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Home My WebLink About03-1077PETITION FOR GRANT OF LETTERS Estate of Goldie I. Chestnut also known as , Deceased Darryl Betts No. -03- Social Security No. 183122359 Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or [-~ Decedent, dated 05/07/2001 and codicil(s) dated named in the Last Will of the state relevant circumstances, e.g., renunciation, death of executor, etc 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 incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was dom!¢iled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 244 Arch Street, Apt. #1, Carlisle, PA 17013 - ~q~'~l~r (list street, number and municipality) Decedent, then 81 years of age, died December 16 ,2003 , at Carlisle Re~]ional Medical Center (Location) Decedent 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 ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: 100~000.00 100,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Darryl Betts - 7535 Wertzville Rd., Carlisle~ PA 17013 RW-1 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 Petitione/~s) and that, as personal representative(s) of the Decedent, Petitioner(s)will well and truly administer the esta~lc~~ Sworn to and affirmed and subscribed - ~" ' -' DARRYL BETTS bef re me this ,~,q~ dayof DECREE OF REGISTER Estate of G01di~ I. Ch¢stnut also known as Deceased No. r~l-O:~- 10-7'7 Social Security No: 183122359 Date of Death: AND NOW, ~t-'~_O_.t~,.Tt _~"~z,~ ~t , ~OO ~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary I~ of Administration ((c.t.a., d.b.n.c,t; pendente lite; durante absentia; durante minoriate) are hereby granted to 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 Certificates(s) ............... $ Renunciation .......................... $ Extra Pages ( ) ............... $ I.T.R ....................................... $ JCP Fee ................................. $ Inventory ................................ $ Other ...................................... $ Attorney: Scott W. Morrison I.D. No: 83943 Address: 4 West Main StreeL P. O. Box 232 New Bloomfield PA 17068 TOTAL ............................. $ .._~9;, CO /oh Telephone: (717)582-2300 DATE FILED: /o1-,31 - 03 OATH OF SUBSCRIBING WITNESS Estate of Goldie I. Chestnut No. ~ i -- (~ ::~ -- I O~ '"] also known as , Deceased Scott W. Morrison and Darryl Betts (each) a subscribing witness to the [~ codicil(s) [~ will(s) presented herewith, (each) duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of the Testator(rix) in her/his/their presence and~ in the presence of each other [~ in the presence of the other~Jbscribing witness(es). -~ . ! ~ v - (Signature) Scott V~. Morrison [. Landisbur,q Darry Betts Carlisle (Address) (Signature) (Address) PA 17040 PA 17013 Sworn to or affirmed and subscribed before me this day of ~lo~ary Public t - ~ ~ .~~~ My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. RW-2 his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. 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, $2.00 P 9898875 No. Local Registrar Date m0$.:~. 2~? COMMONWEALTN OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,. Goldze i Chestnut J~e · r~ maze 3 aa -- lz _Z~y ecember . · ~,~-~. I ~.,,~ ~ ~.,~ , o.,~. .... ~.-.--- r' ~' JP 16,2003 ~ I''-~;= ~ ~ I ~; ~- b ,~:~, I ~,~'~, L~'~<"<~'~ .............. ' ~ J. ........ Carlisle Regional Hedicol Cen~..----~..' J~ .... ' .... ,,. za~ng ~rys~al Plant ~U ~ ~ - ,~ ~.~ ' · ' 244 Arch St~e~t,A~t' ~ J~zu~ ' ...~,,.Pennsylvania ~ ,.~.~ '' Carlz sle, Penna 17013 J~ ,~.~ Cumberland ~ .... ~ ~.. CarLisle ,, ~war d Oyler , ~sze ~ uarryl E. Betts I'"r~t~ ~ ~ ,~--. ~. ~. z. ~ 17013 ~s~, I~/D~'~e~tzville Road, CarLisle,Penns lvanio ~D ~-~ ...... u ~-.D ~-~=~' ,,. --~-~ u~=~=,,,~er ~,~u~o I ~snzana ~emetery I ~ .. . ~ . . ~'~--'~F ............. 12,b. Jz,e ... ba~zlsAe ~enns zvanza LAST WILL AND TESTAMENT OF GOLDIE I. CHESTNUT I, GOLDIE I. CHESTNUT of 515B South West Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do hereby make publish and declare this my Last Will and Testament, hereby expressly revoking all other writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my debts and funeral expenses be paid as soon after rny decease as may be practicable. SECOND: I direct that inheritance tax on property disposed of herein shall be paid from my residuary estate. THIRD: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to my Stepson, Terry E. Chestnut of 16 East Coover Street, Mechanicsburg, Pennsylvania 17055. FOURTH: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to my Stepdaughter, Linda L. Hall of 172 East North Street, Carlisle, Pennsylvania 17013. FIFTH: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to Cathy Judware of 12621 Colman Road, Red Creek, New York 13143. Page one oftwo GOLDIE I. CHESTNUT SIXTH: I hereby give, bequeath and devise all the rest and residue of my estate and property, real, personal and mixed, of whatsoever nature and wheresoever situated of which I may own at the time of my death, or to which I may be entitled or of which I may have the right to dispose at the time of my death, as follows: 1. ONE-HALF (1/2) to Darryl Betts of 7535 Wertzville Road, Carlisle, PA 17013. 2. ONE-EIGHTH (1/8) to Cathy Judware of 12621 Colman Road, Red Creek, New York, 13143. 3. ONE-EIGHTH (1/8) to Norman Gillespie of 7467 Gordon Road, Baldwinsville, New York 13027. 4. ONE-EIGHTH (1/8) to Kevin Gillespie of 1461 Route 370, Cato, New York 13033. 5. ONE-EIGHTH (1/8) to Brenda Gillespie of 26 Salina Street, Baldwinsville, New York 13027. SEVENTH: I hereby appoint Darryl Betts as Executor of this, my Last Will and Testament. I further direct that he shall not be required to give bond or other security in any jurisdiction wherein proceedings may be held in connection with my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7th day of May, 2001. WITNESS: , GOLDIE I. CHESTNUT Page two of two LAW OFFICES SCOTT W. MORRISON Center Square, P.O. Box 232 NEW BLOOMFIELD, PA 17068 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Goldie I. Chestnut Date of Death: 12/16/2003 SSN: 183-12-2359 Date Letters Granted: 12/31/2003 To the Register: Estate No. 2003-01077 File No. 21-03-1077 Will No. Adm. No. PA 17055 I certify that Notice of 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 01/06/2004 Name Terry E. Chestnut Address 16 East Coover Street Mechanicsburq 172 East North Street Carlisle PA 17'013 Cathy Judware 12621 Colman Road Red Creek NY 13143 Norman Gillespie 7467 Gordon Road Baldwinsville NY 13027 Kevin Gillespie 1461 Route 370 Cato NY 13033 Brenda Gillespie 26 Salina Street Baldwinsville NY 13027 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Linda L. Hall Date: 01/06/2004 Capacity: Personal Representative X Counsel for Personal Representative (Signature) Scott W. Morrison, Esquire Name (Please type or print) 4 West Main Street Address P. O. Box 232 New Bloomfield PA 17068 Telephone No. f717)582-2300 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE " BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-060'1 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O3621 BETTS DARRYL 7535 WERTZVILLE ROAD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 183-12-2359 FILE NUMBER: 2103- 1077 DECEDENT NAME: CHESTNUT GOLDIE I DATE OF PAYMENT: 03/02/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $20,000.00 REMARKS: CHECK#NONE SEAL TOTAL AMOUNT PAID' $20,000.00 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACCOUNT NO. LAW OFFICES SCOTT W. MORRISON CENTER SQUARE, P,O. BOX 232 NEW BLOOMFIELD, PA 17068 TELEPHONE: 717-582-2300 FAX: 717-582-4220 October 27, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: Estate ofGoldie I. Chestnut PA No. 21-03-1077 To Whom It May Concern: I enclose herewith two inheritance tax returns to be filed in your County, together with a check in the amount of $225.54 payable to Register of Wills, Agent. Very truly yours, Scott W. Morrison, Esquire SWM:trk Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 0O4561 MORRISON SCOTT W ESQ P O BOX 232 NEW BLOOMFIELD, PA 17068 fold ESTATE INFORMATION: SSN: 183-12-2359 FILE NUMBER: 2103- 1077 DECEDENT NAME: CHESTNUT GOLDIE I DATE OF PAYMENT: 10/29/2004 POSTMARK DATE: 1 0/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 8225.54 TOTAL AMOUNT PAID: 8225.54 REMARKS: SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Z LU z COMMONWEALTH OF PENNSYLVANL~ DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128..0601 [eb]=U',=NT'S NAME (LAST. RRST, AND MIOOLE INiTIAL Chestnut, Goldie I. DATE OF DEATH (MM-DO-Year) 12/16/2003 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH {MM-OD-Yea,} 0312811922 (IF APPLICABLE) SURVI~qNG SPOUSE'S NAME (LAST, FIRST, AND MIDOLE INITIAL) N/A FILE NUMBER 2 I -0 3 1 0 7 7 SOCIAL SECURITY NUI~ER 183-12-2359 REGISTER OF WILLS [] 1. O~ginal Retum r"-~ 4. limited Estate ]6. Decedent Died Testata [] 9. Li~a~on Proceeds Received l'--'~ 2. Supplemental Retum [] 7. Decedenl Maintained a Living Trust [] 10. Speusal Poverty Cradit (~ d ~ea~ be~ee, 12.31.gl a,d 1.~.~-) E~3. Remainder Retum (dateofdea~p~'t~12-13-82) [] 5. Federal Estata Tax Return Required 0__ 8. Total Number of Sale Depesit Boxes [] 11. Elec6on ta tax under Sec. gt13(A) (,~ach ach ol NAME Scott W. Morrison, Esquire FiRM NAME (If AppieaU, e] TELEPHONENUMBER (717)582-2300 COMPLETE MAILING ADDRESS P. O. BOX 232 New Bloomfield 1. Real Estata (Schedule A} (1) 2. Steaks and Bonds (Schedule B) (2) 3. Closdy Held Corpera6on, Parinerahip or Bole-Pmpfieth~ship (3) 4. Mo~gages & Notea Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal Pmpe~ (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Seperata Billing Requested 7. Intar-Vivos Traosfem & Miscellaneous Non*Probata Property {7) (Schedule G or L) 8. Totel Gross Aaaute {total Unea 1-7) 9. Funeral Expenses & AdministmlJve Costs (Schedule H) (9) 10. Debts of BecedenL Morlgage Liabilitiea, & Liens (Schedule I) (10) 11. Total BeducSon$ (t~taJ Lines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 13. Cha~able 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) (6) (11) (12) (13) (14) 152,126170 13,803.70 1,442.07 PA~ 17068 .~ OFFIC~SE ONLY 161,300.21 15,245.77 146,054.44 146,054.44 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount ~f Line 14 taxable at the slx~usal tax rate, or traosfe~s under Seo. 9116 (a)(1.2) 16, Amount of Une 14 taxalY, e at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rata 19. Tax Due x __ (15) 6,000.00 x .,045 (16) x .12 (17) 140,054.44 x ·15 (16) (19) 270.00 21,O08.17 21,278.17 Decedent's Complete Address: ISTREETADDRESS 244 Arch Street, Apt #1 C~TY Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payrr~nts A. Spousal Poverty Credit B. Prior Payments C, Discount I STATE PA I ZIP 17013 20~000.00 1,052.63 interest/Penalty if applicable D. Interest E. Penalty 4. If Line 2 is greater then Une 1 + Une 3, enter the difference. This is'the OVERPAYMEHT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Une 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 + 5A. This is the BALANCE DUE. (5B) (1) 21,278.17 Total Credits ( A + B * C ) (2) 21,052.63 Total Interest/Penalty ( D + E ) (3) 0.00 · ' 225.54 225.54 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 proper~ transferred or its incon~; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for I~fe of either payments, benefts 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 decadent own en Individual Ratirement Account, aonuity, or other non-prebate 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. U~de~ penalties of peduq, I declare I~at I bce eXar~n~l t~i~ [etum, ~cl~i~ ~.