HomeMy WebLinkAbout01-0667
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Ld ~ ETT79 /I. 0/2/955 No. ,;).1 - 0' - fDlo 7
also known as To:
Register of Wills for the
Deceased. County of in the
Social Security No. / 77 - / fa - /.. -59~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an ~hcut
in the last will of the above de edent, dated .-. a.-At""~./ /5-
and codicil(s) dated ~ '7 V. -
/
nam~
, 19 8"
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
h
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ ~, o--z;-c;
$
$
$
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TO OF PENNSYLVANIA 1- ss
COUNTY OF CUMBERLAND j
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly adm'nister the esta according to law.
Swor n to or affirmed and subscribed {W
before me this 12th day of
f/XLUt ~ ~~~ :::~,
J/~ -lUll _...
No. 21-01-667
Estate of
:mREI'TA H. GRASS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JUly 16. /.001 )I1j, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 03-11:)-1984 -Codicil dated: 01-2901991
described therein be admitted to probate and filed of record as the last will of
IDRETTA H. GRASS
'T'R~'T'AMlW1'ARY
DIANE M. ZEIGLER
and Letters
are hereby granted to
yY}'4 i2.. ;k~., e....fA ~
_ Re~ster of Wi
FEES
$ 80.00
$ 1/..00
$ 10.50 .
$ 1~: 88
TOTAL _ $125.50
Filed ......... .JULY. 16, 20.Q1. . . . . . . . . . .
Probate, Letters, Etc. .........
Short Certificates( 4) . . . . . . . . . .
-CODICIL
KenunClalion ................
~&ges
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
/'V1_' f\ n P -M . -J " .. " _ H{___ '7 _ 11, .,.... I
HI0".80'1 REV'JiHCJ
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registtar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
21-01-667
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Local eglstrar
Fee for this certificate, $2.00
P 7430977
JUN 2 '7 LOO\
Date
) Ae\l 2181
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
NAME OF DECEDENT (Firm. Middle, LasI!
SEX
STATE ~llE NUMBER
SOCIAL SECURIT'f NUMBER
DATE OF OfATH ,Mcrnh. 08). _}
..
AGE\la"BiMoaYl
2. Female 3. 177 - 16 - 1594
8lRTHPlACf: (C.ty ....r.cJ PlACE OF OE,(f"H ,Ct\ecJl, 0I'Iy one -- ~ rnstruclll,)ffl ()(I ~ SlOe)
State or Fc,eoqn Counlty) HOSPITAL
_.... 0 E~I"", 0 OOA 0
Pa ...
FACIlJT'V NAME (II noIlOS1ofUlto,... Qlve street and numbefl
.. June 27 2001
5. 80 Yrs
COU"TY Of' OEJIlH
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...
CUmberland
DECECEIIT'S USUAl. OCCUPIU'ION
(Give Iund d work daM dutlOQ r'TlOIt
of wortlitIg life; do not use ,e(lred )
Clerk
WASOECEOEIflEVER'..
u.s. ARMED FORCES?
... 0 ....xJ
MARITAl. STAruS._
NewerMan*S, ~.
"'-"""1S_"Yl
... Widowed
17c.O 'WW. dec.,.,. w.cs in
-
418 North 21st Street
Camp Hill, Pa 17011
17.. SIal. Pa
...
FAJ'HER'S NAME (fie'Sl.~. last)
1.. Harry E. Hoffman
INFORMANT'S NAME (l,poIP''',
. Diane Zeigler
METHOO OF DISPOSITION
-XJ C'.....,_ 0
0IIw (SpaaIyI
'lb. County
No. dlIcedent MId
17d. wilhinectUlllJil'Mt;ot
MOTHER'S NAME iF..st. Middle. Matden 5ufname)
Theresa Knoble
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-
... WU.
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-
...
INFORMANT'S MAlUNG AOOflESStSlr.... C...,tTown. SIato. z"c_,
604 Monroe Street Bressler Pa 17113
IIIIIIEOIATE.CAUSE (Fit\at
a..e Of COIlCMiOn
r-*'g.lRdMtI\~ --.
