The URL can be used to link to this page

Home My WebLink About03-0843 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills for the · Deceased. County of in the Social Security No. '~--~ { c'/._ I (O - ,¥c/~- Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or,older an t~..~ecut ~x. \ named in the last will of the above decedent, dated and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) ent was domiciled at death in 0.9,~ ~O~c_~0._~t~ C,~, ,t,, Pe, onsylvania, with Decend h~A last family or pgiogipal ~skdenc~at ' - ' .J ~ ' . ' (list street, number and muncipality) D cen em, t e. - . d - . . · / ' Except as follows, deceden~d not ma~, was not d~vorce~and &d ~t have a child born or adopted after execution ofthe 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 $ (lf 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: WHEREFORE, petitioner(s) respectfully ~request(s) the pr.obate of the last will and codicil(s) presented herewith and the grant of letters --~ .%~'~t Y3a ~y~(k~ ~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~ 0 ~ ' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY or ~LLI3qL~ ~:~L/3C~i3 _ ss 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,- ~_?'~~ ~~- before me this [~TB ~a~.~[ (J It ~' Estate Of l~ EL~<~_ E. ~F_~E~._ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 6 ~Lr. iL0 ~ ,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 described therein be admitted to probate and filed of record as the last will of FL~~ ~d Letters are hereby granted to Register of Wil~ V ~ FEES Probate, Letters, Etc .......... Short Certificates(.~l...' ....... $ i~- D 0 ATTORNEY (Sup. Ct. I.D. No.) ~ .X.-:. Jq.C~,,3... ..... s ~ s iD.DO .~ss TOTAL ~ $ iii. Filed Q C:T..' 15, .......................... PHONE This is to certify that the information here given is correctly copied from an original certificate of death duly filed 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 for this certificate, $2.00 ~ ~~ Local Registrar P 9G48521 OCT 1 42001 No. ~ Date ;43Rev 2/87 COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH U~R t Y~ I U~R I O~ OATE ~ ~H I ~ ~ ~ 1 ~,m oa~.'~ I ~e~c~v) I~t ..... ~"~--~'~"~'~ I I '~ ..... ~'~'~' I~ ~CE~ ~ H~ ~IN? I~-~~ ~.~. ~ ~NO ~ ~ES~N~STRY J ~ ~CE~NT EVER ~ ~NT'S E~AT~ J9 --_---. II~ WfL~ ~'~ a~ ~ ~e. C~. ~. le C~ I~e~l.s - 7 PZne C~ele l~ ,,.~ Pen~glvania ~ 1,..O~.~ West Pen~boao Neville, PA 17241 U~r,-m ~T' ~~l~ ,~ .~ . ,~ ~. Frank Flege~ l= 138~ P~netown ~~r~4ngton, PA 19034 ~'~ .~ ~ ~'~--) l,,~.Octob~ 14, 2003 l~,, Pen~ylvan~a Caem~or H~r~b~ I ~ ~ ' :~ t~m~ ~_~ ~s~. · .g ~,~ . g, PA 17109 I ..... ~.~_~ ~ ' r Ira. 4 ' E~ ~ ~s. ~ ~ ~~ ~ ~ ~ ~ I~"' I'" = ~- o[ ~ , I i ~ ~/1~ o ,.~- o~ I I' o ~oI ~,, i~. I~. ,--~. . ~, , , . .. U (~ ) IYr~/, ,~ / .~msz~.'ss~.~u.e ~o.~.~. ........... ] HELENE E. FLEGEAL of 7 Pine Circle, Newville, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. tltem I direct that all my debts shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ~ttnt ~Wt~: I give, devise, and bequeath my entire estate to my daughter Sonia Flegeal-Kipp and my son Frank H. Flegeal. equally, share and share alike, per stirpes. tlttm ~ree: I appoint my daughter Sonia Flegeal-Kipp Executrix of this my last will. Should she fail to qualify or cease to act as Executrix, I appoint my son Frank H. Flegeal to act as Executor with the same rights, powers, and duties. ~tem.~0ur: I appoint my son's wife Lucinda B. Flegeal Guardian of any property which passes to any person under the age of 18 years and with respect to which I am authorized to ~-Tappoint a Guardian and have not otherwise specifically done so. Should she fail or cease to act as Guardian, I appoint my daughter Sonia Flegeal-Kipp to act with the same rights, powers, and duties. Guardian shall establish separate guardianship accounts and shall have the power to use income from time to time for the beneficiary's education, including technical and vocational training and graduate school, travel, support, and welfare without regard to his or her parent's ability to provide for such education, travel, support, and welfare, or to make payment for these purposes, without further responsibility, to the beneficiary or to the beneficiary's parents or to any person taking care of the beneficiary. Guardian shall administer the account until the beneficiary becomes 18 years of age, at which time the Guardian shall transfer the principal and income remaining in the separate guardianship account to the beneficiary in full and the guardianship terminated. ~ttm.