HomeMy WebLinkAbout03-0505Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of John M. Adams
also known as
Nola Sanderson , Deceased
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
Social Secur~y No. 198-32- 9025
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix
the Decedent, dated 09/18/98 and codicil(s) dated None
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
-"] B. Grant of Letters of Administration
(c.ta.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
(COMPLETE IN ALL CASES:)
Decedent was domiciled at death in
Attach additional sheets if necessary.
Cumberland
Residence
County, Pennsylvania with his/her last family
PA
$ 3,750.00
(Location)
or principal residence at 108 Amy Drive, North Middleton Twnshp
(list street, number, and municipality)
Decedent, then 64 years of age, died 05/26 ,1903,at.Holy Spirit Hospital,
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
situated as follows:
to th._[e ~d:
~anderson, 105 Amy Drive
/~ 6~.~'/~F~_'~---'--~ IPineRidge Village, Carlisle,
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
~rinted name and residence
PA 17013
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law. ~
Sworn to or affirmed and subscribed
Nola Sanderson
before me this 20t~ay of
J1 ]n~. 1~ 2003
Donna M. Otto,lst Deputy
No.
Estate of John M. Adams
Social Security No: 198- 32- 9025
AND NOW, June 20th
21-2003-505
Deceased
Date of Death: 05/26/03
, ~ 20,~ consideration
of the Petition on the reverse side hereon, satisfactory proof having 1Seen presented before me,
IT IS DECREED that Letters [~] Testamentary r~ of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Nola Sanderson
in the above estate and that the instrument(s) dated 09/18/98
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
Donna M. Otto, 1st ~ty
Letters ...........
Short Certificate(s)..6... $ 18.00
Renunciation ........ $
Affidavits ( ) ....
Extra Pages ( _4 ) $ 12.00
Codicil ........... $
JCP Fee .......... $ 10.00
Telephone:
Esq.
Attorney: David J. Lenox,
i.D. No: 29078
The Wiley Group, P.C.
Address: 1 S. Ba~i~re~,tT.eet
~--~,.~ ur.. r~'~(' £0.
Dillsbur~, ?A 17019
717/432-;9666
Inventory .......... $
Other ........... $
TOTAL ......... $ 65.00 Mailed Letters
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
to Attorney on 6/20/03
Form RW-1
his is to certify that the information here given is correctly copied from an original certificate of death duly flied with me as
Local Registrar. The 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.
Fee fbr this certificate, $2.00
P 9283751
No.
Local Registrar
HAY 272003
Date
· ~10s.:~ .~. 2~7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
,T CERTIFICATE OF DEATH
( ,. John M. Adams ,.Make :,. 198
64 ~. : /8/1939 York, PA ,~
108 Amy DrZve ~u~ ,?~-. P~.+5~t,~nZ~
,,. rt~ur E. Adams I [,,. Marg B~m
~ NO~a L. ~an~rSon ]~ 105 Amg PrZve CartZs~, PA 17013
~ ' ~' ~' ~ I~.0115~L
~ I~, I~ u.
~ ~ ~ ~ . ~ ~ ~w..~ ulp~,~u ..............~.o~. I~~ '
,,,~ ......... - ...................... ' : ...................... o ,,.
21-2003-505
OF
JOHN M. ADAMS
BE IT REMEMBERED, that I, JOHN M. ADAMS, of
108Amy Drive, Carlisle, Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make,
publish and declare this as and for my Last Will and
Testament, hereby revoking and making null and void any
and all Wills and Testaments and writings in the nature
thereof by me, at any time heretofore made.
ITEM 1= I direct that all my just debts and
funeral expenses be paid as soon after my demise as may
be convenient.
ITEM 2: I specifically give and bequeath my red
Fender guitar and Fender amplifier to my sister, NOLA
SANDERSON.
ITEM 3: Ail the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate,
whether it be real, personal or mixed, including property
over which I have a power of appointment, I give, devise
and bequeath unto the following persons in the shares
designated:
a.
be
Ce
One-fourth
ADAMS.
(1/4) to my daughter, DAWN MARIE
One-fourth
WOLF.
One-fourth (1/4) to my sister, NOLA SANDERSON.
