The URL can be used to link to this page

Home My WebLink About01-0849 PETITION FOR PROBATE and GRANT OF LETTERS d\-- 0\ - ~l.\q Estate of Marqaret R. Kerns also known as No. To: Register of Wills for the , Deceased. County of Cumberland in the Social Security No. 189-09-4355 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 executrix in the last will of the above decedent, dated December 3. 1975 and codicil(s) dated named ,19_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 1000 West South Street, Carlisle. PA 17013 (list street, number and muncipality) Decendent, then 84 years of age, died at Sarah Todd Memorial Home 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: 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: August 12, 2001 , 19 L} PtthM- $ $ $ $ WHEREFORE, petitioner(s) respectfullt re~st&si the probate of the last will and codicil(s) presented herewith and the grant of letters es e ary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. </J '-' Q) u d Q) "1:1 --- ov; ~ Q) ..... ",Q) d "1:10 d';: ~.= 3~ Q) '+-< :;0 ~ d Ol) Ci3 .../7 - ~ ,-1 ~#A.&'I ',6kNA' /' anice L. BloA1er 511 E Oranae'Street ~hippAn~hllrg, PA 17)57 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -, ss COUNTY OF Cumberland J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will wel~___)d trul~ administer t~~ estate ~cCording to law. Sworn to or affirmed and subscribed . '--"/~4L?(.~ . /~ ~ before me this 14th day of /Jan1ce L. B o9fier ()Q s- EMBER ~ 2001 a ;;: ~ ~ \l-\.- lo - - -- -- --- - _ ,;'ft No. 21 - 01 - 849 Estate of Maraget R. Kerns , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW SEPTEMBER 17 't ~~ 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 December 3. 1975 described therein be admitted to probate and filed of record as the last will of Marqaret R. Kerns and Letters Testamentarv are hereby granted to Janice L. Blocher MARY CLEWIS FEES Probate, Letters, Etc. ......... Short Certificates( 2) . . . . . . . . . . Renunciation ................ JCP $ 25.00 $ 6.00 $ $ TOTAL_$ 36.00 .... .~~P.~~~~.E.~.1 7.,. .~99.1......... 5.00 Ronald ~T'WJh~1.Yo~uP'f6'1\.sI3' No.) 78 West Pomfret Street Cari1sie, ~A l/Ul~ ADDRESS (717) 243-0123 Filed PHONE Called attorney on 9-17-01. Put in atty's file in Prothy. 21 - 01 - 849 ~{JMdltl E... \.TtJhl1J IlL cedteM (~ a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and 2Y(s that --h e.. IA.J M present and saw ,r... .~ ~ the testat' , sign the same and that 11 e. signed as a witness at the request of testat.ttL in ~ presence and {in the presence of each other} (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this 14TH day of 7t. nJ. ~ SEPTEMBER G- ~~?QQk c ~t:~:~p- . ~ MARY CLEWIS (J (j (Name) (A ddress) REGISTER OF WILLS OF CUMJ1lKf.J4AJ)j COUNTY OATH OF NON-SUBSCRIBING WITNESS " I. I AI~{), ~j/ ~dVtJ t e (~ a sub~criber hereto, ~ being duly qualified according to law, depose(s) ads SkLf . L ( . familiar with the signature of ~ ~ " ~l testat~ of (OM ef the !...b~\'l ibifll .. itR,ell'. ta) the will presented herewith and I codicil that SJl, P believes the signature on the will is in the handwriting of ~}(.. J<OYJ1S to the best of ~ knowledge and belief. (Address) Th. ~. to certify that the information here given is correctly copied from an original certificate of death dul~ filed with me as I'~o~:/~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg, WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 2i-~. ~!"H&.-t"~~.~ Local Registrar Fee for this certificate, $2.00 p 7578342 AUG 1 4 2001 Date HI05.1 C3 R.... 2117 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH IlINT ~\ Cumberland sex 3. Female SWE rll.E lfUMllER SOCIAL seCURITY PJWBER 3. 