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Home My WebLink About01-0668 PETITION FOB PRORATE and GRANT OF LETTERS ~ '771i5of)1 Estate of ~/##lc1" k.<i;,,~A'.L.~ No. .:21-0' ~U also known as To: Register of Wills for the Deceased. County of ~ II /J1&~ UlA/b in the Social Security No. 171"- .//l- tJ1' d'fi" Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executr llC. in the last will of the above decedent, dated ::;'1(. I Y ;Z If and codicil(s) dated #,//9 named , 19~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (I p /11 J6E/?..J...,.q i\j D County, Pennsylvania, with h i~ last famil~ or principal residence at 3// 41 fA/NA bRUlE- ~AlI)tA f/t- /7().i{5- ('/.~~~r P.t/l/A/S.BcF,fJ TUlPJ (list street, number and muncipality) Decendent, then 7.Jf years of age, died J t...I I ~ 7 , ~ ~tJ I , at l,";J I' N E /V tJ.i.A l?~/{/J: EAJt:)i.-A .. P/I- /7t?.:<S Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered f9J ;:>robate; was not the victim of a killing and was never adjudicated incompetent: . '. AI/rl' 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 Penns'y'lv~nia situated as follows: IV f) IV t:. ~-; t10 Cl $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters i ~s t""me,t f&lr'/ I (testamentary; administration c.I.a.; administration d.b.n.c.t.a.) theron. ~ '" or ~~ .J.~J~ 2.~ .~ ~ / t7 i:q~ -00 !::"O cd .;:: ...3/1 AI ~.A/ ..',;:.A- IJ/? I V t: *~ E/IIcM- (It'l 110':<\S ;;0 e;; .: OIl i:ii OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ S8 COUNTY OF cmm~ 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 administer the estate according to law. ~d< e ~/ /" tfT s.worn to or af n.r m ed. and subscribed { before me this 16th day of ~ .J~10 ~2001 <.nil.""! C, J:. ~ I '. . ~.B . Register .. / ~ 6 J~ J .J tn OQ' ;::s t:l - l::: ~ ~ No. 21-01-668 Estate of EMMET LEE PAUv1 , Deceased DECREE OF PROBATE AND GRANT OF LETTERS 2001 AND NOW JULY 16, 19C_, 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 July 24 , 1986 described therein be admitted to probate and filed of record as the last will of EMMET LEE PAUv1 TESTAMENTARY BEVERLY J. NUTTER and Letters are hereby granted to '-m,,~ C.;;t..;.... Do,.fA ~~-t, l _ Register of 'ills ~ FEES Probate, Letters, Etc. ......... $ 25.00 Short Certificates{ ).......... $ 6.00 Renunciation ................ $ x-pages $ 12.00 JCP S.UU TOTAL _ $4 8.00 Filed ....... ...:;rw,X .+9/.2.QQ1-.... . .. . . . . . AITORNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE H 1 U5.80':; RE\' 9/H6 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original 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. ~. D~ ~~~~--~ Local Registrar I' Fee for t;his certificate, $2.00 p 7431478 JUI 0 S 2001 II. ~ CO....ONWEALTH OF PENNSVLVANIA . OEPARTMENT OF HEALTH' VITAL RECOROS CERTIFICATE OF DEATH 74 v... COUNTY 01 llERW -,- - I Dowo . ! Qjft 01 IMml .-.~- IIIn'..uaE tCIY- _.. '-00uIwt'/I Lo 4v.U...le, l' ...-0 -"...--...--. S1InfU_ IICUIIITV -.. --: 20 -0988 2001 4IN- "~""0IfW'" CumbeA..lan.d 3/13/27 - c. l'Uln4boA.o ~O _0 ::"'0 311 N. cno.la OA.Lve ... cno.la. 'Pa 17025 Anen_tFft. _ UIII Unk 311 N. cno.la OA..,cno.la,'Pa _DECEDEHT EVER" IDUCRDI u.a.~~ .....1lI ...0 'Penn4!J,..lvanLa _awua._ --- C On:::;;,"T"CUII ,-sa .....__. ca4t. '--1PClUiIE" " ,,---- , BeveA..l~ 'PLke 'Penn4boA.o llIlI - ..... . ......., . ,'N!J ~-==-=.. -".,.,---- ,.. ~_(T~ BeveA..l Nu.t.t.eA. - WE1MlOOI~ _0 ~1iI ___0 _0_1Ir..:r' o 51 cno.la. OA. cno.la 'Pa DoIn_ Dor. _ -----'" ---- I'tlONClUNCEDDEAD_Dor._ 7/7/01 CAIE_DlO IolEIlICAL .....a ...0 ---"... --- ........-- "._1: ::::-':'::::=~""""'-__"_Da__"'_"~___""""""'__.