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Home My WebLink About02-0779PETITION FOR PROBATE and GRANT OF LETTERS(; Estate of ~/~ i,~ W , n'~ts.~~u~~Ue~~, No. ~~ ~~ ~~~ • -- also known as ~ To: _ Register of Wills for the _ Deceased. County of Corn en~,~i%U~ _ in the Social SecuritvNo. /l-~ 5Y ` C~7~~~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executR~ ~ named in the last will of the above decedent, dated M~ ~! ~w f L _, ~'Lc7i" a_ and codicil(s) dated _ - Decendent was domiciled at death in ~~ ~ ~z~~-~ ~u p h t y last family or prncipal residence at L t t? +3i~ ~ l~"R!tiL ty, Pennsylvania, with Decendent, then 7 S years of age, died l~c' ~° e`~ ~ ~~' -~ Lam`'" Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted. after execution of the will offered for probate; was not the victim of a killing and was never adjudicated. incompetent: Decendent at death owned property with estimated values as fallows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters E fftm~r~~l' ' (testamentary; ministration c.t.a.; administration d.b.n.c.t.a.) theron. L-nrr~ t , :' ... ~~~` ~~'z~ ~L- v ~ ~ ~~ L N~. tt~ 1~?r_ c~ a~-y c l~ ~~ ,r ~ .s - (.v ~ ~~ L33 t D(-ti~UD Ltltvf ~, n. v ~, m $ i ~ G? LPL' c~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF Cuxt ~ey~ ~~1~ j~, (scare relevant circumstances, e.g. renunciation, death of executor, etc.) The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~~ Sworn to or affirmed and subscribed ~~~~ ~ l~~C~~~~ ~ e me this 28th day of a A st 2 0 nna M.Otto 1st Deputy egist ~~ ~3 ~ (list street, number and muncipality) No. 21-2002-779 ~ ~ Estate of ~ ~/ ~~1, ~ i U~ j~c;~, l., ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August 28th x~ 2002, in consideration of the petition on the .reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 12 , 2001 described therein be admitted to probate and filed of record as the last will of 21-2002-779 i. rl K~„i I 1!r, o u II lu dle.nc~i~+'ill~liE~ti>nval~{edctr~tlxPSdtfrVit:dnRecon{sllOlfice lil[r p~lrn{i~~lnetnr{filin,led wilt me as r hl!ARIV3Nt;; it is, illegal to duplicate this copy by photostat or photograph. .I' h~- tis renilit nlr F'.Of P _8607735 1~:~ --- NtGS.:U Nev. L21 Nr .,, 1xME IK ai COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH gay W. McCulloch SmNNN uNGER1vE.w S MamM qye .,. InwERlop ~• : MNww OIIEOEgMN 6/12`9y't~27 91eoEpv ,E a~;N . Newville PA voR GE.aN Cumberland cm,RGRO. I'"moE GE,vN ~ West E"L""''"""Emil ^•nw,,,, p,,,,, Pennsboro XcfOEM'9 V3~"l p(LVVRpN E`' TW b t II w+~WNq~nyaeurry d°e^vp M~gMwrW zlrv0 pF 0N51NEEEnNpVY1RV YNS pECEDENi EVERIx wl 4a 11 Carrier Postal Service V. E. MMEDVpRtESi yy^ ~® Elw 210 Bi r [9~Ne1 g Spring RD CECEOENi'S "4'M"t IY•. Newville P A 17241 RESIpEVCE '~`"n'^°°^• Harper ' McCulloch KMnHf 9x.WERRNnvN Hale A. McCulloch IOOOE pS00EliKW eNn^ a~,w,NY.G R•me•eN„msl.,.^ _ w~+oEOeap ~~, L Male ,161 ...._..,,34x ACF [K CERN ICnNE yvE yy _ $D~~ ucl4pm «;m ^ ERKA.p.,NM G +m m. C 'x44 LELEDEfN 1 ~ Na® IYeI McNUn. RNiN ECECE i'SEglC4gN MMliµ Y.une.,y Newru G R'NNS•I OI,E Wil - GN 11a.~ •E•'due4x Yw a~we.l. N.wr,Yl xo. e.re.x w.p I,..G ..nN..N.NnN :P'f NAYEIF.K M•n;~ MepnEVr.NrN Edna Fry Mxi'8 MMMB A W RE89 Snort LM/e•n. SYN. E 33 Wildwood Ln New F4EE(19111ON N/n pLemelNµ pemelW ~wville Cemetery _~_,1 y_ 200?----- n,~t' 0730 RNYNp ^ 6ocM ^ NM ~I"meloneMNilfleatW white Newville PA 17291 E Inc li Big Sprin wC3' ~ NNnNNe ^ `Y• ^ No Q' n. G w ^ SuYN. ^ e«aee,we..m,„.e ^ N4 .._ -_._-_....,......o ewNeNw~ - --"..._....,,..,~.e wel~NO~n„pNleellNnx41 .n ~GUxnxe,wno.LnE.Key:a:~na.E.