HomeMy WebLinkAbout01-0516
__ PETITION FOR GRANT OF LETTERS
EstateofCARLM~SCHNEIDER No.21 - ~ I -S""/?
also known as
CARL r~CHNEIDER
, Deceased
Social Security No. 198074122
CARL D. SCHNEIDER
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut OR
Decedent, dated 10/4/00 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.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 or principal
residence at 325 WESLEY DRIVE, LOWER ALLEN TOWNSHIP, MECHANICSBURG, PA
(list street, number and municipality)
Decedent, then 92 years of age, died MAY 12 2001 at 325 WESLEY DRIVE, MECHANICSBURG, PA
, - , (location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
T atal ..................................................................................................................... $
80,000.00
80,000.00
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:
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Signature
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Typed or printed name and residence
I
CARL D. SCHNEIDER
1500 HIGHLAND DRIVE
SILVER SPRING, MD 20910
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 the estate .according .to law. . / /
Sworn to and affirmed and subscribed ~ e /' jJ ~ ~ &. ~ ~
before me this ~ '3/ .J- day of
;:;r~ ;J~~./~DM
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DECREE-OF REGISTER
r~'
Estate of CARL M~SCHNEIDER
also known as
Deceased
No. 21-01-516
Date of Death: 5/12/01
Social Security No: 198074122
, in consideration of the Petition on the
AND NOW, MAY 31. 2001 2001
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary 0 of Administration
((e.t.a., d.b.n.e.t.; pendente1i!"e;:.durante a':.s~ntia: durante minoriate)
are hereby granted to CARL D. SCHNEIDER
in the above estate and that the instrument(s), if any, dated 10/4/2000
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $ 200.00
Short Certificates( s) .... .~.........
Renunciation ..........................
Extra Pages (3 ) ...............
I. T.R.......................................
JCP Fee .................................
Inventory ... ......... ............. .... ...
Other ......................................
~(I ..JJ"J..!pC' .(!./1.$~<:;Jr r'4
Register of Wills r
$
$
$
$
$
$
$
$
18.00
9.00
Signature
5.00
Attorney: ROBERT L. KNUPP
I.D. No: 07083
Address: 407 NORTH FRONT STREET, P.O. BOX 11848
HARRISBURG PA 17108
Telephone: (717) 238-7151
DATE FILED: MAY 31, 2001
TOTAL .............................$ 232.00
MAILED LETTERS TO ATTORNEY MAY 31, 2001
H105.805 REV 9/86
This is to .certify that t~e. inform~tion he~e given is correctly copied from an original certificate of death duly filed with me as
Local RegIstrar. The ongmal certificate wIll be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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COMMONWEALTH OF PENNSYLVANIA e OEPARTMENT OF HEALTH. VIT.\L RlCOROS
CERTIFICATE OF DEATH i i
I Lwt FOlt NUMBtR
SEX SOCIAL URf~ NUMBER
2. r-hle 3. l~ i + 07
Fee for this certificate, $2.00
p
7533402
No.
Hl05.;43 R.. 2187
TYPElPR1HT
IN
PERMANENT
BLACK INK
NAME Of DECEDENT ,f." M-.. l....'
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AGE ,La.. B""""'vl UNDER' YEAR
I\oIoIlUIa Days
BIRTHI'lACf (C.V .,.0<1
SlaleOl f"'eognCOIJfllIVI
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COUHTY Of OEATH
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Date
DATE Of DEATH ,M"""'. ea,. ._,
M:1 12, 2001
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MAfllTIll. STATUS. M.",.d
Never MarreeeJ. WidOwed.
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RACE. _Inclian. ~k. WhiI.. lIlC.
(Sl>edrl
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SURVIVING SPOuSE
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DUE 10 (OR ASA CONSEQUENCE Of):
DUE 1O(0fI AS A CONSEQUENCE Of):
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WERE AU'lOPSY FIHOIHGS MANHER Of DEATH DATE Of INJURY
AlMULA8Lf PRIOR 10 (MonIh. Day. \\""1
COlIIPI.ETtON Of CAUSE }(XJ 0
Of OEATH1 H......' Hamocide
Att_ 0 Pending _igation 0
Yes 0 No 0 Suic:ide 0 CCluld "'" be ""onn""" 0
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allTlf_ ,Ct1ec:o only one!
