HomeMy WebLinkAbout03-1008BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Estate of Kathleen M Peterson No.~J - ~)C~' ! 0(") Y
also known as
Kathleen M Peterson
Jeffrey Steinbrink
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
, Deceased
Social Security No. 353407089
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or
r~ Decedent, dated 04/23/2003 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
residence at 139 North 26th Street~ Camp Hill Borou,qh
(list street, number and municipality)
Decedent, then 55 years of age, died November 24 ,2003 , at Hospice of Central PA Residence
(Location)
Decedent 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 ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows:
139 North 26th Street, Camp Hill Borough, Cumberland County, Pennsylvania
County, Pennsylvania, with his/her last family or principal
11,000.00
159~000.00
1707000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature Typed or printed name and residence
Jeffrey Steinbrink
630 North President Avenue
Lancaster PA 17603
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and afffirm(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 representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate ~.~ding
Sworn to and affirmedi IJ~,'~and subscribed Jef:f~e~/'Ste~r~brink
before me this ~r"' day of
December, 2003.
DECREE OF REGISTER
Estate of Kathleen M Peterson
also known as
Deceased
No. ' - I
Social Security No: 353407089 Date of Death: 11/24/2003
AND NOW, ~~z~ .~ , ~00.~ , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary r-1 of Administration
(c.t.a,, d.b.n.c.t.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Jeffrey Steinbrink
in the above estate and that the instrument(s), if any, dated April 23, 2003
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ....................................
Short Certificate(s) ..~.....~...?..~ $
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages (8x$3) .............. $
Codicil ................................. $
JCP Fee ................................. $
Inventory & Tax Forms ............. $
Other ...................................... $
TOTAL ............................. $
RW-7A
$ 235.00
12.00
24.00
10.00
281.00
Attorney: Jan L Brown
I.D. No: 67993
Address: 845 Sir Thomas Court Suite 12
Harrisbur,q
PA 17109
Telephone: 717-541-5550
DATE FILED: 12/~;/2003
10S,805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
[x)cal Registrar. The original certificate will be forwarded to the State Vital Records Off]ce for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9 6 5 ! 1 1 ~ ~~ NOV 2 (3 2003
No.
Local Registrar
[)ate
T4a Rev 2/87 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
" Kathlee_n M. Peteason ], r._.o~ ] ..... I .'
^GE,t..e.~. [ u.~n,~ u.,~.,-i-r~-~l o*~E~m, a~c~ I' .~m~ p-~ -- 40 -- 7089 ]~.Novemb¢~ 24, 2003
.. D~ph~n [. ~quehanna Twn ~osp<ee of Cen~al PA Residence I~~~..' ['~*
~,,-:~ ........ , I I~°~'' !. '~.~~, J ...~..~ I ...~.~,v,~
~ ~"'~ Cumberland ~ ~' ~ ~
~.E.'S.~(~.~..~ '~'~ "".~ ~..o, Camp H~l~
~s~m ~. 139 North 26th S~eet, C~p Hil~, PA 17011
~: .................. - ,~ J~,,. ~ ' '< ~ '~ ~ ~ .,P~nnsylvani~ Crematory H~risb~ . P
~ ;' ' /'-'1 . / ~ =~n ~E~DA~E~F~I~ C~ ~ ' ' --
LAST WILL AND TESTAMENT
OF
KATHLEEN M. PETERSON
I, KATHLEEN M. PETERSON, of Cumberland County, Pennsylvania, declare this to be
my Last Will and Testament. I revoke all other Wills and Codicils that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor fi.om the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement fi.om any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my Will or with my valuable papers and found within 30 days of
the probate of my Will. Gifts may only be to persons who survive me or to organizations which
exist at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
On the condition that CLAUDIA and MARK WASHBURN, or the survivor, takes
possession of my pets and any domestic animals I own at the time of my death, I give and
bequeath to CLAUDIA and MARK WASHBURN the sum of THIRTY THOUSAND
DOLLARS ($30,000.00) to be distributed at the earliest possible time after my death (so to be
used for the medical care, home modifications and repairs resulting from having my dogs). This
bequeath is conditioned upon CLAUDIA and MARK WASHBURN taking possession of my
pets and providing for my pets during my pets' natural lifetimes. It is my strongest desire that my
dogs remain together during their lifetimes.
In the event that both CLAUDIA and MARK WASHBURN are unable to care and
provide for my pet companion(s), then I give and bequeath the above referenced sum of
THIRTY THOUSAND DOLLARS ($30,000.00) to THE HELEN O. KRAUSE
FOUNDATION, or its successors, of Dillsburg, Pennsylvania, with the same conditions and
terms as set forth above. It is my strongest desire that my dogs remain together during their
lifetimes.
-2-
Article V
I give and bequeath the sum ofTEN THOUSAND DOLLARS ($10,000.00) to my dearest
friend, JOANNE SHEAFFER, of Lancaster County, Pennsylvania.
Article VI
I give and bequeath the sum ofTEN THOUSAND DOLLARS ($10,000.00) to my
friend, JEFFREY STEINBRINK, of Lancaster County, Pennsylvania.
Article VII
I give and bequeath the sum ofTEN THOUSAND DOLLARS ($10,00.00), all of my
Lenox Temple Blossom pattern china, all of my Gorham Newport Scroll silver flatware, and my
entire doll collection to PHYLLIS and ELIZABETH STOCKTON, or the survivor.
Article VIII
I give and bequeath to my nephew, ADAM PETERSON any remaining household items
that he may desire.
Article IX
I give and bequeath to my nephew, MARK PETERSON, any remaining household
items that he may desire.
-3-
C. Upon attaining the age of twenty-five (25), one-third (1/3) of the principal and
accumulated income, of the child's remaining share shall be distributed outright to the child.
D. Upon attaining the age of twenty-eight (28), the remaining principal and accumulated
income of the child's share shall be distributed outright to the child.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
Article XIII
I hereby appoint MARCEY PETERSON, as Trustee of any Trust(s) created in this Will. In
the event of the renunciation, death, resignation, or inability to act, for any reason whatsoever of
MARCEY PETERSON, I nominate and appoint my friend, JOANNE SHEAFFER of Lancaster
County, Pennsylvania, as Successor Trustee of any Trust(s) created in this Will.
Article XIV
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over the
Trust estate, subject to any limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
-5-
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attomey, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
Article XV
I nominate, constitute, and appoint my friend, JEFFREY STEINBRINK, of Lancaster
County, Pennsylvania, Executor of my Last Will and Testament. In the event of the renunciation,
death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and
appoint my friend, JOANNE SHEAFFER of Lancaster County, Pennsylvania, successor Executrix
of my Last Will and Testament. I direct that my Executor or successor Executrix be permitted to
serve without bond and in addition to those powers granted by law, I grant them power to distribute
-6-
in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if
living. My Executor and successor Executrix shall receive reasonable compensation for services
rendered to my estate.
Article XVI
In addition to the powers conferred by law, I authorize my Executor and successor Executrix,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(0 to file any federal income tax remm for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay fi'om my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
-7-
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, KATHLEEN M. PETERSON, hereby set my hand to this my
Last Will and Testament, on .~_fD ;Pt] [ ~-- :~ ,2003, at Harrisburg,
Pennsylvania.
KATHLEEN M. PETERSON
In our presence, the above-named KATHLEEN M. PETERSON signed this and declared
this to be her Last Will and Testament, and now at her request, in her presence, and in the presence
of each other, we sign as witnesses.
NalTle
Address
-8-
I, KATHLEEN M. PETERSON, Testatrix, who signed the foregoing instrument, having
been duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
KATHLEE~ M. PETERSON, the Testatrix,
on ~"~- ~ ,2003.
Public
(-'~ NOTARIAL SEAt
~ J[~l~ & HOU3ND, NOTA~
CITY O~
~_My CO~IMIS$10N EXPIRES MARCH 4,200~_1
K~THLEEN M. PETERSON
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
insmmaent as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
witnesses, on ~?c';/ ~3 ,2003. ,~_..Z;
(N~' (?0, ~. ~PO.f~ Witness
otar~Pub~i~ - ~
~ [ NOTARIAL SEAL
~ / J($SICA A. HOLLAND, NOTARY PUBLIC
~ / CI~ OF HARRISBURG, DAUPHINCOUN~ l
/ ~ COmmISSION EXPIRES ~ARCH 4.2006.
-9-
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, KATHLEEN M. PETERSON, hereby set my hand to this my
Last Will and Testament, on /~f) 7-~[ Z_ ~j , 2003, at Harrisburg,
Pennsylvania.
KATHLEEN M. PETERSON
In our presence, the above-named KATHLEEN M. PETERSON signed this and declared
this to be her Last Will and Testament, and now at her request, in her presence, and in the presence
of each other, we sign as wimesses.
Name Address
-8-
LAST WILL & TESTAMENT
OF
KATHLEEN M. PETERSON
JAN L. BROWN & ASSOCIATES
ATTORNEYS AT LAW
845 SIR THOMAS COURT, SUITE 12
HARRISBURG, PENNSYLVANIA 17109
717-541-5550
Kathleen M Peterson
Continuation of Certification of Notice Under Rule 5.6(a)
Page 1
11/24/2003
Names and addresses
Name Address
Adam Peterson 428 Banbury Place
Valpariso IN . 46383
Mark Peterson 428 Banbury Place
Valpariso IN 46383
Carl Peterson 139 N 26th Street
Camp Hill PA 17011
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE $.6(a)
Name of Decedent: Kathleen M Peterson
Date of Death: 11/24/2003
Will No. 2003-01008 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 12/22/2003 :
Name Address
Claudia and Mark Washborn
Joanne Shaeffer
Jeffrey Steinbrink
Phyllis and Elizabeth Stockton
2068 CR 125 E
M~h0m~t
630 N President Avenue
Lan~$ter
630 N President Avenue
Lanci~ster
1125 Winding Drive
Cherry Hill
IL 61853
PA 17603
PA 17603
NJ 08003
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:.
Marian Peterson, decedent's mother, who passed away on 8/18/03.
Capaci~:
Date: 12/22/2003
Sig
Name: Jan L Brown & Associates
Address: 845 Sir Thomas Court Suite 12
Harrisburq PA
Telephone(717) 541- 5550
Personal Representative
Counsel for Personal
Representative
JAN L. BROWN, ESQUIRE*
JACQUELINE A. KELLY, ESQUIRE
*ADMITTED IN PA AND D~STRICT OF COLUMBIA
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLDE ENGLISH GAP
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMAIL: jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BRENDA F, KEPHART, LEGAL ASSISTANT
PAULA K. WHITE, LEGAL ASSISTANT
JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT
July 6, 2004
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re:
Estate of Kathleen M. Peterson
Social Security No. 353-40-7089
File No. 2003-01008
PA File No. 21-03-1008
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wili~
1. Inventory.
2. Inheritance Tax Return in duplicate.
3. Estate Check 1051 in the amount of $25 for the filing fee.
4. Estate Check 1050 in the amount of $6,384.80 in payment of the tax shown to be due.
Please time stamp and return our file copies of these documents. A return envelope is
provided.
If you have any questions, feel free to contact this office.
Sincerely,
Brenda F. Kephart '
Legal Assistant
bfk
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004126
BROWN JAN L
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
........ fold
ESTATE INFORMATION: SSN: 353-40-7089
FILE NUMBER: 2103- 1008
DECEDENT NAME: PETERSON KATHLEEN M
DATE OF PAYMENT: 07/07/2004
POSTMARK DATE: 07~07~2004
COUNTY: CUMBERLAND
DATE OF DEATH: 11/24/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,384.80
REMARKS:
TOTAL AMOUNT PAID:
$6,384.80
SEAL
CHECK# 1050
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLDE ENGLISH GAP
845 SIR THOMAS COURT, SUITE 12
HARRISBURG, PA 17109
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Peterson Kathleen M
also known as
Kathleen M Peterson , Deceased
No. 2003 01008
Date of Death 11/24/2003
Social Security No. 353407089
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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities.
Name of
Attorney:
Jan L Brown Esquire
I.D. No.: 67993
Personal Representative:
Jeffrey Steinbrink
Address: 845 Sir Thomas Court Suite 12
Harrisburg PA 17109
Dated 6/21/04
Telephone: 717-541-5550
Description
35 shs Geron Corp (GERN) @ $11.16/sh
10 shs Harley Davidson Inc (HDI) @ $45.96/sh
15 shs JP Morgan Chase & Co (JPM) @ $35.27
18 shs Natus Medical Inc (BABY) @ $3.92/sh
Treasury Department; Commonwealth of PA; wages
PSECU Savings, Checking & Money Market Accounts
(Attach Additional Sheets if necessary)
Total
Value
390.60
529.05
70.56
3,662.99
8,328.61
477,253.05
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.
RW-4
Peterson Kathleen M
Description of Inventory
Description
Merrill Lynch Direct
Investment Account 20X-11 R92; cash account
1995 Nissan AItima
Continuation of Inventory
Page 1
2003 01008
Value
63.16
2,650.00
Commonwealth of Pennsylvania Deferred Compensation Program
Estate is beneficiary
State Employees' Retirement System (SERS)
Death in State Service; Estate is beneficiary
Tangible property that includes Lenox china, Gorham flatware and dolls
Household goods
Miscellaneous refunds
Wells Fargo Home Mortgage escrow account refund
United States Treasury; 2003 income tax refund
139 North 26th Street, Camp Hill Borough, Cumberland County, PA
Parcel Identifier 01-21-0271-248
38,867.76
290,677.51
1,000.00
2,000.00
360.17
1,355.04
548.00
126,290.00
Subtotal $ 463,811.64
Grand Total $ 477,253.05
REV-~500 EX + (6-0~)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 3
COUN3Y COBB YEAR
1 0 0 8
NUMBER
DECEDENT'S NAME {LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER
z PetersonKathleenM 3 5 3 - 4 O- 7 0 8 9
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
(.1 11/24/2003 03/10/1948 REGISTER OF WILLS
UJ JIF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ SOCIAL SECURITY NUMBER
Z
LU
1:3
Z
U.I
~-]1. Odginal Retum
r--~ 4. Limited Estate
r~'j 6. Decedent Died Testate (Attach copy of Will)
J--'] 9. Litigation Proceeds Received
E~2, Supplemental Retum
E]4a. Future Interest Compromise (date of death after 12-12-82)
[~]7. Decedent Maintained a Living Trust (Attach copy of Trust)
[--~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
[---~ 3. Remainder Retum (date of death pdor to 12-I 3-82)
r~5. Federal Estate Tax Retum Required
__ 8. Total Number of Safe Deposit Boxes
r-']11. Election to tax under Sec. 9113(A) (A~ach Sch O)
THIS SECTION MUST BE COMPL~ i~Di ALL CORRESPONPENCE AND CONFiDE~IAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME ~ COMPLETE MAILING ADDRESS
Jan L Brown Esquire
I
FIRM NAME (If Applicable)
Jan L Brown & Associates
TELEPHONE NUMBER
717-541-5550
845 Sir Thomas Court Suite 12
Harrisburg
,:;.; PA 17109
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 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)
126~290.00
1~449.81
58~835.73
OFFICIAL USE ONLY
(8)
(11)
(12)
186~575.54
24~676.10
92~348.43
117~024.53
69,551.01
(13)
(14)
69~551.01
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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
20.
0.00 X (15)
38,551.01 X .045 (16)
0.00 X .12 (17)
31,000.00 X .15 (18)
(19)
> > BE SURE TO ~$WERAEL QUESTIO = ESiDE AN~ RECHECK MATH< <
0.00
1,734.80
0.00
4,650.00
6,384.8O
Decedent's Complete Address:
ISTREET ADDRESS 139 North 26th Street
Camp Hill Borough
CITY Camp Hill
STATE
PA
ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C )
(1)
(2)
No
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
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)
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. (EA)
B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB)
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
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 cons derat on? ............................................................................................... []
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a benefic ary des gnat on? ....................................................................................................... []
6,384.80
0.00
0.00
0.00
6,384.80
6~384.80
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjur'/, I decla'e that I have examined this return, includin~l 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 ~nformat on of which preparer has any knowledge.
SIGNATURE OF PEiRSO_N. RESPO~SI_BLE FOR FILING RETURN /DATiE
ADDRESS (~ t4e:~/:~President Avenue
Lancaster
SIGNATURE OF PRE~~ESENTATIVE
ADDRESS 84~S._1~ Thomas Court Suite 12
HarriSburg
PA 17603
PA 17109
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 on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §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 of the child is 0% [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%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
RE~-1502 EX ~ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
Peterson Kathle~n M 21 0:~ 1
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts,
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
139 North 26th Street, Camp Hill Borough, Cumberland County, PA
Parcel Identifier 01-21-0271-248
Copy of tax assessment is attached.
TOTAL (Also enter on line 1, Recapitulation)
VALUEAT DATE
OF DEATH
126,290.00
126,290.00
(If more space is needed, insert additional sheets of the same size)
RE~-1503 EX ~ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Peterson Kathl~en M
ITEM
NUMBER
1.
4
gl 03 1008
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
DESCRIPTION OF DEATH
35 shs Geron Corp (GERN) @ $11.16/sh 390.60
10 shs Harley Davidson Inc (HDI) @ $45.96/sh
15 shs JP Morgan Chase & Co (JPM) @ $35.27
18 shs Natus Medical Inc (BABY) @ $3.92/sh
TOTAL (Also enter on line 2, Recapitulation)
459.60
529.05
70.56
1~449.81
(If more space is needed, insert additional sheets of the same size)
RE~/-1508 EX ~' (6-98)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Peterson Kathleen M
ITEM
NUMBER
1.
2
3
6
7
8
10
11
12
13
14
15
16
21
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
O3
1008
DESCRIPTION
Treasury Department; Commonwealth of PA; wages
Treasury Department; Commonwealth of PA; wages
PSECU Savings Account
PSECU Checking Account
PSECU Money Market Account
Merrill Lynch Direct
Investment Account 20X-11 R92; cash account
1995 Nissan Altima
Commonwealth of Pennsylvania Deferred Compensation Program
Estate is beneficiary
Tangible property that includes Lenox china, Gorham flatware and dolls
Household goods
The Patriot-News; refund
Pinnacle Health System; refund
State Farm; auto insurance cancellation refund
UPost@Home; refund
Newsweek; subscription refund
Sports Illustrated; subscription refund
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
1,768.49
1,894.50
70.48
4,927.77
3,330.36
63.16
2,650.00
38,867.76
1,000.00
2,000.00
90.65
25.00
114.91
1.37
42.48
22.98
58~835.73
Continuation of REV-'I500 Inheritance Tax Return Resident Decedent
Peterson Kathleen M
Decedent's Name
Page 1
21
03 1008
File Number
Schedule E - Cash, Bank Deposits, & Misc. Personal Property
ITEM
NUMBER DESCRIPTION
17 People; subscription refund
18
19
20
Community Life Team Inc refund
Wells Fargo Home Mortgage escrow account refund
United States Treasury; 2003 income tax refund
SUBTOTAL SCHEDULE E
GRAND TOTAL SCHEDULE E
VALUE AT DATE
OF DEATH
22.78
40.00
1,355.04
548.00
1,965.82
$ 58,835.73
RE~-1510 EX ~' (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Peterson Kathleen M
SCHEDULE G
INTER-VIVOS TRANSFERS &
MlSC, NON-PROBATE PROPERTY
FILE NUMBER
21 03 1008
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is ~es.
