HomeMy WebLinkAbout03-05-14 (3) REV-1500 1505610143
PA Department of Revenue OFFICIAL USE ONLY
p pennSylVanla County Code Year File Number
Bureau of Individual Taxes . DEVnRTMENT Or REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 2 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT I J 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 09 2013 09 26 1926
Decedent's Last Name Suffix Decedent's First Name MI
GOUGER CHARLES P
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 12-13-82)
4.'Limited Estate ❑ qa,Future Interest Compromise 5. Federal Estate Tax Return Required
(date df death after 12.12-82)
g Decedent Died Testate 7, Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
® (Attach Copy of will) ❑ (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
TERRENCE J KERWIN 717 362 3 ,215
r .
CCD
REGISTER OF USE O%Y C
;, I 6�:�i i'T
CJ'i
First Line of Address
4245 STATE ROUTE 209
Second Line of Address
'. (n
City or Post Office State ZIP Code DATE FILED
E ;IZABETHVILLE RA 17023
Correspondent's e-mail address: tjk @kerwinlawfirm.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge 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.
SIG AT E OF P RSON RESPONSI L OR FILING RETURN DATE
7 Kathy Hunter
D ESS
120 Sout 15th Street, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
Terrence J Kerwin 3 Mal I
ADDRESS
Kerwin & Ke rn, LLP
4245 State Route 209, Elizabethville, PA 17023
Side 1
1505610143 1505610143
ADDITIONAL Personal Representatives
Gouger, Charles P. SS# 6/9/2013
Under penalties of perjury, the undersigned declare that they have examined this return,
including accompanying schedules and statements, and to the best of their knowledge and
belief, it is true, correct and complete.
ZSignature
Name Mary-G. eidel
Address P.O. Box 1230
City,State,Zip Silverthorne CO -&GM 8o '{9
Date
3 Signature
Name
Address
City,State,Zip
Date
4 Signature
Name
Address:
City,State,Zip
Date
5 Signature
Name
Address:
City, State,Zip
Date
6 Signature
Name
Address:
City, State,Zip
Date
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: GOUGER, CHARLES P.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 223 , 594 . 04
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 301 , 5 6 9 12
(Schedule G) ❑ Separate Billing Requested............. 7•
8, Total Gross Assets(total Lines 1 through 7).......................................................... 8, 525 , 1 6 3 16
.
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 23 , 580 01
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10.
.
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 23 , 580 01
12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12.
501 , 583 . 15
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14.
501 , 583 . 15
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X .00 15.
16. Amount of Line 14 taxable 501 , 5 8 3 . 15 16. 22 , 5 7 1 . 24
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE................................................................................................................... 19. 22 , 5 7 1 24
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21
Decedent's Complete Address:
DECEDENT'S NAME
Gouger, Charles P.
STREET ADDRESS
100 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 22,571.24
2. Credits/Payments
A. Prior Payments 19,000.00
B. Discount 1,000.00
Total Credits(A +B) (2) 20,000.00
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 2,571 .24
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ❑ ❑
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑
c. retain a reversionary interest;or.................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ ❑x
2. If death occurred after Dec. 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?......... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... 0 ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[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 percent
[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 retturn 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 21 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 percent[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 percent,except as noted in
[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 percent[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,w§ether t y bloo or adoption.
pennsylvania SCHEDULE E
DEPARTMENT NCETA RETURN CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN �
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Gouger, Charles P. 21
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 M &T Bank Power Checking Account#9843136947 9,713.95
2 Metro Bank Checking Account#0513109843 11,639.64
3 Metro Bank Savings Account#7760450559 200,757.95
4 Refund -Alert Pharmacy Services 76.29
5 Miscellaneous Refunds 1,306.21
6 Refund - Malpezzi Funeral Home 100.00
III
TOTAL(Also enter on Line 5, Recapitulation) 223,594.04
REV-1510 EX+(08-09)
pennsylvania �±
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Gouger, Charles P. FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate.
1 Janney Montgomery Scott Investment Account 146,504.36 146,504.36
#7122-2984. Transfer on death to decedent's five
children (listed on Schedule J).
2 M &T Bank Retirement Account#35004200893798. 155,064.76 155,064.76
Beneficiaries: Five children listed on Schedule J
TOTAL(Also enter on line 7, Recapitulation) 301,569.12
REV-1511 EX+(10-09)
pennsylvania �SCHEDULE HC�+
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADNNISTRAIT/E COSTS
FW111�� h71 IV�111YG FILE NUMBER
ESTATE OF Gouger, Charles P. 21
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Malpezzi Funeral Home 1,852.84
2 American Legion - luncheon 988.25
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid 2014
2. Attorney's Fees Kerwin & Kerwin, LLP--Terrence J. Kerwin 7,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 458.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Feeman, Mesics& Hopstetter-Oath of Subscribing Witness fee 45.00
See attached 12,735.42
TOTAL(Also enter on line 9, Recapitulation) 23,580.01
Schedule H
Funeral Expenses&
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN AdminlsiImM Coslb c onilnued
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Gouger, Charles P. 21
2 The Sentinel - Estate Notice 253.26
3 Cumberland Law Journal - Estate Notice 75.00
4 Messiah Lifeways-final invoice 12,268.05
5 Messiah Lifeways-2013 Medicare Part B deductible 104.11
6 Postage, copies 10.00
7 Register of Wills-filing of Releases 25.00
i
Page 2 of Schedule H
REV-1613 EX+(01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Gouger, Charles P.
21
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Kathy G. Hunter Daughter 1/5
120 South 15th Street
Camp Hill, PA 17011
2 Mary G. Seidel Daughter 1/5
P.O. Box 1230
Silverthorne, CO 80948
3 David J. Ludwig Son 1/5
413 Deertrack Trail Lane
New Bloomfield, PA 17068
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV-1513 EX+(01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gouger, Charles P. 21
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Joyce Gouger Daughter 1/5
5431 Springtide Drive
Harrisburg, PA 17111
5 Jane Hartman Daughter 1/5
127 South 15th Street
Camp Hill, PA 17011
Note: Spouse, Jane R. Gouger, predeceased
on January 17, 2012. Items specifically
bequeathed in decedent's Will were given away
prior to decedent's death and were no longer in
his possession, as he was in a long-term care
facility at time of death.
Page 2 of Schedule J
ill MIAMI
AGC4UN ..ERI.O.D....... ..... ........PAGE.. .............
9843136947 POWER CHECKING MAY.29-JUN.28,2013 1 OF 1
00 0 06117H NM 017
000003718 FIOS1549D01706281306 07 000000 68473
f CHARLES P GOUGER
JANE R GOUGER
C/O MARY G SEIDEL
223 NORTH 5TH ST
HALIFAX PA 17032
INTEREST EARNED FOR STATEMENT PERIOD 0.08 MECHANICSBURG
INTEREST PAID YEAR TO DATE 0.48
ACCOUNT SUMMARY
P.OS .;:;- :;;;>.�>••::i_:::;:.=r::',•'iii::>::;i:;";>:<zs;::.; =:::°S:ti<.:;;::> :: H >
<>;;:
THE--.- 'ODtT
Net RACTYONS::; .ES =: i:::: ' L•
BALANCE............. .. H k A N K
N0. AMOUNT NO. AMOUNT N0. AMOUNT
9,713.86 ol 0.00 1 ol 0.00 1 0 1 0.08 9,713.94 k
ACCOUNT ACTIVITY
P INC. T :< T
T:::><:> K :::
::: :::•<s:::s:::::::::>:;> ::»:;:::>::s s::>:::;:>:::;>:>::;:;: : : <»:: :>;: ;;:::;:: N EKES
:i. ... .. :o:-:;:<•:.. ..... .. `
DATE:::•.• :::....: :..:::._:. :::•::T ANSACTYONibESCRYt!T:YO :::::;:;: z?: ::= ;;:; S,.i3THER.ADbITI :;:- SiIBTRACTYONS:, $ALANCEi:;:::;i=:
05-29-13 BEGINNING BALANCE 09,713.86
06-28-13 INTEREST PAYMENT 0.08 9,713.94
ENDING BALANCE $9,713.94
N
Q
ANNUAL PERCENTAGE YIELD EARNED = 0.00 2
MANAGE YOUR BANK ACCOUNTS AT YOUR CONVENIENCE WITH MAT MOBILE BANKING.
USE YOUR MOBILE DEVICEN TO CHECK ACCOUNT BALANCES, VIEW RECENT TRANSACTIONS, PAY
BILLS, TRANSFER FUNDS BETWEEN ACCOUNTS, REVIEW ALERTS ACTIVITY, OR LOCATE A
NEARBY HAT BRANCH OR ATM.
8 TO LEARN MORE VISIT MTB.COM/MOBILE. TO GET STARTED, GO TO HTB.COM ON YOUR MOBILE
DEVICE AND USE YOUR WEB BANKING ID AND PASSCODE TO LOG IN.
MYOUR MOBILE CARRIER'S TEXT MESSAGING AND DATA CHARGES MAY APPLY.
MEMBER FDIC.
LODE(8/17)
® Metro Bank
3801 Paxson Street
METRHarrisburg PA 17111-1418
BANKmy8m8etrobnk°oom
>00714 3425975 001 092140
CHARLES P GOUGER .
223 N 5TH ST
HALIFAX PA 17032
We're here 7 days a week,24 hours a day at 1.888.937-0004.
„
e=
50 PLUS CHECKING 0513109843
►�Q
-te
�a� -�,xc'z.,-�,ti1 u}'.'i,e2 ''°'°'',Lti":-i'�s:.e _t:r »�'r!�•aezy�,q'ri�.c�'l�:iT7 e{':Sr"';5-'n-t4�-1�--'.-Fg,�n..F `t�=^�'~� '� }
• -sip.$=?G: r.: :^ cs^' `
^ �5� 6'��,jr '.,. "= iy. .t',,.;'._...4:bA'^'i' _ _,E•✓"2.
�� Ra'_ iti:i'1• M.� _ -3 `M-_ S•Ta'YTV ..'��lJ'�J�(^'•'•"•t!^a�'.�.� .'�i t-�iF. �-M• O Y.Wya_�' ,_�J.t t.
',�i'--tee .G 'A'Y •^
-.x�'2 ai•� e �� \ �srn c'c � S .?..1�`'7°' __s;.84
jt{�Qany+ r•{L.9. �:����t
:L �•' 1_^'C -„,_. 1-_ ti. irr,� 3o ty:.�n ..mac '.••�:.f z'�•X3i F c. .`Z ?ak - '.gF?•-� _ _
' c�..a”-
�:
_^'°'.T F.'r_`a,�y,�,�i�,c�Ri�.���.,�.��s�. ���."t�js5 FR' .ZS i z r��•,t• �_ r`'•Ss:C:.�
. j�t�l ^•SST. y����';[.^e�����i+„•3ti�. .�� .
Transactions By Date
Date Descrl tlon Debit Credit Balance
Interest Summary.
•.4j< :a'
Aacss n:;. r' 5. i;' .:a.....,� ••,'ns;=x:bc-vetifi"-�• x-.'�,:.xr.:_,..�.y_ST a'_c'r.•s`..
� y��..•r`?3�'3—._ �a�l�3� 'aa:..'•��f�l..'.. •-� t"'�.-• .G. ��. .II.;...��
il��,.._ _�p.!•� �•:.',".,4,c: .-- '^=•^-��'�z;��. t_:f�_._a.'}_k..L4,^�2F.`�ir_• 1'- .:s.�;�_a'Cv"c'E' rl '-•,vcP�,� ��-
k - '�ddl` _ �:��i,a!L-..+:�:SF.L:.;� ,.�...f. y_, _.±� �,,.lrL'•. %7.S..SS._.�:
-
Itp ��:='<r - _�:}^�,...;t 4::�i�F"�n`.s•<<'•xt ::�:t., z..:.a^:r..dz- £�'^'i== "-'�;�` �';.�" O
- �f'=.' ,b.c r.?• o—(-,-.ems,, r: �,,;_. YFa':r:�:::,`.�"'�-�=_v_.,tt.a'k; ..3.
• "'�.i. ��pey,���.':1 ir�.,y<. _f•".a2,. r- ,a"y;i °ti-` T•"•7T..--.-s^�..--.'���a� i
Fees Summary
Total Overdraft Fees Year to Date 0.00 g
r
Total Returned Item Fees Year to Date $0.00
For your convenience,a summary of overdraft and returned item tees appears on your monthly statement. Please note that the overdraft fee
summary includes non-sufficient funds fees.,uncollected funds fees and unavalt"funds tees. The summary does not reflect refunded or waived
Items credited to your account.
