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Home My WebLink About01-0237 PETITION FOR GRANT OF LETTERS Estate of Norman L SOMERS No. c::J.-./- 0 I - ~ 3 7 also known as , Deceased Social Security No. 211-03-2578 Bettie J SOMERS Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) GJ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ~_ named in the Last Will of the Decedent, dated March 23, 1989 and codicil(s) dated See attached Renunciation of E. Duane Somers, first named Executor. Renunciation is due to incapacity of E. Duane Somers to serve. State relevant circumstances, e.g., renunciation, death of executor, ete 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 incapacitated: o B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite. durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (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 7-B Mainsville Road, Shippensburg, Southampton Township, Pennsylvania (list street, number and municipality) Decedent, then 87 years of age, died 12/08/2000 _' at Hollidaysburg Veterans Home, Hollidaysburg PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property......................................... $ 30,000.00 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County.............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total..................................................................................................................... $ Real Estate situated as follows: 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 appropriate form to the undersigned: I Signature Typed or printed name and residence I x '~3 j-~ /-,' /' ~ /" I / J A- -- --<r...---t:_--v ; '. .J' / i:c.-j Ly;",/ Bettie J Somers, 65 West Kinq St., Shippensburg PA 17257 \..- IG- -9.l4-0 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and 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 ~co.rdiqg tolaw-,,/ Sworn to and affirmed and subscribed ~. >:) jt~/ JJ {j . (:/f~12~ J-ty~_/- ) ,if aJay of v before me this _ I '/7Ja/U:!~ 6){)O / '--t2/t2j {'. XcLur.h .JiU.I. f'. a.?1:~ Estate of Norman L SOMERS DECREElOF REGISTER Deceased No. 21-01-237 also known as Social Security f'[o: 211-03-2578 Date of Death: 12/08/2000 AND NOW, MARCH 5, , 2001 _ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I!I Testamentary 0 of Administration ((c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minoriate) are hereby granted to Bettie J SOMERS in the above estate and that the instrument(s), if any, dated March 23, 1989 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 60.00 Short Certificates( s) .......)..... Renunciation .......................... Extra Pages ( 1 ).. . .... .. .. .. .. I. T. R. ...................................... JCP Fee................................. Inventory ................................ Other..................................... . Yn7~ Co ct .<,n:J, /IilLi .1"11. ,~7Du ,QJ.f"d-iJ- ' Register of Wills ' $ $ $ $ $ $ $ $ 9.00 5.00 3.00 ~~~ Signature 5.00 Attorney: Forest N Myers, Esq. 1.0. No: 18064 Address: 137 Park Place West Shippensburg Telephone: 717 532.9046 PA 17257 532.8879 (fax) 82.00 TOTAL............................ .$ DATE FILED: MARCH 5. 2001 MAILED LETTERS TO ATTORNEY MARCH 5, 2001 H105.905 REV.(09/0m This is to certifY that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records III accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. C\~s.~/~. Robert S. Werman, Jr., MPH Secretary of Health No. ~II~ Charles Hardester State Registrar 1308905 DEe 2 7 2000 Date Hl05. 143 A"". 2187 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH TY_T IN PERMANENT IkACII. INK ,. NORMAN SEX 2. male STIcrE Ftl.E NUloltlER SOCIAL SECURITY NUMBER 0:1 3.211 -03 NAME Of DECEDENT (FI(Sl Midde. LallI AGE (Last Bir1tlday) UHOl:fll YEAR 82 -- Dayo YIS. IIlflTHPLACE (City aAd Pl.ACE Of DEATH (Ched< oolv one _ ""'ucb"". "" _ _, Sta,. Of FOf""l" Coun"VI HOSPtTAL: Inpal_ 0 7. ... FAClLrTY NAME (If noc: insMubon. gIve streel and number; S. COUNTY Of DEArH Blair ... DECEDENT'S USUAl OCCUIWlOH ~-=:~~::~~ . llL lID. OECEOEHT'S MAlUNG ADllAESS (Slreot, CAyITown. SIaIo. ZlCl Code) 7-B Mainsvile Road ~Shippensburg,PA 17257 SURVIVING SPOUSE iK_.(lMl_nomol - FoUHER'S NAt.AE (F.... M;Qdlo. Last) city/bon> Charles Chalmer Somers NAME ANO AllllAESS Of FAClUTY ~.D.Heath Funeral Home, Mt.Union,Pa LICENSE NUMBER -.J 24. 27.IWn'I: EnI., the _ 01juri0s 01 compIical;ono""""" caused ,he u.t onty OIW cause on each line H. I Approximate ; int.... between : onset and dMIh i /J':- PART II: 0tIw sOgMicanI condiliono tontriluling ID doeth. but _ reaulIing .. tho ...-.y;ng __ givwl in PII\RT I. [ : WERE AUTOPSY FINDINGS -.u.Bt.E PRIOR TO COUPLET1ON Of CAUSE Of DEATH? DUE TO (OA AS A CONSEQUENCE OF): ~~ ~~~~ ~~~/b~4f!/ -::2 e DUE TO (OA AS A CONSEQUENCE OF): MANNER Of DEATH NOlurol h o o DATE OF INJURY (toAonlh. Day. \\lat) TIME Of INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Accidonl HomQlo Pending I_igation Could _ be do<.....ined o o o ~CE OF INJURY. At hom.. flI~,O:;_. 1IICl000, otftco ~ OIC. (SpooIy) -, o NoD _0 NoD SuiOdo M, _, o 11$ -- -- CERTIFIER (~oolv one) "CERTIFYING PHYSlClAN (Physooan cer1lIying cause 01 <lealh Wf1en anoltler physcoan has pronouncecl dealh ano CClIt1gIelod Rom 23) To" beet of my knowMdge.de.thOCC1lfTWd CfuelOlhe~UM(.).ncllMnMf...tated............................................... 2tI. .... ~ @ &l o ... o w ::! oC z -PROHOUNONG AND CEATIFYING PHYStClAH (PtIysclCVl boCh PfonounclO9 oealh and cer1lIying 10 cause of deadl) To"'- beet of my knowMclge. dea" occurred .t the time. dat.. ~nd place, and due to the cause(a) and man"., .. .wled.. . . . . . . . . . . . . . . . . . . . . . . . . 8Ii,drRi~ 30. - . Ot() 21-01-237 OATH OF SUBSCRIBING WITNESS Estate of Norman L SOMERS No. also known as , Deceased Harvey 8 Reeder, Esq. Karen L. Goodman (each) a subscribing witness to the 0 codicil(s) lEI willi presented herewith, (each) duly qualified according to law depose(s) and say(s) that they were present ~d saw the above Testator sign the same and that they signed as a witness at the request of the ~ato~ in thisl . presence ancQ in the , I presence of each other 0 in the presence of the ott~r Cri~g w' I ess(es). / (Signature) 16652 (Address) .1/ ._~>" ') /l (~L<-e-t:~L A', .A:rCY-Ci;:fVlG"-../'----' ~'k.J:.~':"-r.... Karen L. Goodman BeelefSignature) 504 Penn Street Huntin~don PA 16652 (Address) Sworn to or affirmed and subscribed before me this 26th day of February , 2001 ~2~/U Y /;/Jd/t'~/)~A- Notary Public " My Commission Expires: NOTARIAL SEAL , DIANE L MANSBERGER, Notary Put' ! Huntingdon Boro, Huntingdon County, p, \ My Convn. Expires April 3. 2C01 (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission,) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. RW-2 RENUNCIA liON Estate of Norman L Somers No. 21 01 237 also known as , Deceased The undersigned, E Duane Somers, Brother, Executor (Relationship) of (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamentary be issued to Bettie J Somers' \ :)-\-- hand this day of March 2001 Witness my .~ ~i~l t/;~./~ ~,.c? ( ') r} /YL---2~ ~ - (:/. (Signature) E Duane Somers by Bettie J Somers his POA 65 East King Street, Shippensburg (Address) jjl .[/' I.r:;? 4c,y t:, \AJA.i0i So~~~ PA 17257 (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 " " .. 21-01-237 LAST WILL AND TESTAMENT I, NORMAN L. SOMERS, currently residing in the Township of Wayne" County of Mifflin and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do hereby make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills and Codicils thereto by me at any time heretofore made. FIRST: I direct that the costs of settlement of my estate, the medical and funeral expenses, my just debts, the family allowance and all the inheritance, estate, transfer or succession tax or taxes due on my entire estate be paid out of the residue of my estate as soon as may conveniently be after my decease. SECOND: I hereby order and direct my personal representative, hereinafter named, to have a suitable marker or monument erected at my grave. It is my wish and desire to be interred in the I.O.O.F. Cemetery, Mount Union, Pennsylvania. THIRD: I hereby devise all the remainder of my estate of every nature and kind and wheresoever situated, real, personal and mixed, unto my brother, E. Duane Somers. In the event that my brother sha 11 have predeceased me, I direct that the residue of my estate shall pass to my sister-in-law, Bettie J. Somers. In the event that she shall predecease me, I direct that the residue of my estate shall pass to my nephew, Larry D. Somers. FOURTH: I hereby appoint my brother, E. Duane Somers, to be Executor of this, my Last Will and Testament. Should he be unable or unwilling to serve, I then appoint my sister-in-law, Bettie J. Somers, to serve as illY Executrix in his stead. III Ute event thai.: Bettie J. Somers is unable or unwilling to serve, I then appoint my nephew, Larry D. Somers, to serve in her stead. I here by confer upon my Exec utor or Exec ut rix, a s the case may be, all such powers as are presently conferred upon a personal representative by the laws of the Commonwealth of Pennsylvania. I declare that I have discussed the matter of this Will with Harvey 22 - "', "r'" ~, .-' l. / ,', -C:" '-1 ."" \,) 0(" 'I"). ') ~1.. ....~ - 1 - f , ~ 11 B. Reeder, Esquire, and that he has prepared same. I further declare that I have carefully read the provisions hereof and that this instrument expresses my desire and will. LASTLY: I hereby direct that any personal representative appointed herein shall not be required to give bond for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, NORMAN L. SOMERS, the Testator, have to this, my Last Will and Testament, typewritten on one (1) side only of two (2) sheets of paper, to the first sheet thereof having subscribed my name for the purpos,e of identification, subscribed my name and affixed my seal this t.~~/t// day of MARCH, A.D., 1989. ....." ~//'(,J'~'-n ~'Yl, .'-.t' . /,// Norman L. S~mers , ' t:<) ....)r '7-1.'1~. .:~" (SEAL) Signed, sealed, published and declared by the above named, NORMAN L. SOMERS, as and for his Last Will and Testament in the presence of us who have hereunto subscribed our names at his request as witnesses thereto in the presence of said Testator and of each other. / J /)CL~~v,- ,;t. ,/1 . _Y-vlo..,,}. C~h"'L,O "''''- - 2 - E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Norman l SOMERS, deceased Date of Death: December 08, 2000 Will No. Admin. No. 2001 - 00237 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 14, 2001: Name Address E Duane Somers c/o Bettie J Somers, Attorney-in-Fact, 65 W King St., Shippensburg PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. ~~ Forest N. Mye , EsqUire 137 Park Place West Shippensburg, PA 17257 (717) 532-9046 Date: 6-U...o\ Capacity: _ Personal Representative -L Counsel for Personal Representative o S -G' -< Law Office of FOREST N. MYERS ... 137 Park Place West Shippensburg, P A 17257 (717) 532-9046 21-01-237 POWER OF ATTORNEY I, E. DUANE SOMERS, of 21 Cumberland Avenue, Apt. "A", Borough of Shippensburg, Franklin County, Pennsylvania, do hereby appoint my wife, BETTIE J. SOMERS, of21 Cumberland Avenue, Apt. "A", Shippensburg, Pennsylvania as my agent ("my agent") with full power of substitution, in the event that my wife is unable to serve as my agent, I appoint my son, WALTER CREE SOMERS, of 1049 Ashton Drive, Shippensburg, Pennsylvania, as my agent, for me and in my name, to transact all my business and to manage all my property and affairs as I might do if personally present, including but not limited to exercising the following powers: Durable Power of Attorney This power of attorney shall not be affected by my subsequent disability or incapacity. All acts done by my agent pursuant to this power during any period of my disability or incapacity shall have the same effect and enure to my benefit and bind me and my successors in interest as if I were competent and not disabled. Management of Assets 1. Cash Accounts. To collect and receive any money and assets to which I may be entitled; to deposit cash and checks in any of my accounts; to endorse for deposit, transfer or collection, in my name and for my account any checks payable to my order; and to draw and sign checks for me and in my name, including any accounts opened by my agent in my name at any bank or banks, savings society or elsewhere; and to receive and apply the proceeds of such checks as my agent deems best; and to act as my representative payee for all Social Security, Medicare, and other federal and state benefits. 2. Stocks and Bonds. To take custody of my stocks, bonds and other investments of all kinds, to give orders for the sale, surrender or exchange of any such investments and to receive the proceeds therefrom; to sign and deliver assignments, stock and bond powers and other documents required for any such sale, assignment, surrender or exchange; to give orders for the purchase of stocks, bonds and other investments of any kind and to settle for same; to give instructions as to the registration thereof and the mailing of dividends and interest; to clip and deposit coupons attached to any coupon bonds, whether now owned by me or hereafter acquired; to represent me at shareholders' meetings and vote proxies on my behalf; and generally to handle and manage my investments. 3. Personal Property. To buy or sell at public or private sale for cash or credit or by any other means whatsoever; to acquire, dispose of, repair, alter or manage my tangible personal property or any interests therein. 4. Real Estate. To lease, sell, release, convey, extinguish or mortgage any interest in any real estate I own, including, but not limited to, on such terms as my agent deems advisable, and to purchase or otherwise acquire any interest in and acquire possession of real property and to accept all deeds for such property; and to manage, repair, improve, maintain, restore, build, or develop any real property in which I now have or may later acquire an interest. 5. Safe Deposit Boxes. To have access to any and all safe deposit boxes now or hereafter standing in my name; and add to and to remove all or any part of the contents thereof; and to enter into leases for such safe deposit boxes or surrender same. 6. Insurance. To procure, change, carry or cancel insurance of such kind in such amounts against any and all risks affecting property or persons against liability, damage or claim of any sort. 7. Benefit Plans. To apply for and receive any government, insurance and retirement benefits to which I may be entitled and to exercise any right to elect benefits or payment options. '8. Taxes. To prepare, execute and file in my name and on my behalf any tax returns such as Internal Revenue Service forms numbered 1 through 10,000, including return, report, protest, application for correction of assessed valuation of real or other property or claim for refund in any connection with any tax imposed by any government and to obtain an extension of time for any of the foregoing or to execute waivers of restrictions on the assessment of deficiency on any tax. 9. Employment of Others. To employ lawyers, investment counsel, accountants, custodians, physicians, dentists, nurses, therapists, and other persons to render services for, or to. me, or my estate and to pay the usual and reasonable fees and compensation of such persons for their services. 10. Claims. To institute, prosecute, defend, compromise or otherwise dispose of and to appear for me in any proceedings at law or in equity. 11. Medical Procedures. To arrange for and consent to or to withhold medical, therapeutical and surgical procedures for me, including the administration of drugs. 12. Admission Into Facilities. To apply for my admission into medical, nursing, residential, rehabilitation, convalescent or other similar facilities on my behalf, and to sign any consent or admission forms required by such facilities which are consistent with this power, and to enter into agreements for my care by such facilities or elsewhere during my lifetime or for lesser periods of time as my agent may designate, including the retention of nurses for my care. . 13. General Authority. To do all other things which my agent shall deem necessary and proper in order to carry out the foregoing powers which shall be construed as broadly as possible. 14. Reliance on Power. This power may be accepted and relied upon by anyone to whom it is presented until such person either receives written notice of revocation by me or a guardian or similar fiduciary of my estate or has actual knowledge of my death. 15. Hold Harmless. All actions of my agent shall bind me and my heirs, distributees, legal representatives, successors and assigns, and for the purpose of inducing anyone to act in accordance with the powers I have granted herein, I hereby represent, warrant and agree that if this power of attorney is terminated or amended for any reason, I and my heirs, distributees, legal representatives, successors and assigns will hold such party or parties harmless from any loss suffered or liability incurred by such party or parties while acting in accordance with this power prior to that party's receipt of written notice of any such termination or amendment. 16. Pennsylvania Law Governs. Questions pertaining to the validity, construction and powers created under this instrument shall be determined in accordance with the laws of the Commonwealth of Pennsylvania. I have signed this power of attorney this 10 +L.. day of January, 1999. t~ 13~~ E. DUANE SOMERS .- ~-~ \ Witness k~~~?~ Witness . (- ~. ........ /'.:> . II" " '. ..cJ\....\' ':1/'.. J;<":>:':'" ,,- .~<"'.'~{\ .; .~-.::' ( , '.! -, / ... ~ . r -, -.. .' , \ t. ~. .,'; ;:::..<~;:" ~ . 'f . . ..' ..' J"" ACKNOWLEDGMENT COMMONWEAL TH OF PENNSYLVANIA: : SS COUNTY OF FRANKLIN ~ . On this ~ day of JANUARY, 1999, before me, a Notary Public, for the Commonwealth of Pennsylvania, personally appeared the above-named E. Duane Somers, who in due form of law acknowledged the foregoing general power of attorney to be his act and deed and desired that the same might be recorded as such. WITNESS my hand and notarial seal the day and year aforesaid. NOTARIAL SEAL FOREST N MYERS. NOTARY PUBLIC BO~J~'2H OF SH/PPENSBURG fRANKLIN COUNTY MY COMMISSION EXPIRES DEe 172001 ~~~ Notary Public r . ~ ~/ o~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Norman L SOMERS Date of Death: \ 2.~'8. -~J Will No. Admin. No. 2001 - 00237 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Da te: \\-10 - Z-u:..L ~.~ Signatur Forest N Myers, Esq. Name (Please type or print) 137 Park Place West, Shippensburg PA Address (717) 532-9046 Te 1. No. Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3) ,. I 41> ~ Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/05/2002 BETTIE J SOMERS 65 WEST KING STREET SHIPPENSBURG, PA 17257 RE: Estate of SOMERS NORMAN L File Number: 2001-00237 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: 12/08/2002 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, MARY C. LEWIS REGISTER OF WILLS cc: J File Counsel Judge '\ // --~;j/Y- 6' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX FOREST N MYERS FOREST N MYERS LAW OFFC 137 PARK PL WEST SHIPPENSBURG PA 17257 DATE ESTATE OF DATE OF DEATH FILE NUMBER CqYNTY ACN 04-30-2001 SOMERS 12-08-2000 21 01-0237 CUMBERLAND 101 sf., ("/ '-' REV-1547 EX AFP (12-00> NORMAN L Amount Remitted 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 = 154-7- EX-AFP--ri"2- ':-OOY - Ni:iffcE--oF-INHEif fTANCE-"-AjrA-PPRXfsEifENT-,-- Aii-oWAi.fCE-"(fri- -- - ---- -- - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SOMERS NORMAN L FILE NO. 21 01-0237 ACN 101 DATE 04-30-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED 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 .00 .00 .00 33,495.39 .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) (10) 9,427.00 139.144.41 (11) (12) (13) (14) I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 33,495.39 148.57] 4] 115,076.02- .00 115,076.02- NOTE: 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 x 00 = .00 x 045 = .00 x 12 = .00 x 15 = (19)= (15) (16) (17) (18) .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER 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.) *' COMMONWE~1HOFPENNSYL~A~A DEPARTMENT OF REVENUE DEPT. 280601 I-IARR1!':P.IIRG PI',JI1.2l!...-oocL-_ I - -roECEDENT S NAME (LAST, FIRST, AND MIDDLE INITIAL) I Somers, Norman L "Ll1i.TEUFlJEKrR\MM=OlY-YEAR! -- -----:.mm:oFIDRTH-{MM=D~~ ------ 112/08/2000 I 04/19/2013 I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (iAST, -FIRST ANDMlDDLE IN.rrtAL) - ~-- -- I a 1. Original Return R~V.ll1OOEX+I'..oo. w ~ ,,<<n olf~ ~~g u..m 1; REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ffi Q W U W Q 4. Limited Estate - 0 -2.~-pplem~r1tal Ret~~ o o o 4a. Future Interest Compromise (dale 01 death after 12-12-82) 7. Decedent Maintained a Living Trust (Allach copy cl Trus\) 10. Spousal Poverty Credit (date of death between - -. OFFICIAL USE ONLY I FILE NUMBER 21 01 00237 L. COUNTY CODE ---'LE~____ ~BEA ,_ --....-._----..-..__.- -- SOCIAL SECURITY NUMBER 211-03-2578 -- rTHISRETURN MUST BE FILED uit DUPl.ICATEWITH THE REGISTER OF WILLS -- .t- SOCiALSECUAlTYNUMBEA-----.-- I ---cri F1emaindar R-sturn (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes 6. Decedent Died Testate (Attach copy of Will) litigation Proceeds Received AME , ~ Forest N Myers 1Y~ ----------...~- ---.------- ii! - [IRM NAME (If applicable) 8 2 ~~w O~fice ~~est_N My_er~ _____ ____ __ rELEPHONE NUMBER ---1 7171532-9046 --==--- ~-----::::=::-~~~----='---'----,----,--------"--'-----,--,,-----=--~-,-------::--- 1_ Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z Q ~ E ~ w ~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6_ Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) I 137 Park Place West Shippensburg. P A 17257 I -----~ -.- - ,-,"'-"-- ----- -----~-----.- (1) (2) (3) I I I -l I I I I 11. Total Deductions (total Lines 9 & 10) 12. Net Value 01 Estate (Line 8 minus Line 11) None OfFLCIAL USE ONLY None None (4) None (5) (6) (7) 33,495_39 None None (8) 33.495_39 (9) (10) 9,427 _00 139,144.41 (11) 148.571.41 (12) insolvent (13) 13. Charitable a.nd Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Une 13) Copyright 2000 form software only The Lackner Group, Inc. (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, . or transfers under Sec. 9116(a)(1.2) Z Q " ~ ~ .. ~ o u ~ 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT x .00 (15) x .045 (16) x .12 (17) -- - x .15 (18) ---.-- --..--- (19) 120. 0 ~..- Form REV-1500 EX (Rev_ 6-00) Decedent's Complete Address: STREET ADDRESS 7-B MainsvilJe Road CITY I STATE PA Shippensburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) 3. Interest/Penalty i1 applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVEAPA YMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total 01 Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT I ZIP 17257 (1) (2) 0.00 (3) 0.00 (4) (5) 0.00 (SA) (5B) 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. relain the use or income of the property transferred; ....................... .......................... .................. b. retain the right to designate who shall use the property transferred or its income;.. c. retain a reversionary interest; or... ................. ................... ............... d. receive the promise for life of either payments, benefits or care? ................... ........ ..........m.............. 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?.. '~ I o ~ o ~ o ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Unde-r-pe-nalties-of perfury, I deClare-thatfll-,iive eXaminEld ilils reiurn, inClUding llccompanying schedules and staterr'-ents,a-nd to tlie: -best o{my knowledge and belief, it iitrue,co-rreci arldcomplete. Declar~tion of ~eparer other than the pe~~_~al re~=-~~tat~s based on alllnformatl,:_~_?f which preparer has any knowledge SIGNATURE (W PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 4~~~TUR~. ~ \ -~I'J~ . SIGNATlJRE OF PREPARER OTH HA PRESENTATIVE- 65 West King Street Shippensburg, PA 17257 -AnDRESS - ADDRESS- ] 37 Park Place West Shippensburg, PA 17257 .3-2'-01 DA~--- '5-L~ -0 \ --DATE"" For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)1. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stilt 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. 39116 1.2) [72 P.S. ~9116 (aj (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. ~9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ____------L-.._____ ESTATE OF Somers, Norman L TF'LE NUMBER-- - --- _~ _~.-~-~237 ____ 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 I DESCRIPTION VALUE AT DATE OF DEATH ---..- 3,424.44 Commonwealth of Pennsylvania, Dept of Veterans and Military Affairs, Members Fund Balance 2 Holidaysburg Trust Company 30,070.95 3 TOTAL (Also enter on Line 5, Recapitulation) 33,495,39 '* SCHEDULE H \ FUNERAL EXPENSES & · ADMNIS1RA11VE COSTS ~~L__~ ___ _ _ __ ~_ _ _ __L- ______.______.__._______ -- ------- -- -- --~FILE .NUMBER----- --- I 21-01-00237 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Somers, Norman L Debts of decedent must be reported on Schedule I. ITEM ,- -- ---- ~ -- - ------ NUMBER I DESCRIPTION A FUNERAL EXPENSES:- ~ . I Robert D Heath Funeral Home AMOUNT 1. Personal Representative's Commissions Bettie J Sommers Social Security Number(s) I EJN Number of Personal Representative(s): Street Address 65 West King Street City Shippensburg Y ear( s) Commission paid 2001 State P A Zip 17257 - - -I- I I I I I I I I I I I 5,380.00 B. ADMINISTRATIVE COSTS: 1,975.00 2. Attorney's Fees Law Office Forest N Myers -- Forest N Myers 1,975.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant 10 Decedent Probate Fees Register of Wills Cumberland County Register of Wills Cumberland County, filing fees Inheritance Tax Return State Zip 4~ 82.00 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL (Also enter on line 9, Recapitulation) 9,427.00 ESTATE OF . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT __L u ---- .._- ..- --- Somers, Norman L Include unreimbursed medical expenses. ___ __1_- FILE NUMBER I 21-01-00237 ---.-- ---- --..-- --- ..---.._- -- -- - - - -- --- --- -- .._ __ - ____ ___ ____..__ ..__ n_.. __..._..____ ITEM NUMBER I 2 DESCRIPTION Claim of Commonweallth of Pennsylvania, Dept of Veterans and Military Affairs BlIair Gastroenterology Assoc, outstanding medical bill TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 139,124.74 19.67 139,144.41 ......;>-.-..-..-.-..... LAST WILL AND TESTAMENT I, NORMAN L. SOMERS, currently residing in the Township of Wayne" County of Mifflin and Commonwealth of Pennsylvania, being of sound mind, memory and und~rstat\ding, do h""reb)' make and publish this, my Last Will and Testament, h€:reby revoking and making void all former Wills and Codicils thereto by me at any time heretofore made. flRSi: 1 direct that the costS of settlement of my estate, the medic.<JI and funeral /:'xpeIlSl'S, my just debts, the (amily a\lo'Wance and all the inherit:lnc;.e, estate, transfer or succession tax or taxes due all my entire estate be paid out of the residue of my estate as soon as may cOl1Venil'11cly be after my decease. SECOND: hereby order and direct my personal represent-ative, hert:'inaCter named, to have a suitable marker or monument erected at my grave. It is my wish and desire to be interred in r.:he LO.O.F. Cemetery, Mount Union, pennsylvania. THIRD: 1 hereby devise all the remainder of my estate of every 11llture and kind ;)nd whereSol:'ver situ.atl:'d, real, person.al and mixed, unto my brother, E. Duane Somers. In the event that my brother shall have predeceased me, 1 direct that the residue of my est:ate shall pass to my sister-in-law, Bettie J. SOffit:'rs, 111 the evellt that she shall predecease me, 1 direct that the residue of my estate shall pass to my nephew, Larry D. Somers. FQURTlI: 1 hereby appoint my brother, E. Duane Somers, to be Exec.utor of this, my Last Will and TesU'.Iment. Should he he unable or unwilling to s/:'rvt' , I then appoint my sister-in-tnw, Bettie J. Somers, to ::>;:cvt' <:l~ IllY Cj(e(,;ulrlx in IIi:::. :::.tC':IJ. III lllt: eVellt lh...l Delti<: J. Sumer:> is un<"lble or ullwilling to serve, I then appoint my nephew, Larry D. Somers, to St:'TV€ in her stead. hereby confer upon my Executor or Executrix, as the C,lse may be. all sl.Ich powers as arE.' presently conCerred upon a personal representative by the laws of the Commonwealth of Pennsylvania. I declare that 1 havt' discussed lht' matler of this 'Will with Harvey '77, ....'. - ., 0'''7., ~ 1.-.,..-:-" "," - I - ~~ B. Reeder, Esquire, and that he has prepared same. 1 furthl'r declare that I have carefully read the provisions hereof and that this instrument expresses my desire and ""ill. LASTLY: I hert!by direct thilt any personal representative appointed herein 5hD11 not be required t(\ give bond for the [<lithful performance of his duti~s in allY jurisdictiOll. IN WITNESS WHEREOF, I, NORMAN L. SOMERS, the Testator, have to this, my wst Will and Test<lm~llt, typewritten all one (1) side only of two (2) sheets of paper, to the first sheet thereof having subscribed my Il<lme for the purpose of identification, subscribed my name and affixed my seal this ,~~/,./ - day of MARCil, A.D., 1989. /;('-?" y:" ;/ ", Norman L. S'bmers t" /\ ._ --0..", -,..::J (SEAL) SignlOd, sealed, publishl'd and declared by the <lbove Il.:lmf:'d, NORMAN L. SOMERS, as and for his Last wilt and Testament in the presence of us who have herE:'unto subscribed our names at his rl:'quest as witnesses thereto in the presence of said Testator and of each other. I f ~., ./. ./7"c-l,,,",, - 2 -