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Home My WebLink About01-0633 ).'!'-". --'. ,; -~ Estate of -Qosalie F. Arentz alSCI known as Rosalie Fair. Arentz Register of Wills of PETITION FOR GRANT OF LElTERS ~/"'O/ - ftJd3 County, Pennsylvania No. . Deceased Social Security No. 233-44 -2417 Peot,onel'1s). wno IS/are 18 years 01 age or OlOer, appry(les) lor. (COMPLETE 'A' OR 'S' 8ELQW:) g] A. Probate and Grant of Letters Testamentary and aver that Petitioner{s) is/are the exeOJt _named in th~ last Will of the Decedent, dated July 20, 2000 and codicil{s) dated Stale telwan! arcunwt.anees, ..;.... renUnCw,lon. aNI" of uea..nor. ete. EXOl!pt as follows, Decedent did not marry, was not diyorced, and did not have a child bom or adopted aher exeOJtJon of the. documents oHefed for probate; was not the victim of a killing and was never adjudicated incompetent: o B. Grant of Letters of Administration (db.n.e.La..: penOllnte .,.; ourarne 8DSert.a; aur3l'l1e mnorrtate Petitioner{s) aher a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and hein,; c: Name Relationshlo Resloence I . (COMPLETE IN All CASES:) ADdl aodlaonaJ sheers If neoessary. Decedent was domiciled at death in Cumbe r 1 and County, Pennsylvania, with hisiher last family Decedent, then 71 1065 York Road (Monroe Township) Dillsburg, PA 17019 (lISt Sb'eet. numoer and ml61l0paJlry) June 27 2001 197 Chain Saw Road, Franklin years of age. died .19_____ at Tuwu::.ldp, York (location) County :---1~O, 000 $ ... $ ~;- pri:;::;:aJ iG~:da:':::a ~: Decedent at death owned property with estimated values as follows: (If domiciled in PAl An personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania situated as follows: Wherefore, Petitioner(s) resDeetlully 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: 1065 York ROad Dillsburg, PA 1701 Fonn.RW-1 Page 1 of 2 Prepared by the Pennsylvania Bar Association 1991 ....."!:"""" . ^,-'<,.. Oath of Personal Representative ~mmonwealth at Pennsylvania Cauntyot Cumberland The Petitioner(~ above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct ta the best ot the knowledge and belief ot Petitioner(S9 and that, as personal representative~) of the DeCE!dent, Petitioner(jl) will well and truly administer the estate according ta law. before me this Sworn to or affirmed and subscribed 2 day ot 1 j Q.Q..L a/Ria 'Hilda Staub 1IJ/~./ ;-tiAJu/J , ~ ..J?b:.~~ r- Hilda Stauv "' 21-2001-633 Estate of Rosalie Fair Arentz a/k/ a Rosalie F. Arentz Deceased Social Security No: 1.11-44-2417 Date of Death: June 27, 2001 AND NOW, July 5th ,~2001 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Cl Testamentary 0 Of Administration Hilda StaU\l. a/k/a are hereby granted to Hilda Staub 11.D.n.c.t..a.; ~aent. lite; duratna aD6e"1.a~ ::3utat11e rT1Inontate . h . (,)......d. t d In the above estate and t at the Instrument s a e describecl in the Petition be admitted ta probate and filed of record as the last Will of Decedent. July 20, 2000 Attorney: ~ . ew'5 ~ 1.0. No: Jane M. Alexander Address: 071V; 148 South Baltimore Street Dillsburq, FA 17019 Telephone: 717-432-4514 Inventary .................. $ Other ....................... $ 266.00 TOTAL ............. $ Fonn 'RW-1 Page 2 of 2 Prepared b;' the Pennsylvania Bar Assoaalion 1991 MAILED LETTERS 'IO ATIORNEY WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CEFiT. NO, T 4913603 _1,!_ne ~~_LJ.QQ~_ Date of Issc e 01 ThiS C~'rlitication ,--~- 21-2001-633 Name of Decedenr___Rosalia_.________________.. F',' F_. . . __._________Aren!~____~___ Sex .~_"_",_F_e.111ale_,______~_~,____. Social Security No. 233 - 44- 2417 Date of Death~~ne27.!_ 2001 Date of Birtb ~ Fehrllary2.6+-L9BOthpiace ... _ RCl.ine:I.:l.e. W~t:yi.!:.&t!1j.~______________________ Place of Death L2_L...chainSaR~ad ~____ XQrR:_ C01.lJlt;y ,= 'H:~i!t.,' N."tr;',,- - -- _u_ ._l.I~!1k 1 in T <?wn~.hJ-..P__ _________.? e n n3'lv a n iCl., e'l';' ROf(_' ,'11':" i'f'"'''-'-''' Race .lIlhite____ Occupation ___..J:I.o_llseRt.f~ . Decedent's Mantal Statue, __WicioJ.le.d... ___ Mailing AddresslQ6~ Armed Forces? (Yes or No) ____~~_____ _ X<>.!:k_F.Q.~<L______~t~!~ bu .!'.8__ P A St;,'i, l'lformant .. Mrs_~_Hilda__~.t_au~_.______________________._____ "" Fune!(".l: [)irf3ct(;( ~Jame ,:\(Id ;:i,ddress of Funeral Establishment ____Cocklin Funeral Home..Illc;......_30 __~f.O_t.t_~_!_~renll_ema.I1..'___~l)___________ Flmt I In'l'ned:ar8 Cause N.__~hestnut.. Street,_pil.!~burg, PA 17019 Interval Between Onset and Death Myoc11r..diaLl.rLf arc t i.on .. :tl~ a v.Y_~!!I()!t..E:!!:... ~~O PD__~__ ~IIlPl1Ys ema .. ARe mi1i_L<:: AI) _~_!!Q._!!yp_er:.1:~ I1.~iot'l.. Part II (d) _ ..Ar.1: hX1- t i f?_____________ . (Yhe Significant Conditions !vlanner of iJeath Desc"ioe how injury occurred: f\Jatur(.=:t; xxx Homicide Pending investigation Could not he Determined .AcCident SUicide Name and Title of Certfier V.E. Abraham, MD AdcJres'" _~Q.4.Mu!llP~:J:'_Lanl:l--'-_p~l1sburg, PA 17019 (M.D" D.O., Coroner, ME) This of d s 10 certif'( that the information he 2t 11 Iy filed 'W th me as Local Re V:i ) Records Office for perma ET' 9! e tly copied from an or!ginal certificate s'ra 2' ,'ig:na! certificate wi!1 be forwarded to the !,Il'lC '~~~c-~1!::~_~~6_~g~________ ",," '" ", "'-,,' h",i-'~'",~;~ '):"tl'",:'t :',~,) ~3; a t ..J ~'+~,1:c;~pO--L- 1 ~3 . l,()gC!.!!.F..oa<!L!>i 1!_!3l:l~E~,__~~....J__7..Q~_9_______ ""',,_.r,'" 21-2001-633 lIast lIIill nub m.estam.eut OF ROSALIE FAIR ARENTZ I, ROSALIE FAIR ARENTZ, a resident of Big Timber, County of Sweet Grass, State of Montana, make and declare this to be my Last Will and Testament, revoking all former Wills and codicils by me made. ARTICLE I MARITAL AND F AMIL Y STATUS I declare that I am a widow and that I have three (3) children; namely, BARBARA ANN WOLF, LON L. LEREW and SELENA STAR GOUKER. I intend the provisions of my Will to apply to such children. ARTICLE II DEBTS, TAXES 1. FUNERAL INSTRUCTIONS I hereby authorize my Personal Representative to make or ratify all necessary funeral arrangements for my body to be cremated and a suitable monument be erected next to my second husband's final resting place in the Big Timber Cemetery. 2. PAYMENT OF DEBTS My Personal Representative, in his sole discretion, may pay my legal debts, including funeral expenses, the cost of a suitable monument, and costs of administration of my estate, and I hereby authorize and empower my Personal Representative, in case of any claim made against my estate, to settle and discharge the same in the absolute discretion of my Personal Representative. 3. PAYMENT OF TAXES I direct that my Personal Representative payout of my residuary estate, all estate, inheritance, succession and other taxes (together with any interest or penalty thereon), assessed Rosalie Fair Arentz Will -/fici W Ji&- by reason of my death imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect of all property required to be included in my gross estate for estate or like tax purposes by any of such governments, whether the property passes under this Will or otherwise, including property over which I have a power of appointment, without contribution by any recipient of any such power. 4. DISCHARGE OF LIENS In the event any property or interest in property passing under this Will, or by operation of law, or otherwise by reason of my death shall be encumbered by a mortgage or a hen, or shall be pledged to secure any obligation (whether the property or interest in property so encumbered or pledged shall be owned by me jointly or individually), I direct that such indebtedness shall be considered in full as obligation of my estate, and shall be charged to or paid by my estate, or may be assumed on distribution by my beneficiaries, in the discretion of my Personal Representative. 5. COST OF DELIVERY If, with respect to any devise, to effect delivery of my tangible personal property or insurance policies to a beneficiary, it becomes necessary to incur expenses of shipment to complete the delivery, my estate and not the beneficiary who is to receive that devise, shall arrange for and pay the costs of shipment incurred in making such delivery. 6. TAX ELECTIONS I am cognizant ofthe fact that the provisions of the Internal Revenue Code of 1986, as amended, (and other applicable laws) in force at the time of my death, and applicable to my estate, may permit my Personal Representative to elect to claim certain administration and other expenses as deductions, either in the income tax returns of my estate or in the estate tax return. It is my desire that my Personal Representative elect to claim from time to time such expenses as deductions on the particular tax returns which, in the Personal Representative's opinion, should result in the smallest combined taxes paid, irrespective of whether such expenses shall be payable from income or corpus; and my Personal Representative is directed not to make adjustments between income or principal, or between property interest passing to beneficiaries Rosalie Fair Arentz Will -l'JtZ, ~ Ji;L under my Will which may be substantially affected as a result of any election under this Article. It is my wish that such property interests as may be determined as a result of my Personal Representative's election under this Article shall be the interest such beneficiary shall receive. I exonerate my Personal Representative from all liability for any such election and direct that no beneficiary shall have any claim against my Personal Representative or my estate by reason of the exercise of my Personal Representative's judgment in this respect. ARTICLE III SPECIFIC DEVISES 1. SEPARATE WRITING I may leave a written statement or list disposing of certain items of my tangible personal property not otherwise disposed of herein. Any such statement or list in existence at the time of my death shall be determinative with respect to all devises made therein. If no written statement or list is found and properly identified by my Personal Representative within 30 days after my Personal Representative's qualification, it shall be presumed that there is no such statement or list and any subsequently discovered statement or list shall be ignored. If found, :such written list is to take precedence over any contrary devise or devises of the same item or items of property in this Will. F or purposes of the above paragraph: (A) Tangible personal property shall not include money; (B) Any list will be signed by me; (C) Any list will describe the items of tangible personal property and the beneficiaries with reasonable certainty; and (D) Any list may be amended or changed by me prior to my death, without amending this Will. 2. PERSONAL EFFECTS Except as herein provided, I give and devise in fee, all tangible personal property (not disposed of by a separate list and except cash on hand or on deposit) owned by me at the time of my death, including, but not limited to, furniture, furnishings, rugs, pictures, books, Rosalie Fair Arentz Will ~ ~-Ja- silverplate, linen, china, glassware, objects of art, wearing apparel, jewelry and automobiles, to my son, LON L. LEREW. If LON L. LEREW should predecease me then I give and devise all tangible personal property equally to my two daughters, BARBARA ANN WOLF and SELENA STAR GOUKER. ARTICLE IV RESIDUARY ESTATE All of the rest, residue and remainder of the property which I may own at the time of my death, real, personal and mixed, tangible and intangible, of whatsoever nature and wheresoever situated, including all property which I may acquire or become entitled to after the execution of this Will, including all lapsed legacies and devises (but excluding any property over or concerning which I have any power of appointment), I give and devise to my son, LON L. LEREW. If LON L. LEREW shall predecease me, then I give and devise my residue estate equally to my two daughters, BARBARA ANN WOLF and SELENA STAR GOUKER. ARTICLE V APPOINTMENT OF PERSONAL REPRESENTATIVE 1. I hereby appoint my son, LON L. LEREW to be the Personal Representative of my estate. Ifhe is unable or unwilling to act, I hereby appoint my sister, HILDA STAUV, as the successor Personal Representative of my estate. 2. Should an administrator, Personal Representative or estate representative be required outside the State of Montana, I hereby authorize my Personal Representative to nominate the person and such nomination shall be final. 3. I direct that my Personal Representative may serve without bond. ARTICLE VI COMMON DISASTER PROVISION If any of my children and I shall die simultaneously or in such circumstances as to render it impossible to determine who predeceased the other, my child shall be presumed to have survived me and the provisions of this Will shall be construed on that assumption, unless otherwise provided herein. Rosalie Fair Arentz Will ~, ~ -fB- ARTICLE VII INFORMAL PROBATE I hereby authorize my Personal Representative to take advantage of all informal probate procedures allowed by the Montana Uniform Probate Code. My Personal Representative has the power and legal right to ask for a formal or supervised administration to protect the interests of my estate and its beneficiaries. ARTICLE VIII DELIVERY TO MINORS If under this Will or a trust provided for in this Will, any property shall be distributable or payable to a person who shall be a minor under the controlling laws of said minor's domicile, my Personal Representative or my Trustee in their sole and uncontrolled discretion, shall distribute such property to one or more of the following: A. Directly to the minor or on behalf of the minor for the minor's exclusive benefit; B. To a guardian or conservator for the minor; or C. To any person (including my Personal Representative or Trustee) selected as a custodian by my Personal Representative or Trustee under the applicable Uniform Transfers to Minors Act of any state. ARTICLE IX GENDER As used in this Will, the masculine, feminine or neuter gender, and the singular or plural number, shall each be deemed to include the other whenever the context so indicates. IN WITNESS WHEREOF, I, ROSALIE FAIR ARENTZ, the testatrix, sign my name to this instrument this 20th day of July, 2000, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and Testament, and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of sound mind, and under no constraint or undue influence. g ;r~~W~ -J1L We, -;;;;;:;., M D...;"",.", and (;al ( fSu.nnel'S.J..er , the witnesses, sign . our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the testatrix signs and executes this instrument as her Last Will and Testament, and that she signs it willingly and that each of us, in the presence and hearing of the testatrix, hereby sign this Will as witness to the testatrix's signing, and that to the best of our knowledge the tl~statrix is 18 years of age or older, of sound mind, and under no constraint or undue influence. ~/ ,,vitness ~&~~. Wi ess &.k' /?'i" 7 Big Timber, Montana 59011 80y. 7/b Big Timber, Montana 59011 STATE OF MONTANA ) : ss. County of Sweet Grass ) SUBSCRIBED, sworn to, and acknowledged before me by ROSALIE FAIR ARENTZ, the testatri~~ subscribed and sworn to before me fly . ( II t V( I Vl and G' tP... I _ 8 urYV't~;.s +er witnesses, this 20 day of July, 2000. Notary Public or eState ontana Residing at Big Timber, Montana My Commission expires: 7 -- {- 0<.00/ f:\wp51 \ep\w\simple\Arentz, Rosalie.doc Rosalie Fair Arentz Will P"}/rc /J. ~ ~ A ,JiB RENUNCIATION 21-2001-633 In Re Estate of Rosalie Fair Arentz deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Lon L. Lerew, son,and first named Executor of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary WITNESS Hilda staub (spelled incorrectly in will as stauv) hand this $y of my June ,~20'01. be issued to ~~~~ ------ (Signature) {:J/ u~/ 21' /,V/f. ~1; (Address) ;:oL.JIJ //5, ) (Signature) (Address) Subscribed and sworn to beCore me this clyMay of June tt 2001 (Signature) ~ (Address) Notarial Seal HalYard E. A\eX8Jlder, Notary PIdc Oillsbu'V Boro, York CoUntY My CommissIOn Expires Apr. 23". 200& Member. PennsylV8f'l18 ASsoclatlonotNolBllel ~ CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name'of Decedent: Rosalie F. Arentz Date of Death: .June 27, 2001 Will No. 21-01-0633 Admin. No. 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 July 3, 2001 Name Addres s Lon L. Lerew 511 Washington street, Ellisville, MS 39437 Barbara A. Wolf 70 North Emigs Mill Road,#57, ,York, PA 17404-5922 Selena Gouker 2469 Sunset Circle, Glenvilla, PA 17329 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except all parties notified Date: July 5, 2001 Alexander South Baltimore Street Dillsburg, PA 17019 Telephone {717L 432-4514 Capacity: x Personal Representative Counsel for personal representative COMMONWI:ALTH 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 ALEXANDER JANE M 148 S BALTIMORE ST DILLSBURG, PA 17019 -------- fold ESTATE INFORMATION: SSN: 233-44-2417 FILE NUMBER: 21-2001- 0633 DECEDENT NAME: ARENTZ ROSALIE FAIR DATE OF PAYMENT: 09/25/2001 POSTMARK DATE: 09/24/2001 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2001 NO. CD 000306 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,719.25 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HILDA STAW C/O JANE M ALEXANDER ESQUIRE CHECK#1015 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $3,719.25 MARY C. LEWIS REGISTER OF WILLS IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF ROSALIE FAIR ARENTZ ALSO KNOWN AS ROSALIE F. ARENTZ Late of Monroe Township File No. 2001-00633 Disclaimer of Interest Pursuant to 20 P A Cons. Std. Section 6201 DISCLAIMER I, Hilda Staub, named as joint-owner of the following three (3) accounts in Members First Federal Credit Union, 5000 Louise Drive, Mechanicsburg, P A 17055 owned by my sister, Rosalie Fair Arentz also known as Rosalie