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Home My WebLink About01-0129 PETITION FOR PROBATE and GRANT OF LETTERS Estate of PAUL J. GERNERT also known as No. 21-01-129 To: Register of Wills for the -\- Deceased. County of CUMBERLAND in the Social Security No. 1. 60 1. 0 41.::> 7 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; y in the last will of the above decedent, dated A pr ill n , and codicil(s) dated named ?OOO (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at lOq Rllnc:::nn Rn;::!n Borough of Camp Hill (list street, number and muncipality) Decendent, then 96 years of age, died Au gu s t 19, 2000 u Rnly Rpiri~ HORpital 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 5 , 000 . 00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ None situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) pre"ented herewith and the grant of letters TE> R ~ ;:J mE> n ~ ;:J ry (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. " - Ul U u C 1J "0_ ,- Ul Ul_ ... ... ~1J C "00 c':: CU'= 3~ ...'- 50 co c Cll Ci'i ~(V r gbUf-trf- Anna F. Gernert 109 Rllnc:::on Rn;:Jc1 Camp Hill, PA 17011 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND 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. ~~:;:: !Jbu1# Sworn to or affirmed and subscribed before me this 1 s t day o. f . February. '1..Q.Q..l / ~nniil F. ~ernert CI) QQ' ::s I:l - s::: ~ :E: Repister /6 - e:2CJ 7- ..2.-- r- N 21-01-129 o. Estate of PAUL J. GERNERT , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW February 1st 2..Q...Q.l, 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 A pr ill n, ? n n n described therein be admitted to probate and filed of record as the last will of Paul ,1 _ c;~rnprt- and Letters 'T'P ~ t- rl m~ n t- rl ry are hereby granted to Anna F. Gernert FEES ~;f~.o~/~'d7' . Register of Wills Edmund G. Myers (20558) Johnson, Duffie, Stewart & Weidner Probate, Letters, Etc. ......... Short Certificates( ).......... ReJm~raiion ................ JCP $ 25.00 $ 3.00 15.00 $ $ 5.90 TOTAL _ $ 48.00 .... .Eep....l L .2.QQL.......... ..... A TIORNEY (Sup. Ct. J.D. No.) 301 Market St., P. O. Box 109 T.""moyn"". Pro 17n41-010Q ADDRESS Filed (717) 761-4540 PHONE i-' C~ -' " I --' ...::.:::.." I_I,": Hl05.~05 REV'JlfJ'{:, This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 6764218 No. 21-01-129 Hl05. 14J Aev 2187 f~ K~&M Local Registrar . C40~ o1.,j OJ- 0 <=10 I Date COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPIEJPRtNT IN PER'l1'1,NEHT BLACK INK GFt Aft' UNDER I OAY Houri ! Minul.. --=-......--....=~~~-...-="""....=--=-"'. "..,. SEX 2. b'lA It. -aiRiHPL.J.a. Ie.,., ;,tnd PlACE 31a180l' J-cre.gnCounuYI HOSPiTAl CITY. BOAO. TWP Of DEATH ill <II :J <II " OJ " s c.atQiac o. respiralory .allese, IhocK or hean failure r "lu--J,JlLA-- (1. A ^ ~. ~lO(ORAS "CONSEOUENCE Of); 1 : DUE 1O(OA AS A CONSEQUENCE Of): DUE 10 (OR AS A CONSEQUENCE Of) WERE AU~ FINOtNQS A'AULA8lE PfUOA 10 COMPlE11OH OF CAUSE OFDEArH? WANNER Of DEATH ~ o o DATE OF INJURY lUonlh_Oay. ,*,a.) Ham_ o o o Nalw" YN 0 ~~ u.. 211I. CERTifIER tCt'<<;1I oNy or'let .CERTIFYING PHYSICIAN IPhY$oClcln cerbtytng ~use d dealh when .JIlOlher PhvSoC.an has pronounced <.ledlh d(1O cO'n(JIl;'red lIern ..'3} To ItMI bht of nt,. know'-dge, ...... accwnd duella Ihe lI:auNII) and manner.. Iteted. . kcdllnt Pending InveSltgatioo YNO ~D -... Could not be dele,mlned ... ~ ill f;l o C; ~ " Z 'PRONOUNClNG AND CERTIfYINQ PHYSICIAN (Phy5lC.an boIh ~onoul\C109 oe..lh .....d CerJ,ly,ng 10 c<luse 01 oealhl Tothe beM: 0' mV knowledg., deathOCl:urrH allhe u.ne, dale,.and piKe, .and due 10 lhe UUM(I).and manner a. slated.. "MEDICAL EXAMINER/COROHER On Ihe be.l. of e..min.Uon andJOIlnvesligalion, in my opinion, dealh OCcurred allhe lime, dale, .and place, and duelo lhe CaUM{.)and "'.nnara..latH...,......... ...,..........................,.......... .... ....... ......................,....... J1a. REGI l.:!.d~I'~ DEATH .MCtlIh. aa.,. -'NIl t.ls-f ,q.;7000 ~IO ~. f10E./le. e.. .... ""i_ '10'( OATESk1HEO (MDI"IIh.Oay. 'INrI 2311, 23c. *5 CASE REFERREO TO MEDICAl EXAMINERtCORONER? ~ / v.. 0 HOlY"'" a .~ . IApproxmar. PART.: ou.l9'iftcan1~conIftbu&inglOdulft.but 'iI'lIervW.....n notl'MUllinginthe~cauMoMniftPARTI. : 00Mt and dNdl , 1 TIME OF INJURY INJURY fJ WORf<1 DESCRIBE HOW INJURY OCCURRED. YN 0 ~D 34. d-. 0 06 005325-00002/03.29.00/EGM/KL T/133173.3 . . 21-01-129 mast DIill aub Wtstamtut OF PAULJ.GERNERT I, PAUL J. GERNERT, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II SPECIFIC BEQUEST: GUNS, HUNTING CLOTHING I give and bequeath my guns, hunting clothing, equipment and all items of my personal property relating to hunting, not including those items listed in Article III hereof, unto MAX J. HEMPT, Mechanicsburg, Pennsylvania, provided he survives me. ARTICLE III SPECIFIC BEQUEST: HORSE AND RIDING EQUIPMENT I give and bequeath my horse, all of my riding tack and equipment, including saddle, bridles and the like, unto THE CAPITAL AREA THERAPEUTIC RIDING ASSOCIATION, INC., Grantville, Pennsylvania. 005325-OOOO2/03.29.00/EGM/KL T 1133173.3 . . ARTICLE IV TANGIBLE PERSONAL PROPERTY I give and bequeath my motor vehicle(s), and the remainder of my household and personal effects and other tangible property of like nature (not including cash or securities), together with any existing insurance thereon, unto my wife, ANNA F. GERNERT, provided she survives me. If my wife, ANNA F. GERNERT, fails to survive me, I give and bequeath the same unto my daughter, MARIAN L. GERNERT, Wemersville, Pennsylvania, provided she survives me. ARTICLE V REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, unto my wife, ANNA F. GERNERT, provided she survives me. ARTICLE VI REST, RESIDUE AND REMAINDER - CONTINGENT DISPOSITION Ifmy wife, ANNA F. GERNERT, fails to survive me, I give, devise and bequeath all the rest, residue and remainder of my estate as follows: A. One third (1/3) thereof as follows: I give and bequeath the first FIFTEEN THOUSAND ($15,000.00) DOLLARS of this one-third (1/3) share unto BELLEMANS CHURCH, Dauberville, Pennsylvania, in memory of my foster parents, ELMIRA S. and GEORGE W. HERBINE; and the balance of this one-third (1/3) share unto my daughter, MARIAN L. GERNERT; 2 005325-??oo2/03 .29 .OQ/EGM/~ T/133173.3 B. One third (113) thereof in equal shares unto my sisters-in-law, MARTHA DIEFENTHAELER, LORE WALTHER, and STEFANIE HUY, all of Karlsruhe, Germany, provided that should any of my sisters-in-law predecease me, I give, devise and bequeath such deceased sister-in-Iaw's share unto her then-living issue per stirpes; and C. One third (113) thereof in equal shares.) one unto each of my godchildren, CHRISTINA JEHLE and CATERINA JEHLE, and one unto their mother, CHRISTINA JEHLE, all of Leonberg, Germany, or the survivor of them. ARTICLE VII POWERS OF PERSONAL REPRESENTATIVE My Personal Representative(s) shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. B. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. C. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. 3 005325-00002/03.29.00/EGM/KL T/133173.3 . . D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. E. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. F. To compromise any claim or controversy. G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax refunds and the payment of such taxes without obligation to adjust the distributed share of any person thereby affected. H. I suggest that my Personal Representative confer with my wife's nephew, THOMAS S. WALTHER of Friedrichsdorf, Germany (telephone 06172-79086), with regard to matters of administration and disposition of my Estate to those beneficiaries who reside in Germany. I authorize my Personal Representative to pay such compensation as my Personal Representative deems reasonable and appropriate for the services of my wife's nephew. ARTICLE VIII PERSONAL REPRESENTATIVE I name, constitute and appoint my wife, ANNA F. GERNERT, Executrix of this my Last Will and Testament. Should my wife, ANNA F. GERNERT, fail to qualify or cease to so act, I name, constitute and appoint GERALD L. HEMPT, alternate Executor, and should GERALD L. 4 005325-Q()()()2/03 .29 .OO/EGM/KL T/133173.3 . . HEMPT, fail to qualify or cease to so act, I name, constitute and appoint ALLFIRST TRUST COMPANY OF PENNSYL VANIA, N.A., alternate Executor to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS ~REOF, I have ~ereunto set my hand and seal to this, my Last Will and Testament, this /~y of 1J;.,;):Jf!:) , 2000. . ar.d j) J:0/}~.;I- (SEAL) PAUL J. G~~ERT Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~ ~~q~/ 5 005325-00002/03 .29.oo/EGM/KL T/ 133173.3 . . AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYL VANIA SS COUNTY OF CUMBERLAND We, PAUL J. \"'( ~~ ~. "" "v...J,,~ GERNERT, ~ C'\... ~. '{""'" and '- , the Testator and the witnesses, respectively, w ose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of hislher knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness dO! ~, . . /4A...,.-<L/ Wit ess Subscribed, sworn to and acknowledged before me by PAUL J. GERNERT, Testator, and subscribed and sworn to before me by -t~f""",,,-JJ, ~,~,,-.... _~,./ and \'<( "'~..-- ~ ~ "-1'hJ~ , witnesses, this 1. ~ '""\}0day of ~Y"'~ "- ~ , 2000. 'U~''Y'-.~ Notary Public ~i~~, \~ 6 NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21, 2001 r.:::: .!::::- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: PAUL J. GERNERT Date of Death: August 19, 2000 Will No.: 2001-00129 Admin. No.: To the Register: I certify that notice of beneficial interest 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 S{(Cp(i)/ Name Address 245 Hempt Rd., Mechanicsburg, PA 17055 168 Station Road, P. O. Box 339 Grantville, PA 17028 Phoebe Berks Village, 1 Reading Dr., Apt. 366 Wernersville, PA 19565 Max J. Hempt The Capital Area Therapeutic Riding Association, Inc. Marian L. Gernert Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: Z/{ fp(D( Sig~h~ Name Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative 011073-00001/3.27.01/EGM/DLM/115470.1 IN RE: ESTATE OF PAUL J. GERNERT LATE OF CAMP HILL BOROUGH CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NO. 2001-00129 DISCLAIMER The Capital Area Therapeutic Riding Association, Inc., hereby exercises the rights granted to the Association in Chapter 62 of the Probate, Estates and Fiduciaries Code, 20 Pa. C.S.A. 99 6201-6207, and hereby disclaims the horse, riding tack and equipment, including saddle, bridles and the like, specifically bequeathed to the Association under Article III of decedent's Last Will and Testament. IN WITNESS WHEREOF, and intending to be legally bound, and intending that this Disclaimer shall be filed with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, as provided in 20 Pa. C.S.A. 9 6204 (a), I hereunto set my hand and seal this ~tJ day ofl111 1fc!/:2001. Signed, Sealed and Delivered in the Presence of: The Capital Area Therapeutic Riding Association, Inc. B~ ,_'. 1 ".' ~ ; f"J. 'COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } ss: Anna F. Gernert baing duly !=lwnrn according to law, deposes and says that she is Executrix of the Estate of Paul J. Gernert late of Camp --.Hill Borouqh . ,Cumberland County, Pa., deceased and that the within is an inventory made by Anna .F. G~rn~rt: I the said Executrix of the e~tire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn to and subscribed before me, ~'V r &~wvt-- deJ, Execlltor . Administrator . Anna F. Gernert, Executrix 19 2001 Notarial Seal Nina June Davis, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Oct. 31, 2002 Member, Pennsylvania Association ot:r~~iff Death Day 109 Runson Road Camp Hill, PA 17011 Adareu Date of August Month 2000 Year INSTRUCTIONS /. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of disc;overy of additional assets. 3. Additional sheets may be, aHached as to personalty or realty 4. See Article IV, Fiduciaries Act of /949. ,- M "<t' 0 I'""- M ..::x:; P-l . >- -c CD 0'\ I- W WI N ~ a:: I- 8 III M W ~ CI) 0. 0:: u 0 0 en ~ ClI. e I 0 W W C C\ M :J: a:: Z III f- 0. U. 0:: 0. I- ...J III 0 Z ~ 0 ~ I U. ...J a.. 0'1 M W 0 ~ w C.!) .;.. 0 N > Z 0::: 0+- r--! 'z 0 . c C IJ ::I >c: Vl Z 0 0 c::: U C.!) 0 Z w ~ H 4Ito t:Il a- D -c ro ..::x:; c III s:: . P-., - ""i: ~ .0 0 1II S I ..a -c ~ ro . ClI E III 0 rz:I P-l , .... ;:J 0 I III ....I U u: a:I \, 4-c::?CJ;?~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN EDMUND G MYERS JOHNSON ETAL PO BOX 109 LEMOYNE u ESQ PAl '17043 06-05-2001 GERNERT 08-19-2000 21 01-0129 CUMBERLAND 101 Allount Rellitted S1;* REV-1547 EX AFP U2-DDl PAUL J 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=is4-j-EXAFP-n1f=ooY-NOYiCE--OF-YNHEifiTAifCE-YAX-'A-PPR'AIsEi"-ENT~--Aii-oWANCE-(rR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GERNERT PAUL J FILE NO. 21 01-0129 ACN 101 DATE 06-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ( ) CHANGED (1) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 2.383.65 .00 .00 (8) 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 (9) (10) 3,486.81 .00 NOTE: To insure proper credit to your account, subllit the upper portion of this for. with your tax paYllent. 2,383.65 (11) (12) (13) (14) 3.486 81 1,103.16- .00 1,103.16- NOTE: I~ an assessment was issued previously, lines 14, lS and/or 1&, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (lS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 .00 X 15 = .00 (19)= .00 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ; C; PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: PAUL J. GERNERT Date of Death: August 19, 2000 Will No.: 2001-00129 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 parties in interest? Yes No X The Executrix was the wife of the decedent and sole beneficiary of the residue of the Estate. 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. ~ Signature Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemoyne. PA 17043-0109 Address Date: o {tz(o ( (717) 761-4540 Telephone No. Capacity: Personal Representative X Counsel for Personal Representative REV-1S00EXI6-001 ! i ,...., ~."'"7 -_ ..'"'\ I L? -- Ii. :.../, 01\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 w .... ::rc:~U) u .n' w"u ,,00 u"'... .." .. .. INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o W (,) W o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GERNERT, PAUL J. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) August 19, 2000 January 8, 1904 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Anna F. Gernert OFFICIAL USE ONLY (! [!l1. Original Return o 4. limited Estate 06. Decedent Died Testate {Attac/l copy of Will) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise {dale of death after 12-12-82) o 7. Decedent Maintained a Living Trust {Afuich copy afTrust) o 10. Spousal Poverty Credit (date 01 ojeath OOM~l\ 12.-31-91 am! 1-1-95) FILE NUMBER 21- 0 1 0 1 2 9 -- -- ----- COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 160 - 10 4157 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (dale 01 death prior to 12.-13-82.) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to \ax under Sec. 9113(A) (Attach Sch 0) .... Z W o Z o .. <Il W ~ o u FIRM NAME (I/Applicable) Johnson Duffie TELEPHONE NUMBER COMPLETE MAILING ADDRESS 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 x.O_ (15) -0- x.O_ (16) -O- x .12 (17) O- x .15 (18) 0- (19) n NAME Edmund G. Myers, Esq. Stewart & Weidner (7171 761-4540 OFFICIAL USE ONLY 2,383.65 (11) 3,486.81 (12) (1,103.16) (13) -0- (14) (1,103.16) 1. Real Estale (Schedule A) 2. Stocks and Bonds (Schedule B) z o ~ :J l- ii: <C (,) w 0:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. ne operty (Schedule F) o Separate Billing 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 1) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !4: .- :J lI- ::Ii: o (,) ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 109 Runson Road CITY Camp Hill I STATE PA 1 ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Une19) (1) -0- 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Total Credits (A+ 8 + C) (2) -0- 3. InteresVPenaity if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. -0_ A. Enter the interest on the tax dUe. (5) (5A) (58) 8. Enter the total of Une 5 + 5A. This is the 8ALANCE DUE. -0- Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. ,etain the use or income of the property transferred;.................. ............................ ................ ......................... 0 b. retain the right to designate who shall use the property transferred or its income;.... ...... 0 c. retain a reversionary interest; or.................... ..................... ......w.."'.."....."................................... .......... 0 d. receive the promise for life of either payments, benefits or care? ................... .................................................. D 2. If death occurred after December 12, 1982, did decedent transfer proparty within one year of death without receiving adequate consideration? ........ ..................................................."............................................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4, Did decedent own an lndividual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation? . .................. ............................"........................... ................ No ~ KJ o o o KJ ..0 KJ 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 pedury, I declare that I have examined !his return, including acrompanymg schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all inlormation of which preparernasanYknowledge SiGNATUREO~O:R?g~~TURN ADDRESS Anna F" Gernert, Executrix 109 Runson Road, Camp Hill, PA 17011 SIGNATURE o~ THAN REPRESENTATIVE ADDRESS Edmund G" Myers, Esq. 301 Market St", P. O. Box 109, Lemoyne, PA 17043-0109 DATE <.f/;'c/()/ . tfJ,TE '-I.kj(i! . 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 tor the use of the sUlviving spouse is 3% [72 P.S. ~9118 la) (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 retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Juiy 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/he child is 0% [72 P.S. ~9116(a)(1.2)J. 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. ~911611.2) [72 P.S. ~9116Ia)(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. "".,..",."." .. COMMONWEALTH OF PENNSYLVANIA 'NHERlTANCE TAX RETURN RES'DENT D CEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF GERNERT, PAUL J. FILE NUMBER 21-01-0129 Indude the proceeds of litigation and the data the proceeds wers received by the estata. All property jolntIy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Allfirst Bank - Account No. 00369-8563-5 Date of death balance 1,118.65 2. Guns (Article II of Will) Appraised value 1,190.00 3. Hunting clothing, equipment and all items of personal property relating to hunting. (Article II of will) 25.00 4 . Riding tack and equipment (Article III of will) Appraised value 50.00 5. Horse - 28 year old, gray, crossbred mare (Horse is old and unsound) -0- TOT At (Also enter on line 5, Recapitulation) $ 2 , 383 . 65 (If more space is needed, insert additional sheets of the same size) REV_1511EX+{1-971 '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TM RETURN RESIDENT DECEDENT GERNERT, PAUL J. FILE NUMBER 21-01-0129 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: \. Pe_at Representative's Commissions Name of Personal RepresentaflVe (s) Social Security Numbe~s) f EIN Number of Personal Repre,enlatlve(') Street Address , City State Zip Yea~s) Commission Paid: 2. Attomey Fees - Johnson, Duffie, Stewart & Weidner 3,250.00 3. Family Exemption: (If decedents address ~ notlhe same as claimants, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees - Register of wills - Cumberland County 48.00 5. Accountants Fees 6. Tex Retum Preparers Fees 7. Cumberland Law Journal - advertising letters 75.00 8. The Patriot-News - advertising letters 93.81 9 . Register of wills - file Inventory and Inheritance Tax Return 20.00 TOTAL (Also enter on line 9, Recapitulation) $ 3,486.81 (If more space is needed, insert additional sheels of the same size) REV'''''''''''''O. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEOENT SCHEDULE J BENEFICIARIES FILE NUMBER 21-01-0129 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ESTATE OF GERNERT, PAUL J. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1. TAXABLE DISTRIBUTIONS {include outright spousai distributions) 1. Anna F. Gernert 109 Runson Road, Camp Hill, PA 17011 wife 2. Friend Max J. Hempt 245 Hempt Road Mechanicsburg, PA 17055 AMOUNT OR SHARE OF ESTATE . Personal property; residue Guns;Hunting equipment ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I. The Capital Area Therapeutic Riding Association, Inc. 168 Station Road, P. O. Box 339 Grantville, PA 17028 TOTAL OF PART n. 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) Disclaimed (Copy of Disclaimer attached) 011 073-l)OQ01/3.27.01/EGM/DLM/115470. 1 t(Q)~ INRE: ESTATEOFPAULJ.GERNERT LATE OF CAMP HILL BOROUGH CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NO. 2001-00129 DISCLAIMER The Capital Area Therapeutic Riding Association, Inc., hereby exercises the rights granted to the Association in Chapter 62 of the Probate, Estates and Fiduciaries Code, 20 Pa. e.S.A. ~~ 6201-6207, and hereby disclaims the horse, riding tack and equipment, including saddle, bridles and the like, specifically bequeathed to the Association under Article III of decedent's Last Will and Testament. IN WITNESS WHEREOF, and intending to be legally bound, and intending that this Disclaimer shall be filed with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, as provided in 20 Pa. C.S.A. ~ 6204 (a), I hereunto set my hand and seal this :at) day ofHA J(CJf2001. Signed, Sealed and Delivered in the Presence of: The Capital Area Therapeutic Riding Association, Inc. B~ REV-1500 EX (6-00) , , W I- ll::!1Il Ua::ll: Wa..U J:OO Ua::..J a.. III a.. c( COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPl 280601 HARRISBURG, PA 17128-0601 .... Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 31J D tj2. de ffi DATE OF DEATH (MM- D-YEAR) /ro--d07-3 REV-1500 OFFICIAL USE ONLY s~ L-/ INHERITANCE TAX RETURN FILENUMBER RESIDENT DECEDENT C~-kE- 4i:- NAMEI3AlliSAIUI ..)eA/fJ SIl' /)€.fl- FIRM NAME (II Applicable) ~, --Lao NUMBER SOCIAL SECURITY NUMBER 116 - 3'/ -8 ffl)l DATE OF BIRTH (MM-DD-YEAR) tJI -~/ -/Y''T-Y - J f) -a4,-' 001 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) sPy /) f.l. f>lJl..fJ~t?