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HomeMy WebLinkAbout01-1060 , -, c.... COMMONWEALTH OF PENNSYLVANIA REV - 1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ......,..,...............,.........Oi'Fi"C.lii..CUS.E..ONLy.............................,..... J7 ;ld-.. 3 I- Z W o W () W o DEPARTMENT OF REVENUE FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Schiffmah;Elizab'eth "':?:'~':'>;' DATE OF DEATH OctobeH28,2001 October 6,1913 (IF APPLICABLE) SURVIVING SPOUSE=S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (oate of death prior to 12-13..a2) ~ ti.~ ~ .. Q." r.e.2 o 8;1lI 0( 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Comprise (dale of death after 12-12-82) 7. Decedent Maintained a Living Trust (Aftacha copyofTrust) 10. Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1-95) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 1: .. "C C o Q. III ~ o o THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Frances H. Del Duca 2. Stocks and Bonds (Schedule B) o N ..,.,::rJ .J,.;ID n.~' ~? 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ] )(4) (5) (6) $0.00 4. Mortgages & Notes Receivable (Schedule D) f::: -. z 49,696.25 N \.0 5. Cash, Bank Deposits & Misc. Personal Property (Scheduie E) z o ~ -J ::J !:: D- o<( () w 0:: 6. Jointly Owned Property (Schedule F) Ii) I Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) "'0 f'-J $0.00 1::::: (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) ~61,711.14 (9) (10) r 19,313.57 $0.00 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11 ) 19,313,57 342,397.57 5,900.00 336,497.57 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequestslSec 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) (12) (13) (14) z o i= ~~ I-:J ~ :IE o o SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 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 336,497.57 x .045 15,142.40 $0.00 x (15) (16) (17) (18) $0.00 17. Amount of line 14 taxable at sibling rate x .12 $0.00 18. Amount of line 14 taxable at collateral rate ,,".'.,,-,>.., x .15 19. Tax Due (19) $15142.40 20-1"" I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<.; ii;ih,~";;;';rJ';;i:t~;\\\:!+:.i-3,':~'J;):f;,,; ;:'~?":1:" 'I · Decedent's Com lete Address: STREET ADDRESS Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Credits (A + 8 + C) 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 15,142.40 (2) 757 TotallnteresVPenalty (D + E) (3) $0.00 4. 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 (4) $0.00 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 14.385.28 A. Enter the interest on the tax due. (5A)!..:,;:j;;;:;t;i,;,;;i:;!:;;~u;;h:;_~_~I~ 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 14.385.28 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: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c, retain a revisionary interest; or d, receive the promise for life of either payments, benefits or care? If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an individual retirement account, annuity, or other non-probate property? 2. 3, 4. Yes No Ej ~ ~ t=j DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .S. 99116 (a) (1.1) (ii)). The statute does no exempt 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. ~9116(1.2) [72 P.S. ~9116(a) (1)). The tax rate imposed on the net value of transfers to orfor 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. , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Elizabeth Schiffman All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION FILE NUMBER 2001-01060 , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Elizabeth Schiffman Include the proceeds of litigation and the date the proceeds were received by the estate. be disclosed on Schedule F. ITEM NUMBER FILE NUMBER 2001-01060 All property jointly-owned with the right of survivorship must .