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I'ETITION Hm PIWIIATE IIl1d <alANT 01' LETTEHS
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Ili'~isl"1 III Will\ rill Ihe
t'IlII1I1Y 01 Cumburll1ud___. ill Ihe
l'OI11IlHH1\\'l'allh of 1)t.'lInsyl\'i.lnia
Tht.' Pl'lilioll of lilt.' umk,...ip.llt.'d Il"pt.'l'llull~' 11'Pll"l'nl... Ihal:
YUlIf pl'liliolll'r("'I. \\ho i.. all' IN Yl'ill'" 01 OIl!l'lll nhkr illllhl'l'\l.'t.:ut rlx ------
illlhdaslllill or Ihe 011'0'" ,k,',',klll, dOlled Apr 11 3rd
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I>e~elllklll was dOllliciled OIl dealh ill __ Cumburll1nd.. .__. ._ COIlI1lY. l'ennsYlv~tnia, Wi~l i
ILis_____ lasl ralllily o'p,incipal residell~e at 1099._.Ri<lgeR,~~~. Sl!.~ppensburg. enney van a
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Ill" 'flfl'I, 1II1lllhl'l .IlIlIIlIlUldP,llll\1
I>e,'elllklll, Ihlll ..13..___.. yea,s or age, died .__q~~olJ"r._ .~.'-_.. .1997
OIl ._ -Tha- Ch/llllbur><burg.llospitaL ---.-.--- ___H. ...----
F'~el'l as rollOIlS. d~,'cdcnt did 1I011llallY, '"'' 1101 divllIeed alld did 1101 have a ~hild born or adopled
after t.'\l.',,'utioll pI' lhe \\ill offerl'd for prOhall'; \\a... nOlthl' \'il:lim 01 a killing and was nc\'cr adjudicatcd
int.:ollllll,.'ll'nt: _~____ __ ___________ ---.--.- ~-------.---..
D....('l..lH.klll al lkalh \1\\n....(j prnpl'r1Y \\ilh l'\til11i1ll'd \'ahu.:... a... follow...:
or dllmicikd in 1':1.) Allpe"nnal properlY
(I r lUll dutllkill'd in l'a,l Per~nnal propl'r1~ in Pl'lll1...yl\'~lI1ia
(II IHH dOlllidlcd in I'a,) Per'0I1al properlY in CnUlUY
\'ahll' lIt rl'i1I,,'\Wh.' ill PeI1l1"'~ h"ania
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pre'l'llled hl'rl.'\\ilh allllllll' !!r:lllt of klll'r,
lequeslls) Ih~ plllhale "I' Ihe lasl will and codicil(,)
Tes tamentury.___ _________
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1099 Ridge Road
Shipponsburg PA 17257
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OATil OF I'EnSONAL HEI'IU:SENTATIVE
COMMO\WI:,\I.T/I OFI'E\\SYI.\'Al\IA I
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tall\\.'I<,1 .11 Ihl' "hUH' dl'l'l'di.'r'l IW'ilillll"'I(') \\ill \\\"11 and truly adlllini...ll'r Ihl' e~tall' ac&.:ording (0 law.
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORD!
CERTIFICATE OF DEATH
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lAST I'iILL lIND TESTfIMENT
I, LEE N. IlOOZ, of the 'l'awnship of Ilopcwcll, County of CUlTberland and
Cam'Onwealth of pennsylvania, declare this to be ny Last Will and TeRtarrent
and revoke any will or codicil previously made by me.
ITEM I. - I direct that all ny just debts and funeral expenses,
including ny gravemarker and all expenses of ny last illness, shall be paid
from ny residuary estate as soon as practicable after ny decease as a part
of the expense of the administration of ny estate.
ITEM II. - I devise and bequeath all of ny estate of every nature and
wherever situate to ny wife, Martha E. Booz, providing she shall survive
rre by thirty days.
ITEM III. - Should ny wife, Martha E. Boe)Z, predecease rre or die on or
before the thirtieth day follCMing ny death, I devise and bequeath all of ny
estate of every nature and wherever situate to ny son, Larry L. Booz. If ny
said son predeceases rre, and ny wife shall have predeceased rre, then in that
event, I devise and bequeath all of ny estate of every nature and wherever
situate to ny grandson, Erick Booz.
ITEM IV. - I direct that all taxes that may be assessed in consequence
of ny death, of whatever nature and by whatever jurisdiction inposed, shall
be paid from ny residuary estate as part of the expenses of the administratio
of ny estate.
ITEM V. - I appoint ny wife, Martha E. Booz, Executrix of this ny last
Will. Should ny wife, Martha E. Booz, fail to qualify or cease to act as
Executrix, I appoint ny s";:,n, Larry L. Booz, Executor of this ny Last will.
ITEM VI. - In addition to the powers given ny Executrix by the laws
of the CamDnweal.th of Pennsylvania, ny r:xecutrix or substitute shall be
enpo..rered in her discretion to continue the operation of any business which
I own at ny death.
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ca.MJNWEAL'l11 CF PENNSYLVIINIA ::
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00UNTi' OF ClIMI3ERLI\ND
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We,
and
the witnesses whose I1ilIfeS are signed to the foregoing instnDrent, being
duly qualified acrording t.o law, do dcpo!)c and say that we were present and
saw testator sign and execute the instrurrent as his IlIST WILL; that he signed
willingly and that he executed it as his free and voluntary act for the
purposes trerein 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 tirre eighteen (18) or IIOre years of age and of
sourrl mind and under no oonstraint or undue influence.
SWorn or affirrred to and subscribed
and
., Mitnesses, this 3rd day
of April, 1979.
7' .
J Ld.J.,.J ~. jiJ....,..<J_
Notary Public )
My CaIrn. expires: \ .J...j ~ U f;L
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,
IN RE:
III THE: COURT or CO:.\xCN
PLEI\S 0: CUMBERI.A.'m COt::IT'l,
PE:NHS'i:'VANIA
BOOZ, LEE N.
~n Alleged Incapaci~3~ed
Person
ORPH:J:S COURT OI'JIS!Oll
No. 2.1 '16-60& ~
COY~10NWEALTH OF PENNS'iLVANIA
COUNTY OF -;), I ..I.A.
55.
Paul D. Oranqa, M.D.. bl!ing duly sworn according' to law,
deposes and says that:
-1. He io a licensed physioian with offices at 4225 Lincoln
Way East, Fayetteville, Penn$ylvania.
2. He haa been licensed to practice in Pennsylvania since _
\C\ ~'l.- and he i~ the attending physioian at the
Shippensburg Health Care Center of 121 Walnut Bottom Road,
Shippen~burg, Pennsylvania.
3. Hq ig the Attonding Physician at Shippan~burg Health care
Center for Lee N. Booz, an Alleged incapacita~ed person, who
has been a patient at the Shippensburg Health Care Center
since July 31, 1996.
4. He is familiar with the case and condition of Lee N. BooZ
because of his pe:'sonal examinaticn of him and r.is exa::lination
of medical records pertaining to him.
S. Within a reasonable dQqrae Ot ~e~ical certainty, LeQ N.
Booz is totally incapacitated and is mQntally and physically
unable to make or communicate responsible decisions concerning
his person or his estate, and he is in a comatose state.
