HomeMy WebLinkAbout04-0187
Estate of '/)f4e t:
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
/ratKe..yer No. rt2/-0~- /;f'7
To:
Register of Wills for the . I
, Deceased. County of C u. tit J;,er JtU14 in the
Social Security No. :u; J/ - 03 - I> '1S 7 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executor
in the last will of the above decedent, dated li-,riJ .a
and codicil(s) dated
named
, ~()(J()
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in etA'" w"-/4AtI County, Pennsylvania, with
~ la~t fa91ily or principal residence at I'/)~&' ~b /J,.,vp-.I B~J"~J##~ 01
'ecJUZA 'CSbHLf (/
. (list street, number and muncipality)
, Jb ~l>bt/ ,
years of age, died
m ~h~ , , ~
Except as folIo s, 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
situa ed as follows: 1:1""
.FP;~'~
I/!JOD'~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters "...feslitm;An:UY
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF C(JIJIJJ€~1./I11I1J 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.
Sworn to or affirm ed and SUbSCribed~ ~ ~ ~
before me thiso:?Y7?;/ day of ~ _ _~tE-" ~
~ ~. 3Sl'$ e"luvr;ttyoS/.I!VF ~E ~
~ I ~% /H~/d//k' / .f C4A1~ H/~~~""'JI /7"0 ~
/ LJ/ f ) h. (.) L) "7 R. e Ister ~
/ 'e-<.L /\/ / ~/(t<y
No. o.Jl-O~"/~7
Estate of _rYlRE T 13o\-t-e.yY)mL.(~r
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW hb Ru RP.-L( :.J..!:f ._'" . _~CZJ!f, in con~i(kratio'1 ( . !,,~ L.l',;:;"", ')f)
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrurnent(s) dated A DR.. I 3 ,;)0r,o
..,
described therein be admitted to probate and filed of record as the last will of
mAe-I ~(-\=-erY) rYll/-PY-
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and Letters \ GO ~\A \'Y1€..Y'-C~R'1-
are hereby granted to rY\ \ (.J1 A <? \ -T~ SR.ll, e
\.
~-a~ljgZ~/~JL<-i~nn/~ ~~L)_
/' Register of ills~ I /<lJ- .J~~
FEES
Probate, Letters, Etc. ......... $I~'JO
Short Certificates( ).......... $ I\. <]' /'")(j
cjefliation ................ ~ to, 00
TOTAL _ $,J~C;:CD
Filed ..:.h -:- ~~. -:O.y . . . . . . . . . . . . . . . . .
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ATTORNEY (Sup. C. I.D. No.) 36"~/3
~ C!./p~.$U'K'eI. /ll~")1/csl~ /}f _
ADDRESS ~ I 7~S::.
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PHONE
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REGISTER OF WILLS OF C Lt IJ1 BBeU/-/I1l) COUNTY
OATH OF SUBSCRIBING WITNESS
(!.HA,€LES E. S/t/GZJ)s 71L
e66idl
~) a subscribing witness to the will presented herewith, (~ being duly qualified according to
law, depose(s) and say(s) that liE wA-S present and saw
hAt; "T ~~Eh/R1YET?
the testat,.;}( , sign the same and that HE signed as a witness at the
request of testat~ in heY" presence and (in the presence of each other) (in the presence of the
other subscribing witnes8(es)).
x~r~J;J
(!.J,llr/~.5 E~~" e/fffa;llf
(" C.louser ~eI." /1/eWA;&.Sbq~./ P}f 17~~
(Address)
Sworn to or affirmed and subscribed before
me this c:j~,4 day of
~~OZM~~~0
~L~_ 'AID P~y Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
!
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
testat_ of (one of the subscribing witnesses to) the
that
presented herewith and
codicil
believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF ~Llm1J:1#r?/.AAlI) COUNTY
OATH OF NON-SUBSCRIBING WITNESS
/H/~/f-~t: ~ SA-~ll€
~) a subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that
~ /S familiar with the signature of J')1,ff; 7; &>FFEAf4lY~
eod~~il
testat~ of (9Re ef the :nlB3erieiRg u:itR8EEiE t@) the will presented herewith and
codicil
that 11& believes the signature on the will is in the handwriting of
/J1#l: 7: ~/J(/I1YG7f
to the best of --"~__ knowledge and belief.
Sworn to or affirmed and subscribed before ~ ;;::C ~ --
me this ~...f!!9/ day of /11, ~H/1~ ~ s1N~g
~~~ .Jf~ 3sZI3 tJ?A'Nr,eJ!S/,tH: """'" ~'" 11'/"". AI /70//
~~-- ~-~/~~~~//.o~/-?z-V (Address)
r Register
(Name)
(Address)
H105.805 REV 9186
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
No.
J/ALJ.t../2~./':~
Local Registrar
p
9826051
C..tbU4M:t- {~~'I
ate
Hl05 14JAev 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
Tl'PE-,PRINT
iN
PERM"'''''EN J
BlA.CK INk
NAME OF DECEDENT (fit'S! ModdIe.l_1
lb.
Cumberland
SEX
.. Female
STATE filE NUW8EA
SOCIAl SECURITY NUMBER
DATE OF DEATH ,McnIh. Da.,. '~J
. February 18, 2004
AGE IlaS( BIf1hCl3YJ UNDER I YEAR
Monlh. OIYS
.. 204- 03
5.
COUNTY OF OEAJH
81 y"
BIRTHPlACE (C,ry oJOd
Slat.afCle.onCounIrYI
Madison, Ohio
Pt..ACE 0# DEAJ'H fCt>eck or>ty or-. ~~ ... tflSlludoOflS on orhel """I
HOSPITAL:
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DECEDENT'S USUAL OC:CUPRION
(~":o.~II~:o~::~=r
".. Homemaker ,,"-
DECEDENT'S WAILING ADDRESS (SP.... CilylTown. SIaIe. Zip Code)
...
RACE .AIMneaIl JncIian, EUacll. 'White. _ec.
tS~)
,..
(RHEA'S NAME ,First MiadIe.laSl)
1006 Apple Drive
Mechanicsburg, Pennsylvania 1705
DECEDENT'S
ACTUAL
RESIDENCE
lSeelf'lSltUCllOnl
on0ltl8l'SIde)
17.. Sl~._
Pennsyl"3nia
();d
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_in.
..cumberland -' ,,0.01 :::..."":."'.::::..
UOTHER'S NAME If.st. Middle. M8Iden Surname)
14.
.rc.o ".der:ltdel'lllliYedin
MARITAL STATUS - M.....
1M. Married, Widowed.
DlvofC:_ {Specrfyt
Widowed
I..
White
Own Home
SURVIVING SPOUSE
,1'1....... iJlvetnalOWllWn81
.."
17b.
TlNG AS SUCH
Feb 21, 2004
UCENSE NUMBER
Mechanicsburg
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INFORMANT'S NAME (T ypelPriml
200.
METHOD OF DISPOSITION
~IQ Cr.mation 0
~hef~Iy'
Unknown
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Michael R. Sallie
Remowlll 110m SI... 0
FD-014318-L
21c. Woodlawn Memorial Gardens
NAME AND ADDRESS OF FACIliTY
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DUE 10 lOR AS A CONSEQUENCE OF)'
Z2c. M ers Funeral Home Inc.
