HomeMy WebLinkAbout04-0689Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Mary E. Kirtle¥
Ted B. Windsor ,Deceased
Petitioner(s), who is/are 18 years of age or older, app~y(ies) for:
Social Security No 297- 32 - 6563
(COMPLETE 'A' or 'B' BELOW:)
] A. Probate and Grant of Le~ers Testamentary and aver that Petitioner(s) is/are the execut or
the Decedent, dated 01/20/2004 and codicil(s)dated None
__named in the last Will of
State relevant circumstances, e§., renunciation, death of executor, otc
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate: was not the victim of a kirling and was never adjudicated incompetent:
] B. Grant of Letters of Administration
(cta; d b.n.c.t a: pendente lite; durante absentJa; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
Relationshi Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary ~ ~ L
Decedent was domiciled at death in Cumberland :~ :* ~' ~ ,
County, Pennsyl~ia with his/her last ramify
or pdncipM residence at 23 Kower Court, Borouch of Mechanicsbur¢, Mechani~sbur~,gpA 170~,'5
(list street, number and municipality) ~
Decedent then 68 years of age, died 01/23/2004 at 23 Kower Court, Mechan~bsburg~ PA , :
(LocAtion) OO
Decedent at death owned property with estimated values as follows: ? [
(~f domiciled in PA) All persona~ property ,,~ ,
*~ 24,000. O0
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
~iate form to the undersigned:
L S~gnature ~rinted name and residence ]
Ted B. Windsor
23 Kower Court, Mechanicsburg, PA 17055
Prepared by the Pennsylvania Bar Association
Copy rig h t lc) 1996 form software only CP Systems. I nc
Form RW-1 (f991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~/~/~ ~/~¢¢--~t~ -
before me this ~ ~ day of
Ted ~ Windsor
Estateof Mary E. Kirtley
Social Secubty No: 297-32-6563 Date of Death: 01/23/2004
[~Sceased
CO
AND NOW, __., 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
(cta; dbn cra: pendente lite; durante absentia; durante minoritate)
are hereby granted to Ted B. Windsor
in the above estate and that the instrument{s) dated 01/20/2004
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters $
Short Certificate(s) .... $
Renunciation .... $
Affidavits ( ) $
Extra Pages ( ) . $
·
Codicil .......
JCP Fee ..... $
Inventory ...... $
Other
Regis er of W s
Attorney: Jennifer B. Hi?p
iD. No: 86556
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Prepared by the PennsyJvanfa Bar Associatior~ Copyrfght (c) 1996 focm software only CPSystems. I nc
Estate of
also known as
Register of Wills of C~be~nd County, Pennsylvania
OATH OF SUBSCRIBING WITNESS
M~r~, ~. ~irtley ~o. ~ I - Oq- 6*' LC~ (~
, Deceased
Jennifer B. Hipp Bonnie L. Williams
(each) a subscribing witness to the [] codicil(s) ~ w~,(~) presented herewith, (each) being duly qualified according to law
depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as
a witness at the request of Testator(rix) in his/her/their presence and [] in the presence of each other [] in the presence of the
other subscribing witness(es).
(Signature)
(Address)
(Signature)
(Address)
O~e n~/e~ :~: MB~i~i~tPreet
Shiremanstown, PA 17011
Bonnie L. Williams
One West Main Street
Shiremanstown, PA 17011
Sworn to or affirmed and subscribed
Pre~ared by the Pennsylvania Bar Association
Co pyrig h t (c} 1995 form software only CPSystems. I nc
NOTE:
To be taken by officer authorized to administer oaths
Please have present the original or copy of instrument(s)
at time of notarization.
ARNING: it is illegal fo d,,.~ ,
P 9961723
Elizabeth Kirtle
68 :
Cumberland
OMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS:
CERTIFICATE OF DEATH
C i
8-27-[93 Mansfield, OH
Mechanicsbu 23 Kower Court
Professor University
23 Kowar Court
Mechanicsburg, PA 17055
George S. Kirtley
Ted B. Windsor
,r~ co.~_Cumb__e r 1 and
~o
arried
aret E.
Cremation Societ~
5:qo
INJURY OC. CU p~ D
LAST WILL AND TESTAMENT
OF
MARY E. KIRTLEY'O [ ~ ~''
I, MARY E. KIRTLEY, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST: I give and bequeath the sum of Ten Thousand
and No/100 Dollars {$10,000.00) to my friend, MARJORIE A.
