HomeMy WebLinkAbout03-0628 PETITION FOR GRANT OF LETTERS
Estate of EVELYN M. HUGHES No. ~- ~ 'O,..~ - ~
Also known as
Deceased Social Security No.
ll,fARGARET B. BROWN
189-18-6445
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioners are the executors named in the Last Will of
~ the Decedent, dated March 28, 1993 and codicil(s) dated
David G. Brown and Marqaret B. Brown named as Executor and Executrix under Will. David G. Brown died in October of
2000, therefore, Mar,qaret B. Brown will be the only Executrix
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 to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b.n,c.t.a.: pendente lite; durante absentia; durante minodtate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following
spouse (if any) and heirs:
Name Relationship
COMPLt: I ~- IN ALL CASES: Attach additional sheets if necessary.
Residence
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at
Manor Care Health Service, Camp Hill, Cumberland County, Pennsylvania
(List street, number and municipality)
Decedent, then 88 years of age, died June 25, 2003, at Manor Care Health Service, Camp Hill, Cumberland County, Pennsylvania
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ..................................................................... $ 16,000.00
(If not domiciled in PA) Personal property in Pennsylvania ..................................... $
(If not domiciled in PA) Personal property in County .................................................... $
Value of real estate in Pennsylvania ...................................................................................................................... $
Total ......................................................................................................... $ 16,000.00
Real Estate situated as follows:
Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature
Typed or printed name and residence
Margaret B. Brown
615 Harding Street
New Cumberland, PA 17070
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
Sworn to and affirmed and subscribed
Before me this i ,~J day of
The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the
Decedent, Petitioner will well and truly administer the estate according to law,
MARGARET B.' BROVV~I (
NO.
Estate of
EVELYN M. HUGHES
Social Security No: 189-18-6445
Deceased
Date of Death: June 25, 2003
AND NOW, 0J.L~' / ,2003, in consideration of the Petition on the reverse
side hereon, satisfactory I~oof having been presented before me,
IT IS DECREED that Letters [] Testamentary of Administration
d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate
are hereby granted to Mar.qaret B. Brown in the above estate and that the
instrument(s) dated March 28, 1993 and described in the Petition be admitted to probate and filed of
record as the last Will of the Decedent.
FEES
Letters ........................... $ ,.~C). ~
Short Certificate(s)
Renunciation ..............
Affidavit ( ) ..................
Extra Pages ( ) .......
Codicil ............................
JCP Fee .......................
Inventory ......................
Other ..............................
TOTAL .........
$
$ L,~ ¢0
$
Register of-V~s -
$ '7..2. oo
$ i6. oO Attorney: EDMUNDG. MYERS, ESQUIRE
$ I.D. No: 20558
$ Address: Johnson, Duffle, Stewart & Weidner,
301 Market Street, P.O. Box 109, Lemoyne, PA 17043-
Telephone: 717-761-4540
Register of Wills of Cumberland County, Pennsylvania
OATH OF SUBSCRIBING WITNESS
Estate of EVELYN M. HUGHES
Also known as
No.
, Deceased
CHARLIE A. CLEMENT SR.
a subscribing witness to the Will presented herewith, being duly qualified according to law, deposes and says that he
was present and saw the above Testatrix sign the same and that he signed as a witness at the request of Testatrix in
her presence in the presence of the other subscribing witness.
Charlie A. Clement, Sr.
1075-7 Lancaster Boulevard
Mechanicsburg, PA 17055
Sworn to or affirmed and subscribed
before me this 5~'11~ day of
Notary PubliC"'-
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
NOTE:
To be taken by officer authorized to
administer oaths. Please have
present the original or copy of
Instrument(s) at time of notarization.
:- ,...; ;~IAL SEAL i
DA:~. ',....SEMAN, Notary Public
NOTARIAL SEAL .er~'.'..' '" 5a~. Cumberland County
DANAL. WlESEMAN, Notary Public ,fy ~.. ,: .~ssion Expires Nov. 15,2004J
JLemoyne Boro. CumberlandCount~
Con~n Expires Nov. 15, 20~
Register of Wills of Cumberland County, Pennsylvania
OATH OF NON-SUBSCRIBING WITNESS
Estate of EVELYN M. HUGHES
Also known as
, Deceased
MARGARET B. BROWN
a subscriber hereto, being duly qualified according to law, deposes and says that she was familiar with the signature
of EVELYN M. HUGHES , testatrix of the Will presented herewith, and that such subscriber believes the
signature on the Will is in the handwriting of EVELYN M. HUGHES to the best of such subscriber's knowledge
and belief.
