HomeMy WebLinkAbout02-0982i'ET1TlON FOR YR013ATE and GRANT OF LET /TREKS
Lsta[e of George H. Landis No. °Z~ ~oZ - 7 ~~
also known as George H. Landis, Jr. To: '
Social Security No. -
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
"I'he petition of the undersigned respectfully represents that:
Your petitioner(, who ism 18 years of age~orrltler2~~ tl~e9e~C,~cut or _ named
in the last will of the above decedent, dated p 1 ~ ~~~xX
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Uecendent was domiciled at death in Cumberland Cowtty P nnsylvania, with
h is last family or principal residence at Claremont Nursing & Rehaf~i~itation,
375 Claremont Drive, Carlisle ~~- A/~ ,rte yy~,~. ?,~y,f, ~,,~. ~,,~,~
(list street, numb~and muncipality)
90 October 12 2002
Uecendent, then years of age, died ~ x~~c ,
at Claremont Nursing &,Rehabilitation Center __ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will off red for probate; was not the victim of a killing and was never adjudicated
incompetent: no exeep€lons
Uecendent at death owned property with estimated values as follows: 10 000.00
(If domiciled in I'a.) All personal properly $ ~
(If not domiciled in Pa.) Personal property in Pennsylvania $_
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ -0-
situated as follows: nc~n
WHEREFORE, petitioner( respectfully request(s) the probate of the last will ~kx~
presented herewith and the grant of letters Testamentary
(testamentary; administration e.t.a.; administration d.b.n.c.t.a.)
theron. .'
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b a ~. Riverview rive
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~;, E. Onalaska, WI 54650
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OATH OF PERSONAL REPRESENTATIVE
CUMMUNWLAL'I'H OF YLNNSYLVANIA 1 ss
CUUNTY OF ~-~
3'he petitioner( above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner) and that as personal represen-
tative(s`~ of the above decedent petitioner( will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed s n"`O~~ v,
before me this lst day of ~
ember 2002 °
- - ~
~z~~,> ~
Deceased
. W „Donna M. Otto, 1st Depute ster ~
NO. 21-2002-982
Estate of George H. Landis, a/k/a George H. Landis, JrDeCeaSed
llECREL++' OF YROI3ATE ANll GRANT OF LETTERS
AND NOW November -4th 2002 ~x , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
1"I' IS DECREED that the instrurnent(~dated April 25, 1997
described therein be admitted to probate and filed of record as the last will of
Georcie H. Landis, also known as George H. Landis, Jr.
and Letters Testamentary
are hereby granted to Dennis E. Snider
FEES
Probate, Letters, Etc. .........
Short CertificatesO ......... .
l~sx~~s~-it4vx .Bond........
x-Pages (2)
JCP
TOTAL
Filed .NOVelnbe.r.:4 this 2.00
$ 40.00
$ 6 ..66
$ 15.00
$ 6.00
$ 77.00
Register of Wills DO na Otto, st i
Deputy
JAMES D. CAMERON, ESQ.
I.D. NO. 53998
1325 DTO1z~~F0u~,. No.)
HARRISBURG, PA 17102
ADDRESS
(717) 236-3755
PHONE
~'
MAIL LETTERS TO ATTORNEY ON 11-04-2002
.. .
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~'~`~°~ ~ ~~~~'%``~I OCT 1 4 2002
P 8629735
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rJRey 2~8? COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALiH • VITAL RECORDS
CERTIFICATE OF DEATH
~: !A7E «~I F vt;'ntlEP
NAME OF DECEDENT If psi '.t. evr
. Landis
,.~eorge H Uln_______
AGE sr '~ "roavl UNDER I YEAR
Monrhe r UaYa
90 Yra
s.
- COUNTY OF DEATH
•Bb.Cumberland ~
bEx
_ __ _ _ _-.... ____._ ______ _~__.__.. _ ~L+CIAL-rECCR17yNUMdER DAiEOFCtAlhtlr,V.'.e..,~a: I
Jr. 2Male 3.716 - 09 - 7843 •. October 12, 2002
UNDER I DAY ATE Of BIRTtI BIR IHPLAr,E 1 PLACE OF C tATl i ~ . --~ -~ ---- --
: entl f
r.r
H r M 1 ~~ A -'ay -r' ~r` HOSPt1AL a~~OT HE R'~
~ B 5/25/ I2 SusquePAnna Twp ~anant we wannm _.~ DOAt „ ar'~IiX R ,,,,,. `''n°
u t t.~
--~- -'-- -- - __ _ - --- - -- _
CITY BORO, TWP OF DEATH FACnITV f AME Ir cal ~v I ~ . ~ue.•I '~ ~nu~ WAST,+DEC LCENT OF HISPANIC GRIGINV RACE Amera:u Inuiau dla..k, Whne. ere
No e' 1 'Na 1 11 / . sWC ry Cuban, `'Le::~P11
Me.lcan ? n w~a . we
Carlisle ~laremont Nursing&Rehabilitat ion B ,B White
DECECENT'S USUAL OCCUPATION _
Gve AU+do/wrxN .lor'e d<n:ro]r+~Gtt
of woramg Ina do na use rnerea) kIND OF dUSINESSIINDUSTRY _ WAS DECE ":EHI EJERIN DECEDENT'S EDUCATI.N MAHI iAL STAN ISMan aJ ~ SURVIVI~SPOUSE
US. ANMED fUHCESv ~ ly_ :yh D'.eV 1!er:e .YI caul Nav Ma 0 Ntbweo. III 1 Ie.r.a~ue ~a,. nl
E+e umlary+Sacor nary ~ Ilepq D vorced i_:ucx. h.
X7
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Brakeman
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'°I~ "`x;"
PA. Railroad Ye
Widower ts
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DECEDENT'S MAILING ADORESS~,oo caret. Gryr'ow .
.
. __
. __ _ _
n ;tale 2.p ~.wle, DECEDENT'S
ACTUAL ,7a. Slate_.__._Pa• ___-_~._-___ Did t7c.l_I Yee. decedem lead in _-~-_._____,_--__-_-n•D
375 Claremont Dr. RESIDENCE drkadant
Carlisle Pa. 17013
1 ISLe mvruwux~s Ina m a
Cumberland '°w^ah'D' N Np°eCp1e"1rved Carlisle
°^°'nn151tld1
170
11 wenm xtual limns of
,a
FATHER'S NAMEIF~rst. M~u:lle Lash
,B George H. Landis ,m~ °n
.
___ ..._ _ ._~~rylboro
ry.__._. _
MOTHER'S NAME:i ~~sl MuU~e Mn oai :.ui ,ar nl
Sr. ,B Ida B. Welker
INFORMANT'S NAME17ypxPnnr) INFORMANTS MAa1Hr ADDRESS rye eel, Crtyr ,Scare .'.gyp (-lxlel
N. 6032 Riverview Dr. E. Onalaska, Wisconsin 54650
Rev. Dennis E. Snider
mb
za
METHOD OF DISPOSITIyyO--N~1 rr'' DATE OF DISPOSITION PLACE OF DISPOSITION tame u~ Cem®lery, Cremalwy LOCATION ~ Clry/Tuwn. Scala. 2w Ca7s
Rural LJ Cromarwr u Removal Irom Stara ^ (MOrnh. Uay, YfNU of Omer Place
•
Donatan^ anerlspeoey) ^ October I5, 2002 Rolling Green Memorial
Lower Allen Twp. Pa. 17011
21a. ltd
21b. _ _ 2,c. ___ _ __-
~
NAME AND ADDRESS OF FACILITY
' SIGNATURE. OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH UCENSE NUMREH
FD-o (2774-L Richardson F.H.29 S. Enola Dr. Enola, Pa. 17025
22a. _ __ 22b. _ 22c. ___
Complete Hems 23a<only when camN~ng
~• Dhyslclarl w trot avallade al nme el death b
cemry cause of deem. To the best of my hnowladge. Jnatn occunad I Iha came. dale ano place slaletl LICENSE NUMBER DATE StGNEO
ISgnalure p Tiuel l jMUnm )ey, v art
L.
