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Home My WebLink About01-0127 PETITION FOR PROBATE and GRANT OF LETTERS Estate of VERDELLA M. DAVIS also known as Deceased. Social Security No. 0;0/- I g-~V3 3 No. To: .:LI- 0 I - I ~ 1 Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners are 18 years of age or older and the Executrice~ named in the last will of the above decedent, dated July 13A t973 and codicil(s) dated [none]. f.o6~.-r E. .=DAV IS flt'd"(Ctlts't"Ol On ~Ido /t::')qO, Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 982 Torway Road, Gardners, Dickinson Township. Decedent, then 74 years of age, died January 20, 2001, at 982 Torway Road, Gardners, Pennsylvania. 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 incompetent: Decedent 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: Dickinson Township, Cumberland County, P A $ unestimated $ $ $ unestimated WHEREFORE, petitioners respectfully request the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. ~/ha ~~_ Patricia A. Beam I ) 60 Myerstown Road Gardners, P A 17324 (717) 486-5688 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA) : SSe COUNTY OF CUMBERLAND ) The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best ofthe knowledge and belief of petitioners and that as personal representatives of the above decedent, petitioners will well and truly administer the estate accordin to law. Sworn to or affirmed and subscribed befo~.1 e this :J!-I.E day of -}'~A. , d..~6 I. ~~(J, e;eJ-l~ ~A.('{i. ~i-n/)./l OVIlJ4 . / 'I RegIster / G" d.-00 - / Lf Patricia A. Beam No. 21-01-0127 Estate of Verdella M. Davis, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, FEBRUARY 1, 2001 , in consideration ofthe petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated July 13, 1973 described therein be admitted to probate and filed of record as the last will of V erdella M. Davis and Letters Testamentary are hereby granted to Kay Y. LaRue and Patricia A. Beam. Will Book # Page ~ {1 J/y~~ tu~. (!a, :n~ ~- Register of Wills JCP TOTAL $ 115.00 $ 6.00 $ $ 5.00 $ 126.00 Mark A. Denlinger, 83794 ATIORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, P A 17013 (717) 243-3341 FEES Probate, Letters, Etc. Short Certificates(Z ) Renunciation Filed FEBRUARY 1, 2001 ~ ..' .... , r- .... c. I...:' ~._l F: IFILESIDA T AFILEIEST A TESI6473-petition. Ill' 't..{"f'l<;..Q:0<; TZFY C)/~f.. This is to certify that the information here given is correctly copied from an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 6947940 No. Il'~~. ~~~~~ Local Registrar JAN 2 2 2001 Date H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER SOCIAL SECURITY NUMBER ORe OF DEATH (Month, Day. Year) .. JaYlUakY 20,2007 ~RINT . \NENT (INK NAME OF DECEDENT (Rrst, Middle. Last) SEX Vekdella Mae Vav~~ ~\ 5. COUNTY OF DEATH Cumbe.ltlaYld UNDeR 1 DAY IiolJn ! Mlnut.. '.6emale ..'201-78 -2433 PLACE OF DERH (Check onty one aeelnltrUCIions on other side) HOSPITAL: OTHER: _0 ~o .. FACILITY NAME (It nQI insCilution, give ttreet and runber) 982 TO./tway Rd. =ily)o [);d - liveina townahlp? 17d.O :;::~=oI MOTHER'S NAME (Fir". Middle, Maiden Surname) 11. Eva Fko~t INFORMANT'S MAIUNG ADDRESS (Street. Cit,ITown. Slate. Zip Code) "".7180 M e.lt~towYl Ra. Ga.ltdYlek~, Pa. 77324 PlACE OF DISPOSITION. Name of Cemelety, Crematory LOCATION. CltyfTown, Slate. Zip Code or Other ptaee 1. AGE (Last Birthday) BIRTHPLACE (City and Cumbekl:~dC'o UNDER 1 YEAR Months Days 74 V.s. lb. DeCEDENT'S USUAL. OCCUPATtON (Give klnd 01 wen: done duri~ mOSt ".. La'6O"ti'k' do not U'" 'ed) 110. MaYlu6ac.tuk~Ylg DECEDENT'S MAIUNG ADDRESS (Street, CityfTown, State, Zip Code) DECEDENT'S 982 TOkway Rd. ~1~iNCE GakdYle.lt~, PA 77324 ~.::'::.r' 11. FATHER'S NAME (First, Middle. Lase) 11. Cl de StakYlek INFORMANT'S NAME (Type/Print) Patk~c.~a A. Beam was DECeDENT EVER IN U.S. ARMED FORceS? .....0 No~ 17b. Cou Cumbek.laYld .... METHOO OF DISPOSITION Burial C8I Cremation 0 Remov'l from State 0 Other (Specify\ MAAfTAlSTATUS. Married NeoN Marrted, wtdowed. . JlN<>n:ocl~pecily) w-<.aowea 1.. 17C.cr V... deeedenlItvedin Vi ('I b j l'lAim SURVIVING SPOUSE (If wite, give meiclen name) Ow, c' /bote I 21C. Ukiah ChUkC.h Cem NAME AND ADORESS OF FACILITY ~p'~b~oYl-Ho.ll~Yl ek LICENSe NUMBER PA 77324 77065 22b. To the best of my knowledge. dealh occurred at Ihelime, dale and ptlce Itated. (Signature and Title) .... TIME OF DEATH DATE PRONOUNCED DEAD (Month, Day. 'tMr) ... 7 :05 PM M.S. JaYlUak 20 2007 27. PART I: Ent.,. the disH.... injuries Of eompllulion. which cauMd the deeth. Do no! enl.,. the mode of dyIng..uch IS cardiae Of r-.plratory arrett, atlodt or hea" tailur.. Lilt onty one caUM on each IIn.. t : L /..v.-vl- WERE AUTOPSY FINDINGS ~ILABLE PRIOR 10 COMPLETION OF CAUSE OF DEATH? MANNER OF DEATH DArE OF INJURY (MOl'lIh, 08y. 'lMr) Natur" ){ZJ _ 0 SU~'" 0 _... 0 Pending Investlgallon 0 Could no! be determined 0 .....0 No 0 2". 2ab. 21. CERTIFIEPI (Check criy one) -CERTIFYINQ PHYStClAN (Physician certifying ClUlMI 01 death wtlen another physicien has pronounced de8th and completed Ilem 23) Tothebtstotmyknowtedge, c:te.thoccu~du.tothecaUM(e) end manner...tated..................................................... "PRONOUNCINQ AND CERTIFYING PHYSICIAN (Physician both pronouncing de8lt1 and certitying 10 cause'" de8th) To the best at my knowtedge, dum oceufnld a' the tlm., daI., and place, and d.... 10 the ClIuM(l) and manner.. .Iated.. . . . . . . . . . . . . . . . . . . . . . . . . -MEDICAL EXAMINER/COAONEA On the bIi. of ..,mlnatlon and/or Inv.etlg.tlon, In my opinion, d..th occurred al the tlm., date, end place. and due lolhe cauM(s) end m.nner....ated...........................................................................................,..... . '1a. REGISTRAR'S SIGNATURE AND NU ~. ~b..t...~ I~ \ I'-A\ 101 23b. 2 . WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? ~.O N~ '". I ApproxkTtat. '-- : onMI end dMth I I PART II: Dlher aigntflc&nt condition. contributing 10 de.th. but not resuftlng In the undertying ClUM given in PART l. ~ TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED _ 0 No~ DATE SIGNED (Month, Day. Year) o 34. ... LAST WILL AND TESTAMENT 21-01-127 I, VERDELLA M. DAVIS, of Dickinson Township, Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament. 1. I give, devise and bequeath all of my estate unto my husband, ROBERT E. DAVIS, absolutely, and I hereby appoint my said husband as Executor of my estate. 2. In the event my said husband shall predecease or fail to survive me, then I give, devise and bequeath all of my estate, both real and personal property, unto my children, KAY Y. LARUE and PATRICIA A. BEAM, absolutely, and I hereby appoint my said daughters as Executrices of my estate. IN WITNESS WHERE~~,O.: have hereunto set my hand and seal this 13~nday of ~, 1973. ~~n('~SEAL) Verdella M. Davis SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix, VERDELLA M. DAVIS, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of said Testator and of each other. W;~L *ii; .// .< ~d/R~ LAW OFFICES IARTSON AND SNEL.8AKER 21-01-127 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS Rnt-h R M()(")k f)p("'kE>~ CJuliltii :(aIEk) a subscribing witness to the will presented herewith, (JC~ being duly qualified according to law, depose(s) and say(s) that she was present and saw Verdella M. Davis the testat r; '\I' , sign the same and that 5he signed as a witness at the request of testat rix in her presence and >>>>JtJltt~R~Rf<:~~jt~ (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this rL day of ~ k NO RIAL SEARegister CORRINE L MYERS, Notary Public Carlisle Boro. CumberlandCounty COmmlssi~!,!~~.~pires Ma 27 2003 ~ ~~~ /#~a,~~ '" (Name)~~ /IfJPe? -e~,..J'~ /~~~~~ ~4 _ZJ~~ (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each), a subscriber hereto,(~ach) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of codicil testat_ of (one of the sub~ibing witnesses to) the will presented herewith and "-" codicil 'c that "c~elieves the signature on the will is in the handwriting of testat_ believes the signature of the will {)~ented herewith and that codicil '.c". l;>elieves the signature on the will is in the handwritiri~f to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) 21-01-127 REGISTER OF WILLS OF C'lJW~F.RT.z\Nf) COUNTY OATH OF SUBSCRIBING WITNESS William F. Martson JtO.dittii ~~ a subscribing witness to the will presented herewith, (oadIJ being duly qualified according to law, depose(s) and say(s) that he was present and saw uerdella M n;::m; s the testat rix , sign the same and that he signed as a witness at the request of testatr.i.x.-- in h pr presence and (jOx~IIR:1~~kXXk~ (ihe presence of the othe' sobscribing witoess(es)). / 11/ !J/J. /2.. / .-L-- Sworn to or affirmed and subscribed before ,,~ a:;;; f"tlY\- me this O(~ (Name) ~ 10 E. Hiqh Street, Carlisle, PA 17013 (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of codicil will testat_ of (one of the subscribing witnesses to) the presented herewith and codicil believes the signature on the will is in the handwriting of that to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) - t: -- F: \FlLES\DA T AFlLE\EST A TES\6473-notice.cer CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: VERDELLA M. DAVIS Date of Death: January 20, 2001 File No. 21-01-0127 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 or about February 5, 2001. Kay Y. LaRue, 604 Ridge Road, York Springs, P A 17372 Patricia A. Beam, 1180 Myerstown Road, Gardners, P A 17324 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: February 5, 2001 ~i:~ture MfJIf:f:mi~~' MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Attorneys for Personal Representative --- ---.. .' ,,~ .":t"'-;' ~.- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 000398 DENLINGER MARK A TEN EAST HIGH STREET CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT ______n fold 101 $2,802.16 ESTATE INFORMATION: SSN: 201-18-2433 FILE NUMBER: 21-2001- 0127 DECEDENT NAME: DA VIS VERDELLA M DATE OF PAYMENT: 10/18/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2001 TOTAL AMOUNT PAID: $2,802.16 REMARKS: KAY Y LARUE & PATRICIA A BEAM C/O MARK A DENLINGER CHECK# NO # SEAL INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS v /b-c:20~- /y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN DEPT. Z80601 HARRISBURG. PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP 1l2-DOl Racer t1ed Re(1;~t~-: . :;:;'-'....",.' <~G of ,c/ills DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 DAVIS 01-20-2001 21 01-0127 CUMBERLAND 101 VERDELLA M "01 ole 27 A10 :11 MARK A DENLINGER MARTSON ETAL 10 E HIGH ST CARLISLE ESQ Clerk C . ',.<J\Jri PA 1 ~!'9berlar:d Co., PA 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 ~ REY=is'4j-ix-AFP-n'2=OOY-NOTici--OF-YNHiRiTANCi-TAX-APPR'A-isiHENi'-,--AL:rOWANCi-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DAVIS VERDELLA M FILE NO. 21 01-0127 ACN 101 DATE 12-17-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 82.450.00 .00 .00 .00 2.395.85 .00 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 84.845.85 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsi Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 16.868.72 5.706.85 Ul) (2) (13) (14) 22.571; 57 62.270.28 .00 62.270.28 I~ an assessment was issued previously, lines 14, 15 and/or 1&, 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. Amount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due REDITS: PAYMENT DATE 10-18-2001 NOTE: (9)= .00 2.802.16 .00 .00 2.802.16 .00 X 62.270.28 X .00 X .00 X 00 = 045 = 12 = 15 = T ECEIPT NUMBER CD000398 DISCO (+) INTEREST/PEN PAID (-) .00 AMOUNT PAID 2.802.16 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 2.802.16 .00 .00 .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.) D, ../ REGISTER OF WILLS OF CUMBERLA:ffi90UNTY STATUS REPORT UNDER RULE l(;~~' , , (For Resident Decedents Dying After July' 1~ 1992) Name of Decedent: VERDELLA M. DAVIS '02 MF\f~ 18 no :17 Date of Death: January 20, 2001 File No.: 21-01-0127 ("" . V~~l CUlnU, Social Security No.: 201-18-2433 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 thefollowing: 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 parties in interest? Yes No x The personal representatives were the sole beneficiaries of the estate; therefore, no accounting was necessary as they were aware of the complete administration of the estate throughout. d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~ A :J--'-r Mar A. Denlinger, Esquire MARTSON DEARDORFF WILLIAMS & OTIO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative Signature: Name: Address: Date: .~ '~ 2002 F:\FILES\DA T AFILEIEST A TES\6473,srep -206 -If . ....'~...,..., ~ REV 1500 I OFFICIAL USE ONLY _ ~~"=~. 1_'NH"'~:,.."i;:;;'E~~~RN _ [~~_ ~~ . _~ l~~~~~~'~~~~~{:~ANDMiDDLEINITIA[) ---- ==== D~t~;;~U;;;;UMBER ... -~___ [JATE1JFlJEAT'Rl'M"M-O~ ~TE Ot- BIRTH ('MM:tm:vEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE- ~ ~~~~:A~~E~ ;URVIVING SPOUSE'S NAME; ~~/;;S~ :~; ~DDlE INITIAL) - - --t SOCIAL SEC~~~I~U~~~ OF WILL~_ I -03. Rema\l,de~uro~ofoeatflpnOr\012-n."32) w ~ :::.i:S:cn u~~ w~8 %~...J U~m ~ /0 ~ z w o w U w o c:l / IV I-a-- 1: OriginalRetum I 0 4. Limited Estate -.o------z:--supptemental Ret\..im- -----,.--~- 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12.82) 7. Decedent Maintained a Living Trust (Altach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) .~ iilz ~w 15~ u\r lRM NAME (If appliC8ble) Martson Deardorff Williams & Otto rElEPHClNE NUMB-ER---- , 717/243-3341 o 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 10 East High Street Carlisle, PA 17013 ----- _....~--_.-.._.._._.".~_.~._-,._._---_._----- .. ___ ____ _n,,__ ___ ________~______.._____..__.._._____ Copyright 2000 form software only The Lackner Group. Inc. 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) z o ~ => ~ ~ < u w ~ 3. Closely Held Corporation, Partnership or Sole~Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly OWned Property (Schedule F) o Separate BWing Requested 7. Inter~Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 82,450.00 OFFICIAL USE ONLY (1) (2) (3) (4) None None None (5) 2,395.85 (6) None (7) None (8) 84,845.85 (9) 16,868.72 -.,,--,.,----- (10) 5,706.85 (11) 22,575.57 62,270.28 (12) (13) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 62,270.28 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) z o ~ => ~ ,. o u ~ 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 x .00 (15) 62,270.28 x .045 (16) 2,802.16 19. Tax Due x .12 (17) x .15 (18) (19) 2,802.16 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Form REV-1500 EX (Rev. 6.(0) Decedent's Complete Address: STREET ADDRESS 982 Torway Road CffY-- ~._-~ Gardners I STATEPAIZIPJ7324- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,802.16 Total Credits (A + 8 + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the Iotal of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (SA) (58) 0.00 2,802.16 2,802.16 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"'N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................. 0 181 b. retain the right to designate who shall use the property transferred or its income;................................ D 1:81 c. retain a reversionary interest; or............................................................................................................ D 1:81 d. receive the promise for life of either payments, benefits or care?.......................................................... D 1:81 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........ ...... .......... ...... ....... .......... .... ... ....... .... ... ....... ............. ....... ....... .......... D 1:81 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death?...... D 1:81 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..... ... .... ... ... ... .......... ....... ... .... ... ... .... ....... ... .... .... ..' ... ... .... ... ... .... ... ... ........ D 1:81 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Uiider penarues of perjury, fdeclare that I have examined this return, including accompanying sChedules and statements. and tathe best army knowfedge andbelief,itis true~oorTect and oompleie.-- Declaration of_~rer other than the p_~rsonal representative is ~ased on alllnfarmatian of whIch preparer h"as any kno\yledge. ____.___ __ ____ __ ____ ____ SIGNATU OF PERSON RESPONSI E F FILING RETURN ADDRESS DATE 604 Ridge Road V4ic York Springs, PA 17372 It) ~I r;r-,.---------;l\Dmess--.--~--"~-'-------'- -- --- 1180 Myerstown Road Gardners, P A 17324 -~~._---~-----_.-- 10 Easf Hil!h Street Carlisle, PA 17013 or dates of death on or a er July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a)(1.1) (i)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the 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 retum 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 oflhe child is 0% [72 P.S. ~9116Ia) (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.5. ~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. I \ _____L____ __ ESTATEOF DAVIS,VERDELLAM. ---- - I FILE NUMBER ---- -- ____ ___ ___________...L.....2l.-.<>1..:.00127__ All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,_ neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property whic~ Is jointly-owned wltn right of survivorship must Ije disclosed on schedule F. *' SCHEDULE A REAL ESTATE COMMONWE.IILTHOFPENNS'I'lVANlA J INHERITANCE TAX RETURN RESIDENT DECEDENT --.-..-"-'" iTEM NUMBER ui- DESCRIPTION VALUE AT DATE OF DEATH 82,450.00 Residence sitUate at 982 Torway Road, Gardners, designated as Cumberland Counti"Parcei"No. - 08-43-2759-014 and conveyed by Deed dated July 10, 1948, and recorded in Cumberland County, Pennsylvania, Deed Book "V", Volume 13, Page 442 (copy attached). Value per average of appraisal attached. TOTAL (Also enter on Line 1, Recapitulation) 82,450.00 '* I SCHEDULE E I I CASH, BANK DEPOSITS, & MISC. I PERSONAL PROPERTY L _1__________ _ ESTATEO~ ~.~VI&\VERDELLAM.=__===== \ FILE ~~~~IE~00127 .- COMMONWE.IIL lH OF PENNSYWANlA INHERITANCE TAX RETURN RESIDENT DeCEDENT Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER - 1 DESCRIPTION Cas~ 2 Blue CrosslBlue Shield, premium refund VALUE AT DATE OF DEATH 185~OO 98.00 44.33 234.46 1,052.44 50.00 500.00 32.62 98.50 79.32 21.18 2,395.85 3 The Sentinel, refund 4 Adams County National Bank, Checking Account No. 1973487 5 Adams County National Bank, Savings Account No. 9617671 6 Adams County National Bank, Club Account No. 5108144 7 Property tax rebate for (2000) 8 Comcast Cable, refund 9 Coins in house State Farm Insurance, refund of vehicle insurance 10 11 Sprint, refund TOTAL (Also enter on Line 5, Recapitulation) *' SCHEDULEH FtN:RALEXPENSES& ~llVECOS1S COMMQNWEM. THOF PENN$'fLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _l_ _ ____ -IFILE NUMBER-- ____--L~21~~I- 00127 ________ _..,._.____...~ -------1-.___________....______.._..___ -~------'._",'--' .__.~.- ESTATE OF DAVIS, VERDELLA M. Debts of decedent must be reported on Schedule I. --TTEM! ---- - NUMBER, A. --rFONERAL EXPENSeS:- ~--~---~ , Gibson-Hollinger Funeral Home, Mt. Holly Springs, PA I 2 I Uriah United Methodist Church, funeral reception 3 I James Gingrich Memorials L I I AMOUNT DESCRIPTION B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Social Security Number(s) I ErN Number of Personal Representative(s): 2. Street Address City Slate Zip Year(s) Commission paid Attorney's Fees Martson Deardorff Williams & Otto (estimate) 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees Slate Zip 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I 2 3 Other Administrative Costs Cumberland Law Journal: Advertising Letters Testamentary The Sentinel: Advertising Letters Testamentary State Farm Insurance, vehicle insurance Total of Continuation Schedule(s) +- I TOTAL (Also enter on line 9, Recapitulation) 6,708.30 100.00 90.00 4,200.00 126.00 75.00 90.59 158.76 5,320.07 16,868.72 taLI SCHEDULE I I ~ DEBTS OF DECEDENT, MORTGAGE I CCMMONWE^,THOF PENNSYl.VANIA I LIABILITIES, & LIENS INHERITANCE TAX ReTURN RESIDENT DECEDENT L -------,--.-.-------. .--.-------- ESTATE6F-- ------------ ----rFILE NUMBER ---- DA VIS,VERDELLA ~_ __~..2' - 01 -00127__ _ _ Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT 75.28 Adams County National Bank, checkmg account, outstandmg checks on date of death-- - -- 2 Bankcard Services, Account No. 5401 2680 12007644 369.71 3 GPU Energy 48.96 4 Cumberland County, PA, Grant Agreement dated 11/19/97: Principal amount of grant $14,217.00; forgiveness to date of death: $236.95 per month x 38 months ~ $9,004.10. (See attached Grant Agreement) 5,212.90 TOTAL (Also enter on Line 10, Recapitulation) ------ 5,706.85 *' SCHEDULE J BENEFICIARIES NUMBER \ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ____.._J_.___.._..._._,_..____~__ i TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Kay Y. LaRue . 604 Ridge Road York Springs, PA 17372 I. 2 Patricia A. Beam 1180 Myerstown Road Gardners, P A 17324 Daughter 1112 estate residue Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover she t II. I'NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTiONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DiSTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE T . 201-CT-Warranty Deed HenrY' Hall, Inc.. IndiaDa, Fa. ~bts J)eeb, ~alJe ti)e lOth day of July of our Lord one thou,sand nine hundred and forty-eight. :Befuleen CLYD~ C. STl,RN~R and FNA M. STARN~R, his wife, of Dickinson Township, County of Cumberland and State of Pennsylvania, ~n the year Grantor s , and V'SRDTolLLA S. DAVIS and ROBTo:RT E. DAVIS, her husband, of Dickinson ~ownship, County of Cumberland and State of Pennsylvania, Grantee s : .ttllesseti). that in consideration of One (.~l.OO) Dollnrs, in hand paid, the receipt whereof is hereby acknowledged, the said grantorS do hereby grant and convey to the said lfrantee s, ALL THAT CklRTAIN tract of land situate in Dickinson ~ownship, County of Cumberland and State of Pennsylvania, bounded and described as follows: Bounded on the east by a public road known as Township ~ Road No. 534; on the north by other property of the grantors herein; and on the south and west by lands now or formerly of Jacob R. Meals, having a frontage on said public road of 94 feetand extending in depth at an even width 515 feet. AND B'7.ING Tract No. 2 of the properties conveyed to thl grantors herein by the Executor of Thomas J. Howe dated December 31, 1942, and recorded in the Office of the Recorder of Deeds of Cumberland County, Pennsylvania, In Deed Book "?", Vol. 12, Page 416 " 11 II SCl-I1=-J:>LU-t, ,n Illnb the said grantor s , do hereby covenant that they will W.J1RR.1.NT generally the property hereby conveyed. In mUnegg _bettof, said grantors ha ve hereunto set their hand s seals the day and year first above written. '''''?~ ~:';::,::"':::i"'" tL.~.C~ ~....~n!~u... .n......u............yv.1tuS~... and ...~ ..~~ ..m....m..~~ ~~ State of :t'ennsylvania I '>- 88. \ County of Cumberland On this, the loth day of July , 1948 , before me the undersigned officer, personally appeared Clyde C. Starner and H:va M. Starner known to me (or satisfactorily prO'lJen) to be the persons whose names areBUbscribed to the with- in instrument, and acknowledged that they executed same for the purposes therein contained. 111 witness whereof, I hereunto set my hand and official seal. ~___<f:::___J.~_________.hn~ ~__.\t~_____________________n_________n_ Title of Officer. i.X CDiOl"ISSIOllEXPI~ MARCile, 1,"-'1 CERTIFICATE OF RESIDENCE do he1'ebll certify that the precise residence of the within named grantee is 9 rJ?P;( ,Ara.4, (lv-J' 7)" /~f' ~ ~ ~, " " /:i ~ ~ Al '(j s:: ol I':: ~- i2g; ~z E-<I':: m<.::: E-< 0 . ell E-< {.) . tt~ ~~ ~<<: ~~ 19 _u _m~_:__um_m.uu__.__m Attorney tor-r-----.----..----- '(j d ol :Il H ;>eIl o:!:H P> .Cl ell . ~: rx'1':: Pr<l ~~ >1':: 0- .,..I .ct ., s:: g E-t d .. 0 o II> rlo~ l>,.O.!<l rl . 0 ..... rl ... ~~A ~. ~ COMMONWEALTH OF PENNSYLVANIA } ~ ~ /., / 88. County of -'c."'::':JJllIt; ,_.~.u.. RECORDED on this ....._.___._.L..~..~.. day of --...~----.......-...-. A. D. 19~r, in the Recorder'~ office of 8aid County, in De.d Book I V ' Vol. ..../.3._........___, Page ...._d::-:t::~um_u__.._. ro "" CJl rl >-- f-l Z < ~ ~ < ~ I I I (I) . . -",dO g.g,s Given under my hand and the Beal of the Baid office, the date abOtJe written. -2~.rW..'f-~order. Buyers Business Brokerage Land Development Site Locations Commercial Sales Residential Sales SUBEJCT PROPERTY ,- 982 TORW AY ROAD GARDNERS, P A 17324 DICKINSON TOWNSHIP FOR SALE: STYLE: EXT: SQ. FT. TAXES: HEAT: COOLING: WELL/SEPTIC: $84,900 LISTED: 6/4/2001 1 Y2 Story Cape Cod Vinyl Siding 1248 $1016.00 Oil Forced Hot Air 2 Window Units 3 Bedrooms 1 Bath 1 Car Garage Detached Lot Size: 1.1 Acres This home has the following updates in 1998: New Vinyl Siding New Windows New Furnace New Kitchen Floor It is my professional opinion that this home owned by Patricia A. Beam and Kay Y. LaRue should sell in the price range of$80,000.00 to $84,900.00. Do~~.w . R. L. Simons & Associates, REALTOR !;CflEDt/<.E ''A " 325 S. Hanover Street Carlisle, PA 17013 (717) 249-5555 Fax (717) 249-8032 www.thetristate.com/rlsimonsrlsimons@pa.net 1000 GOODYEAR ROAD GARDNERS, P A 17324 DICKINSON TOWNSIDP SOLD: $87,500 49 DAYS 8/11/2000 STYLE: Ranch EXT: Aluminum SQ. FT.: 1092 TAXES: $1,204.00 HEAT: Oil Forced Hot Air COOLING: Central Air WELL/SEPTIC: 3 Bedrooms 1 Bath 1 Car Garage Attached Block Workshop Detached One Fireplace in Living Room 97 OLD STATE ROAD GARDNERS, PA 17324 DICKINSON TOWNSHIP SOLD: $86,900 83 DAYS 5/31/2000 STYLE: Traditional2-Story EXT: Aluminum SQ. FT.: 1200 TAXES: $523.00 HEAT: Oil Forced Hot Air COOLING: None WELL/SEPTIC: 3 Bedrooms 1 Y2 Bath Lot Size: 0.52 Acres Garage None 377 STATE ROAD GARDNERS, P A 17324 DICKINSON TOWNSHIP SOLD: $62,000 212 DAYS 5/5/2001 STYLE: Ranch EXT: Asbestos Siding/Vinyl SQ. FT.: 800 TAXES: $406.00 BEAT: Oil Forced Hot Air COOLING: Window Units WELL/SEPTIC: 2 Bedrooms 1 Bath Garage: None February 14,2001 MDW&O Ten East High Street Carlisle, PA 17013 Re: Estate ofVerdella M. Davis Dear Ms. Myers: The following information is being provided as per your request: Acct. Type Acct. Number Acct. Balance On 0.0.0. Ace. Int. 100.0.0. Ownership Date Joint Savings 96-1767-1 $1,047.44 $5.00 Individual N/A Checking 197-348-7 $234.46 N/A Individual N/A Club 5108144 $50.00 N/A Individual N/A Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please feel free to contact me. Sincerely, ~(JrAJ 0.. 11 ~ Lois A. Kirne Certificate of Deposit Coordinator SCIfEDCkE "E') I-kM5 4-(, r<1 j ))> - (LIUJ I w' Sdlll-18 :'.::!-::.-:i j, ':U-G'lr-;~, ."""11: i.' l)f ;j[I'O:' GRANT AGREEMENT '.f,' "~I "I'll :';UUII~'>_-'", TIllS AGREEMENT, made and entered into this 19/h day of November, 1~~? q[.;fvleiin PI') 2 OS" Verdel/a M Davis a/982 Torway Road, Gardners, P A hereinafler called Owner, and Cumberland County, a municipal corporation of the State of Pennsylvania, hereinafter called Municipality, and WHEREAS, the Housing and Community Development Act of 1974 provides funds for relmbilitation in federally assisted Community Development Projects, and Owner desires to use the benefits of the I9741-1ousing and Community Development Act for the purpose of rehubilitating Owner's property located at 982 Torway Road, Gardners P A and has entered into an Agreement with Gross Construction of even date herewith, for said rehabilitation; and WHEREAS, the Municipality in accordance with the said Act of 1974, adopted certain reg\llations and conditions with respect to grants made under the Act of 1974, and has appointed the Redevelopment Authority of Cumberland County its agent for the administration of such gnll1t program with authority to execute any and all documents necessary to implement said program; and WIIL.:REAS, the Municipality pursuant to Resolution and the regulations and conditions adopted by the Municipality has issued to said Owner a grant in the amount of $14,217.00 for said rehahilitation. NOW, THEREFORE, in said consideration of said grant Owner covenants and agrees that the grnnl shall be refunded it title to the property at 982 Torway Road, Gardners, PA is sold, tronsferred, conveyed. or equitable interest is extinguished within a period of five (5) years from the date of the grant agreement according to the folIowing lien forgiveness formula. The grant amollnt shall be forgiven by one-sixtieth (1/60) of the original sum after the lirst monlhly anniversary date of the grant agreement and by one-sixtieth (1/60) on each subsequent monthly anniversary date thereafter if the grantee(s) continue to reside in the property as their principal res~dence: The grantee's principal residence shall be considered to be other than the properly identified above if the grantee is a resident in a nursing home rehabilitation center. or personal care facility for a period longer than six consecutive months. In the event the property is conveyed or otherwise disposed of, or the grantee ceases to utilize the property as their principal plnce of residence, the entire obligation which has not been forgiven as per the above formula shall be due and payable. (n the case of the grantee's death, the property ceases to be their principal place of residence on the date of death, and the forgiveness of the grant ~haIl cease as'of the date of death. The entire grant amount such amount 'as has not been forgiven shall be du!.: and payable upon conveyance of the property unless: a lineal descendant becomes the owner of the residence until the entire obligation is forgiven pursuant to the above formula. The Mllllicipnlity's interest in the property shall be secured with the filing of appropriate documents in the County's Recorder of Oeeds and/or Prothonotary Office. The Municipality's interest shall ~CilEDttzE ":.:c" -/- ....l..~ '-t nOOK 56.') I'm ~38 be for the full cost of repairs made at the time of the application and any and all repairs to conect subsequent unrectifaed code violations. However, at its discretion the Municipality may drop this requirement at any time. WITNESS ollr hands and seals, the day and year aforesaid. WITNESS / "lr'-1V-- )ll.<~A/' o OWNER(S) ./ Verdella M. Davis \Lud~k, ~h<;~ BUUK 565 rAGE 23H LAW OFFICES lTSON AND SrlELF.lAK1i;R LAST WILL AND TESTAMENT I, VERDELLA M. DAVIS, of Dickinson Township, Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament. 1. I give, devise and bequeath all of my estate unto my husband, ROBERT E. DAVIS, absolutely, and I hereby appoint my said husband as Executor of my estate. 2. In the event my said husband shall predecease or fail to survive me, then I give, devise and bequeath all of my estate, both real and personal property, unto my children, KAY Y. LARUE and PATRICIA A. BEAM, absolutely, and I hereby appoint my said daughters as Executrices of my estate. seal IN WITNESS WHERE~F".: have hereunto this 13~~day of ~, 1973. , set my hand and ~~nr.~SEAL) Verdella M. Davis SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix, VERDELLA M. DAVIS, as and for her Last Will and Testament, in the presence of us; who.at her request, have hereunto subscribed our names as witnesses thereto, in the presence of said Testator and of each other. W;~ f1fi:h -1 . J:;d/;? ~L II