G. His diagnosis of Lee ~:. 800% is:
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IN RE:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-GOG ORPHANS'COURT
IMPORTANT NOTICE
CITA TION WITH NOTICE
A petition hes been filed with this Court to have you declered an Incapaciteted Person. If the Court
finds you to be en Incepacitated Person, your rights will be affected, including our right to m8nege money
and property and to make decisions. A copy of the petition which hes been filed by
Martha F.. Aooz is attached.
You are hereby ordered to appear at a heering to be held in Court Room No.2, Cumberlend
County Courthouse, Cerlisle, Pennsylvania. on AUQust 20 , 19...2.Q., at 3: 30 -E...,M, to
tell the Court why it should not find you to be an Incepacitated Person and appoint a Guardian to act on
your beh81f.
To be an Incapacitated Person me8ns that you are not able to receive and effectively
evaluate information and communicate decisions and that you are unable to manage your
money and/or other property. or to make necessary decisions about where you will live.
what medical care you will get, OT how your money will be spent.
At the hearing. you have the right to appear, to be represented by en ettorney, and
to request 8 jury trial, If you do not have an attorney. you have the right to request tho
Court to appoint an attorney to represent you and to have the attorney's fees paid for you
if you cannot afford to pey them yourself. You also have the right to request thet tho Court
order that en independent evaluation be conducted as to your alleged Incepecity.
If the Court decides that you are an Incapacitated Person, the Court mey eppolnt 0
GU8rdian for you, based on the nature of any condition or disability and your copecity to
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IN RE:
.
.
.
.
.
.
IN THE COORT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
.
.
8002, LEE N.
An Alleged Incapacitated :
Person
.
.
.
.
ORPHANS COURT DIVISION
.
.
: No.21-96-606
.
.
Final Decree-Adjudication of Totally Incapacitated Person and
Appointment of Plenary Guardian
AND NOW, on lA)C(L1rJ-?..-u ,1996, on consideration of the
presented petition and after hearing held following due notice, it
is hereby ORDERED and DECREED that, based on a finding that LEE N.
BOOZ suffers a total coma from severe head trauma resulting from an
automobile accident and, therefore, is so severely physically and
mentally impaired that he is unable to make, communicate or
participate in any decision relating to his estate or person, LEE
N. BOOZ is adjudged totally incapacitated. MARTHA E. BOOZ is
appointed plenary guardian of the person and estate of LEE N. BOOZ
and she shall have all the powers granted to her in the Preliminary
Decree, dated August 6, 1996.
Within 12 months of the date of this decree and at least annually
thereafter, the respective guardians shall file with this Court a
report that includes all information as required pursuant to 20 Pa.
Cons. Stat. ~ 5521(c).
LEE N. BOOZ, has twenty (20) days from the date of th'
file exceptions. Failure to file exceptions within, t
result in this decree becoming final. . \
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REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C~MMO~VlVAN"
DEPARTMENT OF REVENUE
OEPT 28O"J01
HARRIS8URG PA t712l1OMI
Of:aDCNT'$ NAME jV.ST, flASI.1HJ t.IOOI.E Hrw.lloIM. ~ bIoci., ~...ulh
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o 4. Liml1ed ESIaIe 0 4a. Future Inleresl Comprolms'lI"~""""l.lI"J 0 5. Fed...1 Eslale Tax Retum Requited
1ZI 6. OecedentDied Toslale ""''''''..r~WIJ 0 7. OecedentMa~Ia~eda L.Iving Trusll'llxl>"",~T""'l _ 8. TolalNumbe,olSafe lleposJtBoxos
o 9. Utigalion Proceeds Received 0 10. Spousal PovertyCredrtl"~""_1I.11." ..,.,.9\1 0 11. EIectioo lOlax under See. 9113(A)l'llxI>Sc>01
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE OIRECTED TO:
NAME COMPlETE foWUNG ADDRESS
HAMILTON C. DA VIS ESQ 75 EAST KING ST
FIRM NAME III """""","I
JOEL R ZULLINGER HAMILTON C DA VIS. P.C. SHIPPENSBURG PA 17257
TElEPHQljE NUMBER
(717)532.5713
DATE Of fllATIt
o 3 /0 4 /1 9 2 4
THIS RETURN MUST BE FUD IN DUPLICATE WlTN THE
REGISTER OF WILLS
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89,794.53
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9. Funeral Expenses & Adm~istrallve Costs (Schedule H)
10. Debts clOeceden( Mor1gage (labilities, & Uens (Schedule I)
(9)
(10)
(8) ,3
2,637.77
5,268.19
(11)
11. Total DeductJonl(lOlal Unes9& 10)
12. N.t Valu. of Eltat. (Une 8 minus Line 11)
13. Charitable and Govemmenlal BequostslSe<: 9113 Trusts '0' which an e_n 10 lax has nol been
made (Schedule J)
14. Net Value Subject to Tex (Une 12 minus Line 13)
15.Amounlo'~ne14taxable 2 5 7 0 7 8 6
atlhespousaJlaxrale , ,
See inslnJclions on reve"" side 10< applicable pertenlage
16.AlMUntollinel4laxable 3 5 7 8 0 7
al6%rale ,
17. AlMUntolline 14 taxable
al15%rale
x .00
x .06
X .15
18. Tex Du.
19.
OFFK:1Al USE ONLY
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9,794.53
2 6 905 9 6
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292 888 5 7
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o 0 0
PA
17257
SClClALSECUUTY~
2 0 2 -2 0 -4 4 5 5
DAIEOIOlAHl
0/04/1997
24684
2,1 4 6 84
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Under pen~ a perJUry. I ded.n lI'lac I h.M e1nined II'lIS relum, indudll'lO ~Ylng SChedules a')d Slalements, <r1d kI 1M tlesl of my Iv'lowIedge a'lO be!oel. II is true. CCilT'eCt a')d c:cn'l;lIete. Oedcrabct\ of ~~.er
Itm thlt peI'SOnal represenlalM! IS based on" inlotmabon 01 vrfI(:h prepcret h:ts 3'1'1' kllO'Wll!dqe
SIGNATURE OF ERSDN RESPONSIB(E FOR FlUNG RETURN ADDRESS 1099 RIDGE ROAD
e SIIIPPENSBURG
ADDRESS 75 EAST KING ST
SIIlPPENSBURG
(IF N"PlJC'"AAE) SUMYIOO SPOuSE'S NN.IE l\.AST. FIRST. N(J LIDDlE ItITlAlI socw. S[CUUTY N..MJ[R
1. Real Eslale (Sd1edule A)
2. StocI:s and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
J. CIose~ Held COIporaIion, partn."hip 0' SoJe.Proprielolship
4. ~agos & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Misrellaneous Personal Property
(Sd1edule E)
6. Joinlly ().med Property (Schedule F)
7.rnlOr.VIVOS Trans!e" & Miscellaneous Non.probale Property
(Sd1edule G 01 L)
8. Total Groll Allots (lOlal Unosl.7)
PA
17257
DATE ~ /
7 (,Itj~
OAT} Iv !7r
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Decedent's Com lete Address:
51REEl AOORESS 1099 RIDGE ROAD
alY SllIPPENSnURG
SlAlE PA
n1' 17257
Tax Payments and Credits:
1. Tax Duo (Pago 1 Uno 18)
2. CrodltslPaymonls
A. Spousal PovOf1y Credil
B. PrlOf Payments
C. Dlscounl
(1)
2,146.84
3. IntoresVPenally if applicablo
D. Intorest
E.Penalty
Total Credils (A + B +C) (2)
TOlallnteresVPenally ( 0 + E) (3)
4. If line 21s greater than line 1 + line 3, enter the dilference. This is the OVERPAYMENT.
Check box on Plgl1 Une19to requelt I refund (4)
5. Iflino 1 + line 3 is greater than line 2, enter lhe difference. This Is the TAX DUE. (5) 2,146.84
A. Enter the interest on the tax due. (SA)
B. Enterlhetotal of Une 5 + SA. This is the BALANCE DUE, (5B) 2,146.84
Make Check Payable 10: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old decedent make a transfer and: Yes No
a. retain the use or Income of the property transferred; ..............................................................0 00
b. relaln the right to designate who shall use Ihe property Iransferred or Its Income; ................. 0 00
c. retain a reversionary Interest; or ..............................................................................................0 00
d. receive the promise for life of either payments, benefits or care? ...........................................0 00
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ............................................................................................... 0 00
3. Old decedent own an "In trust for" or payable upon death bank account or security
at his or her death? .......................................................................................................................0 00
4. Old decedent own an Individual retiremenl account, annuity, or other non.probale property? .....0 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
72 P.S. ~9116 (a) (1.1) (I) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use oflhe
surviving spouse from 6% to 3% for dales of death on or after July 1, 1994 and before January 1, 1995.
72 P.S. ~9116 (a) (1.1) (Ii) provided for Ihe reduction of the rate Imposed on the nel value of transfers to or for the use of the surviving
spouse from 3% to 0% for dalas of death on or after January I, 1995. The statute does not exemDt a transfer to a surviving SPOUSB
from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse
Is the only beneficlary.
FOR DATES OF DEATH ON OR AFTER JANUARY 1,1995. Please answer the following question by placing an "x"'n the
appropriate space.
Old the decedent create a trust or similar arrangement which Is soley for the surviving spouse's benefit for his or her enUre
IIfeUme? Yes 0 No 00
If you answered yes to the above queslion, the tax on the trust or similar arrangement is postponed unlil thB death of the second
spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficlary(ies). Enter the vBlue of the trust on
Schedule J, Pert II, In order to remove it from the calculation of the tax dua In this estale. You may wish to file Schedule 0 In order to
make the election evailable under Section 9113. If the election is made, the trust or similar arrangement Is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must
aUach Schedule 0 to a tlmely.fiIed tax retum, along with Schedule(s) K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
,
.-- . ..,..- -....,..... ._-... ' -
~
; I "
j ViiSWIICKS'
RIFE MOTOR COMPANY,INC.
768 H. fronklln 51.' (homblllbu10. PA 17201 .
PHONE: 17171263.8518
fAX: 17171. 263.4293
(lJIIJIIN\ -(It(11lW
OII\nlIl:iUll\
I'~
".
1/ ~ I??
,,'.
:'1
1j; (JAOir\ It 117 CChce>rn:
S"-hivc'1: ~Sf,~17df~' a/tie 0:F -lie ~/loW/i'1
,.
..
r; 8ts:. ;,~
"
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'tf/''I F -rJl ~WK I'PCc.!i07K r1/~:E ,S6,()OO
~ 1'1?'1 0cs t erll Sidr True' fo r -:J1: tt ":",,
'. .
H:
J1cde / f?CLj p- siI-! ~0K PIXie If J e I< 93S"J3/ ,; 36 J 00,0
~ 1773 (),'d~ond' }(eo Jtd(:'tOr- #:;
l1()de I C IJ. 0 <; 'i 0137 .rN' / L? 9 CC J/ S'.~ f' /()() f,;,l'~
.8'~S"J 00-0
S) /9P'I f)"~ mond ' RC!o
/'1oc/e / ell6 ~'t 0 F r
'7f.dct" V" .:ti=.5
SIN /0 '1J..c. (It' / IE. /oo9'~.9.E
,; 7/)00
(!)
Jrl1 J'}JCk 1{.aefor
J'1()cle( ~lUSi d'J/.S r
#1
slAt/ /1 j, () ~ / oS 1'.3 '! .11 ()OIRJ!J
@) /9'Jf 11 a~k If'U;fr;/' :J;f (.
J1or/eJ ;e'J'6ST ..vIV Rt;/.1.ST /'1"&
'.,It' S'()~a
~_D"'~ '*
tDUlIOHWEALTH or PENNSYLVANIA
IIKRlIAHCE TAXRETURH
RESIDENT DEaDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUM8ER
Boaz LEE N 21 96 0606
Indude 1110 proceeds olltlglllon Ind 1110 date 1110 pIllalOd. WIf1II1lClIIIod by 1110 esllte. An ptOperty jointly_ad wlth thl right 01 lurvlvol1hlp mUlt be dlstlolad on &chtdult F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. OlTSlown Bank IRA n 093 35,780.71
son. Larry L, Booz was designated as beneficiary
2,
Payment Due from Erie Insumnce
2,500.00
3.
Payment Due fTom Erie Insurance
5,000,00
4,
Annuity account #211-417 Erie Insurance. Qualified Relirement Plan, designated beneficiary
was spouse, Martha E. Booz.
3,299.49
5,
Zurieh Kemper SEP Annuity, contract #k005382869, designaled beneficiary was spouse,
Martha E. Booz
42,714.33
6.
Miscellaneous Personal Effects
500.00
TOTAL (Also enler on line 5. Recapilulalion) $
(If more space Is needed, insert additional sheels of the same size)
89,79453
~. ... ..- ... --. .... "- .
,
THIS PAPER INCLUDES" WATERMARK WITH VISIBLE AeERS. TIllS PAPER INCLUDES" WATERMARK WlTIl VISIBLE AeERS.
,.. ell 00 ,.. ell
0- ell , ~ 0- ell 00 ,~
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LI. 1-l.!lj:Q 1tI 1-1.!Ij:Q I III 1tI
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C I-MZ Z ~ ..a Z I-MZ Z III ..a
z Ula:1Il ~>-I- .1 <Z: Ula:1Il III >-1- .1
~~ <Z: III ~ :Cl-<Z: .. ~~ 1Il III ~ :Cl-<Z: ..
UI O-~ >-a:1:l " ::l O-~ >-a:1:l .
~~ :I 1Il00toI <Z:<Z: ~~ Cl 1Il00toI <Z:<Z: -
Q :tell:t c.ll.~ ::c :tell:t ~~1Il
:J' :t I-..UI U :J' I- I-..UI U
~g I- ..11-... cn~ ..11-...
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Q L- za:a: > L- za:a:
ffii :I w II: M"'~ ffii ... w II: toI"'lIl
l- i: w IL Ll.Ll.lIl I&. i: w IL Ll.LI.lIl
C 0 C 0
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0 0
II. u. II.
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tof,lIoIOIfflEATH Of PEHHSYLV/JM
IHHERITANCI:TAXRETURH
RESIDENT DEaDENT
4...... ,,_.... r' ~...
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
BOOl LEE N
"Ill'''. WlI madt Joint wlthln on. Y"I 01 lb. dtctd.nr. data 01 duth, "mult be rtporlJd on Schldule 0,
FIlE NUMBER
21 Q6
0606
SURVMHO JOUIT TEHAHTIs) NAME
A. Martha E. Booz
ADDRESS
RELAnllNSIIP TO DEaDEHT
1099 Ridge Road
Shlppensburg PA 17257
spoUle
B
c
JOINTLY.QWNED PROPERTY:
LETTER DATE DESCRIPTION Of PROPERTY %Of DATE Of DEATH
ITEM FORJOlNT lIADE _.....~_.._.-l_o::auIIIIUl1'iIlWOI_'*'bIyW'ognuntlOt.AIlad1 DATE Of DEATH DECOS VALUE Of
HUlIBER TEHAHT JOUIT dood .. joinIlr-l'old ... ,,_ VALUE Of ASSET INTEREST DECEOEHTS INTEREST
1. A. various The decedent owned various items jointly with his spouse 0.00 O. 0.00
Martha E. Booz. who survived him
TOTAL (Also enler on linB 6, Recapilulalion) S 0.00
(II more space is needed, insert addilional sheels of the same size)
""',........."... ...:-
...."IlI.,,'" ~_
. '~
~THOF PEHHSYLVAIM
IltlEIUlAHtE TAXRETURH
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
BOOZ LEE N
21 Q8
0606
Debb 01 dtctdlnl mUll be llporlld on Sehldul. t
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
6,634.00
1.300.00
324.49
1.
2.
3.
FUNERAL EXPENSES:
Fogelsanger Bricker
Cemetar}'
Church, food and flowers
B. AOMINISTRA TIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Rep<esentaliYe (s) waived
SocIal Sewrlty Numbef(s) I EIN Number of Pel1Oll8l Representali'le(s)
S1reet Address
State
ZIp
2.
3.
CIty
Year(s) COmmissIon Paid:
Allllmey Fees Hamilton C. Davis, Esq.
Famiy Exemption: (II decedents address Is not the same as claimants, a!taCh IlIptanalion)
Clainant Manha E. Booz
S_Address 1099 Ridge Road
CIty Shippensburg State PA
RelationShIp of CIaImanIIO Oea!dent spouse
ZIp 17257
9,000.00
3,500.00
4.
Probate Fees Cumberland County Courthouse
264,00
5. Aa:Iluntants Fees
6. Tax Relum Preparefs Fees
7,
8,
9,
Legal Advertising. The News Chronicle
Legal Advertising. Cumberland Law Journal
Reserves for contingencies
55.28
60.00
500.00
TOTAL (Also enle. on line 9, Recapilulation) $
(If more space Is needed, inSer1 additional sheets of the same size)
21,637.77
COMMONWEALTff or PENNSYLVANIA
DEPARTMENT OF REV[t4UE
eUREAU OF INDIVIDUAL TAXES
OEPT 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
~'Jt.,~
~
NO. AA 2963 96 "[V 116> EX "'961
RECEIVEO FROM:
I
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
HAMILTON C DAVIS ESQUIRE
10'
.,,~. 1tJ.J... ~la
75 EAST KING STREET
SHIPPENSBURG, PA 17257
FOlDtl[AE
FOlD ilEnE
ESTATE INFORMATION:
FILE NUMBER
Pl-1QQI-.-06()1-.
NAME OF DECEDENT (LAST)
Bon7 I ~~ N
DATE OF PAYMENT
7 tn7/1 Q99
POSTMARK DATE
7/01-./1 QQI'l
COUNTY .
C:C:N POP-PO-4!t5"1
IFIRST)
IMII
"
CIIMR~RI tlNn
DATE OF DEATti
TOTAL AMOUNT PAID
$2,146.84
vz
r.l_G:~~"rLF1 ():- \\iLl_S
~.....
RECEIVEO 8Y /,//; I j , /
. ,_ ~. ,/, I" I' ~",/.1
MARY C. LEWIS . . /.
,. Ii II.' "
REGISTER OF WILLS
j
REMARKS MARTHA E BOOZ
HAMILTON C DAVIS
SEAtCHECKII 8913
ESQUIRE
. .
,................
~. ~.M~~ _'~'u~ '1:'
BUREAU Dr INDIVIDUAL TAXES
INH[RlTANC[ TU DIVISION
I)[P1. 1106'1
HARAI5IUAG, Pi 111%'."01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE Ocr
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
9 7998 ~
'@N'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-05-1998
BOOZ
10-04-1997
21 96-0606
CUMBERLAND
101
A-.nt R_ltted
HAMILTON C DAVIS ESQ
75 EKING ST
SHIPPENSBURG PA 17257
'1'.,..,..,,, 1""'"
lEE
N
KAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
itEY:i54r'EX-jiFP-fiiF97T"iicific'E--On-NHE'Rii'ANCE-TAX-APPRAiSEHENY-,--ALLOWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOOZ LEE N FILE NO. 21 96-0606 ACN 101 DATE 10-05-1998
TAX RETURN WAS I I X I ACCEPTED AS F:LED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Estat. ISchedul. Al
2. stocks and Bonds ISchedul. BI
3. Clos.ly Hald Stock/P.rtnership Int.r..t ISchadula CI
ct. Hortg.gu/Hota. Rec.lvabl. ISchedul. 01
S. Cash/Bank Deposits/Hi.c. Personal Property (Schedule E)
6. Jointly Owned Property ISchedul. FI
7. Transfers (Schedule 0)
8. Total Als.t.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.ral EXPans.s/A~. Costs/Hisc. Expanse. (Schedule H)
10. Oabt.lHortgag. Liabllitl.s/Li.n. ISch.dul. II
11. Tot.l Daductlons
12. Hat Valus of Tax R.turn
13. Charltabl./GoY.~ant.l Bequests; Hon.elect.d 9113 Trust.
1", Hat V.lus of E.tat. Subject to T.x
I I CHAHGED
III
121
131
1"1
ISI
161
171
.00
.00
230,000.00
.00
89,794.53
.00
,00
181
NOTE: To insure proDa...
credit to your account,
oubait the upper portion
of this fono with your
tax pa_t.
319.794.53
?6.9n~ 96
292,888.S7
.00
292.888,57
If an assessment was issued previouslY, lines 14, IS and/or 16, 17 and 18 will
reflect figures ~hat include ~he total of ALL re~urns assessed ~o date.
ASSESSMENT OF TAX:
15. A.aunt of Line 14 at Spousal rat. 11S)
16. A-ount of Line 1" t.xabl. at Lin..l/Cla.. A r.t. 1161
17. A-ount of Line 1" t.xabl. .t Coll.t.r.I/CI..s e rat. 1171
18. Principal T.~ Due
NOTE:
TAX CREDITS:
PAYHENT
DATE
07-06-1998
RECEIPT
HUllBER
AA296396
DISCOUNT It I
INTEREST/PEN PAID I-I
.00
191
1101
21.637.77
5.268,19
1111
1121
1131
11"1
I Sch.dule J I
257,107.86 x.OO:
35. 7ilil. 71 X. Db.
.00 X .IS:
1181
AIl0UNT PAID
2.146.84
BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-07-1998 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
2.146,11"
.00
2.146.84
2.146.84
,00
1. 06
1. 06
. Ir PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl. YOU MAY eE DUE
A REFUND. c.. PEVERSF SIDE OF TNIS FOHN FOR INSTRUCTIONS.l
IS' ,.Vi I --~,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
IHltl:NIlANC[ lAM DIVISION
DEPt. 0'80bDI
HARRISBURG, Pi 1710'S-ObOl
NOTICE or INltERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
or DEDUCTIONS AND ASSESSHENT Of TAk
('
HAMILTON C DAVIS ESQ
75 EKING ST
SHIPPENSBURG PA 17257
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-05-1998
BOOZ
10-04-1997
21 96-0606
CUMBERLAND
101
AMount Renitted
*'
"'-Ihl" AI, I,t.".
LEE
N
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiE"v:is4i-EX-jiFP-[o'F97Y-iiiiiicE--OF-i-NHEiiii'ANCE-TAX-"A-PPRAisEHENT-,--jiLl.-OWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BODZ LEE N FILE NO. 21 96-0606 ACN 101 DATE 10-05-1998
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. (Schedul. Al
2. stocks and Bonds (Schedule BJ
3. Closely Held stock/Partnership Int.rest (Schedule C)
4. Hartg.g../Notes Receivable (Schedule OJ
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule GJ
8. Tot.l Asset.
(1)
121
131
I~l
ISI
161
(7)
.00
.00
230.000.00
.00
89,794.53
,00
.00
lBI
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H)
10. nebts/Hartg.ge Liabilities/Liens (Schedule IJ
11. Total Deductions
12. Net Value of Tax Return
13. Ch.rltable/Governnental Bequests; Non-elected 9113 Trusts ISchedule J)
14. Net Value of Estat. Subject to Tax
21.637.77
5,268.19
llll
1121
1131
1141
191
IlOI
NOTE: To insure proper
credit to your account,
sub..i t the upper portion
of this for.. with you~
tax paYllent.
319.794.53
'~.90~ 9~
292.888.57
,00
292.888.57
If an assessment was issued previously. lines 14, IS and/or 16, 17 and lB will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
1S. A.ount of Line 14 at Spousal ~ate lIS)
16. Allount of Line 14 texable at Lin.al/Class A ~at. (16)
17. A.ount of Line 14 taxable at Collat.~al/Class 8 rate 117)
18. PrincIpal Tax Due
NOTE:
257,107.86 X' 00=
35.780.71 x' 06=
.00x.15=
Ile)
TAX CREDITS:
PAYHENT
DATE
07-06-1998
DISCOUNT It I
INTEREST/PEN PAID 1-)
.00
RECEIPT
NUHBER
AA296396
AMOUNT PAID
2.146.84
BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-07-1998 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
2.146.84
,00
2,146.84
2.146.84
.00
1,06
1,06
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS TNAN $1. NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY eE DUE
A REFUND, SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS,)
RESERYATlDH:
PI.IlPOSE or
HaTlCE :
PA'ftIEKT:
REf1ICD(CRJ:
DeJECTIONS:
ADMIN
ISTUTlVE
CORRECTIONS:
DISCDUHT:
PENALTY:
INTEREST:
~ -. .-. ".
t;:
Cl'
E.t.t.. of ~t. dYlna on or b.for. o.c.-ber 12, 1982 .- If any future Inter..t In the e.tat. I. tr~.ferred
In po.....lon or enjo~t to Cia.. e (collat.ral) beneflclarl.. of the dec.dent .ft.r the .xplr.tion of any ..tat. for
Ilf. or for y..r., the ~Dlth her.by .xpr...ly r...rv.. the right to appral.. end ...... tran.f.r Inheritance l.x..
.t the lawful Cia.. I (collat.r.l) rat. on any .uch future Int.r..t.
To fulfill the r.qulr..ant. of Section 21~0 of the lnherltanca end E.tat. tax Act, Act 21 of 1995. (72 P.S.
s.ctlon 9140).
DetlCh the top portion of this Notice end sUb.lt with your payaent to the Register of Will. printed on the r.v.r.. slda.
...... chack or .oney ord.r paYable to: REGISTER OF WILLS I AGENT
A rofund of D tax crodlt, which wos not raquGstod on tho Tax Return, .ay be reqw.ted by c~l.tlng en """"lIcetlon
for R.fund of PennSYlvania Inherltanc. end E.tat. lax" (REY.1313). Applications ar. .vallabl. at the Offlc.
of the Ragl.ter of Will., any of the Z3 Revenue District Offices, or by call1na the spacial Z4-hour
an.warlng ..rvlta nuaber. for for.. ordering: In Pennsylvanl. la800-36Z.Z050, out. Ide P.nn'Ylvanla and
within loc.l Harrl~rg ar.. (717) 787-8094, TDDI (717) 77Z-ZZ5Z IHe.rlng IlPalred Only).
Any p.rty In Intar.st not s.tlsfh.d with the appral...ent, .llowanc. or disallowance of deductions, or .....ltIant
of t.x (Including discount or Int.r..t) a. shown on thl. Notice .u.t object within .Ixty (60) day. of r.c.lpt of
thb Notice by:
..wrltton prot.st to the PA D.part.ent of Revenue, loatd of Appeal., Dept. Z810Z1, Hatrl5burg, PA
...l.ctlon to have the .att.r d.t.r.lnod at audit of the .ccount of the par.onal rapr..ant.tlv.,
..appa.l to the Orphan.. Court.
OR
171Z8-1021,
OR
F.ctual .ttot. dlscov.r.d on thl. .......ent .hould b. addr....d In wtltlng to: PA D.part..nt of R.v.nue,
Bur.au of Individual taxe., ATTH: Po.t A.......nt R.vlew unit, D.pt. Z80601, Hartl.burg, PA 171Z8-0601
Phone (717) 787.6505. Se. pege 5 of the bookl.t "In.tructlon. for Inheritance Tax Raturn for. R..ld.nt
Decadant.. (REY-ISOl) for an explanation of ~lnl.tratlv.lY correctable arror..
If any t.x due I. paid within three (3) cal.ndar .onths aft.r the dee.dent.. d..th, . flv. parcent (SX) dl.count of
the tax paid Is allowad.
the IS;( tax -.sty non.partlclp.tlon penalty Is coaputed on the total of the tax and Inter..t ....ned, Bnd not
paid before Janu.ry 18, 1996, the flr.t day .ft.r the end of the tax 8808.ty period. lhls nonapartlclp.tlon
penalty Is app.alabl. In the .... .annor and In the the .... tI.. p.rlod as you would appGal the tax end Int.rnt
that has bHn a...nad a. Indlcat.d on this notlc..
lnt.r..t I. charged beginning with first day of d.llnquency, or nine (9) aonths and uno (1) day froe the data of
de.th, to the data of p.yaant. l.x.. which beea.e d.llnquent before January 1, 1'8Z be.r Int.r..t at the rate of
.Ix 16X) percent par ~ c.lculat.d at . dally r.te of .000164. All t.x.. which b.ca.e d.linquent on and aft.r
January 1, 198Z will be.r Int.re.t at a rata which will vary fro. cal.nd.r y..t to cal.ndar y.ar with that rat.
announced by the PA D.part..nt of R.venue. Th. appllcabl. Int.r..t rat.s for 198Z through 1998 .t.:
~ Int.r.st R.t. D.lly Int.r..t Factor !!!! Int.r..t Rllt. Dally tnt.r..t Factor
1982 ZDX .OOOS48 1987 'X .000Z47
1983 \6% .000438 1988-1991 IIX .000301
\... IIX .000301 \992 'X .000Z47
1985 \1% .000lS6 1993.1994 n .00019Z
\... lOX .000Z74 1995-1998 9> .000Z47
ulnt.r..t 1. c.lculated a. follow.:
INTEREST = BALANCE or TAX UNPAID X HU"BER or DAYS DELINQUENT X DAILY INTEREST rACTDR
..Any Notlc. I..ued .ft.t the tax b.c~. delinquent will t.flact an Int.r.st calculation to fifteen 115) d.y.
beyond the data of the a..a...."t. If p......nt Is .ado IlIft.r the Inl.nst caputatlon date .hown on the
Notlta, addltlONlI Int.r..t aust be calculated.
IN RE:
BOOZ, LEE N.
An Alleged Incapacitated
Person
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSLYVANIA
ORPHANS COURT DIVISION
.;(/- 9" -l'D Db
No. 1996
ORDER OF COURT
PRELIMINARY DECREE FOR EMERGENCY AND PERMANENT GUARDIANS
AND NOW, this ...Lr;!!day of ~l( 1996, upon filing, presentation,
reading and consideration of the within Petition and after
examination of the PETITIONER, it is hereby ORDERED and DECREED:
1. MARTHA E. BOOZ, wife of LEE N. BOOZ, is appointed
Emergency Guardian of the Person of LEE N. BOOZ, an alleged
incapacitated person, commencing upon the issuance of this decree
and continuing for a term of 72 hours; however, the term of this
appointment can be extended for an additional twenty (20) days, if
the emergency circumstances continue. The emergency Guardian of
the person shall have the following powers, in addition to any
otherwise granted by law to a plenary guardian of the person:
To handle all issue and matters pertaining and relating
to the person of LEE N. BOOZ, specifically including but
not limited to: his living arrangements, his medical and
psychiatric care, the administration of medication to
him, the employment and discharge of physicians,
psychiatric care, the administration ot medication to
him, the employment and discharge ot physicians,
psychiatrists, dentists, nurses, therapists and other
professionals for his physical and mental treatment and
care.
2. MARTHA E. BOOZ, wife of LEE N. BOOZ, is appointed
Emergency Guardian of the Estate of LEE N. BOOZ, an alleged
incapacitated person, commencing upon the issuance of this decree
and continuing for a term of 30 days, unless extended or made
permanent by further Order or Decree. The Emergency Guardian of
the Estate shall have the following powers, in addition to those
otherwise granted by law to a plenary Guardian of the estate:
To handle and manage all aspects ot the estate of
LEE N. BOOZ, specifically including but not limited to:
a. His cash, checks, and any bank or savings
accounts held in his name. his stocks and bonds, his
personal property including motor vehicles, his real
estate, his life and other insurance of which he is a
beneficiary, his entitlement to any governmental and non-
governmental benefit plans, federal, state, and local
taxes, claims made or to be made on behalf of him or
against him, the execution of documents, entry into
contracts affecting him and the payment of reasonable
compensation or costs to provide services for him.
b. To continue the operation of any business in
2
which LEE N. BOOZ may be interested or engaged
(regardless of the form or organization of any such
business, whether the same be a sole proprietorship, a
partnership or a corporation). The Guardian shall have
all the rights and powers in connection with such
business as LEE N. BOOZ personally would have, including
by way of example and not limitation: the powers to
operate or join in the operation thereof as a going
concern: the right to change the form of any such
business by the reorganization or incorporation thereof
or the formation or reformation of a general or limited
partnership with respect thereto: and also including the
right to invest in any business or make agreements for
the utilization in any business or lease to or in
conjunction with any business any of the property of LEE
N. BOOZ for such periods of time and upon such terms and
conditions and to liquidate or sell the same or any part
thereof, all as the Guardian shall deem advisable for the
best interests of the Estate, without any liability for
loss resulting from the operation of such business except
where such is the result of gross negligence or fraud on
the part of the Guardian. In connection with the
continued operation of any business, the Guardian shall
be entitled to receive such compensation as may be
commensurate therewith and is specifically authorized and
3
empowered to engage the services of such persons as may
be reasonable necessary or desirable to provide legal,
accounting and business management expertise to or for
such business and to engage employees and agents therefor
and to agree for the compensation of Guardian provided
for above. The rights and powers granted to the Guardian
shall be exercisable without court approval and without
the need to post any bond or security.
3. The Clerk of the Orphan's Court shall issue a citation
upon the next of kin of LEE N. BOOZ, the alleged incapacitated
person, to show cause for the following:
a. Why Emergency plenary guardians of the person and
estate of LEE N. BOOZ should not be appointed:
AND
b. Why the alleged incapacitated person, LEE N. BOOZ,
should not be adjudged an incapacitated person and permanent
plenary guardians of his person and estate should not be
appointed.
4. An evidentiary hearing on the request for emergency and
permanent plenary guardians shall
(do,l(.~ /1 cio!kin Courtroom No.
i] l(J tJ.
Pennsylvania, on the-?C) day of
o'clock
(II) .
(prevailing
4
be held before the Honorable __
Q , Courthouse, carlisle,
(JH J l.W--' - 19 9 &. , at .i3. (J
time).
5. Relative to the request for permanent/emergency guardians,
the Petitioner shall cause certified mail service upon the next of
kin of the alleged incapacitated person with the following:
a. A copy of thePetition for appointment of emergency
and permanent plenary guardians.
b. Notice of the time and place of the evidentiary
hearing.
c. citation with rule to show cause why
emergency/permanent guardians should not be appointed for the
alleged incapacitated person.
6. Because of time constraints resulting from emergency
conditions and pursuant to 20 Pa. Cons. Stat. Section 5513, the
court finds the provisions of 20 Pa. Cons. Stat. Section 5511 are
not feasible under the circumstances and are hereby waived: except
to the extent provided for herein.
7. Because of the condition of the alleged incapacitated
person, LEE N. BOOZ, his presence at the above scheduled hearing is
waived.
B. Because of the circumstances, unless an objection hereto
is filed by the next of kin of LEE N. BOOZ within 10 days of the
notice to them, medical evidence of the condition of LEE N. BOOZ
may be submitted at the hearing by Affidavit or Written Answers to
5
Interroqatories.
9. The emergency guardianship ot the person may by extended
tor up to
a turther
20 additional days, without he~ng,
pet! t!on to the Court. /' 1/
By The Cpurt: I
I .
Upon submission ot
J.
I
.
6
of his accident.
4. The alleged incapacitated person was injured in a motor
vehicle accident on June 16, 1996, and as a result of severe head
trauma injuries received in that accident he has been and remains
in a continuous comatose state and is totally unconscious. There
is attached hereto as Exhibit "1" an Affidavit of Dr. Johnathan E.
Rhoades, M.D., the attending physician, setting forth the condition
of and prognosis for the alleged incapacitated person.
5. As a result of the comatose and unconscious state of the
alleged incapacitated person, there is both immediate and permanent
need for guardians of the person and estate of the alleged
incapacitated person, as will more fully and completely explained
in the allegations below.
6. There is attached hereto and labeled Exhibit "2" a
conformed copy of the Last will and Testament of the alleged
incapacitated person. The original will is in the custody and
possossion of the PETITIONER. To the best of the knowledge,
information and belief of the PETITIONER, the alleged incapacitated
person has never executed any Power of Attorney nor any Health Care
Declaration.
7. The next of kin of the alleged incapacitated person are
set forth on a list which is attached hereto and labeled Exhibit
11311.
8. To the extent known by PETITIONER, the sole assets of the
alleged incapacitated person consist of the wrecked motor vehicle
2
(which has been totaled by the insurer) and other motor vehicles as
shown on the attached Exhibits "4A", "4B" and "4C". The total
estimated value of these sole assets is approximately $304,794.
9. The alleged incapacitated person, together with
PETITIONER, operated an unincorporated milk transport business
under the business name of "LEE N. BOOZ MILK HAULING". The
PETITIONER worked daily in the business with the alleged
incapacitated person, is a joint owner of all bank accounts and
other business assets (other than the motor vehicles described
above), and is the person who has for 20 years taken care of all
banking and financial parts of the business (including the
payroll) .
10. The estimated sole income of the alleged incapacitated
person consists of social security benefits of approximately $1274
per month. The other income of the alleged incapacitated person is
joint with the PETITIONER.
11. The alleged incapacitated person was not a member of the
Armed services of the United states and is not receiving any
benefits from the United states Veteran's Administration.
12. The costs for medical and other care of the alleged
incapacitated person since his accident (June 16, 1996) and for the
foreseeable future have been paid by his medical insurance
coverage(s) and by his wife, the PETITIONER.
13. Because of his mental and physical condition, the alleged
incapacitated person is totally unable to manage his financial
3
affairs, property and business and to make and communicate
responsible decisions relating thereto, including the ability to
communicate his need for assistance in these areas. This is
because he is in a continuing comatose state and is totally
unconscious and his attendance at any hearing would be harmful to
his physical and mental condition and would be meaningless.
14. Because of his impaired mental and physical condition,
the alleged incapacitated person lacks the capacity to make or
cOlDDlunicate responsible decisions concerning his person and is
unable to do anything.
15. There are no alternatives to the appointment of a
guardian of the estate of the alleged incapacitated person.
16. The severity of the alleged incapacitated person's mental
and physical condition and the lack of viable, less restrictive
alternatives necessitate that a plenary guardian of his estate be
appointed to manage and handle all aspects of the alleged
incapacitated person's estate, specifically including, but not
limited to: all issues relating to his cash, checks, and any bank
or savings accounts held in his name, his stocks and bonds, his
personal property, his real estate, his life and other insurance of
which he is a beneficiary, his entitlement to any governmental and
non-governmental benefit plans, federal, state, and local taxes,
claims made or to be made on behalf of him or against him, the
execution of documents, entry into contracts affecting him and the
payment of reasonable compensation or costs to provide services for
4
. ,;,.' .'. .. W' . .~ .
him, and the continuation of his business.
17. There are no a1 ternati ves to the appointment of a
guardian of the person of the alleged incapacitated person.
18. The severity of the alleged incapacitated person's mental
and physical condition and the lack of viable, less restrictive
alternatives necessitate that a plenary guardian of his person be
appointed to handle all issues relating to the person of the
alleged incapacitated person, specifically including, but not
limited to: his living arrangements, his medical and psychiatric
care, the administration of medication to him, and the employment
and discharge of physicians, psychiatrists, dentists, nurses,
therapists and other professionals for his physical and mental
treatment and care.
19. PETITIONER is not aware that the alleged incapacitated
person signed any powers of attorney or advance health care
directives or in any other way designated anyone to serve as his
agent over any medical care, or that he designated in writing his
wishes with regard to health care, including the use or refusal of
life-sustaining treatment.
20. Due to the emergency nature of these circumstances and in
light of the comatose condition of the alleged incapacitated
person, it is requested that the Court:
a. Waive the requirement of twenty (20) days notice to
the alleged incapacitated person;
b. Waive his attendance at any hearing on the Petition;
5
c. Appoint an Emergency Guardian of the Person and
Estate of the alleged incapacitated person, in the form of an
Order of the Court as is submitted with this Petition.
21. It is further requested that the Court enter a finding
that at any hearing on the appointment of a Plenary Guardian for
the Person and Estate of the Alleged incapacitated person, the
Testimony of Medical witnesses may be presented by way of
Affidavit, unless any of the next of kin of alleged incapacitated
person object.
22. The proposed emergency and plenary guardian of the person
of the alleged incapacitated person is MARTHA E. BOOZ, the wife of
the alleged incapacitated person, who resides at the same address
as set forth above.
23. The proposed emergency and plenary guardian of the person
is 71 years of age and is employed as set forth above.
24. The proposed emergency and plenary guardian of the estate
of the alleged incapacitated person is MARTHA E. BOOZ, the wife of
the alleged incapacitated person.
25. The proposed guardian of the estate is 71 years of age
and is sui juris and employed as specified above.
26. The proposed emergency and plenary guardians have no
interest adverse to the alleged incapacitated person.
27. The consent of the emergency and proposed plenary
guardians is attached as Exhibit "5".
28. No other court has ever assumed jurisdiction in any
6
-. - '.... - -.., - .
proceeding to determine the capacity of the alleged incapacitated
person.
29. No other guardian has been appointed for the estate or
person of the alleged incapacitated person.
WHEREFORE, PETITIONER respectfully requests that this Court
enter an Order:
1. appointing the PETITIONER Emergency Guardian of the
Person of Lee N. Booz for a period of 72 hours from the date
of the Court's Decree and appointing the PETITIONER Emergency
Guardian of the Estate of Lee N. Booz for up to 30 days from
such Order; and
2. Awarding a citation directed to the next of kin of
Lee N. Booz, with days notice and service thereof to be
given to them, to show cause why the PETITIONER should not be
appointed plenary guardian of the person and estate of Lee N.
Booz(until such time as his condition improves and a further
Order of court is entered) with the powers as provided by law
and, in addition, the powers specified in the proposed Order
which is attached (and labeled Exhibit 6); and
3. Waiving the requirement that the alleged
incapacitated person be present at the hearing (or, in the
alternative, that any hearing be held at the alleged
incapacitated person's room at the Shippensburg Health Care
Center, Shippensburg Township, Cumberland County,
Pennsylvania); and
7
4. Providing for extension of the Emergency Guardianship
of the person of Lee N. Booz for up to twenty (20) days upon
further application to the Court if need arises.
/"
II Booz
VERIFICATION
I, MARTHA E. BOOZ, Verify that the statements made in the foregoing
Petition are true and correct to the best of my knowledge,
information and belief. I understand that false statments herein
are made subject to the penalties of 18 PA. CONS. STAT. ANN.
SECTION 4904 relating to unsworn falsfication to authorities.
~iA(j-, 6-. ~r
DATED:
(Seal)
8
M~CUA & DAYIS
.."....91111..
1..'It\l' ..."...IV"
PI....
LAST WILL l\ND n::s'l'J\/oEm'
I, lEE N.'OO'JZ, of the ToomShip of IklpeWCll, OJunty of QI1berland and
0;mra1WC41th of peM9ylvania, declare this to be IT1i Last Will and Testan'Cl1t
aOO revoke any will or codicil previ0ll51y made by 100.
1'lUI I. - I direct that all IT1i jus t debts and funeral expenses,
incl~ IT1i gravanarker and all mcpenses of IT1i last illnese, shall be paid
fran IT1i residuary eatate as eoon as practicable after IT1i cJeoease as a part
of the expense of the aanwetration of IT1i estate.
1M II. - I devise and bequeath all of IT1i estate of fNCry nature and
wheIlM!r eituate to IT1i wife, Martha E. Booz, providing she ehall survive
ne by thirty daye.
1M III. _ Should IT1i wife, Martha E. Booz, predecease ne or die 00 or
before the thirtieth day follCMing IT1i death, I devise and beqUeath all of IT1i
estate of every nature and wherever situate to IT1i Sal, Larry L. Booz. If IT1i
said eon predeceases ne, and IT1i wife shall have predeceased ITI!, then in that
event, I devise and bequeath all of IT!i estate of every nature and wherever
situate to IT1i grandson, Erick Booz.
