HomeMy WebLinkAbout04-1080PETITION FOR PROBATE and GRANT OF LETTERS
also known as Td:
. . - -, .D~ccqsed.
Soc'a~ Security No. /~7/~ ?-- ~ JSff ~
The petition of the undersigned respectfully represents that:
Your petitioner~, who is/~r~ 18 years of age or older an]the ~executt~r'
in the last will of the above decedent, dated
and codicil(s) dated
Register of X)/ills for the .
County of ~ in the
Commonwealth of Pennsylvania
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
l~ecendent was domiciled at death in (~ZIA,/.~-~qI.~N~ ~. County, Pennsylvania, with
h /~ last family or princip~ rgsidence at //~
(list streW, number ~d muncipahty)
Dec,nde, t, then .~ years of age, died
Except as follows, d<edent did not m~ry, was not ~vorced [nd did riot have a chilh bor~ o(dd~pted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~ ,.
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Penfi§ylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the pr%bgl;e of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF O_~t~v'r~k~o~,~Oo~w,L f ss
The petitioner(s) above-named swear(s) or 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
No.
AND NOW
the reverse side hereof, satisfactory proof having been p, ese,,ted .e,ore me,
IT iS DECREED that the instrument(s) dated
described therein be admitted to probate an~ filed o~f record as the last will of
and Letters -{'-_~x~* ~.,--'lr'v, ~ ,
are hereby granted to k~::~ ~
~ 0 ~/. ~3 (t~('y..) 4 l~__ , in consideration of the petition on
FEES
Probate, Letters, Etc ..........
Short Certificates( ) '
TOTAL
Filed ....~1 :.
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
IO5 112 REV 8/88
(FEE FOR THIS
CERTIFICATE S200)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
T 5761696
Name of Decedent CLAUDE R _ CRA.qV.
Sex MALE Social Security No. 121 - 09- 6837
Date of Birth JUNE 05 · 1918 Birthplace OVERTON TOWNSHIP~
Last
Date of Death NOVEM~,ER 14: 2004
fBRADV,'~f3 COfIN'P¥) ~ PA.
Place of Death MESSIAH VILLAGE CUMBERLAND UPPER ALLEN TWP. Pennsylvania
FacilJtyName AUTO PARTS Sr~tE C[i~B°r°ugh°rTowmshiP
Race WHITE Occupation CLERK Armed Forces? (Yes or No) YES
Decedent's MESSIAH VILLAGE,
Marital Status WIDOWED Mailing Address 100 WIT. ALLEN DRIVE.~ECRANTCSBDR~.pA.17~55_61R0
Informant GENE CHASE Funeral Director JAMES A. BOWEN
Name and Address of
Funeral Establishment MARYOTT-BOWEN FUNERAL ~OME: INC_-217 YORW AURNf~R; ~WANDA; PA 1 RR4R
Immediate Cause
fa) CHRONIC LYMPHOCYTIC LEUKEMIA
(b)
(c)
(d)
Part I:
Part 11: Other Significant Conditions
CAD.
Manner of Death
Natural ;~ Homicide []
Accident [] Pending Investigation []
, Interval Between
' Onset and Death
Describe how injury occurred:
Suicide [] Could not be Determined []
Name and Title of Certfier W. SCHAENER
Address LEMOYNE~ PA. 17043
MD
(M,D., D.O., Coroner, M.E.)
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Records Office for permanent flllng~j,~ ~ 08-097
NOVEMBER 18,2004 P.O,BOX 04, TOWANDA. PA. 18848
DAVIS, MURPHY
AND NIEMIEC
TOWANOA, PENNSYLVANIA
LAST WILL AND TESTAMENT
OF
CLAUDE R. CHASE
I, CLAUDE R. CHASE, of 108 North Fourth Street, Towanda~.Borough, ,
Bradford County, Pennsylvania, being of sound and disposing mind and ~mory, ~
hereby make, publish and declare this as and for my Last Will and Testament, hereby
revoking all former wills and codicils by me at any time heretofore made.