DESCRIPTION OF PROPERTY
ITEM IN(3-UDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NU MBE R T.E DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REN. ESTATE.
VALUE OF ASSET INTEREST (~Am.~C~LE) VALUE
1. American Funds IRA Account 212-67095984
Carl L Peterson, father, beneficiary
Not taxable--decedent was younger than 59 years
DOD value = $5,948.10
2 Vanguard IRA Account 09949419135
Carl L Peterson, father, beneficiary
Not taxable--decedent was younger than 59 years
DOD value = $1,997.53
TOTAL (Also enter on line 7 Recapitulation) $
(If mom space is needed, insert additional sheets of the same size)
E~/-1511 EX + (12-99)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESlDENTDECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Peterson Kathleen M
ITEM
NUMBER
8
9
10
11
12
13
14
15
16
17
18
Debts of decedent must be reported on Schedule I.
FUNERAL EXPENSES:
Cremation Society of Pennsylvania
161-38-6867
DESCRIPTION
21
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative (s) Jeffrey Steinbrink
Sodal Secudty Number(s)/EIN Number of Pemonal Representative(s)
Street Address 630 North President Avenue
City Lancaster State PA
Year(s) Commission Paid: 2004
AttomeyFees Jan L Brown & Associates
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Carl L Peterson
State PA
Zip 17603
Street Address 139 North 26th Street
City Camp Hill
Relationship of Claimant to Decedent father
Probate Fees Register of Wills, Cumberland County
Accountant's Fees
Tax Return Preparer's Fees Larry J Wilcox, CPA, PC; 2003 income tax returns
75.00
5,000.00
12,236.00
3,500.00
437.00
240.00
Zip 17011
03
Cumberland Law Journal; legal advertising
The Patriot-News Co; legal advertising
Postage
Money Order fee
PSECU; satisfaction fee
State Farm; auto insurance; policy 661 6272-F18-38C
AT&T; telephone bill at 139 N 26 St Camp Hill PA
Borough of Camp Hill; sewer bill at 139 N 26 St Camp Hill PA
Comcast Cable; cable bill at 139 N 26 St Camp Hill PA
Gran-U-Lawn; lawn application at 139 N 26 St Camp Hill PA
Penn Waste Inc; refuse bill at 139 N 26 St Camp Hill PA
Pennsylvania American Water; water bill at 139 N 26 St Camp Hill PA
1008
TOTAL (Aisc enter on line 9, Recapitulation)
AMOUNT
75.00
211.81
26.28
5.00
27.00
107.77
30.64
60.00
166.35
30.61
40.74
114.52
24~676.10
(Ifmorespaceisneeded, insedadditionalshee~ofthesamesize)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Peterson Kathleen M 21
Decedent's Name Page 2
03 1008
File Number
Schedule H - Funeral Expenses & Administrative Costs - B7.
ITEM
NUMBER
19
2O
21
22
21
22
DESCRIPTION
PPL Electric Utilities; electric bill at 139 N 26 St Camp Hill PA
Shipley Energy; oil delivery and service at 139 N 26 St Camp Hill PA
UGI Utilities Inc; gas bill at 139 N 26 St Camp Hill PA
Verizon; telephone bill at 139 N 26 St Camp Hill PA
Recorder of Deeds; re 139 N 26 St Camp Hill PA
Susquehanna Title Agency; title examination 139 N 26 St Camp Hill PA
SUBTOTAL SCHEDULE H-B7
AMOUNT
101.46
1,938.56
60.04
49.82
42.50
100.00
2,292.38
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~ & LIENS
FILE NUMBER
Peterson Kathleen M
Include unreimbursed medical expenses.
DESCRIPTION
PSECU VISA
21
03
ITEM
NUMBER
1.
2
3
4
7
8
9
10
11
12
13
14
Community Life Team
Harrisburg Pharmacy
HealthSouth Rehab Of Mechanicsburg
Moffitt Head & Vascular Group
PA Department of Revenue; 2003 income tax liability
AT&T
Comcast Cable
Pennsylvania American Water
PPL Electric Utilities
UGI Utilities Inc
Verizon
Wells Fargo Home Mortgage Inc
Loan No. 0016971343; mortgage payments Dec 03-Apr 04
Wells Fargo Home Mortgage Inc
Loan No. 0016971343; mortgage payoff; see payoff statement
TOTAL (Also enter on line 10, Recapitulation)
1008
VALUE AT DATE
OF DEATH
961.88
80.00
310.36
15.00
30.00
2.00
48.12
39.64
83.15
119.93
41.38
28.68
5,116.29
85,472.00
92~348.43
(Ifmorespamisneeded, insedaddi~onalshee~ofthesamesize)
REV"1513 EX + (~.nm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Peterson Kathleen M
NUMBER
4
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal disl, ibutions, andtransfe,~ under
Sec. 9116 (a)(1.2)]
Joanne Sheaffer (specific bequest)
630 N President Ave, Lancaster, PA 17603
Jeffrey Steinbrink (specific bequest)
630 N President Ave, Lancaster, PA 17603
Phyllis and Elizabeth Stockton (specific bequest)
1125 Winding Dr, Cherry Hill, NJ 08003
Carl L Peterson (100% residue)
139 North 26th Street, Camp Hill, PA 17011
21 03 lOO8
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Collateral
Collateral
Collateral
Lineal
10,000.00
10,000.00
11,000.00
38,551.01
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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)
Form View - public tax file 11-25-03.fp5
Page 1 of 1
Form View public tax file 11-25-03.fp5
Search
Table View
Viewing: 1 of 1
District_Number 01
Parcel_Identifier 01-21-0271-248
Map_Suffix_Number
House_Number 139
Direction N
str,st 26TH STREET
Owner_Name_l PETERSON, KATHRYN M
Owner_Name_2
Land Use Code R
Property_Descrlptio
Living_Area 1564
Current_Land_Valu 20160
C u trent_Improvement_Value 106130
Current_Total_Valu 126290
C urrent_Preferred_Valu
Acreage .14
CleanGreen_Status
Taxable_or_Exempt 1
Sale_Amount 118500
Sale_Month 10
Sale_Day 12
Sale_Century 19
Sale_Year 95
Deed_Book_and_Page 00129-00591
Year_Built 1914
Home I Help
htt.o://205.247.227.59:591/FMRes/FMPro?_db=public%20tax%20file%2011-25-03.fp5&-op=c 12/09/2003
936/O0169715N3/XP522/2/~/O0000085~7200
Mag 03, 2004
Brenda Kephart
8k5 Sir Thomas Ct, Ste
717 5~1 9223
Harrisburg PA 17109
(717)5~1-5550
Mortgagor:
Propertg:
956 Loan Number:
Loan Tgpe:
Kathleen M Peterson Estate
139 N 26th Stre
Camp Hill PA 17011
00169715q3
Conventional
THIS STATEMENT REFLECTS THE PAYOFF DATE YOU PROVIDED. ALL FIGURES MUST
BE VERIFIED 2~ HOURS PRIOR TO PAYOFF. FOR YOUR CONVENIENCE, PLEASE USE
OUR VOICE RESPONSE SYSTEH AND SELECT OPTION 1, THEN OPTION $.
ALL FIGURES SUBSECT TO FINAL VERIFICATION BY THE NOTEHOLDER.
ALL REMITTANCES MUST BE MADE BY CASHIER'S CHECK OR CER'FIFIED FUNDS,
This loan is due for the Hag 01, 200N pagment.
Principal:
Current total unpaid Principal Balance
Interest:
Interest at 7.62500% from Ok-O1-Ok to 05-05-04
Recording Fees
Fax Fee
Bugdown Fee
~ ~ TOTAL AMOUNT TO PAY LOAN IN FULL ~ m
$ 8~,825.13
609.87
27.00
10.00
.00
85,~72.00
LAST WILL AND TESTAMENT
OF
KATHLEEN M. PETERSON
I, KATHLEEN M. PETERSON, °fCumberland County, Pennsylvania, declare this to be
my Last Will and Testament. I revoke all other Wills and Codicils that I may have prev/ously made.
My just debts and expenses of my last illness, fimeral, and admin/stration of my estate shall
be Paid by my Executor from the principal of my residuary estate as Soon as practicable al/er my
death.