F. Arentz, do hereby disclaim any interest in said accounts effective as of the date of her death, June 27, 2001: a) Savings account no. 201422-00 b) Checking account no. 201422-11 c) Investment Savings account no. 201422-05 A letter from Denise A. Anders, Insurance Products Supervisor, stating the value of the accounts as of date of death is marked as "Exhibit A" attached hereto and made a part hereof. I, Hilda Staub, never intended to have, and do not now claim any interest in said funds. IN ~.I .ESS WHERE. FORE, the undersigned has signed this document this~# day of \W--<<~~--;;vt~'{~ 2001. WITNESS: -v1 /;;k/ ..' ./ o~~~ Hilda ~~~ ~/- (Seal) Notarial Seal HaJvard E. Alexander, Notary Public Dillsbul"Q Boro. York County My CommiSSion Expires Apr. 23; 200lS Member, Pennsvtvani? I\ssociationofNotarles MembersJ FEDERAL CREDIT UNION INSUJ{AN~'E HEI'A Inl\lENT 5000 LOUISE DRIVE P. O. BOX 40 MECHANICSBURG, P^ 17055 I -800-2~U-2128 \1I (717) C>'J7-11(') HEGULAR SA VINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrueu Interest to Date of Death Total Principal and AccrueJ Interest Name of Joint Owner Date Joint Ownership CreatcJ 201422 -00 0]/311200 I $25.00 $.00 $25.00 Hilda Staub 01/31/2001 CHECKING ACCOUNT: Account Number/Suffix Date Account OpeneJ Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and AccrucJ Interest Name of Joint Owner Date Joint Ownership Created 201422 -11 01/3 1/200 I $636.63 $.00 $636.63 HilJa Staub 01/31/200 I !NVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Opcneo Principal Balance at Datc of Dcath Accrued Interest to Date of Death Total Principal anJ Accrued Interest Name of Joint Owncr Date Joint Ownership CreateJ 20 J 422 -05 03/091200 I $101,021.68 $108.16 $101,129.84 Hilda Staub 03/091200 I -- If tJ ( Denise A. Anders Insurance Products Supervisor July 20, 200 I EXHIBIT "A" Estate of: ROSALIE ARENTZ Date of Death: 06/27/2001 Social Security Number: 233-44-2417 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Rosalie F. Arentz No. 21-01-00633 also known as Date of Death 06/2 7 / 2 0 0 1 , Deceased Social Security No. 2 3 3 - 4 4 - 2 4 1 7 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 of the Commonwealth of Pennsylvania except that whi<:h appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct I/We understand that false statements herein are made subject to the penalties of 18 Pa C.S. Section 4904 relating to unsworn falsification to authorities. Attorney Jane M. Alexander, Esquire ljijJjo SftL1L 1.0. No.: 07355 Address: 148 S. Baltimore street Dated #- df/ 9- ,- ?J1- Dillsburg, PA 17019 r-- "--- j'.....' Telephone: (111) 432 -4514- Description 1. Members 1st Federal Credit Union Savings Account no. 201422-00 (Hilda Staub on account disclaimed file) Value 25.00 c' ~ ,':', 2. Members 1st Federal Credit Union Checking Account no. 201422-11 (Hilda Staub on account disclaimed file) 636.63 3. Members 1st Federal Credit Union Savings Account no. 201422-05 (Hilda Staub on account disclaimed file) 101129.84 4. Estate of Bessie R. Beardsley - balance of bequest 145.41 5. Nationwide Life Insurance Co. - premium refun 20.86 Policy no. 397-717721 (Attach additional sheets if necessary) T05~e attached NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal rep- resentative, include the value of each item, but such figures should not be extended into the total of the Inventory. Estate of Rosalie F. Arentz No. 21-01-00633 Inventory continued 6. American Bank of Montana account no. 2105534 173.83 7. Triangle Telephone Cooperative Association Inc. refund of patronage capital credits 1449.70 8. Pioneer Medical Center - refund of overpayment 30.32 Total $103611.59 krv I'"~I [:'16 I~II REV.1500 * w ,.., ,.~'" o .", W"O 2000 0"'''' Il:'" < c.. IlrZt-+1 lu-Hnf'.\ \\"if OW'( II- INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2 1 - 0 1 COUNTY CODE YEAR I- Z W o W o W o DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) Arentz, Rosalie F. DATE OF DEATH (MM.OD.YEAR) DATE OF BIRTH (t,IM.QO.YEAR) June 27, 2001 February 26, 1930 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 233 - 44 o 633 o lfJ""" 2417 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCiAl SECURITY NUMBER (Xl 1. Original Return o 4. limited Estate o 6, Decedent Died Testate ~AllachcopyolWill) o 9. litigation Proceeds Received o 2. Supplemental Rel"m o 4a. Future Interest Compromise (dalt of death a"" 12-12-82) o 7, Decadenl MaintaIned a living Trust (A\IacIICClP)'olTrult,l o 10. Spousal Pover1y Credit (dat, 01 death between 12-31.911100 1.1.95) o 3. Remainder RetulR (dall olllllllh prior 10 12.13-821 o 5. Federal ESlele Tax Relum Required 1.. 8, Tolel Number 01 Sale Depooll Boxeo o 11, Election to lax under Sec, 9113(A) IAtlacllSGh0) l- Z W C z Ii' on w '" '" o o THIS SECTION MUST BE COMP ETElliA\.' NAME Jane M. Alexander, Esquire FIRM NAME (If Applicable) HFID& I,: FOR/Ii ON H \l liE IiIRECTED TO: C~'f8ET'!;M.AIL'I!~lf'ri~ore street Dillsburg, PA 17019 Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole.Proprietorship 4. Mortgages & Noles Receivable (Schedule 0) (I) (2) (3) (4) (5) TELEPHONE NUMBER (717) 432-4514 z o ~ ::J l- ii: <I: o w I:t: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Sctledule F) o Separate Bilting Requested (6) C !"-j OFFltlll.~ USE ONl Y ...-'''''''. .,",,', -' 103611.59 c\ 103611.5!! 13251.52 90360.07 90360.07 4066.20 4066.20 7. Inler-Vivos Transfers & Miscellaneous Non.Probale Property (Schedule G or Ll (7) 8, T olal Gross Assets (Iotal Lines 1.7) g, Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 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 nol been made (Schedule J) 14 Net Value Subject 10 Tax (Line 12 minus line 13\ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' ::l D.. :i: o o ~ 15. Amount of line 14 laxable allhe spousal lax rate, or transfers under Sec. 9116 (aj(1.2) 16. Amount of line 14 taxable allineal rale 90360.07 17. Amount of line 14 taxable al sibling rate 18, Amount of line 14 taxable at coilaleral rate 19. Tax Due 20 lKI > > BE SURE TO ANSWER ALl. QUeSTIONS ON REVERSE SIDE AND RECHECK MATH < < . (8) 12493.54 757.98 (11) (12) (13) (14) x.o_ (15) 45 (16) x,O_ x .12 (17) x ,15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . 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V) sl!J,.J:) flllOl SL"S6~ SZ"6lH IUnoOS!O ':) SlU&uJ,.(Bd JO!Jd '8 llp9JO ~~e^"d lesnods 'V SIUow~'dfSllpaJ:) 'z (6~ OUIl ~ .Oed) .na xe1 . ~ :sJ,paJ:l pue sJuaw~ed xel OZ"990v (I) 6~OLl dlzl va 3!V!S I 6::mqsTTTO All3 peoR )1..l0k 50)0\ SS3MOOV 133M!S :ssaJPP'lt aJaldwo:l s.Juapaoaa llfY.lIllO.fl,tll . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYL VAMA INHERITANCE TAX RETURN 1 H filE NUMBER 21-01-00633 ES1ATE Of Arentz, Rosalie F. Includ. 111. proceed. or IUgalion and 1I1e dale Ihe proceed. were received by 1he e'!ale. All propolly Jolnlly-owned with the right 01 survivorship musl be dl.closed on Schedule F. ITEM VALUE AT OA TE NUMBER OESCRIPTlON OF OEA m 1. Members 1 st Federal Credi t Union 25.00 Savings Account no. 201422-00 (Hilda staub on account disclaimed file) 2. 3. 4. 5. 6. 7. 8. Members 1st Federal Credit Union Checking Account no. 201422-11 (Hilda staub on account disclaimed file) 636.63 Member 1st Federal Credit Union Savings Account no. 201422-05 (Hilda Staub on account disclaimed file) 101129.84 Estate of Bessie R. Beardsley - balance of bequest 145.41 Nationwide Life Insurance Co. - premium refund Policy no. 397-717721 20.86 American Bank of Montana account no. 2105534 173.83 1449.70 Triangle Telephone Cooperative Association Inc. - refund of patronage capital credits Pioneer Medical Center - refund of overpayment 30.32 TOl At (Also enler on lilo" 5, Recapitulation) $1 0361 1 . 59 IN TilE COllin' OF COMMON I'LEAS OF CUMBERLAND COUNTY I'ENNSYLV,'. nA OIU'IIANS' COURT DIVISION IN RE: ESTATE OF ItOSALlE FAil{ ARENTZ ALSO KNOWN AS ROSALIE F. ARENTZ Late or MOil roe TowlIshil' File No. 2001-00(,JJ Uiseh,i1llc,' or IlItCl'Cst l'UrsUllllt to 20 I' A COliS. Sill. Section .,20 I OISCLAIMlm I, I liMa Slauh, nal\\ed as joilll-owner oflhe following lhree (3) accoullls ill ~1cllihcrs First Federul CredilLJllioll. 5000 Louise Drive. Mechanicsburg, PA 17055 owncd hy my si:.lcl. Rosalie F~lir A.-cllt/. also known as Rusalie F. Arentz. do hereby disclaim any interesl ill said aCCOllB(S effeclive as or Ihe dale of her death, June 27, 200 I: a) Savings accoUIlIIlO, 201422-00 Il) Checking aceoUlllllo. 201422-11 c) IlIvesllllelll Savillgs account 110, 201422-05 A leller from Denise A, Anders, Insurallce Producls Superl'isor. staling Ihc \;duc 01'111' accoullls as of dale of dealh is marked as "Exhibil A" allaehed hercto ami made a pari hcrcor. I, llilda Slauh, lIever illlel1lled 10 have, and do nolllow c1ailll allY illtercst ill said rUlllb /'/ I ' IN WITNESS WIIERE~-ORE, lhe \Illdersigned has signed lhis doculllcnl this /(.:..:-~ day,!f ~ 9/ ",,:,-, ", '/' t A<., /:200 I. WITNESS: . ,))"/,." , .Lk:..-,yPc__ '-'f/ ' _j6.t!:s.,., Ililda Stllui. /Jt". {~. (Seal) Sworn 10 01' affirllled 1II1l! subscribed bef\l~e me Ihis _ .{::~ day of l' c' c:.."'"~\\'I' =.J L , 2001 , J{i.'<A-"<I!i[&-<~" L'<-__ I Notary Public / Notarlat Seal Halvard E. Alexander, Notary PullIIc Dlllsbu'll Bora, York Cowlly My CommiSSIOn Expires Apr. 23; 2llOlI Member. PenmWI\lfl"!~ l\o;snciallonofNolarteS Metnbersl.'''' FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 WUlSE DR lYE P. O. BOX 40 MECHANICS BURG, PA 17055 1-800-283-23280<(717)697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created 201422-00 01/31/2001 $25.00 $.00 $25.00 Hilda Staub 01/31/2001 CHECKING ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created 201422.11 01/3112001 $636.63 $.00 $636.63 Hilda Staub 01/31/2001 INVESTMENT SAVINGS ACCOUNT: AccoUI1l Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created 201422 -05 03/091200 I $101,021.68 $108.16 $101,129.84 Hilda Staub 03/09/2001 IT UNION July 20, 2001 Estate of: ROSALIE ARENTZ Date of Death: 06/27/2001 Social Security Number: 233-44-2417 RfV1S11EX'(1"'1 '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Arentz, Rosalie F. FILE NUMBER 2101-00633 Debts of decedent musl be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cocklin Funeral Home - funeral service 2504.28 2. Lowry Funeral Home - Big Timber Mont 1293.00 B. ADMINISTRATIVE COSTS: 1. PeJSOnal Representative's Commissions Name of Personal Representative (s) Hilda Staub 4000.00 Social"ecurity Numbe~s) I EIN Number of Personal Representallve(s) Street Address 1065 Ilork Road City Dillsburq State PA Zip 17019 Year(s) Commission Paid: 2001 - $500.00 2002 - $3500.00 2. Attorney Fees Jane M. Alexander, Esquire 4000.00 3. Family EKemption; (It decedent's address is not the same as claimant's, attach explanation) Claimant none claimed Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 266.00 5. Accountant's Fees Samuel D. Thuma, CPA 200.00 6. Tax Return Preparer's Fees 7. Cumberland Law Journal - advertising grant of letters 75.00 8. The Sentinel - advertising grant of letters 100.31 9. Filing of Inheritance tax return and Inventory 20.00 10. Filing of estate release 10.00 11. Halvard E. Alexander - otary fee 12.00 12. Members 1 st Federal Credit Union - checks charge 12.95 TOTAL (Also enler 011 line 9. RecapllulaliOll) $12,493.54 (If more space is needed, insert additional sheets of Ihe same size) flfVI51}(A.('~11 . ~ ~~~~ COMMONVVLAlfll OF P[NNSYI.VAN'^ INUfRHANCE TAX HETUfUl mSI[)(Nr DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ES1ATE OF Arentz, Rosalie F. FILE NUMBER 21-01-00633 Include unrelmbursed medical expenses. ITEM NUMBER DESCRIP110N Livingston Community Health Care System - expense of last illness AMOUNT ._--------_....._.,._~---- 476.00 2. Deaconess Billings Clenic - medical bill of decedent 100.00 3. Spirit Physician Services - medecal bill of decedent 15.09 4. Winding Hill Veterinary Clinic - debt of decedent 122.00 5. Montana Power Company - debt of decedent 13.89 6. Members 1st Federal Credit Union - wire transfer fees 20.00 . . 