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No. 21-96-1027
Eslale of GERALIl L 1l0UCII
I Deceased
DECREE OF PROBATE AND GRANT Q}' LETTERS
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AND NOW IlECEMIlER 12 19~, in consideralion of the petition on
Ihe reverse side hereof, satisfactory proof having been presellted before me,
IT IS DECREED Ihol The inSlrument(s) daled IlECEMIlER 4, 1996
described therein be admitted to probale and filed of record as lhe laSl will of
GERALD L BOUCH
and Leuers TR~T^MRNT^RV
arc hereby granted to RONALD B. BOUCII
'f)Jl.t<q (I. Y:l' I .tli '1'., I J' 11 . ~v,'1'~ih,u, Q. p...:t...
Rtgistcr or Wills . r
FEES
Probate, Leuers. Etc. ......... S 50.00
Shnrt Certificates(7).......... S 21.00
RIIflIlIlWIlIlI . EXTRA . PAGES.. S 15.00
JCP S 5.00
TOTAL _ S 91.00
Filed .OEcEI1l1ER .1Z.. .L991i..............
PATRICK F LAUER, JR ESQUIRE
ATIORNEY lSup, Ct. 1.0. No.)
2108 MARKET ST. CAMP HILL, PA 17011
ADDRESS
717 763-1800
PHONE
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CALLED EXECUTOR DECEMBER 13. 1996
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21-96-1027
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' vITAL RECORDS
CERTIFICATE OF DEATH
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PO Box 92 20 W. Main St. walnut Bottom pa 17266
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967 W. Trindle Rd. lot9 ~~~
Methanicsburg, Pa 17055 ~
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Nfttln"....."..-~ E.dward G. Bouch
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HQlUUMU......llf____ Ronald Souch
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Dec. 9, 1996
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to post any bond or give any security of any type for any purpose
whatsoever, any law or rule of court of the Commonwealth of
pennsylvania or any jurisdiction to the contrary not withstanding.
FOURTH
I name and appoint my brother, RONALD B. BOUCH, executor of
1 this, my Last Will and Testament.
FIFTH
It is further my desire that my Executor, after consultation
with any heir or heirs of mine who survive me, and in his own
discretion, choose such articles from my tangible personal property
(exclusive of cash, stock certificates, bonds, and all other
tangible evidences of intangible personal property) as he believes
will be useful to such heir or heirs, or desirable for such heir or
heirs to have, either from a sentimental point of view or
otherwise; and to deliver such articles to such heir or heirs, or
among such heirs in equal or unequal shares as determined by the
further exercise of his discretion, provided no other heir objects
to the distribution after being given suitable opportunity to do
,so. Any such distribution shall be taken into account in regards
to the final disposition of the assets of my estate.
'I
,
Page 2 of 6
. .__ -.__ _r"..... -_ ...
SIXTH
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My Executor shall have the following powers in addition to
those vested in them by law and by other provisions of this Will,
applicable to all property, real, personal and mixed and
wheresoever situate, whether principal or income, exercisable
: without court approval, and effective with respect to each item of
said property, until actual distribution thereof:
A.
To retain, as investments, any and all assets of my
estate, real, personal or mixed, without regard to any principal of
i' diversification, and to purchase and acquire real or personal
property, and to hold any and all of such real and personal
property retained or acquired without making the same productive of
income;
B. To permit occupancy of any real estate retained or
acquired upon such terms and conditions as they shall deem proper;
C. To pay all taxes, charges and expenses of
maintenance,
upkeep,
improvements,
development,
protection,
, preservation and investment of any retained or acquired real or
, personal property, such payments to be made from either principal
, or income, as my Executor shall determine;
D. To retain or invest any and all funds, whether
principal or income, in any real or personal property without
,restriction to legal investments; to purchase investments as
Page 3 of 6
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: COMMONWEALTH OF PENNSYLVANIA
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~ COUNTY OF DAUPHIN
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AFFIDAVIT
)
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SS:
I, GERALD L. BOUCH, Testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified
I
i according to law, do hereby acknowledge that I signed and executed
I
\ the instrument as my last Willi that I signed it willingly and that
\ I signed it as my free and voluntary act for purposes therein
I
\ expressed.
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IN WITNESS WHEREOF, I, GERALD L.
qfrJ..
BOUCH, have hereunto set my
/J [CEJ,)tJ~1)
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'\ hand and seal this
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i SWORN or affirmed to and acknowledged
\ before me, and Ger~ld L. Bouch, the
Testa1;or, this ~ day of
! t'9rQ~' 1996.
\ JA///::J.,/I t-tJ:;I/"iioL
\ NOTARY l(fBLIC
j .' .
\My Comm~ss1on Exp1res:
: N,)\1na1 Seal
Sh!>tl'i A MlIllCh Nclary Public
Clmo '1" llc<O. currooMrdCcxrtl
tly');"""'-.s>J" E..!>tesAlJQ 1a, ,;,>97
~,..,W':1>-;;;;"",,,",.,,,,,,,,,,,,""'a'Nn!.lr." Page S of 6
, 1996.
day of
/
~..<!.;?:L
GERALD L. BOUCH
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COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
We, 5Qo.~d tJiqW)
and if n I VI C; ~/)f,t I) '7/2. s
,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we are present and saw the Testator sign and execute the
instrument as his Last Will; that he signed willingly and that he
executed it as her free and voluntary act for the purpose therein
expressed; that each of us in the hearing and sight of the Testator
signed the Will as witnesses; and that to the best of our
knowledge, the Testator was at that time eighteen (18) or more
years of age, of sound mind and under no constraint or undue
influence.
and
before me by
_VI D L fr 'f'. ~)tJ /.1 i) rf.S
.J;.C{J~, 1996.
