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Home My WebLink About01-0704 Estate of Ruth C. Stake also known as PETITION FOR PROBATE and GRANT OF LETTERS ;;),\-0\- ~ No. To: Register of Wills for the 1 Deceased. County of Cumberland in the Social Security No. 173-03-4490 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ors in the last will of the above decedent, dated September 22 and codicil(s) dated named , 19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland her last family or princiJli!1 residence at 121 Walnut Bottom $4/-reH~1f ~rt7 / list street, numbe and muncipality) February 21 County, Pennsylvania, with Road, Shippensburg, PA 17257 Decendent, then 91 years of age, died at Shippensburg Health Care Center 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: ,xH) 2001 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: $ 2,000 $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.La.; administration d.b.n.c.La.) theron. 1~~~Ge~~ ~ g 938 Houser Road C.- cd.~ Fayettville, PA 17222 3~ (l) "- 5 0 ~ C eo V3 ~:;!<<- J(~ ~~(~f:~:::.~~ 450 H1llcrest Dr1ve Carlisle, PA 17013 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I sc< COUNTY OF CUMBERLAND j ~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will nd truly ad mini r the estate according to law. C. l \0- JJ. ~ - \ \ Sworn to or affirm~Twd before me thO LY . V:l ~. :=c l:::l /)(.#U/. Cb. ~ Roh.er (formerly Linda ~ '- R. Stake) ~o. 21 - 01 - 704 Estate of Ruth C. Stake , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW JUL Y 30, ~ 2001, 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 september 22, 1961 described therein be admitted to probate and filed of record as the last will of Ruth C. Stake and Letters TestffiHentary h b t dt Ronald E. Stake and Linda R. Rohwer (formerly Linda R. Stake) are ere y gran e 0 FEES $ 25.00 $ 1 00 $ $ 6.00 ~.uu TOTAL_$ 39.00 Filed ....... J U ~.Y. .30.,. .200.1. . . . . . . . . . . . . Probate, Letters, Etc. ......... Short Certificates( 1 ) . . . . . . . . . . Renunciation ................ X-Pages JCP ATTORNE nald E. John 8 West Pomfr ,Street Carlisle, PA Ad~i:ess ( 7 1 7) 243 -0123 PHONE Called attorney on 7-30-01. .~ih 16453 21 - 01 - 704 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the reqUest of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY ~ OATH OF-NON-SUBSCRIBING WITNESS ,. Ronald E. Stake and Linda R. Ro~r~.(f6rmerly Linda R. Stake) (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they f 'I' 'h h' f Ruth C. Stake aml.lar wIt t e signature 0 . XJUIIJCX testat rix of (one of the subscribing witnesses to) the will presented herewith and Ronald E. Stake and ~XX thaL.i.uJa K. ftulu; el {f0meLly LludClbelieves the signature on the will is in the handwriting of R. Stake) Ruth C. Stake to the best of their knowledge and belief. Sworn to or affirmed and subscribed before *-d~ If? ;(?~ me this 27TH day of ..i/ . '" ~. (Name~, A'. /J Y)A Jut? ~ ~:50~c/Le,Q;/-lJI. ~ fCl/)O/~ .~ J1IARY. c' ~~ ~ .- ~dd~__~ . C]t1 Regll _~~\)~ ~ ~ ~~~Q ~~~~l.~ ~l~~ (Address) '05.112 REV 888 oEE FOP. THIS ERTIFICA TE S2.00\ WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 4778131 ~;;;;~7;~ it't\.1" Of pl;;~~~ \\II_~\..~~'tt --:. l~" .... ~'\ If~~~'" !Ji'~~\ !:e! ,"- -~~ - ~ -- \~i ~c:;:,'f" )-~ ,(.,.), A.,. .h~ ~, "~:', ,\: \ *\~.. . '~.." '-~/ *f ~ a.. ',' .~~\" ~ r...<) /.'1~ ", -....~ :t!,,?>/i;----{~~~\/ ~-~~",../" EN1 \\, 111,,111 ""'~/~/!!!!.!1fIJJI February 24, 2001 Dale or Issue of This Certification Name of Decedent Ruth F:rst Elizabeth Stake Middle Last Sex female Social Security No. 173-03-4490 Date of Death February 21, 2001 Date of Birth April 22, 1910 Birthplace Saltillo, PA Place of Death Shippensburg Health Care Center Cumberland F,iCilltv Name County Shippensburq, City. Borough or TowOShlp Pennsylvania Race white Occupation housewife Armed Forces? (Yes or No) no Decedent's Marital Status widowed Mailing Address Shi~pensburg Health Care Center, Shippensburg, PA Number Street City or Town State Informant Ronald Stake Funeral Director _ Barbara G. Partner Name and Address of Funeral Establishment Robert I. McClain Funeral Home, Cassville, PA 16623 Part I: Immediate Cause Interval Between Onset and Death (a) Dysphagia (b) Alzheimer's dementia (c) Congestive heart failure Part II: (d) Aspiration pneumonia Other Significant Conditions Manner of Death Natural ~ Homicide 0 Accident Pending Investigation 0 Suicide 0 Could not be Determined 0 Describe how injury occurred: Name and Title of Certfier Yogindra S. Balhara, MD (M.D., D.O., Coroner, M.E.) Address Fifth Avenue, Chambersburg, PA 17201 Local RegIStrar of Vital Records Dlstnct No February 24, 2001 Da.te nece:,..ed b'., Lc,,~~Ct: 8ecIs1rCif Street Adjress City. Bomugh, Township WILL I, RUTH C. STAKE, presently residing in the Borough of Saltillo, County of Huntingdon and Commonwealth of Pennsylvania, my post office address being Saltillo, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my last Will, hereby revoking and making void all former Wills and Codicils thereto by me at anytime heretofore made. AND FIRST: I hereby order and direct that the costs of settlement of my estate, the medical and funeral expenses, my just debts and all the inheritance, estate, transfer or succession tax or taxes due on my entire estate be paid out of the residue of my estate as soon as may conveniently be after my decease. SECOND: I hereby order and direct my Executor, hereinafter named, to purchase and have erected a suitable monument at my grave. THIRD: All the rest, residue and remainder of my estate, real, personal and mixed, of every nature and kind and wheresoever situated, I give, devise and bequeath absolutely unto my beloved husband, Edgar C. Stake, Saltillo, Pennsylvania. FOURTH: In the event that my beloved husband, Edgar C. Stake, should predecease me or in the event that we should die at the same time, then I give the following orders and directions, make the follow- ing appointments and dispose of my entire estate as follows: 1. I hereby order and direct my Executors, hereinafter named, to execute the directions contained in the first paragraph of this, my last Will, and I further order and direct that the funeral expenses of my beloved husband, Edgar C. Stake, be paid out of my estate if they have not been previously paid. 2. I hereby order and direct my Executors, hereinafter named, to execute the directions contained in the second paragraph of this, my last Will, and I further order and direct that a suitable monument be purchased and erected at the grave of my beloved husband, Edgar C. Stake, if such monument has not been previously purchased and erected. 3. In the event that any of my children are under the age PAGE I ~e,~ of twenty-one (21) years at the time of my death, I hereby nominate, constitute and appoint my son, Ronald E. Stake, to be testamentary guardian of the person or persons of such minor child or children to serve during his, her or their minority. 4. All the rest, residue and remainder of my estate, real, personal and mixed, of every nature and kind and wheresoever situated, I give, devise and bequeath absolutely, in equal shares, unto my three (3) children, Ronald E. Stake, Linda R. Stake and David A. Stake. 5. In the event that any of my said children are under the age of twenty-one (21) years at the time of my death, I hereby nominate, constitute and appoint my son, Ronald E. Stake, to be testamentary guardian of the estate or estates of such minor child or children to serve during his, her or their minority. LASTLY, I hereby nominate, constitute and appoint my beloved hus- band, Edgar C. Stake, to be the Executor of this, my last Will. In the event that he should predecease me, or in the event that we should die at the same time, or if for any reason he should be unable or un- willing to serve as my Executor, then I hereby nominate, constitute and appoint my son, Ronald E. Stake, and my daughter, Linda R. Stake, to be the Executors of this, my last Will. I hereby expressly direct that my Executor or my Executors, as the ease may be, shall be excused from filing any bond or bonds in the administration of my estate. IN WITNESS WHEREOF, I, RUTH C. STAKE, the Testatrix, have to this, my last Will, typewritten on one side only of two (2) sheets of paper, to the first sheet thereof having subscribed my name for the purpose of identification, subscribed my name and affixed my seal this Ole:< ~ . day of September, A.D., 1961. ~<2... ~ Ruth C. Stake (SEAL) PAGE II : Signed, Sealed, Published and Declared by the above named RUTH C. STAKE, as and for her last Will, in the presence of us, who have here- unto subscribed our names at her request~ as witnesses thereto, in the presence of the said Testatrix and of each other. ~ 73r.vJ'rJML ai~ /'~- Name ~g. ddress ~,Il Ad ress /' E. - CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Name of Decedent: Ruth C. Stake Date of Death: February 21, 2001 Will No: 21-01-0704 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 November 9,2001: Ronald E. Stake 938 House Road Fayettville, P A 17222 Linda R. Roher 450 Hillcrest Drive Carlisle, PA 17103 David Stake 3534 Foxworth Court Buford, GA 30518 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: November 9,2001 Ronald E. John squire 78 West PomtJ e Street Carlisle, P A 013 Phone: 717- 43-0123 Capacity: Counsel for personal representatives 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 JOHNSON RONALD E 78 WEST POMFRET STREET CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 173-03-4490 FILE NUMBER: 21-2001- 0704 DECEDENT NAME: STAKE RUTH C DATE OF PAYMENT: 11/16/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/21/2001 NO. CD 000537 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $83.39 I I I I I I I I TOTAL AMOUNT PAID: $83.39 REMARKS: RONALD E JOHNSON ESQ CHECK#1233 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS \, / 6'- 02~e: - // 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 REY-1547 EX AFP U2-00) Recorc'3 U Re~1jste: DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-14-2002 STAKE 02-21-2001 21 01-0704 CUMBERLAND 101 C RONALD E JOHNSON ESQ-02 ANDREWS & JOHNSON 78 W POMFRET ST CARLISLE JAN 18 P 3 :15 Clerk-'. PACurotD&rla,-;~; ?....."\ t'H RUTH AlIOunt Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY= is'4-j-EX-A FP--fi'2-:ooi--tjoYici-oF-i-NHiifiTANCE-YA i-jrppRA-iiiiiitfr;-ALLOWAifcE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STAKE RUTH C FILE NO. 21 01-0704 ACN 101 DATE 01-14-2002 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 ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 2,695.47 .00 .00 (8) NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYllent. 2~695.47 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 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ 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: (9) llo) 842.44 .00 lll) (12) ll3) (14) 842 44 1~853.03 .00 1~853.03 .00 X 00 = 1~853.03x 045= .00 X 12 = .00 X 15 = .00 83.39 .00 .00 83.39 (19)= PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 11-16-2001 CDOO0537 .00 83.39 TOTAL TAX CREDIT 83.39 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) " i~-045GJ ~/Z) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ReCOf08() Regist~;>; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-14-2002 WERT 05-01-2001 21 01-0757 CUMBERLAND 101 -02 JAN 18 P 3 :1 5 EDWARD P SEEBER ESQ JAMES ETAl 134 SIPE AVE HUMMELSTOWN *' REV-1S47 EX AFP Cl2-00) ALVENA K urt t-::-A Allount Rellitted CterkJ' fA 1 P6~iberk~ ,,,. MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is'4j-ix--AFP--fiz-:ooi--NOTici--o':-XNHiififANCi-y-Air"A-ppR"A-isiiiENT-;-Ail-owANci-ifi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WERT ALVENA K FILE NO. 21 01-0757 ACN 101 DATE 01-14-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 .00 447.434.15 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 8~146.00 8.911.97 (11) (12) (13) (14) NOTE: .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account~ submit the upper portion of this forll with your tax paYllent. 447~434.15 ]7.057 97 430~376.18 430~376.18 .00 (19)= .00 .00 .00 .00 .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 1:, ~,.-- L-J ./ ll( /' L ,,.' v STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ir'U/n tt SIri/<:1!!.- Date of Death: zh/ /01 , , Will No. 2/-~/-07t1Y 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~ 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: tpJ C, a ~p~ Na e (Plea,~ tJ~~p~t) 7/;, M ~I'fi >-r ~ ~p~ A_ _Z~/J Ad ress (7/7) ;<'13 -tile :r Tel. No. (MAH:rmf/AM3) Capacity: Personal Representative ~counsel for personal representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/06/2003 STAKE RONALD E 938 HOUSER ROAD FAYETTEVILLE, PA 17222 RE: Estate of STAKE RUTH C File Number: 2001-00704 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. I, for decedents dying on or after July I, 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: 2/21/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: JFile Counsel Judge , ' cM/~ 16 -~ - 1.:2/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY REV-1500 INHERITANCE FILE NUMBER TAX RETURN RESIDENT DECEDENT 21-01-0704 w <( ~!::(I) 00::" w"-O rOO u g: ~ X "- <( f- Z W C w U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Ruth C. Stake DATE OF DEATH (MM-DD-YY) February 21, 2001 (IF APPLICABLE) SURVIVING SPOUSE'S NAME DATE OF BIRTH (MM-DD-YY) April 22, 1910 1. Original Return o 2. Supplemental Return o 4a. Future interest Compromise o 7. Decedent had Living Trust 4. Limited Estate 6. Decedent Died Testate COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 173-03-4490 THIS MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER D 3. Remainder Return o 5. Fed. Est. Tax Return Req'd _0_8. Total number of SOB's 9. Lit'g'tion Proceeds Rec'd 10. Spousal Poverty Credit 11. Election to tax wi Sec. 9113(A) rnis:l!!@:1@liMl!;ReliUlRlm!illlM$llwMitl!@!l1!1!$1ll!~we!l!!~MiNlll;q~!l1!@$frnOO1:1W#NNfQ~Mltt@N\1W*lnn;l;!i:ni NAME: COMPLETE MAILING ADDRESS: f-- Z w co z o "- <f) w 0:: 0:: o o Ronald E. Johnson, Esquire FIRM NAME: Andrews & Johnson TELEPHONE NUMBER 717 243-0123 z o f= ::5 ;:) f- a:: <l: U w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3.Closely Held Corporation, Partnership or Sole-Prop. 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administration Costs (Sch H) 10. Debts of Decedent, Mortgage liabilities, & Liens 11 . Total Deductions (total lines 9& 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (1) (2) (3) (4) (5) (6) (7) (9) (10) z o ;:: <( f-- :J "- :; o o >< .. f-- 15. Amnt of Line 14 taxable at the spousal rate, or transfers under Sec.9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due $1,853.03 $0 $0 "'::'::'::::':'::::',:,:::,:,::';:,::'::,:::::" :"""",t,;;;,;,;,;,:,;,;,:,;,~;,:":,,~,,,,:;;;::,;,:::,::::. 20 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I;@;;iii!l$c'llllil1jf,w:iIi~!lWg(,jjl,jjWlliijll$lj!!l!l$m!!l'tltM!'i~t:!lIPi!$M~lijlill!lllil!<Ml\f,i'lML", ::.::~::':~:.:.:.... .. Ronald E. Johnson, Esq. Andrews & Johnson 78 W. Pomfret St. Carlisle, PA 17013 FFICIA~ USE ONL1 9 ro Q l..... 15 <: $0.0 $2,695.4;;" $0.0 ~ 0'> () (8) :....'''1 ~:::':,:,~ N ;..~~,695.~ $842.44 $0.00 () .- (11) (12) $842.44 $1,853.03 $1,853.03 x.o_ x.045 x.12 x.15 $0.00 $83.39 $0.00 $0.00 $83.39 (15) (16) (17) (18) (19) Dec';-dent's Complete Address: STREET ADDRESS Shippensburg Health Care Center 121 Walnut Bottom Road CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts (1) Total Credits (A+B+C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 4. Totallnterest/Pentalty (O+E) If Line 2 is greater than Line 1 + Line 3, enter the difference This is the OVERPAYMENT Check box on Page 1 Line 20 to request a refund (3) (4) 5 If 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 + SA. This is the BALANCE DUE. Make Check to: REGISTER OF (5) (5A) (58) $83.39 $0.00 $0.00 $83.39 $83.39 AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and" yes no a. retain the use or income of the property transferred b retain the right to designate who shall use the property transerred or its income c retain a reversionary interest: or d retain the promise for life of either payments 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 disignalion? D D D D D D D ~ ~ ~ lD ~ ~ ~ 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 perjury, I declare that I have examined this return, including accompanying schedules arod statsmerots, arod to the best of my knowledge arod belief, it is true, correct arod complete For dates of death on or after July 1, 1994 arod before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72PS Sec 9116(a)(1.1){I)J For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUlViving spouse is 0% [72 P.S. Sec. 9116(a)(1, 1)(ii)] The statute does not exempt a trarosfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the sUlViving 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 deseased child tweroty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S, Sec. 9116(a)(1 ,2)] The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P,S Sec.9116(a)(1.3)]. A sibling is defined, under Section 9102, as an The tax rate imposed on the rletvalue of transfers to orforthe use of the decedent's lineal beneficiaries is 4.5%, except as rooted in 72 P,S, Sec. 9116(1.2) [72 P.S. Sec,9116(a)(1} individual who has at least one parent in common with the decedent, whether by blood or adoption SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Ruth C. Stake 21-01-0704 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH PSERS-insurance premium refund $560.50 2 Shippensburg Health Care Center-refund $1,191.52 1 Shippensburg Health Care Center-patient account $875.8] .j PSERS-final pension payment $67.64 TOTAL (also online 5, Recapitulation) $2,695.47 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Ruth C. Stake 21-01-0704 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) A. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: I Martin L Brown Funeral Home, Inc. -balance of funeral expense $238.44 2 Administrative Costs: I Personal Representive Commissions Social Security Number of Personal Representative: 2 Attorney fees to Andrews & Johnson $350.00 3 Family Exemption Claimant Relationship: Address of Claimant at decedent's death: Street: City: State & Zip 4 Propate Fees to Register of Wills $39.00 Miscellaneous Expenses: I Register of Wills-P A Inheritance Tax Return - filing fee $15.00 2 Reserve for closing and accounting $200.00 3 4 5 G 7 8 9 ]() 11 TOTAL (also on line 9, Recapitulation) $842.44 B. c. SCHEDULE 1 BENEFICIARIES ESTATE OF FILE NUMBER ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE 1 Linda R. Roher 450 Hillcrest Drive, Carlisle, P A 17013 daughter one-third 2 Ronald E. Stake 938 House Road, Fayettville, PA 17222 son one-third 3 David Stake 3534 Foxworth Court, Buford, GA 30518 son one-third Ruth C. Stake 21-01-0704 ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0 WILL I, RUTH C. STAKE, presently residing in the Borough of Saltillo, County of Huntingdon and Commonwealth of Pennsylvania, my post office address being Saltillo, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my last Will, hereby revoking and making void all former Wills and Codicils thereto by me at anytime heretofore made. AND FIRST: I hereby order and direct that the costs of settlement of my estate, the medical and funeral expenses, my just debts and all the inheritance, estate, transfer or succession tax or taxes due on my entire estate be paid out of the residue of my estate as soon as may conveniently be after my decease. SECOND: I hereby order and direct my Executor, hereinafter named, to purchase and have erected a suitable monument at my grave. THIRD: All the rest, residue and remainder of my estate, real, personal and mixed, of every nature and kind and wheresoever situated, I give, devise and bequeath absolutely unto my beloved husband, Edgar C. Stake, Saltillo, Pennsylvania. FOURTH: In the event that my beloved husband, Edgar C. Stake, should predecease me or in the event that we should die at the same time, then I give the following orders and directions, make the follow- ing appointments and dispose of my entire estate as follows: 1. I hereby order and direct my Executors, hereinafter named, to execute the directions contained in the first paragraph of this, my last Will, and I further order and direct that the funeral expenses of my beloved husband, Edgar C. Stake, be paid out of my estate if they have not been previously paid. 2. I hereby order and direct my Executors, hereinafter named, to execute the directions contained in the second paragraph of this, my last Will, and I further order and direct that a suitable monument be purchased and erected at the grave of my beloved husband, Edgar C. Stake, if such monument has not been previously purchased and erected. 3. In the event that any of my children are under the age PAGE I .~~e,~ of twenty-one (21) years at the time of my death, I hereby nominate, constitute and appoint my son, Ronald E. Stake, to be testamentary guardian of the person or persons of such minor child or children to serve during his, her or their minority. 4. All the rest, residue and remainder of my estate, real, personal and mixed, of every nature and kind and wheresoever situated, I give, devise and bequeath absOlutely, in equal shares, unto my three (3) children, Ronald E. Stake, Linda R. Stake and David A. Stake. 5. In the event that any of my said children are under the age of twenty-one (21) years at the time of my death, I hereby nominate, constitute and appoint my son, Ronald E. Stake, to be testamentary guardian of the estate or estates of such minor child or children to serve during his, her or their minority. LASTLY, I hereby nominate, constitute and appoint my beloved hus- band, Edgar C. Stake, to be the Executor of this, my last Will. In the event that he should predecease me, or in the event that we should die at the same time, or if for any reason he should be unable or un- willing to serve as my Executor, then I hereby nominate, constitute and appoint my son, Ronald E. Stake, and my daughter, Linda R. Stake, to be the Executors of this, my last Will. I hereby expressly direct that my Executor or my Executors, as the case may be, shall be excused from filing any bond or bonds in the administration of my estate. IN WITNESS WHEREOF, I, RUTH C. STAKE, the Testatrix, have to this, my last Will, typewritten on one side only of two (2) sheets of paper, to the first sheet thereof having subscribed my name for the purpose of identification, subscribed my name and affixed my seal this 010:{ ~ . day of September, A.D., 1961. ~~.~ Ruth C. Stake (SEAL) PAGE II Signed, Sealed, Published and Declared by the above named RUTH C. STAKE, as and for her last Will, in the presence of us, who have here- unto subscribed our names at her request. as witnesses thereto, in the presence of the said Testatrix and of each other. d+~ '-8~ tv, .jJ~ Name ~J?J. ~. Addresi <; - , ~,IZ Ad ress /