HomeMy WebLinkAbout96-00533
CU~lUER!.^ND
Register of Wills of b:aFlcastlllr County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No, J I '7 C.
L) .3 _~
Estato 01 _Jo.b1'!L~Q'l,''l'_Q!'L
also known as
, Docaasod '1
Social Socurity No. 197-40-7074
C^NDY ^NN T^YLOR
PlltlliOnor{s). who .!fOfO 18 yon,s 01 ngo Of oldOf. npply)lUs) lor:
(COMPLETE "A' OR 'B' BELOW:)
123
A, Probato and Grant 01 Lollors and aver that Pe1itioner(~ is/O)(ll(the executOL- namod in the Last Will 01 the
Decedent,dated January 22. 1991 ~~ll'~x
Slalc rclovant clfcum!lancos. o,g., renunciatIon, death Dr oxoculor. ole
EKcopt os follows, Docodont did not marry. was not divorcod and did not havo [) child born or odoptod oltar oxocution of tho documonts altored
lor probata; was nol tho victim 01 n killing and wns novor adjudicatod incapacitated:
o
B. Grant 01 Lellors 01 Administration
(C.1.0.. d,b.M.cta.: pondonlo Iile. dUl.lanlo absontia; duranto minOrllOlo)
Potitioner(s) alter a prapor soarch has/have ascertainod tho Decedent lolt no Will and was survived by the following spouse
(if any) and heirs:
Noma
Relationship
Rosidenco
(COMPLETE IN ALL CASES) Attoch odd,loonal sheets i' necessary.
Docedent was damicilod at death in DAUPHIN County, Ponnsylvania, with llilfIhor last family or principal
residenco at 125 Beech Street. Carlisle. Pennsylvania
(Iisl slrcot. numbor and mumcipallfY)
Docedent,thon 45 yoars 01 age, diod January 15, 19~, at Hershey
Medical Center, Derry Twp.
Ilacahonl Dauph1n county. lIershey
P^
Decodont 01 death ownod proporty wilh ostimatod values os follows:
(it domiciled in PA All persanol property.... .. $
(if nol domicilod in PA Personal properly in Pennsylvanlo.... . . $
(it not domicilod in PA Persanol proporty in Caunly. .... ....... $
Valuo 01 ronl estate in Pennsylvania . .......... $
TaiBI. .. ..... ... ... $
10.00
10.00
Roal Estato situatod os tollows;
Whorofor, PotillonerQl) rospecUully raquest(s) Iho proboto 01 the '0" W"'X~I!jNQtlCpresonted with this Petition and tho grant allenors in
tho appropriate form to tho undorsigned;
Typed or printod nome Bnd rosidenco
17013
C^NDY ^NN TAYLOR
c/O HARTMAN UNDERHILL /'. ill<Uil/IKI:;K
221 C. ChesLI.tlt Street
Lancaster. PA 17602
nw.,
21-96-533
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COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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JoAnne Colton
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125 Beech St. ~~
" Carlisle, PA 17013 ,JI"__."""
,oItlO(ll'N."'I......._~flO1 Harry W. Wise
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....()AlU,N 1........lT~ Michael L. Cotton
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.,197 _ 40 _7074
'O.!(O'D(.II"~o.._,
.. January 15. 1996
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US!.' WIIL 1IND ~
OF
JalINN UJ!"!\.ri
Ir JoANN corroN, a legal resident of South Middleton Township,
CUmberlam County, Pennsylvania, being of SOlll"d am disposing rnirxl, mem:>ry
am urx:lerstarrling, do hereby rMke, plblish am declare this as am for my
last Will am Testament, hereby revoJdrg all other wills am codicils
heretofore made by 100.
FIllST: I direct that all my just debts am funeral expenses,
includirq my grave marker, shall be paid fran the assets of my estate as
soon as practicable after my d""""'''''.
SEXXlID: I direct that all taxes that may be assessed in consequence
of my deathr of whatever nature am by whatever jurisdiction i1tq;losEdr shall
be paid from my residuary estate as a part of the expense of the
administration of my estate.
'lHIRD: I devise am bequeath the residue of my estate, of every
nature am wherever situate, to my husban:l, MIaIAEL L. corroN, provided he
shall survive 100 by thirty (30) days.
FUlRIH: Shoold my husban:l, MIaIAEL L. corroN, predecease 100 or die
on or before the thirtieth day following my death, I rMke the following
specific bequests:
A. To my daughterr cardy Ann Taylor, I bequeath all my
je\relry, my jewelry boxes, the contents of the cherry am maple
secretary with fold down desktopr am the freestarrling full-length
swivel mirror in white frarre:
B. To my step-daughter, Jennifer Lynn Cotton, I bequeath the
cherry am maple secretary with fold down desktop, arry jewelry
fonnerly owned by my husban:lr am the jewelry box fonnerly owned by
my husban:l, Michael L. Cotton.
FIFlH: Shoold my husban:lr Michael L. Cotton, predecease 100 or die
on or before the thirtieth day following my deathr I devise am bequeath the
residue of my estate, of every nature am wherever situate, in equal shares,
to my daughter, cardy Ann Taylor r am my step-daughter r Jennifer Lynn
Cotton, provided that the share of either who shall predecease Il'e shall be
distributed to her issue, per stirpes.
SIX'IH: I direct that the share of arry beneficiary urx:ler the age of
21 years shall be held, IN'IKlsr, however, by FARMERS 'IKlsr a:MPANY, as
Trustee, to hold said share for the benefit of each said beneficiary urx:ler
the age of 21, upon the following terlrs am comitions:
A. To pay the income am so much of the principal as may, in
the sole discretion of my Trustee, be necec:sary for the
maintenance, support, rredical expenses am education of each
beneficiary .
B. 'I11e llITOlInt to be paid for the benefit of any of said
beneficiaries shall be determined fran time to time by the
need of each of said beneficiaries, am the llITOlInts am tiroos
of said payrrents shall be determined by such need. 'I11e said
payrrents may be made by my Trustee directly to each of the
said beneficiaries, or to such of them as may be, in the sole
q:>inion of my Trustee, of such age am ability to harrlle
prq:>erly the fUn:1s so paid to such beneficiary, or may be made
by my said Trustee directly to the person havirg the custody
am care of any of the said beneficiaries, or may be made by
my said Trustee directly to any institution entitled to such
payrrent by reason of services rerxlered or to be rerxlered to
any of the said beneficiaries.
c. To pay the acx::urculated incare am principal then rernainirg
in its haOOs to the said beneficiaries, upon each
beneficiary's attainirg the age of 21 years.
D. Arrj am all payrrent or payrrents of any sum or sums,
whether in cash or in Jdn:1, am whether for principal or
incaner payable to said beneficiaries, shall be made upon the
sole receipt of the respective beneficiary to whan the payrrent
is made, am free fran anticipationr alienation, assignmentr
attachment am pledger am free fran lXlntrol by the creditors
of any such beneficiary. All shares of principal am incare
herein given shall be free fran anticipation, assignment,
pledge or obligation of any beneficiary, am shall not be
subject to any execution or attachment.
SEVENIH: I naninater constitute am appoint my daughterr CANDY ANN
TAYIDRr Executrix of this, my last Will am Testament. In the event of the
renunciation, death, resignation or inability to act for any reason
whatsoever of the said CANDY ANN TAYIDR, I naninate, constitute am appoint
FARMERS 'IRJST a:MPANY, Executor of this, my last will am Testament. I
hereby relieve my Executor or her suocess:or fran the necessity of postirg
security in connection with their duties as such in any jurisdiction in
which they may be called upon to act, insofar as I am able by law so to do.
IN WI'INESS ~F, I have hereunto set my haJyj am seal to this, my
last Will am Testament, consistirq of typewritten pages( each of which
bears my signature, this ....?:?,vD day of ~.........C/~ Y , 1991.
/fhw< ~
JoAnn Cotton
(SPAL)
Al'IN1NT~
cx:tft:lNWFAI.l OF mlNSYLVANIA )
CXXJm"i OF C1JMBERI1\ND )
ss.
I, Jal\nn Cotten, Testatrix whose name is signed to the attached or
foregom; instrument, havm; been duly qualified accordm; to law, do hereby
ac:krIcM1edge that I signed an:! exeaJted the inst:nDoont as my last will: that
I signed it willm;ly: an:! that I signed it as my free an:! voluntary act for
the p.ll1Xlses therein eJqlressed.