~u~ ~ s~,.~ ~ ~ ~t ~ my k~e ~ ~li~, ~ ~ ~e, ~ ~ ~pleH. S,G~TURE ;~O~ESP~SIBLE FOR FLUNG RETURN DATE ADDRESS ~535 We~ville Ro~d Carli.~ j SIGNATURE O F.~] ~A_~R O_TJ[k~:tA~ ~EP~E~ENTAT~VE ADDRESS~ 4 ~/Ve~ Main Street, P. C~. Box 232 NeW'Bloomfield PA 17013 DATE PA 17068 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 alter Jenuary 1, 1995, the tax rate imposed on the net value of transfem to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemat a transfer to a surviving spouse from tax, and the statuto~/requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefciary. For dates of death on or after July 1, 2000: The tax rate imposed on lhe 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 lax rate imposad on the net value of transfers to or for the use of the decodeat's lineal besefciades 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 trensfers to or for the use of the decedeut's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Sec6on 9102, as en individual who has at least one parent in common with the decedent, whather by blood or adoption, COMMONWEALTH OF P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDF. NT ESTATE OF Chestnut. Geldie I, SCHEDULE E CASH, BANKDEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER 21 03 1077 Include the pmcesds of ,tigaflon and the date the proceeds were mce~ved by the estate. All properly Jothtly.ownld with the right of lun~orlhip must be disclosed on Schedule F. ITEM NUMBER 2. 3. 4, DESCRIPTION PNC Bank checking account #5004083707 Franklin Templeton Investments Account #111-11119174368 Sale of car Sale of personal property VALUE AT DATE OF DEATH 4,341.56 3,137.36 1,339.61 354.98 TOTAL (Also ente~ on line 5, Recapitulation) i $ 9,173.51 (If mom space is needed, inset additional sheets of the same size) SCHEDULE G INTER IVOSTRANSFERS& MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Chestnut. Goldie I, 21 03 1077 T~is sci~dule must be cornpl~ a~ fled if the answer to any of questfons 1 b~rough 4 on the ~ s~ d ~e REV.I~ CO~R SHEET ~ y~. DESCRIPTION OF PROPERTY % OF ITEM ~NO-U~ *~ .~U~ O~ ~ ~.~, ~ ,e.,~r~,~ ~0 ~E~ ,~ ~E ~ o~ ~.,~p. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALU~ NUMBER AT~"~'H A ~O~Y ~ ~ ~ ~ ~ E~TA~ VALUE 0F ASSET INTEREST 1. Fidelity and Guaranty Life Insurance Company 10,759.11 100. 10,759.1 Annuity Policy #L9003176 2. Lincoln Benefit Life Company Annuity #LBF1060826 88,935.89 100. 88,935.8 3. lNG USA Annuity & Life Insurance Company 52,431.70 100. 52,431.7(~ Account No. 80068737 TOTAL (Nso enter on line 7, Recapitulate) $ 152,126.7{'} (If rno~e space is needed, insert additional sheets of the same size) STATE OF Chestnut. Goldie I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on ~:)redule I. FILE NUMBER 21 03 1077 ITEM NUMBER 5, 6. 7. DESCRIPTION FUNERAL EXPENSES: Ewing Brothers Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Ccmmissions Name of Personal Representel~ve ($) Darr~l Betts Sodal Security Number(s) I EtN Number of Pe~onal Representative(s) SbeetAddreas 7535 Wertzville Road 206-62-3419 C~y Carlisle sate PA Year(s) Commission Paid: 2004 AttomeyFeas ScottW. Morrison, Esquire Family Exemp~on: (If decadent's address b not the same as claimant's, attach explana~on) Claimant ap 17013 Street Address City Relalionship of Claimant to Decedent Probate Fees Donna M. Otto Accountant's Fees Tax Ret~m Prepare~'s Fees State Zip TOTAL (Also ~ter o~ line 9, Recapitulation) $ AMOUNT 573.70 6,500.00 6,500.00 230.00 13,803.70 (ffmomspaceisneeded, insertadditioaasheels~thesamesize) ~TH OF PENNSYLVANIA INHERJTANC~ TAX RETUI~¢ RESIDENT DECEDENT ESTATE OF Chestnut. GoldJe I. SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS Include unreimburesd medical expenses. ITEM NUMBER DESCRIPTION FILE NUMBER 21 03 1077 2. 3. 4. 5. 6. 7. 8. 9. 10 11. UGI - account PP&L - electric bill Dillers - trash hauling Sprint - telephone bill Allstate - account Mellon Bank - account balance Eric Hench - carpet cleaning West Shore EMS - account Sentinel - estate advertising Cumberland Law Journal - estate advertising Group's tax and payroll service - account TOTAL (Also enter on line 10, Recapitulation) AMOUNT 234.53 145.88 36.25 25.62 42.25 168.01 58.50 497.34 98.69 75.00 60.00 1,442.07 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chestnut Goldie I. NUMBER 1. 2. 3. 4. 5. 6. 7. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pndude oublght spousal distributions, and bansfers under Sec. 9116 (al (1.2)] Terry E. Chestnut 16 East Coover Street Mechanicsburg, PA 17055 Linda L.. Hall 172 East North Street Carlisle, PA 17013 Cathy Judware 12621 Colman Road Red Creek, NY 13143 Darryl Betts 7535 Wertzville Road Carlisle, PA 17013 Norman Gillespie 7467 Gordon Road Baldwinsville, NY 13027 Kevin Gillespie 1461 Route 370 Cato, NY 13033 Brenda Gillespie 26 Salina Street Baidwinsville, NY 13027 I FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT Do Not List Tmetee(s) Stepson 1077 AMOUNTORSHARE OFESTATE 3,000.00 Stepdaughter none none none none ~one 3,000.00 3,000..00 and one-eighth rest ahd residue one-half rest and residue one-eighth of rest and residue one-eighth of rest and residue one-eighth of rest and residue 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 ri- _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (if rno~e space is needed, insert edditio~al sheets of the same size) LAST WILL AND TESTAMENT OF GOLDIE I. CHESTNUT I, GOLDIE I. CHESTNUT of 515B South West Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do .hereby make publish and declare this my Last Will and Testament, hereby expressly revoking all" other writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my debts and funeral expenses be paid as soon after my decease as may be practicable. SECOND: I direct that inheritance tax on property disposed of herein shall be paid from my residuary estate. THIRD: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to my Stepson, Terry E. Chestnut of 16 East Coover Street, Mechanicsburg, Pennsylvania 17055. FOURTH: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to my Stepdaughter, Linda L. Hall of 172 East North Street, Carlisle, Pennsylvania 17013. FIFTH: I hereby give and bequeath the sum of THREE THOUSAND DOLLARS ($3,000.00) to Cathy Judware of 12621 Colman Road, Red Creek, New ~/ork 13143. GOLDIE I. CHESTNUT Page one of two SIXTH: I hereby give, bequeath and devise all the rest and residue of my estate and property, real, personal and mixed, of whatsoever nature and wheresoever situated of which I may own at the time of my death, orto which I may be entitled or of which I may have the fight to dispose at the time of my death, as follows: 1. ONE-HALF (1/2) to Darryl Betts of 7535 Wertzville Road, Carlisle, PA 17013. 2. ONE-EIGHTH (I/8) to Cathy Judware of 12621 Colman Road, Red Creek, New York, 13143. 3. ONE-EIGHTH (I/8) to Norman Gillespie of 7467 Gordon Road, Baldwinsville, New York 13027. 4. ONE-EIGHTH (1/8) to Kevin Gillespie of 1461 Route 370, Cato, New York 13033. 5. ONE-EIGHTH (1/8) to Brenda Gillespie of 26 Salina Street, Baldwinsville, New York 13027. SEVENTH: I hereby appoint Darryl Betts as Executor of this, my Last Will and Testament. I filrther direct that he shall not be required to give bond or other security in any jurisdiction wherein proceedings may be held in connection with my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7th day of May, 2001. WITNESS: , (SEAL) GOLDIE I. CItESTNUT Page two of two I! PNCBAN Feb~un_.