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Home My WebLink About02-0919 Estate of C~",I>e.,.I~ Register of Wills of DaI::J131=liFl County, Pennsylvania PETITION FOR GRANT OF LETTERS MAr',,! A..te..1 G.........her No. .Q\-O;;l-,\\q also known as , Deceased Social Security No. 2./1-2.).- (.."/", P"ri';OOle.M,whoiBlarelByea,.olegeo,oIde',applyliulloo; (COMPLETE "A" OR "B" BELOW,) Q A. Probate an Grant of letters and aver that Petitioner(s) is/are the execut~ named in the Last Will of the Decedent, dated 1# IS' 8 and codicillsl dated State rele".....t ciroomst"nC&$. e_Il_. renunciation. dearh"feKecuror. etc. Except as follows, Decedent did not marry, was not divorced, and did not have 8 child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: Q B. Grant of Letters of Administration 1(;.l.a"d.b.n,c,"".:pef1de'..eli.e;du'lIOleablJe,nia;dur..."eminori'"te) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse lif anyl and heirs, I Name Relationship Residence I I I J;; IN ALL L;:A;,t:;':I Attacn aaaltlonSI sheets if necessary. Decedent was domiciled.~t death in (! LI~b<<,.("....J: residence at .., /~ No .,~ S'f. c..-~ /.1;/1 'fA lall~l..el."unnb." ldrn.>nicip),IVJ 'l / /:J. f County, /70/1 Pennsylvania, with his/her last family or principal Decedent, then ACf years of age, died .20 D~ at CA'.',!'" C.OIl4.... "3J<I...... UOS6;C~I:.t_&.. 1),1..,"""'0" "..:&, Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property .............................. $ (If not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . $ (If not domiciled in PAl Personal property in County. . . . . . . . 0 . . 0 0 . . . . . . . . . . . . . $ Value of real estate in Pennsylvania ..... 0 0 0 0 0 0 . . . . . . . 0 . . . . . . 0 . . 0 . . . . . . . . . . . . . . . 0 . . $ Real Estate situatedT::8;0Ii~~~:' 0 oil#," 0 . . 0 0 0" 0 -... ..... ..00.00.. . .. . ... ... . . . 0 0 ...0. 00' $ . , 7, "of!> , 00 o Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil{s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence ole...'" 'PI.. .."",10__ RW-7 1'"':J.-ql../-? Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitionerls) and that. as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. j'tt~ yf~A. ':'~~..(J- Sworn to and affirmed and subscribed before me this cl. A'ld. day of ()iUJiA~ 20~ ~(jj.7J{~ DECREE OF REGISTER Deceased No. aJ . O~. q Iq Estate of MARY ADEL GAMBER also known as Social Security No: 211-22-6441 Date of Death: 9-12-2002 AND NOW, OCTOBER 10, 2002 ,~_, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented befor!1:me, IT IS DECREED that letters []I:: Testamentary 0 of Administration TESTAMENTAE"Y are hereby granted to jC,!.8.;d.b.'u::.!.; pe~(I/:(1telile;durante eb""".ia; du,amemir-.o,"""c) JEAN PHYLLIS GAMBER HENRY in the above estate and that the instrument(sl. if any. dated 1 0-1 ~-1 qqR described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES letters........ ..,................ $ Short Certificate(sl.......... Renunciation................. . Affidavit ( l............,.... Extra Pages ( )............ CodiciL......................... JCP Fee........................ Inventory & Tax Forms... Other,........................... 115.00 .~_. ~Mn~j\t>.~~,~"'cr.nl,.I.~~ .. \ ':1::'0 RegISter of Wills $ 1 ? nn $ 5_00 $ $ 6.00 $ $ 5.00 $ $ Attorney: I.D. No: Address: <.113 TOTAL................ $ 141 00 Telephone. mailed to atty 10-10-2002 DATE FilED: ilW-7a HIO'i,80'i REV 9/86 This is to cerrifY that the infotmation hete given is correctly copied from an original cerrificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. \\IIII(~\.1"'Orpi1---.~~ l";os~..',",."., . '.t~\. t~_. ". ~, ~~. ' -~.- -,- "P~ ~~..~ .' '.' \~~ 1<.>1. . _llf_fi-.- I.:r:.. ~ 1. .\'.'_. ~'.:-~/*i ~~r::J~'/ '".,:?l4fENl ~\ ~'<i""", "'''''''''''###1,,1/111,1 /) // -;!,~.., ~,.., t.~....!....'" -' //, {,'/r" .".' v . . '" ~?"4 Local Registrar ,;;-? ~..:'~,"_._" ,;..--/ d Fee for rhis certificate, $2.00 P 8387805 SEP 1 5 2002 Dare ',;_14JR...2J87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH AGE(l_~ UNDER 1 YEAR - "" Mel Ganber UHOER 1 0Ifr oRE OF BlATH ....... I ..-- .-Day....1 : 4-4-13 ." 2. FEmale ST.llJlF"'"~UIlOSEA SCCIA~ SECln'IlTY t-lUt.l&f:R NAME OF oeaOENT If.._ MoOo:Ie, L_, .. ..211 - 22 -6441 ONEOFOERl(,_.Oa,,'....., . Septffilber 12, 2002 89 BlRT~IC"V_ ;w.0I h:r""l"CounIrYl LancastE"x, Pa. MAflfTAlSWUS.'-- '--Mlnillcl.~ "'""'""- .4. Widowed ,. ~OFOERHOCI><<."'''v''''''.__,,,..,_..on__ HOSPITAl.: ~O E~....[j ="YIO COOHT< "'....... .. CITY. 8OAO. TWPOF DEAfH , FAClUrv NAMElN_"'-'-'.gM!5II_anll~1 } Dauphin ... Susquehanna Twp. Carolyn croxton Slane Hosp. Res. DECEDENt'SUSUAlOCCIJAllJlON KlNDOFIlUSlNESS/lNOUSTAV -SDfCEOENTEVERIH ,,",c-lur>dllf kaan.dur _ U$.AAUEDfOACES1 '7--,;::IJOI>OI"'~ed. .....0 ,.~ 11 'l\=!! bar 11~. Education-SChools I . DECEDENT'S MAILING ADORESSjS/l.... c.rno-. s... z'" c.m.l 212 N. 32nd Street canp Hill, PA 17011 .. PE>.nnsy 1 van1a .. - .... ,,~~ Hill .......1 17..K1~~="" ..........'1:-' MOTHER'SNA/lE,f.:II,ModOle.~Sul""'" Mary pachelbel ". "'''"'1'5~~'''ill-'t~'''l';!town, PA 17036 P\.ACEOFOISPOS/11ON....."'c.-,.~ lOCRJON.~~.lipeoo. ~"""- !h.D _.___.......110 ... ,~ MJHlR'S NAME (First Moo<k ~alIll .~ WClRMANT'SNAME(TypM'<onQ n.. Ctmbt?.rland Willian Garden Jean Henry ........"''''''''''''''" O ~Kl c........O --- """ "L ..........."', ~"-s-.O 21c. E. Petersburg I'Enn. HMlEANOAOOFIESSOFFACIUTY ,,-. E. Pe-tersburg, PA ~ lICENSE NUMBER ... ~tJ I'/(,D"f-L _ ""'_OIrftP1'~"'_._lIf_laoM. ... ,......... ,"'-~ :-_.... , i ~K1 """~ Ollw~cor.dlIioI-.---.IIl.....bolt ...-....in....~_....inf\lUfT1. . P<;~c....Vf) OUllDlOflASACONSEOUENCE Of): E DUE lOtoRASACONSEOUENCE Clf), OUE 1'OlORASACQIISEauENCE Of): WEREAliTOPSYF-.otNGS YANNER ~ tlERH ...............'" COMPLETION OF CAU6E 0 Of"DERH7 -- ........ - 0 "-lini~ 0 ",0 ~O ....... 0 CcIllldIlllt""__ 0 DAn;: OF INJURY _Oav._l liME OF INJUAY INJtJRV fIi1 WOfIK7 DESCRIBE HOW ItUIAY QCC:I.IfVtED. .. 0 NDO M. .... CEllTlFlEIIo.-only~ 'C&lT"'_PflYSICIAII(Pl'l~c"lIlyInQ_d___plty&c_Ilal;",~"""'''<loI'I(Ic<llTlJHOC<l,"",,231 ................,_........_oce__.._cauMi.)....._......... . ... PlACEOFlNJUflY-A1_._._.IacIooy.o/lII:e bu*lIng,-,~ _. LOCRION(Sll...~SlaIiI) .MlOlCAl.. UAMIHERICORONER On.... bHilaot ......w..t1on ando'Ol'Iowe.......... in lilY oplnioft.d..lhocc"....., at the lime. d.le,;lnd ~., .odd...lo the C8Use(., and _..,.calM.. ............. :11.. REGlSTRAR'S SlGN,.,E AND NIJM8~J\-"; ..:'_.>_~I.r....I,'~,' ,," . '.~ '< ~:~~-;:~-~, .;-,'.'-:.~t..:/ -- o '#1'tIJHa I'tCINGAHOCERTIFYINQPH'tSCl4Ni~b<;Jr."'o'''''''''''''9<led''d'ldce<lllyonglOc.>u500OI_1 T.__OI.'k/Io..'-dgtI.....IKlC......._...........~......pl..........d...IClI...""....I_m."""....l.I".. Lz.,( ,.(, '" I n. IlATEFIt.EOl"""",_0a1.'lea1l " ..4:1 1--1 .Joe ... WILL ~1-o~-9 Iq I, Mary Adel Gamber, of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Will. I intend this Will as my last Will revoking all previous Wills and Codicils. I intend that this Will dispose of my property at my death. The natural objects of my bounty are my daughter, Jean Phyllis Gamber Henry, my sons, Samuel Melvin Gamber and Russell Garden Gamber, and my grandchildren, Matthew Gamber, Gretchen Brodie, Tammy Simonetti, Todd Henry, Mark Gamber and Colin Gamber. These are the beneficiaries of my estate. I direct all of my legally enforceable debts (including any expenses of my last illness) and my funeral expenses be paid before distributing my estate. Dispositive Provisions I. I give and bequeath all of the items of tangible personal property that are designated in a list, if any, in my handwriting, signed and dated by me at the end thereof, and attached to this Will, to the persons specified in that writing. II. I give and bequeath all my shares of stock in Hershey Foods and Rite Aid to be divided equally among those of my grandchildren, heretofore named, who survive me by thirty (30) days. If any grandchild does not survive me by thirty (30) days, or has predeceased me, I direct that that grandchild's share of the stock go to his or her issue, if any, per stirpes. If that deceased grandchild dies without issue, then I direct that that grandchild's share be equally divided among those of my grandchildren living at my death or deceased but leaving issue. If the transfer of this stock causes a generation-skipping tax event such that the value of the stock exceeds the allowed exemption under !l2631 of the Internal Revenue Code, then I direct that that stock, the value of which exceeds the exemption allowed, be divided equally among my children who survive me by thirty (30) days, per stirpes. III. All the rest and residue of my estate, real and personal, I devise, bequeath and appoint to my children, heretofore named, to be divided equally among them if they should survive me by thirty (30) days. If any of my children shall not survive me by thirty (30) days, I devise, bequeath, and appoint that child's share of my estate to that child's issue, if any, per stirpes. IV. I order that any gift here disposed that has any debt or encumbrance attached to it is devised subject to that debt or encumbrance. V. Any debt that any of my children or grandchildren have that is to be paid to me must be paid to my estate before that child or grandchild takes under this Will. Page 1 of3 Ch1~/.?~L J' ~ MARY L GAMBER Executor I. I appoint my son, Samuel Melvin Gamber, as my Executor. If he is unable or unwilling to serve, I appoint my daughter, heretofore named, as Executrix. II. I authorize the Executor of my Will, with respect to all property, real and personal, in addition to the powers conferred by law, to do the following: a. retain assets b. purchase investments c. hold cash d. vote and grant proxies e. sell, exchange or dispose of all said property f distribute in cash or in kind g. delegate to agents powers over said property h. assign or compromise claims I. lease, manage, develop real estate ]. borrow funds k. abandon property l. make certain tax elections m. receive and use employee benefits n. invest in its own securities or common trust funds III. The Executor of my Will shall not be required to furnish any bond or other security for the faithful performance of his duties in this or in any jurisdiction. IN WITNESS WHEl:OF, I have set my hand and seal to this my last Will and Testament this IS day of O...f" 6.e.r , 1998. WcPt;{i~L~/Zn~/ Mary del Gamber Signed, sealed, published and declared by MARY ADEL GAMBER, the above named testatrix, as and for her last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses. ~,I.Ld itness ..5-.53 HPj IJ"E.~IIE. J{bH~~:/fI1. IT.:>3J / Address Page 2 of3 CJ-t1 jJ~A'fb# ~xlm/ MAR EL GAME .~,Ii,t~it'"rJ Wt ess 0"3 E/"", Ave-.j.k;$~72 IJO~ 3l Address ~~~ \lAA- W ness ~u ~ ~ fM. \~~~A- n\:iS~ Address COMMONWEALTH OF PENNSYL VANIA: COUNTY OF DAUPIDN : SS e, MARY ADEL GAMBER, l)......i e( ~. 