~il~: All estate, inheritance, succession, and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ~tem ~ix: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. $tem ~bet~en: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his or her sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition, to mortgage or pledge real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of October, 2000. He--l'ene-E. Flegeal The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names. I COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND : We John H. Broujos and ~ o 7 ''J'~' ~a{',/, , witnesses whose names are signed to the attached or foregoing instmmeni being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. [,.~.D~.,. ~ Sworn and subscribed to before C~ ! ' t~// ]' me th~ 9th day of October, 2000. NOTARY PUBLIC Notarial Seal Bridget Ann Corcoran, Notary Public Carlisle Boro, Cumberland County My Commission Expires June 10, 2002 COMMONWEALTH OF PENNSYLVANIA : .' SS COUNTY OF CUMBERLAND : I Helene E. Flegeal whose name is signed to the attached document, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. Helene E. Flegeal, Testatrix O Sworn and affirmed to and acknowledged before me this 9th day of October, 2000. NOTARY PUBLIC Notarial Seal Bridget Ann Corcoran, Notary Public Carlisle Boro, Cumberland County My Commission Expires June 10, 2002 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: 4~ ~-~¥~ ~-~ ~-i. ~ t c~I Cc_~ ~ Date of Dea~: [0}.l'~,~ ~ To ~e Register: I ce~ ~at nofce of ~neficiM ~te~t) ~ a~trafion requffed by Rule 5.6(a) o~ ~ O~h~s' Cou~ Rules was served on or mailed to *e following beneficiaries of the above-captioned estate o. ~'~ 1~[~ : Ni~me Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except /'~)/A Signature Name Address I I Z ~'~'O~VL~/?-~ ~---~ Capacity: X 'Personal Representative Counsel for personal representative COMMONNEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX XNHERXTANCE TAX DIVISION APPRAXSEHENT., ALLONANCE OR DISALLO#ANCE Po BOX 28060]. OF DEDUCTIONS, AND ASSESSHENT OF TAX ON HARRISBURG, PA 17lZ8-0601 JOINTLY HELD OR TRUST ASSETS RE¥-ISq8 EX AFP DATE 12-20-200q ESTATE OF FLEGEAL HELEN E DATE OF DEATH 10-11-2005 FILE NUMBER 21 05-08q5 COUNTY CUMBERLAND SSN/DC 217-16-5985 SONIA R KIPP ACN 0q100577 112 HORNERS RD Amoun* Remi~ed CA~. I S LE PA 17015-8508 " ~-' MAKE CHECK PAYABLE AND REMIT PAYMENT TO: ~<'--~-~ ~;~ ,.r' u-C2)C..~ REGISTER OF WILLS "~"~ ~' .... ~ O(,.DF._.~, CUMBERLAND CO COURT HOUSE C~ ~,:: r-- cz: :-, <~ CARLISLE, PA 17015 ~ON~HZS ~ ~ RETAIN LOgER PORTION FOR YOUR ~EV:~'~P~"~:6~''~ -- ................................................ NOTICE OF INHERITANCE TAX APPRAZSEMENT~ ALLOHANCE OR DZSALLOgANCE OF DEDUCTZONS~ AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE ESTATE OF FLEGEAL HELEN E DATE OF DEATH 10-11-200~ COUNTY CUMBERLAND FILE NO. 21 05-08q5 S.S/D.C. NO. 217-16-5985 ACN 0q100577 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 1705007160 TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 07-05-1996 Account Balance fi,256.06 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 2,118.05 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 2,118.05 REGISTER OF WILLS AT THE Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK Tax Due 517.70 OR HONEY ORDER PAYABLE TO: '"REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) INTEREST IS CHARGED THROUGH 12-Z8-ZOOq TOTAL TAX CREDIT I .