HomeMy WebLinkAbout03-0150
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of AnI.! ;-1- C7 No. Oll- O~- \SO
also known as / To:
Register of ~llS for t,7e J
, Depased. County of \)l-1A~M q.., in the
Social Security No. .:;;;.a ( D 9 - /.7 b Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or ~lder in the execut C'r< named
in the last will of the above decedent, dated d:;2 -3 . ,19~
and codicil(s) dated ' I
(state relevant circumstances, e.g. renunciation, deatb of executor, etc.)
Decendent was domiciled at death in Cu t- )
h 10 last family or principal residence at
(list street, number and muncipality)
yeWf ag~ied , 19 o 5.
at CI " 11 r
Except as follows, decedent did not marry, s not div ced 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: 8: CC
(If domiciled in Pa.) All personal property / /0'00 I -
(If not domiciled in Pa.) Personal property in Pennsylvania /
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvani cc
situated hS follo s: c,q},
So v 14
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c. La.; administration d. b.n.c. La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA l ss
COUNTY OF Cum~r\~ J
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.
Swom to 0' aW,med and 'ub,"dbed { eM tJ-r/--I'?- en
before me this ~O+-h day of oq'
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No. ~ -03 -ISD
Estate of \-\a.Q Cl..J \-\ Q~ ' Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW \=""....e.~\ Hl~ 4 ~ / I ,!joo3 19_, in consideration of the petition on
the reverse side hereof, satisfact ry proof havmg been presented before me,
IT IS DECREED that the instrument(s) dated ~ - {}(3 - ICJq~
described therein be admitted to probate and filed of record as the last will of
\-\~ \--\('i'\t ;
and Letters ~ ~..It>.~ Mt) ts
are hereby granted to ~:,. ~ ~ 'k' 'ell;> rt. '2 ~
~"" -'-ql'llh 1,,+ kj,p '~a' ~
FEES Register of Wills
Probate, Letters, Etc. ......... $ U; O. 00
Short Certificates( ).......... $ 3 . W AITORNEY (Sup. Ct. 1.0. No.)
R-eft1:lfleiatiGn ~ p~. $ In.iiJ
$ It) . 0[) ADDRESS
TOTAL _ $ iq ,tJ{)
Filed .c2.-:~. ~:-. 9~. . . . ... . ..,. . . . . . . . . .
~ PHONE
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This is to certify that the information here given is correctly copied from an original certificate of death duly hIed 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 8922215 ~.dl. '.
~ 2003
../
No. Date
.
.
,
.
nAV 1191 COMMONWEALTH OF PENNSyLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
SllI:TE FilE NUM"f'R
NAME OF DECEDENT {Flrsl, M<ddle. L8!l1} SEX SOCIAL SeCURITY NUMBER
,. H .. Male .. 205-09-1368 2, 2003
AGE (last Blrlhdil\ll
f"h'~ ,
87 v" I';P"-"vll-J
..
COUNTY OF DEATH RACE - AfT\f>', lln lollil'ln, R1ad, Wl'Ill" ..t,
(Sp"c,lvl
. Cumberland ... White .
... ,..
DECEDENT'S USUAL OCCUPATION MARITAL STATUS. M'trled SURVIVING SPOUSE
(~~:~i~~i;'~~ ~eu~r;~?tr~Or Never Married, Widowed. (lfw,f" q'w' ""1 ,j.",p ,,,,,,]
Divorced (SpeCify)
Machinist
Township "'r
Rd.
PA 17257 170. Cumberland 11d.O =;'=~~=oI l':llylhn,(l
MOTHER'S NAME (F'rBl. M,,-jdle, MllIdfIll S(Jr"~lllal
,.. Ida Mae Mumma .
INF nMANT'!}.M4IlING ADDRE~S{~'I'~", (~lly/Tn~n !3t"'l~.lil\r."Il1") .
E. 411 Briar Lane Chambersbur PA 17201
Ml THOD OF DISPOSITION PlAC. Of OJ. P05IrION. N..maorCam..ary. ,,,,,,,,aIOfy LOCATION . Clt~.,rown, le'a. IIp Cf'<1l'l
,. Bunal [~ CremlUon 0 RalT\OVllI from 9I:lltl 0 or Othtlr PI..cI Shippensburg
" Oonallon 0 Other rsPflClfyl 0
t. 2111. ,.. Cumberland Count
SIG EN OR SON ACTING AS SUCH
n.m. 24-28 muBt be completed by o E PRONOUNCED DEAD {Month. Day, Yea,) ~s CASE
person whO pronounces death. February 2, 2003 NoD
...
27. MAT I: Ent... t'- dI........ Injuries 0' compllelltlone whIch otIuHd 1"1 de.lh. Do not entlr the mode ot dylng, sueh e. cardiae or rl!lplrl.Ory arrest .noc~ 0' he.rl rallure ,Appro_lmlta PAATII: OtMr slgntrlCllnt concIl.~. conlnbUllng '0 d...'h. but
U.t onty ana caUM on aaeh line : Interval b-'WHn ~ !'Mulling In the undl'l'lying CAU!\f! Q,vfln "l PAnT I
IMMEDIATE CAUSE (Final ! onMl and delth
clisease or condition Chronic Obstructive Pulmonar Disease Coronary Artery Diseas~=___
rMUJtingirlcle8tt1}---+ .