__ I=- l--- I -.. -...---....-... ..................._......._L h.J,L _lOlDII...A~II"CE 01'1: .........,..- .-........- ---- ---......, --- ........_1.AaT _All IUYOITf ~ _lOlDIIASAOONSEClUlENCE 01'1: -lOlDII AS AOONSEClUlENCE 01'1: QNdMl__ r..0I~ _HllW~~ - ourotTI_ PNCllllO 01_ _OIDERH ..... 0 ...1$ .....0 ...0 - - - g o - ........ --..... - -~....- - '-.-.,,_PNYSICloUI~~_..____.._____231 ~.._.....,--..---..._II---- .................................................... _N#O~PIIYSClAN"'-____~IO_..~ ~.._.....,--..-_....._-.-.....-_....-..---_......................... -.oICALCY.~"~ 011.......... .-r '-..an....u IIA",-'-l. III.,............................,....... piece,...... to... .....ell.. --_.......... .......... .............. ............................................ ................... :na. a ~~%~ hl/~,/v'1 )f. LAST WILL AND TESTAMENT OF EMMET LEE PALiVI I, EMMET LEE PALiVI, a legal resident of Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATIONS AND DEFINITIONS A. I am divorced. I have one daughter, LOIS JANE JACOBS Except as otherwise provided in this my LAST WILL AND TESTAMENT, I have intentionally omitted to provide herein for my daughter, LOIS JANE JACOBS, and for any other relatives or for any other person, whether claiming to be an heir of mine or not. B. The following definitions obtain in any use of the terms in this Will: 1. "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to, and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance with the rule of per stirpes distribution and not in accordance with the rule of per capita distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2. "Survive me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me. 3. As used, in this Will, the words "Executor," "he," "him," "his," and the like shall be taken as generic and applicable to a natural person of either sex or a corporate person of other legal entity. Page 1 of 4 Pages c. I have served in the Armed Forces of the United States. Therefore, I direct my Executor to consult the legal assistance office at the nearest military installation to ascertain if there are any benefits to which my dependents are entitled by virtue of my military affiliation at the time of my death. Regardless of my military status at the time of my death, I direct my Executor to consult with the nearest Veterans Administration and Social Security Administration office to ascertain if there are any benefits to which my dependents may be entitled. I I PAYMENT OF DEBTS AND TAXES I direct my Executor to pay the following as soon after my death as may be practicable: 1. All of my just debts and the expenses of my last illness, funeral and of the administration of my estate; but my Executor need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any benefic- iary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. I I I RESIDUARY ESTATE A. I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest. Page 2 of 4 Pages B. I give my Residuary Estate to BEVERLY J. NUTTER of Enola, Pennsylvania, if she survives me. C. if BEVERLY J. NUTTER should fail to survive me, I give my Residuary Estate to my Brother, WILLIAM PADM or if he fails to survive me, to his descendants. IV APPOINTMENT AND POWERS OF EXECUTOR I nominate and appoint BEVERLY J. NUTTER, as Executor of this my LAST WILL AND TESTAMENT. If BEVERLY J. NUTTER is unable or unwilling to serve in this capacity, I appoint WILLIAM PADM of Enola, Pennsylvania to serve instead. I request that my executor be permitted to serve without bond or surety thereon. I authorize my Executor to do any and all things which in his opinion are necessary to complete the administration and settlement of my estate, including full right, power and authority, without the order of any court and upon such terms and under such conditions as my Executor shall deem best for the proper settlement of my estate; to bargain, sell at public or private sale, convey, transfer, deed, mortgage, lease, exchange, pledge, manage and deal with any and all property belonging to my estate; to compromise, settle, adjust, release and discharge any and all obligations or claims in favor of or against my estate; and to borrow money for the payment of inheritance and estate taxes or for any other pur- pose. Without in any way limiting the scope of the powers enu- merated herein of my executor, I hereby specifically give to him full power to retain any and all securities or property owned by me at the time of my decease whenever, in his absolute and uncontrolled discretion, such a course shall seem to him to be best, without liability for depreciation or loss, and free from investment restrictions incident to executorship, whether imposed by common law or statute. In the execution of his duties and powers as Executor he shall have the power to comply with all legal requirements as to the execution and delivery of deeds and all other writings, documents or formalities without the order of any court; and he shall furnish a statement of receipts and dis- bursements at least annually to each person then entitled to receive income or property from my estate. Page 3 of 4 Pages this IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, day 0 f ;l ~ r} v I~; 19 8 6, set my h and and sea I tot his my i ./ WILL AND TESTAMENT consisting of four (4) typewritten pages. LAST cf:~J!Zf~ .EJ.'VJMET LE PALM Testator i-, i / ,_1 i 1;1~ .:v1 (SEAL) Signed, sealed, published and declared by the Testator, EMMET LEE PAL~, 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, have hereunto subscribed our names as witnesses. NAME ADDRESS /#(~ c.., LL.SA~. t~ ~CVlA4.du, P4 ~~~ /?J. /' / jZ~~Ou~~ ( ...., /, \J}/ . /7, ,L. , __ ." .0. </'t ,.,.-'. ' /7 L:'~-/~.- . 17 / .~~. '-'C-j'~~~ '- -L---r- j - __ Page 4 of 4 Pages Acknowledgment COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY OF CUMBERLAND ) I, EMMET LEE PALM, 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; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to PAL'VI, the Testator, this (SEAL) and acknowledged before me, by EMMET LEE /) 1 da y 0 f(}~_I:--.:/ 19 86 . -(D i/ -/ Y ./1 ~-L2;t--;UL!L--Lr/~Q ./~J;~-1 / ~ET LEE PAu~, Testator ~Y~bliC~L Affidavit ROSA A. RODRIGUEZ, NOTARY PUBLIC CARLISLE BOROUGH, CUMBERLAND COUNTY MY COMMISSION EXPIRES OCT. 23, 1989 Member. Pi"mgylvania .l\ssociatoon ot Notaries COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY OF CUMBERLAND ) We, !lJ!Jyelv~ II 7 APSeo71 and 1b-,...e-/ #-; r: (!.,he()...tha.wt , 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 Testator sign and execute the instrument as his Last Will; that EMMET LEE PALM, signed willingly and that he executed it as his free and voluntary act for the pur- poses therein expressed; that each of us in the hearing and sight of the the Testator signed the will as witnesses; 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 or~ffirmed to and subscribed to before me by JJ.lBy~~-~t5'- /~ a.Ed ~~mU4- F: ~~LfAa.A-f witnesses, this~~_day of oc.lfk.':J 1986. (SEAL) ~rJ?~ Q~~/ t!Iu.~~ ~~ESSO ~ PUBfc ~ ROSA A. RODRIGUEZ, NOTARY PUBLIC CARLInE eOROUCH, CUM8ERLI,ND COUNTY MY COhl~ISSION lXPIRES OCT. 28, 1989 ~.ll'\b.\i" hllflsylwnla Assutiltion of Notaries 21-01-668 AFFIDAVIT ATTESTING TO THE EXISTENCE OF COMMON LAW MARRIAGE We, ~~v~r'y ~ Nn~~pr and Emmet L. Palm the undersigned, do hereby affirm that we have expressly agreed to and entered into a common law marriage. ,. Pursuant to this common-law marriage, we established the relationship of husband and wife. We hold ourselves out to the community as husband and wife, and have cohabited for 8 years. We each sign this affidavit as evidence of our mutual agreement, and with the understanding that it may be used as evidence of our marriage contract. We agree to provide the Trustees of the Pennsylvania Employees Benefit Trust Fund with any additional information that may be required as proof of our marriage. ~~~ e /~, Signa re ~ sp~use ~~@~ Signature of spouse i) \ I On this /q~-L, day of 7u~~ , 1916: before me appeared w."'A.<P~ 4.71?u and ~ ~ ;1P"./Z.. , the affiants who bei duly sworn, aff~rm that the facts contained therein are true and correct and acknowledge that they executed the same for the purposes therein recited. P~>i~ ,~!Y~~I;~~~~~~:'~~-.\, p ::{~ 1 I::' .: ,_ ~'; l-.... I ... _._ '. t i., ., ,. ,,-, .:,', r,,:.,," ':'?\' 'n 19'j,J \ ' '.. ' _" -.' J",'.' ,_.~ jJ', ~.,J .. 1... L-v, ..' i~___4.______' -~---_..__._- ~-;b.~ g ~--<"~- Notary Public PEBTF - 5 4192 4.6 ~" ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~MMet 07 It) 7/;U;O/ ~ee PC%- / y\'\ Date of Death: Will No. J. 001- D b & b 8' Admin. No. c2/- () I - tJ ~ h g To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Nam~ Address BfV&~ L Y .I tv U. TT~~ 3/1 I\J ~AI /)M ~'IJE. ~ )SD tfA LU; Y I\D e: AI IJtA- ~A ( 7025 fi/l//JtA . fJl, 7 0 ;;l..s- o LO)5' 3-ANf. -JAcoBS Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date:: ()?/~3-k) ~;~ Signature Name tet/uk .r ~CL~f' I - Address 3 II 1// j!'4t7M ,LJ",et t,If. fMOUl I/, / 70,;zS" Telephone (7/1) 7 3,),- 31 Jf :2. Capacity: ~ Personal Representative _Counsel for personal representative ~ ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: C/J1/?/er Lee ;00/ /J7 Date of Death: Ju!/t 7 t:il,tJo J / / Will No. d 0 ~ I ~ 00 k, h g Admin. No. c:Jj- () j-Ob t & 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: 1. State whether administration of the estate is complete: Yes V- 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 person~ representative file a final account with the Court? Yes ~ No_____, b. The separate Orphans' Cuurt No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Da te: / tJ /17 /;;0 0 / ~~?~ I~v~(~ J ~lctitel Name (PI ase type or print) 3/1 ,I CA)tJLA- ~/tJE h;tltJ,- ~ /7tJ'J.:) Address (7/7) "73) -31 Lf-2. Te 1, No. Capacity: y' Personal Representative Counsel for personal representative ( MAH : rm f / AM 3 ) ~ --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: Emmer ~e~- 07/07 /~{J{)I h- ~P1 Name of Decedent: Will No. ~()O I~ DO bb~ Admin. No. ~ 1- () I - 0 b t cf) To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except t)I.<-'/' I AM ;?J j.jtI fof('f'JjP{.?d) Date: /0// 9/d~VI ~4Ud7 Signature I ~4~ ../ Name & (/e,r /7' _ J A/uZ'ce/" ;}f1tl [ Address 3// /JI L-fr' tJ ~4 ~/ t/ LA /!j /7.tJJ?5 Telephone (1I~ 73 ~- 3'f'Y~ Capacity: V Personal Representative _Counsel for personal representative 10. ce Inventory of the real and personal estate of Ew-.. Me t ~eQ.. <P a.l m deceased , q 17 F 0 I[ D T Ai,! ~ U S G l REG G HE:G K (tV 0 A eel C~SH ON HANG 55. C- H E-c..K IRS REFUND R E: FUN D FORD f)'\.OTO Rev "E FUND E ~ I E AUTO mo BIL E :r.N~ eo '-!J.... ~ 15 - '74} :2 { 5"1- \9- 2-. (Co 20 3 5L-f "'~e- ~Jl f? c;~ ~oo~ - 1-.;>._ ,,\.)'1~~ \~ REV-1~Dl~~ol <tQ. " ~ -\4.4 J...O COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 O"FICIAL USF ONLY I- Z W o W o W o w ,., ::t,:$cn 0"':': w"o ,,00 o"'~ ..", .. " INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~.L - O.L CQUNTYCQDE YEAR __.662 NUMBER DECEDENTS NAME (lAST, FIRST, AND MIDDLE INITIAL) t11d L SOCIAL SECURITY NUMBER )7 ;<0 - orFg . A ;..