HomeMy WebLinkAbout03-0363Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Evelyn M. Swartz
also known as
Helen L. Raudabau~h and Linda K. Sanders
Petitioner(s), who is/are 18 years of age or older, app~y(ies) for:
, Deceased
Social Security No. 194- 26 - 6624
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ices named in the last Will of
the Decedent, dated 10/07/1997 and codicil(s) dated None
Named Executor Dauphin Deposit Bank and Trust Company (now Allfirst) and residuary
beneficiary Creedin H. Otto, Jr., both renounce in favor of Helen L. Raudabauqh and T,inda K.
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
N/^
Sanders
B. Grant of Letters of Administration
(c.ta.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name Relationship Residence
(COMPLE~P_ IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at
Decedent, then 96 years of age, died 03/29/2003 at Mechanicsbur~,
325 Wesley Dr. , Apt. 3220, Lower Allen Township, Mechanicsbur~, PA 17055
(list street, number, and municipality)
PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
60,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
Si~lnature
Typedorprintednameandresidence
Helen L. Raudabaugh
9 Pheasant Street, Mechanicsburs, PA 17050
Linda K. Sanders
501 N. Market Street, Mechanicsbur~, PA 17055
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this A~'13~ay of
t_~f- ~ .(~J4,~,,.~, For the Register
Helen L. Raudab~augh
--J~i/~da K. Sanders
No.
Estate of Evelyn M. Swartz Deceased
Social Security No: 194-26-6624 Date of Death: 03/29/2003
AND NOW, ~ ~ ~ Or~ , c~0~ ~ in consideration
'
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~'] Testamentary [~] Of Administration
(c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Helen L. Raudabau~h and Linda K. Sanders
in the above estate and that the instrument(s) dated 10/0 7/1997
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
~ Reg}ster o ~Vi/I~
Short Certificate(s) ..... $ /~ . (j~
Renunciation ........ $ IO .(,.}(..~ Attorney: Jenni£er B. MIFF, Escjuire
Affidavits ( ) .... $ I.D. No: 86556
Extra Pages ( ) .... $ ~O , OO Address: One West Main Street
Codicil ........... $ Shiremanstown, PA 17011
JCP Fee .......... $ IO · OO Telephone: 717/737- 8761
,nventory ..........
Other ........... '
TOTA. .........
Prepared by the Peoosylva~la Bar Association Copyright (c) 1996 form software on~ CPSystems, loc.
Form RW-1 (1991)
In ReEstate of EVELYN M. SWARTZ
To the ~ of' W'dis of CUMBE~.AI~
County, Pennsylva~a.
The middle, ned .... JOHN CAI~PBELL, VICE P. RESIUENT OF ALT.1;'TRgT ']q~TT.q'1' CrANPA_]q~[' ~][OF
PENNSYLVANIA, N.A., FORMERLY KNOI~N AS ~ BANK, SUCCESSOR BY MERGER TO
the above decedent, hereby renounce(s) t~ df, bt to ad~!~tcr thc cstatc and respectfully ~k(s) Rmt L~t~rs DAUPHIN
DEPOSIT BANK & TRUST
TESTAMENTARY
I~I.EN RATII~ARATICF! AN-Ti I.TN-Fi,A,, SAlqpl~.Rg
his
ha. lid this / '7 day of APRTL X]~ ?an3
Register of Wills of Cumberland County, Pennsylvania
RENUNCIATION
Estate of Evelyn M. Swartz No. ~ I - ~O 3 -- OJLo_-~
also known as
, Deceased
The undersigned, Nephew/Res iduary Bene f ici ary
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
Helen L. Raudabaugh and Linda K. Sanders
of
WITNESS his hand this 24th day of April, 2003
(Signa~[~'ure) Creedin 1~. Otto/.
220 Silver Springs Road
Mechanicsbur~, PA 17055
(Address)
(Signature)
(Address)
(Signature)
Sworn to or affirmed and subscribed
before me this ~'/'"~'7c~-~ day
of Dfc;/ , oo5
Notary Public
My Commission Expires:
(signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
(Address)
NOTARIAL SEAl..
BONNIE t. WILLIAMS, NOTARY PUBLIC I
SHIREMANSTOWN BORO., CUMBERLAND C0.1
MY COMMISSION EXPII~S APRIL 18, 2005
NOTE: Renunciations executed outside the Office of Register of Wills
in some counties are required to be notarized.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software on)y CPSystems, Inc. Form #RW-4 (1991)
Register of Wills of
OATH
Cumberland County, Pennsylvania
OF SUBSCRIBING WITNESS
Estateof Evel,yn M. Swartz No. ~t-~)~-,'~o3
also known as
, Deceased
James D. Bosar Carol A. Bo~ar
(each) a subscribing witness to the ~ codicil(s) ~] will(s) presented herewith, (each) being duly qualified according to law
depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as
a witness at the request of Testator(rix) in his/her/their presence and ~ in the presence of each other ~'~ in the presence of the
other subscribing witness(es).
