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HomeMy WebLinkAbout01-0886 MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of HELEN L. ROGERS No.21 01 ff(P also known as HELEN LOUISE ROGERS , Deceased Social Security No. 206348555 DOUGLAS ROGERS Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) Gl A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut OR Decedent, dated 12/29/75 and codicil(s) dated N/A named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: o B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 622 MESSIAH VILLAGE, UPPER ALLEN TOWNSHIP, MECHANICSBURG, PA 17055 (list street, number and municipality) Decedent, then 88 years of age, died SEPTEMBER 5 ,2001 , at HOLY SPIRIT HOSPITAL, HARRISBURG, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County.............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ Bl!., l!>(!;)G).l>--'U &3 fa CS> (!;)LJ (J u Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence DOUGLAS ROGERS 1254 BROWNING COURT LANSDALE PA 19446 RW-1 /1-9- / '-i Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petijioner(s) will well and truly administer the ~ ~ . . Sworn to and affirmed and subscribed -;L DOUGLAS ROG S before me this 2;5 TH day of DECREE OF REGISTER Estate of HELEN L. ROGERS also known as HELEN LOUISE ROGERS Social Security No: 206348555 AND NOW, SEPTEMBER 26TH reverse side hereon, satisfactory proof having been presented before me, Deceased No.21 01 886 Date of Death: September 5th,2001 2001 ,in consideration of the Petition on the IT IS DECREED that Letters J;I Testamentary a of Administration are hereby granted to ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) OOUGLAS ROGERS in the above estate and that the instrument(s), if any, dated DECEMBER 29TH, 1975 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. $ 11:\ nn $ $ $ $ $ $ $ FEES Letters .................................... $ 200.00 Short Certificates(s) ...........5. Renunciation........................ .. Extra Pages ( 2 ) ............... I. T. Roo. ................. .... .... ........... JCP Fee................................. Inventory ................................ Other..................................... . 6.00 ~~.(' -~ / Signature 5.00 Attorney: GERALD J. BRINSER I.D. No: 09655 Address: 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Telephone: (717)838-6348 226.00 TOTAL............................ .$ ",0. Ct _ "2!>~ - v I MAILED LETTERS 'IO ATTORNEY DATE FILED: REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing . ess to the will presented herewith, (each) being dul law, depose(s) and say(s) tha lfied according to present and saw the testat , sign the same and tha request of testat_ in h other subscribing witness(es)). Sworn to or affirmed and s me this cribed before day of 19_ (Name) Register (Name) (Address) 21-2001-886 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS x~L/t1f1t G: ~I(/Se .. . ~ 'f) t) UIP /A--:J Ro6E i~ _ (each) being duly qualified according to law, depose(s) and say(s) that 'they are familiar with the signature of Helen L. Rogers codicil testat~ of s~) the (wil~ presented herewith and codicil that thEW believesKhe signature on the (wil~ is in the handwriting of Helen L. Rogers to the best of their knowledge and belief. Sworn (0 or affirmed and subscribed before ~~ "" ff~ m~~~ber 26th ,;;a~o~fl~~.' (N m~e) Z!{a~~01/J~J fV1/JX;;;;). Mddr.. c. ewlS / R' t egis er ) (Name) .LA~:) d" h: ) p,.,. (Address) ~ f',,; ~"', ',' '<...'r:, This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. 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. ~ Fee for this certificate, $2.00 p 7621922 SEP 0 7 200) Date 21-2001-886 143 Rev. 2IffT COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH CUn'iJer land s USUAL 0CCUPRl0N l~"':':~ C::':::'.I:'r 11 Re istered Nurse I1It. Private DJty DECSlENT'S YAIUtG ADOIlESS CSlr"'~, s.. ZipCodel DECEDENT'S ACTUAL RESIDENCE - on llltlef IIClel SEll SlATE FIlE NUldEA SOCIAL SECURITY NUMBER NAME Of' DECEDENT (for.. ModclIe. l", 1. Helen L. AGE (l811 ~ UNDER' YEAR ManItIe 0.,. Fanale ~ 206 34 utlDER , OM ....... I ~ ! 81RT~ (c.....and $We Of Fcreogn CounlrYl SUR\/MNG SPOUSE ,...... go-..-. ".,.... 11.. $I-. P.(;J ,.. '71:,Xl ......... ...... TTpf'Pr AllAn . 622 Pine Place ,.. Mechanicsburg, pa 17055 FRMER'SNAME\fW1I. ~.I.MI) ,n.. DicI ...... he in. Ctmberland -....' ,u.o ~-:":::of MOTHER'S NAME IF... Modele. MMlen &./WIle) ,~ Minnie Manzer INfORMANTS MMlNO AODAlE8S(SlrwI. CiIyIbwn. s... Zip CclCMI 1254 Brownin Ct Lansdale ,pa 19446 PlACE OF 0ISP0SIT10N. N-. oIc-y. er-.o.y LOCA1'ION. ClIyIlOwn. se.. ZlpCacllo Of 0IIlet PIKe CilP'.:-- 11.. Harrisburg, pa ~ In~ mI~;tp~tB8i ORESlGNEO .. -- (Monft. OIly. -, L :t:1JTY2.~ . n.. 'WoSCASl! REFEAAEOlO MEDICAl ElWoI~I" ..lB r/J HoD 2t. I AppnlaiINlIe '---.-. :_ MIIdN11l I I I PART I: 0lIw..... -.dIIioIw--....._.....ltul "'lMUIIinlI in.... UftdeItwiItg _ gi.- in A\RT I. ~\~ E DUE 10 lOR AS A CONSEQUENCe Of): DUE 10 lOft AS A CONSEOUENCE Of): WEAE AU10PSY FINDINGS ~PAIOftlO OF CAUSE Ml\HNER Of DfATH DATE OF INJURY ,........ Day. \Ioafl TIME OF INJURY INJURV R WORK1 DESCAltlE HOW IHJURV OCCUNIEO. "-'Iing~ . 0 NoD .0 ...0 ....... 0 AccideIIl 0 SuIcidt 0 HomicicIe OERH? CO<lkI_ be _..........s za. n. CSIT....lO>eck only llMI "CSlTFtWG I'HYSICIAIt (PttyllClllftcenlyong e-.- d _ ...... anolNr pl\vsoC_MsIllOflOlJf'QO dellll> ana ~ nem 23) . To.............,..--.......eocunM..........c8UM(.)....._..__.................................................... . "PIIOMOlIMClflQ AHO CIInll'YlNO PttYStC!AH ~ bOIh ;JIanauncong _ _ ce<1oIylng 10_ 01_1 To \he..... of My 1InowIedQe. ..... eccuned.. ....... ...... MIl piece. ......... ... c.....c.) MIl m.nne,.. ...-.. . . - . . . . . . . . "IEDICAL EXAMlNIRIC<lftONER On lIW...... of ..aminatlon andIOIltweatlgatioft.ln my opinIoII. death occurred at the time. dat., and piKe. ..... due to the ""..(a) ancI _.. etated.. .. . . . . . . .,. . ... . . . . . . . ... . . . . . . .. . . . . . . . . ... .. . . .. . . ... . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ... . . :l1a. ... REGIST" SlGNAI'UAE.;;;'U~ _ U?cAt:/ "<. ';7 ~-"' b? ,/ ~ 1/ J 1EClSt JlIt11 Club Qrt~tClttttut I, HELEN L. ROGERS, a resident of the Township of Jackson, County of Susquehanna and State of Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all wills and codicils heretofore made by me. ITEM I I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II All the rest, residue and remainder of the property which I may own at the time of my death, real and personal, I bequeath and devise in equal shares to my sons, Douglas Rogers, Wayne Rogers and Paul Rogers, per stirpes. ITEM III Should any of my issue entitled to ~ ~ "'t- a share of my estate not have attained the age of twenty five years at the time of distribution to him or her, I devise and bequeath the share of each such issue to County National Bank of Montrose, Pa. (IN SEPARATE TRUST), to hold, manage, invest and reinvest the share so received, and the accumulation of income thereon, and to use and apply the income and principal or so much thereof, as