HomeMy WebLinkAbout01-0004
/6-/9;P- 9
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500 EX + (6-00)
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FILE NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME {lAST, FIRST, AND MIDDLE INITIAL)
Timberlake Isabella O.
DATEOF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEAR)
21-01-0004
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
181-32-5721
THIS RETURN MUST BE AlED IN DUPLICATE WITH THE
NUMBER
11/21 2000 10 15 1901
IF APPLICABLE SURVIVING SPOUSE'S NAME lAST, FI 5 ,AND MIDDLE INITIAL
REGISTER OF WILLS
SOCIAL SECURI Y NUMBER
X 1. Original Return
4. LimIted Estate
X 6. Decedent Died Testate
(Attach copy ofWflQ
o 9. LItigation Proceeds Received
3 date of death
. Remainder Return rlor to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
4a. Future Interest Compromise {date of death after 12-12-82)
7. Decedent MaIntained a Living Trust
(Attach copy of Trust)
D 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1- 1.95)
o
D
11. Election to tax under Sec. 91 13{A)
(Attach Sch 0)
NAME
COMPLETE MAILING ADDRESS
John E.Slike
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsa
TELEPHONE NUMBER
2109 Market Street
Camp Hill, PA 17011
R
E
C
A
P
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T
U
L
A
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (SChedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
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)
14. Net Value Sub'eel to Tax (Line 12 minus Line 13)
(8); 148,598.41
(11) 10.373.28
(12) 138,225.13
(13) 3.000.00
(14) 135,225.13
(1)
(2)
(3)
None
137,643.26
lfone
OFFICIAL USE ONLY
(4)
(5)
None
10,955.15
(6)
None
None
7,797.99
2,575.29
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x .0 0 (15) 0.00
0.00 X .0 45 (16) 0.00
X .12 (17) 0.00
135,225.13 X .15 (18) 20 .283.77
(19) 20,283.77
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
, C
Add
, De>;ed!!nt s amp ete ress:
STREET ADDRESS
1700 Market Street
CITY I STATE I ZIP
Carno Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
20,283.77
7,000.00
368.42
Total Credits ( A + B + C) (2)
7,368.42
Total Interest/Penalty ( D + E) (3)
4. 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. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WillS, AGENT
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.. PLEASE ANsWER fi-iEFOLLOWINGGUEsfiONSBY PLACING AN "X'; IN fi-iE APPROPRIAfE BLoci(s
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; . ~ ~ix
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or. . . . .
d. receive the promise for life of either payments, benefits or care? .
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
D
D
D
0.00
12,915.35
0.00
12,915.35
[]]
[]]
[]]
Under penalties of perJury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true,
correct and complete. Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge.
SIGNAT E OF PERSON RESPONSIBLE FOR FILING RETURN
John E. Slike
2109 Market Street
- - -Cam- - -Bin; - PA - - ii6ii - - - - - - - - - - - - - - - - - - - - - - - --
Saidis, Shuff, Flower & Lindsay
2109 Market Street
- - -Cam- - -Biii - - PA - - :(i6ii - - - - - - - - - - - - - - - - - - - - - - - --
DATE
(,/,101
DATE
(./17t>
For dates 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 is 3% [72 P.S. 9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2)
[72 P.S. 9116(aX1)].
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. 9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyrfght(c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV-1503IEX t ",1-97),
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Isabella O. Timberlake
SS{I 181-32-5721
11/21/2000
21-01-0004
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE
NUMBER OF DEATH
1 425.960 shares Vanguard 500 Index Fund 124.56 53,057.58
2 5445.227 shares Vanguard GNMA Fund 10.09 54,942.34
accrued dividends 218.34
3 First Union Investment Acct., containing:
20.51 units AHLMC Mu1tic1ass CMO, 6% 97.5 20,000.00
400 shares Pacific Telesis 7.56%, due 1/31/26 23.5625 9,425.00
TOTAL (Also enter on line 2, Recapitulation) 137,643.26
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
REV-1508 ~^ + 0-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCET/1.Y.. RETURN
RESIDENT DECEDENT
ESTATE OF
Isabella O. Timberlake
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS!I 181-32-5721
11/21/2000
FILE NUMBER
21-01-0004
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
1
DESCRIPTION
PNC Bank, checking acct. #5080042325
accrued interest
IRS, refund of 2000 income taxes
Country Meadows, refund
VALUE AT DATE
OF DEATH
5,764.30
2.75
2,907.00
2,281.10
2
3
(decedent was in nursing home at time of death - no furnishings
of value)
TOTAL (Also enter on line 5. Recapitulation) $ 10,955.15
(If more space is needed, insert additional sheets of the same size)
Copyrlght(c) 1996 form software only CPSystems, Inc. Form REV-15G8 EX (Rev. 1-97)
REV-1511 FX1-p-97)
, . .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Isabella 0, Timberlake
SSII 181-32-5721
11/21/2000
FILE NUMBER
21-01-0004
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
Clawson Funeral Home 1,139.32
B. ADMINISTRATIVE COSTS,
1. Personal Representative's Commissions 5,200.00
Name of Personal Representative(s) John E. Slike
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 2109 Market Street
City Camp Hill State PA Zip 17011
-
Year(s) Commission Paid: 2001
2. Attorney's Fees Saidis, Shuff, Flower & Lindsay 1,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
-
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 261.00
s. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
The Patriot News, advertising costs 104.67
The Cumberland Law Journal, adverising costs 75.00
Register of Wills, filing fee 15.00
Short certificate 3.00
TOTAL (Also enter on line 9, Recapitulation) S 7,797.99
(If more space is needed, insert additional sheets of the same size)
Copyrfght{c) 1996 form software only cPSystems, Inc.
