HomeMy WebLinkAbout04-0779
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of JEANNETTE G. BURGETT No. t/:</ ,{} t.j - 779
also known as To: Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 187-16-5945 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner is 18 years of age or older and the Executor named in the last will of the above
decedent, dated August 31,1998 and codicil(s) dated [none].
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or
principal residence at 507 West Louther Street, Carlisle Borough.
Decedent, then 81 years of age, died August 14, 2004, at Carlisle Area Regional Medical
Center, Carlisle, Pennsylvania.
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 ~~'killil!& and w4s~ever
adjudicated incompetent: :3 :;: ~ c:i' (\
c. ... .::.. ,,)
n:. ~
Decedent at death owned property with estimated values as follows: ffi: :!
(If domiciled in Pa.) All personal property ::i $ un~tiIl\ated
(If not domiciled in Pa.) Personal property in Pennsylvania $ .......,......
(If not domiciled in Pa.) Personal property in County ~ $ ;c
Value of real estate in Pennsylvania Ui $ une(~tiiilated
situated as follows: Carlisle Borough, Cumberland County \0
WHEREFORE, petitioner respectfully requests the probate ofthe last will and codicil( s) presented
herewith and the grant of letters testamentary thereon.
71/~~
F. William Gregory
691 Brockton Way
West Melbourne, FL 32904
(321 )724-5563
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OATH OF PERSONAL REPRESENT A TIVE
COMMONWEAL TH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
The petitioner above-named swears or affirms that the statements in the foregoing petition are true
and correct to the best of the knowledge and belief of petitioner and that as personal representative of the
above decedent, petitioner will well and truly administer the estate according to law.
Swomto or affirmed and subscribed ~ V~~d'" 7
before me this .:~~ day of F. William Gregory""-
~ ~~.
)J1m --- ~1. . ~.Jjjl
Reglst J
. LK
~
No. .;2/-0 </-77 q
Estate of Jeannette G. Burgett, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, [&~ dO -fLt:J.M "" 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 31,1998, described therein be admitted to probate
and filed of record as the last will of Jeannette G. Burgett and Letters Testamentary are hereby granted to
F. William Gregory.
Will Book # ,~~i~/ftJ
Page
FEES $ d.l0 ,00 lvo V. Otto III, Esquire (27763) "fl'-'
Probate, Letters, Etc. ATroRNEY (Sup. Ct. J.D. No.)
Short Certificates( S) $ J 5 Vi> MARTSON DEARDORFF WILLIAMS & OTTO
R-enuRciation ~'P:v'I4.?) $ cr. o-D 10 East High Street
0C p ~ PIl $ /0 00 Carlisle, P A 17013
TOTAL $304.00 (717) 243-3341
Filed ~ a..ol-/.....f~OOC-j
C!cuL ~'& w-/!P~ ';txtrc4 tUJ- /Le~.
F:\FILESIDA T AFILEIEST A TES\3449-I.lellers. Ie,
HI()~.;';()" RI.:V 9/';,6
This is to certify that the information here given is correctly copied fron: an original cer~ificate of death dult filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fllmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00 l~'._~, \:~~
Local Registrar
p 10589758 AUG 1 8 200~
No. Date
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Hl0$. ~43R~. 2/'7 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH' VITAL RECOA~~ h:.
CERTIFICATE OF DEATH " 0
~NT STAJI Fq,E NUMBER
ENT NAME OF DECEDENT I,...... MIdcH. ..._1 SEX SOCIAl. SECUAlrr NUMBER
iNK .. Jeanette G. Burgett i'ema1e 2.187 - 16 14, 2004
AGE ilnl-Yl UNDER , VIAll UNDER 1 D/(t 8IRTHPI.ACE {Coly ...
- I Days HourI ! ....... . SIal. or fcr-.gn Ccun&rVl
81 v..... Carlis1e,PA =-',0
. COUNTY OF OERH
~,
'I. ...
'7a. SaahI Pa Did .7c.o __.dM:redMIllfMlrI .....
507 West Louther St. -
Min.
... Carlisle, Pa 17013 _1 (";::t,rl; ~l&fj
.110. -
FRHEA'S NAME (FYsl. MdeIlI. lnt)
... William C. Bur ett
INFORMANT'S NAME cr_mq
F. William Gr 0
METItOO 01' OOSPOSITlON
. _iii c-... 0
_0 ""*- 2004
. .
F E uct:N
No~
I~""" "ART": OINrIigniftcM(~~IO".buI
'-- nac rMUling iI'ItM~""s;w.nin PMT I.
~ &-t~~ ~ : on.-......
S~ ~,1.s ,
I
L ,
DUE 1D1OA AS A CONSEQUENCE Of)o :
{ : DUE 10 lOA AS A CONSEOUENCE Of)o I
I
I
DUE 10 lOA AS A CONSEQUENCE Of)o I
I
WE"" AU1lJPSY FINDINGS lWlNEA 01' DEATH DATe OF INJURY TIME OF INJURY
-..tILE PAIOlllO )f _.0..,._,
COIoIPlETION 01' CAuSE - 0
01' DERH? - _0 ...0
) -- 0 --...... 0
_0 ...~ _0 ...0 0 o PlACE OF INJURv. AI......... fa"". .....IadoIy. om.:. II.
- ~lICIlIbe~
buicIng.~. lSpcM
- - ... -.
CUlT.... fCNck any ~
.C8IT...-....a ""SIClAIf(Ph~cerwyingcauMr:Jo.tl wMn~ ~haI pr~dQlrl anoc~"em 231
.,..........""~,.IIttI~.........CIIU..).....IftMMf............................................................. .
.~ AND ClflTlnlNQ HtYSICIAN (PhysIc.." both prOl'lOunClngOHlt1 and~ 1Ol;alJM of dH1f\l
1e1he,,",of"'Y~. d..IttOCCurrM......~. dII....ndpIK.. .nddulllo....C.uM(.)Mdm.nnft"..~led. .................
"III!DICAL EXAII'N!AICOAON!R
On lite... 0' ".",lna'lon and/or Invea".alion.ln my opinion, d..th occurred .'Ihe 11m.. d.le. and ~.c., and due.o the c.uM(a) and
"a. fI'I""""" ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
REGISTRAR'S SIGNATURE ANO NUMBER ~. ~~c:\...~
b"ll;::)lltDI &'\)04-
F:IFILESIDA T AFILEI WILLSI3449, WIL Idln
LAST WILL AND TESTAMENT 3(1-DY.-l19
I, JEANNETTE G. BURGETT, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me
made.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
.-, r. :0
of the administration of my estate. My personal representative shall have no~~tY or 6B1igatiQli ~
" . ',. \)
obtain reimbursement for any such tax so paid, even though on proceeds of insura~ or oth~
cri ; ':":L
property not passing under this Will. --"
-..J
2. .........-~
\() ,':)
If my sister, BETTY 1. FRITZ, shall survive me by thirty (30) days, then I give,.:devise ana"
'.0
bequeath all of my estate, both real and personal property, unto my sister, BETTY 1. FRITZ,
absolutely, and I hereby appoint the said BETTY 1. FRITZ as Executrix of my estate.
3.
In the event the said BETTY 1. FRITZ shall predecease or fail to survive me by more than
thirty (30) days, and in the event we shall die in a common disaster and it cannot be determined which
has survived, I shall be deemed to have survived my sister. I direct that my estate, both real and
personal property, shall be disposed of in the following manner:
(a) I give one-third (1/3) thereof unto F. WILLIAM GREGORY, absolutely.
(b) The remaining two-thirds (2/3) thereof I give equally to MARK ALLEN WISE,
TRACY WISE KOV ACEVIC and RYAN M. KOVACEVIC, absolutely. I further direct that if any
of the said legatees shall fail to survive me, then his or her share shall be divided equally among the
surviving legatees mentioned in this paragraph.
(c) I nominate, constitute and appoint F. WILLIAM GREGORY as Executor of my estate
under the provisions of this third paragraph of my Last Will and Testament.
U!
J.G.B.
Page 1 of 4 Pages
4.
I nominate, constitute and appoint TRACY WISE KOVACEVIC as Guardian of the estate
of RYAN M. KOVACEVIC.
5.
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of her or his duties in any jurisdiction.
6.
I authorize and empower my personal representative, in her or his sole and absolute
discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose
of or grant options in regard to any or all property of any kind forming a part of my estate for such
terms and such prices as she or he may deem advisable; to borrow money for any purposes connected
with the protection and preservation of my estate; to mortgage or pledge any real or personal
property forming a part of my estate or to join in or secure the partition of same; to compromise any
claims or demands of my estate against others or of others against my estate; to make distribution in
kind and to cause any share to be composed of cash, property or undivided fractional shares in
property different in kind from any other share; to employ agents, attorneys and proxies and to
delegate to them such power as my personal representative considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate. 31 J day of
IN WITNES S WHEREOF I have hereunto set my hand and seal this
~ ' 1991- ~lk~
(SEAL)
Jeannette G. Burgett
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
Page 2 of 4 Pages
TjJLn%lJ:resen~ofthe=::~
Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, Jeannette G. Burgett, Testatrix, 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.
~- 4
~:tk!._~
,/ eannette G. Burgett '
Sworn or affirmed to and acknowledged before me by Jeannette G. Burgett, the Testatrix,
this O/6C day 0 ,199t
No...;al Seat I/.). .. . ~. cti ~
Denise l. N e, Notary Public I V WI UA&- ,
Carlisle Bora. tumberland cou~ty Notary Public
My CommisSion Expires Feb. 26, 2001
COMMO~'ArT~a8;sp~~~~~ANIA )
: SS.
COUNTY OF CUMBERLAND )
We, LJ I } }) ~ J:: VY)Lr-..J:sll\. and r e J.... S
the witnesses whose names are signed to the attached or foregoing instrument, being ly qualified
according to law, do depose and say that we were present and saw Jeannette G. Burgett, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that
the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each
of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of
our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
. s-+-.
Car/lslc. flA J 7tJ) ?
~~~~dl
Ad ress JD e. I-h~ Sf'
fAr-I} 6)C 'A /7a 13
.
Sworn or affirmed to and subscribed before me this 2;/-st day of WI 11'1 f1.IJi ,
199K 1V'7J
NOIa'aIS'al ~ Iff
Denise l. Nye, Notary Public .
