HomeMy WebLinkAbout03-0527Register of Wills of CL BE ^ County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Esmta of Ruby N. Booth
also known as
, Deceased
Petitioner(s), who is/ara 18 years of age or older, apl~ly(ies) for:
Social Security No. ~
(COMPLETE 'A' or 'B' BELOW:)
[] A. Probate and Grant of Letters Testamenta~/and aver that Petitioner(s) is/are the execut, fix named in the last Will of
the Decedent, dated February 17, 1997 and codicil(s) dated .. Ju13. e 9, 2003 '-"--"--'
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
[ ' ] B. Grant of Letters of Administration
(c. La.; d.b.n.c. La; pendente lite; durante absentia; durante rninoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if an),) and
heirs:
Name
Reiationshi
(COMPLETE JN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland
or principal residence at 3,535 Logan Street, Camp Hill, PA
0ecedent, then ..,89 years of age, died June 19, 2003
Residence 3
County, Pennsylvania with his/her last family
(list street, number, and municipality)
at Manor Care, Camp Hill, Cumberland County, PA
Decedent 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 dorrdciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
$ 500.00
$ N/A
$ N/A
81,250
situated as follows: 3535 Logan Street, Camp Hill, PA
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the unde~d:
~ature
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form ~oftware only CPSysterns, Inc.
~rinted name and residence
Cheshire, CT 06410
Form RW-1 (1991)
[q:c ,
Oath of Personal Representative
Commonwealth of Pennsylvania
County of
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and sub~crib.d Shirley Miller
before me thi~.~:-~ da), of
',~.~Z,49;cL .... ~.~cC'~(2~--~; 560 Highland Avenue
For the Register
Estate of Ruby N. Booth Deceased
Social Security No: 196-14-0538 0ata of Death: June 19,2003
AND NOW, .:: L~ ? ;
, ~, Jt~¢onsJderati~!
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary [--"I Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to ,Shirley Miller
in the above estate and that the instrument(s) dated February 17, 1997 and June 9, 2003
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Renunciation ........ $
A~davits ( ) .... $
Extra Pages ( )
Codicil ........... $ ,/~"~.
JCP Fee .......... $ //~'~
Inventory ..........
Other ........... $
Attorney: Thomas E. Flower, Esquire
I.D. No: 83993
Address: .S. AIDISa SHUF.Fa FLOWER & LINDSAY
2109 Market Street, Camp Hill, PA 17011
Telephone: 717/737-3405
TOTAL ......... $
Prepared by the Pennsylvania Bar Aasoclatl'on Copyright (c) 1996 form software only CPSystems, Inc.
Form RW- 1 (lggl)
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATFORNEYSeATeLAW
2109 Market Street
Camp Hill, PA
CODICIL
OF
RUBY N. BOOTH
I, RUBY N. BOOTH, the within named Testatrix, do hereby make and publish this
Codicil of my Last Will and Testament dated February 17, 1997.
HRST
I hereby amend ITEM 4 of said Will to provide as follows:
I hereby nominate and appoint ffhw/¢v' iH diet to serve as Executor of
this my last will and testament. Should the executor thereby named fail to qualify or cease to
as executor, then I appoint ~Or~,e[ ~J ~[ as alternate or successor
Executor. My attorney has hand-written the foregoing names at my direction, and I have placed
my initials in the margin to the left of this item, in order to authenticate, ratify and confirm the
said appointment.
SECOND
I hereby revoke ITEM 6 of said Will.
THIRD
In all other respects I hereby ratify, confirm and republish my Last Will dated February
17, 1997, together with this sole Codicil as and for my Last Will.
IN WITNESS WHEREOF, I, RUBY N. BOOTH, have hereunto set my hand and seal to
this Codicil to my Last Will and Testament this _~ day of ~_~, 2003.
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATFORNEYS*AT*LAW
2109 Market Street
Camp Hill, PA
Signed, sealed, published and declared by the above-named RUBY N. BOOTH, Testatrix, as and
for a Codicil to her Last Will and Testament in the presence of us, who have hereunto subscribed
our names at her request as witnesses, thereto, in the presence of said Testatrix and of each other.
Thomas E. Flower
ADDRESS
2109 Market Street
Camp Hill, PA 17011
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
We, RUBY N. BOOTH, Thomas E. Flower, and "~jl~tA b, C TT', the
Testatrix and witnesses, respectively whose names are signed ~o the foregoing or attached
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
Testatrix signed and executed the instrument as her Codicil and that she signed willingly and that
she executed as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed the Codicil as witness and that to
the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind
and under no constraint or undue influence.
Thomas E. Flower, Witness
Notarial Seal '1
Sallie AIIshouse, Notary Public
Carlisle Bom, Cumberland County _
My Commission Expires Mar. 29, 2004
Subscribed, sworn to and acknowledged before me by RUBY N. BOOTH, the Testatrix, and
,cribed to ~and s__worn pr. affirmed to before me by Thomas E. Flower and
~ t_J)~t:~7"J" , witnesses, this ~ day of CJ/Z/9~,, ,2003.
I, RUBY N. BOOTH of the TOWNSHIP of HAMPDEN, COUNTY of
CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good
bodily health and of sound and disposing mind and memory, and not acting under
duress, menace, fraud, or undue influence of any person whomsoever, merely calling
to mind the frailty of human life, and being desirous of disposing my worldly goods
while I have the strength and capacity so to do, I do make , publish and declare this
my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my
former Wills and Testaments, including codicils thereto, by me at any time made, and
declare this alone to be my LAST W~ILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME
WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1. I direct that my Executors hereinafter named, pay and discharge all of
my just debts, funeral and testamentary expenses.