(Signature) ( James D.~B~gar
One Wes~%M~in Street
Shiremans~Swn, PA 17011
(Address)
(Signature)
Carol A.
One West Main Street
Shiremanstown, PA 17011
(Address)
Sworn to or affirmed and subscribed
before me this (.~~'jlL J'----- day
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
MY' NOTARIAL SEAL i
BONNIE' L WILLIAMS, NOTARY PUBLIC I
HIREMANSTOWN BORO., CUMBERLAND CO.I
COMMISSION EXPIRES APRIL 18, 2005 I
NOTE: To be taken by officer authorized to administer oaths.
Please have present the original or copy of instrument(s)
at time of notarization.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-2 (1991)
LAST WILL AND TESTAMENT
OF
EVELYN M. SWARTZ
I, EVELYN M. SWARTZ, of Lower Allen Township, Cumber-
land County, Pennsylvania, make, publish and declare this as and
for my Last Will and Testament, hereby revoking all other Wills
and Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
~?~ogether with any insurance policies thereon, as follows:
(A) One-third (1/3) thereof to my niece, HELEN L.
RAUDABAUGH, of Mechanicsburg, Pennsylvania.
(B) One-third (1/3) thereof to my niece, LINDA K.
SANDERS, of Mechanicsburg, Pennsylvania
(C) One-third (1/3) thereof to my nephew, CREEDIN H.
OTTO, JR., of Mechanicsburg, Pennsylvania.
If any of the individuals named herein predecease me, I
direct that their share or shares under this, my Last Will and
Testament, be given, absolutely, to the CARE ASSURANCE FUND OF
~HANY VILLAGE, Mechanicsburg, Pennsylvania, to be used to fund
payments for people in need at Bethany Village, said need to be
determined by the appropriate officials of the CARE ASSURANCE
FUND OF BETHANY VILLAGE.
SECOND: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
n, improvement, zoning or management of real estate and to
ose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
ral and other tax laws, including, but not necessarily being
~m~ited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
in cash or in kind or partly in each.
aries
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
?HIRD: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
2
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
FOUR?H: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
FIFTH: I nominate and appoint DAUPHIN DEPOSIT BANK AND
TRUST COMPANY, of Harrisburg, Pennsylvania, Executor of this, my
Last Will and Testament. I direct that my Executor, and its
successors, shall not be required to post security or a bond for
the performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this -~.{k day of
c z.4o . ,
EVELYN (SEAL)
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
3
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Evelyn M. Swartz
Date of Death: March 29, 2003
Will No. 21-03-0363 Admin. No.
To the Register:
I certify that notice of estate administration required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
April 25, 2003:
Name Address
Linda K. Sanders
Helen L. Raudabaugh
Creedin H. Otto
501 N. Market St.
Mechanicsburg, PA 17055
9 Pheasant St.
Mechanicsburg, PA 17050
220 Silver Springs Road
Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date: 4/29/03
Capacity:
Shiremanstown, PA 17011
(717) 737-8761
Personal Representative
X Counsel for Personal
Representative
JAMES D. BOGAR
JENNIFER B. HIPP*
*Also admitted to New Jersey Bar
JAMES D. BOGAR
ATTORNEY AT LAW
ONE WEST MAIN STREET
SHIREMANSTOWN, PENNSYLVANIA 17011
e-mail mail@bogarlaw.coln
June 20, 2003
TELEPHONE
(717) 737-8761
FACSIMILE
(717) 737-2086
Direct e-mil jhippi~bogarlaw.com
VIA HAND DELIVERY
Donna Otto
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE:
The Estate of Evelyn M. Swartz
No. 21-03-0363
Date of Death: March 29, 2003
Dear Ms. Otto:
I represent the Estate of Evelyn M. Swartz. Enclosed is a
check made payable to the Register of Wills in the amount of
$8,700.74, same constituting a prepayment at discount on account
of Pennsylvania inheritance taxes in the above-captioned estate.
The prepayment is determined as follows: $61,057.83 multiplied
by 15% or $9,158.67, less discount in the amount of 5% or
$457.93, resulting in payment of $8,700.74. Please provide me
with the appropriate receipt in this matter.
Your time and consideration in this matter are greatly
appreciated.
Very truly yours,
J R B. HIPP
JBH/blw
Enclosure
cc: Linda K. Sanders, Co-Executrix
Helen L. Raudabaugh, Co-Executrix
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-11 62 EX(11-96)
CD 002729
HIPP JENNIFER B, ESQ.