UCENSE NUMBeR
.RN 300SD(P L 'Ie If 6'(
'MSCASE REFERRED TO:O EXA....INERlCOAONER1 NO~
20.
I ApproxinWe PAIIY II: Other aiQnil\cMf eondiIione contributing to dealh. but
I iUrvIIt bMwMn rIQI tHtaing ... the UAdeftying ca&.- g;...n in PMT I
: or.- and dNlft
!~ .[ ~P'D
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DUE 10(00 AS A CONSfOUENCE Of):
DUE TO lOR AS A CONSEOUENCE Of)
WERE AUlOPSY FINOINGS
A\AJlABLE PfUCA 10
COMPlETION OF CAUSE
OF DEATH?
MANNER OF DEATH
Nalurlll
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DATE OF INJURY
(Monlh,o.y. "arl
TIME OF INJURY
lHJURy R WORk' DESCRIBE HOW INJURY OCCURRED.
Ace"",,,
Homocide 0
Pendlng IfMISfigalioo 0
Coutd not be del.,ml...-d 0
_ 0 NoD
y.. 0
NoD
Suicide
...
2". 21b. 29.
CERHflER JCt'-':k oni~ one)
'CERTIFYING PHYSICIAN (phvsoctall cerlolywog ColuSll QI dealh ...hen olllOl"e' ptl...soc:,afl hasprOOOlJnced deal" a/'lO CQl"nplOllea t1ern 2Jl
To h be.t ot my knowtedge, dellh OCCURed dua liD th. cauI.(s) and mannef a. statH.
lOCATION(Str__CotyITown. SlaIel
neGIZ".A"S SIGNATURE AND NUMB~A (
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SIGN E AND TITlE 1 CER~ER
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o ~:.~NDMllE~ I" ~ ~ \ ~ "0 ~".:b""li 7' ~
NAME AND ADORESS OF PEASON WHO COMPLETED CAUSE Of'DEATH
(lIem211 Type Ol'P,int r:z ~ J"
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:TEfeD(M~;; 19) ,~OOi
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.PRONOUNCING AND CER1IFYING PHYSICIAN IPhVslclall borll ;)I'OIloOtJfOCJfl9 tJealh and t:ellrlyong 10 t:aU!;6 01 dealhl
To th. bftl of my kna""~ft, dUlh occuned al the u.n., d.te, ~nd place, and du.la Ihe cause(.) and maolle,... Il..led
'MEDICAl EXAMINER/CORONER
On Ihe b..i. at ..eminellon and/or Inw.sUgalion, in my opinion, death OCcurred althe Ume. dale, and place, and duelo the ceu.e(a) .nd
manne, al slaled.. . . . . . . . . . . . . . .
JI.
LAST WILL AND TESTAMENT OF MAE T. BOFFEMMYER
"
I, MAE T. BOFFEMMYER, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my nephew, MICHAEL R. SALLIE, per
stirpes. In the event any grandchild of my said nephew inherits through my will and he or she is
under the age of twenty-five (25), his or her share shall be added to and held in trust under the
terms and conditions as set forth in any testamentary trust established under the last will and
testament of my said nephew.
3.
I nominate, constitute and appoint my nephew, MICHAEL R. SALLIE, to be the Executor
of this my Last Will and Testament. In the event that he should predecease me or for any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint my sister, JANE L.
KITZMILLER, to be Executrix in his place and stead. I further direct that they shall not be
required to file bond or other security in the Office of the Register of Wills for the purpose of
administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this W day of
a~~ , A.D. 2000.
~
~ !naP, .;; , i . '.. (SEAL)
MAE T.BOFFE R
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mae T. BofTemmyer
Date of Death: February 18, 2004
Will No.
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April
9, 2004:
Name
Address
Jane L. Kitzmiller
300 East Main Street, Mechanicsburg, PA 17055
Michael R. Sallie
3503 Countryside Lane, Camp Hill, P A 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: April 9, 2004
~HI~~[;)
6 Clouser Road
Mechanicsburg, PA 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
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STATUS REPORT UNDER RULE 6.12
Nam
Decedent:
Mae T. I'offem:nyer
Dat 0 Death: 2-18-04
Wi! N
Admin. No. 21-04-0187
Cou
the
Pursuant to Rule 6.12 of the Supreme Court Orphans'
ules, I report the following with respect to completion 0
inistration of the above-captioned estate:
1.
State whetherltdministration of the estate is complete:
Yes No
2. If the answer is No, state when the personal
rep es ntative reasonably believes that the administration will e
com Ie e: :...~ q)Lc>wT.(S
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
acc un with the Court? Yes No
b. The separa te Orphans' Court No. (i f any) for
the pe sonal representative's account is:
c. Did the personal representative state an
acc un informally to the parties in interest? Yes No
ap
Ce
d. Copies of receipts, releases, joinders and
ov Is of formal or informal accounts may be filed with the
o the Orphans' Court and may be attached to this report.
I
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1~-22-04
Da
Signature
C~arles E. Shields, III, Es ire
Name (Please type or print)
6 Clouser Road, Mechanicsbur , PA 7055
Address
(717 ! 766-0209
Te 1. No.
CapacLty: Personal Represent~tive
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Counsel for personal
representative
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REV.1500EXI6.()Q)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
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FILE NUMBER
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE
YEAR
NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
B oFF E Itf III YIFle, /IIAE'
DATE OF OEATH (MM.OO-YEAR)
02 -1/ - doo4
SOCIAL SECURITY NUMBER
.2tP'I -03
(,,957
T.
DATE OF BIRTH (MM-DD-YEAR)
O$'- 3 -/'12.Z
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
#/,4
1ZJ1, Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Atlac:hOOPyofWill)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dateo! deatn alter 12-\2.82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date o/death betwlHln 12.31.91 and t-1-95)
D 3. Remainder Return (date o/death prior to 12-13-82)
o 5. Federal Estate Tax Return Requ'ired
L 8. Total Number of Safe Deposit Boxes
o 11. ElecUon to tax under Sec. 9113(A) {AllachSch0)
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COMPLETE MAILING ADDRESS
NAME elllf-;(LES e:: S/T/E'~().S
AI/A
7n-7~' -t:)2.o9
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FIRM NAME 1""_1
17o~
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (ScI1edule 8)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable {Schedule OJ
(1)
(2)
(3)
(4)
(5)
J8t;!.?, tJOO. DO
.,. ~lf 7. qtf J. "(p
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- 0-
OFFICIA - SE ONLY
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6, Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7)
'J
::11. ~~,. 9:1
/,737.7S"
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';"1
(6)
(8)
i 39:1, 5 ~7."ltJ
(9)
(10)
9. Funeral Expensas & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Uabll1tles, ~ Liens (Schedule I)
11. Total Deductions (total Unes 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an eiection to tax has not been
made (Schedule J)
(11) , 31, 737. (,. 7
(12) f j,,,. 779.5'3
(13) 0
(14) ;S 3'0,7 'J'f.S3
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable al the spousal tax () 0
rate, or transfers under Sec. 9116 (a}(1.2) xO a..- (15)
tI xO iJ5.. 0
16. Amount of Line 14 taxable at lineai rate (16)
17. Amount of Line 14 taxable al sibling rate f) x .12 (17) 0
l' "
18. Amount of Line 14laxable at collateral rate 3~o, 71". s3 x .15 (18) 5"1, If'!. 93
19. Tax Due (19) ~ 5f., //9. 93
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20. '....J
'CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
> > BE SURE TO ANSWERlALL QUES'l18fl& ON RiNll!ltSe SIDE AND RECHECK IIIIA11-1< <
Decedent's Complete Address:
STREET ADDRESS /~P' #/'~IF Z)A!!/YG
CITY h1Et!NIIAI/as.,8((~(;. I STATE to". I liP /7i!I1sS'
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credil
B. Prior Payments
C. Discount
(1)
,. SiI; 119.. '13
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Total Credits ( A + B + C ) (2)
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54, /1"1.'13
(3) 0
(4) 0
(5) ~S~, 11"1. ?3
(SA) b
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(5B) .s'/. 119.93
3. InleresUPenalty if applicable
D. Inlerest
E. Penalty
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TotallnteresUPenalty ( D + E )
4. if Line 2 is greater than Line 1 + Line 3, enter Ihe difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is grealer than Line 2, enler the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest or............................".........................................................................................'" D
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
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 trusl 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
contains a beneficiary designation? ........................................................................................................................ 0
No
~
IXI
IKI
lID
IX]
00
1'31
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SIGNATURE OF ERSON RE~O~~ FOR FILING RETURN
)/: ~~-
ADDRESS "'lei{. If. ~UG
3soJ CotI#rItYS/~G tA-NG/ ~If/lfP HI", F'A 17~11
SIGNATURMJyRE~RER OTHER TH EPRESENT
~E. . /l
ADDRESS CNA lUGS iF': Slfl~t./)S
" CLP/lSGl(! ,e,AJ>/ n/4'C'H A-/II/t!SdllI!6/ 17# /'7~SS
DATE
/, '(/-tJJ'
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 preparer has any knowledge.
~ ;:;,(>.{-':r~~t_,;?t/~-t~~:~~~".<!;:A~~J:;..'au.;~~~~'lif.mR.'i!';-ri~~..Wl?~l;', 'Y.~Sti;mt~~
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 PS. 99116 (a) (1.1) (i)].
FDr dates Df death on or after January 1, 1995, Ihe tax rate imposed on the net value of transfers to or for the use Df the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a sUlviving 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.
FDr dates Df 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,
Dr a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate impDsed on the net value DI transfers 10 Dr for the use 01 the decedent's lineai beneficiaries is 4.5%, except as noted in 72 PS. 'j9116(1.2) [72 P.S. 99116(a)(1)].
The lax rate impDsed on the net value Df transfers ID or for Ihe use of Ihe decedent's siblings IS 12% [72 P.S. 'j9116(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~'~"''''':.
COMMONWEALTH OF PENNSYLVANIA
lNHERlT ANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
BoI"F t /JI /11 Yae..
FILE NUMBER
2J-"</-/f7
/htIP€ 7:
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
.5; '1'19 .:JIM,ur ~ (!PM", Nfl
CUSIP AI"'. 70~"SI /0 "-
HI fI",s: (,7 .to. ~s: 37
S7PeK ,,1= /;P.-'L
~
,f-VG. ~oS'.SZ
,r' ..:?'1~ 9'1.;;. 9(,
TOTAL (Also enter on line 2, Recapitulation) $.2 1/7" 9'1':;. ?ro
(If more space IS needed, Insert additional sheets of the same size)
, c -.---- ~ j-jC,;jSI:iC,- aCldij~Bi,r~rDEVt::L0fJfv1i;:NI . - ---------- -. - OMS No. 2502.0265 - .- -
I' !~':::P/J--: !~N:N v,
SETTLEMENT STATEMENT Titlepro for Windows ™
ASSURED LAND TRANSFERS, INC.
301 Market Street B. TYPE OF LOAN
PO Box 109 01.FHA o 2. FMHA 03 CONV.UNINS.
Lemoyne, PA 17043,0109 04.VA 05. CONY. INS.
(717) 761,4720 6. FILE NUMBER: 17. LOAN NUMBER:
138331
MORT. INS. CASE NO.:
13693.1
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p_o_c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER
Timothy R Penny Michael R. Sallie, Executor of the Will of Mae T. Integrity Bank
Boffemmyer
2700 Cumberland Blvd. 1006 Apple Drive
Camp HIli PA 17011 Mechanicsburg PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Assured Land Transfers, Inc. i. SETTLEMENT DATE:
1006 Apple Dr'ive 07/02/2004
Mechanicsburg, PA 17055 Friday
Mechanicsburg Borough PLACE OF SETTLEMENT: 3345 Market Street 01:30 PM
Cumberland County, PA Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. Gross Amount Due From Borrower 400. ~ross Amount Due to Seller
101. Contract sales price 127,000.00 401. Contract sales price 127,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges (line 1400) 5,299.75 403.
104. 404.
105 405.
Adjustments for items paid in advance by seller(s) Adjustments for items paid in advance by seller(s)
106. CityfTown tax 406. CityfTown tax
107. County/City tax 07/02/04 to 12/31/04 219.13 407. County/City tax: 07/02/04 to 12/31104 219.13
108. Assessments 408. Assessments
109. School Tax 409. School Tax
110. 410.
111 411.
112. 412.
120. Gross Amount Due from Borrower 132,518.88 420. Gross Amount Due to Seller 127,219.13
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
201. Deposit or earnest money 5,000.00 501. Excess deposit (see instructions)
202. Principal Amount of new loan(s) 104,000.00 502. Settlement charges to seller (line 1400) 1,270.00
203. Existing 10an(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of First Mortgage Loan
205. 505. Payoff of Second Mortgage Loan
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. CityfTown tax: 510. CitylTown tax
211. County/City tax 511. County/City tax
212 Assessments 512. Assessments
213. School Tax 07/01/2004 to 07/02/2004 2.97 513. School Tax 07/01/2004 to 07/02/2004 2.97
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Tota) Paid By/For Borrower 109,002.97 520. Total Reduction Amount Due Seller 1,272.97
300. CASH AT SETTLEMENT FromlTo BORROWER 600. CASH AT SETTLEMENT To/From SELLER
301 Gross Amt. due from borrower (line 120) 132,518.88 601. Gross Amount due Seller (line 420) 127,219.13
302. Less AmI. paid by/for borrower {line 220) 109,002.97 602. less reduction in Amt.due Seller (line 520) 1,272.97
303. Cash (8) FROM 010 Borrower 23,515.91 603. Cash (8) TO o FROM Seller 125.946.16
Seller's Signature
Buyer or Borrower's Signature
'~'W~:I''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
'BOFrEi'm /11 YElf?,
/lJ A-G
FILE NUMBER p
.2/ -01'./-/07
r
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and.a willing 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
sUNivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
12€/Ii E,SrA-7;!;'; L~T 0.& t:./l-A/LJ //II~,tUI'6t) 6'1' J)euCZUNG
HpltSE oSlrIlI#TE'.47 /I1117b /HtI1'7L.€ iD"zIJfE~ ,6,II/!t1PtfN
8P /11FdH"'AlIC!,rd/(A!tr., e<<Al4E~N,d &kNTy" ;c,NN'S-
y.c J'AN/tI-. /11t1.eE ".<7H-eTIC<<~"'~Y 2)ES'(!"f!/8ezJ /J1II 7);'".r
C!$4r.-f/# J>6ED ~"'.eFP:Z: /t)H~A" """'J> EZ/U.d€/-"f'
~ NN",4 ~~ "V/S HI/P"I, r; #I-#-E' r, ~rG~"YG7f!,
SING.(of" /-lE'R5f)~ J);f-rc'2 "TlnYE~,/ /9,f~,~./) A!!Gc,~RJ
/h C/(/I/,OEt2.LA-.lYLJ ~k#7Y.i>Gi:tJ ~ t'y:' hpUUNE
3~ -4?6~ i!.:2~,
Sill/) fJREMI5~S ttJ€~e: S{)LD By C-HUC.I< 13/l.lc/Ce'C,
~tlCTtf}Jf}e:'71.. To HI'/{ {31J).f)€!?, TII11{)P{V R. P€/VAJY.