All inheritance, estate, and SUccession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate w/thout reimbursement from any
person. This provision is not a waiver of any fight Which my Executor has to Claim reimbursement
for anY-such taxes Which become payable as the result of any property Over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum wlx/eh I have either
handwritten or signed, located with my Will or with my valuable papers and found within 30 days of
the probate of my Will. Gifts may only be to persons who survive me or to organizations which
exist at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
On the condition that CLAUDIA and MARK WASHBURN, or the survivor, takes
possession of my pets and any domestic an/reals I own at the time of my death, I give and
bequeath to CLAUDIA and MARK WASHBURN the sum of THIRTY THOUSAND
DOLLARS ($30,000.00) to be distributed at the earl/est possible time after my death (so to be
used for the medical care, home modifications and repa/rs resulting from having my dogs). This
bequeath is conditiOned upon CLAUDIA and MARK WASHBURN taking possession of my
pets and providing for my pets during my pets' natural lifetimes. It is my strongest desire that my
dogs remain together during their lifetimes.
In the event that both CLAUDIA and MARK WASHBURN are unable to care and
provide for my pet companion(s), then I give and bequeath the above referenced sum of
THIRTY THOUSAND DOLLARS ($30,000.00) to THE HELEN O. KRAUSE
FOUNDATION, or its successors, of Dillsburg, Pennsylvania, with the same conditions and
terms as set forth above. It is my strongest desire that my dogs remain together during their
lifetimes.
-2-
Article V
I give and bequeath the sum ofTEN THOUSAND DOLLARs ($10,000.00) to my dearest
friend, JOAN'NE SHEAFFER, of Lancaster County, Pennsylvania.
Article VI
I give and bequeath the sum ofTEN THOUSAND DOLLARs ($10,000.00) to my
fr/end, JEFFREY STEINBRINK, of Lancaster County, Pennsylvania.
Art/cie VI/
I g/ye and bequeath the sum ofTEN THOUSAND DOLLARS ($10,00.00), all of my
Lenox Temple Blossom pattern china, all of my Gorham Newport Scroll silver flatware, and my
entire doll collection to PHYLLIS and ELIZABETH STOCKTON, or the survivor.
Article VII/
I give and bequeath to my nephew, ADAM PETERSON any remaining household items
that he may desire.
I give and bequeath to my nephew, MARK PETERSON, any remaining household
items that he may desire.
-3-
_Article X
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my parents, CARL and MARIAN
PETERSON or the survivor. In the event that both CARL and MARIAN PETERSON
predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath the remainder of
my estate, of whatsoever nature and wheresoever situate IN EQUAL SHARES, to my nephews,
ADAM PETERSON and MARK PETERSON.
Article XI
Ifa beneficiary under this Will has not attained the age of twenty-eight (28) years, the share
of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary according to
the terms in Article XII.
Article XII
In the event that a Trust is created by or as a result of any part of this Will, the terms and
conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of the
Trust as the Trustee shall consider advisable for the support, health, care and education (including
college, trade school, or other similar training or education) of the child until the child attains the age
of twenty-eight (28) years.
B. Upon attaining the age of twenty-two (22), one-third (1/3) of the principal and
accumulated income, of the child's share shall be distributed outright to the child.
'4-
C. Upon attaining the age of twenty-five (25), one-third (1/3) of the pr/ncipal and
accumulated income, of the child's remaining share shall be distributed outfight to the child.
D. Upon attaining the age of twenty-eight (28), the rema/ning principal and accumulated
income of the child's share shall be distributed outfight to the child.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
Article XIII
I hereby appoint MARCEY PETERSON, as Trustee of any Trust(s) created in this Will. In
the event of the renunciation, death, resignation, or inability to act, for any reason whatsoever of
MARCEY PETERSON, I nominate and appoint my friend, JOANNE SHEAFFER of Lancaster
County, Pennsylvania, as Successor Trustee of any Trust(s) created in this Will.
Article XIV
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over the
Trust estate, subject to any limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
-5-
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attomey, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
Article XV
I nominate, constitute, and appoint my friend, JEFFREY STEINBRINK, of Lancaster
County, Pennsylvania, Executor of my Last Will and Testament. In the event of the renunciation,
death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and
appoint my friend, JOANNE SHEAFFER of Lancaster County, Pennsylvania, successor Executrix
of my Last Will and Testament. I direct that my Executor or successor Executrix be permitted to
serve without bond and in addition to those powers granted by law, I grant them power to distribute
'6-
in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if
living. My Executor and successor Executrix shall receive reasonable compensation for services
rendered to my estate.
Article XVI
In addition to the powers conferred by law, I authorize my Executor and successor Executrix,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
Co) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising fi:om the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
to make distributions in cash or in kind, or in both, and to determine the value of any
(g)
such property,
(h)
to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay fi:om my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
' 7-
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, KATI-ILEEN M. PETERSON, hereby set my hand to this my
Testament, on /~.~[ ,7 ~ , 2003, at Harrisburg,
.4
Last
Will
and
Pennsylvania.
KATHLEEN M. PETERSON
In our presence, the above-named KATHLEEN M. PETERSON signed this and declared
this to be her Last Will and Testament, and now at her request, in her presence, and in the presence
of each other, we sign as witnesses.
Name. Address
-8-
I, KATHLEEN M. PETERSON, Testatrix, who signed the foregoing instrmnent, having
been duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my fi'ee and voluntary act for the purposes therein expressed.
Swom to or affirmed and
acknowledged before me by
KATHLEE~ M. PETERSON, the Testatrix,
on ~'~- &'~ ,2003.
Public
[ NOI'ARIAL SEAL
[ JE~ICRA. HOLLAND, NOTARY PUBLIC I
! CITY OF HARRISBURG, DAUPHIN COUNTY
~ MY COMMISSION EXP, IRES MARCH 4r 2006~
K.~THL~I~N M. PETERsON -
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Swom to or affirmed and
subscribed to before me
and '~c~¢.a I ;,~. [.t)~ /q~ch
witnesses, on ~pr,;I ~_3 ,2003.
Not~Public
~ ~ NOTARIAL SEAL
JESSICA A. HOLLAND, NOTARY PUBLI~
CI~ OF HARRISBURG, OAUPHIN COUN~
~ COMMISSION EXPIRES MARCH 4~ 2006
Witness
Witness
-9-
BUREAU OF TNDZVZDUAL TAXES
TNHERTTANCE TAX DI'V'rSTON
DEPT. ?80601
HARRTSBURG, PA 171Z8-0601
JAN L BROWN ESQ
JAN L BROWN & ASSOCS
845 SIR THOHAS CT 12
HBG PA 17109
CONHONWEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
COUNTY
ACN
REV-15i17 EX AFP [D1-05)
08-50-2004
PETERSON KATHLEEN H
11-24-2005
Z 1~.-~'.- 1008 ~.~
CuI~ERLAN]~ ii;i
HAKE CHECK PAYABL~AND RE~ZT PAYHENT TO:
REGZSTER OF WZLLS --'
CU.BE.LA.D CO C"U.T USE
CARLISLE, PA 17013
CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS
REV-1547 EX AFP [01-03) NOT~CE OF ZNHERZTANCE TAX APPRAZSENENT~ ALLOWANCE OR
DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF PETERSON KATHLEEN HFILE NO. 21 03-1008 ACN 101 DATE 08-50-2004
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNIcKEST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: 0RTGINAL RETURN
1. Reel Es~a~a (Schedule A) (1)
2. S~ocks end Bonds (Schedule B) (2)
3. Closely Held S'cock/Par~cnership Zn~ares~ (Schedule C) (3)
~+. Not,gages/No,es Receivable (Schedule D) (~)
E. Cash/Bank Daposi~s/Nisc. Personal Proper~y (Schedule E) (.~)
6. Jointly O~ned Propar*y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,:al Assa*s
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funeral Expenses/Adm. Cos*s/Hisc. Expanses (Schedule H) (9)
10. Dabis/Norigage Liabilities/Liens (Schedule T) (10)
11. Tote1 Deductions
12. Ne"t Value of Tax Re~urn
126/290.00
1/449.81
.00
.00
58/835.73
.00
.00
(8)
24,676.10
NOTE: To insure proper
credi~ ~o your account,
submi~ ~ho upper portion
of ~his form ,i~h your
~ax payment.
13.
NOTE:
186,575.54
ZF PA/D AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZT/ONAL ZNTEREST.
re~lect figures that lnclude the total o~ ALL returns assessed to date.
(1.;) .00 X O0 = .00
(16) 38,551.01 x 045 = 1,754.80
(17) . O0 x 12 = . O0
(lB) 51,000.00 x 15 = 4,650.00
(19)= 6,584.80
AHOUNT PAZD
6,584.80
ASSESSNENT OF TAX:
1~. Amoun* of Line 1~ a~ Spousal ra*e
16. Amoun~ of Line lq ~axeble a* L1naal/Class A re~e
17. Amoun~ of Line 1~ a* Sibling ra~a
18. Aeoun~ of L/ne 1~ ~axable a~ Collateral/Class B ra~e
19. Principal Tax Due
TAX CREDZTS:
PAYNENT RECEZPT DZSCOUNT (+J
DATE NUNBER ZNTEREST/PEN PAZD (-)
07-07-2004 CD004126 .00
TOTAL TAX CREDZT I 6,584.80
BALANCE OF TAX DUEl .00
ZNTEREST AND PEN. . O0
TOTAL DUE .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REg)UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SZDE OF THzs FORN FOR ZNSTRUCTTONS.
Chari*able/Governman~el Baques*s; Non-alec*ad 9115 Trusts (Schedule J) (15) . O0
Ne'l: Value of Es~:a~e Subject: ~:o Tax (lq) 69,551.01
Zf an assesseent was Assued previously, Lines 14, 15 and/or 16, 17, 18 and 19
(11) 1]7.024.53
(12) 69,551.01
RESERVATION:
Estates of decedents dying on or before December II, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lamfuI Class B (colIaterat) rate on any such future interest.
