Loading...
HomeMy WebLinkAbout03-0187PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Social Security No. , Deceased. Register of WAlls for the~ County of (~/07~o~'/d}/~! Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execute in the last wilt of the above ~tecedent, dated and codicil(s) dated ! in the named ,19.__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~t4 ~ lgpr/~, mc~' County, Pennsylvania, with h t~? last family or principal residence at ,_'~,~- /(list street, number and muncipality) Decendent, then ~t~) years of age, died Except as foll0~vs,/decede~t ~lid 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 adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ 'O~m' ~::~qc~x[ f The petitioner(s) abovemamed 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. Sworn to or aJ~f_irl'ned and subscribed~ '~/~~ ~ ~~ ~ ~ / - - ~ore me this ~ day of ~ ~' No. ~ I -~.~- I_,~. Estate Of ---~x(-~\ ~ ~ ~~_~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~.F('5/-I --~,' otOOO-$ 1~ , 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 k4- - ~Q -] - described therein be admitted to probate and filed of record as the last will of--]--~('~e I ~c,-.'-'~ and Letters ~ Cu'3~vo°4"%c~,c~ are hereby granted to FEES Probate, Letters, Etc .......... $ Ia), cid Short Certificates( ) .......... $ cj ._MLP $ lO.OD ~ TOTAL Filed ..... ~J..-..~..-..O...~. ................ R-egister °f Wi~~[ ~ ~~ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil / ' (each) a subscribin~vitness to the will p~sented herewith, (ea~) being duly qualified according to law, depose(s:sly(s).that / ~ / . present and sa: the testat / , sign the as me a~ that / signed asa witness at the request of/Aestat in ~ presence and (in the pr%ence of each other)(3fi the presence of the other subscribing witness(es))./~ / / Sworn to or affirmed and subscribed before ~ // me this __ _ day of {~ (~ame) ........ -~ : 19__ /Addre.sl) / Register . / / REGISTER OF WILLS OF ClIMRFRI ANn COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-03-187 (each) a subscriber heret ach) being duly qualified according to law, depose(s) and say(s) that THFY I~ ~ familiar with the signature of THELMA D ERNST , testat flR g of (one of the subscribing witnesses to) the presented herewith and codicil that THEY believe~ the signature on the will is in the handwriting of THELMA D ERNST to the best of Sworn to or affirmed and subscribed before me this 5TH day of MARCH 2003 19.__ ~'~ '~ ' ~ Regmter THE tR knowledge and belief. d (Name) his is to certi~ that the infbrmation here given is correctly copied fi'om an original certificate of death dui>' filed with me as Local Registrar. The original certificate will be forwarded to thc State \/ital Records ()/,'lice for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. 105A43 ~e¥. 2187 COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH 5 ~sle Dr~ve _ ,~ ~ch~lcsb~.Pa 17055 ~.,~, ~rland ~, ~ ~ ~~oa J~. 10 Strlcker Drive York Haven Pa 17370 , WILL OF THELMA D. ERNST I, Thelma D. Ernst, SSN 172-01-2956A, a legal resident of Pennsylvania declare this to be my Will and revoke all other Wills and Codicils I have made. I direct that the expenses of my last sickness, funeral expenses, inheritance and estate taxes, and the cost of administration, be paid by my Executrix out of my estate as soon after my death as is practicable. All estate, inheritance or other death taxes and assignments are to paid out of the residue of my estate and no taxes shall be apportioned or charged against any person who takes under this Will or otherwise. I give equally to: Dorothy E. Skiba, daughter; Rebecca E. Mulholland, Jeffrey A. Fegan, Alecia E. Staley, Matthew D. Ernst and Jessica R. Antenucci, grandchildren. Wherever in the Will it is provided that any person shall benefit hereunder if such person survives me, such person shall be deemed not to have survived me, if he or she dies within thirty (30) days after my death. I hereby appoint Dorothy E. Skiba of York Haven, Pennsylvania, as Executrix of this my Will, and I request that she be permitted to serve without bond or surety thereon, exempt as required by law. I further give to my Executrix the power to name an attorney at law as co-executor of this my Will, and upon such power of appointment being exercised said attorney at law shall qualify as co-executor. To the extent allowed by law, I hereby waive appraisement and inventory of my estate. This Will is not joint or mutual in any respect with any other Will executed by any other person. If any part of this Will shall be invalid, illegal or inoperative, for any reason, it is my intention that the remaining parts, so far as possible and reasonable shall be fully effective and operative. IN WITNESS WHEREOF, I, ~/7-~ J ~ ~ j~)- ~ w ~43'-'~ have subscribed my name to this Will, consisting of two (2) typewritten pages, affixing my signature to each of the pages for identification this 9~--~day of _O~,~Lfl-_ 19~. SIGNATURE We, the undersigned, saw the above name _,7~,,_ ~o_ x/). ,~/~ ,~ 7c sign the foregoing instrument on each page thereof in our presence. ~,~t.~hen declared it to be .,.3, ~.2 Will and asked each of us to act as witness to it. We then in .Yc~v.~oresence and in the presence of each other signed our names as attesting witnesses. All of this was done on the date last above written in this instrument. - ~z ~ig~t'atUre of'f~itness- ~ - Sigr(~dure of Witness Signature of Testat Page 2 of my Will ACKNOWLEDGEMENT AND VERIFICATION OF LAST WILL AND TESTAMENT OF THELMA D. ERNST . ~I~ID. ER THE PEN.ALTIES FOR PERJURY, WE, ,~d/"c'-~ .~. k-~.xo_~c.~ ~_./--, ._L)6~qr~to 'Z- ~"~and '~.~ o._~ ~x%~) ~'-~c."~ , the testat___ and the undersigned witnesses, respectively, wh6se names'are signed to the attached or foregoing instrument dated the~L2_~q:lay of ~,o~,'/ ,19 ~9, and designated as the Last Will and Testament of ~ _..~Vf ~ , hereby declare: (a) The Testat executed the instrument as ~last will: (b) That, in the presence of the witnesses, Testat signed or acknowledged ~¢- signature; That Testat executed the Will as ~ free and voluntary act for the purposes expressed in it; (c) (d) That each of the witnesses, in the presence of the Testat signed the Will as witness; (e) That, the Testat was of sound mind; and (f) That, to the best of their knowledge, the Testat more years of age. __ and of each other, __ was at the time eighteen (18) or Signature of Testat Signature ~f mtnes3 ' ~/~ Signature of ~tness OF THELMA D. ERNST S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 May 16, 2003 In re: Estate ofThelma D. Ernst; DOD 2-20-2003; SS# 172-01-2956 No. 2003-00187; PA No. 21-03-0187 EIN: 45-6140731 File: 196001 Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Register: Please find enclosed a check from the Estate of Thelma D. Ernst in the amount of $1,800.00, payable to the Register of Wills, Agent. This is a prepayment of the Pennsylvania Inheritance Tax for the Estate. Kindly send the receipt for this payment to me. Thank you for your help. Sincerely yours, S. Berne Smith cc: Dorothy E. Skiba, Executrix S. Berne Smith, Esq. 107 N. 24th Street Camp Hill, PA 17011-3602 Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG. PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ISOClAL SECURITY NUMBER ~NS~i THEL~ D- 1 !72~01~2956 DATE OF DEATH DATE OF BIRTH I TH S RETURN MuST BE FILED IN DUPLICATE WITH THE IFebrUa~20:2003 ; JJuJY26, 1912 ~ REGISTER OF WILLS i~:APP~icABLE~ suRVi~iNG ~pous~,s NAME (~S~: ~,RST: AND MIDDLE iNiTiAL) ISOCIAL SECURITY NUMBER I'-' I ]X]I. Original Return ]2 Supplementa Return I J3 Remainder Return (d,i.o, deahpdo ,o 2- ' ~ 13-82) ~ ~4. Limited Estate ~4a. Future Interest Comprise (date of death a,er ~2-1~-0~) ~5. Federal Estate Tax Return Required ~6. Decedent Died Testate (Attach copy of Will) ~7. Decedent Maintained a Living Trust (A,ach a copyof Trust) 0 ~ ~;~lc~bo~ra~f~r ~PcO~i; ~s I 19. Litigation Proceeds Received ~10. Spousa Pove~Credit(da,eo, deathbe~een~23~ 9~ and~ 95) ~ '. - .~. ( ) REV - 1500 I ...................... ...................... i~;i,';;'~'~'~'~'~ ........ :'"',":: ....... ': ..... 7:::"7' ........ INHERITANCE TAX RETURN I I ~i o3 RESIDENT DECEDENT J CoUNTYcODE I yEAR i NUMBER Z F-Q. 0 O THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME S. Berne Smith ESquire FIRM NAME (If Applicable) ICOMPLETE MAILING ADDRESS 1i07 N 24~h s~eet I TELEPHONE NUMBER 717~737-6789 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) 5. Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Misc. 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) $0.00 $0.00 $0.00 $0.00 $56,594.21 $1,140.57 $0.00 OFFICIAL USE ONLY (8) $57,734.78 $7,898.88 $778.85 (11) $8.677.7~ $49,057.05 $0,00 (12) (13) (14) $49,057.05 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20. ~ $49;057.05 X x .045 x .12 x .15 (15) (16) (17) (18) (19) $0.00 $2.207.57 $0.00 $0.00 $2,207.57 Copyright 2000 David James Thorpe, Esq. Decedent's Complete Address: STREET ADDRESS 325 Wesi~Y Drive ICITY Mechanicsbur9 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 $94.74 Total Credits (A + B + C) (1) (2) $2,207.57 Total Interest/Penalty (D + E) (3) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT $1,894.74 $0.00 $312.83 $312.83 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 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 revisionary interest; or d. receive the promise for life of either payments, benefits or care? 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? 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? Yes No 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 know edge and belief, it is true, correct, and complete, Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. ADDRESS ~' 10 Stricler;D~ ve, YOrk Haven PA t7370 SIGNATUREOFPREPAREROTHERTHANREPRESENTATIVE /~. ~~ ~. ~. DATE ADDRESS 107 N. 24th Street, Camp Hill, PA 17011-3602 DATE 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 no 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. Copyright 2000 David Jmnes Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF THELMA D. ERNST FILE NUMBER 21-03-0187 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 2. 3. 4. 5. 6. 7. 10. Cash on hand a~ date of death Furniture at assisted living apartment (most was donated to the home). Estimated value of retained furnishing Clothing all donated to Good Will Costume Jewelry. Value estimated Refund of unused home owner (tenant) insurance premium Refund of AARP Medical Insurance premium PNC Bank, Performance Money Market - Account # 5080035168 Account was opened 02/28/1997; Date of death balance Accrued interest on Account # 5080035168 (See letter of JUly 10, 2003, from PNC Bank attached hereto) GE Capital Assurance annuity, policy number: 0100378975. Date of death value: (See letter of June 26, 2003, from (SE Capial Assurance attaChed hereto) Glenbrook Life and Annuity Company, contract # AC0002327. Date of death value: I(See letter of July 9, 2003, from Glenbrook Life attached hereto). VALUE AT DATE OF DEATH $7t .25 900.00 0.00 50.00 30.00 127.00 10,941.44 1.37 29,692.07 14,781.08 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $56,594.21 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF THELMA D. ERNST FILE NUMBER 21-03-0187 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. DOR©~HY E. SKIBA i0 St[icke~ D~ige; D~Ughter B. C. JOINTLY-OWNED PROPERTY: ITEM Lb ~ i bR DATE DESCRIPTION OF PROPERTY DATE OF DEATH % OF DATE OF DEATH NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number Attach VALUE OF ASSET DECD'S VALUE OF TENANT JOINT deed for jointly-held real estate. INTEREST DECEDENT'S INTEREST 1. A. = O7/10100 PNC Bank - nterest Checking account # 507'0074147 2,281.14 50% 1,1:40.57 (See letter of PNC Bank dated July 10. 2003 prey ous y attached ) TOTAL (Also enter on line 6, Recapitulation) $1,140.57 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF THELMA D. ERNST FILE NUMBER 21-03-0187 Debts of decedent must be reported on Schedule I. ITEM NUMBER 7. 8 9 DESCRIPTION Reception luncheon Flowers 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 Pa d Attorney Fees: S. Berne Smith, 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 Probate Fees Accountant's Fees Tax:Return Preparer's Fees Short certificates Estate Notice - The Sentinel Estate Notice - Cumberland Law Journal AMOUNT 4,586.00 56.25 104.15 2,886.89 82.00 27.00 81.59 75.00 TOTAL (Also enter on line 9, Recapitulation) $7,898.88 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF THELMA D. ERNST FILE NUMBER 21-03-0187 Include unreimbursed medical expenses. DESCRIPTION AMOUNT ITEM NUMBER 2. 