HomeMy WebLinkAbout01-1087
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of
also known as
RAYMOND LEURY
No.
To:
21-01-1087
Register of ~ills for the
npceased. County of u m 0 e r 1 and in the
Social Security No.'-'-m=''lT;~rJ7- 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 r i x
in the last will of the above decedent, dated Dee em be r 1 2 .
and codicil(s) dated
named
,19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Cumberland . .
Decendent was domiciled at death in County, Pennsylvama, with
h ;i s last family or principal residence at 62 80 Car 1 i s 1 e
Mechanicsbur Cumberland Count
(list street, number and muncipality)
cltZ.,'l Tw f'.
0.65.
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Decendent, then ~__ years of age, died No v e mb e r 18 , , WX 2001,
at P<(/1-vC,4";,r.:=,e qc=~/c;~.c. ~s/".r~"-.. /.A-01JG~S'7</<! ~.
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: .
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: none
$ 5,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters t est am en tar y
theron.
(testamentary; administration c.I.a.; administration d.b.n.c.l.a.)
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3240 Pleasant Valley Road
Crystal Spring, PA 15536
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 'I '8
COUNTY OF _GUMBERLAND j S
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best cf the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent ;letitioner(s) will well and truly administer the estate according to law.
Sworn to or aff~rmed and subscribed { 9 ~~ ~~
before me this -'--~__ day of \" ~
~r~~~~J~: To n/e~ ,_i\oe~",,--~
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17- c:2-.y' - 0.2--
~o. 21-01-1087
Estate of
RAYMOND LEURY
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW November 28 , 2001 X~_, 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 Dee em be r 12. 1989
described therein be admitted to probate and filed of record as the last will of RAY M 0 N D LEU R Y
and Letters T est am en tar y
are hereby granted to J 0 - E 11 enS hoe m a k e r
FEES
P. C.
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Probate, Letters, Etc. .........
Short Certificates( )..........
x-page.s .
RenunciatIOn
JCP
$ 25.00
12.00
$ 21. 00
................ $
$ 5.00
TOTAL _ $ 63.00
. NQY~F;~. .2.~... ~P.QL............
ATT EY (Sup. Ct. 1.0. No.)
Jordan D. Cunningham, Esquire
I n #71144
ADDRESS
2320 North Secona Street
Harrisburg, PA 17110
PHONE
(717) 238-6570
Filed
on d :n:D
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H105.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
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Vi!.,;'vJ(./ /"' <: ~7 C::V.4~'t-e"7 ....
Local Registrar
p
7884505
l~UV 20 ZOOl
Date
2J-OI-I087
.f4 Rev. 1/91
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
UNDER 1 01<<
Hour. Mlnut..
SEX
2. Male
SWE Fl.e NUMBER
SOCIAL SECURITY NUMBER
DArE OF DERH (Month, Dav. _)
o. 11-18-07
BIRTHPlACE (C;oy IIld PlACE OF DEATH (Check only one _ ""'uctions on ""'"'_)
Stale or Foreign Country} HOSPfTAL: OTHER:
Ca.nada. '-'lent of ::=u 0
7. ...
FACILITY NAME (H not inelilullon, give street and m.mber)
~)O
. lb. La.nc.tL6:tu
DECEDENT'S USUAL 0CCUI\lln0N
(~~0I~~::;'.'&~
Mec.ha.n.i.c. 1. 1 MUIla.nc.e
DECEDENT'S MAILING ADDRESS (SIr.... C'vITllMl. SUllo. ...", Code) DECEDENT'S
P.O. Box 78 ~E
HallltL6bUllg, PA 77708 ~::.")
11.
FATHER'S NAME (F.... MkXh. LoSl)
". Paul. LeUll
INFORMANT'S NAME (Typon;hinl)
Jo Ellen S oemaku
METHOD OF DISPOSITION
O - 0 CromoIIon ~ Romovollrom Sl... 0
Dew-. Olhor (SpoclIyl
1.
SIGNAI'URE OF FUNE
Ie.
La.nc.tL6:tu
~NDOFBUS~ESMNDUSTRY
RACE. Amoticon IndIIIn.llIac:k. WIlk.. etc.
1SI>ecifv)
10.
Wh-i.te
SURVIVING SPOUSE
(H wife, give maiden name)
17.. State
PA
Vauph-i.n
Did
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'-hip? 17d.D ~~~Of
MOTHER'S NAME (F.... MkXh. M_ Sumeme)
". Maude Whea.ti
INFORMANT'S MAILING ADDRESS (SIr.... CjtyITllMl. Stale. Zip Code)
3240 PleQ..6a.n:t Valley Roa.d, Clty~:ta.e Spk-i.n , PA 75536
PLACE OF DISPOSITION - Nome of 0._. C~rv LOCRlON. CllyllOwn. SI.... Zip Code
OfOlhef"- Cltema.:t-i.on Soc.-<.ety 06
1 . PA Cltelna.tOlt
NAME AND IdlORESS OF AACILlTV
22c.4700 Jonu:town
LICENSE NUMBER
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IWp
17b.
HQ.l[l[~bUll 9
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77709
77709
Do.
TIME OF DERH
20. 8 1 f.. M. 25. I <( ~#1:7(
27. PART I: Ent... the .......Inturiea 01 compIk:Itiona which ClUMd lhe death. Do not enter the mode of d'ffng, 1UCh.. CVdtacor reapIratory arr..., Ihock OI'....rt "lure.
UM only one ce... on each 1M.
""RT n: Ot....1lOnlfI<:en1 condlIlone c:on1tibullng 10 _. buI
no! .-ng '" the undertylng _ given'" PART I.
b.
DUE 10 (OR AS A CONSEOUENCE OF):
DUE 10 (OR AS A CONSEQUENCE OF):
WERE AU10PSY FINDINGS
-.u\BLE PRIOR 10
COMPlETION OF CAUSE
OF DEATH?
MANNER OF DERH
Natural
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DArEOFINJURY
IM-. DaV. _)
TIME OF INJURY
INJURY 1J WORK? DESCRIBE HOW INJURY OCCURRED.
.....~NoO
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HomicIde
PendinOl_1lon
Coukt noI be determined
o
o . M
O. PLACE OF INJURY. No homo. f.rm. S1_. f.ctory..-
building, etc. (Specify)
300.
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210. 21b.
CEIITIFIER (CIlecI< only one)
.CERTIFYING PHYSICIAN (Phvo;cian cor1fyIng _ 01_ wilen enoIher phyoicien Ilea P<onounced delIlh end corn_nom 23)
To'" -":ofmylcnowlelllgit, deethoccurred due to the cau.e(.)and...............tatec:l. ....................... 0.............................
-
21.
'''~AND Cl!RTIFYINGPHYSlCWI<Ph_bodlP<onounclno_andc:er1lfylng 10 ceu.. 01 doel1)
To.... bNI of my knowledge, ....... 0CCUINd.. the....... .Ie, and place, and due 10 the CIIUH(a) and manner.. lUted.. . . . . . . . . . . . . . . . . . . . . . . . .
.IIEDlCA1. EXAIIINERICORONER .
On.... _01_ ondIor lmr..uptlon, In my opinion, d_ occurnd lilt'" limo. elat., onct pI_, _due to tho """00(0) end .
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21-01-1087
LAST WILL AND TESTAMENT
OF
RAYMOND LEURY
I, RAYMOND LEURY, of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish, and declare this as
and for my Last will and Testament, hereby revoking any and
all prior Wills, and any and all Codicils thereto, by me at
any time heretofore made.
FIRST
I direct the payment of my debts and the expenses of my
last illness and funeral from my estate as soon after my
death as conveniently may be done. I direct the Executrix
not to have conducted a religious or a funeral service
except as to have my remains cremated and disposed of as I
have previously directed her to do so.
SECOND
I give, devise and bequeath, all the rest, residue and
remainder of my estate to Jo-Ellen Shoemaker, provided that
she is living on the ninetieth (90) day after the date of my
)
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death.
It is my specific desire and intent not to make a
devise or bequeath to my brother or sister.
THIRD
In the event Jo-Ellen Shoemaker does not survive me, or
does not survive me by said period of ninety (90) days, I
then give, devise and bequeath all the rest, residue and
remainder of my estate unto her children, in equal shares,
share and share alike.
FOURTH
I direct that no Executor, or other fiduciary named,
nominated,
or appointed in this, my Last will and
Testament, shall be required to post any bond or give any
security of any type for any purpose whatsoever, any law or
rule of Court of the Commonwealth of Pennsylvania or any
other jurisdiction to the contrary notwithstanding.
FIFTH
My Executor shall have the following powers in addition
to those vested in them by law and by other provisions of
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this Will, applicable to all property, real, personal and
mixed and wheresoever situate, including property held for
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minors, whether principal or income, exercisable without
Court approval, and effective, with respect to each items of
said property, until actual distribution thereof:
A. To retain, as investments of my estate or
trust, any or all assets of my estate, real, personal or
mixed, without regard to any principle of diversification,
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and to purchase and acquire real or personal property, and
to hold any or all of such real and personal property
retained or acquired without making the same productive of
income.
B. To permit the children, or any of them, to
occupy any real estate retained or acquired upon such terms
and conditions as my Executor shall deem proper.
C. To pay all taxes, charges, and expenses of
maintenance, upkeep, improvement, development, protection,
preservation, and investment of any retained or acquired
real or personal property, such payments to be made from
'~ either principal or income as my said Executor shall
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ct determine.
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D. To retain, sell or invest any and all funds,
whether principal or income, in any real or personal
property without restriction to legal investments; to
purchase investments at premiums; to exercise all rights of
a security holder or shareholder in any corporation; and to
lease, mortgage, pledge, give options upon or sell at public
or private sale and without approval of any Court and
without any responsibility to the buyer or buyers to see to
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the application of the purchase price, any real or personal
property, or portion or portions thereof, irrespective of
the manner or the means by which the same was acquired by my
said Executor.
E. To make any payment or distribution herein
provided for in cash, kind or partly in cash and partly in
kind, at valuations fixed by my Executor at the time of
distribution.
SIXTH
Any and all payment or payments of any sum or sums,
whether in cash or in kind and whether for principal or
income, payable to a beneficiary, or any of them, shall be
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made upon the sole receipt of the respective individual to
whom the payment is made, and free from anticipation,
alienation, assignment, attachment, and pledge, and free
from control by the creditors of any such beneficiary. All
shares of principal and income herein given shall be free
from anticipation, assignment, pledge or obligations of any
beneficiary, and shall not be subj ect to any execution or
attachment.
SEVENTH
No provision in this will is intended to exercise any
power of appointment.
EIGHTH
I nominate, constitute and appoint Jo-Ellen Shoemaker,
Executrix of this, my Last will and Testament, but should
Jo-Ellen Shoemaker predecease me or for any reason fail to
qualify as such Executrix, or having qualified, fail to
serve as such Executrix then I nominate, constitute and
appoint Jordan D. Cunningham, my surviving Executor of this,
my Last will and Testament.
5
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IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, consisting of six
(6) typewritten pages, the first five (5) of which bear my
signature in the margin for the purpose of identification,
/?i1
this ,;1--
day of December, 1989.
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(SEAL)
Signed,
sealed,
/'..~..
puolished and declared by the above
named testator as and for his Last will and Testament, in
the sight and presence of us, who at his request, in his
sight and presence, and in the sight and presence of each
other, have hereunto subscribed our names as witnesses.
&fYlr-J ;J. lJu -J. ~ 0
WITNESS
Y2~) ~NUpj
WITNESS
6
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COMMONWEALTH OF PENNSYLVANIA
ss;
COUNTY
OF
DAUPHIN
I, Raymond Leury, 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.
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/;U/;,zorA ~"7
~YMOND LEU Y
Sworn or affirmed to and acknowledged before me, by
Raymond Leury, the testator, this / ~
1989.
day of December,
Notarial Seal
Blanche A. toper-Roth, Notary PubIc
Harrisburg, Dauphin CoUrty
My Commissinn Expires Nov. 8, 1993
Member, Pennsyl'lania Associalion of Notaries
~t2~-'4u-,
NOTARY PUBL
COMMONWEALTH OF PENNSYLVANIA
SS;
COUNTY
OF
DAUPHIN
We, the undersigned, being the witnesses whose names
II are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we
7
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were present and saw the testator sign and execute the
instrument as his Last will and Testament, that he signed it
willing and that he executed it as his free and voluntary
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act for the purposes therein expressed; that each of us in
the hearing and sight of the testator signed the Last will
and Testament as a witness; and that to the best of our
knowledge the testator was at that time eighteen (18) or
more years of age, of sound mind and under no constraint or
undue influence.
EdJYIo 1 Q. ~-l~)
WITNESS
Address: c9~J ..1. h -tit ,1:1 .
LJVl J.b;) fJA J7113
Address;;J;;;Ul't::U~f;! I1t&~
Address: ?PQ L//<7~/ ~/7 LJ%./
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...... re:i//7I'</r~ ./ 7.o7~
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Sworn or affirmed to and subscribed before me by the
above named witnesses, this ~ day of December, 1989.
~IJ~.&,
... NOTARY PUBrJt -
Notarial Seal
BlanCheA.loper~~ ~
Harri$lUg. D<'--r ':1 '^^" "I
My Comr. isSion EXptfes Nov. 8, 1993
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Postage
Certified Fee
Return Receipt Fee
U1 (Endorsement ReqUIred)
ru
CI Restricted Delivery Fee
CI (Endorsement Required)
Postmark
Here
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Total Postage & Fees $
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SENDER: COMPLETE THIS SECTION
. Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse t
so that we can return the card te ~ou.
. Attach this card to the back of the mail piece,
or on the front if space permits.
1. Article Addressed to:
JORDAN 0 CUNNIN;HAM
2320 N SECOND ST
HARRISBURG PA 17110
3. Service Type
~ified Mail
D Registered
D Insured Marl
D Express Mail
D Retum Receipt for Merchandise
DC.C.D.
4. Restricted Delivery? (Extra Fee)
Dyes
2: Article Number
(Transfer from service label)
PS Form 3811, March 2001
'/Doo ()l, 00 . ()Q C). ~
Domestic Return Receipt
)\95
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102595-01.M.1424
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APR 11 2002
Estate No.: 21-01-1087
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
In Re: Estate of RAYMOND LEURY
Late of
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: JO-ELLEN SHOEMAKER
Counsel for Personal Representative: JORDAN D CUNNINGHAM ESQ
Date of Grant of Original Letters: NOVEMBER 28, 2001
Date of Delinquency Notice: MARCH 10,2002
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on MARCH 10, 2002, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
Date: APRIL 10, 2002
fh.
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for ~4<-1 Ie;; ~.Jat f: ~ 11 /11m Courtroom No.3. If the
Certification of Notice is fil prior to the hearing date, the hearing will automatically be
cancelled.
George .
&1< ~te~/ J-i - IY- O:J-
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,--.
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CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent:
RAYMOND LEURY
Date of Death:
11/18/01
Will No.:
File #2001-01087
Admin No.:
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the OThans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on Mar c h . <), 200 2 :
Name
Address
Tn-F.ll~n Sho~maker
3240 Pleasant Valley Road
Crystal Springs, PA 15536
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 3 / 2 9 /0 2
By:
Signat
~ yin
Name
2320 North Second Street
Harrisburg, PA 17110
.,., .
D. C~ha~ESqUire
Address
717/238-6570
r'-
Telephone
Capacity: D Personal Representative
B Counsel for personal representative
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CUNNINGHAM & CHERNICOFF, P.C.
Attorneys at Law .
2320 North Second Street
Harrisburg, Pennsylvania 17110
Register of wills
Cumberland County
Hanover and High streets
Carlisle, PA 17013
111I11I11I11I11....11..11.1111.1
JORDAN D. CUNNINGHAM
ROBERT E. CHERNICOFF
MARC W. WITZIG
HENRY W. VAN ECK
JOHN M. HYAMS
CUNNINGHAM & CHERNICOFF, P.C.
ATTORNEYS AT LAW
P.O. BOX 60457
HARRISBURG, PENNSYLVANIA 17106-0457
HERSHEY TELEPHONE
(717) 534-2833
IRS NO. 23-2274135
Street Address:
2320 N. 2nd Street
Harrisburg, PA 17110
TELEPHONE (717) 238-6570
FAX (717) 238-4809
August 16, 2002
Register of wills
Cumberland County
Hanover and High Streets
Carlisle, PA 17013
Re: Estate of Raymond Leury, Deceased
File No. 2001-01087
Dear Sirs:
Enclosed for filing are the following documents:
1.
Return;
An original and three (3) copies of the Inheritance Tax
2.
An original and three (3) copies of the Inventory;
3. A check made payable to Register of Wills, Agent, in the
amount of $173.34 representing payment of tax;
4. A check made payable to Register of wills in the amount
of $25.00 representing the filing fee for the Return and Inventory;
and
5. A self-addressed, stamped return envelope.
Please docket the enclosed Inheritance Tax Return and Inventory and
return time-stamped copies to me in the enclosed envelope.
If you have any questions regarding the above captioned
matter, please do not hesitate to contact me.
JDC/bam
Enclosure
cc: Jo Ellen Shoemaker (w/enc.)
Register of Wills of ,CUMBERLAND County, Pennsylvania
Co
INVENiTORY
Estate of
RAYMOND LEURY
No.
2001-01087
also known as
Date of Death
11/18/01
, Deceased
Social Security No.
097-26-5197
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Personal Representative:
Name of
Attorney:
Jordan D. Cunningham, Esquire
Jo Ellen Shoemaker
I.D. No.:
23144
Address:
2320 North Second Street
Harrisburg, PA 17110
(717) 238-6570
Dated
3240 Pleasant Valley Road
Crystal Spring, PA 15536
August 16, 2002
Telephone:
Description Value
l. Waypoint Bank shares 352.25
2. UGr - shares 876.33
3, Waypoin~ Bank Account 1,758.97
. .
4. Trailer - 1977 1,000.00
5. 1987 Dgdge Dynasty 600.00
Total: $ 4, 5 8 7 . 55
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the ejection of the personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
RW-8
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CUNNINGHAM JORDAN D ESQUIRE
2320 N SECOND STREET
HARRISBURG, PA 17110
-------- fold
ESTATE INFORMATION: SSN: 097-26-5197
FILE NUMBER: 2101-1087
DECEDENT NAME: LEURY RAYMOND
DATE OF PAYMENT: 08/19/2002
POSTMARK DATE: 08/1 6/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 11/18/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: JORDAN D CUNNINGHAM ESQUIRE
CHECK# 036737
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EXI11-96)
NO. CD 001536
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$173.34
$173.34
/7- 02 Y -.,,2/
~ 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
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
,; COUNTY
ACN
"'i.
JORDAN D CUNNINGHAM ESQL~
CUNNINGHAM & CHERNICOF
2320 N 2ND ST
HBG
_.' i ('
PA lllt~O
09-30-2002
LEURY
11-18-2001
21 01-1087
CUMBERLAND
101
Allount Rellitted
'*
REY-15~7 EX AFP 101-02)
RAYMOND
J
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=is'4-j-E3f-AFP--('oY:02Y-NOYICE--oF-YtiHEifITANCE-YAX-A-PPRAISEMENT~--AL1-oWANCE-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEURY RAYMOND J FILE NO. 21 01-1087 ACN 101 DATE 09-30-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
( ) CHANGED
Il}
(2)
(3)
(4)
(S)
(6)
(7)
.00
1,228.58
.00
.00
3,358.97
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
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 J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
lS. Allount 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:
NOTE:
DATE
08-16-2002
K~l,;~.Lrl
NUMBER
CD001536
(+)
INTEREST/PEN PAID (-)
.00
(9)
nO}
978.41
2.453.57
.00 X
.00 X
.00 X
1,155.57 X
AMOUNT PAID
173.34
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
4,587.55
(ll)
1l2}
1l3}
1l4}
3.431 98
1,155.57
.00
1,155.57
00 =
045 =
12 =
15 =
.00
.00
.00
173.34
173.34
n9}=
173.34
.00
.00
.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 MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
.,
GSK
.'-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Raymond Leury
Date of Death: November 18, 2001
Will No.:
Admin. No.: 2001-01087
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 administration of the estate is complete:
Yes B No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: n/ a
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No G9l
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 El No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts maybe filed with t ofth hans' Court
and may be attached to this repo
Date: J}-l1-o3
Cunningham & Chernicoff, P.C.
2320 North Second Street
Harrisburg, PA 17110
Address
(717) 238-6570
Telephone No.
Capacity: 0 Personal Representative
gCounsel for personal representative
. .
IN RE:
ESTATE OF
RAYMOND LEURY,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
FILE NO. 2001-01087
ESTATE SETTLEMENT AGREEMENT
THIS AGREEMENT, is made the 15th day of October, 2003, by
and among Jo-Ellen Shoemaker, Administratrix of the Estate of
Raymond
Leury,
deceased
(herein
referred
to
as
Administratrix,) and Jo-Ellen Shoemaker, as the sole intestate
heir of the said Estate, hereinafter referred to as the
"heir".
In accordance with her desire that the administration of
the Estate of Raymond Leury be terminated without the expense
and delay of a Court accounting, the parties hereto, in
consideration of the mutual covenants herein expressed, and
intending to be legally bound hereby, agreed that:
1. The Estate of Raymond Leury, who died November 18,
2001, is now in the process of administration, Letters of
Administration having been duly granted to the Administratrix,
by the Register of Wills of Cumberland County, Pennsylvania on
November 28, 2001.
2. Jo-Ellen Shoemaker is the sole intestate beneficiary
of the Estate.
3. The parties acknowledge that the Administratrix has
received the assets and made the paYments to the decedent's
creditors and the parties approve the administration of
Decedent's Estate in its entirety.
4. The parties hereto agree that the remaining balance
of the Estate assets shall be distributed to Jo-Ellen
Shoemaker. Without intending to limit the rights or remedies
of the Administratrix, the parties further agree to indemnify
the Administratrix and save the Administratrix harmless
against all liability, loss, and expense (including, but not
limited to, costs and counsel fees) which the Administratrix
may incur, whether due to the Administratrix's negligence or
otherwise, as a result of making the above described
distributions without a Court audit.
5. The parties, and each of them, hereby forever fully
release, compromise, settle and discharge any and all claims,
demands, actions or causes of action, legal or equitable,
absolute or contingent, vested or hereafter to accrue, which
2
, .
. .
any of them may have against any other party hereto or against
the Estate of RaYmond Leury, deceased, or the Administratrix
thereof, by reason of any matter, cause or thing growing out
of, or relating to any property or assets of the said Estate,
or growing out of or relating to any act of the Administratrix
in her administration of said Estate, even if attributable to
negligence, and agree that any period for the limitation of
actions for the collection of any erroneous distribution or
distributions shall commence only at such time as the
Administratrix shall have obtained actual knowledge of such
erroneous distribution or distributions and that in no event
shall the period for collection or any erroneous distribution
or distributions be less than two (2) years after the actual
discovery thereof by the Administratrix.
6. The parties agree to execute such additional
releases as the Administratrix may submit to them in order to
confirm their discharge from any further liability to the
parties in connection with the said Estate.
7. The foregoing provisions which apply to the
Administratrix shall apply also to any Administratrix who may
be appointed in connection with any ancillary administration
3
, .
. .
which may be required in order to complete distributions in
the Commonwealth of Pennsylvania.
8. This Agreement may be executed in multiple
counterparts and, when so executed, shall be binding upon all
the parties, and their respective heirs, next-of-kin, personal
representatives, and assigns.
IN WITNESS WHEREOF, the parties have hereunto set their
hands and seals the day and year first above written.
ESTATE OF RAYMOND LEURY
By?). ~.
J~Ellen Shoemaker
Administratrix
INTESTATE HEIRS:
~~~~
o-Ellen Shoemaker
4
Register of Wills of ,CUMBERLAND County, Pennsylvania
c..
INVEN,TORY
Estate of
RAYMOND LEURY
No.
2001-01087
also known as
Date of Death
11/18/01
, Deceased
Social Security No.
097-26-5197
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Personal Representative:
Name of
Attorney:
Jordan D. Cunningham, Esquire
Jo Ellen Shoemaker
I.D. No.:
23144
Address:
2320 North Second Street
Harrisburg, PA 17110
(717) 238-6570
Dated
3240 Pleasant Valley Road
Crystal Spring, PA 15536
August 16, 2002
Telephone:
Description Value
l. Waypoint Bank shares 352.25
2. UGI - shares 876.33
3 , Waypoip.~ Bank Account 1,758.97
. .
4. Trailer - 1977 1,000.00
5. 1987 Dgdge Dynasty 600.00
Total: $ 4, 58 7 . 5 5
(Attach Additional Sheets if necessary)
.
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative. include
the value of each item. but such figures should not be extended into the total of the Inventory.
RW-8
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CUNNINGHAM JORDAN D ESQUIRE
2320 N SECOND STREET
HARRISBURG, PA 17110
u_.____ fold
ESTATE INFORMATION: SSN: 097-26-5197
FILE NUMBER: 2101-1087
DECEDENT NAME: LEURY RAYMOND
DATE OF PAYMENT: 08/19/2002
POSTMARK DATE: 08/1 6/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 11/18/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: JORDAN D CUNNINGHAM ESQUIRE
CHECK# 036737
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 001536
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$173.34
$173.34
/7- 02.y-",,2/
'" BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
TI'
JORDAN D CUNNINGHAM ESQ~~
CUNNINGHAM 8 CHERNICOF
2320 N 2ND ST
HBG PA Illi.1:O
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
d COUNTY
ACN
09-30-2002
LEURY
11-18-2001
21 01-1087
CUMBERLAND
101
j ('
'*
REY-15~7 EX AFP IUI-UU
RAYMOND
J
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 ~
REY=is4j-E3f-AFP--foY:02Y-iioYicE--OF-YNHEififAN-CE-YA'X-A-PPRAisEMEiiT~--Atl-oWAiiCE-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEURY RAYMOND J FILE NO. 21 01-1087 ACN 101 DATE 09-30-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
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)
S. 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
1.228.58
.00
.00
3.358.97
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
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 J)
14. Net Value of Estate Subject to Tax
(9)
nO)
978.41
2.453.57
(11)
(2)
(13)
(14)
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
4,587.55
3.431 98
1,155.57
.00
1,155.57
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
.00 X 045=
.00 X 12 =
1,155.57 X 15 =
(19)=
.00
.00
.00
173.34
173.34
--. . l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-16-2002 CDOO1536 .00 173.34
TOTAL TAX CREDIT 173.34
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 MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
..
G;K
, "
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ravmond Leurv
Date of Death: November 18, 2001
Will No.:
Admin. No.: 2001-01087
Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes E9 No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: n/ a
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No GQl
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 El No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with t ofth hans' Court
and may be attached to this repo
Date: J}-l7-oQ
Cunningham & Chernicoff, P.C.
2320 North Second Street
Harrisburg, PA 17110
Address
(717) 238-6570
Telephone No.
Capacity: 0 Personal Representative
WCounsel for personal representative
. .
IN RE:
ESTATE OF
RAYMOND LEURY,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
FILE NO. 2001-01087
ESTATE SETTLEMENT AGREEMENT
THIS AGREEMENT, is made the 15th day of October, 2003, by
and among Jo-Ellen Shoemaker, Administratrix of the Estate of
Raymond
Leury,
deceased
(herein
referred
to
as
Administratrix,) and Jo-Ellen Shoemaker, as the sole intestate
heir of the said Estate, hereinafter referred to as the
"heir".
In accordance with her desire that the administration of
the Estate of Raymond Leury be terminated without the expense
and delay of a Court accounting, the parties hereto, in
consideration of the mutual covenants herein expressed, and
intending to be legally bound hereby, agreed that:
1. The Estate of Raymond Leury, who died November 18,
2001, is now in the process of administration, Letters of
Administration having been duly granted to the Administratrix,
by the Register of Wills of Cumberland County , Pennsylvania on
November 28, 2001.
. .
2. Jo-Ellen Shoemaker is the sole intestate beneficiary
of the Estate.
3. The parties acknowledge that the Administratrix has
received the assets and made the paYments to the decedent's
creditors and the parties approve the administration of
Decedent's Estate in its entirety.
4. The parties hereto agree that the remaining balance
of the Estate assets shall be distributed to Jo-Ellen
Shoemaker. Without intending to limit the rights or remedies
of the Administratrix, the parties further agree to indemnify
the Administratrix and save the Administratrix harmless
against all liability, loss, and expense (including, but not
limited to, costs and counsel fees) which the Administratrix
may incur, whether due to the Administratrix's negligence or
otherwise, as a result of making the above described
distributions without a Court audit.
5. The parties, and each of them, hereby forever fully
release, compromise, settle and discharge any and all claims,
demands, actions or causes of action, legal or equitable,
absolute or contingent, vested or hereafter to accrue, which
2
~ .
. ,
any of them may have against any other party hereto or against
the Estate of Raymond Leury, deceased, or the Administratrix
thereof, by reason of any matter, cause or thing growing out
of, or relating to any property or assets of the said Estate,
or growing out of or relating to any act of the Administratrix
in her administration of said Estate, even if attributable to
negligence, and agree that any period for the limitation of
actions for the collection of any erroneous distribution or
distributions shall commence only at such time as the
Administratrix shall have obtained actual knowledge of such
erroneous distribution or distributions and that in no event
shall the period for collection or any erroneous distribution
or distributions be less than two (2) years after the actual
discovery thereof by the Administratrix.
6. The parties agree to execute such additional
releases as the Administratrix may submit to them in order to
confirm their discharge from any further liability to the
parties in connection with the said Estate.
7. The foregoing provisions which apply to the
Administratrix shall apply also to any Administratrix who may
be appointed in connection with any ancillary administration
3
, .
. .
which may be required in order to complete distributions in
the Commonwealth of Pennsylvania.
8. This Agreement may be executed in multiple
counterparts and, when so executed, shall be binding upon all
the parties, and their respective heirs, next-of-kin, personal
representatives, and assigns.
IN WITNESS WHEREOF, the parties have hereunto set their
hands and seals the day and year first above written.
ESTATE OF RAYMOND LEURY
~-' ~
By~j-, e.it.
J04Ellen Shoemaker
Administratrix
INTESTATE HEIRS:
~~ft-~
o-Ellen Shoemaker
4
~E"-:SOO ~x 6-;j(
, COMMONWEALTH OF
, PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128.0601
I-
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
RAYMOND LEURY
DAT1.'1 ?IlI~ /l'r.DD. YEAR)
REV-,1500
OFFICIAL USE ONLY a-
11-:l'-/-~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
kL~ oL
COUNTYCOOE YEAR
-.LD...'1..'L
NUMBER
SOCIAL SECURITY NUMBER
097
26
5197
DATE OF BIRTH (MM.DD.YEAR)
7/10/33
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Real Estate (Schedule A)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 2. Supplemental Rftum
o 4a. Future Interest Compromise (date of death after 12-12.82)
o 7. Decedent Maintained a Living Trust {Attach copy of Trust)
D 10. Spousal Poverty Credit (dale 01 death between 12.31-91 and 1-1-95)
NAME
Jordan D. Cunnin ham Es Ulre
FIRM NAME (If Ap.plicable)
CunnLngnam & Chernicoff, P.C.
TELEPHONE NUMBER
717/238-6570
ITIJln~"'iT~~~,~J'1 ~~;;::tiier:)~Y:'ii:1~\~~k:i:J:;J~rI';:~~I-T:\le{;:>"l\~IIJ'~"" ;.;<I~' ,~<~j'jf, :f~\~~~;lij,:~!'r.\~(~; ~ l:lIJAillf~ "I.'. .'I\;:,,-iJ~:?l~!i
z
o
~
...J
::)
!::
II..
<l:
o
w
ct:
[K] 1. Original Return
o 4_ limited Estate
o 6_ Decedent Died Testate iAttach copy of Will)
D 9. Litigation Proceeds Received
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4, Mortgages & Notes Receivable (Schedule D)
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)
8. Total Gross Assets (total Lines 1-7)
9 Funeral Expenses & Administrative Costs (Sched~le 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)
D 3. Remainder Return (date of death pMor to 12-13-82)
o 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)
COMPLETE MAILING ADDRESS
Cunningham & Chernicoff, P.C.
2320 North Second Street
Harrisburg, PA 17110
14. Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
1,228.58
3,358.97
(6)
(7)
(8)
4,587.55
(9)
(10)
978.41
2.453.57
(11) 3,431.98
(12) 1,155.57
(13)
{14} 1,155.57
13 Charitable and Governmental Bequests/See 9113 Trusls for which an election 10 tax has not been
made (Schedule J)
z
o
~
I-'
::)
II..
:!;
o
o
X
~
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
17 Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable al collateral rate
19 Tax Due
200
1,155.57
x .0 (15)
x.O_ (16)
x .12 (17)
x .15 (18) 173. 34
(19) 173 . 34
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REvE~E'$JbE'AND RECHECK IilATH .< < ,~')'r~>" i',,"., ., ;.'tt ::Vrc
Rue:: 15 02 01: 35p
Jo Shoemaker
717-464-3765
Decedent's Complete Address:
STREET ~QDRESS
p.2
ern'
6280 Carlisle Pike, Lot 512
Mechanicsbur'2'
.PA
170'i5
[STATE
Tax Payments and Credits:
,. Tax Due (Page' Lin. 19) (11
2. CredibIPayments
A. Spo"",1 Poverty Credit
B. Prior Paymenls
C. Discount
-r ZIP
Total Clidit. (A' 6' C) (21
3. lntQrQstlPliInalty if applicable
D.lnlerest
E. Pen.lly
Tol.,lnleresVPenally ( D + E ) Pl
4. If Line 2 i. gr..tor llI.n Line' . Line 3. enter llIe di~erence. This Is the OV~ftPAYMENT.
C.eok bOl on Page' LiIle 20 to request. refund (4)
5. It line 1 ... Line 3 is greater tl'l;.n Une 2. enter the dflference. ThIs is the TAX DUE. (5)
A. Enter the interest on the tax due.
(SA)
8. Enler I.e 10l.1 of Line S . SA. Thi. is the IlALANCE QUE.
(56)
Make Check Payable to: REGISTER OF WILLS, AGENT
ii"t".;I0id~~~~~:~~~~~;Q~~~~lIl!: ,I Ai ...---.2rfOl'r.-l.lluTtM .-. r._~~ ~~~~~:z=.O:;\J~":tl~:~:
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
o
o
mmO
o
Q
.U
o IX]
IF THE ANSWER TO ANY OF THE ABOVE QUeSTIONS IS YES, YOU MUST COMPLETE SCHEDULe G ANO FILE IT AS PART OF THE RETURN
1 . Did decedent make a transfer and:
a. retain \he use or income of the property transferred;. ..........."",,,,,,,,,.....,,.........................,",,..,,,.......
b. retain tl'1e right to desigl'lale who shall use the property transferred or its income: .......
c. retain a reversionary interest.; or... ............................,........-.... ...............,....
:1. receive t'rle promise for life of either payments, benefits or care'? .,.._.. ................. ..m...............,
2. If death oCC"Jrred after December 12, 1982, did decedel"lllr:msfer property withIn one year of d.eath
wilhout re~iving adeQuate t:Ol'lsideration7 .....""......... . ....................... ........-.................'''...
3. Did decedent own ar. ~in trust for' 01' payable upon death bank account or SIlCUrity at his or her death? ......-.
4. DId decedent own an Indi'llidual Retirement Account, annuity, or other non.probale property which
contains a beneficiary designation? ...... m....'...."............. . ........ ..-........."''',,.................'........
No
00
iii
IX]
IX]
IXI
IXI
U!\11Cf llenaltles :',1 t:lEl1ur" I C:ecla~ that 1 h.l'(r ~i"e:.llrli5 relum. ;tlGilldin~ atCOlTlP<ln~ng 5cl19dIJIM :;'1d $'.alcm~nl$, 3Nl to IlIe be.! or my l:no'4'l~dge an13 bellt!.
it i5 INt, ~Wl!::1 ..no ~ompl~:e.
Oildarallan III pr~O<lr<:r tlthg, \I1oln Iht per!onlll rtpreulllalf.... ii biI:lell ~ IIllfllorm.1io1'l of I'Ihicl'l ~repa'er I'Iag a.,)' krtowlQdqlt.
oad, Crystal Spring, PA 15536
R THAN REPRESENTATIVE
17110
:._ ..,.:::lL>..::::.,~..-T:.:.~.~;:.~~::;.;~.!t~~iZu;t.-::~:~Oi~2i~;;:~:};r~::~~::;;[~~:r:.i~~ft:~~.i~~i\~.~~2}l.-~;tBh~~r~~jr.7~~~iZ}:~.;f,r~~~~~'
For dales of death on ar after July 1, 19S4 and before January 1. 1995, the tal rate imposed on the net value Jf uclnsfer.; to or for Ihlill.,lSi of ,he surviving spouse is 3%
In PS. \9116 (a) (1.\) to!
~or dales of death on or after January 1, 1995. tMe tax rate :mposed on the net value of transfers to or fgr the use of the surviving spouse ~s 0% [72 P.S. 99'16 (a) [1.1) (lL
The stQtute does not exemof a transfer to a sUl'i'iving spOlJse from tax, and lhe stau.:tory requiremlilnts for disclosure of assels and nling o!I tax relUrl'l are :lli:J a~p~cable evan
the sl.;NNing spouse is the only beneficiary.
For d.lel 01 ceath on or .fter Ju~ 1. 2000:
The lax rate imposed on Ine net value or trGlosfers from a ceceCl~E::d child l....n:nty-one 'fears of age or YOLr'lger 8t death to or for ~he use of a natural parent, an adopr'lle pareol'
or' slepp.,.nl of lho child i, 0% [72 P S. \9116{,)(12)].
The ICl;( rale imposed on tMe I'Iell ....alue of transfers to Of fer the use of the decedent's lineal benefICiaries IS 4.5%. exce~t as noted io 72 P,S. ~9~ 15(1 ,2) (72 P.S ~9116(a)(1
I].
The tax rate imposed on the I1et ",alue of ~ransrers to or fOl' the use or th8 decedent's siblings is 12% (72 PS ~9116(a)(':3)I. A sibling is defined. under Secticn 9102, 3$ ,I'
individual who "as at least one parel'\f in eommon with the decedenl. whether by blood or adoption.
RfV,"'rl
RUG-15-2002 15:23
717 464 3765
17",:Q
95%
"",,,,"-n-'1nH
P.02
Rf;V'1~EX.(1-97)~
" 'fJfm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
RAYMOND LEVRY
2001-01087
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Waypoint Bank - 25 shares at $14.09 per share on 11/16/01
VALUE AT DATE
OF DEATH
352.25
2.
vcr - 30 shares at $29.21 per share on 11/16/02
876.33
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
1,228.58
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REV-1508 EX. (1.97)
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RAYMOND LEURY
FILE NUMBER
2001-01087
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1,
DESCRIPTION
Waypoint Bank - Account #114363571
VALUE AT DATE
OF DEATH
1,758.97
2.
Trailer - 1977
1,000.00
3.
1987 Dodge Dynasty
600.00
TOTAL (Also enter on line 5, Recapitulation) $ 3,358.97
(If more space IS needed, Insert additional sheets of fhe same size)
REV-1511 EX+ (12-99)
. ,,'t.Li';~~".
. '. i\'""
,~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
RAYMOND LEURY
FILE NUMBER
2001 - 01087
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Cremation Society of Pennsylvania 93.00
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions
Name 01 Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City-.-____________State____Zip
Year(s) Commission Paid:
2. Attorney Fees - Cunningham & Chernicoff, P.C. 600.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Cily State __Zip
Relationship 01 Claimant to Decedent
4. Probate Fees - Regis ter of wills of Cumberland County 105.00
5 Accountant's Fees
6 Tax Return Preparer's Fees
7. Claude Weaver - Appraisal of personalty 125.00
8. West Shore Shopper - Advertisement for sale of trailer 15.00
9. Shipley Energy (fuel oil to maintain in tegri ty of mo bi Ie home) 40.41
TOTAL (Also enter on line 9, Recapitulation) $ 978.41
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
C""""'('''., \';f,
~~-
~~~r
COMMOi'JWEALTH OF PENNSYlVANifl,
INHERITANCE TAX RETURN
RlSIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
RAYMOND LEURY
FILE NUMBER
2001 - 01087
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
66.95
AT&T
2.
Verizon
72.49
3.
Comcast
67.60
4.
Cannon Mobile Home Park (4 months lot rente
1,300.00
5.
Susquehanna Valley Ambulance Service
44.20
6.
Lancaster General Hospital (anesthesia fees)
87.78
7.
Vascular Surgery Assocites (surgery fees)
487.92
8.
Lancaster General Hospital (physician's fees)
296.33
9.
Lancasger General Hospital (emergency room fees)
30.30
TOTAL (Also enteron line 10, Recapitulation) $ 2,453.57
(If more space is needed, insert additional sheets of the same size)
~E~-1513 ~X.~ (9-00*,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
RAYMOND LEURY
FILE NUMBER
2001 - 01087
NUMBER
I
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 I') 11.2)]
1.
Jo Ellen Shoemaker
3240 Pleasant Valley Road
Crystal Spring, PA 15536
niece
AMOUNT OR SHARE
OF ESTATE
100%
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
,.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)