-111 DATE OF DEATH (MM.DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER ~ t/ 'I - Pi' - I' F57 DATE OF BIRTH (MM-DD.YEAR) o IJ . 00/ 03/ /3 .;1;7 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) /Y?lrZe'I" &t-er/' J [5J 1. Original Return o 4. Limited Estate 06. Decedent Died Testate (AI:tacl100pyo(Willj D g. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (data of death after 12.12-82) o 7. Decedent Maintained a Uving Trust (!\t1achCO'f1jolTrus\) D 10. Spousal Poverty Credit (date ofdealh between 12-31.91 and 1-1-95) D 3. Remainder Return {date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. To\al Number of Safe DepOSIT Boxes o 11. Election to lax under Sec. 9113(A) (Attach Sch 0) .... '" w o '" o .. '" w :l1 o o COMPLETE MAILING ADDRESS ~::I II /f/ paN M /,A/# LA /l4 fili? 7F& .t<: NAME LJ,CJ/,e';e,( /' ;r ,,!J/f f (/ f5. / /,6,;15 FIRM NAME {ll Applicable) TELEPHONE NUMBER 7/7 '1.3';(-3'1-"1-~ 1. Real Estate (Schedule A) 2. Slacks and Bonds (Schedule B) (1) c (2) c (3) c (4) (5) ..,. ? ..3,;2/?, "75 . (6) ~ - (7) ..../ (8) (9) S. ':'-93,oCJ (10) Jf (>( " /,.:}.S/ (11) OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or So\e~Propr\e\orship z o ~ ..J ::l l- e:: <( o w 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate BiUing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) .... ?/ 2,;?~,'7'S- 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) ,.,~::? b o-? .5/ ,,. ,~ ? ;7;2.. 7'- cJ 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 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) (12) (13) (14) ,;((. '7;? ~O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' ::l D. ::!! o (.) ~ · :? (, 'T;2. ~() 15. Amount of Line 14 taxable at the spousal lax rate, or transfers under Sec. 9116 (a)(1.2) ,.0_ (15) v_ 16. Amount of Line 14 taxable at lineal rate '.0_ (16) 17. Amount of Line 14 taxable al sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) c> -- 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ~'JS /1/ L/YtJL4 /J?? ( r/&" CI1Y -f/Yt' .L/9 I STATE /:4 I ZIP / 7 0 .;z:5 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) u Total Credits ( A + 8 + C ) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Tatai interesUPenatty ( D + 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 ro 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. (SA) 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) <' Make Check Payable to: REGISTER OF WILLS, AGENT M'll!" ~- -".-_1 .,III! 1 J 11.11 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"'N THE APPROPRIATE BLOCKS .....0 o ........0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; ............. ....................... b. retain the right to designate who shall use the property transferred or its income; .... c. retain a reversionary interest; or........... ........................... d. receive the promise for life of either payments, benefits or care? ......... ........... ....... . ....... ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....... ................................. ...... ............. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefiCiary designation? ...................... ............................. .......................... ................. Yes o ...........0 ...0 .......0 .......Jl No EE [ZJ r;;<J ~ ['a ['2J ClI Under penalties of perjury, I declare that 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 Declaration of preparer other than the personal representative is based on arf information of which preparer has any knowledge ADORES ,3/ II .A/ ~tJ "'# /J ;.