Loading...
HomeMy WebLinkAbout03-0456Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Mildred M. Bietsch No. I - 0,5- qS~ also known as , Deceased Social Security No. 175-03-1161 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE "A" OR "B" BELOW:) E A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors Decedent, dated 7/17/1991 and codicil(s) dated none \* named in the Last Will of the 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 incapacitated: B. Grant of Letters of Administration (c.t,a,, d.b.n.c.t.a.: pendente lite, durante absentJa; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE 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 1035 Mud Level Road~ Shippensburg~ PA 17257 (list street, number and municipality) Decedent, then 87 years of age, died May 6 ,2003 , at Charnbersburg Hospital (Location) 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 ........................................................................................ $ Total ..................................................................................................................... $ 0.00 Real Estate situated as follows: \* 1035 Mud Level Road, Cumberland County, Shippensburg, PA 17257 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: Signature - Typed or pdnted name and residence Elmond R. Bietsch, Jr. 25 Forest Lane~ Shippensburg~ PA 17257 Barbara Reisinger, 313 Dwelling Court~ Shippensburg~ PA 17257 Virginia Reisinger, 413 Sunset Lane~ Shippensburg~ PA 17257 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate accord, lng.to law. Sworn to and affirmed and subscribed fi'~~/~'-~ ~ day -[E'li'n~tc~ 1~. B~etsch~ Jr. before me this ~¢ of Barbara Reisinger V~ginia l~Singer' DECREE OF REGISTER Estate of Mildred M. Bietsch Deceased also known as Social Security No: 175-03-1161 Date of Death: 5/6/2003 AND NOW, (~.t ~ ~t., ~00~ , , in consideration of the Petition on the reverse side hereon~satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary ~ of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to \*Elmond R. Bietsch, Jr., Virginia Reisin~er and Barbara Reisinl~er in the above estate and that the instrument(s), if any, dated -I - t-~ - o~ I described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ ~ ,(~ Shod Certificate(s) ...............$ ~ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages ( ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ TOTAL ............................. $ Io.oo b/7 . o ch RW~TA Register of V~lls ~,~ U Attorney: HAMILTON C. DAVIS I.D. No: 10264 Address: P.O. BOX 40 SHIPPENSBURG PA 17257 Telephone: 532-5713 DATE FILED: Lo - qL _ his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. Tile original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 9286836 o. Fee for this certificate, $2.00 Lg~'["Registrar v - H105.143 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '. E~male ~' 175 -- 03 -- 1161 4. 5-6-2003 I ; I,. ~5'-2A-1915 I'. ~l.t~, PA I,~ I 87 ¥"'. DECEDENT'S USUAL OCCUP/O'ION 1035 Mud Level P~. ,,~m~.~m~, m 17257 ,L Henry K. Weaver I'" Carrie Mae I~ ~.. V~ M. Re.t.s/.r,,ge~ ~,. 413 Stmset I. ane Sl-d.~, Pa 17257 i~ o,~,~ El ~. 5-9-2003 la,.. Parklawns /0t~nm~l Gar8o~ 12,td. c'nm~eersburq, Pa 17201 County ~ 014831-L ~c.}l°-u~'N~er-Br5c~!<l=t'' F.H.,Inc. PO Box 336 Shbq, PA 17257 -,,-.--,. ~. ~-c//~''/ ???/2c-- ,,~. I '"""'-'"" /. ; I I":--[] .-~----- Ul I I"' [] .o I v,, .- ~o,. Ix~,. ~. I~c. I~. · . i:~,. in. 13~. I~. " 3ih.I ' % ~--v ~ · ' .... ~ ........... ~'7"'7 ................................... ,,. O~'~b~r~. I ~ LAST WILL AND TESTAMENT I, MILDRED M. BIETSCH, of Southamptom Township, Cumberland County, ~eclare this to be my Last Will and Testament and revoke any Will or Codicil ~reviously made by me. ITEM I: I direct that all my just debts and funeral expenses, including ~y gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I bequeath those articles of my household furniture and furnishings and those articles of my personal effects and personal property as set forth in a separate memorandum, which I shall place with my Will or deposit with my attorney, to the persons therein designated. ITEM III: I give and bequeath the full sum of $200.00 each, to my .~ldaughter, VIRGINIA REISINGER, my grandson, KENNETH REISINGER and my Igranddaughter, SUSAN KAUFFM~.  