HomeMy WebLinkAbout04-0871REV-346 EX (8-92)
PA DEPARTMENT OF REVENUE
FOR REGISTER'S OFFICE USE ONLY
County Code
Year
File Number
ESTATE INFORMATION SHEET
DECEDENT INFORMATION: Enter data as it will appear on ail documents submitted to the department.
I Name (Last) (First) (Middle)
I Docedent's Social Security Number IDate of Death IDate °f Birth
TYPE FILING: Enter check (~') mark to indicate the nature of the return to be filed wit, h the department.
[] Probate Return [~Joint Assets Only [] Estate Tax Only [] Litigation Purposes (No Other Assets)
Enter check (~') mark to indicate the nature of the proceedings at the Register of Wills
LETTERS GRANTED: Office. (Attach additional sheets if explanation is necessary.)
~] Testamentary []Administration [--'] No Letters [] Other (Please Explain)
ATTORNEY/CORRESPONDENT Enter all data concerning the attorney or other individual to receive all
INFORMATION: tax information and correspondence.
Name (Last) (First) (Middle) ~p~,eme Court I.D. #
z
Street Address
State Zip Code ' T~l~phone Number
PERSONAL REPRESENTATIVE
INFORMATION:
Enter all data concerning the personaLreprese.~.ative(~)
of
the
estate
authorized by the Register of Wills ::: '
Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
Street Address
State Zip Code Telephone Number
City ~// ~' J,i/I ,/~"IA/ G 5 ?'Z /,V A/ /o,,~ / 7 ~ ?.?. 71'7- ~ ~/ ?- ~, Y~.5''
Co-Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
I I
Street Address
City
State Zip Code Telephone Number
Co-Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
~treet Address
City State Zip Code ITelephone Number
PreparedB~ ~,, .~~.j~/._~-- Date
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~7~a, cla.~ ~.. 7]ia,~S~,,'! No.
also known as 7~'-~ ~-~/t~ ~7~n,~l To:
Deceased.
Social Security No. ~'71- St'- o°ff~''
Register of Wills for the
County of ~ttn,/,e.r-/~n~
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut ~'&
in the last will of the above decedent, dated
and codicil(s) dated
in the
named
,
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C~m~r~d county, Pennsylvania., with
h ;~ last family or principal residence at
(list street, number and muncipality)
Decendent, thep ~',~ , years of age, eli.ed 2 ~'e-~/~' /~' ' ~.,,~tgtg~ ,
Except ~s followS, decedent did not marry, was not divorced a'nd did not have- a cfiild borl~r adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent 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
sitj~ated as follows:
$
WHEREFORE, petitioner(s) respectfully rqquest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
,,q/,//Y,,¢ 7-'A,'am,,osa, q/
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF E/~
Thc petitioner(s) above-named swear(s) or affirm(s) that thc statements in thc foregoing petition arc
truc and correct to thc best of the knowledge and belief of petitioner(s) and that as personal represcn-
tativc(s) of thc above decedent petitioner(s) will well and truly administer thc estate according to law.
Sworn to or affirmed a~ subscribed {
before me this . c-~.'~re davy _o~f~
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being ~d-01~:qualified~ ~ . accordi.~ng to
law, depose(s) and say(s) that ~ !i; ~. resentiand saw
the testat
request of testat
other subscribing witness(es)).
signed
witness
at
the
, sign the same and that· a~
in h presence and (in the presence of each ot~er) (in th~resence of the
i..
Sworn to or affirmed and subscribed before Y
me this day of (Name)
Register
(Address)
(Name)
(Address)
REGISTER OF WILLS OF ~//t/~-~_~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
~ a subscriber hereto,-x%~--l~being duly qualified according to law, depose(s) and say(s) that
.~tt/~- /~ familiar with the signature of ~',~'/J~' ~5~ ,~J/~,~p',~,/,q/
testat~P of (ox~dr--~ae--s-~~o) the will presented herewith and
codicil
that ~',~r~: believes the signature on the will is in the handwriting of
to the best of /'/R knowledge and belief.
Sworn to or affirm.edWal subscribed before
r~ tl'Ajs ~ t~3' day of
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF C'/g~?~~///) COUNTY
OATH OF SUBSCRIBING WITNESS
-feactv) a subscribing witness to the will presented herewith, 4e, ac, h-) being duly qualified according to
law, depose(s) and say(s) that /Y'~F /~S' present and saw
the testator' , sign the same and that ~ signed as a witness at the
request of testatt,r' in ht'.r presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed anJl subscribed before
me this __ ~r-~ day of
,~_.~t(.._ Register
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s)~[~d say(s) that
familiar with the signature of
codicil
testat of (one of the subscribing witnesses to) the will p:resented-Cherewith and
codiCil
that believes the signature on the wil~i~ is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19
Register
(Name)
(Address)
(Name)
(Address)
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. Thc 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 for this certificate. $2.00
No. ~ J Date
Local Registrar
R105 144 Rev 1t91
IYPEtPRIN]
PERMANENT
BLACKINK
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
2 9 - 3 5 6 S,A,E ~,~E
NAME OF DECEDENT (F~st MuJdle tasl} SEX ]~L SECURI~ NUMBER OATE OF DEATH IM, ,~lh
Thomas E Thompson ~. Male 1~'571-68-8975 . September 15,
2004
June 3,1951 Washington ,~,,~Q ~o~,,.~ m~[] "~*~
Cumberland I.mast Pennsboro I~- Holy Spirit Hospital I,.~'~"'"'"°"~""" i,o White
............... ~,~, " ...... ~' ~ I,Married I~nna Tsakopiakou
Police Officer ,,&aw Entorcementl,,. ,,.12°'* .
76 West main Street
,Bew Kingstown PA 17072 ,,,.~.,~Cumberland ~* m ...... ,-~ New Kj~}~_~.9 ....... ~,~,
Edward F. Shompson ,,. Pa~l ~ 9e Frl shy lhompson
..... ~ ~,~ _x ~ ~l,b 9-ZU-ZUUq I, Hollinger Crematory ,,~t Holly Sprin~s PA
....... ~,~~,~*~ - I~,Ct~S~u~.~% i.a.~ ...... m~ ...... Mvers Funeral Home
/~ ~~/~~ .... u~4u~4u - b I=. 37 E. ~aju~.~,S[. Mechani~o~f~~ pA 17055
Cardiac Tamponade
Aortic D~ssecCion ~
CoroB~r
~ S~p~ J7,200~ ........
Michael L. Norris, Coroner
6375 Basehore Road, Suite #[
Mechanicsbnrg, Pa. 17050
LAST WILL AND TESTAMENT OF THOMAS EDWARD THOMPSON
I, THOMAS EDWARD THOMPSON, of Silver Spring Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved wife, ANNA THOMPSON, to her
own use and benefit absolutely.
3.
In the event my said wife, Anna Thompson, should predecease me or di~-~c.~bout ~e same
time I do, such as in an accident or disaster common to both of us, I give, devise'i~d bequeath m
said estate in equal shares, per stirpes, to PAULINE ELIZABETH THoMPSoN and~
ELIZABETH ANN THOMPSON.
In the event both my said children predecease me without surviving issue, then to my wife's
child from a previous marriage, SOPHIA KATSOUROS, and to my sister, TERRY
THOMPSON, in equal shares, per stirpes.
5.
In the event anyone inheriting through this will does so while still a minor, I appoint as
Guardian of the child and as Guardian of the child's funds, my mother, PAULINE ELIZABETH
THOMPSON, of Marshall, North Carolina. In the event, however, that she cannot act as such
Guardian, I appoint my friend, CARL JOSEPH SICH, Ill, currently of 4506 Greencove Circle,
Baltimore, Maryland 21219.
6.
I nominate, constitute and appoint my wife, ANNA THOMPSON, to be the Executrix of
this, my Last Will and Testament. In the event that she should predecease me or for any reason be
unwilling or unable to act as such Executrix, I nominate, constitute and appoint my mother,
PAULINE ELIZABETH THOMPSON, to be Executrix in her place and stead. In the event that
she should predecease me or for any reason be unwilling or unable to act as such Executrix, I
nominate, constitute and appoint my friend, CARL JOSEPH SICH, IH, to be Executor in her
place and stead. I further direct that they shall not be required to file bond or other security in the
Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this c~,/~ day of
IHOMAS EDWARD THOMPSON
Signed, sealed, published and declared by the above-named THOMAS EDWARD
THOMPSON as and for his Last Will and Testament, in the presence of us, who at his request and
in his presence, and in the presence of each other, have hereunto subscribed our names as
2
C~ERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
TO THE REGISTER:
Thomas E. Thompson, a/k/a Thomas Edward Thompson
September 15, 2004
Admin. No. 21-04-0871
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
October 14, 2004:
Name
Anna Thompson
Address
76 West Main Street, New Kingstown, PA 17072
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: October 14, 2004
CHARLES E. SI-l/ELD& III ~
6 Clouser Road
Mechanicsburg, PA 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Th0m3.S E. 'T'hn1Tp::;nn, i'l/k/i'l 'T'hClfl'li'lS F'ilwrlro 'T'hnrrpsnn
Date of Death: 9-15-04
Will No.
Admin. No. 21-04-0871
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 No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
/
Da te : March 3 r 2005
"",,1
~,- ~
Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717 ) 766-0209
Te 1. No.
Capacity:
Personal Representative
x
Counsel for personal
representative
(MAH:rmf/AM3)
cA
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
June 15, 2005
Telephone
(717) 787-3930
FAX (717) 772-0412
CHARLES E. SHIELDS, III
ATTORNEY AT LAW
6 CLOUSER ROAD
CORNER OF TRINDlE AND CLOUSER ROADS
MECHANICSBURG, PA 17055
Re: Estate of THOMAS E. THOMPSON
File Number 2104-0871
Dear Sir/Madam:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 12/15/05. Because Section 2136
(d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be
granted that would exceed the maximum time permitted.
(')
L'")
~:S-4~
Claudia Maffei, ~
Document Processing Unit
Inheritance Tax Division
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REV '500 EX (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
711 ()/JtPtSD/'I, md/h/fS E.
REV-1500
DATE OF DEATH (MM-DD-YEAR)
() l) - IS - 0200 'I-
FILE NUMBER
~ 1- 01/
COUNTY CODE YEAR
NUMBER
SOCIAL SECURITY NUMBER
577 - ~e
8'17S"
DATE OF BIRTH (MM-DD-YEAR)
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
;//2- " - 315'
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
/HtJII1PSIJ#, ~II/lf/A
!Zl1. Original Return
D 4. Limited Estate
IZI 6. Decedent Died Testate (Mach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
13. Charitable and Governmental Bequests/See 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)
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NAME e I{ II illeS E.
FIRM NAME (If Applicable) /ilIA
7/1-
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TELEPHONE NUMBER
7"-02~q
COMPLETE MAILING ADDRESS
~ C LD uS i::7e /2t>.
mEt..HII-If) Ie s S t.u~(;" PA /7tJ s-r
(1)
(2)
(3)
(4)
(5)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
I
,-
OFFICIAk-. YSE ONLY
0-
;,./; .
~ 3~ Cj'lf1. II
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
... ~ -
(6)
(7)
- 0-
(9)
(10)
f;> / J/, J.1f). 09
.,. ;1./ s: /25: ",
(8)
f- J K ~ 1 9- 'If). II
(11)
(12)
(13)
, a:I'I,3'1S. 17
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
D-
o-
x.o~ (15) -0
x .0 'IS (16) -0
x .12 (17) -0
x .15 (18) -0
(19) - e. -
-0
-t!)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 7' tv, IJ/A-/N ST.
CITY A/EJV klA/t;s 7i141N I STATE PA T ZIP /71J7Z-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
- 0-
-0
- eJ
-0-
Total Credits (A + B + C ) (2)
-0 -
3. Interest/Penalty if applicable
D. Interest
E. Penalty
-0-
-0-
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)
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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)
(5B)
C>
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
~
~
~
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~
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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 10 the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other Ihan the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
~~o-
ADDRESS 1/ AlN'1f 71(~A1I'S'()
7GJ W, 11119-/111 S7:; NIF~ kIAl&S.TfJW#" PI4 /7()71
SIGNAT R PARER OTHER T EPRESENTATIVE
~.
ADDRESS {JH;fR.~ &: SHIELDS -ar
6 CJ.lJtI.s~ /It>., hlE(!.H/-INICSBUIe6-, PA /'7Dr~
DATE
~3~6
DATE ,.2../.
7'/ 3 ~b
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. 99116 (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. 99116 (a) (1.1) (ii)J,
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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1 )J.
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. 99116(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.
, .
REV-1502EX. (1-97)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ____
I Jf()A/PS~#, -r#t)/I1AO' E.
FILE NUMBER
2/-0 '1- 8 7/
All re~1 property owned solely or as a tenant in common must be reported at fair market value. Fair m rk I . ..
between a willing buyer and a willing seller, neither being compelled to buy or sell both having reasonable kid a ~;:a u~ IS de~ned as the pnce at which property wouid be exchanged
survivorshiD must be disclosed on Schedule F. ' nowe ge 0 ere evant acts. Real property which is jointly.owned with right of
ITEM
NUMBER
1.
~.
DESCRIPTION
~es; dtnh../ Real cshti Joca.te.q;11 Si!yu' Spr;n;j t6wnsJ,;p,
CumbtrllUld c,,1.l.t1~1 Pe.nnsy(tlltYdt:(J ha,v;",q 4t1 o.Jc1rttst' ,#
7(, (P. n1a..:n Sf.} AJew K,'n9st?;wn, I'J4. 1707:1._
TIt/s flMfJer"f J,4ItI~ q'tcecl~ntl ;J..erSo'ld/ rt!S,'ckHce ~rojJ~r!j
fJltrl has hee.n det!4&J1; h/f Sttrn'n'hf tI/,.'c/ow per Mr k,;-h/S
,,( h,s IV/II tVJttl ~.r /a,.t ~r Ills e.srale su'fkh?~.I11
j11"~ee{.s by Jnfe~h',',r lJt:u IPf Deee.mber ..z~ 2.oc~
AfllJrll/sa/ J,,, A7A'/'K E. II/Ihr /f.$s~~'a~s /?H-t" v"r//.Ie
at II 7 4, "00. 110.
(see &nfD/'d1~" ~~y "I GKet.lI !7-/K ~ alul &-I'y d/'
1I/IIurc ~/1rtfl/.fal q/fached At're~)
VALUE AT DATE
OF DEATH
17'/, a>.o. 00
Aec;cJel1l-;a.1 Rea.J I:sra.1t. loCJLhJ;11 5/'IIIM' Sfring 7Ol.Vrlsh/p
Cu..m btrlMta (1fA.N1,!jj I Pertn~yIVfLl1l4, hlW;1f13 CU1 addruJ Gf
11;- tv, Ifla/n Sf'./ New ~/t,~frJsv", ~A /7() 7Z.
I 7h,'J /l,.,p/~r'j /s Je/7 .s~/c/ t:'fl t:l /'lu,eAqp 4.AcI
Sale t!.9/J!rt:td- gRoss HelJ.sft.<;s MU/ l3a.rba.r4 f1eus,fu.~,
h/J w,'.ft, ';"r &1J~,'tlt/'l;lh'tJA ;/J ~ fNJlou.lJt "I '71; /)()CJ. PI')
(Set. ~I'f of sa/" 1!ral}l~/1t and 14 A-dd~c/um IMret
alia ckA' h ert.to.)
~
79, Of) (), I')t:)
TOTAL (Also enteron line 1, Recapitulation) $ / S;', !JOt). /)0
(If more space is needed, insert additional sheets of the same size)
r~
.WIGI n L.. . II...,"....... "''lj;Il''''''''''''UI.-.;;;p...
04-309M1 M
File No. 04-309M1 M
APPRAISAL OF
LOCATED AT:
76 W Main Street
New Kingstown, PA 17072
FOR:
Charles Shields III ESQ.
6 Clouser Road
Mechanicsburg, PA. 17055
BORROWER:
Thomas E. Thompson
AS OF:
Septem ber 15, 2004
BY:
Mark E. Hilbert
Mark E. Hilbert & Associates
Mark E. Hilbert & Associates
....-=',."'1...,-"
Tax Parcel # ;):5 ~ /'7- /02 I -CJoS-
TillS INDENTURE
MADE THE 21;1, day of 1;e~vbt~
and four (2004).
III the year of our Lord two thousand
BETWEEN ANNA THOMPSON, Executdx of the Estate of THOMAS E.
THOMPSON, also known as THOMAS EDWARD THOMPSON, Deceased,
late of the Township of Silver Spring, Cumberland County, Pennsylvania, Grantor
AND
the same said ANNA THOMPSON, his survlvlllg widow and the residuary
beneficiary under his last will and testament, of the same said place, Grantee.
WHEREAS, the said Thomas E. Thompson, also known as Thomas Edward Thompson was vested
in his lifetime with title to the premises hereinafter described in the Township of Silver Spring,
Cumberland County, Commonwealth of Pennsylvania; and
WHEREAS, the said Thomas E. Thompson, also known as Thomas Edward Thompson died, testate,
on the 15th day of September, 2004, and Letters Testamentary were duly issued to Anna Thompson,
as Executrix, and docketed to No. 21-04-0871; and
WHEREAS, the lands herein-mentioned were not specifically devised.
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Anna Thompson,
Executrix, as aforesaid, for and in consideration of the sum of ONE AND NO/tOO ($1.00)
DOLLAR and other good and valuable considerations, to her in hand paid by the said ANN A
THOMPSON, Grantee, at and before the ensealing and delivery hereof, the receipt whereof is
hereby acknowledged, has granted, conveyed, bargained, sold, aliened, released, and confirmed, and by
these presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the
COlnmonwealth of Pennsylvania, does grant, convey, bargain, sell, alien, release, and confirm unto
the said ANNA THOMPSON, Grantee, the premises more fully described hereinbelow as follows, to
\\ it:
ALL THAT CERTAIN piece or parcel of land situate in Silver Spring Township, Cumberland County,
Pennsylvania, being bounded and described according to a survey made by D. P. Raffensperger,
Registered Surveyor, dated June 18, 1975, as follows to wit:
BEGINNING at an X-cut in concrete on the North side of U.S. Route #11, South 85 degrees 52
minutes West 40.0 feet to a point at the corner of land now or formerly of Charles F. Mosier and
Kim K. Mosier, his wife; thence along said lands North 04 degrees 08 minutes West, the distance of
160.20 feet, thence North 85 degrees 52 minutes East, the distance of 12.0 feet; thence North 02
degrees 55 minutes 45 seconds West, the distance of 79.79 feet to a point on the South side of an
alley; thence along said alley North 85 degrees 52 minutes East, the distance of 48.5 feet; thence
South 05 degrees 00 minutes East, the distance of 190.0 feet to a point, the place of BEGINNING.
BEING the same premises which Randy Whitley and Lisa M. Whitley, formerly known as Lisa Roth,
husband and wife, by their deed dated November 14, 1995, and recorded in the Recorder of Deeds
Office in and for Cumberland County in Deed Book 131, Page 422, granted and conveyed to Thomas
E. Thompson. The said Thomas E. Thompson is now deceased and his estate is the Grantor herein.
TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and
prem ises hereby granted and released, or mentioned and intended so to be, with the appurtenances
unto the said Grantee, her heirs and assigns, to and for the only proper use and behoof of the said
Grantee, her heirs and assigns, forever.
AND THE SAID GRANTOR, Executrix as aforesaid, her heirs, executors and administrators, do
covenant, promise and agree to and with the said Grantee, her heirs and assigns, by these presents,
that the Grantor has not clone, committed any act, matter or thing whatsoever whereby the premises
hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in
title, or otherwise howsoever.
-
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
7H ~h1fJ.sON / 7.!1tfJ/dAt) E.
REV-l508 EX' (l-97)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
d I - () 'I - 87 I
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.
~.
~.
~
5.
, .
7.
<6.
DESCRIPTION
C.HECk FJqJ)1Y/ SToNE ~~~Sc .l'/-ttTlJ SM.-ES", /Nl?, ef ~SL&'
VALUE AT DATE
OF DEATH
, 71./1f. 7S"
~ I 7 "OfJ . ()O
,
" ~ &()(). 10
SIrU; OF 1'11'1 ~AY~N"
RIEf'AYhlr;NT O&: AOVA-NCE:
/1M. , dt ~ lISt.G'.
CHt2'tSLI:7I.. t.E~A/l(}II/J Ifi'? SIJL.P t:it>R.
~Ilj) hillS rANG /9?~ - ,t5/lRK4:711 :J)~klN - UNA-flu;: is SGZL.
~ DF 7JlIS Z, II""~
VOL. J<S /()1I6~ IJASH~ /9S't) I 1)/51::{ 3D!/) FoIe.
p~ Q}lIZ.cI< tece.ivtcl -h-11\t .so\.\.~(l l11o.rJlo..v.l lrl(.C,~..;c..
~1Yy. , VIA' 1~~1.7~S'l~{)312.q
FflDm S7(;N," /if)HSE A-ti1i; SAlE$
J
~~t' ,co
! 3 DiP. Of)
~ .B t!)t!),()()
f7 q 5.36,
" 300.00
C hl'Y ~I~r I+~cla.i ll'\ s.\cl t: '("
TOTAL (Also enter on line 5, Recapitulation) $ 3 l/J 'I 'fa. /I
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) _
.~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
T~()II1F'S ()N ;'
T.IId//l/fS
FILE NUMBER
:Z/-Olj- 371
ESTATE OF
E:
Debts of decedent must be reported on Schedule l.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
/tIYiFnS F=lu'E~A-L HDmG 6F AtEeHAII/~S8<<J((;
~
S. ~'9. 'tf
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) ~A/ItIA -r,vttJ/lfj'JStJlf!
Social Security Number(s)/EIN Number of Personal Representative(s) ~I ::t - '4 - :5 J sf,
Street Address 7~ tu. /JIH//V S7:
City /lie-III KIN6$7C~/'I
WAl vEf)
State ~ Zip /707'%
Year(s) Commission Paid:
2
Attorney Fees CII/!-/2.LES E"'. SIIII:ZDS.zz
~ ~ I$(); Ill)
3
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant A-A/AI,f- 7Jft)ht/J.r~/I
Street Address 70 tu. 4/1/# 57
City AlE"W K/NtiSJ2;lUN
Relationship of Claimant to Decedent ~ / OIJW
~
3, SOt). ()~
State /14 Zip
1707'2
4.
Probate Fees a,wj ONI; /fa I ,. ~ s u.e ~f rrlt.rr c e rl-, '/;C a.:h.$
f
11!J;l.OO
5.
Accountant's Fees ~ tAY\e,t
Tax Return Preparer's F~
eru.kl,~l/ J H+R. ~IDcJ<.
'I'll- 4/, 10111 ,~TZ.
(t.,/'i1t.)
~ ~S7). DO
6.
A dd;h~"{J.1 6hDrt ~ e.rr, 'h-ca.re.s
#lIe/;f"n,tt.1 ;shul: cert; f, ctIo-res
II ,,,: h 'tin'; ShDl't (!e,rf//,Wes
,ft/tI,"h'nllll /JrDbak fee
,c;//4f Fee f>> If~J"sfY' ill IV/lIs ;;1" ~ /11t~r. -r;..;x
A-iJ'erhfih.1 I f u. lit 6e.r/4"tf k w JO/.f,."aJ
//7
TOTAL (Also enter on line 9, Recapitulation) $ 1~/11f1. 1)'1
(If more space is needed, insert additional sheets of the same size)
, SeNE!), Ii I t!#d-:!.
ES?: ~1=7?YPAt~PIV',. m~hJ,f-..f4::
13, ! uA"terl'/st'!Jw,__far/;sJe cfy,tl!l~L......-
Pl.;. 1J?41'I<g.I(,'/kt;tff4/~$1i.tH~lt:lf'stl4
IS: :ffJe,itJJt(r~ &- ~r-~f:'-'Shl'eL~7!l/~M~fJ/~S;~+
elL I reS/J/j,.)
AU; Nt? 2 1- ~~- 6"71
~/t)f,?r
'(p~().IJO
'! / f.. 2()
Myers Funeral Ho:m.e,. Inc.
Boyd L. Myers Jr.. Sl\pervisor
37 East Main Stte~t
Mt\chanksburg, Pelln~yly'::tnja 17055
(/ t 7) 766-3421
f,l:\' (717) 795-7.29 t
A $tandard of excellence in Cl;lntraJ pennsylva.nia sine\;: 1910
Tu.esd:~y, December 20, 2005
Mrs. Anna Thompson
76 West Main Street
New Kingstown, Pa. 17072
Dear Mrs. Thompson,
Thank you t"r.>r selecting auI' funeral home to provide services for your family during your bereavement. I
hope ttl.C!t you found our services to be of the highest standards and' that they met your needs and' those
of your family and friends.
The fcllowil'1g is- a summary of the servIce charges as previously explained and provided in written form
anq h'erell'llndicated as PAID-IN~FULL.
Thomas Edward (Turkey) ThQmp~o-n
SUMMARY OF EXPENSES
TOTAL OF SERVICE ReNDE.RED
LESS; Credits granted
LESS: Total Payments
CURRENT 8ALANCr:
$7,114.64
1,845.00
5,26.9.64
$0.00
Crecliis.(3:'(lnted; SU~45.0 P;!Ckclge Pnce Discount
If there -are any questions or concerns that remain unanswereo, please call me.
3mcerely I
/;1 /
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REV-1512 EX. (1-97)
._0-
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
7}t~IIIAs()~ T/f/)I?/A-S tE.
FILE NUMBER
;;ll -0 '-1- 97/
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
CO NJ LI./flE"1e. L"IfH
B ;f.NK ~ /fl./!:
(SEE t/A-t.liA rtIJN
# 32"tf ()/IJ() o/5'$' o5'S ;iff WA-(U(IW/"I
!-ETTE;{? ATrAeHE't:>)
1/39/Z/./'I
~
;.
~(jurry lINE #' 1/3i" S'/U 1/'1e :l2SB li-r (J)M!HpIlPI
JJA/II~ AI,A.
(SEE J//h.kA7"/~N' L..E1n:-7t A-7'l.IH!HGD J.
3.
Y,fll r,fN PAKK - IfJAlJl.IYCE "]:Jut: PH L/N1? o~ CA.E1JrT.
..,
"l/, ,;z 9/. 9 t)
~
1/17/1.9tf
TOTAL (Also enter on line 10, Recapitulation) $ J./ S, / as. 11 8
1,lf more space IS needed, Insert additional sheets of the same size)
unwilling or unable to act as such hxecutnx, 1 nommate, constltute and appomt my mother,
PAULINE ELIZABETH THOMPSON, to be Executrix in her place and stead. In the event that
she should predecease me or for any reason be unwilling or unable to act as such Executrix, I
nominate, constitute and appoint my fIiend, CARL JOSEPH SleH, In, to be Executor in her
.- II'
place and stead. I further direct that they shall not be required to file bond or other security in the
Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 02.~ ~
I
UfJ l-ct)
day of
,A.D.2()(11.~ D. J~
-4l~0<- Ltf{~ (SEAL)
THOMAS EDWARD THOMPSON
Signed, sealed, published and declared by the above-named THOMAS EDWARD
THOMPSON as and for his Last Will and Testament, in the presence of us, who at his request and
in his presence, and in the presence of each other, have hereunto subscribed our names as
witnesses.
tit/[hv C~ ~dd~ ~
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04-10-2006
THOMPSON
09-15-2004
21 04-0871
CUMBERLAND
101
APPEAL DATE: 06-09-2006
( See reverse side under Objections)
Amount Remitted I I
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:is47-Ex-AFP-io3:osj-NoTIcE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
THOMAS E FILE NO. 21 04-0871 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
~J
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CHARLES E SHI~LDS III
6 CLOUSER RD
MECHANICSBURG
PA 17055
ESTATE OF
THOMPSON
REV-1547 EX AFP (06-05)
THOMAS
E
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 04-10-2006
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total D~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. A.ount of Line 14 at Spousal rate (15)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. A.ount of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
152,000.00
.00
.00
.00
34~940.11
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
14,270.09
215.125.68
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
. 00 X 045 =
.00 X 12 =
.00 X 15 =
+
INTEREST/PEN PAID (-)
AMOUNT PAID
DATE
NUMBER
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for. with your
tax pay.ent.
186,940.11
229.395 77
42,455.66-
.00
42,455.66-
(19)=
.00
.00
.00
.00
.00
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
STATUS REPORT UNDER RULE b.12
Name of Decedent: Thomas E. Thompson
Date of Death:
September 15,2004
Will No.
Admin. No.
21-04-0871
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~ 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 per~onal 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 the personal 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
Cerk of the Orphans' Court and may be attached to this report.
s~f~
Date:
ff ~~~
/
Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717 ) 766-0209
Te 1. No.
Capacity:
Personal Representative
x
Counsel for personal
representative
(MAH:rmf/AM3)
/
. ~y
r\..,
--/ /