( ( 1//3 SiGNATURE OF PREPARER OTHER THAN REPRESENTATIVE fJ,4- C,A/iJtA /7.-:1 ,25 DATE ADDRESS _1'>liiilllJJ!!Rlij__lmltlillllil'lll ILIII 11I':t. _]~I ~_. . JI'IlIliIIllL., IW !iIIllIUI;..j.L.II~ 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 P.S. ~9116 (a) (1.1) (i)]. For dates of death an or after January 1, 1995, the tax rate imposed on the net vaiue of transfers to or far the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt 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 stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed an 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% [72 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. R"';M",",""'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~OO/-CJO~(,? FILE NUMBER ESTATE OF E ~. lYJ fr' ("'. A. e. €. f~; J-n '! 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. J.. ; I 'f. b. (. . DESCRIPTION 19'(7 FOf\r' I'/'/.{",i '-./.-~ fZ'2GoCtl-fCi':/rJG /fecI CIlSIf 0"'; Hf/-NI) 5,S. ('1"<2"(.": /i'\S {<,~~lINO VALUE AT DATE OF DEATH ,..s' ,-:l /.5, 00 7"11, 2..[ 5"1. CO 1'7,00 "J l~, < 2-0 /"" rr ~J::r{)N6 (<,Rr=-urJP JY7 DT b f\ Co '7 t:').,j ,-:J; -' ( F (. . '(.; f\ L.:' (::f',IE fjJ<> C c ,~O~C)CI .j ACt 1()';'c:.j)lI_E TOTAL (Also enter on line 5, Recapitulation) $ b.1 c2 ~ , 1( S (If more space is needed, insert additional sheets of the same size) REV-1511'EX+ (12-99) ,_ .9i..,.I\t ~..~. ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 0200/- OO,,(,g FilE NUMBER ESTATE OF E mmef .Le e. f'a / /YI ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: a ~~1f>1/ n(}/(/ , S~t<il/{ce IJ J-j-65.00 1. F()NEM \... l-.,UNcH EoN (.,0.00 POST Ftc;, r-. , -::t, 00 B ADMINISTRATIVE COSTS: I. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Stree1. Address City State _ Zip Relationship of Claimant to Decedent 4- 8'. D 0 4. Probate fees Sf.fo R't" c.f_i~:t it=' g>.Ov 5. Accoun1ant's Fees Co1> I~.s 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ /:5' 9' 3. 0 D Debts 01 decedent must be reported on Schedule I. (\1 mOTe space is needed, insert addit'lonal sheets of the same size) REV.fSI2EX.(1-9lj *, r ',., '. ~~ - ...-'C .... SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS P~/IVI 0160 1- DOC,6l? FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF r-rVlI'h d 1-- Include unreimbursed medical expenses. ITEM NUMBER FOAtJ IYlOTD,\; DESCRIPTION CREDIT COf(PDf(ffTION AMOUNT 1 " 00, 3,51 ""1 TOTAL (Also enleron line 10, Recapitulalion) $;) D (, "3,51 (If more spacE: is needed, insert additional sheets of tile same: size) ~ THE ATTACHED FORMS ARE A COMPLETED RECORD FOR THE ESTATE OF: NAME OF DECEASED: Emmet Lee Palm DATE OF DEATH: July 7,2001 WILL NO. ~oo/ - {)O 66 g ADMIN NO. 02/- tJ / - () {, (, &' ADMINISTRATION OF ESTATE HAS BEEN COMPLETED BY: Sign~~ A~ (9. /& Z7;;, / /~~: ;r /d oc) / Beverly J. Nutter, ExecutrixfCommon Law Spouse (Legal forms attached verifying Legal Spouse in the state ofPA) 311 N Enola Drive Enola, PAl 7025 (717) 732-3942 Tel No. - ' AFFIDAVIT ATTESTING TO THE EX:ST~;CE OF COMMON LAW MARRIAGE We, ~-~-P'7 3 Nn.tpr and E..et L.. Palr: the undersigned, do hereby affire that we have expressly ag=eed to and entered into a common law marriage. . Pursuant to this common:law marriage, we established ~he relationship of husband and wife. We hold ourselves out have cohabited for to the community as husband and ~i:e. 8 a:::: years. We each sign this affidavit as evidence of our ~utual ag=ee=e~t. and with the understanding that it may be used as evidence == ~~ marriage contract. We agree to provide the Trustees of ~e Pennsylvania Employees Benefit Trust Fund with any additiona: information that may be required as proof of ou= ~ar=iage. '4LU' C /~ Sign~~e ~ spouse C~ c;< ~ signature of spouse . A On this /'1.t~ day of 7(-(I"-<<-"....!