HomeMy WebLinkAbout03-25-14 (2) � 1505610140
REV-1500 EX (02-11)(FI)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO Box 28os0� INHERITANCE TAX RETURN
Harrisbur9,PA 17128-0601 RESIDENT DECEDENT 2 1 1 3 0 9 2 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDWYY
0 7 2 0 2 0 1 3 � 9 1 8 1 9 1 5
DecedenYs Last Name Suffix Decedent's First Name MI
K N 0 H R E L S I E S
(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 � 4a.Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 6.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 O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
N
D A V I D R . G A L L 0 W A Y 7 1 7 �6 9 7 � 6 � �
c -� rn rn
REGIS�; �WILLS ONL�
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rn z � �
� D' r f� i�t
First Line of Address n Z � GJ1 �
Cn
5 4 E • M A I N S T R E E T v �., '� -n ",�
0
Second Line of Address Q C � � �
. � w r
� —1 r
City or Post Office State ZIP Code
�► DATE FILE�'`� �
M E C H A N I C S B U R G P A 1 7 0 5 5
Correspondent'se-mail address: DAVIDaWALTERSGALLOWAY • 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.
SI NATU E OF PE SON SPONS LE FOR ILING RETURN D TE
Z
ADDRESS
FREDA J • WE Z 355 N • LOCUST POINT ROAD MECHANICSBURG PA 17050
SIGNATURE OF P ARER OTHER THAN REPRESENTATIVE AT
.� as /
ADDRES
DAVID R . ALLOWAY,ESQ 54 E • MAIN ST • MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
�
15�5610140 1505610140 ��
� 1505610240
REV-1500 EX(FI)
DecedenYs Sociai Security Number
oecedent's Name: E L S I E S • K N 0 H R
RECAPITULATION
1. Real Estate(Schedule A) .. . . . . .. . . .. . . .. . . . . . ....... .. . .... ... .. ... �• '
2. Stocks and Bonds(Schedule B) . .... .. . . .... .... .. . . .. .... . .. . . . . .. . . 2• '
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . ... 3. •
4. Mortgages and Notes Receivable(Schedule D) . .. . . ...... .. . . ... ...... . . 4. •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . ... . 5. 5 3 7 5 1 . 2 9
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . .. . 6. •
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property
(Schedule G) � Separate Billing Requested .. .. ... 7. .
8. Total Gross Assets(total Lines 1 through 7) . . ... .......... .... ....... . 8. 5 3 7 5 1 . 2 9
9. Funeral Expenses and Administrative Costs(Schedule H) . .. .... . . . . . . . ... . 9• 6 3 1 3 . � 2
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 4 6 4 8 . 9 6
9 9 � ) . . . . . .. . .. .. .
��. Total Deductions(total Lines 9 and 10) .... . . . .. . . . . ... .. . . . .. .. . ... .. 11. 2 � 9 6 1 . 9 8
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . .... .... . .... ...... . . 12. 3 2 7 8 9 . 3 1
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .... . .. .... . . . . . . .... . 13. 5 9 1 . 3 7
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . .. ... . . . . .. . .. .. . 14. 3 2 1 9 7 . 9 4
TAX CALCULATION-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.0 _ 0 . 0 O 15. O . 0 �
16. Amount of Line 14 taxable
at lineal rate X.0_ � • � 0 16. � • 0 �
17. Amount of Line 14 taxable
at sibling rate X.12 1 . 0 0 17. 0 . 1 2
18. Amount of Line 14 taxable
at collatera�rate X.15 3 2 1 9 6 . 9 4 �g. 4 8 2 9 . 5 4
19. TAX DUE .... . . ... . . .. . . . . ...... . . ...... . .... . .. . .. . . . . .. . . . .. . 19. 4 8 2 9 • 6 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
L 1505610240 1505610240 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 13 0923
DECEDENT'S NAME
ELSIE S. KNOHR
STREET ADDRESS
801 N. HANOVER STREET
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 4,829.66
2. Credits/Payments
A.Prior Payments
B.Discount 4,580.00
Total Credits(A+B) (2) 4,580.00
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 249.66
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 ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X
c. retain a reversionary interest ..................................................................................................... ❑ ❑X
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer propeRy 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? ......... ❑ 0
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.