,
* TTl.€ME'N/ ttJ'+S ,.<taD 0;1/ o//(q:t~ ~()t(. ~ss
..5Il-LG5 jJ/Ci(!E LUA-S I/~ '0 "00. DO.
(SEe T/2ttE &JPf f/F DGCD M..JJ .;}ETTLGh1E'NT
~GET /I Tr.4CHlE"])).
$ IZ 7000.00
,
TOTAL (Also enter on line 1, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
L. SETTLEMENT CHARGES Case # 136331
700. Total Sales Commission based on Price: $
Division of Commission at: $
701.
702.
703.
704.
600.
601.
602.
603.
604.
805.
606.
807.
806.
609.
810.
811.
900.
901.
902.
903.
904.
905.
1000.
1001.
1002.
1003.
1004.
1005.
1006.
1007.
1008.
1100.
1101.
1102.
1103.
1104.
110 .
1106.
1107.
Title Charges
Settlement or closing fee
Abstract or title search
Title Examination
Title Insurance Binder
Document preparation
Notary fees Johnson, Duffie, at al.
Attorney's fees
(includes above items No.
Title Insurance Assured Land Transfers, Inc.
(includes above items No.:) 1101-1104 and 1108 Basic
Lender's coverage $ 104,000.00
Owner's coverage $ 127,000.00
Endorsements 100, 300 & 8.1 to
Insured Closing Letter to
Courier Fee to
Government Recording and Transfer Charges
Recording Fees: Deed $ 41.50 Mortgage $ 48.50
City/County tax/stamps: Deed $1,270.00 Mortgage $
State tax/stamps: Deed $1,270.00 Mortgage $
Assignment of Rents to
Total
Commission paid at Settlement
Items Payable In Connection With Loan
Loan Origination Fee
Loan Discount
Appraisal Fee to
Credit Report to
Inspection Fee to
Mortgage Insurance to
Assumption Fee to
Document Preparation Fee to
Flood Search Fee to
Commitment Fee to
E. J. Copenhaver
Integrity Bank
Integrity Bank
Integrity Bank
%
Paid From
Borrower's
Funds At
Settlement
Paid Fnj)m
Seller's
Funds At
Settlement
Items Required By Lender To Be Paid In Advance
Interest from 07/02/2004 to 07/31/2004 @
Mortgage Ins. Premium 0 Months to
Hazard Ins. Premium 0 Years to
o Years to
o Years to
Reserves Deposited With Lender For
Hazard Insurance 0 Months @ $
Mortgage Insurance 0 Months @ $
CityfTown Taxes 0 Months @ $
County Taxes 0 Months @ $
Assessments 0 Months @ $
School Taxes 0 Months @ $
o Months @ $
o Months @ $
0.0000
/Month
/Month
/Month
/Month
JMonth
/Month
/Month
/Month
300.00
250.00
15.00
1,040.00
/Day
1000
Assured Land Transfers, Inc. 35.00
Assured Land Transfers, Inc. 25.00
Release $ 90.00
1,270.00
1,270.00
Recorder of Deeds 21.00
Johnson, Duffie, et al 1,100.00
Settlement Agent
5,299.75
1,270.00
1108.
1109.
1110.
1111.
1112.
1113.
1200.
1201.
1202.
1203.
1204.
1205.
1300.
1301-
1302.
1303.
1304.
1305.
1400.
Additional Settlement Charges
Escrow for 2004 School Taxes to
Total Settlement Charges (enter on lines 103 & 502, Sections J & K)
Parties agree that no liability is assumed by Settlement Agent for the accuracy of information furnished by others as shown on the HUD-1 Settlement Statement.
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
~.~~&r
Seller's i nature
Seller's New Address & Phone:
Dale
REV'''''''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF L] r-r _
~()"',..e/H/J1Yt:~",
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
/JI;/-E -r. FILE NUMBER .;2/-oil -14'7
Include the proceeds of rrtigation and the date the proceeds were received by the estate. All property jointJy-owned with the right of survivol'$hip must be disclosed on Sch9dule F.
ITEM
NUMBER
1.
:J.
3.
f.
s:
C.
7.
DESCRIPTION
Pleo-IU7?ON t:J1- /2E'/rt. If<S-r. 7;/-l<iFS (SEt? SETT';EA<G'7./r r$ffEEr
-/7rl+eHeo 70 S19fel> ./t-. /7_ h"... "1"7 )
J '1 f:Z C#/iV/COL€T Sf!DA-AJ, VIA! I G I A-)( 6. fi IC.I dT 15"4 I.f 70
f1~/illtL/t1 f1lAN -fte-r: Alo. $iJ- 7007 -70('S PAle !dIWK
Cb It (!#.5 r tfE Pttl1l.b
1ZE~1fn;: -;1.t/f77MIt:v/OG - f(tvHEC)tJ}AJSf'~ INS ute
SALlE' OF jJI;;IfSo/llM.-ry ,2,y CHuCi: I3I?-/CK.~
/l-UC,7(,:7lV'C~7-( ($l?'€ <;;;'7/frGN/,9VT f'1Tr""eJiBJ)
,olVe t!AA'J; ,.f(.a: 1
". lJe.spik su--enr/ ~~ettd efl;rI.s ~ ""/1lIH &I.P,a!. P4/U~S t,..
~/. IU4IJa,ff "'1>1f( ,dA't!,. ",/I n!"ests iraYe. f4/leel 6 iw,.
;;'/ld 1T5 ,~ ;"p'4j" #pr. /~.:u>~ TAu,,~ lilt' hitVI!' 41',IK/
~ /!"YUldD/'J /vsf .two""..,,' eshht4~ ~/ fie 4'..., do J'"alkt!
If/h,,&1t M Jel;~Ye a, 6, k,r,y IU"kra~.
VALUE AT DATE
OF DEATH
, 21'1. /3
?l
;;; 00.00
, .;? L/. .3{)
:rIS7.33
~ 'I, :Z~(P. ;('5"
,
~,Boo."""
