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Home My WebLink About04-0874 Estate of Register of Wills of Dauphin County, Pennsylvania PETITION FOR GRANT OF LETTERS . KAREN L. HESS No,;ll- 04 -~74 also known as , Deceased Social Security No. 184-60-1799 Pellu"""'lel. whO ie'",. 18 y.e"ol-ue 01 01"", appIylin! to. (COMPLETE" A" OR "B" BELOW:) Q A. Probate and Grant of letters and aver that Petitioner!s) Is/are the execut Decedent, dated and codicil Is) dated named in the last Will of the St"le.e1ev""ci'CUfnl',,"Ce'I,e.g..","''''cielion.dnthofUeculOt.ItC. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~ B. Grant of Letters 01 Administration le_'.e_. <l.b.n.C.l.e pendente lite; """'nt..bun",,; "",...'''....''''n''...> Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: r Name Relationship Residence I Arme c. Landis Mother 3 Greenwav . Mechanicsbur<7. PA 11fl'>'> (e TE IN ALL CASES:) Attach additional sheats if necessar y Decedent was domiciled at death in Cnmhe:rl ;:mn. residence at ?1.6. V~c:!r M!:dn C::r,..clOr, ~i-r.'am~C!r("'lf"7n, (1001 ~"""l. numb.., and '.....n'cop.."y) 38 . August 25 Decedent, then _ years of age, died County, Pennsylvania, with his/her last family or principal PA 17m 1 , 1~00~ at 214 F.""t M"in Str....t. Shiremanstown, p, _U)f;~"onl Decedent at death owned property with estimated values as follows: ?:" >': '3 c. (If domiciled in PAl All personal property ....................... ......~ dlf not domiciled in P.o.) Personal poperty in Pennsylvania. . . . . . . . . . . . . . . .~'. (If not domiciled in PAl Personal property in County. Value of real estate in Pennsylvania . . . . . . . Total . . . . . . . . . . . . . . . . . . . Real Estate situated as follows: . . a.,. < $ -">1,500.00 $ ~ ~ sea $ $ !~l.,)UV.UU -0 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with tb.i.s p'etition l:rhb the griint:of letters in The appropriate form to the undersigned: '1' lJi ~ , 0\ Typed or printed name and residence Mechanicsburg, PA 17055 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law, DECREE OF REGISTER KAREN L. HESS Estate of X" ~ C ~J;~ Deceased No, dJ--04 -771 also known as Social Security No: 184-60-1799 Date of Death: August 25, 2004 AND NO~ d-3 .;)OO~, \i-, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary 0 of Administration are hereby granted to Ann.. Co T .<mrH" Ic_\./I.; <l,b,n_c,!.; pendenl" Iii..; <l",an,,,.bMf'Ili.; du,an'" ""nO""I1' I in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters... ,.., ,.,. ,.", ........". Short Certificatelsl.......... Renunciation.,.... ......... ,., Affidavit ( )................. Extra Pages ( I............ Codicil..".,....",...........,. JCP Fee........................ Inventory & Tax Forms.., Other..."."."......""....." {tl TOTAL........,......, IlW-7. $ ~S .00 l~-GO $ $ $ $ $ $ I O.6\) $ $ $4-1 ,01) R.g;"" of W;l~ Tharnas S. Beckley Attorney: I.D, No: 77040 Address: 212 North Third Street Harrisburg. PA 17101 Telephone: (717) 233-7691 DATE FILED: September 23. 2004 U'''~5r1~ ~!,:\' ""'~f, Thi, 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. No. a~c:!~ Fee for this certificate, $2.00 p 10530086 AUG 272004 Date (JC~ ;;; ~~~ ::; ., 0".<" if' g c2l-0l/-y7t./ C/) rrl -0 N W #29-344 NAME Of'DECEOENTlFirsl. Mod<lMI.~) Karen COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL REGQROS CERTIFICATE OF DEATH J? . (Coroner) -0 W 0\ 0'\ ,144Aev.1/91 L Hess STREFILE "IlItlI&EA SEX SOCIAL seCURITY rnJU9ER .. Female .. 184- 60- 1799 DAJEOF OEATHlMOO1h,Day.Vear) .. Au ust 25 2004 """,,,'YEAR Monlhl o.~ UNDER 1 DAY -. -. DAJE OF BIRTH lMonth, Oa~. Vear) PLACE OF DERH (Cl>ocI< onlyOrNl- see"'slrocoonsOXIorhlll soJe) HOSPIToI,L Toran to Canad .r'IplIl~nt 0 ER/OutpM~1II 0 1. , ... f'ACILlTYNAMElltnol,nSlJ1u1ion,gr.ssl'liHIlandnumbell BIRTHPLACE lCi1~ and SlaIeorFor~CounIry) CITY, Mar 26,1966 . TWP OF OooH "",0 ~~)o ,. Cumberland Shiremanstown 234 East Main Street RACE . AmerICan mob,", B*;k. Whq..cc l!lpecdyl White .. klNO OF etJSINESSllt40USTflY BURVMNQ SI"OUSE (llwi1.,givemaideonamef 234 East Main stteet ,.'>hiremans town Pa 17011 FRlEFl'S NAME tFinl. Middle. la$lj ,. Jack Hess INFORMAHT'SNAME{T~l Ann Lanais ......., ,.,",o.mON BurImD er......ion[j:FI1ernowIlromStMeO l1b.eo.. Cumberland "" -- ..... ......., ... llG.OYll..decedenfllved.. ~ ERSON ACTING AS SUCH OATEOFDlSPOSITtON o """"''8':'d 7- c L{ , '''''N15!~3'4_ L ~ ,*"dKadent~.-.d Shiremanstown 11cl.~wlIhlnecl""llmlIIoI MOTHEA'SHAME IF''.. Middle, MaidenSurnam.) 1 . Anne Jennin s INFORMANT'S MAILING AODflESS {S/feorl, C~~fTown, SIaIlI. Zop Code) 3 Greenway Drive Mechanicsbur ,Pa 17055 PlACE DlSPOSITION- Mleolc.mel!KY.Cf_tory LOCRION.CMy .SW.,ZlpCode ~-- Holli.nger Crematory ..... NAME AND AOORf:SS OF FACILITY JIG. ers-Harner Funeral LICENSE NUMBER '" . 1blhlbntolmyk~,dNIhOCC;urrltd.11hlrlim..dlll.IIldplac>>'I.IItd. lSign8Iur.BndTiIle) OA1E PRONOIJNCEO DEAD {Monlh. Day. Yea,} .. M ,. August 25, 2004 v. """ I: e-lhedIMMM,lnjurlMor~wI1lchcauudlhedellh. DoIlOlIfII.rllMlrTllKleolclying.sucllasCWdiecorrnpif.IOfyu,..t,sho<:korhHilr.lIur. Ultonl>>'__on.KIt~"" ",0 Pend in I ve ti a on OUE 10 (OA AS A CONSEQUENCE OF) ,- :inter<'.,be1WHn :o~.nddHtll : PARTII: OIherllgnlrlCllnlOOllllllonsGOolrlbullnglOdNIIl,bu1 not1MUlllAglnlheundMly~cauuQivenI!tPARTI DUE 10 (OR AS A CONSEOUENCE OF): DUE TO(OR AS A CONSEQUENCE Of) , WERE AUlOPSY FINOlNGS MULABLE PRIOR TO COMPlETION OF CAUSE OF DEATH? MANNEflOFDEATH DJJEOF(NJURY (M<)nIh.Oa~, Yea,> TtMEOF'NJURY INJUAY AT WORK? DESCAtsE HC1N fNJUAY OCCURREO. Nalurel o o o Homierdll Pendinglrwntigalioll CouIdllOlbedllllfmirted o r1f. YlII 0 NoD ".0 ",0 """"'" -. .... CUlTlfIBIlfCho<;lconlyone) "CUlTWY-..a PtlV8fCtt.N (Ptlysiclllll cllllrfylOQ cause or dealh when anoIhe< phYSIC'"'' has p",oounced dealh am.! Complllloo 118m 23) TG the M.I 01..., kno...., lINin OCC:UfNd.....to the GllIIH(.) snd msnner .. IYled. . ...... ... O PlACEOFfNJUflY.AlIlom..'um.llrMt,f&clOry,o!lk:e bu*jj~..cc.(Sp;lO~~) .... LOCAflONlSlree\, Cil~lTown, SIaIa) .... SIGWlfURE AIW TIT E OF E OMEDtCAL EXAIIINERfCORONER On tM ...... ot..-anel;1on 8fIdIor Imr..ug.tlon, In my O9lnion, d..th oeGur,.. al tha time, dale, and place, end due 10 the ceu..(e) and __Meted........................................,................,............"...,.................,... . 318. REQI81"RAR'~NA:rURE AND NUMBER .. ~ ~ bJ ~/il1 Chief De uty Co 0 e UMBEA OATCSlGNEOlMonlh,o.y.Yeer) o 1. ,. August 26, 2004 NAME ANO ADDflESS Of' PERSON WHO COMPlETEO CAUSE OF DUifH (flem27) Type or Prinl Todd Co Eckenrode, Chf . Dep. Coroner <'d 6375 Basehore Rd., Suite #1 ~u. Mechanicsburg, Pa. 17050 DATEFIlEO{MOnlh.Oa~, YeaI) "PfIOHOIIHClHQ AN[) CEftnFYI'tQ PHVIIClAlt (Phy8lCliW'l bolh prorlOlJ/lCO'lg dealt> and cer"ty'f\g ICl cause 01 dearll> TQ Ihll..., OIl wry llnoMIdge,dHIh IICCllrTMI.llMtIme, ale, end pI!IG., ilndduetolhllC-.{.)........n...r..Ifaled.. 031. , ... INRE: Estate of Karen L. Hess, deceased : IN THE COURT OF COMMON PLEAS :OF CUMBERLAND COUNTY, PENNSYLVANIA : No. 21-04-0874 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. Karen L. Hess August 25, 2004 21-04-0874 Admin. No. To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on September 24, 2004. Name Anne C. Landis Address 3 Greenway Drive, Mechanicsburg, P A 17055 Notice has been given to all persons entitled thereto under Rule 5.6(a) except: None. Capacity: Signature: ::::::-.. ~/ Name: Thomas S, Beck1ev. Esquire Address: 212 North Third Street P.O. Box 11998 Harrisburg. P A 17108 Telephone: (717) 233-7691 Personal Representative X Counsel for personal representative Date: Seotember 24. 2004 <11ll1l8 r~() EZ: Zlel LZ d3S 170. ',}-! ~ CLAIM FORM ESTATE OF K~R.:E'T\T T. HF.