~~.aA:iw`il`m•'"..e::naol..:°,.ma :w`::~.Neni"°'na m:`: ::...Y,«.. C 'YEOILAt FYAMINfWLONONEK ~~~~~~~~~~~~~~~~'~~~~~ G minl ne peele ul ewminNbn enNaelnrefNgNlan, In mYOplnlen, e•eIN oeeunee N IKe Ilme• ON•• enE pYf ...... r u aM1lp......, e• IM Eue la 111ebuN(etene N .................................... NEGSiNnN'E SIGNRYPE "NO ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~.-+rgl•Q F1. ~e1L~~~~D~~ I Heal IZeyisn~ar .n. ^ xo ^ Last Will of JAY W. MCCULLOCH I, JAY W. MCCULLOCH, of Newville, Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am married and my spouse's name is BLANCHE L. MCCULLOCH. All references to "my spouse" in my Will are to her. The names and birth dates of my children are: OWEN H. MCCULLOCH, born January 25, 1.956 NEAL A. MCCULLOCH, born October 10, 1957 RUTH A. ROLAR, born January 21, 1960 HALE A. MCCULLOCH, born September 20, 1961 All references to my children in my will are to these children, as well as any children subsequently born to me, or legally adopted by me. Page 1 Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: JAY W. MCCULLOCH, sole Trustee, or his successors in trust,, under the JAY W. MCCULLOCH LIVING TRUST, dated Marcia 12, 2001, and any amendments thereto. Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date c-f my death. Section 3. Testamentary Trust If my spouse survives me, I authorize my personal representative to establish, with the assets of my probate estate, if any, or with any property distributed to my personal representative from my Trustee, a testamentary trust (or trusts) for the benefit of my spouse and my other beneficiaries under the same terms and conditions of my revocable living trust as it exists at the date of my death. I appoint the Trustee and successor Trustee named in my revocable living trust as the Trustee and successor Trustee of my testamentary trust(s). The Trustee of my testamentary trust(s) shall have all the administrative and investment powers given to my Trustee in my revocable living trust and any other powers granted by law. My Trustee shall be under no obligation to distribute property directly to my personal representative, but rather may distribute such property directly to the Trustee of the testamentary trust(s). Any property distributed to my testamentary trust(s) by the Trustee of my revocable living trust shall be distributed by the Trustee of my testamentary trust(s) in accordance with. the Page 2 terms and conditions of my revocable living trust as it exists on the date of my death. Article Three Powers of My Personal Representative My personal representative shall have the power to perform all acts reasonably necessary to administer my estate, as well as any powers set forth in the statutes in the State of Pennsylvania relating to the powers of fiduciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative, in its sole and absolute discretion, may elect to have all, none, or part of the property comprising my estate for federal estate Page 3 tax purposes qualify for the federal estate tax marital deduction as qualified terminable interest property under Section 2056(b)(7) of the Internal Revenue Code. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Article Five Appointment of My Personal Representative I appoint JAY W. MCCULLOCH to be my personal representative. If JAY W. MCCULLOCH cannot act, or is unwilling to act, I appoint, in the order named, the following successor personal representatives: First, LYNETTE MCCULLOCH; then Second, OWEN H. MCCULLOCH. I direct that my personal representatives not be required to furnish bond, surety, or other security. Page 4 I have initialed all of the pages of this Will, and have signed it on March 12, 2001. ~~c I~r AY W. MCCULLOCH The foregoing Will was, on the day and year written above, published and declared by JAY W. MCCULLOCH in our presence to be his Will. We, in his presence and at his request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses and have initialed each page. We declare that at the time of our attestation of this Will, JAY W. MCCULLOCH was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. ~ ~, ITN SS Address: 2515 ~1e~`LySb~.ra ~C~ . ~} 3 ~~~~P~ i7of i ~~ ~%~ WITNESS Address: 9Z6 /I/~~,~.e„ ~ ~.~ ~t~~^.,~rS.,,, . P~4 l 7cSS- STATE OF PENNSYLVANIA ) ss. COUNTY OF CUMBERLAND ) Page 5 -. We, JAY W. MCCULLOCH, and the Testator and the witnesses, respectively, whose names are signed to the foregoing Will, having been sworn, declared to the undersigned officer that the Testator, in the presence of the witn~°sses, signed the instrument as his last Will, that he signed, and that each of the witnesses, in the presence of the Testator and in the presence of each other, signed the Will as a witness. ~a ~~~ JAY W. MCCULLOCH OZC, l(,~~ WI ESS f G^' `~ WITNESS Subscribed and sworn before me by JAY W. MCCULLOCH, the Testator, and by /IJF~Ay sa,,~.,.~t( and 7ho.~.~,~r 3. /4'InrMY the witnesses, on March 12, 2001. NOTARY PUBLIC My commission expires: NOTARIAL sEAL CHRISTINE M. ANRENS, NOTARY PUBLIC CARLISLE 80R0., CUMBERLAND CO. PA MY COMMISSION EXPIRES AUG. 12,1001 Page 6 COMMONWEALTH OF PENNSYLVANfA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT AHRENS THOMAS J ESQUIRE 5521 CARLISLE PIKE MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: ssrv: psi-34-o730 FILE NUMBER: 2102-0779 DECEDENT NAME: MCCULLOCH JAY W DATE OF PAYMENT: 1 1 / 1 3/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/ 1 6/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ $30,574.30 TOTAL AMOUNT PAID: REMARKS: LYNETTE M MCCULLOCH Ci0 THOMAS J AHRENS ESQUIRE CHECK#109 INITIALS: SK SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REV-1162 EX(11-96) N0. C~ 00183$ 530,574.30 REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA `v BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-Ofi01 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 Ex AFP cai-asp DATE 03-03-2003 ESTATE OF MCCULLOCH JAY W DATE OF DEATH 08-16-2002 FILE NUMBER 21 02-0779 COUNTY CUMBERLAND THOMAS J AHRENS ACN 101 AHRENS LAW OFFICES Amount Remitted 5521 CARLISLE PIKE MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MCCULLOCH JAY W FILE N0. 21 02-0779 ACN 101 DATE 03-03-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate [Schedule Al (1l .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 15 335.60 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 28,696.63 tax payment. 6. Jointly Owned Property (Schedule F) (6l .00 7. Transfers (Schedule G) (7) 692,621.49 8. Total Assets (g) 736,653.72 APPROVED DEDUCTIONS AND EXEMPTIONS: 19,692.76 9. Funeral Expenses/Adm. Costs/Misc. Expenses [Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1,77 2.7 2 11. Total Deductions (11) 21 .465 _ 48 12. Net Value of Tax Return (12) 715, 188.24 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14 Net Value of Estate Subject to Tax (14) 715,188.24 . NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 . 