HomeMy WebLinkAbout03-0778PETITION FOR PROBATE & GRANT OF LETTERS
Estate of ELLA LORENE CULBERTSON
also known as
, deceased.
Social Security No. 202-20-5259
No. 21-03- 77 8
To: Rogister of Wills for tho
County of Cumberland
Commonwealth of Pennsylvania
The Petition of the undersigned respectfully represents that:
Your Petitioners, who are 18 years of age or older and the Co-Executors named in the Last Will of the
above decedent dated January 6, 1983 , and codicils dated none . The Executor
named Forrest G. Culbertson died November 2, 1989 Renunciations for none
attached hereto.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal
residence at 801 North Hanover Stree{, Carlisle Borough
Decedent, then 95 years of age, died
North Hanover Street, Carlisle
July9 , 2003, at
the Church of God Home, 801
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decedent at death owned properly with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in PA
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania, situated as follows:
$40,000.00
$
WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented
herewith and the grant of letters testamentary thereon.
Signature(s) and Residence(s) of Petitioner(s):
Max E. Gulbertson
1212 Forqe Road
Carlisle, PA 17013
717-243-4598
Shirley Ar~ Blakeslee
7 East Countryside Drive
Boiling Sprin.qs, PA 17007
717-258-6947
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND ·
SS
The Petitioners above named swear or affirm that the statements in the foregoing petition are true and
correct to the best of the knowledge and belief of Petitioners and that as personal representative of the above
decedent, Petitioners will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~ ~ ~_.. ~
before me this 25th day of Vrv~x E. Culbertson
~.~_tember ,200.3.. ,d
Donna ~. Otto,1;t Depu~tY R;gist~,'Yf~.~t
No. 21-03- ??8-
Estate of
ELLA LORENE CULBERTSON , deceased.
DECREE OF PROBATE & GRANT OF LETTERS
AND NOW, September 26th ,2003, 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 January 6, 1983 described therein be admitted to probate and filed of record as the
Last Will of Ella Lorene Culbertson ; and Letters Testamentary are hereby
granted to Max E. Culbertson and Shirley Ann Blakeslee
FEES
Probate, Letters, Etc ........ $ 80.00
Short Certificates (-2- ) .... $ 6.00
Renunciation(s) ........... $
JCP .................... $10.00
Other Will pares (-2-) .... $.6.00
TOTAL: .... $102.00
Filed. Septea~o~_~ .26th, 2003 .......
Call Attorney on 9/26/2003
DOnna M. Ot to ,R~'~t~ / ~
IRWIN McKNIGHT & HUGHES
Marcus A. McKni,qht III, Esq. (25476)
ATTORNEY (Sup. Ct. I.D. No.)
60 West Pomfret St., Carlisle, PA 17013
ADDRESS
717-249-2353
PHONE
21-2003-778~
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat
request of testat__
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19
, sign the same and that signed as a witness at the
in h presence and (in the presence of each other) (in the presence of the
Register
(Name)
(Address)
(Name)
(Address)
21-2003-778
REGISTER OF WILLS OF CU~EgU~m COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Marcus A. McKnight III -and- Gary Blakeslee ,
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are familiar with the signature of Ella Lorene Culbertson ,
testat rix of (~m~x~f~h~xx~laacxitm~x~Rn~mm~ma) the will presented herewith and
that each believes the signature on the will is in the handwriting of
Ella Lorene Culbertson
to the best of
Sworn to or affirmed and subscribed before
me this 25th day of
^
Donna M. O~0, ist D~pu~y~ ~- f t Regis~
their knowledge and belief.~~
60 W. Pomfret St.. Carlisle; PA
(Address)
(Name)
17013
7 E. Countryside Dr., Boiling Springs PA 17007
(Address)
LAST WILL AND TESTA~AENT
I, ELLA LnRENE CLtLBERTSON, of Centre Township, Perry County~
Pennsylvania, being oF sound and disoosin.o mind and memory, do
hereby declare this to be my last will and testament; revoking all
Former wills by me at any time heretofore made,
FIRST: I direct my hereinafter named executor, or alternate
executor and executrix, as the case may be, fo Day all of my just
debts, Funeral expenses, inheritance taxes and costs oF administration
of my estate as soon after my decease as it is practical fo do so,
SECOND: In the event my husband~ Forrest G, Culbertson survives
my decease, then and in that event I give, devise and bequeath all
o~ my proDerty~ real, pers,~nal and mixed and wheresoever situate
unto my aforesaid husband fo be his absolutely.