ITEM2. I order and direct that my bodily remains be cremated. Further, I
order and direct that my ashes, if possible, be scattered on the top of, or near the
vicinity of my late Husband's grave, situate at the Rolling Green Cemetery, Camp
Hill, Pennsylvania. My late Husband's full name is FRED W. BOOTH.
ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and
in fee, to my CHURCH, THE WEST SHORE BAPTIST CHURCH, located at
21st and Market Streets, Camp Hill, Pennsylvania.
ITEM 4. I nominate and appoint CARL W, GITTINGS as Executor of this
my LAST WILL and TESTAMENT. Should the Executor named fail to qualify or
cease to act as Executor then I appoint THE P.N.C. BANI( as executor in his stead.
Page 1 of 3
RU~3Y(~q. BOOTH
ITEM 5. I hereby direct that all my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
ITEM 6. I order and direct that my Personal Representative(s) named herein
use the legal services of JAMES M. BACH, as the Attorney for my Estate.
ITEM 7. I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my death in respect
of all property comprising my gross estate for tax purposes, whether or not such
property passes under this LAST WILL, shall be paid by my Executor out of my
residuary estate.
ITEM 8. I grant to my personal representatives herein named, in addition to,
but not in limitation of those powers vested by law, to be exercised without prior
application to or approval of any court, the power and authority to retain
indefinitely any property, to invest and reinvest any assets or the proceeds derived
from the sale of assets, although said investments may not be of the character
prescribed by law, to sell, convey, assign, transfer and encumber any property, to
pay, settle or compromise all claims, to make distribution or divisions in cash or in
kind, and in general to exercise all powers in the management of any property
hereunder which any individual could exercise in the management of similar
property owned in his own right, and to execute and deliver any and all instruments
and to do all acts which may be deemed necessary and proper.
(.
~, R~BY N. BOOTH
--END
Page 2 of 3
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
$$
I, RUBY N. BOOTH, the TESTATRIX, whose name is signed to the
attached or 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
purpose therein expressed.
Sworn to or affirmed and acknowledged before me, by: RUBY N. BOOTH the
TESTATRIX this__17th_ day of FEBRUARY _, 1997.
RIBB~'N. BOOTH
J0gVIES M. BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, PA 17055
My Commission Expires:
5/13/99
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
We, FRANCIS J. LAFFERTY and ESME GOODSIR, the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw TESTATRIX sign
and execute the instrument as her LAST WILL; that the TESTATRIX signed
willingly and that she executed it as her free and voluntary act for the purpose therein
expressed; that each witness in the hearing and sight of the TESTATRIX signed the
WILL as witnesses; and that, to the best of our knowledge, the TESTATRIX was, at
the time, 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn to or affirmed and acknowledged before me, by: FRANCIS J. LAFFERTY
and ESME GOODSIR, witnesses, this 17th_ day of _F_.F,I~.~sAB~ 1997.
' FRANCI~ J. L}~FERTY
WI TNE "'S~~ ~.~..~D~a/Qx'
ESME GOODSIR
· BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, PA 17055
My Commission Expires:
05/13/99
Page 3 of 3
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No. 21-03-0527
To the Register:
Ruby N. Booth
June 19, 2003
Admin. No. 2003-00527
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 July 9, 2003.
Name Address
Dr. Dan MacDonald
The West Shore Baptist Church
21st and Market Streets, Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date:
Thomas E. Flower, Esquire
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
Personal Representative
X Counsel for Personal
Representative
RE~' 1500 EX (6q]O~- i~
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
Z
LU
I--
Z
2:
0
ILl
0
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Booth, Ruby N.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
06/19/03 05/24/14
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
n/a
r~l. Odginal Return
E~4. Limited Estate
r~6. Decedent Died Testate (Aitach copy of Will)
F']2. Supplemental Return
[~] 4a. Future Interest Compromise (date of death after 12-12-82)
[-'--~ 7. Decedent Maintained a Living Trust (A~t~ch copy of Trust)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of 0eath ~etween 12-31-91 and 1-1-95)
NAME
Thomas E. Flower
FIRM NAME (If ApplicaUe)
Saidis, Shuff, Flower & Lindsay
TELEPHONE NUMBER
(717) 737-3405
~21 _ 03 0527
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
196-14-0538
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
E~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortga{le Liabilities, & Liens (Schedule I)(10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
El3. Remainder Return (dale of death prior to 12-13-82)
El5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
E~] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
2109 Market Street
Camp Hill, PA 17011
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
81,250.00
3,758.37
(8)
9,894.80
55,204.78
(11)
(12)
(13)
(14)
85,008.37
65,099.58
19,908.79
0.00
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .o (15)
x .o (16)
x .12 (17)
x .15 (18)
(19)
0.00
.Decedent's Complete Address:
STREETADDRESS
3535 Loqan Street
crrYcamp Hill
I STATEpA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3. Interest/Penalty if applicable Total Credits (A + B + C ) (2)
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
I zIP17011
(4)
0.00
0.00
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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; ............................................ [] []
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? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perju~, 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILIN. G RETURN
DATE
ADDRESS
560 Highland Avenue, Cheshire, CT 06410
SIG~TUI~E OF PREPARER 0'~ THAt~,~,EPRESENTATIVE
ADDi~ESS~ ' . ,
DATE
Saidis, Shuff, Flower & Lindsay, 2109 Market St., Camp Hill, PA 17011
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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is 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 RS. {9116(1.2) [72 RS. {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.
RE'~-1502 EX+ (6-98,~,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Ruby N. Booth 21-03-0527
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
ITEM
NUMBER
1.
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 survivorship must be disclosed on Schedul F.
DESCRIPTION
Single-story dwelling house and lot, situated at 3535 Logan Street, Camp Hill,
PA, sales price per contract entered into by decedent.