~- 19~"::; before me appeared W "-LV~-L. /:t.-:/ /"_~ _ and ~..-.xr ~ .-L -.: /_ , the affiants who bei duly sworn, affirm that the f~cts- contained therein are true and correct and aCknowledge that ~~ey executed the same for the purposes therein recited. -" ,//.+ . . /-- '-{raA.."'rc...-L-lAL...-' W Notary PUblic 0.-!'.......~--<""- \ UOrAAW,5FAl. I ftlt&4A\..tllClatO H'larfl'u~~ : 1'I~l5bot' Pau,I.'" Co~ ' L~to~~!~~Z3 ~~_i 4.6 -n'T"r , .,- '"""." , ,-.-' .Ae4 .(i.d.'1k~~. . )1".;t~4." : .' ...." . . .' II .,~, t:cAc'rA/ ,.. "I H-:: ~..<.~o.L<'1U<<<.. . ,&,. lj~.,.t.U'- ~~.~L. 'j-' ~,.....,~.>---.. .., T ~".' 'ill ::;' . of ~ j1"';& \ Ii> ti :SO::.L >::r:(.,.,~h_:r ;:;: ~<~.ML ,cc.~'N-I$"~ Y'7-':re.E ?': ~ ,.., ;f:.rX:',:,1.;;1.- SEC;;1tJ'!':,' ;r .;& SP'X:sE f F ?:'='~, Ai F 'F : !) A V ~ T It BEV€c-:1y_J Sut>:'2r ,; being sclem.l}' s'JJK1rn~ hel.':@,~DY ~?r-~ ~r: ::, n' :'...~~i 1. rntending to b@ legally bound, I nsv<>, ent8I'e'J ;;. C,<,;lj,'_i".L;-r: :.a';l:~~:",?,':r'f1!: wit.h rll',Ill<1t, L, Palm (. Da.'Ile' . J ,l o,n 1:i?C81'l'::tF.r 1 ;$~ {date.' 2. ?ursuant 1:0 this COtI'lOIl law lllIUTi~. we l:'.ave elirtaj:';'~shoo t::e. J"to~il:tl""""""::- of lIluIl:mld lUl4 wife. 3. E.J1;~t L.. ?alli {~'e mlloo1 llJld ! prefWutly hold ourselvcs <'''J.t to tbe ".......,llity as l1usband and wife llIkI have done so for p ye:us. 4. In support of. this Affidavit, I hereby agree to furni$l:i to the Board of 'l'rI.lstees of too Pimn$yl\l111lUt PUblic Firplo~ Health anci Welfare Fund sUch further ~tlt.tiOll as it ITaY require. .., to and. subrierfbed be1'~ ..... / V ".# lIB wuS , ' /'"""., dI.y of x,:fn~>",,,'~;i{c(:',1.../ '( 19 L),..!. to .~ _~"::'l.t1.,J""r:.... .k ffOtary PubUc' ,- ~;~.~?;i~.< .:r.3.,(- t'1 / b-Ql-Y-V- Y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recoraed..()rnce omATE Register Wills ESTATE OF DATE OF DEATH FILE NUMBER .01 DI C -7 All :j):t)UNTY ACN BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 BEVERLY J NUTTER 311 N ENOLA DR ENOLA 12-03-2001 PALM 07-07-2001 21 01-0668 CUMBERLAND 101 '* REV-1547 EX AFP 112-001 EMMET L Allount Relli Hed PA 1702&:~b~.;I~lld C;~Op~ 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=is47"-ix-"FP--n"2-:00Y-NOYici-OF-iNHiifiTAifCi-YAX-XppRAIsiiiE"N:r-.--"iioWANci-oR'----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PALM EMMET L FILE NO. 21 01-0668 ACN 101 DATE 12-03-2001 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. AlIOunt of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due 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 DepositslHisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernllBntal Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax NOTE: U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 6,328.95 .00 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this fOrR with your tax paYllent. 6,328.95 3.656 51 2,672.40 .00 2,672.40 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (9) UO) 1.593.00 2,063.51 (1) (2) (3) (4) (19)= TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE ~ -"-"'ATTllN OF ADDITIONAL INTEREST. (Schedule J) 2,672.40 X .00 X .00 X .00 X ( 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.)