HomeMy WebLinkAbout07-29-10t ~
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1505610140
_••••1 REV-1500 EX (01-10)
PA Department of Revenue
OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po eox 28oso1 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 0 9 0 8 3 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 9 1 8 5 5 6 1 0 7 1 5 2 0 0 9 0 1 1 4 1 9 2 3
Decedent's Last Name Suffix Decedent's Firs t Name MI
S T A M B A U G H D O R O T H Y L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
Q. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
R M A R K T H O M A S E S Q U I R E 7 1 7 7 9 6 2 1 0 0
First line of address
1 0 1 S O U T H
Second line of address
M A R K E T S T R E E T
City or Post Office
M E C R A N I C S B U R G
Correspondent's a-mail address: rmarkthomasCc~gmail.com
State
P A
ZIP Code ~
1 7 0 5 5
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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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN URE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
~' ~ ~ / _
ADDRESS
1,25 YORK STREET WELLSVILLE PA 1,7365
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
101 SOUTH MARKET STREET_ MECHANICSBURG PA 1,7055
PLEASE USE ORIGINAL FORM ONLY
REGISTER QF WILLS USE OIL
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Dp~E FILED r, ,
Side 1
150561014D 15056101,40 J
r
15D561024D
REV-1500 EX
Decedent's Social Security Num ber
~ecedent'srvame: DOROTHY L• STAMBAUGH 1 8 9 1 8 5 5 6 1
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. •
2. Stocks and Bonds (Schedule B} ...................................... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages and Notes Receivable (Schedule D) .......................... 4. •
5. Cash, Bank De osits and Miscellaneous Personal Pro e
p p rty (Schedule E).......
5. 6 6 5 1 . 8 7
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 3 6 . 7 4
7. Inter-Vivos Transfers i~ Misceflaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 6 8 8 8 . 6 1
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ...... ... 9. 1 5 8 7 . 3 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ...... ... 10. •
11. Total Deductions (total Lines 9 and 10) ...................... ...... ... 11. 1 5 8 7 . 3 4
12. Net Value of Estate (Line 8 minus Line 11) ................... ...... ... 12. 5 3 ~ 1 . 2 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............. ...... ... 13. 2 6 5 . D 6
14. Net Value Subject to Tax (Line 12 minus Line 13) ............. ...... ... 14. 5 D 3 6 . 2 1
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x.o 0 0 0 15. D. 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 5 0 3 6. 2 1 16. 2 2 6. 6 3
17. Amount of Line 14 taxable
at sibling rate X .12 D 0 D 17. D. D O
18. Amount of Line 14 taxable
at collateral rate X .15 D D D 18. D. D D
19. TAX DUE ............................................. ....... ..19. 2 2 6• 6 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1,505610240 1505610240 J
REV-1500 EX Page 3 Fite Number
Decedent's Complete Address: 21 09 0831
•
DECEDENT'S NAME
DOROTHY L. STAMBAUGH_ ___ _ __ ~____-_- __ -_-~_--
STREETADDRESS
770 Polar Church Road _________ _ ~ - _- - ------
CITY ------ --- ------- - 'TSTATE - -_-- ZIP
Camp Hill PA 17011
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
8. Discount
3. Interest
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(1) 226.63
Total Credits (A + B) (2} 0.00
(3)
(4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 226.63
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ................................................................ ...... ^
^ 0
b. retain the right to designate who shall use the property transferred or its income; ......................... ......
^
c. retain a reversionary interest; or ......................................................................................... .......
^ 0
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
^
Xn
without receiving adequate consideration? ................................................................................
?
"
" .......
^ -
..
or payable-upon-death bank account or security at his or her death
in trust for
3. Did decedent own an .......
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.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
(72 P.S. §9116 (a) (1.1) (ii)J. 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.
1=or dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116(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 percent, except as noted in
72 P.S. §9116(1.2} (72 P.S. §9116(a)(1)J.
« The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, undo
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood ar adoption.