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 suNiving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on tlie 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 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 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)j.
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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,whether by blood or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ELSIE S. KNOHR 21 13 0923
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC BANK 50,362.79
CHECKING ACCT XXXXXX3364
2. PERSONAL PROPERTY-GROSS SALES 788.50
BILL ROWE,AUCTIONEER
3. PERSONAL PROPERTY 95.00
CODOCILS TO BENEFICIARIES
4. ERIE INSURANCE 5.00
REFUND OF RENTER'S INSURANCE
5. WEST SHORE HEARING CENTER 2,500.00
REFUND FOR RETURN OF HEARING AIDS
TOTAL(Also enter on Line 5,Recapitulation) $ 53 751.29
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELSIE S. KNOHR 21 13 0923
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FAMILY SERVICE LIFE INSURANCE COMPANY-
PREARRANGED FUNERAL SERVICE
2. SULLIVAN FUNERAL HOME- 335.00
DIFFERENCE BETWEEN PREPAID FUNERAL SERVICES AND ACTUAL INVOICE
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)ofPersonalRepresentative(s) FREDAJ.WENTZ 2,685.00
StreetAddress 355 N. LOCUST POINT ROAD
�ity MECHANICSBURG State PA Z�p 17050
Year(s)Commission Paid: 2014
2, AttomeyFees: OAVID R. GALLOWAY, ESQUIRE 2,685.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. ProbateFees: REGISTER OF WILLS OF CUMBERLAND COUNTY 423.50
PROBATE FEES AND FIRST AND FINAL ACCOUNTING FILING FEE
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. ESTATE NOTICE PUBLICATION-CUMBERLAND LAW JOURNAL 75.00
8. ESTATE NOTICE PUBLICATION-PATRIOT NEWS 109.52
TOTAL(Also enter on Line 9,Recapitulation) $ 6 313.02
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT� �
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELSIE S. KNOHR 21 13 0923
RepoR debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ANGELS ON CALL 533.13
VISITING NURSES
2. CHURCH OF GOD HOME 8,502.46
RENT
3. TRASH REMOVAL FROM APARTMENT 250.00
RICHARD CASSEL
4. ST. STEPHEN LUTHERN CHURCH 5,000.00
CHARITABLE DONATION-CHECK WRITTEN PRIOR TO DEATH BUT DID NOT
CLEAR ACCOUNT UNTIL AFTER DEATH
5. PERSONAL PROPERTY- EXPENSES&COMMISSIONS 197.13
BILL ROWE,AUCTIONEER
6. POSTAGE-SHIPPING 166.24
CODICILS TO BENEFICIARIES
TOTAL(Also enter on Line 10,Recapitulation) S 14 648.96
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ELSIE S. KNOHR 21 13 0923
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. WILLIAM MARTINEZ Collateral 33.33
P.O. BOX 28043
PANAMA CITY, FL 32411
2. JENN�FER MARTINEZ Collateral 33.33
1258 HARBERT AVE.,#201 $2,000.00
MEMPHIS,TN 38104
3. COURTNEY MARTINEZ Coilateral 33.33
7914 NIKERTON DRIVE $2,000.00
GERMANTOWN,TN 38138
4. GLORIA F. ENGLE Collateral 10.00
5575 REGIMENTAL PLACE 5 GENERATIONS OF
CINCINNATI, OH 45239 PHOTOGRAPHS
5. ALLEN &LOIS YOHN Collateral 1.00
1356 CAMBRIDGE COURT HUMMINGBIRD-COUNT
PALMYRA, PA 17078 CROSS STITCH
6. AUDRY YOHN Collateral 1.00
19 CREEKVIEW DRIVE EMBROIDERED
MIDDLETOWN, PA 17057 PEACOCK
7. JACK&SARA JANE KELLEY Coilateral 10.00
550 SOUTH PRINCE STREET PHOTOS WARBLERS,
PALMYRA, PA 17078 GYRFALCONS, OWLS
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. ST. STEPHEN LUTHERAN CHURCH 591.37
30 W. MAIN STREET
NEW KINGSTOWN, PA 17072
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 591.37
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
ELSIE S. KNOHR 21 13 0923
DecedenYs Name Page 1 File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and Uansfers under
Sec.9116(a)(1.2).j
8. HEATHER L. FIDLER (MANZ) Coilateral 12.50
324 AWOL ROAD PHOTO-RACE HORSE
JONESTOWN, PA 17038 LEXINGTON
9. CO�LEEN DEFRAITES Sibling 1.00
6040 CONSTANCE STREET SCHERENSCHNITTE-
NEW ORLEANS, LA 70118 GERMAN SCISSOR ART
10. GORDON &ANNE SCHLEGEL Collaterai 5.00
2230 WOLFANGEL ROAD PHOTO-BALD EAGLE
CINCINNATI, OH 45244
11. KEITH UTSICK Coilateral 2.50
401 DEERFIELD ROAD PICTURE BLACK-
CAMP HILL, PA 17011 CAPPED CHICADEE
12. KEVIN UTSICK Collateral 50.00
230 SOUTH 16th STREET APPALACHIAN MT.
CAMP HILL, PA 17011 DULCIMER W/CASE
13. ALICE YOHN Collateral 1.00
17 ARBOR DRIVE 2 SCALLOPED-EDGE
MYERSTOWN, PA 17067 DOILIES
14. ST. STEPHEN LUTHERAN CHURCH Collateral
30 W. MAIN STREET PROCEEDS-AUCTION
NEW KINGSTOWN, PA 17072 JEWELRY, FURNITURE
15. KAYE SCHLEGEL Collateral 1.00
795 E RHUE HAUS LANE CARVED CEDAR
HUMMELSTOWN, PA 17036 WOODEN BOWL
LAST WILL AND TESTAMENT
OF
ELSIE S. KNOHR
I, ELSIE S. KNOHR, of 99 West Portland Street, Apartment 6, Mechanicsburg,
Cumberland County, Pennsylvania, declare this to be my last will, hereby revoking any prior
will or codicil.
FIRST: Regarding my funeral arrangements, I direct that my Pastor, Donald J.
Seiple, of St. Stephen Lutheran Church, New Kingston, Pennsylvania, administer same
pursuant to prior arrangements with the Sullivan Funeral Home of Enola, Pennsylvania. In
my lifetime, I purchased a burial lot in the Stone Church Cemetery of St. Paul's Evangelical
Lutheran Church, 6839 Wertzville Road, Enola, Pennsylvania, and direct that my remains be
interred therein, beside those of my deceased husband, Daniel Louis Knohr.
SECOND: I give and bequeath fifty percent (50%) of the entire sum of my savings
account number 1-15168 on deposit with the Harris Savings and Loan Association to the
Mechanicsburg Area Public Library of 16 North Walnut Street, Mechanicsburg,
Pennsylvania.
THIRD: I give and bequeath fifty percent (50%) of the entire sum of my savings
account 1-15168 on deposit with the Harris Savings and Loan Association to the Harrisburg
Chapter of the American Red Cross located at 804 North Sixth Street, Harrisburg,
Pennsylvania 17102-1099.
�
FOURTH: I give and bequeath in equal portions the entire sum contained in my
"ready access" certificate of deposit held by the PNC Bank at account number 31800047510
and further, the sum of $50,000 from my savings account number 5130109277 held also by
said PNC Bank, or the entire account if the balance is less than $50,000 at the time of my
death, to the following entities:
(a) The Helen Opperman Krause Animal Foundation, Inc., P. O.
Box 311, Mechanicsburg, PA 17055-0311.
(b) The Juvenile Diabetes Foundation, Central Pennsylvania
Chapter, 2600 North Third Street, Harrisburg, PA 17110.
(c) The Hershey Medical Center, Four Diamonds Fund, 500
University Drive, Hershey, PA 17033.
FIFTH: I give and bequeath to St. Stephen Lutheran Church of New Kingston, PA,
the entire proceeds remaining at the time of my death in my annuity with the Glennbrook
Life Insurance Company of P.O. Box 94042, Palantine, Illinois 60094-4042 pursuant to the
death benefit provision of said annuity at Policy No. GA206943. By this declaration I intend
to effect a change of beneficiary designation under said annuity contract, as necessary, to
facilitate this bequest.
SIXTH: I give and bequeath the sum of $2,000 each to my two grandnieces, Jennifer
Martinez and Courtney Martinez of 114 Ray Bridge Drive, Hattiesburg, Mississippi 39402,
with the request that such sums be used for the funding of their college education or in the
event that I die prior to their matriculation, to their father, William Martinez, in trust
nevertheless, for said grandnieces, to be used and applied in equal shares for their college
2
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expenses and, provided further if either or both grandnieces do not choose to enter college,
the money shall be used for their equal benefit as determined in the good judgment of their
father, William Martinez.
SEVENTH: I give and bequeath to my sister, Sally C. Martinez of 3919 Hessmer
Avenue, Apartment 106H, Metairie, Louisiana 70002, provided she survives me for a period
of thirty (30) days, any residue of said PNC savings account number 5130109227, remaining
after payment of the legacies provided in Items Fourth and Sixth above. If she does not
survive me, I give the residue of said account to the above grandnieces, and their father,
William Martinez, in equal amounts. In the further event that said grandnieces, or either of
them, are/is are under age 18 at the time of my death, the minor's share of said residue shall
be held by their father, William Martinez, in trust nevertheless, until such time as each
attains the age of 18.
EIGHTH: I give and bequeath my 1991 Geo Metro automobile to my nephew,
Harold L. Yohn, of 717 Creekside Lane, Lebanon, PA 17034.
NINTH: All of my furniture and jewelry shall be sold by auctioneer Bill Rowe of
211 Old Stone House Road, Carlisle, PA, or if said business is discontinued, by such other
reputable auctioneer as my attorney, Thomas R. Miller, Esquire, shall appoint, with the
proceeds of said auction to be distributed to St. Stephen Lutheran Church of New Kingston,
Pa.
TENTH: I give and bequeath all my clothing, linen, and kitchen effects to Goodwill
Industries of 1150 Goodwill Drive, Harrisburg, PA.
3
ELEVENTH: I give and bequeath the residue and remainder of my estate to my
sister, Sally C. Martinez, if she survives me for a period of thirty (30) days. If she does not
so survive me, I give the residue of my estate to my grandnieces, Jennifer and Courtney
Martinez, and their father, William Martinez, in equal shares with the provision that if at the
time of my death said grandnieces are under the age of eighteen, their respective shares shall
be held by their father William Martinez, in trust nevertheless for their equal benefit, until
they each reach the age of 18.
TWELFTH: No interest of any beneficiary under this Will, or any Codicil hereto,
shall be subject to anticipation, or voluntary or involuntary alienation.
THIRTEENTH: In addition to the powers given them by law, my Executor and their
successors, shall have the following powers, applicable to all property held by them,
effective without Court Order and until actual distribution:
(a) To retain any property received by them;
(b) To sell, lease, or mortgage real estate for any purpose,
publicly or privately, for such prices and on such terms as they deem proper,
without liability on the third persons dealing with same to see to application of
the moneys so paid;
(c) To compromise controversies;
(d) To distribute in cash or kind or both at such valuations as they
may fix;
(e) To hold investments in the name of a nominee;
(fl To vary investments, when deemed desirable by my fiduciaries,
and to invest in such bonds, stocks, notes, real estate mortgages or other
4
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securities or on such other real or personal property as my fiduciaries shall
deem wise, without being restricted to so-called "legal investments";
(g) To borrow money from any party, including either fiduciary, to
pay indebtedness of mine or of my estate, expenses of administration, death
taxes, or other taxes;
(h) To pay from principal all costs, death taxes or other taxes,
expenses and charges in connection with the administration of my estate,
without pro-ration or deduction from the share of any beneficiary.
FOURTEENTH: I appoint PNC Bank as the Executor of this Will and direct that
said fiduciary need not post bond in any jurisdiction.
IN WITNESS WHEREOF, I, ELSIE S. KNOHR, hereunto set my hand to this, my
last Will, typewritten on six (6) sheets of paper including the self-proving attestation clause
�
and signatures of witnesses, this �7 day of ��.����� y , 1997.
�,�� 1' ' ��-v� (SEAL)
ELSIE S. KN HR
Witnessed:
t`x - ��� residing at h��o Gc+ si.zr,�0s'�,f �'r-GYI�2��f�cs��?c,/�i 7cit�'
�'2'��.1_�` . ,��
���-z� residing at /04� «J�.,1 s-o:n!" ��� ���c�'�icSh'��L � ��c��.
��� � �,
,� �'� residing at aYV �oct�w:�i �� ��'C�"�crr���c� 7'J�
5
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF C�:'iL����?c.�,c�`.a .
ELSIE S. KNOHR, the testatrix,�'c�v�� L �'�,-�J �.,��,�,,� � �'�,p,� , and
��r��?' � ��� , the witnesses, whose names are signed to the foregoing instrument,
being first duly sworn, each hereby declares to the undersigned authority that the testatrix
signed and executed the instrument as her last will in the presence of the witnesses and that
she had signed willingly, and that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
testatrix, signed the will as witness and that to the best of her knowledge the testatrix was at
the time eighteen years of age or older, of sound mind and under no constraint or undue
influence.
WITNESS: TESTATRIX:
� _ � � ' �'��:__��='��
r
WITNESS: ITNESS:
�',..�..., �-_� ,li/ �
l� ,� /" •� :�.
Subscribed, sworn to and acknowledged before me by ELSIE S. KNOHR, the testatrix, and
subscribed and swarn to before me by <lE,;f�.}�� � � ,��,,,-u' � �,�.G�r� L C�-
and �03�; g I�,4,/� , the witnesses, this ��� day of �,��j�,��y , 1997.
�, �:�.�— c��
Notary Public
My Commission Expires:-�c�LS�; ��', �`��°
Notarial Seal
Roy Earle Cook,Notary Public
Mechanicsbur�Boro,Cumberland County
6 My Commission Expires Aug.22,2000
Member,Pennsyivania Association of Notaries
�=
iP .
CODICIL TO LAST WILL AND TESTAMENT
OF
ELSIE S. KNOHR �
I, ELSIE S. KNOHR, of 99 West Portland Street, Apartment 6, Mechanicsburg,
Cumberland County, PA, declare this to be the First Codicil to my last will executed by me on
J�.nuarv 27, 1997.
]. Regarding the bequest of personalty, as set forth in Paragraph 9 of my Last Will
and Testament, it is my intention to amend said Paragraph and make the following specific
bequests: -
(a) To Gloria F. Engle of 783 East Camino Corridor, Tuscon, AZ 85737, I bequeath
my photographs of five generations of women on my maternal side and five
generations of inen on my paternal side. �
(b) To Allen and Lois Yohn of 121 East Oak Street, Palmyra, PA 17078, or the
survivor of them, I beyueath my framed Hummingbird-counted cross-stitch. '
(c) To J. Dave and Audry Yohn of 12 Riverview Drive, Middletown, PA 17057, I
bequeath my fr�..med �m�roider.ed peacock (mainly blue in color).
(d) To Jack and Sara Jane Kelley of 550 South Prince Street, Palmyra, PA 17078, or
the survivor of them, I bequeath my framed photographs af gyrfalcons, snowy
owls and black and yellow warblers.
(e) To Heather L'. Fidler of 717 Creekside Lane, Lebanon, PA 17034, or the survivor
of them, I bequeatll my photograph of the race horse "Lexington". In the event
,�
�
Heather Fidler is under the age of 18 at the time of my death, said possession shall
be held by her parents, Harold and Alice Yohn of the same address until such time
as she attains the age of 18.
(� To Colleen DeFraites of 6040 Constance Street, New Orleans, LA 70118, I
bequeath my Scherenschnitte-German scissors art, as contained in two frames.
(g) To Gordon and Anne Schlegel of 2230 Wolfangel Road, Cincinnati, Ohio 45244,
or the survivor of them, I bequeath my frame� photogra�h of a bald eagle.
_ (h) To Lee and Kaye Schlegel of 795 East Rhue Haus Lane, Hummelstown, PA
17036, or the survivor of them, I bequeath my carved cedar wooden fruit bowl,
approximately 10-1/2 inches in diameter.
(i) To Keith Utsick, of 6455 Wertzville Road, Enola, PA 17025-1167, I bequeath my
framed picture of the black-capped chickadee, perched on a feeder. In the event
that ICeith Utsick is under the age of 18 at the time of my death, said items shall
be held by his parents, Sam and Joyce Utsick, of the same address, on his behalf,
until such time as he attains the age of 18.
(k) To Kevin Utsick of 230 South 16th Street, Camp Hill, PA 17011, I bequeath my
Appalachian mountain dulcimer with black case.
(1) To Alice Yohn of 717 Creekside Lane, Lebanon, PA 17034, I bequeath two small
scalloped-edge doilies.
(m) To Sallie Martinez of 3919 Hessmer Avenue, Apartment 106H, Metairie, LA
70002, I bequeath my small myrtlewood bowl.
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2. This Codicil supersedes any prior declazations affecting disposition of the
aforementioned items of personalty. However, the disposition of all other personalty shall be as
stated in the said Paragraph 9, and all other provisions of my said Last Will and Testament shall
remain in full force and effect.
IN WIT`NESS WHEREOF, I, Elsie S. Knohr, hereunto set my hand to this First Codicil
my Last Will and Testament, typewritten on four (4) sheets of paper, including the self-proving
�
attestation clause and signatures of witnesses, this /�—day of 4-J�'�--�i , 1997.
v���.�� ,rl,.z��:.�-�'�.., (SEAL)
ELSIE S. KNOHR"
Witnessed:
��--�..,-�`� ���-�� residing at %a� C��.�' Sti�./ .3� �Z�J:c.s..�.'�,��
�/���o� /'� residing at �S��dLt.�S �r'- �/1���l �� /7���
..�:�GU��� residing at ���_��p �~�'/�:--�f •(f��i,7�S�- -
��.��� '
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND .
ELSIE S. KNOHR, the testatrix, �i.e�+2�v9- � ��'f-;Q�'`�''�'��'��'`�c'`�'°��'�,`����
�S�.E 'A U �'�--�-- ,the witnesses,whose names are signed to the foregoing instrument,being
first duly sworn, each hereby declares to the undersigned authority that the testatrix signed and
executed the instrument as the First Codicil to her last will in the presence of the witnesses and
of each other, and that she signed willingly, and that she executed the Codicil as her free and
3
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voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the testatrix, signed the Codicil as a witness and that to the best of their
knowledge the testatrix was at the time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
WITNESS: TESTATRIX:
�tP-�-{�`" �i �-� � . ` � �„��t.�
,
WITNESS: WITNESS:
� � , � � /,,�7eoe, � ,cQ�,��p
�
Subscribed, sworn to and acknowledged before me by ELSIE S. KNOHR, the testatrix, an�
subscribed and sworn to before me by Gl3t�2�t- �, �� ,�'�c�'����:�'ail�T��an�
�S���Z•c�� �v'�'��- , the witnesses, this l/ - day of a,i c,,��—� , 1997.
T.� �vw�t�� �
Notary Public
My Commission Expires: �L�c.oS'�"�`,�'o �'`�
Notarial Seal
Roy Earle Cook,Notary Public
Mechanicsburg Boro,Cumbe�land County
My Commission Expires Aug.22,2000
Member,Pennsylvania Association of Notaries
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5;t:�y�;fit• .
