HomeMy WebLinkAbout02-1027Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of ~~..~/Ll ~ • ,~" G/~c+'~}-~'`_ No. ~/°lJo~ ~Qa~
also known as
,Deceased Social Security No.! ~~ ~ y ~O ~~G
Pentioneilal, who is/ate tF3 years of age or older, ~pplyfieaf for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut named in the Last Will of the
Decedent, dated ~[,- -~ ~i- ~.~ and codicil(s) dated
~' ~~' Ty ~ ~ . F^ c~ICO.i~7'- ~~EaC'c~f}-_S~i ~1-:~ G~-~7'
State relevant circumstances, e.g., [enunciation, death of ezecu[ot, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(c.t.e., d.b.n.c.t.a.: pendente lire; detente ahaentia; du,ante nunontatel
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Decedent at death owned property with estimated values as follows: ^_~
{If domiciled in PA) All personal property .............................. S ~ C7! Gt!-'-/7.
(If not domiciled in PAI Personal property in Pennsylvania ...................... S
(If not domiciled in PA) Personal property in County .......................... S
Value of real estate in Pennsylvania ............................................... S
Total .............................................................. S-~~: DO(? r°.._-
Real Estate situated as follows: I
Wherefore, Petitioner(s) respectfully requestls) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature Typed or printed name and residence
~ [. l ~.r Q ~ ~ ~1 ~~ s~
~lZ1 S.~ a /} ~ 7ivc
RW-7 ~ n _ ice, . ~
residence at y ~ •~. ' ~
~,lla ~~n , m ~ ~ln• ,~,qt an9,~,h~l,~ty,
Decedent, then '~ years of age, died l/ ~ ~ ~ , 20(~ at kf-/~ ~R1Sb u k' ~/ S~"S f i T~ ~-
ILecauonl
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Dauphin
The Petitioner(s) above-named swear(s) and affirmisl that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representativels) of the Decedent,
Petitionerlsl will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this 18th day of
November 2002 l~.I~ ~~~ ~~~5
DECREE OF REGISTER
Estate of Ellen L Degroat Deceased
also known as
No.
Social Security No: 193-14-6988 Date of Death
21-2002-1027
11-12-2002
AND NOW, November 18th 20 02 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ®Testamentary ^ of Administration
(c.[.a.; d.b.n ct.; penden~e Ine; du~an~c aLSentia; du~an,e nunu~ita~~_I
are hereby granted to Linda En lish
in the above estate and that the instrument(s), if any, dated December 9thR 198
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........................... S 200.00
Short Certificate(sl...•~•-.. $ 6.00
Renunciation .................. S
Affidavit ( )••..••••••••••••• $
Extra Pages (4 )............ S 12.00
Codicil .......................... S
JCP Fee ........................ S 10.00
Inventory & Tax Forms... S
Other ............................ S
//. P
Register of Wills
Donna M. Otto,lst Deputy
Attorney:
I.D. No:
Address:
TOTAL ................ S 228.00 Telephone:
DATE FILED:
M~ILED LETTERS 'PO EXECU`T'RIX ON NOVII~IBER 18th, 2002
November 18th, 2002
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This is to cernlti• rha~ the Intormanon nere given is co(~re(:('~~ a->~,,.,. r.r:,r:l _~r: «~. _ ~ _:~~: ~_ ... _
Local Kegistrar The original certitic<~re will he for~svarded ~;.~~ tl,~ ~~ ,_~ '~ t.~' '-~~_. ;r, (. "
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COMMON'f:EALTH Of PENNSYLVANIA • DEPARTMENT Of HEALTH • VITAL RECORDS
CEF;TIFiCATE OF DEATH
NAME OF DECEDENT (FMR. Midde. LaR) SE% SOCML SECURITY NUMBER OR TN.MClyr. Dar. '.MI
,. Ellen L. DeGroat ]. Female ]. 193 - 14 - 6988 / ~Q~
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LAST WILL AND TESTAMENT
OF
ELLF,N L. DeGROAT
I, ELLEN L. DeGROAT, having my legal residence at 16 Deckert
Road, Harrisburg, Susquehanna Township, Dauphin County, Pennsyl-
vania, do hereby declare this to be my Last Will and Testament,
revoking all other Wills and Codicils heretofore made by me.
ITEM ONE: I direct that the expenses of my last
illness and funeral be paid from my estate as soon as practicable
after my death.
ITEM TWO: I devise and bequeath all of the
remainder of my estate and property, of whatsoever nature and
wheresoever situate, to my husband, Cletus M. DeGroat, if he
survives thirty (30) calendar days after my death.
ITEM THREE: If my husband, Cletus M. DeGroat, does
not survive thirty (30) calendar days after my death, then I
devise and bequeath all of the remainder of the estate and
property, of whatsoever nature and wheresoever situate, to my
issue, per stirpes, who so survive.
ITEM FnUR: All estate, inheritance, succession and
other death taxes, imposed or payable by reason of my death, and
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interest and penalties thereon, with respect to all property com-
prising my gross estate for death tax purposes, whether or not
such property passes under this Will, shall be paid out of the
principal of my general estate, as if such taxes were adminis-
tration expenses, without apportionment or reimbursement. I
authorize my legal representative to pay all such taxes at such
time or times as may be deemed advisable.
ITEM FIVE: I appoint my husband, Cletus M. DeGroat,
Executor of this Will and direct that he he permitted to serve
without bond, and without any intervention of any court except
as required by law. I authorize my Executor to sell, encumber,
mortgage, invest, distribute in kind, or retain any items of
property of my estate in such manner as he shall deem proper
limited only by his own discretion. If for any reason my
Executor appointed under this Will should fail to serve in that
capacity, I appoint my daughter, Linda English, m.y Executrix,
with the same powers and privileges set forth above. And if
my daughter, Linda English, hereinabove appointed under this
Will should fail to serve in that capacity for any reason, then
I appoint my daughter, Regina Leonard, my Executrix, with the
same powers and privileges set for above. And if my daughter,
Regina Leonard, hereinabove appointed under this Will should
fail to serve in that capacity for any reason, then I appoint
my daughter, Priscella Steger, my Executrix, with the same
powers and privileges set forth above.
- 2 - ~~ ~- ~ - ~?`
IN WITNESS WHEREOF, I have at Middletown, Pennsylvania,
this ~ day of ~.~G 1983, set my
hand and seal to this, my Last Will and Testament consisting of
three (3) pages.
~--rc/ ~ ~~ ( SEAL )
ELLEN L. DeGROAT
SIGNED, sealed, published and declared by Ellen L. DeGroat,
the above named Testatrix, as and for her Last Will and Testament,
in the presence of us, who, at her request, in her presence and
in the presence of each other, have hereunto subscribed our names
as witnesses.
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n~~3 Residence
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ACKNOWLEDGMENT
COMMONP7EALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN .
On this, the ~t~ day of .~Ccc~r-~-~~'r 1~~~_
before me a Notary Public, the undersigned officer, personally
appeared ELLEN L. DeGROAT, known to me (or satisfactorily proven)
to be the person whose name is subscribed to the attar_hed or fore-
going instrument, acknowledged that she signed and executed the
instrument as her Last Will; that she signed it willingly; and
that she signed it as her free and voluntary act for the purposes
therein expressed.
IN GWITNESS PiHEREOF, I have hereunto set my hand and official
seal.
. ~ _
(SEAL)
Notary Public
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS .
COUNTY OF DAUPHIN
/, _ / l~^
We , ~'Y'i 1~. mL;~~~~ P ~'C~.and /
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testatrix sign and execute
the instrument as her Last Will; that she signed it willingly
and that she executed it as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that
to the best of our knowledge the Testatrix was at that time 18
or more years of age, of sound mind and under no constraint or
undue influence.
WIT SS
WITN SS
SWORN and subscribed to
before me this ~h day
of ,~E'c~w..+~ ~Y . 1983.
~~
Notary Public
4~~8'~iG9A E. W~~"3~~, hfi3'z~a~ ,",~~a,~EC
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CERTIFICATION OF NOTICE -
~UNDER R~TLE 5.6(a)
,.-~
Name of Decedent:~L~. ~/l/ L ~ ~~"'.TA'~'~7`
Date of Death: / ~ - /~~. - o :~-
Will No. c~~'~o{ r~d~ ~ Adm. No.
To the Register:
I certify that notice of estate administration 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
Name Address
L. i N i.~~ ~%~ q ~i S ~ ~~~/7 (.u ~t-/r~ r=i ~ / 17 l~'~, ~ .O
Notice has now been given to all persons entitled thereto under Rule 5.6a) except:
Date:
(Signature)
Name: Li ~,~/~~9- L= ~ ~ /~`.Su_~j
Address• ~~ ~ / r~ ~ F' '~~J
A, ~is.bc~ fi'/7io~
Telephone ~/~ Sam/ 5 = Lo i 7 ~'
._ _ Capacity: ~ Personal Representative
Counsel for Personal
Representative
REV.15QOE)((6-00)
COMMONWEI\L TH OF
PENNSYLVI\NII\
DEPI\RTMENT OF REVENUE
DEPT. 280601
HI\RRISBURG, PI\ 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (lAST, FIRST, AND MIDDLE INITIAL)
DeGroa t Ellen L.
DATE OF DEATH (MM-DD-YEAR)
11/12/02
DATE OF BIRTH (MM-DD-YEAR)
9/20/14
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
o 4. limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ofdeatl1 after 12-12-82)
o 7. Decedent Maintained a. Living Trust (Atlac:hcopyofTrustl
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and H.95)
OFFICIAL USE ONLY
<:./
FILE NUMBER
.,:). L- ()~
COUNTY CODE YEAR
_ -'-0 .;J.-~_
NUMBER
SOCIAL SECURIT'I NUMBER
193 14
6988
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURIT'I NUMBER
o 3. Remainder Return (date of dealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit BOx.es
o 11. Election to tax under Sec. 9113(A) (Attach Sell 0)
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NAME
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COMPLETE MAILING ADDRESS
3247 Wakefield Road, Apt.A
Harrisburg, PA 17109
Linda M. E
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717/545-6172
1. Real Eslale (Schedule A)
2. Stocks and Bonds {Schedule B)
3. Closely Held Corporation, Partnership or Sole~Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Biffing Requested
7. Intef.IJivtls Transfers & Miscellaneous Non-Probate Property
(Sche<lule G or L)
8. Total Gross Assets (total lines 1~7)
9. FUileral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(1)
(2)
(3)
(4)
(5)
84,893.44
(6)
(7)
7,646.20
(9)
(10)
(B)
7,803.90
60.82
12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(l.2)
x.o_ (15)
x ,042- (16)
x .12 (17)
x .15 (16)
(19)
16. Amount of Line 14 taxable at lineal rate
84.674.92
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
OFFICIAL USE ONLY
92,539.64
(11)
(12)
(13)
7,864.72
84.674.92
(14)
84,674.92
3.810.37
3,810.37
Decedent's Complete Address:
.
STREET ADDRESS 141 David Drive .
.
CITY Middletown I STATE PA I ZIP 17057
Tax Payments and Credits:
1. Tax Due (Page lUne 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
190.)1
Total Credits (A+ B + C ) (2)
190.51
3. InteresUPenalty if applicable
D. Interest
E. Penaity
TotallnteresUPenalty ( 0 + E ) (3)
4. If Une 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)
3,810.37
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
3,619.86
A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,619.86
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or ................".......................,.,....,............. ............... .............. ........................ ....... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ......................................................... ................................... .................. D
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? ........................................................................................................................ IXJ
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I dedare that I have examined this retum, includfng accompanying schedules and statements, arid to the best of my knowledge and belief, it is true, correct
and compJete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS NG RETURN DATE
G
ADDRESS
3247 Wakefield Road, Apt. A, Harrisburg, PA 17109
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
~'1tAZa;%imt&:f~~$!:~.r ..--~:.:'""""_l'1i',!r;l~~~JEll_. L.~ '"! ~..~..,>.Ji.m]L,._ ,I ~.....4~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse ;s 3%
[72 P.S. ~9116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin9 spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren~
or a stepparent of fhe child Is 0% [72 P.S. ~91l6(a)(1.2)l.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin9s is 12% [72 P.S. ~9116(a)(1.3)]. A siblin9 is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rtv'~''''''':'.
COMMONWEALTH OF PENNSYLVANIA
lNHERIT,A.NCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Ellen L. DeGroat
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Community Bank CD 139937 5,024.71
2. Community Bank CD 139938 5,005.13
3. Community Bank CD 139939 10,212.72
4. Community Bank CD 146871 10,063.36
5. Community Bank CD 146869 10,063.36
6. Community Bank CD 146870 15,095.05
7. Community Bank CD 139935 5,005.13
8. Checking Account 5400944109 3,137.42
9. Savings Account 5400944120 18,238.20
10. Refund from Camp Hill Care Center 3,048.36
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
84,893.44
"'V"""'{'~".,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOEN' OECEOEN,
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Ellen L. DeGroat
FILE NUMBER
ThIS schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RaATIONSHIPTQ DECEDENT AND THE DATE OF TRAflSFER DATE OF DEATH DECO'S EXCLUSI~~ TAXABLE VALUE
AnACHACOP'l'OfTHE DESO FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IFI\PPLlCABlE
1.
Preneed funeral account 7,646.20 100 7,646.20
TOTAL (Also enteron line 7, Recapitulation) $ 7,646.20
(If more space Is needed, insert additional sheets of the same size)
~EV-1511 EX+ (12-99) _
.' *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ellen L. DeGroat
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hetrick Funeral Home 7,540.40
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State ~ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Stat. _ Zip
Relationship at Claimant to Decedent
4. Probate Fees
Register of Wills 228.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Paxton Herald 35.50
TOTAL (Also enter on line 9, Recapitulation) $ 7,803.90
(If more space is needed, insert additional sheets of the same size)
FlEV'151'EX'(T'9:l'~...
~
COMMONWEALTH OF PENNSYLVAN~A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
ESTATE OF
Ellen L. DeGroat
Include un reimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Heri tage Medical Group
2.
3.
PharMerica
AMOUNT
16.62
7.00
37.20
West Shore EMS
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, Inser\ additional sheets of the same size)
60.82
REV-1513 EX+ (9-00)
...... *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT .
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Ellen L. DeGroat
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ustT,ust""(s)
I TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under
Sec. 9116 (e) (1.2)]
1. Regina Leonard daughter
141 David Drive, Middletown, PA 17057
AMOUNT OR SHARE
OF ESTATE
1/3
3
Priscilla E. Steger
1 Twin Oak, Leesport, PA 17533
Linda M. English
3247 Wakefield Road, Apt. A
Harrisburg, PA 17109
daughter
1/3
2
daughter
1/3
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, AS APPROPRIATE, ON REV.150Q 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.
TOTAL OF PART II - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Register of Wills of Dauphin County, Pennsylvania
INVENTORY
Estate of
Ellen 1. DeGroat
No.
21-02-1027
also known as
Date of Death 11/12/02
. Deceased
Social Security No. 193-14-6988
Personal Representative{s) of the above Estate, deceased, verity that the items appearing in the following inventory include all
of the petrsonal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent',:> death. and
that Decedent ownEld no real eGtate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. l/We understand that
false statements herein are made subject to the p.enalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Personal Representative:
Name of
Attorney:
Linda M. English
1.0. No.:
Address:
Dated
Telephone:
Description Value
Bank C.D. 's, Savings Account and Checking Account 81,845.08
Refund from nursing home .3,048.36
Funeral preneed account 7,646.20
Total: 92,539.64
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative. include
the value of each item. but such figures should not be extended into the total of the inventory.
RW-8
\y COMMONWEALTH OF PENNSYLVANIA
BuREau of INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 NOTICE OF INHERITANCE TAX
HARRISBURG. PA 17128-0601
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% ~FP coi-oar
DATE 03-24-2003
ESTATE OF DEGROAT ELLEN
DATE OF DEATH 11-12-2002
FILE NUMBER 21 02-1027
COUNTY CUMBERLAND
LINDA M ENGLISH ACN 101
APT A Amount Remitted
3247 WAKEFIELD RD
HBG PA 17109
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
L
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DEGROAT ELLEN L FILE NO. 21 02-1027 ACN 101 DATE 03-24-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) 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
C1) .00 NOTE: To insure proper
(2) .0 0 credit to your account,
(3) ,00 submit the upper portion
C4) .00 of this form with your
C5) 84,893.44 tax payment.
c6) .00
c7) 7,646.20
c8) 92,539.64
APPROVED DEDUCTIONS AND EXEMPTIONS: 7,803.90
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 60.8 2
(11) 7.864.72
11. Total Deductions 84,674.92
12. Net Value of Tax Return C12) .00
13 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedu le J) C13)
. 84,674.92
14. Net Value of Estate Subject to Tax I14)
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
c15) • 00 X 00 = . 00
c16) 84,674.92 X 045 = 3,810.37
c17) .00 X 12 .00
c18) .00 X 15 .00
c19)= 3,810.37
I AlC I:KtLl I J
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID C-)
AMOUNT PAID
01-24-2003 CD002088 190.52 3,619.86
TOTAL TAX CREDIT 3,810.38
BALANCE OF TAX DUE .O1CR
INTEREST AND PEN. .00
TOTAL DUE .O1CR
~ 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
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Estate of
INVENTORY
Register of Wills of Dauphin County, Pennsylvania
Ellen L. DeGroat
also known as
Deceased Social Security No. 193-14-6988
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. IlWe understand that
false statements herein are made subject to the pena{ties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Personal Representative:
Name of
Attorney:
LD. No.:
Address:
Telephone:
Description
Date of Death 11/12/02
Linda M. English
Dated
Bank C.D.'s, Savings Account and Checking Account
Refund from nursing home
Funeral preneed account
Value
81,845.08
.3,048.36
7 , 646.2(3
Total: 92, 539.64
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
RW-8
~ ~~ ~
P[,EASE FILE THIS REPORT wIT ESTATEI S NOT COMPLETEDF L E a 6.12 FOARRMDYESS~OY
THE STATUS OF THE ESTATE. IF
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ellen L. DeGroat
Date of Death: November 12 , 2002
Estate No.: 21-02-1027
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 xx No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
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 xx No
B.
C.
D.
Date: ~- ~ ~," ° ~j
(MAH:rmt/AM3)
The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
Did the personal representative state an account informally to the parties in
interest? Yes xx No
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.
Capacity:
Signature
Linda M English
Name (Please type or print)
3247 Wakefield Road, Apt. A
Address Harrisburg, PA 17109
717/545-6172
Telephone No.
Personal Representative
Counsel for Personal Representative
R.W. - 58
PLEASE FILE THIS REPORT WITHIN TT ~ NOT COMPLETED FLE a 6.12 FORM YEARLY
THE STATUS OF THE ESTATE. IF ESTA
UNTIL COMPLETION ~ ~ r . ,~
~,;
u ~`'~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ellen L. DeGroat
Date of Death: November 12 , 2002
Estate 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 xx No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
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 xx No
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
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.
Date:
~' ~.,~ ~ ~ ~ Signature
n Linda M English
1. (~,, ,./ Name (Please type or print)
r . 1 rV
`~~~ ~ ;~,c. ~ .~ 3247 Wakefield Road, Apt. A
~~ ,~.,~~' ~ f.~ Address Harrisburg, PA 17109
. ~ ~
,~ ,~, ~ , ~;ti~ 717/545-6172
°~' ~, Telephone No.
(MAH:rmt/AM3) ~ ' ~ ~ ,i ~~
~~ -~
~ ~UL~~~
~ %~1~' .~"Z. 1 Personal Representative
l ~ ,(,(_
~`~~~ r' ~ Counsel for Personal Representative
~ ~~ .}
R.w. - sa /~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
NO. CD 002088
ENGLISH LINDA M
3247 WAKEFIELD ROAD APT # A
HARRISBURG, PA 17109
-- told
ESTATE INFORMATION: SSN: 193-~4-6988
FILE NUMBER: 2102-1027
DECEDENT NAME: DEGROAT ELLEN L
DATE OF PAYMENT: 01 /24/2003
POSTMARK DATE: 00/00/0000
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 2/ 2002
101 ~ 53,619.86
REV-1162 EX111-961
TOTAL AMOUNT PAID:
REMARKS: LINDA M ENGLISH
CHECK#1007
SEAL
INITIALS: AC
RECEIVED BY: DONNA M. OTTO
53,619.86
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS