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HomeMy WebLinkAbout01-0020 PETITION FOR PROBATE and GRANT OF LETTERS Estate of ELEANOR C. MUSSELMAN also known as Deceased. Social Security No. 203-10-8128 ) ) ) ) ) NO. (~I- ot-GOAD TO: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania. The petition of the undersigned respectfully represents that: Your Petitioner is 18 years of age or older and the executrix named in the last will of the above decedent, dated 27 September 1991 and codicil(s) dated nla. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family ~r principal residence at 222 Messiah Circle, Mechanicsburg, Pennsylvania. ['*\~ ~\le... \~W?)~ II Decedent, then 86 years of age, died on 8 February 2006, at Holy Spirit Hospital, Camp Hilt Cumberland County, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never I adjudicated incompetent: nla Decedent at death owned property with estimated values as follows: (if domiciled in Pa.) All personal property (if not domiciled in Pa.) All personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania Situated as follows: $1.037.000.00 $ $ $ WHEREFORE, Petitioner(s) respectfully request the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary. ' Signature and residences ofPetitioner(s): , f ~ r ,,/. " / l' ,~h"7 "j/ j;k< .~:~;J-~~ ~ Deborah L. Musselman 2304 Edgewood Road Harrisburg, PAl 71 04 ,~~;:( ?2~~4- ~,~..~~ ~ fv\ls-s.Ah1~ <Tv; ft~5l-h OATH OF PERSONAL REPRESENTATIVE COMMONWEAL TH OF PENNSYLVANIA ) SSe COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent petitioner will well and truly administer the eft//rdiryo 1~~7? ..c:::, Sworn to or affiImed and subscribed ,iif~ ~ /,/;/?:d;kfb?' ~~"'-- before me this ].. L day of Deborah L. Musselman I.? / " / FCBKlA.~~~~ ' 2006. L"'\ 2304 Edgewood Road tlt~ ~;r~,~""2/~ \, I .' _, ", . '/; Harrisburg, PA 17104 1.0 ,-r;M }J lU LdAl htU\L.I\lii.Ll~J{[ L {q /~// ~1J/?-/j ( Regi~ "r)' //4 'rtlW~'~,Y-HLtR\.'f )- . l' U H IO::;;.SO:'i REV 1/0) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. Fee for this certificate. $6.00 Local Registrar P 12225651 Date Rev.01Kl6 'RINTIN ANENT :KINK 1 Name of Decedent (First, middle, lasl) COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER 3. Social Security Number '7.03 10 c;LUO(Q Cumberland East Pennsboro o Other-S ci 10, Race: American Indian, Black. White, etc. (Specilyj hite :., 11 Decedent's Usual OCcu alion Kind of work done durin most of workin lile; do not stale retired Kind of Work Kind 01 Businessllndustry homemaker own home Deceden!'s Ma~ing Address (Street, cityrtown. state. zip code) 222 Messiah Circle Mechanicsburg, PA 17055 12. hi hest radeco !eted College (1.4 or 5+) 14 Marital Status: Married, Never married. 15. Surviving Spouse (il wile, give maiden name) Widowed, Divorced (Specifyj 17b. County Did Decedent liveina 17C.)( Yes,Deceden!livedin TTpppr A 1 1 pn Townsh~? 17d 0 No, Deceaenl Lived wllhin ,4.clualLimi!sof Twp. CitylBoro 18. Father's Name (Firsl, middte, tast) 19. Mother's Name (First, middle, maiden surname) Raymond W. Sawyer, Sr. Alma Trostle Deborah L. Musselman 2Cb, tnforman['5 Mailing Address (Street, cityr'lown. stale, zip code) 2304 Edgewood Rd.Harrisburg, PA17104 lOa. Informant's Name (TypeJprint) FD 013163 L PA17043 Musselman FH&CS,324 Hummel Ave.,Lemoyne 22c. Name and Mdress of Facility 21d. Location (cpown. state, zip code) Lower hHR1.rwp 21b. Date 01 Disposition (Month, day, year) 21c. Place of Dispos~ion (Name of cemelery, crematory or other place) o ReroovalfromState o Donation Feb.11,2006 22b. License Nurrber Slate Hill Cemeter ete Items 23a-c only when certifying physK:ian is nol available at lime 01 dealh to certify cause 01 death Items 24-26 must be co~leted by person who pronounces death death occurred althe ~me, date and place slaled. (Signature and title) 23b. License NulTiler 23c. Date Signed (Monlh, day, year) : Approximaleinlef\lat. : onset to death 26 Was Case Referred to a Medica! Examiner/Coroner? o Yes )1\NO Part II: Enter other sionificant cond~ions contributina to dq!lth, bul not resulting In the underlying cause given in Part 1 28. Did Tobacco Use Contribute 10 Death? DYes 0 Probably ,..'1( No 0 UnkooWl1 29. It Femate. XNot pregnant within past year o Pregnant atUme of death o Not pregnant, but pregnant within 42 days 01 death o Not pregnant. but pregnant 43 days 10 1 year beforedealh o Unknown if pregnant within the past year 32c_ Place of Injury: Home. Farm, Street, Fac1ory, Office Building.elc, (Speci/yl 24 zD06 IMMEDIATE CAUSE (Final disease or cond~ion resulting in death) ----7 a. Sequentially list cond~ions, if any, n leatfiillg to the cause listed on Line a - Enler the UNDERLYING CAUSE _ (disease or iniury that in~iated the events resulting in death) LAST b. avcf f()L..-r Due to (orasaconsequenceo~: Due to (or as a consequence of): d. JOb. Were Autopsy Findings Performed? Ava~able Prior to Completion Yes )l No I of Cause of Death? D~ DYes DNa 33a. Certifier (check only one) Certifying physICian (Physician certifying cause of dealh.when another physician has pronounced death and COl'T'4'teled Item 23) To the best of my koowledge, death occurred due to the cause{s) and manner as stated .......'" Pronouncing and certifying physician (PhysICian both pronouncing death and certifying 10 cause 01 death) To the best of my knowledge, death occurred at the time, dale, and place, and due to the cause{s) and manner as stated.",... Medical examinerlcoroner On the basis of examlnadon andlor lnvestlgation, in my opinion, death occurred at the time. date, and place, and due to the cause{s) and manner as stated ........0 36, Dale Filed (Month, day. year) 31. MannarofiJeath >' Natural 0 Homicide o Accnent 0 Pending Investigation o Suicide 0 Cculd Not Be DeleftTtned 32a. Oateoflfljury (Month, day, year) 32b. Deserbe how Injury Occurred: 32d, Time of Injury 32e.lnjuryatWork? DYes 0 Ne 321. 11 Transportatiofllnjury (Spedf)'l o DriverlOperator 0 Passenger o Pedestrian 0 Other - Specify: 33b. Signature and Title 01 Certifier ~~ 33c. License Nurroer 32g. Location (Street, cityllown. state) M .....0 II , k.P tftJ- tJ62.121-L 33d Dale Signed (Month, day, year) 1ft;( ) 2.,')0(2 .. ................0 Fe.h.uav 1021/1....<1/1/1 34 Name and Address 01 Person Who Co~leted Cause of Death (lIem 27) TypelPrint LE,uJe'E ;3-k!i<'I) !'f,p ,_'" ,?r;5DCt4TE~ c/Ji(I;JiOL06-IS/ 5, ~. C " , C'C'-)' No,~ - LI- ! ;(1),0 Estate of Eleanor C. Musselman, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, r'l:J3f\UJl'R'-( i~ (j ,2006, in consideration ofthe Petition for Probate and Grant of Letters, satisfactory proof having been presented to me, IT IS DECREED that the instrument dated 27 September 1991 described therein be admitted to probate and filed of record as the last will of Eleanor C. Musselman and Letters Testamentary are hereby granted to Deborah L. Musselman. i-~ /) I~. ~, I r It I , . . /) I ,L- \.t ,__-l \,.,~. ,.x ,t l _~ ~ ,- i..1 / I Register of Wills 'i)) { 11/\'/1-.=-.'; , I.: ..{'j A ~. h . ..' ,,' v I t'\.. ct L ,.f'>..Ij'.( J/ t-. - --,;' , -/':~'I FEES {'-f j f _ ' Probate, Letters, Etc. ...........$ 'II L.I ( ~ ., ',iIU_ $ ~@al:!ftelaYeB...){ N................ \Yep~. It'f- TOTAL j""\ i~!./") _~'! (,~ 'A i\ LLI , -7. I :)..Cc /5 . Ll) $ r;5..~' c~ C S . Ari Attorney-at-Law (I.D. No. 17225) 525 North 12th Street Lemoyne, P A 17043 (717) 761-5361 Short Certificates ( 3 )..........$ I ~ ' co Filed CRW/September 26, 1991/10192 1East ltIill aub Qestantent OF ELEANOR c. MUSSELMAN I, ELEANOR c. MUSSELMAN, of the Township of Silver Spring, County of Cumberland, and Commonwealth ot Pennsylvania, being of sound and disposing mimi, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills heretofore made by me. ARTICLE I I direct the payment of my legal debts and the expenses of my last illness and disposition of my remains from my estate as soon after my death as conveniently may be done. All of the foregoing shall be considered expenses of the administration of my estate. ARTICLE II I bequeath all of my tangible personal property (excluding cash or securities), together with any existing insurance thereon, to my daughters, DEBORAH MUSSELMAN GRIFFITHS, of Upper Allen To\vnship, Cumberland County, PennGylv~nia, and P~\~'1ELA r,lUSSEL1\ff..N ROSEl'"~BLUI'~I, of r~ew York, New York, share and share alike, to be divided between them as they may agree. In the event of disagreement as to any item, such item shall pass in accordance with Article III hereof. ARTICLE III I devise and bequeath all of the residue of my estate to my daughters, DEBORA MUSSELMAN GRIFFITHS and PAMELA MUSSELMAN ROSENBLUM, share and share alike. Provided that should either of my daughters predecease me, I direct that the share of such deceased daughter shall pass to her CRW/September 26, 1991/10192 issue per stirpes. In the event that a daughter shall predecease me without issue, the share of such deceased daughter shall pass to my surviving daughter, or to her issue, per stirpes. ARTICLE IV I appoint my daughter, DEBORAH MUSSELMAN GRIFFITHS, Executrix of this my last Will. In the event of her inability or unwillingness to act or continue to act as Executrix, I appoint my son-in-law, DANIEL W. GRIFFITHS, Executor. ARTICLE V I direct that my Executrix, or her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I hereunto set my hand and seal this Zlltt, day of September, 1991. i,:~> (' .'" ' ,<, , ".. r-:: li. j ; ~.~" ""."-'o..C,:" },.,~,~ l. )".''\.',~-I''')-' /~L:. {., ';'y"..:r:: <- Eleanor C. Mussleman ' . (SEAL) Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us, who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. iJ/ZLL l~I~~.::;...' --2 , ~;:('~.>:-? ~ -}/' ., //,- /' / c.;,../~:>~ /~~<-;:::? r~;!_ CRW/September 26, 1991/10192 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND I, Eleanor C. Mussleman, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ;;,- 0\ /- ----Ll. l~ nt<, C- (f) 'vv. ;0"';' L',I<:< <'._ Eleanor C. Musselman Sworn or affirmed to and acknowledged before me, by Eleanor C. Musselman, the Testatrix, this .,'<" j 'day of September, 1991. \-.. -'~-~.! ^-'~"".f .~ ~t -'-"""- Notary Public ~. '1-"'-'-- -" '<'" ) --~ -------.-----J NOTAR Pl StAL OIANrlE U'I,G, NDT'\~Y PUBLiC lEMOYNE BOR,). c.uMBERlANO co. MY COMMISS\ON. EXPIRES DEC. 21, 1~93 CRW/September 26, 1991/10192 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: We, Co . ,Z ,~....,\,:: ,}'" y '1.. ,'\', and\'~ ~')"'\V" \:\ \1<' "1'- ..tX ,"~" the witnesses ::> ! , .. whose names are signed to the foregoing instrument, being duly qualified accortting t~'iaw, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at least 18 years of age, of sound mind and under no constraint or undue influence. ~ L " 1. '_.__ .~j~/f(~y~>'.';1J! -( , co')'! \.>< ,\;'.1 i,,_}<.:-t Sworn to or affirmed to and subscribed to before me by C. (), ,.... \.-\, ;,.~~ <r;r,";'''/j \. '. ". , witnesses, this ') I '1"aay of Septemo'er, 1991. ;~. , \ . and , x'\ i) '>..... ",~, . , . "ex ,. ( .' . .... "\ " '-.".-,) .~~- ..... ,.~.;~ .,>< ',,/; " /, i.. Notary Public NOTARIAL SEAL DIANNE LENIG. NOTARY PUBLIC LEMOINE. r;GRO. CUMBERLAND co. MY COMmSS!I)N EXPfRES DEC. 21. 1993 --.-------- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Eleanor C. Musselman Date of Death: 8 February 2006 Will No. Admin. No. 2001-0020 To the Register: I certify that notice of beneficial interest 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 1 March 2006 Name Address Deborah L. Musselman, 2304 Edgewood Road, Harrisburg, P A 17104 Pamela M. Rosenblum, 711 Amsterdam Avenue, New York, NY 10025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: '1 M ~J, 2.cN~ ~JlQ~ Signatur't- Name: Sa L. Andes Address: 525 N. 12th Street, Lemoyne, PA 17043 Telephone: (717) 761-5361 Counsel for personal representative ,... t -8 'q ~1.' b'J~ 6- /".illJ ~ 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 MUSSELMAN DEBORAH L 2309 EDGEWOOD ROAD HARRISBURG, PA 17104 n______ fold ESTATE INFORMATION: SSN: 203-10-81 28 FILE NUMBER: 2101-0020 DECEDENT NAME: MUSSELMAN ELEANOR C DATE OF PAYMENT: 04/26/2006 POSTMARK DATE: 04/26/2006 COUNTY: CUMBERLAND DATE OF DEATH: 02/08/2006 NO. CD 006610 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $40,000.00 I I I I I I I I TOTAL AMOUNT PAID: $40,000.00 REMARKS: DEBORAH L MUSSELMAN CHECK# 112 SEAL INITIALS: CM RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS SAMUEL L. ANDES ATTORNEY AT LAW 525 NORTH TWELFTH STREET P. O. BOX 168 LEMOYNE,PENNSYLVANIA 17043 TELEPHONE (717) 761-5361 25 April 2006 FAX (717) 761-1435 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, P A 17013 RE: Estate of Eleanor C. Musselman No. 21-2001-0020 Ladies and Gentlemen: I enclose a check for $40,000.00 to make a deposit against the inheritance tax owed in the above estate. Please issue your receipt and mail it to my office at your convenience. Please call my office if you have questions or need anything else. Sincerely, 5~LAwLc, Samuel L. Andes Ie Enclosure \Ij I,,-,r, ',; I..._} 1"0 e..,-H i...J.......i . 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',~:.I l:'" ':;;\ 'C,' ;" \ :(.\ ------------ REV-1500 EX (r;.oO) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY FILE NUMBER 21-2001-0020 COlMY CODE YEAR ~BER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z Musselman, Eleanor C. 203-10-8128 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DlJPUCAIE WITH THE C W 02-08-2006 10-27-1919 REGISTER OF WILLS 0 W (IF APPLICABLE) SURV1V1NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C none n/a LLJ o 1. Original Retum D 2. Supplemental Retum D 3. Remainder Return (dale 01_ JIior 1012-13-82) ~~en D 4. Umited Estate D 4a. Future Interest Compromise (dale or death after 12-12-82) D 5. Federal Estate Tax RetlJTl Required c..>O::~ UJo..o D 6. Decedent Died Testate (Allam copy of Wil~ 0 :x: 00 7. Decedent Maintained a Uving Trust (Mach copy of Tf\5Q _ 8. Total Number of Safe Deposit Boxes oO::...J 0.. CD 0.. D 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date of death between 12-31-91 am 1-1-95) D 11. Election to tax under See. 9113(A) (AltachSchO) <( I- l"Hls SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ." z NAME COMPLETE MAILING ADDRESS w 0 SAMUEL L. ANDES z 0 FIRM NAME Of Appicable) P.O. BOX 168 0.. en w LEMOYNE, PA 17043 0:: a:: TElEPHONE NUMBER 0 717-761-5361 0 1. Real Estate (Schedule A) (1) OFFICIAL IJ.SE ONLY 0 c::> (~ ..:.:.? 2. Stocks and Bonds (Schedule B) (2) :::-=0 CT" -~ ::0 (/) r - 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) C,L;-OO f"ll ,; :~r- -u 4. Mortgages & Noles Receivable (Schedule D) (4) t7rTl , ...c-~::o -.J ... , 1,036,943.50 0')7' , 5. Cash, Bank Deposits & Miscellaneoos Personal Property (5) (') (J \ -0 Z (Schedule E) ,:n ),0 -~~ l :JL C-)C~ ~ ' ) 0 6. Jointly Owned Property (Schedule F) (6) 3,352.69 ~ - ::u "-> ,'\ ~ :_,)-1 .. D Separate Billing Requested I;.-' N .- ::::> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) I- (Schedule G or L) 0: 8. Total Gross Assets (total Lines 1 - 7) (8) 1,040,296.19 < 0 9. Funeral Expenses & Adminis\rative Costs (Schedule H) (9) 17,150.65 W c:: 10. Debts of Decedent, Mortgage Liabil~ies, & Liens (Schedule I) (10) 13,018.97 11. Total Deductions (total Lines 9 & 10) (11) 30,169.62 12. Net Value of Estate (Line 8 minus Line 11) (12) 1,010,126.57 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,010,126.57 SEE INSTRUCTIONS FOR APPUCABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax Q ~ rate, or transfers lJ1der Sec. 9116 (a)(1.2) x .0_ (1S) $1,010,126.57 X.O~ (16) $45,455.70 ~ 16. Amount of Line 141axable at lineal rate ::::> a. 17. Amount of Une 14 taxable at sibling rate X .12 (17) :E 0 18. Amount of Une 14 taxable at collateral rate X .15 (18) 0 ~ 19. Tax Due (19) $45,455.70 20. D I CHECK HERE IFYOU ARE REQUESTING AREFUND OFAN OVERPAYMENTl SlFPA42021F.1 >>BESURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 222 Messiah Circle CITY Mechanicsburg I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $45,455.70 $40,000.00 $2,000.00 Total Credits (A + B + C) (2) $42,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) (3) 4. If Une 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) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (S) A. Enter the interest on the tax due. (SA) B. Enter the total ofUne5 + SA. This is the BALANCE DUE. (58) 3,455.70 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOVVlNG 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 I2r b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . , . . . . . ., 0 'KI c. retain a reversionary interest; or ............,'........... . . . . . . . . . . . . . . . . . . . , . . . . , . , . .. 0 ~ d. receive the promise for life of either payments, benefits or care? .............................,. 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . .. . .. . . . . . . . . . . .. . . , . .. . . . .. . .. , .. . .. . .. .. . .. . .. 0 ~ 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 El IF THE ANSWER TO Am OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjll)', I declare that I have examined this return, including accompanying schedules and statements, and to the best cJ my knowledge and belief, it is true, correct CI1d COJllllele. Declaralioo of preparer othec1han the personal representative is based OIl all information of which preparer has any koo.vIedge. SIGNATURE OF P:.~~0;~t:~NS~_~ FOR f~lre~~~'~(:7-e;.~,/,- ,/ Z,( ~ p~~ . ~/ ,:,: l ADDRESS I ' ! 17104 DATE . 7.<- .... I... > Samuel L. Andes, P.O. Box 168, Lemoyne, PA 17043 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) 0)]. 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. ~9116 (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)1. 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)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)1. 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. STF PA42021F.2 REV-150B EX + (1-97) (I) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Musselman, Eleanor C. 21-2001-0020 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Money Market Account and five mutual fund accounts held with ISI Financial Group, Inc. as are more particularly described on the attached letter. $1,036,943.50 TOTAL (Also enteron line 5, Recapitulation) $ 1,036,943.50 (If more space is needed, insert additional sheets of the same size) STF P A42021 F.9 April 26, 2006 Samuel LAndes 525 North Twelfth Street P.o. Box 168 Lemoyne, P A 17043 Dear Mr. Andes, Enclosed, please the information you requested for the account of Eleanor Musselman. The first item is the account value as of February 8, 2006. You will note that this is on T.D. Waterhouse Institutional Services letterhead due to the fact that they are the actual custodian of the funds. Secondly, the account for Eleanor C. Musselman was an individual account and her daughter Deborah Musselman was the power of attorney on this account. If you require any additional information, please give our office a call. Sincerely, ~ Christine K. Weit Director of Client Services ISI Financial Group Enclosure .unrn/Jirlino finonria! spmritu fnr unll and fhnse who denend on Imll. Waterhouse Institutional Services TD Waterhouse Institutional Services 100 Wall Street New York, NY 10005 T:800-431-3500 ACCOUNT # 506-80226-1-4 ELEANOR C. MUSSELMAN VALUE AS OF FEBRUARY 8, 2006 POR.TFOLIO POSITIONS LONG .>i MARKET MARKET PRICE VALUE ACCT QUANTITY DESCRIPTION SYMBOL I . CASH & CASH EQUIVALENTS I 1001 I CASH 15,632.18\TD WATERHOUSE MONEY MARKET CMFMZ 15,632.18 PORTFOLIO (SWEEP) MUTUAL FUNDS CASH 23,278.802 DF A FIVE YEAR GLOBAL FIXED DFGBX 10.23 238,142.14 INCOME PORTFOLIO CASH 21301.46 DF A INVT DIMENSIONS GROUP DFGFX 9.82 209,180.33 INC- TWO YR GLOBAL FIXED INCOME PORTFOLIO CASH 11,859.205 SEI INSTL MANAGED TRUST TRMVX 21.73 257,700.52 LARGE CAPITAL VALUE PORTFOLIO CASH 9,048.523 SEI INSTL MANAGED TRUST SELCX 20.01 181,060.94 LARGE CAP GROWTH PORTFOLIO CASH 10,507.179 SEI INTERNATIONAL EQUITY SEITX 12.87 135,227.39 FUND CL A TOTAL-MUTUAL FUNDS 1,021,311.32 TOT AL ACCOUNT 1,036,943.50 A division of TD Waterhouse Investor Services. Inl. Member NYSF/SIPC National Headquarters: 100 Wall Street. New Y"rk. NY 10005 REV-1509 EX + (1-97) (I) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Musselman, Eleanor C. 21-2001-0020 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Deborah L. Musselman 2304 Edgewood Road, Harrisburg, PA 17104 Daughter B. c. JOINTLY-OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY 'I, OF DATE OF DEATH ITEM FOR JOINT MADE IWe name of finardallnslitliion arK! bariI account rumber or similar identifying number. DATE OF DEATH DECD'S VAlUE OF NUMBER TENANT JOINT Attach deed for jointly-reld real estate. VAWE OF ASSET INTEREST DECEDENTS INTEREST 1. A. Checking account #50-0202-6215 with PNC Bank $6,705.38 50% $3,352.69 TOTAL (Also enter on line 6, Recapitulation) $ 3,352.69 (If more space is needed, insert additional sheets of the same size) ~TI:'p4..d?n?1J: in REV-1511 EX + (1-97) (I) COMMONWEALTH OF PENNSnVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Musselman, Eleanor C. 21-2001-0020 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman Funeral Home, Lemoyne, PA (funeral expense) $5,000.00 Gingrich Memorials (gravemarker) $110.00 Pete's Cafe and The Bricker House (post-funeral reception) $1,075.90 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative( s) Social Security Number(s) I EIN Number of Personal Representalive(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees SAMUEL L. ANDES $10,000.00 3. Family Exemption: (W decedent's address is not the same as c1aimanrs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills $774.50 5. Accountanrs Fees 6. Tax Retum Preparer's Fees 7. Cumberland Law Journal - advertising $75.00 Carlisle Sentinel - advertising $115.25 TOTAL (Also enter on line 9, Recapitulation) $ 17,150.65 .. (If more space is needed, Insert additIOnal sheets of the same size) REV-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Musselman, Eleanor C. 21-2001-0020 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. U.S. Treasury - federal income tax for 2005 $1 ,191 .00 2. PA Department of Revenue - state income tax for 2005 $6.00 3. Messiah Village - final bill $5,249.92 4. Associated Cardiologists, P.C. - medical services $74.11 5. Bankcard Services - Visa card balance $6,340.15 6. Alert Pharmacy $132.35 7. AT&T - final phone bill $14.82 8. Verizon - final phone bill $10.62 TOTAL (Also enter on line 10, Recapitulation) $ 13,018.97 (If more space is needed, insert additional sheets of the same size) STF PA42021 F.13 REV-1513 EX + (9-DO) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER 21-2001-0020 Musselman, Eleanor C. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Deborah L. Musselman Daughter 50% 2304 Edgewood Road Harrisburg, PA 17104 2. Pamela M. Rosenblum 711 Amsterdam Avenue Daughter 50% New York, NY 10025 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 BEl NG MADE 1. none B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. none TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 .. (If more space is needed, Insert additional sheets of the same sIze) STF P A42021 F.14 C:JMMONWEiCLTH OF PEP,NSYLVAr"IA D=PiCRTMEIJT OF REVErJUE BUREAU OF If\JDI\/IDUAL TAXES DEFT 280601 hARRISBURG, PA 17128-0601 REV~1162 EX(11~96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ANDES SAMUEL L 525 NORTH 12TH STREET LEMOYNE, PA 17043 ESTATE INFORMATION: SSN: 203-1 0~81 28 FILE NUMBER: 2101-0020 DECEDENT NAME: MUSSELMAN ELEANOR C DATE OF PAYMENT: 09/07/2006 POSTMARK DATE: 09/07/2006 COUNTY: CUMBERLAND DATE OF DEATH: 02/08/2006 NO. CD 007178 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,455.70 I I I I I I I I TOTAL AMOUNT PAID: $3,455.70 REMARKS: CHECI<# 119 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS 10-17-2006 MUSSELMAN 02-08-2006 21 01-0020 CUMBERLAND 101 APPEAL DATE: 12-16-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~~!_~~9~9_!~~~_~~~g______~___~~!~!~_~g~~~_~g~!!g~_Eg~_yg~~_~~~g~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ELEANOR C FILE NO. 21 01-0020 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX A~P~~:t~E"'E~T .'.. ,ALlOWANCE OR DISALLOWANCE OF'iDE~HONSAND ASSESSHENT OF TAX SAMUEL LANDES PO BOX 168 LEMOYNE DATE C! 'STATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17043 ESTATE OF MUSSELMAN REV-1547 EX AFP (06-05) ELEANOR C TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 10-17-2006 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 1,010,126.57 X 045 = 45,455.70 .00 X 12 = .00 .00 X 15 = .00 (19)= 45,455.70 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 1.036.943.50 3.352.69 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 17,150.65 13.018.97 (11) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,040,296.19 30.169 62 1,010,126.57 .00 1,010,126.57 . .........., ... (+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-26-2006 CD006610 2,105.26 40,000.00 09-07-2006 CDOO7178 .00 3,455.70 INTEREST IS CHARGED THROUGH 11-01-2006 TOTAL TAX CREDIT 45,560.96 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 105.26CR REVERSE SIDE OF THIS FORM INTEREST AND PEN. .00 TOTAL DUE 105.26CR · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~I ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE r'-:(:'<"'X~H~~:(,{A:~E TAX :'STATEMENT'QF ACCOUNT . , ~ i." REV-1607 EX AFP (03-05) SAMUEL LANDES PO BOX 168 LEMOVNE 200S NOV 27 Pt.1 3:Dj(JE ESTATE OF CLERK Or- DATE OF DEATH ORnUI\t\\,'e, (",r\IIRTFILE NUMBER ,r.....II..r...,i~.,J \..It.;'"', ''1I~UNTY CUI.' t"". n'l :"'n-/-L ,,' ..... ,'j., AcN 11-13-2006 MUSSELMAN 02-08-2006 21 01-0020 CUMBERLAND 101 AIIount R_l Heel ELEANOR C PA 17043 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO' COURT HOUSE CARLISLEI PA 17013 NOTE: To insure proper credit to your accountl subBit the upper portIon of this fOrM with your tax P.~t. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) .** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MUSSELMAN ELEANOR C FILE NO.21 01-0020 ACN 101 DATE 11-13-2006 THIS STATEItENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE HAltED ESTATE. SHONN BELOW IS A SUlltARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYltENTSI THE CURRENT BALANCEI ANDI IF APPLICABLE I A PROJECTED INTEREST FIUURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-10-2006 PRINCIPAL TAX DUE: 451455.70 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-26-2006 CD006610 21105.26 401000.00 09-07-2006 CD007178 .00 31455.70 10-24-2006 REFUND . .00 105.26- TOTAL TAX CREDIT 451455.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PA YltENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FO," FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Eleanor C. Musselman Date of Death: 02-08-2006 Will No. Admin. No. 21-01-0020 To the Register: 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: yesX 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_ NolL- 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? YesL No_ D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~f \ } 07 '~gn~Jl Name: Address: Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 Telephone # 717 761-5361 ,"'-". en C> S2 ::iC < <:- (":- f-- -'" a:: -', Capacity: K Counsel for Personal Representative L,L C) u: L:....J t:-:) (' r, l~U c:: l'"'- I (!) => o<C ,..... c-.::> = C'-l Lt:::-C:5 cJu, '/' n) ': ~~' UI D- O::, 0-" ~ U <t c.. :1./- ()I-~O RELEASE WHEREAS, Allfirst Trust Company of Pennsylvania, N.A., formerly known as Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, is the duly appointed Trustee under Agreement with Eleanor C. Musselman of Cumberland County, Pennsylvania; and WHEREAS, the said Trustee has submitted to the said Eleanor C. Musselman an account of its Trusteeship, which has been examined and approved by the said Eleanor C. Musselman; and WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans' Court Division of the Court of Common Pleas of Cumberland County and having the same confirmed, the said Eleanor C. Musselman has requested her Trustee to make settlement with her at once. AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Eleanor C. Musselman have this day had and received of and from Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, Trustee as aforesaid, the sum of One Hundred Eighty Two Thousand, Six Hundred Ninety Five Dollars and Ten Cents ($182,695.10) in cash in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever discharge the said Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things whatsoever including gross negligence, to the day of the date hereof. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2b day of Ji ~...., /J , 2000.~...A:~.. WITNESS: jJU/1t G;I/~ r ,t'" ." i t"'n' I, ~(l "\"":;:t.-~ ~~I~N.'/ \.. ..; l/.{'.,-,<- I (SEAL) Eleanor C. Musselman Notarial Seal Dolores J. Metzler, Notary Pub:ic Upper Allen !,wp., Cumberland County My CommIssIon Expires May 10. 2004 Member, Pennsylvania ASsOC!fj.!L0nQf NQ:"!liJS COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) On this, the1.fp~ay of pf.(!L/~V ,2000, before me, a Notary Public in and for said State and County, personally appeared Eleanor C. Musselman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and acknowledged that she executed the same for the purposes therein contained and desires that the same be recorded as such. WITNESS my hand and Notarial Seal. /J-~~71Y. ~ Notary Public ~ My Commission Expires: Notarial Seal Dolores J. Metzler. Notary Public Upper Allen Twp., Cumberland County My Commission Expires May 10. 2004 Member, PennsylVania AssoCIation 01 Nolarie~ iii allflrst J.I ' o,,,,;lO c..- Allfirst Trust 213 Market Street Harrisburg, PA ]710]-2]27 7172552059 January 2, 2001 Cumberland County Courthouse Register of Wills 1 Courthouse Square Carlisle, P A 17013-3387 RE: Eleanor C. Musselman, Trustee uJa Dear Sir or Madam: Enclosed please find a Release to be recorded. We have also enclosed a copy of the Release to be time stamped and returned to us in the self-addressed envelope provided. Our check for $7.00 is enclosed to record the Release. If you have any questions, please feel free to contact me at (717) 231-6032. Sincerely, ) / ((tty/'lo~~ ~+4..- (Mrs.) M~ Alice Rodgers Trust Associate MAR/bb "'-.""'..i- ;:-# :- c Enclosures AFT-2007 ~,