HomeMy WebLinkAbout06-27-05
REVl500EX!S-001
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
. - DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 05
0332
COUNTY CODE YEAR
NUMBER
I-
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W
C
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
EMERSON, BETTY J
SOCIAL SECURITY NUMBER
200-22-5960
DATE OF DEATH (MM-DD-YEAR)
03/29/2005
DATE OF BIRTH (MM-DD-YEAR)
03/03/1922
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WilLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~1.0riginaIRetum
D 4. Limited Estate
o 6. Decedent Died Testate (Atwch cop~ of Will)
o 9. Litigation Proceeds Received
03. Remainder Retum (date ofdeall1 priortOJ 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) (AnaGh Sd10)
o 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Altacl1cop~ofTrust)
o 10. Spousal Poverty Credit (date ofdealtl between 12-31-91 ood 1-1-95)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
CRAIG S EMERSON 914 R HillSIDE DRIVE S
FIRM NAME (IfAppIi~",'; NORTH MYRTLE BEACH, SC 29582-3577
TELEPHONE NUMBER
(843) 272-9309
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
42,048.34
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
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5
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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/See 9113 Trusts for which an election to tax has IlOt been
made (Schedule J)
102,599.74
(5)
11,454.10
(6)
(7)
156,102.18
(9)
(8)
11,016.03
1,097.00
(11)
(12)
(13)
12,113.03
143,989.15
(10)
14. Net Value Subject to Tax (line 12 minus line 13)
(14)
143,989.15
SEE INSTRUCTIO/lS O/l REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
, .0 (15)
143,989.15 '.0 45 (16)
6,479.51
16. Amount of line 14 taxable at linea! rate
, .12 (17)
17. Amount of lirte 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
, .15 (18)
19. Tax Due
(19)
6,479.51
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
tJ A P fJ
Si{.
io I), 7/D5
~/-QS __oj~
Decedent's Complete Address:
STREET ADDRESS
.ll.24 L1SBURN ROAD.
APT 103
CITY CAMP HILL
STATE
PA
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)
6,479.51
341.01
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
Total Credits (A + 8 + C) (2)
341.01
TotallnteresUPenalty ( D + E ) (3)
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 re<juest a refund (4)
5. If Line 1 + Line 3is greater than Line 2, enter the difference. This is the TAX DUE.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(58)
6,138.50
A. Enter the interest on the tax due.
6,138.50
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;........... .................... ......... ................ ................... ......... 0 [i]
b. retain the right 10 designate who shall use the property transferred or its income; ............................ ........ 0 [iJ
c. retain a reversionary interest; or........ ..................... ........................... ..................... 0 [iJ
d. receive the promise for life of either payments, benefits or care? ...... ....................... ............. ....... ........ 0 [iJ
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................... ........................... .... 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which
contains a beneficiary designation? ... ..................... ................... ......................... 0 [iJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare Ihat I have examined this return, indudiog accompanying schedules and statements, and to the best of rny knowledge and belief. it is true, correct and COIlllleie
OecIaration ofprepararothefthanthepersonal representative is based on all infOl'lllation of which preparer has any knowledge.
~~E~BLE FOR FILING RETURN
':}14 R HILLSIDE: C(.<\\!E <;; NORtH t-A.'/RID: 8EACK, 5C 2~-:3611
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
DATE
6.27'U05
ADDRESS
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 ta or far the use of the surviving spouse is 3%
[72 PS ~9116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not 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 stepparant of the child is 0% [72 P.S. ~9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX+ 16-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
BETTY EMERSON AKA, BETTY J EMERSON
FILE NUMBER
21-05-0332
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. AT&T 78 SHARES
2. COMCAST 126 SHARES
3. LUCENT TECHNOLOGIES 75.6682 SHARES
4. MET LIFE 85 SHARES
5. sac COMMUNICATIONS 808 SHARES
6. VERIZON COMMUNICATIONS 412 SHARES
VALUE AT DATE
OF DEATH
1,467.96
4,222.26
206.57
3,351.55
18,899.12
13,900.88
TOTAL (Also enter on line 2, Recapitulation) $
42,048.34
REV-150' EX+ 1'-9'1 ..
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISe.
PERSONAL PROPERTY
ESTATE OF
BETTY EMERSONAKA, BETTY J EMERSON
FILE NUMBER
21-05-0332
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
SOVEREIGN BANK CHECKING #0461075695
2 SOVEREIGN BANK CD #0765145529
3 SOVEREIGN BANK CD#0465102143
4 M AND T BANK CD #31003914391531
5 JEWELRY - WEDDING SET
6 JEWELRY - COSTUME
7 FURNITURE - BEDROOM SET, DESK, CHAIRS
B HOUSEHOLD GOODS - TELEVISION, RADIO
9 WESTERN-SOUTHERN LIFE #W0020880196
VALUE AT DATE
OF DEATH
3,847.43
10,191.57
10,08267
1,513.72
500.00
200.00
700.00
100.00
75,464.35
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
102,599.74
REV-1509 EX- 16-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
BETTY EMERSON AKA, BETTY J EMERSON
FilE NUMBER
21-05-0332
If In aSlet was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. CRAIG S EMERSON
914 R HillSIDE DRIVE S
NORTH MYRTLE BEACH, SC 29582-3577
SON
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEAT1-I
ITEM FOR JOINT MAllE INCLUDE NAME OF FINANCiAl tNSTlTIfTION AND BANK ACCOUNT NlNBER OR SJMN.AR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 01/02/88 CITIZENS BANK 036076150 6100701166 1,094.12 50 547.06
2. 01/02/88 M AND T BANK 031302955 30676509 9,040.70 50 4,520.35
3. 01/02188 TRI-CONTINENTAL 712.373 SHARES COMMON STOCK 12,573.38 50 6,386.69
TOTAL (Also enter on line 6, Recapitula1ion) $ 11,454.10
REV,'5" EX+ 112,991W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATM COSTS
ESTATE OF
BETTY EMERSON AKA, BETTY J EMERSON
Debts 01 decedent must be "'ported on Schedule ),
RLE NUMBER
21-05-0332
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
NEILL FUNERAL HOME, 3401 MARKET STREET, CAMP HILL, PA 17011-4428
J C SNYDER FLORIST, PAXTANG, PA
ROMBERGER MEMORIALS, PEN BROOK, PA
8,661.00
185.50
134.50
2.
3.
B.
,.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative!,) SEE EXPENSE ATTACHMENT
1,197.03
Social Security Number(s)/EIN Number of Personal Representative{s)
Street Address
City
. State
Zip
YeaTts) Commission Paid:
2.
Attorney Fees
500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
.Zip
Relationship of Claimant to Decedent
4.
Probate Fees
338.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
11,016.03
REV-1512 EX' (12-031 .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILmES, & LIENS
ESTATE OF
BETTY EMERSON AKA, BETTY J EMERSON
FILE NUMBER
21-05-0332
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I.
Holy Spirit Hosprtal
171_00
2_
3.
Alert Pharmacy
847.00
Pinnicle Health Med Svcs
10.00
4.
Bank of America
69.00
TOTAL (Also enter on line 10, Recapitulation) S
1,097.00
COMMONWEALTH OF PENNSYLVANIA, INHERITANCE TAX RETURN, RESIDENT DECEDENT
Schedule H Attachment
Betty Emerson aka, Betty J Emerson
File Number: 21-05-0332
ADMINSTRATlVE COSTS
Registered Mail
V-haul rental
$76.90
$227.00
$10.00
$211.46
$216.00
$45.22
$90.45
$320.00
U-Haul boxes
Country Inn & Suites, Mechanicsburg (4-8,9,2005)
Amber Inn, Mechanicsburg (4-10,11,12,13,2005)
Red Roof Inn, Harrisburg (4-8,2005)
Red Roof Inn, Harrisburg (4-16,17, 2005)
Gas
TOTAL
$1,197.03
REV.1513 EX' 19-001 ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
BETTY EMERSONAKA, BETTY J EMERSON
FILE NUMBER
21-05-0332
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVlNG PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS Dnclude outright spousal distributions, and transfers under
Sec. 9116(,) (1.2))
1 KEllY KOHlSTRUCK, 210 BLACKHAWK AVE, MADISON, WI 53705 GRANDDAUGHTER 5,000.00
2 SCOT EMERSON, 101 N 21ST ST, CAMP Hill, PA 17011 GRANDSON 5,000.00
3 CRAIG S EMERSON, 914 R HillSIDE DR S, N MYRTLE BEACH, SC 29f SON 133,918.15
.
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 000
(If more space is needed, insert additional sheets of the same size)
.
LAST HILL & TESTAI"iENT OF
P,!;"'T''T''! :I:~~.SC:\
.I., Betty Emersoil, of 501 \~ood Street, Harrisburg (Susquehanna
Township, Dauphir. County) f Pennsylvania, being or so~~d and cispos-
i:1g mind, memory and understanding, do hereby make, publish e.ne
declare this to be my Last ~'Jill 0: Testament, hereby revoking and
rna]~ing void any and all prior wills, codicils, writings thereto, by
,., 7-"
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--. .; I"" ..~,-,..
,~-C(JO.OO \3~~- ;-.
,Ii ' ~ ~. ,..-,::-. yY'
" / ~, ~ - ~~- \) '.
Lequeath the sum 0= ~-G-G".-G{1. '':0 each of my,: V
It- c,-,L-:..~'
grandch:.lc.ren, ~y ::mcr_....lt u: S-~~---Aver.ue'.r I~a"r~:t'Sonbu;(a, Va"'.
I:) I /1;J} '~}-.A--j., C",--y~1O I~ ?;'1 -
and Scott Emerson of --3-fr5--pine~~._R-d-~~;---S11IItmta"ff$tovm'; --Fa-. Nothing
me at any time heretofore made.
~~=:r:
:.erein shall be ccnstrued as to deny my grandchildren their :ull
shares of my IRA account as stipulated i~ the bene:ici2ries
provision of the said IRA account.
ITEM ~!: All the rest, residue and remainder of my estate ~
give, devise and bequeath unto
,-/~:.--,1Z('p)'il;:"'; ~-:
I'.ow~r ,n?,.. Cou..'1t.'J.,,___Pz;,.
. "
my son, Craig S. Emerson of ~r~
In the event my son does ~ot survive
Lie by at least 30 days, then, in that eve::.t, _ give, ce"lise and
bequeath all the rest, residue and remainder of my estate to my
g=andchildren Scott anc Kelly Emerson to be divided equally ~etween
tl;.err_.
ITEl.1
III:
...-4-;:...:::-1~ L:Y'...-.--..- 'i2-~ "I-~"J --,;;,,),.\-r-?~L_~,--L:...i.7'''
~ ""rroiT'~ r.,..".~'J c:: 'l:'MGrC:(""\-D- .=Ie::: .....hp rJ";:;r~L",..,
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c:"yQt+- ?'M'5i',...cQ..... ,~-..ti.~.:;:.---<:.j.,~11 rcz.c:--: -:.~-e
e!: "J ~ :-....... _c<
1'...... VU~.J;:di:ln h"", <;:r.a...l..l-h~u,? +-~~ rJ.g~o-u,:;>t;:; -c.;;~-00:'-r:-Z
i~(} iR('OWe-..o-"" -4-'\...q tb=Ust.. -oor__-t-he--rrta_mt-EnCii1<3'-e--a-r.::: CC.Ue-a-t-i-en--e-:f----rny
.g~ra~ .
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for 3.fll' rea€gJ;l erE'i.g
c
.........""'l"'e.on._ .cannn+
<:::::&:Irup as
~.i..a.A-..Q-f---t.-ae--ost3te of Seett Emerson-;-- t:f:Cl"l, ':;"l~ LLa.L e.,,-.:::;;uL, I
appe-i-fl:t--m-~.:l:-.dcal;ll3hter, Kol1y Smersar_1 -"he sLall eA<;;;J..\....";',so;:: all .crf-
+-1-\&:1 <:::::::::.mA pnwpr.c:::.
ITEN IV:
I nominate, constitute and appoint my son, Craig S.
Emerson, as Executor of this my Last Will & Testament. No fiduciary
acting hereunder shall be required to post bond or enter security in
any jurisdiction.
IN WITNESS WHEREOF, I have set my hand and seal to this my Last
Will & Testament consisting of this and two other pages this M
day of < <;f?/'i7k"[3~ . 1989.
~f'~~;
Betty Emerson
We, the undersigned, hereby certify that the foregoing Will was
signed 1 sealed, published and declared by the abovenarned Testatrix
as and for her Last i<"Hll & 'l'estament r in the presence of us, \iho, at
her request and in her presence and in the day and year above
- 2 -
wri.ttei1, have 3ig~2d tJelo\: z:.s \litnesses; ~nd we certify, that the
ti:ne 8: e1:ec'.J.ticn t:-tereof, said Testatrix \.,fas of sound and disposing
mind a:;rd memory.
Residing c.t i-j.;U,S D UJd&>~,Q'r..1
. ii ~ ,. . Ii~ . 11
VC,jr.nL A J"'-J ! re.-.
Residing at 11/ c91d P, c'nll 0 R I2cl-
~ Al ""fl '1Jl..lQ., Po.)
. B'
,JA Illff)n, .u../I/..
~o:tu~~ CO. Quw
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CCITL'TlOnWe<3~t.~... 0i.. re:-ll.Sil.',,-;;;'l1ia:
S8
COUNTY OF CU~BERLAND
~~e I Bet ty Emerson I Ie -re- , and
~~"(~C(4 A.. /~/v<o estatrix and the vlitnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testatrix signed and executed the instru-
ment as her Last Will and that she signed willingly, and that she
executed as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix, signed the Will as witnesses and that to
the best of their knowledge, the Testatrix was at the time eighteen
(18) years of age or older, of sound mind, and under no const~aint
O~ u~due influence.
~n C'~
: _ tn. j)N'~(
fcdJu rill , a, liUbU)
Sworn to and subscribed before me
this OC day of ,)~h^k.r, 1989.
/;7../7/ ~' /CJ
~~--k;< CU1:~
/' ' Notary Public
I NOTl\FU,\l SEAL
~1r.I4M~'" A ,.....101'\ klr'lT ~o\' 0' 1m I...
My Con~i$sion Expires:
/"MRRIS6lJtiG. DAUPHIN COON rr
MY COMMISSiON EXPIRES DEC. 28. 1992
Ml'mDer. Pennsylvania Association of NcJarics
04(~8/2005 13:11 7176977065
ACSHEEL Y
PAGE 01
COpy FAIR
IAST WILL & TESTAMENT
BETTY EMERSON
I. BETIY EMERSON, of 501 Wood Street, Harrisburg
(Susquehanna Township, Dauphin County), Pennsylvania. being of sound
and disposing mind, memory and understanding, do hereby make, publish
and declare this to be my Last Will and Testament, hereby revoking and
making void any and all prior wills, codicils, writings thereto. by mc at any
tinle heretofore made.
ITEM I: I bequeath the sum of $5,000.00 to each of my
__. I",
grandchildren, Kelly Emerson of Madison, WI, and Scott Emerson. of
\ 0 I N. 2\ st St, Camp Hill, PA. Nothing herein shall be constmed as to
deny my grandchildren their full shares of my IRA account as stipulated in
the beneficiaries provision on the said IRA account:
illMJ.I: All the rest, residue and remainder of my estate \ give,
de-.lse, bequeath tllltO my son, Craig S. Emerson of North Myrtle Beach,
SC. In the event my son does not survive me by at least 30 days. then, in
that event I give, devise and bequeath all the rest, residue and remainder
of my estate to my grandchildren Scott and Kelly Emerson to be divid/'d
equally between them.
ITEM III: Del/'te.
,
ITEM1Y: Inolllinate, constitute and appoint IlIV SOI1, Craig S.
ll1<'rson as Executor of this lllV Last \,yill & Test;nnent. "'ofiduci:lr\'
acting hereunder shall he required to post bond or enter securi!\' ill ;\11\'
j\lri....dictioIL
I'" WITNESS WHEREOF, I have hereunto sct m\' hand and ""i! to
this. nl\' Last \,yill ;1I1d Testalllcnt consisting of this and 1\\'0 othn "a,I;"s
"II his 1st dav of September, I ')H').
BETTY EMERSON
\Yt'. tht' II1HIt:'Tsignt'd, Ilt'rt'hv Cl'flifv tllat the foregoing \Vill \\";1\ ...igl1td
;..\ "lied. ]'lIhlished ;m,~ declared bv the ahovl->.n:lllled T"statri, ;1." ;11](1 (or 11('1 il:-;
\\ iil .",- rl'st:ll1H>llL ill thl' prt'scncl'" of liS. ",ho, at her rl'qlll'st all ill her pn....ITc,
:llHI ill 1 ht' da\' and \Tar :1hovt" writtcll, ha\'t' signed helow :IS \\'itlll'SSt'\. ; lId 1\1"
t",Tlit\, 11ut the tilllt"~)f executioJl rhtTl'of, said Tcstarri~ WilS 01 sound ;:1111
di\1,()\il1:~ Illilld alld ll\t'lllOrv.
Sai], \1. Dielel
Rc:.;iding at 125) D. '\\'jJJi_d!ll~J}llrg Dri':l'
t-I.:IJTjsJ~tlrgJI) A
P:il 'ili:l ;\ C:lilJ)
Resiclillg:!r !_I_J)](IJ:JJ)!.lr.tl__H__~!
Ca III Jl UiU"J'!\
:z
\
C()\ I \I()~WEAI.TH OF PENNSYLVANIA
SS
('()~ NT)' OF U!MB;:RLAND
\V\' Bdl\' EllltTSOll, ~alt~:_i\L Pjl,tt'l,and r_;Hx.id;J_6_,---c.~;ljr() 111(' "ft'....,LlI ri\
:ll\(1 tilt, \\'itJlL'SSt'S. respectivd:', whOSt' namt"s art" sigIled to tht" :lll;lCllt'd (1]
(IJII P,r)ill.~~ instrument, being first clulv sworn, do ht'rt'hv declare \0 ,l1t' llltki"i\~ll('Ll
;\\1111(I)"i\\'lh:lt wt' \H'TC present and saw the Testatri:x, Sigllt"d alld t'\CC\ll(>d Iht'
ill"lnlllll'lll as IltT Last \VilI alld thai she willingl:', and that she C\l,Ctltt',1 :1\ i~t'l 11t'('
:111\1 \'IJIII1\l:irv act for the purposes therein t"xprt'sscd, alld that t':l\:h or Ihl' ".jllll'....\-
l"'I. ill llll' prt'St"IlCt. ;ll'd Iwaring of the Tl~statri:\, SiglH'd th(~ \\'ill :\S \'"jlllr'......,.". :llld
tll;t! Il) lh, hest ollht'ir kllo\\'l~dge the Tt'statrix \\'.1S al that tilll\"' t'iglll,.'(']I \'l':lr... III
;l,\~t' I \1' I dtkr. of SOUlld mind :-Ind 1I1Hlt-r no c01\straint or U1Hlllt' illf!\lVlll',',
8-t.!.lY.L EUWl'SOIl "",,-
<;;)Iki\.t .Dind
Pat rL~:j.!L.!..\'_ S;-:iJiUl~_
S\\,( lrJl alld sldy;cribed hefore Illl'.
t 1\'1" i \t da\' Septt'lllber, I ()S<J,
Ri, It:lnl i\ (~~linl
\':'ll:11'\, Pllhlk
\1\ I "lit,j','-I<'11 ["pin's:
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL fAXES
DEPT. 280601
HARRISBURG, PA 17'128.0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
EMERSON CRAIG S
914 R HILLSIDE DRIVE S
NORTH MYRTLE BEACH, SC 29582
-.------ lold
EST A TE INFORMATION: SSN: 200-22-5960
FILE NUMBER: 2105-0332
DECEDENT NAME: EMERSON BETTY
DATE OF PAYMENT: 06/27/2005
POSTMARK DATE: 06/27/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 03/29/2005
NO. CD 005485
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,138.50
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$6,138.50
REMARKS: EMERSON CRAIG S
CHECK# 1019
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS