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Home My WebLink About01-1032 Estate of" LotJELLA. B 1<6i/l.( also known as PETITION FOR PROBATE and GRANT OF LETTERS ;2J-OI-lo3~ No. To: Register of Wills for the Deceased. County of cumberland in the Social Security No. i~- i;J. -- Q3S?3 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated JONE 16. 1998 and codicil(s) dated named ,19_ EA (2. L D {<'= I YVI DlZc..-L=-A- sEh s-/ /999 , (state relevant circumstances, e.g. renunciation, death of execlltor, etc.) his (list street, number and muncipality) Decenden~~hen 'j5-1 yell!~ of age, died /0 ft 7 , 1-9 ~L, at t:k!LV ~PII2'T l/QS"PITAL (Am]:> _~LL I=>A 170ft Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted ~fter execution of th~l 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: ~"~ If7:L1a o/J4.ij:,7t,9 ~/3 s-. CJCJO . $ $ $ $ ~q. ~CJO - , WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.La.; administration d.h.n.c.La.) Ji~dviJtf ' -00 t:";:: cU..;:: 3~ II) to- :; 0 ~ t: 0{) Vi OATH OF" PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 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 beli of petitio r(s) and that as rsonal represen- tative(s) of the above decedent petitioner(s) will well d truly a i .ster tees e ccording to law. c-.. /7O-~J _!I Sworn to or affirmed and before me this 9th en ac' :::s I::l - $: ~ ~ N 21-2001-1023 o. Estate of LOUELLA B. KElM , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER 9TH ,_____ _______ _ _ : ~ 20O,4n cOIlsideraiiun ( - i".: L';C;!i.-',!'. ~Hl the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ,TUNE 16, 1 qqR described therein be admitted to probate and filed of record as the last will of LOUELLA B. KElM and Letters TEST~NI'ARY are hereby granted to HARRY-JIDBERT KElM FEES $ 270.00 Probate, Letters, Etc. ......... Short Certificates( 5) . . . . . . . . .. $ 15 .00 Renunciation ................ $ x~ PAGES (3) $ q on JCP TOTAL _ $ 5.00 Filed ID\l.EMBER.' th,.200 1. . . . $. 299 .00. . A TIORNEY (Sup. Ct. 1.D. No.) ADDRESS PHONE MAIt.ID I.E'l'TERS TO EXE:CU".[()'R '_T'n~ ~f'_~ ~_.,: Th~s is to certify that the information here given is correctly copied from 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. Fee for this certificate, $2.00 .p 7744241 No. 21-2001-1032 .rl // / U:,;.:.l!,/jf.-,/~ --;(;.~ ..; ...... ...... OCT 1 9 200t Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH :3 Rev 2117 NAME Of DECEDENT If".. MIcldIe. lalli t. Louella B. Keirn AGE. (l.. Btr1hclaYl UNDER t YEAR Mal*- 0.,. SEX Female PlACE Of DEAI'HICI>eck """""". __ ,,,.IIUC1oOnS on _ _ HOSPITAL; ~g ~O ~o CUmberland DECEDENT'S USUAl 0CCUfIIIn0H (~"i::~~':::.I:'i' unk. -.urECAUM(F..... c--. CII concliIion c=-.gon-I- ~ '" a. ~~..---- ...:ii.... ........ iIIImecliMe :_. E-.UNDeIUlNG -_CAUM(o.-ar ...... --........... - .,...angondaal>lLMT -;"'WIU& _ AU10PSY WERE AU1tlPSY F..oINOS :=PEJIFOAMEO? olUUlA8LE PAIOR 10 = COIFUmONOI'CAUSE ~ 01' DERH? E DUE 1O(OA AS" CONSEQUENCE OF): UAHHER Of DEATH DATE Of INJURY lMoMl. Day. ..... ........ )l! Homicida 0 ""*"' 0 """"--'1On 0 Suil;ide 0 eou.s_..dM_ 0 '1M 0 No _0 NoD - ~ ~ I ... 2Ib.. a. C&n....1Chack or-., onel 'C&n1l'YlllG I'HYSlClAN (PhyllOln ~ c:.- aI_ ........ anoIIler 1lI\vSIC.... has pr"""""<*ldealll ana CllmpIeled "em 231 To........."',~......-..rH.........-<<.I_____ .......................... ........... ............... 