HomeMy WebLinkAbout02-0336PETITION FOR PROBATE and GRANT OF LETTERS
Estate of -Poro't'-f~¥t (~, Cie
No.
also known as To:
Social Security No.
· Deceased.
..9.1-0.9._- ,3,~c~
Register of Wills for the
County of C ~ ~1o e c- ~o ad_
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner~, who is/ar~-18 years of age or older arc'the executor-
in the last will of the above decedent, dated
and-.codie.~oj-dated-
in the
0 TI
named
,19q7
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C_,, t~ ~ ~ cia a ok County, Pennsylvania, with
her- last family or principal residence at C_h~,-~ ~ 6 ~d ~e $,'~em~aT
(list street, number and muncipality) - C~ ~ I t S t~ ~ ~ ~L~ ~
Decendent, the~.. ~ ~ y~ars of age, died ~a cc ~ ~ ~ ~ ~ ~ ~
at ~ ~~~ ~~ '
Except as follows, decedent did not marry, was not ~vorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~ o~ ~
Decendent at deatl~ 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¢~ respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters '-{-~5 ~,~ m ~ ~,'-t ,x ~
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
200
Sworn to or affirmed and subscribed
be[ol;e-~aet_~t~l_~, this _ ~u~ day of
~Y C L~S ~ --ffegister
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA '~
COUNTY OF C--~O~~ MT~ f ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct ~o the best of t~.e knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the adore decedent petitioner(s) will well and truly administer the estate according to law.
No. ,2)_/- o..~-~33~o
Estate of DOROTHY
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW APRIL3, 2002 ~:2g~_~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dater MAY21, 1997
described therein be admitted to probate and filed of record as the last will of DOROTHY M CLEPPER
and Letters TEST~ARY
DAREI,I, E CLEPPER
are hereby granted to
FEES
Probate, Letters, Etc .......... $ 270.00
Short Certificates(/~ .......... $ 30.00
xxx ~ .e..xg.r.a...~a.g.e.s... $ 9.00
~'-c? ~ $. 5'7.00
TOTAL __ $ 314.00
Filed ...4-3-2002 .......................
called attorney on 4-3-02
ADDRESS
PHONE
21-02-336
WILL
I, DOROTHY M. CLEPPER, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM ONE: I direct that all my debts and funeral expenses,
including my gravemarker shall be paid from my residuary estate as
soon as practicable after my decease as a part of the expense of
the administration of my estate.
iTEM TWO: i, give, devise and bequeath my entire estate to my
husband, GEORGE D. CLEPPER, if he survives me by 60 days. In the
event that he predeceases me or is not then living on the 61st day
after my death, then I give, devise and bequeath my entire estate
as follows:
One-half (1/2) of my estate to my son, DARRELL E. CLEPPER, per
stirpes.
He
One-half (1/2) of my estate to my son, FREDERICK M. CLEPPER,
per stirpes.
ITEM THREE: I appoint my husband, GEORGE D. CLEPPER, Executor of
this my last will. Should he fail to qualify or cease to act as
Executor, I appoint my son, DARRELL E. CLEPPER, to act as Executor
with the same rights, powers and duties.
ITEM FOUR: Ail estate, inheritance, succession and other taxes,
imposed or payable by reason of my death, and interest and
penalties thereon, with respect to all property comprising my gross
estate for tax purposes, whether or not such property passes under
this will, shall be paid out of the principal of my residuary
estate, without apportionment or right of reimbursement.
ITEM FIVE: I direct that my personal representative or guardian
shall not be required to give bond for the faithful performance of
their duties in any jurisdiction.
PAGE ONE OF FOUR PAGES
ITEM SIX: In addition to the rights and powers given to the
fiduciaries by law or elsewhere in this will, I give to my Executor
during the full time necessary and for the administration of my
estate the following rights and powers to be exercised in his sole
discretion.
ao
To retain any real or personal property which may at any time
form a part of my estate so long as he or she deems it
advisable.
Be
To invest in any real or personal
restrictions to legal investments.
property without
To repair, alter, improve or lease for any period of time any
real or personal property and to give options for leases.
To sell at public or private sale, for cash or credit, with or
without security, to exchange or to partition real or personal
property, an to give options for leases.
E. To make distribution in kind.
F. To compromise claims.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~ day of
DOROTHY PI. CLEPPER
The preceding instrument, consisting of this and three other
typewritten pages, each identified by the signature of the
Testatrix was on the day and date thereof signed, published and
declared by the Testatrix therein named as and for her last will,
in the presence of us, who at her request, in her presence and in
the presence of each other hav~es.
PAGE TWO OF FOUR PAGES
CONSqONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
witnesses' who~ n~m~ ale signed to the attached or foregoing
instrument being duly qualified according to law, do depose and say
that we were present and saw the Testatrix sign and execute the
instrument as her last will; that she signed willingly and executed
it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the
Testatrix signed the will as witnesses; and that to the best of our
knowledge, the Testatrix was at the time 18 or more years of age,
of sound mind and under no constr~~_ue influence.
Sworn and subscribed to
before me this ~2 day
~~ , 1997.
of
--'
PAGE THREE OF FOUR PAGES
COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
I, DOROTHY M. CLEPPER, whose name is signed to the attached
instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my last
will; that I signed it as my free and voluntary act for the
purposes therein expressed.
DOROTHY M/ CLEPPER ' '
Sworn and subscribed to and acknowledged before me this .~/ day
of /~ , 1997.
' Notary Pubic
PAGE FOUR OF FOUR PAGES
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
Dorothy M. Clepper
March 23, 2002
Admin. No.:
21-02-00336
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
q-lo- o'~- ·
Name Address
Darrell E. Clepper
Frederick M. Clepper
800 Redwood Drive, Carlisle, PA 17013
13421 Del Prado Drive South, Largo, FL 33774-5404
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none
Date:
John H. Broujos, Esquire #06268
4 North Hanover Street
Carlisle, PA 17013
(717) 243-4574
Capacity:
__ Personal Representative
X Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
001322
JOHN BROUJOS ESQUIRE
4 NORTH HANOVER STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 200-22-5436
FILE NUMBER: 2102-0336
DECEDENT NAME: CLEPPER DOROTHY M
DATE OF PAYMENT: 06/21/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/23/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $9,700.00
REMARKS:
TOTAL AMOUNT PAID:
JOHN BROUJOS ESQUIRE
$9,700.00
SEAL
CHECK# 100
INITIALS: JA
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
REV-lSOO EX'~ (6-00)
I-
Z
ILl
I.U
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
CLEPPER, DOROTHY, M.
DATE OF DEATH (MM-DD-Year)
03/23/2002
"'oRI
~ ~ ~ I r~6. Decedent Died Testate (Attach copy of W~,,)
REV-1500
INHERITANCE TAX RETURN
RESlBENT BECEBENT
DATE OF BIRTH (MM-DD-Year)
04/14/1918
OFFICIAL USE ONLY
17- -I
File NUMBER .......
2 1 -0 2 0 0 3 3 6
COUNTY CODE YEAR -- -- NUMBER--
SOCIALSECURITYNUMBER
2 0 0-2 2-5 4 3 6
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. Original Retum
r--~ 4. Limited Estate
Z
LU
Z
0
UJ
0
Z
Z
E~]9. Litigation Proceeds Received
~"-] 2, Supplemental Return
[-'1 4a, Future Interest Compromise (dateofdeath a~ter 12-12-82) .
---]7, Decedent Maintained a Living Trust (Ntach copyofTrust)
O 10, Spousal Poverty Credit (date of death ~n 12.31-91 and1-1-95)
r"-i 3. Remainder Return (dateofdeathpfiorto 12-13-82)
'--]5, Federal Estate Tax Retum Required
1__ 8. Total Number of Safe Deposit Boxes
r~ 11, Election to tax under Sec. 9113(A) (Attach Sch O)
THIS SECTION MUST BE COMPL~ tl=D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
JOHN H. BROUJOS, ESQUIRE
FIRM NAME (If Applicable)
BROUJOS & GILROY, P.C.
