HomeMy WebLinkAbout04-1004
I
Reg ister of Wills of
Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
BARBARAJ. WERT
Deceased
No. ~'-~'4 - '\~~i...\
Social Security No. 184-26-5431
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of
the Decedent, dated
September 24. 2002
and codicil(s) dated
Stale relevant circumstances, e.g. renunciation, death of Executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and wj3$,.$urvived by the following
spouse (if any) and heirs: ~ .' . 0::"
~
Name Relationship Residence_..
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COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in
Cumberland County, Pennsylvania, with her last family or principal residence at
36 Kensineton Drive. Lower Allen Township
(List street, number and municipality)
Decedent, then 70
years of age, died
October 21. 2004
at
36 Kensineton Drive
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property.....................................................................$
(If not domiciled in PA) Personal property in Pennsylvania.....................................$
(If not domiciled in PA) Personal property in County....................................................$
Value of real estate in Pennsylvania ......................................................................................................................$
T 0181......................................................................................................... $
200.000.00
95.000.00
295.000.00
Real Estate situated as follows:
36 Kensineton Drive. Lower Allen Township. Cumberland Countv. P A
Wherefore, Petitioners respectfUlly request the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
T ed or rinted name and residence
James H. Wert
1612 W. Silver Spring Road
Landisville, PA 17538-1015
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
S~'"'
. (-tk-r
JAMES H. WERT
Before me this
day of
~~\.J ' ,2004.
'O~ ,,~~ "3.,~) ~ C\<.","",
\(~
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No.
d \-()4 - \oo~
Estate of
BARBARA J. WERT
, Deceased.
Social Security No: 184-26-5431
Date of Death:
October 21. 2004
AND NOW, ~ ~~~~~'L'\( ~ ,2004, in consideration of the Petition on the reverse side
hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters Testamentary
d.b.n.c,t.a.: pendente lite: durante absentia: durante minoritate
are hereby granted to JAMES H. WERT in the
above estate and that the instrument(s) dated September 24. 2002 _~ ,....
described in the Petition be admitted to probate and filed of record as the last wft( of the ~cedent."
~~, ."
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FEES
Letters........................... $ l.. ~ 'J
Short Certificate(s) $ \ 5
Renunciation.............. $
Affidavit ().................. $
Extra Pages ()....... $ '\ ~
Codicil............................ $
JCP Fee....................... $ \ ~
Inventory...................... $
Other.............................. $
TOT AL......... $ ~ \ S
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Register of Wills ." ',:::~ .., , \J~
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Attorney ~~
1.0. No: 20558
Address: Johnson, Duffie, Stewart & Weidner.
301 Market Street, P.O. Box 109, Lemovne. PA 17043-
Telephone: 717-761-4540
Lower Allen
. ACTUAL twp.
36 Kensington Dr. RESIDENCE decedent
live in a
IICamp Hill, PA 17011 (See instructions Cumberland town:ihip? 17d.O No, decedenl lived
on other side) 17b. County within aduallimils 01 citylbOro
fATHER'S NAME (Fird Middle, law MOmER'S NA~E (F..t. Middle. ~id"f: Surname)
a Raymon A. ert t9. Harrl.et Crl.S
INFORMANrs NAME (Type/Print) INFORMANrS MAILING ADDRESS (Sir...,. CityfTown, Sra'a. Zip Code)
20a. .T:>m",,,, H W~rt ~r 20b.1612 W. Silver Spring Rd.Landisville,PA
METHOD OF DISPOSITION I ~ DATE OF DISPOSiTION PLACE OF DISPOSITiON. Name of Cemelery. Cremalory .tOGATION" CityfTown. Slate, Zip Coda
. BUIlal t:Xcremation Gamovat from Slale 0 (Month, O.y, Vear) or Olrler Place
Donation 0 o 2tJO-26-04 2~olling Green Mem.Park ~p'mp Hill,PA
. 21a. Olher (Specify)
SIGrT~Rl 'f .FLJNERAL SE~E L1~OR PERSON ACTING AS SUCH r. LICENSE NUMBER T:fJ tt~~rrM!SrfF ~1t&rcs Inc.)24 Humme!"Ave.
. 22.. . ,......& 22b011248 L
C~ete items 23a-c only when certifying .. To the best of my knowtedge. deiilth occurred at the time. dale and place slated LICENSE NUMBER [:~ ~GNrn"
phy~ician iii not available at lime of death 10 (Signature and Title) (Month, Day, Year)
certtty cause of death. 23.. 23b. 230.
Items 24-26 must be compk!ted by TIME OF DEATH ,I ~ATE PRONOUNCED DEAD (Monlh, Day. Year) WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER?
person who pronounces death. J l) ,,;;- H 1.1 25. 'z. [ ('1( r(~i# l.....L 'Z t'(. if Yes 0 No li!I
20. 26.
27. PART!: Entet th. dAM..... InJurl.. or compllc.tion. wNch c.uud lha d..th. Do not anl.f lha mod. of dying. luch .. c.rdl.c Of '..pif.lory iIIrr..t, .hock or h..rtl.ilur.. : ~=~j=~een PART U: Other significAnt condiltons contributing to death, but
L1.1 only one c.u.. on Nch IIn.. not resufting In the undertying cause gi~en in PART I.
IMMEDlATE CAUSE (Final t{ 7/ / t.'Ait'i C'J I\.icc--.rL (it-. t.dlr /"'AI t', \ : on5et and dealh
dlsea~ or condition NON $-rv,41f Z y';.",-, A/S'("cA lur /("^'6 I '1~' f
resulting in death)--+ a,
CUE TO (OR AS A CONSEQUENCE OF)
Sequentially list conditions r ~/..AIH.~'iIS Ct"} I C fI.., 't'i. {i'Utt.l It!,-
if any. leading 10 immediate DUE TO (OR AS A CONSEQUENCE Of): ['Llf D
cau~e. Enter UNDERLYING
CAUSe (Disease or injury c,
Ihal illlllated e~ents OUE TO (OR AS A CONSEQUENCE OF)
resulling on death) LAST d
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TiME OF INJURY INJURV AT WORK? DESCRIBE HOW INJURY OCCURRED
PERFORMED? AVAILABLE PRIOR TO E:( (Month, OilY. Year)
COMPLETION OF CAUSE Natural Homicide 0
OF DEATH? 0 0 Ye.O NoD
Accident Pendmg Inve:i1igation
\0.0 NoGr 0 0 JOa, 30b, 1.1 30e. 30d.
Ye.O NoD Suicide Could not be detennined PLACE OF INJURY AI home, farm, slreut, ra1::tj1: ~~ lOCATION (Street, CityfTown. Stale)
bUilding, elc. (Spe(;ll:,i
2b. 26b. 29. 30.. 30r.
