HomeMy WebLinkAbout10-27-09IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUTNY, PENSYLVANIA
ORPHANS' COURT DIVISION
NO. a~_ D~- ~~77
ESTATE OF
MARGARET KOIS
PETITION UNDER SECTION 3102
OF THE PROBATE. ESTATES AND FIDUCIARIES
CODE FOR THE SETTLEMENT OF A SMALL ESTATE
TO THE HONORABLE JUDGES OF SAID COURT:
1. Your Petitioner, Larry S. Rankin, whose address is 1114 Hillside Drive,
Carlisle, PA 17013, is an adult individual and the one (1) and only surviving nephew of
Margaret Kois, deceased on May 27, 2008, Social Security Number 211-07-8426.
2. The Decedent, Margaret Kois, was born on January 25, 1911 and was 97 years
of age at the time of death. Her residence was Thornwald Home located at 442 Walnut
Bottom Rd., Cazlisle, PA 17013. She was a single woman at the time of her death.
3. The Decedent's sister, Elizabeth Rankin is residing in a nursing home and
therefore the Decedent's sole heir as set forth in her Last Will and Testament, a true and
correct copy of which is attached hereto and incorporated as Exhibit "A", is her sister's
son, Larry S. Rankin, who has signed this Petition. He is identified as follows:
4. Lany S. Rankin was nominated in Decedent's Last Will and Testament as
Executor.
5. The Decedent's sole assets worth approximately $5,821.88 are listed as
follows:
checking account with M&T Bank (#12454591) in the amount of $5,154.35, plus
interest;
premium refund in the amount of $96.12 from the Comptroller State of New
York;
lump sum benefit in the amount of $182.76 from the New York State and Local
Retirement System; and
insurance refund in the amount of $388.65 from Blue Cross Blue Shield of
Western New York.
6. Decedent had been receiving medical assistance from the Department of
Public Welfare in connection with her residing at a skilled nursing facility prior to her
death. The Department has agreed to accept $4,771.88, plus interest on checking
account, as payment in full. A letter of acceptance from the Department of Public
Welfare is attached hereto as Exhibit "B" and is incorporated by reference.
7. The Petitioner made an estimated inheritance tax payment in the amount of
$750.00. The Petitioner filed a Pennsylvania Inheritance Tax Return and has received
acceptance of the return. A refund in the amount of $750.00 is due the estate and the
Petitioner will be reimbursed for said tax payment. The copy of the return and the
response from the Department of Revenue are attached hereto as Exhibits "C" and "D."
8. It is requested that the assets of the Decedent be turned over to the Petitioner to
pay the administration expenses and make distribution as follows:
administrative expenses, reimburse Petitioner for inheritance tax paid and the
balance to the Department of Public Welfare.
WHEREFORE, Your Petitioner prays that an Order be made authorizing
distribution of the accounts as set forth in the foregoing to Petitioner for him to apply
against the expenses of administration and debts.
fric~a D. Naylor, E,t;gi
I.D. #83760
104 S. Hanover Street
Carlisle, PA 17013
(717)243-7437
Attorney for Petitioner
VERIFICATION
I verify that the statements made in the foregoing Petition are true and correct. [
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904 relating to unsworn falsification to authorities.
~~,~ ~~ ~,
CONSENT
The undersigned acknowledge, pursuant to the penalties of 18 Pa.C.S.A Section
4904 relating to unsworn falsification to authorities, that he is the sole heir of the Estate
of Margaret Kois; that he is an adult; that the statements made in the Petition filed by
Tricia D. Naylor, Esquire are true and con•ect to the best of their knowledge, information
and belief; that he concurs and consents to the proposed distribution to himself.
WITNESS:
DATE a
JOS.RQ• REV (01/0'1)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
+ WARNING: It Is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 I,,,a`tls~ ~~. This is to certify that the information here given is
~~~EP TN OF pF~y~` correctly copied from an original Certificate of Death
r~ duly filed with me as Local Registraz. The original
~ certificate will be forwazded [o the State Vital
_~ 5 Records Office for permanent filing.
P 14528961 -='
~g9rMFNT OE?E?~~ , ~ 2 8 2(Ml8
Certification Number Local Registraz Date Issued
RIMY lpV ll/AY
1vPE~~
nucxYrc
qb
7
COMMONWEALTN OF PENNSYLVANIA • DEPARTMENT OF NEALTN • VRAL RECORDS
CERTIFlCATE OF DEATH
(SaY ImHmctlon• a,M sxembr~ Yn nv.rrl
I.NYbd r•nPI R11Y ae.. bR.PM s.sY bsbrmarPwlba o' ~•'•C ^u bwbao.Y lbaY. M: nn
Margaret Roie
Female 211 - 07 - 8426 May 27, 2008
bq NaBMgry IAtlw1 LLdrl 0.MYaBM ]. aa,YbR r. gDYlli ae)
97 a. "°" Y" 'awe aaY
January 25, 1911 3choleroi, PA
rq
^IYbMtl ^anrawrP Dow QYPbp xma ^wbr.a ^onar~r.by
®. CaaYa C•0.n rpAl Boa hy.a0•W rPRiN IW. MnVaNYn.WY•b NnaaA P.Nb O•WnAaIMPaeCM] 9Y ^Yb tY.Rn:MYa, bYn.BtrA. NTb.Pb
Cumberland Carlisle Thornwald Houle 1"Y.Yw~ae. 1•`P•YA
11.OUYT,YW qMb• mYq r.NigYY IL WYDxaWx•w FN• IL OgbnY•FYOnm InW~YaP/BMbR m.Yrj 1,.I.W db',MVM.HmeI.Mr, 16.9^Mq.'BR.••IR NS.WmYln iwml
pbtl WaY NaaBYr•/ UA.bmq FVa•t
nYY
V ^M ®,b Yanabrv] 1BP ~YnIR19 ~a•T IN RbrI
Homeaeker OWII Hpae
I0. 0.oYfP YF] /Y1~ IHetl bl/ / 4•A aa. Q myl OwM1w
°tl
°"s
1114 Hillside Ih. w.+rRrYa Ia aY PA u
Y n:
In,®r.
omxlwb [`~+rliele
,
~
Carlisle PA 17013 1>a wPq Cumberland T0M1bMp9 ,rap wo.aa-,ue„rp
n PwnxY.6M.nrb `baYn requwd dsrme
Y. YYmf Mb W K ael, mlw enYnl
Victoria Ma c
TY.MbnYl•IYw IR9P/Pang
xm rmmbn Y+b •m.. mYt M I km, nw yl mbl
Jean Rankin 1114 Hillside lh., Carlisle PA 17013
sib gbaeamPYbwl ^o,arm ^omam sib oaanbmna BYa. Y]~wt nblma
0.amam Orbtl YYYFbY~bYRYYPb1 sib lPYUnid//brm.wb>bmnM
p
RYmllmm 6w
^a
., ~
wq°~r""'ml.l.r°e"rwm.rB"'°a°prYOw JBm@ 3, ZOOH Holy Croee CeBetary Lackawanna, NY
ffi gPaYa OYM YbaY Ib0.•Irbr Yr.1YmWMS•YgF0.1Y
- ~ Hoffman-Roth Funeral Home & Crematory
0 3144E 219 N. Hanover Ca lisle PA 17013
rmsasaF.limaMr
ggYYllamnYwaaYamnb ffimr am]bb.wpn,wb ®.Yaarmgarrgenwb
IV•Il.rlrl
sL.lYane Mnba
9e C•Y nbYn YaM. M1Y.MM
gY]..ae.b S' I~N.$SS43(.~ s~a~~acor
rbrYmYr R1ryiY1 GrWRn &irea RYN .UY IMUIn 0.M1~ 91.WY fs Vrntlblb'afiunM/CVga
ar RRYns Y.n
~
?
' lanRYnon pYlMCmMma~ulsni
J
o
PY.
~ 0 ^Y. ~rY
wIRP:oPbuTll a.. rbualRl.rle MYRaan rr,Y PYR 61ralY
YYYA
Xmfl.MI: 6YrIhhdOL1-dYY41MIYtlmRY0.r0.-YYJigla.nrblR D]~YmNMY UTYnNYmM
i
XCp ]wno U•QMbbb G•T}
.
RYI
b WYI rMlwigF
agpxµgYnsrFFNI
abBMYCaYYanblpPw.rrwYRaYYn~,,WOY/wmsm YT Fa X14 QPrtl10.'
p
~
/
~bl !
n
p
,R
awwrenbBn. b
r0 (a,.,,,b _
y~.INAy~~YBybr
B :
Q
q RBFY•Yraww
tl
a
s~
~
YMYaR111CGtYn pbbly YnmlYRYm q:
y
M ~.YtlI^.Y~I LS0.L ^ROla9Y+
M
PRwBwnBP
qb,N ~
b(a YBmRPPIRnaI: ^ IapYM,rpIP'HYYabI'~
0.
I n1bBE•YI
lbbwn PNNgWYir Mlm
Ab ~ Zm.~~RMgI d1.1rsg0YN 9.IYYa MFIIb'4 M. W1 1d.C~bHw IHW QwM
~ ffi~
~PYbrv.
Qlw.a ^xnrb
aaraowr am
^YY ~NO ^1L ^W ^,mY, QPRNgsreY,ya mml]Ima%W eb.sMYaY.tln msTY4aYnm M414dY1 ss4labRnalM'IYYt W lbn. ml
^rr. ^wYYlYOaw.n
x ^w Ow ^uwrmaw ^PP~Ipr OP•wM
. pm. ~.
9b Cnr ICp RMaal
.Wn. SggY•rTn• CRw~
• s~mA0PM+11m IPn~ruYagysgaranYb YYi aabxpryabnMpwbaaa.brmmwYYa L4 )'
n
nrera.Rrwr.,rlem.,.eybrwyyr..a..w•L____________ ~
_____ '
- - `"I//
'
_______________
~wlrsahbltltlYlnn's~+OOa RRbffi9BBMrmBAB9b~a~
'
p
NrsrP.WNgsmrYrIM MRNPb NMblrta•IPINwwrYMYL ^ BM Ib
. XUrdR fn CnsV•B M. NA
• WuIMrIC•rw
GMO
Ya
b p
6 ~ ~ ~~ Q
Y
vw
.alrlapnN.pyhaf AMPq MImPm]YrrRY-rwY,rwbrgbabrY,M1.Yabd ^ G
M.XnnM aPan~@a Gryirw0.~aa•ailnm t]I ]W/P
~ mpp~~aa tt N+ Dar...ets.~.d
~~ oa Pw lYbY,eY YN
- N• GU_C7i~ I2.I l ld l 1 10 1 ~ E
aN TS
o
A~T~ n s/
rPRRm naa w. Oaf"I ~}`d
LAST WILL AND TESTAMENT
MARGARET KOIS
I, MARGARET KOIS, presently residing in Cumberland County, Pennsylvania, being of
sound and disposing mind and memory, and not acting under duress, mace, fraud or
undue influence of any person whomever, do make, publish and declare this to be My
Last Will and Testamrent, and I do hereby expressly revoke all other Wills, Codicils to
Wills, and testar-rentary writings heretofore made by me.
FIRST: I direct that all my legally enforceable debts and my funeral and
testamentary expenses be paid as soon as practicable after my death.
SECOND: I give, devise and bequeath all the rest, residue and remainder of
my property, real or personal, and wheresoever situated at the time of my death, to my
sister, ELIZABETH RANKIN, presently residing at 8 Strawberry Drive, Carlisle, PA
17013.
Provided however, if at the time of my death my said sister ELIZABETH
RANKIN has praleceased me or sire is residing is a nursing home or any kind of assisted
living facility then I give, devise and bequeath all of the rest, residue and remainder of
my property, real or personal, and wheresoever situated at the time of my death to my
said sister's son, LARRY S. RANKIN.
THIRD: I nominate, constitute and appoint my said nephew, LARRY S.
RANKIN, Executor of this My Last Will and Testament, without bond or security, and
with full power to sell, mortgage, lease and convey any and all property by me owned. In
the event LARRY S. RANKIN shall not survive me or shall fail to qualify, die, resign or
refuse to act as such Executor or be otherwise incapacitated, I nominate, constitute and
appoint JOHN C. OSZUSTOWICZ, Executor.
