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Home My WebLink About01-0687 Register of Wills of CUMBERLAND County, Pennsylvania PETITION FOR GRANT OF LETTERS - (1log '1 Estate of ROWENA E. CRAIN also known as No. 21- 01 , Deceased Social Security No. 165 -10 - 9285 DONALD E. SHUPP Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 03/06/1984 and codicil(s) dated None EXECUTOR, RICHARD H. CRAIN, DIED 03/27/1999. named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: NONE D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his/her last family or principal residence at 1000 W. SOUTH STREET, BOROUGH OF CARLISLE (list street, number, and municipality) Decedent, then ~years of age, died 07/05/2001 at TODD MEMORIAL HOME, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania $ 110,000.00 $ $ $ NONE situated as follows: NOT APPLICABLE Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a riate form to the undersi ned: Si nature T rinted name and residence DONALD E. SHUPP 603 SANDBANK ROAD, MT. HOLLY SPRINGS, PA 17065 -J4D -i lP Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND 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 representative(s) of the Decedent. Petitionens) will well and truly administer the est9a~cOrding to iaw. Sworn to or affirmed and subscribed --i ~ ~~ T~ DONALD E. SHUPP before me this ~ day of No. 21-01 Estate of ROWENA E. CRAIN Deceased Social Security No: 165 -10 - 9285 Date of Death: 07 /05/2001 1[--10 AND NOW, , ~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to DONALD E. SHUPP in the above estate and that the instrument(s) dated 03/06/1984 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. Letters. . . . . . . $ 1135 (/\ .,00 , C')l~ lc. . v FEES Short Certificate(s). $ Renunciation. $ Attorney: ROGER M. MORGENTHAL, ESQUIRE Affidavits ( $ 1.0. No: 17143 FISHMAN & MORGENTHAL SUITE 3 95 ALEXANDER SPRING ROAD CARLISLE, PA 17013 Extra Pages ( ) . $ \.5. Of) Address: Codicil. . $ JCP Fee. $ ~oo Telephone: 717/249-6333 Inventory. $ Other . . $ TOTAL. . . . . . . .. $ ~4Ll.DD Prepared by the Pennsylvania Bar Associ~ I",UUV' ",... " , lUll form software only CPSystems, Inc. Form RW-1 (1991) 1 f\~ Q"'\ Dl='V ('lIQr:. This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with Local Registrar. 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. me as No. li- ~.~~~~ Local Registrar Fee for this certificate, $2.00 p 7577915 J.l1L Ill: 9 2001 Date Hl05.143 AllY. 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH \lNT :~ J ~ CumbeJtland Ie. CaJtLi.-6le. SWE 'II.E _lEA .EHT INK NAME 01' DECEDENT If.... 1.liaclIe. LillI I. Rowena E. CJta.tn OR%lYH~~.ltb.r') 4. UNDER' YEAR ...-.. Days UNDER' Olti HounI lol_ l ~,o DECEDENT'S USUAL OCCUPRIOH (~~a:=.::~~ . n.. -6eam-6tJte-6-6 11b. GaJtme.nt Co. DECEDENT'S LIMING ADORESS /Sk_ C~. SIaM. 1''1> Cedel DECEDENT'S 1000 We.6t South St. ~i~~~NCE (See tnS1ruCllOnS II. CaJtl-<'.6le., PA 17013 onOlNr_' 'RHEA'S NAME (I"nI. MiolJe. LMII II. HaJtJt M. Shu SJt . -<ll;lMAHrS NAME cr_Prirol -. Ronald Tate IolETtIOO OF llISPOSITlOH O 1IurIII1XI c._ 0 R_lIom $1...0 DonotiDft 0Uw (Speclvl . 21.. SlG 171. Sial. _. 17b. Coun Did ~n1 .... in . CumbelliaYld _Ship? 17"u ::"1li.in,,"==':=0I CaJr.l.<..6le LlOTHER'S N~LlE \1'... d~ 1.1-.. ~nomelb h ,to M-tlaJtea uJte .:stum aug 'NF~lum~~~t~tl~'teI, PA 17013 I.IldIIlAl STATUS. 1.1_ N_Manied. ~. Oiwonled (Sc>eclyl ,.. w.<.dowed 17..0 VeI.~""_1n SURVIVING SPOUse (W ...... goIoemaclln ""'""' cily_. PlACE 01' llIS1'OS1T1ON. N..... 01 Cametlry. Crlm.lOry Of 00'* PIK. 2,~t. Holly SpJt.tng.6 Cern. PA 17065 01 PART ft: OIlIer I;gnitICI/lIlXlOldlIiGN conttilKblg 10 _II>. bul IlIlll8dingirl""~_gNeniftPMT I. C kl-;-~t""~r ,,) J~~^ -1--;... YI f,,~;,.. I: WERE AUlOPSY 'INOlNGS AlAlt.ABLE PRIOA 10 COMPlETION OF CAUSE OF DEJint, DUE 10 100 AS A CONSEOUENCE Of): DUE 10 100 AS A CONSEOUENCE OF): MANNER Of DEATH DATE OF INJURY (t.\on1Il. Day. "'ar, TIME OF INJURY INJURY R WORK? DESCRIBE HOW INJURY OCCURRED. Hal"''' J2I o o HomiCide 0 Plnding ,n".'igallon 0 CouIcl_ be d...nnined 0 _ D NoD -- "MEDICAL EXAIoIINERlCORONER On the baaJa 0' ...mtn.Uon .ndJOf' InvesUg.ation, In my opinion, de.th oc:c::ur,.a at the lime. date. and pllce, and due 10 the cau..(4' and manner 1.1.lted.................................................................................................. 31a. REGISTRAR'S SIGNATURE AND N \\. ~~~~~- 70(.$- _0 NoD Suicide 210. 2.... zt. cvrr_1l1C/l<<:l< onoy """I "CEIlTIFYING I'tIYSICIAN (Ph_ ...."- cause d de.... .....", ."""'''' C>l>vaocolR "".Il""""""'''' OSaln """ comPOled nom 231 T...-.to'ntyltnowledge, ..thoccu"ed duelO"" cau..(I).ndm.one, ".I'.ted. ........................................ "P~NG AND CEIO'11'YINCl PHYSICIAN (Phys;ctM I>oIh ;><anounc:or>g 0......"., certo'yong 10 CMI.. of """~\ To lhe bnl o. my Ilnowtedgft. d..t" OCcurred allha lime" d.le. ...et ",.ce. and du. 101M cauMia) and m.nn.,.. .'ilted.. LAST WILL AND TESTAMENT OF ROWENA E. CRAIN I, ROWENA E. CRAIN, of the Borough of Mount Holly Springs, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form following: 1. I hereby expressly revoke all wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. 3. Should my husband, Richard H. Crain, survive me for a period of thirty days following my death, I devise and bequeath the remainder of my estate to Richard H. Crain. 4. Should my husband, Richard H. Crain, predecea,se me or die on or before the thirtieth day following my dea,th, I devise and bequeath the remainder of my estate to the brothers and sisters of myself and my sa,id husband, who are then living, in equal shares. 5. I nominate and appoint my husband, Richard H. Crain, as Executor of this my Last Will and Testament; and as substitute Executors I nominate and appoint in order of preference, first, my brother, Donald E. Shupp; and second, my sister-in..-,law, l1ary Fry. 6. I direct that my personal representative shall not be required to file bond or security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this b ~ day of March, 1984. WITNESS: --R ou..I~ ~. e~ (SEAL) Rowena E. Crain ~\~~ fA ~ /Ib? ~ - 1 - COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, Rowena E. Crain, Testatrix, 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 and t~cknowledged before me, by Rowena E. Crain, Testatrix, this ~~ day of March, 1984. It (JU..I~ l,. ~~ Testatrix c:a ~~u.- '-T. ~.~) JP~,::C~J [!., t=:~f~T7)L=ft~ :' :,=>'~~.:\'~~.,~~[ T~<:JDL,~C (''urf.lDedand County C;.:Jl';::~?~ PA My Commission Expires January 27, 1981 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, Tom H. Bietsch and Roger ]1. Morgenthal, 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 savl Testatrix, Rowena E. Crain, sign and execute the instrument as her Last \~ill; that she signed will- ingly and that she executed it as her free and voluntary act for the purposes therein expresoed; 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 influence. Sworn or affirmed to and subscribed to before me by Tom H. Bietsch and Roger M. Morgenthal, witnesses, this b~ day of March, 1984. ~l~~ witness :Jas~ )It1 ~ CJ~-\:;-r: ~~ JA M~""''!:7 E U!"n '"" ,.. ...'l..,;., . . nr.:RTZLER. NOTARY PDEUC CuruberAa...'1d Coumy C9J!5s).'~, PA My COmmission Expires Jmmary 27, 1987 - 2 - E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ROWENA E. CRAIN Date of Death: JULY 5.2001 Estate No.: 21-01-0687 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on JULY 20. 2001 Name Address DONALD E. SHUPP 603 SANDBANK RD.. Mr. HOLLY SPRINGS. PA 17065 MARY FRY 196 E. YELLOW BREECHES RD.. CARLISLE. PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE Date: Seotember 14. 2001 rJ/Yl1/UtI'-)AvJ-- Signature J ' FISHMAN & MORGENTHAL Name Roqer M. Morqenthal . Esquire. #17143 Address 95 Alexander Sorinq Road. Suite 3 Carlisle. PA 17013 Telephone (717) 249-6333 Capacity: _ Personal Representative ...x.. Counsel for Personal Representative 'v/6-ca-~S-- d7 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-05-2001 CRAIN 07-05-2001 21 01-0687 CUMBERLAND 101 ROGER M MORGENTHAL ESQ FISHMAN & MORGENTHAL 95 ALEXANDER SPRG Rn CARLISLE PA 17013 *' REY-1547 EX AFP (12-00> ROWENA E Allount Rellitted ) CHANGED ll) (2) (3) (4) (5) (6) (7) .00 562.98 .00 .00 121,311.47 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-v:i54-j-i)f-AFP-(i"2:iiiff-NOTici--oF-i-NHiififANCE-~"-AirjrpPRAisiMENT~--Ai.i-oWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CRAIN ROWENA E FILE NO. 21 01-0687 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. 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 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 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: NOTE: 18,316.55 156.210.15 lll) ll2) ll3) ll4) (9) llO) .00 X 00 = .00 X 045= .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 121,874.45 174.!i26 70 52,652.25- .00 52,652.25- ll9)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AHOUNT 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 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.) 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 ZEIGLER & ZIMMERMAN 355 NORTH 21ST STREET SUITE 201 CAMP HILL, PA 17011-3707 ------.- fold ESTATE INFORMATION: SSN: 195-32-4432 FILE NUMBER: 21 - 2000- 0687 DECEDENT NAME: BUCK CHARLES F JR DATE OF PAYMENT: 08/30/2001 POSTMARK DATE: 08/29/2001 COUNTY: CUMBERLAND DATE OF DEATH: 07/24/2000 NO. CD 000217 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,053.12 I I I I I I I I TOTAL AMOUNT PAID: $2,053.12 REMARKS: MELLON BANK NA C/O ZEIGLER & ZIMMERMAN CHECK# 2439167247 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ..... 0/1~ ill STATUS REPORT UNDER RULE 6.12 Name of Decedent: ROWENA E. CRAIN Date of Death: JULY 5.2001 No. 21-01-0687 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: xx Yes _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 (Estate insolvent due to DPW Medicaid Claim) b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? xx Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Date: 6/17/03 Signature ::;lLW1:J ; 11,;1;;} HarriSburQiPA 17112-6015 City, State, Ip (717~ 671-8754 Telep one Number Capacity: _ Personal Representative ..lL Counsel for Personal Representative l t: It'r! 8 L Nnr [0. -- Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/10/2003 SHUPP DONALD E 603 SANDBANK ROAD MT HOLLY SPRINGS, PA 17065 RE: Estate of CRAIN ROWENA E File Number: 2001-00687 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: 7/05/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: j File Counsel Judge \~~ I REV-1500 EX + (6-00) OFFICIAL USE ONLY d COMMONWEALTH OF PENNSYLVANIA REV-1500 )(P 1Lf-5- DEPARTMENT OF REVENUE - DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 00687 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER CRAIN , ROWENA E. 165-10-9285 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 07/05/01 11/29/1915 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 8 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required ~ateof death after 12-12-82) PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copyofWill) (Attach acoPyofTrust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credlt (date of death between D 11. Election to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch 0) :tIl1$Smlo~i\lU$jllgP!ilMi'i4I'1tgP;A44bl)jjRgSP9twil~&eq~f'Qg@\W1Mi!ifQRMAtloN$1iQj,jijpijeQIi'le.ciili:ll9i NAME COMPLETE MAILING ADDRESS COR- ROGER M. MORGENTHAL, ESQUIRE 95 ALEXANDER SPRING ROAD, RE- FIRM NAME (If Applicable) SUITE 3 SPON DENT FISHMAN & J'lDRGENTHAL CARLISLE, PA 17013 TELEPHONE NUMBER 717-249-6333 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) 562.98 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 121. 311.47 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) None 8. Total Gross Assets (total Lines 1-7) (8) 121. 874.45 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 18,316.55 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 156,210.15 11. Total Deductions (total Lines 9 & 10) (11) 174,526.70 12. Net Value of Estate (Line 8 minus Line 11) (12) (52,652.25) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value SUbJect to Tax (Line 12 minus Line 13) (14) (52,652.25) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 (15) TAX 16. Amount of Line 14 taxable at lineal rate 0.00 X .0 ~ (16) 0.00 - COMPU- 17. Amount OT L.ine 14 taxableat$iblingrate 0.00 X .12 (17) 0.00 TATION 18. Amount 01 Line 14 taxable at collateral rate 0.00 '.15 (18) 0.00 19. Tax Due (19) 0.00 20. 0 !cHj;;ckHeijeIFYQl)ARelle&ul!.$'tiIiGAf\!;R)NPOFANl:M;j:iMYMeffltl c . ,;. BE SURE TO ANSWER ALL. QUESTIONS ON PAGE 2.AND RECHECK MATH<<. . o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco lP - Forms SoHware Only PA REV-1500 EX (6-00) D d C Page 2 ece ent s omDlete A ress: STREET ADDRESS SARAH A. TODD MEMORIAL HOME 1000 WEST SOUI'H STREET CITY I STATE I ZIP CARLISLE PA 17013 dd Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit S, Prior Payments C. Discount (1) 0.00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 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 perjUlY, 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 information of which arer has an knowled e. SIG T RE OF PE 0 SP I E F R FILING RETURN DATE eg 01 N REPRESENTATIVE DATE ADD SS 95 ALEXANDER SPRING ROAD, SUITE 3, CARLISLE, PA 17013 on on use spouse [72 P.S. S 9116(a)(1.1)(i)]. For dates of death on or aftltr January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 19116 (a) (1.1)(i;)]. The statute dn",,,, nnt ,,"'leAmnt 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 isO%{72 P.S.i9116(aX1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%. except as noted in 72.P.S. ii 9116(1.2) [72 P.S.1i 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. 89116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blOOd oradoption. o PA15002 NTF 29756 Copyright 2000 GreatlandlNelco LP - Forms Software Only Estate of: ROWENA E. CRAIN 21-2001-00687 The following person(s) are signing the return as representative(s) of the estate: OONALD E. SHUPP 603 SANDBANK ROAD MI'. HOLLY SPRINGS, PA 17065 ,- LAST WILL AND TESTAMENT OF ROWENA E. CRAIN I, ROWENA E. CRAIN, of the Borough of Mount Holly springs, cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form following: 1. I hereby expressly revoke all Wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. 3. Should my husband, Richard H. Crain, survive me for a period of thirty days following my death, I devise and bequeath the remainder of my estate to Richard H. Crain. 4. Should my husband, Richard H. Crain, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the remainder of my estate to the brothers and sisters of myself and my said husband, who are then living, in equal shares. 5. I nominate and appoint my husband, Richard H. Crain, as Executor of this my Last Will and Testament; and as substitute Executors I nominate and appoint in order of preference, first, my brother, Donald E. Shupp; and second, my sister-in-law, l1ary Fry. 6. I direct that my personal representative shall not be required to file bond or security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal b~ day of March, 1984. this WITNESS: _11 C/1,.V~ ~. e~ (SEAL) Rowena E. Cra~n ~1J~ fA~ /i1~ - 1 - COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, Rowena E. Crain, Testatrix, 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 and ,~cknowledged before me, by Rowena E. Crain, Testatrix, this b ~ day of March, 1984. f1~~[,. e,~ TestatrJ.x CJ ~~u.- (. J--..\ qL) J/::::"""l:' r'::~-'~:~'-"~.~' " '."":LU~ cll;.,j'.;!....::.j (.'~1~'l\~Y (:;_I:'~',. r-;\ My Commission Expir.... JanUill"Y 27,1987 COMl10NWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, Tom H. Bietsch and Roger l1. Morgenthal, 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 Testatrix, Rowena E. Crain, sign and execute the instrument as her Last will; that she signed will- ingly 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 influence. Sworn or affirmed to and subscribed to before me.FY Tom H. Bietsch and Roger M. Morgenthal, witnesses, this I" ~ day of March, 1984. ~ IJ.~ Witness ;Jas~ J1A ~ C;;\k.\CA~ ( +-4~ JA~"""Y.<' 1"7 ,r-~T ..... .~< -. 1.:;, ,~._-:.~:, ?L!'2'1. !'J':'T'/'.F'JY r:.rctfc <':CJ~!b;1~T~j COUP'.y c"~r-l". PA My Commission ExpireJ Jon,my 27, 1~87 - 2 - REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROWENA E. CRAIN SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2001-00687 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 UNITED STATES SAVINGS BOND, SERIES E, #Q6149593440E, $25.00 DENOMINATION, ISSUED 5/77, 107.80 2 UNITED STATES SAVINGS BOND, SERIES E, #Q6089583780E, $25.00 DENOMINATION, ISSUED 5/76, 111.60 3 UNITED STATES SAVINGS BOND, SERIES E, #L1081690484E, $50.00 DENOMINATION, ISSUED 9/74, 226.38 4 UNITED STATES SAVINGS BOND, SERIES EE, #L2737790EE, $50.00 DENOMINATION, ISSUED 5/80, 117.20 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 562.98 7 CPA31 NTF 10905 Copyright Forms Software Only, '997 Nelco, Inc. REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROWENA E. CRAIN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-00687 Include proceeds of litigation & date proceeds were received by the estate. All orop.lolntlv-owned with rlcht of survlvorshlD must be disclosed on $ch. F. VALUE AT DATE OF DEATH ITEM NO. DESCRIPTION 1 CREDIT BALANCE ON ACCOUNT AT UNITED CHURCH OF CHRIST HOMES, SARAH A. 'IDDD MEMORIAL HOME, ACCT# 100634 3,413.62 2 CHECKING ACCOUNT #50-8057-4102, PNC BANK, Mr. HOLLY SPRINGS, PA 27,865.09 3 DECEDENT'S UNDISTRIBUI'ED SHARE IN THE ESTATE OF HER LATE HUSBAND, RICHARD H. CRAIN, FROM ESTATE ACCOUNT IN M&T BANK, CARLISLE, PA 90,032.76 TOTAL (Also enter on line 5, Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 121,311.47 7 CPA81 NTF 10908 COPYright Forms Software Only, 1997 Nelco, Inc. Checking Account Statement p~c; Bank o PNCBAN< Primary account numher: 50-8057.4102 Page 1 of 1 For the period 06/27/2001 to 07/26/2001 Number of enclosures: 0 ROWENA E CRAIN 603 SANDBANK RD MOUNT HOLLY SPRINGS PA 17065-1138 11" For 24.hour customer service or current rates: Call1-8B8-PNC-BA~JK ~ Writli! to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 C Visit us at www.pncbank.com ~ I TOO terminal: 1-800-531-1648 FOI he~'1 ino; llll1'3ired (hen~~ onh- YOIl l';lrlWd YOllr OWIl 11101WY and YUII try I" keq> lip 1111 llw I;lh"sl lil1(11H"j,1! 11("\\':-. So why do you net'd a financial iuh'isor? Fill'<llldallll<ll kel." han' lW('OIlH' inn ('dihh" Illlllplt.X ,lIld ynllr ill\'CSllllt'lIt dlOict's are endless. P~C Brokerage Corp hlYestment (:oll."llhanls can help YOIl ill m;-lIl\' 'C,,"S. They !lan' Ihe ,il'lJ(' ;111cl eXIll'rlisc In itWesligate and 111llkrst;\tlIl foctay's changing tlll;-lIu-ia) lllarkPlplac('. .\11 fll\"(>Sllllt'1I1 C :Oll~lI)l;.llll C-III help yon 1I('\"(')op all illn>sImenl strategy tailol c.d 10 IHN>t YOIIl" fillandal IH't'ds. C0I11;ICI a P:'\iC nrokcragT Corp 11J\'t'stlll{'lJI C:olIslIlLnll In sel np a free 110 obligalion conslllt,ltjoll. p~C nl"Uker~lge IlI\"(>SlllWtH CUlIsllhallls CllIlH' r(';1I Iwd 1111 llUgl1 ollr I :lISl01l1t-'1 Sl'rrict' Ct'nter at 1-8UH-ifi2-filll, its ,,-d)-sile at ",,\'w.pnd}rf)kl'Tugl..l~OIll Ill" ;-my P:\,(: Ihllk III ;lll('11 nnkt.'. Checking Account Summary Account flllmher: 50-8057-4102 AccOIltlt link~. rlllllllwr: 0165109285 Rowena E Crain Bahlllce Summary .(hl Ending balance :2i,NII;J.()9 Please see the Activity DEltail section for additional information. Beginning b;'llance ~t..~ll.~)O~1 Dp.pO<;it<; anrJ other .1dui\ion<; 1120_0H Ch!?,-~ S ;Jnd other deduction<; Average monthly b<llancf.! 27,li."I.OQ Charg@s and fees .no Activity Detail DepDsits and Other AdditiDns DCltl1' 1)7 IU ,D.,mount D!?srription ~r.;!o.()tJ llil'Ccl DI'POSl1 - ~{)(" .....1 f~."i TIl';"lll\" .~rU IIi., lO~r.!'~~).\ There was 1 Deposit or Other Addition totaling $920.00. Daily Balance Detail Oat>> orl':.!7 Balance 2Il,~H;~I.O~l D.1I" 07 1):\ B;ll'ln<:c~ 27,.~I"_~)Oll Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 08/15/2001 Ron Tate 307 Fairview St Carlisle, PA 17013 Due Date: 08/28/2001 Re: Rowena E Crain Account Nr: 100634 Date Payments -------------------------------------------------------------------------------- Balance Description Charges Days Quant Rate -------------------------------------------------------------------------------- BALANCE FORWARD 07/04/01 Personal Laundry Se 07/04/01 Medical Supplies 07/31/01 Room & Board - Semi 07/31/01 Room & Board - Semi 15.00 9.05 158.00 158.00 828.33 15.00 9.05 -4,898.00 632.00 1. 00 1. 00 31 4 "" L<JJJ i:J;z /It-0n..iI..U/LLWC( CVilcL uv.-e, - ~~. u LPJ &vtcJJ )l1/L {YI (il C}>z/J{~ J!i Lu~~ (/) Y:f Vi'-6 ('n.. ", Yu'cr -PluUJI J2i.1. L\..~ NOTE: Please remit by August 28, 2001, the Last amount printed on the statement. Please include Account Nr. from statement on MEMO LINE of your check. Any payments received after 07/31/2001 are not reflected on statement; please deduct any additional payments you may have made and remit the balance remaining. Thank You. 828.33 843.33 852.38 -4,045.62 -3,413.62 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROWENA E. CRAIN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-00687 Debts of decedent must be reDorted on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 GIBSON-HOLLINGER FUNERAL HOME, INC., MI'. HOLLY SPRINGS, PA, FUNERAL SERVICES 5,579.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) OONALD E. SHUPP Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 603 SANDBANK ROAD City MT. HOLLY SPRINGS State 6,095.00 PA Zip 17065 Year(s) Commission Paid: 2001 2. Attorney Fees Name: FISHMAN & MORGENTHAL 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 6,095.00 0.00 4. Pro bate Fees 0.00 5. Accou ntant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 REGISTER OF WILL, PROBATE COSTS AND SHORT CERTIFICATES 249.00 8 CUMBERLAND LAW JOURNAL, ADVERTISING LETTERS, 75.00 9 THE SENTINEL, ADVERTISING LETTERS, 87.35 10 REGISTER OF WILLS, FILING ThlHERITANCE TAX RETURN, 15.00 11 M&T BANK, CHECKS FOR ESTATE ACCOUNT, 21.20 12 EXECUTOR, RESERVE FOR MISCELLANEOUS CLOSING EXPENSES, 100.00 TOTAL (Also enter on line 9, ReC8oitulation) $ (If more space is needed, insert additional sheets of the same size) 18,316.55 7 CPA11 NTF 10911 COPYright Forms Software Only, 1997 Nelco, Inc. REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROWENA E. CRAIN Include unreimbursed medical expenses, ITEM NO. DESCRIPTION SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-00687 AMOUNT 1 THREE SPRINGS FAMILY PRACTICE, MEDICAL BILL, 120.15 2 PENNSYLVANIA DEPAR1MENT OF PUBLIC WELFARE, BUREAU OF FINANCIAL OPERATIONS, ESTATE RECOVERY PROGRAM, RESTITUTION FOR MEDICAL ASSISTANCE RECEIVED BY DECEDENT, 156,090.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 156,210.15 Copyright Forms Software Only, 1997 Nelco, Inc. *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105.8486 July 31, 2001 FISHMAN & MORGENTHAL ROGER M MORGENTHAL ESQUIRE SUITE 3 95 ALEXANDER SPRING ROAD CARLISLE PA 17013 Re: ROWENA CRAIN CIS #: 940134849 Co/Rec: 21/0075168 Date of Rirth: 11/29/1915 SSN: 165-10-9285 Dear Attorney Morgenthal: Please be advised that the Department of Public Welfare maintains a claim in the amount of $156.090.00 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely S6.022.64, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $150.067.36, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. Xf the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, )XQ.(~L.~ Margaret L. Sohn Claims Investigation Agent 717-772-6609 717-705-8150 FAX Enclosure 'fS>\ Q'2- ~ REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES ROWENA E. CRAIN No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 DONALD E. SHUPP 603 SANDBANK ROAD Mr. HOLLY SPRINGS. PA 17065 2 MARY FRY 196 E. YELLCl'N BREECHES ROAD CARLISLE. PA 17013 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) BROTHER SISTER-IN-LAW 21-2001-00687 AMOUNT OR SHARE OF ESTATE 0.00 0.00 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX [S NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 Copyright Forms Software Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size)