HomeMy WebLinkAbout01-0453
MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Estate of
VIOLET R. VAN SICKLE
No.21
01
4..{ 5'3
also known as
, Deceased
Social Security No. 209-12-5829
LOUISE D. VAN SICKLE
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
Gl
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut l"'l)(
Decedent, dated 1/9/85 and codicil(s) dated 10/18/85
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family o!'princip~
residence at 118 NOVEMBER DRIVE, APT. 1, ..:fWP!, CUMBERLAND CO., CAMP HILL, PA 00 RU.
(list street, number and municipality)
Decedent, then 80 years of age, died APRIL 8 ,2001 ,at FREY VILLAGE, MIDDLETOWN, PA 17057
(location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property.........................................
(if not domiciled in PA Personal property in Pennsylvania ....................
(if not domiciled in PA Personal property in County..............................
Value of real estate in Pennsylvania ........................................................................................
Total .....................................................................................................................
0"
~
$ /.;< S, t?rp D
$
$
$
$ /,;),,5, c> ~ 0 ~
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Typed or printed name and residence
LOUISE D. VAN SICKLE
429 B. RENO STREET NEW CUMBERLAND PA 17070
I / ....~ '" ,..-
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer e estate accor ing to law.
!L .
OUISE D. VAN SICKLE
before me this
7TH
Sworn to and affirmed and subscribed
_ day of
MAY. 2001.
~ e. '/OJ~ ~u. I!. fJ. . 5If)~. ~l~
Estate of
DECREE OF REGISTER
VIOLET R. VAN SICKLE
Deceased
No.21 - 01 - 453
also known as
Social Security No: 209-12-5829 Date of Death: APRIL 8. 2001
AND NOW, MAY 8, 2001 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary 0 of Administration
are hereby granted to
((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
LOUISE D. VAN SICKLE
in the above estate and that the instrument(s), if any, dated 01-09-1985 CODICIL DATED 10-18-1985
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $ 235.00
Short Certificates(s) ...J.........
Renunciation......................... .
Extra Pages ( 2 ) ...............
CODICIL
I.T.R.......................................
JCP Fee .................................
Inventory ................................
Other.................................... ..
YY}J~ t?;(~ 101,t {lP..~1J;~(2t.p'~~
. , Register of Wills .
$ 9.00
$
$ 6.00
$ 10.50
$
$ 5 . 00
$
$
Signature
Attorney: GERALD J. BRINSER. ESQUIRE
1.0. No: 09655
Address: 6 E. MAIN STREET, P.O. BOX 323
PALMYRA PA 17078
Telephone: (717)838-6348
DATE FILED: MAY 8, 2001
TOTAL .............................$ 265.50
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMON\NEAL TH OF PEHt;~;\ LV A.NiA
DEPAflTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR S CEFHiF!CATION OF DEATH
T 4861556
-~g
D:)~I:' of \:;~l e
2JJ1
//2-'-" '.
\I:iQ:l~t
R.
n\T~'E)i95J-~
FErrale
209-12-5829
Date of D')i:llhPfri:l.~/~~_.
l'Iu;3 ._1E},19x)
~Yi..~
...~ Hill, PA
~qtlirl(b.
WUte
S:lies Clerk--Retail
.i~\rlTldd Forces"}
No)
NJ
Oecedent's
Wid::w
429 B. FaD st., tav a.:nrerlarrl, PA 17070
Looise D. Van.Sickle
IBniel B. BroNn
BroNn El.'Ineral fute, 100 Eddge st., MifflintOiJl1, PA 17(159
C:au,St;
Interval Between
Onset and Death
In~l~
4 wks.
c;<: r'1~jltion~';
occurred
x
Deterrn;ned
Jc:sq:h W. Iahr, M.D.
(M.D.. DO . Coroner. ME)
1022 N. Uri.m st., Midlleto.-ln, PA 17(157
9'
Opl8C.i rorn-^\~0lnal G(~rti icate
c:rtdicate 'N]!'! e f-(")fvval'iJed to tt18
nH? as L~)ca! ReG sl:
iG
for perm3 ", \
iiir':iLvv1", .. ;j '-if L....AJ.... ./
. '// (~~9Fn~v'~'?J-.
'KE Ebster st. Mifflin fum.
