HomeMy WebLinkAbout09-03-15 � �pennsylvania 15 0 5 61,41,�5
cePnar�re��or�nEveuuc EX(03-14)(FI)
REV�i JOO OFFICIAL USE ONLY
Bureau of Individual Taxes Counry Code Year File Nwnber
Po eox 280601 INHERITANCE TAX RETURN 1 �"j/ ` j �. j ' /�D
Harrisburg, PA 17128-0601 RESIDENT DECEDENT �� � ( . � � :
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
i 12/11/2014 _ i 03/26/1913 ;
�
_. __._.... _... . ..__. , . _ _._ __. + i ___ _ _
Decedent's Last Name Su�x DecedenYs First Name MI
_. _.. _.. __� -_ _ __ _
, Martin � � Jerome
_ ____ __ _._----_- -- --. _ _ _ _ �.� � _. .. _ _ _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
_..._... _ __. _......_. ... ..._..-- -__._..__.---. _..---� ------_, _. ......._.�___ ._.._...___ . ..._..... . � _
� i � ' '
_ ... ._. ._..� __ _-----_._._..__..._ _..... _ _._ ....... _ ._......�_.; , __.. � �_... .._._ _._. _ ___ '
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BEI.OW
� L�riginal Return p 2.Supplemental Retum p 3. Remainder Retum(date o(death
prior to 12-13-82)
p 4.Agriculture Exemplion(date of 0 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required
death on or afler 7-1-2012) death after 12•12-82)
�} 7.Decedent Died Testate p 8.Decedent Maintained a Living Trust � 9. Total Number of Safe Oeposit Boxes
(Attach copy of will.) (Attach copy of trust.)
p 10.Litigation Proceeds Received O 11.Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No irust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPON�ENCE AND CONFIDENTIAL TAX INFORMATION SHOUL�BE DIRECTED T0:
Name Daytime Telephone Number
__ _ _ _._ _.................._ .------___—.__..__ __.......... �. __..__ ._ _ _.. ___
Michael A. Scherer, Esquire ! (717) 249-6873
_ _ _ _. _ __ _
First Line of Address
_._._. __.._._. _....... _ _ __ - ... _...— -_..
Banc Scherer LLC � ,_� �
__
--.____---- ----- --_. .....
Second Line of Address �'� � �
__. __-- ---------..__ . _...___ _....... . ......._._.
_..._.__. _.._.._ _.....__. C"� C�1 C'>
19 West South Street c o �r' �-' c.>
..._.. ....._ �._.___........ ..___...----._..._�_..___...___.___...__ -.. __.. __.. �_� .. .__. . j �`� �7 '�} a
fT� "
Ciry or Post Office State ZIP Code ;�� �� — � � �"�
_. .._......._._. . _._._.._ _..._____.. ____..__. _...__ , ___._.___. . _ � ' ' � 1
Carlisle PA � 17013 �,�� W '
..
_ ___ ____ ______--.
______.__. __ ___ _ I _ __ _ ,
_.� 3
Correspondent�s ema��address: mscherer@baricscherer.com .� ' ..:
: �>
REGISTER OF WILLS USE @j,�7iY �-' C �
.-,�....,r �.. .. ,u.�, ����
REGISTER OF WI�lS USE ONLY � C.�� � � �
:
�:�9ATE FILED MMDDWYY i 1"�
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;... �,,_ . , �
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DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
� �I����)���������I�������������4������5����I���������I��� 15�5 61,41�5 J
�
, �1
� 1505614205
REV-1500 EX{FI)
DecedenYs Social Security Number
DecedenCs Name: i
RECAPITU�ATION
� ��,�0�.��
1. Reai Estate(Schedule A). ...... ............ . . ..... ... ..... ... .. 1 �
2. Stocks and Bonds(Schedule 8) ....................... 1 145.99
.. . .. ... ... . .. 2. �
_ __ _
3. Closely Held Corporafion,Partnership or 5ole-Proprietorship(Schedule C) . .... 3.
4. Mortgages and Notes Receivable(Schedule D)................ . . ... .. . .. 4, l
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. ��&,339.37
-_-- --__ _- --.__ .._ _
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6 j
f -.._ __.
7. inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ! 316,488.82
(Schedule G) O Separate Billing Requestecl.....-.- 7. ¢
;.. _
8. Total Gross Assets(total Lines 1 through 7)............... � 536,974.18
.............. 8.
