69 9 PROPOSED DISTRIBUTIONS TO BENEFICIARIES Current Value Fiduciary 01/06/2005 Acquisition or as noted Value TO: CleversburQ Cemetery Association One-third (1/3) share - $98,360.21 less prior distribution of 65,360.21 65,360.21 $33,000.00 65,360.21 65,360.21 TO: Susan T. Sullivan Two-third (2/3) share - $196,720.42 less prior distribution of 97,812.25 97,812.25 $70,931.00, and less PA inheritance tax paid of $27,977.17 97,812.25 97,812.25 Total 163,172.46 163,172.46 10 SUSAN 1. SULLIVAN, Executrix of the Estatc of Gladys A. Gardncr, deceased, hcrcby declares under oath (penalties of perjury) that she has fully and faithfully discharged the duties of her officc; that the foregoing First and Final Account is tme and correct and hIlly discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in lull; that, to her knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. ~1 ' i ! . ' l . / ( /;/{/,./() 11/ .....1- (I ( Lu,71.J<-- Susan T. Sullivan, Executrix . Subscribed and sworn to by SUSAN 1. SULLIVAN, before me this 12 e-" day of)Cn"'-"d ' 2005. (/ " t t: ,/ .: ?<~v.,i, . /tWi-' ~I '-"NOiiii1alSeal~ . Linda K. Klein, Notary Public Shippensburg, PA Cumberland County M Comf!lJ~.~i~~..~x9it~!~ugust 15, 200B WEIGLE & ASSOCIATES. PC ATTORNEYS AT LAW 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 ~--.) ,-...., EST A TE OF GLADYS A. GARDNF:R File No. 21-04-0523 -..- FAMILY SETTLEMENT AGREEMENT "4J' ~ ,- THIS AGREEMENT made this" _ day of.~rt tL{t. ,2005, BETWEEN: GARNET D. STUM. TREASURER OF CLEVERSBURG CEMETERY ASSOCIATION, and SUSAN T. SULLIVAN, being the residuary legatecs under the Last Will and Testament of Gladys A. Gardner, latc of the Township of South Newton, Cumberland County, Pennsylvania, AND SUSAN T. SULLlV AN, Executrix of the Estate of Gladys A. Gardner, deceased. WHEREAS, Gladys A. Gardner died May 12, 2004, tcstate; and WHEREAS, Letters Testamentary were granted to Susan T. Sullivan on June 3, 2004. by the Registcr of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Gladys A. Gardner have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Lettcrs to the said Executrix, thc said parties hereto desire to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of contirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desire that a Family Settlement Agreement be executed, which Family Settlement Agrcement will be duly recorded among the deed records in and for Cumberland County, WEIGLE:: c< ASSOCIATES, PC - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSRURG. PA 17257 j397 V 7'..) , .-...~_.,.) EST A TE OF GLADYS A. GARDNER "..- ) - ,.--, . , " ....~ .1 -- J File No. 21-04-0523 .1 --,-- , i F AMIL Y SETTLEMENT AGREEMENT . , : ~ '\ ' . ..." I'y THIS AGREEMENT made thIS "'1, day ot~t- t1",U"1 ,2005, BETWEEN: GARNET D. STUM, TREASURER OF CLEVERSBURG CEMETERY ASSOCIATION, and SUSAN T. SULLIVAN, being the residuary legatees under the Last Will and Testament of Gladys A. Gardner, late of the Township of South Newton, Cumberland County, Pennsylvania, AND SUSAN T. SULLIVAN, Executrix of the Estate of Gladys A. Gardner, deceased. WHEREAS, Gladys A. Gardner died May 12, 2004, testate; and WHEREAS, Letters Testamentary were granted to Susan T. Sullivan on June 3, 2004, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Gladys A. Gardner have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said parties hereto desire to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desire that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. WEIGLE & ASSOCIATES. PC. ~ ATTORNEYS AT LAW - 126 EAST KING STREET ~ SHIPPENSBURG, PA 17257-1397 \ . ~'..' ,::-- --'.l EST A TE OF GLADYS A. GARDNER q '- ,'.,,-.. i File No. 21-04-0523 1 -'--- , .- ~-. 1 F AMIL Y SETTLEMENT AGREEMENT . I : ~ - ... ~ '\ r THIS AGREEMENT made this 'U::J" day of:~i. tUf.:} ,2005, ", BETWEEN: GARNET D. STUM, TREASURER OF CLEVERSBURG CEMETERY ASSOCIATION, and SUSAN T. SULLIVAN, being the residuary legatees under the Last Will and Testament of Gladys A. Gardner, late of the Township of South Newton, Cumberland County, Pennsylvania, AND SUSAN T. SULLIVAN, Executrix of the Estate of Gladys A. Gardner, deceased. WHEREAS, Gladys A. Gardner died May 12,2004, testate; and WHEREAS, Letters Testamentary were granted to Susan T. Sullivan on June 3, 2004, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Gladys A. Gardner have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said parties hereto desire to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desire that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. WEIGLE & ASSOCIATES, Pc. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 Ll". C.) U...j" c:) Fi ~~ C'_~ ( C:~I 1_'; cc C~':l c -;. LT. CL': REGISTER OF WILLS. CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 Name of Decedent: Gladys A. Gardner Date of Death: May 12, 2004 Will No.: 21-04-0523 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes lil No 0 2. If the answer is No, state when the,personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No !Xl b. The separate Orphans' Court No. (ifany) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes !:Xl No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk ofttte Orphan' <{o and may be attached to t . rt. / Date: I -, 2- -0 ::,- // / /. /...,/ Si N tn Jerry A. Weigle, Esquire Name WEIGLE & ASSOCIATES, P.C. 126 East King Street Shippensbur~. PA 17257 Address ""s.: " >::::;; u f{~ ~,~: ~_ U_!;::,o uct: C', ' t:5 ;~ u Capacity: 0 Personal Representative 00 Counsel for personal representative -:T 717 -532-7388 Telephone No. -,.~ ~ L'O c;::;:> <:=- "" vuf