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Home My WebLink About04-0197PETITION FOR PROBATE and GRANT OF LETTERS Estate of Helen M. Hosie also known as Helen Mary Hosie Helen Hosie Deceased. Social Security No. 1 85 - 38 - 027'1 No. To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of aee or qlder~ ~an the execut°r in the last will of the above decedent, dated l~larcn z; and codicil(s) dated in the named -, 19.92 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with l~r last family or principal residence at 387 Walton St., Lemoyne, PA at (list street, number and muncipality) Decendent, then 98 years of age, died December 3, 2003 , 19 , Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ 218,000 $ $ $. WHEREFORE, petitioner(s) respectfully_ request(5) the probate of the last will and codicil(s) presented herewith and the grant of letters ~esx:amenEary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and trUly administer the estate according to law. · . Sworn to or affirmed and subscribed r _ before me this c~-~'7'-~/ day of ! ~' No. a,~/-O'~,-/97 Estate Of Helen M. Hosie , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of and Letters ~~~~ ~/ are hereby granted to FEES Short Certificates( ) .......... .Renunciation ................ $ TOTAL __ Filed .-~F_.,,'dA~.z-.'.~.-q.y...~.~;.. ~:~O..,~ ..... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE o,,I r-ca , 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 974?067 Local Registrar No. Date COMMONWEALTH OF PENNSYLVANIA · DI?ARTMENT OF HEALTH · VITAL RECORD8 CERTIFICATE OF DEATH ,.~,. ,.,~ Last Will and Testament of Helen Hosie I, Helen Hosie, of Putnam Circle, Honesdale, County of Wayne and State of Pennsylvania, being of sound mind, memory and understanding, and mindful of the uncertainties of life, do make and execute this, my Last Will and Testament, hereby revoking all Wills and Codicils, as well as all othert instruments of a testammentary nature, heretofore made by me, in manner and form as follows, that is to say: FIRST: I direct that all my just debts and funeral expenses be paid as soon after my dealth as conveniently may be possible. SECOND: All of the rest, residue and remainder of my estate, whether real, personal or mixed property, and wheresoever situate and whereof I may die seized, I give devise and bequeath unto my beloved husband, Thomas A. Hosie, Sr., provided that he survives me for a period of thirty days after the date of my death. THIRD: Should my said husband, fail to survive me for a period ofthirty~ days after the date of my dealth, I then give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether the same be real, personal or mixed, to Thomas A. Hosie, Jr. If he should fail to survive me by thirty days after the date of my death, then his share will pass to his living issue per stirpes. FOURTH: I name, constitute and appoint my husband, Thomas A. Hosie, Sr., as executor of this, my Last Will and Testament. Should my said husband fail to survive me or fail to qualify or serve as my executor, I name constitute and appoint Thomas A. Hosie, Jr. Executor of this my Last Will and Testament. I further direct that my executors hereunder shall not be required to furnish bond or surety for the faithful performance of his duties hereunder. In witness whereof, I have set my hand and seal to this my Last Will and Testament this :5[ [ day of~r~ff/z;, 2-/' ,1992. Testatrix Signed, Sealed, Published and Declared by the above-named Testatrix, Helen Hosie as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. Address ilress AcknoWledgment CommonWealth of PennsylVania: County of Wayne: SS I, Helen Hosie, the Testatrix whose name is signed to the foregoing instrument, having been duly sworn according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~~~~_~~ IZlelen Hosie Testatrix Sworn to and acknowledged before me this c~}'s4 day of ~ 1992. Nota0 Public Seal Nots. rial Seal Virginia Gay W(,niger, NC'a.ry Public Hcr~e.'cJale Boro, Wayne Count,./ My Oornrnission Expires Nov. 15, 1993 Meml2er, Penr~oylvania A~;o.~a~ign o~ iq:.;,tari~s AffidaVit CommonWealth of PennsylVania: : SS County of Wayne. · . witnesses whose names qlr¢ signed to the foregoin~nstru~nt, b~[n~auly-~orn according to law, do dep~'se and say that we were presem and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testatrix, signed the Will as a witness; and that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Witnesses {/ ' Sworn to and subscribed before me by and 0"-~C_xrh '--~t~2oz.d.zie. x~)/~'z_ , witnesses, this 1992. Seal Nota~ Public Virc~irqa Ga'/~,,'¢eni~e~; Notary Public M7 Corr~r,'i,:;,5o;~ E>.:~?:.:~ Nov. 15, 1~3 £g: t d LE 83~ I~0. Name of Decedent: Helen CERTIFICATION OF NOTICE UNDER RULE 5.6(a) M. Hosie a/k/a Helen Hosie a/k/a Helen Mary Hosie DateofDeath: December 3, 2003 Will No. 2004-001 97 Admin. No. 21 -04-0197 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on .April 6, 2004 : Name Address Thomas A. Hosie Jr. 387 Walton St., Lemoyne, PA 17043 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date:April 6, 2004 Address104 S. Hanover St. Carlisle, PA 17013 Telephone (71 Y 243 - 7437 Capacity:__ X Personal Representative ~.Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN FILE NUMBER 21 _ 04 0197 RESIDENT DECEDENT DECEDENT'S NAME {LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-- Hosie, Helen M. 185-38-0271 Z LM DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAE) t"t THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U.I 12/03/2003 1 12/05/1905REGISTER OF WILLS Iil (IF APPLICABLE) SURVIVING SPOUSE'S NAME {LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER uJ U.I ~'~'-~ 1. Original Return -'-]4. Limited Estate [~]6. Decedent Died Testate (Attach c~w d wa) [~9. Litigation Proceeds Received [~2. Supplemental Return ~-~ 4a. Future Interest Compromise (date of (teath a~ter 12-12-82) ~----~ 7. Decedent Maintained a Living Trust (A.~a~ copy of Trust) [---~10. Spousal Poverty Credit (date of daath between 12-3%91 and 1-1~J5) ]-'--~ 3. Remainder Return (date ordeath p~o~ to 12-13-82) r--] 5. Federal Estate Tax Return Required . 8. Total Number of Safe Deposit Boxes [~-~11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME Tricia D. Naylor FIRM NAME (~fApCi~ab~e) Law Office of John Oszustowicz TELEPHONE NUMBER (717) 243-7437 COMPLETE MAILING ADDRESS 104 S. Hanover St. Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Mlecelleneous Personal Prope~ (5) {Schedule E) 6. Jointly Owned Property (Schedule F) (6) ---]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses &Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) {10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 0.00 216,971.74 0.00 0.00 0.00 32,538.79 ~.~ 0.00 '"" (8) 13,836.77 0.00 (11) (12) (13) (14) 249,510.53 13,836.77 235,673.76 0.00 235,673.76 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate (16) 17. Amount of Line 14 taxable at sibling rate {17) 18. Amount of Line 14 taxable at collateral rate (18) 19. Tax Due {19) x .0 __ (15) 45 · ~.,.,.,~.o..,~ x .o x .12 x .15 10,605.32 10,605.32 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREETADDRESS 387 Walton St. C~TY Lemoyne I STATEpA 7043 J Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Pdor Payments 0.00 C, Discount 0.00 (1) 3. Interest/Penalty if applicable To~al Credits (A + B + C ) (2) D. Intamst 0.00 E. Penalty 0.00 Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page I Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE, A. Enter the interest on the tax due. '(3) (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT. 10,605.32 0.00 0.00 0.00 10,605.32 0.00 10,605.32 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or ils income; ............................................ [] [] c. retain a reversionary interest; or ............... : .......................................................................................................... [] [] d. receive the promise for life of either payments, benefits or cam? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. :.?