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Home My WebLink About01-0894 PETITION FOR PROBATE and GRANT OF LETTERS ;J\ - 0\ - ~!J- Estate of KA THRYN T-J also known as No. To: Register of Wills for- the I Deceased. County of Cumberland in the Social Security !yo. 20' -.32.- ..,1<17 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s)t who is/are 18 years of age or older alllthe executors in the last will of the above decedentt dated Fehrnary 10 and codicil(s) dated S'T'l1'T'Tlf'R named t 19QQ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendenfwas domiciled at death in Cumberland CountYt Pennsylvaniat with h er last family or principal residence at 325 Wesley Drive, Apt" 100, Lower Allen Township (list street, number and muncipality) Decendentt then 86 years of age, died September 21 ,~ 2001 , ~ 325Weslev Drive. Mechanicsburg. PA Except as followst decedent did not marry, was not divorced and did not have a child born or adopted after execution of the 'Yill 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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. '" u u c::- o -0_ .- '" "'- u\.o a:o r::: -00 c';:; (U.;:; _lU ,ei:l.. 0<- So (; r::: tlO 00 416 Cocklin Street MpC'h;:m; C'~hllrg, PA 170e;e; ssll 210-40-4000 loe; M~n~inn Dr;ve MQdial p~ 19oh)-1019 ss/l 204-30-8576 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ""1 58 COUNTY OF ..--i"'t.UMBERLAND J The petitioner(~) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the ~est of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly admini ter the estate accor 'ng to law. ~ 00' ::s ~ - 1:: ~ -::--.. . ~ Sworn to o. r af.firme d. and 5llbscribe.d f before me this 26th day of \. ~ ,~OOl ~. - ;,~.~,,~~ ~7 - 7 ReglSt No. 21-01-894 Estate of KATHRYN H. STETLER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW September 28 ~20~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 10, 1999 described therein be admitted to probate and filed of record as the last will of Kt=I thryn H. Stetler and Letters Testamentary are hereby granted to Tl1np ~h~mpnpk ~nn S~nnr;:t Stol1ffpr ?70j)f:;/'J~&~U~ ~ R stet of Wills FEES Probate1. Letters, Etc. ......... x-pagt:s. Short Certtficates( )........... Renunciation ................ 70.00 $ 12.00 $ ] 8. 00 $ $ 5 . 00 TOTAL _ $ 105.00 . .S.~~~~~.~~. ??'.. ?~~.~............ Michael Cherewka fI 3507':\ A TIORNEY (Sup. Ct. 1.0. No.) 624 North Front Street Wormleysburg, PA 17043 ADDRESS JCP Filed (717) 232-4701 PHONE 105.805 REV 9/86 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. ~ -:;1'-~-<:r 1-" ~91-Registrar ~... .~'2..-J'0!.~____~ (/ Fee for this certificate, $2.00 p 7742274 SEP 2 4 200\ Date 21-01-894 I Rev. 2117 COMMONWEALTH OF PENNSVLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Y... SEX ,female STAlE FilE ~R SOCIAL SECURITY NUMBER NAME OF DECEDE:NT (f1lSl. _. L., t.Kathryn H. Stetler /IDE llall IlithdaYl UNDER 1 Y!AR .... Dep 3206 -32 -4797 DATE OF OEATH._.~. ._, a. 9-21-2001 ..86 COUNTY OF DEAl'H UNDER 1 DIIIt ....... ......... i ORE OF IIflTH ,.IootonII>. OIly. '...1 ~o ... Cumberland DECEDENrS USUAl 0CC\lPlVl0N ~.:=:~'::.::~~ 1~secretary insurance DECEDENT'S IiWUNG ADOAESS (SIr...~. s...lipCodlt\ DECEDENT'S 325 Wesley Drive, Apt. 100 ~=NCE --- Jiechanicsburg, PA 17055 -~ FRHEJrS NAME (F1ISl. Middle. Laoq teWilliam Hartman WFOflIoIANTS NAME (T ypeIf'hnll une K. Shamenek WETHODOF 0ISP0SlTl0N .... (X c......... 0 0lMr CSPeaIV' MSDECEDENT EIIEA us. ARMED FORCES? _0 NDCX (1~1 2 MAflIW. SWUS. MMiIcI ,....., ....... ....... IlMln:ed (SpeQIy) widowed la. SUIMVING SPOUSE II...... \10M........... tl. Cumberland Did ........ ... ill. --..? 17...0 ~-=-::oI MOTHER'S NAME lFOII. Modele. ...... 5uI~ te. Viola Kister INFORMANrS MM.ING ACOAES8lS1r'" CiIyIbIn..... Zip CodeI 416 Cocklin Street, Mechanicsburg, PA 17055 PUCE OF 0ISI'0SI'fl0H.....0I CeNtery. Ct...