.CUTIf'VING PttYSlCIAM (Pllysc:.... c"""Y"'9 cause <iI dealh """'" """""" ""'ysoc........s poonounced <lea'" ana c"""""8<I ..... 2JI
To......... of...y .no....... death occurred due.1heI cau..c.) and manner ... ...1.... - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.PRONOUNCING AND CERTIfYING PHYSICIAN (PII~ bolh ;>Ionouoc"'9 death and cenofvOOQ 10 cau... 0/ "".,1>,
Tothe-.'ot"'yknowtedglt, de.moccur,ecIa' Ihe..... date, ,andp'ac.. andd"elO ltNleauM{.Jandmann.,.. .'.led.. ...........
"MEDICAL EXAMINER/CORONER
On the baa'. of ...am'n.tlon and/or inv.aUg.'ion, in my opinion. death oc.CUffed at the "me. dale. and place. and due to the cauaeCa) i1nc1
m...,..,.. ataled.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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REGISTRAR'S SIGNATURE AND NUMBE
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titian Pike
. PA1711
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n"E Of INJURY
INJURY AT 'NORK1 DESCRIBE HOW INJURV OCCURRED.
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LOCATIOH (511_. CoI'fITo-, _'"
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LAST WILL AND TESTAMENT
OF
CARL M. SCHNEIDER
21-01-516
I, CARL M. SCHNEIDER of Bethany Village Retirement Center, Mechanicsburg,
Cumberland County, Pennsylvania, being of sound and disposing mind, hereby make, publish and
declare this my Last Will and Testament, hereby revoking and making void all prior Wills and other
testamentary writings at any time heretofore made by me.
I. I direct my Executor or successor Executor, hereinafter named, to pay all of my just
debts, funeral and testamentary expenses as soon as conveniently can be done after my demise.
II. I specifically give, devise and bequeath the following specific bequests:
A. Five (5%) percent of the value of my savings account No. 0010320359 in the
Commerce Bank on the date of my death to the PENNSYL VANIA SOCIETY
OF CHRISTIAN ENDEAVOR, 33 Bridle Path Road, Feasterville,
Pennsylvania.
B. Two (2%) percent of the value of my Estate to the HARRISBURG
CITADEL OF THE SALVATION ARMY for its Youth Programs.
C. Five (5%) percent of the value of my Estate to my grandson, DAVID
MATTHEW SCHNEIDER, of Washington, D.C.
1
...
D. Five (5%) percent of the value of my Estate to my granddaughter,
KATHRYN ALEXANDRA SCHNEIDER of Rochester, New York; the said
sum shall be held by my hereinafter named personal representative as the
personal guardian for KATHRYN ALEXANDRA SCHNEIDER in a interest
bearing account until she obtains the age of twenty-one (21) years, at which
time all accumulated interest and principal shall be distributed to her.
III. I give, devise and bequeath all the rest, residue and remainder of my estate in equal
shares to my sons, CARL DAVID SCHNEIDER and PAUL GILBERT SCHNEIDER, per stirpes.
IV. Should there be any property of whatsoever kind and wheresoever situate of which
I have the right to dispose at the time of my death, including but not limited to any special or general
power of appointment or both, I hereby appoint the same to my legatees set forth in Paragraph ONE
hereof.
V. I request my Executors to consult with ROBERT L. KNUPP, ESQUIRE, and KNUPP,
KODAK & IMBLUM, P.C., of Harrisburg, Pennsylvania, as attorneys for my estate, they being
familiar with my affairs.
VI. I nominate, constitute and appoint my son, CARL D. SCHNEIDER as Executor of
this, my Last Will and Testament and further direct that he shall serve without bond.
VII. If the said CARL D. SCHNEIDER is for any reason unable or unwilling to serve as
Executor of this, my Last Will and Testament, then I nominate, constitute and appoint my son, PAUL
G. SCHNEIDER, as successor Executor. He, too, shall serve without bond.
2
. . ,
...
VIll. My said Executor or successor Executor shall have the power to discharge all the
debts, liens and encumbrances upon my estate, as well as any taxes thereon, to pay for the cost of the
fmal disposition of my remains and fmal illness, if any, to receive any and all commissions and other
compensation for services rendered by me during my lifetime and to perform any and all fiduciary
duties authorized by statute. Further, I direct my Executor or successor Executor to preserve my
estate and any instructions pertaining to the distribution of the same from any attachment or
anticipation while in the hands of my said personal representative, it being my express intent that all
legacies shall be free from any attachment or anticipation while in the hands of the accountant for
my estate.
