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Home My WebLink About01-0384 PETITION FOR PROBATE and GRANT OF LETTERS ~\- D\ - 3~4- Estate of Gladys W. Sourbeer also known as Register of Wills for the , Deceased. County of Cumberland in the Social Security No. 204-03-8225 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner{s), who is/are 18 years of age or older an the execut rices in the last will of the above decedent, dated December 1 and codicil{s) dated N / A No. To: named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in her last family or principal residence at Shippensburg Cumberland County, Pennsylvania, with 1835 Ritner Highwav. North Newton Township, (list street, number and muncipality) Decendent, then 81 years of age, died March 22 ffi Chambersburg Hosoital. Chambersburg. PennRylv~ni~ 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 probate; 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 Pennsylvania situated as follows: 1835 Ritner Highway. North Newton County. Shiopensburg. Pennsylvania , ~ 2001 , $ $ $ $ Township. 2,000.00 65.000.00 Cumberland WHEREFORE, petitioner{s) respectfully request{s) the probate of the last will and codicil{s) presented herewith and the grant of letters testamentary (testamentary; administration c.La.; administration d.b.n.c.La.) theron. Ii be~t~ ].g 67 Cones toga Drive ~~ Shippensburg Mobile Estates 3~ u'- ShippenRhllr~, FA 177r:;7 30 ~ c:: tl/) V) ~.i~e~4 194 Big Spring Terrace Newville. PA 17741 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm{s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well d truly administer the estate according to law. ,10- ~.;{4 _M~ affirmed and 16TH V') oQ' :::s ~ - ~ ~ ~ No. ?1 - 01 - 384 Estate of Gladys W. Sourbeer , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APR I L 17, ~ 200 ~ 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 December 1, 1981 described therein be admitted to probate and filed of record as the last will of Gladys W. Sourbeer and Letters Testamentarv are hereby granted to Donna L~e Rosenberry and Anna Ma rv Mp-ntzpr Will Book # Page ~6(?!12~ ~~. - Register of Wills -- - - - - - MARY CLEWIS FEES Probate, Letters, Etc. ......... $ 11 S . 00 Short Certificates( ) . . . . . . . . .. $ q nn Renunciation ................ $ X-Pages $ 6.00 JCP TOTAL_$ 13~:&& Filed .......... ~P.R. ~ ~. .1l2 . ?'.QQ 1. . . . . . . . Jered L. Hock, Esquire, 19211 ATTORNEY (Sup. Ct. I.D. No.) 3211 N. Front St.; PO Box 5300 Harrisburg, PA 17110-0300 ADDRESS (717) 238-8187 PHONE Mailed letters to attorney on 4-17-01 'hi' is co cerrih' that the information here given is correctly copied from an original cerrificate of death duly filed with me as l,oell Registrar.' The original certificate will be forwarded to the State Vital Records OHice tor permanent tiling. Fee for this certiflcate, $2.00 WARNING: It is illegal to duplicate this copy by photostat or photograph. /7 ~"'(J /. , '(( ~ , Local Registrar No. ~;;~ /.ilI\IIII~ "\.\\\ ,Qf Pt:h~---_ I>,,-,,,r-.-- -~4'-- ;;/~~// ,\<J~~_ <{~/ ~~\~\ ~f ~{, ' ':. , \7 ~ '<:::I' '-" I:;;Z:~ ~ '-'\I'-(fs. . ,'I~~ ~*~ ;;*{ ~<%''', /~\\' ~ Af,f' " /k~'\' ~"'----IMENl u\ ~ III """''''''/1/1''1111'' J" p 7249167 ju,cRcll 23 ./ 2.0 (; / Date ~II 7187 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAUE OF DECEOfNT I' ,r~M.M~~------ -.---- 'I:t\<. .....1fl Glad s W. Sourbeer AG[ It.," fl"""..l UNDER I VEAR UNDER I 01/.1/ !Aonth. Days 81 v,. Frankl in OECEOENl'S USUAL OCCU_IOOI (~~:'::_c'io~::2~ Ie. Wh i t (' SURVIV'NG SPOUSE III N1tp llvf' ft1,11ll'100 narnfl\ T9~fls.hj~__ c_,,!_~ PA 17257 17257 _DIllY! CAuse (FonN c~_OI c()f'1dd1Of"l ,~ on deMh)-'-" . tlsthf\'lt- --ooE IQ',OR AS A CONSE~UENce ()f-)' I ApC)IO_,m.te : Ir".rwI~ I onMI .nd de.'" -tJea~_- 01"... ,'O(ufk.ne condhIons ronfnbuttnq 10 diU"". hVt not reau"'I19..... m. undertyu''9 Cftlllla Q?ven In PAAT I 21.PAmt ~..- ~_,-.o"'_. _ Em..UIlDf:IIl.V_ CllUSf: (0.0..- Of """". rhaf 1I\lt&afed evet'lta ''''''''"'>0 ",_ILAlT I : DUE TO (on AS A CONSr OlJE ~r OF) I : -_._._----_.__.....,..-~- ! DUE TO [OR AS A CONSEOUENCE Of) ~ AN AUTOPSV WERE AU'TOPSY FINDINGS a,4ANNfA OF DfATH r>ERFOR_D? -.L..OIll.E PAIOA TO E1" COMP\.ETlQN OIF CAUSE N.tw.l 0 OF DEATH? Home.,. .Ac_ 0 Pending _Igo'1on 0 - 0 No _0 NoD Sulcide 0 Could"", be "",.....ined 0 DATE or INJURV (104",,111,0..,. "'lit) nMr or INJURV INJURY AT WORI<1 OFscn,eE HOW IN..Juny OCCURRf" 0 "" 0 NoD 3OlI. . M. _. 3lloI. PL'CE OF INJURV . At home. I.rm. ,,,_. lacIOrf. 011..,. lOC1lT1ON (S~- C"yI1'own S""O' butIdtnQ. etc C5Pft(:lfy) ~ - ~ CI[A'TtfIL'IE.. IC~eck ont'I Oflftl ' .CEATlfYtNO PHYSICIAN (Ph'(!ICl8n cl'l'1ly1nQ cauSAl d d~Ath ~ .1f\OI.h.,r otW!.tC18n has Dfonounctld dea1h and comptated>>~ 23) To Ihe bin. o' my knowtec:toe. de"" OCCUttN due.o ,h. cMlU(a) _net manner.. ...tN. . . . . . . . . JJ DD .fII'IItONOUNCIN AND CERTIFYINO PHYSICIAN (Phy~Jan holh ptonounc1nq oea1h and CM11VtrlQ 10 CItUS4!t 01 df>.nhl TG Ih. tt.et of Ifty Icl"Ow~, ct-.I" occurred., the 11m., d.t_, and pl.c.. .J1d du. '0 ,"'. cau..(a) and mam\.r.. _,a'H . 'MEDICAL EXAMINER/CORONER On the b..'. 0' ..Iminltfon and/or Inv.stlgatlon. In My opinion, d.ath oc~urr.d.' the 11m.. dat., .nd plece,"'d due to the C.U"(I) Ind J1. mlnn., I. ~t"ed.. . . . . . . . . . . . . . . . . . . . . .. ..... ............. . ..... , .. . ... j. . : . . . . . . . . . . . . . . ,". . . :.. . . . . . . . . . . . .... . REGISTRAR'S SIGNATURE ANO NU!AB [] 17257 Shippensburg, I'^ ..'/# /2.1/1'2/ ,)1 DATE f\lEO {Month D~.,., 'feat! ~--/!!.irgc If 2- -7 I 7.- 08 ( / -, ... LAST WILL AND TESTAMENT I, GIADYS W. SOURBEER, of R. D. I, Shippensburg, C~r land County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this my Last Will and Testament, hereby revoking and making void any II 'I II and all former wills and codicils by me at any time heretofore made. II ii li I, I '! FIRST. I direct my hereinafter named Executrices to pay all my just II debts and funeral expenses as scxm as corweniently may be after my decease; I I I further direct that all taxes that may be assessed in consequence of my I death, of whatever nature and by whatever jurisdiction imposed, shall be Paid I I fran my residuary estate as a Part of tlle expense of the administration of my Estate. SECCND. I give, devise and bequeath all my property, real, personal and mixed, whatsoever and wheresoever situate, in two (2) equal shares, share and share alike, to my two (2) daughters, name I y, ANNA MARY t.1ENTZER, and 'I OONNA LEE ROSENBERRY, absolutely; provided, however, that in the event I I either of my aforesaid daughters shou ld predecease me: then in that event I I I, I give, devise and bequeath the share of my said deceased daughter to the child or children of my said deceased daughter, living at the time of my I II decease, equally; provided further, that in the event any of my aforenamed I Legatees are not of full legal age at the time of my decease, then in that I I event, I hereby naninate, constitute and appoint CCMMONWEALTH NATIONAL BANK, of the Crnmonwealth of Pennsylvania, as the Guardian of the said minors' estates, the said Guardian to take and receive the share of the said minor I child or children, and irwest and reirwest the same in legal or nan-legal 'I investments, whichever in its discretion it deems proper, and the said Guardian I to have full power and authority in its discretion to pay such amounts of .! II incane and principal as are necessary for the support, maintenance and education II 'I of the said minor child or children, and upon the said minor child or children II each reaching full legal age, to pay the said share to the said child. II II l! ij 11 it II .., ~- (SEAL) () THIRD. I hereby naninate, constitute and appoint my said daughters, namely, AW-JA MARY MENTZER and DOONA LEE ROSENBERRY, or the survivor of than, I ! I I I have full power and authority to do any and all things necessary for the canPletF administration of my estate, including the power to sell any and all real and I t I I I \ I as the Executrices of this my Last Will and Testament, my said Executrices to personal property of which I may die seized, at public or private sales, in their discretion, both for purposes of administration and distribution,' and without any Order of any Court; and I further direct that my said Executrices not be required to file any Bond in connection with the settlement of my estate. IN WITNESS WHEREOF, I, GLADYS W. SaJRBEER, have hereto set my hand and seal to this my Last Will and Testament, written on three (3) sheets of paper, this 1st day of DecEmber, 1981. ~4~7 1.,J-d2,,~{l;~)SFAL) Signed, sealed, published and declared by GlADYS W. SOURBEER, the Testatrix, as and for her Last will and Testament, written on three (3) sheets of paper, in the presence of us who have, at her request, signed our names as witnesses hereto in the presence of the said Testatrix and of each oth7'\ . .e{ I ,,/ ~ .... ,,-...{' \ . -'l,'.A/.'vf \.. -' :1 . I ) . "^/I l- . o' :fh. vtV,-- ~I o. . \' ~.!; '~.f\. t) .(\G \, V.'~)1.. .\.A-.-\:."'- (\ d..:LA. .J '.J \.: -2- .. . CCMM~VEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERlAND We 1 GIADYS W. SOURBEER, ROBERT J. YOCUM, and TERESA J. BURKHOLDER, the Testatrix and the vvitnesses, respectively, whose names are signed to the attached or foregoing instrument being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instru- ment as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as Witness, and that to the best of their knowledge, the Testatrix was at the time, eighteen years of age or older, of sound mind and under no constraint or undue influence. J,U ~L /~ s W~ Sourbeer . . i I " . -J\{ "if.1v _1 1\ ..' ,1 ...../ l ,: ~ { //;" /, I\v I ''-L V\. . /../'- i f il/ Ii v-......__ ~' v r lY i/'" Roberit J.f Yocum \...J' \. ~. \)J, .Q~C \ . I~A k .\"-0 \ A 0 h........L- T~. Burkholder Subscribed, sworn to and acknowledged before me by GIADYS W.SOURBEER, the Testatrix 1 and subscribed and sworn to before me by ROBERT J. YCCTJM and 'IERESA J. BURKHOlDER, Witnesses, this 1st day of December, 1981. _"'''''' ~ r"', t ,....,......., (r 1\,. \ l 1 ~; ", i I \ "'-. \ ~ " \. _ ~ I.L.C~ '~'.4 \.... ". , (.' ^ ,,\ (: J' \:::) Notary Public ~:<. EUZABETH K. T A YLOH ". SHIPPENSBLlRO, CUMH. co. Notary Pubflo Exp. 9-19-/B -3- (" '.. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent Date of Death Will No.: 2001-00384 Gladys W. Sourbeer March 22, 2001 Admin. No.: To the Register: I hereby 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 Anril17. 2001 . Name Address Donna Lee Rosenberry 67 Conestoga Dr.: Shippensburg Mobile Estates: Shippensburg Mobile Estates: Shippensburg. P A 17257 Anna Mary Mentzer 194 Big Spring Terrace: Newville, P A 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: July ((1. 2001 ~ Name Jered L. Hock. Esquire Address 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 Telephone (717) 238-8187 Capacity: Personal Representative X Counsel for Personal Representati ve Document #: 211445.1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DONNA LEE ROSENBERRY 67 CONESTOGA DR SHIPPENSBURG MOBILE ESTATES SHIPPENSBURG, PA 17257 -------- fold ESTATE INFORMATION: SSN: 204-03-8225 FILE NUMBER: 21 - 2001 - 0384 DECEDENT NAME: SOURBEER GLADYS W DA TE OF PAYMENT: 1 2/26/2001 POSTMARK DATE: 12/21/2001 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2001 NO. CD 000697 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $500.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DONNA L ROSENBERRY CHECK#147 SEAL INITIALS: AC RECEIVED BY: $500.00 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS c: P% T HU: U,vp('J 1I1I111111111111111 ," J ::i~;~~:, J /u I j ~:'.; ~.~ ~ ,;, t ,-.......:J ~ . ,:~, t~~ ~ ~~~ ~ rr ~ '" ~ \"3, .~" ~~'~ .~ ~ c:J ~ ~ ~. ~ ~ ~ ~~j '~ ih ~ l' ~.10 J 1 ~) ,~~ " "CJ ~.: ..." t...: .. { .~ f" e, 1,,*-: ',..~ (;\;...~. ~ C.E ~ .o"^",,.'c, en.' I) I) r- V>n SEN VrI'.lS: .0 . ~O~ '/') ,9 61. e.B ~.9;::1 ~~~ ~ :::: :::: e 8 g, o 0.. ""' r- ._ .....\0..:::: rI'.l . "'''''I'-,~, i' o.lo"'" ... -, ~ . ~ ._C~.. ~ ~ ~ ~ ~ /h -;;..;;~- Y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~bI?~!MEN,T2~601 HAR~~~G,PA,11128-0601 December 12, 2001 .01 ole 27 mo :13 Telephone (717) 787-3930 FAX (717) 772-0412 Law Offices of Metzger & Wickersham 3211 North Front St. P.O. Box 5300 Harrisburg, Pa. 17110-0300 Clen..;- ' Cllrnhc, , ',' .1 .}..JV! ieA Re: Estate of Gladys W. Sourbeer File Number 2101-0384 Dear Mr Hock: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before June 22,2002. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, Jeffrey D. Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HOCK JERED L ESQ POBOX 5300 3211 NORTH FRONT STREET HARRISBURG, PA 17110 -------- fold EST A TE INFORMATION: SSN: 204-03-8225 FILE NUMBER: 2101-0384 DECEDENT NAME: SOURBEER GLADYS W DA TE OF PAYMENT: 06/20/2002 POSTMARK DATE: 06/19/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2001 NO. CD 001309 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $635.00 I I I I I I I I TOTAL AMOUNT PAID: $635.00 REMARKS: JEROD L HOCK ESQUIRE CHECK#197 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HOCK JERED L ESQ POBOX 5300 3211 NORTH FRONT STREET HARRISBURG, PA 17110 -------- fold ESTATE INFORMATION: SSN: 204-03-8225 FILE NUMBER: 2101-0384 DECEDENT NAME: SOURBEER GLADYS W DATE OF PAYMENT: 06/20/2002 POSTMARK DATE: 06/19/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2001 NO. CD 001308 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $39.10 I I I I I I I I TOTAL AMOUNT PAID: $39.10 REMARKS: JEROD L HOCK ESQUIRE CHECK# 21276 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS June 19, 2002 <: G Certified Mail, Return Receipt Requested 3211 North Front Street PO. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Ms. Mary C. Lewis Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Other Offices Colonial Park Mechanicsburg 717-652-7020 717-691-5577 Millersburg Shippensburg 717-692-5810 717-530-7515 Re: Estate of Gladys W. Sourbeer No. 2001-00384 Dear Ms. Lewis: Enclosed for filing are original and one copy of Inheritance Tax Return. Also enclosed are checks in the amounts of$635 and $39.10 for payment of inheritance tax and interest and check in the amount of $15 for filing of the Return. Please note that an extension was granted for filing the Return. So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy of the cover sheet with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, GER, WICKERSHAM, KNAUSS & ERB, P.C. i:::: Jered L. Hock ~ JLH/amm Enclosures Document #: 236944.1 James F. Carl Edward E. Knauss, IV* Jered L. Hock Karl R. Hildabrand* Steven P. Miner Clark DeVere E. Ralph Godfrey Steven C. Courtney Francis J. Lafferty, IV David H. Martineau Andrew W. Norfleet Melissa L. Van Eck Andrew C. Spears Young-Suh Koo * Board Certified in civil trial law and advocacy by the National Board of Trial Advocacy cc: Donna Lee Rosenberry cc: Anna Mary Mentzer -; ...a - i Q LLI - LI.. - t- ce I.LI C.;) rn r- ru _cO -- ~ ~-~~ :::::. ~::::r ~-====ru ~g ~ ~ 0 == ~Cl ~r=t :::- ---== ~ ::= --=::::. ru ;::.. ::::::::: :::::--- -:::: 6 ~ :::::'0 ;;;;_ ~ r- &S't- -0 . ~ ,S:- ({ - .~ CG ~ (/) ~ - (.) ! .- u.. ;~ ~, ~ 1- .. /6 -02c:;:J y- ~ " BUREAU OF INDIVIDUAL TAXES '" INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-29-2002 SOURBEER 03-22-2001 21 01-0384 CUMBERLAND 101 JERED L HOCK ESQ METZGER WICKERSHAM PO BOX 5300 HBG PA 17~" ."_., -- L * REV-1547 EX AFP (01-02) GLADYS W Allount Rellitted CHANGED (1) (2) (;3) (4) (5) (6) (7) 40,000.00 .00 .00 .00 280.00 .00 .00 (8) 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 ~ iffy = isirj-Ex--AFP-Col-:02-r-NcfficE--oF-"rNHEifiTANCE-TA)rAPPRA-isEifENT~--Aii-oWAN-CE-ifR----------- - -- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SOUR BEER GLADYS W FILE NO. 21 01-0384 ACN 101 DATE 07-29-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED 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 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) 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) 14,806.00 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 40,280.00 15.050 00 25,230.00 .00 25,230.00 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: 244.00 (11) (12) (13) (14) (15) .00 X 00 = .00 (16) 25,230.00 X 045 = 1,135.00 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 1,135.00 . '" '....n. IU:l..