HomeMy WebLinkAbout04-1085 ?ET [TJON FOR PROBATE and GRANT OF LETTERS
also known as
Register of Wills for the
Deceased. County of in the
Social Security No. / 7 2 ~ ~ / - ~ / Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executo3 named
in the last will of the above decedent, dated ~ ~5 . '7~ ~ c, 6 ( ,19~
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ c ~ $ 5,~/A ~ d~ County, Pennsylvania, with
h ~ P-- , last family or principal residence ~at -~/-~ u' cc ~o ! V / ~.4
(list street, number and muncipality)
Decendent, then . ~ c> years of age, died d//~ J ~ ~ ~c;~ 5z' , 19 ,
at.
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of ~he 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 Pennsylvania $
(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 probate 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 REP SENTATIVE
CO~ONWEALTH OF PENNSYLVAN~
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 be~ef of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) M!i we!! an~uiy ad~ni~er th~ ~tate according to law.
to or affirmedp~d subscribed ~~~
Sworn
before me thix_ ~3 ~ day of ]
AND NOW ¢ O~/kJ&'~,'t~i-,_ , in consideration of the petition on
he~¢o~, satisfactoo' oroof having been ~eser~ed before me,
~e reverse side
iT ~S DEC~ED that the instrument(s) dated
described therein be admkted [o probate and filed of re~ord as the last will of
~d Letters --
are hereby granted to ~.~
FEES
Probate, Letters, Etc .......... $.
Short Certificates( ) .......... $ ATTORNEY (Sup. Ct. I.D. No.)
Renunciation ................ $
$ ADDRESS
TOTAL _ $
Filed ................................... PHONE
LAST WILL AND TESTAMENT
OF
Euma A. Templin
BE IT KNOWN that I, Euma A. Templin , a resident of
3300 Union Deposit Road, Harrisburg , County of Dauphin , in the State of
Pennsylvania , being of sound mind, do make and declare this to be my Last Will
and Testament expressly revoking all my prior WiIls and Codicils at any time made.
I. PERSONAL REPRESENTATIVE:
Pennsylvan~aappoint Norman D. Templin of 4908 Erie Road, Harrisburg
, as Personal Representative of this my Last Will and Testament and provide if
this Personal Representative is unable or unwilling to serve then I appoint
Wilbert E. Weldon of r,_2_2_5J_~P_a.l'_._k~.__ay ,W~s,t, Har~i.,'sburg pennsylvania,
as alternate Personal Representative. My Personal ~,~prr~mauve snan oe aumorize~ to carry out all
provisions of this Will and pay my just debts, obligations and funeral expenses. I further provide my
Personal Representative shaI1 not be required to post surety-bond in this or any other.jurisdiction, and
direct that no expert appraisal be made of my estate unless required by law.
II. GUARDIAN:
N/AIn the event I shall die as the sole parent of minor children, then I appoint
as Guardian of said minor children. If this named
Guardian is unable or unwilling to serve, then I appoint
as alternate Guardian.
BEQUESTS:
I direct that after payment of all my just debts, my property be bequeathed in the manner
following:
I :request that my entire trust be divided in equal shares to my children:
Norman D. Templin
Wilbert E. Weldon
Maurine E. Leeper
Testator's Initials
Page ... of
Execute and attest before a notary.
Caution:~ Louisiana residents should consult an attorney before preparing a will.
~e= . oB,.. rows vary, $o consult an atmme-- on ·, ' ' k, and '
~, a. la~al mattars. Th,s product was not prepared by a namon .... a'L' _~u_~._t~; a s.u.~.arm
IN WITNESS WHEREOF, I have hereunto set my hand this q ~ day of ~
, (year), tO this my Last Will and Testament. :2-o 0 l
Testator Signature
IV. WITNESSED:
The testator has signed this will at the end and on each other separate page, and has declared
or signified in our presence that it is his/her last will and testament, and in the presence of the testa-
tor and each other we have hereunto subscribed our names this day of
(year). '
t~ss Signa~)~e Y - Address
'.tnes~ Signalture Address
Witness Signature Address
· ACKNOWLEDGMENT
State of ~_e a0t sy
County of ~ct cci? ", ~ }
We, 6,m~_ A-
., and a~
the testator and the witnesses, respectively, whose n~es ~e signed to the attached and foregoing
instrument, were sworn ~d decl~ed to the undersigned that the testator si~ed the instrument as
hisser Last Will and Testament and that each of the witnesses, in the presence of the testator ~d each
other, signed ~e will ~ witnesses.
Testator:~ ~~'~~,~ Witness: .~~ ~- ~
Witness:
Witness:
person~ly ~own to me (or prov~ to me on the b~is of safisfacto~ evidence) to be the ~rson(s) whose nme(s)
is/~ subscribed to ~e wi~ Ms~ment ~d ac~owl~ged to me that he/she/~ey ex~uted ~e s~e M his~effthek
authofi~d capaci~(i~), ~d that by Ms~er/thek si~amre(s) on ~e Ms~ment ~e person(s), or ~e enfi~ upon
~h~ of wMch the person(s) acted, ex<ut~ ~e Ms~ment.