7. Pa Dept. of Revenue - 2001 Income Tax Return 11.00 101 AL (Also enter on line 10, Recapitulation) $ 757. 98 (If mOle space is needed, insert additional sheels of the same size) "IU_'II"I '. SCHEDULE J BENEFICIARIES COMUOlIWEAlTIIOF I'{NIlSVlVAIM INIIERIIAHCE lAX RHunN II " FILE IIUMBER 2101-00633 RELATIONSIlIP TO OECEOENr -^MOUNIOi1si1~ Do 1101 Llsl Truslee\_' OF ES1A IE ;TATE OF Arentz, Rosalie F. ~nER NAME AND ADDRESS OF PERSOII(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (Intlude ..trlghl spousal dlsl,lbuli""s' I. Lon L. T~erew 511 Washington street Ellisville, MS 39437 son 100% residue ". ENTER DOLLAR AMOUNTS FOR DISTR1BU~IONS SIlOWII ABOVE ON LINES 15 THROUGlll i. AS APPROprMl E. Oil REV 1500 COV[I1 SIlEO NON, TAXABLE DISTRIBUTIONS: A. SPOUSAL DIS1R1BU110NS UNDER SECTION 9113 FOR WHICH AN ELEC110N 10 TAXIS NOT BEING MADE I. B. CllARllABlE AND GOVERNMENTAL DISTRIBUTIONS I. TOTAL OF PART n. ENTER TOTAL NON,TAXABLE DISTRIBUTIONS ON LINE \3 OF REV 1500 COVER SHEET $ (If mf\ff\ t'IYVr> i" "N",''''\ In..,."l ."Ual"",,1 ..1",1, f II ~" ' ' ~.~" I ;1~, ~,~..~ ,~,,, l~! I,. fl. ' I ,> J i ~"'. .." ' - '_. "':' ''" '''''.'i'tr,~",!)ii~ h,;r.' \'lj;.:.r:;; "~';,~' "" .' ' >'" ~.. '\': ~~II!" "\Ili.-~....",f, :I:' ~ ~ "--". ,I. , J, ,h \''''\!-.:~[q'I,;-o'''i,'j I~ ~",~, , ,,,,.~ T' , '(~~"i.1 ., \', {"..:r;,....~:-", I",,~ ~ ,..-.'.' '" ,~.\~,,\~ ~,~; 'i~ ~. 1 \.l ~ , t~~ . < ~(1!' '. It.. ~, 'f" . c, <1'1 ~l ", . r. ~'i!i. '''~!1; '1 "'I ~ " l' .,.If '\ r . ,1" ( .1; r ,oW? .,F .' ,"".,-, ':;~~~Y";'''i~,:;' - _.!n;~, .:'~ !:,i"i:;~~l~;~;I:!~~:~ ,,;}, .. . "" '. ..l'l.., ~'.", """;""r'., >'-'.'.\ ". ' '" ", .','~' ""~:I'~~""'li~..;r'r' ,'/,\,::!J .\".-: ",:-.: ',' ',,' ,,~\":k...:.:~t\\,':I"j.,.,.,; :(~;~;:: "(::".>;.,,, ':,'t;"; . , , '~;?(:':L ::"'~ "'i,"" 4,f ~@~v 1!Iant Will aUll Wentamcut OF ROSALIE FAm ARENTZ I, ROSALIE FAIR ARENTZ, a resident of Big Timber, County of Sweet Grass, Slate of Montana, make and declare this to be my Last Will and Testament, revoking all former Wills and codicils by me made. ARTICLE I MARITAL AND FAMILY STATUS I declare that I am a widow and that I have three (3) children; namely, BARBARA ANN WOLF, LON L LEREW and SELENA STAR GOUKER. I inlend the provisions of my Will 10 apply to such children. ARTICLE U DEBTS, TAXES I. FUNERAL INSTRUCTIONS I hereby authorize my Personal Representative to make or ratify all necessary funeral arrangements for my body to be cremated and a suitable monument be erected next to m)' second husband's final resting place in the Big Timber Cemetery. 2. PAYMENT OF DEBTS My Personal Representative, in his sole discretion, may pay my legal debts, . including funeral expenses, the cost of a suitable monument, and costs of administration of my estate, and I hereby authorize and empower my Personal Representative. in case of any claim made againsl my eslale, 10 seUle and discharge the same in the absolute diserelion of illY Personal Representative. 3. PAYMENT OF TAXES 1 direct that my Personal Representative payout of my residuary estate, all estate, inheritance, succession and other taxes (together with any interest or penalty thereon), assessed il7/'lltt;jz? )JL by rcason of my death imposed by the govemment of the UnHed States, or any state or territory thereof, or by any roreign govenunent or political subdivisionlhereof, in respect of all property required to be included il1111Y gross estate for estate or like tax pUflloses by any ofsllch govenu11cnls, whether the properly passes under this Will or otherwise, including property over which I have a power of appointment, without contribution by any rcctpient of any sllch power. 4. D1SCllARGE OF LIENS In the event any prol'crly or intercst in properly passing under this Wilt, or by operation of law, or otherwise by reason ormy death shall be encumbered by a mortgage or a lien, or shall be pledged to secure any obligation (whether the property or interest 111 property so encumbered or pledged shall be owned by me jointly or individually), I direct that such indebtedness shall be considered in full 85 obligation of my estate, and shan be charged to or paid by lilY estate, or may be assumed on distribution by my beneficiaries, in the discretion or I"ny Personal Representative. S. COST OF DELIVER Y If, with respect to any devise, to eITed delivery of my tangible personal property or insurance policies to a beneficiary, it becomes necessary to incur expenses of shipment to comlllete lite delivery, my estate and not the beneficiary who is to receive that devise, shall arrange for and pay the costs of shipment incurred in making such delivery. 6. TAX ELECTIONS I am cognizant of the fact that the provisions of the internal Revenue Cooe of 1986, as amended, (and other applicable laws) in force at the time afmy death, and applicable to my estate, may permit my Personal Representative to eleclta claim certaln administration and other expenses 8S deductions, either in the income tax retums of my estate or in the estate tax retum. H is my desire that my Personal Represenlative elecllo claim from time:: to time such expenses as deduclions on the particular tax rctums which, in the Personal Reprcsenlalivc's Ol,illioll, should result in the smallest cOlub,ncu taxes paid, irrespective of whether such expenses shall be payable from income or carpus~ and my Personal Representative is directed not to make adjustments between income or principal, or between property interest passing to beneficiaries Rosalie Fair Arentz Will J{J (2. ?