HomeMy WebLinkAbout01-0507
Estate of Ethel M. Siemons
also known as
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No. :J J - CJ I - s-tJ 7
, Deceased
Karl H. Siemons, Michael Siemons and Thomas L. Siemons
Petitioner{s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
Social Security No. 184-48- 9669
[!] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors
the Decedent, dated 04/14/1978 and codicil(s) dated None
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
D B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner{s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at 206 Front Street, West Fairview, PA 17025 \ tao:t~JJIuno ~ _ /
(list street, number, and munidipality)
Decedent, then ~years of age, died 05/01/2001 at Homeland Center, Harrisburg, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If ddmiciled 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
500,000.00
$
$
$
$
75,000.00
206 Front Street, West Fairview, PA 17025
situated as follows:
Wherefore, Petitioner{s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a riate form to the undersi ned:
n~u~ T
Karl H. Siemons
2616 Market Street, Carn Hill, PA 17011
Michael Siemons
214 Front Street, West Fairview, PA 17025
Thomas L. Siemons
600 Mountain Street, Eno1a, PA 17025
Ic;-.i-3~-11
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Oath of Personal Representative
21-01-0507
Commonwealth of Pennsylvania
County of Cumberland
~
~().~p~.~a.~)[)~
For the RegIster -"V - tf"
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
~~~M ~~I
Karl H. Siemons
~~--4~~-
~hael Siemons
-.. ~ ~.,~
homas L. Siemons
Sworn to or affirmed and subscribed
before me this ~ay of
, ,:](!J() I
......;i?
No. 21-01-507
Estate of Ethel M. Siemons
Deceased
Social Security No: 184 - 48 - 9669 Date of Death: 05/01/2001
MAY 25,
, 2001 ,in consideration
AND NOW,
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary D Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Karl H. Siemons, Michael Siemons and
Thomas L. Siemons
in the above estate and that the instrument{s) dated
04/14/1978
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
~t!.
~"J~Ao LaM...t!,I1. ~d'>~.IJ} ~ Qt/('/4
' . . ,
RfJgister of Wills
~./~
E. Sl~, -E~(uire
Letters. . . . . . .
$ 375. 00
Short Certificate(s). .6.
$ 18.00
Renunciation.
$
Attorney:
Affidavits (
$
1.0. No:
06262
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Extra Pages (
) .
$
Address:
Codicil. .
$
Camp Hill, PA
17011
JCP Fee.
$
5.00
Telephone:
717/737-3405
Inventory.
$
Other . .
$
TOTAl. . . . . . . .. $ 398.00 MAILED TO ATTORNEY MAY 25, 2001
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
21-01-507
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
(each) a subscribing witness to
law, depose(s) and say(s) that
codicil
e will presented herewith, (each) being duly qualified according to
present and saw
the testat , sign the same and that
request of testat_ in h presence and (in tll
other subscribing witness(es)).
signed as a witness at the
resence of each other) (in the presence of the
Sworn to or affirmed and subscribed before
me this day of
19_
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
KARL H. SIEMONS AND THOMAS L. SIEMONS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of ETHEL M. SIEMONS
~
will presented herewith and
codicil
believes the signature on the will is in the handwriting of
THEY
testat~ of (one of the subscribing witnesses to) the
that
ETHEL M. SIEMONS
to the best of THEIR
knowledge and belief.
Sworn to or affirmed and subscribed before 'JI-A If) ~,S< .. ·
me this ~~ day of (Name)
TLZ;, d^ fX~1 dt:.a ~/?''f' 51 C9n-p;..J~ /k /70 IJ
~"'tI "---- ';a./!u ~/.o~P'" (Address)
Register
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1{l5,R0" ~,?\' o/Qf.;
This is to certify that the information here given is correctly copied fran: an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph,
No.
t2-v):.'( ~
Local Registrar
Fee for this certificate, $2.00
p
7297725
MAY 0 3 ZOOl
Date
ev 2117
COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
AGE (laIIllinhGayj
UNDER t YEAR
ManlIII Oaya
UNDER t DItIt
HelIn ! IlIinlMa
:
SEX
female
SWEFU_A
SOCIAL SECURITY NUWER
3.184 - 48
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NAMEoiDECEDeNT(i;sr.Mdcae.l"_ --.---..-------------
t. Ethel M. Siemons
8IRTHPUCE tc.ty and
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housewife
Harrisburg
.... lit.
IClHO Of: BUSlHESS/lNOUSTRV
17025
Harry Matter
Kar 1 H. SienalS
DECEDENT'S
ACTUAL
RESIDENCE
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206 Front st.
te. West Fairview, PA
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'MEDICAL EXAMINER/CORONER
On the ba8ia of ...ml".lon .ndlOt investigation, in mv opinion. d..th oc:euned .1 1M II..... d.I., .nd place, and due 10 Ihe e.UH(I).nd
_..... .. a'.IM.. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . _ . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . , , . . . . . . . . . . . . . .
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REGI"'S SIGNATURE AND N~
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21-01-507
31Itt%illl1lIill mUl- ar~}5bttttmf
I, ETHEl" ~'.1. SIEHONS, of the Borough of Hest Fairview, County
of Cumberland and State of Pennsylvania, do make, publish and declare
this to be my Last Will and Testament, hereby revoking any other wills
by me at any time heretofore made.
FIF~T :
I give, devise and bequeath my entire estate
unto my husband, John G. Siemons, and I name, constitute and appoint
the said John G. S iemons to be the Executor of this my will.
SECOND:
In the event my said husband shall fc0il to
survive me, I give, devise and bequeath my estate unto my sons, VarI,
l-lichae.l and Thomas Siemons, and in such event I name, constitute and
appoint my sons, F.arl, Bichael and Thomas Siemons to be the Executors
of this 'tvill.
IN ~,lITNE..SS WHEREOF, I hereunto set my hand and seal this ~ I -a..J-
day of March, 1962.
/'
Zb{L'~ </~y: ~.~~-"_____ ~(SEAL)
Signed, sealed, published and declared by the above named
Testatrix as and for her Last Will and Testament in the presence of us,
who, in her presence, at her request, and in the presence of each other,
have hereunto subscribed our names as witnesses.
(~y~ L~
11
lJ
LJ
'-- \
(~A-JJ. ihd~
I hereby republish this Will this 14th day of
April, 1978.
-= I--I~ )4:
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w~~
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u'
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Ethel M. Siemons
Date of Death: May 1, 2001
Will No:
21-01-0507
Admin. No.
To the Register:
I certify that Notice of 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 June ~, 2001.
Name
Address
Thomas L. Siemons
Michael Siemons
Karl H. Siemons
600 Mountain Street, Enola, P A 17025
214 Front Street, West Fairview, PA 17025
2616 Market Street, Camp Hill, P A 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date: Ct f ~ I Of
. Slike, Esquire
S DIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
_Personal Representative
-X. Counsel for Personal
Representative
iii allfirst
:21-C) 1- ~o 7
Allfirst Trust
213 Market Street
Harrisburg, PA 17101-2127
717255 2059
July 19, 2001
Cumberland County Courthouse
Register of Wills
1 Courthouse Square
Carlisle, PA 17013-3387
RE: John C. Siemons, Trustee U/W
Dear Sir or Madam:
Enclosed please find our check in the amount of$19.00 representing the cost for having three
(3) Releases recorded for the Trust under the Will of John C. Siemons. I have also enclosed
copies of the Releases to be time stamped and returned to us in the enclosed envelope provided.
If you have any questions, please feel free to contact me at (717) 231-6032.
Sincerely,
~ .~
(Mr~ers
Trust Associate
MAR/bb
Enclosures
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RELEASE
WHEREAS, Allfirst Trust Company of Pennsylvania, N .A., formerly known as Allfirst Bank,
formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company,
is the duly appointed Trustee under the Will of John C. Siemons of Cumberland County,
Pennsylvania; and
WHEREAS, Ethel M. Siemons was the income beneficiary of the Trust; and
WHEREAS, Ethel M. Siemons died May 1, 2001; and
WHEREAS, in accordance with the Will of John C. Siemons, upon the death of Ethel M.
Siemons, the Trust is to terminate and the balance is to be distributed equally among John C.
Siemons' sons; and
WHEREAS, the said Trustee has submitted to the said Thomas Siemons an account of its
Trusteeship, which has been examined and approved by the said Thomas Siemons; and
WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans'
Court Division of the Court of Common Pleas of Cumberland County and having the same
confirmed, the said Thomas Siemons has requested his Trustee to make settlement with him at once.
AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Thomas
Siemons have this day had and received of and from Allfirst Trust Company of Pennsylvania, N.A.,
formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit
Bank and Trust Company, Trustee as aforesaid, the following:
1,248 shares
10, 118 shares
5,060 shares
443 units
Alltel Corp.
Sprint Corporation Foundation
Sprint Corporation PCS Group
ARK Fund, U.S. Government Bond Fund
Cash
$ 71,747.52
200,336.40
104,691.40
4,341.40
37.98
$381.154.70
in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said
Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever
discharge the said Allfirst Trust Company of Pennsylvania, N .A., formerly Allfirst Bank, formerly
known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its
successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things
whatsoever including gross negligence, to the day of the date hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this I" t;J,. day of M
, 2001.
WITNESS:
X~..i I( L-:.-
. '"
--"",
COMMONWEAL TH OF PENNSYLVANIA )
) SS:
COUNTY OF CUMBERLAND )
On this, the I (o~y of J~~
, 2001, before me, a Notary Public
In
and for said State and County, personally appeared Thomas Siemons, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and
acknowledged that he executed the same for the purposes therein contained and desires that
the
same be recorded as such.
WITNESS my hand and Notarial Seal.
