Loading...
HomeMy WebLinkAbout01-0258 -- PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~VeLLfN~ WytG{50r{~ No. 'Z/-o/-d..5? also known as ~ To: IV I It' Register of Wills f~~~he j . " JJef:e~rJ. County of( A.J Iff /1E"Jf;]/f/JIJ in the Social Security No. I (~ ~ - ~(p - ~)f :::>.2 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner~, who is/a~ 18 years of age or~jd?; an the exec!,!! Of< in the last will of the above decedent, dated ~NLAJ4.tZ'1 .Zo and codicil(s) dated , _ NONe named , 19~ (state relevant circumstances. e.g. renunciation, death of executor, etc.) q 1 :;je 6R~.( 1U4f Z if at DecC~~'fCtn ~P{)IN ( (~~;S %/~rV~)d ~ ,-t9: mol, Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for pr bate; was not the victim of a killing and was never adjudicated incompetent: . /.' '" 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 pennsYlvani~ situated as follows: ---ND ~ c: J.!tJ, crJOI 00 $ $ $ $ WHEREFORE, petitioner(s) respectfully r pre<:;ented herewith and the grant of letters theron. 3 <I) u c: II) ~3 <I) ... ~'lJ C -00 c'= CU'= -II) ~Q., II) '- ~ 0 ~ c: OIl r.i3 ~L~~~~ fi~~~~ttl?; 1,1- ti.f3' -<;127 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ..~ (.. (I. ". ~ S~ COUNTY OF AAtv\ ~(?L-JttVD J Mary C.. Lewis '/ Reqis r of Wills /l.fJ-d15.JJ~ - The petitioner(s) above-named sw?ar(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petiti'mer(s) will well and tml, adf"i~r the estate according to law. Sworn to or affirmed and suhscribed GUlft,J t:vf... ~ before ItA i 7th _ day of' ~. f-t 19 OJ ~ ;:: ~ ~ No. ~/-6 j-' 258 Estate of ~(/~LL{ ~ -1. t(lIJ4&-&o^"C:/~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW /11Mc If 8th, 1-9:Zl16 I, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated .'1 fhvI iA 14 Ie (,1 z-o I I tj q f) described therein be admitted to probate and filed of record as the last will of ~ VGt.g 1: ~ ~~eK. _ and Letters -1' f IfM / 1/4 t?- are hereby granted to (?;ruer (<. !3Utc..l/ FEES Probate, Letters, Etc. ......... $ 70.00 Short Certificates( q . . . . . . . . .. $ 6 . 00 Renunciation ................ $ x-Pages (2) $ 6.00 JCP TOTAL _ $ 5.00 Filed .. ./Ylff.R0H. 8th.. j'?(J,t? I... .8.7.00 9lZmu-J e:f~ ~W~ ~ r' ~ ~ /1 tY~Jv 0"zr..7 ffO~~(S~/~o.) ~ 50 llJ41Jove R ~'r ~L-/St..f fftJ1()}3 I I ADDRESS 7ft 'Zll3-s1z, 1 PHONE CALL ATTORNEY . . - . f' . 1 ere l'ven is correcrlv copied from an .original certificate of death duly tiled with , I to certity th,lt the m ormation 1 g., '- fi - rr : 1. .IS .' '1'1' ., 1 . C'. . t 1'11 be Forwarded to the State Vital Records Of iCe for permanent 1 mg. I .Cl ~;:! RegIstrar. 1C ongll1a certlIlca e w WARNING: It is illegal to duplicate this copy by photostat or photograph. me as No. L:L~. ~~&.~ Local Registrar Fee for this cenificHe, S2.an P I 6948383 ~EB 2 6 2001 Date 21-2001-258 ""05.:0<3 R... 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH .NT STATE ~llf ~UM8ER NA"'E OF OECEDENT !F,;;M.d(jj;,~--"-_._-- ..-.-------.------------ sE'X---- SOCIAL SECURrl'l NUMBER Evelyn T. Waggoner ~ Female ~ 16~ - 36 - 6853 AGE (L... 6ort"OaYl UNDER 1 YEAR Montha Days UNDER 1 011:I DaTE OF DEATH ,Menon. Day. ....n 24,2001 ~NT ~K Yrs -." j M...ut.. BIRTHPl.4Ci IC.Iy.M Stale or f cre.gn CountfY) S. COUNTY OF [)E,(TH 97 g:'IyIO ,;: I .... Cumberland Carlisle RACE . Amencan Indian. Black. Whill, etc (Spealyl Ie. 10. White DECEDENT'S USUAL OCCUPIJION K/ND Of' BUSINESS/1NOUSTRY i~_~Iif~~~~;';,t:'i' . 11.. School Teacher 11...Country School OECE7DE70'$ S~~ thEH:noc~~, ~trCee t ~~~:NT'S 170. Sla,. RES/DENCE Car1isle,Penna. 17013 ~~~ ,.. 17b. County MARITAL STRUS. M_ Nevef MaNiecI, Wdowed. ru8WV' SURVIVING SPOuSE Iff Nil.. 9Mt matOefl name) Cumberland Did cleC_" IMI in . --.;p1 17e.O YeI. dec<<lent lived if' FATHER'S NAME (F.... "'<ldIe L3"b ro v e C 1 ev elan d II. INFOflMANT'S NAME (T Y?e'P'inll -. Se mour A . METHOD Of' DlSPOSIT~ . - 'fY. c,......_ 0 Donat_ 0 OI_lSQecllyl . 21.. SlGNlJURE Waggoner .1Io._1iwc1 lTd. wiIIIin actual _ 01 MOTHER'S NA...E iF.... ....,.".. ....-. Su,n""",) ft. Laura Etta Thumma INFORMANT'S ......IUNO ADDRESS (Str_. CttyfTown, s..... rop Code) _. 630 South Hanover Street,Carlisle,Penna.1701 PLACE OF DISPO. SITION. Nome 01 Cemelary, Cra",atory LOCATION. C!tvlTown.ll..... t'V, Code m~~' . North M1da~eton Tw~. 21.~estm1nster Cemetery 21~umberland County, Pa. NAME ?DAOOAESSOF FACILITY b10 Sou+'h HaHover S ree ~~1n BrotherslcarlIS~~tP~n sy~van all 13 LICENSE NUMBE R ORE SIGNEO (MonII\. Day. Carlisle arylbon>. ~ ~\J\) DUE TO (OR AS A CONSEOVENCE Of): ! : DUE TO (OR AS A CONSE OVE NCE Of): DUE TO (OR AS A CONSEOUE NCE ClF)' WERE AUTOPSY FINDINGS A'oIUlA8lE PRIOR TO COMP\.ETION OF CAUSE Of' DEAfH1 MANNER Of' DEATH DATE OF INJURY IMonttt. Day. ""at) TIME OF INJURY 'NJU!lY IJ WORK7 DESCRIBE "OW INJURY OCCURRED. Nalwal ~ o o Homicide o o o ~CE Of' INJURY. AI hom., 'a';~;ee'. factory, ollie. M. -.0. "e. ISpec,tvl 30.. _ 0 NoD - Pending lnve$bg.'Jon 'MEDICAL EXAMINER/CORONER On the taaJa ot examination andlor investigation. in my opinion, d..th occurred at the time, date, and place, and due to the cauM(I) and "'ann..... st.'ed.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ........ 31.. REGISTRAR'S SIGNATURE AND NUIAB la l,dt-.\ 10 I ORE SIGNEDl_. Day. _I ?cobl Y.. 0 NoD 300. Suicide Could not be detlm'lIned 2Ie. 21b. CElnlF\ER ,CN,e. only onel -CERTlFYfNG PHYSIClAN (Physc...an CP.ftlfy~ cause d dt'ath ~e" Aoot"er pI"lvsecoan has ptonourced dear" ana camUlete<1 Item 23\ ToO. bteMot"'yknow~, caethoeeurredducttolhec.uH(s}andmann.'...t.ted..... ................................. 29. "PAONOUNCJNG AND CERTIFYING PHYSICIAN (PhySIC.an tloft: ;,1ronounctng death and certifYing 10 C8USe of oeart'll To the ~ of my II:no"'ed2~, de.th occurred.' ttMI time, date, and place, and due to the caUM(S)and manner.. stated.. . . .. .. ., ... , . . . . .. .. . '" 60 d()b\ , --- ~ , L 21-2001-258 LAST WILL AND TESTAMENT OF EVELYN T. WAGGONER I, EVELYN T. W AGGONE~ of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. DISTRIBUTION OF ESTATE THIRD: I give my entire estate to the Salem Stone United Church of Christ, Carlisle, P A. POWERS OF EXECUTOR/RIX FOURTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchaser for the application of any c;J~/k initials --. .,.--"" consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF EXECUTOR/RIX FIFTH: I appoint Robert R. Black, Esquire executor of my will. If Robert R. Black, Esquire is unable or unwiliing to qualify as executor or having qualified is unable or unwilling to act, I then appoint Jean Kline of 1842 Spring Road, Carlisle, or the survivor thereof, as executor/s hereof. I direct that my executor shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE SIXTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS SEVENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this Z 0 (i} day of I a t1 v A r '( , 1998 ~ ~Jt ;::;JJ "E eiyn : Waggoner ~. 7jfltf~ /. ~ Witness, Tho~s J. Ahrens ./ '/ N ~~ (OJ L },'1C(CX., " 1fc.7~ Witness, Linda A. Rohm ., , . , /I , ' .- ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Evelyn T. Waggoner, the testatrix in, and Thomas J. Ahrens and Linda A. Rohm, the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been dilly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~!f:~~ Testatrix,. velyn T. wa~ er . /kw> ! ;;L Witness, 11IOll1~. l\hrens &Ld~ 4 1i~ Witness, Linda A. Rohm ~(IL!JJc NotarY Pubhc _lltACK.NOTNft'MUC CMJSI.E IORO.. CUMBERlMD CO.. PI. MY CDIMISSIOH EXPIRES SEPT. 10. 2001 e. --- CERTIFICATION OF NOTICE UNDER RULE 5.6 (c) Name of Decedent: Evelyn T. Waggoner Date of Death: February 24, 2001 Will No.: 21-01-0258 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: May 23, 2001. Name Salem Stone United Church of Christ Address P.O. Box 357, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 5/~/o/ r&-M 0(y(krz Robert R. Black, Esq. 36 South Hanover Street Carlisle, Pennsylvania 17013 Telephone (717) 243-3727 Capacity:---X- Personal Representative _ Counsel for Personal Representative INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION NO. 21-2001-258 ESTATE OF EVELYN T. WAGGONER Deceased FIRST AND FINAL ACCOUNT OF ROBERT R. BLACK, EXECUTOR OF THE ESTATE OF EVELYN T. WAGGONER LATE OF BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA Date of Death: Letters Testamentary Granted: Letters Advertised: Sentinel - Cumberland Law Journal- Account Stated as Final February 26, 2001 March 8, 2001 March 16,23,30,2001 March 23, 30, April 6, 2001 SUMMARY & INDEX PRINCIPAL PAGE 2 2 3 42,924.83 1,366.46 -5.343.52 Receipts Conversions (Gain) or (Loss) Less Disbursements Balance Before Distributions Advancements to Beneficiaries Principal Balance Remaining 4 38,947.77 -35.000.00 3,947.77 INCOME Receipts Less Disbursements Income Balance Remaining 4 4 1,140.09 - 0.00 1,140.09 COMBINED BALANCE REMAINING 5 $ 5..087.86 RECEWTSOFPmNCWAL 2001 2/24 M&T Bank, money market account 15004198150482 29,335.59 2/24 M&T Bank, certificate of deposit 31003910775453 10,038.10 2/24 M&T Bank, checking account 443077 1,522.89 2/24 Broken watch and costume jewelry 0.00 6/25 PSERS, balance, retirement account, final payment. 589.24 6/25 Pioneer Life Insurance Co., rebate, health insurance premium. 219.32 6/25 Chapel Pointe Nursing Home, rebate, healthcare service. 206.46 7/29 Lincoln Life Insurance Co., proceeds policy #J721. 1.013.23 Total Receipts of Principal 42,924.83 PmNCWAL CONVERSIONS TO CASH 2001 Gain Loss 3/16 M&T Bank, money market account 15004198150482 Proceeds 29,389.19 Account Value 29.335.59 53.60 3/16 M&T Bank, certificate of deposit 31003910775453 Proceeds 10,019.03 Account Value 10.038.10 19.07 3/16 M&T Bank, checking account 43077 Proceeds 2,854.82 Account Value 1.522.89 1,331.93 Net Gain on Conversion $1,366.46 2 2001 4/16 4/16 4/16 5/22 5/22 2002 1/9 Landis & Bank, on account, attorney's fees 1/9 Robert R. Black, on account, Executor's commission 1/9 Landis & Black, probate costs advanced 2/15 Orrstown Bank, service fee Reserved: Landis & Black, balance, attorney's fees Robert R. Black, balance, Executor's commission Total Disbursements of Principal DISBURSEMENTS OF PRINCIPAL Belvedere Medical Corp., invoice Ewing Brothers Funeral Home, balance, funeral bill Robin K. Sollenberger, Tax Collector, personal tax PSERS, reimbursement for unearned retirement M&T Bank, reimbursement for unearned social security payment 26.78 610.00 9.80 736.55 579.00 500.00 1,000.00 276.39 10.00 500.00 1.095.00 5,343.52 RECEIPTS OF INCOME 2001 4/15 Orrstown Bank, interest, checking account 158.57 5/15 Orrstown Bank, interest, checking account 168.16 6/7 Orrstown Bank, interest, checking account 173.62 7/15 Orrstown Bank, interest, checking account 129.16 8/15 Orrstown Bank, interest, checking account 141.38 9/16 Orrstown Bank, interest, checking account 148.30 10/15 Orrstown Bank, interest, checking account 110.19 3 11/15 Orrstown Bank, interest, checking account 85.34 12/16 Orrstown Bank, interest, checking account 12.31 2001 1/15 Orrstown Bank, interest, checking account 9.27 2/15 Orrstown Bank, interest, checking account 3.79 Total Receipts of Income 1,140.09 DISBURSEMENTS OF INCOME 2001-2002 None Total Disbursements of Income 0.00 ADVANCEMENTS TO BENEFICIARIES 2001 11/15 Salem Stone United Church of Christ 35.000.00 35,000.00 Total Advancements to Beneficiaries 4 INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION NO. 21-2001-258 ESTATE OF EVELYN T. WAGGONER Deceased SCHEDULE OF PROPOSED DISTRIBUTION Combined Balance for Distribution Remaining as per First and Final Account TO: Salem Stone United Church of Christ 5,087.86 Costume jewelry in kind 5,087.86 0.00 TOTAL BALANCE FOR DISTRIBUTION $ 5,,087.86 ROBERT R. BLACK, Executor under the Last Will and Testament of Evelyn T. Waggoner, deceased, hereby declares under penalties of perjury that he has fully and faithfully discharged the duties of his office~ that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period~ that all known claims against the estate have been paid in full~ that the first complete advertisement of the grant of letters was more than four months from the date the account was filed; that, to his knowledge, there are no claims now outstanding against the Estate~ and that all taxes presently due from the estate have been paid. He understands that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. ~Q- jltt3>>~ ROBERT R. BLACK, Executor 5 \1 /6 -c2/o--/;;./ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ROBERT R BLACK ESQ LANDIS & BLACK 36 S HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-29-2001 WAGGONER 02-24-2001 21 01-0258 CUMBERLAND 101 *' REV-1541 EX AFP HZ-DO) EVELYN T Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=is4"j-ExAFP-fi'2-:oo1--NoT'icE--oF-'X-NHEifiTAircE-YAx-;fpPRAISEifENT~--ALi-oWAiicE-oR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WAGGONER EVELYN T FILE NO. 21 01-0258 ACN 101 DATE 10-29-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate IS. Allount of Line 14 taxable at Collateral/Class B rate 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 Cl 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) S. Total Assets n) (2) (3) (4) (,5) (6) (7) .00 .00 .00 .00 41,905.00 .00 .00 (S) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. 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) no) 41256.00 1 .353 . "00 nl) (2) (3) (4) NOTE: ns) (6) (7) ns) .00 X .00 X .00 X .00 X NOTE: To insure proper credit to your accountl subllit the upper portion of this form with your tax payment. 411905.00 1i.';Og 00 361296.00 361296.00 .00 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (9)= 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 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ,. " ~ ,,'" STATUS REPORT UNDER RULE 6.12 Name of Decedent: f: \/E LLf Ai ~ /IV ~ G!s-(;,ve'Z Date of Death: Will No. '7 OU /.- tV-;; y 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: ({ (] v/ ~. Stat~yhether administration of the estate is complete: Yes~ No 1 . 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 per~nal representative file a final account with the Court? Yes No . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account 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. ~&~/- (lf3f~v Signature Rr)~ Ie') f-- ~ {.,K Name (Please type or print) 3 V; 5' -rJ-/hI d / tf<. sr Address {I'? .- 74'?;/?'17-'1 Tel. No. Date: / It ?;/O? , . (MAH:rmf/AM3) Capacity: Personal Representative ~counsel for personal representative - Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (71 7) 240 - 6345 .- Date: 1/06/2003 ROBERT R BLACK 36 SOUTH HANOVER STREET CARLISLE, PA 17013 RE: Estate of WAGGONER EVELYN T File Number: 2001-00258 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. I, for decedents dying on or after July I, 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: 2/24/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: v File Counsel Judge RE\.l5{lOEX Ifi.-OOj COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 .... Z W C W o W C UJ ..., :lII:::~(/) U .", UJo.u ",00 u...... 0.10 0. " INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Waggoner. Evelyn T. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) February 24, 2001 February 6, 1904 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A ~ 1. Original Return o 4. Limited Eslate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death afler 12-12-82) o 7. Decedent Maintained a Living Trust (Attacl1 copy of Trust) o 10. Spousal Poverty Credit (d.ateofdealtl~ 12.31-':11 aM 1-1-'35} OFFICIAL USE ONLY G. __ / -'--.- d{! 5 --._{~ FILE NUMBER 21 -01 2 5 8 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 168 - 36 6853 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date 01 death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. E\ectionto tax under Sec. 9113(A) (ArtachSch0) COMPLETE MAILING ADDRESS 36 South Hanover Street Carlisle, PA 17013 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) (19) 0.00 ..., % UJ o % o 0. '" ~ .. o u NAME Robert R. Black, Esq. FIRM NAME (II Applicable] Landis & Black TELEPHONE NUMBER 717-243-3727 OFFICIAL USE ONLY (8) 41,905.00 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (1) (2) (3) (4) (5) 0.00 0.00 0.00 0.00 41,905.00 (11) 5,609.00 (12) 36,296.00 (13) 36,296.00 (14) 0.00 4. Mortgages & Notes Receivable (Schedule D) z o ~ ;:) .... ii: <C o w 0:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owfled 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) (9) (10) 4,256.00 1,353.00 (6) 0.00 (7) 0.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (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 Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' ;:) ll- ::!E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14laxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS Chapel Pointe Nursing Home 770 South Hanover Street CITY Carlisle I STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenal1y if applicable D. Interest E. Penally TotallnteresUPenal1y ( 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. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................ ................. ........................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ C. retain 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 without receiving adequate consideration? ................................... .................................... ..................................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or securily at his or her death? .............. 0 123 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................ ................... .. ............................ 0 123 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 pe~ury. r declare lhat f have examined this return, inducting accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. OR FILlMG RETURN ~ Robert R. Black, Esq. q16( SIGNATURE OF ADDRESS 36 17013 Robert R. Black, Esq. ADDRESS 36 South Hanover Street, Carlisle, PA 17013 For dates of death on or after July 1, 1994 and before January I, 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)]. The statute does not exemnt 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 flet 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 orlor the use of the decedent's lineai beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a}(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiings is 12% [72 P.S. ~9116(a}(l,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 Estate of File Number 21-01-258 Waggoner, Evelyn T. Include the proceeds of litigation and the date the proceeds were received hy the estate. All property jointlY-ilwned with the Right of Survivorship must be disclosed on Schedule F. Item Number Value at Date of Death Description 1. M&T Bank, certificate of deposit 31003910775443. See attached letter. Principal $10,000.00 Interest $38.00 M&T Bank, savings account 15004198150482. See attached letter. Principal $29,272.00 Interest $63.00 $29,330.00 $10,038.00 2. 3. M&T Bank, checking account 443077. $1,523.00 4. 5. 6. 7. Principal $1,523.00 Interest $0.00 Lincoln National Life Insurance Co., proceeds $1,013.00, policy #]721. Non-taxable. Pioneer Life Insurance Co., premium refund, health insurance. P A PSERS, final retirement payment. Chapel Pointe, rebate, health care service. $0.00 $219.00 $589.00 $206.00 TOTAL (also enter on line 5, Recapitulation) $41,905.00 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of File Number Waggoner, Evelyn T. 21-01-258 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1. Ewing Bros. Funeral Home $610.00 B. Administrative Costs: 1. Personal Representative Commissions Name of Personal Representative: Robert R. Black Social Security No. of Personal Representative: Street Address: 60 Conway Street City: Carlisle, PA 17103 Year(s) Commission to be paid: 2002 $2,095.00 2. Attorney Fees - Landis & Black $1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant None 4. Probate Fees $251.00 5. Accountant's Fees $0.00 6. Tax Return Preparer's Fees $0.00 7. Reserve for Closing and Filing Releases $300.00 TOTAL (Also enter on line 9, Recapitulation) $4,256.00 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES & LIENS Estate of File Number Waggoner, Evelyn T. 21-01-258 Include unreimbursed medical expenses. Item Number Description Amount 1. Belvedere Medical Corp., invoice. 2. Robin Sollenberger, Tax Collector, personal tax. 3. P A PSERS, reimbursement for unearned retirement. $27.00 $10.00 $737.00 $579.00 4. M&T Bank, reimbursement for unearned social security. TOTAL (Also enter on line 10, Recapitulation) $1,353.00 E_e of File Number Waggoner, Evelyn T. 21-01-258 Relationship to Decedent Amount or Share Number Name and Address of Person(s) Receiving Property Do Not List Trustee(sl of Estate I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. 0.00 ENTER DOllAR AMoUNTS FOR DISTRIBUTIONS SHOWN ABovE ON LINES 15 THROUGH 17, As APPROPRIATE, ON REV 1500 CovER SHEET SCHEDULE J BENEFICIARIES II. NON-TAXABLE DISTRIBUTIONS A. Spousal distributions under Section 9113 for which an election to tax Is not being made. 1. B. Charitabfe and Governmental Distributions 1. Salem Stone United Church of Christ P.O. Box 357 Carlisle, PA 17013 100% TOTAL OF PART 11- Enter Total Non-Taxable Distributions on Line 13 of REV 1500 Cover Sheet 100 % -. LAST WILL AND TESTAMENT OF EVELYN T. WAGGONER I, EVELYN T. WAGGONER, of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. DISTRIBUTION OF ESTATE THIRD: I give my entire estate to the Salem Stone United Church of Christ, Carlisle, P A. POWERS OF EXECUTORlRIX FOURTH: I confer u?on my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchaser for the application of any !;7% initials -. consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF EXECUTORlRIX FIFTII: I appoint Robert R. Black, Esquire executor of my will. If Robert R. Black, Esquire is unable or unwilling to qualify as executor or having qualified is unable or unwilling to act, I then appoint Jean Kline of 1842 Spring Road, Carlisle, or the survivor thereof, as executor/s hereof. I direct that my executor shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE SIXTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS SEVENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this 2011; day of .Ju<1vl1ry ,1998 ~~ 00J;t ~ w/ 1. ..-I ---E elyn . Waggoner ~ 7ttfv:' ! LL- Witness, Tho~s 1. Ahrens i7{X'do" N- ;;:r/~ Witness, Linda A. Rohm ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Evelyn T. Waggoner, the testatrix in, and Thomas J. Ahrens and Linda A. Rohm, the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. t~!r.!~~ .---.1 11ld1rtw:- Witness, Thoma 6~~A-.-J 4 -;;:rI"? Witness, Linda A. Rohm (4fW3 i/l-,IJJr NotarYPubhc ......11. 8lAaC, NOTNll'PUIIUC CNlUSlE IORO.. CUMBERlAND CO.. fa. MY COIlMISSIOH fJlPIRES SEPT. ID, 2001 mM&fBank August 23,2001 RE: Estate Search The Estate of: Date of Death (D.O.D.) EVELYN T WAGGONER 2/24/2001 To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Account Number Account Title Opening Branch Type CHK 443077 EVELYN T WAGGONER 4319 SAY 15004198150482 EVELYN T WAGGONER 4335 C/O OF JEAN KLINE CD 31003910775443 EVELYN T WAGGONER 4319 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed NO Safe Deposit Box titled in the Decedent's name existed at our office. D.O.D. Balances (Includes Accr. Int.) $1522.89 $29,335.59 $10,038.10 Account Description Accrned Interest $.00 $63.34 $38.10 If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION BY: e ~ ~---e< .A.AJ~ Authorized Signature DATE: fi~ L 5/ -u)() i Manufacturers and Traders Trust Company. 1100 Wehrle Drive, P.O. Box 701, Buffalo, NY 14240-0767 n Lincoln Financial Group. THE L1NCQCN NAnONAl LiFE iNSURANCE COMI'AN'I ~ THE ESTATE OF EVELYN WAGGONER CHAPEL POINTE, 770 S. HANOVER ST. CARLISLE, PA 17013-1557 o 1 ", x JUL 18, 2001 IN PAYMENT OF: POLICY NO J721 INSURED: EVELYN WAGGONER DEATH CLAIM PROCEEDS ON PAYMENT CONTRACT #J721 INFORMATION REGARDING CHECK CALL 1 860 466 1697 !!!!!!!! -- -- -- - !!!!!!!! -- - -- -- --- !!!!!!!!! DETACH BEFORE DEPOSITING n Lincoln DAI[ JUL 18, 2001 FinanciaJ GrOUp$ THE LINCOLN NATIONAL LIFE INSURANCE COMPANY 1300 soum CLINTON STREET FORT WAYNE, INDIANA 46801 PAY ONE THOUSAND, THIRTEEH TO WELLS FARGO BANK !NCL~,Nfl N A CHECK NUMBER A 09559721 $1.013.23 CH,U NO A 0 9 5 5 9 72 1 '" AMQUN r *****..1,013.23** AND 23/100 ________.________________._OOLLARS PAY TO THE: ORDER OF THE ESTATE OF EVELYN WAGGONER CHAPEL POINTE, 770 S. HANOVER ST. CARLISLE, PA 17013-1557 rRS eM! 4BAB NOT VAllO AFTER !20 DAYS /), /) / ~ f/~~;??U~ ...-.-----.~-.....----..p__'-----_._.__.--..,-.------.---. ELDON J SUMMERS TREASUReR lI'09SS97eloll' ':07t.90CJ275': . 871,,,,ab'i 0:;:1' PIONEER LIFE INSURANCE COMPANY PL13%105A CHECK NO. 0000412806 304 NORTH MAIN ST., ROCKFORD, Il 61101 BANK OF AMERICA COMMERCIAL DISBURSEMENT ACCOUNT HORTHSROOK, ILLINOIS 70-2328 ~ PAY TWO HUNDRED NINETEEN AND 32/100 _______________________.__.___..________.____.____.___p.____________.. TO THE OROER OF ESTATE OF EVELYN T WAGGONER %.JEAN K KLINE 1842 SPRING CARLISLE, PA 17013 DATE 05/01/2001 CHECK AMOUNT *********219.32 ';;:;;E:;;;;';;"~,." ~~ 11'0000 I, I. 280 bll' 1:07 I. g 2 OJ 281,1: 87 b 5 7'" b OJ 1.85"'