HomeMy WebLinkAbout01-0031
REV-1500EX+(e-oG)
'* COMMONWEALTHOF
PENNSYLVANIA
DEPARTMENT Of REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
/6-~-b
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAt.E (lAST. FIRST, AN) lIlDDLE INITIAL)
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BIGLER GORDON MONTGOMERY
DATE OF DEATH (MtMJO-V...) DATE OF BIRTH (MM-DD-Y"')
12/16/2000 03/03/1923
(IF APPliCABlE) SURVIVING SPOUSES NAt.E (lAST. FIRST. AND MllOlE INITIAL)
OFFICIAL USE otL y
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FILE NUMBER
2 1 -0 1 0 0 3 1
""COiiifycoor~---~-
SO<>>L SECURITY N\JMIlER
201-16-0225
THIS RETURN MUST BE FILED IN OUPUCATE WtTH THE
REGISTER OF WILLS
SO<>>L SECURITY NUMBER
III
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[g] 1. Original Return
o 4. Umited Estate
[g] 6. Decedent Died Testate (AIt""''''ofWl)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 43. Future Interest Compromise (dale uf de;th ater 12-12-82)
o 7. Decedent Maintained a living Trust (Attach COVf ufTMll
o 10. Spousal Poverty Credit (dati of tWh ,*-12-31~1l1lC1' 1-1-95)
03. RemairlderRetum (dlIllIJ'.....priorto12-13-82)
o 5. Federal Estate Tax Return Requiled
~ 8. Total Numbef of Safe o.po.. Boxes
o 11. Election to tax under Sec. 9113{AIt_.MI
.fiii$li!li'ltlQilMllllit8liibOMlltlttiil1tAUJ*'RRi1lii1&Nbimet_!lI>NRIW!!i'tIAi!;tM!lll~MMAtlQli~illlf~teb . .
Z NAME COMPLE1E MAILING ADDRESS
i David C. Cleaver 1035 Wayne Avenue
is: FIRM NAME ("AppIcaI>I>)
III David C. Cleaver & Associates P.C.
i lELEPHONE NUMBER
717-264-1110 Chambersbu PA 17201
(1)
(2)
(3)
(4)
(5)
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1. Real Estate (ScheWle A)
2. Stocks and 800ds (ScheWle B)
3. Closely Held COJPOf3tion, Partnership or Sole-Proprietorship
4. Mortgages 8 Noles Receivable (ScheWle D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OWned Properly (Schedule F) (6)
o Separate Billing Requested
125,000.00
OFFICIAl USE ONL V
12,603,51
137,603.51
(8)
13,902.60
14,696.72
(11)
(12)
(13)
26,599.52
109,203.99
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or Ll
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expe!lses 8 Administrative Costs (Schedule H) (9)
10. Debts of Decedent. Mortgage Liabilities, 8 Liens (ScheWle I) (10)
11. lolat Deduction. (total Lines 9 810)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjecllo Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rale, or lransf... under Sec. 9116 (a)(1.2)
19. Tax Due
X .0_(15)
109.203.99 X .04.5 (16)
X .12 (17)
X .15 (IB)
(19)
(14)
109,203.99
4,914.16
4,914.16
20. 0
I1fW:%@';@'W!@!i,1;#:"'i1iil!!i'iMBEj$UR6NfO'A 'sw . Atilil.Q '1'lIlTIOIIIS:ON: . l:llEue:S10l!!ANI1l'lIlCI'IE'K:MA: ., : ::::gJI!fij'fi'i{i!i..::t::NWiHjijNii
16. Amount of line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Com lete Address:
STREET ADDRESS 9 H
9 at oint Avenue
STATE PA
ZIP 17257
Tax Payments and Credits:
1. Tax Due (Page Hine 19)
2. CredilslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,914.18
ToIaICredits(A+B+C) (2)
3.