5e;" er l~ ' j.....e. . <;;e:V , and .);"'" {~lor , the testalrix and the witnesses, respectivel , whose names are signed to the attached or foregoing instrumeni, being ftrst duIy sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrumeni as her Will and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witness and that to the best of his or her knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. J~J.:}i!JA'7 . I ttness .l4<~J1. ,~~ WI ess ~~ \~ Wit ss ~(~t/~~4#~~ MYEL GAMBER Subscribed, sworn to and acknowledged before me by MARY ADEL GAMBER, the testatrix, and subscribed and sworn to before me ~ D........,e.( S. 5eiue.r/,'1 )"....,e ~ $'(.(Ven, , J:..... 1~/or , witnesses. this I da of Dc-I-<> "e.. ,1998. Pag," 3 of3 No;:arial Seal Kathryn S. Ta'IIo,. Nota!'\j Public Derry Twp.. Dauphin C"""tj My Commission Expi,es Aug. 26, 2002 08/26/02 TBU 14:24 FAX 92552749 REGISTER OF WILLS IaiOOl Register of Wills of Dauphin County, Pennsylvania RENUNCIA TION ;?l!a;J Ad'dtfl~er No. :J I -('J:L -'11 q Estate of also known as . ,Deceased The undersigned. SO-~()e!_l2;(~~fr,~h~ So",", of tl'1. above Decedent, hereby renouncefs) the right to administer the estate and respectfully reQuest(s) that L~fUrsf{;k-7 be Issued to Jeo..... -Ph.y//; s Q 4..mb-er- /-Je......(f Witness ~ hand this I ,.... dey of O,*- '-.(,f" . 20 /!I 2..- . '/. ~~J:LflAJ (Signature' X 3'fr €~~~ ~I . "I (Signature) IAddr..sl " (Signature) (Address) ...............oIN......,.........I.... ,,*1" \D 1IhlI...... ....... '"-"... "I "'_OfNOulry'.~.1 NOTE: Renunciations executed outBid. tne Office of Register of Wills ale requirod In ItClm$ countlee to be notarized. RW-13 (Rvod 9/92) NCTA l l KATHRYN S TAYLOR NotaryPullhc Derry Township Dauphin County My Commission Exp"es August 26. 2006 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1112B-Of3.01 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT TAYLOR KATHRYN S ESQ 308 ELM AVE HERSHEY, PA 17033 -------- fold ESTATE INFORMATION: SSN: 211-22-6441 FILE NUMBER: 2102-0919 DECEDENT NAME: GAMBER MARY ADEL DATE OF PAYMENT: 11/21/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/12/2002 NO. CD 001874 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,500.21 I I I I I I I I TOTAL AMOUNT PAID: $3,500.21 REMARKS: CHECK# 2694 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS REV-15i10fXIS-DOl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY W 0- ~.g,t/) <.> "'"~ w"-<'> ,,00 <.>"'" ,,-ell "- " INHERITANCE TAX RETURN RESIDENT DECEDENT _L1--_~ 0 ~ FILE NUMBER 02-1 -0 ~ GL:t__ CQUNTYCODE YEAR NUMBER I- Z W o W U W o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) tf.1'>t ber M 4..r DATE OF DEATH (MM-DD-YEAR) SOCIAL SECURITY NUMBER ;lit -2-7- (; 'f- '/1 A. DATE OF BIRTH {MM-DD-YEAR} 0'1 -/2 - o:z 0-'1- - o,,/- -/3 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return o 4. Limited Estate g! 6. Decedent Died Testate ,1\t1acl\ cop'j 0\ Will} o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-82) o 7. Decedent Maintained a liv"lng Trust (Allacl1 copy of Trust) o 10. Spousal Poverty Credit (date oldealh between 12-31-91 and 1-1.95j o 3. Remainder Return (date of death priOl" to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) ,1\t1achSchO} 0- Z W o Z o "- w w " " o <.> FIRM NAME {lI Applicable} f!.o:JI..rr- 5'. l4-Aflor 308 ~/IM Au.!. I-I~r-sj,-ea. PA /7/)33 , ::r 31"" - .2 3.:l.s- OFFICIAL USE ONLY 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) -4S'11/6 . ~ Cj r -4;) ~r.A 00 , 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule Dj z o ~ ::::l l- ii: <( u w D:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly o"wned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) B. Total Gross Assets {total Lines 1-7} 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage LIabilities, & Liens (Scheoule I) 11. Total Deductions (total Lines 9 & 10) (11) (12) (13) (14)1> 8 (6) (7) (B) '1 /1 8~ 2.. ~1 99dl ~. <30 (9) (10) 9 ?':<CP. t7 0 12. Net Value of Estate (Line B minus line 11) 13. Charitable and Governmenlal 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' ::::l 0.. :i: o U ~ 15. Amount of Une 14laxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) ~ 8 f) SlCs> .;;1.1 x.O_ (15)~ xoir .