THIRD: In the event my husband~ Forrest G. Cuibertson ore-
deceases me, or in the event oF our simultaneous decease as the result
o¢ a common disaster, then and in that event I dispose nf my estate
as ~oI lows:
(a) I give and bequeath to my son~ /~ax E.Culbertson my
gun cabinet foqether with all ri~les, shot guns, Fire arms oF any
nature and hunf in~ equipment to be his absolutely.
(b) I give and bequeath to my three children, Rebecca Arlene
Blumenschein, ~ax E. Culbertson and Shirley Ann Blakesslee all oF
my household Furnishings to be divided between them as nearly equal
as they are aL}le tc do so. Any items oF household Furnishings which
they do not desire fo keep may be sold and the net proceeds derived
~rom the sale fhereo¢ shall be divided between them in eaual shares.
(c) I direct that all the rest, residue and remainder
my estate, both reel 8nd pers~,nal property, be sold at either public
or orivafe sale, whichever in the opinion oF my alternate executor
and executrix sbal I be ~or the best interest o¢ my esfafe~ and, aefer
the payment o¢ the items sst ¢orfh in Paragraph First above, my
remainino net estate shall be divided equally between my three children¢
namely, Rebecca Arlene Blumenschein, t~ax E. Culberfson and Shirley Ann
Blakesslee.
FOURTH: ! name, constitute and appoint my husband, Forresf G.
Culberfson as the executor o~ this my last will and testament. In
the event my husband predeceases me, or in the event o~ our simultaneous
decease as the result o¢ a common disasfer~ then and in fhaf event
! name~ constitute and appoint my son, f&ax E. Culberfson and my younger
daughter, Shirley Ann Blakesslee as joint executor and executrix o~
this my last wilt and testament. Said joint ex~'~cufor and executrix
are authorized and emeowered fo sell any real estate which I may own
af the time o¢ my decease, af either eublic or p~-ivafe sale, and fo
make, execufe~ acknowledge and deliver a good and valid deed fo the
purchaser or purchasers fhereo¢. Neither my execufor~ nor alternate
ex :cufor and executrix shall be required fo give bond in order fo
serve in this ~iduciary capacity.
IN Vt ITNESS WHEREOF~ I have hereunto set my hand and seal fo
this my last wi II and testament this ~fh day o~ January,
~ [:),~ 4~ ~,
-2-
Signed, sealed, published and declared by Ella Lorene Culberfson,
the above named testatrix as and for her last wi II and testament in
our presence, whop af her request, in her presence, and in the presence
oF each ofher~ have subscribed our names as affesfinq witnesses.
-3-
LAST WILL AND TFSTA/~AENT
OF
ELLA LORENE CULBERTSON
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Estate No.:
ELLA L. CULBERTSON
JULY 9, 2003
21-03-0778
To the Register:
I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on October 8, 2003 .
Name Address
Shirley A. Blakesslee
Max E. Culbertson
Linda A. Wiles
7 E. Countryside Drive, Boiling Springs, PA 17007
1212 Forge Road, Carlisle, PA 17013
206 Greenbriar Road, Elliottsburg, PA 17024
Connie Snyder
David E. Blumenschein
Gary Blumenschein
Donald Blumenschein
RR 2 Box 4C, Landisburg, PA 17040
RR 1 Box 127, Landisburg, PA 17040
7 Greenbriar Road, Elliottsburg, PA 17024
RR 3 Box 1124, New Bloomfield, PA 17068
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none:
Date: 10/08/03 ~~' ~~'~ \~'~ '~--~,
..... IRWIN & McKNIGHT ~
Name Marcus A. McKnight III, Esquire
Address 60 West Pomfret Street
Carlisle, PA 17013
Telephone (717) 249-2353
Capacity:
X
__ Personal Representative
__ 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 003095
IRWIN MCKNIGHT & HUGHES
ROGER B IRWIN ESQUIRE
60 WEST POMFRET STREET
CARLISLE, PA 17013
ESTATE INFORMATION: SSN: 202-20-5259
FILE NUMBER: 2103-0778
DECEDENT NAME: CULBERTSON ELLA LORENE
DATE OF PAYMENT: 10/09/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~1,767.19
TOTAL AMOUNT PAID'
~1,767.19
REMARKS' IRWIN MCKNIGHT&HUGHES
C/O ROGER B IRWIN ESQUIRE
SEAL
CHECK# O2033O
INITIALS: SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX DZV/SZON
DEPT. 280601
HARRISBURG, PA 17128-0601
COMHONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-1G,~7 EX AFP (01-03)
MARCUS A MCKNISHT ESQ
IRWIN & MCKNIGHT
60 W POMFRET ST ~
CARLISLE PA 17015~
DATE 12-15-2005
ESTATE OF CULBERTSON
DATE OF DEATH 07-09-2005
FILE NUMBER 21 05-0778
COUNTY CUMBERLAND
ACN 101
Amoun*{: Rem/4:'l:ad
ELLA L
MAKE CHECK PAYABLE AND REHZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS L/NE ~,~ RETAIN LONER PORT/ON FOR YOUR RECORDS ~
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CULBERTSON ELLA L FXLE NO. 21 05-0778 ACN 101 DATE 12-15-2005
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE ]:NTEREST - SEE REVERSE
APPRAXSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B)
$. Closely Held S~ock/Par~nership /n~eres~ (Schedule C)
4. Not,gages~No,es Rece/vable (Schedule D) (4)
5. Cash/Bank Depos/~s/H/sc. Personal Propar~y (Schedule E)
6. Jo/n~ly Owned Proper~y (Schedule F) {6)
7. Transfers (Schedule G) (7)
8. To~el Asse~s
APPROVED DEDUCTIONS AND EXENPTIONS:
9. Funeral Expansas/Adm. Cos~s/N/sc. Expenses (Schedule H) (9)
10. Debts/Hot,gage L/ab/1/~/ss/L/ans (Schedule Z) (10)
11. To,al Deduc~/ons
12. Ne~ Value of Tax Re~urn
15.
14.
Char/~abla/Governaen~al Bequests; Non-elected 9115 Trusts (Schedule J)
Ne~ Value of Es~a~e SubSec~ ~o Tax
.00
~$/755.87
.00
.00
.00 NOTE: To /nsure proper
.00 cradi~ ~o your account,
.00 submi~ ~he upper por~/on
of ~h/s form w/~h your
~ax payment.
(8)
2,~12.00
6.00
NOTE:
~$,755.87
(11) 2.418. oo
(la) ~1,337.87
(is) . O0
(14) c~1,337.87
Zf an assessment was lssued previously, lines 1~, 15 and/or 16, 17,
reflect figures that lnclude the total of ALL returns assessed to date.
18 and 19 will
(is) .00 x O0 = .00
(16) ~1,$$7.87 x 0~5 = 1,860.20
(27) .00 x 12 = .00
(28) .00 x 15 = .00
(19)= 1,860.20
ASSESSMENT OF TAX:
15. Aaoun~ of L/ne lq a~ Spousal ra~e
16. Aeoun~ of L/ne 14 ~axabla a~ Lineal~Class A ra~e
17. Amoun~ of L/ne 14 a~ S/bl/ng ra~e
18. Amoun~ of L/ne 14 ~axable a~ Collateral/Class B ra~e
19. Princ/pal Tax Due
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-)
10-09-2005 CD005095 95.01
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULAT/ON OF ADD/TZONAL INTEREST.
ANOUNT PAID
1,767.19
TOTAL TAX CREDIT 1,860.20
BALANCE OF TAX DUEI .00
XNTEREST AND PEN. .00
TOTAL DUE .00
TOTAL DUE ZS LESS THAN $1, NO PAYHENT 1S REQUIRED.
TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
HOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decadents dying on or before December 11, 19BI -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (coIlatmraI) beneficiaries of the decedent after the expiration of any estate for
life or for years, the CoeeonNealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawfu! Class D (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILES, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Nills, any of the Z$ Revenue District Offices, or by calling the special Iq-hour
answering service for forms ordering: 1-800-361-Z050; services for taxpayers aith special hearing and / or
speaking needs: 1-B00-~7-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17128-1011,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 1711D-0601
Phone (717) 787-6SOS. Ssa page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is alIowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January ID, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January l, 198Z 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 19aZ through Z003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1981 ZOZ .goose8 1987 9Z .0001~7 1999 7Z .OOO19Z
1983 161 .000~38 1988-1991 111 .000301 2000 81 .000119
198q 11Z .000301 1991 91 .0002~7 2001 91 .000147
1985 132 .000S56 1993-199q 72 .000192 2002 62 .O0016q
1986 IOZ ,000174 1995-1998 91 .0001~7 2003 SZ .000157
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPA/D
X NUNBER OF DAYS DELINQUENT
X DAILY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bm calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
ELLA L. CULBERTSON
Date of Death:
JULY 9, 2003
No. 21-03-0778
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: X Yes __ No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
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? X Yes No
do
Date: 2/9/04
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the C19rk of Orphan's tEourt and may be
attached to this report. /f ..-, /~ ]
Signa~e -~'~ ~' ~
~W~ & Mc~
M~cus A. Mc~ight IH, Esquire
Nme (please type or print)
60 West Pomfret Street
Address
C~lisle, PA 17013
City, State, Zip
(717) 249-2353
Telephone Number
Capacity:
X
Personal Representative
Counsel for Personal Representative
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,3
OFFICIAL USE ONLY
FILE NUMBER
21-03-0778
COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Culbertson Ella L.
DATE OF DEATH (MM~ DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
07/09/2003 I 05/18/1908
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Original Return ~ 247! Supplemental Return
4. Limited Estate . Future Interest Compromise (date of death after 12:- 12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
[~9. Litigation Proceeds Received [__J Spousal Poverty Credit
10.
(date of death between 12-31-91 and 1 - 1-95)
SOCIAL SECURITY NUMBER
202-20-5259
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(d.ate.of ~d~e a~t _h
3. Remainder Return pnorm
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
r-.-] Election to tax under Sec. 9113(A)
1
1.
(Attach Sch O)
NAME
Marcus A. McKnight Esq.
FIRM NAME (if Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717/249- 2353
COMPLETE MAI LING ADDRESS
60 West Pomfret Street
West Pomfret Professional Bldg. ~!
Carlisle, PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole -Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
r--] 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)
13.
14.
None
None
None
None
43,755.87
None
None
2,412.00
6.00
OFFICIAL USE ONLY
(8) 43,755.87
(11) 2,418.00
(12) 41,337.87
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13).
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13) (14)
41,337.87
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 41,337.87 X .045 (16)
17. Amount of Line 14 taxable at sibling rate X .12 (17)
18. Amount of Line 14 taxable at collateral rate X .15 (18).
19. Tax Due (19)
0.00
1,860.20
0.00
0.00
1,860.20
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
801 North Hanover Street
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable D. Interest
E. Penalty
STATE I ZIP
?A 17013
(1) 1,860.2
93.01
TotalCredits(A+B+C) (2)
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
Ii. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................... [] E~]
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? ............ .................... J'--1 []
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? ............ ' .................... J J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
93.01
0.00
0.00
1,767.19
0.00
1,767.19
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.
SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN Max E. Culbertson DATJ[
..... ~ ~ 1212 For~e Road . I-A I~,~
SIGNATURE~EgARER~ER~HA~R~ESENTATIVE IRWIN & Mc~IG~ bA~
_/ /~..//I ~/~/ 60 West Pomfret Street ~
/ 1 ...........................
For dates of death~ or a~er Ju~ 19~ and before Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for t~
e
u
se
o
f
t
he
pou e
For dates of doath ~er ~, 1 ~$, the tax rato impos,d on the net valu~ of transf*m to or for the us~ of tho survivin~ spous*
[72 ~.S. ~1 lfi (a) (l~ii~stat~o do~s not ex~mpt a transfor to a survMn~ spouso from tax. and th, statuto~ requkemonts for disclosuro
and fHin~ a tax fotura am still applicabl~ ,yen if th* survivin~ spouso is the on~ bon,ficia~.
For datos of do~th on or a~or Jul~ 1, 2000:
Tho tax rat~ imposod on the net value of transf,rs from a docoasod child twonty-one ~oars of a~o or ~oun~or at death to or for the use of a natural
paront, an adoptiw parent, or a stepparent o[ the child is 0% [72 ~.S. ~1 lfi (a) (1.2)].
The ta~ rato imposed on the net value of transfors to or for the use of the doc~dont's lineal beneficiarios is 4.5%, oxcopt as noted in 72 ~.S. ~115(~.2)
lhe tax rato imposed on tho net valuo o~ transfers to or [or the use o~ the docodont's siblings is 12% [72 ~.S. O115(a)(1.3)]. ~ siblin~ is dofinod, undor
Section ~102, as an individual who has at Ioast one parent in common with the decodont, wh~thor b~ blood or adoption.
Copyright (c) 2000 form software only T he Lackner Group, Inc. Form R~V- 1
ADDITIONAL Personal Representatives
Estate of Ella L. Culbertson SS# 202-20-5259 07/09/2003
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.
Signature
NsJne
Address Line 1
Address Line 2
City, State, Zip
Date
Shirley A. Blakesslee
7 E. Countryside Dr
PA 17007
REV-1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella L. Culbertson SS# 202-20-5259 07/09/2003 21-03-0778
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
-investment account
1
2
3
American Express Financial Advisors
PNC Bank NA - checking account
Church of God Home, refund
30,460.24
11,065.29
2,230.34
TOTAL (Also enter on line 5, Recapitulation) $ 43,755.87
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97)
REV- 1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella L. Culbertson SS~/ 202-20-5259 07/09/2003 21-03-0778
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
2
3
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney's Fees IRWIN & McKNIGHT
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State Zip
notice publication
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal estate
Register of Wills filing fee
The Sentinel - Legal - estate notice publication
2,100. O0
102.00
75.00
25.00
110.00
TOTAL (Also enter on line 9, Recapitulation) $ 2,412.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1511 EX (Rev. 1-97)
REV-1512 EX + (1-97/
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella L. Culbertson SS~/ 202-20-5259 07/09/2003 21-03-0778
Include unreimbursed medical exl~enses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Brockie Pharmatech 6. O0
TOTAL (Also enter on line 10, Recapitulation) $ 6.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-151Z EX (Rev. 1-97)
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ella L. Culbertson SS~/
NUMBER
4
5
II.
SCHEDULE J
BENEFICIARIES
202-20-5259 07/09/2003
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright s~u~l distributions, and
transfers under Sec. 9116~(1.Z)]
Shirley A. Blakesslee
7 E. Countryside Drive
Boiling Springs, PA 17007
David E. Blumenschein
RR 1 Box 127
Landisburg, PA 17040
Donald Blumenschein
RR 3 Box 1124
New Bloomfield, PA
17068
Gary Blumenshein
7 Greenbriar Road
Elliottsburg, PA
17024
Max E. Culbertson
1212 Forge Road
Carlisle, PA 17013
Continued . j.
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-03-0778
AMOUNT OR SHARE
OF ESTATE
Daughter
Grandson
Grandson
Grandson
Son
1/3 interest
1/15th
interest
1/15 interest
1/15 interest
1/3 interest
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
Estate of: Ella L. Culbertson
Soc Sec #: 202-20-5259
Date of Death: 07/09/2003
Continuation of Schedule J, Part I
(Taxable Bequests)
Item
Name and Address of Beneficiary
Relationship
Amount or
Share of Estate
6
7
Connie Snyder
RR 2 Box 4C
Landisburg, PA
17040
Linda A. Wiles
206 Greenbriar Road
Elliottsburg, PA 17024
Granddaughter
Granddaughter
1/15 interest
1/15 interest
~ '7 I t
deceases me , .:~ ;~,, tg~:,., even~. :~, '~u] s~mulf
~;..:n ,::?binet tT:,,etXe: ,~,r, th :: ! I r if les,
':? ~t,-:~:cscne in~ ,,Y~>: 7.. C~.:l~ertsTn :,~n:1
n~e]y, :R~:s. ecc~ ~,rlene ~Jumensc~eJn, ~ex ~:. Su~ber~san ~n~ Shirley
" ' and fo
~'. ~ . i .~ ',,'~T .,. ,
FROM :-AMERICAN EXPRESS FINANCIAL ADU PHONE NO. : ?17 975 2700 Sep. 22 2003 10:14AM P2
I'-'!'" ~ .~ Suzanne Lunemann
~ .... 09116/2003 11:27 AM
To:
cc:
Subject:
Roger A Place/Field/WH/AEFA~AMEX
ELLA L CULBERTSON'
September 16, 2003
ROGER, ALLAN PLACE
342 NOR:I'I;I I~OMT. ~T-REET
SUITE 201
WORMLEYSBURG, PA 17043-1112
Dear ROGER Ar.r &N PLACE:
Thank yrm for~.~-'~-~ ,.-~'~,,~.ui~ regardiz~ ]~.LLA L CULBERTSO'N'e m::coun~. The..~,c arc ~ v~uc~
Mutual Funds
Account_l~l~ .Total Value # of ~h~ Asset Vslue Per Share
01127986705 2 002 $10031.$8 2036267 4.V20
01437986705 5 002 . $6740.31 83&347 8.040
~Number Total Value
Ub3U1UI6575 9 00! $13688.35
Asset Value Pcr Sham
The date of death values provided are for esta~ tax purposes and are not a value to be paid. Accounts may be
~a.thjec! tn ~m~r~t flrl~ni-,Hn'n ~ governed by ~'~eh produot. Ploooo noto ~t t~, volu~, htdi~,~u.~tl £uz ally ~
Insurance product(s) reflect t~e gros~ dead~ benefit at date of death, not the cash value.
We appreciate the opportuaity to be of service to you, Please comact us if you have any questions.
Sh~.~rely,
Suzanne Lunem~.
Death Seitienamts Processing Team
703 I0 AXP Financial Center
Min-eapoli~ MN 55474
888-723-8476, option 1, 3, !
PN CBAN(
October8,2003
Marcus A. McKuight RI
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 17013-3222
Estate of Ella L. Oulbertson, deceas~
SSN: 202-20-5259
DOD: 7/9/2003
De. ar Mr. McKnight:
In response to your request for Date of Death balances for.the customer noted above, our
records show the following:
Checking Account
Account #5140354962
ELLA LORENE CULBERTSON
DOD balance: $11,064.50 + $,79 accrued interest
Interest Paid 1/1/2003 - 7/9/2003 - $7.85
Established 03/23/1989
Please note that thi__q office only provides date of death balances for deposit accounts
(fflAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statements. If you need assistance with any of these items,
please call I-8$8-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
01°~C¢.
Sincerely,
Rachelle Wells
1-800-76~--1775
P7-PF$C-04-F
500 first Ave.
Pittsburgh PA 152
Member FDIC
TOTAL P.01
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Nix E. CULBF_.RTSON & SHIltL~ A. BLAKESSLEE
being duly sworn according fo law, deposes and says that l~e y are the Co-Executors
of the Estate of Ella L. Culbertson
late of Carlis~e~r_B°_r0ugh ...... Cumberland County, Pa., deceased end fhet fha
within is an inventory made by them , the sald Co-Executors
of the entire estate of said decedent, consisting of all the personal property and real estate, except reel estate outside
the Commonweel*h of Penn,sylvania, end fhef the figures opposite each item of the Inventory represent it's feir value
as of the date of decedents death. ~ , ~~~~
Ma~. Culbertson, Execu~r
Sworn J \ and subscrib~
./
I ~ Bom, ~~ ~n~
J ~~ ~g. 14,~7
Date o~ Dea~
cu+or - A%w.W~FeY~xx Blakesslee
1212 Forge Road, Carlisle, PA 17013
7 E. Countryside Drive. Boiling Springs.
Addras, PA 17007
2003
Day Month Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
0
-0
~ tO
Inventory of the real and personal estate of
ELlA L. CULBERTSON
deceased
American Express Financial Advisors, investment account
PNC Bank NA, checking account
Church of God Home, refund
TOTAL:
$30,46( 24
11,06! 29
2,23(i.34
$43,75~,.87