HomeMy WebLinkAbout02-0886
Estate ojr(rI 'n-~ Q-\-
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
:\,7e.p\\r\ No. ~1-0..1- y~
To:
Register of Wills for the
Deceased. County of('j,m/,er!ti,lci in the
Social Security No. 0l ()~- ""'n - ~'J (, b I...j Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or olde! ar th~ execut
in the last will of the above decedent, dat.ed '?, J ;?- c, _ C ~
and codicil(s) dated ' I
named
,M'~~
(state relevant circumstances, c.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ,,"eN\ J
h"\ ~ last family or principal residence at
C~ty, Pennsylvania, wit
'" -, . Lei
(list street, number and muncipality)
Decendent~then /;> years pf age, ,died 9 / j'l , 1'/, :;;2. 00, Q
at 8 C -< s. . l--eh-"'--;~y)(O', I?A- ,.-,c;4-':I
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 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:
$ d. rL tlY.tr::>
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~St-r. m<"/)+r. rt
(testamentar ; admlOlstratlOn c.La.; administratIOn d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF (j,? rYJb~Cl nri
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
subscribed [
ayof
Register
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No. 21-02-0886
Estate of ROBERT J. ZEPLIN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW OCTOBER 1, Jql9 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 AUGUST 29, 2002
described therein be admitted to probate and filed of record as the last will of
ROBERT J. ZEPLIN
and Letters TESTAMENTARY
are hereby granted to LOUISE HARDEN
~ HJj (():tt./1tr, f1'-' .t!.1J ~*-~47
RegIster of Wills
FEES
Probate, Letters, Etc. ......... $ 50.00
Short Certificates(4 ) . . . . . . . . .. $ 12.00
~EXTRA.EGS...4.. $ 12.00
JCP $ 5.00
TOTAL _ $ 79.00
Filed .QC;;r9.~E;lJ.. .1.,. .ZOP.2. . . . . . . . . . . . . . . . .
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
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MAILED TO .- TWIlI OCTOBER 1, 2002
. .
LAST WILL AND TESTAMENT
OF
ROBERT J. ZEPLIN
21-02-886
I, ROBERT J. ZEPLIN, of Lemoyne, Cumberland County,
Pennsylvania, being of sound mind and memory, do make publish and
declare this my last will and testament, hereby revoking and
declaring null and void any and all wills and codicils made by me
at any time heretofore made.
FIRST:
I direct my Executor hereinafter named to pay my
legal debts, the expenses of my last illness, my funeral expenses
and the administration expenses of my estate.
SECOND:
I give, devise and bequeath all of my property,
real, personal and mixed of whatever nature and wheresoever
situate, which I may own or have the right to dispose of at the
time of my death to LOUISE HARDEN, of Lemoyne, Pennsylvania. In
the event that LOUISE HARDEN should predecease me or fail to
survive me for a period of sixty (60) days, I give, devise and
bequeath all of my property to my nephew, ,JOHN ZEPLIN of York,
Pennsylvania.
THIRD:
I name, constitute and appoint LOUISE HARDEN, as
the Executor of my estate.
If she shall not survive me, shall
not serve as Executor for any reason, or shall cease to serve as
Executor for any reason after appointment, I appoint JOHN ZEPLIN,
......
as Executor of this Will. None of the individuals named in this
paragraph shall be required to furnish a bond for the faithful
performance of his or her duties as Executor.
FOURTH:
In addition to all of the powers conferred by law
upon my Executor and not in limitation thereof, I hereby
authorize my Executor to sell any stocks, bonds, or other
personal property and any and all real estate which I may own at
the time of my death, without the order of authority of any Court
being required, at public or private sale, upon such terms as may
in the discretion of my said Executor seems to be in the best
interest of my estate. In pursuance of his or her power, my
Executor shall execute and deliver all documents of conveyance,
including deeds or bills of sale or any other instruments which
may effectively transfer title. I further authorize my Executor
to settle and compromise any and all claims in connection with
the administration of my estate herein and to do any and all
things in his or her discretion that shall be conducive to the
best interest of my estate.
FIFTH:
Any individual who has not been included as
receiving a distribution from my estate has been intentionally
excluded and is not to receive any of the proceeds of my estate.
I have made no provision in this Will for any of my relatives,
but for my nephew, JOHN ZEPLIN, as I do not wish for them to
receive any share of my estate.