189 - 09 - 'lENT INK NAME OF DECEDENT IF.... UodOIe.lM' ,. Margaret R. Kerns AGE (latlllirll'oaayj UNDER 1 YlAA -- Dayo 81RTHP\.\CE lC"Y .nd c~r!fai1~o . PA PUCE OF DE.crHlCheck HOSPITAL: Inpat_ 0 ~lo Carlisle RACE . AlMrican 1Nian.1llack. WIlMa. oIc. t~l White .... 11.. SI... PA MARITAL STAfUS . M_ N__Iacl, _. llNor<:ed ~ 14. Divorced I1C.o --',_1Iwd1to SUf\\l\WIG spouse ,.... il'W"'-' namel DECEDENT'S USUAL OCCUPAllOH <<<r...:::~~~:'r UL Homemaker 11 o..m Home DECEDENT'S MAILING AODAESS (SIr....~.!wo. ZopCodel DECEDENT'S 1000 West South St ~~~ Carlisle PA 17013 ~~ ,^",S DECEDENT eVER IN U.s. ARUEO 'OACeS'1 vuO Nom 12. Cumberland Did ...... .... In . -.oIlIp? ""P. 1111. "'.~ ~-=':=OI Carlisle c:ilyIIIclfo. PA 17257 ;l~ DUe 10 (OIl AS.A CONSEQUENCE OF): . . 21. / Approximat. '~- :--..... I I I PART .: 0Ihet aigniIIcanI CDndIIiono -.ribullng 10 .ath. but _...-noil\_~_\liolA..PAflT I. lb. c. II. DUE 10 (OIl AS" CONSEQUENCE (1): Cul'/J o C-ll r DUE 10 (OIl AS A CONSEOUENCE (1): WERE AUlOPSY ,INOINGS MANNER OF DEAfH ~ PfIIORlO ~ COIolPLETlOH tY CAUSE 0 OF DERl1? _utoJ HomicicM --.. 0 PendinQ 1f\Ye:.tigalion 0 v.. 0 No SulclcIa 0 Could noI be dal.....u>a<1 0 O~E Of INJURY 1~..1. (lay. _I TIUE OF IHJURY INJURY III WORK? DESCRIBE ttON INJURY OCCURRED. _ D NoD CIII. IA. P\}.CE OF INJ\lRY . "I home. !a..... "'....llClory. olllee .. 2....:n. ~ _.ISpec...) cun"'f1.o-""""..... "CIIITlFYlHG PHYSICIAN f""_ ~ c:auM d _ "".. ano<har ph,"",,",, ha. prClt'OunCld de.... .no com_ ~orn 231 TQIhe.......t~~.de.thoccllrredduetolh.Caus.e(.).ndm~n.r.. stated............................................ ......... "MEDICAL EXAMINER/CORONER On Iha bu.. of ...mltt..ton and/or ",v..tlgatlon,ln "'y opinion, de.t" occurred at the time. date, and pl.c.~.nd due to the CIUN'I)'M S1.~n... .. .tated.. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REGISTRAR'S SIGNAJURE AND NUMBER ~.~~~~ ~I\ ~ \ 101 o I LI .f'JIONOl,IttClH ,,"D CERTIfYING PHYSICIAN......,...,.." boIh PI..-ncong ""... and c..../'I"'91O oau.. 01 cle...., To Ihe ....., my knowtltcfV4t, dea'" occwtted It ~ tIm., date. and place. and due 10 ttM c.u..C.' .1\4 manner.. ~~a~ed.. . :.. . . ~ . . . . ~ . . . . . . . . . . . . . t-t 3061 .. , LAST WILL AND TEST.AMENT OF MARGARET R. KERNS I, MARGARET R. KERNS, of the Borough of Carlisle, ClDllberland COlmty, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking all prior wills and codicils. ITEM I: I direct that all my just debts and funeral expenses including my grave marker and all expenses of my last illness, shall be paid from the assets of my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II: I give and bequeath the SlDll of Two HlUldred ($200.00) Dollars to each of my granddaughters, namely, Debra L. Blocher, Linda A. Blocher and Susan K. Blocher. ITEM III: I give, devise and bequeath the residue of my estate of every nature and wherever s i tua te to my daughter , Janice L. Blocher, providin she shall survive me by thirty (30) days. Should my daughter, Janice L. Blocher predecease me or die on or before the thirtieth day following my death, I give, devise and bequeath the residue of my estate of every nature and wherever situat to my grandchildren as named in Item II above equally, provided that the share of any grandchild who predeceases me or dies on or before the thirtieth day following my death shall be added to the share or shares for my other grandchild ren. ITEM IV: I direct that all taxes that may be assessed in conse- quence 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 V: I appoint my daughter, Janice L. Blocher, Executrix of this my Last Will and Testament. Should my daughter, Janice L. Blocher, fail to qualify or cease to act as Executrix, then I appoint Ronald E. Johnson, Executor of this my Last Will and Testament. ITEM VI: I direct that my Executor and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. I'd IN WITNESS WHEREOF, I have herelUlto set my hand and seal this ,3 --" day of lJec;e/;'?p~p'l , 1975. 