DUE TO (OR AS A CONSEQUENCE Qf) i
8eQultntlalyllMconctIIloM b.
If Iny. IMdlng 10 ImrnKbta DUE 10 (an AS A CONSEQUENCE OF)' I !
CIUM. Entar UNDERLYINQ
CAUSE (OIlMl9M or inJl.ll'V ,
Ihl'll,nrtilllledevenl9 DUE TO (OR AS A CONSEQUENCE OF)' I
r~J1hng In dMlh) LAST ,
d
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJUny TIME OF INJURV INJURV AT WORK? DESCRIBE HOW INJURY OCCURnrD
PERFORMED? """'LABLE PRIOR TO (Month,Oqv Yf',lr)
COMPLETION OF CAUSE j( 0 ....0 NoD
OF DE~H? Natural _Ido
....0 ....0 NoD -"' 0 Plndlna InYMt~ 0 3 .. ....
No 0 o PlACE OF INJURY -AI home.tllrm. streel, lactory. olflce lOC.a:rION (S1reet. CilyrTown, SIal"!)
Su"",," Coutd not be determined bulktlog, -'c. (Sr"C1tyl
.... _. ... _.
CERTIAEJII (Check only Of1e}
*CERTlIfYING PHVIICIAN (Pt1ysician certifying cause 01 detIth lilIherlenolh... phyeioi.en Iuu ptonout'1Ced durh 8nd compl8ted hem 23) 0 Coroner
TOlNbeetof""k~.""'hoceurN<ld...tolhac--<-)andmannar_""', '.. ....... ....... _...... . . . . . . . . .
*ftIItONOUHClNQ AND ce..-rllfYJNG PHYSICIAN (phylliclan balh pronouncing dHlh end oatIftVlng to =-- 01 dBlh) DATE SIGNF.O (""<:'If''''. [l'IV ~h'''l
To the bMt of my 1lftowlMge, elMth occurr.d at the Ulna, dille, and P", 1Iftd.. to the oaUM(.) and IMftftW II......., .... ................ Ll , February 3, 2003
NAME AND ADD as oF PERSON WHO COMPlETED CAUSE OF DEATH
...DtCAL IXAMlNEAICOAOHER (11""'27) TV"'.' .""'Mic hae 1 L. Norris, Coroner
On the...... oI...mlMtton .ndJor tnvntIo-tton. In my opinion. CIeIttt oooul'Nd at eM tfMI..... Iftd.............. te h HUM(.)'" ~... 6375 Basehore Road, Suit.. III
m....,..,...,lItH.......,..........."......,.."........"...,...,......,..,.................".......,.......... . Mechanicsburg, Pa. 17050
'111. .
AEOISTRAA.S $IQNRURE AND NUMBER D,tCfEFllE
~~ 6 kJ?J.7 &
33. ...
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LAST WILL AND TESTAMENT
I, HARRY H. COY, of 214 Goodhart Road, Shippensburg, Cumberland County,
Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare
this my Last Will and Testament, hereby revoking and making void all wills by me at any time
heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I give and bequeath my 20-gauge model #37 pump gun and my 30-30 model
#94 golden spike rifle to my good friend, GEORGE C. GOODHART, ofR. D. #2, Shippensburg,
Pennsylvania, absolutely.
THIRD. I give, devise and bequeath all of the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever situate, to three of my children, namely
HERBERT E. COY, who presently lives in Fayetteville, Pennsylvania, NANCY ANGST, who
presently lives in Athens, Georgia, and ROSETTA TUCKER, who presently lives in Chulavista,
California, on a per stirpes distribution basis. It is my specific intent and desire to exclude my other
children, namely, DORIS JEAN COY ETTER and RICHARD COY, from any distribution
whatsoever, under this my Last Will and Testament.
FOURTH. I nominate, constitute and appoint my son, HERBERT E. COY, of
411 Briar Lane, Chambers burg, Pennsylvania, to be the Executor of this my Last Will and
Testament; ifhe be unable to fulfill the duties of Executor, I then nominate, constitute and appoint
my grandson, STEVEN R. COY, of 471 South Fourth Street, Chambersburg, Pennsylvania, to be
the Executor of this my Last Will and Testament.
FIFTH. I direct that my personal representative(s) not be required to give bond for the
faithful performance of their duties in any jurisdiction.
SIXTH. I hereby direct that all federal, state and other death taxes payable because of
my death, with respect to the property forming my gross estate for tax purposes, whether or not
passing under this Will, including any interest or penalty imposed in connection with such taxes,
shall be considered a part of the expense of administration of my estate and that such be paid out of
the rest and residue of my estate.
IN WITNESS WHEREOF, I, HARRY H. COY, have hereunto set my hand and seal to this
my Last Will and Testament, written on one page this 1- :s day of February, 1998.
.H~? H ~ (SEAL)
MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257.1397
~ . . -
This instrument was by the Testator, on the date hereof, signed, published and declared by
him to be his Last Will and Testament, in our presence, who at his request and in the presence of
each other, we believing bim to be of sound and diWing mind and emo 'fa ,ere to
subscribed our names as witnesses. h l (tJ I Z'1
- W/ ,/ I
kafj~//V (arAj
COMMONWEAL TH OF PENNSYLVANIA
: SS.
COUNTY OF CUMBERLAND
I, Harry H. Coy, the person whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
)! cU-Jtuj ?I (P (J
,1998.
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MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - sHIPPENsBURG, PA 17257.1397
. . , . -
COMMONWEAL TH OF PENNSYLVANIA
: SS.
COUNTY OF ZUMBERLAND {
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IWr ' J
We, ",/ / J < ,
the witnesses whose names are signe o the foregoing instrument, being duly qualified ccording
to law, do depose and say that we were present and saw Harry H. Coy, the Testator, si and execute
the instrument as his Last Will; that he signed willingly and that he executed it as his free and
voluntary act for the purposes 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 the
time eighteen (18) or more years of age and of sound mind and under no constraint or undue
influence.
'AL
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~ PA ~'f,fj,.~.nd CoUntY
,". ' ,.Ju ..$11.
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257.1397
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: )/~r7 ;I~all
/
Date of Death: ~~ r J. ) 0 .t
Will No. Admin. No. ~3,. oo/(m
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
Name Address
Ar ~~~I y.;!. Coy - I.J If B'rlD./, ),ue. - o 4Clll1 6 ~r~ J, ~ ?4- J >,,;2.P I
I
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name a/ud..-/ c"c 7
Address YI/ Er-t~r ) o.1t-e...
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CL M. J7~J
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.l.. >- I;;: Telephone (7r~ if;' V - 7{);-e-
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c.) l3 i:;: s:: Capacity: t/' Personal Representative
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_Counsel for personal representative
REV. :500 v: . (WOI .II . REV-1500 OFFICIAL USE ONLY I
COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER
DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 03 00150
DEPT. 280601
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Coy, Harry H. 205-09-1368
!z DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
w
0
w 02/02/2003 REGISTER OF WILLS
0
w
0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
181 1. Original Return o 2. Supplernental Return o 3. Remainder Retum (date of death prior to 12-13-82)
w
.... o 4. Limited Estate o 4a. Future Interest Compromise (date of death after o 5. Federal Estate Tax Return Required
:.:=:;!;Ul
0":':= 12-12-82)
wo..o 181 6. Decedent Died Testate (Attach copy o 7. Decedent Maintained a Living Trust (Attach
,,00 8. Total Number of Safe Deposit Boxes
0"..J -
o..Gl of Will) copy of Trust)
0..
<( o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (dale of death between o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
12-31-91 and 1-1-95
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
AME COMPLETE MAILING ADDRESS
.... Michael J. Hanft, Esquire
z
w IRM NAME (If applicable)
0 19 Brookwood A venue, Suite 106
z Hanft & Knight, P.c.
0
0.. Carlisle, P A 17013
ELEPHONE NUMBER
717/249-5373
1. Real Estate (Schedule A) (1 ) 25,000.O<P '..' R OFFICIAL USE .pNL Y
2. Stocks and Bonds (Schedule B) (2) Nont5
c~ 'T1
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) Non~. rrl
a:J
4. Mortgages & Notes Receivable (Schedule D) (4) NonlP- --
.....
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ('.
(Schedule E) 28,311.6~) -0
6. Jointly Owned Property (Schedule F) (6) Non~ ' w
z o Separate Billing Requested )> .:1 d
0 0
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
~ (Schedule G or L)
....
0:: 8. Total Gross Assets (total Lines 1-7) (8) 53,311.60
<(
0
w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 9,362.60
"
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,040.45
11. Total Deductions (total Lines 9 & 10) (11 ) 10,403.05
12. Net Value of Estate (Line 8 minus Line 11) (12) 42,908.55
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 42,908.55
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2) -
z 42,483.55 .045 (16) 1,911.76
0 16.Amount of Line 14 taxable at lineal rate x
S -
~
0.. 17.Amount of Line 14 taxable at sibling rate x .12 (17)
::;;
0
0
S 18. Amount of Line 14 taxable at collateral rate 425.00 x .15 (18) 63.75
19. Tax Due (19) 1,975.51
20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc. ". Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
214 Goodhart Road
CITY Shippensburg I STATE PA I ZIP 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1 ) 1,975.51
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) O~OO
3. InteresVPenalty if applicable
D. Interest 25.09
E. Penalty
TotallnteresVPenalty (D + E) (3) 25.09
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund 2,000.60
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2,000.60
Make Check Payable to: REGISTER OF WILLS, AGENT
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 its income;.................................... I
c. retain a reversionary interest; or.........,...........................................................................".,...... ...................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ~
receiving adequate consideration?...,...........................................,.".,........................................................ ......... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 0 ~
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.
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of
preparer other than the personal representative is based on all information of which pre parer has any knowledge.
SIGNATURE OF PERSON RESP ADDRESS DATE
Herbert E. Coy 411 Briar Lane 11/0 L/
/' Chambersburg, PA 17201 ~
ADDRESS DATE
ADDRESS DATE
19 Brookwood A venue, Suite 106 2 ... (/-()c.f
Carlisle, PA 17013 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)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 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.
*' SCHEDULE A
REAL EST ATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Coy, Harry H. 21 - 03 - 00150
All real property owned solel~ or as a tenant in common must be refrorted at fair market value. Fair market value is defined as the price
at which property would be exc anged between a willing buyer and a wiling seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Real Estate situate at 214 Goodhart Road, Shippensburg, South Hampton Township, Cumberland County, 25,000.00
Pennsylvania
TOTAL (Also enter on Line 1, Recapitulation) 25,000.00
* SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Coy, Harry H. \ FILE NUMBER
21 - 03 - 00150
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Citizens Bank Certificate of Deposit No. 6140760011 10,024.45
2 Citizens Bank Checking Account No. 6100641260 13,862.15
3 20 gauge model #37 pump gun 125.00
4 30-30 model #94 golden spike rifle 300.00
5 1974 Mobile Home 4,000.00
TOTAL (Also enter on Line 5, Recapitulation) 28,311.60
,
*' SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Coy, Harry H. I FILE NUMBER
21 - 03 - 00150
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 Fogelsanger-Bricker Funeral Home, Inc. 5,333.10
2 Springhill Cemetery - opening grave 500.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees to Hanft & Knight, P.C. 2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 The News - Chronicle Co. (advertising) 56.00
2 Cumberland Law Journal (advertising) 75.00
Total of Continuation Schedule(s) 898.50
TOTAL (Also enter on line 9, Recapitulation) 9,362.60
. *'
Schedule H
Funeral Expenses &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN Adninistrative Costs continued
RESIDENT DECEDENT
ESTATE OF Coy, Harry H. I FILE NUMBER
21 - 03 - 00150
3 Robert Wyriek - cemetary preparation 100.00
4 Chas Thomas - tearing down shed and trailer 500.00
5 Shull - Koontz - tombstone engraving 275.00
6 News Chronicle - advertising mobile home 23.50
Page 2 of Schedule H
. SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYlVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Coy, Harry H. 21 - 03 - 00150
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Adam Electric - electric bills 136.44
2 Harrisburg Hauling - garbage bills 210.77
3 Sprint - phone bill 47.36
4 Sears 79.98
5 Dymond Insurance - real estate insurance 145.00
6 Vivian Coy, Tax Collector - real estate taxes 420.90
TOTAL (Also enter on Line 10, Recapitulation) 1,040.45
~EV.1513 EX+ (9.00) *'
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Coy, Harry H. I FILE NUMBER
21 - 03 - 00150
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 George C. Goodhart none 20 gauge model #37
401 Walnut Bottom Road pump gun and 30-30
Shipp ens burg, P A 17257 model #94 golden spike
rifle
2 Herbert E. Coy son 1/3 residue of estate
411 Briar Lane
Chambersburg, P A 17201
3 Nancy Angst daughter 1/3 residue of estate
197 Merlin Drive
Athens, GA 30606
4 Rosetta Tucker daughter 1/3 residue of estate
1460 Lavel Avenue
Chula Vista, CA 91911
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF.REV-1500 COVER SHEET
, . .... .
'." -
.... _..~. --. -. . ~'-OS-150
LAST WILL AND TESTAMENT
I, HARRY H. COY, of 214 Goodhart Road, Shippensburg, Cumberland County,
Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare
this my Last Will and Testament, hereby revoking and making void all wills by me at any time
heretofore made.
FIRST. . I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
"-
SECOND. I give arid bequeath my 20-gauge model #37 pump gun and my 30-30 model
#94 golden spike rifle to my good friend, GEORGE C. GOODHART, ofR. D. #2, Shippensburg,
Pennsylvania, absolutely.
,
THIRD. I give, devise and bequeath all of the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever situate, to three of my children, namely
HERBERT E. COY, who presently lives in Fayetteville, Pennsylvania, NANCY ANGST, who
presently lives in Athens, Georgia, and ROSETTA TUCKER, who presently lives in Chulavista,
California, on a per stirpes distribution basis. It is my specific intent and desire to exclude my other
children, namely, DORIS JEAN COY ETTER and RICHARD COY, from any distribution
whatsoever, under this my Last Will and Testament.
FOURTH. I nominate, constitute and appoint my son, HERBERT E. COY, of
411 Briar Lane, Chambersburg, Pennsylvania, to be the Executor of this my Last Will and
Testament; ifhe be unable to fulfill the duties of Executor, I then nominate, constitute and appoint
my grandson, STEVEN R. COY, of 471 South Fourth Street, Chambersburg, Pennsylvania, to be
the Executor of this my Last Will and Testament.
FIFTH. I direct that my personal representative(s) not be required to give bond for the
faithful performance of their duties in any jurisdiction.
SIXTH. I hereby direct that all federal, state and other death taxes payable because of
my death, with respect to the property forming my gross estate for tax purposes, whether or not
passing under this Will, including any interest or penalty imposed in connection with such taxes,
shall be considered a part of the expense of administration of my estate and that such be paid out of
the rest and residue of my estate.
-
IN WIlNESS WHEREOF, I, HARRY H. COY, have hereunto set my hand and seal to this
my Last Will and Testament, written on one page this 1- :s day of February, 1998.
'Jfc.?V1? ;/ ~ (SEAL)
"
MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
-
-
..
. . .~ ..
. ~:::~_U~;._~>,.~,~;.~;;">' :. , .J;..,.,... ~ ,., -_.......-_.. ......_.._'.--~~..
, ',..'."'
lbis instrument was by the Testator, on the date hereof, signed, published and declared by
him to be his Last Will and Testament, in our presence, who at his request and in the presence of
each other, we believing him to be of sound and dt%!ing mind and emo , a ere to
subscribed our names as witnesses. ~ /
l.W ' ,
/k.cWI~/ IV (ar::J
"-
COMMONWEALTH OF PENNSYLVANIA .
: SS.
COUNTY OF CUMBERLAND
I, Harry H. Coy, the person whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
jj ~ru; ?I (il;/
Sworn or affirmed to and acknowledged
befor~m Harry!:!:- oy, the Testator,
this L ayof f:. ,1998.
C{-
-
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET _ SHIPPENSBURG. PA 17257-1397
. I. "COMMONwE~THOFI .NSYLVANIA
: SS.
We, and ,
the witnesses whose names are signe o the foregoing instrument, being duly qualified ccording
to law, do depose and say that we were present and saw Harry H. Coy, the Testator, si d execute
the instrument as his Last Will; that he signed willingly and that he executed it as his free and
voluntary act for the purposes 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 the
time eighteen (18) or more years of age and of sound mind and under no constraint or undue
influence. 0~L/:iJ#cd
"-
U /pali~t' /V(a(Ji
.. NOT 'Al
.. JerrY"" WG\otil. . "'f'/ ~bllc
~ PA ~~i'i-~Jld COUnty
j · \1S$ Ju $1 1991
~.
-
-
I
MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003553
COY HERBERT E
411 BRIAR LANE
CHAMBERSBURG, PA 17257
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
____un fold ---------- --------
101 I $2,000.00
,- t'
,
ESTATE INFORMATION: SSN: 205-09-1368 I
FILE NUMBER: 2103-0150 I
DECEDENT NAME: COY HARRY H I
DA TE OF PAYMENT: 02/11/2004 I
POSTMARK DATE: 00/00/0000 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/02/2003 I
I
TOTAL AMOUNT PAID: $2,000.00
REMARKS:
CHECK# 497
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
C//-
ORPHANS' COURT DIVISION OF THE oK
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: HARRY H. COY
Date of Death: 2/2/2003
Admin. No. 21-03-00150
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~ 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 representative file a final account with the Court? Yes _ No -X
b. The separate Orphans' Court No. (if any) for the personal representative's account
IS:
c. Did the personal representative state an account informally to the parties in interest?
Yes~ No
-
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts
may be filed 1@th the Clerk of the Orphans' Court and may be attached to this report.
.
Date: L/ ("-J Respectfully submitted,
- 1 16..::- of
...-
N HANFT & KNIGHT, P.c.
r::t:: A~ nH-
D.-
r.;:;:
""'" . ~.'~
~'D P
0: r " Michael J. Hanft, Esquire
---
Attorney ill No. 57976
19 Brookwood A venue, Suite 106
Carlisle, PA 17013-9142
(717) 249-5373
Counsel for personal representative
F:\Uscr Folder\Firm Docs\EstatcsIJ248-1status,rpl,vvpd
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISIDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX AFP eDl-OS)
,1)A TE 04-12-2004
ESTATE OF COY HARRY H
DATE OF DEATH 02-02-2003
FILE NUMBER 21 03-0150
'04 APR 14 ;~ 9 ~NTY CUMBERLAND
MICHAEL J HANFT ESQ AC 101
HANFT & KNIGHT I Allount Rellitted I
19 BROOKWOOD AVE 106 eLl
CARLISLE PA 17013 ClIlntJ<.:
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 ~
REV =is4-j-E1f-AFP--foY:03Y-NoYicE--oF-YNHEifiTAirci-TA,rA-PPRAYsEifiNi':--A[lowAirci-cfR'-------------- ___
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF COY HARRY H FILE NO. 21 03-0150 ACN 101 DATE 04-12-2004
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 25.000.00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion
4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 28.311.60 tax paYllent.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 53,311.60
APPROVED DEDUCTIONS AND EXEMPTIONS: 9,362.60
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 1.040.45
11. Total Deductions (11) 10.403 Oli
12. Net Value of Tax Return (12) 42,908.55
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 42,908.55
NOTE: If an assessment was issued previously, linlls 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of abb returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (16) 42,483.55 X 045 = 1,911.76
17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Allount of Line 14 taxable at Collateral/Class B rate (18) 425 . 00 X 15 = 63.75
19. Principal Tax Due (19)= 1,975.51
TAX CREDITS:
. ~..._. ..---., . l+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
02-11-2004 CD003553 24.49- 2,000.00
TOTAL TAX CREDIT 1,975.51
BALANCE OF TAX DUE .00
INTEREST AND PEN. .60
TOTAL DUE .60
IE IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION: Estates Df decedents dying Dn Dr befDre December lZ, 198Z -- if any future interest in the estate is transferred
in pDssessiDn Dr enjDyment tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr
life Dr fDr years, the CDmmDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes
at the lawful Class B (cDllateral) rate Dn any such future interest.