CERTIfiER (Check only one) SIGN IIlTA V.v.iTLE ?)I"CERTiFIER .,~tA)
.l~~~~F~:tGof~~~I;~~~~~s';;::rh c:~c't~~~u~ t~ a.El:~a:~:~(:r~~J~~x~~a~.h:l~f~d~~~~~~~ .~~~~~ .~~ .~~~~~~~~~~. '.I~'~~.:: ..~: HHHHHH 0 3tb. 1/ V "VC:> 0-'
.PRONOUNCING AND CERTIfYING PHYSICIAN (Phylikian both pronouncII1Q death and certlfYlflY to causo of death) lICEo(SE NUMBER TOA1E SIGNED (Month, Day, Yeer)
To the b... of my knowledge, d.ath occurred althe Urn.. dat., and place, and due to the cau...(>>) and manner aM alated.. H'HHHHH 0 3te.ih i)tJ''i 1"5[ S L 3td. 10" Z-l- ~'vV
.MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PERSON WHO COM~iTEo~~Sl)r.. DEA Jl:\ t)
(lIern 27) Tfpe or Pnnt ~,"',,...,,,.> ../2. , , ~ \ I 2.
On the bul. of ...mlnatlon and/or Inve.tlgatlon, In my opinion, death occurred at the Urn., date. and place, and due 10 the cauI"{') and 1 s..' ~. "j-( /*...(~ DI(
manner .. stated... ..... ...... ..... ..... ...... ..... .......... ... ..." .......'............... ........ ..................... ........ ................,....,..,.................. 0 11 fh'L.l.-,5<-J '1; t ~ IIf {'1If/
31a. 32.
REG'STRA~R~~ J.?V ~I/r I DATE FILED (Monlh. Day. Year) (
33 1,z.-j~ - . 38 /:J./'7 -./~ ~ d () t) c../
CERTIFICATE OF DEATH
STATE FilE NUMSE:R
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0131 01-00001/9.24.02/EGM/KL T/162692.3
1Las't Will anti 'Orestament
OF
BARBARA J. WERT
I, BARBARA J. WERT, of Lower Allen Township, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts and the expenses of my last illness and funeral
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
FUNERAL INSTRUCTIONS
I direct that any visitation organized as a result of my death shall be with a closed casket
only except as to my immediate family including my brother, nieces, nephews, grandnieces and
grandnephews, and spouses.
ARTICLE III
SPECIFIC BEQUESTS - GRAND NIECES AND GRAND NEPHEWS
I give and bequeath the sum of TWO THOUSAND ($2;000.00) DOLLARS each unto
each one of my grandnephews and grandnieces who survives me.
ll: S- Am! VO.
,\' ,
, ~.)
0131 01-00001/9.24.02/EGM/KL T/162692.3
ARTICLE IV
SPECIFIC BEQUEST OF TANGIBLE PERSONALTY
I give and bequeath my automobile(s), household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto my brother, JAMES H. WERT, provided he survives me, with the suggestion that he
distribute these items among himself, my nieces and nephews and grandnieces and grandnephews,
in such fashion as he, in his sole judgment, deems appropriate.
ARTICLE V
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue and remainder of my estate, of whatever
nature and wherever situate, as follows:
A. Fifteen (15%) percent thereof unto my brother, JAMES H. WERT, or his then-
living issue, per stirpes, should he predecease me;
B. Fifteen (15%) percent thereof unto my nephew, TIMOTHY J. WERT, Columbia,
South Carolina, or his then-living issue, per stirpes, should he predecease me;
C. Fifteen (15%) percent thereof unto my niece, CINDA RAPP, Moraga, California,
or her then-living issue, per stirpes, should she predecease me;
D. Fifteen (15%) percent thereof unto my niece, NANCY W. SYLER, Tequesta,
Florida, or her then-living issue, per stirpes, should she predecease me;
E. Fifteen (15%) percent thereof unto my nephew, JAMES WERT, Berkeley,
California, or his then-living issue, per stirpes, should he predecease me;
2
013101-00001/9.24.02JEGM/KL T/162692.3
F. Fifteen (15%) percent thereof unto my niece, RAYANNE BERNEDE, Honfleur,
France, provided that should she predecease me, I direct that her share shall be
distributed pro-rata among my remaining residuary legatees in the same proportions
as each legacy bears to the other; and
G. Ten (10%) percent thereof unto my niece, M. CHRISTINA WHITE, Pembroke
Pines, Florida, or her then-living issue, per stirpes, should she predecease me.
ARTICLE VI
UNIFORM TRANSFERS TO MINORS
In the event any beneficiary of my Will has not reached the age of twenty-one (21) years at
the time for distribution of his or her share, distribution of said share may be made in the discretion
of my Personal Representative after considering the age and needs of the beneficiary, either directly
to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20
Pa. C.S.A S 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform Transfers to
Minors Act in the state of residence of such beneficiary as the case may be. My Personal
Representative may designate as such Custodian any institution or person, including my Personal
Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the
time such distribution is made. A receipt for any payment or distribution so made shall be a full
discharge therefor to my Personal Representative, who shall not be responsible to see to, or be
liable for, the application of such proceeds thereafter.
ARTICLE VII
POWERS OF PERSONAL REPRESENTATIVE
My Personal Representative(s) shall have the following powers in addition to those vested
in them by law and by other provisions of my Will applicable to all property, whether principal or
3
013101-00001/9.24.02/EGM/KL T/162692.3
. '
income, including property held for minors, exercisable without court approval and effective until
actual distribution of all property:
A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine.
B. To retain any or all of the assets of my estate, real or personal, without restriction to
investments authorized for Pennsylvania fiduciaries, as they deem proper, without
regard to any principle of diversification or risk.
C. To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of
diversification or risk.
D. To sell at public or private sale, to exchange, or to lease for any period of time any
real or personal property and to give options for sales, exchanges or leases, for such
prices and upon such terms or conditions as they deem proper.
E. To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
F. To compromise any claim or controversy.
G. To make such elections, decisions, concessions and settlements in connection with
all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes as my Personal Representative shall deem appropriate,
without obligation to adjust the distributed share of any person thereby affected.
4
0131 01-00001~9.24.02/~GM/KL T/162692.3
ARTICLE VIII
TAX CLAUSE
I direct that all estate, inheritance, transfer and other taxes of similar nature payable by
reason my death, together with any interest or penalties thereon, and imposed with respect to any
property, whether or not disposed of by this Will, shall be paid out of the residue of my estate.
ARTICLE IX
APPOINTMENT OF PERSONAL REPRESENTATIVE
I name, constitute and appoint my brother, JAMES H. WERT, Executor of this my Last
Will and Testament. Should my brother, JAMES H. WERT, fail to qualify or cease to so act, I
name, constitute and appoint my niece, NANCY W. SYLER, alternate Executrix to complete
the administration of my estate. I direct that no fiduciary appointed herein shall be required to
post bond for the faithful administration of the duties required in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this ~L{"~day of ~ 2002.
B!i~~1- (SEAL)
5
0131 01-00001/9.24.02/~GM/KL T/162692.3
. .
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
AFFIDAVIT AND ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We, BARBARA J. WERT, f:- at"r\. l."o. G:, \..~ \. ~~~ and
C - 'Lc-':) \. \. ')('" ,d('y', . ~ . , the Testatrix and the witnesses, respectively,
whose names are signed to the attached or 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 purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
Testatrix, signed the Will as witness and that to the best of hislher knowledge the Testatrix was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
BARB~J:6P!r~
~~
Witness / ~~
14Uu~- L
Witness
6
0131 01-00001/9.24.02/~GM/KL T/162692.3
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~.
