The URL can be used to link to this page

Home My WebLink About02-0916 PETITION FOR PRODA TE and GRANT OF LETTERS Estate of Wendell A CHAMBERLIN No. 21-02-916 also known as To: , Deceased. Register of Wills for the County of Cumberland Commonwealth of Pennsylvania in the Social Security No. 178-16-6927 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor in the last will of the above decedent, dated Januarv 23 1985 and codicil(s) dated First named Executrix, Lillian M Chamberlin, is unable to serve due to health condition, and therefore renounces. named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 129 Walnut Bottom Road Shiooensbura Shiooensbura T ownshio Cumberland Countv Pennsvlvania (list street, number and municipality) Decedent, then 81 years of age, died 912412002 at Shiooensbura Health Care Center Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never ajudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: r20c:.0 . dO> $ $ $ $ ~ ~ u u " u :s1 ~- u ~ ",,, u ~ " ~.g 3'~ u"'- -~ B 0 . " '" on WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentarv thereon. (testamentary; administration C.1.a.; administration d.b.n.c.t.a.) ~&Lf 5940 Sampache Drive Shiooensbura PA 17257 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF Cumberland The petitioner(s) above-named swear(s) or affirm(s) th" the statemel1ts in the foregoing petition are true and correct to the best of the knowledge and belief ofpetitioner(s) and that as personal represen- tative(s) of the above decedent petitioncr(s) will well and truly ad 'nister the est according to law. '" ~. ~ ;:; , ~ Sworn to or affirmed and SUbSCribedd before me this 9""" day of aber 2002 n?~n./ /7} (J/-z'" / ,:;) L ~e;JJ5r~ J...... A:3~ ,~ N 21-02-916 o. Estate of Wendell A CHAMBERLIN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW October 9 2002 , 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 1/23/1985 described therein be admitted to probate and filed of record as the last will of Wendell A CHAMBERLIN and Letters Testamentarv are hereby granted to Jeffery L Chamberlin r{)JI'MLV/?} fJr.4J ~ ~ _ Register of Wills k -y FEES jcp . . . $ )......$ ....... $ $ TOTAL _ $ OCTOllER .9., . 2Q02. . . . . . 50.00 6.00 ll.UU Forest N Myers 18064 . ~cr Probate, Letters, Etc. . Short Certificates ( x-pages Renunciation. . . 5.00 78.00 ATTORNEY (Sup. Ct. !.D. No.) 137 Park Place West Shiooensbura PA 17257 ADDRESS 717.532.9046 Filed. PHONE r~ HIOS.805 RE\'9186 This is to certify that the infotmation.here given is cortectly copied from an otiginal certificate of death duly filed with Local Registrar. The ongmal certtficate wdl be forwatded to the State Vital Records Office for permanenr filing. me as Fee for this certificate, $2.00 WARNING: "is illegal to duplicate this copy by photostat or photograph. g~g-L~ No. """"""N'''",,,,~ ,""<1>-\"." OF PM"'-. ,"'~....'r",', \,\.::..."'\' ---' -~. .' "J'.,~::.. ~~ ,,"co'-' c ___... ..:,gB!!f". . ':;;., !~(.;- '-"-,- '- ~~ ~CJ -, ,- --: " '~~......."t.'..'.. I~! \*:. .-_-~. -.', -~/*l ~".'..4~"" ,.,.~t"'ENT n{'to";",,'" ........'''h"",'''JJI'''1 ~('~~~ Date p 8710663 . ". . .., COMMONWEALTH OF PENNSYLVANIA. D"-""MENT OF HEALTH. YITAL RECORDS CERTIFICA:, )F DEATH . 81 ~. ....,~,.,.... 1<<,ililIE" 178 _ 16 - 6927 DoG'EOP'I)[.IIFH,,,,,,,,,,n..._1 .. 9-24-02 1oI....""~"'....._l.Ml I. wendell A. Chamberlin AGl'I1_~ UlCll!ltl - - """ -1- ,~.o.,-~ - ~"''"-~ 'lWp. . CO. PA ......0'>lI...~""."...~ M "'" 1-29-21 M...", ~IO Cumberland White ." .,,-=,.;1.<::~ n !bdt Lift Operator ,.. DECRlEHT'IllIM.lNG~.I!lkMI.~Sl-.llpc.oct.l 129 Walnut Bottom Road Shippensburg, PA 17257 ,. fJlh<<JI'1INMElfIoeI.""-.U"" Adam Chamberlin Jeffer;~Chamberlin ,....,,1 __ ......- Married Lilliam M. ...Qt~........... ShiDDensburQ Twp. ............."""'" (.---- ". Reed - ,~ Cumberland mdJ~_=.. _~""""_I!llIr"", Benita Fo~elsan~r - 4 Il aoe ...~;' V'tt,' h. ppenBburg, PA 17257 tOCllFlOtt. .ZIloOool'- Sc:lut:haIpt:al Twp. I CUrb. lb.. PA _____0 .~...... o --- ..""" - 0129S4.-L ---'- Middle sitting cf!IiIlttery P"'gP' 17257 H_. MG _.._..~..,. ---_. ....0 ..0 --- -.- .--.g..-..- . -..