(see attached settlement sheet)
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
Of DEATH
$81,250.00
81,250.00
REV-{508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruby N. Booth
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-03-0527
ITEM
NUMBER
1.
3.
4.
5.
6.
7.
8.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
DESCRIPTION OF DEATH
$ 201.88
PNC Bank checking account #5140005666 (non-interest bearing)
140 Camp Hill Shopping Mall, Camp Hill, PA
Jewelry sold to Rose Marie Antiques, sale price
Household goods appraised at $970, sold through news paper ad & at estate yard sale
Paintings by decedent, sold at West Shore Babtist Church
Loose change
partial refund of payment on PNC mortgage loan satisfied at settlement
pro-rata adjustment at settlement for sewer/trash paid by seller in advance
pro-rata adjustment at settlement for r/e taxes paid by seller in advance
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
530.00
1,686.00
217.00
2.50
60.37
20.34
1,040.28
3,758.37
EV-'1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Ruby N. Booth
FILE NUMBER
21-03-0527
ITEM
NUMBER
5.
6.
7.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Cremation Society of Pennsylvania
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Shirley Miller
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 560 Hi~lhland Avenue
city Cheshire
Year(s) Commission Paid: 2003
Attorney Fees
State CT Zip 06410
Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation)
Claimant
Street Address
State __ Zip
City
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
AMOUNT
Advertise grant of letters, Patriot News (117.61), Cumberland Law Journal (75)
Settlement costs to sell real estate
Shod Certificates
Patriot News, estate yard sale advertisement
Chuck Bricker, Auctioneer - appraisal of household goods
James & Donna Gordon, clean-up of house prior to sale
PA American Water Co. - final bill
PPL Electric - final bill
UGI - final bill
$1,114.96
1,250.00
4,250.00
241.50
192.61
2,626.58
9.00
23.60
50.00
75.00
37.17
4.03
20.35
$ 9,894.80
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-;512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruby N. Booth
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-03-0527
ITEM
NUMBER
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Include unreimbursed medical expenses.
DESCRIPTION
West Shore Health & Rehab Center, unreimbursed nursing care
Holy Spirit Hospital
Internists of Central PA
UGI, heating fuel
PA American Water Co.
PPL Electric
Saidis, Shuff, Flower & Lindsay, lifetime legal services, estate planning & elder law
local per capita tax
Boscov's, credit card bill
Comcast, tv cable bill
Fetrow Electric, wiring repair
Walmart, credit card bill
Verizon, phone service
Ron Moore, lawn care
Taste of Home, cook book purchase
Patriot News, subscription balance
PNC Bank, mortgage loan balance
VALUE AT DATE
OF DEATH
945.00
15.49
56.42
713.07
39.75
37.93
782.50
11.00
2,394.33
71.22
176.39
2,217.30
56.44
100.00
23.90
1.60
47,562.44
TOTAL (Also enter on line 10, Recapitulation) $ 55,204.78
(If more space is needed, insert additional sheets of the same size)
REV-1~13 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruby N. Booth
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-03-0527
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
West Shore Babtist Church
c/o Dr. Dan MacDonald, Pastor
21st & Market Streets
Camp Hill, PA 17011
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If mom space is needed, insert additional sheets of the same size)
AMOUNT OR SHARE
OF ESTATE
100%
19,908.79
I, I[I-~5I~BI~:~ of the TOWNSHIP of HAMPDEN, COUNTY of
CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good
bodily health and of sound and disposing mind and memory, and not acting under
duress, menace, fraud, or undue influence of an7 person whomsoever, merely calling
to mind the frailty of human life, and being desirous of disposing my worldly goods
while I have the strength and capacity so to do, I do make, publish and declare this
my LAST WII.I. AND TESTAMENI. I hereby revoke, cancel and annul all my
former Wills and Testaments, including codicils thereto, by me at an7 time made, and
declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME
WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
~ I direct that my Executors hereinafter named, pay and discharge all of
my just debts, funeral and testamentary expenses.
~ I order and direct that my bodily remains be cremated. Further, I
order and direct that my ashes, if possible, be scattered on the top of, or near the
vicinity of my late Husband's grave, situate at the Rolling Green Cemetery, Camp
Hill, Pennsylvania. My late Husband's full name is FRED W. BOOTH.
~ All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and
in fee, to my CHURCH, IJglF,2~RE BAPTIST CHURCII_, located at
21st and Market Streets, Camp Hill, Pennsylvania.
~ I nominate and appoint C-&RL-~GITT!N_G~ as Executor of this
my LAST WILL and TESTAMENT. Should the Executor named fail to qualify or
cease to act as Executor then I appoint IHF2~ as executor in his stead.
Page 1 of 3
~ I hereby direct that all my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
~ I order and direct that my Personal Representative(s) named herein
use the legal services of JAMES M. BACH, as the Attorney for my Estate.
LTEM~ I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my death in respect
of all property comprising my gross estate for tax purposes, whether or not such
property passes under this LAST WILL, shall be paid by my Executor out of my
residuary estate.
~ I grant to my personal representatives herein named, in addition to,
but not in limitation of those powers vested by law, to be exercised without prior
application to or approval of any court, the power and authority to retain
indefinitely any property, to invest and reinvest any assets or the proceeds derived
from the sale of assets, although said investments may not be of the character
prescribed by laTM, to sell, convey, assign, transfer and encumber any property, to
pay, settle or compromise all claims, to make distribution or divisions in cash or in
kind, and in general to exercise all powers in the management of any property
hereunder which any individual could exercise in the management of similar
property owned in his own right, and to execute and deliver any and all instruments
and to do all acts which may be deemed necessary and proper.