Notarial Seal
Stacy L. FI1ck, Notary Public
East Pennsboro l'Np., CtInlierIInd ~
My Commission expires Jan. 12, 2004
....
RELEASE
WHEREAS, Allfirst Trust Company of Pennsylvania, N .A., formerly known as Allfirst Bank,
formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company,
is the duly appointed Trustee under the Will of John C. Siemons of Cumberland County,
Pennsylvania; and
WHEREAS, Ethel M. Siemons was the income beneficiary of the Trust; and
WHEREAS, Ethel M. Siemons died May 1, 2001; and
WHEREAS, in accordance with the Will of John C. Siemons, upon the death of Ethel M.
Siemons, the Trust is to terminate and. the balance is to be distributed equally among John C. .
Siemons' sons; and
WHEREAS, the said Trustee has suhmitted to the said Michael Siemons an account of its
Trusteeship, which has been examined and approved by the said Michael Siemons; and
WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans'
Court Division of the Court of Common Pleas of Cumberland County and having the same
confirmed, the said Michael. Siemons has requested his Trustee to make settlement with him at once.
AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Michael
Siemons have this day had and received of and from Allfirst Trust Company of Pennsylvania, N .A.,
formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit
Bank and Trust Company, Trustee as aforesaid, the following:
1,248 shares
10,119 shares
5,059 shares
443 units
Alltel Corp.
Sprint Corporation Foundation
Sprint Corporation PCS Group
ARK Fund, U.S. Government Bond Fund
Cash
$ 71,747.52
200,356.20
104,670.71
4,341.40
38.87
$381.154.70
in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said
Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever
discharge the said Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly
known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its
successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things
whatsoever including gross negligence, to the day of the date hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /(, day of Ju It
,2001.
WITNESS:
v~ LtH_~
c .. ?
~~_~/~SEAL)
MIchael Siemons
COMMONWEAL TH OF PENNSYL VANIA )
) SS:
COUNTY OF CUMBERLAND )
On this, the I~y of J Ll ~
, 2001, before me, a Notary Public
In
and for said State and County, personally appeared Michael Siemons, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and
acknowledged that he executed the same for the purposes therein contained and desires that
the
same be recorded as such.
WITNESS my hand and Notarial Seal.
G
Notarial Seal
Stacy L. Frick, Notary Public
East Pennsboro lWp., Cumbertand County
My Commission Expll'86 Jan. 12, 2004
~ ,j w
......
, .
RELEASE
WHEREAS, Allfirst Trust Company of Pennsylvania, N .A., formerly known as Allfirst Bank,
formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company,
is the duly appointed Trustee under the Will of John C. Siemons of Cumberland County,
Pennsylvania; and
WHEREAS, Ethel M. Siemons was the income beneficiary of the Trust; and
WHEREAS, Ethel M. Siemons died May 1, 2001; and
WHEREAS, in accordance with the Will of John C. Siemons, upon the death of Ethel M.
Siemons, the Trust is to ter.minate ::lnd the balance is to be distributed equally amOl)g John C.
Siemons' sons; and
WHEREAS, the said Trustee has submitted to the said Karl H. Siemons an account of its
Trusteeship, which has been examined and approved by the said Karl H. Siemons; and
WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans'
Court Division of the Court of Common Pleas of Cumberland County and having the same
confirmed, the said Karl H. Siemons has requested his Trustee to make settlement with him at once.
AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Karl H. Siemons
have this day had and received of and from Allfirst Trust Company of Pennsylvania, N.A., formerly
Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and
Trust Company, Trustee as aforesaid, the following:
1 ,247 shares
1 0, 119 shares
5,059 shares
452.833 units
Alltel Corp.
Sprint Corporation Foundation
Sprint Corporation PCS Group
ARK Fund, U.S. Government Bond Fund
$ 71,690.03
200,356.20
104,670.71
4.437.76
$381.154.70
in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said
Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever
discharge the said Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly
known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its
successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things
whatsoever including gross negligence, to the day of the date hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this .t.8'~ day of ~ D
,2001.
WITNESS:
~~.-
".lallv ~~
Karl H. Siemons
(SEAL)
."
.
..
.. .
..1
COMMONWEAL TH OF PENNSYL VANIA )
) SS:
COUNTY OF CUMBERLAND )
On this, the ~ ~ay of JU/I....L
In
, 2001, before me, a Notary Public
and for said State and County, personally appeared Karl H. Siemons, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and
acknowledged that he executed the same for the purposes therein contained and desires that
the
same be recorded as such.
WITNESS my hand and Notarial Seal.
Notarial Seal
Stacy L. Frick. Notary Public
East Pennsboro 'l'NP.. CUmber1and ~
My Commission Explree Jan. 12.2004
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
SLlKE JOHN E
2109 MARKET STREET
CAMP Hill, PA 17011
-------- fold
ESTATE INFORMATION: SSN: 184-48-9669
FILE NUMBER: 21-2001- 0507
DECEDENT NAME: SIEMONS ETHEL M
DATE OF PAYMENT: 07/30/2001
POSTMARK DATE: 07/27/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01/2001
NO. CD 000094
A,CN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $24,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$24,000.00
REMARKS: JOHN E SLlKE
CHECK# 22
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WillS
LAW OFFICES
JAMES O. FLOWER
JOHN E. SLIKE
ROBERT C. SAlOIS
GEOFFREY S. SHUFF
JAMES O. FLOWER, JR.
CAROL J. LINOSA Y
JOHNNA J. KOPECKY
KARL M. LEOEBOHM
JOSEPH L. HITCHINGS
THOMAS E. FLOWER
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EM AIL: attomey@ssfl-Iaw.com
www.ssfl-Iaw.com
CARLISLE OFFICE:
26 W. HIGH STREET
CARLISLE, P A 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
REPLY TO CAMP HILL
July 27, 2001
Register of Wills
Cumberland County Courthouse
Carlisle, P A 17011
Re: The Estate of Ethel Siemons
File No. 21-01-0507
Dear Ladies:
Enclosed please find a check in the amount of $24,000 representing a payment on
account of inheritance taxes in the above estate.
Please issue a receipt at your convenience.
Very truly yours,
S't: S~~}i'LOW~R & LINDSAY
Shelby~) ifgling, Estate;:}>aralega!.'
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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
SLlKE JOHN E
2109 MARKET STREET
CAMP Hill, PA 17011
____u__ fold
ESTATE INFORMATION: SSN: 184-48-9669
FILE NUMBER: 2101-0507
DECEDENT NAME: SIEMONS ETHEL M
DATE OF PAYMENT: 02/04/2002
POSTMARK DATE: 02/02/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01/2001
NO. CD 000826
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,658.72
I
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TOTAL AMOUNT PAID:
REMARKS: JOHN E SLlKE ESQUIRE
CHECK#1037
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$3,658.72
MARY C. lEWIS
REGISTER OF WillS
LAW OFFICES
JAMES D. FLOWER
JOHN E. SLIKE
ROBERT C. SAID IS
GEOFFREY S. SHUFF
JAMES D. FLOWER, JR.
CAROLJ. LINDSAY
JOHNNA J. KOPECKY
KARL M. LEDEBOHM
JOSEPH L. HITCHINGS
THOMAS E. FLOWER
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
210:mJA-~~J STREET
CAMP HILb~N5YLVANIA(lV011
TELEPHONE: (717) 73~~-S-FA:CSI:MItlR: (717) 737-3407
EMAIL: attomey@ssfl-Iaw.com
.02wwFE3-1~4'cop 3 :33
C!c'rk
CUfllbL,
CARLISLE OFFICE:
26 W. HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
REPLY TO CAMP HILL
February 1,2002
Register of Wills
Cumberland County Courthouse
Carlisle, P A 1 70 13
Re: The Estate of Ethel M. Siemons
File No. 21-01-0507
Dear Ladies:
Enclosed please find an original and two copies of an inheritance tax return to be filed in
the above estate. Also enclosed is a check for the filing fee and a check for the balance of tax
due.
Kindly return a time-stamped copy of the return to me in the envelope provided.
Thank you.
Very truly yours,
SAIDI~fHUF... F, FLOWER~,&LINDSAY
Uu Yl /
Shelby L. YinJint/E~e Paralegal
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REV-1500 EX + (6-00)
CAPB
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FILE NUMBER
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Siemons Ethel M.
DATE OF DEATH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
184-48-9669
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
DATE OF BIRTH (MM-DD-YEAR)
21-01-0507
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 1. Original Return
4. Limited Estate
X 6. Decedent Died Testate
(Attach copy of Will)
D 9. Litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach copy of Trust)
D 10. Spousal Poverty Credit
1
o
3 date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
C P
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R N
R 0
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NAME
COMPLETE MAILING ADDRESS
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John E. Slike
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsa
TELEPHONE NUMBER
2109
Camp
Market St.
Hill, PA~t'!ll
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160,90 '; 00
296,091; 19
None
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3 -3405
Real Estate (Schedule A)
Stocks and Bonds (Schedule B)
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 (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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)
(8) 668,413.59
(11) 25.705.19
(12) 642,708.40
(13)
(14) 642,708.40
(15)
(16)
(17)
(18)
(19)
0.00
28,921.88
0.00
0.00
28,921.88
(1)
(2)
(3)
(4)
(5)
None
211,422..40
(6)
None
None
20,609.31
5,095.88
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
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 642,708.40
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x
X
X
X
.0 0
o 45
.12
.15
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
206 Front Street
CITY I STATE I ZIP
West Fairview PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
28,921. 88
0.00
24,000.00
1,263.16
Total Credits ( A + B + C 1 (2)
25,263.16
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. It Line 2 is greater than LIne 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable 10: REGISTER OF WILLS, AGENT
0.00
0.00
3,658.72
0.00
3,658.72
jum~t:~~~~mk~~~~~]~~:~!:~]~tt~~~~~]j!~~~~~~~~~j]]~Y:~tk~~~~]]~~]]]~!~!!j!~~:,j~~~j!f~~~~~~,:f~~m~t]6~~j~m:u: "
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ~ ~iX
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or .
