The URL can be used to link to this page

Home My WebLink About03-0054PETITION FOR PROBATE and GRANT OF LETTERS Estate of' pOlt, O'T'8~ ~. ~r~t,~L~ No. also known as To: Social Security No../~ ~ ",~6 ~t. .--'~ fSc~sed' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or. old~e.r an the execut~-~ in the last will of the above decedelat, dated and codicil(s) dated /J 00{~A~,b ~ ~- .at-o a -.s q Register of W~ills for. the- ~. County of Commonwealth of Pennsylvania in the named ,.~-- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C~ ~,~$a~.(&td ~ County, Pennsylvania, with h _~- last family or principal residence at (list stre~t,~u~;r a~cipality) De~n~ent, th~ Except a[ follows, decedent d~ not marry, was not d~vorced and d~ 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: DO 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 Pennsylxania situated as follows: .~ 00 ~' WHEREFORE, petitioner(s)respectfully r?~(~~ate of the last will and codicil(s) presented herewith and the grant of letters "~ - lA- ~] theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ] COUNTY OF ff~'__.,~_./~..,~A, f 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 truly administer the estate according to law. NO. 21-2003-54 Estate Of Dorothy R. Gambler , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW January 21st, x~ 2003., 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 Codicil - November llth, 2002 and Will ~, .Ap~ril 1,0ttn..2002.,, described therein be admitted to probate and men or recora as me mst wm of Dorothy P. Gambler ; and Letters are hereby granted to Testamentary Betty J. Leader FEES Probate, Letters, Etc..2.3.5. ...0.0.. $ 235.00 30.00 RhqrC&rtificates( ....... $ ooxc~±. 10.50 enunciation ................ $ x-Pages (3) $ 9.00 JCP lO. O0 TOTAL __ Filed ...J.~..u.a..ry..2.1,s.t. ,.2..0.Q.3 ............ ATTORNEY (Sup. Ct. I.D. No.) PHONE Mailed Letters to Executrix on !-21-03. REGISTER OF WILLS OF ~-~.-~[~ COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the ,~ql presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that ~. ~ x.x.y )~ ~ present and saw the testa ' , sign the same and that -~ sign~:d as a witness at the request of testat~ in h ~ presence ~_ .... ~S ........ ~c~ arq~c'~cacncc of thc m~er ~~s)). or affirmed ~subscribed befor~ ~~~ ~°~i~° _ ~/,-- day o ~~_ ~ (Na~ _ .~ (Name) 21-2003-54 (Address) REGISTER OF WILLS OF (-~"~-~/$'~' COUNTY OATH OF NON-SUBSCRIBING WITNESS that (.eaeh')~ subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ]eq familiar with the signature of J~0~07'~ /~. ~,~,t~L~;n , codicil testat g.~,lk of.t'~n'~ ............ f~f th .... ~'~'~;~';"g. '":~,,,,~oo~o .......... .~, the ~ presented herewith and codicil believes the signature on the ~lf is in the handwriting of to the best of ~-'~ knowledge and belief. (,N.~'~ /3 ~,._~,~ .x~ Sworn to or affirmed and subscribed before ~~~~a~' me this -'~/-~L~'' day of ~~ ~" , ~~~~~&Register. ' (Address) (Name) (Address) 21-2003-54 21-2003-54 CODICIL TO MY LAST WILL AND TESTAMENT On 7/23/02 Alan Sweger asked me to loan him $5,000.00 for a period of ninety (90) days. Up until now this money has not been paid back. In order to keep everything fair And equal, I believe the following should take place. In the event of my death, if this remains unpaid, the amount of the loan ($5,000.00) should be deducted from the share of the estate due to June Sweger, his wife, and added to the share due to Betty Leader. Since these are the last remaining members of my immediate family, I believe this is the easiest solution. In witness whereofI have executed this codicil this 27th day of November, 2002. J~N M LEADER-~ DOROT~thr R GAMBLER LAST WILL AND TESTAMENT OF DOROTHY R. GAMBLER I, DOROTHY R. GAMBLER, having my legal residence at 2108 Cedar Run Drive, Apt. 101, Camp Hill, Cumberland County, Commonwealth of Pennsylvania hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I bequeath the following items to CLARENCE S. SHENK, III: A. The large framed pheasant picture, the framed picture of a house at 146 North 25~ Street in Camp Hill, his father's Dickenson College Hall of