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
iSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance end Estate Tax" (REV-ISIS). Applications ara available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-562-2050; services for taxpayers aith special hearing and / ar
speaking needs: 1-800-447-~0Z0 (TT only).
Any party in interest not satisfied aith the appraisement, alloeanca, or disalloaanca of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object mithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
~ureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. ZB0601, Harrisburg, PA 17ZZB-060I
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-ISOI) for an explanation of administratively correctable errors.
If any tax due is paid within three (SI calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one fl) day from the date of
death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of
six [6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 1982 mill bear interest at a rate which ail! vary from calendar year to calendar year eith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are:
interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .000548 1988-1991 11X .000301 ~ 9Z .000247
1985 16X .000458 1992 9X .000247 ZOOZ 6Z .000164
1984 llZ .000301 1993-1994 72 .00019Z 2003 52 .0001~7
1985 13Z .000S56 1995-1998 92 .000247 2004 4Z .000110
1986 lO[ .O00Z7fi 1999 7Z .00019Z
1987 lO[ .000274 ZOO0 7Z .00019Z
--interest is calculatmd as follows:
INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DEL/NI~UENT X DAILY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
'^RR'SBURG, P^ 17128-0001 RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRS% AND MIDDLE INITIAL)~
I--
Z Peterson Kathleen M
UJ
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD*Year}
I.U
0 11/2412003 03/10/1948
ILl
t'"'l (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST~ AND MIDDLE rNITIAL)
REV-1500
INHERITANCE TAX RETURN
[]1. Odginal Return
[~4. Limited Estate
[~-'] 6~ Decedent Died Testate (AttachcopyoIWll)
i [] 9. LitJga~n Proceeds Received
[~]2. Supplemental Return
[~] 4a, Future Interest Compromise (date of (teath after 12.12.82)
F'l 7Decedent Maintained a Living Trust i~ch copy ofTrusQ
] t0 SpoueaIPovedyCredJt(dataOfdea~betwen12.31.91andl.l.95)
OFFICIAL USE ONLY
~FIL~N~MBE~-
2 1 -0 3 'i 0 0 8
NUMBER
SOCIAL SECURITY NUMBER
3 5 3-4 0-7 0 8 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
COMPLETE MAILING ADDRESS
FIRM NAME (IfApplica~le)
Jan L Brown & Associates
TELEPHONE NUMBER
__ 717-541-5550
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3)
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Pemonal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Intar-Vivce Tmcefers & Miscellaneous Non-Probate Prope~y (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mor~age Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
845 Sir Thomas Court Suite 12
(8)
(11)
¢2).
(13)
(14)
1,938.N2
4,704.31
6,642.33
-6,642.33
-6~642.33
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(12)
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
20.
0.00 X (15)
31,908.68 X .045 (16)
0.00 X .12 (17)
31,000.00 X .15 (18)
(10)
[] ..... em.,' - ~ ~ ,' re,me ,,e, ",', ~
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
0.00
11435.8g
0.00
4~650.00
6,085.89
NAME
Jan L Brown Esquire
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
E~3. RemainderReturn Idateofdeathpdo~to12-13-82)
r~5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (^,.~h ach o)
Decedent's Complete Address:
ISTREETADDRESS 1 39 North 26th Street
Camp Hitl Borough
a~Y Camp Hill
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
Credits/Payments
^. Spousal Poverty Credit
B. Prior Payments
C. Discount
I STATE PA I Z~P 17011
61085.8g
Total Credits ( A + B * C ) (2)
6~384.80
3. Interest/Penalty if applicable
Q Interest
E. Penalty
Total Interest/Penalty ( D + E ) {3)
4,If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I 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, (5B)
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; ........................................................................... [] []
b, retain the right to designate who shall use the property transferred or its income; ........................................ [] []
c, retain a reversionary interest; or ...................................................................................................... [] []
d, receive the premise for life of either payments, benefits or care? ............................................................. [] []
2. If death ocourred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?. .............................................................................................. [] []
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate propedy which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of berlur~, I declare t~at I have examined this return, includin[~ accompanying schedu es and statements, and to the best of rn knewlbe n ' ~
0.00
298.91
0.00
0.00
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN,~.~..~[~ DATE
ADDRESS 492 Cottage Road
South Portland
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
12/21/2 004
ME 04106
ADDRESS 845 Sir Thomas Court Suite 12
Harrisbur,q
DATE
12/21/2004
PA 17109
For dates of death on or after July 1, 1994 and before Januar~ 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 on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §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 bNenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepperent of the child is 0% [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%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S. §9116(a)(1,3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
ATTACHMENT TO REV-1500
ESTATE OF
Peterson Kathleen M
FILE NUMBER
21 03 1008
The original Rev-1500 was filed on July 7, 2004, and accepted as filed on August 30,
2004.
This Supplemental Return is being filed to report additional deductions not reported on
the previously filed return.
During the decedent's last illness her father, Carl L. Peterson, began paying bills on her
behalf out of his personal funds. Set forth in this Supplemental Return are expenses paid on the
decedent's behalf prior to her death and shortly thereafter. Carl L. Peterson presented his
statement for reimbursement to the Estate after the initial Inheritance Tax Return was filed.
REV-1511 EX + (I 2-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Peterson Kathleen M
ITEM
NUMBER
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule
DESCRIPTION
I
FILE NUMBER
21 03
1008
FUNERAL EXPENSES:
Cremation Society of Pennsylvania
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attomey Fees
Family Exemption: {If decedeet's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills, Cumberland County
adjustment to previously reported probate fees
Accountant's Fees
Tax Retum Preparers Fees
Household repairs at 139 N 26 St Camp Hill PA
AMOUNT
1,034.90
-90.00
993.12
TOTAL (Also enter on line 9, Recapitulation) $
1,938.02
(if more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~
FILE NUMBER
~ 03 ~oo8
Include unrelmbursed medical expenses,
Peterson Kathleen M
ITEM
NUMBER
1.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
Borough of Camp Hill
Comcast Cable
Penn Waste Inc
LJGI Utilities Inc
Verizon
DESCRIPTION
Housekeeping charges at 139 N 26 St Camp Hill PA
Golden Lake Recreational Dog Camp
and veterinarian costs
PSECU VISA
rvlichael W Harling, Tax Collector
East Pennsboro Ambulance Service
Young's Medical
State Farm
Blockbuster
VALUE AT DATE
OF DEATH
66.02
39.64
78.31
22.24
121.75
360.00
1,509.65
920.30
840.00
69.00
110.00
388.47
4.23
146.70
58.00
~eriodicals including Patriot-News, Sports Illustrated, People, Time Magazine
TOTAL (Also enter on line 1 O, Recapitulation) $
(If mom space is needed, insed additional sheets of the same size) 4,704.31
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Peterson Kathleen M
21
Decedent's Name Page 1
03 1008
Fi~e Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER
16
Moffitt Heart & Vascular Group
DESCRIPTION
adjustment to previously reported debt
SUBTOTAL SCHEDULE I
GRAND TOTAL SCHEDULE
AMOUNT
-30,00
-30.00
$ 4,704.31
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Peterson Kathleen M
NUMBER
1
2
3
4
[].
1.
1.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outdght spousal distributions and ransfers unde
Sec. 9116 (a)(1.2
FILE NUMBER
21 03
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
1008
AMOUNTORSHARE
OF ESTATE
Joanne Sheaffer (specific bequest)
Jeffrey Steinbrink (specific bequest)
Phyllis and Elizabeth Stockton (specific bequest)
Carl L Peterson
139 North 26th Street, Camp Hill, PA 17011
Collateral
Collateral
Collateral
Lineal
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON
00% residue
10,0OO.OO
10,O00.00
11,000.00
REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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)
LAST WILL AND TESTAMENT
OF
KATHLEEN hi. pETERSON
I, KATHLEEN M. PETERSON, °£Cumberland Coun . .
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be pa/d by my Executor from the principal of my residuary estate
death, as soon as practicable after my
All/nheritance, estate, and succession taxes (inclUding interest and Penalt/es thereon, but not
including any generation skipping tax) payable by
reason of my death shall be pa/d
out of and be
charged generally against the prine/pal of my residuary estate without reimbursement
person. This provision is not a waiver of any r~ght Wh/ch my Executor has to from any
for anY'such taxes which become payable ~s cialm reimbursement
°fapPointrnent. the result of any property over w/a/ch I have the power
Article 1]I
I give, devise and bequeath in accordance with any memorandum which I have either
handwhtten or signed, located with my Will
or with my valuable papers and found within 30 days of
the probate of my Will. Gifts may only be to persons who survive me or to organizations which
exist at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
pos .On the condition that CLAUDIA and MARK WASHBURN, or the s · -
session of my pets and - - urmvor, takes
any (~omestic animals I own at the time of my dca . '
bequeath to CLAUDira ~_., ...... ~ th. I g~ve and
--~ ,~m ~v~tRK WASHBURN the sum of THIRTY THOUSAND
DOLLARS ($30,000.00) to be distributed at the earliest possible time after my death (so to be
used for the medical care, home modifications and repairs resnlting from hay/rig my dogs). This
bequeath ~s conditmned upon CLAUDIA and MARK WASHBURN taking possession of my
pets and providing for my pets dur/ng my pets' natural lifetimes. It is my strongest desire that my
dogs remain together during their lifetimes.
