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Home My WebLink About02-0806 DlI-Q}. ~ PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~OBERT Z. WEIDLER also known as , Deceased. To: Register of Wills County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 204 - 03 - 8026 The petition of the undersigned respectfully represents that: Your petitioner, who is18 years of age or older, is the personal representative named in the last will of the above decedent, dated May 23, 1997. Decedent was domiciled at death in EAST PENNSBORO TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, with his last family or principal residence at 46 ERFORD ROAD, CAMP HILL, CUMBERLAND COUNTY, PENNSYLVANIA 17011. Decedent, then 90 years of age, died AUGUST 18, 2002, at BEVERLY HEAL THCARE SERVICES, 46 ERFORD ROAD, CAMP HILL, CUMBERLAND COUNTY, PENNSYLVANIA 17011. 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. 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 situated as follows: TOTAL $ 9,950.00 $ $ $ $ 9.950.00 WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. Jy;flJd~ c. ~~ MELVIN C. SHETRON 1051-D Allendale Road Mechanicsburg, PA 17055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner above-named swears that the statements in the foregoing petition are true and correct to the best of the knowledge of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. '/r;.eMrv a, ~ MELVIN c. SHETRON Sworn to and subscribed before me this 6thlay of September, 2002. /7 -vb. -// Ji- CERTIFICATE OF NOTICE UNDER RULE 5.6{!tl Name of Decedent: ROBERT Z. WEIDLER Date of Death: AUGUST 18, 2002 Will No. 2002 - 00806 Admin. No. 21 - 02 - 0806 To the Register: I certify that notice of beneficial interest or 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 September 12, 2002: Name Address ROSS EUGENE WEIDLER 1173 WINTERTIDE DR HARRISBURG PA 17111 MELVIN C. SHETRON 10510 ALLENDALE RD MECHANICSBURG PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: September 12, 2002 35 East High Stre Carlisle, PA 17013 717 -243-6090 Atty for Estate of ROBERT Z. WEIDLER :"-".1 :....,.1 -:::::; ..~ ~..,'" H105.805 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 Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. 8386628 No. t?Av!(/ TJZ ~~p-- u Local Registrar Fee for this certificate, $2.00 p AUG 2 0 2002. Date ~3 Rev_ 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 1. AGE (LaS! BlfthOav) Ibbert z. Weidler SEX .. Male STATE FILE ~UMBER SOCIAL SECURITY NUMBER NAME Of DECEDENT iF;S1. Mldole. L~) .... Cunberland E. PE>.nnsboro 3.204 - 03 8026 DATE Of DEATH ~Mcnlh. Da~. '''earl ..August 18, 2002 UNDeR 1 YEAR _ Dayo UNDER I DAY DATE OF BlATH BIRTHPLACE IC." ;olr.d PlACE OF DEATH 10'1:.'0' or.." Qf>lt __ ."ee )(1SlfU(.tlf.-"~ on other SlOe. Hour1l M!nut... ,Mor'lh. Uay ANn SLale or fCf"llJl1 Country) HOSPITAL - SUnbury, PA """,oonIO E"""'_..", 0 DCA 0 ~ 1. k CITY. BORO. TWP OF DEATH FACILITY NAME i" r\Ollfl!.NlJll()(\ gll/e Slfeel aM flUmoetl ~:::Iy' 0 90 v... COUNTY OF DEATH DECEDENT'S USU"L OCCUPAJ"1QN (Gi'Jelw1d aI.work done dUring most C~.le~."'9"';""'U"''''ed) Se.rvice Station . 11.. l1b. DECEDENT'S .....L1NG ADORESS (Su.... C"'IlOwn. Slate. lop C_, 46 Erford Road Canp Hill, PA 17011 11. FATHER'S NAME \Flfst Mladle. LaSl) DECEDENT'S ACTUAL RESIDENCE (See Il\$lfl.CbOnS on ocne. Sldel 17.. $1.... MARITAl STATUS. Mamed Ne.,... Ma"Ied, Widowed. llNo<cod (Spec"" l~e.r Marriro 11. 17.:Jet_._......E. eons RACE - Ame"can Indian. Black, White .~ \Specttyl 10. White SURVIVING SPOUSE IU*,..~~mil108ll~) Ie. 17b. Cou Cunberland No, 4ecederif w.d 17,..0 wiltUnKtuallllmlCSof MOTHER'S NAMe tF..st. M'date. Maloen ~name) Did __ Milt. township? ro ..... c..,_ OR PERSON ACTING"S SUCH Blanche 11. INFORf1'1j~.mt:~~~e'.~n; ~sburg, PA 17011 ..... PLACE OF DISPOSITION. Name of Came1aty, C,ematoty Of OU* f>>tace " Unknown" 11. INFORMANT'S NAME (T vs*Prinl. Ross Weidler Ibbert M. Weidler LOCATION. City/Towft, St.le. rIP Code The Old Graveyard 21c. N.....E AND ADORESS OF FACILITY er Funeral LICENSE NUMBER Carlisle, PA 17013 21d. Heme 1903 Mkt St, rn; 7~11 DATE SIGNED (I.IonIh.Dav._' 3b. ':Ie. ~ 1"6' 02- w..S CASE REFERRED TO MEOK;AL EXAMINERlCORONEA? _0 NoXJ .... '1. 27. PART I: Ent., the diseaMS. ~or tom9ticallOl"lS which caused the dealh Do not ani.' lhe mode of dying, such aa c.rdtlic 01 resplratory arrest, shock or Martlailur. L... Otttt one cause on each tiM. p AD{M~Day, Year) -'0 ,O~ H. I AppIe_unare ::::-..= I i PART R: OI....