'l'ftONOIlNC_ AND CERTIf'tING IIHYSlCIAN (Physoc.an bolh ;)ronounc:ono _ and cer1IIyong 10 cause 01 deall>\ T.... -"my~. ...._.._...... _. _plK., ....._to _cllUM(.l_ m....... ................................... "MEDICAL EXAIIINEAICOAONER On !he buI8 .hllaminatlon andJ<< investigation. In my opinion. dea'lI OCcu"ecIal.1Ie u.n.. dale. and place. and due to IIIe C8UH(.) and _.. "ateel.. . . . . . . . . . .. . . . . . . . . ... . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . ... . . .. . . . . . . .. . . . . . . . . . . . . . . . :tl.. REGlST ~~~7~ bl,/~/,/I STAll FILE NIl_R SOCIAL SECURITY NUMBER :t.183 - 12 - 4383 C/l MAAlTAl STAtUS. MIIn'iacl ~ .....Ied. WidawecI. 0Mlrcect iSPICIYl t.widowed 17C.o _. dacedenl ~ in RACE . "-' .........lIIKIl. WhIte. .-c. (SpacIy1 11. White SUA\IMNG SPOUSE ,I ...... QNe...... nameI IWp Came Hill ~. PART I: TIME OF INJUAY INJURY AI' WORK? DESCRI8E HOW INJURY OCCUflREo. __ 0 NoD o ft. DATE FIUD (MOnIh. Day. 'llllarl ~~__tfJ~Lu / 7' :/001 LAST WILL AND TEST AMENT OF LOUELLA B. KEIM I, LOUELLA B. KEIM, Social Security Number 183-12-4383, of the Commonwealth of Pennsylvania, declare that this is my LAST WILL AND TEST AMENT and I revoke all other wills and codicils previously made by me. I. I appoint my husband, EARL DONNELLY KEIM, as my Personal Representative concerning this Will. If my husband is unable or fails to serve, I then appoint my son, HARRY HUBERT KEIM to serve as my Personal Representative. A. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. B. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker for my grave), and written charitable pledges which I have made. I grant my Personal Representative the power to extend or renew any debt for such time as my Personal Representative shall deem appropriate. C. All estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. D. My Personal Representative is requested to settle my estate as soon after my death as may be practicable, and to payor deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. Last Will and Testament of LOUELLA B. KEIM ~ ff. ~~/:l.~, Pagel ~ ~ ~ E. I may leave a letter of intent with the executed copy of this Will for the purpose of giving guidance to my Personal Representative concerning the distribution or sale of certain items of my property. I request, but do not require, that my Personal Representative honor my wishes therein expressed. II. I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my Husband, EARL DONNELLY KEIM, as his sole and absolute property if he shall survive me. III. In the event that my spouse shall not survive me, I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my son, HARRY HUBERT KEIM as his sole and absolute property if he shall survive me. IV. If any beneficiary to any share of my estate which is not subject to the provisions of any trust which may be created by this will is at the time of distribution of his or her share, a minor under the laws of his or her domicile, I direct that the minor's share be converted into qualifying property and delivered to the Minor's Guardian as Custodian for the minor under the Uniform Gifts to Minors Act or the Uniform Transfers to Minors Act as may then be in effect in either the state in which the beneficiary or the Custodian resides, or any other state of competent jurisdicti on. A. The Uniform Gifts to Minors Act or The Uniform Transfers to Minors Act, as may then be in effect in the state concerned, is hereby incorporated by reference. The property affected by the Act shall be managed, held, and distributed in accordance with the provisions of the Act. B. The financial custodian will serve without bond or surety and without intervention of any court, except as required by law. C. The receipt by the Custodian, for the minor, of any principal or income transferred pursuant to this paragraph shall be a full acquittance and discharge of my Personal Representative or Trustee, as applicable, from liability with respect to such transfer and from further accountability for the principal or income so transferred. V. Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. VI. Any beneficiary who fails to survive until One Hundred and Twenty (120) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. Last Will and Testament of LOUELLA B. KEIM~ 'P Page 2 Y1f t/1M.dl~ 8. A"~." ~ ~ VII. Definitions: A. The term "descendants" as used in this Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. B. The term "children" as used in this Will includes adopted and afterborn persons. The term "children" as used in this Will shall not include step-children, the natural born or adopted children of a person's spouse who are not the natural born or adopted children of the person. A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will. C. The term "per stirpes" as used in this Will means that whenever a distribution is to be made to the descendants of any person, the property to be distributed shall be divided into as many shares as there are (1) living children of the person, and (2) deceased children, who left descendants who are then living, of the person. Each living child (if any) shall take one share and the share of each deceased child shall be divided among his then living descendants in the same manner. D. The term "Personal Representative" as used in this Will shall have the same meaning as Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. VIII. In addition to any powers granted by the laws of the jurisdiction in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may deem necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services, such compensation will be that allowed by law. IX. If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. This document was prepared under the authority of Title 10 U.S. Code, section 1044, and implementing military regulations and instructions, by Captain John T. Rothwell, a member of The Judge Advocate General's Corps, United States Army, who is licensed to practice law in the State of Arkansas /J J. ~ Last Will and Testam::~~~LOUELLA B. KEg ~ y. _'I11Y ~01jlJ.Jt, 0=, }IU--. U ~ ~ IN WITNESS WHEREOYd--I have at Carlisle Barracks, Pennsylvania, on / ~ I Cf'i 'r:, , set my hand and seal to this my LAST WILL AND TEST ENT, consisting of ~ typewritten pages, each page bearing my handwritten signature. c?~~~ ;:5. X~ LOUELLA B. KEIM (SEAL) The foregoing instrument was, at Cr1~L'SL~ L3ARRIiC!k:'~ ~NNSYI(A:}lViH , on ) 1o~~!:/q9 f ,signed, sealed, published and declared by LOUELLA B. KEIM, the testator, t be her LAST WILL AND TESTAMENT III the presence of all of us at one tIme, and at the same time we, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testator is of sound and disposing mind and memory at the date hereof. Last Will and Testament of LOUELLA B. KEIM~ ~ .0 /J' Page 4 1iv c6..~ Q. .J~~-A~ ~ ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ACKNOWLEDGMENT I, LOUELLA B. KEIM, testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. r/~/8'J~ LOUELLA B. KEIM (SEAL) AFFIDA VIT we,E)PJArj {',,/f:eJ/c~7, jf:(~~ !-I.l(,itkoPF / We N~ A ~sh , the witnesses, sign our names to this instrument, being duly qualified a ordIng to law, do depose and say that we were present and saw the testator SIgn and execute the instrument as her Last Will; that the testator signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. , and Jf.~IJ~ WITNESS a;'~a-4~~L WI S Subscribed, sworn to and acknowledged before me by LOUELLA B. KEIM, the testator, and subscribed and sworn to before me byd~tl' ~ C j:~ j ~.p .(0;$ H. ~l.ko,PP.and WeN& ILl3ud. ,thewitnesses,on~ ~r(~A~~e. Notarial Seal tandridge, Notary Public Carlisle Boro, Cumberland County My Commission Expires May 14, 2001 Mflmhflr Pp,nnsvlvania Association Of Notaries Last Will and Testament of LOUELLA B. KE~. ~ /) PageS O)hA~l. fl:5..,J1'-~ . ~ ~ NOTARY PUBLIC My Commission Expires: , (Jc; . IJ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: LL:>v~L.LA B. 1< G"11'f1 Date of Death: 10 - J 7 -a I Will No. ~CJol ~ 6103;t Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of thy OrpJ:lans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~ ~ ~ tJ/ . / / ~ 3l?' r'J I Name Address J /IA 1212,/ J-/ I<n t'1 ~q ..s. Yofll< Qb bILLSgo(2(~ '1'4 /7019 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: V 1/.- .30- 0 I ~ a (.1;1 ~:',~'S '~ U'\ <<:') 0\ c::::I: s( a.: Namet/ I-IAl212.'I H I<EI f11 Addressv' g,sCI .5 'YoRK t2h \D'LLS~01Ua '-PA 170lQ () o CV'l :::> ~ , .~""o; I,,,.,' I''''.~ ~",..,il :;.. E~~ o 1:.1) 00.) CUCI: a:: Cij ...~:: 'CD 1;.0 ...S:: 4)= ou Telephone (Illy v/ '-13;)- 3<g-g~ p Capacity: L Personal Representative _Counsel for personal representative lnventory of the real and personal estate of !..OVi~LLA l3. KEIrt1 ,STATE EMPLOyErS C/d:;1:>iT (}AJftJjJI) 1'1E:i'18CR.;J;J. 0 ,g3 I ~ 413 <<6 3 0' 5AAfU: ACLat-rO. 04 eflEc.iLJtUG 5 , ~;) mO"-'TfI c'&J2..TI '::IcATE 5;1 ~ '1 ~s 3 ,~ '1 S 4 , ~ It REAL tE'sTATE .- DUJELL/~ 3G,o 3 T(G( Albu::. (2. b C.AM-P 141 LL """PA l ,0' I AuTOfYlO f3'L~S , 1991.c 'l=bIUTI AL "&:J/VA)EVIt.LE: V'IAJtI I~~ H X 6~ K'=- TLf d;;2 qlJg-3 ~ULy ''8UJc BaoK.. Iq" CH(;tJ!20Ler vEG;A V/AJt:t.. /V77 B'7U' 333 ~ 3 'BMJ"-. /k.c.ov;uTS CornmE"r<<- C l3AJ-ftt( CHE""L~'~ t\CLT!b ()5/~11~L/ PA , I , . , , L/~e rNS~ .5 /{po '7 .." c?5CJ~~ ~ ;;;501<6 d S- CJ L-/t ;;;:5 CJ '~q /L.-'J/7dS-- AMI9l.ICAAJ GEAJt/2AL LIFE AA.lh Au;b&NI l=bL'L y.tL to , <61,4 deceased an "... ....',....., ::=t'tl ::S :l. eY <'" ~!; !:.::l'~ '" .- - (fr 'TarAL ~ L :t::> Z --" Vl ~ 88 9 Q::) 5 ~qO 7S- ~ ~/~ /01 7~S- I 000 dd7~SS- ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } ss: according to law, deposes and says that he of the Estate of LtJV~LL.A'~ I<~J'V/ /JA i"\'\~ Itl., I 'p~/)eu{,;'+ C led d h h late of ~l'~.l.L.._.J:t ~__-'~'L_ C) _. , umber and ounty. Pa., decease an t at t . within is an inventory made by "' the said of the entire estate of said decedent, consisting 'of all the personal propdrty and, real estate, exc,pt 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. being duly and subscribed before me, J-/A121l V J./(./8ERT 1<Ei,V/ E..cut~r . Administr.tor 19 ~q S'ovtrl b ILL~uf2.tJ. y Iflt< "YA Addr... f2b 170/1 Date of Death /7 DIY CK-r()I5~/< Month ,;)00 I Vur 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 anets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. i: r< i r^ >- \' .,; () CD .... W lit ~ ~ .... ~ II - W ~ CD 0 A.. U 0 0 c.n -j CD . W ~ W 0 0' ~ J: CD II CD I- .... A.. ..J LL ..; A.. E Z LL ..J -< 0 :I: A. 0 W 0 -< w i- ~ > eX ~ Z ~ Z 0 Q f c: ::a 0 en Z ~ ~ Z w -< - A.. -a c: j;J G - ;: "~t 0 CD '-11 J:j -a .oW CD E I ... ::a ~ 0 II 0 .... 0 u: CD 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 KEIM HARRY HUBERT 839 S YORK ROAD DILLSBURG, PA 17019-9525 n__n__ fold ESTATE INFORMATION: SSN: 183-12-4383 FILE NUMBER: 21 - 2001 - 1 032 DECEDENT NAME: KEIM LOUELLA B DA TE OF PAYMENT: 01/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2001 NO. CD 000751 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $10,226.48 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HARRY H KEIM CHECK# 4 SEAL INITIALS: VZ RECEIVED BY: $10,226.48 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ~/ ?--c2D - ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV-1607 EX AFP lO1-03) HARRY H KEIM 505 CABIN HOLLOW RD DILLSBURG PA 17019 ~~ {-'.. :~ "' \ DATE ESTATE OF DATE OF DEATH FILE NUMBER L:9 FJ ~O\@JITY ACN 08-25-2003 KEIM 10-17-2001 21 01-1032 CUMBERLAND 101 LOUELLA B 'Lioo; Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i6'ifj-iif-AFP--('ol-:oij-------...--iNifERITANCi--YAif-sY1rfEMi-riY-'ifF'-Acfcouiff--.-i.------------------ --- ESTATE OF KEIM LOUELLA B FILE NO. 21 01-1032 ACN 101 DATE 08-25-2003 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A S~"ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-26-2002 P R I NCI PAL TAX DU E : ......................................................................................................................................................................................._.................................. 10,167.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-15-2002 CDOO0751 508.35 ~ 08-08-2003 REFUND .00 567.83- TOTAL TAX CREDIT 10,167.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. l \, /?-c:;~ - Y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG 1 PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ~i DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-26-2002 KEIM 10-17-2001 21 01-1032 CUMBERLAND 101 HARRY H KEIM 839 S YORK RD DILLSBURG . *' REY-1547 EX AFP CDl-02) LOUELLA B PA 17019 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y-=is4j-E3f-AFP--ro1-:02i--Ntjy-iCE--OF-i-NHEifiTAirCE-TAX-A-PPRA-isEitENT~--Ar.i-oWAirCE-cfR------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KEIM LOUELLA B FILE NO. 21 01-1032 ACN 101 DATE 08-26-2002 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~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. 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) (5) (6) (7) 881900.00 .00 .00 .00 1421965.00 .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) 51795.00 139.00 NOTE: .00 X 00 = 2251931.00 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. 