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Home My WebLink About03-0890Estate of Sylvia A. Goho also known as PETITION FOR GRANT OF LETTERS No. ~,~'/"'/'~ - Wayne L. Goho Petitioner(s), who is/are 18 years of age or older, apply)ies) for: , Deceased Social Security No. 202200805 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or J'~ Decedent, dated 5/13/1998 and codicil(s) dated named in the Last Will of the State re evant 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 incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 540 Rupley Road, Camp Hill, PA 17011 (list street, number and municipality) Decedent, then 75 years of age, died October 13 ,2003 , at Holy Spirit Hospital, Camp Hill, PA (Location) 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 domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: 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 undersigned: Signature Typed or printed name and residence Wayne L. Goho 540 Rupley Road, Camp Hill, PA 17011 / 7- - 2' Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 and affirmed and subscribed before me this 28th day of October 2003 Donna M. Otto,lst DECREE OF REGISTER Estate of Sylvia A. Coho also known as Deceased No. 21-2003-890 Social Security No: 202200805 Date of Death: 10/13/2003 AND NOW, Octob~.r 2R~-h ,2003 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary O of Administration ((c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minoriate) are hereby granted to Wayne L.Goho in the above estate and that the instrument(s), if any, dated May 13, 1998 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 25 · 00 Short Certificates(s) ....3. .......... $ 9.00 Renunciation .......................... $ Extra Pages( 2 ) ............... $ 6·00 I.T.R ....................................... $ JCPFee ................................. $ 10.00 Inventory ................................ $ Other ...................................... $ TOTAL ............................. $ 50.00 Attorney will pick up letters on Wednesday 10/29/2003 Signature Attorney: R. Mark Thomas I.D. No: 41301 Address: 101 S. Market Street Mechanicsburg PA 17055 Telephone: (717) 796-2100 DATE FILED: October 2Bth. 2003 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 for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar g 4 8 g 7 4 OCT 1 No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH .~..~.-.oI u,,,~.,.~ ~ ~m's.~,~ ~ c~ ~ z~c~, ~ ~e L. ~ho 540 Rupley Rd. !5._~ ~ll,PA 17011 E~r Shultz ' ....... Wa~e L. ~ho ~as~,T~ ~ ~Y a~ ~ Hill,PA 17011 ~ ~AC~E~E ~: 21-2003-890 o -03- 8qo LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, SYLVIA A. GOHO, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to WAYNE L. GOHO. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my husband WAYNE L. GOHO, provided he survives me. In the event that my husband and I shall die simultaneously or in the same common accident or disaster, or any circumstances causing doubt as to which of us survived the other, then I direct that WAYNE L. GOHO shall be deemed to be the survivor of us. V If my husband, WAYNE L. GOHO shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, as follows: My property is to be divided into four (4) equal shares with each of the following individuals being entitled to one (1) share: 1. My husband's son, STEPHEN W. GOHO- one (1) share 2. My nephew and godson, FRANK R. WATTS - one (1) share 3. My brother, DONALD A. WATTS - one (1) share 4. My sister, LILLY NILSEN - one (1) share. In the event any of the above mentioned heirs should predecease me then his/her share shall lapse and be added to the remaining shares. VI I nominate, constitute and appoint my husband, WAYNE L. GOHO as Executor of this LAST WILL, to serve without bond. If my husband is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my attorney, R. MARK THOMAS, ESQUIRE as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, SYLVIA A. GOHO, have set my hand to this LAST WILL this /~day of /74~ , 1998. SYLV~k A. GOHO Signed, sealed, published and declared by the above-named SYLVIA A. GOHO, as and for her Last Will and Testament, in the presence of us, who, at her request andJaein r presence, and in the presence of each other, have hereun~ subscribed o}lr names as ~yi~s. ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND . I, SYLVIA A. GOHO, 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 as my free and voluntary act for the purposes therein expressed. sYL~L4~ A. GOHO ~ ' Swom or affirmed to and acknowledged before me by SYLVIA A. GOHO, Testatrix, this /~/-~day of ~ ~/~ ,1998. N~ry Public Nolarlal Seal Anne Ca _taxx/y, Notary Public County ,, y , mm~ss~3n Expires Mar. 11, 2002 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND · We, ~f£~_L ZOcc/--~'~e/TS,~._ZZ2L and 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 SYLVIA A. GOHO signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as wimesses; and that to the best of o~ur~ coknnOs~lae.dmgte~rthu~dLe~t~e~caes.at the time 18 years of 1998. Sworn affirmed to and acknowledged before this ,/~ff~- day of /']~'d~. N'ot~xy Public NotarfaJ Seal . Anne Car_~, Notary Public . .1~_ ~bur~ Bom, Cumberland Countf My Commission Expires Mar, 11, 2002 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Sylvia A. Goho Date of Death: 10/13/2003 Estate No. 2003-890 SSN: 202-20-0805 File No. 21-03-0890 Date Letters Granted: 10/28/2003 Will or Administration No. To the Register: I certify that Notice of 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 10/28/2003 Name Address Wayne L. Goho 540 Rupley Road Camp Hill PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 11/14/2003 Capacity: Personal Representative X Counsel for Personal Representative Signature R. Mark Thomas, Esq. Name (Please type or print) 101 S. Market Street Address Mechanicsburg PA 17055 Telephone No. (717) 796-2100 EV 15~0 ¢,X + (6-00) ;-. Z Z o uJ o 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL' Goho, Sylvia A. DATE OF DEATH (MM-DD-Year) 10/13/2003 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT IDATE OF BIRTH (MM-DD-Year) 03/05/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (L~ST, FIRST, AND MIDDLE iNITIAL) Goho, Wayne L. OFFICIAL USE ONLY FILE NUMBER 2 1 0 3 0 8 9 0 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 2 0 2-2 O- 0 8 0 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1 9 8- 1 4-9 8 4 8 r~l. Original Return ~'~ 4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) r--~ 9, Litigation Proceeds Received --]2. Supplemental Return r-I 4a. Future Interest Compromise (date of death after 12-12-82) n-'] 7. Decedent Maintained a Living Trust (Attach copyofTrust) r'~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1.95) NAME R. Mark Thomas, Esq. FIRM NAME (if Applicable) TELEPHONE NUMBER 717-796-2100 [] 3. Remainder Return (date of death prior to 12-13-82) J'~l 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes --"]11. Election to tax under Sec. 9113(A) (Attach Sch O) B ~iDE TAX ~,I'FORM HOULDBE, DIRECTED ~O1 : COMPLETE MAILING ADDRESS 101 S. Market Street Mechanicsbur~] PA 17055 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, Mortgage 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) 13,535.79 375,249.98 OFFICIAL USE oNLy (8) 5,297.00 (11) (12) (13) (14) 388,785.77 5,297.00 383,488.77 383,488.77 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 0.00 x X __ X X 20. .12 ,15 (15) (16) (17) (18) (19) Deceder~t's Complete Address: STREET ADDRESS 540 Ruple¥ Road 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 Interest/Penalty if applicable D. Interest E. Penalty ISTATE PA I zip 17011 (1) Total Credits ( A + B + C ) (2) 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 (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 + 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 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, 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 RETUR~ ADDRESS 5zf~/Ru pley Road DATE Camp Hill SIGNATUR~E PA 17011 zDATE . ADDRESS 101 S. Market Street Mechanicsburg PA 1 7055 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. §9t 16(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Goho. Sylvia A, 21 03 0890 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 DESCRIPTION 1, Checking Acct. #5140205975 PNC Bank, Firstside Center, 500 First Ave. 4th Floor, FICIF, Pittsburgh, PA 15219-3128 Miscellaneous personal property VALUE AT DATE OF DEATH 13,035.79 500.00 TOTAL (Also enter on line 5, Recapitulation) I $ 13,535.7,0 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Goho. Sylvia A, 21 03 O89O If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Wayne L. Goho 540 Rupley Road Spouse Camp Hill, PA 17011 c JOINTLY-OWNED PROPERTY: Lb l I t::H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF BEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTERES 1. A. 11/5/81 30 Series EE Bonds 62,840.00 50. 31,420.00 2. A 1/10/83 30 Series EE Bonds 57,732.00 50. 28,866.00 3. A Members 1st F.C.U Acct. 7041-00 6,638.52 50. 3,319.26 Acct. 7041-05 160,654.17 50. 80,327.09 Acct. 7041-47 26,189.04 50. 13,094.52 Acct. 7041-48 26,189.04 50. 13,094.52 Acct. 7041-49 99,438.66 50. 49,719.33 Acct. 7041-50 68,113.54 50.i 34,056.77 Acct. 124422-00 5,617.36 50. 2,808.68 TOTAL (Also enter on line 6, Recapitulation) $ 375,249.98 (If more space ~s needed, insert additional sheets of the same size) Goho, Sylvia A. Continuation of REV-1500 Inheritance Tax Return Resident Decedent PaRe1 Schedule F-2 - Jointly-Owned Property 21 03 0890 LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE include name of financial institution and bank account number or similar identifying number, Attach DATE OF DEATH DECD'S VALUE OF NUMBEF~ TENAN' JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE~ Acct. 124422-05 7,139.68 50. 3,569.8" Acct. 124422-43 26,819.04 50. 13,409.5,c Acct. 124422-44 76,372.92 50. 38,186.46 Acct. 124422-45 126,755.97 50. 63,377.99 SUBTOTAL SCHEDULE F-2 118,543.81 GRAND TOTAL SCHEDULE F-2 $ 375,249.98 OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Goho. Sylvia A. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 03 Debts of decedent must be reported on Schedule I. ~TEM NUMBER A. 1. DESCRIPTION FUNERAL EXPENSES: Musselman Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Wayne L. Goho Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address 540 Rupley Rd. City Camp Hill State PA Year(s) Commission Paid: Attorney Fees R. Mark Thomas, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 198-14-9848 Zip 17011 Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal Publication Patriot News Co. Publication State Zip TOTAL (Also enter on line 9, Recapitulation) $ 0890 AMOUNT 4,203.00 840.00 74.00 75.00 105.00 5,297.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX +.(~-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Goho. S via A. NUMBER I. 1, 1, 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] Wayne L. Goho 540 Rupley Road Camp Hill, PA 17011 FILE NUMBER 21 O3 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse 0890 AMOUNT ORSHARE OF ESTATE 383,488.77 (If more space is needed, insert additional sheets of the same size) TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV-1500 COVER SHEET $ B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, SYLVIA A. GOHO, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to WAYNE L. GOHO. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my husband WAYNE L. GOHO, provided he survives me. In the event that my husband and I shall die simultaneously or in the same common accident or disaster, or any circumstances causing doubt as to which of us survived the other, then I direct that WAYNE L. GOHO shall be deemed to be the survivor of us. V If my husband, WAYNE L. GOHO shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, as follows: My property is to be divided into four (4) equal shares with each of the following individuals being entitled to one (1) share: 1. My husband's son, STEPHEN W. GOHO - one (1) share 2. My nephew and godson, FRANK R. WATTS - one (1) share 3. My brother, DONALD A. WATTS - one (1) share 4. My sister, LILLY NILSEN - one (1) share. In the event any of the above mentioned heirs should predecease me then his/her share shall lapse and be added to the remaining shares. VI I nominate, constitute and appoint my husband, WAYNE L. GOHO as Executor of this LAST WILL, to serve without bond. If my husband is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my attorney, R. MARK THOMAS, ESQUIRE as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, SYLVIA A. GOHO, have set my hand to this LAST WILL this /'"4~'/~-day of /7i~:?~-- , 1998. SYLV~k A. GOHO Signed, sealed, published and declared by the above-named SYLVIA A. GOHO, as and for her L.ast Will and Testament, in the presence of us, who, at her request and in.her presence, and m the presence of each other, have hereunto subscribed otlr names asffitnes~es. ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND · I, SYLVIA A. GOHO, 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 as my free and voluntary act for the purposes therein expressed. /2, SYL{iA A. GOHo Sworn or affirmed to and acknowledged before me by SYLVIA A. GOHO, Testatrix, this /~,g~'/;/~-- day of ,/]//~'y-" ,1998. Notary Public AFFIDAVIT [ Anne Car_mody, Notary Public [MechanicsburgcommlsslonBOm, Cumberland Coun / LMy Expires Mar. 11,200?[ / COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND · We, I/,: c~/:~ C..Z. and the wimesses 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 SYLVIA A. GOHO signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as wimesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or mg~e, of soun. d mind.~d un~6/ cons train t or undue influen ce. ,,./ //i/j~///// Sworn affirmed to and acknowledged before this ,,'-~-~'/'-- day of /]L~:2~.:"_ , 1998. Nbt~ry Public ...... " Notarial Seal Anne Car_mody, Notary Public Mechanicsbur[} Bom, Cumberland Counb, My commission Expires Mar. 11, 2002 Savings Bond Calculator Page 1 of 3 Savinc Series EE Bonds I Denomination Serial Number Issue Date # Bonds Total Price 60 $30,000.00 Serial Number Issue Date Series M2285411 11/1981 EE M2285412 11/1981 EE M2285416 11/1981 EE M2285417 11/1981 EE M2285418 11/1981 EE M2285419 11/1981 EE M2285420 11/1981 EE M2285421 11/1981 EE M2285422 11/1981 EE 22855423 11/1981 EE M2285424 11/1981 EE M2285427 11/1981 EE 2285428 11/1981 EE M2285429 11/1981 EE M2285430 11/1981 EE M2285431 11/1981 EE M2285432 11/1981 EE M2285433 11/1981 EE M2285434 11/1981 EE M2285435 11/1981 EE M2285436 11/1981 EE M2285437 11/1981 EE M2285438 11/1981 EE M2285439 11/1981 EE M2285440 11/1981 EE M2285441 11/1981 EE M2285442 11/1981 EE M2285443 11/1981 EE Total Interest $90,672.O0 issue Deuom Price $1,000 $500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 1,000 500.00 Total Value $120,672.00 Interest Interest Value $1,598.00 $2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 1,598.00 2,098.00 Rate 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% YTD In: $4,00~ Next Final Accrual Maturit3 11/2003 11/201 l 11/2003 11/2011 11/2003 11~011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11~003 11/2011 11/2003 11/2011 11~003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 11~003 11/2011 11/2003 11/20tl 11/2003 11/2011 11/2003 11/2011 11~003 11/2011 11~003 11/2011 11/2003 11/2011 11/2003 11~011 11/2003 11/2011 11/2003 11/2011 11/2003 11/2011 http://wwws.publicdebt.treas.gov/BC/SBCPrice 10/30/2003 Savings Bond Calculator Page 2 of 3 M2285444 11/1981 M2285445 11/1981 M3680904 01/1983 M3680905 01/1983 M3680906 01/1983 M3680907 01/1983 M3680908 01/1983 M4057576 01/1983 M4057577 01/1983 M4057578 01/1983 M4057579 01/1983 M4057580 01/1983 M4057581 01/1983 M4057582 01/1983 M4057583 01/1983 M4057584 01/1983 M4057585 01/1983 M4057586 01/1983 M4057587 01/1983 M405788 01/1983 M4057589 01/1983 M4057590 01/1983 M4057591 01/1983 M4057592 01/1983 M4057593 01/1983 M4057594 01/1983 M4057595 01/1983 M4057596 01/1983 M4057597 01/1983 M4057598 01/1983 M4057600 01/1983 M4057599 01/1983 EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE EE Viewing Bonds 1-60 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 500.00 1,598.00 1,598.00 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 1,424.40 2,098.00 2,098.00 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 1,924.40 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 11/2003 11/2003 01/2004 01/2004 01~004 01/2004 01/2004 01~004 01/2004 01/2004 01/2004 01/2004 01/2004 01~004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 01/2004 11/2011 11/2011 01/2012 01/201 01/201 01/2012 01/2012 01/2017 01/2012 01/2012 01/2012 01~012 01~01J 01/201 01/201 01~01 01/201J 01/2012 01/2012 01~012 01/2015 01/2012 01/2012 01/2012 01~01 01/201 01/201 01/201J 01/2012 01/2012 01/2012 01/201J Note Description NI Not Issued NE Not Eligible for Payment http://wwws.publicdebt.treas.gov/B C/SBCPrice 10/30/2003 3345 INS FUNERAL PURCHASE CONTRACT (STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED) (Charges are only for those hams that you selected or that are required. If we are required by or by a cemetery or crematory to use any items, we will explain the reasons in twiting below.) Section 13.204 of the Rules and Regulations of the Pennsylvania State 8oard of Funeral Directors requires this contract to pe signed by the person or persons arranging for the funeral service and by the funeral director. (A) OUR SERVICE: BASIC SERVICES OF FUNERAL DIRECTOR & STAFF... $ EMBALMING ...................................... $ ~'"~'~'~ If you selected s funeral that may require embalming such ss a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such es a direct cremation or immediate burial. If we charged for embalming, we W" explai~.t~ b,e~w~.. . ~ OTHER PREPARATION OF THE BODY ................ USE OF FACILITIES, STAFF & EQUIPMENT: Fu neral Cer~.e~3ny ( Con~ua~d .t Fu~l Home ) .............. Visitatioh~-~ Conducted at Funeral Home )~ .............. $ Memorial Service ( C<x,d~aed at Funeral Home ) ............. USE OF STAFF AND EQUIPMENT: Funeral Ceremony ( Conducted at another facility ) .............. $ Visitation / Viewing ( Conduaed a~ ~no~her f,,c,~y ) ............. $ Memodal Service ( Co,x~aed a~ anoth~ f~y ) .............. $ Graveside Service ................................ $ TRANSFER OF REMAINSTO FUNERAL HOME ............ $ ( ~ Miles Transported) AUTOMOTIVE EQUIPMENT: Casket Coach (Hearse) ............................. $ Funeral Sedan .................................... $ Limousine ....................................... $ FIowerCar ....................................... $ Service / Lead / Clergy Car ......................... $ MISCELLANEOUS MERCHANDISE: Acknowledgment / Thank You Cards .................. $ Visitors' Register Book ............................. $ Memorial Folders / Prayer Cards ..................... $. __ CASKET ~ $ __ OUTER BURIAL CONTAINER (As Selected) $ C~MN [] S-~' PA Receptacle (other than casket) $ Wearing Apparel $ $ FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME ...................... $ RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME ..................... $ DIRECT CREMATION (As Selected) ............................................ $ IMMEDIATE BURIAL (As Selected) ............................................. $ Total (A) $ MUSSELMAN FUNERAL HOME e & CREMATION SERVICES, INC. / / Established 1895 No. / BRIAN C. MUSSELMAN, Supervisor WILLIAM G. PEGAN '- .' 324HummelAvenue LEMOYNE,PA17043 / ~ / "~ ~ Phon;t(717)76~31440 ~ , Date Full~ame of deceased ~'~lul ('l'' ~'-~' (~¢:~J/~O --Age //' --x j ~ ,.~'" (Please PRINT Na~e) ·~'~ Oats Death t 3/ . Deceasedis I of person arranging.services. (Give Relationship) (A) ~orward (B) CASH ADVANCE ITEMS: Total $~, ~-' ~ F~owers ............................................ $ Telephone Calls and Telegrams ......................... $ Transportation Cost .................................... $ ~ ~2. cart Copy Death Cs,,,cate.../...o. $ --- Out-o~-Ci~ and ! or State Funeral Directors Charges ........ ; NowspaperDeat. Noti s .............................. $ ,2 O-- Z / 5" Tent and ~raYs Servicing Charge ........................ $ Crematio~Authorization,~._} Fee..,.~-. ...................... $~ ....... $ ....... ....... $ ....... $ /5' /? ....... , (C) OTHER ITEMS: Total(B) $ .....~X, ~ $ Total (A) & (B) Total (C) $ _ ~r ET~~~'~~C~ Total Antet~$ ~ LEGAL, CEM MENTS COMPELLING THE PURCHASE OF ANY ITEMS LISTED ABOVE: The un~ereigned purchaser(a) hereby attest to the following: (1) I/We did (t~) did not ( ) authorize embalming of the above named deceamKI. (2) I/We were shown a Casket Price List and an Outer Burial Container Price List before the showing of caskets end outer burial containers. (3) I/We were given/offered for retention a General Price List upon the beginning of a di~cuseion of funeral armngemeots and/or selection of service~ and merchandise. TERMS: Net due 30 days. A charge of 1.5% per month (18% per annum) for UNANTICIPATED LATE PAYMENT will be charged on any amount unpaid after due date. I, or we, having read the above, accept and approve same, and jointly and severally_promise to make full payment therefor. Each purchaser understands that this promise to jointly and severally make full payment means the ~-uneral Home has the right to collect the entire amount from anyone or more of the purchasers without reso~ to any claim against any other purchasers. This right exists regardlass of whether or not one or mom of the pumhasers have agreed among themselves how much each will co~,ribute to make furl payrl~ent. Receipt of a I~ of this contract is acknowMdged, /~ ~ /J /7-- S.S. No. City State Zip Code Signature of Purchaser(s) Signature of Pumhaser(s) We agree to provide the sewice & mercflandise indicated above. Musseiman Funeral Home & Cremation Services, ~ Street Address City and State Zip Code S~.~Addre~s '.,..