HomeMy WebLinkAbout01-0726
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of. ~o~c..e.. :j( I S': .......tt'~'" S-
a/so known as
No.
To:
21-01-726
Register of Wills for the
1 Deceased. County of in the
Social Security No. /7 if - 3 () - ~ \ s:- Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
co] /
Your petitioner(s), who is/are 18 years of age or older an the execut o-r l r DC;
in the last will of the above decedent, dated Oc.. ; () ~q,.- \ ~
and codici1(s) dated
named
,19~
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (' \oJ """ b e- j Ca ~ I 1:> County, Pennsylvania, with
h ~.- last family or principaLresid~nce at ~.s -Ie. "'I J t'., ('14....- (, 1.. {~ > P A-
_ '( {) ) "'\ S\ I 'V~ ~ (f'r,t' 1-'1 \ IN P ~
(list street, number and muncipality)
8:3
Decendent, then
at
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:
years of age, died
oJ v lj
~<il
~o, ~
,49:
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:
$ r,~ () ~0. 1)0
$
$
$ J OS) 00'0 ~o
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters -+ t's -\0 ~ ~Q~4 4.~
(testamentary; a ntstratlon c.t.a.; admlntstratlon d.b.n.c.t.a.)
theron.
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OATH OF" PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1..ss
COUNTY OF C 0-1","", ~ ~ 1 ft<Ao. J J
The petitioner(s) labove-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 well and truly administer the estate according to law.
affirmed and
3rd
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~o. 21-01-726
Estate of .) <:> ~ ~ ,"- ~. S'. w-.. .... 0 !) s , Deceased
DECREE OF PROBATE A~D GRANT OF LETTERS
AND NOW AUGUST 6 ~200 1 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated October 12. 1991
described therein be admitted to probate and filed of record as the last will of
JOYCE R SIMMONS
TESTAMENTAR Y
WALTER L SIMMONS AND SUSAN A ECKERT
and Letters
are hereby granted to
FEES
t'J ~rr 7 ~9
Probate, Letters, Etc. .........
Short Certificates( )..........
x-page~
RenuncIation
Copies
JCP
$ 235.00
$ 3a.OO
3.00
................ $
$ 2.00
5.50
TOTAL _ $ 275.00
. . . . 6~.Q3'7 209.1 . . . . . . . . . . . . . . . . . . . .
-:) A TIORNEY . 1.0. No~
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ADDRESS
Filed
~~ -\- 9(;.'8
PHONE
~~~
.:
REGISTER OF WILLS OF Cl?~ 1~",I(Jo/ COUNTY
OATH OF SUBSCRIBING WITNESS
Sworn to or affirmed and subscribed before
me this day of
19_
ified according to
present and saw
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly
law, depose(s) and say(s) that
the testat , sign the same and that
request of testat_ in h presence and (in the prese e
other subscribing witness(es)).
signed as a witness at the
each other) (in the presence of the
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF CV wv---h Q;r JOr,/\ / COUNTY
OATH OF NON-SUBSCRIBING WITNESS
,$ t/SA-/J ;J. ~
).. IE t.V I S oS ,)+1. n-JO;U S
(each) a subscriber hereto, (each) being duly qu lified according to law, depose s) and say(s) that
d/ e t1 r e- familiar with the signature of ., JI\ ~
O;;-~P
will
presented herewith and
codicil
believes the signature on the will is in the handwriting of
\:[;; yt e- ;(,$r/?! /J1 C /J -5
/
to the best of tJ r./ r knowledge and belief. /J
Sworn to or affirmed and subscribed before ttJtl)~ ~ c{::~",.~. ._~
me this 3rd day of (Name)
~_AUG~_ 1'9'2001 I!b::JI./ ~oX 010%';= 's~/.v h /71:106
/'/7T'-~ ~a~:Jf~/,,~r
1/3' ; / (Nf1J1'e~ / /)
'7, I/t? //11 r),/ J V/ft/// lJr: L:4A/) Is Ie / /f /7c / ~
/ / I
(Address)
testat~ of (one of the subscribing witnesses to) the
W4.. (+c- L. S.... ......."'" 0 ...... 1
that.f'.J.s~", A ~0J:-tW-+-
~
, REV 888
FE" FOP THI~
3200
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 4900885
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~~-,,'T/MENT \\\ " 11.1\
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1-31-01
Date 01 Issue 01 This Certilication
Name of Decedent
.:h'tG
F:r st fJ1./
A
~\1Iddlf'
d7IU /fAOWS
Last
Sex ____J .. Social Security No. _/7L~ - 3;215
Date of Birth __~),D -1'6 __ Birthplace /L1A~Uk ,It
Place of Deat~f5f~ ~T/fJL ~!!!~--u./f 1../0 co>, '''o~/f!!d5,f.C
Race_W_~l[cf____Occupation /k7lO &IJ6 _ _~______ Armed Forces? (Yes or No)
Decedent's ,L;'\ /'1 ~
Marital Status &A)JOfYJe!) Mailing Address d./J r)IN~S V~ u'/WUAS/A:: rl1-/'7{)/3
Nur~ber Stret't City or lowr, State
Informant.J#lLLTd L-_~MM()JC/S Funeral Director __.-1JdfCt//t-U J Stl/JiOIVI~
Name and Address of ~IILI Ctf ~ " / ~
Funeral Establishment ~~ONJ& "'O~ NIJP{E ~ /vllJt.~..ihLL€., /11
Date of Death
'1-)..[-01
Pennsylvania
Part I:
Immediate Cause
GIJ..U $T~ ~j\I(J~7II'S
(a)
I
I Interval Between
: Onset and Death
~~iu--
(b) ~_______
(c)
(d)
Part II. Other Significant Conditions
Manner of Death
Natural ~ Homicide
Accident 0 Pending Investigation
Suicide 0 Could not be Determined
Describe how injury occurred:
o
o
o
Name and Title of Certfier ~~ S CA&LlhdL
Address ~ !Nf:}UVUT bJ11cH ~ Cf/eUJkf, ti /'10/3
(M.D., D.O., Coroner, M.E.)
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. T e original c tifi te will be forwarded to the
State Vital Records Office for permanent filin
_1~JI~1 .
~; :'f:~ ~)pU", ,,,"I 0') :_OCi11 Rqgl;;;JrJI
(;;i y', GO! )l,ijh, T UV,I13hlP
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'1
21-01-726
1lIttst mill ttn~ (Ile$t~m1?ttt
of
JOYCE R. SIMMONS
I, JOYCE R. SIMMONS, of the Township of Silver Spring,
Cumberland County, pennsylvania, declare this to be my Last
Will and Testament, hereby revoking and making void all Wills,
Codicils, or Writings, in the nature thereof by me at any time
heretofore made.
ITEM I. I direct that the payment of my debts and the
expenses of my last illness and funeral sh~ll be paid from my
estate as an administrative expense as soon after my death as
conveniently may be done.
ITEM II. I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever
jurisdiction imposed, shall be paid as part of the expenses of
the administration of my estate.
ITEM III. I specifically give, devise, and bequeath to
WALTER D. SIMMONS, my grandson, ten thousand ($10,000.00)
dollars; to DEBORAH M.HOWELLS, my granddaughter, ten. thousand
($10.000.00) dollars; to LINDY R. WARNER, my granddaughter,
ten thousand ($10,000.00) dollars; to DENNIS R. ECKERT, my
grandson, ten thousand ($10rOOO.00) dollars; and to KIMBERLY
D~ SIMMONS, my granddaughter, ten thousand ($10,000.00)
dollars, per capita.
ITEM IV. I give, devise and bequeath all the rest,
residue and remainder of my estate, real, personal and mixed,
of whatever nature and wheresoever situate, of which I shall die
seized, or to which I may be entitled, or over which I shall
possess any power of appointment by Will at the time of my
decease, whether acquired before or after the execution of this,
my Will, to my son, WALTER L. SIMMONS, and my daug"hter, SUSAN A.
Page 1 of 2 pages.
~~"Lf. ../~JiSEAL)
J R. SIMMONS .
..
~,.
..
ECKERT to share equally, evenly, absolutely, in fee simple and
per stirpes.
ITEM V. I appoint my son, WALTER L. SIMMONS and my
daughter, SUSAN A.ECKERT, Co-Executors of this my Last Will and
Testament.
ITEM VI. I hereby give full power and authority to my
Co-Executors to compound, compromise, settle and adjust all
claims and demands in favor of or against my estate; to sell
and dispose of any or all of my estate, real or personal or both,
for such prices and upon such terms of credit or otherwise, and
in such manner as my said Co-Executors, deems best, without an
Order of Court, at private sale if he/she sees fit, and to furnish
and deliver to the purchaser or purchasers all necessary or proper
deeds and other instruments of conveyance and transfer thereof.
ITEM VII. I request that no bond or other security shall be
required of either Co-Executors acting hereunder for the faithful
performance of his/her duties, any law of any state or jurisdiction
to the contrary notwithstanding.
ITEM VIII. It is my desire that the Co-Executors retain
GALEN R. WALTZ, Esquire, as attorney for my estate.
IN WITNESS WHEREOF, I have set my hand and seal to this my
Last Will and Testament consisting of this and one (1) other
page, at the end of which I have also set my hand and affixed ~
seal for greater security and better identification, this _~~
day of October, 1991.
~~-J;/HJ/~
J; c' R. SIMMONS
~ve, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published, and declared by the above-named Testatri:;c as and for her
Last Will and Testament, in the presence of us, who, at her request ill1d in her
presence, and in the presence of each other, have hereunto set our hands and
seals the day and year above written, and we certify that at the time of execu-
tion thereof, said Testatrix was of sound and disposing mind and memory.
(SEAL)
Residing at JJ7.34 ~u~~JI.
/)
ref-
~
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent
Date of Death
Will No.
Joyce R. Simmons
July 28. 2001
2001-00726 Admin. No.:
To the Register:
I hereby certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on August 23,2001.
Name
Address
Walter L. Simmons
R.D. #1. Box 208F. Blain PA 17006
Susan A. Eckert
43 Harmony Hall Drive. Carlisle. P A 17013
Dennis R. Eckert
173 Beetem Hollow Road. Newville. PA 17241
Deborah M. Howells
90-5 Lancelot Avenue. Mechanicsburg. P A 17055
Lindy R. Warner
2 Shoemaker Lane. Mechanicsburg. PA 17055
Walter D. Simmons
54 Cold Springs Road. Dillsburg. PA 17019
Kim D. Rusch
10 Autumn Drive. Morristown. NJ 08057
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
-
Date: Augusr23,2001
'~f)~ d GMAb:J
19nature
Name Donna L. Godfrey, Esquire
Address P.O. Box 744
Carlisle, P A 17013
Telephone (717) 701-4038
Capacity: Personal Representative
X Counsel for Personal
Representative
Document #: /94830.1
IN RE: Estate of Joyce R. Simmons : IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA ,.
: REGISTER OF WILLS
: No. 01-726
PRAECIPE
TO THE REGISTER OF WILLS:
Please withdraw my appearance as attorney for the Estate of Joyce R. Simmons
effective August 7,2001.
Respectfully Submitted
TURO LAW OFFICES
?t<f/!-2.
Date
en R. Waltz, Esquire
28 South Pitt Street
Carlisle, PA 17013
(717) 245-9688
Attorney for Estate
t.., ,
I ~ _~ J.J r" ....... /
/ L ~ ~ /.- 6
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG1 PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DONNA L GODFREY ESQ
GODFREY & ASSOCS
PO BOX 744
CARLISLE
'02
JUL -1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'n r: COUNTY
. ~ U ACN
06-24-2002
SIMMONS
07-28-2001
21 01-0726
CUMBERLAND
101
*'
REY-1547 EX AFP (01-02)
JOYCE
R
Allount Rellitted
PA 17P:\~r,..
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: iS4-j-Ex-AFP--C oi-:o 21--No'T-icE-oF--rNHEriiTANci-TA X-APPRA-isEiiENT~--Ai:.LowANci-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SIMMONS JOYCE R FILE NO. 21 01-0726 ACN 101 DATE 06-24-2002
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
reflect figures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of line 14 at Spousal rate (15)
16. Allount of line 14 taxable at Lineal/Class A rate (16)
17. Allount of line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
127,500.00
.00
.00
.00
175.075.78
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule 1)
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)
26,851.63
1.298.76
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
274,425.39 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this for.. with your
tax paYllent.
302,575.78
28.11in 39
274,425.39
.00
274,425.39
(19)=
.00
12,349.14
.00
.00
12,349.14
. ft. '....11. KI:"'I:~rl II (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-26-2001 CDOO0441 490.66 9,322.54
05-24-2002 CD001208 10.81- 2,560.47
TOTAL TAX CREDIT 12,362.86
BALANCE OF TAX DUE 13.72CR
INTEREST AND PEN. .00
TOTAL DUE 13.72CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS lESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DONNA L GODFREY ESQUIRE
POBOX 744
CARLISLE, PA 17013
_____n_ fold
ESTATE INFORMATION: SSN: 179-30-3215
FILE NUMBER: 2101-0726
DECEDENT NAME: SIMMONS JOYCE R
DATE OF PAYMENT: OS/24/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/28/2001
NO. CD 001208
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,560.47
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,560.47
REMARKS: SUSAN A ECKERT
C/O DONNA L GODFREY ESQUIRE
CHECK#1029
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
May 16, 2002
.02 l<iilY 24
:L6
Telephone
(717) 787-3930
FAX (717) 772-0412
Law Offices of
Godfrey & Associates
P.O. Box 744
Carlisle, Pa.17013
L. ,
Cu
Re: Estate of Joyce R. Simmons
File Number 2101-0726
Dear Mr Courtney:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before October 28,2002. Because
Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional
extension(s) will be granted that would exceed the maximum time permitted.
//} /~I Si~"'71~~ /f /1
C/~/::</.)/ ,7.'.....-.~l,~,. ':,/ "/:.1) J,..;i,-",
./ j)'--"'j;Jt;Ju '_;',,'''/l__'~' ' v
-----=-~ Jeffrey D.HollenbusA, Supervisor
Document Processing Unit
Inheritance Tax Division
STATUS REPORT UNDER RULE 6.12
Name of Decedent
Date of Death
Will No.
S.S. #
Pa. File No.
Joyce R. Simmons
7/28/01
2001-00726
179-30-3215
21-01-0726
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No.
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
N/A
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 attached to this
Date: June 3, 2002
i"I:)
, . ""
Name Steven C. Courtney. Esquire
Address P.O. Box 744
70.
Carlisle. P A 17013
Telephone
(717) 701-4038
CapaCity:
Personal Representative
X Counsel for Personal Representative
Document #: 222430.1
(!,
REV -1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OfFICIAL USE ONLY
REV-1500
I~ - .:2 '18- t.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-01-00726
COUNTY CODE
VEAR
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Simmons Joyce R.
SOCIAL SECURITY NUMBER
179-30-3215
DECE-
DENT
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
4/20/18
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
CHECK
APPRO-
PRIATE
BLOCKS
~ 1. Original RetU1'n
4. Umited Estate
6. ~eden1 Cled 'Testate
(Attach copy of Will)
9. litigation Proceeds Received
~ 2. Supplemental Return
4a. Future Interest CompromIse
(date of death after 12-12.82)
7. Oec::edent Maintained a Living Trust
Attach a copy of Trusl
10. ~pousal Povertycredd (date of death betwun
12-31-E11and 1-1-95)
3. Remainder Return
o (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
011. Election to laK under Sec. 9113(A)
{Attach Scn 0)
......;.....
.........~_!i.l~\Nj,;~lN~t\QN~~fljiiTj_il1tktpi'
COMPLETE MAILING ADDRESS
P.O. Box 744
Carlisle, PA 17013
............'...'.
COR-
RE-
SPON
DENT
Donna L. Godfrey, Esquire
FIRM NAME (If Applicable)
Godfre & Associates
TELEPHONE NUMBER
717-701-4038
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely H~ld Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5)
6. Jointly Owned Property (ScI1edule F)
o Separate Blllin9 Requested (6)
127,500.00
0.00
0.00
0.00
OFFICIAL USE ONLY
~
c:i
r....,
175,075.78
0.00
r'J
-'"
RECA-
PITULA-
TION
7. Inter-Vivos Transfers & Miscellaneous
Non-Probate Property (ScI1edule G or L)
(7)
0.00
B. Talal Gross Assets (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (S'h.du'. H) (9) 26.851.63
10. Debts of Decedent. MortgageLlabtlltles, & Liens (Schedule I) (10) 1,298.76
11. Talal Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une B minus Une 11)
13. Charitable and Governmental Bequests/See 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)
(8) 302,575.78
(11) 28,150.39
(12)274,425...39
(13) 0.00
(14) 274,425.39
TAX
COMPU-
TATION
seE INSTRUCTIONS ON PAGE 2. FOR APPLICABLE RATES
15. Mount of Line 14 taxable.t the apousaJ tax
rate, or tran~fer. under Sec. 9118 (aX1.21 X .0 (15)
16. Arnounl 01 Uno ,.....b'..III....'..I. 274,425.39 x.o .045 (16)02,349.14
17. AmountciLlne14taxa.bl."hlbllngrate X .12 (17)
18. Amount of Line 14 taxatll..t collateral rate X .15 (18)
19. TaxDue (19)12,349.14
20 0 ~~j{~.;~1!t"__~~ij.~f<<ijWM~I.M:R!:Ijw.lRM
... ......!OO.~.~' ........;~$i{~W2%Mi4Ufd4_$W?1@1i,\t;;
o PA 15001
NTF 28755
Copyright 2000 Gr_tland/Nelco LP - Forms Soflw.,.. Only
PA REV -1500 EX (5-00)
Page 2
Deced&nt's ComDlete Address:
STREET ADDRESS
0, v,_~ "rive
CITY LSTATE I ZIP
. ,le PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. CreditS/Payments
A. Spousal Poverty Credit
B. Prior Paymen1S
C. Discount
(1) 12,349.14
9,322.54
466.13
Total Credits (A + 8 + C)
(2)
9,788.67
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This Is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Une 5 + SA. This Is the 8AlANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
:. ",:';;! P:l~::;i:~g!'~~~~i6LcS~i~~;;~~~'~I~~~i1!eU~~~1~!'i!~ii\!'t;~!~~~i'''~il~'I'!'~l'~a~!igbciii
1. Did decedent make a transfer and:
a. Te1ain the use or income of the property transferred; .. . . . . . . . . . , . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .....
C. retain a reversionary interest; or. . , . . . . . . . . . . . . . . . , . . . . . . , . . . , . . . . , . . .
d. receive the promise for Itfe of either payments, benefits or care? .,...................,...,...
2. If death occurred after December 12, 1982. did decedent transfer property within one year of death
without receiving adequate consideration? . , , . . . . , . . , . . . . . . . , . . . . . . , . . . . . . . . , . . , . . . , . . . . . .
3. Did decedent own an win trust for" or payable upon death bank account or security at his or her death?
4. Did oecedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , . . . , . . . . . . . . . , , . . . , . .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Unoer penalties of perjury, I declare that I have examined this return including accompanying schedules and statements, and to the best of my
knowledge and befief, it is true, correct and complete. Declaration o~ preparer other tfian the personal representative is based on information of
which re arer has an knowled e.
SIGNAt RE ~ ~ORWct.E~R~' ;TE
(3)
(4)
(5)
(SA)
(58)
2,560.47
2,560.47
~ I
8 ~
o
~
ADDRESS
RDlll, Box 208F,
SIG TURE OF PREPARE
and 43 Harmony Hall Drive, Carlisle, PA 17013
DATE
ADDRESS
P.O. Box 747, Carlisle, PA 17013
$~
MHMKM{t%Wft W~\WWt ~}\:.. .~"... . .:.~.;.:.~:::::~ ,",)~.' .,' /(" ~' ,"~'.~ .. " , ~ ~ ,,~ ::??S~~.~.:::.~:::,: ~~;:;':tt:(::;::::~:::~:~~.~.~:~~:~:~:tmHtt:.::?<:;:::~:~::::::'::;:::::~:::~Jk'.
":':':'~':'~~~:'::;:;;':'. .::;Jt::;:~:i::::::::':~:::.,' .,.~. >" >:??t~:~::::: r:::r:::::~:~:~:~:~:k{;::;
For d.tes 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 s'urvlvl"g spous. Is 3%
[72 P.S. I e118 (a) (1.1)(1)).
For da1es of death on or atler January 1, 1995, the tax rate Is Imposed on the net value of transfer!;: to or for the use of the surviving spouse Is 0% [12 P.S. 18116 (a) (1.1)(il)).
The statute nOI!!l!t nnl .xOIOrnct. tranlfer to a surviving spoule from tax, and the statutory requIrements for disclosure of assets and filing a tlVC return are sUlI applicable even
If
the slKVlvlng spouse II the only bimeflclary.
For d.tes of death on or after July 1, 2000:
The tax: rate Imposed on the net vlllue of transfers froma deceased child twttnty-one years of age or younger at death to or fOf the use of a natural parent, an adoptIve parenl,
Of. stepparent of the child Is 0% (12 P.S.I9116(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.!li%, except as noted In 72.P,S. I 9118(1.21 [72 P.S. 19116(a}(1}l.