REV-1508 EX + (6-98)
'~ SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN R SI DENT DECEDEN RN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DOROTHY L. STAMBAUGH 21 09 0831
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, apital Blue Cross -long term care payment 2,400.00
65 Court Street
ochester, NY 14647
2. apital Blue Cross -long term care payment 1,090.00
65 Court Street
ochester, NY 14647
3. olden Living Center (personal account) 49.58
70 Poplar Church Road
amp Hill, PA 17011
4. olden Living Center -refund 3,112.29
70 Poplar Church Road
amp Hill, PA 17011
TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (01-10)
~. pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
DOROTHY L. STAMBAUGH 21 09 0831
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S)
A. Diane E. Swinehart
B
C
JOINTLY-OWNED PROPERTY:
25 York Street
Vellsville, PA 17365
ADDRESS
,TIONSHIP TO DECEDENT
ughter
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °!° OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. 2/4/06 embers 1st Federal Credit Union, Savings Account #296654-00 5.08 50. 2.54
000 Louise Drive, P. O. Box 40
echanicsburg, PA 17055
2. 2!4/06 embers 1st Federal Credit Union, Checking Account #296654-11 468.39 50. 234.20
000 Louise Drive, P. O. Box 40 _
echanicsburg, PA 17055
TOTAL (Also enter on Line 6, Recapitulation) ~ $ 236 74
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
', pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DOROTHY L. STAMBAUGH 21 09 0831
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman Roth Funeral Home & Crematory, Inc.
B
2.
3.
4
5.
6.
7.
8.
9.
10.
City State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Year(s) Commission Paid:
Attorney Fees: R. Mark Thomas, Esquire
Family Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
ZIP
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
The Patriot News (publication fee)
Cumberland County Law Journal (publication fee)
Additional Death Certificates
Wellsville Post Office (certified mail charges}
125.89
1,000.00
102.00
75.00
162.03
75.00
36.00
11.42
TOTAL (Also enter on Line 9, Recapitulation) I $ 1
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
DOROTHY L. STAMBAUGH
FILE NUMBER:
71 nQ nA'~1
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. Diane E. Swinehart ineal 0.33
125 York Street
Wellsville, PA 17365
2. Lisa M. Freas ineal 0.33
135 East High Street
Hummelstown, PA 17036
3. Hannah J. Lecky ineal 0.17
c/o Shannon E. Lecky, 4101 York Street, Apartment J
Harrisburg, PA 17111
4. Haven Z. Lecky ineal 0.16
c/o Shannon E. Lecky, 4101 York Street, Apartment J
Harrisburg, PA 17111
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. Orchard Springs Fellowship of the Assemblies of God 265.06
2140 Carlisle Road
Aspers, PA 17304
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
265.06
If more space is needed, use additional sheets of paper of the same size.
f"
LAST WILL AND TESTAMENT `~~~ n ~~ --
OF ~~ ~ ~^
,~• r--s
DOROTHY M. STAMBAUGH -~ ~~',-=; , -
__ _ ~..:
I, DOROTHY M. STAIV~IBAUGH, a resident of Wellsville, York County:,~Pet~nsylv~nia, = ~ -` `,
do publish and declare this to be my Last Will and Testament, hereby revoking all other pnor vuills ~ -
and codicils made by me. ` '
FIRST: Family Background and Appointment of Executor.
(A) Family and Background Information. I am a widow. I have one child, DIANE
E. SWINEHART, and she will be referred to as "my child" or "my daughter" throughout this Will.
(B) Appointment of Executor and Trustee. I appoint my daughter, DIANE E.
SWINEHART, and my son-in-law, DOUGLAS C. SWINEHART, to act jointly only as my
Executors. If either of them predeceases me, becomes incapacitated, resigns or does not complete
the duties of Executor, then the remaining one of them shall act individually as my Executor. The
aforenamed persons are all hereinafter referred to collectively as "Executor", and they shall serve
without bond and without being required to account to any court. The Executor shall serve as
Trustee of any trusts created under this Will. When acting as Trustee, the Executor shall have such
powers as are otherwise granted under this Will to the Executor.