One-fourth (1/4) to my brother, ARTHUR E ADAMS,
II.
(1/4) to my daughter, DEBRA ANN
WITNESSl
-1-
SEAL )
~0HN M. ADAMS
The shares to my daughters shall be divided equally
among the issue per stirpes of any predeceased daughters.
The shares of my brother or sister shall be divided
equally between my daughters per stirpes in the event my
brother or sister shall predecease me.
ITEM 4: I direct my hereinafter named Executrix to
pay all inheritance, estate, succession and legacy taxes
of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise
passing by reason of my demise, and may be subject and to
charge such taxes against my residuary estate, it being
my intention that none of the aforesaid taxes, either
federal or state, on any property required to be included
in my gross estate, under the provisions of any state of
federal law now in force or hereafter enacted, shall be
prorated among the persons interested in my estate to
whom such property is or may be transferred or to whom
any benefit accrues.
ITEM 5: I appoint my sister, NOLA SANDERSON, as
Executrix of this my Last Will and Testament. Should my
sister, NOLA S]%NDERSON, predecease me, fail to qualify,
cease to act or renounce probate, I then appoint my
brother, ARTHUR E. ADAMS, II, as Contingent Executor of
this my Last Will and Testament.
ITEM 6: I direct that my Executrix, or her
successor shall not be required to give bond for the
faithful performance of their duties in any jurisdiction.
WITNESS
-2-
~ ~ ~ (SEAL)
J~HN M. ADAMS
ITEM 7: My Personal Representative shall have the
following powers in addition to those vested in them by
Law and by other provisions of this, my Last Will and
Testament, exercisable without court approval, and
effective until distribution of all property:
To retain any or all of the assets of my
estate, real or personal, without restriction
to investments authorized for Pennsylvania
fiduciaries, as they from time to time may deem
proper, without regard to any principal of
diversification or risk.
To invest in all forms of property without
restriction to investments authorized
for Pennsylvania fiduciaries, as they from
time to time may deed proper, without regard to
any principal of diversification or risk.
To sell at public or private sale, to exchange,
or to lease for any period of time, any real or
personal property and to give options for
sales, exchanges or leases, for such prices and
upon such terms or conditions as they from time
to time may deem proper.
To allocate receipts and expenses to principal
or income or partly to each as they from time
to time may deem proper.
To borrow money from persons or institutions,
themselves included, and to mortgage or
pledge any or all real or personal property
as they in their sole discretion shall chose,
without regard to the dispositive provisions of
this instrument.
To compromise any claim or controversy asserted
by or against my estate or trust estate.
To make distribution in cash or in kind or
partly in cash and partly in kind, and in such
manner as they may determine, and at valuations
finally to be fixed by them.
WITNESS:
J~HN M. ADAMS
( SEAL )
-3-
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this /,~ day of .~0 , 1998.
J ADAMS
-4-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
:
: SS
:
We, JOHN M. ADAMS, DAVID J. LENOX, ESQUIRE, and
JANICE E. YOCUM, the Testator and the witnesses
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator
signed and executed the instrument as his Last Will and
Testament and that he executed it as his free and
voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing
of the Testator, signed this Last Will and Testament as
witness and that to the best of their knowledge the
Testator was at the time eighteen (18) years of age or
older, of sound mind and under no constraint or undue
influence.
Sworn to and subscribed
before me this /~
WITNESS '
day of ~., 1998.
!
NOTARY PUBLICF
MY COMMISSION EXPIRES:
Notarial ~'r~. ~-~'i
S. Dawn Gladfelter, Notary Pubi c
Dillsburg Boro, York County
My Commission Expires M/y
Member, Pennsylva~ia
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: John M. Adams
Date of Death: May 26, 2003
Estate Number: 21-03-0505
To the Register:
I certify that notice of beneficial interest 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 13, 2003:
Sallie
Ad&ess
Nola Sanderson
Debra Ann Wolf Small
Dawn Marie Adams
Arthur E. Adams, II
108 Amy Drive, Carlisle, PA 17013
16 George St., Hanover, PA 17331
14 George St., Hanover, PA 17331
29 Butter Road, Dover, PA 17315
Notice has now been given to all persons entitled t~ N/A.
Date: August 13, 2003
Signa~u?e ~/ .,/
Name: David J. Lenox, Esquire
Address: One S. Baltimore St.
Dillsburg, PA 17019
Telephone: (717) 432-9666
Capacity: Counsel for personal Rep.
COMMONWEAL33.1 OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 171280601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFiCiAL USE ONLY
FILE NUMBER
21 03 00505
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Adams, John M. SOCIAL SECURITY NUMBER
198-32-9025
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE INITH THE
05/26/2003 02/08/1939 REGISTER OF WILLS
IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Oo
i
[] 1. OriginaI Return [] 2. Supplemental Retum
] 3. Remainder Return (date of death pdor to 12-13-82)
[]
[]
[]
David J Lenox
4. Limited Estate [] 4a. Future Interest Compromise (date of death after
12-12-82) [] 5. Federal Estate Tax Return Required
6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
of Will) copy of Trust) --
9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach SCh O)
:IRM NAME (If applicable)
The Wiley Group
r'ELEPHONE NUMBER
717/432-9666
1 S. Baltimore Street
Dillsburg, PA 17019
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
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
None
None;~
None
None
6,617.58
None
None
4,623.93
707.24
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USE ONLY
(8)
6,617.58
5,331.17
1,286.41
1,286.41
(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
643.21 x .045 (16)
643.20 x .12 (17)
x .15 (18)
(19)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
28.94
77.18
106.12
20. []
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Dec6dent's Complete Address:
ISTREET ADDRESS 108 Amy Drive
CITY Carlisle
STATE PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
ZIP
(1)
17013
106.12
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (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 the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5BI
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
106.12
106.12
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 ether 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 p~fia;[i=$ of perju~, I n~"Jere that I have ex~rfii.ed this return, including accofi~yanying 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 know~edge.
SIGNATURE OF PERSON RESPONSI~.E FOR FILING RETURN ADDRESS ! 05 Amy Drive
Nola Sa n de~j~n ~/
URE OF I~RSON REgPON~/I~'~E'FOffF[~-G RE'TORN ADDRESS Carlisle,'PA 170'] 3
DATE
SIGNATURE OF PREPARF~THER THAN~IREPRESENTATIVE ADDRESS DATE
David J Le~ [ y ,..7~ /' .
1 .S. Baltimore Street ~,/ff':~//~
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) (ii].
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.
OF
JOHN M. ADAMS
BE IT REMEMBERED, that I, JOHN M. ADAMS, of
108 Amy Drive, Carlisle, Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make,
publish and declare this as and for my Last Will and
Testament, hereby revoking and making null and void any
and all Wills and Testaments and writings in the nature
thereof by me, at any time heretofore made.
ITEM 1: I direct that all my just debts and
funeral expenses be paid as soon after my demise as may
be convenient.
ITEM 2: I specifically give and bequeath my red
Fender guitar and Fender amplifier to my sister, NOLA
SANDERSON.
ITEM 3: Ail the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate,
whether it be real, personal or mixed, including property
over which I have a power of.appointment, I give, devise
and bequeath unto the following persons in the shares
designated:
a. One-fourth (1/4) to my daughter, DAWN MARIE
ADAMS.
b. One-fourth (1/4) to my daughter, DEBRA ANN
WOLF.
c. One-fourth (1/4) to my sister, NOLA SANDERSON.
d. One-fourth (1/4) to my brother, ARTHUR E ADAMS,
II.
WITNESS!
-1-
(SEAL)
The shares to my daughters shall be divided equally
among the issue per stirpes of any predeceased daughters.
The shares of my brother or sister shall be divided
equally between my daughters per stirPes in the event my
brother or sister shall predecease me.
ITEM 4: I direct my hereinafter named Executrix to
pay all inheritance, estate, succession and legacy taxes
of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise
passing by reason of my demise, and may be subject and to
charge such taxes against my residuary estate, it being
my intention that none of the aforesaid taxes, either
federal or state, on any property required to be included
in my gross estate, under the provisions of any state of
federal law now in force or hereafter enacted, shall be
prorated among the persons interested in my estate to
whom such property is or may be transferred or to whom
any benefit accrues.
,ITEM 5: I appoint my sister, NOLA SANDERSON, as
Executrix of this my Last Will and Testament. Should my
sister, NOLA SANDERSON, predecease me, fail to qualify,
cease to act or renounce probate, I then appoint my
brother, ARTHUR E. ADAMS, II, as Contingent Executor of
this my Last Will and Testament.
ITEM 6: I direct that ~my Executrix, or her
successor shall not be required to give bond for the
faithful performance of their duties in any jurisdiction.
JOHN M. ADAMS
_ ( SEAL )
-2-
ITEM 7: My Personal Representative shall have the
following powers in addition to those vested in them by
Law and by other provisions of this, my Last Will and
Testament, exercisable without court approval, and
effective until distribution of all property:
1. To retain any or all of the assets of my
estate, real or personal, without restriction
to investments authorized for Pennsylvania
fiduciaries, as they from time to time may deem
proper, without regard to any principal of
diversification or risk.
2. To invest in all forms of property without
restriction to investments authorized
for Pennsylvania fiduciaries, as they from
.time to time may deed proper, without regard to
any principal of diversification or risk.
3. To sell at public or private sale, to exchange,
or to lease for any period of time, any real or
personal property and to give options for
sales, exchanges or leases, for such prices and
upon such terms or conditions as they from time
to time may deem proper.
4. To allocate receipts and expenses to principal
or income or partly to each as they from time
to time may deem proper.
5. To borrow money from persons or institutions,
themselves included, and to mortgage or
pledge any or all real or personal property
as they in their sole discretion shall chose,
without regard to the dispositive provisions of
this instrument.
6. To compromise any claim or controversy asserted
by or against my estate or trust estate.
7. To make distribution in cash or in kind or
partly in cash and partly in kind, and in such
manner as they may determine, and at valuations
finally to be fixed by them.
WITNESS
/',
r' -i~)
? ......
J~HN M. ADAMS
(SEAL)
-3-
IN WITNESS WHEREOF, I have hereunto set my hand and
~ea~ th~ /,~-'~;X da~ o~ ....... J~.,Z~,..Z~-~O ,~.
J ADAMS
-4-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
ss
We, JOHN M. ADAMS, DAVID J. LENOX, ESQUIRE, and
JANICE E. YOCUM, the Testator and the witnesses
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator
signed and executed the instrument as his Last Will and
Testament and that he executed it as his free and
voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing
of the Testator, signed this Last Will and Testament as
witness and that to the best of their knowledge the
Testator was at the time eighteen (18) years of age or
older, of sound mind and under no constraint or undue
influence.
Sworn to and subscribed
before me this /~
day of ~~-t~_, 1998.
!
NOTARY PUBLICF
MY COMMISSION EXPIRES:
COMMONWEALTH OF PENNSYLVANIA
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Adams, John M.
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
FILE NUMBER
21-03-00505
Include the .proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivomhlp must be disclosed on schedule F.
ITEM
NUMBER
I
2
3
4
5
6
7
8
9
PNC Bank Account No. 5000831819:
DESCRIPTION
Sale of Track:
PP&L Refund:
Comcast Refund:
Subscription Refund:
State Farm Insurance Refund:
Personal Property:
Sprint Refund:
Sale of 1976 Layton Mobile Home Seriel #02110879J:
VALUE AT DATE OF
DEATH
392.52
1,400.00
42.10
20.56
80.27
157.13
500.00
25.00
4,000.00
TOTAL (Also enter on Line 5, Recapitulation) 6,617.58
08/27/.20~3 13:23 17172433520
PNC CARLISLE
Page: 1 Document Name: untitled
~ STFD 1 THF TRANSACTION STATEMENT FORMAT 03/08/27 14.27.42
STMT CO 40 OP MS 50852 ACTION COMPLETE
ACTION PAGE 2 SEARCH FROM 03/05/02 THRU 03/06/26
5000831819
PROD CODE DDA ACCOUNT
ACTN POST EFPECTIVE
TRACE ID
__ * 05/07
027009032
· 05/09
024638732
_ + 05/14
H302651868
· 05/22
028336071 XMKT
~ * 05/28
SHORT NAME ADAMS JOHN M
CHEC~ NUMBER TRAN AMOUNT D/C
DESCRIPTION
1118 49.35 D
CHEC~ 1118 REFERENCE NO.' 027009032
]119 24.00 D
CHECK 1119 REFERENCE NO. 024638732
1.00
I-GEN103052800000420 CANCELLED CHECK RETURN FEE
1120 39.80 D
C~ECK 1120 REFERENCE NO, H302651868
1121 52.99 D
CHECK t121 KEFERENCE NO. 028336071 XMKT
D
BALANCE
510.31
486.31
446,51
393.52
392.52~
PAGE
02
COIvlMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Adams, John M. 21 - 03 - 00505
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Nola Sanderson
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 105 Amy Drive, Pine Ridge Village
City Carlisle State PA Zip 17013
Year(s) Commission paid 2003
Attorney's Fees Wiley, Lenox, Colgan, & MarzT_~3cco, P.C.:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills:
State Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
The Carlisle Sentinel (advertise estate):
Cumberland Law Journal ( advertise estate):
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
1,500.00
2,000.00
65.00
102.11
75.00
881.82
4,623.93
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
4
5
6
7
8
9
ScheduleH
Adams, John M.
Nola Sanderson (reimbursement for repairs to decedent's mobile home):
Pine Ridge Village (July Lot Rent):
Robin Sollenberger, tax Collector:
The Sentinel (advertise mobile home for sale):
Comcast Cable (advertise mobile home for sale):
Register of Wills (filing fee):
National Integreted Group (return pension check):
FILE NUMBER
21 03-00505
180.00
334.00
109.14
41.72
30.00
25.00
161.96
Page 2 of Schedule H
COMMONWEAL'R-I OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Adams, John M.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
21 - 03 - 00505
Include unreimbumed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
DESCRIPTION
SICO Company (balance of heating budget plan):
PP&L:
Sprint (phone):
Holy Spirit Hospital:
State Farm Insurance (homeowners):
Checks written bom decedent's account - not cleared as of date of death:
AMOUNT
202.51
42.10
72.53
41.34
108.62
240.14
, TOTAL (Also enter on Line 10, Recapitulation) 707.24
REV-1513 F.~+ (9.O0)- ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Adams, John M.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 - 03 - 00505
NUMBEF
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Nola Sanderson
105 Amy Drive
Carlisle, PA 17013
Debra Ann Wolf Small
16 George St.
Hanover, PA 17331
Dawn Marie Adams
14 George St.
Hanover, PA 17331
Arthur E. Adams, II
29 Butter Road
Dover, PA 17315
RELATIONSHIP TO
DECEDENT
Dc* Not I lit
sister
flaughter
daughter
brother
AMOUNTORSHARE
OF ESTATE
one-fourth
one-fourth
one-fourth
one-fourth
5 through 18, as appropriate, on Rev 1500 cover sheet/
~?&OUJ&D'STR'BUT ONS UNDER SECT,ON 011~OR w.,c. AN ELECT,ON TO T~,S NOT
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Adams, John M.
also known as
No. 21 -03 - 00505
Date of Death 5/26/2003
, Deceased Social Security No. 198-32-9025
Nola Sanderson
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney: David J Lenox
I.D. No.: 29078
Personal RepresentatiYe.
Signature:
v,o~a ~anoerson
Signature:
Address:
1 S. Baltimore Street
Dillsburg, Pa 17019
Telephone: 717/432-9666
personal Property
Signature:
Address:
105 Amy Drive
Pine Ridge Village
Carlisle, PA 17013
Telephone: 717-243-5735
Dated:
PNC Bank Account No. 5000831819:
Sale of Truck:
PP&L Refund:
Comcast Refund:
Subscription Refund:
State Farm Insurance Refund:
Personal Property:
Sprint Refund:
Sale of 1976 Layton Mobile Home Seriel #02110879J:
392.52
1,400.00
42.10
20.56
80.27
157.13
500.00
25.00
4,000.00
Total Personal Property
$6,617.58
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$6,617.58
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 002961
........ fold
LENOX DAVID J ESQUIRE
THE WILEY GROUP
1 SOUTH BALTIMORE STREET
DILLSBURG, PA 17019
ESTATE INFORMATION: SSN: 198-32-9025
FILE NUMBER: 2103-0505
DECEDENT NAME: ADAMS JOHN M
DATE OF PAYMENT: 08/29/2003
POSTMARK DATE: 08/29/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 05/26/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $106.12
REMARKS:
TOTAL AMOUNT PAID:
DAVID J LENOX TAX PAYMENT
HAND DELIVERY ON 8/29/2003
$106.12
SEAL
CHECK# 1382
INITIALS: SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
STATUS REPORT UNDER RULE 6.17
Name of Decedent:
Date of Death: ..~!
Will No. ,-~l --O_q -
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes v-" No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
c. Did th~v~rsonal representative state an account informally to the parties in
interest? Yes 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 report.
Date:..
Signature/ ~/ ~' -
Name (Please type or Iprint) ~' -
Add~s .~.., ~~ ~ [~
('n~)
Tel. No.
Capacity:
Personal Representative
. y"' Counsel for personal
representative
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 180601
HARRXSBURg, PA 17128-0601
COMHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRAISEMENT, ALLOHANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DAVID d LENOX
THE WILEY GROUP
I S BALTIMORE ST
DILLSBURG PA 17019
REV-].Sd7 EX AFP (01-05)
DATE 10-13-2003
ESTATE OF ADAMS JOHN
DATE OF DEATH 05-26-2003
FILE NUHBER 21 03-0505
COUNTY CUMBERLAND
ACN 101
~, Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV'l$47 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
ESTATE OF ADAMS
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN MFZLE NO. 21 03-0505 ACM 101
DATE 10-13-2003
TAX RETURN HAS: (X) ACCEPTED AS FILED
RESERVATTON CONCERNZNG FUTURE TNTEREST - SEE REVERSE
( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedu/a A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Receivable (Schedule D) (q)
$. Cash/Dank Deposits/Misc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tote! Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funera! Expenses/Ads. Costs/M/sc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)_.
11. Total Deduct/ohs
12. Nat Value of Tax Return
6~617.58
.00
.00 NOTE: To insure proper
.00 cred/t to your account,
.00 sube/t the upper portion
.00 of th/s form w/th your
tax payment.
.0O
(8)
q,623.93
13.
NOTE:
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of L/ne lq at S/blLng rata
18. Amount of L/ne lq taxable at Collateral/Class B rata
19. Pr/ncipel Tax Due
tAX CREDITS:
PAYHENT / RECETPT
DATE NUMBER
08-29-2003 CD002961
707 .Iq
(11)
6,617.58
5.331.17
1,286.ql
AMOUNT PAID
106.12
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
106.12
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.)
DISCOUNT
INTEREST/PEN PAID (-)
(15) .00 x O0 = .00
(16) 6q3.21 x Oq5 = 28.9q
(17) 6q3.20 x 12 = 77.18
(la) .00 x 15 = .00
(19)= 106.12
(12)
Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
Nat Value of Estate Subject to Tax (lq) 1,286.~1
Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of .ALL returns assessed to data.
RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transfarrad
in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
1ifa or for years, the Coaacnaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class S (collataral) rata on any such futura interest.
PURPOSE OF
NOTICE: To ~ulfi11 the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (TZ P.S.
Section 9140).
PAYNENT: Detach tho top portion of this Notice and submit aith your payment to the Ragtstar of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-131S). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-$020 (TT only).
OBJECTIONS: Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZI, Harrisburg, PA 171ZB-10ZI, OR
--election to have the ;attar determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADHIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. ZB0601, Harrisburg, PA 171ZB-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount of
the tax paid is allowed.
PENALTY: The lSZ tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 19aZ will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor.. Yea.~r Rate Factor Yaa.~r Rate Factor
1982 ZOZ .000548 1987 9X .000Z47 1999 7Z .OOOlgZ
1983 16Z .000458 1988-1991 llZ .000301 ZOO0 8Z .O00Z19
1984 IZZ .000301 199Z 9Z .000Z47 ZOO1 9Z .000Z47
1985 132 .000356 1993-1994 7Z .O00IgZ ZOOZ 6X .000164
1986 IOZ .000274 1995-1998 92 .000247 2003 5Z .000137
--Interest is calculated as follows;
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after tho tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond tho date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.