IN WITNESS WHEREOF, I have to this, my Last Will and Testament, typewritten on three
(3) pages of paper, set my hand and seal at the end thereof this 4J-7/.J day of
() ( -r u 13 2-= R-
, 2000.
JP ~A1177~I"",J ~
CARL M. SCHNE ER
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, CARL
M. SCHNEIDER, as and for his Last Will and Testament in the presence of us who, at his request,
in his presence and in the presence of each other, all being present at the same time, have hereunto
set our hands as witnesses.
(SEAL)
(SEAL)
3
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COMMONWEALTH OF PENNSYLVANIA:
:SS:
Dit L Pj1Jf)
COUNTY OF
I, CARL M. SCHNEIDER, Testator whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
~ #&d ~ ~~.le.-
CARL M. SC IDER
Sworn to and subscribed before me
this J./tA day of O(t]l)&~
~M~
y Public
c -y ~~mmission Expires:
, 2000.
(SEAL)
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Notarial Seal
. Bon~je Jo Hull, Notary Public
I . " Hams.burg, Dauphin County
~y CommisSIon Expires July 7, 2003
f-.iie,r./)l;if, Pennsylval"iaAssoclation ot Notaries
COMMONWEAL TH OF PENNSYL VANIA :
:SS:
COUNTY OF JJ.tvj ~II)
WE, ~C~ '^, \~~ and ~O h(rf.1- f.)? '4011/( ,
the witnesses whose names are signed to the \tthched or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw CARL M. SCHNEIDER, Testator, sign and execute
the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as witness, and that to the best of our knowledge, the Testator was at that time 18 or more years of
age, of sound mind and under no constraint or undue influence.
----.,...
Sworn to and subscribed before me
this 4~
day of (1 rtJN.-/f
, 2000.
ary Public
y Commission Expires:
Notarial Seal
Bonnie Jo Hull, Notary Public
Harrisburg, Dauphin County
My Commission Expires July 7, 2003
Member, Pennsylvania Association ot f\Jotaries
(SEAL)
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ORIGINAL'
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: CARL M. SCHNEIDER
Date of Death: MAY 1 2, 2001
Admin. No. 2001-00516
To the Register:
I 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 JUNE 8, 2001:
PA Society of Christian Endeavor, 33 Bridle Path Rd., Feasterville, PA 19053
Harrisburg Citadel of the Salvation Army, 1122 Green St., Harrisburg, PA 17102
David M. Schneider, 3005 11 th Street, Washington, DC 20010
Kathryn A. Schneider, 25 Stoneham Road, Rochester, NY 14625
Carl D. Schneider, 1500 Highland Drive, Silver Spring, MD 20910
Paul G. Schneider, 25 Stoneham Road, Rochester, NY 14625
Date: June 8, 2001
~~
~ ~
Robert L. Knupp, Esq- - ~
PO Box 11 848
Harrisburg PA 17108
(717)238-7151
Counsel for Personal Representative
Robert L. Knupp
Robert D. Kodak
Gary J. Imblum
LAW OFFICES OF
KNUPP, KODAK & IMBlUM, P.C.
CAMERON MANSION
407 NORTH FRONT STREET
POST OFFICE BOX 11848
HARRISBURG, PA 17108- 1848
Telephone: 717/238-7151
Facsimile: 717/238-7158
email: robert.knupp@verizon.net
Robert Ewing Knupp
(1909-1976)
Robert H. Maurer
(1923-1998)
July 17, 2001
MARY C LEWIS REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUSE SQUARE
CARLISLE P A 17013
RE: Estate of Car! M. Schneider
No. 2001-00516
Dear Ms. Lewis:
Enclosed herewith please find a check in the amount of $1,000.00 representing the
prepayment of Inheritance Tax in the above matter. Thank you for your attention in this matter. If
you have any questions, please call.
Very truly yours,
KNUPP, KODAK & IMBLUM, P.C.
/s/ Gf~~~
Robert L. Knupp .,(A
RLK/aa
Enclosure
cc: CARL D SCHNEIDER EXECUTOR
1500 HIGHLAND DRIVE
SILVER SPRING MD 20910
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
KNUPP ROBERT L
POBOX 11 848
HARRISBURG, PA 17108
____h__ fold
ESTATE INFORMATION: SSN: 198-07-4122
FILE NUMBER: 21-2001- 0516
DECEDENT NAME: SCHNEIDER CARL M
DATE OF PAYMENT: 07/18/2001
POSTMARK DATE: 07/17/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 05/12/2001
NO. CD 000060
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,000.00
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TOTAL AMOUNT PAID:
REMARKS: KNUPP ET AL
CHECK# 49354
SEAL
INITIALS: PB
RECEIVED BY:
$1,000.00
MARY C. LEWIS
REGISTER OF WILLS
Robert L. Knupp
Robert D. Kodak
Gary J. Imblum
LAW OFFICES OF
KNUPP, KODAK & IMBLUM, P.C.
CAMERON MANSION
407 NORTH FRONT STREET
POST OFFICE BOX 11848
HARRISBURG, PA 17108-1848
Telephone: 717/238-7151
Facsimile: 717/238-7158
email: robert.knupp@Verizon.net
Robert Ewing Knupp
(1909-1976)
Robert H. Maurer
(1923-1998)
February 11,2002
MARY C LEWIS REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUSE SQUARE
CARLISLE P A 17013
RE: Estate of Carl M. Schneider
No. 2001-00516
Dear Ms. Lewis:
Enclosed herewith please find an original and three copies of the Inheritance Tax Return and
Inventory in the above matter along with appropriate filing fee. Please accept the original and one
copy for filing and return the remaining time-stamped copies in the enclosed self-addressed stamped
envelope.
Thank you for your attention in this matter. If you have any questions, please call.
Very truly yours,
KNUPP, KODAK & IMBLUM, P.C.
RLK/aa
Enclosure
cc: CARL D SCHNEIDER EXECUTOR
1500 HIGHLAND DRIVE
SILVER SPRING MD 20910
!
49354
KNUPP, KODAK, & IMBlUM, P.C. 407 NORTH FRONT ST. HARRISBURG, PA 17108
DATE : Jul 16/2001
CHE #: 49354
AMOUNT: $1,000.00
ACCOUNT: TRUST - 1
PAID TO: CUMBERLAND COUNTY REGISTER OF WILLS
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CLIENT: 3363 - ESTATE OF CARL M SCHNEIDER
MATTER: 1010167
t
LAW OFFICES OF
KNUPP, KODAK & IMBLUM, P.C.
CAMERON MANSION
407 NORTH FRONT STREET
P.O. BOX 11848
HARRISBURG, PA 17108-1848
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OR\G\NAL
INVENTORY
CARL M. SCHNEIDER
CARL D. SCHNEIDER, EXECUTOR
, Deceased
No. 21 01 00516
Date of Death 5/12/01
Social Security No. 198-07-4122
Estate of CARL M. SCHNEIDER
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe
verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Morn~: ROBERTL.KNUPP
I.D. No.: 07083
Address: 407 NORTH FRONT STREET, P.O. BOX 11848
HARRISBURG PA 17108
Telephone: (717) 238-7151
Personal Representative:
~,~~~ LL-...
Dated
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Description
HIGHLAND PARK CAMPMEETING ASSN.
1 SHARE OF STOCK
Value
25.00
EVERGREEN FUNDS
PA MUNICIPAL FUNDS
ACCT #16-1008238159
COMMERCE BANK
SAVINGS ACCOUNT #010320359
8,567.16
a ('";
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(I2~i864.14
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EVERGREEN FUNDS
PA MUNICIPAL BOND FUND - A
DIVIDEND CHECK NO. 001215264
WAYPOINT BANK
CHECKING ACCOUNT #1800030017
~
N
35.51
v
C.n
::::;.
2e7269.70
WAYPOINT BANK
SAVINGS ACCOUNT #1860010264
1,893.61
Total
61,337.38
(Attach Additional Sheets if necessary)
~OTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
Include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
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Continuation of Inventory
CARL M. SCHNEIDER
21
01
00516
PaQe 1
Description of Inventory
Description
Value
AMERICAN BIBLE SOCIETY
ANNUITY
DIVIDEND CHECK #0000236135
EVERGREEN FUNDS
PA MUNICIPAL BOND FUND - A
DIVIDEND CHECK #001215264
ALM INTERNATIONAL
GIFT ANNUITY FUND
61.50
35.51
62.25
1993 CHEVROLET CAVALIER
APPRAISED VALUE
1,500.00
ERIE INSURANCE
REFUND ON AUTO INSURANCE
23.00
CENTRAL PA CONFERENCE LOAN COMMISSION
UNITED METHODIST CHURCH
5,000.00
Subtotal
$
6,682.26
61,337.38
Grand Total $
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
KNUPP ROBERT L
POBOX 11 848
HARRISBURG, PA 17108
-------- fold
ESTATE INFORMATION: SSN: 198-07-4122
FILE NUMBER: 2101-0516
DECEDENT NAME: SCHNEIDER CARL M
DA TE OF PAYMENT: 02/12/2002
POSTMARK DATE: 02/11/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 05/12/2001
NO. CD 000853
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $540.23
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TOTAL AMOUNT PAID:
REMARKS: ROBERT L KNUPP ESQUIRE
CHECK# 51919
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$540.23
MARY C. LEWIS
REGISTER OF WILLS
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H \ G \ t'}bNbALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
v
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
SCHNEIDER, CARL M,
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
j6u~ ~33 - 7
FILE NUMBER
21-0100516
C5liNrvC05E ----vE~ - - 'iM:iiiER- -
SOCIAL SECURITY NUMBER
198-07-422
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (date ofdealh ptiorto 12-13-82)
o 5. Federal Estate Tax Return Required
.!.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax underSec, 9113(A) 1_"""0)
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COMPLETE MAILING ADDRESS
407 NORTH FRONT STREET
'.......,'
<<UEU"';]
NAME
ROBERT L KNUPP
FIRM NAME (If Applicable)
KNUPP, KODAK & IMBLUM, P,C,
TELEPHONE NUMBER
(717 238-7151
PO BOX 11848
HARRISBURG
05/12/2001
01/04/1909
PA
17108
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
N/A
[Kl1. Original Return
D 4. Limited Estate
[KJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust {Attach copy ofTrus~
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL" USE ONLY
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4, Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6, Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
35,396,93 X ,045 (16)
X ,12 (17)
X ,15 (18)
(19)
61,312,38
..,.,
m
CJ
16. Amount of line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~
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(8)
61,337,38
10,297,15
13,718,30
(11)
(12)
(13)
24,015.45
37,321,93
1,925,00
(14)
35,396,93
1,592,86
1,592,86
, ,.0.""::'
I
Decedent's ComDlete Address: - ; " ~
T
STREET ADDRESS BETHANY VILLAGE
325 WESLEY DRIVE
CITY I STATE PA I ZIP 17055
MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,592.86
1,000.00
52.63
Total Credits (A + B + C)
(2)
1,052.63
3. InteresVPenalty if applicabie
O. Interest
E. Penalty
TotallnteresVPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the totai of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make to: REGISTER OF WILLS, AGENT
540.23
540.23
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 [KJ
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [KJ
c, retain a reversionary interest; or ........ ...................,............ ............................. .......................... ... D [Z]
d. receive the promise for life of either payments, benefits or care? .. .........................................................0 [KJ
2. if death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?...... ........................................ ..................................... ....... 0 [KJ
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ..... .. ...... 0 [KJ
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? ........................ ............................................................. ................ 0 [KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare that j have examined this retum, including accompanying schedules and statements, and to lt1e besl 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 pre parer has any knowledge.
SIGNATURE OF PERSON RESPON:ZFI~~G~ DATE
AD SS 1 0 HIGHLAND DRIVE
SILVER SPRINGS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
-- ~ ~
ADDRESS~ P.O. BOX1~o48
HARRISBURG
MD 20910
DATE
~
PA 17108
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;;;;;;;;;ii!ii
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Hiiii!i!:jUtliHWiiii i!immmUmm mm!mmWmmmHlllmmmmim1Wmmmmllmm!!!JlWiiii
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to ortor the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of 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. ~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%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
""ro"'",~" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 01
ESTATE OF
SCHNEIDER CARL M,
00516
ITEM
NUMBER
t
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
HIGHLAND PARK CAMPMEETING ASSN,
1 SHARE
VALUE AT DATE
OF DEATH
25,00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
25,00
""''''''.''.71.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SCHNEIDER CARL M
FILE NUMBER
21 01
00516
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.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
VALUE AT DATE
OF DEATH
8,567.16
PA MUNICIPAL BOND FUND - A
EVERGREEN FUNDS
ACCOUNT NO. 16-1008238159
COMMERCE BANK
SAVINGS ACCOUNT #01 0320359
23,864.14
PA MUNICIPAL BOND FUND - A
EVERGREEN FUNDS
DIVIDEND CHECK NO. 001215264
WAYPOINT BANK
CHECKING ACCOUNT NO. 1800030017
35.51
20,269.70
WAYPOINT BANK
SAVINGS ACCOUNT NO. 1860010264
1,893.61
AMERICAN BIBLE SOCIETY
ANNUITY
DIVIDEND CHECK NO. 0000236135
PA MUNICIPAL BOND FUND - A
EVERGREEN FUNDS
DIVIDEND CHECK NO. 001215264
ALM INTERNATIONAL
GIFT ANNUITY FUND
61.50
35.51
62.25
1993 CHEVROLET CAVALIER
APPRAISED VALUE
APPRAISAL ATTACHED
ERIE INSURANCE
REFUND ON AUTO INSURANCE NO. Q56 0802424 H
1,500.00
23.00
CENTRAL PA CONFERENCE LOAN COMMISSION
5,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
61,312.38
"
A.W. Troutman Co.
1--1
TROUTMAN'S
Chevrolet - Oldsmobile
1111)-11
Knupp, Kodak & Imblum, PC
407 N. Front Street
P.O. Box 11848
Harrisburg, P A 17108-1848
June 27, 2001
Estate of Carl M. Schneider
Enclosed please find a check in the amount of$1500.00 for the purchase of a
1993 Chevrolet Cavalier VIN# I G IJC5444P7292199.
I have seen and appraised said vehicle and based on the fact that the state
inspection ran out in June 2000 and the need for four tires, I have appraised its value at
$1500.00.
Enclosed are copies of the NADA appraisal guide and the Old Car Market Guide
by Black Book.
Sincerely,
~A~
David A. Trourtnan
640 State Street, P.O. Box 100, Millersburg, PA 17061
692-2137 or 1-800-504-6119
.,
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
SCHNEIDER CARL M.
FILE NUMBER
21
01
00516
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOOVER FUNERAL HOME 7,355.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s} I EIN Number of Personal Representative{s}
Street Address
City State Zip
Yea~s) Commission Paid:
2 AttorneyFees KNUPP, KODAK & IMBLUM, P.C. 2,500.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 232.00
CARLISLE, PA
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. CUMBERLAND COUNTY LAW JOURNAL - ADVERTISEMENT OF ESTATE 75.00
8. THE SENTINEL - ADVERTISEMENT OF ESTATE 100.31
9. HOOVER FUNERAL HOME - DEATH CERTIFICATES OF ELSIE SCHNEIDER 21.00
10. UNISHIPPERS - AIRBORNE EXPRESS 13.84
TOTAL (Also enter on line g, Recapitulation) $ 10,297.15
(If more space is needed, insert additional sheets of the same size)
e~'''m.'''"''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
SCHNEIDER CARL M.
FILE NUMBER
21 01
00516
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
20.00
2.
3.
4.
5.
6.
7.
B.
9.
10.
11.
12.
13.
14.
15.
PENNSYLVANIA EYE ASSOCIATES
ACCOUNT NO. 19788
VERIZON -
TELEPHONE BILL
65.07
VERIZON
TELEPHONE BILL - FINAL
44.28
PP&L UTILITIES
ELECTRIC SERVICE
47.93
J.C. SNYDER FLORIST
27.56
MCI
LONG DISTANCE TELEPHONE SERVICE
22.52
PA AMERICAN WATER SERVICE
WATER SERVICE - FINAL BILL
59.26
CARLISLE IMAGING ASSOCIATES
MEDICAL BILL
48.00
BETHANY COTTAGE
ASSISTED LIVING EXPENSE
ACCT NO. 198074122
BETHANY SKILLED NURSING
ASSISTED LIVING EXPENSE
ACCT NO. 198074122
MECHANICSBURG. CUMBERLAND COUNTY
CITY, TOWNSHIP SCHOOL REAL ESTATE TAXES
2,680.21
6,850.33
78.65
LOWER ALLEN TOWNSHIP
SEWER CHARGE
52.80
ALERT PHARMACY AT BETHANY VILLAGE
PHARMACY/MEDICAL CHARGES
3,592.56
PPL ELECTRIC UTILITIES
ELECTRIC SERVICE - FINAL BILL
101.74
VERIZON
TELEPHONE SERVICE - FINAL BILL
27.39
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
13,718.30
RCV-1513E~.(9_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
<::1'1-11
NUMBER
I.