___~.._.but no( f'HUtIing in Iha undaItylng C8UH given in PART I. PROSTATE CANCER DUE 10 lOR AS" CONSEOuENCE on SoquontioIy .. ........... if any, lNdinrg 10 immediate cauM. Ent., UNOERLYIHQ CAUSE lOiHaa or '"IUt'f . IhaIlnlbilledevtrnll rasultlng en oealhl LAST DUE 10 (OR"S "CONSEOUENCE OF), c. DUE TO 100 AS" CONSEOUENCE OF}. WAS"NAUlOPSV PERFORMED? o WERE "UlOPSY FINDINGS AIIlllI..A8LE PRIOR 10 COMPLETION OF CAUse OF DEATH? MANNER OF DEATH DATE Of INJURV IMonItt. Day. 'tear) TIMe OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. ..-", o o Pendtng InWlSligaHon o o o PlACE OF INJURY.AI hom.. farm, $lreal. factory, office M, building, etc. ISpecII'Jl 300. _ 0 NoD Natural Horn..... _0 No Vn 0 NoD &Meido CoWd no<< be detenntned .... 2111. CERTifiER IChed( ani,;, onel .CERTIF'ttNGi PHYSICIAN (Ph'f$ICliIO certrfylf'K) cause 01 death when analhef ptW!.iC.an has prOflOtJnc.ecI decalh ana compleled llem 23) To the ... of my know~. de.th occurred due to the c.,..(.~ end manner.. I.ated. . . . . . . . . . . . . . . . . . . . . . . .,. 'PRONOUNCING AND CEATlfYtNQ PHYSICIAN IPhrSICIdn hott\ Ol'onounerog \.led'" and Cettlf'(lng 10 cause of <Jedlh\ To the.... o' my kno..... d..thoccurr'" ill the Ume, date, o1nct place, .nd due to lhe caU"(I) and manner.. Ilillad DATE SIGNED iUonln, Day. 'tUf) 031. ld. 8/20/02 N....E AND "DDRESS Of' PERSON WHO COlAPLETED CAUse OF DEATH (lle(n27)T~trinl t-NANK A. DELEO D.O. o 3400 DERRY ST HOG 7PA 17111 Ol.- .MEDlCAL ex..MINER/CORONER On the basil of ..amine.ton and/or Investlg.alion, in my opinion, dealh occu-:red allhe time. dale, and place, and due 10 the cause(s) .nd mann... Ilst.ted...........,....................,...,.......................,.,.,..............,..,.,............. 31.. REGISTRAR'S "TURE AND N~' ..."j 4-.(:,~/C.;'~,/ /...... (' "':/ ::':.-l<!.~of...::-~I!.1-.,~ IL-- .- 1/ i? b{l~ 'Ii 33. LAST WILL AND TESTAMENT 21-2002-806 I, ROBERT Z. WEIDLER, of 1051-0 Allendale Road, Mechanicsburg, Cumberland, Pennsylvania 17055 do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. An antique wooden stand to my nephew, Ross Eugene Weidler; and all the B. Rest, residue and remainder to Melvin C. Shetron, or if he be deceased, then to my nephew, Ross Eugene Weidler. 4. I nominate and appoint Melvin C. Shetron to be the personal representative of my estate, to serve without bond. If he cannot or does not serve, then I appoint Ross Eugene Weidler to be the substitute personal representative, also without bond. '. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2'5 ~ay of May, 1997. , .~ 1-' \JJ9P (SEAL) ROBERT Z. WEIDLER Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~, f1~}(M1C/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28060' HARRISBURG. PA 17128-060' REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HAROLD S IRWIN III ESQUIRE 35 EAST HIGH STREET SUITE 201 CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 204-03-8026 FILE NUMBER: 2102-0806 DECEDENT NAME: WEIDLER ROBERT Z DATE OF PAYMENT: 10/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/18/2002 NO. CD 001728 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $306.76 I I I I I I I I TOTAL AMOUNT PAID: $306.76 REMARKS: HAROLD S IRWIN III ESQUIRE CHECK# 6339 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~-1500 EX'(6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG, PA 17128-0601 ~/ RI!Y-1500 INHERITANCI! TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY /1-Y0-// fiLE NUMBEft. DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) WEIDLER, ROBERT Z. DATE OF BIRTH OCTOBER 1, 1911 (IF APPLICABLE) SURVIVING SPOUSE'S NA 21 COUNTY CODE 02 YEAR 0806 NUMBER SOCIAL SECURITY NUMBER 204 - 03 - 8026 DATE OF DEATH AUGUST 18, 2002 E (LA T, FIR T AND MIDDLE INITIAL) OCIAl SECURITY NUMBER 4. limited Estate _ 2, Supplemental Return 3. Remainder Return (dates of death prior to 12-13-82) 5. Federal Estate Tax Return Req l 1. Onginal Return L 6. Decedent Died Testate (Attach copy of Will) EX. A 9. Litigation Proceeds Received 4a. Future Interest Compromise (for dates 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) NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 717-243-6090 1, Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 3, Closely Held Stock/Partnership Interest (Schedule C) 4, Mort9ages and Notes Receivable (Schedule D) 5. Cash, Bank Dep & Mise Personal Property (Schad E) 6, Jointly Owned Property (Schedule F) 7, Transfers I Mise, Property{Schedule G) (Schedule L) 8. Total Gross Assets (total lines '\-7) 9. Funeral Expenses & Administrative Costs (Sched H) 10. Debts, Mortgage Liabilities & Liens (Schedule I) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) 13. Charitable and Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate 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 _ 8, Total No. of Safe Deposit Boxes 11, COMPLETE MAILING ADDRESS 35 EAST HIGH STREET, SUITES 201/202 CARLISLE, PA 17013 (1) OFFICIAL USE ONLY 0.00 (2) 0.00 (3) 0.00 (4) 0,00 (5) 10,007.71 (6) 0,00 (7) 0,00 (8) 10,007.71 (9} 7,855.00 (10) (11) 7,855.00 (12 2,152.71 (13) 0.00 (14) 2,152.71 x, = (15) - 0,00 $ x .045 = (16) x .12 = (17) 0,00 $2,152.71 x .15 = (18) 322.90 (19) 322.90 _'" , ;1 ..l.r~4: ' 1"_'1" ' ( Decedent's Complete Address: STREET ADDRESS 46 ERFORD ROAD CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits I payments A. Spousal Poverty Credit B. Prior Payments C. Discount $16.14 (1) $322.90 Total Credits (A+B+C) (2) $16.14 3. Interest I Penalty if applicable D. 