~ City and State Zip Code STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND Name of Decedent: Sylvia A. Goho Date of Death: 10/13/2003 File No. 21 03-0890 , PENNSYLVANIA Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the 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: If the answer to No. 1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES b. The separate Orphan's Court No. (if any) for the personal representative's account is: NO X Date: 6/8/2004 Did the personal representative state an account informally to the parties in interest? YES X NO 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. Z,.¢..~: 0[ ?? P0. Signature R. Mark Thomas, Esq. Name (Please type or print) 101 S. Market St. Address Mechanicsburg PA 17055 717-796-2100 Tel. No. Capacity: Personal Representative X Counsel for personal representative ~BUREAU OF ZNDIVTDUAL TAXES TNHERZTANCE TAX DZVZSTON DEPT. Z80601 HARRISBURG, PA 171Z8-060! R MARK THOHAS ESQ 101S HARKET ST HECHANICSBURG COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLD#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX '~: DATE PS'~ '" " :*~ ESTATE OF DATE OF DEATM FILE NUHBER 12 COUNTY '04 " ACN REV-15gi7 EX AFP C01-05) 03-15-2004 GOHO 10-13-2003 Z1 05-0890 CUMBERLAND 101 Aeoun~ Reei~ed SYLVIA A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15~? EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GOHO SYLVIA A FILE NO. 21 03-0890 ACN 101 DATE 05-15-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHAN~ED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~narship Zn~eres~ (Schedule C) (3) ~. Hor~gages/No~es Receivable (Schedule D) (q) 5. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) ($) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~al Asse~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Deb~s/Hor~gage Liabilities/Liens (Schedule I) (10) 11. To~al Deductions 12. Ne~ Value of Tax Re~urn 15. lq. Chari~abZe/Governmen~al Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~e Subjec~ ~o Tax 13~535 375z249 O0 00 O0 00 79 ~ax payment. .98 00 5,297.00 .00 NOTE: To insure proper cradi~ ~o your account, submi~ the upper portion of ~his form ~i~h your 388,785.77 (11) 5.297.00 (~2) 385,488.77 (Is) . O0 (l~) 383,488.77 NOTE: Zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will reflect flgures that /nclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~e 16. Amoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e 17. A.oun~ of Line 1~ a~ Sibling ra~a 18. Aeoun~ of Line 1~ ~axabla a~ Collateral/Class B ra~e 19. Principa! Tax Due TAX CREDITS: PAYHENT RECEIPT D/SCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) (~5) 383,488.77 x 00 = .00 (l~) .00 x 045: .00 (~7) .00 x 12 : .00 (18) .00 x 15 : .00 (19)= . O0 ANOUNT PAID IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS RE{~UIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in tho 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 ComaonNealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the 1aclu1 Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of 2000. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, mhich was not requested on the Tax Return, may 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 Rills, any of the Z5 Revenue District Offices, or by calling the special 24-hour ansmaring service for forms ordering: 1-800-56Z-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-4q?-30ZO (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty ¢60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-lOZ1, 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 tm: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg) PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) 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 (SI) discount of the tax paid is allowed. 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 and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would 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, 196g bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z miZI bear interest at a rate which wi1! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The appZicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 1982 lOX .000548 1988-1991 11Z .000501 1985 16Z .000438 1992 9Z .000247 1984 117. .000501 1993-1994 77. .00019Z 1965 13Z .000556 1995-1998 9Z .000Z47 1986 IOZ ,000Z74 1999 7Z .000192 1987 IOZ .000Z74 ZOO0 7Z .00019Z --Interest is calculated as follows: I'NTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~ 9Z .000247 200Z 6Z .000164 ZOO3 SZ .000137 2004 4Z .000110 X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bm calculated.