SWOrn or affinned an:! ac:krIcM1edged before me by Jal\nn Cotton, the
Testatrix, this ,;:;'1 "A day of ,/> n., "u--"'---"-l ' 1991.
(1 ~ ~ (SFAL)
~trix Jal\nn Cotton
J-1fv~.I~ .///. fJi~~)
..- Notary PubliC,-,(
AFFffi1\vrrll
~ OF mlNSYLVANIA )
ss.
CXXJm"i OF C1JMBERI1\ND )
) /., -i -L/L-j!/ _l:. J .
We, a:lward L. Schoq:p an:! 1\& cLVl r}. (t:/~, the w~tnes!:'~ whose
names are signed to the attached or forego~ instrument, beirq duly
qualified accordirq to law, do depose an:! say that we were present an:! saw
Testatrix sign an:! exeaJte the instrument as her last will: that Jal\nn
Cotton signed willirq1y an:! that she exeaJted it as her free an:! voluntary
act for the p.lI1XlSe therein eJqlressed: that each of us in the hearirq an:!
sight of the Testatrix signed the Will as witJ'lec'~<:!S: an:! that to the best of
oor knc:M1edge the Testatrix was at that tiJre eighteen or Il'Ore years of age,
of soon:l mind an:! un:ler no constraint or urxh1e influence.
~ ?r aff~4an:! subscribed to befo:e me by a:lward L Schoq:p
an:! AIJ..:I'/{. ~//v , witnesses, this ,.o.;:>."A,day of \,;,~n-<u.';t/'
1991. t
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HARTMAN UNDERHILL & BRUBAKER
^nORNEYS AT LAW
01 (AS' CUUtNur Sl'IUf
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LANCASTER. ptH~II'tl\a~IA 1l101"IZ
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REGISTER OF WILLS
CUMBERLAND COUNTV, PENNSVLVANIA
In the Estate of
JOANN COTTON
No. 0533 of 1996
Deceased
CERTIFIC~TION OF NOTICE UNDER RULE 5.6(al
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 beneficiary of the above-captioned
estate on July 15, 1996:
NAME
Michael L. Cotton
ADDRESS
125 Beech street
Carlisle, PA 17013
Notice has now been given to all persons entitled thereto
under Rule 5.6(a) except:
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BRIAN S. BLACK, ESQ.
HARTMAN UNDERHILL & BRUBAKER
221 E. Chestnut Street
Lancaster, PA 17602
717-299-7254
N/A
Date:
07/15/96
I" 'l -,n '.~'r....
S!: o.'.i ,. .Il
Counsel for Personal
Representative
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
IUV. uoo[X to-1t4)
2. SupplolHonlal Rolurn
401. Futuro Inlollls1 Complorni~o
(lor dalos 01 doalh ollor 12-12-02)
[g] 6. Oocodont Died To~tQlo 0 7. Docodont Mailllainod Q Uving Trust
(Anacl1 co 01 Will) (Annell a cop 01 TUIsI)
C P ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
o 0 NAME
R N
R D BRIAN S. BLACK ES .
E E
5 N TELEPtiONE NUMDER
- T
CAB
H P L
E P 0
C R C
K 0 K
P S
717 299-7254
1, Rool EslolO (Sellodulo A) (1)
2. Stocks and Bonds (Sehodulo B) (2)
3. Closoly Hold Stoek/Portnorship Intorost (Sellodulo C) (3)
4. Mortgages and Nolos Rocoivablo (Schodulo D) (4)
5. Cosh. Bonk Doposits & Miscollonoous Porsonal PIOporty (Sch. E) (5)
6, Jointly Ownod Proporty (Sehodulo F) (6)
7. Tronslors (Sehodulo G) (Schedulo L) (7)
8. Total Gross Assats (lolnl Uno9 1-7)
9. Funaral Expensos, Admlnlstrativo Costs. Miscollnncou9
Exponsos (Schodulo H)
to. Dobts. Mortgago lIabilitios, UO"s (Schedulo I)
11. Total Deductions (Iotal lines 9 & 10)
12. Not Voluo 01 Estato (Uno 0 minus Lino 11)
13. Charitablo and Govornmontal Bequests (SChoduro J)
14. Not Voluo Sub'oct 10 Tax (Uno 12 minus Uno 13)
15. Spousal Translors (lor datos 01 doalh ollor 6-30-94)
Seo ImlUuctions for Applicablo Percent ago on pago 2,
(Includo valuos lrom Sehodulo K or Sehedulo M,)
16. Amount 01 Uno 141axablo at 6% ralo
(Include values from Schodule K or Schodulo M.)
17. Amount 01 Uno 141axable at 15% rolo
(Include volues from Schedule K or Schedulo M.)
18. Principal lox duo (Add 10x horn Une 15. 16 ond 17.)
19.CroditsfSp povcny Prior Payments Discount
20. If Uno 191s grootor than Uno 10, onter lho dillcrenco 011 L1no 20. TIlI:J 1:J lho OVERPAVMENT.
lXl D Check hero II au aro re ucstln a refund of our ~ye a mcnl
21. II Uno 18 is grealor thon Uno 19. enler tho dllloronco on Uno 21. Till!; j9 tho TAX DUE.
A. Enter tho Inlete!;1 on tho balance duo on Uno 21A.
B. Enler tho total 01 Uno 21 and 21A on Uno 21B, This is Iho BALANCE DUE.
Make Chock Pa ablo to: Ro Istor of Wills. A ont
. . BE SURE TO ANSWER ALL OUESTIONS DN PAGE 2 AND TO RECHECK MATH ... ...
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COTTON, .1 nANN
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FILE NUMBER
21.%.0533
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Unll., p.nall... ot p"Ju'y,llI.tlar. Ihall have ..aml".lIlhIS ,eluIM, '''tludH'IQ actomp''')'I''Q Ithedul.s a"d IIlleme"IS, and 10 lhe best 01 my lnowl.dg. and b.lt.l, n III''''..
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which plfPoIlf' hn any .nowl.dg..
,NAtU,RE OF PERSON R'TIPO SlOLEFOR FlLlNO RClUR'.c; /0 I1l1P.'l':U\N UNDERIlILL & BRUDlIKER
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..\ . .tv\., Ie\'; <... Lanc_a~.!:.er. I'A 17602
OF ~t A~Et{'JGER i"A 'PAESENTAlIV' ~~.~T~~.i~~~~.~~~~.~~~.t_~~:~.~~~~~~._.... ._..........
, t-J' ~v,. i.:Lllc,,~t~r, PA 17602
Copy"gh'('1 '99410,m lollw",', only CPSysl.mS,ll'It. ._-~-
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01/15/1')')(,
SOCIAL S[CUIlITY NU....O[ n
197-1.0- 7071.
()'l/IO/I ')50
IlF ^I'PLICAOllI5UIWIVINO spouse's fjAM[ tlM1,r IIIST ANn P'4l00l[ INITlAll
Cotton Michael L.
X 1. Original Rolurn
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125 lI"pch StI'p"t
CarlIsi", I'A 11013
euunl)'
CUMIIEIlLANIl
SOCIAL S[CUIHIY NUMU[ II
A....OUNT R[C[IV[OI5[[ INSTRUCTIONS)
0.00
Romalndor Roturn
(lor dolOS 01 doolh prlo' to 12-\3-02)
Federal Estate Tax Rohlfn Required
Total Numbor 01 Solo Dop05i1 Bak09
o 5.
8,
COMl'l[l[ MAILINO ADDRESS
"ARTMAN UNDEllllILL & BRUBAKER
221 E. Chestnut Street
Lancllster PA 17602
None
None
None
None
None
None
None
(9)
(0)
None
None
(11)
(12)
(13)
(14)
0.00 X .
0.00 X ,06 .
0.00 X ,15 =
(18)
Interest
0.00
(10)
0.00
0,00
0.00
(15)
0,00
(16)
0.00
(17)
0.00
0.00
(t9)
(20)
0.00
0,00
(21)
(21A)
(218)
DATE
7-jf-f!(,
DATE
q.IY/~'
Fo,m 1500 IA.v. 7-".1
~
~
IJISr WIIL 1IND ~
OF
JaI\NN U11'!u4
I, Ja/INN a:7l'1'ON, a legal resident of South Middleton Township,
o..unber1an:! COUnty, Pennsylvania, beirq of so.m:l an:! disposirq min:l, DY.:!I1lOry
an:!1.II'lderstan:i, do hereby make, pJb1ish an:! declare this as an:! for my
last Will an:! Testament, hereby revoJdIq all other wills arx:l codicils
heretofore made by 100.
