HomeMy WebLinkAbout04-1040 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
~state oZ ~'~- _N ~,'~., No. "11 -0 ~1 -/0 ~t 0
also known as To:
Register of W~iJls for the
Deceased. County of c._Lo_x--~.'x~c\o-,~Ain the
Social Security No. \-~ ~ - \'~- ~ O~"L°x'~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, app[ \ e_~ for letters of administration
on. the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in County, Pennsylvania, with
h e_x- last family or principal residence at
(hst street, number and mumc~paht~)
Decendent, then c~i4 years of age, died (-.)~_ \t_~ ,. , J-9 ~oc~-~,
Decendent at death owned property with estimated values as folllows:
(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 $
situated as follows: ~,
Petitioner.__ after a proper search ha ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of adminis~r~ttion in the
appropriate form to the undersigned. : :,
~°
~]- i: o ccrlif~, lhat thc mlbrmation here givcn is correctly copied l:mm an original certificate of death duly filed with me as
i ,{ ~ k:zgislrar. Thc original certificate will bc forwarded to thc State Vilal Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~.~711~ ~ ~ .?~:¢ Local Registrar
...... ;' - . OCT 1 5 2004
Rev. 2t87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Harrisburg Harrisburg Hospital
~.S. ARMED FORCES? { (~ "~ ~ ~" ~"} MARITAL STATUS - MaM~, SUR~V*NG SPOUSE
~idgweO
t H 1 ' (S~ Insets li~ tn a
. o ly Spr[n s Pa17065 .,
.. Merle J. Adams h, Mary Hazlett
~.. o~(s~> ~,~.. 10/18/2004 ~g. Holly Springs Cern. l~-HollvSDrin~s. PA17061
~.ys~an~s~ ~ a~eatflmem~to S mt~andTIUe
~m~o~n~sd~ffi TIMEOF~T~ __~ DATE~U~EFD~D(M°nffi'P~Y}YeaO// .I ~ ,/ I W~CASEREFERREDTOAMEDI~LE~MINEE~ORONE~/
/
W~ANA~OPSY ~REA~OPSYFIND,~S MANNER OF DEATHoF__iH? ' 'TE OF INJURY TIME OF INJURY I
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· ~ ~A~s~~.~.~l,O;hE,~yN~e~ha~p~dd~h~d~l~item23) ~ SIG UREANDTI~E FCERT '
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~-~x-.<:~- ~ ~xxc~., No. ~ / - (~ t// - /b 70
also known as To:
Register of W~ls for the
Deceased. County of ~~=c~in the
Social Security No. ~ ~ ~ - ~ ~ ~ ~ ~ ~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ~ ~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in County, Pennsylvania, with
h ~ last family or principal residence at ~ ~. ~~ ~ ~ ~k~ ~~.~.
(hst street, number and municipalit~
Decendent, then ~ years of age, died ~9~ ~ ~ , ~ ~,
Decendent at death owned property with estimated values as folllows:
(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 $
situated as follows: ~. ~
Petitioner after a proper search ha ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of adminisi~tion in the
appropriate form to the undersigned.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
26<--.0-.\ C;,\-.,.oC>6'--'
Date of Death:
\()!\L\!O~
Will No. ''-00'\ - 0\Ou.,o
Admin. No. I---\".'2..oc!'\-OIOu.,o yo",,,, 1.\-O!.\-\ou.,o
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the foUowing beneficiaries of the above-captioned estate on 1 I ? a, I () "'>
I (
~
Address
\ ,,\ :".~ \.\.~II"",~~
"':LliO \~ \~~ ~ ~<:u.J' O')(~ '''\?A,
.
Notice has now been given to aU persons entitled thereto under Rule 5.6(a) except
C'G ~,~
Date: 7_\ ~ \ 0"::>
~ \?~'~^".d
-'~ J ~
- ' \\)~').~
Signature
Name 'y.J'\';/>.'r(" C;,\:-:'SC'0,
N
Address 1-1 7,-0 \~\-.....,...,~" ~~~~~
~<"h" O'/..\;~A <\?~ \ '1 ~SQ
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'....._'
Telephone (, n) 1./2..1-\ - "i, " 1 \
Capacity: ~ Personal Representative
_Counsel for personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
phone: (717)240-6345
Date: 02/01/2005
GIBSON WILLIAM R
2170 HUNTERS TOWN HAMPTON RD
NEW OXFORD, PA 17350
RE: Estate of GIBSON EDNA J
File Number: 2004-01040
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
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 ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 02/26/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
Clerk of the Orphans' Court
cc: File
Counsel
Judge
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
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July 15, 2005
2005 JUL 22 Pi: 2: 08
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C:t7:1'7}1'81~;j99b
PbJ((717) 772~0412'
WilLIAM R. GIBSON
2170 HUNTERSTOWN-HAMPTON ROAD
NEW OXFORD, PA 17350
Re: Estate of EDNA J. GIBSON
File Number 2104-1040
Dear Sir/Madam:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 01/14/06. Because Section 2136
(d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be
granted that would exceed the maximum time permitted.
Claudia Maffei, Superv'
Document Processing Unit
Inheritance Tax Division
Sincerely,
~~.
Q:;;'l.-
In the Court of Common Pleas of
IN RE:
Estate of
Edna J Gibson
Cumberland
County, Pennsy vania
ORPHANS' COURT DIVISION
NO. 21-04-1040
Certification of Notice Under Rule 5.6(@}
Name of Decedent: Edna J Gibson
Date of Death: 10/11/2004
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was serv d
on or mailed to the following beneficiaries of the above-captioned estate on 08/18/2005
Name
William R Gibson
Address
2170 Hunterstown-Hampton Road, New Oxford, A
Notice has now been given to all persons entitled thereto under Rule 5
n/a
Date:
Signature
Name:
Address:
Telephone:
Capacity:
Personal Representative
X Counsel for Personal Representative
-:1
,"', ~
en
Cj"',
',__,,_i
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
NO. CD 006201
GIBSON WILLIAM R
2170 HUNTERSTOWN HAMPTON RD
NEW OXFORD, PA 17350
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__n_n_ fold
101
$15,783.93
ESTATE INFORMATION: SSN: 176-12-9293
FILE NUMBER: 2104-1040
DECEDENT NAME: GIBSON EDNA J
DATE OF PAYMENT: 01/12/2006
POSTMARK DATE: 01/11/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/14/2004
TOTAL AMOUNT PAID:
$15,783.93
REMARKS:
WALTON DAVIS ESQ
CHECK#1338
SEAL
INITIALS: RSK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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WALTON V. DAVIS
ATTORNEY AT LAW
63 WEST HIGH STREET
GETTYSBURG, PA 17325
VOICE (717) 337-1600
FAX (717) 337-2009
January 10, 2006
Register of Wills
Cumberland County
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In re: Estate of Edna J. Gibson; File #21-04-1040
Dear Register of Wills:
Enclosed please find the Inheritance Tax Return and Inventory for the above referenced
estate. Also enclosed are checks necessary for the filings.
Should you have any questions, please do not hesitate to contact me.
Sincerely,
Yi:!d~/~~~~ L
Legal Assistant U 1
Enclosures
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Edna J Gibson
No.
Date of Death
21-04-1040
also known as
10/11/2004
---~~~-_.._----'_.._..._-_._------_.__._---_._---
, Deceased
Social Security No.
Attorney:
William R Gibson
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.
Personal ReDres~ntative . , ~ \ . '
-______ Signature: __----"-~J...\..L~. \-<. r~
William R Gibson
Signature:
Walton V Davis
1.0. No.:
20083
--------.----------------- -._---,._,,-
_._--._---~._-~._--_._~._--_._--.__.._------
Firm:
--.Walton_Jl...Oavis, Attor~ at Law..______
Signature:
Address:
63 West High Street
Gettysburg, PA 17325
(717) 337-1600
Address: 2170 Hunterstown-Hampton Road
New Oxford, PA 17350
Telephone: (717) 266-9675
Telephone:
_.._~---_.._._-_._--_.__.._------ --
----~--_._._._--_.-.._- .------.----------
Dated:
Personal Property
Cas h...............................................................................................