In the event that both CLAUDIA and MARK WASHBURN are un
P~vide for my pet compamon(s), then I g~ve and bequeath the ab ...... ,- abl~ to care and
THIRTY THOUSAND ~- ,,vt ~*~erencea sum of
s) OOLLARS ($30,000.00) to THE HELEN O. KRAUSE
FOUNDATION, or its successors, ofDillsburg, Pennsylvan/a, with the same conditions and
terms as set forth above. It is my strongest desire that my dogs remain together during their
lifetimes.
-2-
I give and bequeath the sum ofTEN THOUSAND DOLLARS ($10,000.00)
fi/end, JOANNE SHEAFFER, of Lancaster County, Pennsylvania.
to my deares~
I give and bequeath the sum ofTEN THOUSAND DOLLARS ($10,000.00) to my
fi/end, JEFFREy STEIN'BRINK, of Lancaster County, Pennsylvarfia.
I give and bequeath the sum ofTEN THOUSAND DOL
Lenox Temple Blossom pattern ch/ns, all of my Gotham Ne,,,,.o~L~AR~..($10'00'00)' all of my
entire doll collection ,,~, ~t scroll silver flatware, and my
to PHYLLIS and ELIZABETH STOCKTON, or the survivor.
I give and bequeath
that he may desire, to my nephew, ADAM PETERSON any remaining household
I give and bequeath to my nephew, MARK PETER, SON,
items that he may desire.
any remaining household
-3-
Article X
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my parents, CARL and MARIAN
PETERSON or the survivor. In the event that both CARL and MARIAN PETERSON
predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath the remainder of
my estate, of whatsoever nature and wheresoever situate IN EQUAL SHARES, to my nephews,
ADAM PETERSON and MARK PETER.SON.
_Article XI
Ifa beneficiary under th/s Will has not attained the age of twenty-eight (28) years, the share
of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary according to
the terms in Article XII.
Article XII
In the event that a Trust is created by or as a result of any part of this Will, the terms and
conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of the
Trust as the Trustee shall consider advisable for the support, health, care and education (including
college, trade school, or other similar training or education) of the child until the child attains the age
of twenty-eight (28) years.
B. Upon attaining the age of twenty-two (22), one-th/rd (1/3) of the principal and
accumulated income, of the child's share shall be distributed outright to the child.
'4-
C. Upon attaining the age of twenty-five (25), one-third (1/3) of the principal and
accumulated income, of the child's remaining share shall be distributed outright to the child.
D. Upon attaining the age of twenty-eight (28), the remaining principal and accumulated
income of the child's share shall be distributed outright to the child.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
Article XIII
I hereby app°int MARCEY PETERSON, as Trustee ofany Trust(s)created in this Will. In
the event of the renunciation, death, resignation, or inability to act, for any reason whatsoever of
I~fA.RCEY PETERSON, I nominate and appoint my friend, JOANNE SHEAFFER of Lancaster
County, Pennsylvania, as Successor Trustee of any Trust(s) created in this Will.
Article XIV
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over the
Trust estate, subject to any limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
-5-
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or fight arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
to make distributions in cash or in kind, or in both, and to determine the value of any
(g)
such property,
(h)
to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
Article XV
I nominate, constitute, and appoint my friend, JEFFREY STEINBRINK, of Lancaster
County, Pennsylvania, Executor of my Last Will and Testament. In the event of the renunciation,
death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and
appoint my friend, JOANNE SHEAFFER of Lancaster County, Pennsylvania, successor Executrix
of my Last Will and Testament. I direct that my Executor or successor Executrix be permitted to
serve without bond and in addition to those powers granted by law, I grant them power to distribute
'6'
in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if
living. My Executor and successor Executrix shall receive reasonable compensation for services
rendered to my estate.
Article XVI
In addition to the powers conferred by law, I authorize my Executor and successor Executrix,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(0 to file any federal income tax return for any year for which I have not filed such
rem prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay fi'om my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
-7-
0) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
IN WITNESS WHEREOF, I, KATHLEEN M. PETERSON, hereby set my hand to this my
Last Will and Testament, on /~['-f) ~ [ ~ ~
2003,
at
Harrisburg,
Pennsylvania.
KATHLEEN M. PETERSON
In our presence, the above-named KATHLEEN M. PETERSON signed this and declared
this to be her Last Will and Testament, and now at her request, in her presence, and in the presence
of each other, we sign as witnesses.
Name Address
-8-
I, KATHLEEN M. PETERSON, Testatrix, who signed the foregoing instrument, having
been duly qualified according to law, acknowledge that I signed and executed this insmanent as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
KATHLEE~ M. PETERSON, the Testatrix,
on ~"~- &~ ,2003.
~. ) [ NOTARIAL SEAL
,1£
I CITfOFNARRISBURG, OAUPHINCOUN ¥ /
K~THL~EN M.-PETERSON -
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instnnnent as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and heating signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
witnesses, on IQ?t,;/ ~3 ,2003.
~,.. NOTAR AL SEAL
".. '~ JESSICA A. HOLLAND, NOTARY PUBLIC
Witness
Witness
-9-
STArns REPORT UNDER RULE 6.12
Name of Decedent: Kathleen M Peterson
Date of Death: 11/24/2003
Will No. 2003-01008
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
I . State whether administration of the estate is complete:
Yes x No
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. I is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
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 X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
~~~
Signattke_'
Date: 2/1/2005
Jan L Brown & Associates
Name (Please type or print)
845 Sir Thomas Court Suite 12
Harrisbu ra P A 17109
Address
(717) 541-5550
Tel.No.
Capacity :
Personal Representative
X
Counsel for personal
representative
[:11 .
11 1 -,
;:cj (~-
_:....J
J38
eft
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF KATHLEEN M. PETERSON, DECEASED
FILE NO. 2003-01008
FAMILY AGREEMENT AND FINAL RELEASE
THIS AGREEMENT by and between JEFFREY STEINBRINK, as Executor of the
(')
Estate of KATHLEEN M. PETERSON, Deceased, and CARL L. PETERSON,~ sole
.....
residuary beneficiary.
I
r'~
~'t:'.:) -n
WHEREAS, KATHLEEN M. PETERSON, late of Camp Hill Borougbo;e\nrlberltiiid
:.::::,1 r'J
-" j ',-
County, Pennsylvania, died testate on November 24,2003, having first made hefLast Will;\jjld
Testament dated April 23, 2003, which instrument was admitted to probate and is recorded in
Cumberland County Courthouse, Register of Wills, File No. 2003-01008;
WHEREAS, JEFFREY STEINBRINK has been duly appointed as Executor of the
Estate of Kathleen M. Peterson, Deceased; and
WHEREAS, the parties in interest under the Last Will and Testament of Kathleen M.
Peterson, Deceased, are:
I. Claudia and Mark Washburn, friends OR Helen O. Krause Animal Foundation,
Inc., charity;
2. Joanne Sheaffer, friend;
3. Jeffrey Steinbrink, friend;
4. Phyllis and Elizabeth Stockton, friends;
5. Adam M. Peterson, nephew;
6. Mark Peterson, nephew; and
7. Carl L. Peterson and Marian E. Peterson, parents.
WHEREAS, CLAUDIA AND MARK WASHBURN are entitled to a specific bequest
of THIRTY THOUSAND DOLLARS ($30,000) on the condition that they take possession of
Page I of6
...
decedent's pets and any domestic animals owned at the time of death. This bequest was not
made, because CLAUDIA AND MARK WASHBURN did not take possession of decedent's
pets;
WHEREAS, HELEN O. KRAUSE ANIMAL FOUNDATION, INC. is entitled to a
specific bequest of THIRTY THOUSAND DOLLARS ($30,000) on the condition that it take
possession of decedent's pets and any domestic animals owned at the time of death. This bequest
was not made, because HELEN O. KRAUSE ANIMAL FOUNDATION, INC. did not take
possession of decedent's pets;
WHEREAS, JOANNE SHEAFFER is entitled to a specific bequest ofTEN
THOUSAND DOLLARS ($10,000) and upon receipt thereof signed a Receipt and Release
Agreement. Said Receipt and Release Agreement is attached hereto and made a part hereof and
marked Exhibit B;
WHEREAS, JEFFREY STEINBRINK is entitled to a specific bequest ofTEN
THOUSAND DOLLARS ($10,000) and upon receipt thereof signed a Receipt and Release
Agreement. Said Receipt and Release Agreement is attached hereto and made a part hereof and
marked Exhibit C;
WHEREAS, PHYLLIS AND ELIZABETH STOCKTON are entitled to a specific
bequest of TEN THOUSAND DOLLARS ($10,000) and upon receipt thereof signed a Receipt
and Release Agreement. Said Receipt and Release Agreement is attached hereto and made a part
hereof and marked Exhibit D. PHYLLIS AND ELIZABETH STOCKTON are also entitled to
decedent's Lenox Temple Blossom pattern china, Gorham Newport Scroll silver flatware and
entire doll collection;
Page 2 of6
WHEREAS, ADAM AND MARK PETERSON are each entitled to any of decedent's
remaining household items that they may desire;
WHEREAS, CARL L. PETERSON AND MARIAN E. PETERSON, or the survivor,
are entitled to decedent's residuary estate. The said Marian E. Peterson died on August 16,2003,
and her interest vested in her husband, Carl L. Peterson;
WHEREAS, each of the parties to this Agreement have been furnished with a complete
listing of the estate assets, receipts and disbursements as set forth on the Statement of Account as
attached hereto and marked as Exhibit A;
WHEREAS, it is the desire ofthe parties to this Agreement that final distribution of this
estate be accomplished without a formal accounting to the Orphans' Court Division ofthe Court
of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense,
delay and publicity of a formal accounting;
WHEREAS, the parties to this Agreement each acknowledge to have received a proposed
Schedule of Distribution attached hereto and marked as Exhibit A.