Subscribed, sworn to and acknowledged before me by BARBARA J. WERT, Testatrix,
and subscribed and sworn to before me by ~C\~ ,~r\ (~ \.._\., ~f;'",("" and
C . ~"'\.~ \..\. \c-\ ctrx-r ) (f . , witnesses, this 2.4~ay of ~p~\broJ....2002.
~ ~ \. \l. ~,\.Il.. \.... 1\...\'\'\. ~\. \..""')~<>.......
Notary Public
NoIarIaI Seal
McheIe M. Bross, NoIaIy P\dc
l.emoyne Boro, CtmberIaIlCI CotI1ty
My Qmnisslon ExpIres Sept. 23, 2006
Member, ~ AA~ f'lfNcll!lltls
7
TO Register of Wills Office FROM
Cumberland County Courthouse JOHNSON, DUFFIE, STEWART & WEIDNER
1 Courthouse Square Attorneys at Law
Carlisle, PA 17013-3387 P.O. Box 109
Lemoyne, PA 17043
(717) 761.4540
Fax: (717) 761-3015
SUBJECT: DATE: January 14, 2005
Estate of Barbara J. Wert
No. 21-04-01004
Dale of Dealh: October 21, 2004
Enclosed is a check in the amount of $58,000.00 as a payment on account of Inheritance
Tax for the above-captioned Estate, being made within the 90 days to allow for the 5%
discount.
,
SIGNED: Edmund G. Mvers csh
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
__nnn fold
ESTATE INFORMATION: SSN: 184-26-5431
FILE NUMBER: 2104-1004
DECEDENT NAME: WERT BARBARA J
DATE OF PAYMENT: 01/24/2005
POSTMARK DATE: 01/21/2005
COUNTY: CUMBERLAND
DATE OF DEATH. 10/21/2004
NO. CD 004876
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $58,000.00
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TOTAL AMOUNT PAID:
REMARKS:
CHECK#127
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$58,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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CERTIFICATION OF NOTICE UNDER RULE 5.6/a)
Name of Decedent: BARBARA J. WERT
Date of Death: OCTOBER 21,2004
Will No.: 21-04-01004
Admin. No.:
To the Register:
I certify that the Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned
estate on January If, 2005.
Name Address
James H. Wert 1612 W. Silver Spring Rd.
Landisville, PA 17538
Timothy J. Wert 7018 NC Rte 57, Rougemont, NC 27572
James G. Wert
Cinda Rapp 651 Moraga Rd. #16, Moraga, CA 94556
Katina Hubbard and Jed Hubbard
James Wert 1385 Gilman St., Berkeley, CA 94706
Emilv Rebecca Wert and Jacob A. Wert
Nancy W. Syler 88 Fairview West, Tequesta, FL 33469
Andrew Syler, Michael Syler and Christopher
Syler
M. Christina White 17816 NW 15m Street
Juliana White, Lauren White and Audrev White Pembroke Pines, FL 33029
Rayanne Bernede 85 Rue Ste Leonard, Honfleur, France 14600
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Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None.
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Signature
Name: Edmund G. Myers, Attorney
Johnson, Duffie, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone: (717) 761-4540
,2005
Date: January (<]
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Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
also known as
Date of Death 10/21/2004
, Deceased
Social Security No. 184-26-5431
.lAMES H. WERT
-
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true
and correct. If We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
I.D. No.:
20558
Personal Repres~etar. .. ... ......,. .'
Signature: ~)~4Jt;;;t ...
ES H. WERT
Signature: .
Attorney:
EDMUND G. MYERS
Signature:
301 Market St.
Lemoyne, PA 17043-0109
Telephone: 717/761-4540
Address: 1612 W. SILVER SPRING RD.
LANDlSVILLE, PA 175~:&
Address:
Dated:
~ -/ S---- C?~-
( .-
Telephone: (717) 898-2166
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Personal Property
6 Series EE Bonds - Various Dates/Face Amounts
(Name of decedent only)
(See attached - date of death values)
'"''''
--525.76
2,784 Shares of Allied Irish @ $34.355 per/share
95,644.32
10 Shares MetLife Common @ $40.1215 p/share
342.25
1,633.015 Shares - Tri-Continental Corp.
(jl) $16.45 per/share
26,863.09
The Vanguard Group - Account No. 09844427248 consisting of:
Prime Money Market Fund
924.502 Shs. International Growth Fund
110.688 Shs.iTotal Stock Market Index Fund
30,113.82
$11,455.46
15,762.76
2,895.60
Folger Nolan! Fleming Douglas Investment Account consisting of:
Money Markbt Funds
Various Stocks -
Open End M'\1tual Funds -
58,891.08
$ 3,556.81
11,048.75
44,285.52
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$402,627.18
\J'.
"
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
also known as
, Deceased
Date of Death 10/21/2004
Social Security No. 184-26-5431
Members 1st Federal Credit Union
Account No. 146303 - date of death balance
504.04
M&T Bank - Account No.1 0293132
Date of death balance
5,741.56
Household Goods - appraised value
1,315.00
1998 Nissan Maxima GXE - appraised value
4,700.00
The Patriot-News - subscription refund
31.00
Cash
136.63
Penn Treaty - refund
39.03
USAA - Subscriber's Savings Account
2,236.32
Vanguard Brokerage Services - Mutual Funds
1,598.694 Shs. Dodge & Cox Income Fund @ $12.85 per/share
560.549 Shs. Harbor Capital Appreciation Fund @ $26.49 per/share -
1,433.772 Shs. Pimco Total Return Fund@$11.00per/share
51,163.65
$20,543.22
14,848.94
15,771.49
Comcast - cable service - refund
8.63
U. S. Treasury (IRS) - income tax refund - Form 1040 - 2004
1,119.00
P A Department of Revenue - income tax refund - P A 40 - 2004 - Amended
252.00
Total Personal Property
$279,627.18
2
.
.. .
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
Date of Death 10/21/2004
also known as
. Deceased
Social Security No.
184-26-5431
Real Estate
Real Estate - No. 36 Kensington Drive, Lower Allen Township,
Cumberland County, PA
Book Y, Volume 26, Page 545
Sale Price - Copy of Settlement Statement attached.
123,000.00
Total Real Estate
$123,000.00
3
REV. 1500 EX + (6.-00\
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
21 04
COUNTY CQ[)E YEAR
SOCIAL SECURITY NUMBER
01004
NUMBER_
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT'OF REVENUE
DEPT ~80601
HARRISBURG, fA 17128-0601
DECEDENT'S NAME (LAS~, FIRST, AND MIDDLE INITIAL)
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WERT, BARBARA J.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
184-26-5431
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
10/21/2004
09/25/1934
SOCIAL SECURITY NUMBER
181 0 --------------
1. Original Retur~ 2 Supplemental Return
0 4 Limited Estate[ 0 4a. Future Interest Compromise (date of death after
12-12-82)
181 6. Decedent Die~ Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach
of Will) i copy of Trust)
0 9. Litigation Pr04eds Received 0 10. Spousal Poverty Credit (date of death between
1 -
--------- --
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
FIRM NAME (If applicable) ,
JOHNSON, DU~FIE, STEWART & WEIDNER
TELEPHONE NUMBER
717/761-4540 I
1. Real Estate (S~hedUle A) --' - -- - - --------c==_____
2. Stocks and Bo1dS (Schedule B)
I
3. Closely Held c4rporation, Partnership or Sole-Proprietorship
4. Mortgages & NItes Receivable (Schedule D)
5. Cash, Bank De osits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned i roperty (Schedule F)
o Separate ~illing Requested
7. Inter-Vivos Tra~sfers & Miscellaneous Non-Probate Property
(Schedule G or iL)
8. Total Gross A~setS(total Lines 1-7)
9. Funeral Expen~es & Administrative Costs (Schedule H)
10. Debts of Deced~nt, Mortgage Liabilities, & Liens (Schedule I)
i
11. Total DeduCtiorS (total Lines 9 & 10)
!
12. Net Value of E~tate (Line 8 minus Line 11)
13. Charitable and tovernmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedul$ J)
14. Net Value Subject to Tax(Line 12 minus Line 13)
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NAME
EDMUND G. M
(IF APPLICABLE) SURVIVI!NG SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
COMPLETE MAILING ADDRESS
301 Market St.
Lemoyne, PA 17043-0109
, , ,
(1 ) 123,000.00
(2) 128,495.60
(3) None
(4) None
(5) 156,251.76
(6) None ..1''-
(7) 130,326.27
(8)
538,073.63
(9)
24,657.25
(10)
7,398.13
(11 ) 32,055.38
(12) 506,018.25
-----------------
(13)
(14) 506,018.25
EE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Copyright 2000 form software only The Lackner Group, Inc.
15. Amount of Line 4 taxable at the spousal tax rate, x .00 (15)
or transfers und r Sec. 9116(a)(1.2)
z 16. Amount of Line ~ 4 taxable at lineal rate .045 (16)
0 x
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::> 17. Amount of Line ~4 taxable at sibling rate
"- 192,844.97 x .12 (17) 23,141.40
::!:
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>< 18. Amount of Line 4 taxable at collateral rate
<( 313,173.28 x .15 (18) 46,975,99
>-
19. Tax Due (19) 70,117.39
----------
Form REV-1500 EX (Rev. 6-00)
Form Approved CM B No 2502-0265
B. TYPE OF LOAN
1. D FHA 2.0 FMHA DCONV UNINS
4. D VA 5. 0 CONV. INS.
6 ESCROW FILE NUMBER: 7. LOAN NUMBER:
00515277-001 RRH
, ...
A u.s DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
Abstract Land Associates, Inc.
3912 Market Street
,
Camp Hill, PA 17011
(717) 763-1450
FINAL
8. MORTGAGE INSURANCE CASE NUMBER:
C NOTE: This fOITn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(P.O. C.)" were paid outside the dosing; they are shown here for informational pwposes and are not included in the totais.
D NAME OF BORROWER: HRB Development LLC
ADDRESS OF BORROWER: 650 Hunters Lane
Lewisber PA 17339
The Estate of Barbara J. Wert
ADDRESS OF SELLER:
36 Kensington Drive
Camp Hill, PA 17011
9
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1 (
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E. NAME OF SELLER:
NAME OF LENDER:
ADDRESS OF LENDER:
G. PROPERTY LOCATION: 36 Kensington Drive
Camp Hill, PA 17011
Cumberland County 13-25-0022-088
Parcel # 13-25-0022-088
H. SETTLEMENT AGENT Abstract Land Associates, Inc.
PLACE OF SETTLEMENT: Johnson, Duffie, 301 Market Street, Lemoyne, PA 1-7043
SETTLEMENT DATE: 5/26/2005 PRORATION DATE: 5/26/2005 DISBURSEMENT DATE
J. SUMMARY OF BORROWER'S K. SUMMARY OF SELLER'S TRANSACTION
::;oli;';Q"li1$"'} ~r
101. Contract Sales Price 123,000.00 401. Contract Sales Price
102. Personal Property 402. Personal Property
103. Settlement charges to Borrower (line 1400) 2,267.25 403.
104. 404.
105 40~
5/26/2005
123,000.00
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE'
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE'
106. CityfTown Taxes 406. CitvfTown Taxes
107. County Taxes OS/26/05 to 12/31/05 294.80 407. Counlv Taxes OS/26/05 to 12/31/05 294. BO
108 Assessments OS/26/05 to 06/30/05 103.30 408. Assessments OS/26/05 to 06/30/05 103.30
109. Sewer OS/26/05 to 06/30/05 11.51 409. Sewer OS/26/05 to 06/30/05 11.51
110 Trash OS/26/05 to 06/30/05 18.93 410 Trash OS/26/05 to 06/30/05 18.93
111 411.
112 412.
113 413.
-
114 414.
115 415
120. GROSS AMOUNT DUE FROM BORRDWER: 125,695.79 420. GROSS AMOUNT DUE TO SELLER: 123,42B.54
201. Deposit or earnest money 3,000.00 501. Excess deposit (see instructions) 3,000.00
202. Principal amount of new loan(s) 502. Selllement charges to Seller (line 1400) 1,741.33
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210 CityfTown Taxes 510. CitvfTown Taxes
211 County Taxes 511. County Taxes
212 Assessments 512. Assessments
213 513.
214 514.
215. 515.
216. 516.
217 517.
218 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER: 3,000.00 520. TOTAL REDUCTIONS IN AMOUNT DUE SELLER: 4,741.33
"''''''','>., I
301. Gross amount due from Borrower ( line 120) 125,695.79 601. Gross amount due to Seller (line 420) 123,428.54
302. Less amount paid by/for Borrower ( line 220) 3,000.00 602. Less reduction in amount due Seller (line 5201 4,741.33
303 CASH ( IIrI FROM) ( 0 TO ) BORROWER: 122,695.79 603. CASH (D FROM) (1i1I TO) SELLER: 118,687.21
L SETTLEM~NT CHARGES E"r.ROW .11 . 0
I iUO. TPTAt.M,t;;~lllA.I=l~~~Pl:!MNB$.~
BASED '!Ill PRICE$ 123,00000 @ %= PAID FROM
DIVISION '"Y COMMISSION (LINE 700) AS FOLLOWS: BORROWER'S FUNDS SELLER'S
AT SETTLEMENT FUNDS AT
701 $ -~ to SETTLEMENT
702 $ to
703 Commission paid at settlement
704.