3. 4. Final phone bill Bethany Court Apartment rent Pharmacy bill _~003 personal tax bill 17.90 707.00 44.15 9.80 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $778.85 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J I BENEFICIARIES ESTATE OF THELMA D. ERNST FILE NUMBER 21-03-0187 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I. II. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Dorothy e. Skiba, 10 Stdcker Drive, York Haven, PA, 17370 2. Rebecca Mulholland. 4233 6th Ave., Temple, PA 19560 3. Jeffrey A. Fegan, 542 Appalachian Ave., Mechanicsburg, PA 17055 4. Alecia E. Staley, 1672 Douglas Ddve, Carlisle, PA 17013 5. Matthew E. Ernst, 15 S. Main Street, Watsontown, PA 17777 6. Jessica R. Antenucci, 20 Coover Street, Mechanicsburg, PA 17055 Daughter Granddaughter Grandson Granddaughter Grandson Granddaughter 1/6th of estate 1/6th of estate 1/6th of estate 1/6th of estate 1/6th of estate 1/6th of estate NTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE !B CHARITABLE AND GovERNMENTAL DISTRIBUTIONS : TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. I, Thelma D. Ernst, SSN 172-01-2956A, a legal resident of Pennsylvania declare this to be my Will and revoke all other Wills and Codicils I have made. I direct that the expenses of my last sickness, funeral expenses, inheritance and estate taxes, and the cost of administration, be paid by my Executrix out of my estate as soon after my death as is practicable. All estate, inheritance or other death taxes and assignments are to paid out of the residue of my estate and no taxes shall be apportioned or charged against any person who takes under this Will or otherwise. I give equally to: Dorothy E. Skiba, daughter; Rebecca E. Mulholland, Jeffrey A. Fegan, Alecia E. Staley, Matthew D. Ernst and Jessica R. Antenucci, grandchildren. Wherever in the Will it is provided that any person shall benefit hereunder if such person survives me, such person shall be deemed not to have survived me, if he or she dies within thirty (30) days after my death. I hereby appoint Dorothy E. Skiba of York Haven, Pennsylvania, as Executrix of this my Will, and I request that she be permitted to serve without bond or surety thereon, exempt as required by law. I further give to my Executrix the power to name an attorney at law as co-executor of this my Will, and upon such power of appointment being exercised said attorney at law shall qualify as co-executor. To the extent allowed by law, I hereby waive appraisement and inventory of my estate. This Will is not joint or mutual in any respect with any other Will executed by any other person. If any part of this Will shall be invalid, illegal or inoperative, for any reason, it is my intention that the remaining parts, so far as possible and reasonable shall be fully effective and operative. .... _ ~ I yp ten~ pages, amxing my signature to each of the ~dentfficatmn this ~_.~_.~day of__('~, ~ 19~_.. pages for SIGNATURE We, the undersigned, saw the above name _/~m. ~c, x/). -~A'~/'~ ,~' 7~' sign the foregoing instrument on each page thereof in our presence. ~a.e.~hen declared it to be ~, ~, Will and asked each of us to act as witness to it. We then in ~/'q3resence and in the presence of each other signed our names as attesting witnesses. All o~'this was done on the date last above written in this instrument. ig~ature of'~tritness- ~ Sigt~a~ure of Witness Page 1 of my Will Signature of Testat Page 2 of my Will ACKNOWLEDGEMENT AND VERIFICATION OF LAST WILL AND TESTAMENT OF THELMA D. ERNST r~,~-~ wml.~, respecuvely, WhOSe names'are signed to the attached or fore oin instrument dated the,-~ ~:"Xda,, of /5, ./ ,,,~r~ . . . g g . ~ _ --,.'-i~--~- J ,~,o~, ~, , t v ~7, aha aes~gnated as the Last Will ana lestament of ~ I~F. ~'~.~,~t--- , hereby declare: (a) The Testat executed the instrument as ,.O~ta~last will: (b) That, in the presence of the witnesses, Testat signed or acknowledged ~ signature; (c) That Testat executed the Will as ~ fi'ee and voluntary act for the purposes expressed in it; (d) That each of the witnesses, in the presence of the Testat and of each other, signed the Will as. witness; (e) That, the Testat was of sound mind; and (0 That, to the best of their knowledge, the Testat was at the time eighteen (18) or more years of age. Signature of Testat Signature Of Witnes~ Signature of'~tness Date: July 10, 2003 PNCBAN S. Berne Smith Attorney-at-Law 107 N. 24th Street Camp Hill. PA 17011-3602 RE: Estate ofThelma D. Ernst; DOD 02/20/2003; SS# 172-01-2956 No. 2003-00187; PA No. 21-03-0187 File: 196001 Dear Mr. Smith, Per your request dated June 22, 2003, below you will find the information regarding any and all accounts for Thelma D. Ernst. Only two accounts were located for the above listed customer: Interest Checking - Account # 5070074147 O Opened 10/28/1992, titled with only Thelma's name O Dorothy E. Skiba was added as a joint owner on 07/10/2000 O Both Thelma D. Ernst and Dorothy E. Skiba were listed as joint owners On this account at time of death. O Date of Death balance - $2,281.06 O Accrued interest =$ .08 O Total balance of principal and interest -- $2,281.14 2. Performance Money Market - Account # 5080035168 O Opened 02/28/1997, titled with only Thelma's name O Account was never titled differently nor made joint O Only Thelma's name appeared on account at the time of death O Date of Death Balance: $10,941.44 O Accrued interest = $ 1.37 O Total balance of principal and interest -- $10,942.81 There was no safe deposit box opened at PNC Bank for Thelma D. Ernst. ,~,rely, ,,,, PNC Bank, Branch Manager Upper Allen Office A member of lhe PNC Financial Services Group 12 ] Klm At'res, Drivt' Mechamcsburg P(~mqsylvania GE Capital Assurance A GE Financial Assurance Company GE Capital Assurance $100 AIbert Lankford Dr., P.O. Box 10776 L ynchburg, VA 2450&0716 Toll Free(800) Z21-9501 fax: (434) 544-2902 June 26, 2003 S. Berne Smith 107 North 24th St Camp Hill PA 17011-3602 Re: Decedent: Thelma Ernst Policy Number(s): 0100378975 Dear Mr. Smith: Please express our sincere sympathy to the family of Thelma Ernst. Our records indicate the designated beneficiary of the above policy to be The Thelma Ernst. For all claims the following are required: one certified death certificate showing manner or cause of death for Thelma Ernst the complete original policies. If you do not return the original policies, you must indicate why in the section pertaining to Decedent Information on the Deferred Annuity Claim Form. one certified Letters Testamentary naming the Estate's Personal Representative. This document must be certified within 90 days of receipt by our Company a Deferred Annuity Claim Form completed by Estate Representative for the Estate of Thelma Ernst. When completing the "Claimant Information" section of the claim, please be advised that we are unable to use the decedent's social security number for tax reporting purposes. Please have the Personal Representative review the instruction section pertaining to an Estate Claimant on the enclosed Deferred Annuity Claim Form, for additional requirements necessary to settle this claim. The Designated Annuity Value represents the total annuity value. Policy Number 0100378975 Designated Annuity Value* As Of 2/20/03 $29,692.O7 Taxable Interest Portion $9,692.07 *Interest continues to be credited daily. If assistance is needed, please contact Kathy Yarborough at the toll-free number listed above, extension 4821. Sincerely, Annuity Claims Department Enclosure ksy BUREAU OF 1NDIV/DUAL TAXES TNHERTTAHCE TAX DTVTSTnN DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15~i? EX AFP (D1-03) '0~ FEB25 A8:30 S BERNE SMITH ESQ 107 N 2qTH ST CAMP HILL Ct~mb:;,,,~,~ Co., PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-12-200q ERNST 01-20-2005 21 05-0187 CUMBERLAND 101 Aeoun~ Rae/t'l:ed THELMA D MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOT/CE OF TNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTTONS AND ASSESSMENT OF TAX ESTATE OF ERNST THELMA D FILE NO. 21 05-0187 ACN 101 DATE 01-12-200q TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNTNG 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) $. Closely Hel,d Stock/Partnarsh/p Zntares~ (Schedule C) ($) q. Mortgages/No'es Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jo/n~ly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Daduc~/ons 12. Nat Value of Tax Return O0 O0 O0 O0 56/59q 21 1~1~0 57 O0 (8) 7,898.88 778.85 (11) (12) 13. lq. NOTE Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:5) Net Value of Estate Sub,iect to Tax (lq) If an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. (is) .00 x O0 = (16) q9,057.05 x OqS= (17) .00 x 12 = (18) .00 x 15 = (19)= AHOUNT PAID ASSESSMENT OF TAX: 15. Amount of L/ne lfi et Spousal rate 16. Amount of L/ne lq taxable et Lineal/Class A rate 17. Amoun~ of L/ne lq at S/bl/ng rate 18. Amount of L/ne lq taxable a~ Collateral/Class B rate 19. Pr/ncC)al Tax Due TAX CREDITS: PAYMENT RECE/PT DISCOUNT (+) DATE NUMBER 05-16-200~ CD002577 11-17-200~ CD00$2$q INTEREST/PEN PA/D (-) 9q.7q .00 1,800.00 312.8~ ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To 2nsure proper credit to your account, submit the upper port/on of th/s form with your tax payment. 57,73q.78 ~.&77.73 q9,057.05 .00 q9,057.05 18 and 19 ~111 .00 2,207.57 .00 .00 2,207.57 TOTAL TAX CRED/T I 2,207.57 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 { 1F TOTAL DUE 1S LESS THAN $1, NO PAYMENT 1S REQUTRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR}, YOU MAY BE DUE . A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS.) .,~.~) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 198g -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coamonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Iamful Class B (collateral) rate on any such futura interest. To ~ulfill the requirements of Section ZIqO of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which mas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of gills, any of the Z5 Revenue District Offices, or by calling the special gq-hour answering service for forms orderir~g: 1-800-56Z-lOS0; services for taxpayers with special hearing and / or speaking needs: X-BOO-qq7-5OgO (TT 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. ZBIOZ1, Harrisburg, PA 171lB-lOg1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Interest Daily Interest Daily Interest Daily Year Rate Factor Yaa..__r Rate Factor Year Rate Factor 1982 20Z . O00Sq8 1987 9Z . ooggq7 1999 77. . 00019Z 1983 16Z . 000q58 1988-1991 llZ . 000301 ZOO0 8Z . 000Z19 198q ZlZ .000301 1992 92 . O00Zq7 2001 97. . O00Zq7 1985 132 .000556 1993-199q 72 .000192 gOOZ 6Z .00016q 1986 lOX . O00Z7q 1995-1998 92 . O002q7 2003 5Z .000137 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAZLY ZNTEREST FACTOR Factual errors discovered on this assessment should be addressed in writing to: PA Departaont of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. g80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-lEO1) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (JZ) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning mith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO5 are: --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 be calculated. Gienbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Member of Allstate Financial Group July 9, 2003 Estate of Thelma D. Ernst 107 N. 24th St. Camp Hill, PA 17011-3602 Re: Thelma Ernst Contract Number: GA111794 Claim Number: AC0002327 Dear Estate of Thelma D. Ernst: We, at Glenbrook Life and Annuity Company, are sorry to hear of your loss and extend our sympathy. Your claim for benefits under the above referenced annuity has been completed. A check has been sent to you under separate cover and will arrive within the next five business days. This payment was computed as follows: Annuity Value as of 7/9/2003 Portion Payable to You: Federal Withholding: State Withholding: Claim Interest: Total Net Proceeds: $14,781.08 $14,781.08 $o.oo $o.oo $o.oo $14,781.08 This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable.) A 1099 tax statement reflecting $4,781.08 as your taxable income will be sent next January to assist you in preparing your tax return for 2003. ' The annuity value on the date of death, 02/20/03 was $14,605.82. This may be necessary for estate purposes. If you have any questions or need further assistance, please contact me at 1-877-499-6418. Sincerely, Dawn