NOW, THEREFORE, WITNESSETH, in consideration ofthe mutual promises,
covenants and agreements recited herein, the parties do declare and agree as follows:
1. JEFFREY STEINBRINK, Executor, does hereby state that he has fully and
faithfully discharged the duties of his office, and the Statement of Account (Exhibit A) is true
and correct and fully discloses all significant transactions during the accounting period. He
further states that all known claims against the Estate have been paid in full, and to the best of his
knowledge there are no claims outstanding against the Estate and all taxes presently due from the
Estate have been paid.
Page 3 of6
2. CARL L. PETERSON does hereby release and forever discharge the said
Executor, JEFFREY STEINBRINK, his heirs, executors, administrators and assigns, JAN L.
BROWN & ASSOCIATES, attorneys at law, and JAN L. BROWN, ESQUIRE from any and
all liability which may from time to time arise in connection with their service as Executor and
Attorneys of the Estate of Kathleen M. Peterson, Deceased. CARL L. PETERSON does further
agree to indemnify and hold them harmless from any and all liability which may arise against the
estate from creditors or claimants.
3. CARL L. PETERSON does hereby acknowledge receipt of the assets described
on the Schedule of Distribution attached hereto.
4. CARL L. PETERSON does further agree with the aforesaid Executor that should
any liability come due to the estate of the said decedent after the signing ofthis Agreement, he
will contribute his share of the estate to satisfy any and all claims, demands, suits or causes of
action which may be successfully prosecuted against the said estate or the aforesaid Executor
after the signing, sealing and delivery ofthis Agreement.
5. Each of the parties acknowledges that this Agreement shall be indexed and
recorded in the estate proceedings and that the terms hereof shall be binding upon their respective
heirs, successors, administrators and assigns.
6. This Agreement shall be governed by the laws ofthe Commonwealth of
Pennsylvania.
Page 4 of6
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
JMJUtt(Z.Y
20-r11
day of
,2005.
WITNESS:
l)~ (L g~
~~u~
JEF S:rEINBRINK, Executor
STATE OF MAINE
SS:
COUNTY OF
.2 I 0 (1,
On this the '" day of rJ1//<t rit ,2005 before me, a Notary
Public, the undersigned officer, personally appeared JEFFREY STEINBRINK, known to me or
satisfactorily proven to be the person whose name is subscribed to the within instrument, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
c~
Notary Public
~
1MIffl!U.eN FOQQ
Notary Public, MaIne
My Commission Expires September 9, 201 i
Page 5 of6
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7// /)/ day of
,2005.
WITNESS:
c~~lr~;~
LJ3V/lda / f ~O ;t!;
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF
dayof feb/UCl/i/
Public, the undersigned officer, personally appeared CARL L. PETERSON, known to me or
On this the
/
, 2005 before me, a Notary
satisfactorily proven to be the person whose name is subscribed to the within instrument, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
'CPo..uJaJ{ 'W.2J:R -'
Notary Public
IlOTARIAl. SEAL
1'llllIA" IlIlITE, NOTAIlI' PlI8UC
IlIlmlI\\XTON TWP., OAUPHIN COUHlY
II'r COMMISSION EXPIRES APRILS 2001
Page 6 of6
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"
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,
,
1
STATEMENT OF ACCOUNT OF THE ESTATE OF KATHLEEN M. PETERSON
Date of Death 11/24/2003
Real Property
139 North 26th Street, Camp Hill Borough
Personal Property
Geron Corp; 35 shs @ $11.I6/sh
Harley Davidson Inc; 10 shs @ $45.96/sh
JP Morgan Chase & Co; 15 shs @ $35.27/sh
Natus Medical Inc; 18 shs @ $3.92/sh
Treasury Department wages
PSECU bank accounts
Merrill Lynch Direct 20X-IIR92; cash
1995 Nissan Altima
Comm ofPA Deferred Comp Program, estate benef
SERS; death in state service; estate benef
Reimbursements/refunds
Tangible Property
Lenox china, Gorham flatware and dolls
Household goods
Total Assets
Income Earned Since Date of Death
Dividend income
Interest income
Realized gain on sale of securities
Total Income
Expenses
Funeral expense
Legal fee; Jan L Brown
Executor fee; Jeffrey Steinbrink
Accountants' fees
Family exemption; Carl L Peterson
Administrative costs
Debts of decedent
Inheritance Tax
Total Expenses
Net Assets Available for Distribution
1/20/2005
Exhibit A, Page 1
$126,290.00
$390.60
$459.60
$529.05
$70.56
$3,662.99
$8,328.61
$63.16
$2,650.00
$38,867.76
$290,677.51
$2,263.43
$1,000.00
$2,000.00
$477,253.27
$6.70
$5.80
-$57.56
-$45.06
-$1,109.90
-$12,236.00
-$5,000.00
-$640.00
-$3,500.00
-$4,535.52
-$97,052.74
-$6,085.89
-$130,160.05
$347,048.16
DISTRIBUTION TO BENEFICIARIES ACCORDING TO TERMS OF WILL*
Joanne Sheaffer, friend
Specific cash bequest
Jeffrey Steinbrink, friend
Specific cash bequest
Phyllis and Elizabeth Stockton, friends
Lenox china, Gorham flatware and dolls
Specific cash bequest
Carl L. Peterson, father, 100% residue
139 North 26th Street, Camp Hill Borough
Household goods
Cash distribution on 2/1/05
Cash distribution on or before 4/1/05
Total Distribution
$10,000.00
$10,000.00
$1,000.00
$10,000.00
$126,290.00
$2,000.00
$182,758.16
$5,000.00
$347,048.16
* Actual cash distribution may be increased or decreased based on interest accrued, market value of assets,
presentation of an obligation and/or payment of additional charges. After final distribution is made, the
residuary beneficiary agrees to reimburse the personal representative if called upon to pay further liabilities
of the decedent in the future.
1/20/2005
Exhibit A, Page 2
IN THE MATTER OF THE ESTATE
OF KATHLEEN M. PETERSON,
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
: ORPHANS' COURT DIVISION
: NO. 2003-01008
RECEIPT, RELEASE AND REFUNDING BOND
WHEREAS, KATHLEEN M. PETERSON during her lifetime executed a Last Will and
Testament on April 23, 2003; and
WHEREAS, pursuant to Article V of the Last Will and Testament, the sum ofTen
Thousand Dollars ($10,000.00) was specifically bequeathed to the undersigned, JOANNE
SHEAFFER, of 630 North President Avenue, Lancaster, Pennsylvania 17603; and
WHEREAS, KATHLEEN M. PETERSON died on November 24,2003, and Letters
Testamentary were issued to JEFFREY STEINBRINK on December 5, 2003.
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS, that JOANNE
SHEAFFER does hereby acknowledge having received from the Estate of Kathleen M. Peterson
the specific bequest under her Last Will and Testament; and in consideration of the distribution
of said Ten Thousand Dollars ($10,000) to me in hand paid and intending to be legally bound
hereby, I do hereby, for myself and my successors and assigns, remise, release, quitclaim, and
forever discharge the said Executor Jeffrey Steinbrink and the Estate of Kathleen M. Peterson of
and from all rights, suits, claims, accountings, actions and demands whatsoever, now or hereafter
to it accrued or accruing by virtue of this full distribution.
In further consideration thereof, I, JOANNE SHEAFFER, do hereby covenant and agree
that upon demand by the aforesaid Executor I will pay and refund unto him any portion thereof as
the Executor may require in the event that any additional charges, expenses, taxes or any other
-1-
Exhibit B
lawful claims or demands shall hereafter be made against the Estate to the extent of said
distribution and to indemnify and save harmless the Executor and his successors and assigns, and
Jan L. Brown & Associates of and from any and all liabilities, claims, actions, losses, damages,
costs and expenses, not presently known to them, for which they may be liable or answer for in
respect to the aforesaid contingencies. The provisions of this Release are applicable to all such
loss or liability, including any resulting from the negligence or mistake of law or fact by the
Executor and/or Jan L. Brown & Associates.
I, JOANNE SHEAFFER, do further agree that all of the provisions of this instrument
shall be binding upon my successors and assigns.
IN WITNESS WHEREOF, and intending to be legally bound hereby, the undersigned has
hereunto set her hand and seal this :<.. S 11.. day of , 2004.
/1 0-.7
WITNESS:
c1tb.;(,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF LAJY\Q.AsI-e"
SS:
On this the !), ~ day of rYI4y , 2004, before me, a Notary
Public, personally appeared Joanne Sheaffer, knewH te Rl8 (sr 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.
WITNESS my hand and official seal the day and year aforesaid.
NOTARiAl SEAL
VERONICA R. BURGESS, Nolary Public
Lancaster, Lancaster County, FA
My Commission Expires NOY.4, 2006
diRk;,/} cr f<v/A1fl/ll-
Notary Public
- 2-
IN THE MATTER OF THE ESTATE
OF KATHLEEN M. PETERSON,
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. 2003-01008
RECEIPT, RELEASE AND REFUNDING BOND
WHEREAS, KATHLEEN M. PETERSON during her lifetime executed a Last Will and
Testament on April 23, 2003; and
WHEREAS, pursuant to Article VI of the Last Will and Testament, the sum ofTen
Thousand Dollars ($10,000.00) was specifically bequeathed to the undersigned, JEFFREY
STEINBRINK, of 630 North President Avenue, Lancaster, Pennsylvania 17603; and
WHEREAS, KATHLEEN M. PETERSON died on November 24, 2003, and Letters
Testamentary were issued to JEFFREY STEINBRINK on December 5, 2003.
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS, that JEFFREY
STEINBRINK does hereby acknowledge having received from the Estate of Kathleen M.
Peterson the specific bequest under her Last Will and Testament; and in consideration of the
distribution of said Ten Thousand Dollars ($10,000) to me in hand paid and intending to be
legally bound hereby, I do hereby, for myself and my successors and assigns, remise, release,
quitclaim, and forever discharge the said Executor Jeffrey Steinbrink and the Estate of
Kathleen M. Peterson of and from all rights, suits, claims, accountings, actions and demands
whatsoever, now or hereafter to it accrued or accruing by virtue of this full distribution.
In further consideration thereof, I, JEFFREY STEINBRINK, do hereby covenant and
agree that upon demand by the aforesaid Executor I will pay and refund unto him any portion
thereof as the Executor may require in the event that any additional charges, expenses, taxes or
-1-
Exhibit C
any other lawful claims or demands shall hereafter be made against the Estate to the extent of
said distribution and to indemnifY and save harmless the Executor and his successors and
assigns, and Jan L. Brown & Associates of and from any and all liabilities, claims, actions,
losses, damages, costs and expenses, not presently known to them, for which they may be liable
or answer for in respect to the aforesaid contingencies. The provisions ofthis Release are
applicable to all such loss or liability, including any resulting from the negligence or mistake of
law or fact by the Executor and/or Jan L. Brown & Associates.
I, JEFFREY STEINBRINK, do further agree that all ofthe provisions of this instrument
shall be binding upon my successors and assigns.
IN WITNESS WHEREOF, and intending to be legally bound hereby, the undersigned has
hereunto set his hand and seal this
\ -Z"""
day of
Mtr
,2004.
WITNESS:
~j/7d-tL t~(}Ai;
JEFF.~~
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF
On this the / If dayof!1a V , 2004, before me, a Notary
Public, personally appeared Jeffrey Steinbrink', known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, and acknowledged that he executed
the same for the purposes therein contained.
WITNESS my hand and official seal the day and year aforesaid.
~'
k9
tary bhc
~.-I{~
- 2-
&~~
f
t
f1!!!'1!t1ll!4l'lf\~.~
1IJl!\1'l 'I!!""~!L';/i.I:!ljlG:lC ,l
~;",,_:~': f,'.' ,- 'J;(r _ 'Ir.~' iI-',il 'Con i'i;1lfi)J
ttC: ..~] ,'},<'~; '~,(j r: ':'r.':'';': '''M -"
,..___~....__._,'.-_,.~_,. .,~~.'. .".,,,.'..-_100;.....
IN THE MATTER OF THE ESTATE
OF KATHLEEN M. PETERSON,
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
: ORPHANS' COURT DIVISION
: NO. 2003-01008
RECEIPT, RELEASE AND REFUNDING BOND
WHEREAS, KATHLEEN M. PETERSON during her lifetime executed a Last Will and
Testament on April 23, 2003; and
WHEREAS, pursuant to Article VII of the Last Will and Testament, the sum ofTen
Thousand Dollars ($10,000.00) was specifically bequeathed to the undersigned, PHYLLIS
STOCKTON, of 1125 Winding Drive, Cherry Hill, New Jersey 08003, and her minor daughter
ELIZABETH STOCKTON; and
WHEREAS, KATHLEEN M. PETERSON died on November 24,2003, and Letters
Testamentary were issued to JEFFREY STEINBRINK on December 5, 2003.
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS, that PHYLLIS
STOCKTON does hereby acknowledge having received from the Estate of Kathleen M.
Peterson the specific bequest under her Last Will and Testament; and in consideration of the
distribution of said Ten Thousand Dollars ($10,000) to me in hand paid and intending to be
legally bound hereby, I do hereby, for myself and my successors and assigns, remise, release,
quitclaim, and forever discharge the said Executor Jeffrey Steinbrink and the Estate of
Kathleen M. Peterson of and from all rights, suits, claims, accountings, actions and demands
whatsoever, now or hereafter to it accrued or accruing by virtue of this full distribution.
In further consideration thereof, I, PHYLLIS STOCKTON, do hereby covenant and
agree that upon demand by the aforesaid Executor I will pay and refund unto him any portion
-1-
Exhibit 0
thereof as the Executor may require in the event that any additional charges, expenses, taxes or
any other lawful claims or demands shall hereafter be made against the Estate to the extent of
said distribution and to indemnifY and save harmless the Executor and his successors and
assigns, and J an 1. Brown & Associates of and from any and all liabilities, claims, actions,
losses, damages, costs and expenses, not presently known to them, for which they may be liable
or answer for in respect to the aforesaid contingencies. The provisions of this Release are
applicable to all such loss or liability, including any resulting from the negligence or mistake of
law or fact by the Executor and/or Jan 1. Brown & Associates.
I, PHYLLIS STOCKTON, do further agree that all of the provisions of this instrument
shall be binding upon my successors and assigns.
IN WITNESS WHEREOF, and intending to be legally bound hereby, the undersigned has
to ;.h
day of -:fvl.:j
,2004.
hereunto set her hand and seal this
WITNESS:
.tfA~
PHYLLIS STOCKTON, individually and on behalf
of ELIZABETH STOCKTON
-2 -
'.
SlKlb uF NEW JERSEY
SS:
COUNTY OF
CAMDEN
On this the
~
day of
-:)-..>'\-4
,
, 2004, before me, a Notary
Public, personally appeared Phyllis Stockton, 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,
WITNESS my hand and official seal the day and year aforesaid,
DEIRA L lAY
NOfAIVPUlUCOfNEW .,
ConImIaIon Ix1*" IISIW
- 3-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP 112-041
I:':::~:':"~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-01-2005
PETERSON
11-24-2003
21 03-1008
CUMBERLAND
101
KATHLEEN
M
CJ
C'Ii")
JAN~:t. B~OWNESQ
JAKt. BRbWtr & ASSOCS
84S.sIR'rH.Qr.tAS CT 12
HB~_.: PA 17109
Allount Rellitted
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 ~
RE-V =r!\"-EX--AFP--nr=6!'--NOY-iCE-OF-iNHErtiflirCE-"-AX-l-PPRl-fsElf'iNi'~--ALtowlNCE-oR-----_._----- - --.
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF PETERSON KATHLEEN M FILE NO. 21 03-1008 ACN 101 DATE 03-01-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
. 00 NOTE: To insure proper
. 00 credi t to your account,
. 00 submit the upper portion
.00 of this forll with your
. 00 tax paYllent.
.00
.00
(8) . 00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
llO)
1,938.02
4.704.31
(11)
ll2)
ll3)
ll4)
6.642 33
6,642.33-
.00
62,908.68
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ~
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
EDI S:
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
31,908.68 X 045 =
.00 X 12 =
31,000.00 X 15 =
ll9)=
.00
1,435.90
.00
4,650.00
6,085.90
DATE
07-07-2004
NUMBER
CD004126
+
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
6,384.80
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6,384.80
298.90CR
.00
298.90CR
. 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.)
BUREAU OF INDIVIDUA~~;C.ft n~[::lr:t= 0F
INlEAITANCE TAX DIVISloNiI:__\..JU'Y'_J,--,j '--. I h..-,-_ ~
PO lOX 2SG6Gl
HARRISBURG PA 1712&-0601
"
COMMONWEALTH OF PENNSYtvANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-16Dl EX AFP (03-05)
ryo".r nC.1) '")') ".',.',ll: 53
LUJJhl 1\ '-'- Fi
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-04-2005
PETERSON
11-24-2003
21 03-1008
CUMBERLAND
101
_t RMlttecl
KATHLEEN
M
CLEF:K OF
Jl..Q:,...A-.::'-:l':'-~ ('{I\ lilT
JAN L BRO N;' ~S4 .". ,j. D;\
JAN L BROCks ASSOCS .' . .
845 SIR THOMAS CT 12
HBG PA 17109
HAKE CHECK PAYABLE AND REMIT PA~ENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper cr.dlt to your ~ountl s~lt the upper portion of this fo~ with your tax P8~t.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
................................................................................................................
REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF PETERSON KATHLEEN M FILE NO.21 03-1008 ACN 101 DATE 04-04-2005
THIS STATEHENT IS PROVIDED TD ADVISE OF THE CURREHT STATUS OF THE STATED ACN IH THE IlAltED ESTATE. S BELDIl
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF AP LICABLE,
A PROJECTED INTEREST FIQURE.
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT, 03-01-2005
PRINCIPAL TAX DUE, 6,085.90
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-07-2004 CDOO'i126 .00 6,384.80 ,
03-15-2005 REFUND .00 298.90-
,
TOTAL TAX CREDIT 6,085.90
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
.
SIDE FOR CALCUlATION OF ADDITIONAL IHTEREST.
I IF TOTAL DUE IS LESS THAN U,
NO PAYMENT IS REquIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDITw ICRI,
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I