in Trustee's discretion, may be necessary or appropriate for such issue's support and education (including college education, both graduate and undergraduate, or trade school), or to make payment for these purposes, without further responsibility to such issue or to any person taking care of such issue. Trustee may accumulate the income from such trust until such issue attains the age of twenty one years; thereafter the net income shall be paid at least semi-annually to such issue. (i) As each of my issue attains the age of twenty one years, or if he or she has attained the age of twenty one years at the time of distribution, each of such issue shall have the right then and continuing thereafter to withdraw one-third (1/3) of the balance of the separate trust fund established for each such issue, and any accumu- lated income thereon. (ii) As each of my issue attains the age of twenty five years, Trustee shall pay over to such issue the then-remaining balance of principal and income. (iii) If any of my issue shall die after the establishing of the separate trust but before attaining the age of twenty five years, the trust shall then terminate and such share shall be distributed to his or her personal representative. ITEM IV I appoint my son, Douglas Rogers, executor of this my Will. In the event my said son shall predecease me or fail to qualify as such executor, I appoint \:L ~ ::1: my son, Wayne Rogers, substitute executor; and I vest my said executor or substitute executor with full power and authority to sell, transfer and convey any property, real or personal, which I may own at the time of my death at such time and price and upon such terms and conditions as he may determine. ITEM V I direct that neither my executor, substitute executor, nor trustee be required to give bond or other security for the performance of their duties in any jurisdiction. ITEM VI My corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in effect from time to time during the period over which its services are performed. IN WITNESS WHEREOF, I have hereunto set my hand this ..E:L day of ~ ' 197 6 . /~"\ c:f (/~~/ Helen L. Rog~s ~ \.( ~ The foregoing instrument, consisting of this and two preceding pages, was on the day and date thereof signed, published and declared by HELEN L. ROGERS, the testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ;2 ~~ l .~ . 7) ~'1 r:(. .residing at /4 7-'l~-?<#~' - ~ ' ,c-<:_-~."....) '- ~/~ .../ .. - "'x~" \.-.k // &:7_~~;77-a~..~,~~ residing at 1// ~.~ . ~:;"~ ,..',.. d---tAL~ ----- F, MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: HEl.,~~HOGERS Date of Death: ~LqlQl_~~_~____~__ Estate No. ____~__~____~_______ SSN: 206-34:85~5 File No. .~L- 01 ~ oot8'G Date Letters Granted: 9/25/01_~ Will or Administration No. _~____~____~____n~_~___~__~__~_______ To the Register: I certify that Notice of Estate Administration 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 9/27/0~__~ ------------------ ~------- Name WAYNE ROGERS Address R.D. #2, BOX 2665 ~_________________ ____n__ _J:lALLSTEAD ___ _______n_______H_~_____ __ P A 1~822 ___ _ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except R()lJg~~_RQGERS A~QYAUL RO~ERS, ~HO M~T INOUR OFFICE. Personal Representative X Counsel for Personal Representative ~~.~j~- Signature GERALD J. BRINSE~ESQUIRE 1#09~~____. Name (Please type or print) Date: 9/27/01 Capacity: Address 6 E. MAIN STREET. P.O,J;lOX 323 __ PALMY~ ______ _____ __P_A_.Jl_078____ Telephone No. (717)838-6348 ____.