FITZPATRICK, of Carlisle, Pennsylvania. Should ~ARJORIE A.
FITZPATRICK predecease me, I direct that this bequest be and
become a part of my residuary estate to be disposed of as set
forth hereinbelow.
SECOND: I give and bequeath the sum of Ten Thousand
Dollars and No/100 Dollars ($10,000.00) to my Mother, MARGARET W.
KIRTLEY, of Towson, Maryland. Should NLARGARET W. KIRTLEY
predecease me, I direct that this bequest be given to the
PICKERSGILL RETIREMENT HOME, of Towson, Maryland, for g~eral~
purposes as that organization deems appropriate.
THIRD: I devise and bequeath all the rest, reszd~e
and remainder of my estate of whatever nature and wherever
situate, including any property over which I hold power of
appointment and together with any insurance policies thereon,
unto my husband, TED B. WINDSOR, provided he survives me by sixty
(60) days.
FOURTH: Should my husband, TED B. WINDSOR, predecease
me or die on or before the sixty-first (61st) day following my
death, I give and bequeath all shares of Exxon and Energizer
Stock, in kind, in equal shares, to the following: my brother,
GEORGE P. KIRTLEY; my step-daughters, ELIZABETH JO STEPANON,
REBECCA JUNE SIBLE, HOLLY WINDSOR and LAUREL WINDSOR; my friend,
MARJORIE A. FITZPATRICK; my sister-in-law, DOROTHY BEECH; my
brother-in-law, EUGENE B. WINDSOR; and my brother-in-law, ALFRED
A. WINDSOR. Should FLARJORIE A. FITZPATRICK predecease me, I
direct that her share be divided equally among the remaining
surviving beneficiaries herein. Should GEORGE P. KIRTLEY,
ELIZABETH JO STEFANON, REBECCA JUNE SIBLE, HOLLY WINDSOR, LAUREL
WINDSOR, DOROTHY BEECH, EUGENE B. WINDSOR or ALFRED A. WINDSOR
predecease me, I give and bequeath such individual's share unto
his or her issue per stirpes by representation, and if there be a
failure of same, then i give and bequeath such deceased
individual's share to my surviving beneficiaries as provided
herein.
FIFTH: Should my husband, TED B. WINDSOR, predecease
me er die on or before the sixty-first (61st) day following my
death, I devise and bequeath all the rest, residue and remainder
of my estate ef whatever nature and wherever situate, including
any preperty ever which I held power ef appeintment and tegether
with any insurance policies thereon, in equal shares, te the
follewing: my brether, GEORGE P. KIRTLEY; my step-daughters,
ELIZABETH JO STEFANON, REBECCA JUNE SIBLE, HOLLY WINDSOR and
LAUREL WINDSOR; my friend, NLARJORIE A. FITZPATRICK; my sister-in-
law, DOROTHY BEECH; my brother-in-law, EUGENE B. WINDSOR; and my
brother-in-law, ALFRED A. WINDSOR. Sheuld MARJORIE A.
FITZPATRICK predecease me, ! direct that her share be divided
equally among the remaining surviving beneficiaries herein.
Sheuld GEORGE P. KIRTLEY, ELIZABETH JO STEFANON, REBECCA JUNE
SIBLE, HOLLY WINDSOR, LAUREL WINDSOR, DOROTHY BEECH, EUGENE B.
WINDSOR or ALFRED A. WINDSOR predecease me, I give and bequeath
such individual's share unte his or her issue per stirpes by
representatien, and if there be a failure of same, then I give
and bequeath such deceased individual's share te my surviving
beneficiaries as provided herein.
2
SIXTH: Should any of my beneficiaries not have
attained the age of twenty one (21) years at the time for dis-
tribution to him or her, I give, devise and bequeath the share of
each such beneficiary to my hereinafter named Trustee or
Trustees, IN SEPARATE TRUSTS, to hold, manage, invest and rein-
vest the shares so received, and to use and apply from time to
time such portion of income and principal for the said
beneficiaries' education (including college, trade school or
other similar training or education), support and welfare as my
Trustee or Trustees, in their sole discretion, deem advisable.
My Trustee or Trustees may make the payments for the support and
maintenance of my beneficiaries directly to said beneficiaries or
to their Guardian or Guardians. Any payments made by my Trustee
or Trustees pursuant hereto shall be made without further respon-
sibility to the said beneficiaries, their Guardian or Guardians,
or to any person taking care of my beneficiaries. The Trustee or
Trustees, in exercising their discretionary authority with
respect to the payment of income or principal of the within Trust
to my beneficiaries, shall take into consideration any income or
other resources available to my beneficiaries from sources
outside this Trust. In addition, my hereinafter named Trustee or
Trustees shall have the right, in their sole discretion, to
purchase and pay for out of the principal, as well as income,
such insurance policies as will provide for the beneficiaries'
medical care.
Any income or principal not so applied shall be dis-
tributed to each beneficiary when he or she attains the age of
twenty-one (21) years. In the event any of my beneficiaries die
prior to the termination of this Trust established herein for
their benefit, the interest of said beneficiary in said Trust
shall cease with any income and principal being divided evenly
between or among that deceased beneficiary~s brothers or sisters
or the separate Trusts established hereunder for their benefit
and, in the absence of any brothers or sisters, or any Trust
established hereunder for their benefit, to my other
beneficiaries~ or the Trusts established hereunder for their
benefit, in equal shares.
SEVENTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale~ or to lease~
for any period of time~ any real or personal property and to give
options for sales~ exchanges or leases~ for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide~ or improve real estate
and to enter into agreements concerning the partition~ subdivi-
sion~ improvement~ zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks~ common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper~ without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
4
Federal
limited
laws.
(F) To exercise any election or privilege given by the
and other tax laws, including, but not necessarily being
to, personal income, gift and estate or inheritance tax
(G) To make distributions to my herein named benefici
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
EIGHTH: I nominate and appoint my stepdaughters,
ELIZABETH JO STEPHANON and LAUREL WINDSOR, as Co-Trustees of the
hereinabove described trusts. I direct that my Trustee or
Trustees, as the case may be, shall serve without bond and shall
receive fair and reasonable compensation.
N~NTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
TE~T~: Ail interests hereunder, whether principal or
mncome, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
5
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
ELEVENTH: I nominate and appoint my husband, TED B.
WINDSOR, Executor of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said TED B. WINDSOR, I nominate and
appoint my step-daughter, LAUREL WINDSOR, Executrix of this, my
Last Will and Testament. I direct that my Executor or Executrix,
as the case may be, and their successors, shall not be required
to post security or a bond for the performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF,
seal to this,
I have hereunto set my hand and
my Last Will and Testament, this ~<'J day of
2004.
,. , 'lt ! ,' ~' ,~(?:i/ (SEAL)
MARY E.."KIRTLEY /
Signed, sealed, published and declared by the above-
named Testatrix as and fer her Last Will and Testament in our
presence, who, at her request, in her presence and in the
have hereunto subscribed our names as
presence of each other,
attesting witnesses.
Address
Address
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Mary E.
Date of Death: January 23,
Will No. 21-04-0689
To the Register:
Kirtley
2004
Admin. No.
I certify that notice of estate administration required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
July 23, 2004:
Name Address
Ted B. Windsor
Margaret W. Kirtley
Marjorie A. Fitzpatrick
23 Kower Court
Mechanicsburg, PA 17055
Pickersgill Retirement
Community
615 Chestnut Avenue
Towson, MD 21204
1017 North Pitt Street
Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date:
Shiremanstown, PA 17011
(717) 737-8761
Personal Representative
X Counsel for Personal
Representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mary E. Kirtley
Date of Death:
1/23/2004
Will No. 21-04-0689
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the fo[lowing with respect to completion of
the administration'of the above-captioned estate:
State whether administration of the estate is complete:
Yes xx 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 Orphans' Court No. (if any) for
the personal representative's account is:
c. 0id the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
S i g~a-fuge ~ J
Jennifer B. Hipp, Esquire
Name (Please ty~e or print)
One West Main St.
~-[~[3 Shiremanstown, PA 17011 ' ~'"~ Address
(717) 737-8761
Tel. NO.
(MAH: rmf/AM3 )
~Capacity:
__Personal Representative
__Counsel for personal
representative
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURI
RESIDENT DECEDENT
OECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
Kirtley Mary E.
DATE OF DEATH (MM-OD-YEAR) I DATE OF mIRTH (MM-OD-YEAR)
01/23/2004 08/27/1935
(IF APPLICABLE) SU RV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Windsor, Ted B.