Personal Property........................ ................. ...... ..... .....................
Stocks/Listed.................................................................................
Stocks/Closely Held......................................................................
Bonds.. ...... ............ ........... ...... ...... ...... ........... ...... ...... ...... ...............
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property......... ............ .................. ................. ...... ...........
35,309.53
216,063.28
Total Personal Property ...................... ........... ........
251,372.81
.,
-,
Total Real Property...... ............ ...... ..... ............ .......
125,000.00.
Total Personal and Real Property......................... I
r',,)
376,372.811
!~'" ..,
Total Out-of-State Real Property..........................
.......-,
f"'.":i
~
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of Edna J Gibson
No.
21-04-1040
10/11/2004
also known as
Date of Death
-~~----~-~----------:-i)eceased. -
Social Security No.
Cash
M&T Bank deposit account #15004200019237
5.544.26
M& T Bank deposit account #625302
2.333.41
PNC Bank Certificate of Deposit Account #31500208012
10.014.13
PNC Bank Certificte of Deposit Account #31700225458
10.018.72
PNC Bank Checking Account #5140184561
632.35
Smith Barney Investment - Moneymarket
6.766.66
Total Cash
35.309.53
Stock I listed
400.0000 Smith Barney Investment - Renaissancere
10.840.00
266.0000 Smith Barney Investment - Archer-Daniels
4.543.28
400.0000 Smith Barney Investment - Bank of America
17.680.00
800.0000 Smith Barney Investment - Energy Louisana
20.160.00
300.0000 Smith Barney Investment - Exxon Mobil
14.613.00
300.0000 Smith Barney Investment - General Elec Co
10.038.00
600.0000 Smith Barney Investment - Lincoln Natl
15.900.00
300.0000 Smith Barney Investment - Met Life Inc
11.175.00
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
376.372.81
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Edna J Gibson
No.
21-04-1040
10/11/2004
also known as
Date of Death
--------- --- - --:l)ecease(j--
Social Security No.
712.0000 Smith Barney Investment - PNC Financial SVC
37.380.00
1.300.0000 Smith Barney Investment - Enoents
14.573.00
400.0000 shares Smith Barney Investments - SBC Comms
10.540.00
600.0000 shares Smith Barney Investments - St. Paul Cap
15.660.00
400.0000 shares Smith Barney Investments - Tel & Data Sys
10.596.00
250.0000 shares Smith Barney Investments - Verizon NW Engld
6.605.00
400.0000 shares Smith Barney Investments - Washington Mutual
15.760.00
Total Stock / Listed
216.063.28
Real Estate
7 South Walnut Street, Mount Holly Springs Borough, Cumberland County,
Pennsylvania
125.000.00
Total Real Estate
125.000.00
2
· REV.150bb + (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 04
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
I-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gibson, Edna J
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
10-11-2004
06-08-1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
1040
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
w D 1. Original Retum D 2. Supplemental Retum D 3. Remainder Ratum (date of daath prior to 12.13-82)
...
1:3 ~ r:1 D 4. Limited Estate D 4a. Future Interest Compromlsa (date of death aftar D 5. Federal Estate Tax Retum Required
w l1. 8 12-12-82)
i3 f iil [!] 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
~ copy of Will) copy of Trust)
D 9. Litigation Proceeds Received D 10. ~n~~I:,J~~1~fredit(dateofdealh between D 11.Eleclion to tax under Sec. 9113(A) (Attach Sch 0)
Ti-IISSE<:Tt()N"'USTBE.'(;P..,ptETED;ALt:(;PRRESP()ND~flQEi.4N-b'i:<<()N~i1:)~~1;I~;f~~iN~,()RMAfi()Ni$i:fOQtp'BI$[)iREc:TtSPT(): ..
!it NAME COMPLETE MAILING ADDRESS
~ Walton V Davis
~ FIRM NAME (If applicable)
~ Walton V Davis, Attorney at Law
II:
8 TELEPHONE NUMBER
(717) 337-1600
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
z 6. Jointly Owned Property (Schedule F)
~ D Separate Billing Requested
:3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L) D Separate Billing Requested
~ 8. Total Gross Assets (total Lines 1-7)
fd 9. Funeral Expenses & Administrative Costs (Schedule H)
a::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
63 West High Street
Gettysburg, PA 17325
(1) 125,000.00 OFFICIAL USE ONLY
(2) 216,063.28
(3) None
(4) None
(5) 15,276.68 ..
(6) 10,016.43
(7) None
... 1"."1
(8) 366,356.39
(9) 22,544.06
(10) 1,500.00
(11 )
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
, 15.Amounl of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0 .045 (16)
i= 16.Amount of Line 14 taxable at lineal rate 342,312.33 x
~
;:)
a. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
~
0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
><
~ 19. Tax Due
(19)
24,044.06
342,312.33
0.00
342,312.33
0.00
15,404.05
0.00
0.00
15,404.05
CoPyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
~
Decedent's Complete Address:
STREET ADDRESS
71 South Walnust Street, Mt. Holly Springs,
CITY Mount Holly Springs
ISTATE PA
IZIP 17065
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
15,404.05
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
379.88
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
379.88
15,783.93
15,783.93
I~-
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. B ~x
b. reta~n the right. to des~gnate who shall use the pr?perty transferred or its income;.................................... ~
c. retain a reversionary Interest; or.................................................................................................................. 0 ~
d. receive the promise for life of either payments, benefits or care?............................................................. 0 [!]
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?...................................................................................................................... 0 ~
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 peljury, I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief, it Is true, comecl and
complete. Declaration of preparer other than the personal representative is baSed on all infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSI\E FOR FIL. ING RETURN ADDRESS
illiam R Gibson 2170 Hunterstown-Hampton Road
,.-:< ~-----' New Oxford, PA 17350
SIGNA U OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
[!]
~
DATE
L If ob
D TE
ADDRESS
63 West High Street
Gettysburg, PA 17325
t/ 'i Jo~
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. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .S.
~9116 1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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Rev-1S02 EX+ (S-98)
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
All real property owned solely or as a tenant In common must be reported at fair mar1<et value. Fair market value is defined as tha price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowIadge of the relevant facts.
Real property wihlch Is JolnUy-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 7 South Walnut Street, Mount Holly Springs Borough, Cumberland County,
Pennsylvania
VALUE AT DATE
OF DEATH
125.000.00
TOTAL (Also enter on Line 1, Recapitulation)
125.000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule A (Rev. 6-98)
HUP 1 UNIFORM SETTLEMENT STATEMENT
OMB Approval No. 2502-0265
· A. U.~. DEPARTMENT OF HOUSING AND URBAN i. _LOPMENT SETTLEMENT STATEMENT
B. TYPE OF LOAN 6. File Number: 7. Loan Number:
I. FHA 2. FmHA
3. X Cony. Un ins. 4. VA 5. Cony. Ins. 8. Mortgage Insurance Case Number
C. NOTE: This form 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 closing; they are shown here for informational purposes and are not included in the totals.
NOTE: TIN - Taxnaver's Identification Number
D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER:
Derek A. Bream William Gibson, Executor Countrywide Home Loans
Estate of Gibson 4830 Carlisle Pike
604 N. Baltimore St 2170 Hunterstown/Hampton Rd Mechanicsburg, PA 17050
Mt. Holly Springs, PA 17065 New Oxford, , PA 17350
G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN
7 South Walnut Street Jacqueline M. Verney, Esquire
Mi. Holly Springs, PA 17065 44 South Hanover Street- Carlisle PA 17013
PLACE OF SETTLEMENT I. SETTLEMENT DATE
44 South Hanover Street 07/15/2005
Carlisle. P~ 170i3
J. SUMI\IARY OF BORROWER'S TRANSACTION K. SlIMMARY OF SELLER'S TRANSACTION
100. GROSS AMOllNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract sales nrice 125 000.00 40 I. Contract sales nrice 125 000.00
102. Personal DroDertv 402. Personal nrODertv
103. Settlement charges to borrower (Line 1400) 5 025.12 403.
104. 404.