34- 3J7
P>fril 10, 2JJ1
last Dill atth Qft$tamtnt
21-01-453
o F
VIOLET R.
VAN SICKLE
I, VIOLET R. VAN SICKLE, of 1704 Bridge Street, New
Cumberland, Cumberland County, Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this as and for
my LAST WILL AND TESTAMENT, in the manner and form following, hereby
revoking and making void all former Wills or writings in the nature
thereof by me heretofore made:
ITEM 1-
I direct my Executrix, hereinafter named, to
pay all my just debts and funeral expenses as soon after my decease
as is practicable.
ITEM 11-
All the rest, residue and remainder of my est-
ate, whether real, personal or mixed, of whatever nature and descript-
ion, and wheresoever the same may be situate at the time of my death,
I give, devise and bequeath unto my beloved daughter, LOUISE D. VAN
SICKLE, of 1704 Bridge Street, New Cumberland, Pennsylvania, provid-
ing she is living at my death.
ITEM 111- In the event my said daughter fails to survive
me, then I give, devise and bequeath all the rest, residue and re-
mainder of my estate to the following, share and share alike, if liv-
ing; otherwise, to the survivors thereof, share and share alike:
A- One-sixth (l/6th) to my niece, KAREN
L. ESH, of R. D. 1, Port Royal, Pennsylvania;
I ....:/ 'J Jr-' ,'f
/M-~<:<E ~ //t:h-t4-r.,,).-4 (SEAL)
VIOLET R. VAN SICKLE
-1-
B- One-sixth (1/6th) to my sister,
ADRIENNE E. WRIGHT, of North Seventh Street, Mifflin-
town, Pennsylvania;
C- One-sixth (1/6th) to my brother,
ARTHUR W. BRACKBILL, of Port Royal, Pennsylvania;
D- One-sixth (1/6th) to my brother,
RICHARD C. BRACKBILL, of R. D. 1, Port Royal, Penn-
sylvania;
E- One-sixth (l/6th) to my sister ,ALMA
E. HUSLER, of R. D. 1, Port Royal, Pennsylvania; and
F- One-sixth (1/6th) to my brother, OTHO
BRACKBILL, of R. D. 1, Port Royal, Pennsylvania.
ITEM IV-
I do hereby nominate, constitute and appoint
my said daughter, LOUISE D. VAN SICKLE, to be the Executrix of this,
my LAST WILL AND TESTAMENT, to do any and all things necessary for
the complete administration of my estate, providing she is living
at my death.
I further direct that my said Executrix shall serve
without bond.
ITEM V-
Should my said daughter fail to qualify as
such by reason of death, disability, or unwillingness to serve,
then I do hereby nominate, constitute and appoint my nephew, DONALD
HUSLER, ~"of R. D., Mifflintown, Pennsylvania, to be the Executor
Y-R.V,
of this, my LAST WILL AND TESTAMENT, and I direct that my said
Executor shall serve without bond.
ITEM VI-
I hereby direct my Executrix, or Executor,
to retain ELMER E. HARTER, ESQUIRE, of Harrisburg, Pennsylvania,
~g;// @ ~~~;;}. (SEAL)
VIOLET R. VAN SICKLE
-2-
to be the attorney for the administration of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand
and seal to this, my LAST WILL AND TESTAMENT, this ~~ay of
January, A. D. 1985.
;C:L~ ?? ~U(SEAL)
VIOLET R. VAN SICKLE
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, VIOLET R. VAN SICKLE, as and for her LAST WILL AND TESTA-
MENT, in our presence and in the presence of each other, we, be-
lieving her to be of sound and disposing mind, memory and understand-
ing, have, at her request, hereunto subscribed our names as witnesses
thereto, in the presence of each other and of the Testatrix:
at
/1
J~t(j ~~"'-''-'--1f=u Residing at 'f"t'L-V~ e
-3-
COD I C I L
I, VIOLET R. VAN SICKLE, the within-named Testatrix, do
hereby make and publish this CODICIL, to be added to my LAST WILL
AND TESTAMENT bearing date of January 9, 1985:
By adding ITEM I-A, which is as follows:
"ITEM I-A- If I should become ill and
there is no reasonable expectation of my recovery,
it is my desire that I be allowed to die, and not be
kept alive by artificial means or heroic measures,
and I direct my Executrix, hereinafter named, to so
advise my family, my physician, my lawyer and my
clergyman, any medical facility in whose care I hap-
pen to be, and any individual who my become respon-
sible for my health, welfare or affairs. This
statement shall stand as an expression of my wishes
while I am still of sound mind."
