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Home My WebLink About10-05-06 ---I 15056041046 REV-1500 EX (05-04) PA Department of Revenue '* Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (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 _ 1. Original Retum c::::;) 2. Supplemental Retum c::::;) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c::::;) 4. Limited Estate c::::;) - c::::;) 4a. Future Interest Compromise (date of death after 12-12-82) c::::;) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::::;) 10. Spousal Poverty Credit (date of death c::::;) 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 () 8. Total Number of Safe Deposit Boxes c::::;) Firm Name (If Applicable) .~ :"1' I C~ () ::<'J C:.J f"'"rl ('~ C) ''1 -Tl ,:=5 rTl ,- C") -To, 1''':> + Correspondent's e-mail address: beamercs (i) epi K.net 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 belief, 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. b /7//tJ Side 1 L 15056041046 15056041046 ---I .-J 15056042047 REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 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) c:;:) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property (Schedule G) c:::::) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . .. . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . .. . . . . . . . . . ; .. . . . . . . . . . . .. 11. 12. Net Val~ of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule.J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousaUax rate, or transfers under Sec. 9116 (a)(1.2)X.OJL 15. 16. Amount of Line 14 taxable at lineal rate X.O ~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable '. at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ". . . .... . . . . . . " . . . .. . . .,19.. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042047 c:::::) 15056042047 .-J RE>J-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME G.t.. t;,~. / A /I., r? AI..IH ae File Number 21-/)'- 00/70 STREET ADDRESS / () .s- C fA IY/ BE'AtlA-ItJ/:) D~/IIE CITY C,4/1/1fJ H I~'- I STATE ~ A- I ZIP /71!J// Tax Payments and Credits: 1'. Tax Due (Page 2 Line 19) 2. Credits/Payment!) A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) I ~()19..IS () () o Total Credits ( A + 8 + C ) (2) f ~/ 0/9./3 3. Interest/Penalty if applicable D. Interest E. Penalty o o (3) 0 (4) D (5) ~ ;1.." o/f,/3 (5A) 0 (58) ~~v 0/'1,/3 Total Interest/Penalty ( D + E ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS (- 1. Did dec~dent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the'right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [2g 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? ........................................................................................................................ IKI 0 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. ~9116 (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. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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. ~9116(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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(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 INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I' ~t. JJ1 EJeI (;L~/l/ /f ~. SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1, DESCRIPTION WIlJh,'''i'tilt 4tlthtA/ ::r/lr~JID,..r Fit,,.d CI"$s A (A-WSJ./X) h~/'/ t:lJ /'11,.1 ,,/ Ea'M/A,qt .;r;Ht:.S fJ1V.fe.rt't..tI AeU-. /t/o. :271) - ()59~. -/-3 / AJ /lV nt/lie //rt'H/,dd ~ EA'UM'~ $Ae.!' a,. ;Zl-~" -/71:) VALUE AT DATE OF DEATH x ;:is; Co2. SZ TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ :I~ 1)/).3.. S;{ "l"""~'''''l '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PA-Lhle-;eJ r; L/)I2/A SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY /1-. FILE NUMBER :2,-1- ~6. - I 70 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH .sr:, .3>> ~ rJO ~ iI. De> A. t/,s. 7H4JU'j'.1 hhuul Iht IIf S Illul"" /Ofk;A ~,. 2DOS /~. IJ4tl t{ Rev~.1 /?ehu,A' tm 13 //~Irv~ 9f) 6r ~S' I/NFO N()7lf: 1JG(JE/)ENT /../ rED 1cJ/7}I I/€~ (JDII1IJAN/{)A) /)F 3'f Y€A-R6" /fNt) FUI'l/Ylrul!!E A#/J TNE L/KE /AI ~ ~SI{)EA/(!,E #(/~ CJtuAlED lBy #1/11. TOTAL (Also enter on line 5, Recapitulation) $ '.3 e. /tD (If more space is needed, insert additional sheets of the same size) ...,~~,'.; '*' COMMONWEALTH OF PENNS~ LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAL /I1/FJeJ (;LOlli A SCHEDULE F JOINTLY-OWNED PROPERTY A. If an asset was made joint within one year ofthe decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. C H IH'l..t...ES La). F,C./C.ES, :1~. B. c. JOINTLY -OWNED PROPERTY: ADDRESS /()s CUmSERLIfIJl> '"J:>R.,VE CIfM P ,.., I Lot. ,1111- /7 D II FILE NUMBER ~/-IP~ -/70 RELATIONSHIP TO DECEDENT ~ NPJ+.tJ1oN" S"TAoANGI:F1t To lifE" 8L.DO&> LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. '11111113 ConllH~eE eAIJ/( STI't7l:WlENT SAVINGS 11 S-Oh ~'- I~.'l/ J J 22'.26 JrU7: #- I)lfl O/S 711 II J. ,4. 4111/',3 eoltlmElleE B~K ~~GIAL"~ (!HEek'''''' JI 5"~~ ~ J 0, 29s: /I S- J 4 7. Sf" ~ A-e.C7: :It DSI :20' "37 (SEIE rA-lUA 1iIJJI} LE-rriSt& ArrAeHED) TOTAL. (Also enter on line 6, Recapitulation) $ S/7'2,~ (If more space is needed, insert additional sheets of the same size) Commerce _Bank* Charles E Shields III 6 Clouser Road Mechanicsburg, P A 17055 Commerce Bank 5032 Simpson Ferry Road Mechanicsburg, P A 17055 (717) 766-6800 (717) 766-8244 Dear Mr. Shields, Per your request, this letter is in regards to Mr. Charles W Fickes Jr. and his checking and savings account balances. On the day of Ms. Gloria Palmer's death, January 4,2006, the checking account carried a balance of$10,295.11. On that same day, Mr. Fickes' savings account carried an approximate balance of$I,229.28. If you need any additional information regarding this matter, please feel free to contact me. Sincerely, L Laura Delaney Customer Service Representative Commerce Bank / Harrisburg, N.A. P.O. Box 8599 100 Senate Avenue Camp Hill, Pennsylvania 17001-8599 09/13/2006 Commerce _Banku To Whom It May Concern, This letter is to verify that Mr Charles W Fickes Ir was added as a signer to checking account 512096637 on April 17th of2003. Please feel free to contact me with any further questions at 717-766-6800. agdalena Keegan Assistant Store Manager Commerce Bank / Harrisburg, NA P.O. Box 8599 100 Senate Avenue Camp Hill, Pennsylvania 17001-8599 Commerce .Bank GLORIA A PALMER CHARLES W FICKES JR 105 CUMBERLAND DRIVE CAMP HILL PA 17011 *** SAVINGS *** STATEMENT SAVINGS BEGINNING RATE ACCOUNT NUMBER 0410157411 PREVIOUS STATEMENT BALANCE AS OF 12/31/05 ........... ............. PLUS 1 DEPOSITS AND OTHER CREDITS................ ... LESS 1 WITHDRAWALS AND OTHER DEBITS ................ CURRENT STATEMENT BALANCE AS OF 01/18/06 .................. ....... NUMBER OF DAYS IN THIS STATEMENT PERIOD 18 STATEMENT DATE 01/18/06 0410157411 ACCOUNT NO. ,Cl<'TI 0.25000 1,229.28 .10 1,229.38 .00 DEBITS ----------------------------------------------------------------------------------- *** SAVINGS ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 01/17 INTEREST PAYMENT 01/17 CLOSING WITHDRAWAL CREDITS .10 1,229.38 -------------------------------------------______0___-______________________________ *** BALANCE BY DATE *** 12/31 1,229.28 01/17 .00 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE 23-2324730 .10 *** INTEREST EARNED THIS STATEMENT PERIOD DAYS IN PERIOD ......................... INTEREST EARNED........................ ANNUAL PERCENTAGE YIELD EARNED (APY) .... *** 16 .10 0.19% GLORIA A PALMER CHARLES W FICKES JR 105 CUMBERLAND DRIVE CAMP HILL PA 17011 25 *** CHECKING *** REGULAR CHECKING ACCOUNT NUMBER 0512096637 PREVIOUS STATEMENT BALANCE AS OF 12/05/05 ........ ... .......... ... PLUS 5 DEPOSITS AND OTHER CREDITS ... ................ LESS 27 CHECKS AND OTHER DEBITS ............ .......... CURRENT STATEMENT BALANCE AS OF 01/05/06 . .................. ... ... NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 *** CHECK TRANSACTIONS *** SERIAL DATE 3249 12/07 3251* 12/08 3253* 12/06 3254 12/06 3255 12/06 3256 12/07 3257 12/08 3259* 12/08 3260 12/12 3262* 12/14 3263 12/19 3264 12/19 3265 12/19 AMOUNT 111.92 579.95 84.12 106.70 331.07 63.00 25.03 160.00 74.35 50.49 244.66 35.52 53.46 *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 12/06 AC-FORD MOTOR CREDI-CHECKPMTPA CK-000032S5 12/07 AC-CLARKE AMERICAN -CHK ORDER 12/16 AC-CPARC -PAYROLL 12/21 AC-US TREASURY 303 -SOC SEC 12/29 DEPOSIT 12/30 AC-CPARC -PAYROLL 01/03 AC-HIGHMARK RETIREM-PENS PMTS SERIAL 3266 3267 3268 3269 3270 3301* 3302 3303 3305* 3306 3307 3309* 3319* DEBITS 331.07 16.75 DATE 12/22 12/15 12/20 12/20 12/28 01/04 12/27 12/27 12/28 12/30 01/05 01/03 01/04 01/05/06 0512096637 CYCLE-001 10,395.64 2,948.78 3,629.26 9,715.16 AMOUNT 13.95 200.00 71.24 400.00 34.04 18.50 47.47 61.57 50.94 34.86 579.95 29.72 150.00 CREDITS 645.79 662.00 751.00 645.79 244.20 ----------------------------------------------------------------------------------- *** BALANCE BY DATE *** 12/05 10,395.64 12/06 12/12 8,842.75 12/14 12/19 8,904.41 12/20 12/27 8,972.18 12/28 01/03 10,463.61 01/04 9,873.75 8,792.26 8,433.17 8,887.20 10,295.11 12/07 12/15 12/21 12/29 01/05 9,682.08 8,592.26 9,095.17 9,638.20 9,715.16 12/08 12/16 12/22 12/30 8,917 .10 9,238.05 9,081.22 10,249.13 .~".~.,!"" . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF P I-W!J /'t 'L It tilt I:Uf.. I 19' O/l;/ IT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ,4. FILE NUMBER .2/- I:JI, - I 70 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 EXCLUSION TAXABLE VALUE ATTACH A COPI' OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABlE) NUMBER 1. p",.tJfeef/ve. L, k - r4"AJ,le II-nlJU /1'1 (j;eA) &1Ih-A et M 3S-p{,~ If~ - y~dU4hb" fld" r"hl'AtIlIiwi IJ~J//de/ ~ E~~I"; ". / tt>o?; ~ 10,6197,71, -e;- /0..... '9l7' p,,~S ~.. TOTAL (Also enter on line 7, Recapitulation) $ !()/ ''1~ 7~ (If more space is needed, insert additional sheets of the same size) REV-15i.1 EX+ (12-99) . * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF fAt.IHEJtJ QLt;IlIA /1-. ITEM NUMBER A. FILE NUMBER Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: ~hlJe (/J1U,.r~ FII/Jera/ IIbllfe / #eMJ t!U ,.,,/;'e.,./4J1e1 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) UJEIVJ>Y 5. ,(!.A i'iY.Ft:># Street Address /b! ftlp,ulr'dr /),./ye. City IIAIlA/5811A/; State~Zip /7/lb Year(s) Commission Paid: 2. Attorney Fees eh4r1~~. Sh,'elcls 1iL E$~. (PitAst. 'fi;. ~t..,.l ~ .,;". r~"","" ,",PWI Ac::hc.-.1 ~mt. ~tJ~ :z;.;-It',,'ly' nil 'ill f4u1e1 ue. 1eIC#JJ tavJ s." d, ell ~ ~o .n ;tliM., eI-F.,.rs IInI,' "1"01tMAe 4tvJ IUImu, ~mrtxe~~ecedent's ad ress IS not the same as claimant's, attac~planat~ ~,A. 3. Claimant IVIIIE Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees IW.d ot'id incJ ',So~~ of- short ce..-+; f,cO;1"es Accountant's Fees }'O-.,,:tA Htl.fhHhm of j.l4.M,1+oni Mus-set' hI' PAIiI./''I/,iIi Ann Dul Tax Return Preparer's Fees at I-I+~ 810tk I1-em;wn,# ~~~ llI.sorfztJ inCOllle-Ja,c reJ.w..ns IDI/I e1.utnJ.. PA- 'II eJDta.J: :r-tt?MS ,,~ E)Gpen~e w ~tf1 ~o..rd' 1; 1<o.nclj tl,\l\'\f.r (see 'lofDt"Mo..\.lDha.\ shett t'Mld ltemiz~+1oVl of ~(f'tr1Je$ Q.tttlc.l1eJ J Allred/sly in eullt be.rluttl ft:uv ,purJlQ./ /f~J/trt,.s""j iJ1 CIll"/,'sle Senl;/Ie.1 Aid,'h',,,.! S/"rt CQhKCaft~ ,f."'/i/''tJ,,,,,1 ~N.d1l 111,,,, ~ f>> ;&J,'sn, pf /Y;I/~ 5. 6. 7. 8', fJ. 10. II. 1'2. ,;21-t;~ -/70 AMOUNT (, I' ,,, ().. f)~ 7. wAIVD ~ 3 /()IJ.IJf) ~ ;NPhE ~ 7~.f')O f ~ Sf). fJ"I I.;;qs:oo 'st'), b() 'fI 7$"',"0 l' /07.9'1 'I I 2.. d~O , '0. #0 ~ /$. dO TOTAL (Also enter on line 9, Recapitulation) $ /P1 'so,9'f (If more space is needed, insert additional sheets of the same size) RS-': IJF ~A!I/f A-. ~,f-L../J(B'( ~/-~~ -/70 !~E~~~"!2/!1!.-;f?n.~~r_n~~~_ ....~7!:..4t(~~Z?._'?M/' __ ./)r e;x,cJ.E7YS6.. ,_ . '.. _,.~__._._T.'._...._...~___.__.~...._""~____..._.______..___..__.._. "_""'_"'T. __./i~6/1-~l./Yti~_t<.~~~)' ~__./!~~€??___ _n _ __._____..__.____.___________.___.________________ _n_ _____ -....---lIJ/ltl1If.-llk~I'".-.---!:r. __ ._~_....~.s:.k~J1.?_~ _~~._.._. _~t_~_~erJe!!t_~rLjJM_______. __.__.__.____ _..c.~6r s~~._~!...__e,'!f!!1':!d.l.~~6.!:!!1_.1!!!15._Ae~_._G.!"____~5I!!!~.)I:.~~.~ S". __._____.__._.__ u_' ___________. ~/~'ffI1.- &I~~eL~~t__!A.4/._~(/N~~.1J!..._!!~~_.../.c!~'!i_!'_!:t_d/!J'h(6!!!' e;{ ______ ________.__ _t!)e.~g.s~A~ pt',;,!_ /ltllpe.t!_~~..['I?rt__ ~~~~~__ ~!1.---Y/l-~~C~-~(li----- __n__.' .-____._____ ---- --k{~.!M.--h~-n-/l'Ef/."tf/--/J:R-~t)H-e..~ -~/!It_-!JL-~.---~/{.-~~.!~!!..~---n- _____.________.____ _~d_'::/~____Zt:._~tl$:.___~~_il~.!!.~ __zf;"__~~4!.._If~~_~_(i.? ~_/h/i~1_____ --.------.---.--.-....- --- $.1zt..,t!S__._~/_A~_~24~_~~z7*!!!~/!~.._~/I,t._tl_II__~'[{~~(i ~~__ _________ -..--_....._,___..__.___~tllttL.--aLlt:L-.dat---~-.-Mt.'PL"-- ndl!l!~ $___~~. ~HI__~~__~i_ ..'_ _.__._d.____..____ _arL/!lL/1t~kt:l ft~'1~--~!.~--M!~L~-Aee.eJ~~~7'" .l(z~~iJ!~_&~______d____U_. _&M~L_____~4._~___~A__~at~[~_...~~(____~~.~~~L-(7;.k!i-.l.~________._.... _ _____.__ ..<<Q"hlL~~,ltte_.g~f~___~~~~~~e___4U~-a4L.--c5'~~h! ______._ t?t..__djkL~~kd_.__~t:!./!t~_____ __...___.. _ .____ ._....___ .. __._....____._________._._____ -. ..__/}!~,___~!?!.~~__~~..[__!VL ~j~~t:I-.&.~L!-~.~--(./.!--!!!-~~~it:!!g--_- _f!JIIIJ.I!.~er;__..d~ /~_~~~.~/~rt._/~ _.___(Y/eI!t?~!1..~!.__~_~rn ~~_~~_______ _-_!e.teeqh~~~; &me_kr~~et 4ff4/ AA:'" _/-2_~~~ .. _n_ ..~;:~:4~=;;;f:;Y:c1~~T1:jr~:~.. ~~,.t'.!/~t!/ft~e.j"yL/~/"fc""'--d~""~daLJ{Ut;tL .~i/~~jtL"~ S".1J.P.~~H.M.t;, ~/uL_4HL~~_. ........ ._._&-R.t"..~ --~~~.-~--.--.-.. "__d... . _ ._______ .._.._.____..._...__......_. __"'_.___." ._..._.'d___.___________ __. . l__LJ7,-.llI!'6i't ~U"e,-~...lZ.>, 4J'{t}.t.s~~! ~.....--rn___- __~J~.tJ4IJii!I..J//~t.-d~I'~S~!lt/e~t! /IN /J1r. ~__ .:SZ?l>O COMMONWEALTH OF . . PENNSYL VANIA Plaintift' COURT OF: COUNTY OF: v. CIVIL/CRIMINALIEQUITY ACTION: /~;i:4.,,- III DOCKET NUMBER: AFFIDAVIT OF SERVICE I, Roger C. Spitz, being duly sworn according to law, do hereby affrrm that I am not a party to the action or otherwise interested in the subject matter in controversy, I am over 21 years of age and I am a Constable duly authorized under the laws of the Commonwe~th ofPelUlSylvania; that on the ::;0 day of ;::r~A( ;:2o(J t:. . . at II.P ~p.m., I served (document served) Lil'1/rr -t:'r&-- /411: 5AI'f! kls at (place of service) :2C1C/ ~. / G +-4 ST Crlt F' )h'// ;-?14- in the manner described below: M Personally delivered it into the hands of the person to be served. [ ] Personally delivered it to an adult family member with whom that person resides. The relationship to the person to be served is [ ] Personally delivered it to an agent or person in charge of the person's office or usual place of business. [ ] Personally delivered it to an agent in charge of the apartment building where the person resides. [ ] Other: Descriution of Reciuient Sex: Skin Color: m Cat/ Facial Hair: Height (approx.): S- I III1 Hair Color: ~r.t 7 / ~ ') Weight (approx.): I [; C/ -:rr:- ;;20 Rog~tz Pennsylvania State Constable Cumberland County ID # BOOIS1? CHARLES E. SHIELDS, III A1TORNEY-AT-LA W 6 CLOUSER ROAD Cor11l!r ofTrindle and Clouser Roads MECHANICSBURG, PA 17055 GFDRGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795-7473 January 18, 2006 Mr. Randy Palmer 204 South 16th Street Camp Hill, PA 17011 Via Hand Delivery Re: Estate of Gloria Palmer, deceased Dear Mr. Palmer: Please be advised that I have been retained by your sister, Wendy Rathfon, to help in the administration and settlement of the estate of your late mother. Since no will has been found and since it does not currently appear to be very likely that a will is going to be found, your mother is considered to have died "intestate." When someone dies "intestate," the administration and distribution is controlled by the laws of the Commonwealth. Currently these laws provide that you and your sister have equal rights and authority to administer your mother's estate. This would mean that you would have to be sworn in as co-administrator at the office of the Register of Wills and to be responsible for paying debts, fees, taxes and the like from estate assets. You would also be jointly responsible for filing assorted documents and returns. (These items are almost always prepared by the attorney.) I understand that you and your sister are not on the best of terms and that you may well have reasons why you would prefer not to be involved in the administration of your late mother's estate. If you have no desire to be so involved, you can sign a "Renunciation" form in front of a Notary. If you wish to renounce the administration, if you let me know, I can prepare the form and forward it to you or I can have you sign in front of me and I will notarize it for you. Please advise as to your desires either way. Please note, renouncing your rights to act as co-administrator does not mean you are renouncing your rights to your inheritance. Preliminary indications are that there is about $20,000.00 in probate assets. This is only an estimate and this will be subject to the payment of funeral expenses, medical bills, debts, legal fees, administrative expenses and inheritance taxes. At this preliminary stage it will be hard to guess how much or how little will be left. If you wish, you can wait and see before making up your mind as to what you want to do regarding your share of the inheritance. You mav wish to consult with an attorney before makinl! UP your mind. Mr. Randy Palmer January 18, 2006 Page 2 I understand that your relationship with your mother was somewhat strained in late years. If you are certain and definitely sure that you want to disavow any inheritance, you can do so. You can do this in a number of ways - one of which is to assign your share to your sister if you are disposed to do that. Please advise as to what you might wish to do regarding your inheritance after you have had plenty of time to think it over. Thank you for your kind attention to this matter. I look forward to hearing from you. Very truly yours, .~g~6~ Charles E. Shields, III Attorney-At-Law CES/mjj GEORGEM. HOUCK (1912-1991) Roger C. Spitz PelUlsylvania State Constable 421 East North Street, Suite 102 Carlisle, P A 17013 . Dear Mr. Spitz: 4ft _..u ; )/%/,. CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner ofTrindle and Clouser Roads MECHANICSBURG. PA 17055 TELEPHONE (717) 766-0209 FAX (717) 795-7473 January 24, 2006 Re: Estate of Gloria Palmer, deceased It was a pleasure to meet you and I want to take this opportunity to thank you for your prompt and efficient hand delivery of the correspondence to Mr. Randy Palmer. Please find enclosed Check No. 1552 in the amount of $50.00 for constable services rendered. I look forward to working with you again in the future. CES/mjj Very truly yours, ~t~ Charles E. Shields, III Attorney-At-Law ~ . /lJ.1 E'. .<<.1" f-t, S1- Roger C. Spitz PENNSYLVANIA STATE CONSTABLE CUMBERLAND COUNTY 385 ~"r. ~TillfYl. St PHONE 717249-5079 717226-0174 Ste. 102 Carlisle P A 17013 Date I~O / . 20 0 G;, FOR CONSTABLES SERVICES RENDERED ON /170 20Cl~ . SERVICE WAS ON ,.Q,q/j fdj" </r 1// c~ r.Ot - Constable Service---- $ 0 ' Mileage @ $.36 per mi.-- $ J./ 114 Total Due Upon Receipt-- $ ,5'0/ p...::- THANK YOU ~ CHARLES E. SHIELDS III ~ 6 CLOUSER RD. MECHANICSBURG,. PA 17055.,9735 1552 Date 1/2'1#' 3-7615/360 292 Pay to the FJ order of f<..fJG~ (!. SPI T Z H.r7Y uu! ;0 I$~~ H ,'""W" Dollars Citizens Circle Account trJ ='=:--7: . a Citizens Bank Pennsylvania ~ For/~'u~~: d:l'v'L~ ~ 1:03 bO 7 b .50-: b .007037 is''' .~ft~JL.~ .552 OCllll*e~ '* t/J-I E, .<<.r f-t, sr Roger C. Spitz PENNSYLVANIA STATE CONSTABLE CUMBERLAND COUNTY 305 ',,'I. \\'il16-c..., 3t PHONE 717 249-5079 717226-0174 Ste. 102 Carlisle P A 17013 Date ,pO / . 200~ FOR CONSTABLES SERVICES RENDERED ON 1170 20 C/ ~ . 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Z :u ~ $::' ~~!11~~~ r ' n: < ,,~ ~ P E ); .... o -.j o ~ Iooi c: ..... ~ f\ H&R Block OLOE LIBERTY SQUARE HARRISBURG, PA Office: 36642 (717)657-0310 Professional: #130242 ANN OPDYKE DEELEY Client: GLORIA PALMER Tax Preparation 260.00 Total 260.00 Coupon 85993 15 .00 E-Check #2689 Tendered 245.00 Change Que 0 .00 Emp 1 oyee No. 130242 Thank You for choosing H&R Block for your tax services. 2/27/2006 7:04:13 PM 5256634 (-ttr+ i 1"'-1 . .----.--f &j 4 ' l, (')? (lf~>~Vl .\ ," ;' c./ 'p, I ! l.-. / lYl~.~h ,) .1K~ (~ i./VLl~ ; REV-151~ EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF fl AlII/at, (;t.()I2/A ,4.. FILE NUMBER ~/-~~-/70 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. 130nn; e k. /)1; lIer. Tt't4.,Su.rer I L"c.ue.r IfIJt.li h;wtJsl..tp TAoMl.J. ~ as./H) TOTAL (Also enter on line 10, Recapitulation) $ :J..S, IJP (If more space is needed, insert additional sheets of the same size) . REV-15.3 EX+ (9-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF /'A-tlllE'le) ~tJ~A ,4-. FILE NUMBER ,zl-/)" -/70 1. RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTrustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] WftI1"r S. I&d~A 441JAI.te,~ If) f ~da'r/elfe. IJr. - - I IIIl,.r/SbU';,1;/A /711D AMOUNT OR SHARE OF ESTATE NUMBER I /00 ii> ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n 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) r LAST WILL AND TESTAMENT OF GLORIA A. PALMER I, GLORIA A. PALMER, of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do hereby declare. this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. ITEM I. I give, devise and bequeath all of my estate of every nature and wherever situate to my daughter, Wendy Sue Palmer. ITEM II. If Wendy Sue Palmer shall be a minor at the time for distribution to her of the above bequest, then I give, devise and bequeath all of my property of every nature and wherever situate to Bernard P. Hoover, Jr., of New Cumberland, Pennsylvania, Trustee, in trust. My said Trustee shall hold, invest and reinvest the assets of said trust, utilizing all of the income therefrom and so much of the principal thereof as is deemed necessary by my trustee to provide for the health, comfort, education and general welfare of the said Wendy Sue Palmer. My Trustee is further directed to pay to ~endy Sue Palmer all of the assets of said trust, including any accumulated interest, directly to Wendy Sue Palmer, at the time she attains her eighteenth (18) birthday. A. In the event Bernard P. Hoover, Jr. shall precedease me and Wendy Sue Palmer still be a minor, I designate _. ,""__,_.~.",.__..____..r'__'~'__'-' Commonwealth National Bank as substitute trustee. ITEM III. If Wendy Sue Palmer shall be under the age of eighteen (18) years at the time of my death, I appoint Bernard P. Hoover, Jr. and Marilyn Hoover, his wife, or the survivor of them, as guardians of the person of Wendy Sue Palmer. ITEM IV. I hereby nominate and appoint Bernard P. Hoover, Jr., Exec utor of this my Last Will. No bond shall be required by my Executor or Trustee in any jurisdiction. this / J..t!! day 0 f IN WITNESS WHEREOF, ~! L./ i ~{_L, I have hereunto set my hand , 1974. .J Z / / / ". /.1.....~ . !~. :',.~ .~ I" t.I (7 / C (, (j) , .' I :..' .1/;1//'( ./ The preceding instrument, consisting of this and one other typewritten page, was on the date thereof signed, published and declared by GLORIA A. PALMER, the testatrix herein named, 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 subscribed our names as witnesses hereto. <._-/). . /;7 /1 . j [) ~b--J'Vruv C. (/' tLy_i'--1t....lL t Residing at '-f1( ..ui'd.Jry I yJ~. IJ,IJUlCC../ l:ij jL:J.) Residing at I' ') ;'lvlt,.2..ll ,d-t~ 111/);, / 6..