1n 0 nJl d- t(! n/vY'<U Margaret R. Kerns The preceding instrument, consisting of this one (1) typewritten page, identified by the signature of the Testatrix, was on the day and date ther f signed, published and declared by Margaret R. Kerns, the Testatrix herein named, as and for her Last Will in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witness thereto. LAW OFFICES ~~t;Jk~. . /_ IFf:; ,'/fc;. ',/ /. Y.?'~ ~(1(3iut LANDIS 8: BLACK CARLISLE. PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Name of Decedent: Margaret R. Kerns Date of Death: August 12, 2001 Will No: 21-01-0849 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 January 16, 2002: Janice R. Blocher 511 East Orange Street Shippensburg, P A 17257 Debra L. Peters 326 Mountainview Road Mt. Holly Springs, P A 17065 nc; -- =<0 ::s :;!. 0" <' m... 2 ::o~ on '-g:_g~ r~ ('l ru C- ::x:=s Z 'L,,,.~ - CXl -0 Linda A. Drumheller 8122 Boss Street Vienna, VA 22182-3774 --" u ::p. . . ..- ~ Susan K. Campbell 155 Kline Road Shippensburg, P A 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: January 16, 2002 Ronald E. Jo 78 West Po Carlisle,P 17013 Phone: 717-243-0123 Capacity: Counsel for personal representatives "-v!/}-?- b BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENTI ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RONALD E JOHNSON ESQ .02 ANDREWS & JOHNSON 78 W POMFRET ST CARLISLE f\PR 19 D12:1 6 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-15-2002 KERNS 08-12-2001 21 '01-0849 CUMBERLAND 101 *' REY-1547 EX AFP (01-02) MARAGRET R Allount Rellitted .. \,,1,',:', : PA ~8~~y MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-V =is4-j-ilc--AFP--("oi-:021--No'fici--oF-i-NHiifiTAifCE-Y-AX-APPR7fisiifENT~--AiioWAifcE-ifR----------- - --- -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KERNS MARAGRET R FILE NO. 21 01-0849 ACN 101 DATE 04-15-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. 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 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) (S) (6) (7) .00 .00 .00 .00 1,952.63 .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) 11096.00 135.021.74 (11) (12) (13) (14) NOTE: .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent. 11952.63 136.117 74 1341165.11- .00 1341165.11- (19)= .00 .00 .00 .00 .00 TAX CREDITS: . .... ....... I n;c~c...rl II l + J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) COK / r. - . ." Will No.: Admin. No.: Name of Decedent: Date of Death: 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. Stat~er administration of the estate is complete: Yes~ No 0 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 ~ntative file a final account with the Court? Yes _ N~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the person~sentative state an account informally to the parties in interest? Y ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the. 0 h and may be attached to this report. Date: #J/PJ h~ 0\ a i-- ---- a h · ~ !ldP( N71' ~. /f!mff'erd, ~;/fl? A4-/70/J Address ,,< t./;r - OJ ZY Telephone No. Capacity: OJersonal Representative l.)(.Counsel for personal representative J;i / 7- 7-~ - OFFICIAL USE ONL Y COMMONWEALTH OF PENNSYLVANIA REV-1 500 INHERITANCE FILE NUMBER DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 TAX RETURN RESIDENT DECEDENT 21-01-0849 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Margaret R. Kerns 189-09-4355 z w DATE OF DEATH (MM-DD-YY) DATE OF BIRTH (MM-DD-YY) THIS MUST BE FILED IN DUPLICATE 0 W August 12, 2001 October 29, 1916 WITH THE REGISTER OF WILLS U W (IF APPLICABLE) SURVIVING SPOUSE'S NAME SOCIAL SECURITY NUMBER 0 I w tJ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return <! ~ f- Cf) 0 ii: ~ =:J 4. Limited Estate 0 4a. Future interest Compromise 0 5. Fed. Est. Tax Return Req'd w Q.. 0 I 0 0 Xl 6. 