HomeMy WebLinkAbout03-0891PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
· Deceased.
Social Security No. o? t9 Z - / ~- (~ ~-/ ~ ~
Register of Wills for the
County of (~_.c~ h e-,~ to~.r~d
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 /lJL~-o, / a,
and codicil(s) dated _-.---
in the
named
,1~ ~oo
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~2_,~..~ /3 ~ .--/o~ .d County, Pennsylvania, with
h i ~ last family or principaJ, re_sidence at
(list street, number and muncipality)
Decendent, then ~5~ years of
~ . . . o , died ,,z~._~ ;~ ~.¢- / ~ , 1~ ,.Tao/ ,
Except as follows, dec~dent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
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 $
situated as follows: ~/~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters '-b~-~ ¢r,<~t c-n ¢~-~ c-~/ '
I
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF _(-~;rn~r(nr~d J~
Sworn to or affir,meo~and subscribed
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.
No. lC/
Estate 0~/~//~ J/~Y~?_/3/,~ f'-~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereo~atisfactory proof hax~ing been presented before me,
IT IS DECREED that the instrument(s) dated"7?
described therein be admitted to probate and filed of record as the last will
.~, in consideration of the petition on
FEES
Probate, Letters, Etc .......... $c~. O c>
Short~rtificates( ) .......... ~ .~. cp--
Renunciation ................ $
,t/-) TOTAL $/~/'"// ~-~
Filed . .~.~..c~./..,~-~ .........
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
105.805 REV 9/86
This is to certif~ that the information here given is correctly copied from an original certificate of death duly filed with me as
kocal,Re'gistrar', The original certificate will be forwarded to the State Vital Records Office for permanent ~ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 7555645
No.
Local Registrar ~1~
x._ 6 Dat; '
H105.143 Rev 2/87
TYPE/PRINT
PERMANENT
BLACK INK
Cumberland
Farmer
COMMONWEALTH oF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
John W. Fe~enbaugh
UN~R I O~ I ~ ~ ~RT,' ~ aRTH~ (C~ ~ ~) 6740
~.Aug21, 1925 ~. Silver Spring Twp., I..
~. Silver Spring ~. 63 Honeysuckle Drive ~.~,m.
Agriculture ~ ~ E~~ ~ ~~ ¢~'.~
"- ,z I"- Marri~ [,;. Velma J. RJ~er
PennsvIvanJa ~ ~,.~ ~.~z Ri~r ~nrinn Twn
Cumberland
63 Honeysuckle Drive
,,. Mechanicsburg, Pennsylvania
George B. Fe[tenbaugh
Aug 15, 2001
Velma J. Fertenbaugh
,,. Gertrude Fearnbaugh
I~. 63 Honeysuckle Drive Mechanicsbur,q, Pa. 17050
12,,. Letort Cemetery I,~d. Carlisle, Pennsylvania 17013
FD-014318-L ~. My~ ,rs Funeral Home, Inc. 37 East Main Street Mechanicsbur(j, Pa 17055
DUE TO (OR AS A CONSEQUENCE OF}:
DUE TO (OR AS A CONSEQ~JENCE OF):
LICENSE NUMBER IDATE 6~QNED
INJURY AT WO~K?
LAST WILL AND TESTAMENT
I, JOHN W. FERTENBAUGH, of 63 Honeysuckle Drive, Mechanicsburg,
Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my
last will and testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this Will,
shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my spouse, Velma J. Fertenbaugh.
4. ;~ my spouse does not survive me r)y a period of sixty (60) days, then my
estate I give devise and bequeath to my children, share and share alike, the child or
children of any deceased child taking the share their parent would have taken if living.
5. I nominate and appoint my spouse to be the personal representative of my
estate, to serve without bond. If my spouse cannot or does not serve, then I appoint
Dada K. Harlacher, Jane L. Geiling and Carol A. Convery to be the substitute co-
personal representatives, also without bond.
6. I suggest that my personal representative retain the services of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 16th day of
November, 2000.