Fame plaque and picture, and the corner cupboard; and B. The sum of Ten Thousand ($10,000.00) Dollars in thanks, among other things, for the past care and assistance he has rendered on behalf of my cat, "Pixie"; and C. Five Thousand ($5,000.00) Dollars for the future care and assistance he provides to my cat, "Pixie". ITEM THREE: I bequeath the following items to LOUISZITA SUMMERS: A. Three chests of drawers, one bed and one desk; and B. The sum of Five Thousand ($5,000.00) Dollars. ITEM FOUR: I bequeath the following to my ex-neighbors, MONIKA RAHN and JAMES RAHN: A. Ice Cream freezer, Igloo Kooler, Thermos Jug and Halloween decorations. ITEM FIVE: If my taxable estate for Pennsylvania Inheritance tax purposes exceeds $40,000.00, I bequeath the sum of $1,000.00 to my great-niece, Christina Bernard, and to each of my sisters' (JUNE M. SWEGER's and BETTY LEADER's) children who survive my death. If my taxable estate for Pennsylvania Inheritance tax purposes is $40,000.00 or less, I make no such bequest. If any of my sisters' children have predeceased me, his/her/their $1,000.00 bequest shall pass to said decedent's issue, in equal shares, per stirpes. ITEM SIX: I devise and bequeath all of the remainder of my estate and property, of whatsoever nature and wheresoever situate, to my sisters, JUNE M. SWEGER and BETTY J. LEADER, in equal shares. If either should predecease me, her share should pass to her issue in equal shares, per stirpes. If either should predecease me without leaving surviving issue, said share shall pass to the survivor of my said sisters. If both should predecease me, this bequest shall pass to the issue of my deceased sisters in equal shares, per stirpes. ITEM SEVEN: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM EIGHT: I appoint my sister, BETTY J. LEADER, Executrix of this Will and direct that she be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executrix to sell, encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such manner as she shall deem proper, limited only by her own discretion. If for any reason my Executrix, BETTY J. LEADER, appointed under this Will should fail to serve in that capacity, I appoint my sister, JUNE M. SWEGER, Executrix of my Last Will and Testament, with the same powers and privileges set forth above. IN WITNESS WHEREOF, I have at Camp Hill, Pennsylvania, this /d'e~ day of (~9-zqff__ set hand and seal to Last Will and Testament 2002, my this, my consisting of four (4) pages, including the acknowledgment. Dorothy R. Ga/fibler SIGNED, sealed, published and declared by DOROTHY R. GAMBLER, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. /~./-'~' ~Residence ~~4~ //~6~-~ - ,hzR,~ n ACKNOWLEDGMENT the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free 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 Dorothy R. Gambler, the Testatrix, and subscribed and sworn to before me by ~ t/~J'.~'/tg~'~'"'a~~. __ p. [. ~ witnesses, this /(3 tfi day of ~ ,2002. Notadal Seal John S. Davidson, Notary Public · _Derry Twp., _Dauphin County My uornmission P_xpires May 3, 2005 CAMP DOROTHY R. GAMBLER 2108 CEDAR RUN DRIVE APARTMENT #101 HILL, PENNSYLVANIA 17011 LAST WILL AND TESTAMENT Yos~ & DAvI.so~ 320 WEST CHOCOLATE AVENUE P.O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 IN RE: ESTATE OF DOROTHY R. GAMBLER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECEASED NO. 2003-00054 CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dorothy R. Gambler Date of Death: January 15, 2002 Will No. Admin. No. To the Register: I hereby certify that notice of the 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 May 6, 2003: Betty J. Leader, 18 Bellmore Road, Camp Hill, PA 17011 June M. Sweger, 9 Judy Lane, Harrisburg, PA 17112 Monika and James Rahn, 202 North 25th Street, Camp Hill, PA 17011 Louiszita Shenk Summers, 905 Pisgah State Road, Shermansdale, PA 17090 Clarence S. Shenk, III, 108 Hominy Drive, R R #4, Box 579BB, Newport, PA 17074 Christina Bernard, 38 Kensington Drive, Camp Hill, PA 17011 Shirley Anne Monroe, 6110 Springford Drive, Apt. D-20, Harrisburg, PA 17111 Barry Lee Sweger, 2402 Toftree Drive, Harrisburg, PA 17112 Steven Lloyd Sweger, 1128 Columbia Avenue, Apt. 8, Lemoyne, PA 17043 Suzanne Nell Staub, 9 Judy Lane, Harrisburg, PA 17112 Jan D. Leader, Jr., 773 East & 1850 North, North Ogden, UT 84414 Jeffrey L. Leader, 4706 Ruth Ann Street, Harrisburg, PA 17109 Christop!