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
........ fold
ESTATE INFORMATION: SSN: 194-26-6624
FILE NUMBER: 21 03-0363
DECEDENT NAME: SWARTZ EVELYN M
DATE OF PAYMENT: 06/24/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/29/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $8,700.74
REMARKS:
TOTAL AMOUNT PAID:
HELEN L RAUDABAUGH
C/O JENNIFER B HIPP
$8,700.74
SEAL
CHECK//102
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD OO2995
HIPP JENNIFER B, ESQ.
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
........ fold
ESTATE INFORMATION: SSN: 194-26-6624
FILE NUMBER: 2103-0363
DECEDENT NAME: SWARTZ EVELYN M
DATE OF PAYMENT: 09/10/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/29/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $198.35
TOTAL AMOUNT PAID:
9198.35
REMARKS: LINDA KSOUDEREXECUTRIX
C/O JENNIFER B HIPP ESQUIRE
SEAL
CHECK# 104
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 17178-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-03-0363
COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Swartz Evelyn M.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
03/29/2003 I 08/03/1906
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. F~RST, AND MIDDLE IN{T~AL)
SOCIAL SECURITY NUMBER
194-26-6624
THIS RETURN MUST BE RLED IN DUPUCATE WITH THE
REGISTER OF WIII $
SOCIAL SECURITY NUMBER
1. Original Return ~ 247! Supplemental Return
4. Limited Estate . Future Interest Compromise (date of death after 12-12-8Z)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
[~]9. Litigation Proceeds Received [---] 10. Spousal Poverty Credit
(date of death
3. Remainder Return priorto 1Z-13-8Z)
5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
~ 11. Election to tax under Sec. 9113(A)
(date of death between 1:>-31-91 and 1 - 1-95) (Attach Sch O)
i i iiTHi~ SECTION 'MUST BE COMPLE~EDi ~[L ~RRES~ND~N~ ~ C~NFiDEN~i~ ~ iNFORM~i0~ ~H~ BE DIRECTED 3j~i
NAME
COMPLETE MAILING ADDRESS
3ennifer B. Hipp Esquire
FI R M NAM E (I f Applicable)
TELEPHONE NUMBER
717/737-8761
One West Main Street
Shiremanstown, PA 17011
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses 8, 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.
14.
N6 e
41,748.48
None
3,000.00
23,493.96
None
None
4,748.15
1,114.13
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USE ONLY
(8) 68,242.44
(11) 5,862.28
(lZ) 62,380.16
(13~
(14) 62,380.16
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
62,380.16
X .0 0
X .0 45
X .12
X .15
(15) 0.00
(16) 0.00
(17) 0.00
(18) 9,357.02
(19) 9,357.02
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
325 Wesley Drive
Apartment 3220
CITY
Mechanic sbur~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
8,700.74
457.93
STATE
(1)
Total Credits ( A + B + C )
ZIP
17055
9,357.02
3. Interest/Penalty if applicable D. Interest
E. Penalty
Total Interest/Penalty ( 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 re~luest a refund (4)
5. 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. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................... r-"] ~']
b. retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ...................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ r'-] J~]
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? ................................ r'-'] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
0.00
0.00
198.35
0.00
198.35
Under pe,,alties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative {s based on all Information of which preparer has any knowJedge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN [-Ielen L. Raudabaugh DATE
SIGNATURE OF PREPARER OTHER THAN REPRESEN Jennifer B. Hipp Esquire DATE
.-~.{ ,t One West Main Street _
---
Fo~ dates o~ death on or a~e~ Ju~ 1, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net value of t~an~ers to or for the use of the
su~iving spouse is 3% [72 P.S. 9116 (a) ( 1.1 ) (i)].
For dates o~ death on or a~er Janua~ 1, 1995, the tax ~ate imposed on the net value of transfers to or for the use of the surviving spouse ~s 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a t~ansfe~ to a surviving spouse from tax, amd the statutoU ~equi~e~n~ for disclosure of asse~
and filing a tax return are sfi~l applicable even W the surviving spouse is the only beneficiaU.
For dates of death on or a~et Ju~ 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child ~en~-one years of age or younger at death to o~ for the use of a natural
parent, an adoptive pa~ent, o~ a ~epparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The mx ~ate ~mposed on the ,et value of transfers to or for the use of the decedenfs lineal beneficiaries ~s 4.5%, except as noted in 72 P.S. 9116(1.2)
The mx rate imposed on the net value of tran~ers to or fo~ the use of the decedent's siblings is 12% [72 P.S. 9116(a~1.3)]. A sibling is defined, unde~
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood o~ adoption.
