The URL can be used to link to this page

Home My WebLink About01-0809 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Ge..yQ! ~ \ Y\ '€ I~ ';}Jl4v/J( No. e,;>\ - D \ - '001 also known as To: Deceased. Social Security No. I&-&- - ::;L r.f.- 12 J;o 3 ::2- Register of ~ills for tht; County of J ..l.N\~~l~ d. in the 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 (9 (L in the last will of the ahO;teCedent. dated . and codicil(s) dated LriA..J2 '-I, / f7 Y named ,19_ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C _ Ll1%\~~"(" l~ ~ County, Pen~~vania, with ,~ h e.y- last family or principal residence at Cj' '10 \..l) CLl nu.. ~ v/.){~ ~ Ca. e..l IS l-.e I U . ( (70L! (list street, number and muncipality) A<...L s- ) c tJ ,~(!JO), years pf a e, died at l +14- Except as follows, decedent di 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: 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: I <DO 0 , 0 '" $ $ $ $ WHEREFORE, petitioner(s) respectfully ~uest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters '\ -'2...~+tt VHBW.+o..ty (testamentary; admimstration c.La.; administration d.b.n.c.t.a.) theron. ~ '" i~ -BLA~~ A. f. ~~C- ~.~ ~~0~~~;1.~ ~ ~A-/7(f)SS- eGO';: 3~ "''- :;0 <;i c: 00 Vi --- OATH OF PERSONAL REPRESENTATIVE COMMONWE~H OF PENNSYLVANIA } ss COUNTY OF yY] b-e }-{ U-rt d . 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 petit" ner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well an ul dminister e t according to law. en QQ' ::! ~ ... l:: ~ ~ Sworn to or affirmed and subscribed t. befo,e A';;~~ 16th "1'9 ~~Oo{ { 7"17 ';'~'Y'I,J./J/ Jq~.r.; li-L4-'-\ No. 21-01-809 Estate of GERALDINE H SHANK , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW SEPTEMBER 10 :J' 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 i JUNE 4, 1974 described therein be admitted to probate and filed of record as the last will of GERALDINE H SHANK and Letters TESTAMENTARY are hereby granted to HUEY A E LONG '/?;Ju~ ~:///t"H4If/ </'~,~ eglster of Ills I FEES Probate~ Letters, Etc. ......... x-pa~~s . SB8ptk~rtificates( ).......... Renunciation ................ JCP $ $ $ $ 5.00 TOTAL _ $ 36.50 . . AqGV:l:T. . . Hi... .~QOl. . . . . . . . . . . . . 1~:88 ':~8 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS Filed PHONE n lU).lSU) K.t V ~/86 ; '11S is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local R{:gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent Bling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7555627 No. 21-01-809 H 105. ; 4J Ae" 2187 {~~..~ Local Regis rar - U G ({cr i do, , Date ;;.... 00 , NAME Of DECEDENT If...y MlddIe.l._1 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPE./PRINT IN PERMANENT BLACK INK Geraldine H. Shank su a. Female PlACE OF oe.crH ICt>ec1l 0Flty .... -. .... Of'1"tUCtooM on OINt Sldet HOSPITAL ._.ro =.....,0 Did - ...... Cumberland -' ....0 :::..."":':'..'.::'.. UOTHEA.sHAUE'f......-.........s..Amanda R. Tracey II. WOlWAHT'SMAlUHO AIlllllESS(Slr_oo,Ibon. _. q,~ 801 Charles Street Mechanicsburg, Pa. 17055 PlACE Of'0ISP0Sm0H._..~ c.--. lOCRlON .c...-. _.llo"- .. au...",- Warrington Friends Quaker AGE(Lal:lBotthoaYI UNDER 1 YEAR MonIM Dew- SiRTHPt..Aa tCoIy ~ StaleOlfCf89'COWllryt Baltimore. Maryland 7. FACLIT"t NAME (tI' noI1f15141J11on. gn.oe SltINC and nt.Imtlef'l 72 v.. COUNTY OF DEAr... Cumberland .... ... DECEDENT'S USUAl OCClJNJ1OH lGN.1und of... done dur~ rnoeI ~~'t1&'i'l'P1irn1'lbr Manufacturing .... 1'" DECEDENT'S MAaJHQ AOOAESS (SIr... CCW/i:Jwn. SIa. ZlpCOdlt) 940 Walnut Bottom Road Carlisle, Pennsylvania 17013 DECEDENT'S ACTUAl RESIDENCE -""""""'" ...-- '0- FAl'HER'S NAUE (First Micde. LaIC) ,.... Arthur A. KiUle Huey Long ". lHfOAlolAHT'SHAME(l_onll o w '" :> '" . ::; . rrV. METHOOOF OISPOSIT~ . 0 -JIll C_O .......... 00..._ "0. 21c. LICENSe HUMBER FD-012662-L \J .;: --.. _. Of' corN .. . 