· I~BYN. BOOTH·
WITNESS.~/_ ~ ,/~'
END=
Page 2 of 3
&CKNO~.LEDGMENT~
COMMONWEALTH OF PENNSYLVANIA )
) ss
COUNTY OF CUMBERLAND )
I, RUBY N. BOOTH, the TESTATRIX, whose name is signed to the
attached or 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
purpose therein expressed.
Sworn to or affirmed and acknowledged before me, by: RUBY N. BOOTH the
TESTATRIX this__17th_ day of_ FEBRUARY =, 1997.
_ .,
RIBB~I. BOOTH
Jt~HES M. BACH, ES~-~U~RE
NOTARY PUBLIC
Mechanicsburg, PA 17055
My Commission Expires:
5/13/99
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
ss
We, FRANCIS J. LAFFERTY and ESME GOODSIR, the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw TESTATRIX sign
and execute the instrument as her LAST WILL; that the TESTATRIX signed
willingly and that she executed it as her free and voluntary act for the purpose therein
expressed; that each witness in the hearing and sight of the TESTATRIX signed the
WILL as witnesses; and that, to the best of our knowledge, the TESTATRIX was, at
the time, 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn to or affirmed and acknowledged before me, by: FRANCIS J. LAFFERTY
and ESME GOODSIR, witnesses, this ~ day of ~ 1997.
FRANCI~ j. ESME GOODSIR
F''=- ~OTARIAL SEAL ='-I
J^TTC . ,, =...,,',.L'~A.~H, Nom., .... :
[ .. Cumbe,Taad Couaty ~
j MvComm ss or 53'0 roa ~,~r~ t ~ ~ l~q ~
J~i3VIES M. BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, PA 17055
My CommiSsion Expires:
05/13/99
Page 3 of 3
CODICIL
OF
RUBY N. BOOTH
I, RUBY N. BOOTH, the within named Testatrix, do hereby make and publish this
Codicil of my Last Will and Testament dated February 17, 1997.
FIRST
I hereby amend ITEM 4 of said Will to provide as follows:
I hereby nominate and appoint ~,~iFI~v' ~ t~ter to serve as Executor of
this my last will and testament. Should the executor thereby named fail to qualify or cease to
as executor, then I appoint ~t}r~e[ ~J boa[ as alternate or successor
Je erson,,, t'41>
Executor. My attorney has hand-written thc foregoing names at my direction, and I have placed
my initials in the margin to thc left of this item, in order to authenticate, ratify and confirm the
said appointment.
SECOND
I hereby revoke ITEM 6 of said Will.
SAIDIS
;HUFF, FLOWER
& LINDSAY
ATrORNEYS*AToLAW
2109 Market Street
Camp Hill, PA
THIRD
In all other respects I hereby ratify, confirm and republish my Last Will dated February
17, 1997, together with this sole Codicil as and for my Last Will.
IN WITNESS WHEREOF, I, RUBY N. BOOTH, have hereunto set my hand and seal to
this Codicil to my Last Will and Testament this _~ day of~[~__, 2003.
' ~l~ ~BOOTH
i
Signed, sealed, published and declared by the above-named RUBY N. BOOTH, Testatrix, as and
for a Codicil to her Last Will and Testament in the presence of us, who have hereunto subscribed
our names at her request as witnesses, thereto, in the presence of said Testatrix and of each other.
Thomas E. Flower
ADDRESS
2109 Market Street
Camp Hill, PA 170
SAIDIS
UFF, FLOWER
~ LINDSAY
I'FORNEYSoAToLAW
!09 Market Street
Camp Hill, PA
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
We, RUBY N. BooTH, Thomas E. Flower, and '-/~b/,~)tA ~). ~CDT'"/", the
Testatrix and witnesses, respectively whose names are signed to the foregoing or attached
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
Testatrix signed and executed the instrument as her Codicil and that she signed willingly and that
she executed as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed the Codicil as witness and that to
the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind
and under no constraint or undue influence.
ThOmas E. Flower, Witness
Subscribed, sworn to and acknowledged before me by RUBY N. BOOTH, the Testatrix, and
subscribed to and sworn or, affirmed to before me by Thomas E. Flower and
.~'~ ~. t '~t'l:~Tr"/'' , witnesses, this ~ 'day of (_J/Z~, 2003.
Notarial Seal
Sallie AIIshouse, Notary Public
Carlisle Boro, Cumbefl..a~d C_o~un..~,,,
My Commission Expires Mar. zu,
^. Settlement Statement
B. Type of Loan U.S. Department of Housing FINAL
1. [JFNA 2. '[~FmHA 3. 0Conv. Unins ] 6 FileNumber I 7 LoanNua?dUrbanDevel°p'~ent -- OMBNo 2502-0265
· - mocr 8, Mortgage Insurance Case Number
C. N ore: Item s rnark~l "p. oc. "were pa d outs de the c~os ns; they are shown here for information purposes and are not inctuded in the t~tats
WARNING: II is a crime to knowingly make false statements to the United States on this or any other- simits/form. Penalties upon'
........ ,-,~,~uwe~. Jonn M. t~oste~ac and Michelle L. Kostelac
ADDRESS:
E. NAME OF SELLER: Estate of Ruby~
ADDRESS:
F. NAME OF LENDER: First Ho~'zon Home Loans
ADDRESS:
G. PROPERTY ADDRESS:
H. SETTLEMENT AGENT:
PLACE OF SETTLEMENT:
I. SETTLEMENT DATE: 07/1 ~
J. SUMMARY OF ~
4076 Market Street, Camp Hill, PA 17011
3535 Logan Street, Camp Hill, PA 17011
Hampden Township
s~~
' -', ~ ...... : ..,-~,'~.>-ozzz tax: 71%243~6486
2109 Market Street, Camp Hill, PA 17011
100· GROSS AMOUNT DUE FROM BORROWER
101· ~ --T~250 . 00
lO2.
193. Settlement char~
104.
105.
Ad'ustments for items aid b seller in advance
107. _Co. unt._taxes 07 1.8 03to1.2 31 03 1.13.3______8
108. ~8c~ool,_Tax.e~ 07 18 03to06 30 04 926.90
109· ~
110. 20.3.._.___~4
111.
112.
85 387.00
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER
201. De osit or earnest mone
202. Princi_~ amount of new loans
203· Exis~~ct to --
204,
205.
206·
207.
208.
209.
A~stments for items U~er
i 500.00
65 000. O0
K. SU~~~~;~~
400. GROSS AMOUNT DUE TO SELLER:
213·
214·
215.
216.
217.
218·
219.
401. Contlact sales rice
402. Personal Pro rt 81 250.00
403· '----------------~-~
404·
405.
Ad'usb'nents for items aid b seller ia advance --
407. Court taxes 07 18 03to~~ 113.-'~8
408. School Taxes
502. Settlement cha es to seller line 1400-
503· Existi loan s taken sub' ct to
504. Pa ff of First Mort a eLoan
505.
506.
507.
508·
509.
513.
514·
515.
516.
517·
518.
626.58
47 562.44
Affustrnents for items un aid b selle~
220. TOTAL PAID BY/FOR BORROWER .[ 519. ~
........... 66 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER--
300. AT SE LEMENT FRO, OR,O SORRO R
· ~' ~-=Mcr~t tO OR FROM S R
301· ~ross amount due from bo~o.r line 120 ~~_l..,O ~ FROM SELLER
302. ·
303. CASH FROM BORR~ER
SUBS~FITUTE FORM 1099 SELLER STATEMENT: The information contained herein
~ negh ence penalty or o~ler sanct on will be imposed on OU ' ' ' is important tax infomlation and is bein
line 40~ above constitutes the ~-~o- a .......... Y if this item is required to be re~lted ~ ,~* ,~ ~-- g furnished ta the Internal Revenue e~ice -.-- ·
~'":~,. SE'LE.'S'8,~. . o~,.. ~ .4. ~ o ""' 7r'~"".-~W"~be'~,""P~~"~: o.
,, A.~.E~6, o~1 ,,<,0~.o4,/ r~te~L~
/ --
TitlcExprcss Scttlcmcnt System Printed 07/21/2003 at 13:17
REV. HUD-I (3/86)
801. Loan O~ation Fee
802. Loan Discount
~aisal Fee
804. Credit Re~
805. Courier Fee
806. Tax Related Sar./Fee
807. Flood Determination Fee
808.
809.
810.
811.
I].S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
. . SETTLEMENT STATEMENT
L SETTLEMF. NT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION based on price $81,250.00 @ 0. 000 =
Division of commission (line 700) as follows:
701.$ to
702.$ to
703.Commission_~aid at Settlement
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
%
%
to Mark Hackman
to Total Credit Service
to First Horizon Home Loans
to Total - t Solutions Lender PD 90.00
to Federal Flood Certifications
900. ITEMS REQUIRED BY LENDER T~O BE PAID IN ADVANCE
File Number: MT2003-189
PAGE 2
jINAL
PAID FROM~-J~ PAID FRO~------'~-
BORROWER'S I SELLER'S
FUNDS ATJ FUNDS AT
SETTLEMENT t SE'I-I'LEMENT
1002. Mo r t a~q~.~_~ In su ran ce
1003. Cit Pro eft Taxes
1004. Coun Pro--xes
1005. School Taxes
1009. A re ateAnal sisAd'ustment
1100. TITLE CHARGES
1101. Settlement or clos~_~q fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
350.00
25.44
15.00
24.~0
901. Interest From 07 18 2003 to 08 01 2003 $ 8.5760 /da
902. Mort~remium for to --
903. Hazard Insurance Premium for · . --
904. to Ca~tal Re ion Insurance an
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1o01. Hazard Insurance
3 m°'-~--~-----~31.8_____~3 /mo
/mo
/mo
6mo__~. $~ 20__._. 65 /mo
2 m °'-~.--~----~~ 8~0.7 8 /mo
~ -
1105. Document Pra_e_p__aration --'--------------------
1106. Notar~ Fees
1107. Attorne~ fees to Saidis Shuff Flower & Lindsa
to SSFL POC SELLER
_~ve items No:
1108. Title Insurance to ACCP II',.C.
(includes above items No:
1109. Lender's Polic~ ~00.00 -
1110. Owner'sPoli__i~ 81_~_1_1_1_1_~250.00 - 75__.__.0.75
1111. END 100. 300, 8___.~1 to ACCP Ino.~
1112. Insured Clos~ to ACCP Inc.
1113.
1200. GOVERNMENT RECORDING AND TRANSFE~R CHARGES
1201. Recordin FeesDeed$ 38.50 ;Mort a eS 72.50 ;Releases
1202. Ci /Count tax/stare S~Deed$812.50 ;Mort a eS
1203. State Tax/stam__~_..~ Deed $812.50 ;Mort a e $
1204. Record PowerofAttome~z- to l~ecorder of Deeds
1205. SatofPNCMt_~ to Recorder of Deeds
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Overniq~ to Saidis Shuff Flower & Lindsa
14.0C 4.00
750.7!
35.00
1302. Termite
1303. 2003~Tax
1304. 2003-04 School Tax
1305. Radon
1306. Water/Sewer
1307.
