HomeMy WebLinkAbout04-0581PETITION FOR PROBATE and GRANT OF LETTERS
Estate of MARK B. BURLISON
also known as
Deceased.
Social Security No. 16 9- 4 4- 6 8 4 8'
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older a~lt~e execut or
in the last will of the above decedent, dated February 11
and codicil(s) dated none
To:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
in the
named
., 19.82
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland
h is last family or principal residence at 40~ East Coover
Mechanicsbur9
County, Pennsylvania, with
Street, Borouqh of
(list street, number and muncipality)
Decendent, then 51 y_ears of age, died Apr il 24
at Milton S. Hershey Medical Center, Dauphin County,
~.2004 ,
PA
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: no except.ions
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: none
5,000.00
(Curtis W. Seiler, designated in the Will as a Co-Executorr has renounced
in favor of Petitioner.)
WHEREFORE, petitioner(s) respectfully r.eque, st(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters. ~:eslzamen,cary
· ~ .. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
~g :5 ~/ dacK i'{. Burllson -
'~0
805 Old Silver Spring Road
Mechanicsburg, PA 17055-
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF CUMBERLAND
3
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) °f the ab°ve decedent petiti°ner(s) will ~_ ~TF~is~he est?a~cc_~rd~ng t° law'~ {O~ ~
Sworn to or affirnlqd and subscribed .,- ~ -X-' ~.~4,~ z.,c.<~x/,, ~
before me this :Q/%x. day of [ ~'/ aac~ R. Burlxgon - ~.m
June % i ' % , ~ ~ ' ~
~ ~4~ter[ ~
Estate Of MARK B, BURLISON , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ,.~ ~ ,_~ i,' ~r- ~ 2004, in consideration of the petition on
the reverse side horeof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated February 11, 2004
described therein be admitted to probate and filed of record as the last will of Mark B. Burlison
and Letters Testamentary
are hereby granted to Jack R. Burlison
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ...' .......
Renunciation ................
.5,~P
TOTAL
Filed .(..0..7 ~..I.-..~..o.c.'>..~ ...................
Marlin R. McCaleb (No. 06353)
ATTORNEY (Sup. Ct. I.D. No.)
P.O. Box 230
219 East Main Street, Mechanicsbur~%0~
ADDRESS
(717) 691-7770
PHONE
RENUNCIATION
In Re Estate of. MARK B. BURLI$ON deceased.
To the Register of Wills of Cumberland ,County, Pennsylvania.
-i
The undersigned Brother-in-Law and named Co-Executor [ of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to Jack R. Burlison -,
WITNESS my
hand this__/____~day of ~/~g/ ,~ 2004
Curtis W. Seiler
6407 Knights Bridge Road
Hixson, TN 37343
(Address)
(Signature)
(Ad~e~s)
(Signature)
(Addr~)
REGISTER OF WILLS OF CUMBZR~,aND COUNTY
· OATH OF SUBSCRIBING WITNESS
Janet M. Forry
(~ a subscribing witness to the will presented herewith, (ff4~ being duly qualified according to
law, depose(s) and say(s) that z was present and saw
Mark B. Burlison . .
the testat, or , sign the same and that I signed asa witness at the
request of testator in h i s ' presence and (gl~gl~{~~~t~) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this /kD'/~ day of
June ~ . 2~ 2004
Rcgistzr
Notarial Seal
Marlin R. ~, Nom~ Public
Mechanicsburg Bom, Cumbedand County
My Commission Expires Dec. 14, 2006
Member, Pennsylvania AssodatJon Of Nomfi~
-REGISTER OF WILLS OF
Jane&~e)For rlk~
10 Ridgeway Drive, Mechanicsburg,
PA 17050
(Address)
(Name)-
(Address)
COUNTY
:.-. OATH OF NON-SUBSCRIBING WITNESS ,~:~
(each) a subscriber here-~(each) being duly qualified accordin~Nko
law,
depose(s)
and
say(s)
that
~',,,,. familiar with the signature ofXX,X ,
~ codic~
testat__x~._ of (one of the sub~r,~ing witnesses to) the will Xl~esented herewith and
~ ~ codicfl~
~at ~ .... ~eves the signature on the will is i~e h~dw~ting of
testat belie~ ~e signat~e of the will p~nted herewith and that ~
~elieves the signatur~ c:~C~s in ire haldw&~, %
Sworn to or affirme~d subscfibed~fore "x,~ ~
me this . da~ ' %'~ame) -
(A ddr~s)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMsv. R*.am) COUNTY
· OATH OF SUBSCRIBING WITNESS
Marlin R. McCaleb
(~__~) a subscribing witness to the
law, depose(s) and say(s) that
Mark t3. Burlison
will presented herewith, ~atah) being duly qualified according to
I was present and saw
the testat or ., sign the same and that I signed as- a witness at the
request of testat or in h is ' presence and (~.~x~l~t~x) (in the presence of the
other subscribing witness(es)).