Manage your Accounts 2417.Enroll In Mobile Bankingl
Wherever life takes you,do your banking 2417 with Metro Bank Mobile.Check your account balances,view transaction history, •.
transfer money between your Metro accounts,set up account alerts and find store and ATM locations nearby.Search your g
app store for"Metro Bank"to download our FREE AndroidTM or Apples app.Mobile Web and Text Banking are also available.
For more details,visit mymetrobank.com.
Stay connected to Metro Bank on Twitter and Facebookl
Twitter-Follow us @My_MetroBank
Facebook-Like us at facebook.comlmymetrobank
18 Cycle Page 1 of 2 92ROROUOVII f
NOTE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC
1 `
I(
rn
lr �
m
Q O
f R 4i bx CD
uj
z
w
' 4r
!
i
1�
It
i vJ�
f
T
c �
OZ o ,
sum IN
H
103�Id3a0 MSIW 1SOl SI111N3A3
II!)D3Z139II M(]NOS,i�11NW ONI M/303SVIf�LRd 3H1
sa3wolsm o.L33ltoro
J133HO s,H3lHsd3
I
1M1 [w we eoot-,va
` 0 M 000 wgeNco
CON N eO Cp� mN
L r' qL�' Oi tll tOI CC CM'C C h E C6 P
co
� MsW+zm 0�Q N0 W Cp1� �t
.O.L mC=
Ot���—
N C mOpW E MO— e
Ll �':-;� eT 0 r O to
y� C�m�`�0��',ri ` rrt0�C7)t!
Ws P z 0,s;.: N v tD 0 r�m 0>
O C3C� IW W O Q
NOD
OD
m 3WC-0 EM ;:r!' cm
`a V m CO CL C'4
�C ((, co0LO co C4
C v.`% ` Wt COr OMC? `
�—G�-W wp 1?,.
.�.� 0)O�-� 00�a-p N 1� t- t!1 c0 c9 C V
EEpmVdat f/. N (OVrtpO�rCWOn
y p�WCE�ca
co
M m�m�maW:. tinn-r �mOMD >Mo
LLI `mod'
vO� mmEm' _ Q ..' °v
w ..>Wg�E asap w
u-<° 0 `° pa E�� V Q
pQ w w Ol
QQRO T ��"O �E`` C
C JQZ'T G O C "ma�cEO F' m00
r C E $ w O 80 CN m�N Iq
c wows Oa?�5€�� 4 a a W y umi je�v
N J f- lL E cg�Ra etf Q O O 3 V
�f�Ze-mR
U Ms
U U
a ^
a y -
U F
m o
•
C W
co co
'WD
oe m2
o � —
� 4
W a>' aar U
cn W•�
A ao w
1% E r i Z o 00
09WHH V m Q w
a c
R, 000���
WUEH xW
o. U >4 H
m_mtnR$H1&0
oWAU zw O U. 0
zN OMOMA w W. C m�
zN JAN ry W :y 3 N
�S.SUEWcaUN 8E
Z QZi
Page: 1 Document Name: untitled
STFT 1 THE TRANSACTION STMT FORMAT 13/10/28 11.12.32
STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE
ACTION COID
PROD CODE REA ACCT 35004200893798 SHORT NAME GOUGER CHARLES P
CURB CODE PAGE 23 SEARCH FROM 106/10/02 THRU 113/10/03
ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE
TRACE ID DESCRIPTION
04/02 167,064.76 C 167,064.76
CDSGN113040200002593 *RENEWED AT 0.20%, MATURES ON 10/02/14
04/10 400.00 D 166,664.76
013100010820963 RET FED WITHLD NORMAL 0008169766R3253
04/10 3,600.00 D 163,064.76
013100010820932 RETIREMENT DISB NORMAL 000816976683051
05/10 400.00 D 162,664.76
013130003820375 RET FED WITHLD NORMAL 000816976683253
05/10 3,600.00 D 159,064.76
013130003820294 RETIREMENT DISB NORMAL 000816976683051
06/10 400.00 D 158,664.76
013161005212212 RET FED WITHLD NORMAL 0008169766R3253
06/10 3,600.00 D 155,064.76
013161005212168 RETIREMENT DISB NORMAL 000816976683051
07/11 192721909 31,030.42 D 124,034.34
EPSDRFL PARTIAL WITHDRAWAL - DECEASED
PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM
Date: 10/28/2013 Time: 11:14:26 AM
Page: 1 Document Name: untitled
STFT 1 THE TRANSACTION STMT FORMAT 13/10/28 11.12.37
STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE
ACTION COID
PROD CODE REA ACCT 35004200893798 SHORT NAME GOUGER CHARLES P
CURR CODE PAGE 24 SEARCH FROM 106/10/02 THRU 113/10/03
ACTN POST EFFECTIVE CHECK NUMBER IRAN AMOUNT D/C BALANCE
TRACE ID DESCRIPTION
07/11 192721910 31,030.42 D 93,003.92
EPSDRFL PARTIAL WITHDRAWAL - DECEASED
08/14 226721932 31,036.20 D 61,967.72
EPSDRFL PARTIAL WITHDRAWAL - DECEASED