~~ S't~43 (16) x 12 (17) x .15 (18) oft 3'8~43 (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibiing rate 18. Amount of Line 14laxable at collateral rate 19. Tax Due 2DD CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS .2 I 2.. ^ . s-& . ill 011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Cr.oits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3(,.84~t3 1M.... ;l.~ Total Credits (A+ B + C) (2) 1St.. 2.~ 3. tnteresVPenalty If applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) 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 (3) (4) (s)~5 ~ @? ...:1./ 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SA) (5B/'3 st:>o.,;;,/ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ...0 IF THE ANSWER TO ANY OF THE A~OVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.................. ........ 0 b. retain the ri9ht to designate who shali use the property transferred or its income; ......... 0 c. retain a reversionary interest; or......, ................................................... ... 0 d. receive the promise for life of eithElr payments, benefits or care? ............. .......................... ............................ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..................... ........................... 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 4. Did decedent Dwn an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . .......................... .................... ..................... ......................."....... i i(i ~ ~ ~ ~ Under penalties of pe~ury. I declare that I have examined this re/um, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESP R FILING RETUIla 4/ ADDRESS 74/ 0.33 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS JU 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 sunliving spouse is 3% [72 PS. ~9116 (a) (1.1) (i)]. For dates of death on 6r after January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse Is 0% [72 P.S. 99116 (al (1.1) (II)]. The statute does not exemot a transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the sUlViving spouse is the only beneficiary. For dates at 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)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries i.4.5%, except as noted in 72 P.S. 99116(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. 99116(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. REVO',,""""097I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 'IJO S .;;2. 8 00 sJ.a.rd> DESCRIPTION ~ d.s Corr' ~ 73. 1?rfG ,4i61 e<<r S-w.. e ~.. 18 VALUE AT DATE OF DEATH -1.3] 'loB. co J 'I 'l 'f.. ~o TOTAL (Also enter on line 2, Recapitulation) $ 4 ~-: E3 r; .2 ' 00 (If more space is needed, insert additional sheets of the same size) '''''''''1'''''. COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUlVivorship must be disclosed on Schedule F. ITEM NUMBER 1, 2. 3. 1. <5-' ~. VALUE AT DATE OF DEATH DESCRIPTION C<~ rM....erGe. #= Zo 8 'f7S<i' CJ6 93 O<.V'v/:.- ~. (, ., ( . " , " ~ ' I I _.J .\ LJ a.1Jd C"'''-~ (pCjOB.87 37.11 ~<<. J~.5K.d1reV>l~ FCwL ?~~ --r;:.a...o.s lLW\erl~ {!)~C-. c.t.~ }..tf-t- t~(r~5F:L S'-I'\.~J'(f e,o/d. 0; ~Cfl,o... -.A -/-h...,es 1 '1/. .5"8 It z7.fb .;J...j-<j 00 I 3~. dc> Fur,.,;Jvrc... I :,- 00.00 ;: p S Pc... LL =IF 8 + DI 8 (r,D6- 3'1- ;;2 5" 2 -4-112. , ? -ptJ c... 43~ c.o ID ItR(.,.1/ J $45; 1/fCJ...11 TOTAL (Also enter on line 5. Recapitulation) (If more space is needed, insert additional sheels of lhe same size) Rt:V-1511 EX-+- (12-99) _ ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FilE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. e &n-e..~ t::y.~~ 50~.OO (;,.c1. -7f-i""~ G'v a...~eJ~e-a-I ).....,+k_ (!J...u~L ~'it4.4-7 .2- M'r~.r~ - J.+iJ.-C'\'\-eA FU-N'-eAtt.l /to ....e, 7 [3 ).(. . 0 () 3. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)fEIN Number of Personal Representative(s) Street Address City ______~____State ____Zip Year(s) Commission Pa-rd: 2. Attorney Fees To o. 00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City _.__________~___ State _Zip Relationship of Claimant 10 Decedent 4. Probate Fees 143.~O 5. Accountant's Fees 6. Tax Return Preparer's Fees "3" 0." <:> 7. Aro-b.l~ 9J.H- B TilPft- 18.88 TOTAL (Also enter on line 9, Recapitulation) $ 9f~.eo (If more space IS needed, Insert additional sheets 01 the same size) REV-1513 EX+ (9-00:W- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETUAN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTruslee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ~ 0" res1d.v"(f Sec. 9116 ~(t.2)J 5..... ,. 5 <L""'....e,\ t1~IR:'" ~~ -IItll'Pb IJol/ 1~ of re.,,1 .3 -"''' e.7C I I 5..", ~. ~"Se.. II G~f~., ~m""~,;r.hf;~:ljll\.IJX1t.OI.z '/3 1 reSt .;t+o1- ....." . " el...,C/ !.k- JeLU"- 7~l(l!. Ga."'J''fr I4v U~I< rAnD), .3 ""s D~U' r. "'''''. I 'lIP I>f lI-I<>'*- I d-d. J.Jell.r~ 9,; liP lJ.tj-fr;1> et. 8'.....,L&""" .If D . ~~r". Ie: M ;llofJ l' 1 ~U:. 6, -r;;: ~""1 S,'""-.."",,,it~ 804 E1r""'U-tl..- ~. ~ "~a-itIer J ~ "F'A '"70..53 Ii ~ fite b 1\1. 3.2~ ~&. t1~"'''''''' (,. M..;tl1.e...... GtfL..... U', t2 J.J;IJP~ I}DI! 0- I>~ ",-j" ....r ' Or~~1.Jer Gre:fd.~-oro.ue. I ~~~1s:!b~ ~A 1 . '7000 ;I" 1 .,-J" 8. M....../:'- GltU"'b-u; ;Zoo?>ief O...b &ve-tcl.!>-..M rJt~""" lIP 6~~e.+DU!)k; ---rx. 7B(pd).(p tf t.....J ~......... bf 'i> kl:- 61...... Ga.-....be.r. ...:>- '11 /,0.). +'ti st:, 17ft..31:.. Y. N 1(. 10 '( IDO/4;- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET " NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ,. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~ "-'d- eL e-L. e-L- (If more space is needed, insert additional sheets of the same size} .:2-1- OJ- -"'11"1 V Proof of Publication of Notice in the Hershey Chronicle Hershey, Pa.lJournal Register Company (Under Act. No. 587 Approved May 16, 1929) State of Pennsylvania County of Dauphin } Edward S. Condra, Publisher of the Hershey Chronicle, of the County and State aforesaid, being duty sworn, deposes and says that the Hershey Chronicle, a periodical published in Hershey, County and State aforesaid, was established in 1984, since which date the Hershey Chronicle has been regularly issued in said County, and that printed notice of publication attached here is exactly the same as was printed and published in the regular editions and issues of the Hershey Chronicle on the following dates, viz., OrYobft /;;- rYC/ ~ / ~d . , J Affiant further deposes that he is Publisher of the Hershey Chronicle, a periodical of general circulation, to verify that foregoing statement under oath, and that neither the affiant nor Hershey Chronicle is interested in the subject matter of the aforesaid n~tic~ or advertisement~nd th~~~1l allegat.ionSill,~h oing statement as to time, place and character of publIcatIOn are true. ~C:::::'- -' . :=, <c. ~ . - - ..'<. ':',.:, _.....- .""~-, ..--.......... "'.~JJ?" '~ Pen~ ,," ' L..elle~ "'.1esll!r\'iellia,y on said EsI8t8. hlMi ~ granled.lo;;l!ie under- l!iIll'lfld., Nh~ In- _.to !he: eelaI8 are requeStedto~~ dla!epaym&nland !llCl6e having <;Iaims agalnstlhe e~e 'are requested to present them lonetlle- =J=~'lIl" :;":'.~J~" ~_J,.c,c ~. '., 'ft~~~ " ~,~. , , .", .',", " ,-' e MyC /J)o) :3 20 - " Jacqueline A. Coble. Notmy PUbl::!'C Derry Twp., Dauphin County ission Expires: My Commission Expires Sept. ?O.~ Statement of Advertising Costs: ~.oo Publishing Notice Affidavit ~ To Hershey Chronicle, Dr. For publishing the notice of publication here to on the above stated dates Probating same Total $ $ $ ~6.00 $.OG d9. CKJ Publisher's Receipt for Advertising Costs Hershey Chronicle, a weekly newspaper, hereby acknowledges receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. Hershey Chronicle, dag.(glk~a 06b Proof of Notice of Publication in Dauphin County Reporter 213 North Front Street, Harrisburg, PA 17101 Under Acts approved May 16, 1929, P. L. 1784 and April 24, 1931, P. L. 67, 45 P. S. let seq. State of Pennsylvania } ss: County of Dauphin Donald Morgan, agent of the Publisher of the Dauphin County Reporter, of the County and State aforesaid, being duly sworn, deposes and says that the Dauphin County Reporter, a legal periodical published in the City of Harrisburg, County and State aforesaid, was established January I, 1898, and designated the Legal Periodical for Dauphin County, on February 5, 1919, since which date the Dauphin County Reporter has been regularly issued in said County, and that the printed notice of publication attached hereto is exactly the same as was printed and published in the regular editions and issues of the Dauphin County Reporter on the following dates, viz: OCTOBER 18, OCTOBER 25 AND NOVEMBER 1, 2002 Affiant further deposes that he is the Agent of the Publisher of the Dauphin County Reporter, a legal Periodical of general circulation, to verify the foregoing statement under oath, and that neither the affiant nor the Dauphin County Reporter is interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing ents as to time, place and character of publication are true. Copy of Notice of Publication NotarlaI Seal JoyCe A.Tambol8l, Notary PubIlc HarrisbuIg ~ County My CornmIs&lOoi ExpI.... Oct. 5, 2004 _,f'lMsylvanlaAlfJociallCl,OIN01artes Statement of Advertising Costs: DECEDEJ'I."TS ESTATES NOTICE IS HEREBY GIVEN that let~ ters testamentary or of administration have been granted in the following estates All persons indebted to the said estat~ are required to make payment. and those having claims or demands to present the same without delay to the administrators or executors or their a,ttonaeys named below. Estate of Mary Adel Gamber ESTATE OF MARY ADEL GAMBER. late of Cumberland Counl)', Pennsylvania (died September 12, 2(02). Executrix: Jean P. Henry. 457 Drayer Drive, Hummelslown, PA 17036. Attorney: Kalhryn S. Taylor, Esq., 308 Elm Avenue, Hershey, PA 17033. oI8-nl To DAUPHIN COUNTY REPORTER, Dr. For publishing the notice or publication attached hereto on the above stated dates .............$ 64.00 1.00 Probating same ................. $ Total ....................$ 65.00 Publisher's Receipt for Advertising Costs The Dauphin County Reporter, a legal periodical, hereby acknowledges receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. DA By ~. CERTIFICATION OF NOTICE UNDER RULE 5.6Ia) Date of Death: M1 Ade.( qllltlber '1/12../0:2- I 1 Name of Decedent: Admin. No. To the Register: \ certify that notice of (beneficial interest) eslale admlnislralion 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 {D /, / " ~ : , , Name 1"2 5lt.....ue..l l'Je,1"h., ~~er 1l.....-<</1 ~~........ar .\.......... -P';II;Si?v'-~"'~ -r-...-..t.~ -ro:;..":j 51 "'. f\.dt'\ l'1dt\..&....., (ij~....... G~ "Brcc:l:e- ~ui:: (Q4L....t....... eo I~n q a....k Address=_ _..