HomeMy WebLinkAbout01-0700
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of: Clementine Y. Cameron No. 21-01-700
Also known as: N/A To: Register of Wills for the
Deceased County of Cumberland in the
Social Security Number: 117 6-05-6965 Commonwealth of Pennsylvania
The Petition of the undersigned respectfuUy represent t~at:
1. Your Petitioner( s), who is/are 18 years or older and the executrix named in the last will of the above
decedent, dated March 29, 2001 and the codicil dated N/ A.:.
I (NONE)
(State relevant circumstances, e.g. renunciation, death of executor, etc.)
2. Decedent at death was domiciled in Cumberland County, Pennsylvania, with hislher last family or
principal address at:
Street address City Municipality State Zip code
355 S. Sporting Hill Road Mechanicsburg Hampden PA 17050
#93
3. Decedent, then 86 years of age, died on June 8, 200-1 at Holy Spirit Hospital, Camp Hill, P A .
4. 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 a victim of a killing; and, was never adjudicated
incompetent:
I (NONE)
5. Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $115,704.83
(Ifnot domiciled in PA) Personal Property in Pennsylvania N/A
(If not domiciled in P A) Personal property in County N/A
Value of real estate in Pennsylvania $0.00
situated as follows:
/'-OJ..y~ -7
21-01-700
WHEREFORE, petitioner(s) respectfully request(s) the probate and codicils{s) presented herein and the grant
of letters:
I Testamentary
(Testamentary, administration c.t.a.; administration d.b.n.c.t.a.) thereon.
signatures
and
residences
of
petitioner(s)
321 Blacksmith Road
Camp Hill, PA 17011
JCP
TOTAL
$
5.00
270 00
Fax: (717) 975-0697
~b~
?-~?-CJ7 '
Filed
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CERTIFICATE OF SERVICE OF
NOTICE OF ESTATE ADMINISTRATION UNDER RULE 5.6(a)
NAME OF DECEDENT: CLEMENTINE Y. CAMERON
DATE OF DEATH: JUNE 8, 2001
WILL/ ADMIN NO. : 21-01-~---' CJQ
TO THE REGISTER:
I certify that Notice of Estate Administration 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 August 10, 2001:
NAME AND ADDRESS STATUS
1. Tracey Pontius Daughter
321 Blacksmith Road
Camp Hill, PA 17011
Notice
5.6 (a)
I None
has now been given to all persons entitled thereto under Rule
except:
NAME
I NIA
ADDRESS
Date: ~
Signature:
Name: ~ane G. adcliff, Esquire
Address: ~44S Trind~e Road
~CamD Hi~PA 17011
Telephone: (717) ,737-0100
I.D. No.: 32112
Capacity: Counsel for Personal Representative
fhis is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local R~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent Pilmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~~"
Local R gistrar 0
Fee for this certificate, $2.00
p
7386933
tJ~
17 ~tJd /'
Date
t1\05;43~ 2187
COMMONWEALTH OF PENNSVLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPUPRINT.
IN
PERMANENT
BLACK INK
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TIME Of DEATH DATE PRONOUNCED DEAD tMo<\tl> Oay. """'I
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27. PART .; Ent., .he diM.ses, inltJItes or c:omphcaltOnS which caused IhelJe.'h Do 00180181' the mode 01 clymg, such as carcjtac 01 fesptralory .uesl. shock or he." failure
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WERE AUlOPSY FINDINGS MANNER OF DEATH
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Of'DEATH?
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DATE Of I/oIJURV
(Monlh. Oay. --'31)
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TlWE Of INJURV INJURV AT WOf\Kl
DESCRIBE HOW INJURY OCCURRED
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DUE rolOR AS ACQN5[auENi:;Eofl,-----------~
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CEATIFI€R tChc' ani, <JOel
.CERTIFY8NG PHYSICIAN IPhvs.c.an Cefb'yll"'q cause ~ death wiler .lnOltlet pt\Vs.c'<1n hdlS PlOflOt.lllC~ tJ~d.If1 d/'lO comlJleled lie," lJ)
To the be.1 0' my knowledo-. d..th OC'Cu<<ed due to .. cauM(st and maPMr .. ..ated.
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PLACE OF INJURY. AI home, 'iII,m. SI,"', faaory.orfice
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SIGNATURE TITlE Of CERTIFIER
311.. ~jff ~A-4~'
UCEN MIlER OAT JGm::D (M,,"". Oay~ .","',
o 3'c. 05 -o.;t 'f!ll.1:::" L.. J'd. L_~.!..!. '01 _~____
NAME AND AOORESS Of' PERSON WHO CQI,IPlETED C~ DEATH
(lIeiSG;~'~,'t ,4I\IItA.'l.C.I41 fYI{)
o ,6 It L (j:'" il.!!",- 'sT
n ~ y i704J
DATE FILED 1M""'" Day 'leall
J4 JJ N~,1. 00
"PRONOUNCING AND CERTlf'ftNG PKlSiCIA.N lPhys..c1dO PoIt~ ;J1:)1l0\JflCl"9l.l~d.lh dlldt:eflily.ng IO~dust: ul ()edltl\
To the ~ 01 my knowtadg.. death IIK:curred allhe dine. date, and place, and due to the caLl..C_. and mant'le,.. .Ialed
'MEDICAL EXAMINERlCORONER
On the bl.s of ...amination andJor 'nvesligalion. in my opinion, death occurred at the time, date. and place, and due to the c.use(a) and
manner .. st.ted.. . . . . . . . . . .. ....................... ..... .............. .......................................
J..
RS SIGNATURE AND NUMBER
'" .
lliast mill ttUh (U-rshtmrnl
of
CLEMENTINE Y. CAMERON
BE IT REMEMBERED, that I, CLEMENTINE Y. CAMERON of 1125 Columbus
Avenue, Apt. 6, Lemoyne, Pennsylvania 17043, being of sound mind, memory
and understanding, do make, publish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all
Wills and Testaments and writings in the nature thereof by me, at
anytime heretofore made.
I am a widow.
I have one (1) child: Tracey L. Pontius. My social
security number is 176-05-6965.
ITEM 1. BURIAL AND FUNERAL INSTRUCTIONS:
I direct that my body be donated to research and anatomical study.
I further direct that my next of kin may then dispose of my remains as
their deem appropriate provided that I desire that no viewing be held.
ITEM 2. DEBTS AND FUNERAL EXPENSES:
I direct that all my just debts and funeral expenses be paid as soon
after my demise as may be convenient.
ITEM 3. TANGIBLE PERSONAL PROPERTY:
I give and bequeath all tangible personal property owned by me at my
death and all insurance policies on such property as follows:
a. To those individuals who survive me and who are designated on a
list or memorandum signed by me which refers to this Will or is
WITNESS:
~ : .. {;v
(} / ~/'. l .. /{_
15- &,~ 1 ~ ~(SEAL)
CLEMENTINE Y P CAMERON
1
. .
found with a copy thereof, I give and bequeath the items listed
beside their names.
b. The balance (including any items under subparagraph (a) above
the bequest of which has lapsed) shall be included in my
residuary estate, and shall by distribution by my hereafter
named Personal Representative to the beneficiaries thereof as
herein provided. My Personal Representative shall have the
right to dispose of said remaining items of personalty to become
part of my residuary estate, either in kind or in cash as a
result of liquidation thereof as my Personal Representative, in
my Personal Representative's sole discretion, deems appropriate
under the circumstances. It is my intent, however, that should
any beneficiary of my residuary estate desire to receive a
particular item in kind which was not specifically bequeathed to
that beneficiary, to the extent reasonably possible, my Personal
Representative shall attempt, but not be obligated, to follow
that beneficiary's request.
c. If any beneficiary of any item of tangible personal property
aforesaid has not yet attained the age of 21 at the time of my
death, I order and direct that my Personal Representative,
hereinafter named, to hold said items in safekeeping for that
beneficiary and to deliver the same to that beneficiary upon he
or she reaching age 21 . For these purposes my Personal
Representative shall be entitled to use or set aside from my
estate sufficient funds to provide for that safekeeping.
ITEM 4. RESIDUARY ESTATE:
All the rest, residue and remainder of my Estate of whatsoever nature
and wheresoever situate, whether it be real, personal or mixed,
including any insurance policies therefor, property over which I have
power of appointment, and proceeds from any insurance policies payable
to my estate, I give, devise and bequeath to my daughter, TRACEY L.
PONTIUS, provided my daughter, TRACEY L. PONTIUS, survives me.
WITNESS:
\
CL!;:1INE~~
( SEAL)
2
ITEM 5. ALTERNATE RESIDUARY ESTATE:
In the event my daughter, TRACEY L. PONTIUS, fails to survive me, I
then give, devise and bequeath my entire residuary estate to my
grandson, TODD CAMERON PONTIUS, or the issue of my grandson, TODD
CAMERON PONTIUS, who survive me, share and share alike, in equal shares,
per stirpes. In the event I am not survived by my daughter, grandson or
their issue, I then give, devise and bequeath my entire residuary estate
unto JAMES and ELAINE MEAD, or the survivor of them, if they, or either
of them, survive me.
ITEM 6. TRUST PROVISIONS:
In the event any beneficiary herein has not then reached the age of
25, that beneficiary's share shall be held by my Trustee, JAMES AND
ELAINE MEAD, or the survivor of them, hereafter appointed, IN SEPARATE
TRUST FOR EACH BENEFICIARY, for the following uses and purposes and
subject to the following terms and conditions:
a. Trustee may accumulate the income from that share or so much
thereof from time to time as my Trustee considers advisable; and
Trustee may expend and apply so much of the net income including
accumulated income and so much of the principal of that share as
Trustee may consider necessary for the support, maintenance,
medical and dental expenses and education of the beneficiary,
including college education, both graduate and undergraduate,
or post-secondary vocational or technical training, in
accordance with the beneficiary's talents, abilities and needs;
and Trustee may pay all expenses which my Trustee deems
necessary and desirable in connection therewith, including, by
way of illustration, room and board, clothing, travel expenses,
tuition, books and supplies, and reasonable sums for personal
and living expenses. The amount to be paid for the benefit of
WITNESS:
I
c V; e~SEAL)
CLEMENT~N~-Y. CAMERON
3
the beneficiary shall be determined from time to time based on
the beneficiary's needs, considering the beneficiary I sather
income and assets, including any income payable for the benefit
of the beneficiary from other sources as other trusts or social
security or other governmental benefits, with the further
direction that the funds shall be liberally disbursed. The said
payments may be made as my Trustee deems appropriate directly to
the beneficiary if the beneficiary is, in the sole opinion of my
Trustee, of an age and ability to handle the funds so paid; or
directly to the person having custody and care of the
beneficiary; or directly to any institution entitled to such
payment by reason of services rendered or to be rendered to the
beneficiary:
b. The Trustee for the purposes of carrying out my intentions
stated above shall have the following powers, in addition to all
other powers granted by law or other provisions of this Will:
1. To retain any property, real, personal or mixed, and to
manage the same for the benefit of this Trust;
2 .
To sell at public or private
period of time, any real or
prices and upon such terms
appropriate;
sale, or to lease for any
personal property for such
and condi t ions as may be
3. To compromise any claim or controversy and to abandon any
property which is of inconsequential value;
4. To make distribution to my herein-named beneficiaries, on
their behalf, in cash or in kind; and
5. To carryon any business owned or controlled by me at my
death, for whatever period of time is deemed proper, and to
do all things necessary and appropriate to manage,
supervise and operate the business and to close out,
liquidate or sell the business at such time and upon such
terms as are deemed proper.
c. Trustee shall invest all trust funds received by my Trustee
including, but not limited to, income received from the
retention of property in kind and cash received from the
liquidation and sale of property, in any minimal risk
investments including, but not limited to: checking accounts,
savings accounts, money market accounts, certificates of
l
{J.i e~
I (SEAL)
CLEME~I E Y. CAMERON
4
,',
deposit, mutual fund accounts or other minimal risk investments,
or any combination thereof. Distribution from the Trust shall
be made solely for the benefit of the beneficiary of the Trust
in accordance with my instructions set forth in subparagraph
(a) i provided, however, that my Trustee shall be entitled to pay
for any taxes, professional services or other fees arising out
of the administration of the Trust and shall be entitled to
periodic, reasonable compensation for services rendered
hereunder, which may be equitably apportioned between principal
and income.
d. Any and all payment or payments of any sum or sums, whether in
cash or in kind or whether for principal or income, payable to
the beneficiary, shall be made upon the sole receipt of the
respective individual to whom the payment is made, free from
anticipation, alienation, assignment, attachment, and pledge,
free from control by the creditors of any such beneficiary and
shall not be subject to any execution or attachment.
e. When the beneficiary reaches age 25, the then remaining assets,
principal and any accumulated or undistributed income of the
beneficiary's Trust shall be distributed to the beneficiary,
absolutely.
f. In the event the benef iciary dies before reaching age 25 the
remaining principal and any accumulated income of his or her
Trust shall be distributed at his or her death to his or her
then-living issue, in equal shares per stirpes, or in the event
there are no such issue, his or her share shall be distributed
to my then living residuary beneficiaries, or alternate
residuary beneficiaries as the case may be, as set forth and in
the proportions provided for herein, subject to the terms and
conditions of this Trust if the beneficiary thereof is under the
age of 25.
g. Should the principal of the Trust herein provided for be or
become too small in the Trustee's discretion so as to make
establishment or continuance of the trust inadvisable, my
Trustee or Personal Representative may make immediate
distribution of the then-remaining assets, principal and any
accumulated or undistributed income outright to the Guardian of
the Person of any minor beneficiary herein appointed or to the
person or persons and in the proportions they are entitled.
WITNESS:
e V; e(j~
CLEMENTINE Y. CAMERON
(SEAL)
5
ITEM 7. APPOINTMENT OF TRUSTEE:
I appoint JAMES AND ELAINE MEAD, or the survivor of them, as Trustee
of any Trust created by this my Last Will and Testament. Should JAMES
AND ELAINE MEAD, or the survivor of them, predecease me, both fail to
qualify, both cease to act or both renounce the position of Trustee, I
then appoint MELLON BANK as Alternate Trustee of any Trust created by
this my Last Will and Testament.
ITEM 8. APPOINTMENT OF GUARDIAN OF PROPERTY:
I appoint JAMES AND ELAINE MEAD, or the survivor of them, as Guardian
over any property which passes either under this Will or otherwise to
any beneficiary who is then a minor. Should JAMES AND ELAINE MEAD, or
the survivor of them, predecease me, both fail to qualify, both cease to
act or both renounce the position as Guardian of the Property of any
minor children, I then appoint MELLON BANK as Alternate Guardian of the
Property of a Minor. This appointment of a Guardian shall not supersede
the right of any fiduciary in his/her/its discretion to distribute a
share where possible to such beneficiary or to another for such
beneficiary's benefit.
Such Guardian shall have the power to use
principal as well as income from time to time, for the beneficiary's
support and education.
ITEM 9. APPOINTMENT OF PERSONAL REPRESENTATIVE:
I appoint my daughter,
TRACEY L.
PONTIUS,
as the Personal
Representative of this my Last Will and Testament. Should my daughter,
WITNESS:
\
CLE::';;INEtY~RON
( SEAL)
6
....
TRACEY L. PONTIUS, predecease me, f ai I to qual i fy , cease to act or
renounce probate, I then appoint JAMES AND ELAINE MEAD, or the survivor
of them, as the Alternate Personal Representative of this my Last Will
and Testament.
ITEM 10. PAYMENT OF TAXES:
I direct my Personal Representative to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which my
Estate or the transfer of any property passing hereunder or otherwise
passing by reason of my demise, may be subject and to charge such taxes
against my residuary estate, it being my intention that none of the
aforesaid taxes, either federal or state, or any property required to be
included in my gross estate, under the provisions of any state or
federal law now in force or hereafter enacted, shall be prorated among
the persons interest in my Estate to whom such property is or may be
transferred to whom any benefit accrues.
ITEM 11. POWERS OF PERSONAL REPRESENTATIVE:
In addition to the powers conferred by law, I authorize my Personal
Representative in my Personal Representative's absolute discretion:
a. To retain in the form receive, and to sell either at public or
private sale any real or personal property;
b. To manage real estate;
c. To invest and reinvest in all forms of property without being
confined to legal investments, and without regard to the
principle of diversification;
WITNESS:
ej&~
CLEMiNTINE Y. CAMERON
( SEAL)
7
d. To exercise any option or rights arising from ownership of
investments;
e. To compromise claims without court approval and wi thout the
consent of any beneficiary;
f. To disclaim any interest in property;
g. To claim an elective share of the estate of any deceased spouse;
h. To join with any spouse I may have upon my death in the filing
of any federal income tax return for any year for which I have
not filed such return prior to my death, and to consent to the
treatment of any gifts made by my spouse as being made one-half
by me for gift tax purposes notwithstanding the fact that such
action may result in additional liabilities for my estate. Any
income or gift taxes due on such returns and any deficiencies,
interest, penal ties, or refunds thereon, shall be allocated
between my estate and my spouse and my spouse's estate, or all
to any of them, in such manner as my Personal Representative and
my said spouse may agree.
i. To disburse my estate in kind or by way of liquidation thereof
in whole or in part as my Personal Representative in my Personal
Representative's sole discretion may deem appropriate under the
circumstances.
ITEM 12. NO BONDING REQUIREMENT:
I direct that my Personal Representative, Guardian and Trustee or
their successors shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
ITEM 13. SURVIVAL:
Any person or organization herein named or referred to shall be deemed
to have survived me only of such person or organization shall in fact
survive me for a period of at least thirty (30) days.
Any person or
WITNESS:
\
C0J [~
CLEMENTf~E Y. CAMERON
(SEAL)
8
.
organization named or referred to herein who shall not survive me by a
period of thirty (30) days shall be deemed to have died before I do.
ITEM 14. GENDER AND NUMBER:
Where appropriate to the context, pronouns or other terms expressed
in one number or gender shall be deemed to include the other number or
gender, as the case may be.
ITEM 15. EXCLUSION:
It is not my intention to make provision in this, my Last Will and
Testament, for any relative or any other person not expressly provided
for herein, except for children born to or legally adopted by me after
the date of this instrument, and if any such person has not been
expressly mentioned herein, he or she has been omitted by me
intentionally and with full knowledge of his or her relationship and
existence, and not by any oversight or neglect.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this~~ay
of ~LL
, 'lDQ1.
~~
~~L
~ A ?J.... .. '<J
/''/ < (/(/-
L-l!.lffvt~~~ , . < L./z1?;1 j)~AL)
CLEMENTINE Y [CAMERON
9
..
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, CLEMENTINE Y. CAMERON ,''rrAJ lit J \-.Y~-\.\ u~
\
and Diane
G. Radcliff, Esquire, the TESTATRIX and the witnesses respectively,
whose names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that
the TESTATRIX signed and executed the instrument as Last Will and that
TESTATRIX had signed willingly (or willingly directed another to sign
for the TESTATRIX), and that TESTATRIX executed it as TESTATRIX'S free
and voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the TESTATRIX, signed the
Will as witnesses and that to the best of their knowledge the TESTATRIX
was at that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
/
c4#'~'
Sworn to and subscribed to
before me this ~~ day
of 7JYM../u
, ~~/.
~~~~
NOTARY PUBLIC
My Commission Expires:
_:-' _.,'t< ","-*:"1." '''~.-''"'"'~~;_'.'_'''''''~''''''''''_____.'_'.._,..,."..."",,
Notarial Seal
Debomh L. Donley, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires Sept. 23, 2003
Member, Pennsylvania Association 01 Notaries
10
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
RADCLIFF DIANE GILBERT
3446-3448 TRINDLE ROAD
CAMP HILL, PA 17011
---.-.-- fold
ESTATE INFORMATION: SSN: 176.05-6965
FILE NUMBER: 21-2001- 0700
DECEDENT NAME: CAMERON CLEMENTINE Y
DA TE OF PAYMENT: 09/04/2001
POSTMARK DATE: 08/31/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 06/08/2001
NO. CD 000226
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,000.00
REMARKS: TRACEY L PONTIUS
C/O DIANE G RADCLIFF
CHECK# 1481
SEAL
INITIALS: PB
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
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
RADCLIFF DIANE GILBERT
3446-3448 TRINDLE ROAD
CAMP HILL, PA 17011
_____h_ fold
ESTATE INFORMATION: SSN: 176-05-6965
FILE NUMBER: 21-2001- 0700
DECEDENT NAME: CAMERON CLEMENTINE Y
DATE OF PAYMENT: 12/31/2001
POSTMARK DATE: 12/27/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 06/08/2001
NO. CD 000706
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $954.38
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: TRACEY L PONTIUS
C/O DIANE RADCLIFF ESQUIRE
CHECK#1516
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
$954.38
MARY C. LEWIS
REGISTER OF WILLS
!I-d'l~ -7
BUREA6~ INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
ReCCd
Rpt,
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
1\11 :2 ~OUNTY
ACN
02-26-2002
CAMERON
06-08-2001
21 01-0700
CUMBERLAND
101
DIANE G RADCLIFF ESQ
3448 TRINDLE RD
CAMP HILL
.02
MAR -1
v,*
REY-1!i47 EX AFP 101-82)
CLEMENTIN V
Allount Rellitted
PA 170'jer~
Gwnbc~, i,".
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 ~
REY=is4-j-EY-AFP--((ff=oii--No'Tici--OF-'rNHEifffANCi-yAi-APPRAisEMENT~--Ai:l-owANcE-ifi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CAMERON CLEMENTIN V FILE NO. 21 01-0700 ACN 101 DATE 02-26-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previously, lines 14. 15 and/or 16, 17. 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of line 14 at Spousal rate (15)
16. Allaunt of line 14 taxable at lineal/Class A rate (16)
17. Allount of line 14 at Sibling rate (17)
18. AIIount of line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
C EDIT :
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
n)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
300.00
115.706.60
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9.
10.
11.
12.
13.
14.
(9)
nO)
1,051.00
413.88
(11)
(12)
(13)
(4)
Funeral Expenses/Adll. Costs/Hisc. Expenses (~chedule H)
Debts/Hortgage Liabilities/liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
NOTE:
.00 X 00 =
114,541.72 X 045 =
.00 X 12 =
.00 X 15 =
T
+
INTEREST/PEN PAID (-)
210.53
.00
AHOUNT PAID
4,000.00
954.38
DATE
08-31-2001
12-27-2001
NU"BER
CD000226
CD000706
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
116,006.60
1.464 88
114,541.72
.00
114,541.72
(19)=
.00
5,154.38
.00
.00
5,154.38
5,164.91
lo.53CR
.00
lo.53CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
1
DIANE G$ RADCLIFF, ESQUIRE
Attorney at Law
3448 T rindle Road
Camp Hill, Pennsylvania
Phone: (717) 737-0100
Facsimile: (717) 975-0697
August 31, 2001
Cumberland County Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Clementine Y. Cameron
PA File Number: 21-01-0700
We are sending you the enclosed via {x} u.s. Mail { } Overnight
Mail { } Hand Delivery, the following item(s) :
NUMBER ENCLOSED DESCRIPTION OF DOCUMENT
1 Check in the amount of $4,000.00 as pre-
payment of Inheritance Tax. Please return
provide this office with a receipt of this
payment. An envelope is provided for your
convenience.
,
STATUS REPORT UNDER RULE 6.12
NAME OF DECEDENT:
Clementine Y. Cameron
DATE OF DEATH: June 8, 2001
O'/c>o
WILL NO.: 21-01-9800- 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: January 2002
3. If the Answer to No.1 is Yes, state the following:
a. Did the personal representative file a fmal 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
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 attach.
to this report. \ .~..-- _ ~
'> O-t'~~ \
Si~e ~ \
DIANE G. RADCLIFF. ESQUIRE
Name (please type or print)
Date:
May 23. 2003
a
N
c;)
3448 Trindle Road. Camp Hill. P A 17011
Address
,,~!
0..:
(717) 737-0100
Telephone number
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Capacity: _ Personal Representative
.-X.- Counsel for personal representative
COMMONWEALTH OF
PENNSYLVANIA
OEPARThENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
................................................................/-...
OFFICIAL USE QNL Y C
nn..l.~n.=n?: </~. 7
FILE NUMBER
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
C
w
t.J
w
C
s
..oi
U"
00.
"2_
O~lD
<(
5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
THIS SEcnON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
c NAME COMPLETE MAILING ADDRESS
G>
1;1
8-
~
8
2. Stocks and Bonds (Schedule B)
(2)
(3)
(4)
(5)
(6)
3. Closely Hek:I Corporation, Partnership or Sole-Proprletorshlp
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~
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()
w
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
. Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Probate Property
(Schedule G or l)
(7)
$0.00
(8) $116,006.6 U!
$1,051.00
$413.88
(11) $1464.8
(12) $114,541.7
(13) SOD
(14) $114,541.7
(15) $0.0
(16) $5,154.3
(17) $0.0
(18) SOD
(19) $5,154.3
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Uabilities & liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
z
o
>=
~~
f-=>
Q.
~
o
o
13. Charitable and Govemmental8equestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
:1
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
x .12
x .15
20._
CHECK HERE IF YOU ARF.- RfOUf:; liNG A R[ FUND OF /\N OVERPAyrl1ENT
Copyright 2000 David James Thorpe, Esq.
Decedent's Complete Address:
Sli'<EET ADDRESS
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. PrIor Payments
C. Discount
(1)
$5.154.38
Total Credits (A + B + C)
(2)
$4.200.00
3. Interest/Penalty If applicable
D, Interest
E. Penalty
TolallnlerestlPenalty (0 + E) (3)
4. If 1100 2 is greater than line 1 + line 3. enter the difference. This Is the OVERPAYMENT.
ChecJc box on Page 1 Line 20 to request a refund (4)
5. If line 1 + line 3 is greater than line 2. enterthedtfference. This Is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Une 5 + 5A. This Is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
$0.00
$954.38
$954.38
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or Income of the property transferred;
b. retain the right to designate who $hall use the property transferred or Its Income;
c. retain a revlsWnary Interest; or
d. receive the promise for life of either payments, benefits or care?
2. If death occurred on 0( before December 12. 1982. did decedent within two years
Yes
I
No
I
56 preceding death transfer property without receiving adequate consideration? 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 sccoont, amulty, or other non-probate property?
.
.
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 petjury, I declare that I have examined this return, indu<lng accompanying schedules and statements. and to the best d my knoNIedge and belief. It Is true. correct.
and complr,te.
Dedatation of preparer ottleJ than !.he personal representative is based on all the Information d whk:h preparer has any knowledge.
SIGNATU OF PERSON RES~ FOR F(LjIN RETURN
eX. Iv..., a. ~ L _
ADDRESS
3448TrI
Copyright 2000 David James Thorpe, Esq.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
CLEMENTINE Y. CAMERON
FILE NUMBER
21-01-0800
Include the proceeds of litigatIon and the date the proceeds were received by the estate. All property jolndy-owned with the right of survivorship must be disclosed on
Schedule F.
DESCRIPTION
TOTAL (Also enler on line 5. Recapitulation)
(If more space is needed. insert additional sheets of the same size)
Copyright 2000 David James ThoIpe, Esq.
COWNONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTlY-OWNEO PROPERTY
ESTATE OF
CLEMENTINE Y. CAMERON
FILE NUMBER
If an asset was made Joint within one year of the decedent's date of death, ft must be reported on Schedule G.
JOINTLY-OWNED PROPERTY:
DESCRIPTION OF PROPERTY DATE OF DEATH
InClude name offll\andallnstiMiOl'1 and bank account number or Similar Identifying number. AtIatt1 VAlUE OF ASSET
desdforjolnlly-heldreaJesta!e.
TOTAL (Also enter on line 6. Recapitulation)
(If more space Is needed. insert additional sheets of the same size)
Copyright 2000 David James Thorpe., Esq.
COt.HONWEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF CLEMENTINE Y. CAMERON
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
FILE NUMBER
21 01 0800
'l'<K: ~- - ~7::;' :::"",-~i- r;~,.-~s';":::'II'~"-;::."'~- -~.q - 'P'%:~ - 7-~::--;~-;: "~\l'" ,. III..:, '\~), ,~ ,~:'J:"F~-:~f"-~~~::1~~~-\-~
, "'" ' 'II -. -II' .- .." " '. ',' . '0.. ,; . . i'.... ~*. ~. .
, ,~, '; , 11
~ -... II _-.- _II' ...I '.:' ..1' .
II ." .. ...... .1111 ..... l1lil1li ..,' .I'.J
" ". . .. .. - II.' . _
. ':. l1li .I T, . -rll l1li1...... iIII. . ._. ..
>....l1li.-. .." III ".1111. ... III -.. I 111'-
......!I.:i. .:. · ..-....1111 _ ~ · SI-.-.
.. II . 11-1111... -. _ _.. -... I
1111__11 1.-. ~,. -II ....... ... II 1111
· ...... .. .... · ....",- .
--I'. ~ .1....r1.III:i I!.:......I
. .....- .- ..... III II. l1li-'
I .....",.. ..,.............. ._____..
III. -..."" '-..11 rP - . II1II
I. ...., ...--..... . ............... ....
.. I........ .. .--"1 ...
. -. .. ........... -.. I...
.... .. _.... IIIIIIIlIIIIIII ..... -.- .
III . _.___ _ . -.-..... ..
. .~----.... - -..-.. . lUll.
...---- .... ....l1li ..11
II ....-... ~ if ..
.. - ... ... ....1. - - I
,III> _. ... ..... ..1. ...... .' ... ... . ..
. . . I .. ...... ...... _ . . . ." '.
..... ..l1li. .' 1.;_' ........~. ..~'I..
III -. -- ...... ...11
; ... ' .... ............. ......'
III .'-. 11.l1li _...... '. .'.".
..-... . . .. -" ..
....111': ..-. ....-. . '
-. · lflii .. 1II!1InI,.. ...
-... . .".~. .. .
........ · . ..r... .. ,.
..' ... .. .. .,.l1li..1
. .'1111" ..' 111.-1-." · ...
.. . II .'.' ._111_.-.,..
... .,..... ._: .. .. IIlII . _ _. ....' .
OESCRIPTION
OESCRIPTION
AMOUNT
.
.
TOTAL (Also enter on line 9. Recapitulation)
(If more space Is needed. insert additional sheets of the same size)
I I
Copyright 2000 David James Thorpe, Esq.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABilITIES, & LIENS
ESTATE OF
CLEMENTINE Y. CAMERON
FILE NUMBER
21 01 0800
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
TOTAL (Also enter on line 10. Recapitulation)
(If more space Is needed. insert additional sheets of the same size)
Copyright 200Q David lames Tho1pe, Esq.
COtv1MONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
CLEMENTINE Y. CAMERON
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
21 01 0800
AMOUNT OR SHARE
OF ESTATE
NUMBER
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
(If more space Is needed, insert additional sheets of the same size)
Copyright 2000 David James Thorpe, Esq.
3-101 MARKET STREET
CAMP HILL. PA 17011
17171737-8726
c/f/u&
FUNERAL HOME INC.
35()1 DERRY STREET
HARRISBL'Rn. PA 1711 I
(17) )64-26.r~
"For the Perfect Tribute"
fREDERICK H. WHITE.. Fl). SUPLRVISOR
SI EPH[N J. WII.SU,\CIL F1J. Sl'I'U{VIS()[{
Payment Receipt
Receipt No.: 3388
26 June 2001
Services Rendered for:
Clementine Y. Cameron
Description
Amount
Humanity Gift Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
Death Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Services Total $
250.00
16.00
266.00
Adjustments (Payments)
$
(266.00)
Balance Due on Account
Ref No.: 1001600/2415
$
0.00
TRACEY L. PONTIUS
321 BLACKSMITH RD.
CAMP HILL, PA 17011
July 5, 2001
Diane Radcliff, Esquire
3448 Trindle Road
Camp Hill, PA 17011
Dear Ms. Radcliff:
Enclosed as discussed is the death certificate for my mother, Clementine Y. Cameron.
With respect to the Mellon Bank Account, the value of our joint account on the date of her death
was $4,949.21. The Mellon Bank representative with whom I spoke indicated that the account
was established in both names prior to 1991; their records do not go beyond that year, and the
joint account appears as far back as that time.
Should you need any additional information, please contact me at 787-6469 (work) or 761-3265
(home).
Sincerely,
e:dLtU.-VJ #~
Tracey Pontius
Private Client Group
214 Senate Avenue
Suite SOl
P.O. Box 0810
Camp Hill. Pennsylvania 17001-0810
7179754600
800937 0735
frY ""7 mr~i ~ '1 m "",r",
8~~;l;, B IH!.".~ ,~~:'l' ll[\i;i~l
June 20, 2001
Ms. Diane Radcliff, Attorney
3448 Trindle Road
Camp Hill, PA 17011
Re; Estate of Clementine Y. Cameron
Account 872-22573
Dear Diane:
Enclosed are date of death (06/08/01) values for the Clementine Y. Cameron Estate. Her
account was opened February 2, 1978 as a joint account with Tracy L. Pontius.
Don't hesitate to call if you need further details or have any questions.
i
51,' n,'cprelY, ~', .
~ .~
.{-i- 'I1A,!. cefZ(Jf1.
r= -
. '
I Virginia G. Walter
Assistant Vice President
Sr. Financial Consultant
VGW/crt
enclosure:
Date of Death Values
cc: Tracy L. Pontius
321 Blacksmith Road
CampHiII,PA 17011
Clementine Y. Cameron
Account 872-22573
Date of Death Values - June 8, 2001
Price
Security Description Quantity 06/08/01 Total
CD American Natl Bk & Tr
Chicago Illinois 22,000 103.8310 22,842.82
7.00% Aug 23 2005 Semi
CD Capital One Bank FSB
Falls Church Virginia 15,000 106.8510 16,027.65
7.450% Jun 012004 Semi
CD First USA Bank
Wilmington Delaware 13,000 102.9220 13,379.86
7.000% Feb 03 2003 Semi
CD Greenpoint Bank
Brooklyn NY 21,000 10 1.3580 21,285.18
6.400% May 21 2002 Semi
CD Household Bank FSB
Prospect Heights III 1,000 103.7260 1,037.26
7.000% Apr 192005 Semi
CD MBNA America Bank
Newark Delaware 6,000 103.2190 6,193.14
6.500% Dec 22 2003 Semi
CD Providian Bank
Salt Lake City Utah 2,000 100.4680 2,009.36
6.000% Oct 01 2001 Semi
CD Providian N.B. Tilto
N.H. Frmly First Deposit 2,000 100.2290 2,004.58
6.200% Aug 20 2001 Semi
CD Providian N.B. Tilto N.H.
Frmrly First Deposit 20,000 99.2280 19,845.60
5.250% Mar 08 2004 Semi
CD Providian N.B. Tilto N.H.
Frmrly First Deposit 19,000 101.7050 19,323.95
5.650% May 23 2006 Semi
CD Providian N.B. Tilto N.H.
Frmrly First Deposit 2,000 104.6910 2,093.82
6.650% Jan 05 2004 Semi
Federal Home Loan Bank
Callable Bonds 15,000 101.2970 15,194.55
7.020% Nov 142005
Federated Utility Fund CI F 4,316.2270 9.8600 42,557.99
Franklin US Govt Ser CI A 5,087 6.7800 34,489.86
Kemper Income & Capital
Preservation Fund CI A 998 8.1 900 8,173.62
Cash Balance 1.I9 1.00 1.I9
Total 226,460.43