615 Harding Street
New Cumberland, PA 17070
Sworn to or affirmed and subscribed
before me this I~ day of
, 20 0--~
For the R~gist~tr ~.?i~t (,~.
his 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 fbr permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9267357
No.
iTEM #
SHOULD READ AS FOLLOWS:
Local Registrar
Date
4alley ~a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
: I i ~e . , 9 4 I Pottsville,PA l, ,~
~ce~m'~u~u~ ]~amp~,cZ[~N~s,ny~ Manor Care I,~~ ~.~. r,~}white
~:~) Secretarial Svcs. ~ ~ I ~~
~er ,,~. I,,. None
· ctu~ ,,.. ~. Pennsylvania ~ ,,~.~ ~.~
Nanor Care Health Service
Camp Hill,PA 17011 ~ ~. X Camp Hill
~ws,~u~ ~. u~.. t,,~ ,m.~ Cumberland
aret B. Bro~ ~~ [~. 615 Harding Street~ Ne~ Cumberland, PA 17070
~ ~"' ,,~. %Ap.~ 27, 2003 I",- Odd Fellows Cemetery L,,. nanoy ~p., S;~uylkill Co
~-'~'~' I~'.~ tl~ I°~ ~°~°°~~'°'~' ~'
I~-
. · .............................................. ~,,~.
............................................................
LAST WILL AND TESTAMENT
I, EVELYN M. HUGHES, presently of Harrisburg, Dauphin County,
Commonwealth of Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this to
be my Last Will and Testament in the manner as follows:
ITEM 1: I hereby annual and revoke any and all Wills and
Codicils by me at any time heretofore made.
ITEM 2: I hereby direct that my hereinafter named Executor
or Executrix shall pay all of my just debts, funeral expenses and
administration expenses as soon after my decease as it reasonably
convenient.
ITEM 3: I hereby direct that any and all succession, legancy,
inheritance, transfer, and estate taxes which are levied or assessed
upon any property which is included in my gross estate for the
purposes of any such tax shall be paid out of my estate by my
Executor or Executrix in the same manner as an administration
expense and shall not be prorated or apportioned among or charged
against my respective devisees, legatees or beneficiaries.
ITEM 4: I direct that my funeral and burial arrangements
shall be conducted by the Grace Methodist Church of Harrisburg,
Pennsylvania. I further direct that my interment shall be in the
Odd Fellows Cemetery of Shenandoah, PA in the North End Lot No.
29, Range 15. (Deed to cemetery lot is attached)
ITEM 5: The property at 2301 Kensington Street, Harrisburg,
Pennsylvania (Deed attached) is to be placed on sale, and sold at
the market value. Following the sale of the real estate and property,
including all household items all monies are to be added to my
residuary estate.
ITEM 6: I give, devise and bequeath from my residuary estate
as follows:
I give to Margaret B. Brown my diamond ring and diamond
watch, together with my furs and any other personal clothing
she may desire.
I give to Esther McCutheon my Persian fur jacket.
I give to Sue Machamer the china doll, the one which lies
on its side.
ITEM 7: I give and bequeath the sum of Five Thousand (5,000.00)
Dollars to be paid to Ben and Sue Machamer of Kensington Street,
Harrisburg, Pennsylvania for the kindness they have shown to me.
ITEM 8: I give and bequeath the sum of Two Thousand ($2,000.00)
Dollars to the Odd Fellows Cemetery of Shenandoah, PA for maintaining
the lot and for providing and placing of potted Geraniums on the
lot. Presently the lot is in perpetual care.
ITEM 9: The estate at the present time inclydes the
following:
1. A small life insurance policy with the Prudential
Insurance Company (Policy attached).
2. Two Certificates of Deposit (One Certificate for
$20,000 Dollars and another one for $15,000 Dollars) at the Harris
Savings Association, together with a savings account.