PURPOSE OF
NOTICE: TD fulfill the requirements Df SectiDn Z140 Df the Inheritance and Estate Tax Act, Act Z3 Df ZOOO. (7Z P.S.
SectiDn 9140).
PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDur payment tD the Register Df Wills printed Dn the reverse side.
--Make check Dr mDney Drder payable tD: REGISTER OF HILLS. AGENT
REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested bY cDmpleting an "ApplicatiDn
fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-13l3). ApplicatiDns are available at the Office
Df the Register Df WillS, any Df the Z3 Revenue District Offices, Dr by calling the special Z4-hDur
answering service for forms Drdering: l-800-36Z-Z050, services fDr taxpayers with special hearing and I Dr
speaking needs: l-800-447-30Z0 (TT Dnly).
OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns, Dr assessment
Df tax (including discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df
this NDtice by:
--written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. Z8l0Zl, Harrisburg, PA l7lZ8-l0Zl, OR
--electiDn tD have the matter determined at audit Df the accDunt Df the persDnal representative, OR
--appeal tD the Orphans' CDurt.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue,
Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. Z8060l, Harrisburg, PA l71Z8-060l
PhDne (717) 787-6505. See page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident
Decedent" (REV-150l) fDr an explanatiDn Df administratively cDrrectable errDrs.
DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5X) discDunt Df
the tax paid is allDwed.
PENALTY: The l5X tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and 'nterest assessed, and nDt
paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn
penalty is appealable in the same manner and in the the same time periDd as YDU wDuld appeal the tax and interest
that has been assessed as indicated Dn this nDtice.
INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDm the date Df
death, tD the date Df payment. Taxes which became delinquent befDre January 1, 198Z bear interest at the rate Df
six (6X) percent per annum calculated at a dailY rate Df .000164. All taxes which became delinquent Dn and after
January 1, 198Z will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate
annDunced by the PA Department Df Revenue. The applicable interest rates fDr 198Z thrDugh Z004 are:
Interest Daily Interest Daily Interest Daily
Year Rate FactDr Year Rate FactDr Year Rate FactDr
~ -m-- :Dlrnm mlI-l99l --,rr- ~ mil -W- .~
1983 l6X .000438 199Z 9X .000Z47 ZOOZ 6X .000164
1984 11X .000301 1993-1994 ]X .00019Z Z003 5X .000137
1985 l3X .000356 1995-1998 9X .000Z47 Z004 4X .000110
1986 lOX .000Z74 1999 ]X .00019Z
1987 lOX .000Z74 ZOOO ]X .00019Z
--Interest is calculated as fDllDws:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NDtice issued after the tax beCDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days
beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the
NDtice, additiDnal interest must be calculated.
;l0
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 NOTICE OF INHERITANCE TAX
HARRISBURG, PA 17128-0601 APPRAISEKENT~ ALLOKANCE OR DISALLOKANCE
OF DEDUCTION , AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP CUI-OSl
DATE 05-31-2004
ESTATE OF COY HARRY H
DATE OF DEATH 02-02-2003
FILE NUMBER 21 03-0150
.04 f'JiW 28 COUNTY CUMBERLAND
P:3 :33 SSNI'DC 205-09-1368
HERBERT E COY ACN 03125059
214 GOODHART RD I Allount Rellitted I
SHIPPENSBURG lpA 17257-9656
ell,',.
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 ~
RE-Y=iS4-i-Ex--AFP--fol-:oil------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-31-2004
ESTATE OF COY HARRY H DATE OF DEATH 02-02-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0150 S.S/D.C. NO. 205-09-1368 ACN 03125059
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT NO. 6140760011
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (X> TIME CERTIFICATE
DATE ESTABLISHED 03-20-2000
Account Balance 10,024.45 NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT. SUBMIT THE
Amount Subject to Tax 5,012.23 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 5.012.23 REGISTER OF WILLS AT THE
Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK
Tax Due 751.83 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS. AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 06-08-2004 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 751. 83
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 19.31
TOTAL DUE 771 .14
II IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. II
( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 . INtlERITANCE TAX
HARRISBURG, PA 17128-0601
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS REV-UD4 EX AFP 'Dl-D3l
DATE 06-09-2004
ESTATE OF COY HARRY H
DATE OF DEATH 02-02-2003
FILE NUMBER 21 03-0150
COUNTY CUMBERLAND
HERBERT E COY SSN/DC 205-09-1368
ACN 03125059
214 GOODHART RD I Allount Rellitted I
SHIPPENSBURG PA 17257-9656
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 ~
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (01-03)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 06-09-2004
ESTATE OF COY HARRY H DATE OF DEATH 02-02-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0150 S.S/D.C. NO. 205-09-1368 ACN 03125059
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT NO. :-,6140760011
--,
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 03-20-2000
Account Balance .00 NOTE: TO INSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X .45 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due .00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE no
JI IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 1f..