~er R. £eader, 899 Old Silver Spring Road, Mechanicsburg, PA 17055 Todd S. Leader, 4 White Dogwood Drive, Etters, PA 17319 Shawn D. Leader, 1104 Spring Lane, Absecon, NJ 08201 Jason M. Leader, 114C Umbel-to Avenue, New Cumberland, PA 17070 Date: Notice has been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions. c/ lo ' Jon~.yost, ~squire //v , 320LWest Chocolate Avenue // ~. ~(~ P.O. Box 437 Hershey, PA 17033 (717) 533-5101 X Capacity: Personal Representative Counsel for Personal Representative 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. CD REV-1162 EX(11-96) 002831 YOST JON A ESQ 320 W CHOCOLATE AVE HERSHEY, PA 17033 ........ fold ESTATE INFORMATION: SSN: 182-22-8338 FILE NUMBER: 2103-0054 DECEDENT NAME: GAMBLER DOROTHY R DATE OF PAYMENT: 07/22/2003 POSTMARK DATE: 07/21/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/15/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $27,467.12 TOTAL AMOUNT PAID: $27,467.12 REMARKS: BETTY J LEADER C/O JON A YOST ESQUIRE SEAL CHECK# 1023 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV - 1 ~eo EX + (6.0o) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ILE~T~?C 03 00054 ODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER GAMBLER, DOROTHY R 182-22- 8338 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 01/15/2003 11/24/1929 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A, ~oo z [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after [~ 5. Federal Estate Tax Return Required 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) -- [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) ~ ~ MUS~E:CO~ ........ ~I~==' ~'~' ~ ..... ~ ~Fi~AX~ i::i~ i?~~ .................. ........... .... "i:~%:~ ~IAME COMPLETE MAILING ADDRESS JON A YOST fIRM NAME (If applicable) YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE tELEPHONE NUMBER HERSHEY, PA 17033 717/533-5101 1. Real Estate (Schedule A) (1) None None None None 187,540.75 None 54,053.40 17,403.73 3,629.04 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) .~..~ (11) (12) (13) (14) 241,594.15 21,032.77 220,561.38 220,561.38 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 17.Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 187,236.38 33,325.00 20. [] (15) (16) (17) (18) (19) 22,468.37 4,998.75 27,467.12 Copyright 2000 form software only The Lackner Group, Inc. Form REV-I$00 EX (Rev. 6-00) Decedent's Complete Address: ISTREE ! ADDRESS CITY CAMP HILL 2108 CEDAR RUN DRIVE, APT #101 STATE PA 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 z~ 17011 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 27,467.12 0.00 0.00 27,467.12 27,467.12 (4) (5) (5A) (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 dght 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 accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ESPONSIBLE FOR FILING RETURN O .E.T.AN R ESEN AT,VE ADDRESS ADDRESS 18 BELLMORE ROAD CAMP HILL, PA 17011 DATE DATE DATE ADDRESS 320 WEST CHOCOLATE AVENUE HERSHEY, PA 17033 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERrTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GAMBLER, DOROTHY R 21 - 03 - 00054 Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyjointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH ALLFIRST BANK CHECKING ACCOUNT # 00361-4080-5 ALLFIRST BANK SAVINGS ACCOUNT # 4901720031 THREE CHESTS OF DRAWERS, ONE BED AND ONE DESK FRAMED PHEASANT PICTURE, FRAMED PICTURE OF FAMILY HOUSE, DICKINSON COLLEGE HALL OF FAME PLAQUE AND PICTURE AND CORNER CUPBOARD ICE CREAM FREEZER, IGLOO KOOLER, THERMOS JUG & HOLLOWEEN DECORATIONS 111,689.50 74,466.25 660.00 675.00 50.00 TOTAL (Also enter on Line 5, Recapitulation) 187,540.75 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF GAMBLER, DOROTHY R FILE NUMBER 21 - 03 - 00054 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH % OF NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE INTEREST CF APPLICABLE) 1 PENNSYLVANIA STATE EMPLOYEES CREDIT 27,026.70 100% 3,000.00 24,026.70 UNION ACCOUNT # 8607005488-1 2 PENNSYLVANIA STATE EMPLOYEES CREDIT 30,026.70 100% 30,026.70 UNION ACCOUNT # 8607005488-2 TOTAL (Aisc enter on line 7, Recapitulation) 54,053.40 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GAMBLER, DOROTHY R 21 - 03 - 00054 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: ZIMMERMAN AUER FUNERAL HOME ARTZ MEMORIALS-MONUMENT & LETTERING ADMINISTRATIVE COSTS: Personal Representative's Commissions BETTY J. LEADER Social Security Number(s) / EIN Number of Personal Representative(s): 171-28-4926 Street Address 18 BELLMORE ROAD City CAMP HILL State PA Zip 17011 Year(s) Commission paid 2003 Attorney's Fees JON A. YOST/YOST & DAVIDSON Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs JACK MESSINGER-RENT FOR FEBRUARY AND MARCH TO MAINTAIN AND CLEAN OUT DECEDENT'S APARTMENT Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 2,103.00 1,195.00 4,500.00 8,250.00 294.50 850.00 211.23 17,403.73 8chedl~ H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY v.-,.~.., 21 - 03 - 00054 2 78.23 PP&L-ELECTRIC SERVICE TO DECEDENT'S APARTMENT MAINTAIN UNTIL APARTMENT COULD BE CLEANED OUT H&R BLOCK-PREPARATION OF DECEDENT'S 2002 TAX RETURNS 133.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER GAMBLER, DOROTHY R 21 - 03 - 00054 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 3,043.00 CHECK # 2350 WAS ISSUED ON01/13/03 TO MANOR CARE BUT CLEARED THE ACCOUNT AFTER THE DATE OF DEATH CUMBERLAND APOTHECARY-MEDICAL SUPPLIES PP&L-DECEMBER &JANUARY ELECTRIC SERVICE ANDREWS AND PATEL-MEDICAL EXPENSE PA DEPARTMENT OF REVENUE-2002 PA INCOME TAX LIABILITY DR. FINEBERG-MEDICAL EXPENSE 308.84 133.20 48.03 44.00 51.97 TOTAL (Also enter on Line 10, Recapitulation) 3,629.04 REV-1513 EX+ (~-O0) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Bo Nnt Lint Tm~tee(S) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 MONIKA AND JAMES RAHN Friends 50.00 202 NORTH 25TH STREET CAMP HILL, PA 17011 2 SHIRLEY ANN MONROE Niece 1,000.00 6110 SPRINGFORD DRIVE, APT D-20 HARRISBURG, PA 17111 3 BARRY LEE SWEGER Nephew 1,000.00 2402 TOFTREE DRIVE HARRISBURG, PA 17112 4 STEVEN SWEGER Nephew 1,000.00 1128 COLUMBIA AVENUE, APT-8 LEMOYNE, PA 17043 See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET GAMBLER, DOROTHY R 21 - 03 - 00054 SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GAMBLER, DOROTHY R 21 - 03 - 00054 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE DO Not List Trustee(s) OF ESTATE [include outright spousal distributions, and transfers under I. TAXABLE DISTRIBUTIONS Sec. 9116(aX1.2)] 5 SUZANNE STAUB Niece 1,000.00 9 JUDY LANE HARRISBURG, PA 17112 6 JASON LEADER Nephew 1,000.00 114-C UMBERTO AVENUE NEW CUMBERLAND, PA 17070 7 JAN D. LEADER, JR. Nephew 1,000.00 773 EAST & 1850 NORTH NORTH OGDEN, UT 84414 8 JEFFREY L. LEADER Nephew 1,000.00 4706 RUTH STREET HARRISBURG, PA 17109 9 CHRISTOPHER LEADER Nephew 1,000.00 899 OLD SILVER SPRING ROAD MECHANICSBURG, PA 17057 10 TODD LEADER Nephew 1,000.00 4 WHITE DOGWOOD DRIVE ETTERS, PA 17319 11 SHAWN D. LEADER Nephew 1,000.00 1104 SPRING LANE ABSECON, NJ 08201 12 CHRISTIANA BERNARD Grand Niece 1,000.00 38 KENSINGTON DRIVE CAMP HILL, PA 17011 13 CLARENCE S. SHENK, III Friend 15,675.00 108 HOMINY DRIVE RR#4, BOX 579BB NEWPORT, PA 17074 14 LOUISZITA SUMMERS Friend 6,600.00 905 PISGAH STATE ROAD SHERMANSDALE, PA 17090 15 JUNE M. SWEGER Sister 93,618.39 9 JUDY LANE, HARRISBURG, PA 17112 Page 2 of Schedule J SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GAMBLER, DOROTHY R 21 - 03 - 00054 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE DO Not List Trustee(s) OF ESTATE [include outright spousal distributions, and transfers under 1. TAXABLE DISTRIBUTIONS Sec. 9116(aX1.2)] 16 BETTY J. LEADER Sister 93,618.39 18 BELLMORE ROAD CAMP HILL, PA 17011 I Page 3 of Schedule J LAST WILL AND TESTAMENT OF DOROTHY R. GAMBLER I, DOROTHY R. GAMBLER, having my legal residence at 2108 Cedar Run Drive, Apt. 101, Camp Hill, Cumberland