3. A $25,000 Certificate of Deposit with Corestates Bank,
together with a substantial amount in a checking account.
4. A $10,000 Certificate with Merrill Lynch Short-Term
Global Income Fund.
ITEM 10: I give, devise and bequeath all the rest,
residue and remainder of my estate, both real and personal, unto
David G. Brown and his wife, Margaret B. Brown.
ITEM 12: I hereby nominate, constitute and appoint David G.
Brown and Margaret B. Brown to be the Executor and Exectrix of
this my Last Will and Testament.
It is my further wish and desire that the aforenamed personal
representatives shall not be required to file a bond or other security
for the faithful performance of their duties.
IN WITNESS WHEREOF, i hereunto set my hand and seal to this
my Last Will and Testament this 28th day of March, 1993.
(SEAL)
Signed, sealed, published and declared to be the above named Testator,
as and for her Last Will and Testament, in the presence of us, who,
at her request, in the presence and in the presence of each other,
have subscribed our names as witnesses thereto.
'O3
LAST WILL AND
TESTAMENT
EVELYN M. HUGHES
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: EVELYN M. HUGHES
Date of Death: June 25, 2003
Will No: 21-03-0628
To the Register:
I certify that notice of estate administration as required by Rule 5.6(a) of the
Orphan's Court Rules was served on or mailed to the following testate and intestate
beneficiaries of the above-captioned estate on August 8, 2003.
Name
MARGARET B. BROWN
SUE MACHAMER
BEN MACHAMER
Esther McCutcheon
Odd Fellows Cemetery of
Shenandoah
Address
615 Harding Street
New Cumberland, PA 17070
2362 Kensington Street
Harrisburg, PA 17104
2362 Kensington Street
Harrisburg, PA 17104
2300 Kensington Street
Harrisburg, PA 17104
Ringtown Road
Shenandoah, PA 17976
.7:
Notice has nOw been given to all persons entitled thereto under Rule 5.6(a) except
NONE
Date: August 8, 2003 Signature
Name
Address
Telephone
Capacity:
EDMUND G. MYERS
Johnson, Duffie, Stewart & Weidner
301 Market Street
P.O. Box 109
Lemoyne, PA 17043-0109
(717) 761-4540
Personal Representative
X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA ~ 7128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD O03439
MYERS EDMUND G
301 MARKET STREET
P O BOX 109
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 189-18-6445
FILE NUMBER: 2103-0628
DECEDENT NAME: HUGHES EVELYN M
DATE OF PAYMENT: 01/14/2004
POSTMARK DATE: 01/1 3/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 06/25/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,975.11
TOTAL AMOUNT PAID:
$1,975.11
REMARKS'
SEAL
CHECK# 95
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV- 1500 EX + (6-00)
CAPB
~pRL
~10
~AC
~TK
Co"
R
E
C
A
P
I
T
U
L
A
T
I
O
N
C
0
M
T
0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURI
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HUGHES Evelyn M.
DATE OF DEATH (MM-DD-YEAR) [ DATE OF BIRTH (MM-DD-YEAR)
06/25/2003 I 12/06/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21-03-0628
COU NTT CODE YEAR N U M B ER
SOCIAL SECURITY NUMBER
189-18-6445
THIS RETURN MUST BE FILED IN DUPLICATEWITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(date of death
3. Remainder Return prior to 12-13~82)
5. Federal EstateTax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach ScL O)
~ 1. Original Return ~ ,47! Supplemental Return.
4. Limited Estate . Future Interest Compromise (date of death after 1;~- 1;'-8;>
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
~-]9. Litigation Proceeds Received [~]10. Spousal Poverty Credit
(date of death between lZ-31-91 and 1-1-95)
NAME
Edmund G. Myers
FIRM NAME (If Applicable)
Johnson, Duffie, Stewart & Weidner
TELEPHONE NUMBER
717/761.-4540
1. Real Estate (Schedule A) (i)'
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
---] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
COMPLETE MAILING ADDRESS
P. O. Box 109
301 Market Street
Lemoyne, PA 17043-0109
None
None
None
None
17,974.48
None
None
2,346.55
460.52
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
OFIEICIAL USE ONLY
(8) 17,974.48
(11) 2,807.07
(12) 15,167.41
(13) 2 ~ 000. O0
(14) 13,167.41
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X .0 0
0.00 X .0 45
X .12
13,167.41 x .15
(15) 0.00
(16) 0.00
(17) 0.00
(18) 1,975.11
(19) 1,975.11
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
Manor Care Health Services
CITY
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE I ZIP
PA 17011
(1)
Total Credits ( A + B + C ) (2)
1,975.11
3. Interest/Penalty if applicable 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 recluest a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
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 ife of either a Tents benefts or care?
P Y ....................
2. If death occurred affer 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 penaltiesof perjury, 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,
0.00
0.00
0.00
i,975.11
0.00
1,975.].1
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 FILING RETURN Hargaret $. BRO~ DATE
) .-~,.// / .~, ~ 615 Hardin~ Street /
/ l'
SIGN~EOFPR~AREROTHERTHANREPRESENTATIVff Johnson, Duffie, Stewart & Weidner DA~E~
' ~ P.O. Box 109
For dates of death om or after July 1, 1994 and before Janua~ 1 1995, the tax rate imposed on the net value of transfers to or for the use
survMm9 spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. the
For dates of death om or after .January 1, 1995, the tax rate imposed om the net value of transfers to or for the use of the surviving spouse is 0%o
[72 P.S. 9116 (a) (1.1) (}i)]. The statute does mot exempt a transfer to a survivin~ spouse from tax, amd the statutory requirements for d~sclosure of assets
and fi~im9 a tax return are still applicable even if the survivin~ spouse is the only beneficial.
For dates of death om or after July 1, 2000:
The tax rate imposed on the net vaJue of transfers from a deceased child twenty-one years of age or younger at death to or for the use o~ a natural
parent, am adoptive parent or a stepparent of the child is 0% [7~ P.S. 9116 (a) (1.2)$
The tax rate imposed om the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
The tax rate imposed on the met vaJue of transfers to or for the use of the decede,t's siblings Js 12~/o [72 P.S. 9116(a)(1.3)]. A siblin9 ~s defer]ed, under
Section 9102, as an individual who has at least ode parent in common with the decedent, whether by blood or adoption.
Copyright (c) ~O00 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
RE'V- 1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
HUGHES SS# 189-18-6445 06/25/2003
FILE NUMBER
21-03-0628
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
2
DESCRIPTION
HCR-ManorCare Refund of Nursing Home Account
Highmark Blue Shield Refund received for unused portion of the
Pennsylvania Blue Shield Premium Payment
Parthemore Funeral Home & Cremation Services, Inc. Refund of
Overpayment on Account
Wachovia Bank, N.A. Checking Account No. 1000613116296. Opened
1/2/1950
Accrued income on item 4 through date of death
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
997.78
222.03
92.66
16,658.79
3.22
$ 17,974.48
(If more space is needed, insert additional sheets of the same size)
Copyright(c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
R~V-~S~ EX ,(~-gT/ SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
Evelyn M. t4UGHES SS~/ 189-18-6445 06/25/2003
FIlE NUMBER
21-03-0628
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
2
3
4
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Har~aret B. BROWN
Social Security Number(s) / EIN Number of Personal Representativel
Street Address 615 Hardin~ Street
City New Cumberland. State PA
Zip 17070
Year(s) Commission Paid:
Attorney's Fees Johnson, Duffle, Stewart & Weidner
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountanfs Fees
'Tax Return Preparer's Fees
Other Administrative Costs
Cumberland County Register of Wills Office - Filing Fees for
Inheritance Tax Return and Inventory
Reserves for Additional Estate Administration Costs
The Cumberland Law Journal - Notice of Estate Administration
The Patriot News - Notice of Estate Administration
898.00
750.00
72.00
28. O0
400.00
75.00
123.55
TOTAL (Also enter on line 9, Recapitulation) $ 2,346.55
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc, Farm REV- 1511 EX (Rev, 1-97)
R~V-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M. HUGHES SS~/
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
189-18- 6445 06/25/2003
FILE NUMBER
21-03-0628
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
M&T Bank Fee
M&T Bank Fee
M&T Bank Fee
Neighbor Care
Neighbor Care
Estate Check Fee
Estate Check Fee
- Check Clearing After Date
Pharmacy
of Death
AMOUNT
1.00
1.00
1.00
94 . 95
362.57
TOTAL (Also enter on line 10, Recapitulation)
460.52
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1512 EX (Rev. 1-97,
REV-~1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn M. HUGHES SS# 189-18-6445
SCHEDULE J
BENEFICIARIES
06/25/2003
FILENUMBER
21-03-0628
NUMBER
II.
1
NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116~)(1
Margaret B. Brown
615 Harding Street
New Cumberland, PA 17070
Benjamin & Sue Machamer
2362 Kensington Street
Harrisburg, PA 17104
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Friend
Friend
AMOUNT OR SHARE
OF ESTATE
Res idue
5,000.00
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Odd Fellows Cemetery of Shenandoah, PA
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
21000. O0
2,000.00
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1513 EX
LISTING OF EXHIBITS FOR
ES T~4 T E
OF
EVELYN M. HUGHES
EXHIBIT A
Last Will and Testament of Evelyn M. Hughes signed
and dated on the 28th day of March, 1993.
EXHIBIT A
LAST WILL AND TESTAMENT
I, EVELYN M. HUGHES, presently of Harrisburg, Dauphin County,
Commonwealth of Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this to
be my Last Will and Testament in the manner as follows:
ITEM 1: I hereby annual and revoke any and all Wills and
Codicils by me at any time heretofore made.
ITEM 2: I hereby direct that my hereinafter named Executor
or Executrix shall pay all of my just debts, funeral expenses and
administration expenses as soon after my decease as it reasonably
convenient.
ITEM 3: I hereby direct that any and all succession, legancy,
inheritance, transfer, and estate taxes which are levied or assessed
upon any property which is included in my gross estate for the
purposes of any such tax shall be paid out of my estate by my
Executor or Executrix in the same manner as an administration
expense and shall not be prorated or apportioned among or charged
against my respective devisees, legatees or beneficiaries.
ITEM 4: I direct that my funeral and burial arrangements
shall be conducted by the Grace Methodist Church of Harrisburg,
Pennsylvania. I further direct that my interment shall be in the
Odd Fellows Cemetery of Shenandoah, PA in the North End Lot No.
29, Range 15. (Deed to cemetery lot is attached)
ITEM 5: The property at 2301 Kensington Street, ~arrisburg,
Pennsylvania (Deed attached) is to be placed on sale, and sold at
the market value. Following the sale of the real estate and property,
including all household items all monies are to be added to my
residuary estate.
ITEM 6: I give, devise and bequeath from my residuary estate
as follows:
I give to Margaret B. Brown my diamond ring and diamond
watch, together with my furs and any other personal clothing
she may desire.
I give to Esther McCutheon my Persian fur jacket.
I give to Sue Machamer the china doll, the one which lies
on its side.
.ITEM 7: I give and bequeath the sum of Five Thousand (5,000.00)
Dollars to be paid to Ben and Sue Machamer of Kensington Street,
Harrisburg, Pennsylvania for the kindness they have shown to me.
ITEM 8: I give and bequeath the sum of Two Thousand ($2,000.00)
Dollars to the Odd Fellows Cemetery of Shenandoah, PA for maintaining
the lot and for providing and placing of potted Geraniums on the
lot. Presently the lot is in perpetual care.
ITEM 9: The estate at the present time inclydes the
following:
1. A small life insurance policy with the Prudential
Insurance Company (Policy attached).
2. Two Certificates of Deposit (One Certificate for
$20,000 Dollars and another one for $15,000 Dollars) at the Harris
Savings Association, together with a savings account.
3. A $25,000 Certificate of Deposit with Corestates Bank,
together with a substantial amount in a checking account.
4. A $10,000 Certificate with Merrill Lynch Short-Term
Global Income Fund.
ITEM 10: I give, devise and bequeath all the rest,
residue and remainder of my estate, both real and personal, unto
David G. Brown and his wife, Margaret B. Brown.
ITEM 1.2: I hereby nominate, constitute and appoint David G.
Brown and Margaret B. Brown to be the Executor and Exectrix of
this my Last Will and Testament.
It is my further wish and desire that the aforenamed personal
representatives shall not be required to file a bond or other security
for the faithful performance of their duties.
