HomeMy WebLinkAbout12-14-12 (4)
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1505610140
REV-1500 EX (01-10)
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 8 3 2 4 7 0 4 1 1 1 2 2 0 1 1 0 5 2 4 1 9 3 9
Decedent's Last Name Suffix Decedent's First Name MI
S T O N E R S H I R L E Y C
(if Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S T O N E R R. M I C H A E L
Spouse's Social Security Number
1 8 8 3 2 4 7 0 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return (date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise (date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
❑ 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit (date of death ❑ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Aymber
c
R MARK THOMAS, E S Q U I RE c> ;:0 M
c a M C
71
ca
CRE TE OFPILS LFf ONLY
T --I
r- t f'-W I rri
First line of address > CO ~ -
1 0 1 S MARKET S T R E E T
Second line of address
C,f2 C!1 ~
City or Post Office State ZIP Code DATISCRILED
M E C H A N I C S B U R G PA 1 7 0 5 5 6 3 2 8
Correspondent's e-mail address: RMARKTHOM GMAIL.COM
Under penalties of perjury, I declare th I have examined this retu includin accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Dec n of prepay r other tha t perso I representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RES O OR I E - DATE
/L~ - Z
ADDRESS L/ 1J
115 PIN OAK IV CARLISLE PA 17015
SIGNATURE OF P t2A!~ I
NTATIVE D E
MER T N
/P J
ADDRESS
101 SOUTH MARKET STREET MECHANICSBURG PA 17055-6328
PLEASE USE ORIGINAL FORM ONLY
Side 1
I l
1505610140 1505610140 J J
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: SHIRLEY C. STONER 1 8 8 3 2 4 7 0 4
RECAPITULATION
1. Real Estate (Schedule A) 1.
2. Stocks and Bonds (Schedule B) 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
4. Mortgages and Notes Receivable (Schedule D) 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 8 7 2 5 7 . 7 7
6. Jointly Owned Property Schedule F 1 0 8 4 7 6. 5 2
y (Schedule F) ❑ Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 2 2 8 4 9 8. 4 1
(Schedule G) ❑ Separate Billing Requested 7.
8. Total Gross Assets (total Lines 1 through 7) 8. 4 2 4 2 3 2 . 7 0
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 1 3 5 8 2 . 4 7
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) 10.
11. Total Deductions (total Lines 9 and 10) 11. 1 3 5 8 2 . 4 7
12. Net Value of Estate (Line 8 minus Line 11) 12. 4 1 0 6 5 0 . 2 3
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 4 1 0 6 5 0 . 2 3
TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a) (1.2) x 0_ 3 2 6 9 7 5. 2 7 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 8 3 6 7 4. 9 6 16. 3 7 6 5. 3 7
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0. 0 0
19. TAX DUE ......................................................19. 3 7 6 5. 3 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 11 1294
DECEDENT'S NAME
SHIRLEY C. STONER
STREET ADDRESS
115 PIN OAK DRIVE
CITY STATE ZIP
CARLISLE PA 17015-9030
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 3,765.37
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,765.37
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; ❑ FX(I
b. retain the right to designate who shall use the property transferred or its income; ❑ x❑
c. retain a reversionary interest; or ❑ ❑
d. receive the promise for life of either payments, benefits or care? ❑ x❑
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? x❑ ❑
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ❑x ❑
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.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[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 if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [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 percent, 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 percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
SHIRLEY C. STONER 21 11 1294
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. THE BANK OF LANDISBURG - CD - ACCT#700026276 15,024.99
2. THE BANK OF LANDISBURG - CD - ACCT#700026279 35,959.95
3. ORRSTOWN BANK ACCT# 111001582 14.13
4. ORRSTOWN BANK ACCT#4000040502 32,541.70
5. JEWELRY - INCLUDING 2 DIAMOND RINGS AND GOLD COIN NECKLACE 77.00
6 2004 PONTIAC SUNFIRE - KELLY BLUE BOOK VALUE 3,640.00
TOTAL (Also enter on line 5, Recapitulation) $ 87 257.77
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SHIRLEY C. STONER 21 11 1294
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. R. MICHAEL STONER 115 PIN OAK DRIVE SPOUSE
CARLISLE, PA 17015
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 8/27/08 WELLS FARGO - CD 247402093743617 47,797.94 50. 23,898.97
JOINT W/ R. MICHAEL STONER
2. A. 1/4/07 ORRSTOWN BANK # 111001180 CKING 16,555.09 50. 8,277.55
JOINT W/ R. MICHAEL STONER
3. A. 9/17/01 DEED BOOK 248 PAGE 2026 152,600.00 50. 76,300.00
CUMBERLAND COUNTY
INSTRUMENT # 200131043 ASSESSED VALUE
TOTAL (Also enter on Line 6, Recapitulation) $ 108 476.52
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHIRLEY C. STONER 21 11 1294
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICAME) VALUE
1. WELLS FARGO - IRA ACCOUNT 257400091196546 62,357.19 100.00 62,357.19
2. THE BANK OF LANDISBURG CD# 700023085 9,448.33 100.00 9,448.33
POD ZACHARY M. KISNER*
3. THE BANK OF LANDISBURG CD# 700026021 32,229.39 100.00 32,229.39
POD ZACHARY M. KISNER*
4. THE BANK OF LANDISBURG CD# 700023086 41,997.24 100.00 41,997.24
POD STEVEN KISNER*
5 THE BANK OF LANDISBURG CD# 700023084 48,374.41 100.00 48,374.41
POD R. MICHAEL STONER
6 THE BANK OF LANDISBURG CD# 700021986 34,091.85 100.00 34,091.85
POD R. MICHAEL STONER
*Attached hereto as an exhibit are the Disclaimers from
decedents son and grandson. The gift of $15,000 referred to
in the disclaimers is evidenced by the 4 checks attached
which were received over one year before decendent's death.
TOTAL (Also enter on Line 7, Recapitulation) $ 228 498.41
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHIRLEY C. STONER 21 11 1294
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FLOWERS, TOMBSTONE, PASTOR & FUNERAL HOME EXPENSES 8,258.97
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees: R. MARK THOMAS, ESQUIRE 5,000.00
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 323.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL (Also enter on Line 9, Recapitulation) $ 13 582.47
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SHIRLEY C. STONER 21 11 1294
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. R. MICHAEL STONER Spousal 326,975.27
115 PIN OAK DRIVE
CARLISLE, PA 17015
2. STEVEN KISNER Lineal 41,677.72
113 HIGH STREET
DLINCANNON, PA 17020
3. ZACHARY KISNER Lineal 41,997.24
113 HIGH STREET
DLINCANNON, PA 17020
4. JOSEPH A. STONER Lineal 0.00
25 WAGNER DRIVE
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
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, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, SHIRLEY STONER, a resident of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do make, publish and declare this to be my LAST
WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me.
I
I declare that I am married to R. MICHAEL STONER, and that I have one (1) child from a
previous marriage, namely STEVEN KISNER and one (1) grandchild, namely ZACHARY
KISNER. As a result of my marriage to R. MICHAEL STONER I have three stepchildren, namely
JENNIFER DORSON KAN, MIKE C. STONER and JOSEPH A. STONER. No provisions have
been made in this Will for either my stepson, MIKE C. STONER or my step-daughter, JENNIFER
DORSON KAIN, due to their self-imposed estrangement from their father and me.
II
I direct that all my just debts and funeral expenses shall be paid from my residuary estate as
soon as practicable after my decease.
III
I direct that all taxes that may be assessed in consequence of my death, of whatever nature
and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the
expense of the administration of my estate.
IV
I hereby make the following specific bequests to my son and my grandson as follows:
1. To my son, STEVEN KISNER, I hereby make the fallowing specific bequests:
A. The sum of FORTY-FIVE THOUSAND DOLLARS ($45,000.00); and
B. All jewelry, except those items listed below which are being given to my
grandson, ZACHARY KISNER.
2. To my grandson, ZACHARY KISNER I hereby make the following specific
bequests:
A. The sum of FORTY-FIVE THOUSAND DOLLARS ($45,000.00); and
B. My two (2) diamond rings and gold coin necklace
V
I hereby give, devise and bequest to my son, STEVEN KISNER, and my grandson,
ZACHARY KISNER, any items of personalty which I own, including furnishings, wall hangings
and any other items which they may choose. In the event that they are unable to agree upon any
items, those items upon which there is no agreement shall be sold at either public or private sale and
the proceeds added to the residuary of my estate. .
VI
All the rest, residue and remainder of my Estate whether real or personal, wherever situate,
including any property over which I may have a power of appointment I give, devise and bequest to
my husband, R. MICHAEL STONER, provided that he survives me by thirty (30) days.
2
VII
If my husband, R. MICHAEL STONER, shall predecease or fail to survive me by thirty
(30) days, the rest, residue and remainder of my Estate, whether real or personal, wherever situate,
including any property over which I may have a power of appointment, I hereby direct to be divided
into three (3) equal shares which are to be distributed as follows:
A. One (1) share to my son, STEVEN KISNEP, per stirpes;
B. One (1) share to my grandson, ZACHARY KISNER, per stirpes; and
C. One (1) share to my stepson, JOSEPH A. STONER, per capita.
VIII
I nominate, constitute and appoint my husband, R. MICHAEL STONER as Executor of this
LAST WILL, to serve without bond. If my husband is unable or unwilling to act in that capacity,
then I nominate, constitute and appoint my son, STEVEN KISNER as Executor of this LAST
WILL, to serve without bond.
IN WITNESS WHEREOF, I, SHIRLEY STONER, have set my hand to this LAST WILL
this day of May, 2010.
'J" a - 14L
S EY ONER
Signed, sealed, published and declared by the above-named SHIPLEY STONER, as and for
her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, SHIRLEY STONER, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the
purposes therein expressed.
AH -477EY TON R
Sworn or affirmed to and acknowledged before me by SHIRLEY STONER, Testatrix,
this S day of May, 2010.
MMONWEALTH OF PENNSYLVANIA
Notarial Seal / C
j 1-411-
Joette L. McGowan, Notary Public N ary Public
Mechanicsburg Soro., Cumberland County
My Commimlon Expires .luly ll. 2010
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND
We, R. Mark Thomas and S6lq , ( f-Z , the 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 Testatrix sign and execute the instrument as
her LAST WILL; that SHIRLEY STONER signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the
Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testarix was at the
time 18 years of age or more, of sound mind and under no constraint or undue influence.
a
4
Sworn or affirmed to and acknowledged before me by R. Mark Thomas and
this -fM day of May, 2010.
/11~
?"'ry Public
COMgA Nyy~LTH F PGNN Y
Ni
NOWW .Real
Mochan bu MCGO"n, Notary Public
My Com
Sm., Jb my 6 2C010
5
r '
In re: ESTATE of SHIRLEY C. STONER IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
File No. 21-11-1294
DISCLAIMER
1, ZACHARY KISNER, grandson of Shirley C. Stoner, deceased, hereby acknowledge
having read and understood the Last Will and Testament of Shirley C. Stoner, deceased, dated
May 5, 2010, and further, as set forth below, and for the reasons set forth hereinafter, do hereby
disclaim and/or renounce my following interest in her estate:
1. Pursuant to Article IV, paragraph 2A, I am entitled to a specific bequest of the sum of
Forty-Five Thousand Dollars ($45,000.00).
2. Prior to the death of Shirley Stoner, my grandmother, she gave me a gift of
$15,000.00.
3. Also, prior to her death, Shirley Stoner, deceased created two (2) Certificates of
Deposit totaling $41,607.56 made payable on her death to me.
4. With full knowledge that pursuant to the Last Will and Testament of Shirley Stoner, I
could legally claim my entitlement to the additional $45,000.00, as set forth in the Last Will
and Testament, I hereby disclaim and/or renounce that interest since I believe the monies
listed above represent the same monies she intended to bequeath to me
IN WITNESS WHEREOF, I, AYHARY KISNER, have set my hand to this Disclaimer
this day of 2012.
ACHAR SNER
Signed, sealed, published and declared by the above-named ZACHARY KISNER, in the
presence of us, who, at his request and in his presence, and in the presence of each other, have
hereunto subscribed our names as witnesses.
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
: ss
COUNTY OF CUMBERLAND
I, ZACHARY KISNER, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
Disclaimer; that I signed it as my free and voluntary act for the purposes therein expressed.
NOTARIAL SEAL
JEANETTE K RUTH
Notary Public
MECHANICSBURG BORO., CUMBERLAND CNTY CHARY R
My Commission Expires Feb 26, 2016
Sworn or of rmed to and acknowledged before me by ZACHARY KISNER, this
= day of _ Or , 2012.
Z'gotary Public
RHIRI TONER 11123
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FIL P6
In re: ESTATE of SHIRLEY C. STONER IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
File No. 21-11-1294
DISCLAIMER
1, STEVEN KISNER, son of Shirley C. Stoner, deceased, hereby acknowledge having
read and understood the Last Will and Testament of Shirley C. Stoner, deceased, dated May 5,
2010, and further, as set forth below, and for the reasons set forth hereinafter, do hereby disclaim
and/or renounce my following interest in her estate:
1. Pursuant to Article IV, paragraph 2A, I am entitled to a specific bequest of the sum of
Forty-Five Thousand Dollars ($45,000.00).
2. Prior to the death of Shirley Stoner, my mother, she gave me a gift of $15,000.00.
3. Also, prior to her death, Shirley Stoner, deceased created a Certificate of Deposit in the
amount of $41,983.90 made payable on her death to me.
4. With full knowledge that pursuant to the Last Will and Testament of Shirley Stoner, I
could legally claim my entitlement to the additional $45,000.00, as set forth in the Last Will
and Testament, I hereby disclaim and/or renounce that interest since I believe the monies
listed above represent the same monies she intended to bequeath tome
IN WITNESS WHEREOF, I, STEVEN KISNER, have set my hand to this Disclaimer
this day of '2012.
STEVEN KISNER
Signed, sealed, published and declared by the above-named STEVEN KISNER, in the
presence of us, who, at his request and in his presence, and in the presence of each other, have
hereunto subscribed our names as witnesses.
F
/a
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
: ss
COUNTY OF CUMBERLAND
I, STEVEN KISNER, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
Disclaimer; that I signed it as my free and voluntary act for the purposes therein expressed.
NOTARIAL SEAL
JEANETTE K RUTH
Notary Public
MECHANICSBURG BORO., CUMBERLAND CNTY STEVEN KISN R
My Commission Expires Feb 26, 2016
Sworn or affirmed to and acknowledged before me by STEVEN KISNER, this
J day of ~ 2012.
otary Public
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G _ ¢ F ES ABL!SFD 19
_ 03
0. B0 179 c LANDISBURG, PA '7040
December 30, 2011
R Mark Thomas
Attorney at Law
101 South Market Street
Mechanicsburg, PA 17055-3851
RE: Estate of Shirley I Cook Stoner
Date of Death: November 12, 2011
SS#: 188-32-4704
Dear Sir:
The information you requested is as follows. I will break them down as to who is listed on the account
as POD. The first group belonged to Mary M Cook (mother) with Shirley J Cook Stoner as POD.
Date Account Account Type of Balance Prior Interest Accrued
Opened Number Account to Interest Bearing/Rate Interest
03/30/2009 700021963 CD $17000.00 1.58% $68.09
04/14/2009 700021986 CD $34,000.00 3.17% $91.85
07/23/2009 700022663 CD $40,000.00 3.51% $392.77
06/ /20 1 700025646 CD $15,000.00 1.01% $153.04
u ged to Shirley as sole ownership with R Michael Stoner listed as POD.
t c ount Account I Type of tBalance Prior Interest I Accrued
pened Number Account o Interest Bearing/Rate Interest
03/08/2010 700023084 CD $48306.32 3.84%
_ $68 09
04/14/2009 700021986 CD $34,000.00 3.17% $91.85
Group 3 were also sole ownership with Zachary M Kisner listed as POD.
Date Account Account 'T'ype of Balance Prior Interest Accrued
Opened Number Account to Interest Bearing/Rate _ Interest
03/08/2010 700023085 CD $9,399.79 0.75% $48.54
08/02/2011 700026021 CD $32,207.77 2.16% $21.62
~jl 411 G 70 . f
LANDISBURG - 717-789-3213 BLAIN 536-3118 e SHERMANS DALE - 582-8511
Group 4 is a sole ownership with Steven Kisner listed as POD
Date Account Account Type of Balance Prior Interest Accrued t'
Opened Number Account to Interest Bearing/Rate Interest
03/08/2010 700023086 CD $41,983.90 3.34% $13.34
The last group are listed as sole ownership with no designated POD.
Date Account Account Type of Balance Prior Interest Accrued ,r
Opened Number Account _ to Interest Bearing/Rate Interest
09/09/2011 700026276 CD $15,023.82 0.391 $1.17
09/09/2011 700026279 CD $35,957.14 0.94% $2.81
If I can be of further assistance, please advise.
Very truly yours,
Connie L Welcomer
cc: Decedent's folder
+ 13
ORRSTOWN
BANK
A Tradition of Excellence
December 23, 2011
R. Mark Thomas
Attorney at Law
101 South Market Street
Mechanicsburg, PA 17055
Fax: 796-3600
Re: Estate of Shirley I. Stoner (In our system we have a different middle initial.)
Social Security Number 188-32-4707
Date of Death 11/12/2011
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No, 111001180
Account Type- 50+ Interest Checking
Date Opened- 1/4/2007
Joint Account (name/date)- R. Michael Stoner, 1/4/2007
Balance- $16,554.89
Accrued Interest- $0.20
Account No.- 111001582
Account Type- 50+ Interest Checking
Date Opened- 6/12/2009
Date Closed- 11/16/2011
Joint Account (name/date)- No
Balance- $14.13
Accrued Interest- $0.00
Account No.- 111800181
Account Type- Money Market
Date Opened- 1/16/2007
Date Closed- 11/7/2011
Joint Account (name/date)- R. Michael Stoner, 1/16/2007
Balance- $0.00
Accrued Interest- $0.00
2695 Philadelphia Avenue
Chambersburg, PA 17201
1.888.ORRSTOWK
CERTIFICATE OF DEPOSIT
Account No.- 4000040502
Account Type- 60-119 Month Growth CD
Date Opened- 2/11/2011
Joint Account (name/date)- No
Balance- $32,537.72
Accrued Interest- $3.98
Account No.- 4000026376
Account Type- 36-41 Month Income CD
Date Opened- 6/13/2008
Date Redeemed- 6/14/2011
Joint Account (name/date)- Mary M. Cook, 6/13/2008 Dallas Eugene Cook, 6/13/2008
Balance- $0.00
Accrued Interest- $0.00
SAFE DEPOSIT BOX
Account No.- 137011
Box Type- 3x5
Date Opened- 1/15/2010
Joint Account (name/date)- R. Michael CtnnPr1 /15/2410
Rental Amount- $15.00
Next Due Date- 1/15/2012
Charge Method- Debit Account # 111001180
Best Regards,
1 R. Worthington 7
Deposit Processing Clerk
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Property Mapper
Cumberland County, PA
~..,.,y t 'V sY :rk v 1t>' r ?X `l4~ f'',~ _ Ir ~.rft ~j Y~rl~n ~4 J
PIN: 21-11-1031-W'l
F5i
FL#..s, F k•" iA.t> 1}, YLi~t{ s LOT I PIT 60 ISO
z nx ( _s s~? r r
G.- 510NER, RALPH MICHAEL
If?
Prep
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5", e Feet; 1820
r t sr r t"<' ri yH
o x . A ~7t''• :A t~i`~ 4 4~ `y.." `~yY; ti ,i4*f ; _ f;
A'~es~cd Land value 9700
r
Sal, Date; 'Un SCID 16 200!
(38;00;00 PM
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Copyright 2011 Esri. All rights reserved. Tue Dec 4 2012 10:27:42 AM. 4
115 PIN OAK DRIVE
PIN: 21-11-3031-023
Deedbook: 00248-02026
Lot Description: LOT 1 PB 60 PG 150
Owner: STONER, RALPH MICHAEL
Land Use Code: 112
Property Type: A
Acreage: 14.63
Square Feet: 1820
Taxable Status: T
Clean & Green Status: A
Assessed Land Value 9700
Assessed Building Value 142900
Assessed Total Value 152600
Sale Price 1
Sale Date: Sun Sep 16 2001 08:00:00 PM
Year Built: 1976
Municipality: MIDDLESEX TOWNSHIP
Height in Stories: i
Type of Dwelling: DETACH
Primary Exterior: Vinyl
Basement Percentage:
Air Conditioning: NO
Total Rooms: 4
Bedrooms: 2
Full Bath: 1
Half Bath:
LANDEX Document Data Page 1 of 1
Instrument 200 1 3 1 043 Book: 248
Recorded Date: SEP 17, 2001 Page: 2026
12:00:00 AM Total Pages: 3
Instrument Type: DEED Parcel Numbers: N/A
County: CUMBERLAND
Municipality: MIDDLESEX TOWNSHIP
Recording Status: VERIFIED
Notes:
GRANTOR GRANTEE
STONER,RALPH MICHAEL STONER,RALPH MICHAEL
STONER,SHIRLEY C
http://www.landex.com/webstore/jsp/cart/DocumentSearchResults jsp?LastName=STONE... 12/3/2012
LANDEX Document Data Page 1 of 1
Instrument 201030061 Book:
Recorded Date: OCT 20, 2010 Page:
10:23:41 AM Total Pages: 3
Instrument Type: CLEAN AND GREEN- Parcel Numbers: 21113031023
DEED
County: CUMBERLAND
Municipality: MIDDLESEX TOWNSHIP
Recording Status: VERIFIED
Notes: 115 PIN OAK DR
GRANTOR GRANTEE
STONER,RALPH M CUMBERLAND COUNTY
STONER,SHIRLEY C
http://www.landex.com/webstore/j sp/cart/DocumentSearchResults. j sp?LastName=STONE... 12/3/2012
Rontld C.L. Smith Funeral Home Invoice
31 ZS Walnut St. Date Invoice #
Harrisburg, PA 17109
11/14/2011 512
Phase # 717-834-4515
Bill To
R. Michael Stoner r"
I 1 f Pine Oak Dr.
Carlisle, PA 17015
Client Terms Due Date
Shirley Stoner COD 11/14/2011
Quantity Description Rate Amount
Professional Services of Staff and Directors 1,595.00 1,595.00
Embalming 495.00 495.00
Other Preparation of the Body 175.00 175.00
Memorial Service 350.00 350.00
Graveside Services 175.00 175.00
Funeral Coach 200.00 200.00
Lead/Clergy Car 100.00 100.00
Coleman Casket 1,780.00 1,780.00
Sentinel Vault 1,295.00 1,295.00
In Loving Remembrance Blue Register Book Package 75.00 75.00
Opening and Closing of Grave 500.00 500.00
Equipment Rental 295.00 295.00
12 Death Certificates 6.00 72.00
Obituary in Patriot News 266.97 266.97
00,"7 wile, "Coom Zoo.
Fcow~72 S
C0A1M6t4ria.u TZ7 G/FE cispie- -5
CL/N/G /At OF FGOwERg
Tomg S7-o~u~ - ~FsS_
lif'4 eeea a A&a&me a V6 y a ed Vaal Total " ~f s 7
Payments/Credits $-7,373.97
{ ,j \ Balance Due $0.00
'3I"I-N z:R V A M T L Y Ft,Jti F?.RrL FION1 F5
RICE MEMORIAL WORKS
a diufsion of .3-01683
Drawing ;1r MEMORIALS Since 1921 Drawing Sent to Cust. Approved
'
421 W. Main Street, New Bloomfield, PA 17065 Found. By +n. ~ Found. Ordered
(71 7) 552-2512 • Fax (717) 5S2 404 Vendor Q_ Aok. #k_
www.gingrichmemorials.corn - -
Grave Position Verified Cremation
SOLD TO: C CQ~+o t+, £>P - Date of Order
r- ( I~ I c f Cemetery
V 1~ti i s ;,1~
i_ L n'►• -
cam q Cemetery Location
Phone _ Cell c S~ J / Center Over Graves Sec. f Lot #
Email- Approx. Date of Completion
1I t:-F
Lettering
5 -7 0
i
Type sl f2ret~- Material r~-t r to-~or~~ ~*a v_ri~r
Additional Lettenn
9. ,
.
Size X X - Finish rc? r C ❑ Back D Base
Size X X Finish
Description .
Location on Cemetery
❑ Vase ❑ Photo ❑ Other
Agreement: ;A 50% deposits required to commencement of work COSTS: _
r ~jy~
Agree to pay stated balance upon erection regardless of labor troubles or shipments or any other good reasons. This order or Memorial $ V V
contract cannot be cancelled by customer unless agreed by both parties. the article heroin mentioned shall remain the prope riy of
James R. Gingrich Memorials until paid in full and they reserve the right to remove the same is not paid as stated. Foundation $ c f O 0
I agree to carefully proofread all names and dates for accuracy and accept full responsibility for any errors or omissions. THERE Cemetery Fees $
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE
CEMETERY., $
I further agree to pay the balance stated for the work performed under this contract within thirty (30) days of receipt of the final
invoice and further agree that interest shall accrue at the rate of one and one-half, percent (13'2%) per month on the unpaid balance $ _
owed to James R. Gingrich Memorials not paid within thirty (30) days of the invoice date. In addition thereto,-1 agree if It becomes
necessary for James R. Gingrich to institute legal proceeding to collect any funds due from me for my account being past due thirty r $ _
(30) days, to pay all court costs and attorneys fees Inc b -J s R. Gingrich Memorials to collect the same. TOTAL { $ , r C)
Dealer GI 5 "1-
DEPOSIT
r(c-, f7t~ $ S,7
Customer.
~Balance Due $
(I further agree that the above names, spelling, and da are correct) Upon Completion