, the
Sworn or affirmed to and subscribed to
~f(JU"'/ tJ/'rl'll(r
witnesses, this L{4k day of
;1
'J i l! ,7 t /...
\.tIU,l{,~ 1J'luzu
NOTARY PUel.lIC
No,"",IS<!al fuJ
ShetJyA,Mffl.h NO!.1ryl'lli"
C..U;4-1 H~ BcfO Clt"~..,.:t:lJ'd Ct~
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PATRICK F. LAUER, JR.
Attoraey at Law
, 2108 Mad<d Slrod
"* BuildIDI
CImp HBI. PA l'lbll
(7\7) 763-1100
"\.
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21~9'~1027
JRDlJune 30, 1992117858
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\~I;
In Re: Eslate of GERAL D L BOUCfl
Latc of MONROE TOWNSfllP
ORPHANS' COURT DIVISION,
COURT 011 COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.:
21 - 96 - 1027
No,
NOTICE OF FAILURE TO FlLE CERTIFICATION AND REQUEST TO
CONDver A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representalive: RONALD B BOUCfl
Counsel for Personal Representative: PATRICK F LA"ER JR
Date of Grant of Original Letters: DECEMBER 12, 1996
~.
Dale of Delinquency Notice: MARCfl 2~, 1997
The undersigned, Mary C. Lewis, Register of Wills, in accordance wilh Rule 5.6, Supreme Court
Ol]lhans' Court Rules, hereby nolifies the Ol]lhans' Court Division, Court of Common Pleas of
Cumberland County, thai neither the above named personal representative nor the above named counsel
for the personal representative have filed with the Register of Wills or Clerk of the Ol]lhans' Court his,
her or its certification required by Rule S.6(d), Supreme Court Ol]lhans' Court Rule and that the requisite
notice, pursuant to Rule S.6(e), Supreme Court Ol]lhans' Court Rules, was given by the Regisler of Wills
on MARCH 22 , 19..i? and that the ten (10) day notice to file the certification has expired.
Accordingly, in accordance with Rule S.6(e) the Court is hereby notified of such delinquency and the
undersigned requcsts tbat a Court conduct a hearing to determine whether sanctions should be imposed
upon the delinquent personal representative or counsel for the delinquent ersonal representative.
Date: APR IL ~, 1997 (~Q/t.. I 01.11'
. Lewis, Register of Wills "fJ&
Distribution: Personal Representative
Counsel for Personal Representative
Estate File 011.. I / J 0" 7 :J ,4
A HEARING IS SET FOR ,riA., /J.../17 AT..;): O(l r.m.
IN COURTROOM NO, 1. J /
IF THE CERTIFICATION OF NOTICE IS FILED PRIOR TO THE HEARIN[ DATE, THE HEARING
WILL AUTOMATICALLY BE CANCELLED. -J _\ I ~ ~/ ~
.~ C'vV\ ~ ~
AROLD E SHEELY P
"
"
"
,
"
,
I
. .
i+
1\
,
,
ii to post any bond or give any security of any type for any purpose
\, whatsoever, any law or rule of court of the Commonwealth of
.,
!t Pennsylvania or any jurisdiction to the contrary not withstanding.
ii
Ii
I
! FOURTH
I I name and appoint my brother, RONALD B. BOUCH, executor of
"
Ii this, my Last will and Testament.
"
:1
,.
FIFTH
It is further my desire that my Executor, after consultation
,
i\ with any heir or heirs of mine who survive me, and in his own
II discretion, choose such articles from my tangible personal property
II
'! (exclusive of cash, stock certificates, bonds, and all other
!
,
:i tangible evidences of intangible personal property) as he believes
:1 will be useful to such heir or heirs, or desirable for such heir or
,
I heirs to have, either from a sentimental point of view or
Ii otherwise; and to deliver such articles to such heir or heirs, or
I: among such heirs in equal or unequal shares as determined by the
':
:1 further exercise of his discretion, provided no other heir objects
:; to the distribution after being given suitable opportunity to do
'so. Any such distribution shall be taken into account in regards
, to the final disposition of the assets of my estate.
Page 2 of 6
"
\1
:t SIXTH
\! My Executor shall have the following powers in addition to
1\
those vested in them by law and by other provisions of this Will,
!l
:! applicable to all property, real, personal and mixed and
II wheresoever situate, whether principal or income, exercisable
\1 without court approval, and effective with respect to each item of
i 1 said property, until actual distribution thereof:
i!
!' A. To retain, as investments, any and all assets of my
;, estate, real, personal or mixed, without regard to any principal of
Ii diversification, and to purchase and acquire real or personal
1\ \ property, and to hold any and all of such real and personal
II property retained or acquired without making the same productive of
i\ income;
Ii
:; B. To permit occupancy of any real estate retained or
II acquired upon such terms and conditions as they shall deem proper;
\ \ c. To pay all taxes, charges and expenses of
1\ maintenance, upkeep, improvements, development, protection,
I'
:: preservation and investment of any retained or acquired real or
"
,
!: personal property, such payments to be made from either principal
,
i
:! or income, as my Executor shall determine;
;,
"
" D. To retain or invest any and all funds, whether
: principal or income, in any real or personal property without
,restriction to legal investments; to purchase investments as
I,
Page 3 of 6
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II COMMONWEALTH
AFFIDAVIT
OF PENNSYLVANIA )
)
COUNTY OF DAUPHIN )
I I, GERALD L. BOUCH, Testator, whose name is signed to the
II attached or foregoing instrument,
II
I' according to law, do hereby acknowledge that I signed and executed
'I
i the instrument as my last Will; that I signed it willingly and that
SS:
having been duly qualified
I signed it as my free and voluntary act for purposes therein
expressed.
I
I
,I
,
Ii
II hand
I
BOUCH, have hereunto set
/J ~ CE;(1j/t)~.<L
-/ , 1996.
I
~o// /t.~
GERALD L. BOUCH
my
IN WITNESS WHEREOF, I, GERALD L.
q.. irA
and seal this
day of
II
,I
Ii SWORN or affirmed to and acknowledged
II before me, and Ger~d L. Bouch, the
Testa1;or, this ~ day of
~,~, 1996.
.Jj,lhJ~4 fj}j,/1;'-t'L .
" NOTARY llPBLIC
II My commis~ion'~l\pires:
'~silaI
~... Mf1CI1, NaatyNlic
Ca!rll H Boro.Curti<lI1ai1:l Cou1IY
M)'<:Or/'.rrJSSlDO'E1!)IIlsAug. 18. 1997
r, .P...,.,...,.... alNoloWO Page 5 of 6
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I:
iI COMMONWEALTH OF PENNSYLVANIA
SS:
! COUNTY OF DAUPHIN
Ii
Ii
II We, ::rQ~lI~{lAh~lJf and J//Myf ~ 56t.d)zR.,S. ,
Ii the witnesses whose names are signed to the attached or foregoing
I instrument, being duly qualified according to law, do depose and
I
I say that we are present and saw the Testator sign and execute the
I
I instrument as his Last Will; that he signed willingly and that he
II
:1 executed it as her free and voluntary act for the purpose therein
!:
I'
:: expressed; that each of us in the hearing and sight of the Testator
Ii
ji signed the Will as witnesses; and that to the best of our
Ij
i knowledge, the Testator was at that time eighteen (18) or more
I'
d years of age, of sound mind and under no constraint or undue
ii . fl
'i ~n uence.
!i
I
I Sworn ,or affirmed to and subscribed to before me by
:1 ~1.fJ.JI.",.l (J,ff&.fr and _VIDLtfA <;;. Sr/ui)'f1.s
i!witnesses, this cfik day of ~~ 1996.
I!"
. " ,
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NOTARY PU~IC ( :, \
\
Nol:lMI Seal \,
Shet1t A. MOOt NotVy PIbIc
C1n'll H;l8ofO c..-.w<l COOl'tV8 7
My Cofr,missjon EJpres /lug 18 I,?
Mo'nll)l.lf, p~vtvaooAssoOiil(lO 01 Ntot.1f\c;."S
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Page 6 of 6
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
In Re: Estate of
Gerald Bouch,
Deceased
Orphans Court Division
No. 21 - 96 - 1027
PETITION FOR SETTLEMENT OF SMALL ESTATE
The petition of Ronald Bouch, executor of the estate of Gerald
L. Bouch, respectfully represents:
1. Your petitioner is Ronald Bouch, who is the executor of
the estate of Gerald L. Bouch.
2. The decedant, Gerald L. Bouch, died on December 6, 1996,
in Harrisburg Hospital, Harrisburg, Pennsylvania, having as his
final address 967 West Trindle Road, Lot 9, Mechanicsburg, PA 170SS
in Cumberland County.
3. The above-named decedent died testate, having first made
a last will and testament dated December 4, 1996, which will has
been duly probated and letters testamentary on the estate of the
decedent were duly issued by the Register of Wills to your
petitioner on December 12, 1996.
4. The names, addresses, and
having an interest in the estate of
of kin are as follows:
Name
Ronald B. Bouch
relationships of all persons
the decedent as heirs of next
Relationship
Brother
Address
20 W. Main st.
Walnut Bottom,
PA 17266
Kevin, Kimberly, and
Kelly Bouch
116 King Louis Court
Cincinnati, OH 4S2SS
Children
S. The decedent was survived by persons entitled to claim the
family exemption under 20 Pa. C.S.A. Section 3121; however, the
estate has insufficient assets to claim even the family exemption.
6. The total value of the decedent's personal estate is less
than $10,000 and consists of the following assets which have the
following values:
Asset
snowblower
television
bedroom suit
desk and bookcase
shed
car
misc personal effects
Value
$lS0.00
$12S.00
$300.00
$100.00
$300.00
$1000.00
$SOO.OO
.
7. The following is a list of all known, unpaid creditors and
the amount of their claims, which claims are proposed to be paid
from the assets of the decedent remaining after payment of the
funeral expenses, administrative costs, and miscellaneous expenses
of the estate. It is not expected that any distribution will be
available.
Name
Beneficial National Bank (USA/K-Mart)
PNC Bank
Amount
267.82
19,137.78
8. A pennsylvania Inheritance Tax Return has been filed and
the amount of tax due upon the decedent's estate has been paid. A
copy of the inheritance tax official receipt and a copy of the
statement of the Department of Revenue showing no tax due is
attached hereto and made a part hereof.
9. It is proposed that the following distribution of the
decedent's estate be made to the following creditors, heirs, or
next of kin.