0 ~ ---' Decedent Died Testate 0 7. Decedent had Living Trust 0 8. Total number of SDB's Q.. !D - Q.. 19. n 10. Spousal Poverty Credit n 11. Election to tax wI Sec. 9113(A) <! Lit'g'tion Proceeds Rec'd f- :#j~$.::ffig9.*Ip'ijH$.iRg&Qlggp.JQ.jffl~R**W::qQ$R~$.#:P.NP.~NQ~M;NQ.@iP.Nf@j~ifN4.Mt.A~tINfP.RMti:t@f:Rt&i'fff:r::::':'f:r::rr:::: z NAME: COMPLETE MAILING ADDRESS: w 0 z Ronald E. Johnson, Esquire 0 Ronald E. Johnson, Esq. a... FIRM NAME: Cf) w Andrews & Johnson Andrews & Johnson ~ ~ TELEPHONE NUMBER 78W. Pomfret St. 0 0 717 243-0123 Carlisle, AA-.17013 ;, (i.~' 8 :T.12:- -.. 1. Real Estate (Schedule A) (1) $0.00: OFFICIAL USE ONt Y 2. Stocks and Bonds (Schedule B) (2) $0.00 ...,.., rI 3.Closely Held Corporation, Partnership or Sole-Prop. (3) co {',J 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 ........ Z 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E) (5) $1,952.63 0 i= 6. Jointly Owned Property (Schedule F) (6) $0.00 ,~~...,\ <( o Separate Billing Requested \"....J ..J :J 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. (7) !:: 8. Total Gross Assets (total lines 1-7) (8) $1,952.63 a. <( 9. Funeral Expenses & Administration Costs (Sch H) (9) $1,096.00 U w 10. Debts of Decedent, Mortgage liabilities, & Liens (10) $135,021.74 a:: 11 . Total Deductions (total lines 9& 10) (11) $136,117.74 12. Net Value of Estate (Line 8 minus Line 11) (12) ($134,165.11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject to Tax (Line 12 minus line 13) (14) ($134,165.11) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 15. Amnt of line 14 taxable at the spousal rate, 0 i= or transfers under Sec.9116(a)(1.2) x.O_ (15) $0.00 <x: f- $0.00 $0.00 ::l 16. Amount of Line 14 taxable at lineal rate x.045 (16) Q.. ~ 17. Amount of Line 14 taxable at sibling rate $0 x.12 (17) $0.00 0 u 18. Amount of Line 14 taxable at collateral rate $0 x.15 (18) $0.00 >< <x: 19. Tax Due (19) $0.00 .... 20 n CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ...... ....... :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.....:.:.:.:.:.....:.;.:......;.:.....:.;...;...;...;...:..,....;.....;.;..;.......;.....;.:.;...:...:......;...;.;...;....:...;.;.;.;.:.;.:...:..: .....;.:.:..........:.:...:.:.:.;.:.:.:.:.:...;.;.;.:...;.....;.:...;....:...;.;...;.....;.;.;.:...:.:.:.:.....:.:.:.;. ........;.:..........;...;......................-.............................. ......................................y............. ................. .................... ..... .t:"tt~:~::t{{m:{{}*~ee,~$.Qr#tlt{~b~;N.~Wat~~~~qQ.a~;~QN.~,Pli,('J{fiVt#'~m;:'~lillP.1M~\iil~H~m1a~mmtMm!1#.itttt!:'ttttttt~ttt;';'ff'tt:, c. Decedent's Complete Address: STREET ADDRESS 1000 West South Street CllY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts Total Credits (A+B+C} 3. Interest/Penalty if applicable D. Interest E. Penalty 4. TotallnteresVPentalty (D+E) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1 ) (2) (3) (4) (5) (5A) (5B) $0.00 $0.00 $0.00 $0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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: yes no a. retain the use or income of the property transferred: b. retain the right to designate who shall use the property transerred or its income: c. retain a reversionary interest: or d. retain the promise for life of either payments or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receMng adequate consideration? 