IN WITNESS WHEREOF, I have hereunto set my hand and
t..-.."
seal to this CODICIL this / g -- day of October, A. D. 1985.
Ii . . .' /
./ ' . .....J 1/" . / /..
~ ~~-f ;..,/,9. //??.1A.' PL '_
VIOLET R. VAN SICKLE
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-
named Testatrix, VIOl..ETR. VAN SICKLE, as and for her CODICIL to
her LAST WILL AND TESTAMENT, in our presence, and in the presence
of each other, we, believing her to be of sound and disposing mind,
memory and understanding, have, at her request, hereunto subscribed
our names as witne ses thereto, in the presence of each other and
residing
f.,-J.;.
~ i :k.
- \..,/
residing at
REGISTER OF WILLS OF
OATH OF SUBSCRIBING WITNES
21-01-453
the testat , sign the same and th signed as a witness at the
request of testat_ in h sence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
ith, (each) being duly qualified according to
present and saw
codicil
(each) a subscribing witness to the will presented he
law, depose(s) and say(s) that
Sworn to or affirmed a
me this
subscribed before
day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF C LU1!1 BeKLJ\:1JD COUNTY
OATH OF NON-SUBSCRIBING WITNESS
11~11R\.f BlC1ZR- v GIZa vn HBR'~
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
iI'J G- kR.E. familiar with the signature of V J D LeI R... V :5 LO<J.f
codicil
testatJ1..1L of (one ef the 3Hlw:rihing w'tA8sses tot the will
that
V\fE.
believef the signature on the
Y i DLE T R Vim SiCKLE:-
to the best of 0 L-l R... knowledge and belief.
Sworn to or affirmed and subscribed before ~ n. A 0 \\Q I\..I\..)
i1 ~ "-
me this f] 'r ~ day of (Name)
,'Vl;rt1, _fiJODI '3~ \-t''-LC.~~ C(:('j ~'P'ERSf/~, Ij3/9
'ff):L'{f(J, ~ux/) ,V>4. fJ,a.. ~.ut>~(J~ IJf I. ... /1!Yl;es.s) I
Register ../c;lI~ ~
(Name)
S'a.mp Q. 5 CLbtJv'€.-
(Address)
MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
~
---
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: _\l!QLEI_R--,-YAN SICKLL
Date of Death: 4l~(lL_______ __~_ Estate No. 2001-00453
SSN: 2Q9_-12:!:ifl2~___ ______ ___ FileNo. 21-01:Q4-~_____ ___ ____
Date Letters Granted: 9a~lQ1_
Will or Administration No.________ _ _ ___ __
To the Register:
I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served
on or mailed to the following beneficiaries of the above-captioned estate on f\.i/A____ __ ___
Name
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
EXECUTRIX IS ALSO SOLE BENEFICIARY.
--- -- - - -- -- -- --- ---_._._.---_._._~-_._--_._~._._-_._.__._-_._-_.- ----
Personal Representative
X _ Counsel for Personal
Representative
.~~~~j~-
Signature
GERALD J. BRINSfR-,--~S~UIR_I;_(ttQ9Q~5j
Name (Please type or print)
Date: 6/1/01
Capacity:
Address
6 E. MAIN STREI;ILEJ)___ 6QX~2:3___ _u_ _ __
EALMYIi~__ _____ __ ___
f'.A._1]QI13
Telephone No. (717'la~13::6~4an
REV-11o\OO ex + (&-00)
.- COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.0601
It. -;;!.~9 - s
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFAClAL USE ONLY
(J,'
FILE NUMBER
21-010453
""'OOiiNTYcoor -YEAR- --iiiimiER--
I-
Z
W
C
W
U
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
VAN SICKLE VIOLET R.
DATE OF DEATH (MM-DD- Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAl SECURITY NUMBER
209-12-5829
THIS RETURN MUST BE FILED IN DUPlICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
I!!
~:$U)
u"''''
w"U
rOO
uf~
..