2311865.00 (11) (12) (13) (14) ~.934 00 2251931.00 .00 2251931.00 (19)= .00 101167.00 .00 .00 101167.00 rAynl:NI KI:~I:.Lrl (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 01-15-2002 CDOO0751 508.35 101226.48 TOTAL TAX CREDIT 101734.83 BALANCE OF TAX DUE 567.83CR INTEREST AND PEN. .00 TOTAL DUE 567.83CR · IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) 1 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) " Name of Decedent: STATUS REPORT UNDER RULE 6.12 LcnJELLA {3 t(E"IM /0 - 17 - ;;200 J D O~ Date of Death: Will No.: ;21- 0 I --I03;;t. Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State ~~er administration of the estate is complete: Yes 0' No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the ~sonal representative file a final account with the Court? Yes ~ No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal ~~entative state an account informally to the parties in interest? Y es ~ No 0 c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to thi~S r. epo : ~ c2 Date: 10-15'-03 _ ~~L - ~ Signature IJ A (2{l\/ J-I KE/^1 Name 50S CAB/A..) J-Iol..L07J...J f2b bl LLS~Ui2.Co"PA /7019 Address 7 I 7 - 4 :3 ;t -oS 13 Telephone No. Capacity: EfPersonal Representative o Counsel for personal representative w I- ~:$(/) ull::~ wc..U ::tOO ull::...J c..lll c.. <( c, ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 /) -ao FILE NUMBER ~L-~~ COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT -L 0 .:::L ..::l._ NUMBER I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I~ ~ I vV( LD.JE t.i.-A Is SOCIAL SECURITY NUMBER 1f)"3 - i'~ - 43g-3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF DEATH (MM-DD-YEAR) 10'- i 1 - ~~oo l 3 ~ j q .- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF BIRTH (MM-DD-YEAR) I ~ .;tC' ,.vA- ~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death afier 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z W C Z o c.. (/) w ll:: ll:: o U COMPLETE MAILING ADDRESS 83ct :; YLJQJ(... \) \ LLS'13 u~ Qb 'nA r! rio fq FIRM NAME (If Applicable) TELEPHONE NUMBER 11'''(--, ., --' "--- 3<6<62_ 111 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) ~ 1'100 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) ...- I Lf C) I '1 (<).r; z o ~ ..J :J !:: ~ <C o w ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) - (6) (7) o d3J. 2'&::- , 8. Total Gross Assets (total Lines 1-7) (B) 079s /39 (11) (12) (13) 5'93 [I a 0l5', q31 . 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) - 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) 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) d d 5', q 3 / SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ :J ~ :! o o g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15) x .0 t./~ (16) x .12 (17) x .15 (18) (19) /0 I I Co 7 16. Amount of Line 14 taxable at lineal rate ,.., dd-S", q ~ j - /0, I~ 7 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT REV-1502EX. (1-97) ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT L6"VCLLA 'g l<elM SCHEDULE A REAL ESTATE FILE NUMBER C) I .. ~OCJ I -/03"2_ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real property which is jointly-owned with right of survivorshin must be disclosed on Schedule F. ITEM NUMBER 1, 'buJCLL-i ~ 3~3 Tl2Jl.JbLC eAm(::> HILL 'T(2;IUDLi- DESCRIPTION VALUE AT DATE OF DEATH f2b /10/1 .- LOT II C <6'g" q (.)() , TOTAL (Also enter on line 1, Recapitulation) $ <68"', 900 - (If more space is needed, insert additional sheets of the same size) -----. w , COMIINIIlEAlTH C1F PENNlM.YMM _AlICE TAX AE'RlRN SCHEDULE E CASH, EWI( DEPOSIT8, &-.c. PERIOtIAL PROPERlY ..:. .t,:__l t .....:. :.1 E81'ATE OF UntLLA- J<EI v11 ......pIlIMdItI..... ..............._.........,..-. MIIIIIIIfIIllr ..."_ I lTBI fiUIIER 1. d. 3. 'f. S. &, I. . 8 tl fD. tL t ;). 1'3. f...........1 I fl_1le -I .'11.... VA&.lEAT QFl8 .A, cg-/~ ~'''* CPmM~ lJAtOX-. CJlEc/i..lt<XQ Accr;lt 1C>b/30t:f II;;Ztl ~ t:JI"fpwyCO C/li:.'bir IJlJ/tnJ mEJ'l8Ei2d. Olff3'~43g3 STATE AaT It 61 6€i $""1 S-;;. .53 S'f .suAa..;"5 ~HE"cJ(.(~ fa. t'\'101.>Ttt ~nnc1cre: a " ---. .1 ,.;>>,. ,. I ~ I' - fI 6" IlPC,) 7 d)SD;;JS - ~50Ig" ... OJSO 41 - ~S-001q 10 I 7 ~.s - ~ viI-) 'G C;U-4..K .5~ Kl... TI.f d~ D f;" 3 ",/Ud I V, 1 870 I~ 3~3 /01, 7~S S.d- ~o 5"7~ If ICfCll,p ~n1\'- '"&~e"u..LE ICf', CUEvlla..Er vE:G.-\ C~ a42J~ AIJ,-Tl~~ .. SAtE 0;: ~/rvtU: '+Nb HuvsEJlOLb ;rTeM S ." 7/0 wvau~ ~"p'IVE"r 1>IAIUO STE:IUO !eN h ~OCU> A,c..&.trt1 ~ APPl-I~CS (w~ ,ba.tE2, (U:F(lJbG.EeA~, F/l.EJ:Z'-ClL) b,t.JI#.J(Q TABU:: ANb c.U~I(2~ H,~ F~T br=:&1( StUJQZ.. vU\n:: A~b STE/lUk.(". 51W~ ;r~R-y m \ .sC.EtLA1Jeor.) ~ JIav~//dU:> In;m$ - 6~ 1 SOGJ - i(co 3co -- 3aO - - 400 - ICWO - 50'0 mAL(AIID....CII...5.~.....) . 14;;t 'tis,S IM__...--.............. ....rJ-M ,pJI........................, REV.1510 EX. (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LOVE"LLA 73 1<1= jll1.rl FILE NUMBER C} J- .;)O{) I .- icJ 3?-.. 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 TRANSFEREE. THEIR RELATiONSHIP TO DECEDENT ANa THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) NUMBER 1- 'PEP~..)Y Lv' A /JIlt- STl\rc= &/PuyC;:S \g'4.4'-1 / oc/1o I o-o~~ ()-- I2En t2E/I11Z1U r 6'1 SrEH CJ - TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . ~,:~,'{) .MfJ.. ~ ""..\ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS LOLJELLA "[5 KEi"VJ FILE NUMBER ;;)1-';;001 -/()32 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER A FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 TArt'~ \= S'/ope: ":;:-U-,.;JEJ2AL J-fot0E :srEt::LTOA.J PA /7/1 '3 - 5D 3LJ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) WAI\)Cb Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: ..-"- 2. Attorney Fees DIA~~ 'hILS 300 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees (2.f&t:::> n~a_ OF WILLS. ---- 3/S 5. Accountant's Fees IV ;',1-- 6. Tax Return Preparer's Fees 7. AbymTi~IA...(" "FCE~ Cum eE1LLAAJ'b (JJL;/i.J1'/ TttE $D-JTiA>6 L LAW JCJ\,JQ,uAL 16 71 .- TOTAL (Also enter on line 9, Recapitulation) $S-7~S-- (If more space is needed, insert additional sheets of the same size) REV.1S12 EX' 1,.97)_ ~ . ~..~ ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Lt?u~lLA B /(0,11 FILE NUMBER ,;) I - dUO I .- {03 2 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. ,d. 3. l\. S. '.pp l ELl=: c rRIL V EIlJ7CIU 'PA. Af"e:.O-IC4-,v WA,e:a CL:-, 3'2 qg-- , 0 '-C'. ;]7 ~ ( ld- q~ 49 70 :)-0 IS U~i QE(c.1Ql)8L CS=- 'DE:El:>$ ''P{(ol::.EJl.TV '-rr'2NuSFI:::~ .--- 139 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lou I=. L-LA:13 SCHEDULE J BENEFICIARIES 1< L::" 11"1 FILE NUMBER 0J I - dOO' .- /03 ::2 RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. J-\AQR\f <63~ bILLSBO(lGJ HOE E a.1 K i.:: t ''1 S YofLK (2~ vA 110\<1 ~10 AMOUNT OR SHARE OF ESTATE 100 C'fc; ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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. /J /4- 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS j/ /A- 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) -