Carlisle Boro, Cumberland count~ Notary Pubhc
My Commission !Cxpires Fer, e'f: ? !i1
. . I
Member Pennsvh.'?n!a .4ssociat;on of J'Jot~f!e~-
Page 4 of 4 Pages
F: IFlLESIDA T AFILEIEST A TESI3449_1. notice.cerl
CERTIFICATION OF NOTICE UNDER RULE 5,6(a)
Name of Decedent: Jeannette G. Burgett
Date of Death: August 14, 2004
FileNo, 21-04-0779
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 or
about September 2, 2004,
Mr. F. William Gregory Mr. Mark Allen Wise
691 Brockton Way 8105 Cherry Laurel Lane
West Melbourne, FL 32904 Irving, TX 75063-4214
Ms. Tracy Wise Kovacevic, individually
and as guardian of Ryan M. Kovacevic
117 Beard Road
Enola, PA 17025
Notice has now been given to all perso~ thereto under Rule 5,6(a) except: N/A
Date: September 2,2004 Signature <...~
Name Ivo V. Otto III, Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
0\ ,t Attorneys for Personal Representative
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COMMONWEALTH OF PENNSYLVANIA *'
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 04-0779
BUREAU OF INDIVIDUAL TAXES AND
DEPT. 280601 TAXPAYER RESPONSE ACN 04138089
HARRISBURG, PA 17128-0601
DATE 10-11-2004
REY-lS45 EXAFP tn-DUI
TYPE OF ACCOUNT
"{ EST. OF JEANNETTE BURGETT D SAVINGS
';(i 5.5. NO. 187-16-5945 D CHECKING
DATE OF DEATH 08-14-2004 D TRUST
29 D \=QH&TY CUMBERLAND IX] CERTIF.
'04 OCT i l .";'~
REHIT PAYHENT AND FORHS TO:
MARK A WISE REGISTER OF WILLS
,8195 tll[RR~f b.~.\:IREb b.tl CUMBERLAND CO COURT HOUSE
IR"Itlt Tll 1iQ'~ ~..:';:':' , CARLISLE, PA 17013
> 'I'/C'9 Bi.st'(Jf#6' :V,2-. C\T:1L'
Flowe, )JIov"IIJ/ TX 7s' oz/3
J
IIAYPOINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction frail the financial institution, attach a copy
to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onweslth
of PlIOflsylV1:lnif:l. Qu.sti~IS ~ay b. ans~.r8d by c3111n& (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7100016929 Oat. 12-27-2001 To insure proper credit to your account, two
Established (2) copies of this notice Must acco.pany your
Account Balance 11,439.72 pay.ent to the Register of Wills. Nllke check
payable to: "Register of Wills, Agent".
Percent Taxable X 16.667
AftOunt Subject to Tax 1,906.66 NOTE: If tax paYIlBnts are made within thrBe
(3) months of the decedent's date of death,
Tax Rat. X .15 YOU may dBduct a 5~ discount of thB tax due.
Potential Tax Due ~ ;n 1.70 Any inheritance tax due will becolle delinquent
nine (9) lIonths after the date of death.
PART TAXPAYER RESPONSE
[!][~ilili~Ii.I!~$~l!__!!!!I~IiIi!~i!_~!m~I!!i!.iiii_~~~Uii!!!{.~!!..ll!!II!~!!~lili~i~!~~1!r,.(.
"'~""'"~'''''''''''''-'-'-'--~'~''''-''''''''''''''''l~'''""",~"".",',H.,.,.",.,.,~.,.,~.,......,.............~l.,."'-"'-""""""""""l"""~""~'~'~""""'",.,.,~.,.,.,.,.........,.........,......l...............................,..._..._._.'.-.'.-.-.'.-.'.-.~-~.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'"'~""""',~"""""'~"""""r."'''''l''''''''''''''''''''_.l._
.. ........~,......,.,.r.,.,.,.,.,. ...... ............ ....... ... ... ... ... ., '1 ""'l'" .,. ""'l"""""" .......,................. ... ........ ... 'Ir"" ""'0"1'0" ....,.,. .'..'.,.'.'.'..,...... ..,.,n ...'.,.'...'.'...,.,...,.....,.......,.......................... ... ... ....".. ..,......,... ... .....
.. [] The above infor~ation and tax due is correct.
1. You .ay choose to re.it paY.Bnt to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interBst, or yoU may check box "A" and return this notice to the Register of
[ ONE ] Wills and an official assess.ent will be issued by the PA Department of ReVBnUB.
BLOCK B. ~ The above asset has been or will be reported and tax laid with the pennsylvania~heritance TJ' return
ONLY to bB filBd by thB dBCBdBnt.s rBPr..BntBtivB.Jt\VlAI 0 '0 e. Htl.H sT. al.l~l.li', A /700
c. [] The above inforaation is incorrect and/or debts and deductions were paid by you. 7/7 -~t{J 37Jt{ I
You lIust COMplete PART ~ and/or PART ~ below.
PART If you indicate a different tax rat., please state your
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Oat. Established 1
2. Account Balance 2
3. Percent Taxable 3 X
... Amount Subject to Tax ..
5. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 X
B. Tax Due e
PART DEBTS AND DEDUCTIONS CLAIMED
[!]
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) $
declare that the facts I have reported abov. are true, correct and
V- .. . belief. HOME (~~ ,~~l ~76~ ~
WORK Un '7tP9 v-g /0
TELEPHONE NUM ER
GENERAL INFORMATION
1. FAILURE TO RESPOND WILt. RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.stion
sub.itted by the financial institution.
2. Inheritance tax baDDNas delinqusnt nine Months after the dBcedent"s date of death.
3. A joint account is taxable BVe" though the decedent's na.. was added as a .attar of conven!enca.
4. Accounts (including thoSB held between husband and wife) which tha decedent put in joint naBes within onB year prior to
death are fully tsxablB as transfers.
5. Accounts established jointlY betwBen husband and wife .ore than one year prior to daath are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the infor.atiaR and COMPutation in tha notice are correct and daductions arB not being cleimad, place an nxn
in block nAn of Part 1 of the nTaxpayar Responsan saction. Sign two copies and subllit th8. with your check for ths a.ount of
tax to the Registar of Wills of tha county indicated. The PA Depart.ent of Ravenue will issue an official asses~ant
(For. REV-1548 EX) upon receipt of th. raturn frail th. Regist.r of Wills.
2. BLOCK B - If the asset specifiad on this notice has baan or wUI be reportad and tax paid with the Pannsylvania InheritancB
lax RBturn filed by the dacedent.s reprBsantative, placs an "Xn in block nB" of Part I of the "Taxpayer ResponsB" section. Sign one
copy ~nd raturn to tha PA Dapartllant of Revenua, Bureau of Individual TaxBs, Dept 280601, Harrisburg, PA 17128-0601 in thB
anvalope provided.
3. BLOCK C - If the notice info,..etion is incorract and/or deductions are being clai.ed, chack block nCn and cOllpleta Parts 2 and 3
according to the instructions below. Sign two copies and sub. it tha. with your check for the allount of tax payabla to the Ragister
of Wills of the county Indicated. The PA Departllant of Revenue will issua an officIal assessllent (Forll REV-1548 EX) upon raceIpt
of the return fro. the RegIstsr of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account origInally was established or tItled in the manner exIsting at date of death.
NOTE: For II decedent dying after 12/12182: Accounts which the decedBnt put in joint nalles within one (I) year of death are
taxable fully as transfers. However, there is an exclusIon not to exceed $3,000 par transfBree ragardlass of the valua of
the account or the number of accounts held.
If a double asterisk (..) appBars before your first n~e in the address portion of this notice, thB $3,000 exclusion
already has been deductad frail tha account balance as r&ported by ~ financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of tha account that is taxabla for each survivor is deterllined as follows:
A. The percent taxable for joint assats established 1I0re than one y.ar prior to the decedent's death:
1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 . PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
EXBllple: A joint assat ragisterad in the nalla of the dac.dant and two other persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100 . 16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percBnt taxablB for assets created within one year of the dacedent's daath or accounts owned by thB decadent but hald
in trust for another individual(s) (trust beneficiarias):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 . PERCENT TAXABLE
OWNERS DR TRUST BENEFICIARIES
Exuple: Join~ accountrBglstered in th~ nallA of the dBcadent and two other parsons and .stablishad within one year of daath by
the deCadent.
1 DIVIDED BY 2 (SURVIVORS) - .50 X 100 . 50% (TAXABLE FOR EACH SURVIVOR)
.. Tha allount subject to tax (line 4) is daterdned by lIultiplying thB account balance (line 2) by the percent taxl!lble (line 3).
5. EntBr tha total of the dBbts and dBductions listed in Part 3.
6. The Mount taxablB (line 6) is dater.ined by SUbtracting the dabts and daductions Cline 5) frail the a.ount SUbjBct to tax (line 4).
7. Enter tha appropriata tax rate (line 7) as deterllInad below.
ht. of D..th Spouse lin..l Sibling Collater.l
07/01/94 ~o 12/31/94 37. 67. 157. 157.
01/01/95 to 06/30/00 07. 67. 157. 157.
07/01/00 to present 07. 4.5%- 127. 157.
liiThe tllX rate i.posed on tha ne't valua 01' transfers fro. a decaas.d chIld twenty-one years of age or younger at
d8l!1th to or for the use of I!I natural parent, an I!Idoptive pl!lr.nt, or a stepparent of the child is 0%.
The linasl class of heirs includes grandparants, parants, chIldren, and linaal descendents. "Children" includes natural children
wh.thar or not thay have been I!Idoptad by othars, adopted children and step childran. "Lineal descandentsn includes all childran of the
natural pl!lrents and their descendents, whethar or not they hava been adopted by othars, adopted descandants and thair descendants
and step-descendl!lnts. "Siblings" are dBfined as individuals who have at least one parent in com.on with the decedant, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and daductions are detBr.inad as follows:
A. You IBgally ara responsibla for pay.ant, or tha estate subject to administration by a parsonal rBpresantative is Insufficiant
to pay tha daductibla itBIIs.
B. You actually paid the d.bts after death of th. deeadent and can furnish proof of pay..nt.
C. Dabts baing clal.8d lIust ba ItBllizsd fully In Part 3. If additional spaca is naaded, use plain paper 8 1/2" xiI". Proof of
payment I18Y ba requested by thB PA Department of Revenue.
-
MARTS ON DEARDORFF WILLIAMS & OTTO i
,
MDW&O I
ATTORNEYS & COUNSELLORS At LAW
WiLLIAM 1'. MARTSON ~ARL C. RISCH
Il'\FOR.'vjj\:!'loN . ADVICE' ADVOCACY
JOHN B. FOWLER III DAVID A FITZSIMONS
EDWARD L SCHORPP DAVID iR. GALLOWAY
10 EAST HIGH STREET DANIEL K. DEARDORFF ANTH4NY T. LUCIDO
CARLISLE, PENNSYLVANiA 17013 THOMAS 1. WILLIAMS. CHRISTOPHER E. RICE
TELEPHONE (717) 243-3341 Ivo V. OTTO III JENNtER L. SPEARS
FACSIMILE (717) 243-1850 GEORGE B. FALLER JR.'" HIt, ARY A. DEAN
INTERNET www.mdwD.com .BOARD CF:RTIF1W CIVIL TRIAL SPECl.f,.LlST
,
,
November 9, 2004 I
,
i
i
HAND DELIVERED ,
i
Office of Register of Wills ,
Cumberland County Courthouse
Carlisle, P A 17013 I
I
,
RE: Estate of Jeannette G. Burgett i
,
Estate No. 21-04-00779 I
,
Date of Death: August 14, 2004 j
Dear Clerk:
I
Enclosed with this letter is estate check number 115 in the amount of$40,000,OO represen(im:
payment of Pennsylvania Inheritance Tax in the above-referenced estate. i ~
I
Will you please issue the appropriate receipt and forward it to me at the above addresf. I
thank youi)1 advance for your prompt attention to this matter. j
!'j I
Very truly yours,
~ i
-., MARTSON DEARDORFF WILLIAMS & OTTO
J
-
Ivo V, Otto 1II
!VO/vio
Enclosure
F ',fll.ES'.oA T AfJLE',EST A TESIJ44'! I n)W intxpayment
INFORMATION . ADVICE . ADVOCACY SM
COMMO,"",','"A_Tf-< OF PEN~~SY,_VA'\IA R[V-1162 EX!ll 96)
DEPAR~~/ENT O~ '>EVE~jUE
eJ"E;",J OF IN::;VDLAL T;"XES
~=", 2806':,1
'1;.,;:;'>'S3UR:::i,",A ',7128-:'G01
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004606
GREGORY F WilLIAM
691 BROCKTON WAY
WEST MELBOURNE, Fl 32904
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
. lol,j ______n
101 I $40,000,00
ESTATE INFORMATION: SSN, 187-16-5945 I
FILE NUMBER: 2104-0779 I
DECEDENT NAME: BURGETT JEANNETTE G I
DATE OF PAYMENT: 11/09/2004 I
POSTMARK DATE: 11/09/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/14/2004 I
I
TOTAL AMOUNT PAID: $40,000,00
REMARKS: G F WilLIAM
CHECK# 115
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS
F ',FILES\OATAFILF.",ESTATl:SJ449 I guardian,[yan
Cr~"tcd 1[,22;04 8'IOAM
Rcvl,ed 12/1'04 IOOIA.\1
INRE: ESTATE OF IN THE COURT OF COMMON PLEAS OF
JEANNETTE G. BURGETT, deceased CUMBERLANT> COUNTY, PENNSYLVANIA
late of the Borough of Carlisle, ORPHANS' COURT DIVISION
Cumberland County, Pennsylvania NO.2 I ,04-0779
PETITION FOR THE APPOINTMENT OF A GUARDIAN OF THE EST ATE OF
A MINOR UNDER THE AGE OF 14 YEARS
PURSUANT TO 20 PA. CONS. STAT. Sec, 51 Ilia)
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
The Petition of TRACY KOVACEVIC, by her attorneys, MARTS ON DEARDORFF
WILLIAMS & OTTO, respectfully states that:
1. Petitioner is the natural mother of Ryan Kovacevic,
2, Ryan Kovacevic, the minor. was born on February 5,1992, and resides at 117 Beard
Road, Enola, Pennsylvania with petitioner.
3. The minor has an approximate 22.22% interest in the residuary estate of Jeannette
G, Burgett, which value is estimated at less than $25,000,00.
4, Tracy Kovacevic has been appointed Guardian of the estate of Ryan Kovacevic under
the Will of Jeannette G, Burgett A copy of the Will is attached as Exhibit "A",
5, The proposed guardian, Tracy Kovacevic, is 35 years of age and resides at 117 Beard
Road, Enola, Pennsylvania,
6. The proposed guardian is the minor's natural mother, and has no interest adverse to
the minor. The consent of the proposed guardian is attached as Exhibit "B",
7. The minor's father and husband of Petitioner, Rodger D, Kovacevic, has no objection
to the appointment of Petitioner as Guardian of the estate of said minor.
8. The minor is named as a beneficiary with an 18-3/4% interest in Fidelity & Guaranty
Life Insurance Company, Annuity No. 03063991 owned by Jeannette G, Burgett, which interest is
valued at approximately $42,390,00, No guardian for said minor was designated on the account.
9. The minor is a beneficiary with a 25% interest in Waddell & Reed Financial Services
Account No, 32368951 registered to Jeannette G, Burgett, which interest is valued at approximately
$8,470,00. No guardian for said minor was designated on the account.
10, Neither Fidelity & Guaranty Life Insurance Company nor Waddell & Reed Financial
'10
\,
Services will accept the appointment of Tracy Kovacevic as Guardian of the estate of Ryan
Kovacevic as set forth in the Last Will and Testament of Jeannette G. Burgett as probated, Both
companies have requested your Honorable Court to appoint a Guardian of the estate of said minor
to hold and manage the funds to be distributed to him.
11. The Petitioner requests that no bond be required for her appointment as Guardian of
the estate of said minor.
WHEREFORE, petitioner requests that this Court appoint Tracy Kovacevic as Guardian of
the estate of Ryan Kovacevic, a minor, to hold and manage any funds to be distributed to him from
any source until such time as he attains the age of eighteen (18) years,
MARTSON DEARDORFF WILLIAMS & OTTO
BY~
Ivo V. Otto III
10 East High Street
Carlisle, P A 17013
(717) 243,3341
Date: (~(Jce~4,- (,,2(1(')"-1 Attorneys for Tracy Kovacevic, Petitioner
IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF
JEANNETTE G, BURGETT, deceased CUMBERLAND COUNTY, PENNSYLVANIA
late of the Borough of Carlisle, ORPHANS' COURT DIVISION
Cumberland County, Pennsylvania NO. 21-04-0779
CONSENT OF PROPOSED GUARDIAN
I hereby consent to act as guardian of the estate of Ryan Kovacevic, a minor.
I reside at 117 Beard Road, Enola, Pennsylvania, and am employed as an Information
Technology Auditor,
I am a citizen of the United States and can speak, read and write the English language.
I am not the fiduciary or an officer or employee of any corporate fiduciary of an estatc in
which the minor has an interest or the surety or an officer or an employee of the corporate surety of
such a fiduciary,
I have no interest adverse to the minor.
It is not the intention ofthc guardian to apply for an allowance for the support or education
of the minor during minority,
\'~.t';Ia :2CY?:i..{'.J!A/{..V
Tracy K ace c
Date: 12<k.?>?iz.L.'L ,2 , 2004
r
\
"' DEe 0 7 20G4~
.--- IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF
JEANNETTE G. BURGETT, deceased : CUMBERLAND COUNTY, PENNSYLVANIA
late of the Borough of Carlisle, : ORPHANS' COURT DIVISION
Cumberland County, Pennsylvania : NO. 21-04-0779
DECREE
I AND NOW,~, 200t upon consideration of the petition of Tracy Kovacevic,
it is hereby ordered and decreed that Tracy Kovacevic is appointed guardian of the estate of Ryan
I
Kovacevic, a minor, without bond, and shall hold and manage all funds distributed to said minor
I from any source until he attains the age of eighteen (18) years.
i
By the Court:
g$ ....,
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F- ~ l\..t.J..i;tcy ~ b0(,"""" r. +vI G~_ ' l
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004941
OTTO IVO VICTOR III
10 E HIGH STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- .-------
101 I $14,275.47
ESTATE INFORMATION: SSN: 187-16-5945 I
FILE NUMBER: 2104-0779 I
DECEDENT NAME: BURGETT JEANNETTE G I
DATE OF PAYMENT: 02/14/2005 I
POSTMARK DATE: 02/14/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/14/2004 I
I
TOTAL AMOUNT PAID: $14,275.47
REMARKS: MARTSON ET AL
CHECK# 131
INITIALS: RSK
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~.\\.\>. '\>..
ROV.;:..EX.(....) ~ REV -1500 OFFiCif\L USE ONL.Y !
~ I
~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER
DEPAR6~~T2~~VENUE RESIDENT DECEDENT 21 04 00779
_ ____ __~fl~l>BURG, PA 17128-0601_____ _. _~__________~_________.______._____._ __Q.Q.Ul'LTy CODE___.Y~B.N.U",B_ER
. -----iOECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) .-- ------------------ ---- ------ soCiAL SEClTRiTY-NLiMBER-
'BURGEIT,JEANNEITEG. ! 187-16-5945
~ . DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) I THis RETURNMUST BE FILED IN DUPLICATE WITH THE
~ !08/14/2004 ! 06/25/1923 ~ REGISTER OF WILLS
o i (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) I SOCIAL SECURITY NUMBER --- n
I
------ ~ ~Original R~iu;:_,;__- . ----~- -- 0 2, S-;:;ppleme;:;taIRetum---.- - --- ------0- '3. Remainder Retum(date of death prior to 12.13-82)
w
:.:: ~ VI 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 0 5, Federal Estate Tax Retum Required
u II<: :.:: 12-12-82)
wA.U
~ 51 9 ~ 6, Decedent Died Testate (Attach copy 0 7, Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes
~ CD of Will) copy ofTrust)
0( 0 9, Litigation Proceeds Received 0 10, Spousal Poverty Credit (date of death between 0 11,Election to tax under Sec, 9113(A) (Attach Sch 0)
---- . '. .. .. .'. . .(('. ........1.~;~,.~.I;.;~..~~.e.2;~ -;T"."""""".""",,,"..)I."..}(I ..11."..............,....,..)111.......", .... .....(1."...... ...1(..1(..,...11...........
111. .' .- tSl'" - -1.,IIID.I'Il._L~ll!IlllImlIBi_INII_.l':4il~l.IlI.I.j.~Ql.~._li~
AME COMPLETE MAILING ADDRESS
';'!Z Ivo V. Otto III, Esquire !
:l! l!l FIRM NAME (If applicable)--! .
~ ~ Martson Deardorff Williams & Otto I Ten East HIgh Street
UA. ___ _, Carlisle PA 17013
!TELEPHONE NUMBER '
717/243-3341
=c===l=
,
1. Real Estate (Schedule A) (1) 95,000.00
-~--_._~~
2. Stocks and Bonds (Schedule B) (2) 1,389.58
------------~-~----
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) _ _~___J\rOIl~ ::-:
4. Mortgages & Notes Receivable (Schedule D) (4) None .,"
-_._-_.~_._------~ ~' ,~
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 51 304 02
(Schedule E) _ __~---'--_ '__ -:-:
6. Jointly Owned Property (Schedule F) (6) 3,809.43 (n
~ 0 Separate Billing Requested --- --~-- - --- ...:-
3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 259,957.42
~ (Schedule G or L)
~ 8. Total Gross Assets (total Lines 1-7) (8) 411,460.45
U
:l! 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 34,8 16.96
~~-
10. Debts ofDecedent, Mortgage Liabilities, & Liens (Schedule I) (10) 771. 96
11. Total Deductions (total Lines 9 & 10) (11) 35,588.92
12. Net Value of Estate (Line 8 minus Line 11) (12) 375,871.53
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 375,871.53
-~-----. - ~---_...-
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2) --~~ ______n_ -
~ 16.Amount of Line 14 taxable at lineal rate x .045 (16)
I- _
0(
I-
::>
!Ii 17.Amount of Line 14 taxable at sibling rate x .12 (17)
o ---__________ un___ __._
U
S 18. Amount of Line 14 taxable at collateral rate 375,871.53 x .15 (18) 56,380.73
119. Tax Due (19) 56,380.73
! 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
,
~~G!!Iiii:~~~~q.i_j_H~~jlrrl.$~fiW"~I.Rlillll~iii.IG~~t.(l~"~.~~ .~~________._n..
Copyright 2000 form software only The Lackner Group, Inc. Form REV.1500 EX (Rev. 6-00)
Decedent's Complete Address:
.STREET ADDRESS
507 West Louther Street
>---~_. -"-~-----_..,----~---~~---- -_.~.-
CITY Carlisle i STATE PA ZIP 17013
Tax Payments and Credits:
1, Tax Due (Page 1 Line 19) (1 ) 56,380.73
2, Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments 40,000.00
------_.._--,-. ------
C. Discount 2,105.26
Total Credits (A + 8 + C) (2) 42,105.26
-.--'- - ------,------...-
3. Interest/Penalty if applicable
D. Interest
E. Penalty -'.----------.--.---
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 14,275.47
A. Enter the interest on the tax due. (5A) "-----
8. Enter the total of Line 5 + 5A. This is theBALANCE DUE (58) 14,275.47
-----.._---------
Make Check 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. ..tal. 10. "'" '" ;.oome of 10. .""",rty ""oo,.rred;.... .... ............. ....... _. ... ..... .... ..... ..... ....... .... ..... ....... ~ I
b. ~:::~ :h~e~~~~i~~~~s:~~;~s~~~. ~~~~I. .~.~~. ~.~~. :.~~:.~_~. .~~~.~.~~~~~~.~. .~.~ .i.t~. ~~.~.~~~.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'~~::::::::::: ~...'.'.
c.
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?............................................................_................................................... 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 own an Individual Retirement Account, annuity, or other non-probate property which 0
contains a beneficiary designation? ................ ............. .......... ................... .......................... .............. .............. ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
__~_m_______ __ _____.......__.______
Under penalties 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
pre"arer !'ther than the personal representative Is based on all Information of which preparer has any knowledge, ..~.._._.._.__._.__ . __ n. _..._...
SIGNATURE OF PERSON RESPONStBLE FOR F ING RETURN ADDRESS DATE
F.Wi'm re ry 691 Brockton WaF _ :< /_~_O()S-
. West Melbourne, L 32904
ADDRESS DATE
SIGNATURE OF PREPARER OTHERTHAr'JREPREifENTATIVE u .~- --AD[lRESS-- DATE
Ivo V. tto III, E~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. ~9116 (a) (1,2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
*' SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
0"-_"-.- -~---_._-~._-------
-'-'--'~,------_._--------
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
"------------..--
All real properw owned solel~ or as a tenant in common must be reMorted at fair market value. Fair market value is defined as the price
at which property would be exc anged between a willing buyer and a wi ing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
--------'--..---- .'------- ... ------ . - _._-_._--_.~._-_.__._--_._----- "._--------
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
-~-.-
1 Residence situate at 507 West Louther Street, Carlisle, Cumberland County, PA, known as parcel No. 95,000.00
05-26-1796-175, being described in Deed dated August 31, 1998, and recorded in Cumberland County,
PA, Deed Book 185, Page 496, and being conveyed to Betty J. Fritz and Jeannette G. Burgett. Betty 1.
Fritz died September 11, 2001. Value is actual sale price. See attached settlement statement
----.---,.. 0___"_ ________________________________.___
TOTAL (Also enter on Line 1, Recapitulation) 95,000.00
*' SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~--- ---- ----.-.-,--__~_._. _______J_____._...____~__.._____
- --~._~---~-_...- --.------..-------..--,
ESTATE OF BURGETI, JEANNETIE G. FILE NUMBER
21 - 04 - 00779
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
.~_.~------- --~--- --
I 31 shares, Prudential Financial CUSIP #744320102 1,389.58
___L- ____.__.__~__L___ -.--------,-
TOTAL (Also enter on line 2, Recapitulation) 1,389.58
*' SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
_.~----_._- ___ ___n__
ESTATE OF BURGETI, JEANNETIE G. FILE NUMBER
21 - 04 - 00779
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
--_.~-- --~-_._~--- -..-----..----- -_."._---------.~------
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
_.~--_..- -_.._________... _00_.-
1 Commerce Bank checking account #536167032 1,296.32
2 M&T Bank checking account #2670066402 31,827.74
3 Waypoint Bank, CD #1716001466 [Betty Fritz predeceased] 3,502.23
4 1 $50 Series EE Savings Bond, issued 8/1993 41.16
5 Cumberland County Employee Retirement Plan, prorated retirement benefit for 8/04 76.48
6 Cash 2,103,11
7 Parker Jewelers gift certificate redemption 50.00
8 Coins, actual sale price 710.00
9 Hoffman-Roth Funeral Home, refund 37.27
10 Rowe's Auction, sale of house hold goods and personal property 8,005,00
11 Capital Blue Cross, refund of premium 130.03
12 Jewelry, appraised value 2,160.00
13 Cameras and jewelry sold to Northgate Antiques, actual sale value 415.00
14 Conseco Insurance Co, refund 36.03
15 Comcast, refund 6.02
16 Sprint, refund 0,64
17 P A Department of Revenue, Bureau of Unclaimed Property, funds from redemption of PSG&E Bond 100.00
18 Household items retained by heirs, appraised value 210.00
19 Prudential Financial, uncashed dividend check 15,50
20 Vintage Treasures, proceeds from sale of jewelry 150.00
Total of Continuation Schedule(s) 431.49
"~--'-'-------"'--'---'- --
TOTAL (Also enter on Line 5, Recapitulation) 51,304.02
. SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
- ---- -- '--"."'-' ----... -'-" ,.~ .._---,-,-- ' ... ----- -- -- --- . ~---_.,- ------- ____~__.M__ _......m__ ,,-.-----.--....---- --- __uP_.___
.- -----~...,,_..._-_.__.----- -- --_._--.._~-_._-- - ----~.. --------- --_0'_.___--
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
__ __ ________n __ _ __" _ ____ __
Include the ftroceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorsh p must be disclosed on schedule F.
-~._---~._,._-~--------- ---------.-----
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
---------.--...------;------- ---~-- -__'__"_'___ u __ _______,__ .._______.________
21 Tax proration 431.49
________________.__._________ .u ________________.______________ .' __ ______
Page 2 of Schedule E
*' SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTL Y -OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT ---------..--+--
__._ u _~_______ ---. --~---
-
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
_._----~--~-_..- --_.0.__.__------ ----------- --- -~-_.._-_._.._-
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
- - --- ---_.__...._._~ ----- ._---.-
A Tracy Kovacevic 117 Beard Road Friend
Enola, P A 17025
B Mark A. Wise 8105 Cerry Laurel Lane Friend
Irving, TX 75063
JOINTLY OWNED PROPERTY:
-------.-.------ ----~~-- DESCRIPTION OFPROPERW------ ------------
ITEM LETTER DATE ,Include name of financial institution and bank account number' DATE OF DEATH %OF DATE OF DEATH
MADE DECD'S VALUE OF
NUMBER FOR JOINT ,or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST
TENANT JOINT ,estate.
1 A&B 12/27/2001 Waypoint Bank, CD #7100016929 11,439.72 33.3% 3,809.43
TOTAL (Also enter on line 6, Recapitulation) 3,809.43
*' SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
.-------..- -------- -,.-------
. -------- .-----..----------
ESTATE OF FILE NUMBER
BURGETT, JEANNETTE G. 21 - 04 - 00779
u.!his schedule must be completed and filed if the answer to any of h 4 on page 2 i~~s.
ITEM DESCRIPTION OF PROPERTY i % OF
Include the name of the transferee, their relationship to decedent and the date of transfeq D: TE OFF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER Attach a copy of the deed for real estate, ,V LUE 0 ASSET, INTEREST (IF APPLICABLE)
1 Fidelity and Guaranty Life Insurance Co., 226,077.49 100% 226,077.49
annuity #03063991. Beneficiaries: F. William Gregory
12.5%, Robert E. Shrawder 12.5%, Mark A. Wise 18.75%,
Tracy Kovacevic 18.75%, Ryan Kovacevic 18.75%, friends;,
Christine Stuebbe 18.75%, cousin I
[224,079.45 principal + 1,998.04 accrued interest] :
I
2 Waddell & Reed account #32368951. Beneficiaries: 33,879.931 100% 33,879.93
Christine Stuebbe, 25%, cousin; Ryan Kovacevic 25%,
Tracy Wise Kovacevic 25%, Mark A. Wise 25%, friends.
----~------ -- _.._--------~---_...
TOTAL (Also enter on line 7, Recapitulation) 259,957.42
. SCHEDULEH
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA ADMNSTRATIVE COSTS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
---------- ------',.--------.--- - .________-1-_ _______._
_.-----_.--~._._-- .--_.--_..~_.--_._---------_..._._----_.._-_..__.-
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
--- ------~.._-'".- -------,-,-'.--.-. -.------------- ._____n
Debts of decedent must be reported on Schedule I.
- -- ---- '-------- .~_._--
ITEM DESCRIPTION AMOUNT
NUMBER
--~- ----...----- ,.----------,.
A. ' FUNERAL EXPENSES:
1 Hoffman-Roth Funeral Home, Carlisle, PA 8,461.50
2 Carlisle Memorial Service, Inc., gravemarker 150.00
3 Funeral reception 462.49
I
B. ADMINISTRATIVE COSTS: 9,500.00
1. Personal Representative's Commissions
F. William Gregory
Social Security Number(s) I EIN Number of Personal Representative(s):
165-26-5596
Street Address 691 Brockton Way
City West Melbourne State ~Zip 32904
Year(s) Commission paid
2. Attorney's Fees Martson Deardorff Williams & Otto (estimated) 11,700.00
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 to Decedent
4. Probate Fees Cumberland County Register of Wills 304.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
1 Register of Wills, Short Certificates 6.00
2 Certified mailing, Department of Public Welfare 4.42
Total of Continuation Schedule(s) 4,228.55
-"-'-~---"----'-'----'--'--'''''-'~''--- -- '--~--------------'----'--'-'----'------~----,-------- .- - ------,---..----
TOTAL (Also enter on line 9, Recapitulation) 34,816.96
. Scheck.E H
FU'BCII ExpeIISeS &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN AdniI'1islrcmve Cos1s contiooecl
RESIDENT DECEDENT
-- ._--_._~-------- ~---~--------_.._--_.._-~ ---- -_.~ -~-..__..._._--_._--
-- ---.---------_.. ---_._~--~-----,,-_.__.._-_. _n___ -------------.----.------------ --- - ----,._-~----
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
----_._--..---.- . - ----------------------
3 I Cumberland Law Journal, advertising Letters Testamentary 75.00
4 The Sentinel, advertising Letters Testamentary 143.15
5 Register of Wills, filing fee, Inheritance Tax return 15.00
6 Register of Wills, filing fee, Petition for Guardianship 12.00
7 Register of Wills, certified copies of Petition 4.00
8 UPS, overnight mailings 50.37
9 EVP stock valuation report 6.20
10 F. William Gregory, reimbursement for travel expenses 383.69
11 Giant Food Stores, cleaning supplies 25.36
12 Wahnart,housereparrs 9.48
13 S.W. Barrett Real Estate & Appraisal Services, appraisal fee 275.00
14 Hilton Lock service, change locks on house 53.16
15 Rowes Auction, appraisal of personal property retained by heirs 125.00
16 Parker Jewelers, jewelry appraisal and cleaning 381. 60
17 Borough of Carlise, sewer/water pending dispostion of real estate 97.08
18 PPL, electric service pending disposition of real estate 55.75
19 Verl Williams, trash hauling 400.00
20 UGI, gas service pending disposition of real estate, thru 12/13 97.51
21 County of Cumberland, 1 % realty transfer tax 950.00
22 County of Cumberland, 2005 real estate taxes 19.20
23 Frances Sanderson, lawn care pending disposition of real estate 50.00
24 Reserved for filing fees and miscellaneous expenses 1,000.00
--------..-- -----.-----.........-. .-." ".------_._---~- ~-----
Page 2 of Schedule H
*' SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
. ~._-_._------_._------ ... - ~._-_. ________
_'__".""_~ ____,_,,_ ._u_ ________
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
--- ----~-------------
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Borough of Carlisle, account payable 19.47
2 Sprint, account payable 62,87
3 Lane Bryant, account payable 426,60
4 PPL Electric, account payable 51.03
5 Frances Sanderson, lawncare services, account payable 148.00
6 UGI, account payable 19,15
7 Corncast, account payable 44.84
TOTAL (Also enter on Line 10, Recapitulation) 771.96
REV-1513 EX+ (9~O) *'
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
~ESIDE'iTQE~~~l'l'r___ __.. ...J. _____.
-" --~----------_._-_._- --- ----------
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
----------~.---~-.__. -_._--~._----_.._------- . -------------------
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
...... ..~._- --.------.---+-....- Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Mark A. Wise Friend 50% ofSch. F;
4409 Biscayne Drive, Flower Mound, TX 75028 18.75% ofSch. G,l;
25% of Sch. G,2;
22.22% of estate
residue
2 Tracy W. Kovacevic Friend 50% of Sch. F;
117 Beard Road, Enola, P A 17025 18.75% ofSch. G,l;
25% of Sch. G,2;
22.22% of estate
residue
3 F. William Gregory Friend 12.5% ofSch. G,l;
691 Brockton Way, West Melbourne, FL 32904 33.34 % of estate
residue
See Continuation Schedule(s) attached
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheElt
II. 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
- - ---- ._._--_._.._---~------ .__ _...___.._____.n___ ____._______________.._ ____________________ __n __
*' SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
- ~-"-"'-~ -------_.'.-,- ~._----_.----
_ ____~___.__._____._.______.._._ .._'.n__..____________. -------..'--
ESTATE OF BURGETT, JEANNETTE G. FILE NUMBER
21 - 04 - 00779
--'--_._~_._.._-----,_._,_._-------_.-
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY DECEDENT OF ESTATE
- - -----------------.- --,'."-- [inelude-outrightspousal distributions,-arld transfers-under- _D~ fo!ot_~~~,.r~st~eJsl
I. TAXABLE DISTRIBUTIONS See, 9116(a)(1.2)]
4 Tracy W. Kovacevic, Friend 18.75% ofSch. G, 1;
as Guardian of Ryan M. Kovacevic 25% of Sch. G,2;
117 Beard Road, Enola, P A 17025 22.22% of estate
residue
5 Robert E. Shrawder Friend 12.5% ofSch. G, 1
691 Brockton Way, West Melbourne, FL 32904
6 Christine Stuebbe Cousin 18.75% ofSch. G,I;
105 Deep Water Cove, Newport News, VA 23606 25% of Sch. G, 2
Page 2 of Schedule J
F:\FILES\DA T AFILE\ WILLS\3449, WIL \dIn
LAST WILL AND TESTAMENT
I, JEANNETTE G. BURGETT, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me
made,
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My personal representative shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
If my sister, BETTY J. FRITZ, shall survive me by thirty (30) days, then I give, devise and
bequeath all of my estate, both real and personal property, unto my sister, BETTY J. FRITZ,
absolutely, and I hereby appoint the said BETTY J. FRITZ as Executrix of my estate.
3.
In the event the said BETTY J. FRITZ shall predecease or fail to survive me by more than
thirty (30) days, and in the event we shall die in a common disaster and it cannot be determined which
has survived, I shall be deemed to have survived my sister. I direct that my estate, both real and
personal property, shall be disposed of in the following manner:
(a) I give one-third (1/3) thereof unto F. WILLIAM GREGORY, absolutely.
(b) The remaining two-thirds (2/3) thereof I give equally to MARK ALLEN WISE,
TRACY WISE KOV ACEVIC and RYAN M. KOVACEVIC, absolutely. I further direct that if any
of the said legatees shall fail to survive me, then his or her share shall be divided equally among the
surviving legatees mentioned in this paragraph.
(c) I nominate, constitute and appoint F. WILLIAM GREGORY as Executor of my estate
under the provisions of this third paragraph of my Last Will and Testament.
W/~
.. rI'j
... '., -
" J.G.B.
Page 1 of 4 Pages
4.
I nominate, constitute and appoint TRACY WISE KOVACEVIC as Guardian of the estate
ofRY AN M. KOVACEVIC.
5.
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of her or his duties in any jurisdiction.
6.
I authorize and empower my personal representative, in her or his sole and absolute
discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose
of or grant options in regard to any or all property of any kind forming a part of my estate for such
terms and such prices as she or he may deem advisable; to borrow money for any purposes connected
with the protection and preservation of my estate; to mortgage or pledge any real or personal
property forming a part of my estate or to join in or secure the partition of same; to compromise any
claims or demands of my estate against others or of others against my estate; to make distribution in
kind and to cause any share to be composed of cash, property or undivided fractional shares in
property different in kind from any other share; to employ agents, attorneys and proxies and to
delegate to them such power as my personal representative considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate. 3/4 day of
IN WITNES S WHEREOF I have hereunto set my hand and seal this
~ ' 199B:
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
Page 2 of 4 Pages
OwIffi%lJ:resenreOflhe::;::;:
Page 3 of 4 Pages
COI\.1MONWEAL TH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, Jeannette G. Burgett, Testatrix, 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.
('7 . z;t;,.. p 4. - v.
\. /~/(i, t.-V.r/-,? <-_. #~
,,;1eannette G. Burge(t F ,
/'
Sworn or affirmed to and acknowledged before me by Jeannette G. Burgett, the Testatrix,
this O/6C day 0 ,199t
Nota'alSeal ,f/J. - .~. ai ~
Denise L. N e, Notary Public \ V WI U/IJJL.. ,
Carlisle ~oro, tumberland Cou~ty Notary Public
My Commission Expires Feb. 26. 2001
COMMOM'ALTi?~;Sp~~~~~ANIA )
: SS.
COUNTY OF CUMBERLAND )
We, lJ.,} h '"""" t=: YyJ.vls m and C 1) r 1: I ne I... ~ -erS
the witnesses whose names are signed to the attached or foregoing instrument, being ly qualified
according to law, do depose and say that we were present and saw Jeannette G. Burgett, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that
the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each
of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of
our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
. :5-1-,
Carlisle 'PI} J 7!Jj ?
~~P~-.J
Ad ress JD e. fh~ ST'
02~r-IJ .s)c 'A J '70) 3
.
Sworn or affirmed to and subscribed before me this 2J1-st day of ~ t.UJi ,
199K
Nol..lalSeal ~, ~
Denise L. Nye, Notary Public .
M;~~~~i~~t~~ ~~~~e;I~~~ ~~u~,~~o, i Notary Pubhc
Member. PennsY!\'2.nia .n.ssociation o(ffrJt~r!cs"~'
Page 4 of 4 Pages
1 Settlement Statement
/ A. U,S. Department of Housin9 and Urban Development
i
.' / S. Tvoe of Loan OMS No. 2502-0265 REV. HUD-1 13/86)
1, DFHA 2, OFmHA 3, OConv, Unins, I 6, File Number I 7, Loan Number 18. Mortgage Insurance Case Number
, 4, OVA 5, OConv. Ins. S27-777
C. Note: llt~~s o~~:edu~~~~~)~~~: ~i~ ~I~~e:t~~t do:i~~~~~e;I~;::~~~sh~r:;~~~f~~~ti~ ~~p~~ea~~l~e:~~~ ~gJ~d:~~ns~O:~tals_ I TitleExpress Settlement System
~~~~J~G~~~ ~n~~~~~ Wh~~~~~Z~~;~~~~ to~~:~~~:~ntl~1j~~~~~t~g~ ~h~~tfo'na~&Oihae~ds~~:~T~'1~~nalties upon Printed 01/18/2005 at 09:30 KJB
D, NAME OF BORROWER: Dickinson College
ADDRESS:
E. NAME OF SELLER: Estate of Jeannette G. Burgett
ADDRESS:
F, NAME OF LENDER: NON.APPLlCABLE
ADDRESS:
G, PROPERTY ADDRESS: 507 Louther Street, Borough of Carlisle
Cumberland County. PA
H, SETTLEMENT AGENT: The Sentinel Agency LLC
PLACE OF SETTLEMENT: 2146 North Second Street Harrisbura. PA 17110 "..~
I. SETTLEMENT DATE: 01/18/2005
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales orice 95 000.00 401, Contract sales orice 95 000.00
102, Personal Prooertv 402, Personal ProDertv
103. Settlement chames to borrower (line 1400\ 1 817.25 403,
104, 404,
105. 405,
Adiustments for items paid bv seller in advance Adiustments for items paid bv seller in advance
108, School Taxes 01/18/05 to 06130/05 431.49 408, School Taxes 01/18/05 to 06/30/05 431.49
109. 409,
110, 410.
111, 411.
11:2, 412,
120. GROSS AMOUNT DUE FROM BORROWER 97248.74 420. GROSS AMOUNT DUE TO SELLER 95 431.49
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Denosit or earnest monev 501. Excess Deoosit (see instructions)
202, Princioal amount of new loans 502. Settlement charaes to seller (line 140m 982.36
203, Existinn loanls) taken sub'ect to 503, Existino loanls) taken subiect to
204, 504, Payoff of First Mortoaoe Loan
NONE
205, 505.
206, . 506.
207. 507.
208, . 508,
209. 509,
Adiustments for items unDaid bv seller Adiustments for items unpaid by seller
211, County taxes 01l01/05to01/18/05 19.20 511. County taxes 01/01/05 to 01/18/05 19.20
213. 513,
214. 514.
215. 515.
216, 516,
217. 517.
218. 518,
219, 519,
220. TOTAL PAID BY/FOR BORROWER 19.20 520. TOTAL REDUCTION AMOUNT DUE SELLER 1 001.56
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
30t Gross amount due from borrower (line 12m 97248.74 601, Gross amount due to seller !line 420\ 95431.49
302, Less amounts naid bvifor borrower (line 220\ 19.20 602, Less reduction amount due seller (line 520\ 1 001.56
303. CASH FROM BORROWER 97 229.54 603. CASH TO SELLER 94 429.93
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue
~~~.I~S:t~~~~~ir~~tW~:: ~:~~~nar~~~r.tf:tec:'ty,~~o~~T~~~o~e~~~~m~~~~ ~8l~~~~:~Jfe~~~r~~~sbp~~~~~dOf this
transadion.
SELLER INSTRUCTIONS: If this real estate was your principal residence. file Form 2119. Sale or Exchange of Principal Residence. for any gain. with your Income
tax return; for other transactions, complete the appUcable parts of Form 4797. Form 6252 and/or Schedule 0 (Form 1040).
You are required by law to provide the SetUement Apent. Tax 10 No: 04-3621035 with your correct taxpayer Identification
number. If you do nol provide your correct taxpayer Identification number. you may be subject to civil or criminal penalties imposed by law.
Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number.
TIN: I SELLER(S) SIGNATURE(S): I
SELLER(S) NEW MAILING ADDRESS:
SdJd~ (( /J r; /~ f
~
U,S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 527.777 PAGE
. SETTLEMENT STATEMENT REV. HUD-1 13/86) TitleExoress Settlement System Printed 01/18/2005 at 09:30 KJB
L. 5ETTLEMENT CHARGES PAID FROM PAID FROM
I 700. TOTAL SALES/BROKER'S COMMISSION based on price $95 000.00 @ 0.000 = BORROWER'S SELLER'S
Division of commission !line 7001 as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENl
702. $ to
703. Commission paid at Settlement
SOD. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriaination Fee %
802. Loan Discount %
803. Aooraisal Fee
804. Credit Reoort
805. Lender's Insoection Fee
806. Mortaaae Aoolication Fee
807. Assumotion Fee
808. .....
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to (a)$ /dav
902. Mortoaoe Insurance Premium for to
.903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. (a) $ /mo
1002. Mortoaoe Insurance mo. (a) $ /mo
1n03. CitvProoertvTax mo.(ij)~ /mo
1004. Countv Prooertv Tax mo. (a) $ /mo
1005. School Taxes mo.(ij)~ /mo
1009. Aaareaate Analvsis Adiustment
1100. TITLE CHARGES
1101. Settlement or closina fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Preoaration
1106. Notarv Fees
1107. Attornev's fees to Martson Deardorff Williams & Otto (POCl
!includes above items No: )
1108. Title Insurance to The Sentinel Aaencv LLC 828.75
!includes above items No: )
1109. Lender's Coveraae $
,1110. Owner's Coveraae $ 95000.00 .828.75
1111.
1112.
1113. Attorney's Fee to McNees Wallace & Nurick (POC bv Buver)
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordina Fees Deed $ 38.50 . Mortaaae $ . Release $ 38.50
1202. City/County tax/stamos Deed $950.00 . Mortoaoe $ 950.00
1203. State Tax/stamos Deed $950.00 . Mortaaoe $ 950.01
1204,
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301, Survey
1302. Pest Insoection
1303. Final Sewer/Water #02455-A to Borouah of Carlisle 32.31
1304.
1305,
1306,
1107
Commerce
flBanku
August 23, 2004
Martson Deardorff Williams & Otto
10 E High St
Carlisle, PA 17013
RE: Estate of: Jeannette G Burgett
Social Security #: 187-16-5945
Date of Death: August 14, 2004
Dear Sir/Madam:
In reference to the letter regarding the above mentioned
Estate, we would like to inform you of the information that
we have researched and found.
Type: Checking
Account #: 536167034
Date Opened: 2/4/03
Primary Owner: Jeannette G Burgett
Date of Death Balance: $1,296.32
Accrued Interest: $.11
If there are any questions or additional information that
is needed, please feel free to contact me at (717) 795-7118
ext. 3151.
Sincerely,
~C\. Ci ~O-'LJ~.j)
Wanda J. Morris
ClF Team Leader
Commerce Bank / Harrisburg, NA
P.O. Box 8599
100 Senate Avenue
Camp Hill, Pennsylvania 17001-8599
~LA' /)
_ .. d4 . [" \J:.'r'-_c- I
Rug 27 04 08:18a CIS 13028342136 p:>. 1
'=IM&rBank
49') Mitchcll RUJd. Millsbllru. 1>1; 199<>(, M~lil (\Ilk DE-MB-12 Phmlc (XliX) ~()2-,nl\lI
F"" ('07.) <)J4.2'IS~
^Ugll~t 27. 2004
F~IX ; 717-243-1850
Martson Deardorff Williams & OUo
Attorneys At L..w
Ten E~lst Hi~h Street
Carlisle, Pennsylvania 17013
R,-,: Rsfafe or .Ieaf/llelle U /31/r1[I:"
,"odal,\'ecurify: 187-1 (j-5CJ45
note 0[/)('(1117: A l(~lIS/ /./, 200..J
Dear Sir or Madam:
PCI' your inquiry datcd August 20, 2004, plc<lsc bt~ advi~u 111,,( a( thc time of dcntb, the drn.lVc-namcd decedenl h~ld on
deposit with this b~lJlk thc /()Ilowing:
l. '/)'I1t! IJjAccmml ( "hccking Account
Il('('()unl Nllf1/h(:r 26700ti6402
(Jwn(.,.,~hip (Names 1/1) .h'antit!ffc ( : IIlIrgd/
(J{lcning nak / % //70 /." l,I'cd 8/2f//(J.I
lJulalk.'1! rm DUll! I?!'f)l!cllh $3/,827. N
;lc(:f'/wd /rIlC'J"csl $ (). O()
fIlIal $3/.827.7-1
Plca.~e he advised, there was no sntc deposit box 'blind Ihr' the ,lhuve lk(;txknl.
For fllrlhl~r ~1C(.otllll illl.)rllllllion. rq;arding own('rship, closures ~U\d/or I'cimbUl'Sclllcnl of funds, please (':111 the
Stollchcdgc Otlkc # 717-240-4524.