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
o
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[!]
[!]
[!]
Under perullties of perjury, I declare that I have examIned this u!turn, Including accomp~nylng schedules and statements, and to the best of Trr'j k.nowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on aU Information of whIch preparer has any k.nowledge.
S\GNA11~RS~R f'pNSIBlEFORF\lINGRE1URN Karl, Michael, Thomas Siemons
;2 ~ -- -~~lt-~j'It~p~t:' ii6ii - -- - --- ----------- - -- -- --
SIGNATUREOFPREPAREROTHER1~AN REPRESENTATIVE Saidis, Shuff, Flower & Lindsay
iL~ >~ II;. ---~~?--~j'I1~\~t:'ii6ii-------------------------
DATE
11:),( J v
DAlE
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
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 exempt 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)(11].
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 indi.....idual who has at least one parent in common with the decedent, whether by blood or adoption.
CopyrIght (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV-'1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ethel M. Siemons SS# 184-48-9669 05/01/2001 21-01-0507
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the 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
knowledQe of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 206 Front Street, West Fairview, PA 17025 76,000.00
(based on sale price - see copy of settlement sheet attached)
2 1/2 interest in land, New Buffalo, Perry County, PA 8,000.00
(other 1/2 interest owned by Benjamin and Elizabeth Witmer-
based on assessed value of $16,000)
3 Farmhouse, Tyrone Township, Perry County, PA 76,900.00
(based on re-assessment value)
SCHEDULE A
REAL ESTATE
TOTAL (Also enter on line 1, Recapitulation) $ 160,900.00
(If more space is needed, insert addit'lonal sheets of the same size)
copyright (e) 1996 form software only CPsystems, Inc. Form REV-1502 EX (Rev. 1-97)
REV-'1503 EX + (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Ethel M. Siemons
SSff 184-48-9669
05/01/2001
All property jointly-owned with right of survivorship must be disclosed on Schedule F,
21-01-0507
ITEM DESCRIPTION VALUE AT DATE
NUMBER UNIT VALUE OF DEATH
1 777 shares A11te1 Corp., common stock 54.61 42,431. 97
2 6300 shares Sprint Corp., FON, common stock 21.380 134,694.00
3 3150 shares Sprint Corp., PCS Group, common stock 25.63 80,734.50
4 Various Series E Savings Bonds (see attached) 38,230.72
TOTAL (Also enter on line 2, Recapitulation) 296,091.19
(1f more space is needed, Insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
REV-'1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Siemons
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS# 184-48-9669
FILE NUMBER
21-01-0507
05/01/2001
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
DESCRIPTION
VALUE AT DATE
OF DEATH
10
11
12
13
1
10,361.14
26.53
2,471.10
0.30
12,516.69
130.92
76,569.23
95.30
1,999.04
0.92
32,556.78
12.23
32,278.35
18.20
24,923.81
133.86
3,078.00
Pennsylvania State Bank, CD #10338
accrued interest
A11first Bank, #79060498
accrued interest
A11first Bank, CD #87008141022881
accrued interest
A11first Bank, CD #80000002027619
accrued interest
A11first Bank, statement savings #87005700053713
accrued interest
First Union Bank, CD #247412051284411
accrued interest
First Union Bank, CD #247412051283923
accrued interest
First Union Bank, CD #24712063622510
accrued interest
Cash settlement from litigation plus reimbursement of
portion of taxes and insurance for New Buffalo property
from Witmers
IRS tax rebate
Household furnishings
Antiques, based on sale prices
Grandfather clock
2
3
4
5
6
7
8
9
300.00
9,500.00
2,450.00
2,000.00
TOTAL (Also enter on line 5, Recapitulation) $ 211,422,40
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev, 1-97)
REV~1511 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ethel M. Siemons
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
ADMINISTRATIVE COSTS,
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
B.
2.
3.
4.
SSfI 184-48-9669
FILE NUMBER
21-01-0507
05/01/2001
DESCRIPTION
AMOUNT
FUNERAL EXPENSES,
Musselman's Funeral Home
Evan's Cemetery Memorials, engraving
1,320.60
125.00
Year(s) Commission Paid:
Attorney's Fees Saidis, Shuff, Flower & Lindsay
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
17,200.00
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees
Register of Wills
398.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
Cumberland Law Journal, estate notice
The Patriot News, estate notice
filing fee for tax return
PNC Bank, check printing fee
Costs incurred in sale of 206 Front St., West Fairview
Paramount Exterminating, termite certification
L.W. Brodisch Real Estate, appraisal fee
75.00
114.03
15.00
55.40
373.28
583.00
350.00
TOTAL (Also enter on line 9, Recapitulation) $ 20,609.31
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1 ~97)
COMMONWEA.L TH OF PENNSYLVA.NIA.
INHERITA.NCE TA.X RETURN
RESIDENT DECEDENT
ESTATE OF
Ethel M. Siemons
REV-'1512 EX + (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE liABiliTIES, AND LIENS
FILE NUMBER
21-01-0507
SSfI 184-48-9669
05/01/2001
Include un reimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
7
8
9
10
11
12
13
14
DESCRIPTION
AMOUNT
223.00
111.25
236.50
400.15
139.78
104.33
662.78
989.00
115.00
456.60
232.09
838.27
272.03
315.10
Sprint phone bill
VCI
PPL
Shipley Oil
Verizon phone bill
PAWC
Delores Kitner, Perry Co. property, taxes
Travelers Insurance, fire and liability insurance
Hamilton Musser, preparation of tax returns
Rhodes Pharmacy, medical expense
Homeland Center, nursing home
East Pennsboro, taxes on Fairview property
East Pennsboro, sewer and trash
Shipley Energy, heating oil
TOTAL (Also enter on line 10, Recapitulation) $ 5,095.88
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REV~ 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Ethel M. Siemons
SS/I 184-48-9669
05/01/2001
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a}(1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
1
Karl H. Siemons
2616 Market St.
Camp Hill, PA 17011
son
2
Michael Siemons
214 Front St.
West Fairview, PA 17025
son
3
Thomas L. Siemons
600 Mountain St.
Eno1a, PA 17025
son
FILE NUMBER
21-01-0507
AMOUNT OR SHARE
OF ESTATE
1/3 of estate
1/3 of estate
1/3 of estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)
Perry County Board of Assessment Appeals
County Veterans Memorial Building
25 W. Main Street, P. O. Box 37
New Bloomfield, PA 17068
(717) 582-2131, Ext. 4115
(717) 582-5162 (fax)
Board of Assessment Appeals
Mark K. Keller
John J. Amsler, Jr.
Edward R. Kennedy
Director of Assessments
Dr. Robert S. Barr, CPE
Chief Assessor
David A. Ulsh, CPE
Solicitor
William Bunt
DECISION ORDER
MAILING DATE: October 2, 2000
PARCEL NUMBER: 270,111.00-010.000
SIEMONS, JOHN G ET UX
206 FRONT STREET
WEST FAIRVIEW PA 17096-3215
Dear Property Owner:
This letter is to officially notify you of the decision of the Perry County Board of Assessment Appeals
regarding the above-referenced parcel.
DATE OF APPEAL HEARING: 10/02/2000
DATE DECISION RENDERED: 10/0212000
EFFECTIVE FOR TAX YEAR: 2001
DECISION RENDERED: [] Withdrawn By Applicant
[ ] Abandoned For Failure To Appear
[] Denied - No Change
[X] Approved Review Appraiser's Changes
[ ] Revised Assessment Based on Hearing
[ ] Other:
TOTAL VALUE
FAIR MARKET
CLEAN AND GREEN
CLEAN AND GREEN
STATUS
Old Assessed Value:
New Assessed Value:
103,950
75,990
NOT
APPLICABLE
BOARD OF ASSESSMENT APPEALS:
Mark K. Keller, Chairman
John J. Amsler, Jr.
Edward R. Kennedy
Perry County Board of Assessment Appeals
PROPERTY OWNER INFORMAL REVIEW ACCEPTANCE OR REJECTION FORM
· As.of AV[jV'::'\ 30) ;],oC') (date), I/we have requested an appeal .of cur assessment.
. As.of the ab.ove date, I/we have met with an .official assessment representative te discuss my/cur
preperty assessment in questi.on.
. The parcel/acc.ount number .of the subject preperty is as fell.ows:
f.) -70 l \ \ ) ,00 - () \ 0, oen
Parcel/Acceunt Number
. The current Market Value .of this preperty is $ \ o?J elso
,
. The current Clean and Green value (if applicable) .of this preperty is $ /11 ) A
I
Review Appraiser's Recommendation:
~~ .-- C7'5'~)
) ,./ L-
/ - / ~
/
Property Owner's Decision:
I/we accept the, recelJ)men~a.tjen of, the reviewl;lppraiser and understand thl;l(iftMaO,arclapprevEls the
recemmendatien. a ferml;llappeal hearing will net be scheduled and anyprevielJsrl'iql:le$t fer a fermal
appeal will be considered te be withdrawn. I/we further understand that ,if th,e~oard~ees not approve
the recemmendatien, an appeal hearing will be scheduled if I/we filed a fermalappeal by the deadline
listed en the change of assessment noticEl. '
o ,I/we reject the reCOmrnendl;ltien .of the review apprl;liser and understand that if I/we have fi,led a request
fer a fonnal hearing by the appeal deadline, as stated en the netice, an appeal nearing will.!Je
scheduled.
flroperty OVo/ner($) Signature(s): _
'~-, ,', ./"/" ,j
j~/7 ,..{" /'," /<} /)
,/'/'/~/;'<~~:(~' /<i]~;~~-_.~-- _ .-- - -- ?'.'c. /-/
----...~-
1.01'1 Number
I/we acknowledge receipt .of a duplicate signed c.opy.of this form.
(initials)
FOflT! 216 (v. 1.1)
06/26/01
~1 302 934 2955
CIS
12:30
Saidis, Shuff, Flower & Lindsay
Attorneys At Law
2109 Market Street
Camp HilI, P A 17011
Re: Estate of Ethel M Siemons
Social Security: 184-48-9669
Date of Death: Mav 1.2001
Dear Sir or Madam:
-"
Allfirst Financial Center N A.
PO Box 900
Millboro, DE 19966
June 26, 2001
~ 002/004
allfirst
Per your inquiry dated June 6, 2001 please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
I.
Type of Account
Account Number
0079060498
Relationship Checking W/lnt
Ownership (Names of)
Ethel M Siemons
John G. Siemons,DECD
Karl H Siemons. POA
Michael Siemons, POA
Thomas Krouse Siemons, POA
Opening Date
08/28/64
Balance on Date of Death
$2,471.10
Accrued Interest
$
.30
Total
-Tri'iT4IF--------------
2.
Type of Account
Statement Savings
Account Number
87005700053713
Ownership (Names of)
Ethel M Siemons
Marc John Siemons
06/26/01
12: 31
~1 302 934 2955
~ 003/004
CIS
Opening Date
03/26/93
Batance on Date of Death
$I, 999. 04
Accrued Interest
$
.92
Total
$))7jij7jrmm-----n-m----mm_m_______
3.
Type of Account
Certificate of Deposit
Account Number
80000002027619
Ownership /Names oj)
Ethel M Siemons
Karl H Siemons. POA
Michael Siemons. POA
Thomas Krouse Siemons. POA
Opening Date
10/25/99
Balance on Date of Death
$76,569.23
Accrued Interest
$ 95.30
--$76:6MsJ-_m__m___m_-
Total
This CD was a rollover from one that \lias opened 0/1 07/25/96. which wGsc10sed on 10/25/99.
4.
Type of Account
Certificate of Deposit
Account Number
87008141022881
Ownership /Names oj)
Ethel M Siemons
Karl H Siemons. POA
Michael Siemons. POA
Thomas Krouse Siemons. POA
Opening Date
12/31/97
Balance on Date of Death
$12.516.69
Accrued Interest
$ 130.92
--STi.64T6T
Total
5_
Type of Account
Safe Deposit Box
Account Number
/0005321000/1180
Ownership /Names oj)
Ethel M Siemons
Karl H Siemons. POA
Michael Siemons, POA
Thomas Krouse Siemons, POA
Opening Date
11I13/98
06/26/01
12:31
~1 302 934 2955
CIS
I4i 004/004
These accounts were converted/rom the acquisition of another jinanciallnstitution. UJTjortunately,
we are unable to access any information pertaining to the date the account '\1oIQS made joint
This leuer does not include any accounts in which the rUceased may have been listed as Power of Atrorney,
Custodian of Uniform Tranqers, R2presentative Payee, or Trustee under a Written Agreement.
For further account information, c!osuresandlor reimbursement a/funds ,-eler to below branch"
CAMP HILL OFFICE
3045 MARKET STREET
CAMP HILL, P A 17011
717-255-2279
'C~'"''
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Re: Estate of Ethel M. Siemons
Date of Death: May 1,2001
Social Security No. 184-48-9669
The following is a complete record of the above decedent's accounts as of May 1,2001 decedent's
date of death. If the decedent had a safe deposit box, indicate number _'
Balance on Date of Death
Account No. Type of Principal Accrued Names en Date
Account Interest Account (All Opened
Owners)
10338 CD 10,381.14 26.53 ETHH h ~IJ:.I'ION 07/17/UU
A;uu. ~
Signature o~2k'ficial
Date: nl,,- 11-0 I
Title: R ~.u::J-
-..-----------------------
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LAW OFFICES
SAIDIS, SHUFF, FLOWER &
2109 MARKET STREET
CAMP HILL. PA 17011
LINDSAY
;.j.
f~N'
Reference 10: \73193
First Union National Bank
Attn: Account Verifications
POBox 40028
Roanoke VA 24022-7313
June 20, 2001
SAlOIS, SHUFF, FLOWER & LINDSAY
2109 MARKET STREET
CAMPHILL,PA 17011
SUBJECT: Verification I Confirmation of Account and Balance Information provided for:
ETHEL M SIEMONS (SSN# 184-48-9669)
Date of Deatb: May 1, 2001
Deposit Account Information
Account
Type
Account
Number
Date of Death
Balance
Average
Balance'"
Date
Opened
Maturity Interest Accrued YTO Date
Date Rate Interest Interest Paid Closed
CERnFICATEOF DEPOSIT 247412051283923 $32,278.35 7/31/2000 8/29/2001
LEGAL TITLE: ETHEL M. SIEMONS
REISSUED FROM CD #247022056113510 (07/2911997 TO 07/3 1/2000) UNDER SAME TITLE.
CERTIFICATE OF DEPOSIT 247412051284411 $32,556.78 7/31/2000 8/3l/2001
LEGAL TITLE ETHEL M. SIEMONS
REISSUED FROM CD #247022056113511 (07/30/1997 TO 07/31/2000) UNDER SAME nTLE.
$18.20
$736.03
$12.23
$736.26
CERTIFICATE OF DEPOSIT 247412063622510
LEGAL TITlE ETHEL M. SIEMONS
$24,923.81
9116/1986 9116/2001
$133.86
$1,013.34
... Due to system limitations, we can only provide a twelve month average balance on depository accounts.
No Safe Deposit Box found for customer.
... Date of death balance does not include accrued interest.
... If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during th e period.
June 20, 2001
Date
Orema Rubinoff
Depository Representative
abs; ag
Servicenter Associate
Title
(540)563-7323
Phone Number
001032
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Inventory 1 ftL~/1t'1'4 ~ A/'A-~.J
Accrual Bonds
Redemption Date: 5/2001
Issue Yield Next Final
Serial Number Denom. Series Date Value Interest To Date Accrual Maturity
C1008881205E $100 E 12/1972 $480.56 $405.56 6.66% 10/2001 12/2002
C1008881167E $100 E 11/1972 $479.48 $404.48 6.66% 9/2001 11/2002
C1008881118E $100 E 10/1972 $479.48 $404.48 6.66% 8/2001 10/2002
C533731705E $100 E 9/1972 $479.48 $404.48 6.66% 7/2001 9/2002
C532909299E $100 E 8/1972 $479.48 $404.48 6.66% 6/2001 8/2002
C532909261E $100 E 7/1972 $488.00 $413.00 6.60% 11/2001 7/2002
C1002466634E $100 E 6/1972 $483.32 $408.32 6.57% 10/2001 6/2002
C1002301369E $100 E 5/1972 $481.96 $406.96 6.56% 9/2001 5/2002
C535822842E $100 E 4/1972 $481. 96 $406.96 6.56% 8/2001
4/2002
C535822815E $100 E 3/1972 $481. 96 $406.96 6.56% 7/2001 3/2002
C533730767E $100 E 2/1972 $481.92 $406.92 6.56% 6/2001 2/2002
C533730742E $100 E 1/1972 $490.40 $415.40 6.50% 11/2001 1/2002
L814383875E $50 E 5/1971 $253.20 $215.70 6.47% 5/2001 2
L816706126E $50 E 6/1971 $251.18 $213.68 6.48% 6/2001 6/2001
L816706246E $50 E 7/1971 $249.44 $211.94 6.45% 7/2001 7/2001
L821212601E $50 E 8/1971 $243.82 $206.32 6.49% 6/2001 8/2001
L805765753E $50 E 4/1971 $253.20 $215.70 6.47% 4/2001 2
L805765632E $50 E 3/1971 $253.20 $215.70 6.47% 3/2001 2
L800392227E $50 E 2/1971 $253.20 $215.70 6.47% 2/2001 2
L800278478E $50 E 1/1971 $252.60 $215.10 6.46% 1/2001 2
C527778898E $100 E 12/1971 $488.80 $413.80 6.49% 10/2001 12/2001
C527778875E $100 E 11/1971 $487.64 $412.64 6.49% 9/2001 11/2001
C527778842E $100 E 10/1971 $487.64 $412.64 6.49% 8/2001 10/2001
C527778816E $100 E 9/1971 $487.64 $412.64 6.49% 7/2001 9/2001
L800278364E $50 E 12/1970 $280.02 $242.52 6.82% 12/2000 2
L793182518E $50 E 11/1970 $279.38 $241.88 6.81% 11/2000 2
L792844159E $50 E 10/1970 $279.38 $241.88 6.81% 10/2000 2
L790761163E $50 E 9/1970 $279.38 $241.88 6.81% 9/2000 2
L788763328E $50 E 8/1970 $279.38 $241.88 6.81% 8/2000 2
L785478056E $50 E 7/1970 $278.72 $241.22 6.80% 7/2000 2
L785478016E $50 E 7/1970 $278.72 $241.22 6.80% 7/2000 2
L785477864E $50 E 5/1970 $274.72 $237.22
6.75% 5/2000 2
L783240435E $50 E 3/1970 $274.72 $237.22 6.75% 3/2000 3
L776308642E $50 E 1/1970 $274.00 $236.50 6.74% 1/2000 3
L6205111 $50 S 1/1970 $273.42 $232.92 6.47% 1/2000 3
L6677127 $50 S 3/1970 $273.42 $232.92 6.47% 3/2000 3
L5422921 $50 S 5/1970 $276.08 $235.58 6.50% 5/2000 2
L771731745E $50 E 11/1969 $270.04 $232.54 6.69% 11/1999 3
L768040765E $50 E 9/1969 $270.04 $232.54 6.69% 9/1999 3
L763956689E $50 E 7/1969 $269.42 $231. 92 6.68% 7/1999 3
L758227640E $50 E 5/1969 $277.20 $239.70 6.78% 5/1999 3
L754689410E $50 E 3/1969 $274.54 $237.04 6.75% 3/1999 3
L749734894E $50 E 1/1969 $274.54 $237.04 6.75% 1/1999 3
L4305835 $50 S 11/1969 $272 .14 $231.64 6.45% 11/1999 3
L4237328 $50 S 9/1969 $270.00 $229.50 6.42% 9/1999 3
L3735743 $50 S 1/1969 $271.40 $230.90 6.44% 1/1999 3
L4175978 $50 S 3/1969 $271.40 $230.90 6.44% 3/1999 3
L4175990 $50 S 5/1969 $268.74 $228.24 6.41% 5/1999 3
L4237310 $50 S 7/1969 $270.00, $229.50 6.42% 7/1999 3
L749734824E $50 E 11/1968 $270.88 $233.38 6.70% 11/1998 3
L743414141E $50 E 9/1968 $268.28 $230.78 6.67% 9/1998 3
L738461535E $50 E 7/1968 $268.28 $230.78 6.67% 7/1998 3
1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable)
. = Possibly eligible for U.S. Savings Bond Education Benefit Program.
See footnotes on Inventory Summary page.
1
Inventory 1
Accrual Bonds (continued)
Redemption Date: 5/2001
Issue Yield Next Final
Serial Number Denom. Series Date Value Interest To Date Accrual Maturity
L731009886E $50 E 5/1968 $265.14 $227.64 6.63% 5/1998 3
L730971320E $50 E 3/1968 $262.56 $225.06 6.59% 3/1998 3
L724285117E $50 E 1/1968 $262.56 $225.06 6.59% 1/1998 3
L301438 $50 S 1/1968 $312.58 $272.08 6.93% 1/1998 3
L301453 $50 S 3/1968 $312.58 $272.08 6.93% 3/1998 3
L2002844 $50 S 5/1968 $286.74 $246.24 6.63% 5/1998 3
L2040657 $50 S 7/1968 $291.36 $250.86 6.69% 7/1998 3
L2049457 $50 S 9/1968 $272.36 $231.86 6.45% 9/1998 3
L3666240 $50 S 11/1968 $269.94 $229.44 6.42% 11/1998 3
Ll72438 $50 S 9/1967 $308.10 $267.60 6.88% 9/1997 3
C428473954E $100 E 1/1963 $803.24 $728.24 6.30% 10/2001 1/2003
C428473940E $100 E 12/1962 $803.24 $728.24 6.30% 9/2001 12/2002
C427433659E $100 E 11/1962 $799.92 $724.92 6.29% 8/2001 11/2002
C427420484E $100 E 10/1962 $799.92 $724.92 6.29% 7/2001 10/2002
C426238835E $100 E 9/1962 $799.88 $724.88 6.28% 6/2001 9/2002
C425346652E $100 E 8/1962 $810.12 $735.12 6.24% 11/2001 8/2002
C425346637E $100 E 7/1962 $802.44 $727.44 6.21% 10/2001 7/2002
C423868371E $100 E 6/1962 $802.44 $727.44 6.21% 9/2001 6/2002
C421322258E $100 E 5/1962 $800.36 $725.36 6.20% 8/2001 5/2002
C420166505E $100 E 4/1962 $800.36 $725.36 6.20% 7/2001 4/2002
C420166491E $100 E 3/1962 $800.44 $725.44 6.20% 6/2001 3/2002
C418283662E $100 E 2/1962 $810.56 $735.56 6.16% 11/2001 2/2002
C418283650E $100 E 1/1962 $802.80 $727.80 6.13% 10/2001 1/2002
C418272567E $100 E 12/1961 $802.80 $727.80 6.13% 9/2001 12/2001
C418272549E $100 E 11/1961 $800.44 $725.44 6.12% 8/2001 11/2001
C416817326E $100 E 10/1961 $800.44 $725.44 6.12% 7/200J. 10/2001
C416817314E $100 E 9/1961 $800.52 $725.52 6.12% 6/2001 9/2001
C416801589E $100 E 8/1961 $807.48 $732.48 6.07% 8/2001 8/2001
C413955071E $100 E 7/1961 $799.84 $724.84 6.04% 7/2001 7/2001
C413955057E $100 E 6/1961 $799.84 $724.84 6.04% 6/2001 6/2001
C410648180E $100 E 5/1961 $805.44 $730.44 6.02% 5/2001 2
C409208999E $100 E 4/1961 $805.44 $730.44 6.02% 4/2001 2
Ll72711 $50 S 11/1967 $311.04 $270.54 6.91% 11/1997 3
1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable)
. = Possibly eligible for U.S. Savings Bond Education Benefit Program.
See footnotes on Inventory Summary page.
2
Inventory 1
Inventory Summary
Redemption Date: 5/2001
Number Inventory Redemption
of Bonds Value Value Interest
Accrual Bonds
Pre-January 1990 Issue Dates: 85 $38,230.72 $38,230.72 $33,567.22
January 1990 and Later Issue Dates: 0 $0.00 $0.00 $0.00 *
85 $38,230.72 $38,230.72 $33,567.22
Current Income Bonds 0 $0.00 $0.00 $0.00
Inventory Totals 85 $38,230.72 $38,230.72 $33,567.22
Footnotes
* Proceeds from Series EE & I Savings Bonds with issue dates beginning January 1990
may be eligible for special tax exemption when used for post-secondary education.
For further information concerning the benefits and restrictions that apply,
please contact the Internal Revenue Service.
1 These bonds are not eligible for payment within 6 months of their issue date.
2 These bonds have reached final maturity and will earn no additional interest.
They can be exchanged for HH Bonds within a year of their final maturity date.
3 These bonds have reached final maturity and will earn no additional interest.
They are not eligible for exchange for Series HH Bonds since they have been held
over a year past their final maturity date.
3
MAILING DATE: July 1. 2000
District: 280 ~ WATTS TOWNSHIP
:~~:.:~'i~ /l'
TAXABLE Y
Land Size....: 9.00 acres
property Type: L3
Vacant Land
Control No: 00521286
THIS IS NOT A TAX BILL
Parcel Identifier:
280,064.00-020.000
2000 Assessed Value Old Assessed Value
Market Value (2000 Market x 100%) (1973 Market x 75%)
Land 20,000 20,000 ~,500
Buildings 0 0 0
TOTAL 20,000 20,000 ~,500
2000 Clean and Green Values
Land NOT NOT NOT
Buildings APPLICABLE APPLICABLE APPLICABLE
TOTAL
Clean and Green values become effective only upon application and approval. All
applications must be received by the Assessment Office by 4:00 p.m. on October 15,
2000. Those previously approved for Clean and Green do not need to re-apply.'
WWW.COURTHOUSEONLINE.COM PASSWORD:PRILKSFS
Pennsylvania law requires that a/l real estate be valued as of the most recent county-wide reassessment. CutT9nt/y, the most recent
reassessment or tax base year is 1973. The new tax base year will be 2000, with the new assessed values becoming eff()ctive for the 2001 tax
year. It is very important for you to know that when the new 2000 tax base is determined after this reassessment, all taxing districts are
required by law to lower the millage rate by the same proportion that the tax base went up. No taxing district may collect any more
revenue as a result of the reassessment than it did the previous year. Exception: After the new tax base and equalized mil/ages are
determined, the faw permits counties, townships, and boroughs to raise revenue by not more than five (5) percent, and school districts by not
more than ten (10) percent. The essential point is that an Increase In market values does not mean a corresponding Increase in taxes.
Individual changes In taxes will depend upon a specific property's change as compared to the overall change for the taxing district.
The ESTIMATED impact statement printed below is our best estimate of change, based on 2000
COUNTY tax figures. This estimate does not include any borough, township, or school district impact.
ESTIMATED COUNTY TAX IMPACT,
$
$
28
54
2000 County Tax BEFORE Reassessment.
2000 County Tax AFTER Reassessment.
Current 2000 County mi~ls =
Adjusted 2000 County mi~ls =
~8.660
2.700
OMB NO. 2502-0265 ~
A. _~__ ..___..._.._.!L..rYPE()F.k<2A.'J:....-_.~___=.----
10FflA 20FmllA 3 [!JCONV UNINS 40VA_5.[]C()NV l~~
U.S. DEPARTMENT OF HOUglNG 8. URB...N DEVELOPMENT 6 FILE NUMBER . . '. E LOAN NUMBER:
SETTLEMENT STATEMENT 8 ~~%~AGEiNS CASE NUMBER'-'~L~~I)RTGAGE INS CASE NUMBER-
7.250%/F/238 MMl
C. NOTE: This ro"" is fumished to give you a .'iletoment of Clctual settlement r:0315. AfflOvnf.'i paid to and by file snftJemont agOnt are shown.
Items marked "[POCT were paid oufs/eM the cIos.ing, thsy 8~ shown hAm for Informational pl.upo.'ies and Bff3 not included In tire IOtals
1.0 ~190 CLuflltlpl'tJJ\.UVT1OfrJ
D. NAME AND ADDRESS OF BORROWER- E NAME AND ADDRESS OF SELLER F NAMEANDADDRESSOFI.FNDER
LEWIS P. LUFTIC
ESTATE OF E,HEL M SIEMONS
PENNSYI.VANIA STATE EMPLOYEES
CREDIT UNION
G PROPERTY LOCA TlON:
208 FRONT STREET
WEST FAIRVIEW, PA 17025
CUMBERLAND County, Pennsylvania
H SETTLEMENT AGENT'
Midstate Abstract Company
PUlCE OF SETTLEMENT
2331 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION
~9RDSS AMOUNT DUI::.~()BR.DWE~____-;;-__
'"' C_~_."D .. - ~ - -i-"'~.Ql!!