-v LOCRlON. Citf(1ilwn. sa... Zipc- CIf 0lMr "'- 17cJD ...._........ T nu",r A"",n '1'nunAhip ..... t7.. so.rPennsyl vania I,.. ~. L 2t.paddletown Cemeter PA NAME AND AOOflESSOF FACILITY farthemore FH&CS,Inc., New Cumberland,PA LICENSE NUU8ER ORE SIGNED ~.Il8y. 'tlurI 17070 . ....1 0' *8 CASE REFERAED 10 MEDICAL _all NoD alOfy .".... SIlocIl or hMII....... I~ '~**-, :-.....- I I I PART I: CllIlar IigIliIICMI ClOIIlIIiaN ~ 10 dulI\.1luI IIllI ~ift.. undIIlriftg_ givenift FMT I. ~TECAUM (F... ....CIt c:oncMoon ~'-*'llon""'l- COIlo.f-"h-.- l..e.c.ut kwtL ~ =~..____ b ~... .......10_ I ::;_. E.-UNDDLYING _CAUM(o...CIt..." c. .___ ____ OUElO(Ofl AS A CONSEOUENCE OF); :w:tI'-*'llon~LMT It. ~:=~~ ~~ __ COW'LETlOHOF CAUSE ~ OF DEAI'H1 ..0 MANNER Of DERH ......... 'goo Haonicide 0 -- 0 Pendin9 -"iDn 0 Suiclda 0 Could IIllI be delarmtned 0 DATE OF INJURY I-.Oav. -I TIME Of INJURY IN.IUAY /fl WORK? DESCAIlIE HOW INJUAY OCCUflflED. _ 0 NoD ~!! :IlL _ CERT....1C/leclI only one! .e&n'1FYlIIG PHYSICIAN (Physooance<lllylng cause ~ _ ""-..- phySIC","'" s:-onounca<l dealll and Compleled 118m 231 ,..__01.."-......... ......occ__..._causee.l.ndma_'._.................. ............. a. . ... PlACE Of INJURY. Al_.larm. _lar:tDry. oltlca ~ a1C.lSpecoIvI ... bJ, /~,/ { I -. OC/flION~. ColYl1Own. SlaIal - 0 No'P NoD -s:; '!!:;I "=.:I .1'RONOl1NC1HG AND CERTII'YING ",YSIClAN (PhySIC....llOIl1 ;><onouncoog de"" and ~ 10 cause 01 deatl>l ~ To__'!'my......-..g.._.._......__. da'.._"''''_. __.._.......e.I.ndm......'....'...................... .iI ..DICAL EXAIIlNEflICOftONER On the be.. of ...,m...'1on and/or Inv..'IgaIion. In my opinion, d.ath occurred at the I...... d.'.. and p1ac., and due 10 !he c.uM(a) and __.. st.ted.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . .. . .. . . . . . . . . . . . .. . :n.. l REGISTRAR'S SIGNATURE AND NUMBER ... .33. ~~/ ~ ~.A...#'/~I?. __ 17011 . Last Will of KATHRYN H. STETLER 21-01-894 I, KATHRYN H. STETLER, of Mechanicsburg" Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am not now married. . The names of my children are: SANDRA STOUFFER JUNE SHAMENEK All references to my children in my will are to these children, as well as any children subsequently born to me, or legally adopted by me. Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust . All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: wH JJ Page 1 \,,~-\> . KATHRYN H. STETLER, SANDRA STOUFFER and JUNE SHAMENEK, Trustees, or their successors in trust, under the KATHRYN H. STETLER LIVING TRUST, dated Februarv 10, 1999 , and any amendments thereto. Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date of my death. Article Three Powers of My Personal Representative . My personal representative shall have the power to perform all acts rea- sonably necessary to administer my estate, as well as any powers set forth in the statutes in the State of Pennsylvania relating to the powers of fidu- ciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. . ;?rN<::# ~ Page 2 . Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exer- cise any available elections with regard to any state or federal tax laws. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, ex- cluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. . Article Five Appointment of My Personal Representative I appoint the following to be my personal representatives: JUNE SHAMENEK and SANDRA STOUFFER, or the survi- vor of them. I direct that my personal representatives not be required to furnish bond, surety, or other security. I have initialed all of the pages of this Will, and have signed it on (\:) n- e1' <L ;> J~Yl. f(KoyUaAY 10 / 19Q1. o ,rJr:. d; t:f.. J. ~1/ Ki\~H~ y~ ~tETLER . :7r ~S-JA1 "",,*-> Page 3 . The foregoing Will was, on the day and year written above, published and declared by KATHRYN H. STETLER in our presence to be her Will. We, in her presence and at her request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses and have initialed each page. We declare that at the time of our attestation of this Will, KATHRYN H. STETLER was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. ~.u)~ "-'WITN 55 Address: ~~)N.filJl7f NICe:! I !