HomeMy WebLinkAbout01-0306
Cumberland County
Clifford E. Chamberlin
PETITION FOR GRANT OF LETTERS
Estate of Clifford E. Chamberlin
No.
21-01-306
also known as
, Deceased
Social Security No. 182-22-8026
Betty M. Chamberlin
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
[i]
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
Decedent, dated JUNE 1970 and codicil(s) dated
named in the Last Will of the
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 incapacitated:
o
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 the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
(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 65 Chamberlin Road, (Southampton Township) PA 17257
(list street. number and municipality)
Decedent, then 72 years of age, died September 12 ,2000, at Penn Hall, Chambersburg, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
75,000.00
none
75,000.00
Real Estate situated as follows: no real estate
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:
Typed or printed name and residence
Bett M. Chamberlin, 5 Summit Dr., Shi
I b--c2/87~ I~
before me this
19th
Oath of Personal Representative
day of
March, 2001 _
ry/r~/~~M,0f ~~/
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 according to law. \
Sworn to and affirmed and subscribed 13~ tT:.~ rn tv ~..J.M.A L
Betty M. Charllberlin
Estate of Clifford E. Chamberlin
DECREE OF REGISTER
also known as
Deceased
21-01-306
No.
Date of Death: 9/12/00
Social Security No: 182-22-8026
AND NOW, MARCH 22 2001
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary Cl of Administration
are hereby granted to Betty M. Chamberlin
, in consideration of the Petition on the
((c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
in the above estate and that the instrument(s), if any, dated 6/70
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters ....................................
Short Certificates(s) ...............
Renunciation ..........................
Extra Pages (
) ...............
................................................
I.T.R.......................................
JCP Fee .................................
Inventory.............................. ..
Other..................................... .
TOTAL .............................$
$
115.00
$
$
$
$
$
$
$
$
12.00
3.00
5.00
135.00
~4'yC:7/h- {.4<,j /7/ / ~//y
R gister of Wills
z;rL ~ JdL~7A ·
Attorney: Joel R. Zullinger
I.D. No: 17516
Address: 14 N. Main Street, Suite 200
Chambersburg
PA 17201
Telephone: (717)264-6029
DATE FILED:
'-"{\<; ~n" '~,':",V o/.~r;
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.
No.
Fee for this certificate, $2.00
p
6909005
~,.4 /v;
Date
.~ t:'t:.5
Ifni 2117
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
t. Clifford E. Chamberlin
AGE ll.. ~ UNDER 1 Y'EAA UNOIER 1 OAr
-,.,.,. -1"-
. .
. .
: .
SEX
..Male
!TAfI''lI~''
SOCIAL SECUAtT"l' NUMBfR
NAME OF MCfDEHT (F", MIddIe.l"',
..182
- 22
2000
I.
COUNTY OF llERH
72
v...
PUCE 011 OEAT'N fCNrclt croIlf."..... ... oMtruCllO"I on Ofhel w:tlt.
HOSPtlAL: -
_0
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RACE. AIMftQft~' BIKk. White _
"i7hite
'I.
SUAVMNG SPOUSE
t1l'MIe.'7"~l'I.ImlM
-,-
65 Chamberlin Road
."hi ensbur PA 17257
FRMEA"S NAME (F". r.tJc:de. lall)
II. Charles E. Chamberlin
_s_cr_"'l
Bett M. Chamberlin
UETHOOOF~
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. ....
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Cumberland ....0 :....-=-=..
MOT'H!R'S NAME (f". MIddII,'MeldenSufNft'lreI
. Velva Bowers
-----
5 Chamberlin Road, Shi
. ,..,. Of , CNINIofy
-
.ZJo~
ensburg, PA 17257
l .CiIyf1'owft.9t....lIpCede
Shippensburg
&mberland Ct.
PA
2.00e
Cemetery
OF IIOCIUl'V
r-Bricker. F .R. Inc. P.O. Box 336, Shbg. ,PA 17257
UCEN5E NUMBEA DArI: SIGNED
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REGISTRAR'S SIGNATURE AND NUMBE
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21-01-306
LAST WILL AND TESTAMENT
I, Clifford E. Chamberlin, a resident of the Township of
Southampton, County of Cumberland and Commonwealth of Pennsyl-
vania, being of sound mind and memory, do make, publish and
declare this to be my Last Will and Testament, hereby revoking
any and all Wills by me heretofore made.
FIRST: I direct my Executrix, hereinafter named, to pay all
my just debts and funeral expenses as may conveniently be done
after my decease.
SECOND: I give, devise and bequeath all my estate, be it
real, personal or mixed, to my wife, Betty M. Chamberlin, for her
own proper use and behoof forever.
THIRD: In the event my wife, Betty M. Chamberlin predeceases
me or we should perish in a common disaster, then I give, devise
and bequeath my entire estate, be it real, personal or mixed,
to my children equally, share and share alike, or their heirs.
In the event any of my children are minors at the date of my
death, then I give, devise and bequeath my entire estate, be it
real, personal or mixed, to my son, Ronald E. Chamberlin and
my daughter, Connie M. Watkins, IN TRUST NEVERTHELESS, to pay
the income and so much of the principal which they in their
discretion deem necessary for the care, maintenance, support and
education of my minor children, said trust fund to remain in
tact until the youngest child has received his high school
education. When the youngest child has received his high school
education, then I direct that any amount of principal and income
in said Trust Fund be divided equally among my children or their
heirs, with the share of any minor child or children being held
until he attains the age of twenty-one years.
McCREA & McCREA
FOURTH: I hereby nominate, constitute and appoint my wife,
ATTORNEYS AT LAW
NEWVILLE & SHIPPENSBURG
PENNA.
Betty M. Chamberlin to be the Executrix of this my Last Will
and Testament. In the event my wife, Betty M. Chamberlin, should
be unable to serve as Executrix for any reason whatsoever, then
I nominate, constitute and appoint my son, Ronald E. Chamberlin
and my daughter, Connie M. Chamberlin, to be the substitute
Executors.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this, my Last Will and Testament, written on two sheets of paper,
dated this
day of June, 1970.
? ~7 // 6/ ,- /":/.r;:;
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This instrument was by the Testator, Clifford E. Chamberlin,
on the date hereof signed, published and declared by him to be hi
Last Will and Testament, in our presence, who at his pequest and
in his presence and in the presence of each other, we believing
him to be of sound and disposing mind and memory, have hereunto
subscribed our names as witnesses.
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McCREA & McCREA
ATTORNEYS AT LAW
NEWVILLE 01: SHIPPENSBURG
PENNA.
Cumberland County
Clifford E. Chamberlin
21-01-306
OATH OF NON-SUBSCRIBING WITNESS
Bradley S. Gerlach, Vice President & Trust Officer Orrstown Bank, and Frank E. Koser, II, Assistant Vice President
Orrstown Bank
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they
, testat ~ of (one of the
familiar with the signature of Clifford E. Chamberlin
codicil
subscribing witnesses to) the will presented herewith and that they
codicil
will is in the handwriting of testator
believes the signature on the
Sworn to or affirmed and sub-
to th~eest of their knowledge and belief.
.3
Bradl~. - . ~ach, Vice P:.';'de~t & Trust Officer Orrstown Bank
1t4a~i" -. PA 17013
-~
(Name)
Frank E. Koser, II, Assistant Vice President Orrstown Bank
Carlisle PA 17013
scribed before me this 19th day of
March,2001
\
~/~/c?~///.?~H~~
rY /For the Register
(Address)
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Clifford E. Chamberlin
Date of Death: 9/12/00 ______~_~ Estate No. 2001:-00306 __________
SSN: 182-22-8026
File No. 21-01-0306
Date Letters Granted: 3/22/01
Will or Administration 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 4/26/0L_ ___~__~
Name
Betty M. Chamberlin
Address
5 Summit Drive
Shippensburg
PA 17257
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
no exceptions
Date: ~29iQ1___~_________
Signature ~~ -t<~~~_ - -
Joel R. Zullinger
Name (Please type or print)
14 North Main Street
Address
Suite 200
Capacity:
Personal Represert~tive
X Counsel for Personal
Representative
Chaml:l_ersbu rg
PA 17201
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Telephone No. __~__
REV-1500 EX ~ (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
c
/(P -- ~ 18'- /:2-
FILE NUMBER
2 1 -0 1 0 3 0 6
"'COuNTY"CoiiE ---YEA~ - - 'NU'MeER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
Chamberlin Clifford E.
DATE OF DEATH (MM-DD-Year)
1 8 2 - 2 2 - 8 026
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
DATE OF BIRTH (MM-DD-Year)
09/12/2000 11/01/1927
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
Chamberlin Be M.
001. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 3. Remainder Return (date of death prior to 12-13.82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec, 9113(A) (Attach SchO)
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy oITrus!)
D 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95)
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COMPLETE MAILING ADDRESS
14 North Main Street, Suite 200
NAME
Joel R. Zullin er
FIRM NAME (If Applicable)
Zullin er-Davis
TELEPHONE NUMBER
717264-6029
Chambersbur
PA 17201
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
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 I) (10)
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)
0.00 I
76,302.891~
I
OFFICIAL USE ONLY
9,300.00
I
76,901.271
(8)
162,504.16
10,839.00
(11)
(12)
(13)
10,839.00
151,665.16
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
151,665.16
(14)
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
151,665.16 X .0L (15)
X .0_(16)
X .12 (17)
X .15 (18)
(19)
O.ot)
0.00
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
MAY- 4-131 FRI
9:513
P.02
Decedent's Com lete Address:
$TR~ET AOOAtSS 65 Ch b I' R d
. am er In oa
CITY
Chambersburg
sr"re PA
ZIP 17201
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Povel1y Credit
B. Prior Payments
C. Discount
(1)
0.00
3.
Inl~r~sVPenally If applicable
D. Interest
E. Penally
Tolal Credlls (A + 8... C ) (2)
TotallnteresVPenally ( 0 + E) (3)
4. If Line 21$ grc3ter than Line 1 . Line 3, enter lhe difference. This Is the OVERPAYMENT.
Check box on Page 1 LIne 20 to request a refund (4)
5. If Une 1 + Line 3 is grealer than Line 2, enter the difference. This Is the TAX DUE. (5)
A. Enter the IntcrCSl on the lax due. (SA)
B. Enler the lotal of Line 5 .. SA. ThiS Is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WlLLSI AGENT
".. ... ... ,.. ..... 't' '\, lW~.' \ ........ ':: ,': ::..~ \,'.. \', '1":' ".,.,.tf\1\'~~,~ ".I\t"'~'~~.':t.~:,:,:~:~!~:{:,!~~~tii;lfmWtrw'~\~~.~~~\~~~~~;~~I~iiiti~fMffl~~U~!WltlH~~;~~;';:f~n*~:?\~tWiilijJ;lFf\'U'?~mL~}.~~~~~m::f+:;'f;.r.&tilmlmf!4l~l~t'VJ~~~:~;~;!;!f~:;~i;j..i~;.;mllfrl"~'fj1Ji:niti!':.;~\';::r.i~t:i~;;!.:r:';~:F':"'':'::~:!':';~::-'~'.I\. '.:r.:..~\::,::..:.~, . ..
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN II X" IN THE APPROPRIATE BLOCKS
,. Did decedent make a transfer and: Yes No
a. relain the use or Income ofthe property transferred; ........................................................................... 0 00
b. relain the rlghl to designata who shall use !he property transferred or Its Income; ........................................ 0 00
e. retaIn a reversionary Inlerest: or ...................................................................................................... 0 00
d. receive Ihe promise for life of either payments, benefits or care? ............................................................. 0 ~
2. If death occurred after December 12, 1962. did decedent transfer property within one year of death
without receiving adequate consideration? .................................... .............. ........... ......... ........ .......,........ 0 lZJ
3. Oid decedent own an Oln trust for' or payable up 011 death bank account or seCurity at his or her death? ................. 0 (Z)
4. Did decedent own an IndIvidual Retirement Account, annuity, or other non-probate property Which
contains a bellefiCiary designation? ....................................................................................................... 00 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Undor IIOnalllo: of lIO~u'Y.1 d<.'CI~o Ihall h:lVO ox~rnlnOd !his roturn, Includlna occomP3nylng 5ehodulO$ an~ ~13l0Il1Cln13. 1'1'1410 lho bel.1 01 rN( knowlOdOD \lIld boiler. n Is 1Iue. corrocl anCI cO/T1JlOIG.
Ocel~r~lion 01 ~op~or Olllor lh:ullho IlOr~on:ll rOPfo:ontNJvo IS b~:Od on llullltOlm~ 01 WIlleh Pl(lpaIIll he: any knowtodge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~T~ I
'13.1'}'YJ.e~nt7~-> S/~~/
AOORESS ~ummit Drive - I - /
hippensburg PA
SIGN F PREPARER 0 R TH
PA 17201
"'t. .,.. ..,.... t'.. ..,.,,',,'" ~,'t'Y", .::.~.~:..:~~.~:I.'::::;.'.,..l':t:t1\;"M."\\fI""".ltj~'tt'!'W~!?!~f;":r.pfi;;nwj'I"'1~tL\'7f'LIY{'rl!'!r.~~;~..:.~;;:~~!~.;f'fr-+i~~~~l~wU~~!tF:t;;t:.~:.:.~.:.~::r.f~.tr.n'tfr1tSft~.r..l~I~~~.;L~~~:.iif"';m,fn)\t1tJl'!il~:~:~~:~;.~~m'.w,,'\;~llltJ+tt\llllt~I"UI:k'llmtf\'~mm:ktr,.;~r.~,.I,:~~~:~':)....rt~~..:r,:~:
For dates of death on or aller July " 1994 and before January 1. 1995. the tall rate Imposed on the net value of transfers to Of for the use of the survIving spouse Is 3%
/72 P.S. ~9116 (al (1.1) (i)].
FOf dates of death ()(I or afler January '. 1995, the lax rate Imposed on the net value of Iransfers 10 or for the use of !he surviving spouse Is 0% /72 P.S. 89116 (a) (1.1) Oi)).
The stature ~..!loJJm~mPJ a transfer 10 a surviving spouse from lax I and the statutory requirements for dlsdosure of assets and ftling a tax relum are still applicable even If
the surviving spouse is Ihe only beneficiary.
For dates or death on or aner July 1, 2000:
The tax rQle Imposed on the I'let value or transfers Irom a deceased child lwerlty.one years of age or younger at dealh to or for the use of a natural parent. an adopllve parent.
or a stepparenl of the child Is 0% 172 f).S. ~9116{al(1.2)).
The tax rale imposed on Ihe 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(1.21172 P.S. ~9116(a)'1)j.
!h~ !~)( r~tc imposed .on tho net value ~f transfers t~~r.fo( I.he u~e of t~e ~€~de~~'s s!bllng~ 18,12% [72 P.S. ~9116'a)(1.3)J. A sibling Is defined. under SecUon 9102. as an
REV-1503EX+(6-97) ..
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. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IDENT EDENT
ESTATE OF
Chamberlin Clifford E
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 01
0306
ITEM
NUMBER
1.
DESCRIPTION
114 shares Cumberland Valley Cooperative Stock @10.00
VALUE AT DATE
OF DEATH
1,140.00
2. Account #50 00 0632 01 3, Orrstown Bank, consisting of the following assets:
1139 shares common stock Orrstown Financial Services @38.50
43,851.50
1007.4450 shares Nationwide Fund D @31.08
31,311.39
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
76,302.89
,REV-150BEX:+197) _~_
..~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Chamberlin Clifford E
FILE NUMBER
21 01
0306
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1977 Mercury Grand Marquis, copy of appraisal attached
VALUE AT DATE
OF DEATH
8,600.00
2.
1977 Dodge truck sold for $700.00
700.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9,300.00
.' ~"'"."~ '*
. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Chamberlin Clifford E.
FILE NUMBER
21 01
0306
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DE CD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST
(IF APPLICABLE)
1. IRA Account #1400011601 3, Orrstown Bank, beneficiary
Betty M. Chamberlin, decedent's spouse, consisting of
the following assets:
Em-Homestate Banking & Finance 360.183 shares @12.38 4,459.07 100. 4,459.07
Federated Growth Strategies 311.204 shares @45.16 14,053.97 100. 14,053.97
Janus Balanced Fund 1281.869 shares @23.66 30,329.02 100. 30,329.02
Federated Fund #851 including accrued interest 809.32 100. 809.32
PBHG Growth 192.180 shares @55.25 10,673.20 100. 10,673.20
Vanguard International Growth Port 322.253 shares @21.38 6,889.77 100. 6,889.77
Vanguard Short Term Corporate Bond 920.810 9,686.92 100. 9,686.92
shares @10.52
TOTAL (Also enter on line 7, Recapitulation) $ 76,901.27
(If more space is needed, insert additional sheets of the same size)
.' ~""":"'" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Chamberlin Clifford E
FILE NUMBER
21
01
0306
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
2.
FUNERAL EXPENSES:
Fogelsanger Bricker Funeral Home, funeral expenses
Andrews Memorial Services, gravemarker
7,329.00
3,360.00
B.
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
0.00
City
State
Zip
2.
3.
Yea~s) Commission Paid:
Attorney Fees
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
0.00
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees Register of Wills-JCP fee 5.00; probate petition 115.00; extra pages 3.00;
short certificates 12.00; filing return 15.00
150.00
5.
Accountanfs Fees
0.00
6.
Tax Retum Preparer's Fees
0.00
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,839.0CJ
. :""":~~' '*'
. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
AMOUNT OR SHARE
OF ESTATE
1.
Betty M. Chamberlin
5 Summit Drive
Shippensburg, PA 17257
spouse
entire estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. 0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
.
JM::T \'ITL]' .r\NTl TTST/\f1f:>JT
J, Clifford J:. ChamberJ.in, a resident of the Township of
Southampton, County of Cumberland ,and CommomvcH] th of Pennsyl-
vania, being or sound mind and )l1(,Plory, do mnke, publish and
dccl<HC t11 i s to be my Lns t lVi 11 and Tes tament, herehy revokin.t':
rl n y n n d n 11 ~\: i 11 s h)' rn e her e to For e In D de.
r r r: \ :'j'" :
(1 ire c t J11 Y Lx:: C II t r ix, hen:' j n aft ern a me d, top a y all
my just debts and funer<JJ expenses ns f,WY cOll\'cnicntly be done
;1 f t C T my de c e ("I S C .
:;r:COND: I gIve, devi5c and bequcnth 3]) my estnte, he it
1'C<.11, person:! 1 or m:i;xcc1, to my 1.;1 Fe, 1:('tt)' ~!. CJwInhe1'l in, for her
OIql proper use and behoof forever.
TiilPD: In the event my Idfe, Petty j\L Chal'lbcrlin predeceases
ne or we sl10uld perish in (1 COlnmon di~1(l5ter, then T pi'Ve, devise
and bCquCDt}l my cnt1 rc c.stnte, he i t r(~nl, personal or n-Li.xcd,
1: 0 Jll Y chi 1 d r c n e qua 11 y, s 11 (l reD n d ~; h :1 r c nJi}, C, 0 r the i r he i r;~ .
! Il the
event allY of my children 3rc minors
at thc
~1:l tc or
'11","
, '.':
d e:l t h, t 11 en T g i v c, de vis e (] n d h c q II eat}, my en t ire cst ate, be j t
Te,l] , pcrson;l1 or mixed, to my son, Pon:~ld F. Clulj11berlin and
my dllUj;htcr, Connie ~1. \\':ltkins, Tj) TPUST NTYL:PTlTI:LI:SS, to pav
tll.c income and so mucll of the principal tvhicl1 they in their
This instrument was hy the Testator, Clifford E. Chamberlin,
on the dnte hereof signed, published and declared by him to be h:i.;
Last Will and Testament, in our presence, who at his request and
in his presence and in the presence of each other, we bclievin~
him to he of sound and disposing mind and memory, have hereunto
subscribed our names as witnesses.
\ i;
./ l."
SENT B~: ORRSTOWN BANK;
7175329342;
MAR-30-0112:53;
PAGE 1/1
~~.
Clifford and Betty Chamberlin
Account #50 00008301 9
Security N llme
Federated Fl.llld 851
Accrued Interest
Shares
19.0300
Account Total
Clifford E. Chamberlin lRA
Account #14 00 0116 OJ 3
Security Name
Em-Homestate Ranking & Fianance
Federated Growth Strategies
Janus Balanced Fund
Federated Fund #851
Accrued Interest
PBHG Growth
Vanguard International Growth Port
Vanguard Short T enn Corporate B_ond
Account Total
Shares
360.183
311.204
1281.869
807.620
193.180
322.253
920.810
Clifford Chamberlin
Account #50 00 0632 01 3
Security Name
Orrstown Financial Services
Nationwide Fund D
Shares
1,139.0000
1,007.4450
Account Total
Grand Total All Accounts
Pol!l1.lt" Fax Note
7671
PhOf1(l II
:Market Value
19.03
.04
19.07
Market Value
4,459.07
14,053.97
30,329.02
807.62
1.70
10,673.20
6;889.77
9,686.92
76,901.27
Market Value
43,851.50
31~311.39
75,162.89
151,083.23
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LAW OFFICES OF
ZULLINGER - DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Charnbersburg , P A 17201
717-264-6029
Fax: 717-264-1884
zulngrj~cvn.net
Dale F. Shughart, Jr.
of counsel
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, P A 17257
717-532-5713
Fax: 717-530-5222
davish@cvn.net
May 16, 2001
Register of Wills
Cumberland County Courthouse
~li~e,P1\ 17013
Dear Ms. Lewis:
RE: EState of Clifford E. Chamberlin
Enclosed for filing in your office is an original and one copy of the P 1\ Inheritance Tax
Return for the above estate, along with check in the amount of $15.00 for filing fee. There is
no inheritance tax due with this return.
Very truly yours,
Ll~7C :3~~
If / :~~_ tf
. \ Joel R ZWliriger
encls.
~
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND _, PENNSYLVANIA
Name of Decedent: Clifford E. Chamberlin
Date of Death:
9/12/00
File No.
21-01-0306
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES ---1<_
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 Orphan's 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 Clerk of the Orphans' Court and may be attached to this report.
Date: 7/5/01
~'~ I .kJ
- .~ -~~~
Si' ature
c
Joel R. Zullinger
Name (Please type or print)
14 North Main Street
Address
Chambersburg _____ PA 17201
{I17)2_64-6Q_29 _ _______________
Tel. No.
Capacity: Personal Representative
X Counsel for personal representative
\ /b-a/R- /.;j../
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~~*
REV-1547 EX AFP U2-DDl
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060 1
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JOEL R ZULLINGER
ZULLINGER DAVIS
14 N MAIN ST STE
CHAMBERSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-02-2001
CHAMBERLIN
09-12-2000
21 01-0306
CUMBERLAND
101
CLIFFORD
E
200
PA 172011
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is4"7-E:'i[-AFP-fi'2:ooY-NclT"icE--oF-YNHEifiTANCE-YAx-'APPR'AisEMENT~--A[rOWAirCE-(rR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CHAMBERLIN CLIFFORD E FILE NO. 21 01-0306 ACN 101 DATE 07-02-2001
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
76.302.89
.00
.00
9.300.00
.00
76.901.27
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
162.504.16
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/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
10.839.00
.00
(11)
(12)
(13)
(14)
10.839 on
151,665.16
.00
151,665.16
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. 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
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
(15) 151.665.16 X 00 = .00
(16) .00 X 045 = .00
(17) .00 X 12 = .00
(18) .00 X 15 = .00
(19)= .00
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.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.)
REV-1500 EX + (6_00)
*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Chamberlin Clifford E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH {MM-DD-Year}
[Xl 1. Original Return
o 4. Limited Estate
006. Decedent Died Testate (Attach copy of Will}
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of deatll af\oer12-12-a2)
o 7.' Decedent Maintained a Living Trust (Attach copy ofTrusq
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
c.
09/12/2000 11/01/1927
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Chamberlin Be M.
I-
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W
C
Z
C
II.
Ul
W
'"
'"
o
o
Fi!llf'
COMPLETE MAILING ADDRESS
14 North Main Street, Suite 200
:!liiill
NAME
Joel R. Zullin er
FIRM NAME (If Applicable)
Zullin er-Davis
TELEPHONE NUMBER
717264-6029
Chambersbur
151,665.16 xoL (15)
X .0_(16)
X .12 (17)
X .15 (18)
(19)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jolntiy Owned Property (Schedule F) (6)
o 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. Debls of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
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. Not Value Subject to Tax (Line 12 minus Une 13)
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)
16. Amount of Une 14 taxable at lineal rate
17. Amount of Line 14 taxable atsibJing rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
/~~.;;J.lft- /2
FILE NUMBER
21-010306
CQUNTYCODE ~~ - - NUMBER--
SOCIAL SECURITY NUMBER
182-22-8026
THIS RETURN MUST BE FilED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date 01 deatll priorto 12-1J-82)
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSchO)
PA 17201
0.00 I OFFiclALUSEONLY
76,302.891
I
I
I
I
I
I
~
1
9,30000 I
I
I
76,901.27.
(8)
162,504.16
10,839.00
(11)
(12)
(13)
10,839.00
151,665.16
(14)
151,665.16
0.00
O.Oll
MAY- 4-e1 FRJ:
9::;>e
p.e2
~ecede'n~'s Complete Address:
$TR~eT ADIlAESS ~5 Ch b . R d
<> am erlin oa
CITY
Chambersburg
Tax Payments and Credits:
1. Tax Due (Page Hlne 19)
2. Credits/Payments
A, SpOusal PovMy Credil
e. Prior Payments
C, Discounl
I SWE PA I ZIP 17201
(1) 0,00
Total Credits (A+B -C) (2)
3, InlercslIf'enally If applicable
D.lnleresl
E. Penally
TotallOleresllPena!ty ( 0 - E ) (3)
4. If Line 21s grcalerlnan Line I + Line 3, entanhe difference. Thls Is the OVERPAYMENT,
Check bOK on Page 1 Line 20 to request a relund (4)
5, II Line 1 + Line 3 is grealer than Line 2, enier the difference, Tnis Is the TAX DUE. (5) 0.00
A, Enter the InlerCSt on the lax due, (SA)
e, Enter Ihe lolal of Une 5 + SA. This Is the BALANCE DUE. (56) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
.. .. ." .........,. -\""",.. . ",.","', ".:n<,'\"".' ""'"II\'\'I\'~~'~:,l~~.;""!,,,,,:,;t!,,!\,"iiltnllf'lr~~~:~:,,?;,,,l:ltiWfl.llll1!lJ?I~I!II~f!;~!";,,.~;.;*m:;;;;;iilijl~;lllr!l;1r-I!'!.~~W"!~!i
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1, Did decedent ma~e a transfer and: Yes No
a. relain the use or Income oflhe property Iransferred; """."""."""".""""."".""""""""."""""""""." 0 00
b. relain ihe rlgnlto designate who shall use the property IrsosfeHed 01 Its Income; ",,,,,.,,,,,,,,,..,,...,,,,,,,,,,,,,,,, 0 00
c, relaln a reversionary Inleresl; or """""'..".........".."",....",.."""".",,,..",,""".".,.." "."",,,,,,, '",,,,,,,, 0 00
d, receive lhe promise forlile 01 either payments, benanls or care? "".",,,,,..,..,,,,,,,,,,,,,,,,,,,.,,,,,..,,,,,.........,,. 0 1ZI
2, If death occurred after December 12, 1962, did deceoenllransler property wllhln one year of death
without receiving adequale consideration? "'"'' """".."",,,,,,,,,,,,,,,. ,"..""".. ""","" ",,"'" """" "." "...".." 0 [Z]
3, Did ~nl OVIn an 'In trust lor' or payable upon death bank accounl or security at his arhar death? """"."."", 0 00
4. Did decedent own an Individual ReUrement Accounl, annully, or other non-probate PlOllerty wnich
contains a beneficiary deslgnalion? "."""""""""."""..""""."..."""""....".."....,,,,,,,,,,,,,,,,,,,,,,,,,,,,,."'" [Z] 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDLlLE G AND FILE IT AS PART OF THE RETLlRN,
Undor oonorullO .lllIl~U"', I d,<I;lCQ ~J\ I.m .'3_ ~i, lOI\lln, lnellldl~ DCtOm~lni ,,~uilt MO 'I3\D1!>Qn~, 1'IllI1O \Nl bo,r ~ ItYf knowlo<lDo ,"0 bo~r, n r.lNe, 00</001 Sfl(IOOI1\l101$.
Oocl:lr"lion of M1pNOf oll1Or IMn lho por:;OI1J1 rODrO:Ofllotlvo Is bl'COd 011 OIllflIOfl'l'lOIIon ofWfllcn proporol hD~ DtIy knowlodgB,
SIGNATURe OF PERSON RESPONSIBlE FOR FiliNG RETURN OAT
PA
,
PA 17201
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:/fllfltl!ll~r.l~~/~!!::~~~:'Iilii'..ii!ifl"blf1I!~!/).!E~i;;~i';.';;W.:;::,'\l~!IilllfiIUllllh~'I:~u{I.lIWII..lI11mkltl:l\Im~*"M~~'!I"",~::~r_'".
For dales of dealn on or aller July 1, I 994 and before January " 1995, tne laXtale Imposed on Ihe nel value oftranslers to or tor the use oflne surviving spouse Is 3%
(72 P,S, ~9116 (al (1,1) (ill.
For dates of deatn on or .fler January 1, 1995, the lax rala Imposed on rhe net value ollranslers 1001 lor Ihe use of the surviving spouse Is 0% [72 P,S. @9116 (a) (1 ,1)(iill,
The statute ~.Jl.olexeml1l a Iransler to a surviving spouse Irom tax, and the Slalutory requlremenls for disclosure of assets and lIIing a tax relurn are still applicable even If
1M surviving spouse is the only beneficiary,
For d31es of de31n on or af/er July 1, 2000:
Tht lax rate ImpOscd on the net value of transfers from a deceased child Iwanly-one years Of!lge 01 younger al dealh to 01 101 the use of a natural parenl, an adopllve parenl,
or a stepparent of !he child Is 0% (72 P.S. ~91 t6{a)(1 ,211,
The tax rale imposed en the nel value oll/ansfels 10 or for \he use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S. ~9116(1.21172 P.S. ~9116(a)(II1,
The la.x ralC imposed on Ih3 net value of Iransfers 10 or for Ihe use of Ihe d.ace.deni'S siblings Is 12% (72 P.S. fi9116(a)(1.3)l. A sibling Is denned, undel Secllon 9102, as an
'~'~"':I"" '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
1 ENT E ENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Chamberlin Clifford E
AU property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 01
0306
ITEM
NUMBER
1.
DESCRIPTION
114 shares Cumberland Valley Cooperative Stock @10.00
VALUE AT DATE
OF DEATH
1,140.00
2. Account #5000 0632 01 3, Orrstown Bank, consisting of the following assets:
1139 shares common stock Orrstown Financial Services @38.50
43,851.50
1007.4450 shares Nationwide Fund D @31.08
31,311.39
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
76,302.89
~'~"~."":' '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Chamberlin Clifford E 21 01 0306
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on SChedule F.
ITEM
NUMBER
1.
DESCRIPTION
1977 Mercury Grand Marquis, copy of appraisal attached
VALUE AT DATE
OF DEATH
8,600.00
2.
1977 Dodge truck sold for $700.00
700.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, insert addltlonai sheets of the same size)
9,300.00
''''''''':',.''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Chamberlin Clifford E.
FILE NUMBER
21 01
0306
This schedule must be completed and filed jf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRElATIONSHIPTOOECEDENTANDTHE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPV OfTHE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST
(IFAf'PLICABLE)
1. IRA Account #1400011601 3, Orrstown Bank, beneficiary
Betty M. Chamberlin, decedent's spouse, consisting of
the following assets:
Em-Homestate Banking & Finance 360.183 shares @12.38 4,459.07 100. 4,459.07
Federated Growth Strategies 311.204 shares @45.16 14,053.97 100. 14,053.97
Janus Baianced Fund 1281.869 shares @23.66 30,329.02 100. 30,329.02
Federated Fund #851 including accrued interest 809.32 100. 809.32
PBHG Growth 192.180 shares @55.25 10,673.20 100. 10,673.20
Vanguard International Growth Port 322.253 shares @21.38 6,889.77 100. 6,889.77
Vanguard Short Term Corporate Bond 920.810 9,686.92 100. 9,686.92
shares @10.52
TOTAL (Also enter on line 7, Recapituiation) $ 76,901.27
(If more space IS needed, Insert addltionai sheets of the same size)
:~15"":I":1 '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Chamberlin Clifford E
FILE NUMBER
21
01
0306
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger Bricker Funeral Home, funeral expenses 7,329.00
2. Andrews Memoriai Services, gravemarker 3,360.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5) 0.00
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as craimanfs, attach explanation) 0.00
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills-JCP fee 5.00; probate petition 115.00; extra pages 3.00; 150.00
short certificates 12.00; filing return 15.00
5. Accountanfs Fees 0.00
6. Tax Return Preparer's Fees 0.00
7.
TOTAL (Also enter on line 9, Recapitulation) $ 10,839.011
(If more space IS needed, Insert additional sheets of the same size)
,'~"'3E:"'~".
. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
i= ?1 01 mOR
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Betty M. Chamberlin spouse entire estate
5 Summit Drive
Shippensburg, PA 17257
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON liNES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRiBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 0,00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. 0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON liNE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
r,,^'<~T \\.fTT...l. I\NTJ TI;,STA~1!:~',rT
r, eJ i fford j" Ch,nnherJ -;",, ;! l'C~,jc1cllt of the Townshi p of
,C;outh;llPpton, COllnty 0 f Cumher 1 (lnd (1n(1 COPltilOnh'CaJ th of Pcnnsy]-
V;tlli,~, hcin~ or sound lnlnd 3JJd ]110PJOry, (10 make, puhlish and
tlecl:lrc tJlis to J)(' my l.,nst 1'.riJ1 (lnd Testament, hcrcliy rcvokin,p,'
rln}" nnd all ~\'i]ls hy me heretofore m:1de.
:' T:: :.,~' :
(1ircct r:!y xccutrix, hcrc:inaftcr nlltncd) to 'p;ry nIl
my just dehts nn(] funer3] expenses "5 n,lY conn;nicntly he done
;lrt:(!T lilY llcccosc.
,(;r:C()NJ): T ~~i\rc:, (l.e'fi::;c ,ll'ld hcqtlcath all. f!1Y estate, l'lc it
real) pcr~~Olla'i O}~ l\l:i~\c!~, to my vife, r;ctty l,l. (Jl.1,mberlin, fOT her
o\,,'n j)YOr'CT use an(1 1~(~110of forr::vcr.
T1!1PfJ: In the ,,,'cnt nil' I'ii Ce, netty ",1 ChaYlherl3,n pTedeeense~;
rlC~ or \,./c should pcrl~;h in (: COlliJnon di~:;;lstcr, then T p.ivc, devise
nnd hL'qllcatb my entire C.~.;to1tC, he it r(~[ll, person;J] or m.ixc(l,
to my (:]lildrcn equally, share nnd shnrc (11j').-..c, or their heirs.
I II th!' (.'vc'n1 ~~ n y (\ r my ell j 1 drcn nrc Ill'] nors n t tl"1(, {'~:l tc r,'>;'~ )l~;~
death , then 1 r iv'c , devise and h,,<]\)CotJ, my entire estate , he i t
rct\l ~ P('T~.~on;l'l or j1)~XC(t, tn my :~on, Pon.nld 1:. rh[lr!ll~er1i.n anr.l
my d;'1l1~lhtcr~ ('onnie ~i. 1"::ltt~ins, 1;'.' TPl.l,(:;T i-.)J:VrnTPl:LE,SS, to pt'lV
tJi(,j ncomr> :llld so mucll of thr' rrinc'ipnl tvh:i ell they in their
"-('try 1_,'. ellamher] in to he the] :;eclltrix of tl11S my Last 1'Ii.J 1
;,]J1\.l TC::ttll:1C'nt. 1n the event my \\r:ifC', 1'~etty \~. Ch;~1ll1:'crlin) should
1'C un~lbJe to ~,;crvc as ExC"cutrj x for any reason \':h~ltsoeVeY, then
I nominate, con:'ti tute ~nd '1nl'oi nt 11Y son, POJ1~ld E. Chamher] in
Iln,1 my ,!:lto,l1ter, Conni.e "I. r:h~1l1herljn, to )'<, the substitute
Executor;:; .
P! "'TTNI'.';~ "'1 If'.!'J 'n!' , T hav(' 1101'e\1nt0 set II1\' himd and seal to
this, my Last Will and Testament, written on two sheets of paper,
dated this day of .June, 1970.
(._'-_....,,"_.....~
(SEAL)
Thi:; instrument. \'.'as hy the Te:;t.11tor, Clif'ford F. Chmrherlin,
on the ,1"t(' hereof signee1, published ~nd declared by him to he hi
Last Will and Test~ment, in our presence, who at his request and
in l)is pTc~..;cncc anti in the pre~cl')c(, of 0:1ch ot1"1cr, "Ie bc]ievine
him to he of sOllnd and disrosinr mind and memory. hnvc hereunt.o
.suhscribc""c1 our names ;,lS\\,j tncssc~-:;..
StNT SY, ORRSTOWN SANK;
7175329342;
MAR-30-0j 12:53;
PAGt i /1
Clifford and Betty Chamberlin
Account #50 00 0083 01 9
Security Nllme
Federated Fund 851
Accrued Interest
Shares
19.0300
Account Total
Clifford E. Chamberlin lRA
Account #14 000116013
Security Name
Em-Homestate Ranking & Fianance
Federated Growth Strategies
Janus Balanced Fund
Federated Fund #851
Accrued Interest
PBHG Growth
Vanguard lnternational Growth Port
Vanguard Short Tenn Corporate Bond _
Account Total
Shares
360.183
311.204
1281.869
807.620
193.180
322.253
920.810
Clfjjord Chamberlin
Account #50 00 0632 013
Security Naole
Orrstown Financial Services
Nationwide Fund D
Shares
1,139.0000
1,007.4450
Account Total
Grand Total All Accounts
Post-It" Fax Note
7671 D...
Co.lOap!.
PI'lOfloft #
F.,. .J,,.,.LC
Market Value
\9.03
.04
19JJ7
Market Value
4,459.07
14,053.97
30,329.02
807.62
1.70
10,673.20
6,889.77
9,686.92
76,901.27
Market Value
43,851.50
31,311.39
75,162.89
151,083.13
Kelley Blue Book Used Car Values
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d:-I
Pennsylvania' April 25, 2001
1997 Mercury Grand Marquis GS Sedan 40
Buy il New Cilr
BllY_ilUse_cLC<lr
~istYQllL<:'ar foLS_aJe_Online
FiD<lncingQuote
ln~urance_ QUQte
Warrqnty QUQte
Parts _ &_ AccessQries
PaymentCil/culiltor
Engine: va 4,6 Liter
Trans: Automatic
Drive: Reilr Wheel Drive
Mileage: 24,000
Equipment
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Cassette
Dual Air Bags
Power Seat
Consumer Rated Condition:
Good
"Good" condition means that the vehicle is free of ilny major defects. The
paint, body and interior have only minor (if any) blemishes, and there are no
major mechanical problems. In states where rust is a problem, this should be
very minimal, and a deduction should be made to correct it. The tires match
and have substantial tread wear left. A clean tLtle_ history is assumed. A "good"
vehicle will need some reconditioning to be sold at retail; however major
reconditioning should be deducted from the value. Most recent model cars
owned by consumers fall into this category.
Trade-In Value
$8,600
Trade-in value represents what you might expect to receive from a dealer for
this consumer owned vehic:le. Keep in mind that the dealer must then absorb
the cost of making the vehic:le ready for sale, advertising, sales commissions,
arranging finilncing ilnd insurilnce ilnd stilnding behind the vehic:le for any
mechanical or safety problems.
Now get a new__c;aLP-tic:.e report of the car
http://www,,../kw.kc.ur?kbb;951219&;t&39;Mercury; I 997%20Grand%20Marquis&5;ME;E6 4/25/01