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HomeMy WebLinkAbout04-0682 PETITION FOR GRANT OF LETTERS Estateof FrederickW. House No. also known as Deceased Social Security No. 177243048 Rosella J. House Pet,tioner(s), w~o mare 1 $ years of age or cider appiy)les) !or (COMPLETE "A" OR "B" BELOW:) A Probate and Grant of Letters and a~wr-that Petitioner(s) is/are the execut [] Deceden , dated ~/"/~, ~ b? 2~,~ ~I ~.~-~ and codicil(s dated ~ narr~ in the: Last Will of the State relevant circumstances e g renunciation, dea~ of executor~c ~ Except as follows Decedent did not marry, was not divorced and did not have a child born or adopted after exeoutlolq Of t[tl~documents offered for probate: was not the victim of a kdllng and was never adiudioated incapacitated: B. Grant of Letters of Administration (cra d b n c t a pendente lite durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES;) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 815W. KellerSt,Mechanicsburg, PA 17055 (list streel number and municipality) Decedent, then 74 years of age, died June 26 2004 , at Manor care, Chambersburg, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property $ ~' - ~ ~ ' (if not domiciled in PA Personal property in Pennsylvania $. (if not domiciled in PA Personal property in County VDILJD Of real estate in Pennsylvama S. Total $ Real Estate situated as follows Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters the appropriate form to the undersigned: Signature Typed or printed name and residence Rosella J. House 315 W. Keller St., Mechanicsburg, PA 17055 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this_ L _T day of / DECREE OF REGISTER Estate of Fr¢¢¢rick W. House also known as Deceased No. Social Security No: 177243048 Date of Death: 6/26/2004 AND NOW, ..~[..( L ~ Z. I ~/. ~.~L~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary [~ of Administration ((cra, dbnct; pendente lite; durance absentia; durante minoriate) are hereby granted to Rosella J. House in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. Letters .......................... $ '/-''~ ~ /'') ' ~'~' ~'~'J~ L~ ~,~- ~J~- ~' ~-- ~ ~-/'- ~/' ~,,' '~,I -,r--~,, ~1 Short Certificates(s) ............$ Renunciation .................... $ Extra Pages ( ~ ) .......... $ S I.T R $ JCP Fee $ Inventory ......................... $ Other ~ TOTAL ............. Attorney: John D. Grigsb¥ 61212 I.D. Ne: Address: 101 S Market Street Mechanicsburg Telephone: 717 796 6537 PA 17055 DATE FILED: ERTIFICATE OF DEATH Franklin 815 Wes Ke er Street Mechanicsburg, Pa 17055 LAST WILL AND TESTAMENT b3E iT RE[~iHBERED ?HAi' I , FREDERICK ', . H'OESE, a residen~ of Cumberla~ Pennsylvania, being el sound and ¢isposin~ mind, rr~uozy ~nd do make, pshlish and declare this to b~ ' ~q WII,I. and TEa~n}4EN~, here}oy ~evoking any and all Wills and Codicils orevicusi¥ mace by me. ~..a~ am marzied z,e RC, SELLA J. HOUSE, and tha~ I nave ere ,i!;: child, namely KAREN LADAWN VASILIADIS, and {1) one step chi],t narnely NOBERi STRAYER. An! references in this Will to my .~.:l~,~er zns£uae n.3. E only the aoeve children, but any childrer hereafhe~ bern ho er adopted by r:te. !_ d_z~,_ that a_± my fiusl debts and funeral expenses shall be oain zzom my residuary eszate as seen as practicable after my aeoesse. i oizect %:taz all taxes that may be assessed in consequence ?f xy death, s.f whatever nazure and by whatever 2urisdio%ion imposed, shall £:e paid ; ~, .... my residuary estate as a pare ef %he ~on~r lat.~z.~r. (if my estate iV ! give, tevise and ~equeath all my property, whether rea_ or pets©hal, wherever s~tuaie, insiuding any property over which I nay have a powe~ {if appoinlmenl to my wife, ROSELLA J. HOUSE prey_dod th~i s~e su!v!ves :::e by ~hirty (30) days. V If my wife, ROSNRRA J. HOUSE shall predecease er fail %o survive me by ~n~r~y {30} days, I give, devise anl bequeath all of my proper~y, whe~he~ real or personal, wherever situate, including any property ever which i may have a power of appointme~i, to my children, KAREN LADAWN VASILIADiS and ROBERT' STRAYER, and any olhel children i m~ have, in equal shares, eer s~irees. VI ane appoin~ my wife, ROSELLA j. HOUSE, WILL, to serve without bond. If my wife %o act in ~hal capacity, then ~ neminale, as Executrix of this hAST · s unsblo e~ unwilling sonsui%u~e ani appoin% my daughter, FAREN LADAWN VASIL!ADiS, as Executrix of this LASI' WI~I~, io serve without bond. if KAREN LADAWN VASILiADIS is unable or nlwil!ing to ac% in zhat capacity, ~hen ne:~ina~e, cons~itule and appoin% my step son, ROBERT SI'hAYER , as Rxec_:ter of ~h!s LAST WILL, ~e serve without bond. :.