TELEPHONE NUMBER
717-243-4574
COMPLETE MAILING ADDRESS
4 NORTH HANOVER STREET
CARLISLE ~ PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnemhip or Sole-Pmpdetorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash. Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
'--] 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/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
238,468.89
OFFICIAL USE ONLY
(8)
238,468.89
11,310.00
(11)
11,310.00
227,158.89
(12)
(13)
(14)
227,158.89
SEE INSTRUCTIONS ON REVERSE SIDE 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
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x ~ (15)
227,158.89 x .045 (16)
x .12 (17)
x .15 (18)
(19)
> > BE SURE TO ANSWER AlL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
10,222.15
10,222.15
Decedent's Complete Address:
STREET ADDRESS
Church of God Home
801 North Hanover Street
CITY
Carlisle I STATE PA z~P 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
9,700.0Q
485.00
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B, Enter the total of Line 5 + EA. This is the BALANCE DUE, (EB)
Make Check Payable to: REGISTER OF WILLS, AGENT
"X" i~N THE
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN
APPROPRIATE
BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
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? ....................................................................................................... [] []
10,222.15
10t 185.00
37.15
37.15
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 perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my know~edge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~ OF PERSON RESPONSIBLE FOR FILING RETURN
'ADDRESS 800 Redwood [~rrve
C~.rlisle
SIGNATURE OF PREPARER OT, Jd,ER THAN R~--PI~SENTATIVE
ADDRESS 4 N. ~nover Street -
Carli~l~
DATE
12/23/2002
PA 17013
DATE
12/23/2002
PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not 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)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV*1508 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
CLEPPER. DOROTHY, M, 21 02 00336
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Members 1st FCU savings acct # 14886 2,136.44
10.
11.
12.
13.
14.
15.
16.
Orrstown Bank, Certificate of Deposit # 5080058899 - $10,391.12
Orrstown Bank, Certificate of Deposit # 5080062829 - $10,131.10
PNC Bank checking acct # 51-4039-9335
PNC Bank, Ready Access CD # 21001052237
PNC Bank, Certificate of Deposit # 31400198436
PNC Bank, Certificate of Deposit # 21001051620
PNC Bank, Certificate of Deposit # 31600087980
PNC Bank, Certificate of Deposit # 31300189497
PNC Bank, Certificate of Deposit # 31400049534
PNC Bank, Certificate of Deposit # 21001051854
PNC Bank, Certificate of Deposit # 3150020438
PNC Bank, Certificate of Deposit # 21001051644
PNC Bank, Certificate of Deposit # 31800206049
Refund of equity from Church of God Home - $22,000.00
Misc. refund from Church of God Home - $7.54
Household furniture (appraisal attached) - $1,008.00
Refund of pre-paid funeral expenses - $53.86
Refund of premium for homeowners insurance - $2.00
Cash from safe deposit box - $20.00
Cash from room at Church of God Home - $88.07
TOTAL (Also enter on line 5, Recapitulation)
20,522.22
50,352.77
50,784.94
10,369.18
10,272.30
10,252.25
10,236.78
10,194.48
10,058.45
10,055.80
10,033.79
10,020.02
22,007.54
1,061.86
_110.07
238,468.89
(If more space is needed, insert additional sheets of the same size)
Personal Property: Estate of Dorothy M. Clepper
Item Description Value
I Kitchen Items $25.00
2 Bathroom Items $5.00
3 ~Jewelry $20.00
/
4 rJiamond Ring $250.00
5 iCIothes $50.00
6 Desk $75.00
7 Table with 2 chairs $30.00
8 End Table $5.00
9 Sofa $75.00
10 Wing Back Chair $35.00
11 Orange Swivel Chair $25.00
12 Green Swivel Chair $35.00
13 TV Console $50.00
14 Octagional Compote $25.00
15 Table Lamp $5.00
16 Table Lamp $5.00
17 Floor Lamp $10.00
18 Caned Chair $50.00
19 Caned Chair $50.00
20 Wall Clock $5.00,
21 Headboard and bed frame $15.00
22 Mattress and Box Spring $50.00
23 Dresser $25.00
24 Dresser $25.00
25 Microwave Cart $10.00
26 Microwave $25.00
/I I"1 IUl IIC OLallU ~,.~, UU
28 Night Stand $5.00
29 Foot Stool $2.00
30 Foot Stool $2.00
31 Magazine Rack $2.00
32 :~icture: Outdoor Scene $10.00
33 Picture: Horses $2.00
Total: $1,008.00
REV-1511EX + (,-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
CLEPPER. DOROTHY, M,
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 02
00336
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Westminster Cemetery - marble base for grave marker 804.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
C~y State
Year(s) Commission Paid:
Attorney Fees Broujos & Gilroy, P.C.; EIN 23-2267691
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
city
Relationship of Claimant to Decedent
Probate Fees - Register of Wills
Accountant% Fees
Tax Return Preparer's Fees
Inventory - Register of Wills
Inheritance Tax Return - Register of Wills
Family Settlement Agreement - Register of Wills
State Zip
0.00
10,000.00
0.00
314.00
150.00
10.00
15.00
17.00
TOTAL (Also enter on line 9, Recapitulation) $ 11,310.00
(If more space is needed, insed additional sheets of the same size)
REV-1513 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
CLEPPE ~. DOROTHY. M,
NUMBER
I.
1.
2.
II.
1.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Darrell E. Clepper
800 Redwood Drive
Carlisle ~ F~
Frederick M. Clepper
13421 Del Prado Drive South
Largo, FL 33774-5404
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINEI
FILE NUMBER
21 02 OO336
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
son
son
1/2
1/2
15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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)
2.
3.
4.
5.
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
Dorothy M. Clepper, deceased
File No.: 21-02-00336
Date of Death: March 23, 2002
Members 1st FCU savings acct # 14886
Orrstown Bank, Certificate of Deposit # 5080058899
Orrstown Bank, Certificate of Deposit # 5080062829
PNC Bank checking acct # 51-4039-9335
PNC Bank, Ready Access CD # 21001052237
6. PNC Bank, CD # 31400198436
7. PNC Bank, CD # 21001051620
8. PNC Bank, CD # 31600087980
9. PNC Bank, CD # 31300189497
10. PNC Bank, CD # 31400049534
$ 2,136.44
10,391.12
10,131.10
50,352.77
50,784.94
10,369.18
10,272.30
10,252.25
10,236.78
10,194.48
11. PNC Bank, CD # 21001051854
12. PNC Bank, CD # 31500020438
13. PNC Bank, CD # 21001051644
14. PNC Bank, CD # 31800206049
15. Refund of equity from Church of God Home
10,058.45
10,055.80
10,033.79
10,020.02
22,000.00
16. Miscellaneous refund from Church of God Home
17. Refund of premium for homeowners insurance
18. Cash from safe deposit box
19. Cash from room at Church of God Home
20. Refund of pre-paid funeral expenses
21. Household furniture (appraised value)
7.54
2.00
20.00
88.07
53.86
1,008.00
Total
238,468.89
Darrell E. Clepper, Executor of the Estate of Dorothy M. Clepper, late of Carlisle, Cumberland
County, Pennsylvania, states that the within is an inventory made by Darrell E. Clepper as the
Executor of the entire estate of decedent, consisting of all the personal property and real estate,
except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each
item of the Inventory represent its fair value as of the date ofdecedent's death.
~)arrell E. Clepper, Executor
Date: December 23, 2002
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
001981
BROUJOS JOHN H ESQUIRE
4 NORTH HANOVER STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 200-22-5436
FILE NUMBER: 2102-0336
DECEDENT NAME: CLEPPER DOROTHY M
DATE OF PAYMENT: 12/23/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/23/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $37.15
TOTAL AMOUNT PAID:
$37.15
REMARKS: DARRELL E CLEPPER
C/O JOHN H BROUJOS ESQUIRE
SEAL
CHECK# 1 O7
INITIALS' CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
/NHERITANCE TAX DZ¥/SZON
DEPT. 180601
HARRISBURG, PA 17118-0601
JOHN H BROUJOS ESQ
BROUJOS & GILROY
q N HANOVER ST
CARLISLE
COHHON#EALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RE¥-IE4? EX kFP (01-0S)
PA 17013-q602
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
02-10-2005
CLEPPER
05-25-Z001
11 02-05:56
CUHBERLAND
101
Amount Remitted
DOROTHY H
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF NTLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS -.~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CLEPPER DOROTHY H FILE NO. 21 02-0:5:56 ACN 101 DATE 02-10-200:5
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Receivable (ScheduZe D) (q)
E. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities~Liens (Schedule Z) (10)
11. Total Deductions
12. Net Value of Tax Return
15.
Charitable/Governeental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
2:58~68.89
.00
.00 NOTE: To insure proper
.00 credit to your account,
.00 submit the upper portion
.00 of this form with your
tax payment.
.O0
(8)
11,:510.00
.00
NOTE:
Z:58,q68.89
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULAT/ON OF ADDITIONAL INTEREST.
ASSESSHENT OF TAX:
1.;. Amount of Line 1~ at Spousal rate
16. Amount of Line 1~ taxable at Lineal/Class A rate
17. Amount of Line lq at Sibling rate
18. Amount of Line lq taxable et Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+J
DATE NUMBER TNTEREST/PEN PAID (-)
06-21-2002 CDO 01:522 510.5:5
12-2:5-2002 CD001981 .00
(1.6) .00 X O0 = .00
(16) 227,158.89 x Oq5= 10,222.15
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 10,222.15
AMOUNT PAID
9,700.00
:57.15
reflect figures that include the total of ALL returns assessed to date.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
10,2q7.68
25.5:5CR
.00
25.53CR
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
If an assessment .as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill
(11) 11.310,00
(12) 227,158.89
(15) . O0
(1~.) 227,158.89
BUREAU OF ZNDTVZDUAL TAXES
TNH£RTTANCE TAX DTVTSZON
DEPT. 180601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ZNHERZTANGE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (01-05)
JOHN H BROUJOS ESQ
BROUJOS & GILROY
q N HANOVER ST
CARLISLE
Reco'~:;:.' ~;.~: ;3i DATE 05-05-2005
Ret. F~ ~iilS ESTATE OF CLEPPER
DATE OF DEATH 05-Z$-2002
FILE NUMBER 21 02-0536
'03 JUN -2 H1 :I~OUNTY CUMBERLAND
ACN 101
Aeoun'~ ReeL,*ed
DOROTHY M
PA 17o:]C~tlmb~ia~ {~ ~;~::)., i:::A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit: ~o your account, subei~ ~he upper portion of ~his fore wi~h your ~:ax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) ~#a INHERITANCE TAX STATEMENT OF ACCOUNT aa~
ESTATE OF CLEPPER DOROTHY M FILE NO. 21 02-03:56 ACN 101 DATE 05-05-2003
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHOWN BELOW
ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS., THE CURRENT BALANCE, AND., ZF APPLICABLE,
A PROdECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-10-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
10,222.15
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
510.53
06-21-2002
12-25-2001
Oq-Zl-ZO03
CD001322
CD001981
REFUND
.00
.00
9,700.00
37.15
25.53-
ZF PAZD AFTER THIS DATE, SEE REVERSE
SZDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT 10,222.15
BALANCE OF TAX DUE .00
ZNTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
Family Settlement Agreement
File No. 21-02-0336
THIS is an agreement entered into this ~'t~'~day of .~¢~xS 'F , 2003, by and between
Darrell E. Clepper, Executor and Beneficiary under the E~'tate of Dorothy M. Clepper, of 800
Redwood Drive, Carlisle, PA 17013, and Frederick M. Clepper of 13421 Del Prado Drive South,
Largo, FL 33774-5404, Beneficiary, whose names are set forth as signatories at the end of this
Agreement.
WHEREAS:
A. Dorothy M. Clepper, of Church of God Home, 801 N. Hanover Street, Carlisle, PA
17013, died on March 23, 2002.
B. On April 3, 2002, Letters Testamentary were granted to Darrell E. Clepper at File No. 21-
02-0336 in the Register of Wills Office for Cumberland County, Pennsylvania.
C. Executor has administered the Estate of Dorothy M. Clepper up until the present time and
has paid all debts of the estate, including Inheritance Tax owed.
D. Dorothy M. Clepper died testate, thereby vesting all rights and interest in her personal
property to her two sons, Darrell E. Clepper and Frederick M. Clepper.
E. Estate of Dorothy M. Clepper has received assets as set forth in Exhibit A attached hereto
and made a part hereof and has paid debts and expenses as set forth in Exhibit B attached hereto
and made a part hereof.
F. There remains to be distributed to beneficiaries the assets set forth in the Schedule of
Distribution in Exhibit C attached hereto and made a part hereof.
G. Executor and Beneficiaries desire to forego a formal accounting and schedule of
distribution and desire to conclude the estate by virtue of the filing of this document.
NOW, THEREFORE, Executor and Beneficiaries intending to be legally bound, state as follows:
1. The Executor and Beneficiaries agree that the Executor of the Estate of Dorothy M.
Clepper need not file a formal accounting or schedule of distribution.
2. Executor states that all costs of the estate are paid.
3. Beneficiaries agree that the final distribution of all estate assets remaining after payment
of debts and expenses shall be made to the Beneficiaries.
4. The parties acknowledge that any distribution made by Executor pursuant to this
Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release
Executor with respect to acts or omissions in the administration and distribution of the estate and
hereby agree to return such funds as were distributed under the administration of the estate as
may be required for the payment of any proper claims not discharged prior to this distribution.
5. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
6. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Dorothy M. Clepper, subject to the provisions
hereof.
IN WITNESS WHEREOF, Executor and Beneficiaries, intending to be legally bound hereby set
their hands and seals the day and year first above written.
WITNESS:
D'a-rrell E. Clepper, Executor & Beneficiary
Frederick M. Cleppei~, Beneficiary
EXHIBIT A
ASSETS and INCOME
ASSETS
2.
3.
4.
5.
Members 1st FCU savings acct # 14886
Orrstown Bank, Certificate of Deposit # 5080058899
Orrstown Bank, Certificate of Deposit # 5080062829
PNC Bank checking acct # 51-4039-9335
PNC Bank, Ready Access CD # 21001052237
6. PNC Bank,
7. PNC Bank,
8. PNC Bank,
9. PNC Bank,
10. PNC Bank,
CD# 31400198436
CD# 21001051620
CD# 31600087980
CD# 31300189497
CD# 31400049534
11. PNCBank, CD#21001051854
12. PNCBank, CD#31500020438
13. PNC Bank, CD # 21001051644
14. PNC Bank, CD# 31800206049
15. Refund ofequityfromChurch of God Home
16. Miscellaneous refund from Church of God Home
17. Refund of premium for homeowners insurance
18. Cash from safe deposit box
19. Cash from room at Church of God Home
20. Refund of pre-paid funeral expenses
21. Household furniture
TOTAL ASSETS
INCOME
Interest earned on 20rrstown Bank CDs when redeemed 4/18/02
Interest received on Orrstown Bank CD 4/15/02
Interest earned on savings account
Interest earned on estate checking account
Interest earned on estate money market account
Burial allowance from Cumberland County Veterans Affairs
TOTAL INCOME
$ 2,136.44
10,000.00
10,000.00
50,352.77
50,784.94
10,369.18
10,272.30
10,252.25
10,236.78
10,194.48
10,058.45
10,055.80
10,033.79
10,020.02
22,000.00
7.54
2.00
20.00
88.07
53.86
1,008.00
237,946.67
151.32
415.00
4.89
43.14
2,906.71
100.00
$ 3,621.06
TOTAL ASSETS AND INCOME $ 241,567.73
EXHIBIT B - EXPENSES
1. Westminster Cemetery - marble base for grave marker
2. Broujos & Gilroy, P.C. - attorney fees
3. Register of Wills - probate fees
4. Register of Wills - Inventory filing fee
5. Register of Wills - Inheritance Tax Return
6. Register of Wills - Family Settlement Statement
7. Rotz & Stonesifer - tax preparer's fee for 2003 personal income tax and
federal and state fiduciary returns
Subtotal
Inheritance Tax ($10,222.15 less $510.53 discount)
TOTAL EXPENSES
804.00
10,000.00
314.00
10.00
15.00
17.00
525.00
11,685.00
9,711.62
$21,396.62
EXHIBIT C - DISTRIBUTION
Assets
Income
Expenditures
Balance
Advance Distributions:
Darrell E. Clepper (10/14/02)
Frederick M. Clepper (9/19/02)
$ 80,000.00
80,000.00
Balance for Distribution
$ 237,946.67
3,621.06
241,567.73
- 21,396.62
$ 220,171.11
- 160,000.00
$ 60,171.11
Checkbook Balance
64,426.42
Final Bills
Register of Wills - filing fee for Family Settlement Agreement
Broujos & Gilroy, P.C. - legal fees
Total
$ 17.00
5,000.00
-5,017.00
Balance for final distribution
Darrell E. Clepper
Frederick M. Clepper
Checkbook Balance
$ 29,704.71
29,704.71
$ 59,409.42
-0-
NOTE: When 2002 federal income tax refund of $266 is received by Executor, he will send
$133 to Frederick M. Clepper.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Dorothy M. Clepper
Date of Death: 3-23-02
Will No. Admin. No. 21-02-00336
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:
State whether administration of the estate is complete:
Yes X No
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
Date:
o
If the answer to No. 1 is Yes, state the following:
mo
Did the personal representative file a final account/statement with the
Court? Yes No X
bo
The separate Orphans' Court No. (if any) for the personal representative's
account is:
Did the personal representative state an account informally to the parties
in interest? Yes X No
do
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be
attached to this report.
S ~g~iature ~ /
Capacity:
Darrell E. Clepper
800 Redwood Drive
Carlisle, PA 17013
243-3087
X Personal Representative
Counsel for Personal
Representative