TOTAL (Also enter on line 5, Recapitulation) $ I /, ~" 7. "I
(If more space is needed, jr:sert additional sheets of the same size)
ll~:/l C;/'2',=\\>~: -..... ',~'~.'> ~ ~-, --
~ ,Ii i ,r;:-:;, 1 ~,~,2
t',i==<'~')::~' ';, ,::o.I..':CT ~,~1r'1
P'::",:;\E: '.=\1
Buy & Sell on commission - Complete Sale Serltce
93 Texaco Rd., Mechanicsburg, PA 11055 766-5785
BRICKERS.AUCTION
p..-nal PNperty of MA rc- I, B L..,t.F c;-J/ ElL e 'ST4 [(-
Addre..
Sold At Public a.le
zo
..-
Total SaMI
h'2 /. ~ I 2,,,-
OUtstanding
Total CheCks
-
Total Caah
c..n After Payoul
Ex.........
--
p,qperty F..
Sale Setup or H....
Total Expen...
~\D,00 \
:Y10,O ()
---,
I 9-7D, 00 ~
)..i../O, 0 iJ \
,1 r! 'V 0" l
,rIl, v .
Auctioneer & ca....
Aft. Cost
---
l~j ;J~n..~ F?di
(?~.;~/J
'~'''EX'('9" '*'
CQMMONWEAL1H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DeCEDENT
ESTATE OF B ..,. ~ ...-r4
0" EMmYCA,
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
::U-olf- It7
If an asset was made joint within one year of the decedent's. date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT{S) NAME
RElATIONSHIP TO DECEDENT
ADDRESS
A !JJICfUFL ~ SAlUtE
B.
c.
3Soj
CA-mp
(!olav r;t.y 5/ Dc t-I'fNfiF
HILL, ,hI /7bll
N€/lHe:W
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
HEM FOR JOlNT MAOE \nclooe name of financial ins~tuijon and bank account number or similar identifying number. Atla::h DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held realestale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
M v/i)EY hlJ!./:/J(Er A-ee7: },f,. 5 /),3 OI;J..s-o<(Z "1/, 7S'f. "7 ~
1. A. c; rc.a S7:> 5, e17.;13
Iff" PAle. I3HNK (:.Ee p~tjlr aoSti'-oIJ..T !, Tlf$-
/l{alr ,4 71>>CHel>) If' fj<< inf1,,.,,,.hohQ! note
at Sck".E. fJ.5 k> ine";;;1y 1z, o6hti" ",fh'c;""
d.D.d J"tr/_h'M.$ Ii-_ "'AI~.
TOTAL (Also enter on line 6, Recapitulation) $ s-, F11.:z3
-
(If more space is needed, insert additional snoots of the same size)
EFORM 1 00472-0900
o PNCBAN<
Your account was DEBITED for the following reason:
D Check # posted on
IX! Closed account 50301.25042
o Branch adjustment (branch name)
o Service charge error
o Other'
encoding error _ pos'ed to incorrect 2ccount
Account Number File 10
AMOUNT $ 11,754.47
5030125042 040
PNC Bank, National Association
o MAE T BOFFEMMYER
E MICllAEL R SALLIE
B 1006 APPLE DR
I
T MECHANICSBURG, PA 17055-3409
I
'1>5:g //. -.:l '{
FOR BANK USE ONLY
Branch #/Dept. # Date
0000115 02/24/2004
Prepared By (PRINT Name) Authorized By
BELGIN STUBBB
~
~~
'^.
:J--1-
~ ~
r l'-
~'i--
~ f-
o
'>J
Customer's Advice of Charge
~
(:f;--
~"\' ""- ~ '- ,
V '-.:.....
J' '-
() <oJ ~
'~
() ,~ "
~,
'-\ ~
~f ~~~
~ ~' ~
A
r\
'\
e/\
G'
"-
'"
M
~
--l.
t
~
~.
~
'-.)
REV-1511 EX+ (12-99) .
l}",~~.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
80~FE 111M Y cR,
FILE NUMBER
:2-1 -O~-1tJ'7
liMe 7:
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. IbYR~.s FtlNYMt /<<1111E &P ~
A1E(JNI9I11Ic,s.8U.!26 ~ Ilf. Sil
,+DPlr,..IIJJI{. jJ,tfy/JfENrS 14 !J1YE7<S: (~E I"-I/Plf!€ /fITA(!JIefJ). ~~, SlJO.OO
:/. rfJAlEML. /lfE/ft.. J/-r 1711.5T UJJ/~D /JfE 7$,IpL>/ST CI-I U Iu';,' ~ .i1~""V.o-iP
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) /J1ICHA-El R. SA-Ul€ to;('IY~]).
Social Security Number(s)/EIN Number of Personal Representative(s) /" /- ~() - 'II"
Slreet Address 3 Sl),J ~"NPz.y.s II) E" VMlE
City ell-III fI H IU- State I#- Zip /7tt)I/
Year(s) Commission Paid:
;&:
2. Attorney Fees C/ftf-/U..€S E bHI€l-b.5, :IJ1!. /3,7SI:UtJ
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant #'N'~ IVtIAIE
Street Address
City Stale _ Zip
Relationship 01 Claimant to Decedent
a..uI fJri;iMI ;,shle ,f. Sh,r! ~,.h flu tl!.s ~
4. Probale Fees ;} il S. CO
5. Accountant's Pees
6. Tax Return Preparer's Fees m~. /<EN ~y PI" JELlGIl1A-tJ, ;r:;eIE/A41tIN ~ (!D. r'
r.tf. I~, I11f W ,t4 ~()O3; CUSE P/4T" IfJ'II,I'1# 'If) -K>,'I,. "'II,t''''IIell. 7fJo...o
7. A-Jt'vn:S/"f (!umbu.{U/./ L..w ,,7;urn.1 ~
7.:f'.oO
r. ~./YVhs~J CArhSk $,nh'ne/ ;VewSf?~per ~/pB'.9'~
9. IftJ,ni.sal pf /<ul e.sfafi -f,. /J1 ",.k /f,'//Jut "
3 CD. DO
f/). "'il.slntd of 'f,He ~ /l/MII'se~ I 7'ri~ c?P"1 ~s/rR.d ~115.gj)
..
II. ~. SC.NOOL -rA-){ P/lbteofTlolv' 1 SEE St:'TT{.EfHi:-.u, SH'EeT ;r-~L- 2.97
;(E'tfl IFST/fTG" T.e"iwSI""~ /,A;< ED 7Z> St!/Y€l1,+. IT~A1. S~. ~
;3. I, :170.00
TOTAL (Also enter on line 9, Recapilulationl S J9,9Q9.'?.2.
Debts of decedent must be reported on Schedule I.
(II more space is needed. insert additional sheets of the same size)
GEORGE M. HOUCK
(1912.1991)
Mr. Mark Hilbert
219 East Main Street
Mechanicsburg, PA 17055
Dear MrHilbert:
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindle and ClJJuser Roads
MECHANICSBURG. PA 17055
March 17, 2004
RE: Mae T. Boffemmyer Estate
TELEPHONE (717) 766.0209
FAX (717) 795-7473
Please find enclosed a check for the amount of$300.00 for the appraisal at 1006 Apple
Drive, Mechanicsburg.