___ _______~______ . . ~ MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY , Deceased No. 21 01 0886 Date of Death 09/05/2001 Social Security No. 206-34-8555 Estate of HELEN L. ROGERS also known as HELEN LOUISE ROGERS Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IN/e verify that the statements made in this inventory are true and correct. IN/e understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. . Personal Representative: Name of Attorney: GERALD J. BRINSER 1.0. No.: 09655 Address: 6 E. MAl N STREET DOUGLAS ROGERS EXECUTOR Dated MAY 14, 2002 PALMYRA PA 17078 Telephone: (717)838-6348 Description Value Mortgages & Notes Receivable P I'" CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN- MTG. RECEIVABLE - BALANCE AT DATE OF DEATH 16,733.99 f',J \....oJ Cash, Bank Deposits, & Misc. Personal Property PNC BANK - CHECKING ACCOUNT #5070098747 (INCLUDES ACCRUED INTEREST OF $.12) ',-'J 1,739.18 PNC BANK - SAVINGS ACCOUNT #5001902412 (INCLUDES ACCRUED INTEREST OF $1.25) 3,170.52 PNC BANK - CERTIFICATE OF DEPOSIT #21001015120 (INCLUDES ACCRUED INTEREST OF $2.16) 3,227.45 Total 69,179.40 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory H~LEN L. ROGERS 21 01 0886 PaQe 1 Description of Inventory Description PNC BANK - CERTIFICATE OF DEPOSIT #31800190667 (INCLUDES ACCRUED INTEREST OF $4.37) Value 7,565.91 PNC BANK - CERTIFICATE OF DEPOSIT #31600212847 (INCLUDES ACCRUED INTEREST OF $92.58) 13,070.39 BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT (INCLUDES ACCRUED INTEREST OF $176.12) 23,176.12 FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE 185.70 MAGAZINE SUBSCRIPTION - REFUND 7.20 A.F.L. INSURANCE - REFUND 302.94 Subtotal $ 44,308.26 69,179.40 Grand Total $ " "MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of HELEN L. ROGERS also known as HELEN LOUISE ROGERS , Deceased No. 21 01 0886 Date of Death 09/05/2001 Social Security No. 206-34-8555 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: GERALD J. BRINSER I.D. No.: 09655 Address: 6 E. MAIN STREET DOUGLAS ROGERS EXECUTOR Dated MAY 14, 2002 PALMYRA PA 17078 Telephone: (717)838-6348 Description Value Mortgages & Notes Receivable ~.1 ~ P I "V CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN - MTG. RECEIVABLE - BALANCE AT DATE OF DEATH 16,733.99 f'J W Cash, Bank Deposits, & Misc. Personal Property \,..IJ PNC BANK - CHECKING ACCOUNT #5070098747 (INCLUDES ACCRUED INTEREST OF $.12) 1,739.18 PNC BANK - SAVINGS ACCOUNT #5001902412 (INCLUDES ACCRUED INTEREST OF $1.25) 3,170.52 PNC BANK - CERTIFICATE OF DEPOSIT #21001015120 (INCLUDES ACCRUED INTEREST OF $2.16) 3,227.45 Total (Attach Additional Sheets if necessary) 69,179.40 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 . Continuation of Inventory HELEN L. ROGERS 21 01 0886 PaQe 1 Description of Inventory Description PNC BANK - CERTIFICATE OF DEPOSIT #31800190667 (INCLUDES ACCRUED INTEREST OF $4.37) Value 7,565.91 PNC BANK - CERTIFICATE OF DEPOSIT #31600212847 (INCLUDES ACCRUED INTEREST OF $92.58) 13,070.39 BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT (INCLUDES ACCRUED INTEREST OF $176.12) 23,176.12 FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE 185.70 MAGAZINE SUBSCRIPTION - REFUND 7.20 A.F.L. INSURANCE - REFUND 302.94 Subtotal $ 44,308.26 69,179.40 Grand Total $ 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 ROGERS DOUGLAS 1254 BROWNING COURT LANSDALE, PA 19446 -------- fold ESTATE INFORMATION: SSN: 206-34-8555 FILE NUMBER: 21-2001- 0886 DECEDENT NAME: ROGERS HELEN L DA TE OF PAYMENT: 11/30/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/05/2001 