9. Funeral Expenses and Administrative Costs(Schadule H)................... 9.� 28,738.17
( ..._- --------___ __
10. Oebts of Decedent,Mortgage Llabiiities and Liens(Schedule I)............... 10.: 31.OQ
11. 7otal Deductions(total Lines 9 and 10). .-• . •-- -- •-- ���-�--�--•-� •- �1 28,769.17
12. Net Value of Estate(Line 8 minus Line 11)... ... .. ............. .... . t2. 508,205.01
13. Charitable and Governmental BequestsJSec.9113 Trusts tor which
--.� _.._-. _ .___ ____
an election to tax has not been made(Schedule J) ........................ 13.
;,.. . ...___. __----- ------
i
14. Net Value Subject to Tax(Line 12 minus Line 13} ,.,........ 14, � 508,205.01
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount oi Line 14 laxable
at the spousal tax rate,or
transfers under Sec.9116 �
(a)(1.2)x.o_ ( . 15.(
L_v .__.__._...r_._--- �- --.__.._ .
i6. Amount of Line 14��cabie 5D8,205.01 16 22,869.23
at lineal rate X.0�
17. Amount of Line 14 taxable
_� __.._----.- -----------
at sibling rate X.12 77
-----------_..,_ ._., _.� ---. _ ,
18. Amount of Une 14 taxable
at collateral rale X.15 ���
1�J. TAX DUE ................ .. . ............... .....,.. , 13.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT f'�]
Under penal�ias of pery'ury,I declare I have examined ihis return,Including accompanying schedules and statements,and to Ihe best ol iny knowledc�e and beliel,
it is true,wrrect and complete.Declaralion of preparer other than the person responsible for Oling ihe retum�based an ail informatfon of which preperer has
any knowledge.
SIGN F PE SON RES SIBL F FI RETURN DATE �
� � jl
A DRESS
16 Woburn bey Avenue, Camp Hill, PA 17011
SIGNAT EP RER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
� � f�n,� 4'�3�,s
A 19 West South Street, Carlisle, PA 17013
� �iu�ii iiiii i�ii iiiii�ii��i��iii�i�i�i�ii iiiii iiii iiii S�de� J
15 4 15�5614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Jerome Martin
------_......-- — ---------..._..------ _...__........._...----
STREETADDRESS 195 Enola Street
_--------__........_
CITY STATE PA ZIP 17025
Enola
Tax Payments and Credits:
22,869.23
1. Tax Due(Page 2,Line 19) ���
2. CreditslPayments 22,000.00
A.Prior Payments __
B, Discouni 1,100.00
(See insfructions.) Total Credits(A+B) (2) 23,100.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. 230.77
Fill in oval on Page 2,Line 20 to request a refund. �4) _._..._
5. If Line 1 +Line 3 is greater than Line 2,enter the dif(erence,This is the TAX DUE. �5)
Make check payable to: REGISTER OF WILLS, AGENT.
. . ,
_,. ..,.� .: �4. � ,�._�, � . :�,_��. ,�:,�...� . .._� .- . ,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a, retain the use or income of the property transferred.....................................................•,......•••,.••..••••.••.•.....•..•.• � 0
b. retain the right io designate who shall use the property transferred or its income ............................................ ❑ �
c, retain a reversionary interest .............................................................................................................................. ❑ "❑
d. receive the promise for life of either payments,benefits or care?...................................................................... � �
2. If death occurred after Dec.12,1982,did decedent iransfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. � ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa beneficiary designation? ........................................................................................................................ � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,Y4U MUST COMPIETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
� ., r � �z
,,; , s,,:3�... , -��� ,.. :, .. _��� �:e. �:x ��.., ..,���� �. '�:.. ... .,
For dates of death on or after July 1, 1994,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the suroiving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)j.
For dates of death on or after Jan. 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)j.The statute does not exempt a transier to a surviving spouse from tax,and the statutory requirements for tlisclosure of assets antl
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For tlates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a step-parent of the chiltl is 0 percent[72 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5 percent,except as notetl in[72 P.S,§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the tlecetlent's siblings is 12 percent(72 P.S. §9116(a)(1.3)J.A sibling is defined,
untler Section 9102,as an individual who has at least one parent in common with the decetlent,whether by blood or adoption.
REV-1502 EX+(p2-15}
� pennsylvania SCHEDULE A
�� DEPARTMENT OFREVENUE
lNHGR1TANG[TAX RETURN REAL ESTATE
a�stu,E�t o�c�t�er��
ESTATE OF: FILE NUMBER:
Jerome Martin 21-14-1205
., ....__
All real property owned solely or as a tenant in tommon must be reported at fair market value.Fair market value is defined as the price at which property
wouid be exchanged between a willing buyer and a wiliing seller,neiCher being compeiled to buy or sell,both having reasonable knowledge of the retevant facts.
Real property that is jointly-owned with righC of survivorship must be disClosed on Schedule F.
�,,,,,.�.,„....<... . ......... _.�_�...,_ vv,,....� m�„�,,,,,,W,,,,,, �u __�__....
Attach a copy of the settlement sheet if the property has been sold �
ITEM Incfude a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DA7E
NUMBER OF DEATN
DESCRIPTION
_.. �..,.�.. ._..,.
r 195 Enola Street $94,000.00
Enola, Pennsylvania 17025
reported at sale price in arm's length transaction
�
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i
i
yk
#
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................................................�.............� �,..,...............................:......,.....:««.«
TOTAL(Also enker on Line 1,Recapitulation.) $94,000.00
__ _........................_._ _,...� . ..�
if more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(02-15)
�pennsylvania SCHEDULE B
e��, DEPARTMENTOFREVENUE
INHEfi[TANCE TAX RETURN STOCKS & BONDS
RESIDENT�ECEDENT
ESTATE OF FILE NUMBER
.lerome Martin 21-14-1205
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPT[ON OF OEATH
i. 4.57 shares A T&T Stock $ 145.99
TOTAL(Also enter on Line 2,Recapitulation) $ 145.99
If more space is needed,insert additional sheets of the same size
REv-iSoE Ex+(os-i2)
,�i pennsylvania SCHEDULE E
Z�,� �EPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETORN PERSONAL PROPERTY
RES[DEMT DECEDENT
ESTATE OF: FIIE NUMBER:
Jerome Martin 21-14-1205
Include the proceeds of litigation and the date the proceeds were receivetl by the estate.
AII property jointiy owned with right of survivorship must be disciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�� Newspaper refund $ 126.21
2. Med Alert refund $ 239.69
3. Comcast refund $ 17.79
4. United Health Insurance refund $ 288.00
5. Highmark refund � 87.20
6. Masonic dues refund $ 88.00
7. Computershare refund � 2.18
8. Nationwide Homeowners Insurance refund $ 151.52
9• PA State Tax rebate $ 300.00
10. 2015 County/Borough tax proration from ciosing $ 315.76
11. 2014-2015 School tax proration from closing $ 155.55
12. Final water/sewer/trash proration $ 12.34
13. M & T Bank; checking; Acct. No. xxxx 8344 $ 37,884.00
14. M & T Bank; savings; Acct. No. xxxx 3532 $ 55,527.82
15. Santander Bank; Acct. No. xxxx 6931 $ 18,614.92
16. Met Life; Acct. No. xxxx 5399 $ 7,856.14
17• Auction Proceeds: contents of decedent's home $ 4,546.25
18. Cash on hand $ 126.00
TOTAL(Also enter on Line 5, Recapitulation) $ 126,339.37
Tf more space is needed,use additional sheets of paper oF the same size.
REV-1510 EX+(02-IS)
i'i�J'pennsylvania SCHEDULE G
� DEPARTM[NTOfREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RES(OENT DECE�ENT
ESTATE OF fILE NUMBER
Jerome Martin 21-14-1205
This schedule must be completed and filed if the answer to any of questions i through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °lo OF DECD'S EXClUSION TAXABIE
INCIUDE THE NAME OF THE TRANSFEREE,THEIR RELATIOVSHID TO�ECEDENT AND
NUMBER THE�ATE OF TRANSFER.ATrACH A COPY OF TNE DEED FOR REAL ESTA7E. VALUE OF ASSET INTEREST �If APVUCABtEj VAWE
' Principal Financial Group 316,4as.s2 �00% 316,ass.s2
Contract No. xxx 2309
TOTAL(Also enter on Line 7, Recapitulation) $ 316,488.82
If more space is needed,use additional sheets of paper of the same size.
kEv-lsii Ex+�oz-is)
,'�i pennsylvania SCHEDULE H
�„� DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
iNHeR�rnNce rnx aeruaN ADMINISTRATIVE COSTS
RES[DENT DECEDENT
ESTATE OF Jerome Martin FILE NUMBER
21-14-1205
Decedent's debts must be reported on Schedule I,
I7EM
NUMBER DESCRIPTION AMOUNT
A. 1 FUNERAL EXPENSES: $ 7,329.30
Richardson Funeral Home
2. John Martin: flowers - funeral spray & pillow $ 376.25
3� Geraid Kirkessner: grave/church/funeral meal & mail $ 1,089.58
4. Brachendorf Memorials: headstone downpayment $ 120.00
5. Brachendorf Memorials: headstone engraving & replacement $ 100.00
g. Zion Lutheran Church Cemetery: headstone cement $ 78.4$
B. ADMINISTRATNE COSTS:
1. Personal Representative Commissions:
Shirle E. Kirkessner $ 2,465.00
Name(s)of Personal Representative(s) _y_._. _—
Street Address 16 Woburn Abbey Avenue
City Camp Hill ___..__.__._.___State_PA ZIP 17011 __
Year(s)Commission Paid: 2015 __
Z. Att°rneY FeeS: garic Scherer LLC $ 9,500.00
3, Family Exemption: (If decedenYs address is not the same as daimant's,attach explanation.)
Claimant
Street Address
City _ State ZIP__..______.___
Relationship of Claimant to Decedent ---.-.......-
a. Probate Fees: Registet' of Wills $ 520.50
5. Accountant Fees:
6. Tax Return Preparer Fees: � 5��.��
�. PAWC: water service $ 122.47
g PPL $ 198.42
9 Oppel Fuel: heating oil $ 1,727.55
10. Nationwide Insurance: homeowners insurance $ 497.52
11. East Pennsboro Township: sewer & trash $ 257.40
�2, CitiCards: address change $ 1.05
13. Gerald Kirkessner: reimbursement $ 257.76
14. Advanced Disposal ****�� $ 221.03
***"`***SEE ATTACHED SHEET
TOTAL(Also enter on Line 9, Recapitulation) $ 28,738.17
If more space is needed,use additional sheets of paper of the same size.
Estate of Jerome Martin
Estate No. 21-14-1205
SCHEDULE H-FUNERAL EXPENSES & ADMINISTRATIVE COSTS
15. Michael Cease: house sale commission $ 1,410.00
16. Gerald Kirkessner: business envelopes $ 8.47
17. Marathon Landscaping: grass maintenance $ 90.00
18. The Sentinel: legal advertising $ 158.68
19. Cumberland Law Journal: legal advertising $ 75.00
20. Santander Bank, N.A.: date of death balance fee $ 20.00
21. Realty Transfer Tax: sale of 195 Enola Street $ 940.00
Enola, Pennsylvania 17025
22. 2015 County Real Estate tax: 195 Enola Street $ 537.01
Enola, Pennsylvania 17025
23. Water/sewer/trash final bill: 195 Enola Street $ 136.70
Enola, Pennsylvania 17025
REV-1512 EX+(02•15)
�pennsytvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS
RESIUENT DEC[DENT
ESTATE OF �erome Martin FIIE NUMBER
21-14-1205
Report debts incurred by the decedent prior to death that remafned unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION Of DEATH
�. Davis Hawley Eyecare $ 31.00
TOTAL(Also enter on Line 10, Recapitulation) $ 31.00
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
� pennsylvania SCHEDULE �
DEPARTMENT OFREVENUE
iNHERRANCE TAX RETURN BENEFICIARIES
RESIOENT DECEDENT
ESTATE OF: FILE NUMBER:
Jerome Martin 21-14-1205
RELATIONSHIP TO OECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADORESS OF PERSON(S)RECE[VING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE D[STR[BUTIONS[Include outright spousal distri6utions and transfers under
Sec.9116(a)(1.2),]
1� daughter 1/3 of residual
Shirley E.Kirkessner
16 Woburn Abbey Avenue
Camp Hill, PA 17011
2. John E. Martin son 1/3 of residual
609 Holly Hills Drive
Hartweli, GA 30643
3. Ronald J. Martin son 1/3 of residual
921 Susan Circle
Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON l[NES 15 THROUGH 18 OF REU-15D0 COVER SHEET,AS APPROPR[ATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAI NON-TAXABLE DISTR]BUTIONS ON LINE 13 OF REV•1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
, - ' _ .
e'i.�l� �J��,�i�W ��%,� V��r��Ir/
OF
JEROME MARTIN
I, JEROME MARTIN, of, Enola, Cumberland County, Pennsylvania, do hereby declare
this to be my Last Will and Testament and hereby revoke all Wills and Codicils previously
��
made by me.
� ITEM ONE: I direct the payment of my debts and the expenses of my last illness and
.��
� funeral from my estate as soon after my death as conveniently may be done.
y�
I have purchased a cemetery lot wherein my wife, Blanche A. Martin, is interred and it is
my desire to be interred with her at the same location.
� ITEM TWO: I give and bequeath such of my personal property as may be listed on a
�
signed and dated memorandum kept with my Will to the persons named thereon, provided
�� they survive my death. Should such a memorandum not be found with my Will, it shall be
conclusively presumed that none was prepared, and all of my personal property shall pass
according to the remaining provisions of this Will.
iTE�N THREE: I �ive, devise and bequeath tre rest, residue and remair��r of my
estate of whatever nature and wherever situate to my children, JOHN E. MARTIN, RONALD J.