Limited Estate · Future Interest Compromise (clare of death after 1~. 1Z-82)
Decedent Died Testate . Decedent Maintained a Living Trust 0
(Attach copy of WIll) (Attach copy of Trust)
[] S. L,tlgaflonProceeds Received [] 10. SpousaIPoverty Credit
(date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
21-04-0689
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
297-32-6563
THIS RETURN Muir BE FI LED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
494- 22 - 9050
date of dea h
3, Remainder Return irior 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
Jennifer B. Hipp Esquire
FI RM NAM E (~f Applicable)
TELEPHONE NUMBER
717/737-8761
COMPLETE MAILING ADDRESS
One West Main Street
Shtremanstown, PA 17011
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (S)
(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)
(1)
(Z) 23,822
(3) N~ne
None
1,016;91
45~22
None
1,407.00
494.00
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)
~O FFICIA~'Lrs~'O N Ly
CO
(8) 24,884.75
(11) 1,901.00
(12) 22,983.75
(13L
(14) 22,983.75
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX 1.2)
16. Amount of Line 14 taxable at lineal rate
17. An~unt of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
2,938.53 X .0 0 (15) 0.00
10,000.00 X .o 45 (16) 450.00
X .12 (17) 0.00
10,045.22 X .15 (18) 1,506.78
19. Tax Due (19) 1,956.78
~ Copyright (c) Z000 form software only The Lackner Group, loc. Form REV- 1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADORESS
23 Kower Court
CITY
I STATE ZIP
Mechanicsbur~ PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. CredO/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Tota[Credits(A+B+C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) 0.00
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) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the d~ference. This is the TAX DUE. (5) 1,956.78
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line $ + SA. This is the BALANCE DUE. (5B) 1,956.78
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 w~thin one.year of death
w~thout 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.
1,956.78
Under penaltres 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 ~ersonal representative I$ based on all Information of which preparer has any knowledge.
SIGNATUREO~=PERSONRESPON~,~//~~~[BLE , RFILI GRETURN Ted B. Windsor DATE
- ' ~i~ ~h-~ [~-~'~.~'~ ;- ~ ' ' ~.¥~ ~- .................... ~o'l~-o
SIGNATUR~OFP~EPAREROTHERTHANREPRESENTATIVE Jennifer B Hipp Esquire DATE
~/~ 9 One West Main Street
For astra of a*sth ~ or =~ July ~, ~SS4 =~d b~fo,~ J=~u=~ 1, ~9S, th~ ~ ~=~ i~po==d ~ th= ~ ~=l~ o~ ~;~;f;= ~;";; ~;;'~';"~;;';f"~';
su~iving spouse is 3% [72 P.$. ~116 {a) (1.1) (i)].
[72 P.S. 9116 (a) (1.1) (ii)]. The santa does not ex~mpt a transfer to a surviving spouse from tax, and the stal~lo~ requirements for disclosure of
and ~ling a ax return are ~ill applicable even if the sullying spouse is the on~ beneficial.
F=r dates of death on or a~er Ju~ 1, 2000:
parent, an adop~ve paren~ or a stapparent of the chil~ is 0% ~72 P.S. 9116 (a~
~e ~x rata i=posed on the net value of transfers ta or for the use of the ~ec~ent's lineal benef c ar es s 4 5%, excspt as noted in 72 P S 9116(1.2)
~e ax ~ta imposed on ~e net value ot tran~e~ to or for the use of the dec,dent's siblings is 12% ~72 P.S. 9116{a~1.3)]. ~ sibling is defined, under
Se~on 9102, as an individual who has al least on~ parent in common with the ~ecedent, whsth~r by blood or ~doption.
SCHEDULE B
COMMONWEALTHOFPENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FiLE NUMBER
Mary E. Kirtley SS~/ 297-32-6563 01/23/2004 21-04-0689
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE
OF DEATH
1 136.341 shares Eastman Chemicals - shares of stock 38.45 5,242.31
2 17.715 shares Eastman Kodak - shares of stock 29.88 529.32
3 259.876 shares Lilly Eli & Co - shares of stock 69.46 18,050.99
TOTAL(Also enteronline 2, Recapitulation) 23,822.62
(if more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSysterns, {nc. Form REV- 1503 EX (Rev. 1-97)
JAC.QUELINE L. POWE:LL & ASSOCIATES, INC,
43A BROOKWOOD AVENUE, SUITE 6, CARLISLE, PA 17013
PHONE (71 7) 258-0751; FAX (717) 258-9731
www.]powellasso¢.¢om
July 20, 20O4
To Whom It May Concern:
Please be advised that we have determined the Date of Death Values for Mary E Kirtey
as follows:
Securities held by Mary Kirfley
Date of Death Values
as of January 23, 2004
Eastman Kodak i EK i 17.715 $29.88 $529.32
Eastman Chemicals j EMN J 136.341 $38.45 $5,242.31
._E.!i__L. i.!l,y_ .................................... i.. __ L_ L_ Y___.__2_5_9 ._8_7~6. = ...... __$..6_9_:_4_.6$18,050.99
$23,822.&2
These securities were held in Mary's individual name.
If you have any questions, or need additional information, please do not hesitate to
contact my assistant, Diana Frey, at 71%258-075 I.
Sincerely,
Securities offered through Financial Network Invesff'nent Corporation. Member BIPC.' Registered
Broker/Dealer
Jacqueline L. Powell & Associates, Inc. and Financial NeNvork are not affiliated.
REV-1508EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Mary E. Kirtley SS~/ 297-32-6563 01/23/2004 21-04-0689
include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right cf
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Citi Cards - Refund
Highmark - Insurance Refund
1993 Ford Escort, VIN 1FAPP15J8PW380851 - Per attached appraisal
TOTAL (A[so enter on line $, Recapitulation)
0.68
616.23
400.00
1,016.91
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software orfly CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97)
L.B. Smith Ford, Inc.
1100 Market Street · Lemoyne, Pennsylvania 17043
Phone: (717) 761-6700 or (800) 422-3673 · FAX: (717) 761-3951
Email: fords @ lbsmith.com
P-EHICLE IDENTIFICATION NO.:
ABOVE INFOR~-ATION PROVIDED BY:
(Title)
The Winning Combination of Sales and Service
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
[NHERITANCE TM RETURN
RES[DENT DECEDENT
ESTATE OF
Mary E. Kirtley SS# 297-32-6563 01/23/2004
FILE NUMBER
21-04-0689
Ifanase~ w~ madejointwithinoneyearofthedeceden~sd~eofdeath, itmustberepo~edonScheduleG.
SURVIVINGJOINTTENANT(S)NAME ADDRESS RELATIONSHIPTO DECEDENT
A. Natalia Sitnikova Unknown None
Exchange Student
JOINTLY-OWNED PROPERTY:
L: t I ~ DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM :OR JOINTI MADE Include name of flnanclaHnstltutlon and bank
accountnumberors[milarldentlfyingnumber. DATE OF DEATH DECD'S VALUE OF
NUMBE~q TENANT JOINT AttachdeedforJointbf-heldrealestate. VALUE OF ASSET INTEREST DECEDENTS INTERE<;
1 A M&T Bank - Savings Account 90.44 50.00% 45.22
No. 021000000996449, date
of death balance $90.44,
accrued interest $0.00
TOTAL (Also enter on ~ine 6, Recapitulation) $ 45.22
(If more space Is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1 SOS EX (Rev. 1 -97)
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
James D. Bogar
Attorney At Law
One West Main Street
Shiremanstown, PA 17011
Phone (888) 502-4349
Fax (302) 934-2955
July 29, 2004
Re: Estate ol? Mary E. Kirtlev
Social Security: 297-32-6563
Date of Death: January 23. 2004
Dear Sir or Madam:
Per your inquiry dated July 23, 2004, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1. Type of Account
Account Number
Ownership (Names o29
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
10262628
Mary E Kirtley, Ted B Windsor
Joint Owners
05/11/92
$4,088.20
$ 0.00
$4,088.20
Type of Account
Account Number
Ownership (Names o29
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
2678082492
Mary E Kirtley, TedB Windsor
Joint Owners
03/04/80
$3,351.41
$ 0.00
$3,351.41
'3.
Type of Account
Account Number
Ownership ~ames o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Savings Account
021000000996449
Mary E Kirtley, Natalia Sitnikova
Joint Owners
05/02/94
$90.44
$ 0.00
$90.44
Please be advised, there was no safe deposit box found for the above decedent. For further account information, regarding
ownership, closures and/or reimbursement of funds, please cai1 the Stonehedge Office # 717-240-4524.
Sincerely,
Nancy Clagett
Records Management
COMMQNWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary E. Kirtley SS~; 297-32-6563
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
01/23/2004.
FILE NUMBER
21-04-0689
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
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's Fees Jennifer B. [~ipp Esquire
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
ProbataFees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
RESERVES: Costs to conclude administration of Estate including
filing fee for PA Inheritance Tax Return, Inventory and First &
Final Account; preparation of Personal and Fiduciary Income Tax
Returns
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystsms, Inc.
1,110.00
97.00
200.00
$ 1,407.00
Form REV-1511 EX (Rev. 1-97)
REV-I$1ZEX+(1-9?)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary E. Kirtley
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS~/ 297-32-6563 01/23/2004
FILE NUMBER
21-04-0689
Include unreimburse4 medical expenses.
iTEM
NUMBER DESCRIPTION AMOUNT
1
2
3
Andorra Radiology Associates, P.C. - Medical Bill-Final
Capital One - Credit Card Bill-Final
Central Penn Hematology and Medical Oncolo&y Practice -
Bill-Final
194.00
200.00
100.00
TOTAL (Also enter on line 10, Recapitulation) $ 494.00
(If more space is needed, inser~ additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1512 EX (Bev. 1-97)
REV- 1513 EX *(9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary E. Kirtley SS# 297-32-6563
NUMBER
1
2
3
SCHEDULE J
BENEFICIARIES
01/23/2004
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
II.
TAXABLE DISTRIBUTIONS [Include outright spou~l distributions, and
tra~fem under S~. 9116~1,Z)]
Marjorie A. Fitzpatrick
1017 North Pitt St.
Carlisle, PA 17013
Margaret W. Kirtley
Pickersgill Retirement Community
615 Chestnut Avenue
Towson, MD 21204
Ted B. Windsor
23 Kower Court
Mechanicsburg, PA
17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(e)
Friend
Mother
Spouse
FILE NUMBER
21-04-0689
AMOUNT OR SHARE
OFESTATE
Specific
bequest of Ten
Thousand
($10,000.00)
Dollars
Specific
bequest of Ten
Thousand
($10,000.00)
Dollars
Rest, residue
and remainder
of Estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
$ 0.00
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)
Copyrlg ht (c) ZQO0 form software only The Lackner Group, Inc. Form R Er-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
OF
MARY E. KIRTLEYp~ ~ ~
I, MARY.E. KIRTLEY, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare thfs as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST: I give and bequeath the sum of Ten Thousand
and No/100 Dollars ($10,000.00) to my friend, Y_A=RJORIE A.
FITZPATRICK, of Carlisle, Pennsylvania. Should MARJORIE A.
FITZPATRICK predecease me, I direct tha~ this bequest be and
become a part of my residuary estate to be disposed of as set
forth hereinbelow.
SECOND: ~ give and bequeath the sum of Ten Thousand
Dollars and No/100 Dollars ($10,000.00) to my Mother, MARGARET W.
KIRTLEY, of Towson, Maryland. Should M~RGg_~ET W. KIRTLEY
predecease me, I direct that this bequest be given to the
PICKERSGILL RETIREMENT HOME, of Towson, Maryland, for general
purposes as that organization deems appropriate.
THIRD: I devise and bequeath all the rest, residue
and remainder of my estate of whatever nature and wherever
situate, including any property over which I hold power of
appointment and together with any insurance policies thereon,
unto my husband, TED B. WINDSOR, provided he survives me by sixty
(60) days.
FOURTH: Should my husband, TED B. WINDSOR, predecease
me or die on or before the sixty-first (61st) day following my
death, I give and bequeath all shares of E~(on and Energizer'
Stock, in kind, in equal shares, to the following: my brother,
GEORGE P. KIRTLEY; my step-daughters, ELIZABETH JO STEFANON,
REBECCA JUNE SIBLE, HOLLY WINDSOR and LAUREL WINDSOR; my friend,
MARJORIE A. FITZPATRICK; my sister-in-law, DOROTHY BEECH; my
brother-in-law, EUGENE B. WINDSOR; and my brother-in-law, ALFRED
A. WINDSOR. Should ~ARJORIE A. FITZPATRICK predecease me, I
direct that her share be divided equally among the memaining
surviving beneficiaries herein. Should GEORGE P. KIRTLEY,
ELIZABETH JO STEFANON, REBECCA JUNE SIBLE, HOLLY WINDSOR, LAUREL
WINDSOR, DOROTHY BEECH, EUGENE B. WINDSOR or ALFRED A. WINDSOR
predecease me, I give and bequeath such individual's share unto
his or her issue per stirpes by representation, and if there be a
failure of same, then I give and bequeath such deceased
individual's share to my surviving beneficiaries as provided
herein.
FIFTH: Should my husband, TED B. WINDSOR, predecease
on or before the sixty-first (61st) day following my
me or die
death, I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate, including
any property over which I hold power of appointment and together
with any insurance policies thereon, in equal shares, to the
following: my brother, GEORGE P. KIRTLEY; my step-daughters,
ELIZABETH JO STEFANON, REBECCA JUNE SIBLE, HOLLY WINDSOR and
LAUREL WINDSOR; my friend, MARJORIE A. FITZPATRICK; my sister-in-
law, DOROTHY BEECH; my brother-in-law, EUGENE B. WINDSOR; and my
brother-in-law, ALFRED A. WINDSOR. Should MARJORIE A.
FITZPATRICK predecease me, I direct that her share be divided
equally among the remaining surviving beneficiaries herein.
Should GEORGE P. KIRTLEY, ELIZABETH JO STEFANON, REBECCA JUNE
SIBLE, HOLLY WINDSOR, LAUREL WINDSOR, DOROTHY BEECH, EUGENE B.
WINDSOR or ALFRED A. WINDSOR predecease me, I give and bequeath
such individual's share unto his or her issue per stirpes by
representation, and if there be a failure of same, then I give
and bequeath such deceased individual's share to my surviving
beneficiaries as provided herein.
2
SIXTH: Should any of my beneficiaries not have
attained the age of twenty-one (21) years at the time for dis-
tribution to him or her, I give, devise and bequeath the share of
each such beneficiary to my hereinafter named Trustee or
Trustees, IN SEPARATE TRUSTS, to hold, manage, invest and rein-
vest the shares so received, and to use and apply from time to
time such portion of income and principal for the said
beneficiaries' education (including college, trade school or
other similar training or education), support and welfare as my
Trustee or Trustees, in their sole discretion, deem advisable.
My Trustee or Trustees may make the payments for the support and
maintenance of my beneficiaries directly to said beneficiaries or
to their Guardian or Guardians. Any payments made by my Trustee
or Trustees pursuant hereto shall be made without further respon-
sibility to the said beneficiaries, their Guardian or Guardians,
or to any person taking care of my beneficiaries. The Trustee or
Trustees, in exercising their discretionary authority with
respect to the payment of income or principal of the within Trust
to my beneficiaries, shall take into consideration any income or
other resources available to my beneficiaries from sources
outside this Trust. In addition, my hereinafter named Trustee or
Trustees shall have the right, in their sole discretion, to
purchase and pay for out of the principal, as well as income,
such insurance policies as will provide for the beneficiaries'
medical care.
Any income or principal not so applied shall be dis-
tributed to each beneficiary when he or she attains the age of
twenty-one (21) years. In the event any of my beneficiaries die
prior to the termination of this Trust established herein for
their benefit, the interest of said beneficiary in said Trust
shall cease with any income and principal being divided evenly
between or among that deceased beneficiary's brothers or sisters
or the separate Trusts established hereunder for their benefit
and, in the absence of any brothers or sisters, or any Trust
established hereunder for their benefit, to my other
beneficiaries, or the Trusts established hereunder for their
benefit, in equal-shares.
SEVENTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers,
ty, exercisable without court approval
distribution of all property:
(A) To
for any period of
options for sales,
applicable to all proper-
and effective until actual
sell at public or private sale, or to lease,
time, any real or personal property and to give
exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
4
Federal
limited
laws.
(F) To exercise any election or privilege given by the
and other tax laws, including, but not necessarily being
to, personal income, gift and estate or inheritance tax
(G) To make distributions to my herein named benefici-
aries in cash or ~n kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of
extent the plan or the law permits them to
any other rights which they may have under
manner they consider advisable.
qualified plan) to the
do so, and to exercise
the plan, in whatever
EIGHTH: I nominate and appoint my stepdaughters,
ELIZABETH JO STEPHANON and LAUREL WINDSOR, as Co-Trustees of the
hereinabove described trusts. I direct that my Trustee or
Trustees, as the case may be, shall serve without bond and shall
receive fair and reasonable compensation. ~
NINTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
TENTE: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
5
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
ELEVENTH: I nominate and appoint my hush&nd, TED B.
WINDSOR, Executor of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever 'of the said TED B. WINDSOR, I nominate and
appoint my step-daughter, LAUREL WINDSOR, Executrix of this, my
Last Will and Testament. I direct that my Executor or Executrix,
as the case may be, and their successors, shall not be required
to post security or a bond for the performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ~J day of
~'~ ~'~ ~I , 2004.
FLARY E. IKIRTLEY
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
have hereunto subscribed our names as
presence of each other,
attesting witnesses.