~. ~::~~~~~:;:;e'IO Bo~"!we;i~,"-e 14(0)-__.~= .---2',30~11
Aml/slmenls For "ems Paid By Sellar In advan""_:"'==."-:
1 06. CilvIT own T ."". to
107. County ;3xes to
108. School Taxes -01/31102 "to 0.7101102 .-..- --------353.81
109 SEWER 8. REFUSE PRORATION 01/31/02 to 0~01102.f--___' ....;~
1.!Q....__..~._.~------------~ -- ---..-
111.
~._._~_..._.--..- --
120 GROSS AMOUNT DUE FROM BORROWER 78,94280
200. AMOUNT!l PAID av OR IN BE;HALF Of BORROWER: ... ---C~-=
201:_,.~_a~ito(eamegtmoney ..~______________ _____ J._ _~,OOO_O~
,202. Prir:..~'p_ol Amount ~~Loa.~(S.L ___ ____ + 3_~l)OO:OO
,!","""~"l"~'"'""'"_ -: -;t- =
!!.- --- "-"~ -~~~~=---~. --= ....~
~. Adillstmenb For Items Unpaid !lY 5011.'-____. - -- ...
210. Cif\lfTown Taxes ~_ to r ___._
211, CounIyT.... _ .....J!!!ll1I()2.~Jl~1102......I_ _.1!h65
~.SchOOI1""es.____.~l<>__._ __1==_ ....-=
~~:. I __
~.' . -1~ .----
220. TOTAL PAID IlYIFOR BORROWER
~: CASH AT SETTLEMENT FROMITO BQ.~R: .._
~:..,g.r!?~G A~!Jnt PUft Fro'!!_~~~r:{~~'?l______ _
302. Less Amovnt Paid By/For BOrTowar (line 220) (
JOJ CAS/I ( X FROM) ( TO) BORROWER
39.02065
.-.- 78,942'80
-39,02065)
39,9?2 15
23--2114.,26
I SETTLEMENT DATE
JdlTluary 31, 2002
K. SUMMARY OF SELLER'S TRANSACTION
_~90..:_~S.~.~DUE:rQ. SEILE~-,-_.____._
~_~~,~~~l1!!~~lc_~_prlce ____ . _ ___n___ __ --4 ___2.~,()oO._QQ
~~_~_~r:_~:~~~~~e~!Y_~=~~=-~_ -~=___ _:~~---~L-=-----~-:_--
~g:. ------- u~__._.___-. .-J- _.-
~iJstm;;nts F-orltf!_ms Paid 81_S011er in advanct: -- -- -=_=-==.
.~ityrrown Tax~. .. ..~_..-.!o..__.._._._~...
_~2?:_~tyl_~2:.......,________._.___J~_____ .._~__ _._______
408. School Taxes ______J:113~!.!!~~~E!Q_'!Q?________ __ J!J387
~09 SroWER &RE!lJSE'p.RORA.!ION 01131102IolJ.4.~01~._____.s850
410.
411- =---~_.~--~--~.~- ~__-~____
412.
420 GROSS AMOUNTDlJE ro SEllER 75,41237
500. REDUCTIONS IN AMOUNT DUE TO SELl.F.R:
_~01_ -,:~:x~"0e~~-'_L~.I~~f~CliDr13L_=-~--- ~~-l-- ----~_--:--
4:~._.-._:__~~t.t.I...Tm~'~!C ..~~..g. ,1':' S....811f~~_{~_i~~O.O...).' ~ _ IG5.QO
~03 F.1(}gl~r191o~)take~lJbJect.2_ _ ~ _ _
504 Payoff of first Mortgage
~?~~~~~~~ind ""!J'tg~___~=-- -- -:----~E-~- ;:..-=
~~. I~=~S~I r~~alne~~~y'~~_I:~~=~~~_~~_ ~-=__ ~_ 4.00000
~t--- n-::-n_ ..---===------=-=--I==-___~
AdlUsfmGnts FC}!./mms Unpaid BySel!or _ __"___
510. CityfTown T;lxes .__,____~_}~... I._~__________
.~~~:--~~~~~~::::-- _n__~Q.1/~~ ~~ 0..1131/02 -..----F--~-Q!?-~
~~~~.=.~_. '.~- .n~.'.: m_m~ .~-=m-E'-~~~=
515.
515.
517
.5ia--------.--..-----~. --..
..______.._m__ ~n. ._.___n
519.
--..-
520 TOTAl. REDUCTION AMOUNT DUE SEll.E1i
600. CA!lH AT SETTLEMENT TO/FROM SELLF.R:
.!~01:- ~ro~~,A'moU!l!.p_U8 T. 0 _S~_II!!J~-~~~-42i)1_ - --=.-=---
602. Ler.~ Redut..1ionli Due S~llc;-(Lin8 !)}Oj~ 1<
I
I
4.185.65
.________n
__~41?~'
4,78!ifi!J
80.1 CASH ( X TO) ( fROM) SELI.FR
71,fi2B.n
The u"dersigned f\ereby acknowledge rec@lpl of lJ completed copy of pages 1&7 of Chig statemont & any attachmAnls rcferrBo to hersin
Borrower
LEWIS P LUFTIG
Seli<lr ESTATE OF ETHEL M SIEMONS
BY,_.
:.~ rr1\ f\\
: 'i;~ 1(1\
'.,J LiJ
~
.--"'"'\
., .
,I
,.
U
'-
- .
",' ...'.,y'
"..;1'Hd",",,,,,,',I.
1']','''-"
PI\092
TOO. TOTAL COMMISSION Based on Pnce
DivisKJn Of Comm;:J~;on (line 700) as FollOw$.:
701. $ 10
702. $ to
703. Commission Paid al Settfement
704 10
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. LOBn Origination FOfI % to "____. __.__~_ __~__ _____,_~
802. loan OiscOl,rnt.. % to
803. Appraisal Fe. 10 PENNSYLVANIA S1A TE EMI'LOYEES CREOiTUNKlN- POC $200.oiiii ------ -
804. Gredit Reporl 10 PENNSYLVANIA STATE EMPLOYEES CREOIT UNION POC $14.00b --. - ----
80S. Flood GCllille.tion Fee--- --.- 10 PENNSYLVANIA STAT! EMPI OYI.ES CREDIT U(ijibr;r- _= n15 Q() =:=---=-_:...
806.-U(fde~mn"re;;----~~_=--- io_~~~NSy~y~NI^SYM~E~!JLOYCES_Gf:{~_nl"--ll~I~~ --=~_ _ 100.00 ___ __
807. Assumption Fee to
808 n_~~______...__________________.___ --.__ ___ ____.....__n ._ .______
-'-'~-'---'--~--._----_._-'" --
809.
810.
811.
BOO. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901.lntere,t From 01/31102 to 02101102 @ S 6.952100/day ( 1 days ..___~_ ~~ __._~
902. M01tAa2~_JnsurancePremjumfor mon\hslo U".__~_ __.______._______._ _________.___ ____~__...'._ _~. .__ _u______
903. HaZ8fd In3urance Premiurn for ~ars to _~_~______,__ ______ ________ __ __ ___,___~- __________ ___,___ ___._,
904_
905_
1000. RESERVES DEPOSITED WITH LENDER
1001. Hezarrllnsurence 3.000
--
J.QQ2. Mortgage Insurance
1003_ c!h;fTown Taxes
1004. COun-iTaxes
1005. School Taxo!;
1006
1007.
1008. AGGREGATE AOJUS1ME:NT
1100 TITLE CHARGES
1101. Settlemenl or Closing Fee
1102. Abstrpd or Title Search
1103. Title Examination
1104. Tille InSUrance Binde-r
1105_ Document prenaration
1106. CIt1sir;:; ServIce Le"~r
1107 Attorney's Fees
- Ij"dUdes above item numbers:
1108. TItle In9uronce to MIDSTATEABSTRAC;T. ... _______ .._
(inclUdes above item numbtlrs.1102, 1103 & .!_104 _____________ ~ ____~_.._
1109. Lender's Coverage $ 35,000.00
1110 Owne(sCoverage S 76,000.00
1111 Endorsements 100, 300. 8.1 to Mkfstale Abstr;n:t Corn PinY-
1112. Nolary Fee \0 Cash
111:3. Notary FeR 10 C85h
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 25.50: Mortgog9 S 51.50:
1202_ CitvlCountv TakiStuRlJ)S; Deed 760.00; Mortgage
120~. Slate TaX/stamps; Revenue Stan:!P~_____760,OO, M~!!~_. .._ .~ ___._."~______~__ ____.
1204.
120S.
1300. ADDITIONALSEITlEMENT CHARGES
1301 SliNey
1302. Pes! 'n'DeC!lon
1303 EXPRESS COURIER FE:E
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103 Seellon J and 502. Seellon K)
By;lgnong pl109 1 of IMi, ~18lomonl, the lllonatorl.,,, lICknowkodge l'tlt'.illpl of" UJl'I'Ip1819li r.:apy of palJQ 1 or ml9 t-vQ P"'98 lllatemc:nl
L SETTLEMENT CHARGES
$ ______i!L_.._~._
-
PAlnrllOM
nORROWER'S
PAlO mOM
~inll r.rs
FUN()SA'f
SETll.EMENT
FUNOS AT
SETTLEMENT
------.--
--
12.000
B.OOO
monlhs ~L_~_2.J.?..~r m~~_________
months @~~_-y~!__~__ ._______ _________ ___
months ~___~_~---.eer mE!!!!!_~_____________._
months (i.i2 $; 20.94 per~~_~ .....__________.___
months @ $ 11.28 per rnonth
month. @ $ __.~=i>.r-monlh===~-=-:=:=::-::-~I_::-::-____ _=______::-=-=
months @......l... per m_9I"lth~___ _"________.._ ___~____ '-__
monlhs ftiJ -;-.. per month -- ~--=314_32
---~ ---------..----
._---~-
251.28
-~-641:52
10
to
IO---~---------=---====__________-=_________= _____ _-===-
to _ _ .___ ___'__._,____
10 _____ __
10 Midstsla Ab~lract Company _ ..____~_____~__ ___". 35.00 .."~__
to
-~~~-----~==_~____J ~_= -------
. .. __..214.75 ---
_______-I_.._ ____ __
--------------~_.._- ----- -.
