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Home My WebLink About01-0725 Estate a/Dorothy L. Klin2er Also known as PETITION FOR PROBATE and GRANT OF LETTERS No.: :lJ-D l-{) 'I ~S To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania , Deceased Social Security No. 207-03-0452 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the exectors named in the last Will of the above decedent, dated February 21,1992 and codicil(s) dated None. (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at Manor Care, 940 Walnut Bottom Road, Carlisle, Pennsylvania 17013. (list street, number and municipality) Decedent, then ei2hty-one (81) years of age, died July 17,2001, at Manor Care, 940 Walnut Bottom Road, Carlisle, Pennsylvania 17013. 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: _ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania Situated as follows: None. $ 42,000.00 $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last Will and codicil(s) presented herewith and the grant of letters Testamentar . (testamenta mi istration c.t.a.; administration d.b.n.c.t.a.) i~~I(~ enneth E. Klin2er 59 Paradise Park New Bloomfield, P A 17068 thereon. "0 l.- eo_ <<1_.n -;;-~I:" _uu U Co) e ... C 0 ~.g :g C't;; u ClOuQ., Ci5~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYL VANIA } } ss COUNTY OF CUMBERLAND } The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief ofpetitioner(s) nd that as personal representative(s) of the above decedent petitioner(s) will well and truly administer estate according to I Sworn to or affirmed and subscribed before me this 3rd day of Au~s~, 2001. ] I /602C/Y-5 No. 21-01-0725 Estate of Dorothy L. Klio2er, Deceased DECREEE OF PROBATE AND GRANT OF LETTERS AND NOW, August 6th , 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 February 21st,] qq? Described therein be admitted to probate and filed of record as the last Will of DGrothy L. Kline;er; and Letters Testamentary are hereby granted to Garv L. Kline;er and Kenneth E. Kline;er. FEES Probate, Letters, Etc. ......... .$80 . 00 Short Certificates (5) ..........$ ~ Renunciation... ...... ...... ....$ x-Pages (2) $ 6.00 JCP TOTAL $ 5.00 $106.00 Filed . .~':l~~t.. .~~~! .?q~~. . .,. ... ... 352 S. Sporting Hill Road, Mechanicsburg, PA 17050 ADDRESS 717-737-2033 PHONE MAILED LE'I'TERS TO GARY KLINGER 05.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Re;gistrar, The original certificate will be forwarded. to the State Vit~t~ecords Office for permanent flling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7555264 No, 21-01-725 ~4~~~A.U~ ~J~ Local Registrar 0 ;}J7 If ~CJ61 Date t1\OS.;4.] Rev 2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ST.4QE FIlE NO_R SOCIAL SECURITY NUMBER TYPfJI'RINT IN PERMANENT BLACK IHK NAME Of DECEDENT If".. MoOdIe. L", SEX a. Female I. lIHOER 1 YEAR - Oap IIlftTHPlAClIColy...'O PlACE Of CEIITH ,C_k or>Iy """ u _ ,n$l."",,,,,.. on.- _I :iUlaorfcle.qnCOlJ#lJIy, HOSPITAl. 1111*_ 0 ... eel and I'lUf1\OefI =...,0 .... Cumberland Ie. DECEllE'O"S USUAL OCCUPRION (~':,,~~::..a::.:::zt~ . It.. Telephone operator nb. DECEDEHT'S MAILING ADORESS (SIt.... CIIyITown. Stall. Z~Codel Health Care DECEDENT'S ACTUAl RESIDENCE tSee_ on '*'-' SlOe) Pennsvlvania 17L Sa... ~ 3. 207 03 4. July 17,2001 RACE . _Indi.n. iliac>. _. Ole (Spec;.fyl 10. White MARITAl STATUS. M_ __.... WidowM. o.-c.d ISpeciy) Widowed SURVIVING SPOuSE 1M ....., g.ve ma.oen name) 14. "c.O YeI,___in 119 North York Street 'IL Mechanicsburg, Pennsylvania 1705 FATHfIl'S NAWE (FilS'. M_ La.., 111>. ColIn Did - MlAa Cumberland --"1 17t1./XI ::"'*::'::'.. MOTHER'S _IF..I. _. "'_ Surnamel Clly- I.. INFOfIMANT'S_ (lypetP....1 Hazen Bingaman Sr, ~ Mechanicsbura Gary L. Klinger 1.. Elinor Hudson 1NF000000ANT'S MAIUNO ADOflESS 1SIt_ C4yiT1Mn. _. Z'op CadeI . 119 North York Street Mechanicsbur Pa. 17055 PlACE OF DISPOSITION. Nemo uI c.~. C'.1NlliIy lOCAl1ON . CttrfIOwn. Scal., r.. c..... Of 01'* PIK. DATE PRONOUNCED DE!.!> ,M""lh. Day. ""'at) 24. . 1:20A.M. M as. July 17,2001 21. PART I: En.., the diM..... iniuries. or wmpIecallOna which cawed ltwt dealh 00 not enter the moo. ot dymg, such as cardiaC' Of ,esc.,a'O/Y MI"" shock Of heatt la..... llll ""'" ONI cauao on Hdlline . ~tfe.~~~,:(r:t I c ~~ACONSEauENCEOF) ~ DUE 10 (OR AS A CONSEQUENCE OF) .. ~ 5l o UI o (; UI :I . z Ll,(t.2II,;;..l 2001 lICENSE NUMBER FD-012662-L WERE AUTOPSY FINOINGS IMNNER Of CEIITH ~e PRIOR 10 COMPlETION OF CAUSE ~ 0 OF DEATH? Natural Horn....... Ace....'" 0 P."""", __1OI'l 0 V.. D NoD Sure.... 0 Coutd not be del.rml....d 0 DATE OF INJURY (Moo"'. Day. "'atl Lewistown, Pennsylvania :It. . AjJj)rolWn"'. '-- :__dllIII I l ~ PART N; 0lIw0r .'9f'iIIcant _CCIlIt-inG 10 _. 1M _ ruulIing in "'" ~ _ gMn in I'iUrT I TIUE OF INJURY INJURY AT WORK? IlESCRIIIE HOW lNJURYOCCU/IftED. _ D NoD at. PlACE OF INJURY - AI home. 101m. ",-. 'utOty. alfie. bu*linv. Me ISpec.v) JOe. M. _. 2.... CERTIFtl:R tCl'eck onironel .CEftTIf"VING PHY&JCIAN (Ph,SIC..an Cef~ ~se '" dealtl ~ ,al"lottl8f ptws.coal\ has ptOllOllnced decun ano COO\lkle<:llll~n 23) To the beet 01 m, know~, de..... OCCUR............. c.uH(a).nd manMr .. ._.lM . PfIONOUHCING AND aRT "'r1NG PHYSK:JAN IPh~ldI"l tloU1 pt QrlOuOC"'9 cJe61t1 df\d Cetllly.ng 10 cause of aealtl\ To 11M beat ot my knowte4g., d..'" occurred at the tIInII. etat., And place. and due '0 th. cau.,(s) and mann.,.. a'ated.. 'MEDICAL EXAMINER/CORONER On lhe b.... 01 ......in.,lon tiIdIot 1n"".lIga_. in mr opinion. dulh occ;u""d allh"Um., dal., and place, and du.IO Ihe c.uM(al.nd manne, .a .t.teO.. . . . . . . . . _ _ . . .. . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. o :s.. ~ ~/.- O/-O'~" LAST WILL AND TESTAMENT OF DOROTHY L. KLINGER I, DOROTHY L. KLINGER, of the Township of Hampden, County of Cumberland, and state of Pennsylvania, being in good bodily health and of sound and disposing mind and memory, and not acting under duress, menace fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing of my worldly goods while I have the strength and capacity so to do, I do make, publish and declare this my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my Executors hereinafter named pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that I be buried in a lot which I own, situate at Juniata Memorial Cemetery, Lewistown, Pennsylvania. ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and in fee, to my dearly beloved Children, GARY L. KLINGER and KENNETH E. KLINGER, share and share alike, per stirpes. ITEM 4. I nominate and appoint GARY L. KLINGER and KENNETH E. KLINGER as Co-Executors of this my Last Will. ~L~ DOROTHY L. KLING 1 . .. ~ ITEM 5. I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passes under this Last Will, shall be paid by my Executor out of my residuary estate. ITEM 7. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. ~ :it Pr DOROTHY L. KLING -------------------------------END------------------------- 2 - ---,..>';..... .......,~,~-~.".,.....-..........,........, .,.--........ ,,-,............'......... ~ : COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, DOROTHY L. KLINGER ,TESTATRIX, whose:! name> i:) signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that T signed ~t~willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn or affirmed to and acknowledged before me, by DOROTHY L. KLINGER , the TESTATRIX, this 21st day of February , 1992. ~ ~--_._---------- ARY PUBLIC 1 chanicsburg, PA y Commission Expires: ----- :.~:-,;., NOT M=: l,1J '- S Ei~~. ATIORNr-" i 1\ 4A!:"S ~, ", "., . - I ;-',""h.. . ,,Ii. (i~\l.I~. rL!fnry Puollc C~r~;tH>rI3n~ c,~:;.)~, My Cllitini~sl;,~ E;z~,;'~~ h:hl B. 1995 -.........-.-.- The preceding instrument consisting of thi~ Jjld two (2j o the r t y pew r i t ten p age s ,id e n t i fie d by t 11 e :3 i 9 n a t lH (\ 0 I: t. h TESTATRIX, was on the date thereof signed, publish('cl and declared by DOROTHY L. KLINGER _, the 'I'Es'rl\TRIX th(~rcin 1l:HliC'd as and for her LAST WILL AND TESTAMENT. - - ~~~OL GLADY B. S RAMELL I Re sid in gat 35,2 S. S po r tin 9__!~_~_l:~__..!~.~?~(1 Mecha~nicsburg, P_~__.....:~_?~~_? ~~ CHRIS FORTI Residing at 352 S~ Sporting Hill RQ~~1 'Mec~anicsburg, FA 17055 A F F I D A V I T COMMONWEALTH OF PENNSYLVANIA ) t ) ) ss COUNTY OF CUMBERLAND 11ft;' We GLADYS B. SPRAMELL I and CHR I S F:bRTI , t.he witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw TESTATRIX sign and execute the instrument as her LAST WILL~ that she signed willingly and that she: executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the TESTATRIX signed the WILL as witnesses; and that to the b(~:;t of nul" knowledge the TESTATRIX was at the time 18 or more years of aqc / r:> sound mind and under no constraint or undue influence. S W 0 r n o,r a f fir me d to and sub s c rib e d to be for e Tn p h '/ GLADYS B. SPRAME"LLI and CHRIS FORTI , wlt:.nc::;sc~j, t:.hi --.2Ls.t day 0 f February , 19 n. r:---.