Sworn to or affirm.eg and subscribed before
me this ~--~ I~c day of
June o xx 2004
Marlin (~hmMe~Caleb
219 East Main Street, Mechanicsburg, PA
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH ,, ~CRIBIN WITNESS
(each).
subscriber
her% (each) being duly i~ed according to law, depot) and say(s) that
.' x,,. familiar with the slg.nature of codicil "N ,
testat-~ of (one of the%ibing witnesses to)~he will presented her~'th and
'~ ~ .. . ~ codicil
that ~x __ 'x,~lieves the signatureXox~.the will is in the handwrit~g of
testat belie~the signature of the will ~,~ented herewith andxfl~at ~ _ .
.believe~n the handwritin~f ~ _
Sworn to or affirmed and subscrib'txt, before
me this __da~ '~X (Name)
(Address)
Register
(Name)
17055
(Address)
LAST WILL AND TESTAMENT
I, I.~RK B. BURLISON, of the Borough of Mechanicsburg, County of Cumberland
and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void all former wills and codicils by me
at any time heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be
paid by my Co-Executors, hereinafter named, as soon as conveniently may be done
after my decease.
SECOND. I give, devise and bequeath all the rest, residue and remainder o~
my estate, real, personal and mixed, whatsoever and wheresoever situate, unto
my mother, JEAN R. BUP~ISON, absolutely and in fee simple, if she survives me.
THIRD. If, however, my mother shall not survive me, then and in that evenl
11I give, devise and bequeath all the rest, residue and remainder of my estate,
il
real, personal and mixed, whatsoever and wheresoever situate, in equal shares
~llunto r~y brother, JAC~ R. BURLIo~, and ~y sister, MARJO .... A. ~I .... , share and
LAW OFFICES
SNELBAI~ER,
McCALEB & ELIC~ER
share alike, absolutely and in fee simple.
If either my brother or my sister shall predecease me leaving lawful
issue to survive me, then I order and direct that the share which such deceased
brother or sister would have received had he or she survived me shall be distri-
buted unto his or her said lawful issue per stirpes, said issue to take the
ancestor's share by representation and not per capita.
LASTLY. I nominate, constitute and appoint my brother, JACK R. BURLISON,
and my brother-in-law, CURTIS W. SELLER, Co-Executors under this, my Last Will
and Testament, both to serve without bond in this or any other jurisdiction. It
for any reason either of them shall fail to qualify as such Co-Executor or
cease so to serve, it shall not be necessary to appoint a substitute Co-Executo~
to serve in his place, but in such event my remaining or surviving Co-Executor
~NELBAI~ER,
MC~ALEB 8~ ELI(:~ER
shall serve with full power and authority under this, my Last Will and Testa-
ment.
IN WITNESS g~EREOF, I, MARK B. BURLISON, have hereunto set my hand and
seal to this, my Last Will and Testament which consists of two (2) typewritten
pages to each of which I have affixed my signature this // day of
/~z~g/~/~ , A.D., One Thousand Nine Hundred Eighty-two (1982).
The preceding instrument, consisting of this and one (1) other typewritten
page, each identified by the signature of the Testator, was on the date thereof
signed, sealed, published and declared by MARK B. BURLISON, the Testator therei
named, as and for his Last Will and Testament, in the presence of us, who, at
his request, in his presence, and in the presence of each other, have subscribe
our names as witnesses hereto.
SNELBAKER.
M¢CALEB & ELICKER
COMMONWEALTH OF PENNSYLVANIA)
:
COUNTY OF CUMBERLAND)
SS.
We, MARK B. BURLISON, MARLIN R. McCALEB, and JANET M. FORRY, the Testator
and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testator signed and executed the instrument as his L~
Will and Testament and that he had signed willingly, and that he executed it
his free and voluntary act for the purposes therein expressed, and that each
the witnesses, in the presence and hearing of the Testator, signed the Will as
witness and that to the best of his or her knowledge the Testator was at that
time eighteen (18) years of age or older, of sound mind and under no constraint
or undue influence.