- - 150.00
----------- =--- -~..
--
.....-frifci
Releoses S
77.00
16000
__~ ==~ -=---=-i60QO
.._-- - - - ._----
to
to ~...--------~--.--------f---- ____.
to Midsl.teAbslra"'C;'o'TllPony ____~__~_...!'.K..9 ______ 1500 _____
------------------.-. --_._-----~----
2,530.43
165 00
Certified to be a true copy_
Mid5tai;-Ab;tr;C(Company
SBttlemenl Agent
r::-"'.
~
: I:)
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,...1.-,
f;)
L"J
17
U;
c;-:J
'I
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C LuF'TtG IwFTIG J 7)
Phll"'f.
/ 32..HYi (
!:,
his ""1t'a, kno1'n to m~ to be the persons WhOSfl ntJ.m~B are subscribed to the within instrumentl
lincl tlckno'oVledgad tht1t the,)' executed the same 1'01' the purposlB thfil'eln conta,lI}Od-.
In Witness Whereot, I hereunto Bet IR,) htl.Ju~ and ot'ftoll:l1 981:11.
..,."'
..-
"
G. F~~ Glo~s.,p I ,'SEAL)
M.}' cODunlss1on expire 8 Jan. 7. 1 C)l)5. Notar.)'. Publio
I hareb)' .cart!f,)' that t.he p.:ac1s6 residence ot'the su.ld Grtu}:t,ees 1s Liverpool Twp..,
Perl',)' Co.., Ptt... (Ml11ersl.own, Rd. 1, p&.) ~Harr)r"-B._Q~;t,~~.r.~ttPrne) for Grlintees.
Entered FebrU:.l.r,) 10, 195~ tlnd compared b) ~erb6rt ~1'l Baker, Recorder.
.,
: l'f~i
,
N~
gooK
'1'1 7
f"''''r-
I rhlCL-P
ELIZABETH H. WI'llAER, his wU'e, of C1t)' of Harrisburg, Count.)' or' Dauphin, u,s tenants b) i _ ~
entireties. with right of' survivorship, dnd not 118 t.enants 1n cOlUmon. gl~t\.ntees WI'INF.SSE1'H.llVJc{,p
Ih~t In conslder..tlon 01' F:IGHT IIUNI1RED dolhrs, ($BOU.OO), In h~nd puld, the receipt wheret (,tf
at 1s nereb) aCknowledgaq. the su1d gruntor dOBs hereb) grc>.nt tinct cOnvB.1 to the Said gra.n-I
I
LESIEH C. ARNE-'Y
thous~nd nine hundred ~nd flft)-thre. BETWEEN LESTER C.
DEE 11
Tbla Deed. Mtlde the 4th dUo" of Fe'prutlr~. In thii )'etir one
TO
ARNRY. single IDl1n. of' New Butftllo BorOUgh, Count~ ot Perl')
JOliN G. SIEMONS ET AL
und CommonW~a.lth at' Penns"l.vtlni/i. gr'd.ntor. lind JOHN G.
CONS. :~800.00
SIEMONS AND ETHEL M. SIEMONS, his wHe, 01' Wost Falrvle"
Boroutlh, Cumb"lund Count~, ..nd BElIJAMIN M. WI'ThmR AND
tees
All that cert~in piece, ptlrcel. 0.1.' trtlct of It:md sltut1t ~ 1n the 'fownshlp of Wtttts.
Parr)' Count)', Penns:tlvt:l.nlli. bounded anci described tiS 1'0110\''/8, to wit:
EEGINNING at ..... point at wutel,ls edge, on Susquehu.nnu. lHver and Itlnds of A. G. Bruaw.
thnnce d.long line of sd.id 1l1nds Northr)rl.)' to 11 point tit center of old ma.cu.dtlID state hlgh-
Wa) tlnd lands now ot' Hd.rris J~ Bixler gstato. thence ti.long said center line of old macadu.
rOtoLd I1nd Harris J. Bixler Fstu.ta t.l.) d. point tit intersection ot sam1 with New State Highwfl.)'
Routes 11 tind 15; thence u.long lIne of Ue" Stl1te Highwa,}' to oth.er ltinds of Harris J. Bix-
lei' Estti.te; t.henr:e u.lang line of ~llm6 In d. southerl.)' direction to bank of a.toremsntloned
I /filWh
JIJ/v/Z
L.
Susquahd.nntl Rivel'. thanclj tl.long bunk 0]' :laid River to point. of Bai}lnn1ng. land Qont~1nlng
,1,1
nine (9) acres. more or less. (Not.e: ttH'm Old IDactld/i1l1 rQ4d S!.Ol..\l.q roti.d !lOld Concrete ROtldIV"
BEING the rerotiinder of thtit tJ'u.ct, l,)f lu.nd which Muria M~ ~~'lli\\l".~nd ,0. Emor)' Freet. he
husbtind. by tha 1r deed dated AUI!UIJt 2U. 19<15. I'SOOi'dad in tho Otf10s tor ,tn-a Racor.ding of
Deeu8. &c., at Bloomfield, 1n tlnct tol' the Gaunt.,)' 01' Perl'.)', in Deed Bopk No.., J.;~.~. Ptl~81'.
550, sold and conv8)'ed unto Lester C. A'rnBl. ~~'<..l.n.tor h.ereln.
And th~ sdict gro.ll\tor dofts hertlb) ,covenant and u.~r8e to, d.n9- \.Ilith the sb.ld. grti.ntees thuti
th~ sI11d gl'd.ntor w1l1 wu.rr.1nt genertlll) tt16 propert,) here-b) convo,yed.
IN WIr:lNESS WHEREOll'. slild grCintor has hereunto :Jut his ndnd and saul the dCi.)' tind I'e""r
1'll'st above written.
(r. ll. S.)
($1.10)
(Pu. n.".)
($8.00)
Lestsr C. J\rne~
(SI,:AL)
Seti.led tlnd deliverod in the presence of
F. 1.1. Ml11lg~1I
STAT" OF PENNSYLVANIA,)
--8S '
COUNTY OF PERRY ) . ..
On this ~tn du~ of ~ebru~r.)'. A. D. t953. betore me. Ii Justice of
the Peace 1n tlnd for Buid r.ount.)< unct St.tlta. cUllle the libove IUlmtuj IJe3i.fJl~ .:. Arne)' known to
me to uti the persotts whO-SEl l\l\.me is Rub-aeribad to the witll1n Instrument and acknowledged
tne tOi'egoing deed to be hiB ~ct d.n<l deed, and desired the Sd.tD6 to be rOQQl'ded ~8 suol\.
WI'X'NESS m)' hand Mnd ot1'1c1......1 sRul, the dli.)' d.nd .)'su.r u.t'oresaid.
Fr~nk M. Ml11lg~n
(SEAL)
2- '1-507
1fia~llbill tttrlt ur~glnm~al
I, ETHEL H. SIEt-10NS, of the Borough of \<Jest I'airview, County
of Cumberland and St.ate of pennsylvani[\) do make) publish and declare.
this to be my Last Will and Testament, hereby revoking any other wills
by me at any tim~ heretofore made..
I'TruST:
I give J devise and bequeath my entire estate
unto my husband, ..John G.. S iemons) and I name r constitute and appoint
the said John G. S iemons to be the Executor of this my will.
SECOND:
In the event m~' said husband shall fail to
survive me. 1. give", devise and bequeath my estate unto my sons, Varl r
Hichael and Thomas Siemons, and in such event I name, constitute and
appoint my sons, Farl, Nichael and Thomas Siemons to be the Executors
of this will.
IN IHTNESS WHEREOF, I hereunto set my hand and seal this -< f ...)-
da)' of Barch, 1962.
Z:,tA~~L: ;;/:
~~
~ ~-
..--(SEAL)
Signed, sealed, publ ished and declared by the above named
Testatrix as and for her Last Will and Testament in the presence of us,
who, in her presence r at her request t and in the presence of each other I
have hereunto subscribed our names as witnesses.
')~~L~ ~. 2~J
c),eJJ Jnd~
I hereby
April, 1978.
republish this Will this 14th day of
-=j/!~ )Zt
J'
A~' 1l~.#'Y~
WITNESS: U
~'.'f7
-9--'.T j, '.1.d
t"'. ......31...'~ " , ~ '--, " ~ 'l, ,((~. ~'ll~{"'ef~\tt:::(W'i".;J ~t.r,~:n.\"i~ i'f "',:" ~ <1~'~\~~" )
,', ", '- ',"',''.' ,~> ':,',~.'~:. f'."~'- ':""" -- ",' '
Ree.
Reg.
.02 FEB
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
C/r
Name of Decedent: Ethel M. Siemons
Date of Death: May 1, 2001
Will No.
21-01-0507
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
complete:
1 .