FIRST: I direct that all my iust debts, funeral expenses and expenses of
administration be pa~d as soon as may be possible after my decease.
SECOND: I give, devise and bequeath all the rest, residue and remainder
of my property of whatsoever kind and nature, whether real, personal or mixed, and
wheresoever situate, unto my beloved wife, Eva B. Chase, if she survives me for a
period of thirty (30) days.
THIRD: Should my wife, Eva B. Chase pradecease me or fall to survive
me for a period of thirty (30) days, I give, devise and bequeath all the rest, residue
and remainder of my estate to my grandchildren who are living at the time of my death,
share and share alike.
FOURTH~ I hereby nominate, constitute and appoint my son, Gene Chase,
guardian of the estate of any minor grandchildren who should take under this my Last
Will and Testament. Should my son, Gene Chase die or otherwise be unable or
unwilling to act, I nominate, constitute and appoint my daughter-ln-law, Emily Chase,
guardian of the estate of any of said minor grandchildren.
DAVIS, MURPHY
AND NIEMIEC
TOWANDA, P£NNDYLVANIA
FIFTH: I hereby nominate, constitute and appoint my wife, Eva B. Chase,
Executrix of this my Last Will and Testament. Should my wlfet Eva B. Chaser die
or otherwise be unable or unwilling to act, I nomlnate~ constitute and appoint my
son, Gene Chaser Executor of thls my Last Will and Testament. Should both my
wlfe~ Eva B. Chase and my son~ Gene Chase, die or otherwise be unable or unwilling
to act~ I nominate, constitute and appoint my daughter-ln-lawt Emily Chase,
Executrix of this my Last Will and Testament.
SIXTH: I direct that neither my Executor nor Executrlx~ nor Trusteet be
required to furnish any bond or surety regardless of the place of his or her residence.
IN WITNESS WHEREOF, I, the Testator have hereunto set my hand and
seal this ~ day of~'~ , A.D., 198:3.
Claude R. Chase /
The foregoing instrument was at the date hereof, s~gned~ sealed~ published and
declared by Claude R. Chase~ the Testator herein, as and for his Last Will and Testament~
in our presence, who in his presence, at his request and in the presence of each other
have hereunto set our names as witnesses.
resldlng at
DAVIS, MURPHY
AND NIEMIEC
TOWAN DA, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA )
t SS
COUNTY OF BRADFORD )
I, Claude R. Chase· whose name is signed on the attached instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it willingly and that I
signed it as my free and voluntary act for the purposes therein expressed.
Claude R. Chase
Sworn and subscribed to before me
Towanda, ~radFerd Co.,
My Commission ~xpires Jam 9, 19~
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF BRADFORD )
We~. William J. Davis and Janice Judson
the witnesses whose names are signed to the aftacbed |nstrumenf· being duly qualified
according to Jaw, depose and say that we were present and saw the Testator therein sign
and execute the instrument as his Last Will and Testament; that he signed willlnglyend
that he executed it as his free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testator signed the WHI as witnesses; and that
to the best of our knowledget the Testator w~.s at that time eighteen (18) years of_~age
or more, of sound mind and under no constrmnt or undue ~nfluence.A ^ ~'~
Sworn and subscribed to before me [[ /[~
STATUS REPORT UNDER RULE 6.12
Name ofDecedent: Cl..l/tllJE R CJ/ASE
Date ofDeath:AltJVeM-REA 1'1; ~crJ-!I
Will No.: /)1JI)4-tJ.IlJfl'tJ
Admin. No.: ,J? /-C/j- / c;?{?!
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 0
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. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes .x No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal ~resentative state an account informally to the parties
in interest? Yes ~ No 0
c. Copies ofreceipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orph311S' Court
3l1d may be attached to this report.
Date: ~AfX}5"
~!lf'~f
igna e . . ~
'W'J
'i ",.-.."
"_'._ c.d '~II
, II .,. .". ..... I :IuO
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;D >i!:.l31:) Capacity:
(je1.EB6tA~ EflIl.I7ff~dFE""'A~ dF~~
N3lTIe
//5' Sl.PtIE1? /?l)
fi1BY/AA#~~ pA 1'7tJ55'-5T#
Address
(r/~) ?,&;-711ff-
Telephone o.
~Personal Representative
o Counsel for personal representative
ZS : II fN SZ HVrsOOl
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.
Y) J:\.1..:('i r:~itT.-'("(\::;)..i
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\lEV-l500EX 16-00i
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L-J!!L _-'1> f'~
COUNTY CODE YEAR NUMBER
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Wo.U
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0. III
0.
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W
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W
o
W
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITiAl)
f
SOCIAL SECURITY NUMBER
I I
6ff'3'l
~1.0riginaIReturn
o 4. Umlted Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Utigation Proceeds Received
....
%
W
"
%
o
0.
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W
"
"
o
"
,
DATE OF BIRTH (MM-DD-YEAR)
;;mAlE 5: / 'If
IRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death alter 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copyofTru$l)
o 10, Spousal Poverty Credit (dale of death between 12-31-91 and 1_1_95)
D 3. Remainder Return (date ofdealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
/l.... 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F)
~ o Separate Billing Requested
...J Inter -Vi'Vos Transfers & Miscellaneous Non-Probate Property
::l 7.
I- (Schedule G or L)
ii:
<( B. Total Gross Assets (total Lines 1-7)
0 Funeral Expenses & Administrative Costs (Schedule H)
W 9.
a::
10 Debts. of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 rninus Line 11)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
COMPLETE MAILING ADDRESS
//5 SlJJ/E,e J2])
MEe/IAN'/tlSBtlt'q #1 17/?S5-5J1'4/f
1~
9J/~,1'l
rT'8'FICIAL~EO~Y,-g 1
\ :."J (_ 11"\ ,~-:>
i _~.f2 P ~:.: ;:~~ ~3
':;'(f1 p...) i s.:~
~2 <.n I ~~;
3~. OJj/~ 7:L
.!(f{ J ?p~ Fr
:n) 9'1/.3'1
,-)
-".1
,-."
(J'l
N
. () C'")
-'j
--......-,..,)
(8)
I(}~ i'~/,g{,
9} 'JrJ~, ()f)
I, 9()~1'17
-
(11) 1~1f/,/1
(12) 9% IJIjO" 1'1
(13)
(14) 9'h MtJ, /9
13. Charitable and Governmental Bequests/See 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
16. Arnount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x.O_ (15)
,.04L (16)
x .12 (17)
x .15 (18)
(19)
9Z 1J4(),19
1j..9?5: up
Ifg:?~ tJJ
z
o
!;;:
I-'
::l
ll-
::E
o
o
~
15. Amount of Une 14 taxable at \he spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS
,
CITY
ME:r!IfAI/(eS8~
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) /;;.3!l5, f.V
Total Credits (A + B + C ) (2)
3. InteresVPenally if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 1 Une 20 to request a refund (4)
A. Enter the interest on the tax due.
(5)
(SA)
If} ,gf.;; ()()
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (58) '!; . ~i 5, tlJ
Make Check Payable to: REGISTER OF WILLS, AGENT
~fi 11111l1l!ll11ll~ JIl 4i-M"_I.,,,;'lIlb-1L ..U_lb1JllllB_.l
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
............~ 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,
1. Did decedent make a transfer and: Ves
a. retain the use Dr Income of the property transferred;....... .................... D
b. retain the right to designate who shall use the property transferred Dr its income; 0
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, Dr other non-probate property which
contains a beneficiary designation? .
No
or
~
~
~
~
Under penalties of perjury, I declare thaI I have examined this relurn, including accompanying scheaules and statements, am! 10 tile best of my knowJ$dge and belief, jt is true, correct
and complete.
Declaration of pre parer other than the personal representative is based on all informalionofwhich preparerhas any knowledge.
ADDRESS
~
DATE
ADDRESS
_ ~m I I
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. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (Ii)].
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. 99116(a)(1.2)J.
The lax rale imposed on the net value of transfers to or forthe use of the decedent's lineal beneficiarieGexcept as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX. ll.9:ti
'*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CL4t1PE R, ellAsE
FILE NUMBER /)'/ /III
"'f I ~V7 - /OJ"tJ
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1,-7. $Slf/E Ie AA./lJ EE tIS SAW,r6'S"~s' 94'.75
~~ ~F . 'MIff . 'tiE JJA7JE S~1. ]:E '(Mf/NA7l'# EIt
pSFNr J;
I tsT
1; r,wlf Ic//fI3'::J Ee It)t1,~ 4,iJ3'% /(;j~()/~
'/JJl<<'1f 'l//'11Y e ~5, 00 J},fO$ 7/!1fl)i'
gJ.2PdJ; 9 /lfj?'5 ~ ,15, tJ() Lj,tt1$ 9A(I(l5
TOTAL (Also enteron line2, Recapitulation) $ 1-. 6, 75
(It more space is needed, Insert additional slIeets of the same size)
'REV.l508EX.il-971
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CL.A-t/]J~ R, ~IIABE
FILE NUMBER
-1/-t.5/j-/oft)
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
CASH
rejEVIS/()~ BIBlE; EUl!1I(/O RAJmIt, tl/Jllf/lfml/ IlI'J(/
~ s~ t!JF e[.p!f!f ~IIIRTj PA$S) 1IA'J)nM'~
[\ottilie eslrmt:l;ff.'a J
PfU;PA!D QM#10I/1:.4lSlOK9 (!AsKET; WtT
6/6,1'.$
/()(), tJ1tJ
.R;345,tJt1
TOTAL (Also enter on line 5, Recapitulation) $ .g) (J If /, 9)..
(If more space is needed, insert additional sheets of the same size)
REV"l9EX'(1~71.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
f/Atl])~ R, 6rASE
FILE NUMBE~,/ III I ~
-<'. -O~ -/tJa'tJ
If an asset was made joint within one year of the decedent', date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
GE/IE]3,01Ast5
115 St.OVB( Ra4/); ~/(J58VIl(iJ
PA /W55-5Y#
&w
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Incll.lCle name offinancial inslilulion and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. /9?5 M-I-T BA#K C'l/n!KIlltj AeMUtf/ ,g~)111,!j{) .5tJ% /6)/tJ5:15
#-76j/~'1II/
50fi
~, A. Ifl/5 M+-T BANk SAW,vg5 AeetulAJT /3; ~Jf, ~S t;7h~,/3
#/5tJ()-f2 (}t'/?IJ~
TOTAL (Also enter on line 6, Recapitulation) $ ~:l]8"67,r.r
(If more space is needed, insert additional sheets of the same size)
R~'''O,''.''.n '*'
COMMONWEAl1H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
(!I.A(/JJ~ ~ t!HAS/5
FILE NUMBER ://-04 -/O$'()
This schedule must be completed and filed if the answer to any 01 questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLLJDETHENAMEOFTHETRANSFEREE,THEIRRELAI10NSfiIPTODECEOENTANDTHE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET IF APPLICABLEl
INTEREST
1. :mA At-I-T BM'~ Ae&t/ff 6;7:11/, 9: lOt) % 5;~;;
J tF .35tJdlj,t(JCT:</fIIS.J
~, .17?A f1+7/JAIIK, ;1, 51~f/ /otJ% ~5'1'1,,f1
'J If I15T" MIfI2~rr Pdwal R/#,ERAL
f/QME/, A{!~{/N/
."If:: 3/~()371Ib7/MI
g, ANNUITY) -# W,,';:I(l5$1'957 ~~ 5'?;~ /tfi Z ..(~ 5i'J, S2
lJENEFIf!lMYJ 71M071IY ~ (};.;t5l.
:?t/iJ(" .(.~
+ AI/Alw!YJ iF- WrJtJ/l,N 3M;?'! ~6) sa'}: ,. lot/J:,
Ye/EFleIMYJ Pl?lsew-A 4.(:#.4$
5 AIINUITY #= ,W'otJ:l.tJ/3 aJf6 o%j !JE6; ~ IOlJt .j6;5J/" f!,
J3!E:l/EFlelAf<Ih JOI/IJ If. 6MsE
-ad er1;fh!7U1tfIJ lYe>'kr/{-
Soi/fkrn L1# Box .:J.'ll!;
t!/Ilf!iiJlJ{l/i ()flIf7ftPl~a9/r
TOTAL (Also enter on line 7, Recapitulation) $ iZ 9t~.YI
rs
i5
c
q5
(If more space Is needed, insert additional sheets of the same size)
REV.-1'511 EX+ (12-99) ~.
. *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
~1-(}ll- /t7f'rJ
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
!hPAtf} GIUI:€) II~ (!A.c;m; AliI) JfwLT :tg-?S,Ot!
1:RA FJ~ 81:111:Frr dF ,tU/(ltffF B()I#fJI hlNE/lAl..I!MfI; ~51'f;f7
(M+T BA/I~Aet!<</#r# ..J/oCJ.19//6$.:<t'1 )
lJA/.ANei5 tt4 pAYAfEJ/r7P IIAIlJ(Jl?~ li~lI~ 977,1'/
~/~:1~I;)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions tJ,t()
Name of Personal Representative{s) ~ H &tA.SC"
Social Security Number~umber of Personal Representative(s)
Street Address /11} SLOVER. R'J)
City ME:l!II;4N/(lSl?tU{j State ~ Zip 17(J$
Year(s) Commission Pa'ld: ,/ /JUiUL-
2. Attorney Fees at'o
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant finl.s;-13. &lAsE ~5W,tlJ
Street Address //5" .C:;LI) VEIl Rp State 11L Zip /'/tJ.5:./i'
City ME(T/fAI/j I!~JUIHi
Relationship of Claimant to Decedent St/N
4. Probate Fees 7f',~tI
5. Accountant's Fees at't1
6. Tax Return Preparer's Fees tl,(lfJ
7. FlI./,(/ti Ft=~ /& (/(J
TOTAL (Also enter on line 9. Recapitulation) $ r;; 113 ,()O
{!;.AtlPE J?, ~/I-As~
Debts of decedent must be reported on Schedule 1.
(If more space is needed, insert additional sheets of the same size)
RE,V-1512EX.(1-SJ1
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~7C0tA~
FILE NUMBER '4'
,)/-0. -lOg'O
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
MESSiAH ~.lA9~ r&R .MI,f5~ 61A'E
AtEllT PttAIMIAeYJ RI<#ElJ/t'AW1IS
PIle trSA MRP BAIMt!J:; /AI FI//.I.,
(A{!(!tllldT# /f:?tl ~f1t11651'#t35)
6 J>///I,tJtJ
5(J, /1
/#,~
~.
3,
TOTAL (Also enter on line 10, Recapitulation) $ I; 9pi~ /1
(If more space is needed, Insert additional sneets oj tne same size)
, REV-1'51~ EX+ 19-00*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
CfAcllJE R ~IIAS~
FILE NUMBER
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (al 11.2)]
, 7IMtfTlIY KARl ~ _ ~ (jR4/{lJstJlI
PftJ.({ AtJR77I V4t.tEY PKny~:(tJ/I.
J.EWISV/ILE) 7X" 15tJ11-.:?9/~
J, PI?IS(!li/A A, ))ER'PS4 -# f$/rAI/1)l)AIIQ;
4:f1J7tJ iAt/((fi tjal.;/ R[) 1/f1
C!At./FtJ,flVlA) 1vJ]) 4t761f
3. qmJIN R I eJIA~ (JRA,(Il}S()A!
115 .sUJrEll f?))
Mf3(!IMIIIC!S8IR~ pA 17t>55
4, MAR.y(tTT-]J(}wal !VI/ERA/. /frJMt=
MA-IN Sr
701il/ANOA pA laTif,f
AMOUNT OR SHARE
OF ESTATE
~~J .'Jfc;, 55
.1 b} 68b,.~!J
~~J5a(p,~5
.!lJ 5"1~?/
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
,
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
- :".
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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
".1".1'1) 1,/
No. 2004- 01080 PA No. 21- 04- 1080
Esta te Of: CHASE CLAUDE R
(Last, First, Middle)
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Late Of:
UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 121-09-6837
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WHEREAS, on the 23rd day of November 2004 an instrument dated
December 6th 1983 was admitted to probate as the last will of
CHASE CLAUDE R
(Last First. Middle)
late of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 14th day of November 2004 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH
for CUMBERLAND County, in the Commonwealth of
certify that I have this day granted Letters
CHASE GENE BARRY
who has duly qualified as EXECUTOR(RIX;
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
Register of Wills
Pennsylvania, hereby
TESTAMENTARY to:
in and
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 23rd day of November 2004.
,11Poncta ~lAtLV_ i ~~,()\no ,c&l)
, Reg,,'er of ~~o Ci . ,\..
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* *NOTE* * ALL NAMES ABOVE APPEAR (LAST. FIRST. MIDDLE)
II
LAST WILL AND TESTAMENT
OF
CLAUDE R. CHASE
I, CLAUDE R. CHASE, of 108 North Fourth Street, Towando Borough,
Bradford County, Pennsylvania, being of sound and disposing mind and memory, ~
hereby make, publish and declare this os and for my Lost Will ond Testament, hereby
revoking all former wills and codicils by me at any time heretofore made.
FIRST: I direct that all my just debts, funeral expenses and expenses of
administration be paid as soon as may be possible after my decease.
SECOND: I give, devise and bequeath all the rest, residue and remainder
of my property of whatsoever kind and nature, whether real, personal or mixed, and
wheresoever situate, unto my beloved wife, Eva B. Chase, if she survives me for a
period of thirty (30) days.
..
TH IRD: Should my wife, Eva B. Chase predecease me or fail to survive
me for a period of thirty (30) days, I give, devise and bequeath all the rest, residue
and remainder of my estate to my grandchildren who are living at the time of my death,
share and share alike.
FOURTH. I hereby nominate, constitute and appoint my son, Gene Chase,
guardian of the estate of any minor grandchildren who should take under this my Last
Will and Testament. Should my son, Gene Chase die or otherwise be unable or
lAVIS, MURPHY
AND NIEMIEC
unwilling to act, I nominate, constitute and appoint my daughter-in-law, Emily Chase,
RHEVS"No"ClIUN5ELORS
AT LAW
ANDA. PENNSYLVANIA guardian of the estate of any of said minor grandchildren.
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FIFTH: I hereby nominate, constitute and appoint my wife, Eva B. Chase,
Executrix of this my Last Will and Testament. Should my wife, Eva B. Chase, die
or otherwise be unable or unwilling to act, ., naminate, constitute and appoint my
son, Gene Chase, Executor of this my Last Will and Testament. Should both my
wife, Eva B. Chase and my son, Gene Chase, die or otherwise be unable or unwilling
to act, I nominate, constitute and appoint my daughter-in-law, Emily Chase,
Executrix of this my Last Will and Testament.
SIXTH: I direct that neither my Executor nor Executrix, nor Trustee, be
required to furnish any bond or surety regardless of the place of his or her residence.
IN WITNESS WHEREOF, I, the Testator hove hereunto set my hand and
seal this b day ofYC(f , A.D., 1983.
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.($~ (SEAL)
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The foregoing instrument was at the date hereof, s,igned, sealed, published and
declared by Claude R. Chase, the Testator herein, as and for his Last Will and Testament,
in our presence, wha in his presence, at his request and in the presence af each ather
have hereunto set our names as witnesses.