Copyright (c) ~000 form software o,]y The Lackner Group, loc. Form ~-~00 ~X (~ev. 6-00)
ADDITIONAL Personal Representatives
Estate of Evelyn M. Swartz SS# 194-26-6624 03/29/2003
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Linda K. Sanders
501 N. Market Street
Name
Address Line 1
Address Line 2
City, State, Zip
Date
Mec~ha~ivburg, PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 28O601
HARRISBURG. PA 17128-0601
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
i~COUNTY CODE , FILE NUMBER ,
'~ DECEDENT'S NAME (LAST, FIRST, MIDDLE)
Swartz, Evelyn M.
'~1 ADDRESS OF DECEDENT (STREET) (ZIP CODE)
325 Wesley Drive, Apt. 3220 Mechanicsbur9 17055
~.~ NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
Jennifer B. Hipp, Esquire
(STREET NAME) (CITY) (STATE) (ZIP CODE)
One West Main Street Shiremanstown PA 17011
~;~ NAME. ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE aox OPENING
SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
194-26-6624
DATE OF DEATH
M~ch 29, 2003
(CITY) (STATE)
a. (NAME) (RELA~ONSHIP)
Jennifer B. Hipp, Esquire None
(STR~-T NAME) (CITY) (STATE) (ZIP CODE)
One West ~ain Street Sh~remanstown PA 17011
b. (NAME) (RELATIONSHIP)
Linda K. Sanders Niece
(S I ~(EET NAME) (CITY) (STATE) (ZIP CODE)
501 N. Market St. Mechanicsburg PA 17055
¢. (NAME) (RELATIONSHIP)
Helen L. Raudabaugh Niece
(STREET NAME) (CITY)
9 Pheasant St. Mechanicsburg
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(STATE) (ZIP CODE)
PA 17050
(NAME)
PNC Bank, N.A.
(STR~T NAME) (CITY) (STATE)
325 Wesley Drive Mechanicsburg PA
NAME OF PERSON MAKING LAST ENTRY
._ .E!J_e_lyn...M...._.Swartz
anuaDATE OF CONTRACT TO RENT BOX ~ NUMBER OF aox
ry 7, 1993 ! 6
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
(ZIP COOE)
17055
DATE AND TIME OF LAST.ENTRY
July 5, 2002
l,~ TITLE UNDER WHICH SOX IS REQUESTED
Evelyn M. Swartz
a. (NAME)
Linda K. Sanders
(STREET ADDRESS)
501 N. Market St.
(C~TY) (STATE)
Mechanicsburg, PA
r~ NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
(ZIP CODE)
17055
b. (NAME)
Helen L. Raudabaugh
(STREET ADORESS)
9 Pheasant St.
(ClZY)
Mechanicsburg
(STATE) (ZIP CODE)
PA 17050
Jennifer B. Hipp, Esquire
rl~ WASAWlLLI. THE BOX? [] YES ~[NO
If yes, a. Date of will:
b. Name and address of personal representative, if named in the will
(NAME)
(STRE. t:7 NAME) (CITY) (STATE) (ZIP CODE)
C. ;~&i,,e and address of attorney, if any · '
(NAME)
(S i NEET NAME) (CITY} (STATE) (ZIP CODE)
O;Al-I- UI-I-'U;:311 I1%1V1-1%1 lull1'
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, sedal number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, ~ast date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and descdbe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible,
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
1 United States of America Savings Bond, Series EE, 3 @ $10,000.00 each
(Nos. X-0-002-161-907-EE; X-0-002~-161-905-EE; X-0-002-161-906-EE
2 August 7, 1997 D~mand Note in the amount of $3,000.00 from the Central
Pennsylvania Conference Committee on Loans, The United Methodist Church
3 New York Life Annuity, Polic7 No. A-475 089
4 New York Life Annuity, Policy No. A-490-052
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIER SAFE DEP_QSlT~BOXJNVEN. T,~I~Y:,, .... / --
SIGNATURE o SlGNATUR~~' / ~ ~~'~'--~"'"'--'"~
PRINT J~E
i~n~a ~. 5anaers, ~o-~xecu~rlx .
J~nnif~ B. Hipp, Esquire Helen L. Raudabauqh, Co-Executrix _
PRINT TITLE DATE CHECK APPROPRIATE BOX:
Attorney [] E~tata Representative [] Joint owner of ~afe deposit box __
NOTE: Attach additional 8'I," x 11~ sheet(s) if necessary or use duplicates of this page of form.
REV- 1503 EX + (1-97)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESIDENTDECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Evelyn M. Swartz SS~/ 194-26-6624 03/29/2003 21-03-0363
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE
OF DEATH
1 983.092 shares Putnam Imvestments - Account No. 13.22000 12,996.48
0388777146, date of death balance $12,996.48
2 U.S. Savings Bond - Serial No. X2161905EE, issue date 9,584.00
2/1992, denomination $10,000.00, issue price $5,000.00
3 U.S. Savings Bond - Serial No. X2161906EE, issue date 9,584.00
2/1992, series EE, denomination $10,000.00
4 U.S. Savings Bond Serial No. X2161907EE, issue date 9,584.00
2/1992, series EE, denomination $10,000.00
TOTAL(Alsoenteronline2, Recapitulation) 41,748.48
(If more space m needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97)
PUTNAM INVESTMENTS
May 16, 2003
Putnam Investor Services
Post Office Box 41203
Providence, Rhode Idand 029Ft0-1203
1-800-225-1581
wu'w.putnaminv, com
ATTN JENNIFER B HIPP
JAMES D B OGAR
ATTORNEY AT LAW
ONE WEST MAIN ST
SHIREMANSTOWN PA 17011
Account No.: A0Y 1194266624BBB0
Registration: Evelyn M Swartz
Reference No.: 0388777146
Dear Ms. Hipp:
Thank you for contacting us regarding the above-referenced account, established on April 27,
i995. Ihe financial markets were closed on March 29, 2003. Therefore, we are providing
information fc.r the preceding business day in the table below.
I . ~ ..:!: ACi:0unt.Number
[ AOYI 194266624BBB
983.092 '1 $13.22 ':[ ..... $12'99;'48
Should you have any questions, please call us toll free at 1-800-225-1581. One of our
representatives will be pleased to assist you.
Sincerely,
Patricia Fredrick
Putnam Investor Services
Savings Bond Calculator Page I of I
03/2003
Series
EE Bonds ,
LUpdat~l
Denomination
$ ~o,ooo
Serial Number
Issue Date
Savin,
Bond
# Bonds Total Price
3 $15,000.00
Issue
Serial Number Issue Date Series Dehorn Price
X2161905EE 02/1992 EE $10,000 $5,000.00
X2161906EE 02/1992 EE 10,000 5,000.00
X2161907EE 02/1992 EE 10,000 5,000.00
Total Interest
$13,752.00
Interest Value
$4,584.00 $9,584.00
4,584.00 9,584.00
4,584.00 9,584.00
Total Value
$28,752.00
Interest
Rate
6.00%
6.00%
6.00%
YTD Interest
$840.00
Next Final
Accrual Maturity Note
08/2003 02/2022
08/2003 02/2022
08/2003 02/2022
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
ME Matured (Exchangeable for HH)
MN Matured (Not Exchangeable for HH)
Please rate this service.
(Please print and/or save this page before submitting your survey)
Service Excellent Good Fair Poor
Savings Bond Calculator
[ SubmitSun~ey a [Reset]
hltp://wwws.oublicdcbt. I rcas.~ov/BC/SBCPricc '~/I t/?nnl
SEamS EE
02 1992 -
dk-~*MECHANICSB~TRG ..... !;PA 17055
~'~:0000 qO00 ?m:Oq
qO00 E l, & I, qO ?,'
REV- 1507 EX + (1-97)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M. Swartz SS# 194-26-6624 03/29/2003
FILE NUMBER
23.-O3-O363
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Central Pennsylvania Conference of the United Methodist Church
Demand Note
TOTAL (Also enter on line 4, Recapitulation)
VALUE AT DATE
Of DEATH
3,000.00
3,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1507 EX (Rev. 1-97)
CENTRAL PENNSYLVANIA CONFERENCE
THE UNITED METHODIST CHURCH
303 MULBERRY DRIVE/P.O. BOX 2053 / MECHANICSBURG, PA 17055-2053 /TELEPHONE (717) 766-5275
May 14, 2003
Attorney Jennifer B. Hipp
One West Main Street
Shiremanstown PA 17011
Dear Attorney Hipp:
This letter is in response to your recent communication conceming the Demand Note in
the name of Evelyn Swartz that we are holding in the Central Pennsylvania Conference
Loan Fund.
At the time of Mrs. Swartz death, March 29, 2003, the value of her certificate was
$3.000.00. A check made payable to her Estate in that amount is enclosed.
If you need further information please feel free to contact me.