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Elizabeth Schiffman Debts of decedent must be re orted on Schedule I. ITEM NUMBER FILE NUMBER 2001-01060 AMOUNT TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Elizabeth Schiffman NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY NUMBER FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 2001-01060 AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Jessic~a'Schiffman.'.: . ?9.9~~~Q~~y,~hBurenl~. .... . ~i1mington, DE 19802. (If more space is needed, insert additional sheets of the same size) 11 M8ffBank December 11, 2001 RE: Estate Search The Estate of: Date of Death (D.O.D.) ELIZABETH SCHIFFMAN 10/28/2001 To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Type Account Number Account Title Opening -Branch D.O.D.. Accrued Interest Balances (Includes Accr. Int.) $49,647.65 $.00 CHK 435546 OPENED 9/67 JOSEPH H SCHIFFMAN ELIZABETH SCHIFFMAN 4319 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description No Safe Deposit Box titled in the Decedent's name existed at our office. If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800~724~ 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION BY: ~ (J~ C ~ ,- ,,- /J , Authori~Signature ~tf-- DATE: (2-((-0 Manufacturers and Traders Trust Company. 1100 Wehrle Drive, P.O. Box 7ffT. Buffalo. NY 14240-07ffT . ~.:. COMMONWEALTH OF PE.NNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN RE'iI-1514 EX + (1-97) Check Box 4 on Rev-1500 Cover Sheet NAME.(S) OF LIFE TENANT(S) DATE OF BIRTH TERM OF VEARS LIFE ESTATE IS PAVABLE Elizabeth SChiffman Term of Vears Term of Vears Term of Vears Term of Vears $ 508,855.00 .28919 7.0 % $ 147,156.00 1. Value 01 fund from which life estate Is payable 2. Actuarial factor per appropriate table Interest table rate -- 0 3 1/2% 0 6% 0 10% iQNartable Rate 3, Value of life estate (Un~ 1 multiplied by Line 2) DATE OF BIRTH Term of Vears 1. Value 01 fund from which annuity Is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout -- 0 Weekly (52) B BI-weekly (26) B Monthly (12) o Quarterly (4) 0 Semi-annually (2) Annually (1) Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Une 2 multiplied by Une 3 5. Annuity Factor (see InstructJons) Interest table rate 031/2% 0 eoA. 010% o Variable Rate % 6. Adjustment Factor (see InstructIons) 7. Value of annuity -- If using 31/2%,6%,10%, or If vartable rate and period payout Is at end of period, calculation Is: LIne 4 x Line 6 x Line 6 " using variable rate and period payout Is at beginning of period, calculation Is: (Une 4 x Une 5 x Une 8) + Line 3 $ $ NOT,e: The values of the funds ~hlCh create the above future Interests must be reported as part of the estate assets on Schedules A through G of thiS tax return. The resulting hfe or annuity Interest(s) should be reported at the appropriate tax rate on Unes 13, 15, 16 and 17, (If more space Is needed, Insert additional sheets of the same size) 7 PA15141 NTF 10881 Copyright Forms Software Only, 1997 Nelco, Inc. :..- , '. . ~.- REV-I647 EX+ (I-S7) COMMOfIINEAL 11-1 a: PENNSYlVANIA Il+ERlTANCE TAX RETURN RESIDENT ce:ceceNT SCHEDULE M FUTURE INTEREST COMPROMISE ESTATE OF Check Box 48 on Rev-1500 Cover Sheet FILE NUMBER Joseph H. Schiffman 21-99-747 This schedule Is appropriate only for estata of decedents dying aftar December 12, 1982. This schedule ts to be used for all future Interests where the rate of tax which will be applicable when the future Interest vesta In poueaelon and enjoyment cannot be established with certainty. . Indicate below the type of Instrument which created the future Interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF N3ETO BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1.Jessica Schiffman daughter 1-13-53 47 2.Joshua Schiffman son 11-17-54 45 3. 4. 6. II. For decendent. dying on or after July 1, 1994, If a surviving spouse exerclted or Intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document In which the surviving spouse exerclaes such withdrawal right. n LImited rlaht of withdrawal n Unlimited rlaht of withdrawal III. Explanation of Compromlte Offer: Decedent's spouse is not expected to exercise her limited right to withdraw. Upon the death of the decedent's spouse, specified amounts are to be given to various charities before the beneficiaries receive the remainder. . IV. Summary of Comproml.e Offer: 1. Amount of Future Interell $ 361,699 2. Value of Line 1 exempt from tax as amount paSSing to charities, etc. (also Include as part of total shown on Line 13 of Cover Sheet) $ 900 3. Value of Line 1 pa.slng to spouse at appoate tax rate Check One 0 6".41, 3%, 0 0% $ (also Include as part of totat shown on Line 15 of Cover Sheet) 4. Value of Line 1 T8Xllble et 60,(, Rate (also Include aa part of total shown on Line 16 of Cover Sheet) $ 360,799 5. Value of Line 1 Taxable at 15% Rete (alao Include as part of total shown on Line 17 of Cover Sheet) $ 6. Total value of Future Interest (sum of Llnee 2 thru 5 must equal Line 1) $ 361,699 (If more .pace la needed, Insert additional theete of the same size) 9W46AN 1.000 ,- v.- . - - - REV-1849ex. (1-97) COMMO/'MIEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Joseph H. Schiffman 21-99-747 Do not complete this schedule unless the estate Is making the election to tax .ssets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election appllee to the Un! f!e s Credi t Trust (IMrltal, residual, A, B, By-paIS, Unified Credit, etc.) If a trust or similar arrangament meets tha requirements of Seotlon 9113(A), and: a. The trust or similar arrangement is Ilstedln Schedule 0, and b. The value of the trust or similar arrsngementl8 entered In whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically Identify Ihe trusl (all or a fractional portion or percentage) to be Included In the election to have sucllllU8t or similar property treated as a taxable transfer In this estale. If lesa lhen the entire value of Ihe trusl or slmUar property II Included as a taxable transfer on Schedule 0, the persona' representative shall be considered 10 have made Ihe election only as to a frectlon of the trust or simler arrengement. The numerator of thia fracllon 18 equal to the amount of the tlUllt or simIlar arranaement Included liS a tlllCllble a_Ion Schedule O. The denominator II eaualto the IoIaI value of the II\lSt or IImllar IIITlInaemenl. SCHEDULE 0 ELECTION UNDER SEC. 91'13(A) PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedenfs survivina SDouse under a Section 9113tA\ trust or similar arranaemenl llESCRlPllON Unified Credit Trust established pursuant to the decedent's will VALUE Life interest in paragraph III of 147,156 Part A Total S 147,156 PART B: Enter the descrlDtlon and value of all interests included In Part A for which the Section 9113 A\ election to tax Is belna made. DESCRIPTION VALUE Same as above 147,156 9W48E2 '.000 Part B Total $ (If more space Is needed, Insert additional sheet. of the aame alze) 147,156 .Nov 06 01 01~24p -/ Jao~u~lin~ L Pow~ll 717-258-9731 p.l ~ dactfYCliM $2. 12awell <5t &odtdes . 43A BrookWU04 AtIlmUt, S'4ite 6, G1.rlL~k, PA t 7013 (717)258-0751; fax (7l7Jl58-9731 October 29 ~ 2001 TO: Frances Del Duca FAX: 258-4940 FROM: Tracee Zygmunt FAX: 258~97.3 J PAGES: 7 RE: Elizabeth Schiffman Date of Death Values The date of death values (as of Friday, October 26, 2001) for the Pershing accounts of Elizabeth Schift'man follows: Total Assets IQW..Y.~~ $312.014.89 W1.98470 $743,999.59 ~nt # JlegistratiQJ1 5AD-012129 Elizabeth Schiffman, Jessica Schiffman POA 5AD-084532 Jessica Schiffman and Joshua Schiffman TTEES FBO Elizabeth Schiffman Non-Marital Tmst B DelW1Ii un the individual holdings in each account can be found on the enclosed lists. Please do not hesitate to contact me for further qlll!'l~lions. Sincerely. TVlUd Tracee L Zygrn Sales Assistant Enclosures &""U.l'!ti,~.~ un;.!'<'..:! tl~lt)U,Kh Finane!".! NCI.~~,,-k In\ll."'T/1l:nt Carporarian Ml!Illill.''I' Xl PC lW.qjstellld Bw!,,:r/l.'>eab' J(I(<I'~;:tJth: L Powell &' AU<KI((tes ",Ill Fin(lllcia! Nl!/W<)..k rM Tlot /If'(iliatf(L PETITION FOR PROBATE and GRANT OF LETTERS Estate of Elizabeth Schiffman also known as No. To: 21-01-'-1060 Register of Wills fDr th~ County of Cumber .Land in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rix in the last will of the above decedent, dated May 1 9, 1 998 and codicil(s) dated Deceased. Social Security No. 027-01 -41 "'} 9 named ,'W_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Oecendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 551 South Hanover st., Carlisle, PA 17013 (list street, number and muncipality) Oecendent, then~. ._ years of age, died 1 0 - 2 8 - 01 iilt at Sunrise Assisted Living, 501 Skl.Les B.Lva., west Ches~er, PA' Except as follows, decedent did not marry, was not ~ivorced and did not have a child born or adopted after execution of the witl offered for probate; was not the victim of a killing and was never adjudicated incompetent: Oecendent 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, '. l situat cd as follows:" ..:, . " 3~.~ ( $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters tes tamentarv theron. (testamentary; administration c,La.; administration d.b.n.c,La.) '7 ::; ~ ~7 ::J I- 0::: ~ ..,,:0 c'= -= .~ ..f_::'" ~-~ an Buren st. DE 19802 "" 7i OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ,~ ~ titi 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 b' petitioner(s) and t at as personal represen- tative(s) of the above decedent petitioner(s) will ell and t ly administer t estate according to law. VJ ~. ;:s l:l ..... l::: ~ ~ Sworn to or affirmed and subscribed beforcNg;JE~ER~2-Ild_~~'trO ~f ":ff)(b'Y~,j - Register 17-w~--3 ~o. 21-01-1060 Estate of ELIZABETH SCHIFFMAN , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW NOVEMBER 20 Jf' 2001, in considenltlon of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) dated May 19, 1998 described therein be admitted to probate and filed of record as the last will of Elizabeth Schiffman TESTAMENTARY Jessica Schiffman and Letters are hereby granted to ~() %:J'_~f-".) AV nv'7" egister of WIlls FEES 270.00 9.00 "L I . uu 5 nn 5.00 316.00 Frances H. Del Duca #06269 Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ x-pages Renunciation ................ $ JCP ATTORNEY (Sup. Ct. J.D. No.) 10 W. High st., Carlisle, PA 17013 $ TOTAL _ $ Filed ~.q~ ~ . f.'. . ?9P.~ . . . . . . . . . . . . . . . . . . . . ADDRESS 717-249-1323 ~ PHONE ~t1L4,~ H105.805 REV 9/86 This is to certifY that the information here given is correctly copied from an original <;ertificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filtng. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7745146 ".., /; Uj.&.~/ ~1/1 // '-. '-' {;::t..,.. . ,__" ,-I ?~-:2....r.5:-!/,:'~ *~"___.,..:Jk . l/ Local Registrar J No. OCT 3 0 ZOO~ Date 21-01-1060 i43Aev.2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH l,/24dEI?1 UHIlER I OM -1- SEX a. STI1JE FilE NUflelEA SOC'Al SECUR,n' NUMBER Fe.ma.f.e. 3. 07.7 01 _ 4179 ORE OF OERH1Mcnlh. Da~ ...., .. 10-7.8-7.001 BlRTHl'LAC.e IC...,.... Slate or fCle.gft Counuy) PlACEcYOEATHfCNM:kOflfyllN__ ....'OfllfucloonsonUlhel... HOSPITAl, '-'....0 ~o P1l.ov.i..de.nc.e., RI 1. FACI.JTY NAME (If not~. 9'''' SIt"' and numberl Che.~te.Jr. ... Wut Che.~te.Jr. KIND Of' 8USlNESSJINOUSTRV MIl DECEDENT EVER IN U.S.ARMEOFOfICESl ....oHo!&' IoWlITAlSTAruS._ ---. 1lMIocM-., .. W.i..dowed ... wh.i..te. SUIMVING SPOUSE elf.... QNeIft8lden,.... DECEDENT'S USUAl ClCCIJMIOH I~~"='::~::r lIL Owne.1l. ,,-. Anu OECEllEHT'SMAlUNG_SS_.C_. _Z"'~ 501 Sk.i..lu Blvd Wut Chute.Jr., PA 19380 12. 17.. Sta&e Che.~te.1l. Did - ...... _1 11..0 ::...~=.. MOTHER'S_IF... _. _s.._ ... f the.l Watmann lHFOllIWIT'S MAIUNOAOORESS_ ~ _.Z;P~ 7.004 N01l.th Van BUke.n StJr.e.e.t, W.i..lm.i..n ton,Vf 19807. PlACEOf' ._..~~ LOCRlON.~_.lIpea. orOUloo_ C1l.e.maUon Soc..i..e.:ty HaM.i..~bUkg, PA 171 09 PA C1l.e.mato _AND_SS 110.0 ___.. ...... ..... We.~t Che.~te.1l. - 4100 JONESTOWN BOAD Dc. c. LICENSE NUMllER SlClHEO 5ciZ3'1/~- L ~i~dJ>-o/ _CASE HEFEAREom ~ EXAUlHEllICOlIOHER1 ..... ./ 2e. ....~ f'1J Hour .- MATII: 0IIw........_-........1O_.bu1 i................ IlOl""'" in... ~cauM..... in PMT t 10ftMI .... ..... I I I I : d. WERE AU10PSV FlNDlNGS -...&lE PRIOR 10 COUPUmON OFCAUSE 01= DEArH7 IlANNEROF DEATH Hop.: - -- - ~ o o DATE OF INJURY (Month, Oey, 'lUr1 TIWE OF INJUAY tNJURY IfJ WOAK7 DESCIlIlIE HOW "'-"- OCCURRED. ....0 - -.g "-igaI.... o o o PlACEOFINJURV..._......._.,............ ... "'-.... _""I _. .... 0 HoD Could r'ICM be determtned ,... CEJrl'.....,~ _ enol -CIUlTWYING ~AfiI (Physca.an cerWo,tngcauseol dMlh when anoIhcw phySIC...., has pronounced de. ana ccm~"em 231 TO"'beelOfllll"~'.""OOC"""''''''Io'''caUM(.)andrnanner......................._...................................... . ... -PfIONOUHaNG AND CERTIFYING PHYSICIAN (Phvsclan bolh pronounclOQ OMIh and ~ 10 cause 0I~) To.... .....ofmyllno..... .....OCC.......IdIhe....... dale, .ncfptec:., McIduelalhecauM(a. andrnanlle'.................'................. 010lEDlCAL EXAIoIINERlCOROHER On the.... of ..amine'ton end/ot inveaUg'-ion. in my opinion, de.1II OCcurred 811M tf~, d.... and place. and due to the c.....(.) ancI ................ted..................... ............................. ,............................................... 31.. REG1ST J,t( ~I/r' I o JOHN J. DALY III, D.O. u. OATEFILEO_.Oay._, 993 BALTIMORE PIKE 'd3()~ -i'oo/GLEN MILLS, PA 19342 1- , '1 ..... ~ . 1 I r \ J'}, \ LAST WILL 21-01-1060 I, ELIZABETH SCHIFFMAN, of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any wills previously made by me. I. I bequeath to Eleanor Jones, of 350 Green Spring Road, Newville, Pennsylvania, 17241, the sum of Eighteen Thousand ($18,000) Dollars only in the event my husband, Joseph Schiffman, survives me. II. I bequeath to Ann Allison, of 1131 Maple Street, Carlisle, Pennsylvania, the sum of Ten Thousand ($10,000) Dollars only in the event my husband, Joseph H. Schiffman, survives me. III. If my husband, Joseph H. Schiffman, survives me, I devise the residue of my estate of whatsoever nature or wheresoever situated to my Trustees hereinafter named IN TRUST nevertheless, to divide the same into two separate trusts, to be known as Marital Trust "A" and Non-Marital Trust "B", respectively; to hold, to invest and to reinvest the same, to collect the income therefrom, to pay all taxes and other charges that may be made properly against the trust estates, and to distribute the income and principal thereof as follows: A. (1) . The corpus of Marital Trust "A" shall be ~5 funded with such portion of the residue of my estate as is necessary to reduce the Federal Estate Taxes payable as a result of my death to a minimum, after taking into account the value, as finally determined for Federal Estate Tax purposes of the interests in property passing to my husband, by operation of law or otherwise, which interests qualify for the marital deduction under the Internal Revenue Code, and taking maximum advantage of all credits available and deductions allowed against the Federal Estate Tax under said Internal Revenue Code, but only to the extent that such credi ts and deductions do not increase death taxes on my estate. (2) . I direct that my Executor shall have the discretion to allocate the corpus of this trust; provided, however, (a) . Only such assets as are eligible for the marital deduction shall be deposited in this trust, and at the values at which they are finally included in my gross estate for Federal estate tax purposes; (b) . The assets to be distributed to this trust shall be selected in such manner that the cash and other property distributed will have an aggregate fair market value fairly representative of the distributee's proportionate share of the appreciation in the value, to the date or dates of distribution of all property then available for distribution. ~5 2 (c). If any property of Marital Trust ~A" is or becomes unproductive or underproductive, my husband shall have the right which may be exercised by instrument in writing to require my fiduciaries within a reasonable period of time to make such property productive of a reasonable income or to dispose of it and invest the proceeds in property which is productive of a reasonable income. (d). The fiduciaries hereunder shall have no rights, powers, duties, privileges or immunities which would disqualify Marital Trust ~A" from marital deduction and all provisions of this will shall be construed in such manner and the powers and discretions provided herein or by law are to be as to assure compliance with Federal estate tax, marital deduction provisions of the Internal Revenue Code in this respect and any provision of this will which is incapable of being so construed or applied shall be inapplicable. (e). The decision of my said Executor shall be final, conclusive and binding upon all beneficiaries. (3) . The Trustee shall pay over the net income from the trust estate to my husband from the date of my death, in quarterly installments, for the term of his natural life. (4) . In addition, the Trustee, in its sole '6} discretion, shall pay over to my husband out of the 3 principal of the trust estate, such sums as may be necessary to pay any medical expenses, incurred by my husband as a result of accident, illness or emergency which may affect him. (5). Should the total of the above sums fail to provide for the maintenance and support of my husband, according to his accustomed standard of living at the time of my death, the Trustee in its sole discretion shall pay over to my husband out of the principal of the trust estate, such sums as may be necessary to provide for his accustomed standard of living. (6) . In addition to the above provisions, my husband shall have the power to withdraw such amount from principal as he shall desire from time to time including the complete exhaustion of Marital Trust ~A". (7) . Upon the death of my husband the Trustee shall payout of the principal of the trust estate the expenses of my said husband's last illness and funeral, if his own assets be insufficient for this purpose. (8) . Upon the death of my husband, my Trustee shall pay the remaining principal of Marital Trust ~A" to such person or persons including his estate in such proportions in such manner and for such estates as he shall appoint by his will referring to the power of appointment {~ given hereby. 4 (9) . In default of such appointment, either wholly or partly, my Trustee shall payout of the unappointed principal of Marital Trust "A" any increase in Federal Estate tax and Pennsylvania inheritance or estate taxes on the estate of my husband resulting from the possession of the power of appointment given to him by the preceding paragraph and shall add the balance of Marital Trust "A to Non-Marital Trust "B". 9(a). The corpus of Non-Marital Trust "B" shall be funded with the balance of the residue of my estate. The Trustee shall pay over and distribute the income and principal of Non-Marital Trust "B" as follows: 9 (b) . During the lifetime of my husband, my Trustee shall pay to or for his benefit all the net income of Non-Marital Trust "B", quarter-annually or more frequently at the convenience of the Trustee. 9 (c) . My Trustee shall pay him so much of the principal of Non-Marital Trust "B" as said Trustee in its sole discretion deems proper for his comfortable support and maintenance or for any illness or emergency which may befall him but no payment shall be made to him from the principal of Non-Marital Trust "B" until the principal of Marital Trust "A" is completely exhausted. IV. All principal and income distribution to any beneficiary, be 10 5 shall, until free of the actual debts, contracts, alienations and anticipation of such beneficiary and the same shall not be liable to any levy attachment, execution or sequestration while in the hands of my Trustee or Executor. V. All estate, inheritance, succession and other taxes imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid out of the principal of Non-Marital Trust B, after the setting apart of Marital Deduction Trust "A", as if such taxes were administrative expenses, without apportionment or right of reimbursement. I authorize my Executors and Trustee to pay all such taxes at such time as may be deemed advisable. VI. My Executor and Trustee may retain any of the assets of my estate which come into their hands and shall invest and keep invested the principal of said trust estate in such manner and in such securities or other proper:ty, real or personal, and upon such terms and for such length of time as the Executor and Trustee shall deem meet and proper, it being intended hereby to give unto the Executor and Trustee full and complete authority to hold, possess, manage, control, sell, convey, encumber, lease, give, and execute options, invest and reinvest the whole and every f,,S part of the trust estate according to their sole judgment 6 and discretion, without any limit upon their power and authority so to do, either by statue or otherwise. VII. Upon the death of my husband or if my husband does not survive me, the remaining principal and any undistributed income or the residue of my estate shall be distributed to my children, Jessica Schiffman and Joshua Schiffman in equal shares after distribution of the following specific bequests: A. To the National Office of Planned Parenthood of America, for its education fund, the sum of Two Thousand ($2,000) Dollars. B. To Yivo Institute for Jewish research, of 1048 Fifth Avenue, New York, New York, 10028, the sum of Three Hundred ($300) Dollars. C. To the League of Women Voters, of Carlisle, Pennsylvania, for its education fund, the sum of Three Hundred ($300) Dollars. D. To the National Abortion Rights Action League, (N.A.R.A.L.), of 1105 14th North West (Fifth Floor), Washington, D.C., 10005, for its education fund, the sum of Three Hundred ($300) Dollars. E. To Dickinson College, the sum of Three Thousand ($3,000), to be used equally for the Alumni Association, the Audio-Visual Department and the Library of ~5 the College. 7 VIII. I appoint my daughter, Jessica Schiffman and my son, Joshua Schiffman, to be Executors of this my will. IX. I appoint Jessica Schiffman and Joshua Schiffman to be Trustees of the Marital Trusts under this Will. X. I direct that neither my Executors nor my Trustees be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will this Ir;btday of May, 1998. ~J~~SEAL) 8 The preceding instrument consisting of eight (8) page(s) was on the date thereof signed, published and declared by ELIZABETH SCHIFFMAN, the testator herein, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our n~es ~., as witne s her.e~ / . ~n~~ , ~I/r \iuIJ._~ STATE OF PENNSYLVANIA . . . . SS COUNTY OF CUMBERLAND . . . . We, ELIZABETH SCHIFFMAN, Frances H. Del Duca and Carol A. Treaster, the testator and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as witness and that to the best of Her knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~_/J~~~ Tes ator l' , . SUBSCRIBED, sworn to and aCknowledged before me by the testator, and subscribed and sworn to before me by Carol A. Treaster and Frances H. Del Duca this /~~ day of May, 1998. ~#,f(!G71) Notary ubI c c NOTARIAL SEAL SHIRLEY P. CLEVENGER, NOTM:r\' PUBLIC J c.& rlisle Borough, CumOOrial1d County I My Comm!$slo.... EJ:p:res March 5, 2000 RENUNCIATION 21-01-1060 I In Re Estate of Elizabeth Schiffman deceased. To the Register of Wills of Cumberland County, Pennsylvania. Joshua Schiffman, son The undersigned of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Jessica Schiffman WITNES~ 't00", ~Q~ hand this \ '5i- day of _ j.J{)I/()'/\ Ioe.V :'M1'2DO \, ~ shua Sch.t5~rritu~eb Arguello Blvd. Francisco, CA 94118 (Address) (Signature) tv"I ct Lf) - 0... (Address) 0\ - ":r.J "'('j ~~) C :> ('0 (1;) ~ Cl ~./) a> ........ ,~"". 0 en ~.o (Signature) (,) ()J - .:..s::: (J,)a: p '1)= a: ....,_ ..J (.)0 (Address) c CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Elizabeth Schiffman Date of Death: October 28, 2001 Will No. 2001-01060 Admin. No. To the Register: I certify that notice of beneficial interest required by Hule 5.6 (a) of the Orphans' Court '!lules was served on or mailed to the following beneficiaries of the above-captioned estate on 11/27/01 Name Dickinson College National Office of Planned Parp~thood YIVO Institute for Jewish Research League of Wanen Voters National Abortion Rights Action T oPflgt.lP- (N A R A To,) Address Carlisle, PA 17013 31 So. LJJlle st., Lanc-af;tp-r, FA 17flO? 1048 Fifth Ave., New York, NY 10028 P.O. Box 331, rflrlif;lp-, FA 17n1~ 1105 14th st., 5th Fl., N.W., Washi~a58g, DC Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 11/27/01 ,~'#~ 1/ a/d~ "SJ.gnature Name Frances H. Del Duca Address 10 W. High st., Carlisle, PA r- <:1: 0 0.: ..- C) 0.. () co N -Z"::} ~v ~ <;3 ()) Cl ~:i ~::: ..'" "0) ,-.-< Q.) 0 ~ .0 as Q.) ..- ~ a:: p .1) a:: U c:s Telephone ( 711-249-1323 Capacity: Personal Representative x Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DEL DUCA FRANCES H 10 W HIGH STREET CARLISLE, PA 17013 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 027-01-4179 FILE NUMBER: 21 - 2001 - 1060 DECEDENT NAME: SCHIFFMAN ELIZABETH DATE OF PAYMENT: 01/24/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/28/2001 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: JESSICA SCHIFFMAN C/O FRANCES H DEL DUCA ESQUIRE CHECK#106 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-961 NO. CD 000792 MARY C. LEWIS REGISTER OF WILLS AMOUNT $14,318.13 $14,318.13 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 1712B-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DEL DUCA FRANCES H 10 W HIGH STREET CARLISLE, PA 17013 ____hn fold ESTATE INFORMATION: SSN: 027-01-4179 FILE NUMBER: 21-2001- 1060 DECEDENT NAME: SCHIFFMAN ELIZABETH DA TE OF PAYMENT: 01/25/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/28/2001 NO. CD 000797 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $67.15 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: FRANCES DEL DUCA ESQUIRE CHECK#107 SEAL INITIALS: AC RECEIVED BY: $67.15 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS \, / '/-c2c:2-..E BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '"' HE::i. , DATE ESTATE OF DATE OF DEATH FILE NUMBER P 2 :1 9 COUNTY ACN 03-11-2002 SCHIFFMAN 10-28-2001 21 01-1060 CUMBERLAND 101 '02 MAH 1 8 FRANCES H DELDUCA 10 W HIGH ST CARLISLE PA 17~:~Dl1a3 '(~lTI nm:: , '* REV-15'1 EX IFP 101-02' ELIZABETH Allount Rellitted 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=i5'4-j-E3f-AFP--foY:02Y-NoYicE--oF-YtiHEifiTANci-TAir1rpPR1risEirENT~--ALrOWAi'-ci-(fR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SCHIFFMAN ELIZABETH FILE NO. 21 01-1060 ACN 101 DATE 03-11-2002 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~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. AlIOunt 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 CREnIT~: n~.. . l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-24-2002 CDOO0792 753.59 14,318.13 01-25-2002 CDOO0797 3.53 67.15 TOTAL TAX CREDIT 15,142.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 312,014.89 .00 .00 49,696.25 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) ClO) 19,313.57 .00 Cll) (12) (13) Cl4) NOTE: .00 336,497.57 .00 .00 X 00 = X 045 = X 12 = X 15 = Cl9)= · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 361,711.14 19.313 57 342,397.57 5,900.00 336,497.57 .00 15,142.40 .00 .00 15,142.40 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 ~;~ 1t .. Name of Decedent: tt.1211 ~E-71-( 5CHlrFm/Jrv Will No.: !()~ J-f -.hv ( ;).ft:J ( 0/ Dr; 0 Admin. No.: Date of Death: Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State ~hether administration of the estate is complete: Yes if\. No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 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? Yes IZl No 0 J". c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. d~ 1-) //;p~ Signature r 11 fl /V Lz c::; Name f-( tiEL /) t.I c/l-- Date: q-:::. (( - 0 :5 (() tv ~.:f'f /1 / ~ /-I Address t2 d IC L r -> L ':i€ ')/ //9 r7c)( ~ 3 7(7 ~c/7 (5;;1.- Telephone No. Capacity: 0 Personal Representative ~ Counsel for personal representative