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Home My WebLink About01-0043 " L1c/ ) rp>>J /fo-olr:J/- .3 REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 c>d:b3 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DESCH. CLEMENTINE M. 162-22-2224 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 10/09/2000 01102/1928 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Umited Estate 4a. Fulurelnterest Compromise 5. Federal Estate Tax Return Required ~ate of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. aceden! Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach copy 01 Will) ~ltachacoPyofTrus'l BLOCKS 9. Utigation Proceeds Received 10. pousal POl/erty Credl (date of death between 0 11. Election to lax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch 0) :1111$$dIC.l\ffi.l\!l$fi'llgQPMlij~jlttj4li!(li ...........~ij_~iJl'e{J&~IIlRiAJNMll:ml!QtllMtilij;j!d'iiI@U~l'lli!rRl!!lllil!lft$ii NAME COMPLETE MAILING ADDRESS COR- Michael Cherewka RE- FIRM NAME (If Applicable) 624 North Front Street SPON DENT Cherewka & Radcliff, LLP Worm1eysburg, PA 17043 TELEPHONE NUMBER (717) 232-4701 - OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or SOle-Proprietorship (3) , 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) 42.852.20 RECA- PITULA- 7. Inter - Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 110.968.66 8. Total Gross Assets (total Lines 1-7) (8) 153.820.86 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 4.910.00 10. Debts of Oecedenl, Mortgage LIabilities, & Liens (Schedule I) (10) 174.30 11. Total Deductions (total Lines 9 & 10) (11) 5.084.30 12. Net Value of Estate (Line 8 minus Une 11) (12) 148.736.56 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) 0.00 has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Une 13) (14) 148 736.56 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal lax rate, or transfers under Sec. 9116 (a)(1.2) X .0 (15) - TAX 16. Amount of Line 14 taxable at lineal rate 148,736.56 X .0 ~ (16) 6,693.15 COMPU- 17. Amount of Line 141axableat sibling rate X .12 (17) TATION 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (19) 6,693.15 20. 0 1:~!!))!ll$.fl~ajjilI(ijj)jI&Rll~jijQ;iiij~rt)NPtQ@'fil'pyJ.ijlIi\WMm;1 iniimMI#M%M!MImmnnminmfiH\j~J~ijll!ltl:jI!lN$WlilijM;iW'Ill~$tiJMil:l!@JiA~~'!lN$iij~!lWI!li\j~:MA'fu~i1@H@tmmm%MMmm%1inM% o PA 15001 NTF 29755 Copyright 2000 Greatland/Nelco LP - Forms Software Only PA REV -1500 EX (6-00) Page 2 Decedent's Comnlete Address: STREET ADDRESS 2 Patricia Drive CITY I STATE I ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6.693.15 6,000.00 315.79 Total Credits (A + 8 + C) (2) 6.315.79 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page '1 Une 20 to request a refund 5. If Line 1 + Une 3 is greater than Une 2, enter the difference. This Is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This Is the BAlANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. (3) (4) (5) (SA) (58) 377.36 377.36 Did decedent make a transfer and: a. retain the use or Income of the property transferred; .........,.,............... ."......., 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 me of either payments, benefits or care? ...........,.,...... . . , . . . . . , . 2. If death occurred after December 12, 1982, did decedent transfer property within one year ot 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? . . . . . . . , . , . , , , . . . . . . . , , . , . , . . . , . . , . . , . . . . . . . , . , , . . . . . , .. 0 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 declare that I have examined this return including accompanying schedules and statements, and to the best of my knowledge and benet, it is true, correct and complete. Declaration 01 preparer other ilian the personat representative is based on Information of which re arer has an knowled e. URE-oF P~ , FOR ILING RETURN OAT RESS 4 Woburn Court, Camp Hill, PA 17011 SIGN~~'m;~ REPRESENTATIVE ADDRESS 624 North Front Street, Wormlyesburg, PA 17043 Yes No ~ ~ B ~ IKJ 6{)J DATE / ?IS/Oj lmM~Mmti~1~PNKmMUM1t]m$.w~n1@]@tMH%ilimmnm*-t~Wf.tt1ili$.filWt~MMkt;;1MHMHM:mn@HMWMHMHMMttWm~WMiliM1M~mg1;M@ttMnMtM~M1Mr~ For deates of death on or afler July 1, 1994 and before January 1, 1995, the lax rale Imposed on the net value of Iransfers 10 or for the use of the surviving spou$e is 3% {72 P.S,I Q't't6~&)(,.'tHI)l, For dates of death on or after January " 1995, the tax rate Is Imposed on the nel value of transfers 10 or for the use of the survivIng spouse Is 0% [72 P.S. I S11a (a)(1.1)(II)]. The statute noe!! nnt "'YAmnl a Iransfer toa surviving spouse from tal(, and the statutoryrequlrements for disclosure of assets and fJllnga taXreturnare stl!! applicable e~en If the survIvIng spouse Is the only beneflclllf"Y. For dates of death on or after July 1,2000: The taxra'te Impoced on the net value of transfers from.. d81::eased child twen\y-oneyears of age or younger al death 10 or for the !.lse of a nalural parenl, an adoptive parenl, or a stepparent at Ihe child Is 0% [72 P,S.19116(aJ(1.2)]. The lax rate Imposed on the ne"t value of transfers 10 or for the use of the dElceden!'s lineal benefIciaries is 4.5%. except as noted In 72.P.S.' 9116(1.2) [72f'.S.191't6{a){1}1, The tax rate Imposed on the nel value of Iransfers to or for the use of Ihe decedenl's siblings Is 12% (72 P.S. 19116{aJ(1.3)J. A sibling Is defined, under Section 9102, as an Indlvldue.1 who has at least one parent In cornman with Ihe decedent, whether by blood or adoption. o PA 15002 NTF 29756 Copyright 2000 GreaUandlNelco LP - Forms Software Only REV.1509 EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R N D EDENT ESTATE OF CLEMENTINE M. DESCH SCHEDULE F JOINTLY-OWNED PROPERTY FI LE NUMBER ;2./-0 1-00</3 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Danielle T. Plessl 4 Woburn Court Camp Hill, PA 17011 Daughter B. Deborah J. Strohecker 50 Reeser Drive York Haven, PA 17370 Daughter JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECD'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 12/01/99 waypoint Bank ~cct #3700000767 1,011.04 100 1,011.04 2 A 12/01/99 i'laypoint Bank !\.cct #3705000606 41,841.16 100 41,841.16 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. 42,852.20 Form REV-l509 EX (Rev. 1-97) REV-1510 EX + (1.97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEAL THOF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT ENT ESTATE OF CLEMENTINE M. DESCH This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER 1 DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE THEIR RELAll$TNII~ttIP TO DECEDENT AND,TI=~ERDRAI=TIIE OF TR~~SFER. AmerUs Life Insurance Annuity Policy #1715093 100 FILE NUMBER DATE OF DEATH VALUE OF ASSET %OF DECD'S EXCLUSION INTEREST (IF APPLICABLE} 9,468.66 2 Real Estate at 2 patricia Dr, East pennsboro Twp, Deeded to Danielle T. Plessl & Deborah J. Strohecker on 9/26/2000 with each receiving a 1/2 undivided interest 100 107,500.00 TOTAL (Also enter on line 7, Recaoitulationl $ (If more space is needed, insert additional sheets of the same size) Copyrlght (c) 1887 form software only CPSystems, Inc. 0.00 6,000.00 -:2 ( - () 1- 00 '(3 TAXABLE VALUE 9,468.66 101,500.00 110 968.66 Form REV-1510 EX (Rev. 1-97) AEV-1511 EX+(1M97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESID NT CEDENT ESTATEOF CLEMENTINE M. DESCH Debts of decedent must be reported on Schedule I. FILE NUMBER 2.1-"1- <ooy" ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Woodlawn Memorial Gardens 470.00 2. Sullivan Funeral Home 2,358.