3. Did decedent own an "in trust fof' or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary disignation? D D D D D D D ~ ~ ~ ~ ~ ~ ~ IF THE ANSWER TO AtN OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowtedge and belief, rt. is true, correct and complete. A A~ ::2-- DATE 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 SUNNing spouse is 3% [72P.S. Sec. 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 ofthe sUlvivin9 spouse is 0% (72 PS. Sec. 9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a sUMving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if 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 deseased child twenty..one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. Sec. 9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) (72 P.S. Sec.9116(a)(1). The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. Sec.9116(a)(1.3)] A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. LAST WILL ANDTESTAMENr OF MARGARET R.KERNS I, MARGARET R. KERNS, of the Boroughbf Carlisle, Cumberland County, Pennsylvania, declare this to..be my Last Will and Testament, hereby revoking all prior wills and codicils. ITEM I: I direct that all my just.debts and funeral expenses including my grave marker and all expenSes' of tny,.tast: illness, shall be paid from the ass'etsof mi estate as soonas:'praetiea.D!~;a:Etet my-.decease'as a part of the expense' bf the administration oX: my"esta't~:'i~r . ITEM II: I give and bequeath the' sum of TwO Hundred ($200.00) Dollars to each of my granddaughters,riamely; Debra L. Blocher, Linda A. Blocher and Susan K. Blocher.' . . ITEM III: I give, devise and .bequeatll the residue .of my estate of every nature and wherever situate to mydaughter~ Janice L. Blocher, providin she shall survive ine by thirty (3'0) days. SJibi.11dniy dB;tlghter, Janice L. Blocher predecea.seine or die on or before the' thirtieth: aay;,fOllowii1g my death, I give, devise and bequeath the residue of 111)1"' estate':of .e, ", .',,~tuieand wherever situat to my grandchildren' as riamed in Item Habave eq. ;/R:f6vided'thatthe share of any grandchild who predeceases'roe'or dies on'c' . '. . rEf the thirtieth day follomg my death shall be added to the"shareor'shB.res'for my other grandchild ren. '. ITEM IV: I direct that all taxes' that may be assessed in conse- quence of my death of whatever nature imd by.whateverjurisdictionimposed shall be' paid from .myresiduary estate as a part .ofthe:,,e-xpense of the administration of my estate. " - .":':", -" ,. ,.,~: ~ ITEM V: I appoint my daUghter~.J~b~S:;IJ~'Blocher,ExecUtrix of this my Last Will and Testament.' ShbulCf my daught"ei':; J ariice L. Blocher, fail to qualify or cease to act as ExecUtrix, theil'I appoint Ronald E. JohnSon, Executor of this my Last Will and Testament. ITEM VI: I direct that my ExecUtor and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have .hereunto' .se:froy'h.a.hd and seal this 3 ~ .tJe~ep"1~~r ,1975. . ''':~'~':'d .: , lj';("'~', day of 1n:~'rr: :, . ........111f,~,;~ ~~~~~ret R. Kerns -~~':\,.. ._:"{: The preceding instrument, consisting:i'l.";~thi~.~ one (1) typewritten page, identified by the signature pfthe:.TestatrO' .."0 ~"()i1' the day and date ther signed, pUblished 8l1d dec1a:t:ed bY;.Margl:l-i'e.tR"J(~ ..~~;res.tatrixherein named, as and for her LaSt Will in the presence of us,':Wh9;~<.~#;her'request, in her presence and in the' presence of eaCh other, havesuoscriD'e<l' our names as witness thereto. . >"t~tV"::: UW OP'P'lCU ~~, LANDIS It BLACK J:kLliu." P&NNaYLVANIA j.. . t: t.': '. r SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY EST ATE OF FILE NUMBER Margaret R. Kerns (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER 21-01-0849 VALUE AT DATE OF DEATH Checking account # 50998439-Allfirst Bank (see letter attached and copy of check issued for the balance in the account. The difference between the amount stated in the letter and the amount of the check issued to close the account was the result of one or more outstanding checks that had not yet cleared as of the date of death) $1,952.63 TOTAL (also on line 5, Recapitulation) $1,952.63 !l ~Iffirst MAIL CODE 1260101 P.O. Box 1596 Harrisburg, PA 17105 (717)240-6701 October 23, 2001 /1\i; /U UL_", L_ - . n., _-- 2 51;;lm ==3,/1 !Ii --',.---. ~ -- Ronald E. Johnson 78 West Pomfret Street Carlisle, PA 17013 Re: Decedent Margaret R. Kerns Dear Mr. Johnson, I am enclosing the information requested on your client, Margaret R. Kerns. Margaret had only one account, an interest-bearing checking, with Allfirst. The information is as follows: 1. Type of account: Relationship with Interest checking 2. Account number: 50998439 3. Names on account: Margaret R. Kerns , ~. L;U~ a j0iut aCC0unt; Margaret opened the account 8/28/64 5. Balance at DOD: $2068.58 Thank you for your time. ~ ((~-( da L. illiams Financial Services Representative Carlisle Main BSMEM02-9906 '* ,'* * '* * 'Q::; W ::I: U "0 \,-1 ,', 1XI '~-.i w 'U .... % <I: '"""l '0 "0 N f::;-' IllM I.L. 0<1: :z I- ,.... '..,> .... -.... I.L. "'0 (lJ '- "'0 ~ ~ ::J: Q.I t= ..... Z I/l!!l '-E -0 Ill.: ~ ;::.2 I/l OJ!! ::::.-:=.= o 'E ';:::'0.1>> I-C>~ -'CD (lJ ......,6 ~ Me: Cl '0:;; CD "0 C :> ~ 5 "0 8 .!!! c: CD ~ 5 "0 CD o .!!! ~ rn ... o rn rn rn o ... o o tll ... l!! .z 'i g .c o .. 5 o . . - ... ... .:r lf1 o o nJ [j o .. ~ [tJ .:r [tJ C'- ... ... rn nJ nJ ~ SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Margaret R. Kerns (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) 21-01-0849 c. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: 1 PREP AID 2 Administrative Costs: 1 Personal Representive Commissions $250.00 Social Security Number of Personal Representative: 2 Attorney fees to Andrews & Johnson $450.00 3 Family Exemption Claimant Relationship: Address of Claimant at decedent's death: Street: City: State & Zip 4 Propate Fees to Register of Wills $36.00 Miscellaneous Expenses: 1 Register of Wills-filing fee for P A Inheritance Tax Return $10.00 2 Reserve for closing and accounting $350.00 TOTAL (also on line 9, Recapitulation) $1,096.00 A. B. SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Margaret R. Kerns 21-01-0849 ITEM NUMBER DESCRIPTION AMOUNT Commonwealth of Pennsylvania, Department of Public Welfare, Estate Recovery Program Class Three Claim pursuant to Section 3392 (3) Class Six Claim pursuant to Section 3392(6) (See letter tax) $24,285.15 $110,736.59 TOTAL (also on line 10, Recapitulation) $135,021.74 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 October 15, 2001 ANDREWS & JOHNSON RONALD E JOHNSON ESQUIRE 78 WEST POMFERT STREET CARLISLE PA 17013-3216 Re: MARGARET KERNS CIS #: 040140605 Co/Rec: 21/0082801 Date of Birth: 10/29/1916 SSN: 189-09-4355 Dear Attorney Johnson: Please be advised that the Department of Public Welfare maintains a claim in the amount of $135,021.74 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 $24,285.15, was incurred during the last six months of the decedent's lifej 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 $110,736.59, 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. Sincerely, )Jt4.(~L.~ Margaret L. Sohn Claims Investigation Agent 717-772-6609 717-705-8150 FAX Enclosure SCHEDULE J BENEFI CIARIES ESTATE OF FILE NUMBER Margaret R. Kerns - - ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE I No Funds Available for Distribution to Beneficiaries 2 3 4 21 01 0849 ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0