HomeMy WebLinkAbout06-10-15 r Pennsylvania 1505618627 3M464710.000
DEPgRIfAEMT OF REVENUE E!:(03-14)(TP)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2� 14 1047
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
08272014 01161939
Decedent's Last Name Suffix Decedent's First Name MI
GALEN GERALD J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
GALEN JUDY KAY
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
FX-1 1. Original Return El 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
❑ 4. Agriculture Exemption(date of ❑ 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7. Decedent Died Testate El 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received 11. Non-Probate Transferee Return 0 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
❑ 13. Business Assets F 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ELIZABETH B . PLACE 717-233-1000
First Line of Address
SKARLATOSZONARICH, LLC
Second Line of Address
17 S . 2ND ST . , 6 FL
City or Post Office State ZIP Code
HARRISBURG PA 17101
Correspondent's email address: EBP@SKARLATOSZONARICH •COM
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REGISTER OF WILLS USE CL LY '
REGISTER OF WILLS USE ONLY C7 I'
DATE FILED MMDDYYYY C l• i
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY '
Side 1
111111111111111 IN IN
1505618627 1505618627
^
. N 1505618635
N
REV-1500E%(T9)
Decedent's Social Security Number
Decedents G4LEN GERALD J
RECAPITULATION
1. Real Estate(Schedule A) . . ' . . . . . . . . . . . . . . . . . . . ' . . . . . 1 0^00
2. Stocks and Bonds(Schedule eV . , , . . . . . . . . . . , . . . . . . . . . . . u. 0.00
3. Closely Held Corporation,Partnership'xSole-Proprietorship(Schedule C). . . . . 3. O .00
*. Mortgages and Notes Receivable(Schedule D). . . . . . . . . . . . . , . . . . 4. 11^ 00
u. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . o� 41392~00
V. Jointly Owned Property(Schedule F) D Separate Billing Requested. . ' . . 0. 1,88q ^00
7. mter-VivoaTransfers&Miscellaneous Non-Probate Pmperty
(Schedule G) | | uopo,otoaminnRequemou. . . . . r. 491083 ^ 00
8. Total Gross Assets(total Lines 1through 7) . . . . . . . . . . . . . . . . . . u. 55,364 ^ 00
n� Funeral Expenses and Administrative Costs(Schedule*). . . . . . . . . . . . . n. 111553.00
10. Debts oaDecedent, Mortgage Liabilities and Liens(Schedule V' ' . . ' . . . , 10. 1787^00
11. Total Deductions(total Lines oand 1o). . ' ' ' . ' ' ' ' ' ' ' ^ ' ' ' ' ' ' ' /1. 19,340 ^00
12. Net Value mEstate(Line aminus Line 11> . . . . . . . . . . . . . . . . . . . 12. 41,024 ^ 00
13. Charitable and Governmental eoquents/Sec[n13Trusts for which
unelection 1ntax has not been made(Schedule J), . . . , . . . . . . . . . . . 1o. 0 ^00
1* Net Value Subject wnTax(Line 12minus Line 1n)
TAX CALCuLAr|ow -SEE |NSTRWCOONS FOR APPLICABLE RATES
15� Amount o/Line 1ataxable
otthe spousal tax rate,or
transfers under Sec.9116
(a)(1.o)x.u�_ 391929'00 1*. O^OO
16. Amount,dLine 14
vtlineal rate x/7-:2- 1`095.00 1e. 49.00
17. Amount nfLine 14taxable
atsibling rate x.12 0 . 00 17. O^OO
18. Amount v(Line 1*taxable
mcollateral rate x.10 O ^ UO 1e. 0 ^ 00
19, TAX DUE . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . /*. 49 .00
20. FILL IN THE BOX IF YOU ARE REQUESTING mREFUND cFwwovERPAYMsNT 0
true,Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and beli.ef,
it is correct and complete._-- Declaration_of preparer_-other-_the person responsible f- filling_ the return -__--_ll-_-_..- which- preparer has
any knowledge.