6.39 .'I... al. OK //" /l11 27. MftT I: Ente, the cUeaM., iniwt- Of compeic~ *"idt cauMd 1M death 00 not Meflhe mode of ~ng. sucn as Cilfdiac Of ,.spiratory anMl. 'hock or he.... faJIut. Lilt 0I1tt one cauuGn HCh_. .j q Q! lU \~ (ON GfS'l'VIZ H eo4<<- \ (-r:\~Ll.lo( ~ DuE 10 lOR AS' CONSEQUENCE Of), <:O\'l.OtJ1\"<-'1 ~Th jlIi!'1 '\)\ SIZ-t\I "'"- DUE 10 (OR AS A CONSEQUENCE OF): 0UE.1O(OA AS ACClNS[OUENCE Of) v' . WERE" AUTOPSY FINDINGS ~PRIOA 10 COUPlETION C6 CAuSE OFOERH7 Homicide WANNER Of DEATH OATE OF INJURY lMonIrl. Day. --..., c:J.- o o STAtE FilE NUMBER SOCIAL SECURITY NU_t.H ..168 - 24 2632 L)AIt:OfutAll;,McnIh.Oa~. "'J ..August 10, 2001 ... White MAAlTAL8TATUS......... ,..., MMied.~. '"--- Widowed ... South Middleton Twp. SU,...,MNGSPOuSE il -.. ~1NIIden Nme) .... Warrington Twp., Pennsylvania ... .... .- ::--= . : l. DJI'1S ! YG4.t-<, PART.: OdwSignlftcanlconcltiofw~IO......&M ,......inOiI'I...~~gil.oMinAt.IITI CI-\ti?C,AJtL O'!h~u..c-t1-1.r€ ~1..(L..I--tt:>v4!'A't Dt. "D1At3r~J' 1''l-'t€t...L1T101J' """~oS'l) O~I2II~ TIME OF INJURY INJURV IiI WORK? DESC::RJBE HOW INJUAY (X;CURRED. -! - PendJog lnvIt:IUgauon o o o PuCE OF INJURY - AI hom.. tum. .;.... ladofy. olfk:. building. Me. ISpeClM _. LOCATION $_. c.ty/lOwn. Stltel ....~.. :::r '1 v.. 0 HoD -... Coukt tlOI be del.'RlIned )Ie. 2M. CEllTIF~ lC~ 0fV\r one! .CEIITIf'VIMG PHYSICIAN (Ptlf!ilCo6O Cefllfylng ~sa d Uf~1h wt\etl .ulOlhllf phVSoC..an has plDnOldlCe<J lJeilltl aoo CUll)pleled llemlJI T....bMlotm'know....... ..UlOCCunM___"'.cauM(...ndm.nne'......tH. .................................. ... ~ :i 5l frl o ~ o w ~ . Z 'PAONOUNCIHG AND CERTIFYING PHYStCaAH IPta'fSIC.an ooltl Ol'onouncong oe.1h oIOd c.erlliyong 10 cause 0' deart.l To thI ~ 01 m., knawledga,lMaII'i OCCUff" al &he...... d.te, and plec:a. and dua to tMca""la..nd mann.,.. ".Iad.. .UEOtCAL EXAMIHER/COAOHER On 11M baai. of .......In.llon andIQI' 11W..livaUan. in my opinion. d..th O(;l;u".d allhe time, dale. .nd place,....d due to the cause(.) and manner......eeI ..... ............. . ..... ...,... .............. ". ~'f- ~111~i1I<,2! .... 0 HoD ... ,.. LICENSE NUWM:R DATE SK1HEDt~. Oa.,.. 'lfurl o "e. o-D4"9~--L .... 6/IQ(0 ( ~.2~=~Of'W~~~~CO...S~TfJ<~~FF:':w, t'1 D lG\ll J{JR./IVG /lOti-I) CAol!..L.l.f~ ~ri '101"}. o ... DATE FIlEDIMonItl, Day. i'Ul, to. 1 U~ T J:J.. , ~CCl .. .' ~ " I,! i~ II " i I I, .1 II ,I II II 'I I, . . ~1-CJ/-I?o9 LAST WILL AND TESTAMENT OF GERALDINE H. SHANK ! i i I I Icounty of Cumberland, and Commonwealth of Pennsylvania, declare I i jthiS to be my last Will and revoke any previous wills made by me. ~ ,I I, GERALDINE H. SHANK, of the Borough of Lemoyne l , lCINDY SHADE, if she survives me. I ITEM I: I bequeath my cameo jewelry to my frien I , !!to my Ideath, I I ,Iof her I ITEM II: I bequeath the remainder of my jewelry niece, SUSAN LONG. If she is a minor at the time of my I authorize my Executor to deliver said jewelry to either parents or to the person with whom she resides or who has I fcar or control of her, without bond, and the receipt of such perso I , I !shall be a complete release of my Executors. ! I ~y I , I , ! ITEM III: I devise and bequeath the residue of estate, of every nature and wherever situate, as follows: I I ~INKEL, if she survives me. Isurvive me, then this share shall be added to the share in para- ~ ~raph B of this ITEM III. I l ~ t I ~ONG, if she survives me. ""::Eo:':~:E" live me. then I devise her share to her daughter. SUSAN LONG. 310 BRIDGE STREET Ii Page 1 of 3 pages NEW CUMBERLAND, PA. 1 7070 ~ II A. One-half thereof to my sister, HELEN If my sister, Helen Kinkel, does not B. One-half thereof to my sister, PEGGY If my sister, Peggy Long, does not sur- .. ITEM IV: I appoint DAUPHIN DEPOSIT TRUST COM- PANY of Harrisburg, Pennsylvania, guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: 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 from my residuary estate as a part of the expense of the administration of my estate. ITEM VI: I appoint HUEY A. E. LONG, Executor 'of this my last Will. rl ITEM VII: I direct that my Executor or Guardian ior their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, GERALDINE H. SHANK have LAW OF'f"ICES STONE 8< SAJER 310 eRIDGE STREET Page 2 of 3 pages NEW CUMSERLAND I PA. 17070 .' 1974, L / f day of hereunto set my hand and seal this ~~/~~~ GE D I . S NK (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED, by GERALDINE H. SHANK, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who, in her presence, at her request and in the presence of each other, have hereunto set our names as witnesses. i~.IJ~ Witness Ult~ ~ '~OM.~ /{, A~ress *I \._",~ n,..,J .~~. (\ .[) ~ress ~ ~~ --~. ro . . ~~~"h4 \~~~\) I W~tness '- I I LAW OFFICES STONE e. SAJER Page 3 of 3 pages 310 BRIDGE STREET NEW CUMBERLAND. PA. 17070 21-01-809 ,. REGISTER OF WILLS OF~ COUNTY OATH OF SUBSCRIBING WITNESS C hlJ- (C (~S Ii 5.f-o n e codicil (each) a subscribing witness to the ~ presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that . ~, present and saw e~ 1 VI e the testat , sign the same and that h e... signed as a witness at the request of testat_ in h t ~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). ( ~ ) n . ~.:=:::_ .. Sworn to or affirmed and subscribed before ~:t:l- ~ ~iS SEPTEMB::h . ~ 'f/iL'8~/lJ:; ~lrj.jr;U~l.J) // /n.l/e~~((/~p<<UJf<~;2//-Cif . ~ (Addrtss) -W I ~ R~~~I (Name) (Address) TER OF WILLS OF COUNTY ATH OF NON-SUBSCRIBING WITNESS testat_ of (one of the subscribing wit.oesses to) the presented herewith and codicil bilieves the signature on the will is in the handwriting of that to the best of knowled~iand belief. I /' Sworn to or affirmed and subscri)ed before me this day of 19_ (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF CO OATH OF SUBSCRIBING WITNESS / /' ,/ // ./ / // codicil / (each) a subscribing witness to the will presented herewith, (e,lh) being duly qualified according to law, depose(s) and say(s) that ,/ present and saw /// ,/1 the test at , sign the same and that / signed as a witness at the / reqUest of testat_ in h presence and (in }he presence of each other) (in the presence of the other subscribing witness(es)). / //// Sworn to or affirmed and subscribed before ,I / me this day of 19 ----.L- (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS .l: 1-0 n testat~ of (one of the that h e... (each) /;/bscriber hereto, (each) being duly qualified ccording t.9--law, depose(s) and saytt~ E I <. familiar with the signature of Gr '-e J--'f I d' n -e 'd.?/J:... codicil subscribing witnesses to) the ~ presented herewith and Adicil believes the signature on the~ is in the handwriting of {;;e;er/dln--e to the best of h l5 JI- ShJlh?~ , knowledge and belief. Sworn to or affirmed and subscribed before me this 16th day of AUGUST ~ 2001 '>>;rJlo/'<~/'U);" )~;I Reglste ~ I /) (AddrfjSs) ?JU eRa Y[p5 (Name) VJtr it d41 (0 ) h CJ R-f (Address) ~~~~ j/uey .t:)Lo /7/ , S+ h-f7tJS.r € ----- Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) G~fL~tLv~ '-j../ 0 SA ~k- 10. d...OO / Date of Death: Cho ;) 00/- &'8f!JCj Will No. Admin. No. ,;} / - C 1- () rC; 7' To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ' ~ ,.;(. CO I : Name fie /"'->1 ~~ e I --~j_S4 N (L (5 n - E /J1/]~ lC- e Indy S/;p cle_ I Address 3?tJl It{:~t?~ A~-tt/bM()r~ fJ/lj) V . 7';; 1,2 t./y .S ~ :;JC' ~tLd6u.J k - GA - ).; /75::l 7 ~~~+ ST GfLfL I/J /)O,3t) Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: ~J ,~s; ,;Ju{i I'~, ! ak~ Signature (/ (J Name #r~'7 .# Lu//j' ~c1 / CJ; a-1/~~ u;C Address / // ~.eL'/lI/1/c--f6q~/ #r /lCss- Telephone ( 7/7-~Y7-(-S-.;21 ~ Capacity: _ Personal Representative _Counsel for personal representative I 7-1/-A- 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE CJ *' NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP 101-021 HUEV A LONG 801 CHARLES ST MECHANICSBURG '02 MAR-1 1-\11 :22 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-26-2002 SHANK 08-10-2001 21 01-0809 CUMBERLAND 101 GERALDINE H Allount Rellitted P A It'Ml$,5 GlImbu 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=is4j-ix--AFP--coY:02Y-NoYici--oF-YNHiifiTAi'-ci-YA'x-APPRAisiiiENT-:--AU-OWANCi-ifi-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHANK GERALDINE H FILE NO. 21 01-0809 ACN 101 DATE 02-26-2002 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. Mortgages/Notes Receivable (Schedule D) 5. 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) .00 .00 .00 .00 2.594.12 .00 .00 (8) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 2,594.12 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/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 2,594.12 .00 (11) (12) (13) (14) 2.594 12 .00 .00 .00 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. 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 T X DITS: NOTE: .00 .00 .00 .00 X 00 = X 045 = X 12 = X 15 = (19)= .00 .00 .00 .00 .00 DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 . 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 HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \., 16 - /7~- /c:b BURf~U OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN ...IIEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (o1-D!) ROBERT M FREY FREY & TI LEY 5 S HANOVER ST CARLISLE DATE ESTATE OF DATE OF DEATH ~I~E NUMBER COUNTY ACN 01-28-2003 PALMER 06-30-2000 21 00-0809 CUMBERLAND 101 BRENDA J Allount Rellitted PA 17013 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-iFP--foY:oiY-No7ficE-oF-YtiHEifiTANcE-7fA'x-APPRAySEMENT-:--iLUiwANCE-cfi------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PALMER BRENDA J FILE NO. 21 00-0809 ACN 101 DATE 01-28-2003 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE 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) 5. 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) .00 .00 .00 .00 17.310.00 .00 .00 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. (8) 17,310.00 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/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 7,458.00 61. 00 (11) (12) (13) (14) 7.519 00 9,791.00 .00 9,791.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ 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 T X CREDITS: .00 9,791.00 .00 .00 X 00 = X 06 = X 00 = X 15 = (19)= .00 587.00 .00 .00 587.00 + AMOUNT PAID 336.00 DATE 12-04-2002 NUMBER CDOOI911 INTEREST/PEN PAID (-) .00 INTEREST IS CHARGED THROUGH 02-12-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 336.00 251. 00 75.15 326.15 · 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.) REV-1470 EX (0:8~) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Brenda J. Palmer REVIEWED BY ACN 2100-0809 101 John Kuchinski ITEM SCHEDULE NO. EXPLANATION OF CHANGES H B3 The claim for the family exemption has been disallowed. The claimant must be a spouse or if no spouse, a parent or child living in the same household as the decedent as of the date of death. . J 1-3 Taxable at 6%. The tax rate change for lineal heirs is effective for dates of death on or after 7-1-2000. ROW Page 1 ( 'y"\ . Will No.: d /ra! ({J f Of Name of Decedent: Date of Death: 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~ther administration of the estate is complete: Yes~ No D 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.~ personal representative file a final account with the Court? V NoD b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal ~~ntative state an account informally to the parties in interest? Yes 111' No D c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk; of the. Orphans' Court and may be attached to this ~/ Date: *1 0) ';--~ '_.J Signature dr>c/ n LO/lY ,. /. I Njbl C!tu4,J!I./) ~~~;a 7z{. Addr ss 1/7- b7? ((Q/ Telephone No. Capacit~sonal Representative D Counsel for personal representative rv-l C,_ co I _J ::::::J -, ['I P .~ ,- I- ..,~ ~ .1 r ... ....,,\-..J REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 w ..., ~:!!;CIl ulI::~ wD-U ::coo ulI::..J D-al D- oC( INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o W C / o DECEDENT'S NAM~ (LAST, FIRST, AND ~~NITIAL) I: ' " c&e,oQ'd-tn € DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) V-ltP.~ ~OO I S- /~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) / - ..y- ~ f _{J 'i FILE NUMBER !Xl-1!11 COUNTY CODE YEAR NUMBER -:{":3.;z, SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) COMPLETE MAILING A. DD~E~S. . /2. ~ _ " -+- ~O I (~~- f:Y-./ Aech4J1,c-SOtll!'j, j:f/?iD.s::r I- Z W C Z o D- CIl w II:: II:: o U '/1- 697-I_s TELEPHONE NUMBER I I- I OFFICIAL USE ONLY 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) -0- -0 --- -C) - ;.-c- ,~ .c;-f?': /;l. (8) e::?.5- 9~ / ~ (11) L~s9t/.- /.2. (12) (13) --0 - 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o !;i: ....I ::) !:: c.. <( o w 0::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (9) (10) d S- c; t/ /,.;( - " (14) _Cl (6) (7) 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 (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) c.. :iE o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O _ (15) (19) 16. Amount of Line 14 taxable at lineal rate x.O _ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT REV-1508 EX. (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERS NALPROPERTY COMMONWEALTH OF PENNSYLVANIA INHERIT CE TAX RETURN RE D NT DECEDENT ESTATE OF FILE NUMBER O{f) ( cfJO Pt) ;f -'ti-.h..// /'} r -~( 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. ITEM NUMBER 1. VALUE AT DATE OF DEATH DESCRIPTION (ft~ - C~ ae-e~ U~ I S~fut'- ~/~ q/CJ! fl.1 .J l'/)MLB1/ C~L-L- :;13<--11/{3/~1 CL~J r~ 9q,~~1r q I D I ';;d.~ gl( Id./I 3 3f.~r l.2 9 TOTAL (Also enter on line 5, Recapitulation) $ d.. S 9c( /;2.. (If more space is needed, insert additional sheets of the same size) Huey A E Long 801 Charles Street Mechanicsburg, P A 17055 January 10, 2002 [uti Commonwealth of Pennsylvania Department of Public Welfare Bureau of financial Operations Estate Recovery Program POBox 8466 Harrisburg, PA 17105-8486 Re: Geraldine H. Shank CIS 520147104 In accordance with your November 6,2001, letter I am enclosing Estate check number 0096, in the amount of One Thousand Two Hundred Fifty Five dollars and 58 cents ($1255.58) which is the remainder of the Estate of Geraldine H Shank. This was her only asset. she was a resident of Manor Care Nursing Facility in Carlisle, the enclosed includes the refund from the phone company, and the nursing home. All the final expenses have been paid, as listed. Trust this will close this m tter, and I will receive an acknowledgement of same. REV-1511 EX+ (12-99) . .~j~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: G,-;}.7/, d ~ 1 ~ -e c;S ~' tUJJ - ( !>-.~ 0 '1. 7 '::::j.Lrw--fA../l_/ 1 fa ~ 7 ~~~ 7 _,;-: 0 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees -3&..50 5. Accountant's Fees 6. Tax Return Preparer's Fees .. d 7. ~ a/!t7L eLL- ~~ e,l[;!: q- / ~ .5-:>: ~ ~ .~.... . "~ u.~J /'7 TOTAL (Also enter on line 9, Recapitulation) $ as?y:~~ Debts of decedent must be reported on Schedule 1. 'f) g () l' (If more space is needed, insert additional sheets of the same size) .. . *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG. PA 17105-8486 November 06, 2001 HUEY LONG 801 CHARLES ST MECHANICSBURG PA 17055 Re: GERALDINE SHANK CIS #: 520147104 Co/Rec: 21/0086953 Date of Birth: SSN: 168-24-2632 Dear Mr. Long: Please be advised that the Department of Public Welfare maintains a claim in the amount of $51,468.63 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $20,467.91, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $31,000.72, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. ~~~rel(Yy//( /lJ;:uk.~~,- Iatfi1f2k., p~rson Claims Investigation Agent 717-772-6615 717-705-8150 FAX Enclosure