~~ THE BON TON ORPHANS' COURT DIVISION OF COURT OF COMMON PLEAS OF COUNTY CUMBERLAND NO. 21- 0 4 - 0 8 7 4 Notice of claim by in the amount of S 209.50 filed pursuant to section 3384, Probate, Estates and Fiduciaries Code Laws of 1972, Act No. 104 effective July 1, 1972 as amended. Date 19 9441 LB~' FREEWAY TO THE" CLERK OF THE ORP.HANS' COURT DIVISION: Lock Box 30 Enter the claim of THE BON TON Dallas, TX 75243 (Claimant and Address) 209.50 in the amount of S against the above entitled Estate. The decedent who resided at 234 EAST MAIN STREET, SHIREMANSTOWN PA (Address) 1 7 QiJ-d on 8/25/ 04 ( DateL ANNE C. LANDIS c/o THOMAS A. BECKLEY,ESQ. Written notice of said claim was given to (Personal Representative or Counsel) at P.O. BOX 11998 HARRISBURG PA 17108 on (Address) (Date) The basis of aforesaid claim is as follows: (Itemize fully to enable personal representative to make proper investigation). Acct.#116-047-390 (Name) ClaLrnant's Counsel ame) (Address) 1 G, 441 LBJ FREEWAY Lock Box 30 u Dalasp'fSX) 7f5243 ~~J PROBATE COURT Cumberland County, State of Pennsylvania Karen L. Hess, Deceased Case #21-04--984 Proof of Mailinq I mailed the creditors claim to the fiduciary (and attorney, if applicable) as follows: I deposited a copy/copies of the clainl with the United States Postal Service in a sealed envelope with the postage fully pre-paid. I used first-class mail. I am employed in the county where the mailing occurred. The envelope(s) was/were addressed and mailed as follows: Ms. Anne Landis c/o Thomas A. Beckley, Esq. P.O. Box 11998 Harrisburg, PA 17108 Date of Mailing: I~N County of Mailing: Dallas, Texas I declare enalty of perjury that the foregoing is true and correct. Date: for The Bon Ton P.O. Box 741026 Dallas, TX 75374 P.~1 Document Name: untitled CMD=> PH 717 303 1894 NAME *KAREN L*HESS ADDR 3 GREENWAY DR CITY MECHANICSBURG 4TH % ANNE LANDIS SPSE EMPL EADD ECTY EPHN RPHN LST PAY 20040727 1ST LET 20041002 NM 30.00 061 * COLLECTIONS * BTS QUEUE 83 LOC 116047390 F O-AC CP 22.50 LIM 0 RP 10.00 CYC 79 ?? MP .00 PA 17055 STAT DTLH MPI 3 AGE 3 TU 1 09/04 SCR 0 WAC 1 EMP CUR SEP AUG ADJ PDUE 40.00 40.00 30.00 DSP N ADUE 50.00 50.00 40.00 SSN 184 60 1799 PUR .00 .00 25.00 PAY .00 .00 .00 OPEN 20030713 CRED "00 .00 .00 FCHG .00 28.09 26.90 NBAL u209.50. 209_<;0 1 01 ~ 1 RE\I.l5OCUof6.oo] *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER ____n______ _00_ f8I 1. Original Return -0 2. Supplemental Return o 4. Limited Estate 0 4a. o 6 Decedent Died Testate (Attach copy 0 7. of Will) o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale of death between 0 11.Election to tax under Sec. 9113{A) (Attach Sch 0) I_~~--__.IIII.................. NAME COMPLETE MAILING ADDRESS Thomas S. Beckley COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE OEPT.280601 HARRISBURG. PA 17126-0801 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Hess, Karen L ~ z w c w U w c DATE OF BIRTH (MM-DD-YEAR) 21 2004 _____ COUNTY CODE _ _Y~_R ----------- SOCIAL SECURITY NUMBER 00874 NUMBER DATE OF DEATH (MM-DD-YEAR) 08/25/2004 03/26/1966 184-60-1799 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER I DU o 3. Ramainder Return (date of death prior to 12-13-82) w ~ :..:~(I) u~~ w.u ,00 u~~ .m . . Future Interest Compromise (date of dealh after 12-12-82) Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes Copyright 2000 form software only The Lackner Group, Inc. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) ,~ ~z Ww ~o ~z 00 U. FIRM NAME (If applicable) Beckley & Madden 5. Federal Estate Tax Return Required 212 North Third Street t<:> .(~ ~n Post Office Box 11998 CJ c..: ~-, (_~ 1 f-ll Harrisburg, PA 17108 (:;C") <-:> -:;,-) C) -.