Yes
State
X ;
whether
No
administration
of
the
estate
is
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes ; No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes~; No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date:
I J" / '--f / 6 --v-
(
0'i
Sig
Na E. Slike, Esquire
I. . No. 06262
SAlOIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
Personal Representative
X Counsel for Personal
Representative
\ /6-02.3.;.J -//
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
Rc'(;-
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-25-2002
SIEMONS
05-01-2001
21 01-0507
CUMBERLAND
101
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
'02 f-\PR-1
P12 :48
*
REV-1547 EX AFP Ul-D2)
ETHEL
M
Allount Rellitted
PA 1 t;l.t;o,
\~~" \ ~_! ~
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 ~
RE-Y-=iStrj-ix--AFP--fol-:02i--Ncffici--oF-'rtiHiififANcE-TAX-APPRA-isii'-ENT~--AiLOWANCE-ifR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SIEMONS ETHEL M FILE NO. 21 01-0507 ACN 101 DATE 03-25-2002
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. Hortgages/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
ll)
(2)
(3)
(4)
(5)
(6)
(7)
160,900.00
296,091.19
.00
.00
211,422.40
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. 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)
llO)
20,609.31
5.095.88
lll)
ll2)
ll3)
ll4)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
668,413.59
25.705 19
642,708.40
.00
642,708.40
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. AIIount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
ll5) .00 X 00 = .00
ll6) 642,708.40 X 045 = 28,921.88
ll7) .00 X 12 = .00
(18) .00 X 15 = .00
ll9)= 28,921.88
. ft. ...."' . KI:\,;I:.Lrl n I+J
DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID
07-27-2001 CDOOO094 1,263.16 24,000.00
02-02-2002 CDOO0826 .00 3,658.72
TOTAL TAX CREDIT 28,921.88
BALANCE OF TAX DUE .00
INTEREST AND PEN. .60
TOTAL DUE .60
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
\ / b -c2..sc:l- / /
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 11128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESS KENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-l!;~8 EX iFP (01-02)
'Ul
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
: -j 7SSN/DC
ACN
09-16-2002
SIEMONS
05-01-2001
21 01-0507
CUMBERLAND
184-48-9669
01148285
Allount Rellitted
ETHEL
M
MARC J SIEMONS
300 FRONT ST
W FAIRVIEW
1 ti ; \
PA 170?5
f'""'l
, 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 ~
RE-Y=is4-i-EX--AFP--foi-:oii------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 09-16-2002
ESTATE OF SIEMONS
ETHEL
M DATE OF DEATH 05-01-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0507
TAX RETURN WAS:
S.S/D.C. NO. 184-48-9669
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01148285
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
87005700053713
TYPE OF ACCOUNT: (~SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-26-1993
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,999.96
0.500
999.98
.00
999.98
.15
150.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 09-24-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 150.00
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.78
TOTAL DUE 155.78
· IF PAID AFTER THIS DATE, 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. )
\. /6- eZ8r2 - II
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
# .
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
Recn':i~
.-:.
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
.03 JUL - 7 P 4 : 1 4
c,~
PAl 7'J.l ~ il. '.";
06-20-2003
SIEMONS
05-01-2001
21 01-0507
CUMBERLAND
101
Allount Rellitted
*
REY-1S'5 EX AFP 101-05)
ETHEL
M
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, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y =is93-i3f-iFP-foi-:031------..-iiftiEi.rfiNC-i-y"iri-iEcoiir-iij-USYirENy-..------------------------ -- ---
ESTATE OF SIEMONS
ETHEL
M FILE NO. 21 01- 0507
ACN 101
DATE
06-20-2003
ADJUST"ENT BASED ON:
VALUE OF ESTATE:
BOARD OF APPEALS REFUND
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adllinistrative Costs/
"iscellaneous Expenses (Schedule H)
Debts/"ortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governllental Bequests; Non-elected 9113 Trusts
Net Value of Estate Subject to Tax
10.
11.
12.
13.
14.
TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
160,900.00
296,091.19
.00
.00
210,422.42
.00
.00
(8)
667,413.61
25,705.19
641,708.42
.00
641,708.42
.00
28,876.88
.00
.00
28.876.87
. '" .......... "1;"'1;.....-. l"'J A"OUNT PAID
DATE N~BER INTEREST/PEN PAID (-)
07-27-2001 CDOOO094 1,263.16 24,000.00
02-02-2002 CDOO0826 .59- 3,658.72
TOTAL TAX CREDIT 28,921.29
BALANCE OF TAX DUE 44.42CR
INTEREST AND PEN. .00
TOTAL DUE 44.42CR
(9)
(10)
20,609.31
5,095.88
(1lJ
(12)
(13)
(14)
· IF PAID AFTER DATE INDICATED, SEE REVERSE (IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
(Schedule J)
(15)
(16)
(17J
(18)
.OOX 00 =
641,708.42X 045=
.OOX 12 =
.00 X 15 =
(19)
~
BOARD OF APPEALS
DEPT. 281021
HARRISBURG, PA 17128-1021
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
JOHN E SLlKE ESQ
SAIDIS SHUFF ET AL
2109 MARKET ST
CAMP HILL PA 17011
IN RE ESTATE OF:
ETHEL M SIEMONS
DOCKET NO. : 0223815
TAX TYPE: INHERITANCE
APPEAL TYPE REFUND
FILE NUMBER: 21 01-0507
ACN: 101
APPRAISEMENT: MARCH 25, 2002
PETITION FILED: OCTOBER 21, 2002
EXAMINER: WILLIAM J. ZDRADZINSKI
Direct Dial: (717) 787-5761
Fax: (717) 787-7270
Email: wzdradzins@state.pa.us
MAILING DATE: APRIL 28,2003
DECISION AND ORDER
On March 25, 2002, the Department issued an appraisement and assessment that
accepted the original inheritance tax return as filed. That return reported that Allfirst Bank
Savings Account #87005700053713 was solely owned by the decedent. Petitioner has
now established that account had been jointly owned by decedent and Marc John Siemons
for more than one year prior to decedent's death. Therefore, the taxable value of Allfirst
Bank Savings Account #87005700053713 should be reduced to $999.98 or one-half of its
date of death balance.
Accordingly, it is hereby, Ordered that the petition for refund is granted. The
Department is directed to reduce the taxable value of Allfirst Bank Savings Account
#87005700053713, reported as item 5 on Schedule E, to $999.98. It is further Ordered that
a refund be issued for any resulting overpayment, plus appropriate interest.
FOR THE BOARD OF APPEALS
JOSEPH R. SLEEK, MEMBER
Page 1 of 2
ETHEL M SIEMONS
BOARD DOCKET NO. 0223815
Page 2 of 2
ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE BOARD OF
FINANCE AND REVENUE, 1101 SOUTH FRONT ST., SUITE 400, HARRISBURG, PA
17104, WITHIN NINETY (90) DAYS OF THE MAILING DATE OF THIS DECISION.
TELEPHONE (717) 787-2974
A CASH REFUND CHECK WILL BE MAILED TO YOU BY THE BUREAU OF
INDIVIDUAL TAXES.
IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATE FORMAT UNDER THE
PROVISIONS OF AMERICANS WITH DISABILITIES ACT OF 1990, PLEASE CALL
(717) 783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL HEARING
AND SPEAKING NEEDS: 1-800-447-3020 (TT ONLY).
/ /~- ~<',,::./- / /
\
.~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-IU7 EX AFP COI-05>
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
.03 JUl 28
~TE
ESTATE OF
DATE OF DEATH
FILE NUMBER
f' 0 ~NTY
Ii.; ":"'~
ACN
07-07-2003
SIEMONS
05-01-2001
21 01-0507
CUMBERLAND
101
ETHEL
M
f1l;( ,
Allount Re.itted
C'~
PA 17011 CtTl;[;.;
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} subllit the upper portion of this for. with your tax pay.ant.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..
iifi=i6o-j-i1f-AFP--fcff:03-f------...--fNiiERITANc'E-TAX--STATEHE-riT-ifF-iCCOUify--.-..---------------------
ESTATE OF SIEMONS ETHEL M FILE NO.21 01-0507 ACN 101 DATE 07-07-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE} APPLICATION OF ALL PAYMENTS} THE CURRENT BALANCE} AND} IF APPLICABLE}
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-19-2003
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
28}876.87
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-27-2001 CDOOO094 1}263.16 24}000.00
02-02-2002 CDOO0826 .59- 3}658.72
06-23-2003 REFUND .00 44.42-
TOTAL TAX CREDIT 28}876.87
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE} SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1}
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CRJ}
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
ot DATE
'J )ills ESTATE OF
- DATE OF DEATH
FILE NUMBER
COUNTY
.04 FEB 25 ;~ 8 :29 SSN/DC
ACN
*
/'
BU~\U OF INDIVIDUAL TAXES
INh 'lANCE lAX ~iVISION.
DEP' 280601
HA 'BURGI PA 17128-0601
REY-I604 EX AFP (01-03)
Ct..irlC'3~,3n;j
Court
Co., PA
12-30-2003
SIEMONS
05-01-2001
21 01-0507
CUMBERLAND
184-48-9669
01148285
Allount Rellitted
ETHEL M
MARC J SIEMONS
300 FRONT ST
W FAIRVIEW
P A l~9~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (01-03)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 12-30-2003
ESTATE OF SIEMONS
ETHEL
M DATE OF DEATH 05-01-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0507
ADJUSTMENT BASED ON:
S.S/D.C. NO. 184-48-9669
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
01148285
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO. 87005700053713
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 03-26-1993
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT. SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS. AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
cj/
· IF PAID AFTER THIS DATE, 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 HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 E) .3-88) --
; .*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
INHERITANCE TAX
EXPLANATION
OF CHANGES
Siemons, Ethel M
FILE NUMBER
Steven James
ACN
21 01-0507
01148285
REVIEWED BY
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
The above referenced ACN has been adjusted to $0 as it was reported and paid on the
probate return.
ROW
Paqe 1