<
04/08/2001 08/16/1920
(IF APPLICABLE) SURVlVtNG SPOUSE'S NAME (LAST, FIRST, AND MIDDlE INITIAL)
N/A
00 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (AIlachcopyofWl)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a.Future Interest Compromise (daleofdeathaller12.12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (dale of dealh between 12.31.91 and 1.1-95)
o 3. Remainder Return (dale ofdeath priOrkl 12.1J..82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Depos. Boxes
D 11. Election to lax under Sec. 9113(A) 1-' So'OI
THIS SECTION MUST BE COMPLETlED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
GERALD J. BRINSER ESQUIRE 6 E. MAIN STREET
FIRM NAME (If A~'able)
BRINSER WAGNER & ZIMMERMAN P.O. BOX 323
TELEPHONE NUMBER
717838-6348 PALMYRA PA 17078
....
z
w
Q
Z
o
..
'"
w
'"
'"
o
u
z
o
i=
:3
::J
l-
ii:
c(
u
w
II::
z
o
S
::J
11.
:Ii
o
U
S
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Recer,able (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(17)
(18)
(19)
i
OFFICIAL USE ONLY
I
126,223.13 !
I
1
1_______ .
126,223.13
2,441.50
116.23
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(l.2)
0.00 X
.OL(15)
X .04.5 (16)
8. Total Gross Assets (total Lines 1.7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
16. Amount of line 14 taxable at lineal rate
123,665.40
0.00
0.00
X .15
2.557.73
123.665.40
123.665.40
0.00
5.564.94
0.00
0.00
5,564.94
17. Amount of Line 14 taxable atsibting rate
X .12
20. 0
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
d t' C
d
Dece en s omDlete A dress: .
STREET ADDRESS
118 NOVEMBER DRIVE
APT. 1
CITY CAMP HILL I STATE I ZIP
PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discounl
(1)
5.564.94
278.28
Total Credits (A...8...C)
(2)
278.28
3. InleresVPenally if applicable
D.lnlerest
E. Penalty
T otallntenesVPenalty ( D ... E ) (3)
4. if Line 2 is greaterlhan Line 1 ... Line 3, enler the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 10 requesl a refund (4)
5. If Une 1 ... Line 3 is grealer than Line 2, enler the difference. This is the TAX DUE. (5)
A. Enler the interesl on Ihe lax due. (5A)
B. Enler the totai of Line 5 ... 5A. This is Ihe BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILL$, AGENT
5,286.66
5,286.66
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a Iransfer and: Yes No
a. retain Ihe use or income of the property Iransferred; ........................................................................... 0 00
b. retain the right 10 designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ............................................................"........................................ D 00
d. receive the promise lor life of eilher paymenls, bEnefits or care? ............................................................. 0 00
2. If death occurred after DecembEr 12, 1982, did decedenl transfer property within one year of dealh
without receiving adequale consideration?........................................ ......................... ............................. 0 00
3. Did decedent own an 'in trust for' or payable upon death bank accounl or securily al his or herdealh? ................. 0 00
4. Did decedent own an Individual Retirement Accounl, annuily, or other non-probate property which
contains a bEneficiary designation? ....................................................................................................... 0 00
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 lhat I have examined lhis return, includi~ accompalyiog schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNATURE OF PERSON RESP SIBLE FOR F ING RETURN DATE
t1u.W. d), u..-r . 0
D ESS 429 B. RENO STREET
NEW CUMBERLAND PA 17070
SIGNATURE OF PREP R OTHER THAN RE~ ES DATE
E. MAIN STREET, P.O. BOX 323
PALMYRA
PA 17078
ADDRESS
For dales 01 dealh on or after July 1, 1994 and bEfore January I, 1995, Ihe lax rale imposed on the net value oltransfers to or for Ihe use 01 Ihe surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dales of dealh on or after January I, 1995, the tax rate impoSed on the nel value of transfers 10 or lor Ihe use oflhe surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (Ii)].
The slatute does not exemol a transfer to a surviving spouse from tax, and the statutory requiremenls lor disciosure of assets and filing a lax retum are stin applicabie even if
Ihe surviving spouse is the only bEneficiary.
For dates of death on or after July I, 2000:
The tax rate imposed on the net value of Iransfers from a deceased child twenty-one years of age or younger at death to or for Ihe use of a nalural parenl, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)1.
The lax rale impoSed on Ihe nel value of transfers to or for Ihe use oflhe decedenl's lineal bEneficiaries is 4.5%, excepl as noled in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)I.
The lax rate imposed on Ihe net value of lransfers 10 or for Ihe use of the decedenl's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibiing is defined, under Section 9102, as an
individual who has at leasl one parent in common with the decedent, whether by blood or adoptioo.
RE':'~EX.I''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
VAN SICKLE VIOLET R
FILE NUMBER
21 01
0453
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
POSTMARK CREDIT UNION - SAVINGS ACCOUNT #B61
VALUE AT DATE
OF DEATH
100,254.79
2.
WAYPOINT BANK - CHECKING ACCOUNT #1800012312
(INCLUDES ACCRUED INTEREST OF $.28)
10,272.49
3.
WAYPOINT BANK - CERTIFICATE OF DEPOSIT #756318384
(INCLUDES ACCRUED INTEREST OF $13.78)
15,013.78
4.
HOUSEHOLD FURNISHINGS - SALE PROCEEDS
570.49
5.
ALLSTATE INSURANCE - REFUND
37.00
6.
MEDICAL REIMBURSEMENTS
74.58
TOTAL (Also enter on line 5, Recapitulation) $
(It more space is needed, insert additional sheets of the same size)
126223.13
"''':'''0'''"*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
VAN SICKLE VIOLET R
FILE NUMBER
21 01
0453
Debts of decedent must be reported on Schedule I.
ITEM ,
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FUNERAL LUNCHEON 100.00
2. INSCRIPTION 55.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal RepresentaUve (5)
Social Security Numbe~s) I EIN Number of Personal RepresentaUve(s)
SfreefAddress
City State Zip
Year(s) Commission Paid:
2. AttomeyFees BRINSER, WAGNER & ZIMMERMAN 2,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. ProbafeFees REGISTER OF WILLS 265.50
5. Accountants Fees
6. Tax Return Preparer's Fees
7. REGISTER OF WILLS - (2) SHORT CERTIFICATES 6.00
8. REGISTER OF WILLS -FILING FEE 15.00
TOTAL (Also enfer on line 9, RecapUulation) $ 2441.50
(If more space is needed, insert additional sheets of fhe same size)
REV.~"EX.(1.97)'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
VAN SICKLE VIOLET R
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 01
0453
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
P P & L - ELECTRIC
14.12
2.
VERIZON - PHONE
2.11
3.
CAMP HILL PLAZA APARTMENTS
100.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is neeced, insert additional sheets of the same size)
116.23
""':""'.,''',..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
VAN ""f' (I <= VIOl FT R. ?1 01 04fi::l
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distnbutions)
1. LOUISE D. VAN SICKLE DAUGHTER ENTIRE
429 B. RENO STREET RESIDUARY ESTATE
NEW CUMBERLAND, PA 17070
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
-::::>
\~
Ja$t Bill aub ~t$trontnt
--2..L
VIOLET R.
VAN SICKLE
I, VIOLET R. VAN SICKLE, of 1704 Bridge Street, New
Cumberland, Cumberland County, Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this as and for
my LAST WILL AND TESTAMENT, in the manner and form following, hereby
revoking and making void all former Wills or writings in the nature
thereof by me heretofore made:
ITEM I-
I direct my Executrix, hereinafter named, to
pay all my just debts and funeral expenses as soon after my decease
as is practicable.
ITEM II-
All the rest, residue and remainder of my est-
~
ate, whether real, personal or mixed, of whatever nature and descript-
ion, and wheresoever the same may be situate at the time of my death,
I give, devise and bequeath unto my beloved daughter, LOUISE D. VAN
SICKLE, of 1704 Bridge Street, New Cumberland, Pennsylvania, provid-
ing she is living at my death.
ITEM 111- In the event my said daughter fails to survive
me, then I give, devise and bequeath all the rest, residue and re-
mainder of my estate to the following, share and share alike, if liv-
ing; otherwise, to the survivors thereof, share and share alike:
A- One-sixth (1/6th) to my niece. KAREN
L. ESH, of R. D. 1, Port Royal, Pennsylvania;
/ / -, )/" " -.
/~-< T ('/, ,/,:7'< /10./--4
VIOLET R. VAN SICKLE
(SEAL)
-1-
B- One-sixth (1/6th) to my sister,
ADRIENNE E. WRIGHT, of North Seventh Street, Mifflin-
town, Pennsylvania;
C- One-sixth (1/6th) to my brother,
ARTHUR W. BRACKBILL, of Port Royal, Pennsylvania,
D- One-sixth (1/6th) to my brother,
RICHARD C. BRACKBILL, of R. D. I, Port Royal, Penn-
sylvania;
E- One-sixth (1/6th) to my sister,ALMA
E. HUSLER, of R. D. I, Port Royal, Pennsylvania, and
F- One-sixth (1/6th) to my brother, OTHO
BRACKBILL. of R. D. 1, Port Royal, Pennsylvania.
ITEM IV-
I do hereby nominate, constitute and appoint
my said daughter, LOUISE D. VAN SICKLE, to be the Executrix of this,
my LAST WILL AND TESTAMENT, to do any and all things necessary for
the complete administration of my estate, providing she is living
at my death.
I further direct that my said Executrix shall serve
without bond.
ITEM V-
Should my said daughter fail to qualify as
such by reason of death, disability, or unwillingness to serve,
then I do hereby nominate, constitute and appoint my nephew, DONALD
HUSLER, ~,.of R. D., Mifflintown, Pennsylvania, to be the Executor
Y.RY,
of this, my LAST WILL AND TESTAMENT, and I direct that my said
Executor shall serve without bond.
,
ITEM VI-
I hereby direct my Executrix, or Executor,
to ret,ain ELMER E. HARTER. ESQUIRE. of Harrisburg, Pennsylvania,
~--/ .:2?' /;:;;;~-A';(:: (SEAL)
VIOLET R. VAN SICKLE
-2-
to be the attorney for the administration of my estate.
IN WITNESS WHEREOF, I have
and seal to this, my LAST WILL AND TESTAMENT,
January, A. D. 1985.
hereunto set my hand
this ~ ~ay of
~.-/ a ~~Lt.(SEAL)
v v
VIOLET R. VAN SICKLE
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, VIOLET R. VAN SICKLE, as and for her LAST WILL AND TESTA-
MENT. in our presence and in the presence of each other. we, be-
lieving her to be of sound and disposing mind. memory and understand-
ing. have. at her request, hereunto subscribed our names as witnesses
thereto. in the presence of each other and of the Testatrix:
~1~ ~ 1J ~""., "
.~JuJ ~Cu..~$u..u Residing at -^~~ C'<-'
-3-
COD I C I L
I, VIOLET R. VAN SICKLE, the within-named Testatrix, do
hereby make and publish this CODICIL, to be added to my LAST WILL
AND TESTAMENT bearing date of January 9, 1985,
By adding ITEM I-A, which is as follows,
"ITEM I-A- If I should become ill and
there is no reasonable expectation of my recovery,
it is my desire that I be allowed to die, and not be
kept alive by artificial means or heroic measures,
and I direct my Executrix, hereinafter named, to so
advise my family, my physician, my lawyer and my
clergyman, any medical facility in whose care I hap-
pen to be, and any individual who my become respon-
sible for my health, welfare or affairs. This
statement shall stand as an expression of my wishes
while I am still of sound mind,"
IN WITNESS WHEREOF, I have hereunto set my hand and
/.-.,
seal to this CODICIL this I f5 ~ day of October, A. D. 1985.
!;At-,f ,...' /f:.,c4: k .;'
VIOLET R. VAN SICKLE
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-
named Testatrix, VIOLET R. VAN SICKLE, as and for her CODICIL to
her LAST WILL AND TESTAMENT, in our presence, and in the presence
of each other, we, believing her to be of sound and disposing mind,
memory and understanding, have, at her request, hereunto subscribed
our names as witne ses thereto, in the presence of each other and
residing
~-I-:,.
residing at
LAW OFFICES
BRINSER, WAGNER & ZIMMERMAN
6 EAST MAIN STREET - SECOND FLOOR
(EAST MAIN & SOUTH RAILROAD STREETS)
P. O. BOX 323
PALMYRA, PAl 7078
PHONE: (717) 838-6348
FAX: (71 7) 838-6912
MECHANICSBURG OFFICE
MESSIAH VILLAGE
100 MT. ALLEN DRIVE
MECHANICSBURG, PA 17055
PHONE/FAX (717) 795-1737
GERALD J. BRINSER
KEITH D. WAGNER
JOHN M. ZIMMERMAN
July 3, 2001
Mary C. Lewis, Register of Wills
Cumberland County Court House
S. Hanover Street
Carlisle, P A 17013
In Re:
Violet R. Van Sickle Estate
No. 21-01-0453
Dear Ms. Lewis:
Enclosed you will find two (2) copies of the Inheritance Tax Return for the above-
captioned estate, along with two (2) checks: # 103 in the amount of$5,286.66 as payment of
the tax due; and #104 in the amount of$15.00 in payment of the filing fee.