~,~E ~K ,~. H~USm, have sez my hand 1N WITNESS NHEr~E'.3F, , this LAST N!LL this 6t' da}' of April, 2004. Signe!, FREDERICK W. presence of %he presence WlZlesses. FREDERICK W. H~SE seeiee, pus~ished and declared sy the above-named I!OUSE, as ani for his Las! Will and Tes~amen%, in ihe us, who, al his reques~ and in his presence, and irt of eech (it}leK, }lave hereunto subscribed our names as ACKNOWLEDGEMENT ~b~b,T~ C~ CUMBERLAND SS. !, FRBDER~CK W. HOUSE, Testator, whose name is signed tc the attached or £osegeing instrument, having been duly qmalified ascertinG lc ]aw, do hereby as~nowledge that ! signed and executed the instr~men~ as my LAST WILL; thal I signe~ it as my free and vo_untary ac% for the purposes therein expressed. Sworn HOUSE, ~~.~USE~ or afiirme~ ~c ant acknowledged before me by FNEDERiCK .W. Testalor, lh~s 6=r: day of April, 2004. lorarv AFFIDAVIT SS. signed ,.o ihe a~%a,2hei e_ £oregein~ ir s~sxJrr,enE £;eirG tc!y quai{ fled acceriin%l ~o law, do depose and ~. ~ ~.re~ n~ Testa~cr sion and exec:ule l:ls%rume} r ~:~ his R~.ol WILL; thal FREDERISK W HOUSB -' ' ' wiiiinql} ~ni that he execuled il as his free ani voluntary ace for ~he pk~rposes therein expressed; ~ha~ each of us in the heazing and sigh~ of ~he T'estaler signed the Will as witnesses; and inat ~o irle 8esi ef ou~ knowledge, ihe ?esla~or was at ~ne lime 18 years of age or --o~e, cf sound mind and unde~ no coRslrain% er uxcue inf~uense. !firmed shis 6::~ dav cf April, 2004. to and acknowledged before me Notazy Pab!ic Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 GRISBY JOHN 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055 RE: Estate of HOUSE FREDERICK W File Number: 2004-00682 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 10/31/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, GLENDA F2RNER Clerk of the Orphans' Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 HOUSE ROSELLA J 815 W KELLER STREET MECHANICSBURG, PA 17055 RE: Estate of HOUSE FREDERICK W File Number: 2004-00682 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 10/31/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, GLENDA FARNER S~ Clerk of the Orphans' Court Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(ti) Frederick W. House Date of Death: June 26, 2004 Will No. Admin. No. 2004-00682 To the Register: I certify that notice of (beneficial interest) ~ 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 10 / 01/2004 . Name Address Rosella J. }Iouse 815 W. Keller St., Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except_. Date: 10/12/2004 Name John D. Grigsby, Esq. Address 101 S. Market St. Mechanicsburg, PA 17055 Telephone( ) 717-796-6537 Capacity:. Personal Representative _ x Counsel for personal representative BUREAU OF. INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT,. 280601 HARRISBURG, PA 171Z8-0601 COHNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-I~,~7 EX AFP C61-0S) DEBRA K WALLET D K WALLET LAW OFFICES Zq N $2ND ST CAHP HILL PA 17011 DATE 09-20-Z00~ ESTATE OF ROBINSON DATE OF DEATH 07-2~-2005 FILE NUNBER Z1 05-0682 COUNTY CUHBERLAND ACN 101 Aaount ReaL*ted GERTRUDE S HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF CUNBERLAND CO~3URT I~:~USE CARLISLE, PA F'~01~ ~::, : CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ , ' DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF ROBINSON GERTRUDE S FILE NO. 21 03-0682 ACN. 101 DATE "09'20-Z00~ TAX RETURN NAS: ( ) ACCEPTED AS FILED {X) CHANGED SEE~TAC~ED~=.~NOTICE_ RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE ,/" "~ APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Nortgages/Notes Receivable (Schedule D) (q) .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this fora with your 5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return .00 tax payment. lIZ95.