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CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CWUSER ROAD
Corner of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991 )
TELEPHONE (717) 766-0209
FAX (717) 795-7473
October 6, 2005\
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, P A 17013
Re: Estate of Kathryn M. Marburger
No. 21-05-00114
Dear Register of Wills:
Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Kathryn N1.
Marburger Estate as well as Check No. 156, in the amount of $2,769.48 for Inheritance Tax dl,le,
Check No. 157, in the amount of $90.00 for Additional Probate and Check No. 158 in the
amount of $15.00 for the filing fee.
Thank you for your kind attention to this matter.
Very truly yours,
~
Charles E. Shields, III
Attorney-At-Law
CES/mjj
Enclosures
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~OMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
M A If 'B u I? r; E ,€ K /1 TN ~ 'y N
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DATE OF DEATH (MM-DD-YEAR)
t7/- 27- d?CI?S
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DATE OF BIRTH (MM-DD-YEAR)
() 7 - 04 - /1/ t>
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
FIRM NAME (If Applicable)
TELEPHONE NUMBER
7/7- 76~ ,.. 192.09
OFFICIAL U~ ONLY
FILE NUMBER
:2.. / - CJ .s-
~ N~BER" -L ~
COUNTY CODE YEAR
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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 D)
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)
SOCIAL SECURITY NUMBER
/7 l/ - 09
THIS RETURN MUST BE FILED I DUPLICATE WITH THE
REGISTER WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (d t~ of death prior 10 12-13-82)
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o 5. Federal Estate Tax R turn Required
o 8. Total Number of Saf ~eposit Boxes
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o 11. Election to tax unde ~ec. 9113(A) (Attach Sch 0)
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()1ECH/fNICSBU~G,
(1)
(2)
(3)
(4)
(5)
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(8)
(11)
(12)
(13)
(14)
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(7)
(9)
(10)
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13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax f)
rate, or transfers under Sec. 9116 (a)(1.2) I' S-tJ/1 S'l~.IJO x .0 tL.- (15)
16. Amount of Line 14 taxable at lineal rate x.O~ (16)
() X .12
17. Amount of Line 14 taxable at sibling rate (17)
0 x .15 (18)
1 B. Amount of Line 14 taxable at collateral rate
19. Tax Due (19)
20.0
CHECK --lERE ,F "OU ARE ~EQUESTJNG .:\ REFUND JF AN 'JVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS .:2/ P t9/G SI'Il//I/C- ;(1).
CITY /P€UlJ//~l.€ I STATE ~/I I ZIP 17~~1
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
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Jr. t! / O. DO
f. 'Cf 'I p, DO
Total Credits ( A + 8 + C )
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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Total Interest/Penalty ( 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 request a refund (4)
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.
10
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5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5)
'f-:l., 7~ 1; (j P
A. Enter the interest on the tax due.
(5A)
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8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves
a. retain the use or income of the property transferred; .......................................................................................... D
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? . ............. ........................... ......................... ....... ............................................... 1XI
No
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DATE
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CAli. LISLe , Ill- /7P/3
N. REPRESENTATIVE
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ADDRESS SH I eLl>!; 11l
(g CLOU6ER nU;(!,HANI C5 BUR-G.) fJA /7055'
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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 P.S. 99116 (a) (1.1) (i)].
DATE
/0 05
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 exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 PS. 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.
, ~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDivIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162iEX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BIEGA DIANE L
8 LIME KILN ROAD
CARLISLE, PA 17013
nn_n_ fold
ESTATE INFORMATION: SSN: 174-09-6459
FILE NUMBER: 2105-0114
DECEDENT NAME: MARBURGER KATHRYN M
DATE OF PAYMENT: 04/22/2005
POSTMARK DATE: 04/22/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 01/28/2005
TOTAL AMOUNT P
REMARKS: D L BIEGA
CHECK# 1655
SEAL
INITIALS: VZ
RECEIVED BY:
TAXPAYER
NO. CD 005237
ACN
ASSESSMENT
CONTROL
NUMBER
AMOU~T
I
101 I $18,81C 00
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AID: $18,81C 00
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GLENDA FARNER STRASBA GH
REGISTER OF WILLS :
.