~ - WitneSs~
Subscribed, sworn to and acknowledged before me by FIARK B. BURLISON, the Testat
and subscribed and sworn to before me by MARLIN R. McCALEB and JANET M. FORRY,
witnesses, this //~/~ day of ~zx~ , 1982.
Notary Public
CATHARINE £. BOUSUM, NOTARY PUBLIC
M£CHANICSBURG BOROUGH
Cili~iBi RLAND COUNT~
Pr~,~,~!.:~r~N F~Pi~F% F[~ ~7,. 1982
LAW OFFICES
MARLIN R. McCALEB
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mark B. Burlison
Date of Death: April 24, 2004
Will No. 21-04-0581
To the Register:
I certify that notice of beneficial interest and estate
administration required by Rule 5.6(a) of the Orphans' Court
Rules was personally served on the following beneficiaries of
the above-captioned estate on June 22, 2004.
Name
Jack R. Burlison
Jean E. Burlison
Curtis W. Seiler
Marjorie A. Seiler
Address
805 Old Silver Spring Road
Mechanicsburg, PA 17055
408 East Coover Street
Mechanicsburg, PA 17055
6407 Knights Bridge Road
Hixson, TX 37343
6407 Knights Bridge Road
Hixson, TX 37343
Notice has now been given to all persons entitled thereto under
Rule 5.6(a). ~~~/6-
Date~i June 22, 2004
Marlin R. McCaleb
Attorney I.D. No. 06353
219 East Main Street
P.O. Box 230
Mechanicsburg, PA 17055
(717) 691-7770
FAX: (717) 691-7772
Counsel for Personal Representative
N~\)l)
OFFICIAL USE ONLY
AEV-1500 EX + (6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Burlison Mark B.
DATE OF DEATH(MM-DD~YEAR)
21-04-0581
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
169-44-6848
THIS RETURN MUST BE RLED IN DUPUCATE WITH THE
NUMBER
ITIAL
REGISTER OF WILLS
so fA S RI Y UM ER
OL
X 1. Original Return
4. LImIted Estate
X 6. Decedent DIed Testate
(Attach copy of Wflij
o 9. litIgation Procllieds Received
o
3 ate of death
. RemaInder Return rior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
Supplemental Return
Future Interest compromIse (date of death after 12-12-82)
Decedent Maintained a Living Trus\
(Attach copy of Trust)
o 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1-1-95)
o
11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
NAME
COMPLETE MAILING ADDRESS
219 East Main Street
P. O. Box 230
Mechanicsburg, PA 17055
Marlin R. McCaleb Es .
FIRM NAME (ff AppHcable)
Law Offices-Marlin R. McCaleb
TELEPHONE NUMBER
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6
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or (3) None
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Oepos~s & Miscellaneous Personal Properly (5) 4,643 .15
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6) None
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,726.76
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) None
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value 01 Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
(3,083.61)
OFFICIAL lI,~ ONLY
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4,643.15
7.726.76
(3,083.61)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of Une 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
20. X
(15)
(16)
(17)
(18)
(19)
.0 0
.045
.12
.15
0.00
0.00
0.00
0.00
0.00
(3,083.61)
X
X
X
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Copyright (c) 2000 form software only Toe Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
/
'1~
Decedent's Complete Address:
STREET ADDRESS
408 East Coover Street
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D.lnterest
E. Penalty
Totallnterest/Penalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
mmm\\\\\\\\\\\\\\\\\mmlll\\I!\\\\\\\\\\\\llnm\\\\11111Im\\\\\\I\\I\~lllml\I\\I\II\I\I\\II\~IIII\\\\\\llllmllllllml!IIIII\\\II\\III\llllllllmlllllmmll111~lmm!llmmm~mr:lllllllllllllm!!lmmlmmmlllmm1l1ml
llmm~mJlllllllllllimllll]1ll1lmlI11lI1mml111mmll1llJIII!fi!Jlllllilll!!!11!lllllllm!11!!lllli!
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
0.00
0.00
0.00
0.00
0.00
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or. . , . . . . . . . . . . . . . .. . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . .. .............. 0
3. Did decedent own an ~in trust forn or payable upon death bank account or security at his
or her death? .. .,......................,.......... . . . . . . 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ve. No
~~
IT!