Thank you
CES:cas
enclosures
Very truly yours,
g
Charles E. SliieldsIII
Attorney-At-Law
March 17, 2004
Glenda M. Wethington
Tn-County Abstract Service
3414 Chestnut Street
Camp Hill, Pa. 17011
RE: Boffemmyer Estate
Dear Glenda:
Please find enclosed a copy of the invoice and a check for $115.00 for the title search for
the Estate of Mae T. Boffemmyer.
Thank you
Very truly yours,
(})uAJu t ~W~If[
Charles E. Shields III
Attorney-At-Law
CES:cas
enclosures
GLENDA M. WETHINGTON
TRI-COUNTY ABSTRACT SERVICE
3414 CHESTNUT ST.
CAMP HILL, PA 17011
Invoice
DATE
3/1212004
INVOICE #
04-445
I BILL TO
I SHIELDS, CHARLES E. III, ESQ.
6 CLOUSER ROAD
I MECHANICSBURG, PA 17055
I
P.O. NO.
TERMS
PROJECT
I I Net 30 I
i
i
I QUANTITY DESCRIPTION RATE AMOUNT
I CUMBERLAND COUNTY SEARCH: BOFFEMMYER: 1006 APPLE DRIVE, l! 0.00 110.00
PART OF LOT 39, SECTION B, ORCHARD CREST
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lVlyers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pellllsylvania \7055
: n 71')6-34: I
]'-'ax (7]7) 7qS..j~91
A standard of eXl'ellellce in Celltral Pennsylvania since 1910
T uGoday, March 9. 2004
Me'hael R. Sallie
3503 l., H.try Side Lane
CZ!!lp Iii', Pa 17011
Dear Mr S :,:->
Thank you Ie: selocting our funeral home 10 pro'Jide services for your family during your bereaV0IC18nt
I hepe thai you found our services to be of the highest standards and that \lley met yeur needs anel these
of your family and friends. The follOWing ,5 a summary of the service charges ;;5 previous'y explainEr' J^']
pro"jed in written form Or) the serJlce' for
Mae T. Boffemmver
SUMMARY OF EXPENSES
TOTA.L OF SERVICE RENDERED
LlSS. Credils granted
LES~ TOlal Pajments
CURRENT BALANCE
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511,506.52
1,69500
2.500.00
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:f UF::rc a.". ,j"j qU2StiOr',s 0, ..:nC8rns that remair unan~~ c~d please can me.
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BOYD L. MYEIIS, .lit, Stlpflliwr
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01' I'l!NERAL GOODS AND SERVICES SELECnm
t,h.lll')C' .nt' "1",' f<!r rhl'Y, lllOl~ thll you ,e!t(Ctd or th:u are required If we are rt:4uirt(l by law or by ;l (('fntltn qf cn'nLII~ If\' !(J tl~t ,un ilrnl~ \\'1' v. ill
ol,J.d,. in 'lfltJng r.tl'J'\
If \ I"! '( 11.( I{J ,j fiJJltr,ll tlLH nl;l~ require t'mhahlliI1g, such as a funenl with \'iewing, you may havt to pa.~' (M embOilmin,g Yuu d'l nl)( hJ\l' fO r~Y lor tmh;l:1I1in~
\', ~ 'Ilr';d: jf ~ Ilu,~dt'clt;i Jft,ilrjt_OltnrS ~u(~,as a ~iS5.~t cremation ot i~\m~di-.tlt buri),llf Wt {hl{~nllo[ tmhA\m\n~L Wl' will nplolin \~:hy hrHn\
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Sl1MMAR Y OF C!lARGE.S
A. Professional S('nice~, f:l.nlilil,;~ Jnd
Equipment. and AutOlllolivc
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8 Merchandise
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PAID AT TIME OF OR PRIOR TO
ARRANGEMH,TS (: I,. I:' " < ~ ;
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REASON F~\l. EMHAI , . . 1...;f1: :.,~
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If any h.w, (c~ctery ~ or uem,ltury reqllir(-mCms have rtyuJf(:d IlK purdlilsc
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SI'H.IOT.II. OF PROHSSIONAl
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SERVICES
TOT AI. MERCHANDISE SHEClHl.
C. SPECIAL CHARGES,
Forwarding of remains to
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EQUIPMENT
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RE'I'-~512EX.II'911*..>.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENt DECEDENT
ESTATE OF
t3o~pJ;; P/lff Vel<,
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
/1M.!; -r:
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FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
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7.
7.
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DESCRIPTION
AMOUNT
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SI'/tING /2tJ,+.i) p/fff/ILY ,oMCT/cc
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tJR.7'.-(c,dE,f>{C- INST. of P/!.
~ul1N'rum flnAGING ~ TrtevI-hFUTIC
8f..eLlSU? D/G€$71J/€ 1>JSr:A~e ~~OC~.
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TOTAL (;",Iso enter nn line 10, ?ecapituiation) $ /1 7 3 7, 7~
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i,a !:lore space IS needed, insert aoditional shests of ttle :.lame SiZe)
''''''''''':''"''..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF '" ,~
<.1 oF';::t /1(.1/ y &: "'~
/h,p.e; -r.
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. 11I1C/{,fez.,f. ~t.t..IE
3~3 &{,{lIIr~ysl.tJE" t:ANE
(1,+/11;0 #/~t:1 j/?I(- /7t'HI
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AlF""HE~
21-of/-/J'7'
AMOUNT OR SHARE
OF ESTATE
I t)t) ft
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PAIn n. ENTERTOTl,L NON.TAMBLe DISTRIBUTIOI,S ON LINE 13 OF REV 1000 COVER SHEET $
(if more spa-.::e is n?eded, insert dddltional sheets ot the same S\Z~}
. .
LAST WILL AND TESTAMENT OF MAE T. BOFFEMMYER
I, MAE T. BOFFEMMYER, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my nephew, MICHAEL R. SALLIE, per
stirpes. In the event any grandchild of my said nephew inherits through my will and he or she is
under the age of twenty,five (25), his or her share shall be added to and held in trust under the
terms and conditions as set forth in any testamentary trust established under the last will and
testament of my said nephew.
3.
I nominate, constitute and appoint my nephew, MICHAEL R. SALLIE, to be the Executor
of this my Last Will and Testament. In the event that he should predecease me or for any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint my sister, JANE L.
KITZMILLER, to be Executrix in his place and stead. I further direct that they shall not be
required to file bond or other security in the Office of the Register of Wills for the purpose of
administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J:td day of
a~J
, A.D. 2000.
~~
"JrJCUJ Al . . ~"'.;n~L.- (SEAL)
MAE T. BOFFEM Y R
Signed, sealed, published and declared by the above-named MAE T. BOFFEMMYER, as
and for her Last Will and Testament, in the presence of us, who at her r uest and in her presence,
and in the presence of each other, have ~ 0 s~scribed our n witnesses.