Wiseman Life and Annuity Claims Enclosures Overnight Address: 300 North Milwaukee Avenue, Vernon Hills, IL 60061 Toll Free Fax: 1-866-635-4523 S. BERNE SMITH Attorney-at-Law 107 N. 24ta Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 March 9, 2004 In re: Estate ofThelma D. Ernst; DOD 2-20-2003; SS# 172-01-2956 No. 2003-00187; PA No. 21-03-0187 EIN: 45-6140731 File: 196001 Ms. Glenda Famer Strasbaugh Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Ms. Strasbaugh: Enclosed is Status Report Under Rule 6.12, reflecting that the Esta'~ ~f The~a D. Emit, Deceased, is now closed. The Family Agreement is being submitted herewith. Also enclosed is my check number 513 on behalf of the Estate in the amount of $17.00, payable to the Register of Wills for filing the Family Agreement in the above estate as part of the status report. If anything further is required, please advise. Please time stamp and return to me the extra copy of this letter for my record, using the enclosed, stamped return envelop provided. Thank you for your attention to this matter. I have appreciated the fine help of the staff in settling the Estate. They do an excellent job. Sincerely yours, S. Berne Smith cc: Dorothy E. Skiba, Executrix (w/Enc.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: THELMA D. ERNST Date of Death: February 20, 2003 WillNo. 2003-0187 Admin. No. 21-03-0187 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Not applicable. 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: Not applicable. Co interest? Yes X Did the personal representative state an account informally to the parties in No D. Copies of' receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attacked to this report. Mard~j~ 9, 2004r Signature S. Berne Smith, Esq. Name (Please type or print) Address: 107 N. 24th Street Camp Hill, PA 17011-3602 Telephone No. 717-737-6789 Capacity: __Personal Representative X Counsel for personal representative S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 January 3, 2003 In re: Estate of Thelma D. Ernst; DOD 2-20-2003; SS# 172-01-2956 No. 2003-00187; PA No. 21-03-0187 File: 196001 Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Register: Please note my appearance as counsel to the Executrix, Dorothy E. Skiba, in the above captioned Estate. Thank you for your attention to this matter. cc' Sincerely yours, S. Berne Smith Dorothy E. Skiba, Executrix CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name of Decedent: Thelma D. Ernst Date of Death: February 20, 2003 File No. 2003-00187; PA File No.21-03-0187 To the Register of Wills of Cumberland County, PA: 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 March 11, 2003: Name Address Dorothy E. Skiba. Rebecca Mulholland Jeffrey A. Fegan Alecia E. Staley Matthew D. Ernst Jessica R. Antenucci 10 Stricker Drive York Haven, PA 17370 4233 6th Avenue Temple, PA 19560 542 Appalachian Avenue Mechanicsburg, PA 17055 1672 Douglas Drive Carlisle, PA 17013 15 S. Main Street Watsontown, PA 17777 20 W. Coover Street Mechanicsburg, PA 17055 Notice has now been given to all persons entitled under Rule 5.6 (a) except: None. Date: March 11, 2003. Name: Address: Telephone: Capacity: X S. Berne Smith 107 N. 24th Street Camp Hill, PA 17011-3602 717-737-6789 Personal Representative Counsel for Personal Representative 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: Margaret T. Bryden Date of Death: Set~tember 14, 2003 Estate No.: 2003-00817 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: State whether administration of the estate is complete: Yes XX No Date: 9/8/04 (MAH:rmt/AM3) If the answer is No, state when the personal representative reasonably believes that the admifiistration will be complete: (date) 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 XX Bo Co The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties in interest? Yes XX No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~~1 atur~ John F. King, Esquire Name (Please type or print) 600 N. Second St., 5th Floor Harrisburg, PA 17101 Address cj~:£d 6-d3S t70. Do Capacity: (717) 236-8000 Telephone No. Personal Representative e.w.- 5~3 XX Counsel for Personal Representative