The tax rate Imposed on the net value of transfers to or for the u_ of the decedent's siblings Is 12% 172 P.S. 19118(aX1.3)]. A sibling Is defined, under Section 9102, as an Individual
who has.t least one patent In common with the decedent, whether by blood or adoption.
o PA 15002
NTF 29756
Copyright 2000 Greailand/Nelco LP - Forms SoflwlII"e Only
REV>1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
Joyce R. Simmons
Fj~'=-~~~~'O~ 2 6
All real property owned solely or as a tenant In common must be reported a1 fair market value. Fair market value is defined as the
price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which Is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Real Property located at 25 and 29 King Drive, Carlisle
Cumberland County, Pennsylvania
-See Attached Settlement Sheet
127,500.00
9 PA15021 NTF 10871
CopyrIght 18119 Grea.Uand/Nelco LP. Forms Software Only
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insen additional sheets of the same size)
127,500.00
OMB NO 2502 0265 ,.-:0.
~-,
A. LAN"
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1_0FHA 2.0FmHA 3.DCONV UNINS 4_0VA 5. ~CONV INS
I'. ( 7. 6883652
SETTLEMENT STATEMENT HOON
8. MORTGAGE INS CASE NUMBER
I L. NUll:: This form is furnished to give you 8 statement of aclual saWamenl costs. Amounts paid 10 and by the settlement agent are Shown
Items marked "(POC]" were paid outside Ihe closing; they are shown here for informational purposes and are not included in the to'lals
" "'" (HOOO,pfdlHOON/24)
I D. "AMO. O. I', NAM" ANU AUUK""" UnENUO"
MICHAEL A. HOON PRIMARY RESIDENTIAL
ESTATE OF JOYCE R. SIMMONS MORTGAGE, INC
Waller L SImmons, co-executor ;
Susan A. Eckert, co-executor I
~ '
; \
G. PROPERTY LOCATION: H. SETTLEMENT AGENT; 23-2402316 l. SETTLEMENT DATE:
25 & 29 (land) KING DRIVE PURITY ABSTRACT COMPANY
CARLISLE, PA 17013 March 29, 2002
CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT
3329 Market Street
Camp Hili, PA 17011
,. ,.
100. GR(15' , 4110. "ELLER,
: es ce ~ n aes ce
ersona '""" ."""
e emen ",ee , no
404.
us ns r ems~y a ar n sovance ~smants or ms a, y; oar In a vance
~ ax. wp axes un wp axes 242.9ll'i'
, ax to
. ax ax 0
100.
".
120. GROSS AMOUNT DUE FROM BORROWER 136,136.07 420. GROSS AMOUNT DUE TO SELLER 128,000.94
, apos~ ee ns~ons
~. epes or eames money xcess
nn pa no ew oan s e emen .... . .
~. xlSlng ns ensu ec 0 xlslng n. ensu Jec 0
~. t"aYOTTOTflr$ 0 age
~ eeon ge
~. . epes re lne yse er
ns~ .
,". npe/ y a., ~us men s or ems npa y .r
n wp I axes to I" oun wp axes to
, ax 0 ax
ax '0 I" ax to
~
210. 1 "".
220. TOTAL PAID BVn=OR BORROWER 122,750.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 9,609.00
, ,
"'.. n ue rom , "'.. oun ua 0 a a, ,na =
a" O<ln a Y ., 0","",,' na"'u) t:lOL Less Keaucuons uue :::;e er na . .
303. CASH ( X FROMJ( TO J BORROWER 1.3,366.07 603. CASH ( X TO J r FROM> SELLER 118,391.94
The undersigned hereby acknowledge receIpt of a completed copy of pages 1&2 of thiS statement & any attachments referred to herein.
Booowe'
MICHAEL A. HOON
Seller ESTATE OF JOYCE R. SIMMONS
BY:
70 M I 8"0 on t"rlce
IVIs/ona Omml$SIOn m. .s
0
0
Omrnl$SIOn " a e ernen
II!:OO. TE I
oan nglns on aa
I BUL Loan Ulscount J.UUUU "1<1
ppralsa aa
r I epo
en e nspec on aa
. ee
ax ervlce
I!:iUO. uocumem I"'rep t*ee
900'=
901. Interesl From 03129102 to
ogaenu nee (9lum
aza l'\$\Jrance r urn or
004.
.u,.
100U.
~
""~r nsurance
age urance
n wp axes
, "
"
>D. TL'
~1101. Settlement or CloSing FeEl
. ra 0( Ie aare
. e nation
. nsu osng r
men repara on
o ees
orne s ees
VBI8m
:;::
$
L. SETTLEMENT CHARGES
@ %
ows:
0
I A
0
10 I-'KMI
0
0
0
'~== .
0
0
o
'PAID'
04/01/02 @
m s
years 0
$
27.093800/day
2.000 months
mon 5
mon s
mon s
man ,
man ,
man .
to
,
3 days
%)
21.00 per rnontl'l
per mon
per month
per mon
BJ.4f per montn
I moo
peT mon
per mon
o '"
10 O.
o
o
rlcan I e nsurance o.
e ,
e nsurance 0
mcu 58 ve eml1um rs:
"0
10 a
I" '0.
1201. Recoro\ngFees: Deed $
~
a
mps:
~01 SUNey
~ as nspec
26.00;MO~
avenue mps ~
10
m51 00
:iN! 00
IO~
14UU~ nteron na. ec
lly~ta_~~1Igl81on...~.__pl 'wmpo8leClc;opy
Certified to be a true copy.
on an
1)\10& IllII
Releases $
ao
ge
:. Section K)
pa..... ternanl
I"'UKI(Y At::IS I KAG I l:UMPP.NY
Settlement Agent
~ge2
PAIDI'ROM
BORROWER'S
f\.JNCSAl
SETTLEMENT
PArD FROM
SELLfOR'S
I'UNDSAT
SETHEMErJT
81.28
c
82.00
~
,1
.1
(HOON/HOON/26)
RE<,503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
, RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
Joyce R. Simmons
FilE NUMBER 21-01-00726
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
None.
9 PA 15031 NTF 10872
Copyright 1999 Gre...\\andiNe\coLP - Forms Software Only
TOTAL (Also eole< 00 Uoe 2, Recapitulalioo) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV" 1504 EX + (1-97)
COMMONWEALTH Of PENNSYLVANIA
" INHE,RITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Joyce R. Simmons
SCHEDULE C
CLOSELY-HELD CORPORATION
PARTNERSHIP or SOLE-PROPRIETORSHIP
FILE NUMBER 21-01-0072 6
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent,
other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
Of DEATH
None.
9 PA15041 NTF 10873
Copyrlghl1999 GreallandlNetco LP - FO(ms Software Only
TOTAL (Also enter on line 3, Recapillllation) $
(If more space is needed, Insert additional sheets of the same size)
0.00
REV -1507 EX + (1 97)
,- COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Joyce R. Simmons
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
21-01-00726
An property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NO. DESCRIPTION
,.
VALUE AT DATE
OF DEATH
None.