#....... ~ +1:111',4 1-,.." ~ -'I~ I\-C .,..,.. u.... ' 2-'1""" c.k:t~ /JII' Dr., ,.j~........;-rx 71." I~ +$ 7 D_.,<C/' 0"" Jj.J...-.IsN_. "PA l"1eclf, t:r/I# 11-;11 5/,""'1- U., J.~..ui't...,"'D~/D'!I g 0'(- 1l/v-o.nf... ?,t., #kI'fL~1'A 17033 ~I ~ N. ~!::!!l':St:, CO......, #:J{. ~ If D II ~ 3 'i" A...-fl.o~ Dr., l1eJ..a...Jc~h"'1-"PA I t"SS .;I"o~:"er-o...t:.s UlIe.. IS~/, 'ieo'1c~u/la.,""T)(:7lI.'aJ. J7' w. ~ $.,.I;f1:: 3~. N. Y., N.'r. /bOf/f- o/A Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 1 jet /05 ( / Signature Name Address 0 ~ ,.,.. ~L61r4 Telephonel11p 51~- .23~ /7033 I Capacity: _ Personal Representative ...,( Counsel for personal representative /7- 7""/- .,,2./ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION IlEPT. 2806111 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-20-2003 GAMBER 09-12-2002 21 02-0919 CUMBERLAND 101 Anount Rui tted KATHRYN S TAYLOR 308 ELM AVE HERSHEY \'. PA V033-9501 *' REV.1547 EX AFP (Dl~I5) MARY A ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 45.892.00 .00 .00 45.910.29 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOIIER PORTION FOR YOUR RECORDS .... iiE'v=i5'47-EX--AFi.-coFo3'--NOYfcE-.Oi'-YN'HEiffTAifCE-YAX-APPRAfSEMENi'";-ALLOWANCE-oi----------------- DISALLOIIANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GAMBER MARY A FILE NO. 21 02-0919 ACN 101 DATE 01-20-2003 TAX RETURN WAS: I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Re.l Est.t. (Schedule AJ 2. stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule El 6. Jointly Owned Property ISchedule F) 7. Transfers ($c:.hedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule Hl 10. Debts/Hortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Ch8ritab1e/Govern..ntal BequestSj Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estata Subject to Tax If an assesS8ent was issued previouslY, lines 14, 15 and/or 16, 17, 18 and re1'lect figures that include the total D'f ALL returns assessed to date. ASSESSMENT OF TAX: IS. AlIOunt o'f Line 14 at Spousal rat. (15) 16. ~ount of Line 14 taxable at Lineal/Class A rata (16) 17. ~ount of Line 14 at Sibling rat. (17) 18. ~oont of Line 14 taxable at Collateral/Class B rate (18) 19. Prlnci~l Tax Due NOTE: (9) (10) 9,926.00 NOTE: To insure proper credit to your account I sub_i t the upper portion of this for_ with your tax payaent. 91,802.29 9.Q?~ nn 81,876.29 .00 81,876.29 19 will 00 = 045 = 12 = 15 = .00 3,684.43 .00 .00 3,684.43 .00 Ill) (12) (13) (14) .00 X 81,876.29 X .00 X .00 X (19)= TAX CR"DIT". 1+) AMOUNT PAID DATE NUHBER INTEREST/PEN PAID 1-) 11-21-2002 CDOO1874 184.22 3,500.21 TOTAL TAX CREDIT 3,684.43 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOHN FOR INSTRUCTIONS.' Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 HENRY JEAN PHYLLIS GAMBER 457 DP~AYER DR HUMMELSTOWN, PA 17036 RE: Estate of GAMBER MARY ADEL File Number: 2002-00919 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. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 9/12/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STP~ASBAUGH REGISTER OF WILLS cc: File Counsel Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: oZ~9 o ~ - cx:5>~! ~ Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes~ No[-'] 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: ao Did the personal representative file a final account with the Court? Yes _ No ~] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal re~resentative state an account informally to the parties in interest? Yes ~1 No ['-1 Date: 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./~/~ ~ ~Y~ Signa~ d ._~ m '" ~ :' Name Ad,ess Telephone No. Capacity: [-"] Personal Representative JX] Counsel for personal representative