-:"~F PERSON/RESI~NSIBL,~-.FQ~ FILING RE'~RN ADDRESS / ' ~ · 38~alton St., Lemoyne, PA 17043 104 S. Hanover St., Ca~e. ~ 17013 DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a)(1.1) (i)J. For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9t16 (a) (1.1) (ii)]. The statute does no~ exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is lhe only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on lhe net value of Iransfers from a deceased child twenly-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116{a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. R~V-I~Oa ~X + (~.a~ (~) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hosie, Helen M. SCHEDULE B STOCKS&BONDS FILE NUMBER 21-04-0197 All p,-Gpe~ly jointly,owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1, See attached ~'chedule VALUE AT DATE OF DEATH TOTAL (ALso enter on line 2. Recapitulation) $ 21 6,9 71 . 7 4 (If more space is needed, insert adc~nal sheets of the same size) Item 3 4 6 7 9 10 11 Schedule B Stocks & Bonds Estate of Hosie, Helen M, DESCRIPTION 672 shares Exxon Corp. Common Stock CUSIP 302290101 208 shams PPL Common Stock CUSIP 709051106 240 shares Royal Dutch Common Stock CUSIP 780257705 114 shams Lucent Technologies Inc. Common Stock CUSIP 549463107 1568 shams IBM Common Stock CUSIP 459200101 244 shares Honeywell International Inc. Common Stock CUSIP 438516106 58 shares Comcast Common Stock CUSIP 20030N101 12 shares Avaya Common Stock CUSIP 053499109 38 shares Agere Systems cl B Common Stock CUSIP 00845V209 616 shares Verizon Common Stock CUSIP 92343V104 36 shams ^T&T Common Stock CUSIP 1957109 36.57 40.385 46.345 3.09 90.87 29.49 31.872 13.555 3.12 32.44 20.2,5 File # 21-04-0197 Value at Date of Deeth 24,575.04 8,400.08 11,122.80 352.26 142,484.16 7,195.56 1,848.58 162.66 118.56 19,983.04 7Z8.00 216,971.74 REV-1509 EX* (6--98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hosie, Helen M. SCHEDULE F JOINTLY-OWNED PROPERTY 'FILE NUMBER 21-04-0197 If an asset was made joint w~in ane year of the d~_~__ent's da~ of death, Jt must be reported on ~-~_ h~,_,!e 43. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Thomas M. Hosie, Jr. 387 Walton St., Lemoyne, PA 17043 Son JOINTLY-OWNED PROPERTY: L~.) mr-I< DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOIN'[ MADE INCLUDE NAME OF FINANCIAL INSTTTUTh3fl AND BANK ACCO~JNT NUMBER OR SIMILAR DATE OF hEATH DECD'S VA/ME OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATrACH DEED FOR JOINT[Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1, A. See attached schedule 32,538.79 TOTAL (Also enter on line 6, Recapitulation) $ 32,538.79 (If more space is needed, insert additional shee~s of the ~ame size) Schedule F Hosie, Helen M. 21-04-0197 Letter for joint tenant 1 A 3 4 6 A A A A A The Honesdale National Bank 4.7% 5/11/02 27416 The Honesdale National Bank 4.7% 5/11/02 27417 The Honesdale National Bank 1.71% 7/6/04 1201913237 The Honesdale National Bank 1.71% 7/6/04 1201913238 Farmers & Merchants Bank 8.1% 2/17/90 9112 11458 Wayne Bank Checking Account #2223137 Total Date of Death Value of Asset 5,006.68 11,014.69 5,013.97 5,013.97 20,074.88 18,953.36 % of Decds Interest 50 50 50 50 50 50 Date of Death Value of Decedents Interest 2503.34 5507.35 2506.99 2506.99 10037.44 9476.68 32538.79 All CD's in joint names Helen Hosie & Thomas Hosie Jr. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA'ffi OF Hosie, Helen M. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS I FILE NUMBER 21-04-0197 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. 1. 5. 6. 7. FU~RN. EXPENSE$: Hessling Funeral Home The Town House Diner ADMINISTRATNE COSTS: Personal Representative $ Commissions Name of Personal Representa6ve (s) Social Security Number(s) / EIN Number of Pemonal Rep~esontetJve($) Street Address City , State Year(s) Commission Paid: A~omeyFeea John C. Oszustowicz Famly E~empl~on: (If decedant s address is not the same as claimant s, attach explanation) Claimant Zip, Relationship of Claimant to Decedent Probate Fees Accountant s Fees Tax Relum Pmpar~s Fees Advertising - Legal The Sentinel Cumberland County Law Journal TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, ~eft additional sheets of lhe same size) /~OUNT 5449.00 131 .76 7750.00 346.00 85.01 75.00 $ 13;83g_77 REV-1513 EX* (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hosie, Helen M. SCHEDULE J BENEFICIARIES FILE NUMBER ?.1-04-0197 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include oubight spousal distributions, and b-ar.