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Home My WebLink About01-0202 c. OFFICIAL USE ONLY REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /&-;2/),-/ FILE NUMBER D E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Jones Mar ie M. DATE OF DEATH (MM-DO.YEAR) NUMBER 21-01-0202 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 206-38-9026 THIS RETURN MUST BE FilED IN DUPUCATEWlTH THE DATE OF BIRTH (MM-OD-YEAR) REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate (Attach copy ofWfll) D 9. LItIgation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) X 7. Decedent MaintaIned a LIving Trust (Attach copy of Trust) 010. Spousal Poverty Credit (date of death between 12-31-91 and 1- 1-95) o 3 date of death " Remainder Return rlor to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) C P 0 0 John E. Slike, Es uire R N FI RM NAM E ([f Applicable) R D 2109 Market Street E E Saidis, Shuff, Flower & Lindsa Camp Hill, PA 17011 S N T TELEPHONE NUMBER C o M P T U A T X A T I o N R E C A P I T U L A T I o N 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule r) (10) 11. Tolal Deduc:tions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub "eel to Tax (Line 12 minus Line 13) (8) 655,201.49 (11) 16.106.33 (12) 639,095.16 (13) (14) 639,095.16 (1) (2) (3) OFFICIAL USE ONLY None 646,776.00 None (4) (5) None 8,425.49 (6) None None 12,979.10 3,127.23 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 639,095.16 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. (15) (16) (17) (18) (19) .0 0 .045 .12 .15 x X X X 0.00 28,759.28 0.00 0.00 28,759.28 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Oecedent's Complete Address: STREET ADDRESS 1700 Market Street CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 28,759.28 0.00 25,000.00 1,315.79 Total Credits ( A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 26,315.79 Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make~heck Payable to: REGISTER OF WILL~, AGENT . :; ': ,:ii:,:j::,:i::,::::,:i::,:::i::::i::,:i::":!:i::i!i!!}!i!i!!i!im!i!!!!!!!i!. :!!!!!i!!!:i!i!!!!i!!i!i!!j:i::j:jj:j~:;:::;::::'::::' .".. ..'::;: .:il;:;:::;::;::::::::'::::::;:;!!i;!i!!ii:ii ;~:~i:!:!!:!:!!!!!!!!!!!!!!IJi!iiJJ!]!i! i!!!]!!!!i!! iiii!iiii!iiii!i!ii!i!i!!!!!!!!!!!!i!!!!!!!!!!!!!!!!!!!!!!!!II! !!!!i!l!W!!!!! !!!!!!!!!!!!iI!!!!!!i!!iii!ii!!i iii" . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X,; IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 8. retain the use or income of the property transferred; . ~ ~x~ b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 2,443.49 0.00 2,443.49 D D D ~ ~ ~ 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 preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Robert E. Jones 1026 East Lisburn Road -- M':;~hani;'-';b':'r--; -PA --ii055- --- -- - -- --- --- -- - --- Saidis, Shuff, Flower & Lindsay 2109 Market Street ----------------------------------------------------- Carn Hill PA 17011 DATE ~ t../ /1 :r...,~~ ", DATE For d es of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (il]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% (72 P.S. 9116 (a) (1.1) (iO]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aXn]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) . REV-1503 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Margie M. Jones SSfl 206-38-9026 02/06/2001 All property jointry-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-01-0202 ITEM VALUE AT DATE DESCRIPTION UNIT VALUE NUMBER OF DEATH Funded Revocable Trust, PNC Bank Trustee consisting of: 1 B1ackrock PA Muni Money Market Principal 6,000.00 2 B1ackrock PA Muni Money Market Income 2,472.00 3 900 shares Carlisle Companies, Inc. 40.54 36,486.00 4 2300 shares Tyco IntI. Ltd. 60.95 140,185.00 5 1398 shares Ford Motor Co. 28.74 40,179.00 6 150 shares General Motors 58.12 8,718.00 7 600 shares Rite Aid Corp. 4.31 2,586.00 8 620 shares Kellogg Co. 27.28 16,914.00 9 700 shares Exxon Mobil 84.34 59,038.00 10 429 shares CitiGroup, Inc. 55.13 23,651. 00 11 800 shares PNC Financial Services 74.00 59,200.00 12 2700 shares Pfizer Inc. 45.85 123,795.00 13 159 shares General Motors Corp. 27.71 4,406.00 14 1126 shares Evergreen Equity Tr Blue Chip 29.23 32,921.00 15 1450 shares Evergreen Equity Tr Growth 7.78 11,278.00 16 887 shares Evergreen Equity Tr Balanced 8.79 7,800.00 17 3818 shares B1ackrock Funds PA Tax Free Port. 10.82 41,422.00 18 617 shares Evergreen Equity Tr Balanced FD CIA 8.79 5,422.00 19 2608 shares Evergreen Fixed Income Tr High 3.51 9,155.00 20 15000 shares Conestoga Valley Sch Dist. PA 100.82 15,122.00 21 3 shares Evergreen Equity Tr. Balanced Fund 8.79 26.00 TOTAL (Also enter on line 2, Recapitulation) 646,776.00 (If more space is needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) . REV-1508 EX t (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mar~ie M. Jones SS# 206-38-9026 02/06/2001 21-01-0202 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 2 3 4 5 DESCRIPTION PNC Bank, checking account # 5140032365 Medical Expense, refund Verizon, refund Cornerstone Administration, refund of medical costs Blue Cross/Blue Shield, refund of premium VALUE AT DATE OF DEATH 7,217.03 405.61 10.60 475.35 316.90 Note: Personal property and household furniture was adeemed TOTAL (Also enter on line 5, Recapitulation) S B, 425.49 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-150a EX (Rev. 1-97) . REV-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Margie M. Jones SSfl 206-38-9026 FILE NUMBER 21-01-0202 02/06/2001 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES, B. DESCRIPTION AMOUNT Myers-Harner Funeral Home, Inc. 1,900.00 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative{s) Social Security Number(s) I EIN Number of Personal Representative{s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees Saidis, Shuff, Flower & Lindsay Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 10,187.00 City Relationship of Claimant to Decedent State Zip 4. Register of Wills Probate Fees 442.00 5. Accountant's Fees 250.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs Cumberland Law Journal, advertising The Patriot News, advertising Register of Wills, filing fee 75.00 110.10 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 12,979.10 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) , , REV.1S12 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margie M. Jones SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS!! 206-38-9026 02/06/2001 FILE NUMBER 21-01-0202 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 DESCRIPTION Neighbor Care Pharmacy, medication West Shore Anesthesia Assoc, Internists of Central Pa, medical expense Manor Care, final bill Metropolitan Medical, ambulance service AMOUNT 798,06 715,00 100,00 1,454,17 60,00 TOTAL (Also enter on line 10, Recapitulation) S 3,127.23 (If more space is needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) '. . REV-1513 EX +(9-00) . . COMMONWEALTH OF PENNSYLVANIA INHE:;RITANCET/JJ( RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Margie M. Jones SSlf 206-3B-9026 02/06/2001 FILE NUMBER 21-01-0202 R.LATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Include outright spousal distributIons, and transfers under Sec. 91 16(a){1.2}1 1 Margie Ann King 14 Robin Hood Trail Berlin, MD 21B11 Robert E. Jones 1026 East Lisburn Road Mechanicsburg, PA 17055 Gwendolyn M. Jones P.O. Box 591 Camp Hill, PA 17011 Jeffrey A. King 13055 Falcon Point Place Truckee, CA 96161 Kevin E. King 610 Hidden Branches Wintervi11e, NC 28590 Rebecca E. & Russell E. Jones 1026 East Lisburn Road Mechanicsburg, PA 17055 daughter 25% res idue 2 son 35% residue 3 daughter 20% residue 4 grandson $5,000 cash, 5% residue 5 grandson $5,000 cash, 5% residue 6 granchildren $5,000 cash, 5% residue to each ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c:) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9~OO) Estate of Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS No. ~ J- ~ 1- ..1.b.:L Margie M. Jones also known as , Deceased Social Security No. 206 - 38 - 9026 Robert E. Jones Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [KJ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 11/01/1995 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: D B. Grant of Letters of Administration (c.I.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationshio Residence 1 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 1700 Market St., Borough of Camp Hill, Camp Hill, PA 17011 (list street, number, and municipality) Decedent, then ~years of age, died 02/06/2001 at Manor Care Health & Rehab, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 650,000.00 $ $ $ $ situated as follows: none Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si nature Robert E. Jones 1026 E. Lisburn Rd., Mechanicsbur , PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. . , Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. /~v~ Robert E. .tones Sworn to or affirmed and subscribed a. before me this~ day of ,-=-::j~'m.lAJr-.J-.J-- ' c:20" / , l, "CU<fj- () .4 LU<~ 'f!' I'd )I.t'~~, ~ '- For the Register N~ 21-01-202 Estate of Margie M. Jones Deceased Social Security No: 206 - 38- 9026 Date of Death: 02/06/2001 AND NOW, FEBRUARY 21, 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [RI Testamentary 0 Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Robert E. Jones in the above estate and that the instrument(s) dated 11/01/1995 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . $ 410.00 $ 15.00 , '-rYxv{f ('. X'p.-<,~ fU' e. ~,.,jj/;;;zZA->6, ~ I , -L Register of Wills r P'ft4 Attorney: Sl ike Affidavits ( $ 1.0. No: 262 Saidis, Shuff, Flower & Lindsay 2109 Market St. Short Certificate(s). .5. Renunciation. $ Extra Pages ( 4 ). $ 12.00 Address: Codicil. . $ Camp Hill, PA 17011 JCP Fee. $ Telephone: 717/737 -3405 Inventory. $ Other $ 5.00 TOTAL. $ 442.00 MAILED TO ATTORNEY FEBRUARY 21, 2001 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) H105.805 REV 918(, This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7176249 No. a~./ ,/31.., .-;7/,., ~ <. ". ~-::'-0 .,;-. <.-e::.i'"'t~ ~_..yro .~"? y~.'--'-'-"-~ Local Registrar (/ FEB 0 8 2001 Date ) Re",. 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH NAMEOFOECEOENT(fll';, Mtdoa..l_J -------..--------------- SEX .. AGE(L"'_vI Mari UHOER . YeAR - llayo M 93 v,.. Jones UNDER . DIft -lM- z. 8lRTHPLACE (Coty ar.d S\8Je 01 FCf8lgn CounffV. PlACE OF OEAI'H ICt'>eck 0f\Iy l'lf"\e .. 'OSlruct.oos on 0Ihet ,.gel HOSPITAL, Inpa._ 0 ER/OuqIolio", 0 7,Lebanon, PA ... FAClUTY NAME (II noIlnst'MIOO, give slreet and numbefl ::".,10 ();d - IMl it,. _1 t7d.GG :"'''"::'.':::01 Camp Hill Bora MOTHER'S NAME ,First, MIddte. Malden Surnamel ... Stella Walmer INFORMANT'S ....lllNO ADDRESS (SUoo.. QlyITown. _. z;p ~ .1026 E. Lisbum Rd.., Mechanicsbur , PA 17055 PlACE OF DISPOSITION. N.... oIc-"Y. CI_ lOCATION .C~, Sl.... Z1I>~ Of 0IMf Plac. __ M. PlACE OF INJURY" AI: home, farm, SI'"" factory, omc. building. Me. cSpeedvl -- _.... _. CEllTNIIIChock Oriy onot -ClRTFntIG PHYSICIAN (Physcaen certiynJ cause d death ..nen anolhef phYSlCI8n has pronounced death ana completed ttem 231 ,.....beeI..""knDwIedge...lhoc:cun..s.........cauM(.)andm.nner.....ted............................................. . 5. COUNTY OF DEAl'H Cunberland Camp Hill Bora ... tel. KIND OF BUSINESS/INDUSTRV 'oNOS DECEDENT EVER IN US. ARMEDFORCES1 Yoo 0 No 6a ... DECEDENT'S USUAl OCCUPoVION (~~~:'''::'~~:'l' . Uo. Re istered Nurse ub.Private Prac. MD DECEDENT'S MAIlING ADDRESS ($b... c"'~. _. Z",C_1 DECEDENT'S 1700 Market Street ~~'::NCE Camp Hill, PA 17011 ;"'~ ... FAl'HER'S NAME (FlrSl. Midde. last) '2. 13. 17.. Slate Pennsvlvania 'lb. Cumberland ". INFORMANT'S NAME (T ypWPrinl) James G. Moore Robert E. Jones IolETHOD OF DlSPOSlTlON _ 0 cr--..fi ___.0 Dllw 21c. :U. 27. MAT I: Enlet.... diM..... injuries Of complications which l;., only one CauM on HCh line. _TECAU8ElFinaI ~cw condihon r....no If1 ded'l)---.. A:rH DUE 10 (OR AS"A CDNSEOU NCE Of): .. ~..- iI_-.a.._ ~. EIur UlC)EJlLY1NQ _ (llooooooOf.....y ...~.,.. '-*'11" _I lAST l : d. DUE 10 (OR ASA CONSEQUENCE Of): DUE 10 (OR AS A CONSEQUENCE Of): 'oNOS AN AU10PSY WERE AUlOl'SY FlNDlNGS IoIANNER OF DEATH PERFORMED? -.uBlE PRIOR 10 COMPLIITION OF CAUSE LV-- 0 OF DEAl'H7 NoI_ - -'" 0 ""__igatlon 0 ... 0 No YooO No 0 _ido 0 CoukS noc be del..-mlned D DATE OF INJURY (Month. Day. ""1 ~PAOHOUMClNG AND CERTIFYING PHYSICIAN (Phy5K:.an tloIh ptooounc;tog oealh and cettdyll"lQ to cause Of death\ To IhII beet of my knowlecf9a. death occurred at 1IMIIIIhtI, date, and piKe. and due to... cauH(.) and manner.. .tated.. ............ "MEDICAL EXAIIINER/CORONER On the buia of ..am'natlon and/or Inveltltation. in my opinion, de.th occurred.' t....Um.. d.te. and place, and due to the cause(_) and 1118ftftef.. "ated.. .. . . '" . . . . . .. . . . . _... . .. . .. . . . .... .. . . . .. ... .... ..... .. . ... .. . ... ... _ ... . ... . .. . .. .... . . . . . .... )1._ REG' 33. 's SIGNATURE AND NUMBER ...~~ ~/P?"'-;/I STATE FILE NUMBER SOCIAl SECURITY NUMBER 3. 206 38 9026 DATE OF DEATH IMCNh. 0..,. ........ .. February 6, 2001 0000 RACE. American Indian. BIadt.. Whit.. etc. (~) MARITAl STATUS._ Never Man.. Widowed. Wi~r White SURvlVING SPOUSE tlf..... gtv. rnaICS8R nwne) ... 170.0....__.. 1Wp. - PA St, CH, PA 17011 ORE SIGNED _.DoY. _. :I3b. Z3c. MIl CASE REFERRED TO MEDICAl EXAMINERlCDRONER1 YooKX FD NoD K. I AppIoximal. I interval betWeen : 0RHl and death I . I PAR7H: Dllwlig,.;/lconl_"""""""'"lto_.... nollOSUlling..tho..-.y;ng _ givon.. PoUl7 I. 7>~t '1 TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. ... 0 NoD lOCRIQN (SOl... CoIyITown. SIarel ~f o 34. SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA 21-01-202 LAST WILL AND TESTAMENT OF MARGIE M. JONES I, MARGIE M. JONES of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testa- ment, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I direct that my executor hereinafter distribute my tangible personal property in accordance with written instruc- tions made by me on a separate list. In the absence of such a list or designation on said list, my executor shall distribute my tangible personal effects among my three children as he, in his discretion shall determine. Any items not distributed shall be sold at a public or private sale and the proceeds thereof added to the residue of my estate. III - I bequeath the sum of $5,000 each to my grand- children, Jeffrey A. King, Kevin E. King, Rebecca E. Jones and Russell E. Jones. IV - I devise and bequeath all the rest, residue and remainder my estate of whatever nature and wherever situate as follows: /hms- Page 1 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill. PA A. I bequeath 25% of said residue to my daughter, Margie Ann King. Should she predecease me, her share shall be divided evenly between her children, Jeffrey A. King and Kevin E. King, the share of a deceased beneficiary to be paid to his issue per stirpes. B. 5% of said residue shall be paid to my grand- son, Kevin E. King, or his issue per stirpes. C. 5% of said residue shall be paid to my grand- son, Jeffrey A. King, or his issue per stirpes. D. 35% of said residue shall be paid to my son, Robert E. Jones. If he predeceases me, his share shall be divided evenly among his widow, Carolyn B. Jones, and his chil- dren, Rebecca E. Jones and Russell E. Jones, the share of a deceased beneficiary to be paid to his or her issue per stirpes. E. 5% of said residue shall be paid to my grand- daughter, Rebecca E. Jones, or her issue per stirpes. F. 5% of said residue shall be paid to my grand- son, Russell E. Jones, or his issue per stirpes. G. 20% of said residue shall be paid to my daughter, Gwendolyn M. Jones. If she is deceased, the gift to 'Y>1 m r- Page 2 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill. PA her shall lapse, and it shall be divided proportionately among the surviving beneficiaries, the share of a deceased beneficiary to be paid to his or her issue, per stirpes. v - I direct that any debts owed to me by any of my children or grandchildren shall be considered as lifetime gifts to them and shall not be deducted from their respective shares of my estate. VI - All taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be considered a part of the expense of the administration of my estate and my personal representative shall have the absolute power in his or her discretion to pay the same at once whether or not the law under which they are imposed permits the postponement of all or part of them to a later time. VII - I appoint my son, Robert E. Jones, Executor of this, my Last Will and Testament. Should my said son fail to qualify or cease to act as such, then I appoint my daughter, Margie Ann King, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. YVLmS Page 3 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA this, the IN WITNESS WHEREOF, I have hereunto set my hand and seal on /4j"- day of II ~'-f!u.... , 1995. .~ m __T~ M gie M. Jones (SEAL) Signed, sealed, published and declared by MARGIE M. JONES, Testatrix therein named, on this and three (3) other sheets of paper as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~ ! I / I. LA ~) ~~ Name (J I/v.g // vU..l . J' Address! ~\Qlr" 1J1\ Address / .~ 1/ fi' . ~ Page 4 SAIDIS, GUIDO, SHUFF & MAS LAND 2109 Market Street Camp Hill. PA COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will 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 witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~ m ..:::::r~~ Testatrlx Subscribed, sworn to and acknowledged before me by the testatrix, and s~scribed and ~ to before me by both wit- nesses, this I~ day of ~ , 1995. vY'C(,~ otary Public NOTARIAL SEAL THElMA S. ~cCAUSUN. Notary Public Camp HIli.. CUf!lberland County My Commission Expires July 3. 1996 \ /b-/.s~-/~ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-UD7 EX AFP lDl-D51 JOHN H BROUJOS ESQ BROUJOS 8 GILROY 4 N HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER C9UNTY ACN ' 01-23-2003 VUIlLEUMIER 02-24-2000 21 00-0202 CUMBERLAND 101 FRANCES S Allount Rellitted 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'ifi-E;f-A~:p-(oY:03T------..i"-iNiiERiTANCE--TAX-STAfEMEN"T-ifF'-Accoui-ff--i"i.------------------ --- ESTATE OF VUIlLEUMIER FRANCES S FILE NO. 21 00-0202 ACN 101 DATE 01-23-2003 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: 02-12-2001 PR I NC I PAL TAX DUE: .....,....",....,....",.."..,...."....."..."......"..""..."....",,,....,..,..,".."'...._..""..."""""..."'''..'''....,,,..,,,,....,,...'''...'''''''''..'''''.,.,,,...,,,,,..,,,....,,,,..,,,,,..,, 165,789.54 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-18-2000 AA425593 8,157.89 155,000.00 12-04-2000 AA451537 .00 2,631.65 01-22-2003 WRITEOFF .00 5.76 TOTAL TAX CREDIT 165,789.54 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 II 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" lCRJ, ".. -.... -- ~..., & Dl::l::lINn ~FI= REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J r ... REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(~) i---. - Name of Decedent: Margie M. Jones Date of Death: February 6, 2001 Will No. 21-01-0202 Admin. No. To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March to , 2001. Name Address Margie Ann King Robert E. Jones Gwendolyn M. Jones Jeffrey A. King Kevin E. King Rebecca E. Jones Russell E. Jones 14 Robin Hood Trail, Berlin, MD 21811 1026 E. Lisbum Road, Mechanicsburg, P A 17055 P.O. Box 591, Camp Hill, PA 17011 13055 Falcon Point PI., Truckee, CA 96161 610 Hidden Branches, Winterville, NC 28590 1026 E. Lisbum Road, Mechanicsburg, P A 17055 1026 E. Lisbum Road, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: '~/S' /01 -, ! ~ ~ ~1" /J ..uv"- John; . Slike, EsqUlre SAIbIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, P A 17011 (717) 737-3405 Capacity: _Personal Representative X Counsel for Personal -- Representative IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~ V STATUS REPORT UNDER RULE 6.12 Name of Decedent: Margie M. Jones Date of Death: February 6, 2001 Will No. 21-01-0202 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: complete: 1. Yes State X ; whether No administration of the estate lS 2. If the answer is representative reasonably believes complete: Within next three months been prepared and filed. No, state when the personal that the administration will be - after income tax returns have 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes ; No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X; No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: f1"1Ui "] :LOGJd-- j S' nature. me: John E. Slike, Esquire 1.0. No. 06262 SAlOIS, SHOFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 'Z:,' -,- Capacity: Personal Representative ~" - ,-, ~,! 9 X Counsel for Personal Representative ....,. ....-- /(; -did --J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE s'f~ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JOHN E SLIKE ESQ SAIDIS ETAL 2109 MARKET ST CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-30-2001 JONES 02-06-2001 21 01-0202 CUMBERLAND 101 '* REV-1547 EX AFP 112-00) MARGIE M Amount Reali tted ',PA 17011 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-:o0Y-NOYicEOF-YtiHERiTANCE-YA'X-APPRAISEMEN:r,--ALI"owAifcE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JONES MARGIE M FILE NO. 21 01-0202 ACN 101 DATE 07-30-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED I~ an assessmen~ was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will re~lec~ ~igures that include the total o~ ALL re~urns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 646,776.00 .00 .00 8,425.49 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) ClO) 12,979.10 3,127.23 CllJ Cl2) Cl3) Cl4) NOTE: .00 639,095.16 .00 .00 X 00 = X 045 = X 12 = X 15 = NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 655,201.49 16.106.33 639,095.16 .00 639,095.16 Cl9)= .00 28,759.28 .00 .00 28,759.28 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-02-2001 AA496550 1,315.79 25,000.00 06-14-2001 AA496728 .00 2,443.49 TOTAL TAX CREDIT 28,759.28 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 A D~I:'IIUn ~r~ nr"I......__ ---- -- ----- - - -- ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. _........... __'_.-','~:~ r--- _ _____.____._ _.-_ - ---:- - - --- ---,.",....--.:- --' -..---~.---...:-.-.-.-.---..,~...-..,-:,.-.--.............-:-.-..-'-.-----""""t - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 '* No.AA 496728 REV-ll62 EX (11-96) PENNSYL V A~IA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: I Sl..IKE JOHN E 2109 MARKET STREET CAMP HILL. PA 17011 ESTATE INFORMATION: l FILE NUMBER fil-tlOO1-0eOe BSN eOh-3S-902h NAME OF DECEDENT (LAST) (FIRST) (MI) JONES MARGIE M '" DATE OF PAYMENT h/U5/2001 POSTMARK DATE 0/14/2001 COUNTY CUMKALAND DATE OF DEATH 2/06/2001 ~ REMARKS C/O JOHN E Sl..IKE ESQUIRE CHECK" 110 SEAL REGISTER OF WILLS <------_.._._,~_._---- ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 .2,443.49 .;t. ~ -~ , ~ " FOLD HERE -~ .. , \\ ,,'~ .. .,.~ .. . .. ~ . .. '" . i ". I ~ ./ , .:..~.... ~ ..... . . 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