Address
Address
6
Register of Wills of COMSE~LAN~ County, Pennsylvania
INVENTORY
Estate of Mary E. Kirtley
No. 21-04- 0689
Date of Death 01/23/2004
Deceased Social Security No. 297-32- 6563
Ted B. Windsor,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the CommonweaRh of Pennsylvania except that which appears in a memorandum at the end of this
inventory. I ~Ve verify that the statements made in this Inventory are true and correct. I/~Ve understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Sect[on 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
I.D. No,:
Address:
Jennifer B. Hipp Esquire
86556
One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Personal Representative
Ted B 'Windsor
Signature:
Address: 23 Kower Court
Mechanicsbur~,
Telephone: 717/766-6039
Dated: IO ' I $ - O H
PA 17055
Description
(See continuation page(J) attached)
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, lnc,
~f:Z~ ~[ IS0 ~70.
Value
(Attach additional sheets if necessary) Total: 24,839.53
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory,
Form #RW-7 (1992)
Estate of:
Date of Death:
County:
Mary E. Kirtley
01/23/2004
Cumberland
INVENTORY
CASH:
Citi Cards - Refund
Highmark - Insurance Refund
0.68
616.23
PERSONAL PROPERTY:
1993 Ford Escort, VIN
1FAPP15JSPW380851 - Per
attached appraisal
400.00
STOCKS/LISTED:
136.341 shares Eastman Chemicals
shares of stock
17.715 shares Eastman Kodak - shares
of stock
259.876 shares Lilly Eli & Co - shares
of stock
5,242.31
529.32
18,050.99
TOTAL RECEIPTS OF PRINCIPAL ...............
616.91
400.00
23,822.62
24,839.53
-1-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFINDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EXI11 96)
NO. CD 004508
HIPP JENNIFER B. ESQ.
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
ESTATE INFORMATION: SSN: 297-32-6563
FILE NUMBER: 2104-0689
DECEDENT NAME: KIRTLEY MARY E
DATE OF PAYMENT: 1 O/18/2004
POSTMARK DATE: 10/18/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 01/23/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,956.78
TOTAL AMOUNT PAID:
$1,956.78
REMARKS:
CHECK# 4402
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF TNDIVZDUAL TAXES
INHERITANCE TAX DTVISXON
PO BOX 180601
HARRISBURG, PA 17128-0601
COHHONWEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-I~7 EX AFP (09-04)
JENNIFER B HIPP ESQ
ONE W HAIN ST
SHI~/~t4ANSTOWN
PA 17011
DATE 1Z-ZO-ZO0~
ESTATE OF KIRTLEY
DATE OF DEATH 01-Z:5-200~
FILE NUNBER 21 0R-0689
COUNTY CUHBERLAND
ACN 101
Amount Remitted
MARY E
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
~,_,~,. ~ u-~ CARLISLE, PA 1701:5
CU~G J~ZS ~-'~..~L: ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS ~
c~ c:~ 0 DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF I~/RTLEY HARY E FILE NO. 21 0~-0689 ACN 101 DATE 12-20-200~
TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATTON CONCERNTNG 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)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
4. Hortgages/Notes Receivable (Schedule D) (4)
E. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (E)
6. Jointly Owned Property (Schedule F) (6).
7. Transfers (Schedule G) (7).
8. Total Assets
APPROVED DEDUCTIONS AND EXENPTIONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Nortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
O0
25~822.62
O0
O0
1/016.91
~5 ZZ
O0
(8)
1,~07.00
~9~.00
(11)
13.
14.
NOTE:
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13)
Net Value of Estate Sub~ect to Tax (14)
If an assessment vas issued previously, lines 1~, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this fore with your
tax payeent.
2~,88~.75
ASSESSNENT OF TAX:
15. Amount of Line 14 at Spouse1 ra~e
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Aeount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS
PAYHENT RECEIPT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
10-18-200~ CDOOq508 .00
1.gOl.flO
IF PAID AFTER DATE [NDZCATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
22,98:5.75
18 and 19 #ill
(1;) 2,938.5:5 x O0 = .00
(~6) 10,000.00 x 0~5= ~50.00
(17) . O0 x 12 = . O0
(18) 10,0~5.22 x 15 : 1,506.78
(19)= 1,956.78
1,956.78
.00
.00
.00
AHOUNT PAID
1,956.78
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
( IF TOTAL DUE TS LESS THAN $1, NO PAYHENT ZS REI~UIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF TH/S FORH FOR [NSTRUCTIONS.)~.~-*~._~