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s} Social Security Number(s} I EIN Number of Personal Representative(s} - - Street Address City State _Zip Year(s) Commission Paid: 0.00 2. Attorney Fees 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant N/A Street Address City State_Zip Relationship of Claimant to Decedent 4. Probate Fees 57.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Register of Wills- Inheritance Return & Inventory Filing Fees 25.00 TOTAL rAlso enter on line 9 Recaollulation) $ 4 910.00 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1997 form software only CPSystems, Inc. Form REV-1511 EX (Rev.1~97l AEV-1512 EX -I- (1-97/ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF CLEMENTINE M. DESCH COMMONWEAL THOF PENNSYLVANIA INHERITANCE TAX RETURN R 1DENT DECEDENT FILE NUMBER z (-.0/ - ='1"3 Include un reimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Conner-Rich-Kearney-Torchia AMOUNT 20.00 2 PAWC 19.59 3 Verizon 9.92 4 Penna Power & Light 44.69 5 East Pennsboro Township 80.l0 TOTAL (Also enter on line 10 Rec.nit"I.'ion) $ l74. 30 {If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSyslems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI ECEDENT SCHEDULE J BENEFICIARIES ESTATE OF CLEMENTINE M. DESCH FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSONISI RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) RELATIONSHIP TO DECEDENT Do Not Ust Trusteels) ;4(-0/-00<(3 AMOUNT OR SHARE OF ESTATE 1 Danielle T. Plessl 4 Woburn Court Camp Hill, PA 17011 Daughter 74,368.28 2 Deborah J. Strohecker 50 Reeser Drive York Haven, PA 17370 Daughter 74,368.28 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART 11 - 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) 1997 form software only CPSystems, Inc. 0.00 Form REV-1513 EX (Rev. 1-97) " LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, CLEMENTINE M. DESCH currently residing at East Pennsboro Township, Cumberland County, Commonwealth of Pennsylvania, being in good health and of sound and disposing memory do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me, FIRST: I direct that all of my debts not barred by the statute oflimitations, expenses of my last illness, funeral expenses, costs of administration and claims allotted in the administration of my estate shall be paid by my Executor hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: I have not included in this Will any provision for my son, CARROLL L. DESCH, III, it being my express desire that he not receive any share of my estate, THIRD: I bequeath my automobiles, household and personal effects and other tangible personalty oflike nature (not including cash or securities), together with any existing insurance thereon, to my two daughters, DANIELLE T, PLESSL and DEBORAH J, STROHECKER, in equal shares, If either of my daughters should predecease me, then I give, devise and bequeath my tangible personalty to her issue, per stirpes, surviving me, and in default of such issue, her share of my estate shall be added to the share of her sister or her sister's issue, FOURTH: I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situate, to my two daughters, DANIELLE T, PLESSL and DEBORAH J, STROHECKER. If either of my daughters should predecease me, then I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal or mixed and of any nature whatsoever and wherever situate, to her issue, per stirpes, surviving me, and in default of such issue, her share of my estate shall be added to the share oiher sister or her sister's issue, /' //,'rkriM iJUil 1- v \..._",.~-, FIFTH: I hereby nominate, constitute, and appoint DANIELLE T. PLESSL, as Executor of this, my Last Will and Testament. In the event that DANIELLE T. PLESSL shall predecease me, or be unwilling or unable to act as my Executor, as aforesaid, then I nominate, constitute and appoint DEBORAH J. STROHECKER without necessity for posting security regardless of state of residence, as Executor of this, my Last Will and Testament. All references to the Executor herein shall be applicable to said substitute Executor. SIXTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: I. To sell at public or private sale, exchange, transfer, partition, give options upon, lease, mortgage, pledge or otherwise dispose of any property, real 0r personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executor shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities or other securities, or such property, real or personal, as the Executor shall deem wise, without being limited by any statutes or rule of law regarding investments by the Executor. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as my Executor may deem it wise, and even though such property is not the kind of property an Executor would purchase as an investment; and even though to retain such property might violate sound diversification principals. 4. To cause any security or other property which may constitute a portion of my estate to be issued, held or registered in the Executor's own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the fmancial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor is necessary to obtain the benefit of any such reorganization, ~"/ ~~ ,~~ .f " ,,' v / ---- .' L 1J}A1~~i!~.f' 2 consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to my Executor as owner of any securities constituting a portion of my estate resulting from any reorganization, consolidation, readjustment, sale, conversion or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including such compensation to the Executor which shall be in accordance with established fees throughout the period of administration of my estate. 7. To determine what is "income" and what is "principal" hereunder, and my Executor's decision thereon shall be fmal; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. 8. The Executor may make payments to or on behalf of any person who is the beneficiary hereunder but in no event, however, shall payments be made to any creditor or other such person because of anticipation of payment by the beneficiary, and any such claim made by way of anticipation by the beneficiary shall be of no validity or legal effect. 9. To borrow money from any person, firm or corporation, including any corporation acting as an Executor hereunder, for the purpose of protecting and preserving or improving my estate hereunder; to execute promissory notes or other obligations for amounts so borrowed. 10. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers and other agents and employees and to pay reasonable compensation out of my estate or any funds held hereunder to which said compensation is attributable. 11. To carry on any business owned or controlled by me at my death for whatever period of time my Executor shall think proper, and my Executor shall have the power to do any and all things my Executor deems necessary or appropriate, including the power to close out, liquidate or sell the business at such time and upon such terms as my Executor shall deem best. c/tLMJ ~~ xfh1 3 12. To do all other acts in my Executor's judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor pay, or provide for payment of all such taxes at such time, or times, and in such manner as my Executor deems best. IN WiTNESS WHEREOF, I, CLEMENTINE M. DESCH, the Testator to this, my Last Will and Testament, typewritten onfour sheets of paper which I have identified at the bottom of each page by my signature, hereunto set my hand and seal the 2(, t$ day of ~l!.t... 2000. -~ ~ // ....... ". <- - /-Vrvuh t;Aff/ "r-z -J( CLEMENTINE M. DESCH The preceding instrument consisting of this and three other typewritten pages, each identified by the signature of the Testator, CLEMENTINE M. DESCH, this day and date thereof signed, published and declared by CLEMENTINE M. DESCH, the Testator therein named, as and for her Last Will, in the presence of us who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses. >>-~l,A~,~"--J $ K.kk;;! ~hfI 4 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, CLEMENTINE M. DESCH, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instmment as my Last Will; that I signed it willingly; and that I signed jt as my free and voluntary act for the purposes therein expressed. /:~. 1 . ~.~. . .' ;; ~' 'C./h-< ., t' ", I C-7tuPli41 'h?f C:' . L CLEMENTINE M. DESCH Swom or affirmed to and acknowledged before me by CLEMENTINE M. DESCH, Testator, the 2,1#1 day of ~.JeWkL ,2000. (SEAL) ~~ Notary Public Notarial Seal Michael Cherewka, Notary Public Wormleysburg Boro, Cumbertand County My Commission Expires Feb. 5, 2001 Member, PennsywanlaAssoclatlonotNotartes COMMONWEALTH OF PENNSYL VANIA : SS COUNTY OF CUMBERLAND We:S"",,^~ \,,,,,, L. ~<l-"~" .r an~)~~ L .KaJcf,{'~, 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 Testator sign and execute the instmment as her Last Will; that she signed 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 Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~ ... ~ ~4jV~ ~~v , dLA JA; 'r/- ~~ om or affIrmed to and subscribed to before me bY~;VIFEJIL J- kiJ~Land o L . Kr+ 1" witnesses, this 2(, iff. day of s't~ , 2000. (SEAL) JJtdad Lh.-/ /.IdA. Notary Public 5 Notarial Seal Michael Cherewka, Notary Public Wormleysburv BOrtl, Cumberland County My CommiSSion Expires Feb. 5, 2001 ".".......... n_......_......._l_ A_...._._...~_ _,~,_,__,_~ - I] O"i,X(J') l\F\' 'liS() This is to certify that the information here given is correctly copi~d frorr: an original certificate of death du~~ tiled with Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent hllllg. me as WARNING: It is illegal to duplicate this copy by photostat or photograph- he for this certitlcate, $2.00 IIIII,~~\.W'otpl,t----___ ,i'~~. .~~"\ t~~. " ~"- ~~I .... \~~ ~C=:J -,..+- 'I-~ ~c-)\ -{,n' /~~ \*\~"'~:"'/*$ \.~ -... /~l ":.~ A.::s", ":. 'f,? ",\,'r I" <""- tMEN1 \\\" ,.", """''''''#NIII1I111,,11 at:.-:tc/ ~ ~-!A-1" . ~ Local Registrar 7 ~ p 6916992 OCT 1 0 2000 Date No. Rev, 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH Uemen;tin.e M. DeAch SEX 2. Fema.le STAlE FILE NUMBER SOCIAL SECURITY NUMBER NAME OF DECEDENT lflrs. MldOIe. LasI) .. ..162 - 22 - 2224 DAlE OF DEATH IMcmn. Oa't. ....,1 O. Oct 9. 2000 AGE (last BirthOay) UNDER 1 VEAR Monlha Oaya UNDER I DNI Hor.n Minut.. BlRTHPlACE !C,ry iior4 Stale 01' Fcreqn CountlY) 5. COUNTY OF DERH 72 VIII. 'Pa =oIylo 11.. Slale MARllAl STRUS._ Never W.".*I. W~. ONoocod (Specoly) '0. Wi..dow .7..1XI....___.. EGAt RACE. Amencan "'n. Black. Whit.. etc: ISpecIy) WhUe SUlMV1NG SPOUSE {II 'tMt.. 9'\'e tnalOen name) Dauphin. ... Ie. DECEDENT'S USUAL OCCUPArION (~"~tno"'_:ia~::::t:), CGAhi..eA. 2 'P~i..ci..a D~i..ve Lnola, 'Pa 17025 CumbvzJ.and l>d - Min. ~? ..... ... FIiJHER'S NAME (fin" MIddHI. laSl) 11. Lt.to~e 'PeU.e[;A.i..n..L INfORMANT'SNAMErr,pelP"n'l Dani e./...le 'P.le/J/J.l 171>>. Coun Ne.__ 17d.0 .ilhinKt....lifMsol MOTHER'S NAME ,FIISI. MIddle. Malden Surname. 11. Len.a 5eA.ano INfORMANn M,4ll1NO ~SS IS..,. CoIylTown. -. Z'l>~J. . It- WoDwm Ct.., l-amp IIU.A., Y'a 17011 PlACE Of OISPOSfTKlN. Neme 01 Cemetery, Cremalory LOCAl'M)N . CIIyITown. Slat.. lip Code Of 0Ih0f ...... city~ l: WERE AUTOPSY FINDINGS AVl'ILA8LE PRIOR 10 COMPLETtoN OF CAUSE OF OERH? Lv 'Pa D~.,Lnola, 'Pa DArE SIGNED lMonlh. Day, Veall 2311. Dc. Wt\S CASE REFERRED TO MEOtCAl EXAMINERlCOAONEA? a. "'.~.D. NeD I Approximat. PART H: Other signiftcant concMions contributing 10 death. but : inlerval becw..n not ~ in 1M loIftdlIftying eauH given in PART I. I onMI.-wf death I l _. TIME Of' DEATH 20. 10:36 A. .. 25. 27. NRT I: Enter lhe diHuel, injuries Of compltcaliont which caused lhe death 00 nolant., lhe mode of dying, s l* aNy or.- cause on each tine (Month. Day. Year) 1-O<D ......... ~ DATE OF INJURY (Monlh. Day, Veaf) TIMe Of INJURY INJURV AT WORK? DESCRl8E HOW INJURY OCCURRED. MANNER Of DEATH ......... Pendtng ~vntigalion o o o PLACE OF INJURY _ AI home. tarm~~Ht. lactofy, office M. buikinQ. etc. lSpec.llv~ _. ... 0 NeD Homicide -MEDICAL EXAMINER/CORONER On the b..ie of examination and/or in.....Ugation. in my opinion. death occurred atlhe 11m.. date, and place. and due to Ihe uu..(a) and mannera.stated.... ........... ...."............",....... 11.. REGI l-<.t / I,{I /1 /1 lOCATKlN (5-_. C4yfTown. SIaIe) NertJ V.. 0 NeD Suic:'" o CoutO not be delermlned 2". 21D. CERTIFIER ICheck oniy ooel .CERTIFYING PHYSICIAN WhySlCICYl cerltty\ng cause d dealh when dnot"., phvSIC.at\ has prooouncecl dealh ano completed Item 23) To &he bllel 0' my know'-dQe. death occurnd due 10 lh4I cauM(I) and manne,.. slllted. . . . . . . . . , . . . . . . . . . . ... .PRONOUNCING AND CERTIFYING PHYSiCIAN (PhySlCWl bolt1 O,l'Of"\ounClng Oealh and cE'f1d'(lllg 10 cause 01 dealt'll To",- MM o. my knowledgft. death occurred at the time. da.e, and place. and due to 1M cau..(..) and manner a. atalltd.. .... tJ()O COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 55: Danielle T. Plessl bei~9 ~I\I ~s late of \ within i~ of the ~ the Co as of th\ 1 \ \ j \ \ \ I \ \ I Date of\ \:0 1m \G) ]~ I A. m . n 1\ :0 2. A s~ 0 3. Add'~ 4. See 1 F \(J) \ \ I \ \ I I \ \ \ \ \ \ \ \ \ ~ \ ~ \ \ , % ~. - ~ ." 0 5 :J: ~ :t wn 1> ..oJ: ~ oJ1'l ::tl (J\:Il .... J'I1 m :z~ lV . 1'. C 1> ::0 'T\ Gl ::09" 0 2::0 '1J -41) 1> 0 mn -lr ..... . ."" ...,J 'T\ .... 1j .... ... 0 J> -l -l -< fJl ,. . I I I C/l m )> r n ::t f!1 n ^ * 0 n " 0 Z :!! m ~ 0 0 ~ ~ r ~ C ~ m m Z m m Z .... g n~ s: 0 00 I'U C ~ )> "'11 ....~ Co c: o~ ..... " ",,"11 m .....m :1 .....0 "~ m~ 1m Z ~ O~ IJ1 O~ 0;: ng ro::D -n ...QJ: rn Om ...Qm :to 0 0 "'- ;0 "'- ,~ m 0 :D IT flJ r 0 ro n~ ..... ~ 0 1> 0 0 r I ~ 0 Z 0 0 IT\~ 0 00 " 0 ... 3~ 0 6 IT rnd J;- Z Z tJJ f-- . -l . .... ;!; Z fT\ en m ~ :1 Z g; 11 ... 'jj 0- ~ ro I ro ro I ro ro ro ~ ! JJ m 3:; )> ::D " C/l ..... ...' l'U JJ m ("') m <: :lJ3m fT1 1> 0 m ~~ .....< (J) ;-\ -; v.J rn · \ JJ ,~ r~ -I S )> r )> 3:; o c Z -I '1J )> 6 t:CfJ .... r r '\,U1 ~ ~. A ~ " <: N I . 0- " o o o . o o ~( ,~ ~I ui r I I g :J: !B m I J ~ - .. o 1II ..D E :3 o Q) ... III ..J -,,, m o m :< m c ." " o ~ )> z("')~ cOm)> 3:;ZC/l("') OJ-IC/lz mJJ3:; JJOm rz -I .... o ... '" 0- '" o o o . o o ~ o c Z -I -a ..!! u: J:oGlon )>mcmO ::D":D"S: ::D;-irn)>s: CiiI\))>~O l'll~cs:z io~m:E p~z~~ " oO~ )> <"'I1J: ~ 6::D0 ::! c!:g"'l1 ~ )>m" 6 rzm C> -ICZ ~ ~m~ m -< 1/1 < )> z 5> I 1 1 1 \ 1 \ 1 1 1 I 1 \ \ 1 ] 1 1 I I 1 1 I \ \ , A \ \ 1 l 1 I 1 I \ \ 1 \ \ 1 \ \ \ I 1 \ 1 \ \ I 1 z X m ~ =t )>"0 zm OZ mZ )>~ ~!< m)> (l)Z ....- )>)> -I m .... ~ o ." ." - o - ~ r- ::XJ rn o rn - "'0 -t ~. z p )> )> J:a ...... ....... (X) (.11 .a:=- ~f ~ ~ - cb ~ -'& o o a:a l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CHEREWKA & RADCLIFF LLP 624 NORTH FRONT STREET WORMLEYSBURG, PA 17043 -------- fold ESTATE INFORMATION: SSN: 162-22-2224 FILE NUMBER: 21-2001- 0043 DECEDENT NAME: DESCH CLEMENTINE M DATE OF PAYMENT: 07/09/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/09/2000 NO. CD 000027 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $377.36 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DANIELLE T PLESSL C/O CHEREWKA & RADCLIFF LLP CHECK# 123 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $377.36 MARY C. LEWIS REGISTER OF WILLS /(-dO/';.3 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 MICHAEL CHEREWKA CHEREWKA & RADCLIFF 624 N FRONT ST WORMLEVSBURG PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-20-2001 DESCH 10-09-2000 21 01-0043 CUMBERLAND 101 C")J? _ RE~-1547 EX AFP <12-DD) CLEMENTIN M Allount Rellitted 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'-Ex--AFP--n'2--ooY-NoricE--oF-YNHERiTANce-rAx-jrpPRAIsEifENT:--AirowANce-oR'----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DESCH CLEMENTIN M FILE NO. 21 01-0043 ACN 101 DATE 08-20-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 148,736.56 X 045 = 6,693.15 .00 X 12 = .00 .00 X 15 = .00 (19)= 6,693.15 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 42,852.20 110,968.66 (8) 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. Charitab1e/Governllenta1 Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) ClO) 4,910.00 174.30 (11) Cl2) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 153,820.86 5.084 30 148,736.56 .00 148,736.56 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-09-2001 AA477854 315.79 6,000.00 07-09-2001 CDOOO027 .00 377 . 36 TOTAL TAX CREDIT 6,693.15 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( 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.) c PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE EST ATE. IF EST A TE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: CLEMENTINEM. DESCH Date of Death: 10/09/2000 Will No.: 21-2001-0043 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account IS: C. Did the personal representative state an account informally to the pmties in interest? Yes X 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: 1f/~/ol ~ Ck/k sfgnature Michael Cherewka, Esquire Name (Please type or print) 624 North Front Street Wormleysburq, PA 17043 Address (MAH:rmt/AM3) (717) 232-4701 Telephone No. Capacity: Personal Representative R.W. - 27 X Counsel for Personal Representative