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl 517.70 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.9q TOTAL DUE 525.6q i IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX( 11 96) DEPARTMENT OF REVENUE BUREAU OF INDiViDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: iNHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004766 FLEGEAL-KIPP SONIA R 112 HORNERS RD CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 04100577 $323.64 ESTATE INFORMATION: SSN: 217-16-5985 FiLE NUMBER: 2103-0843 DECEDENT NAME: FLEGEAL HELENE E DATE OF PAYMENT: 12/27/2004 POSTMARK DATE: 12/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/11/2003 TOTAL AMOUNT PAID: $323.64 REMARKS: CHECK# 111 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CO!~IMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 00481 6 DUPLICATE FLEGEAL-KIPP SONIA R 112 HORNERS RD CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $610.88 ESTATE INFORMATION: SSN: 217-16-5985 FILE NUMBER: 2103-0843 DECEDENT NAME: FLEGEAL HELENE E DATE OF PAYMENT: 01/07/2005 POSTMARK DATE: 01/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/11/2003 TOTAL AMOUNT PAID' $610.88 REMARKS' IN C/O JEFF COHICK CHECK//112 INITIALS: RSK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CO,~,MONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 00481 6 FLEGEAL-KIPP SONIA R 112 HORNERS RD CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $610.88 ESTATE INFORMATION: SSN: 217-16-5985 FILE NUMBER: 2103-0843 DECEDENT NAME: FLEGEAL HELENE E DATE OF PAYMENT: 01/06/2005 POSTMARK DATE: 01/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/11/2003 TOTAL AMOUNT PAID: $610.88 REMARKS: IN C/OJEFFCOHICK CHECK# 112 INITIALS: RSK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CO~.MMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF: INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004805 DUPLICATE HARTMOYER KRISTYN A 143 EWE ROAD MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... Vo/ ESTATE INFORMATION: SSN: 160-68-79§7 FILE NUMBER: 2.104-0843 DECEDENT NAME: HAFITMOYEFI KENNETH K II DATE OF PAYMENT: 01/06/2005 POSTMARK DATE: 01/06/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/01/2004 TOTAL AMOUNT PAID: $610.88 REMARKS: CHECK# 112 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV- 1500 [, '~ (6-00) REV.1500 i PENNSYLVANIA DEPARTMENT OF.EVENUE INHERITANCE RETURN DEPT. 280601 HARRISBURG, '17128-0601 RESIDENT DECEDENT ~' DECEDENTS NAME (~ST, FIRST, ~D MIDDLE IN~L) SOC~L SECUR~ NUMBER z Helena E. ~ 217-16-5985 c~ DATE OF DEATH (MU-D~-~R) ~ ~X~ OF B~RTH (UM-~-Y~R) ~1 ~IS R~RN MUST BE FI~D IN DUPECA~ ~ ~E o 10-11-2003 11-28-1918 REGISTER OF~LLS ~1 (F APPLICABLE) SURVMNG SPOUSE'S N~E (~ST, FIRS~ AND MIDDLE IN~) ~1 SOC~L SECURI~ NUMBER ~ ~ 1. Original Retum ~ 2. Supplemen~l Return ~ ~ ~ 3. Rem~nd~ Re~rn (~te of dea~ ~ to 12-13-82) ~ ~ ~ 4. Limited E~ate ~ ~. Fu~relnterestCompromise(~teof~athaffer~2.~2.s2) ~ ~ 5. Federal Eslate T~ Relum R~uir~ m ~ ~ 6. De,dent Di~ Testate (A~ ~ o~) ~ 7. D~ent Maintained a Living Trust (~ach copy of T~t) 8. Total Numb~ ~ S~e Deposit Boxes ~ . < ~ 9. Litiga~on Pr~s Remived ~ 10. Spou~l Pov~ Credit (dale of dea~ be~,n 12-31-91 a~ 1-1-95) ~ 11. El~m to t~ u~er S~. 9113(A) (~ s~ o) z N~E ~ COMPLE~ MAILING ~DRESS ~ S. Cohick, EA o 390 Alexander Spring Road ~ FIRM NAME (If A~li~) ~ Cohick ~ Associates Carlisle PA 17013 ~ TELEPHONE NUMBER O ~ ~249-5321 1. Real Estate (S~ule A) (1) 2. Stocks and Bonds (S~ule B) (2) I 3. Closely Held Co~oration, Padn~ship ~ Sol~Propdetor~ip (3) 4. M~gages & Notes R~ivable (S~ule D) (4) 5. Cash, Bank Deposits & Mismllaneous Persmal Prope~ (5) I6,56~ (S~edule E) ' 6. Join~y Owned Prope~ (S~ule F) (6) . ~ Separate Billing R~uest~ ~ 7. Inter-Vivos Transf~s & Mi~llan~us Non-Probate Prope~ (7) ~ (S~ule G or L) ~ 8. T~I Gm~ A~ (to~l Lines 1 - 7) ~ ts) 16,561.61 ~ 9. Funsal E~enses & Administrative Costs (S~edule H) (9) 2/3 8~. 9~ 10. Debts of D~ent, U~gage Liabilities, & Liens (S~ule I) (10) 867.80 11. To~l ~u~s (total Unes 9 & 10) (11) 3~252.75 12. N~ V~ue ~ ~e (UAe 8 minus Line 11) (12) 13,308.86 13. Chari~ble and Governmental Bequest~Sec 9113 Trusts f~ whi~ ~ ele~on to t~ has not been (13) made (~ule J) 14. N~lue~toT~(Une 12minusUne 13) (14) 13~308.86 SEE INS~UC~S F~ APPLIC~LE ~ 15. ~ount ~ Line 14 t~ble at ~e spousal t~ ~ rate, or transf~s und~ S~. 9116 (a)(1.2) X .0 (15) 16. ~ountofLine14t~bleatlin~lmte 13,308.86 x .o 45 ¢~) 598.90 17. Am~nt of Line 14 t~ble at sibling rate X .12 (17) 18. ~ount ~ Line 14 t~ble at ~ll~eral rate X .15 (18) ~ 19. T~, tlS) 598.90 20. ~ CHECKHE~I~.yOU~ERE~iNG~N~O~NOV~RpAy~~ STF PA420:21F. 1 · Dec,dent's Complete Address: I STREETADDRESS 7 Pine Circle c~' Newville ISTATE PA J z,P 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 598.90 A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. interest/Penalty if applicable Total Credits (/~I~ C) (2) D. Interest 1 1.9~ IR. Penalty Total Interest/Penalty (1~ E) (3) 11,98 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) 0.00 5. If Line 1' Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (5) 6 10.88 A. Enter the interest on the tax due. (5A) El. Enter the total of Line ~ 5A. This is the BALANCE DUE. (5B) 610.88 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOVVING 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 dght to designate who shall use the property transferred or its income; ................... c. retain a reversionary interest; or d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at h s or her death? ..... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................... D 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 pena ties of perjury I declare lhat I have exa~ ied this return including accompanying schedules and statements, and lo the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other lhan the personal representative is based on all information of which preparer has any knowledge. S' " TURE OF PERSOn, PO,S,BLE FOR F'L,,C.RETUR, DATE,. 112 I-I_Qcners Road, Carlisle PA 17013 8JGtIA'i'UR~R O N ~ES ' 390 ~,lexande~r Sprincj Road, Carlisie PA 17013 - For dates of death on or after July 1 1994 and before january i i995 the tax rate imposed on the net ValUe of transfers to or for the use of the su~'iving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. ' ' ' For dates of death on or after January 1, 1995, the tax rate im posed on the net value of transfers to or for the use of the surviving souse is 0% [72 R 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 ~ling a tax retum are stil applicabl~ 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 decedenrs 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 RS. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at lesst one parent in common with the decedent, whether by blood or adoption. STF PA42021F.2 RFV-1508 EX + (1-97) ESTATE OF FILE NUMBER Fleqeal, Helene E. 21-03-0843 Include the proceeds of litigation and the date the proceeds were received by lhe estate. All property jointly-owned with the right of survivomhip must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~. M & T Bank - checking account 2. M & T Bank - certificate of deposit 3,892.24 3. Sale of records 4,022.45 4. Sale of used books 23.00 5. Sale of household items 621.00 6. 2003 federal income tax refund 396.83 7. USAA - medical insurance reimbursements 561.00 8. Green Ridge - refund 768.94 9. PP & L - refund 64.36 16.79 11. 1996 Volkswagen Golf GTI Hatchback 6,195.00 TOTAL (Also enter on line 5, Recapitulation) $ 16.561.61 STF PA42021F.9 (If more space is needed, insert additional sheets of the same size) REV-1'511 EX + (1-97) (I) ESTATE OF FILE NUMBER Fie ea.g.~.Q~_Helene E. 21-03-0843 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT ~. Prepaid B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sonia R. FlegeaI-Kipp Sodal Secudty Number(s) / EIN Number of Personal Representative(s) Street Address 1 12 Homers Road City Carlisle State PA Zip 17013 Year(s) Commission Paid: 2005 2. Attorney Fees 750,00 3. Family Exemption: (ff decedent's address is not the same es claimant's, attac~ explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 111.00 5. Accountant's Fees 1,250.00 16. Tax Return Preparer's Fees 189.00 7. Bank fee for checks 8, Register of Wills - filing fees 9,95 75,00 TOTAL (Also enter on line 9, Recapitulation) $ STF PA42021 F. 12 (If more space is needed, insert additional sheets of the same size) 2._~.~38z[. 95 RE-'V-1'512 EX + (1-97) (I) I ' I SCHEDULE I COMMONWEALTH OF PENNSYLVANIA / DEBTS OF DECEDENT, E,)TATE OF FILE NUMBER Fie eq_e..~_,_ Helene E. 21-03-0843 Include unreimbursed n~dical .expenses. ITEM NUMBER DESCRIPTION AMOUNT ~. Sprint - balance due 2. Bank Card Services - credit card 75.83 3. Kuhn Communications 49.50 4. Continuing Care RX 5.09 5. Presbyterian Homes 48.00 689.38 TOTAL (Also enter on line 10, Recapitulation) $ 867.80 STF PA42021F. 13 (If more space is needed, insert additional sheets of the same size) REV-'I'513 EX + (9-00) ~""E"'T^,CET~X,E~,,, BENEFICIARIEs ESTATE OF FILE NUM NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)) OF ESTATE l. Sonia R. Flegeal-Kipp 2. Frank H. Flegeal daughter 1/2 residue son 1/2 residue I~. NON-TAXABLE DISTRIBUTIONS: SHEET 1'. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NONITAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional s of the same size) ~TF PA42021F. 14 INVENTORY REAL AND PERSONAL ESTATE OF Helene E. Flegeal, Deceased Late of West Pennsboro Twp., Cumberland County, PA Date of death: October 11, 2003 Social Security Number 217-16-5985 1. M & T Bank- checking account $ 3,892.24 2. M & T Bank - certificate of deposit 4,022.45 3. Sale of records 23.00 4. Sale of household items 396.83 5. 2003 federal income tax refund 561.00 6. Sale of used books 621.00 7. USAA - medical insurance reimbursements 768.94 8. Green Ridge - refund 64.36 9. PP & L- refund 16.79 10. 1996 Volkswagen Golf GT~ Hatchback 6,195.00 COMMONWEALTH OF PENNSYLVAN]:A : : SS COUNTY OF CUMBERLAND : SON]:A FLEGEAL-K[PP, being duly sworn according to law, deposes and says that she is the Executor of the Estate of HELENE E. FLEGEAL, Deceased; that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of HELENE E. FLEGEAL, deceased, except real estate outside the Commonwealth of Pennsylvania and that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn, to and subscribed before me this ~4~.~ dayof.]anuary, 2005. Notary¥~.ublic - ,.,, ..... :,.SDN[A FLEGEAL-~PP rr SONIAr R 112 HORNERS CARLISLE KIPP RD COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Ilt;iERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN Wv BUREAU OF INDIYIIlUAI. HtXESn INHERITANCE TAX dlVlstON PO BOX ZBD6Dl HARRISBURG PA 171Z8-0601 REV-IU4 EX AfP (1.2-04J PA 17013-8508 01-24-2005 FLEGEAL 10-11-2003 21 03-0843 CUMBERLAND 217-16-5985 04100577 Altount Re..itted HELEN E 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 ~ .--------------------------------------------------------------------------------------------------------------- REY-1604 EX AFP (01-03) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 01-24-2005 ESTATE OF FLEGEAL HELEN E DATE OF DEATH 10-11-2003 COUNTY CUMBERLAND FILE NO. 21 03-0843 ADJUSTMENT BASED ON: S.S/D.C. NO. 217-16-5985 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 04100577 FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 1705007160 TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 07-05-1996 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 4,236.06 0.500 2,118.03 .00 2,118.03 .45 95.31 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOYE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 02-08-2005 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 95.31 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.73 TOTAL DUE 9A.D4 . IF PAID AFTER THIS DATE, SEE REYERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.) 'Sf.. aX RE\I-1470EX(o..88) '* INHE-RITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Helene Flegeal 2103-0843 REVIEWED BY ACN Emerson Luciano 04100577 SCHEDULE ITEM EXPLANATION OF CHANGES NO. The above referenced ACN tax rate has been reduced to 4.5% PaQe 1 BUREAU OF INOIV~DU~L .TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1U7EXAFP 112-041 r, I C...; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-31-2005 FLEGEAL 10-11-2003 21 03-0843 CUMBERLAND 04100577 HELEN E SONII( R 112 HORNERS CARLISLE KIPP RD Allount Rellitted PA 17013-8508 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... ~W :r&7t'.!r.A'''''..rnr-.d'!.,.......iiij,."fAmM!m~l''"1'llr.!t7tYl!m.'J.lf.b'l!'