00 15. Amount of Line 14 at Spousal rate (15) • = X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 715, 188.24 X 045 . 32, 183.47 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 .00 Principal Tax Due 19 (19)= 32,183.47 . rwv nsrnTTC. . DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 11-13-2002 CD001838 1,609.17 30,574.30 TOTAL TAX CREDIT 32,183.47 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 4 Name of Decedent: y A Date of Death: ~t/C~ t/• CERTIFICATION OF NOTICE UNDER RULE 5.6(a) w. ~~~ ~z.~~~ 2~t'~ Will No. d Z ~ ~ 7 ~ ~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~' Z ~ ~ ~~ 7-- Name Address ~ l~v~~ ICb~~~2 ~/y TJbGwona IPar~:~ /~'h~cC,~~r~r{. ~C ~ ~fU9~~ a 1 Q(.cJf-1~/ l/ ~A , r~'IC ~~LLC'(~ ~~ Z-/ Gt~I~7~ Z~JCaJ L~'9NE , ~,J~.t-(~i!!! ~,~1 7 ~ y I / /~ ~ ~- ~ ~~~L 1 V~LU! 233 ~y~~DFVCC~ Lr4tiE, /~/~wv~l~ , ~~ 17Z~I ~~,~~~- ~-~ ~~~ C~~~cai,l L r7C- N1C~~L~v~(~~ I~,~S("~-F ~Z33 C.~~~-Awao.~ Lt~r~E;~ ~IFwb~~~~ 1 I`ii' l~Z~ J Not ce has now been given to all persons entitled thereto under Rule 5.6(a) except ~, - /L~ -. p z ~ G Date: / ~ Gam--_ Signature / Name TN~my,; ,/. AN.?F•~~ Address S ~ Z 1 ~i4io (. i ~ CF' ~~ ~~ /'-`~Fcl wry'c,S ~ c~12~ } Pt"r labs o Telephone (~~~) ~~7 - /~/ ~ ~ Capacity: Personal Representative `' Counsel for personal representati~~e REV"'t'E~'I'''J *' REV-1500 Ul'i'!Gi(,[ l'~;' ON Y ]~g5-d. ~ INHERITANCE TAX RETURN .. Cor.wIONWEALTH OF PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 02 0779 OEPT.280601 ..--L-._ _ HARRISBURG. P!- _17128-0601 --.-"'- _.-L CO!,lliTY ~ODE:___~AR __ ~ NUMBER ~ , DECEDENT'S NAME-iU;:ST, FIRST, AND MIDDLE INITIAL)-- ------- --I ---- --'-- ---. .---- SOCIAL SECURITY NUMBER McCulloch, Jay W 161-34-0730 ffi DATE OF DEATH (MM-DD-YEAR) --I--DATE OF BIRTH-,MM-DD-YEAR) -.---.- .- - -- --.----.,.- t THIS RETURN MUST OE FILED IN DUPLICATE WITH THE lil 0&116/2002 061291]927 REGISTER OF WILLS lil 0 -- -,,,._----- --- ---- _.n ___ _~_...._______...___ .-- (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ o 2~ Supplemental Retum .- - ~RemainderReIUm(daleOfdealh~Pri<lrto 12-1:3~8~ 1. Original Retum w ::.:::~V,I o 4. limited Estate o 4a. Future Interest Compromise (date of death after o 5. Federal Estate Tax Retum Required U"'~ 12-12-82) w"U ~ 6. Decedent Died Testate {Attach copy 181 7, Decedent Maintained a living Trust (Attach %~9 8. Total Number of Safe Deposit Boxes u..m of Will) copy of Trust) ~ o 9. litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between o 11. Election to tax under Sec. 9113(A) (Attach Sdl O) ~,,_...1~~~1,~91a,n.~,1~1~~,5,~,- _ _", ".."'."'....,._."..', ...~_.....c~~.~~ ..._.'-~ THI$$iJ!lt'(l!i:MI.l$T'iII!CllM~tEl'Eb;'AI.l.'CDRRES~!:lNb~CE~l!.,C(lI\ll'lQFi!'lr~tM:,1l!f(ll\MAT\<lI!SfIO!I~DBEl'l\RECTED,TQ, AME COMPLETE MAILING ADDRESS .;,~ Thomas J. Ahrens WZ ---- -- ~i!i IRM NAME (If applicable) 5521 Carlisle Pike OZ Ahrens Law Offices, P.C. Mechanicsburg, PA \ 7055 ui? ---- ELEPHONE NUMBER ~ \~""-""" - - - - - . - - ~------------- - 1 Real Eslale (Schedule A) (;) ------ None - I .. ___n____ __ OH!-::I'\L.U:'-i lNtJ -- --- 2. Slocks and Bonds (Schedule B) (2) 15,335.60 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) None -- ----- 4. Mortgages & Notes Receivable (Schedulo D) (4) None --- 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2&,696.63 (Schedule E) - 6. Joinlly Dwned Property (Schedule F) (6) None Z I o Separate Billing Requested -- - ---- 0 g 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 692,621.49 ~ (Schedule G or L) ~ ii: 8. Total Gross Assets (tolal Lines 1-7) (8) 736,653.72 ~ = 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ]9,692.76 --- 10. Debts of Decedent, Mortgage Liabilitios, & Liens (Schedule I) (10) 1,772.72 11. Total Deductions (tala I Linos 9 & 10) (11) 21,465.4& 12. Not Value of Estate (Line 6 minus Line 11) (12) 715,1&&.24 --- ------- 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an ejection to tax has not been (13) mode (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 715,1&&.24 --.- ----- -----.------..- ----- .-- ---- .- ---.- ---'- ~-- ---- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPL'CAB~E RATES !15.Amounl of Line 141axable ot the spousal tax rale, x .00 (15) or transfers under Sec. 9116(0)(1.2) ----------- - ----...- Z 116. Amounl of Line 141axable at lineal rate 715,1&&.24 .045 (16) 32,1&3.47 0 x ~ ------_._~- -- --'- ~ ~ .. , 17.Amount of Line 14 taxable at sibling rate x .12 (17) '" 0 \ 18. Amount of Line 14 taxable at collateral rate -------- _._~ - u ~ x .15 (18) 119. Tax Due ----- ------ (19) 32,1&3.47 -- ! 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT :y............. .......................,.,.jj~.~Ill\EiO.~,..l\i;i.QOr;$'1'Iq!iSO!iI!E~~.~i!Srb!;.~~pl<J5J:~EC~~,,!~<~~~_ ~______.m'~'.~--"--- Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6.00) Decedent's Complete Address: STREET ADDRESS 210 Big Spring Road -- -1--1 --- CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Duo (Page 1 Line 19) (1) 32,183.47 -- ---- 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount 1,609.17 Total Credits (A + B + C) (2) 1,609.17 -- --- 3. Interest/Penalty if applicable D. Interest ---- -- E. Penalty -- TotallnteresUPenolty (0 + E) (3) 0.00 - 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) -- -- Check box on Page 1 Line 20 to request a refund 30,574.30 5. It 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 Ihe total of Line 5 + SA. This is the BALANCE DUE. (58) 30,574.30 -....---...-- 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;.. ........".. ................ ~ I 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 0 receiving adequate consideration?. ................. ,.............. ............ .............. ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. ,.. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~ 0 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 perjury. I declare thai I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparerotherthan the persona! representative i!3 based on all information Ofw.':Jich preparer has any knowledge.. ..___ ____ _______ ____ .__..____ SIGNATURE OF PERSON RESPONSiBLE FOR FILING RETURN APDRESS DATE .. McCulloch 233 Wildwood Lane _J.Jjl3./tJL . NewvilIe, PA 17241__ ---.- -- APDRESS DATE SIGNATURE OF PREPARER--OTHER THAN REPRESENTATlVE--- - ADDRESS- ---.-- ----- -.---.- ----- -- DATE -- Thomas J Ahrens 5521 Carlisle Pike Mechanicsburg, PA 17055 11-/3/D"1- ,. 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 sUIViviog 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent. or a stopparent 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.5. ~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 slbJ1ngs 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. I *' SCHEDULE B I COMMONWEALTHOFPENNSYLVAN~ STOCKS & BONDS . INHERITANCE TAX RETURN ____ RESfDENTDECEOENT __ ___ ___ ~_ ____ _ ______ ESTATE OF -II h - - --jFILE NUMBER--- McCu oc , Jay W 21 _ 02 _ 0779 --- - -- --.....- All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM 1 . -.---- D~SCRIPTION.- ! -~NITVALUE I VALUE AT DATE OF NUMBER. I DEATH 1--l $500~avingsbo~ds,dated06,07,080f19&7 - - - . -S7T ~25.00 2 $1000 savings bonds, dated 9/19&7 I 112& 2,256.00 3 $1000 savings bond dated 2/19&& 1 1122.40 1,122.40 4 $1000 savings bond dated 3119&& 1100.40 1,100.40 5 $1000 savings bonds dated 9119&& and 1/19&9 107&.80 2,157.60 6 $1000 savings Bonds dated 03, 05 of19&9 1057.60 2,115.20 7 ANCB Corporation Stock 21.50' 4,&59.00 I I 1 I I 1 I I 1 I I I I I I I 1 I --- -------- -.-.-- L ...--t' .--- TOTAL (Also enter on line 2, Recapitulation) 15,335.60 *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. COfI.NON'JI/EAl TH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT -.. -- ESTATE OF McCulloch, Jay W I FILE NUMBER 21-02-0779 - ------ - Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ,- ----- ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH -- .- -- - 1 1995 Ford Explorer XL 5,945.00 2 PSECU Share Account (SI) Account # &704363764 4,610.11 3 PSECU (S50) 36 Month Certificate, Account #&704363764 1&,141.52 -- -...-.- ----.....-- 1-- .---- TOTAL (Also enter on Line 5, Recapitulation) 28,696.63 . SCHEDULE G INTER-VIVOS TRANSFERS & , COMMONWEALTH OF PENNSYLVANIA I__ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY -- -., RESIDENT DECEDENT --- - - -- --.- ---- -- ESTATE OF FILE NUMBER McCulloch, Jay W 21 - 02 - 0779 ----- Tllis schedule must be completed and filed if thea.n.swer to any of questions 1 through _4~"lIe 2 is yes. _ I =-ro . I r . DESCRIPTION OF PROPERTY DA EAT % OF ~" r--'---~-"--".'- ~O",". "ro,_~,w,~. ;~~~, NUMBER Attach a copy oflhe deed for real estate VALUE OF A SET . (IF APPUCABLE) . , INTEREST , u '""'""'~,.,~ N.,,". ""'" -, ~i ;" I - '."'; i ,""Ii I l ''''''' W. McCulloch Living Trust 2 Money Market account at Farmers National Bank in name 31,004.&9 100% 31,004.89 of Jay W. McCulloch Living Trust 3 IRA at Farmers National Bank, beneficiary is Jay W. 41,456.&7 100% 41,456.87 i McCulloch Living Trust 4 CD at Farmers national Bank in name of Jay W. McCulloch 26,777.221 100% I 26,777.22 Living Trust 1 Real Estate - Home and land located at 251 Wildwood Laue,1 1 I 5 117,580.001 100% 117,5&0.00 , North Newton Twp., Newville, Cumberland County, PA 1 17241 1 466,220.001 6 Real Estate - Farm located at Wildwood Lane, North 100% 466,220.00 Newton Twp., Newville, Cumberland County, PA 7 1926 Ford 2 door coupe VIN 12544206 transferred within 1 6,500.00 100% 3,000.00 3,500.00 , year of death to Owen H. McCulloch on 4/30102 & Transfer of household items valued at $2&39, within one 2,&39.00 100% 2,&39.00 year of death toOwen H. McCulloch on 4130/02 9 Transfer of household items valued at $2&39, within one 2,&39.00 100% 2,&39.00 0.00 year of death to Hale McCulloch on 4130102 1 2,839.001 10 Transfer of household items valued at $2&39, within one 2,&39.001 100% 0.00 year of death to Neil McCulloch on 4130102 1 1 11 Transfer of household items valued at $2839, within one 2,&39.001 100% 1 2,839.001 0.00 year of death to Ruth Roller on 4130/02 1 I I 1 __1_ 1__ _L_ _ --.-..