_ AND AOOflESS Of' FACILITY
ers-Hamer Funeral Home
LICENSE NUMBER
23b. RN-S;1aO::7/- L . 'Z,7/0/
WAS CASE REFERRED TO MEDICAl. ElWl.NERiCOAONER? "'"'
...0 Not>..!
211.
I ApptoJUmate PART II: Other si9'iflcant condaions contributing 10 dMth. bwc
I....... bMween rWJt ~intM ~~gNenin PIIRT 1.
: onMI and death
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PLACl! OF DISPOSITION. _ oIc-..y, C,._
01 ou... Ptoco
21c.
........-.. Cllftll;Iiona
~--.g"'-
....... __YINO
CAUSE(~Oflf'ltUlY
,,*.-..c:t ~
,-....",gen <*II'l. LAST
l:
DUE 10 (OA AS A CONSEOUENCE on
DlJElO(ORASA CONSEOuENCE OF):
wo.s AN AUlOPSY WERE AUTOPSY .INDINGS MANNER OF OEATH
PEl'lFORMEO? _lA8l.E PRIOR 10
COMPl.ET1ON OF CAUSE 0
Of' oeRH? ?1 -
Pending IlWesOgation 0
...0 ....0 ido 0 ~ not be delltfmlned 0
DATE OF INJURY
(MOOIh. Cay. "at)
TlYE Of lNJUR'I'
"'>\JR' R WORK? DESCRIBE HOW INJURY OCCURRED.
.... 0 ...0
200. M. 301:.
PlACE OF INJURY. Al home, farm, stteel. lac:fO(y, office
buiIdinc). e(C, tSpec:lt'Il
.... 2ab. 211. 200.
CSlTIFI&A ICheck oniy onel
-CERTliFYtNG PHYSlClAM{Pt\ySlC.anc.~1f\g caused dQth ~ anOltlef phySiC.an has pronOl.lI,ced dealh ana Compteled lIern 231
To.......ot my knowledQe. deethoccurred "lOlhecaUM(.).ndm~nne'.. .lated. .........
~MEDICAL EXAMINER/CORONER
On ttMt baaitl 0' examination andlor investig,ation. in my opinion. de.th occurred atlhe time, date, .nd place. and due to the cause(s) and
manta_.. stated.. . . . . . . . . . . . . . . .. .... .. . . . . . . .. .. . , . . . .
31..
REGISTRAR.S SIGNATURE ANO NUM8ER
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NAME AND AOOAESS OF PERSON WHO COMP
(lIem Z7) Typo 01 P,jnt ~
o32~
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.PRONOUNCIHG AND CERTIFYING PHVSIC'AN (PhVSCI;Vl t:xlth ptOf1OuOC'1lg lledlh and cl!f1llyng 10 cause 01 deathl
To 1M"'" of my knowledge, death occunecla. tI\e u.n.. date. and plac;:e, .nd due to ttM cause(.) and manne,.. stated..
33.
CXDICIL TO
WILL OF
LORETTA H~ GRASS
I, LORETTA H. GRASS, of the Borough of Camp Hill~ Cumberland County~ Pennsy1vania~
declare this to be my sole codicil to my last will dated 15 March 1984.
ITEM I. I hereby revoke ITEM IV of my will and in lieu thereof provide as
follows:
ITEM IV. I give and bequeath the sum of Five Thousand
($5,000.00) Dollars to each of my grandchildren who survive my
death by sixty (60) days. Should all of my grandchildren
predecease me or be deceased on the sixty-first day following my
death, than this bequest shall lapse and pass instead as a part of
the residue of my estate.
ITEM II. I hereby revoke ITEM VI of my will and in lieu thereof provide as
follows:
ITEM VI. I appoint my daughter, DIANE M. ZEIGLER, of Bressler,
Pennsylvania, executrix of this my last will. Should Diane M.
Zeigler fail to qualify or cease to serve as executrix of this my
last will, I appoint my son, WILLIAM C. GRASS, of E1kridge,
Maryland, executor of this my last will.
ITEM II. In all other respects, I hereby ratify, confirm and republish my last
will dated 15 March 1984, together with this sole codicil as and for my last will.
IN WITNESS 1tiEREOF, I have hereunto set my hand and seal this ~ j day
~ ~, ,1991.