InterestlPenalty if applicable
D. Interest
E. Penalty
T otallnt...estlPenally ( 0 + E )
4. If Line 2 is lTeat... than Line 1 + Line 3. enter the diff...ence. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a relund (4)
5. If Line 1 + Line 3 is lTeater than Line 2, ent... the difference. This is the TAX DUE. (5)
A. Ent... the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
Mmi1IHmHtM@~nMF1WNjffHM~ltiHtrMMM;RE~lN1WMmt?:mMMt1HmiiH1mllimm~tllf1~mrimJMfftWJJt.1Jil&tJt~i~nnfIH~1M{Mllf?lW1UWilitt.tHf%JJ.i~riililMiWffmMJlf.@~
(3)
4.914.18
4,914.18
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X. IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;......................................................................... 0 1XI
b. retain the right to designate YAlo shall use the property transferred or its income;...................................... 0 1XI
c. retain a rev....ionary interest.or.................................................................................................. 0 1XI
d. receive the promise for life of either payments, benefits or care?......................................................... 0 1XI
2. If death OCCUlTed aft... December 12, 1982, did decedent transf... property within one year of death
without receiving adequate consideration?......................................................................................... 0 1XI
3. Did decedent ovm an 'in trust for" or payable upon death bank account or security at his or h... death?.............. 0 1XI
4. Did decedent ovm an Individual Retirement Account, annuity, or othe< non-probate property YAlich
contains a beneficiary designatianL...................... ....... ........... ........... .......... ................ ................... 0 1XI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
l))der peIlelies of perjury, I declare thfi I haYs examined this return, inclJdi~ acc:om~g schedues lWld statements, tnd kl the best d my know8dge tnI beief, it iI D, ocmcl: P oomphte.
Declaration of preparer other IhEll the personal repl'8S8flIatiw is based on 81 informetiOO of v.tIich prepEnI" has r!IlY knowBdge.
SIGNATURE ~ RESPONSIBLE FO FlUNG RFURN , DATE
. , . 9/14/01
ADDRESS un Road
PA 17240
DATE
9/14/01
PA 17201
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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 SllViving spouse is 3%
[12 P.S. S9116 (a)(1.1) O)J.
For dates of death on or aft... 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) (n)).
The statute does not exemot a transfer to a surviving spouse trom tax. and the statutory requirements for disciosure of assets and filing a tax rehrn are stiU 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 !rom a deceased child twenty-one years of age or younge< 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. S9116(a)(1.2)J.
The tax rate imposed on the nelvalue of transf.... to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) (72 P.S. S9116(a)(1)J.
The tax rate imposed on the net value oftransf.... to or for the use of the decedenrs siblings is 12% (72 P.S. ~9116(a)(1.3)J. A siJling is defined, under Section 9102, as an
individual YAlo has at least one parent in common with the decedent, YAlether by blood or adoption.
_'~'(H" '*
COMMONWEALTH OF PENNS'VtVANIA
INHERITANCE TAX RETURN
ES EI'IT I'IT
SCHEDULE A
REAL ESTATE
ESl AlE OF FILE NUMBER
BIGLER GORDON MONTGOMERY 21 01 0031
All real property owned IOIeIy or as a tenant In common must be reported at fair market valu.. Fair market value is defined as the price at which property would be exchanged
belween a willing buyer and. willing seller, nailher being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property whlc~ 10 Jolntly.ownod with
right of
survtvorshln must be disclosed on Schedule F.
11Et.!
NUMBER
1.
DESCRIPTION
Two tracts of real estate situate in Shippensburg Township, Cumberland County, PA,
recorded in Cumberland County Deed Book 0, Volume 32, Page 26, returned at sale
price
VAlUE AT DATE
OF DEATH
125,000.00
lOT Al (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
125 000.00
"""'EX'''~ '*
COMMONW~THOFPENNSYlVAN~
INHERITANCE TAX RETURN
RESIOENT OECEDENT
SCHEDULE E
CASH. BANK DEPOSITS. & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
BIGLER GORDON MONTGOMERY 21 01 0031
Include the proceeds of litigation and the dale the proceeds w"'e rece~ed by the estate. All property jolntly-owned with tho right of ourvtvorsltlp muot be dlocloood on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1983 FIOrd Ranger, said, returned at sale price
VALUE AT DATE
OF DEATH
500.00
2.
1988 Chrysler, said, returned at sale price
1,500.00
3.
1968 Americana mobile home, sold, returned at sale price
1,500.00
4.
1968 Newport mobile home, sold, returned at sale price
1,500.00
5.
Checking Account, Orrstown Bank
613.70
6.
Household furnishings sold at public sale (net proceeds)
6,912.55
7.
Cash in decedent's wallet
277.26
TOTAL (Also enter on line 5, Recapitulation) $
Of mQ(e space is needed, insert additional sheets of the same size)
12803.51
_""M:.
COMMONWEAL 1M OF PENNSYLVANIA
INHERITANCE nJ( RETURN
RES DENT OECEOENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
EST ATE OF
BIGLER GORDON MONTGOMERY
FILE NUMBER
21
01
0031
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home 6,666.50
B. AOMINISTRA TIVE COSTS:
1. P8l1!llf\al Representative's Commissions
Name of Personal Represenlat~e (s)
Social Security Number(s) I EIN Number of Personal Represenlalive(s)
Street Address
City Slate z.,
Year(s) Commission Paid:
2. Attorney Fees David C. Cleaver 6,500.00
3. Family Exemption: (If decedents address is not the same as c1aimanfs, attach explanation)
Claimant
Street Adchss
City Slate Z"~
Relationship of Claimant to Decedent
4. Probete Fees Cumberland County Register of Wills 273.00
5. Accountanfs Fees
6. Tax Return Preparef's Fees
7. Horn & Company Appraisals - real estate appraisal 463.30
TOTAl (Also enter on line 9, Recapitulation) $ 13 902.80
(If more space is needed, insert additional sheets of !he same size)
....,""EX.".?'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TI\)( RETURN
RESIOENT DECEDENT
ESTATE OF
BIGLER GORDON MONTGOMERY
Includ. unr.lmbursed medical .xpen....
ITEM
NUMBER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 01
0031
1.
Valleybank, now Allfirst Bank. balance due on mortgage on decedent's real estale
DESCRIPTION
2.
GPU Energy. electric
3.
Carlos Leffler, Inc. . fuel oil
4.
Borough of Shippensburg . water and sewer
5.
Sprint. phone
6.
Homeowners Insurance
7.
Comcast Cable' final billing
8.
Orrstown Bank. loan
AMOUNT
12,036.37
316.33
587.09
395.26
27.24
246.00
5.37
1,083.06
TOTAl (Also enter on line 10, Recapitulation) $
(If mor. space is needed, insert additional sheets of th. same siz.)
14696.72
~"':~,(~" '*
COMMONWEAlTH OF PENNSYLVAN~
INHERITANCE TAX RETURN
RESIOENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ALE NUMBER
~,,.,, ~..., 71 n1 nM1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do No! List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS Onclude oldright spousal distributions)
1. Randy Gordon Bigler Son One-half
106 Tidwell Drive
Huntsville, AL 35806
2. Trudy Jean Collier Stepdaughter One-half
15489 Paxton Run Road
Newburg, PA 17240
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEE $
(If more space is needed. insert additional slIeels of lhe same size)
Will
PETITION FOR PROBATE and GRANT OF LETfERS
Will
Estate .... ~?~~?~. ~??t.&~T!l~~Y. !3.i.&~~~ . . . . . . . . . . . . . .
also known as _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No. . . . . . .~ I. ~ . Q. ~ . :-. .J I. . . . . . . . . . . .
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
To: Register of Wills for the
.C.l.lmberland
County o~ in the
Commonwealth of Pennsylvania
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Deceased.
Social Security No. .?9k.1.8.-:Q4Z?..................
The petition of the undersigned respectfully represents that:
Your petitioner(:s) is/are 18 years of age and the execut Q:rs. . . . . . . . . . . . . . . . .. named in the last will of the
above decedent, dated.. .~~Y. P.............. 19.9.3... and codicil{s) dated .... N.o.ne...................
........................ ..............................................................................................................................................................................
........................ ..............................................................................................................................................................................
(State relevant circumstances. e.g. Renunciation. death 01 executor. elcJ
Cumberland
Decedent was domiciled at death in Shippensburg, / County, Pennsylvania, with h:i.& . . last famil{
or principal residence at ...~.9. .~~~1??~~~. .~~E71!'-:~? . ~?~l?1?~~~.b.~~g ~ . ~:~ . J ~?? 7. . . . . . . . . . . . . . . . . . . . . . . . .
(Shippensburg Township)
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. . .. . . .. .. .. . .. .. . .. . . .. . .. . . .. . .. .. ~ .. . .. . .. .. .. .. . . .. . . . .. . - . .. . .. .. . . .. .. .. ..
(list stree\, number and municipality)
Decedent, then. . . 77. years of age, died . . .:Q~c;eIjlb~.r. . L 8, . 2.0.QQ . . . . . . . . . . . . . . . . . . . . . . . . . .. :llik... . ,
at . . . ~~. ~o.t.p.~~1].~. ~y.e.n:l!~ ~ . ?r;ipp.~I11?1?l}rK,. .Gl!~l?~~)..a.n.q. <::9!lP.t.Y. t . :r~!1P's.y.:J.Y{lp..i.a. . . .. . . . . . . . . . . .. .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after
execution of the will offered for probate, was not the victim of a killing and was never adjudicated incom-
petent ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ . ~ -' PP.O...QO . .
(If not domiciled in Pa.) Personal property in Pennsylvania $ . . . . . . . . . . . .
(If not domiciled in Pa.) Personal property in County $ . . . . . . . . . . . .
Value of real estate in Pennsylvania $ . . . . . . . . . . . .
situated as follows: 9.9. .Hotpoint .Avenue,. .SbippensblHg.,. .FA. . . {S-hippensb-u:J;g. Townshifl)' . .$.1.50,000.00
.. .. . .. . - .. . . . .. - .. . . .. .. .. . .. . .. .. . . .. . .. .. . .. . . .. . . . . . .. .. . . .. .. .. .. . . . . . . . .. . . .. .. .. .. .. . . . . . . . .. . .. . . . . .. . . . .. .. . - .. .. . .. .. - . . . . . - . .. ..
. . . .. . . . . . . .. - . . .. .. . . . . . .. . . . . . .. . . . .. .. .. .. .. .. . .. .. .. .. .. .. . . .. .. .. .. . . .. . . . . . . .. .. . . .. .. .. . . .. . . .. - .. .. .. . . . . .. . . . - . . .. .. .. . .. . . . . .. .. .
WHEREFORE, petitioner(s) respectfully request the probate of the last will and codicil(s) presented here-
with the grant of letters. . t~~.t.a.II!~I1~?-~:-Y_. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .... . . . . .. therecn.
(Testamentary. administration c.l.a,. administration d.h,n.c.l.a.)
~ Signature{s) and Residence{sl
~o{t:~i @J............... .OIPcl':."'rl~to{i~.............
. .106 .Tidwel-l 'Drive' . . . . . . . . . . .. . .. . .. . . . . . . . . . . .. . . . . . 1-5489' Paxton' Rurr 'Road' . . . . . . . . . . . . . . . . . .
, HuntsviH~.,. .AL .'. 35.8.Q6. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . N.e.wburg.,. .PA. . 1724Q. . . . . . . . . . . . . . . . . , . . . .
.. ... -....... -... -"" -. -.. -................. ................................ -.............. -.... -... - ... -. ........ -. ....
. ........... ................................................ ................................ -.................. -.............. -.... ...
. ... . ...... - ..... ............................................................................. -......... -............... .....
/ L, - Q ~..-o- L?
OATH OF PERSONAL REPRESENTATIVE
COMMOMWEALTHOFPENNSYLVANIA t
COUNTY OF . ~~~ . ~~~~~~~~D ~
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 above petitioner(s) will well and truly administer the estate accor;8in ~ ~.