------ TOTAL (Also enter on line 7, RecaPitUlatio~)t -- 692,621.49 *' I SCHEDULE H I FUNERAL EXPENSES & COMMONWEA\.THO'''NNSYLVAN,^ -.1 D INISTRAT VE COST 1- INHERITANCE TAX RETURN A MIS RESIDENT DECEDENT ~. ----~---._._....__.._. - - --,,-._- ---- -.-" ---- -- -------------.- -- _.~-_.._.-..._-- -----_...-----._-'~ ---- --' ---- -- ---- --- --- ----,,"-- ESTATE OF McCulloch, Jay W I FILE NUMBER 21-02-0779 -...---.---.----.--..----....-..---- -- ---- --- ----~----_...__._- Debts of decedent must be reported on Schedule I. ---..----..--.....--..---..-.-.--..-- - - - -- - ~- - --".- N~1J~R 1_ _ _ DESCRIPTION 1.- AMOUNT ---- -..--- --~ ----- ---" .-- ---- A. I FUNERAL EXPENSES: \ 1 Funeral luncheon 250.00 I I \ I \ I B. I ADMINISTRATIVE COSTS: I 15,000.00 1. Personal Representative's Commissions 1 Lynette McCulloch Social Security Number(s) 1 EIN Number of Personal Representative(s): \ 207-60-7356 I Street Address 233 Wildwood Lane I City Newville State ~ Zip 17241 Year(s) Commission paid 2002 I 2. I Attorney's Fees Ahrens Law Offices, P.c. 3,650.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address I City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills I 4&6.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs 1 Estate Notices 162.35 2 P A Inheritance Tax filing ree 15.00 I I Total of Continuation Schedule(s) 1 129.41 _.____L-__...._ _~._ _' _._ -..------.- -_.'._~ - ---,,-- -- --_.-----.----- TOTAL (Also enter on line 9, Recapitulation) 19,692.76 .. I Schedule H i COMMONWEALTH OF PENNSYLVANIA I Funeral Expenses & INHERITANCE TAX RETURN I Administrative Costs continued I RESIDENT DECEDENT -- ~-.~._--._-_..._"._'-"'._-' -- -...--.--....--..--..-..- -.-------'.-' --.- -_..._-~'---' ---' ----- ---- .--- - -- ..- -. ..--...--..------....-.. - ---- ESTATE OF M C]I h J W I FILE NUMBER C u OC, ay . 21-02-0779 3 I Postage ----- - -- - - - - --l-- - - TI.()O - 4 Check fee I 3.00 5 I House maintenance costs I &9.41 I I \ \ I \ I I I I I I I I I I I I ___1__._________.___ _ ___ .__ .1..._ ___._ ____ Page 2 of Schedule H . ~ I SCHEDULE I I ~ I DEBTS OF DECEDENT, MORTGAGE I COMMONWEACTH OF PENNSYLVAN~ I LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DEceOENT I _.._"-m___.__"__'_ __ _....____._.__ --. .-- - -.~.-.----.-~-.._.- ESTATE OF --- - ----- --- -IFILENUMB~ --- -- McCulloch, Jay W 21 _ 02 _ 0779 - --"._-- -' -- .-- -.- - -. .--- -- ---- - .----- -- --'..- -- .---'.-- Include unreimbursed medical expenses. ----- ._..~-.__._-_...._-_.._- --...---- ~--._-' --' --- -"-- -- .._._'-~ ITEM NUMBER DESCRIPTION AMOUNT ---- _.._------_._----._-._~._--_._._- - ------ -- --- 1 Balance on Discover credit card, purchases prior to death, bill received after death 197 .9& 2 Dr. Dennis Burkett, dental bill for work performed prior to death 290.40 3 PP&L - electric bill 44.24 4 Presbyterian Homes - final nursing home bill 913.50 5 Carolyne Potter, work performed prior to death 120.00 6 Register of wills of Cumberland County - final bill for estate of Blanche McCulloch 1 &4.20 7 Agway bill 22.40 _..______ _.___".___._____m___ __ ._.___'___.._ .___.____ TOTAL (Also enter on Line 10, Recapitulation) 1,772.72 REV-'''''''''''') *' I SCHEDULE J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN _..__,_ RESIDENT DECEDENT_ _1__._____..__._._ ___ _ ___._____ __._ _____ ESTATEOF----- ------- --- IFiLENUMBER------ McCulloch, Jay W I 21 _ 02 _ 0779 - NUMBERt_-~AME AND ADDRESS OFPERSON(S) RECEIVING PROPERTY ~ r R:.