HomeMy WebLinkAbout01-0186
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
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FILE NUMBER
21-01
-- --
COUNTY COOE YEAR
o 0 186
-----
NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
WISE, LILLIAN H.
DATE OF DEATH (MM'()[)'YEAR) DATE OF BIRTH (MM-DD-YEAR)
1-29-2001 9-12-1910
(IF AFPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
SOCIAL SECURITY NUMBER
138 - 03
-1009
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return
o 4. Umned Eslate
KI.. 6. Decedent Died Testate (AltachoopyofWiII)
o 9. LitigaUon Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12.82)
o 7. Decedent Maintained a Uving Trust {Attach <:opy ofTiW}
o 10. Spousal Poverty Credit (dale of dl!Nllh between 12-31-91 and 1.1-95)
o 3. Remainder Retum(daleoldealhpriorIo12'13-a2j
o 5. Federal--E&tate--Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) _ "" 01
NAME
PAUL BRADFORD ORR
FIRM NAME (''''''_'
L 0 F CE OF PAUL B ORR
TELEPHONE NUMBER ( )
717 258-8558
COMPLETE MAILING ADDRESS
LAW OFFICES OF PAUL BRADFORD ORR
50 East High Street
Carlisle, PA 17013
(1) 0
(2) 57,595.14
(3) 0
(4) 0
(5) 15.995.22
(6) 5,579.46
(7) 0
- OfFiCIAL USE ONLY
1. Real Estate (Schedule A)
2. Stoc~s and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Reoelvable (Schedule D)
.....
5. Cash, Ban~'Deposlts & Mlsoellaneous Personal Property
(Schedule E)
6. Jointiy OWned Property (SchedUle F)
o Separate Billing Requested
7. inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
B. Totat Gross Assete (total Lines 1.7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Oeoe<1ent, Mortgage Liabilities, & Uens (Schedule I)
11. Total Deduollons (Iotal Lines 9 & 10)
12. Net Value 01 Eetate (Line 8 minus Line 11)
13. Chantable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
-
(8) 16,257.44
(9) 9 ,010.38
(10) 7.247.06 ':
(11) 16 7..~7.44
(12) fo? 01 ? 1A
.
(13) 5,000.00
(14) 57,912.38
14. Ne' Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of Line 14 taxable althe spousal tax
rate, or ~ansfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x .045 (16) 2,606.06
x .12 (17)
x .15 (IB)
(19) 2.606 06
16. Amount of Line 14 taxable at lineal rate
57.912.38
17. Amount 01 Une 14 taxable al sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
.......
6ft
;t;Nswe .
'QO STI It
Decedent's Complete Address:
ST~~ />.OO~SS Messiah Village
100 Mt. Allen Drive
CITYM h . b I STATE PA I ZIP 17055
ec anl.CS urg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 1 g)
2. Credits/Payments .
A. Spousal Poverty Credit
B. Prior Payments 3 . 400 . 00
C. Discount
(1) 2.606.06
Tolal Credits (A+ B + C) (2) 3.400.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( 0 + E ) (3) 0
4. If Une 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) 793 . 94
5. If Line 1 + Line 3 is grealer than Une 2, enler the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
~1iIl!1!l ~~ ~~~W~~i'G_~!lII!I:iiWlW~ "--iIIl'_M_\1!mOOl1!;!~""'B -~~ ~w ... lif\'lf~~%h\jTh%1tWk'1'ih"
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. ~.id ~=~tu:: :~~:f:::property transferred;.........................................................:............................. 0 INO_
b. relain the right to designate who shall use the property transferred or ils income; ............................................ 0 -
C'.3tain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~::~e:::na:~~:~:~;~:ra:~~;~;~..~~~~..~~;;h.~;~k.;~~~;~;.~~;;,~~.~;.~;~.~;.~~;.~.~;~.?:::::::::::::: B )f
4. ~~~~n~:e::e~~:~ I~:~~~:~o~~ti~~~~t~~~.u.~~,..~n.~~~~:.~r.~t~~~.~.~~~~~~~I~.~~~~~.~..~~i~h....................... Co ~
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, induding accompanying schedules and statements. and to the besl of my knowledge and belief, It is true, correct
and complete.
Declaration of prepsrei' other than the pel1OO8l representative is based on all infonnation of which preparer has any kllOWledge.
SIGNATUR RSOIII RESPONSIBLE FOR FILING R TURN DATE
ADORE
ADDRESS
50 E. Ji/f5-R
Sf,
foR
CARUSGt:
E)'\~TE-
pA },OJ3
~ '" ~ii!lRIIIItl!1lI ltOOliltt:mlltt!ii#lOOlOOill!~ll!@lmwa_e-"'u.ID""""!iII:1_!.\!tI1illffiIDiliiilil~~IliIl- ~!illii;lt\ ~='w~~llfIPII
For dates of death on or after July 1, 1994 and before January 1,1995, the lax rate imposed on the net value oftransferll to or for the use of the sUlViving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on 01 after January 1, 1995, the tax rate imposed on the net value of transferll to or for the use of the sUlViving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exempt II transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the sUlViving spouse is the only benefLciary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transferll from a deceased child twenty-one yearll of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J. c~
The tax rate imposed on the net value of transferll to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J.
"
The tax rale imposed on the net value of transferll to or for the use of the decedent's Siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under S~on 9102, as an
individual who has at least one parent in common with Ihe decedent, whether by blood or adoplion.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
.
No.AA 478215 REV-1162 EX (11-96)
RECEIVED FROM:
I
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
ORR PAUL BRADFORD
50 E HIGH STREET
101
$3,400.00
CARLISLE, PA 17013
FOLD HERE FOLD HERE --.
ESTATE INFORMATION:
FILE NUMBER
21-2001-0186 SSN 138-03-1009
NAME OF DECEDENT (LAST)
WISE LILLIAN H
(FIRST)
(MI)
DATE OF PAYMENT
3/29/2001
POSTMARK DATE
0/00/0000
COUNTY
CUMBERLAND
$3,400.00
TOTAL AMOUNT PAID
TAXPAYER
SK
,e",,>o ~ ~ (! ;;Y;~~jU<-'
MARY . L S _/))f " 1lU.-t.
REGISTER WILL~rJr t1
DATE OF DEATH
1/29/2001
REMARKS
C/O PAUL ORR
CHECKl* 1382
SEAL
R<V_~~"'.(..n(':.
COMMONWEALTH OF P<NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WISE, LILLIAN H.
SCHEDULE B
STOCKS & BONDS
FILE NUMBER 21-0 1 00186
AU proptr\y jointty-owned with right of lurvivol'lhip mUlt be disclosed on Schedule F.
ITEM
NUMBER
1,
DESCRIPTION
VALUE AT DATE
OF DEATH
$27,337.50
1125 Shares of Northwest Natural Gas
2. 200 Shares of Nuveen Select Tax Free Income Portfok~~ $2,850.00
3.
480 Shares of Public Service Enterprise Group
4.
235 Shares of South Jersey Industries
$20,467.20
$6,940.44
-
->
c_~
, -
--
TOTAL (Also enteron Ilne2,Recapltulation) $57,5'1'':; .14
(If more space Is needed, Insert additional sheets of the same size)
,
LF.GG
MASON
Legg Mason Wood Walker, Incorporated
214 Senate Avenue, 7th Floor, P.O, Box 8853, Camp Hill, PA 17(101.8853
777.737.6500 800.433.8186 Fax: 777.737.0800
Member New York Stock Exchange, IncMember SIPC
March 8, 2001
Judith W. Weikert
410 Pawnee Drive
Mechanicsburg, P A 17050-2546
Dear Ms-Weikert:
The following is a list of assets in the Lillian H. Wise account with valuations as of,
January 29, 2001, her date of death:
Shares
100
1125
200
480
234
5518
Security Description
Great American Recreation $10 Pfd
Northwest Natural Gas
Nuveen Select Tax Free Income Portfolio
Public Service Enterprise Group
South Jersey Industries
Great American Recreation Due 5/31/2006
Price as of
29-Jan-Ol
$0.00
$24.30
$14.25
$42.64
$29.66
$0.00
If you require additional information, please feel free to contact me.
Sincerely,
--.............,..
aT~omas
Financial Advisor
c::
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~
JVT/jl
Total
Value
$0.00
$27,337.50
$2,850.00
$20,467.20
$6,940.44
$0.00
3~~~/tj TiM-
'J',.
REV'~EX"'''"'l,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF WISE, LILLIAN H.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER 21-01 00186
Include \lie proceeds of litigation and \I1e date the proceeds were received by the eslale. All property jolntiy-owned with the right of survivorship must be dlscloled on Schedule F,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Delaware Decatur EqUity Income
Account Number 5011794261
Regular Investment Account
Fund
$15,297.37
2.
Summit Bank Passbook SaVings
Account Number 0653007502
$142.85
3.
Zenith 21" Color TV (Eight years old)
$50.00
0_1.-
$25.00
$480.00
4.
Used Recliner
5.
Personal Furniture: Messiah Village Sheltered Case
Unit (Provided by Deceased)
-
......
0_
TOTAL {Also enteron iine 5, Recapitulation} $15,99.,,5.22
(If more space is needed, insert additional sheets of the same size)
1II,II"I",I.I"I,lililltt,""I,II,II"II,I,I""II".,111
JOHN WRISLEY JR
L.O. THOMAS & COMPANY
2106 NEW ROAD, SUITE A-6
P.O. BOX 293
LINWOOD NJ 08221-0293
DELAWARE~
INVESTMENTS
Price
Date
1/29/2001
Transaction
BALANCE FORWARD
REDEMPTI ON
~r _~-L-
l/~ ~,.
IJ,
Transaction
Summary
Certificates
Held By Yon
0.000
DELAWARE DECAlUR EQUITY INCOME FUND A
Transaction Conlinnation
Statement Date: 01/29/2001
01131
Del.phone
Fund #
001
Account Type
REGULAR INVESTMENT ACCOUNT
Account'"
5011794261
LILLIAN H WISE
410 PAWNEE DR
MECHANICSBURG PA 17050-2546
Deakr
0000302
Bnmch
000
AE-1D
630
l
.
.
.
Dollar
AmountS
8,000.00
S.S./TAX I.D. 138-03-1009
Share Shares Plus (+)
Price S or Minus (-)
17 .61 454.2B7-
Total Shares
Owned
1,322.962
868.675
~.5 5 3,fP
- ,-
_11/5/;' 131,
Unissued Shares
Held By Us
868.675
Total Shares
Owned
868.675
Dividends
YID
SO.OO
Capital Gains
YID
SO.OO
Total
Distributions
SO.OO
IN TODAY'S VOLATILE MARKET ENVIRONMENT, IT'S IMPORTANT TO DIVERSIFY YOUR PORTFOLIO
AND KEEP A LONG-TERM PERSPECTIVE. FOR INFORMATION OR A PROSPECTUS ON ANY FUND IN THE
DELAWARE INVESTMENTS FAMILY OF FUNDS CONTACT YOUR BROKER OR CALL US AT 1.800.523.191B
5cliCCtul Distribution Options: Dirldcnds: REINVEST C~p!!:ll G..!!'..: REINVEST
Additional Invesnnent/ Address Change
(USE ONLY FOR DElAWARE DECATIJR EQUITY INCOME FUND A)
LI LLIAN H WISE
410 PAWNEE OR
MECHANICSBURG PA 17050-2546
o HasYourAddress-Changed?
Please complete the
reverse side and return to
Delaware Investments.
ACCOUNT NUMBER
001 50117942616
I ~I~I ~I~ 111111 ~1I11111 ~II
DO -64110* 1386 463176 424
DATE
f
f
DOLLARS CENTS
MAKE CHECK PAYABLE TO:
DELAWARE DECATUR EQUITY INCOME FUND A
1
2
3
4
.
.
i
I
DELAWARE INVESTMENTS
P.O. BOX 7369
PHI LA. PA 19101-7369
1",111,1","1111"""11',,.1,,11,,11,,1,1"1,11,'
2
Please do nol send cash.
Minimum Investment $100.00
FINANOAL ADVISER COPY
516508
Form L.-8
9-90
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF TAXATION
TRANSFER INHERITANCE TAX BRANCH
eN 249
TRENTON, NEW JERSEY 08646-0249
(609) 292-5035
.....AFFlDAVIT AND SELf-EXECl1TING WAIVER
(Bank Accounts,.Stocka and Bonds)'
DECEDENT'SNAME:~ _,\\ \'t\V\ \\ \~llt?' !)ocialsecyrityNUmber:-1')ct b3lliO 9
. ~}.\ ~~\'('~\\\)
DATE OF DEATH: COUNTY: ...-- Y.fl\l\?~~i\~ll\: OTESTATE OINTESTATE
To be used ONLY when the assets listed on the reverse side are passing to a member of one of the following groups,
either by contract O.e, survivorship), the decedent's will or thl!' intestate laws of this state.
1. Parent and lor grandparent, where the decedent's date of death Is on or after July 1, 1988.
2. Child, step-child, legally adopted child, or any Issue of any child or legally adopted child, where;
3. Survtvlng spouse where the decedent's date of death Is on or after January 1 , 1985, AND:
The beneficiary succeeds to the assets by contract (e.g. survivorship) or the property Is specifically bequeathed to
said beneficiary, or the property was not specifically bequeathed by ALL heirs at law by Intestacy or ALL resIduary ben8llcla-
ries under the will are described In number 1thru 3 above.
, "
If there are AI-f( assets passing to AI-f( beneficiary other than a member of the class listed above, be advised that a
complete Transfer Inheritance Tax Return must be filed in the normal manner, listing air assets In the estate, Including any which
were acquired under an affidavit or waiver, and all beneficiaries.
I hereby request the release of the property listed on the reverse of this page.
I have IIsteg.tbll beneficiaries on the reverse of this page.
Sate of New Je
County of
being duly sworn, deposes and says t~ the foregoing
belief. ..' ~~tM);k. ~ ..,
~':-~A;::;::T-
7i9:!:!!!:. ,;T' .' / 7~~~
" ,. .!fl$filf4Xi.jl~'/""k\'iJi!1N''''C/OJI,7/,,- . I.'.. ."i^ ZIp I
~'....I~
thoro~~~!"~L~a~:c:~~~~~~1seio~~:f~~~~:~:=~~~:r.~~;:s~=
must be filed by the releasing institution within five business days of execution with the DMslon ofTaxatlon, Transfer Inheritance
Tax Branch, 50 Barrack Street, CD-249, Trenton, NJ 08846-0249. The affiant should be given a copy.
'0
Subscribed and sworn befor
9\C,\
Of
\.,\
By
- See Reverse 51 . e. for Schedules and Instructions-
THI~ I'nRM MAV RF RFPRnm Ir.Fn
GS 156 F {REV. 5197) CUST. SERV.
~h11('\(H"\" f'l:.d/l-fQ~l
\<,<~ ,..,.t Vlllue At
< <c' << < Dete of Deeth
Thle Column For
Division Use
If the decedent died testate, a complete copy of the last will and testament, separate writings and all codicils
thereto must be submitted. -~
In the case of bank accounts be sure to list the name of the institution, tille of the account and BALANCE as
of the DATE OF DEATH.
In the case of stocks be sure to include the name of the company, manner of registration and the number of
shares. Bonds should include the name of the issuer, manner of registration, date and face value.
A separate affidavit is required for each inslilution releasing assets.
RIDERS MAY BE ATTACHED WHERE NECESSARY
36110004[L4/1/93j
REV"~EX.".n").
COMMONWEAlTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF E
WIS , LILLIAN H.
SCHEDULE F
JOINTL Y.OWNED PROPERTY
FILE NUMBER
21-01 00186
If an IU.t Wh mad, Joint within on. year of the decedent I date of death, it mUlt be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Judith W. Weikert
410 Pawnee Drive
Mechanicsburg, PA 17050
Daughter
B.
c.
c_ _
JOINTL Y.QWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financiallnalilutkln .m bank acco\iI'o\ number 01' sinllar identifying number. DATE OF DEATH DECOS VALUE OF
NUMBER TENANT JOINT Attach deed Jot jointly-hekl real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. CAP Account $11,158.92 50 $5,579.46
CAP Account Number 9620077812 -
.--" Brokerage Account Number 87404695
c_ -
.
TOTAL (AlSO enter on line 6, Recap~ulation) $ 5, 57g...,,46
(If more space is needed, insert additional sheets of the same size)
CAP^CCOU~T
CAP First Statement 1/0112001 thru 1/3112001
48,307
PA
R
z
8'20017812
010562 1 3DG 65 ***AUTO**3-DIGIT 170
1."111".111,."1,1,11"."1,1,1,1,.1,.1,11,,,,,1111,,,1,1,,1
LILLIAN H WISE
JUDITH W WEIKERT
~ 410 PAWNEE DR
III MECHANICSBURG PA 17050-2546
-
..
-
..
iiiiiiI For Investment guidance or service
- Call your Flnsnclal Advisor,
iiilii WIWAM CASHMAN, at (888) 243-1422
-
-
_ CAP Account number: 96200n812
;; Brokerage Account number: 87404695
-
- Account Overview
For Client Services call (888) 213-1353
Or write to: CAP Department
One Hfsf Union Center
Charlotte NC 28288-1164
Asset & Earnings Summary
Type of Asset
Evergreen Money Market
Brokerage:
Cash
Money Market Mutual Funds
Stocks and Options
Bonds
Mutual Funds
Brokerage Subtotal
Annuities
Retirement
Market
value 12/29
MarKet
value 1/31
Percent
of assets
Earnings
this month
Earnings
this year
10,212.33
11,158.92
100.0%
40.43
40.43
Total
$ 10,212.33
$ 11,158.92
100.0%
$ 40.43
$ 40.43
I
~
Iovestments in Stoc),
I ARE NOT I(
Brokerage services are';'
I'i.
separate DOn-bank affi1'.
NYSE and Slpc. r
'Ij[bt J1! k
, ':~;~l. fJ~<!<^'
,!tt:i~;;f:k'\ i 1__
>;"W;r~,::'::i ~',i
-.-,,-.,<
,k::,~-'i~'
'I""
~NTEED I MAY WSE VALUE I
"ed broker-dealer, member of !be NASD, and
are carried by First Clearing Corporation, member
:k:~:~
""
/;~'1(,
~\ ':"?,
~--~ .,,-- I'll' ,
&'~ annUl~ are o&~l:~"',' .. ;',:;.;',l*'",'
UnIOn Secunties and;';"".,,, > ".1/';''''''
k'<......_~.""'lo>.-.'. "",'l~,'
oration. Variable annuities are offered through First
,,1
010562033112323003 NYNY NNNNNNNN 000001
"",.
page 1 of 3
CAP^CCOU~T
CAP First Statement 1/0112001 thru 1/3112001
48,309
3
PA
R
z
8'20077812
Account number:
Brokerage Account number:
96200n812
87404695
-
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News from First Union:
Rate Summary as of 1/3112001
Average Rate This Statement Period
'7 Day Annualized Yield
5.07%
PLAN FOR YOUR RETIREMENT WITH A FIRST UNION
IRA. MAKE YOUR YEAR 2000 CONTRI8UTION BY
APRIL 16TH, AND YOU CAN EVEN MAKE YOUR YEAR
2001 CONTRIBUTION NOWI YOUR BROKERAGE IRA
BALANCE CAN EVEN BE USED ~EET THE CAP
MINIMUM BALANCE REQUIREMENT AND WILL APPEAR
ON YOUR CAP ACCOUNT STATEMENT. TO ESTABLISH A
FIRST UNION IRA, CONTACT A RETIREMENT
SPECIALIST AT 1-888-840-2517.
Evergreen Treasury'
Evergreen Money Market'
4.93%
5.04%
Realized Gain/Loss - YTD
Unrealized Gain/Loss
. Refer to relevant section if applicable
$ 0.00
$0.00
AccountFee~Expenses
This Period
Account Maintenance Fees 0.00
This year
0.00
Galn/Loss Summary .
Account Summary
This month
$ 10,212.33 +
4,286.40 +
3,380.24 -
0.00
0.00
40.43 +
$11,158.92 +
SWEEP OPENING BALANCE
DEPOSITS
CHECKS
OTHER WITHDRAWALS
SERVICE FEES
SWEEP DIVIDENDS
Sweep Closing Balance
Daily Activity
Deposits
Date
Amount
Description
3,000.00 DEPOSIT - CHECKING (1 ITEM)
286 40 DEPOSIT - CHECKING
l,ooO.O~ DEPOSIT - CHECKING (1 ITEM)
$ 4,286.40 tMt rL<~F~"t- -.{) CAP
1/11
1/19
C.1l29
Total
Checks
Number
Amount
Dale
Number
Amount
Date
~
~
1008
3.380.24
1/04
Total
$ 3,380.24
010562 033112323003 NY'NY NNNNNNNN 000002
tff/1<
page 3 of 3
First National
. .
Bank of Absecon
SIAIElVIENf
106 New Jersey Avenue
P.O. Box 324
Absecon, NJ 08201-0324
609-641-6300
0820 B25
LILL:u.N H WISE
JUDITH W WEIKERT
410 PAWNEE DR
MBCHANICSBURG PA 17050
PAGE 1
149716
KARCH 02 01
DIRECT INQUIRIES TO YOUR LOCAL BRANCH
609-641-6300
__________________ NOW ACCOUNTS ACCOUNT SUMMARY FOR
149716 -------------------
PREVIOUS STATEMENT WAS DATED
DEPOSITS AND OTHER CREDITS
CHECKS AND OTHER DEBITS
BALANCE ON STATEMENT DATE
02/02/01
1 TRANSACTIONS,
o TRANSACTIONS,
03/02/01
BALANCE WAS
TOTALING
TOTALING
465.13
.45
.00
465.58
INTEREST BARNI!D IS .45 BASED ON THE STATEMENT PERIOD OJ!' 28 DAYS
WITH AN ANNUAL PERCENTAGE YIELD BARNI!D OF 1.27.
2000 INTEREST PAID 18.02
INTEREST PAID YTD
3.57
_____________________________________ CREDITS ------------------------------------
DATE TRANSACTION DESCRIPTION
02/02 INTEREST RATE 1.250 PCT
03/02 28 DAYS-INT
J\MOUNT
.45
____________________ NOW ACCOUNTS ACCOUNT DAILY BALANCE SUMMARY -------------------
DATH J\MOUNT DATE J\MOUNT DATB J\MOUNT
02/16
465.13
03/02
465.58
NOTICE SEE REVERSE SIDE FOR IMPORTANT INFORMATION
""'.""~."..,,\'\.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
WISE, LILLIAN H.
FILE NUMBER
21-01 00186
Oebts of clecedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Funeral/Casket $6,956.96
2. Fruit Baskets ( 3) $135.00
3. Luncheon $300.00
4. Flowers (Casket) $162.99
5. Organist $50.00
6. Cemetary Memorials $310.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative s Commissions
Name of Personal Reprasenlative (s) J u d i t h W. Weikert
Social Security Numbe~sll EIN Number of Personal Represenlative(.)
Stnoel Address 410 Pawnee Drive
City Mechanicsburg Slate PA Zip 17050
Yea~s) Commission Paid:
2. Attorney Fee. $600.00
3. Family Exemption: (If decedents address is not the same as claimants. attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees $239.50
Filing
AcJu&l.'htl M. i sin g $175.93
5. N/A
6. Tax Return Preparers Fees $80.00
7.
TOTAL (Also enter on line 9, Recapitulation) $9,010.38
(If more space is needed, insert additional sheets of the same size)
w
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'Adams-Perfect Funeral Homes, Inc.
Roger B. Read, Mgr.
1650 New Road
Northfield, New Jersey 08225
Mrs. Judy Weikert
4.10 Pawnee Drive
Mechanicsburg, Pa 17050
12131/89
Balance forward
01/30/01
02/12/01
Lillian H. Wise-
INV #11034
PMT #1010 - received check ITom Judith Weikert
AMOUNT
7,131.96
-6,956.96
~~
I~
2/14</01
BALANCE
0.00
7,\31.96
175.00
AMOUNT DUE
$175.00
~
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CUMBERLAND LAW JOURNAL
2 LIBERTY AVENUE
CARLISLE, P A 17013
April 6, 2001
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication oflegal notices.
TO:
Paul B. Orr, ESQUIRE
Lillian H. Wise, EST ATE
RE:
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
~----~---------------------------------------------------------------
---------------------------------------------------------------------
Advertisement inserted on following dates:
March 23,30, April 6, 2001
Advertising Cost
Proof of Publication
Second Proof Request
Payment received
Total Amount Due
Payment received
by
Cl\fU. ~lJr
It)- ~1.()'
I: '~\9
$ 75.00
$ 0.00
$ 0.00
$ 0.00
-------------
$ 75.00
--------
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16,1929), P. 1.1784
ST ATE OF PENNSYL VANIA ;
ss.
COUNTY OF CUMBERLAND ;
Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County
and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland
Law Journal, a legal periodical published in the Borough of Carlisle in the County and State
aforesaid, was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
V1Z:
MARCH 23,30, APRIL 6, 2001
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
R~
Wille. LWiaD H.. dec'd.
Late of Grantham.
Executrtx:JudyWeikert, 410 Paw-
nee Drive, Mechanlcsburg, PA
17055.
Attorney: Paul Bradford Orr, Es-
quire, 50 East High Street,
Carlisle. PA 17013.
SWORN TO AND SUBSCRIBED before me this
6 day of APRIL. 2001
VJJjjO-cfC/r-ftI4!
Notary
IolOT A/IIAt seAl.
TRICIA L IAII!Y, Nata" I'IIbIIc
So"""'",~ Twp., Cumberland Co. 'A
_"tr C'l;')~miuion fxplN$ Aug. 12.20'02
JUDITH W. WEIKERT
410 PAWNEE DRIVE
MECHANICSauRG. PA 17050
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(717) 243-2611
Statement Date: 06/13/2001
Page 1
Type
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Late
Ad-No Date Amt Due lass/Bal First-Words
196145 03/28/01 84.11 10 EST TE NOTICE LETTERS TESTAMENTARY
04/27/01 16.82 100.93
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i . JUDITH W. WEIKERT
I 410 PAWNEE DRIVE
I MECHANICSBUi PA 17050
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PlEASA,~TVllLE, NJ 08232
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REQUEST 20010517000748 200.00
ROLL 000825 20010207 000000006603064
JOB 05053 P ACCT 075] 000512359400
REQUESTOR CHERIE L CHAMBERS
.7030000051235940
JUDlTH W WEIKERT
410 PAWNEE DRlVE
MECHANICSBURG PA 17055-
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REQUEST 20010517000748 50.00
ROLL 003265 20010326 000000006607389
JOB 05060 P ACCT 0751000512359400
REQUESTOR CHERlE L CHAMBERS
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JUDITH W WEIKERT
410 PAWNEE DRIVE
MECHANlCSBURG PA 17055-
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,emit To: FHlCHER FLOWERS, INC.
1622 PACIFIC AVE.
ATI,ANTIC CITY, NJ 08401-6938
INVOICE
(609) 345-8560
Invoice No. :
Invoice Date:
Your Customer ID:
317693
02/02/01
WISELI
Sold L...IL. LIAN~."H.~~E
To 22W: 0 H TS E
_LINWG ,N 0
'-.,Jitd./I/; A/ It/eikerL
Delv SERVICES OF LILLIAN WISE
To ADAMS PERFECT FUNERAL HOME
NORTHFIELD, NJ 08225
........................................................................... .
----------------------------------------------------------------------------
Order Date: 02/01/01 I Ordered By/PO: LILLIAN
Delv Date: 02/02/01 Sales Clerk: VCG
--------------------------------------------------------------------------
Merchandise Quantity Price
--.------------------------------------------- ----------------- ----------
FULL CSKT SPRAY MIXED SPRING LOTS OF
FORSYTHIA ROSE COLORS 1 150.00
Enclosure Card Message:
Delivery Charge 3.99
==========
Sub Total
Sales Tax
153.99
9.00
----------
----------
TOTAL
162.99
----------------------------------------------------------------------------
PAID BY Visa
4828 6204 XXXX XXXX ** DO NOT PAY THIS INVOICE **
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RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Streee
Carlisle, PA 17013
WISE LILLIAN H
File Number 2001-00186
Remarks JUDITH W WEIKERT
AC
Transaction Description
PETITION FOR PROBA
CODICIL
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Check# 1353
Total Received.........
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Receipt Date
Receipt Time
Receipt No.
2/16/20C
10:53:11
102466~
Distribution Of Receipt ----------------------
Payment Amount Payee Name
200.00
10.50
15.00
9.00
5.00
$239.50
$239.50
CUMBERLAND COUNTY GENERAL f
CUMBERLAND COUNTY GENERAL F
CUMBERLAND COUNTY GENERAL I_
CUMBERLAND COUNTY GENERAL f
BUREAU OF RECEIPTS & CNTR ~
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REV-1737.7 EX + (9-00)
COMMO~WEAL*NNSYLVANIA
INHERITANCE TAX RETURN
NONRESIOENT DECEDENT
ESTATE OF
WISE, LILLIAN H.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, .. LIENS
Use Schedule I, Pari 2, ONLY for
proportionate method 01 tax computation.
FILE NUMBER
21-01 00186
Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and
owing as of the date of decedent's death.
Complete Part 2 ONLY when the proportionate method of tax computation Is elected.
PART 1 - OBLIGATIONS AGAINST PENNSYLVANIA REALTY
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
.
'.1:.-
'"
11
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TOTAL PART 1 $
PART 2 - ALL OTHER DEBTS OF THE DECEDENT
ITEM
NUMBER
1.
2 .
3 .
4 .
5 .
6 .
7 .
8.
9 .
10.
DESCRIPTION
AMOUNT
Ambulance Bill (West Shore EMS)
Medical Co-payment
Medical Co-payment
Medical Co-payment
Furniture and Bedding
Phone for Room
Medical Co-payment
Medical Co-payment
Center for Neurobehavioral Health
Country Meadows
$3,094.91
$20.32
$31.48
$16.45
$1,149.98
$37.08
$15.19
$10.00
$77.65
$2,794.00
TOTAL PART 2 $ 7 247. Of)
.~
TOTAL (Also enter on line 10. Recapitulation) $ 7 , 2 If'? . 06
(If more space is needed, insert additional sheets of the same size)
423 NORTH-21ST STREET"~
CAMP IIILL PA 17 011
STATEMENT
SHOW AMOUNT $ J/_, l / r
PAID HERE L-({7 Lv
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ADDRESS SERVICE REQUESTED
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1717\ 975-0900
OFFICE PHONE NUMBER
04/17/01
CLOSING DATE
26008-1-1
YOUR ACCOUNT NUMBER
02
PAGE NO.
16.45
NEW BALANCE
LILLIAN H. WISE
CARDIOVASCULAR SURGICAL
423 NORTH 21ST STREET
CAMP HILL PA 17011
INST.
1."111".111."",11,,,11,,1,1,,1,1,.,11,1,1.,,1.1,,11,,1,1.1
NOTE: Charges and paymenls not appearing on this
statement will appear on next month s statement.
PLEASE RETURN THIS PORTION WITH PAYMENT ,
- -- - '"~""" '"'M''' '" m" ""'"'"' M' "" ""CO,, '" AA' "'""~ "'" '" ,,,,,~,,,- - --j
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DATE PROVIDER EXPLANATION OF ACTIVITY CHARGES PAYMENTS
NAME PATIENT NAME AND DEBITS AND CREDITS
10BOl MEDICARE (EC) FILED
12301 PENNA BLUE SHIELD FILED
11501 MEDICARE ADJUSTMENT -157.00
12201 MEDICARE PAYMENT .19.59
12201 APPLIED TO CO-PAY $4.90
12201 INCORRECT POSTING - ADJUSTMENT 24.49
32601 PASS REJ NO COVERAGE ON DATE OF SERVIC
.
.
------ --..",
ST~,-'M7'i,~TE' 04/17/01 ./ PLEASE INDICATE YOUR ACCOUNI NUMBER WHEN CALLING OUR OFFICE' 2600B-l-l
CL SING T:
INS PEND,.u C^"",, , BAL TOTAL BAL CURRENT BAL PAST DUE NEW 8Al..ANCE
PAY THIS AMOUNT
16.45 16.45 16.45 16.45
SEND INQUIRIES TO: (717) 975-0900
CARDIOVASCULAR SURGICAL INST.
423 NORTH 21ST STREET BALANCE SHOWN IS PATIENT OUE.
CAMP HILL PA 17011 IF YOU HAD INSURANCE AND WE
TQ~ M! ~~..~A.~~Q.4~ C!IICUI1'TTcn TY'I'e ..... ",,..,,.. .....,SP..
'TLY.
1406
3-50/310
JUDITH W. WEIKERT It !o
410 PAWNEE DRIVE ~ I
MECHANICSBURG. PA 17055 DATE (/ I tJ{y
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232-2030
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Exp 03/2002 VI 00
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Auth< 024176
RAOIOShACK 01-2002
608 (anp nm Shop l\al1
Canp Hill. PA 17011-5115
(717) 761-1701
Order: 272129 04/02/2000 02:56P 016 JAfI
430017\ EXI BELL RII1GER
4300880 E1501 BB AlIP IVOR
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14.99
19.99
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Total
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The card holder ldentlfied hereon may apply tho total
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to be paid according to its current terns.
JUDITH WEIKER I
Sales and ~eturns dre subject to the terMS and
conditions identified on the back.
THAlIK 'IOU
JUOITH WEIKERT
fOR SHCPPIIIG AI
RAOIOSHACK
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A Div;s1on of Tandy Corporation
http://www.RadioShack.con
- - Now Hiring - -
Flexible Hours
Generous Discounts
Career Opportunities
To join our team visit
your local store manager
or www.Rad;oShack.com
SEARS
CAMP HILL. PA 02624
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RETAIN FOR COMPARISON WITH MONTHLY
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026241244561
TRAN# PG/STORE REG#
4561 99 02624 124
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ACCT #: W4828n204282~90210302
AUTH CODE: 01226"-0
03/23/00 IISA TOTAL 61.45
CARDHOLDER ,6,CKNJI'il.EDGL:; I~FCEIPT
OF GOODS AND/OR SERVICE) IN THE
AMOUNT OF
$61.45
AND AGREES TO PERFOfii'! 'iE
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1000 NORTH FRONT STREET
WORMLEYSBURG, PA 17043
15.19'\
Return Service Requested
MC VISA __Disc AMEX
Card/!-=- _ _ _ Exp __/__
Signature
*************************SINGLE-PIECE
LILLIAN H WISE 53748 13782
428 MESSIAH VLG PO BOX 2015
MECHANICSBURG PA 17055
MOFFITT, PEASE & LIM ASSOCIATES, INC
1000 NORTH FRONT STREET
WORMLEYSBURG, PA 17043
RETURN TOP PORTION. RETAIN LOWER
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Insurance Charges rending to Dr: 700.00
Ins Pay/Adj agains Ins pending 41. 92 -78.08 580.00
12/04/00 1 13 F HOSPITAL SUBSEQUENT CARE 99233 414.01 85.00
02/05/01 Medicare P~yment. 60.77
02/05/01 Accept Asslgn Adj. -9.04 15.19"
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410 PAWNEE DRIVE
MECHANICSBURG, PA 17055
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AKE
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WABLETO:
MOFFITT, PEASE & LIM ASSOCIATES, INC
1000 NORTH FRONT STREET
WORMLEYSBURG, PA 17043
)ATE LAST PAID AMOUNT
00/00/00 0.00
PAT# I-LILLIAN H WISE
DR# 13-BACHINSKY, WILLIAM B, MD
Ph: (717)-731-8315
Acct/!: 53748
Date: 05/18/01
Page 1 of 1
'CENTER FOR NELJROBEH~WlORAL HEAL.TH
26E EAST ROSEVILLE ROAD
LANCASTER PA i 760i..-3858
800-880-4692
IS YOUR INSURANCE INFORMATION CORRECT?
IF WRONG, CAll US IMMEDIATELY
PRIMARY INSURANCE
MEDICARI~ PART B
P. O. BOX 890418
CAMP HILL, PA 17089
I ACCT. NO. 6041
I DATE 5/11/01
01 02 03 04
138031009A
SECONDARY INSURANCE
LILLIAN WISE
c/o JUDITH WEII<ERT
410 PAWNEE DIU 'IE
MECHANICSBURG, PA 17055
PA BLUE SHIELD 65 SPECU~L
PO BOX 898845
CAMP HILL. PA 17089
Please detach and rstum this portion of your statement with your paVmenl
SERVICE
DATE
PROCEDURE
CODE
DESCRIPTION OF SERVICES
CHARGES
CREDITS
CASE-03 NURSING HOME CHARGES 1/5/0i.
1/05/01 90801 CHRG - EVALUATION 1.50.00
1/10/01 INS - MEDICARE PART B
1/30/01 PMNT - MEDICARE PART B 47. i.7
- $11.79 CO-INSURANCE: THIS IS YOU RESPONSI ILITY
i/3()/01 ADJ - MEDICARE ADJUSTMENT 1.13
- $79.91 APPLIED TO DEDUCTIBLE
4/30/01. PMNT - PA BLUE SHIELD 65 SPECIAL 91..70
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;JUDITH W. WEIKERT
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REGARDING THIS BILL. PLEASE KEEP THIS PORTION
OF YOUR BILL FOR YOUR RECORDS.
CENTER FOR NEUROBEHAVIORAL HEALTH
26E EAST ROSEVILLE ROAD
L.ANCASTER F'A 17601-3858
800,-,880-4692
MAKE CHECKS PAYABLE TO:
:ENTER FOR NEUROBEHAVIORAL HEALTH
:6E EAST ROSEVILLE ROAD
ANCASTER PA 17601-3858
'ATIENT: LILLIAN WISE
LILLIAN WISE
c/o JUDITH WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG, PA 17055
STATEMENT DATE PAY THIS AMOUNT ACCOUNT NO.
6/20101 $ 29.97 604
:;H,l~(;ES ANO CREDITS MADE AFTER STATEMEN7 SHOW AMOUNT $
D)TE "VILL APPEAR ON NEXT STATEME~n PAID HERE
CENTER FOR NEUROBEHAVIORAL HEALTH
26E EAST ROSEVILLE ROAD
LANCASTER PA 17601-3858
111
ck box if above address is incorrect or inSLJrance
nhaschanged,and indicate change(s) on reverse side,
STATEMENT
PLEASE DETACH AND RETURN TOP PORTION WITH
YOUR PAYMENT IN ENCLOSED ENVELOPE.
CASE-02 NURSING HOME CHARGES 6/2/00
CHRG - PSYCHOTHERAPY 20-30 MIN
INS - MEDICARE PART B
PMNT - MEDICARE PART B
$7.49 L CO-INSURANCE: THIS IS YOUR RESPONSIBILITY
ADJ - MEDICARE ADJUSTMENT
- 22.48 PT RESP
- PA BLUE SHIELD 65
- PA BLUE SHIELD 65
- PA BLUE SHIELD 65
- DENIED NO CVG L7
* TOTAL FOR CASE 02 *
JUDITH W. WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG, PA 17055
~ DATEk?-02-CJ/
PAYTOTHE L [J 'J.,., . /. j _ ::
ORDER OF ~ 711. / LI..IA~
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CODE
DESCRIPTION
100
'00
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90816
100
101
/01
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INS
INS
PMNT
CHARGES
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70.00
29.97 -
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SPECIAL
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29.97
3-50(310
1456
$ 29.97
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CENTI::K rUt"< l~cUROBEHAVIORAL HEALTH
26E EAST ROSEVILLE ROAD
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CASTER PA 17601-3858
lENT: LILLIAN WISE
STATEMENT DATE PAY THIS AMOUNT ACCOUNT NO. .
6/20/01 $ 47.68 604
CH,"GEO AND CReo'TS ',''DE .IFT" ;n;""""f SHOW AMOUNT $
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C/O JUDITH WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG, PA 17055
CENTER FOR NEUROBEHAVIORAL HEALTH
26E EAST ROSEVILLE ROAD
LANCASTER PA 17601-3858
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,ifaboveaddresSisincorrectorinsurance
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STATEMENT
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~9~~. PAYME~T IN ~CL.q~_~g_ E_N.VELOPE
---"~
,
I PROCEDURE
, CODE
DESCRIPTION
CHARGES CREDITS
CASE-04 NURSING HOME CHARGES 1/19/01
90818 CHRG - PSYCHOTHERAPY 45-50 MIN
INS - MEDICARE PART B
PMNT - MEDICARE PART B
$11.92 CO-INSURANCE: THIS IS YOUR RESPONSIBILITY
ADJ - MEDICARE ADJUSTMENT
- 35.76 PT RESP
INS - PA BLUE SHIELD 65 SPECIAL
PMNT PA BLUE SHIELD 65 SPECIAL
- DENIED NO CVG L6
* TOTAL FOR CASE 04 *
110.00
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14.64-
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410 PAWNEE DRIVE 2 ^ '7 OJ
: MECHANICSBURG, PA 17055 DATE - U/, -
LAno THE /1 L -Ii? ILlo/)~.AA4;'''' / / /....Mi $ 77- & 5
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CENTER FOR NEUROBEHA VIORAL HEALTH
26E EAST ROSEV1LLE ROAD
LANCASTER PA 17601-3858
800-880-4692
/ .~
ATE DR" DEseRT PTION CHARGE (/ ADJUSTMENT RECEIPTS BALANCE
12/04/00 13 HOSPITAL VISIT LEVEL 2 80.00 26.03 44.44 9.53
99232 436 790.2
12/05/00 13 HOSPITAL VISIT LEVEL 2 80.00 26.03 43.18 10.79
99232 436 790.2
12/06/00 13 HOSPITAL VISIT LEVEL 2 80.00 .00 .00 80.00
99232 436 790.5
01/02/01 8 NURSING HOME VISIT LEVEL 1 50.00 29.91 20.09 .00
99311 300.9
01/10/01 8 NURSING HOME VISIT LEVEL 2 65.00 32.62 32.38 .00
99312 300.9
(;t~, r
')
11.r,/'t.1;1
r )y'
/
** Statement Due Upon Receipt * Thank You **
* Insurance Pending
.00
20.32
.00
.00
.00
100.32
80.00
CURRENT
OVER 30 DA YB
OVER 60 DA VS
OVER 90 DA VS
OVER 120 DA YB
TOTAL
ACCOUNT BAI.ANCE
INSURANCE
PENDING
CLOSING
DATE: 03/21/01
ACCOUNT
NUMBER 15470
If you have any questions regarding this bill, call
our office at (717) 774-1366 between 10:00 a.m.
and 4:00 p.m.
Monday thru Friday
Thank You
INTERNISTS OF CENTRAL PA
108 Lowther ST Box 107
Lemoyne, PA 17043-0107
(717) 774-1366
Tax ID: 23-2146427
LILLIAN H WISE
123 MESSIAH VILLAGE
POBOX 2015
MECHANICSBURG, PA 17055
Account: 15470.0
05/30/01
Date
Patient
Doctor
Procedure Diagnosis
Amount
-----------------------------------------------------------------------------
12/04/00 LILLIAN DENTE, MD 99232 436 80.00
01/31/01 Payment from MEDICARE-PRIMARY- -43.18
01/31/01 Medicare Adjustment -26.03
02/15/01 Payment from Patient ~~1.~
03/28/01 Payment from Patient ~l,--9.53~_
12/05/00 LILLIAN DENTE, MD 99232 436 ~u.OO
01/31/01 Payment from MEDICARE-PRIMARY- -43.18
01/31/01 Medicare Adjustment ~~2~~
. "/,,/,, un...... u.. .1fc~Z~~~~::W)..n.:"" ~ /
Balance remaining on charges listed above: 0.00
Summary of services provided during the period: 12/04/2000 - 12/05/2000
It,7?
-f- 7, C.3
fJ: ()-'J 2-
Date Oa.1:.e Da1:e
Numbe.r Amount posted NumDer Amoun.t posted NUniber Amount posted
1.0.54 50.00. 1.2/:17 1075 SOD.OC 1:1/30 1094 60.00 1/240
1068* 1.7~L74. :12/30 1076 2.40.62 :12/2g 1085 .51..48 :1/2.
1069 36.00 :12/2g 1074- 60.00 1/05 3.eae... 244..55- 1/21
1070 4.J.5.58 :12/23 1079 25.00 1/:L2 '],089 62.00 1/24
1071 '1.9.&1 J..2/30 1080 25.00 1/:L:1 :L090 30.0..00 1/.21
1072 35.00 J.2/23 1081 1..000.00 1/1:1 JIII/1W! 20.00 1/25
1.073 .20.00 12/29 :1.082 2,794.00 1/14 :10.00 1/35
1.074 220.00 12/23 1083 1.,720.00 1/191 $8,098..78
1tIYu(l1.cateoB .. br$l\.k :l.n cbeck n1..lll1b.r ..equ4nC$
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01 71lU~~\. V~ ~~ 717uJ,--, ';:<000.
REQUEST 20010921005229 2794.00
ROLL P01996 20000114 000000081688644
JOB 09706 P ACCT 9999999999999999
REQUESTOR TARA THIDEMANN
. 092101002286
JUDITH W WEIKERT
410 PAWNEE DR
MECHANICSBURG PA 17050-0000
"/~'
. dt{;irljl ~
JI~:{ I TCJ '/, () (j
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{MvL ~~ ~
t~2
PLEASE MAKE CHECK PAYABLE TO:
INTERNISTS
of Central Pa.
-'--"-LTD_=_::'~:::,::::'~""=:
Richard Schreiber, :-'1.D., FAe,p.
L. Lynne Britton, :\tD.
Lawrence B. Zimmerman, M.D.
MichaelA. Del\Iichele, M.D,
Carla J. Dente, M.D.
R. George Azizkhan, D.O.
Dean L. Lehman, P A-C
Peter M. Brier, M.D
Michael L. Gluck, :\1.D.
James A Tyndall, M.D
Ira J. Packman, M.D
IRS# 23-2146427
HARRISVIEW PROFESSIONAL CE~TER. 108 LOWTHERST,. PO BOX 107. LE.\IO'r.'JE. PA 17043-0107. (7171 774-1366 FA.'{ (7171 774-4232
PLEASE DETACH AND RE-
TURN THIS PORTION WITH
YOUR PAYMENT. PLACE IN
ENVELOPE PROVIDED.
WE WILL GLADLY BILL YOUR
CREDIT CARD. SEE OTHER
SIDE.
LILLIAN H WISE
123 MESSIAH VILLAGE
POBOX 2015
MECHANICSBURG PA 17055
L
J
o PLEASE CHANGE ADDRESS IF INCORRECT
DETACH THIS STUB AND RETURN WlTH PAYMENT
. .'
03/21/01
15470
. .'
100, 32
-. ,
20.32
CHARGES OR PAYMENTS MADE
AFTER CLOSING OA TE WILL
APPEAR ON NEXT STATEMENT.
Page No. 1
~
ATE DR# DESCRIPTION CHARGE ADJUSTMENT RECEIPTS BALANCE
12/04/00 13 HOSPITAL VISIT LEVEL 2 80.00 26.03 H.H 9.53
99232 436 790.2
12/05/00 13 HOSPITAL VISIT LEVEL 2 50.CO 26.03 43.rB 10.79
99232 436 790.2
12/06/00 13 HOSPITAL VISIT LEVEL 2 80.00 ,00 ,00 BO.OO
99232 436 790.5
01/02/01 8 NURSING HOME: VISIT LEVEL 1 50.00 29.91 20.09 ,00
99311 300.9
01/10/01 8 NURSING HOME VI S IT LEVEL 2 65.00 32.62 32 .38 ,00
99312 300.9
** Statement Due Upon Receipt * Thank You **
* Insurance Pending
CURRENT
OVER 60 DAYS
OVER 90 DAYS
OVER 120 DA VS
TOTAL
ACCOUNT BALANCE
OVER 30 DA VS
,00
20.32
,cc
,00
.00
100.32
CLOSING
DATE: 03/21/01
ACCOUNT
NUMBER 15470
INSURANCE
PENDING
BO.OO
20.32
PLEASE MAKE CHECK PAYABLE TO:
INTERNISTS
of Central Pa.
LTD
Peter M. Brier, M.D.
Michael 1. Gluck, M.D,
James A. Tyndall, M,D.
Ira J. Packman, M.D,
Richard Schreiber, M.D., FAC.P,
L. Lynne Britton, M.D.
Lawrence B. Zimmerman, M.D.
Michael A. DeMichele, M.D.
Carla J, Dente, M.D.
R. George Azizkhan, D.O.
Dean L. Lehman, PA-C
IRS# 23-2146427
HARRISVIEW PROFESSIONAL CENTER. 108 WWTHER ST.. PO BOX 107. LEMOYNE, PA 17043.0107. (717) 774-1366 FAX (717) 774-4232
PLEASE DETACH AND RE-
TURN THIS PORTION WITH
YOUR PAYMENT. PLACE IN
ENVELOPE PROVIDED.
WE WILL GLADLY BILL YOUR
CREDIT CARD, SEE OTHER
SIDE.
LILLIAN H WI SE
123 MESSIAH VILLAGE
POBOX 2015
MECHANICSBURG PA 17055
I
r\
X
L
J
o PLEASE CHANGE ADDRESS IF INCORRECT
DETACH THIS STUB AND RETURN WITH PAYMENT
o ,.
02/14/01
o
15470
.. 0
217.66
,.
'0
31. 48
CHARGES OR PAYMENTS MADE
AFTER CLOSING DATE WilL
APPEAR ON NEXT STATEMENT.
Page No. 1
~
, ,', \
E PR# liesC!tI P1'ION . . C1iN<ilE' .
.
12/03/,O(} , 13 HOSPITALVX'SIT J,EVEL 2 $0:,0,0 '
9923~ 436 790,.2
12io4/0,d 13 HOSPITJU. 'VrSrT, LEVEL 2 ap'. be . .
992.3~ 43.6, 1~~.'2
12/tl5/00 13 HOSPITAL VIsH LEVEL , SO.{lO
99232 436 790.2
12/06/00 13 HOSPITAL VISIT LEVEL , 80.00 .'0'0, . ;Q~
99232 436 790.5 . .
01/02/01 8 NURSING HOME VISIT LEVEL 1 50.00 1,.7.a~ 7.'Q'.09 '11 'ids
99311 300.9
01/10/01 8 NURSING HOME VISIT LEVEL 2 65.00 13 .19 32.38 '19.43
99312 300.9
01/23/01 1. NURSING HOME VISIT LEVEL , 65.00 20.96 35.23 8.81 .
99312 786.05
01/29/01 7 NURSING HOME VISIT LEVEL , 65.00 .00 .00 65.00 .
99312 276.5
** Statement Due Upon Receipt * Thank You **
* Insurance Pending
CURRENT
OVER 60 DA VS
OVER 90 DA VS
TOTAL
ACcOUNT BALANCE
OVER 120 DAVS
OVER 30 DA VS
1.48
.00
.00
.00
.00
217.66
CLOSING
DATE: 02/14/01
ACCOUNT
NUMBER 15470
INSURANCE
PENDING
DUE FROM PATIENT
186.18
H.4.8
PLEASE . MlT:paOMP1:LY , "'. ',I"
i WE WILL GI.ADI.Y Bill. VISA ~J1ASTEF1CARD OR DISCCYJER,"!')\!U:; .
IIF YOU SUf'PL Y US WiTH TiiE FOLLOWiNG INFORM/H'ON.
, CARDHOLDER
NAME
VISA
/,CCOUN-r Nurv18f:R
, M!C
DISCOVEFi
NOVUS
EXPIRATION DATE
CARDHOLDER
SIGNATURE
If you have any questions regarding this bill, call
our office at (717) 774-1366 between 10:00 a.m.
and 4:00 p.m.
Monday thru Friday
Thank You
MESSIAH VILLAGE STATEMENT
Resident: LILLIAN H WISE Discharge Dale 0112912001
Resident Number Date
00003001B 02/2B/2001
Page Amount Due
1 3,094.91
100'Mt. Ailen Drive
P.O. Box 2015
Mechanicsburg, PA 170552015
(717) 697-4666
B
I JUDITH WEIKERT
L 410 PAWNEE DRIVE
L MECHANICSBURG. PA 17055
T
o
Date
Description
CharQes
Credits
Total
01/01/2001
Beginning Balance
MEDICAL
WEST SHORE EMS
74.55
3,020.36
3,094.91
3\ 1>\01
O~
Current Past 31-60 Days 61-90 Days 91-120 Days Over 120 T etal Due IlLlAN H WISE
74.551 Due
3,020.36 0.00 0.00 3,094.91 51 M~ ?I
ANC:c 'cK' 1;-2001
"10 FIN
Statement End Date:
02128/2001
REV.1737-' EX + (9-00)
REVERSE ~
COMMONWEAL~mNNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF WISE, LILLIAN H.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-01 00186
When flat rate method is elected. list the beneficiaries of the Pennsylvania property.
When proportionate method is elected, list all beneficiaries.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)]
1. Judith W. Weikert
RELATIONSHIP TO
DECEDENT
Do Not List Truslss(s)
AMOUNT OR SHARE
OF ESTATE
Daughter
100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV.1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE
SIDE OF REV.1737 COVER SHEET, AS APPROPRIATE.
U. NON.TAXABLE DiSTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
,.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I. Seaview Baptist Church
Linwood, NJ
$4,000.00
2 Rescue Mission
Atlantic City, NJ
$1,000.00
TOTAL OF PART II
ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REY.1737 COYER SHEET $ 5 000 nn
(If more space is needed. insert additional sheets of the same size)
YOUR RECEIPT
TOTAL 1000.00
Thank you for your gift!
~I
PO. Bl1x 535K . Atl,llltic City. NJ llH4U4
9/5/2001
Ministry of Rescue 1000.00
YOUR GIFT CHANGES LIVES
Estate of Lillian H Wise
Judith W Weikert
410 Pawnee Drive
Mechanicsburg PA 17055
No goods (.Jr SC17,icI'S lucre provided to yot/ in cOl/llection with tllis contribution. Your gift is tax-deductible if you itemi::e.
Detach here tlnd refum with your uext gift. }
YOUR NEXT GIFT
My tax-deductible contribution: $
One of the ways you can continue to support the work of God in Atlantic City
is to remember the Mission in your will. For further information. or with
questions please feel free to coil us.
I;;
. ~
3ii4i1ij)
-""~
i,
Estate of Lillian
Judith W Weikert
410 Pawnee Drive
Mechanicsburg PA
H Wise
17055
\~
(,0"",.-,
.ECFRl
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YOllrgiftis tax-deductible if !fOil itemize.
Please return this portion with your next gift in the envelope provided to: P.O. Box 5358 . Atlantic City. NJ 08404
JUDITH W. WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG. PA 17055
3-50/310
1485
DATE g -do -(J /
~~~i~ci~E ;41/tl~ (~,r?~u. -:4~ I $ ~ tJ6t;, tJd
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MEMO.t.H.lAj, tskk_
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REV. PAUL AIELLO, JR.
Pastor
Judy W. Weikert
410 Pawnee Drive
Mechanicsburg, P A 17050
Dear Judy,
This is to confirm that the Seaview Baptist Church has received from
you a check #1428 in the amount of$4,000 from the estate of Lillian Wise.
Also, per our phone conversation I understand that you want the check to be
used to support people going on mission work tours ($2,000) as well as to
start a fund for the balcony pew pads ($2,000).
We still miss Lillian and often mention her name. Her influence
continues to be felt today. Her remembrance of her church in this way will
allow her to continue making a difference here at Seaview Baptist.
Take care. May the Lord bless you and Glenn and Roger in the weeks
and months and years ahead.
Sincerely,
;::;=>~ AufJ2. (<-
Rev. Paul Aiello, Jr.
2025 SHORE ROAD
.
LINWOOD, NEW JERSEY 08221
.
609/927-5015
JUDITH W. WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG. PA 170~
3-50/310
1428
DATE ,-)--4/ - I) /
! "t~:~r;E~AA~ Md(A~/
1 1-w-- 'f,I/!/LUd. ~-
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. flrstunion.com
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LAWQFFlCE5
THOMAS D. BEGLEY. JR
A PIlOF"[SSIONAlCORPQRATIO'<
ATTORNEY AT LAW
"'a E MAIN ST
PO. 80X tl27
MOORESTOWN, N...I. OBO~7
LAST WILL OF
LILLIAN H. WISE
I, LILLIAN H. WISE, of 22 Ocean Heights Avenue, Linwood, New
Jersey 08221, declare this to be my last Will, hereby revoking all
prior Wills and Codicils.
SECTION 1. IDENTIFICATION-
1.1. Child - I have one child, JUDITH W. WEIKERT.
All references in this Will to my "child" are to said named child.
1.2. Grandchildren - I have two grandchildren, ROGER
WEIKERT and GLENN WEIKERT.
All references in this Will to my
"grandchildren" are to said named grandchildren.
SECTION 2. PAYMENT OF EXPENSES - 1 direct that the expenses
of my last illness and funeral be paid from my estate as soon as
practicable after my death.
SECTION 3. TAX CLAUSE - All estate, inheritance, succession
and other such tax as payable by reason of my death with respect to
all property comprising my gross estate, whether or not such
property passes under this Will, shall be paid out of the principal
of my general estate as if such taxes were administration expenses,
without apportionment or right of rei~bursement. My Executor may
pay all such taxes at such time or times as in his discretion is
deemed most advisable.
SECTION 4. SPECIFIC BEOUESTS AND DEVISES -
4.1. Tanqible Personal prooerty - 1 give certain
tangible, non-business, personal property in accordance with a
written statement or list prepared pursuant to N.J.S.A. 3B:3-11, in
my handwriting or signed by me which describes the items and the
devises with reasonable certainty.
I give all of my remaininc
tangible, non-business, personal property, including any automo.
biles, together with all insurance on such property to my child.
4.2. Grandchildren - I give and bequeath to each of
my grandchildren the sum of FIVE THOUSAND DOLLARS ($5,000.00).
SECTION 5. RESIDUE - I give, devise and bequeath the entire
residue of my estate unto my daughter, JUDITH W. WEIKERT, or to her
issue, per stirpes.
SECTION 6.
APPOINTMENT OF EXECUTOR - I appoint JUDITH W.
WEIKERT, or in the event of such person's death, resignation,
refusal or inability to act, then MARLENE F. McINTYRE as Executor
of my Will, and neither shall be required to give bond or furnish
sureties in any jurisdiction.
SECTION 7.
APPOINTMENT OF TRUSTEE - I appoint JUDITH W.
WEIKERT, or in the event of such person's death, resignation, \
refusal or inability to act, then MARLENE F. McINTYRE as Trustee,
and neither shall be required to give bond or furnish sureties in
any juriSdiction.
SECTION 8. POWERS OF FIDUCIARY -
8.1.
General Powers - In addition to the powers
above provided for, and those given by law, my Executor and
Trustee, without any order of court and in its sole discretion,
I-AWO,I'ICES
may:
THOMAS O. BEGLEY,-.lR
p 0 80X ein
8.1.1. Make Investments - Retain any property
received hereunder and invest and reinvest in any property,
including by way of illustration and not by way of limitation,
common stocks up to one hundred percent hereof, any common or
, "'IlO>(SS'O>.lALCOR<>ORATIO",
"TTOANE'1' AT L.AW
"'0 E. MAl'" S1
....OOA(S'lOWN. N.,J 013057
2
"
~AWO!CFlCE5
THOMAS D. BEGLEY, JR.
A PROHSS'ONA~ CORPORATION
ATTORNEY AT LAW
"0 E MA'N ST
PO. SOX 6<:"
MOORESTOWN, N,..! 06057
diversified trust funds maintained by any bank or savings institu-
tion, and any form of life insurance, annuity or endowment
policies; in so doing, my fiduciary may act without restriction to
so-called legal investments and without responsibility for
diversification.
8.1.2. Purchase Investments - Purchase invest-
ments at premiums and charge premiums to income or principal or
partly to each.
8.1. 3.
Stocks and Bonds
Subscribe for
stocks, bonds or other investments; exercise any stock option or
similar right; join in any plan of lease, mortgage, merger,
consolidation, reorganization, foreclosure or voting trust and
deposit securities thereunder; and generally exercise all the
rights of security holders of any corporation.
8.1.4. Reqistration - In the sole discretion
of the fiduciary, register securities in the name of its nominee or
hold them unregistered so that title may pass by delivery.
8.1.5. Votinq - Vote, in person or by proxy,
securities held by it and in such connection to delegate its
discretionary powers.
8.1. 6.
Repair - Repair, al ter, improve or
lease, for any period of time, any property and give options for
leases.
8.1.7. Sell - Sell at public or private sale,
for cash or credit, with or without security, and exchange or
partition property and give options for sales or exchanges.
3
LAW OlTICE5
THOMAS D. BEGLEY,..JR.
A PRO~E55tONALCORPOIlATION
ATTORNE"" AT LAW
"'0 ~.. MAl'" 5"'1
P O. BOX 827
MOORESTOWN. N.,,!. 08057
8.1.8. Borrow - Borrow money from any person,
including any fiduciary, and mortgage or pledge any property.
8.1.9. Compromise - Compromise claims.
8.1.10. Trust Additions - Add to the principal
of any trust created hereunder any property received from any
person by Deed, Will or in any other manner.
8.1.11. Distributions - Make distribution of
both income and principal in cash or in kind or partly in each.
8.1.12. Post-Termination - Exercise all power,
authority and discretion given by this trust, after termination of
any trust created herein until the same is fully distributed.
8.1.13. Emplovment of Agents
Employ such
agents as my Executor or Trustee may deem advisable in the
administration of my estate or any trust pre-owned hereunder and to
pay them such compensation if my Executor or Trustee may deem
proper out of income or principal or out of both.
8.2.
Limitations
Notwithstanding any of the
powers conferred upon Fiduciary, no individual acting as Fiduciary
hereunder shall exercise or join in the exercise of discretionary
powers over income, principal or termination of any Trust (1) for
his or her own benefit or (2) to discharge his or her legal
obligation to support any Beneficiary.
8.3. Deleqation. From time to time, any Fiduciary
may delegate to any Co-Fiduciary the exercise of any powers,
discretionary or otherwise, and may revoke any such delegation.
Such delegation and revocation shall be evidenced by a writing
delivered to such Co-Fiduciary.
While such delegation is in
4
LAW OFT'CES
THOMAS O. BEGLEY,..JFl
~ ~\'IO'l"''''\Of<~L (001'01<"'1\0><
ATTORNEY AT l-AW
"0 E. MA'N ST
PO. BO}( 827
MOORESTOWN. N.J 08057
_....~--~-~--~-_.__..__.~- -
--~_.-,--_.~..~-...,....._--~:~---,..--:"'-;:""~--
effect, any of the powers, discretionary or otherwise, so delegated
may be exercised and action may be taken with the same force and
effect as if the delegating Fiduciary has personally joined in the
exercise of such power and the taking of such action.
Anyone
dealing with the Fiduciary shall be absolutely protected in relying
upon their written statements relative to the fact and extent of
such delegation.
8.4. Release of Powers. Any Fiduciary may release
in whole or in part, temporarily or irrevocably, any power,
authority, or discretion conferred by this instrument, by a writing
delivered to the Co-Fiduciary, and to each Beneficiary then
eligible to receive income distributions from any Trust.
Such
renunciation or release shall not affect the grant of power,
authority, or discretion renounced or released to the Co-Fiduciary
then acting.
SECTION 9.
AGE REOUIREMENT - If any person, other than my
child named in Section 1, less than thirty (30) years of age lS
entitled to receive a share under this Will, then although such
share shall vest immediately and indefeasibly, my Executor shall
pay such share to my Trustee herein named to be administered as
herein provided.
My Trustee shall invest and reinvest the
undistributed share.
One-half (1/2) of said share and any
accumulated income shall be distributed to such person when he or
she attains the age of twenty-five (25) and the remainder shall be
distributed to such person when he or she attains the age of thirty
(30) .
At any time prior to the attainment of the age of thirty
(30), my Trustee may, in Trustee's discretion, use so much of the
5
j '.
LAW OFFICES
THOMAS D. BEGLEY, JR
A Pl1OnSSIONAL CORPORATION
ATTORNEY AT" LAW
"0 C MAIN ST
P.O BO)( 827
MOORESTOWN, N,J Oa057
""_',,J\~"i}!l:I;~1\'1.!~!.~,l'.4,.qll..4."~~l:;.'
'.j,,r.iL~,...-;~~:7'"
net accumulated income and principal of said share, even to the
point of exhausting principal, as my Trustee, from time to time,
believes desirable (i) for the health, support, education, best
interests, and welfare of such person, (ii) to permit him or her to
enter into or engage in a business or profession in which my
Trustee believes that he or she has reasonable prospects for
success, and (iii) to permit him or her to make a reasonable down
payment on a personal residence.
SECTION 10.
RULE AGAINST PERPETUITIES - Anything herein to
the contrary notwithstanding, no Trust hereunder shall extend
beyond twenty-one (21) years after the death of the last survivor
of myself, and my issue living at the date of my death.
At the
expiration of that period my Trustee shall distribute the remaining
portion of any Trust property in my Trustee's hands to the
beneficiaries entitled to the income thereof at that time.
IN WITNESS WHEREOF I subscribe my name this 29th day of
August, 1996.
~ va, k ~ lci-"',Lf./~
LILLIAN H. WISE
The foregoing instrument was signed, pUblished and declared by
LILLIAN H. WISE, the Testatrix, to be the Testatrix's Last will and
Testament in the presence of each of us, present at the same time,
and we, at the Testatrix's request and in the Testatrix's presence,
and in the presence of each other have hereunto subscribed our
names as witnesses this 29th day of August, 1996.
G1~d4~
~ ., ~.-
(l~nc ~v -0kv-
6
LAWOFFJCES
THOMAS D. BEGI...EY, ...JR.
. ""O.ESS'O~AL COrlPQPAr,ON
ATTORN!;'" AT LI'.W
40!;. MA'N S'"
POBOX 8Z7
MOQRESTQWN, N.J. 08057
WE, the Testatrix and EDWARD LADREW & CATHERINE LADREW
the witnesses, respectively, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testatrix signed and executed
the instrument as his/her Last Will and that he/she signed
willingly and that he/she executed it as his/her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the
Will as witness and that to the best of the witnesses' knowledge
the Testatrix was at the time eighteen years of age or older, of
sound mind, and under no constraint or undue influence.
Cj~ U~"-"'-"--
LILLIAN H. WISE, Testatrix
,Ii IJ ~
(~ ~Lh-( -" :t; It ~
wi'tness l
L~4<''''; .~_.(Z:hh-
Witness
STATE OF NEW JERSEY
ss.
COUNTY OF ATLANTIC
Subscribed, sworn to and aCknowledged before me by LILLIAN H.
WISE, the Testatrix, and subscribed and sworn to before me by
EDWARD LADREW & CATHERINE LADREW , the witnesses,
this 29th day of August, 1996.
'/L;<~
t/ JAM l. lEITIl
A Notary Public of New Jeney
My ComIllllSion bpilf$1/8199
7
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of 1-// !/al7 If. WI S-6
also known as
Deceased.
Social Security No. 1:3? -tJ 3 -; () a 7
No.
To:
Register of ~~he
County of r/a.0 ~i in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your pe. titioner(s), who is/are 18 years of age ~der an the execut(l/C
in the last will of the above decedent, dated wI- 2. 9
and codicil(s) dated d
/V {/. 8"1 / q q JY
21-01-186
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
(list street, number a d muncipality)
Decendent, then 1.0 years of ag~ ~~..;? J ,'W: ,;;(00/,
at n u7Tt12.e/J tJ./7Wi - -IS r /i h I J II r:Jt .
Except as follows, decedent did not marry, was not divorced and did n have a chlld born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
County, Pennsylvania, with
G
Decendent was domiciled at death in
h ..P f last family or principal residence at
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:
$ Il'l ()(j ()
$ 9'1. O(f ()
$ 51,!. ()od
$ --~-
70 -kJ ?'-t 060
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
f the last will and codicil(s)
~
'"
~
j~ 3w/-I-h /)j, aJe/krC
"'~
<!) ....
il 1hJ~ngbt//fr;7M()
~)l..
<!) '-
;:;0
(;j
c
OJ)
Cii
(~ Jf.~,il~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEA!1TH OF PENNSYLVANIA ~ ss
COUNTY OF (-<urn hJA/~ J
~
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the b~st of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will we! nd truly administer the estate ~ccording to law.
V:l
~.
::s
l:l
......
s:::
~
~
~o. 21-01-186
Estate of
LILLIAN H WISE
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW FEBRUARY 16 ~2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that theinstrument(s) dated AUGUST 29,1996 Coodicl Nov. 8,1998
described therein be admitted to probate and filed of record as the last will of
LILLIAN H WISE
TESTAMEMTARY
JUDITH W WEIKERT
and Letters
are hereby granted to
'7p>//l/gXfi/~i~h/,~/ ~ ~-zy
~ister of ills
FEES
'111~' - PAUL ~. oRg
$ 200.00
$ 9.00
lO.~U
. . . . . . . . .. . . . . .. $
15.00
$ 5.00
TOTAL _ $ 239.50
Filed ...... .:f~~... .D... .499.1. . . . . . . . . . . . .
Probate, Letters, Etc. .........
Short Certificates( )..........
CODICIL
Renunciation
x-pages
JCP
ATTORNEY (Sup. Ct. I.D. No.)
So E H lG-Ha ST
ADDRESS
III - 2..S8'- g~~g
PHONE
o
-.....
i,..Ji
HIOS.RO,,) REV 9lR6
This is to certifY that the information here given is correctly copied from an original certificate of death duJy filed with me as
Local ~e.gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
~~~.
Local Registrar n
p
7121200
a L~'(" (/ ;2(.) 0 I
1 Date
21-01-186
Hl05.143Aev.2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
rYPEJPFlJHT
IN
PERMANENT
BLACK INK
....
Cumberland
SEX
a.
STATE FIlE NUMBER
SOCIAL SECuRITY NUMBER
DATE OF DEATH ,Mcrntl. DaY.~1
NAME OF DECEDENT (FIrst, MWe. La!;I.)
I.
AGe (LOIS! Birthday) UNDER 1 YEAR
MonIht Oap
Female
3. 138 - 03-
January 29,2001
90 v,.
BIRTHPLACE (Oli' .nd PlACE OF DEATH (Check only Of'le.~ -;ee InsltUChOfl$ 00 0Itler !IOe)
Stateorf"Ofe.gt1CountrYJ HOSPITAL OTHER:
Philadelphia, Pa. Inpal..... 0 ='" ()Q
='~IO
COUNTY OF DERH
RACe . Amenc&n Indian, Slack, Whit._ lMC:.
(Spetlty)
Ie.
1..
White
StlRVlVING spouse
III """e. 'Jive maiden namel
oeCEOENl'S USUAL OCCUPoVION
(~v~k1,:'~~~u~r~:f
".. legal Secretary "..
DECEDENT'S MAiLING ADDRESS (Street. CilyflOwn, SIaIe. Zip Code)
...
Fnl/ER'S NAME jF",,1. M,~ L<t:>ii
100 Mt. Allen Drive
Mechanicsburg, Pa. 17055
Cumberland
0Kj
Meed."
Mina
lOwnstlip?
MARITAL STATUS - Mamed
N.."., MarrMtd, Widow4td,
Oiwrced (Spec.tyl
Widowed
I Jrp",r AII"'n
hop
11b. County
No, ~1MJd
17d.O wldWIectuethmdsof
cityJbc:wo
...
INfORMANT'S NAME (T ypetPrinfl
John Hobson
Judith W. Weikert
MOTHER'S NAME (Fits!. MI(jdIe. Malden Surname)
I
:il
'"
:>
'"
0(
:0
0(
RemoYallrom State 0
... Emma Hi h
INFORMANT'S MAILING AOORESS (Street ~!TOwn, State. ZiP COde)
.... 410 Pawnee Drive Mechanicsbur Pa. 17050
PlACE OF DISPOSITION. Name of CMllltety, Crematory LOCATION _ CitylTown, Slat.. Zip COQIt
or OItWtfP1actt
LICENSE NUMBER
Feb 3, 2001
LICENSE NUMBER
21c.
Friends Central Cemetery
NAME AND ADDRESS OF FAClUTY
linwood, New Jersey
FD 01431 -l
22c.
23Q. k.
Wt.S CASE REFERAED TO MEDICAL EXAMINERlCOftONEA?
,..0
No~
'lJ
...
I ApgrollinMll.
:inC.......~n
I onaeI and de.th
1
:
PAItTU:
OtIW~ COf'Idi&ioNcotlfributinglCdum. tlU
not relUlbng in the l.If'ldeftving C&UH Qi\l_ in PART I.
-c0DM
l:
oue 10 (OIl AS A CONSEQuENCE Of):
WERE AUTOPSY FINDINGS
AVAJl.A8LE PRIOR 10
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
NaturiU
,eg
o
o
DATE OF INJURY
(Monlt\. Day, Yearl
TIME OF INJURY
/N.JtJRV AT WORK? DESCRIBe HOW JHJUAY OCCURRED
Ac:Cident
Pending Investigation
o
o
o ~CE OF INJURY - AI homo, farm~;eel, lactOfY, office
bUIlding. etc, ($pee.....}
3...
Voo 0 NoD
Hon-lIcide
"
LhL~
,..
....0
No 14
Suicide
Coukl noI be det8rmlnllCl
2ae. 21b.
CERTifiER (Check on4vonel
'CERTIFYING PHYSICIAN (PhYSIC..n cerlllyll.g cause ot dealtl wne,., ,l(Ioc/ler ptlySICtan hdS Pf~ed de",m ana cOfflpleled lIem 23)
To IhII be.1 01 my know~, death fX(:Uf..... du.. to the c.~.) and IMInMr a. stated. . .
...
~
~
o
w
~
o
~
o
w
~
Z
'PRONOUNCING AND CERTlFVING PHVSICIAN (PhYSICian boII1 ;llonOU/"lClog Oecl.lh dnd certilylng to C<lllStI ot dE-dIN
To Ihe be.1 01 my knowledg., deaUl occurted al the Urn., date, and ptac:e, and due to the causa(aland manner as _laiN.,
'''ED~AL EXAMINER/CORONER
On tM ba.~ Q' .JramJnMJon andJM IO\l8sllg_lIon, In my opinion, death occurred at lhe lime, date, and place, and due to the caus.e.) and
",ann.ra.stated.. .......,."......_..... ..... ......,.,.....
31a.
AEGIST
LAST WILL OF
LILLIAN H. WISE
I, LILLIAN H. WISE, of 22 Ocean Heights Avenue, Linwood, New
Jersey 08221, declare this to be my last Will, hereby revoking all
prior Wills and Codicils.
SECTION 1. IDENTIFICATION-
1.1. Child - I have one child, JUDITH W. WEIKERT.
All references in this Will to my "child" are to said named child.
1.2. Grandchildren - I have two grandchildren, ROGER
WEIKERT and GLENN WEIKERT.
All references in this Will to my
"grandchildren" are to said named grandchildren.
SECTION 2. PAYMENT OF EXPENSES - I direct that the expenses
of my last illness and funeral be paid from my estate as soon as
practicable after my death.
SECTION 3. TAX CLAUSE - All estate, inheritance, succession
and other such tax as payable by reason of my death with respect to
all property comprising my gross estate, whether or not such
property passes under this will, shall be paid out of the principal
of my general estate as if such taxes were administration expenses,
without apportionment or right of rei~bursement. My Executor may
LAW OFFICES
pay all such taxes at such time or times as in his discretion is
deemed most advisable.
THOMAS D. BEGLEY, JR.
A PROFESSIONAL CORPORATION
SECTION 4. SPECIFIC BEOUESTS AND DEVISES -
ATTORNEY AT LAW
P. o. BOX 827
4 .1. Tangible Personal Property - I give certain
tangible, non-business, personal property in accordance with a
written statement or list prepared pursuant to N.J.S.A. 3B:3-11, in
my handwriting or signed by me which describes the items and the
40 E. MAIN ST.
MOQRESTOWN, N...). 08057
devises with reasonable certainty.
I give all of my remaining
tangible, non-business, personal property, including any automo-
biles, together with all insurance on such property to my child.
4.2. Grandchildren - I give and bequeath to each of
my grandchildren the sum of FIVE THOUSAND DOLLARS ($5,000.00).
SECTION 5. RESIDUE - I give, devise and bequeath the entire
residue of my estate unto my daughter, JUDITH W. WEIKERT, or to her
issue, per stirpes.
SECTION 6.
APPOINTMENT OF EXECUTOR - I appoint JUDITH W.
WEIKERT, or in the event of such person's death, resignation,
refusal or inability to act, then MARLENE F. McINTYRE as Executor
of my Will, and neither shall be required to give bond or furnish
sureties in any jurisdiction.
SECTION 7.
APPOINTMENT OF TRUSTEE - I appoint JUDITH W.
WEIKERT, or in the event of such person's death, resignation,
refusal or inability to act, then MARLENE F. McINTYRE as Trustee,
and neither shall be required to give bond or furnish sureties in
any jurisdiction.
SECTION 8. POWERS OF FIDUCIARY -
8.1.
General Powers - In addition to the powers
above provided for, and those given by law, my Executor and
Trustee, without any order of court and in its sole discretion,
LAW OFFICES
may:
THOMAS D. BEGLEY,..JR.
A PROFESSIONAL CORPORATION
8.1.1. Make Investments - Retain any property
ATTORNEY AT L.AW
P. Q. BOX 827
received hereunder and invest and reinvest in any property,
including by way of illustration and not by way of limitation,
common stocks up to one hundred percent hereof, any common or
40 E. MAIN ST
MOORESTOWN, N..). 08057
2
LAW OFFICES
THOMAS D. BEGL.EY. JR.
A PROFESSIONAL CORPORATION
ATTORNEY AT LAW
40 E. MAIN ST
P. O. BOX 827
MOORESTOWN, N.J 08057
diversified trust funds maintained by any bank or savings institu-
tion, and any form of life insurance, annuity or endowment
policies; in so doing, my fiduciary may act without restriction to
so-called legal investments and without responsibility for
diversification.
8.1.2. Purchase Investments - Purchase invest-
ments at premiums and charge premiums to income or principal or
partly to each.
8.1.3.
Stocks and Bonds
Subscribe for
stocks, bonds or other investments; exercise any stock option or
similar right; join in any plan of lease, mortgage, merger,
consolidation, reorganization, foreclosure or voting trust and
deposit securities thereunder; and generally exercise all the
rights of security holders of any corporation.
8.1.4. Registration - In the sole discretion
of the fiduciary, register securities in the name of its nominee or
hold them unregistered so that title may pass by delivery.
8.1.5. Voting - Vote, in person or by proxy,
securities held by it and in such connection to delegate its
discretionary powers.
8.1. 6.
Repair
Repair, al ter , improve or
lease, for any period of time, any property and give options for
leases.
8.1.7. Sell - Sell at public or private sale,
for cash or credit, with or without security, and exchange or
partition property and give options for sales or exchanges.
3
LAW OFFICES
THOMAS D. BEGLEY. JR.
A PROFESSIONAL CORPORATION
ATTORNEY AT LAW
40 E. MAIN ST.
P. O. BOX 827
MOORESTOWN, N.J. 08057
8.1.8. Borrow - Borrow money from any person,
including any fiduciary, and mortgage or pledge any property.
8.1.9. Compromise - Compromise claims.
8.1.10. Trust Additions - Add to the principal
of any trust created hereunder any property received from any
person by Deed, will or in any other manner.
8.1.11. Distributions - Make distribution of
both income and principal in cash or in kind or partly in each.
8.1.12. Post-Termination - Exercise all power,
authority and discretion given by this trust, after termination of
any trust created herein until the same is fully distributed.
8.1.13. Employment of Agents
Employ such
agents as my Executor or Trustee may deem advisable in the
administration of my estate or any trust pre-owned hereunder and to
pay them such compensation if my Executor or Trustee may deem
proper out of income or principal or out of both.
8.2.
Limitations
Notwithstanding any of the
powers conferred upon Fiduciary, no individual acting as Fiduciary
hereunder shall exercise or join in the exercise of discretionary
powers over income, principal or termination of any Trust (1) for
his or her own benefit or (2) to discharge his or her legal
obligation to support any Beneficiary.
8.3. Deleqation. From time to time, any Fiduciary
may delegate to any Co-Fiduciary the exercise of any powers,
discretionary or otherwise, and may revoke any such delegation.
Such delegation and revocation shall be evidenced by a writing
delivered to such Co-Fiduciary.
While such delegation is in
4
LAW OFFICES
THOMAS D. BEGLEY. JR.
A PROFESSIONAL CORPORATION
ATTORNEY AT LAW
40 E. MAIN ST
P. O. BOX 827
MOORESTOWN, N.J. 08057
effect, any of the powers, discretionary or otherwise, so delegated
may be exercised and action may be taken with the same force and
effect as if the delegating Fiduciary has personally joined in the
exercise of such power and the taking of such action.
Anyone
dealing with the Fiduciary shall be absolutely protected in relying
upon their written statements relative to the fact and extent of
such delegation.
8.4. Release of Powers. Any Fiduciary may release
in whole or in part, temporarily or irrevocably, any power,
authority, or discretion conferred by this instrument, by a writing
delivered to the Co-Fiduciary, and to each Beneficiary then
eligible to receive income distributions from any Trust.
Such
renunciation or release shall not affect the grant of power,
authority, or discretion renounced or released to the Co-Fiduciary
then acting.
SECTION 9.
AGE REOUIREMENT - If any person, other than my
child named in Section 1, less than thirty (30) years of age is
entitled to receive a share under this Will, then although such
share shall vest immediately and indefeasibly, my Executor shall
pay such share to my Trustee herein named to be administered as
herein provided.
My Trustee shall invest and reinvest the
undistributed share.
One-half (1/2) of said share and any
accumulated income shall be distributed to such person when he or
she attains the age of twenty-five (25) and the remainder shall be
distributed to such person when he or she attains the age of thirty
(30) .
At any time prior to the attainment of the age of thirty
(30), my Trustee may, in Trustee's discretion, use so much of the
5
LAW OFFICES
THOMAS D. BEGLEY, JR.
A PROFESSIONAL CORPORATION
ATTORNEY AT LAW
40 E, MAIN ST.
P. O. BOX 827
MOORESTOWN, N.d_ 08057
net accumulated income and principal of said share, even to the
point of exhausting principal, as my Trustee, from time to time,
believes desirable (i) for the health, support, education, best
interests, and welfare of such person, (ii) to permit him or her to
enter into or engage in a business or profession in which my
Trustee believes that he or she has reasonable prospects for
success, and (iii) to permit him or her to make a reasonable down
payment on a personal residence.
SECTION 10.
RULE AGAINST PERPETUITIES - Anything herein to
the contrary notwithstanding, no Trust hereunder shall extend
beyond twenty-one (21) years after the death of the last survivor
of myself, and my issue living at the date of my death.
At the
expiration of that period my Trustee shall distribute the remaining
portion of any Trust property in my Trustee's hands to the
beneficiaries entitled to the income thereof at that time.
IN WITNESS WHEREOF I subscribe my name this 29th day of
August, 1996.
~~ Ie\- ~,,~
LILLIAN H. WISE
The foregoing instrument was signed, published and declared by
LILLIAN H. WISE, the Testatrix, to be the Testatrix's Last Will and
Testament in the presence of each of us, present at the same time,
and we, at the Testatrix's request and in the Testatrix's presence,
and in the presence of each other have hereunto subscribed our
names as witnesses this 29th day of August, 1996.
d
''1 1
0~:hr'_~
(J~?iG ~a /kv-
6
LAW OFFICES
THOMAS D. BEGLEY. JR.
A PROFESSIONAL COR~)ORATION
ATTORNEY AT LAW
40 E. MAIN ST.
P. 0_ BOX 8~~7
MOORESTOWN, N...). 08057
WE, the Testatrix and EDWARD LADREW & CATHERINE LADREW
the witnesses, respectively, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testatrix signed and executed
the instrument as his/her Last Will and that he/she signed
willingly and that he/she executed it as his/her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the
Will as witness and that to the best of the witnesses' knowledge
the Testatrix was at the time eighteen years of age or older, of
sound mind, and under no constraint or undue influence.
(, (-eJ!.,~-""h. \=L ~:-l< 0 i A7 .~-
LILLIAN H. WISE, Testatrix
G~~~ ;;f; Jt~
W1.tness
,'r ~ o' 4 "T'
'- r<<;;. <1 ("916' . A.1,.. /7<'4-"/'0'
Witness
STATE OF NEW JERSEY
ss.
COUNTY OF ATLANTIC
Subscribed, sworn to and acknowledged before me by LILLIAN H.
WISE, the Testatrix, and subscribed and sworn to before me by
EDWARD LADREW & CATHERINE LADREW , the witnesses,
this 29th day of August, 1996.
,J . y
..........~&<~
t/ -
JANE l. LEITH
A NotIfy Public of New Jersey
My Commission Expires 7/1/99
7
21-01-186
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewi , (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that
request of testat_ in h presenc
other subscribing witness(es)). //
,/
Sworn to or affirmed and subscri~~ before
me this ./ day of
/
19_
signed as a witness at the
and (in the presence of each other) (in the presence of the
(Name)
(Address)
/1
"
Register
(Name)
,.
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
~/M/Ih 1/), JtJ~hd- tVi1L :Ilia/II? EI Mm1tfS,
-
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and. say(s) that
We- are.-, familiar with the signature of ,)////0/1 /../, IuIS~
codicil
~ presented herewith and
. codicil
believes the signature on th@ is in the handwriting of
testat.1.x-- of (one of the subscribing witnesses to) the
that
I_de-
j ; / //411 J-I, !u/ ;~
to the best of OrA r
knowledge and belief. (;Jv.-L/ffi)f.J1 ~d-
tCfUdlfh t{), t1J t" I 'k -f' v~
.4 (Nam~ .
L/!o idal/kL W. JJltd~~liK.5kN J;11 j;ys-o
dIJ.:[) rri-l IE' --nrA'3J1ls~ J J _
~ ~ ~rl-<<~
/J (Name) /J
-y'a 7 r~ ~. ~~, ~~.
/7ttJS?:J
Sworn to or affirmed and subscribed before
me this 15th day of
f FEBRUARY XP9 2001
'/'Y (Z;Y///);h~~ 4//~1
Register
(Address)
~0!-- ~)'\%I'P' 1'1 '\ cI
)
~~~" ~~~
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Lillian H. \Ji.se
Date of Death:
TanUelry 29, 2001
Will No.
21-2001-0186
Admin. No. N / A
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on May 24. 200 1
Nam~
Address
Judith W. Weik~rt
410 Pawnee Drive, MechanicRubrg, PA
17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: May 2 4, 200 1
Signature
Name Paul Bradford Orr, Esquire
Address 50 E a s t Hi g h S t r e e t
Carlisle, PA
17013
Telephone ( 7 1 Y 2 58 - 8 5 5 8
Capacity: _ Personal Representative
-X-Counsel for personal representative
/Cr-dJ()-/3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
v
an-U07 EX iFP Cl2-DDI
PAUL BRADFORD ORR
PAUL B ORR LAW OFFICES
50 E HIGH ST C:2'1
CARLISLE PA 17V.llJnbf.:.;
FEB 13
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-14-2002
WISE
01-29-2001
21 01-0186
CUMBERLAND
101
LILLIAN
H
ReG').
Roc
'02
f11:,\ ."7
~-\!U ..4
Allount RelliUed
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 ~
ifEV=i6"o-j-ix-AFP-fi'2=ooY------...-iNiiERITANC'E-fAX-STA-fEME-tif-oF'-AC-couiff--.-i.---------------- -----
ESTATE OF WISE LILLIAN H FILE NO.21 01-0186 ACN 101 DATE 01-14-2002
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: 12-17-2001
P R I NC I PAL TAX DUE: ...................................................................................................................................................................................---.......-...............
2,831.06
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-29-2001 AA478215 141.55 3,400.00
12-28-2001 REFUND .00 710.49-
TOTAL TAX CREDIT 2,831. 06
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 $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
'v /6--Q/O-KJ
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
- BUREAt~ OF INDIVIDUAL TAXES
INHERIfANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ReGon:1e -j
Aepi::,;-c
"02 JAN -4 Pi2 :36
PAUL BRADFORD ORR
PAUL B ORR LAW OFFICES
50 E HIGH ST Cler~:-'
CARLISLE PA It1vftle,:;; H\
12-24-2001
WISE
01-29-2001
21 01-0186
CUMBERLAND
101
'*
REV-1547 EX iFP 1l2-DO)
LILLIAN
H
AIBount ReIBiHed
(9)
(10)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
57.595.14
.00
.00
15,995.22
5.579.46
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdIB. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/GovernlBental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
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=i54-j-EX-AFP-n2=OOY-NOYicE--OF-YNHEifiTANCE-YAX-XPPRAISEMENT-,--Aii-oWANcE-oR'-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WISE LILLIAN H FILE NO. 21 01-0186 ACN 101 DATE 12-24-2001
TAX RETURN WAS: ( ) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
L Real Estate (Schedule A)
2" Stocks and Bonds (Schedule B)
3.. Closely Held Stock/Partnership Interest (Schedule C)
4.. Mortgages/Notes Receivable (Schedule D)
5" Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
NOTE:
( X) CHANGED SEE ATTACHED NOTICE
9,010.38
7.247.06
(11)
(12)
(13)
(14)
.00 X
62,912.38 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
subIBit the upper portion
of this forlB with your
tax paYIBent.
79,169.82
Hi ,,257 44
62,912.38
.00
62,912.38
00 =
045 =
12 =
15 =
.00
2,831.06
.00
.00
2,831.06
(19)=
PAX CREDITS'
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-29-2001 AA478215 141. 55 3,400.00
TOTAL TAX CREDIT 3,541.55
BALANCE OF TAX DUE 710" 49CR
INTEREST AND PEN. .00
TOTAL DUE 710.49CR
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. AIBount of Line 14 at Spousal rate (15)
U. AIBount of Line 14 taxable at Lineal/Class A rate (16)
17'. AlBOunt of Line 14 at Sibling rate (17)
18. AIBount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
C/;
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
h\LL\AN
H, WlSF
Date of Death:
Will No.
2.00 1- 0 0 \ g Co
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
rE!presentative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
the personal
sonal representative file a final
No X. -
r-\LE.!) ~f!JH -r1J). Rb'..TURN...
b. The separate Orphans' Court No. (if any) for
representative's account is:
a. Did t
account with the Court?
c. Did the personal representative state an
account informally 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
~:::,O~:I~I;~hans' Court and may be ?Jr~ ~o ~eport.
Signature
PAUL fS. OR~
Name (Please type or print)
So EAST HI trH Sf
Address
n I~) 'cA )~.. <jS-5~
Te 1. No.
Capacity: Personal Representative
~counsel for personal
representative
(MAH:rmf/AM3)
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/06/2002
JUDITH W WEIKERT
410 PAWNEE DRIVE
MECHANICSBURG, PA 17050
RE: Estate of WISE LILLIAN H
File Number: 2001-00186
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/29/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
MARY C. LEWIS
REGISTER OF WILLS
cc:
')File
Counsel
Judge
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