Form REV-1511 EX {Rev. 1-97)
REV-1512:; fH-97),
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
Isabella O. Timberlake
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSft 181-32-5721
11/21/2000
FILE NUMBER
21-01-0004
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
DESCRIPTION
Country Meadows, perscriptions
State Employes' Retirement System, benefits received after
date of death
Pa Dept. of Revenue, final 2000 taxes
AMOUNT
15.90
3
2,520.39
39.00
TOTAL (Also enter on line 10, Recapitulation) S 2,575.29
(If more space is needed, insert additional sheets of the same size)
Copyrlght{c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Re.... 1-97)
REV-1513f:X+Ii9..-00) ,
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Isabella O. Timberlake
NUMBER
I.
SS1t 181-32-5721
11/21/2000
RELATIONSHIP TO OECEOENT
Do Not List Trustee(s)
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal dlstrlbutfons, and
transfers under Sec. 9116(aX1.2)]
Max F. Confer
PO Box 311
Pine Grove Mills, PA 16868
friend
2
Paula W. Miller
1405 Swordfish Way
Kitty Hawk, NC 27949
grandniece
3
grandniece
Ann W. Anderson
196 Haynes Rd.
Sudbury, MA 01776
4
grandniece
Susan W. Wray
6621 Church Ave.
Pittsburgh, PA 15202
5
Michal Jones
RD #3, Box 201
Shelocta, PA 15774
grandniece
FILE NUMBER
21-01-0004
AMOUNT OR SHARE
OF ESTATE
1/4 of res idue
share of 3/4
residue
share of 3/4
residue
share of 3/4
residue
share of 3/4
residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Trinity Evangelical Lutheran Church
2000 Chestnut St.
Camp Hill, PA 17011
2
Wilson College
1015 Philadelphia Ave.
Chambersburg, PA 17201
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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
1,000.00
2,000.00
3,000.00
Form REV-1513 EX (Rev. 9-00)
F~~r.
Securltl..
First Union Securities
One PPG Place, Suite 2.
Pittsburgh, P A 15222
Tel 412 394-3100
800777-2488
March 28,2001
Estate ofIsabella O. Timberlake
John E. Slike, Executor
21 09 Market Street
Camp Hill, PA 17011
RE: Account #8358-8248-PTBX
Dear Mr. Slike:
The following are the values of the assets in the decedent's account as of her date of
death, November 21,2000:
:J.J,Si iI- FHLMC 1648K Multiclass CMO
6% due 12/15/23
rP
97.50
-::- ;{O, cYo.;i. 00
4tlO sf,. Pacific Telesis 7.56%
Fin 1 Toprs due 1/31/26
t.E
23.5625
9't"4-" ve,,"
/
Please don't hesitate to contact us if we can be of any further assistance.
Sincerely,
ff~ ~0a;z----
Owen J. Mulvaney
Vice President/Investment Officer
OJM:pgn
First Union Securities. Inc.
Member NYSE/SIPC
(/j-
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H-=&
THE\IanguaI'd:,ROUP,
JOHN E SLIKE
SAlOIS SHUFF FLOWER & LINDSAY
2109 MARKET STREET
CAMP HILL, PA 17011
January 23, 2001
GNMA Fund
500 Index Fund
09893986507
Zureta T. Jones Atty-In-Fact
Isabella 0 Timberlake
Dear Mr. Slike:
We received your request to provide you with the account values for the above-referenced
accounts. As of November 21, 2000, the number of shares, the price per share, the value of
each account, and the accrued dividends (if applicable) were as follows:
500 Index Fund
GNMA Fund
425.960
5,445.227
$124.56
$10.09
$53,057.58
$54,942.34
Accrued
Dividends
N/A
$218.34
Fund
Shares
Price
Value
The GNMA Fund was opened on September 6, 1995. The 500 Index Fund was opened on
July 10, 1996.
If you have any questions, please call our Client Services Department at 1-800-662-2739.
An Associate will assist you.
Sincerely,
Client Services Department
ksr
00545871
n)~r ~)t'ri"L' !)(l\ 21)00. V.llln- hlr:.c:l', PLnn~:'k~1I1i~1 Ul-1.~2-':()(JO
hTo-llhq-roQC: . Innl.\",\11L;1l:lr,Ll'{)1l1
FEB-01-2001 15'47
PNCBANK elF DEPARTMENT
412 705 0057 P.01/02
./
0PNCBAN<
Decedent Reporting
Firstside Center
500 First Avenue, 4t1l Floor
Pittsburgh, PA 15219-3128
/SCP
February 1, 2001
Saidis Shuff Flower & Lindsay
Attn: John E. Slike
2109 Market Street
Camp Hill, PA 17011
RE: Estate of Isabella O. Timberlake, Deceased
SSN: 181-32-5721
EIN: 25-6754044
000: 11/21/2000
Dear Mr. Slike:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5080042325 Established 09/16/1994
ISABELLA 0 TIMBERLAKE
SPECIAL ACCOUNT
DOD Balance: $5,764.30 + $2.75accrued interest
The Decedent did !lQ.\ maintain a Safe Deposit Box or any Loans at the time of their
death.
Page 1 of2
A member ofThC' PNC FinDncial St'rvlC't's Group
PNC 8.wk NA Pjn~burqh Pt'Msyh,anld l!i2GS
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LAST WILL AND TESTAMENT
OF
ISABELLA O. TIMBERLAKE
I, ISABELLA O. TIMBERLAKE of Lemoyne, Cumberland County,
;t
i Pennsylvania, declare this to be my Last Will and Testament,
"
heceby revoking any will previously made by me.
I - I direct the payment of all my just debts and
:u~eral expenses out of my estate as soon as may be practical
a..:car ,ny death.
II - I bequeath the sum of $1.,000 an.d-my [" ~ ' to
~rinity Evangelical Lutheran Church, Camp Rill, PA
III - I bequeath the sum of $2,000 to Wilson College,
Cha~~erSbUrg, Pennsylvania.
IV - I direct that my executor hereinafter named
C0nverc all of my re~aining assets into cash and that the pro-
~=eds thereof be added to the residue of my estate.
SAID~.GLIDO V - I devise and bequeath all the rest, residue and
& MASLA:-iD
:::1O'Y '..lurker S(r~~:
Camp Hill. ?.-\
r2~~inder of my e~tata of whatever nature and wherever situate
he distributed as follows:
"
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Page 1
~.
-
~
/ /A. onec1"o t~ esi e shall be paid unto
Maxy ~onf.2 in~o;' Mi s enns ania, or if he is
depeased -f Ohiyfss per _rpes.
B. ~T~e-( :~aining iil1.e'..il_...j....:~~,!! .Ar sam residue
shall be divided af~ng my grandnieces, Paula W. Miller, Ann W.
Anderson, Susan W. r If ~ ", and Michal Jones, or if any of them is
deceased, to their issue per stirpes.
VI ... I appoint John E. Slike, Esquire of this, my Last
Will and Testament. Should he fail to qualify or cease to act as
: such, then I appoint PNC Bank, N.A. to act in this capacity.
,
,
I
11
II
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Neither of my personal representatives shall be required to post
bond i~ this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my
:1 c:his, c:he / ...,- -.t.S- day of }l d-...O....".A"'~
hand and seal on
I 1993.
Ii
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'~I_l^ .H" r'~, J\.-,t,. h,. - (SEAI..)
y" , Isabella O. Timber-lake
SAID IS. GUIDO
& MASLA,'ID
2109 ,\1arke[ Street
Ca.mp Hill, PA.
S~q~eG, ~ealec, ~u~lished and declared by ISABELLA O. TIMBERLAKE,
\ Testatrix therein named, on this and one (1) other sheet of paper
:1 as and for her Last Will and Testament, in our presence, who, in
','.,\' her presence, at her request, and in the presence of each oc~,er-,
have hereunto subscribed our names as attesting witnesses.
~~
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Address '
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Name /
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/ / /01. ;.' LL. ,F
Address
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. Page 2'
-iAlDIS, GUOO
&. MASL.-I.:'W
:[09 .'v(ar\;'et Strce~
Camp Hill. PA
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COMMOW~EALTH OF PENNSYLVANIA)
SS.
COUNTY
OF
CUMBERLAND)
, WE, the undersigned, the testatrix and the witnesses,
iresgectively, whose names are signed to the foregoing instru-
lment, being first duly sworn, do hereby declare to the under-
signed authority that the testatrix signed and executed the
instrument as her Last Will and Testament and that she signed
;willingly (or willingly di=e~ted another to sign for her), and
~that she executed it as her free will and voluntary act for the
ljPurposes therein expressed, and that each of the wit"esses, in
!the presence and hearing of the testatrix signed the will as
~witnesses and that to the best of their knowledge the testatrix
0was at that time eighteen years of age or older, of sound mind,
ijand under no constraint or undue i"fluence.
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':'estatrix
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" . . Witness
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Wicness
Subscribed, sworn to and acknowledged
testatrix, and subscribed and s~orn to before
"r..esses, this .. day of ..----
before ~e by the
me by both '",it-
, 1 9 9 3.
\
- ../:.;.....':"-'-
Notary Public
~;JT'\"=J\i. S:::..:.:..
i-MELI\~A S i\~c~,:',:,jSL:i< nJ:j."'... ?uClic
~ ;!./i~~ ;;:' ~i~,. ,~: ~ ;~~~/~~~.~'!~; J!~;: fl; ~~ ~6
Register of Wills q.f Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
dJ./- Ol-()oot/
Estate of Isabella O. Timberlake
also known as
No.
, Deceased
Social Security No. 181- 32 - 5721
John E. Slike
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or'S' BELOW:)
[KJ A~ Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or
the Decedent, dated 11/15/1993 and codicil(s) dated None
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, 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:
o S. Grant of Letters of Administration
(c.I.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
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:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at 1700 Market Street, Camp Hill Borough, PA 17011
(list street, number, and municipality)
Decedent, then ~years of age, died 11/21/2000 at Manor Care, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
130,000.00
$
$
$
$
situated as follows:
none
Wherefore. Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a riate form to the undersi ned:
Si nature
John E. Slike
2109 Market Street, earn Hill, PA 17011
/~-/9f- 9
Prepared by the Pennsylvania Sar Association
Copyright (c) 1996 form software only CPSystems. Inc.
Form RW-1 (1991)
O,th . of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) 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(s) and that. as personal representative(s) of
the Decedent. Petitioner(s) will well and truly administer the estate, cording to law.
p~
Sworn to or affirmed and subscribed
before me this -1.L day of
2000
No.
21-2001-0003
Estate of Isabella o. Timberlake
Deceased
Social Security No: 181- 32 - 5721 Date of Death: 11/21/2000
January 3rd, 2001
. in consideration
AND NOW.
of the Petition on the reverse side hereon. satisfactory proof having been presented before me,
IT IS DECREED that Letters [Jg Testamentary 0 Of Administration
(c.I.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
John E. Slike
in the above estate and that the instrument(s) dated
11/15/1993
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters .
$ 235.00
$ 15.00
Short Certificate(s). 5 .
Renunciation.
$
Affidavits (
1.0. No:
06262
Saidis, Shuff, Flower & Lindsay
2109 Market St.
$
Extra Pages ( 2 do.
$
6.00
Address:
Codicil.
$
Camp Hill, PA 17011
JCP Fee.
$
5.00
Telephone 717/737 - 3405
Inventory.
$
Other
$
MAILED LETI'ERS AND ORDER m ATIORNEY
TOT AL.
$
261.00
Prepared by the Pennsylvania Bar Association Copyright Ie) 1996 form software only CPSystems.lnc.
Form RW-1 (1991)
-
I HI 0'5.80'; RFV ()Ii<,()
I
This is to certify that the information here given is correctly copied from an original certificate of death du!~ filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent bling.
l11e as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
,,"t~(1Irotpl;---__
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/' -'( i~~'r:2-1.~~C:~-
Local ltegistrar
Fee f()I' this certifIcate, $2.00
P 6920384
NOV 2 1 2000
Date
21-2001-0004
2/17
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
UNtlEfI , VEAA
MonIho Doyo
UNllEfll DIlY
HourII i MintA..
.
SEX
a. Female
STAlE FIlE ~UM8ER
SOCIAl. seCURITY NUMBER
DATE Of OEATH ,_. Do,. ._,
NAME Of OECfOENl (FilS. MiOcJIe. l_~
I. l~abella O. T~mb~lake
AGE (La. Bwthday)
a. 1 g 1
- 32
- 5721
c. 11-21-2000
118. SIaIe
PA
loWllTAl SWUS._
~...... ..arried, Widowed.
~ ~-...,
("",$+12 ,c.V~voJtced
11..0.....__..
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BIRTHPlACE ~C.rv and
Stale or Fcr89l"1 Cououy)
PlACE (y DeATH lCt>eck 01'1.,. Q/'\e ~- ,. ,nstfucllOffl on othel __.
HOSPITAl,
1npoI.... 0 ER/OuIj)oh." 0 IlOA 0
99 v...
COUNTY OF llERH
DECEDENT'S USUAl. OCCUPAJION
t~oI":-:OO:=~~:T
11 SOc~a.t WoJtkeJt 11..
DECEDENT'S MAlt.ING AIlOfIESS 15U.... Cllyt-.o. s... ZIpC_1
1700 MaJtket StJteet
Camp H~ll, PA 17011
,..
FRHElI'SNAME \FO.. _. L01I)
II. JMe h V. Ou
INfORMANT'S NAIoIE (T ypoIf',intl
. M.6. Su.6an WJta
METHOO OF IllSPOlllTlON
O _0 c,-!;tl _.....51...0
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SIGNR\lfIE OF F
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DECEDENT'S EOUCRIOH
0;
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(0-12) 12
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'a.
LICENSE NUMBEfI
Did
-
Mine
CwnbeJtland -.nip? "...0 :;...""::".=:..
MOTHER'S NAME (F..... MdtII. MMSen Surname)
". Lola WUk.i.n.6
INFORMANT'S MAIlING AIlOfIESSlSlr.... Cily11Own. Slolo. rip Ccdl
. 6621 ChuACh Avenue P~tt4buA h PA 15202
PlAClEOFIllSPOJITIOH. _."C~,C,_ LOCRION.~. _. ZIp eo.
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a". PA CfLematoJt ala. HaJtJt~buA PA 171 09
NAMEANOADOAESSOFFACIU1Y c.1.ema.ti.o.n Soci..e o~ PA
_.4100 Jone~towl1 I<oad. -HaJtJt.u.buA FA 17109
LICENSE NUMBER om SIGHED
_.00>. _,
.....
1711.
_.
11-23-2000
:N.
17. MIlT t. Enter the....... injuries Of eompticMionI which caused IN death 00 noI
list only OM cauu on NCh tine
:110. .
_ CASE REFEflRED 10 MEDICAl. EXAIotINERlCORONER?
Yu Itl f'u
...0
_a..21I.....bo~by
pillIOn whO pronouncea dNlft.
__,ECAU.IFonal
~ 01 Condition
r-*'g in deaI'l)----"
at.
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: GnMt and dealh
I
I
I
-......--
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-,-",,,,,,,y
....--
'-*'ll" _, LAST
""'SIIHAUTOPSV
PEflFOAlAEDl
WEllE AUTOPSY FINDINGS
_LAlllE PfllOA 10
COMPLIITION 0# CAuSE
OF llERH?
TIWE OF INJURY
INJUflV Itr WORk7 DESCAlBE HOW INJURV OCCUAREO.
Suicidll
o
o
Hom~
P.nding "'-'9ohon
... 0 ...0
... 0 ...
YnO
...~
AccicMnI
Could not be detefTnIf\.:I
UII. 2". 21.
_"'lEA 'ChOCk"" onol
-CERTIfYING PHYSICIAN (Ph'($ICt8n c~ cauMd. (leMh whef'l ar\Qlt'I8I ,*,Y5lCoarl has plonounced de~ ana completed hem 231
To"''''1 of my know",. ..th occ,,"" "'10 &he caU"{I).nd m.nner .I. I'.'ed. . . . . . . . . . . . . . . . . .
-PRONOUNCING AND CERTifYiNG PHYSICIAN (F'hVSC&iln both ;)Ionouoc,ng death and Cer1llyang 10 cause 01 death)
To"" bft;1 ofmrknowMdge, death Gec",r" .111M....... dal.. ~nd place..and dt.t8 10 the cauM{a)and mann.r.. ...led......
'MEDICAL EXAMINEIIICORONEfI
On the b&.i. 0' Ollam,,,.tion andJor inveslIg.lion, in mr opinion. d.alh occurred etlh. 11m., del.. and plac., and due 10 the cauM(') and
mMn.r.. .Ialed... ........ ..,.... .... .....'.. .,.. .... .............. ... .. .................................
:....
fIE~.SSIGN~~~
I>>. ~ ... '7r:?-t,~ ~ ___ ~/~V/ I
\~
.y. h,
\ <'.1 1..<
".if, ,},~
1>"
SAlOIS, GUIOO
& MASLAND
2109 Market Street
Camp Hill, PA
II
II
I
..
. <
LAST WILL AND TESTAMENT
OF
ISABELLA O. TIMBERLAKE
I, ISABELLA O. TIMBERLAKE of Lemoyne, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament,
hereby revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses out of my estate as soon as may be practical
after my death.
II - I bequeath the sum of $1,000 ~o
Trinity Evangelical Lutheran Church, Camp Hill, PA
III - I bequeath the sum of $2,000 to Wilson College,
Chambersburg, Pennsylvania.
IV - I direct that my executor hereinafter named
convert all of my remaining assets into cash and that the pro-
ceeds thereof be added to the residue of my estate.
v - I devise and bequeath all the rest, residue and
re~ainder of my estate of whatever nature and wherever situate
be distributed as follows:
/
.--~L.) .
Page 1
SAlOIS, GUIDO
& MASLANO
2109 Market Street
Camp Hill, P A
II
'i
II
Ii
I"
...
--
/ ,/A. ~fO. ,th 0 sa es e shall be paid unto
Max ]V; Conf~in Gro Mi s enns ania, or if he is
dep'eased,r:1O hisj ss per rpes. /'
,r' '. \l5 'f L",\
shall be dIVide~'at~~~ ~;m;~~~~~i:~i~ :~~~::~1~,r:~~d~~
Anderson, Susan W. ~s, and Michal Jones, or if any of them is
deceased, to their issue per stirpes.
VI - I appoint John E. Slike, Esquire of this, my Last
Will and Testament. Should he fail to qualify or cease to act as
such, then I appoint PNC Bank, N.A. to act in this capacity.
Neither of my personal representatives shall be required to post
bond in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on
J '-~ 7!J- day of r7 ~
this, the
, 1993.
/
a:.
~' .. "1 "'; "1"
" ~Jla 6/; k f lufq})~
\' Isabella O. Timberlake
(SEAL)
Signed, sealed, published and declared by ISABELLA O. TIMBERLAKE,
Testatrix therein named, on this and one (1) other sheet of paper
as and for her Last will and Testament, in our presence, who, in
her presence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
f1~ 1(grH.
Address '
d/09 /11a.,J{(/ y/ (~'VJ Jl7/ 1/ -
Address Page 2
SAIDIS, GUIDO
& MASLAND
2109 Market Street
Camp Hill, PA
. .'.
..
.
."
..
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY
OF
CUMBERLAND)
WE, the undersigned, the testatrix and the witnesses,
respectively, whose names are signed to the foregoing instru-
ment, being first duly sworn, do hereby declare to the under-
signed authority that the testatrix signed and executed the
instrument as her Last Will and Testament and that she signed
.willingly (or willingly directed another to sign for her), and
that she executed it as her free will and voluntary act for the
purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the testatrix signed the will as
witnesses and that to the best of their knowledge the testatrix
was at that time eighteen years of age or older, of sound mind,
and under no constraint or undue influence. ~
,~,tLik CD It\1i.l~JJL-
~ Testatrix
Subscribed, sworn to and acknowledged before me by the
testatrix, . and sub~cribed and s71rn,to .b~re me by both wit-
nesses, thlS 1.5 - day of~~tv<- , 1993.
~< I' ~j ,J'
/icbhuV ,j.', 't~<-,-
1:fbtary Public
NOTARIAL SEAL
THELMA S. McCAUSLIN. Notary Public
Camp Hili, Cumberland County
My Commission Expires July 3.1996
s
--
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICA TION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Isabella O. Timberlake
Date of Death: November 21,2000
Will No.: 21-01-0004
Admin. 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 January 8 , 2001.
Name
Trinity Evangelical Lutheran Church
Wilson College
Max F. Confer
Paula W. Miller'
Ann W. Anderson
Susan W. Wray
Michal Jones
Address
2000 Chestnut Street, Camp Hill, PA 17011
1015 Philadelphia Ave., Chambersburg, PA 17201
Box 311, Pine Grove Mills, P A 16868
1405 Swordfish Way, Kitty Hawk, NC 27949
196 Haynes Road, Sudbury, MA 1776
6621 Church Avenue, Pittsburgh, PA 15202
RD 3 Box 201, Shelocta, PA 15774
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date:
I/~/(j,
.; _,,_-.J
Capacity:
!\A.. P
Joh , Slike, Esquire
S DIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
-.1LPersonal Representative
_Counsel for Personal
Representati ve
71 ?737340~.'
7177373407 Sf-:! I D I S, '::;HIJFF t"1f=1SLAi'fD
641 P01
APR 24 '01 11:44
JAMES D. FLOWER
JOHN E. SLlKE
ROBERT C. SAlDIS
GEOFFREY S. SHUPF
JAMES D. FLOWER JR.