NO. CD 000577 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,225.00 I I I I I I I I TOTAL AMOUNT PAID: $5,225.00 REMARKS: DOUGLAS ROGERS CANNOT READ POSTMARK OR CHECK SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS 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 NO. CD 000573 HAMILTON C DAVIS 20 EAST BURD STREET SUITE 6 POBOX 40 SHIPPENSBURG, PA 17257 ACN ASSESSMENT CONTROL NUMBER AMOUNT -------- fold 101 $1,381.97 ESTATE INFORMATION: SSN: 206-34-8555 FILE NUMBER: 21-2001- 0886 ROGERS HELEN L 11/29/2001 DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: ,/ TOTAL AMOUNT PAID: $1,381.97 /"" REMARKS: HAMILTON C DAVIS CHECK# 0282 SEAL INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS nns~EIPT IS REPLACED WITH CD 000601 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 BRINSER GERALD J 22 N RAILROAD ST PALMYRA, PA 17078 -------- fold ESTATE INFORMATION: SSN: 206-34-8555 FILE NUMBER: 2101-0886 DECEDENT NAME: ROGERS HELEN L DA TE OF PAYMENT: OS/23/2002 POSTMARK DATE: OS/21/2002 COUNTY: CUMBERLAND DATE OF DEATH: 09/05/2001 NO. CD 001202 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $223.68 I I I I I I I I TOTAL AMOUNT PAID: $223.68 REMARKS: GERALD J BRINSER SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS \I?~ 9~/Y 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 DATE ESTATE OF DATE OF DEATH FILE NUMBER :C~OUNTY ACN 06-24-2002 ROGERS 09-05-2001 21 01-0886 CUMBERLAND 101 GERALD J BRINSER BRINSER ETAL PO BOX 323 PALMYRA .02 JUL -1 L" PA 1707Bur * REV-15~7 EX IFP 101-02> HELEN L Allount Rellitted ) CHANGED 1I) (2) (3) (4) (5) (6) (7) .00 .00 .00 16.733.99 52.445.41 .00 62.455.01 (8) 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 ~ REv=is4-j-iX--AFP--rcff:ozi--No'fici--oF-.rNHiiiifAifci-'fAx-APPRAisiMENT~--Ar.l-owANci-iri----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROGERS HELEN L FILE NO. 21 01-0886 ACN 101 DATE 06-24-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Rea~ 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 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 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 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~ abb returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: NOTE: (9) 1I0) 41291.51 NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent. 1311634.41 4.441 1)1 1271192.90 .00 1271192.90 1I9)= .00 51723.68 .00 .00 51723.68 150.00 1I1) 1I2) 1I3) 1I4) .00 X 00 = 1271192.90 X 045 = .00 X 12 = .00 X 15 = I"ATnt:NI KC~C.l.rl {+J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11 30 2001 CDOO0577 275.00 51225.00 05-21-2002 CDOO1202 .00 223.68 TOTAL TAX CREDIT 51723.68 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.) " REV-1SOOEX' (~) 'w/ .' COMMONWEALTH OF PENNSYLVANIA , DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAl USE ONLY ____/?_=_. c?-~_____ FilE NUMBER 21 -01 0 8 86 COUN'ricOOE -YEAR- - - iWiER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z W C W o w c ROGERS HELEN L. A/K1A HELEN LOUISE DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 09/05/2001 11/22/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A 2 06- 3 4 - 8 5 5 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ~ lI::-tIl uO:lI:: wo..u :rOO U O:...J o..lQ 0.. c( [Xl 1. Original Return D 4. limited Estate 00 6. Decedent Died Testate (Al!ach copy of Wil) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dale of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Al!achtopYOfTruSI) o 10. Spousal Poverty Credn (daleo/death between 12-31-91 and 1-1-95) o 3. Remainder Return (dale of death prior III 12-13-82) o 5. Federal Estate Tax Retum Required .L 8. Total Number of Safe Deposn Boxes o 11. Election to tax under See. 9113(A) (Al!ach Sch 0) I- Z W C Z o 0.. tIl W 0: 0: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS GERALD J. BRINSER 6 E. MAIN STREET FIRM NAME (If Applicable) BRINSER WAGNER & ZIMMERMAN P.O. BOX 323 TELEPHONE NUMBER 717838-6348 PALMYRA PA 17078 z o 5 ~ I- 0:: <C o w 0:: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposils & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Cools (Schedule H) (9) 10. Debls of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests/See 9113 Trusls for which an election to tax has not been made (Schedule J) ~< I ,~ I I 16.733.991 I 52,445.41 ! OFFICIAL USE ONLY i I 62,455.01 L~' ___I (8) 131,634.41 4,291.51 150.00 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I- ~ a.. :IE o o ~ I- 15. Amount of Line 14 taxable atlhe spousal tax rate, artransfers under See. 9116 (a)(1.2) 19. Tax Due 0.00 X .0L (15) 127,192.90 X .04.5 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF M OVERPAYMENT (11) (12) (13) 4,441.51 127,192.90 (14) 127,192.90 5,723.68 5,723.68 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < ~-~.,,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RlETURN RlESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF ROGERS. HELEN L.. A1K1A HELEN LOUISE All property jointly-owned with the right of survivorship must be'disclosed on Schedule F. ITEM NUMBER 1. FILE NUMBER 21 01 0886 DESCRIPTION CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN - MORTGAGE RECEIVABLE - BALANCE AT DATE OF DEATH VALUE AT DATE OF DEATH 16,733.99 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 16733.99 .r / ~(Q)~\~- Ray Davis 0'6/20'/0'0' LO^N ^MORTIZATION SCHEDULE PAGE 1 BUYER. .rCHARLES & JUNE BOMAN AND WII,LIAM & KATHRYN BOMAN R. r. #1. Box 512 Susquehanna. PA 18847 AGENT..rHELEN ROGERS . /.1 ~22 Messiah Village.; f,(). ~~(J/.s Mechanicsburg. Pa 170'55-2015 Property. r Township of Jackson County of Susquehanna Commonwealth of Pennsylvania PURCHASE PRICE...... INITIAL DEBT. ...... INTEREST RATE....... PAYMENT FREQUENCY... (M) NUMBER OF PAYMENTS.. ADDITIONAL PRINCIPAL 26.000.00 21.000.00 7.000 .. Monthly 60 0.00 DOWN PAYMENT PAyBACK..... . INTEREST. . . . . PAYMENTS. .'. . . STARTING. . . . . STARTING PYMT 5.000.00 24.949.80' '3.949.80 " 415.83 07/20/00 1 PAYMENT. . . . . . . . . . . . . . . . . . . . NO. DATE AMOUNT INTEREST . PRINCIPAL BALANCE AFTER l..- -21,0ge.&e ~07120'/00 ..v415.83 1.22.50' .....-293.33 20.W_6.....,67_. ~--. ~~--" s-r20..J9 ~95-. 0'4 ::;20. 4+-1:.-~- U3-09J20/00' (~.cr};; J,....~-8.L___.:...11.9--.-01---~-..~-. ].9~0-..1-14.-37--._. 4 10/20 /00'- ~i 0 I ~4--1-5--0~_3-~-1-1--.~ - -- ---;-u.___un.__ ..2.98 .49 ----- ...-1-9-,--816.---38 V~0100'-------4-15. 83-------..H.~.-60------------.----- .j~'0. ~ 1-9-.,..s16. 15- Y"6 12/201-0'0' 415. 8~ ----.-u-------.-11-3.;-84--____:-_--.- 30'1...99 _0' ____~1~T-2-l4..-16--- 2,494.98* 709.14* 1.785.R4* FOR YEAR 1900' f 0:1/20/~1_~Jf~/Jo--'-- 415.83 _ 112.08 . 30..3.75 ---1-8 .-9Hb-.-41-~ I ~lli0'ltJ-(.~c.:./1 col _41~:::8}=.:, - IJ.~_._}l__ ._._-- __ _}0' 5 ~.5 }---!_~.._~~!:.-.8..2_. : :~2-0+01~~1-S-. 8s-------108. 5..3_.-----.-.____....3.07.60-~.:::---: .18--.297-;.59-- A -- L20 /01 ~~. 41-~--~ - .1-06-;-7-4-.--..------.~-~9_'T'0_9_--_..--. -1.1-.98-&-..--5-0- 11 05/2-0/01 -4' I,? Q~ HH. ~J ~--."----..--3_i~_0__----1:.7-.. 6''1'1760 ~0L0-l_.~~~. 1"3- o. 415_..83---.----~--~-103-. 12- 312 ~ 71." 