HomeMy WebLinkAbout02-0826
INRE:
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ESTATE OF EUNICE E. EDDER
ORPHANS' COURT DIVISION
NO.
CIVIL TERM
PETITION FOR DISTRIBUTION OF SMALL ESTATE
(Pursuant to 20 Pa. C.S.A. ~3102)
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
The Petition of John D. Hendrickson, respectfully states as follows:
1. Eunice E. Edder died on December 3, 2001, domiciled in the Borough of
Carlisle (770 South Hanover Street), Cumberland County, Pennsylvania. A true and
correct copy of her Death Certificate is attached hereto as Exhibit "A."
2. Petitioner is John D. Hendrickson, an adult individual whose business
office is in the Borough of Carlisle (770 South Hanover Street), Cumberland County,
Pennsylvania, and is named as the Executor in Decedent's Will, at paragraph four (4)
thereof, which provides as follows: "I nominate and appoint John D. Henrickson (sic],
or his successor at The Alliance Home, Carlisle, PA to be the personal representative
of my estate, to serve without bond." John D. Hendrickson is the current executive
director of the Alliance Home of Carlisle, PA, Inc., which now trades as Chapel Pointe
at Carlisle.
3. There is no family relationship between the Decedent and the Petitioner.
4. Decedent died testate leaving a Will dated December 30, 1992, the
original of which is attached to this Petition as Exhibit "B" and is incorporated herein
by reference thereto as if fully set forth herein.
Small Estate Petition: Estate of Eunice E. Edder
Page 1 of4
5. Decedent left her entire estate to The Alliance Home of Carlisle, PA.
6. Petitioner does not intend to file said Last Will and Testament for probate
as this is a small estate with three small assets.
7. Decedent's sole assets at death were: (i) Insurance benefits from two Met
Life policies (one 1932 policy having a face value of $226.00 and one 1934 policy
having a face value of $106.00), (ii) Met Life common stock having a value of
approximately $583.00, and (iii) Two pension checks from the Christian & Missionary
Alliance having a total value of approximately $500.00.
8. To the best of the knowledge, information and belief of your Petitioner, all
final bills of the Decedent have been paid. Specifically, The Alliance Home (now
Chapel Pointe at Carlisle) has been satisfied by medical assistance payments and
the funeral home was paid under a pre-paid plan.
9. (A) Decedent was never married and had no children. The sole
beneficiary of the estate is a charitable organization of which the Executive Director is
one and the same as the Executor of the estate, and the estimated value of the estate
is significantly less than $25,000.00
(B) Pa. O. Ct. R. 5.6 requires that a Notice of Beneficial Interest in Estate
be sent to the spouse and children of a Decedent within three months of the grant of
letters, however, this Petition is for distribution of a small estate without the grant of
letters and decedent never married and had no children.
(C) 20 Pa. C.SA 93102, providing for settlement of small estates on
Petition, provides that the Court may direct distribution "with such notice as the Court
shall direct."
(D) Your Petitioner requests an Order for Distribution waiving notice to
any individuals or entities, except the Estate Recovery notice to the Pennsylvania
Small Estate Petition: Estate of Eunice E. Edder
Page 2 of 4
Department of Public Welfare.
10. The Alliance Home of Carlisle, PA, Inc., now known as Chapel Pointe at
Carlisle, is the only party interested in the above estate as beneficiary, heir or
claimant, and therefore no notice is required to any other party except for the Estate
Recovery notice. For purposes of waiving notice, The Alliance Home of Carlisle, PA,
Inc., now known as Chapel Pointe at Carlisle, has joined in this Petition.
11. Petitioner files this Petition pursuant to 20 Pa. C.SA 93102.
WHEREFORE, Petitioner requests your Honorable Court to enter a Decree
ordering that the Estate of Eunice E. Edder, Deceased, be awarded 100% to The
Alliance Home of Carlisle, PA, Inc., now known as Chapel Pointe at Carlisle, without
notice to any additional party except for the Estate Recovery notice, and without
appraisement, and with authority of the Petitioner, John D. Hendrickson, to receive,
collect and distribute the bequest from the Estate of Eunice E. Edder to Chapel Pointe
at Carlisle, and to make any and all necessary assignments and transfers.
Dated:5~~~ II) <2e.!l~
Respectfully submitted,
~ ~ 7~?
Stephe D. Tiley, EsqUire
5 South Hanover Street
Carlisle, PA 17013
(717) 243-5838
Supreme Court 1.0. No.: 32318
Small Estate Petition: Estate of Eunice E. Edder
Page 3 of 4
VERIFICATION
I, John D. Hendrickson, depose and say that I am the Petitioner in the above
matter; and that the facts set forth in the foregoing Petition for Distribution of Small
Estate are true and correct based partly upon personal knowledge and the remainder
upon information and belief; I understand that this Verification is made subject to
penalties of 18 Pa. C.S.A. 9 4904, relating to unsworn falsification to authorities.
Dated:
Uo,~
John D. Hendrickson
VERIFICATION
The Alliance Home of Carlisle, PA, Inc., t1dlb/a Chapel Pointe at Carlisle, by
John D. Hendrickson, deposes and says that it is a legatee in the above matter; and
that the facts set forth in the foregoing Petition for Distribution of Small Estate are true
and correct based partly upon personal knowledge and the remainder upon
information and belief; 1 understand that this Verification is made subject to penalties
of 18 Pa. C.S.A. 94904, relating to unsworn falsification to authorities
The Alliance Home of Carlisle, PA, Inc.
t1d/b/a Chapel Pointe at Carlisle
Dated:
~ a 'Y!:';'aZWh~
John D. Hendrickson, Executive Director
Small Estate Petition: Estate of Eunice E. Edder
Page40f4
,,,V).OlJ) "tV 'Jm(l
--r"~;s 'S ro cer:j~y7 t:ut ,t;1C inFormacion here given is correctly copied ftOm qn original certificate of deach dul~ filed with roe as
Lo",l R"t;ism r The original certificate will be forwarded to the State Vital Records Office for permanenr filtng.
WARNING: II is illegal to duplicate this copy by photostat or photograph.
tel: for thiS cerriticate, $2.00
p
7714681
No.
)1~_ t:\. ~ta..\-&-~~
Local Registrar
DEe
4 2001
Date
IHOS. ..,A...;!!lI7
COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
'lINT
l(NT
".
N......EOFOECEDENT\f"".~~----_..._--------------- sO:
J. Female
I. Eunice E.
..oElla_9><1nca" UNOERIYEAA
Mo>nlhl Dip
COU",TY O~ CIEflI'l
UNDEAIDI/.'I'
-1"'inoJtooo
BIRT~IC"'f'''''
SIoI.00FClIqICCIUn/IYl
ST,",fF'lE~ER
SOClM..SEC\!PorN~BER
,. 189 - 10 - 7560
DATE Of'OE,I,TI'l ,"'CM,O'O\._'
a. Dec. 3, 2001
-..
(1"01'5+14
PV\CEOI'DEAfl'llCI'eclo"...,..one _"'''''ucloOl'>l'''''__1
l'\OS$'l"",l.;
tnpa,.....IO ~O
=",,0
88 'In
Duquesne,PA
~,
Cumbe~land
R.
Ca~lis1e
pel pointe at Carlisle
-MSDECE:OENTEvEAIN ot:<<Oft-ll',i!lVC1I\'1O"I
U,S.AA...eDFORCES1
_0 Ml>al
OE.CE:ot:tfT"\. VSUM. OCCUPRiON KIND OF BUSlNiSSlINOl./S1PoY
(~~~a::.::~:r
11.. Teacher 1t Public School
OECf;Of.Nl'SMNUNG AOOAESSlS/r".C~. s... 4> Co<Iel OECEOENl'S
770 South Hanover St. ~~LNCf:
Carlisle, Pa 17013 ~:='"
17a.Sl...
PA
White
MMt1AlSTATUS._
_I,lorritcl.~.
--
Never Married
SUlWIVlNGSoI'OUSE
i1l_,gnoI,,-,_
,.
17<:.0....._........
,.
~.IInlEA.SNA...E(F....M_,l....J
,t. us J. Edder
lHFOR/oIANf'SJ<<ME(Tl'IlWl'finll
Cha l'Pointe at Carlisle
"""""'"
8urIol0l c_O '--_81...0
~--
""
-
....
-......f 17..ex :;"""':::'::::00Il
MOTHEfl'Sru.MEIf,.,_,""_Suo~""'1
". Edn
lHFORW.NT"SIoU\I SSlSltftl.c~sa..Z-ti>(:ulo.)
770 SOu Han v S
Pl..A<<OF~ION-""",,oIc-t"'Y>CN.noIor'f lOCR1ON.C~s.,eI.lII>C<MII
._-
''".
2001
-
C"l'I,r1i",lA
--
L
t1cyersailles Cemete
......IoIEANO.tOORESI;OFF,o,CIUTY
"'.
111I. McKee!! rt, PA
Hoffman-Roth Fun~a1 Home
<td"..O'.lh.OOnol....a'I..._ol~_IR"..~..'"""".,01Y'''ohI.._o'hel'''.'''''.
L
WERE AUTOPSY FINDINGS
_l.A8t.EPI'UOAlO
OFCAUSl:
.........NfflOf OEATH
ONEOI'Uol./'JP,'r
(_,o.t<_l
M
o
o
..0
'~imlI"
l:='-==
II
.....1IlT1I'
~~~~IO_.l>\lI
"""-"lngin_~_gMoIInPNlTI.
llMEOFINJUF!Y
INJUflYRWOI'\K7
OIlSCfllllEHOW INJUflYOCClJRAfO.
-...
'_r>g_llQillio..
CouId_boIdelo...","""
o
o
OI"UoC!.OFlNJUFlY.....""""',........'"'.IIlCll><)'._.M,
~ooe.l~
_.
-.
-
"'"...""
_0
~11'f
-~
". ""-
CUlTlfllAlo-.okonlyG'lOl
.l:I.'"ll"fItOO~IICI.....JPIt...,_c~_oI__oWI<>Ih<I<QllyIC'""....p'ono<J""""dq"''''''''~<Iirn~31
To..._o'...,.J<rIOwlo<Igo.~alh~__"'__..,~I__"".'a..IoN<l..
...
.II'M>HOUHCINGAHOcanlf"'f_PI'l',.SlCl"1I(Ph-,..;.....1;l()I~ pl"""""'"o>g_thanc:lco<lolyot>QlOc......OI<lOa"'l
To...._.......,kno-.......lh..,cur....al"'-_.d.....""p/"'...""..""lcll...c.~.I_"'.......>>..al.....'
'''EOlCA1.f)lAMINIRICOflO",EA
~tM.MM'"'uaml"all....a"dlorl"....1I0.lton,I......,oplnjo",d..lhOCcu....d II lhe 11m., dal.. and plac.,anddu. to lhto<<......lal knd
..............1.1..,......................................__................................................. ........
31a.
Po GISTAAA'S S NATI.lRE ANO 'l\.. . l"
.... '- (:\. ~~~
Q,),~I,ol
-...r~.
...... 0 HooD
,..
SlGNIUURl:.lol<<lmLEQ(..Cf:ATlf
, -) <-/
LICENSENU"'8EA
OJ1.1;,O 31 ~.() z..tX;;(
NAME ......0 .oDORESS"Yf ~Po$ON W"rtO COMptET"fO C"'USE OF DUfl'l
(~ern2nTl'P'o<"'lnt I)'l...c>."y .. n .
o -Hi<> ""-'1,.1"''''_
J'~^rChU r;4:?9o
OATEFI~EO~.O..,..""",)
~-c\,~()(,\
".
~.
LAST WILL AND TESTAMENT
I, EUNICE E. EDDER, of 770 South Hanover Street, Carlisle, Cumberland County,
Pennsylvania 17013, mindful of the brevity of this life and having placed my faith and confidence
in Jesus Christ, my Savior and Lord, who redeemed my soul through his shed blood and death
upon Calvary's Cross for my sins and who thus assures me of eternal life, do hereby make, publish
and declare this to be my last will and testament, hereby revoking all wills previously made by me.
1. I direct my personal representative to pay all of my debts, funeral and administrative
expenses as soon as convenient after my decease.
2. I authorize and empower my personal representative to sell any realty and/or
personalty owned by me at my death and not specifically devised or bequeathed herein, at either
public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in
fee simple, as I could do if living. My representative is authorized and empowered to engage in
any business in which I may be engaged at my death, for such period of time after my death as
seems expedient to said representative.
3. All the rest, residue and remainder of my property, real and personal, I give, devise and
bequeath to The Alliance Home of Carlisle, P A, 770 South Hanover Street, Carlisle, P A, for
general purposes.
4. I nominate and appoint John D. Henrickson, or his successor at The Alliance Home,
Carlisle, P A to be the personal representative of my estate, to serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 0
-
.L7p~, . 199,&.
day of
~"';'.d...Pef~/hd (SEAL)
UNICE E. EDDER
Signed, sealed, published and declared by the above-named person as and for a last will
and testament, in our presence, who, at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
C, ~~.~~
~figf
EJo.Qa" 'IJ E>>IBrr".
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1T128-Q601
Ii - I ;),~- Cf
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
217
REV-15DO t!:x (6-OQ)
w
~
","~
u~'"
W~U
~oo
u&~
"
N/A
[R] 1. Original Return
D 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received D 10. Spou"'el Povurty Cred~ (dillte of deal" betWeen 12-31-91 and '-'-95) 011. Election to tax under Sec. 9113(A) (Attach 5ch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESpoNDENCE ANDCONFI[)ENTiA!4"TA)(JNFORMl\tIQN$HQIlLD~~iDIRE(:TEDT()ii
NAMe: COMPLETE MAILING ADDRESS
SteDhen D. Tilev 5 South Hanover Street
FIRM NAME (If App!;cable) Carlisle, PA 17013
I-
Z
W
C
w
'-'
w
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Edder Eunice E.
DATE OF DEATH (MM-DD.YEAR) I DATE OF BIRTH (MM-DD-YEAR)
12/3/2001 I 311811913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
v
D 2. Supplemental Retum
D4a. Future Interest Compromise (date of death after 12-12-8'2\
07
Decedent Maintained a Living Trust (Attach copy of Trust)
I-
Z
W
C
Z
~
en
w
0:
0:
o
'-'
Frev & Tilev
TELEPHONE NUMBER
71?) 243-5838
FILE NUMBER
2 1-
D 2
826
1. Real Estate (Schedule A)
(1) NONE
COUNTY CODE
NUMBER
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE
4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4) NONE
YEA'
SOCIAL SECURITY NUMBER
189-10-7560
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03
05
Remaind.rRlIIum(dat.ofdeathpoorto12-13-82)
Federal Estate Tax Re\urn Required
(5)
(6) NONE
z
o
>=
<C
..J
:0
l-
ii:
<C
'-'
W
0:
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. lnter.vivos Transfer & Miscellaneous Non-Probate Property
(Schedule G or L)
(7) NONE
8. Total Number of Safe Deposit Boxes
OFFICIAL USE ONLY
510
1,373
1,883
1,814
1,814
69
68
1
o
o
o
o
o
19. Tax Due (19)
20.0 !~@;.._~_.~t!ml\t"i:~~iSIB_.'ill!E
:>:> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE.SIDEAND RECHECK MATH<<
8. TOTAL GROSS ASSETS (total Lines 1.7)
(8)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10) NONE
11. TOTAL OEDUCTIONS (total Lines 0;} & 10)
(11)
(12)
12. NET VALUE OF ESTATE (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not
been made (Schedule J)
(13)
(14)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate ,or transfers under Sec.9116 (a)(1.2) X .0 (15)
z -
0
>= 16. Amount of Line 14 taxable at lineal rate X .0 (16)
<C -
I-
:0
Q. Amount of Une 14 taxable at sibling rate .12
::;; 17. x (17)
0
'-'
X 18. Amount of Line 14 taKable at collateral rate x .15 (18)
<C
I-
217
Edder Eunice E.
21-02-826
Decedent's ComDlete Address:
STREET ADDRESS
CITY TSTATE \ZIP
Tax Payments and Credits:
,.
2.
Tax Due (Page 1 line 19)
Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
Total Credits ( A + B + C ) (2)
o
3. lr\teresVPenaltj \1 applicable
D. Interest
E. Penally
4.
TotallnterestlPenalty ( 0 T E )
If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
(5)
(5A)
(58)
o
(3)
o
5.
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make to:
OF
o
o
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
,.
Did decedent make a transfer and:
a. retain the use or income of the property transferred;
b. re1ain 1he right 10 designa1:e who shall use the property transferred or its income;
Yes
o
o
o
o
o
o
c. retain a reversionary interest; or
2.
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
3.
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation?
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
o
No
o
o
o
o
o
o
770 South Hanover Street, Carr""", PA 171113
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
5 South Hanover Street, Carlisle, PA 171113
For dates of death on or aftar July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. Section 9116 (a)(1 ,1){iJ].
For dates of death on or after January 1,1995, tt1e tax ra\e imposed on the net value of transfers to or lor the use of the surviving spouse is 0% [72 P.S. Section 9116 (a)(1.1)(ii)).
The statute does not exernpt a transfer to a surviving spouse frorn tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicabie even if
1M surviving spouse is the ooly bimeliciaf)F
For dates of death on or after July 1, 2000:
Tl'1e 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. Section 9116(a){1.2)].
The lax rate imposed on the net value of transfers to or for Ihe use of the decedent's lineal beneficiaries Is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P,S. Section 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. Section 9116(a)(1.3)] .A sibling is defined, under Section 9102, as an
individual who has at least one p9rent in common with the decedent, whether by blood or adoption.
AT
REV-150~ EX + (1-97r (!)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITA.NCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Edder Eunice E.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-02-826
ITEM
NUMBER
1.
DESCRIPTION
19 SharesMetlile slack @ $26.74
VALUE AT DATE
OF DEATH
510
TOTAL (Also enter on line 2 Recacituiation' $
(II more space is needed, insert additional sheets 01 the same size)
510
Historical Prices
IJIJ/OJ 6:03 PM
1lA.sootFlNANCEm
~ -Finance Home - Yahoo' - HelD
Historical Prices - MET (METLlFE INC)
As of Dec-04-0 1
More Info: QyQl!l1 Chart I News I Profile I Research I SEC I Messaaes I ~
Start: I Dee. ;: f3I2Oo'
End; I Dee ;:~
i!> Daily
o Weekly
o Monthly
o Dividends
Ticker Symbol: Imet I Get Data I
ADVERTISEMENT
I GRADUATED IN:
Date Open High Low Close Volume Adj.
Close.
Dec-04-0 1 27.00 27.75 26.98 27.75 3,311,900 27.52
Oec-03-01 27.30 27.35 26.82 26.97 1,768,400 26.74
Download Spreadsheet Format
* adjusted for dividends and splits please see F AQ.
IIIII
IIIII
classrn.~
Questions or Comments?
Copyright CI 2003 Yahoo! Inc. All rights reserved.Privacv Policv -Terms of Service
Historical chart data and daily updates provided b'jCommoditv Svstems Inc. reS\).
Da1.a and informalion is provided for informational purposes only, and is notintended for trading purposes. Neither Yahoo nor any of its data or content providers (suchas CSI)
shall be liable for any errors or delays in the content, or for any actions taken in reliance thereon.
http://table.financeyahoo_com/d?a=ll&b=3&c=2001&d__ II&e=4&f=2001&g=d&s=met
Page I of J
AT .
REV-15o's EX + (1-97) (I)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eunice E. Edder
FILE NUMBER
21-02-826
Include the proceeds of litigation and th" dale the proceeds were received by the 811late. ALL PROPERTY JOINTLY.OWNED WITH THE RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F.
ITEM
NUMBER
1.
2.
3.
DESCRIPTION
Metlife dividend check number 0009571278
Final pension benefit from The Christian and Missionary Alliance Check No. 0001134
Melife Insurance Policy proceeds check no. 001984528
VALUE AT DATE
OF DEATH
4
682
687
TOTAL [Also enter on line 5, Recapitulation \ $
(If more space IS needed, Insert additional sheets of the same size)
1,373
AT
REV-1511 EX + (1-97) (l~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDEN"T
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Eunice E. Edder
21-02-826
D t
d d t
tb
rtd Shdll
eb sof ece en mus e repo e on c e ue .
ITEM
NUMBER DESCRiPTION AMOUNT
A. FUNERAL EXPENSES:
1. (Pre-paid)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative ($) John D. Hendrickson
Social Security Number(s) I EIN Number of Personal Representatille(s)
Street Address 770 South Hanover Street
Clty Carlisle State PA Zip 17013
Year{s) Commission Paid: 2003 600
2. Attorney Fees 600
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Slale Zip
Relationship of Claimant to Decedent
4. Probate Fees 22
5. Accountant's Fees
6. Tax Return Preparer's Fees 0
7. Death Certificates 6
8. Postage for mailing of Metlife policies 5
9. Register of Wills and filing Inheritance Tax Return 15
10. Commonwealth of Pennsylvania, Department of Public Welfare, Estate Recovery Program 566
TOTAL (Also enter an line 9, Recaoituiatian\ $ 1,814
(If more space is needed, insert additional sheets of the same size)
217
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eunice E. Edder
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-02-826
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee/sl OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under So<:. 9116 (a> (1.2)]
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV.15QO COVER SHEET
II. NON~TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
The Alliance Home of Carlisle, PA Inc, lId/b/a Chapel Pinte at Carlisle, 770 South Hanover Stree
Carlisle, Pennsylvania
100%
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 68
(If more space is needed, insert additional sheets of the same size)
\./?-/~ 9
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Rec(JrJ('
Re('~"
.'
F,t DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
AlO :28 COUNTY
ACN
STEPHEN D TILEY
FREY & TILEY
5 S HANOVER ST
CARLISLE
'03 MAY 23
Cic.rk
P A 17 iOlJ:rfMlJ, ;"
r- ~
s 1-1-\
05-19-2003
EDDER
12-03-2001
21 02-0826
CUMBERLAND
101
Allount RiPllitted
*'
REY-1541 Ell. If' <Ol-ts)
EUNICE
E
) CHANGED
ll)
(2)
(3)
1<0)
(5)
(6)
(7)
.00
510.00
.00
.00
1.373.00
.00
.00
IB)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=iS'4-j-Eif-"FP--coFoil"NOi"icE-OF-YNHEifiTANCE-TAX-A'PPRA'iSEiiENi':--"LioWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF EDDER EUNICE E FILE NO. 21 02-0826 ACN 101 DATE 05-19-2003
TAX RETURN WAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule Al
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax R.turn
13. Charitable/Govarn..ntal Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Est.te Subject to Tax
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. A.aunt of Line l~ at Spousal rate (15)
16. Aaaunt of Line 14 taxable at Lineal/Class A rete (16)
17. AbDUnt of Line 14 at Sibling rate (17)
18. A.aunt of Line 14 taxable at Collateral/Class B rata (18)
19. Principal Tax Due
1,814.00
.00
Ill)
(12)
(13)
ll<o)
(9)
(10)
NOTE: To insure proper
credit to your account}
sub.it the upper portion
of this for. with your
tax payaent.
1,883.00
\.814 on
69.00
68.00
1. 00
14. 15 and,or 16, 17, 18 and 19 will
returns assessed to date.
.ooxoo=
.00 X 045 =
.00 x 12 =
.00 X 15 =
(19)=
.00
.00
.00
.00
.00
T6Y c.."nIT":
l+T AHOUNT PAID
DATE NUHBER INTEREST'PEN PAID 1-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIDN OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS.)
~OK
t/
STATUS REPORT UNDER RULE 6.12
Name of Decedent: EUNICE E. EDDER
Date of Death: December 3, 2001
Will No.
Admin. No. 21-02-0826
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:
1. State whether administration of the estate if complete:
Yes (X ) No ( )
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
(a) Did the personal representative file a final account with the
Court? Yes ( ) No (X ).
(b) The separate Orphans' Court no. (if any) for the personal
representative's account is:
(c) Did the personal representative state an account informally to
the parties in interest? Yes ( ) No ( )
(d) Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
:,1
r-
N
CJ',
e::::
/J -
~0A
Sign ure
I
-'1L41
Date: June 11, 2003
Stephen D. Tiley
Name
~
~
:z
:::>
.-,
,j
5 South Hanover Street
Address
(Dei:
a::
,....
p
,')
.0
;:;::
c\)=
:36
(717) 243-5838
Telephone No.
Capacity: ( ) Personal Representative
( X) Counsel for personal representative
FREY AND TILEY I ATTORNEY'S AT LAW
Account:
Date:
Payee:
Amount:
Memo:
F&T Checking-Orrstown
9/12/02
Register of Wills
31.00
Estate of Eunice E. Edder
Filing Fee & Certified Copies
{Jtl~
",,,1-
&' "
4 aU J
\ 'd-' ^ rfJ 0'1
advance \ u, rb
\/0
,g-
3772
31.00