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
. .
PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDur payment made payable tD the name and address
printed Dn the reverse side.
-- Make check Dr mDney Drder payable tD: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an
"ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REY-1313). ApplicatiDns are available at
the Office Df the Register Df Wills, any Df the Z3 Revenue District Offices Dr frDm the Department's Z4-hDur
answering service fDr fDrms Drdering: 1-800-36Z-Z050; services fDr taxpayers with special hearing
and I Dr speaking needs: 1-800-447-30Z0 (TT Dnly).
REPLY TO: QuestiDns regarding errDrs cDntained Dn this nDtice shDuld be addressed tD: PA Department Df Revenue, Bureau
Df Individual Taxes, ATTN: PDst Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17IZ8-0601, PhDne
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5X) discDunt
Df the tax paid is allDwed.
PENALTY: The 15X tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt
paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd.
INTEREST: Interest is charged beginning with first day Df delinquency Dr nine (9) mDnths and Dne (I) day frDm the date Df
death tD the date Df payment. Taxes which became delinquent befDre January I, 198Z bear interest at the rate Df
six (6X) percent per annum calculated at a dailY rate Df .000164. All taxes which became delinquent Dn and after
January I, 198Z will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate
annDunced by the PA Department Df Revenue. The applicable interest rates fDr 198Z thrDugh Z003 are:
Interest Daily Interest Daily Interest Daily
~ ~ ~ Year ~ ~ ~ ~ ~
198Z ZOX .000548 1987 9X .000Z47 1999 ]X .00019Z
1983 16X .000438 1988-1991 llX .000301 ZOOO 8X .000Z19
1984 llX .000301 199Z 9X .000Z47 ZOOI 9X .000Z47
1985 13X .000356 1993-1994 ]X .00019Z ZOOZ 6X .000164
1986 lOX .000Z74 1995-1998 9X .000Z47 Z003 5X .000137
--Interest is calculated as fDIIDws:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days
beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the
NDtice, additiDnal interest must be calculated.
REV-1470 EX (6-88)
'* .- ~
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
HARRY COY 2103-0150
REVIEWED BY ACN
SCOTT ELLISON 03125059
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
THE ABOVE ACCOUNT HAS BEEN REPORTED AND PAID ON THE PROBATE RETURN.
ROW Paqe 1
PURPOSE OF
NOTICE: TD fulfill the requirements Df sectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S.
SectiDn 9140).
PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDur payment tD the Register Df Wills printed Dn the
reverse side.
__ Make check Dr mDney Drder payable tD: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the tax return, may be requested by cDmpleting an "ApplicatiDn
fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df
the Register Df Wills, any Df the 23 Revenue District Offices Dr by calling the special 24-hDur answering service
fDr fDrms Drdering: 1-800-362-20S0; services fDr taxpayers with special hearing and Dr speaking needs:
1-800-447-3020 (TT Dnly).
OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns Dr assessment
Df tax (including discDunt Dr interest) as shDwn Dn this NDtice may Dbject within sixty (60) days Df receipt Df
this NDtice by:
--written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing tD have the matter determined at the audit Df the accDunt Df the persDnal representative, OR
--appeal tD the Orphans' CDurt
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errDrs disCDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue,
Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
PhDne (717) 787-6S0S. See page S Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident
Decedent" (REV-lSOl) fDr an explanatiDn Df administrativelY cDrrectable errDrs.
DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (S%)
discDunt Df the tax paid is allDwed.
PENALTY: The IS% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt
paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn
penalty is appealable in the same manner and in the the same time periDd as YDU wDuld appeal the tax and interest
that has been assessed as indicated Dn this nDtice.
INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day
frDm the date Df death, tD the date Df payment. Taxes which became delinquent befDre January 1, 1982
bear interest at the rate Df six (6%) percent per annum calculated at a dailY rate Df .000164.
All taxes which became delinquent Dn Dr after January 1, 1982 will bear interest at a rate which will varY frDm
calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable
interest rates fDr 1982 thrDugh 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate FactDr Year Rate FactDr Year Rate FactDr
i9iiZ ~ :Oo054i 1988-1991 -m:- :iiOii3iil ZoOi ---w- .iiiiii241
1983 16% .000438 1992 9% .000247 2002 6% .000219
1984 n% .000301 1993-1994 n .000192 2003 S% .000137
1985 13% .0003S6 1995-1998 9% .000247 2004 4% .Ooono
1986 10% .000274 1999 n .000192
1987 9% .000247 2000 8% .000219
--Interest is calculated as fDIIDWS:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (IS) days
beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the
NDtice, additiDnal interest must be calculated.