FOURTH: All estate, inheritance, transfer, legacy, succession and other death
taxes of any nature, payable by reason of my death, wh~h may be assessed or imposed
upon or with respect to property passing under this Will or property not passing under
this Will, shall be paid out of my estate as an expense of administration, and m part of
said taxes shall be apportioned or prorated to any legatee or divide under this Will or any
person owning or receiving any property not passing under this Will.
FIFTH: Any person who shall die at the same time as I, or in a comrr~n
disaster with me, or under such circumstances that it is difficult or impossible to
determine which died first, shall be deemed to have predeceased me.
.~ .~
IN WITNESS WHEREOF, I have set my hand and seal to this Will, which
consists of this aar~ two other typewritten pages, each of which bears my initials in the
margin, this _~ day of ~ ~~-yb 2 r , ?003.
Margaret Ko'
The preceding instrument, consisting of this and two other typewritten pages, was on the
day and date thereof signed, published and dec)m~ed by Margaret Kois, the testatrix
therein named, as and for her last Will, in the presence of us, who, at her request, in her
presence abe in the presence of each other, subscribed our names as witnesses hereto.
l~Q.-~ lJl. /CCc_,-L~ n Of IIl7 AiCI~~IG~~ llii /',e /i.ifi. ~/7
'~~~ n4.n.Pf,JS Of ~Yh%~ Ir~a~i2t.(f 73~~~n ~(~, ~/Z /,S~e~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIASIL ITV
ESTATE RECOVERY PROGRAM
PO 80X 5488
HARRISBURG, PA 17105-5456
February 24, 2009
TRICIA D NAYLOR ESQUIRE
109 S HANOVER STREET
CARLISLE PA 17013
Re: MARGARET KOIS
CIS #: 990394393
SSN: 211-07-8426
Date of Death: 05/27/2008
Dear Attorney Naylor:
I am in receipt of your correspondence dated February 23, 2009
regarding the above-referenced estate.
The Department has reviewed the information presented and agrees with
the accounting of the estate. Please notify us of any change in
circumstances as they may change this agreement.
Thank you for your cooperation in this matter. If you have any
questions, please contact me.
Sincerely,
~vUL'Gf'wd.r ~~~A'N'`Q1.
Barbara I. Aschenbrenner
TPL Program Investigator
717-772-6617
717-772-6553 FAX
LA W OFFICE
TRICIA D. NAYLOR
104 SOUTH HANOVER STREET. CARLISLE, PA 17013
DATE:
To:
COMPANY:
FAX NUMBER:
FROM:
RE:
MESSAGE:
TELEPHONE:
02/23/09
243-7437 • FAX: (717) 258-8379
Barbara I. Aschenbrenner
Department of Public Welfare
717-772-6553
Tricia D. Naylor
Margaret Kois
CIS# 990394393
Dear Ms. Aschenbrenner:
Attached please find the inheritance tax return for the above decedent. I am filing a small estates petition
with the court once I receive acceptance from the Department of Revenue of the attached inheritance tax
return.
I propose to distribute the net of the decedent's assets to the Department of Welfare after administrative
expenses and executor and attorney fees are paid. 1'he decedent's assets are approximately $5,821.88
minus executor fee of $300.00 and attorney f'ee of $750.00 leaves a balance of $4,771.88, plus interest.
There will also be filing fees for the small estates petition and inheritance tax return to be paid.
Please confirm that distribution of the balance of the decedent's assets after administrative expenses and
executor and attorney fees have been paid is acceptable to you.
Thank you,
Tricia D. Naylor
# OF PAGES INCLUDING COVER SHEET 7
This fax transmission, including any a[tachments, may con[ain confidential information prutec[ed by auurney-client ut• other
lega/Privilege. Unauthorized use, distribution or copying is prohibited /f you received this Jax !n error, please notify the
sender and then destroy the erroneous transmission.
15056051058
REV-1500 EX (08-05)
PA Deperunent of Revenue OFFICIAL USE ONLY
Bureau of IMivitlual Tazea County Code year Fqe Number
Po Box 23oeo1 INHERITANCE TAX RETURN
HardsDUry, PA 17123-0601 RESIDENT DECEDENT %-'1 08 0877
ENTER DECEDENT INFORMATION BELOW
social Security Number Oate o1 Death Date of Birth
211-07.8426 05/27/2008 01/25/1911
Decetlent's Last Name SuHiz De;:edenrs Fus1 Name MI
Kois Margaret
IN ADPlicable) Enter Surviving Spouse's Information Bel ow
Spouses Last Nama Sulr~x Spouses Rrsl Na
me MI
Spouse's Social Security Number
THIS RETURN MUBT BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
t. Original Return 2. SuDPlemental Rslurn 3 Remaintler Return (date of tleam
9. Limiletl Estate prior to 12-t3-82)
4a. Future Intarasl Compromise (tlale of 5. Fetleral Eslale Taz Return Repuiretl
tlealh after 12.12.82)
6. Decotlent Died Testate
(AUacn Copy of Will) T. Decedent Mainreinetl a Living Trust B. Total Number of Safe Deposit Boxes
(Atlacn Copy of Trusp
9. Litigation Proceetls Received 10. Spousal Poverty Cretlit (date of tlealn 11. Election to lax under Sec. 9t13(A)
trolwean 12.31-Bt entl t-1•g5) (Attach Scn. Oj
CORRESPONDENT - THIS SECTION MUST SE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0
Na
me :
Dayume Telephone Number
Tricia D. Naylor
(7'. 7) 243.7a37
Firm Name (If AppLCable)
Law Office of ""'r (~ I ~ ~ • p
IDY IG Grllr!t !Jr W,..: s JS VNIv
-
~
First line of address
104 S. Hanover Street O
0
1
T
Second line of etltlress _
_
.
r'-~ ~'1 Fig i l•7
City a Posl OKCe
Canisie
correspondents email address: tnaylor@carlislepalaw.corr
Unoar penalDes of penury, l tladare Ihel I have examinetl Nit return, aWUdinq
it is true, mrtea ono COmpIBIe. Dedan111on of preparer Other Nan Ilea person
SIGN TVRE OF PERSON RESP SIBLE FOR fILING RETURN
ADDRESS
111 Hillsid Drive, Carlisle, PA 17013
SIG OF p ROT ER AN REPRESENTATIVE
104 $. Hanover StrgE?f, Ca , PA 17013
I_ 15056051058
-=ice f*i G', C7
~~ W t ~'
1
]
'2
-..-" ~ ~ ~ ~ C
_
,
r-
State ZIP Code }:StW~i aTnu ,
~
.
~
7
PA 17013 '~~~ 3 ~4~
_
~ ~~
~ _
y N ~,:~,
w
.pmperrying edle(luka entl aWNTeDt;. and ID Ina Daal pf my kilpwledge 80tl DNNI
rprownlalive is Dasad on all imormalum of which prepargl has any knowledge. .
DATE
y/z s/o q
DATE
~~~a~
Side 1
I :>ustlus I uss
]5056052059
REV-1500 EX
7ecedenl's Social Severity Number
Deceaenrs r4ame: Margaret Kois
271-07-8426
RECAPITULATION
1 Real estate (Schedule A).
..
1.
2. Stocks and Bontls (Schedule B)
2
3 Closely Heltl Corporation, Pannarship Or Sole-Proprietorship (Schedule C) 3
4 Mortgages 8 Notes ReCeivaDle (SchedulB D)
4
5. Cash, Bank Deposits 3 Miscellaneous Personal Property (Schedule E) 5
5,821 88
6. Jointly Owned Propeny (Schedule F
Requestetl
7
S
. Inter-Vivos Transfers d Miscellaneous Non•Probate Property
(Schedule G)
Separete Billing Requestetl.. 7.
6. Total Gross Assets (total Lines 1-7). .
...
9. Funerel Expenses 8 Atlministrative Costs (SUetlule H)
B
5,821.88
10. Oebts of Decedent, Mortgage Liabilibes, 8 Liens (SChetlule 0 9 1, 050.00
.
11 Total Detluctions (total Lines 9 8 70)... . t0
t 2, 850.06
12. Nat Value of Estate (Line B minuc Line 11) .. 11 13,900.08
73. Charitable antl Governmental BequestySec 9113 Trusts for which
an 9lection to tax has not been 12 0D0
made (Schedule J)
13
14 Net Value SuDJect to Tax (Line 12 minus Line 13)
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
t 1a o.oD
5. Amount of line 14 taxable
at (he spousal tax rete, or
transfers untler Sec. 9116
(a)(t.2) x .0_
18. Amount of Llne 14 taxable 15.
at lineal rate X .0 _
17 Amount of line 14 IaxaDle t 6.
at sibling rate X .12
16. Amount of Line 74 taxable 1 ~
at collateral rate X .15
t8.
19. TAX DUE
..
19
0.00
20. FILL IN 7NE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 15056052059 Side2
!5056052059
REV-1500 E% Paga 3
Decedent's Complete Address:
Margaret Kois
STREETADDRESs
1114 Hillside Drive
CITY
Carlisle
Tax Payments and Credits:
~. Taz Due (Page 2 Line 19)
2. CrediWlPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Inceresl
E Penally
Fitt Number
21 08 0877
DECECENTS SOCIAL SECURCY NUMBER
21t-07-6426
STATE Zip
PA 17013
I t) 0.00
Total Credits i A • B • C ; f2)
750.00
4. II Line 2 is greater than Line 1 . Line 3, enter the diNerence. This is the OVERPAYMENTOtaI InteresUPenalty l D + Ii) (3)
Fill in oval on Page 2, Llne 20 to requeat a rotund.
(41 __
5 II Line 1 + Line 3 is greater than Lina 2, enter the difference. This rs the TAR DUE.
;51 __
A. Enter the interest on the tax due.
ISA) _
B. Enter the total of Line 5 + SA. This is Ne 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:
a retain the use or income of the property transferred;. _ .,,.., , ,
b Yes No
. retain the dght to desgnate who shall use the property transferred or its income;.
c
t
i
. re
a
nareversidnaryinlerestor..._ _.
_.
d
. receive the promise for life of either payments, benefits or care?._ _.
2. If death occurred aNer December 12
1992
did de
d
,
,
ce
ent transfer properly within one year of death
wittaulreceivingadequateconsideration?.•._..._.._.
--.
-~-,
3. Ditl decadent own an 'in trust fof or payable upon death bank aaount or secunly al his or her death% _ -
.
a Did decedent own an Individual Retirement Account, annwty. or otner non-probate oropeny wn~cn r ~~
contains a beneNCiery destgne6on? ....__. ,--_
750.00
IF THE ANSWER TO ANY Of THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July i, 1994 and before January 7. 1985, the tax rate imposed on the net value of transfers to or for the use of the surviving Spouse
is (hree (3) percent [72 P.S. §9116 (a) (1.1) (i)j.
For dates of death on or after January 1, 1995, the tax rata imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax relum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or aher duly 1, 2000:
The fax 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 zero (OJ percent (72 P.S. §9116(a)(1.2)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent except as noted in
72 P.S. §9116(1.2)172 P.S. §9716(a)(111.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (tt) percent (72 P S. §9116(aJi tap. A sibling is defined under
Section 9102, as an intlividual who has at least one parent in common with the decedent, whether by blood or atlootion
750.00
REV-i 508 Ex. (6-68)
COMMONWEALTN OF PENNSYLVANIA
INHERITANCE Tqx RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
:STATE OF -
Margaret Kois FILE NUMBER
21-08-0877
IncluOe Ina proceeds of Inlgenon and the date lne proceeds were received Dy the estate
All property Jdndy~Owned with right of survivorship must ba diaeloaad on S:hadul! F
TEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1, MdT Bank Checking Account #12454591
4,854.35
2. 2008 IRS Tax Rebate
300.00
3 State of New York -refund of health insurance premium
96.12
4. BlueCross BlueShield of Western New York - refund of health insurance
I 388.65
5. Office of the New York State Comproller -death benefit
j 182.76
TOTAL (Also enter on line 5. Recapitulation) E 5.821.88
(II mor! space is nestled, nseA addxbnal sheets of the same size)
REV~1611 E%~ (1299)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Margaret Kois
A I FUNERALEXPENSES:
t
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-C8.0877
Debts of degdsnt must be reported on Schedule 1.
B. ADMINISTRATIVE COSTS:
1. Personal ReWesenlative's Commisagna
Name of Personal Reprecenlauve(sl Larry S. Rankin
Soual Security Number(zJIEIN Number of Pesonal Reprceentaave(s) 188.30.0152
Sueet Aaaress 1114 Hillside Drive
Gty Carlisle Slate PA
Lp 17013
veer(s) Cammisaion Paid: 2009
2. Adorney Fces
7. Family Exemption. (If tlecedenYS'adtlre5a is not the same as daimanl'a. attach explanation)
Claimant
Street Atltlre55
City
Stele jip
ReialionsNp of Claimant to Deuredenl
a. I Ptobale Fees
5. Acwunlanl's Feea
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on hne 9. Recapuuiabon) S
pl more space is needed. mser! addnwnai snee!s o! me same sues
300.00
750.00
1,050.00
Pennsylvania
OEVApTMENI p[gEVE NOE
IrvNER:TnNCE Tar gETUprv
0.FSIpENi pECEDENi
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS j
FILE NUMBER
o..~~ ~_~
os
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TA% DIVISION
PO BOX 290601
IWRRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OP TAX
REV-1547 EX AFP (03.99)
TRICIA D NAYLOR
T D NAVL OR LAW OFFICE
104 S HANOVER ST
CARLISLE PA 17013
DATE 07-20-2(109
ESTATE OF KOIS MARGARET
DATE OF DEATH 05-27-2008
FILE NUMBER 21 08-0877
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 09-18-2009
(See reverse side und;r Objections)
Aaount Resitted~-~'~
MAKE CHECK PAYABLE AND REMIT PAYMENT 70:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALON6 THIS LINE "--- RETAIN LOWER PORTION FOR YOUR RECORDS (~ _
REV-1547 EX AFP (01-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KOIS MARGARET FILE N0. 21 08-0877
ACN 101 DATE 07-20-2009
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON:
1. Real Estat• (Senadul• A) ORIGINAL RETURN
2. Stocks and Bontls (SChatlule B)
3. Cl os sly Nsld Stook/Partnership Interest (SChetlul• C]
4. MortBa9as/Notes Recoivabl• (Schetlula O)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Sehotlul• G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expansaa/Atlm. Costs/Misc. Expanses (Schadulo H) (9) 1,050.00
30. Debts/MOrtBaB• Liab111 Lies/Lions (Sehodul• I)
110)__ 12.850-06
13. Total Datluctions
12. Nat Value of Tax Return Q1) 13.90D DA
13. ChorlYabl•/GOVarnmantal Bequests; Nan-slat tad 9113 Trusts (Schadula J) (12) 8,078.18-
14. Nat Valw of Estate Sublset to Tax (13) .00
(la) 8,078.18-
NOTE: If an assass~ent was issued previously, lines 14, 15 and/or 16, 17, 18 end 19 will
reflect fiDUres that include the total of ALL returns asassssd to date.
ASSESSMENT OF TAX•
15. Amount o/ Lin• 14 at Spousal rata C15 00
16.
Amount
of
Lina
14
taxabl• at
LSneal/Class A rats
)
(16) .
OD X
17.
Amount
of
Lin•
14
at Slblinp
rata . X
!B
A (17) .00 X
. mount of Lino 14 taxabl• at Collatoral/Class B rat• (18) .00
19.
Prlneipal
Tax Du• X
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
(19)- .00
AMOUNT PAID
* IF PgiD AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
OD .00
045. .00
12 .00
15 .00
750.00
750.000R
.00
750.000R
( IF TOTAL DUE IS LESS THAN al, NO PAYMENT IS RE9UIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), VOU MAV BE DUE
A REFUND. SEE REVERSE SiOF DF THIS Enpw ono 7ucTpurT lnue i
C1) •00 NOTE: To Inaur• proper
C2)~ p0 cratlit to your account,
(3) 00 submlt th• upper portion
of thia form w3 th your
(4) •00 tax Payment.
(5) F.8 1 88
(6) .00
(7) .00
(e) 5,821.88