17, 364. 8 i ~ 1-3 07 ~20/0:r- C)~ -o-'::<,):j 415. 3--3----- ----10-1:-;-30- _;:"31.4-._-.5.3_."'_.___.___17....050.. 3.6. ~9.l 1-4--0-81 2-0-/4-1--8~-2'4-0 \.41-5..-8-3~__--.. ..- _ 99_.46_ _ 316.37 . _06.7-3-3...-99) 1 5 '09/20'/01 4 1 5 . 83 9'7 . 61 318 . 22 16 . 415 . 77 16 10/20/01 415.83 95.76 320.07 16.095.70 17 11/20/0'1 415.83 93.89 321.94 15,773.76 18 12/20/01 415.83 92.0'1 323.82 15.449.94 4,989.96* 1.225.74* 3.764.22* FOR YEAR 190'1 19 01/20/02 415.83 90.12 325.71 15.124.23 20 0'2/20/0'2 415.83 88.22 327.61 14,796.62 21 03/20/02 415.83 86.31 329.52 14.467.10 22 04/20'/0'2 415.83 84.39 331.44 14.135.66 23 0'5/20/02 415.83 82.46 333.37 13.802.29 24 06/20'/02 415.83 80.51 335.32 13.466.97 25 07/20/02 415.83 78.56 337.27 13.12~.70 26 0'8/20/02 415.83 76.59 339.24 12.790.46 f~ eM 2--0 -'fA. \ ~ ./~Z~ Ib / 5 z r -=-5--2- __D.,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ROGERS. HELEN L.. AlKlA HELEN LOUISE FilE NUMBER 21 01 0886 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. DESCRIPTION PNC BANK - CHECKING ACCOUNT #5070098747 (INCLUDES ACCRUED INTEREST OF $.12) PNC BANK - SAVINGS ACCOUNT #5001902412 (INCLUDES ACCRUED INTEREST OF $1.25) PNC BANK - CERTIFICATE OF DEPOSIT #21001015120 (INCLUDES ACCRUED INTEREST OF $2.16) PNC BANK - CERTIFICATE OF DEPOSIT #31800190667 (INCLUDES ACCRUED INTEREST OF $4.37) 2. 3. 4. 5. PNC BANK - CERTIFICATE OF DEPOSIT #31600212847 (INCLUDES ACCRUED INTEREST OF $92.58) BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT (INCLUDES ACCRUED INTEREST OF $176.12) FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE 6. 7. 8. MAGAZINE SUBSCRIPTION - REFUND 9. A.F.L. INSURANCE - REFUND VALUE AT DATE OF DEATH 1,739.18 3,170.52 3,227.45 7,565.91 13,070.39 23,176.12 185.70 7.20 302.94 TOTAl (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 52 445.41 ~.'"~.,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ROGERS. HELEN L.. AJI<JA HELEN LOUISE FILE NUMBER 21 01 0886 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 PROPERTY %OF ITEM INCLUDE THE NAME Of THE l1WISfEREE. THEIR RELATIOIlSHIP TO DECEOEKT AAD THE CATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER AITACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPUCAIllE) 1. GLEN BROOK LIFE - (2) ANNUITIES WITH TWO NAMED 47,155.15 100. 47,155.15 BENEFICIARIES 2. FEDERAL HOME LIFE INSURANCE CO. - ANNUITY 15,299.86 100. 15,299.86 WITH TWO NAMED BENEFICIARIES TOTAL (Also enter on line 7, Recapitulation) $ 62.455.01 (If more space is needed, insert additional sheets of the same size) -...."."'" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ROGERS. HELEN L.. A1K1A HELEN LOUISE FILE NUMBER 21 01 0886 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HONORARIUMS - MINISTERS/MUSICIANS 200.00 2. FUNERAL LUNCHEON 180.00 3. FLOWERS 110.51 4. JACSON CEMETERY 50.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees BRINSER, WAGNER & ZIMMERMAN 3,500.00 3. Family Exemption: (If deoedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 226.00 5. Accounlanfs Fees 6. Tax Retum Preparer's Fees 7. REGISTER OF WILLS -INHERITANCE TAX RETURN FILING FEE 15.00 8. REGISTER OF WILLS - INVENTORY FILING FEE 10.00 TOTAL (Also enter on line 9. Recapitulation) $ 4291.51 (If more space is needed, insert additional sheets of the same size) ~."u.,,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROGERS. HELEN L.. A/K1A HELEN LOUISE SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 01 0886 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. OUTSTANDING CHECK AT TIME OF DEATH AMOUNT 150.00 TOTAl (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 150.00 -~'Q':," '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) AMOUNT OR SHARE OF ESTATE 1. DOUGLAS ROGERS 1254 BROWNING COURT, LANSDALE, PA 19446 WAYNE ROGERS R.D. #2, BOX 2065, HALLSTEAD, PA 18822 PAUL ROGERS 103 LAKES VALLEY RD., STRASBURG, VA 22657 SON 1/3 RESIDUE 2. SON 1/3 RESIDUE 3. SON 1/3 RESIDUE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) .' 