HUREAU OF IYDIYIDWIL TAXES �) �� � �: enns Lvarna
Penns lvania lnheritance Tax �c•
PO BOX 280691 ! y
HARRISBURG �A 17128-0601 II1fO��Ilc'�tIO11 NOtIC@ DEPARTMENT OF REVENUE
And Taxpayer Response �EY•IS�S EX D�eEIIEC(0l-121
FILE NO.2113-0923
ACN 13i492B0
DATE 09-23-2013
Type of Account
Estate of ELSIE S KNOHR Savings
SSN 204-Qi-7308 Checking
Date of Death 07-20-2013 Trust
DAVID M CLECK County CUMBERLAND CertifiCate
2o wArrs LN
CARLISl.E PA 17013-7750
PNC BANK NA provided the department with the information below indicating that at the death of the
above-named decedent ou were a'oint owner or beneficia of the account identified.
Account No.5140303364 Remlt Payment end Forms to:
Date Established 0401-2008 REGtSTER OF WILLS
Account Balance $50,3fi2.79 7 COURTHOUSE S�UARE
Percent Taxable x 50 � CARLISLE PA 17013
Amount S�bject to Tax $25,181.4Q �
Tax Rate X 0.150
Potentiaf 7ax Due $g�777,21 NOTE•: If tax payments are made within three months of the
decedent's date of death,deduct a 5 percent discouni on the tax
W+th 5%Discount(Tax x 0.95) $ see NO7E') due. Any inheritance tax due will become delinquent nine months
after the date of death.
PA� Step 1 : Please check the appropriate boxes below.
1
A �No tax is due. I' I am the spouse of the deceased or I am the parent of a decedent who was
I 21 years old or younger at date of death.
IProceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential T�Due.
8 �The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Da not check any other boxes.
� �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.}of the deceased.
(Select correct tax rate at
right,and complete Part � 12% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships(including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back o/this form.
� �Asset witl be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed fo Step 2 on reverse. Do noC check any other 6oxes.
Please sign and date the back of the form when finished.
PAR7 Debts and Deductions
2
Allowable debts and deductions must meet both of the following criteria:
A. The decedent was legaliy responsible for payment,and the estate is insufficient to pay the deductible items.
B. You paid the debts after the death of the decedent and can furnish pr�of of payment if requested by the department.
(If additional space is required,you may attach 8 1/2"x i t"sheets of paper.)
Date Paid Payee Description Amount Paid
Total Enter on Line 5 of Tax Calculation} $
PART T1X Ca,ICllIatlO�'1
3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Llne 3),
please obtain a written correction from the�nancfa(institutfon and attach lt to this form.
1. Enter the date the account was established or titled as It existed at the date of death.
2. Enter the total balance of the account including any interest accrued at the date of death.
3. Enter the percentage of the account that is taxable to you.
a. First,determine the percentage bwned by the decedent.
i. Accounts that are held"in trust for"another or others were 100%owned by the decedent.
ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100°!o divided
by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners
=25%,etc.)
b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries.
4. The amount subject to tax is determined by multiplying the account balance by the percent taxable.
5. Enter the total of any debts and deductions cfaimed from Part 2.
6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax.
7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent.
If indicating a different tax rate,please state (�aj�� �� :
your relationship to the decedent: ,
1. Date Established 1 FA�8�ftm�tlt O'f RBYprtt]@ ,
2. Account Balance 2 $ P� ��� '�
�
3. Percent Taxable 3 x � �;—'
4. Amount Subject to Tax 4 $ �
3
5. Debts and Deductions 5 - +¢`
6. Amount Taxable 6 $ �
7. Tax Rate 7 X 6
.7. r
8. Tax Due 8 $ 8�
9. With 5%Discount(Tax x.95) 9 X - .t_.. - � � �
Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form,
afong w�th a check for any payment you are making. Checks must be made payable to"Register of Wifls,Agent." Do not send
payment directly to the Department of Revenue.
Under penalty of perjury, I declare that the facts I have reported above are true,correct and comp{ete to the best of my knowledge and
belief.
Work
Home
Taxpayer Signature Telephone Number Date
IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE
DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020