W~SS~y h~d ~d offici~ seal.
I ...... ~o~i~C~
[PATRIOIA V. BI~IN~R, No~ Pub!io A~ant ~.~own.
[ Hagi~burg, Dauphin ~un~ ~pe of
I My Commission ~ires Feb. 8, 200~
Page~of~ _, (Seal)
~l~ ~ ~~ff_~ ~[~eg~ ~lce ~r ~. ~la p~, ~ in~.d.d ~r '~a~o.J ~ o.~ and M ~ta sub8~ ~r
*- ..... x .........., a~m~y on a. ~egm maim. ires pm~ ~ ~ pmp~d by a ~n limned ~ ~cfice law M ~is s~' KI07-IC
certify that lhe information hele ~xen ~ correctly ~,~pic,~ fr~m~ an original certificate of death duly Filed with me
Re~islrar. The original cel'lif~cale will be Forxvardc~ ~o th~~ ~tatc Vital Records Office lbr permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee fi)r this cerlificalc. $2.00
~'~~'~i~ ~ Local ae~ist,'a,-
H1O§ 143 Rev Z/e7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS k_,.
r~.e..,., CERTIFICATE OF DEATH
,~o.,. ~ .~,~ ~"~ ~ ~. c~,,,,v~ ~ 004
90 :
White
Maker ~ ~ ~s~.~
· ~o.,~ 9 ~'~ Widowed
4908 Erie Road ,~..~, Pennsylvania .
Harrisburg, PA. 17111 - ~ '~'Q~'~' "
Albert Zeiders NAME iF,si
D. Temp~n
~~ H~arrisburg,
. ri[ m~o.
DUE ~ I~ ~ A C~SEOU~E ~
RF'.'_150~.Di"_OOI
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
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CFFlC1AL USE ONLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2-/_ 0</ ~~~5_
CQUNTYCODE
YEAR
NUMBER
SOCIAL SECURITY NUMBER
i72-o/
738/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
/c I, Eu/VI /7.
DATE OF DEATH (MM.DD-YEARI DATE OF BIRTH (MM-DD-YEAR)
i/-o9-C)~ 03-::?g-/.y
I'F APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
o 4, limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Receivoo
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death alter 12-12-82)
o 7. Decedent Maintained a Living Trust (AlIac/lcopyofTrusl)
o 10. Spousal Poverty Credit (dale of de~ between 12-31.91 and 1-1-95)
o 3. Remainder Return (date 01 death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
B. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltachSchO)
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COMPLETE MAILING ADDRESS
1/908 lEt2o:.
/,jJ!l;2 ~/:; /, uP '1/
TELEPHONE NUMBER
-7/7 6-iP/-o .y5~
1. Rea! Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule DJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Scnedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
/99t/.90
(6)
(7)
B. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabi)jjies, & liens (Schedule I)
(9)
(10)
(8)
7J!9. 3.3
11, Total Deductions (Iolal Lines 9 & 10)
12, Net Value of Estate (line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
rnade (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15, Amount of line 14 taxable at the spousal tax
rate, or transfers under Set:. 9116 ta)t1.2j
x ,0_ (15)
xO ';5- (16)
16. Amount of Line 14 taxable at lineal rate
I f ~5. 5" 7
17. Amount of line 14laxable at sibling rate
x ,12 (11)
x .15 (18)
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL,~ESTIONS ON. REV:E~_~ A~D RECtlEc!< MATH <,<._
,~'
(11)
112)
(13)
(14)
(19)
;? oAd
/?H 171t1-3"'1'SS-
r-- OFFICIAL USE ONLY
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1991, 'Ie)
7Z'I, 33
102105,57
CJ -
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St,,95
Decedent's Complete Address:
STREET ADDRESSD Ell 13 C ,;.J /7 tI
'J2 ~
/1, ~
Ij~ c/2,cu/<..d
RoA c.l
CITY
CAlM
III
ZIP 170ft
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C, Discount
(1)
5& ,9 S-
~
o -
" -
;;(,as-
Total Credits ( A + B + C ) (2)
i ,35-
3, InteresVPenalty if applicabie
0, Interest
E. Penalty
TotallnteresVPenalty ( 0 + E ) (3)
4. If Line 2 is greater Ihan Line 1 + Line 3, enter the difference, This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4)
-- 0
5, If Line 1 + Line 3 is greater than Line 2, enler the difference, This is the TAX DUE. (5)
5-</,ID
8, Enter the totai of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
A, Enter the interest on the tax due,
s'l,/O
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1, Did decedent make a transfer and: Yes No
a, retain the use or income of the property Iransferred;........."....,...."..,....,..,...,..,....,..,.."",..,..............,..,...',..,..,.., 0 C2'J
b, retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~
c. refain a reversionary inlerest; or.......................................................................................................................... 0 l1'l
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 C8I
2. If death occurred after December 12, 1982, did deceoenf transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an 'in trust fo~ or payable upon death bank account or secunty at his or her deafh? .............. 0 ~
4. Did deceoent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 (2iI
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 pe~ury, I declare that I have examined this refum, including aGCOmpaIlylng schedules and statements, arid to the best of my knowledge and belief, it is true, correct
and complete.
Declaration 01 preparer other than the personal representative is based on all information of which prepare!' has any knowledge,
DATE
/- /6'-0:;;-
L7<:,,~" J' FpC 2'/l-J
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
/ 7/ { (
DATE
ADDRESS
LI ll..ILI if . _....lIi'1\!
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)l.
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, S9116 (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 retum 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 chiid is 0% (72 P,S. 99116(a)(I.2)),
The tax rate imposed on the net value of transfe" to orlor the use of the decedent's lineal beneficianes is 4,5%, except as noted in 72 P,S. S9116(1.2) [72 P.S. 99116(a)(I)].
The tax rate imposed on the net vaiue of transfers to or for the use of the deoedent'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.
","~"''''I'''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
,1,
E U Mil
/7:;: /VI P /1 "J
FILE NUMBER
-:2.1-
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.
J,
VALUE AT DATE
OF DEATH
DESCRIPTION
C ,Tr). If,.; '> dA-vK
10 -30,( 7B9
~'2o;/ I (h~^,cc. ;?;z:. 0 Z tlCJI - 0 -;8 '7
.-
(!;, c"/:.'''.iC, lIavuJ,) i ;d- &/0088 - ~~.z - z
/ f3SI ~D
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{!, 71 ~ii,v s J;yt/IJt<
~t)-oo/ 789
/t< - 0 Z C}c:l / - 0 78 9
/;J!ZtJV1 d6.Alc!,f} .J-
SA I/-IN] s ,4: U)<' NT 7i c,P/O - ,2 2 5' 7 SZ
/809,'30
TOTAL (Also enter on line 5, Recapitulation) $ I 9 9 ~ 9 0
(If more space is needed, insert additional sheets of the same size)
REV-151-r EX+ (12-99)
~1f
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
t=LJ/V7A
/1.
I €/>7?/IAJ
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: Ii 001/,c;e FUAJ.:,I!,II ;-/,""'A & (' #,srl'
1. Ad/lA.II~.c /!';IM h U,€SA/,tf",r
I Bg.:3 3'
2. s T~~~hs'o"'; j:'/owE;< S' 1~f3, 00
.3 fJAJ,70P. I-'(,i" II/{I/ ,AI, /so,J /00,00
1- j oad 0," C-"e?/L,c p,AJ( stlly (} ,,~/.c t.. ( 10S.T S'6,e."c.: ~F~.G,d;'''^,) / so. 00
5- VCJ('AI/s{ ,J/l.rsy Z/_"j'/I/<( ~5.uo
L. JJ ,e,6 SS /1.",,1 ;J(.'o~(2AoM~ ;(/;/v~/,vE J E.6~E;e bS,oO
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
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 10 Decedent
4. Probate Fees 5'1101.'/ tJ L'~ 7', r, Co "r4.!; ~3 ,0
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 729.33
o
(If more space is needed, insert additional sheets ollhe same size)
.REV-1513 EX+ 19-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
/ €" /VI ,-) (uJ
NUMBER
I
2,
-
t:: U Nl f)
FILE NUMBER
fl.
1.
NAME AND ADDRESS OF PERSON(SI RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under
Sec. 9116 (al (1.2))
/IIORMrl4 --::0, T~Mf1II1J
1../908 E~II'E ~CJ,4d
1-t.4/oU.lS6u-45/1:J/-l/7//(
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
<;'o"v
~
y/;/ic,-or~:. we/dON
Zt.5r tARkINA'f \";~':s7
IIAL,'1.IVs6<fRf / /Jr I111 z
S'oAJ
1/.3
3.
.ttfAV~//"C 1:::., .L c<...':?cf,<
sa oS vEtJo",silRc ;/6J'i'/lS 4AJ.
/..jr4.'<.12,-::;-IJL14'1/ P/1 /7/12..
~
.3
ult<;5llnz
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)
1-888-910-4100
Cail Citize"s' PhoneSank anytime for actount information,
current rates and answers to your questions.
3
1
US059 BR307
EUMA A TEMPLIN
C/O NORMAN D TEMPLIN
4908 ERIE RD
HARRISBURG PA 17111-3455
Account Statement
o OF 2
Beginning November 06, 2004
through December 07, 2004
Contents
Checking
Savings
Page 1
Page 2
Checking
SUMMARY
Balance Calculation
Previous Ba(ance
Check<
Withdrawals
Deposits & Additions
Current Balance
1,251.60
1,066.00
185.60
.00 +
.00 e
EUMA A TEMPLIN
Citizens Basic Checking
610088-442-2
Previous Balance
TRANSACTION DETAILS
Checks" There. is a b~ak in chuk sequmce
Che.<k II Amount Date
569 146.00 11/12
Check #
570
Withdrawals
Other Withdrawals
Date Amotlnt Description
11/24 185.60 Closing Withdrawal
Daily Balance
Date
Date
11/12
Balance
185.60
Balance
331. 60
11/10
Date
11/24
Amount
920.00
Date
11/10
Balance
.00
1,251.60
o
Total Checks
1,066.00
o
o
Total Withdrawals
185.60
{urn:nt Balance
.00
1-888-910-4100
(aU Citizens' PhoneBank anytime for account infonnatkm,
CUIT~nt fates and amwers to your questlons.
Account Statement
. OF 2
Beginning November 06. 2004
through December 07,2004
Savings
SUMMARY
Balance Calculation
Previous Balance
Withdrawals
Deposits & Additions
Interest Paid
Current Balance
1,809.30
1,809.30
.00 +
.00 +
.00 .
Balance
Average Daily Balance
1,302.69
EUMA A TEMPLIN
Basic Savings
6140-225752
Prevto\ls Balance
TRANSACTION DETAILS
Withdrawals
Other Withdrawals
Date Amount De$crfptlon
11/26 1,809.30 Withdrawal
Daily Balance
Date
11/26
8alance
.00
Date
Interest
Current Interest Rate
Annual Percentage Yield Earned
Number of Days Interest Earned
Interest Earned
Interest Paid this Year
.25%
.24%
25
.22
3.71
Balance
Balance
Date
1,809.30
o
o
Total Withdrawals
1,809.30
Current Balance
.00
LAST WILL AND TESTAMENT
OF
Euma A. Templin
BE IT KNOWN that I, Euma A. Templin , a resident of
3300 Union Deposit Road, Harrisburg , County of Dauphin , in the State of
Pennsylvania , being of sound mind, do make and declare this to be my Last Will
and Testament expressly revoking all my prior Wills and Codicils at any time made.
1. PERSONAL REPRESENTATIVE:
Lappoint Norman D. Templin of 4908 Erie Road, Harrisburg
Pennsylvama , as Personal Representative of this my Last Will and Testament and provide if
this Personal Representative is unable or unwilling to serve then I appoint
Wilbert E. W!;.ldon of 2251 Parkway Wl:st, Harrisb\lrg Pennsylvania'
as alternate Personal Representative. My Personal Representative shall be authonzeC:l to carry out all
provisions of this Will and pay my just debts, obligations and funeral expenses. I further provide my
Personal Representative shall not be required to post surety bond in this or any other jurisdiction, and
direct that no expert appraisal be made of my estate unless required by law.
II. GUARDIAN:
In the event I shall die as the sole parent of minor children, then I appoint
N/A as Guardian of said minor children. If this named
Guardian is unable or unwilling to serve, then I appoint
as alternate Guardian.
III. BEQUESTS:
I direct that after payment of all my just debts, my property be bequeathed in the manner
following:
I request that my entire trust be divided in equal shares to my children:
Norman D. Templin
Wilbert E. Weldon
Maurine E. Leeper
~ a,... -r
Testator's Initials
Page _ of _'
Execute and attest before a notary,
Caution:' Louisiana residents should consult an attorney before preparing a will,
This product do.. not constitvm the ",nderlng of legal advice or .servl~.. Thl, product '- Intended for informational UN only and is not a lub.sdtutt for
leglll advice. S~t. laws vary. 50 eon!lult an attorne)' on aU legel matterl. This product WIIS not prepared by 1II person licensed tc prtctle, law in this atatt. Kl 07 ~ 1 A
AQRH
IN WITNESS WHEREOF, I have hereunto set my hand this 1 tJ...
(year), to this my Last Will and Testament.
day of
Z-OO/
~
,c
(''J <'Vl<A.",-" (i', Lt,
r ,I' ^ i\ 1-' )~L-L' r -r
,
Testator Signature
IV. WITNESSED:
The testator has signed this will at the end and on each other separate page, and has declared
or signified in our presence that it is hislher last will and testament, and in the presence of the testa-
tor and each other we have hereunto subscribed our names this day of
(year).
, ~,~_ J. rlJt n~
~i~~
Witne Sign ure
d-eJ<f ).J. ~0 '~~
Address
~ ~4 rlll(
38(0 \ r'l1wvl<- I/v.{'
Address
lib:; fA- nil \)
/(.P-I/({"-\STf'<;.~] Vlf ~ /(", ',-+41<-1/1(701,,-
Address
ACKNOWLEDGMENT
State of eeVttlsyl~l(1L }
County of va LtV /.UI'\
We, €w.tL A. \'Q\Mp(tI\
, and
the testator and the witnesses, respectively, whose names are signed to the attached and foregoing
instrument, were sworn and declared to the undersigned that the testator signed the instrument as
hislher Last Will and Testament and that each of the witnesses, in the presence of the testator and each
other, signed the will as witnesses.
Testator: [,.~ <l.,:~ r if'~ t. u [, )'1\ I\.
Witness:
Witness:
Witness:
tiM,LV:. 1 2-001
On G. 'f::r~. l before me,
appeared t I.\.,IIV1.. t\ ,-ey11t1
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hisfher/their
authorized capacity(ies), and that by hisfher/their signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
WITNESS y hand and official seaL
:.-'
. .
(ktitZl"- V. 0et: 'tUfe"
Signature
Affiant _Known~Produced ID
Type of ill fA-+' l> {J, <A.
PATRICIA V. BITTINGER, Notary PUlJllp
Harrisburg, Dauphin County
My Commission Expires Feb. e, 21JU5
--- Page ___ uf .__'
This product dOllS not eonstitute the rendering of legal advice or servicIIll. This pro doc! i.intended fl.")r Informational use only end is not a substitute for
legal advice. Slate laws vary. so consult an attornllyon 811111g81 matters. This product wai'J nrrt prepared by a person licensed to practice law in this .tate.
(Seal)
K107-IC
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
TEMPLIN NORMAN D
4908 ERIE ROAD
HARRISBURG, PA 17111
_____u lold
ESTATE INFORMATION: SSN: 172-01-7381
FILE NUMBER: 2104-1085
DECEDENT NAME: TEMPLIN EUMA A
DATE OF PAYMENT: 01/20/2005
POSTMARK DATE: 01/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/09/2004
NO. CD 004864
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $54.10
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$54.10
REMARKS:
CHECK# 0993
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 02/28/2005
TEMPLIN NORMAN D
4908 ERIE ROAD
HARRISBURG, PA 17111
RE: Estate of TEMPLIN EUMA A
File Number: 2004-01085
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (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 is due by:
03/05/2005
Your prompt attention to this matter will be appreciated.
Thank You.
~:lY'
GLENDA F=~~:r
Clerk of the Orphans' Court
cc: File
Counsel
Judge
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
~ujl11J
/\~tI
f1 f /EI'VJ pit cJ
Name of Decedent:
/<1' 2 c:JCJ,r
,
Will No.
Admin. No.
;? PO -.;; (/)IOas-
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 following beneficiaries of the above-captioned estate on J 1'1/\/ :? /, 2- '" ",,,- :
,
1/1116L- ,Q /" E, 14.6/ /o~
j{/AUICfAlL E, )Ec/Jc,<
AfiR/-t'.4AJ D, ()cH/~A/
,
Address
:< .(5"/ A/2KWA'( 1/{(c..(T ~? Ii /'"?/O
5/3&YJ .ZJ Ei/D/J ~ld6 /(;/flr,( ;2j )I~ /?:;
I /7//l.-
~litJ8 /fi!/L'dd ,Ie/it ;)z. /7//1
Name
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date /~I S;. 2?'oS--
co:)
ignature
Name Jo,ep#,JI), 77#/:?-.AJ
Address 4908.E,4/L ,4,<;> d
/-t~S6"fL[ A I /1' /(
Telephone (7rIJ 52':-/- 0-1:;--/
Capacity: X Personal Representative
_Counsel for personal representative
>
BUREAU OF INDIVIDUAL_tAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
'*
REV-1547 EX AFP (03-05)
~ ~)
Ie...
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-04-2005
TEMPLIN
11-09-2004
21 04-1085
CUMBERLAND
101
Allount R_i Hed
EUMA
A
NORMAN ittMPLIN
4908 ERIE RD
HBG
PA 17111
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 ~
1't!f!.-nrl:"Yf.m.m!'U!'.'lrtltm.W.!MftAW4M!r.'Wt.lWAlmN!Rf~.1rCtW~MM.~yt'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TEMPLIN EUMA A FILE NO. 21 04-1085 ACN 101 DATE 04-04-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
1.994.90
.00
.00
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax PBYllent.
1.994.90
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
729.33
.00
(11)
(12)
(13)
(14)
729 33
1.265.57
.00
1.265.57
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
r~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. AIIount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
.00
1.265.57
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
(19)=
.00
56.95
.00
.00
56.95
TAX CREDITS:
, ~. ..-... .----. l"'J AMOUNT PAID
DATE NUI1BER INTEREST/PEN PAID (-)
01-20-2005 ~ CD004864 2.85 54.10
TOTAL TAX CREDIT 56.95
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE i..
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) c-"") S ~
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OFFiCiAL USE ONLY
REV-1500
INHERITANCE TAX RETURNFiCE~M~ER0416~5--
RESIDENT DECEDENT C!TYCODE y~ - NUMBER - -
I-
Z
W
C
W
U
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
........-- -- /'7
/ IE" /I/} 1::J A../ k ,f . r/ .
DATE OF DEATH (MM-DD-YEAR)
/1 - CJ 9 .- A CJ 0 ~ 03 .- 2 g... /9/
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
/"7:2 - 0/ - 7381
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
w
~
::r::::$cn
oo::::r:::
wQ.o
J:oo
oO:..J
Q.a1
Q.
<
o 1_ Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
~ 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
~
Z
W
C
Z
o
Q.
CI)
w
0:
0::
o
U
z
o
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0:
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u
W
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~
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Q.
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u
><
~
NAME ... J
/VoR
FIRM NAME (If Applicable)
;I "..;
u,
TELEPHONE NUMBER
~7/ 7 6-~/ .- o4S
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)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
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)
COMPLETE MAILING ADDRESS .?, ./1j
QC;o8 C~/C ,::..~;?
/,k,2-2.1 S /'U;)5 } J~ I 71// - 3 -'/S.,5-
(1 )
(2)
(3)
(4)
(5)
, OFFICIAL USE ONLY
: I
\..-..-:' .....
r...... ~,
17~t~ 93
, I
\ I
I
!
!
(6)
..,..-. .
j
! - .
! C'"
L___'__,_'..'___--__.~~ .,. - --~ --~---- ,.",
(7)
(8)
; 7 fvt c 9' g
(9)
(10)
(11 )
(12)
(13)
'- 0
i 7 Ivlo I 'I g
o
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)
i '7 (.; l> , 'j,t5
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)( 1.2)
16. Amount 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
/7&~,~B
x .0 _ (15)
x .0 i/ 5'" (16)
79,5/
x .12 (17)
x .15 (18)
(19)
79,S"1
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~;;';'\::~;;;y-~.:.~'( '.
20.0
> > BE SURE TO AN$.~>A[~,~Ql:S,.ION~4 Q~R~.;~r;$~E~~pR~c;HE:C~.,~Ttli~L~,,~;;\;,
RE\1-1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
E U JV/1
FILE NUMBER
;/,
--J~
/ .1:' /t-'/"" / Ai
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
{I <!J.<-( Nt () .;j u; g ,,1/ It.. c);L i.J,c; "" Ai S y Iv _ i "v / f'1
(;Q5/fS"L~P7' -UE/.?~l-.#l/~~c,{) 7 /
I~ c.J .~,-~,f v ~ ;: cJ,,<.; C ///. J ~I' ..I! ,/ ~2 c' I' ~ /l '7
/41=;:. /7) A v { r t 7' 'v c';:;' { .A-', h < ,Y rt ~" A'-! ~.6' p 1/,'-" ;-
VALUE AT DATE
OF DEATH
/7Ct,'18
'~\j~
TOTAL (Also enter on line 5, Recapitulation) $ /7 t6 - 7'8
(If more space is needed, insert additional sheets of the same size)
,
RJP-046 (2-99)
COMMONWEALTH OFPENNSYL VANIA
TREASURY DEPARTMENT
BUREAU OF UNCLAIMED PROPERTY
AFFIDAVIT AND INDEMNIFICATION AGREEMENT
Barbara Hafer
Treasurer CLAIM NUMBER 99420000
STATE OF &NA/~7/i/~"///l COUNTYOF-_~)d...Jp h I~
BEING first duly sworn, ~ ~ /'// AA/ __I). -;;;/14/1 h Ai ("Claimant(s)") deposes" nd represents as follows:
THAT Claimant(s) resides at A/gG> &/E ~a~4(_1 ~ 'f'.L,e,s6v..t' ~/1':"3</S5
THAT Claimant(s) has made a claim for unclaimed property held by the Treasury;
THAT Claimant( s )i.~..-':l!l~_~I_~.._!2-R~~-~~!)t!~~ t~~.1"r7~~~ry,f_~~.proof ()t~r1t!~I~.rll~nt to the UncIa imed Property 1 .the foUowingoriginal
property information: - ... ."
Property 10
5276572
5276573
Property Description
Demutualization Cash
Demutualization Stock
Cash Claimed
_ ,_____...,.._ .'--"'.'_h'_'_._.'_
$29.48
$1,737.50
Shares Issue Name Holder
-------._-_.-.~,~-~-_.--- ~------_..-.--._,-.-....----
o METlIFE INC DEMUTUAL
o METLlFE INC DEMUT METUFE INC DEMUTUAL
because such property described above has been lost, stolen, destroyed or misplaced and Claimant, his/her heirs, assigns or
successors have not received or enjoyed any benefit from the property or proceeds therefrom;
THAT Claimant(s), in exchange for payment by Treasury of said claim, agrees to at all times indemnify, save, defend, and
keep harmless the Treasury, its employes and representatives, from and against any and all claims, demands, actions, or
suits against them, whether groundless or otherwise, and any and all losses, damages, liabilities, costs and fees arising out of
or in any way connected with the payment of the claim, particularly by reason of a claim for payment to any third person
claiming an ownership interest therein or who may hereafter come into possession of the original Security, regardless of
whether such claims, actions, losses, damages, suits or liability arise in whole or in part from the gross negligence or willful
misconduct of the Treasury;
THAT Claimant( s} agrees that this Affidavit and Indemnification Agreement shall be construed in accordance with the Jaws of
the Commonwealth of Pennsylvania; and
. THAT Claimant(s) acknowledges and understands that any information and/or documentation supplied with the
claim, if false, will subject Claimant to prosecution under 18 Pa. C.S.S4904, relating to unsworn falsification to
authorities; the conviction of which could subject Claimant t<?_a prison term of up..te-two years and a fine of up to
$5,000, 'f~ ~~ s12i~:~ ·
BEFORE ME, the undersigned authority, on this day personally appeared .(/tlfJttM1 p. H"1.!J(ln' ,
known to m, (or introduced to me by ), to be the person whose name is
subscribed to the foregoing instrument, and acknowledged so he/she executed the saJ1!e for the purposes and
consideration therein expressed and SUBSCRIBED AND SWORN TO ME this the fl't~ day of
~ A.D. 20 tJ ~ . Q . - V /J.: .
Notary Signature: \(.J}.Jv..~ .. I ~~II
Printed Name of Notary: f 'I.<tr l~ ~ V.. t't t-1h') a.
My commission expires:
NOTARY STAMP
NOTARiAl SEAL
PAmlClA V. BITTlNGER. Notary Public
Harrisburg, Dauphin County
My Commission &plres Feb. 8, 2005
CERTIFICATION OF NOTICE UNDER RULE 5.6(2)
Name of Decedent:
E U /t7/1
fr,
7(:- M /,;/ ;; .AI'
Date of Death:
II - () 9"" Z 00 ~
Will No.
Admin. No.
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 following beneficiaries of the above-captioned estate on / 0 '~ Z c.q . 0 .s.-
~ .
/
/
~.e/f/~N' -:v ,,77#0.J"';/</
.
, /l/; I b e:;z. 7
,.-
C1
/,1/6 l/t) ,u
~6 ~ ~r2
Address
~t)o3 E,{2/,c' ;2 cl /h4/5 ~c-,,€!> iJ".)// r
;(;2 67 /In,2k''''~y wdsr /~,2rS4'R'Z ;) /7//2-
..
Av /U N C
.-
~,
..sy 0 B !)6Y~JA/,
;/:;. I ?//,2
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
/} ...----r'-,. ,,'
,,/.<1 /// /' ../
Name / '7>"/:>'/;':"'/> /y;, ~~" ../' ~/
(.( .( _ t:L.L_ _ / _
Address 4'?cL9 h2 / /" ~//9 ~
,6~:?'JL,'?) J ;;; / .?dl"
Telephone (71 ?) ...56-/- ~ v S-Y
Capacity: ,X Personal Representative
_Counsel for personal representative
LAST WILL AND TESTAMENT
OF
Euma A. Templin
BE IT KNOWN that I, Euma A. Templin , a resident of
3300 Union Deposit Road, Harrisburg , County of Dauphin ,in the State of
Pennsylvania , being of sound mind, do make and declare this to be my Last Will
and Testament expressly revoking all my prior Wills and Codicils at any time made.
1. PERSONAL REPRESENTATIVE:
. I. appoint Norman D. Templin of 4908 Erie Road, Harrisburg
PennsylvanIa P al R 'f h' L W'll d rr d 'd 'f
' as erson epresentatlve 0 t IS my ast 1 an ~ estament an prov! e 1
this Personal Representative is unable or unwilling to serve then I appoint
Wilbert E,W~ldon of 2251 Parkway W ~st, Harrisburg Pennsylvania '
as alternate Personal Representative. My Personal Representative shall oe authorizea to carry out all
provisions of this Will and pay my just debts, obligations and funeral expenses. I further provide my
Personal Representative shall not be required to post surety bond in this or any other jurisdiction, and
direct that no expert appraisal be made of my estate unless required by law,
II. GUARDIAN:
In the event I shall die as the sole parent of minor children, then I appoint
N/A as Guardian or said minor children. If this named
Guardian is unable or unwilling to serve, then I appoint
as alternate Guardian,
ill. BEQUESTS:
I direct that after payment of all my just debts, my property be bequeathed in the manner
following:
I request that my entire trust be divided in equal shares to my children:
Norman D. Templin
Wilbert E. Weldon
Maurine E. Leeper
6 cL- <(
Testator's Initials
Page _ of _.
Execute and attest before a notary.
Caution:' Louisiana residentS should consult an attorney before preparing a will.
This product does not constitute the rwndering of fegaladvfce or services. Thfs J)roduct Is intended for informational UN only and ~ not 8 IUbstitute for KI07-1A
legal advice. StaUt laws vary. so consult an attorney on allleget matters, This product was not prepared by II person licensed to practice law in this state.
AQHH
IN WITNESS WHEREOF, I have hereunto set my hand this rz t~
(year), to this my Last Will and Testament.
day of
-:2- 00/
~
l--
c~ <.-v-~ <7.' ct..
Testator Signature
T /:: /\ i\ 1-) ~-'""\L-E- ~ (
IV. WITNESSED:
The testator has signed this will at the end and on each other separate page, and has declared
or signified in our presence that it is hislher last will and testament, and in the presence of the testa-
tor and each other we have hereunto subscribed our names this day of
(year).
. ~;~ v,~~
~ss Signat e
d-f;y .)J. ~~ -~ llitct
Address
Wt, ~4 1"711(
38lP \ . ntM~ I/v-e
Address
IfbJ fA- nil ~
1<' 8 j- 1If<.""-5 TI'4>"'J VI, ~ f(", ~>.( A;<.IA { 7G:J ~
Address
'ACKNOWLEDGMENT
State of ee /A(,{ S'j I~ w. LL }
County of \)au..yLtlY\
We, €wvtL A.. \LQWp{l~
, and
the testator and the witnesses, respectively, whose names are signed to the attached and foregoing
instrument, were sworn and declared to the undersigned that the testator signed the instrument as
his/her Last Will and Testament and that each of the witnesses, in the presence of the testator and each
other, signed the will as witnesses.
Testator: t, -~ ~ ~~H ref t u y )'<\1\.
~
. . .
lUMJW- 1 2-001 ~.~~~{dv V. 0rt 1t1Ji er
On -1 V-__ . l l . before me, ~v '- -\
appeared t ll- M tl.. f\ \,...e. UUO L ~
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that helshe/they executed the same in his/her/their
authorized capacity(ies), and that by hislher/their signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
WITNESS y hand and official seal.
Witness:
Witness:
Witness:
Signature
Affiant Known ./ Produced ill
Type of ill -ptr t:cL cq;::&
(Seal)
PATRICIA V. BITfINGER, Notary Publlo
Harrisburg, Dauphin County
My Commission expires Feb. 8'_~S!26
Page _ of ._'
nm. ~.... _t _......... .... ~"fI oJ ~ ~ _ _~ Th1a prcaJuL'! is JntGndac! far informational use only and is not a substitute for
legal advice. State laws vary. so consult an attorney on alllagel matters. This product was nut prepared by a person licensed to practice law in this state. K I 07-1 C
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
TEMPLIN NORMAN 0
4908 ERIE ROAD
HARRISBURG, PA 17111
_n_nn fold
ESTATE INFORMATION: SSN: 1 72 -0 1 - 7381
FILE NUMBER: 2104-1085
DECEDENT NAME: TEMPLIN EUMA A
DATE OF PAYMENT: 02/28/2006
POSTMARK DATE: 02/28/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 11/09/2004
NO. CD 006384
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $79.51
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$79.51
REMARKS: N TEMPLIN
CHECK# 0992
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
05-15-2006
TEMPLIN
11-09-2004
21 04-1085
CUMBERLAND
501
APPEAL DATE: 07-14-2006
( See reverse side under Objections)
Amount Remitted I ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~Y!_~~9~~_!~~~-~~~~------~___~~!~!~_~9~~~_~9~!!9~_~9~_!9~~_~~~9~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
EUMA A FILE NO. 21 04-1085 ACN 501
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
NORMAN D TEMPLIN
4908 ERIE RD
HARRISBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17111-3455
ESTATE OF
TEMPLIN
REV-1547 EX AFP (06-05)
EUMA
A
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 05-15-2006
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
1,766.98
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
.00
Ul)
(2)
(3)
(14)
(9)
UO)
NOTE:
If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
:l,8. Amoufitof Line 14 taxable at Collateral/Class B rate
1:19. Prin~i\)al Tax Due
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
1,766.98
DO
1,766.98
.00
1,766.98
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.OOXOO=
1,766.98 X 045 =
.00 X 12 =
.00 X 15 =
(9)=
(5)
(16)
(7)
(8)
.00
79.51
.00
.00
79.51
TAX CREDITS:
n~~~~. l+J AMOUNT PAID
'DATE NUMBER INTEREST/PEN PAID (-)
'2'-,28-2006 CDOO6384 .00 79.51
>
TOTAL TAX CREDIT 79.51
, BALANCE OF TAX DUE .00
INTEREST AND PEN. .23
TOTAL DUE .23
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~fV
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 10/30/2006
TEMPLIN NORMAN D
4908 ERIE ROAD
HARRISBURG, PA 17111
RE: Estate of TEMPLIN EUMA A
File Number: 2004-01085
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: 11/09/2006
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
\
crl
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
EUMA
;:/
"TL~/~{ ;J /; Ai
Date of Death:
11- q -o,{./
2/
o ~/- JOB 5"
Estate No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration ofthe above-captioned estate:
1. State whether administration of the estate is complete:
Yes lSl 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. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No jLl
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes.lZl No 0
c. Copies of receipts, releases, joinders and approval of fomlal or infomlal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. Z.-----.. -- ", 'C'
/-
Date: 11- -=' ~() b ~~"," ,/.;' .I' ./
( 'gnature /
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......
j;:;e..(/:l/I/.)
Name
Address
L!/? /< :','
71 7 5&/ t!? </S~
Telephone No,
61 ., I'
Capacity: J2I Personal Representative
o Counsel for personal representative
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