-/J THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 030 - 3'( -0-.5;'9/ [W. Original Return o 4_ Limited Estate ~. Decedent Died Testate (Attach copy 01 Will) o 9. Litigation Proceeds Received TELEPHONE NUMBfR ,.. 717 - (,91 -6/3/ o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after 12-12-62) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing 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) o 3. Remainder Return (dale of death priorto 12-13-82) o 5. Federal Estate Tax Return Required I 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o ~ ~ :;) c.. :E o o g COMPLETE MAILING ADDRESS 50'1 Uh l<.el/elL sr- me Cl.-I{ 11 A) /(!, S 1.5 ,<-It...~ / A ~ / 70S- S- (1) (2) (3) (4) (5) I/~, 7t>P,- ~/'3:J, J/ J .. P/;~ /Si!JJL -:).'/ .2t/3D OFFICIAL USE ONLY (6) (7) (8) J:Jf 8'9':), 70 z o ~ :;) .... it <( o W 0::: (9) ~~~6', 10 (10)_iC7"'9, n (11) (12) (13) 1/~S81,:J.7 i 35"0 ~, J-/3 13. Charitable and Governmental 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) - /3S0~ f l-J-3 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 19. Tax Due /3StJeJ13 JJIA AI /11 AJ/~ x .0_ (15) ~oo x .0_ (16) x .12 (17) x .15 (18) (19) -0- Decedent's Complete Address: t STREET ADDRESS ..- i,oJ. - . JD'-1 K.--II IL S I, CITY I STATEp -<) I ZIP J '} ?I..::, - " n I {;:-: (' II t, i ....,: i...:'. (..-( /. r Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 0 2. Credits/Payments A. Spousal Poverty Credit 8, Prior Payments C. Discount Total Credits ( A + 8 + C ) (2) - 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterest/Penalty ( D + E ) (3) - 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) - .,J} - -..' 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) -() - Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... 0 m b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ;<.0 c. retain a reversionary interest; or.......................................................................................................................... 0 )<.0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~O 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 XJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 _~O 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 .><p 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 pe~ury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, $IPNATURE OF PERSqN RESPONSIBLE FOR FILING RETURN DATE ~L I ~.._' 1- - (I )(~.:'.r(..-- .'" ".~.1'.' ,.~_.- ~ . I' . ADDRESS / . , '<c Ii, -- J- r'. i: ~ ,.J..) ~ f/I ' . i..< - ))-.J t,,/I /' .:; , i .r'~ / i -' ~ .~ i "'. -' ; t/ i .- ~,...... t , SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE , DATE ADDRESS 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. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(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. """~"".'"'' .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF -,y FILE NUMBER I( <~ l / .-. I .) 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 which is jointly-owned with right of survivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH /' ,) I , , , , ~ I 1/ /--., '.~ I I ,",,' ! / " f. -:J i.J < I / ,,' " ,/ .,'\ /- J -' / , IY! ..1 I.) 7 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) 11//, }r.J0, - REV-1503 EX + (1-91) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATJ~) \ ~ It 1 i Ii --; It I Y ;) f";,- SCHEDULE B STOCKS & BONDS FILE NUMBER d I -jl/l&/ -/ ?C All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. /.~ ,:;; (0 if. f -,,> , .;;.1 '2 ,) , 111.-/1 i'..::.... i -jL jvd/ r-""'"-' ~..... -.... -::; ... 'j ;(. I. I., .' J ,; ( - , DESCRIPTION r "i' ..._ I 'I I", l: jdf'M"~ G' ..J' ".1 {._J:- ........_ ../ , .. ~ / VALUE AT DATE OF DEATH (Pt.I;;' /"0 7)- d-- 00 :;:;'" ( () "7 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) '1 _. -?+-I ~< J, 1/ :EV"~EX.(1':7~ _~ - ~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT I ESTATE OF FILE NUMBER Jet~R""\' A S/vYDFf( 21-;>(J{).'- '30 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. d, ':t v' '1, ./ ..:;, {, 7, 1. - DESCRIPTION VALUE AT DATE OF DEATH c ~ '::,/1 0 tV 1/ If tV D 93 f3//J2ER.. I J,-=- (p~5'(), - ;) ~5-0, - - '3 (, I tJ, -.::- ", . , (,,',": /t' / ^ (,'. ',1 q r f~ ':~ , 1 '-.I.,C' ;J.fi '(/ d eff ~c. , AT ,,)/,-'@.I D<rIfv ~ ~ (~ " A)..' .cl IIJ 7.. /Uk. pCl.",- Uv,-o ~ 7(/ V.....'f4J f!..11'i T, ,) 1'.' ~ " Go fl T '9 7 f? Ii , I.... (L. c./() rllf:; ;;00,- TIJt/ 1$ J../OO. - ? f--~/t!)/.TU (Le- ..' {It (/1 Ie tV G 4 .5 A t/ j IU(, flUe p,~MI..... --- - ')C _ -: c,i A T< A ~n J:1.... j-oO;l / --I "" 1 ,,/, ('0 /'YJ 13, (1-' ""Q. P'" T ,"-'10 ~OO(- & ,.,. ~ /'1 .~ I /'I .i.' A 1 LA /J"j/U /j ) (-(c. ~ II ,p ~ <20 e f A L '- f-. E U I . _SAlllfJG: <jtf, - TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV.l509 EX +;1.97) _~. ..~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF 51,) Y D E/~J -Jp~J-12 p~ (1. I FILE NUMBER d J-dOO/-/Jt) 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. B. c. JOINTLY-OWNED PROPERTY: LETTER ITEM FOR JOINT NUMBER TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH V AWE OF ASSET %OF DECD'S INTEREST DATE OF DEATH V AWE OF DECEDENT'S INTEREST 1. A. '1;-)0l1J Y't1eW\ he~ ~ I Jcr{P~(,3 5 /PI' TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ~ca, 30 . ~."".~.: . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS E~Ij9J /) € ~J J e. ~ f"R ey IJ I FILE NUMBER ;< 1- ;JOt> 1- /3 tJ Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. DESCRIPTION FUNERAL EXPENSES: FIA.- rJ (1 tl ~ '- ,.../ D WI C rn ~ I Pc:z.z. I ~ 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 2. 3. 4. 5. 6. 7. City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant 8 " ~8 A Ii .q ve.~ ~ S I.J If /) E: R. Stree!,Address ..j 0 LJ W, J( ~II E IL S 7 City ", ~ff7J AI le,S ~1.4-/l. ~ State PII Relationship of Claimant to Decedent ().J I fc:.. Probate Fees Accountanfs Fees Tax Return Preparer's Fees AMOUNT g ~ iJ;;-, IU Zip . 170~3- Zip {,3,- TOTAL (Also enter on line 9, Recapitulation) $ (] "f/!J~/O (If more space is needed, insert additional sheets of the same size) - REV-1512 EX + (1-97) SCHEDULE I DEBTS OF DECEDENT , MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J ( .} .f ~ ~ 'I A, S IJ Y I) f-K- FILE NUMBER (JI- rJOCJ/-/JO Include unreimbursed medical expenses. ITEM NUMBER 1. f tJ C. f3 It AJ 1<.. I ;.. fN~ !3,4pl( tf(U/1 (" E if '<-11'1 J..f 0' 3 0 '-I&- 0 I '30" '3 ..)~ 'I AMOUNT ; cg Ij/lb,- j pPt:o. {IIIW /( (J..flfl. 0 5 e,v, (' ~ S '-I a &, Lf J-C;?y ~ 7'-1 3 0 '& t, <; 'Jol,vr 'J.3o'f,I?+-:;' //S-.;2,3tr Ii, ~JJ()f/,o.s 131'91.;/( ';-'-11,;,& 7970 Ot-D3 ~;;JJ."3 I 3 ~ ;).. ,(" t../ .- j l.;.' Ve (2., 2. (.) IU 7/ 7 - 6 '77- 5-/ 3 I W A ({ I).s / / 3 -if 3'1 -7 ~ 3 {! rl;<i/( I,., S S J-/ R.. ~ II(}[IC-. fl / '" FYI b, N5 '--II, tf6 1, I 7'1,19 / 7ft}, ;) 7 ~, Holy 5~/tf. T 1-1 ~ s ~/ T4L I~, - 9. (JIve.. r!,i/'f FeU- :Jj-O ~/, '3 b II), A /') I) (2 (. t...J'::, f/ fA I€- L II . fl P / y S;:" f , T 1---1 tJ S r', 7 /J C I~, F/ e €'t j;-,-! 9/ C;()o/ /)"9(){; 9 73 f( /3 e,Re-IA,T c.,"'y ,:fJ3-003/-IDY3fo-,,176 13-; - d-J.,fj9 9 ~-19, () 7 / 3St. , 10 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) o 6y7',,/? If) }~i91l.j7 . -:""".:'~ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE Y 7 i cJ c; ''. . , . / I SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1. IE Nil f. jQlll '" /1.) ;'1' /0;; l( Sf.' ./ j,>,v F l> ./1 /.J) :/1/;1 11' I 'li,},(., i </1 ,/ (' . I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)