SIXTH: All pronouns referring to an Executor and the
term "executor" shall be construed to mean any person acting as
my Executor as the case may be.
IN WITNESS WHEREOF, I have set my hand and seal at
Cumberland County, Pennsylvania this
21
day of fLJ vo'-t'
2002.
;; ,.}-[...,) j ~ ~
Robert J. Zeplin-
SIGNED, sealed, published and declared by the above named
Testator, Robert J. Zeplin, as and for his Last Will and
Testament, in the presence of us, who at his request, in his
presence and in the presence of each other, have hereunto
subs
r names as witnesses.
Name
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Address
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Addres '
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
I, Robert J. Zeplin, Testator, whose name is
signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my Last Will; that
I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
? () t J'
/ tJ- L.j j/ .J<-).. '. \
Robert J. Zeplin
SWORN or affirmed to and acknowledged before me by
Robert J. Zeplin, the Testator, this
l q-vh
day of
A\J..~\J.'St
, 2002.
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, ~t+ y <'W.J'-.;
and 1'-41'.'( V. (04 ,'c,.PO-,'
, the
witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the
Testator sign and execute the instrument as his Last Will,
that he signed it willingly and that he executed it as
his free 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
(18) or more years of age, of sound mind and under no
constraint or undue influence.
/
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Address: c:<1.3 CiuUtL: '.
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SWORN or
affirmed to and subscribed to before me by
(l+-; 6/Wp.'L
, and ~l{ fl. 6t-.-(),,--
witnesses,
this
? "
day of A-"1'"' t-
, 2002.
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CERTIFICATION OF NOTICE UNDER RULE 5.6Ia)
Date of Death:
Name of Decedent: ;:;? 0/;'" 0 f ,j,
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Will No,
Admin, No,
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To the Register:
[ certify that notice of (beneficial interest) estate administration required by Rule 5,6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
l1
J' AIA' /./Jr.
/ y
,
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Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
.It 103
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Signature
Name Jf~ d!)<~ <~
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Address 6!r!i (1 t(1/~ ._~_
J:;~~ A~ /7ct;'.~
7/7 .
Telephone () 77{,1- 66 q /
Capacity: ;L,. Personal Representative; F')<:'...,. c
_Counsel for personal representative
-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV.1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HARDEN lOUISE
285 CLARK STREET
lEMOYNE, PA 17043
____nn fold
ESTATE INFORMATION: SSN, 204~30~5664
FILE NUMBER: 2102-0886
DECEDENT NAME: ZEPLlN ROBERT J
DATE OF PAYMENT: 06/18/2003
POSTMARK DATE: 06/17/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/17/2002
NO. CD 002695
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,525.23
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I
I
I
I
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I
TOTAL AMOUNT PAID:
REMARKS: lOUISE H HARDEN
HAND DELIVERED
CHECK# 117
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
------
$5,525.23
DONNA M. OTTO
DEPUTY REGISTER OF WillS
.J,?-9/-//
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Y BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
LOUISE HARDEN
285 CLARK ST
LEMOYNE
"OJ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
":-ICOUNTY
',-,' " 'ACN
07-28-2003
ZEPLIN
09-17-2002
21 02-0886
CUMBERLAND
101
,JUL 2d
*
kEV-1547 EX AFP (01.031
ROBERT
J
PA 17o..,!3
Al10unt Remitted
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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=i54-j-Eif-AFi'--foFo:3rNOT-icE--OF-YNHEifii'ANCrTAX-j("PPRA-isEiiENT:--ALL-OWAifcE-CrR"-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ZEPLIN ROBERT J FILE NO. 21 02-0886 ACN 101 DATE 07-28-2003
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. A.ount of Line 14 at Spousal rate (15)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. Al10unt of Line 14 at Sibling rate (17)
18. Al10unt of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
36,834.91 X 15 = 5,525.23
(19)= 5,525.23
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule BJ
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
11)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
47,205.65
.00
.00
IB)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
10,270.74
100.00
Ill)
112)
113)
114)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
47,205.65
10.:'170 74
36,B34.91
.00
36,834.91
TAX CREDITS:
1+, AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID 1-)
06-17 2003 CD002695 .00 5,525.23
TOTAL TAX CREDIT 5,525.23
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 FORM FOR INSTRUCTIONS.)
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OFFiCIAL USE ONLY
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
-b-rL1<Lf..rL
NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2-' -Jll-
COUNTVtooE YEAR
I-
Z
W
C
W
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W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ze 1in Ro r Jo
DATE OF DEATH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
204
30
5664
DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GJ 1. Original Return
D 4. Limited Estate
[l] 6. Decedent Died Testate (Atlach copy 01 Will)
D g. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (daleo/death after 12-12-82)
D 7, Decedent .Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credill:date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (dale of death prior to 12.13-821
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11, Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
COMPLETE MAILING ADDRESS
FIRM NAME (II Applicable)
285 Clark Street
Lemoyne PA 17043
TELEPHONE NUMBER
(717) 77 4-6891
Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
DC
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OFFicj~ USE -bNL y
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(1)
(2)
(3)
(4)
(5) $47 205 65
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G orL)
8. Total Gross Assets (total Lines 1-7)
(8) 847 205 65
~
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'-0
.;,;.
D:l
(6)
(7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(9) $1n ?7n 7&
(10) $100.00
11. Total Deductions (total Lines 9 & 10)
(11) $10 370 74
(12) 836 834 Q1
(13)
(14) $36 834 91
12. Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental Bequests/See 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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
,0_ (15)
x,O_ (16)
x .12 (17)
x .15 (18) ~ ~~? l:i ?1.
(19) 85525. 23
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
$36.834.91
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
000 m ..
CITY
Lemoyne
I STATE PA
I ZIP 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousai Poverty Credit
B. Prior Payments
C. Discount
(1) $5525.23
Total Credits (A + 8 + C ) (2)
3. InteresUPenally if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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.
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE, (58) $5525 23
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
..,.kJ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;" .
b. retain the right 10 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? .
Yes
.................w......o
o
........0
.....0
No
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GI
GI
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the besl Of my knowledge and belief, i/ is true, correct
arTd complefe
Declaralion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
rJ-3
AD
285 Clark Street Lemoyne PA 17043
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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. 99116 (a) (1.1) (ii)
The statute does not exemot 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
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 paren
or a stepparent of Ihe child is 0% [72 P.S. &9116(a)(1.2)j.
The lax rale imposed on the net value of transfers to or for the use of the decedent's lineal benelciaries is 4.5%, except as noted in 72 P.S. &9116(1.2) [72 P.S. &9116(a)(I)].
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 a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
,,,,.t~8EX"t....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Robert .Jonn ZPtll in
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.
FilE NUMBER C' <;> r
'~OJ :l -00 C> V.b
ESTATE OF
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
$4000 00
$7090 61
$2922 . 78
$17 221 27
$12 270 Q9
1995 Ford Fl50
2
AllFirst Money Fund acct If 00982~0536-6
3
A11First checking account #oml02 9899.1
4
PNC Investments account #89687784
5
Waypoint Bank certificate of deposit account fl00264761
6.
Public School Retirement System
$3700 00
TOTAl(Alsoenteronline5,Recapitulation) $ 47 205 65
(If more space is needed, insert additional sheets of the same size)
REV_1511EX.(1-97)~
..~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
'Rn'b'1"l""t Tnl:lt? ZQpliv
FILE NUMBER I
R.,OO;;{ - 003''1)1<>
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Parthemore Funeral Home $8452.02
2 Veterans grave marker $250 00
3 Catholic cemetaries $127 5 00
4 Country Buffet (wake) $213 92
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City Slale Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills $79 80
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $10 ?7" 7/.
(If more space is needed, insert additional sheets of the same size)
REV-IS12EX.(1-9Ij
ESTATE OF
COMMON',.'Y'EALTH OF PENNSYl.VANII\
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Robert John Zeplin
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
,9.,.009. -00 'l)'g'1o
DESCRIPTION
AMOUNT
Gregory J, Katshir esquire (Last Will and Testament prep)
$100 00
TOTAL (Also enter on line 10, Recapitulation) $ 100.00
(If more space is needed, insert additional sheets of the same size)
REV"5'3, EX+ (9'00*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Robert John Zeplin :::l. (')0 A - O::J 'b'
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
J TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 Ie) (1.2)1
1.
Louise Harden friend 100%
285 Clark Street
Lemoyne PA 17043
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II NON. TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $
'%' G
(If more space is needed, insert additional sheets of the same size)
iii allflrst
P.g8 1 of 3
-I
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I
I
I
ROBERT J ZEPLlN
285 CLARK ST
LEMOYNE PA 17043-2010
1",111111111""1"1"11",1,111,,,,,,1111,,,1,,1,,1,1,1,1,,1
The Money Fund Alternative
4:'!;'U...' no 2DnZtbrus.,otembel' .19, 2002
Robart J Zaplln
Acct No 00982-0536-6
" alltlrst.com 0 24...f1our
Customer Service
1-800-533-4630
Activity Summary
Number of checks enclosed
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this statement
Dapolltl and addition.
D.te Description
o Balance on 08/20
1. OO~ Deposits and additions
$7,084.98 Balance on 09119
$7,084.79
$5.82
$5.82
$53.00
30
$7,084.79
5.82
$7,090.61 ..)W ~
1dR3-./ 1./,/ ~oug h. lob b'
(B,4.\)~\y~ -
Amount
09/19 INTEREST PAID
$5.82
$5.82
End of Day Ladger Balance
Account balances are updated in the section below on days when transactions posted
to this account.
Date
Balance
08120
09119
$7,084.79
7,090.61
000958
0011-98317535642 050
iii allflrst
-,
\
-I
ROBERT J ZEPLIN
285 CLARK ST
LEMOYNE PA 17043.2010
1",111",111",,1,,1,,11.,,1.111111.,,1111...1,,1,,1.1,1.1,,1
Page T ot 6
Relationship With Interest
Roberl J ZepUn
Activity Summary
Accl No U0102-9899-1
AUQust 27, 2002 thru September 25, 2002
o alffirsl.com 0 24-hour
CUSlomer Service
1-800-533-4630
Number of images enclosed
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this statement
Deposits and additions
O.te Description
6
0.2~
$2,657.62
$2,657.60
.55
.55
$2.57
30
Balance on 08/26
Deposits and additions
Checks
Balance on 09/25
$2,922.78
959.55
-611.68
$3,270.65
;'~'10.bb
. I b
37-76.'6'1
~\'l\aJ
?v- Bf-ts
? /2ODR:."
@ Ct\\?vst-
\D/~JO~
)
Amount
$959.00
09/18 ACH CREDIT
US TREASURY 303 SOC SEC 204305664A SSA
3031036030ROBERT J ZEPLIN 20022564012348
09/25 INTEREST PAID
Checks
.55
$959.55
.. Oenotes mllsing .equence number
NumlJer O.te Amount Num~r Date Amount Number Dille Amount
723 08/28 $60.75 725 09/04 $234.62 727 09/03 $36.51
724 08/28 20.00 726 08/28 9.80 728 08f29 250.00
$611.68
00045.
OO~5.983H9()157) 050
rt OCJ9. IL)
~ grJO ,~/, -
.- 363 9!J If '-
J OJ .'1-0 A\\~~
10 (,? I (j Id- ~~ VJi~rls:t{,
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End of Day Ladger Balance
Account balances are updated in the section below on days when transactions posted
to this account.
Date
Balance
Date
BBI/tnce
Date
Balance
08/26
08/28
08/29
$2,922.78
2,832.23
2,582.23
09/03
09/04
$2,545.72
2,311.10
09/18
09/25
$3,270.10
3,270.65
Due to a change by the Pennsylvania legislature, which is effective June 29. 2002,
the time period for an account to be inactive before it is surrendered to the
Commonwealth of Pennsylvania has been changed from 7 years to 5 years. This
applies only to accounts opened through a Pennsylvania branch. The initial
reporting under this regulation will affect accounts that have been inactive for
5 years as of December 31, 2002.The Allfirst Bank Rules for Consumer Deposit
Accounts are revised effective September 1, 2002 to reflect this new change. An
insert will be included in your next statement showing this change.
The annual percentage yield earned reflects the amount of interest earned on the account
during the statement period and the average daily balance in the account tor that period.
The interest rate paid will fluctuate according to money market conditions.
About your Relationship Checking with Interest account. When you maintain an average
daily ledger balance of $1,000 in your checking account; or $2,500 in your checking,
money market and savings accounts; or $7,500 in all related accounts you will not be
assessed the $10 monthly maintenance fee.
Balancing your checkbook. Look on the back of your first statement page for a fast and easy
way to balance your checkbook.
What your icons mean
o Customer Service
G) Credit to your account
o Important reminder
e Charge to your account
~ Other banks' A TM
transaction
00045B
0015.9B317907571 050
P.g<< 3 of 6
For questions about
your sraremenl Dr-
change of address
information, please see
page 2.
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Check and other rtems receIved for dipoSit'lr. su6'Ject to the ProvlSfOllS of the Uniform Commel'Clal Code. Certain depoSItS are
subject to delays In availability according to Bank poliCy.
_...._, TIi1S ISYOUR RECEIPT _'" FDIC
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COMMONWEALTH OF PENNSYLVANIA
PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM
j~o~
Mailing Address
PO Box 125
Harrisburg PA 17108-0125
Toll-Fr.. - 1-888-773-7748
(1-888-PSERS4U)
Local- 717-787-8540
Web Address: www.pseTs.slate.pa.us
Building Location
5 North 5th Street
Harrisburg P A
October 24, 2002
LOUISE HARDEN
285 CLARK ST
LEMOYNE PA 17043
RE: ROBERT J. ZEPLlN
S.S.# 204-30-5664
Dear Ms. Harden:
I have received notification of the death of Robert J. Zeplin, a member of the Public
School Employees' Retirement System (PSERS).
With regard to the settlement of the account the approximate amount due you as
beneficiary is $3,700.00.
The approximate gross distributions of the account is as follows:
1. Gross Amount of Distributions
2. Taxable Amount
3. Capital Gains included in Taxable Amount
4. Nontaxable Contributions
$3,700.00
$3,700.00
$00.00
$00.00
Enclosed for your review are the available payment plans. In order to process the death
benefit, one of the payment plans must be selected. Please read the enclosed
information on the payment plan options very carefully and before making a decision, I
recommend that you:
. Contact your tax consultant, because the death benefit is subject
to federal income tax and the tax consequences will affect your
income.
. Complete the election forms and return them to PSERS
\ \ Please Note: Interest is credited only to the member's date of death. .
As soon as the completed application is received in this office, a benefit can be
recalculated and payment sent.
Louise Harden
285 Clark St
Lemoyne Pa 17043
RE: Robert J. Zeplin
. S.S.# 204-30-5664
Page 2
October 24, 2002
If I can be of further assistance, you may reach me by calling toll-free 1-888-773-7748
Extension 4755, (local calls 720-4755) between 7:30 a.m. and 3:30 p.m. each business
day. If you prefer, you may also reach me by FAX at 717-787-7021.
Sincerely,
~&,S~
Carol E. Sydansk
Exceptions Processing Center
LAST WILL AND TESTAMENT
OF
ROBERT J. ZEPLIN
I, ROBERT J. ZEPLIN, of Lemoyne, Cumberland County,
Pennsylvania, being of sound mind and memory, do make publish and
declare this my last will and testament, hereby revoking and
declaring null and void any and all wills and codicils made by me
at any time heretofore made.
FIRST:
I direct my Executor hereinafter named to pay my
legal debts, the expenses of my last illness, my funeral expenses
and the administration expenses of my estate.
SECOND:
I give, devise and bequeath all of my property,
real, personal and mixed of whatever nature and wheresoever
situate, which I may own or have the right to dispose of at the
time of my death to LOUISE HARDEN, of Lemoyne, Pennsylvania. In
the event that LOUISE HARDEN should predecease me or fail to
survive me for a period of sixty (60) days, I give, devise and
bequeath all of my property to my nephew, ,JOHN ZEPLIN of York,
Pennsylvania.
THIRD:
I name, constitute and appoint LOUISE HARDEN, as
the Executor of my estate.
If she shall not survive me, shall
not serve as Executor for any reason, or shall cease to serve as
Executor for any reason after appointment, I appoint JOHN ZEPLIN,
I
as Executor of this Will. None of the individuals named in this
paragraph shall be required to furnish a bond for the faithful
performance of his or her duties as Executor.
FOURTH:
In addition to all of the powers conferred by law
upon my Executor and not in limitation thereof, I hereby
authorize my Executor to sell any stocks, bonds, or other
personal property and any and all real estate which I may own at
the time of my death, without the order of authority of any Court
being required, at public or private sale, upon such terms as may
in the discretion of my said Executor seems to be in the best
interest of my estate. In pursuance of his or her power, my
Executor shall execute and deliver all documents of conveyance,
including deeds or bills of sale or any other instruments which
may effectively transfer title. I further authorize my Executor
to settle and compromise any and all claims in connection with
the administration of my estate herein and to do any and all
things in his or her discretion that shall be conducive to the
best interest of my estate.
FIFTH: Any individual who has not been included as
receiving a distribution from my estate has been intentionally
excluded and is not to receive any of the proceeds of my estate.
I have made no provision in this Will for any of my relatives,
but for my nephew, JOHN ZEPLIN, as I do not wish for them to
receive any share of my estate.
SXXTH: All pronouns referring to an Executor and the
term "executor" shall be construed to mean any person acting as
my Executor as the case may be.
IN WITNESS WHEREOF, I have set my hand and seal at
Cumberland County, Pennsylvania this
Z'i
day of It,,') ")''1'
2002.
I? Ji-..,). j ~ ~
Robert J. Zeplin-
SIGNED, sealed, published and declared by the above named
Testator, Robert J. Zeplin, as and for his Last Will and
Testament, in the presence of us, who at his request, in his
presence and in the presence of each other, have hereunto
'Ub'~b71: ":e' "'
Name
witnesses.
90G /1f>.fifSr
iAC~L1-~ ~
Address
(7g~1~ ~7\ J
,~jl3 {~ JI.
ci1~J Itl. 17"~3
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
55:
COUNTY OF CUMBERLAND
I, Robert J. Zeplin, Testator, whose name is
signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my Last Will; that
I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
l?iJ-.L,j {) )..).t... "
Robert J. Zeplin
SWORN or affirmed to and acknowledged before me by
Robert J. Zeplin, the Testator, this
I qi'h
day of
f\ '^~ \J. 'St
, 2002.
~ - -,
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t~ic =--..
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. 'I ...,..... ',' ......... ........., ...~,'..I'
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, ~~'1 (,Ir-r._"~,
and /"41.'1 V (~f.''-'~>''
, the
witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the
Testator sign and execute the instrument as his Last Will,
that he signed it willingly and that he executed it as
his free 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
(18) or more years of age, of sound mind and under no
constraint or undue influence.
9Jlky;{/#~ '
Address: c:<J3 ~-tC xI;.
~~. ~,/7't:'~3
'7 (Jc /qjf f:fjL
t?
i.... "",,, '1--<
/ I
SWORN or
affirmed to and subscribed to before me by
R",-,/ (h1i'-It.
, and ~I( {Z. 61-.-llo"-.
witnesses,
this
? '1
day of ~~. t-
, 2002.
lic
NOTA",^, Sr.:A!
'7B~'~Y'( "1.",;"....,,;. ..
nv~:.. r. ftl'::\J,;'i;,:J ht~!~"'!1 ~1~""
'--.;J "t -......" ,,~..J....
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;oe,,;e~~<<.-:.;;.;:,;,L::;. ,,,..',.A;:
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 8/03/2004
HARDEN LOUISE
285 CLARK STREET
LEMOYNE, PA 17043
RE: Estate of ZEPLIN ROBERT J
File Number: 2002-00886
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: 9/17/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBTkUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
DEPT. 280601
HARRISBURG,
PA
1
7
1
28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002695
HARDEN LOUISE
285 CLARK STREET
LEMOYNE, PA 17043
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $5,525.23
ESTATE INFORMATION: SSN: 204-30-5664
FILE NUMBER: 2102-0886
DECEDENT NAME: ZEPLIN ROBERT J
DATE OF PAYMENT: 06/18/2003
POSTMARK DATE: 06/17/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/17/2002
TOTAL AMOUNT PAID: $5,525.23
REMARKS' LOUISE H HARDEN
HAND DELIVERED
CHECK//' 117
INITIALS: SK
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
TAXPAYER
STATUS REPORT UNDER RULE 6.12
Name of Decedent: '-' )~/~ ¢ c~-~-,
! '/
Will No.: ,~/?/-t/1 ~'~/'fO ~' ~ 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~wh~ther 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:
a. Did the personal representative file a final account with the Court?
Yesf No [-]
b.The separate Orphans' Court No. (if any) for the personal representative's
account is: ~
c.Did the personal ~l~resentative 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~hans~£ourt
and may be attached to this report.
Date: ,
Signature
Name
Ad~lres-s
Telephone No.
Capacity: ,~Personal Representative
[-] Counsel for personal representative