----.-.--- .-- _ !' ;.~" . ~: \It.! ~i}; ~'i : ,} '_, ::: ~~.\,:" . . AT I v, ,".' ~",,, """ "'C' 0"0' "0 ..... ..., '.\,'j" ,I ',", t..-,. J I"" 11 :~1~~~~~(:<~_~ .:-~~'~_n "j. J995 ~~- Y PUBLIC anicsburg, PA Commission Expires: 3 ."- b -.,. -~. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dorothy L. Kline;er Date of Death: July 17,2001 Will No.: 2001-00725 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 AU2ust 7, 2001: Name Address Gary L. Klinger 119 N. York Street Mechanicsburg, P A 17055 Kenneth E. Klinger 59 Paradise Park New Bloomfield, P A 19068 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except (None). Date: August 7, 2001 Name: James M. Bach, Attorney-at-Law Address: 352 S. Sporting Hill Road Mechanicsburg, P A 17050 Telephone: 717-737-2033 Capacity: 0 Personal Representative I:8J Counsel for Personal Representative .~ -',. IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION f ----- THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of Dorothy L. Klinger, deceased, Estate No. 2001-00725 (Name and Address) TO: Garv L. Klinger 119 N. York Street Mechanicsburg. P A 17055 Kenneth E. Klinger 59 Paradise Park New Bloomfield. PA 19068 Please take notice of the death of decedent and the grant of letters to the personal representative( s) named below. Gary L. Klinger, 119 N. York Street, Mechanicsburg. PA 17055 Kenneth E. Klinger, 59 Paradise Park. New Bloomfield, PA 19068 The Decedent Dorothy L. Klinger, died on the 7th day of July. 2001, at Manor Care, 940 Walnut Bottom Road, Cumberland County, Carlisle, Pennsylvania. [gJ The Decedent died testate (with a Will); or D The Decedent died intestate (without a Will). The personal representative(s) of the Decedent is: Gary L. Klinger Kenneth E. Klinger If the Decedent dies tesiate, the Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013. Phone 717-240-6345. If the Decedent dies intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, I Courthouse Square, Carlisle, P A 17013. Phone 717-240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Signature: ~4 ~ Name: Jam s M. Bach. Attorney-at-Law Address: 352 S. Sporting Hill Road Mechanicsburg, P A 17050 Telephone: (717) 737-2033 Capacity: D Personal Representative [gJ Counsel for Personal Representative Date: August 7, 2001 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 BACH JAMES M 352 S SPORTING HILL ROAD MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SSN: 207-03-0452 FILE NUMBER: 21-2001- 0725 DECEDENT NAME: KLINGER DOROTHY L DATE OF PAYMENT: 1 0/ 1 1 /2001 POSTMARK DATE: 10/10/2001 COUNTY: CUMBERLAND DATE OF DEATH: 07/17/2001 NO. CD 000370 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,267.42 I I I I I I I I TOTAL AMOUNT PAID: $1,267.42 REMARKS: GARY L KLINGER & KENNETH E KLINGER C/O CHECK#106 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ,/b-c21/c?- 6~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RecoraecJ of Register of VViHs .01 NOV 30 P 3 :21 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-26-2001 KLINGER 07-17-2001 21 01-0725 CUMBERLAND 101 JAMES M BACH ATTY 352 S SPORTING HI~..~f'-'..".. /..', MECHANICSBURG I.. .... -'.'jl. \.~,ourt 'rlana Co.. PA * REV-l!i47 EX AFP n2-00> DOROTHY L Allount 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=[s4-j-ix-AFP--fi"2=O(.-r-No'fici--oF-'rNHiiiiTANCE-Y-AX-APPRAisiiiENT~--Ai.i-oWAi'-cE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KLINGER DOROTHY L FILE NO. 21 01-0725 ACN 101 DATE 11-26-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED 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 (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 41.206.00 .00 .00 (8) 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 Subject to Tax (9) (10) 13,041.14 .00 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 41,206.00 13 041 14 28,164.86 .00 28,164.86 NOTE: 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 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) .00 X 00 = .00 (16) 28,164.86 X 045 = 1,267.42 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 1,267.42 PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 10-10-2001 CDOO0370 63.37 1,267.42 TOTAL TAX CREDIT 1,330.79 BALANCE OF TAX DUE 63.37CR INTEREST AND PEN. .00 TOTAL DUE 63.37CR . 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.) \../6 - (;2y?- 0-- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-16D7 EX AFP (12-DDJ ReCOfCh;- .. Rf)rjj-,t~::,;- of DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-31-2001 KLINGER 07-17-2001 21 01-0725 CUMBERLAND 101 DOROTHY L JAMES M BACH ATTY 352 S SPORTING HILL RD MECHANICSBURG PA Ort.58 Cwnberj",' , .02 FEB -1 P 1 :44 Allount Rellitted , FA. MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE} PA 17013 NOTE: To insure proper credit to your account} subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=ir;ifj-EX-AFP-li'2-:oii'r------...--iNHERii'-ANC'E--YAX-STAfEM'E-NY-OF-ACCouiff--.-..--------------------- ESTATE OF KLINGER DOROTHY L FILE NO.21 01-0725 ACN 101 DATE 12-31-2001 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE} APPLICATION OF ALL PAYHENTS} THE CURRENT BALANCE} AND} IF APPLICABLE} A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-26-2001 P R I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 1}267.42 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-10-2001 CDOO0370 63.37 1}267.42 12-17-2001 REFUND .00 63.37- TOTAL TAX CREDIT 1}267.42 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE} SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1} NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR)} YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) Q STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy L. Klinger Date of Death: July 17,2001 Will No.: 2001-00725 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: [8J Yes 0 No 2. If the answer is to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? DYes [8J No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? [8J Yes 0 No c. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repo . James M. Bach, Attorney-at-Law Name (Please type or print) Date: October 9,2001 352 S. Sporting Hill Road, Mechanicsburg, PA 17050 Address 717-737-2033 Phone No. Capacity: Personal Representative x Counsel for Personal Representative .., REV.1500EX(6-OO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I {, - ;. '-I [?~5 REV-1500 OFFICIAL USE ONLY <1 .? C- w .... ",:$., u"'''' w"U ,,00 u"'... .... .. "" I- Z W C W () W C ... z w o z o .. ., w '" '" o u z o ~ :J l- ii: <( () w a: z o !;( I- :J a.. :iE o () ~ FILE NUMBER d I -~.L COUNTICOOE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT 12.flZ2..5 NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Klinger, Dorothy L. DATE OF DEATH (MM-DD-YEAR) DATE OF 61RTH (MM-DD-YEAR) July 17,2001 March 11, 1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 207 03 0452 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [X] 1. Original Return D 4. Limited Estate D 6. ~ecedent Died Testate (Attach copy of Will) D 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale 01 death aller 12.12.82) o 7, Decedent Maintained a living Trust (Attach copy 01 Trust) D 10. Spousal Poverty Credit (date ofdealh between 12.31.91 and 1-1-95) o 3. Remainder Return (dale of death prior to 12.13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Allach Sch 0) M. Bach, Attorney-at-Law FIRM NAME (If Applicable) 52 S. Sporting Hill Road echanicsburg, PA 17050 TELEPHONE NUMBER 717-737-2033 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or Sole~Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 41.206.00 (6) (7) (8) 41,206.00 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 13,041.14 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Une 8 minus Une 11) (11) 13,041.14 (12) 28,164.86 (13) (14) 28,164.86 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 28,164.86'012. (16) 1,267.42 x .12 (17) x .15 (18) (19) 1,267.42 16. Amount of Line 14 taxable allineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,-(,', ," ., ," 'h'.l"/ '> ...BE SURE TO ANSWER'Au. QUES110NS oil' REVERS 'SIDE'AoNDRECHECK MATH < < .'.