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Ro.'"V-1&l6EX' {19Z1
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~/-o~- 11t.J
,
ESTATE OF
M!t~ BUt< 6-t=~ J J<A rHl<.yN /11.
I
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 d,~closed on Schedule F.
ITEM I NALUEAT DATE
NUMBER DESCRIPTION I' OF DEATH
1.
F ~ IYJ Trll5f of
e t1fo,do-tn b IA ra '.
~tS8S. IS
I,
I' P
I , OU
,II
~ I J 9S9./~
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,
I,
,00
~.
,4. ellte/(,', A-r!tf: 3l/-0 ~!{;;,
13 . 7:17 t: /I-~c r. ~ d. 1:), d. b" /f.
e!. Sav:/1fS !fee..f: 70- 7L16~4
]). I/If. A-ccr. ~ q.o. d. D" C.
(see Ofh'c/al J/rt/J,foh'o" ~f ;-"'{1J1 7Yu.st <lzuhed)
+f-RHI,f pI /l~rsoflu/fy be/~/1?I"J t; ~ececl~nt
(see /fem/zetl /11 venkry slJ~~t I/'tlzu.kd here;;)
r(e!-u.ntl frPH/ cfItN,/m }/ett /~ Center
~
-;? S :1. SlJ
3.
~393.39
TOTAL (Also enter on line 5, Recapitulation) $ to /i, I 'I (), z. 7
(If more space is needed, insert additional sheets of the same size)
ow .fmtrustmtlhm.com
TRUST
April 6,2005
Charles E. Shields, III
Attorney at Law
6 Clouser Rd.
Mechanicsburg PA 17055
RE: Kathrvn M. Marburqer
Mr. Shields:
In reference to the above customer, our records show the enclosed information to be
accurate as of January 28, 2005. Our researching fee for the information we have
provided is .$ 15.00. Please send your remittance to the following address:
Farmers and Merchants Trust Company
A TIN Karen Davis
20 South Main Street
Chambersburg, PA 17201-0819
If I may be of any further assistance, please contact me.
Sincerely,
-<~tU e ~rD
Karen E. Davis
Deposit Operations Manager
717-264-6116 888-264-6116 P.O. Box 6010 Chambersburg, PA 17201-6010
FIN A NC I A L SOL U TI 0 N S ... FRO M P EO.p L E YO U KNOW
RE: Kathrvn M Marburqer
DATE OF DEATH 01/28/05
ACCOUNT INFORMATION
X CHECKING
SAVINGS
,
,
II
____CERTIFICATE OF DEP~SIT
SAFE DEPOSIT
SHARES OF STOCK
DATE OPENED 11/22/00
DATE CLOSED
still open
ACCOUNT NUMBER
34-03351
ACCOUNT BALANCE AT DATE OF DEATH
$ 6,585.15
ACCRUED INTEREST
$
0.08
TOTAL ACCOUNT BALANCE
$ 6,585.23
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NAME(S) ON ACCOUNT
Kathrvn M. Marburqer
REGISTRATION OF ACCOUNT
I'
II
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ti-
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Individual
ACCOUNT INFORMATION
CHECKING
X SAVINGS
___CERTIFICATE OF DEP~SIT
SAFE DEPOSIT
SHARES OF STOCK
DATE OPENED
11/22/00
DATE CLOSED
Still open
ACCOUNT NUMBER
70-74654
ACCOUNT BALANCE AT DATE OF DEATH
$ 61,959.15
h-
ACCRUED INTEREST
$
0.00
TOTAL ACCOUNT BALANCE $ 61,959.15
NAME(S) ON ACCOUNT Kathrvn M. Marburqer
REGISTRATION OF ACCOUNT Individual
Schedule E
Items of Personalty
Kathryn M. Marburger
,
Items beloneine to Kathrvn M. Marburee'r at Green Ridee Villaee
Bedroom set (exclusive of single bed) consisting of dresser,
Mirror, chest of drawers and nightstand
Single bed with flowered comforter and pillow sham - sold
. Glider rocking chair and foot rest
Floor lamp .
Small roll top desk with three drawers
Burgundy colored recliner chair
Walker
3 Wheeled walker - sold
Scratched up' small round end table
Table lamp
10 year old television and TV stand
Shower chair (handicapped type )
Small cassette player and box of old tapes
Small box of personal items - toothpaste, tissues, soap, etc. - no value
Box of old photos from Kay's life - given to Diane and 2 granddaughters - no value
10 year old VCR
Swivel floor lamp
$ 85.00
25.00
10.00
2.50
20.00
50.00
5.00
20.00
5.00
2.00
10.00
10;00
1.00
TOTAL
2.00
5.00
$25250
NOTE: Decedent had given away much of her personalty befor~ entering home:
C.J
+ + + + + + + + + + + + + + *
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o C) 0 0 :::J C) '::J ':::l '::J .:J '::J '::J C::::l 0 .:::J ':::l
<:) <:) <:) 0 If\O <:) 0 C) 0 0 0 0 0 0 0 '1\
G 0 & 0
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.^ '.1"\ 0 ('J 0 0 c!\ (.:::l '^ N 0 C)
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Page 1
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REV-1509 EX .[1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF /JJ A
'f"R 13 u I? C i:7e,
KII TN/lyAJ nt.
FILE NUMBER
, I
;l/-~s--//'1
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If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RE T10NSHIP TO DECEDENT
A. DllfNc L. 8/~6A
g /../M€ /</I.../IJ tZbA-D
eltlll.ISLE, PI! /1013
D "u 6-H-rf:7(
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE DESCRIPTION OF PROPERTY
MADE Include name of financial institution and bank account number or similar identifying number. Attach
JOINT deed for jointiy-held real estate.
DATE OF DEATH
VALUE OF ASSET
0/0 OF
DECO'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1.
A.
11/17/1'7 ernzeJs" INt. 5TIJC~ CEI~TIFICA-TE N~.
/02 S"'" 15SuEf) All)!/. /7, 1997 fi;/2 I, 38'1
.5I1H/lES {)r u-P/rAl S-rPeK.
1175/6 (!/7IZeNS, /Nl!. 571NJI< t!Ea'17FlcATe No.
//,5>3 ISSt(E;1:) S/FPT. ZS". 2L';t:>3 ~,t;Z. If
,
SNA.IUf$ oF" eA/'lr,;fL .s~CI<
2.
,4..
~
l).{)..D. vlrL./J.€ of SfI/I./lES LcJ.I!-s $5: "I)
fJC7f .sN/f~E /Is PE~ J/A-LU A-T/t?/1/
Pr<OV/J)(;.n 'By SU..sA-N /l)P/~J<,.sECIlG7l1RY $18K,J1S.00 .5V4
139/f tJ87.SD
I
(}ALelfL.ATlP/l/: 7OrAt.. Sk"f~ :: 1,3'5
.,.
l,3CCS ~ 5fo5.00 0::: 1-1ggJ /15".00
3.
A-.
~11'I1'3 CITIZEIV's NA-r. 8U"- ~cr. Lf~81qB
(SEE NoTIt=. LtF7781 IJ..r7ItCHEb)
t: 10, "'40.'10 .,sz,?"
,
.s; OZO.oS-
tf,
A-.
j/,/lIft CITIZE/IJ$ AlAr. BIWI< .+-eeT. '31(.107
(SEE /roT/P. LE77C7< A-777f(!H~)
~
10, 77Q. srt 5t1.?,
, 5"~ 389. f-o
TOTAL (Also enter on line 6, Recapitulation) $ '10 ~ 1f"1. 35
(If more space is needed, insert additional sheets of the same size)
,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
BUREAU OF INDivIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 P5-0114
ACN 05 ~2567
DATE 09 '1-2a05
REV-1545 EX AFP (09-001
DIANE L BIEGA
8 LIMEKILN RD
CARLISLE PA 17013
TYPE F ACCOUNT
EST. OF KATHRYN M MARBURGER 0 SAVINGS
S.S. NO. 174-09-6459 DCHECKING
DATE OF DEATH 01-28-2005 ~ 0 TRUST
COUNTY CUMBERLAND IX] CERTIF.
REMIT PAYMENT AND FO~ S TO:
REGISTER OF WILLS I
CUMBERLAND CO COURT HrUSE
CARLISLE, PA 17013 I
,
,
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CITIZENS NATIONAL BANK has p..ovided the Depa..tment with the info..mation listed below which has been used I
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../b eficia..y of
this account. If you feel this info..mation is inco....ect, please obtain w..itten co....ection f..o. the financial institution, a ch a copy
to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of th Co..onwealth
of PennsYlvania. Questions may be answe..ed by calling (717) 7B7-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTI S
Account No. 488198 Date 09-14-1993
EstBblished
",ccount Balance
Percent TaxBble
Anount Subject to
Tax Rate
Potential Tax Due
x
10,040.09
50.000
5,020.05
.15
753.01
TAXPAYER RESPONSE
To insu..e p..ope.. c..edit to you.. acco
(2) copies of this notice must acco
pay.ent to the Registe.. of Wills.
peyable to: "Registe.. of Wills, Agen
x
NOTE: If tax pay.ants a..e Bede withi th..ee
(3) months of the decedent's date of .ath,
you AY deduct a 57. discount of the x due.
Any inhe..itance tax due will beco.. linquent
nine (9) months afte.. the data of de
Tax
PART
ill
A. 0 The above info...ation and tax due is co....ect.
1. You may choose to "&Bit pay.ent to the Registe.. of Wills with two copies of this notice
a discount 0.. avoid int....st, 0.. you ..y check box "A" and ...turn this notice to the R.gi
Wills and an official assesSBent will be issued by the PA Depa..tment of Revenue.
B. ~ The above asset has basn 0.. will be ...po..ted and tax paid with th. P.nnsylvania Inhe..itance
~to b. filed by the d.ced.nt's ..ep...ssntative.
C. 0 The above info..mation is inco....ect and/o.. debts and deductions we... paid by you.
You must coeplet. PART 0 and/o.. PART ~ below.
..etu..n
[CHECK ]
ONE
BLOCK
ONLY
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Anount Subject to Tax
5. Debts and Deductions
&. A.ount TaxBble
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
&
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOLl T PAID
TOTAL (Enter on Line- 5 of T_ CoII(Iutationl
$
Under ~tie. of perjury, I decl..... that the facts I h_ reported above are true, correct: and
ez::;;;r ;/l:o/}~~ ;;;;:AZ :let.
TAXPAYER SIGC~ 'Y" -;r J
.
~u..MONWEALTH OF PENNSYLVANIA
DEPARTMENT OF. REVENUE,
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 105-0114
ACN 05l~2566
DATE 09Hol-2005
TYPE! IOF ACCOUNT
EST. OF KATHRYN M MARBURGER I 0 SAVINGS
S. S. NO. 174- 09-6459 [X] CHECKING
DATE OF DEATH 01-28-2005 0 TRUST
COUNTY CUMBERLAND D CERTIF.
REMIT PAYMENT AND FO~S TO:
REGISTER OF WILLS 1 !
CUMBERLAND CO COURT ~bUSE
CARLISLE, PA 17013 !I
REV-1543 EX AFP lO9-00)
DIANE L BIEGA
8 LIMEKILN RD
CARLISLE PA 17013
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CITIZENS NATIONAL BANK has provided the Department with the inforllation listed below which has been used I ~n
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/~~neficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, 1tach a copy
to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of t , Comllonwealth
of Pennsylvania. Questions lIay be answered by calling (717) 787-8327. !
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCT
Account No. 316707 Date 03-01-1968
Established
NS
\Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
10,779.59
50.000
5,389.80
.15
808.47
TAXPAYER RESPONSE
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To insure proper credit to your ac nt, two
(2) copies of this notice IIUSt acc any your
paYllent to the Register of Wills. ke check
payable to: "Register of Wills, Ag tn.
NOTE: If tax payments are made wi~in three
(3) 1I0nths of the decedent's date death,
you lIay deduct a 57. discount of th tax due.
Any inheritance tax due will becolI elinquent
nine (9) 1I0nths after the date of tho
Tax
x
PART
IT]
[J The above information and tax due is correct. ~'
1. You may choose to rellit paYllent to the Register of Wills with two copies of this notice ~o obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Re ~ster of
Wills and an official assesSllent will be issued by the PA Department of Revenue. ; ,
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B. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritancel~ax return
to be filed by the decedent's representative.
[CHECK ]
ONE
BLOCK
ONLY
C. [J The above information is incorrect and/or debts and deductions were paid by you.
You lIust cOllplete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1, Date Established
2. Account Balance
3. Percent Taxable
4. A.ount Subject to Tax
5. Debts and Deductions
6. A.ount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
x
PART
[!]
DATE PAID
PAYEE
DESCRIPTION
AMd NT PAID
TOTAL (Enter on Line 5 of Tax COIIPUtationJ
$
of perjury, I declare that the
f .y knOWledge and belief.
/If
facts I have reported above are true, correc!~ and
)
( 7/7 ) 766-19 My
PHONE NUMBER
(
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REV-1510 EX. (1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF /Jf~/?,(JtI/16l:-7f, }(,4r#~J//f/ /1/.
FILE NUMBER
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02/- 4,5"
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This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSIC TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IF APPLICABL
1. AI/st~ Ad,VMl1Q~ ,4l\nlA.,'rM GA 1\ 3121 pu- t-- 100% f
yO) 1~7. 8f -0- 4b} 7 ~7. gE'
Ails-tall LI'Je ~ s u.rf.cM.t.t Co, t>~ Pa.l a..h'rt e) Ill,
l:w.1o rwte.: GIUlbt"'f)D~ (..;-t~ ,4.MI~ Ann~ ~
wa.s Ct part of ~ ~lI~rali ~lIf')
alfods
(see otf;c,'o-I va,ILla h OVl f,--om A-lIs f-~
ed l1ereb).
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TOTAL (Also enteron line 7, Recapitulation) $ it)) 17'67, 9"8'
(If more space is needed, insert additional sheets of the same size)
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Life and Annuity Claims
P.O. Box 94212
Palatine,IL 60094-4212
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,..v-<:.J "", " ;;,
Allstat~.
You're in good hands.!
March 29, 2005
Charles E. Shields, ill - Attorney at Law
6 Clouser Road
Comer ofTrindle & Clouser Roads
Mechanicsburg, P A 17055
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Re:
Administrator for:
Contract No:
Claimant(s):
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Dear Mr. Shields: Ii
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We have been requested to complete futernal Revenue Service (IRS) Form 712 with regard to the ' '
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referenced contract. i I,
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The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract 4*
with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contral4t).
The contract referenced was an annuity contract, which is not reportable on IRS form 712. i!
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The following information is provided regarding the value of the annuity and other data as of the dat~\
specified: i i
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Kathryn M. Marburger
Allstate Life fusurance Company
GAI13121
Diane Lee Biega
Date of Death: January 28,2005
Annuity Value* as of Date of Death: $ 40,787.88
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Cost Basis: $ 40,201.10
Named Beneficiary: Diane Lee Biega
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*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrendw
Charges. ! i
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If you have any questions, or need further assistance, please contact the Customer Care Unit at 1-877-499~
6418. I
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Sincerely,
Life and Annuity Claims
kmr
Overnight Address: 544 Lakeview Parkway, Vernon Hills, IL 60061
Toll Free Fax: 1-866-635-4523
~"".."," ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
II
EST ATE OF
..2-/-lbs- CJ//~
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FILE NUMBER
/J1AI(I?JUI?GE~ KATHI<Yf\I /YI.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
.1.
3.
~.
5.
B.
1.
\
2.
3.
4.
5.
6.
7.
$.
q.
10.
II,
DESCRIPTION
FUNERAL EXPENSES:
;J-aer Cremcth'on ~rv; Ge...5
HOIJ~rar;t(111 Ii Ik oS ~r Se../6e;/cI
Gre.e.nrJ'dfr me-mor;a-I ~r ga-H1eri~ af ~;ly ~ fr,'r:...f/d~.
f./ fUJ O/" 111';1( HI 10 /J1. nOn! bo f{ , Sf /e-te y; () ryan / s t
flpI1Prtlr/~11? ti fJa.sfor Daile Saffor.l 5t. Pe-f~
ADMINISTRATIVE COSTS: (see ~P/J;' /1ua h 011 f,f, tt...tf1I~ c1)
Personal Representative's Commissions
Name of Personal Representative (s) D I If- NE L. 13/ E: G A-
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 8' LIAfE KILN ~j).
City () If /l. LIS L G State jJ A
Zip
/71J l3
AMOUNT
Year(s) Commission Paid:
AttomeyFees CN.II-Ilte:s E. cSHIE~.s ff
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant /V~NE
Street Address
City
Relationship of Claimant to Decedent
State
Zip
.1
~f. / ~O.IJO
~7 S.I)()
C',,3 7. rb
~
SO.OO
!l'
~- ~.o()
~IVeoD
Probate Fees OAt! ori3;1\1l1 '1:).sIA.~ of short certi6'cA.ru-
Accountant's Fees \.- .
-_J n\lH~-r.sol\lS TA-Y 5ettvlCf= of CA-iI2.LlsLE'
TaxRetumPreparer'sFees '"P~ of 1040, PA l.\D, ~S/. 1041, PA 4-1 , e;tc,. (e~f)It).)
,4t1verti.sin; ;~
A-drerf/.s/(J ;"
~ e.; IW\ b '^-t'S ement
~ Cumwlcurrl taw Jbut'nal
~ {lllr//Sk cfUJf;ne/ Alet#Jf7Aper
~ O,lLr1eS E. S~~l,ld~ tor fu @tW1
,
ro Ff.M Trws
iqJ 385.00
iA!I?NE;'
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13.
It ~..t ; +" 0 11 (1.,\ So ho rt c ert; -h'c.o..+c $
A- J.J.: +itH'lo-l iPro6..fe fee
Gst (rt {.'/"Yl8 :r ...he.ritMLa. 7o..~ Re.tu.rYl
"1?e.i IY\ b LtV'se.me.nts 1:l. C:hlLrl~~ (;. 5h,'e)d~ IE)
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
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.! qq.OO
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~ !~ 5.5. 00
: I
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'i 7S.00
, 1
I'i
~il/.s. 2~
!, I '; S'. 1)0
11 ;l.00
9~ . tJO
s-. 80
: I
$ t~, 8~f,~
Sheet1
1:~~te_ExpensesJ~r 1i~!l!ryl'l_~_~rll!J,"-g~r,_~Q9~___________ - - - - - -i __ __
fle~:t'r:~::~~ Services H_ Hba~~J-~s-'- C~~N~P -tf~b~~6i~=+~e~~~'i~<jt~::~__--=
-_pasto-r SeibQlcL'Feb-04-0S-- --:15-93- I---=:-E~~QQI----- Jg~I1_c;h_~___ :i~----
-~!~~~~~~~l;~~~ j~iiI~ ;~:~ ... . ~~ii- ......--~]~t~ijl-==:=--
Evans City Cemetery ,A.SSOC ,JApr 08 05 1646 ~t~Q_.Q9J ____9.9n Chk__'_I' i- ___
Kills~Y~YQ~Funeral Hm EVCYApr 0805 1647 $52500, Receipt.
~~:~f3;~~~~r~~,~~~i~~(;~r~Ch~~; ~~ ~~ Ds~:~rdff~~~~::t~f~~t=I=-_
Flower Vases _J.Apr 0605 ,_Q~~v!.Cr(t __~?..Q~_ _____lRec;El,ipt ---JJ-------
Graveside Flowers n!~pr O?_O~_, J)~(~\~_r...9rd _ j12.9-5i--- ~=~!R.~~~p.t-=_~~__~--- ~~_
-- ___?lJll_T~t~IJ _________$?-'_3!}~_~90L__________________, ,11--
Ira_v~-, E~pen.~~s._ .. I I ! i
_Mjl~_'3.9.eJr_~y'~I~(J -- ---------T700 MilesT--- ---$210~ooi----------Tnone----i-i !--
-- -- --- --- - - ____1______ --- ___ __. ____ __ - _______,-,+____
_Jl!rl1.pLk~.IolIs__ ____m__. __ Apr g~_05 L _ ---.f~~_.I-- $10.!5_Q~_ _ __-B~ceipL__ jj_____ __
.lLJrIlJ)i~eTQIIs.__ __ .___ __r,APr.1005J.___ 9'!~!1____ _~JO.50!_ !Receipt -..J____
~:::: ----- - ---- --.. ___It-P-,"-Q.5 g_5__._ __Casll_ _+ _ _ $8.1L. _ _ __ _~ne ~---I-i ________
-- -.. --. -. --. !A~r06.Q5 1- c:as~. $36.5&1_. n 1~"Cei~L+i I
~::;_ ~~- ~- -=--_ - i~;~~ ~~=-l~~ ___ _=-~~~1~ ., ~:~: . q.-:-u_
--.----- =-----~- ~u~Total L=-__~- ,~~=~.:.- $3~7.32 !___ ! _ HI-~
Total $2727.221 1
-+ ~. r: ,',.-r.L /'
)lA~..e./)' .- r~~<,t;i~. i ." f1,1 ~; <'0.
Page 1
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! EST. f)j::" /J1/f1( 6Ut2Gt:7<) !(/l7?-//2Y/!/ At.
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b'i Ej/dIlS edp . (ilJ1tftIJ . /!-s/!. .
7, ! . K/115o/ ~Ji;/z Et(h~rtl/ &A1e ~I EYCHIJ .~..
0. j Sf. hteri Lu IMrrtll C/;t(;yJ, ~ kmt:ra/ L U J1cJ,
1- I 7k. (;//1 &$J'el or d!l;;,nqak ~r. J=/owen"
jl). i . j:=;blf/er/k fL'S
. If, [ Gr~e.$/~n.m~~
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/~. J . ;::Ull~ftl! IJ!~/.r.
j~ L.@I{l'Qr-ec.i.KX@lr/x.ft.,t: ~Mrl!l~f2eI"j/,'.[/~~ ctd l)J!er
. Le.s k1eri_ re./Cl/e,P{ A'L4/h0f. ~.}o'5f~/;6.,x- .7t:J{) ml'/~S ... . =:
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I'/. L 7<</'/l~},A-.~.. .7"14- .Ir!~m&IJ~/yJiu~~bv.1.:::7el!4/r/x
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:2/-0$ -Of/if
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:4s ZS: ()/)
po
;200. "0
"r
/ :17.>>
~ 8': 09
~2. oS
~" ..32
2 /0. t'Jt:)
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2/.00
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REV-1512 EX' (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
K A iff I!.Y N /J1.
FILE NUMBER
2-/-tlW - /1 r
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF /J1 /Iff 13 U I( G Eft?"
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ITEM \
NUMBER DESCRIPTION AMOUNT
1. HltlA p~Y.5/c;atU" 55. 76
~. 1)..-. "D~ ~~ft.r'" 7if
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TOTAL (Also enter on line 10, Recapitulation) $ fliP. SO
Include unreimbursed medical expenses
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
/J14~GtlR6m, K/lT#"(f'/I/ /7/.
FILE NUMBER
2./ - ! s- - //'1
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NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMlbuNT OR SHARE
I OF ESTATE
1. 12ot31f1/ AAlAlF SC~€t€
/620 #/,p~~.er 2>/CIJI'G"
1J1€{!H/lA//Cs.8u/t6" /-1- /7~.sv
G/lANbbA-U(;H Te7€!.
;,.
..... t)tJt).oo
:;(. ~€/Y€c ])//!A/€ GE/tiNG
~o 3 .!=/UJS T R. O.A- D
r;.H/ltJNEI(~,,f7/1 /7.32..t{.
G.ef.AlADA-UGJ.lT~
:?,I
~ ~a-I "0
,
3. ])/111'11: L. 8/E'6A
\ 8 LI/nE KILN ~]).
C;fI<.L../SL~ / P/I /7tJ/3
DAlIGHTt::?(
j(E. IbuG"
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 11500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
,
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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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)
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LAST WILL AND TESTAMENT OF KATHRYN M. MARBURGER
I, KATHRYN M. MARBURGER, single woman, of Green Ridge Village,
Newville,Cumberland County, Pennsylvania, being of sound and disposing mind, memory and I
understanding, do make, publish aod declare tbis my Last Will and Testament, bereby revoking Ifd
making void any and all prior Wills by me at any time heretofore made. I
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease ~s the
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same can conveniently be done. I
2.
I give, devise and bequeath my Estate as follows:
B.
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Five Thousand and No/IOO ($5,000.00) Dollars to- my granddaughter, ROBIN rNE
SCAER. . I
Five Thousand and No/IOO ($5,000.00) Dollars to my granddaughter, RENEE ~~
GElLING. .
A.
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All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever ~td
wheresoever situate, I give, devise and bequeath to my beloved daughter, DIANE L. BIEGA, to ~er
own use and benefit absolutely.
4.
In the event my said daughter, Diane L. Biega, should predecease me, I hereby direct alllthe
rcst, residue and remainder of my Estate to be distributed my said granddaughters, Robin Anne S: er
and Renee Diane Geiling, in equal shares, per stirpes. (As used herein, PM ~, shall mean nat
issue of the whole blood only and shall not extend to step or adopted children).
5.
I nominate, constitute and appoint my daughter, DIANE L. BIEGA, as Executrix of this my
Last Will and Testament. In the event that she should predecease me or for any reason be unwilling
or unable to act as such Executrix, I nominate, constitute and appoint my son-in-law, WILLIA
BIEGA, to be the Executor ir her place and stead. In the event that William 1. Biega, should fo
reason, be unwilling or unable to act as such Executor, I nominate, constitute and appoint CITI
NA TIONAL BANK OF EVANS CITY as my Executor in his place and stead. I further direct t
v j -J..1 . '7-1 r .. ;J /
^,-l/i U[)~ 711, / J1~ f~
6.
they shall not be required to file bond or other security in the Office of the Register of Wills f~ the
purpose of administering my Estate.
In addition to the powers conferred by law, my Executrix or Executor shall have the
following discretionary powers:
A. To retain as part of my Estate any property received hereunder, without any duty ~f
di versification.
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B. To invest and reinvest the principal of my Estate in stocks, bonds, mortgages, sec~ ities
or other property, real or personal, without being limited to the classes of securities or
investments in which fiduciaries are by law authorized to invest funds.
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C. To sell, exchange, lease, encumber, option or otherwise dispose of all or any portiq...tOf
my Estate, real or personal, in such manner and upon such terms and conditions as ~ all
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be deemed advisable; and to make, execute and deliver deeds, mortgages, leases, , I
assignments and oth~r documents necessary to effectuate any powers herein grante~
D. - T 0 make distribution of my Estate in kind, in cash, or partly in kind and partly in c~ h
and to this end, allocation of assets in kind shall be in the sole discretion of my Ex~ utrix
or Executor.
7.
I direct my Executrix or Executor to pay all inheritance taxes, whether Federal or Stat4:
imposed upon or with respect to my Estate, from the assets of my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this a ~ day of
--~~UJ1j.;/1~/ , A.D. 2003.
.>Z iat~J m, ~~ (5$ L)
K'ATHRY M. MARB RGE
Signed, sealed, published and declared by the above-named KATHRYN M. MARBURGJR as
and for her Last Will and Testament, in the presence of us, who at her request and in her prese,ce,
and in the presence of each other, have hereunto subscribed our names as witnesses. .1
(2h'.A." .n,2cL..t:.o- /':';3..S-M>-u.-~_-)/ 47/4'('~~ ~. /?-? V/
!tiM 11ft 1U '
_' '1M Da4 Alq
;1'(0 mountainJlew TenClce) Newville IPt.-I /721-11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
)1
REV-11162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005886
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 174-09-6459
FILE NUMBER: 2105-0114
DECEDENT NAME: MARBURGER KATHRYN M
DATE OF PAYMENT: 10/11/2005
POSTMARK DATE: 10/07/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 01/28/2005
TOTAL AMOUNT PAID:
$2,76$.48
REMARKS:
CHECK#156
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASB~I~
REGISTER OF WILLS
REGISTER OF WILLS