0d~) ";<,/~
of
LORETTA H. GRASS
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Signed, published, and declared on the date hereof by the above-named testatrix as
and for the sole codicil to her last will dated 15 March 1984, in the presence of us,
who at her request, in her presence, and in the presence of each other, have subscribed
our names as witnesses hereto.
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2
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, does hereby
acknowledge that I signed and executed the foregoing instrument as my sole codicil to
my last will, that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed., "- jJ
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Loretta H. Grass
Sworn or affirmed to and
acknowledged before me by
t~e(:~GstatriXI~' ~ ~bove this
! ()fh ~ay of\ jll),oUtt\,c[,, 1991-
l' , .' ^ L \) (JjA.L~~
Notary hc
NOTARiAl SEAL
WENDY K. STRAUB, NOTARY PUBLIC
LfMOYNE BORO, CUMBERlAND CO
MY COMMISSION EXPIRES MAY 6, 1991
)
( SS.:
)
\.;
COMtlONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
WE, GEORGE A. VAUGHN, III, and MICHAEL L. BANGS, 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 the testatrix sign and execute the
instrument as her sole codicil to her last will; that she signed it willingly and that
she executed it as her free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the testatrix signed the codicil as witnesses
and that to the best of our knowledge, the testatrix was at that time 18 or more years
of age, of sound mind, and under no constraint or undue influence.
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NOTARIAl SEAL
= BSTRAORQUB, NOTARY PUBLIC
If\' · CUMBERlAND CO
COMMISSION EXPIRES MAY 6. IfHU
3
WILL
OF
LORETTA H. GRASS
I, LORETTA H. GRASS, of the Borough of Camp Hill, Cumberland
.~ County, and State of Pennsylvania, declare this to be my last will and
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" revoke any will previously made by me.
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ITEM I. I direct that all my just debts and funeral expenses,
including my gravemarker and all expenses of my last illness, and any
and all taxes and assessments imposed by any governmental body as a
result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as
practicable after my decease as a part of the expense of the
administration of my estate.
ITEM II.
I give and bequeath all of my household goods,
automobiles, jewelry, and all other articles of household and personal
use, equipment and ornament, together wi th all insurance thereon and
relating thereto, to such of my issue, per stirpes, who survive my
death by sixty (60) days to be divided among them by my executor with
due regard for their personal preferences in as nearly equal shares as
practical. The decision of my executor with regard thereto shall be
final, binding, and conclusive on all parties.
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ITEM III. I give and bequeath to my sister, CLAIRE G. HOFFMAN,
of Camp Hill, Pennsylvania, the sum of FIVE THOUSAND ($5,000.00)
DOLLARS, provided she survives my death by sixty (60) days. Should my
sister predecease me or be deceased on the sixty-first day following
my death, then this bequest shall pass instead to those of my
grandchildren, in equal shares, who survive my death by sixty (60)
days.
Should all of my grandchildren predecease me or be deceased on
the sixty-first day following my death, then this bequest shall lapse
and pass instead as a part of the residue of my estate.
ITEM IV.
I give and bequeath the sum of FIVE THOUSAND
($5,000.00) DOLLARS in equal shares to those of my grandchildren who
survIve my death by sixty (60) days.
Should all of my grandchildren
predecease me or be deceased on the sixty-first day following my
death, then this bequest shall lapse and it shall pass instead as a
part of the residue of my estate.
ITEM V. I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever
situate to such of my issue, per stirpes, as survive my death by sixty
(60) days.
ITEM VI.
I appoint GEORGE A. VAUGHN, III, Attorney-at-Law,
executor of this my last will. Should the said George A. Vaughn, III,
predecease me or otherwise fail to qualify or cease to serve as
2
executor of this my last will, I appoint SAMUEL L. ANDES, Attorney-at-
Law, executor of this my last will.
ITEM VI1. I direct that my personal representati ves shall not be
required to give bond for the faithful performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
/.s- day of '-?1~-I, 1984.
~S)V~~
3
The preceding instrument, consisting of this and THREE other
.~ typewritten pages, each identified by the signature of the testatrix
\ was on the date thereof signed, published and declared by LORETTA H.
