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HomeMy WebLinkAbout03-0049PETITION FOR PROBATE and GRANT OF LETTERS Estate of' ..-~er~ · ~. ~ t ~-~__ No. also known as~/-[, lt~l~LOT'T~ ~ ~'IT'7__ To: Social Security No..I F_ 9 - I ~- ~ ~eceased. Register of Wills for the County of ~ tt.~£/.t~/ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executo E~ in the last wilt of the above decedent, dated /9'/~P',e/4 _~ ~' and codicil(s) dated in the named ,19 ~-- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in tt~ t,&t~/~,e,' L/Fn/O _ County, Pennsylvania, with last'family or principal residence at (list street, number and muncipality) Decendent, then Except as follows, decedent did not marry, was not d~vorced and did not have a child born or adopted after execution of the will offereO for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent 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: $':1 8'00. o o $ $ $ WHEREFORE, petitioner(s) respectfully req.uest(s), the probgte of the last will and codicil(s) presented herewith and the grant of letters ---fi~/'~-/~l~n-/~ ~Te theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland) SS The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and~ruly administer the estate according to law. Sworn to or affirmed and subscribed ~,~f~~ before me this 17th day of~ ~:~-~'[~j.2~ ~' Donna bl Otto, 1st D~. ut ~ ' .... ' -- / 7-// 1%]'0. 21-20u3-49 Estate Of I~T~ C. SEITZ,aka , Deceased CHAR~ I. STEIZ DECREE' OF PROBATE AND GRANT OF LETTERS AND NOW January 17tn, X4Z_2D..Q3, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 28th. 1995 described therein be admitted to probate and filed of record as the last will of IRENE C. SEITZ, aka CHAR~ I. SEITZ -; and Letters TESTAMENWA RV are hereby granted to LIN-DA A. I~CAFFERY AND JAMES B, $EITZ FEES Probate, Letters, Etc. $ 40.00 Short Certificates(2 ) .......... $ 6.00 Renunciation ................ $ 6.00 x-Pages ( 2 ) $10. JCP TOTAL Filed . .q.~..u...a_,~...!7. t..h:.2.0.03 DONNA M. OTTO, iST DEPUTY ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE MAILED LEGG~RS TO LINDA A. MCCAFFERY, EXECUTRIX ON 1-17-03 21-2003-49 SAIl)IS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA LAST WILL AND TESTAMENT OF IRENE C. SEITZ also known as CHARLOTTE I. SEITZ I, IRENE C. SEITZ, also known as CHARLOTTE I. SEITZ, of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I bequeath my automobile to my daughter, Linda A. McCaffery. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto my children, Linda A. McCaffery and James B. Seitz. Should my said son predecease me, his share of the residue shall be paid to Kathryn Seitz provided she was his widow at the time of his death or, if she was not his widow, to his children per stirpes. Should my said daughter Linda predecease me, her share shall be paid to her children per stirpes. Page 1 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA IV - I appoint my children, Linda A. McCaffery and James B. Seitz, Executors of this, my Last Will and Testament. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the ~ day of ~' ~ ~ / , 1995. , ~ (SEAL) Irene C. Seftz ~/ Also known as: ~ Charlotte I.-Seit~ ~- Signed, sealed, published and declared by IRENE C. SEITZ, also known as CHARLOTTE I. SEITZ, Testatrix therein named, on this and one (1) other sheet of paper as and for her Last Will and Testa- ment, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address- ? ' Addre s s Page 2 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA COMMONWEALTH OF PENNSYLVANIA) : COUNTY OF CUMBERLAND ) SS. WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by the testatrix, and subscribed and sworn to before me by both wit- nesses, this 28 ~ day of /~eM , 1995. ~tary Public NOTARIAL S~L THELMA S. McCAUSLIN, Notary Public Camp Hill, Cumb?an~, ,Co.u?..,.,. My Commissior'., E×p. es ,~u~y ~,/~ .-o ~0 ~ '=11 o COMMON~VEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 LU REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR)I DATE OF BIRTH (MM-~DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFiCiAL USE ONLY FILE NUMBER COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~ Original Return [~4. Limited Estate E~6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received E~2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) [~7. Decedent Maintained a Living Trust (Attach copy of Trust) ] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) J--~ 3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME L ina FIRM NAME (IfApplicable) TELEPHONE NUMBER COMPLETE MAILING ADDRESS 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 B) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) F--] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liab, ilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Val~e of Estate (Line 8 minus Line 11) 13. 14. (11) 0 O 0 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (13) (14> SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line14 taxable at lineal rate qq 00°~ x,0 ~ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty STATE (i) IZIP / 78 Total credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the right to designate who shall use the property transferred or its income; .......................................... ..~ c. retain a reversionary interest; or .......................................................................................................................... [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate 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 which contains a beneficiary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanyim:J schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pr__,~rer other than the personal representative is based on all information of which preparer has any knowledge. / DATE SIGNATURE OF PREPARER O~HER THAN REPRESENTATIVE ~ DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 paren or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-,~2EX~I~-~I ,~ SCHEDULE I DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ITEM NUMBER 1. Include unreimbursed medical expenses. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 10, Recapitulation)$ (If more space is needed, insert additional sheets of the same size) REV-l§13 EX+ (9-00) ~ COMMONWEALTH OF PENNSYLVANIA ~NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER I SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] - ooo RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ~ION-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128~0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV 1162EX(11-96) CD 002395 MCCAFFERY LINDA A 273 SALEM CHURCH ROAD MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 189-18-5373 FILE NUMBER: 2103-0049 DECEDENT NAME: SEITZ IRENE C DATE OF PAYMENT: 04/04/2003 POSTMARK DATE: 04/03/2003 COUNTY: CUM BERLAN D DATE OF DEATH: 11/15/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $198.00 TOTAL AMOUNT PAID: $198.00 REMARKS: LINDAAMCCAFFERY SEAL CHECK# 0104 INITIALS' DO RECEIVED BY: DONNA M. OTT© DEPUTY REGISTER OF WILLS REGISTER OF WILLS Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Will No. ~- [ - 0 ~ - O O Ct~? Admin. No. To the Register: I certify that notice of (beneficial interest) estate _administration required by Rule 5.6(a) of the Orphans' C.~ourt Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~m~7~t' ~. _r{~'~r-, · Name Address Notice has now been given to all persons entitled thereto under Rule $.6(a) except Date: ~Ni~natu:e Name Address Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DTyTSZON DEPT. 180601 HARRTSBURC, PA 17118-0601 LINDA A HCCAFFERY 273 SALEH CHURCH RD HECHANICSBURG CONHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX Recor,~?~ :;:'~::,~: of DATE RO~? ::~ ~ ~*~w, ESTATE OF DATE OF DEATH FILE NUHBER '03 M/~Y 23 ~lO :28COUNTY ACN PA 17~-0~60 ~ ~- RE¥-1;47 EX AFP (~1-~$) 05-19-2003 SEITZ 11-15-2002 21 05-00~9 CUHBERLAND 101 Amoun~ Ramified IRENE C HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SEITZ IRENE C FZLE NO. Z! 03-00R9 ACN 101 DATE 05-19-2003 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANDED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 8. S~ocks end Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership In~eras~ (Schedule C) ($) ~. Hot,gages/No,es Receivable (Schedule D) (q) $. Cash/Bank Daposi~s/Hisc. Personal Proper~y (Schedule E) (5) 6. Jointly O~nad Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al AssaYs APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expensas/Ad~. Cos~s/H~sc. Expanses (Schedule H) (9} 10. Deb~s/Nor~gage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Na~ Value of Tax Ra~urn .00 .00 .00 .00 11~000.00 .00 .O0 (8) .00 NOTE: To insure proper cradi~ ~o your account, sub.i~ ~ha upper portion of ~his form ~i~h your ~ax payment. 13. 1~. NOTE: ASSESSHENT OF TAX: 15. Aaoun~ of L/ne lq e~ Spousal ra~a 16. Aaoun~ of Line lq ~axabla a~ Lineal/Class A ra~e 17. Aaoun~ of Line 1~ a~ Sibling ra~e 18. Aeoun~ of Line lq ~axabla a~ Collateral/Class B ra~a 19. Principal Tax Due TAX CREDITS: PAYHENT I RECEZPT DATE NUNBER 0~-03-Z003 CD001395 11,000.00 6,600.00 (x1) ~.600.0o (la) R,~O0.O0 Charit:abla/Govarnaan~al Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0 Nat: Value of Es~a~e Sub,~ec~ ~o Tax (1~,) ~,~00.00 Zf an assessment ~as issued previously, 1/neb 1~, 15 and/or 16, :17, 18 and 19 ,~11 reflect figures that include the total of ALL returns assessed to date. DISCOUNT INTEREST/PEN PAID (-) (15) .00 x O0 = .00 (16) ~,~00.00 x OR5= 198.00 (17) . O0 x 12 = . O0 (lB) .00 X 15 = .00 (19)= 198. O0 AHOUNT PAID IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 198.00 .0O TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 198.00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTZCE: PAYMENT: REFUND OBJECTZONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Colloneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To ~ulfill the requirements of Section 21~0 of the Znhlritance and Estate Tax Act, Act Z~ of ZOO0. (72 P.S. Section 91q0). 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: REGZSTER OF NZLLS, AGENT A refund of a tax credit, Nhich was not requested on the Tax Return, lay be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS15). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by ceiling the special Z~-haur ansNering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / ar speaking needs: 1-800-~7-~020 (TT only). Any party in interest not satisfied ~ith the appraJsallnt, alloeence, or disallowance of deductions, or assessment of tax (including discount ar interest) as sho~n on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Zl, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to tho Orphans' Court. Factual errors discovered on this assesslent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. lB0601, Harrisburg, PA 17128-0601 Phone [717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" [REV-1501) for an explanation of administratively correctable errors. If any tax due is paid ~ithin three [5) calendar Ionths after the decedlnt's death, a five percent (523 discount of tho tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and lnterlst assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the sale manner and in the the same tile period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning NJth 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, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~. AIl taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through 2003 are: [nterest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .O00S~B 1987 9Z .O00Zq7 1999 7Z .OO019Z 1983 162 .000~38 1988-1991 llZ .000301 ZOO0 ax .000219 198~ 112 .O0030Z 1992 9Z .0002~7 Z001 92 .0002q7 1985 132 .000356 1993-199~ 72 .000192 ZOOZ 6Z .00016~ 1986 IOZ .000274 1995-1998 92 .0002~7 2003 52 .000157 --Interest is calculated as follo~s: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DATLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent NiII reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest lust be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death Will No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes___~ 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 per, s/onal representative file a final account with the Court? Yes / No b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~.~. c. Did the personal representative sta~e 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 Cerk of the Orphans' Court and may be ~tached to this report. Date: ~/~'[ ~ ~' ~%.._~'t~/'/~") ~~e i~'~'~~ab r ~C~~~~~ ~/~ Name (Please type or print~ Tel. No. ~m : :: Capac i ty: Persona 1 Representative (MAH:rmf/AM3) __Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEt'~UE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004232 GOULD THOMAS D 2 EAST MAIN STREET SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 184-26-3037 FILE NUMBER: 2104-0049 DECEDENT NAME: FIKE WlLMA J DATE OF PAYMENT: 08/04/2004 POSTMARK DATE: 08/04/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 12/05/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~1,397.26 TOTAL AMOUNT PAID: ~1,397.26 REMARKS: · SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I-- Z DJ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FIKE WILMA J D~E OF DE~H (MM-DD-Y~R) D~E OF BlaH (MM-DDWEAR) 12-05-2003 05-27-1933 OFFICIAL USE ONLY FILE NUMBER 2 1- 04 000 49 SOCIAL SECURITY NUMBER 184 - 26 - 3037 DJ DJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER FIKE ERN B - - ~oo []1. Original Return E~]4. Limited Estate []6, Decedent Died Testate lA,ach copy of Will) E~9 Litigation Proceeds Received NAME DIANE M. NILSEN E~2. Supplemental Return [~4a. Future interest Compromise (date of death after 12-12-82) E~7. Decedent Maintained a Living Trust (^t~,~ch copy of Trust) ] 10, Spousal Povedy Credit (date of death t~,een 12-31-91 and 1-1-95) I!,.. FIRM NAME {if Applicable) TELEPHONE NUMBER (717) 766-3272 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 B) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) g. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 O, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (1 O) 11, Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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) E~5, Federal Estate Tax Return Required 8. Total Number of Safe Bedosit Boxes [~11 Election to tax under Sec. 9113(A) (^uach sch o) COMPLETE MAILING ADDRESS 16 NITTANY DRIVE MECHANICSBURG, PA 17055 SEE INSTRUCTIONS ON REVERSE SiDE FOR APPLICABLE RATES 8,966.81 31,480.44 o , (B) 9,396.98 (11) (12) (13) (14) OFFICIAL USE ONLY 40,447.25 9,396.98 31,050.27 31,050.27 15 Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 (a)(1,2) 16, Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18, Amount of Line 14 taxable at collateral rate 19. Tax Due 31,050.27 x .0_ (15) x .045 (16) x .12 (17) x .15 (18) (19) 1,397.26 1,397.26 REV.-,1502 EX+ (6-9~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER WILMA J. FIKE 21-04-00049 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the 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. Real property which is Jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH f. NONE TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) RE~-'1503 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHER~TANCETAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER WILMA J. FIKE 21-04-00049 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. none TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) RE~-~504 EX+ (1-97)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER WILMA J. FIKE 21-04-00049 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER WILMA J. FIKE 21-04-00049 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH NONE TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF WILMA J. FIKE 21-04-00049 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of suwivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. Keystone Health Plan - Refund Peoples Life Insurance - Refund PNC checking account %5070073881 PNC savings account 15030027979 TOTAL (Also enter on line 5, Recapitulation) 94.00 10.02 6,165.27 2,697.52 $ 8,966.81 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-04-00049 Ifanass~sm~e~intwithinoney~rofthed~e~'sdm~d~,#must~m~edon$chedubG. SU~IVINGJOINTTENANT(SJNAME ADD.SS RE~TIONSHIPTODECEDENT A. ERNEST B. FIKE HUSBAND 16 NITTANY DRIVE MECHANICSBURG, PA 17055 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of fi n&r~cia~ institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF ~IUMBER TENANT JOINT beed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTERE~ 1. A. unk PNC Certificate of Deposit 62,960.88 50 31,480.4 See Mutual Release and Settlement TOTAL (Also enter on line6, Recapitulation) $ 31,480.44 (If more space is needed, insert additional sheets of the same size) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERI?ANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF WILMA J. FIKE FILE NUMBER 21-04-00049 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 INCLUDETHENAMEOFTHETRANSFEREE'TH~IRRELATIONSHIPTODECEDENTANDTHE DATE OFTRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER VALUE OF ASSET INTEREST 1. None TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, inse~ additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILMA J. FIKE 21-04-00049 Debts of decedent must be reported on Schedule [. ITEM NUMBER A. 5. 6. 7. DESCRIPTION FUNERALEXPENSES: Malpezzi Funeral Homo James Gringrich Memorials ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s). Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Thomas D. Gould 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees AMOUNT 7,897.98 100.00 1,250.00 149.00 TOTAL (Also enter on line 9. Recapitulation) $ 9,3 9 6.9 8 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES~& LIENS ESTATE OF FILE NUMBER t~TT,H~. ,.T. F'r:~'R 23.-04-00049 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. None TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1'513 EX+ (9-00~,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WILMA J. FIKE SCHEDULE J I BENEFICIARIES FILE NUMBEfi 21-04-00049 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List'~'uetee($) OF ESTATE ! 1. 1. ~XABLE DISTRIBUTIONS [include outright spousal distributions, and tmnsfem under Sec. 9116(a)(1.2)] DIANE M. NILSEN 16 NITTANY DRIVE MECHANICSBURG, PA 17055 Daughter 31,050.27 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET {If more space is needed, insert additional sheets of the same size) MUTUAL RELEASE AND SETTLF/W .NT KNOW Aff~L MEN BY THESE PRESENTS that ERNEST B. FIKE, (hereinafter referred to as FIKE) for and in consideration of THIRTY-ONE THOUSAND FOUR HUNDRED EIGHTY AND 44/100 ($31,480.44) Dollars, and other good and valuable consideration, does hereby remise, release and forever discharge DIANE M. NILSEN and the ESTATE OF WILMA J. FIKE, her representatives, agents, successors and assigns, or any of them, their heirs, executors and administrators, of and from all, and all manner of, actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, claims and demands whatsoever in law or in equity, specifically including all claims related to the Certificate of Deposits, accounts and other funds held by PNC Bank. KNOW ALL MEN BY THESE PRESENTS that DIANE M. NILSEN, individually and as Personal Representative for the ESTATE OF WILMA J. FIKE, (hereinafter referred to as NILSEN) her representatives, agents, successors and assigns, or any of them, their heirs, executors and administrators, for and in consideration of One ($1.00) Dollar and other good and valuable considerations, receipt whereof is hereby acknowledged, does hereby remise, release and forever discharge FIKE, his representatives, agents, successors and assigns, of and from all, and all manner of actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, claims or demands whatsoever in law or in equity, specifically including all claims related to the Certificate of Deposits, accounts and other funds held by PNC Bank. IN CONSIDERATION of the payments made, any and all contracts, warranties of every kind and character now existing between the parties and any and all claims demands or liability of any kind and character that have been made between the parties is forever discharged. THE PARTIES agree that this release and settlement is a compromise of doubtful and disputed claims and that the payments made hereunder are not to be construed as an admission of liability on the part of any party and any liability is expressly denied. In the event any party breaches the terms of this release and settlement the breaching party shall pay $2,500.00 as liquidated damages or actual damages and reasonable attorney fees and ccsts. IN WITNESS WHEREOF, the set ~ hands and seals. THOF~S D. GOHLD Attorney for NILSEN undersigned