105. 405.
Adiustments for items naid bv seller in advance Adiustments for items naid bv seller in advance
106. ciht/town taxes 406. CiNftown taxes
107. Countv taxes 07/15/2005-12/31/2005 172.45 407. Countv taxes 07/15/2005-12/31/2005 172.45
108. Assessments 408. Assessments
109. 409.
110. 410.
III. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 130 197.57 420. GROSS AMOUNT DUE TO SELLER 125 172.45
200. AMOlJNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Denosit or earnest money 3 000.00 50 I. Excess denosit
202. Princinal amount of new loanls) 100 000.00 502. Settlement charges to seller ILine 1400) 8.980.98
203. Existing loanl 5) taken subiect to 503. Existing loan(s) taken subiectto
204. 504. Payoff of first mortgage loan
205. second mortaaae 18 750.00 505. Pavoffofsecond mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
Adiustments for items unnaid bv seller Adiustments for items unnaid bv seller
21.0. Citv/town taxes 510. Citv/town taxes
211. COUllNtaxes 511. CounNtaxes
212. Assessments 512. Assessments
213. 513.
214. School Tax 07/01/05-07/15/05 47.63 514. School Tax 07/01/05-07/15/05 47.63
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 121 797 :63 520. TOTAL REDUCTION AMOUNT DUE SELLER 9.028.61
130 197.57
121 797.63
8 399.94
125 172.45
9 028.61
116 143.84
SELLER'S STATEMENT
The infonnation contained in Blocks E. G, H, and I and on line 401 (or, ifline 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the
Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required
to be reported and the IRS detennines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identitication number. If you
do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of
perjury, I certifY that the number shown on this statement is my correct taxpayer identification number.
(Seller's Signature)
William Gibson, Executor
(Seller's Signature)
Estate of Gibson
{) EASY SOFT. Inc. 200 I Previous editions are obsokte
Page I
form HUD-I (3/86) ref Handbook 4305.2
L ' ~TLEMENT CHARGES
700. TOTAL SALES/BROKER's COMMISSION based (,. Ice $ 12 5 . 0 0 0 . 0 0 @ 6.000% PAID FROM PAID FROM
Division of Commission lIine 700) as follows: BORROWER'S SELLER'S
70 Ui 7 . 500 . 00 to B-H Aaency FUNDS AT FUNDS AT
702.$ SETTLEMENT SETTLEMENT
703. Commission naid at Settlement 7 500.00
704.
800. ITEMS PA Y ABLE IN CONNECTION WITH LOAN
80 I. Loan Oriflination Fee $
802. Loan Discount $
803. Aooraisal Fee to William Bassett Appraiser (POC 5310.00\
804. Credit reoort to CI S (POC S 35.00)
805. Lender's Insoection Fee
806. Flood Check Fee to Landsafe Flood 26.00
807. Tax Service Fee to Countrywide Tax Service 90.00
808. Document Prep Fee to Countrywide 400.00
809.
810.
811.
812.
813.
900. ITEMS REOlllREO BY LENDER TO BE PAlO IN ADVANCE
901. Interest from 07/15/2005- 07 /31/2 0 05 @ $16.100 ner day 273.70
902.'Mortfla!!e Insurance Premium for
903. Hazard insurance Premium for
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance 3 month (s \ @ $31. 00 per month 93.00
1002. Mort"ape insurance
1003. City Prooertv Taxes
1004. County Pronerlv Taxes 7 month(s) @ $31.04 ner month. 217.28
1005. Annual assessments
1006. schoo 1 taxes 3 month(s) @ 596.59 per month 289.77
1007.
1008. A!!!!re!!ate Accountin!! Adiustment -124.20
1100. TITLE CHARGES
t 101. Settlement or c1osin!! fee to Jacauel ine M. Verne v Esrruire 500.00
1102. Abstract or title search to Karen Coon 110.00
1103. Title Examination to Jacqueline M. Verney Ese 100.00
1104. Title insurance binder to
1105. Document nreoarat;on to
1106. Notarv fees to Valerie Gsell 15.00 5.00
1107. Attornev's fees to Wlaton V. Davis Esquire 125.00
{includes line numbers: .. .... .
1108. Title Insurance to Penn At torney's Title Ins Co 357.50-'
{includes line numbers: ENDS 100. 300 8.1 & CPL-($35.00\ ..>. .---:. ..... ....... ./
1109. Lender's covera!!e $ 100000.00
1110. Owner's covera"e $ 125000.00
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin" fees: Deed $ 38.50 Mortga!!e $ 84.50 Release $ 123.00
1202. Citv/cntv tax/stamos: Deed $ 1 250.00 Mortpage $ 1.250.00 ..
1203. State tax/stamos: Deed $ 1 250.00 Mortpape $ 1.250.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest insoection to Home Paramount (POC\/Interstate Termite 35.00
1303. Mable Satterson tax collector 2005-06 school tax 1 159.07
1304. JM Verney. Esa e-mail-$50. 00/wires-540. OO/overniaht mail-$20.00 110.00
1305. Boro of Mt. Holly SprinQs water/sewer 100.98
1306.
1400. TOTAL SETTLEj\,IENT CHARGES (enter on lines 103. Section J and 502 Section Kl 5 025.12 8 980.98
CE TIFICA TION: 1 have carefull reviewed the HUD-l Settlement Statement and to the best of my knowledge and beliet; it is a true and accurate statement of all receipts and
disbu sements made on my accou or by' me in this transaction. I further certifY that I received a copy of the HUD-I Settlement Statement.
, 1
O.a...o lL A. ~c
Borrower Derek A. Bream
Seller Estate of Gibson Borrower
The HUD-I Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of
thi~ transaction.
.0
07/15/2005
ttleme Agent Jacqueline M. Ve ey, Esquire Date
W ARNI : It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a tine and
imprisonment. For details see: Title 18 U.S. Code Section 100 I and Section 10 10.
rD EASY SOFT. Inc. 2001 Previous editions are obsolete Page 2 fornl HUD-I (3/86) ref Handbook 4305.2
I
Rev-1503 EX+ (8-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
All property Jolntly-owned wtth right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 400 Smith Barney Investment - Renaissancere 27.10 10.840.00
2 266 Smith Barney Investment - Archer-Daniels 17.08 4.543.28
3 400 Smith Barney Investment - Bank of America 44.20 17.680.00
4 800 Smith Barney Investment - Energy Louisana 25.20 20.160.00
5 300 Smith Barney Investment - Exxon Mobil 48.71 14.613.00
6 300 Smith Barney Investment - General Elec Co 33.46 10.038.00
7 600 Smith Barney Investment - Lincoln Natl 26.50 15.900.00
.
8 300 Smith Barney Investment - Met Life Inc 37.25 11.175.00
9 712 Smith Barney Investment - PNC Financial SVC 52.5 37.380.00
10 1,300 Smith Barney Investment - Enoents 11.21 14.573.00
11 400 shares of Smith Barney Investments - SBC 26.35 10.540.00
Comms
12 600 shares of Smith Barney Investments - St. Paul Cap 26.10 15.660.00
13 400 shares of Smith Barney Investments - Tel & Data 26.49 10.596.00
Sys
14 250 shares of Smith Barney Investments - Verizon NW 26.42 6.605.00
Engld
Total of Continuation Schedule{s) See attached page
TOTAL (Also enter on Line 2, Recapitulation) 216.063.28
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule B (Rev. 6-98)
.