"~.~RI(I W: FER'I'i=NBAUGh ~ '
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, JOHN W. FERTENBAUGH, RHONDA S. VON KLITZlNG and HEATHER
A. BARBOUR, the testator and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his last will and that he
had signed willingly, and that he executed it as his free and voluntary act for the
purpose herein expressed, and that each of the witnesses, in the presence and hearing
of the testator, signed the will as a witness and that to the best of their knowledge the
testator was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence.
COMMONWEALTH OF PENNSYLVANIA :
-'SS,'
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by JOHN W.
FERTENBAUGH, the testator herein, and subscribed and sworn to before me by
RHONDA S. VON KLITZlNG and HEATHER A. 3UR, witnesses, this 16TH day
of November, 2000.
, ~/~BARBI
Notary Public ~.~
EV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
o¢' -/3- oo ,'
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL)
[~1. Original Return
[~]4. Limited Estate
E~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
z
u.I
z
O
uJ
0
E~2. Supplemental Return
E~] 4a. Future Interest Compromise (date of death after 12-12-82)
[--~ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
E~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
FIRM NAME (If Applicable)
TELEPHONE NUMBER
'-//7- 91-
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
- /?
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
/~,2 -2oz - 0/7¢
---]3. Remainder Return (date of death pdor to 12-13-82)
~-~5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
E~11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5, Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
J'~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(8)
/,~ (,' ~//-/ ....-
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15, Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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,
OFFICIAL USE ONLY
'F
x.O__
x.O
x .12
x .15
(15)
(16)
(17)
(18)
(19)
O
0
Decedent's Complete Address:
STATE
IZIP
~& /'70.5'0
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E ) (3)
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)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1, Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] [~
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 "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPOBSIBLE FOR FILING RETURN
ADDRESS
SIGNATURE OF PREPARER C)'I'HER THAN REPRESENTATIVE
ADDRESS ' -
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (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. §9116 (a) (1.1) (ii)
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
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 paten
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
~"=~'"'" ~ SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
All proper~y jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
FILE NUMBER
VALUE AT DATE
OF DEATH
EV-1511EX,+ (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ABMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
FILE NUMBER
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) '~/~/n4 (L ,}, j~'p'
SocialSecurityNumber(s)/EINN~mberofPersonalRepresentative(s) /'~..=2 -..2,,~ ~ (~)/~'~/
Street Address ~ ~ /~tO'~ ~. ¢ .% ,z.d./E_/~.. ~ .,~.
City de'~ ~4 ~'ex/~2 ~ /'~ State P/~/ Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
5.
6.
7.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
REV-'1513 EX+ (9-00~,
-,~,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
oo $ - 271
NUMBER
I
1.
II
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
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 NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
qEV-1500'EX (6-00)
COMMONWEAl_IH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
UJ
~-00
Q.
I.-
Z
uJ
C~
Z
Q.
LU
Q~
0
n~
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
FE TEt G I./Gt-/ gorily
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
d.
~]2. Supplemental Return
E~4a. Future Interest Compromise (date of death after 12-12-82)
[~]7. Decedent Maintained a Living Trust (Attach copy of Trust)
E~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL. USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
[~3. Remainder Return (date of death prior to 12-13-82)
---]5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
NAME \[ E L_ ~ ~
FIRM NAME (IfApplicable)
J . F E T E Af &4z/ ¢ /./
TELEPHONE NUMBER
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
n~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
(i3)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) ~"~ x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
0
0
,0
[~1. Original Return
E~4. Limited Estate
~.6. Decedent Died Testate (Attach copy of Will)
~]9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
- - 7Va
Decedent's Complete Address:
STREETADDRESS~.~
STATE
ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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.
(1) O
Total Credits ( A + B + C ) (2) ~
Total Interest/Penalty ( D + E ) (3)
(4)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5)
(5A)
(5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of 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 his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS ~/ - - d,~
ADDRESS'~- '
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 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
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 paren
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. 99116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWE^LTH OF PENNSYLV^NI^
INHERIT^NCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
All propert7 jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
~,~o 3
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
R~-1511E~+ (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
5.