.lll:'l!'d'OW..j,ili..................... ESTATE OF FLEGEAL HELEN E FILE NO.21 03-0843 ACN 04100577 DATE 01-31-2005 THIS STATEHENT IS PROVIOEO TO AOVISE OF THE CURRENT STATUS OF THE STATEO ACN IN THE NAHED ESTATE. SHOWN BELDW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2005 PRINCIPAL TAX DUE:. 95.31 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-23-2004 CD004766 1.73- 323.64 TOTAL TAX CREDIT 321. 91 BALANCE OF TAX DUE 226.60CR INTEREST AND PEN. .00 . . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 226.60CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORH FDR INSTRUCTIONS. I ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVIstotl: . PO BOX Z80601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, AllOWANCE OR DISAllOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-15~7 EX AFP 112-a~1 ,~() tt 1.7 10 ll: if DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-14-2005 FLEGEAL 10-11-2003 21 03-0843 CUMBERLAND 101 AlIOunt Re.itted HELEN E C., rr-.u LcrH\ O.PP}--fLl,;,.,!,TC: .C. . tv H:~T f hI .{ U 1 \j ..J.........~Jj; ,.....~ 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 ~ RrV' =rJW-Ex'A'p--nr.-6!"-Noi'i:-cE-oF-1NHErti'flNcE-TAX-APPRAi'sEitENT~..ALtowlNCE-OR......_....... ..- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FLEGEAL HELEN E FILE NO. 21 03-0843 ACN 101 DATE 03-14-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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. MortgageslNotes 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) .00 .00 .00 .00 16.561.61 .00 .00 (8) NOTE: To insure proper credit to your account, subait the upper portion of this forll with your tax paynent. 16,561.61 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage liabilities/liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax (9) UO) 2,384.95 867.80 (11) (12) (13) (14) 3.21i? 75 13,308.86 .00 13,308.86 19 will (Schedule J) I~ an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. AlIOunt of line 14 at Spousal rate (15) 16. A.ount of line 14 taxable at lineal/Class A rate (16) 17. Allaunt of line 14 at Sibling rate (17) 18. Allount of line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due T X C T: NOTE: .00 X 13,308.86 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 598.90 .00 .00 598.90 DATE 01-06-2005 NUMBER CD004816 + INTEREST/PEN PAID (-) 11.89- AMOUNT PAID 610.88 -J; TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 598.99 .09CR .00 .09CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $I, 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.) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/15/2005 FLEGEAL-KIPP SONIA R 112 HORNERS RD CARLISLE, PA 17013 RE: Estate of FLEGEAL HELENE E File Number: 2003-00843 Dear Sir/Madam: It has come to my attention that you have not filed th~ Status Report by Personal Representative (Rule 6.12) in the above ~aptioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, w~thin two (2) years of the decedent's death, shall file with the Regi~ter of Wills a Status Report of completed or uncompleted administrrtion. This filing is due by: 10/11/2005 I Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~__L~~j~.k.. iJ , ~ /- ./ ~~. GLENDA FAP~~ER STRAS~UGH REGISTER OF WILLS cc: File Counsel Judge '- .' i.1' IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF HELENE E FLEGEAL DECEASED NO. 21-03-0843 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of death: HELENE E FLEGEAL October 11. 2003 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a formal account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest: Yes No x d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and attached hereto. D~t;: ~ 05 e~.dl'()w-~r \~ ' , " \_ 'J Name: Address: Sonia Fleoeal-Kipp 112 Horner Road Carlisle PA 17013 717/243-1216 Personal Representative ; ,.. Telephone: Ca pacity: ( c: , Co...,] ( ., \..-. \..:".