'\ GRASS, the testatrix therein named, as and for her last will, in the
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presence of us, who at her request, in her presence, and in the
presence of each other, have subscribed our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
The undersigned, LORETTA H. GRASS, being the testatrix whose name
is signed to the attached or foregoing instrument, having been duly
qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it
willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
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Loretta H. Grass
tL)
Sworn or affirmed to and
acknowledged before me by
the testatrix named above
this lSti1 day ~
1984.
. gff
Notary Pu IC
"SHERRY l MANSEll, Notary Public
Lemoyne, Cumberl,:nd Co., Pa.
My Commission ;".xpires April 13, 1987
COMMONWEALTH OF PENNSYLVANIA
)
( 8S.:
)
COUNTY OF CUMBERLAND
WE, LOU ANN GRISSINGER and LYNN KINDER, 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 the testatrix sign and execute the instrument as her last will;
that she signed it willingly and that she executed it as her free and
voluntary act for the purposes therein expressed; that each of us in
the hearing and sight of the testatrix signed the will as witnesses;
and that to the best of our knowledge, the testatrix was at that time
18 or more years of age, of sound mind, and under no constraint or
undue i nf 1 uence.
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Sworn or affirmed to and
acknowledged before me this
! 5 !;jl day 0 f f1'f.....bA_l!_h , 1 9 8 4 .
.J.~.~ l,. ~1VJ,J~
Notary Pu lic
SHERRY L. MANSELL, Notary Public
'.emO\lne, Curr~)er!cnd ('c., Fa.
.My (~mmissiQI1 tl<.pires April 13, 1981
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CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: LD R Ej Tf) J-I. G>e/J55
Date of Death: ~ /;:L. 7 /0 I
Will No.: :l.oO/-OOiPt:.7 Admin No.: C;ZJ-O/-O~~7
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) o~e Orp~' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on ~.:EL:/ / :
/ '
Name
Address
UJ/I//It/YJ e, (;,e/J.5S 177) Sg/f7 ~~, C~ /J1:t}
.J ., /' c:2/ 2;2,
CLIt/RE G. JhrF/J1AN /~g AI" /.5H7 S/ {!,/}/J'J,p M/:~/70//
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~/ G- L T /$5' }(ENIf/GZ> LA-NG ETT67<5" /l4 /73/7
mlc///7e:-L 0* ZE/G- , 9/~ /f/Gk6~ ,e~9~~ ~/t. /7//3
fiD/9-//1 cr; ZC/&L..67< 9h6/J .8/J.5L. /JV& L OyA/C 4:1
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Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:~/()/
(
.:J)/flN6 Ad. ZE/aL.c7?
Name
~Ot./ A1/JItJ/2'C;C ST
.sr~LrCJ~ p/J J7//d'-c2707/
Address
(7/7) tj..3~--~(Pt/
Telephone"'
Capacity: 'l;g.Personal Representative
o Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ZEIGLER DIANE M
604 MONROE ST.
STEELTON, PA 17113
-------- fold
ESTATE INFORMATION: SSN: 177-16-1594
FILE NUMBER: 2101-0667
DECEDENT NAME: GRASS LORETTA H
DATE OF PAYMENT: 03/01/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/27/2001
NO. CD 000905
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,681.00
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TOTAL AMOUNT PAID:
$3,681.00
REMARKS: DIANE M ZEIGLER
CHECK#0347034618
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
REt1500EXIS-OOI,
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Rem H,
DATE OF DEATH (MM- -YEAR) DATE OF BIRTH (MM-DD-YEAR)
otpj.:n /~oo / 05/';V //902/
(IF APPLlCABL ) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
/I/'t4
[j..11. Original Return
o 4. Limited Estate
06. Decedent Died Testate (Altecil C<lIJ~ oj Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death atter 12-12-82)
o 7. Decedent Maintained a living Tr\Jst {Altach copy 01 Trust)
o 10. Spousal Poverty Credit (date o/death between 12-31-91 and 1_1_95)
OFFICIAL USE ONLY
G
/!.a - :2~ - 2..-
FILE NUMBER-- -~------
2...l-..Q.L QOu,.kl
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
/17- J"
/59 L/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13.82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
~ 0 t-f /V1 () tV I< CJI:= .sr
SrGELTON/ P/I /7//3
1. Real Estate (Schedule A) (1) 93. IJOO
2. Stocks and Bonds (Schedule B) (2) ,i//A
3. Closely Held Corporation, Partnership or Sole.Proprietorsh'lp 13) AJ/~
4. Mortgages & Notes Receivable (Schedule D} (41 f:7~
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
Z (Schedule E) /II' jI;
0 6. Jointly Owned Property (Schedule F) (6)
!;;: o Separate Billing Requested
..J (7) ~/,L}
::l 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
I- (Schedule G or L)
a::
<C B. Total Gross Assets (total Lines 1-7)
() 9. Funeral Expenses & Administrative Costs (Schedule H) (9) // . .,)t'?~
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10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I} (10) /7. II .2
/
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Govemmental8equestsfSec 9113 Trusts for which an election to tax has not been
made (ScheduleJ)
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
x.O_ (151
,,,,/S-
x.k_ (16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
(111
(12)
(13)
(14)
(19)
.... ~. ~ .>
OFFIC IC~SE ONLY
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Decedent's Complete Address:
STREET ADDRESS
,
07;
ZIP /7CJ / /
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
InteresUPenally if applicable
D. Interest
E. Penalty
~
1/J
(1)
3
Total Credits ( A + 8 + C )
(2)
AI~
.
4.
TotallnteresUPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter Ihe difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 10 request a refund
(3)
(4)
(5)
(SA)
Alp
..vjq
,
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is Ihe TAX DUE.
AIM
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
II_~" - -'111 "'Iil!llllr'- n Jill III ,-- 1 lI'II;III!_l]jllllT~_
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;..... ................... ... ........ ............ ..... 0 ~
b. retain the right to designate who shall use the property transferred or its income; 0 /XI
c. retain a reversionary interest; or........ ................... .................. ......... .................. ................ . 0 ~
d. receive the promise for life of either payments, benefits or care? .... .. 0 IX!
2. If death occurred alfer December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............... ... ............ ...................... 0 [}g
3. Did decedent own an uin trust foru or payable upon death bank account or security at his or her death? ..... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .............. .. ............... 0 e&.-
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~LJry. I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaralion of preparer other Ihan the personal represenlativeis based on all information of which preparerhas any know!edge.
OF PERSON RESP
r
DATE
ADDRESS
ftJ/)1.f ON oe
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
/i /'7//
DATE
ADDRESS
-.- ~! :i1_....HIIIIIIIIIUIILll 1.._ rn !..Jlllm~n UlllllUli.m1l1UIiI~
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 or for the use of the surviving spouse is 3%
[72 PS 99116 (a) (1.1) (i)]
For dates of death on or alfer 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. 99116 (a) (1.1) (ii)).
The statute does not exempt 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 for the use of a natural parent, an adoptive parent,
or a stepparenl of the child is 0% [72 P.S. 99116(a)(I.2)].
The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noled in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use at the decedent's Siblings is 12% [72 P.S. 99116(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.
REV-1502EX + (1-97)
.
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
02-00/- CJo6~ 7
All real property owned solety or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1
ESTATE OF
.LO/<E7T/)
II. GIGA.:5S
DESCRIPTION
SJAlGU::- F/1;n~L Y ~mF
23R leI< - e/Jf'c COLJ
?t.a.?tZH/JSL?):- /9.5c' - IVCW
{AlO jJl2C:/I/Oc;lS owNeR)
VALUE AT DATE
OF DEATH
9 ~ cnro
~J3 IJ, O{hd-
CAI?1P HI LL/
:sr.
PA /7//3
L Of
Alo. .5'0
TOTAL (Also enleron line 1, Recapitulation) $ f,9, 000
(If more space is needed, insert additional sheets of the same size)
REV.1SOB EX + (1-9"7)
'*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
H. GRASS
FilE NUMBER
~"O/- "tj(;,t,7
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LIP? ETTA
Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinUy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
~.
.3.
1.
,s.
VALUE AT DATE
OF DEATH
DESCRIPTION
)lLLF//?..5T LJAA./J.(
Cl4ct:?/</A/C; /lac: T # (503 R3-SS9j-51
..DArE "F'J)EATH(~7;'/) /3/J,L./fNCL?
