HomeMy WebLinkAbout01-0185
REV.1500EX (6.QO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INtlERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FRICK, MABEL 1.
DATE DF DEATH (MM-DD-YEAR) DATE DF BIRTH (MM-DD-YEAR)
01/27/01 03/26/14
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[3 1. Original Return
o 4. Limited Estate
[] 6. Decedent Died Testate (Attach copy 01 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 (Attach copy olTrust)
o 10. Spousal Poverty Credit (data of death tIelweelI U-31-9~ alYj ~-1-95\
/(;,- ;}/()-/;(.
OFFICIAL USE ONLY
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FILE NUMBER
---,--L-JLl .JL-L-1l..---2-_
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
200 - 24
0841
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date 01 death prior to 12-13-82.\
o 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSd1 0)
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NAME
CDMPLETE MAILING ADDRESS
Debra K. Wallet, Es .
FIRM NAMEalwIfApP~"~ices of
L utI Debra K. Wallet
TELEPHONE NUMBER
(717) 737-1300
24 N. 32nd Street
Camp Hill, FA 17011
1. Real Estale (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
720.00
3,872.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4_ Mortgages & Notes Receivable {Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. tnter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(6)
152,142.77
(7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
13,260.75
60B. 77
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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
45
x.O_ (16)
x .12 (17)
x .15 (16)
(19)
16. Amount of Line 14 taxable at lineal rate
142,865.25
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
.~
OFFICIAL USE ONLY
(8)
156,734.77
(11) 13,B69.52
(12) 142,B65.25
(13)
(14) 142,B65.25
6,42B.94
6,42B.94
. CHECK'MAllfif
Decedent's Complete Address:
STREET ADDRESS 4624 Hampden Avenue
CITY Camp ,Hill I STATE PA I ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(I)
6,428.94
4,000.00
200.00
Total Credits ( A + B + C ) (2)
4,200.00
3. InteresUPenaity if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 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)
5. If Line 1 + Line 31s greater than Line 2, enter the difference. This is the TAX DUE.
2,228.94
A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,228.94
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 1m
b. retain the right to designate who shall use the property transferred or its income; ......................... ..... 0 1m
c. retain a reversionary interest; or...................................................................................................... ..... 0 @
d. receive the promise for life of either payments, benefits' or care? ...................................................................... 0 1m
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 1QlI
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 XllI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............... ......................................... .............................................................. 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of pfeparer other than the personal representative is based on all information of which preparer has any knowledge.
SI~ P~RSON RESPO.NSIBLE FO~ FI ING!E RN
ADDRESS
DATE
10 "l Ol
4624 Hampden Av., C mp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
WJIIftL 1! ~
DATE
1012"1- tD1.
ADDRESS
24 N. 32nd St., Camp Hill, PA 17011
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. g9116 (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. g9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value oftransters to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. g9116(a)(1)].
The tax rate imposed on the net vaiue at transfers to or tor the use of the decadent's siblings is 12% [72 P.S. g9116(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.
REV'150JEX.(1'971~_
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R I NT NT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Frick Mabel!.
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
FilE NUMBER
21 01
0185
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
3,872.00
PP&L Stock
88 shares at $44/share
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,872,00
REV.1508EX'If.97)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE Of
Frick. Mabel!.
fiLE NUMBER
21 01
0185
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
VALUE AT DATE
OF DEATH
Cash in possession of decedent
20.00
2.
Personal property located at son's residence:
china service for 8, bed, chest of drawers, dresser, quilt, wedding ring
300.00
3.
1987 Pontiac Bonneville (based upon actual sale)
400 .00
TOTAL (Also enter on line 5. RecapitulaTIon) $
(if more space is needed, insert additional sheets of the same size)
720.00
, .
REV.1S09EX'11.97)
'*
SCHEDULE F
JOINTL Y.OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Frick Mabel I
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
21 01
0185
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. William H. Frick,II!
4624 Hampden Avenue
Camp Hill, PA 17011
son
I
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name 01 financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed forjoinlly-held real estate. VALUE OF ASSET INTEREST DECEDENfSINTEREST
1. A. before PSECU Share Account 2,169.00 50. 1,084.50
1993 P.O. Box 67013, Harrisburg, PA
2. A. before PSECU Checking Account 7,740.83 50. 3,870.42
1993 P.O. Box 67013, Harrisburg, PA
3. A. all PSECU CD #0200240841 10,000.00 50. 5,000.00
PSECU P.O. Box 67013, Harrisburg, PA
CDs - (interest taken monthly)
4. A. none PSECU CD #0200240841 10,000.00 50. 5,000.00
made P.O. Box 67013, Harrisburg, PA
joint (interest taken monthly)
5. A. within PSECU CD #0200240841 20,000.00 50. 10,000.00
one yr P.O. Box 67013, Harrisburg, PA
of (interest taken monthly)
6. A. death PSECU CD #0200240841 10,000.00 50. 5,000.00
or P.O. Box 67013, Harrisburg, PA
were (interest taken monthly)
7. A. estab- PSECU CD #0200240841 10,000.00 50. 5,000.00
lished P.O. Box 67013, Harrisburg, PA
from (interest taken monthly)
8. A. exist- PSECU CD #0200240841 10,000.00 50. 5,000.00
ing P.O. Box 67013, Harrisburg, PA
joint (interest taken monthly)
9. A. funds PSECU CD #0200240841 20,000.00 50. 10,000.00
P.O. Box 67013, Harrisburg, PA
(interest taken monthly)
10. A. PSECU CD #0200240841 15,000.00 50. 7,500.00
P.O. Box 67013, Harrisburg, PA
Ifinterest taken monthly)
TOTAL (Also enter on line 6, Recapitulation) $ 152,142.77
(If more space is needed, Insert addItional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Frick, Mabel!.
21
01
0185
Paqe 1
Schedule f-2 - Jointly-Owned Property
LETlER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number Of similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for iointly-heJd real estate. V AWE OF ASSET IN1ERESl DECEOEN1"S INTEREST
11. A. 9/99 PNC Bank CD #31000164367 10,011.80 50. 5,005.90
4242 Carlisle Pike, Camp Hill, PA
12. A. beforE Fulton Bank CD#025-0123974 36,764.85 50. 18,382.43
1996 599 12th Street, Lemoyne, P A
13. A. appro} Commerce Bank Money Market Acct. #0032050346 7,932.81 50. 3,966.41
1996 100 Senate Avenue, P.O. Box 8599, Camp Hill, PA
14. A. 12/99 M&T Bank (previously Keystone Bank) CD #3782398824 10,000.00 50. 5,000.00
3805 Trindle Rd., Camp Hill, P A
(interest taken monthly)
15. A. from Mid-Penn Bank CD #309-001204 10,000.00 50. 5,000.00
joint 4600 Carlisle Pike, Mechanicsburg, P A
funds (interest taken monthly)
16. A. beforE Mid-Penn Bank CD #309-001237 30,000.00 50. 15,000.00
1998 4600 Carlisle Pike, Mechanicsburg, PA
(interest taken monthly)
17. A. 9/97 Waypoint Bank Checking Acct. #2300005779 3.582.63 50. 1,791.32
235 N. 2nd St., Harrisburg, PA
18. A. jt. Waypoint Bank (previously Harris) CD#2300013468 7,375.67 50. 3,687.84
acr;;:t., 235 N. 2nd St., Harrisburg, PA
befor 1997
19. A. befor Waypoint Bank Stock 10,580.00 50. 5,290.00
1995 920 shares at $11.50/share
20. A. all U.S. Savings Bonds 63,127.90 50. 31,563.95
made (see attached list)
joint
in thE
1970' ,
SUBTOTAL SCHEDULE f.2 94,687.85
GRAND TOTAL SCHEDULE f.2 $ 152,142.77
Inventory 1
Accrual Bonds
Redemption Date: 1/2001
Issue Yield Next Final
Serial Number Denom. Series Date Value Interest To Date Accrual Maturity
C2098931679E $100 E 3/1972 $481.96 $406.96 6.56* 7/2001 3/2002
C2098931678E $100 E 3/1972 $481. 96 $406.96 6.56* 7/2001 3/2002
C2098931680E $100 E 3/1972 $481.96 $406.96 6.56* 7/2001 3/2002
C2098931681E $100 E 2/1972 $481.92 $406.92 6.56* 6/2001 2/2002
C2098931682E $100 E 2/1972 $481.92 $406.92 6.56* 6/2001 2/2002
C2098931683E $100 E 1/1972 $480.80 $405.80 6.55% 5/2001 1/2002
C2098931689E $100 E 1/1972 $480.80 $405.80 6.55* 5/2001 1/2002
C2098931688E $100 E 12/1971 $476.20 $401. 20 6.51% 4/2001 12/2001
L2183287007E $50 E 12/1971 $238.10 $200.60 6.51% 4/2001 12/2001
C2098931687E $100 E 11/1971 $474.96 $399.96 6.50% 3/2001 11/2001
C2098931686E $100 E 11/1971 $474.96 $399.96 6.50* 3/2001 11/2001
C2098931685E $100 E 10/1971 $474.96 $399.96 6.50% 2/2001 10/2001
C2098931684E
$100 E 10/1971 $474.96 $399.96 6.50% 2/2001 10/2001
L2183287008E $50 E 9/1971 $243.82 $206.32 6.49* 7/2001 9/2001
C2098931690E $100 E 9/1971 $487.64 $412.64 6.49% 7/2001 9/2001
L2183287009E $50 E 9/1971 $243.82 $206.32 6.49* 7/2001 9/2001
C2098931691E $100 E 8/1971 $487.64 $412.64 6.49% 6/2001 8/2001
L2183287010E $50 E 7/1971 $243.24 $205.74 6.48* 5/2001 7/2001
L2183287011E $50 E 6/1971 $244.44 $206.94 6.49% 4/2001 6/2001
L2183287012E $50 E 6/1971 $244.44 $206.94 6.49* 4/2001 6/2001
L2183287013E $50 E 10/1970 $279.38 $241. 88 6.81% 10/2000 2
L2183287014E $50 E 9/1970 $279.38 $241.88 6.81% 9/2000 2
L2183287015E $50 E 9/1970 $279.38 $241.88 6.81% 9/2000 2
Q6361540985E $25 E 9/1965 $155.56 $136.81 6.09% 6/2001 9/2005
Q6361540986E $25 E 9/1965 $155.56 $136.81 6.09* 6/2001 9/2005
Q6361540987E $25 E 8/1965 $154.76 $136.01 6.08* 5/2001 8/2005
Q6361540988E $25 E 8/1965 $154.76 $136.01 6.08% 5/2001 8/2005
Q6361540990E $25 E 7/1965 $155.49 $136.74 6.09* 4/2001 7/2005
Q6361540989E $25 E 7/1965 $155.49 $136.74 6.09* 4/2001 7/2005
Q6361540991E $25 E 6/1965 $155.49 $136.74 6.09% 3/2001 6/2005
L2183287019E $50 E 6/1965 $310.98 $273.48 6.09% 3/2001 6/2005
Q6361540993E $25 E 5/1965 $170.25 $151.50 6.36* 2/2001 5/2005
Q6361540992E $25 E 5/1965 $170.25 $151. 50 6.36* 2/2001 5/2005
Q6361540994E $25 E 4/1965 $175.36 $156.61 6.35* 7/2001 4/2005
L2183287020E $50 E 4/1965 $350.72 $313.22 6.35* 7/2001 4/2005
Q6361540995E $25 E 3/1965 $175.38 $156.63 6.35% 6/2001 3/2005
L2183287021E $50 E 3/1965 $350.76 $313.26 6.35* 6/2001 3/2005
L2183287022E $50 E 2/1965 $349.06 $311.56 6.34* 5/2001 2/2005
L2183287023E $50 E 2/1965 $349.06 $311.56 6.34* 5/2001 2/2005
L2183287025E $50 E 1/1965 $380.54 $343.04 6.59* 4/2001 1/2005
L2183287024E $50 E 1/1965 $380.54 $343.04 6.59* 4/2001 1/2005
L2183287026E $50 E 12/1964 $380.54 $343.04 6.59% 3/2001 12/2004
L2183287027E $50 E 10/1964 $389.44 $351.94 6.56* 7/2001 10/2004
L2183287028E $50 E 9/1964 $389.44 $351. 94 6.56* 6/2001 9/2004
L2183287029E $50 E 8/1964 $387.62 $350.12 6.55* 5/2001 8/2004
L2183287006E $50 E 5/1964 $381. 34 $343.84 6.50* 2/2001 5/2004
L2183287030E $50 E 4/1964 $392.78 $355.28 6.49* 7/2001 4/2004
L2183287031E $50 E 4/1964 $392.78 $355.28 6.49% 7/2001 4/2004
L2183287032E $50 E 3/1964 $392.82 $355.32 6.50% 6/2001 3/2004
L2183287033E $50 E 3/1964 $392.82 $355.32 6.50* 6/2001 3/2004
L2183287034E $50 E 2/1964 $390.94 $353.44 6.48* 5/2001 2/2004
C2098931701E $100 E 1/1964 $774.48 $699.48 6.45* 4/2001 1/2004
L2183287035E $50 E 6/1963 $390.68 $353.18 6.39% 3/2001 6/2003
1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable)
. = Possibly eligible for U.S. Savings Bond Education Benefit Program.
See footnotes on Inventory Summary page.
1
Inventory 1
Accrual Bonds (continued)
Redemption Date: 1/2001
Issue Yield Next Final
Serial Number Denom. Series Date Value Interest To Date Accrual Ma turi ty
L2183287036E $50 E 6/1963 $390.68 $353.18 6.3n 3/2001 6/2003
L2183287037E $50 E 5/1963 $387.74 $350.24 6.3n 2/2001 5/2003
L2183287038E $50 E 5/1963 $387.74 $350.24 6.3n 2/2001 5/2003
L2183287039E $50 E 4/1963 $399.36 $361.86 6.3n 7/2001 4/2003
L2183287040E $50 E 4/1963 $399.36 $361.86 6.3n 7/2001 4/2003
L2183287041E $50 E 3/1963 $399.42 $361.92 6.3n 6/2001 3/2003
L2183287042E $50 E 5/1962 $392.34 $354.84 6.23% 2/2001 5/2002
L2183287043E $50 E 4/1962 $400.18 $362.68 6.20% 7/2001 4/2002
Q6361540996E $25 E 4/1962 $200.09 $181. 34 6.20% 7/2001 4/2002
L2183287044E $50 E 4/1962 $400.18 $362.68 6.20% 7/2001 4/2002
Q6361540997E $25 E 3/1962 $200.11 $181.36 6.20% 6/2001 3/2002
C2098931702E $100 E 3/1962 $800.44 $725.44 6.20% 6/2001 3/2002
C2098931704E $100 E 2/1962 $794.64 $719.64 6.19% 5/2001 2/2002
C2098931703E $100 E 2/1962 $794.64 $719.64 6.19% 5/2001 2/2002
L2183287045E $50 E 2/1962 $397.32 $359.82 6.1n 5/2001 2/2002
L2183287046E $50 E 1/1962 $393.52 $356.02 6.16% 4/2001 1/2002
C2098931705E $100 E 1/1962 $787.04 $712.04 6.16% 4/2001 1/2002
L2183287048E $50 E 1/1962 $393.52 $356.02 6.16% 4/2001 1/2002
C2098931706E $100 E 12/1961 $787.04 $712.04 6.16% 3/2001 12/2001
Q6361540998E $25 E 12/1961 $196.76 $178.01 6.16% 3/2001 12/2001
C2098931707E $100 E 12/1961 $787.04 $712.04 6.16% 3/2001 12/2001
L2183287047E $50 E 12/1961 $393.52 $356.02 6.16% 3/2001 12/2001
C2098931709E $100 E 11/1961 $784.76 $709.76 6.15% 2/2001 11/2001
C2098931708E $100 E 11/1961 $784.76 $709.76 6.15% 2/2001 11/2001
C2098931710E $100 E 11/1961 $784.76 $709.76 6.15% 2/2001 11/2001
Q6361540999E $25 E 10/1961 $200.11 $181.36 6.12% 7/2001 10/2001
C2098931711E $100 E 10/1961 $800.44 $725.44 6.12% 7/2001 10/2001
L2183287049E $50 E 10/1961 $400.22 $362.72 6.12% 7/2001 10/2001
C2098931712E $100 E 9/1961 $800.52 $725.52 6.12% 6/2001 9/2001
C2098931713E $100 E 9/1961 $800.52 $725.52 6.12% 6/2001 9/2001
C2098931714E $100 E 9/1961 $800.52 $725.52 6.12% 6/2001 9/2001
C2098931715E $100 E 9/1961 $800.52 $725.52 6.12% 6/2001 9/2001
Q6361541001E $25 E 8/1961 $197.92 $179.17 6.10% 5/2001 8/2001
Q6361541000E $25 E 8/1961 $197.92 $179.17 6.10% 5/2001 8/2001
L2183287050E $50 E 8/1961 $395.84 $358.34 6.10% 5/2001 8/2001
L2183287051E $50 E 8/1961 $395.84 $358.34 6.10% 5/2001 8/2001
L2183287052E $50 E 7/1961 $392.08 $354.58 6. on 4/2001 7/2001
Q6361541002E $25 E 7/1961 $196.04 $177.29 6. on 4/2001 7/2001
Q6361541003E $25 E 7/1961 $196.04 $177.29 6.07% 4/2001 7/2001
Q6361541004E $25 E 7/1961 $196.04 $177.29 6. on 4/2001 7/2001
Q6361541005E $25 E 7/1961 $196.04 $177.29 6. on 4/2001 7/2001
1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable)
* = Possibly eligible for U.S. Savings Bond Education Benefit Program.
See footnotes on Inventory Summary page.
2
Inventory 1
Current Income Bonds
Redemption Date: 1/2001
Issue Deferred Interest Next Final
Serial Number Denom. Series Date Value Interest Rate Payment Maturity
M6493652HH $1,000 HH 11/1997 $1,000.00 $0.00 4.00% 5/2001 11/2017
M6493653HH $1,000 HH 11/1997 $1,000.00 $0.00 4.00% 5/2001 11/2017
M6493651HH $1,000 HH 11/1997 $1,000.00 $0.00 4.00% 5/2001 11/2017
M6493650HH $1,000 HH 11/1997 $1,000.00 $0.00 4.00% 5/2001 11/2017
M6241988HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M6241987HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M6241986HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M6241984HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M6241985HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M6241983HH $1,000 HH 1/1997 $1,000.00 $0.00 4.00% 7/2001 1/2017
M5899017HH $1,000 HH 5/1996 $1,000.00 $0.00 4.00% 5/2001 5/2016
M5899015HH $1,000 HH 5/1996 $1,000.00 $0.00 4.00% 5/2001 5/2016
M5899016HH $1,000 HH 5/1996 $1,000.00 $0.00 4.00% 5/2001 5/2016
D4169171HH $500 HH 5/1996 $500.00 $0.00 4.00% 5/2001 5/2016
M5489652HH $1,000 HH 6/1995 $1,000.00 $0.00 4.00% 6/2001 6/2015
M5489653HH $1,000 HH 6/1995 $1,000.00 $0.00 4.00% 6/2001 6/2015
M5489655HH $1,000 HH 6/1995 $1,000.00 $0.00 4.00% 6/2001 6/2015
M5489656HH $1,000 HH 6/1995 $1,000.00 $0.00 4.00% 6/2001 6/2015
M5489654HH $1,000 HH 6/1995 $1,000.00 $0.00 4.00% 6/2001 6/2015
D3 8 8 0 5 77HH $500 HH 6/1995 $500.00 $0.00 4.00% 6/2001 6/2015
D3797939HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797924HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797925HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3792926HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797927HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797928HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797929HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797937HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3797938HH $500 HH 2/1995 $500.00 $0.00 4.00% 2/2001 2/2015
D3058158HH $500 HH 2/1992 $500.00 $0.00 6.00% 2/2001 2/2012
M3440050HH $1,000 HH 1/1991 $1,000.00 $0.00 4.00% 7/2001 1/2011
1 = Not eligible for payment (purchase price) 2 = Matured (exchangeable for HH) 3 = Matured (not exchangeable)
. = Possibly eligibie for U.S. Savings Bond Education Benefit Program.
See footnotes on Inventory Summary page.
3
Inventory 1
Inventory Summary
Redemption Date: 1/2001
Number Inventory Redemption
of Bonds Value Value Interest
Accrual Bonds
Pre-January 1990 Issue Dates: 94 $38,127.90 $38,127.90 $33,909.15
January 1.990 and Later Issue Dates: 0 $0.00 $0.00 $0.00 .
94 $38,127.90 $38,127.90 $33,909.15
Current Income Bonds 31 $25,000.00 $25,000.00 $0.00
Inventory Totals 125 $63,127.90 $63,127.90 $33,909.15
Footnotes
* Proceeds from Series EE & I Savings Bonds with issue dates beginning January 1990
may be eligible for special tax exemption when used for post-secondary education.
For further information concerning the benefits and restrictions that apply,
please contact the Internal Revenue Service.
1 These bonds are not eligible for payment within 6 months of their issue date.
2 These bonds have reached final maturity and will earn no additional interest.
They can be exchanged for HE Bonds within a year of their final maturity date.
3 These bonds have reached final maturity and will earn no additional interest.
They are not eligible for exchange for Series HH Bonds since they have been held
over a year past their final maturity date.
4
''''''''''''''"*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Frick Mabel\.
FILE NUMBER
21
01
0185
Debls of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Neill Funeral Home (all inclusive fee) 6,379.75
340 I Market Street
Camp Hill, PA 17011
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representalive(s)
Street Address
City State Zip
Year{s) Commission Paid:
2. Attorney Fees - Debra K. Wallet, Esq. 3,000.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 3,500.00
Claimant William H. Frick, III
Street Address 4624 Hampden A venue
City Camp Hill State PA Zip 17011
Relationship of Claimant to Decedent son
4. Probate Fees 320.00
5. Accountant's Fees
6. Tax Return Prepare~s Fees
7. Executor's expenses - postage, certified mail, etc. 21.00
8. Attorney's expenses - postage, notary, copies, etc. 40.00
TOTAL (Also enter on line 9, Recapitulation) $ 13,260.75
(If more space is needed, insert additional sheets of the same size)
REV_1512 EX + (l-Q7)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
CQMMONWEAL1H OF PENNSYLVANIA
INHERITANCE TAX RE1URN
RESIDENT DECEDENT
ESTATE OF
Frick Mabel!.
FILE NUMBER
21 01
0185
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Beacon Medical
Medical Arts Bldg., Camp Hill, PA
80.77
2.
Holy Spirit Hospital (Medicare deductible)
21st Street, Camp Hill, PA
100.00
3.
U.S. Treasury
2000 Federal Income Tax
401.00
4.
Pinnacle Health
27.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same sjze)
608.77
"'''''''.''.'"*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Fri~k M" OAII ?1 C11 C11RS
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List Trustee(s} OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. William H. Frick, III son 100%
4624 Hampden Avenue
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
Il. 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)
.I
~fV'~'3 EX + (1-\12)
\>.'~~
1~>~:Jr
COMMONW~AlHi ;)1 ~ENNSYl\IlNI^
CfPAlll"',fNI 0' ~fVENU(
lNHUITANC! TAX 1.'11\1'510""
OEPt 28Cl601
I1AUI$8URG, PA 17128.0601
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
MUST BE COMPLF.rED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE AOORE'5S
COUNTY CODe FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
2e>O' ZA - d;<-( )
DATE OF DEATH
OECEDENT'S NAM:,1lAST; FI,=T. MIDDLE) t1/f f I
r-rlc'" /' Itl O('.-l - L 7 - c> I
ADDRESS OF DEC~Nl ~"ETI H~ /"1,oole" 4ve C;;"I H; J ) ('):1-'ATEI 17;~7
NAME AND ADDRESS OF PERSON REQUE!T1NG THE OPENING~'f SAFE DEPOSIT BOW----- -------~--~--------
INAMil. l' II I
WI Iq...
\STREET ADDll;~SS) ,11 . (CITY),
1-'1 !-fq....<fld.el1 nvC':. CC;~VO )II! I
NAME, ADDRESS A.NO RElATIONSHIP (IF ANY) TO DECEDENT, OF PERSON{S) PRESENT AT/THE BOX OPENING
a. (NAME) ft{lATlONSH'jf
1,0:1\,'0.-... Y::/','ck ~AJ /EXI:(
/
.:zr: 7 (CITYl
~ick
{3;1"1
IllP CODE}
(7DII
(STREET ADDRESSh
J<::'C
b. lNAME)
ISTATE)
(ZIP CODE)
(RELATlONSH!P)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. (NAME)
(RElATIONSHIP)
(STREET ADDRESS)
(ClTY)
(STATE)
(ZIP CODE}
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
.... ..~--_..._,_._,..._----------
iNAME\
PI) C
(STREET ADDRESS) )
2_</'-- Co<r/l~ (
, NAME OF PERSON MAKING lAST ENTRY
(,J ;11 ;o..~ H F(I'e ~ rrr-
I.fJ DATE OF CONTRACTTO RENT BOX NUMBER OF BOX
I 2- - 15" J
NAME AND ADDRESS OF PERSONIS) HAVING ACCESS TO BOX
Cl. (NAME)
f; k e
Cc.
(STATE) (ZIP CODE)
/ ,t/./t I 7~1 J
DATE AND TIME OF lAST ENTRY
/~-JJ-2.."Oc)
TITlE UNDER WHICH BOX IS REGISTERED -----
!1.be\ - t=",,'c~ Or iJ:'l'~~ 8 Fr;c~)zr
&"k
;VONS
b. (NAME)
{STREET ADDRESSI
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE) (CITY}
(STATE)
(ZIP CODE)
W NAME AND TITlE OF EMPLOYE TAKING THE INVENTORY
.6 ria.", {.,) &c..-.. J err[; Cf4
W WAS A Will IN THE BOX? DYES r 'NO If ye., o. Dale of will:
b. Namll!l and add,.", of personal representutlve, If nam.d In the win
{NAMEI
(STREET ADDRESS)
(CITY\
ISlA1E)
(ZIP CODE)
c. ~nd address of cHorney, If any
(NAMEj
(STREET ADDRESSI
(CITY)
(STATEI
(ZIP CODEI
Page ___) ____ of
SAFE DEPOSIT BOX INVENTORY
2'
----lNSTRUctioHs -- n,_ . --.,.- .u.____ . ._u,.___.___.._.__... ..___,__._..__, - "-- . .._._.,~----_.. -.-.----.--.
. "_' ..._ _.______,__u,__. ._------------. _...~------- ---
(I) Cash: Reporllolol only_
(2) Stocks: lisl in detail every common or preferred certificale, 'Warrant or other rights found in box. Stocks ore
to be designated by nome of company, certificate number, dole of cerlificote, name in which stock is registered,
and number of shores and dass of stock.
(3) Obligations af U_ S. Government: Number of items, dale of issue, face value, names in which regislered
I and type of ownership, i.e., joinHy held, payable on death, etc. .
(4) Bonds: Designate by name, amount, serial number, or other designalion, IBearer Bonds)
I (5) Bonk and Savings and loan Passbooks: Slote name of deposilor, number of book, Jost date appearing in
book, nome of bonk and branch, and balance.
(6) Jewelry, Coins, S1amps, Manuscripts, etc: list and describe os fully os possible
(7) Deeds, Mortgages.. Current Insurance Policies or other evidences of indebtedness: List and describe os
fully as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO_
I MI~? ~__egfC( 5 of -PC~:?_o1\C\ \ I) '\ IJ!-<'- O^-Iv ,
/
-
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CERTIFY UNDER PENALTY OF PHUURY THAT THE ABOVE REORD IS.. P RSON -------._.._~--~---_.
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LAST WILL AND TESTAMENT
OF
MABEL I. FRICK
I, MABEL I. FRICK, of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding, do hereby make, publish, and declare this to be
my Last Will and Testament and hereby revoke all other Wills and Codicils that I have
made, including the Will which I executed on MARCH 22, 1977.
FIRST: I give, devise, and bequeath all of my Estate, of whatever nature and
wherever situate, to my beloved son, WILLIAM H. FRICK, III, of Camp Hill,
/
Pennsylvania, so long as he shall survive me by thirty (30) days.
SECOND: Should my son fail to survive me by thirty (30) days, then 1 give, devise,
and bequeath all of my Estate, of whatever nature and wherever situate, to those of the
following individuals who survive me by thirty (30) days:
A.
Three (3) shares to my nephew, KENNETH PIETRAK, of Levittown,
Pennsylvania;
B.
One (1) share to my nephew, MICHAEL STERNER, of Rawson,
Ohio;
C.
One (1) share to my niece, ELIZABETH BURNS, of Bexley, Ohio;
D.
One (1) share to my niece, DONNA HARRISON, of Levittown,
Pennsylvania;
r
'1
--Y
t
C--,
cY
'(
E. One (1) share to my sister, RUTH STERNER, of Findlay, Ohio;
F. One (1) share to my brother, JOHN MCFADDEN, of Mifflin,
Pennsy (vania;
G. One (1) share to my nephew, RESSLER BOMGARDNER, of
Hummelstown, Pennsylvania.
Should any of these listed individuals fail to survive me by thirty (30) days, that
individual's share shall be redistributed among the individuals who have survived me by
thirty (30) days.
THIRD:
All interests of any beneficiary in the income or principal of this
Estate, while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
FOURTH:
All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged
gt:nerally against the principal of my residuary estate without reimbursement from any
person.
FIFTH:
I nominate, constitute, and appoint my son, WILLIAM H. FRICK, III,
as Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of WILLIAM H. FRICK, III, to act for whatever reason in this
capacity, then I nominate, constitute, and appoint PNC BANK, N.A., its successors and/or
its assigns, as Executor of this, my Last Will and Testament.
-
SIGNED, PUBLISHED, and DECLARED by the Testatrix, MABEL l. FRICK, as
her Last Will and Testament, in the presence of us, who at her request, in her presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
("L"'(j~li '0 \. \ \ l0!..~
\ G \._ , \,}...., L__ \ ~~.., " L.
\
"""". \\0\\,-,\, ~("\~'~ ,~"" \\O~S
~AM"'~' W~
V'tq A lI..oJ ".....; J)(..
~,,^..sj,....,. ~A Ho~-S'
I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve
him of such obligation. Any of my representatives shall be entitled to reasonable
compensation for the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ift'o day of
~,..:l
, 1996, on this, the third of three typewritlen pages. f have
also signed the left-hand margin of the first two of these pages for purposes of identification
only.
"'y) \d.>0
MABEL I. FRICK
~
J
,
':J- J'--.JJ'~
I . .
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We. Dehra K. Wallel antI L. \. r n\\v'\' \ \\, \\'-'.\he witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix sign and execute the instrument as her Last Will
and Testament; that MABEL I. FRICK executed it as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed
the Will as witnesses; and that. to the best of our knowledge, the Testatrix was at that time
18 years of age or older, of sound mind, and under no constraint or undue influence.
U2~~, \\~--
I,JJJnA. 1::. W.........-
Sworn or affinned to and subscribed to before me by ~~<o- 'L. "^-.>,'- \ '-e--\
and ~ \, ""--C<-~'-\\....... \-\0...\\ e..-\''\:-, witnesses, this II day of
1lpt<!;L
1996.
~ a, f711.4...L:c
Notary Public
I NOTARIAL SEAL
JUDITH A. MUNDIS, Nolary Public
Camp Hill BolO. Cumberland County
My Commission Expires May 10. 1999
1
,
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I. MABEL I. FRICK. Testatrix, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and that I
signed it as my free and voluntary act for the purposes therein expressed,
"-
\Y'\ f:\....\.....')
MABEL I. FRICK
,
'''-y
\ '," ~~._~~
\. \ '
Sworn or affirmed to and subscribed before me by MABEL I. FRICK, the Testatrix,
this K day of
f/ PR.. l
, 1996.
(1, d, It, (). )J7u....I~
C Notary Public
1.10TAFllAL SEAL
JUDITH ^. MUNOIS, Notary Public
Camp Hill Bero. CumberJiIIld Cc:m!y
My COnlm1ssion Expires May 10, 1999
i
."
".,. .,i
),;/
NEILL FUNERAL HOME, INC.
/
I
/
/
3501 Derry St.
Harrisburg, PA 17UI
(717) 564-2633
Stephen J. Wilsbach, ED., Supervisor
CONTRACT NY 02081
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED CASE #
Charges are only for those items that you select or that are required. If we are required by law or by a cemetery or crematory
to use any item, we ~III explain the re, ~~on in 7riti~.9 below. 'i ,..
Arrangements for: \ ,; d . (-. . . ,.f "i Date 01 Arrangement: "1,.' " I, ," ,20C: I
Date of Death: oj", I ,'I ,20C f
340 I Market St.
Camp Hill, PA 17011
(717) 737.8726
Frederick H. White, ED., Supervisor
SERVICES, FACILITIES, AUTOMOBILE, OTHER EQUIPMENT
AND OTHER SERVICES:
Itemized General Price Ust:
Basic Professional Services of
Funeral Director and Staff: $
'>:,
other Care of the Deceased:
Embalming $
Sanitary Care of the
Unembalmed Remains
Dressing, Casketing and Cosmetology
Post Autopsy Care/Post Organ Donation
Restoration Charge
Refrigeration
Care and Custody While Sheltering Remains
Other Care of the Deceased:
Total Care of the Deceased $
Directing of Services and Use
of Facilities:
Visitation $
Funeral Ceremony
Memorial Ceremony
Graveside
Special Hrs. Charge
Total Directing of Services and
, ,Use 01 Facilities I i $
Automotive, Other Equip., Other Services
and Other Charges: ,
Transfer of Remains to Funeral Home $
Hearse/Coach and Driver
Limousine/Other Passenger Vehicle and Driver
Safety/Lead Vehicle and Driver
Flower Van and Driver
Utility Vehicle and Driver
Cemetery tent and grave equipment
Additional Transportation Charges:
Total Auto, Other Equipment and Services $
And/or
Personalized Service Program Package
(a complete description of the package that you
selected Is in the General Price List provided you):
$
Other 'Services:
,':.:Immediate Burial hl.. ',' . i .'.. :, ' . $
.' Direct Cremation Without a Service $
Forwarding Remains to Another Funeral Home $
Receiving Remains trom Another Funeral Home $
$
Total Service Charges with
Personalized Packages $
Ijl1C ,~. -
/... ,\,.,
2.1q'::.
MERCHANDJ~E: . r ...
Casket. ..l... ". , \. \.""" \ '..' \.. " ("~-, (\, $
, . ,I..H. ,:,\"l:.
Outer Burial Containers:
I r" '
\ _ 1\1.. t i\\..", {I;: ,"
Cremation Urn:
Cremation Container;
Clothing as Selected;
'\1.'\'\,/ \ \. ~>, l~: (-'("'-<:.1. ,1
I
Grave Marker:
Acknowledgment Cards as Selected
Memorial Register
Memorial Folders/Prayer Cards
Combination Shipping Un/VAir Tray
", ,; t ,J.,,~ 'I
Total Merchandise
CASH ADVANCES,
Sales Tax; , ; l . ,.. "
Cemetery: \', (:\.\. \,\ y. ( "'C.. <..It
Death Certificates (No. . 11. @ $ l-
Permit Disposition/Burial Permit
Medical Examiner's Charge
Honorarium: \:' {,. (L (,'i 'I.
MusiciansNocalist:
Air or Other Transport:
Out ot Town Funeral Homes:
Newspaper Notices;
Telephone/Telegraph/Fax;
Motor Escort:
'I' -
\n".:
/..
~.
IIC
Total Cash Advances
We charge you for our services in obtaining:
$
,
''2..<. . '\ 'b..
I). t-(CC.' l'{:S
$
'I~S
'1,.-
"/( c
~\::::,,\,-
$
$
SUMMARY:
Basic Professional Services ot
Funeral Director and Staff
Other Care of the Deceased
Directing Services and Use of Facilities
Automotive, Other Equip. and Services
and/or
Personalized Service Program Package
Other Services
Total Service Charges with
Personalized Packages
Merchandise ", :
, .
Cash Advances
Total Charges
(Credits) to Account:
Payments (cash, cheok, or credit card)
""$ ~'1Q,~ ~
$ ~~1.t~I~-
,
Balance due after credits
(
(
(
(
$
)
}
}
)
(G9nerlc-6121IOO--AL, AK, AR, CO,CT, DC, FL, GA, HI,IA,ID, IL, IN, KS, KY, MA. ME, MD, MI, MN, MQ, MS,NO, NE, NH,NJ, NM, N\', OH, OK, PA, PR, RI, se,so, TN, VA, WA, WI, WV, WY)
Page 1 OF2
/6, -.;2/6 -/~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
Rece"{ ",:;,"
.. .'1 ....A~........l!
RAC';",h:;Y
"""'0{vl...",,'
of
VilHs
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-17-2001
FRICK
01-27-2001
21 01-0185
CUMBERLAND
101
"01 Ole 27 AlO :11
DEBRA K WALLET ESQ
D K WALLET LAW OFFI~ES
24 N 32ND ST Clerki,
CAMP HILL Cumt>>Alflpf"il=O" PA
'*
REY-1541 EX AFP <12-001
MABEL
I
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
3,872.00
.00
.00
720.00
152,142.77
.00
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is'4-j-EX-AFP--fi'2-=ooY-NejT"icE"-OF-YNHEiiiTANci-YA'x-APPRAisEMENi'-,--iLi-oWANCi-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FRICK MABEL I FILE NO. 21 01-0185 ACN 101 DATE 12-17-2001
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
r~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
13,260.75
608.77
(11)
(12)
(13)
(14)
(9)
(10)
.00 X
142,865.25 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
156,734.77
13 .869 1i2
142,865.25
.00
142,865.25
00 =
045 =
12 =
15 =
.00
6,428.94
.00
.00
6,428.94
(19)=
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
04-24-2001 AA496509 210.53 4,000.00
10-27-2001 CDOO0454 .00 2,228.94
TOTAL TAX CREDIT 6,439.47
BALANCE OF TAX DUE 10.53CR
INTEREST AND PEN. .00
TOTAL DUE 10.53CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A RFFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
. /6 - bZ/O. /.;:;/
~ ,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
RecOrctB(!( of DATE
Reqister ESTATE OF
~ DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
om Ole 27 AlO :14
WILLIAM H FRICK III
4624 HAMPDEN AV~. _
CAMP HILL Ci'ft< -1..7 In 1..:6:0 oiJ.:u r~
C.ltfnbc;"J'''--~ Pi\
#\f 0i id'{ H) i-~.r\
*'
REV-16D4 EX AFP 112-001
12-07-2001
FRICK
01-27-2001
21 01-0185
CUMBERLAND
200-24-0841
01115454
MABEL I
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (12-00)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 12-07-2001
ESTATE OF FRICK
MABEL
CUMBERLAND
I DATE OF DEATH 01-27-2001
COUNTY
FILE NO. 21 01-0185
ADJUSTMENT BASED ON:
S.S/D.C. NO. 200-24-0841
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK
ACN
01115454
ACCOUNT NO. 025-0123974
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 04-27-1997
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
TAX CREDITS:
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
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 LESS THAN $I. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl.
u_.. ~n, "''' nUl: A Dl:l:lINn _ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
MABEL I FRICK
FILE NUMBER
REVIEWED BY
CLAUDIA MAFFEI
ACN
2101-0185
01115454
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
Above-referenced ACN(s) are being adjusted to reflect zero tax due since they have been
reported on the probate return.
ROW
Paae 1
~ 16 c;2,)C -/c.2
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG,. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~. AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP lDl-D21
'02
JlPH 1 9
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'1 -(:QW\ITY
:'. 'Sstt7DC
ACN
04-22-2002
FRICK
01-27-2001
21 01-0185
CUMBERLAND
200-24-0841
01154519
Allount Rellitted
MABEL
I
WILLIAM H FRICK III
4624 HAMPDEN AVE
CAMP HILL
PA 17011 t..,,:,,,
Cumi)
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 ..
RE-y=is4-i-E)f-AFP--fo-i=o21------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-22-2002
ESTATE OF FRICK
MABEL
I DATE OF DEATH 01-27-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0185
TAX RETURN WAS:
S.S/D.C. NO. 200-24-0841
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01154519
FINANCIAL INSTITUTION: PSECU
ACCOUNT NO.
0200240841-54
TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 01-07-1993
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT. SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS. AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-26-2001 CDOO0559 .00 774.28
TOTAL TAX CREDIT 774.28
BALANCE OF TAX DUE 774.28CR
INTEREST AND PEN. .00
TOTAL DUE 774.28CR
. IF PAID AFTER THIS DATE. 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.
___ ________ ____ __ _....._ .._..u .._.... ......r!>TD..,..TTn...~ ...
c
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mabel 1. Frick
Date of Death: January 27, 2001
Will No.
2001-00185
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
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
c:lccount informal.ly to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and'
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
12/21/01
N
l!)
""
a....
I"Q
N
u
c::J
\J.u.u.. -It . LJM\.c.r
Signature
Debra K. Wallet, Esq.
Name (Please type or print)
. ~)
o
o
~
,.',
"'6
24 N. 32nd St., Camp Hill, PA 17011
Address
-
p
.,,' ,'.'D
;...0
cs:;:
ltl=
-.- ....,
au
(717 ) 737-1300
Tel. No.
Capacity:
Personal Representative
X
Counsel for personal
representative
(.MAH:rmf/AM3)
c
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Mabel I. Frick
Date of Death:
1/27/01
Will No.
2001-00185
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 No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: March 31. 2002
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
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informal.ly to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and.
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 10/27/01
---.bO~ 'V. .J~
Signature
Debra K. Wallet, Esq.
Name (Please type or print)
24 N. 32nd St., Camp Hill, PA 17011
Address
( 717) 737-1300
Tel. No.
Capacity:
Personal Representative
X
Counsel for personal
representative
(MAH:rmf/AM3)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0185
ACN 01148270
DATE 10-16-2001
REY-1543 EX iFP (0'-001
) :
EST. OF MABEL FRICK
S.S. NO. 200-24-0841
DATE OF DEATH 01-27-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
00 CERTIF.
** WILLIAM FRICK
4624 HAMPDEN AVE
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAYPOINT BANK has provided the DepartBent with the inforBation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of
this account. If yoU feel this inforBation is incorrect, please obtain written correction froB the financial institution, attach a copy
to this fOrB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBBonwealth
of PennsYlvania. Questions say be answered by call1~g (717~ 787-8~Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2300013468 Date 06-20-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
To insure proper credit to your account, two
(Z) copies of this notice BUSt accoBpany your
7 paYBent to the Register of Wills. Make check
'~ """~,. ", ....1..., o' ."", ....'".
(100.00 )1
: If tax paYBents are Bade within three
7,375. (3) Bonths of the decedent's date of death,
.045 yoU Bay deduct a S7. discount of the tax due.
331 91 Any inheritance tax due will becoBe delinquent
. nine (9) Bonths after the date of death.
TAXPAYER RESPONSE
Tax
x
PART
[!]
A. 0 The above inforBation and tax due is correct.
1. You Bay choose to reBit paYBent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you say check box nAn and return this notice to the Register of
Wills and an official asseSSBent will be issued by the PA Departaent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. 0 The above asset has been or will be reported and tax paid with the PennsYlvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~The above inforsation is incorrect and/or debts and deductions were paid by you.
~You BUSt cOBplete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
I!l
TAX RETURN - COMPUTATION OF
lINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
~
DATE PAID
1
DEBTS AND DEDUCTIONS CLAIMED
TAX ON JOINT/TRUST ACCOUNTS
x .r::;o90 Ulrn+.an-+l~~
'J
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax Computation)
I
$
perjury, I declare that the facts I have reported above are true, correct and
y knowledge and belief.
HOME (
WORK (
TELEPJ.lnNI=
)
)
J L~19 L
NIIMRI:'D
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. l80601
HARRISBURG, PA 171l8-0601
'*
INFORMATION NOTtCE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0185
ACN 01148272
DATE 10-16-2001
REV-1543 EX AFP lD9-00)
EST. OF MABEL FRICK
5.5. NO. 200-24-0841
DATE OF DEATH 01-27-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF.
WILLIAM FRICK
4624 HAMPDEN AVE
CAMP HILL PA nOll
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAY POINT BANK has provided the Departsent with the inforsation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If yOU feel this inforaation is incorrect, please obtain written correction froa the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the CosBonwealth
of Pennsylvania. Questions .ay be answare~ by cell ins (71?) 787-!3l?
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2300005779 Date 09-13-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
3,582.63
50.000
1,791.32
.045
80.61
TAXPAYER RESPONSE
To insure proper credit to your account, two
(l) copies of this notice Bust accospany your
paYBent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax pay.ants are sade within three
(3) sonths of the dacedent's date of death,
you aay deduct a 57. discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) Bonths aftar the date of death.
Tax
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A. r=J The abova inforsation and tax due is correct.
1. You say choose to resit paYBent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yOU say check box "A" and return this notice to the Register of
Wills and an official assessaent will be issued by the PA Departaent of Revenue.
B~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
. ~ to be filed by the decadent's representative.
C. r=J The above inforsation is incorrectand/or debts and daductions wera paid by you.
You sust cosplete PART ~ and/or PART ~ below.
PART
~
DATE PAID
-~
DEBTS AND DEDUCTIONS CLAIMED
:[f you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
perjury, I declare that the facts I have reported above are tru., correct and
my knowledge and belief.
CllHMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURI:, PA 171Z8-0601
'*
/ ~~, ~/ tJ-- /c;L
XNFORMATXON NOTICE
AND
TAXPAYER RESPONSE
0-
FILE NO. 21 01-0185
ACN 01118238
DATE 04-13-2001
REV-154S EX AFP CD9-DDI
l)
fit n
?
TYPE OF ACCOUNT
EST. OF MABEl I FRICK 0 SAVINGS
S.S. NO. 200-24-0841 0 CHECKING
DATE OF DEATH 01-27-2001 0 TRUST
COUNTY CUMBERLAND iii CERTlF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WILLIAM H FRICK
4624 HAMPDEN AVE {-,
CAMP HILL PA"ll/7011
PNC BANK has provided the Depart.ent with the infor.ation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint ownerlbeneficiary of
this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the C~onwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31000164367 Dat. 09-20-1999
Established
x
10.011.80
50.000
5,005.90
.045
225.27
TAXPAYER RESPONSE
To insure proper credit to your account, two
IZ) copies of this notice .ust acco~ny your
pa~ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Allount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax pay~nts are .ads within three
(3) .onths of the decedent.s date of death,
you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will becu.e delinquent
nine (9) .onths after the date of death.
Tax
PART
[!]
[CHECK ]
ONE
BLOCK
ONL.Y
A. 0 The above inforution and tax due is correct.
1. You AY choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you uy check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue.
B.~The above asset has been or will be reported and tax paid with the PennsYlvania Inheritance Tax return
~to be filed by the decedent.s representative.
c. 0 The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
x
If you indicate a different tax rate. please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
lINE 1. Date Established
2. Account Balance
3.. Percent Taxable
4.. Amount Subject to Tax
5.. Debts and Deductions
6. Allount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3
4
5
6
7
8
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on line 5 of Tax COllPutation)
Under penalties of perjury, I declare that the facts I
~to the best of IlY knowledge and belief.
)~_ TIT
have reported above are true, correct and
HOME (ll1. >13' -31.,15
WORK (> ~~
TFIFPHONE NUMBER TE
PHONE: (717) 737-1300
..1!aw Dffian of
DEBRA K. WALLET
24 N. 32nd STREET
CAMP HILL, PA 17011-2917
Email: Walletdeb@aol.com
FAX: (717) 761-5319
April 24, 2001
Ms. Mary C. Lewis
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Mabel I. Frick
Will No. 2001-00185
Dear Ms. Lewis:
Enc\9sed please find a Certification of Notice Under Rule 5.6(a) for filing in the above-
captioned estate.
I have also enclosed a copy to be stamped and returned in the enclosed pre-addressed
envelope.
Sincerely yours,
\-Q.u.v., 1( ."j~
Debra K. Wallet
.....,
-. J
~
o
DKW/mml
Ene.
cc: William H. Frick, III, Executor
t'-.J
,.!>~
'~;J
~;-~
""'-..1
-.-J
/~ -cJ /0 rt:;{
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~I-
C-/
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP <12-00)
WILLIAM H FRICK III
4624 HAMPDEN AVE
CAMP HILL PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
05-28-2001
FRICK
01-27-2001
21 01-0185
CUMBERLAND
200-24-0841
01115454
Allount Reali tted
MABEL
I
. .
\ "
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 ~
RlEfv=i5~8-Ex--AFFi-(i2-:o0)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-28-2001
ESTATE OF FRICK
MABEL
I DATE OF DEATH 01-27-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0185
TAX RETURN WAS:
S.S/D.C. NO. 200-24-0841
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01115454
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
025-0123974
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 04-27-1997
x
36,916.43
0.500
18,458.22
.00
18,458.22
.45
830.62
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY 10-28-2001~. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 830.62
INTEREST AND PEN. .00
TOTAL DUE 830.62
IE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IE
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU MAY BE DUE A REFUND.
___ __..____ ____ _... _I."'" r''''...._ r'ftn ......C"....b..,.......Tnu~ "
PHONE: (717) 737-1300
.Law tDffiaej. of
DEBRA K. WALLET
24 N. 32nd STREET
CAMP HILL, PA 17011-2917
Email: Walletdeb@aol.com
FAX: (717) 761-5319
~..
October 27, 2001
Mary C. Lewis, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
t.]"";
Re:
Estate of Mabel I. Frick
Will No. 2001-00185
~
Dear Ms. Lewis:
Enclosed are an original and one copy of the Pennsylvania Inheritance Tax Return, one
copy of an Inventory of the Estate, and one copy of a Status Report Under Rule 6.12 for filing
in the above-captioned estate. I have also enclosed a check in the amount of $2,228.94
representing the tax due, and a check in the amount of $25.00 representing the filing fees for
the tax return and the inventory.
I have enclosed copies of each to be stamped in and returned to me in the enclosed pre-
addressed envelope. Thank you.
Sincerely yours,
~~.... "". I.J~
Debra K. Wallet
DKW/mml
Ene.
cc: William H. Frick, III, Executor
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM :
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALLET DEBRA K
24 N 32ND ST
CAMP HILL, PA 17011
_____n_ fold
ESTATE INFORMATION: SSN: 200-24-0841
FILE NUMBER: 21-2001- 0185
DECEDENT NAME: FRICK MABEL I
DATE OF PAYMENT: 10/29/2001
POSTMARK DATE: 10/27/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 01/27/2001
NO. CD 000454
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,228.94
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: WILLIAM H FRICK III
C/O DEBRA K WALLET
CHECK#125
SEAL
INITIALS: SK
RECEIVED BY:
$2,228.94
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
v
COMMONWEALTH OF PENNSYLVANIA
PEP.~TMENT OF REVENUE
BURf..u OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG., PA 171Z8-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0185
ACN 01154519
DATE 11-16-2001
REV-1S45 EX AFP 109-001
EST. OF MABEL I FRICK
S.S. NO. 200-24-0841
DATE OF DEATH 01-27-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
lil CHECKING
o TRUST
o CERTIF.
WILLIAM H FRICK III
4624 HAMPDEN AVE
CAMP HILL PA 17011
REHIT PAVHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided tha Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction froll the financial institution, attach a COpy
to this fo"m and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (111) 181-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0200240841-54 Date 01-07-1993
Established
x
42,153.26
50.000
21. 076.63
.045
948.45
TAXPAYER RESPONSE
To insure proper credit to your account, two
(Z) copies of this notice must aCCOllpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
ill
A. 0 The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c.~~e above information is incorrect and/or debts and deductions were paid by you.
. ~~u must complete PART ~ and/or PART ~ below.
PART
1!1
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
I!l
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4" A.ount Subject to Tax
5" Debts and Deductions
6. A.ount Taxable
7. Tax Rate
a. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
a
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax c~utation)
$
Under penal ties
co~lete to the be t
l-u--m. ') ~
perjury, I declare that the facts I have reported above are true, correct and
.y knowledge and belief.
HOME (
WORK (
TFLEP ONE
)
)
NUMBER
db \6 \
~
R~ ~1-OI-OI85
Act0 OII<-S4S19
P SECU Accj~-H= O:toC):) L~. OW8'I- SLI
lsnUJV~ ~t (LQP~~cL ffil
R E..v - 1500 SCJ~J1U F.
, R~~tcL llLlQ.'63 ~-h k.$ 3zno.~:l.
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0'''''
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
WILLIAM H FRICK III
4624 HAMPDEN AVENUE
CAMP HILL, PA 17011
____un fold
ESTATE INFORMATION: SSN: 200-24-0841
FILE NUMBER: 21-2001- 0185
DECEDENT NAME: FRICK MABEL I
DATE OF PAYMENT: 11/27/2001
POSTMARK DATE: 11/26/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 01/27/2001
NO. CD 000559
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
01154519 I $774.28
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$774.28
REMARKS: WILLIAM H FRICK III
CHECK#126
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
/ ~~ ~~/ 0 .--/,}-/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
Rec'{)'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
DEBRA K WALLET
D K WALLET LAW
24 N 32ND ST
CAMP HILL
.02
FEB 13~10 :47
Allount Rellitted
ESQ
OFFICES
C;cti\
PA 1nill\bc
'*
0-'
REY-16D7 EX AFP <lZ-DDl
01-22-2002
FRICK
01-27-2001
21 01-0185
CUMBERLAND
101
MABEL
I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:i6'ifj-Ex-AFP-fi'2-:ooY------...--iNirERITANc'E--YA3f-Si'jrfEMEtiY-ifF'-AC-Couiff--.-..---------------------
ESTATE OF FRICK MABEL I FILE NO.21 01-0185 ACN 101 DATE 01-22-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYMENTS~ THE CURRENT BALANCE~ AND~ IF APPLICABLE~
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-10-2001
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
6~428.94
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-24-2001 AA496509 210.53 4~000.00
10-27-2001 CDOO0454 .00 2~228.94
01-07-2002 REFUND .00 10.53-
TOTAL TAX CREDIT 6~428.94
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
III IF PAID AFTER THIS DATE~ SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $l~
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. )
\ / b - Q'1-/0 - /.:2/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-UD7 EX AFP cDl-D2l
""" . ..' .", '\
WILLIAM H F~icKJttf'
4624 HAMPDEN AVE
CAMP HILL PA 17011
,'~ !
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-20-2002
FRICK
01-27-2001
21 01-0185
CUMBERLAND
01154519
MABEL
I
Allount Rellitted
('\
\ ,t
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=ic;oj-Ex--AFP--foY=o'2Y------...--fNiiERITANc'E--fAx--STA-fEMENf-cfF'-A'CcoUi..-f--i'i.---------------- -- ---
ESTATE OF FRICK MABEL I FILE NO. 21 01-0185 ACN 01154519 DATE 05-20-2002
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A S~"ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-22-2002
PR I NCr PAL TAX DU E : ...........................................................................................................................................................................................................................
.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-26-2001 CDOO0559 .00 714.28
05-01-2002 REFUND .00 714.28-
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
IE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. 1
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
55:
William H. Frick, III
being duly sworn according to law, deposes and says that he
is Executor of the Estate of Mabel I. Frick
late of _~amE.~)Hil~__ ------------------- I Cumberland County, Pa., deceased and that the
within is an inventory made by Wi 11 i.<ll11 H Fri l"k, TTT _, the said Expcutor
of the entire estate of said decedent, consisting of all the personal property 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
and subscribed before me,
w'
October 27
::m~ fYl. dOf0'
~ 2001
William H. Frick, III
Notarial Seal
Mary M. Loper, Notary Public
Car!'P HUt Bora, Cumberland County
My COmmIssion Expires Oct. 27, 2003
M ,PennsytvaniaAssociationotNotarles 01
4624 Hampden Av., Camp Hill, PA 17011
Addr.ss
01
Date of Death
Day
Month
Y.ar
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
>- "
CD
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III
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Inventory of the real and personal estate of
Mabel I. Frick
deceased
1. PP&L Stock (88 shares at $44/share) 3,872 00
2. Cash in possession of decedent 20 00
3. Personal property located at son's residence (china service for 8, 300 00
bed~, chest of drawers, dresser, quilt, wedding ring)
4. 1987 Pontiac Bonneville (based upon actual sale) 400 00
TOTAL
4,592
00
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Mabel I. Frick
also known as
No.
To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 200-24-0841 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 executQr
in the last will of the above decedent, dated April 18.
and codicil(s) dated NONE
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
her last family or principal residence at 4624 Hampden Av.. Ham?den Township,
Camp Hill~ PA 17011
(list street, number and muncipality)
Decendent, then 86 years of age, died January 27 fC~ 2001 ,
at Holy Spirit Hospital
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: NONE
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 140,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
en
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Cii
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William H. F iCK I
4624 Hampden Av.
r.Rmp Hill, FA 17011
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTHnOF PENNSYLVANIA 1- ss
COUNTY OF ~l1JYU~2:1?,-LA1\lp 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.
en
~.
~
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.....
;::
~
~
i I n 11"\ 11'1
No. Jll-Of- 01 i 5-
Estate of
Mabel I. Frick
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
200}
AND NOW rm.} <..0 )4-, 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 April 18, 1996
described therein be admitted to probate and filed of record as the last will of
Mabel I. Frick
and Letters Testamentary
are hereby granted to William H. Frick, III
$235.00
I '::>.00
$ 15.00
Reft1:ifteiatigQ ................ $
~ $ 0.00
TOTAL _ $ ~ryD. DD
Filed . F@; .t.\..9.) .2...cror...........
FEES
ProbN-!~ Letters, Etc. .........
S~~rtcertificates(.5) . . . . . . . . . .
Debra K. Wallet, Esq. (23989)
ATTORNEY (Sup. Ct. I.D. No.)
24 N. 32nd St., Camp Hill, FA 17011
ADDRESS
(717) 737-1300
PHONE
H105 H05 REV 9iH(,
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local .~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
if~~~~~
Local Registrar
Fee for this certificate, $2.00
p
7121151
9~ ?o/ ~)O ,
)ate
Hl05_i4JA.~ 2/e17
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPEJPRINT
IN
PERMANENT
BLACK INK
file
S.
CO\lNTYOf OERH
.C~~~,~b
L4~
UNDER 1 DAY
Holn ! MinuI..
SEP
2. ~ ~~~~ I 'C
STAlE FilE NUMBER
SOCIAL SECURITY NUMBER
2.200 - 2~
~
~
S
~
o
~
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z
PlACE OF DEATH ICt>eclt oroIy t)(\8.. '>H ,nSIluc1.oos on urMl SIde)
HOSPITAL:
Inpalient [Q/ E~.nI 0
-
-
o
w
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::>
'"
.
::;
.
CII 4
TOCOA AS A CONSEOUENCE Of)"
. JtvO
t b DUE f'IORAS' CClNSEOUOjCE On
._~I\ ~HJ>j"6:J
~ 10 (OR AS ACONSEOUENCE OF):
tcJ1!O
.
WERE AUTOPSY FINDlNGS MANNER Of DEATH
A\IIUlA8LE PfUOA 10
COMPLETtOH Of CAUSE
OF DERH?
:t3b. lie.
W\S CASE REFERRED TO :0 EXAMlNEFUCOAOHEA1 No~
...
I Approllitnat. PART I: ou. ~ condIIioM COI'*lbuIing 10 ..th. ~
:=..= noI.....-ngift.. ~c.uMg&Wn in PART I.
I
I
AcC;:d.'"
~
o
o
DATE Of INJURY
(Moon, Day. 'Mar)
TIME OF INJURY
INJURY iii WORK? DESCRIBE HOW INJURY OCCURRED
Pendlng kweshgalion
o
o
o
Voo 0 NoD
Noowol
HomJCidII
Yos 0
NoD
Sdcide
COuld noI be del.rlnl~
o
,-
a.. 21b. 21.
CERTWlER let-eell oniy onel
.CERTIFYING PHYSICIAN (PhySlCaan CefWyong cause d 4ealh \/When anoIhllf Dhvs.c.an has prQflOl.lnced aealh ana complele<:lllem 23)
To 11M bul 01 mv kno_leclge. death OCCuri'''' dull to.... cauM(l. and man....r.. ItatltCl. ,
'PRONOUNCING AND CERTifYING PHY$lClAH (Phys.c;;1iIfl bolh O)f:)(lQl.joc>OQ lJedth and cerlllV'f"lg to CdlUsa at oealtll
To the ~t ot mv know'-dg., death OCCUfNd al IN dmtI, date, and piKe, and due to 1M caUM(I) and manner... .tated
.:~~~:::::'::;.c:.:~:~or InvesUg.tion, in my opinion, de.lh occurred allhe Ume, dale, and place. and due 10 the C8U..(.).nd
M.nn.r..sl.t................ ... .... ................ .. ........ ....... ...
31..
REGIST
1,;2.11 ~ ll;){.
34.
() J/JJ(/R,v _'10 1 ,;2 00 I
3
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~
LAST WILL AND TESTAMENT
OF
MABEL I. FRICK
I, MABEL 1. FRICK, of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding, do hereby make, publish, and declare this to be
my Last Will and Testament and hereby revoke all other Wills and Codicils that I have
made, including the Will which I executed on MARCH 22, 1977.
FIRST: I give, devise, and bequeath all of my Estate, of whatever nature and
wherever situate, to my beloved son, WILLIAM H. FRICK, III, of Camp Hill,
/
Pennsylvania, so long as he shall survive me by thirty (30) days.
SECOND: Should my son fail to survive me by thirty (30) days, then I give, devise,
and bequeath all of my Estate, of whatever nature and wherever situate, to those of the
following individuals who survive me by thirty (30) days:
A.
Three (3) shares to my nephew, KENNETH PIETRAK, of Levittown,
Pennsylvania;
B.
One (1) share to my nephew, MICHAEL STERNER, of Rawson,
Ohio;
c.
One (1) share to my niece, ELIZABETH BURNS, of Bexley, Ohio;
D.
One (1) share to my niece, DONNA HARRISON, of Levittown,
Pennsylvania;
('
\
1
.-/
~
~
(-;
LV
;
L
\
I
E. One (1) share to my sister, RUTH STERNER, of Findlay, Ohio;
F. One (1) share to my brother, JOHN MCFADDEN, of Mifflin,
Pennsylvania;
G. One (1) share to my nephew, RESSLER BOMGARDNER, of
Hummelstown, Pennsylvania.
Should any of these listed individuals fail to survive me by thirty (30) days, that
individual's share shall be redistributed among the individuals who have survived me by
thirty (30) d~ys.
THIRD:
All interests of any beneficiary in the income or principal of this
Estate, while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
FOURTH:
All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged
gt;I1erally against the principal of my residuary estate without reimbursement from any
person.
FIFTH:
I nominate, constitute, and appoint my son, WILLIAM H. FRICK, III,
as Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of WILLIAM H. FRICK, III, to act for whatever reason in this
capacity, then I nominate, constitute, and appoint PNC BANK, N.A., its successors and/or
its assigns, as Executor of this, my Last Will and Testament.
SIGNED, PUBLISHED, and DECLARED by the Testatrix, MABEL I. FRICK, as
her Last Will and Testament, in the presence of us, who at her request, in her presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
~r \-\~
\0 \._,~~ .~.'\JL
\
~\, \\0\\'..\ ~r\\('~ ,~\~ \'O\Ji~
...b AMl4.. -il, W~
Yle; A Ii t.~ ".'e..,)..k.
~,,^c..'''''~, ~A 11o.rs-
I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve
him of such obligation. Any of my representatives shall be entitled to reasonable
compensation for the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ii''''' day of
~r:l
, 1996, on this, the third of three typewritten pages. I have
also signed the left-hand margin of the first two of these pages for purposes of identification
only.
~~0
MABEL I. FRICK
J
':J- ~
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We, Debra K. Wallet and G:\\ z:-.~--\~^\ \\cA- \ '""--r\;~he witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix sign and execute the instrument as her Last Will
and Testament; that MABEL I. FRICK executed it as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed
the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that time
18 years of age or older, of sound mind, and under no constraint or undue influence.
~\\~
\J A)l\A. ~. W...........
Sworn or affirmed to and subscribed to before me by ~~-O- \L. \.,.)0--\ '-~::\-
and ~ \\ ~,-~,*'v, ~ \ \ e.-'"\"\- , witnesses, this II day of
fJpte,'L 1996.
Ma,m~
Notary Public
NOTARIAl SEAL
JUDITH A. MUNDiS, Notary Public
Camp Hill BOlO. Cumberland County
My Commission fJcpires May 10, 1999
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, MABEL I. FRICK, Testatrix, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and that I
signed it as my free and voluntary act for the purposes therein expressed.
,
\-l.y) ~ ~\ ~j-~_~LA~
MABEL I. FRICK
Sworn or affirmed to and subscribed before me by MABEL I. FRICK, the Testatrix,
this ~ day of
ftr~; L
, 1996.
C1.l~ a. mLl~~
tJ Notary Public
NOTARIAL SEAL
JUDITH A.. MUNDIS, Notary Public
Camj) Hi>> Bcfo. Cumberland Coooty
My Commission Expires May 10, 1999
IN THE ORPHANS' COURT DIVISION
OF THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF MABEL I. FRICK, DECEASED
No. 2001-00185
APPROVAL OF ACCOUNT , WAIVER, RECEIPT,
RELEASE AND AGREEMENT OF INDEMNITY
The circumstances leading up to the execution of this instrument are as follows:
1. Mabel I. Frick died on January 27,2001, leaving a Will dated April 18, 1996,
naming William H. Frick, III as Executor.
2. Letters Testamentary were granted to William H. Frick, III by the Register of
Wills of Cumberland County on February 16, 2001.
3. It is the desire of the Frick heir that the Estate be distributed without the
formality of a court proceeding in order to save the expense, publicity, and delay incident to
such court proceeding, and the Executor is willing to make such distribution upon the
execution of this instrument.
4. An account of the administration of the Estate of Mabel I. Frick has been prepared
by the Executor. A copy is attached hereto as Exhibit A.
5. In consideration of the foregoing, the undersigned hereby:
A. Represents and warrants that he has read and understands this instrument
and that the facts set forth above are true and correct to the best of his knowledge, information
and belief;
B. Declares that he has examined the attached account of the administration of
the Estate and the attached schedule of distribution; that he finds them to be true and correct in
all particulars; that he accepts and approves them as if they had been duly filed, audited,
adjudicated and confirmed absolutely by the Orphans I Court Division of the Court of Common
Pleas of Cumberland County, and as if the amounts shown as distributable had been duly
awarded to him;
C. Waives the filing and auditing of the account of the administration of the
Estate in the Orphans I Court Division of the Court of Common Pleas of Cumberland County,
and agrees that the Orphans I Court Division of the Court of Common Pleas of Cumberland
County may by its decree confirm the account and approve the schedule of distribution;
D. Requests the Executor to make distribution of the principal and income in
accordance with the schedule of distribution, and effective upon delivery to him of the amounts
shown as respectively distributable, acknowledges receipt of such property;
E. Agrees to refund to the Executor any amount which may at any time be
determined to have been an erroneous distribution to him, regardless of the cause of such
erroneous distribution, even if attributable to negligence, and agrees that any period for the
limitation of actions for the collection of any erroneous distribution shall commence only at
such time as the Executor shall have obtained actual knowledge of such erroneous distribution
and that in no event shall the period for collection of any erroneous distribution be less than
two years after the actual discovery thereof;
F. Absolutely and irrevocably remises, releases, quitclaims and forever
discharges William H. Frick, III, individually and in his capacity as Executor, from any and all
-2-
actions, suits, payments, accounts, reckonings, liabilities, claims and demands relating in any
way to the administration of the Mabel I. Frick Estate;
G. Agrees to indemnify and hold harmless, to the extent of the funds received
by him hereunder, William H. Frick, III, individually and in his capacity as Executor, from
and against any and all claims, loss, liability or damage (including legal fees and costs in
connection therewith) which he may suffer or to which he may be subjected by reason of his
administration of the Estate, the settlement of his Executor's account and the distribution of the
assets of the Estate without having the formal approval of the Orphans' Court Division of the
Court of Common Pleas of Cumberland County, including, but not limited to, any liability for
any federal estate tax, Pennsylvania inheritance tax or any other death taxes, together with
interest and costs incidental thereto, relating in any way to the Estate; and
H. Declares it to be his intention that this instrument, consisting of three pages,
shall be governed by the law of Pennsylvania and shall be legally binding as an agreement
under seal upon him and upon his heirs, executors, administrators and assigns.
Executed on '1:x.(.c.... b tor :l ,
,2001.
u ~ .)~ TIT (Seal)
WILLIAM H~K, II .
-3-
BEFORE THE REGISTER OF WILLS,
CUMBERLAND COUNTY, PENNSYLVANIA
No. 2001-00185
FIRST AND FINAL ACCOUNT
OF WILLIAM H. FRICK, III, Executor
For
ESTATE OF MABEL I. FRICK, Deceased
Date of Death: January 27,2001
Date of Executor's Appointment: February 16, 2001
Accounting for the Period: February 16 to December 21,2001
PURPOSE OF ACCOUNT: William H. Frick, III, Executor, offers this Account to
acquaint interested parties with the transactions that have occurred during his administration.
The Account also indicates the proposed distribution of the Estate.
It is important that the Account be carefully examined. Requests for additional
information or questions or objections can be discussed with:
Debra K. Wallet, Esquire
24 N. 32nd Street
Camp Hill, PA 17011
I.D. #23989
(717) 737-1300
Exhibit A
Proposed Distribution
to Beneficiaries
PRINCIPAL
Receipts
Less Disbursements
Federal and State Taxes
Principal Balance on Hand
Balance Before Distributions
Distributions to Beneficiaries
Combined Balance on Hand
SUMMARY OF ACCOUNT
Page
Current
Value
Fiduciary
Acquisition
Value
0.00
2
$4,592.00
2
$4,592.00
4,592.00
0.00
0.00
0.00
0.00
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory:
(Value as of Date of Death)
Cash and Bank Deposits:
Cash in possession of Decedent
$20.00
Tangible Personal Property:
1987 Pontiac Bonneville
Personal Property located at
son I s residence
$400.00
300.00
$700.00
Stocks:
PP&L Stock
88 shares at $44/share
$3,872.00
TOTAL ASSETS LISTED IN INVENTORY:
DISBURSEMENTS OF PRINCIPAL
Federal and State Taxes:
P A Inheritance Tax (partial payment)
$4,592.00
2
$4,592.00
BEFORE THE REGISTER OF WILLS,
CUMBERLAND COUNTY, PENNSYL VANIA
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mabel!. Frick
Date of Death: January 27,2001
Will No. 2001-00185
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
April 24, 2001.
Name
Address
William H. Frick, III
4624 Hampden A venue
Camp Hill, PA 17011
Michael Sterner
8281 TR 25
Rawson,OH 45881
Elizabeth Burns
6638 W. Saddlehorn Road
Glendale, AZ 85310
Ruth Sterner
304 151 Street
Findlay, OH 45840
Ressler Bomgardner
19 Kokomo Avenue
Hummelstown, P A 17036
Donna Harrison
101 Village Lane
Levittown, P A 19054
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None.
Additional individuals named in will have pre-deceased.
Date: April 24, 200 1
\.O~~.W~
Debra K. Wallet, Esquire
24 N. 32nd Street
Camp Hill, PA 17011
(717) 737-1300
Counsel for personal representative
~t<t':<
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-<l601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
'*
No.AA 496509 REV-1162 EX (11-96)
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
WALLET DE8RA K
!4 N 32ND 9T
101
.4,000.00
CAMP HILL. PA 17011
I,
~-- FOLD HERE
FOlD HERE -
ESTATE INFORMATION:
FILE NUMBER
&! 1-2001-0 letS
B9N 200-24-0841
(FIRST)
(MI)
NAME OF DECEDENT (LAST)
FRICK MABEL I
DATE OF PAYMENT
4/24/2001
POSTMARK DATE
0/00/??oo
COUNTY
CUMBERl.AND
TOTAL AMOUNT PAID
.4,000.00
SK
RECEIVED BY <..~ e ~~~
MARY C. LEW .I J/ ~. ,'-
CHECK. 123 REGISTER 0 ILLS~
SEAL d~
REGISTER OF WILLS r . 7 - ~
--.----'-.........---'______._._._.____--'~.___'.______.J____........__ _ '.. /.
-"-'" - -- - - - - -,- - - -'- ----
DATE OF DEATH
1/27 /BOO 1
REMARKS
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