~;urs under Sec. 9116 (a) (12)] Thomas A. Hosie, Jr. 387 Walton St., Lemoyne, PA 17043 RELATIONSHIP TO DECEDENT Do Not List Son 100% AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, Insa~t additional sheets of t~e same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) OO3949 NAYLOR TRICIA D 104 S HANOVER STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 185-38-0271 FILE NUMBER: 2104-01 97 DECEDENT NAME: HOSIE HELEN M DATE OF PAYMENT: 05/18/2004 POSTMARK DATE: 05/1 8/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $10,605.32 REMARKS: TRICIA NAYLOR TOTAL AMOUNT PAID: $10,605.32 SEAL CHECK# 502 INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17128-0601 CONHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX TRICIA D NAYLOR J OSZUSTOWICZ LAW OFC lOq S HANOVER ST CARLISLE PA 17015 DATE ESTATE OF DATE OF DEATH FILE NUHBER ACM REV-*ISq? EX AFP (01-03) 07-05-200q HOSIE HELEN N 11-05-2005 11 0q-0197 CUMBERLAND 101 Amoun~ Remi~ed I HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~.~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HOSIE HELEN MFZLE NO. 21 0~-0197 ACN 101 DATE 07-05-200q TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership Zn~ares~ (Schedule C) (3) q. Mor~gagas/No~as Receivable (Schedule D) E. Cash/Bank Deposits/Misc. Personal Propar~y (Schedule E) (5) 6. Join~ly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~al Asse~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Exponses/Adm. Cos~s/Misc. Expanses (Schedule H) (9) 10. Dobbs/Mortgage Liabili~ios/Lions (Schedule Z) (10) 11. To,al Deductions 12. Na~ Value of Tax Ra~urn 216/971.7q .00 .00 NOTE: To insure proper credi~ ~o your account, submi~ ~ha upper por~ion .00 of ~his fore wi~h your .00 ~ax payment. 32/558.79 .00 (8) 15,856.77 .00 15. NOTE: 2q9,510.55 (11) 13.83&. 77 (12) 255,675.76 Charitable/Governmental Bequests; Non-alac~ad 9115 Trusts (Schedule J) (15) Na~ Value of Es~a~a Subjac~ ~o Tax (lq) Zf an assessment was issued previously, 11nes 14, 15 and/or 16, 17, ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~e (15) 16. Amoun~ of Line lq ~exabla a~ Lineal/Class A ra~a (16) 17. Amoun~ of Line lq e~ Sibling ra~e (17) 18. Amoun~ of Line 1~ ~axable a~ Collateral/Class B ra~e (18) 19. Principal Tax Due reflect figures that include the total of ALL returns assessed to date. DZ~CUUNT INTEREST/PEN PAID (-) TAX CREDITS: PAYMENT DATE 05-18-200q · O0 X O0 = 255,673.76 x OqS= · O0 x 12 = · O0 X 15 = (19)= AMOUNT PAID 10,605.52 RECETP1 NUMBER CD0059q9 .00 2:55,675.76 .00 10,605.32 .00 .00 10,605.52 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 10,605.32.00.00.00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE ~ / A REFUND. SEE REVERSE S/DE OF THIS FORM FOR [NSTRUCT/ONS.) ~ ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. .00 18 and 19 w111 RESERVATION: Estates of decedents dying on or before December 12, 198Z -- if any future interest in tho estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for lifo or for years, the Coeaonmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rata on any such futura interest. PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADH/N- ISTNATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST= To fulfill the requirements of Section Z140 of the inheritance and Estate Tax Act, Act 23 of ZOO0. (TI P.S. Section 9140). Detach the top portion of this Notice and submit eith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, ahich mas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania inheritance and Estate Tax" (REV-1513). Applicatlons ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering= 1-800-56Z-Z050; services for taxpayers aith special hearing and / or speaking needs= 1-800-~47-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) es shown on this Not[ce must object eithin sixty (60) days of receipt of this Not[ce by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered an this assessment should be addressed in writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dapt. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea page 5 of the booklet "instructions for Xnharitance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is alloeed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January l, 198Z bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. Ail taxes which became delinquent on and after January 1, 198Z mill bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 ara: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor 198Z lOX .0005~8 '~'~'~'8-1991 1II .000501 1983 16Z .000q3B 199Z 9Z .O00Z~7 1984 Ill .000301 1993-199~ 7X .§OO19Z 1985 13Z .000356 1995-1998 9Z .000247 1986 lOX .000274 1999 7Z .000192 1987 lOZ .O0027~ ZOO0 7Z .O00XeZ --Interest is calculated as follows= Daily Year Rate Factor 2001 9Z .000247 200Z 62 .000164 2003 52 .000137 200~ ~Z .000110 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0197 ESTATE OF HELEN M. HOSIE, DECEASED Late of Cumberland County, PA FAMILY SETTLEMENT AGREEMENT THOMAS A. HOSIE,/ILL, EXECUTOR Date of Death: December 3, 2003 Letters Granted: February 27, 2004 First Complete Advertisement of Grant of Letters: March 23, 2004 Account stated to July 27, 2004 John C. Oszustowicz, Esq. 104 South Hanover Street Carlisle, PA 17013 (717) 243-7437 AGREEMENT TO INDEMNIFY, RECEIPT, AND RELEASE THIS AGREEMENT, by and among Thomas A. Hosie, Jr. Executor of the Estate of Helen M. Hosie Deceased, and Thomas A. Hosie, Jr. WHEREAS, Helen M. Hosie died December 3, 2003, testate, a resident of Cumberland County, Pennsylvania; and WHEREAS, the Last Will and Testament of Helen M. Hosie dated March 21, 1992, was duly probated in the Office of the Register of W~tlls of Cumberland County, Pennsylvania as appears of record at Number 21-04-0197 (a copy of the Will is attached hereto and marked Exhibit A); and WHEREAS, Letters Testamentary were issued to Thomas A. Hosie, Jr. on February 27, 2003; and WHEREAS, said Executor has duly administered the estate according to the laws of the Commonwealth of Pennsylvania; and WHEREAS, in Item THIRD of her W~fll, decedent directed Executor to give, devise and bequeath the rest, residue and remainder of her estate of whatsoever nature and wheresoever situate to Thomas A. Hosie, Jr.; and WHEREAS, Thomas A. Hosie, Jr. has been furnished with a complete listing of the estate assets, receipts and disbursements; and WHEREAS, it is the desire of the parties to this Agreement that final distribution of this estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting. NOW, THEREFORE, in consideration of the mutual promises, covenants and agreemems recited herein, the parties do agree as follows: Beneficiary does hereby release and forever discharge Executor, from any and all liability which he had or may have or which may from time to time arise in connection with his service as Executor of the Estate of Helen M. Hosie, Deceased, and hereby authorize and request the Orphans' Court Division to charge the same against his share of said estate, and in consideration for said distribution, hereby agree to refund any amounts so distributed which may be required to fully discharge any tax liability of the estate, debts of the decedent, or administration expenses. The party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon his respective heirs, successors, executors, administrators and assigns. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. f ,2004· Thomas A. Hosie, Jr., Executor Thomas A. Hosie, Jr., Benel~c~ary 304 Ninth Street HOnesdele, PennsyNenla 18431 Last of Helen Hosie I, Helen Hosie, of Putnam Circle, Honesdale, County of Wayne and State of Pennsylvania, being of sound mind, memory and understanding, and mindful of the uncertainties of life, do make and execute this, my Last Will and Testament, hereby revoking all Wills and Codicils, as well as all othert instruments of a testammentary nature, heretofore made by me, in manner and form as follows, that i~' to say: FIRST: I direct that all my just debts and funeral e~penses be paid as soon after my dealth as conveniently may be possible. SECOND: All of the rest, residue and remainder of my estate, whether real, ~.. personal or mixed property, and wheresoever situate and whereof I may die seized, I give devise and bequeath unto my beloved husband, Thomas A. Hosie, Sr., provided that he survives me for a period of thirty days after the date of my death. THIRD: Should my said husband, fail to survive me, for a period of~i~'~ days after the date of my dealth, I then give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether the same be real, personal or mixed, to Thomas A. Hosie, Jr. If he should fail to survive me by thirty days after the date of my death, then his share will pass to his living issue per stirpes. FOURTH: I name, constitute and appoint my husband, Thomas A. Hosie, Sr., as executor of this, my Last Will and Testament. Should my said husband fail to survive me or fail to qualify or serve as my executor, I name constitute and appoint Thomas A. Hosie, Jr. Executor of this my Last Will and Testament. I further direct that my executors hereunder shall not be required to furnish bond or surety for the faithful performance of his duties hereunder. In witness whereof, I have set my hand and seal to this my Last Will and Testament this ~./' day of~,ff/~, :2../' 1992. Testatrix Signed, Sealed, Published and Declared by the above-named Testatrix, Helen Hosie as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. Address · ~di:tr~ss / ' Acknowledgment Commonwealth of Pennsylvania: County of Wayne: SS I, Helen Hosie, the Testatrix whose name is signed to the foregoing .. instrument, having been duly sworn according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. .~/~ ~ ~~~_.. Helen Hosie Testatrix Sworn to and acknowledged before me this ~}a-[ day of ~ 1992. Nota0 Public 0 Not,-~rial Seal Vi .rginia Gay Weniger, Notary Public Ficne~a~e Boro, Wayne Coun,~ My Oornr;~don Expires Nov. 15, 1993 CommonWealth of PennsylVania: : SS County of Wayne : we, an~~.~ '%~-, ~'~-75 the witnesses whose names q~r~ s~igned to the foregoin~nstru~nt, b~rt~du'ly-~orn a.ccording to law, do depose and say that we were presedt and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testatrix, signed the Will as a witness; and that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Wimesses [/ ' ~ Sworn to and subscribed before me by ~ Mill Ior'~ '-~. %q~(.xj,~ and 0~-~.O4h '"~o.20~_d.zie.~)/e~'z_ , witnesses, this ~}N' day of FF~K~h~ ,. 1992. lklota~ Public Notarial Seal ] Vi .rgP. ia Gay Wen'.r.~er, Notary Public lqcr,~a~dsle ~..~'Wayne County My Co.mmissJon E,-.:pirer~ NO*,'. 15 1993 Me:nb~r. Ponr~,,/*./lv~n,a A~c.,~,O~c~n Of Notarle¢ Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/01/2005 NAYLOR TRICIA D 104 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of HOSIE HELEN M File Number: 2004-00197 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent1s death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 12/03/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, /A . '~'/!'~;T ~. '~"J JP<=. GLENDA F]\~R..1\JER STRASBAU REGISTER OF WILLS cc: File Personal Representative(s) Judge ~b STATUS REPORT UNDER RULE 6.12 Name of Decedent: He\en M Hosie Date of Death: '21~ 2003 Will No. Z.DOY J DD I qi Admin. No. 7- J - 0 y - 0 J q7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X 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 rePFesentative file a final account with the Court? Yes No ~ . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may attached to th's eport. Date:~ 3) 05 T Name (Please Ln IDY S. HanDVer S+ Address LOYlfsJe, PA (117) 2-43-7'-13, Te 1. No. LJ_! C.) E~:: ,~ C), ("'-,.; C'0 I - - . Capacity: Personal Representative )( Counsel for personal representative C_) (MAH:rmf/AM3) VL