Name
Yorktowne Crematory
photographer
probate Fees
PennDoT transfer of car
PennDoT transfer of car
Erie - car insurance pending transfer
Ronald B. Bouch - clean up
Mildred Bouch - clean up
UGI - gas bill
UGI - gas bill
UGI - gas bill
Admin costs and notices
Distribution
2,417.70
295.70
91.00
69.50
30.50
199.00
200.00
105.00
28.00
21.53
51.69
488.20
WHEREFORE, your petitioner respectfully requests your
Honorable Court to decree the distribution of the decedent's
personal estate to the persons entitled thereto as set forth in
Paragraph 9 above.
Respectfully submitted,
{lttfD/ :~i C~ -
Matthew J. Eshelman, Esquire
Attorney or Petitioner
2108 Market Street, Aztec Building
Camp Hill, pennsylvania 17011-4706
10# 72655 Tel. (717) 763-1800
Date:
.. ~. ..... OJ 1.I-o~:H~jUU
KMART CURPORATIO" PAGE 02 02/14/19Y7
ON-LINE STATEMENT HISTORY DISPLAY .12:37:46
URGANIZATION 101 LOGO 552 ACCOUNT 0007101552000375660
________ INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ---------*
ILLING CYCLE 09 DATE THIS SlHT 11091996 SHORT NAME BOUCH GERALD L
TATE OF RESID PA DATE LAST STMT 100'71996 CUST IWR 0007101552000:375660
NTERNAL STATUS A CYC/DATE DUE 1 12041996 ALT CUST
GRACE EXPIRE 12091996 CORP ACCT 0000000000000000000
STORE ORG 101 10 552020000
..-~
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LOCI( CODE 1
'LOCI( CODE 2
,TATEI1ENT FLAG
:SER CDDEi
iSErl CDDE2
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!SER COOE5
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:REDIT CLASS
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lAYS IN CYCLE
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ORGANIZATION
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DATE DATE
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07 OPEN-TO-BUY 1,667.59 TOTAL PAST OUE .00
Y-T-D INTEREST .00 TOTAL PMT OUE 10.00
N Y-T-D LATE CHG' .00 FIXED PMT AMT .00
Y-T-O OVLM CIIG .00 SCHED PHT AMT 10.00
LAST YTO INTR .00 INTERES" FREE 32.41
22 INT THIS STHT .00
SN
Nl BONUS BEG BALANCE 49
'0 BONUS USED CTD 49
31 BONUS EARNED CTO 31
1 BONUS ENO BALANCE 31
PF2=ARQA PF3-ASMW PF4=ARSO
KHAR" CORPORATION
ON-LI"E STATEMENT HISTORY
101 LOGO 552 ACCOUNT
BEG BAL 51.72
OEBITS 1 32.41'
CREOITS 1 51.72
END BAL 32.41
PF5=ARTD PF6-ASSO
PAGE 03 02/14/1.997
DISPLAY 12;37;55
0007101.552000375660
CR
AMOUNT fXN PLAN *-------- 0 E S C RIP T ION -------*
49 C040 0 BP AUTO REOEMPTION
DEPT- REF_55208999996084123456789 AUTH-OOOOOO
STORE-S52089999 GLS-2 BPS-000000049 SKU-128456789
32.41 0001 550 PURCHASE, THANK YOU (ELIGIBLE 130.571
DEPT- REF=5500242759631300002?103 ~UTH-OOOOOO
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DATE DATE
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BEG U(IL 3:!," 1
DE-UITS:! 267.02
CREDITS 1 32.41
END OI'tL 267. o:!
rFs~nRTO PF6~Azno
PAOE 03 02/14/1997
DISPLAY 12130.15
0007101~G200037~660
CR
AHOUNT TXII Pl^N .----'-'- 0 E S C RIP T I 0 II -----,'.
22.75 0001 550 PURCH,'SE. THANK YGU (ELIOI OLE ~22. 75)
DEPTs: REF=55002774696357774631 S02 HUTlI==OOOOOO
STORE=S50027746 GLS=2 ors=000000002:!75 5KU~774631~O:!
245.07 0001 550 P.URCltASE, THANK YOU (ELIGIBLE 1,231.20)
DEPT= REF=55002774696357774631503 AUlll=OOOOOO
STORE=550027746 OLS=2 DPS.000000023120 SKU.774631503
32.41 C400 0 PAYHENT-TH^NK YOU
DEPT= REF=99999999999435171350123 AUTH=OOOOOO
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OH-Llf1E STATEMENT ~IIS10RY OISrLAY 1213BI~b
ORGANIZATJOU 101 LOGO !j5:! N:COWH 000710J ~,:J~fJOo:rl~j~,(~O
.._._______ INFORMATION BElGlJ REFLEC1S THE (1CCaUNT ."IT c'-f"'dE~lEN" lIi1E _.________,Ir
JILlll~G CYCLE 01,' D(\lE lH1S 5fMT 010';'1997 SHOHT th'lf\f- Houcn GERALD I.
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.... END OF
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.It:CR conES
;JSCR CODC6
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STATE OF PENNSYLVANIA
IN THE MATTER OF
ESTATE OF:
GERALD L. BOUCH
TIlE ORPHAN'S COUR1' FOR
CUMBERLAND COUNTY
BSTATB~I 21-96-1027
STATEMENT OF CLAIM
1. The creditor, Beneficial National Bank USA/K-Mart,
certifies that there is due and owing by GERALD L. BOUCH, deceased,
the sum of TWO HUNDRED SIXTY-SEVEN DOLLARS AND EIGHTY-TWO CENTS
($267.82) .
2. The nature of the claim is a K-Mart Card account
number 7101552000375660.
3.
NATIONAL BANK
19850-5522.