SCHEDULE J
BENEFICIARIES
"ARL M.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfe", under
Sec. 9116 (al (1.2)]
CARL DAVID SCHNEIDER
1500 HIGHLAND DRIVE
SILVER SPRING, MD 20910
PAUL GILBERT SCHNEIDER
25 STONE HAM ROAD
ROCHESTER, NY 14625
DAVID MATTHEW SCHNEIDER
3005 11TH ST.
WASHINGTON, D.C. 20010
KATHRYN ALEXANDRA SCHNEIDER
25 STONE HAM ROAD
ROCHESTER, NY 14625
FILE NUMBER
?1 n1
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
SON
SON
GRANDSON
GRANDDAUGHTER
nnii1R
AMOUNT OR SHARE
OF ESTATE
50% OF RESIDUAL
50% OF RESIDUAL
5% OF NET VALUE
OF ESTATE
5% OF NET VALUE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
2.
3.
4.
1.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
PENNSYLVANIA SOCIETY OF CHRISTIAN ENDEAVOR
33 BRIDLE PATH ROAD
FEASTERVILLE, PA 19053
HARRISBURG, CITADEL OF THE SALVATION ARMY
1122 GREEN
HARRISBURG, PA 17102
2
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)
1,200.00
725.00
$
1,925.00
/
LAST WILL AND TESTAMENT
ORIGINAL WILL IN SAFETY DEPOSIT BOX
OF OF KNUPP, KODAK & IMBLUM, P.C.
AT FIRST UNION BANK
CARL M. SCHNEIDER
I, CARL M. SCHNEIDER of Bethany Village Retirement Center, Mechanicsburg,
Cumberland County, Pennsylvania, being of sound and disposing mind, hereby make, publish and
declare this my Last Will and Testament, hereby revoking and making void all prior Wills and other
testamentary writings at any time heretofore made by me.
I. I direct my Executor or successor Executor, hereinafter named, to pay all of my just
debts, funeral and testamentary expenses as soon as conveniently can be done after my demise.
II. I specifically give, devise and bequeath the foUowing specific bequests:
j A. Five (5%) percent of the value of my savings account No. 0010320359 in the
Commerce Bank on the date of my death to the PENNSYL VANIA SOCIETY
OF CHRISTIAN ENDEAVOR, 33 Bridle Path Road, Feasterville,
Pennsylvania.
B. Two (2%) percent of the value of my Estate to the HARRISBURG
CITADEL OF THE SALVATION ARMY for its Youth Programs.
~. j Five (5%) percent of the value of my Estate to my grandson, DAVID
MATTHEW SCHNEIDER, of Washington, D.C.
1
D.
/
Five (5%) percent of the value of my Estate to my granddaughter,
KATHRYN ALEXANDRA SCHNEIDER of Rochester,New York; the said
sum shall be held by my hereinafter named personal representative as the
personal guardian for KATHRYN ALEXANDRA SCHNEIDER in a interest
bearing account until she obtains the age of twenty-one (21) years, at which
time all accumulated interest and principal shall be distributed to her.
/ III.
I give, devise and bequeath all the rest, residue and remainder of my estate in equal
shares to my sons, CARL DAVID SCHNEIDER and PAUL GILBERT SCHNEIDER, per stirpes.
IV. Should there be any property of whatsoever kind and wheresoever situate of which
I have the right to dispose at the time of my death, including but not limited to any special or general
power of appointment or both, I hereby appoint the same to my legatees set forth in Paragraph ONE
hereof.
V. I request my Executors to consult with ROBERT L. KNUPP, ESQUIRE, and KNUPP,
KODAK & IMBLUM, P.C., of Harrisburg, Pennsylvania, as attorneys for my estate, they being
familiar with my affairs.
VI. I nominate, constitute and appoint my son, CARL D. SCHNEIDER as Executor of
this, my Last Will and Testament and further direct that he shall serve without bond.
VII. If the said CARL D. SCHNEIDER is for any reason unable or unwilling to serve as
Executor of this, my Last Will and Testament, then I nominate, constitute and appoint my son, PAUL
G. SCHNEIDER, as successor Executor. He, too, shall serve without bond.
2
vm. My said Executor or successor Executor shall have the power to discharge all the
debts, liens and encumbrances upon my estate, as well as any taxes thereon, to pay for the cost of the
fmal disposition of my remains and fmal illness, if any, to receive any and all commissions and other
compensation for services rendered by me during my lifetime and to perform any and all fiduciary
duties authorized by statute. Further, I direct my Executor or successor Executor to preserve my
estate and any instructions pertaining to the distribution of the same from any attachment or
anticipation while in the hands of my said personal representative, it being my express intent that all
legacies shall be free from any attachment or anticipation while in the hands of the accountant for
my estate.
IN WITNESS WHEREOF, I have to this, my Last Will and Testament, typewritten on three
(3) pages of paper, set my hand and seal at the end thereof this ~ day of
[} /l)p,f ~
,2000.
/ Y (!kD [f). .s~HI)hC>E-K.
ARL M. SCHNEIDER
~
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, CARL
M. SCHNEIDER, as and for his Last Will and Testament in the presence of us who, at his request,
in his presence and in the presence of each other, all being present at the same time, have hereunto
set our hands as witnesses.
/JI f(O/3k:r 1. ~VP/-'
, ,
~)
N K"AUlr ]) 1!o"4t{,
(~
3
COMMONWEALTH OF PENNSYLVANIA:
:SS:
. ..
COUNTY OF
]jPrf JPH7n
I, CARL M. SCHNEIDER, Testator whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
L1i 0+u If} Jew/)etOi:/{
(C RL M. SCHNEIDER
Sworn to and subscribed before me
this J/I3
day of M mfIJ-{
,2000.
L cI .&mtl .-Z /JWf.-
IN6tary Public
My Commission Expires: 07 /tll f!i
(~
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF ])AUPTf70
WE, ~UKr '-. !c'/){)/>p and K6ehzr D. !6Dr7K
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw CARL M. SCHNEIDER, Testator, sign and execute
the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as witness, and that to the best of our knowledge, the Testator was at that time 18 or more years of
age, of sound mind and under no constraint or undue influence.
/i! ~.Mer- J. t:.,(.J;:>p
/-1/ Koekr D. ~~
Sworn to and subscribed before me
this Jj7.l day of 1)(!.i7J~
,2000.
Ii &()/)/[ ~ Jlul.L
otary Public
My Commission Expires: 0'1/07 I/)3
~
v /~ --- ~..32-7
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-25-2002
SCHNEIDER
05-12-2001
21 01-0516
CUMBERLAND
101
AlIOunt Remi tted
F1 C(>~
ROBERT L KNUPP
KNUPP ETAL
PO BOX 11848
HBG
'02 I\PR-1
P12 :48
~~~~~~;9~
*
REY-1541 EX AFP CUl-D2)
CARL
M
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
25.00
.00
.00
61.312.38
.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 ~
R'E-y=is47-E"x-iF"P--(cfi=oz'r-No'fici-OF-i-NHiiiifANCi-y-i)rA-PPRAisii'-EN~--ii:lowAiici-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SCHNEIDER CARL M FILE NO. 21 01-0516 ACN 101 DATE 03-25-2002
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. Hortgages/Notes Receivable (Schedule D)
S. 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/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total a~ ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
10,297.15
13.718.30
(11)
(12)
(13)
(14)
(9)
(10)
.00 X 00 =
35,396.93 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
61,337.38
24.015 45
37,321.93
1,925.00
35,396.93
(19)=
.00
1,592.86
.00
.00
1,592.86
TAX CREDITS:
. ~. .._n . "..ow..... . II ("J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-17-2001 CDOOO060 52.63 1,000.00
02-11-2002 CDOO0853 .00 540.23
TOTAL TAX CREDIT 1,592.86
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIP' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)