MARTIN and SHIRLEY KIRKESSNER, in equal shares, perstirpes.
Page 1 of 4
ITEM FOUR: While in the hands of my fiduciaries, neither the principal nor the
income of my estate or any trust created hereunder shall be liable for the debts of any
beneficiary hereunder, nor shall the same be subject to seizure or attachment by any creditor
of any beneficiary under any writ or proceeding at law or in equity, and no beneficiary
hereunder shall have any power to sell, assign, encumber or in any manner to anticipate or
dispose of his or her interest in the trust estate or in the income produced thereby.
�
ITEM FIVE: I direct that no Executrix or other fiduciary named, nominated, or
appointed by this my Last Will and Testament shall be required to post any bond or give any
'':� security of any type for any purpose whatsoever, any law or rule of the court of the
;
,�I� Commonwealth of Pennsylvania or any other jurisdiction to the contrary nofinrithstanding. I
�� direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or
application of the validity of this instrument.
ITEM SIX: My Executrix shall have the following powers in addition to those vested in
them by law and by other provisions of this Will, applicable to all property, real, personal or
�mixed and wheresoever situate, including property held for minors, whether principal or
income, exercisable without court approval, and effective, with respect to each item of said
property until actual distribution thereof.
A) To*etain, �s investments Qf my estate Qr trust, any or all assets of my estate,
real, personal, or mixed, without regard to any principal of diversification, and to purchase and
acquire real or personal property and to hold any or all of such real and personal property
retained or acquired without making the same productive of income.
Page 2 of 4
B) To permit the children, or any of them, to occupy any real estate retained or
acquired upon such terms and conditions as my Executrix or Trustee shall deem proper.
C) To pay all taxes, charges and expenses of maintenance, upkeep,
improvements, development, protection, preservation and investment of any retained or
acquired real or personal property, such payments to be made from either principal or income
as my Executrix or Trustee shall determine.
D) To retain or invest any and all funds, whether principal or income, in any real
or personal property without restriction to legal investments; to purchase investments at
premiums; to exercise all rights of a security holder or share holder in any corporation; and to
lease, mortgage, pledge, give options upon or sell at public or private sale and without
approval of any court, any real or personal property, or portion or portions thereof, irrespective
of the manner or the means by which the same was acquired by my said Executrix.
E) To make payment or distribution herein provided for in cash, kind or partly in
cash and partly in kind, at valuations fixed by my Executrix at the time of distribution.
ITEM SEVEN: I appoint my daughter, SHIRLEY KIRKESSNER, Executrix of this my
Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my
signature in the margin for the purpose of identification, on this the 17th day of November,
2006.
._..
� (SEAL)
� JEROME MARTIN
Page 3 of 4
Signed, sealed, published and declared by the above named Testator, Jerome Martin,
as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight
and presence, and in the sight and presence of each other, have hereunto subscribed our
names as witnesses.
ADDRESS ��M��c�.fa i� f� �i L��a S�rir�s ���00�
� ADDRESS S63 /��G/� �1 �����/� �71��^SJ' l�� j7��7
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, Jerome Martin, Michael A. Scherer, Esquire, and �°��� �`-�eTt� , the
Testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument of his Last Will and Testament, and that
he signed willingly and that he executed as his free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testator,
signed the Will as witnesses, and that to the best of their knowledge, the Testator was at the
time eighteen (18) years of age or older, of sound mind and under no constraint or undue
influence.
Sworn to and subscribed before me this the 17th day of November, 2006.
��--�1�--�-�� `✓�` ` J -�S/t.t�:�
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Amanda L.Fisher,Notary Public
Page 4 of 4 Carlisle Boro,Cumberland County
My Commission Exoires Apr.17,2010
Mernber,Pennsylvania Association ot Notaries
, LAW OfFICES
� 0'BRIEN BARIG & SGHERER
`=- 19 WFST SOUTH STREET �
r----.
CARLISLE,PENNSYLVANIA 17013
BE IT KNOWN that I want my children to know that on this the 17th day of
November, 2006, I have executed a new Last Will and Testament. I want the
following items to go to each of my three children, assuming I do not give these
items away before my demise. If necessary, this document may be used as a
� s s �-J �.. �.... -!'- t e
CU�ILiI i0 ?�'iy� �.dSi VViii a�1Ci � estan�e��: S�i�i��u ti iEi� �c di�y ui5dt"�,'C�Cii"�Ei�� �� i�
who is to get what listed herein.