~ )JJL unuer my Will which may be substantially affected as a result or any election under this Article. Il is my wish that such IlCoperty interests as may be dctennined as a result of my Persolla} Representative's election under this Article shan be lhe interest such beneficiary shaH receive. exonerate my Personal Representative from all liability for any such election and dimcl that no beneficiary shall have any claim against my Personal Representative or my estate by reason of the exercise of my Personal Representath/c's judgment in this respect. ARTICLE III SPECIFIC DEVISES l. SEPARATE WRITING I may leave a wriUen statement or list disposing of ccrtain items of my tangible personal property no\ otherwise disposed of herein. Any such statement or list in existence allhe lime of my dealh shaH be dctenninative with respect to all devises made therein. If no writLcl1 statement or tist is founu an\l properly identilied by my Personal Representative within )0 days after my Personal Represenlalive's qualification, it shall be presumed that there is no such slatement or list am! any suhsequenUy discovered statement or list shaH be ignored. U found, suel1 wriUen Ust is hI take precedence over any contrary devise or devises of the same item or lte",s 01 property In till. Will. For purposes orthe above paragraph: (A) Tangible personal properly .hallllll.l include money; (B) Any lisl will be signed by me; (C) Any li.1 will describe Ihe ilem. ollangible personal property and the beneficiaries with Teasonab\e certainty; and (0) Any 1;51 may be ame",led or changed by me prior to "'y dealh, wilhonl amending Ihi.WilI. 2. PERSONAL EFFECTS Except as herein provideu, I give 8ml devise in fcc, alllangible personal properly (nol disposed olby a separale list and except cash on hand or 011 deposil) owned by me .llhe time of my death, including, but not limited to, fUnliture, fumishings, rugs, pictures, books, RosaUe Fair Arentz Will :,2(1 f1 /iP-JiB- silvcllJlate, linen. china. glassware. objects of art, wearing apparcl~ jewelry and automobiles, to my SOli, LON L. LEREW. If LON L. LEREW should predecease me then I give and devise all tangible personal property equally to my two daughters, BARBARA ANN WOLF and SELENA STAR GOUKER. ARTICLE IV RESIDUARY ESTATE All of the rest, residue and remainder of the property which I may Qwn allhe lime Qf my dealh. real. personal and mixed, tangible and illtangible~ of whatsoever nature and whcrcSQcvcl" situated, including 011 propcrty which I may acquire or become entitled to arrer the ex.ecution of this Will, including alllal,sed legacies and devjses (but excluding any property over or conceming which 1 have any power of appoinlment)~ 1 give and devise to my son, LON L. LEREW. Ir LON L. LEREW shall predecease me, lhen I give and devise my residue eslale equally to my two daughters, BARBARA ANN WOLF and SELENA STAR GOUKER. ARTICLE V APPOINTMENT OF PERSONAL REPRESENTATIVE I. I hereby appoint my son, LON L. LEREW to be the Personal Representalive or my eslale. Ifhe is unable or unwilling to act, I hereby appoinlmy sisler, HILDA STAUV, as the successor Personal Representative of my estate. 2. Should an administrator, Personal Representative or estate representative be required outside the State of Montana, 1 hereby authorize my Personal Representative to nominate the person and such nomination shall be finaL 3. I direct that my Personal Representative may serve without bond. ARTICLE VI COMMON DISASTER PROVISION If any or my children and l shall die simu'\aneously or in such circumstances as to renuer it impossible tu determine who P,"cucccasedthe other, my child shaU be prcsumct.lto have survived me and the provisions of\1\i8 Will shall be construed 011 that assumption, unless olherwise provided her.in. Ros.lie Fair Arentz Will ~.~ -IL \1 ARTICLE VII INFORMAL PROBATE I hereby authorize my PersouD! Representative to take advantage oCall inConnal prohate procedures allowed by the Montana Ullifonn Probate Code. My Personal Representative has the power and legal right to ask for a ronnal or supervised administration to prolecllhe interests of my estate and its beneficiaries. ARTICLE VlIl DELIVERY TO MINORS If under Ihis Will or a trust provided [or in this Will, any properly shall be ulstributah\c or payable to a person who shall be a millor under the controlling taws of said minor's domidtc,lny Personal Representative or my Trustee in their sole and uncontrolled discretion, shall distribute such properly to one or more ofthc [ollowing: A. Directly to the minor or on behalf unite minor for the minor's exclusive benefit; D. To a guardian or conservator for the minor; or C. To !luy person (including my Personal Representative or Trustee) selected as a custodian by my Personal Representative or Trustee under the appHcable Unifonn Trans{crs to Minors Act of any state. ARTICLE IX GENDER As used in lhis Wiltlhe l11ascuHne~ feminine or neuter gender. and the singular or plural number, shall each be deemed to include the other whenever the context so indicates. IN WITNESS WHEREOF, I, ROSALIE F AIR ARENTZ, Ihe leslalrix, sign my name 10 Ihis inslrument this 20lh day or July, 2000, and being firsl duly sworn, do hereby declare to the undersigned authorily Ihall sign and execule Ihis inslrumenl as my Lasl Will and Teslament, and that J sign it willingly, Ihall execule il.. my rree and volunlary act ror Ihe purposes therein expressed, and that I 8m \8 years orage or older, of sou no mind, and under no constraint or undue influence. !~I..! ~7/~ Rosllie Fair Alen~ Will :?Jf ~ 7d--! -JiL We, ;;:?;, AI. D....;....~ ..,d hall f2-x,ufler'.,kr . the witnesses, sign our names 10 this instrument, being first duly swum, and do hereby declare (0 the undersigned .~ authority that the testatrix signs and executes this instrument as her Last Will and Testament. anu Utal she signs it willingly and that each of us, in Ule presence and hearing of the testatrix, llcrcby sign this Will as witness to the testatrix's signing, and that to the best of our knowledge the testatrix tS 18 years of age or older, of sound mind, and under no constraint or umJue influence. Will;~ ~,.. /'J''/7 Big Timber, Montana 59011 la& A1NW\M,;hA- Wi less 80'< 7/1, Big Timber, Montana 59011 STATE OF MONTANA ) : 55. County of Sweet Grass ) SUBSCRIBED, sworn to, and acknowledged before me by ROSALIE FAIR ARENTZ, the teslatri any subscribed and sworn to before fIle.Av '/ rd (IVI. and (:{~l_ I3l.(rt1ltc.isi1"r witnesses, this 20 I day of July, 2000. Notary Public or I Ie State Montana Residing at Big Timber, Montana My Commission expires: 7 - 1- cJ. 00 I (:\wpSI\ep\w\simple\ArenlZ, Rosalie.doe , , , \ f f Ros.lie F.ir An:nl.l. Will 1!L~ -~; . /--- . J13 ~ , I , i , l : 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 JANE M ALEXANGER ESQUIRE 148 SOUTH BALTIMORE STREET DILLSBURG, PA 17019 ___~n__ fold ESTATE INFORMATION: SSN: 233-44-2417 FILE NUMBER: 2101-0633 DECEDENT NAME: ARENTZ ROSALIE FAIR DATE OF PAYMENT: 06/28/2002 POSTMARK DATE: 06/27/2002 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2001 NO. CD 001345 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $153.78 I I I I I I I I TOTAL AMOUNT PAID: $153.78 REMARKS: JANE M ALEXANDER ESQUIRE CHECK# 1021 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS BUREAU OF lNDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2110601 HARRISBURG, PA 171211-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JANE M ALEXANDER ESQ 148 S BALTIMORE ST DILLSBURG PA 17019 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-24-2002 ARENTZ 06-27-2001 21 01-0633 CUMBERLAND 101 '* REV-1547 EX AFP 101-OZl ROSALIE F Allount Rellitted I 53.1$- 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=is4'-E3f-AFP--fiff':02Y-NoYicE--OF-YNHERiTANCE-YA;rAppRAisEHiNT-,--AL1-owAN-croR"------------- ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ARENTZ ROSALIE F FILE NO. 21 01-0633 ACN 101 DATE 06-24-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 et Spousal rate (IS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) lB. Amount of Line 14 tllxllble at Collllterlll/ClllSS B rate (lB) 19. Principal TllX Due X C D 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) 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 .00 103,611.59 .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/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) nO) 12,493.54 757.98 (11) (12) (13) (14) NOTE: .00 90,360.07 .00 .00 X 00 = X 045 = X 12 = X 15 = DATE 09-24-2001 AMOUNT PAID 3,719 .25 NU11BER CD000306 INTEREST/PEN PAID (-) 195.75 INTEREST IS CHARGED THROUGH 07-09-2002 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, subllit the upper portion of this forI! with your tax paYllent. 103,611.59 13.251.52 90,360.07 .00 90,360.07 (19)= .00 4,066.20 .00 .00 4,066.20 3,915.00 151. 20 2.58 153.78 IF TOTAL OUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDe OF THIS FORH FOR INSTRUCTIONS.) ~ ~k.D)~/~. /~~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '02 DATE ESTATE OF DATE OF DEATH FILE NUMBER :C@UNTY ACN 06-24-2002 ARENTZ 06-27-2001 21 01-0633 CUMBERLAND 101 wiJL -1 JANE M ALEXANDER ESQ 148 S BALTIMORE ST . DILLSBURG PA 1701~ . cl '* REY-1547 EX AFP 101-021 ROSALIE F Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =isirj-Ex-AFP-coY=02Y-NoTicE--OF-INHE'RiTANcE-TA'x-APPRAiSEHiNT~--AL1-oWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ARENTZ ROSALIE F FILE NO. 21 01-0633 ACN 101 DATE 06-24-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: l!i. Allount of Line 14 at Spousal rate (5) 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 awned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 103,611.59 .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 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 12,493.54 757.98 (1) (2) (3) (4) NOTE: .00 X 90,360.07 X .00 X .00 X NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 103,611.59 13.251 52 90,360.07 .00 90,360.07 00 = 045 = 12 = 15 = .00 4,066.20 .00 .00 4,066.20 (9)= "..~..... . (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-24-2001 CDoo0306 195.75 3,719.25 INTEREST IS CHARGED THROUGH 07-09-2002 TOTAL TAX CREDIT 3,915.00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 151. 20 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.58 TOTAL DUE 153.78 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF ROSALIE FAIR ARENTZ A/KIA ROSALIE F. ARENTZ Late of Monroe Township File No. 21-01-00633 RELEASE KNOW ALL MEN BY THESE PRESENTS, that Lon L. Lerew, being the beneficiary of RosaIie Fair Arentz a/kla Rosalie F. Arentz Estate, acknowledge that I have had and received of and from Hilda Stauv a/kla Hilda Staub, Executrix of the Estate of the said Rosalie Fair Arentz a/kla Rosalie F. Arentz, deceased, funds due from the said estate as set forth in the First and Final Account. WHEREFORE, I do, by these presents, remise, release, quit-claim and forever discharge the said Hilda Stauv a/kla Hilda Staub, her assigns, heirs, Executors, of the duties of the trust imposed and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof. I~- IN WITNESS WHEREOF, I have hereunto set my hand and seal this f7 I' day of ,2002. ~ ~~~.....- Lon L. Lerew ~I) SS COUNTY OF YORK On this, the / ~~y of ___J r..0--y , 2002, before me, the undersigned officer, a Notary Public, personally appeared Lon L. Lerew sworn to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto ,et my ~:/{' ~ ;4< ary Public My Commission Expires: Notarial Seal Halvard E. Alexander, Notary Public DiIIsbu'"9 Boro, York CoUnty My Commission Expires Apr. 23, 2005 Member, Pennsylvania Association otNofa/1es STATUS REPORT UNDER RULE 6.12 Vv ./ NamcofDcceucnl: Rosalie Fair Arentz a/k/a Rosalie F. Arentz Dale of Dealh: June 27. 2001 File No: 21-01-00633 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules. I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. Did the personal representative state an account informally to the parties in interest? Yes x No c. 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. Datt~ : ame (Please type or print) 148 S. Baltimore st., Dillsburg, PA 17019 Address ( 717) 432-4514 Tel. No. Capacity: Personal Representative x Counsel for Personal Representative