SECOND: Funeral and Last Illness Expenses; Taxes.
(A) Expenses of Funeral and Last Illness. I direct my Executor to pay my funeral
expenses and the expenses of my last illness from my estate.
(B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy,
transfer and other death taxes or duties, by whatever name called, including any and all interest and
penalties thereon, imposed under the laws of any jurisdiction by reason of my death, upon or with
respect to any and all property included in my gross estate for the purpose of such taxes, whether
such property passes under or outside of this Will, out of my residuary estate, without being prorated
or apportioned among or charged against the respective devisees, legatees, beneficiaries, transferees
or other recipients of any such property or charged against any property passing or which may have
passed to any of them. The Executor shall not be entitled to reimbursement for any portion of any
such taxes from any such person.
THIRD: Tan¢ible Personal Property. Except for those items enumerated in the Letter of
Instruction, I bequeath all my tangible personal property, including but not limited to clothing,
jewelry, furniture, household furnishings, household goods, personal effects, motor vehicles and all
other similar articles which I own, and the insurance thereon, to my daughter, DIANE E.
1 -~~ t
LAST WILL AND TESTAMENT
OF
DOROTHY M. STAMBAUGH
PAGE 2
SWINEHART, and if she does not survive me, then to my daughter's issue to be divided among
them as they may select in as nearly equal shares, per stirpes, as is practical. Tangible personal
property shall not include: (1) any and all property used by me in any business, (2) cash on hand or
on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness and (5) any life,
health or accident insurance policies. Notwithstanding any other provisions in this Article THIRD,
I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with this Will,
containing directions as to the ultimate disposition of certain items of my tangible personal property,
and such Letter of Instruction shall determine the distribution of such items.
If there is any disagreement as to distribution, I direct my Executor to make such distribution,
and the decision of my Executor shall be final and binding. Any items not selected or any items
which my Executor considers unsuitable for my beneficiaries may be distributed or sold in the sole
discretion of my Executor, and if sold, the net proceeds therefrom shall be added to the residue of
my estate. Any such article allocated to a minor may, as my Executor deems advisable, either be
delivered to the minor or to any person to safeguard on behalf of the minor. The reasonable costs
of protecting, appraising, packing, storing, shipping, cleaning, delivering and insuring all items
distributed in this Article THIRD shall be paid as expenses of administering my estate.
FOURTH: jThis article has been intentionally left blank.]
FIFTH: Residuary Estate.
(A) I give, devise and bequeath all the rest, residue and remainder of my estate, of every
kind and character, real, personal and mixed, tangible .and intangible, and wherever situated,
including any lapsed or renounced legacies, devises or residuary bequests and any property over
which I may have a power of appointment, as follows:
(1) FIVE PERCENT (5%) to ORCHARD SPRINGS FELLOWSHIP OF THE
ASSEMBLIES OF GOD, Aspers, Pennsylvania; and
(2) NINETY-FIVE PERCENT (95%) to be divided as follows:
(a) ONE-THIRD (1/3) to my daughter, DIANE E. SWINEHART, or if
she does not survive me, then to my son-in-law, DOUGLAS C. SWINEHART;
. ~~~
~-
LAST WILL AND TESTAMENT
OF
DOROTHY M. STAMBAUGH
PAGE 3
(b) ONE-THIRD (1/3} to my granddaughter, LISA M. FREAS, or if she
does not survive me, then to her children in equal shares, per stirpes; and
(c) ONE-THIRD (1/3) in equal shares to the children of my
granddaughter, SHANNON E. LECKEY.
(B) Whenever the Executor is directed to distribute any estate property to a beneficiary
who is less than twenty-five (25) years old, the Executor shall hold such property in separate trust
for the beneficiary until he/she becomes twenty-five (25) years old, and in the meantime the Executor
shall use such part of the income and principal of the separate trust as the Executor deems necessary
to provide for the proper health, maintenance, support and education of the beneficiary. If the
beneficiary dies before becoming twenty-five (25) years old, the property then remaining in separate
trust shall be distributed to the beneficiary's issue in equal shares, per stirpes, subject to the terms
of this paragraph.
(C) Prior to final distribution of my estate, the Executor, in the Executor's discretion, may
make partial distributions to one or more beneficiaries or trusts. As a consequence, the executorship
and any trusts created under this Will may exist contemporaneously. A distribution maybe made
subject to any indebtedness or liability of my estate.
SIXTH: Spendthrift Provision. No beneficiary shall have the power to anticipate,
encumber or transfer his interest in the estate in any manner other than by the valid exercise of a
power of appointment. No part of the estate shall be liable for or charged with any debts, contracts.,
liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a
beneficiary.
SEVENTH: Powers ofExecutor. In addition to such powers and duties as mayhave been
granted elsewhere in this Will or by law, but subject to any limitations stated elsewhere in this Will,
the Executor shall have and exercise exclusive management and control of the estate and shall be
vested with the following specific powers and discretion:
(A) In the management, care and disposition of the estate, the Executor shall have the
power to do all things and to execute such instruments as may be deemed necessary or proper,
including the following powers, all of which may be exercised without order of or report to any
court:
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.~ ~ ~:-~
c.. '
LAST WILL AND TESTAMENT
OF
DOROTHY M. STAMBAUGH
PAGE 4
(1) To sell, exchange or otherwise dispose of any property at any time held or
acquired hereunder, at public or private sale, for cash or on terms, without advertisement.
(2) To invest all monies in such stocks, bonds, securities, mortgages, notes, choses
in action, real estate or improvements thereon, and any other property as the Executor may
deem best, without regard to any law now or hereafter enforced limiting investments of
fiduciaries.
(3) To retain for investment any property deposited with the Executor.
(4) To vote in person or by proxy any corporate stock or other security and to agree
to or take any other action in regard to any reorganization, merger, consolidation, liquidation,
bankruptcy or other procedure or proceedings affecting any stock, bond, note or other
security.
(5) To use attorneys, real estate brokers, accountants and other agents if such
employment is deemed necessary or desirable, and to pay reasonable compensation for their
services.
(6) To compromise, settle or adjust any claim or demand by or against the estate and
to agree to any rescission or modification of any contract or agreement affecting the estate.
(7) To renew any indebtedness, as well as to borrow money, and to secure the same
by mortgaging, pledging or conveying any property of the estate, including the power to
borrow from the Executor at a reasonable rate of interest.
(B) Except as otherwise provided in this Will, in making distributions from the estate to
or for the benefit of any minor or other person under a legal disability, the Executor need not require
the appointment of a guardian but shall be authorized to pay or deliver the same to the custodian of
such person, to pay or deliver the same to such person without the intervention of a guardian, to pay
or deliver the same to a legal guardian of such person if one has already been appointed, or to use
the same for the benefit of such person.
(C) In the disbursement of the estate and any division into separate shares, the Executor
shall be authorized to make the distribution and division in money or in kind, or both, regardless of
the basis for income tax purposes of any property distributed or divided in kind, and the distribution
-~ 7-~
U
LAST WILL AND TESTAMENT
OF
DOROTHY M. STAMBAUGH
PAGE 5
and division made and the values established by the Executor shall be binding and conclusive on all
persons taking hereunder.
(D) The Executor shall be authorized to lend or borrow, including the right to lend to or
borrow from my estate at an adequate rate of interest and with adequate security, and upon such
terms and conditions as the Executor shall deem fair and equitable.
(E) The Executor shall have discretion to disclaim on my behalf any interest, in whole
or in part, in property passing (i} by intestate or testate succession, (ii) by inter vivos transfer, (iii)
by joint tenancy or tenancy by the entirety, (iv) from any life insurance policies, annuities or other
accounts having designated beneficiaries, "pay on death" beneficiaries or "transfer on death"
beneficiaries, (v) under any trust, and (vi) from any other source. The Executor shall be authorized
to execute an appropriate writing and to perform all acts necessary to make a qualified disclaimer
as defined by the Internal Revenue Code and regulations.
EIGHTH: Rights and Liabilities of Executor. No bond or other security shall be required
of any Executor. This instrument shall always be construed in favor of the validity of any act or
omission by the Executor, and the Executor shall not be liable for any act or omission except in the
case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any
investment, the overall performance of the entire estate shall betaken into account. The Executor
shall be entitled to receive reasonable compensation for services actually rendered to my estate and
reimbursement of reasonable expenses actually incurred on behalf of my estate.
NINTH: Tax Elections. In determining the estate, inheritance and income tax liability
relating to my estate, the Executor's decision as to all available tax elections shall be conclusive on
all concerned. In accordance with Internal Revenue Code §2632(a) (or its successor provisions) and
without regard to whether a federal estate tax return is actually filed, the Executor shall allocate so
much of the federal Generation Skipping Transfer (GST}. exemption amount as will fully exempt any
generation skipping transfer which may occur under this Will.
TENTH: Definitions and General Provisions.
(A) Survival. Any beneficiary who dies within sixty (60} days after my death shall be
considered not to have survived me.
LAST WILL AND TESTAMENT
OF
DOROTHY M. STAMBAUGH
PAGE 6
(B) Other terms. The use of any gender includes the other gender, and the use of either
the singular or the plural includes the other.
(C) Captions. The captions set forth in this Will at the beginning of the various divisions
hereof are for convenience of reference only and shall not be deemed to define or limit the provisions
hereof or to affect in any way their construction and application.
(D} Powers of Appointment. By this Will, I exercise any powers of appointment which
I possess at the time of my death.
(E) Issue. In making a distribution to the issue of any person, the property to be
distributed shall be divided into as many shares as there are living children of the person and
deceased children of the person who left children who are then-living. Each living child shall take
one share, and the share of each deceased child shall be divided among his then-living descendants
in the same manner. A posthumous child shall be considered as living at the death of his parent.
IN WITNESS WHEREOF, I, DOROTHY M. STAMBAUGH, the Testatrix, have to this
my Last Will and Testament, typewritten on seven (7} pages, including the Acknowledgment and
Affidavit, set my hand and seal this 29`h day of January, 2007.
DOROTHY M. STAMBAUGH
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and
Testament, in the presence of us, who have hereunto subscribed our naives at her request, as
witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us
further declares that he believes the Testatrix to be of sound mind and memory. The preceding
instrument consists of this and six (b) other consecutively numbered typewritten pages including the
Acknowledgment and Affidavit.
-, ,.--~ ,
~~2~w ~~ ~ ,~~ `~ residing at Mechanicsburg, Pennsylvania
Mark E. Halbruner, Witness
~~~.-~~ ~~ ~--~-'~-~--~-~~ residin at Boilin S rin s, Pennsylvania
_ g g p g
Carol L. Frankland, Witness
ACKNQWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
The Testatrix and the witnesses whose names are signed and subscribed to the attached or
foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix signed and executed the instrument
as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed
another to sign it for her; that she executed it as her free and voluntary act for the purposes therein
expressed; that each of the witnesses were present and saw the Testatrix sign and execute the
instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix
signed the will as witnesses; and that to the best of their knowledge the Testatrix was at that time
eighteen years of age or older, of sound mind and under no constraint or undue influence..
Mark E. Halbruner, Witness
~~ ~ - _ jlj- rPLJl" L~W"~-
Dorothy M. Stambau h, Testatrix
A 1 ~
;' -''L.
Carol L. Frankland, Witness
Sworn to or affirmed, subscribed to, and acknowledged, before me by the above-named
Testatrix and witnesses, this 29`'' day of January, 2007.
f
Notary Public l
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse S uare
Carlisle, PA 1713
STAMBAUGH DOROTHY L
Receipt Date: 9/03/2009
Receipt Time: 10:23:07
Receipt No.: 1058116
___
Estate File No.: 2009-00831
Paid By Remarks: R MARK THOMAS
CJ
------------------------ Receipt Distrib ution ------ ------- ------- ----
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 45.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
Check# 2478 $ 87.00
Total Received......... $ 87.00
-f~s~d
III~IHIIIBII1~BaBrll
GOLDEN LIVINGCENTER -WEST SHORE
' Name Fadli Patient # T Statement Date
DOROTHY STAMBAUGH Amount 0285 40715 0001 09/01/09
BALANCE FWD CUR CHARGES CREDITSIPAYMENTS PAST DUE ENDING BALANCE
3112.29- 3112.29 0.00 0.00 0.00
Date/Period Covered Descri tion QTY/Da s Amount
0&12;09
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1 1 I REFUND 31129
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PAYMENT WILL BE 1 N
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ERED DELIN DENT IF N T RE EIVED BY THE 15TH. PAYM
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RECEIVED AFTER THE 1 5TH MAY NOT BE REFLECTED ON THIS STATEMENT.
You can now use Visa, Mas tercard ar Discover to our balance. Pa en t due b 15t h of each Month.
For Billing {nquiries Pease Cal{: (866) 325-5606
Detach Hsro and iasa,m for Turley Payment Processing
GOLDEN LIVINGCENTER -WEST SHORE
C/0 NORTHEAST BILLING OFFICE
1500 AROMORE DRIVE, SUITE 101
PITTSBURGH PA 15221-4466
it address is incorrect, indicate changes below.
~ - --------------._-----------------•---------------------------------------------------------- i
F---------------------------------------------------------~~~----{~{
E
DIANE SWINGHART
125 YORK STREET
WELLSVILLE PA 17365-9641
PRE-SORT
Facility Patient Type
Account # 00285 40715 0001
Name: DOROTHY STAMBAUGH
_ .._ . _ . _ _.._. ~.._ Amoum Paid
uaTe ua~e vuC nln~xnll vim
09!01 /09 09115/09 0.0 0
Name of Cardholder:
CR CARD# 21P:
Exp Date: Amt Paid:
Signature:
Please Make Check or Money Order Payable To:
GOLDEN LIVINGCENTER -WEST SHORE
P.O. BOX 644407
PITTSBURGH PA 15264-4407
1049970028540?15300010901200900000000D0000000000
Name: STAMBAL;GII, DOROTHY Account Type.•hon-Transferring
Tax ID: 1$9-18-5561 Allowance: S 0.00
' ~ Res ID:• 40715 Date Opened: 02/09!09
Status: Closed 08/18/09 Restraints: No Dd Or Mail In Dep
Account #: 641201255
Current Balance: S 0.00
Statement Date: 89!17/09
Status Reason: Deceased 07/15/09
]-acouat Disbursing
Date Dssariptioa Debit Credit Reject Salaaae Hatch Record 8sq Credited Check
06!01/09 OPENING BALANCE
06/01/09 INTEREST PAID
07/01/09 INTEREST PAID
08/03/09 INTEREST PAID
08/18109 TO CLOSE ACCOUN'T'
49.58
0.00 49.58 40601 0
0.00 49.58 40701 0
0.00 49.58 40803 0
49.58 0.00 101255 0 2000042935076 2455
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Page.• 1
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tele: (717) 248166 Fax: (717) 249-2663
November 20, 2009
Cumberland Law Journal is published every Friday by the Cumberland County
Bar Association and is designated by the Court of Common Pleas as the official legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: R. Mark Thomas, Esquire
RE:
Dorothy L. Stambaugh Estate
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
November 6, November 13, and November 20, 2009
Advertising Cost $ 75.00
Proof of.Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Total Amount Due $ 0,00
Becky H. Morgenthal, Executive Director
The Patriot-News Co. ~ ~ ~}~~0~~~~~~
• 812 Market St. h
„~klarrisburg, PA 17101 ~~ Now you know
Inquiries - 717-255-8213
R. MARK THOMAS
ATTN: JOETTE L. MCGOWEN
101 SOUTH MARKET STREET
MECHANICSBURG PA 17055
INVOICE ALL CHARGES ARE NET
ACCT # NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT
35242 R. MARK THOMAS 0002018295 10/23/09 METRO WEST BOLD TEXT CHARGE $4.00
35242 R. MARK THOMAS 0002018295 10/23/09 METRO WEST BASIC AD CHARGE $51.01
35242 R. MARK THOMAS 0002018295 10/30/09 METRO WEST BASIC AD CHARGE $51.01
35242 R. MARK THOMAS 0002018295 11/06/09 METRO WEST BASIC AD CHARGE $51.01
AFFIDAVIT CHARGE $5.00
TOTAL:
REMITTANCE ADDRESS
The Patriot-News Co.