Rev-1S03 EX+ (8-98)
*'
SCHEDULE B
STOCKS & BONDS
continued
C0Y.40NWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
15 400 shares of Smith Barney Investments - Washington 39.40 15.760.00
Mutual
.
TOTAL (Also enter on Line 2, Recapitulation) 216.063.28
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule B (Rev. 6-98)
SMITH BARNEY
atJgroupj'
CONFIDENTIAL FACSIMILE
TO:
DESTINATION FAX:
FROM:
PAGES:
SUBJECT:
MICHELE BRAUNING
17173372009
"Mcvey, Gloria T [PVTC)"
9 (Inclt..ding this cover page)
EDNA GIBSON
PER YOUR REQUEST
< < GlBSON.xls > >
<<GIBSON STAdT.pdf>>
Gloria T Mcvey
Sr. Client Svcs Asst.
Smith Barney
727-507-5708
800-237-5232
727-507-5757 Fax
glori a.t. mcvey@smithbarney.com
This facsimile tra.'l$mission is proVided for your internal use 0.11y, If the reader of this message is not the intended recipient, you are hereby notified that
you have received this document in error, and that any review, dissemination, cblribution or copying of the message is strictly prohibiled If YOIJ have
received Ihis communication in error, please notify us immediately by telephone and return the original message to us by mail.
Smith Barney IS e civision and service mark of Cnigroup Global Merkets Inc.
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Rev-1508 EX+ (8-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
Include the proceeds of UtigaUon and the date the proceeds were received by the estate.
All property JolnUy-owned with the rtght of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M&T Bank deposit account #15004200019237 5.544.26
2 M& T Bank deposit account #625302 2.333.41
3 PNC Bank Checking Account #5140184561 632.35
4 Smith Barney Investment - Moneymarket 6.766.66
TOTAL (Also enter on Line 5, Recapitulation)
15.276.68
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
DEC-22-2005 21:42
PNCBt=NK
412 768 3458
P.01
o PNCBAN<
December 23, 2005
Michele Brauning
Attorney at Law
63 W High St
Gettysburg, PA 17325
RE: Estate of Edna J Gibson (Deceased)
SSN: 176-12~9293
DOD: 10-14-2004
sep
Dear Ms. Brauning:
In response to your request for Date of Death balances for the customer noted above, our
records show the following;
Certificate of Deposit
Account #31500208012
Established 03-29-2001
EDNA J GIBSON
Wll..LIAM R GIBSON
DOD balance: $10,000.00 + $14.13 accrued interest
Account #31700225458
Established 04-30-2002
EDNA] GIBSON
WILLIAM R GmSON
DOD balance: $10,000.00 + $18.72 accrued interest
Cheeklng Account
ACCOWlt #S 140184561
Established 04-01-1963
EDNA J GIBSON
DOD balance: $632.35 + $0.00 accrued interest
Page 1 of2
DEC-22-2005 21:43
PNCBRNK
412 '(b8 ..::S4::>8
t-'.k:2
Please note that this office only provides c1ate of death balances for deposit accountS
(IRAs, CDs, Checking and Savings aecowlts). We do not process any baudal
traasamODI or provide statements. If you need assistance with any of these items,
please c.al11-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~~~
Erica L Schlegel
1-800-762-1775
P7 -PFSC-04-F
500 First Ave.
Pittsburgh fA U219
Me\nber FDIC
Page 2 of2
TOTAL P. 02
(: WENDY RANG - Roe: ~rocI - Date of Oeeth ~eQuest
~ ~
~"::..-.-.. :.:=-
~age 11
From:
To:
Date:
Subject:
DATE OF DEATH REQUESTS
RAN~t WENDY
8/24/20051:12:39 AM
Re: prod - Date of Death Request
To: Wendy.
Please find the dQte of death balance }'Ou had requested on the below aecounts for decedent
EDNA J GIBSON -social security # 176-12-9293 for the Date of death: 1011412004
~ Account Number: 625302 - BQlance $2,333.41 + $ 0.00'=$2,333.41 total )
l 2. Account Number: 15004200019237 - Balance $5,543.91 + $ 0.35=$5.544.26 total
>>> <wrang@mandtbank.com> 08/22105 9:15 AM >>>
Account Information
Date of death: 10114/2004
Account Number: 15004200019237
Product Type: Deposit Account
Account Number: 625302
Product Type: Deposit Account
R.equest Details
Deliver to: Requestor
Delivery Optioni; E-mail
Delivery Details: EBRNWSR
7. '~
K~! 'ml
~N\f8 I ~N\f OIJ
~Wir.:7.l ~OO? 'H 'nn\f
WALTON V. DAVIS
ATTORNEY AT LAW
~ West ~11 Street
GErrYS8URQ, PENNSYLVANIA 1732S
(717) 337-1600
F~(717)337-2009
August 18, 2005
ctQ)~r
M&T Bank
631 Holly Park
Mt Holly Springs, P A 17065
AnN: Estate Department
In re: Edna 1. Gibson, deceased
Dear Estate Department:
Please be advised that my office represents William R. Gibson, administrator, for the estate
of Edna 1. Gibson. Mrs. Olbson died on 9ctober 14, 2004.
Please provide to me in writing the date of death value for any accounts that she may have
had as of the date of her death. Mm. Gibson's social security number is 176-12-9293. Should you
need any other information, please do not hesitate to contact me.
Michele D. Brauning
Legal Assistant
Electronic mail- bblawmdb@earthlink.l)et
--PI ttlS~ .su. ~_,f;b:A..~. C~ wi ~J 7ue.:it ,.()~S.
f! Mla'Bank
Wendy S. Rang
Branch Manager
Mt. Holly Springs Branct'l
631 Holly Pike
Mt. HOlly Springs, PA 17065
7174863008 _7174$67269
WtaI'1QelTl8ndlbank.com
'~
Q fli '(IN
_____~hl~R I ~N\i W
~WiF.:7.l ~OO7. '177. '~)nIi
.
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-04-1040
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 7,633.90
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address .
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Walton V Davis 450.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 216.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 14,244.16
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 22,544.06
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1H2 EX+ (8-981
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
Cot.9.1ONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Hollinger Funeral Home & Crematory, Inc. - Funeral
7.633.90
Subtotal
7.633.90
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule H-A (Rev. 6-98)
II'
.. .11I....
.....
...-
-
HoIIin~er Funeral Home & Crematory, Inc.
Eric L. HoIIinqer. Supervisor
March 24, 2005
Edna J. Gibson
7 South Walnut Street
Mount Holly Springs, P A 17065
The Funeral Service for Edna J. Gibson
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. Professional Services
Funeral Director & Staff. . . . . . . . . .
~RALHOMESER~CECHARGES
SELECTED MERCHANDISE:
Tapestry Rose. . . . . . . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . . . . . . . . . . .
3620.00
3620.00
2895.00
6515.00
Cash Advances
Cemetery Charges.
Newspaper Notice.
Certified Copies .
Clergy Honorarium
Flowers. . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
610.00
214.40
40.00
175.00
79.50
1118.90
Total
Total Cost; .
. . . . . . . . . . . . .
Cill3~
History
11 /16/2004 Payment. . . . .
TOTAL AMOUNT DUE
-7419.50
214.40
y~
\\/ \lJll.-&OL\
. j..! /.
501 NORTH BALTIMORE AVENUE · MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 . (717) 486-3433. FAX (717) 486-3215
www.hoIlinqerfuneralhome.com .
Rev.1502 EX+ (6.98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
ITEM
NUMBER
AMOUNT
DESCRIPTION
13
14
1
Attorneys Fees for Settlement of 7 South Walnut Street
125.00
2
Boro of Mt. Holly Springs water/sewer
100.98
3
Dauphin Oil Company - Heating oil for 7 S. Walnut Street, Mt. Holly Springs, PA
17065
2.076.36
4
Donald Williams - Home repairs for sale of 7. S9uth Walnut Street, Mt. Holly Springs
536.00
5
H&R Block - 2004 Amended Income tax returns
98.00
6
Home Paramount - Pest Inspection and treatment with regard to sale of 7 South
Walnut Street, Mt. Holly Springs, PA 17065
905.24
7
Metro Med Services - Medical Bill
41.25
8
Metro Med Services - Medical Bill
200.00
9
Metropolitan Edison - Electric for 7 South Walnut Street, Mt. Holly Springs, PA
17065 (October 2004 through July 2005)
222.89
10
Mt. Holly Springs Borough - Water and Sewer for 7 South Walnut Street, Mt. Holly
Springs, PA 17065
108.15
11
Mt. Holly Springs Borough - Water and Sewer for 7 South Walnut Street, Mt. Holly
Springs, PA 17065
51.69
12
Mt. Holly Springs Borough - Water and Sewer for 7 South Walnut Street, Mt. Holly
Springs, PA 17065
49.98
Notary fees from sale of 7 South Walnut Street
5.00
Realtor's commission from sale of 7 South Walnut Street
7.500.00
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev.1502 EX+ (6.98)
*'
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALlli OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
ITEM
NUMBER
DESCRIPTION
AMOUNT
15
School Tax prorations from sale of 7 South Walnut Street
47.63
16
Sprint - Telephone at 7 South Walnut Street, Mt. Holly Springs, PA 17065 (October
2004 through June 2005)
381.63
17
Tax prorations from sale of 7 South Walnut Street
-172.45
18
Tim Bear Yard Services - Lawn maintenance for 7 South Walnut Street, Mt. Holly
Springs, PA 17065 (October 2004 through June 2005)
210.00
19
Transfer Tax from sale of 7 South Walnut Street
1.250.00
20
Walton V Davis - Reimburse for legal advertisement
75.00
21
Walton V Davis - Initial consultation regardil)g .estate administration
273.00
22
Walton V. Davis - Reimburse for legal advertisement
158.81
Subtotal
14.244.16
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
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Walton V. Davis
Attorney At Law
63 West High Street
Gettysburg, P A 173Z5
BILL TO
William R. Gibson
2170 Hunterstown-Hampton Road
New Oxford, PA 17350
File No. 141
DATE
03/31/2005
04/05/2005
04/20/2005
04/22/2005
04/25/2005
CURRENT
273.00
DESCRIPTION
Balance forward
Will for one person.
PMT#3359. Payment - thank you
* Travel to and inventory of lock box in Mt. Holly
Springs.
* Complete inventory form and transmit to
Department of Revenue.
1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST
DUE DUE DUE
0.00
0.00
0.00
Please include your file number on your check. Thank you
AMOUNT
74.00
-74.00
208.00
65.00
OVER 90 DAYS
PAST DUE
0.00
Statement
DATE
5/2/2005
AMOUNT DUE
$273.00
BALANCE
0.00
74.00
0.00
208.00
273.00
AMOUNT DUE
$273.00
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT.
9/21/04 Wheelchair Van/One-Way
~!.?t!Q4__ MHeaijeJwtleeichalrvan- ---
Tota/
A0130
50209-
1
40.00
1.25
40.00
,---.. .. .'--....."".....,.
1.25
41.25
0.00
0.00
Metro Mad Services, 877 214.e018
GIBSON, EDNA J. 04-39828
PAY THIS AMOUNT 1111.
-~,
T~
\01 \C\ 10L\-
t,
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT.
9/21/04 Wheelchair Van/round trip A0130
9/21/04Miieagelwheelchairvanmm "mmS6209
9121104WaifflmelWheeIchair/PerMin A0420
...... ......._-.................................-......... ..........-.............. .h......................._............................h ........ .............................._........................
Tota/
1
36
60
80.00
.... ................. .........",...
1.25
...... ..... ..... ...............
1.25
80.00
.....--.....-.. .. ............".......-..........
45.00
.... ....................... ............................,...
75.00
200.00
0.00
0.00
Metro Moo Services, 877 214-6018
GIBSON, EDNA J. 04-39712
PAY THIS AMOUNT 1111.
'~~ '.
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H&R Block !Mjl
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prepared for:
date prepared:
04/12/2005
prepared by:
CARLA GREEN
H&R BLOCK
106 ABBOTTSTOWN STREET
EAST BERLIN, PA 17316- 0000
(717)259- 9469
Today's Savings
9
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for year- round service:
Refund /
(Balance Due)
$0.00
$35.00
( ~S.OO ~~ ')
H&R BLOCK
106 ABBOTTSTOWN ST
EAST BERLIN, PA 17316- 0000
(717)259- 9469
· In simple terms, the Marginal Tax Rate is the tax rare that you pay on your last dollar of taxable income. It is the
highest federal tax bracket that affects your tax calculation. The Effective Tax Rate is the percentage of
your total income that you paid in taxes. For 2004, your Marginal Tax Rate is 0% and your Effective Tax Rate is
0%.
Summary
Refund/(Bal Due)
H&R Block Fees
Refund/(Bal Due)
$0.00
$96.00
$35.00
Filing, Refund and Balance Due Information
Tax Return efile / Mail To
Federal The federal return has been E- Filed.
Pennsylvania Please mail the return to:
REFUND/CREDIT
PA DEPARTMENT OF REVENUE
3 REVENUE PLACE
HARRISBURG, PA 17129- 0003
Delivery: You will receive a check from Pennsylvania for the amountof$35.00.
Advantage (2004) FDADVICE-1V 1.0
Form Software Copyright 1996 - 2005 H&R Block Tax Services, Inc.
.
H&R..~lockl~l...
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2004 Tax Return Summary
Federal Year over Year Comparison
INCOME Year 2004 Year 2003 Change($)
Wages, salaries, tips $1,150 $0 $1,150
Taxable interest income $753 $0 $753
Ordinary dividend income $16 $0 $16
Taxable IRA distribution $2,312 $0 $2,312
Total income $4,231 $0 $4,231
ADJUSTED GROSS INCOME
Total income less total adjustments $4,231 $0 $4,231
OTHER COMPUTATIONS
Alternative minimum taxable income $4,231 $0 $4,231
Filing status Single
An H&R Block Tax Professional is available year. round to provide you with information about these opportunities.
For more information about tax, mortgage and financial services call 1. 800. HRBLOCK or visit hrblock.com.
This H&R Block Advantage document provides suggestions that may help you improve your tax and financial situation. Its contents should be considered in conjunction with
information you receive from other sources that are familiar with your specific circumstances. H&R Biock Financial Advisors, Inc., asubsidiary of H&R Block Inc. offers investment
services and securities prod uets. H&R Black FinancIal Advisors, Inc. is a dually- registered Investment advisor and broker- dealer and a member of NYSE/SJPC. Tax services
offered through subsidiaries of H&R Block Services Inc. Mortgage services offered through H&R Block Mortgage Inc. H&R Block Inc., H&R Block Services Inc, and H&R Block
Mortgage Inc. are not registered broker- dealers.
Client Sum (2004) FDBASUM-1V 1.0
Form Software Copyright 1996 - 2005 H&R Block Tax Services, Inc.
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Client Services
Name
EDNAJ. GIBSON
Date of Birth
June08,1920
SSN
176-12- 9293
Relationship
SELF
Number of Months Supported
N/A
Tax Preparation Fees
Total Tax Preparation
(PA)
$96.00
Total HRB Fees
Total Fees
$96.00
$96.00
Net Amount Delivery
You will receive a check from Pennsylvania for the amountof$35.00.
$35.00
If, due to H&R Block's error, you are entitled to a larger refund (or smaller tax liability) than what we calculated, we will refund your tax preparation
fee for that return. At participating locations. Refund claims must be made during calendar year 2005.
An H&R Block Tax Professional is available year- round to provide you with information about these opportunities.
For more information about tax, mortgage and financial services call 1- 800- HRBLOCK or visit hrblock.com.
This H&R Block Advantage document provides suggestions that may help you improve your tax and financial situation. Its contents should be considered in conjunction with
information you receive from other sources that are familiar with your specific circumstances. H&R Block Financial AdvJsors, Inc., a subsidiary of H&R Block Inc, offers Investment
services and securities products. H&R Block Financial Advisors, Inc. is a dually- registered Investment advisor and broker- dealer and a member of NYSE/SIPC. Tax services
offered through subsidiaries of H&R Block Services Inc. Mortgage services offered through H&R Block Mortgage Inc. H&R Block Inc., H&R Block Services Inc. and H&R Block
Mortgage Inc. are not registered broker- dealers.
Client Sum (2004) FDBASUM. 2V 1.0
Form Software Copyright 1996 - 2005 H&R Block Tax Services, Inc.
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I
NOTICE OF CANCELLATION
Please Note:
This form must be distributed in duplicate with every Home Paramount Service Agreement. The Home
Paramount representative should insert the Branch Number, the Date of the Transaction, and the
Cancellation Expiration Date. Customer must sign and date the top of the form to acknowledge receipt
of the Notice of Cancellation. In the event that the customer requests emergency service to be rendered
before the three (3) day right of cancellation ends, customer must execute a separate Waiver of Right to
Cancel Form.
CUSTOMER ACKNOWLEDGEMENT
Cnstomer herehy ~Ckn~Wled~eived. has read and nnd~rs:ands the ~ancellation Rights.
Signatn reo \ l) , ", """" Print Name: MIl; JtIU G', 8.'\ &v.
-
Date: ~ -2! .-u.r
Address: '7
(Insert Date of Transaction)
You may CANCEL this transaction, without any 'Penalty or Obligation, within THREE (3) BUSINESS
DAYS from the date of transaction.
If you cancel, any property traded in, any payments made by you under the contract or sale and any
negotiable instrument executed by you will be returned within TEN (10) BUSINESS DAYS fQllowing
receipt by the seller of your cancellation notice, and any security interest arising out of the transaction
will be cancelled.
If you cancel, you must make available to the seller at your residence, in substantially as good condition
as when received, any goods delivered to you under this contract or sale; or you may if you wish comply
with the instructions of the seller regarding the return shipment of goods at the seller's expense and risk.
If you do make the goods available to the seller and the seller does not pick them up within 20 days of the
date of your Notice of Cancellation, you may retain or dispose of the goods without any further
obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the
seller and fail to do so, then you remain liable for performance of all obligations under the contract.
(Buyer's Printed Name)
(Date)
(Buyer's
Signature)
\02005 Home Paramount Pest Control Companies, Inc.
D_",,~.;........ C...l;+:.-..... f'7/nA' n...........l........ 'I~:t.... ro.."t"'......._ I V....l1..u., _ ,....11('tl"\n"I~ I Pin1- _ J:l~n,.h
HP250 (3/05)
.....
,p..;
INVOICE
Invoice # d.o~dq,..O~
BillinRAd. d~ccount#: ..
~lt. ~~RoQ
Service Address and Account#:
Jl+~:st ~:r
erfor+d () (~~ &r0lA-
.00
<:91,00
D~e ~ervEe:
- ...O~
Comments:
cfr:mount: ,
~~~
Pa. Sales Tax: :
Total Due: qOS. ;).4 ,
;:2/ C/r~; ~/?
~2tt~-
Remit oayment INCLUDING YOUR ACCOUNT NUMBER to:
./
Attachments:
Service tickets ( )
Contracts ( )
Other ( )
------
HOJ'l1E PARAMOUNT
5153 E TRINDLE RD
MECHANICSBURG PA
17050
Not ir'....uu...5 ]UVI "\-\.HUIIL numoer may cause aelay In posting your payment.
06/24/05
$0.00
DAUPHIN OIL CO, INC.
P.O. BOX 600
CARLISLE, PA. 17013
(717) 243-5515
Prey B. .nee:
$157.46
$0.00
TERMS: ""11h% Late charge due on balances
outstanding more than 30 days from date of
invoice"" (18% per annum)
CUSTOMER
$157.46
ff8cuJt YOU
Custoller Billing History
Account: 24317 Cnt 1 No: 24317 Add~'e S 5 : 7 S WAUmT ST Current: '1;121.1210
Company: 31-60: $157.46
Contact : GIBSON, EDNA ~lount Ho 11 y PA 17065- 61-90: $0.0Il.i
Ph on e: (717) 486-3235 DYer 90: $0. illIZi
Balance: $157.46
Ref Num Dclt e Code Item Description Qty Tax Amoi_mt Balance
28056 1l16/01/05 FUEL FUEL #2 12'3 IZI. illIZI 201. 11 157.46
274'36 04/07i05 FUEL FUEL #2 141. 3 0.00 220.2'3 '-43. 65
26824 03/11/05 FUEL FUEL #2 1'36.3 0.00 306.03 -263.'34
c~616.3 1()2/14/05 FUEL. FUEL #2 155.8 0. 0e! 242.89 -56'3. '37
25554 io1/25/05 FUEL FUEL #'"' 11'7.8 0.00 277.1'3 -812.86
c.
24786 01/03/05 FUEL FUEL 1*2 161. 3 0.0121 251. 47 -10'30.05
241'35 12/14/04 FUEL FUEL #2 107 0.00 166.81 -1341. 52
12/08/04 P PAYMENT 121 0.1210 ;77.41 -,151218.33
23616 11/22/1214 FUEL FUEL #2 11214. '3 121.1210 163.54 -143121.89
11/08/04 P PAYMENT 0 0.00 -2'39.80 -1594.43
... .
23003 1121/25/04 FUEL FUEL #2 127.6 0.00 1'38.93 -12'34.63
10/04/04 P PAYMENT 0 0.00 -2'39.80 '-14'33.56
-
0'3/21/1214 P PAYMENT 121 121.00 -41'3.8121 -11'33.76
~
22575 08/03/1214 FUEL FUEL #2 68.7 121.00 89.24 -773.'36
07/0'3/1214 P PAYMENT 0 0.0121 -23'3.80 -,863.20
...
05/17/04 P PAYMENT 0 0.00 -23'3.80 -623.40
.
22435 05/17/04 FUEL FUEL #2 147.4 121.00 1'31.47 -383.60
04/12/134 P PAYMENT 0 13.013 -239.80 -,575. 07
.
21815 03/27/134 FUEL FUEL #2 156.4 0.0121 203. 16 -335.27
03/11/1214 P PAYMENT 0 Ill. 013 -239.80 -538. '+3
21131 02/26/04 FUEL FUEL #2 142.8 121.00 185.50 -2'38.63
20507 02/07/04 FUEL FUEL #2 162.8 0.00 211. 48 -LfB4. 13
02/02/04 P PAY~lENT 0 0.00 --239.80 -6'35. 61
1':3704 01/19/04 FUEL FUEL #.-. 152.3 0.00 197.84 -455.81
c.
01/02/04 P PAYMENT 0 0. 1110 -239.80 -653.65
19018 12/29/03 FUEL FUEL #2 128.8 0.00 167.31 -413.85
18257 12/09/03 FUEL FUEL #2 179.2 0.00 232.'78 -581.16
12/03/03 P PAYMENT 0 0.00 -:..239.80 -813.'34
11/11/03 P PAYMENT 0 0.00 --239.80 -574. 14
17625 11/06/03 FUEL FUEL #2 131 0.00 170: 17 -334.34
10/07/03 P PAYMENT 0 0.00 -239. 8~ -504.51
171'33 09/18/03 FUEL FUEL #2 7 "1 'J 0.00 95.0'3 -264.71
W.L.