I ' jloij:lt~~~~Y~l:i~(IfI!91:lfjf:l~im '. "
B01 Loan Origination Fee
802 Loan Discount Fee
803. Appraisal Fee
804. Credit Report
805 Lenders Inspection Fee
806 Mortgage Insurance Application Fee
807 Assumption Fee
808
809
810
811
IWO. !Tl'M~fl.E~YI!!itl~1ti"'\;t;j[.lJ;iiT~n~fi!~J!ilJt;j~m ~"i
901 Interest From to @ $ /day % ( days)
902 Mortgage Insurance Premium for Month(s) to
903 Hazard Insurance Premium for Years(s) to
904
905
I ,~.(JQQ...BE$!;RV!;~t!~!1~iTI1giIYJt!-l:~1;
1001 Hazard Insurance months@ $ per month
1002 Mortgage Insurance months @ $ per month
1003 City Property Taxes months@$ per month
1004 County Property Taxes months @ $ 40.94 per month
1005 Annual Assessments months @$ 89.78 per month
1006 months@ $ per month
1007 months @ $ per month
1008 months @ $ per month
~
1101 Settlement or closing fee
1102 Abstract or title search
1103 Title examination
1104 Title insurance binder
1105 Document preparation
1106 Notary fees to SettlemenVNotary/Clerical Fees 10.00 10.00
1107. Attorney's Fees
(includes above items numbers: )
1108 Title Insurance to Abstract Land Associates, Inc. 973.75
(includes above items numbers: )
1109 Lenders coverage $
1110. Owner's coverage $ 123,00000
1111. Overnight Fees to Abstract Land Associates, Inc. 15.00
1112
1113.
r', 1 ~9..~VgRNMgtfl!BE,t;I?IjiJf:j~!ID?:~B~
1201 Recording Fees: Deed $ 38.50 Mortgage $ Release $ 38.50
1202 City/County tax/stamps Deed $ 1,230.00 Mortgaoe $ 1,230.00
1203 State tax/stamps Deed $ 1,230.00 Mortgaoe $ 1,230.00
1204
1205
113(Jd_Al)l)itiPNA~~'j;:jj;~MI;At&H
1301. Survey
1302. Pest Inspection
1303. 2005 CountylTwp Taxes to Bonnie Mill, Tax Collector 491.33
- 1304. Tax Cert to Abstract Land Associates, Inc. 10.00
1305.
1306
1307
1400 TOTAL SETTLEMENT CHARGES (Enter on iine 103,Section J. and - iine 502, Section K) 2,267.25 1,741.33
I have carefully reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my
acoo unt or by me in this transa ction. I fu rther certify that I have received a copy of the HU 0.1 SetUe ment Statement
)
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I .' .) /~ .... .
__ /h..o::1 "I ,'/ +( l/t'-'
HRB Deveiopment/LLCf
I '~'
1 I Borrowers Sellers
,9ntwhidll have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this
SeUlementAgent ,,;!;;(tb/(:I.:J - Date
t {
WARNiNG, It is a crime to knowingly make false slatements to the United States on this or any similarlorm. Penalties upon oonviclion can include a fine and imprisonment Fordetails
see: Title 18 U.S Code Section 1 001 a nd Section 1010.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REtURN
RESIDENT DECEDENT
ESTATE OF
WERT, BARBARA J.
FilE NUMBER
21 - 04 - 01004
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
2
3
4
5
DESCRIPTION
UNIT VALUE
41 Series EE Bonds - Various Dates/Face Amounts
(P.O. D. - James H. Wert, Brother)
(See attached - date of death values)
6 Series EE Bonds - Various Dates/Face Amounts
(Name of decedent only)
(See attached - date of death values)
2,784 Shares of Allied Irish @ $34.355 per/share
34.355
10 Shares MetLife Common @ $40.1215 p/share
34.225
1,633.015 Shares - Tri-Continenta1 Corp.
@ $16.45 per/share
16.45 I
TOTAL (Also enter on line 2, Recapitulation)
VALUE AT DATE OF
DEATH
5,120.18
525.76
95,644.32
342.25
26,863.09
128,495.60
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ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WERT, BARBARA J.
FILE NUMBER
21 - 04 - 01004
Include the proceeds of litigation and the date the proceeds were received by the estatEAII property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
2
3
4
5
6
7
8
9
10
11
12
13
14
DESCRIPTION
The Vanguard Group - Account No. 09844427248 consisting of:
Prime Money Market Fund
924.502 Shs. International Growth Fund
110.688 Shs. Total Stock Market Index Fund
Folger Nolan Fleming Douglas Investment Account consisting of:
Money Market Funds
Various Stocks -
Open End Mutual Funds -
Members 1st Federal Credit Union
Account No. 146303 - date of death balance
M&T Bank - Account No.1 0293132
Date of death balance
Household Goods - appraised value
1998 Nissan Maxima GXE - appraised value
The Patriot-News - subscription refund
Cash
Penn Treaty - refund
USAA - Subscriber's ~avings Account
Vanguard Brokerage Services - Mutual Funds
1,598.694 Shs. Dodge & Cox Income Fund@ $12.85 per/share
560.549 Shs. Harbor Capital Appreciation Fund @ $26.49 per/share -
1,433.772 Shs. Pimco Total Return Fund @ $11.00 per/share
Comcast - cable service - refund
U. S. Treasury (IRS) - income tax refund - Form 1040 - 2004
(See explanation attached)
P A Department of Revenue - income tax refund - P A 40 - 2004 - Amended
(See explanation attached)
VALUE AT DATE OF
DEATH
30,113 .82
$11,455.46
15,762.76
2,895.60
58,891.08
$ 3,556.81
11,048.75
44,285.52
504.04
5,741.56
1,315.00
4,700.00
31.00
136.63
39.03
2,236.32
51,163.65
$20,543.22
14,848.94
15,771.49
8.63
1,119.00
252.00
TOTAL (Also enter on Line 5, Recapitulation)
156,251.76
Estate of Ea.-bara J. Wert
No. 21-04-01004
Explanation for Item Numbers 13 and 14 - Schedule E
Explanation for Item Numbers 9 and 10 - Schedule I
Executor hired Mangold Tax Service to prepare the decedent's Federal and State income tax returns for
2004. The Service completed the returns even though they did not have all of the decedent's 2004 - 1099-
R Forms. The Tax Service filed the returns electronically. Amended Returns were filed as soon as the
errors were detected.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WERT, BARBARA 1.
FILE NUMBER
21 - 04 - 01004
ESTATE OF
ITEM
NUMBER
This schedule/1lus~be_~omJ>le~E!d al'lc:l filed if the answer to any of questions 1 through 4 on p<!ge 2 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH % OF
Include the name of the transferee. their relationship to decedent and the date of transfer. . DECO'S EXCLUSION TAXABLE VALUE
Attach a copy of the deed for real estate. VALUE OF ASSETI INTEREST (IF APPLICABLE)
Vanguard - Individual Retirement Account
Date of death value
Beneficiary: James H. Wert, Brother
(Consisting of: 1,050.386 Shs. Wellington Fund @ $29.27
p/sh ~ $30,744.80; 3,061.217 Shs. High-Yield Corp. Fund
~D $6.38 ~ $19,530.56; 1,235.149 Shs. Windsor II Fund @
$27.87 p/sh ~ $34,423.60 and 4,220.843 Shs. IT Bond
Index Dund@ $10.81 p/sh ~ $45,627.31)
130,326.27
130,326.27
TOTAL (Also enter on line 7, Recapitulation)
130,326.27
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WERT, BARBARA 1.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATlVE COSTS
FILE NUMBER
21 - 04 - 01004
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
FUNERAL EXPENSES:
Musselman Funeral Home
DESCRIPTION
AMOUNT
i
2
Rolling Green Cemetery - interment charges and marker charges
3
Dr. Randal Pelton - Honorarium - Funeral Service
4
Richard Holbert - Honorarium - Funeral Service
5
James H. Wert - Food, etc. purchased for funeral meal
6
Sci/Cem Funeral
B.
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
JAMES H. WERT
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 1612 W. SILVER SPRING RD.
City LANDISVILLE State P A
Year(s) Commission paid
Zip 17538
2.
Attorney's Fees
Johnson, Duffie, Stewart & Weidner
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills - Cumberland County'
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
I
Other Administrative Costs
Cumberland Law Journal - advertising letters
2
The Patriot-N~ws - advertising letters
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
4,462.28
1,790.63
300.00
100.00
400.00
73.08
0.00
9,750.00
313.00
75.00
109.30
7,283.96
24,657.25
ESTATE OF
Schedule H
Funeral Expenses &
Acministrative Costs cootinued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WERT, BARBARA J.
. FILE NUMBER
21 - 04 - 01004
"
-'
Register of Wills - Short Certificates
4
Register of Wills - file Inventory and Inheritance Tax Return
5
Chuck Bricker - household goods appraisal
6
L. G. Connor - real estate appraisal
7
USAA - Homeowner's Insurance
8
UGI - balance due on purchase of gas waterheater.
9
Leggett - charge to open clogged sewer line
10
Duty's Locksmith - change locks at residence.
11
USAA - Automobile Insurance
12
Bill Stauffer - leaf clean-up
13
Comcast Cable - cable charges
14
Verizon - telephone charges
15
P A Water Company - water charges
16
PP&L - electric service charges
n
UGI - gas charges
18
Mark Evans - interior painting to prepare real estate for sale.
19
Lower Allen Township - sewer/trash
20
Union National Bank - charge for Estate checks.
21
Edie Waste, Inc. - hauling trash from residence
22
Rohrer's Hardware - electrical outlet covers - residence
23
Recorder of Deeds - 1 % transfer tax - sale of 36 Kensington Dr.
24
Abstract Land - Tax Certification - sale of 36 Kensington Dr.
25
Bonnie Miller, Tax Collector - County/Township real estate taxes due at settlement - sale of
36 Kensington Dr.
Page 2 of Schedule H
14.00
30.00
80.00
300.00
459.38
492.64
119.00
111.62
140.03
50.00
14.03
42.88
128.80
188.76
500.00
2,750.00
152.70
n.lO
228.00
18.59
1,230.00
10.00
196.43
Schedule H
Funeral Expenses &
Amlinisbative Costs cootinued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WERT, BARBARA J.
26
Notary Fees - sale of 36 Kensington Dr.
--- ---.. ---- -..- --- --
-----.....-
FILE NUMBER
21 - 04 - 01004
-T ,-
Page 3 of Schedule H
10.00
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REl1URN
RESIDENT DECEDENT
WERT, BARBARA J.
FILE NUMBER
21 - 04 - 01004
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Ruth Taylor - Caregiver - nursing services
DESCRIPTION
2
Connie Mott - Caregiver - nursing services
3
Linda Beates - Caregiver - nursing services
4
Griswold Special Care - nursing services
5
Bonnie Marshall - Caregiver - nursing services
6
M&T Bank - Home Equity Line of Credit - Acct. No. 000114565390001
Date of death balance
7
Checks that cleared after death - M&T Bank - Account No.1 0293132: Check No. 3422 - M&T Bank -
Loan Payment - $100.00; Check No. 3432 - $50.00; No. 3457 - PP&L - $38.12; No. 3458 - PA Water Co
- $24.70; No. 3459 - Bank of America - $41.99; No. 3460 - Linda Beates - Caregiver - nursing services-
$414.25; No. 3461 - VGI - balance due on gas fireplace - $644.00; No. 3463 - Bonnie Marshall-
Caregiver - nursing services $229.25; No. 3464 - Suzanne Keener - Caregiver - nursing services -
$399.75; No. 3466 - Griswold Special Care - nursing services - $285.00; No. 3469 - VGI - $99.00; No.
3470 - American Institute for Cancer - $15.00.
8
Bank of America - Acct. No. 4888 6032 5075 7325 - Credit Card Charges -
9
u. S. Treasury (IRS) tax due on amended Form 1040X - 2004.
(See Explanation attached).
10
P A Department of Revenue - tax due on P A 40 - 2004
(See Explanation attached).
I]
Mangold Tax Service - preparation of decedent's Federal & State 2004 income tax returns.
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
78.00
78.00
316.90
247.50
78.00
2,310.65
2,341.06
184.02
1,466.00
233.00
65.00
7,398.13
Estate of Barbara J. Wert
No. 21-04-01004
Explanation for Item Numbers 13 and 14 ~ Schedule E
Explanation for Item Numbers 9 and 10 - Schedule I
Executor hired Mangold Tax Service to prepare the decedent's Federal and State income tax returns for
2004. The Service completed the returns even though they did not have all of the decedent's 2004 - 1099-
R Forms. The Tax Service filed the returns electronically. Amended Returns were filed as soon as the
errors were d~tected.
REV-1513 EX+ (9-00)
"
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WERT, BARBARA J.
FILE NUMBER
21 - 04 - 01004
NUMBER
RELATIONSHIP TO
DECEDENT
Do. NolLis.! Trustee1sl-
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
James H. Wert - 1612 W. Silver Spring Rd.
Landisville,P A 17538
Brother
2 Timothy J. Wert - 339 Barmount Drive, Nephew
Columbia, SC 29210
3 Cinda Rapp - 651 Moraga Road #16, Niece
Moraga, CA 94556
4 Nancy W. Syler - 88 Fairview West, Niece
Tequesta, FL 33469
See Continuation Schedule(s) attached I
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropri~te, on Rev 1500 cover sheJt
,
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
AMOUNT OR SHARE
OF ESTATE
Automobile;
household goods;
POD Bonds; IRA
Account; Fifteen
(15%) percent residue
Fifteen (15%) percent
residue
Fifteen (15%) percent
residue
Fifteen (15%) percent
residue
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
i
"
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WERT, BARBARA J.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
-.- ----
I TAXABLE DISl1RIBUTIONS [include outright spousal distributions, and transfers under
. Sec. 9116(a)(1.2)]
5 James Wert- 1385 Gilman Street,
Berkeley, CA 94706
FILE NUMBER
21 - 04 - 01004
RELATIONSHIP TO
DECEDENT
Do Not List Truslee(sL
Nephew
AMOUNT OR SHARE
OF ESTATE
Fifteen (15%) percent
residue
6 Rayanne Bemede - 85 Rue Ste Leonard Niece Fifteen (15%) percent
Honfleur, France 14600 residue
7 M. Christina White - 17816 NW 15th Street Niece Ten (10%) percent
Pembroke Pines, FL 33029 residue
8 James G. Wert - 7018 NC Rte 57 Grandnephew $2,000.00 cash
Rougemont, NC 27572 bequest
9 Katina F. Hubbard - 651 Moraga Rd. #16, Grandniece $2,000.00 cash
Moraga, CA 94556 bequest
10 Jed Hubbard - 651 Moraga Rd. #16, Grandnephew $2,000.00 cash
Moraga, CA 94556 DOB: 6/13/1988 bequest
11 Andrew Syler - 88 Fairview West, Grandnephew $2,000.00 cash
Tequesta, FL 33469 bequest
12 Michael Syler - 88 Fairview West, Grandnephew $2,000.00 cash
Tequesta, FL 33469 DOB: 9/20/1987 bequest
13 Christopher Syler - 88 Fairview West, Grandnephew $2,000.00 cash
Tequesta, FI, 33469 DOB: 3/11/1990 bequest
14 Jacob Alexander Wert - 1385 Gilman St., Grandnephew $2,000.00 cash
Berkeley, CA 94706 bequest
15 Emily Rebecca Wert - 1385 Gilman St., I Grandniece $2,000.00 cash
Berkeley, CA 94706 DOB: 3/13/1997 bequest
16 Juliana White - 17816 NW 15th St., Grandniece $2,000.00 cash
Pembroke Pines, FL 33029 6/15/1999 bequest
17 Lauren White - 17816 NW 15th St.,
Pembroke Pil(1es, FL 33029
I
18 AudreyWhit~-17816NW 15th5t.,
Pembroke Pi,es FL 33029
Grandniece
DOB: 11/18/2000
Grandniece
DOB: 91212003
$2,000.00 cash
bequest
$2,000.00 cash
bequest
Page 2 of Schedule J
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005475
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA .17043
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
+_n___~ fold
101
$9,064.76
ESTATE INFORMATION: SSN: 184-26-5431
FILE NUMBER: 2104-1004
DECEDENT NAME: WERT BARBARA J
DATE OF PAYMENT: 06/22/2005
POSTMARK DATE: 06/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/21/2004
TOTAL AMOUNT PAID:
$9,064.76
REMARKS:
CHECK#172
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
EDMUND G. MYERS
301 MARKET ST
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
418
6/22/2005
BARBARA T. WERT
21-04-1004
Bill To:
JA
LEMOYNE, PA 170430109
Qty
1
Fee Description
Additional Probate
Fee
Total
70.00
$70.00
Total:
$70.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with yoU! payment. Thank you.
