HomeMy WebLinkAbout04-0582PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' /~---'~/~ '~' ~5~(y~'ff./__ No.
also known as To:
· Deceased.
Social Security No. / 7J - ~ft9 ~ ,~ .~..~y
Register of Wi~~,Z/~:7
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an, the execute, named
in the last will of the above decedent, dated e~-~ ~ :~',~',/~.~'"./~_~?z~e,~ , 19
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~'~b4Af~-,J-~,/'j/~ Cou_ntv, Pennsylvania, with
last family or principal residence at
(list street, number and muncipality)
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:~-~?~//. ~ . .~Z)~AA1 ~ C.~,~,,5~Z~:
WHEREFORE, petitioner(s) respectfullY request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA q
COUNTY OF j~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well an_c~ truly administer the estate according to law.
Sworn to or af~rmed and subscribed (- ~.~__-/~ : ~ ~
befol'6"me this ~J.~, dav of / ~ / ~ ~'
Estate Of /~,/&/~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW "~.~.//~-/2.r~/ eD-.-/ ~n consideration of the petition on
the reverse side he~'of, satisfactory proof having been~prese~ted~ before me,
IT IS DECREED that the instrument(s) dated
described therein late a.~nitted to p/rg~a~et~d filed of record as the last will of
and Letters
FEES
Probate, Letters, Etc ...........
Sh~'~ ~¢~rtfficates( ) ..........
Renunciation ................ $
TOTAL
Filed .~._~e~. ~7~,/.,..~C;PC').~. ........
Register of Wi~ff--~,~2~~'t
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
his :is to certify that the intbrmation here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
Local Registrar
Date
HI0~[ 143 Rev. 2/$7
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
'r~l~.~mNT
'" .............. CERTIFICATE OF DEATH
y 15, 2004
PA 17090
o~. 2,b. 5/20/2004 2,~.esbninster Memorial Carlisle, PA 17013
L
AVAILABLE PRIOR TO
COMPLETION OF CAUSE Naa~ral ~ Hom~ide
Puneral
Carli
SAIDIS,
SHUF'F &
MASLAND
ATrORNEYS*AT*LAW
26 W. High. Street
Carlisle, PA
LAST WILL AND TESTAMENT
OF
LEORA J. POWELL
I, LEORA J. POWELL, of North Middleton Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this as
and for my Last Will and Testament, hereby revoking all other
Wills and Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my
last illness and funeral from my estate as soon after my death
as conveniently may be done. It is my desire to be interred in
the cemetery lot next to my deceased husband in Deep River,
Connecticut.
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal
representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my
grave.
SECOND
If, at the time of my death, I am the Holder of a
Promissory Note or Notes on 190 West Main Street, Chester,
Connecticut, with a maturity date of October 18, 2001, then in
that event I give, devise and bequeath my interest in the
aforesaid equally to LOIS MAPLE, ROBIN POWELL, RAYMOND POWELL,
LYNN POWELL and PAT BURNS, per stirpes.
SAIDIS,
SHUFF &
MASLAND
26 W. High Street
C~rlisle, ]PA
I also give, devise and bequeath any and all accounts Wil
Advest to LOIS MAPLE, ROBIN POWELL, RAYMOND POWELL, LYNN POWELL
and PAT BURNS, per stirpes.
THIRD
I give, devise and bequeath the specific items of person~
property as set forth below to the person indicated:
(a). To my son, GREGORY L. BURGARD, if he survives
me, my pine glass front side board, together with its
contents.
(b). To my son, GENE L. BURGARD, JR., if he survives
me, my coin collection, my cherry cradle, pine server and
dry sink, together with the contents of each.
(c). All of my jewelry owned by me at the time of my
death to be divided equally between my granddaughter,
CORINNE MAPLE and my dear friend who has been like a
daughter to me, PAT BURNS. Provided, however, if PAT BURNS
predeceases me, her share of my jewelry shall pass to MEGAN
BURNS.
(d) . My grandfather clock and two portraits of the
Maple children to my daughter and her husband, ROGER MAPLE
and LOIS MAPLE or the survivor of them.
(e). My still life painting and the portrait of my
deceased husband, Robert L. Powell, both of which were
painted by PAT BURNS to PAT BURNS.
SAIDIS,
SHIJFF &
MASLAND
A"FIX}R.W~YS · A.T ,LA~W
26 W. Hi{~h Street
Carlisle, PA
FOURTH
I give, devise and bequeath all the rest, residue and
remainder of my estate in equal shares unto my children, GREGORY
L. BURGARD and GENE L. BURGARD, JR., per stirpes.
FIFTH
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will or
otherwise shall be paid out of the principal of my residuary
estate.
SIXTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument, in his/her
absolute discretion:
(a) To retain in the form received, or to sell
either at public or private sale any real or personal
property;
(b) To exercise any options to subscribe for
stocks, bonds, or other investments.
(c) To join in any plan of lease, mortgage,
consolidation, exchange, reorganization or foreclosure
of any corporation in which my estate or any trust may
hold stocks, bonds or other securities;
(d) To sell, transfer, convey, mortgage, pledge,
lease or exchange any property, real or personal, which
at any time may form part of my estate, for the payment
of debts or taxes, or for any purpose of administration
or distribution, for such prices and upon such terms
as my personal representative, in his/her sole discretion,
may deem wise, and to execute and deliver deeds of
conveyance or transfer thereof;
GREGO
RY L. BURGARD, to act as Executor, of this my Last Will and
Testament. Provided, however, that if he is unwilling or unable
to act as Executor, I direct the duties of Alternate Executor,
be performed by ROGER MAPLE.
(e) To make settlements and compromises on such
terms as my personal representative in his/her sole
discretion may deem wise without the necessity of
obtaining any court approval thereof;
(f) To make distribution hereunder either in cash
or kind, as my personal representative in his/her
discretion may deem wise.
SEVENTH
I do hereby nominate, constitute and appoint my son,
EIGHTH
I direct that no personal, representative, guardian, trustee
or other fiduciary appointed under this instrument shall be
required to give bond for the faithful performance of their
duties in any jurisdiction.
SAID]IS,
SHUFF &
MASLAND
A'ITORN~YS,AT,LAW
26 W. High Street
Carlisle, PA
IN WITNESS WHEREOF, I, LEORA J. POWELL, have hereunto set
my hand and seal to this my Last Will and Testament, consisting
of four (4) typewritten pages, the first three (3) of which
bear my signature in the margin for identification, this ~3
SAIDIS,
SHUFF &
MASLAND
A~'I'OR~YSe~.TeLA~W
26 W. High S~t
Carlisle, PA
Signed, sealed, published and declared by the above-named
LEORA J. POWELL, as and for her Last Will and Testament in the
presence of us, who have hereunto subscribed our names at her
request as witnesses thereto, In the presence of said Testatrix
and of ea~J~ther.
/ '~'~ ADDRESS
~'COMMONWEALTH OF PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND :
WE, LEORA J. POWELL, Robert C. Saidis , and joan E.
Smith , the Testatrix and witnesses, respectively whose
names are signed to the foregoing or attached instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her
Last Will and Testament and that she signed willingly and that
she executed as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix signed the Will as witness
and that to the best of their knowledge the Testatrix was at the
time 18 or more years of age, of sound mind and under no
constraint or undue influence. ~~~~
~6~ERT Cfi SAIDIS , Witness
AN E. SMITH .... ~ Witness
SAIDIS,
SHUFIF' &
MASLAND
ATTOPJ~YS*AT*LAW
26 W. High Street
Carlisle, PA
Subscribed, sworn to and acknowledged before me by LEORA J.
POWELL, the Testatrix, and subscribed to and sworn or affirmed
to before me by Robert C. Saidis ~ and Joan E. Smith
witnesses, this ~day of ~-~/a~-~/~ , 1.998.
Notary Public
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Leora J. Powell
Date of Death: May 15, 2004
WillNo. 2004-00582 Admin. No. PA No. 21-04-0582
To the Register:
I certify that notice of (beneficial interest) a ~ ti n required by Rule 5.6(a) of the Orphans' Court Rul,es was
served on or mailed to the following beneficiaries Of the above-captioned estate on September 7, 200~ :
Name Address
Hrs. Lo±s Maple 16 Eedarbrook Lane, East Lyme, ET 06333
Mr. Rob±n Powell 175 South Street, Granby, ~ 01033
Mr. Raymond Powell
Ms. Lynn Powell
153 Goode Street, Burnt Hills, NY 12027
28 West Alvord ST., #3, Springfield MA 01108
Mrs. Patricia Burns
Ms. Corrine Maple
P.O. Box 518, 30 Connally Drive
Old Saybrook, CT 06475
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: September 7, 2004
Name Gregory L. Burgard
Address
283 Sled Drive
Shermans Dale, PA 17090
~lephoneQ17) 582-8779
Capacity: X Personal Representative
Counsel for personal representative
REV-1500 EX (6-00) . f
.. ' .-
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Powell, Leora J.
DATE OF DEATH (MM-DD-YEAR)
05/15/2004
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-YEAR)
09/21/1936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
LL-~4-
COUNTY CODE YEAR
~ ~8-1_ _
NUMBER
[] 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER
198 -30 - 2457
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
FIRM NAME (If Applicable)
TELEPHONE NUMBER
(717) 582-8779
COMPLETE MAILING ADDRESS
283 Sled Drive
Shermansdale, Pa
(1)
(2)
(3)
(4)
(5)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
~'':l.'3410
1?.6::3q.::3q
17090
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
*
(6)
(7)
(9)
(10)
20.q'7.~4
,QR 06
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
296,473.17
x.O_ (15)
x ~ ...2. (16)
x .12 (17)
x .15 (18)
(19)
8.184.Q?,
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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20. D
c.)
c::;.
(8)
325,773.49
(11)
(12)
(13)
21.115.40
::304.65R.OQ
(14)
304,658.09
13,341.30
1.227.74
14,569.04
* See note on schedule F
~.
REV-1503 Ex . {1-97)
ESTATE OF
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Powell, Leora J.
FILE NUMBER
21-04-0582
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
VALUE AT DATE
DESCRIPTION OF DEATH
MFS Municipal Series Trust Municipal Income Fund $ 24,986.63
Class A CUSIP 55273N574 2,985.261 shares
Van Kampen High Yield Municipal Fund Class A 13,984.66
1,353.791 shares
Fidelity Contra Fund (FCTX) 1,091.281 Shares 55,949.98
Fidelity Government Income (FGOVX) 4,309.477 shares 43,310.24
39 day yield: 3.04%
Fidelity Cash Reserves (FDRXX) 293.830 shares 293.83
7 day yield 0.77%
Fidelity Government Income FGOVX/504 2,225.859 shares 23,369.88
30 day yield 3.04%
Fidelity Growth and Income FGRIX/027 793.295 shares 28,415.83
pioneer Fund A Growth and Income 74,652.40
pioneer Value Fund A Growth and Income 47,761.27
Income - Fidelity Fund ( To death) 1,409.38
TOTAL (Also enter on line 2, Recapitulation) $ 31 3 , 134 . 10
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX .1"1l7),
, '
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Powell, Leora J.
FILE NUMBER
21-04-0582
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking Account 9,878.11
2. Savings Account 461.28
3. Automobile - Buick LeSabre Book VAlue 2,300.00
TOTAL (Also enter on line 5, Recapitulation) $ 12, 639 . 39
(If more space is needed, insert additional sheets of the same size)
,R",,-l509 EX .~-911
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Powell, Leora J.
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21-04-0582
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Elizabeth G. Keeney
8.
c.
JOINTLY-OWNED PROPERTY:
ADDRESS
635 Willow Valley Square
Apt. H-IOl Manor North
Lancaster, Pa 17602-4869
RELATIONSHIP TO DECEDENT
Mother
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1998 Single Family Dwelling 230,000 50 115,000
2411 Enola Road
Carlisle, Pa. 17013-8692
Account #: 951676-6
M & T Mortgage Corporation
Note; This was as right of survive rship
and therefore not entered on line 6 of
REV-1500
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-',.')11 EX+ (12-99) .
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Po;vell, Leora J.
FILE NUMBER
21-04-0582
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule 1.
DESCRIPTION
1.
FUNERAL EXPENSES:
Ewing Brothers Funeral Home, Inc.
2. Westminster Cemetary (Opening/Closing Grave)
3. Westminster Cemetary (MemorialStone)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Greqory L. Burqard
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 283 Sled Drive
City
Snprmansdale
State~_Zip 17090
Year(s) Commission Paid:
2004/2005
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
5.
6.
7.
8.
9.
10.
11.
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Estate Notices
Dr. Rostahe Hospital Visit
Budget Rental (Removal of Housegoods and furnishings)
u.S. Post Office (Notices and beneficiary distribution
Goodwill & Volunteers of America (Donation of Househol
Goods,furnishings and clothing)
AMOUNT
7,352.18
995.00
1,833.00
6,234.00
427.50
319.00
350.00
103.25
202.58
20.96
219.17
) 30.70
2,830.00
TOTAL (Also enter on line 9, Recapitulation) $ 20, 91 7 . 34
(If more space is needed, insert additional sheets of the same size)
. .
REV.1512 EX... (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Powell, Leora J.
FILE NUMBER
21-04-0582
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
198.06
1.
CitiBank Credit Card Balance
TOTAL (Also enter on line 10, Recapitulation) $ 198.06
(If more space is needed, insert additional sheets of the same size)
. ' REV-?51'3 EX+ (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Powell, Leora J.
FILE NUMBER
21-04-0582
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Gregory L. Burgard Son 263,733.49
283 Sled Drive
Shermansdale, Pa. 17090
2. Pat Burns Friend 8,184.92
P.o. Box 518; Connally Drive
Old Saybrook, CT 06475
3. Raymond Powell Step-son 8,184.92
223 Sunnyside Road
Scotia, N.Y. 12302
4. Lois Maple Step-daughter 8,184.92
16 Cedarbrook Lane
East Lyme, CT 06333
5. Lynn Powell Step-daughter 8,184.92
28 West Alvord Street # 3
Springfield, MA 01108
6. Robin Powell Step-son 8,184.92
E~T1RiD&B.~ ~~U~.f~tRlemI6~ROWN A~E Or9L~~~ 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT.2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005641
BURGARD GREGORY L
283 SLED DRIVE
SHERMANSDALE, PA 17090
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__nun fold
101
$14,569.04
ESTATE INFORMATION: SSN: 198-30-2457
FILE NUMBER: 2104-0582
DECEDENT NAME: POWELL LEORA J
DATE OF PAYMENT: 08/02/2005
POSTMARK DATE: 08/02/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/15/2004
TOTAL AMOUNT PAID:
$14,569.04
REMARKS:
CHECK# 1093
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Leora J. Powell
DmeofDemh: May 15, 2004
WiliNo.: 2004-00582
Admin. No.: PA No. 21-04-0582
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion ofthe administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 00 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 Z No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal &esentative state an account informally to the parties
in interest? Yes JK.L No 0 .
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this r
Date: f~b5'
Gregory L. Burgarn
Name
283 Sled Drive, Shermans Dale, PA 17090
Address
(717) 582-8779
Telephone No.
Capacity: rn Personal Representative
OS : \ I H'} Z- SiY} seCl 0 Counsel for personal representative
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006206
BURGARD GREGORY L
283 SLED DRIVE
SHERMANSDALE, PA 17090
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__n____ fold
101
$4,942.37
ESTATE INFORMATION: SSN: 198-30-2457
FILE NUMBER: 2104-0582
DECEDENT NAME: POWELL LEORA J
DATE OF PAYMENT: 01/13/2006
POSTMARK DATE: 01/12/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 05/15/2004
TOTAL AMOUNT PAID:
$4,942.37
REMARKS:
ELIZABETH KEENEY
CHECK# 215
SEAL
INITIALS: RSK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
r
Elizabeth G. Keeney ..
Apt. HlOl
635 Willow Valley Sg.
Lancaster, PA 1760Z
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ItfHERtTANCE TAX
RECORD AD~UST"ENT
4642609 P.02
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717 293 51*,"';
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IU~f~U OF INDIVIDUAL TA~ES
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PO IDll 2110'01
HAAA:SJuQ; 'A 17IZI-"01
I LLOW VALLEY MAN~R_ :-'-''''1'''' L.U""
W COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
JAN-11-2006 16:03
, .
.'.\
GREGOR~ l JURGARD
283 SLED DR
SHERHAHSDALE PA 17090
PATE
ESTATE OF
DATE OF DEATH
FILE NU"IER
COUNTY
ACH
R~-15'S tx aFP tD3-as)
01-0'-2006
POWEll
05-15-2004
21 04-0592
CUI1BEIHAND
101
LEORA
J
NOTE, T. '..... ...... ...... .. .... ......., ....,. ... uP... p...,.. .. 'PI. .... .,.. 'OUr tax ........ .
CUT A~ONG THIS LINE ... ~ET'IN LOWER PQoTION FOR TOU~ RECORDS ...
"AKE CHECK PAYABLE AND REH%T p~Y"ENT TO:
REGISTER OF WILLS
CUMBERLAND, CO COURT HOUSE
CARLISLE, fA 1~013
-----------------------.------------------------------.-------------------.----------------------------.....----------------------------
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
l
.
BUREAU OF INDIVIDUAL:t~-~
INHERITANCE TAX DIVISION I,....,
PO BOX Z80601 -- ..
HARRISBURG PA 171Z8-0601
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-06-2006
POWELL
05-15-2004
21 04-0582
CUMBERLAND
101
'if:"1r ~~l,;) 10 p.~..~i
r:"'L.-..;.J \..;-; ll. 0 i I
I. '"~ r
. ;:;0
CLt~:;'< C:::
(:'PPr-4 t:,\.~'~
GREGORY L (j~'!WARD :- ,
283 SLED DR '
SHERMANSDALE PA 17090
Allount Rellitted
.
REV-1593 EX AFP (03-05)
LEORA
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account, subllit *he upper portion of *his forll with your tax paYllent.
REV-1593 EX AFP (03-05)
--+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
---------------------------------------------------------------------------------------------------------------------------------------
ESTATE OF POWELL
LEORA
.. INHERITANCE TAX RECORD ADJUSTMENT ..
ACN 101
J FILE NO. 21 04-0582
DATE
01-06-2006
1. Real Estate (Schedule A)
2. S*ocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership In*erest (Schedule C)
4. Mor*gages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Proper*y (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deduc*ions
Net Value of Tax Return
Charitable/Governllen*al Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
ADMINISTRATIVE CORRECTION
10.
11.
12.
13.
14.
TAX:
IS. Allount of Line 14 at Spousal rate
16. Amount of Line 14 taxable a* Lineal/Class A ra*e
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B
19. Principal Tax Due
TAX CREDITS:
rate
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
313.134.10
.00
.00
12.639.39
115.000.00
.00
(8)
440,773.49
38.400.69
402.372.80
.00
402.372.80
.00
17.738.45
.00
1.227.74
18,966.19
. ~..._.' ~~. . (-+ J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-02-2005 CD005641 .00 14,569.04
EREST IS CHARGED THROUGH 01-21-2006 TOTAL TAX CREDIT 14,569.04
THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4.397.15
ERSE SIDE OF THIS FORM INTEREST AND PEN. 545.22
TOTAL DUE 4.942.37
INT
AT
REV
(9)
(10)
17 ,868.17
20,532.52
(11)
(12)
(13)
(14)
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(IS)
(16)
(17)
(18)
.00 X 00
394.187.88X 045=
.OOX 12 =
8.184.92X 15 =
(19)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
J. ~
REV-1470 EX (6-88)
REVIEWED BY
ITEM
SCHEDULE NO.
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
LEORA J POWELL
SCOTT ELLISON
FILE NUMBER
ACN
2104-0582
101
EXPLANATION OF CHANGES
THE FOLLOWING DEDUCTIONS HAVE BEEN APPROVED. ONE HALF OF THE DATE OF
DEATH MORTGAGE, ONE HALF OF AMOUNT PAID TO CARLISLE PETROLEUM CO AND
AMOUNT PAID FOR PATIO CARPET. Only one half of deductions may be claimed as
decedent only owned one half of the real estate.
ROW
Pa~e 1
BUREAU OF INDIVIDUAl'TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-30-2006
POWELL
05-15-2004
21 04-0582
CUMBERLAND
101
LEORA
J
('"
GREGOR~ t BURGARD
283 SLElJ DR
SHERMANSDALE PA 17090
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF POWELL LEORA J FILE NO.21 04-0582 ACN 101 DATE 01-30-2006
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-05-2006
PRINCIPAL TAX DUE: 18,966.19
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-02-2005 CD005641 .00 14,569.04
01-12-2006 CD006206 537.62- 4,942.37
TOTAL TAX CREDIT 18,973.79
BALANCE OF TAX DUE 7.60CR
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 7.60CR
If
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
pt
11-28-2005
POWELL
05-15-2004
21 04-0582
CUMBERLAND
101
APPEAL DATE: 01-27-2006
( See reverse side under Objections)
Amount Remitted I I
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-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
LEORA J FILE NO. 21 04-0582 ACN 101 DATE 11-28-2005
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
-
!
,A.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
, .. e- . _""I ,e- ~ NOTICE OF INHERITANCE TAX
. BUREAU OF INDIVIDUAL TAXEF-CC~nr=c Oi-i-~~~SEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION ;: ... ,,' ,-.. .... , OF' DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX Z8060 1 '
HARRISBURG PA 171Z8-0601
7~1S
t-\J.,,,
- (~
-II r, L3
'""j .': ,
I I ,.. I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
r'
GREGORY L BUR9ARD
283 SLED DR
SHERMANSDALE
PA 17090
ESTATE OF
POWELL
REV-1547 EX AFP (06-05)
LEORA
J
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. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
.00 X 00 = .00
414,522.34 X 045 = 18,653.05
.00 X 12 = .00
8,184.92 X 15 = 1,227.74
ll9)= 19,881.25
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
ll)
(2)
(3)
(4)
(5)
(6)
(7)
.00
313,134.10
.00
.00
12,639.39
115,000.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
llO)
17 ,868 .17
198.06
Ul)
ll2)
ll3)
ll4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
440,773.49
18.066 23
422,707.26
.00
422,707.26
.
. .........., -. l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-02-2005 CD005641 .00 14,569.04
INTEREST IS CHARGED THROUGH 12-13-2005 TOTAL TAX CREDIT 14,569.04
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 5,312.21
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 554.38
TOTAL DUE 5,866.59
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE r
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~
..
REV-1470 EX (6-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
Leora J Powell
REVIEWED BY
Deborah Washington
INHERITANCE TAX
EXPLANATION
OF CHANGES
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
F 1 Accepted jointly owned property.
H 8- No such items listed as assets of this estate or this decedent.
9&11
ROW
FILE NUMBER
ACN
2104-0582
101
Page 1