11Last JIItll attb m~stattttttt I, HELEN L. ROGERS, a resident of the Township of Jackson, County of Susquehanna and State of Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all wills and codicils heretofore made by me. ITEM I I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II All the rest, residue and remainder of the property which I may own at the time of my death, real and personal, I bequeath and devise in equal shares to my sons, Douglas Rogers, Wayne Rogers and Paul Rogers, per stirpes. ~ ~ "'t- ITEM III Should any of my issue entitled to a share of my estate not have attained the age of twenty five years at the time of distribution to him or her, I devise and bequeath the share of each such issue to County National Bank of Montrose, Pa. (IN SEPARATE TRUST), to hold, manage, invest and reinvest the share so received, and the accumulation of income thereon, and to use and apply the income and principal or so much thereof, as in Trustee's discretion, may be necessary or appropriate for such issue's support and education (including college education, both graduate and undergraduate, or trade school), or to make payment for these purposes, without further responsibility to such issue or to any person taking care of such issue. Trustee may accumulate the income from such trust until such issue attains the age of twenty one years; thereafter the net income shall be paid at least semi-annually to such issue. , - ~(Q)[PV .\ \'L ~ -::J:: (i) As each of my issue attains the age of twenty one years, or if he or she has attained the age of twenty one years at the time of distribution, each of such issue shall have the right then and continuing thereafter to withdraw one-third (1/3) of the balance of the separate trust fund established for each such issue, and any accumu- lated income thereon. (ii) As each of my issue attains the age of twenty five years, Trustee shall pay over to such issue the then-remaining balance of principal and income. (iii) If any of my issue shall die after the establishing of the separate trust but before attaining the age of twenty five years, the trust shall then terminate and such share shall be distributed to his or her personal representative. ITEM IV I appoint my son, Douglas Rogers, executor of this my Will. In the event my said son shall predecease me or fail to qualify as such executor, I appoint my son, Wayne Rogers, substitute executor; and I vest my said executor or substitute executor with full power and authority to sell, transfer and convey any property, real or personal, which I may own at the time of my death at such time and price and upon such terms and conditions as he may determine. ITEM V I direct that neither my executor, substitute executor, nor trustee be required to give bond or other security for the performance of their duties in any jurisdiction. ITEM VI My corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in effect from time to time during the period over which its services are performed. IN WITNESS WHEREOF, I have hereunto set my hand this ~1 day of ~ , 197b. /~of~/ Helen L. Rog s