08/29 241721907 31,038.76 D 30,928.96
EPSDRFL PARTIAL WITHDRAWAL - DECEASED
10/03 115.74 C 31,044.70
I-GEN113100300000001 INTEREST PAYMENT GENERATED c
10/03 276721907 31,044.70 D .00
EPSDRFL CLOSEOUT - DECEASED
PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM
Date: 10/28/2013 Time: 11:14:29 AM
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018096
HUNTER KATHY
120 SOUTH 15TH STREET
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
101 $19,000.00
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-0721
DECEDENT NAME: GOUGER CHARLES P
DATE OF PAYMENT: 09/03/2013
POSTMARK DATE: 08/30/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 06/09/2013
TOTAL AMOUNT PAID: $19,000.00
REMARKS: RECEIPT TO ATTY
CHECK# 105
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
4
copy
LAST WILL AND TESTAMENT
I, CHARLES P. GOUGER, of the County of Cumberland, and
Commonwealth of Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare the
following as and for my Last Will and Testament, hereby revoking
and making null and void any and all former Wills by me at any
time heretofore made, viz:
ITEM I. I direct that all my just debts and
funeral expenses including my grave marker-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 II . I direct that all taxes that may be
assessed in consequence of my death, of whatever nature and by
whatever jurisdiction imposed, shall be paid from my residuary
estate as part of the expense of the administration of my estate.
ITEM III• I give, devise, and bequeath my
entire' estate, real, personal, and mixed, of whatever nature and
wherever situate unto my wife, JANE R. GOUGER.
ITEM IV. In the event my wife, Jane R.
Gouger, shall predecease me, or die simultaneously with me, or so
nearly so that it cannot be determined which of us survived the
Page 1 of 10 Initials
' I
Z 'd
9622-2L2 (LIL) 831131SdDH1 S3IS3W WUW33A WdLT :ZI EIo2 BI unr
I
other, then, in any of such events, I give, devise and bequeath
my estate as follows:
A. To my stepson, DAVID J. LUDWIG, any vehicle which
I own at my death, all my tools, my gold watch, my wedding
band, and all my fishing 'equipment.
B. My wife's dinner ring consisting of two (2) large
and six (6) small diamonds, which was given to my wife by
her mother, I order and direct be reset, at the expense of
my estate, into two (2) rings, each consisting of one (1)
large diamond and three (3) small diamonds. I give one (1)
reset ring to my daughter, MARY G. SEIDEL and one (1) reset
ring to my daughter, KATHY HUNTER.
C. To my daughter, JANE G. HARTMAN, my wife's ring
consisting of one (1) large diamond and two (2) smaller
diamonds which belonged to my wife's maternal grandmother.
D. To my daughter, KATHY HUNTER, my wife's diamond
earrings, wedding ring with five (5) diamond chips, and
circular etched gold bracelet.
E. To my daughter, MARY G. SEIDEL, my wife's silver
tea service consisting of five (5) pieces which was given to
my wife by her mother.
F. To my daughter, MARY G. SEIDEL, two (2) vases by
Mary Gregory, hand blown and etched, which belonged to my
Page 2 of 10 Initials
E 'd 8620-2L2 (LIL) 831131SdOH1 SOIS3W WUW333 WdLI :ZT ET02 81 UDC
wife's maternal grandmother and Waterford crystal dish,
bowl, cut glass vase, sugar and creamer, marble top •table,
glassware from England given to my wife by my said daughter,
gold Miraculous Medal and spoon collection.