1308.
to Bower_______~sPest
~etrow
toKath Fetrow
~est
to Ham den Townshi
1400. TOTAL SETTLEMENT CHARGES enter on lines 103, Section J and 502. Section
20.00
20.00
397.50
278.18
969.40
99.00
HUD CERTIFICATION OF BUYER AND SELLER ~ -- 2,626.5~
I have carefully rev awed the HUD-1 Settlement S atement and to the bas of my I~lowb~dge and belief,
in th s transaction. I fuflher certify hat I have received a Copy of the HU D-1 Settlement Statement it is a true and accurate statement of all receipts and disbursements made on my account or by me
JOnn M. ~ostelac
~'[¢rlelle L. Rostmac
WARNING: IT IS A CR ME TO KNOWINGLY MAKE FALSE STATEME
UNITED STATFS ON THIS OR ANY NTS TO THE
CAN 'NC LUDE A FIN E AN D ,MPR SOSINMMIELANRT F~O~R~M~.P~E .N~L~TI_E_S UPON CONVICTION iThh~vHeUcaD: !. ?~rit Statement which i have pr epa. ecl is. t ...........
U.S. CODE SECTION 1001 AND SECTION 1~1~a~ u= ~AILS ;SEE TITLE 18: ~ ~ w~, cause the funds to be d sburse~ in ~ ..~ f~a,e account d this transaction.
rdance with this stetemen[
TJtlcE×prcss S¢~cmont System Printed 07/21/2003 at ]3:]7 " - - -- ~AT~: ( --
REV. HUD-I (3/86)
FIIJG-~ ~--21dk]3 2:1: 2,ti PNC~qNIK 47 :.:~ ?1:~8 ;?1,%1--t P.
PNCBAN<
August 19, 2003
Thomas E. Flower
2109 Market Street
Camp Hill, PA 17011
Estate of Ruby N. Booth, deceased
SSN: 196-14-0538
DOD: 6/19/2003
Dear Mr. Flower:
In response to your request for Date of Death balances for the tmstomer noted above, our
records show the following:
Checking Account
Account #5140005666
RUBY N BOOTH
DOD balmace: $201.88 (non-~nterest bearing)
Safe Deposit Box
Established 12/12/1990
#15lA
Located
RUBY N BOOTH
SHOPPING MALL BRANCH
140 CAMP HILl_, SHOPPING MAI,L
CAMP HILL PA 17011
717-761-2099
Established 04/30/1987
For Ix~an information, please call 1-888-762--2265. (Account) ILA #4001008012622290
Page I of 2
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Sav/ngs accounts). We do not process ~ny financial
transactions or provide statements. If you need assistance with any of these items,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office_
Sincerely,
Rachelle Wells
1-800-762-1775
PT-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Page 2 of 2
Mc,nber FDIC
APPRAISAL
Personal Property of ~L)~ ,AJ, ~6~'/~ ~-~c~7"~/-~-
Appraised by Chuck E. Bricker AU094-L Date
ITEM VALUE ITEM VALUE
jO,bO
REV--485 EX+ (9-00) ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0801
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX I: LOCATED AND RETURNED TO ABOVE ADDRESS
UCOUNTY CODE . FILE NUMBER ~ SOCIAL SECURITY OR DEATH CERT, IFICATE NUMBER
oG/
'~1 ADDRESS OF DECEDENT (STREET) -- -- ~',' /'~ <CITY) . . ~TATE> IODE>
~ ERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
(STREET NAME~~~~~
~ ~STATE) (ZIP CODE)
~ ADDRESS AND RELATIONSHIP (IF ANY) TO ~9~T, OF PERSON(S) PRESE~ AT THE BOX OPENIN~ a. (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY) (STATE) (ZIP CODE)
b. (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY) (STATE) (ZiP CODE)
c. (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY) (STATE) (ZIP CODE)
~AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(STREET NAME)
b. (NAME)
(STREET ADDRESS) !STREET ADDRESS)
(CITY) (STATE) (ZIP CODE) (CITY)
TITLE OF EMPLOYEE TAKING "[HE INVENTORY
'''WASAW'LL,.THESOX? YES . NO
(STATE) (ZIP CODE)
b. Name and address of personal representative, if named in the will
(NAME)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
c. Name and address of attorney, if any
(NAME)
(C~TY)
(ZiP CODE)
BUREAU OF INDIVIDUAL TAXES
ZHHERXTANCE TAX DXVZSTON
DEPT. 180601
HARRISBURG, PA 17118-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
THOMAS E FLOWER
SAIDIS ETAL
2109 HARKET ST
CAMP HILL PA 170'~1
DATE 10-21-2003
ESTATE OF BOOTH
DATE OF DEATH 06-19-2003
FILE NUMBER 21 03-0527
COUNTY CUMBERLAND
ACN
Aaoun'l: Reai~ad
REV-I~4? EX RFP (01-05)
RUBY N
HAKE CHECK PAYABLE AND RENTT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOOTH RUBY N FILE NO. ZZ 03-0527 ACH 101 DATE 10-21-2005
TAX RETURN NAS: { X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATZON COHCERNZNG FUTURE ZN',=KEST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. CloseZy Held S~ock/Par~nership Zn~eras~ (Schedule C) ($)
q. Nor~gages/No~as Reca/veble (Schedule D) (q)
$. Cash/Bank Daposi~s/M/sc. Personal Proper~y (Schedule E) ($)
6. Jo/n~ly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~a! Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ada. Cos~s/H/sc. Expanses (Schedule H) (9)
10. Dab~s/Nor~gage L/ab/1/~/as/Lians (Schedule I) (10)
11. To,al Deductions
81~250.00
.00
.00
.00
3~758.37
.00
.00
(8)
9,89~.80
55,20q.78
(11)
12.
15.
NOTE:
ASSESSMENT OF TAX:
1.;. Amoun~ of Line lq a~ Spousal ra~e
16. Amoun~ of L/ne 1(~ ~axable e~ L/neal/Cless A ra~e
17. Aaoun~ of L/ne 1~ a~ S/bl/ng ra~e
18. Aaoun~ of L/ne lq ~exable a~ Collateral/Class B ra~e
19. Pr/nc/pal Tax Due
TAX CREDITS:
PAYMENT KECEZPT DISCOUNT
DATE NUHBER ' INTEREST/PEN PAID (-
NOTE: To /nsure proper
cred/~ ~o your account,
suba/~ ~he upper por~/on
of ~h/s fora ~/~h your
~ax payment.
85,008.37
65.099.58
19,908.79
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL [NTEREST.
.00
.00
.00
.00
( ~F TOTAL DUE [S LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THTS FORM FOR ZNSTRUCTTONS.)
AHOUNT PAXD
(15). .00 x O0 = .00
(16) .00 x 0~5= .00
(17) .00 x 12 = .00
(lB) .00 x 15 = .00
(19)= . O0
Ne~ VeXua of Tax Re~:urn (12)
Char/~:ebXe/Governeen~:el Bequest:s; Non-elected 9113 Trusts (Schedule J) (13) ~9,908.79
Ne~: VeXue of Es~:a~:e Sub~ec~: ~:o Tax (1/~) . O0
Tf an assessment ~as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ~111
reflect figures that include the total of ALL returns assessed to date.
RESERVATION:
Estates of decedents dying on or before December 1Zj 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the sxpiration of any estata far
life or for years, the Coamonaaalth hsrsby expressly reserves tho right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATZVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of 2000. (72 P.S.
Section 91q0].
Detach the top portion of this Notice and submit aith your payment to the Register cf Hills printed on the reverse side.
--Hake check or money order payable to: REG/STER OF #ILLS, AGENT
A refund of a tax creditj ehich ams not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, er by calling the special 2~-hour
answering service for fores ordering: 1-800-362-2050; services for taxpayers mith special hearing and ! or
speaking needs: 1-800-~7-3020 (TT only).
Any party in interest not satisfied with the appraisemsnt~ alloeance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of race[pt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--elect[on to have the matter detersinad at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of
the tax paid is allowed.
The 152 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. This non-participation
penalty is appealable in the same manner and in the the sase time period as you mould appeal the tax and interest
that has been assessed as indicated on this not[ce.
Interest is charged beginning with first day of deIinquancy, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ahich became dsIinquent before January 1, 1982 bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January 1, 1982 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 far 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yea.~r Rate Factor Yea.~r Rate Factor
1982 ZOX .0005q8 1987 92 .0002~7 1999 72 .000192
1983 162 .000~38 1988-1991 llX .000301 ZOO0 82 .000219
198~ 11X .000501 1992 92 .0002~7 2001 92 . O00Zq7
1985 I~Z .000356 1995-199~ 72 .000192 ZOOZ 62 .00016~
1986 102 .O00Z?~ 1995-1998 92 .O00Zq7 2005 52 .000157
--Interest is calculated as follows:
ZNTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELTNQUENT X DAZLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assesssant. If payment is made after the interest computation date shown on tho
Notice, additional interest aust be calculated.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN THE ESTATE OF RUBY N. BOOTH,
deceased
No. 21-03-0527
Late of Camp Hill, Pennsylvania
CERTIFICATION OF NOTICE
I hereby certify that written notice of the date, time and place of presentation of the First and
Final Account for the Estate of Ruby N. Booth for audit and proposed statement of distribution has
been given by first class mail on December 1, 2003 to the Office of the Attorney General and every
unpaid claimant who has given written notice of a claim and to every other person known to have
or to claim an interest in the estate as beneficiary, creditor, heir or next of kin pursuant to
Pennsylvania Orphans' Court Rule 6.3.
Date:
Thomas E. Flower, Esquire
Attorney I.D. No. 83993
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
FIRST AND FINAL ACCOUNT OF
SHIRLEY MILLER, EXECUTRIX
FOR THE
ESTATE OF RUBY N. BOOTH
NO. 2003- 00527
Date of Death:
Date of Executor's Appointment:
First Complete Advertisement of
Grant of Letters
Accounting for the Period:
June 19, 2003
June 30,2003
July 18,2003
June 30,2003--November30,2003
Purpose of Account: Shirley Miller, Executrix, offers this account to acquaint interested
parties with the transactions that have occurred during her administration. The account also
indicates the proposed distribution of the estate.
It is important that the account be carefully examined. Requests for additional information or
questions or objections can be discussed with:
Thomas E. Flower, Esquire
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17001-0737
[717] 737-3405
PRINCIPAL:
Receipts
Less Disbursements:
Debts of Decedent
Funeral Expenses
Administrative Expenses
Fees and Commissions
Principal Balance on Hand
INCOME:
Receipts
Combined Balance On Hand
Items To Be Disbursed:
Balance of Fees and Commissions
Proposed Distribution to Beneficiary
SUMMARY
Page
No.
3
3-4
4
5
6
6
6
6
(10,057.75)
(1,114.96)
(937.34)
(4,000.00)
37,943.53
(16,110.05)
21,833.48
0
21,833.48
(1,500.00)
(20,333.48)
00.00
Notes for Purposes of Information
6
2
PRINCIPAL RECEIPTS
07/22/03
07/23/03
08/13/03
08/15/03
09/09/03
09/17/03
9/17/03
09/18/03
09/26/03
09/26/03
10/13/03
11/18/03
Net Proceeds of Sale of Real Estate
Proceeds of Sale of Household Goods & Effects
Refund of PNC loan payment
Refund of Overpayment, Verizon
Refund of Premium, Pa. Blue Shield
Refund of American Water bill
Refund of overpayment of filing fee - Register of Wills
Liquidation PNC checking account #51-4000-5666
PSERS/pro-rated final pension payment
Refund of Premium, Kemper property insurance
Refund of Utility Bill, UGI
Refund of Boscov's overpayment
Total Principal Receipts
$ 32,121.60
2,435.50
60.37
5.05
135.01
35.17
5.00
571.04
154.67
28.75
22.04
2,369.33
$ 37,943.53
DEBTSOFDECEDENT
07/22/03
Patriot News, subscription fee balance
UGI, utility bill
PA American Water, water bill
1.60
713.07
35.17
3
Fetrow Electric, bill for service call
Kathryn Fetrow, tax collector: 2003 per capita tax
Boscov's, credit card bill, minimum payment
Comcast, t.v. cable bill
Saidis, Shuff, Flower & Lindsay: lifetime legal services
Ron Moore, lawn maintenance
PPL Electric, utility bill
Taste of Home, bill for cookbook
Walmart, balance credit card bill
Verizon, telephone bill
08/14/03 Internists of Central PA, medical bill
08/15/03 Boscov's, final credit card payment
09/04/03 West Shore Health & Rehab, unreimbursed nursing care bill
Total Debts of Decedent
176.39
11.00
2,394.33
71.22
782.50
100.00
37.93
23.90
2,217.30
56.44
56.42
2,435.48
945.00
10,057.75
FUNERAL EXPENSES
07/22/03
Cremation Society of Pennsylvania
Cremation
Medical documents/courier fee
Death certificates
Obituary notice
Coroner's fee
Total funeral expenses
995.00
55.O0
10.00
29.96
25.00
$ 1,114.96
4
ADMINISTRATION EXPENSES
07/22/03 Chuck Bricker, appraisal fee
07/28/03 Cumberland Law Journal, estate notice
Register of Wills, additional short certificates
08/14/03 Patriot News, ad for estate yard sale
Patriot News, estate notice
08/15/03 Pa American Water, residential water service
08/15/03 PPL Electric, utility bill
08/28/03 PNC Bank, check printing fee
9/4/03 UGI - utility bill
9/17/03 Register of Wills, filing fee for inheritance tax return
10/13/03 Register of Wills, probate fees
Jim & Donna Gordon, clean-up of property prior to sale
Register of Wills, short certificates
PNC Bank, fee for lost safe deposit key
12/ /03 Register of Wills, fee to file account
Total administration expenses
50.00
75.00
9.00
22.00
117.61
39.75
4.03
27.60
20.35
15.00
241.50
175.00
15.00
12.50
113.00
937.34
5
FEES AND COMMISSIONS
Shirley Miller, Executrix's Commission
Paid to date
To be disbursed
Saidis, Shuff, Flower & Lindsay, Attorneys' Fees
Paid to date
To be disbursed
Total Fees and Commissions
$ 250.00
1,000.00
3,750.00
500.00
$5,500.00
CASH ON HAND
PNC Bank Checking Account #50-0387-0936
$21,833.48
ITEMS REMAINING TO BE DISBURSED
Shirley Miller, Balance of Executrix's Commission
Saidis, Shuff, Flower & Lindsay, Balance of Attys.' Fees
Total Items to Be Disbursed
$1,000.00
500.00
$1,500.00
PROPOSED DISTRIBUTION TO BENEFICIARY
The West Shore Baptist Church $20,333.48
21 st and Market Streets
Camp Hill, PA 17011
NOTES FOR PURPOSES OF INFORMATION
Decedent's house was under contract of sale at the time of her death and was sold by the
Executrix at the contract price. The Sales price was $81,250, and a mortgage loan of $47,562.44
was paid off at settlement. No gains or losses were realized on sale or other disposition of Estate
assets, so for accounting purposes "fiduciary acquisition values" equal "current values" of all
estate assets.
6
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND )
SS.
Shirley Miller, Executrix under the Last Will and Testament of Ruby N. Booth,
deceased, hereby declares under oath that she has fully and faithfully discharged the
duties of her office; that the foregoing First and Final Account is true and correct and
fully discloses all significant transactions occurring during the accounting period; that
all known claims against the estate have been paid in full; that, to her knowledge, there
are no claims now outstanding against the estate; and that all taxes presently due from
the estate have been paid.
Sh{rley Mill~, Executrix
Sworn to and subscribed before me
this //~ o f ,~/o,,-/w.~Cf, 2003.
FIRST AND FINAL AC~OUN~
FOR THE ESTATE OF
RUBY N. BOOTH, DECEASED
LATE OF CA~.~ HII.T,, PA
Shirley ~ller, Executrix
No. 21-03-0527
hereby certify that written notice cfi the filing ::'~
Aoceunt, and cfi the date, time and [~ce
whe~ the same will be preeented to the Court
for oortlr~ and ot the ~ day to file writter,
every ~ ~ and to every c~her persor,
known to the aocxxm~ to have ~ cteim ~n
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
26 WEST HIGH STREET 2109 MARKET STREET
CARLISLE, PA 17013 CAMP HILL, PA 17011
TEL: (717) 243-6222 TEL: (717) 737-3405
FAX: (717)243-6486 FAX: (717)737-3407
':'~a~.e,-nem of Proposed Dtst~outKm, and of t~e
~ime and ~ ~ ~ ~ ~ ~ ~md ~o
v~ ~ ~ ~ ~ ~ Prod
have ~ ~ ~ ~ ~ ~ ~ ~ ~'
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No. 2003-00527
Ruby N. Booth
June 19, 2003
Admin. No.
21-03-0527
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: Yes X; No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court? YesX;
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 X~
do
accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report.
Copies of receipts, releases, joinders and approvals of formal or informal
Date:
Signature
Name: Thomas E. Flower, EsqUire
I.D. No. 83993
SAIDIS, SI-lUFF, FLOWER &' LINDS~
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity: __ Personal Representative
X Counsel for Personal Representative