~~~~E~::-l A~Og~~~:"~~ARE _ I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) I I I JAY W. MCCULLOCH LIVING TRUST, dated March 12,2001 I Trust 1100% I I I I I I I I I I I I I I \ I I I I I I I I I I Enter dollar amounts for distributions shown above on Jines 15 through 18, as appropriate, on Rev 1500 cover sheet II. [NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNOER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I I I I I I I \ I I I lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I I I 1 I I I I I . \ I I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI _______.__________.______._ _____ .__ ___ _1.._______ cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 AHRENS THOMAS J ESQUIRE 5521 CARLISLE PIKE MECHANICSBURG, PA 17050 RE: Estate of MCCULLOCH JAY W File Number: 2002-00779 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after Jul y 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/16/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge J Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 MCCULLOCH LYNETTE 233 WILDWOOD LANE NEWVILLE, PA 17241 RE: Estate of MCCULLOCH JAY W File Number: 2002-00779 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2 ) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/16/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge cJ REGISTER OF WILLS OF CUMBERLAND COUNTY COMMONWEALTH OF PENNSYLVANIA IN RE: ESTATE OF Jay W. McCulloch * NO. 2002-0779 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jay W. McCulloch Date of Death: August 16, 2002 Will No.: 2002-0779 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes _ No X 2. Ifthe answer is No, stpte when the personal representative reasonably believes that the administration will be complete: ~ (;pr€mbpr{ :,0, 2-00'1 J 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No - 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 - No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to this report. /f/ 1L-- Date: g-IJ-04 . Signature Thomas J. Ahrens, J.D. Name (Please type or print) 5521 Carlisle Pike Vel ' rq iP!!~qUI!\:) Mechanicsburg, PAl 7050 U"3,~ Address < vO. (717) 697-1800 fZ: Zd f l 9ntl Telephone No. Capacity: _ Personal Representative ~ Counsel for Personal Representative STATUS REPORT IND , R R 1 I I F (, t ~ N:unc of Decedent : t J Date of Dcalh : ~-~~- 2 ovZ CslateNwubcr: 02 - n 79 L~'C~ Pursuant to Rulc G.12 of the Supreme Court Orph:uts' Cow•t Rules, I report Ibe. following with respect to completion of the admiuistratimt of the above-captioned estate: 1. 5lale whetheyaJwiuislraliun of the eslale is cuwplclc: Ycs / _ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be cmuplctc 3. if the answer to No. 1 is Yes, stale the following: A. Did the personal represeuLtliye file a fm•mal final account wi(h the court' Ycs No !3. Did the personal repr~oseulative state au account informally to the parties iu interest? Ycs t/ No C. Did the personal representative file approvals of the accouol, receipts, joinders :ut<I releases with the Icrlc of Orphans' Court? 1'cs No D. Did the personal representative couytlclc final distribution? 1'es / No Date : ~' / ~ ~ O,5 .: o c ; Cap~eity ~ ~,•_ Personal Representative C' G ~ , ,, i. ,_. r_ -- ' Couuscl fm• Personal r , ~ ', - Represculativc ~,~~ ~_ ~.~ C~=_' ~~_ ~--; ( J Signature ,/ II Na yyio! .>I4 I~I~.Chv ,l Namc (Please type or print~ SSz~ Crv,~~,s/~e ~',/c'~ /~1~CIlA tti eC~btl'2/- /~~ J-7QS II Address t7i7~ ~r7~ Iga~ 'Pclephouc Nuwbcr