6,
7.
DESCRIPTION
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) '~--~t n~t¢~., j. F~ F'/'~I,~ b& ¢.~
I~ -22
Social Secud~ Numbers) / EIN Numbe~of Pemonal Represen~tive(s)
StreetAddress ~ ~e }/~tz~[~ I~,O~
Ci~ ~e~_Jl~,d & b ~ ¢~ S~te P~ zip
Year(s) Oommission Paid:
AEomey Fees
Family Exemption: (If de,dent's address is not ~e same as claimant's, a~ach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
REV,-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NUMBER
I
1
II
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT ORSHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
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 Il- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
I, JOHN W. FERTENBAUGH, of 63 Honeysuckle Drive, Mechanicsburg,
Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my
last will and testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this Will,
shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or pdvate sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representatiYe.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my spouse, Velma J. Fertenbaugh.
4. ~f ;.-3y spouse does not survive me by a period of s!xb/(60) days, then my.
estate ! give devise and bequeath to my children, share and share alike, the child or
children of any deceased child taking the share their parent would have taken if living.
5. I nominate and appoint my spouse to be the personal representative of my
estate, to serve without bond. If my spouse cannot or does not serve, then I appoint
Darla K. Harlacher, Jane L. Geiling and Carol A. Convery to be the substitute co-
personal representatives, also without bond.
6. ! suggest that my personal representative retain the services of Harold S.
Irwin, i11, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 16~h day of
November, 2000.
~,~)fil(I iN'. FER'I"[=NBAUGi-I ~ '
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, JOHN W. FERTENBAUGH, RHONDA S. VON KLITZING and HEATHER
A. BARBOUR, the testator and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his last will and that he
had signed willingly, and that he executed it as his free and voluntary act for the
purpose herein expressed, and that each of the witnesses, in the presence and headng
of the testator, signed the will as a witness and that to the best of their knowledge the
testator was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence.
~7"-3~HN W. '
COMMONWEALTH OF PENNSYLVANIA :
.'SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by JOHN W.
FERTENBAUGH, the testator herein, and subscribed and sworn to before me b~,.
RHONDA S, VON KLII'ZlNG and HEA witnesses, this 16'n day
of November, 2000. T~~
Notary Public
Nolarial
Harold S. irwin III, Nc)taw Public
Ca[lisle Boro, Cumberland Courlty
My Commission Expires Se. pl. 23, 2002
Member, Pennsylvania ^ss¢~iation of Noi'aries
BUREAU OF ZNDZVZDUAL TAXES
]NHERZTAHCE TAX DZYZSTON
DEPT. Z80601
HARRISBURG, PA ]71Z8-0601
CONNONWEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLOWANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
RE¥-IE~i? EX AFP (BI-nS)
VELNA J FERTENBAUGH
65 HONEYSUCKLE DR
HECHANICSBURG
:~,:~C O~ DATE 01-1Z-ZO0~
L.: Wiil$ ESTATE OF FERTENgAUGH
DATE OF DEATH 08-15-2001
FILE NUNBER 21 05-0891
FEB Z5 AS :31 COUNTY CUHBERLAND
ACN 101
Co., PA
CUT ALONG THZS LZNE ~
Aaoun'~ Ram/'l:'l:ed
dOHN
W
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
RETA/N LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOT/CE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF FERTENBAUGH JOHN W FZLE NO. 21 0:3-0891 ACN 101 DATE 01-12-200~
TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVAT]:ON CONCERN]:NG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nership /n~m*as~ (Schedule C) ($)
~. Nor~gages/No~es RaceAvable (Schedule D) (~)
$. Cash/Bank DeposA~s/HAsc. Personal Propar~y (Schedule E) (5)
6. JoAn~ly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Assa~s
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expansas/Adm. Cos*s/Hisc. Expenses (Schedule H) (9)
10. Dab~s/Hor~gega LAabilA~Aes/Lians (Schedule Z) (10)
11. To~el Deduc~Aons
12. Ne~ Value of Tax Re~urn
15.
lq.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Ne~ Value of Es~a~a Subjec~ ~o Tax
O0
O0
O0
00
00
00
00
(8)
6,6~.00
.00
NOTE: To insure proper
credA~ ~o your accoun*,
subaA~ ~ha upper por*ion
of *his form wA*h your
~ax payment.
NOTE:
.00
(12) 6,6~. O0-
(l:s) . O0
(l~) 6,6~.~. 00-
Zf an assessment was issued prev/ously, 11nes 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
18 and 19 will
ASSESSNENT OF TAX:
15. Amoun~ of L/ne lq a~ Spousal ra*e
16. Amoun~ of LAne 1~ ~axabla e~ LLnaal/Class A re~e
17. Aeoun~ of Line 1~ a~ Sibling ra*a
18. Amoun* of LAne lC~ ~axabla a* Colla*aral/Class B ra~a
19. Principal Tax Due
TAX CREDITS:
PAYHENT RECETpT DTSCOUNT (+)
DATE NUNBER TNTEREST/PEN pAID (-)
IF PAZD AFTER DATE /NDZCATED, SEE REVERSE
FOR CALCULATION OF ADDZTZONAL /NTEREST.
(1.6) .00 X O0 = .00
(16). .00 X 0~5 = .00
(17) .00 x 1Z = .00
(18) .00 x 15 = .00
(19)= .00
ANOUNT PAZD
TOTAL TAX CREDZT I .00
BALANCE OF TAX DUEl .00
TNTEREST AND PEN. .§0
TOTAL DUE . O0
( TF TOTAL DUE TS LESS THAN $1~ NO PAYNENT TS RE~UTRED.
TF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR)~ YOU NAY BE
A REFUND. SEE REVERSE SZDE OF THZS FORN FOR TNSTRUCTZONS.
RESERVATION:
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coamonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class D ¢colletera1) rate on any such futura interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TI P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side.
--Make check or money order payable to: REGISTER OF #ILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1SI:5). Applications are available at the Office
of the Register of Mills, any of the g$ Revenue District Offices, ,Jr by calling the special Z4-hour
ansaaring service for fores ordering: I-BOO-:56Z-ZOSO~ services for taxpayers with special hearing and / or
speaking needs: 1-BOO-447-SOZO (TT only}.
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--arJtten protest to the PA Department of Revenue, Board of Appeals, Dept. g81021, Harrisburg, PA 17liD-lOll, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the arphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revieu Unit, Dept. gBO6Oij Harrisburg, PA 17lAB-0601
Phone (717) 787-6SOS. See page S of the booklet "Instructions far Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one il) day from the date af
deathj to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z} percent per annum calculated at a daily rate cf .000164. All taxes whlch became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary fram calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The appZicable interest rates for 198Z through 2003 are:
Interest Daily Interest Daily Interest Daily
Year , Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .000S48 1987 97. .000247 1999 77. .00019Z
198:5 16Z .000458 1988-1991 117. .000:501 ZOO0 87. .000Z19
1984 llZ .000301 199Z 9Z .000247 20Ol 97. .0002:47
1985 13Z .000356 1993-1994 77. .00019Z ZOOZ 6Z .000164
1986 107. .000:~74 1995-1998 97. .000?47 2:003 57. .000137
--Xnterest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ail1 reflect an interest calculatien to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Name of Decedent:
Date of Death: A~]['
Will No. c~/' o~ {9 0 ~'
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
?ql
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration 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
Name
.arol
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Capacity:
Signature
Telephone(f/~ (~9j ff~
~rsonal Representative
__Counsel for personal representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: .~J t~ ~/tJ l.,).
Date of Death: ~-I,.~ -
Will No.: ,,1 [ 2 D-r3 3 ~' 9 /
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes IX No []
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes .~ 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 ['--]
Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Sigriature-/d, - ~_.)'
Name
Address
f/,?- 2/- 377
Telephone No.
Capacity: ~] Personal Representative
[--] Counsel for personal representative