IN WITNESS WHEREOF, i hereunto set my hand and seal to this
my Last Will and Testament this 28th day of March, 1993.
(SEAL)
Signed, sealed, published and declared to be the above named Testator,
as and f~r her Last Will and Testament, in the presence of us, who,
at her request, in the presence and in the presence of each other,
have subscribed our names as witnesses thereto.
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estate of Evelyn M. HUGHES
a~so known as
, Deceased
No. 2003-00628
Date of Death 06/25/2003
Social Security No. ]-89-18- 6445
Margaret B. BROWN,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subiect to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
I.D. No.:
Edmund G. Myers
20558
Personal Representative
Signature: //' c~ZI~ ~_~, /~~ j
Margar~ B. ~ROWN ~
Signature:
Address: 13. O. Box 109 Address: 615 Hardin~;. Street
Lemoyme, PA 17043-0109 New Cumberland, PA 17070
Telephone: 717/761- 4540 Telephone: 717/774- 6841
Dated:
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Value
Total: 17,974.48
;WOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form #RW-7 (1992)
Estate of:
Date of Death:
County:
INVENTORY
Evelyn M. HUGHES
06/25/2003
Cumberland
CASH:
HCR-ManorCare - Refund of
Nursing Home Account
Highmark Blue Shield - Refund
received for unused portion
of the Pennsylvania Blue
Shield Premium Payment
Parthemore Funeral Home &
Cremation Services, Inc.
Refund of Overpayment on
Account
Wachovia Bank, N.A. Checking
Account No. 1000613116296.
Opened 1/2/1950
Accrued income through date of
death
997.78
222.03
92.66
16,658.79
3.22
TOTAL RECEIPTS OF PRINCIPAL ...............
17,974.48
17,974.48
-1-
BUREAU OF INDZV/DUAL TAXES
ZNHERITANCE TAX DZVISZON
DEPT. Z8060!
HARRTSBURG, PA 171Z8-060!
COHNONWEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTZCE OF ZNHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
EDHUND G MYERS
JOHNSON ETAL
PO BOX 109 C~;'i: L, od~t
LEHOYNE PA 170~$ ~til~Ub/=&;'~d Co., PA
~ p~Tg? os-ol-zOO4
...... ~? ~,F~r,3~TE OF HUGHES
DATE OF DEATH 06-Z5-ZOOS
FZLE NUNDER 21 05-0628
'04 FEB 27 ;P~ CUHBERLAND
ACN 101
Aeount
REV-l~47 EX AFP (B1-05)
EVELYN M
MAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGZSTER OF WTLLS
CUMBERLAND CO COURT HOUSE
CARLZSLE, PA 17015
CUT ALONG THZS LZNE I~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF HUGHES EVELYN MFZLE NO. 21 05-0628 ACN 101 DATE 03-01-2004
TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORZGZNAL RETURN
1. Reel Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Zntarest (Schedule C) ($)
q. Nortgagas/Notas Receivable (Schedule D)
5. Cash/Bank Deposits~Misc. Personal Property (Schedule E)
6. JointZy Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXENPTZONS:
9. FuneraZ Expenses/Ada. Costs/H1sc. Expanses (Schedule H) (9)
10. Debts/Hortgege L~abilities/Liens (Schedule Z) (10)
11. Total Deductions
12. Nat Value of Tax Return
17~,974.48
.00
.00 NOTE: To insure proper
.00 credit ~o your account,
.00 subeit the upper portion
.00 of thLs fore ~ith your
tax payeant.
.o0
(8)
2,346.55
15.
NOTE:
17,974.48
460.52
(zz) 2.807.07
(12) 15,167.41
Z,O00.O0
15,167.41
AHOUNT PAZD
1,975.11
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ~NTEREST.
(15) .00 x O0 = .00
(16) .00 x 045= .00
(17) . O0 x 12 = .00
(~8) 15,167.41 x 15 = 1,975.11
(zg)= 1,975.11
1,975.11
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT 1S RE~UZRED.
IF TOTAL DUE 1S REFLECTED AS A "CRED/T' (CR), YOU NAY BE DUE L
A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTZONS.
ASSESSNENT OF TAX:
15. Aeount of L/ne lq ak Spousal rata
16. Aeount of Line 1~ taxable ak Lineal/Class A rake
17. Amount of Line 1~ at Sibling rata
18. Aeount of Line lq taxable ak Collateral/Class B rake
19. Princi~a! Tax Due
[AX CREDZTS:
PAYNENT RECE/PT DZ$COUNT
DATE NUHBER ZNTEREST/PEN PAZD (-)
01-13-2004 CD003459 .00
Cheritable/Governeentel Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Subject ko Tax (lq)
]:t: an assessment Nas lssued previously, 1lees 1~, 15 and/or 16, 17,
reflect figures that lnclude the total of ALL returns assessed to date.
18 and 19 will
RESERVATION:
Estates of decadents dying on or before December 12) 198Z -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for
life or for years) the Coaaonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S.
Section 91qO).
Detach the top portion of this Notice and submit eith your payment to the Register of Nills printed an the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, ehich ems not requested on the Tax Return) may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Nills) any of the Z3 Revenue District Offices, or by calling the special Iq-hour
answering service for forms ordering: 1-800-362-Z050; services for taxpayers aith special hearing and / or
speaking needs: 1-800-q47-30ZO (TT only).
Any party in interest not satisfied aith the appraisement, alloeance, or disallowance of deductions) or assessment
of tax (including discount or interest) as shown on this Notice must abject within sixty (603 days of receipt of
this Notice by:
--erittan protest to the PA Department of Revenue) Board of Appeals, Dept. ZBiOZ1, Harrisburg) PA 17lIB-lOg1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue)
Bureau of Individual Taxes, ATTN: Post Assessment Raviea Unit, Dept. Z80601) Harrisburg, PA 17lIB-g601
Phone (717) 787-6S05. See 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 decadant's death, a five percent (SI) discount of
the tax paid is alloaad.
The 1SI 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 same tiaa period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death) to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
19BI ZOZ .OOOSq8 1987 9Z .000247 1999 7Z .O0019Z
1983 16Z .000438 1988-1991 llZ .000301 ZOO0 8Z .O00Zl9
1984 llZ .000301 199Z 9Z .000Z47 2001 9Z .000Z47
1985 132 .000356 1993-1994 7Z .00019Z ZOOZ 6Z .000164
1966 102 .000274 1995-199B 9Z .000247 2003 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAXD X NUI~BER OF DAYS DELTNQUENT X DATLy TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days
beyond the date of the assessment. If payment is made after the interest computation data shown an the
Notice, additional interest must be calculated.
JERRY R. DUFFLE
RICHARD W. STEWART
C. ROY WEIDNER, JR.
EDMUND G. MYERS
DAVID W. DELUCE
RALPH H. WRIGHT, JR.
MARK C. DUFFIE
MICHAEL J. CASSIDY
MELISSA PEEL GREEVY
ROBERT M. WALKER
WADE D. MANLEY
LAW OFFICES
JOHNSON, DUFFIE, STEWART & WEIDNER
A Professional Corporation
301 MARKET STREET
P.O. BOX 109
LEMOYNE, PENNSYLVANIA 17043-0109
WEBSITE: www. idsw.com
HORACE A. JOHNSON
COUNSEL TO THE FIRM
TELEPHONE 71%761-4540
FACSIMILE 717-761-3015
E-MAIL: mail~jdsw.com
WRITER'S EXT. NO. 114
E-MAIL dlw@jdsw.com
May14,2004
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Estate of Evelyn M. Hughes
File No. 2003-00628
Our File No. 013385-1
Dear Register:
Enclosed please find a Status Report for the above referenced Estate. Should you have
any questions, or require any additional information, please feel free to contact the undersigned.
Very truly yours,
JOHNSON, DUFFLE, STEWART & WEIDNER
Dana L. Wieseman
Legal Assistant
:228994
Margaret Brown, Executrix
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.
EVELYN M. HUGHES
June 25, 2004
21-2003-00628
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, 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?
Yes No X
b. The separate Orphans' Court No. (if any) for the personal
representative's Account is:
parties of interest?
Did the personal representative state an account informally to the
Yes X No
Executrix was sole beneficiary
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
Date: May~4, 2004
>-.
JOHNSON, DUFFIE, STEWART & WEIDNER
301 Market Street
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
Capacity: ~Personal Representative
(x) Counsel for Personal
Representative