HomeMy WebLinkAbout01-0696
PETITION FOR PROBATE and GRANT OF LETTERS
. S f\.( rr t..f..
Estate of I r i s J EM.l!R- ~
r~ known as .,.
Tri s IT~;"" "', 6rf'"
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 168-24-2950 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(t), who is/Ale 18 years of ag~ or older an the execut 0 r
in the last will of the above decedent, dated March 1
and codicil(s) dated
No.
To:
21-01-696
~
named
1979
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
'~~
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 5322 Coblestone Dri ve, LG~ e.f' AHt'tA.. ~ ~
Mechanicsburgr PA
(list street, number and muncipaIity)
De-,~.endent,J:he.n 71 years of age, died June 2
~ Holy Spirit Hospital, Camp Hill, PA
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 for probate; was not the victim of a killing and was never adjudicated
incompetent: Iris J. ~~i th marri pd T.ymrln H. Orr MrI rch 25, 1 9AB.
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:
2001
$ 30,000
$
$
$
WHEREFORE, petitioner~ respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamenta ry
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
theron.
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Thomas W. Scbtt
1701 Sunrise Drive
Dauphin, PA 17018
, ~W.~
OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF CUMBERLAND J
The petitioner(s) above-na.'!led 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 an~IY admin~st~r the e ate according to law.
Sworn to or affirmed and subscribed. J~GD en
before me this 16th day of ~.
JULY xj-2..Q.Ql a.
lio:
~
~
No 21-01-696
.
Estate of
IRIS J SMITH aka IRIS JEAN ORR
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JULY 26 ?OO 1 , 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 MARCH 1 1979
described therein be admitted to probate and filed of record as the last will of
IRIS J SMITH AKA IRIS JWN ORR
TESTAMENTARY
and Letters
are hereby granted to
THOMAS W Sr.OTT
'7~1ya~~p"J~ ~'7'
. . ster of WIlli
FEES
Probate, Letters, Etc. ......... $ 60. 00
Short Certificates( ).......... $ 21. 00
Rx-pag,es. $ 6.00
enunCIation ................
JCP $ 5 . 00
TOTAL _ $ 92.00
Filed ... .J:lJ:t. y.. .1. Q J . 2!>.Q 1 . . . . . . . . . . . . . . . .
Thomas W. Scott, ID #15681
K. . ArrORNEY (Sup. Ct. LD. No.)
l111an & Gepnart
218 Pine Street, PO Box 886
Ha,rrisburg.-1D&!SS 17108
(717)232-1851
PHONE
'-
21-01-696
REGISTER OF WILLS OF Cu.J}1 a~LrrN[) COUNTY
OATH OF SUBSCRIBING WITNESS
tlMrvt A5 VV. S co T T kN D :J1YN f:- E .' .s co T T
-codicil
(each) a subscribing witness to the @presented herewith, (~being duly qualified according to
law, depose(s) and say(s) that we W 2:RE present and saw
iRis S.0M,TI.j- NIKjlt- L/~_t~..r~ eRR-
the testat 1<. i '{.. ,sign the same and that V\I E signed as a witness at the
request of testat~ in hER.. presence and (in the preseaee of eadl othCl) (in tll8 pre~pnr.p of the
.other SQ9serieilig .. itaess( es)).
~w. M-
sworn.to O';jffirmed and SUbS~ed before
me this ~~ 18 - day of
~ ~
crr~ . Jg~ .
Register
~; MI"r'l"AD .... c;';r'=--'-'~~~
mil, niAL ../>.
.. MM~ ~LETTA l~H~~f7~' ~.,.~:
j U1I ;..Ha=.rrisburg. Dau. P,"I! V(,hJd; f
~issi~n &pjres Oct. 4,'~jJ;
~'~~'~~~"~::""''''~d<i!''~..l~;....~.J
p,,- .
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REGISTER OF WILLS OF COUNT
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified acco mg to law, depose(s) and say(s) that
familiar with the sig ure of
codicil
testat_ of (one of the subscribing will presented herewith and
codicil
that eHeves the signature on the will is in the handwriting of
day of
19_
(Name)
to the best of
Sworn to or affirmed a
me this
(Address)
Register
(Name)
(Address)
05.805 REV 9/86 h
'.'1is is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed wit me as
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.
No.
~/7(~
Local Re::::-r--
Fee for this certificate, $2.00
p
7429473
JUN 0 3 M
Date
21-01-696
'.. 2J87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAMlE OF DECEDENT If "st. McldIe.lM'
Iris Jean
,.
Orr
SEfemale
J.
llIRTHPI.ACE lCoIy and PUCE OF DERH fC/>edo 0flI\I1lNI- _lIlIItudoOnO on_ ....
3laho 01 FCteqI CounloYl HOSPITAl.; OTHE'"
West Fairview lnpaI...c ~ l!~ 0 D04 0 ::::e 0
SWE fIlE NlJMMII
SOCIAL SECURITY NLfM8ER
Mil: (t_lI<tItldaYI
..168
-24
2950
DAlE OF DERH IMcnlIl. o.~ '_1
4.~~ 2, :{bClI
71
UNDER 1 YlAIt
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_COUNTY OF DERH
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DECEDENT'S I.II!!m. OCCUMION
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ITY NAMf (1111C11~. 91...... _""",,*,
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ICENSE NUMSER
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INPOAMAHT"loWlJNGAOOflUS~. 0IyIT0wn..... Zip Code,
1701 Sunrise Dr. Dauphin, Pa. 17018
Pl.Aa OF OISPOSfT1OH. ~a1c.m.t.y. C'MIlIlOIy LOCA1'IOH.~. ....Z1lICocIe
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lICENSE NUM8ER DArE SIGHED
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DUE (OR AS A CONSE~NCE OF):
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IS AN AU10PSV WERE AUTOPSY FlNOfNGS MANNER OF DEATH
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OF DEATH? Halural ~
Acctdenl 0 Pe-.g ........igariOn 0
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DATE OF INoJUAY
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TlIolE OF IHJUAY
INJURY iii WORK? DESCRI8E HOW lHJURY OCCURRED.
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C&lTlFYlHG PHYSICIAN (Pll~c"""v<"9cauoe d de..,,_ a_ "".."'.anhaspr~ de.." ana COfllIlIeIfI(l ttem 231
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PlACE OF INJURY. AI home. tann. 511.... taclcNy. office
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IIEDlCAL EXAMINER/CORONER
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21-01-696
i~ ,...~If Mrtilrt"t '/. .~. .
~" ~~_ i1!lt.Jllu:,!4.:
OF
IRIS J. SMITH
I, IRIS J. SMITH, of the Commonwealth of Pennsylvania,
being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament,
hereby revoking and making void any and all will or wills by
me at any time heretofore made.
As to such estate as I possess at the time of my decease,
I dispose of in manner as follows:
1. My Executor shall pay from the residue of my estate
all my debts, funeral expenses, administration expenses, and
all estate, inheritance, succession, and transfer taxes
imposed by the United States or any state, territory, or
possession which shall become payable by reason of my death.
It shall not be necessary to file any claims therefor, nor
to have them allowed by any court; provided that no proceeds
from a qualified employee benefit or retirement plan which
may become part of my estate shall be used to pay debts,
claims, taxes or administration expenses.
2. I give, devise and bequeath all of the rest,
residue and remainder of my estate, real, personal and
mixed, of whatsoever kind and nature, and wheresoever situate
at the time of my decease, in equal shares, unto my children,
JANE E. SCOTT, JEAN E. TALLEY, DEAN H. SMITH, and RHONDA L.
LANG.
3. If and in the event any of my children predecease
me, and are not living sixty (60) days after the date of my
'-
LAST WILL AND TESTAMENT
OF
IRIS J. SMITH
decease, then and in such event, I direct my Executor to
distribute the share of said deceased beneficiary to his or
her issue, per stirpes; in default of such issue then to my
other then-living children or their issue, per stirpes.
4. I hereby nominate, constitute and appoint THOMAS W.
SCOTT, Executor of this my Last Will and Testament, to serve
without bond or security, and I hereby authorize, empower
and direct him to sell and convey, by good and sufficient
deed, in fee simple estate, any and all of my real estate,
at public or private sale, for such price or prices, upon
such terms and conditions, as in his judgment is best for my
estate, and to that end to sign, seal, execute, acknowledge
and deliver all deeds or other instruments necessary therefor,
as effectively as I could do if I were personally present.
If and in the event that THOMAS W. SCOTT, does not
survive me, and is not living sixty (60) days after the date
of my decease, or does not complete his duties as Executor,
then and in such event, I hereby nominate, constitute and
appoint JANE E. SCOTT, Executrix of this my Last Will and
Testament, to serve without bond or security, and I hereby
authorize, empower and direct her, as Executrix, to sell and
convey, by good and sufficient deed, in fee simple estate,
any and all of my real estate, at public or private sale,
for such price or prices, upon such terms and conditions, as
-2-
LAST WILL AND TESTAMENT
OF
IRIS J. SMITH
in her judgment is best for my estate, and to that end to
sign, seal, execute, acknowledge and deliver all deeds or
other instruments necessary therefor, as effectively as I
could do if I were personally present.
IN WITNESS WHEREOF, I, IRIS J. SMITH, the Testatrix,
have to this my Last Will and Testament, typewritten on
three (3) consecutively numbered pages, set my hand and seal
this IS!, day of ~ , 1979.
'\
(S EAL)
u
t~fo~
Signed, sealed, published and declared by the above named
IRIS J. SMITH, as and for her Last Will and Testament, in
the presence of us, who have hereunto subscribed our names
at h request as witnesses hereto, in the presence of the
sa estatri and of each other.
residing at~~ ~lll~ Q.
residing at yZ~~ ~/O'/ i1uyuL.,-.J~
-3-
1::
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Jean Iris Smith; NKA Jean Iris Orr
Date of Death: June 2,2001
Will No.: 2001-00696 Admin. No.:
To the Register:
I certify that Notice of Beneficial Interest required by Rule 5 .6( a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on August 16,
2001:
Name:
Address:
Rhonda L. Lang
RR 1 Box 10-B Deer Trail Circle
Liverpool, P A 17045
Dean H. Smith
904 Bonny Ln
Mechanicsburg, P A 17055
Jean E. Talley
19341 Maggies Ct.
Boonsboro, MD 21713
Jane E. Scott
1701 Sunrise Dr.
Dauphin, PA 17018
Notice has ,now been given to all persons entitled ilier::::rder Rule 5,6(a) except
Date: c2u;; It) ;;L6D) ,,~W. W
Signature
Name: Thomas W. Scott
Address: Killian & Gephart
218 Pine Street
Harrisburg, P A 17108
Telephone: (717)232-1851
Capacity: lL Personal Representative
Counsel for Personal
Representative
\. /6 -c::2.v6-~
'vBUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-15-2002
ORR
06-02-2001
21 01-0696
CUMBERLAND
101
THOMAS W SCOTT
KILLIAN & GEPHART
218 PINE ST
HBG
.02 APR 19
:15
c;:~
P 'l~l:t.tnt-Q~
*
REV-1547 EX AFP (01-02)
IRIS
J
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
39J904.00
.00
116J229.00
(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-Y=is4-j-i;fAFP--ro1-:02i--No'fici--OF-.rNHiifiTAifcE-i:Ai-jrpPRA-isiMENT~--ALi-owANcE-crR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ORR IRIS J FILE NO. 21 01-0696 ACN 101 DATE 04-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. 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/Hisc. Expenses (Schedule H)
10. Debts/Hortgage 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 Subiect to Tax
12,717.00
6J858.00
(11)
(12)
(13)
(14)
(9)
(10)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
156,134.00
19.575 00
136,558.00
.00
136,558.00
NOTE: 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~ Abb 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:
.00 X 00 = .00
136,558.00 X 045 = 6,145.00
.00 X 12 = .00
.00 X 15 = .00
(19)= 6,145.00
rAY"I:N' KC""C~r"1 {+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
08 16-2001 CDOOO172 39.47 750.00
02-28-2002 CDOO0906 .00 5,357.00
TOTAL TAX CREDIT 6,146.47
BALANCE OF TAX DUE 1.47CR
INTEREST AND PEN. .00
TOTAL DUE 1.47CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDI'r' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH 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
KILLIAN & GEPHART LLP
PO BOX 886
HARRISBURG, PA 17108-0886
-------- fold
ESTATE INFORMATION: SSN: 168-24-2950
FILE NUMBER: 21-2001- 0696
DECEDENT NAME: SMITH IRIS J
DA TE OF PAYMENT: 08/20/2001
POSTMARK DATE: 08/16/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 06/02/2001
NO. CD 000172
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $750.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: THOMAS W SCOTT
C/O KILLIAN & GEPHART LLP
CHECK#102
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
$750.00
MARY C. LEWIS
REGISTER OF WILLS
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
SCOTT THOMAS W
218 PINE STREET
PO BOX 886
HARRISBURG, PA 17108
u__uu fold
ESTATE INFORMATION: SSN: 168-24-2950
FILE NUMBER: 2101-0696
DECEDENT NAME: SMITH IRIS J
DA TE OF PAYMENT: 03/01/2002
POSTMARK DATE: 02/28/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 06/02/2001
NO. CD 000906
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,357.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: THOMAS W SCOTT
CHECK# 112
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
$5,357.00
MARY C. LEWIS
REGISTER OF WILLS
STATUS REPORT UNDER RULE 6.12
C {,I
OJ(
....
.;
Name of Decedent Iris J. Smith a/k/a Iris Jean Orr
Date of Death June 2. 2001
Will No. 2001-00696 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 of the above-captioned estate:
1.
State whether administration of the estate is complete:
Yes-X- No_.
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No~.
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? Yes --X- No_
Date:
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report.
/r:~C~
Signature
,
5/20 L 2 l.'O~
I I
N
-;q
a
2
Thomas w. Scott. Esquire
Name (Please type or print)
~iil
~,_~ '/J
N
~
::c
,'. ..6
';;': ,::;
JJ::::::
Go
Killian & Geohart
218 Pine Street
Harrisburg. P A 17101
Address
-, ...,'.......
\....i !,~"."',J
um
~n:
a:
~
p
(717) 232-1851
Tel. No.
Capacity:
---X- Personal Representative
Counsel for Personal
Representative
~
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
~
Date: 5/07/2003
SCOTT THOMAS W
218 PINE STREET, PO BOX 886
HARRISBURG, PA 17108
RE: Estate of SMITH IRIS J
File Number: 2001-00696
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: 6/02/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:
JFile
Counsel
Judge
(
REV-15oo EX + (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA REV-1500 /~ ,;; '1& c:<
DEPARTMENT OF REVENUE - -
DEPT. 280601 INHERITANCE TAX RETURN ALE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 01 0696
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Orr Iris Jean 168-24-2950
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
06/02/2001 07/17/1929 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- -
3. Remainder Return
CHECK ~' Original Return ~' Supplemental Return 8 (date of death prior to 12-13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax. Return R.equired
(date of death after 12-12.-82)
PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) tttach a copy of Trust)
BLOCKS 9. Litigation Proceeds Received 10. pousal Poverty Credit (dale of death between 0 11. Electian to tax under Sec. 9113{A)
12-31-91 and 1-1-95) (Attach Sch 0)
;tH!$~(IQNMtJi\\j~gI\!iiilA~\\~l!~_iji'eQNijj~I~j'A1!jf,jl!QtlMJ:tlPNi~l\Qg!l!fj~!tQi
NAME COMPLETE MAILING ADDRESS
COR- Thomas w. Scott 218 pine Street
RE- FIRM NAME (It Applicable) Harrisburg, PA 17108
SPON
DENT Killian & Gephart
TELEPHONE NUMBER
717-232-1851
.""'
~.l" ~ c:PFFICIA_L,!-@' ONLY
1. Real Estate (Schedule A) (1) :i CO N """":'
2. Stocks and Bonds (Schedule B) (2) Cy 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 -:'.
";1:;.,
4. Mortgages & Notes Receivable (Schedule D) (4) 0 ;.::::)
5. Cash, Bank Deposits & Miscellaneous Personal I
~
Property (Schedule E) (5) 39,904
6. Jointly Owned Property (Schedule F) --0
\..v
0 Separate Billing Requested (6) 0 b:
RECA- 0
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TlON Non-Probate Property (Schedule G or L) (7) 116,229
8. Total Gross Assets (total Lines 1 ~ 7) (8) 156,134
9. Funeral Expenses & Administrative Casts (Sct1edule H) (9) 12,717
10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 6,858
11. Total Deductions (total Lines 9 & 10) (11) 19,575
12. Net Value of Estate (Line 8 minus Line 11) (12) 136.558
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) 0
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 136,558
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of line 141axable at the spousal tax
rate, or transfers under ~c. 9' 16 (a)(' .2) 0 X.O 00 (15) 0
TAX 16. Amount of line 14 taxable at lineal rate 136,558 x.O 0.045 (16) 6,145
-
COMPU- 17. Amount of line 141axable at sibling rate 0 x.12 (17) 0
TATlON 18. Amount 01 line 14 taxable at collateral rate 0 X .15 (18) 0
19. Tax Due (19) 6,145
20. 0 !effl!d~Bl!~l!jti'Ql)*~jj,~i1l~l/M;liJll~Ni;j~~~A*Mi\ftf)1
.. .............................,'..,{).{,~."',~,$l;II'\$'T\\t.Al\t$.\.!iIlffi;i!;l\!pal)i$mlQf!lM)NJfi!;Gel\JA!itl:J'\em!~MI\1'~,{,,"""""""
o PA 15001
NTF 29755
Copyright 2000 GreatlandlNelco LP . Forms Software Only
PA REV-1500 EX (6-00)
D d . C I
Page 2
ece ent s omplete A ress:
STREET ADDRESS
5322 Coblestone Drive
Cumberland County
CITY I STATE I ZIP
Mechanicsburg PA 17055
dd
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
6,145
o
750
38
Total Credits (A + B + C)
(2)
788
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
TotallnteresVPenalty (D + E)
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
5. \1 Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3) 0
(4) 0
(5) 5,357
(5A) 0
(5B) 5,357
.................-......................
......-.........,-.....
...............,..,_.,.....
i~E~~~X~~W~~fk~~6[[6Wi~~aU~~fi6~~~~~~E;Nrii.:N;;~;;i~4R~A~~~a~~iA4~~[aEk~
1 Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ;
. ~: ;:::~ :;e~;:i~n:~ii~~;~S~:~ shall.use tI1.~ prope~ lransferred.orit'. inco~e;. . . : : : . . . . . . . . . .
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? .......................................... 0 ~
3. Did decedent own an "in trust for" 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
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 ~riUlY, J 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 re rer has an knowled e.
SIGNATURE OF PERSON RESPffl LE FOR FI~I~G RET DATE
I V\J 02/27/2002
ADDRESS
/'
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Thomas W. Scott
ADDRESS
218 pine Street
DATE
02/27/2002
Harrisburg
[72 P.S. 119116 (a) (1.1) (i)].
For dates of death on or after January '. 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. 119116 (a) (1.1) (ii)].
The statute do",,,, not "'1C",mot a tlll11sfer to a survivin9 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 pa.rent.
or a stepparent 01 the child is ()% [72 P .5. 19116(a)(1.2)j.
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. %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% [12 P.S. 1911&(a)(1.3)). AsibHng is defined, under Section 9102. as an individual
who has at least one parent in common with the decedent, whether by olood or adoption.
o PA15002
NTF 29756
Copyright 2000 Greatland/Nelco LP - Forms Software Only
AEV-1S08 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Iris Jean Orr
SCHEDULE E
CASH, BANK DEPOSITS. & MISC.
PERSONAL PROPERTY
Include proceeds of litigation & date proceeds were received by the estate.
FILE NUMBER
21 01 0696
All prop. jointly-owned with right of survivorship must be disclosed on 5ch. F.
VALUE AT
DATE OF DEATH
ITEM
NO.
11.
DESCRIPTION
Erie Insurance Co.
466
2
PNC Bank
38,245
3
PNC Bank
880
social Security payment
4
PSECU
14
5
US Treasury
300
Tax Rebate 2000
TOTAL (Also enteron line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
39,904
9 PAl5081 NTf 10875
Copyright 1999 GreatlandlNe)co LP - Forms Software Only
ERIE INSURANCE EXCHANGE
P.O. BOX 1699 ERIE. PA 16530
NAMED INSURED COPY
Member. Erie Insurance Group
ERIE.
CANCELLATION NOTICE
MAIL DATE 08/06/01
BAL: $466.00 CR
CANCEL LA TION EFFECTIVE
06/02/01 12.01 AM
POLICY NUMBER QOl 2003940 H
POLICY EFFECTIVE DATE 01/20/01
PIONEER FAMILY AUTO POLICY
STANDARD TIME
NAMED INSURED
1".111",1.,,1111.,,1,,1.,,11,1
ESTATE OF I JEAN ORR
KILLIAM & GEPHART
POBOX 886
HARRISBURG PA 17108
AA7695
WE ARE NOTIFYING YOU THAT THE ABOVE POLICY IS CANCELLED AS OF THE CANCELLATION
EFFECTIVE HOUR AND DATE SHOWN ABOVE. IF WE HAVE BEEN ASKED TO PROTECT OTHER
INTERESTS, WE ARE REQUIRED TO ADVISE THEM OF THIS CANCELLATION.
THE REASON FOR THIS ACTION ;
ASSURED DECEASED
***FORMERLY - ORR, I JEAN
***FORMERLY - 407 A MAIN ST
PREVIOUS BALANCE
UNUSED PREMIUM
PRESENT BALANCE
$.00
$466.00 CR
$466.00 CR REFUND CHECK ENCLOSED
00003
AA7695
BAIR NORMA J BAIR INS INC.
932EXC 6/00
Marilyn Bhodes
Branch Service Manager
Harrisburg Office
717 232 9426 T 888 762 2265 T
0PNCBAN<
0. PNCBAl\K
Decedent Reporting
Firstside Center
P7-PFSC-4-F
500 First Avenue
Pittsburgh, PA 15219-3128
A member of The PNC Financial Services Group
2 North Second Street
Hanisburg Pennsylvania 17101
/SCP
July 23,2001
Corinne Eggers Woodhouse
218 Pine Street
P.O. Box 886
Harrisburg, P A 17108-0886
RE: Estate of Iris Jean Orr, Deceased
SSN: 168-24-2950
000: 6/2/2001
Dear Ms. Woodhouse:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5140059509
Established 04/011197 5
IRIS JEAN ORR
DaD Balance: $38,244.63 (non-interest bearing)
Our office only provides date of death balances for IRA's, CD's, Checking and
Savings accounts. We do NO Financial Transactillns lIr Statement Orders. For
Further information please call 1-800-4-BANKER lIr YlIur local PNC Branch and
ask to speak with a Financial Services Representative.
~ 05&dw
Rachelle Sciullo
1-800-762-1775
A member of Tht PNC Financial Sel'\liees GrotJp
One PNC PI;JZ;l :.!49 Fifth Avc:nul: Pittsburgh PCflns.ylv;mifl 15222 2707
TOTqL P. 01
PO. Box 67013 (717) 234-8484 (Horrisburg)
Horrisburg, PA 171 06-7013 (BOO) 237-7328 (Notionwide)
website - http://www.psecu.com
DIRECT DEPOSIT...
Pennsylvonio Stote Employees Credit Union
IT'S FAST, EASY AND CONVENIENT!
SEE YOUR PAYROLL OFFICE & SIGN UP.
1",111",111""1,1,.1,1",11..1..11.,.11,,1,,,1,1,,1,1,11,,1
IRIS J ORR
5322 COBBLESTONE DR
MECHANICSBURG PA 17055-3478
JOINT OWNER
4005850
REV-1S10 EX + <1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Iris Jean Orr
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 01
0696
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECD & DATE OF TRANSFER.
NO. ATTACH COpy OF THE DEED FOR REAL ESTATE. V ALU E OF ASSET INTEREST (IF APPLICABLE)
11. New York Life variable Annuity 116,229 100.000 0 116,229
TOTAL (Also enter on line 7, Recapitulation) $ 116,229
9 PA 15101
NTF 10877
(If more space is needed, insert additional sheets of the same size)
Copyrighl1999 GreatlandlNlllco LP" Forms Software Only
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Iris Jean Orr
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FI LE NUMBER
21 01
0696
Debts of decedent must be reported on Schedule I.
ITEM
NO. DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
1 Gingrich Memorial 1,508
2 Mechanicsburg Cemetary 1,160
3 Musselman Funeral Home 7,714
Total from continuation pages 1,225
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Representative(s)
Social Security Number(s)/EIN No. 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 claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Craimant to Decedent
4. Probate Fees 92
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1 Cumberland Law Journal 60
2 Musselman Funeral Horne 10
3 Sentinel 81
4 State Employee Retirement
System 864
Total from continuation pages 3
TOTAL (Also enter on line 9. Recapitulation) $ 12,717
(If more space is needed, insert additional sheets of the same size)
9 PA15111 NTF 10878
Copyrighl1999 GreatlandlNe/co LP - Forms Software Only
Schedule H part 1 (Page 2)
Estate of: Iris Jean Orr
Item
No. Description
Amount
4 Organist/pastor
5 pealers Flowers
6 Pennsylvanis Bakery
7 West Shore Elks
Total (Carry forward to main schedule)
150
393
100
582
1/225
Schedule H part 2 (Page 2)
Estate of: Iris Jean Orr
Item
No. Description
Amount
5 Waypoint Bank
Total (Carry forward to main schedule)
3
3
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Iris Jean Orr
Include unreimbursed medical expenses.
ITEM
NO.
1.
1 AT&T
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 01 0696
DESCRIPTION
AMOUNT
35
2 AT&T Universal Card
1,130
3 Bon Ton Department Store
3,658
4 Hechts Department Store
1,583
5 Holy Spirit Hospital
450
6 PNC Bank
2
9 PA1S121
NTF 10874
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6,858
Copyright 1999 Grealland/Nelco LP - Forms Software Only
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Iris Jean Orr
21
01
0696
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (a) (1.2)J
1 1. JRhonda Lang Daughter d,s era
2 \Jane Scott Daughter ,J-S c;/
3 pean H. Smith Son 2S- 'fa
4 ean Talley Daughter d. .5- ~
ENTER DOLLAR AMTS. FOR D1STRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET $ 0
o PA 15131
NTF 33293
(If more space is needed, insert additional sheets of the same size)
Copyrighl2000 GreatlandINelco lP - Forms Software Only
imk..._.t~ *~flJft ~~~ fij'i"ri\~.~d
~~~i\t~I~"i,~",~~, '.t~..,~~
OF
IRIS J. SMITH
I, IRIS J. SMITH, of the Commonwealth of Pennsylvania,
being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament,
hereby revoking and making void any and all will or wills by
me at any time heretofore made.
As to such estate as I possess at the time of my decease,
I dispose of in manner as follows:
1. My Executor shall pay from the residue of my estate
all my debts, funeral expenses, administration expenses, and
all estate, inheritance, succession, and transfer taxes
imposed by the united States or any state, territory, or
possession which shall become payable by reason of my death.
It shall not be necessary to file any claims therefor, nor
to have them allowed by any court; provided that no proceeds
from a qualified employee benefit or retirement plan which
may become part of my estate shall be used to pay debts,
claims, taxes or administration expenses.
2. I give, devise and bequeath all of the rest,
residue and remainder of my estate, real, personal and
mixed, of whatsoever kind and nature, and wheresoever situate
at the time of my decease, in equal shares, unto my children,
JANE E. SCOTT, JEAN E. TALLEY, DEAN H. SMITH, and RHONDA L.
LANG.
3. If and in the event any of my children predecease
me, and are not living sixty (60) days after the date of my
LAST WILL AND TESTAMENT
OF
IRIS J. SMITH
decease, then and in such event, I direct my Executor to
distribute the share of said deceased beneficiary to his or
her issue, per stirpes; in default of such issue then to my
other then-living children or their issue, per stirpes.
4. I hereby nominate, constitute and appoint THOMAS W.
SCOTT, Executor of this my Last Will and Testament, to serve
without bond or security, and I hereby authorize, empower
and direct him to sell and convey, by good and sufficient
deed, in fee simple estate, any and all of my real estate,
at public or private sale, for such price or prices, upon
such terms and conditions, as in his judgment is best for my
estate, and to that end to sign, seal, execute, acknowledge
and deliver all deeds or other instruments necessary therefor,
as effectively as I could do if I were personally present.
If and in the event that THOMAS W. SCOTT, does not
survive me, and is not living sixty (60) days after the date
of my decease, or does not complete his duties as Executor,
then and in such event, I hereby nominate, constitute and
appoint JANE E. SCOTT, Executrix of this my Last Will and
Testament, to serve without bond or security, and I hereby
authorize, empower and direct her, as Executrix, to sell and
convey, by good and sufficient deed, in fee simple estate,
any and all of my real estate, at public or private sale,
for such price or prices, upon such terms and conditions, as
-2-
.
LAST WILL AND TESTAMENT
OF
IRIS J. SMITH
in her judgment is best for my estate, and to that end to
sign, seal, execute, acknowledge and deliver all deeds or
other instruments necessary therefor, as effectively as I
could do if I were personally present.
IN WITNESS WHEREOF, I, IRIS J. SMITH, the Testatrix,
have to this my Last Will and Testament, typewritten on
three (3)
this !:S!,
consecutively numbered pages, set my hand and seal
day of on~~
, 1979.
(SEAL)
J. SMITH
Signed, sealed, published and declared by the above named
IRIS J. SMITH, as and for her Last Will and Testament, in
the presence of us, who have hereunto subscribed our names
at h request as witnesses hereto, in the presence of the
sa estatri and of each other.
residing at~).. ~l()~ Q
1 ;'),
residing at '-;f2.(9--J [)f-j-/{)~/ &l-";,LI"{~><J
-3-