1M IV. - I direct that all tal<eS that rrorj be assessed in consequence
of IT1i death, of whatever nature and by whatever jurisdiction inposed, shall
be paid fran IT1i residuary estate as part of the el<pCllSes of the aclninistrati
of IT1i estate.
I'!nl V. - I appoint IT1i wife, Martha E. Booz, ExeCUtrix of this IT1i Last
will. Should IT1i wife, Martha E. B:>oz, fail to qualify or cease to act as
ExeCUtrix, I appoint IT1i s:>n, Larry L. Booz, ExeCUtor of this IT1i li1St Will.
I'IEM VI. - In additicn to the pawers given IT1i ExeCUtrix by tI>:! laws
of tI>:! O:JmOI1WCalth of peM9ylvania, lIIf EXeCUtrix or substitute shall be
elT\X>'lCrcd in her discreticn to continue tI>:! cperation of any busiross which
I o.m at lIIf death.
~ \. fll'
t;>f,~,~,t 2.
\
i
i
I'lJ}! VII. _ 1 direct that rrrj E><c<:Utrix or gwmlian or tOOir successors
.
shall not be required to give bald for tOO faithful perfoanance of their
duties in any jurisdiction.
IN Wl'1NES5 WIIEm:F, I hereW\to set rrrj hand md seal this 3rd day of
April, 1979.
IS/
L ~(
/'1'. is () d 'Z.
~ (II. 11.1UZ;
(SEAL)
'Ihe preoedinq instr\JllCllt, oonsietlnq of this md tloO other typeWritten
pages, each identified by tOO signature of tOO testator, was 00 tOO day md
date thereof siqned, published an:! declared by Lee N. IlOOZ, tOO testator
tOOrein narred, as md for his laSt Will, in tOO presence of us, wI"D, at his
request, in hie presence, an:! in tOO prosence of each otOOr. have subscribed
our nanes as witnesses hereto.
/;},/::I)7' J. Iv~.L~: residing at
I I
l;j '1 L ,),:i).....v' r. /L"''<-L-'residin<J at
,
~'n1 CF PmNSYLV1\NIA ::
:: ss
0JUNl'{ OF aMlERU\ND I :
I, Lee N. IlOOZ, tOO testator wl"Dse nane is eiqned to tOO foregoing
inst:J:unl!nt, having been duly qualified acoordin9 to law, do hereby acl<now1edqe
that I signed md executed tOO instr\JTl!llt as rrrj laSt Willi that I signed it
willinqlYI md that I signed it as rrrj free md IIOIW\tary act for tOO purposes
tOOrein expressed.
/. "/
I-- ~ ( ~ eo~ "1-
N. vuuZ
MeCRlA I DAVIII
""o..no It bw
al"uu . ...'.......11
'111'.
SWorn or affinrod before ITC by Lee N.
IlOOz, tOO testator, this 3rd day of April. 1979
t S/
Notary Public
My Cam1. expires:
~
WISnRHSTAAtRUCKS'
RIH MOTOR COMPANY,INC.
1(3!1 frcnll,n 51' ChombCllburg, PA 11201
PHO!,[ (117) 263.8518
fAX 01/)263.4293
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psychiatric care, the administration of medication to
him, the employment and discharge of physicians,
psychiatrists, dentists, nurses, therapists and other
professionals for his physical and mental treatment and
care.
2. MARTHA E. BOOZ, wife of LEE N. BOOZ, is appointed
Emergency Guardian of the Estate of LEE N. BOOZ, an alleged
incapacitated person, commencing upon the issuance of this decree
and continuing for a term of 30 days, unless extended or made
permanent by further Order or Decree. The Emergency Guardian of
the Estate shall have the following powers, in addition to those
otherwise granted by law to a plenary Guardian of the estate:
To handle and manage all aspects of the estate of
LEE N. BOOZ, specifically including but not limited to:
a. His cash, checks, and any bank or savings
accounts held in his name. his stocks and bonds, his
personal property including motor vehicles, his real
estate, his life and other insurance of which he is a
beneficiary, his entitlement to any governmental and non-
governmental benefit plans, federal, state, and local
taxes, claims made or to be made on behalf of him or
against him, the execution of documents, entry into
contracts affecting him and the payment of reasonable
compensation or costs to provide services for him.
b. To continue the operation of any business in
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which LEE N. BOOZ may be interested or engaged
(regardless of the form or organization of any such
business, whether the same be a sole proprietorship, a
partnership or a corporation). The Guardian shall have
all the rights and powers in connection with such
business as LEE N. BOOZ personally would have, including
by way of example and not limitation: the powers to
operate or join in the operation thereof as a going
concern 1 the right to change the form of an}' such
business by the reorganization or incorporation thereof
or the formation or reformation of a general or limited
partnership with respect theretol and also including the
right to invest in any business or make agreements for
the utilization in any business or lease to or in
conjunction with any business any of the property of LEE
N. BOOZ for such periods of time and upon such terms and
conditions and to liquidate or sell the same or any part
thereof, all as the Guardian shall deem advisable for the
best interests of the Estate, without any liability for
loss resulting from the operation of such business except
where such is the result of gross negligence or fraud on
the part of the Guardian. In connection with the
continued operation of any business, the Guardian shall
be entitled to receive such compensation as may be
cOlDIDensurate therewith and is specifically authorized and
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empowered to engage the services of such persons as may
be reasonable necessary or desirable to provide legal,
accounting and business management expertise to or for
such business and to engage employees and agents therefor
and to agree for the compensation of Guardian provided
for above. The rights and powers granted to the Guardian
shall be exercisable without court approval and without
the need to post any bond or security.
3. The Clerk of the Orphan's Court shall issue a citation
upon the next of kin of LEE N. BOOZ, the alleged incapacitated
person, to show cause for the following:
a. Why Emergency plenary guardians of the person and
estate of LEE N. BOOZ should not be appointed;
AND
b. Why the alleged incapacitated person, LEE N. BOOZ,
should not be adjudged an incapacitated person and permanent
plenary guardians of his person and estate should not be
appointed.
4. An evidentiary hearing on the request for emergency and
permanent plenary guardians shall be held before the Honorable __
in Courtroom No. Courthouse, Carlisle,
Pennsylvania, on the day of , at ____
o'clock (prevailing time).
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5. Relative to the request for permanent/emergency guardians,
the Petitioner shall cause certified mail service upon the next of
kin ot the alleged incapacitated person with the following:
a. A copy of the Petition for appointment of emergency
and permanent plenary guardians.
b. Notice of the time and place of the evidentiary
hearing.
c. Citation with rule to show cause why
emergency/permanent guardians should not be appointed for the
alleged incapacitated person.
6. Because of time constraints resulting from emergency
conditions and pursuant to 20 Pa. Cons. stat. section 5513, the
court finds the provisions of 20 Pa. Cons. Stat. section 5511 are
not feasible under the circumstances and are hereby waived: except
to the extent provided for herein.
7. Because of the condition of the alleged incapacitated
person, LEE N. BOOZ, his presence at the above scheduled hearing is
waived.
8. Because of the circumstances, unless an objection hereto
is tiled by the next of kin of LEE N. BOOZ within 10 days of the
notice to them, medical evidence of the condition of LEE N. BOOZ
may be submitted at the hearing by Affidavit or Written Answers to
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HAMILTON C. DAVIS
AlTORNEY AT LAW
P.O, BOX 375
SHIPPENSBURG. PENNSYLVANIA 17257
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To
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUS SQUARE
CARLISLE PA 17013
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