ITEM IV: I devise and bequeath the residue of my estate of every nature B nd wherever situate in equal shares to such of my children, ELMOND R. (RAY) IETSCH, JR., VIRGINIA REISINGER, and BARBARA REISINGER, as shall survive me ITEM V: Should any of my children, ELMONI) R. (RAY) BIETSCH, JR., VIRGINIA REISINGER, and BARBARA REISINGER, predecease me or die on or before the thirtieth day following my death but leaving issue who so survive me, such issue shall receive, per stirpes, the share that such predeceased child would have received had he or she so survived me. ITEM VI: I appoint his or her respective parent or guardian, guardian of any property which passes outright either under this Will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to ~istribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including secondary, college education, both graduate and undergraduate, professional and other education) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor or to the minor's parent or to any person taking care of the minor. ITEM VII: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the iadministration of estate. my I ITEM VIII: I appoint ELMOND R. (RAY) BIETSCH, JR., VIRGINIA REISINGER and BARBARA REISINGER, Executors of this my Last Will. ITEM IX: I direct that my Executors or guardian or their successors ~hall not be required to give bond for the faithful performance of their ~llduties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on four (4) sheets of paper, dated this day of · [ M~dred M. Bietsch The preceding instrument, consisting of this and three (3) other typewritten pages, each identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. residing at residing at ~-~~ I ~A COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : I, MILDRED M. BIETSCH, the 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; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~/~J ~ ~2~~,(SEAL) - - ~ildred M. Bietsch - Sworn to or affirmed and acknowledged before me by Mildred M. Bietsch, the Testatrix, this /7~ day of .J~/.t/' , 1991. Notary Public NOTARIAL SEAL VELDA M. SEASE, Notary Public Shippensbur§ Boro, Cumberland Co., Pa. My Commission Expires April 16, 1994 COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, ~;¢//~ ~, ~,~c5 and ~t~ac~e~d~.° ~-~ng~st , the witnesses whose names are signed to the a r foregoi rument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by D~¢/[~ &. f,'pe$ and Da~¢~;~ e k. Oc~-~/~'~9~ , witnesses, this" /7~A day of Notary Public , 1991. M. SFASE, Notary Public PERSONAL PROPERTY MEMORAMDUM TO ACCOMPANY WILL OF MILDRED M.. BIETSCH As provided in ITEM II of my Will, I hereby designate that the following listed property shall go to the persons whose names are designated hereon. ITEM Guns and everything that goes with them Baseball Gloves Old chest in bedroom Ail bells, old 78 records and old radio and cabinet Stereo and all albums Drop leaf table Sewing cabinent and everything in it Hutch in dining room NAME E. Ray Bietsch, son Ryan Bietsch, grandson Sharon Bietsch, granddaughter Barbara Reisinger, daughter Michael Reisinger, grandson Edward Reisinger, grandson Teresa Crum, granddaughter Lori Holesa, granddaughter SIGNED: CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name of Decedent: Mildred M. Bietsch Date of Death: May 6, 2003 Will No.: 2003-00456 PA No. 21-03-0456 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on August 21, 2003: Name Barbara Reisinger, Elmond R. Bietsch, Jr., Virginia Reisinger, Kenneth Reisinger, Susan' Kauffrnan, Address 313 Dwelling Court, Shippensburg, PA 17257 25 Forest Lane, Shippensburg, PA 17257 413 Sunset Lane, Shippensburg, PA 17257 48 White Oak Boulevard, Mechanicsburg, PA 1.7055 413 Sunset Lane, Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under R~le 5.6(a) except None Date: 08/21/2003 · Name: Hamilton C. Davis, Esq. Address: P.O. Box 40 Shippensburg, PA 17257 Telephone: 717-532-5713 ~..J Capacity: __ personal representative ~-.4 X counsel for personal ~ representative 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 003518 DAVIS HAMILTON C P O BOX 040 SHIPPENSBURG, PA 17257-0040 fold ESTATE INFORMATION: SSN: 175-03-1161 FILE NUMBER: 2103-0456 DECEDENT NAME: BIETSCH MILDRED M DATE OF PAYMENT: 02/02/2004 POSTMARK DATE: 01/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/06/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,294.69 REMARKS: TOTAL AMOUNT PAID: $5,294.69 SEAL CHECK# 130 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT 280601 HARRISBURG, PA 17128-06(~1 REV-1500 INHERITANCETAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COUNTY CODE 03 00456 YEAR NUMBER ; DECBDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ' Bietsch, Mildred M. 175-03- l l 61 DATE OF DEATH (MM-DD-YEAR) : DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 05,/06/2003 ! 08,'24/1915 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A, ------[~ 1. Original Return [] 2. Supplemental Return ] 3. Remainder Return (date of death prior to 12-13-82) ] r'-I Future Interest Compromise of death after 4. Limited Estate 4a. (date 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7, Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-g51 [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: qAME Hamilton C. Davis FIRM NAME (If applicable) Zullin. ger - Davis, PC TELEPHONE NUMBER 717/532-5713 I COMPLETE MAILING ADDRESS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 10. 11. 12. 14. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & 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) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) 124,500.00 None None None 9,654.14 None None 15,887.67 606.64 Net Value of Estate (Line 8 minus Line 11 ) 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) (8) 134,154.14 16,494.31 117,659.83 117,659.83 (11) (12) (13) (14) 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) x .00 (15) 16. Amount of Line 14 taxable at lineal rate 117,659.83 x .045 (16) 5,294.69 5,294.69 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. [] x .12 (17) x .15 (18) (19) >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS CITY Shippensburg 1035 Mud Level Road iS'FATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 5,294.69 0.00 0.00 5,294.69 5,294.69 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; .................................................................................. ~ ~ 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? ....................................................................................................................... [] [] 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? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under Penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Ei~ol~d R. Bietsch, Jr~ ~ ~ SIGNATURE OF PERSON RESPONSI-'~J~ FOR ~(LING RET~[~i ADDRESS ,. S~t~IAT~RE OF PREPARER O~EPR~i~JlI~TA?~VL~ ADDRESS V Hamilton C. D: 25 Forest Lane Shippensburg, PA 17257 313 Dwelling Court Shippensburg, PA 17257 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ADDITIONAL Personal Representatives Bietsch, Mildred M. SS# 175-03-1161 5/6/2003 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. 3Signature '~///~./.,~-~2.,~ ./ ~1~~ Name Virginia(~eisir~ger- 4 5 6 7 Address 413 Sunset Lane City, State, Zip PA 17257 Date Signature Name Address: Shipl:iens~)urg, / / City, State, Zip Date Signature Name Address: City, State, Zip Date Signature Name Address: City, State, Zip Date Signature Name Address: City, State, Zip Date COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF 'FILE NUMBER Bietsch, Mildred M. 21 - 03 - 00456 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is del ned as the price at which property would be exchanged between a willing buyer and a willing seller neither being compelled to buy or sell, both hav ng reasonable knowledge of the re evant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1035 Mud Level Road, Shippensburg, PA third party at arm's lenght price and terms. and ordinary expenses of sale. 17257 ( See attached settlement sheet). Sold to an uarelated Sale necessary to settle estate. See Schedule H for necessary TOTAL (Also enter on Line 1, Recapitulation) iVALUE AT DATE OF DEATH 124,500.00 124,500.00 COMMONWEALTH OF ~ENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF Bietsch, Mildred M. i FILE NUMBER 21 - 03 - 00456 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 1 2 3 4 5 6 7 8 9 DESCRIPTION Citizens National Bank Checking Account No. 6100792935 Miscellaneous Household Goods and Furnishings and Personal Effects - Public Sale Pro Rated Real Estate Taxes from Sale of House Sprint Refund Highmark Blue Shield Refund Comcast Refund Commonweath of Pennsylvania Rent Rebate Waste Management Refund Miscellaneous Personal Property TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 2,306.15 5,484.10 777.83 23.01 276.45 2.74 500.00 63.86 220.00 9,654.14 COMMONWEALTH OF PENNSYL ,ANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF :FILE NUMBER Bietsch. Mildred M. , 21 - 03 - 00456 Debts of decedent must be reported on Schedule I. ITEM : NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Fogelsanger-Bricker Funeral Home Parklaxvns ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Hamilton C. Davis, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Legal Advertising - The News Chronicle Legal Advertising - Cumberland County Legal Journal 6,494.00 265.00 5,400.00 101.00 75.00 Total of Continuation Schedule(s) 3,552.67 TOTAL (Also enter on line 9, Recapitulation) 15,887.67 COMMONWEALTH OF PENNSYLVANIA iNHERITANCe. TAX RETURN RESIDENT DECEDENT Schedule H Furerai Expemes & Administrative Costs continued ESTATE OF Bietsch, Mildred M. i FILE NUMBER ! 2 -03-00456 3 2.247.67 4 Real Estate Settlement Expenses. It was necessary to liquidate this asset for the benefit of settling the estate (not for the benefit of the beneficiaries) Dan Hershey Auctioneering - Denny Gotshall - Personal Property Appraisal Steve Barrett, Appraiser- Real Estate Appraisal Reserve for contingenies 30.00 275.00 1,000.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX ~ETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Bietsch, Mildred M. i FILE NUMBER I 21 03 00456 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 DESCRIPTION Penelec Waste Management Chambersburg Hospital Oliver Oil TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 123.26 116.61 31.54 335.23 606.64 REV-1513EX+(9~0) .~ COMMONWEALTH OF PENNSYLVANIA INHERrTANCE TAX RETURN RESIDENT DECEDENT SCHEDULEJ BENEFICIARIES ESTATE OF FILE NUMBER Bietsch, Mildred M. 21 - 03 - 00456 NUMBER 4 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Elmond (Ray) R. Bietsch, Jr. 25 Forest Lane Shippensburg, PA 17257 Barbara Reisinger 313 Dwelling Cburt Shippensburg, PA 17257 Virginia Reisginer 413 Sunset Lane Shippensburg, PA 17257 Kenneth Reisinger 48 White Oak Boulevard Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT DO Not Li~t Tru~te~) Son Daughter Daughter Grandson See Continuation Schedule(s) attached !Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheetI AMOUNT OR SHARE OF ESTATE Guns valued at $50.00 and I/3 Residue Bells, Records and Radio valued at $15.00 and 1/3 Residue Bequest of $200.00 and 1/3 of Residue $200.00 Il. I NON-TAXABLE DISTRIBUTIONS: IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT i BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES continued ESTATE OF FILE NUMBER Bietsch, Mildred M. 21 - 03 - 00456 [ RELATIONSHIP TO ! AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT DO Not List Trustee(s) OF ESTATE 7 I0 11 [include outright spousal distributions, and transfers under TAXABLE DISTRIBUTIONS Sec. 9116(a)(1.2)] Susan Kauffman ;Grandaughter 413 Sunset Lane Shippensburg, PA 17257 Ryan Bietsch P.O. Box 109 Shiloh, NJ 08353 Sharon Bietsch 4189 Nantucket Drive Mechanicsburg, PA 17050 Michael Reisinger 5553 Jonathan Street Shippensburg, PA 17257 Edward Reisinger 2572 Mongul Hill Road Shippensburg, PA 17257 Teresa Crum' 1266 Rimer Highway Shippensburg, PA 17257 Lori Holesa - Hainds 39 Laurch Drive Shippensburg, PA 17257 Grandson IGrandaughter Grandson Grandson Grandaughter Grandaughter $200.00 Baseball Gloves Yalued at $10.00 Chest valued at $35.00 Stereo and albums valued at $20.00 Drop Leaf Table valued at $20.00 Sewing cabinet valued at $20.00 Hutch valued at $55.00 Page 2 of Schedule J U.S. Department of Housing and Urban Development ,13.111 No. 2502-:12n'~ iP~,.ae Ii A. Settlement Statement ll.~r.?e of Loan I. ~ FHA 2 .... FmHY, 3. i~ Cons'. Lmns. o. File Nan:be:' 7 Loan Nutnber :~ Nlo~age [nsul~ce L'~ac Nmnber 4. ~ VA 5. ~Conv [ns. 3134-S D. Name ~d ~d~s of Bom~wc¢ E Name. Addr~s. and T&xpayer :dentificat on ~ of Seller F N~ne ~d &ddrc~s ot Lender M~rhn R. and M~ian O. Nolt Estate of Mi[dr<d M. flietsch Owsro~n Bank 1037 Mud Le~el Road ; Barbara Re,singer. Elmond R. Bictsch, Jr. 77 East King Street Shipecnsburg, PA t7257 . ~ and V rginia Reislnger, Executors Shippensburg, PA 17257 iH. ";enlemem Agent Name, Address and Taxpayer [dentltication Number ~ Hamdton C. Davis P.O. Box 40 Shippensburg, PA. 17257 25-1530888 Place of' Settlement ' [. Senlement Date 20 E. Burd Street, Ship, P.A. 17257 10f9'2003 G. Property LocaUon 1035 Mud Level Road Shippensbarg, P-k 17257 Southampton Tou, nship. Cumberland County T~Lx Parcel No. 39-I 1-0310-015 J. Summary of Borrower's Transactions K. Summary. of Seller's Transaction 100. Gross Amount Due From Borrower 400. Gross .Amount Due To Seller 10l. Contract sales pr/ce [24,500.00 40[. Contract sales price [24,500.1)0 102. Personal Proper:y 103. Settlement charges to borrower (line 1400) 104. 105. Adjustments for items paid by seller in advance 106. Cit3,/town taxes to 107. County taxes 10;09,03 to 12/31,03 Assessments to 109. School Tax I0/09,03 to 06,30/LM t 10. Garbage Fee 111. 112. 200. Amounts Paid By Or in Behalf Of Borrower 3,093.25 49.86 727.97 128,971.08 41)2. Personal Property 403. 404. 405. Adjustments for items paid by seller in advance 406. City,town taxes to 407. Coun~'taxes 10/09.03 to 1231,03 408. Assessnlents to 4{)9. School Tax 10/09,03 to 06/30,04 410. Garbage Fee 41l. 412. 420. Gross,Amount Due To Seller 49/% 727.97 125,277.83 500. Reductions in Amount Due To Seller 201. Deposits or earnest money 501. Excess deposit {.see instructions) 202. Principal amount of new loan(s) 124,500.00 502. Settlement charges to seller (line 1400) 2,247.67 203. Existing loan(s) taken subject to 204. 205. 206. 207. 208. 209. Adjustments for items unpaid by seller 210. City/town taxes to 211. County taxes 503. Existing loan(s) taken subject to 504. Payoff of first mortgage loan 505. Payoffofsecond mortgage loan 506. 507. 508. 509. Adjustments for items unpaid by seller 510. City,,town taxes to to 511. County, taxes to 212. Assessments to 512. Assessments to 213. School Tax to 513. School Tax to 214. I 514. 215. 515. 216. 217. 218. ,. 219. 220. Total Paid By/Fur Borrower 124,500.00 300. Cash At Settlement From/To Borro',~er 31.1 I. Gross Amount due from borrower (line 120) 128,971.08 302. Less amounts paid by'for borrower (line 220) ( ~- 303. Cash ;X_.~ From '~ To Borrower $ 4,47 [.08 516. 517. 518. 519. 520. Total Reduction Amount Due Seller 2,247.67 600. Cash At Settlement ToiFrom Seller 60[. Gross ,aunount due to seller (line 420) 125,277.83 61)2. Less reducnons in amt. due seller {.line 520) .._4':'" 7 O,)'" 603. Cash !~'(.~ To :_~ From Seller I23,031).10 a~.~ount.-' or//.b4~,nc ~m this tran~c£ton. ~~[ ~.her ¢em~ that [ have teceivefl a :o,,tpleted copy ot pages I and 2 of th~s HUD-I S<:tlement. ~S~ementf~, ~u r~.~ ~ 'Y Borrower Marlin R. N~t ,-- ~-~~~-, ...... ~ ....... -~ ~: - - - ~ . ~ , .-,. ,~. ~ ~ catatepr.~{jl~ca .v~Vc~Barg~msmger Il ~ morrower Marian O NoR ~ ' -~ .... ~ ' '' ~ ' z .~-' ' -' '~~~ '- , -- ~e,rer El ..... d R. B,etsch, Jr.~.~irmnia Rci~ .... Seller's Taxpayer Identification Number Solicitation and Certification JE'UFLEMENT AGENT CERTIFICATION HLD- I 3,9l Seller'i Si.mature Date REhi'.\. bill 43i)52 L. Scttlenlcnt C'har'~es i'~e 2 F~mds at Setdement %2. S ~o 703 C,)mnt~ssi~n ?aid at Settlement TO'. 800. items Pa~bteinConnecdon~id~Loan ~)I Loan On?~uon Fee % 81~3.~pr:usal Fee :o Owstown Bank 500. Ol) 804. Credit Rcpo~ :o 805. ~ender'~ [n~pecuon Fee 806. %lo,gage insurance Application Fee m 807. Document Preperation Fee m: O=stown Bank 2G0.OO 808. Flood Cemfication Fee to: O~stown Bank 60.00 809. Underwriting Fee roe Owsmwn Bank 200.00 8t0. Avplicauon Fee to: O=sto~n Bank 200.00 900. Item~ Required By Lender To Be Paid in Ad~anze 001. Interest ~mn to (~ S 'day 902. Mo~gage Insurance Premium tbr months to 903. Hazard insurance Premium tbr years to 904. 905. 1000. Reserves Deposited ~ith Lender 100I. Hazard lnsur~ce months :~ $ per month 1002. Mo~gage Insurance months,'~ g per month 1003. Ci~ prope~y taxes months <~: $ per month 1004. Coun~ prope~ cruxes months ~ $ per month 1005. ~mual assessments months ,~ S per month 1006. School T~xes months ~ $ per month 1007. months ,~. S per month 1008. Aggregate Reserve ~diusnnent 1100. Title Charges 1101. Semlemem or glosing t~e to 1102. Abswact or title search to 1103. Title examination to PaM From Seller's Funds at Seult:mcnt 1104. Title insurance binder to 1105. Document preparation to I 106. Norse's fees to 1 I07. Attorney's f'ees to (includes above items numbers: ) ) 1108. Title insurance to Zullingcr- Davis, P.C., Agents 1,133.75 (includes above items numbers: ) 110q. Lender's coverage $ 124,500.01) 1110. Owner's cm, erage $ 124.500.00 till. 1112. I113. 1200. Government Recording and Transfer Charges 120!. Recording tees: Deed $ 39.50; Mortgage $ 85.00; Releases $ i 124.5t) . 1202. City/county tax, stamps: Deed $ 1,245.00 ; Mortgage 1203. State taxi, stamps: Deed $ 1,245,00 ; Mortgage $ 1.245,01} 1204. Recording Fee for Subordination Agreement i 30.01) 1205. 1300. Additional Settlement Charges 1301 S arvey to: 1302 Pest Inspection to: 1303. Seller's Anomey Fe~ to: Hamihon C. Davis. Esquire t not related to Title Insurance) 1304. 1305. 20t13-2OO4 School Real Estate Taxes to Vivian Coy. I'mx Collector 1,002.67 1300. 1307 130~. 1309 1400. Total Settlement Charges (enter on lines 103, Section J and 502. Section K) 3,0q3.25 2,247.07 I'OC Initial Escrow Account Statentent Required by Section II/(c) { 1 ) of the Real Estate Settlement Procedure~ Act (tIES PA) If checked. ~ the terms ofyottr loan require you to have an escrow account to ~sure that the certaia obligations relating to the mortgaged properly, such aa taxes, insurance prem/unu; and other charges are paid. I'he amount specilled l:~'low will be collected, akmg with your mortgage principal and intere,$t payments, dining the tlr~t 12 rnotlths a~er your account ts opened to pay these anticipated expenses: F21etx~.)~tlllt I~egiroling Date: Your escrow account pa)ment will he $ per Pa)ce Purpose Anticipated Due Date Estimated Amount !IUD - I 3, ql RESPA, ,'lB 4305.2 Date No. Funeral of May 16, 2003 Mildred M. Bietsch (A) Services, including merchandise ....... Mrs. Virginia M. Reisinger 413 Sunset Lane Shippensburg, PA 17257 Personal, Staff and Proti~ssional Services Funeral Home Facilities and Equipment Automobile Equipment Casket Interment Receptacle $3,800.00 $2,450.00 (B) Cash Advanced. We have advanced the following funds for your convenience ....................... Clergy Honorarium Certified copies Flowers Total 'A' 75.00 10.00 159.00 $6,250.00 (C) Additional Items, ordered later ....... q'btal 'B' $ 244.00 F4 Duc June 16, 2003 Total 'C' ('omplete Total Amount Paid Balance $6,494.00 $6,494.00 ParMawns Memorial Gardens and lXlausoleum JUN 0 ~ 2003 May 28, 2003 Hamilton Davis 20 East Burd Street Shippensburg, PA 17257 RE: Estate of Mildred M. Bietsch Dear Sir: Please find enclosed an agreement for a scroll. This agreement is in the amount of $265.00. Please send a check in the amount of $265.00 with the signed agreement to our office. Once we receive this back, we will. order the scroll and it will be installed. If you have any questions concerning this matter, please do not hesitate to contact the cemetery office. Enclosures DB/tae Sincerely yours, Dee Barton, Family Service Parklawns Memorial Gardens 321bi Philadelphia Avenue · Chambersbur~. PA 17201 www.di~nitymemorial.eom LAST ~ILL A~YD TESTf~MENT I, MiLDkLD M. B1EZSCH, of Southamp~om Township, Cumberland County, re this to be my Las~ Will and Testament and revoke any Will or Codicil oreviously made by me. ITEM I: I direct that a~ my just debts and fun~r~ ~¥p ...... ~ .... gravemarker and all ezpenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I bequeath those articles of my household furniture and furnishings and those articles of my personal effects and personal property as set forth in a separate memorandum, which I shall place with my Will or deposit with my attorney, to the persons therein designated. iTEM I!I: I g~ive and bequeath the full sum of $200.00 each, to my ~aughter, VIRGINIA REISINGER, my grandson, KENNETH REISINGER and my iranddaughter, SUSAN ~UFF~£~. ITEM IV: ! devise and bequeath the residue of my estate of every nature and wherever situate in equal shares to such of my children, ELMOND H. (F~Y) ~ BIETSCH, JR., VIRGINIA REISINGER, and EAREARA REISINCER, as ~ha~z survive me by thirty ~30) days. , ITEM V: Should any of my Children, ELMOND R (~Y) BIET~CH, ~ ~VIRGiNIA EET~INGER and EAP;~r~ p~c ~ - ....... 1...... ' ......... ......... ii, GaR, predecease me or die on or befo 'the t~ r~ re /' ~ =zeth cay fo!lowzng my death but leaving issue who so survive me, j/such zs=ue sh=!l receive, per stzrpes, the share that such ['radeceased child ljwou!d have recezved hsd he cr she so survived me ~ iTEM V!: I a~oin ~f~ ~ ' ...... ., . z~ T ~ .= ~_ Eer -espectz~.e parent or guar~zan, Euardian of any property which ~'~='=es . , ....... outrff~kt either under this ~il] or otherwise to !a minor and with regpect to which i am authorized to a?polnt a guardian and nave not otherwise specifically done so, provided that chis appointment of a guardian shall not supersede the right of any fiduciary in its discretion to istri~ute a share where possible to the minor or to another for the minor's benefit. Such ~uardian shall have the power to use principal as well as zncome from time to time for the minor's s.upport and education (fncluding secondary, college education, both graduate and undergraduate, professional land other education) without regard to his or' her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor or to the minor's parent or to ~ny person taking care cf the minor. ITEM VII: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whate~er jurisdiction im'posed, shall ~ be paid from ~y residuary estate as part of the e~penses of the iadminisCration of my estate. ~l/ ITEM VIii: I appoint ELMOND R. (RAY)BIETSCH, JR., VIRGINIA KEtSINGER and BARBARA REISiNGER, Executors of this my Last Will. ITEM IX: I direct that my Executors or guardian cr their successors ~h. all not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS ~{EREOF, I hereunto £et my hand and seal to this my Last Will ttand Testament, written on four (4) sheets of paper, dated this day of [ ~i%dred M. ~iet~ch The preceding instrument, consisting of this and three (3) other typewritten pages, each identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her last Will,' in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. 'COFRdONWEAL?H OF PENNSYLVANIA : : SS. COUNTY OF CUMEERLAXD : I, MILDRED M. BIETSCH, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to ].aw, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Mildred M. Bietsch Sworn to or affirmed and acknowledged before me by Mildred M. Bietsch, the Testatrix, this /?{~ day of , Notary Public SO~'~tONWEALTH OF PENNSYLVJ~IA : : SS. COURTY OF CU~BERL;~ND : ,the ~itnesses whose names are signed to the a~tac~ted'or foregoing-' ~ ~strument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time e~ghteen (18) or more years of a~e and of sound mind and upder no constraint or undue in~~ = ~U~C~. this ~ /TF-A day cf ~otarv Public Sworn to or affirmed and subscribed to before me ky ~;¢[L~ ~. f,'~e~ and , ~itnesses, , 199]. As provided ir. :ollowi~g listed property shall go to the persons whose names are designated hereon. ITEM Guns and everything that goes with them Baseball Gloves Old chest in bedroom Ail bells, old 78 records and old radio and cabinet Stereo and all albums Drop leaf table '~ Sewing chbinent and everything in it Hutch in dining room - N.~iE E. Ray Bietsch, son Ryan Bietsch, grandson Sharon Bietsch, granddaughter Barbara Reisinger, daughter Michael Reisinger, grandson Edward Reisingar, grandson Teresa Crum, granddaughter Lori Helesa, granddaughter S !GNED: She was preceded in Arrangements are under death by one great grand- the direction of thc Fogel- dau2/hter, fi>ur brothers and sanger-Bricker Funeral [tV~) :.q:4f. ers. Home, Inc., Shippensburg. Mildred M. Bietsch Shippensburg Mildred M. Bietsch, 87, 'l,'.l:C; .\I,M Level Road, Ship- pcnsburg, ciied Tclesda~ May 6, in the Chambersburg Hospital. Born Aug. 24, 19~5, in Shippensburg, she was a daughter of the late Henry K. and C. arrie Mae {Nyd) Weaver. She was united in mar- riage to Elwood a. Bie~sch, who preceded her in death, Dec. 4, 1990 Mrs. Bietsch is survived by one son, E. Ray Bietsch ,Ir., Shippensburg; two daughters, Virginia M. Reisinger and Barbara A. Reisinger, both of Shippens- burg; 10 ~andchildren; 22 grea~ grandchildren; 10 great great grandchildren; and a number of nieces and nephews. She was preceded in death by three brothers and two sisters. She was retired from Hoffman Mills, Shippens- bm'g, where she worked in the stockroom and as a gen- eral laborer. After retire- ment, she worked part~time fl~r the Robert T. Henry Pharmacy, Shippensbur~, tbr nine years. Funeral services will be held Friday, at 2 p.m. in the Fogelsanger-L4ricker Funer- al Home, Inc., Shippens- burg. Interment will be in the Parklawns Memorial Gardens, Greene Township. Friends.will be received at the flmeral home, Thursday evening fi'om %9 p.m. In lieu of flowers, memo- rial contributions may be sent to the Leukemia and Lymphoma Society Central Pennsylvania Chapter 800, Corporate Circle, Harris- burg, Pa. 17110. Arrangements are under the direction of the Fogel- sanger-Bricker Funeral Home, [nb.. Courthouse art show planned The Carlisle Art Association will hold their annual out- door exhibit on the Courthouse Square, on the corner of Hanover and High Streets in Carlisle, May 17, from 9 a.m. to 4 p.m. Many of the artists will be on hand, demonstrating their painting. CRF MECHANICAL LLC Heating, Air Conditioning, Plumbing and Electrical P.O. Box 159 Shippcnsburg, PA 17257 · 16-Point Cooling Insp¢cti(,n · Experienced ['cchnicians · ";cnior ('itizcn Discount · 24-1-1our Emergency Scr,,icc · Fully [n~ta'cd · Maintenance Programs Available · Servicing All Major Brands · Cl~cr 20 Years of Experience · Saks. Service. and Installation I'honc: 717 532-8o95 ~ Fax: 717 530-0721 1' Uelh, lar: 717-360-6102 ,~t~,~tl wltll IllCb~'/lfl~k~. CP, llle¢l /FULt and choic'5 Tuesday -- Chicken fajita wraps or boa., ings, rice pilaf, gre{m beans, chilled fruit ar., milk. Wednesday -- Field Day - Picnic Lunch Thursday -- I-lot turke'~ sandwich with I hoagie xvith fixings, mashe~l potatoes, butter chilled frmt and choice of milk. Reconstructed Continued From Page 1 When the congregation first decided to have work done on the piano, they thought ~t would be a sma~'l job, however, Miller said they later decided to go all the way and have the piano completely reconstructed. The picturesque instrnment still has /ts original key- board with rosewood keys. Miller said they didn't have to replace many of the keys at all because they were basically all still in very good shape. The technicians from Snyder's wanted to use as much of the original materi- als as they restoration p they did. The entir~ process was five months. from Snyder November to ~ piano, and last returned to th~ ing absolutely Miller said first brought : they asked her thing. "I began Great Thou A~ honestly, Millm a very special ~ said to play Local News Brk Robert T. Henry Pharma- cy, 54 East King street, Shippensburg, will have free Diabetes testing on Wednes- day, May 21, from 2 to 4:00 p.m. All are welcome to attend. There will be no age limits and there is no need to fast before testing. A Lutheran Home Care nurse will be on hand to answer diabetic questions. For more information call Robert T Henry Pharm~ 5812. Th News. Ch Shippens5 (717) 6" Spet ilam & ( or Cheeseb 717-530-5151 U_UTO BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-IS~7 EX &FP i~' DATE i 05-22-2004 !':!( i ESTATE.OF.~ BIETSCH DATE OF DEATH 05-06-2005 FILE NUMBER 21 05-0456 HAMILTON C DAVIS '0~ BARq~UN~Jq:41 CUMBERLAND ACN 101 ZULLINGER DAVIS PO BOX 40 L~,c.~:~ SHIPPENSBURG PA 17257 ~ MILDRED M MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX RFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BIETSCH MILDRED M FILE NO. 21 05-0456 ACN IOl DATE 05-22-2004 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON.' ORIGINAL RETURN 1. Real Estate CSchedule A) 2. Stocks and Bonds CSchedule B) $. Closely Held Stock/Partnership Interest CSchedule C) 4. Hortgages/Notes Receivable CSchedule D) 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) C5) &. Jointly Owned Property CSchedule F) 7. Transfers CSchedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule H) C9) 10. Debts/Mortgage Liabilities/Liens CSchedule 11. Total Deductions 12. Net Value of Tax Return 15. 14. NOTE: 124r500.00 .00 .00 .00 .00 .00 (8> 15,887.67 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 154,154.14 606.64 c12) 117,659.85 Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule Net Value of Estate Subject to Tax Cl4> If an assessment was issued Previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of L/ne 14 at Spousal rate C15) 16. Amount of L/ne 14 taxable at Lineal/Class A rate C16) 17. Amount of Line 14 at Sibling rate C17) 18. Amount of Line 14 taxable at Collateral/Class B rate C18) 19. Principal Tax Due .00 117,659.85 RECEIPT NUMBER TAX CREDITS: PAYMENT DISCOUNT C+) INTEREST/PEN PAID C-) .00 18 and 19 w/Il 5,294.69 TOTAL TAX CREDIT BALANCE OF TAX DUEJ INTEREST AND PEN. TOTAL DUE 5,294.69 .00 .00 .00 C IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DATE 01-50-2004 CD005518 AMOUNT PAID .00 x O0 = .00 117,659.85 X 045 = 5,294.69 .00 x 12 = .00 .00 x 15 = .00 cig)= 5,294.69 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mildred M. Bietsch Date of Death: 05/06/0003 Estate No. 2003-00456 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No_ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No_ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' court and may be attached to this re~ ' )..' _ I/' f.4--..---.- Hamilton C. Davis, Esquire P.O. Box 40 Shippensburg, P A 17257 (717) 532-5713 Date ~/1 /6fJ I I '.0 ':.:,~ I,,~ ,,_ Capacity: _ Personal Representative XX Counsel for Personal Representative J