-I:1rn6w ~,/11 J7 / I 0 . ~\. t 'c, \. \ \ tJ ~~ -f6,;\.r'\~~ WITNESS Address: ~s k \0.,(- t~ ~~ rl\-{ th-CLL -l-\o.\ II. ",h h-~, A\ \~l\~ STATE OF PENNSYLVANIA ) ) ss. ) COUNTY OF DAUPHIN . We, KATHRYN H. STETLER, ~a M~ , and 4I/l:qgj/~ &()~ , the Testatrix and the witnesses, respec- tively, whose names are signed to the foregoing Will, having been sworn, declared to the undersigned officer that the Testatrix, in the presence of the witnesses, signed the instrument as her last Will, that she signed, and ~~......-\~ Page 4 . that each of the witnesses;in the presence of the Testatrix and in the pres- ence of each other, signed the Will as a witness. 'If:11 ~)(, j ~u KA THR Y H. STETLER ~, tJlJU~ WI SS ----- ~~~'- (' \\"\. ~ L\... \. ~~~ -\-::T~C)~ WITNESS Subscribed and sworn before me by KATHRYN H. STETLER, the Testa- trix, and by jJthJQ !I/JM1$.L,u and 4tc#~ grll~ , the witnesses, on ~rtL~ /q, /fff . >>Jdtu/ a~ NOTARY PUBLIC My commission expires: Notarial Seal Michael Cherewka, Notary Public Susquehanna Twp.. .Dauphin County My Commission Expires Feb. 5, 2001 Member, Pennsylvania Association of Notaries . Page 5 6 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: KATHRYN H. STETLER Date of Death: September 21,2001 Will No. 2001-00894 Admin No. To the Register: I certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above-captioned estate on October 23,2001. NAME ADDRESS JUNE SHAMENEK 416 Cocklin Street Mechanicsburg, P A 17055 SANDRA STOUFFER 103 Mansion Drive Media, PA 19063-1019 KATHRYN H. STETLER LIVING TRUST, Allfrrst Trust Company Dated February 10, 1999 June Shamenek & Sandra Stouffer, Trustees 416 Cocklin Street Mechanicsburg, P A 17055 Date: 17-/lD/OI CHEREWKA & RADCLIFF, LLP t.n C l/") CJ c:::::f /lr;;~J Chtt~ MICHAEL CHEREWKA, ESQ. 624 North Front Street Wormleysburg, PA 17043 (717) 232-4701 N c....J c::::l Capacity: Personal Representative --X.. Counsel for Personal Representative () ,,~-J.: ua; OJ a: a: p u .' .0 ';:: ~ w= (Sa COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND L J 55: ~~ Shunen~ ~- -/5 being duly -.tUJ tJ rf) according to law, deposes and says that -She _ Executor of the Estate of Kathryn H. Stetler late of _LOF_~ ALL~n TQwn~thip___ E' Cumberland County. Pa.. deceased and that the within is an inventory made by ~Tw"'\..p .Jh~€.r\ e-__ _, the said Executor of the entire estate of said decedent, consisting of all the personal prop\!rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. $vt1-y/l -!o 6-n()~ and subscribed before me, rJL.p~~) ~/~ U<!.kl'n Sf-reej- -&-//tt1 s-..5 Date of Death NOTARIAl-SEAl.. Roberta L Radcliff. Public ~ Borough, Corny of My CoInrr1iMion Expirea Jan. 20. 2005 21st September Day Month 2001 Y..r INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. 0.. 'r-! -0 >- ..c: [f.l CD I- W $ lit ~ 0::: I- cs ~ W < ~ 0 CD 0-. Q. I- ~ E-l u 0 CI) CD 00 0 w w ~ 0 ~ 0 J: a:: E-I s:: . I to- Q. LL ~ Q) c c I- ..J .. .....-l Z 0 E-l ,...., 0 0 LL ..J -< en ,...., Q. ~ 0 W 0 -< w <1:1 .;. N > 0::: Z ::c: - Z 0 0 1-1 c Q) :J 0 CI) Z Z ) 0 0::: U Z w -< ~ 0 - Q. ~ "'0 ::c: c E-l III ~- - -;: 0 CD I ..Q "'0 CD E I - :J ..! III ..J U u:: ~nventory of the real and personal estate of KATHRYN H. STETLER deceased 1. $100 Series E U.S. Savings Bond #C2047702513E 2. Allfirst Bank Checking Acct #0081851928 Savings Acct #0098122002 C.D. #8000002180143 C.D. #87008000138581 3. 1987 Honda Accord 4. Erie Insurance - return of premium 5. Healthnow - Reimbursement 6. Heritage Medical Group 7. J.C. Penney 8. Patriot News 9. Penn Treaty Network America 10. Principal - medical reimbursement 11. Verizon 432 00 1,958 25 41,945 50 38,697 51 25,061 44 2,260 00 265 ,-00 112 25 34 86 27 80 56 80 1,728 97 26 15 16 88 ~12,623 41 r- ""t"'\ r"-~; ~..... c...J :., -~-s C'-J ? . .....J - ".. - .... ".-~ '-...... 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 CHEREWKA MICHAEL 3905 NORTH FRONT ST HARRISBURG, PA 17110 -------- fold ESTATE INFORMATION: SSN: 206-32-4797 FILE NUMBER: 21 - 2001 - 0894 DECEDENT NAME: STETLER KATHRYN H DA TE OF PAYMENT: 1 2/21 /2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/21/2001 NO. CD 000677 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $40,000.00 I I I I I I I I TOTAL AMOUNT PAID: $40,000.00 REMARKS: PENNSYLVANIA STATE BANK CHECK#16958 SEAL INITIALS: SK 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 CHEREWKA & RADCLIFF LLP 624 NORTH FRONT STREET WORMLEYSBURG, PA 17043 -------- fold ESTATE INFORMATION: SSN: 206-32-4797 FILE NUMBER: 2101-0894 DECEDENT NAME: STETLER KATHRYN H DATE OF PAYMENT: 06/21/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/21/2001 NO. CD 001318 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,093.45 I I I I I I I I TOTAL AMOUNT PAID: $2,093.45 REMARKS: PENNSYLVANIA STATE BANK C/O CHEREWKA & RADCLIFF LLP CHECK#17403 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~ 17-/o-2? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ~02 "j 2 . \ c; " -' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-05-2002 STETLER 09-21-2001 21 01-0894 CUMBERLAND 101 Allount Rellitted MICHAEL CHEREWKA CHEREWKA & RADCLIFF 624 N FRONT ST WORMLEYSBURG PA 1704,3 *' REY-1547 EX AFP (01-02) KATHRYN H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=is4-j-EX--AFP-coi-:02i--NoTIci--oF-'rtiliEifiTANcE-TAjrAPPRAisiifENT-,--ALLOWANci-o"R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STETLER KATHRYN H FILE NO. 21 01-0894 ACN 101 DATE 08-05-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ abh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (lS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. 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) (2J (3) (4) (5) (6J (7) .00 432.00 .00 .00 212,191.41 .00 800,006.15 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule HJ 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 JJ 14. Net Value of Estate Subject to Tax (9) (10) 29,473.39 962.58 (11) (12J (13J (14J NOTE: .00 X 00 = 982,193.59 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. 1,012,629.56 30.431i 97 982,193.59 .00 982,193.59 (19)= .00 44,198.71 .00 .00 44,198.71 rAynl:"I KI:l,;I:~rl l+J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-21-2001 CDOO0677 2,105.26 40,000.00 06-21-2002 CDOO1318 .00 2,093.45 TOTAL TAX CREDIT 44,198.71 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .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.) ~dK 1,</ STATUS REPORT UNDER RULE 6.12 Name of Decedent: KATHRYN H. STETLER Date of Death: September 21. 2001 ~... 2001-00894 Will No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether the administration of the estate is complete: -X..... Yes No 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: If the Answer is "Yes" to No.1, state the following: a. Did the personal representative file a final account with the Court? Yes -X- No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? -X..... Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: DECEMBER 27, 2002 THE LAW OFFICES OF MICHAEL CHEREWKA By: ~~ Michael Cherewka, Esquire Capacity: _ Personal Representative --X- Counsel for Personal Representative REV.1500 EX (6-00l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT W t- x::!!;cn ull:X: wo..u ::1:00 ull:.J 0.. III 0.. <( /7-/0.- f 0J 11 REV-1500 FILE NUMBER ..l.. -L - JL .l COUNTY CODE YEAR Q....JL~...i._ NUMBER I SOCIAL SECURITY NUMBER I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) STETLER, KATHRYN H. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 09/21/2001 04/05/1915 - ____u_ _ ---- -. ------------- -------- - (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 206 - 32 - 4797 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER []: 1. Original Return o 4. Limited Estate [] 6. Decedent Died Testate (Allach copy 01 Will) o 9. Litigation Proceeds Received D . 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-82) Q[] 7. Decedent Maintained a Living Trust (Allach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of dealh prior 10 12-13-82) ~ 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) NAME MICHAEL CHEREWKA FIRM NAME III Applicable) CHEREWKA & RADCLIFF, LLP - .-- -- - -- TE~EPHONE NUMBER Ul7) 232-4701 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) z o ~ ...J ::::l !:: a. oC( () W c::: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 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) COMPLETE MAILING ADDRESS 624 NORTH FRONT STREET WORMLEYSBURG, PA 17043 (1) (2) (3) (4) (5) 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) 432.00 212,191.41 (6) (7) 800,006.15 (9) (10) (8) 29,473.39 962.58 : 1,012,629.56 (11) (12) (13) 30,435.97 982.193.59 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) (14) 982,193.59 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 982,193.59 x .0 ___ (15) x .0_45 (16) 44,198. 71 x .12 (17) 0.00 x .15 (18) 44,198.71 (19) z o < ~ ::::l a. :!: o u X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 (3) 0.00 (4) (5) 2,093.45 (5A) 0.00 (58) 2,093.45 Decedent's Complete Address: STREET ADDRESS .325 Wesley Drive, 11100 CITY M h . b ec anlCS urg STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 40,000.00 -----2~105.-26 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + 8 + C ) (2) 4. Total Interest/Penalty ( 0 + 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. 8. Enter the total of Line 5 + 5A. 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 a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........ ......................................................................... ............................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................ ........ ............. ............... .................................... :[] ZIP 17055 44,198.71 42,105.26 No D [Xl [Xl [Xl Iil Iil o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ESPONSI8LE Fo.;:rlNG REJ"~ ..~ ADDRESS r I 416 C klin Street Mechanicsburg, PA SIGNA~U~E OF PREPARER OTHER THAN REPRESENTAT~~&(ta'4.L--. _ ADDRESS 624 North Front Street 17055 \iorIIl1eysbllrg, Pb-___J704L DATE ~t1~~ DATE '/t7~V For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 deceased 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. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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. REV -1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KATHRYN H. STETLER SCHEDULE B STOCKS & BONDS FI LE NUMBER 0894-01-21 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH $100 Series E U.S. Savings Bond #C2047702513E 432.00 TOTAL (Also enter on line 2, Recapitulation) $ 432.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems. Inc. Form REV-1503 EX (Rev. 1-97) REV-1508 EX+(1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT KATHRYN H. STETLER FILE NUMBER 0894-01-21 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 1,957.97 0.28 Allfirst Bank Interest accrued to 09/21/2001 Checking Acct #0081851928 2 Allfirst Bank Interest accrued to 09/21/2001 Savings Acct #0098122002 41,911.49 34.01 3 Allfirst Bank Interest accrued to 09/21/2001 C.D. #80000002180143 137,468.21 1,229.30 4 Allfirst Bank Interest accrued to 09/21/2001 C.D. #87008000138581 25,000.00 61. 44 5 1987 Honda Accord 2,260.00 6 Erie Insurance - Return of uneared premium 265.00 7 Healthnow - Reimbursement of medical expense 112.25 8 Heritage Medical Group - Refund of overpayment 34.86 9 J.C. Penney - Return of credit balance 27.80 10 Patriot News - Return of premium 56.80 11 Penn Treaty Network America - Return of uneared premium 1,728.97 12 Principal - medical reimbursement 26.15 13 Verizon - return of overpayment 14.45 14 Verizon - return of overpayment 2.43 TOTAL (Also enter on line 5, Recapitulation) $ 2 12 . 191 . 41 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV -1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KATHRYN H. STETLER SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 0894-01-21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE THEIR DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDEi~TD~NPn T=~ D,1Tlj 0/ 1~~~SFER. NUMBER ATTACH A COPYOF TH EE F R R A ST T . VALUE OF ASSET INTEREST (IF APPLICABLE) 1 Kathryn H. Stetler Living Trust dated February 10, 1999 377,068.49 100 0.00 377,068.49 2 MetLife Annuity Contract #A2054892 34,079.58 100 0.00 34,079.58 3 Principal Life Annuity Contract #0072463 62,346.24 100 0.00 62,346.24 4 Principal Life Annuity Contract #0086968 79,945.58 100 0.00 79,945.58 5 Principal Life Annuity Contract #0090962 54,439.01 100 0.00 54,439.01 6 Principal Life Annuity Contract #0094644 52,524.03 100 0.00 52,524.03 7 Principal Life Annuity Contract #0284601 73,552.49 100 0.00 73,552.49 8 Zurich Life Annuity Contract #FK4009539 66,050.73 100 0.00 66,050.73 TOTAL (Also enter on line 7 Recapitulation) $ 800 006.15 (If more space is needed, insert additional sheets of the same size) CoPyri9ht (c) 1997 form software only CPSystems, Inc. Form REV-151O EX (Rev. 1-97) REV-1511 EX+(1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KATHRYN H. STETLER FILE NUMBER 0894-01-21 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 10. DESCRIPTION AMOUNT FUNERAL EXPENSES: parthemore Funeral Home 8,960.00 1. ADMINISTRATIVE COSTS: 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: 0.00 2. 3. Attorney Fees 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 20,000.00 N/A 4. Probate Fees 305.00 5. Accountant's Fees 0.00 6. Tax Return Pre parer's Fees 0.00 7. Register of Wills Short Certificate 3.00 8. Register of wills Filing fees - Inventory and Inheritance Return 25.00 9. The Sentinel Legal Advertising 90.59 Cumberland Law Journal Legal Advertising 75.00 Total miscellaneous expenses from continuation paqe(s) 14.80 TOTAL (Also enter on line 9, Recaoitulation\ $ 29,473 .39 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSyslems, Inc. Form REV-1511 EX (Rev. 1-97) SCHEDULE H MISCELLANEOUS EXPENSES {continued} ESTATE OF: KATHRYN H. STETLER FILE NUMBER: 0894-01-21 ITEM NO 11. DESCRIPTION PA State Bank Check charges Total. (Carry forward to main schedule) . . . $ AMOUNT 14.80 14.80 REV-1512 EX + 11-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF KATHRYN H. STETLER FILE NUMBER 0894-01-21 Include unreimbursed medical expenses. ITEM NUMBER 1 Quantum Imaging DESCRIPTION AMOUNT 4.72 2 Kilmore Eye Associates 15.00 3 PA Department Revenue Balance of 2001 Income Tax 188.00 4 U.S. Treasury Balance of 2001 personal income tax 434.00 5 Verizon Final Billing 31.56 6 Heritage Diagnostics Center 69.72 7 Conner-Rich Associates 80.39 8 Beacon Medical Group 9.64 9 Verizon 3.06 10 Health Rehab of Mechanicsburg 27.87 11 Heritage Medical Group 16.62 12 Erie Insurance 82.00 TOTAL (Also enter on line 10, Recapitulation) $ 962.58 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1997 form software only CPSystems. Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX+(1-97) COM MONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KATHRYN H. STETLER SCHEDULE J BENEFICIARIES NUMBER I. FILE NUMBER 0894-01-21 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 June Shamenek 416 Cocklin Street Mechanicsburg, PA 17055 Daughter 464,834.78 2 Sandra Stouffer 105 Mansion Drive Media, PA 19063 Daughter 464,834.78 3 Steven D. Stouffer 513 Third Avenue Garwood, NJ 07027 Grandson 13,131. 01 4 Sheri Peifer 1341 Asper Drive Boiling Springs, PA 17007 13,131. 01 Granddaughter 5 Adam L. Shamenek 755 Whisler Road Etters, PA 17319 13,131.01 Grandson See Schedule Attac hed. . . ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. 0.00 Form REV-1513 EX (Rev. 1-97) SCHEDULE J BENEFICIARIES (continued) ESTATE OF: KATHRYN H. STETLER FILE NUMBER: 0894-01-21 ITEM NO NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE 6 Matthew P. Shamenek 755 Whisler Road Etters, PA 17319 Grandson 13,131. 00 Last Will of KATHRYN H. STETLER I, KATHRYN H. STETLER, of Mechanicsburg" Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am not now married. The names of my children are: SANDRA STOUFFER JUNE SHAMENEK All references to my children in my will are to these children, as well as any children subsequently born to me, or legally adopted by me. Article 1\vo Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: WH J; Page 1 f'r't'""(~,::,- KATHRYN H. STETLER, SANDRA STOUFFER and JUNE SHAMENEK, Trustees, or their successors in trust, under the KATHRYN H. STETLER LIVING TR UST, dated February 10. 1999 , and any amendments thereto. Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date of my death. Article Three Powers of My Personal Representative My personal representative shall have the power to perform all acts rea- sonably necessary to administer my estate, as well as any powers set forth in the statutes in the State of Pennsylvania relating to the powers of fidu- ciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. ?r6tt;~ ~ Page 2 Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exer- cise any available elections with regard to any state or federal tax laws. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, ex- cluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Article Five Appointment of My Personal Representative I appoint the following to be my personal representatives: JUNE SHAMENEK and SANDRA STOUFFER, or the survi- vor of them. I direct that my personal representatives not be required to furnish bond, surety, or other security. I have initialed all of the pages of this Will, and have signed it on ~J 0- d (L ,;> _,tlYl. RltJrUaIlY 10 I 1'1'11- o -, ~.JiR~H7hE~R .2 ~~v :71" I-<S.fJA1 ,nrrb Page 3 The foregoing Will was, on the day and year written above, published and declared by KATHRYN H. STETLER in our presence to be her Will. We, in her presence and at her request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses and have initialed each page. We declare that at the time of our attestation of this Will, KATHRYN H. STETLER was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. ~!J!:ft. aJWflCiVI WIT SS Address: l'Ylt5 N. fiJJrJlN r[(~1 I ~1:x;51)U7JIO ~l.. C ~.. l. \ \) >--t~ i()'iUL\-::"-':2> WITNESS Address: ~s k \.(")\ t~ ~~ r'il--i: 'thcc-L ~\o..\ll~<C-'U('~, A\ \'lU\::) COUNTY OF DAUPHIN ) ) ss. ) STATE OF PENNSYLVANIA We, KATHRYN H. STETLER, ~a It/l~ , and 4tti:Qille 13Y'()~ , the Testatrix and the witnesses, respec- tively, whose names are signed to the foregoing Will, having been sworn, declared to the undersigned officer that the Testatrix, in the presence of the witnesses, signed the instrument as her last Will, that, she signed, and ~(T'\'n Page 4 that each of the witnesses;in the presence of the Testatrix and in the pres- ence of each other, signed the Will as a witness. /t:'a ~----,)t j ~u KA THR Y H. STETLER ~, VJIW~ WI SS ----- ~lL c \1\. ~ "-~ '\ '-\~. -r:=:n._.D~ WITNESS Subscribed and sworn before me by KA THR YN H. STETLER, the Testa- trix, and by JaAN U/;~.hf and ;ftc-idle ';ru% , the witnesses, on ~,.tt~ /~ Iff? J11ikt/ ~~ NOTARY PUBLIC My commission expires: Notarial Seal Michael Cherewka. Notary Public SUSCluehanna Twp., Dauphin County My Commission Expires Feb. 5, 2001 Member, Pennsylvania Association of Notaries Page 5