intending to be legally bound DATE ERNEST B. FIKE DIANE M. NILSEN LAST WILLAND TESTAbIENT OF WILMA J. FIKE I, WTLMA J. FIKE, currently residing at 16 Nittany Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055 being of sound mind, memory and understanding do hereby make and publish this my Last Will And Testament hereby revoking all previous Wills and Codicils made by me. Item I. I order and direct that all of my just debts, funeral expenses and inheritance taxes may be paid as soon as conveniently possible immediately after my death. Item II. I may leave a written list, which will be dated and either in my own handwriting or signed by me, that sets forth my wishes regarding distribution of specific personal property. The may include proceeds from any insurance policies. If I do, list then I intend it to qualify as an amendment to should be determined that any such list does amendment to this Will, it is my hope that those in my estate will nevertheless respect it. Item III. this Will. If it not qualify as an entitled to share I give and bequeath my estranged husband, ERNEST B. FIKE, nothing, except as required by law. It jointly owned assets (real and personal) not entirety property, but rather, as jointly owned, is my request that be designated as with no ROS. Item IV. Ail of the rest, residual, and remainder of my estate, real, personal and mixed of whatever kind and wheresoever situated, I give and bequeath to my daughter, DIANE M. NILSEN. Item V. I hereby nominate and appoint my daughter, DIAI~E M. NILSEN, to be the Personal Representative of my estate. Item VI. I direct that no Personal Representative appointed under this Will be required to post any bond or provide any security to serve in that capacity. Item VII. I confer on my Personal Representative, in addition / to those powers granted by law, the following powers to be exercised in a prudent manner and constituting a part of my estate: A. To retain and to invest in all personal property, applicable to all property forms of real and without being confined to investments authorized by a statutory list, without being required to diversify and regardless of any principal of law limiting delegation of investment responsibilities by executors or trustees; To compromise claims and to abandon property which, in my Personal Representative's opinion, is of little or no value; To sell at private or public sale, to exchange or to lease any real or personal property, and to give options for sales or leases; Bo 2 To borrow from anyone, even if the lender is an executor hereunder, and to pledge property as security for repayment of the funds borrowed; To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties; To employ and to rely upon the advice given by investment counsel, to delegate discretionary authority to make changes in investments to investment counsel, and to pay investment counsel reasonable compensation in addition to any fees otherwise paid to my Personal Representative; To employ a custodian, to hold property unregistered or in the name of a nominee (including the nominee of any institution employed as custodian), and to pay reasonable compensation to the custodian~ in addition to any fees otherwise payable to my Personal Representative; To procure and carry at the expense of my estate insurance of kinds, forms and amounts deemed advisable by my Personal Representative to protect my estate and my Personal Representative against any hazard; I. To commence or defend at the expense of my estate any litigation affecting my estate deemed advisable by my Personal Representative; J. To conduct alone or with others any business in which I am engaged or in which I have any interest at my death, with all the powers of any owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry out such business; and K. To distribute in cash or in kind. IN WITNESS WHEREOF, I, WILMA J. FIKE, have to this my Last Will And Testimony hereunto set my hand and seal this ~r~ day of _/~C~.-- , 2003. WILM~ J .~FIKE SIGNED, SEALED, PUBLISHED AND DECLARED Testatrix, WILMA J. FIKE, as and for her Will, us who, at her request, in her presence, and each other, all being present at the same time, hand as witnesses: by the above-named in the presence of in the presence of have hereto set our RESIDING AT ! N~IE RESIDING AT f~ .C-~P~+/J~/~7 ~/~ £ 5 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND : SS. I, WILM~ J. FIKE, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for the purposes therein expressed. WILM~ J. FIKE We, having been duly qualified according to law, depose and say that we were present and saw WIIA~ J. FIKE sign the foregoing instrument as her Will; that she signed it as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and at her request signed the Will as witnesses; and that to the best of our knowledge she was at the time 18 years or more of age, of sound mind, and under no constraint or undue influence. Witness ~--~itness - Subscribed, sworn to, or affirmed, and acknowledged before me by the abovelnamed testatrix and by khe witnesses whose names appear, on this '~F~ day of ~~ , 2003. Notar~ ...... I / ~otsda~ Se~l .. ~ ~ Leo~a M. Gould, No.fy ,-ubiic / MyCom~missionE~:pi esVsr. 27,2004 [ 6