If you have any questions, please feel free to give me a call.
Thank you.
Very truly yours,
BRINSER, WAGNER & ZIMMERMAN
A/-t~
Gerald J. Brinser
GJB/wlc
Enclosures
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
BRINSER GERALD J
22 N RAILROAD ST
PALMYRA, PA 17078
-------- fold
ESTATE INFORMATION: SSN: 209-12-5829
FILE NUMBER: 21-2001- 0453
DECEDENT NAME: V AN SICKLE VIOLET R
DATE OF PAYMENT: 07/06/2001
POSTMARK DATE: 07/05/2001
COUNTY: , CUMBERLAND
I
DA TE OF DEATH: 04/08/2001
NO. CD 000022
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,286.66
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: LOUISE VAN SICKLE
C/O GERALD J BRINSER ESQUIRE
CHECK# 103
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
$5,286.66
MARY C. LEWIS
REGISTER OF WILLS
\, /6- ~oz,9-15-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
GERALD J BRINSER
BRINSER ETAL
PO BOX 323
PALMYRA
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-20-2001
VANSICKLE
04-08-2001
21 01-0453
CUMBERLAND
101
ESQ
'*
REY-1547 EX AFP (12-00>
VIOLET
R
Allount Rellitted
PA 1'7078
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4j-EX-AFP-fi'2=oOY-NO'ficE--OF-YNHEififANCi-TAX-APPRAisEifiNT~--Ail-oWANCi-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VANSICKLE VIOLET R FILE NO. 21 01-0453 ACN 101 DATE 08-20-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
126,223.13
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
2,441.50
116.23
NOTE:
.00
123,665.40
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
126,223.13
(11)
(12)
(13)
(14)
2.557 73
123,665.40
.00
123,665.40
(19)=
.00
5,564.94
.00
.00
5,564.94
PAYMENT RECE:rPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-05-2001 CDOOO022 278.25 5,286.66
TOTAL TAX CREDIT 5,564.91
BALANCE OF TAX DUE .03
INTEREST AND PEN. .00
TOTAL DUE .03
. 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 HAY BE DUE
A D....IJNn_ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
r-
<>t
~_.4f' II
, .
U
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WillS, COUNTY OF CUMBI;RLAND ,PENNSYLVANIA
Name of Decedent: _ 'ilQJ..EIB._Y8t-lS1C~LE__
Date of Death:
4161Q1_
File No.
21Q1~049~_____ _ ____ u____ ___ ________ __ ______
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES __1<__
NO ___
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete: __u____~_ ___p__ ---
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
NOn X__
b. The separate Orphan's Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in interest?
YES____ NO _JL_
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: 8/23/01
Signature
~ERA,-D J. BRINSER-,---E;~QLJIR~
Name (Please type or print)
gj;. MAIN STREE;LE.Q~QX~2~_
Address
PALMYRA_~___ _
PA J7QTI3 __
(1'17)838-634~__ _
Tel. No.
Capacity: Personal Representative
__X~ Counsel for personal representative
/)
,-J
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WillS, COUNTY OF CUMBER!,.AND ... _, PENNSYLVANIA
Name of Decedent: _'yIO!,._ETJLVANJ~I.cKLE_____.___
Date of Death:
~/61QL
File No.
21 Q1..Q49_3.
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 __ L_
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 . u1<_
b. The separate Orphan's Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in interest?
YES NO X * ~,-:blY'v I s sole... bJUY\.Lfr~-<..u:0'-j'
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 8/23/01 ~_,./~L~.
Signature
GERALD J. BRINSER,..f.SQUJR~_ _
Name (Please type or print)
Q. E. MAl N STRI;EI.J>~Q.J:~O_X 32:3
Address
PAlNlyRA____
PA 1707JL
(ZJ1)~38-634~L._ _____
Tel. No.
Capacity: Personal Representative
_X_ Counsel for personal representative