.;If
776
~ W/lYP~/N r 8/f/l/k
SriV/Jr/G'.s Arz.e.T #/O;;(OO;;....3(,/S-
.J)HrE OF .D~T/I (~~/) gl1L..I9AJCG'
:s 5'0
.:J)/RE.{!...r Z)e-pos / r /</9/L..,(?tJ/t{J 'RET/,f?Ej)Je:7Vr
?E/V,:S/OA./ --ro ~LLr://2S/ L3/J/V1(
_ J"" L'I
- AUGa ~r-
7~R
790
1;.
?ROl'cRTY /"/7)( 7?E/3/JTE
P /C tJ~ e-e.D.s rtf! () /JJ /)UC T/ oN
Z/CGL~I€.. /Jue.7/0/1/ ~J
-tJ/AJ/A/:J ~':?/?1 5&T ~ /J1 /~c/..Q /
~ez)/e-oO/l1 Se: r / /.3e.l) ) I
7(E rtt/V..l)S ON -::TIVSt.OZ/7/I-Ce- ?..e/W?la/?7 :
V~S ~/FE'
_ P ..eU..D JtE /V"// At:.
0/0
.;2<,/l?
S'tJCJ
/SCJ
7.
/lJ/5cE~~AI/IGt)a..7' PtK'50/C.J.o9L. ?.ROf'l!f7<ry"
...sb F.4
C!. <'.::; n:L/lJ e- .;:y-CU/G L./C Y
CL..fi~N/I.ee-
- L IAlE A./S .
.:5/)}/Jc..t.,. /J{:pDANces
Sew//J'y /J1/ge#IAI~
$m/JLL FU.ieP/ T~,(?e
TOOLS
,-.- 1.3~.PRoorn ....:5'Cr-
fi!-~ 65
- /)1/sc. /-!OU5t:7/-10?.D J/~5
/00
,yO
-SD
'l-s-
026
10
~S-
~o
"/5"
/S
02~
TOTAL (Also enteron lineS, Recapitulation) $ i 0 7 ~
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
,LO,eETrA
fJ. G~/J5S
FILE NUMBER
0( 00/ - ao C>t:. 7
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: ~ ...3/ /7~
1. /J1'1~~> /III /J AI 67<. FU/lI e-,Ie. /1 L- h0/nE. ANc
- ;V /foFL::5>/.:JNA L $EJeI/ /e€ s
- eASk'ekt/-4ULT .E/ t.3S-
- C! /lU/f'e- .5E721/ /12. E3 ,,2 .;J b
- I3C;9 u-r /CJA/I,/ ~t:J
- ee/U/,F/e..LJ ..01::71 r# (!~ T/F/(!fi rES ~o
dZ. 7?estLIf?12 eC-T/a/V e.19 rh'C>~/ = t? FAne TL:-~ 7~O
- Ope/l/ t9 ~/J II e-
~ .;TP#,V C;e-J:Jrt: - :p()S~ rulf/E;?!/9-L ,L~.-(/c}fFO,IJ ~SO
B. ADMINISTRATIVE COSTS: De /55LL s - PL~ve:~s . /97
1. Personal Representative's Commissions ~OOO
.f)/ANt=- ,
Name of Personal Representative(s) /71, ZE/r:y/..t!EK'
Social Security Number(s)/EIN Number of Personal Representative(s) ,q,t, -3~ -.;?-S-~qo
Street Address (PDq MoNRoe 5/
City SrE&:L-rOA/ State -.a Zip /7//3
Year(s) Commission Paid: ,.;) c>O I
2. Attorney Fees #/4
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) N"M
Claimant
Street Address
City Stale __ Zip
Relationship of Claimant to Decedent
4. Probate Fees /~S-
5. Accountant's Fees tJ ;/1
6. Tax Return Preparer's Fees /00
7. ??JSTAGG .:s-r/7/J'lt>,5 ,;(S-
(T/lI/IVK tocu /1)t1r&3j
B/~i- fS )
TOTAL (Also enter on line 9, Recapitulation) $ /~J'41';<'
(If more space IS needed, Insert additional sheets of the same size)
REV_1S12EX+{1_97JW
' ",
A'~' -
":if ,C
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
PIJG~ 1.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
/'" ;0 Ll <5' FILE NUMBER /
o f' n ..J d< 001 - tJ t) ~ u 7
ESTATE OF
L.O/(E-rTA H.