AL-
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. Z80601 --'HER"'TANCE TAX
HARRISBURG, PA 171Z8-0601 · ~
RECORD ADJUSTMENT REY-I595 EX AFP IDI-D5l
DATE 06-17-2004
ESTATE OF COY HARRY H
DATE OF DEATH 02-02-2003
FILE NUMBER 21 03-0150
COUNTY CUMBERLAND
MICHAEL J HANFT ESQ -.. ACN 101
HANFT & KNIGHT I Allount Rellitted I
19 BROOKWOOD AVE 106
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:i5'9-j-EX-AFP-Hff.:oiY-----.i-iifHERYfANc-E'-rA-i-RE-CORif-AD:rUsrifE'Nr--i.----------------------- - -- ---
ESTATE OF COY HARRY H FILE NO. 21 03-0150 ACN 101 DATE 06-17-2004
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
VALUE OF ESTATE:
1. Real Estate (Schedule A) ll) 25,000.00
2. Stocks and Bonds (Schedule B) (2) .00
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00
4. Mortgages/Notes Receivable (Schedule D) (4) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 18,286.95
6. Jointly Owned Property (Schedule F) (6) 5,012.22
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 48,299.17
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adllinistrative Costs/
Miscellaneous Expenses (Schedule H) (9) 9,362.60
10. Debts/Mortgage Liabilities/Liens (Schedule IJ llO) 1,040.45
11. Total Deductions (11) 10,403.05
12. Net Value of Tax Return (12) 37 ,896.12
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax ll4) 37 ,896.12
TAX:
15. Allount of Line 14 at Spousal rate ll5) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (16) 37,471.12X 045= 1,686.20
17. Allount of Line 14 at Sibling rate ll7) .00 X 12 = .00
18. Allount of Line 14 taxable at Collateral/Class B rate ll8) 425.00 X 15 = 63.75
19. Principal Tax Due ll9) 1,749.95
TAX CREDITS:
'"DATE 'NUMBER INTEREST/PEN P~;D (_) AMOUNT PAID
02-11-2004 CD003553 22.23- 2,000.00
TOTAL TAX CREDIT 1,977.77
BALANCE OF TAX DUE 227.82CR
INTEREST AND PEN. .OO!/
TOTAL DUE 227.82CR &\
. IF PAID AFTER DATE INDICATED, SEE REVERSE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. r~
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE '1'"
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
. --
PAVMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at
the Office of the Register of Wills, any of the Z3 Revenue District Offices or from the Department's Z4-hour
answering service for forms ordering: l-800-36Z-Z050; services for taxpayers with special hearing and I or
speaking needs: l-800-447-30Z0 (TT only).
REPLV
TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060l, Harrisburg, PA l7lZ8-060l, Phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount
of the tax paid is allowed.
PENALTV: The l5X 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 end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day from the date of
death to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 198Z will 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 198Z through Z004 are:
Interest Daily Interest Daily Interest Daily
Vear Rate Factor Vear Rate Factor Vear Rate Factor
- -
198Z ZOX .000548 1988-1991 11X .000301 ZOOl 9X .000Z47
1983 l6X .000438 199Z 9X .000Z47 ZOOZ 6X .000164
1984 11X .000301 1993-1994 ]X .00019Z Z003 5X .000137
1985 l3X .000356 1995-1998 9X .000Z47 Z004 4X .000110
1986 lOX .000Z74 1999 ]X .00019Z
1987 9X .000Z47 ZOOO 8X .000Z19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST 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.
REV-1470 EX (6-88)
'* INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
D~CEDENT'S NAME FILE NUMBER
HARRY H COY 2103-0150
REVIEWED BY ACN
SCOTT ELLISON 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
SCHEDULE E #1 HAS BEEN REMOVED AND PLACED ON SCHEDULE F.
. j~. \
:> ~
ROW PaQe 1
COMMONWEALTH OF PENNSYLVANIA '*
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. Z80601 INHERITANCE TAX
HARRISBURG, PA 171Z8-0601 STATEMENT OF ACCOUNT
REV-1U7 EX AFP <01-05)
DATE 08-02-2004
ESTATE OF COY HARRY H
DATE OF DEATH 02-02-2003
FILE NUMBER 21 03-0150
COUNTY CUMBERLAND
MICHAEL J HANFT ESQ ACN 101
HANFT & KNIGHT I Allount Rellitted I
19 BROOKWOOD AVE 106
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =i6o-j-Ex--AFP--foY:oiY------...--iNiriiiIi"-ANc"E-fAx--si'iffEME-tif-o-F-Acrcoljt.ff--.-i.---------------- -- ---
ESTATE OF COY HARRY H FILE NO.21 03-0150 ACN 101 DATE 08-02-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-16-2004
PR I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 1.749.95
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-11-2004 CDo03553 22.23- 2.000.00
07-15-2004 REFUND .00 227.82-
0
II)
0
2f
0
N
L!:l
::::J
"=C
"'1'
. (;l _.. TOTAL TAX CREDIT
-:Jc3 1.749.95
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. ~ -..J..-
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l