Sworn to or afhrmeo anO sub- Q,~d " ....... "'. ,. l' . . . . . . .. ...................
- Randy(%6r on nlg er
scribed before me this. .5.t,l1day of ~. . . . . . . . . . . . . .~. .. . .. '.' . . . . . . . . . . . . . . . . .
TANU.ARY . YMWOOCK 2001 ./~~c:1La;J... . .................
. . . . . . .~. . ~ - . '1 . . . . . . . ~ (' . r, . _ T~~ciy(lfe~ -coii'1:er
"--(Y7/11J-4. C k/...{Jc:, DI1 () [j I .'F'-}'^-- -. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . .tH-. ;" . . . . . . . . . . . r~Y' . AIL-'< "0 ~
Fur the Register
SS
No. n-:-OJ.:-,11. . . . .
Estate of. . .Gq~c;l9~. ~9P..t.&ql1).~~Y. ~i--g;L~.r. . . . . . . . . . . . . . . . . . . . Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
200'
AND NOW, ... q~A~~ . . ? . . . . . . . . . . . . . .. mmooc, in consideration of the petition on the reverse side
hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated
. . . . . . . . . . . . . . . . . . . . . . .~Y. ?7.,.1.~Q~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
described therein be admitted to probate and filed of record as the last will of .G(?"~9-9~ }19~:!=g9!ll.e.r:y. .l?igJ.~.r: . .
and letters. . . .t.e.s.~~~~~.t~.r:Y: _ . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
are hereby granted to . . . . . .Ra.ndy. .GQr:dQu. :BJ.gl,e:r . ?pd. .'l);t,l<;ly. J.e.<FJ.. ~9.l.1A~r. . . . . . . . . . . . . . . : . . . . . . . . . .
........... ........................................ .~lo.'~i."",.J~j,J6.!1~\..
Documents Attached: Register of Wills
Oath of Subscribing Witness(s) 0
Oath of Non-subscribing Witness(s) 0
Oath of Witness(s) to mark C!
Renunciation(s) 0
Letters
S.C. 4
x-pages
J{"'P
$235.00
12.00
6.00
5.00
258.00
David C. Cleaver 07283
.... -... -....... - -'.. -...... ... ... -........ .
ATIORNEY (Sup. Ct. 1. D. No.)
1035 Wayne Avenue
.. ~ha.II!Qe:n;J:>p.r:g.. f~.. .V-?9~. . . ... . ... . . ... .
ADDRESS
717-264-1110
PHONE
Thl~, IS to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as
Loci! Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
21-01-31
No.
~K
......... ~,~
Local Registrar
Fee for this certificate, $2.00
y
7060189
~~.~
Date
26#0
qev.1191
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
~
NAME OF DECEDENT (First Middle,last)
1. GORDON M
AGE (Lasl BirlhdaYI UNDER 1 YEAR UNDER 1 DAY
Months Dayll Hou~ Mlnut..
BIGLER
sex
..Male
IWE Fill NUM8f:R
SOCIAL SECURITY NUMBER
..201-18-0225
18, 2000
..
COUNTY OF DE~H
77 v...
O,Q'E OF BIRTH BIRTHPLACE (City and PLACE OF DEATH (Check only one !I8Ellnslruclions on other Side)
(MOI'1tn, Day, ~rl Stale Of Foreign Counlry) HOSPITAL
P npollonlO
7. ...
FACILITY NAME (If nOl in81ltullon, give street ano number)
~~'l\'ID
Cumberland
.. ...
DECEDENT'S USUAL OCCUPATION
j~~~g\I~:r~ ~~~';~~r~d)'
Clerk
RACE. AmeriCan lndilln, Black, Whit... ..rc
(Spoc,ly)
White
SURVIVING SPOUSE
(l1w,lp.QIYf'm,l'rl"nn~rr'"l
...,
99 Hotpoint Avenue
~hippensburg, PA 17257
F,tJ'HER'S NAME (I'"ils1. Middle. La!!!)