--y 10, 2004 P.O. ]~x 232 New Bloomfield, PA 17068 Emte of Oold~ L Chestnut, ~ $SN: 18~-12-2359 DOD: 12/16/2003 Dear Mr. Morrison: Xn response to your n~luest R~r D~te of Death ba~ano~ for the customer nord abom~ our ~cotds show ~he following. Account #5004083707 GOLI)IE I CHESTNUT DOD balance: $4,341.27 + $.29 ncoru, ed int~'est Established 0~/0~/200'2 P]emse no~e th .n_t this ~ only provides a~t~ of de~b bslst~ea fOr deport ~cco~mt~ transacdom or provide sta~ments, f~you need ss~stan~e wit~ nny of these items, ple~e call 1-888-PNC-BANK (1-888-762.2265) or stop by your local PNC Bnnk brnnoh office. Sincerely, Ra~holle W, II~ 1-800-762-1775 PT-PFSC-O4-F $00 first Ave. Pittsburgh PA 1~219 FDIC TnTP~ P. ~tt FRANKLIN TEMPLETON INVESTMENTS January 29, 2004 Landis Financial Services Attn: Troy H. Lar~dis 74 West Pomfret Street Carlisle, PA 17013-3216 SUBJECT: Franklin Money Fund - Class A A/C #111-11119174368 Goldie I Chestnut Dear Mr. Landis: We are writing in response to your recent correspondence concerning the death of the shareholder on the referenced account. Until we obtain documentation from the individual authorized to instruct us, we may suspend liquidation and transfer requests for the protection of the account. To remove the temporary suspension and transfer shares held in the account, we require the following: The enclosed Shareholder Request Form, signed by the executor for the estate, indicating the new registration, with the signature guaranteed by an "eligible guarantor institution," as specified on the form. Letters Testamentary issued by the probate court naming the executor for the.estate. The document must be certified by the court within the last 60 days. We are unable to accept a photocopy. The enclosed Account Application, completed and signed by the executor for the estate. To prevent the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain and verify information identififing each party on an account. In Section 1, please have the executor indicate the estate registration and Taxpayer Identification Number as well his/her name, street address of residence, date of birth, and Social Security Number. In addition, the Signature and Tax Certification section must be completed and signed to certify the estate's Taxpayer Identification Number and prevent potential backup withholding in accordance with Internal Revenue Service regulations. Enclosed is a postage paid envelope for your convenience. Our records indicate that the referenced account is the only account registered to Goldie I. Chestnut. According to our records, the referenced account held 3,137.360 shares on December 16, 2003. The net asset value o f the Franklin Money Fund - Class A at the close of market on that date was $1.00 per share, for a total dollar value of $3,137.36. FRANKLIN TEMpLETON INVESTMENTS Page 2 FmnldJn Tmnld~o~ Imamor S.rd~l. lie 1 O0 Fountain Parkway St. Petersb(~O. Fiodda 3371~-1205 tel 800/632.23~ f rankfintemple~on.cern Troy H. Landis January 29, 2004 Additionally, as ofl~cember 16, 2003, the account had accrued .67 in unpaid dividend income, which was included as a portion of the dividend that was reinvested on December 31, 2003. We welcome any questions that you may have regarding this matter. You may contact a Share,llolder Services Associate, Monday through Friday, 5:30 a.m. to 5:00 p.m. Pacific Time, toll free at 1-800/632-2350, ext. 35900, and refer to identification number: 10210-22DEC03. Sincerely, Franklin Templeton Investor Services, LLC Lanie Mena Senior Associate Shareholder Services FIDIEUI'Y ~ND ~UAJ~AJ~ UFE IM~U~E P.O. g~ 81497 Lincoln, NE 68501-1497 1.M&$13.8797 February 19, 2004 SCOTt MORR/SON POLICY NUMBER: Lg(g)3176 ACCOUNT VALUE CONFIRMATION ,. Mr. Merrison: This letter is to coafum the value ofth~ above roferencod annuity issa~l January 15, 2003. TI~ value of the contract as of tho Date of Death is $10,759.11. We appreciate having'this opportunity to b~ of ~rvlc~! If you have any qu~tions, o~m~l additional information, plca~ contact our Policyholder Services l)q~aflm~t at 888-513-8797 optio~ 3. Sincerely, Jennifer WcHer Claims Department