G. To my stepson, DAVID J. LUDWIG, my wife's sterling
silver flatware service for six (6) and odd serving pieces,
Cortland Normal plate, needlepoint rocker, television and
entertainment center, C.D. player and discs, living room
furniture, patio furniture, bedroom furniture (four-post bed
and corresponding dresser, chest of drawers and cedar
chest) , two paintings by Edith Madden, hall clock,
needlepoint pictures, Bose radio, and large gray crock. with
handles and blue etching.
H. To my stepson, DAVID J. LUDWIG, the statues called
"The Favored Scholar", a John Roger's sculpture; "Shepherd
Boy with Dead Dog", by Henneke; .and "Is That You Tommy?", by
Henneke; "Rich Girl-Poor Girl" statue, sculptor unknown,
which has been made into a lamp.
I . To my daughter, JANE G. HARTMAN, the statues,
"Neighboring Pews", by John Rogers; and "Girl With Lamb and
Boy With Dog" which have been made into lamps, and the
Fostoria dishware.
J. To my daughter, KATHY HUNTER, the statues "Little
Page 3 of 10 Initials C L
� '� 8622-2L2 (LIL) 831131SdOHT S3IS3W WUW333 WdLI :2I 6IO2 91 unC
i -
1
i
Sweethearts" , by Henneke; "Coming to the Parson" statue by
John Rogers, gold earrings, cut glass candy dish on
pedestal, Indian plates, queen size maple bed and
corresponding bedroom furniture, kitchen table and chairs.
K. To my daughter, JOYCE M. GOUGER, the statue "First
Love", by Henneke, which has been made into a lamp; *Colonial
man and woman, sculptor unknown, which has 'been made into a
lamp; all' gold chains, including medal of five crosses of
Jerusalem, plain gold wedding band, gold watch, all
turquoise jewelry, Rockwell" plate collection, blue
Centennial plates, gold band dishes, dining room furniture
, and corner cupboard.
L. To my daughter; MARY G. SEIDEL, the statues "Mama"
E.
and "Papa", by Henneke; which has been made into a lamp.
M. To my stepdaughter-in-law, SUSIE D_ LUDWIG, my
I
wife' s pearl and ruby ring, my wife's anniversary ring with
five (5) diamonds, ruby bowl, cut glass daisy dish, octagon
paperweight and gold link bracelet.
N. I order and direct my' hereinafter named Co-
Executrices to permit each of my daughters and stepson to
select any item or items of household furnishing not
otherwise hereinbefore disposed of by me, said item or items
so selected shall not be deducted from such beneficiary's
Page 4 of 10 Initials
S °d 8622-ZL2 (LTL) 831l3lSdOH1 SOIS3W NHW333 . WdLT =21 ET02 ®T, unr
�'� B'ts C C=C GZ-1 G-[L'J—t9�1Z�1 b d'l7'F9 B-b J'1-��i3-`ra�'►��'�—w�L t��-tZ�t�z-ts-t-�,-•t�
5. To my- stepson, DAVID J. LUDWIG, one (1) equal
share.
rTEM V. In the event- any of my daughters,
KATHY HUNTER, JOYCE M. GOUGER, MARY G. SEIDEL and JANE G.
HARTMAN, should predecease me and leave children her surviving, I
give and bequeath the share of said deceased beneficiary to her
children. In the event any of the daughters should predecease me
and leave no children her surviving, I give and bequeath the
share of such deceased beneficiary to the surviving beneficiaries
named in Item IV, in equal shares.
In the event my stepson, DAVID J. LUDWIG, should predecease
me, I give and bequeath the share of said deceased beneficiary to
his wife, SUSIE D. LUDWIG.
ITEM VI . Should any of my beneficiaries
mentioned in this, my Last Will and Testament, entitled to a
share of my estate not have attained the age of twenty-one (21)
years at the time of my death, I give, devise, and bequeath the
share of such beneficiary to my hereinafter named Trustee, in
separate trust, to hold, manage, -invest and reinvest the amount
so received, and the accumulation of income thereon, and to use
and apply from time to time such portion of income and principal
thereof as it thinks proper for the beneficiary's comfortable
support, maintenance, and education, without regard to his or her
Page 6 of 10 Initialsj;;i'
L 'd B622-2L2 (LIL) N31131SdOHI SOIS3W WUW333 WdLT =ZT ETOZ BT unr
ability to provide such support or education, including college, ,
trade schools, nursing, or other higher learning. Any items of
personal property received by said Trustee, from my specific
bequests herein, shall be maintained in kind. When the
beneficiary whose share is held in trust reaches the age of
twenty-one (21) years, his or her share of the principal and
interest shall be distributed to him or to her.
ITEM VIZ. I appoint the COMMERCE BANK, 5032
Simpson Ferry Road, Mechanicsburg, as Trustee of the trusts
created by this, my Last will and Testament.
ITEM VIII. I direct- that my said Trustee, in
addition to and not in limitation of any authority given by law
or by this Will shall have the following powers:
(a) To sell, mortgage, lease, alter, improve,
partition and exchange all or any of the real estate which
constitutes a part of the said trust, for such prices and upon
such terms as to cash and credit as they may deem best, and to"
grant and convey good and sufficient title, without liability on
the part of the purchasers or other persons so dealing with the
Trustee to see to the application of the purchase or
consideration moneys.
(b) To purchase or otherwise acquire real estate and
to exercise the same powers thereover as hereinbefore provided
Page 7 of 10 Initials _
B 'd B622-2L2 (LIL) N31i3iSdOH1 SOIS3W WU W33J WdLT :dT £IOZ 81 unr
with respect to the other real estate of the said trust.
(c) To retain all stocks, bonds and investments owned
by me and to invest and reinvest in other stocks, bonds and
investments, without being confined to what are known as "legal
investments" , and to sell and transfer the same, either in person
or by attorney, without liability on the part of the purchasers
to see to the application of the purchase or consideration
moneys.
(d) To borrow money and pledge any stocks, bonds or
other personal property of the trust as security therefor,
without liability on the part of the lender to see to the
application of said money.
(e) To purchase securities at a premium, to amortize
the premium out of income, or to charge the same to principal or
income, or partly to principal and partly to income, at such
times and in such amounts as they may deem best.
(f) To exercise any option to subscribe for stocks,
bonds or other investments.
(g) To join in any plan of lease, mortgage,
consolidation, exchange, reorganization or foreclosure of any
corporation in which the trust may hold stocks, bonds or other
investments .
(h) To retain indefinitely any part of the trust
Page 8 of 10 Initials C
6 'd 8622-2L2 [LIL) M31131Sd®HI SOIS3W WUW333 WdLI :ZT cToa 8I unr
estate, real or personal, which is or may become unproductive,
or, in the discretion of the Trustee, to make sale thereof. The
Trustee in its discretion may pay the carrying charges and
expenses of property during any year in which it is unproductive
out of other principal of the trust estate, or out of income or
other principal, or partly out of such principal or income, and
it may from time to time reimburse principal or income for the
whole or part of said charges and expenses. The Trustee may
apportion the proceeds of sale of unproductive property between
principal and- income according to law, or, in its discretion, it
may pay proceeds into principal without apportionment .
ITEM IX. I appoint my wife, JANE R. GOUGER,
as Executrix of this, my Last Will and Testament. In the event I
am .not survived by my said wife, Jane R. Gouger, or she fails to
qualify or ceases to act as Executrix of my estate, I appoint my
daughters, KATHY HUNTER and MARY G. SEIDEL as Co-Executrices of
this, my Last Will and Testament.
ITEM X. I hereby direct that no Executor
shall be required to give any bond in any jurisdiction and that
if, notwithstanding this direction, any bond is required by any
Law, Statute, or Rule of Court, no sureties shall be required
thereon.
IN WITNESS WHEREOF, I have hereunto set my hand and
Page 9 of 10 Initials C�
OI -d 8622-2L2 (LIL) 831131SdOHI S3IS3W WUW333 WdLT =ZT 6102 81 unr
seal to this, my Last Will and Testament, consisting of this and
nine (9) other pages, this S- yday of A.D. , 199 .
za, 4"P, Z SEAL)
Charles 4ug
SIGNED, SEALED, PUBLISHED and DECLARED by CHARLES P. GOUGER,
Testator, above named, as and for his Last Will and Testament,
and we at his request, in his presence, and in the presence of
each other, have subscribed our names as attesting witnesses
thereo
7 � �
Address dV7 S 0di - �b��.a,� .5/ /76,4/. 2
l�Alu, o Address ///
Address
Page 10 of 10 Initials
t
1
TT 'd (LTL) 831131SdOH1 SOIS3W WUW33J Wd81 :21 cloa al unC