~:; J "lit'~'~ " '"'",, Decedent's Complete Address: STREET ADDRESS Manor Ca CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount ZIP 17013 Total Credits (A + 8 + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, ~heck box on Page 1 Line 20 to request a refund (4) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (5) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE. (SA) (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a, retain the use or income of the property transferred;.............................................................. .......................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or. ............... .................. ..... .......... ............................ ..,.. ................. ....................... D d. receive the promise for life of either payments, benefits or care? ........................................................m........... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ ......................................... ................................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 No H e H u e @: fl 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 pe~ury, I dedare thai I have examined this retum, including accompanying schedules and staleme . and 10 the best 0 Declaration of preparer other than the personal representative is based on all inlonnalion of which preparer has nowledge. d belief,it is true, correct and complete. SIGNATURE OF PERSON RESPONSI8LE FOR FILING RETURN DATE Gar L. Klin er & Kenneth E. Klin e -.'/-#--- it ADDRESS (Gary) 119 N. York St., Mechanicsbu , (Kenneth) 59 Paradise Park, New Bloomfield, SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE James M. Bach Attorne at-Law ADDRESS 352 S. Sportinq Hill Road, Mecha icsbura. PA 17050 _._. . For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even jf 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 10 or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed 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. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rale imposed on the nel value of fransfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individuai who has at least one parent in common with the decedent, whether by blood or adoption. "'~"<X"''''.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Dorothy L. Klinqer Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC Bank Checking Acct. #50-7009-6418 22.370.73 2. PNC Bank Money Market Acct. #50-0062-7789 7.089.77 3. PNC Bank Certificate of Deposit #31500049535 5,013.15 4. . 'M&T Bank Certificate of Deposit #15004201164081 6,732.31 TOTAL (Also enteron line 5. Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 41 2n" - REV.151lEX.ll.87j *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Dorothy L. Klinger Debts of decedent must be reported on Schedule I ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. Myers Funeral Home 2,586.24 2. Juniata Memorial Park (Headstone) 190.00 . . B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Seo.Jlity Numbe~s) I EIN Number of Personal Representative{s) Street Address City State Zip Yea~s) Commission Paid: 2. Attomey Fees - James M. Bach, Attorney-at-Law 2,742.00 3. Family Exemption: (If deoedenfs address ~ not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 121.00 5. o Accountanfs Fees 6. Tax Retum Preparers Fees 7. Manor Care (5 days leave Charge) 1,000.00 West Shore Anesthesia (Catarac Surgery) 87.75 Beacon Medical Group (Expense not cov. by insurance) 1,181.00 West Shore EMS (Wheelchair van) 470.12 PNC Bank (Check printing fee) 14.99 Patriot News (Legal advertising) 107.67 Cumberland Law Journal (Legal advertising) 75.00 SCCI (Payment from Blue Cross) 4,462.00 PNC Bank (Interest withheld) 3.37 TOTAL (Also enter on line 9, Recapitulation) $ 13,041.14 .. . (If more space IS needed, Insert additional sheets of the same sIZe) REV-1513EX+,i'.97) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy L. Kl1nqer NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Gary L. Klinger 2. Kenneth E. Klinger FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Son AMOUNT OR SHARE OF ESTATE 50% 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. 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)