0'3/11/03 P PAYMENT 0 0.00 -120.00 -359.80
09/11/03 P PAYlilENT 0 0.013 -239.80 -239.80
r
Page 1 of 3
RECEIPT FOR 'PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Receipt Date:
Receipt Time:
Receipt No.:
11/16/2004
14:04:20
1038483
GIBSON EDNA J
2004-01040
GIBSON
CCP
------------------------ Receipt Distribution ------------____________
Fee/Tax Description Payment Amount Payee Name
Estate File No. :
Paid By Remarks:
SHORT CERTIFICATE
PETITION FOR PROBA
JCP FEE
Check# 3249
Total Received.........
6.00
200.00
10.00
----------------
$216.00
$216.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
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8 MT HOLLY SPGS PA 17065
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How to Contact Us
Nationwide Representative:
ANDREW L SHOEMAKER
AGENT NUMBER: 1025005
717 -486-7777
HOMEOWNf" BilLING STATEMENT
Policy" Number
5837 MP 958483
Date Prepared
JUL 20, 2005
For Payment Of:
SECOND INSTALLMENT
Total Amount Due
$ 270.00
Due Date
AUG 19,2005
1...111...111....11...1.1....11..11...1.1...1111...1...11..."
EDNA J GIBSON
7 S WALNUT ST
MT HOLLY SPRINGS PA 17065-1321
See back of thisstatementfor important phone numbers and other information about your insurance.
Note:
This Billing Statement Is for the second Installmentfor your Homeowner Insurance Policy. Please
pay premium on or before the above due. date. Thank you for insuring with Nationwide.
Total Premium Due This Statement....................................................... ................................. $
RETAIN THIS PORTION FOR YOUR RECORDS
270.00
----------------------________________V-o~~_
RETURN THIS PORTION WITH PAYMENT
Total Amount Due
$ 270.00
Policy Number
58 37 MP 958483
Due Date
AUG 19,2005
EDNA J GIBSON
7 S WALNUT ST
MT HOLLY SPRINGS PA 17065-1321
YOUR NATIONWIDE AGENT IS:
ANDREW L SHOEMAKER
AGENT NUMBER 1025005
717-486-7777
Make Check
Pa}'able To:
1...111.1.....1111......11..11.1.1...1.1.1..1..1.1.1..1.11...1
NATIONWIDE MUTUAL FIRE INSURANCE
COMPANY
PO BOX 13958
PHILADELPHIA PA 19101-3958
02 0267000000 37 13 16 0000958483 5 0000u27000 0000027000 58 3
00955
ANDREW L SHOEMAKER
502 N BALTIMORE AVE STE C
MT HOLLY SPGS PA 17065
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EDNA J GIBSON
7 S WALNUT ST
MT HOLLY SPRINGS PA 17065-1321
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D
UOMEOWNER POLICY
DECLARATIONS
Non-Assessable
Page 1 of 2
These Declarations are a part of the policy named above and identified by policy number below. They
supersede any Declarations issued earlier. Your Homeowner Polley will provide the insurance described in
this policy In return for the premium and compliance with all applicable policy provisions. See policy for
details regarding the other coverages and additional coverage options.
Policy Number:
5837 MP 958483
Issued:
FEB 25, 2005
Policyholder:
(Named Insured)
EDNA J GIBSON
7 S WALNUT ST
MT HOLLY SPRINGS PA 17065-1321
Policy Period From:
MAR 29, 2005 to MAR 29, 2006 but only if the required premium for this period has been paid, and only
for annual renewal periods If premiums are paid as required. Each period begins and ends at 12: 01 A. M.
standard time at the Residence Premises.
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The Following Change(s) Have Been Made To Your Policy:
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You may notice a change in premium since your last billing. Residence Premises Information has been
changed.
The limit of liability for Section I Coverage A Dwelling is revised.
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Residence Premises Information:
7 S WALNUT ST
MT HOLLY SPRINGS
PA 170651321
ONE FAMiLY
FRAME DWELL I NG
YEAR OF CONSTRUCTION 1952
PROTECTION CLASS 5
RATED PROTECTION CLASS 5
INSIDE SINGLE CLASS AREA
WITHIN 1000 FT FROM HYDRANT
WITHIN 5 MILES FROM FIRE DEPT
FIRE DISTRICT 0005
MOUNT HOLLY SPRINGS BOROUGH OF
PROTECTION TERRITORY 047
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SECTION I
Property Coverages
Limits Of Liability
Deductible: $100 ALL PERILS
COVE RAG E-A-DWELLI NG
COVERAGE-B-OTHER STRUCTURES
COVERAGE-C-PERSONALPROPERTY
COVERAGE-D-LOSS OF USE
SECTION II
$ 139,400
$ 13 , 940
$ 97,580
$ 139,400
In case of a loss under Section I, we
cover only that part of each loss over
the deductible stated.
Liability Coverages
COVERAGE-~-PERSONAL LIABILITY
FOR EACH OCCURRENCE:
PROPERTY DAMAGE AND
BODILY INJURY
COVERAGE-F-MEDICAL PAYMENTS
TO OTHERS EACH PERSON
Limits Of Liability
$ 100, 000
$ 2,000
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Met-Ed
A RrstEnergy ~--:-
October 06, 2004
I Account Number: 1000212999361
Page 1 of 4
M63
Billing Period: Sap 02 to Oct OS, 2004 for 34 days
Next Reading Date: On or about Nov 03, 2004
Bill Based On: Actual Meter Reading
Bill for: JOSEPH W GIB~vN
7 S WALNUT ST
MOUNT HOllY SPRINGS PA 17065
Residential
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
~L~}f:''\\~ ~,~~ ' ~~-, [Ij r< f7::t72 tl:f ~'7:r;;"r:-""1\("'!~~'":r~r~J~ ~~Ti"" ~ry :l~r;y((~trf;~r;1'.::;r:;j \-~ r:'~~?]}}1M-r:);7(JTJ'l2'r ~j,-,~, r<"4! ~~~.~ $~" '_: ~:~.~
. I
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Met-Ed
A Fi'stEi'&gy ear;;;:-
December 06, 2004 I Account Number., r 100021 2999 3 61
Bill for: JOSEPH W GIB\:)~N
7 S WALNUT ST
MOUNT HOllY SPRINGS PA 17065
..age 1 OJ 4
M63
Billing Period: Nov 03 to Dee 03, 2004 for 31 days
Next Reading Date: On or about Jan 04, 2005
Bill Based On: Actual Meter Reading
Residential
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
> ,,"'A' 'l'IA, -{""-r '\"'1?i>>"~?'-T_VA"!P'>>>'1' {';:1' '".'\f.~ ;,.",>, v )::\'Y'~7f>>' -',17":Y-- " q ,>,,,>> '
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.
Met-Ed
A Fi'stEnetgy ean;;;;::-
January 05, 2005
I Account Number: 1P 00 21 2999361
I
Bill for: JOSEPH W GIBSO~
7 S WALNUT ST
MOUNT HOLLY SPRINGS PA 17065
Page 1 of 4
M63
Billing Period: Dee 04 to Jan 04, 2005 for 32 days
Next Reading Date: On or about Feb 02, 2005
Bill Based On: Actual Meter Reading
Prorated Bill
Residential
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
~,l ~~~, I}' ~ ". (f~~i ~1"~~,,\~~~,,:-r;fuj'0 ~:T1,,j r::7(IiY}~~~l~ { r~f (;~tPr~~iJ:L: t;tff;~(jjJi1.~1 ~t~:u ~'j!((.,,~ i:' }:~~) iX{j ir:~fj=: \\>'tl~::rt]t -'</~~, j~:r ~:":ll~/ ~
4
I .
Met-Ed
-A RrstEnergy Corrpan--;-
February 02, 2005
I Account Numbe' - "100212999361
Page 1 of 4
M63
Bill for: JOSEPH W GIBSON
7 S WALNUT ST
MOUNT HOllY SPRINGS PA 17065
Billing Period: Jan 05 to Feb 01, 2005 for 28 days
Next Reading Date: On or about Mar 04, 2005
Bill Based On: Actual Meter Reading
Residential
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
.
Met-Ed
'A Fi'stEn8rgy Compan--;-
.Aarch 04, 2005
I Account Number.. 0 212999361
Page 1 of 4
M63
Bill for: JOSEPH W GIBSON
7 S WALNUT ST
MOUNT HOllY SPRINGS PA 17065
Billing Period: Feb 02 to Mar 03, 2005 for 30 days
Next Reading Date: On or about Apr 05, 2005
Bill Based On: Actual Meter Reading
Residential
To avoid a 1.50% late Payment Charge being added to your bill, please pay by the due date.
~,~. i~~:; '.:'J"~#A~. ~~I';,U)if:I~t'(i,t;,t['J,' !~f:l;~':ji ',,,,t;\l.~.\J~~iIUJlt}tQ,:,;,~;1 :~'~1: f';-'JJ''j:' :}:"1 ~~~~.:w.'t.,;{,%'i.~,J.~H
..
I. Met-Ed
'A ArsrEnwgy Compan~
May 05, 2005
I Account Numbe. J 00 21 2999 361
Page 1 of 4
M63
Bill for: JOSEPH W GIBSON
7 8 WALNUT 8T
MOUNT HOllY SPRINGS PA 17065
I
I
Billing Period: Apr 05 to May 04, 2005 for 30 days
Next Reading Date: On or about Jun 03, 2005
Bill Based On: Actual Meter Reading
Residential
Your previous bill was
Total payments/adjustments
Balance at billing on May 05, 2005
Current Basic Charges
Met-Ed - Consumption
late Payment Charges
Total Current Charges
. .'
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
~
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,I. Met-Ed
A FrstEnarw Carpani"
June 03, 2005
I Account Number: 10 00 21 2999 3 61
Page 1 of 4
M63
Bill for: JOSEPH W GIBSON
7 S WALNUT ST
MOUNT HOLLY SPRINGS PA 17065
Billing Period: May 05 to Jun 02, 2005 for 29 days
Next Reading Date: On or about Jul 05, 2005
Bill Based On: Actual Meter Reading
Residential
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
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ACCOUNT NUMBER
09902927
DATE61LL MAILED
1/7/05
ACCOUNT NUMBER DATE BILL MAILED
81992027 19/5/04
-
PRESENT READING SERVICE FROM
352098 6/18/84
PREVIOUS READING SERVI(" .
345988 9/29/04
UNITS USED
7908 U3
DESCRIPTION
)rev. Balance $I...
4ater $36.92
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frash $32.28
PRESENT READING
353999
9/29/84
84
Prevo Balance
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Sewer
frash
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$9.56
$9.85
$32.28
2/11/95
$51.69
$56.86
WALNUT ST.
11/12/84
$108.15
$118.97
SERVICE I> 7 S. WA L NUT ST.
ADDRESS
KEEP THIS STUB
FOR YOUR RECORDS
AMOUNT DUE
AFTER DUE DATE
AMOUNT DUE
AFTER DUE DATE
SERVICE I> 7 S
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KEEP THIS STUB 0 :2
FOR YOUR RECORDS
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Rev-1512 EX+ (8-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAL TIi OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gibson, Edna J
FILE NUMBER
21-04-1040
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Bank Card Services - Credit Card
VALUE AT DATE
OF DEATH
949.00
2 Pennsylvania Department of Revenue - 2004 Pennsylvania Income Tax
339.00
3 United States Treasury - 2004 Income tax owed
212.00
TOTAL (Also enter on Line 10, Recapitulation)
1,500.00
(If more space is needed, additional pages of the same size)
COPyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
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REV-1513 EX+ (9-00)
.
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Gibson, Edna J
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not Ust Trustee/a)
FILE NUMBER
21-04-1040
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
William R Gibson
2170 Hunterstown-Hampton Road
New Oxford, PA 17350
Son
100%
100.00
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet
'100.00
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
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Form PA-1500 Schedule J (Rev. 6-98)
03-06-2006
GIBSON
10-14-2004
21 04-1040
CUMBERLAND
101
APPEAL DATE: 05-05-2006
( See reverse side under Objections)
Amaunt Remitted I 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 +--
iiv:is47-Ex-AFP-ioi:os3-NOTIci-oF-INHEiiTANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
EDNA J FILE NO. 21 04-1040 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ncr:v'\,: (\~OTICE OF INHERITANCE TAX
VA~ISEMENT~ ALLOWANCE OR DISALLOWANCE
(C: "OF iMDUCTIONS AND ASSESSMENT OF TAX
ZuO& MAR I 0 PM 12: I; 0
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CLERK OF
ORPHAN'S CQURT
WALTON V DAVIS ~~1?H'1 1fT) If},
63 W HIGH ST
GETTYSBURG
PA 17325
ESTATE OF GIBSON
*'
REV-1547 EX AFP (06-05)
EDNA
J
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
DATE 03-06-2006
I~ an assessment was issued previaus!y, lines 14, 15 and/ar 16, 17, 18 and 19 will
re~lect ~igures that include the tatal a~ ~ returns assessed ta date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 .t Spousal rate (15)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. ADount of Line 14 at Sibling rate (17)
18. ADount of Line 14 taxable .t Collateral/Cl.ss B r.te (18)
19. Principal Tax Due
ITS.
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l Est.te (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)
125.000.00
216.063.28
.00
.00
15.276.68
10.016.43
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdD. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governnental Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
22.544.06
(9)
(10)
1.500.00
(11)
(12)
(13)
(14)
(Schedule .J)
NOTE:
.00 X
342~312.33 X
.00 X
.00 X
00 =
045 =
12 =
15 =
+
AMOUNT PAID
15.783.93
NUI1BER
CD006201
INTEREST/PEN PAID (-)
379.88-
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-12-2006 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account~
sub.it the upper portion
of this fore with your
tax p.Ylleni:.
366.356.39
24.044 06
342~312.33
.00
342.312.33
(19)=
.00
15~404.05
.00
.00
15.404.05
15,404.05
.00
11.41
11.41
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE DU~'
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) '---
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
GIBSON WILLIAM R
2170 HUNTERSTOWN HAMPTON RD
NEW OXFORD, PA 17350
__uuu fold
ESTATE INFORMATION: SSN: 176-12-9293
FILE NUMBER: 2104-1040
DECEDENT NAME: GIBSON EDNA J
DATE OF PAYMENT: 04/17/2006
POSTMARK DATE: 04/13/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/14/2004
NO. CD 006557
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11 .41
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$11 .41
REMARKS:
WILLIAM GIBSON
CHECK# 3600
SEAL
INITIALS: RSK
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)
WALTON V DAVIS ATTY
63 W HIGH ST
GETTYSBURG PA 17325
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-15-2006
GIBSON
10-14-2004
21 04-1040
CUMBERLAND
101
EDNA
J
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 KKK
ESTATE OF GIBSON EDNA J FILE NO.21 04-1040 ACN 101 DATE 05-15-2006
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-06-2006
PRINCIPAL TAX DUE: 15,404.05
PAYMENTS (TAX CREDITS):
.,
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID ;_.1
DATE NUMBER INTEREST/PEN PAID (-) ,
)
01-11-2006 CD006201 379.88- 15,783.93 )
04-13-2006 CD006557 11.41- 11.41 , ,
- i
)
TOTAL TAX CREDIT 15,404.05
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
!Ii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
.~tI
Cumberland County - :Register Of WilTS
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/14/2006
GIBSON WILLIAM R
2170 HUNTERS TOWN HAMPTON-RD
NEW OXFORD, PA 17350
RE: Estate of GIBSON EDNA J
File Number: 2004-01040
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. I, for decedents dying on or after
July I, 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: 10/14/2006
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,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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