$~ .O0 (8) 555.00 $10Z9.R9 (11) (12) 13. lq. NOTE: ASSESSHENT OF TAX: 15. Aaount of Line lq at Spousal rata 16. Aaount of Line lq taxable at Lineal/Class A re~e 17. Aaount of Line lq at Sibling rate 18. Aaount of Line lq taxable at Collateral/Class B rate 19. Princlpel Tax Due TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) Charitable/Govarnaental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Sub~ect to Tax Zf an assessment ~as lssued previously, lines 1~, 15 and/er 16, 17, reflect figures that include the total ef ALL returns assessed to date. 1,295.3q 2,289.15- IF PAID AFTER DATE ZNDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 Z,289.15- 18 and 19 wlll (15) .00 x O0 = .00 (16), .00 x 0,~.5 = . O0 (17), .00 x 12 = .00 (18), .00 X 15 = .00 (19)= . O0 ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on er before December 12, 1982 -- if any futura interest in the estate is transferred in possession or anSoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CommonNaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the 1aclu1 Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: RBGZSTER OF MILLS, AGENT A refund of a tax credit, ~hich ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Mills, any of ire 23 Revenue District Offices, or by calling the special 2q-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers ~ith special hearing and / or speaking needs: 1-SO0-qq7-30ZO (TT only). Any party in interest not satisfied eith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sho~n on this Notice must object ~ithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ~riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601j Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allo~ed. The 1S7. tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent par annum calculated at a daily rate of .00016q. A11 taxes ~hich became delinquent on and after January 1, 1982 will bear interest at a rate ~hich will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor 1982 207. .0005q8 1986-1991 llZ .000301 1983 167. .000~38 1992 97. . OOOZ~7 198~, 117. .000301 1993-199q 77. .00019Z 1985 137. .000356 1995-1998 97. .0002q7 1986 107. . O00Z7q 1999 77. .000192 1987 107. .00027~ ZOO0 77. ,000192 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD Daily Year Rate Factor 2001 9X .O00Zq7 2002 6X .00016~ 2003 57. .000137 ZOOq ~X .000110 X NUNBER OF DAYS DEL/NI~UENT X DATLy XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must be calculated. ~EV-1470 EX (6-88) (~ INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 :)ECEDENTS NAME FILE NUMBER Gertrude S Robinson 2103-0682 F~EVIEWED BY A, CN Sandra J Eslinger 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Real estate located outside Pennsylvania is not taxable for Pennsylvania Inheritance Tax A purposes. I 1 The deductions claimed for expenses related to property outside Pennsylvania have been disallowed. Debts secured by property situated outside of Pennsylvania are not allowable for Pennsylvania purposes, unless the secured debt exceeds the value of the property. ROW Page 1 STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND ,PENNSYLVANIA Name of Decedent: FREDERICK W. HOUSE Date of Death: 6/26/2004 File No. 21 -04-00682 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. 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. Did the personal representative file a final account with the Court? YES NO X b. The separate Orphan's 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 of the Orphans' Court and may be attached to this report. r-~ ~ jy~~' \ nature J n D. Grigsby, Esq. Name (Please type or print) 101 S. Market St. Address Mechanicsburg PA 17055 Date: 2/25/2005 ,f'..:,,~., (_.. 717 -796-6537 Tel. No. uA Capacity: Personal Representative X Counsel for personal representative REV-tl500 EX t (6-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT w ~ :.::~(/} u a::.:: wg;u :I: a:g u c.. m c.. <( ~.~ . ~ . \) v OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 0 0 6 82 COuNTYCOoE ---vEA~ - - NuMaER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ Z W o w () w o HOUSE, FREDERICK W. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER 2 0-26- 9 8 4 0 o 3, Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX'INFORMATION SHOULD8E DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN D. GRIGSBY, ESQ. 101 S. MARKET STREET FIRM NAME (If Applicable) z o .... <( ...J ::> !::: a.. <( () w a: 1 Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6, Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) p 17055 06/26/2004 10/10/1929 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST,AND MIDDLE INITIAL) OFFICIAL USE ONLY i ., c ""-, 2,224.00 11,727.00 (8) 7,360.00 (11) (12) (13) (14) z o i= <( ~ ::> a.. ~ o () ~ .... 20. 0 HOUSE, ROSELLA J. [R] 1, Original Return o 4, Limited Estate [R] 6. Decedent Died Testate (Attach copy of Will) o 9, Litigation Proceeds Received o 2, Supplemental Return o 4a, Future Interest Compromise (date of death after 12-12-82) o 7, Decedent Maintained a Living Trust (Attach copy ofTrust) o 10, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) "". " i "...' CD :r":1':" ~ "'*'" _J 13,951.00 7,360.00 6,591.00 6,591.00 I- Z W o Z o c.. (/) w a: a: o u TELEPHONE NUMBER 717-796-6537 MECHANICSBURG 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under See, 9116 (a)(1.2) 6,591.00 X 2-- (15) X _(16) X12 (17) X ,15 (18) (19) 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 d I C Add Dece ents omplete ress: STREET ADDRESS 815 W. KELLER STREET CITY MECHANICSBURG I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C, Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check 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 incorne of the property transferred; ........................................................................... 0 1ZI b. retain the right to designate who shall use the property transferred or its incorne; ........................................ 0 1ZI c. retain a reversionary interest; or ...................................................................................................... 0 1ZI d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1ZI 2, If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?.... ...... ...... .... ............ ...... .................. ........... .... ......... ......... ..... 0 1ZI 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 1ZI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 1SI 0 It 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge, SIGN URE OF PERSON RESPONS BLE FOR FILING RETURN DA E 9 3() Olbo t/ PA 17055 DATE PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. S9116 (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. S9116 (a) (1,1) (ii)]. The statute does not exernpt 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 irnposed 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. s9116(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. S9116(1.2) [72 P.S. s9116(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, s9116(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. "~,.'''.'''''.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HOUSE. FREDERICK W FILE NUMBER 21 04 00682 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 2,224.00 CHECKING ACCOUNT #244380 MEMBERS 1 ST FCU TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,224.00 REV-.1510 EX.. (1-97) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY 00682 ESTATE OF HOUSE FREDERICK W. FILE NUMBER 21 04 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COpy OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) 1. INDIVIDUAL RETIREMENT ACCOUNT 11,727.00 100. 11,727.00 EDWARD JONES TOTAL (Also enter on line 7, Recapitulation) $ 11,727.00 (If more space is needed, insert additional sheets of the same size) '"""."',,.,,"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HOUSE FREDERICK W FILE NUMBER 21 04 00682 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 7,360.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6 T ax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 7,360.00 (If more space is needed, insert additional sheets of the same size) ./ lVIyers Funeral Ho'me, Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 (717) 766-342\ Fax (717) 795-7291 A standard of excellence in Central Pennsylvania since 191 () . Tuesday, June 29, 2004 Mrs. Rosella J. House 815 West Keller Street Mechanicsburg, Pa. 17055 Dear Mrs. House, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the seiVicecharges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Frederick W. (Freddie) House SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED LESS: Credits granted LESS: Total Payments CURRENT BALANCE $9,029.12 1,669.12 7,360.00 $0.00 Credits Granted: $74.12 Early Pay $1,595.0 Package Price Discount If IhO'~;:rY quos lions or concorns lhal ,omoln unanswored, ploose can me, t!~,L ' nO ..... ~ ~ ~ :Om cr. ~8 ~() E $[0. I, FREDERICK W. HOUSE, a resident of cuJi;~Tlcl.Ira Co~~y, o.~~ N 00 ~ ~;~,. -- ~.... ~ Pennsylvania, being of sound and' disposing mi1ii~t, ~ory~~rid - t. 0 -- o (/)0 understanding, do make, publish and declare thisiio ~ my LAsT LAST WILL AND TESTAMENT BE IT REMEMBERtD THAT WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to ROSELLA J. HOUSE, and that I have one (1) 'child, namely KAREN LADAWN VASILIADIS, and (1) one step child namely ROBERT STRAYER. All references in this Will to my children include not only the above children, but any children hereafter born to or adopted by me. II I direct that all my just debts and funerpl expenses shall be paid froin my residuary estate as soon as practicable after my 'decease. III I direct that all taxes that may be assessed in consequence of my death~ of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and b-equeath all my property, whether real or personal, wherever situate, including any property O'\ler which I may have a power of appointment to my wife, ROSELLA J. HOUSE provided that she survives me by thirty (30) days. V If my wife, ROSELLA J. HOUSE shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, to my children, KAREN LADAWN VASILIADIS and ROBERT STRAYER, and any other children I may have, in equal shares, per stirpes. VI I nominate, constitute and appoint my wife, ROSELLA J. HOUSE, as Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, - constitute and appoint my daughter, KAREN LADAWN VASILIADIS, as Executrix of this LAST WILL, to serve without bond. I f KAREN LADAWN VASILIADIS is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my step son, ROBERT STRAYER , as Executor of this LAST WILL, to serve without bond. for the purposes therein expressed; that each of us in the hearing and sight _of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. -(~f:~~/ ~ Vv1~ Sworn or affirmed to and acknowledged before me this 6th day of April, 2004. ~c6 .- ((le( Notary P blic {;- 7 - 0 y ~ - 0- ,{; f/-A-; C f (0 cc J--r- 01- 0. t;;~ ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, FREDERICK W. HOUSE, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. ~J\on~, ~ ~ FREDERICK W. . OUSE Sworn or affirmed to and acknowledged before me by FREDERICK W. HOUSE, Testator, this 6th day of April, 2004. /~c Nota<ry Jlblic ~V>L'I If "dCO/(( O'61-'CL.lf?(>L.<uL~ O,,/) .C.~ Li- ~ ') 11 (lt~( - - AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA S5. COUNTY :F CUMBERLAND :nd ~~ the witnesses whos names ar signed'to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that FREDERICK W. HOUSE signed willingly and that he executed it as his free and voluntary act IN WITNESS WHEREOF, I, FREDERICK W. HOUSE, have set my hand to this LAST WILL this 6th day of April, 2004. ~u:~ FREDERICK W. HOUSE Signed, FREDERICK W. presence of the presence witnesses. sealed, published and declared by the above-named HOUSE, as and for his Last Will and Testament, in the us, who, at his request and in his presence, and in of each other, have hereunto subscribed our names as ~ -~~ ~~ ~, ~ BUREAU OF INDIVIDUALrTAllES: INtERITANCE TAX DIVISl'ON.'~l ,Ie PO BOX 280601_-<. HARRISBURG PA l11Z8-06DI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE DR DISALLOWANCE OF DEOlICTIDNS AND ASSESSHENT OF TAX .....nr,.../.'li'l cO '''i'O 'j;'; /1 LuY'v ."ll "- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-23-2005 HOUSE 06-26-2004 21 04-0682 CUMBERLAND 101 Pi'i 12: ";0 C' E[ll( nc '- 1".,-,_.-; ~P' "N'" IV\, :"T JOHN D . ~t~~~~~:<U 101 S M Rn ST "'. MECHANICSBURG PA 17055 A.oW1t R...i tted *' REV-1547 EX AFP (03-05) FREDERICK W 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 ~ UV-"MI;,."ft."'Wm~'1M'.'lltJtm.!II!'.!wtA'rfIM!r.m.lWllTftfl\'m'~.'X'C[!I\l'JlM!r.llTt.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOUSE FREDERICK W FILE NO. 21 04-0682 ACN 101 DATE 05-23-2005 TAX RETURN liAS: I X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Est.t. (Schedule A) 2. stocks and Bonds (Schedule 8) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedul. E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8 . Total Assets IlJ (2) (3) 1'0) (5) (6) (7) .00 .00 .00 .00 2.224.00 .00 11.727.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. ExPenses (Schedule H) 10. Dobts/Hortgag. Liobilities/Lions ISch.dule I) II. Total OBductions 12. Net Value of Tax R.turn 13. Ch.ritabl./Gover~ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. N.t Value of Est.te Subject to Tax (9) 110J 7,360.00 .00 Ill) (12) 113J 114J (15) 6,591.00 X 00 = (16) .00 X 045 = (17) .00 X 12 = (18) .00 X 15 = 119J= NOTE: To insure proper credit to your account, sub.it the upper portion of this form with your t_ P8J/1J8l1t. 13,951.00 7.~6n nn 6,591.00 .00 6,591.00 TAX CREDITS. t.} AIllllIHT PAID DATE IIUI1IIER INTEREST/PEN PAID I-J TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN fl, NO PAY"ENT IS RElIUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)