{/!.-tt/-I. d~
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Tax Parcel #_17-23-056t-025
THIS INDENTURE
MADE THE ;l..d
and four (2004).
day of
<iLf
/
ii'
, in the year of our Lord two thousand
~
BETWEEN MICHAEL R. SALLIE, Executor of the Estate of MAE T.
BOFFEMMYER, Deceased, late of the Borough of Mechanicsburg, Cumberland
County, PelUlsylvania, Grantor
AND
TIMOTHY R. PENNY, singte man, of Camp Hill, Cumberland County, PelUlsylvania,
Grantee.
WHEREAS, the said Mae T. Boffemmyer was vested in her lifetime with title to the premises
hereinafter described in the Borough of Mechanicsburg, Cumberland County, Commonwealth of
PelUlsylvania; and
WHEREAS, the said Mae T. Boffemmyer died, testate, on the t 8th day of February, 2.004, and
Letters Testamentary were duty issued to Michaet R. Sallie, as Executor, and docketed to No. 21-04-
1087; and
WHEREAS, the tands herein-mentioned were not specifically devised.
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Michael R. Sallie, Executor,
as aforesaid, for and in consideration of the sum of ONE HUNDRED TWENTY SEVEN
THOUSAND AND NO/toO ($127,000.00) DOLLARS and other good and valuable considerations,
to him in hand paid by the said TIMOTHY R. PENNY, at and before the ensealing and delivery
hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, reteased,
and confirmed, and by these presents, by virtue of the power and authority in it vested by the
Fiduciaries Act of the Commonwealth of PelUlsylvania, does grant, bargain, sell, alien, release, and
confirm unto the said TIMOTHY R. PENNY, his heirs and assigns,
ALL THAT CERTAIN House and Lot of Ground situate in the Borough of Mechanicsburg, County of
Cumberland and State of PelUlsylvania, as shown on a survey dated September 29, 1960, by D. P.
Raffensperger, Registered Surveyor, and more fully described as follows.
BEGINNING at a point on the Southern side of Apple Drive, said point being
t83.37 feet West of the Southwest corner of the intersection of Appte Drive
and Gale Street; thence South II degrees 34 minutes East, 106.25 feet to a
point; thence South 73 degrees 28 minutes West, 75.23 feet to a point in the
Eastern line of Lot No. 40 in said Section "B"; thence North t I degrees 32
minutes West, 115.06 feet to a point in the Southern side of Appte Drive;
thence NOrth 80 degrees 10 minutes East, 75.00 feet along the Southern tine
of Apple Drive to a point, the place of BEGINNING.
BEING a portion of Lot No. 39, a part of Section "B", as shown on the ptan of lots
of Orchard Crest as recorded in the Cumberland County Recorder's Office in Plan
Book No. 10, Page 40.
HAVING THEREON erected a single family dwelling numbered 1006 Appte Drive,
Mechanicsburg, PelUlsytvania.
UNDER AND SUBJECT, NEVERTHELESS, to all easements, restrictions and covenants of record.
BEING the same premises which Leo I. Wharton and Elizabeth B. Wharton, his wife, by their deed
dated June 6, 1986, and recorded in the Recorder of Deeds Office in and for Cumberland County in
Deed Book "Y", volume 31, page 424, granted and conveyed to Mae T. Boffemmyer, single person,
who is now deceased and whose estate is the Grantor herein.
I
TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and
premises hereby granted and released, or mentioned and intended so to be, with the appurtenances
unto the said Grantee, his heirs and assigns, to and for the only proper use and behoof of the said
Grantee, his heirs and assigns, forever.
AND THE SAID GRANTOR, Executor as aforesllid, his heirs, executors and administrators, do
covenant, promise and agree to and with the said Grantee, his heirs and assigns, by these presents,
that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises
hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in
title, or otherwise howsoever.
IN WITNESS WHEREOF, the said Executor of the Estate of Mae T. Boffemmyer, deceased,
Grantor herein, has hereunto set his hand and seal the day and year first above written.
WITNESS:
~f!~
v
~~
MI L R. SALL xecutor
Estate of MAE T. BOFFEMMYER
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
'~
On this, the ~ day of · , A.D. 2004, before me, a Notary
Public, in and for said County and State,/{he u dersigned officer, personally appeared MICHAEL R.
SALLIE, known to me (or satisfactority proven) to be the person described in the foregoing
instrument, and acknowledge that he executed the same in the capacity therein stated and for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seat.
Notary Pubtic
My Commission'expires:
(SEAL)
CERTIFICATE OF RESIDENCE
I do hereby certifY that the precise and exact post office address of the within Grantee is:
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Attorney for Grantee
CHARLES E. SHIELDS, III
ATTORNEY-AT-LA W
6 CLOUSER ROAD
Comer ofTrindle and Clouser Roads
MECHANICSBVRG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
January 14, 2005
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Register of Wills
Cumberland County Court House
1 Courthouse Square
Carlisle, P A 17013
Re: Estate of Mae T. Boffemmyer
21.04-00187
Dear Register of Wills:
q
::"~
Please find enclosed two copies of the Inheritance Tax Return to be filed for the above
esta1e as well as the following checks:
Check No. 400 in the amount of 15.00 for filing costs
Check No. 401 in the amount of$115.00 for additional probate fee
and an additional check in the amount of$54,119.93 for tax due.
Thank you for your kind attention to this matter.
Very truly yours,
Charles E. Shields, III
CES:slk
Enclosures
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
COMMONWEAI_TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
-~------ fold
ESTATE INFORMATION: SSN: 204-03-6957
FILE NUMBER: 2104-0187
DECEDENT NAME: BOFFEMMYER MAE T
DATE OF PAYMENT: 01/18/2005
POSTMARK DATE: 01/15/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/18/2004
REV-1162 EX(11-96)
NO. CD 004853
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $54,119.93
I
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TOTAL AMOUNT PAID:
$54,119.93
REMARKS:
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindle and C/nuser Roads
MECHANlCSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766.0209
FAX (717) 795.7473
May 2, 2005
Register of Wills
Cumberland County Court House
I Court Square
Carlisle, PA 17013
Re: Estate of Mae T. Boffemmyer
No. 21-04-0187
Dear Register of Wills:
Please find enclosed for filing to (2) copies ofthe Inheritance Tax Return for the Mae T.
Boffemmyer Estate as well as my Check No. 1433, in the amount of$367.20 for Inheritance Tax
due.
Thank you for your kind attention to this matter.
Very truly yours,
(!Uf'~y
Charles E. Shields, III
CES/mjj
Enclosures
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRA~E~ENT;~LLdNAMCE OR DISALLOWANCE
OF DEDUCTIONS AND ~SSE$SHENT OF TAX
'"
r
DATE
;, F ilsstu.e OF
DATE OF DEATH
FILE NUMBER
'~UNTY
ACN'
04-11-2005
BOFFEMMYER
02-18-2004
21 04-0187
CUMBERLAND
101
CHARLES E SHIELDS III
6 CLOUSER RD
MECHANICSBURG PA 17055
'*
REV-1547 EX AFP (03-05)
MAE
T
Allount Rellitted
f3ro1.~
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 ...
~IV-"1'!rI;,."tf.~.m!!'lI'll'.'Wtm.W.!MJtArfJlM!l!'.m.~m~TftFlW1'~.'lrC[WJlM!l!'.r.Ti'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOFFEMMYER MAE T FILE NO. 21 04-0187 ACN 101 DATE 04-11-2005
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)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notas Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule fJ
7. Transfers (Schedule GJ
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
127. 000.00
247.992.96
.00
.00
11.667.01
5.877.23
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule HJ
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
29,999.92
1. 737.75
Ill)
(12)
(13)
(14)
NOTE: I~ an assessment was issued previoUSly, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
1S. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX ITS:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this for. with your
tax pay.ent.
392,537.20
3] .737 67
360,799.53
.00
360,799.53
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
.00 X 045 =
.00 X 12 =
360,799.53 X 15 =
(19)=
+
AMOUNT PAID
54,119.93
DATE
01-15-2005
NUl1BER
CD004853
INTEREST/PEN PAID (-)
.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-16-2005 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
54,119.93
54,119.93
54,119.93
.00
367.20
367.20
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRArIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estl!ltes of decedents dying on or before Dacubar 12... 1982 -- if any future interest in the BstBte is transferred
in possession or enjoyMent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years... the Co..onwealth hereby expreSSly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such futUre interest.
To fulfill the requireMents of Section 2140 of the InherItance and Estate Tax Act... Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and sub.it with YOUr paYMent to the Register of Wills printed on the reverse side.
--Make check or 1I0ney order payable to: REGlSTEROFWR.LS,AGENT.
Failurlll to pay the tax... interest... and penalty due lIay result in the filing of a lien of record in the appropriate county...
or the issuance of an Orphan's Court citation.
A refund of a tax credit... which was not requested on the Tax Return, lIay be requestud by co~letlng an
-Application far Refund of P-nnsylvania Inheritance and Estate Taxn (REV.1313). ApPlications are available
online at www.revenue.state.OB us, any Register of Wills or Revenue District Offic.... or froa the Depart.ent's
24.hour answering service for forlls orders: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
Any party in Interest not satisfied with the appraisllent... allowance or disallowance of deductions or assessment of tax
(inclUding discount or interest) as shown an this Notice May abject within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA DepartMent of Revenue, Boerd of Appeals. You .ay abject by filing a protast online at
www.boardofaopeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to be valid... YOU must receive e confirmation nu.ber and processed date fro. the
Board of Appeals website. You .ay also send a written protest to PA Department of Revenue... Board of Appeals
P.O. Box Z8l021... Harrisburg... PA 17128-1021. Petitions .ay not bill faxed.
B) Election to have the .atter deterllined at the audit of the account of the personal representative.
C) Appeal to the Orphans' Court.
Factual errors discovered an this assessNent should be addressed in writing to: PA Department of Revenue...
Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, P.o. Box 280601, Harrisburg... PA 17128-0601
Phone (717) 787-6S0S. See page 5 of the booklet -Instructions for Inheritance Tax ~eturn for a Resident
Decedent" (REV-lS01) for an explanation of ad_inistrativaly correctable errors.
If any tax due is paid within three (3) calendar .onths after the decedent~s death... a five percent (S:!) discount of
the tax paid is allowed.
The ISX tax Bllnesty non-partiCipation penalty is co.puted 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 a.nesty period. This non-participation
penalty is appealable in the salle manner and in the the s~e ti~ period as yOU would appeal the tax end interust
that has been assessed as indicated an this notice.
Interest is charged beginning with first day of delinquency... or nine (9) .onths and one (I) day fru. the date of
death... to the date of paYllent. Taxes which becalle delinquent before January 1, 1982 bear interest at the rate of
six (6:!) percent par annu. calculated at B daily rate of .000164. All taxes Which becaMe delinquent an and after
January 1... 1982 will bear interest at a rate which will vary frOll calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200S are:
Interest Daily Interest Daily Interest
Rate FactOr Year Rate Fector Year Rate
~ = !ml-1991 -nr-:mI!rr RID. ~
167. .000438 1992 9% .000247 Z002 6X
11% .000301 1993-1994 n .00019Z 2003 S:<
137. .000356 1995-1998 9X .000247 2004 4:<
107. .000274 1999 n .000192 2005 57.
lOX .000274 2000 n .000192
Year
ml
1983
1984
1985
1986
1987
Daily
Factor
.Dml\T"
.00016".
.000137
.000110
.000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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 assessaent. If paYMent is made after the interest co.putation date shown en the
Notice... additional int.rest .ust be celculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
H,'I,RRISBURG, P,'I, '\ 7128-0601
REV-, '62 EXn 1.96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
-.------ fold
ESTATE INFORMATION: SSN: 204-03-6957
FILE NUMBER: 2104-0187
DECEDENT NAME: BOFFEMMYER MAE T
DATE OF PAYMENT: 05/04/2005
POSTMARK DATE: 05/03/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/18/2004
NO. CD 005288
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $367.20
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$367.20
REMARKS:
CHECK# 1433
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
BUReAU OF INDIVlDUAi..:t.J(ES-
INHERITANCE TAX DIVISION
PD BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-16D7 EX AFP (03-D5)
, ~
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1.;9
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-31-2005
BOFFEMMYER
02-18-2004
21 04-0187
CUMBERLAND
101
A_...t R_1 ttlld
MAE
T
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CHARLES I(L'.IfIELIDSUI
6 CLOUSER RD
MECHANICSBURG PA 17055
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, sub.lt the upper portion of this for. with your t.x payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
.......................................~........................................................................
REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF BOFFEMMYER MAE T FILE NO.21 04-0187 ACN 101 DATE 05-31-2005
THIS STATENEHT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED IHTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-11-2005
PRINCIPAL TAX DUE: 54,119.93
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-15-2005 CD004853 .00 54,119.93
05-03-2005 CD005288 367.20- 367.20
TOTAL TAX CREDIT 54,119.93
BALANCE OF TAX DUE .00
IMTEREST AMD PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
.
SIDE FOR CALCULATION OF ADDITIONAL IHTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYNEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
~
_S
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrind/e and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
December 21, 2005
Register of Wills Office
Cumberland County Court House
1 Courthouse Square
Carlisle, Pennsylvania 17013
Re: Estate of Mae T. Boffemmyer
Admin. No. 21-04-0187
Dear Register of Wills:
Please find enclosed two copies of the Status Report for the above referenced Estate. We
have been reviewing our Estate files and realized that we had not sent in the close out Status
Report. Please accept out apologies for the tardiness. Please clock-in both copies and place one
in my mailbox for me to pick up at a later date.
Thank you for your kind attention to this matter.
Very truly yours,
~~7!l
Charles E. Shields, III
Attorney-At-Law
CES/mjj
Enclosures
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: /l1;re /. ..tO~P ElYJfI1lft::~
Date of Death:
;;l. -I g - oif
Will No.
Admin. No. ,;J / - {) If -CJ (g'7
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 'I 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 ~
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes)( No
{
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~~~1lf'
Signature
Date:
(1~11,(
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Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717 ) 766-0209
Tel. No.
r--..
Capacity:
Personal Representative
,
... -- ~ - -
x Counsel for personal
representative
(MAH:rmf/AM3)
~~