1 . SHIRLEY KIRKESSNER — The grandfather clock and all jewelry;
2. JOHN E. MARTIN — Electric trains and the 30.06 rifle; and
3. RONALD J. MARTIN — All other guns.
, - _
November 17, 2006 L � ' , � -
r � �_y;�:� j� -�,,1�.i
�
Jerome Martirf
. 5/26I2015 125:06 PM
, �,pNEn*cw � OMB Approval No.2502-0265
� =* � n. Settlement Statement(HUD-1)
� V�
G�iAI OE!��
B.Type of Loan
1.�FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
4.❑VA 5.❑Conv.Ins. ❑Other 20151192
C.Note: This form is fumished to give you a statement of actual setllement costs.Amounts paid to and by the settlement agent are shown.
Items marked"(POC)"were paid outside the closing;they are shown here for informational purposes and are not included
in the tolals.
D.Name&Address Mostafa Ramzani,139 N 23rd Street,Camp Hill,PA 17011
of Borrower:
E.Name&Address Estate of Jerome Martin,195 Enoia St.,Enola,PA 17025
of Seller:
F.Name 8 Address
of Lender:
G.Property Location: Property Address
195 Enola St.Enola.Pennsylvania 17025
PIN
09-15-1291-175 �
H.Settlement Agent: Great�Road Settlement Services,LIC,6 S.17th Street,Camp Hill,PA 17011,(717)731-1040
Place of Settlement: 6 S.17th Street,Camp Hill,PA 17011
I.Settlement Date: 5/26/2015 Proration Date: 5/26/2015 Disbursement Date: 5/26/2015
J.SumSnay of BoF1„oMreKs Tr�n�ctio►a+. . , . ..': � a 1+1�.1..,. � ;;�..�,��?��! ` ':
�; ,,;. �
100e'Gross qmo�nt D"u��am;Bonnwer, „ ; .; ' 4l10s" GrDss;A�d4r� o S'eiler
10L Contract sales price $94,000.00 401. Contract sales price $94,000.00
102. Perso�al property 402. Personal property
103. Settlement charges to borrower(line 1400) $1,911.00 403.
104. 404.
105. 405.
AdJustmeMs:foritems-paidbyseller"iriadyance Adj�Istme�ssfor,ifema!j�BiSbysellerin:advance ' `
106. City/town taxes 406. City/town taxes
107. County taxes 5/26l2015 to 12131/2015 $315.76 407. Counry taxes 5/26/2015 to 12/31/2015 $315.76
108. Assessments 408. Assessments
109. School Tax 5/26/2015 to 6/30/2015 $155.55 409. School Tax 5/26/2015 to 6/30/2015 $155.55
110: H20/sew/trash 5/26/2015 to 6/30/2015 $12.34 410. H20/sew/Vash 5/26/2015 to 6/30/2015 $12.34
. 111. 411.
112. 472.
120. Gross Amount Due from Borrower j96,394.65 420. Gross Amount Due to Seller 594,483.65
200. Amourlts Paid by tir imSahaH of Bo�raiye` 500' R,e,d�ct�ohs�n l�oF�rK:Due to Selier°
201. Deposit or earnest money $10,000.00 501. Excess deposit(see instructions)
202. Principal amount of new ioan(s) 502. Settlement charges to seller(line 1400) $1,615.71
203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506. Deposit or earnest money $10,000.00
207. 507.
208. 508.
209. 509.
Adjustments tor ifsms unpaid by seller Adjushsi'ents;for ixerps uhpa(d bq seller
210. City/town taxes 510. Cityttown taxes
211. County taxes 511. County taxes
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 577.
218. 518.
219. 519.
220. ToWI Paid by/for Borrower 510,000.00 520. Total Reductio�Amount Due Seller 511,615.71
300. Cash at Settlement.fromRo;B;odower- ' ' " , C�ah,at Rettl�meritalW,frq�;Selle�'
,, �
301. Gross amount due from borrower(line 120) $96,394.65 601. Gross amount due to seller(line 420) $94,483.65
302. Less amounts paid by/for bortower(line 220) ($10,000.00)602. Less reductions in amount due seller pine 520) (511,615.71)
303. Cash�From p To Borrower 586,384.65 603. Cash�Top From Seller 582,867.94
The Public RepoAing Burden for this collection of information is estlmated at 35 minutes per response for collecting,reviewing,and reporting Me data. This agency may not
collect this infortnation,and you are not required to complete this form,unless it displays a curcently valitl OMB conhol number. No confidentialiry is assured;this disGosure
is mandatory. This is designed to provide the parties to a RESPA covered trensadion with information during the settlement prxess.
Previous editions are obsolete Page t HUD-1
5/26/2015 125:06 PM File Number:20151192
SUBSTITUTE F�JRM 7099 SELLER STATEMENT- The infortnation wnfained in Blocks E,G,H and I and on line 401(or, if line 401 is asterisketl,lines 403 and 404),406,407
and 408�12(applicable part of buyer's real eatale tax reportable to the IRS)is important tax informatlon and is being furnishetl to the Internal Revenue Service.If you are
required to file a retum,a negligence penalty or oNer sanction will be imposed on you if this item is requiretl to be repoRetl and the IRS determines that it has not been reported. �
SELLER INSTRUCTION- If this real estate was your principal residence,file form 2119,Sale or Exchange of Principal Residence,for any gain,with your income tax return;
for other transactions,complete the appliwble parts of fortn 4797,Form 6252 anE/or Schedule D(Form 1040).
You are requiretl to provitle the Settlement Agent with your wrrect laxpayer identificatlon number. �
If you do not provide the Settlement Agent with your correct taxpayer identification number,you may be subject to civil or criminal penalties.
ESTAT ROM MAR IN
-r . � �v
Shirl c ner
Ex t c
Previous editions are obsolete Page 2 HUD-1
5/26/2015 125:06 PM File Number:20151192
. , L.Settl�ment Charges '
' 700. Total Real Estate Broker Fees Paid From Paid From
Division of commission(line 700)as follows: Borrower's Seller's
701. Funds at Funds at
702. Settlement Settlement
703. Commission aid at settlement
704.
800:_Items Payable in Con�ectfon w1th,Loan
801. Our origination charge �from GFE ui)
802. Your credit or charge(points)tor the specific interest rate chosen (from GFE#2)
803. Your adjusted origination charges (from GFE n)
804. AppfafSal fee (from GFE Iq)
805. Credit report (from GFE#3)
806. Tax service (from GFE#3)
807. FlOod certification (from GFE#3)
808.
800. ftems Requiretl by',lender to,Be Paid in'Advance':
901. Daily interest charges from �from GFE uio)
902. Mortgage insurance premium for (from GFE u3)
903. Homeowner's insurance for (from GFE#�1)
904.
905.
1000.Reserves Deposited with Lender
1001. Initial deposit for your escrow account (from GFE#s)
1002. Homeowner's insurance
1003. Mortgage insurance
1004. Ciry propertytaxes
1005.County property taxes
1006.
1007.
1008.
1009,
4100.TItIe Cha[ges
1101.Title services and lender's title insurance (from GFE ua)
1102. Settlement or closing fee
1103. Owner's title insurance to Great Road Settlement Services,LLC �trom GFE iks) $867.00
1104. Lender's title insurance to Great Road Settlement Services,LLC
1105. Lender's title policy limit
1106.Owner's title policy limit$94,000.00
1107.Agent's portion of the total title insurance premium to Great Road Settlement Services,LLC $867.00
1 t08.Underwritefs portion of the total title insurance premium to Stewart Title Guarenry Company $0.00
1109.Closing Protection Letter
1110. ERECORDING to Great Road Settlement Services,LLC $25.00
1111.
1112.
1113.
1114.
1115.
1200.Govemment RecoMing and Tra�ter Charges
� g g (from GFE#7) $79.00
1201.Govemment recordin char es
1202. Deed$79.00 Mortgage Releases $79.00
1203.Transfer taxes (from GFE ita) $940.00
1204. Ciry/County tau/stamps
1205.State tax/stamps Deed$1,880.00 $940.00 $940.00
1206. UPI Certification
1207. E-Rewrding Fee
1300.Additional Settleme�t Charges
1301. Required services that you can shop for (from�Fe as)
1302.
1303.2014-15 School Taxes(7/21/14)to Debbie Lupold,Tax Collector POCS Si,s22.ia
1304.2015 County Taxes to Debbie Lupold,Tax Collector $537.01
1305. 2nd Quarter H20/sewer/trash($128.70);cert($10)to East Pennsboro Twp $138.70
1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 51,911.00 $1,615.71
Items marketl"POC"were paid outsitle the closing by:Borrower(POCB),Lentler(POCL),Mortgage Broker(POCM),Other(POCO),Real Estate Agent(POCR),or Seller(POCS)-
CERTIFICATION:
I have carefully reviewed the HU0.1 Settlement Statement and to the best af my knowledge and belief,it is a Vue and accurate sfalement of all receipts and tlisbursements
made on my account or by me in fhis Vansadion.I tuMer certiy that I have received a copy of HUD-1 Settlement Statement.The Settlement Agent does not warrant or
represent the accurecy of informalion provided by any party,including informatlon conceming POC items antl infortnatlon supplied by the lender in this Vansaction appearing on
Nis HUD-1 Settlement Statement pertaining to"Comparison of Good Faith Estimate(GFE)and HUD-1 Charges'and"Loan Terms",anA the parties holtl harmless lhe
Settlement Agent as to any inaccurecies in such matters. _�
� -7���� � �` ��� ���� "� ��`� EST JEROME A TIN
Mostafa amza ' ^ /
� � ��
��L� Shid y i ssner �, �
��' t S�� �'J ExecuUix
To e best o�m knowledge, N HU0.1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be
disbursed by the undersi as of e settlement of this trensacfion.
" ' 1'� �G� Z��lS�
Great Road Sett ent Services,�LC Da�
WARNING: is a crime to knowingly make false statements to the United States on this or any oMer similar form.PenaiUes upon conviction can include a fine ana
imprisonm t.For Cetails see�TiUe 18:U.S.Cotle Section 1001 and SecUon 1010.
Previous editions are obsolete Page 3 HUD-1
p ��zs��
499 Mitchell Road,Millsboro,DE 19966 Records Management
Phone 888-502-4349
F ax (302)934-2955
January 26,2015
Baric Schere LLC
Attoraeys at Law
19 West South Street
Carlisle,PA 17013
Re: Estate of Jerome Martin
Social SecuritX: 195-07-4596
Date of Death: December 11.2014
Dear Sir or Madam:
Per your inquiry on January 11,2015,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1. Type of Accaunt Checking Account
Account Number 57868344
Ownership(Names o� Shirley E.Kirkessner(POA)
Blanche A.Martin
Jerome Martin
Opening Date 08/28/1964
Balance on Date of Death $ 37,883.72
Accruedinterest $ •28
___ __. _....... _ _.... _....
Total $ 37,884.00
2. Type ofAccount Savings Account
Account Number 15004214673532
Ownership(Names o,� Jerome Martin
Opening Date 08/22/2007
Balance on Date of Death $ S5,526.36
Accrued Interest $ 1.46
_. _. _. _._...
Total $ 55,527.82
� _L� __
_ ___ _
_
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please call the Summerdale Pla�a at 717-255-2261.
We were unable to locate any safe deposit box for the above-mentiooed decedeot.
7'his letter dces not include any accounis in whic6 ffie deceased may have been Gsted as Power oi Attorney,Custodian of Uniform Transfers,
Representative Payee,or Trustee under a Written Agreemenk
Sincerely,
Valarie Mercer
Records Management
� '
Court Order Processing\Decedents- MAl-MB3-01-21 - P.O.Box 841005 - Boston,MA 02284
February 5, 2015
Michael A Scherer
Baric Sherer LLC
N 19 West South Street
9 Carlisle, PA 17013
�
� RE: Estate of Jerome Martin
9 Date of Death: 12/11/2014
�
�
E Dear Mr. Scherer:
$
� Per your request, enclosed please find the account information as of the date of death
o for the above-named decedent. For your information, accrued interest is not included in
� the date of death balance.
5
9
Please feel free to contact me if I can be of any further assistance.
5
�
� Very truly yours,
�
b �,�✓�
9 Ed Stevens
; COP Specialist
� 617-514-5189
3
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1
7
1
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i
Santander
ESTATE OF:JEROME MARTIN
SOCIAL SECURITY#: 195-07-4596
DATE OF DEATH: 12/11/2014
Account#: 7672206931 Type: RETAIL STATEMENT CD Open date:09/22/2011
In the name of:JEROME MARTIN
Date of death balance:$18,614.92
Int.(YTD)from:01/01/2014 To: 11/30/2014 $12.67
Accrued interest to date of death:$0.06
Otherinfo:
Page 2/2
' • .
financial Principal Life
Group Insurance Company
Princor Financial
Services Corporation ,
May 21,201 S
BARIC, SCHER�R, LLC
ATTORNEYS AT LAW
19 WEST SOUT ST
CARLISLE,PA 17013
Re: Jerome Martin
Contract No. 8542309
Dear David Baric and Michael Scherer:
Thank you for contacting the Principal Financial Group for further information on the above listed
policy.Per your request I am providing you with the Date of Death value.
Value as of December 11, 2014 was 316,488.82 with a Cost Basis of 188,262.91.
If you have additional questions concerning this information or need further assistance,a customer
service representative can be reached at 1-800-852-4450,Monday through Friday,7 a.m.,to 6 p.m.,
CST
Sincerely,
Your representative
The Principal Financial Group� Pearl Markle
RIS Annuity Services 1745-349
(800)852-4450
Enc:
APD
Corporate Center:Des Moines,lowa 50392-17701800)852-4450
Securities offered ihrough Princor Financial Services Corporation,(800)247-1737,member SIPC. s
Principal Life and Princor�are members of the Principal Financial Group�,Des Moines,IA 50392.
_2(p�
EE6717-6