..
.
TO Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
FROM
JOHNSON, DUFFIE, STEWART & WEIDNER
Attorneys at Law
P.O. Box 109
Lemoyne, P A 17043
(717) 761-4540
Fax: (717) 761-3015
DATE: June 20, 2005
SUBJECT: Estate of Barbara J. Wert
No. 21-04-01004
,
Enclosed for filing in the above-captioned Estate are the following:
,I
1. Original Inventory.
2. Original and copy of the Inheritance Tax Return.
3. Check in the amount of $9,064.76, Inheritance Tax.
4. Check in the amount of $30.00, filing charges.
5. Envelope to forward the receipts to this office.
fr, 1_,
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
also known as
Date of Death 10/21/2004
, Deceased
Social Security No. 184-26-5431
JAMES H. WERT
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney:
EDMUND G. MYERS
Personal Repres~etar ......... ...... .
Signature: ~}/~~
ES H. WERT
Signature: .
I.D. No.:
20558
Signature:
Address:
Address: 1612 W. SILVER SPRING RD.
LANDISVILLE, PA 175J~
Dated:
t '/S~C7~-
301 Market St.
Lemoyne, PA 17043-0109
Telephone: 717/761-4540
Telephone: (717) 898-2166
i-'.,,,>
'e.,
..'...-_--,.i.__
Personal Property
,
I
:>
1:'1
6 Series EE Bonds - Various Dates/Face Amounts
(Name of decedent only)
(See attached - date of death values)
..j,...
--525.76
2,784 Shares of Allied Irish @ $34.355 per/share
95,644.32
10 Shares MetLife Common@ $40.1215 p/share
342.25
1,633.015 Shares - Tri-Continental Corp.
(jl! $16.45 per/share
26,863.09
The Vanguard Group - Account No. 09844427248 consisting of:
Prime Money Market Fund
924.502 Shs. International Growth Fund
110.688 Shs. Total Stock Market Index Fund
30,113.82
$11,455.46
15,762.76
2,895.60
Folger Nolan Fleming Douglas Investment Account consisting of:
Money Market Funds
Various Stocks -
Open End Mutual Funds -
58,891.08
$ 3,556.81
11,048.75
44,285.52
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$402,627.18
\)--.
,r ,
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
Date of Death 10/21/2004
also known as
, Deceased
Social Security No. 184-26-5431
Members 1st Federal Credit Union
Account No. 146303 - date of death balance
504.04
M&T Bank - Account No.1 0293132
Date of death balance
5,741.56
Household Goods - appraised value
1,315.00
1998 Nissan Maxima GXE - appraised value
4,700.00
The Patriot-News - subscription refund
31.00
Cash
136.63
Penn Treaty - refund
39.03
USAA - Subscriber's Savings Account
2,236.32
Vanguard Brokerage Services - Mutual Funds
1,598.694 Shs. Dodge & Cox Income Fund @ $12.85 per/share
560.549 Shs. Harbor Capital Appreciation Fund @ $26.49 per/share -
1,433.772 Shs. Pimco Total Return Fund @ $11.00 per/share
51,163.65
$20,543.22
14,848.94
15,771.49
Comcast - cable service - refund
8.63
U. S. Treasury (IRS) - income tax refund - Form 1040 - 2004
1,119.00
P A Department of Revenue - income tax refund - P A 40 - 2004 - Amended
252.00
Total Personal Property
$279,627.18
2
~' .-"
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
No. 21 - 04 - 01004
Date of Death 10/21/2004
also known as
, Deceased
Social Security No. 184-26-5431
Real Estate
Real Estate - No. 36 Kensington Drive, Lower Allen Township,
Cumberland County, PA
Book Y, Volume 26, Page 545
Sale Price - Copy of Settlement Statement attached.
123,000.00
Total Real Estate
$123,000.00
3
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SUBJECT: Estate of Barbara J. Wert
No. 21-04-01004
FROM
JOHNSON, DUFFIE, STEWART &. WEIDNER
Attorneys at Law
P.O. Box 109
Lemoyne, P A 17043
(717) 761-4540
Fax: (717) 761-3015
DATE: June 20, 2005
TO Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
)
Enclosed for filing in the above-captioned Estate are the following:
,;
1. Original Inventory.
2. Original and copy of the Inheritance Tax Return.
3. Check in the amount of $9,064.76, Inheritance Tax.
4. Check in the amount of $30.00, filing charges.
5. Envelope to forward the receipts to this office.
ubler, Estate Ui~'a\'~~~'$t?hftJU
.-.: > <~'L.:' k,.,
/11 ~
~I
, ",
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of WERT, BARBARA J.
, Deceased
No, 21 - 04 - 01004
Date of Death 10/21/2004
Social Security No. 184-26-5431
also known as
JAMES H. WERT
-
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney:
EDMUND G. MYERS
Personal Repres~etat' " .
Signature: ~7/~;y{~
ES H. WERT
Signature:
I.D. No.:
20558
Signature:
Address:
Address: 1612 W. SILVER SPRING RD.
LANDISVILLE, PA 1753&
301 Market St.
Lemoyne, P A 17043-0109
Telephone: 717/761-4540
Dated:
t .1';;----C7~-
r..........)
f""~)
( ,0'
f.,'",::
Telephone: (717) 898-2166
Personal Property
i
:;
,"1
6 Series EE Bonds - Various Dates/Face Amounts
(Name of decedent only)
(See attached - date of death values)
..1""
~'-525.76
2,784 Shares of Allied Irish @ $34.355 per/share
95,644.32
10 Shares MetLife Common @ $40.1215 p/share
342.25
1,633.015 Shares - Tri-Continental Corp.
({I! $16.45 per/share
26,863.09
The Vanguard Group - Account No, 09844427248 consisting of:
Prime Money Market Fund
924.502 Shs. International Growth Fund
110.688 Shs. Total Stock Market Index Fund
30,113.82
$11,455.46
15,762.76
2,895.60
Folger Nolan Fleming Douglas Investment Account consisting of:
Money Market Funds
Various Stocks -
Open End Mutual Funds -
58,891.08
$ 3,556.81
11,048.75
44,285.52
I~
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$402,627.18
., .
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
, Deceased
No. 21 - 04 - 01004
Date of Death 10/21/2004
Social Security No. 184-26-5431
also known as
Members 1st Federal Credit Union
Account No. 146303 - date of death balance
504.04
M&T Bank - Account No.1 0293132
Date of death balance
5,741.56
Household Goods - appraised value
1,315.00
1998 N issan Maxima GXE - appraised value
4,700.00
The Patriot-News - subscription refund
31.00
Cash
136.63
Penn Treaty - refund
39.03
USAA - Subscriber's Savings Account
2,236.32
Vanguard Brokerage Services - Mutual Funds
1,598.694 Shs. Dodge & Cox Income Fund @ $12.85 per/share
560.549 Shs. Harbor Capital Appreciation Fund @ $26.49 per/share -
1,433.772 Shs. Pimco Total Return Fund @ $11.00 per/share
51,163.65
$20,543.22
14,848.94
15,771.49
Comcast - cable service - refund
8.63
U. S. Treasury (IRS) - income tax refund - Form 1040 - 2004
1,119.00
P A Department of Revenue - income tax refund - P A 40 - 2004 - Amended
252.00
Total Personal Property
$279,627.18
2
.
..
,.
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of WERT, BARBARA J.
, Deceased
No. 21 - 04 - 01004
Date of Death 10/21/2004
Social Security No. 184-26-5431
also known as
Real Estate
Real Estate - No. 36 Kensington Drive, Lower Allen Township,
Cumberland County, PA
Book Y, Volume 26, Page 545
Sale Price - Copy of Settlement Statement attached.
123,000.00
Total Real Estate
$123,000.00
3
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
418
6/22/2005
BARBARA T. WERT
21-04-1004
EDMUND G. MYERS
301 MARKET ST
JA
LEMOYNE, PA 170430109
Qty
1
Fee Description
Additional Probate
Fee
Total
70.00
$70.00
Total:
Pc(J#/S;)(p~
$70.00
RECEIVf "J
JUN ! 4 L
JOHNSON. r.
STEWART AN.r t;
Checks should be nude payable to the Register of\Vills. Terms: Net 30.
Please rerum one COPY of this invoice with your payment. Thank vou.
09-05-2005
WERT
10-21-2004
21 04-1004
CUMBERLAND
101
APPEAL DATE: 11-04-2005
( See reverse side under Objections)
Moun't Remi1:1:edl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REV:is47-EX-AFP-io3:0Sl-NOTiCi-OF-iNHERiTANCE-TAX-APPRAiSEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
BARBARA J FILE NO. 21 04-1004 ACN 101
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-,,-"'= ,_ ,~_ ,_ NOTICE Of INHERITANCE TAX
BUREAU Of INDIVlOU4t.r~~~t!/i):D UcFir,C ('- APPRAISEHENT, ALLOIIANCE OR DISALLOIIANCE
~~~T~~:QIA)( DIVISION :'~-, :~ j C~ .n~' ,_, ,- - - Of DEDUCTIONS AND ASSESSMENT OF TAX
HARRISBURG PA 17128-0601 -.
zeGS s~p - 2
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
I'Jr,~ Vi. I I
i ii :;;','
r'!CDj/
'.-,,~L:', \
", -,-, " '
\ ,!''''
EDMUND If/MYERS
JOHNSON ETAL
301 MARKET ST
LEMOYNE
PA 17043
ESTATE OF WERT
*'
REV-1547 EX AFP (06-05)
BARBARA
J
TAX RETURN liAS: I X) ACCEPTED AS fILED
I ) CHANGED
DATE 09-05-2005
If an assessmen1: was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
refleC1: figures 'tha't include 'the 'ta1:al of ALL re'turns assessed 'to da'te.
ASSESSMENT OF TAX:
1.6. AaIount oi Line 14 at Spousal rate CIS)
16. Allount of Line 14 taxable .t Lineal/Class A rat. (16)
17. Allount of Lin. 1'1 .t Sibling r.t. 1171
18. AMount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Du.
I
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estat. (Schedul. A)
2. Stocks and Bonds ISchedul. B)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Propert~ (Schedule EJ
6. JOintly Owned Property ISchBdul. f)
7. Transfers (Schedule G)
8. Total Asset.s
(1)
(2)
(3)
1'1)
IS)
(6)
(7)
123,000.00
128.495.60
.00
.00
156.251.76
.00
130,326.27
un
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdII. Costs/Misc. Expenses (Schedule H)
10. Debts/Hort~ Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Ch.rltabl./9over~ental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estat.e Subject to Tax
(9)
(10)
24,657.25
7.398.13
1111
(12)
(13)
11'1)
NOTE:
.00 II
.00 II
192,844.97 II
313,173.28 II
AIlOUNT PAID
58,000.00
9,064.76
DATE
01-21-2005
06-20-2005
NUHBER
C 004876
CD005475
INTEREST/PEN PAID 1-)
3,052.63
.00
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
00 =
045 =
12 =
15 =
(19)=
NOTE: To insure proper
credit to your account,
sub.lit the upper portion
of this form with your
tax pa~nt.
538,073.63
3'.01;5 38
506,018.25
.00
506,018.25
.00
.00
23,141.40
46,975.99
70,117.39
70,117.39
.00
.00
.00
. If PAID AFTER DATE INDICATED, SEE REVERSE
fOR CALCULATION OF ADDITIOIIAL INTEREST.
I If TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQlIIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" ICR), YOU KAY BE DUE
A REFUND. SEE REVERSF ~TnK= "I: -rUT.... .....-- --- -,--
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM
YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: BARBARA J. WERT
Date of Death: OCTOBER 21. 2004
Will No.: 21-04-01004
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 ~ No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: .
3. If the answer to NO.1 is yes, state the following:
A. Did the personal representative file a final account with the Court?
Yes No X
B. The separate Orphans' Court No. (if any) for the personal
representative's account is:.
C. Did the personal representative state an account informally to the
parties in interest? Yes ~ No
D. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans'
Court and may be attached to this report.
12 N'/Os ~.auj}J h~
Signature
Edmund G. Myers, Attorney
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemoyne, PA 17043-0109
Address
Date:
"':-1
(717) 761-4540
Telephone No.
Capacity
~
Personal Representative
Counsel for Personal Representative
~11