County, Commonwealth of Pennsylvania hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I bequeath the following items to CLARENCE S. SHENK, III: A. The large framed pheasant picture, the framed picture of a house at 146 North 25~ Street in Camp Hill, his father's Dickenson College Hall of Fame plaque and picture, and the corner cupboard; and B. The sum of Ten Thousand ($10,000.00) Dollars in thanks, among other things, for the past care and assistance he has rendered on behalf of my cat, "Pixie"; and C. Five Thousand ($5,000.00) Dollars for the future care and assistance he provides to my cat, "Pixie". ITEM THREE: I bequeath the following items to LOUISZITA SUMMERS: A. Three chests of drawers, one bed and one desk; and B. The sum of Five Thousand ($5,000.00) Dollars. ITEM FOUR: JAMES RAI IN: A. I bequeath the following to my ex-neighbors, MONIKA RAHN and Ice Cream freezer, Igloo Kooler, Thermos Jug and Halloween decorations. ITEM FIVE: If my taxable estate for Pennsylvania Inheritance tax purposes exceeds $40,000.00, I bequeath the sum of $1,000.00 to my great-niece, Christina Bernard, and to each of my sisters' (JUNE M. SWEGER's and BETTY LEADER's) children who survive my death. If my taxable estate for Penn~lvania Inheritance tax purposes is $40,000.00 or less, I make no such bequest. If any of my sisters' children have predeceased me, his/her/their $1,000.00 bequest shah pass to said decedent's issue, in equal shares, per stirpes. ITEM SIX: I devise and bequeath all of the remainder of my estate and property, of whatsoever nature and wheresoever situate, to my sisters, FI_INE M. SWEGER and BETTY J. LEADER, in equal shares. If either should predecease me, her share should pass to her issue in equal shares, per stirpes. If either should predecease me without leaving surviving issue, said share shall pass to the survivor of my said sisters, ffboth should predecease me, this bequest shall pass to the issue of my deceased sisters in equal shares, per stirpes. ITEM SEVEN: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM EIGHT: I appoint my sister, BETTY J. LEADER, Executrix of this Will and direct that she be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executrix to sell, encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such manner as she shall deem proper, limited only by her own discretion. If for any reason my Executrix, BETTY J. LEADER, appointed under this Will should fail to serve in that capacity, I appoint my sister, JUNE M. SWEGER, Executrix of my Last Will and Testament, with the same powers and privileges set forth above. IN WITNESS WHEREOF, I have at Camp Hill, Pennsylvania, this /d~'O/' day of ~ ,2002, set my hand and seal to this, my Last Will and Testament consisting of four (4) pages, including the acknowledgment. SIGNED, sealed, published and declared by DOROTHY R. GAMBLER, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~~. '_ ,~.Residence ~~4~ ~/~ ACKNOWLEDGMENT We, DOROTHY R. GAMBLER, ' ]~. ~', the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free 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 Dorothy R. Gambler, the Testatrix, and subscribed and sworn to before me bytfi ~ '. ~ 1~. ¥/~'~"~~ witnesses, this /~ day of ~ ,2002. Notarial ,k)hn S. D~Md~mn, No~y ~ '0!.52 PB871~S04 ~AH_ED FR~ HERGHEY PA, 17033 JL 22 ,:,i! :24 I' CLASS MAIL ls ~ COUNTY COL~RTHOUSE ;e Square BUREAU OF ZNDZV/DUAL TAXES TNHERTTANCE TAX DTVISZON DEPT. 2806n! HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1~7 EX AFP (01-05) JON A YOST YOST & DAV[DSON 520 N CHOCOLATE AVE HERSHEY '03 ~_?-9 DATE ESTATE OF DATE OF DEATH F~LE NUMBER ACN 09-01-Z005 GAMBLER 01-15-2005 Z1 05-005~ CUMBERLAND 101 Amount RemL'H:ed DOROTHY R HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GAHBLER DOROTHY R FILE NO. 21 0:5-005~ ACN 101 DATE 09-01-200:5 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock~Partnership Interest (Schedule C) (3) 4. Hortgagas/Notes Rece/vabla (Schedule D) (4) E. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5) 6. Jo/ntly O~nad Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expanses/Ada. Costs/N/sc. Expanses (Schedule H) (9) 10. Dabts/Hortgega L1abilltias/Lians (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 187z5~0.75 .00 .00 NOTE: To insure proper .00 credit to your account, · O0 suba/t the upper port/on .00 of this form with your tax payment. 5~zO53.qO (B) 2~1,59~.15 17,~0:5.7:5 13. 14. NOTE: (11) 2].n32.77 [12) 220,561.:58 Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) . O0 Net Value of Estate Subject to Tax (14) 220,561 .:58 If an assess.ant ~as lssued previously, 11nas 14, 15 and/or 16, 17, 18 and reflect flgures that include the total of ALL returns assessed to date. (1~) .00 x O0 = .00 (16). .00 x 0~5 = .00 (~7) 187,2:56.38 x 12 = 22,~68.37 (lB) :5:5,:525.00 X 15 = ~,998.75 (19)= 27,~67.12 AMOUNT PATD Z7,~67.1Z ASSESSHENT OF TAX: 15. Amount of Line 14 at Spousal rata 16. Amount of L~ne 14 taxable et L/neel/Cless A rata 17. Amount of L/ne 14 at S/bl/ng rate 18. Aaount of L/ne 14 taxable at Collateral/Class B rata 19. Pr/nc/pal Tax Due TAX CREDITS: PAY;~;4T RECEIPT DTSCOUNT (+) DATE NUNBER ]:NTEREST/PEN PA:ZD (-) 07-21-200:5 CDOOZ8$1 . O0 ZF PA~D AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. Z7, ~67.12 .00 .00 .00 ( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REI~UTRED. TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR [NSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 12, 1981 -- if any futura 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 Comaaneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADNZN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfilI the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of 2000. (71 P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, ehich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at tho Office of the Register of Mills, any of the 25 Revenue District Offices, or by ceiling the special Iq-hour answering service for forms ordering: 1-80O-SBZ-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-q~7-SOZg (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown 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. 281021, Harrisburg, PA 17128-1021, OR --election to have tho matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bo addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150I) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (51) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of tho tax and interest assessed, and not paid before January 1D, 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 tho same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rata of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent an and after January 1, 1981 will bear interest at a rate ~hich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .O005q8 1987 91 .O00Z~7 1999 71 .O0019Z 1983 16Z .000q38 1988-1991 1II .000301 ZOO0 8X .000219 198q llZ .000301 1992 9Z .O00Zq7 ZOO1 9Z .OOOZq7 1985 13Z .000356 1993-199~ 7Z .00019Z ZOOZ 6Z .00016~ 1986 XOZ .OOOZTq 1995-1998 92 .0002q7 2003 SZ .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must ba calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. &~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy R. Gambler Date of Death January 15, 2003 No.: 2003 - 00054 Will No.: Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the above-mentioned estate: 1. State whether administration of the estate is complete: Yes X No If the answer is No, state when the l~rspnal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is yes, state the following: mo Did the personal representative file a final account with the court? Yes No X Bo The separate Orphans' Court No. (if any) for the personal representative's account is: PJ/PF Co Did the personal representative state an account informally to the parties in interest? Yes X No Date: (MAH:rmt/AM3) D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the~rt and may be attached to this report. Signatti~ Jon A. Yost, Esquire Name (Please type or print) 320 West Chocolate Avenue, P.O. Box 437, Hershey, PA 17033-0437 Address (717) 533-5101 Telephone No. Capacity: Personal Representative X Counsel for Personal Representative R.W. -27