FmST: I direct that all my iust debts an:! funeral expenses,
inc1uciin:J my grave marker, shall be paid fran the assets of my estate as
soon as practicable after my dec<"'''''.
SEXXIID: I direct that all taxes that may be "e~~=rl in consequence
of my death, of whatever nature an:! by whatever jurisdiction inposed, shall
be paid fran my residuary estate as a part of the expense of the
administration of my estate.
'lHIRD: I devise an:! bequeath the residue of my estate, of !:Ner'j
nature an:! wherever situate, to my husbard, MIaiAEL L. a:7l'1'ON, provided he
shall survive me by thirty (30) days.
tUJKW: Should my husbarxl, MIaiAEL L. u:Il'IOO, prec1""""""" me or die
on or before the thirtieth day followirq my death, I make the followirq
specific bequests:
A. To my daughter, Can:ly Ann Taylor, I bequeath all my
jewelzy, my jewelzy boxes, the contents of the cherry an:! maple
secretary with fold down desk\:q?, an:! the freestan:iin;J full-length
swivel mirror in white frame:
B. To my step-&ughter, Jennifer ~ Cotton, I bequeath the
merry arx:l maple secretary with fold down desktop, any jewelzy
formerly owned by my husbard, arx:l the jewe1J:y box formerly owned by
my husbarD, Michael L. Cotton.
FIFJH: Should my husbard, Michael L. Cotton, pred~"- me or die
on or before the thirtieth day followirq my death, I d!:Nise an:! bequeath the
residue of my estate, of !:Ner'j nature an:! whereVer situate, in equal shares,
to my daughter, Can:ly Ann Taylor, arx:l my step-&ughter, Jennifer ~
Cotton, provided that the share of either who shall prede<"'''''''' me shall be
distrib.1ted to her issue, per stirpes.
SIXTH: I direct that the share of any beneficiaIy un:ler the age of
21 years shall be held, m 'lRlST, hoI;ever, by F1IRMERS 'lRlST o:MPAN'l, as
TIUstee, to hold said share for the benefit of each said beneficiaIy urxier
the age of 21, upon the followirq teIms an:! corxiitions:
A. To pay the incane an:! so I11lCh of the principal as may, in
the sole discretion of my TIUstee, be 1'leCl'*'<:;;;lry for the
.
-- -...-
.-
. -- - - -.....
nuintcn.:mcc, support, m:rliml cxpcr= arrl crlumtion of mch
beneficiary.
B. '1l1c moount to be paid for the benefit of any of said
beneficiaries shall be detcnnined fran too to too by the
need of each of said beneficiaries, an:! the moounts an:! tim:.!s
of said payments shall be determined by such need. 'lhc said
payments may be made by my Trustee directly to each of the
said beneficiaries, or to such of them as may be, in the sole
opinion of my Trustee, of such age an:! ability to han:lle
properly the furds so paid to such beneficiary, or may be made
by my said Trustee directly to the person havirq the custcdy
an:! care of any of the said beneficiaries, or may be made by
trrf said Trustee directly to any instibJtion entitled to such
payment by reason of services rcrdered or to be ren:iered to
any of the said beneficiaries.
c. To pay the a=1ated incc:too an:! principal then remainin;J
in its hands to the said beneficiaries, upon each
beneficiary's atta:inirg the age of 21 years.
D. Arrj an:! all payment or payments of any SUI\\ or S\B11S,
whether in cash or in ki1Xi, an:! whether for principal or
incc:too, payable to said beneficiaries, shall be made upon the
sole receipt of the respective beneficiary to whan the payment
is made, an:! free fran anticipation, alienation, assignment,
attachment am pledge, an:! free fran control by the creditors
of any such beneficiary. All shares of principal am incc:too
herein given shall be free fran anticipation, assignment,
pledge or ooligation of any beneficllu:y, an:! shall not be
subject to any exeaJtion or attachment.
5EVFNlH: I naninate, constitute an:! ~int my daughter, C1INDY ANN
TAYIDR, Executrix of this, my last Will an:! Testament. In the event of the
renunciation, death, resignation or inability to act for any reason
whatsoever of the said C1INDY ANN TAYIDR, I !X:IIIinate, constitute an:! awoint
~ 'lRlST <nIPAN'{, Executor of this, my last Will an:! Testament. I
hereby relieve trrf Executor or her S'''''O'''''''''''r fran the ne<:::essity of postin;J
SeaJrity in connection with their duties as such in any jurisdiction in
'Nhich they may be called upon to act, insofar as I am able by law so to do.
m Wl'rnESS mmmF, I have hereunto set my han:I an:! seal to this, my
last Will an:! Testament, consist.ip;J of typewritten pages each of 'Nhich
bears trrf signature, this -:7,.?""D day of ~...v(Y"-o9E'>-- , 1991.
!fa- ~
Jal\nn Cotton
(SFAL)
. ... -. -....,.... ...'.
HARTMAN UNDERHILL & BRUBAKER
ATTORNE:Y5 AT LAW
COUUStL
JOHN I. HARTMAN. JR.
THE:ODORe L. BRUBA~E:R
JOSE:PH A. BROWN
CHRISTOPHER S. UNDERHILL
GtORGt T, BRUBAKtR
ANDRtW F. LUCARtLLI
HARRY Sf. C. GARMAN
WILLIAM C. McCARTY
ALE:XANDtR HtNOtRSON. '"
ROBeRT M. fRANKHouseR. JR.
THOMAS W. BeRGeN
MICHAEL W. BABIC
MARK STANLey
MARK t. LoveTT
SUSAN M. KADEL
KEVIN M. fRENCH
STtPHtN R, v.zUN
JOSHUA D. COHEN
MADeLYN P. NIX.
BRIAN S. BLACK
MARIAN J. MARTENAS
KIM R. SMITH
STACtY L, MORGAN
~U01TH A. HUBtR
2i!1 [AST C,H:U1NUf SfHCCT
LANCA5TE:R. PE:NN5YLVANIA 17602-2782
17171 i!SSo7i!B4
rAX 17171 299.3160
September 24, 1996
Office of the Register of Wills
cumberland County courthouse
Hanover and High Street
Carlisle, PA 17013
RE: JoANN COTTON ESTATE
No. 1996-0533
Dear Sirs:
Enclosed herewith for filing are two signed originals of
the Pennsylvania Inheritance Tax Return for the above-cap-
tioned estate. This Return shows no tax due.
Also enclosed herewith is our firm's check in the amount
of $15.00, representing your filing fee for this Return.
Finally, enclosed is a copy of this Return to be date
stamped and returned to our office in the enclosed envelope.
If you have any questions, please do not hesitate to
calL
Very truly yours,
8J-LR C\\;'\('L\.\'v
Ruth chatburn
Estate Assistant
oCt
C'
RC/rlc
Enclosures
. '
-u
~c
-
/5-/1 t! -I;~
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
G
'*
BUREAU OF INDIVIDUAL TAXES
IN-DITAHCE TAX DIVISION
nEPT. Ze0601
HARRISBlRG, PA l11za-0601
NOTICE DF INH~RITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
m.1l41II II'III.NI
JOANN
MAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
ifE'v:i5'4"i"EX--Aiii'--n'2-':96T"iiiificE--Oi'--fNHEiiii'i1iicE-i"tiinippRiiisEHEiir;-,\L,rOWiliicE-oli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JOANN FILE NO. 21 96-0533 ACN 101
If an assBssmBnt was iSSUBd prBviously, linBs 14, 15 and/or 16, 17 and IB
rBflBct figurBs that includB thB tDtal of ~ rBturns assBssBd to datB.
ASSESSHENT OF TAX:
15. Anount of Line 14 at Spou..l rat. lIS)
16. Anount of Line 14 taxable .t line.l/CI... A rat. (16)
17. Anount of Line 14 taxable .t Coll.teral/Class 8 rat. (171
18. PrincIpel Tax Due
BRIAN S BLACK ESQ
HARTMAN ETAL
221 E CHESTNUT ST
LANCASTER PA 17602
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-13-97
COTTON
01-15-96
21 96-0533
CUMBERLAND
101
Anount R..ttt.d
ESTATE OF COTTON
TAX RETURN WAS: ( I ACCEPTED AS FILED
I XI CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rod Est.t. ISch.dule A) III
2. Stocks and Bonds (Schedule OJ (2)
3. Clos.ly Held stock/Partnership Int.r..t (Schedule C] (3)
4. Hortg.g../Not.. Raceivable (Schedule OJ (4)
S. Cash/Bank Depoltts/Hlsc. Personal Property (Schedule E) (S)
6. Jointly Owned Property (Schedule F) (6)
7. Trensfers (Schedule G) (7)
8. Tote1 Assets
.00
.00
.00
.00
.00
.00
.00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Hisc. Expense. (Schedule H) (9)
10. Debts/Hortgage Liabilitie./Liens (Schedule I) (10)
11. Total Deduction.
12. Net Value of Tax R.turn
13. Charitable/Govern.ental aeqUests (Schedule J)
14. Net Value of e.t.t. Subject to Tax
.00
.00
IllI
112)
1131
1141
NOTE:
,00 X ,00=
,00 X ,06=
.00 X .15=
1181
TAX CREDITS:
PAYMENT
DATE
OISCOUNT 1+)
INTEREST (-I
RECEIPT
NUMBER
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
SEE
DATE
ATTACHED
01-13-97
. IF PAID AFTER OATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN Ii, NO PAYMENT IS REQUIRED.
IF TOTAL OUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS,I
NOTICE
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for. with your
tax pay.ent.
.00
nn
.00
,00
.00
will
,00
.00
.00
,00
.00
.00
,00
.00
RES(AVATlOHI [.1.1" of d.ud.n" IIwll.. I'" or II' for. P.c..".r 11, I'" -- Sf any future Inl.r.st In Ih. ..tat. It tren.f.rr~
In pa.....lon ot .nJoy,,"t ,. tl... . 11:011.I.t.l>> hllMflcl.rl.. of lhe d.udent af'.r the ..plratlon of 1II'l:t ..tat. for
Ilf. or fat y..r., ,he Cn..un....I'" htIr.tJy ..p,...ly r.,.tv.. 'M rlaht 10 Itpptal.. IIlnd ...... tran.f.,. Inherltanc. TauI
.1 ,he I~ful tl... I Ceullal.f.11 r.I. on AnY .uch future In'.r.".
PIJRPOS[ Of
MOriCE I
'0 fulfill ,he ,..",IF....," o' hctlDn 1,",0 D' Ihe Inh.t1111tK. nod [.t,'. 'all Act, Act 2Z Df 1991. 7Z P.S.
,"tlon 'UO.
PAYHl:H' I
DI'Kh ,he top pattlon o' lhh Hlltln ..nd lulHlIt ..lth yout paYMnt to tha A.ght.r of Wll11 prlntad on tM rav"", .Id..
H"..... cheEk or aUlI.y ntltar p,y,,"l. '01 REGISTER OF' MILLS, AGENT
'II p.y....." ,.nlY.d .h.1I f Irsl ba ftppll.d 'A MY Int.r..t which .IIY bI due ..lth M:t r..elnda,. IIPpU.d to the tall.
REfUHD CCAII A rafund o. . Ca. c,.dlt, which.... nol raqu..'ed on tha 'all A.turn, .ay ba requ.st.d by cOlpl.tlng BI1 "Application
far Re.und n' r.,vlIylvlW\la InharltN1u and ft,.t. ,.... U[Y~UU). Application. at. avallabl. at th.Offlc.
o' Ih. Neth"t af Wllh, MY of Ih. i'J Aavenu. Dhlrlct Offlc.., or by celllnG the .peclal l4~hour
M.warlng .atvlce nuMI.r. for lor.. ord.tlngl In pann.ylvanla l'aoa~16Z-10!iO, oultld. P.nnnlvanla and
..llhln Ioc:al llerrhbtlto afla t,lI) 'lI1.aOl)~, 100' (111) 111-11U OI.arlng I~alr.d Only).
OIJlCrlOHSI Any patty In Inllt..t nol ...'hflad ..lth Ih. nppr.I....nt, nIlD..anc. or dll8l1owance of d.ductlon., or a......ent
01 I.. I Including dhcounl or In",..1I n aho"'" on Ihh Notlca MItt Object ..lthln .bly (60) day' of r.c.lpt of
Ihlt Notice byl
"..rl1lM prol..I 10 'h. IIA Dep.rllant of A.v,""" BOfltd of App.als, o.pt. 1II10Zl, tlarrhburg, PA
--.IHtlon 10 h.v. th. I."at d.hrllnad .t MJdlt o. th. .ccount of the per.anal r.pr...nt.Uv.,
hlflp.al '0 ttM O,phM.' Cnur'.
17Iza~IOZl,
OR
OR
AOftIN
ISlA" IV[
CORRlCtlDHSI
"ItC'u.1 ."0" dhcovar.d on 'hit .........nt .hould b. nddt....d In writing tal PA D.part.ont of Aevenue,
IUrlllU 0' Indlvldufll ,...., AIINI Po.1 A.......nl Aevl... Unlt, O.pt. lB0601, HarrisburG, PA l7IlB-0601
Phnne 11111 ''''....0... 5.. IUI,. .. 0' the bDokla' "In,ttuctlon' lor Inh.rltenee hx Ratllrn for a Auld.nt
Decld..,I" (RfY-lltal) 'Dr,," ..111,.".1 Ion 01 ed.lnl.lrn'lv.ly cortHlabl. orror..
DISCOlJlll
If any 'a. due h paid within thr.. Il) clllend.r .onth. aft.r tttl d.cttdlf'ltOa duth, II flv. p.rc.nt (!iX) dllcDU'lt of
thl h. p.ld hallowed.
PENal tvl
lhe I"~ 'alC .an..ty nDn-parllclp'llon pan.lty I. coeput.d on Ihe tolnl of the ta. and Int.r..t a.....Id, and not
Pllld b.fot. January la, 1996, Ih. first day ef'.r thll end of Ih. tax .en.,ly p.rlod. 'hi. non~partlclpatlon
p...."ltV It .pp.a.abl. In thl 'M. .",,"ar Md In IhI thl ..... tI.. p.rlod aI you would IIpp.al the tax IInd Int.r..t
Ihlt h.. "..n "......d .. 1r~ICftl.d on 'hit notice.
INUAUII
'nt.r..' I. ch.'Ulld baolnnlno ..Ith flr.1 d.y of d.llnqu.ncy, or nln. (9) .onth. .nd on. (I) day ltD. the dal. of
d..'h, '0 the dal. Df pnyaenl. f.... which b'CIlI' dellnquenl b.for. January I, 19B1 bear Int.r..t at the rat. of
,Ill f6~) percll1' p.r NV\UIl c.lculalad .t . d.11y rnl. of .00016,.. All lalCl' which b.CIII. delinquent on and aft.r
Janu.ry I, 198' ..III b..r Inl.r..I .1 n r.l. which ..III vary frotl cal.ndar y.ar 10 cal.ndar year with thllt rat.
atv1OUf\C1d by lhe I'A O.p.rll.nl Df R.v.nue, lhll appllcabl. Inl.r..t rill.. for 1911l throuGh 1997 ar.1
~ Inl.,.., N.t. n.1 h Inllr..' r,.elor !!!r 'n'''''' Ani. Dnlly Intlr." Fnctar
IlJII 10X .aoo~ItB 19B7 9X .DOOZ47
"as I_X .aOGUB 19BII~I9lJI llX .000301
I"~ 1IX .000301 "" 9X .DODZ47
I"" IU .000156 1995~I9lJ~ 7% .aa019l
I'''' lOX .00Oll" 1995-1997 9X .00Ol47
--Inl.,..t It c.lcul.lld .. foUIN':
INTtRtBT . BALANCE OF TAX UNPAID X NUNDER OF DAYS DCLINQUENT X DAILY INTEREST FACTOR
.'Any HoUce I..UId "".r lhe t... blco... d.llnquenl ..111 r.flect en Int.r..t cnlculatlon 10 flft.en (15) day.
b.yond IhI d.t. of IhI a.....Mnt. If paYIIIMI h .... aft.r lh4I Int.r..t coepulatlon dal. .hown on the
Notln, Mktltlon.1 Inl.r"l lU.t bI caIClll.tld.
STA'I'IJ,.f_; _1~1::e()[I~[,_ll!l!l~IL.B!1_I,~;_ " , 12
_.-----,- ..,. -. -..
Name of Decedent:
.JOANN CO'l"l'ON
Dato of Death: January 15, 1996
Will No,
533 of 19%
Admin, No,
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, 1 report the following with respect to completion of
the administration of the above-captioned estate:
1, State whether administration of the estate is complete:
Yes No x
2, If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: Pending Litigation settlement
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 No
b, The separate Orphans' Court No. (if anYI for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may b a'tach to this report,
Date:~
:J"
Signa ture
BRIAN S. BLACK, ESQ.
Name (Please type orprintl
HARTMAN UNDERHILL & BRUBAKER LLP
221 E. Chestnut Street
AddresSLancaster, PA 17602
I: .
-~ -'
I....)C,.i
(717) 299-7254
Tel. No.
(MAH: rmf/ AM3)
Capacity: Personal Representative
X Counsel for personal
representative
.
- -.. ~~... .._-
- - - ~
--._-----..--...".-
.- '
\
c
STATUS REPORT UNDER RULE 6,12
Name of Decedent: Joann Cotton
Date of Death: 1/15/96
Will No, Admin, No, 1996-00533
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:
Ye6 No X
2, I f the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: 'll1e Estate was opened for purposes of litigation. Trial is not expected
to be scheduled untll nud-20OL
3, I f the answer to No, 1 is Yes, state the following:
a, Did the personal representative file a final
account with the Court? Yes No
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? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report,
Date:
1/11/00
~
Signacu e
Harrv St. C. Garman,Esquire
Name (Please type or print)
Hartman Underhill & BrubaKer LLP
221 East Chestnut Street
Address
Lancaster, PA 17602
( 717) 299-7254
Tel. No.
Attorney 1.0. #19286
Capacity: Personal Representative
~counse1 for personal
representative
(HAH: rmf/ AM3)
"
JlU) JUlIl' .\0, IIJI)~ 17~~S
FEB 1 a lOO~ ~}-
C/
III R~: I'slat~ or ,llIallll CIIIlIIII
I.at~ or Cal'lilll' 1IIII'IIul(II
()RPII,\:-':S' ('Ollln DIVISION
(,()IIRT OF (,()7\17\1l IN PI.EAS OF
('II7\IIlFRI.A:-':1 l ('OlINTY
PENNSYI.VM\IA
I'stat~ No,: 21-11)1)(,-5.1.'
:-':(),21-11)I)(,-5.1.'
NOTICE OF F,\ll.lJIU: TO FILE STATUS In:I'Oln ,\NJ) REQUEST TO ('ONJ)lJCT A
IIEAIUNG I'UI~SI!t\NT TO IUJI,E (),12, SUI'REI\IE COlJln ORI'HANS' COURT IUJI.E
Pcrsollal Rcprcsculatiw:
Couusclll11' P~rsonal R~pr~s~nlati\'~: lIal'l'Y Gal'lIIall, EIlJuil'r
Datc or Dcccdcnt's Dcalll: 01-15-11)1)(,
Dalc ofDelillqu~lIcy Noticc: 12-12-2001
Thc undcrsigncd. Mary C. Lcwis. Rcgislcr of Wills. in accordallcc \\'ith Rulc (,.I;l,
Suprcmc Court Orpll:llls' Court Rul~s, hcrchy nolilics thc Orphalls' Coul'l Di\'isioll, Court of
Common Picas ofCumbcrland Coullty. thatllcith~r Ihc abo\'c namcd pcrsOlwl r~prcscnlatil'c nor
thc abol'c lIamcd cOUIISel lor thc pcrsonal rcprcscntatil'c hal'c lilcd wilh thc Rcgistcr of Wills or
Clcrk oftbc Orphalls' Court his. hcr or its Status Rcporl rcquircd by Rulc (i.I:!. Suprcmc Court
Orpbans' Courl Rulc ,md thattbc rcquisitc noticc. pursuanllo Rulc (,.12, Suprcmc Courl
OI1,bans' Coul'l Rulcs, \\',IS gil'clI by thc Rcgislcr of Wills 011 12-12. ;lOOI. alld Ibaltbc ICII (10)
d,IY 1I0licc 10 filc thc Status Rcporl has cxpircd. Accordingly, in accordallcc \\'ith Rulc 6.12 thc
COUrl is hcrcby notilicd ofsucb delillqucncy allllthc ulldcrsigncd rcqucsts thai a Courl cOllducl a
bcarillg to dctcrminc \\'hclhcr sanctions should bc imposcd uponthc delinqucnl pcrsonal
rcprcscntatil'c or counselll1r thc delinqucnt pcrsonal n:prcscntatil'c.
D,llc: 02-12-2002
. ' 1 l..../
" ') . I. . "
.'1.L'<. l/ \..... :~ 171.'U.~.t':11'L
illary C. l.fwis. Rcgistcr of WI Is
lli/0_PI..'
{),(It'fV-
"V' ' .
,o'
Distribution:
Pcrsonal Rcprcscntalil'c
Coullsellor Pcrsonal Rcprcsclltatil'c
Estalc Filc
;)/lJ'..t' .\ ,;h J Ie; j ,j
A bcaring is schcduled 101'\11 in CoUrlroom No.3.
prior lothc hcarinl\ datc. Ihc hcarilll\ will aUlomaticall1' bc callc'
- - .
I fthc Status Rcport is Ii Icd
I.
JQ'Ll
i\ iJ-^'(; "
'. }'~O 1
:~., U/
REV, 1500 EX. \6,00)
COMMONWEALTH Of PENNSYLVANIA
DEPARTMENT Of REVENUE
DEPT 28060 I
HARRISBURG PA 171280601
15- 11;;2. - 1;U
REV-1500
E
-
(]I' ''-;1.1 \".1 (Jljl ,
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1111 '.1",1/1111
~ 1" 'HI OI, il
UHINt..-l (II)! 'flAil
'lll'.llllll
_____u__.___,__.__~_~______..______.._..,~., ~ . ,',. _...~-
-- -DECEDENf5NAi'~E-li.AST', FlnST,AND iAIDDlTINITlAL)
SOCIAL SECUI1ITY NUMIl[l1
DECE-
DENT
Cot ton .Jol\llfl
DATE Of DEATH (MM,DD.YEAR) -'-----[DATE Of BIRTli\WADO-YEAR/-
01/01/1999 _~~/l0/19~0
(IF APPLICABLE) SURVIVING SPOUSE S NAME ILAST, FIRST, AND MIDDLE INITIAL)
CotLon, ~l1ch~el L,
19"."10-'/0'/01
___._ __H_ __ .__-.__.
THIS RETURN MUST BE FILED IN DUPLICATE
WITH THE RE<:lIST!'..R_OF WILLS____
SOCIAL SECUFlITY NUMBER
I(,'} -"O.IIRO
CHECK
APPRO-
PRIATE
BLOCKS
~ 1. Original Return
4. Limned Estate
6 OllCltd"nIO'ed T.,t.,'.
{Al1dCh copy 01 \'I'll}
9. Utlgatlon Proceeds Received
~: 2 Supplemental Return
4a. rUlUf"lnh,,,,\ICOlflpromIU
I""'" 01 dl'.llllOllel ,,,.12.821
7 Decedl'nl M,\lI1'","edIlLh.n!J TI>)\\
(Atl,,,h.lcopyolllu\')
10. Spau",1 1'0,,,'1'1' CrlHMldltl. 01 dth,lIl b"~..n
12.31-91and 1.1.9~'
8 :
8
011
Remainder Return
(date 01 death p"or 10 12.1J,82)
Federal Estate Tall Return ReqUired
Total Number of Sale DepOSit BOltcs
(Iecl,on 10 1.1.lmd.' S.c, 91131Al
tAlto1Ch ScIlC)
COR-
RE-
SPON
DENT
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jeffre C. Goos, Eo Ulre 221 E~st Chestnut Street
FIRM NAME (II Applicable) L~ncaoter, PA 17602
Hartman Underhlll & Brubaker LLP
TELEPHONE NUMBER
717-299-7254
$0.00 OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1)
2 Stocks and Bonds (Schedule B) (2) $0,00
J Clou,ty Hlltld Corporal,on. Parlnlltr5hlp or Sollt~Pn;lpr'ltlo"hlp (31 $0,00
4, M001ga9es & Notes Receivable (Schedule D) (4) $0.00
5, Cash, Bank DepOSits & Mlscellancous Personal
Prope,ty ISchedule EI 15) $148,436.3"
6 Jointly Owned Prope,ty (Schedule F)
o Separate 81111ng Requested (6) $0.00
RECA-
PITULA- 7, Inter-VIvos Transfers & Miscellaneous
TION Non.Probate P,ope,ty (Schedule G or L) (7) $0.00
8 TOlal Gross Assets (totalUnes 1.7) (8) $148,.1)6.34
9, Funeral Ellpenses & Administrative Costs \SChlltdullt HI(9) $0.00
10 aebllol OlltCed.nl. Morlgaglt liab,lIll.'. & Lien, \Schlltdu1ltll (10) $0,00
'1, TOlal Deductions (totalUnes 9 & 10) (11) $0.00
12, Net Value of Estate (line 8 minus Unc 11) (12) $148,436.J.I
lJ Charitable and Governmental Bequests/Sec 9113 Trusts for whIch an electJOn to talt (lJ) $0.00
has not been made (Schedule J)
14, Net Vllue SUbject to TaK (Une 12 minus line 13) 114) $148,436.34
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15, Amount ollme 14 la.abllta' 'he spousal l,,"
'ill.. 01 lransleflunder Sec.9"6(.1Il',21 $148,436.34 X 0 0 (15) $0,00
TAX 16, Amoun' 01 lmlt 14 l.1.ableal linlt.1I'l1le $0.00 X 0 0,06 (16) $0.00
COMPU- 17. Amountollu'lIt14t".ablealsiblongr"'lt $0,00 X 12 (17) $0.00
TATION 18, Amount ollin. 14 '''"Ilbl.. al COIl.1l..ull rate $0,00 )( .15 (18) $0.00
19, Tax Due (19) $0.00
20 0 I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I
>>BE SURE TO ANSVlER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH<<
o PA 15001
NTf 2!)7~~
Coprroghl2000 Gfllt"ll,tnd NlltlCO lP - Fonn, Soil....'.\' Cf"Y
I'A REV.T500 EX (0'00)
D~~ec!c':lt's Com(llete Address:
STREET ADDRESS. __n ___m______ ---,
-13.~\~ ec ~l_~_t_~t!~ t
PallO 2
_~Il_mb"rlill1Cl COllnly'_,
CITY
Cilrl iol"
Tax Payments and Credits:
1. Tox Duo (1'000 TUno 19)
2, C,oollslPoymonls
A. Spousal Povorty Cu"j,!
O. P,ior Payments
C. Discount
-IST^l-i~'---
I'A
IliP-- -
1'1013
(I)
$0.00
$0.00
$0.00
$0.00
TOlol C'OOlls (A + B + C)
(2)
$0.00
3, Inloro5VPoMlty II npplicablo
D. Inlorosl
E, Ponolly
$0.00
$0.00
(3) $0.00
(4) $0.00
(5) $0.00
(SA) $0.00
(5B) $0.00
TOlallnlooosVPonolly (0 + E)
4. If Uno 21s 0'00100 than Llno 1 + Uno 3. onlor tho dllloroneo, This Is tho OVERPAYMENT.
Check box on Page 1 Una 20 to request a refund
5, If Lino 1 + Uno 31s g,oolor than Uno 2, onloo tho dilleroneo, This Is Iho TAX DUE,
A, Enlor tho Intorost on tho lax duo,
B, Ento' Iho total of Uno 5 + SA, This Is Iho BAlANCE DUE,
MIlko Chock Poyablo 10: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 Did decodont mako 0 transfor and' Yos No
Q. retain tho use or income 01 tho proporty translorred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ I
' :: ::~:~~;o~~~~~~:~:~~:,~s~:~~~~I.US,~ Ih~p'~~ny~'~~~'~n~o',i~S,I~~~:,.,.",:::::::::::"
d. rocolve tho promlso for hie 01 either payments, benefits or coro? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. If doath oceunoo ollor Docombc' 12. 1982, did docooonl t,ansfor property Within one yoar 01 doalh
withoutrecoivingadoquateconsideration? .... ........ ............ ,.... ..,..... ,.,. ..... ..... 8 ~
3. Did decodent own an -in trust far- ar payabfe upon death bank account ar security ot his or her death? ~
4. Did decodent own an Individual Retirement Account. annuity, or other non.probate property which
eanlain. a bonollclary doslgnolion? ................,...........,.......,...,....,....,..,..
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of P9rtUI)', I declaro that I have oxamlnod this return including accompanying schodules and statements. and to the best of my
knowledge and bohol, It Is truo. correct and complete. Declaration 01 preparor othor than the personal reprosontative is based on Information of
which oreparer has ony knowledoe.
SIGNAflJ,RE OF PERSON RESPONSIBLE FOR FlUNG RETURN . DATE
L'\.)~'^-~~ \'I \(IA-:(" t/ -tru:5
ADDRESS O'
c/o 221 East Chestnut Street
SIGNATURE OF P EPA J;R ER THAN REPRESENTATIVE
0'>>
o
~
Lancaster, PA 17602
DATE
~ 1,0 /u3
I
Street
Lancaoter, PA 17602
rOt lUloS ol doalh on 01 aile' Juty I. 199" and belorttJanuarr I, 199~.ltlo tal rille HT'posod O'llhO rn>l...aluo ollranslo'$IO orlOllho \,so ollho surv,...,ng SPOUSfl'S 3....
112PS 19116,alll.l)(I)I
FOtdat" ol dealh on 01' anorJanuarr I. 199~, Ihel". role IS Imposed on lho nel...aluo 011f4ln510" to or loOtle use oHne SU"Mlng spouse IS O~.112 P S 191161011(1 1) (")1
Tho stalulo QQU...ollt~ alranslor 10 a sUf\'1vlng spousolrom I".. and lho sta~utory 1000lf&mOnts lor d'5ClosulQ cf a\Sa!s and I,:,ng a 1.<11 rDlum a'o stdl appllcablo ....en II
!he ,uf'V,....ng .pous. i.lh. only ben(lfoClarr
FOfdat.S ol death on or aft.rJuty 1,2000
The ta. ,ate iff'4)Oted on ItIe fie. ~a1u. ollransloll II'tlm II doceasod ctllld !\ItOtlI)'-onO ~oa" 01 aa" or yC/l,i"\JCI Al oe3tllto 01101 1M uso 01 II n3l1m,1 pa'ont. on odopll~e parenl,
OfUlllpJlllrenlolt!\echildl'l)"Y. 112PS 19116(a)(1211
Theil. 'Itelmpos&O on Ihe nOl valueolt,.n,I." to Of 10rlhO us. of lhe ooc9d6nfsl,,,oal bonO"CHI~OS IS" S... elct'pt 3S nOled ,n12 P 5 19116\121 112 P 5 '91161a)(11\
The la. fato Imposed on Ihe not ...aluoollransle" IOcr lor Itle un ollhodocodOf1I', "bllrO' 15. 11~. 112 P 5 191 Hi{a1\1 311 A SIDI,na IS dal.nod. uncle' Socli0f19102. as on In<hlC!val
whO hilS allollst one parenl.n common 1MItIII1o docodenl. Ythattl81 by blood 01 adopt,on
o PA15002
NTF 291!16
Coc.,-ngtlI2000 GroaI1and.'NalcO I p. ro'"'s So~"'a'U Only
j
~
IlIST WILL AND ~
OF
JaANN wnu:{
I, Ja1\NN ClJITON, a legal resident of south Middleton Taomship,
onnh<>.r1an:! coonty, PennSYlvania, beirq of soon::! an:! disposirq min1, meIl'Ory
an:l1.ll1derStarxii, do hereby uake, pJblish an:! declare this as an:! for my
Last will and Testament, hereby revokirq all other wills an:! codicils
heretofore made by me.
FIRST: I direct that all my just debts an:! funeral expenses,
includin;J my grave marker, shall be paid fran the assets of my estate as
soon as practicable after JIrf 0""""""""'.
SFXnID: I direct that all taxes that may be as~~=il in consequence
of my death, of whatever nature an:! by whatever jurisdiction imposed, shall
be paid fran my residuary estate as a part of the expense of the
administration of JIrf estate.
'IHIlID: I devise an:! bequeath the residue of JIrf estate, of fNery
nature an:! wherever situate, to TIrf husbarrl, MIOllIEL L. ClJITON, provided he
shall survive me by thirty (30) days.
},UJKW: Should TIrf husbarrl, MIOllIEL L. ClJITON, preder""""'" me or die
on or before the thirtieth day follc:r.ring my death, I uake the follc:r.ring
specific bequests:
A. To my daughter, Candy Ann Taylor, I bequeath all my
jewelry, TIrf jewelry boxeS, the contents of the cherry an:! maple
secretarY with fold d= desktop, and the freeS\:anl.i.rq ful1-1en;Jth
swivel mirror in white frame:
B. To my step-daughter, Jennifer ~ Cotton, I bequeath the
Chen:y an:! maple secretarY with fold d= desktop, arrj jewelry
foonerly C1;Il'led by JIrf l1\.1Sba1'lCl., an:l the jewelry box formerly ChII1ed by
TIrf lnJsban::l., Michael L. Cotton.
},'.u'll1: Should TIrf husbarrl, Michael L. Cotton, preder""""'" me or die
on or before the thirtieth day follc:r.ring my death, I devise an:! bequeath the
residue of TIrf estate, of every nature an:! whereVer situate, in equal shares,
to my daughter, Carxly Ann Taylor, an:! my step-daughter, Jennifer ~
cotton, provided that the share of either who shall preder""""'" me shall be
distributed to her issue, per stirpes.
srxm: I direct that the share of arrj beneficiary under the age of
21 years shall be held, IN 'lroST, ha.'eVer, by FAI<MEElS 'IRlST o:::MPANY, as
Trustee, to hold said share for the benefit of each said beneficiary un:ler
the age of 21, upon the follc:r.ring terms an:! corrl.i.tions:
A. To pay the inc:are an:! so much of the principal as may, in
the sole c:li.sc:retion of my Trustee, be J1e<:""'=ry for the
maintenance, sup[Xlrt, ncliCJ.1 ~ ard o:lumtion of eLlch
beneficiary.
B. 'ltle moount to be paid for the benefit of any of said
beneficiaries shall be detetmined fran tiJre to tiJre by the
need of each of said beneficiaries, an:! the aroounts an:! tilOOS
of said payments shall be detel:mined by such need. '!he said
payments may be made by JIrf TIustee directly to each of the
said beneficiaries, or to such of them as may be, in the sole
qJinion of my Trustee, of such age an:! ability to handle
prope'Xly the fun:1s so paid to such beneficiary, or may be made
by JIrf said Trustee directly to the person havirq the 01St0dy
an:! care of any of the said beneficiaries, or may be made by
I!rf said Trustee directly to arTf institution entitled to such
payment by reason of services rendered or to be rerrlered to
any of the said beneficiaries.
c. To pay the aC('lnmllated iro::me an:! principal then remainiIg
in its harxIs to the said beneficiaries, upon each
beneficiary'S at:tainin:J the age of 21 years.
D. Arrj an:l all payrre.nt or paymmts of arTf sum or sums,
whether in cash or in k.in:i, an:! whether for principal or
incare, payable to said beneficiaries, shall be made upon the
sole receipt of the respective beneficiary to whan the payment
is made, an:! free !ran anticipation, alienation, assigr1l1Elt,
attachment an:l pledge, an:! free !ran UJuw.u1 by the creditors
of any such beneficiary. All shares of principal an:! incare
herein given shall be free !ran anticipation, assignment,
pledge or obligation of arTf beneficiary, an:! shall not be
subject to any exeaJtion or attachment.
SEVENIH: I naninate, constitute arrl ~int I!rf daughter, CANDY ANN
'mYLOR, Executrix of this, my last Will an:! 'l.'est.aIoont. In the event of the
I'eI'II.lIX:i.ation, death, resignation or inability to act for any reason
whatsoever of the said CANDY ANN 'mYLOR, I naninate, constitute an:! appoint
F1.RMER3 'lRlST cntPAN'l, ExecUtor of this, JIrf last Will arrl Testament. I
hereby relieve I!rf ExecUtor or her suo:e"""'J:' fran the neoes"'ity of post.in;J
SeaJrity in connection with their duties as such in any jurisdiction in
which they may be called upon to act, insofar as I am able by law so to do.
m wrINESS lo.lill.{WF, I have hereunto set my han:i an:l seal to this, JIrf
last Will an:l'l'est.aIoont, consi.stAn:J of typewritten pages each of which
bears JIrf signature, this -:?...?.Nt:> day of ~....v(:./~y , 1991.
l~~
Jat\nn Cotton
(SFAL)
EXHIBIT "B"
\
h
ori~(\Ct\
,
I
CANDY ANN MARTIN, Executrix
Of the Estate of JoAnn Cotton,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: DAUPHIN COUNTY, PENNSYLVANIA
v,
: No. 4277-S-1997
: CIVIL ACTION-LAW
HERSHEY MEDICAL CENTER
Defendant
: JURY TRIAL DEMANDED
....,
e:.
""
....
L.
c::
,--
~
)>,
t::
'U
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",,:...::.,
L')
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ORDER
,,'
'It"",
. h
.....
..
-,
0/:"
Cl:l
AND NOW, this
11 day of July, 2003, upon consideration of the Amended
Petition to Settle Wrongful Death and Survival Actions, it is hereby ORDERED that:
I, Petitioner is authorized to enter into a settlement in the gross amount of $500,000,
2, Candy Martin, Executrix of the Estate of Joanne Cotton, is authorized to sign a Release,
and mark the above-captioned action settled, discontinued, and ended,
3, The following request for reimbursement of costs to counsel are DENIED:
In house photocopying
Postage
Tmvel
Lexis research
TelcphoncIFax
$1,954.19
$280,53
$ 1,596,00
$1,411.88
$722.14
Total non-reimbursed cost
to be remitted to
Wrongful Death and
Survival Actions
$5,964,74
4, The settlement proceeds shall be distributed as follows:
it'<?"-.:, ,,:, "
i:~,:i', .
~,..... ,
J ~. ./ "'0
~t:~:~"'; ',g
l'i1 ':C'f ':/ 1: 0.
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AllG U ~
Medical Care Availability and
Reduction of Error Fund
PENNSYLVANIA INSURANCE DEI'ARTMENT
.',nlmllr.
I;U,ull~C om~e (717) 70'.lHI
hl:.I10ffi,c (111)lU.76S1i1
l1.imOml~ (717)711.06'.
l'oIIC)'UOicC' {1I1J10S.lJU
10621.ancaMer Avenuc. Suite IS.F
Roscmonl. PA 19010
August 19, 2003
haWmDftIOfl'iu'
1 clrphonc (610) 101.'200
F.. (610)101.2211
Mnrk E. Lovell, Esquire
Hartman, Underhill & Brubaker
221 E. Chestnut Street
Lancaster, PA 17602-2782
RE: Cotton vs. Milton S Hershey Med, Ctr,
FUND FILE NUMBER: 026953-A
FUND CHECK AMOUNT: $200,000
CHECK PAYEE: Candy A Martin, Execx of Est of JoAnn Cotton, Deed & J ler Allys J lartman,
Underhill & Brubaker
Dear Mr, Lovett:
This is to con linn our recent settlement agreement in the above-referenced matter. The Medical Care
Availability and Reduction of Error Fund (the Meare "Fund") will make payment on this claim on December
31, or the last business day of2003,
In accordance with our established procedure, the Fund claim check for the above-reFerenced mailer will be
placed in the regular first class mail at 4:00 p,m, on December 31, 2003. IF your office address will change by
this date, or ifit is necessary to change the check payee, you must notify Joyce Helfrich at the Rosemont Claims
Office, in writing, no later than October 3, 2003 so appropriate changes can be made,
If you prefer, you or your duly authorized representative may pick up the claim check at the Rosemont Claims
Office or at the Harrisburg Office (address' above) between the hours of9:00 a.m. and 12:00 noon on
December 31, 2003, The check may be picked up in either office onlv by prearrangement, in writing, with
Joyce Helfrich at the Rosemont Claims Office, This letter must be received in the Rosemont Office no later
than December 10, 2003, In addition, this letter must identiFy your representative who will be picking up the
check. This representative must present a copy of your prearrangement leller.
If you have any questions or concerns regarding this maller, please do not hesitate to contact me at (717) 783-
3770 extension 201. '
<'"
Very truly yours,
J /rj/!I~
David L. Wortman ~"..::;
Allorney Examiner
DLW/jh
,
,
,
First Class Mail
ATTORNCYS AT LAW
221 CAST CHeSTNUT STRceT
LANCASTER. PENNSYLVANIA 17602.2782
-"
Ql-qb- 533
HARTMAN UNDERHILL & BRUBAKER LLP
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle. PA 17013-3387
FIRST CLASS MAIL
.-..
~~__~,:;~;,.,j;;;-';"..~,~.J;:.tH~;ki;~;fJ-"'~;;-;1.-;' ,
~"'f,..~,,"'~l,il!i"A""'#" '
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1:____AnDunt R.nllhd
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:iS4YEiC"FP-iilFlm--NilYicE--O,,-YtiHEii'iiANCE-YAX-'A-PPRAisEHENT-,--"i.i-oWANCE-OR'-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
JOANN FILE NO. 21 96-0533 ACN 101
/..5 -/ I,') - /..)
~ BUREAU OF INDIVIDUAL TAXES
INIIlNIlAHC[ lAM DIVISION
DfPl. Z8DbDl
IIANNls!lUWG, PA 11118'OhOl
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INIIERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
JEFFREY C GOSS
HARTHAN ETAL
221 E CHESTNUT
LANCASTER
ESQ
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
10-21-2003
COTTON
01-15-1996
21 96-0533
CUHBERLAND
101
ST
PA 17602
ESTATE OF COTTON
TAX RETURN WAS: I X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEHENTAL
1. Re.l Estate (Schedule AI
Z. stocks and Bonds (Schedule OJ
3. Clos51y Held stock/Partnership Interest (Schedule C)
4. Horta.ges/Notes Receivable (Schedule OJ
S. Cash/Bank Deposits/Misc, Parsonal Property (Schedule EI
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
NO. 01
RETURN
III
121
131
141
151
161
171
.00
.00
.00
.00
148.436.34
.00
.00
lBI
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral ExpansBs/Adn. Costs/Misc. Expanses (Schedule HI (9)
10. Debts/Hortgaga Liabilities/Liens (Schedule II (101
11. Total DeductIons
12. Net Value of TaK Return
13. CharItable/Governnentel Bequests; Non.elected 9113 Trusts ISchedule JI
14. Net Value of Estate Subject to TaK
.00
.00
1111
1121
1131
1141
DATE
NUHBER
INTEREST/PEN PAID I-I
U51 148.436.34 X 00 =
1161 .00 X 06 =
U7I ,00 X 00 =
UBI .00 X 15 =
U91=
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
'*'
II,.\U' III" 111.111
JOANN
DATE 10-21-2003
NOTE: To Insure proper
credit to your account,
subnit the upp.r portion
of this forn with your
tax paynent.
148,436,34
nn
148.436.34
.00
148,436,34
,00
,00
,00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCRI. YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIDNS,I
RESERVATIONt E.t,t.. of decedent. dying on or bafor. Oeca.bar IZ, I98Z .- If any future Intare.t In the ..tata I, transfarrad
In possa.slon or enJoy.ant to Class a (collateral) ben.flclarlas of the d.cedent .ftar the expiration of any a.tata for
llfa or for y.ar., the Co..onwealth hereby axprassly rasarves the right to apprals. and assass transfer Inharltanca Taxa.
at tha lawful Cla.s a (collatarall rata on any such future Int.ra.t.
PURPOSE OF
HaTICEl To fulfill the raqulra.ant. of S.ctlon ZI40 of the Inherltanca and Estat. Tax Act, Act Z3 of ZOOO. (1Z P.S.
S.ctlon 91401.
PA~ENT: Datach tha top portion of this Notlc. and sub.lt with your pay..nt to tha Raglster of Wills prlntad on tha rav.rsa .Ida.
--Nah chack Dr .onay ordu peyabla tal REGISTER OF HILLS, AGENT
REFUND (CAI: A rafund of a ta~ cradlt, which was not r.qu.st.d on the Tax R.turn, aay ba r.qu.stad by coaplatlng an "APplication
for Rafund of Penn.ylvanla Inh.rltanc. and Estata Tax" IREV-13131. Applications ara available at the Offlc.
of the Raglstar of Wills, any of the Z3 Ravanua District Dfflc.s, or by calling the spacial Z4-hour
.nswarlng .arvlca for foras ordarlng: 1-800-36Z-Z050, servlcas for taxpayer. with spacial h.arlng and I or
.peaklng neadsl 1-800-441-30Z0 (TT onlyl.
OBJECTIONS: Any party In Intarast not satisfied with the apprals.a.nt, allowanca, or disallowance of d'ductlons, or ........nt
of tax (Including discount or Inter.st) as shown on this Notlca aust Object within .Ixty 1601 day. of receipt of
this NoUca by:
--written prote.t to the PA Depart.ent of Ravanue, Board of Appaals, Dept. Z810ZI, HarriSburg, PA
--alactlon to have the .attar d.t.ralnad at audit of the account of the personal repra.antatlve,
--appaal to tha Orphans' Court.
11lZ8-lOZI,
OR
OR
ADMIN-
ISTRATIVE
CORRECnONS:
Factual arror. dl.covar.d on thl. as.ess.ent should ba addr.ssed In writing tal PA aapart.ant of R.venua,
Bur.au of Individual Taxes, ATTNt Post A..as..ant Ravl.w unit, a.pt. Z8060), HarriSburg, PA I11Z8-0601
Phon. (117) 787-6505. Se. paa' 5 of the bookl.t "Instructions for Inharltanc. Ta. Raturn fat a Re.ldant
Oacadent" (REV-ISO)) for an axplanatlon of adalnlstratlvaly corr.ctabla .rror..
DISCDUNTt
If any ta. due Is paid within thr.. (3) cal.ndar eonths aft.r tha decedent'. death, a five perc.nt (5%) dl.count of
the t.. paid I. allowad.
PEMALTY:
The 15% ta. aana.ty non-participation penalty Is co~uted on the total of the taw and Interast assas.ed, and not
paid before January IB, 1996, the first day after the and of tha ta. ..na.ty p.rlod. Thl. non-participation
panalty Is appaalable In the .... aanner and In tha the .... tl.e parlod as you would appaal the tax and Intare.t
that ha. baan ....s..d .s Indica tad on this notice.
INTERESTt
Inter..t Is ch.rged bag Inning with first day of dallnquency, or nlna 191 Bonths and ana III day froa tha data of
daath, to the data of p.y.ant. TaM's which beca.e delinquent be fora January 1, 198Z ba8r Intere.t at the rata of
.IM (6%1 parcant p.r annul calculetad 8t a dally rate of .000161\. All ta.e. which b.c... delinquent on 8nd after
January I, 198Z will bear Intara.t 8t a r8t. which will vary froa c.lendar y.ar to c81endar year with that rata
announc~ by tha PA Departaant of Revenue. Tha 8ppllcabla Intarest rates for 198Z through Z003 .ra:
Int.r..t Oalty tntanst Dally tnter..t
~~ Vaar....!!!!!....~ Vear....!!!!.!...
Vaar
OaUy
Factor
1982 ZO% .n05'B 19B7 OX .000Z47 1999 7X .aOOI9Z
1983 16% .ao043B 19B8-llJ91 11% .000301 zaoo OX .OaoU9
1984 11% .0nlDI 199Z 'X .oaozu ZaGl 'X .OOOZ'?
19115 15X .oao356 1993-1994 7X .00019Z ZOOZ oX .000164
19116 lOX .OaoZ74 1995-1998 .X .000Z41 Z003 SX .000137
nInter..t I. calculatad as follow'l
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF OAYS OELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. Issued aftar the ta. becoae. dallnquent will r.flect an Interest calculation to flftaen 1151 day.
bayond tha data of tha ..s..s.,nt. If pay.ant Is aade after the Interest co.putatlon data shown on the
Hotlc., additional Intarast aust b. calculatad.