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Home My WebLink About95-0312 This is to certify that the certificate hereunto attached is a tine and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. AUG 18 2001` ? Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 N,os.tuR.a. yeY a. NA~ auac Z COMMONWEALTH OF FENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~3s~a7 «c +• -_-- ` _^ Glad s L. .Mess SEx ~~~~ _- - _ ~remale ,. 209 _ 12 - 8764 April 0 1995 AOE p w aill'G . M) uNOE117YEM t>rrDEnlDAr OREDSBIRrnI anrr~ucr<lCaYa.O PtACEGPDERNICjiery eotyon.-,...racoar.eoaN, ab.l 86 ~~ OM Na.. ~ Ml.le~ l~.O.r,+~ sr.d ra.~txorq ~~ Uct. 10-, ohippensburg q YIa ~ ,, ^ a G . ,,, ~„ ~^ ~, E~r..t W ~~ "'~ Rrbna^ h~0.~N1^ COUNTYOf Y DE ON CRY, aGRO.TMi OF W.atrslanO nWMar1 FACRJTY NAMEQnal Mlim. NMa EDENTOFMSPNNIC ORIGa17 RACE-An,.aun eMMl Bl.ti<. MAeM..t South iviiddleto L ^ ~ ;~~ MY...•D.eMO~... Isomer) eader ,Nursing an ~• ~• Cu erland enter "~^°"~~ White °`~OENraw "A1O0C1'"B'0N a..aalax`~°1m.s°oni,..°';$.d"°j S&Ni011aTRY ~ ARIEDiGNl~81 DENY'SEDIIfwVION ~ SWUE-MrrNa 14 SURVNtlgSP01/8E ArBrarxe...a aw+. v»m.e.~a., . p + Housewife ,., Own riome "'^ "°~ ,~ (t+os+) Widow - SMAILINDADDIEaa19..el CAM+.•+~, Str.,2gCaaN DECEDENT'S +~ , ,T. sMr.. t'ennsyl van; a DM ,,..~,.a,,w.,,,.,M„ti aouth ivll a on 84 Smith load RE81DFlecE ,~,,, „~ ,~Gardners,Penna.17324 •^~~ Cumberland T N..atN.a..tAwa -- "1 t ,Yw ,TaL_I .re.wrnm~ra !<RNER's NMIE(~ .t Miaal.. UM _ ,, ilavid aheaffer MO,f1E11'S NAME IF.t Miaa.. M.ia.n , INFO/WANT7 NAMERrP.~Pr:q ,~ Lillian Ed Olson a MABNgAOplEaal9..,1, CiWBwn. Slr.. dPCeaN MEn,DDas oRE Smith Road Gardners Penns lvania 1 24 Bl.tr~ a.eew.^ Iw,w+ea.str.^ ~ °01"'°"^ °""'"~0~"^ ~~o1.9POffirwN•Ntw.ac..r,MKt~.m..,Y I.ocatoN•cltwa...sN,wzt,c.a. rin ville ^ April 22,1995 rw g ap South niiddleton Twp. DIONRUIBF BF.R,ACE PERSp/ACTIIID AaaucN "`"~~" ~~' ... ""A1EANDA00"~'~ 'yigJTM Sou Hanover a ree 08219-L ,wing Brothers ~ ,, ,•„,~,,,,Ir, ~eN ae.~ro..aaww am, Oe.u, e.t. w.a. // ,oar C DRE ~ ~ , _ /~W /J ~ ~/ ~ as DERN n. rS ~ ~ ~ _ . ,.nsl u i,. n aw swa.rw DEAD D.v.lrrl w,BCASE 11EfEAREDro MEDICAL FJ(AANl/EWCORpNlD,7 C7 S S M. aa. .~V Q ~ ~. ^ s• `~ tY IM . A1T h. Ea.r1M aY..n.,4M.I.earemglk.e.n,aerA au..am.aam. O.oa.mrm..ae.aeFO. wra..a.a.eer ,.eVeMMy.mM lilf.NYen.u~r.n..MIMr YiocMalN.rt t.iuw ,A Y , . . ppo. eee. tAVITR OaMr giapM.d.wvr.eo.teiAMpt.a..m.ea ~ BIYEDIAfE iara~na ^°I'.w.tli4ln an unaaMYg crw9N.. is MRf1. C A1 /3!(Fn.~ ~~ Ca ~ e / ,, ~ "~ ,, - DOE IORASA NCEOF} '.~c 1 E.~.,~ C ~ DVEroroR ASACONSEauENCE OFk 1 a M.1 ~~f.Ma MIIMb ~Y 1 n.ule,9n4netWT OUEro(aR ASACONSSEOUENCE OFk I a. NKRAN AUiDP$Y YIEpE AUIOPaY FlNDMIDS MANNER OF DEVN , ~~,~~) TIME OF INJWIY tN,AIRYRVRKIK7 DESCREYEf10WINJIMY000URAEO. COAKF110N OFOMISE .yr OF DERNT N...a d, rl..wJa. ^ AcCN.r. ^ P.naYp lnnellY.llen ^ `h. ^ N. ^ q. ^ No ~Y. ^ Ne ^ 9WCM. ^ CaWn.tp.O.,.,mM,ea ^ M' nACEaoBUUav-AIIbm..lym e...I Ntlory eAk. , , . wcATaNtsnew.c+w~ .srN nt., x araeq ne.ISacM) x.. iFl~a n p rl a~ IIPnr~c«W..gca..aarnwn..aronr d.YaK~an n~wonance aaam aro comwwrtan zal d slGwauRE ANOTR ~~ ER /,,/ iq'4new1.AP.a.aheaw.aawbnr ewwNNana ~r.wraw.ae ..................................................... M f ~ ~ ,0. VZ ! 'TOPiOAND CBIY1FYaW PNYa1pAN lPlryei'~Oat~warounc+q seem arM C.rlity.p wcaue.aaa.ml LICE DRE DIM~aArill.. Oe%`hrl ..,.Im.,•1•aP.dMtlA.eewl.e MBM Ber.4M, ana pi.e...ea mm,.MU,...u.NN.rqm.m.rw.WW ..... ^ 1 9 O )~ 1 'F ..................... . ~ ]t T.' NAME AND SS OF PERSON WNO COMPLETEp Oi oF..VN (Item 27) Typ. er Prll~yl, ,, r ~ On tlN E..M W ~~anNar Inv.slly.NOn. In mY.W.bR d..M occump .1,~ tl /~ry7y GL , . m.. daN. antl pIM:.. arW du.le 1M e.up(.).~q n~ m.mu.nwt.a .............................................. /~i~tT~V '~ T'£ ~,.. .................................................... ^ 303 nr: GISTRAR'S SIONRU NUMBER I b ~.~e Q ~~ ~ I ~a 0 1 b- C~Cy ~~~,/ ORE FlLED IMmm OeY.N~r) . .Q~ . ( ~ R ~• APr~\ do,199s' REV.15~ 0 E)t'+ (7-4~A1 f` ~~~~''~~ l ~ ~ y"- ~' INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE DEPARTMENT OF REVENUE DEPT. 280601 WITH REGISTER OF WILLS) HARRISBURG, PA 17128.0601 z W O W W D W Y ~ y Y yVjdV =¢o ~gm a y Z O o= w a°, Hess, Gladys L. 209-12-8764 4/20/95 10/10/08 c,~„t IIF APVlICA6lE) SURVIVING SPOUSE'S NAME ILAST, FINST AND MIDDLE INITIAII SOCIAL SECURITY NUMBER N/A ~] 1. Original Return ^ 2. Supplemental Rsturn ^ 4. Limited Estate ^ 4a. future Interest Compromise (for dates of death after 12-12-82) ~] b. Decedent Disd Testate ^ 7. Decedent Maintained a living Trust (Attach copy of Will) (Attach copy of Trust) ALL. CORRESPONDENCE*AND•°CONFIDENTIAL. TAX' INFORMAT[ON~-SHOLLD:~B Keith 0. Brenneman, Esquire 17 1 697- ^ 3. Remainder Rsturn (for dates of death prior to 12-13.82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes :~~,~ . ,. 44 W. Main Street Mechanicsburg, PA 17055 z 0 d c W C 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bonds (Schedule B) (2 ) 3. Closely Held Stock/Partnership Interest (Schedule C) (3 ) 4. Mortgages and Notes Receivable (Schedule D) (4) y 5. Cash, Bank Deposits & Miscellaneous Personal Property ( )`' 91,574.83 (Schedule E) b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) f 3, 650.00 xpenses (chedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 8. Total Gross Assets (total Lines 1-7) i/ '` 9, Funeral Expenses, Administrative Costs, Miscellaneous ~17 , 459 . ~ 1 (10( °" 187:08 ~, ~j ~~ ~` 1 z 0 c r` d 0 IS. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse Side. (Include values from Schedule K or Schedule M.) 1 b. Amount of Line 14 taxable at b% rate (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 13% rate (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 19. Credits Spousal Poverty Cradit Prior Payments (15) x, __ (1 64.2 x .ts . 5, .63 {.:~~~~~~ ~ jc~. ~-~ (18) 5, 544.63 Discount Interest (19) _ 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) _ ~^ 21. If Line 18 is greater than line 19, enter the difference on Line 21. This is the TAX DUE. (yl) _ A. Enter the interest on the balance due on Line 21A. (21A) _ B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 B) _ Make Cheek Payable to: Register of Wills, Agent ~ ~ BE SURE TO ANSWER ALL GUEST10Ng5 ON REVERSE SIDE AND TO RECHECK MATH Undfrueecorrect and complete.el Ideclarettha~all seal esfadte bas base replordted at true moarke9va ue~ Declarationtof preparerdothereth based on all information of which preaarer has anv knowledae_ ~d ~ - ~- u%..~~°` Executor c/o 44 W Main St Mechanicsburg, PA 17055 SIGf]I T~tRE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS •~~ t"~.. ~' Yt't'G~CC~ ~ 44 W. Main St. , Mech~.ni csburg, PA 17055 FOR DATES Of DEATH AFTER 14131 /91 CHECK EH RE If A sPOUSAL POVERTY CREDIT IS CLAIMED ^ FILE NUMBE! 21 95 e~312 Leader Nursing Home 940 Wal>:ut Bottom Road Carlisle, PA 17013 Cumberland (B) 95,224.83 (t l) 17 , 646.39 7~~ 5-~8 :~--4 - 36 , 964 . Ilal 36,964.22 5,544.63 5,544.63 <m<nowledge and belief, the personal representative is DATE °~28~~ 5` DATE ~f cif/~~ / ~/ Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of th• spouse. The rates as prescribed by the statute will be: • 3°Yo (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2°~6 (.02) will be applicable for estates of deeede~s dying on or after 1/1/96 and before 1/1/97 • 1°y6 (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS. 1. 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 cars$ ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate conaidsration$ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate conaideration$ ................................................................................................... 3. Did decedent own an 'in trust for'. bank account at his or her death$ ...................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. a~.ncir~re.ri. s: CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INN~A~M p~~DEN~TRN PERSONAL PROPERTY Please Print or Type ESTATE [7F Gladys L. Hess 21-95-312 (All properly joinHy-oweed with the Riglst of Swviwrs6ip must be dLclosed on Sdsedule F) ITEM DESCRIPTION VALUE AT NUMBER _ DATE OF DEATH 1. PNC Bank, N. A. checking account No. 5140185791 2. PNC Bank, N.A. Certificate of Deposit No. 1763200016735 3. Meridian Bank savings account No. 8337933603 4. Meridian Bank checking account No. 29361029 5. Harris Savings Bank Certificate of Deposit account No. 17-30-121338 6. Farmers Trust Company checking account No. 11-62845 7. Leader Nursing Home - refunds 8. Miscellaneous personalty 9. Insurance Refund - Mutual of Omaha $ 2,881.31 63,477.73 8,142.44 1,167.13 6,234.23 4,212.98 4,343.37 1,112.50 3.14 TOTAL (Also enter on line 5, Recapitulation) 91, 574.83 (Attach additional 8y:" x 11" sheets iF more space is needed.) REV-1510 EX+ (2-8~ SCHEDULE G TRANSFERS ESTATE OF f PLEASE PRINT OR TYPE NUMBER Gladys L. Hess 21-95-312 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRIPTION OF PROPERTY EXCLUSION TOTAL VALUE D%D• DOLLAR VALUE NUMBER Include name of the transferee, their relationship to decedent, date of transfer. OF ASSET OF DECEDENT'S INT. INTEREST 1. 1.9 acres conveyed to Edward C. Olson $3,000 $6,650 100 3,650 and Nancy A. Olson, his wife, October 14, 1994 located in South. Middleton Township, Cumberland County, Pennsylvani Transferees were not related to decedent TOTAL (Also enter on line 7 Recapitula~ion~ I $ ~`~, 65 (If more space ~s needed, insert additional sheeh of same size.) ~`~,~c~_ ~ ~~~ ~iLAGYY~.6 A .~ FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAx RETURN MISCELLANEOUS EXPENSES RESIDENT DECEDENT Gladys L. Hess ITEM DESCRIPTION NUMBER A. Funeral Expenses: ~• Ewing Brothers Funeral Home 4/20/95 Honorarium to rlinister 4/21:./95 B. 2. 3. 4. G 1. 2. 3. 4. 5. 6. 7. 8. Please Print Of ~~ 21-95-312 AMOUNT Administrative Costs: Penonoi RepreseMotive Commissions Edward C. Olson Soaoi Security Number of Plersonal Representative: 399 - 50 - 8226 Year Commissions paid 1995 Attorney Fees to Snelbaker & Brenneman, P. C. family Exemption N/A Claimant Relationship Address of Goimont at decedent's death Street Address ~h' State Zip Code Probate Fees Register of Wills, Cumberland County Miscellaneous Expenses: Cumberland Law Journal - advertise grant of letters The Patriot-News Co. - advertise grant of letters Wayne Myers Auction Service -fee for sale of personalty Reserve for filing fees, notary costs and misc. expenses R & A Bender, Inc. - removal of nonsaleable personalty TOTAL (Also enter on line 9, Recapitulation) 5,932.00 50.00 4,578.74 4,578.74 147.00 40.00 59.08 383.75 1,000.00 690.00 17,459.31 REV-1512 EX~ (1.93i COMMONWEALTH Of PENNSYLVANIA INXERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Gladys L. Hess Please Print or LUMBER 21-95-312 ITEM NUMBER DESCRIPTION AMOUNT 1• Carlisle Community Ambulance -medical expense (transportation) 20.87 2. Three Springs Family Practice -medical expense 6.07 3. Carlisle Hospital -medical expense 75.75 4. CV Nephrology Associates, Ltd. -medical expense 59.68 5. Carlisle Imaging Associates -medical expense 3.84 6. Carlisle Community Ambulance -medical expense (transportation) 20.87 TOTAL (Also enter on line 10, Recapitulation) I $ =r$ 7 08 (If more space is needed, insert additional sheen of same size.) ESTATE scHEau~ ~ '°"""'°""~"TM°"~~ 9ENEFICIARIES: AMR TO~~ Gladys L. Hess I1'EIYI NUMBER NAME AND ADDRESS OF BENEFlGARY A. Taxable Bequests: 1' Edward C. Olson 87 Smith Road Gardners, PA 17325 ITEM NUMBER NAME AND ADDRESS OF SENERCIARY B. Charitable and Governmental Bequests: ~' St. Jude Children's Research Hospital One St. Jude Place Building P. 0. Box 3704 Memphis, TN 38173-0704 21-95-312 RELATIONSHIP SHARE OF SATE None 507 of residue (36,964.22) AMOUNT OR SHARE OF °3TATE 507 of residue (36,964.22) TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) IS 36, 964 22 (If more space is needed, insert additiono! sheets of some size) ~1 I L L I, GLADYS L. HESS, of Gardners, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. includin I direct that all my debts and funeral expenses, g my gravemarker shall be paid from my residuary estate ae soon as practicable after my decease ae a part of the expense of the administration of my estate. - --~_~ ITEM TWO: I give, devise and bequeath my entire estate as folloi~s-t A. I give, devise sad begt}enth one-half / 1.L~'h'~'m., t t'` DUDE CHILDREN'S R88EARC$ H~SPITAL~~- O. Box 318, Memphis, Tennessee 8101. a, a to ST. le treat, P. B. I give, devise and b'qu th one-half (1/2,.~~--of' my enti estate to EDWARD C. OLSON, of 88 th Road, Gardre~`rs, Cumberlan County, Pennsylvania, in the event at he u~~ves me by 60 days In the event that he predeceases a or snot then living on th 61st day after my death, then I gi e, devise and bequeath my en re estate to ST. JUDE CHILDREN'8 RE EARCH HOSPITAL. ITEM THREE: I appoint E ARD C. OLSON, Executor f this my last will. Should he fail to uglify or cease to t as Executor, I appoint FARMERS TRUST COMP Y of Carlisle, P nsylvania, to act as Executor with the same right owere duties. ITEM FOUR: I have specifically excluded my daughter, MARION GLADYS RITTER, and my son, DEAN ELSWORTH HESS, from this my last will. ITEM FIVE: All estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM SIX: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SEVEN: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B• To invest in any real or personal property without restrictions to legal investments. C• To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. •~ /~~- PAGE ONE OF THREE PAGES E. To make distribution in kind. F. To compromise claims. IN ~1I~'NESS WHEREOF, I have hereunto set my hand this - / ~}' \day of 4rcb `~'' , 1994. SIGN~...F'~J~~ ~ ~~ ~ GLADY L. HESS The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof aigned, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of ench other have eubscribed~q r names. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND = ss ,c 1 t We ~~ w ; , ~or G ~ ~~ I y/'~ ~ItJ ~ and ~iC./,J C~ t ~" ~9~N Al C.~ ~Go L. ff~N witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and eight of the Testatrix aigned the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constrain undue influence. Sworn and subscribed to before me this /~ day of ~6 rua ry. _.,2 0 , 1994 . . ~.J. Notary p c IaI~IF.lYNQL~W1f PUBJC ~COWSSI011F~ESMARCH 18,1995 PAGE TWO OF THREE PAGES COMMONWEALTH OF PENNSYLVANIA s t se COUNTY OF CUMSBRLAND t I, GLADY3 L. HESS, chose name is signed to the attached instrument, having been duly qualified according to lap, do hereby acknowledge that I signed and executed the instrument as my lust will= that I signed it as my free and voluntary act for the pnrposas therein ~' expressed. J~...~ QLADYS L. HE $~iD~n and a ~D}~ ffirmed to and acknowledged before me this ~ day of ,t~~"tlb'y , 1994. ~/to' Notary Pu 1 -~ 8410 ~ CA~8lE8~` COIMIY ~ Clal DSNpB YNICf1141953 PAGE THREE OF THREE PAG88 j REV-1500 EX+ (7.94) ~, _, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVFNUEi DEPT. 280b]1 HARRISBURG, PA 1?12Ei~0601 ~ Hess, Glad,~s L. 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bands (Schedule B) (2 ) 3. Closely Held Stoc:k/Partnsrship Interest (Schedule C) (3 ) 4. Mortgage: and Notes Receivable (Schedule D) (d) ~ _ S. Cosh, Bank Deposits & Miscellaneous Psnonal Property (5 .485.1$ -' (Schedule E) b. Jointly Owned Pr~aperty (Schedule ~ (b ) 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Exppe~nses, Administrative Costs, Miscellaneous E l (9 ) xpenses(Schsdu s H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 1. Total Deductions (total Lines 9 b 10) 2. Net Value of E:tats (Line 8 minus Line 11) 3. Charitable and Governmental Bequests (Schedule J) 4. Nst Value Subjsd to Tax (Line 12 minus line 13) SOCIAL SECURITY NUMBE~t DATE OF DEATH 209-12-8764 _ 4/20/95 ° (If AP-LICARLE) SURVIVING Sf0 JSE's NAME (UST, fIRST ANO MIDDLE INITIALI N/A ~ ^ 1. Original Retl.lrn [~X 2. Supplemental Return YtN W~cYa ^ 4. limited Estates ^ 4a. Future Interest Compromise ~ ¢°¢ ° (for dates of death after 12-12-82) `°D ^ 6. Decedent Died Tsstats ^ 7. Decedent Maintained a Living Trost (Attach copy of Will) (Attach copy of Trust) y Z NAME cZ Keith 0. BrEanneman, Esquire to ~ TELEPHONE NUMBER r 717 - 69;1-8528 FOR DATES OF DEATH AFTER 14!31191 CHECK HERI IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ NUMBER Z1 95 x'312 NTY CODE YEAR NUMBEI ^ 3. Remainder Return (for dates of death prior to 12-13-82 ^ 5. Federal Estate Tax Return Required _8. Total Number of Safe Deposit Boxes DIRECTED TO: 44 W. Main .Street Mechanicsburg, PA 17055 z 0 S d W o: z 0 c d I s - ~~ - ~ INHERITANCE~TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER'OF WILLS DECEDENT'S COMPLETE ADDRESS Leader Nursing Home ATE OF BIRTH 940 Walnut Bottom Road 10 10 08 co arlisle, PA 17013 h CumhPrlanrl 5. Spousal Transfers (for dates of death after b-30-94) Ses In:iroctiona for Applicable PercerMags on Revene (15) Side. (Indude values from Schedule K or Schedule M.) (B) 2,485.18 (11) (12) 2,485.18 ~~ 1,242.59 (la) 1, 242.59 x. __ 6. Amount of Line 14 taxable at b% rats (16) x .Ob = (Include values from Schedule K or Schedule M.) 7. Amount of Lins 14 taxable at 15% rate (17) 1 , 242.59 x 15 ' 186.39 (Indude values from Schedule K or Schedule M.) 186.39 9. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg) i. Credits Spousal Poverty Credit Prior Payments Discount Interest o + + _ (19) v ~ 20. If Line 19 is greater than Line 18, enter the difference on line 20. This is the OVERPAYMENT. (20) r- ~ ^ • 21. If Line 18 is greater than line 19, enter the difference on Line 21. This is the TAX DUE. (21) 186.39 A. Enter the interest on the balance due on Line 21A. (21A) 2.85 B. Enter the total of Lins 21-and 21A on Line 21B. This is the BALANCE DUE. (21B) 189.24 Make Check Payable to: RegisNr of Wills, Agent ~ ~ EIE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the k it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other th based on all information of which preaarar has env knowledge. Ir my Knowledge and belief le personal representative i~ SIRE OF vERSON RESPONSIBLE FOR FILING RETURN ADDRESS - DATE 87 Smith Rd., Gardners, PA 17324 ~ 2i >t' SIG ATU F PARER OTHER THAN REPRESENTATIVE ADDRESS DA E ~lt^ i ~Z'v'r'v~^/~-- 44 W. Main St. , Mechanicsburg, PA 17055 Zi ~ a I Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 396 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2°Yo (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 19'6 (.O1) will be applicable for estates of decedents dying on or after 1~/1 /97 and before 1 /1 /98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK ~,~j IN THE APPROPRIATE BLOCKS. 1. 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 on or before December 12, 1982, did decedent within two years preceding .death transfer property without receiving adequate consideration$ 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'. bank account at his or her death$ ...................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. + REV-1508 EX+'(2-871 r ;, ~ SCHEDULE E CASH, BANK DEPOSITS AND GOMMONWEALTFI OF PENNSYLVANIA MISCELLANEOUS INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT Gladys L. Hess (All property jointly-owned with the Right of Survivorship must be dialosed on Schedule F) ITEM NUMBER DESCRIPTION 1. Adams Electric Cooperative Refund 2. PNC Bank, N. A. Certificate of Deposit 1763200016735 Accrued interest to date of death TOTAL (Also enter on line 5, (Attach additional 8'h" x 11" sheets if more space is needed.] Please Print or NUMBER 21-95-312 VALUE AT DATE OF DEATH $ 27.03 2,458.15 $ ,,2; 485.18 v REV.1513 E%+ (2-87( F' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DKEDENT ESTATE OF Gladys L. Hess ITEM SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1• Edward C. Olson 87 Smith Road Gardners, PA 17324 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1• St. Jude Children's Research Hospital One St. Jude Place Building P. 0. Box 3704 Memphis, TN 38173-0704 FILE NUMBER 21-95-3I2 RELATIONSHIP AMOUNT OR SHARE OF ESTATE None I 50~ of residue (1,242.59) AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) 50' of residue (1,242.59) S 1,242.59 (If more space is needed, insert additional sheets of same size) w REV-1547 EX AFP (12-95) COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAxES APpRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 HARRISBURG, PA 171za-06o1 OF DEDUCTIONS AND ASSESSMENT OF TAX ACN 101 DATE 01-29-96 ^' ~ ~+~ ~~~~~ ULALYJ L FILE NO. DATE OF DEATH 04-20-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO '•REGISTER OF WILLS, AGENT^ REMIT PAYMENT T0: KEITH 0 BRENNEMAN ESp 44 W MAIN ST MECHANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION_ FOR YOUR RECORDS ~ ------------------------------------------------------------- ______ REV-1547 EX AFP (12-951 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HESS GLADYS L FILE N0. 21 95-0312 ACN 101 DATE 01-29-96 TAX RETURN WAS: [ ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1l .00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3l .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 91.57 4.83 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 3.650.00 8. Total Assets (g) 95, 22.4.83 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedule Jl 14. Net Value of Estate Subject to Tax NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Collateral/Class B rate 18. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) 09-29-95 AA082196 .0( INTEREST IS CHARGED FROM 01-21-96 TO 02-06-96 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 17, 459.31 (9) (lo) 187.08 (11) 7 7 .646 ;9 (12) 77,578.44 (13) 36,964.22 (14) 40,614.22 (15) . 00 X . 00_ .00 (16) . 00 X . 06. . 00 (17) 40,614.22 X.15= 6,092.14 (1B) 6, 092.14 AMOUNT PAID TOTAL TAX CREDIT 5,544.63 BALANCE OF TAX DUE 547.51 INTEREST 2.30 TOTAL DUE 549.81 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A '•CREDIT•' (CR), YOU MAY BE DUE . f~V.1470 Ea*'~-881 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 „ DECEDENT'S NAME Giad~s L. Hess SCHEDULE. STEM NO. ~ 1 INHERITANCE TAX EXPLANATION F NANGES NUMBER 2195-0312 1D1 EXPLANATION OF CHANGES This item is taxable at 15 percent and nOt part of the residue. TAX EXAMINER: Sohn Rump PAGE