11. Roy O. Bigler
INFORMANT'S NAME [Type.'Prinl)
Trudy J. Collier
METHOD Of DISPOSITION
O ......IKI C.....lIonO
DoMtIOn 0IMr (Specify
1.
SIQNATV OF FUNERAl SEFMCE UCEN9EE 0
l1b, Coon
Cumberland "d.O :'=~'=OI
MOTHER'S NAME (I'"iISl, Middle. Meiden Surrwne)
~ Sarah Ellen Zeigler
INFORMANT'S MAILING ADDRESS (SIrtel. CityfTown. 8181e, Zip Code)
15489 Paxton Run Road, Newbur
PLACE OF DISPOSITION - Name 01 c.mete'Y, Cremeloty
or OtMr Place
Spring Hill cemetery
c1tylbof(J
e ml 23a-c only n certifying
phyIlclan II not ,Y11l1able at lime 01 <te.th 10
cer1lfycauMofdHth.
LICENSE NUMBER
01 1776-L
t P
NAME AND ADCAESS OF FACILfTY
e1sanger-ikicker F .H. ,Inc. ,P .0. Box 336, Shbg. ,PA 17257
LICENSE NUMBER DATE SIGNED
{MOr\lh, Day, Yaar)
PA
17240
....
Items 24-28 mull beoompt8tecl by TIME OF DERH Aprx. D,(f'EP ONOUNCEDOEAC(MOOth.D8y,,'t'e8I)
-.....-....... ... 6:00 A.M.... December'18. 2000
27. MAT I: Enter the dI....... injuries Of compllcalions which caUHd the dNlh, 00 not Itnter the modi of dying, tuch al camllc or respntory aneII, Ihock or he." fallute,
List onty ana cauu on Hch line.
rMM!DIAT! CAUl! (Final
d_orc:ondition
rMUltinoin deelh)--+
Ub. .nc.
WAS CASE REFERRED TO MED~L EXAMINERfCORONER?
v..~ NoD
Probable M ocardial Infarction
CUE TO (OR ASACONSEOU(NCE OF):
I Approxlmat.
,Interval bttwetn
! ClnHt end death
PART II: Othat Ilgniftcant conditions contributing 10 deAlh, but
not rnulllng In '''' onderlylng caUlfl givfln in PART I
8eQuImt1dy Net condltlons
If any, INclIng to ImrMdlate
cauM. E"nter UNDERLYING
CAUlE (Oiseese or injury
1h8llrlllialed events
rellJ/ting in desth) LAST
DUE TO (OR AS A CONSEOUENCE OF):
DUE TO (OR AS A CONSEQUENCE OF):
'M9 AN AUTOPSY
PERFORMED?
d.
WERE AUTOPSY FINDtNGS
A'hdLABLE PRIOR TO
COMPlETION OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
(Month. Day, ..r)
TIME OF INJURY
Coroner
INJURY AT WORK?
Natorl'
k
o
o
Homlclda
Pending InwatlgatlOn
Cookfnotbe~
o
o
O PLACE OF INJURY -AI home, 'Irm.ltl'Ml, 'Ictor')'. office
building. etc. (SPflClty)
....
Yoo
Yoo 0 No~
YooO
No 0
_100"
n.. 21b.
CEA11tr1lE111 (Check only one)
"CERTIFYING PHY8tc1AH (Phy8iCian certifying cause 01 deelh when anothlH' phyaIclan ha pronounced dNth .nd ccmpleted Item 23)
To1tMl~otm,knowtedge, .lthoccunwcldu.tothaC..I).ndmanner...u.tect.,."...,.,.....,......,....,..,...,.".""".,.",.
Suicide
...
o
.MEDlCAL EXAMIN!RICORONEA
On the..... of ...mlnltton Ind/or Irweetlptlon, In my opinion, dHth oocurred m the "me, dm., .net pllCe,.net du. to thIi ClUu(.) Ind
II\IIn...........ed......,........,..................,.......,...".,.,..........,...............,.,."..".,....... .
31.,
REQISTRAR'S SlONATURE "NO NUMBER
I ~ 1,';/11 ST
DIJ"E SIGNED (Month, Day, Yflal}
o . .. December 19,2000
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(nem27)TypoorPrint Michael L. Norris. Coroner
6375 Basehore Road. Suite #1
~... Mechanicsburg, Pa. 17050
D1JE FILED(Month, DAy, "'-II
"~AND catn'''''1NO PHYSK:IAH (Physk;illn boItI pronouncing dealh lInd ctrtllylng to call" 01 d..th)
Tothabe.cormy~, dHthoccurNdellhetlme. ua..and~.andchMlotheoluel(a)lndma"ner_""".,.,.,."...""",.",."
...
...
LAST WILL AND TESTAMENT
OF
GORDON MONTGOMERY BIGLER
I, Gordon Montgomery Bigler, of 99 Hotpoint Avenue, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory,
and understanding, do hereby declare this as and for my last will and
testament hereby revoking all wills and codicils previously made by me.
FIRST
I direct the payment of my debts and expenses of my last illness and
funeral from my estate as soon after my death as conveniently may be done.
SECOND
I give, devise, and bequeath my entire estate, in as nearly equal
shares as is practicable, unto Randy Gordon Bigler, of 225 South Earl
Street, Shippensburg, Pennsylvania, and Trudy Jean Collier of 513 North
Morris Street, Shippensburg, Pennsylvania, per stirpes.
THIRD
I direct that any and all Inheritance, Estate and Transfer Taxes
osed upon my estate passing under my will or otherwise, shall be paid
residuary estate.
FOURTH
In addition to the powers conferred by law, I authorize my personal
representative, in their absolute discretion:
To retain in the form received, and to sell either at public sale or
private sale any real or personal property.
To manage real estate.
To invest and reinvest in all forms of property without being confined
to legal investments, and without regard to the principle of
diversification.
To exercise any option or rights arising from ownership of
investments.
E. To compromise claims without court approval, and without the consent
of any beneficiary.
FIFTH
I nominate, constitute, and appoint Randy Gordon Bigler and Trudy Jean
Collier, or the survivor of them, as Executor and Executrix of this, my last
will and testament. I hereby relieve my personal representative from the
necessity of posting security in connection with their duties as such in
any jurisdiction in which they may be called upon to act insofar as I am
able by law to do so.
IN WITNESS WHEREOF, I have hereunto set my hand
last will and testament, this ~day of
this my
and for his last will and testament
request, in his sight and presence,
other, ~ave hereunto subscribed our
I' } "~ /~.,,~,
/ / ~ Ci,; /(/(/
Signed, sealed, published and declared by the above named testator, as
in the presence of us, who, at his
and in the sight and presence of each
names as witnesses.
_ . C.----::>
? '. (), lCp.-Z_O ha-i c/
1
.'
COMMONWEALTH OF PENNSYLVANIA:
residing at
- . . ./!
(;Ad>t~:-IZc(:'d-d,',,; 7f
d/r
.J
(~ /1 Cv>,-,., ~ .s6{{>t~ ' ~ c1
:tl0esiding at
55
COUNTY OF FRANKLIN
I, Gordon Montgomery Bigler, the testator whose name is signed to the
ttached or foregoing instrument, having been duly qualified according to
aw, do hereby acknowledge that I signed and executed the instrument as my
ast Will; and that I signed it willingly and as my free and voluntary act
for the purposes therein expressed.
We,~(/,:d C C/el/u</ and -:;;: /I A/(4A-vd, 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 testator sign and execute the instrument as his last
will; that the testator signed willingly and executed it as his free and
voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the testator signed the will as a
witness; and that to the best of our knowledge the testator was at that
time eighteen (18) or more years of age, of sound mind, and under no
constraint or undue influence.
Sworn to or affirmed
Bigler, the testator, and
bX J'jA":cI ~~r~
~ day of
and acknowledged before me by Gordon Montgomery
sworn to or affl[med and subscribed to before me
and ,-)0 R. .&.ei( J..A,"d , witnesses, this
, 1991.