~~ C=l ::,'I~:' , (1) None -..;:J ',-,'j (2) None ."',J I :, .u c:'"'j (3) None ., ~ ",,) , " -4 .:) C) (4) None ", -'-'1 VJ (5) 1,996.41 (6) None (7) None (8) 1,996.41 TELEPHONE NUMBER (717)/233-7691 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) z o ~ S ~ ~ . . U W ~ 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 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) (9) (10) 3,230.63 921.84 11 Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) (11) 4,152.47 (12) insolvent 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) (13) (14) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) z o ~ . ~ ~ . ~ o u ~ . ~ 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 x .00 (15) x .045 (16) 19. Tax Due x .12 (17) x .15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT '''''''''''''''''' ,=",;.'""-.;.", 20. 0 ~.................miillllu~lllIIIlIlllDllmllliiiliiiiilH:ii v- Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 234 East Main Street Apartment C CITY Shiremanstown : STATE PA ~~u IZIP 17011 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2 Credits/Payments A. Spousal Poverty Credit B Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 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 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE A. Enter the interest on the tax due. S. Enter the total of Line 5 + SA This is the BALANCE DUE. (3) 0.00 (4) (5) 0.00 (5A) (56) 0.00 Make Check Payable 10: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "XU IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: a. retain the use or income of the property transferred;.. b. retain the right to designate who shall use the property transferred or its income;.... c. retain a reversionary interest; or... d. receive the promise for life of either payments, benefits or care?.. 2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................. 3. Did decedent own an uin 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?. Yes No D ~ D ~ B ~ D ~ D ~ 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 penalties of pe~ury, 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 pre parer other than the personal representative is bas~don .al! !~?r.!!'~!i?,,~~~!.C!I prePIl_Il!!-' has any knowled.2e SIGNATURE OF PERSON RESPONSIBLE FOR FILlN~ RETURN AODRESS Ann,CLandi, .~..~: -Y? d '__~ ~~gi:i;,;;~r;g~:!A 17055 SIGNATURE OF PERSON" RESpor;fsIBLE FOR FI~~ t.o- ---- ADDRESS OATE ;j;7/ "!:TE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Thomas S. ~ ~~/ ADDRESS 212 North Third Street Post Office Box 11998 Harrisburg, PA 17108 DATE /j;7/~ 11,1 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)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) (72 PS. 99116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REnJRN RESIDENT DeceDENT ESTATE OF Hess, Karen L I FILE NUMBER 21:2004 - 00874 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly"",wned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER ] Miscellaneous clothing DESCRIPTION VALUE AT DATE OF DEATH 250.00 2 Television 25.00 3 Miscellenous furniture ]50.00 4 Costume jewelry 55.00 5 ] 988 Dodge Omni (150,000 miles) 450.00 6 Susquehanna Valley Credit Union (checking account) ],066.41 TOTAL (Also enter on Line 5, Recapitulation) 1,996.41 . SCHEDULE H FUNERAL EXPENSES & AIlIIIINISTRATlVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hess, Karen L I FILE NUMBER I 21 - 2004 - 00874 Debts of decedent must be reported on Schedule I, ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers-Hamer Funeral Home, Inc. B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s}: Street Address City Year(s) Commission paid State Zip 2 Attorney's Fees 3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills State Zip 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs The Cumberland Law Journal (Advertisement Fee) 2 The Patriot-News (Advertisement Fee) Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 2,882.00 47.00 75.00 196.63 30.00 3,230,63 ESTATE OF '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hess, Karen L 3 Filing of Inheritance Tax Return 4 Filing of Inventory Schedule H Funeral Expenses & Mninislrative Costs continued I FILE NUMBER 21 - 2004 - 00874 Page 2 of Schedule H 15.00 15.00 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hess, Karen L FilE NUMBER 21 - 2004 - 00874 Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT Bon-Ton Credit Card (Account # 116-047-390) 209.50 2 Comcast Cable bill 3 PP&L Electric bill 4 AT&T bill 5 Health Orthopedic 6 Silkies 7 Donegal Insurance 8 SVFCU Visa Card 9 Verizon 5.00 44.81 13.68 20.00 23.54 43.00 554.16 8.15 TOTAL (Also enter on line 10, Recapitulation) 921.84 REV-1513 EX+ (9-00} *' _L SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hess, Karen L FilE NUMBER 21 - 2004 - 00874 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Ann Landis 3 Greenway Drive Mechanicsburg, P A 17055 Mother 100% Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Hess, Karen L I Deceased No. 21 - 2004 - 00874 Date of Death 8/25/2004 Social Security No. 184-60-1799 also known as Anne C. Landis ------------- The Personal Representative(s) of the above Estate, deceased, ver~y that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each Item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that faise statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Thomas S. Beckley perso;i:ln:~;~eset~ t_- ~L Anne C. Landis 1.0. No.: 77040 Signature: Signature: Address: 212 North Third Street Post Office Box 11998 Harrisburg, P A 17108 Telephone: (717)/233-7691 Address: 3 Greenway Drive Mechanicsburg, PA 17055 Telephone: (717) 691-0938 Dated: Personal PrODertv Miscellaneous clothing c') -;0 . ::n , -lJ ~ 250.00 c.::.:') ,';"'-j Television , 25.00 Miscellenous furniture V:>150.00 Costume jewelry -"J =.: 55.00: r-"..) 1988 Dodge Onmi (150,000 miles) '''''150.06 (:r~ v:> Susquehanna Valley Credit Union (checking account) 1,066.41 Total Personal Property $1,996.41 (Attach additional sheets if necessary) Total Personal Property and Real Estate $1,996.41 v- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX *' REV-15~7 EX AFP (03-05) 1? l'- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 HESS 08-25-2004 21 04-0874 CUMBERLAND 101 KAREN L ~ . THOMAS S-BECKLEY BECKLEY & MADDEN PO BOX 11998 HBG Allount Rellitted PA 17108 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 ~ 1t!v.Ylc,.yt.m.m~1ml.wtJn'1!I!.W.!_AW~M!r.m.lWltlmMtfr~.-xttw~AtY.ftyt'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HESS KAREN L FILE NO. 21 04-0874 ACN 101 DATE 04-04-2005 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. 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 1.996.41 .00 .00 (8) NOTE: To insure proper credit to your account, sub.it the upper portion of this forll with your tax paYllent. 1,996.41 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdII. Costs/Hisc. Expenses (Schedule H) 10. Debts/HortgagB 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) 3,230.63 921. 84 (11) (12) (13) (14) 4.152 47 2,156.06- .00 2,156.06- NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. AlIount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. A.ount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TA ED : 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = (19)= .00 .00 .00 .00 .00 DATE NUttBER INTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) <:: ~ \.1_- C)'c.'- LLJ __ C)~ U::- I.. ~ __ I C) C I - Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Karen L. Hess Name of Decedent: Date of Death: August 25, 2004 Estate No.: 2004-00874 Pursuant to Rule 6.12 of the Supreme Court Otphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes [II No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No lEI b. The separate Otphans' 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Otphans' Court and may be attached to this report. Date: 4/20/05 d"~---, . ~~.-,~- ?--~ Signature Thomas S. Beckley, Esquire Name 212 North 3rd Street, P.O. Box 11998 Harrisburg, PA 17108 Address (717) 233-7691 Telephone No. Capacity: 0 Personal Representative o Counsel for personal representative C.) (.<.1 ( {- vA