HomeMy WebLinkAbout04-1000£,w~ oJ 5abel Edna Wentz
~ocial Securi
Tile petitic
Your petitl
in the lea wi
P~
Deceased.
~o. - 188- ! 2-46~3
, of lhc undersigned respectfully represents that:
entreE), who is/~xeXI8 years of age or older an the executrix
I of the abovc decedent, dated October It 1996
Decendenl
{TITION F()R PROBATE and GRANT OF LETTERS
To:
Register of Wills for the
County of CLimber!and -- in the
Commonwealth of Pennsylvania
name
_
was domiciled at death in Cumberland __ County, Pennsylvania, ,~'it
;t family or principal residence at 891 North,,~=~ .........
(list street, number and muncipality)
Decendent~ then 94 years of age, died_~P~J ~
at_~l ~rth~ aanoue~ Stree~ Carlisle, PA !70!~ -
Except as ~o[lows, decedent did not marry, was not divorced and did not ha~e a child born or adoptc
after execution of the will offered for probate; was not the victim of a killing and was never adjudicate
incompetent:
Decendent at death owned property with estimated values as follows:
(If domicilec~ in Pa.) All personal property $~ t 000. O0
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania $
situated as [ollows:
WHERE1-
presented he
theron.
COMMO
COUNTI
ORE, petitionerO0 respectfully request(s) the probate of the last will and codicil(
:ewith and the grant of letters
(testamentary; administration c.t.a: administration d.b.n.cA.~
Bzidgewatez .....
wviiiu, PA ]724~
OATH OF PERSONAL REPRESENTATIVE
WEALTH OF PENNSYLVANIA '~ ss
OF CUMBERLAND
Thc pet tionerliO(abo,ve-named swear(s) or affirm(s) that the statements in the foregoing petition
true and correct to the oest of the knowledge and belief of petitioner(~ and that as personal represt
tativeCsO of the above decedent petitioner(:O will well and truly administer the es~te acco,r~ing to la
worn to or affirmed and subscribed ,--,~'--~L,-~_~
S r- I
before me this ,~___ _ day of [ ~ ....
~ onna / Frances M.
~( ~ ...... Register (
Esta
AND NO
IT IS DECR~
described thm
and Letters
are hereby gr~
Probate, Lett
Short Certific
l~'~ i/~Z't']"}I5 ~-~ 5 2004. L~.__, in consideration of the petition or
: hereof, satisfactory proof baying be::~, !')?relented before me,
ED Oat the instrument(s) dated October 1: 1996
in be admitted to probate and filed of record as the last will of
abel Edna Wentz
ntedco Frances M. Burd
Filed ...................................
PHONE
717-243-5551
A~ORNEY (Sup. Ct. LB. NC3
Bradley L. griffie, Esquire
34349
ADDRESS
200 North Hanover Street
Carlisle, PA 17013
· ~ '~' "
CERTIFICATE OF DEATH
Church of
i i[t e tament
I, MABEL EDNA WENTZ, of Cumberland County, Pennsylvania, being of sound mil
and memory, do make, publish and declare this to he my Last Will and Testament, hereby
revoking all prior Wills and Codicils heretofore made by me.
$ir t
I direct that my funeral be conducted in accordance with the wishes I have made know
my Executrix, hereinafter named.
conb
I give $1,000.00 each to my three daughters, FRANCES M. BURD, BETTY L LEBG
and MARY L. RUSSELL, and I give my automobile to my granddaughtel; AMY L. BUKD.
I give $100.00 to each of the following charities:
a. Mount Zion Methodist Church, 420 Park Drive, Carlisle, Pennsylvania;
b. House of Freedom Broadcast, 6420 Carlisle Road, Dover, Pennsylvania;
¢. Radio Bible Class, Grand Rapids Michigan; and
d. The Qaiet Hour, Kedlm~ds, Calilbrnia.
$our
I give the entire rest, residue and remainder of my estate to my daughter, FRANCES/v
BURD. In the event my daughter, F1LanNCES M. BURD, does not survive me, then I give the
rest, residue and remainder of my estate to my great granddaughter, AMY L. BURD.
Ld
tO
Any person who survives me for less then thirty (30) days shall be considered to have
predeceased me.
ixtO
Unless provided otherwise in any trust, I direct my Executrix to pay all federal, state, a
other death taxes, payable because of my death on the property forming my gross estate for t~
purposes, regardless of whether it passes under this Will, which taxes shall be paid out of the
principal of my estate such that the burden of payment falls on my residuary estate; the taxes s]
not be charged against any beneficiary of my estate. This article shall not apply to generation
skipping taxes or property subject to my general power of appointment for federal estate tax
purposes.
Except as otherwise provided herein as a trust, if any person under the age of twenty-c
is entitled to a share of my estate, such shares shall be delivered to my grandson, GREGORY
LYNN BURl), as (1) Custodian under the Pennsylvania Uniform Transfers to Minors Act, ant
(2) as to any property which cannot pass under said Act, then to him as trustee.
I hereby nominate, my daughter, FRANCES M. BUR1), Executrix of this my Last Will
and Testament, to serve without bond or security of any type for any purpose whatsoever, and
hereby authorize, empower and direct her to sell and convey, by good and sufficient deed, in fl
simple estate, any and all of my real estate, at public or private sale, for such price or prices, ut
such terms and conditions, as in her judgment is best for my estate, and to that end to sign, sea
execute, acknowledge and deliver all deeds or other instruments necessary therefor, as effecti
as I could do ifI were personally present.
If and in the event that my daughter, FRANCES M. BURD, does not survive me, or is
otherwise unable or unwilling to complete his duties as Executrix, then and in such event, I her
nonfinate, constitute and appoint my grandson, GREGORY LYNN BURD, Executor of this rr
Last Will and Testament, to serve without bond or security, and I hereby authorize, empower
2
id
tie
,n
~ly
~by
nd
direct him, as Executor, to sell and convey, by good and sufficient deed, in fee simple estate, a
and all of my real estate, and to that end to sign, seal, execute, acknowledge and deliver all de~
or other instruments necessary therefor, as effectively as I could do if I were personally presen
IN WITNESS WHEREOF, I have hereunto set my hand and Seal to this, my Last Will
and Testament, consisting of four typewritten pages, the first three of which bear my signature
the margin for the purpose of identification, this ~. day of October, 1996.
MABEL EDNA WENTZ
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix,
and for her Will, in the presence of us, who, at her request, in her presence, and in the presenc
,(xer, have ~l.er~unto subscribed our names as witnesses in attestation thereo£
residing at
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
: SS:
I, MABEL EDNA WENTZ, having been duly qualified according to law, acknowledg{
that I signed the foregoing instrument as my Will, and that 1 signed it as my free and voluntar
act for the purposes therein expressed.
MABEL EDNA WENTZ
ly
ds
as
; of
We, having been duly qualified according to law, depose and say that we were present
saw MABEL EDNA WENTZ, sign the foregoing instrument as her Will; that she signed it as ]
free and voluntary act for the purposed therein expressed; that each of us in her sight and hear
and at her request signed the Will as witnesses; and that to the best of our knowledge she was
that time 18 or more years of age, of sound mind and u~der no constraint or undue influence.
Subscribed, sworn to or affirmed,
and acknowledged before me by the
above named Testatrix and by the
witnesses whose names appear
opp~l:~w 0n/'F~- '~ ~. ! , 1996.
4
~d
ter
ng
it
CERTIFICATE OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mabel Edna Wentz
Date of Death: September 24, 2004
Will No. 2004-01000
Admin. No. 21-04-1000
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was
mailed to the following beneficiaries of the above-captioned estate on November ID, 2004.
NAME ADDRESS
Frances M. Burd
19 Bridgewater Road
Newville, PA 17241
Betty L. Lebo
Mary E. Russell
Amy L. Burd
Mt. Zion Methodist Church
1402 Trindle Road
Carlisle, PA 17013
1148 Newville Road
Carlisle, PA 17013
490 Criswell Drive
Boiling Springs, PA 17007
420 Park Drive
Carlisle, PA 17013
House of Freedom Broadcast
6420 Carlisle Road
Dover, PA 17315
Radio Bible Class
300 Kraft Avenue SE
Grand Rapid, MI 49512
The Quiet Hour
630 Brookside Avenue
Redlands, CA 92373
Notice has now been given to all personal entitled thereto under Rule 5.6(a) except: NONE
L:~ot~seq~or l~sonal Representative
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
REV-1500 EX 16-00)
'.. . "I. COMMONWEALTH OF
~ ' PENNSYLVANIA
. DEPARTMENT OF REVENUE
. DEPT. 280601
""i. HARRISBURG, PA 17128-0601
i' r--./ 'r
/ I - ~, Lv
1;1 -
i
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFiC;AL USE O~~L Y
FILE NUMBER
.:L L -- II L - 1 0 00
COUNTY CODe YEAR - NUMBER- - -
SOCIAL SECURITY NUMBER
J-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Wentz Mabel Edna
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
9/24/2004 3/15/1910
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
w
~
~~(I)
ua:::~
wQ.u
:I: 00
ua:::....J
c..a::l
c..
<2:
~ 1. Original Return
D 4. Limited Estate
El 6. Decedent Died Testate (~ltach copy of Will)
D 9. Litigation Proceeds Received
188
-12
- 4683
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise ldale of deam ailer 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (dale oi oeath prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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f~(~SEc:rrQf(~~~e~Ii~~~~Q~~j~J"~~M~'J~~.S~lff;l~:'
NAME COMPLETE MAILING ADDRESS
Bradley L. Griffie, Esquire 200 N. Hanover street
FIR~ NAME."f Applicable) . Car 1 i s 1 e P A 1 7 0 1 3
Grlffle & ASSOclates '
TELEPHONE NUMBER
717-243-5551
. "
1. Real Estate (Schedule A) (1 ) .00 I OFF,ICIAL USE ONLY I
2. Stocks and Bonds (Schedule B) .00
(2) I
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) .00
4. Mortgages & Notes Receivable (Schedule D) (4) .00 ..........'"
..
--'"
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) .00 ~ .-t
......" _J
(Schedule E) I 1
Z .00
0 .- .
6. Jointly Owned Property (Schedule F) (6) U
~ D Separate Billing Requested
...J 14,333.98
:J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
!:: (Schedule G or l)
c.. 14,333.98
<t 8. Total Gross Assets (total Lines 1-7) (8)
U 1,286.00
w 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
~ 274.52
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10) (11 ) 1,560.52
12. Net Value of Estate (Line 8 minus Line 11) (12) 12,773.40
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) .00
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 12,773.40
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of line 14 taxable at the spousal tax
0 .00
~ rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15)
~ 16. Amount of Line 14 taxable at lineal rate 12,,773.40 x .0 ...!.5. (16) 574.80
:::J
a. 17. Amount of Line 14 taxable at sibling rate x .12 (17) 00
:E
0 18. Amount of Line 14 taxable at collateral rate x .15 (18) .00
U
X 19. Tax Due (19) 574.80
~
20.0 -1_1-' '11 '.~I::II-I:=fflll~C1r!.-J""".'
..'J:W!.h'.' IfI:=f.- -.J<
i. , i.~ =;''';i'~:,..:.J.~'':''::;'''.<':;:''.'''''''~--''.;:-_..~:J>:;"'~:''-''::.;.,.~... ....~~ ~~.:~... -'~~- -. -. '.- .~_~ . ..'..- . , _ ....~.;...:-_-="'~~_......_-+. ...-.-....;_......-, ....,~_ . -.. . .~.. ~'...'- . ,.:~.." - .. '.- -....-... :..':-- .1";.';,_::_~~- -,,-:. -...;.,-. -,.....~-:,.:&:"'..:::;';.-:: ~ ,.' ....,..:.;.,;:-:1jf.-;...,.::...=-. O~,:&i:-J _:...,.....,., _ __~
..;~.~.'~'.:~' .,....;::',~~-=.::.'~".:::.~-,,:.: /. ':'.: lf~.?>(~..Bp$UBE;:rQ:'AN~W':~6lfi;~UE~110~~iQ8'~S~~IPE;L~N.D' ~ECHECKJ~:ATE.t~ctE~';'.r:-;~~{':~;~l~~rf:~itt~~:r~~~
Decedent's Complete Address:
.STREET ADDRESS 801 North Hanover street
Church of God Home
CITY Carlisle I STATE PA f ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
574.80
.00
_00
nn
Total Credits (A + B + C )
(2)
.00
3. InterestJPenalty if applicable
D. Interest
E. Penalty
.00
(3)
(4) .00
(5) 574.80
(SA) .00
(58) 574.80
TotallnterestlPenalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
~*~~:-=-~;"~";;S-~r-':'~\- ~-~~i~~~~~tc:.. ~~~~7:.:;:::~::~~~~~i:~ifitt:~~~~.{:.:.:r~~;'~;:';'-i~~ --:- ~~ - _-'_-r",~~:;-~:::..;~~~,-;__~~~~~~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or................................. ............. ............ ..... ................ ...... ......... ........ ....... ......... .... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ......................... .................. .................. .............. ................................... 0
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .......................... ........... ............................ .............................. .......... ............... [Xl
No
~
fK]
o
~
o
fXJ
D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and stalements, and to the best of my knowledge and belief. it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR~F PERSON RESPONSIBLE FOR FI NG RETU
~ ~~. Fr~nces ~. Burd
ADDRESS
19 Bridge Water Road, Newville, PA 17241
P. PRESENTATIVE
DATE
Bradle L. Griffie
~
AD
17013
~ ~~ :~-:T~~~~~f~~~~t~ ~. >e :~~~ -:..g~~~~::;,~f!r~~~~~~~~t-.:; :~ ~~~-:;~:-~ ~~~~~7f~~~~~:.0~. ~~~~,tt~.t~~:~~~~~~~~~~_~~.. .,
For dates of death on or after July 1. 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J.
The statute does not exemDt 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 sUlViving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1 )J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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.1510 EX -to (2.87)
i""
c/,. ...... .
f't'.A. ;\ , ~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE. TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
ESTATE OF
FILE NUMBER
Mabel Edna Wentz
21-04-1000
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OFTHE COVER SHEET IS YES.
ITEM DESCRIPTION OF PROPERTY
NUMBER Include nome of the transferee, their relationship to decedent, date of transfer.
EXCLUSION
TOTAL VALUE
OF ASSET
DECO.
%
INT.
DOlLAR VALUE
OF DECEDENT'S
INTEREST
1. Flexible premium retirement deferrep
Annuity- I
Southwestern Life Insurance Company.
(from Integon Life Insurance Co~)
~olicy Number 0010629313
Beneficiary: Frances M. Burd
19 Bridge Water Rd.
Newville, PA 17241
(Daughter of Decedent)
Transfer: Date of death"
*
14,333.98 100% $14,333.98
~See attached actuarial statement as to va~ue
TOTAL (Also enter on line 7, Recapitulation) S 1 4 r 3 3 3 . 98
(If more space is needed, insert additional sheets of same size.)
, ft Southwestern Life Insurance Company
n PO Box 749005 Dallas, Texas 75374-9005
1-800-792-4368
February 16, 2006
BRADL Y L GRIFFIE
A TTORNEY AT LAW
200 NORTH HANOVER ST
CARLISLE P A 17013
p
i .
! '
;
,
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!
Insured Name: MABLE WENTZ
Policy Number: 0010629313
Correspondence Number: 06930756
1
""I!
, j
Dear Sir:
Thank you for contacting Southwestern Life Insurance Company. Enclosed is a completed IRS
Form 712 Life Insurance Statement for the above-mentioned policy.
The cash value on the policy as of the date of death 9/24/2004 was $14,333.98. The annuitant was
receiving a month payment of$335.02.
If you have any questions, please call the Client Service Center at 800-792-4368, Monday through
Friday from 7:30 AM - 4:30 PM Central Standard Time.
Sincerely,
Ma. A. Paramo
Claims Services
Enclosure(s): 712 form
, Form 712
(R~v. May 2000)
Department of the Treasury
Internal Revenue Service
Life Insurance Statement
OMS No. 1545-0022
Decedent - I nsured (To be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706-NA, United
States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States.)
1 Decedent's first name and middle
initial
MABEL E
2 Decedent's last name 3 Decedent's social security number
(if known)
WENTZ 188-12-4683
4 Date of death
9/24/2004
5 Name and address of insurance company
Southwestern Life Insurance Compnay PO Box 749005
6 Type of policy
SUPPLMENTARY CONTRACT
8 Owner's name. If decedent is not 9 Date issued
owner, attach copy of the application.
Dallas TX 75374-9005
7 Policy number
10629313
10 Assignor's name. Attach copy of
assignment.
11 Date assigned
12 Value of the 13 Amount of premium (see instructions)
policy at the time of
assignment
14 Name of beneficiaries
FRANCES BURD
15 Face amount of policy
16 Indemnity benefits
17 Additional insurance
18 Other benefits
19 Principal of any indebtedness to the company that is deductible in determining net proceeds
20 Interest on indebtedness (line19) accrued to date of death.
21 Amount of accumulated dividends
22 Amount of post-mortem dividends
23 Amount of returned premium
24 Amount of proceeds if payable in one sum
25 Value of proceeds as of date of death (if not payable in one sum)
26 Policy provisions concerning deferred payments or installments.
Note: If other than lump-sum settlement is authorized for a surviving spouse, attach a copy of the insurance policy.
15
16 $
17 $
18 $
19 $
20 $
21 $
22 $
23 $
24 $
25
34,705.97
14,333.98
27 Amount of installments
28 Date of birth, sex, and name of any person the duration of whose life may measure the number of payments.
29 Amount applied by the insurance company as a single premium representing the purchase of installment benefits
30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits.
31 Were"'the're'-a'ny'.t'ransfers-oTthe"poTicywitiiin-riie""tiiree"yea'rs.p'ri'o"rtotheci"ate"offti"e;.'decedeiit?'-"'--'--.-......-.-"'..-.-........-...."'....-............."-.......""..-Cj"""-e;--...........[~i"."...."'N~-."...._.._........
32 Date of assignment or transfer: I I
Month Day Year
33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? DYes 0 No
34 Did the decedent have any incidents of ownership on any policies on his/her life, but not owned by him/her at the date
of death? DYes 0 No
35 Names of companies with which decedent carried other policies and amount of such policies if this information is disclosed by your records.
The undersigned officer of the above-named insurance company (or appropriate Federal agency or retirement system official) hereby certifies that this statement sets forth true and
correct information.
Signature ~
Title ~
Vice President
Date of certification ~
EV.1511EX. (1-97]
,
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mabel Edna Wentz
FILE NU MBER
21-04-1000
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
Grave Marker expense to Carlisle Memorial Service, Inc
213.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~s) I EIN Number of Personal Representative{s)
Street Address
City
State
Zip
2.
3.
Yea~s) Commission Paid:
AttomeyFees Gri ffie & Associates
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
1,000.00
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
73.00
5.
Accountant's Fees
6.
Tax Retum Preparers Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 1 , 286 . 00
(If more soace is needed. insert additional sheets of the same size)
,
'1E~1512 EX. (1-9'1 ..
COMMONWEA1JH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Mabel Edna Wentz
Please Print or Type
FILE NUMBER
21-04-1000
AMOUNT
ITEM
NUMBER
DESCRIPTION
1.
Belevedere Medical Center (BMC)
(Medical Services)
2.
Philhaven
(Medical Services)
3.
Continental Health Equipment
(Medical Services)
4.
Brockie Pharmatech
(Medical Services)
5.
Mobile Xray Imaging, Inc.
(Medical Services)
TOTAL {Also enter on line 10" Recapitulation)
(If more space is needed, insert additional sheets of same size.)
14.96
24.97
75.00
124.33
35.26
I
I
I
I
i
I
\
I
\
I
I.
i
I
I
I
IS 274.52
,
RE\I'1~3 EX + (1-97)
.
SCHEDULE J ~
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE .OF
Mabel Edna Wentz
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. T AXA8LE DISTRIBUTIONS (include outright spousal distributions)
1. Frances M. Burd
19 Bridge Water Road
Newville, PA 17241
*Only asset in the estate
FJLE NUMBER
21-04-100l
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
Daughter
AMOUNT OR SHARE
OF ESTATE
Beneficiary on
Annuity*
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BE1NG MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
1'-,' . _I _L _ _.J._ _~~L._ ____ _:__\
..
JLa!it gill anb ~t!itament
of
;!!Mabel (fbna gent?
I, MABEL EDNA WENTZ, of Cumberland County, Pennsylvania, being of sound mind
and memory, do make, publish and declare this to be my Last Will and Testament, hereby
revoking all prior Wills and Codicils heretofore made by me.
jf trtit
I direct that my funeral be conducted in accordance with the wishes I have made known to
my Executrix, hereinafter named.
~ttonb
I give $1,000.00 each to my three daughters, FRANCES M. BURD, BETTY L LEBO,
and MARY L. RUSSELL, and I give my automobile to my granddaughter, AMY L. BURD.
~birb
I give $100.00 to each of the following charities:
a. Mount Zion Methodist Church, 420 Park Drive, Carlisle, Pennsylvania;
b. House of Freedom Broadcast, 6420 Carlisle Road, Dover, Pennsylvania;
c. Radio Bible Class, Grand Rapids Michigan; and
d. The Ql.liei Hour, Redlands, Calliornia.
jfourtb
I give the entire rest, residue and remainder of my estate to nlY daughter, FRANCES M.
BURD. In the event my daughter, FRANCES M. BURD, does not survive me, then I give the
rest, residue and remainder of my estate to my great granddaughter, AMY L. BURD.
1
YY\, ~ '\A/
.
jf iftb
Any person who survives me for less then thirty (30) days shall be considered to have
predeceased me.
~ixtb
Unless provided otherwise in any trust, I direct my Executrix to pay all federal, state, and
other death taxes, payable because of my death on the property forming my gross estate for tax
purposes, regardless of whether it passes under this Will, which taxes shall be paid out of the
principal of my estate such that the burden of payment falls on my residuary estate; the taxes shall
not be charged against any beneficiary of my estate. This article shall not apply to generation
skipping taxes or property subject to my general power of appointment for federal estate tax
purposes.
~tbtntb
Except as otherwise provided herein as a trust, if any person under the age of twenty-one
is entitled to a share of my estate, such shares shall be delivered to my grandso~ GREGORY
LYNN BURn, as (1) Custodian under the Pennsylvania Uniform Transfers to Minors Act, and
(2) as to any property which cannot pass under said Act, then to him as trustee.
fligbtb
I hereby nominate, my daughter, FRANCES M. BURn, Executrix of this my Last Will
and Testament, to serve without bond or security of any type for any purpose whatsoever, and I
hereby authorize, empower and direct her to sell and convey, by good and sufficient deed, in fee
simple estate, any and all of my real estate, at public or private sale, for such price or prices, upon
such terms and conditions, as in her judgment is best for my estate, and to that end to sign, seal,
execute, acknowledge and deliver all deeds or other instruments necessary therefor, as effectively
as I could do if I were personally present.
If and in the event that my daughter, FRANCES M. BURn, does not survive me, or is
otherwise unable or unwilling to complete his duties as Executrix, then and in such event, I hereby
nominate, constitute and appoint my grandson, GREGORY LYNN BURn, Executor of this my
Last Will and Testament, to serve without bond or security, and I hereby authorize, empower and
2
""-'-I\A ~, A /
.
direct him, as Executor, to sell and convey, by good and sufficient deed, in fee simple estate, any
and all of my real estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds
or other instruments necessary therefor, as effectively as I could do if I were personally present.
IN WITNESS WHEREOF, I have hereunto set my hand and Seal to this, my Last Will
and Testament, consisting of four typewritten pages, the first three of which bear my signature in
the margin for the purpose of identification, this ~ day of October, 1996.
J11~~~
MABEL EDNA WENTZ
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, as
and for her Will, in the presence of us, who, at her request, in her presence, and in the presence of
a er, have ~r unto subscribed our names as witnesses in attestation thereof
residing at
<83{hMl1e/ b-
w/rde 1ft (JOr 3
residing at
f3(]A1tJJAJeL" DR-
t2/l12LISLb PA /7CJ;3
G
CONIMONWEAL TH OF PENNSYLVANIA
. SS:
COUNTY OF CillABERLAND
I, MABEL EDNA WENTZ, having been duly qualified according to law, acknowledge
that I signed the foregoing instrument as my Will, and that I signed it as my free and voluntary
act for the purposes therein expressed.
'r,rcd.d. ~ LA1~
MABEL EDNA WENTZ
3
'II
We, having been duly qualified according to law, depose and say that we were present and
saw MABEL EDNA WENTZ, sign the foregoing instrument as her Will; that she signed it as her
free and voluntary act for the purposed therein expressed; that each of us in her sight and hearing
and at her request signed the Will as witnesses; and that to the best of our knowledge she was at
that time 18 or more years of age, of sound m(;J}j~.tf(=o :Jt~uence.
less
~&~/
tJkess
Subscribed, sworn to or affirmed,
and acknowledged before me by the
above named Testatrix and by the
witnesses whose names appear
"'- -" >' rI / (
o}'JP~ (!k ~ "" r , 1996.
/~/ ~ 1~11l
1"// TAR Y p' , IC'I ,.-
u /{/
l/
F d' Notaria! Seal
re enck I. Hug'"' '. N ~. .
Carlisle Bora C~r~'~orl~t~tubllC
My Cammissio'n E I.~~. In . Ounry
-xplres U1Y 8, 1999
\..-
4
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GRIFFIE BRADLEY L
200 N HANOVER STREET
CARLISLE, PA 17013
___n___ fold
ESTATE INFORMATION: SSN: 188-12-4683
FILE NUMBER: 2104-1000
DECEDENT NAME: WENTZ MABEL EDNA
DATE OF PAYMENT: 02/28/2006
POSTMARK DATE: 02/28/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/24/2004
NO. CD 006382
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $574.80
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3105
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
$574.80
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GRIFFIE BRADLEY L
200 N HANOVER STREET
CARLISLE, PA 17013
h______ fold
ESTATE INFORMATION: SSN: 188-12-4683
FILE NUMBER: 2104-1000
DECEDENT NAME: WENTZ MABEL EDNA
DATE OF PAYMENT: 05/03/2006
POSTMARK DATE: 05/03/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/24/2004
NO. CD 006651
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $21 .47
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$21.47
REMARKS:
CHECK# 3130
SEAL
INITIALS: MW
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
BRADLEY L GRIFFIE ESQ
GRIFFIE & ASSOCS
200 N HANOVER ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-30-2006
WENTZ
09-24-2004
21 04-1000
CUMBERLAND
101
MABEL
E
Amount Remitted
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, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF WENTZ MABEL E FILE NO. 21 04-1000 ACN 101 DATE 05-30-2006
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: 04-17-2006
PRINCIPAL TAX DUE: 574.80
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-28-2006 CD006382 .00 574.80
05-03-2006 CD006651 21.47- 21.47
TOTAL TAX CREDIT 574.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE
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 TN<:;'TRIJr"TTnN<:' 1
-',
04-17-2006
WENTZ
09-24-2004
21 04-1000
CUMBERLAND
101
APPEAL DATE: 06-16-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9~!_~~9~~_!~~~_~~~~______~___~~!~!~_~Q~~~_~Q~!!Q~_EQ~_YQY~_~~~Q~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MABEL E FILE NO. 21 04-1000 ACN 101
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES (/-jr"li=:- :!,:':(~.pF(R~ISEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION--" ':._.__ .',,--,nr: DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX 280601 "r'
HARRISBURG PA 17128-0601
2t~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
[":10
,-'j j
[1: 2S
CLER~< O~
BRADLEY L GRIf~j[!~~~;
GRIFFIE & AS~OtS
200 N HANOVER ST
CARLISLE
PA 17013
ESTATE OF
WENTZ
REV-1547 EX AFP (06-05)
MABEL
E
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
DATE 04-17-2006
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
.00
14,333.98
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. 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; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
1,286.00
274.52
(1lJ
(12)
(13)
(14)
NOTE:
If an assessment was issued previously, lines
reflect figures that include the total of ALL
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 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
14,333.98
1.560 52
12,773.40
.00
12,773.40
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
12,773.40 X 045=
.00 X 12 =
.00 X 15 =
(19)=
(15)
(16)
(17J
(18)
.00
574.80
.00
.00
574.80
.
~ .. . '''''" , R.... ..., . (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-28-2006 CD006382 .00 574.80
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-01-2006 TOTAL TAX CREDIT 574.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. 21.47
TOTAL DUE 21.47
. IF PAID AFTER DATE INDICATED, SEE REVERSE
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
BED~
Cumberland County - Register Of Will.s
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/27/2006
GRIFFIE BRADLEY LEROY
GRIFFIE & ASSOCIATES
200 N HANOVER STREET
CARLISLE, PA 17013
RE: Estate of WENTZ MABEL EDNA
File Number: 2004-01000
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
9/24/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report" please disregard
this notice.
Sincerely,
I c..,/ &_LlulJ
,&~,ll~'4rrf'<) J.?t~-~v
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/27/2006
BURD FRANCES M
19 BRIDGEWATER ROAD
NEWVILLE, PA 17241
RE: Estate of WENTZ MABEL EDNA
File Number: 2004-01000
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
9/24/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report,. please disregard
this notice.
Sincerely,
,14 / (.,.,9 ,At::: iLiUP
,,~ L-it'~;.IJ Jo~'~
Glenda FarnE=r Strasbaugh
Clerk of the Orphans I Court
cc: File
Counsel
IN RE: ESTATE OF MABEL EDNA WENTZ
: ORPHANS' COURT DIVISION
LATE OF THE BOROUGH OF CARLISLE
: COURT OF COMMON PLEAS
: CUMBERLAND COUNTY
: PENNSYLVANIA
: NO. 21-04-1000
PETITION FOR SETTLEMENT OF A SMALL EST A TE
PURSUANT TO 20 Pa.C.S.A. SECTION 3102
e
s:~
tf{:Eo
t;~~
":;" 00 ::0
-- ^
~8~ ."
OC: :x
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1. Mabel Edna Wentz died on September 24, 2004, a resident of th~~ough ~
w
TO: THE HONORABLE JUDGES OF SAID COURT:
The Petition of Frances M. Burd respectfully represents that:
Carlisle, Cumberland County, Pennsylvania.
2. Petitioner, whose address is 19 Bridgewater Road, Newville, Pennsylvania,
17241, is the daughter of the Decedent and the Executrix named in Decedent's
Last Will and Testament dated October 1, 1996.
3. A Certificate of Grant of Letters Testamentary was issued to Petitioner by the
Register of Wills of Cumberland County Pennsylvania, on November 5, 2004.
4. Decedent's named heirs in her Last Will and Testament dated October 1, 1996
and the distributions set forth therein were as follows:
(a) $1,000.00 each to Frances M. Burd, Betty L. Lebo, and Mary L.
Russel, Decedent's daughters.
(b) Decedent's automobile to Amy L. Burd, her granddaughter.
(c) $100.00 each to the following charities:
,....,
c:;,
=>
c:J"'
en
f'T1
-0
t
0'\
(i) Mt. Zion Methodist Church
(ii) House of Freedom Broadcast
(iii) Radio Bible Class
(iv) The Quiet Hour
5. The rest, residue and remainder of Decedent's estate was divised to your
Petitioner.
6. At the time of Decedent's death, the only asset of which she was seized was a
flexible premium retirement deferred annuity with South Western Life Insurance
Company, with a date of death value of$14,333.98.
7. The annuity was paid over to the named beneficiary thereon, Frances M. Burd,
your Petitioner herein.
8. The aforesaid annuity is the only asset that Decedent had at the time of her death
and that asset was passed to the named beneficiary on the aforesaid policy.
9. As no assets were available to be used by the estate to pay debts of the estate, but
Petitioner had received the benefit of the annuity to which she was entitled as a
named beneficiary, Petitioner contributed the sum of $1,560.52 in funeral
expenses, administrative costs, debts and liabilities of the Decedent, as well as to
pay the Inheritance Tax due on the estate.
10. As such, Petitioner has paid all known estate debts and expenses by her personal
contribution to the estate.
11. There are no assets from which any additional distributions can be made from the
estate to the beneficiaries named above in paragraph 4.
.
12. There are no additional claimants or creditors of whom the Petitioner has
knowledge who has not received full compensation.
13. A Pennsylvania Inheritance Tax Return has been filed previously in this estate,
together with permitted discounts and exemptions and along with any interest and
penalties.
14. The Inheritance Tax has been paid in full, as evidence by the Inheritance Tax
statement of account is attached hereto incorporate as hereby reference as Exhibit
"A."
15. There are no additional disbursements available for any heirs, as the debts and
exemptions exceed the assets in the estate.
16. Notice of the intention of filing the within Petition has been given to the named
beneficiaries, as evidenced on the attached Certificate of Service.
17. In the correspondence to the named beneficiaries in the estate, notice was given
that the within Petition would be filed on August 1, 2006, but, your Petitioner
delayed filing of the Petition for an additional month in order to allow a response
from the named beneficiaries and no response has been received.
WHEREFORE, Petitioner requests your Honorable Court to approve settlement
of this estate with no disbursements to the named heirs, as no assets or benefits exist for
distribution.
Respectfully submitted,
.
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
DATE: 9 JJ 10&
I I
J~~ \n tLfl
FRANCES M. BURD
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'.
REV-1607 EX AFP (03-05)
BRADLEY L GRIFFIE ESQ
GRIFFIE & ASSOCS
200 N HANOVER ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-30-2006
WENTZ
09-24-2004
21 04-1000
CUMBERLAND
101
MABEL
E
Amount Remitted
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, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
--+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF WENTZ
MABEL
E FILE NO.21 04-1000
ACN 101
DATE 05-30-2006
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: 04-17-2006
PRINCIPAL TAX DUE: 574.80
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-28-2006 CD006382 .00 574.80
05-03-2006 CD006651 21.47- 21. 47
TOTAL TAX CREDIT 574.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST
I IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" IC
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE
EXHIBIT
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IN RE: EST A TE OF EDNA MABEL WENTZ
: ORPHANS' COURT DIVISION
LA TE OF THE BOROUGH OF CARLISLE
: COURT OF COMMON PLEAS
: CUMBERLAND COUNTY
: PENNSYLVANIA
: NO. 21-04-1000
CERTIFICATE OF SERVICE
I, Bradley L. Griffie, Esquire, hereby certify that I did, the 18th day of July, 2006,
cause a copy of Petitioners Petition for Settlement of a Small Estate to be served upon the
following by first-class mail, postage prepaid at the following addresses:
Mary E. Russel
1148 Newville Road
Carlisle, P A 17013
Betty L. Lebo
1402 Trindle Road
Carlisle, PA 17013
Amy L. Burd
490 Criswell Drive
Boiling Springs, P A 17007
Mt. Zion Methodist Church
420 Park Drive
Carlisle, P A 17013
House of Freedom Broadcast
6420 Carlisle Road
Dover, PA
Radio Bible Class
300 Kraft Avenue SE
Grand Rapids, MI 49512
.'.
The Quiet Hour
630 Brookside Avenue
Redlands, CA 92373
DATE: 9/ frO ~
fie, E uire
for Petitioner
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, P A 17013
(717)243-5551
(800)347-5552
IN RE: ESTATE OF MABEL EDNA WENTZ
J
SEP 0 7 2006 yJ
: ORPHANS' COURT DIVISION
LATE OF THE BOROUGH OF CARLISLE
: COURT OF COMMON PLEAS
: CUMBERLAND COUNTY
: PENNSYLVANIA
: NO. 21-04-1000
ORDER OF COURT
AND NOW, this --1L day o~ 2006, upon consideration of
Petitioner's Petition for Settlement of a Small Estate Pursuant to 20 Pa.C.S.A. ~3102, the
proposed distribution of the Estate of Mabel Edna Wentz as set forth in the within
Petition is hereby approved and confirmed.
4
ECORD
In Testimony wh f. I hereunto
set my hand and the seal
of said Court at Car1isle,'- PA
Thi8~dayof~'-20 otp
~ch~~~~~) .
Clerk of the Orphans fl'L~-,r
Cumberland County
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ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
In Re: ESTATE OF MABEL EDNA WENTZ
LA TE OF THE BOROUGH OF CARLISLE
CUMBERLAND COUNTY
PENNSYL VANIA
NO. 21-04-1000
CERTIFICATE OF SERVICE OF ORDER
ORDER DATE: 09/]2/06
JUDGE'S INITIALS: EAB
TIME STAMP DATE: 09/12/06
IN RE: ORDER OF COURT IN RE PETITION FOR SETTLEMENT OF A SMALL ESTATE
SERVICE TO:
BRADLEY GRIFFITH, ESQ., RADIO BIBLE CLASS, HOUSE OF FREEDOM BROADCAST,
MT. ZION METHODIST CHURCH, AMY BURD, BETTY LEBO, MARY E RUSSEL, THE
QUIET HOUR
METHOD OF MAILING:
ENVELOPES PROVIDED BY:
I2!J USPS
ORRR
o HAND DELIVERED
o OTHER_
I2!J PETITIONER
o JUDGE
o CLERK OF ORPHANS COURT
MAILED: 09-12-06
SERVICE TO:
METHOD OF MAILING:
ENVELOPES PROVIDED BY:
o USPS
ORRR
o HAND DELIVERED
o OTHER_
o PETITIONER
o JUDGE
o CLERK OF ORPHANS COURT
MAILED:
~~k(
Deputy
Clerk of Orphans' Court
~
STATUS REPORT UNDER RULE 6.12
NAME OF DECEDENT:
EDNA MABEL WENTZ
DATE OF DEATH:
September 24, 2004
WILL NO.:
FILE NO.:
21-04-1000
2004-01000
ADMIN. NO.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 0 NoO
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to number 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 N00
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: N/A
c. Did the personal representative state an account informally to the parties
in interest:
Yes 0 No 0
Estate was settled through the filing of a Petition for Settlement of a Small
Estate pursuant to 20 Pa.C.S.A. 93102, and Court Order dated September
11,2006.
I">~.:;GO
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Name:
Address:
BRADLEY L. GRIFFIE, Esquire
200 NORTH HANOVER STREET
CARLISLE, PA 17013
717-243-5551
Counsel for Personal Representative
Date: ~/~lb~
8'1 : \ Hd S \ d3S 9GGZ Tel. No.:
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