HomeMy WebLinkAbout01-1104
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Nancy J.-e Stone
l\CLr. C '-l Ja r"\e
I
C2j.
~.e
No.
~/-OJ-IIOY
also known as
, Deceased
Social Security Nlo. 174-20-0996
Petitioner{s}, who is/are 18 years of age or older, apply(iesl for"
(COMPLETE "A" OR "B" BELOW:)
~
A. Probate and Grant of Letters and aver that Petitioner(s) is the execut~ named in the Last Will of the Decedent. dated
November 7, 1982 and codicil(s) dated
State relevant circumstances. e,g., renunciation, death of executor, etc.
Except as follows. Decedent did not marry. was not divorced, and did not have a child born or adopted afte~ execution of the documents offered for probate; was
not the victim of a killing and was never adjudicated incompetent:
~
B. Grant of Letters of Administration
(d.b.n,c.t.a,: pendente lite; durante abs tia; durante minoritate)
heirs:
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and w~s survived by the following spouse (if any) and
I Name Relationship Residence I
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in
DeanhurstAvenue Cam Hill PA17011
County, Pennsylvania, with her last family or principal residence at 201
(list street, number and municipality)
Decedent, then -B- years of age, died November 27, 2001, at Holv Spirit Hospital. Camp ~ill. PA 17011
(location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property ............................................... $ 135,000
(If not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
(If not domiciled in PAl Personal property in County ................................. $
Value of real estate in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 85.000
Total. . . .. ........ . . . . . . . . . ..... . . . ..... ..... . .... . . .......... . . . . .............. $210,000
Real Estate situated as follows: 201 Deanhurst Avenue. Camp Hill, PA 17011
Wherefore. Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate
form to the undersigned:
Signature T IPed or printed name and residence
Linda S. Smith
-\-~L ~ 'S-A- . -\ L 2882 Mountain View Drive
Camino, CA 95709
Form RW-1 Page 1 of 2 (Dauphin County) ~ Rev. 9192
/7-;15-0-<
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct
to the best of the knowledge and belief of Petitioner(s) and that as personal representative(s) of the Decedent Petitioner(s) will
well and truly administer the estate according to law.
~ ~~.z S
before me this
4th
Sworn to and affirmed and subscribed
S A..-..\ ~
December
No.
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Nancy JaM Stone
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net f'\( '< J (l t'I{> De~~eased
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Estate of
Social Security No.
174-20-0996
Date of Death: Nover)1ber 2~~2901 _
AND NOW, December 4. 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having
been presented before me,
IT IS DECREED that Letters -tTestamentary 0 of Administration
d.b.n.c.t.; pendente lite; durante absentia; durante minoritate
are hereby granted to Linda S. Smith
in the above estate and that the instrument(s) dated November 7. 1982
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters......................... .
Short Certificate(s) ...(5).
Renunciation................ .
Affidavit ( )................
Extra Pages ( 1) ............
Codicil......................... .
JCP Fee ........................
Inventory ......................
Other.......................... .
TOTAL.............. .
Form RW-1 Page 2 of 2 (Dauphin County). Rev. 9192
$ 270.00
$ 15.00
$
$
$ 3.00
$
$ 5.00
$
$
$ 293.00
:.---~~~(;'V t;Lb7
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Attorney: Patricia ArmstronQ, Esquire
I.D. No: 23725
Address: 212 Locust Street. P.O. Box 9500
HarrisburQ, PA 17108-9500
Telephone: (717) 255-7627
CALL ATTORNEY- WILL PICK UP LETT8RS
This is co 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.
No.
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Local Registrar J'
Fee f(lt this certificate. .'il2.00
P 7885138
NOV 30 200{
Date
21-2001-1104
I He.., 2187
COMMONWEALTH OF PENNSYLVANIA 0 OEPARTMENT OF HEALTH 0 VITAL RECOROS
CERTIFICATE OF DEATH
NAME OF DECEDENT (flrSl_ M~. las)
1.
Nan
Jane
SEX
.. Female
STATE FilE NUMBER
SOCIAL Sf;CURITY NUMBER
AGE (laS1 B.rthdaV.
UNDER 1 YEAR
MORIM Days
3.174
- 20
0996
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UNDER 1 DAY
ttour-. Mtnut..
BIRTHPLACE lC.ty and PlACE OF DEATH ICt>eck Of'ty Qf"'4t -- -;ee '1lSIrOChon, on ~ Stdel
Slale 01 Fctegn CooncrYI HOSPITAL;
1elroyne , PA ,......-Jii'l ER/OuIpo"o.. 0 OOA 0
1. Ia.
FACllOY NAME (II no( InSlof\AlOO. glWt SI'. and nutnQefI
g::ofylO
5. 77
COUNTY OF OEAI'H
V<s,
CUmberland
....
RACE. Atnencan Indian. Black, WhiI.. etC.
(Spocofyl
DECEDENT'S USUAL OCCUPATK)N
(~-:o,~..,w::~~.=~~
. 110. Clerical 11b. Banking
DECEDENT'S MAlllNG "DDRESS (51'.... CofyllOwn. SIaM. z,p Codel DECEDENT'S
201 Deanhurst Avenue ~~:::NCE
Camp Hill, PA 17011 ~:::'"
KINO a: BUSINESS/INDUSTRY
1..
White
n.
MARITAL STATUS. Uamed
N....... Married. Widowed.
~~otvl
WidOWed
10.
SURVIVING SPOUSE
II' ....... \1'111 maiden ~I
17.. Slate
?Pnn"'y'VrmiA
Did
--
he....
Cumberland --, I1d.6C1 :;"'''":'':::..
MOTHER'S NAME IFnI. Middle. Malden Sufname)
Ara Runkle
110.0...-.......
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1..
FATHER'S NAMe (First Middle. laSl)
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INFORMANT'S NAME (TVpoIP';o'1 Linda
-.
METHOD OF DISPOSITION
BuMI KX C,efT\lhon 0 Removal "om Sial. 0
Olhor (Spoc.....
Hanson
91ith
22a.
Comptet. "ems 23a-c
~.notava'
cendy cau.- 01 de
llama 24.21 mual: be compleled by
peqon who plonounc.. dII.lh.
'2b. 012755-L
10 the be~ of my knowtedge, dealh occurred at 1he time. dale anet place slaled
(Signatu,e and Title)
12-3-01
...
INFOA......T'S ....,UNG ADDRESS ( .... C..,ITown. SIoIe. Z;p~)
:lOb. 2882 M:>untainview Dr., Camino, CA 95709
PlAce OF DISPOSITION. Name of cem..ery, c,tmatoty LOCATION. CifylTown. Slat.. rip Code
Of Other PtiM:.
Mt. Olivet Cemetery
New CUmberland, PA 17070
2td.
llonaUon 0
....
S1GNArURE OF FUNE
RSON ACTING AS SUCH
21c.
LICENSE NUMBER
NAME ....0 "DDRESS OF FACILITY
....Myers-Harner FH,
lICENSE NUMSER
1903 Mkt St, CH, PA 17011
DArE SIGNED
(MonIh. Dav. '(earl
2~ ~.
S CASE REFERREO TO MEDICAL EXAMINERlCORONER?
V.. 0 NoKl
....
TIME OF DEArH
'0. :5: I {g
IMMEDIATE CAUse: (FtnaI
lJiSlNSe 01 condlllOO
r-*'g l(I OCNIhI--""
&~C~t:~~~
PART U: Ocher stgndicant condi&ions concributing 10 dealh, but
not rMUfting in the undtffying CauM gn..,. in PART I
_ially...c:ondit.....
ifMy,lMdinglO ~te
UUM. Ena., UNDERLYlNQ
CAUSE (o.eas. 01 "'fUlY
. IhaI nIia&ed 8"'enlS
18SUIIng '" deelh) lAST
DUE lOCoo"sA CONSEOUENCE OF),
DUE 10(00 AS"CONSEOUENCE OF),
WAS AN AUlOPSY
PERFORMED?
.
WERE AUTOPSY FINDINGS
AWtJLABLE PRKJA 10
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
(Monlh. Day, Yea'l
TIME OF INJUR'lI'
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
NalUl'aI
Homicidl
o
o
o PLACE OF 'NJURV - At homo. ,..m":;.o.. 'aClO<y. ./tico
building, etc. jSpecltv)
300.
..... 0 NoD
Accident
o
o
Pending Investigalion
.....0
No
Vo.o
NoD
Suicide
CQUtd ROC be de'enmned
M. JOe.
2". :lIb.
CERTWIER ICreck only onel
'CERTiFYING PHYSICIAN 4PhysICICln certtlytng cause ~ dealh when anoll18f phVSIC.an has pronounced dealtl ana completed Ilem 231
To the beel of "'y knowledge. deelh occunlld dlM to Ih. cau.e(.~ and manMr aa staled. . . . .
D.
UX:;'-:HON (Str8ltl. Clty~, Stalel
REG1STRAR'~NATUAE AN~UMBE~
33 Ct/;cA,/ "':~ '7;z...k.4-e<~_ _ _
bl, I ~I /1/ I
DATE FilED (Monlh Day, iean
).J./J p~
J70\ I
f
.PRONOUNCING AND CERTlf'YING PH'YSICIAN (Physcaan boItl Ol'onou/1C'ng aedlh and (.;ef{IIVIflIJ 10 cause Of dealhl
To the ~t of my knowledgft. death occurred al h Ume, date, and place, and due 10 lhe causa(.) otnd manner.. slaled
...EDIC..l ex....INER/CORONER
On the b..is of ...min.llon andlot investigation, in my opinion. death occurred at Ihe time, date, and place, and due to the cause(s) and
manne, as stated.. . . . . . . . . . " ..... _ . . . . . . . . . . , .. ',....................... . .,....,....,........................
31a.
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RE1J-l5(JO EX 1&-001
REV-1500
.' , COMMONWEALTH OF
PENNSYLVANIA
'. lilii: DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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FILE NUMBER
2 _ 0 0
INHERITANCE TAX RETURN
RESIDENT DECEDENT
YEAR
NUMBER
I-
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W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Stone, Nancy J. a/k1a Nancy Jane Stone
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
11/27/01 02/27/24
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o 4
COUNTY CODE
SOCIAL SECURITY NUMBER
174
0996
- 20
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
o 4. limited Estate
o 6. Decedent Died Testate (AlIacl1 oopy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 dealh afIer 12-12-82)
o 7. Decedent Maintained a living Trust (Attach oopy01 Trusl)
o 10. Spousal Poverty Credit (dale ofdealh between 12-31-91 and 1.1-95)
o 3. Remainder Return (date of dealh prior 10 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SEqnONMUST BE COM!! O. ALL'
NAME Patricia Armstrong, Esquire
FIRM NAME (II ~licable2 _
THOMAS, I HOMAS, ARMSTRONG & NIESEN
TELEPHONE NUMBER
717/255-7627
l'lDENCE AND CONFIDENTIAL tAX INJ;oBIllATION SHOODBE DIR~!l\EDTO;(
COMPLETE MAILING ADDRESS
212 Locust Street, Suite 500
P.O. Box 9500
Harrisburg, PA 17108-9500
(1) $105,B27.00
(2) $ 50,000.00
(3)
(4)
(5) $ 97,127.31
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule Dj
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G orl)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
$ 17,067.39
(9)
(10) $ 745.05
14. Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable allhe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
$235,141.87
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.0
(B)
$252,954.31
(11) $ 17,812.44
(12) $235,141.87
(13)
(14)
x .0 (15)
x.o~ (16) $ 10,581.38
x .12 (17)
x .15 (IB)
(19) $ 10,581.38
> > BESU
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
';+X1y'
lls<ON REVERSE SIDE;~NP f!E;,CHECKMATH < <
E
Decedent's Complete Address:
STREET ADDRESS 201 Deanhurst Avenue
CITY Camp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) $10,581.38
$9,500.00
$ 500.00
Total Credits (A + B + C )
(2) $10,000.00
3. InteresVPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is 9reater than Line 1 + Line 3, enler Ihe difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4)
B. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE.
(5) $
(5A)
(5B) $
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
581. 38
A. Enter the interest on the tax due.
581. 38
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
IZJ D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......... .................. .. ............... 0
b. retain the right to designate who shall use the property transferred or its income;.. ... ................................. D
c. retain a reversionary interest; or..... ......................... .......................... .................................. D
d. receive the promise for life of either payments, benefits or care? ............. ............................ .......... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ......... ............................. ............................ .. ................... D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............ ........................ .. .....................
No
IZI
[X]
IZI
[J9
[ZJ
[J9
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaratfon of preparer other than the personal representative is based on all inlormation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
.J<.... _ L. "S. L.... A-. ,~\....) i:. >l Q.. "--.:> \.~ ~ "-
DATE
~"\,, '" ;4.~~:::I
\ '
ADDRESS
';;>'1-"':::1 "-\\'" _ \l. ...'--'>~... 0 ~ ~...,....C'>
SIGNATURE OF PREPARER OTijER'THAN REPRESENTATIVE
,_")cdt.U\r'_"' ({I"l) ('0)
ADDRESS '
.:)1:).. loev..,.",- .~c'<" ..,. see'>
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DATE
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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 PS. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rale imposed on the net value of transfers to or for the use of the survivin9 spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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(.)(1.2)],
The tax rate imposed on Ihe nel value of transfers to orlor Ihe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The lax rate imposed on the nel value of transfers to or for the use of Ihe decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A siblin9 is defined, under Section 9102, as an
individual who has at least one parent In common with the decedent, whether by blood or adoption.
'''''~''''.I'''"''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Nancy J. Stone a/kJa Nancy Jane Stone
SCHEDULE A
REAL ESTATE
FILE NUMBER
2001-01104
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled 10 buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
OESCRIPTION
VALUE AT OATE
OF OEA TH
201 Deanhurst Avenue, Camp Hill, PA 17011
$105,827
TOTAL (Also enter on line 1, Recapitulation) $ $105,827
(If more space IS needed, insert addItIonal sheets of the same size)
'''''~''':I'''"''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Nancy J. Stone a/k/a Nancy Jane Stone
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
2001-01104
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Treasury Direct Account 1300-024-9016
$50,000
TOTAL (Also enter on line 2, Recapitulation) $ 50,000
(If more space IS needed, Insert additional sheets of the same size)
''"'':'''':''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Nancy J. Stone alkJa Nancy Jane Stone
FILE NUMBER
2001-01104
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
OESCRIPTION
VALUE AT DATE
OF DEATH
$ 211.84
Allfirst Check Account #_________________________
2.
Waypoint (f/kJa Harris Savings) Account #705001032
23,167.92
3.
WayPoint (f/kJa Harris Savin9s) IRA Account #786523235
9,350.59
4. WayPoint (f/kJa Harris Savings) Certificates of Deposit
Account #1000003240
Account #1000003258
Account #1061292338
Account #1061314825
$15,117.16
$11,036.83
$21,687.12
$14,022.24
61,863.35
5.
Miscellaneous Personal Property
1,956.25
Refunds
AARP $148.75
Vet. Life 16.20
Peoples Benefit 11.05
Keystone Oil 351.36
Shelby House 50.00
TOTAL (Also enteron line 5, Recapitulation) $ 97,127.31
(If more space 1$ needed, Insert additional sheets of the same size)
REV-'511EX'I'-97){11
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
2001-01104
Nancy J. Stone a/k/a Nancy Jane Stone
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Burial $6,614.84
Attendance at Funeral and to commence probate process, etc. 1,418.32
B. ADMINISTRATIVE COSTS: (Declined to Take) -0--
1. Personal Representative s Commissions
Name of Personal Representative (s)
Social Security Number(s) ( EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Allomey Fees $4,500.00
3. Family Exemption: (If decedent s address is not the same as claimants, allach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant 10 Decedent
$ 293.00
4. Probate Fees Filina
Publication $ 153.00
Death Certificates $ 30.00
5. Accountants Fees
6 Tax Return Preparers Fees
House Maintenance and Utilities $ 712.78
7.
8. Checks, Forms, etc. $ 57.45
9. Executor out-aI-pocket Expenses to return to property lor cleanout 01 house and final $3,288.00
sale 01 house and removal 01 all remaining property.
TOTAL (Also enter on line 9, Recapitulation) $ 17,067.39
(If more space IS needed, Insert additional sheets of the same size)
''''~':'':''''"''. SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INH~~~i~~~~6:;'E~~~RN MORTGAGE LIABILITIES & LIENS
ESTATE OF Nancy J. Stone a1k1a Nancy Jane Stone FILE NUMBER 2001-01104
Include unreimbursed medical expenses.
ITEM
NUMBER
1. Repayment of SSI
DESCRIPTION
AMOUNT
$643.00
2.
Medical Expense - Conner Rice
EKG Associates
$100.00
$ 2.05
$102.05
TOTAL (Also enter on line 10, Recapitulation) $ 745.05
(If more space IS needed, Insert additional sheets of the same sIze)
~EV.1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
sa -.. U::' J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Nancy J. Stone alkla Nancy Jane Stone
2001-01104
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(SI RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under
Sec. 9116 (al (1.211
1. Linda S. Smith Daughter 100%
2882 Mountain View Drive
Camino, CA 95709
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
I.
TOTAL OF PART 11- 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)
. ,
Oh~~0 (
W-7
21-2001-1104
KNOW ALL MEN~) THESE P~ESENTS: That 13d/~ ~/ ___
or Ihe~Town uf>~"~44__ Coanly Of_C~4-.L,.-",~ _
and State of d~ __ _, __ ____ ,,__ _ _ , being of ~ound an, lh~p():,ing lIIind and lIIelno/ y, do III.lke,
publishmd declare the following to be my LAST WILL AND 'I ESTA -1LNT, hereby revoking all Wills by I/Ie
at any time heretofore made.
JLast Will anb 'lttstamtnt
FIR."T: I direct my Executor/Executrix, hereinafter named, to pay all my funeral expen~es, administration ex-
penses of my estate, including inheritance and succession taxes, state or federal, which may be occasioned by the
passage of or succession to any interest in my estate under the terms of this instrument, and all my just debts,
excepting mortgage notes secured by mortgages upon real estate.
SECOlv'D.^ AU the rest, residue and rClnainder of my estate, both real and personal, of whatsoever :kind or
bequeath one such part to each of the following
~ ~l partf, and I give, devise and
~ persont, to be his/hers absolutely and forever:
character, and wheresoever situated, shall be divided into
~/~ / // ~:I~'d
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The share of any person above named who shall not survive me shall revert to such person's issue in equal shares,
per stirpes; if such pnson has died leaving no issue, the part designated above as being for such person shall be
divided alllong the other bencliciaries named above, in equal shares, per stirpes.
ac
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I "';T WIT.r, ANn '( ESTAMENT and I direct tht such person shall servc without hondo ",' /. ,
IN WI'I.N E" WI/ER lJOF, ~ have hmunt"" my h:~j. ano' "" at _;~y/ ~:d __,
tt,:s ~~L day' f 'l ~~--<-- 19 /-2;-'
(sign here) ~~ (). ~~
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Signed, scaled, published and declared to be his/her LAST WILL AND TEST AMENT by the within named
Test tor in the presence of us, who in his/her prc,ence and at his/her request, and in the presence of each other,
have hereunto suhscribed our names as witnesses:
_of_l1JfvJ ru ~/;pd~
11 :ity .
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of {)I,lA t r' i ,)//CI ;-
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City
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AFFIDAVIT
STATE OF
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COTTNTY OF
Personally appeared (1)
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and (3)_
, '10 hcin~; duly ,'vom, depose anrl sa~' that th ~y attested the said Will and they subseribe.1 the same at the requ:st
and in the pre',cnce of t he said Tl stat .r and in the presence of each other, and the said Testator signed said Will in
.l-n;r nresencc and ackl owl edged that he/she '1ad signed said Will a Id declared the same to be his/ller LAST WLL
J .1\!) j iSTA MFNT, md deponent; further state that at the time of the execution of said 'Xiii the said Testa or
; ppearcd to he of lawf,,1 al;c and s('lmd mini and mcmory and there was no cvidence of Jlndue inf1ucncc. The Ic-
mnents r-1:I1.;e thi'; am bvit at the request of the Testator.
(1)-
(2)_
(3)
,ub<cribed and sworn 1) before me this
day of
19__
(Notary Seal)
Notary I'ublic
(->1 /I /" ?
REGISTER OF WILLS OF Cumberl ann COUNTY
OATH OF SUBSCRIBING WITNESS
\
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(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that he L.0Q. S present and saw
1\ () "c u .::s- STo'l' e
,
the test at f'\"^ , sign the same and that 5\1 e signed as a witness at the
request of testatJ:.I,_~ in 1L..e..{_ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)). ,/)
Sworn to or affirmed and subscribed before ~.LI? ~
me this 4th day of /~/I (Name)
DeCemb~ x:. . ~ 2001 '\Ob t~\' Oa...\:::: U"
1nr~. MA/lW ~J~ (Address)
~- Lewis' . - . . "\ C L \ 01
I' Register ~ '-'-' u. \^l\. u ~ If' aV\-.O'-. r::~
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(Address)
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REGIST~R OF WILLS OF r.lJrnhprl ann COUNTY
~~TH OF NON-SUBSCRIBING WITNESS
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21-2001-1104
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(~) a subscriber hereto, (~ being duly qualified according to law, depose(s) and say(s) that
"'-E- \. S familiar with the signature of \)a. "-C Ll :::r- S-t-o (\,~
~ \.
testat~ of (~~ to) the will presented herewith and
codici
that ~e.- w' I is' the handwriting of
to the best of kl ~
knowledge and belief.
Sworn to or affirmed and subscribed before W
me this 4th . day of (Name)
December .. ~ 2001 \ 0 f.o ---ra. \. \ 0 C\. I.C. D (
J~....u..t!: (Addresf)
Register .. Z7 ~ C L-' V\}.. '0 p f./ \ 0-.11"- (J
(Name)
()lI........
(Address)
COMMONWEALTH OF PENNSYLVANIA
'!:JtoPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ARMSTRONG PATRICIA
212 lOCUST STREET
POBOX 9500
HARRISBURG, PA 17108-9500
___nn_ fold
ESTATE INFORMATION: SSN: 174-20-0996
FILE NUMBER: 2101-1104
DECEDENT NAME: STONE NANCY J
DATE OF PAYMENT: 02/26/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11/27/2001
NO. CD 000893
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $9,500.00
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TOTAL AMOUNT PAID:
REMARKS: PATRICIA ARMSTRONG ESQUIRE
CHECK#107
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$9,500.00
MARY C. lEWIS
REGISTER OF WillS
:Jlomas. .Jlomas. Annslr011UI & ~sen
,/ltloNUJro and CollJJnol/Jl/mro al Lw
SUITE 500
212 LOCUST STREET
P. O. Box 9500
HARRISBURG, PA 17/08-9500
www.ttanlaw.com
PATRICIA ARMSTRONG
Direct Dial: (717) 255-7627
E-Mail: parmstrong@)ttanlaw.com
F[RM (7[7) 255-7600
FAX (717) 236-8278
CHARLES E. THOMAS
(1913 - 1998)
February 25, 2002
Ms. Mary C. Lewis
Cumberland County Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
...-- ,....
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In re: Estate of Nancy J. Stone
Date of Death: November 27,2001
Social Securi~YJ\J.....~rTlber: 174-20-0996
PA No. 21-9'.-rl!~
, .
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Dear Ms. Lewis:
Enclosed is check number 107 in the amount of $9,500.00 payable to Cumberland County
Register of Wills as payment within the discount period for Inheritance Taxes in the above
referenced estate. If you have any questions, please contact the undersigned.
Very truly yours,
THOMAS, THOMAS, ARMSTRONG & NIESEN
......~ /-"1 --.,<.
BY:p;':~=~~~~O~gJ (", (
Enclosure
cc: Linda S. Smith, Executrix
F :\CLI ENTS\MISC\NJStone\Letters\020225RegofWills. wpd
E
'-""
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Nancy J. Stone
Date of Death: November 27.2001
Will No. 21-01-01104
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule
5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries
of the above-captioned estate on March 8, 2002:
Name
Address
Linda S. Smith
2882 Mountain View Drive. Camino. CA 95709
Notice has now been give to all persons entitled thereto under Rule 5.6(a) except
Date: March 8. 2002
({2e1-
C\..~
Signature \_-_
Name Patricia Armstrong. Esau e
Address 212 Locust Street. PO Box 9500
Harrisburg. PA 17108-9500
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Capacity: Personal Representative
~ Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ARMSTRONG PATRICIA
212 LOCUST STREET
POBOX 9500
HARRISBURG, PA 17108-9500
-------- fold
ESTATE INFORMATION: SSN: 174-20-0996
FILE NUMBER: 2101-1104
DECEDENT NAME: STONE NANCY J
DATE OF PAYMENT: 07/19/2002
POSTMARK DATE: 07/18/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 11/27/2001
NO. CD 001429
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $581.38
I
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TOTAL AMOUNT PAID:
REMARKS: LINDA SMITH
C/O PATRICIA ARMSTRONG ESQUIRE
CHECK# 112
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
$581.38
MARY C. LEWIS
REGISTER OF WILLS
:JJ;oma09 :JJ;omao9 ArmO!7ri07IU/ & ~oen
:Jltlomers and ColUnse/lmrs al Lw
SUITE 500
212 LOCUST STREET
P. O. Box 9500
HARRISBURG, PA 17108-9500
www.ttanlaw.com
PATRICIA ARMSTRONG
Direct Dial: (717) 255-7627
E-Mail: parmstrong@ttanlaw.com
FIRM (717) 255-7600
FAX (717) 236-8278
CHARLES E. THOMAS
(191'3 - 1998)
July 16, 2002
Ms. Mary C. Lewis
Cumberland County Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
1 j_k.
In re: Estate of Nancy J. Stone
Date of Death: November 27,2001
Social Security Number: 174-20-0996
PA No. 21-01-01104
Dear Ms. Lewis:
Would you kindly acknowledge receipt by dating and stamping the attached copy of this letter.
Enclosed in duplicate is the Pennsylvania Inheritance Tax Return (Schedules A, B, E, H, I, and
J) together with the following:
1. Copy of decedent's will dated November 7, 1982;
2. A check in the amount of $581.38 payable to the Register of Wills for the Inheritance
Taxes due;
3. There is no Federal Estate Tax Return; and
4. A check in the amount of $15.00 to cover the cost of filing the Return.
Very truly yours,
THOMAS, THOMAS, A MSTRONG & NIESEN
)~Ao
atricia Armstrong
By
Enclosure
cc: Linda S. Smith, Executrix
F:\CLlENTS\MISC\NJStone\Letters\020716Register of WiIIs.wpd
\'/?-C26-~
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
PATRICIA ARMSTRONG ESQ
THOMAS HAL
PO BOX 9500
HBG PA 171n8
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
i) COUNTY
ACN
09-10-2002
STONE
11-27-2001
21 01-1104
CUMBERLAND
101
'*
REV-1547 EX AFP 101-02)
NANCY
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 ~
REV =H;'4-j-'Ex--AFP--foY=o2Y-NoTlc'E--oF-YNH'EifiTANcE-YA';c-A-PPRA-is'Ei'-ENT~--AL.U)WAi'-CE-ciR------------ - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF STONE NANCY J FILE NO. 21 01-1104 ACN 101 DATE 09-10-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
NOTE: If an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
235,141.87 X 045 = 10,581.38
.00 X 12 = .00
.00 X 15 = .00
(9)= 10,581. 38
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
U)
(2)
(3)
(4)
(5)
(6)
(7)
105,827.00
50,000.00
.00
.00
97.127.31
.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)
UO)
17,067.39
745.05
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this form with your
tax paYllent.
252,954.31
(11)
(2)
(3)
(4)
17.812 44
235,141.87
.00
235,141.87
n~_~.. , l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-26-2002 CDOO0893 500.00 9,500.00
07-18-2002 CDOO1429 .00 581.38
TOTAL TAX CREDIT 10,581.38
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORMYEARL Y
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
~'
~
Name of Decedent: Nancy J. Stone
Date of Death:
11/27/01
Will No.:
21-01-01104
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to
completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X
No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes
No X
Personal Representative is
sole beneficiary
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 No
Copies of receipts, releases, joinders and approvals of formal or informal accounts may
be filed with the Clerk of the Orphans' Court and may ~ached to this report.
:~~~L~/T
Signature
D.
Date: October 2, 2002
Patricia Armstrong
Name (Please type or print)
212 Locust Street, Suite 500, Harrisburg, PAl 71 0 1
Address
(717) 255-7627
Telephone No.
(MAH:rmtJAM3)
Capacity:
Personal Representative
X
Counsel for Personal Representative
R.W. - 27
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