23794 Network PL
Chicago, IL 60673-ti237
$162.03
Please include the Account # or Ad Order # (above) with your remittance--Thank You
NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication
_ .norirncrrorh.ccm
' , ~ inreshoiimanrc~'r~.ccm
~'
Diane Swinehart
125 York Street
Wellsville, PA 17365
Statement of Funera{ Expenses for: Dorothy L. Stambaugh
August 19, 2009
Date of Death: July 15, 20u9 Account Id: 15676-160
PACKAGE:
Traditional Funeral Service
TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,350.00
Sub Total: $ 4,350.00
tUIERCHANDISE:
Casket: Sterling ~ $ 2,300.00
Outer Container: Monticello $ 1,320.00
Cbthing /Burial Garments $ 142.00
Sub Total: $ 3,762.00
TOTAL FiJNERAL HOIUIE CHARGES: $ 8,112.00
CASH ADVANCES:
Letort Cemetery $ 850.00
5 Certified Death Certificates at $ 6.00 each $ 30.00
Clergy $ 100.00
Flowers $ 212.00
Hairdresser $ 40.00
Lettering On Monument At Letort Cemetery $ 200.00
Sub Total: $ 1,432.00
" Total Funeral Expense: $ 9,544.00
Total Payments Made: $ 9,544.00
Payments made:
SecurChoice Check 59077 Aug 11, 2009 577.21
ASlianz Check 491404 Aug 14, 2009 8,840.90
Diane Swinehart Check 211 Aug 18, 2009 125.89 - ry ~%' - =__'-' -~~'
Total Salance Due: $ Q~Q
Please return this portion with your Remittance
$ Amount Enclosed
Dorothy L. Stambaugh
Service 1D #: 15676-160
JERVING OUR COMMUNITY SINCE 1 907
Dorothy Stambaugh
C/0 Diane Swinehart, POA
125 York Street
We 11 svi 11 a PA 17365
~, .. ~
00032 189185561
~ Please Fold At Perforation Before Tearing
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Capital BlueCross ~ ~ ~ ~~ Chase I~Aanhattan Bank
CHECK NUMBER K 50-937
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V ~ PAY THIS AMOUNT
:heck invalid
after s months $2 , 480 doll nd 00 cents 2 480.00
PAY TO: Dorothy Stambaugh
C/0 Diane Swinehart, POA
125 York Street
We 11 svi 11e PA 17365 AUTHORIZED SIGNATURE
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Estate of Dorothy Stambaugh
C/0 Diane Swinehart
125 York Street
Wellsville PA 17365
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Check invalid
after 6 months $1 , 090 dollars
PAY TO: Estate of Dorothy Stambaugh
C/0 Diane Swinehart 1
125 York Street
1 ville PA 17365
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CHECK NUMBER Chase Manhattan Bank
MSCKCA 50-937
5101336 ~ 213
P THIS AMOUNT
nd 2 cents a
$1 , 090.20
AUTHORIZED SIGNATURE
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