The name and address of the claimant is: BENEFICIAL
USA/K-MART, P. O. Box 15522, Wilmington, Delaware
4. The name and address of the claimant I s agent is:
BRENDA REUTER, Estate Recoveries, Inc., P. O. Box 24566, Baltimore,
Maryland 21214.
5. This claim is not contingent and is not secured by
any liens or judgments. The last payment on said account was made
on November 21, 1996 in the amount of $32.41.
6. This claim is not based on anyone instrument. Said
balance has accrued since the account was established.
On behalf of Beneficial National Bank USA/K-Mart, creditor, I
do solemnly declare and affirm under the penalties of perjury that
the information in the foregoing claim is true and correct to the
best of my knowledge, information and belief.
.. ~',
.01. ,'(: G. ,[i.'l
BRENDA REUTER
Estate Recoveries, Inc.
P. O. Box 24566
Baltimore, Maryland 21214
(410) 426-9782
.' "..
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State of M~'!iy1J:an&~'County of Harford:
IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this
26th day of February, 1997.
C(IHu J)( I~~
Melissa Perron, Notary Public
My Commission Expires: June 2, 1999.
N - .
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COMMONWIAUH O. '(NtUnVANIA
D('AIlM(N' OJ uvlNU(
01" n0601
HAUtSlUIO, 'A 1717.0601
De DIN'S NA"'I IlAS ,'Ill, MID MIOOH 1"1 IAII
!,I' 1'1;' II
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
u
'OR OATIS O' DIATH AnlR 12/31191 CHICK HIRI
II A SPOUSAL
POVIRTT CRlDIT IS CLAIMID 0
IILI NUMIIR
21
96
1027
.,Y!A.'l
NUMafR
11/5/48
~OU.NIY C().DE
O(CIOIN \ O/r,lPl( I AODItU
967 WEST TRINDLE ROAD, LOT 9
",ECIIANICSBURG, PA 17055
CM' CUMBERLAND
15
e
III
..
BOUCH, GERALD L.
!IOCIAI UCUIlIY NU/r,ll"
208-38-5440
A/r,lQU'" 11(t1'l10 1\1l1~.\I.UtTION\1
DAI( O' DfAtH
12/6/96
I" ,,''''C''IIII \lJ'~'~'NG \PQ\l\l \ ~"""II"11 ""11 ..~D "'.DOlI IN.I'''11
N/A
(XI 1. Original Relurn
o 4. limited E\lale
1XJ6
Remainder Relurn
(far dales of death prior 10 12.13.82)
Federal E\late Tax Relurn Required
03
05,
o
_8,
o 2, Supplemental Relurn
o 40. Fulure Inlere\1 Camp rami Ie
(for datel 0' death aher 12.12.82)
Deced.nt Died Teltot. 0 7, Decedent Maintained a Li~ing Trull
(Allach copy of Willi (Alloch copy 01 Trull)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
HAMI (OMPUI( MAiliNG AOOIUS
MATTHEW J. ESHELMAN, ESQ. 2108 MARKET STREET
"'''HOH'HUM''' CAMP HILL, PA 17011
Total Number of Safe D,polit BOUI
, '-.', ..'~.i "
. :
(II 0
(21 0
(3) 0
(4) 0
(5)_2475..00
5800.00
o
3997.82
(81
8275.00
:0:
..
S
=>
...
i:
..
....
...
'"
1. Real Ellote (Schedule A)
2. S'atk, and Band, (Sthedule 8)
3. CloI.ly Held Slack/Partnership Inlerell (Schedule C)
a>. Martgagll and Natll Recei~oble (Schedule 0)
5. COlh, Bonk Depolitl & MilcelloneouI Penanal Property
ISthedule E)
. Jointly Owned Property (Schedule F)
T,an,le" (Sthedulo G)ISchedule l)
8. TOlal Gran Alletl (lotolUnll 1.7)
9. Funeral Expensel, Adminiltrotive Calls, MileelloneouI
Expensel (Schedule HI
10. Deb", Mortgage Uobilititl, Uenl (Schedule I)
11. TOlal Deductionl (tololUntl 9 & 10)
12. Net Value 0' Eltote (line 8 minuI line 11)
13. Charitable and Governmental BequII" (Schedule J)
lA. Net Value Subiect to Tax (Line 12 minuI line 13)
15. Spoulal Tranl'en (for datil of death after 6.30.94)
See Inltructionl for Applicable Percentage on Revene
Side, (Indude ~olutl from Schedule K or Schedule M.)
16. Amount of line lA loxable at 6% role
(Indude ~olutl from Schedule K or Schedule M.)
17. Amounl of Une lA taxable at 15% role
(Indude voluel from Schedule K or Schedule M.)
18. Principal tax due (Add lax from lin.. 15, 16 and 17.)
19. Creditl Spoulal Poverly Credit Prior Paymen"
+
+
(61
(71
(9 )
(10) 19,405.60
(111 24,403.42
(121 (16,148.42)
(131 0
(141 0
0
X._=
0
x .06 =
x .15 = 0
(18) 0
(191 0
(20) 0
0
(151
(16)
(17)
:0:
..
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=>
...
:E
..
u
><
..
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OilCount
Intertlt
20. If line 19 is grealer than line 18, enter Ihe difference on line 20. Thil il Ihe OVERPAYMENT.
S D...:r.n~iILU..I.TI'l'.'II"l<l'l'l>J.'nII'.'.'l1rt'1":r.l':'t.'1'lll_'l.'J."iJ~",IILJ.1
21. Ulin. 18 is greoler than Line 19, enter Ihe difference on Line 21. Thil il Ihe TAX DUE. (21)
A. Enler the interelt on the balance due on line 21 A. (21 A) 0
B, En'" .he '0'01 of line 21 and 21A an line 21B, Thl, I, ,he BALANCE DUE. (2IB) 0
Malee Check Payable '01 Rlgls'.r a. Wills, Agln' 0
~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ..c:
Under penohill 01 perjury, I dedore that 1 hove examined th:I return, induding accompanying IChedulel and Ilolemenll, and to the bella' my knowledge and beliel.
.t it tru., correct and complele. I dedare Ihat 011 real IItole hal been reporlea at true market value. Declaration of preporer alher Ihon Ihe penonol reprelenlalive il
baled on all information of which preporer hOl any knowledge.
,'GNAW' O' '''IOH !l H'"" '0' ""HG OETUON AOO"" OA~l! / /
'" 2100'S'MARKET STREET, CAMP HILL, PA 170110A (::7sjrg-
(
.. ..-..
.l'voliO"h 111-11I
'*
COMMONWIAlJH O' PlNNIYlVANIA
INHUITANCI 'AX UtUIN
IUIDINl DlttDINT
SCHEDULE F
JOINTLY"OWNED PROPERTY
fiLE NUMBER
21-96-1027
ISTATE O.
BOUCH, GERALD L.
Jolnltonont(.).
RELATIONSHIP TO DECEDENT
NONE
NAME
A.MICHAEL S. SMALTZ,
DECEASED '
ADDRESS
C/O G. SCOTT GARDNER, ESQ.
ATTORNEY FOR THE ESTATE
2117 WEST FOURTH STREET
WILLIAMSPORT, PA
B.
C.
"
ITEM LmER DATE
NUMBE~ FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF
JOINT JOINT OF ASSET '!bINT. DECEDENT'S INTEREST
TENANT
1. A 4/1/9C 1990 REDMAN MOBILE HOME 9000.00 50% 4500.00
A PASSIM JOINT CHECKING ACCT. 2600.00 50% 1300.00
TOTAL IAha onter on lin. 6, Rocapitulatian} S 5800.00
Jolnlly-ownod p,operty.
(If more spac. is n..d.d ins.rt addifional sh..1s of sam. sill)
lI'IlS1I11.I'1I1
*'
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PI.al. Print or T .
COMMONwrALTH o. 'INNsnVANI,t,
INHun...NCI ,.... lUUlN
l(SIDIN' DlcralN'
1.
2.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
AMOUNT
ITEM
NUMBER
A. Fun.ral Exp.nl."
2417.70
295.70
PHOTOGRAPHY & FUNERAL EXPENSES
B. Admlnlltratlv. Co.... NONE TAKEN, RIGHTS RESERVED
1. Penonol Representative Commissions
Social Securily Number of Penonol Represenlotive:
Year Commissions paid
3. Family Exemption
Claimant
Address of Claimant at decedenl's dealh
Street Address
City
Allorney Fees
NONE TAKENr RIGHTS RESERVED
Relationship
Stale
Zip Code
Probate Fees
91.00
91.00
Mlle.llan.oul Exp.nl."
100.00
305.00
1 01.22
199.00
488.20
TRANSFER OF CAR 69.50 + 30.50
PERSONAL CLEAN UP 200.00 + 105.00
GAS BILLS 28.00 + 21.53 + 51.69
CAR INSURANCE 199.00
ADMINISTRATIVE COSTS & NOTICES 488.20
TOTAL (Also enter an line 9, Recapilulalian)
(If mar. Ipae. II n..d.d, Inl.rt addltlonallh..tl of lam. sI...)
S 3997.82
..v.HIl'" P'"
'*
COt.UllOHWIALfH Of ,IHHnWAHIA
IHMllnANeI 'AX liMN
......Nt DtC101NI
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ESTATI OF
21-96-1027
BOUCH, GERALD L.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
1.
A. Taxabl. B.quOIII:
RONALD BOUCH
PO BOX 92
WALNUT BOTTOM, PA 17266
BROTHER
100%
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
a. Charitable and Governmental aequ.I'I:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS lAlla .ntor an lin. 13, Rocapilulalion) S
III maro .pa.. I. n..d.d, InlOrt additional .h.... 01 .am. ....1
,'- /1/'/ h //
/...) ,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
.MI[RIIAHC[ lAIC DIVISION
OCPT. 2'lIObOl
I~NMls.URa, PA 17118-0601
NOTICE or INllrRITANCE TAX
APPRAISEHENT, AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
HATTHEW J ESHELMAN ESQ
210B MARKET ST
CAMP HILL PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-30-1998
BOUCH
12-06-1996
21 96-1027
CUMBERLAND
101
Allount R..1i Ued
c
'*
L
HAKE 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 .....
RE-tj:i5'4j-EX--AFP--fo9"=97T"NoificE--OF-YN'HEiiiTAiicE-ifAX-A-PPRA'isEHENT-,--Ar:rowAiicE-ifli-------------m-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOUCH GERALD L FILE NO. 21 96-1027 ACN 101 DATE 11-30-1998
TAX RETURN WAS: I J ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rool Est.to (Schodul. A)
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Hartg.ges/Hotes Receivable (Schedule OJ
5. Cash/Bank Deposits/HIsc. Personal Property (Schedule EJ
6. Jointly ONnod Proporty lSchodulo FJ
7. Transfers (Schedule G)
8. Totel Assets
'''-lhll1 '''In..,,
GERALD
( X) CHANGED SEE ATTACHED NOTICE
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSHENT OF TAX:
IS. "aunt of Line 14 at Spousal rat. lIS)
16. A.aunt of line 14 taxable at Lineal/Class A rat. (16)
17. AMount of Line 14 taxable at Coll.taral/Class Brat. (17)
18. Principal Tax Due
TAX CREDITS:
PAYHEHT
DATE
(1)
(2)
13J
(4J
(5)
(6J
(7)
.00
.00
.00
.00
2.475.00
5.800.00
.00
(8J
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage liabilities/liens ISchedule I)
11. Tot.l Doductions
12. Net Value of Tax Return
13. Charltable/Govennaent.l Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
191
(10)
3,997.82
4.767.82
1111
112J
(13)
114J
ISchedule J)
NOTE:
.00 X .00=
.00 X .06=
.00 X .15=
(18)
RECEIPT
HUHBER
DISCOUNT 1+)
INTEREST/PEN PAID (-)
I 'OUNT PAID
TOTAL TAX CPEDtT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for~ with your
tax pay.ent.
8,275.00
R.7~1; ~4
490.64-
.00
490.64-
.00
.00
.00
.00
.00
.00
.00
.00
I IF TOTAL DUE IS lESS THAN el, NO PAYHENT IS REQUIRED.
IF TOTAL OUE IS REflECTED AS A "CREDIT"' lCR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.J
RESERVATION, E.t.t.. o. de.Odont. d.l.. on or bo'or. D......r I', I.a, -- I. on. 'utur. Int.r..t In tho ..tot. I. tron,'.rr..
In po.....lon or onJo..ont to Clo.. B 1.011.t.r.ll bon,'I.I.rl.. o. tho d'.odont ..t.r the ..plr.tlon o. on. ..t.t. 'or
II.. or 'or ...r., the Coooonw..lth her.b. .'pr...I. r...r... tho rloht to ..pr.I.. end ...... tr.n...r Inherit.... T....
at the lawful CI... a (collat.ral) rat. on any such future Int.r..t.
PtIIPOsE OF
NOTICE,
To fulfill ~ requlre..nts of Sactlon Zl~D of the InherItance and Eltat. Ta_ Act, Act 21 of 1995. (72 P.S.
SecUon 9140).
PAwtEHT:
Dot..h the top portion o. thl. Hotl.. end .ubelt with .aur P'..ont to tho R'ol.t.r o. Will. prlnt'd an the r...r.. .Ide.
_aHaka check or lIOney order payable tOI REGISTER OF HILLS I AGENT
RUUND(CRh
A r.fund of II lex cr~Jt, which "'.. not taqutlltad on the Tax Raturn, ..y be raquaUItd by cOItplaUng an -ApplIcatJon
for R.fund of p~IYlvBnJ. InherItance and Estat. Tax. (REV~1313). ApPlications at. available at the Offlc.
of the Raglst.r of Willi, any of the 23 Revenue DJltrlct Olflc.., or by callIng the l~cJ.l Z4-hour
anlw.rlng ..rvlce nu.ber. 'or fora. orderIng: In PennSYlvanIa l-aaO-36Z-Z0Sa, outsIde PennsYlvania end
within local Harrisburg .t.. (717) 7a7~a09~, 100. (717) 77Z~ZZ5Z (H.arlng I~alrod Only).
OlJEcnOHSJ
Any party In Intero.t not ..tl.fled wIth the appral.o.ont, allowanco or dl.allowance of d8ductlon., or ...e'...nt
of tax (IncludIng dl.count or Intaro.t) a. shown on thl. Hotice .u.t Object wIthin .Ixty (60) day. of receipt of
this NoUce by:
AD'ClH
I$TRAnYE
CORRECTIONS :
--wrItten prote.t to the PA n.p.rtaent of Rev.nue, Bo.rd of App.al., Dept. ZOIOZl, HarrIsburg, PA 171Z8~1021, OR
--alectlon to hava the .atter det.r.ined at audit of the account of the par.onal rapre..ntatlv., OR
nappe.l to thfl Orphans' Court.
DISCOUNT:
Factual error. dl.covered on thl. ........nt should b. addre...d in writing to: PA D.p.rt..nt of Revenue,
Buraeo of IndiVidual Ta~e., ATTH: Po.t A.I...aent R.vlew unIt, D.pt. Z80601, HarrISburg, PA 171Z0.0601
Phone (717) 787~6505. S.e p.ge 5 of the booklat -In.tructlon. for Inh.rltanc. Tax Return for a ResIdent
Deced.nt- (REV.1501) for an e.planatlon of .delnl.tr.tlv.ly corractabl. arror..
PENALTY:
If any tax due I. paId wIthIn thra. (]) calandar eonths after the d.ced.ntt, death, a five p.rc.nt (5%) discount of
the tax paid I. allowed.
INTEREST:
The 15% tax aanasty non~partlclpatlon penalty Is co~uted on the tot.1 of the tax and Intar..t ....ss.d, end not
paId bafora January 18, 1996, the fIrst day .ft.r the and of the t.. aan..ty p.rlod. This non~partlclpatlon
penalty Is appealabl. In the 18IIa eannar and In the tha '8IIa U.. p.rlod a. you would app.al the ta. and Int.r.st
that has b..n .'.as.ad .. Indlc.ted on thl. notlc..
Intera.t Is charg.d begInnIng wIth fIrst day of d.llnqu.ncy, or nino (91 aonths and one (1) day froe the data of
d.ath, to the data of paY..nt. Ta.a. Which b.c... delinquent b.for. January 1, 198Z bear Int.r..t .t the rata of
Ilx (6%) percent par annua calculatad at a dally rate of .000164. All ta~.s Which b.c... d.llnquent on and aftar
January 1, 1982 will baar Int.ra.t at a rate which wIll vary froa cal.ndar y.ar to calendar y.ar wIth that rat.
announc.d by the PA Departeent of R.v.nue. Th. appliCable Int.re.t rate. for 198Z through 1998 ar.:
!!!! Int.rast Rate nally Intare.t ractor !!.!r Intar..t Rate Dally Int.rast Factor
198Z 'OX .000548 1987 .X .000Z47
198] 16X .0DDl'tla 1988~1991 IIX .000301
1'" IIX .00UOl 199Z 'X .ODDZO
1985 13X .000356 1993-1994 1X .000192
1986 lOX .000Z1~ 1995-1998 'X .000Z47
nlnter.st is calculated .. foHows:
INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.~Any Notlc. II.ued aftar the tax baco.as delInquent will raflact an Int.r.st calculation to flftaen (15) day.
beyond the data of the a"..uent. If paYlHM1t Is ..d. att.r the Interut COllputaUon data shown on the
Hotlc., additional 1nt.ra.t ~.t be calculated.
.
e
--
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~EQt1L() L, 'B,Uc. H-
Date of Death: 1;1- Ob - qb
Will No. ;;21 - q C, - /Oa,7- Admin. No.
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.
Stat~hether administration of the estate is complete:
Yes No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal r~~esentative file a final
account with the Court? Yes No~.
b. The separate 01'phans' CO\yt No. (if any) for
the personal representative's account is: 1v/4
c. Did the personal representative state an
account informally to the parties in interest? Yes rc No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
::::,Of ;f:~"" Cood and may b, aCCa ,d '1 tbi, <epo<t.
v-T\ GtJ~'^
Name (Please. type or print)
JID8 VlwkfQ-, GIM/}!h(1 fA (?olf
Address "I
(117) 7b5 - (800
Te 1. No.
Capacity: Personal Representative
~counse1 for personal
representative
(MAH: rmfl AM3)
I
,
:!
,i
d
I
I
i
IN THE COURT OF COMMON pLEAS OF
CUMBBRLAND COUNTY
In Re: Estate of
Gerald Bouch,
Deceased
Orphans Court Division
No. 21 - 96 - 1027
PBTITION FOR SB~MBNT OF SMALL BSTATB
The petition of Ronald Bouch, executor of the estate of Gerald
L. Bouch, respectfully represents:
1. Your petitioner is Ronald Bouch, who is the executor of
the estate of Gerald L. Bouch.
2. The decedant, Gerald L. Bouch, died on December 6, 1996,
in Harrisburg Hospital, Harrisburg, pennsylvania, having as his
final address 967 West Trindle Road, Lot 9, Mechanicsburg, PA 17055
in Cumberland County.
3. The above-named decedent died testate, having first made
a last will and testament dated December 4, 1996, which will has
been duly probated and letters testamentary on the estate of the
decedent were duly issued by the Register of Wills to your
petitioner on December 12, 1996.
4 . The names, addresses, and relationships of all persons
having an interest in the estate of the decedent as heirs of next
of kin are as follows:
Name
Ronald B. Bouch
Address
20 W. Main st.
Walnut Bottom,
Relationship
Brother
PA 17266
Kevin, Kimberly, and
Kelly Bouch
116 King Louis Court
Cincinnati, OH 45255
Children
5. The decedent was survived by persons entitled to claim the
family exemption under 20 Pa. C.S.A. Section 3121~ however, the
estate has insufficient assets to claim even the family exemption.
6. The total value of the decedent's personal estate is less
than $10,000 and consists of the following assets which have the
following values:
Asset
snowblower
television
bedroom suit
desk and bookcase
shed
car
misc personal effects
Value
$150.00
$125.00
$300.00
$100.00
$300.00
$1000.00
$500.00
7. The following is a list of all known, unpaid creditors and
the amount of their claims, which claims are proposed to be paid
from the assets of the decedent remaining after payment of the
funeral expenses, administrative costs, and miscellaneous expenses
of the estate. It is not expected that any distribution will be
available.
Name
Beneficial National Bank (USA/K-Mart)
PNC Bank
Amount
267.82
19,137.78
8. A Pennsylvania Inheritance Tax Return has been filed and
the amount of tax due upon the decedent's estate has been paid. A
copy of the inheritance tax official receipt and a copy of the
statement of the Department of Revenue showing no tax due is
attached hereto and made a part hereof.
9. It is proposed that the following distribution of the
decedent's estate be made to the following creditors, heirs, or
next of kin.
Name
Yorktowne Crematory
Photographer
Probate Fees
PennDoT transfer of car
PennDoT transfer of car
Erie - car insurance pending transfer
Ronald B. Bouch - clean up
Mildred Bouch - clean up
UGI - gas bill
UGI - gas bill
UGI - gas bill
Admin costs and notices
Distribution
2,417.70
295.70
91.00
69.50
30.50
199.00
200.00
105.00
28.00
21.53
51. 69
488.20
WHEREFORE, your petitioner respectfully requests your
Honorable Court to decree the distribution of the decedent's
personal estate to the persons entitled thereto as set forth in
Paragraph 9 above.
Re.~tfUllYr .~
Matthew J. Eshelman, Esquire
Attorney or Petitioner
2108 Market Street, Aztec Building
Camp Hill, Pennsylvania 17011-4706
10' 72655 Tel. (717) 763-1800
D.t" #