23.. n_ b -;~u>.~ ,is~:4_~~~-- _ _ 23b.R_N 3~ 3 i sc) ~ 2k. Q.h~Izt,- r:~ 1~Y)z.
Items 2428 muss De completed by TIME GF DEATH DATE PRONOUNCED DEADIMUnm. Day.:earl WAS CASE REFERRED 70 MEOKAL E%AMINEWCORONER?
• parson who pronourues death. ~ D L Vea LJ No '
~ M. 25. ~` lU ~ +~ ~ Z y ZCXT L. __ __ 28. _
24. ~
_
27. PART 1: Einar the diseases. inrynes a <omptrcabuns white roused Inv dealt. (b not amer Ina erode of dying, sucn as caru~ac or rnsp:ratury ariast. snow car nna;l,a~iwe I ApOro.rmate PART II: Omer s~gndKant conditions conlnWnrg t° deem bur
List oruy orw cause on each line. ~ interval between .wt resunmg in Iha urweMeg cause given .n PANT I.
o
nser and deem
IMMEDIATE CAUSE IFindl ~
disease or corWiom , L 1 ., 1 :...r L. tl ' l> ~~ •' • ~ "~ l i t.
,. r ' '. r ~ ~ .
resWbng cat deem)-~- a..
DUE TO IOR AS A CUFISEGUENCE OFD:
Sequentially eat conditions b _ .-
.__ ~_ ___-_.~______. -._ ~--_ ____ _..- F____ ______._ _. _ _.___
'
II any loading b immediate DUE 10IOR AS a CONSEOUE NCE OFt: 1
cause. Enter UNDERLYING I
'
~
• CAUSE IOisease or :ny,iy - -
• mat in4iate0 events OUE TO IOR AS A CONSEOUE NCE OF) I
tewbng In deaml UST
a__ i
___`___-_-.__~.____._~
_ __ _ _
WAS AN AUTOPSY WERE AUIOPSV FINDINGS MANNER OF DEATH GATE OF INJURY iiME OF INJURY INJURY AT WONKT DESCRIBE MON.' INJURY OCCURRED.
PERFORMED? AvAIUBLE PRIOR TO IMw.m I~ay rein
COMPLETION OF CAUSE M
M ~ I
N
l L
~
OF DEATH? awra
l
om
G
Yes ~~ Nu I
^ Pending lnvasugatwn ~_~
AcbOeM
_
Ves ^ N° LJ Yas ^ No 1= 30a. 30D ,_I"I_ 70c. 300.,.._ ______._
j Swwde ^ Could rot Cn Jelarm~naJ I pUCE OF IfJ,IIIRV A, Ica i n, ~ I I lory. ott¢a ~IOI: ATION 1~ rata ~~ryrT Sw el
budding ~ i„pac lvl 1
2Ba. 2BD.
29. 30e. 301
1
-L4 ~-
- -~ `- ~~~-
CERTIFIER 1Checa only met SIGNATURE AND TITLE OF '~Ei111FIEH
'CERTIFYING PHYSICIAN IPnyscan ten ty N :- Aea•I wnar•a.r leer car vsA an na u~ni,¢o .1 ~u..~~n.L _n?J~ i
~
Tome bast of my anowMdge, Death occurred dw to Iha cauae(aI arW manner as stated ... ...... ........... .............. '~'-~
31b. ~
LICE NSE NUMREf~ DATE SIGNED M a Uay, rear)
'PRONOUNCING AND CERTIFYING PHYSICIAN.' -car tvn .. :: tf 1 1 -, u.,e~.i.rr.n"~ ! '
._.._.~. _...... v...._.-w... w.-.n...... ..r .r .n. rim- n.r. -..n„ . .,.n n„er .~.r..ael .nn rr:.nr:ar ...i.ten 1 IIO i / 310
l ~.rac,.rr`YPa o~P~ni vr.r,no.~.r ..~n, w.rryc ~cu ~..ux v. uc.an
'MEDICAL EXAMINER/CORONER
`
' r , / ,,
"
On the basin of axaminanon andlor investlgabon, in my opinion, death occurred at ih<time, dale, and place and due to the causela) and ' i ~
'
manner as 3tated .... .... ........ ....... .. ... .. ...... ... ...... ._. ... .............. '
32 .
REGISTRAR'$$IGNATURE AND NUMBER
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~ ~ ~ DALE FI ED M n to ai.
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~5'-.~ I
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' - _--____ _..._ _ -
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r~_- -.
LAST WILL AND TESTAMENT OF
GEORGE H. LANDIS
I, GEORGE H. LANDIS, a resident of Enola, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this
instrument to be my Last Will and Testament, hereby revoking any
and all wills by me at any time heretofore made.
ITEM I: I direct my hereinafter named Executor to pay
all my just debts, funeral expenses, administration expenses and
inheritance, estate, succession or excise taxes, which I owe or may
become due on account of my death, as soon as may be convenient
after my decease.
ITEM II: All the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatever nature and
wheresoever situate which I may own or have the right to, I give,
devise and bequeath to Zion Evangelical Lutheran Church, of 265
North Enola Drive, Enola, Pennsylvania.
A: It is understood that the general bequest to Zion
Evangelical Lutheran Church (with the exception of the property
located at 226 Columbia Road, Enola, Pennsylvania) is to be used
to enable "active, ongoing" ministry within and beyond the
immediate boundaries of the congregation. In specific, it is my
request that the focus for use of this bequest be in the areas of
Youth ministry and Christian Education. A particular desire would
be to utilize this bequest for the employment of a second ordained
pastor or an Associate in ministry whose focus is Youth and
Christian Education.
~_
~- , ~ %~~ i (SEAL)
George H. andis
B: The residence at 226 Columbia Road is to be held
as a residential rental property for five (5) years. Revenue from this
property is to be placed in a memorial trust to be held by Zion
Evangelical Lutheran Church 265 North Enola Drive, Enola
Pennsylvania 17025, in the name of George H. and Claire M.
Landis. Principle and interest to remain with the trust. Should
Zion Evangelical Lutheran Church congregation begin a church
building (physical plant) renovation or expansion program
consistent with ministry growth before the year 2003, said residence
and trust may be disposed of and monies held be utilized to offset
anticipated debt incurred by said building program.
If by December 31, 2003 a program has not begun or
a formal plan in place to begin by the year 2005, the residence at
226 Columbia Road is to be sold with the proceeds of the sale with
any interest to be used for Youth Ministry and Christian education.
In addition, the established trust is to be dissolved
with the proceeds of the trust to be used for Social Ministry
concerns.
ITEM lll: t hereby nominate, constitute and appoint
Dennis E. Snider, Executor of this my last Will and Testament, with
full power in his discretion to do any and all things necessary for the
complete administration of my estate, with full power to sell at public
or private sale and without order of court any real or personal
property belonging to my estate, and to compound, compromise or
otherwise settle or adjust any and all claims, charges, debts and
demands whatsoever against or in favor of my estate as fully as I
could if living.
..~_
-~ ~/~-~~='~~. ~ ~.~~~ -~~~r ~ (SEAL)
George .Landis
A. If my said executor should predecease me or die
simultaneously with me, then I nominate, constitute and appoint Mr.
Patrick Arter of 1 Hunter Lane, Camp Hill, Pennsylvania 17011,
Executor, with the same power and authority as given to my said
Executor, Dennis E. Snider.
IN WITNESS WHEREOF, I have hereunto set my
hand and seal thisa5fi"Day of April, 1997.
ti ~_ ,
l ~ _ L (SEAL)
Georg H. Landis
Signed, sealed, published and declared
by the above-named George H. Landis
as his Last Will and Testament, in the
presence of us, who at his request, in his
presence and in the presence of each
other, we believing him to be of sound
and disposing mind, memory and
understanding, have hereunto
subscribed our names as witnesses
this~~~Day of April, 1997.
,, ~~
~, ' ( ~
~_
~_ ~~ ~ ~
r~ <~~:- ,. ,~' (SEAL)
George H. andis
oATi-~ or- suascr~~a~~v~ wiT~v~ss
Estate of George H. Landis _ _ No..__21_-20112-_9._8.2_.
also knowrr as George H. Landis. Jr_ __
~iatun;l
Dennis E. Snider
N. 6032 Riverview Drive
E.__Onalaska, WI .54650
(Addn;ssl
Dennis E. Snider
~ a Subscrillinq witness to lhr: LZ~X1~{Iwillp~l l>resenled herewilll,~ln;inq rluhr rtualrhed ar:curdrn{i
to law depuse(sl and say(s) that~/he/twasfrresent and saw Ilse alwve 1 esta~ur~r) srltn the same anll
that ~ii~/hel2st~ sr{lned as a witness at the request of I estaunin his}pg; trresc;nce null
in the presence of lire other sul~scrillin~ wituess(r~
ISillnalule)
(/~ddn;ssl _
Swum to ur aflinned and sulrscnl~ed
Ilefore nie Nos __(~~( day of
-------
Novemberl_ 2002. ___ x~xxx.
i ' ~ :.~
..r r ~
Notary Pulnc~ - 1
My Cununisslun Expues:
r .y........,,d ..d .d rr„~ r ~ ..u„~~ ..n.. ..r
,e,.,r r~~ .d~~..,,u ~, ,,.,,., rd.,,w d,u~ ,.r
l)eceasecJ
Notarled Seal
Shane R. Geyef, Notary Public
City Of Manisburg, Dauphin County
lyfy won Expires July 20, 2006
Member. PennsyNa~ia Assoaation Of NolBries
.~
.'
NOTE: To Inc taken liy ullir;er auihunted lu arJnunc,lui ~~;i~h,:.
f'luose have ~iresrnl Ihu un~~inal ur r.u~ry ul Insuunwnll:•1
al lone u( n018rlZallun.
RN-11
OATI-I OF SU[3SCf~If31~1G WITfVESS
Lstato v( George H. Landis __^__ No. ___ 21_2001-_982 _____
also known as George H. LandisR Jr.
Deceased
Jacqueline G. McElhattan~ ___
IK~)l:Dta suhst:ril+intl witness lu llrt: 1K.M+Yc}CC~StL~{?4}dwilll~ Irrese+rletl herewilli, hcirrc{ duly rtu;+lrl+ecl .+r.curelrne{
In law tlc{rUSels) arnl say(s) dial she/~[}2Mx~¢' was/9i[~M. {++r;senl and saw the about, feslatnrlp{~I slits Ilw sanu: anll
that slu:/IX9tDK17~Cs+{{ned as a wiUresS al the ret{uesl u( I eslalu+~) iir his/I~i{~rt ~i~{I+resencu ;Intl
t in tht: presence UI the Uther sulrscrihinll wilness~.
G: 7 ,~--
~.
-- -(Sii ir~,~trrt;~
acqueline G. ~ICElhattan
513 N. Enola Dr.
Enola, PA 17025_
-- -- - _ (address)
(Sit{n~liure)
__ _ -Inlldn;ssl ___
Sworn lu ur alhnncll and subscribed
bclorc ntc Ihr5 _--_ -___-- day ul
h
q~ '
Nulary Publrc; U
My Cunmlrssrun Lx{Ines:
., .Ln• ul N.n •., ~ na n.~o~+. 1
-. - _ :.rariaf Seel
City+.r•.y~tf`ti~r:)t!1 ~.MTrYNI{i__-'-'J
MY ~" "~': • ~:nires Joy 20, 2006
~~•_ - ~ sociaf3on Of Noaaries
NOTE: (u In: lakes Ily ullu:or mrNwrrtu<I lu ulluunc:tul I,arlls.
Please have {nusent the un{final ur sully ul Insuuun:ullsl
al tool: ul nulariTallull.
IRJ~L111iY Jat
Sham R. Geyer, Notary Public
t~ty Of Ft~tug, Dauphin t..txrrxy
lUly C,arlrrlia.~on Expires Joy 20.2006
Marrlber, Plerrmylvania Aseoc~orr Of Notaries
RH-11
National Grange Mutual
Insurance Company
21-2002-982
A Main Street America ~r~rnpany
In the Matter of the Estate of:
KNOW ALL MEN BY THESE PRESENTS, that we, Dennis E, snider
as Executor of the Estate of George H. Landis, Jr.
and National Grange Mutual Insurance Company, a New
Hampshire Corporation, of Keene, New Hampshire, as Surety, are held and firmly bound
unto the Commonwealth of Pennsylvania , in the full and just sum of
Twenty Thousand DOLLARS, ($20, 000.00 )for the
payment of which, well and truly to be made, we bind ourselves, our heirs, executors,
administrators, successors and assigns, jointly and severally, firmly by these presents,
Sealed with our seals, and dated this 21st day of October ,
2002
V~I-~REAS, Dennis E. Snider ,has been, or is about
to be appointed Executor of the Estate of George H. Landis, Jr.
by the Orphans
COUrt of Cumberland County.
NOW, THEREFORE, the condition of this obligation is-such, that if the said
Dennis E. Snider shall well and truly discharge the duties of said
trust according to law, then this obligation is void, otherwise to remain in full force and
effect.
W itn s
By:
~~-- csEai~
Dennis E. Snider
NATIONAL GRANGE MUTUAL
INSURANCE COMPANY
r-Ir.-Fact
C. nders
National Grange Mutual
Insurance Company
A Main Street America company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the National Grange Mutual Insurance Company, a New Hampshire corporation hav-
ing its principal office in the City of Keene, State of New Hampshire, pursuant to Article V, Section 2 of the By-Laws of said Company,
to wit:
"Section 2. The board of directors, the president, any vice president, secretary, or the treasurer shall have the power and authority
to appoint attorneys-in-fact and to authorize them to execute on behalf of the company and affix the seal of the company thereto,
bonds, recognizances, contracts of indemnity or writings obligatory in the nature of a bond, recognizance or conditional under-
taking and to remove any such attorneys-in-fact at any time and revoke the power and authority given to them. "Pursuant to
said by-law does hereby make, constitute and appoint HUEY A E LONG, DONALD E ENDERS JR,
GLENDA J AUKER, JAMES C ENDERS,
its true and lawful Attorneys-in-fact, to make, execute, seal and deliver for and on its behalf, and as i deed, bonds,
undertakings recognizances, contracts of indemnity, or other writings obligatory in the nature of a bo Oct to the following
lumtation:
1. No one bond to exceed dive Hundred Thousand Dollars ($SOO,000.00).
and to bind the National Grange Mutual Insurance Company thereby as fully and to the~~ t as if such instruments were
signed by the duly authorized officers of the National Grange Mutual Insurance Compaq '~v/ all the acts of said Attorney aze
hereby ratified and confirmed.
This power of attorney is signed and sealed by facsimile under and by the authority of ~ wing resolution adopted by the Direc-
tors of The National Grange Mutual Insurance Company at a meeting duly called on the 2nd day of December 1977.
Voted: That the signature of any officer authorized by the By-Laws and pang seal~y be affixed by facsimile to any
power of attorney or special power of attorney or certification of e' en for th eeution of any bond, undertaking,
recognizance or other written obligation in the nature thereof; s ature and st~~~~hen so used being hereby adopted
by the company as the original signature of such office and ~ginal se mpany, to be valid and binding upon
the company with the same force and effect as though u axed. ~~~
By execution of this Power of Attorney, National Granu al Insuran any does hereby revoke, rescind and declare
null and void any previous Power of Attorney at an previously to the aforesaid individuals ~'~;i Uiy~
/N W/TNESS WHEREOF, The National Grange Mutance Com caused these presents to be si,~j~"~,~' ~r'~~~
Secretary and its corporate seal to be hereto affix H day o~~~ 2001. THIS APPOIIVTM~ ~
~` ~ • .-
f. , r^
AND TERMINATE AUTOMATICALLY AS OF ER 31ST, 2 ess sooner o as e ` ~ ~~ , : ,t ~,
1 ~3 0,°=
NATIONAL GRANGE MUTUAL I NCE CO Y By: ' ~
THIS POWER IS INVALID IF RED D LIMP P TIONAL GRANGE MUTUA• INSURANCE_ W ENE~~I~V
HAMPSHIRE " IS NOT SHOWN II2ETY. ~ ~ ~;,~, +~ ~ \,
State of New Hampshire, C Q eshire d%„~f;,,i,~`££ t~;=.. ~`'~~~~``~
~a~
On this 15TH day of Octo r 001, befo u~scriber a Notary Public of the State of New Hampshire in and ~oift~`~"~ounty of
Cheshire duly commis e d qualifie b William C. McKenna of the National Grange Muhxal Insurance Company, to me
personally known to officer es erein, and who executed the preceding instrument, and he acknowledged the execution
of same, and bei a fully osed and said that he is an officer of said Company, aforesaid: that the seal affixed to the
preceding i t~ is the corpo eal of said Company, and the said corporate seal and his signature as officer,v~"te ~ ~ n ~ "`Fixed
and subsc the said instrument b the authorit and direction of the said Com an that Article V, Sectio `~ ~ ~ ~ '
Y Y P Y~ ~ ~q~'~$Y=js~bf
said is now in force. a ~~-.~'` _ °'•.y,. '
/ SS WHEREOF, I have hereunto set my hand and affixed by official seal at Keene, New Hamp yire Etrir '~~ T `~ ~ 1"~
~15T day of October 2001. e.~ o. o -~
yrPublic ~ f~ ~ 8 !- t
~/,~, ' ~ ~v
My Commission Expires: May 13;'~003ry ' `° ~ " ` ,~ ~,t'~,.~
I Lyn E. Landry, Assistant Vice President of the National Grange Mutual Insurance Company, do hereby certify t~i'at•t~i~~~i{~ ~1d
foregoing is a true and correct copy of a Power of Attorney executed by said Company which is still in force and effect.
/N W/TNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Company at Keen ,New ampshire this
21st day of October , 2002 ~~///~
~/ ~_
Assistant Vice Preside
~L~~Ijlll~g-- Any unauthorized reproduction or alteration of this document is prohibited. This power is void unless seals are readable
and the certification seal at the bottom is embossed. The diagonal imprint, warning and confirmation must be in red ink.
CONFIRMATION Of validity of attached bond, call NGM at: Keene 603-358-1339; Richmond 804-270-6611 ext. 138;
Syracuse 315-434-1410.
CERTIFICATION OF NOTICE UNDER RULE 5.6(al
Name of Decedent: George H. Landis,
also known as George H. Landis, Jr.
Date of Death: October 12, 2002
No. 2002-00982
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
November 20, 2002:
Name Address
Zion Evangelical Lutheran Church 265 North Enola Drive
Enola, PA 17025
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except no exceptions
Date• 11/2002
Harrisburg, PA 17102
Telephone f717) 236-3755
Capacity: Personal Representative
X Counsel for personal
representative
Address 1325 N. Front St.
~NV~N~-o~~Y
[ ~ t a t r r u[ GEORGE H. LANDI S
alzu ktlt,wn as GEORGE H. LANDIS, JR.
~:
r.~~,. 2002-0982
- _._ -
w
Date c,[ Death OC`T'OBER 12, 2002
Decease(! Social Security N~. 716-09-7843
I, DENNIS E._ SNIDERL________
f'~r,~uurl Rnrrrnnnnlndv"1'}~ot tlrn nhovn EsUn n, tl ecnosnd, verily lhnt Ihrr ilnnrs nprrnnrintl in the Inllo wlnN invenlnry include sill
.,I U.n t.nrnnnnl nn~ntn wherever siUrnln and ell of Ihn tool oslnlo in Ilrn (; r,rrrrrronwordlh rrl I'nnnsylvnnia vl snid L)ncr~dnnt, Ihnt
I,.n anhmUun rrlnrnd nrilmciln nnnh ilmn ul snid Invnnlury rnprnsnnls it^, fair vnlun ns u( the dsrte ul the Uocedr•nt's donut, and
r,~nt i rnr•n,lnnt awned nn reel nntntn outside of Iho Cunrnronwonlllr ul I'nnn^. ylvnnin nr,cnlil Ilvrt wlriclr nlrrm nr^, in n nrnnrursu idum
nr rl~.. nnJ of Ihin invnulory, 1/a(pb verily lhnl lhn ntninnwnis nmdn in thin Invnnlury ore tern and currncl. I/¢Q}[nndmctnnd llrnl
Inlan nlnlmnnnla Irornin ern rnndn aubjncl lu ihn lronollios of 18 t'n. L.S. Soctiun 49Uri rolntiny to unswurn Irrlarlir;nliorr to
nul L.nrUnn
F'nrsonnl Rnlnn,senlnlivn:
rlnnrn nt
/111rrnrn -,
v JAMES _ D._ CAMgZON - - - - - - ---_ _ _ _ . _. _. _ _ _ _ _ _ _. ~',^.~1'~
- - ---
t u u,r 58998 IS E. SN , EXEC'7TOR
___ ---
n.,,tr-,n 1 325 NORTH FRONT STREET IJntnd~ _ ~ •- 3U > ~
HARRISBURG, PA 17102
-- - -
r nt~t,t..,rrn (717) 236-3755
Doscription
Allfirst Bank checking account number 0016429524
Accrued interest, Allfirst Bank checking=.account
number 0016429524
Allfirst Bank savings account number 0098176471
Accrued interest, Allfirst Bank savings account
number 0098176471
Waypoint Bank certificate of deposit number 905059680
Accrued interest, Waypoint Bank certificate of deposit
number 905059680
Claremont Nursing and Rehabilitation Center
(patient care account)
Metropolitan Life Insurance Company group policy
nt.unber 1023000
(PLEASE SEE ATTACHED FOR CONTINUATION)
(nll~r-h Arirhtinn;ll Slurnt~ it nrr.essnry)
Valur~
2,096.14
-~ "-
~~' X26
w°
30,O~T2,43
---~
.~-
17.58 "~
T-,
18, 5.2-x,.88 -'
--,
;tea
304.28
62.81
2,00000
Tatar; $58, 201.52
!1111( lha 1.lnmorendum ul real ~etnln ouleida lho Conunonweallh of Penusylvnni~ may, nl the election of Ilir, personal represenlntive. include
Ilrn .alna of each item, but each lipurae ehuuld nol ba extondnd into lho lulnl nl !lie Invenlury.
lu-U
INVENTORY (page 21
Estate of George H. Landis,
also known as Georae H Landis Jr. deceased
Capital Blue Cross 334.10
(refund on health insurance premium)
Railroad Retirement Board
(funeral benefit)
969.10
Railroad Retirement Board 600.00
(additional funeral benefit--Veteran status)
United States Treasury
(income tax refund)
1,080.00
Capital Blue Cross 2,137.94
(reimbursement for prescription medications)
my vnUnroi
COMMONWEALTH OF ` ~ L. Y -15 0 0~ OFFICIAL USE ONLY
PENNSYLVANIA
v ~
DEPART
EVENUE INHERITANCE TAX RETU-RN FILE NUMBER
UEPT2800 ? 1 _ 0 2 0 9 s z
~, HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNttCODE YFAR NUM9ER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z LANDIS, GEORGE H., A/K/A GEORGE H. LANDIS, JR. 716 - 04 - 7843
W DATE OF DEATH (MM~DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
W 10f12/2002 OSj25f1912 REGISTER OF WILLS
U
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
0 N/A - -
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return lame of aeaN VSore rail-szl
~ ~ ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise Idaieaaeem ane, laiz ezl ~ 5. Federal Eslale Tax Return Required
w
~ n m ®6. Decedent Died Teslale tannin rwv of wnp ~ 7. Decedent Maintained a Living Trust 4aaacn avr a Jmsq ~ 6. Total Number o1 Safe DeposN Boxes
9. Litigation Proceeds Received ^ 1D. $p009a1 POV¢dy Cfedll Inate of nea0 pat«een 1PJi-91 and 11951 ~ 11. Election to tax under Sec. 9113(A) lAnad, sm of
r-
w
=
NAME
ESQ
JAMES D
CAMERON
COMPLETE MAILING ADDRESS
,
.
.
1325 NORTH FRONT STREET
g FIRM NAME 1nMOxudel HARRISBURG, PA 17102
o TELEPHONE NUMBER
717 236-3755
1. Real Estate (Schedule A)
11) -0- OF IAL USE; LY
~~ :„ rr
2. Stocks and Bonds (Schedule 8) (2) -0- { 3
_0_
3. Obsely Held Caporalion, Padnership or Sale-Proprietorship (3) ~„ -<
1
/. Mortgages 8 Notes Receivable (Schedule D) (4) -0- J
5. Cash, Bank Deposits 8 Miscellaneous Personal Properly (5) 56, 201 , S2
Z (Schedule E)
_0-
o ..
O 6. JolnVy Owned Property (Schedule F) (6)
~ Separate Billing Requested
s -o-
~ 7. In1er•VHOf Transfers 8 MfsceNaneous Non-Probate Prooedv (T) _..
a
Q
U
W
0.'
2
Q
F-
a
U
(Sriredub G a L)
B. ToW Groea Aaae4 (total Unes 1-7) ~ - (B) 56, 201 , 52
9. Funeral Expenses BAdmintsbe9ve Costs (Schedule H) (9) 1 1 , 632.74
10. Debts of Oeoedenl, Mortgage LlabAilies, 8 Liens (Schedule f) (10) ~~ ~ gg7 77
11. Total Dedudlone point Llnas 9 8 10) (11) 32, 620.51
12. Net Value of Estate (Line 6 minus Llne 11) (12) 23, 581 , 01
13. Chedtable and Governmental BequestslSec 9113 Trusts for which an election to laz has not been (13) 23 , 581 , 01
made (Sdredule J)
1/. Nel Value Sub)ecl to Tax (Line 12 minus Line 13) (14) -0-
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Artrounl of Llne 1/ taxable al the spousal tax
rate, a transfers urder Sec. 9116 (a)(1.2)
16. Amount of Une 111axable at lineal rate
17. Amount of Llne 14 Wzable al sibling rate
x .0 _ (15)
x .0 _ (16)
x .12 (17)
7B. Amount of Line 141axable al allateral rate x .15 (16)
19. Tax Dw (191
20. ^ • e e e e
{
Decedent's Complete Address:
STREET ADDRESS
CLARIIhONT NURSING AND REHABILITATION CENTER, 375 CLARII~IONT DRIVE
CITY CARLISLE STATE PA ZIP ~ 701 3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. CredilslPayments
A. Spousal Poverty Credit
R. Pdor Payments
C. Discount
-0-
Total Credits (A+ B + C) (2) -0-
InteresUPenalty it applicable
D. Interest
E. Penalty
Total Inlerest/Penally (D + E )
II Llne 2 Is greater than Line 1 +Lina 3, enter the difference. This is the OVERPAYMENT.
Check box on Page i Lina 20 to request a refund
5. II Line 1 + Line 3 is greater Than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the lax due.
(3) -0
(4) -Q-
l5) -D-
(5A) -0-
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) -Q-
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
i. Did decedent make a transfer and: Yes No
a. retain the use or income of the property Iranslerred :.................................................................................... ...... ^
b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^
d. retain a reversionary interest; or ................................................................................................................... ....... ^ ®..
d. receive the promise for life of either payments, benefits or care7 ............................................................... ....... ^
2. If death occuned after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate censideralion7 ....................................................................................................... ....... ^
3. Did decedent own an'in trust for" or payable upon death bank account or security at his or her dealh7 ....... ....... ^
4. Did decedent own an Individual ReOrement Account, annuity, or other non-probate property which
contains a beneficiary designalion7 .....:........................................................................................................... ....... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
UMn penalties of perjury. I dedere Mal I have examined This reNm, Induding ecwmpanying schedules and statements, and to the best of my knowledge antl belies, d is True, correct and complete.
Detlarolipn d aeperor oMer Men Me personal reoresenWtive Is based on all information pf which Dreparer has any knowledge.
DATE
~- 30 - 03
N6032 RIVERVIEW DRIVE EAST, ONALP.SICA, WI 54650
Fa dates of death on or after July 1, 2000:
The lax rate Imposed on the net value of Uansfers from a deceased child hvenly-one years of age or younger al death to or for the use of a natural parent, an adoptive parent,
a e stepparent of the child is OY° 172 P.S. §9116(a)(1.2)j.
The lax rate Imposed on the net value of Uansfers 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)l.
The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. §9116(a)(1.3)). Asibling is defined, under Section 9102, as an
Individual who has al least one parent In common with the decedent, whether by blood or adoption.
Fa dales of death on or after 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. §9116 (a) (1.1) p)I•
Fa dales of death on or a8er January 1, 1995, the lax rate imposed on the net value of Iranslers to or for the use of the surviving spouse is 0% (12 P.S. §9116 (a) (1.1) (ii)j.
The sleNte does not exempt a transfer to a surviving spouse Irom 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.
,. '9'0 ~-' ~. .. 2m, ' ,
~. c.T~ ~ s•ts : r n ~, r r .,lie r; ..
.~,;~AS.;x a `r'~r '~';e~~~°~"M 4 4' :.r!v~.+e x .~~~ i+~ti' ,~'r:'f ;'"'fir `"~Pb~6 ..
21-2002-9$2
LAST WILL AND TESTAMENT OF
GEORGE H. LANDIS
I, GEORGE H. L.ANDIS, a resident of Enola, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this
instrument to be my Last Will and Testament, hereby revoking any
and all wills by me at any time heretofore made.
ITEM I: 1 direct my hereinafter named Executor to pay
all my just debts, funeral expenses, administration expenses and
inheritance, estate, succession or excise taxes, which I owe or may
become due on account of my death, as soon as may be convenient
after my decease.
ITEM II: All the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatever nature and
wheresoever situate which I may own or have the right to, I give,
devise and bequeath to Zion Evangelical Lutheran Church, of 265
North Enola Drive, Enola, Pennsylvania.
A: It is understood that the general bequest to Zion
Evangelical Lutheran Church (with the exception of the property
located at 226 Columbia Road, Enola, Pennsylvania) is to be used
to enable "active, ongoing" ministry within and beyond the
immediate boundaries of the congregation. In specific, it is my
request that the focus for use of this bequest be in the areas of
Yeuth ministry and Christian Education. A particular desire would
be to utilize this bequest for the employment of a second ordained
pastor or an Associate in ministry whose focus is Youth and
Christian Education.
~~ c ~ . r ~ (SEAL)
George H. andis
B: The residence at 226 Columbia Road is to be held
as a residential rental property for five (5) years. Revenue from this
property is to be placed in a memorial trust to be held by Zion
Evangelical Lutheran Church 265 North Enola Drive, Enola
Pennsylvania 17025, in the name of George H. and Claire M.
Landis. Principle and interest to remain with the trust. Should
Zion Evangelical Lutheran Church congregation begin a church
building (physical plant) renovation or expansion program
consistent with ministry growth before the year 2003, said residence
and trust may be disposed of and monies held be utilized to offset
anticipated debt incurred by said building program.
If by December 31, 2003 a program has not begun or
a formal plan in place to begin by the year 2005, the residence at
226 Columbia Road is to be sold with the proceeds of the sale with
any interest to be used for Youth Ministry and Christian education.
In addition, the established trust is to be dissolved
with the proceeds of the trust to be used for Social Ministry
concerns.
ITEM 111: I hereby nominate, constitute and appoint
Dennis E. Snider, Executor of this my last Will and Testament, with
full power in his discretion to do any and all things necessary for the
complete administration of my estate, with full power to sell at public
or private sale and without order of court any real or personal
property belonging to my estate, and to compound, compromise or
otherwise settle or adjust any and all claims, charges, debts and
demands whatsoever against or in favor of my estate as fully as I
could if living.
.mil-2o-zat /~c~G.~.~ (SEAL)
Ge~ Landis
~„ ~ .,,.
;,,
'' t ~..
A. If my said executor should predecease me or die
simultaneously with me, then I nominate, constitute and appoint Mr.
Patrick Arter of 1 Hunter Lane, Camp Hill, Pennsylvania 17011,
Executor, with the same power and authority as given to my said
Executor, Dennis E. Snider.
IN WITNESS WHEREOF, I have hereunto set my
hand and seal this~+'`Day of April, 1997.
~~ ,
Georg .Landis
Signed, seated, published and declared
by the above-named George H. Landis
as his Last Will and Testament, in the
presence of us, who at his request, in his
presence and in the presence of each
other, we believing him to be of sound
and disposing mind, memory and
understanding, have hereunto
subscribed our names as witnesses
thisa~tDay of April, 1997.
4
,~ -
_~_- ,mod.-~ ~c ~ l~'CLvts~Ln ' (SEAL)
George H. andis
(SEAL)
REV-1508 EX.11~9q
SCHEDULE E p
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8r MISC.
wHli sioErciTliECEOEr~iTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
GEORGE H. LANDIS, A/K/A GEORGE H. LANDIS, JR. 21-02-0982
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
~ Allfirst Bank
1200 Market Street
Lemoyne, PA 17043
Checking account number 0016429524
2. Allfirst Bank
1200 Market Street
Lemoyne, PA 17043
Accrued interest, checking account number 0016429524
3. Allfirst Bank
1200 Market Street
Lemoyne, PA 17043
savings account number 0098176471
4, Allfirst Bank
1200 Market Street
I~noyne, PA 17043
Accrued interest, savings account number 0098176471
5. Waypoint Bank
P.O. Box 1711
Harrisburg, PA 17105-1711
Certificate of Deposit number 905059680
6. Waypoint Bank
P,O, Box 1711
Harrisburg, PA 17105-1711
Accrued interest, certificate of deposit number 905059680
7. Claremont Nursing and Rehabilitation Center patient care
account number 3575
(PLEASE SF,F ATTCHED FOR CONTINUATION)
2,096.14
26
30,072.43
17.58
18,526.88
304.28
62.81
TOTAL (Also enter on line 5, Recapitulation) I b 56 , 201 , 52
(If more space is needed, insert additional sheets of the same size)
SCHEDULE E (pane 21
Estate of George H. Landis,
also known as George H. Landis, Jr., deceased
Date of Death: October 12, 2002
File No. 21-02-0982
8. Capital Blue Cross 334.10
(refund on health insurance premium)
9. Railroad Retirement Board 969.10
(funeral benefit)
10. Railroad Retirement Board 600.00
(additional funeral benefit--Veteran status)
11. United States Treasury 1,080.00
(income tax refund)
12. Capital Blue Cross 2,137.94
(reimbursement for prescription medications)
allfirst
Alll'irst Financial Center N.A.
I?O. L3ux 9UU
Millsboro, DE 19966
Phone (302) 934-2909
F ax (302) 934-2955
December 3, 2002
James Duryea Cameron
Attorney At Law
,~
,,r.'~
1325 North Front Street (~~ ~ n
~'~ U ~ .Ca.i_t_;.~__
Ilarrisburg, PA 17102 i ~'!
`' ~' LIEC ~1 `3 2002
Re: L•stateofGeotgeHLandis Ll~tiil'~]~~::i__3i_i•iJ
Social Security: 716-09-7843 _--.-_______________.___.-
Date of Death: October 12 2002
Dear Sir or Madam:
I'cr your inyuiry dated November 18, 2002, please be advised that at dte time of death, the above-named decedent had on
deposit with this bank the following:
I. 7jpe ojAccou»t Relationship Checking W/lnterest
Accoun[Nuntber 0016429524
Ownership (Names of) George H Landis, Owner
Opening Dnte
Qalunce on Date ojDeath
Accruerllnterest
Iota!
2. 7jpe ojAccount
Accowu Number
Ownership (Nantes oJJ
Opening Date
Qnlnnce at Date ojDead:
Accrver/ /merest
7olrrl
Denis E Snider, POA
0///4/98
$2,096. l4
$ IG
$2, 096.40
Matey Fund Alternative
0098/7647/
GeotgeHLandis, Owner
Dennis E Snider, POA
0//!4/98
$3Q 072.43
$ 17.58
$30,090.01
This lellrr does no! inrhrde mty nccotuus in which the derensed rnny Itnve been lis(ed ns Poorer ofAUOniey,
Custodinn of Uniform 7rnnsfers, Represen(ntive Pn~re, or Trustee under n IPr'itten Agreement.
h iu~n'dter nrrnunt it fnrrrmlion, closures and/or reinrGursern¢nt of funds ref ~r ro bP(ot~ Grnnclc
\VESF SIIOKF. PLA7,A OFFICE
1200 111AKKF.T STRF,F.T
I,F.MOVNR, 1'A 17043
717-255-2271
Sincerely,
Sue Kimble
Assistant I
Cis Services, (302) 934-2909
~-~ Waypont
LOOK FOR US. WE'll GET YOU THERE.
11/22/2002
JAMES DURXEA CAMERON
1325 N FRONT ST
HARRISBURG PA 17102
The information which you requested on the account(s) of GEORGE H LANDIS
(Social Security Number 716-09-7843) islaze as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
905059680
CERTIFICATE
01/29/85
18526.88
304.28
18831.16
Account Ownership SOLE
Name of Joint
Owner, if any
Uate Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
lnfonnation
Requested
1Ll_~~V I~~ OG21_li,r14
~ .~~ NO 2 ' ~ ~~
Si erely,
~~~ [,~ Gz~~ ~
KATI~ UN
SENIOR SERVICES REP.
P.O. BOX 1711, HARRISBURG. PENNSYLVANIA 17 10 5-17 11
Toll FrEE I-866-WAVPOINT (I-866-929-7646) ~ IN YoRI<ARen 717/HIS-4500 ~ yyww.waypointbank.com
PEV ISIIFA. ~19)I '
COMMONWEAL? H OF PENNSVEVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
GF7~RGE H. LANDIS, A/K/A GEORGE H. LANDIS, JR. 21-02-0982
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t. Richardson Funeral Home, Inc. 2,380.00
2. Rolling Green Cemetery
(grave opening)
B. ADMINISTRATIVE COSTS.
1. Personal Representative's Commissions
Name or Personal Representative ls) Rev. Dennis E. Snider
389-58-1606
Social Security Numbers) I E1N Number of Personal Representativels)
street Address N6032 Riverview Drive East
ciN Onalaska state WI Zip 54650
870.00
2,910.00
Yearls)Co : "'°~~"
p AnomeyFees James D. Cameron, Esq. 2,910.00
g_ Family Exemption. (II decedent's address is not the same as claimant's, attach explanallon)
Claimant
Street Address
_Q_
City Slate Zip
Relationship or Claimant to Decedent
4 Probate Fees
Register of Wills of clunberland County 77,00
5 Accountant's Fees
6 TaxRetumPreparersFees (final lifetime returns) 200.00
~. Enders Insurance Associates (fiduciary bond premium) 100.00
8. Register of Wills of Clunberland County (short certificates) 9.00
9. tlunberland Law Journal (legal advertising) 75.00
10. The Sentinel (legal advertising) 98.69
11, Dennis E. Snider (reimbursement--travel expenses for funeral
and probate of Will) 1,999.01
(PLEASE SEE ATTACHID FOR COf1TINUATION)
TOTAL IAlso enter on line 9, Recapilulalion) I $ 11, 632.74
more space Is needed, insert additional sheets of the same size)
SCHEDULE H (,tae 21
Estate of George H. Landis,
also known as George H. Landis, Jr., deceased
Date of Death: October 12, 2002
File No 21-02-0982
12. Register of Wills of Cumberland County 9.00
(additional short certificates)
13. FedEx 17.04
14. Register of Wills of Cumberland County 13.00
(filing fee--Inventory)
15. Register of Wills of Cumberland County 15.00
(filing fee--Pennsylvania Inheritance
Tax Return)
REai5i3 E%~ (f 9)I
` -, ~ SCHEDULE
~' DEBTS OF DECEDENT
COMMONWEALTH OF PENNSYLVANIA f
'"HERITANCE TAX RETUftN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GORGE H. LANDIS, A/K/A GEORGE H. LANDIS, JR. 21-02-0982
Include unreimbursed medical
NUMBER DESCRIPTION
1. Claremont Nursing and Rehabilitation Center
(nursing home care for June, July, and August, 2002; check
written on Decedent's bank account prior to death which cleared
after date of death)
2. Pinker & Associates
(medical expense not covered by insurance)
3. Capital Blue Cross
(automatic deduction of medical insurance premium from bank
account in October, 2002)
4. Capital Blue Cross
(automatic deduction of medical insurance premium from bank
account in November, 2002)
5. Thomas Dental Laboratory
(dental expense not covered by insurance)
6. Claremont Nursing and Rehabilitation Center
(nursing care--balance due)
AMOUNT
16,675.86
100.00
167.05
167.05
34.75
3,843.06
TOTAL (Also enter on line 10, Recapitulation) I $ 20,987.77
(If more space is needed, inseA additional sheets of the same
YV'I~IL ~P Ip ~ 1
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cuMwrmF~tnr a otnnsrtvrunn
nnlF nilnnCE rq( nENnN
OESIUENr UECEt1E 111
ESTATE OF
SCHEDULE)
BENEFICIARIES
GEORGE H. LANDIS, A/K/A GEORGE H. LANDIS, ,7R.,DECEASID
NFAOER I NAME AWU AUURESS OF PERSOT
I 1 AXAULE UIS T RIBU 1IONS (include uuhiyhl
Z
RECEIVING PROPERLY ( Uo Not Llsl
21-02-0982
OF ESTATE
ENTER UOLIAR AMOUNTS FOR UISTRIUUTIONS SHOWN ABOVE ON LINES 15 1HROUGH I7, AS APPROPRIATE, ON REV 1500 COVER SHEET
{{, IJUN~lAX1rULEUISIRIUUIIONS:
A SPOUSAL UISiRI0UTI0NS UNUER SECTION 9113 FOR WHICN AN ELECTION TO TAX IS NOT BE1NG MADE
0. CIIARITAULE ANU GOVERNMENTAL DISIRIUUTIONS
I' Zion l~angelical Lutheran Church
265 North Enola Drive
Enola, PA 17025
TOTAL OF PART 11 • ENTER TOTAL NONTAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SNEET I § 23, 58'1 .07
(II more space is needed, Insert additional sheets of the same size{
s//(/ '
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
JAMES D CAMERON ESQ
1325 N FRONT ST
HBG PA 1710,2
t`` ~
.,1''( ,
REV-1547 E% AFP (01-03)
DATE 06-16-2003
ESTATE OF LANDIS GEORGE H
DATE OF DEATH 10-12-2002
FILE NUMBER 21 02-0982
_,~';~OUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP CO1-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LANDIS GEORGE H FILE N0. 21 02-0982 ACN 101 DATE 06-16-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
~1) .00 NOTE: To insure proper
c2) .00 credit to your account,
(3) ,QO submit the upper portion
~4) .00 of this form with your
c5) 56,201.52 tax payment.
c6) .00
C7) .00
~$) 56,201.52
APPROVED DEDUCTIONS AND EXEMPTIONS: 11,632.74
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 20,987.77
11. Total Deductions (11) 32.620.51
C12) 23,581.01
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le J) C13) 2 3,581.01
T
t t
b (14) .00
14. o
ax
jec
Net Value of Estate Su
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
cis) • 00 X 00 = . 00
c16) .00 X 045 _ .00
cin .00 X 12 = .00
cie) .00 X 15 = .00
ci9)= .00
IMA VRLLIIJ~
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID C-)
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
~ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
w orrnun crc orvCDCC cTnG OF TLITC FnRM FOR TNSTRIl f.T70NS-)
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION NO. 2002-0982
FIRST AND FINAL ACCOUNT
OF
DENNIS E. SNIDER, EXECUTOR
OF THE
ESTATE OF GEORGE H. LANDIS,
ALSO KNOWN AS
GEORGE H. LANDIS, JR., DECEASED
Date of Death: October 12, 2002
Date of Executor's Appointment: November 4, 2002
Advertisement of Grant of Letters:
Cumberland Law Journal--December 27, 2002, and
January 3 and 10, 2003
The Sentinel--November 22 and 29, and December 6, 2002
Accounting for the Period: October 12, 2002 through July 1, 2003
Purpose of Account:
Dennis E. Snider, Executor, offers this account to acquaint
interested parties with the transactions that have occurred
during his administration.
The account also indicates the proposed distribution of the
Estate.
It is important that the account be carefully examined.
Requests for additional information or questions or objections
can be discussed with:
James D. Cameron, Esg.
1325 North Front Street
Harrisburg, PA 17102
(717) 236-3755
SUI~IIKARY AND INDEX
Proposed Distributions
to Beneficiaries
Page
9
3-4 58,256.92 58,256.92
24,687.17 24,687.17
Principal:
Receipts
Less Disbursements--
Debts of Decedent
Funeral Expenses
Administration Expenses
Federal & State Taxes
Fees & Commissions
Balance Before Distributions
Distributions to Beneficiaries
Principal Balance on Hand
Income•
Receipts
Less Disbursements
Balance Before Distributions
Distributions to Beneficiaries
Income Balance on Hand
Combined Balance on Hand
5 20,874.08 20,874.08
5 3,250.00 3,250.00
5-6 3,141.75 3,141.75
6 722.00 722.00
6 5,820.00 5,820.00
Fiduciary
Current Acquisition
Value Value
24,449.09 24,449.09
-0- -0-
24,449.09 24,449.09
8 238.08 238.08
-0- -0-
238.08 238.08
-0- -0-
238.08 238.08
2
24,687.17 24,687.17
RECEIPTS OF PRINCIPAL
Fiduciary
Acquisition
Value
Assets Listed in Inventory
(Valued as of Date of Death)
Allfirst Bank checking account
number 0016429524 2,096.14
Allfirst Bank checking account
number 0016429524 (accrued interest) .26
Allfirst Bank savings account
number 0098176471 30,072.43
Allfirst Bank savings account
number 0098176471 (accrued interest) 17.58
Waypoint Bank certificate of deposit
number 905059680 18,526.88
Waypoint Bank certificate of deposit
number 905059680 (accrued interest) 304.28
Metropolitan Life Insurance Company
group policy number 1023000 2,000.00
Capital Blue Cross 334.10
(refund on health insurance premium)
Claremont Nursing & Rehabilitation Center
patient care account number 3575 62.81
Railroad Retirement Board 969.10
(funeral benefit)
Railroad Retirement Board 600.00
(additional funeral benefit--Veteran status)
United States Treasury 1,080.00
{income tax refund)
Capital Blue Cross 2,137.94
(reimbursement for prescription medications)
Total Inventory $58f201.52
3
Receipts Subsequent to Inventory
(Value When Received)
Railroad Retirement Board 55.40
(additional funeral benefit)
Total Subsequent Receipts 55.40
Adjustment to Carrying Values
None
TOTAL RECEIPTS OF PRINCIPAL $58,256.92
4
DISBURSEI~[ENTS OF PRINCIPAL
Debts of Decedent
10/18/02
10/21/02
10/21/02
12/16/oz
12/16f02
To Be
Paid
Claremont Nursing & Rehabilitation Center
(nursing home care--June, July, August)
Pinker & Associates
(medical bill not covered by insurance)
Capital Blue Cross
(automatic deduction of insurance premium)
Thomas Dental Laboratory
(dental expense not covered by insurance)
Claremont Nursing & Rehabilitation Center
(nursing home care--balance due)
Mobile X-Ray Imaging, Inc.
Totals
16,675.86*
100.00*
167.05
34.75
3,843.06
53.36
(medical expense not yet paid by insurance)
$20,874.08
Funeral Expenses
10/14/02 Richardson Funeral Home, Inc. 2,300.00
(funeral costs )
12/16/02 Richardson Funeral Home, Inc. 80.00
(funeral costs--balance due)
10/14/02 Rolling Green Cemetery 874.00
(grave opening)
$3,250.00
Administration Expenses
10/18/02 Allfirst Bank 31.00
(NSF charge--checking account)
10/22/02 Allfirst Bank 62.00
(NSF charge--checking account)
11/01/02 Register of Wills of Cumberland County 77.00
(probate fee)
11/01/02 Enders Insurance Associates 100.00
(fiduciary bond premium)
12/09/02 Register of Wills of Cumberland County 3.00
(short certificate)
12/16/02 Register of Wills of Cumberland County 6.00
(short certificates)
12/16/02 Cumberland Law Journal 75.00
(legal advertising)
*Denotes checks written on the decedent's checking account prior
to death which cleared after the date of death.
5
12/16/02 The Sentinel 98,69
(legal advertising)
12/16/02 Dennis E. Snider 1,949.01
(reimbursement--travel expenses)
12/19/02 Allfirst Bank .01
(maintenance fee--savings account)
4/14/03 James D. Cameron, Esq. 200.00
(income tax preparation--1040; PA-40)
04/25/03 FedEx 17.04
(income tax returns)
05/09/03 Register of Wills of Cumberland County 23.00
(filing fee--Inventory and Inheritance Tax)
07/01/03 Reserve for filing fees and other
contingencies 500.00
$3,141.75
Federal and State Taxes
04/14/03 PA Department of Revenue 722.00
(form PA-40; final lifetime return)
$722.00
Fees and Commissions
12/30/02 James D. Cameron, Esq. 2,000.00
(attorney's fee)
04/25/03 James D. Cameron, Esq. 910.00
(attorney's fee)
04/25/03 Rev. Dennis E. Snider 2,910.00
(personal representative commission)
$5,820.00
TOTAL DISBURSEMENTS OF PRINCIPAL $33.807.83
6
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
None
PRINCIPAL BALANCE ON HAND
James D. Cameron, Esq., IOLTA
(client trust fund) account $24.449.09
RECEIPTS OF INCOME
Interest
10/22/02 Allfirst Bank savings account
number 00981-7647-1 6.28
11/08/02 Allfirst Bank checking account
number 00164-2952-4 .25
11/20/02 Allfirst Bank savings account
number 00981-7647-1 12.70
11/20/02 Allfirst Bank checking account
number 00164-2952-4 .24
12/24/02 Waypoint Bank certificate of
deposit number 905059680 218.61
TOTAL RECEIPTS OF INCOME $238.08
DISBURSEMENTS OF INCOME
None
DISTRIBUTIONS OF INCOME TO BENEFICIARIES
None
8
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
TO: Zion Evangelical Lutheran Church, 265 North Enola Drive,
Enola, Pennsylvania, in full satisfaction of Item II of the Last
Will and Testament of George H. Landis:
Cash $24,687.17
TOTAL PROPOSED DISTRIBUTIONS TO BENEFICIARIES X24,687.17
9
DENNIS E. SNIDER, Executor under the Last Will and Testament
of the deceased, hereby declares under oath that he has fully and
faithfully discharged the duties of his office; that the
foregoing First and Final Account is true and correct and fully
discloses all the significant transactions occurring during the
accounting period; that all known claims against the Estate have
been paid in full; that, to his knowledge, there are no claims
now outstanding against the Estate; and that all taxes presently
due from the estate have been paid.
~,.
~_~
r:__- ~"
DENNIS E. SNgD~~l, EXECUTOR
Subscribed to and sworn before me,
a notary public in and for the
County of .~Q Grosr~ State of
Wisconsin, by the above-named
DENNIS E. SNIDER, EXECUTOR,
this ~ day of July, 2003.
Nat y Publ' 1
My Commission Expires : (~ ~~ 47
10
~,~f ,
~•~~~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: George H. Landis, also known as George H.
Landis, Jr., deceased
Date of Death: October 12, 2002
Will No. 2002-00982 Admin No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court
Rules, I report the following with respect to completion of the
administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the
administration will be complete: nla
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 X No
b. The separate Orphans' Court No. (if any) for the
personal representative's account is: n~a
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.
X ,.~.._
Date: 0908,[03
Si n ture
Ja s D. Cameron
Name
-- 1325 North Front Street
Harrisbura PA 17102
Address
• (717) 236-3755
Telephone
Capacity: Personal Representative
X_ Counsel for Personal
Representative