Include unreirnbursed medical expenses.
ITEM
NUMBER
1.
~.
3.
1.
$,
(,.
7.
~.
'I,
la,
II.
DESCRIPTION
REI;n&.t~.5EmEI1IT TV "R/9k'RO/9.J)
R E:'T /;f' E /l7 E A.J T
(-{it /..'1, P/Jl/ /J?e:7IIT - .lJ//CC.7:!.T d)t::..-vOS.l7"E..J)
I'111GtlST "" h' -r,>
MIse. t3ANj( aJl/9RCES (EST/JTC /Jee;:)
(J/JSTL-€ tJ Le/9Aj
(. S#/l/17IJOO (!/}-;2j?Gr~
fJA I!IEUf(O /J ssoe. L rz;
e. ~~y'~5 :Z-.Ncd~t::.-.o "-1'1-0/ " 6/.;10/" /
()V/:;7e~-Z> a,/ /J?eo /(h4/€c 6R or;, f;;r< J
Z~/EGL&:7C. /Jpe n"..u L?<:, .
? IC!../-(- uJO Fe g-
b-/ E.5 r .:5/-10 I? E /J 1LI/3 t.I ~/l NeE
P,4i/?/c>T AlElU5:
_ /lD - .:5/1Ll:.- o/' /?~sON/lL f/?oit:.7!-/Y
_ fll) - E.5Tl9rF Alol'leE'
-
MeR LE ZERI3 c.; 'P/lIA/ T/AfG
(P/I/#/ Ph/Nr <tJar::>/DC' t-U//f/LJoa/S ~~
;:j)",,;e !il e I N D ta2 .8loGl< 1311 Sc /J1 t 71/T U/ /Ui. ~)
CLoS/qG t!t)5T5 ON S~Le- o,c
?teofFRry - $E:-e:,f../136LJ MNb 7h:JIV5FE'/l5
SE:iTL1/YJE/Jr e./-ff)~Gt:~ (JIV
.:5,q.LE OF ?/?e>pL?R:l
seetL"e~-'D LAAJ..D '. '/l/llsFCJPS
d..O()/ 5C./fOOL T/lX
A/l//VE 'i? Am,5e-V/ /fix e.c;LLeerz:;~
SEE P/1
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
>tI
7~i'.
71't)
/ ,;z.:<
5,;?
lft)
(PO
3LjJ/.
s-/
1,/0
t,()tJ
..$ 093
9, ,.~o
/;:220
s.~ /'/lGOe,,{
-
REV-1512 EX > (1-97) ~
~
'~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
PAGE ~
ESTATE OF
L()~ETTA J-I.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
CI2,4 Ss-
FILE NUMBER
0( t:JO/-ooh~ 7
Include unreimbursed medical expenses.
ITEM
NUMBER
J Dl .
DESCRIPTION
U r /.L I ry Pfi ymJ6 iI/ /..5
(t./A2/01 -h> /1!?/.3/j€Jl)
VeR I zoA/
- U GI
PPL
'jtJ/fi-1<' !V/)S TrZ)/Sj>OSf!)L
FAWe (w,PrreeJ. .
/3cJleo OF e./f~ /-ldL (SeWeR.)
AMOUNT
.$
I/O
3 LJ6-
/ (,7
3S-
""s-
ilo
TOTAL (Also enter on line 10, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$ ~ z r "Ii(
. REV~15" EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
t-~ JU~7TA
fl. G,e,;:;sS
FILE NUMBER
0:200/- CJ06 ~ 7
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. CLAIRE. G J-/oFFA1fVV
/R f' /II, IS~)I -.:5'L'
e/9/7)~ .1-// t:.L) PA /70//
,
d. MICHAeL W. ZE/GLe..-R.
9/;1. HIGH sr..
--:BR.J;:55~ R jD/I /7//3
.-
3. /JDI7/J1 J: .zeIGL-cR.
1bSl1 i30sLB!-. /fl/E
.t.Emoy NF/ PI'} / 7t?~!3
If. M/}'IO(L.IIVG Z, CZA3J:JFr
~~~ c;~~/l/f:qD Y I #1.1f
,
RELATIONSHIP TO DECEDENT
Do Not ListTrustee(s)
AMOUNT OR SHARE
OF ESTATE
.5 /5 rc.-R
.." --
..::7/006
G;:Z/I,NZ)SON
5;000
G Rrl/ll.D:soN
.s; 000
tJM/Il MU:Jh Tet<..
S; 000
s: hI/I-LI~/l7, 0. CR/1SS so,v 50% 1FrE1<.
.511/f-7 J)1G-GC"7e~ ~e; .1)/5r,a/~ar/o;v
~~KR-I OGe; /JJZJ dJ/0l;;l7
t, 1-.z>/.4ive- J'L1. ZE/G-~ .zJAUG#-rLk?- SlJ1~~Ff~
. b!S <{.elf!. oN f?f>t::{).;5'''''- / 711 :3 -ZY/:;" /' / QtL rON
ENTER DOLLAih~Mii'FOR ~STRIBUTIONS 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
AI/A
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
11I/11
1.
TOTAL OF PART II _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
/IJ /A
(If more space is needed, insert additional sheets of the same size)
\ /6-02~~"'~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DIANE M ZEIGLER
604 MONROE ST
STEEl TON
'02
APj~ 19
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-15-2002
GRASS
06-27-2001
21 01-0667
CUMBERLAND
101
:15
'*
REY-1S41 EX iFP (Ol-Oll
LORETTA
H
PA IlU~
Gum:.
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=is'4'-Eif-AFP-coi-::ozY-NoTIcE--oF-iNHERiTANci-YAx-APPRAisEiiE"NT-.--ALLOWANCi-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GRASS LORETTA H FILE NO. 21 01-0667 ACN 101 DATE 04-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
98,000.00
.00
.00
.00
4,076.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage liabilities/liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
11,502.00
17.112.00
Ul)
(12)
(3)
(4)
NOTE:. To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
102.076.00
28.614.00
73.462.00
.00
73.462.00
NOTE: If an assessment was issued previously. lines 14, lS and/or 16. 17, 18 and 19 will
re~lect figures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of line 14 at Spousal rate
16. Allount of line 14 taxable at lineal/Class A rate
17. Allount of line 14 at Sibling rate
18. Allount of line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
US) .00 X 00 = .00
(6) 68.462.00 X 045 = 3.081.00
(7) 5.000.00 X 12 = 600.00
(8) .00 X 15 = .00
(9)= 3.681.00
TAX CREDITS:
.n. \+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-01-2002 CDOO0905 .00 3.681.00
TOTAL TAX CREDIT 3.681.00
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 "CREDIT" (CR). YOU ItAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
CUmberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/07/2003
ZEIGLER DIANE M
604 MONROE ST.
STEELTON, PA 17113
RE: Estate of GRASS LORETTA H
File Number: 2001-00667
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 6/27/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:
} File
Counsel
Judge
STATUS REPORT UNDER RULE 6.12
cv
0(\
Name of Decedent: ~Ol'? Err/)
Date of Death: ~/d 7/0 I
Will No.: c::( tJ CJ I - 60 (;p t6 7
II, Gtf:..4.ss
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration ofthe above-captioned estate:
1. State whether administration of the estate is complete:
Yes~ No 0
2. lfthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes'i. No 0
b. The separate OJhans' Court No. (if any) for the personal representative's
account is: ;J ~
c. Did the personal~resentative state an account informally to the parties
in interest? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date:-Ei~/03 ~~'>JZ .~~
( S~~re U () - -
I
D/ItNE In ~ ZE/GLI:::~
Name
0\
t;:?
N
0:
0\
.- (~:~1
!.. ~ 1;,0(:.
i,,'.'] ::!C !)
-, .0
"""..1 ":i!:~
':J p ,- E
(1) \1) :::.
0: G 0
(PoL/- rnt>!JROE Sf
Address -5 rL:;~fOI'()/ ,0/1 /7//..3
(7/7) r;39-~hR/
Telephone No.
Capacity: f)(Personal Representative
o Counsel for personal representative