~.Lr.1 I (+ J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-21-2001 CDOO0697 .00 500.00 06-19-2002 CDOO1308 .00 39.10 06-19-2002 CDOO1309 19.12- 635.00 TOTAL TAX CREDIT 1,154.98 BALANCE OF TAX DUE 19.98CR INTEREST AND PEN. .00 TOTAL DUE 19.98CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) () v oK 'II STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WillS, COUNTY OF Cl)MElERI...At\LQ~ ~~_, PENNSYLVANIA Name of Decedent: GI~g~ W_____SPJJrl::>~er ____ Date of Death: 3~2212. 001__ File No. 2_QJ) 1-0~3_84_ _~_ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES ___X__ NO ~______ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to NO.1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES NO ~)( b. The separate Orphan's Court No. (if any) for the personal representative's account is: N/A~ ____~____~ c. Did the personal representative state an account informally to the parties in interest? YES __/Lu NO d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: _k/L'-JQ3. J~~recLl~ttockssq u i11L_ _ ____ Name (Please type or print) 321J North _ F rQoLSJ[~~J;E-,-Q.B9)(_53QQ _. Address HC3IIL$QU[9__ PA 17110-0300 (717)238..8167 Tel. No. 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: 2/07/2003 DONNA LEE ROSENBERRY 67 CONESTOGA DR SHIPPENSBURG MOBILE ESTATES SHIPPENSBURG, PA 17257 RE: Estate of SOURBEER GLADYS W File Number: 2001-00384 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: 3/22/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS , cc:"File Counsel Judge REV -1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 \ I " ;).::J J L! DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER /5%~ HARRISBURG, PA 17128-0601 RESIDENT DECEDENT f,JI r7J COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Sourbeer Gladys W 204-03-~225 DECE- DATE OF DEATH (MM-DD- YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 03(22(2001 06(22(1919 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER - - B 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return (date of deatl1 prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Inlerest Compromise 5. Federal Estate Tax Return Required \f'te of death after 12-12-8Z} PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) tllach a copy of Trust} BLOCKS 9. Litigation Proceeds Received 10. pousal Poverty Credil (date of death between 0 11. Election to tax under Sec. 9113(A} 12-31-91 and 1-1-95) (Attach 8eh 0) tH\&~\PMMU$t:t!J\'ePM~'ltjQ.,i\t'ePIWI~~.~jpml~'tAJ!,jNRi8MAtIQN'$fjQl!iltll!ijiipIR~!lQfQi NAME COMPLETE MAILING ADDRESS COR- Jered L. Hock, Esquire 3211 N. Front St. ; PO Box 5300 RE- FIRM NAME (If Applicable) Harrisburg, PA 17110-0300 SPON DENT Metzger wickersham TELEPHONE NUMBER 717-238-8187 -~ - OFFICIAL USE ONLY . 1. Real Estate (Schedule A) (1) 40 ,'Jioo c' Stocks and Bonds (Schedule B) (2) .. ",) 2. 0 3. Closely Held Corporation, Pa.rtnership or Sole-Proprietorship (3) 0 4. Mortgages & Notes Receivable (Schedule 0) (4) 0 5. Cash, Bank Deposits & Miscellaneous Personal '>' Property (Schedule E) (5) 280 -." 6. JoinUy Owned Property (Schedule F) 0 Separate Billing Requested (6) 0 RECA- -" - PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 0 8. Total Gross Assets (total Lines 1-7) (8) 40,280 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,806 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 244 11. T010I DeduC1ions (total Unes 9 & 10) (11) 15,050 12. Net Value of Estate (Line 8 minus Une 11) (12) 25,230 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0 has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 25,230 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 tal/able at the spousal tax rate, or transfers under Sec. 91 16 (a)(1.2) 0 X.O 00 (15) 0 TAX 16. Amount of Line 14 tal/able at lineal rate 25,230 X .0 0.045 (16) 1,135 - COMPU- 17. Amount of Line 14 tal/able at sibling rate 0 X .12 (17) 0 TATlON 18. Amount of Line 14 tal/able at collateral rate 0 X .15 (18) 0 19. Tax Due (19) 1, 135 20. 0 lOJI!bKHe!l~if}(bI.!AR~giJ~$t'!ld(AlRl:jftjNPtIfAN.OV~Rl'!AYM~!\ . ......................)\,,!l!;'~WqAN$WI$$ALllqQ!;&tiPN$OiitWI\~'\1ANPi$i;Cll!;PKlMtll!W}?............... o PA 15001 NTF 29755 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of Name Address Tax ID Name Address Tax ID 204-03-8225 Executors (Page 1) Anna Mary Mentzer 194 Big Spring Terrace Newville, PA 17241- 188-32-2611 Donna Lee Rosenberry Shippensburg Mobile Estates 67 Conestoga Drive Shippensburg, PA 17257- 206-32-1003 PA REV -1500 EX (6-00) C Page 2 Decedent's omnlete Address: STREET ADDRESS 1835 Ritner Highway Cumberland County CITY \ STATE 1zIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Pa~ents A. Spousal Poverty Credrt B. Prior Payments C. Discount (1) 1,135 o 500 o Total Credits (A + B + C) (2) 500 3. Interes1lPenalty " appncable D. Interest E. Penalty 39.10 o TatallnterestlPenalty (D + E) (3) 39.10 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4} 0 5. If Line 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 635 A. Enterthe interest on ll1e tax due. (SA} 39.10 B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (5B) 39 . 10 + 635 = ,; '" 'HiHll(;KiiIb(i;;;;!it!ii;jjiMiiji0:gti;i;ib~~~;~T:~:;~;itS0'!Eg;1:;lV' 7!!!!;;;!;;:;JimmtWlL;+i'S';' 674: 10 PLEAsE ANSWER THE FoLLOwiiliGoUESrioN's BY 'PLACINGAiIi"X;' IN THE APPROPRiATE BLOCKS 1 Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .........................., ~ I . b. retain ll1e right to designate who shall use the property vanslerred or its income; c. retain a reversionary interest; or. . , . . . . . . . . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death withoutreceiving adequate consideration? . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 ~ 3. Did decedent own an "in trust tor" or payable upon death bank account or security at his or her death? 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .... . . , . . . . . . . . . . . , ' . , , . . . , , ' . . . , . . . , . . . . . . . , . , . . . . . 0 R9 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return\ including accompanying schedules and statements, and to the best of my knowledge and belief, it IS true, correct and complete. Declaration 0 preparer other t"an the personal representative is based on information of which re arer has an knowled e. SIG E OF PERSON PO B FOR FILING RETUR DATE Front St.; PO Box 5300 Harrisburg, PA 17110-0300 F2 1".8.' 911S {a){1.1){i)). For dates of death on or after January 1, 1995, the tax rate is Imposed on the net value of transfers to or for the use of the surviving spouse Is 0,," [72 P.S. 19116 (a)(1.1)(II)]. The statute do...", ...nt ......meta transfer to a surviving spouse from talC., aM the statutory requIrements for disclosure ofasse_s and tillng a tax return are stili 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 at transfers froma deceased child twenty-one years at age or younger at death to or tor the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S.19116(a)(1.2)]. The tax rate Imposed on the net value at transfefS to or for the use af the decedent's lineal bene1lciarlesls 4.5%, exc:ept as noled In 72.P.S.' 9116(1.2) [72 P.S.1911B(a~1)]. The tax rate Imposed on the net value of transfers to or for the use of the decedent's siblings Is 12% [12 P.S. 1911B{a)(1.3)J. A sibling is defined, under Section 9102, asan individual who has at least one parent in common with the decedent, whether by blood or adoption. o PAl5002 NTF 29756 Copyright 2000 GreatlandlNelco LP - Farms SoHwareOnly INRE: GLADYS W. SOURBEER, Deceased IN THE COURT OF COMMON PLEAS DAUPHIN COUNTY, PENNSYLVANIA ORPHANS' COURT DMSION NO. 2001-00384 AFFIDAVIT IORCT.ARATTON My name is Donna 1. Rosenberry. I am a daughter and co-Executrix of Gladys W. Sourbeer. We have listed our late mother's property of 1835 Ritner Highway, North Newton Township, Cumberland County, Pennsylvania, with two realtors. At the end of the second listing, which is just running out, it still has not been sold. The realtor has told us that we would be "pushing it" even to get $40,000 for this property with the mobile home that is over a quarter of a century old and with other conditions of the property. I hereby certifY that the above statement is true and correct to the best of my knowledge, information, and belief, and further state that false statements herein are made subject to the penalties of 18 Pa. C.S.A. ~ 4904 relating to unsworn falsification to authoritie -----..- Date: June.iL, 2002 Document #: 236247.1 .., REV-150J EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. 1. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9 PA 15031 NTF 10872 Copyright 1999 Greatland/NelM LP - Forms Software Only o REV -1504 EX + (1-97) SCHEDULE C CLOSELY-HELD CORPORATION PARTNERSHIP or SOLE-PROPRIETORSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships. FILE NUMBER ITEM NO. 1. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) o 9 PA15041 NTF1OS73 Copyright 1999 Greatland/Nelco LP . Forms Software Only REV-1S07 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES & NOTES RECEIVABLE FI LE NUMBER Gladys W. Sourbeer All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION 1. VALUE AT DATE OF DEATH 9 PA 15071 NTF 10874 Copyright 199913reallandlNelco LP - Forms Software Only TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) o REV -1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer Include proceeds of litigation & date proceeds were received by the estate. All prop. jointly-owned with right of survivorship must be disclosed on 5th. F. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ITEM NO. 11. DESCRIPTION VALUE AT DATE OF DEATH 1986 Celebrity - money received from sale of parts (NOTE: Vehicle was rusted, ceiling rotted, tires worn.) 25 2 County of Cumberland - refund 21 3 cumberland Valley cooperative Association - sale of shares 70 4 Kenny's Auction - sale of items of decedent 152 5 Refund 12 TOTAL ~Iso enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 280 9 PA 15081 NTF 10875 Copyright 1999 Greatland/Nelco LP ~ Forms Software Only REV -1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an asset was made joint within one year of the decedent's date of death. it must be reported on Schedule G. A SURVIVING JOINT TENANT(S} NAME ADDRESS RELATIONSHIP TO DECEDENT B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name of financial institution and bank DATE OF DEATH DECD'S VALUE Of JOINT account number or similar identifying number. NO. TENANT JOINT Attach deed for jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A TOTAL (Also enter on line 6, Recapitulation) $ 0 9 PA 15091 NTF '\0e,76 (If more space is needed, insert additional sheets of the same size) CQPyrlghl198Q GreaUand/Nelco LP - Forms Software Only REV -1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 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 NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. TOTAL (Also enter on line 7, Recapitulation) $ 0 9 PA15101 NTF 10877 (If more space is needed, insert additional sheets of the same size) Copyright 1999 Greatland/N.,lcCl LP - Forms Software Only REV-1511EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: 1. 1 Bricker Fogelsonger - funeral AMOUNT 5,615 2 Clergy - funeral 50 Total from continuation pages 2,057 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State Zip Year{s) Commission Paid: 2. 3. AlIorneyFees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 3,000 City Relationship of Claimant to Decedent 81a1e Zip 4. Probate Fees 135 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 A-I Abstract Associates, rnc. - title search of decedent's real estate 125 2 Aegis Insurance Company - homeowners insurance 256 3 Calls regarding septic system at decedent's residence 9 Total from continuation paaes 3,559 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14,806 9 PA15111 NTF 10878 Copyright 1999 Grealland/Nelco LP - Forms Software Only Item No. 3 4 5 Schedule H part 1 (Page 2) Estate of: Gladys W. Sourbeer Description Amount Donna Rosenberry - reimbursement for large sheet cake for funeral luncheon Donna Rosenberry - reimbursement for food and beverages for funeral luncheon Fisher's Florist & Greenhouse - flowers for funeral 6 Reserve for tombstone 7 Spring Hill Cemetery 8 Tombstone - red marble, reserve for payment 9 Value City - clothes for decedentrs burial Total (Carry forward to main schedule) 15 14 133 737 390 737 32 2,057 Schedule H part 2 (Page 2) Estate of: Gladys W. Sourbeer Item No. Description Amount 4 Cleaning supplies to make house salable 5 Cumberland Law Journal - publication of Estate Notice 6 Darlene pittman, Tax Collector - house tax 7 Davis Greenhouse - additional mulch needed to prepare decedent's real estate for sale 8 Donna Rosenberry - additional title search cost to make house marketable 9 Donna Rosenberry - reimbursement for additional stamps 10 Donna Rosenberry - reimb for calls to Wenger Lawn Service 11 Donna Rosenberry - reimbursement for photocopies of Death Certificate 12 Donna Rosenberry - reimbursement for certified mailing of payment of inheritance tax 13 Donna Rosenberry - reimbursement for mileage and time lost from work 14 Donna Rosenberry - reimbursement for mowing and trimming of decedent's real estate and repairing blade of mower 15 Donna Rosenberry - reimbursement for stamps for bills and thank you notes Total (Carry forward to main schedule) 18 75 1,033 11 25 7 2 o 4 206 50 7 1,438 Schedule H part 2 (Page 3) Estate of: Gladys W. Sourbeer Item No. Description Amount ~6 Donna Rosenberry - shovelling snow around decedent's real estate ~7 Donna Rosenberry - trimming to make decedent's property salable ~8 Gasoline 19 Hauling of large items in decedent.s residence to dump site 20 Insulation in water pipe hole and new plastic cover to preserve real estate 21 Lumber and materials to make house salable 22 Mike Brenninger - surveying boundary lines of decedent's real estate 23 Mr. Wingert - hauling big items of trash from house 24 Metzger, Wickersham. Knauss & Erb, P.C. - long distance calls, photocopy, faxes 25 News Chronicle - publication of Estate Notice 26 pennDOT - new title to mobile home to replace lost title to prepare for sale 27 PP&L - electric bills 28 Register of Wills - reserve for Account 29 Register of Wills - reserve for Releases 30 Register of Wills - reserve for Short Certificates Total (Carry forward to main schedule) 25 70 2 30 ~5 65 ~oo 30 ~28 89 36 246 ~oo 20 ~o 965 Schedule H part 2 (Page 4) Estate of: Gladys W. Sourbeer Item No. Description Amount 3l Reserve for closing 32 Rick Mentzer - carpenter work, painting, and cleaning of decedent's real estate to preserve and prepare for sale 33 Rick Mentzer - reimbursement for hauling small items from decedent's residence to dump site to prepare real estate for sale 34 Robert Rosenberry - reimbursement to repair furnace in decedent's residence to prepare real estate for sale 35 Sollenberger - title on mobile home 36 Sprint - phone 37 The Home Depot - mulch for decedent's real estate to prepare for sale 38 Timmons Oil Inc. - kerosene for furnace during winter months 39 Toll calls to realtor regarding sale of real estate 40 Walter Hammond - building and painting of frame and new door for decedent's real estate to prepare and preserve for sale 41 Wenger Lawn Service - mowing and trimming of decedent's real estate to preserve and prepare for sale Total (Carry forward to main schedule) 75 500 10 75 37 72 3 ll6 5 25 240 ~,~57 REV-1512 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer Include unreimbursed medical expenses. ITEM NO. 1. 1 Intl Therapeutic Services - debt of decedent SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER DESCRIPTION AMOUNT 52 2 Medical medication - debt of decedent 52 3 Newville Community Ambulance - debt of decedent 74 4 PP&L - debt of decedent 40 5 Shippensburg Animal Hospital - bill of decedent 27 TOTAL (Also enter on line 10, Recapitulation) $ 9 PA 15121 NTF "\OB74 (If more space is needed, insert additional sheets of the same size) Copyright 1999 Greatland/Nelco LP - Forms Software Only 244 REV -1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Gladys W. Sourbeer NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 1. ~a Mary Mentzer 94 Big Spring Terrace ewville, PA 17241 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1/2 Residua.ry Daughter 2 )onna Lee Rosenberry hippensburg Mobile Estates 7 Conestoga Drive hippensburg, PA 17257 1/2 Residua.ry Daughter ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II ,- ENTER TOTAL NON- TAXABLE DISTRIBS. ON LINE 13 OF REV-15oo COVER SHEET $ (If more space is needed. insert additional sheets of the same size) o o PA15131 NTF 33293 Copyright 2000 13reatland/Nelco LP - Forms Software Only COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN REV-1514 EX + (1-97) ESTATE OF Gladys W. Sourbeer This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial {actors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. Will Intervlvos Deed of Trust Other :~:::;;~:;;:~'.:::;:::::::::: ~:~:tl%r.%.t(t(.U,W.!Al ~~~/t:}~~~~:;~t:;:1:.r+ ~r~;~t{ff?Atfn.::\JmI!:\E$r:A1te?'lmeIE$IC ::"::".:.,':.\OU... " NEAREST AGE AT DATE OF DEATH (Check Box 4 on Rev-1500 Cover Sheet) FILE NUMBER NAME(S) OF LIFE TENANT(S) DATE OF BIRTH Term of Years Term of Years Term of Years Term of Years $ 0 % $ o 1. Value of fund from which life estate is payable 2. Actuarial factor per appr~riate table Interest table rate - - U 3 1/2% 0 6% 3. Value of life estate (Line 1 multiplied by Line 2) 010% o Variable Rate o NAME(S) OF ANNUITANT(S) '{!'!IJiiliAliINUllN'l&TeRE$J;p_QliIl1AtlON ,.. NEAREST AGE A. T DATE OF BIRTH DATE OF DEATH .....-,...,.........-..........-.."....,-.-,.... ,:::::;::,'::::::,;::;::::,::::::::,:::,;:;:::::,:::::::::':;,:::,:.;.:.,.,.:....... .:.,-,.:...:.:.:.:.:.,.:.:.:.~:.:.>:.,.;.-...,. .. ..............,..... ......,-.-,....,._,_............,. .y(.,::z-',.",:.:,:....:.,'" ..--......-'....--........,-.... .,-...........................................,....,.......' .....,.,-..,..N.._....'............."....,.._......_ .......................,-.. . TERM OF YEARS ANNUITY IS PAYABLE Term of Years Term of Years Term 01 Years 1. Value 01 fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (nUmbeB Frequency of payout -- 0 Weekly (52) 8 Bi-weekly (26) Monthly (12) o Quarterly (4) 0 Semi-annually (2) Annually (1) Other ( ) 3. Amount 01 payout per period o o $ o 4. Aggregate annual payment, Line 2 multiplied by Line 3 5, Annuity Factor (see instructions) Interest table rate 0 3 1/2% 0 6% 0 10% o o Variable Rate % o 6, Adjustment Factor (see instructions) 7. Value of annuity -- If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Une 4 x Une !5 x Une 6 If using variable rate and period payout is at beginning of period, calculation is: (Une4x Une 5x Une6) + Une3 o $ o $ o NOTE: The values of the funds which create the above future interestS must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest's) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (Ii more space is needed, insert additional sheets of the same size) 9 PA15141 NTF 10881 Copyright 1999 Greatland/Nelco LP - Forms Software Only COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE REV -1647 EX+ (9-00) ESTATE OF Gladys W. Sourbeer This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the 'type of instrument which created the future interest and attach a copy to the tax return. (Check Box 4a on Rev-1500 Cover Sheet) FI LE NUMBER nWIII n Trust n Other I. Beneficiaries NAME OF AGE TO BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. n Limited right of withdrawal n Unlimited riaht of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of future Interest. . . .... .... ...... ..... ....... ....,. '" ........... .... $ 0 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .... ..... $ 0 3. Value of Line 1 passing to spouse at appropriate tax rate Check One o 6%, 0 3%, 0 0% . . . ..... ...... $ 0 (also include as part of total shown on Une 15 of Cover Sheet) 4. Value of Line 1 Taxable at lineal rate Check One o 6%, 0 4.5%. . . ..... .... ...... . , . . . $ 0 (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) , ..... $ 0 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) . . . . . . . . $ 0 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . ... .. "." ... ..... ... .. $ 0 o PA 16471 NTF '33294 (If more space is needed, insert additional sheets of the same size) CQPyrlght2000 GreallandlNelco LP - Forms Software Only REV - 1649 EX + <1 -97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gladys W. Sourbeer Do not complete this schedule unless estate Is making election to tax assets under Section 9113{A} of Inheritance & Estate Tax Act. If 'the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust lmarltal, residual A, 8, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the 'trust or sim~ar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) FILE NUMBER PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of aU interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE 9 PA16491 NTF 10882 Pan B Total $ (If more space is needed, insen additional sheets of the same size) o Copyright 1999 Greatlarld/Nelco LP - Forms Softwllfe Only .,., - - ;1(' PJ), , " lAST WI'LIi ,1\N])TESTlIMENT' ;.:,......:. .,.t.,;- '."<C 'l.'t\'\ '~E!-: :~',~.t~NHf'i-;:h';, .} Shippensburg, Cumberlard County, i,::'~_: 'I'es't:..amf'nt', !fJ", "':1 1 ;'7- I, GlADYS W. SOURBEER, of R. D. 1, ~,~.-. ~ (1::' Pennsylvania, being of sourrl mirrl, meoory c;ro- ~~stcmdirg, do ~e ~ .. ,': I,'. " :'.". r,J.'" dL I t'-.,;\~.l'; ......; .. , . '(I:' ;J::t publish this my Last Will and Testament, hereby revoldl'9 and maJ?n9 void any ;l'-:!1'j .:^,)' ,no ..\ -_~;',.'_', lrl('iudlnq;:-he j-aler to sf~i; '.'1.r1'> '.::1': tl.i,[ !',-it "n<1 and all famer wills and codicils by me at any time heretofore made. " ., -" -i;( .>€j';.:ed, at rublic or Pl';':::'l FIRST. I direct my herei:rurl"ter,,~~'ExeCutriCes ,,-to payaH. -~ ~just". debts andd'uneral expenses.'aS' SOOti'''sl~entily.'ft\iiy' 'be' after..,mY aecea~e', Ji)f~.rdl.r!.Ctthati 'aU "taXes' thatmay.""'"aBseSS@dtl1fi OOhsSquehC:e'bf"Iny'" ",,' , , death, of whatever nature and by whatever j~~sdiction inp:>sed, sha,11 be ~id ,-'..'\ ~.:< S0.;'.:hE8R, ha'/(> h'":f8'':, (.1-: ~!'/ (,,',," dil-:\ fran my residuary estate as a part of the expense of _,the, ~inistratiol) of ;(11(0 ''/>1:1tt,'rJ u,', t,,,,-,(, j_:<'!;-' my Es~te. SECClID. I give, devise and bequeath.) all my property, real, personal - / am mixed, whatsoever and wheresoever"si~<<ih~ ",~,.(2J .~..share",\,~siiBr;'" ~ share alike, to my tw,o (~) daughters, namely; ANNA MARY MENTZER, and ~JC.!:-:':':{ ~';\l!().:. iJ ;,,<~::. ~'.J" .IicNilA rnK~, aBSi:>llitely, provided, however, that in the event ~' \'",," '., '. .. . . .,'. . eithtei-'of tfr:I- aforesaid':dai.:1ght~ should predecease me, then in that, event !!:9ive!C",.;de\Jtise' am bequeath, th~ share of my said deceased daughter to the he!: ,<"(;.\C'st, 03 :,rlp,;-d ..'~.r fl.::lli' '~: as . llillkV1l';"'chiildrenibf'tny sa:ia2lleeeaseC! daughter, livin:! at the time of my of ';,:;' .~,':.!d ":'0:;' ,;' " ejr'(; nt ,fl';' decease, equally, provided further, that in the event any of my aforenamed Legatees are not of full legal age at the time of lily decease, then in that event, I hereby naninate, constitute and appoint ~THNATIONA.L BANK, of the Carrnoowealth of Pennsylvania, as the Guardian of the said minors I estates, the said Guardian to take and receive the share of the said minor child or children, and invest and reinvest the same in legal or non-legal investments, whichever in its discretion it deans proper, and the said Guardian to have full power and authority in its discretion to pay such amounts of incane arrl principal as are necessary fOr the suppoit, maintenance arrl educati of the said minor child or children, and upon the said minor child or children each reaching full legal age, to pay the said share to the said child. _<)-l?~~ f ,,~_ ,-, 1,:' C\.:r-1t"(~!'1'H:(r~-,h~'y'~~I;l~te, constitute arrl appoint my said daughters, "'-' ~ly; ~~~:,~ and:-'~~ LEE Ra3nmERRY, or the survivor of then, as the EKecutrices of this IT.rj Last Will ard Testclnent, my said Executrices to , ., (;: .~'.i, I,' , ; ,"::,.~, ~ '" .t.<, J': .T, '!(X:::U-I.;]1Xl 'l'~T'E~>,~ J, nl' ,."', ,-.U;I ' , have full pcMer and authority to do any arrl all things necessary for the ccmpl 'i '. ,;. 1. ,,-. _ ~^.....'t,"":E:t.-;, "":'Zr:'::-~ ,k"'(o'" I' "", ' administration of my estate, including thepcMer to sell any am all real and "l,t.v it,~,: ,';~ . ":,:'c.:;,';, _. . !:'I','~., l"',:"':'<J Li..rs"i:"' duJ-,. ,,;IU:"~l, '::', [,,::"','!)',' :. ,'I' personal property' of which I may die seized, at Public or private sales, in 'd,) , , \;:~,'. , .,'r,',',) '.' '11(' 'l'(~.:.:;t.<<t..:ix sJqned p.;,i ,,-,,,(,"-'" their discretion, both for PurPoses of administration and distribution; and ,1,;;",J' ~i~; tlt.:!' _':._" ....,_, L:,",,:::ud \..bat sl)(;~ had ~J~in,='{.i ....,1,l5,tqLY' c,,'.: :.;:.;~ without any Order of any Court; and I further direct that rnysaid "Executrices shf; f'XCCt.:,!,aj .~ ;...'l.r.l."'i'" ~nd '.'o1unt.a.ry act. fn.:' tJl,,,,,' t.la;;''-~,i'':'':' -- (' ',,'.', not be required to file any Bond in connection with the settlement of my estate. t'''):fJi'(~:~-.!,-,;:';_ "~,." r _,l' j,(., witnesses,i,r: UJo.,- r!n';~~":K-' ('U~1 '01' 'm.m~ss,,~: ~i,G.r.AJ;ll!S'"W"'~,t hayai\le"E!t9 ""t mY, han;j and. s~al,to:,:1;bj,s.J:ll:Y;,..<4lst..; ~il ~. ~jh ~41:eJ!' qrhf.~) {~)j ~~t,fhpf. wper, t.hi;s ilElj;;~t. d~y .P:e-';~,r ~~e,~:...,,, ~j)f i.:)('J"\(:f'. 4~i;;;'~"i1Jf0 'J~'uJSFAL) Signed, sealed, p..1blished and declarEld by GlADYS W. SOURBEER, the Testatrix, as and for her Last Will arrl TeStament. written on three (3) shee.ts of paper, in the presence of us who have r at her r,Qn'l1Ps:t, signed our names as . ...:..::_.i....:....:,:....0;::..,__'_:'!::-~.;-- ~"':1- fEires" '" ;';.1".;:' k'i witnesses hereto in the presence I of the said Testatrix and of each o ac1m(.JW1(..>Clgt..>d rJt"'f.oH' me' tJ': (',j/l.t, , :30,GFi),:'" ',,',:'. ,:md ,SvJDrn to before r,'" r)"1 ., :'1--",:, \.\i~ ~'''''''., .,-".~.- t.h.15 1st d"l~r "~: .'[:~'X' , '\I)P,OJ\r. i Ii . ~",~.... \..-........r\A. '" A \ \.' 1-, ~-'"'~;;~:'':-''-~?{. El..!ZABefl": Ie, iIO-l''''''::'''~'' ",.:1,..., i',,:.~:. ~4~ .LHIW. L jJE-,Jr:GpA UaurUg{:6' C01Ja.f::n:n~6 <3uq' 9bborv.j: lJJ}" 2~rrq gSUJdjJ.j:GT..2' If ..."'...'.;.,.-."..-:.....'~._,,'~.....,.."'~~""'''''~ CCMMC:M'lEI\LTII OF PENNSYL1I1\NIA 55 CXllNI'Y OF ClMBERlAND We, GI1\DYS W. SOURBEER, ROBERl' J. YOC"UM, arrl TERESA J. BURKHOlDER, the Testatrbc and the Witnesses, respectively, whose names are signed to tre attached or foregoing instrument being first duly sworn, do hereby declare to the urrlersigned authority that the Testatrix signed and executed the instru- ment as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence am hearing of the Testatrix, signed the Will as Witness, am that to the best of their knowledge, the Testatrix was at the time, eighteen yea,rs of. age or older, of soond mi. rrl an::] t.mder no constraint or undue influence.. SUbscribed, sworn to and acknowledged before me by GIADYS W.5OURBEER, the Testatrix, and subscribed and sworn to before me bY ROBERT J. YQ:U1 and TERESA J. BURKHOIDER, Witnesses, this ls1o.. day of December, 1981. r::k~~H ~ ~(.. ~r'" . Notary Pubhc' ELIZABeTH K. TAYLOR SHIPPENSBUACl. CUMBo co. Notary PubllG !ll:p. lI-l8-S:f -3- ~. -