IS, MURPHY
o NIEM1EC
DQr--
residing ot
b~.~k) t.
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residing at
Y5 AND caUNSELORS
AT LAW
JA, PENN5YlVANlA
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COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF BRADFORD
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I, Claude R. Chase, whose name is signed on the attached instrument, having been
duly qualified according to low, do hereby acknowledge that I signed and executed
the instrument Os my Lost Will and Testament; that I signed it willingly and that I
signed it os my free and voluntary act for the purposes therein expressed. .
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4?~~fi~c-_W~~
Claude R. Chose
Sworn and subscribed to before me
this IQ-e..-day of ~\~, 1983.
,
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CHARLO~ N01'l'6fClprp-;;blic ~
.1 j '"" '-'"
Towanda, Br,"\'l cr_ ~,.., ; c" 1984-
My Commission 'EXplf<O!5 Jan. 9,
COMMONWEALTH OF PENNSYLVANIA)
:ss
COUNTY OF BRADFORD
)
..
We, William J. Davis and . Janice Judson
the witnesses whose names are signed to the attached instrument, being duly qual ified -
according to low, depose and soy that we were present and sow the Testator therein sign
and execute the instrument os his Lost Will and Testament; that he signed willinglY<Slld
that he executed it os his free and vol untary oct for the purposes therein expressed; that
each of us in the hearing and sight of the TestatOr signed the Will os witnesses; and that
to the best of our knowledge, the Testator was at that time eighteen (18) years of age
or more, of sound mind and under no constraint or undue influenceR
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115, MURPHY
W NIEMIEC
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~a~n)
:YSANDl:DUNHLDRS
Sworn and subscribed to before me
this ~ ~ day Of~ 1983.
AT tAW
DA. PENNSYlVANIA
\,
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CHARLOITE M. g"lY.
Yowenda, Bril~<..' r_ Pa.
My Comml')<:;\~:, ;<,';i;.:.s Jan. 9, 1984
,
January 17,2005
Brenda Farner Strasbaugh
Registrar of Wills and Clerk of the Orphan's Court
1 Courthouse Square
Carlisle PA 17013-3387
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Dear Ms. Strasbaugh:
Re: The Estate of Claude R. Chase, Deceased
UJ
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Enclosed please find the following five items for your actions:
\O~'D
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. Two copies of REV-I 500 with attached copies ofthe will.
. Check for $15 for filing fee to Registrar of Wills, Agent
. Check for $4 tor estate taxes to Registrar of Wills, Agent
. Status Report Under Rule 6.12 for filing with the Clerk of the Orphan's Court
. Certification of Notice Under Rule 5.6(a) for filing with the Clerk of the Orphan's Court
If everything is in order, please cash the enclosed checks as promptly as possible so that I may
close out the bank account for the decedent's estate. If you do not send receipts for the filing of
these things, I will assume that my canceled checks are my receipt.
Numbers tor your information:
. The decedent's Social Security Number is: 121-09-6837.
. The Employee Identification Number of the Estate is: 76-6203543.
. The Will Number is 2004-01080.
. The Administration Number for the Estate is 21-04-1080.
Thank you very much for your kind attention to this request.
Truly yours,
~y/l /1/ '>~/ _ If jb--e:'. /. L 4 /'j / J c;;)5,/l. / -
r,Mv1c.,.,/lt2.U7 vy'tt!tt-tz.! -;f tU cAPmU i r.:~'j~
Gene B. Chase, Executor of the Estate of Claude R. Chase
115 Slover Road
Mechanicsburg PAl 7055-5844
(717) 766-7904 home
(717) 766-2511 ext 2770 work
(:-)
-on
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
CHASE GENE BARRY
115 SLOVER RD
MECHANICSBURG, PA 17055-5844
n_nn_ fold
EST A TE INFORMATION: SSN: , 21-09-6837
FILE NUMBER: 2104-1080
DECEDENT NAME: CHASE CLAUDE R
DATE OF PAYMENT: 01/25/2005
POSTMARK DATE: 01/24/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/14/2004
NO. CD 004882
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,385.00
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 97
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$4,385.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
CER'JI'WICAl'WN OF NonCE UNDER RULE 5.6(a\
Name of Decedent:
('Ll!tlPE R, M4SE
Nt/f, I~ .{la'J/f
~tKJ1-1J/lJfr()
Admin. No.
PA No, ~/-()/)-Jtlg(}
Date of Death:
Will No.
To the Register:
I certify that notice of (beneficial inte....t) estate adminisiration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above.captioned estate on :::TA1fI1I4ttj 5'j ~ttJ.? :
Name
Address
77Mf/TJI-y J(. f1f1A,~) /1M2 AI.. ~~LLtY~Wy=$~..I InvloJhLl:-.7X '/,-!,/}77
'P/(fqtIL/.1/ Ij. 7JeRl.l"A) -ttl.1f1) </ltlfilP. ~6V A>15171J} tlALlr(7/QW4111P $)6/1
tl1J/lJ/ te t!IIASE 1117 .C:;~(JVEl? RD; M/3!IIANI{!c)""-i?u~ 114 1711.5:5"
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
"Ia. .
I
Date:
;];4NUAllY &j ~tYJ.~
~!f:::!;/?~1~'f
Signature
Gene F. {!~ -ExeeuIorf ~
Name rf {!/fb/t!p 1<. (llnc;-e.
Address
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES Ri:cnnOFO OFFICCp....;INHERITANCE TAX
DlERITAIICE TAll DIVISIIIl I _'viJ - . LS=I'ATEMENT OF ACCOUNT
PO lOX 210601 C)E(~!"TC:Q n: \.r,,::l ;1 ~
_ISIIURll PA 17128-0681 , I,',)), c.' "~,, ,,'!,...I
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AEV-1607 EX AFP [03-05)
GENE B CHASE
115 SLOVER RD
MECHANICS BURG
CLERK OF
ORD!.J"I\"" "0' jRT
l !iri\i0 \.,n._~.j.
ClJ\ F'I"'" r'''', "p.
\',.'/:,""'.".-"_, ',k,
PA 17055-5844
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-05-2005
CHASE
11-14-2004
21 04-1080
CUMBERLAND
101
~t R_1UMl
CLAUDE
R
2005 JUL 22 Pt'l 2: 12
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBER~AND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To In..,.. p,,-r credit to your _t, ....It the _r portion of this fo... with your tllX PQ8Mtt.
CUT ALONG THIS LINE' ~ RETAIN LOWER PORTION FOR YOUR RECORDS :a
......~........................................,~............'-...~......,............ ......................
REV-1607 EX AFP (03-05) ... ~NHERITANCE TAX STATEMENT OF ACCOUNT .
ISTATE OF CHASE CLAUDE R FILE NO.21 04-1080 ACN 101 DATI 07-05-2005
THIS STATEIIEIIT IS PROVIDED TO ADVISE OF THE CURRENI' STATUS Of THE STATED ACN IN THE/IIAHEO tSTATE. SMOlIN BELON
IS A SUMllARY OF THE PRINCIPAL TAX IIUE, APPLICATION OF ALL PAYIIENTS, THE CURRENT BALANCE, AIlD, IF APPLICABLE,
A PRO.IECTED IMTEREST FI_E.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-04-2005
PRINCIPAL TAX DUE: 4,385.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-24-2005 CD004882 219.25 4,385.00
06-15-2005 REFUND .00 219.25-
,
TOTAL TAX CRIDIT 4,385.00
BALANCE OF TAX DUI .00
INTEREST AND PEN. .00
. IF PAm AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SmE FOR CALCULATION OF ADDITIONAL INTEREST.
,
I IF TOTAL DUE IS LES$ THAN fl,
ND PAYItENT IS REllUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR),
YOU MY BE DUE A REFUND. SEE REVERSE smE OF THIS FORM FOR INSTRUCTIONS. )
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