TOTAL \Also .nle< on Une 4, Recapitulation) $
(If more space is needed, insen additional sheets of the same size)
0.00
9 PA15071 NTF 10874
CopyrIght 1999 Greatland/Nelco lP - Forms Software Onry
REV-1508 EX+ (1-97)
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Joyce R. Simmons 21-01-00726
Include proceeds of litigation & dale proceeds were received by the estate. All prop. jointly-owned with right of survivorship must be disclosed on Sch. F.
ITEM VALUE AT
NO. DESCRIPTION DATE OF DEATH
1.
2.
3.
4.
5.
6.
PNC Bank
Checking Account
No. 5140058565
DOD Balance
See attached letter
829.29
PNC Bank
Savings Account
No. 5130173148
DOD Balance
Accrued interest
See attached letter
31,750.78
48.25
PNC Brokerage Group
Annuity
Contract No. GA 703804
DOD Balance
See attached letter
..
26,174.58
American Express Financial Advisors, Inc.
Annuity
Contract No. 9300-4191361-5004
DOD Balance
See attached letter
13,530.90
American Express Financial Advisors, Inc.
Annuity
Contract No. 9300-6366869-1004
DOD Balance
See attached letter
22,367.64
American Express Financial Advisors, Inc.
Mutual Funds
Account No. 0051809003-7002
DOD Balance
See attached letter
58,207.94
TOTAL (Also enter on line 5, Recapitulation) S 175,075.78
(If more space is needed, insert additiOnal sheets of the same size)
9 PA15081 NTF 10875
""~_._,_", .00,," "'.^~.,~_'" I~'_'__ '" "^._~ .,.^..,..--~ .....-,..
Schedule E
7. Public School Employee's Retirement System
Pension check for period of7/1/01-7/28/01 796.96
8. Household goods
See attached documentation 3,308.50
9. 1998 Nissan Maxima
See attached sheet 16,500.00
10. 1985 Jeep 300.00
11. School rebate for prepaid real estate taxes 257.98
12. CountylTownship rebate for prepaid real estate taxes 242.96
13. 2001 I.R.S. refimd 760.00
Personal income tax
j
1
j
I
!
~
./
o PNCBAN<
Decedent Reporting
Firstside Center
P7-PFSC-04-F
500 First Avenue
Pittsburgh, PA 15219-3128
October 9, Lool
Walter L Simmons
RD I Box208F
Blain, P A 17006
RE: Estate of Joyce R Simmons Deceased
SSN: 179-30-3215
DOD: 07-28-2001
Dear Mr Simmons:
SCP
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5140058565
JOYCE R SIMMONS
DOD Balance: $829.29 + $0.00 accrued interest
SAVINGS ACCOUNT
#5130173148
JOYCE R SIMMONS
DOD Balance: $31,750.78 + $48.25 accrued interest
Page I of2
A m~mber of The PNC Financial St-rviC('s Group
One PNC Plaza 249 Fifth Avenue Pittsburgh Ptnnsyfvania 15222 2707
Established 07-01-1963
Established 03-01-1983
.1
r
~ PNCBROKERAGECORP
October 1 0, 2001
Walter L. Simmons
R D # 1 Box 208F
Blain, PA 17006
Subject: Date of Death Valuation
Dear Mr. Simmons
The Date of Death Valuation for the Glenbrook Life Annuity Contract #GA703804
belonging to Mrs. Joyce R. Simmons is $26,174.58.
Please don't hesitate to call if you need further assistance.
Sincerely,
~&;~
Donna Pollock
Sales Assistant
Tel: 717-691-4050
Fax: 717-691-4051
A PNC Bank Company
2 East Main Street Mechanicsburg Pennsylvania 17055
www.pncbrokerage.com
IMportant ImatDr Infonnation: Stturi~ brokcrigt and other products and ~ arc provilkd by PNC ~ nmn I
::t':~ brokcr-<ltaler and mcnber s.PC. PNC Brokerage Corp is a subsidiary of PNC Bank, National . :;~ ~
wtUch is not a bto<<er<<akr.
October S, 2001
Mr. Steven Courtney
Attorney - At - Law
P.O. Box 744
Carlisle, PA 17013
Re: Estate of Joyce R. Simmons
Dear Mr. Courtney:
Thank you for your recent inquiry regarding the accounts of Joyce R. Simmons.
The values of the accounts as of 7/28/0 1 are listed below.
Account Number
0115-18090037002
9300-41913615004
9300-6366869 1 004
.
Please contact my office if you have any questions.
Sincerely,
~o~oo
JABllek
Cc: Walter L. Simmons
Total Value
$58,207.94
$13,530.90
$22,367.64
~)
AcJVilncelJ Ad'Jisol Gll1l\j!
Jack Benkovich. CFP"'. 0;
Senior Financial Advisor
CERTIAED FINANCIAL PlANNER ™
practitioner
American Express
Financial Advisors 'nc.
IDS life Insurance Comp..
Westwood Center
4661 Trindle Road
Camp Hill. PA 17011
8us: 717.761.4208 Ext. 26
Fax: 717.761.6282
john.a.benkovich@aexp.com
American Express Financial
Advisors 'nc. Member NASD.
An AEFA associated financial
advisor franchise. Insurance and
annuities are issued by IDS
life Insurance Company, an
American Express company.
American Express Company is
separate from American Express
Financial Advisors Inc. and
is not a broker-dealer.
BRICKERS AUCTION
Buy & Sell on Commission - Complete Sale Service
93 Texaco Rd., Mechanicsburg, PA 17055 766-5785
Personal Property of
f)
Address /) 1::;
:;, '-"
Sold At Public Sale
Outstanding
Total Sale
:3 '::-6 i} ''oS')
/1 ..;:-
./
?V/-jL r
Total Checks
/'2"'2. 2'
- ::;') - (--
I :;), /~ .
I '1,,-
?,1"/'/T l~ T -1-J..
Total Cash
/. 11,/.::;;' ~..
7 ~.-- /. u
..If:-,-, Uf)
Cash After Payout
I' /j
. /' --; 0 L
"
Expenses
Auctioneer & Clerks
-"J -: I
-~ -;- u (\
Adv. Cost
~-
.. ..-
,4-.
,
~, .2 (j
/0<)
/()()
- 5" (j, fJ
I) ~,j) ~'l'V' F.~
r I ,~
C-h'v..~Al\
Property Fee
Sale Setup or Help "
. "
:Total Expenses -~' .
"
......
s-,
_.J
ljl
.,
'.I..-'~
t;; ~
-.
,1 J " u' \
.I l' ---.' / ~- I
....)~
,
,". ")
'~
,-
~,'
Thank You For Selecting Chuck Bricker, Auctioneer & Staff
~grttmtnt
MADE I!tis
d:lyor
. 20 1LL
BETWEEN (.?j' t. c- /..L- tJ.J2-/ c/C E /'C . pany of the first part. hereinafter referred to as Auctioneer.
AND Iv! L T ..5/1'1 H .IV.7 .J- ..s I/C C c/L<!c,Lrc party of the second part. hereinafterreferred to as Owner.
WHEREAS. party of the first part is a duly licensed Auctioneer in and for the Commonwealth of Pennsylvania: and
WHEREAS. Owner is vested with the legallitle andlor custody 10 the following goods. wares, merchandise and real estate, a statement and/or
schedule of which is attached hereto and made a part hereof; and
WHEREA~. Owner h,,!-s e~gaged the services of the Auctioneer to represent him in.sF~~~~he aforementioned g.oOO5, war~s'plerchandise and
real estate.at pubhc sale and auctIOn to be held on the ..................../.:,?.... day of ..........N.........,.......................... 200Jat.........q.J..~. M.. o'clock.
NOW, THEREFORE. WITNESSETH. that for and in consideration of the mutual covenants herein contained. it is agreed by and between the
parties as follows:
I. It is agreed by the Owner of said property and the property shall be offered by the Auctioneer to the best and highest bidder to the pUblic sale and
may be sold to any such bidder unless the Owner has placed a reserve bid on any articles or property offered for sale.
2. Owner of said property agrees to be responsible for any statements or sales recommendations that they may make with respect to said property
and in no event shaH the Auctioneer be liable for any such statements or recommendations made on the part of the Owner.
3. Owner agrees not to interfere with the conduct of the sale in any way nor will he attempt to stop the sale or discontinue the same during its
progress without the consent of the Auctioneer.
4. Owner agrees to pay all expenses in connection with the holding of said sale including advertising of the same. the employment of clerks and
Auctioneer commissions or fees as may be submitted by the Auctioneer who shall be in charge of the sale.
S. Auctioneer shall receive as his commission or fee ................./...(1.... % of the gross amount of the sale which fee shall be due and payable
at the conclusion of the sale and shaD be paid from the proceeds thereof.
~
Witnessed by:
IN WITNESS WHEREOF. the partieS"'hereto have set their hands and seals on the day and year first above mentioned.
.~L/~~.
tJrJLonee,/ l- ~
,
(SEAL)
x
(SEAL)
Owner
(SEAL)
Owner
SCHEDULE OF PROPERTY TO BE SOLD
Real Estate Fee
Fee if not sold
Auctioneer will be paid Real Estate Commission fee. if pro-
perty is sold to person/or persons that were last bidder day of
sale. meaning a negotiated sale.
Fee Per HourlPer Persons
Each
~/ Yv~
,JI~ j.~
The Owner hereby agrees that the sale was conducted in a satisfactory manner and that he has received a comp.lete accounting from the clerks
who conducted the same and hereby discharge all parties connected to the same. .->< W ~ l ::::.
I
i
~
. '
A 0 PA mLn~133"27"g~fb'1jfH'S{"LEI
WW
0"
. ~ 5 VEHICLE IDENTIFICATION NUMBER
~~ JN1CA2101WM914902
MAKE OF VEHm
N1SSan
CON01T10N
rf GOOO 0 FAIR 0 POOR
B.
\Jo.ST N,./l,Mt,,(QR FULl6USlNESS NAME)
tilmmOnS
MI~I~nlAl
f'AST NAME
oyce
~
CO-SELLEA
c.
U\.ST NAMf..(ORFU4- eUSlNESS NAME)
TrlSt;an
K -, NAME i MIDOlUJITIAL Il,"TE ACOlOAEDI
at;ner ne 1'. 1~Jg'j"01
CO-PURCHASER
STREET
2180 Yake Ave.,
PUOCHASE
PAICE
(See note on~)
$16,500 00
LESS
TRADE -IN
TAXABLE
AMOUNT
$16.500 00
.
,i;."'I.rJ1'';''''"' $1/'''6.600 00/3/02
J( 7'" .07 .
see,noteon rewr.;e)'.
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': lJ ~ 1rom 1._.~
18 Finlt Assignment,. _ _ ,'_=<; l~::;
.
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CITY
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MODEL YEAR I BODY TYPE (CP. 11<, Ere.!
1998 ISDN
ORIGINAL PlATE d cl'od< en. 0
-.. - - -" TRANSFER Of PREVlOU$1.Y ISSUED PLATE
o PlATE TO BE ISSUED BY 0 TRANSFER & RENEV*.L OF PLATE
BUREAU (PROOF OF IN-
SURANCE MUST BE AT. 0 TRANSFER & REF'\.ACEtvtENT OF PlATE
'V.CHEO.\ 0 TRANSFER OF PlATE & REP\.ACEMENT Of STICKER
o El<DW<GE PlATE TO BE
~~~ f'tATEND
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gHIO..E.ED. . l~a.REG.GROSSWT. REQAEG.GR05SCOMB.
~IG IN J:~ ~..~ c.. IINCL\JOU'4G lOAD WT. (F APPl.JCABLE)
_ .' Mutual Benefitl~~1 PP00181727 ~5~1 I~~~
ICERTl THAT ON MOtffii . DAY ~~ . ()(:) ~ ~~~I ,--", -:-' AGENT~. .... _.
= I HAIlE CHECKED TO OETE....."~ THAT THE VEHICLE" "SURED AND F- ~ ., t . I:::>' ( < f'\. H l'\, KIt) 0 11 3 3 If V -3
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MATION COMPlJANCEWlTHALlAPPUCA8l.EPROOSIONSOFTl-EvEHlCLECOOE ....1_", .,-" f '{ '-, d
N<DDEPARTMENTAE<lUl.Al1(JNS ~ ~, :"), < ~. (17... -ltd. I
l/WE CER1lF'f THA.l I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COtJP\.E11ON ANQ'TI-W 1HE ~l1ON GIVEN IS mue NIJ CORRECT. F "., EXEMP110N
IS ClAIMED, THE Pl..IRCHASEFt FURTHER CEfITFIES THAT HElSI-E IS AUTHORlZEO 10 ClAIM 1l4S E'XEMP11ON. VWE ACKNOWlEDGE lHAT lIWE MAY lOSE MY/OUR 0PEfWlNG
PAlVLEGEISI OR VEHIClE AEGlSTRAllON(SI FOR FAll..l.fE 10 WJNTAlN FINANCIAL. RESPONSIBUTY ON THE OJRREN'TLV REGISTEReD. VEHIClE FOR 1lE PERIOD Of"
REOOTRATlON. 1!WE ~OGE THAT I~_ '!'AY BE SUBJECT 10 " FIE NOT exceEDING $5.000 AND ~ OF NOT ~ THAN 1\\0 YEARS FOR NN
FALSE STATEMENT THAT I~ MAKE ON THIS FOR""'. " ....-... f
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Camp Hill
D. LAST NAME lOR FULL BUSINESS NAME)
ARST NAME
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ieantrnusl:~Iormf,,(V...44..
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Signature d Second Putchaser ()( Aulhorit:ed Signet"
SignatuN 01 Seller
2ND
ASSIGN-
MENT SignatIKe of Co-PurchasefITiIIe 01 AuthoriZed Sioner
Signature of C>>-Seller"
J.,
~
.
H. ~ z
~d
. l
IF A CO-PUACHASER OTHER THAN VOUR SPOUSE tS USTEO ABCN'E. OECK ONE OF THESE BlOCKS. F NO BLOCK IS CHECKED. l1TlE WD..L BE ISSUED 1:3
"'TENANTS IN COMMON."
A. 0 JOINT TENANTS WITH RIGHT OF SURVIVORSHIP - ON 0EAll-l OF ONE OWNER, TITLE GOES 10 SURVIVING OWNER
B. 0 TENANTS IN COMMON - ON 0EAll-l OF ONE OWNER, INTEREST OF DECEASED OWNER GOES 10 HIS OR HER HEIRS OR ESlJI.TE.
NOTE. IF THE VEHICLE IS BEING LEASEO. CHECK lHlS BLOCK O. F BLOCK IS CHECKEO. COMPlETE AND AT1I\CH FORM MV-IL
. _........................... MESSENGER NuMBER:
.J::60""'.-'c:anlact1'ennOOT
3. APPLICANT'S COPY /TEMPORARY REGISTRATION (VALID FOR 60 DAYS)
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Joyce R. Simmons
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER 21-01-00726
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
None
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR MADE Include name of financial Institution and bank DATE OF DEATH DECO'S VALUE OF
JOINT account number or similar identifying number.
NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
None.
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
9 PA151191
NTF 10876
(If more space is needed, insert additional sheets of the same size)
COpYflghl '999 GreatlandJNelco LP - Forms Software Only
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF Joyce R. Simmons
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FilE NUMBER
21-01-00726
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTV %OF
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECO & DATE OF TRANSFER.
NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
,. None.
.
TOTAL (Also enter on line 7, Recapitulation) $ 0.00
9 PA 15101
NTF 10877
(If more space is needed, insert additional sheets of the same size)
CopyrIght 1999 Greatland/Nelco \,.P - Forms Software Only
REV'-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Joyce R. Simmons
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER 21-01-00726
Debts of decedent must be reported on Schedule I
ITEM
NO. DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
l. Minister 140.00
. 2. Flowers 100.00
3. Meal after funeral service 350.00
4. Solomis Funeral Home 5,077.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representatve(s)
Street Address
City State Zip
Year(s) Commission Paid;
2. Attorney Fees Godfrey & Associates 9000.00
3. Family Exemption: (If decedent's address is not the same as ctaimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 275.00
5. Accountant's Fees 150.00
6. Tax Return Preparers Fees 150.00
7. The Sentinel - legal. asnate notice fee 93.83
8. Cumberland LawJournal Esnate advertisement 75.00
'9. The Sentinel-advertisement fot.sale of Real Property 80.43
TOTAL (Also enter on line 9, Recapitulation) 26,851. 63
$
(If more space IS needed, Insert additional sheets of the same size)
9 PA151l1
NTF 10878
Schedule H
10. Patriot News. Decedent's advertisement for sale 97.00
of real property
II. Reserve for Miscellaneous closing expenses 50.00
1.2. Reserve for filing account 500.00
13. Recorder of Deeds, realty transfer tax, sale of real 1,275.00
property
14. Notary fee - sale of real property 6.00
15. Tax calculation fee for sale of real property 9.00
16. 2002 County/Township taxes 319.00
17. Brickers Auctions, expense necessary for sale 950.00
of decedent's real property
18. Walters - rental of toilet for sale of decedent's 83.74
real property
19. PP&L - continuation of service to decedent's 217.19
real property for sale
20. Verizon - continuation of service to decedent's 140.11
real property to prepare for sale
21. Susquehanna Oil- necessary for sale of decedent's 125.33
real property
22. The Sentinel- Advertisement for sale of decedent's 88.00
real property
23. Sellers' contribution towards 7,500.00
Buyer's closing costs
REV-1S12 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Joyce R. Simmons
Include unreimbursed medical expenses.
ITEM
NO.
1.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-01-00726
DESCRIPTION ,AMOUNT
'Susan Eckert
reimbursement for payment of decedent's bills
363.42
2.
Walter Simmons
reimbursement for payment of decedent's bills
422.43
3.
Commonwealth of Pennsylvania
personal income tax
88.00
4.
Verizon
debt of decedent
40.75
5.
AT&T
debt of decedent
10.95
6.
PP&L
debt of decedent
43.87
7. York Waste --
debt of decedent 29.34
8. Carlisle Hospital
Medical Bill 300.00
TOTAL IAlso enllOron line 10. Recapitulation) S 1,298.76
9 PA15121 NTF 1087.4 (If more space is needed, lnsen additional shee1S of 'the same size)
Copyright 1"99 GreatlandfNe!co LP - Forms Soflware Only
REV-1513 EX+ (g-OO)
, COMMONWEALTH OF PENNSYLVANII\
INHERITI\NCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Joyce R. Simmons
FILE NUMBER
21-01-00726
RELATIONSHIP TO DECEDENT I\MOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not Ust Tru5tee(s) OF ESTATE
I TAXI\BLE DISTRIBUTIONS [include oUlright spousal diS1ribu1ions, and
Iransfers under Sec. 9116 (a) (1.2)]
1. Walter L. Simmons Son 115,962.69
R.D. #1 Box 208F
Blair, PA 17006
2. Susan A. Eckert Daughter 115,962.69
43 Harmony Hall Drive
Carlisle, PA 17013
3. Dennis R. Eckert Grandson 10,000.00
173 Beetem Hollow Road
Newville, PA 17241
4. Deborah M. Howells Granddaughter
90-5 Lancelot Avenue 10,000.00
Mechanicsburg, P A 17055
..
ENTER DOLlAR AMTS. FOR DlSTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV-1500 COVER SHEET
II NON- TAXI\BLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
None.
B. CHARITABLE AND GOVERNMENTAL DiSTRIBUTIONS
1.
None.
TOTAL Of PART II -- ENTER TOTAL NON- TAXI\BLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET $
o PA15131
NTF 33293
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 GreatIAnd/N.rc:o LP - Forms Software Only
Schedule J
5. Linda R. Warner Granddaughter 10,000.00
2 Shoemaker Lane
Mechanicsburg, P A 17055
6. Walter D. Simmons Grandson 10,000.00
54 Cold Springs Road
Dillsburg, P A 17019
7. Kim D. Rusch Granddaughter 10,000.00
10 Autumn Drive
Morristown, NJ 08057
,
, COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
REV-1514 EX + (1-97)
(Check Box 4 on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Joyce R. Simmons 21-01-00726
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5~ 1-89.
actuarial factOrs for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found
in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument whiCh created the future interest below and attach a copy to the tax return.
Will Intervlvos Deed of Trust Other
tAL......... ................'.................nw..................::.....@!"Wl:!a;:S:lt1l,W...INtl;. .....:SA.>. ....JlI..'..ll....
NAME(S} OF
LIFE TENANT(S)
DATE OF BIRTH
Term afYears
Term of Years
1. Value of fund from which life estate is payable
$
2. Actuarial factor per appr~riate table
Interest table rate - - U 3 1/2% 0 6%
3. Value Dillie estate (Une 1 multiplied by Line 2)
010%
o Variable Rate
%
$
NAME(S) OF
ANNUITANT(S)
wiH;;;nHm~NNQI;Q\iltillleae$r;;_eUli~r; Q8;HMW
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
W@W~:M
;:~':::':'::::::::(
ihfiMMtinmH4WMltt~:}~:: .........,
M:n~::MkHiiF/til@t:rwM@::M)tMtfiHJ
TERM OF YEARS
ANNUITY IS PAYABLE
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund tom which annuity is payable $
2. Check appropriate block below and enter corresponding (nUmbeB
Frequency 01 payout-- 0 Weekly (52) B Bi-weekly (26) Monthly (12)
o Quarterly (4) 0 Semi-annually (2) Annually (1) Other ( )
3. Amount of payout per period
$
4. Aggregate annual payrr'lent, Une 2 multiplied by Une 3
5. Annuity Factor (see ins1fuctions)
Interest table rate 0 3 1/2% 0 6% 0 10%
o Variable Rate
%
6. Adjustment Factor (see instructions)
7. Value of annuity -- If using 31/2%,6%, 10%, or if variable rate and period payout is at end of period,
calcula1ion is: Une 4 x Une 5 x Une 6 $
If using variable rate and period payout is at beginning of period, calculation is:
(Une 4)( Une 5 x Une 6) + Une 3 $
NOTE: The values of the funds which aeate the above future interests must be reported as pan of the estate assets on Schedules A through G
of thrs tax return. The resutting life or annuity interest(s) should be reported at the appropriate tax rate on Unes 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
9 PA15141 NTF 10881
Copyright 1999 Gfeatland/Netco LP - Forms Software Only
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST
COMPROMISE
REV -1647 EX+ (9-00)
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FI LE NUMBER
Joyce R. Simmons 21-01-00726
This schedule is appropriate only for estates of decedents dyjng after December 12, 1982,
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
nWIII n Trust n Other
\. Beneficiaries
NAME OF AGE TO
BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994. If a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
n Unlimited right of withdrawal n Limited rloht of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of future Interest. . . . . . .................................. .. . . . . . . . . ............ $ 0
2. Value of Une 1 eKempt {rom tax as amount passing to charities, etc.
(also include as part of total shown on Une 13 of Cover Sheet) . . . . . . . . . $ 0
3. Value of Une 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00% . . . . . . . . . . . . . . ...... $ 0
(also include as part of total shown on Une 15 of Cover Sheet)
4. Value of Une 1 Taxable at lineal rate
Check One o 6%, 0 4.5%. . . . . . . . . . . . . . . . . ..... ... $ 0
(also include as part af total shown on Une 16 of Cover Sheet)
5. Value of woe 1 taXable at sibling rate (12%)
(also include as part of total shown on Une 17 of Cover Sheet) . . . . . . . . . $ 0
6. Value of woe 1 taXable at collateral rate (15%)
(also include as pan of total shown on Une 18 of Cover Sheet) . . . . . . . . . $ 0
7. Total value of Future Interest (sum of wnes 2 thru 6 must equal wne 1) . . . . . . . . .... . . . . . . . . . . . . ..' $ 0
o PA16471
NTF 33294
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 Greatland/Nelco LP - Forms Software Only
REV -1649 EX + (1-97)
COMMONWEALTH OF
PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Joyce R. Simmons 21-01-00726
Do not complete this schedule unless estate is making election to tax assets under Section 9113(A) of Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Tru5t(marltal, residual A, S, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule O. and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the
election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property
Is Included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the etection only as to a fraction of
the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable
asset on Schedule O. The denominator Is equal to the total value of the trust or similar arrangement.
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION VALUE
Part A Total S
PART B: Enter the description and value of all interests Included in Part A for which the Section 9113 (A) election 10 tax is being made.
DESCRIPTION VALUE
9 PA 16491
NTF 10882
Part B Total S
(If more space is needed, insert additional sheets of the same size)
o
Copyright 1999 Greatland/Nelco LP - Forms. Software Ot'lly
). ~. - ~ ~ '.11 ~ 'f.. ' t
. -
1Lust Bill uno (IlestVtffi211t
of
JOYCE R. SIMMONS
I, JOYCE R. SIMMONS, of the Township of Silver Spring,
Cumberland County, pennsylvania, declare this to be my Last
Will and Testament, hereby revoking and making void all Wills,
Codicils, or Writings, in the nature thereof by me at any time
heretofore made.
ITEM I. I direct that the payment of my debts and the
expenses of my last illness and funeral sh~ll be paid from my
estate as an administrative expense as soon after my death as
conveniently may be done.
ITEM II. I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever
jurisdiction imposed, shall be paid as part of the expenses of
the administration of my estate.
ITEM III. I specifically give, devise, and bequeath to
WALTER D. SIMMONS, my grandson, ten thousand ($10,000.00)
dollars; to DEBORAH M.HOWELLS, my granddaughter, ten' thousand
($10.000.00) dollars; to LINDY R. WARNER, my granddaughter,
ten thousand ($10,000.00) dollars; to DENNIS R. ECKERT, my
grandson, ten thousand ($10,000.00) dollars; and to KIMBERLY
D. SIMMONS, my granddaughter, ten thousand ($10,000.00)_
dollars, per capita.
ITEM IV. I give, devise and bequeath all the rest,
residue and remainder of my estate, real, personal and mixed,
of whatever nature and wheresoever situate, of which I shall die
seized, or to ,,.hich I may be entitled, or over which I shall
possess any pm,.er of appointment by Will at the time of my
decease, ,,.hether acquired before or after the execution of this,
my Will, to my son, WALTER L. SIm10NS, and my daughter, SUSAN A.
Page 1 of 2 pages.
~1/7f. J~JcSEAL)
J R. SIMMONS -
--~~~--~_.._-
ECKERT to share equally, evenly, absolutely, in fee simple and
per stirpes.
ITEM V. I appoint my son, WALTER L. SIMMONS and my
daughter, SUSAN A.ECKERT, Co-Executors of this my Last Will and
Testament.
ITEM VI. I hereby give full power and authority to my
Co-Executors to compound, compromise, settle and adjust all
claims and demands in favor of or against my estate; to sell
and dispose of any or all of my estate, real or personal or both,
for such prices and upon such terms of credit or otherwise, and
in such manner as my said Co-Executors, deems best, without an
Order of Court, at private sale if he/she sees fit, and to furnish
and deliver to the purchaser or purchasers all necessary or proper
deeds and other instruments of conveyance and transfer thereof.
ITEM VII. I request that no bond or other security shall be
required of either Co-Executors acting hereunder for the faithful
performance of his/her duties, any law of any state or jurisdiction
to the contrary notwithstanding.
ITEM VIII.
It is my desire that the Co-Executors retain
GALEN R. WALTZ, Esquire, as attorney for my estate.
IN WITNESS WHEREOF, I have set my hand and seal to this my
Last will and Testament consisting of this and one (1) other
page, at the end of which I have also set my hand and affixed ~
seal for greater security and better identification, this _~~
day of October, 1991.
~/f -t~
JR. SIMMONS
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published, and declared by the above-named Testatri4 as and for her
Last Will and Testament, in the presence of us, who, at her request and in her
presence, and in the presence of each other, have hereunto set our hands and
seals the day and year above written, and we certify that at the time of execu-
tion thereof, said Testatrix was of sound and disposing mind and memory.
(SEAL)
__3S'.34 .LfAA~J1-
.Pee
Page 2 of 2 pages.