- \: ..........- --- ~~OI''''''' OUE1DlOAASA --- ........~LM'f "'M_ MANNER 01' CERM _M - go- - --- 0 -- ...0 ..r;r ...0 ..0 - 0 c.w....._ 1.......- :........... , i """'.. .........-......."'~..... --....;...---....--.."""" "'" l1li HCIiI'IMIl.IfWOCCUfIII'IED_ - ~~"'*'- '~~~~_~____,,____o__""'231 lII__..""'.............___._c___I_____... . a o o o JIl.ACf:C1' ....._,-._,.-..,. ~_.(SQOOl\O\ - ... 0 _0 .. ....~.... ~AHD~~~..._~__'*""""""'_ct_ ...__oot..,-........__..__._._......__....'c.....c.,____....... o lit o 11.11) ~.1-i.- ~r'. 'lex- 1/1 0# ~"",,H IkW- f - hI' ff /JV<. . ~ ...........-.~ClRONO 0Il_....."'~_~.lnmy...._.......'0I0IiIitrrlNI.....1IIM._..andjAe......_..._~..... _..~.... ............... ... AEGISTfWl'S9IGPUlf1JAE frIU/ltKI'I o , ", a fZ.( I~ f r1f ,. .);>; 2--0e~ ." ~ .....-.. " .'-. Law Office of FORllST N. MYERS ... ~ 137 Park Place West Shippensburg. PA 17257 (711) 532-9046 - tI .' (JM-110 (ttb-P- ~z-f~tk (~JufrL /O-7'-{~ r:J,./~~- 91' ((:~~(Lr~[p)o ':'> ~\\. jJ \./ ~ U POWER OF ATTORNEY I, LILLIAN M. CHAMBERLIN, of 130 Middle Spring Road, Shippensburg, , Pennsylvania, do hereby appoint my husband, WENDELL A. CHAMBERLIN, of 130 Middle Spring Road, Shippensburg, Pennsylvania as my agent ("my agent") with full power of substitution, in the event that my husband is unable to serve as my agent, I appoint my son, JEFFREY L. CHAMBERLIN, of 5940 Sampache Drive, Shippensburg, Pennsylvania, for me and in my name, to transact all my business and to manage allmY_Pt()peItyJ~nd affai!"s as I might do if personally present, includi!1Z bittn<:!t limited to exercising the following powers: Durable Power of Attorney-~~-- This power of attomey shall not be affected by my subsequent disability or incapacity. All acts done by my agent pursuant to this power during any period of my disability or jnl:l!P8city shall have the same effect and enure to my benefit'and bind meand~mysuccessors iD."lnterest as if I were competent and not disabled. Management of Assets 1. Cash Accounts. To collect and receive any money an<i assets to which I may be entitled; to deposit cash and checks in any of my accounts; to endorse for deposit, transfer or collection, in my name and for my account any checks payable to my order; and to draw and sign checks for me and in my name, including any accounts opened by my agent in my name at any bank or banks, savings society or elsewhere; and to receive and apply the proceeds of such checks as my agent deems best; and to act as my representative payee for all Social Security, Medicare, a\"ld other federal and state benefits. 2. Stocks andB()nds.To take custody of my stocks, bonds and otheI' inye$nents of all 'Iillids, to give orders for the sale, surrender or exchange of any such investments and to receive the proceeds therefrom; to sign and deliver assignments, stock and'bond powers and other documents required for any such sale, assignment, surrender or exchange; to give orders for the purchase of stocks, bonds and other investments qf any kind and to settle for same; to give mstructions as to the registration thereof and the mailing of dividends and interest; to clip and deposit coupons attached to any coupon bonds, w1:\ether now owned by me or hereafter acquired; to represent me at shareholders' meetings and vote proxies on my behalf; and generally to handle and manage my investments. 3. Personal Property. To buy or sell at public or private sale for cash or credit or by any other means whatsoever; to acquire, dispose of, repair, alter or manage my tangible personal property or any interests therein. / . 4. Real Estate. To lease, sell, release, convey, extinguish or mortgage any interest in any real estate I own, including, but not limited to, on such terms as my agent deems advisable, and to purchase or otherwise acquire any interest in and acquire possession of real property and to accept all deoos for such property; and to manage, repair, improve, maintain, restore, build, or develop any real property in which I now have or may later acquire an interest. . - 5. Safe Deposit Boxes. To have access to any and all safe deposit boxes now or hereafter standing in my name; and add to and to remove all or any part of the contents thereof; and to enter into .leases for such safe deposit boxes or surrender same: 6. Insurance. To .procure, change, carIyor cancenh~urallce of such kfudin such amOunts against any and all risks affecting property or persons against liability, damage or claIm of any sort. 7. Benefit Plans. To apply for and receive any government, insurance and retirement benefits to Which I may be entitled and to exercise any right to elect benefits or payment options. ~. Taxes. To prepare, execute and file in my name and on my behalf any tax returns such as Intemal Revenue Service forms numbered 1 through 10,000, including return, report, protest, application for correction of assessed valuation of real or other property or claim for refund in any connection with any tax imposed by any government and to obtain an extension of time for any of the foregoing or to execute waivers of restrictions on the assessment of deficiency on any tax. 9. Employment of Others. To employ lawyers, investment counsel, accountants, custodians, physicians, dentists, nurses, tilerapists, and other persons to render services for, or to me, or my estate and to pay the usuar and reasonable fees and compensation of such persons for their services. . 10. Claims. To irIstitute, prosecute; defend, compromise or otherwise dispose of and to. appear for me in any proceedings at law or in equity. II. Medical Procedures. To arrange for and consent tooelo withhold medical, therapeutical and surgical procedures for me, including the administration of drugs. ~ 12. Admission Into Facilities. To apply for my admission into medicaJ., nursing, residential, rehabilitation, convalescent or other similar facilities on my behalf, and to sign any consent or admission forms required by such facilities which are consistent with this power, and to enter into agreements for my care by such facilities or elsewhere during my lifetime or for lesser periods of time as my agent may designate, including the retention of nurses for my care. / . 13. General Authority. To do all other things which my agent shall deem necessary and proper in order to carry out the foregoing powers which shall be construed as broadly as possible. 14. Reliance on Power. This power may be accepted and relied upon by anyone to whom it is presented until such person either receives written notice of revocation by me or a guardian or similar fiduciary of my estate or has actual knowledge of my death. 1 S. Hold Harmless. All actions of my agent shall bind me and my heirs, distributees, legal representatives, successors and assigns, and for the purpose of inducing anyone to act in accordance with the powers I have granted herein, I hereby represent, warrant and agree that if tills pIl)Vl:f of attorney is terminated or amended for ariy reason, 1 and my heirsfdistributees, lega(repr~sentatives, SI!Ccessors and assigns will hold such party or parties harmless from any . loss sUffered or liability incurred by such party or parties while acting in accordance with this poWer p!iorto that party's receipt of written notice of any such termination or amendment. 16. Pennsylvania Law Governs. Questions pertaining to the validity, construction and powers created under this instrument shallbe deterniiiiedin, accordance with the laws ofthe Commonweiilih of Pennsylvania. I have signed this power of attorney this;2/p y.4.. day 0[\..,),1";7 U(L, (i~ . 1998. - . d ,.~:e~:M .r! Jfl-r-l.J-n . LlLLIANM. CHAMBERLIN i . Witness c r--~'"-'~ Witness / - " -,> .......- ~. ...- -;, ; . , ,"~-..:.,.,..::,;,: ,.: "~~/j~'-: f,f" -.;.: :(1".' ,.,'. . <. ..: ",;"..'- ~ -." ,~ ~ . . ..' ..,.. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLV ANlA: : SS COUNTY OF FRANKLIN On thi5"2~day of j^.~,^n,... 1998, before me, a Notary Public,.,for the Commonwealth' of Pennsylvania, pe(Sonally' appeared the above-named Lillian M. Chamberlin, who in due form of law acknowledged the foregoing general power of attorney to be her act and deed and desirec;l that the smnemight be l}lCorded as. such. VYlTNESS my han4lb1)1nGt~rial seal the day and year-aforesaid. . . ---.-- --', _..;-'~----".'.;-_.- ~. .~--.J& Notary Public /lOTARIAI. SEAl FOREST N MYERS, NOTARY PUBUC BOROUGH OF SHIPPENSBURIl FRANKLIN COUHlY MY COMMISSION EXPIRES DEe 17 2001 . / LAST WILL AND TESTAMENT OF WENDELL A. CHAMBERLIN I, WENDELL A. CHAMBERLIN, of Southampton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils thereto, heretofore, made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. In the event I am not the owner of a cemetery lot at the time of my death, I direct my Executrix to purchase such lot with a contract for perpetual care and to improve the lot and have erected thereon a suitable monument and marker, using therefor funds from my estate in such amount as she in her sole discretion shall deem advisable. SECOND I give, devise and bequeath all my property, whether real or personal, tangible or intangible, together with all insurance policies thereon, unto my wife, LILLIAN M. CHAMBERLIN, provided she shall survive me by thirty (30) days. In the event my wife fails to survive me by thirty (30) days, I then give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance policies 1 .... ~ thereon unto my children, provided they shall survive me by thirty days, in as nearly equal shares as possible, per stirpes. In the event one of my children dies leaving no children, then I give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance policies thereon unto the surviving child. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate unto my wife, LILLIAN M. CHAMBERLIN, provided she shall survive me by thirty (30) days. In the event my wife fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest residue and remainder of my estate, in as nearly equal shares as possible, unto such of my children as shall survive me by thirty (30) days, per stirpes. In the event one of my children dies leaving no children, then I give, devise and bequeath all the rest residue and remainder of my estate unto the surviving child. FOURTH I appoint the parent to be guardian of the person and property of any chi ld or chi ldren who may be minors at the time of my death. FIFTH I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last will and Testament or otherwise, be paid out of my estate. SIXTH Any and all sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienation, assignment, attachment or pledge and free from control by the creditors of such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. SEVENTH I nominate, constitute and appoint my wife, LILLIAN M. CHAMBERLIN, Executrix of this my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act for any reason whatsoever of my said wife, I nominate, constitute and appoint JEFFERY L. CHAMBERLIN, Executor of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification this day of r,~g , 1985. ~..~...9/t ~~ Wendell A. Chamberlin Testator 3 SIGNED. SEALED. PUBLISHED AND DECLARED by the above named Testator, WENDELL A. CHAMBERLIN, as and for his Last Will and Testament, in the presence of us who at his request and in his sight and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses: ~~ ~~~ u i~ COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF FRANKLIN : I, WENDELL A. CHAMBERLIN, the Testator whose name is signed to the foregoing instrument, having been duly qualified according to law. do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~~ Wendell A. Chamberlin Testator Sworn or affirmed to and acknowledged before me by Wendell A. Chamberlin, Testator, the ~~ day of Ja.lLlor,/ 1985. Q'fU- O. Cu.o~ Notary Public JOYCE A. Cl/OUSE, NOIA~Y ~UBUl; stUlllAlIl'fON TWP., FRANKlIN COUNTY I IIY COMMISSION EXPIRES JAN. 5, 1987 , ItmbH. Pennsylvania Association of Notaries 4 COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF FRANKLIN hra,f N. /V}'I"-<' : We, and 4-fr,'cirv LV. f)}as,oru witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw WENDELL A. CHAMBERLIN, Testator, execute the instrument as his Last Will and Testament, that he signed it willingly and that he executed as his free act and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen or more years of age and under no constraint or undue influence. ~ +- 1-3C- , ., 1:~z.-,-,,- u I.~y__. Sworn to and subscribed before me by F:,r<.si IV M'(Lr~ and &iCicu uJ. fV7CUin'U ,witnesses, this day of 1985. (]'o/et- a c.~ NotMY Public My Commission Expires: JO~Ci. A. C~WuS[' r~::rf"X\' :11;';,iUC SOUlllAMPTON l\VP.. fkAkiili~ CDUNTY MY COMMISSION EXPIRES JAN. 5. lSa7. Member, Pennsylvania AssociZition of Notanes 5 j2 CERTIFICATION OF NOTICE UNDER RULE 5.6(!!} Name of Decedent: Wendell A Chamberlin Date of Death: September 24, 2002 Estate No.: 21-02-0916 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 14, 2002. Name Address Lillian M Chamberlin c/o Jeffery L Chamberlin, 5940 Sampache Drive, Shippensburg PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: - \~)r. Forest N. ~ers, Esquire 137 Park Place West Shippensburg, PA 17257 (717) 532-9046 Capacity: _L Counsel for Personal Representative LAW OFFICg FOREST N. MYERS 137 Pork Place West, Shippensburg, Pennsylvania 17257 December 27, 2002 717/532-9046 Fox 717/532-8879 ~t fn myers@earfhlink.net Recorder of Deeds Cumberland County One Courthouse Square Carlisle PA 17013 Re: CHAMBERLIN, Wendell (deceased) Estate No. 21-02-00916 Ladies I Gentlemen: Please find enclosed the original and two copies of the Inheritance Tax Return for the above estate. Please time-stamp and return a copy to me in the enclosed self-addressed, stamped envelope I have provided. - Sincerely, ~ -:\ ~ Forest N. Myers FNM/ash , , -...'.~ Enclosures Original and two copies - Inheritance Tax Return Return envelope F:\Word Processing\Letters\cumb co rec.RE chamberlin, wendell.lnhTaxRet trans Itr.27Dec02.doc LooVorus on the we6 at forestmvers.lawoffice.com Commonwealth of Pennsylvania County of Cumberland 21-02-916 RENUNCIATION Estate of Wendell A CHAMBERLIN No. also known as , Deceased The undersigned, Lillian M Chamberlin, wife, Executrix (Relationship) (Capacity) of the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamentary be issued to Jeffery L Chamberlin C'jt- 2002 Witness my hand this ( Ignature) a, amberlin by her Attorney-in-Fact, Jeffery L Chamberlin 129 Walnut Bottom Road, Shippensburq PA 17257 (Address) ~ (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me th is day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 ".~.j'OOElI+(HOI. . IL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT >'T'!',!!" -11-_9 ?J- ,;rCNLY J '3n COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT.280601 _!"ARR~BURG, ~~~~.i'601 FILE NUMBER I ~ 21 02 00916 NU_MBER ~9UNTY CODE_ X~~__ ~ % W Q W U W Q l~E~:~~~l~:,M~~:;~~R~' AND MIDDLE!NITIAL) --- ~A;~:;~~; (MM-DD YEAR)- 1 ~A:;2::;;: (MM-DD-YEAR) I{IF APPLICABLE) SURVIVING SPOUSE S NAME ( LAST, FIRST AND MIDDLE irilTlAL) I Chamberlin, Lillian M - ~ -1 Original Return - -0--2 Supplemental Return I 0 4. limited Estate 0 4a. Future Interest Compromise (date of death after 12-12-82) , ~ 6_ Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust} ! 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0) ItA's SECnOIl MUST BE COMP~\;C COR-~~;;~=D CONFIDENTIAL TAX '"FQRMATrGN $flQUillD BE DlRECTE~- ....... . -- F- I COMPLETE MAILING ADDRESS - - Forest N Myers FIRM NAME (If applicable) ~ La", Offices of ForestN Myer~_ mp::~~:~~~~ p~eg257 ELEPHONE NUMBER , 717 /532-9046 SOCfAL SECURITY NUMBER 178-16-6927 I I n o 5 Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS --- ---- - SOCIAL SECURITY NUMBER w ~ :w::::!:(/) u~~ w~u %00 u~~ ~m ~ < 3. Remainder Return (date of death prior to 12-13-82) .~ ~ffi ~Q 0% ul( 1. Real Estate (Schedule A) (1) iT' UA, None None None None 12,225.79 None None (8) 2,743.40 12,225.79 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sote-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) % o il ~ ~ K ~ w ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or C) 8. Total Gross Assets (total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (5) (6) (7) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 2,743.40 9,482.39 12. Net Value of Estate (Line 8 minus Line 11) (12) 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) (13) (14) 9,482.39 SEE IIlSTRUCTIOIlS all REVERSE SIDE FOR APPCICABCE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 9,482.39 x .00 (15) or transfers under Sec. 9116(a)(1.2) % .045 (16) Q 16.Amount of Line 14 taxable at lineal rate x ~ ~ ~ ~ 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u ~ 18. Amount of Line 14 taxable at collateral rate ~ x .15 (18) 19_ Tax Due (19) 0.00 0.00 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>BE SliRETO AIlSWt!R'ACi.. QUESnOIlS Oil REi/ERSE SIDE Allb RECHECK M~_H << --~.:. Copyright 2000 form software only The Lackner Group, Inc. Form REV-1600 EX (Rev. 6-00) , Decedent's Complete Address: STREET ADDRESS 129 Walnut Bottom Road CITY Shippensburg I STATE PA I ZIP 17257 --- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0,00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (3) 0.00 (4) (5) 0,00 (SA) (SB) 0.00 TotallnterestlPenafty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT. Check box on Page 1 Line 2Q to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE Make Check Payable to: REGISTER OF WILLS, AGENT 1. Did decedent make a transfer and: 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?.. ..........--.. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No ~ I o .......0 o ~ ~ ~ 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 pe~ury. 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 preparer otherthan the per~o(1al representative is based on ell informEltion of whichpreparer has any knowledg~. :~~?Z--Z~: . -:~~ -j~:Jo~~~';lim DATE \ 2- L'-\. <.e-:;,,-_ - DATE SIGNATURE OF PREPARER OTHER THANREPRESENTATl\lE AOORESS --DATE )<,. t' > ~- 137 Park Place West Shippensburg, PA 17257 \ ~ _Lq... LQ..~ 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. 99116 (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 statutecloes not exemota transfer to a surviving spouse from tax, and the statutory requirements far disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death an 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. 99116 (aJ (1)]. The tax rate imposed on the net value of transfers to or far the use of the decedent's siblings is 12% [72 P.S. S9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEjl,.L TH OF PENNSYL'VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~- ESTATE OF Chamberlin, Wendell A ~I FILE NUMBER- 21 - 02 - 00916 --' Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 12,175.18 Orrstown Bank, checking account #102000837, balance plus accrued interest 2 Blue Cross/Blue Shield refund 50.61 TOTAL (Also enter on Line 5. Recapitulation) 12,225.79 *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRA TIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chamberlin, Wendell A I FIL-E NUMBER 21 - 02 - 00916 Debts of decedent must be reported on Schedule I. ~~~~EI<JFUNERAL EXPENSES~ DESCRIPTION 1 Wagoner's Memorials, headstone marking I' AMOUNT I B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Jeffery L Chamberlin Social Security Number(s) I EIN Number of Personal Representative(s); Street Address 5940 Sampache Drive City Shippensburg State PA Year(s) Commission paid Attorney's Fees Law Offices of Forest N Myers Zip 17257 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Lillian M Chamberlin Street Address 129 Walnut Botlom Road City Shippensburg State P A Zip 17257 Relationship of Claimant to Decedent Spouse Probate Fees Register of Wills Cumberland County, probate fees Register of Wills Cumberland County, filing fees 4. 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Shippensburg Health Care Center, final medical TOTAL (Also enter on line 9, Recapitulation) 670.00 650.00 650.00 78.00 15.00 680.40 2,743.40 '. " FrLE LAST WILL AND TESTAMENT OF WENDELL A. CHAMBERLIN I, WENDELL A. CHAMBERLIN, of Southampton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and Codicils thereto, heretofore, made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. In the event I am not the owner of a cemetery lot at the time of my death, I direct my Executrix to purchase such lot with a contract for perpetual care and to improve the lot and have erected thereon a suitable monument and marker, using therefor funds from my estate in such amount as she in her sole discretion shall deem advisable. SECOND I give, devise and bequeath all my property, whether real or personal, tangible or intangible, together with all insurance policies thereon, unto my wife, LILLIAN M. CHAMBERLIN, provided she shal,l survive me by thirty (30) days. In the event my wife fails to survive me by thirty (30) days, I then give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance policies I ~ thereon unto my children, provided they shall survive me by thirty days, in as nearly equal shares as possible, per stirpes. In the event one of my children dies leaving no children, then I give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance policies thereon unto the surviving child. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate unto my wife, LILLIAN M. CHAMBERLIN, provided she shall survive me by thirty (30) days. In the event my wife fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest residue and remainder of my estate, in as nearly equal shares as possible, unto such of my children as shall survive me by thirty (30) days, per stirpes. In the event one of my children dies leaving no children, then I give, devise and bequeath all the rest residue and remainder of my estate unto the surviving child. FOURTH I appoint the parent to be guardian of the person and property of any child or children who may be minors at the time of my death. FIFTH I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last Will and Testament or otherwise, be paid out of my estate. 2 SIXTH Any and all sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienation, assignment, attachment or pledge and free from control by ~he creditors of such beneficiary. All shares of principal and income herein given shall be free from anticipation. assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. SEVENTH I nominate, constitute and appoint my wife, LILLIAN M. CHAMBERLIN, Executrix of this my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act for any reason whatsoever of my said wife, I nominate, constitute and appoint JEFFERY L. CHAMBERLIN, Executor of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification this day of !k-rv, j.J v . 1985. ~/~~~ Wendell A. Chamberlin Testator 3 SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, WENDELL A. CHAMBERLIN, as and for his Last Will and Testament, in the presence of us who at his request and in his sight and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses: ~~ '-hk~~--- U /.~~ COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF FRANKLIN : I, WENDELL A. CHAMBERLIN, the Testator whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it Willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~~ Wendell A. Chamberlin Testator Sworn or affirmed to and acknowledged before me by Wendell A. Chamberlin, Testator, the ~~ day of 1985. Ja~lLlar'../ I ':~ o/C! _0. c,...a?<..~ Notary Public JOYCE 4. C:i"UZE, NOTA;::r PUBUC Swm~lIrrOH TWP.. FRA~KU~ COUNTY . I III CGIlMISSION EXPiRES JAN. 5. D<l f.otmblY.'. Ptitnsyl..znia AS$oci~t!(.i1 "f r~ot::ri!:s 4 COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF FRANKLIN hr~d N. /Vi'if.." : We, and I1f,-,cicu Lv. fJ7as.OTL) witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw WENDELL A. CHAMBERLIN, Testator, execute the instrument as his Last Will and Testament, that he signed it willingly and that he executed as his free act and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen or more years of age and under no constraint or undue inf 1 uence. ~I..lcr- ., , c'1:-t:.:.-~,--,-- L/ ~-<>-,_ Sworn to and subscribed before me by ;:;'~5i IV. M'f<'r<; and IJ.+'-icia, uJ. f\l74.!;0lV , witnesses, this day of 1985. (ttjl!t.O C~ NotMY Public My Commission Expires: J{!iG~ A. C:U::iJ~E. f!\Y:'1S:'o' :11};:~IG S!:rU11iAlliPTON lWP.. FRA~i{U~ C~Ui'iTY illY CCklkllSSION [XPIR[S JoN. S. IS.7 fhmber. Penosylv.tfira Assodzt1cm of Notaries 5 . "";.';.' .....<.:. .- .", . ......,.-., ',~, ,f,,' ORRSTOW ' .~{~:~,i~;,,::,~;ti;t~ '. ." , . """"'B'ANl("" ,"., ,. ..' L " ;:"..',' , ( j.\" " if" <~?- f' :J Y,l' , ',., >' . '0 ';,,-,.~);,'.:kt~._ ;':'L ""'I:~" _, "'i\>. ~, \ ~{r..\ t':~-J{9'.' ~: . ; i, .. RECEIVED OCT 2 2 2002 ,';" - "":.:"~':;j;,.}.:f-1':,,,, ">,('. " TO: Forest N Myers 137 Park Place West ShippensbLirg, PA 17257 , LAW OFFICE FOREST N, MYERS FROM: ORRSTOWN BANK P,O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Wendell A Chamberlin DECEASED DATE OF DEATH: September 24, 2002 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOllOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS , DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST 102000837 WendeilAChamberlin 3/25/02 12,174.85 ,33, , (2) SAVINGS ACCOUNT DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST Date: 10/21/02 By: Timothea Customer Service Operator, PO Box 250. 5hippensburg. PA 17257. (717) 532.6114. (717) 532-4143 Fax. www.orrstown.com 17-9<8-/.8 \ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-06DI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX FOREST N MYERS F N MYERS LAW OFFICES 137 PARK PL WEST SHIPPENSBURG PA 17257 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-25-2003 CHAMBERLIN 09-24-2002 21 02-0916 CUMBERLAND 101 Anount _itted '*' REV-1547EJ:AFP IU-B5) WENDELL A MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REv=is4-iTX--AFP-fiiFo3rN0'1:Ici--oF-YNHiii'iTAiicE-YAX-APPRAisiMENT~--ALLciiiiAiicE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHAMBERLIN WENDElL A FILE NO. 21 02-0916 ACN 101 DATE 02-25-2003 TAX RETURN NAS: (X I ACCEPTED AS FILED I CHANGED I~ an assessment was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total ~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. A~unt of Line 14 at Spousal rat. (15J 16. Amount of Line 14 taxable at Lineal/Class A rat. (16) 17. ADOunt of Line 14 .t Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due AX R TS' RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Est.t. (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C] 4. Hortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/H.lsc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Tot.1 Assets (II (21 (31 (41 (51 (61 (71 .00 .00 .00 .00 12.225.79 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral ExPenses/A~. Costs/Hisc. Expenses (Schedule HJ 10. Debts/Mortgage Liabilities/Liens (Schedule I) II. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~) 111I. Net Value of Estate Subject to Tax (9) 1101 2,743.40 .00 Ul1 1121 1131 1141 NOTE: 9,482.39 X .00 X .00 X .00 X DATE AI1DUNT PAID NUH8ER INTEREST/PEN PAID (-I TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, sub.t t the upper portion of thts forn with your tax PIaYll....t. 12,225.79 ?743 40 9,482.39 .00 9,482.39 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 1191= .00 .00 .00 .00 IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAY 8E DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 RE: Estate of CHAMBERLIN WENDELL A File Number: 2002-00916 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. ~uly 1, 1992, the -- _uKET NO. 1, for de ..... COURT RULES, NO (2) years ~r~onal represent ' ~_u~uenEs ~yin on r ~2 of the atlve ~z his g o ..... ~ Wills a S~-- ~ dece~ent's death, shall f' . ~ c°u~sel, within two ~uus ~eport of comDlete~ .... 11~ wmth ~ne Re i ~- ~ ~z uncomnl~ .... g stet of ~ ~u ~mlnlstration. This filing will become delinquent on: 9/24/2004 Your prompt attention to this matter will be appreciated Thank You. · Sincerely, GLEN-DA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: WENDELL A CHAMBERLIN Date of Death: 12/24/2001 Will No.: Admin. No.: 21-02-091 6 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 w,__~ether administration of the estate is complete: Yes j~(_] 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 rep~,~entative 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 re~sentative state an account informally to the parties in interest? Yes ~ No ~-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature Address Telephone No. Capacity: [-] Personal Representative [~(.Counsel for personal representative