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REV-1500 EX + (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
..</- 2001-109
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY 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)
WELCOMER STEPHANY L.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-OD-YEAR)
164-40-6364
lHlS RETURN MUST BE ALED IN DUPUCA
OI~lH~{)Ol 06/06/1949
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 1. OnginalReturn Z. Supplemental Retum 3. Remainder Return (da
p"
CAPB 4. Limited Estate 4.. WjJfJrijij~[l'll!' Compromise (dale of death after 12-12- 2) 5. Federal Estate Tax Aeturn
HpRL X 6. Decedent Died Testale 7. Beqllttedl Maintained a Living Trust 1 8. Total Number of Sale Depo
EplO
CRAC (Attach copy 01 Will) $Rt8Dloo3opyofTrust}
KOTK D9. Litigation Proceeds ReceivedD 10. D
ES Spousal Poverty Credit 11. Election 10 tax under Sec. 9
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{tla~1 death between 12-31-91 and H-95} (Attach Sch 0)
tliISiSjiC.TIONMU$T:Be;i::' ~~~ft$.Ilf~l!~'epBRElm i."~~i'lR . i.M:~,4lC3 llMtA'i')ANiSHO tlXllE:nlJ!et~oTO':
NAME
COMPLETE MAiliNG ADDRESS
JEFFREY E. PICCOLA, ESQUIRE
FIRM NAME (II Applicable)
315 N. FRONT STREET
PO BOX 741
HARRISBURG, PA 17108-0741
BOSWELL, TINTNER, PICCOLA & WICKERSHAM
TELEPHONE NUMBER
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A
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L
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71 236-93 7
lReal Estate (Schedule A)
2Stocks and Bonds (Schedule B)
3Closely Held Corporation, Partnership or
Sole-Proprietorship
4Mortgages & Notes Receivable (Schedule D)
5Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6Jointly Owned Property (Schedule F)
Deparate Billing Requested
7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
arotal Gross Assets (total Lines 1-7)
9Funeral Expenses & Administrative Costs (Schedule H)
1CDebts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
l1Total Deductions (total Lines 9 & 10)
l~et Value of Estate (Line 8 minus Line 11)
13:;;haritable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
l.fi1et Value Subject to Tax (Line 12 minus Line 13)
(14) (4,252.53)
(1)
(Z)
(3)
N;inii
None
None
OFFICIAL USE ONLY
(4)
(5)
None
5,181. 25
(6)
1,587.95
(7)
9,875.12
.,~..
(8) 16,644.32
(9)
(10)
5,012.85
15,884.00
~1) 20.896.85
(lZ) (4,252.53)
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15C\mount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16'\mount of Line 14 taxable at lineal rate
17Amount of Line 14 taxable at sibling rate
l,*,mount of Line 14 taxable at collateral rate
19Tax Due
ZOo
(IS)
(16)
(17)
(18)
(19)
.0 0
.0 45
0.00
0.00
0.00
0.00
0.00
x
0.00 X
X
(4,252.53) X
.12
.15
Copyright (c) 2000 10rm software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
4187 ALLENDALE WAY
CITY STATE I ZIP I
CAMP HILL PA 17011
Tax Payments and Credits:
Hax Due (Page 1 Line 19)
2Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3JnterestlPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4Jf 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)
5Jf 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 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to' REGISTER OF WillS, AGENT
0.00
0.00
0.00
0.00
0.00
.. "pLEASE ANSWE~+~E~C:>llOWI~gQUESTION~ BY PlACINGi~
:i:::i:i:::
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....."....."...".,.,.,.,.,..".."..",...,.....,.-----,...,...,--._--,....,...,--.
""'-""""""""""""""""",","","'".".,.".,-',-,-<-,..",.'.'"."---,.----".,.',,,....
IN THE APPROPRIATE BLOCKS
1Did 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 life of either payments, benefits or care?
21f death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
3Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4Did 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.
Yes No
~~
D
D
[]]
[]]
D
[]]
Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge.
THER THAN RE ESENTATIVE
JOAN M. KLINGLER
418 ALLENDALE WAY
-----------------------------------------------------
CAMP HILL, PA 17011
BOSWELL, TINTNER, PICCOLA & WICKERSHAM
315 N. FRONT STREET
- --HARR-iSBURC- - -PA - --iji(f8~074i - -- - - - - - - - - - -- - - --
D
A
(,- \ 2- I
8
A
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E
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9t 16 (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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty~one years of age or younger at death to or for the use of a natural
parent, an adoptive 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(a)(1)].
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.
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
REV-150B EX + (t-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEPHANY L. WELCOMER
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SSlf 164-40-6364
01/21/2001
FILE NUMBER
2001-109
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 ALLFIRST BANK
DESCRIPTION
#0042690838 - CHECKING ACCOUNT
VALUE AT DATE
OF DEATH
1,998.99
2 ALLFIRST BANK
#87005315616045 - SAVINGS ACCOUNT
621.45
3 ALLFIRST BANK
CERTIFICATE OF DEPOSIT #87008140156914
1,293.23
4
PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND
REIMBURSEMENT
371. 00
5
PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND
REIMBURSEMENT
360.00
6
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY - REIMBURSEMENT
36.58
7
PERSONAL PROPERTY
500.00
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 lonn software only CPSystems, Inc.
$ 5,181.25
Fonn REV-1508 EX (Rev. 1-97)
REV-1S09 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEPHANY L. WELCOMER
SCHEDULE F
JOINTLY-OWNED PROPERTY
SSfI 164-40-6364
01/21/2001
FILE NUMBER
2001-109
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A.
SURVIVING JOINT TENANT(S) NAME
JOAN M. KLINGLER
ADDRESS
418 ALLENDALE WAY
CAMP HILL, PA 17011
RELATIONSHIP TO DECEDENT
FRIEND
B.
c.
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %QF DATE OF DEATH
ITEM FOR JOIN MADE Include name 01 financial institution and ban DATE OF DEATH DECD'S VALUE OF
accountnumberorsimilaridentifyingnumbe.
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTSINTERES
1 A 06/12/00 PENNSYLVANIA STATE 3,175.90 50.00% 1,587.95
EMPLOYEES CREDIT UNION -
JOINT SAVINGS ACCOUNT
TOTAL (Also enter on line 6, Recaoitulation) S 1,587.95
T
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CP5ystems, Inc.
Form REV-1509 EX (Rev. 1-97)
REV.151Q EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEPHANY L. WELCOMER
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
SSff 164-40-6364
01/21/2001
FILE NUMBER
2001-109
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY %OF
ITEM RELAirb~tglR,~ t8'b~~~BE~'?~NEDT.r~~8~f~'bEF t~~~SFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1 STATE FARM INSURANCE 7,914.77 7,914.77
COMPANIES - IRA 100 %
2 STATE FARM INSURANOECOMPANY 1,960.35 100% 1,960.35
- ROTH IRA
***Decedent was 50 years
old at the time of death
therefore, IRS'S not
taxable to estate.
TOTAL (Also enter on line 7, RecapitLlation)
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 1996 form software only CPSystems, Inc.
9,875.12
Form REV-1510 EX (Rev. 1-97)
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
STEPHANY L. WELCOMER
SSfl 164-40-6364
01/21/2001
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
1.
2.
3.
4.
DESCRIPTION
1
UNERAL EXPENSES:
CREMATION SOCIETY OF PENNSYLVANIA - FUNERAL
2
GERRY SHORT - ORGANIST - FUNERAL SERVICE
3
REVEREND ELMER SCOFIELD - FUNERAL SERVICE
4
SEXTON - FUNERAL SERVICE
Total of Continuation Schedu1e(s)
DMINISTRATIVE COSTS:
Personal Representative's Commissions .
Name of Personal Representative(s) W6....-\ v<<!.
Social Security Number{s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees BOSWELL, TINTNER, PICCOLA & WICKERSHAM
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
5. Accountant's Fees
Probate Fees
Register of Wills
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
BOSWELL, TINTNER, PICCOLA & WICKERSHAM - REIMSBURSEMENT POSTAGE,
PHOTOCOPIES, ETC.
2
BOSWELL, TINTNER, PICCOLA & WICKERSHAM - RESERVE TO CLOSE
FILE NUMBER
2001-109
AMOUNT
1,292.00
50.00
100.00
25.00
2,550.00
500.00
54.00
25.00
50.00
75.00
191. 54
100.31
3
CUMBERLAND LAW JOURNAL - ADVERTISE ESTATE
4
ROBERT WECLOMER - REIMBURSEMENT FUNERAL LUNCHEON
5
THE SENTINEL - LEGAL - ADVERTISE ESTATE
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 iOIll1 software only CPSystems, Inc.
$ 5,012.85
Fonn REV-1511 EX (Rev.1-97)
Estate of: STEPHANY L. WELCOMER
Soc See #: 164-40-6364
Date of Death: 01/21/2001
Continuation of Schedule H-A
(Funeral Expenses)
Item Description
If
Amount
5 SUSQUEHANNA MEMORIALS - BURIAL
2,500.00
6 WOMAN'S GROUP - FUNERAL SERVICE
50.00
2,550.00
REV.1512 EX + (1+97}
COMMONWEALTH OF PENNSYLVANIA
!NHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEPHANY L. WELCOMER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE liABiliTIES, AND LIENS
SSlf 164-40-6364
01/21/2001
FILE NUMBER
2001-109
Include un reimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 BEACON MEDICAL GROUP - MEDICAL BILL
AMOUNT
15.00
2 PA. DEPTARMENT OF REVENUE - 2000 PA. 40 INCOME TAX RETURN
16.00
3 SUSQUENAHHA VALLYE PAIN MANAGEMENT GROUP - MEDICAL BILL
270.00
4 THE JOHNS HOPKINS HOSPITAL - MEDICAL BILL
15,492.00
5 THE ARLINGTON GROUP - MEDICAL BILL
155.00
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 1996 lorm software only CPSystems, Inc.
$ 15,948.00
Form REV-1512 EX (Rev. 1-97)
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
STEPHANY L. WELCOMER
SSII 164-40-6364
01/21/2001
FILE NUMBER
2001-109
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. AXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116{a){1.2)]
ROBERT L. WELCOMER & BETTY WELCOMER
34 N. HIGHLAND AVE, YORK, PA 17404
(NO ITEMS GIVEN TO PARENTS - ITEMS WERE NOT
IN DECEDENT'S POSSESSION AT TIME OF DEATH
fCftv) b
JOAN M. KLINGLER
418 ALLENDALE WAY, CAMP HILL, PA 17011
r;e nd
BALANCE ESTATE
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18 AS APPROPRIATE ON REV 1500 COVER SHEET
II. ON-TAXABLE DISTRIBUTIONS:
. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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 {cj 2000 fOffi1 software only The Lackner Group, Inc.
0.00
FOffi1 REV-1513 EX (Rev. 9-00)
21-2001-109
LAST WIll. AND TESTAMENT
OF
STEPHANY L. WELCOMER
I. Stephany L. Welcomer. of 418 Allendale Way, Camp Hill. Cumberland
County. Pennsylvania I 70 II. being of sound mind. memory and understanding. do
make. publish and declare this to be my Last Will and Testament. hereby revoking any
and all Wills and Codicils by me at any time heretofore made.
ITEM I: I direct that all expenses of my last illness and funeral expenses,
including my grave marker. if applicable. shall be paid from my residuary estate as
soon as practicable after my decease, as part of the expense of the administration of
my Estate.
ITEM II: I direct that all taxes which may be levied upon property passed
under this Will and outside this Will shall be paid as an expense of the administration
of my Estate.
ITEM ill: I hereby give all my trains. bedroom suite. chest. personal jewelry
and coins to my parents, Robert L. Welcomer and Betty Welcomer of 34 North
Highland Avenue. York. Pennsylvania 17404. or to the survivor of them.
ITEM IV: I hereby give, devise and bequeath the rest, residue and
remainder of my estate, whether real. personal and/or mixed. wherever situate. unto
my friend. Joan M Klingler, of 418 Allendale Way, Camp Hill. PA 17011.
ITEM V:
I hereby direct my Executrix to sell my house and use the
proceeds to carry out my wishes under this Last Will and Testament
ITEM VI:
I hereby authorize and empower my Executrix, hereinafter named,
to sell all the real property and any of the personal property not previously
bequeathed or given under preceding Items of this Will, of which I shall die seized or
possessed, to which I am entitled at my death, in the sole discretion of said Executrix
at private or public sale, without an Order of Court, at such time or times and upon
such terms as my Executrix shall deem proper for the best interests of my Estate,
thereby converting the same into cash; to execute, acknowledge and deliver all
proper writings, deeds of conveyance and transfers thereof.
ITEM VII:
I hereby nominate, constitute and appoint Joan M. Klingler, as
Executrix of this, my Last Will and Testament.
ITEM VIII:
I direct that my Executrix hereinabove appointed, shall not be
required to enter security in any jurisdiction in which she may act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
\ '11'\' day of R~GLl~
,1997.
~^~~. W.~
Step ny. e1comer
(SEAL)
AL
S . DAN . 0 ar\>8Ublic
'lemoyne Boro. CumberJand1:iJunly
My Commission Expires June 27.1998
Memb~r. Pennsylvania Association of Nolarie:
The preceding instrument. consisting of this and three other typewritten pages,
identified by the signature of the Testatrix, Stephany L. Welcomer, was on the day and
date thereof signed, published and declared by Stephany L. Welcomer, the Testatrix
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 herein.
of J/J7 ~~ 14,
of r;ZC/.5(F' h
,.., ""~.""'''',~'''';' .....
COMMONWEALTH OF PENNSYLVANIA
: ss
COUNTY OF G.;""'~"'LAr-ro
We, Stephany L. Welcomer, i-.p..Pf<" e.. \Y\::.D"",,?o.-.J and
rzoN'A..O \..... Il<rJl..c\/\ , the Testatrix and the witnesses, respectively, whose names
are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and that she signed willingly, and that she executed it as
her free and voluntary act for the purposes therein expressed, and that each of the
witnesses in the presence and hearing of the Testatrix and in the presence of each
other signed the Will as witnesses and that to the best of our knowledge, the Testatrix
was at that time 18 years of age or older, of sound mind and under no constraint or
undue influence.
.:\b~ 1v ld.V~~
Step L. elcomer
Yw<.:t l1J C/ tJ~
Witnes
#/~
Subscribed, sworn to and acknowledged before me by Stephany L. Welcomer,
the Testatrix, and subscribed and sworn to before me by LAM:; E. "fkP,"""-..,,,,,, and
R:,,,,,,,,, p I.. C)(-r'^-""I' witnesses, this \~w day of ~uQr ,1997.
Notary Public
"'1--\"2-1\01
~~.
REv..SSEX+I1.921
~ij-
SAFE DEPOSIT BOX
INVENTORY
COMMONWE....lTH Of PENNSYlY"NIA
OEPARTMENT O~ REVENUE
INHERITANCE lAX DIVISION
DEn. 280601
HARRISBURG. PA 17128_0601 Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
c,C!. 't o. r..~ 3 bq
DATE OF DEATH
/. C/o
(STATE)
;1/1
DECEDENT'S NAME (LAST, FIRST. MIDDLE)
vV (c eM F r7
ADDRESS OF DECEDENT (STREET) ICITYI ./?
4{ . '-cr!/f//J/}I.f wt1r CI'9/11r
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
STt fCJ I/r/,v
t....
/II C-(
(ZIP CODE)
i 7<" I (
"fori/'/' It:: LI/V(.~Lc/?
(STREET ADDRESS)
(CITY)
4 / 'if I..t.. F/f/ (J11(.. e. INI'! C . '/YJj"'J./lt Li
NAME. ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT. OF PERSON(S) PRESENT AT THE BOX OPENING
Q. (NAME) (RELATIONSHIP)
JOf}N /c..LltVC-Uf/. F/P/fTA;/).
ICITV}
C t9A1/ (.IL l.'-
(RELATIONSHIP)
(STATE)
(liP CODE)
~
(STREET ADDRESS)
41~
/1(. (f. 'V ;'J/lL
,-^f');t
/
(STATE)
;711
(ZIP CODE)
170/ }.
b. (NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. (NAMEI
(RELATIONSHIP}
(STREET ADDRESS)
{CITY}
{STATEl
(ZIPCODEj
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
{NAME}
{STREET ADDRESS}
AL(.. I'IJ/7 r /JIJMC
jSTATE)
(ZIP CODE)
17<"'f.j
c /; r
, NAME OF PERSON MAKING LAST ENTRY
Ten/'" (..{lve. t-A 12.
DATE OF CONTRACTTO RENT BOX NUMBER OF BOX
. ~'<j jc),.
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (NAME)
b. (NAMEl
--
~
ISTREET ADDRESS)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE) (CITY)
(STATE)
{ZIP CODE}
NAME AND TITlE OF EMPLOYE TAKING THE INVENTORY
c01/t.3' I /f"'(4?~/1 /'?-:C/)
WAS A WILL IN THE BOX? DYES 0J.tt0 If y." a. Oat. of will:
b. Name and addr... of personal representutive, If named In the will
(NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. Nome and address of attorney, if any
(NAME) '-
(STREET ADDRESSl
(CITY)
(STATE)
{ZIP CODe)
Page ___ of ____..
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
1
~
I
(2) Stocks: list in detail every common or preferred certificate, warrant or other rights found in box. Stocks ore I
to be designated by name of company, certificate number, date of certificate, name in which slock is registered,
and number of shores and class of stock. I
(3) Obligations of U. S. Government: Number of items, dote of issue, face value, names in which registered
and type of ownership, i.e., joinlly held, payable on dealh, elc. I
I
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: Slale name of depositor, number of book, lost dote appearing in
book, nome of bank and branch.. and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully 0$ possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: list ond describe os
fully as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
.Ne C C>/VTr/\/'/5, P ..M~r k'
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY,
SIGNATURE //: .J ) c-/ SlGNA'LL.. & ~
'/ A~Y;;--.cc /. /11. :..J ',-
PRINT NAME PRU~ME AND CHEcK APPROPRIAT~XBELOW:
77'1 <:yvJ ~ S iLl )/<::>0,4/1. '-:J-fJ.A,.J Y"1-. k... 11/ (, ).., ~ A.
PRINT TITlE ~~PROPRIATE BOX:
r?{cr9. ll;eculor(trill;) OAdminislrotor(trill;}
o Estate Representative 0 Joint owner of safe deposit bOll;
NOTE: Attach additional 8V2" x 11" sheet (5) if necessary or use duplicates of this page of form.
r^/Z6/01
14:16
~1 302 934 2955
CIS _
,~~I
/,
~~, ,"'1
, '
"
Allfirst Financilll Center N.A.
PO Box 900
MiIlboro, DE 19966
February 26, 2001
Boswell, Tintner, Piccola & Wickersham
Attorneys At Law
315 North Front Street PO Box 741
Harrisburg, P A 17108-0741
Re: Estate orSteohanv L. Welcomer
Social Security: 164-40-6364
Date of Death: January 21. 2001
Dear Sir or Madam:
1@002l003
allfirst
Per your inquiry dated February 8, 200 1 please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
1. Type of Account Relationship w/lnt
Account Number 0042690838
Ownership (Names of) Stephany L Welcomer
Opening Date 01/28/85
Balance on Date of Deoth $1,998.50
Accrued Interest $ .49
Total ..1Uij8."ijij...._....................
2. Type of Account Statement Savings
Account Number 870053/5616045
Ownership (Names of) Stephany L Weicomer
Opening Date 031/7/80
Balance an Date of Death $620.77
Accrued Interest $ 0.68
Total ..S62f4j............-...............
C.J26/01
14:16
ft1 302 934 2955
CIS _.
I4l 003/003
3.
Type of Account
Certificate of Deposit
Account Number
87008/401569/4
Ownership (Names of)
Stephany L. Welcomer
Opening Date
02/24196
Balance on Date of Death
$1.287.96
Total
$ 5.27
..ST:i93"iT-...---.---.n----nm
Accrued Interest
4.
Type of Account
Safe Deposit Box
Account Number
1000535100003025
Ownership (Names of)
Stephony L. Welcomer
Opening Date
11113198
This leiteI' does not include any acCOU/fU in which the deceased may have been listed as Power of Attorney,
Custodian of Uniform Transfers, R~p,.esenta/ive Payee, or Trustee under a WrJUen Agreement.
For fUnher account information, closures ancUor reimbursement of fil'llds refer to below branch:
HIGHLAND PARK OFFICE
344 SOUTH 10TH STREET
LEMOYNE. Pol. 17043
717-737-3322
Sincerely,
,l
Sue Kim
Assistanllll
Cis Services, (302) 934-2909
.j
PSE(~
PENNSYLVANIA
STATE EMPLOYEES
CREDIT UNION
February 16,2001
Account # 0164406364
DENISE L. FOSTER
C/O BOSWELL TINTNER PICCOLA & WICKERSHAM
315 NORTH FRONT ST
HARRISBURG, PA 17108-0741
Dear MS. FOSTER:
The following is the status of STEPHANY L. WELCOMER's account with PSECU as of the date of death.
Joint Owner's Name
Date Established
Date of Death
Date of Birth
06122000 ADDED JOAN M. KLINGER AS JOINT TENANT WIROS
12301994
01212001
06161949
Share(s)
Regular Shares (S I)
Balance
$3,166.09
Accrued Dividend
$9.81
Loan(s)
VISA (L9)
Balance
$ 0.00
Accrued Interest
$0.00
The dividend earned from January I, 2001 through the date of death was $9.81. We do not have safe
deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-
free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227.
Sincerely,
A~\'
<, t'
, 0
V '
Meacie Fair x
Member Service Representative
Finance Support Unit
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990' (717) 234-8484' (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013' (717) 777-2100 (TO D) . (800) 472-1967 (TOD)
www.psecu.com
Savings federally insured up to $100,000 by the National Credit Union Administration.
PETITION FOR PROBATE and GRANT OF LETTERS
:L1-ol- IOq
Estate of S +~ f\-' G'<..Y\..'I L ' VIe:! \L-\;IA1Q..( No.
also known as _ To:
, Register of Wills for the
. Deceased. County of (]JmhPrl <lnd in the
Social Security No. i ~ ../. I-( (J - b'3.b i- Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut r / X
in the last will of the above decedent, dated A "'4.v.$.f Yy ~ti7
and codicil(s) dated ./
named
,194-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
(list street, number and muncipality)
Decendent, then _S"'L_ years of age, died -Z- ( , W 2-Q 0 I ,
at Y ,~ 4- \ \~........d.. a...fUz
Except as follows, decedent did not ma ry, 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
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(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:
-
5 . r-rtJ
t
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ..;-<- J.fo..N1<Z.,^+o-'X"l
(testamentary; administr tlon c.La.; administration d.b.n.c.La.)
theron.
'"
'tr
u
c
'"
]3
'" ~
00:'"
c
-00
1:";:::
ro.';:::::
3~
'" '-
50
'"
c
0/)
Vi
Q ~
'~~'W\.\ ~
t <.-1, ~:~ ~.. 'u;C
,
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYLVANIA 1- ss
COUNTY OF Clnnbel.-land J
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
5t~I1{~
L/
Sworn to or affirmed and
before me this 24 th
Janua
en
()Q'
::s
I::l
-
l::
~
~
/~ -~OS-9
- ~ ur\\
)l' , lJ L\/
J' /3-
"
No. 21-2001-109
Estate of
Stephany L. Welcaner
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW January 25th ~ 2001 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 August 19,1997
described therein be admitted to probate and filed of record as the last will of
and Letters Testamentary
are hereby granted to Joan M Klingler
~ ~ c;J 1!b
!l'kj (; d~~ de-2
rf R"',,~ of Will, C. Lewis .d7 7
FEES
$ 25.00
$ 15.00
$
$ 9 .OU
TOTAL _ $ 5.00
Filed Januar.y. .25:th,20D.l... $ .~-:t...QQ..
Probate, Letters, Etc. .........
Short Certificates( 5) . . . . . . . . . .
Renunciation ................
ATTORNEY (Sup. Ct. I.D. No.)
x-Pages (3)
JCP
ADDRESS
PHONE
MAILED LETTERS AND ORDER TO EXECUTRIX
Th i, is to certify that the information here given is correctly copied from an original certific~te of death du!~ tiled with me as
l.oc1l Registrar. The original certificate will be forwarded to the State Vital Records Oftlce for permanent hlmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~/ .J I.'
r .. n "'4..........
:/ /. <:: 0/ <?, ~ ~'_f::" ) ~,. .) --"'"
'-1: i'....---
Local Registrar d
fee for this certificate, $2.00
p
7175093
JAN 2 3 7001
Date
21-2001-109
43 Rey, 2181
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
NAME Of OECEDENl (hSt Middle. l.llll
.. Stephany L. Welc.omVt
AGE (L'" -1'1 UNDER 1 VEAR UNDER 1 0/11I
Morct\a Oa.,.. Hours ~
SEX
.. Female
STAlE F~E NUMBER
SOCiAl SECURITY NUMBER
OAT e OF DEATH IMc;mh. Day. .....,
.. 164 - 40
6364
~. 1-21-2001
DATE 01' BIRTH
I.Mofl'h, Oav ''e8f1
BIRTHPLACE !CoIy and
~ 01 Fcre.gnCOt..LOtl'l\
PLACE 0,: DEATH (Ctoeck onty QI'\e -- ....lI\$llUCIOOOS on other '$lO8.
HOSPrtAL:
Inpol~ 0
="'10
51
v...
YOJrk.,PA
1.
FACILITY NAME (It nol tnsNuttQl\. 0lV8 $II", ancJ numbefl
..
CwnbVtland
Ie.
MARITAL STATUS.__
Ntvet' Married. Widowed.
0-_ !SPe<:"Yl
Single
RACE. ~ IndiIin. Slack, While. ..
~l
.0. wh-tte.
SURVIVING SPOuSE
I" ........ gi.... mMIen f\WnII)
COUNTY OF DEATH
CumbVtland
[);d
--
We.....
_1
I nwr/r AffrVl
......
DECEDENT'S
ACTUAl.
RESIDENCE
ISee~
on OIher Sldel
17.. saate
21c.
lICENSE NUMBER E AHD AllORESS OF FACl
22c. 410
-.,
11b. Cou
lICENSE NUMBER
. W\f>~~\Q\\L ~~
DUE 10 lOR AS A CONSEOUENCE On
211>. no.
""'5 CASE REFERRED TO ME~XAMINERlCORONER1
. _Ill;:;;, ",,0
I Approximate PART I: ClaMr signiftcanC concMioN conIfi)uIlng 10 death, but
: = == not reIUIIing in'" undIftying C&UM given in PART I.
I "V\,.
I :
d.
WERE AUlOPSY FINDiNGS
A\lUlASlE PRKlfIlO
COMPLETION OF CAUSE
OF DEATH?
OUE 1O((lll AS A CONSEOUENCE Of\,
DUE 10 (OR AS ACQNSEOUENCE Of),
.........
~ HomiCKIe 0
0 P'Ind.nQ lnvMttgatton 0
0 Coukt not be detenfllned 0
OATE OF INJURY
tMO(lIh.Oay, 'tttaI1
TIME OF INJURY
INJURV J(f WORK? DESCRIBE HOW INJURV OCCURRED.
MANNER OF DEATH
Yoo 0 NoD
-.....
M. 3Oc.
v.. 0
No ~
Suicide
PLACE OF INJUf'V - AI home, fa,m, suiNt. tactoly,office
building, etC. ISpec!t\i1
....
.PAONOUNCING AND ClRrlFYING PHYSICIAH (PhySICian born O)fOl1ounc.ng oealh.tocl cerlllyll'lCJ 10 cause ~ dealtll
loth. ~ o. my know\edg.. d..th occurred.t the u.n., da.e, ~nd place. and due to the ~.UM(.) and mann.,.. alaled..
o
LOCATION ~_. C<vfTown. Sial>)
2Ia. 2110.
csnlFlER ,Check oniv OM\
aCIRTlFVlHG PHYSICIAN (PhYSIC.anCP.lIJVlng cause oJ dealh whefl anothef phvSIC.an has pl'onounced dealt! aoo cQmpleled Item 23)
To Ihe tMlat o....Y knowa.ctoe. cM.th occurred due 10 &he UUM(a) and Mann.r.. a.atH.. ...... . . . . . . . . . . . . . . . .
29.
o
. Day. 'fUt)
"MEDICAL EXAMINERlCORONER
~~~::::i:t::::~~~~~'.I~~ ,..n,d/or lnv.aUg.'ion, in my opinion, d~~~~ :~~~~'.e_~ ~t. ~h.~ ~Ime, date, "~~.~I~~~: ~~~.~~~ ~~ ~~~ ~~~~~~.) and 0
Jte.
REG
~'-.
~,h:~<I/I/ I
34.
INRE:
ESTATE OF STEPHANY L.
WELCOMER, DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: ESTATE #2001-109
: SOCIAL SECURITY #164-40-6364
FAMILY SETTLEMENT AGREEMENT
ESTATE OF STEPHANY L. WELCOMER
AGREEMENT executed this li~ day of August, 2001, by and between Joan M.
Klingler, Robert L. and Betty Welcomer, beneficiaries and Joan M. Klingler, Executrix of the
Estate of Stephany L. Welcomer, Lower Allen Township, Cumberland County, Pennsylvania.
WITNESSETH:
WHEREAS, Stephany L. Welcomer died on January 21,2001, testate. Letters
Testamentary were issued by the Cumberland County Register of Wills on January 25,2001 ;
and
WHEREAS, the Executrix has proceeded with the administration of said estate, and has
paid all proper bills, with the exception ofthe medical bill for Johns Hopkins Medical Center and
debts for the estate and has prepared a Pennsylvania Inheritance Tax Return, which documents
have been filed with the Register of Wills of Cumberland County; and
WHEREAS, the Executrix has examined the income and expense statements for the
estate pertinent to the estate assets, income earned and expense paid during the course of the
administration; and
WHEREAS, the parties hereto agree that the Executrix need not file a First and Final
Account and Schedule of Distribution with the Orphans' Court of Cumberland County, and that
this estate is an insolvent estate therefore no money will be distributed to the heirs of the estate,
as listed in the Last Will and Testament of Stephany L. Welcomer.
NOW THEREFORE, the parties hereto intending to be legally bound hereby, mutually
agree, as follows:
1. Pennsylvania Inheritance Tax. The parties hereto, and each of them, agree and
acknowledge that they have fully and carefully examined the Pennsylvania Inheritance Tax
Return and the Schedule J Beneficiary form relating thereto, and finds them to be true and
correct, and acceptable to the parties hereto and each of them, and further that they have received
a copy of these documents.
2. Release and Discharge. The parties hereto do hereby release, remise and forever
discharge the Estate of Stephany L. We1comer, the Executrix and the attorney for the Estate, of
and from all manner of acts, suits, claims, accounts, accountings, debts, dues and demands
whatsoever which she or her legal representatives or assigns may at any time hereafter have,
against the Executrix, the said Estate or the assets thereof, from, for, touching or concerning any
of the assets and property ofthe said Estate and/or any claim or interest thereto or therein, and the
administration, management, collection, sale or distribution of any of the said assets and for or on
account of any money, interest, income, assets or proceeds out of the same, from the time of the
death of the said decedent to and including the date of this Agreement and release.
3. Distribution. Pursuant to the Last Will and Testament of Stephany L. Welcomer, the
items listed in Item ill were not in possession of the decedent at the time of her death and
therefore there will be no distribution to Robert and Betty We1comer.
(a) Taxes. The Pennsylvania Inheritance Tax return was filed on June 14,2001.
Said return was accepted as filed on August 6, 2001.
(b) Creditors' claims. All claims of the creditors, as known to the Executrix, have
been paid. The claim of Johns Hopkins Hospital, in the amount of$15,492.00, will not be paid
as this is an insolvent estate.
(c) Residuary distribution. There are no funds available for a residuary distribution.
4. Final agreements. This instrument is a full and final Family Settlement Agreement by
and between the parties hereto, both fiduciary and individual, all of the same having been arrived
at, concluded and executed after a full and complete disclosure of the assets of the said estate and
the rights of the parties herein and thereto and all of the parties hereto, and each of them, agrees
to abide by the terms thereof.
5. Requirement to execute documents. The parties hereto, and each of them, agree that
they will at all times in the future and whenever necessary, appropriate or convenient, make,
execute and deliver to the said Executrix, and to the other party or persons, any and all
instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary
or convenient to carry out the intention of this Agreement and/or to permit, assist and enable the
Executor to fulfill his duties with reference to the said estate and all of the assets thereof.
6. Entire agreement. This Agreement constitutes the entire understanding among the
parties hereto, and each of them acknowledges that no representations or statement of any kind,
written or oral, have been made to them or any of them prior hereto by the Adminstratrix or by
any other person or party upon his behalf.
7. Heirs. This Agreement shall enure to the benefit of and shall be binding upon, the
parties hereto, and each of them, their heirs, executors, administrators, successors and assigns.
IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands
and seals the day and year first above written.
In the presence of:
~/f~k~r
BERT L. WELCOMER
/3fftwfJ~lHd
BETTY. LCOMER
#r ~ 1UL5L
J N M. KLINGLER (j
t!l~ ~ ~~
VAN M. KLINGLER, CUTRIX
c/
INRE:
ESTATE OF
STEPHANY L.
WELCOMER,
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
: ORPHANS' COURT DIVISION
: ESTATE #2001-109
: SOCIAL SECURITY #164-40-6364
STATUS REPORT UNDER RULE 6.12
Name of Decedent: STEPHANY L. WELCOMER
Social Security No. 164-40-6364
Date of Death:
Will No.
JANUARY 21, 2001
Register File No. 2001-109
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_ No.-X
2. If the answer to #1 is No, state when the personal
representative reasonably believes that the administration
will be complete: OCTOBER. 2001
3. If the answer to #1 is Yes, state the following:
a.
b.
c.
d.
Date: June 14,2001
Did the personal representative file a final
account with the Court? Yes No
The separate Orphans' Court No. (if any) for
the personal representative's account is:
Did the personal representative state an account
informally to the parties in interest? Yes _ No _
Copies of receipts, releases, joinders and
approvals of formal or information accounts may
be filed with the Clerk of the Orphans' Court
and may be attached to th~
Signature: ~ [' PIC(~~
Name: Jeffrey E. Plccola, Esquire
Address: 315 North Front Street,
Harrisburg, P A, 17101
Telephone: (717) 236-9377
Capacity: _Personal Representative l Counsel
I
.-/-
n
STATUS REPORT UNDER RULE 6.12
Date of
Decedent: (;f fht;/I't ( LJd( CVYie r'
Death: Ild/ dCXJ/
,
Name of
Will No.
Admin. No. duO 1-109
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~hether administration of the estate is complete:
yes----I-J..- 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 :x:resentative file a final
account with the Court? Yes No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative s\a}e an
account informally to the parties in interest? Yes~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: q}/JuJ 'l\ / l;;'k p~~
~e
Na~al t]'i~i~rfsr
Po &y' 74~ l-/ttr'15b-v-; (JC-/7/d7-c/7Yj
Address
(10) d3Gr 9.)7'1
Tel. No.
Capacity: Personal Representative
~counsel for personal
~representative
(MAH:rmf/AM3)
,
.
Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate of STEPHANY L. WELCOMER
No.
2001-109
also known as
Date of Death
01/21/2001
, l:18oeim~curity No.
164-40-6364
JOAN M. KLINGLER,
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.
" ~
~~ ~ y
JEFF(E E. PICCOLA, ESQUIRE
Personal Representative
Name of
Attorney:
Signature:
;}~ Y\A-
JOANtlo KLI'NGLER
~
I.D. No.:
18018
Signature:
Address:
315 N. FRONT STREET/PO BOX 741 Address:
418 ALLENDALE WAY
HARRISBURG, PA 17108-0741
CAMP HILL, PA 17011
Telephone: 717/236 - 9377
Telephone:
717/763-4501
Dated:
~-l2--'
Description
Value
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Totai:
5,181. 25
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 #R W-7 (1992)
~.
_t
INVENTORY
Estate of:
Date of Death:
County:
STEPHANY L. WELCOMER
01/21/2001
CUMBERLAND
CASH:
ALLFIRST BANK - #0042690838 -
CHECKING ACCOUNT
1,998.99
ALLFIRST BANK -
#87005315616045 - SAVINGS
ACCOUNT
621.45
ALLFIRST BANK - CERTIFICATE OF
DEPOSIT #87008140156914
1,293.23
PENNSYLVANIA EMPLOYEES BENEFIT
TRUST FUND - REIMBURSEMENT
371. 00
PENNSYLVANIA EMPLOYEES BENEFIT
TRUST FUND - REIMBURSEMENT
360.00
STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY -
REIMBURSEMENT
36.58
4,681. 25
PERSONAL PROPERTY:
PERSONAL PROPERTY
500.00
500.00
TOTAL RECEIPTS OF PRINCIPAL.. .............
5,181. 25
-1-
/ t~ cJe';S - 9
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-06-2001
WELCOMER
01-21-2001
21 01-0109
CUMBERLAND
101
JEFFREY E PICCOLA ESQ
BOSWELL ETAL
PO BOX 741
HBG PA 17108
~~-
REV-l&47 EX AFP tl2-DOl
STEPHANY
L
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
1:5)
(6)
(7)
.00
.00
.00
.00
5,181.25
1,587.95
9,875.12
(8)
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 ~
REY=is4'-EX-AFP--fI2-:00Y-NOTicE--OF-YNHEifiTANCi-TAX-A-PPRA-isEME'Ni':--Aii-oWANCE-iri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WElCOMER STEPHANY L FILE NO. 21 01-0109 ACN 101 DATE 08-06-2001
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
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~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
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
NOTE:
(9)
(10)
5,012.85
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
16,644.32
(11)
(12)
(13)
(14)
20.896.85
4,252.53-
.00
4,252.53-
15.884.00
.00 X
.00 X
.00 X
.00 X
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(19)=
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUtlBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
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 HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
-
INRE:
ESTATE OF
STEPHANY L.
WELCOMER,
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
: ORPHANS' COURT DIVISION
: ESTATE #2001-109
: SOCIAL SECURITY #164-40-6364
CERTIFICATION OF NOTICE
UNDER RULE 5.6(a)
Name of Decedent: Stephany L. Welcomer
Date of Death: January 21,2001
Will No.: 2001-109
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
February 9,2001 to:
Joan M. Klingler
418 Allendale Way
Camp Hill, PA 17011
Robert & Betty Welcomer
34 N. Highland Ave.
York, PA 17404
BOSWELL, T
By:
. Piccola, Esquire
Su re e Court I.D. #18018
315 orth Front Street
P. O. Box 741
Harrisburg, P A 17108-0741
(717) 236-9377
Capacity:
x
Personal Representative
Counsel for Personal Representative
. ~';'.~~
21-2001-109
lAST WIll AND TESTAMENT
OF
STEPHANY L. WELCOMER
L Stephany L. Welcomer, of 418 Allendale Way, Camp Hill, Cumberland
County, Pennsylvania 17011, being of sound mind, memory and understanding, do
make, publish and declare this to be my Last Will and Testament, hereby revoking any
and all Wills and Codicils by me at any time heretofore made.
ITEM I:
I direct that all expenses of my last illness and funeral expenses,
including my grave marker, if applicable, shall be paid from my residuary estate as
soon as practicable after my decease, as part of the expense of the administration of
my Estate.
ITEM II:
I direct that all taxes which may be levied upon property passed
under this Will and outside this Will shall be paid as an expense of the administration
of my Estate.
ITEM III:
I hereby give all my trains, bedroom suite, chest, personal jewelry
and coins to my parents, Robert 1. Welcomer and Betty Welcomer of 34 North
Highland Avenue, York, Pennsylvania 17404, or to the survivor of them.
ITEM IV:
I hereby give, devise and bequeath the rest, residue and
remainder of my estate, whether reaL personal and/or mixed, wherever situate, unto
my friend, Joan M Klingler, of 418 Allendale Way, Camp HilL PA 17011.
ITEM V:
I hereby direct my Executrix to sell my house and use the
proceeds to carry out my wishes under this Last Will and Testament
ITEM VI:
I hereby authorize and empower my Executrix, hereinafter named,
to sell all the real property and any of the personal property not previously
bequeathed or given under preceding Items of this Will, of which I shall die seized or
possessed, to which I am entitled at my death, in the sole discretion of said Executrix
at private or public sale, without an Order of Court, at such time or times and upon
such terms as my Executrix shall deem proper for the best interests of my Estate,
thereby converting the same into cash; to execute, acknowledge and deliver all
proper writings, deeds of conveyance and transfers thereof.
ITEM VII:
I hereby nominate, constitute and appoint Joan M. Klingler, as
Executrix of this, my Last Will and Testament.
ITEM VIII:
I direct that my Executrix hereinabove appointed, shall not be
required to enter security in any jurisdiction in which she may act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
\ a \t~
. I day of (=hJGLJ ~
, 1997.
~ ~. W~
Step ~. elcom~r
(SEAL)
~
..Q~~c
. Lemoyne Bora, ClJmbBr)and"tOunty
My Commission Expires June 27. 1998
--~----_._---_._.- -_._-~
_._...__._._._-~--
Member. PennsylvanlefAssocfiuoflot Notari
The preceding instrument, consisting of this and three other typewritten pages,
identified by the signature of the Testatrix, Stephany L. Welcomer, was on the day and
date thereof signed, published and declared by Stephany L. Welcomer, the Testatrix
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 herein.
of
1J1~~ 14-
of at' /.f(F" /J,
COMMONWEALTH OF PENNSYLVANIA
: ss
COUNTY OF CJm~P..LAr-ro
We, Stephany L. Welcomer, hp...~'"i c. \Y'\::..V\-.\\;f..:,o,..J and
'(1.or...t(~_n \..... ll(Jr--.ll.-C:LI\ ' the Testatrix and the witnesses, respectively, whose names
are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and that she signed willingly, and that she executed it as
her free and voluntary act for the purposes therein expressed, and that each of the
witnesses in the presence and hearing of the Testatrix and in the presence of each
other signed the Will as witnesses and that to the best of our knowledge, the Testatrix
was at that time 18 years of age or older, of sound mind and under no constraint or
undue influence.
~ ~ lJ.1Jl, ~
Step L. J;lcomer
~:t l1C/tl~
Witnes
~?~
Subscribed, sworn to and acknowledged before me by Stephany L. Welcomer,
the Testatrix, and subscribed and sworn to before me by L~'1 E.. r("'k..H4".e,:,)~ and
Ro'f'lY-luJ L O~ ' witnesses, this \qi~ day of FuGu(:JI , 1997.
I!
../
STATUS REPORT UNDER RULE 6.12
Date of
Decedent: (;ft})(/1, L LJd(&rJer-
Death: / !c;;/ cJexJI
,
Name of
Will No.
Admin. No. duO 1-109
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)\hether administration of the estate is complete:
Yes 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 :x:resentative file a final
account with the Court? Yes No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative s\afe an
account informally to the parties in interest? Yes~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: q}/oIuJ ~ / ,:t:'* P~h:..
~e
~
/'D'c., 6;
Name (Pl ase type or print
Po &y 74), /~f".51::t0 (Jc- /7/d?-c/1Yj
Address
(10) d3~r-9S77
Te 1. No.
Capacity: Personal Representative
~counsel for personal
~representative
( MAH : rm f / AM 3 )