(~ Q.
Witness
(----~
\ . .
(~j. a hCl{ c{
(l~~ 9U~w
Notary
Notarial Seal
Carol J. Varner, NotaEy PublIc
C~mbers~~ Bora, Franklin County
M~ COmt11lSSlOn Expires April 3. 1997
16 -D20o- 6
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
Recoraed Office of
Register of Wills
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
DAVID C CLEAVER'01 NOV 26 All 51
D C CLEAVER & ASSOCIATE
1035 WAYNE AVE Clerk-(\'d,L3 Court
CHAMBERSBURG Cl,ft1bQrla1lO(J Co", PA
11-20-2001
BIGLER
12-18-2000
21 01-0031
CUMBERLAND
101
Allount Rellitted
*'
REV-1547 EX AFP lIZ-DDl
GORDON
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =is'irj-Ex--AFP--n'2-:o€ir-NoYicE--o,:-YtiHEifiTAifcE-YA'x-jrpPRA-isEi'-ENT~--ALroWANCE-(rR-------------- - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BIGLER GORDON M FILE NO. 21 01-0031 ACN 101 DATE 11-20-2001
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
S. Total Assets
( ) CHANGED
U}
(2)
(3)
(4)
(S)
(6)
(7)
125.000.00
.00
.00
.00
12.803.51
.00
.00
(S)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
NOTE:
If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
lS. Allount of Line 14 at Spousal rate (lS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
lS. Allount of Line 14 taxable at Collateral/Class B rate (lS)
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
09-17-2001
RECEIPT
NUMBER
CD000265
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
· IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
13.902.80
14.696.72
nll
n2}
U3}
U4}
(9)
no}
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
137.803.51
28..,99 .,2
109.203.99
.00
109.203.99
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
109.203.99 X 045 =
.00 X 12 =
.00 X 15 =
U9}=
AMOUNT PAID
4.914.18
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
4.914.18
.00
.00
4.914.18
4.914.18
.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.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
NO. CD 000265
CLEAVER DAVID C
1035 WAYNE AVENUE
CHAMBERSBURG, PA 17201
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
-------- fold
--------
I $4,914.18
I
I
I
I
I
I
I
I
$4,914.18
101
ESTATE INFORMATION:
SSN:
201-18-0225
21-2001- 0031
BIGLER GORDON MONTGOMEF Y
09/17/2001
00/00/0000
CUMBERLAND
12/18/2000
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
TOTAL AMOUNT PAID:
REMARKS: DAVID C CLEAVER
CHECK# 5582
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
SEAL
REGISTER OF WILLS
E
-
CERTIFICATION OF NOTICE
UNDER RULE 5.6(a)
Name of Decedent: Gordon Montgomery Bigler
Will No.: 21-01-0031
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 18, 2001:
Randy Gordon Bigler
106 Tidwell Drive
Huntsville, Alabama 35806
Trudy Jean Collier
15489 Paxton Run Road
Newburg, Pennsylvania, 17240
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Date: ?/-/A- a/
~(?:~\
Counsel for Personal Representatives
1035 Wayne Avenue
Chambersburg,PA 172Ql
Phone: 717-264-1110
~v'
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Gordon Montgomery Bigler
Date of Death: December 18, 2000
Admin. No.:
Will No.: 21-01-0031
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:
A. State whether administration of the estate is complete: Yes
B. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
C. If the answer to No. 1 is Yes, state the following:
1. Did the personal representative file a final account with the Court? No
2. The separate Orphans' Court No. (if any) for the personal representative's account is:
3. Did the personal representative state an account informally to the parties in interest?
Yes
4. Copies of receipts, releases, joinders and approvals of formal or informal accounts
may be filed with the Clerk ofthe Orphans' Court and may be attached to this report.
Date: Apnl 22, 2002
Cffit2 ~
l'-r.~
103 5 Wayne Avenue
Chambersburg, P A 17201
(717) 264-1110
Counsel for Personal Representative
.>.J
':-'J
P
-'
"; i .