CAROL J. LINDSAY
]OHNNA J. KOPECKY
JOSEPH L. HITCHINGS
KARL M. LEDEBOHM
THOMAS E. FLOWER
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORA nON
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHDNE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAlL: attomey@ssfl-law.com
CARLISLE OFfICe:
26 WEST HIGH STREET
CARLISLE, P A 17013
TELEPHONE: (717)243-6:>21
FACSIMILE: (717)243-6486
KBPL Y TO CAMP H~b!,
VIA TELEFAX
DATE:
4/24/01
TO:
Sue @ Register of \ViUs
FAX NUMBER:
240-7797
FROM:
John E. Slike, Esquire
SAlOIS, SHUFF, FLOWER AND LINDSAY
RE:
Estate of Isabella O. Timberlake
No. 21-01-0004
MESSAGE:
Attached please flnd a copy of the letter and check for the discount payment.
Please note that oW' postage meter prints the date on the envelope. If you have
our origina! envelope that was used to mail the payment, it should reflect a date
of February 21, 2001. Thank you for your cooperation!
Total number of pages (including cover sheet): 3
CJ
Original will follow via:
a Regular Mail
CI Overnight Mail
CJ Hand Delivery
o Other
o
Original will not follow
THIS MESSAGE IS INTENDED ONLY FOR THe; { fSE OF THE INDIVlDUAI.t OR ENTITY TO WHICH IT lS.
ADDRESSED. AND MA Y CONTAIlilNFOR~J\IION THAT IS PRIVILEGEQ, CONFIDENTIAL AND EXEMPT FROM
DISCLOSURE UNDER APPLICABLE LA W IF THE READER o.F THIS MESSAGE IS No.T THE TNTENDED
RECIPIENT, YOU ARE HEREBY No.TIFIED THAT AFY DISSEMINA no.N, DISTRIBUTION OR COPYING OF THIS
COMMUNICA TION IS STRlCTL Y PROHIBITED. If YOU HA VB RECEIVED THIS COMMUNICA TIo.N IN ERRo.R.
PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE AND RETURN THE ORlOrNAL MESSAGE TO. US AT THE
ABo.VE ADDRESS VIA THE U.S. POSTAL SERVICE THANK YOU
NOTE: IF YOU 00 NOT RECEIVE ALL OF THE PAGES OR IF ANY OF THE PAGES ARE UNCLEAR,
PLI:A$E CALL (717) 737-340S AS SOON AS POSSIBLE AND ASK FOR SENDER.
7177373407 SA I D j:::: '::,HUFF r'1!~SLA~lD
541 PO]
APR 24 '~1 11:44
Ii
PNCBANll\
PNe Blat. N.A. tUG
C8aInI PA
JOL.j
00. 12731:l 1-3
0"5_ (:J{,~--'A ; "" ~~, __ _ ____._.
$ 7 CoO. /?o
. J (/'
--------- ". -1 ~ ~LlAAS III :;;:~:.::..
esrATEOFIqdhl"'/h 10.. rln~ Vr:iZ~-
~ r~-' I' 4~ : ~~
500:J ~ 11.,'? SII'
6~b2 ~:fJNdLY/ ~~
::~ . ;;; '-=. (./
v
FOAA4Jf dL '0; . ()QO/_ .~
":0 } ~d .2 ? ~B':
JAMES D. FLOWER
JOHN E. SLIKE
ROBERT C. SAlOIS
GEOFFREY S. SHUFF
JAMES D. FLOWER, JR.
CAROL J. LINDSA Y
JOHNNA J. KOPECKY
KARL M. LEDEBOHM
JOSEPH L. HITCHINGS
THOMAS E. FLOWER
7177373407 <::;1=\ I D 1<:=; '=:;HIJFF r'I~-~6LI=\~lD
L\IY orn(.;LS
541 P02
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESStONAL CORPORAtION
2109 ~yIARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHONE: (7l7) 737.3405 ~ FACSIMILE: (717) 737-3407
EMAIL: attomey@ssfl.law.coll\
WWw~$$f1.law.com
February 21, 2001
Register of Wills
Cumberland County Courthouse
Carlisle, PAl 7013
Dear Ladies:
Re: Tbe Estate of Isabella O. Timberlake
File NQ. 21-01-0004
APR 24 '01 11:44
CARLIS~ OFFICE:
26 W. HIGH STREET
CARLISLE, P A 17013
TELEPHONE: (717)24.'3-6222
FACSIMILE: (717)243-6486
REPLY TO CAMP HI!:!.
Enclosed please find a check in the amount of $7,000 representing a payment at discount
of inheritance taxes in the above estate.
Kindly issue a receipt for the payment at your convenience.
JES/sly
Enclosure
Very truly yours,
SAIDIS, SHUFF, FLOWER & LINDSAY
John E. Slike
/
Register of Wills of
Cumberland
County, Pennsylvania
INVENTORY
Estate of
Isabella O. Timberlake
No.
21-01-0004
also known as
Date of Death
11/21/2000
,Deceased Social Security No.
181-32-5731
John E. Slike
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. l!We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Represen
Name of
Attorney:
John E. Slike. Esquire
Signature:
1.0. No.:
06262
Signature:
Address:
2109 Market Street
Address: 2109 Market St.
Camp Hill, PA 17011
Camp Hill, PA 17011
Telephone: 717/737-3405
Telephone: 717 /737 - 3405
Dated: 5- /30 /0/
Description
PNC Bank, checking account 5080042325
accrued interest
Country Meadows, refund
Vanguard 500 Index Fund, 425.960 shares @ 124.56
Vanguard GNMA Fund, 5,445.227 shares @10.09
accrued dividends
First Union acct. #8358-8248 20.51 AHLMC at 97.50
First Union acct. #8358-8248 400 shares Pacific Telesis
due 1/31/26 at 23.5625
IRS, refund of 2000 income taxes
Value
5,764.30
2.75
2,281.10
53,057.58
54,942.34
218.34
20,000.00
9,425.00
2,907.00
(Attach additional sheets if necessary)
Total:
148,598.41
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.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form tlRW-7 (1992)
~
/~-/P'-?
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
PA 17011
07-16-2001
TIMBERLAKE
11-21-2000
21 01-0004
CUMBERLAND
101
Amount Remitted
REV-1547 EX AFP C12-DDI
ISABELLA
o
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=i5'4-j-EX-AFP--n'2=OOY-NOi'-icE--OF-YNHEifiTAifcE-TAX-A-PPRAYSEi"-ENT~--AiroWANCE-(fR------------- ----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TIMBERLAKE ISABELLA 0 FILE NO. 21 01-0004 ACN 101 DATE 07-16-2001
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
TAX RETURN WAS: (X) ACCEPTED AS FILED
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
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
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
TAX CREDITS:
PAYMENT
DATE
02-21 2001
06-05-2001
NOTE:
RECEIPT
NUMBER
AA478068
AA496683
DISCOUNT (+)
INTEREST/PEN PAID (-)
368.42
.00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
137,643.26
.00
.00
10,955.15
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
148,598.41
]0.373 ::>8
138,225.13
3,000.00
135,225 . 13
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00
.00
.00
20,283.77
20,283.77
20,283.77
.00
.00
.00
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(9)
no)
7,797.99
2,575.29
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
.00 X 00 =
.00 X 045 =
.00 X 12 =
135,225.13 X 15 =
(19)=
AMOUNT PAID
7,000.00
12,915.35
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
/6-/?~- 9
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-IU7 EX AFP lI2-DOl
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-16-2001
TIMBERLAKE
11-21-2000
21 01-0004
CUMBERLAND
101
ISABELLA
o
Amount Remitted
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i'6o-j-Ex-AFP-fi'2-.:ooY------...--ZNHERITANCE-TAX-STA-fEMENT-'(fF"-AccoDiif--.i.---------------------
ESTATE OF TIMBERLAKE
ISABELLA 0 FILE NO.21 01-0004
ACN 101
DATE 07-16-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-09-2001
PR I NCI PAL TAX DUE: .._______..___._.____._._.._.._._._._......................._..___..................................._...._..........................._.
20,283.77
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-21-2001 AA478068 368.42 7,000.00
06-05-2001 AA496683 .00 12,915.35
TOTAL TAX CREDIT 20,283.77
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
SAIDIS
SIIlJ!'t llOWER
&UNVSAY
ATlOItNEYS.AT.lAW
2109 Market Street
Camp Hill, PA
FIRST AND FINAL ACCOUNT OF
JOHN E. SLIKE, ESQUIRE, EXECUTOR
FOR THE
ESTATE OF ISABELLA O. TIMBERLAKE
NO. 21-01-0004
Date of Death:
November 21, 2000
Date of Executor's Appointment:
January 3, 2001
First Complete Advertisement of
Grant of Letters
January 19, 2001
Accounting for the Period: January 19, 2001 to June 7, 2001.
Purpose of Account: John E. Slike, 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:
John E. Slike, Esquire
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17001-0737
[717]
737-3405
SAlOIS
S~tlDWER
&UNUSAY I
AJ1ORNEYS.AT.lAW
2109 Market Street
Camp Hill, PA
II
II
SUMMARY
Proposed Distribution to Beneficiaries
PRINCIPAL:
Receipts
Net Loss on Sale or
other Disposition of Assets
Less Disbursements
Balance Before Distributions
Distribution to Beneficiaries 5
PRINCIPAL BALANCE REMAINING
INCOME:
Receipts
Less Disbursements
INCOME BALANCE REMAINING
COMBINED BALANCE REMAINING
RECONCILIATION:
Assets on Hand
PNC Bank, money market acct.
Estate checking acct. balance
Total
Combined Balance Remaining
Items to be disbursed
Total
Page
No.
3
4
5
5
2
(3,311.53)
28,787.24
3,000.00
1,358.30
0.00
90,066.28
33,226.67
123,292.95
116,092.95
7,200.00
123,292.95
$116,092.95
$149,833.42
117,734.65
114,734.65
$1,358.30
$116,092.95
SAlDIS
sllUfli t10WER
& LIf"IIuSAY
ATIORNEYS.ATolAW
2109 Market Street
Camp Hill, PA
PRINCIPAL RECEIPTS
Per copy of Inventory attached
$148,598.41
Adjustments to principal receipts:
Net deposits to decedent's account posted after
date of death ( including retirement benef.) 1,235.01
TOTAL PRINCIPAL RECEIPTS $149,833.42
GAIN OR LOSS ON SALE OR OTHER DISPOSITION
Gain
Loss
Feb. 15, 2001 - Mandatory redemption of 400 shares
Pacific Telesis, due 1/31/26
Inventory value 9,425.00
Proceeds of sale 10,000.00 575.00
May 2, 2001 - Sale of Vanguard 500 Index Fund
Inventory value 53,057.58
Proceeds of sale 47,140.70
5,916.88
May 2, 2001 - Sale of Vanguard GNMA Fund
Inventory value 55,160.68
Proceeds of sale 57,890.36 2,729.68
May 3, 2001 - Sale of FHLMC, First Union Acct. #8358-8248
Inventory value 20,000.00
Proceeds of sale 19,300.67 699.33
NET LOSS FROM SALE OR OTHER DISPOSITION
$3,311. 53
PRINCIPAL DISBURSEMENTS
2001
Jan. 19
Feb. 09
13
Country Meadows, prescription 15.90
Patriot News, estate notice 104.67
Saidis, Shuff, Flower & Lindsay, reimbursement
for costs advanced 336.00
Register of Wills, Agent, discount
payment for inheritance taxes 7,000.00
21
3
I .
I
SAlDIS
sHUffi t10WER
&UNUSAY
AI1\)JlNEYSoAT.lAW
2109 Market Street
CampHill,PA
Apr.
03
13
18
23
PA Dept. of Revenue, 2000 income taxes
PNC Bank, service charge
Register of Wills, short certificate
Register of Wills, Agent, balance of
inheritance taxes
Register of Wills, filing fee for return
Clawson Funeral Home, cost of funeral goods
and services
Register of Wills, filing fee for inventory
May
June
07
ITEMS TO BE
DISBURSED: Saidis, Shuff, Flower & Lindsay,
attorney fees
Saidis, Shuff, Flower & Lindsay,
executor's commission
Reserve for additional
taxes and filing fees
TOTAL PRINCIPAL DISBURSEMENTS
DISTRIBUTIONS TO BENEFICIARIES
39.00
9.00
3.00
12,915.35
15.00
1,139.32
10.00
5,200.00
1,000.00
1,000.00
$28,787.24
Trinity Evangelical Lutheran Church, specific bequest,
pursuant to Item II of the Last Will and Testament 1,000.00
Wilson College, specific bequest, pursuant to Item III
of the Last Will and Testament 2,000.00
TOTAL DISTRIBUTIONS TO BENEFICIARIES $3,000.00
INCOME RECEIPTS
PNC Bank, interest earned on estate
02/12/01
03/12/01
04/13/01
05/14/01
checking
1. 84
2.23
.53
10.30
account
First Union Securities account 8358-8248
Interest and dividends from
date of death to 12/31/00 562.44
4
14.90
SAIDIS
sHUffi t!OWER
&UNUSAY
ATIORNEYS-AHAW
1109 Market Street
Camp HID, PA
II
Interest and dividends from
01/01/01 to 04/31/01 497.60
Interest and dividends from
05/01/01 to 06/08/01 217.08 1,277.12
(date of redemption)
PNC Bank, interest earned on estate money market account
05/15/01
TOTAL INCOME RECEIPTS
INCOME DISBURSEMENTS
TOTAL INCOME DISBURSEMENTS
5
66.28
$1,358.30
$ 0.00
SAIDIS
SHUf!inoWER
&UNUSAY
ATIORNEYS-AT.lAW
2109 Market Street
Camp Hill, PA
II
,I
I
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
John E. Slike, Esquire, Executor under the Last Will
and Testament of Isabella O. Timberlake, 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 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.
o
like, Esquire, Executor
s ate of Isabella O. Timberlake
Notarial Seal
C Shelby L. Yingling, Notary Public
amp H'i/! B~ro, Cumberfaild County
My CommISSIon Expires Apr. 26, 2064
Member, PennsylvaniaAssociatmof~
6
SAlDIS
SHll!'1i !!OWER
&UNUSAY
ATIOItl'<rn-AToIAW
2109 Market Street
Camp Hill, PA
II
ESTATE OF ISABELLA O. TIMBERLAKE
PROPOSED SCHEDULE OF DISTRIBUTION
COMBINED BALANCE REMAINING
$116,092.95
Pursuant to Item V of the Last Will and Testament, all the rest,
residue and remainder to be distributed as follows:
~ of the residue to Max H. Confer
$29,023.23
~ of the residue to be divided amo~g decedent's grandnieces
Paula W. Miller
Ann W. Anderson
Susan W. Wray
Michal Jones
7
$21,767.43
$21,767.43
$21,767.43
$21,767.43
.--- ;-
Time Stamp and Return
Register of Wills of
Cumberland
County, Pennsylvania
INVENTORY
Estate of
Isabella O. Timberlake
No.
21-01-0004
also known as
Date of Death
11/21/2000
,Deceased Social Security No.
181-32-5731
John E. Slike
Personal Aepresentative(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 verity that the statements made in this Inventory are true and correct IfWe understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities,
1.0. No.:
06262
Personal Aepresen'i~e . ~., I
Signature: ~HL.t. r: I J;J~
John E. Slike
Signature: /)
. ,
Name of
Attorney:
John E. Slike. Es~ire
Address:
2109 Market Street
Address: 2109 Market St.
Camp Hill, FA 17011
Camp Hill, PA 17011
Telephone: 717/737-3405
Telephone: 717/737- 3405
Dated:
2>- /30/ Of
Description
PNC Bank, checking account 5080042325
accrued interest
Country Meadows, refund
Vanguard 500 Index Fund, 425.960 shares @ 124.56
Vanguard GMMA Fund, 5,445.227 shares @10.09
accrued dividends
First Union acct. #8358-8248 20.51 AHLMC at 97.50
First Union acct. #8358-8248 400 shares Pacific Telesis
due 1/31/26 at 23.5625
IRS, refund of 2000 income taxes
Value
5,764.30
2.75
2,281.10
53,057.58
54,942.34
218.34
20,000.00
9,425.00
2,907.00
(Attach additional sheets if necessary)
Total:
148,598.41
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.
Prepared by the Pennsylvania Bar As3oclatlon
Copyright (c) 1996 form software only CPSystems, Inc.
Fonn/lRW-7 (199Z)
(!
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Isabella O. Timberlake
Date of DeathoJ November 21, 2000
Will No. .~1-OO-0004 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:
l.
complete: Yes
State
X ;
whether
No
administration
of
the
estate
lS
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 X ; No
b. The separate Orphans I Court No. (if any) for
the personal representative's account is:
c. Did the personal representative
account informally to the parties in interest? Yes
state
; No X
an
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:
'lIt 0/ b I
Si
Na : John E. Slike, Esquire
I. D. No. 06262
SAlOIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
X Personal Representative
Counsel for Personal
Representative
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