;;~
Nancy Clagctt
Rccurds M<ul<Igcmcllt
-
J~~ ~E'r ~L
"'Way~qi!1J
8/24/2004
MDW&O
10 E HIGH ST
CARLISLE PA17013
The information which you requested on the account(s) of JEANNETTE G BURGETT
(Social Security Number 187-16-5945) is/are as follows:
Account Number 1716001466 7100016929
Class of Account CERTIFICATE CERTIFICATE
Date Opened 062281 122701
Principal Balance 3500.00 11418.86
Accrued Interest 2.23 20.86
Balance at Date of 3502.23 11439.72
Death
Account Ownership JTO JTO
Name of Joint BETTY J FRITZ TRACY
Owner, if any KOVACEVIC
r'\n ....AnTr
Date Ownership 062281 122701 \ r-...p v'V)r\ art.? . '_
Was Established r II ~,t lLM " A V\h ~
Account Number .' !~' ,\ )
Class of Account . n-Jp~<" .5 ck~
Date Opened cScPl).lJ 3 jJ.u' I
'.' .,./" ..,A/"'..'"
Principal Balance ,I.' ' er
C
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested E TTS
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711
Tnll F=r.." 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com
Estate Valuation
Date of Death: 08/14/2004 Estate of: Jeannette G. Burgett Estate
Valuation Date: 08/14/2004 Report Type: Date of Death
Processing Date: 11/02/2004 Number of Securities: 4
File 10: 3449.1
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 1564.282 WADDEL & REED ADVISORS FD INC (910450303; UNCMX)
CORE INV CL A
Mutual Fund (as quoted by NASDAQ)
08/13/2004 4.97000 Mkt
4.970000 7,774.48
2 ) 1067.241 WADDEL & REED ADVISORS FD INC (910450402; UNSCX)
SCI&TECHNOL A
Mutual Fund (as quoted by NASDAQ)
08/13/2004 8.15000 Mkt
8.150000 8,698.01
3) 762.744 WADDEL & REED ADVISORS FD INC (91152T101; UNSAX)
SM CAP CL A
Mutual Fund (as quoted by NASDAQ)
08/13/2004 11. 67000 Mkt
11.670000 8,901.22
4 ) 765.636 WADDELL & REED ADVISORS SELECT (WVAAX)
VALUEFD CL A
Mutual Fund (as quoted by NASDAQ)
08/13/2004 11.11000 Mkt
11.110000 8,506.22
Total Value $33,879.93
Total Accrual $0.00
Total $33,879.93
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
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F IFILES\DA T AFlLE\EST A TES\3449.1. accouncformal
IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
JEANNETTE G. BURGETT,
: ORPHANS' COURT DIVISION
DECEASED : NO. 2004-00779
FIRST AND FINAL ACCOUNT OF F. WILLIAM GREGORY,
EXECUTOR OF THE ESTATE OF JEANNETTE G. BURGETT,
LATE OF CARLISLE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA
Date of Death: August 14,2004
Letters Testamentary Granted: August 20, 2004
Letters Advertised:
Sentinel - August 26, September 2 & 9, 2004
Cumberland Law Journal- September 3,10 & 17,2004
Account Stated to May 11, 2005
*The account also indicates the proposed distribution of the estate.
SUMMARY
PRINCIPAL
Receipts $ 147.710.30
Conversions to Cash 34.08
147,744.38
Less Disbursements -81.102.74
Balance Before Distributions 66,641.64
Distributions to Beneficiaries ' ,62,640.00
Principal Balance Remaining $ 4,001.64
INCOME
Receipts $ 31.58
Less Disbursements 0.00
Balance Before Distributions 31.58
Distributions to Beneficiaries 0.00
Income Balance Remaining 31.58
COMBINED BALANCE REMAINING ~ 4.033.22
r--
PRINCIPAL RECEIPTS
Real Estate 507 West Louther Street, Carlisle, PA $ 95,000,00
Commerce Bank checking account 1,296,32
M&T Bank checking account 31,827.74
Waypoint Bank CD 3,502,23
31 shares, Prudential Financial 1,389.58
1 $50 Series E, Savings Bond 41.16
PSE&G Series R Bond #8078 100,00
Cash 2,103.11
Cumberland County Employees Retirement Plan, benefit 76.48
Parker Jewelers, gift certificate redemption 50.00
Northgate Antiques, proceeds from sale of coins 710.00
Hoffinan-Roth Funeral Home, refund 37.27
Rowe's Auction, sale of household property 8,005.00
Capital Blue Cross, refund of premium 130.Q3
Jewelry, appraised value 2,160.00
Northgate Antiques, proceeds from sale of camera and jewelry 415.00
Conseco Insurance Company, refund of premium 36,03
Comcast, refund 6.02
Sprint, refund 0.64
Household items retained by heirs 210.00
V intage Treasures, jewelry 150.00
Fanners Mutual Insurance Company, refund of homeowners premium 6,00
Prudential Financial, dividend of 12/03 15.50
Real Estate tax proration 431.49
Dickinson College, reimbursement for UGI service after real estate 10.70
disbursement
TOTAL $ 147,710.30
-2-
PRINCIPAL CONVERSIONS TO CASH
GAIN/LOSS
31 shares, Prudential Financial:
Cost Basis: 1,389.58
Redemption: 1.423.66 $ 34.08
TOTAL $ 34,08
PRINCIPAL DISBURSEMENTS
Hilton's Lock Service $ 53.16
Elks Club, funeral reception 462.49
Giant Food, cleaning supplies 25.36
Walmart, house repairs 9.48
Lane Bryant, account payable 426,60
PPL, electric service 125.35
UGI, gas service 123.58
Sprint, telephone service 62,87
Comcast 44,84
Carlisle Borough, sewer/water 116.23
Andorra Radiology, account payable 294.82
Frances Sanderson, lawn care 198.00
Rowe's Antiques, appraisal fee 125,00
Carlisle Memorial Service, grave marker 150.00
S.W. Barrett Appraisal Services, real estate appraisal 275,00
Verl Williams, trash hauling 400,00
F, William Gregory, reimbursement for administration expenses 383.69
Parker Jewelers, cleaning and appraisal of jewelry 381.60
Register of Wills, Agent, partial Inheritance Tax payment 40,000.00
2005 Real Estate Taxes, prorated 19.20
County of Cumberland, 1 % realty transfer tax 950,00
-3-
F, William Gregory, partial Executor's commission 4,500.00
Register of Wills, Agent, balance of Inheritance Tax 14,275.47
Martson Deardorff Williams & Otto, partial attorneys' fees 7,884,28
Martson Deardorff Williams & Otto, disbursements: 615.72
Probate Fee 304.00
Short Certificates 6.00
The Sentinel, advertising Letters Testamentary 143,15
Cumberland Law Journal, advertising Letters Testamentary 75.00
UPS, overnight mailings 50.37
EVP, online stock valuation 6.20
Filing fees, Guardianship Petition 12,00
Copies, Guardianship Petition 4.00
Register of Wills, filing fee, Inheritance Tax return 15.00
Reserved:
F. William Gregory, balance of Executor's commission 5,000.00
Martson Deardorff Williams & Otto, balance of attorneys' fees 3,200.00
Reserved for additional filing fees and miscellaneous expenses 1.000,00
TOTAL $ 81,102.74
PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES
Christine Stuebbe: $ 1,890.00
In Kind: Jewelry, per agreement of heirs 1,745,00
Household goods, per agreement of heirs 145.00
F. William Gregory: 20,250,00
Cash (33.34%)
Tracy Wise Kovacevic 13,500.00
Cash, (22.22%)
Tracy Wise Kovacevic, Guardian of the Estate of Ryan Kovacevic, a minor 13,500,00
Cash, (22.22%)
Mark Alan Wise 13.500.00
Cash, (22.22%)
TOTAL $ 62,640,00
,4-
INCOME RECEIPTS
Commerce Bank checking account, interest through closing $ 0.05
Waypoint Bank CD, interest through closing 2,22
M&T Bank estate checking account interest thru 4/18 29,31
TOTAL $ 31.58
INCOME DISBURSEMENTS
None $ 0.00
TOTAL $ 0.00
INCOME DISTRIBUTIONS TO BENEFICIARIES
None $ 0.00
TOTAL $ 0.00
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
F. William Gregory, being duly sworn according to law, deposes and says: That he is the
Executor of the Estate of Jeannette G. Burgett, deceased; that he has fully and faithfully discharged
the duties of his /her office; that the foregoing First and Final Account is true and correct and fully
discloses all significant transactions occurring during the accounting period; that all known claims
against the estate have been paid in full; that to his knowledge, there are no claims now outstanding
against the Estate; that all taxes presently due from the estate have been paid; and that the Grant of
Letters Testamentary and the first complete advertisement thereof occurred more than four (4)
months before the filing of the Account.
Zu
F, William Gregory,
SwO~d subscribed to before me this
/7 J(~Y;;;:~
Notary Public
NOTARIAL SEAL
VICTORIA l. OTTO. NOTARY PUBliC
CARliSLE BORON CUMBERLAND COUNlY.
MY COMMISSIO EXPIRES DEC, 2 2006
SCHEDULE OF PROPOSED DISTRIBUTION
F. William Gregory, Executor of the Last Will and Testament of Jeannette G. Burgett,
deceased, proposes to distribute the balance in his hands, to wit: $4,033.22, in accordance with the
said Last Will and Testament as heretofore filed in the Office of the Register of Wills of Cumberland
County, Pennsylvania, as follows:
TO: F. William Gregory, per Item 3 of said Will:
In Kind: Jewelry 415.00
Household goods 65.00
Cash: 864.41 $ 1,344.41
TO: Mark Allen Wise, per Item 3 of said Will:
Cash: 896.27
TO: Tracy Wise Kovacevic, per Item 3 of said Will:
Cash: 896.27
TO: Tracy Wise Kovacevic, as Guardian of a minor, Ryan M. Kovacevic,
Cash: 896.27
TOTAL BALANCE FOR DISTRIBUTION $ 4,033.22
STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION
The above distribution is proposed in accordance with the Last Will and Testament of
Jeannette G. Burgett.
?'~~ 4)_
F. William Gregory, Ex u:t /
Sworn and subs ribed to before me this /7d
day of ,2roS--:-
NOTARIAL SEAL
VICTORIA l. OTTO, NOTARY PUBLIC
CARLISLE BORO" ClIMBERLAND COUNTY
MY COMMISSION EXPIRES DEC, 2 2006
-6-
FIFILESIDA T AFILE\WILLSI341l9. WIL\dJn
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,
LAST WILL AND TESTAMENT
I, JEANNETTE G, BURGETT, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me
made.
\.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shan be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate, My personal representative shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
If my sister, BETTY I FRITZ, shall survive me by thirty (30) days, then I give, devise and
bequeath all of my estate, both real and personal property, unto my sister, BETTY I FRITZ,
absolutely, and I hereby appoint the said BETTY I FRITZ as Executrix of my estate.
3.
In the event the said BETTY J. FRITZ shall predecease or fail to survive me by more than
thirty (30) days, and in the event we shall die in a common disaster and it cannot be determined which
has survived, I shall be deemed to have survived my sister. I direct that my estate, both real and
personal property, shall be disposed of in the following manner:
(a) I give one-third (I13) thereof unto F. WILLIM1 GREGORY, absolutely.
(b) The remaining two-thirds (P3) thereof I give equally to MARK ALLEN WISE,
TRACY WISE KOVACEVIC and RYAN M. KOVACEVIC, absolutely. I further direct that if any
of the said legatees shall fail to survive me, then his or her share shall be divided equally among the
surviving legatees mentioned in this paragraph.
(c) I nominate, constitute and appoint F. WILLIAM GREGORY as Executor of my estate
under the provisions of this third paragraph of my Last Will and Testament.
J ./'1
U!
" ... .,K :.;:>--
. J.G.B,
Page I of 4 Pages
..J ~ it {iiA."- 14 ,/
,
I .
4.
I nominate, constitute and appoint TRACY WISE KOVACEVIC as Guardian of the estate
of RYAN M. KOVACEVIC.
5,
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of her or his duties in any jurisdiction.
6.
I authorize and empower my personal representative, in her or his sole and absolute
discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose
of or grant options in regard to any or all property of any kind forming a part of my estate for such
terms and such prices as she or he may deem advisable; to borrow money for any purposes connected
with the protection and preservation of my estate; to mortgage or pledge any real or personal
property fonning a part of my estate or to join in or secure the partition of same; to compromise any
claims or demands of my estate against others or of others against my estate; to make distribution in
kind and to cause any share to be composed of cash, property or undivided fractional shares in
property different in kind from any other share; to employ agents, attorneys and proxies and to
delegate to them such power as my personal representative considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate. 3 I J day of
IN WITNESS WHEREOF I have hereunto set my hand and seal this
~ ' 1998:
f7 .' 'I,) .,'
'&" JJ C vz:- (SEAL)
,__/{__-P tl--t..c.,.;'~lA - ~ :..pt"';'~ ../
/ Jeannette G. Burgett f
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of US, who at her request, have hereunto subscribed
Page 2 of 4 Pages
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Page 3 of 4 Pages
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#.. .. ..
COMMONWEALTH OF PENNSYL VANIA )
SS
COUNTY OF CUMBERLAND )
I, Jeannette G. Burgett, Testatrix, 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.
/) % 1 .,
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\/ :;;f./!:<""v.'/ r z;t;.. " /7 A'.t.;r.r/Z
Jeannette G. Burgett (
Sworn or affirmed to and acknowledged before me by Jeannette G, Burgett, the Testatrix,
this 0161: day o~ ,199t
Notarial Seal ,1/:1,._ .~. d ~
Denise L N e, Notary Public ~ V WI U/lLR.- ;
Carlisle Boro, turn berland C<;.u,," Notary Public
My Commission Expires Feb, 20_ 2001
COMMO~ALTk'OVSPE~~~~~IA )
: SS
COUNTY OF CUMBERLAND )
We, LJ J ) J I ~ ~ VYla..---lsm. and (l LU'f I ne J... ~ 'e{'S
the witnesses whose names are signed to the attached or foregoing instrument, b~ing d ly qualified
according to law, do depose and say that we were present and saw Jeannette G, Burgett, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that
the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each
of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of
our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
I
t::.
Carl/sIc- 'jJJ) 171) I l'
'~~n4~
Ad ress io E. fh'~ Sf'
Carli :sic:: C/ ';4 17013
.
Sworn or affirmed to and subscribed before me this 3;-.st day of 'flu(j ud:
199K
,NotanalSeal l~Jf ~
Denise L. Nye, Notary Public .
Carlisle Bore, C,um.be, rlan.,d Coun.ty,. ! Notary PublIc
My CommiSSion Cxp'r(''';:. Fph ~1r: ?(II1' !
.'.-.-------."..- ,,'
Member PRnnS'II\?'ii.;1 /',3soci3:'OI1 oj f\,,'~lt..':ric
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i c~r"fv that written notice of the filing of
. .,;cum ~nd 01 the date. lime and plaCe
.',<cWle wID be pnIII60led to the Court
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to 8Mj ~. he8 been given to
,lald JIlkilsnl and to every olher person
o tlle acooun\8fll to have or clelm an
t in the estate as creditor. beneficiary.
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COMMONWEALTH OF PENNSYLVANIA .'.
DEPARTMENT OF REVENUE ,
~~ . ,.~-. ^cr NOTICE OF INHERUANCE TAX
BUREAU OF INDIVIDUAL f1~~,ud) UtriCF Cj;i>PRAISEHENT, ALLOWANCE OR DISALLOWANCE
I_.nANCE TAll OIVISII.. - .' OF DEDUCTIONS AND ASSESSIIENT OF TAX
PO lOX 280601
HARRISBURG PA 17128-0601 REV-1M" EX AFP (03-05)
7:1", " ;'(1 j'). 2 DATE 04-25-2005
"c." ,. ,..:J 10:.' 0 ESTATE OF BURGETT JEANNETTE G
DATE OF DEATH 08-14-2004
"." FILE NUIlIlER 21 04-0779
.'iT COUNTY CUMBERLAND
IVO V OT"@'III ACN 101
MARTSON ETAL I _t _ltt... I
10 E HIGH ST
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOMER PORTION FOR YOUR RECORDS ~
1IfV-"1!C,."ft.m.m~1.'lftltm.W.!MftAYflM!lr.'IW.lWllYlfM!ln'~.'X't:t!l\rlM!lr.DI'.............. ...
DISALLOMANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURGETT JEANNETTE G FILE NO. 21 04-0779 ACN 101 DATE ,04-25-2005
TAX RElVRN liAS: I X I ACCEPTED AS FILED I I CH_ED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R_l Est.t. ISc:hMlul. Al III 95 , 000.00 NOTE: Tii' In...r. p.......r
2. stoek. _ _. ISc:hodul. BI (21 1.389.58 c.....lt 0 your _t,
oubalt upper portion
3. Clos.ly H.ld Stock/P.r_rshlp Int.r.st 1_1. CI 131 .00 of thisl fo... with your
.... "'rt_sINot.. R_i_l. ISc:hMlul. DI 1...1 .00 tax ~t.
5. CIIshIB_ IIaposl.tollllse. P.r_l P.......rty ISc:hMlul. EI (&1 51.304.02
6. .JoIntly _ Pr_rty ISc:hMlul. Fl 161 3.809.43
7. T.......,...s ISc:hMlul. III 17l 259 ,957 .42
B. Tot.l Assets IBI 411 ,460 . 45
APPROVED DEDUCTIONS AND EXEMPTIONS: 34,816.96
9. F.......l Expanse""_. Co.tolllise. Expanses ISchedule HI 191
10. _tslllort_ UablliU.s/U.... ISc:hMlula II 1101 771 96
11. Tot.l -..,Uons 1111 ~5 ,1;88 92
12. Net V.l... of Tax R.turn 1121 75,871. 53
13. Charitabla/Ilo...~t.l ....sts; Non-elected 9113 Trusts 1_1. JI 1131 .00
1.... Net V.l... of Est.t. Sub"set to Tax 11"'1 375,871.53
,
NOTE: I~ an ........nt was issu.d pr.vious~. lin88 14. 15 and'or 16. 17. 18 i' d 19 will
r81'l.ct 'figur.s thll1: includ. the tatal of ALL returns ass.ss.d to dat..
ASSESSMENT OF TAX: i
15. _t of Una 1'" .t _1 r.t. 1151 . DO X 00 =; . DO
16. _...t of Una 1'" taxable .t U....11C1.ss A ...t. 1161 .00 X 045 ~
17. _t of Una 1... .t Sibling ...t. 1171 . DO X 12 = . DO
18. _t of Una 1... t_l~ .t Coll.t....l/Cl... B ...t. 1181 375,871.53 X 15 ;:::156,380.73
19. Principal Tax _ . (191= 156,380.73
. i
DATE _ER INTEREST/PEN PAID 1- I AIlOUNT PAID i
11-09-20 4 CD004606 2,105.26 40,000.00 I
02-14-2005 CD004941 .00 14,275.47 I
~ TOTAL TAX CREDIT 6,380.73
BALANCE OF TAX DUE I .00
INTEREST AND PEN. I. DO
TOTAL DUE . 00
. IF PAID AFTER DATE IllllICATED, SEE REVERSE I IF TOTAL DUE IS LESS T/LVI fl, NO PAYMENT IS RElIUIRED.
FOR CALCULATION OF ADDITIOIL\L INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU KAY BE DUE
A REFUIID. SEE REVERSE SIDE OF THIS FORlt FOR :tNsTRUCTIIlIIS. I
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REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12
(For Resident Decedents Dying After July 1, 1992)
Name of Decedent:
JEANNETTE G. BURGETT
Date of Death:
August 14,2004
File No.:
21-04-779
Social Security No.:
187-16-5945
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration ofthe above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No.1 is Yes, state thefollowing:
a. Did the personal representative file a final account with the Court?
Yes X No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account informally to the parties in
interest?
Yes No
Date:
d. Copies of receipts, releases,joinders and approvals offormal or informal accounts
may be filed with the C erk of 'i\ ~rphans' Court and may be attached to this report.
November 9,2005 Signature: \bl\...r-
Name: Ivo V. Otto III, Esquire
Address: MARTS ON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, P A 17013
(717) 243-3341
\:,; Counsel for personal representative
F:\FILES\DA T AFILEIEST A TES\3449.1.srep
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