SIGNATURE OF PERSON RESPON I LE OR FILING RETURN DATE
ADDRESS 4041
JUDY K. GALEN 763 ERFORD ROAD CAMP HILLi PA 17011
SIG�,M, RE F P E THER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
'
�tBETH B . PLACEi ESQ . - 17 S . 2ND ST 6TH FLi HARRISBURG, PA
17101
Side 2
1505618635 __��N
REV-1500 EX(TP) Page 3
File Number
'Decedent's Complete Address: 21 14 1047
DECEDENTS NAME
GERALDGALEN
STREET ADDRESS
7671 ERFORD ROAD
CUMBERLAND
CITY STATE ZIP
ICAMP HILL EA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 49 -00
2. Credits/Payments
A. Prior Payments 49 -00
B.Discount 0 •0 0
(See instructions.) Total Credits(A+B) (2) 49-00
3. Interest
(3) 0 . 00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0 . 00
5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 .00
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑❑
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . . . .
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . . . . . ❑
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death E-1without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . . . ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[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 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a step-parent of the child is 0 percent(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 percent,except as noted in[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 percent[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.
3M4671 4.000
REV-1508 EX-(08.12)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS& MISC.
INHERITANCEENTT'R"
RESIDENT DECE PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Galen Gerald J 21 14 1047
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Collection of Collector's tapes and Audio
Equipment 4,392
TOTAL(Also enter on line 5,Recapitulation) $ 4,392
2w46AD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Galen Gerald J 21 141047
If an asset became jointly owned within one year of the decedents date of death,tt must be reported on Schedule G.
SURJIVM JOINTTBdANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A Galen, Judy Kay 763 Erford Road, Camp
Hill, PA 17011 Surviving Spouse
B Galen, Peter 763 Erford Road, Camp
Hill, PA 17011 Son
C Miller, Darlene 321 Carsonville Road,
Halifax, PA 17032 Daughter
JOINTLY OWNED PROPERTY:
LETTER DATE MSCRP71ON OF PROPERTY %OF DATE OF MATH
CTEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND RANK ACCOUNT NUMBER OR SIMLAR DATE OF DEATH DEC®BJTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DI30 DENTS INTEREST
1 AB PNC Bank Money Market
No. 6325 2,961 33.3333 987
2 ACB PNC Checking Account
No. 6508 3,608 25.0000 902
TOTAL (Also enter on Line 6,Recapitulation) $ 1,889
9w46AE 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09) SCHEDULE G
pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Galen, Gerald J 21 14 1047
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REVA 500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLI.DETIENAMEOFTHE TRANSFEREE.THEIR RELATIONSHIP TODECEDENT AM DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1, American Equity
Investment Annuity
Contract #562787 49,083 100.0000 0 49,083
Transfer 100% to
surviving spouse, Judy
Galen
TOTAL(Also enter on line 7,Recapitulation)$ 49,083
If more space is needed,use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 F,X+(08-13) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Galen, Gerald J 21 14 1047
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Sullivan Funeral Home 6,085
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 1,500
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500
Claimant Judy K. Galen '
Street Address 763 Erford Road
City Camp Hill State PA ZIP 17011
Relationship of Claimant to Decedent
4. Probate Fees: 161
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Vital Records - Death Certificate 9
2 William J. Mansfield, Inc. - Estate
Advertisements 298
TOTAL(Also enter on Line 9,Recapitulation) $ 11 553
3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+(12.12) SCHEDULE
pennsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Galen Gerald J 21 14 1047
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 SkarlatosZonarich LLC - Legal fees for
elder law matter 1,731
2 SkarlatosZonarich LLC - Care Management Fee 1,056
TOTAL(Also enter on Line 10,Recapitulation) $ 2,787
2w46AH 2.000 If more space is needed,insert additional sheets of the same size.
REY;1513 EX+(02-15)
pennsylvania SCHEDULEJ
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Galen, Gerald J. 21 141047
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. jDarlene Miller,321 Carsonville Road,Halifax,PA 1703.2 Daughter 301
21 13 rs A�1
eter Galen,763 Erford Road,Camp Hill,PA 17011 on 794
— 1 -
3] 1Judy Kay Galen,763 Erford Road,Camp Hill,PA 17011 Spouse 35,929
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F-1 I ===J
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
F-1
r-1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
El
TOTAL OFPART il- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $Ir
If more space is needed,use additional sheets of paper of the same size.
f.
LAST WILL.AND TESTAMENT
OF
GERALD JOHN GALEN
I Gerald John Galen of Cumberland Count Pennsylvania,being of sound and '+
, Y� Y � g
disposing mind and memory, do make, publish and declare this to be my Last Will and
N Testament, hereby revoking all Wills and Codicils by me at any time previously made.
0
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FIRST
m
p I direct the payment of my just debts and expenses of my last illness and funeral from
= my estate as soon after my death as conveniently may be done. If there be no cemetery lot
N available for my interment owned by me at the time of my death, I authorize my personal
X representative to purchase such cemetery lot with a contract for perpetual care,using therefore
m funds from my estate in such amount as my personal.representative shall consider necessary and
desirable, and I authorize my personal representative to cause title to or ownership of such lot
W so purchased to be vested in such person as my personal representative shall designate.
W
r
W Further,.I authorize my personal representative to expend funds from.my estate, in such
o amount as mypersonal representative shall consider necessary and desirable.for the purchase,
erection and inscription of a suitable marker for my.grave. ;
_o
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W
F
SECOND
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J
zI give and bequeath my collection of collectors tapes and my audio equipment to my
N sister,Dorothy Marie Cress.
Z
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THIRD
N
I give, devise and bequeath all the rest of my property,real,personal and mixed,to Judy
o Kay Galen,my wife, if she survives me by thirty days. If mywife does not survive me by thirty
days, I give, devise and bequeath all the rest of my property; real,personal and mixed, in equal
shares, as follows:
A. One-half to my daughter,Darlena Marie Miller,
B. One-half to my Trustee to hold in trust.for the benefit of my son,Peter John Galen, and
to hold and distribute the assets as follows:
I
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I. During the life of my son.,Peter John Galen,to pay to said child, or to others for his
benefit, as.much of the income as my Trustee deems advisable for his maintenance,
education,health and support,after first considering funds available to him from other
sources. Any unexpended income shall be added to the principal at the end of,each year. ,a
2. During the life of my son,Peter John Galen,to pay to said child, or to others for his
benefit, as much of the principal as my Trustee deems advisable for his maintenance,
education,health and support, after first considering funds available to h.im from other
N sources.
N
N
0 3. I direct my Trustee that in exercising discretion in paying income or principal to or for
the benefit of my son,Peter John Galen, it is my intention that in addition to and
a notwithstanding any other applicable considerations of my Trustee, my Trustee shall
take into consideration the income, earning capacity;resources and other sources of
receipt of my son,together with any other factor which the Trustee may deem,pertinent,
including the accustomed manner of living of my son.It is my intention that any such
N payment of income or principal.shall supplement, rather than supplant, other resources
N available to my son or for his benefit,and shall provide for basic support only to the
Ca extent such other resources shall prove inadequate or be discontinued. The judgment of
o the Trustee as to the propriety and amount of all such payments shall be conclusive.
a
W
W 4. Upon the death of my son,Peter John Galen,the trust shall terminate and the remaining
U) principal and any accumulated and undistributed.income shall be paid outright to my
W
a daughter,Darlena Marie Miller, if she is then living, and if sheds not then living, to her
°o issue then living,per stirpes.
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FOURTH
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All shares of principal and income hereby given shall be free from anticipation,
z assignment, pledge or obligation of the beneficiaries and any of them, and shall not be subject to
U) any execution, attachment, levy or sequestration or other claims of the creditors of said
0 beneficiaries or,any of them.
Z I
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FIFTH
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o Any person who shall have died at the same time as I or under such circumstances that it
is difficult or impossible to determine who shall have died first,shall be deemed to have
predeceased me.
M
. � F
SIXTH
ti
All death taxes(and interest and penalties thereon)imposed as a.result of my death upon
the property passing under my Will,and upon assets held in any qualified or non-qualified
Page 2
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deferred compensationn plan or IRA, and proceeds of insurance on my life, but not otherwise,
shall'be paid out of my residuary estate, each share thereof, to bear a pro rata portion.of such
taxes.
I authorize my Executor, in my Executor's sole discretion,to make an election, in whole
or in part, to cause a Pennsylvania Inheritance Tax to be payable by my estate on property
passing to or for the benefit of my spouse or to defer the Pennsylvania Inheritance Tax on such
property. My Executor shall be without liability to anyone for making or failing to make such
N election.
N
N
0
SEVENTH.
a
My Executor shall have the following powers in addition to those conferred by l.aw until.
h all.property is distributed:
a
Q
N (a) To retain any real or personal property in the form in which it is received.
N
N
0 (b) To sell at public or private sales for cash and/or credit, to exchange, and to lease
o for any period of time, any real or personal property and to give options for such sales,
exchanges, or,leases.
W
W �
N (c) To purchase all forms of property, including but not limited to stocks,bonds,
W
Z notes and other securities, common trust funds, life insurance policies and real estate, or any
$ variety of real or personal property, without being confined to so-called legal investments and
6 without regard for the principle of diversification. j
W
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(d) To purchase securities at a premium or discount and to charge such premium,or
credit such discount to principal or income.
J
W (e) To exercise any option arising from the ownership of any investment;to join in
Z any recapitalization,merger,reorganization, liquidation, dissolution, consolidation or voting
trust plan affecting any investment;to delegate powers with respect thereto;to deposit securities
under agreements and pay assessments; to subscribe for stock and bond privileges; and
N generally to exercise all rights of security holders.
W
il
4 (f) To hold property unregistered or in the name of a nominee.
LL
0
J (g) To mortgage,e, divide, alter,repair and improve real property and generally to
exercise all rights of real.estate ownership.
(h) To distribute in cash,in kind, or,partly.in each, and to cause any share to be
composed of cash, property, or undivided fractional shares in property different in kind from
any other share.
(i) To compromise claims by or against my estate including but not limited to tax.
i
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V
issues and disputes, without order of court or consent of any party in .interest and without regard
for the effect of such compromise on any interest hereunder. I
(j) To borrow money and to pledge any real or personal property as security for the
repayment thereof.
i
(k) To apply income for the benefit of any incapacitatedindividual to Whom income
.may or must be distributed for any reason during the period of:incapacity. Income not so
in N applied may be distributed to a custodian or accumulated, invested and .if not sooner applied,
rd paid to such individual upon gaining capacity.
(1) To join with my spouse or my said spouse's personal,representative in filing any
a ft made b m said spouse for gift tax purposes
joint income tax return, and to tom m any gifts y y p g p p
even if this may result in additional liabilities for my estate. Any income or gift taxes due on ;'
such returns and any deficiencies,interest, penalties or refunds thereon shall be allocated '
between my estate and my said spouse or my said spouse's estate, or all to any of them, in.such
N manner as my Executor and my said spouse or my said spouse's personal representative may
N
N agree.
m
d (m) To apply expenses of my estate permitted as income tax or real estate tax
a deductions and to value my estate for estate tax purposes by any method permitted.
W i
W
(n) To employ accountants, agents, attorneys, investment counsel, brokers, bank.or ;
atrust company to perform services for and at the expense of my estate and to carry or register
g investments in the name of the nominee of such agent,broker, bank or trust company. The
o expenses and charges for such services shall be charged against principal or income. My
Executor is expressly relieved of any liability or responsibility whatsoever for any act or failure
to act by, or for following the advice of, such accountants, agents, attorneys, investment
counsel, brokers, bank or trust company, so long as my Executor exercises due care in their
selection. The fact that an Executor may be a.me.mber, shareholder or employee of any
W accounting,investment, legal or brokerage firm, agent or bank or trust company so employed
z shall not be deemed a conflict of interest. Any compensation paid pursuant to this subparagraph,
shall not affect in any manner the amount of or the right of any Executor to receive commissions
Z as a fiduciary.
0
(o) To invest any part of my residuary estate in, or lend money to, any closely-held
business in which I may have an interest at my death for any purposes incident thereto,
o including but not limited to expansion and entry into new fields of business provided that only
assets actually invested in such business shall be liable for the debts incurred in its operation. .
�I
(p) To disclaim any interest in property without court approval.
EIGHTM
(a) I appoint Judy Kay Galen,my wife,Executor. If my said wife fails to qualify or 1
Page 4
ceases to act for any reason, I appoint PNC Bank, National Association,Executor in her place.
(b) I appoint PNC Bank,National.Association, Trustee.
(c) Neither my Executor nor my Trustee shall be required to post.security in.any
jurisdiction.
IN WITNESS WHEREOF,I have set my hand and seal to this, my Last Will and
. i
Testament, this,—? Cl day of S �T C Mee e , 1.999. �
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P,
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(SEAL)
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Gerald John en
ih
N Signed, sealed,published and declared by the above-named Testator, as and for his Last
M Will and Testament in the presence of us, who have hereunto subscribed our names at his
o request as witnesses thereto, in the presence of said Testator and of each other..
n:
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W WITNESS:
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z I, Gerald John Galen, the testator whose name is signed to the attached or foregoing
Z instrument,having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; and that I signed it willingly and
as my free and voluntary act for the purposes therein.expressed.
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o Gerald John.Ga en
J
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
On thijPday of D�M ,1999, before me, the undersigned
officer,personally appeared Gerald John Galen, known to me(or satisfactorily proven)to be the
Page 5
- -- - it
person whose name is subscribed to the foregoing,Last Will and Testament, who acknowledged I
that he executed the same as his Last Will and Testament.
....ill •7,.
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F-�Notarial seal penheffer,Notary,PubVic
urg,Dauphin County No
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r ,r:�• siori'Explres Qct:9,2000y vania Association of Notaries
N We, I Mon " i lw'myi and �o� - ScrAe the
witnesses whose names are signed to the attached or fore ming instrument, being duly qualified
C6 according to law,do depose and say that we were present and saw the testator sign and execute
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the instrument as his Last Will and Testament; that the testator signed willingly and.executed it
ashis free and voluntary act for the purposes therein expressed; that each subscribing witness
in the hearing and sight of the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of sound mind and under no
constraint or undue i fluence.
N
fu (SEAL) Residing at:CA ti #"
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SEAL) Residingat:
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Z Subscribed and sworn to before me by both witnesses,
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o this s�day of , 1999.
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Notary i c
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Z Charity Koppenheffer,Notary Public,
Harrisburg,Dauphin County
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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX p y
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 05-25-2015
ESTATE OF GALEN GERALD J
DATE OF DEATH 08-27-2014
FILE NUMBER 21 14-1047
COUNTY CUMBERLAND
SSN/DC
PETER GALEN ACN 15117207
763 ERFORD RD APPEAL BY DATE:07-24-2015
CAMP HILL PA 17011-1126 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT -ALONG. THIS LINE - RETAIN LOWER PORTLON.FOR- YO-UR.RECORDS... F—, .
-------------------------------------------------------------------------------------------
REV-1548 EX AFP C11-14) •
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 05-25-2015
ESTATE OF:GALEN GERALD J DATE OF DEATH:08-27-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-1047 S.S/D.C. 'NO. : ACN: 15117207
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO. : 000005080056508
TYPE OF ACCOUNT: C )SAVINGS 00 CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 01-24-1994
Account Balance 3,609.29 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.083 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 300.76 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 300.76 REGISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 13.53 , OR MONEY ORDER PAYABLE TO:
.. -. .__—__.._....__..--...._... —__,�_.__—._-_- •----•---�-_.—_-- ---• --- ------"-R'E-G—I'STER--Q'F•-WILLSi .AvE'NT...r,. ,
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
04-06-2015 CD020470 .00 13.53
TOTAL TAX PAYMENT 13.53
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX t� Pennsylvania
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 05-25-2015
ESTATE OF GALEN GERALD J
DATE OF DEATH 08-27-2014
FILE NUMBER 21 14-1047
COUNTY CUMBERLAND
SSN/DC
DARLENA M BUCHER ACN 15117206
763 ERFORD RD APPEAL BY DATE:07-24-2015
CAMP HILL PA 17011-1126 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE R.ETAIN..L.DWER P.4.RTION FOR YOUR R-ECORDS: .. .�.
-------------------------------------------------------------------------------------------
REV-1548 EX AFP (11-14)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 05-25-2015
ESTATE OF:GALEN GERALD J DATE OF DEATH:08-27-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-1047 S.S/D.C. NO. : ACN: 15117206
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PNC BANK. NA ACCOUNT NO. : 000005080056508
TYPE OF ACCOUNT: C )SAVINGS 00 CHECKING ( )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 01-24-1994
Account Balance 3,609.29 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.083 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 300.76 UPPER PORTION OF THIS NOTICE
Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 300.76 REGISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 13.53 OR MONEY ORDER PAYABLE TO:
--*R-cGIST-ER OF WI'LL•S, AGENT. "
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
04-06-2015 CD020470 .00 13.53
TOTAL TAX PAYMENT 13.53
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
• �` pennsylvania
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION ---
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 05-25-2015
ESTATE OF GALEN GERALD J
DATE OF DEATH 08-27-2014
FILE NUMBER 21 14-1047
COUNTY CUMBERLAND
SSN/DC
PETER GALEN ACN 15117208
763 ERFORD RD APPEAL BY DATE:07-24-2015
CAMP HILL PA 17011-1126 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG .THIS LINE RETAIN:-.LOWER PORTION FOR YOUR. RECORDS ..
REV-1548 EX AFP C11-14)--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 05-25-2015
ESTATE OF:GALEN GERALD J DATE OF DEATH:08-27-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-1047 S.S/D.C. NO. : ACN: 15117208
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO. : 000005002036325
TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 06-06-2000
Account Balance 2,960.30 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 493.39 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 493.39 REGISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 22.20 OR MONEY ORDER PAYABLE TO:
'OF --WILLS; 'AGENT.^
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
04-06-2015 CD020470 .00 22.20
TOTAL TAX PAYMENT 22.20
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
17 South Second Street,6"'Floor
I.C.1.1 LLC Harrisburg, PA 17101-2039
SOU.nd.Advice.Stnarter Decisions. 717.233.1000 Voice
717.233.6740 Fax
www.skariatoszonarich.com
June 9, 2015
Register of Wills Office
Cumberland County Court House
One Courthouse Square C=::)
ca-1
Carlisle, PA 17013 ice.
61
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RE: Estate of Gerald J. Galen
C:)
No. 21-14-1047 QD
To whom it may concern:
J
CD E.
'('.Vj.
I am enclosing for filing the original and one copy of the Inheritance Tax Return n L-d C-1)
C "
Inventory for the above-referenced estate. Please time-stamp the extra signature pages and 1.
return to me in the envelope provided.
If you have any questions or concerns regarding these documents, please give me a call.
Thank you.
Sincerely,
Sharon K. Shaffer
Sr. Estate Administrator
sharon@skai-latoszoiiaricil.com
Enclosures
I S0059830.1 I A Member of LawPaCtTM-An International Association of independent Law Firms
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