Sincerely,
(Mrs.) Zedna M. Haverstock
Enclosure'Check
COUNCIL ON FINANCE AND ADMINISTRATION
REV- 1508 EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M. Swartz
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS# 194-26-6624 03/29/2003
FILENUMBER
21-03-0363
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
NUMBER
7
8
Copyright (c) 1996 form software only CPSystems, Inc,
DESCRIPTION
Commonwealth of Pennsylvania - Rent Rebate
Contents of apartment and personal property
Highmark Blue Shield, Health Insurance - Refund
PNC Bank - Certificate of Deposit No. 31800198596, date of death
balance $2,000.00, accrued interest $9.62
PNC Bank - Certificate of Deposit No. 31400213878, date of death
balance $10,000.00, accrued interest $32.19
PNC Bank - Certificate of Deposit No. 3110024744, date of death
balance $2,000.00, accrued interest $6.25
PNC Bank - Certificate of Deposit No. 31100213808, date of death
balance $5,000.00, accrued interest $16.09
PNC Bank - Checking Account No. 5070075326, date of death balance
$3,560.53, accrued interest $0.25
The Hartford - Refund of renters insurance policy
VALUE AT DATE
Of DEATH
352.50
200.00
251.53
2,009.62
10,032.19
2,006.25
5,016.09
3,560.78
65.00
TOTAL (Also enter on line 5, Recapitulation) $ 23,493.96
(If more space is needed, insert additional sheets of the same size)
Form REV-1508 EX (Rev. 1-97)
PNCB
May 15, 2003
Se. unif~ B. Hipp
One West Main Str~
Shir~nstown, PA 17011
Estate of Evelyn M. Swartz, decea,~ed
SSN: 19~26-6624
DOD: 3/29/2003
Dear Ms. Itpp:
In responSe to your request for Date of Death balances for the customer noted above, our
records show the following:
Certes of Deposit
Account #31800198596
EVELYN M SWARTZ
DOD balance: $2,000.00 + $9.62 accru~ interest
Established 09/11/2000
Accour~ #31400213878
EVELYN M SWARTZ
DOD balance: $10,000.00 4. $32.19 accrued interest
Established 07/05/2001
Account #31100214744
EVELYN M SWARTZ
DOD balance: $2,000.00 4. $6.2~ accrued interest
Established 07/13/2001
Account #31100213808
EVELYN M SWARTZ
DOD balance: $5,000.00 + $16.09 accrued ~ntcrcst
Established 07/05/2001
Checking Account
Account #5070075326
EVELYN M $WARTZ
DOD balance: $3,560.53 + $.25 accrued interest
Established 01/07/1993
Page 1 of 2
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CT)s, Checking and Savings accounts). We do not process any fiaanclsl
transactions or provide statements. If you need assistance with any of these iteans,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
Rachelle Wells
1-800-762-I??$
P?-PFSC-04-F
$00 ~rst Av~.
Pittsbur~ PA 15219
Pag~ 2 of 2
M~nber FDIC
TOTAL P.02
R~V-lS~ EX*0-97) SCHEDULE H
COMMONWE^LTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCETAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
Evelyn M. Swartz SS~/ 194-26~6624 03/29/2003
FILE NUMBER
21-03-0363
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
Ao
4
DESCRIPTION
FUNERAL EXPENSES:
Pastor for Funeral Service Fee
Rolling Green Cemetary - Internment Fees, Etc.
Stephensons Flowers ~ Flowers for Funeral
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees Jennifer B. Hipp 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
Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cremation Society of Pennsylvania Death Certificates
Cumberland County Law 3ournal - Advertisement of Estate Notice,
May 23, 2003
RESERVES: Costs to conclude administration of Estate including
filing fee for PA Inheritance Tax Return, Inventory and First &
Final Account; preparation of Personal and Fiduciary Income Tax
Returns
The Patriot News Publication of Obituary
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
AMOUNT
50.00
300.00
63.59
3,150.00
156.00
25.00
75.00
750.00
81.40
97.16
4,748.15
Copyright (c) 1996 form software only CPSystems. Inc. Form REV- 1511 EX (Rev. 1-97)
Estate of: Evelyn M. Swartz
Soc Sec #: 194-26-6624
Date of Death: 03/29/2003
Item Description
Continuation of Schedule H-B7
(Other Administrative Costs)
Amount
5
6
The Patriot News Executors Notice
Verizon - Final Bill
93.85
3.31
97.16
REV-151Z EX + {1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
Swartz SS# 194-26-6624 03/29/2003
FILENUMBER
21-03-0363
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Bethany Village Alert Pharmacy - Prescription
2
Bethany Village Skilled Nursing Department
through 03/28/2003
Care for 03/27/2003
Bethany Village Final Rent Payment
TOTAL (Also enter on line 10, Recapitulation)
5.88
364.00
744.25
$ 1,114.13
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M. Swartz SS~/ 194-26-6624
SCHEDULE J
BENEFICIARIES
03/29/2003
NUMBER
2
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 91 l~a~l.Z)]
Creedin H. Otto, Jr.
220 Silver Springs Road
Mechanicsburg, PA 17055
Helen L. Raudabaugh
9 Pheasant Street
Mechanicsburg, PA 17050
Linda K. Sanders
501 N. Market Street
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Nephew
Niece
Niece
FILE NUMBER
21-03 -0363
AMOUNT OR SHARE
OF ESTATE
One-third
(1/3) of rest,
residue and
remainder
One-third
(1/3) of rest,
residue and
remainder
One-third
(1/3) of rest,
residue and
remainder
II.
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
$ 0.00
Copyr{ght (c) Z000 form software only The Lackner Group, inc. Form REV-1513 EX (Rev, 9-00)
LAST WILL AND TESTAMENT
OF
EVELYN M. SWARTZ
I, EVELYN M. SWARTZ, of Lower Allen Township, Cumber-
land County, Pennsylvania, make, publish and declare this as and
for my Last Will and Testament, hereby revoking all other Wills
and Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
gether with any insurance policies thereon, as follows:
(A) One-third (1/3) thereof to my niece, HELEN L.
RAUDABAUGH, of Mechanicsburg, Pennsylvania.
(B) One-third (1/3) thereof to my niece, LINDA K.
SANDERS, of Mechanicsburg, Pennsylvania
(C) One-third (1/3) thereof to my nephew, CREEDIN H.
OTTO, JR., of Mechanicsburg, Pennsylvania.
If any of the individuals named herein predecease me, I
direct that their share or shares under this, my Last Will and
Testament, be given, absolutely, to the CARE ASSURANCE FUND OF
~HANY VILLAGE, Mechanicsburg, Pennsylvania, to be used to fund
payments for People in need at Bethany Village, said need to be
determined by the appropriate officials of the CARE ASSURANCE
FUND OF BETHANY VILLAGE.
SECOND: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
n, improvement, zoning or management of real estate and to
ose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
~~ (F) To exercise any election or privilege given by the
ral and other tax laws, including, but not necessarily being
ted to, personal income, gift and estate or inheritance tax
(G) To make distributions to my herein named benefici-
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
?HIRD: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
2
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
FOURTh: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
FIFTH: I nominate and appoint DAUPHIN DEPOSIT BANK AND
TRUST COMPANY, of Harrisburg, Pennsylvania, Executor of this, my
Last Will and Testament. I direct that my Executor, and its
successors, shall not be required to post security or a bond for
the performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this --7~k day of
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estate of Evelyn
also known as
M. Swartz No. 21-03-0363
, Deceased
Date of Death 03/29/2003
Social Security No. 194-26-6624
Helen L. Raudabau~h and Linda K. Sanders,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this Inventory are true and correct. I/VVe understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Nameof
Attorney: Jennifer B. Hipp Esquire
I.D. No.: 86556
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Personal Representative
Signature:
Helen.~L. Raudaba~gh ~
Lin~a K. Sanders
Address: 9 Pheasant Street
Mechanicsburs, PA 17050
Telephone: 717-691-5986
Dated:
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
.Value
Total: 68,242.44
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pertrtsylvania Rar Association
Copyright lc) 1996 form software only CPSystems, [nc. Form #RW-7 (199;')
Estate of:
Date of Death:
County:
INVENTORY
Evelyn M. Swartz
03/29/2003
Cumberland
CASH:
Commonwealth of Pennsylvania
Rent Rebate
Contents of apartment and
personal property
Highmark Blue Shield, Health
Insurance - Refund
PNC Bank - Certificate of
Deposit No. 31800198596,
date of death balance
$2,000.00, accrued interest
$9.62
PNC Bank - Certificate of
Deposit No. 31400213878,
date of death balance
$10,000.00, accrued interest
$32.19
PNC Bank - Certificate of
Deposit No. 3110024744, date
of death balance $2,000.00,
accrued interest $6.25
PNC Bank Certificate of
Deposit No. 31100213808,
date of death balance
$5,000.00, accrued interest
$16.09
PNC Bank - Checking Account
No. 5070075326, date of
death balance $3,560.53,
accrued interest $0.25
352.50
200.00
251.53
2,009.62
10,032.19
2,006.25
5,016.09
3,560.78
-1-
The Hartford - Refund of
renters insurance policy
STOCKS/LISTED:
983.092 shares Putnam Investments
Account No. 0388777146, date
of death balance $12,996.48
BONDS:
U.S. Savings Bond - Serial No.
X2161905EE, issue date
2/1992, denomination
$10,000.00, issue price
$5,OOO.OO
U.S. Savings Bond - Serial No.
X2161906EE, issue date
2/1992, series EE,
denomination $10,000.00
U.S. Savings Bond - Serial No.
X2161907EE, issue date
2/1992, series EE,
denomination $10,000.00
MORTGAGE/NOTE RECEIVABLE:
Central Pennsylvania
Conference of the United
Methodist Church Demand
Note
65.00
12,996.48
9,584.00
9,584.00
9,584.00
3,000.00
23,493.96
12,996.48
28,752.00
3,000.00
-2-
TOTAL RECEIPTS OF PRINCIPAL ...............
68,242.44
-3-
BUREAU OF ZNDTVZDUAL TAXES
TNHERTTANCE TAX DTVZSTON
DEPT. 280601
HARRISBURG, PA 17128-0601
COHNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
JENNIFER B HIPP ESQ
I W HAIN ST
SHIREHANSTOWN PA 17011
REV-16~? EX AFP
DATE 10-27-2005
ESTATE OF SWARTZ EVELYN N
DATE OF DEATH 03-29-2003
.FXLE NUNBER 21 03-0363
':COUNTY CUHBERLAND
ACN 101
Aeoun~ Reei~ed
HAKE CHECK PAYABLE AND REHZT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF SWARTZ EVELYN HFZLE NO. 21 03-0363 ACN 101 DATE 10-27-2005
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RE$~-AYATZON CONCERN]:NG FUTURE INTEREST - SEE REVERS;:
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~e~e (Schedule A) (1)
2. S~ocks and Bonds (ScheduZe B) (2)
3. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C}
q. Hor~geges/No~es Receivable (Schedule D)
$. Cash/Bank Deposi~s/Hisc. Personal Proper~y (ScheduZe E) ($)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~el Asse~s
APPROVED DEBUCTZONS AND EXENPTZONS:
9. Funeral Expenses/Adc. Cos~s/Nisc. Expenses (ScheduZe H) (9)
10. Deb~s/Nor~gege Liabil/~ies/Liens (Schedule 1) (10)
11. To~el Deduc~/ons
12. Ne~ Value of Tax Re~urn
.0o
i1~7'~8.18
.00
3/000.00
23/~95.96
.00
.00
(8)
~,7~,8.15
NOTE: To /nsure proper
credi~ ~o your account,
sube/~ ~he upper portion
of ~h/s fore wi~h your
~ax payment.
15.
NOTE:
ASSESSNENT OF TAX:
PAYNENT
DATE
06-2~-2005
09-10-2005
68, ZR2. r,r~
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(Z5) .00 X O0 = .00
(~6) .00 X 0~5= .00
(Z7). .00 X 12 = .00
(18). 62,580.16 x 15 = 9,557.02
(~9)= 9,357.02
AHOUNT PAID
8,700.7~
198.35
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
9,557.02
.00
.00
.00
TF TOTAL DUE ZS LESS THAN $1, NO PAYNENT TS REQUIRED.
ZF TOTAL DUE TS REFLECTED AS A "CREDIT' (CR}, YOU NAY BE DUE
REFUND. SEE REVERSE SIDE OF THTS FORH FOR INSTRUCTIONS. }
15. Aeoun~ of L/ne lq a~ Spousal ra~e
16. Aeoun~ of L/ne 1~ *axable a~ L/neel/Class A re~e
17. Amoun~ of Line 1~ a~ S/bi/nH re~e
18. Amoun~ of L/ne lq *exable a~ Collateral/Class B ra~e
19. Principal Tax Due
TAX CREBZTS:
R~CEZPT DZ$COUNT (+J
NUNBER INTEREST/PEN PA~D (-)
CD002729 ~57.95
CD002995 .00
Chari*able/Governeen*al Bequests; Non-elec*ed 9115 Trus~:s (Schedule J) (1-~) . O0
Ne~ Value of Es~:a~e Subject: ~:o Tax (lq) 62,580.16
Z~ an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
1,11~.X5
(1~) 62,580.16
RESERVATION:
Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred
in possession or anSoyaant to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Ceaaoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such futura interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office
of the Register of Nills, any of the ZS Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-$020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty [&O) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 17128-10Z1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to tho Orphans' Court.
Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17lie-0601
Phone (?17) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-ISOi) for an explanation of administratively correctable errors.
If any tax due is paid within three ($) calendar months after the decedant's death, a five percent (SZ) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January lB, 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 with first day of delinquency, or nine (9) months and eno (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of
six (BI) percent per annum calculated at a daily rate of .O0016q. 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 lgBZ through ZO05 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 lOX .0005~8 1987 9Z .000Z47 1999 7Z .00019Z
1983 ZSZ .000~8 1988-1991 llZ .000301 ZOO0 aZ .000Z19
1984 Ill .000301 199Z 9Z .000247 2001 9Z .000247
1985 Z3Z .000556 1993-1994 7Z .O00ZgZ ZOOZ 6Z .000164
1986 IOZ .O0027~ 1995-1998 9Z .O00Z~7 ZOO3 5Z .000137
--Interest is calculated as follows:
/NTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (la) 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.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Evelyn M. Swartz
Date of Death: March 29, 2003
will No.
21-03-0363
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:
State whether administration of the estate is complete:
Yes xx No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No XX
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. ~id the personal representative state an
acccunt informally to the parties in interest? Yes XX No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
lun ~ Jennifer B. Hipp, Esquire
~ ~i!' Name (Please type or print)
~ iii... One West Main St.
Ci ~,,.i' i~i' Shiremanstown, PA 17011
~c '~r .~ :3~ = Address
~717 } 737-8761
Tel. No.
Capacity:
__Personal Representative
(MAH:rmf/AM3)
x
_ Counsel for personal
representative