www.omfn.com Lincoln Benefit Life Company 300 N. Milwaukee Avenue Vernon Hills, IL 60061 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 LINCOLN BENEFIT LIFE COMPANY A Merab~ of Allatate Financial Croup February 6, 2004 Troy H. Landis Landis Financial Services 74 West Pomfert Street Carlisle, PA 17013 Insured: C-oldie I. Chesmut Contract No: LBF1060826 Dear Mr. Landis: We have been requested to complete fits Form 712 with regard to the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is provided as of the date specified: Date of Death: Annuity Value* as of Date of Death: Cost Basis: Named Beneficiary: December 16, 2003 $ 88,935.89 $ 85,00O.00 Dan34 Betts & Marlena S. Betts *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. ff you have any questions, please contact our Customer Care Unit at 1-877-499-6418. Sincerely, Randy Asturrizaga Sr. Claim Processor January 30, 2004 SECOND REQUEST TROY LANDIS LANDIS FINANCIAL SERVICES 74 WEST POMFRET STREET CARLISLE PA 17013 Re: 90141055-Goldie I. Chestnut Dear Mr. Landis: We are sorry to hear of the death of Goldie Chestnut. The beneficiary of the policy is her estate. The death benefit is the accumulated value of $52,431.70 as of December 16, 2003. We will add simple interest to the proceeds from the date of death to the date settlement is mede. The estate mey receive the proceeds in a single sum. Here is what we need in order to pay the proceeds: 1. A certified copy of the death certificate. The death certificate needs to show the cause of death. certified copy of the court appointment of executor or personal representative for the estate of Goldie Chestnut. The enclosed Claimant's Statement, completed and signed by the estate representative. Page 3 of the odginal contract. If the policy has been misplaced, please complete the lost contract section on the reverse of the Claimant's Statement. Please contact our Call Center at 1-800-369-5303 if you need more information. Sincerely, Craig VVigton, FLMI, ACS, ALHC Annuity Services Department 909 Locust Street Des Moines, IA 50309-2899 SCOTT W MORRISON LAW OFFICES CENTER SQUARE P O BOX 232 NEW BLOOMFIELD PA 17068 January 14, 2004 Re: GOLDIE CHESTN/)T SSN: 183-12-2359 Dear Attorney Morrison: Pursuant to your letter dated January 06, 2004, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If you have any questions, please feel free to contact me. Sincerely, Ronald D. Hill, Manager TPL - Casualty Unit (717)772-6604 (717)772-6553 FAX LAW OFFICES SCOTT W. MORRISON CENTER SQUARE, P.O. BOX 232 NEW BLOOMFIELD, PA 17068 TELEPHONE: 717-582-2300 FAX: 717-582-4220 January 6, 2005 Cumberland County Courthouse Register of Wills Carlisle, PA 17013 Re: Estate of Goldie I. Chestnut PA No. 21-03-1077 To Whom It May Concern: I enclose herewith a check in the amount of $892.68 for payment of additional inheritance tax on the above estate. Very truly yours, Scott W. Morrison, Esquire SWM:trk m I'-- ..~ -~ r'- C -H -< 0 t- O m COMMONWEALTH OF PENNSYLVANIA OEPARTMENTOFREVENUE BUREAU OFINDIVlOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD OO4811 MORRISON SCOTT W ESQ P O BOX 232 NEW BLOOMFIELD, PA 17068 fold ESTATE INFORMATION: SSN: 183-12-2359 FILE NUMBER: 2103- 1077 DECEDENT NAME: CHESTNUT GOLDIE I DATE OF PAYMENT: 01/07/2005 POSTMARK DATE: 01/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $892.68 TOTAL AMOUNT PAID: $892.68 REMARKS: SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE "C~~c'c'!" (\.~:'1NcO~CE OF INHERITANCE TAX R: Ur\"',L~~RA:d;~JtENT, ALLOWANCE OR DISALLOWANCE c' ',OF IfEllu~TIONS AND ASSESSHENT OF TAX BUREAU OF INDIVIDUAL TAXES INHERlfANCE TAX DIVISION PO BOX 280601 HARRISBURG~ PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-03-2005 CHESTNUT 12-16-2003 21 03-1077 CUMBERLAND 101 ZOOS JAN 10 (\!'i g: 41 SCOTT W MORRISON PO BOX 232 NEW BLOOMFIELD CLEl\r\ OF ~~tf,:N:,Sr~~(JRr Df, PA 17068 Allount Remitted *' REV-1547EXAFPt09-04l GOLDIE I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REV:is'4-j-EX-AFij-fiiFo3Y"NCii'-icE-.OF-YNHER"fi'ANCE-YA'X-j\PPRiiisEi"-iNT~--AL.rOWANCE-OR----.------------ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHESTNUT GOLDIE I FILE NO. 21 03-1077 ACN 101 DATE 01-03-2005 TAX RETURN WAS: ) ACCEPTED AS FILED I X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate {Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule OJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property {Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets (1) (2) (3) (4) IS) (6) (7) .00 .00 .00 ,DO 9.173.51 .00 152,126.70 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: If an assessment was 1ssued prev10usly, l1nes reflect f1gures that 1nclude the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX TS: + DATE 03-02-2004 10-28-2004 NUHBER CD003621 CD004561 INTEREST/PEN PAID (-) 1,052.63 .00 ~ INTEREST IS CHARGED THROUGH 01-18-2005 AT THE RATES APPLICABLE AS OUTLINED ON REVERSE SIDE OF THIS FORM THE (9) (10) 7,953.70 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 161,300.21 9.39~ 77 151,904.44 .00 151,904.44 14, 15 and/or 16, 17, 18 and 19 w1ll returns assessed to date. .00 270.00 .00 21,885.67 22,155.67 21,278.17 877 . 50 15.18 892.68 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. . if' IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR1, YOU MAY BE DUO^ A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 1.442.07 Ill) (12) (13) (14) .OOXOO= 6,000.00 X 045 = .00xI2= 145,904.44 X 15 = (19)= AHOUNT PAID 20,000.00 225.54 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE REV-1470EX(6-88) '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Goldie I Chestnut REVIEWED BY ACN 2103-1077 101 Deborah Washington SCHEDULE ITEM NO. EXPLANATION OF CHANGES H B-1 The deduction for personal representative commissions have been reduced from $6,500.00 to 650.00. No information was submitted with the return to indicate a demand for extraordinary services. The Department bases its ruling on the assets filed for inheritance tax purposes, reasonableness, research and complexity of the estate. ROW Page 1 ;"'''', :'..' ,r.." ,~'-, r--. :"". """ C'" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT BUREAU OF INDIVID,*L.'.~:r,,)ct$ INHERITANCE TAX DIVISImt. PO BOX 280601 HARRISBURG PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN "'g.. , SCOTT ~=MbRRfsON ESQ PO BOX 232 NEW BLOOMFIELD PA 17068 '* REV-16U7 EX AFP 112-041 02-14-2005 CHESTNUT 12-16-2003 21 03-1077 CUMBERLAND 101 Allount RelliHed GOLDIE I 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IW:1'&fJ.,.IY.,{f!f>>..CGr-.6!1..........'"fARWtmer1'lY.!tlYlAlWf.bV.ll:l!'~OFN....................... ... ESTATE OF CHESTNUT GOLDIE I FILE NO. 21 03-1077 ACN 101 DATE 02-14-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-03-2005 PRINCIPAL TAX DUE:. PAYMENTS (TAX CREDITS): 22,155.67 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-02-2004 CD003621 1,052.63 20,000.00 10-28-2004 CD004561 .00 225.54 01-06-2005 CD004811 12.00- 892.68 TOTAL TAX CREDIT 22,158.85 BALANCE OF TAX DUE 3.18CR INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 3.18CR . ~ SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND ,PENNSYLVANIA Name of Decedent: Goldie I. Chestnut Date of Death: 12/16/2003 File No. 2103-1077 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES~ NO_ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to NO.1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES_ NO-L b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES~ NO_ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 05/06/2006 -~efJtTJ 1~ Scott W. Morrison. Esquire Name (Please type or print) PO Box 232 Address New Bloomfield PA 17068 (717) 582-2300 Tel. No. Capacity: Personal Representative ~ Counsel for personal representative uA