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 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) (5) $306.76 B. Enter the total of Line 5+5A. This is the BALANCE DUE. (5B)$306.76 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 of 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 on or before December 123, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? " .... ... ......................................... ... ....... .... .... 3. Did decedent own an "fn trust tor" 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? ...... No ~ -1L -1L -1L N/A -1L -.2L 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 that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than personal representative is based on an infprmation of which preparer has any knowledge. SIGNATU~F P..ERSON REtIt~ FOR FILING RETURN 'In J.-vrv C , ADDRESS 10510 LENDALE ROAD, MECHANICSBURG PA 17055 Sl E OF PREP ER AN PERSONAL REPRESENTATIVE DATE OCTOBER tJ, 2002 DAlE 35 EAST HIGH STR ET, C RLlSLE, PA 17013 OCTOBER 1'0, 2002 For dates of death on or a er 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. Section 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 (s 0"'/0 (72 P.S. Section 9116 {a){1.1 }(ii}J. 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 stepparent of the child is 0% [72 P.S. Section 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. Section 9116 (1.2)[72 P.S. Section 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. Section 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. REV-1502 EX + (12-85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT Z. WEIDLER 2002 - 0806 (Property jolnlly-ownod wllh Righi of Survivorship musl be disclosed on Schedule F) AU real eslale should be reported al fair markel value which Is deflned as Ihe price al which property would be exchanged between a wIlling buyer and a willing seUer, nellher being compeUed 10 buy or sell, both having reasonable knowledge of the relevant facts. ITEM DESCRIPTION NUMBER SCHEDULE A REAL eSTATE VALUE AT DATE OF DEATH NONE TOTAL (Also enter on line 1, Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) REV-1503 EX + (4-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER (All property jolntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER SCHEDULI! B STOCKS AND BONDS FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Une 2. Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV.1504 EX + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER NONE SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP FILE NUMBER 2002 - 0806 DESCRIPTION VALUE AT DATE OF DEATH TOT L (Also enter on Line 3. Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) REV-1507 EX + (6-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES A,ND NOTES RECEIVABLE ESTATE OF ROBERT Z. WEIDLER (All property jolnlly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH NONE TOTAL (Also enteron Line 4. Recapltulallon) NONE (If more space is needed. insert additional sh9fJts of same size.) REV-1508 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF ROBERT Z. WEIDLER (All property jOlntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH 1. CASH $130.00 2. 3. MYERS - HARNER - Pre-paid Funeral Expenses 6,903.39 ALLFIRST BANK - Money Market Account No. 00941-5836-3 (Value based on bank letter attached as Exhibit UBU) 1,527.02 4. ALLFIRST BANK - Checking Account No. 00894-1553-1 (Value based on bank letter attached as Exhibit UBU). 1,297.30 150.00 5. WOODEN STAND TOTAL (Also enter on Une 5. Recapitulation) $ 10,007.71 (ff more space is needed, insert additional sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 2002 - 0806 Joint ten.nt(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. c. Jointly-owned property. ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECO'S DOLLAR NO. FOR MADE VALUE OJ. INT. VALUE 0 JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST NONE TOTAL (Also enter on Line 6. Recapitulation) NONE (If mom space is needed, insert additional sheets of same size.) REV-151Q EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT Z. WEIDLER 2002 - 0806 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. SCHEDULE! G INTERVIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ITEM DESCRIPTION OF PROPERTY DATE OF NUMBER Include name of the transferee, their relationship to d&C8dent, date of transfer DEATH 'Ie OF EXCLUSION TAXABLE VALUE OF DECD'S (If applicable) VALUE ASSET INTEREST NONE TOTAL (Also enter on Line 7. Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL I!XPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF ROBERT Z. WEIDLER FILE NUMBER 2002 - 0806 ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1. MYERS - HARNER FUNERAL HOME, INC. $ 6,510.00 B. Administrative Costs: 1. Personal Representative Commissions: Social Security Number of Personal Representative:: Year Commissions Paid: 2. Estimated Total Attorney Fees: HAROLD S. IRWIN, III 1,250.00 3. Family Exemption: Claimant Relationship Address of Claimant at decedent's death: Straet Address City Stale Zip Code 4. Probate Fees: REGISTER OF WILLS 60.00 C. Miscellaneous Expenses: 1. REGISTER OF WILLS - File Inventory and Appraisement 25.00 2. HAROLD S. IRWIN, III - Notary Fees 10.00 3. 4. 5. TOTAL $ 7,855.00 (If more space is needed, insert additional sheets of same size.) REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER ITEM NUMBER SCHEDULE I DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS FILE NUMBER 2002 - 0806 DESCRIPTION AMOUNT TOTAL (Also enler on Line 10, Recapitulation) NONE (If more space is needed. insert Bddftional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER SCHEDULE J BENEFICIARIES FILE NUMBER 2002 - 0806 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. ROSS EUGENE WEIDLER NEPHEW WOODEN STAND 1173 WINTERTIDE DR HARRISBURG PA 17111 2. MELVIN C. SHETRON FRIEND 100% RESIDUE 10510 ALLENDALE RD MECHANICSBURG PA 17055 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on Line 13. Recapitulation) $ NONE (If more space is needed, insert additional sheets of same size.) 1.>>' :~~t<, LAST WILL AND TESTAMENT I, ROBERT Z. WEIDLER, of 1051-0 Allendale Road, Mechanicsburg, Cumberland, Pennsylvania 17055 do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. An antique wooden stand to my nephew, Ross Eugene Weidler; and all the B. Rest, residue and remainder to Melvin C. Shetron, or if he be deceased, then to my nephew, Ross Eugene Weidler. 4. I nominate and appoint Melvin C. Shetron to be the personal representative of my estate, to serve without bond. If he cannot or does not serve, then I appoint Ross Eugene Weidler to be the substitute personal representative, also without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this -Z-g ~ay of May, 1997. , . 6lU.1 1- " \JJ ~1 (SEAL) ROBERT Z. WEIDLER Signed, sealed, published and declared by the above-named person as and for a last will and testament in our presence, who at said person's request in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~~~ 1ft_J'}tM1C/ . . ACKNOWLEDGMENT AND AFFIDAVIT WE, ROBERT Z. WEIDLER, GAY L. IRWIN and JOY S. ZERANCE, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. :lc-lJ rf. _ It' ;"(~ ROBE T Z. WEIDLER ~~L GA L R IN /'J COMMONWEALTH OF PENNSYLVANIA :55: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by ROBERT Z. WEIDLER, the testator herein, and subscribed and sworn to before me by GAY L. IRWIN and JOY S. ZERANCE, "''''''", .;,1IT-"'iI"ofM", 1997, c&: Notanal Seal . Notary Public Harold S. Irwin III. Notary Public Carlisle aoro, cun:berland C10unty My Commission Fxpl~ec:: Sept. .4,1998 Member, Pennsylvania A5:;.cuatl9n Ql ~ !l allflrst \l1first Financial Centl'l" :'\j..\. I ) ( ) _ i ~ i l,\ -)t ill September 25,2002 Harold S. Irwin, III Attorney at Law Hitner House, Suites 201 & 202 35 East High Street Carlisle, Pennsylvania 1 701 3 \Iil!,b. >I"P. l)~: : c)l)I'I' RE: Estate of Robert Z. Weidler Date of Death: August 18,2002 Social Security Number: 20H)3-8026 Dear Mr. Irwin: In response to your request, please be advised of the following accounts the above-named decedent had with this bank and the balances on the date of death. 1. Account Type........................... Relationship Checking Account Account Number....................... 0089415531 Owne~hip (Names 00................ Robert Z. Weidler Opening Date........................... 08/28/64 Balance on Date of Death...........$ 1,297.30 Accrued Interest...................... 00.00 Total......................................$ 1,297.30 2. Account Type........................... Money Market Account Account Number....................... 0094158363 Owne~hip (Names 00................ Robert Z. Weidler Opening Date........................... OS/28/84 Balance on Date of Death...........$ 1,525.97 Accrued Interest...................... 1.05 Total......................................$ 1,527.02 Inventory of the real and personal estate of (j/ ROBERT Z. WEIDLER, deceased 1. CASH $ 130 00 2. MYERS - HARNER - Pre-paid Funeral Expenses 6,903 39 3. ALLFIRST BANK- Money Market Account No. 00941-5836-3 (Value based on bank letter attached as Exhibit "B") 1,527 02 4. ALLFIRST BANK - Checking Account No. 00894-1553-1 (Value based on bank letter attached as Exhibit "B"). 1,297 30 5. WOODEN STAND 150 00 ~ TOTAL $ 10,007 71 COMMONWEALTH OF PENNSYLVANIA: :88: COUNTY OF CUMBERLAND MELVIN C. SHETRON, being duly sworn according to law, deposes and says that he is the executor of the estate of ROBERT Z. WEIDLER, late of East Pennsboro Township, Cumberland County, Pennsylvania, deceased, and that the within inventory made by him, the said executor, of the entire estate of said decedent, consisting of all of the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the inventory represent its fair value as of the date of decedent's death. ~~C~~ MELVIN C. SHETRON SWQIl1 to and subscribed before me /5u- day of October, 2002. X Executor NOTAIIIAL SIAL COVLa, BORO 0' CARUSLl!, CUMIlERLANO COUNTY MY COMMISSION ~RES OCTOBER' 1 2002 18 AUGUST 2002 Date of Death: Day Month Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplemental inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. /?-R'6-/4 "v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISE"ENI. AllOWANCE OR DISAllOWANCE t~ OF DEDUCTIONS AND ASSES~ENT OF TAX REY-1541 EX AFP 101-02) HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-02-2002 WEIDLER 08-18-2002 21 02-0806 CUMBERLAND 101 ROBERT z AIIount Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i54-j-E"x-AFP-loY':ozY-NifficE--oF-YNHEifiTANci-TAx-AppRAisEHEN:r;-AL1-owANci-oR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WEIDLER ROBERT Z FILE NO. 21 02-0806 ACN 101 DATE 12-02-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. "ortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 10.007.71 .00 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 10.007.71 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/"isc. 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) UO) 7.855.00 .00 (11) (2) (3) (14) 7.855 00 2.152.71 .00 2.152.71 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. 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. AlIOunt of line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CR I S: NOTE: (9)= .00 .00 .00 322.90 322.90 .00 X .00 X .00 X 2.152.71 X 00 = 045 = 12 = 15 = DATE 10-15-2002 NUMBER CD001728 + INTEREST/PEN PAID (-) 16.15 A"OUNT PAID 306.76 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 322.91 .0ICR .00 .0ICR . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS lESS THAN $1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU "AY BE DUE A REFUND. SEE REVERSE SYDF OF TWT~ IOnPM ~np T....TD"rTTn.... , </' CLAIM AGAINST DECEDENT'S ESTATE CUMBERLAND COUNTY, PENNSYL VANIA FILE NUMBER_21-02-806 ESTATE OF: ROBERT WEIDLER The undersigned hereby presents for filing against the above estate this statement of claim and alleges: BEVERLY ENTERPRISES/DBA CAMP HILL CARE CENTER PO Box 180970 Fort Smith, AR. 72918-0970 The basis of claim is: SEE ATTACHED The amount of the claim is $14,479.55 that is now due and owing. Under penalties ofpetjury, I declare that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief. Signed on January 28, 2003 ~ SANDRA BURNETT I SWEAR THIS STATEMENT IS CORRECT and sworn to before me I'. ' I '.- My Commission Expires BEVERLY ENTERPRISES/DBA CAMP HILL CARE CENTER P. O. BOX 180970 FORT SMITH, AR. 72918-0970 ITEMIZED RESIDENT STATEMENT RESIDENT NAME RESIDENT NUMBER ROBERT WEIDLER 49847-03959-91550 DATE PREPARED STATEMENT TYPE: D INTERIM DISCHARGE Ii] ITEMIZED 1/28/03 5/22-5/31/02 PRIVATE PAY ROOM CHARGE 10 $1,480.60 5/17/02 SYRINGE, LUER SLI 1 $0.44 5/17/02 PROCOJ., QRESSING 2 $29.64 5/17-5/31/02 DFS-3 MATTRESS 11 $150.00 6/1-6/30/02 PRIVATE PAY ROOM CHARGE 30 $4,590.00 6/2-6/30/02 DFS-3 MATTRESS 26 $390.00 LAUNDRY $17.00 7/1-7/31/02 PRIVATE PAY ROOM CHARGE 31 $4,589.86 7/1-7/31/02 DFS-3 MATTRESS 31 $465.00 07/11/02 BARBER AND BEAUTICIAN 1 $8.75 7/22-7/28/02 SYRINGE, LUER SLI 2 $0.88 8/1-8/17/02 PRIVATE PAY ROOM CHARGE 17 $2,487.38 8/1-8/17/02 DFS-3 MATTRESS 18 $270.00 _.--~ ,.~~ -- ,- , I C! ft I ftl\U'1I:; I~ I 1lmE" 1_ $0.00 $14,479.55 $0.00 $14,479.55 '. , 1 It ~~~~~y January 28, 2003 Cumberland County Courthouse Register of Wills 1 Court House Square. Carlisle, PA. 17013 Dear Mr. or Madam: Enclosed please find itemized statement, a claim form and a check in the amount of$5,OO to be used to file a claim against the estate of Robert Weidler, case # 21-02-806. Mr. Weidler incurred this debt while a resident in our facility, Camp Hill Care Center. If you should need additional information or have questions regarding this please feel free to contact me at 479-201-2322 Monday thru Friday from 8:00 to 5:00 PM Central Time. Sincerely, ~o: Corporate Collections encl: cc: Melvin Shelton Harold S. Irwin III, Esquire Client's File P.O. Box 180970 Fort Smith, AR 72918-0970 (SOl) 201-2000.1-(877) 8BEVERLY c:9,f \"\ - 2?Lo - \\ V" REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE 02 YEAR 0806 NUMBER DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER WEIDLER, ROBERT Z. 204 - 03 - 8026 DATE 0 BIRTH DATE OF DEATH OCTOBER 1, 1911 AUGUST 18, 2002 {IF APPUCABl ) SURVIVING POUS 'S NAME (LAST, FIRS AND MlDDL INmAl) socrAL SECURITY NUMBER 1. Original Return L 2. Supplemental Return _ 3. Remainder Return (dates of death prior to 12-13-82) _ 5. Federal Estate Tax Return Req X 6. Decedent Died Testate - (Attach copy of Will) EX. A 9. Litigation Proceeds Received _ 4a. Future Interest Compromise (for dates 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) 4. Limited Estate NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 717-243-6090 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held StocklPartnership Interest (Schedule C) 4. Mort9ages and Notes Receivable (Schedule D) 5. Cash, Bank Dep & Misc Personal Property (Sched E) 6. Jointly Owned Property (Schedule F) 7. Transfers I Misc. Property(Schedule G) (Scheduie l) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Sched H) 10. Debts, Mortgage Liabilities & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate 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 _ 8. Total No. of Safe Deposit Boxes 11. COMPLETE MAiliNG ADDRESS 3S EAST HIGH STREET, SUITES 201/202 CARLISLE, PA 17013 (1) OFFiCIAL USE ONLY 0.00 (2) Q 8 :oil? 0.00 =3 (DO (3) U (1:::', ~: 0.00 i::' '-- (4) n c:: :z: 0.00 I (5) u.J 10,007.71 (6) -0 0.00 N (7) d 0.00 ex:> (8) 10,007.71 (9) 8,161.76 (10) 1,948.96 (11) 10,110.72 (12 2,152.71 (13) 0.00 (14) (103.01) x. - : (15) 0.00 $ x .045 : (16) x .12 : (17) 0.00 $ x .15 = (18) 0.00 (19) Decedent's Complete Address: STREET AOO~t::~S 46 ERFORD ROAD I CITY : CAMP HILL T STATE PA I liP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits '"payments A. Spousal f=loverty Credit B. Prior Payments $306.76 c. Discount (1) $0.00 Total Credits (A+B+C) (2) $306.76 3. Interest / Penalty jf applicable D. Interest E. Penalty Total In'eres~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 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than line 2. enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (SA) (5) $0.00 B. Enter the total of Line 5+5A. This is the BALANCE DUE. (5B)$0.00 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 of 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 on or before December 123,1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred 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 property? ...... No --1L .....1L .....1L .....1L N/A .....1L -L 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 that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than personal reprt::sentative is based on all information of which preparer has any knowledge. SIGNATURE %: PERSON RESPONSIBLE FOR FILING RETURN '7'11 "' ).I. 'rv C 1"-l11l~ ADDRESS 10510 AL SIG T DATE MARCtlt 7 . 2003 AD DATE 35 EAST HIGH STREET, MARCH , 2003 For dates of death on or after J 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. Section 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 _5. Section 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 ;s the only beneficiary. For dates of death on or after July 1. 2000: The tax rare 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. Section 9116 (a)(1.2)1, 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. Section 9116 (1.2)(72 P.S. Section 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. Section 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. REV-1502 EX + <12-85) ,.i"''i;y''"", ., "",,,,- ...~~ ~!!lo'fi""..."~ ~~''''~~l'',~i' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT Z. WEIDLER 2002 - 0806 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price 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. ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 1, Recapitulation) NONE (If mom space is needed, insert additional sheets of same size.) REV-1503 EX + (4-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER (All property jolntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER SCHEDULE B STOCKS AND BONDS FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 2. Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) REV-1504 EX + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER ITEM NUMBER NONE SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP FILE NUMBER 2002 - 0806 DESCRIPTION TOTAL (Also enter on Una 3. Recapitulation) (If morn space is needed, insert additional sheets of same size.) VALUE AT DATE OF DEATH NONE REV-1507 EX + (6-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE! ESTATE OF ROBERT Z. WEIDLER (All propertY jolntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Une 4, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1508 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF ROBERT Z. WEIDLER (All property jolntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2002 - 0806 VALUE AT DATE OF DEATH 1. CASH $130.00 2. MYERS - HARNER - Pre-paid Funeral Expenses 3. ALLFIRST 8ANK - Money Market Account No. 00941-5836-3 (Value based on bank letter attached as Exhibit "8") 4. ALLFIRST 8ANK - Checking Account No. 00894-1553-1 (Value based on bank letter attached as Exhibit "8"). 5. WOODEN STAND 6,903.39 1,527.02 1,297.30 150.00 TOTAL (Also enter on Line 5, Recapitulation) $ 10,007.71 (If more space is needed, insert additional sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 2002 - 0806 Joinllenanl(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jointly-owned property: iTEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECO'S DOLLAR NO. FOR MADE VALUE % INT. VALUE 0 JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST NONE TOTAL (Also enter on Line 6, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT Z. WEIDLER 2002 - 0806 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. SCHEDULE G INTERVIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ITEM DESCRIPTION OF PROPERTY DATE OF NUMBER Include name of/he transferee. tMir relatiOnship to decedent, date of transfer DEATH Of. OF EXCLUSION TAXABLE VALUE OF DECO'S (If applicable) VALUE ASSET INTEREST NONE TOTAL (Also enter on Line 7, Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) REV-1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF ROBERT Z. WEIDLER FILE NUMBER 2002 - 0806 ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1. MYERS - HARNER FUNERAL HOME, INC. $ 6,510.00 B. Administrative Costs: 1. Personal Representative Commissions: Social Security Number of Personal Representative:: Year Commissions Paid: 2. Estimated Total Attorney Fees: HAROLD S. IRWIN, III 1,541.76 3. Family Exemption: Claimant Relationship Address of Claimant at decedent's death: Street Address City State Zip Code 4. Probate Fees: REGISTER OF WILLS 60.00 C. Miscellaneous Expenses: 1. REGISTER OF WILLS. File Inventory and Appraisement 40.00 2. HAROLD S. IRWIN, III . Notary Fees 10.00 3. 4. 5. TOTAL $ 8,161.76 (If more space is needed. insert additional sheets of same size.) REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER ITEM NUMBER SCHEDULE I DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS FILE NUMBER 2002 - 0806 DESCRIPTION AMOUNT 1. BEVERLY ENTERPRISES - Nursing Home Bill $1,948.96 TOTAL (Also enteron Line 10. Recapitulation) $1,948.96 (If more space is needed, insert additional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT Z. WEIDLER SCHEDULE oJ BENEFICIARIES FILE NUMBER 2002 - 0806 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. ROSS EUGENE WEIDLER NEPHEW WOODEN STAND 1173 WINTERTIDE DR HARRISBURG PA 17111 2. MELVIN C. SHETRON FRIEND 100% RESIDUE 10510 ALLENDALE RD MECHANICSBURG PA 17055 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enler on Une13. RecapilulaUon) $ NONE (If more space is needed. insert additional sheets of same size.) LAST WILL AND TESTAMENT I, ROBERT Z. WEIDLER, of 1051-0 Allendale Road, Mechanicsburg, Cumberland, Pennsylvania 17055 do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. An antique wooden stand to my nephew, Ross Eugene Weidler; and all the B. Rest, residue and remainder to Melvin C. Shetron, or if he be deceased, then to my nephew, Ross Eugene Weidler. 4. I nominate and appoint Melvin C. Shetron to be the personal representative of my estate, to serve without bond. If he cannot or does not serve, then I appoint Ross Eugene Weidler to be the substitute personal representative, also without bond. !l allnrst \llfint hn.lOd.d (:~'nll'l. '\. \. ~) () : ~ ( ,"\ I ( 'I ' September 25, 2002 Harold S. Irwin, III Attorney at Law Hitner House, Suites 201 & 202 35 East High Street Carlisle, Pennsylvania 1 701 3 \ II !~~h, ,r< '. : l f: : "\)1'" RE: Estate of Robert Z. Weidler Date of Death: August] 8, 2002 Social Security Number: 204-03-8026 Dear Mr. Irwin: In response to your request, please be advised of the follOwing accounts the above-named decedent had with this bank and the balances on the date of death. ]. Account Type........................... Relationship Checking Account Account Number....................... 008941553] Ownership (Names of)................ Robert Z. Weidler Opening Date........................... 08/28/64 Balance on Date of Death........... $ 1,297.30 Accrued Interest....................... 00.00 TotaL........................ ........ .... $ 1,297.30 2. Account Type........................... Money Market Account Account Number....................... 0094158363 Ownership (Names 01)................ Robert Z. Weidler Opening Date........................... OS/28/84 Balance on Date of Death...........$ 1,525.97 Accrued Interest....................... 1.05 TotaL...... ...... ........ ................ $ 1,527.02 //}- ?i.- / I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES , INHERITANCE TAX DIVISION V DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1541 EX AFP 101-D5I RecorC1~ :1 Re~~i~S-" DATE ESTATE OF DATE OF DEATH FILE NUMBER A 7 :5 9 COUNTY ACN 06-30-2003 WEIDLER 08-18-2002 21 02-0806 CUMBERLAND 101 ROBERT z HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE III '03 JUN 30 Allount Relli Ued Cler: PA 170~lTlbCii;jr 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 ~ REY=is4-j-ix-AFP--('oY:oiY-NOY-ici--OF-YtiHiififAifCE-YAX-APPRAisiifENT~--AL1-oWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WEIDLER ROBERT Z FILE NO. 21 02-0806 ACN 101 DATE 06-30-2003 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE 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 subllit 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. Charitab1e/Governllenta1 Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 291. 76 1.948.96 (11) (12) (13) (14) 2.240 72 2,240.72- .00 88.01- I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. 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 NOTE: .00 X .00 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 .00 .00 .00 .00 TAX CREDITS: ..~-~~. . l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-15-2002 CDOOl728 .00 306.76 TOTAL TAX CREDIT 306.76 BALANCE OF TAX DUE 306.76CR INTEREST AND PEN. .00 TOTAL DUE 306.76CR . 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.) REV-1470 EX (6-88) * INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Weidler, Robert Z. 2102-0806 REVIEWED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H Accepted additional expenses. I Accepted additional debt. ROW Page 1 (?-?b - pI ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE 1 II DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN III '* REV-1U7 EX AFP 111-031 10-27-2003 WEIDLER 08-18-2002 21 02-0806 CUMBERLAND 101 ROBERT z Allount Rellitted PA 17',qp MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'ifj-E3r-AFP--foY=o3Y------...--iNifERITANc'E--TA3r-STAfEM'E-N'T-OF'-ACCoui.ff--.-i.---------------- ----- ESTATE OF WEIDLER ROBERT Z FILE NO. 21 02-0806 ACN 101 DATE 10-27-2003 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A SU"MARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-30-2003 PR I NC I PAL TAX DUE: ................................................................................................................................................................................ ........................................... PAYMENTS (TAX CREDITS): .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-15-2002 CDOO1728 .00 306.76 10-08-2003 REFUND .00 306.76- TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE 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. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent · ROBERT Z. WEIDLER Date of Death' 8/18/2002 Will No. 2002 - 00806 Admin. No. 2102 - 0806 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: 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. 1 is Yes, state the following: a o 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: N/A 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. Date: 7/12/2004 HAROLD S. IRWIN, III . Name (Please type or print 64 SOUTH PITT STREET CARLISLE PA 1701 Address ( 717 ) - 2436090 Tel. No. Capacity Personal Representative X Counsel for personal representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 IRWIN HAROLD S III 64 SOUTH PITT STREET CARLISLE, PA 17013 RE: Estate of WEIDLER ROBERT Z File Number: 2002-00806 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: 8/18/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS CC: File Personal Representative(s) Judge Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 SHETRON MELVIN C 1051-D ALLENDALE ROAD MECHANICSBURG, PA 17055 RE: Estate of WEIDLER ROBERT Z File Number: 2002-00806 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: 8/18/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge