HomeMy WebLinkAbout07-07-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, FA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DODD JOHN C
13880 KENNARD DRIVE
GLENELG, MD 21737
____un [dd
ESTATE INFORMATION: SSN: 195-07-7645
FILE NUMBER: 2105-0955
DECEDENT NAME: SIMMONS ROSEMARY D
DA TE OF PAYMENT: 07/07/2006
POSTMARK DATE: 07/07/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 10/08/2005
NO. CD 006937
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,734.39
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,734.39
REMARKS: DODD JOHN ESQ
CHECK# UNNUMBERED
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
-I
15056041125
REV -1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN 2 1 0 5
RESIDENT DECEDENT
File Number
o 955
Date of Birth
19507 764 5
1 0 0 8 2 0 0 5
10121915
Decedent's Last Name
Suffix
Decedent's First Name
SIMMONS
R 0 S E MAR Y
MI
o
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[Z] 1. Original Return
D 4. Limited Estate
[Z]
D
2. Supplemental Return
D
D
1
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
D
D
D
D
8. Total Number of Safe Deposit Boxes
o A V I 0 H R A 0 C L IFF E S Q
7 1 7 2 3 6 9:3, 1 8
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
R A 0 C L IFF LAW 0 F FIe E P C
First line of address
2 0 E R FOR 0 R 0 A 0
Second line of address
City or Post Office
State
ZIP Code
-, i
DA TEFILED.~ I
SUI T E 200
LEMOYNE
P A
17043
Correspondent's e-mail address:dhrad@ix.netcom.COm
Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and beiief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P RSO RESP,.ElNS.~FO FILING RETJ,lR. N . DATE
( -- '--:. ec..
/"
ADDRESS
13880 GLENELG MD 21737
DATE
?-~"-cC
LEMOYNE
PLEASE USE ORIGINAL FORM ONLY
PA 17043
Side 1
L
15056041125
15056041125
-I
'to
-.J
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: ROSEMARY D. SIMMONS
RECAPITULA TION
195077645
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
.................................. 2.
72151940
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D)
........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested. . . . . .. 7.
33255069
8. Total Gross Assets (total Lines 1-7) 8. 1 0 5 4 0 7 0 0 9
.......................... .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 0 2 0 8 1 1 9
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 8 1 4 6 9 8
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 1 0 2 2 8 1 7
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 9 4 3 8 4 1 9 2
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) ...... ............13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . .................14. 9 4 3 8 4 1 9 2
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O _ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable 0 0 0
at lineal rate X.O 16. 0 0 0
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 17. 0 0 0
18. Amount of Line 14 taxable 9 4 3 8 4 1 9 2 1 4
at collateral rate X .15 18. 1 5 7 6 2 9
19. Tax Due 19. 1 4 1 5 7 6 2 9
............................................... .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
ROSEMARY D. SIMMONS
-----.- ------..
STREET ADDRESS
100 MT. ALLEN DRIVE
File Number
0955
I STATE
PA
T -----
I ZIP
117055
CITY
MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
141,576.29
130,000.00
6,841.90
Total Credits (A + 8 + C) (2)
136,841.90
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
0.00
4,734.39
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
A. Enter the interest on the tax due.
4,734.39
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; ...................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ............................... D 00
c. retain a reversionary interest; or ................................................................................................ D 00
d. receive the promise for life of either payments, benefits or care? ....................................................... D 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. D 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
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 zero (0) percent
[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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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 + (6-98)
'*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROSEMARY D. SIMMONS
FILE NUMBER
0955
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
450 sh Duquesne Light Holdings, Inc. @ $16.7525/share
CUSIP 2662331015
VALUE AT DATE
OF DEATH
7,538.63
1236.481 sh T.Rowe Price New Income Fund @ $9.01/share
11,140.69
T. Rowe Price New Income Fund Dividends-
78.52
100,000 Northwest Business Bk WA 12/01/2004 with accrued interest
99,890.35
100,000 Everbank Jacksonville FSB 12/08/2004 with accrued interest
98,713.08
100,000 Northstar Bk Kans City MO 12/08/2004
97,150.68
100,000 First Cent Bk Cambridge NE 11/30/2004 with accrued interest
97,601.22
100,000 First Cent Bk McCook NE 11/30/2004 with accrued interest
95,558.93
100,000 LaSalle Bk NA Chicago, IL 12/08/2004 with accrued interest
96,583.87
100,000 Standard Fed Bk NA Troy MI with accrued interest
96,583.87
20665.66 Cash Reserve Prime Series Money Market
20,679.56
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
721 519.40
REV-150B EX + (6-9B)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ROSEMARY D. SIMMONS
FILE NUMBER
0955
Include 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
1.
DESCRIPTION
M& T Bank - Checking Acct #79174086
VALUE AT DATE
OF DEATH
11,949.78
2.
M& T Bank - Checking Acct #950260990 with accrued interest
237,695.72
3.
Sovereign Bank - Acct #2331030731
77,768.85
4.
Verizon - Refund
50.55
5.
Capital Blue Cross - Reimbursement
21.90
6.
Deposits in transit at October 8, 2005
(M&T Bank acct #950260990)
2,163.89
7.
Masonic Ring
225.00
8.
Queen Victoria Medallion
115.00
9.
Personal Property (see attached)
2,520.00
10.
Other jewelry - Ring with chipped red stone ($20.00); Masonic Pin ($5.00);
Damaged Opal Ring ($15.00)
40.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
332 550.69
ESTATE OF ROSEMARY D. SIMMONS
FILE NO. 21-05-0955
S.S.N. 195-07-7645
Personal Property
China Closet
Dining Table with 3 chairs
Desk
Trophy Case
Side Chest
Dresser
Mattress/Springs
Dressing Table
Microwave
Chair
China
Flatware
Stainless Flatware
Crystal
Kitchen Glass
Miscellaneous kitchen items
$ 500.00
$ 275.00
$ 100.00
$ 150.00
$ 75.00
$ 50.00
$ 100.00
$ 50.00
$ 20.00
$ 75.00
$ 500.00
$ 200.00
$ 100.00
$ 200.00
$ 25.00
$ 100.00
$2,520.00
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FilE NUMBER
0955
ESTATE OF
ROSEMARY D. SIMMONS
ITEM
NUMBER
A.
1.
2.
3.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Myers-Harner Funeral Home
Holy Cross Cemetery (grave opening)
Gingrich Memorials (grave marker)
6,715.00
775.00
725.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) JOH N C. DODD
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 13880 Kennard Drive
City Glenelg State MD
Year(s) Commission Paid: 2006
Attorney Fees Radcliff Law Office, P.C.
Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation)
Claimant
52,703.50
Zip 21737
40,000.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
Probate Fees
664.00
Accountanfs Fees
Tax Return Preparer's Fees
Filing fees - Inheritance Return and Inventory
Legal Advertising - Cumberland Law Journal
- The Sentinel
Additional Death Certificates
Check Print Charge - Estate account
Certified Mail
Safe Deposit Box key
CG Buser & Son (appraisal)
Additional probate
30.00
75.00
107.99
110.65
15.75
9.30
15.00
35.00
100.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
102081.19
REV-1512 EX + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROSEMARY O. SIMMONS
FILE NUMBER
0955
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Messiah Village 5,566.24
2. Alert Pharmacy 579.27
3. Verizon 89.95
4. Phil Haven 25.25
5. West Shore EMS 94.11
6. MBNA 15.92
7. East Pennsboro Ambulance 80.50
8. Bonnie Miller, Tax Collector 11.00
9. Radcliff Law Office, P.C. 67.50
10. West Shore Country Club 571.39
11. Chase Card Services 1,025.80
12. Susquehanna Surgeons, L TO 20.05
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8 146.98
",v-"" "'. "*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROSEMARY D. SIMMONS
SCHEDULE J
BENEFICIARIES
FILE NUMBER
0955
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. John C. Dodd Collateral 471,920.96
13880 Kennard Drive
Glenelg, MD 21737
2. Susan Simchock Collateral 471,920.96
P. O. Box 943
East Falmouth, MA 02536
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, ROSEMARY D. SIMMONS,
currently residing in Camp Hill, Cumberland County, Commonwealth of Pennsylvania, being in
good health and of sound and disposing memory do hereby make, declare and publish this as my
Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me.
FIRST: I direct that all of my debts not barred by the statute of limitations,
expenses of my last illness, funeral expenses, costs of administration and claims allowed in the
administration of my estate shall be paid by my Executor hereinafter named, from my estate as
soon after my decease as shall be found convenient.
SECOND: I do hereby give unto the Church of the Good Shepherd, 3435 Trindle
Road, Camp Hill, Cumberland County, Pennsylvania 17011, the sum of One Hundred ($100)
Dollars for the saying ,of Masses for the repose of my soul.
THIRD: I give, devise and bequeath unto my nephew JOHN C. DODD, now of
Glen Elg, Maryland and my niece SUSAN SIMCHOCK, now of Cape Cod, Massachusetts, all of
my personal effects, clothing, furniture, dishes and jewelry in equal shares absolutely and in fee
simple. My said niece and nephew shall be permitted to divide this property in such manner as
they shall see fit. In the event of any disagreement, my Executor shall make the division of the
items which are in dispute and that decision will be final.
FOURTH: I give, devise and bequeath all the rest, residue and remainder of my estate
of whatsoever nature and wheresoever situate to JOHN C. DODD and SUSAN SIMCHOCK in
equal shares, provided that if either of them fails to survive me then his or her share shall be
divided per stirpes among his or her issue who shall survive me and further provided that if
either JOHN C. DODD or SUSAN SIMCHOCK should predecease me without leaving issue
who survive me, his or her share shall be distributed to the surviving niece or nephew as named
in this Paragraph, or his or her issue per stirpes.
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FIFTH: I hereby nominate, constitute, and appoint JOHN C. DODD, as Executor
of this, my Last Will and Testament. In the event that JOHN C. DODD shal~ predecease me, or
be unwilling or unable to act as my Executor, as aforesaid, then I nominate, constitute and
appoint the SUSAN SIM CHOCK as Executor without necessity for posting security regardless
of state of residence, as Executor of this, my Last Will and Testament. All references to the
Executor herein shall be applicable to said substitute Executor.
SIXTH: My Executor shall have, in addition to the powers and authority conferred
upon him by law, the following additi?nal powers and authority:
1. To sell at public or private sale, exchange, transfer, partition, give options upon,
lease, mortgage, pledge or otherwise dispose of any property, real or personal, at any time
constituting a portion of my estate, and upon such terms and conditions as the Executor shall
deem wise.
2. To invest any money at any time in such bonds, stocks, notes, real estate,
mortgages, life insurance, annuities or other securities, or such property, real or personal, as the
Executor shall deem wise, without being limited by any statutes or rule of law regarding
investments by the Executor.
3. To retain, without incurring any liability, as investments, any property owned by
me at the time of my death, as long as my Executor may deem it wise, and even though such
property is not the kind of property an Executor would purchase as an investment; and even
though to retain such property might violate sound diversification principles.
4. To cause any security or other property which may constitute a portion of my
estate to be issued, held or registered in the Executor's own name, or in the name of a nominee,
or in such form that title will pass by delivery.
5. To consent to the reorganization, consolidation, readjustment of the financial
structure, or sale of the assets of any corporation or other organization, the securities of which
constitute a portion of my estate, and to take any action with reference to such securities which,
in the opinion of the Executor is necessary to obtain the benefit of any such reorganization,
if7 c11>~j7
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consolidation, readjustment or sale; to exercise any conversion privilege or subscription right
given to my Executor as owner of any securities constituting a portion of my estate resulting
from any reorganization, consolidation, readjustment, sale, conversion or subscription.
6. To pay all costs, taxes, charges and expenses in connection with the
administration of my estate, including such compensation to the Executor which shall be in
accordance with established fees throughout the period of administration of my estate.
7. To determine what is "income" and what is "principal" hereunder, and my
Executor's decision thereon shall be final; and to purchase securities at a premium or discount,
and to apply or charge said premium or discount against income or principal as the Executor may
determine.
8. The Executor may make payments to or on behalf of any person who is the
beneficiary hereunder but in no event, however, shall payments be made to any creditor or other
such person because of anticipation of payment by the beneficiary, and any such claim made by
way of anticipation by the beneficiary shall be of no validity or legal effect.
9. To borrow money from any person, firm or corporation, including any
corporation acting as an Executor hereunder, for the purpose of protecting and preserving or
improving my estate hereunder; to execute promissory notes or other obligations for amounts so
borrowed.
10. To employ legal counsel, accountants, brokers, investment advisors, custodians,
managers and other agents and employees and to pay reasonable compensation out of my estate
or any funds held hereunder to which said compensation is attributable.
11. To carry on any business owned or controlled by me at my death for whatever
period of time my Executor shall think proper, and my Executor" shall have the power to do any
and all things my Executor deems necessary or appropriate, including the power to close out,
liquidate or sell the business at such time and upon such terms as my Executor shall deem best.
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12. To do all other acts in my Executor's judgment necessary or desirable for the
proper and advantageous management, investment and distribution of my estate.
SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed
because of my death, whether the funds, property or insurance proceeds to which such taxes are
attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor
pay, or provide for payment of all such taxes at such time, or times, and in such manner as my
Executor deems best.
IN WITNESS WHEREOF, I, ROSEMARY D. SIMMONS, the Testator to this, my Last
Will and Testament, typewritten on four sheets of paper which I have identified at the bottom of
/9~ day of
eac,~e ~y my initials, hereunto set my hand and seal the
. ~~ 2003.
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The preceding instrument consisting of this and three other typewritten pages, each identified by
the signature of the Testator, ROSEMARY D. SIMMONS, this day and date thereof signed,
published and declared by ROSEMARY D. SIMMONS, the Testator therein named, as and for
her Last Will, in the presence of us who, at her request, in her presence, and in the presence of
each other have subscribed our names as witnesses.
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4
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, ROSEMARY D. SIMMONS, Testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed., ,,/)
~ ~- ~.~~~
IMMONS
Sworn or affirmed to and acknowledged before me by ROSEMARY D. SIMMONS, Testator,
the \ <\"""" day of '.b~(eY"\'se,{" , 2003.
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(SEAL) Notary1=
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NOJari"i S"a! J
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---.-----
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
We SUZIlN.(JEf E. 8.etGJl7d1(..L and 'O/f 1/1 D II /3bC4 IFf; the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw Testator sign and execute the instrument as her
Last Will; 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 Testator signed the Will as witnesses; and
that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound
mind and under no constraint or undue influence.
and
,2003.
~~""""=~----
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. James R. NJb!e liC:"ry C;.,....i~1'
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REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of ROSEMARY D. SIMMONS
No.21
05
0955
also known as
, Deceased
Date of Death 10/8/2005
Social Security No. 195-07-7645
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe
verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: DAVID H. RADCLIFF, ESQ.
1.0. No.: 25483
Address: 20 Erford Road, Ste 200
Lemoyne
Telephone: 717236-9318
t., ~ -e1-rt.
Dated b,/ Z~/~6 6'
PA 17043
Description
450 sh Duquesne Light Holdingsm Inc. @ $16.275/share
Value
[,538.63 .~
J
"J
,
1236.481 sh T Rowe Price New Income Fund @$9.01/share
with dividends
1~,219.21 )
100,000 Northwest Business Bk WA 12/01/2004 with acc'd interest
g31,890.35
100,000 Everbank Jacksonville FSB 12/08/2004 with acc'd interest
98,713.08
100,000 Northstar Bk Kansas City, MO 12/08/2004
97,150.68
100,000 First Cent Bk Cambridge NE 11/30/2004 with acc'd interest
97,601.22
Total
(Attach Additional Sheets if necessary)
1,054,070.09
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
<'
Continuation of Inventory
ROSEMARY D. SIMMONS
21
05
0955
PaQe 1
Description of Inventory
Description
100,000 First Cent Bk McCook NE 11/30/2004 with acc'd interest
Value
95,558.93
100,000 LaSalle Bk NA Chicago, IL 12/08/2004 with acc'd interest
96,583.87
100,000 Standard Fed Bk NA Troy MI with acc'd interest
96,583.87
Cash Reserve Prime Series Money Market
20,679.56
M& T Bank - Checking Acct #79174086
11,949.78
M& T Bank - Checking Acct #950260990 with acc'd interest $237695.72
and deposits in transit of $2163.89
239,859.61
Sovereign Bank - Acct #2331030731
77,768.85
Refund - Verizon
50.55
Reimbursement - Capital Blue Cross
21.90
Personal Property (See attached)
2,520.00
Masonic Ring
225.00
Queen Victoria Medallion
115.00
Miscellaneous Jewelry
40.00
Grand Total $
641,956.92
1,054,070.09
Subtotal $
ESTATE OF ROSEMARY D. SIMMONS
FILE NO. 21-05-0955
S.S.N. 195-07-7645
Personal Property
China Closet
Dining Table with 3 chairs
Desk
Trophy Case
Side Chest
Dresser
Mattress/Springs
Dressing Table
Microwave
Chair
China
Flatware
Stainless Flatware
Crystal
Kitchen Glass
Miscellaneous kitchen items
$ 500.00
$ 275.00
$ 100.00
$ 150.00
$ 75.00
$ 50.00
$ 100.00
$ 50.00
$ 20.00
$ 75.00
$ 500.00
$ 200.00
$ 100.00
$ 200.00
$ 25.00
$ 100.00
$2,520.00