IT!
IT!
Under penalties of perjury, I declare that I hav6 examined thIs return, IncludIng accompanyIng schedules and statements, and to the best of my knowledge and belief, It Is true,
carrect and complete. DeclaratIon of preparer other than the personal representatIve Is based on all Information of which preparer has any knowledge.
SIGNATURE OF P. RQREGSIBLE FOR F LING RETURN
Jack R. Burlison
__ _~Q?_ _q!~h~gy:'~" _ ?.P-"~!'J~ _ !l.5'_":~ __ _ __ h _ __ ____ ____
Mechanicsbur , PA 17055
d:-,GNATURE OF PREPARER OTHER THAN REPRESENTATIVE Law Off ices -Mar 1 in R. McCaleb
219 East Main Street
/- /'l'-a:>~
!iiiii!iliiiili!lliilll!I\I',lilll~i:'!!llili!!llllilllinlllll\\llilrrliiliiliill',llliliimnmlliiiiliili:illi!iiiilIliiiiiimil~m~I;lj~~~i~~~i~I~;~~~~I!;ii!I;!I~~jl;!;!I~fu~~1~;II;!;:!;I!;!;I!;I!;!;I;
II;I;I;I!;i;I;,I;i;II;!i;i;liiiiiilliBillii_lii!!lilimil
DATE ,
1//9/05
DATE
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. 9116 (a) (1.1)(i)].
For dates of death an 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. 9116 (a) (1.1) (ii)). The statute does not exempt 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 ofthe child is 0% [72 P.S. 9116 (a)(1.2)].
The tax rate imposed on the net value oftransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(aX1)J.
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. 9116(aX1.3)]. 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.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV...1500 EX (Rev. 6-00)
LAW OFFICES
SNELBAKER.
MCCALEB ecELICKER
LAST WILL AND TESTAMENT
I, HARK B. BURLISON, of the Borough of Mechanicsburg, County of Cumberland
and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void all former wills and codicils by me
at any time heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be
paid by my Co-Executors, hereinafter named, as soon as conveniently may be done
after my decease.
SECOND. I give, devise and bequeath all the rest, residue and remainder 0
my estate, real, personal and mixed, whatsoever and wheresoever situate, unto
my mother, JEAN R. BURLISON, absolutely and in fee simple, if she survives me.
THIRD. If, however, my mother shall not survive me, then and in that even
I give, devise and bequeath all the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever situate, in equal shares
unto my brother, JACK R. BURLISON, and my sister, MARJORIE~. SEILER, share and
,
share alike, absolutely and in fee simple.
If either my brother or my sister shall predecease me leaving lawful
issue to survive me, then I order and direct that the share which such deceased
brother or sister would have received had he or she survived me shall be distri
buted unto his or her said lawful issue per stirpes, said issue to take the
ancestor's share by representation and not per capita.
LASTLY. I nominate, constitute and appoint my brother, JACK R. BURLISON,
and my brother-in-law, CURTIS ,1. SEILER, Co-Executors under this, my Last Will
and Testament, both to serve without bond in this or any other jurisdiction. I
for any reason either of them shall fail to qualify as such Co-Executor or
cease so to serve, it shall not be necessary to appoint a substitute Co-Executa
to serve in his place, but in such event my remain~ng or surviving Co-Executor
LAW OJ"PICES
SNELBAKER.
McCAI,.EB a El..~CKE:R
i".
.,!l
i. i /:,:jl
shall serve with full power and authority under this, my Last Will and Testa-
ment.
IN WITNESS WHEREOF, I, MARK B. BURLISON, have hereunto set my hand and
seal to this, my Last Will and Testament which consists of two (2) typewritten
pages to each of which I have affixed my signature this
II
day of
r:et3f? (//<1-12..-1
, A.D., One Thousand Nine Hundred Eighty-two (1982).
.1;
,.:';
1h....~1_ Z? ?2.L:.
~
(SEAL)
The preceding instrument, consisting of this and one (1) other typewritten
page, each identified by the signature of the Testator, was on the date thereof
signed, sealed, published and declared by MARK B. BURLISON, the Testator therei
named, as and for his Last Will and Testament, in the presence of us, who, at
his request, in his presence, and in the presence of each other, have subscribe
our names as witnesses hereto.
A~~
9o~,-c rl1- (.::i~
LAW OFFICE$
SNELBAKER.
McCALEB a EL.tCKER
'\ ,1\ jL< ,I
'h"
n I
"['
\ \;
i\'.
;,
COMMONWEALTH OF PENNSYLYANIA)
SS.
COUNTY
OF
CUMBERLAND)
We, MARK B. BURLISON, MARLIN R. McCALEB, and JANET M. FORRY, the Testator
and the witnesses, respectively, whose names are ~igned to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testator signed and executed the instrument as his L.~t
Will and Testament and that he had signed willingly, and that he executed it as
his free and voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the Testator, signed the Will as
witness and that to the best of his Dr her knowledge the Testator was at that
time eighteen (18) years of age or older, of sound mind and under no constraint
or undue influence~
ftuJ./ 7J ?1~A-~~
'Test~
-4../ /.. ~/
, 17 .
... w:
('v-- .~. 1- Y11. \ -J ~.
~ Witness t7
Subscribed, sworn to and acknowledged before me by ~uutK B. BURLISON, the Testator,
and subscribed and sworn to before me by MARLIN R. McCALEB and JANET M. FORRY,
witnesses, this //~ day of cJl~~
, 1982..
&~~ -R. 4<.<2-<--.
Notary Public
CAT,IlARINE E. BOUSUM, NOTARY PUB.IC
MECHANICSBURG BOROUGH
CUMBERLANO COUNH
IAV r."""MI~$ION EXPIRES FEB. 27. 1982
REV-150aEXt{1~97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T AX RETURN
RESIDENT DECEDENT
ESTATE OF
Mark B. Burlison
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS!I 169-44-6848
04/24/2004
FILE NUMBER
21-04-0581
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
NUMBER
I
DESCRIPTION
M&T Bank, checking Acct. #57003499, - principal balance as of
D.O.D.
VALUE AT DATE
OF DEATH
3,227.14
Accrued income on item I through date of death
0.24
2
.380 cal. Smith & Wesson handgun.
150.00
3
1994 Ford Escort automobile.
250.00
4
Allstate Indemnity Co., - refund of auto insurance.
11.00
5
Household contents, furniture and furnishings.
999.75
6
Verizon Wireless, - refund.
5.02
TOTAL (Also enter on line 5, Recapitulation) $ 4,643 .15
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV..1508 EX (Rev. 1-97)
4SS Mitchel! Road
MHlsboro, tiE 19!166
Mall code tlE.MB.12
PtlOne: 888-502-4349
Pax: 3C2.934-29S5
I rlJ M&fBank
Fax
To: Marlin R McCaleb
Fro.... NEV'lCY Clagett
fa", 717-691-7772
Date: June 22, 2004
Re: Estate ot Marl< B. Burlison
Pages: 1
Social Seourity Number: 169-4~!I48
Date of Death: April 24, 2004
Dear Sir or Madam:
Per your inquiry dated June 21, 2004, please be advised that at the time of death, the above-named
decedent had on deposit with this bank the following:
Type of Account
Account Number
Checking Account
57003499
Ownership (Names of)
MIill1< B Burlison
Opening Date
09107/138
Balance on Date of Death
$3,227.14
ACCflJEld Interesl
$
.24
Total
$3.227.38
Please be advised, there was no safe deposit box found for the above decedent.
For further aocount informal/on, closures and/or reimbursement oI'funds, please call the Fairview Office
# 717-938-1829.
Sincerely.
v?1:CV>~ ~
Nanoy Clagett
Records Management
REV-1511 EX + (1-97)
COMMONWEAL. TH OF ?ENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mark B, Burlison
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
SSj; 169-44-6848
FILE NUMBER
21-04-0581
04/24/2004
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES:
Myers Funeral Home,
1,997.66
funeral expense.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representati.e(s) Jack R. Burl i s on
Social Security Number(s) I EIN Number of Personal Representati.eCs)
Street Address 805 Old Silver Spring Road
City Mechanicsburg State ~ Zip 17055
500.00
Year(s) Commission Paid:
2005
2.
3.
Attorney's Fees Law Offices-Marlin R. McCaleb
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Jean R. Nurlison
Street Address 408 East Coover Street
City Mechanicsburg State ~ Zip 17055
Relationship of Claimant to Decedent Mother
900.00
3,500.00
4.
Register of Wills
55.00
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Chuck Bricker, Auctioneer, . commission on sale of household
contents.
333.75
2
Cumberland Law Journal, - advertising Letters.
75.00
3
PennDOT, Bureau of Motor Vehicles, - transfer of auto title.
22.50
4
PNC Bank, - check printing fee.
10.99
5
Putney's Sunoco Service,
preparation for sale.
repair auto (new battery) in
89.56
Total of Continuation Schedule(s)
242.30
TOTAL (Also enter on line 9, Recap.ulatlon) $ 7 , 72 6. 76
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REY..1511 EX (Rev. 1.97)
Estate of: Mark B. Burlison
Soc Sec #: 169-44-6848
Date of Death: 04/24/2004
Item
#
Description
Continuation of Schedule H-B7
(Other Administrative Costs)
Amount
6
Register of Wills,
7
Register of Wills,
Reserve - for final expenses (Account, Releases, etc.).
109.30
8
Short Certificate.
3.00
Filing Inventory and Appraisement.
30.00
100.00
9
The Patriot-News, - advertising Letters.
242.30
REV-1513 EX + (9~OO)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DI:CEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Mark B. Burlison
SS4f 169-44-6848
04/24/2004
FILE NUMBER
21-04-0581
RELATIONSH_'P IO DEq:qENT AMOUII/T O_R SIiARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outrIght spousal dlstrfbutlons, and
transfers under Sec, 9116(aXl.Z)]
1 Jean R. Burlison
408 East Coover Street
Mechanicsburg, PA 17055
Mother Entire Estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
0.00
Fo'm REV-1513 EX (R"', 9-00)
Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate of Mark B. Bur 11 s on
No. 21-04-0581
also known as
Date of Death 04/24/2004
,Deceased Social Security No, 169-44-6848
Jack R. Burlison,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I fWe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penaWes of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
',D. No,'
06353
pers:i::a:::re~;; ~ C3~A L ,
ack R. Burlison -
Signature:
Name of
Attorney:
Marlin R. McCaleb Esq.
Address:
219 East Main Street
Address:
805 Old Silver Spring Road
Mechanicsburg, PA 17055
Mechanicsburg, PA 17055
Telephone:
717/691-7700
Telephone:
717/691-9529
/ //9/0 s
Dated:
Description
Value
(See continuation page(s) attached)
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(Attach additional sheets if necessary)
Total:
4,643.15
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar AssociatIon
Copyright (el 1996 form software only CPsystems.lnc.
FormNRW-7 (1992)
,
"
INVENTORY
Estate of:
Date of Death:
County:
Mark B. Burlison
04/24/2004
Cumberland
CASH:
M&T Bank, checking Acct.
#57003499, - principal
balance as of D.O.D.
3,227.14
Accrued income through date of
death
0.24
3,227.38
PERSONAL PROPERTY:
.380 cal. Smith & Wesson
handgun.
150.00
1994 Ford Escort automobile.
250.00
Allstate Indemnity Co., -
refund of auto insurance.
11.00
Household contents, furniture
and furnishings.
999.75
Verizon Wireless, - refund.
5.02
1,415.77
TOTAL RECEIPTS OF PRINCIPAL...............
4,643.15
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BUREAU OF INDIVIDUAL.TAXES
INHERITANCE TAX DIVISION.
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
*'
REV-1547 EX AFP (03-05)
12
DATE
ESTATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACN
04-04-2005
BURLISON
04-24-2004
21 04-0581
CUMBERLAND
101
Allount Rellitted
MARK
B
-".
LAW OFCS
MARLINR MCCALEB
219 E MAIN ST
PO BOX 230
MECHANICSBURG
PA 17055
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 ~
I1I!V--.t!f~"Yf.m.m!.'U!1.wtm.W.!f.,ftArr4MM.m.lmlWl!"'~.'X'I:t!N'~Rt'I!'.ftW'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURLISON MARK B FILE NO. 21 04-0581 ACN 101 DATE 04-04-2005
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)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
4.643.15
.00
.00
(8)
NOTE: To insure proper
credit to your account.
submit the upper portion
of this for. with your
tax payment.
4.643.15
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
14. Net Value of Estate Subject to Tax
(9)
(10)
7.726.76
.00
(11)
(12)
(13)
(14)
7.726.76
3.083.61-
.00
3.083.61-
(Schedule .J)
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. AMount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. AlIOUnt of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
ITS:
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
(19)=
.00
.00
.00
.00
.00
TA
DATE
NUMBER
INTEREST/PEN PAID (-)
AI10UNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYI1ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~
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LAW OFFICES
MARLIN R. McCALEB
FAMILY SETTLEMENT AGREEMENT,
RECEIPT AND RELEASE
WHEREAS, MARK B. BURLISON, late of the Borough of
Mechanicsburg, Cumberland County, Pennsylvania, died on April
24, 2004, having first made his Last will and Testament in
writing dated February 11, 1982, which since his decease was
duly probated before the Register of Wills of said Cumberland
County and Letters Testamentary were issued by the Register of
Wills of Cumberland County, Pennsylvania to JACK R. BURLISON,
one of the Executors named in the Last Will and Testament of
said decedent; and
WHEREAS, JEAN R. BURLISON is the sole heir and Family
Exemption claimant of the said decedent and the only person
interested in his Estate; and
NOW KNOW ALL MEN BY THESE PRESENTS, that I, JEAN R.
\-.,-
~~QRLISON, sole heir and Family Exemption claimant in the Estate
\ -- S"/~-
:&,f'said decedent, do hereby declare and say that I have
L":-.y
i<-i';;,;
J~~mined the Account of JACK R. BURLISON, Executor as
0:';
~esaid, for the period ending April 29, 2005, and find the
same to be accurate and according to law, and I, JEAN R.
BURLISON, beneficiary and claimant as aforesaid, do hereby
acknowledge that I, this day have, had and received of and from
JACK R. BURLISON, Executor of the Estate of MARK B. BURLISON,
the cash or property set opposite my name in the above stated
Account, in full satisfaction, payment and discharge of all
claims I have or may have against the said Executor or against
Q-S
the Estate of MARK B. BURLISON, Deceased, as claimant or heir,
and all interest accrued thereon, except as aforesaid.
NOW, THEREFORE, I the same JEAN R. BURLISON, beneficiary
and claimant as aforesaid, do by these presents, remise,
release, quit-claim and forever discharge the said JACK R.
BURLISON, Executor, his heirs, executors and administrators, of
and from my share of the Estate as set forth in decedent's said
will and my claim for the Family Exemption and of and from all
actions, suits, payments, accounts, reckonings, claims and
demands whatsoever, for or by reason thereof, or by contract,
or under the intestate law of the Commonwealth of Pennsylvania,
or by reason of any other act, matter, cause or thing
whatsoever, from the beginning of the world to the day and date
of these presents, except for any obligations arising under
this Family Settlement Agreement or under the Schedule of
Proposed Distribution.
AND desiring to avoid the delay and expense of the
settlement of said Estate by filing the foregoing Account of
said administration in the Office of the Register of Wills of
said County and by having the balance in the hands of the
Executor, as shown by said Account, distributed by the Court of
Common Pleas of Cumberland County - Orphans' Court Division, I
do hereby agree that the within Family Settlement Agreement
concerning the matter of settlement may be recorded with the
same effect upon me as if the same had been reported upon by
LAW OFFICES
MARLIN R. McCALEB
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-
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LAW OFFICES
MARLIN R. McCALEB
said Court, and a decree of distribution made on such report by
the said Court of Common Pleas - Orphans' Court Division.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
.-!!1 day of '711tu1 2005.
r
this
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF
CUMBERLAND)
7l
/"1 day of
On this, the
before me, a Notary Public in and
(SEAL)
SS
~7' ' 2005,
for said State and County,
the undersigned officer, personally appeared JEAN R. BURLISON,
known to me (or satisfactorily proven) to be the person whose
name is subscribed to the within instrument and acknowledged
that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
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Notary Public
My commission expires:
Notarial Seal
Marlin R. McCaleb. Notary Public
Mechanicsburg Born. CumlJerland County
My Commission Expires Dee. 14.2006
Member. Pennsylvania Association Of Notaries
.
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
MARK B. BURLISON
Date of Death:
April 24, 2004
Estate No.:
21-04-0581
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 Iil 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 0 No IK1
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes mI No 0
.:t>ate:
>~'7
Ijtay ,
. ..-- .
c. Copies of receipts, releases, joinders and approval offorma1 or informal
accounts may be filed with the Clerkof the Orphans' Court and may be
2::hedlotlrlsreport ~c/~ ~4
Signature
Marlin R. McCaleb
Name
219 East Main Street
Mechanicsburg, PA 17055
Address
(717) 691-7770
Telephone No.
Capacity: 0 Personal Representative
@ Counsel for personal representative
vi