HomeMy WebLinkAbout02-04-13r
1505610140
REV-1500 EX (°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO sox 28oso1 INHERITANCE TAX RETURN
Harrisburg PA 17128-0601 RESIDENT DECEDENT d ~ ~ 3 ~ ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
0 1 0 5 2 0 1 2 0 9 1 7 1 9 3 1
Decedent's Last Name Suffix Decedent's First Name MI
G L A S S D O R I S A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
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 1 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 T0:
Name Daytime Telephone Number
M A R C U S A- M c K N I G H T P C 717 2 4 9 2 353
First line of address
I R W I N ~
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
M c K N I G H T P C.
P O M F R E T
REGISTER OF WILLS USE ONLY
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DATE FIL ~,~
S T R E E T
State ZIP Code
P A 1 7 0 1 3
c:orrespondent's a-mail address:
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Un r penalties of pery'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it As ue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
U E OF PERSON SPONSIBLE FOR FILING RETURN DATE
~~, ~~,~ ~
ADDRESS .~
4100 E ~OD NE HARRISBURG PA 17112
SIGNATUR EP OTHER N REPRESENTATIVE ~y
Anna DAT L '~'~ '~
60 /fiIEST POMFR~`I' STREET CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140
PA 17013
1505610140
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150561024D
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: D O R I S A• GLASS
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. 2 D 5 4 . 8 5
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
S
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l
G
~ S
t
Billi
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t
d
7
(
c
e
u
e
)
epara
e
ng
eques
e
....... .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 D 5 4 . 8 5
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ....... .. 9• 1 1 8 8 4 . 2 8
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ....... .. 10.
11. Total Deductions (total Lines 9 and 10) ...................... ....... .. 11. 1 1 8 8 4 . 2 8
12. Net Value of Estate (Line 8 minus Line 11) ................... ...... ... 12. - 9 8 2 9 . 4 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. - 9 8 2 9 . 4 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 .o _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 D. D D 16, 0. D O
17. Amount of Line 14 taxable
O
D 0
17
O
D
0
.
at sibling rate X .12 . .
18. Amount of Line 14 taxable
O
D D
D
D
O
.
at collateral rate X .15 1 g. .
19. TAX DUE ............................................ ....... ...19. D • D 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 1505610240
REV-1500 ~ Page 3
Decedent's Complete Address:
DECEDENT'S NAME
DORIS A. GLASS _
STREET ADDRESS
1303 RITNER HVVY, LOT 3
CITY
CARLISLE
Tax Payments and Credits:
~~ Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments _
B. Discount
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
00
STATE ZIP
PA 17013
(1) 0.00
Total Credits (A + g) (2) 0.00
(3)
(4) 0.00
(5)
0.00
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; .......... ^
........................................................... a X
b. retain the right to designate who shall use the property transferred or its income;
............................... ^ a
c. retain a reversionary interest or ............................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ...............
........................................ ^ XQ
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................
...................................................................... o a
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^
4, Did decedent own an individual retirement account, annuity or.othernon-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)]. Asibling 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 F>(+ (11-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, $ MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
DORIS A. GLASS 0 0
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 discbsed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. JEWELRY CONTAINED IN SAFE DEPOSIT BOX AT CITIZENS BANK 1,396.85
2. I PERSONAL PROPERTY -APPRAISAL ATTACHED I 658.00
TOTAL (Also enter on Line 5 Recapitulation) I $ 2 054 85
If more space is needed, insert additional sheets of paper of the same size
REV-1511 EX+ (10-09)
. pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DORIS A. GLASS 0 0
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION nnenl INT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME
B.
1
Cdy State ZIP
Year(s) Commission Paid
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
2, AttomeyFees: IRWIN & McKNIGHT, P.C.
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
4
5.
6.
7.
8.
9.
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Acxountant Fees:
Tax Retum Preparer Fees:
REGISTER OF WILLS -FILING FEE
IBIS APPRAISAL SERVICES -APPRAISAL ON JEWLERY
ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY
TOTAL (Also enter on Line 9, Recapitulation) ~ $
If more space is needed, use additional sheets of paper of the same size.
10, 773.28
750.00
43.50
262.50
55.00
11,884.28
REV-1513 EX+ (p1-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DORIS A. GLASS
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. LOTTIE STINE Lineal
4100 E. BEECHWOOD LANE REMAINDER
HARRISBURG, PA 17112
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, 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. $
,,,..,., ~,,....,, ,~ ,,..,;..~.., ,.~~ a~~~~~~~~a~ anccw v. NaNCi vi ire same size.
. LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: 1# is illegal to duplica#e this copy by photostat or photograph.
Fee for this certificate, $6.00
P ~.8~.~,~3~.~
This 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.
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Certification Number
~;~~
Type/Print In
Permanent
~g_
4
x
a ~s-a s G V a- YCA ~ A State Flle Number:
1. Decedent's Legal Name (First, Middle, Last, SufRx)
2. sex 3. Social sscuri Number
DO i h' 4. Date of Death (Mo/Day/YrJ (Spell Mo)
6a. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da Female 184-26-4196 Janua 5 , 2012
6. Date of Birth (MO/Day/Year) (Spell
Month) 7
Bi
h
.
a.
rt
place (City and State or Fo[elgn Country)
80Months Days Hours Minutes -
Sept _ l7 , 1931
8a. Residence (State or Foreign Count 7b. Birthplace (County) Pe
ry) Sb. RlSidanee (Street snd Number -Include-A
t N
p
o.) Bc. Did Decedent Uve In a Township?
1303 Ritn
H
@r
wy, Lot 3 Qyes, degdent Ilyad In
ad. Residence (County)
Cumberland t'^'P•
8e. Residence (Zip Code) No, decedent Ilved within limits of f'`~rl i Q~ - '
9. Ever In Us Armed Forces? 10. MaNtal status at Tlme of Death
ciq'/bo
rn.
Married Widowed 11. Surviving Spouse's Name (H wife, lye name
Q Yes ~ NO Q Unknown Q Divorced Q Never Married Q Unknown B prior to first marriage)
12. Father's Name (First, Middle, Last, suffix)
13. Mother's Name Prior t° First Marnage (First, Middle, Last)
Jacob Ra nd D>,an
Katherine Cook
iaa. Informant's Name
o 14b. RMatlonshlp to Decedent 14c. Informant's Melling Address (Street and Number, CI
ty Sean zlpc d )
Lottie Stine dau titer 4100
r'
s E_ Beech
................ ..... ..•... ...... 1 a. ace eat ea on one wOOd LanE' H
a)rrisbu PA 1711
f....
If Death Occurred in aHosPital: ....'.. ..•~.......•••... •.••.••• .........
~
Y
.
t~•I
o .
.
........... _
nPatient
.................................. ........... ____
- IIf Deeth Occurred Somewhere Other Than a Nospital~ `~` Hospice Facility...,.,. """' •••••'•••
Q Emergency.Room/Out atient pead..om Arrival Nursln H
uE Dededent's Ho e
m
_
z o
e/Long-Term Care Facility Other s ecl
15b. Facility Neme (If not Institution, give street and number; Ssc. CI ( p fY) '-
ty orrown
State
amd Zi
C
d
m ,
,
p
o
1303 R3Cner -
e 15d; county of Death
Lot Carlisle PA 7013
16a. Method Of Disposltlon ~] Burial Q C
l
~~
remat
On 16b. Date of Disposltlon 16e. Plice Of DIS
0 Remove( from. State p Donatitiin ~ '~ ..- _ position (Name of cemetery, crematory, or other place)
Other (spedfy) Jan_ 9, 2012 New Bloo
fi
?
~ m
eld Camels
16d. Looetion of DlsposiLion (City or Town, state, and Zlp) 17 ature of Funeral Se a LI nsee or Person In Charge of Interment 176. LlcenseNUmber
New Bloomfield, PA
~'
s ~- c
17c, Neme and Complete: Address of Funerel Facility 013144L
H _
~ 1H. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 2O. Decedent's Race -Check ON
highest degroe or level of school compleUd at the time of de
th
a
E OR MORE races to Indicate what
. box that best describes whether the decedent Che decedent considered himself or h
Q 8th grade or less
Is S
i
lf
h
pan
erse
co be.
s
/Hispanic/Latino. Check the "NO"
Q No diploma, 9th - 12th grade
~ White
b
f
ox i
[] Korean
decedent Is not Spanish/Hlspanic/Latino.
High school graduate or GED completed
Q Black or Afrlcen American
N
Q Vietnamese
o, not Spanish/Hispanic/Latino
~ Some college credit, but no degree
Q Amerlwn Indian or Alaska Native Q Oth
Yes
Mexic
M
A
l
,
an,
er
z
an
exican gmerican, Chicano
Q Associate degree (e.g. AA, AS) Q y
~ Asian lndlan
es, Puerto Rltan
[] Native Hawaiian
Q Bachelor's degroe (a.g. BA, AB, BS) Q Chinese 0 Guamanian or Ch
D Yes, Cuban
M
'
amorro
Q
aster
s de
~ Fltipino [] Samoan
gree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q yes, other Spanish/Hispanic/Latino 0 Japanese
Q Doctorate (e.g. PhD, Edo) or Professional de
groe (Specify) A Other Pacific Islander
a. MO DDS DVM LLB JD 0 Other (specify)
21. Decedent's single Race Self-Deslgnetlon -Check ONLY ONE to Indicate what the decedent
i
cons
dered himself or herself Lo be. 22a. Decedent`s Usual Occu
W White Q Japanese O Samoan Patlon -Indicate type of work
Bl
ack or African Amorlcan
d
r
Q Korean Q Other Paclflc Islander
PN g most of working IHe. DO NOT USE RETIRED.
o^r
Q A erlean Indian or Alaska Native Q Vietnames
•
+
e Q Don
t Know/Not sure
Q Asian Indian Q Other ASlsn
Q Refused
Q Chinese
22b. Kind of guzlness/Industry
Q Flllpino Q Native Hawaiian Q Ocher (specify)
Q Guamanian or Chamorro Hospital
ITEMS 9e - MUST BE ODMPt.ETED 23a. Date Pronounce Dea (MO Day 23 . s gnaturc of Person Pronoun
PRONOUNCES OR
i
c
ng Death (On y When app (cable) 23c. License Num of
CERTIFIES DEATH
J8nua S , 2012
23d. Data Signed (MO/Oay/yr) 24. Time of Death
25. Was Medical Examiner or Coroner Contacted] Q Yes
•
Q N
CAUSE OF DEATH
O
26. Pert ). Enter the chain of event -diseases, injuries, or complications-that directly caused the death. DO NOT enter terminal events such as
APProxlmate
respiratory arrest, or yentricularfl6rlllatlon without showin th
di
car
ac arrest,
e etiology. DO NOT ABBREVIATE. Ents I interval:
e o
/•~
f only one taus n a Ilne. Add additional Ilnes If necessary I Onset to Death
/
IMMEDIATE CA
`
Cov+~-
~J-(l
.
Q~ T ~
USE ----_>
~ ~(~
~~ at~!"ln ~
(Final disease or condition a
n t
Due t° (O as ()
resulting In death) 4 n -
equentlally Ilst conditions
I
, t
O e to r s sequ f).
If env, leading to the cause
r
-
~
~
Ilsted on Ilne a. Enter the (/7_L-~_ Q ~~~ ~~
U
NDERLYING CAUSE
(disease or Injury that ( D t (o s a co eq Ce Of). -
Initleted the events resulting d.
In death) LAST.
Due to (or as a consequence of): -
~' 26. Part 11. Enter other s1anA,,,.tttlFl,~'~cant dill s co Lf o but n t resultina Ir, they derlyl/nyg~c~a use give In p rt 1
n
`
-~
y`
(y~
n~;
/ ` v rte. ~y~~ r ~v\ r r^
~ 27. Was an autopsy perf mcd7
l 0 v `N r ~i
`
'(J
t/
y
t
w-. `
e
P Yes
2B
We
.
re autopsy fin In ailable
s ar
((`~ ~j 5 r VQ~ co complete the cause of death?
29. If Female: ~ ~ U a
yes No
30. Did Tob eeo Use contribute eath7 Manner of Death
Q Not pregnant within past year Q Yes
Q probably
Q pregnant at Lima of death Natural
but 0 No Q Unknown ~ Q Homicide
Q NOt pregnant
Dregnant
ithi
4
r ,
w
n
2 days of dealt Accident p pending Investigation
Q Not pregnanC, but pragmant 43 days t° 1 year before death 32. Date of Injury (MO/Di Q Sulelde Could not be determined
Q Unknown If pregnant within the past veal Y/Yr) (SPell Month) ~
33. Time of Injury
34. place Of Injury (e.g. home; construction site; farm; school)
35. LoestiOn of In u
1 ry (Street and Number, Clty, State, Zlp Code)
3fi. Injury at Work 37. H Transportation Injury, Specify:
38. Describe How Injury Occurred
Q Yes Q Driver/Operator Q Pedestrian
~ NO Q Passenger ~ Other (Specify)
39~ercifler (Check only one):
Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and ma
t
nne:
r s
ated
ronouneing JL Certirying physician - TO the best of my knowledge, death occurred at the tlme, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/Coron - On the basis of a`I tlOn, and/or Investigation
in my opinion
d
h
,
,
eat
occurred at the time, dale, and place, and due to the wuse(s) and mann
Signature of certifier:
t
3 er s
ated
Title of certifier:
9b. Name, A dress and Zlp Code of son Completing Cause of Death (Item 26) License Number:
39e. Date Signed (MO/Day/Yr)
4 0. Reg sRar s District Num ar 41. Registrar ature
` - ~,_ ~ ~{GKl l _
4 Registrar a Date (MO Dey r
~ e~asuLl\
D
4 ~
~~~~
L ~A~ ` Q ~a'
3. Amendments
i
Disposltlon perm It No. ~ C.. ~'t \ ~r~e~~- HIOS-143
REV 07/2011
/ ° ~~
~~~~
I, DORIS A. GLASS, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
ONE: I direct my Executrix to pay all of my debts, funeral and administrative expenses
as soon as may be done conveniently after my decease.
TWO: I give, devise, and bequeath all of my estate of every nature and wherever situate
to LOTTIE :MARIE STINE. If she has predeceased me, then I give, devise, and bequeath all of
my estate to HARRY P. STINE, SR..
THREE: I nominate and appoint my daughter, LOTTIE MARIE STINE, to serve as
the Executrix of this my Last Will and Testament. If she is unable to serve, I nominate and
appoint MARCUS A. McKNIGHT, III, to serve as Substitute Executor in her place.
FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain
property for such length of time as she may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as she may deem proper; and invest estate property and
income without restriction to legal investments.
7~~7
FIVE: I direct that my Executrix or Substitute Executor shall not be required to post
bond or enter security in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set m hand an
y d seal this ~ day of
August 2008.
~~''~GG~~(SEAL)
DORIS A. GLASS
Signed, sealed, published and declared by DORIS A. GLASS, the above named
Testatrix, 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 subscribed our names as witnesses hereto.
j..
,•,~:
/~
~~
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, DORIS A. GLASS, KAREN S. NOEL and CHERYL L. CLELAND, the
testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will and that she had signed willingly, and that she executed
it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses,
in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of
their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
DORIS A. GLASS
.NOEL
CHERYIL/~. CLELAND
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND ,
Subscribed, sworn to and acknowledged before me by DORIS A. GLASS the testatrix
herein, and subscribed and swo to before me by KAREN S. NOEL and CHERYL L.
CLELAND, witnesses, this day of August 2008. ~~ ~~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
MaNia L. Noel, Notary Public
Carlisle Boro, Cumberland County
My Commission E~ires Sept 18, 2011
Member, Pennsylvaniz Association of Notaries
e
APPRAISAL SUMMARY
It is in my opinion, that as of the d.o.d. January O5, 2012 and reported on February 12, 2012, the
Fair Market Value of the estate personal property of Doris Glass, deceased:
(One Thousand Three Hundred Ninety Six Dollars and Eighty Five Cents)
($1,396.85)
Safety Deposit Box 1
(One Thousand Three Hundred Forty One Dollars and Sixty Cents)
($1,341.60)
Safety Deposit Box 2
(Fifty Five Dollars and Twenty Five Cents)
($55.25)
Ibis Aj~praisa~
Services
Acyssa ~ ~~~o y, rs.~ Amt
Director ,
The report must be read in its entirety The Appraisal Summary ONLY is not the
appraisal report.
~6is /-~PPraisa~jervices
Pale 5 0~ 20
_._.
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_.r ~ _ ..__._ __ _ .... .
~~ ~ ~
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___. . ___ Gam..-.
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~ _.. _.. _..._..___..__. - _-~_...A__.__._ ._. _. __.._~ _.___............._ _._.._.
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• 219 North Hanover Street
Carlisle, Pennsylvania 17013
717.243.4511
toll free 1.866.451.4511
-~ fax 717.243.3723
FUNERAL HOME ~ CREMATORY, INC. `"`"`"~hot~r'onr°th.com
info~hoffmanroth.com
Lottie Stine
4100 East 13eechwood Lane
Harrisburg, PA 17112
January 23, 2013
Statement of Funeral Expenses for: Doris A. Glass
Date of Death: January 5, 2012
Account Id: 16436-009
PACK
AGE:
Traditional Funeral Service
TRADITIONAL FUNERAL SERVICE PACKAGE
$ 4,650.00
MERCHANDISE• Sub Total: $ 4,650.00
Casket: Hyacinth
Outer Container: Monticello $ 3,155.00
$ 1,620.00
TOTAL FUNERAL HOM Sub Total: $ 4,775.00
E CHARGES:
CASH ADVANCES: $ 9,425.00
New Bloomfield Cemetery $ 4
10 Certified Death Certificates at $ 6.00 each
$ 75.00
60
Newspaper Notice -Sentinel .00
Newspaper Notice -Patriot $
$ 144.56
27
Clergy 4 72
Flowers $ 100.00
$ 159.00
Sub Total: $ 1,213.28
Total Funeral Expense: $ 10,638.28
Total Payment Made: $ 10,638.28
__Additional 135.00 for the um engravinghas beenpaid inaddition to above.
---------------
Please return this portion with your Remittance.
Doris A. Glass
Service ID#: 16436-009
Amount Enclosed
SERVING OUR COMMUNITY SINCE 1 907
16s .,~ raisaC er~ice
pp S s
(717 243-3474 c~ O. Bo.~ 24
~ssaC~i6isa~rpraisaCs.com 14S 9V..~fanoverSt.
zvu~v. i6asappraisaCs. com CarCzsCe, ~A 17013
STATEMENT
February 12, 2012
Marcus A. McKnight,-Esq.
Karen S. Noel, Estate Paralegal
Irwin & McKnight
60 West Pomfret St.
Carlisle, PA 17013
1ZE: Doris Glass Estate Personal Property Appraisal.
Dear Atty. McKnight & Ms. Noel:
Please find enclosed three hard copies and three digital copies of the Doris Glass Estate personal
property appraisal report. Should you need any more items appraised or have any questions and
comments, please do not hesitate to contact me at Alyssa@ibisappraisals.com or (717) 243-3474.
I can also provide extra copies if needed.
APPRAISAL FEE:. $262.50
PERSONAL PROPERTY.• $75.00/hour x 3. S hours = $262. SO
PERSONAL PROPERTY:
Ibis Appraisal Services has researched, consulted, and appraised the personal property of the
Doris Glass Estate. The final report was completed and produced on February 12, 2012.
Thank you!
Yours faithfully,
Ibis AppYaisa~
SeY'U1C~•
ACyssa Z1>. ney, I A A~
Director
ALL/al l
Enclosures
113 Forge Rd., Boiling Springs, PA 17007 <~~ ~ ~ ~~~
ROY D. GOTTSHALL,
AUCTIONEER
In Account With