HomeMy WebLinkAbout04-0565In re:
S. BERNE SMITH
Attorney-at-Law
107 N. 24th Street
Camp Hill, PA 17011-3602
PHONE: (717) 737-6789
FAX: (717) 737-6783
Estate of Anne G. Boens; SS # 204-18-9054; DOD: May 30, 2004;
PA File:
My File: 3004
Ms. Glenda Famer Strasbaugh
Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Dear Ms. Strasbaugh:
June 10, 2004
Accompanying this letter is a Petition for Probate and Grant of Letters Testamentary in the
Estate of Anne G. Boens, who died testate May 30, 2004. Attached to the petition are the following:
2.
3.
4.
The original and one copy of the Will of Anne G. Boens.
The Estate Information Sheet for the PA Department of Revenue.
Death Certificate for Anne G. Boens.
The Will is a self-proving Will.
We believe that this covers everything that is required. We ask that we be provided with
eight (8) short certificates. Please send them and the actual letters testamentary to the undersigned
when they are prepared. Because we will be hand delivering all of the above materials to you, we
will be prepared to pay the fees by check at that time.
Thank you for your attention to this matter. If anything further is required, please advise.
Sincerely yours,
S. Berne Smith
Enclosures:
cc: Connie L. Boens, Executrix
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Anne G. Boens
Social Security No. 204-18-9054
No. 0q ' sm_s
To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania.
The Petition of the undersigned respectfully represents that:
Your Petitioner is 18 years of age or older and is the Executrix named in Paragraph 10 of the
last Will of the above decedent, dated March 29, 1996.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last address
at Messiah Village, Upper Allen Township. Her place of residence was 342 Messiah Circle,
Mechanicsburg, PA 17055.
Decedent, then 83 years of age, died May 30, 2004, at Messiah Village. Decedent did not
marry, was not divorced and did not have a child bom or adopted after execution of the Will offered
for probate, was not the victim of a killing and was never adjudicated incompetent.
Decedent at death owned property with estimated values as follows:
1. All personal property
$ 326,000.00
2. Value of real estate in Pennsylvania
None
WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith
and the grant of letters testamentary thereon.
Conme L. Boens
1457 Maplewood Drive :L:'
New Cumberland, PA 1 ~70
Estate of Anne G. Boens, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~ l [,o , ,2004, in consideration of the petition
set forth on the two pre~eding pages, satisfactory proof having been presented before me,
IT IS DECREED that the instrument dated March 29, 1996, described therein be admitted
to probate and filed of record as the last will of Anne G. Boens, deceased, and Letters Testamentary
are hereby granted to Connie L. Boens, Executrix.
FEES
Probate, Letters, Etc.
Short Certificates.~~
Other ~.~ ~b--.~m~
TOTAL
Filed:
15.
o
Attorney: S. Berne Smith
Sup. Ct. I.D. No: 07254
107 N. 24th Street
Camp Hill, PA 17011-3602
Phone: 717-737-6789
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND :
Petitioner, Connie L. Boens, swears or affirms that the statements in the foregoing petition
are tree and correct to the best of the knowledge and belief of petitioner and that as personal
representative of Anne G. Boens, deceased, petitioner will well and truly administer the estate
according to law.
Sworn to or affirmed before me,
this j/./~-/2-}L day of June, 2004
Cohnie L. B(~ns
C_
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.
Fee for this certificate, $2.00
P i0303;,' 3
No.
Local Registrar
JUN 0 Z004
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH :_:
83 *" J= s. Marc 10, . Chester Co.Pa.~.~'~0 t~o~,,~O ~0 ,~. ~] ~ ~,~
C~berland ~.Up~r Allen ~ ~ Messiah Village I~ .... ,~o,~ I,,- ~ite
~CE~NT'S ~ING A~RESS (Str~, C~n ~a~. Z~ C~} ~CEDENT'S Pa 17C.~ Y~, ~ ~ ~
342 Hess~ah C~cle
Hechanicsbu:g, Pa 17055 ....... ~ Cumbe:land ,~.-,,~ ~.~
Connie Boens
.~. 1457 ~plevood D~ive Ney C~land Pa 17070
I
L~ENSE N~l~654_LMe RINAME ~OA~RE~ ~LI~ 1~ ~t 8~t
~E
manne~ al *lat~ ............................................................ ' .... : ........ : .......................
WILL
OF
ANNE G. BOENS
I, ANNE G. BOENS, presently of 1433 Maplewood Drive, N6..i,~,,'Cumbe~land, Cumber-
land, County, Pennsylvania, declare this to be my will and hereby revoke all pri~wills and
codicils made by me.
1. Personal and Household Effects: I give all my jewelry, clothing, .fOrniture,
automobiles and other articles of personal or household use, including insurance on that property:
A. To Husband: To my husband, JAMES P. BOENS, if he survives me. If he
does not survive me, I give all that property
B. To Daughter: To my daughter, CONNIE L. BOENS, if she survives me.
2. Residuary Estate: I bequeath, devise, and appoint all the remainder of my
property, of whatever nature and wherever situated, including property over which I hold a power
of appointment, to my husband, JAMES P. BOENS, if he survives me. If he does not survive me,
then all the residue of my estate shall be divided and given as follows:
a. Five Thousand Dollars ($5,000.00) to [,AURA T. VU and Five Thousand
Dollars ($5,000.00) to JANE O. VU, both of whom presently live at 661 Sandra Ave., Harris-
burg, PA 17109.
b. If I have not established a Charitable Girl Annuity with the remaindermen
as Camp Hill Presbyterian Church and Mt. Carmel Methodist Church, then those named charities
should receive the following bequests: Two Thousand Five Hundred Dollars ($2,500.00) to
CAMP HILL PRESBYTERIAN CHURCH, 101 N. 23rd Street, Camp Hill, PA 17011, and Two
Thousand Five Hundred Dollars ($2,500.00) to MT. CARMEL METHODIST CHURCH, St.
Peters, PA (P. O. Box 208, Elverson, PA 19520).
c. The remainder to my daughter, CONNIE L. BOENS, if she survives me. If
she does not survive me, but leaves descendants who survive me, her descendants shall receive,
per stirpes, the share which CONNIE L. BOENS would have received had she survived me. If
CONNIE does not survive me and leaves no descendants who survive me, then the remainder of
my estate shall be divided equally among those nephews and nieces of my husband and myself
These nephews and nieces are the children of my and my husband's brothers and
who survive me.
sisters.
3.
Lifetime Gifts: Any git~s made during my lifetime to any person or persons who
are beneficiaries under this will shall be considered to be lifetime gifts and shall not be advance-
ments made to that beneficiary or beneficiaries.
4. Survival: If any beneficiary should die within thirty (30) days after me, then he
shall be deemed to have predeceased me for all purposes of this will.
5. Spendthrift Clause: No interest of any beneficiary hereunder shall be subject to
anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have
power in any manner to charge or encumber his interest, nor shall the interest of any beneficiary
be liable or subject in any manner while in the possession of my fiduciaries for any liability of such
beneficiary, whether such liability arises from his debts, contracts, torts, or other engagements of
any type.
6. Facility of Payment for Minors or Incompetents: Any amounts or assets which
are payable or distributable to a minor or incompetent hereunder may, at the discretion of my
fiduciaries, be paid or distributed to the parent or guardian of such minor or incompetent, to the
person with whom such minor or incompetent resides, or directly to such minor or incompetent,
or may be applied for thc use or benefit of such minor or incompetent.
7. Powers: In addition to such other powers and duties as may be granted elsewhere
herein or which may be granted by law, my fiduciaries hereunder shall have the following powers
and duties, without the necessity of notice to or consent of any court:
a. To retain all or any part of my property, real or personal, in the
form in which it may be held at the time of its receipt, including any closely held
business in which I have an interest and the stock of any corporate fiduciary
hereunder, as long as in the exercise of their discretion it may be advisable so to
do, notwithstanding that said property may not be of a character authorized by
law.
b. To invest and reinvest any funds held hereunder in any property,
real or personal, including, but not by way of limitation, bonds, preferred stocks,
common stocks and other securities of domestic or foreign corporations or
investment trusts, mortgages or mortgage participations, mutual funds with or
without sales or redemption charges, and common trust funds, even though such
property would not be considered appropriate or legal for a fiduciary apart from
this provision.
c. To sell, convey, exchange, partition, give options to buy or lease
upon, or otherwise dispose of any property, real or personal, at the time held by
them, at public or private sale or otherwise, for cash or other consideration or on
credit, and upon such terms and for such price as they may determine, and to
convey such property free of all trusts.
d. To borrow money from any person, including any fiduciary here-
under, for any purpose in connection with the administration hereof, to execute
promissory notes or other obligations for amounts so borrowed, and to secure the
payments of such amounts by mortgages or pledges of any property, real or
personal, which may be held hereunder.
e. To make loans, secured or unsecured, in such amounts, upon such
terms, at such rates of interest, and to such persons, firms, or corporations as they
may deem advisable.
f. To renew or extend the time for payment of any obligation, secured
or unsecured, payable to or by them as fiduciaries, for as long a period or periods
of time and on such terms, as they may determine, and to adjust, settle, and
arbitrate claims or demands in favor of or against them.
g. In dividing or distributing any property, real or personal, included
herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind.
h. Without limitation of powers elsewhere granted therein, to hold,
manage and develop any real estate which may be held by them at any time, to
mortgage any such property in such amounts and on such terms as they may deem
advisable, to lease any such property for such term or terms and upon such
conditions and rentals as they may deem advisable, whether or not the term of any
such lease shall exceed the period permitted by law or the probable period of
retention under this instrument; to make repairs, replacements and improvements,
structural or otherwise, in connection with any such property, to abandon any such
property which they may deem to be worthless or not of sufficient value to warrant
keeping or protecting, and to permit any such property to be lost by tax sale or any
other proceedings.
i. To employ such brokers, banks, custodians, investment counsel,
attorneys, and other agents, and to delegate to them such duties, rights and powers
as they may determine, and for such periods as they think fit.
j. To register any securities at any time in their own names, in their
names as fiduciary, or in the names of nominees, with or without indicating the
trust character of the securities so registered.
k. With respect to any securities forming a part of the estate, to vote
upon any proposition or election at any meeting of the corporation issuing such
securities, and to grant proxies, discretionary or otherwise, to vote at any such
meeting; to join or become a party to any reorganization, readjustment, merger,
voting trust, consolidation or exchange, and to deposit any such securities with any
committee, depository, trustee or otherwise, and to pay out of the assets held
hereunder, any fees, expenses and assessments incurred in connection therewith, to
exercise conversion, subscription or other fights, and to receive or hold any new
securities issued as a result of any such reorganization, readjustment, merger,
voting trust, consolidation, exchange or exercise of conversion, subscription or
other rights and generally to take all action with respect to any such securities as
could be taken by the absolute owner thereof.
I. To engage in sales, leases, loans, and other transactions with the
estate of my husband or any trust established by either of us, even if they are
fiduciaries or beneficiaries thereof.
m. To exercise all elections which they may have with respect to
income, girl, estate, inheritance and other taxes, including without limitation
execution of joint income tax returns, election to deduct expenses in computing
one tax or another, election to split girls, and election to pay or to defer payment
of any tax, in all events without their being bound to require contribution from any
other person.
n. To operate, own, or develop any business or property held here-
under in any form, including without limitation sole proprietorship, limited or
general partnership, corporation, association, tenancy in common, condominium,
or any other, whether or not they have restricted or no management rights, as they
in their discretion think best.
9. Taxes: I direct that all estate, inheritance, and succession taxes that may be
assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed,
other than generation-skipping taxes, shall be paid out of the principal of my general estate to the
same effect as if said taxes were expenses of administration, except that any such additional taxes
(and interest and penalties thereon) imposed on account of my interest in or power over any trust
established by my husband shall be paid out of the property held in such trust, and all other
property includible in my taxable estate for federal or state tax purposes, whether or not passing
under this will, shall be free and clear thereot~ provided, however, that my executor(s) may in the
discretion of my executor(s) request that any portion or all of said taxes (to be paid out of the
principal of my general estate) shall instead be paid out of the principal of any trust established by
me, to the extent expressly authorized under the terms of said trust.
10. Fiduciaries: I appoint as Executor hereunder my husband, JAMES P. BOENS. If
he should be unable or unwilling so to serve or to complete the administration of my estate, then I
appoint my daughter, CONNIE L. BOENS of New Cumberland, PA to be my Executrix. If she
should be unable or unwilling so to serve or to complete the administration of my estate, then I
appoint the Trust Department of DAUPHIN DEPOSIT BANK AND TRUST COMPANY,
Harrisburg, PA to serve in her place. No individual fiduciary shall be liable for the acts,
omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary.
No fiduciary named herein shall be required to furnish bond or other security for the proper
performance of his duties hereunder.
11. Gender: Unless the context indicates otherwise, any use of masculine gender
herein shall also include the feminine gender.
IN WITNESS WHEREOF, I, ANNE G. BOENS, herewith set my hand and seal to this,
my last Will, typewritten on nine ( 9 ) sheets of paper including the self-proving attestation clause
and signatures of witnesses, this 2~'~ day of ,/~ RcA/ , 1996.
ANNE G. BOENS
(SEAL)
-706-7
Witnessed:
'~?c~-d~~ residing at
¢~i~,~. i/ ,, i 7.(3,-~{x residing
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND
SS:
I, ANNE G. BOENS, (the Testatrix), and ,,Tn c,n ~. 3"'r'u,~r< r
03~,, P, ~-nova and/7/,,--ra~-,o /~, ~,a,.~,o~.~ (the witnesses), whose
names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the
undersigned authority that the Testatrix signed and executed the instrument as her last will in the
presence of the witnesses and that she had signed willingly, and that she executed it as her free
and voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed the will as witness and that to the best of his
knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
WITNESS:
TESTATRIX:
WITNESS: WITNESS:
Subscribed, sworn to and acknowledged before me by ANNE G. BOENS, the Testatrix, and
subscribed and sworn to before me by ,ft~.~n /0. 3~'Vt~,~,
and /'2~-rt~e,o ~/Pf~,.~,~--o,s , the witnesses, this
~r/7?t~ay of /YT?P~cq/-/ ,1996.
My Commission expires:
Notarial Seal r
Laure E. Kane, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires Nov. 15, 1999
Member, Pennsylvania Association of Notaries
/Notary Public
(SEAL)
CERTIFICATION OF NOTICE UNDER RULE 5.6{a)
Name of Decedent: Anne G. Boens
Date of Death: May 30, 2004
File No. 2004-00565
PA File No.21-04-0565
To the Register of Wills of Cumberland County, PA:
I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
June 17, 2004:
Name Address
Ms. Connie L. Boens, Executrix
Ms. Laura T. Vu
Ms. Jane O. Vu
Mt. Carmel United Methodist Church
Camp Hill Presbyterian Church
1457 Maplewood Drive
New Cumberland, PA 17070
43 Strawhat Road, Apt. 2D
Owens Mills, MD 21117
1700 Butler Pike, Apt. 1D
Conshohocken, PA 19428
2203 Harmonville Rd.
St. Peters, PA 19470.
101 N. 23rd Street
Camp Hill, PA 17011
Notice has now been given to all persons entitled under Rule 5.6 (a) except: None.
Date: June 17, 2004.
Signature.~//~'
Name:
Address:
Telephone:
Capacity:
X
S. Berne Smith
107 N. 24th Street
Camp Hill, PA 17011-3602
717-737-6789
Personal Representative
Counsel for Personal Represemative
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S. BERNE SMITH
Attorney-at-Law
107 N. 24th Street
Camp Hill, PA 17011-3602
PHONE: (717) 737-6789
FAX: (717) 737-6783
February 25, 2005
In re: Anne G. Boens; DOD May 30, 2004; SS# 204-18-9054
PA File No. 21-04-0565; File 2004-00565
My File: 3004
Ms. Glenda Farner Strasbaugh
Register of Wills
Courthouse
I Courthouse Square
Carlisle, PA 17013-3387
Dear Ms. Strasbaugh:
Enclosed are the following with respect to the Pennsylvania Inheritance Tax return filing on
behalf of the above captioned estate:
I. The original and one copy of the tax return.
2. My check in the amount of$15.00 for the filing fee.
3. The estate check in the amount of$15,107.78 to pay the tax due, made payable to
Register of Wills, Agent.
We believe that this is all that is required. However, ifthere are any questions, please contact
the undersigned. We appreciate the fine help of your staff. Thank you.
Sincerely yours, ..
~.JS~~l
S. Berne Smith
Enclosure:
cc: Connie L. Boens, Executrix
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COMMONWEALTH OF
PENNSYLVANIA
OEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BOENS, ANNE G.
DATE OF DEA TH DATE OF BIRTH
May 30, 2004 March 10, 1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
None
X 1. Original Return
2. Supplemental Return
4. Limited Estate
4a. Future Interest Comprise (data of deeth after 12-12-82)
X 6. Decedent Died Testate (Attach copy of Will)
7. Decedent Maintained a Living Trust (Attach II copy o/Trust)
9. Litigation Proceeds Received
10. Spousal Poverty Credit (date ofdealh between 12-31-91 end 1-1-95)
OFFICIAL USE QNL Y
FILE NUMBER
21
COUNTY CODe
0565
NUMBER
SOCIAL SECURITY NUMBER
204-18-9054
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return (date of death priorto 12-
13-82)
5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
011. Election to tax under See, 9113(A)
(Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
S. BERNE SMITH, ESQ. 107 N, 24TH STREET
FIRM NAME (If Applicable) CAMP HILL, PA 17011-3602
TElEPHONE NUMBER
717-737-6789
1. Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
(6)
2. Stocks and Bonds (Schedule B)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Probate Property
(Schedule G or L)
(7)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
$0.00
OFFICIAL"USE ONLY
$11,828.10
$0.00
$0.00
i,.J
$2,032.71
$91,025.67
$226,729.69
r ~
(8)
$331,616.17
10. Debts of Decedent, Mortgage liabilities & Liens (Schedule I)
(9) $9.157.47
(10) $5,083.46
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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14. Net Value Subject to Tax (Line 12 minus line 13)
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)(12)
x
0.00
16. Amount of line 14 taxable at lineal rate
$302.395,22
x
4.5%
17. Amount of line 14 taxable at sibling rate
x
.12
18. Amount of line 14 taxable at collateral rate
$10,000.00
x
15
19. Tax Due
20.D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(11) ~14??OR5
(12) $317,395,22
(13)
$5 000 00
(14)
$312,395.22
(15)
(15)
(17)
$0.00
$13,607.78
$0.00
(16)
(19)
9:1 50n nn
$15,107.78
Copyright 2000 David James Thorpe, Esq
Decedent's Complete Address:
STREET ADDRESS
342 Messiah Circle
CITY
Mechanicsburg
I STATE
IPA
IZIP
117055
Total Interest/Penalty (0 + E) (3)
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)
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. (SA)
B. Enter the total of line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2 Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3 Interest/Penalty if applicable
D.lnterest
E. Penalty
4
5
(11
$15,107.78
(2)
$0.00
$0.00
$15,107.78
$15,107.78
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
2.
Did decedent make a transfer and:
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 revisionary interest or
d. receive the promise for fife of either payments, benefits or care?
If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Did decedent own an individual retirement account, annuity, or other non-probate property?
3.
4.
Yes
~
No
;
@
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Declaration of preparer other than the pe
SIGNATURE OF PERSON RESP
Connie L. Boens. Executrix
ADDRESS
1457 Maplewood Drive, New Cumberland. PA 17070
SIGNATURE OF PREPARER OTHER EiJAN ~PRESENTATIVE
S. BERNE SMITH, ESQ. ~ 1.5~ A~
ADDRESS
107 N. 24TH STREET, CAMP HILL, PA 17011-3602
DATE
February
~2005
DATE
February :2 r ,2005
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 <al (1.1) (i)l
For dates of death on or atter 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)l. The statute does no exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a
tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72
P.S. ~9116(al (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.
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
ANNE G. BOENS
FILE NUMBER
21-04-0565
All property jolnUy-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
VALUE AT DATE
OF DEATH
1.
267 Shares of common stock of Prudential Insurance. Cusip # 744320102. Date of death value May 30, 2004,
was
$44.30 per share. Totai value of the stock at date of death (267 x $44.30) was $11,828.10
$11,828.10
TOTAL (Also enter on line 2, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$11,828.10
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ANNE G. BOENS
FILE NUMBER
21-04-0565
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.
3.
DESCRIPTION
VALUE AT DATE
OF DEATH
$237.00
0.00
Cash at date of death
Clothing - all clothing was donated to Messiah Village for charitable use
Furniture. At time of death, decedent was in a two room, assisted living apartment, and had very little furniture.
The living room furniture was also given to Messiah Village for charitable use. Connie Boens, her daughter, kept
the bedroom furniture as keep sake; it has nominal value, estimated to be about $200.00
200.00
4.
5.
Custom jewelry, a watch and a gold wedding ring with estimated total value $125.00.
Refund - Verizon Phone
125.00
3.93
6.
Refund - Guidepost Magazine
3.74
7.
Partial refund of prepaid funeral expenses
306.17
6
Refund - Penn Treaty Network American Ins. Co. - long term care premium
181.87
9.
Payment from long term care company - Penn Treaty Network American Ins. Co. for nursing home
975.00
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$2.032.71
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ANNE G. BOENS
FILE NUMBER
21-04-0565
If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G.
A.
SURVIVING JOINT TENANT(S) NAME
Connie L. Boens
ADDRESS
1457 Maplewood Drive, New Cumberland, PA 17070
RELATIONSHIP TO DECEDENT
Daughter
B.
C.
JOINTLY-OWNED PROPERTY:
ITEM LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number Attach VALUE OF ASSET DECD'S VALUE OF
TENANT JOINT deed for jointly-held real estate INTEREST DECEDENT'S INTEREST
1. A. Dec. M&T Bank Checking Account # 16260672. Date of death value on May $2,633.97 50% $1,316.99
2000 20,2004, was $2633.97. See attached letter and statement from M&T
Bank attached hereto as Attachment B
2. A 10/13/01 AmeriChoice Federal Credit Union Account # 33642
a. Savings Account 01 25.82 50% 12.91
b. Accrued Interest on Saving Account .02 50% .01
c. Money Market Account 18 105,218.83 50% 52,608.42
d. Accrued interest on Money Market Account 113.43 50% 56.72
(See letter dated July 28, 2004, from AmeriChoice, Attachment C)
3. A 10/11/00 836 Shares of IBM Common Stock. Date of death value per share was 74,061.24 50% 37,030.62
$88.59 for a total date of death value of $74,061.24.
Cusip # 459200-10-1
TOTAL (Also enter on line 6, Recapitulation) $91,025.67
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
ANNE G. BOENS
FILE NUMBER
21-04-0565
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
ATTACH A COPY OF THE OEED FOR REAL ESTATE.
1. MetLife Investors - variable annuity contract No. 3201125307. It was
issued April 26, 2004. The date of death valuation of the Account on May 30, $226,729.69 100% 0.00 $226,729.69
2004, was in the amount of $224,599.67. However, the actual date of
death payment was $226.729.69. Hence. this is the amount which is subject
to PA Inheritance Tax. (See letter of July 16. 2004, from MetLife.
Attachmnent 0 hereto) The beneficiary of the annuity is Connie L. Boens.
The original basis was $50,000.00. Anything above this amount will be
subject to income tax.
TOTAL (Also enter on line 7, Recapitulation) $226,729.69
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 David James Thorpe, Esq
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
21-04-0565
ANNE G. BOENS
FILE NUMBER
Debts of decedent must be reported on Schedule l-
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
1.
2.
3.
4.
5.
6.
B.
1.
2.
3.
FUNERAL EXPENSES:
Myers-Harner Funeral Home. The funeral was prepaid. Refund for overpayment is listed on Schedule E.
Funeral Luncheon at Camp Hill Presbyterian Church
Funeral luncheon at Mt Carmel church where the interment occurred.
Christ Presbyterian Church - expenses and honoraria for guest pastor
Pealer's flowers
Richard Knauer - Grave Stone
0.00
$500.00
100.00
500.00
271.31
110.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney Fees: S. Berne Smith, Esq.
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
6,600.00
4. Probate Fees 351.00
5. Accountant's Fees - Spangler & Associates 180.00
6. Tax Return Preparer's Fees - Spangler & Associates 400.00
7. Estate Notice. The Sentinel 102.11
8. Estate Notice - The Cumberland Law Journal 75.00
9. Postage 20.98
10. Telephone 15.10
11. Photocopies 7.90
12. Stock transfer fee 9.07
13. Filing fee for the PA Inheritance Tax return 15.00
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$9,157.47
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
21-04-0565
ANNE G. BOENS
FILE NUMBER
Include unrelmbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
DESCRIPTION
Messiah Village monthly fee - Ck 1001
Quantum x-rays - ck 1005
Paul Dalbey - foot doctor - ckl006
Nephrology Assoc. - Doctors - ck 1008
Holy Spirit Hospital charges - ck 1013
PA Neuro Assoc. Ltd. - Doctors - ck 1014
Quantum x-rays - ck 1017
Internists of Central Pennsylvania - Doctors. ck 1018
West Shore Pathology - medical tests - ck 1021
Mid Penn Urology - doctors - ck 743
Nephrology Assoc. - Doctors - ck 745
Internists of Central Pennsylvania - Doctors - ck 744
Messiah Village Residents' fee in lieu of tips.
Internists of Central Pennsylvania - Doctors. ck 712
Dr Kunkel - ck 718
Dr Kunkel - ck 730
Internists of Central Pennsylvania . Doctors - ck 734
Premier Eye Care - ck 735
Premier Eye Care. ck 739
Medco Health - prescriptions
Weis pharmacy - prescriptions
Rite Aid pharmacy - prescriptions
Prescribed Massage Therapy
Unreimbursed mileage expense: 90 miles x .14 cents per mile = 12.60
Medicare premium
AMOUNT
$2,998.81
22.79
7.31
79.56
300.00
98.74
95.10
218.99
46.19
18.96
42.59
60.10
100.00
50.10
14.00
134.00
10.10
22.00
34.19
238.54
20.82
4.99
100.00
12.60
333.00
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$5,063.48
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ANNE G. BOENS
21-04-0565
FILE NUMBER
NAME AND ADDRESS OF PERSON IS) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Connie L. Boens, 1457 Maplewood Drive, New Cumberland, PA 17070 Daughter 100% of residue
after payment of
specific bequests
2. Ms. Laura T. Vu, 43 Strawhat Road, Apt. 2D Friend $5,000.00 specific
Owens Mills, MD 21117 bequest
3. Ms. Jaoe 0, Vu, 1700 Butler Pike, Apt. 1D Friend $5,000.00 specific
Conshohocken, P A 19428 bequest
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS
APPROPRIATE, ON REV 1500 COVER SHEET
II. INUN- u,,,,
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO
TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Mt. Cannel United Methodist Church, 2203 Hannonville Rd" St. Peters, PA 19470 $2,500.00
2. Camp Hill Presbyteriao Church, 101 N, 23rd Street, Camp Hill, PA 17011 $2,500.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $5,000.00
(If more space IS needed, Insert additional sheets of the same size)
Copyright 2000 David James Thorpe, Esq.
CO/" r
WILL
OF
ANNE G. BOENS
c.
~
I, ANNE G. BOENS, presently of ]433 Maplewood Drive, New Cumberland, Cumber-
land, County, Pennsylvania, declare this to be my will and hereby revoke all prior wills and
codicils made by me.
Personal and Household Effects: I give all my jewelry, clothing, furniture,
automobiles and other articles of personal or household use, including insurance on that property:
A. To Husband: To my husband, JAMES P BOENS, ifhe survives me Ifhe
does not survive me, I give all that property
B To Dauli:hter: To my daughter, CONNIE L. BOENS, if she survives me.
2. Residuary Estate: I bequeath, devise, and appoint all the remainder of my
property, of whatever nature and wherever situated, including property over which 1 hold a power
of appointment, to my husband, JAMES P. BOENS, if he survives me. If he does not survive me,
then all the residue of my estate shall be divided and given as follows:
a. Five Thousand Dollars ($5,000.00) to LAURA T VU and Five Thousand
Dollars ($5,00000) to JANE O. VU, both of whom presently live at 661 Sandra Ave., Harris-
burg, PA 17]09.
b. If 1 have not established a Charitable Gift Annuity with the remaindermen
as Camp Hill Presbyterian Church and Mt. Carmel Methodist Church, then those named charities
should receive the following bequests: Two Thousand Five Hundred Dollars ($2,500.00) to
1
,Il'7 ,. 11'- ")?'Ie oJ ;
A
CAMP HILL PRESBYTERIAN CHURCH, 101 N. 23rd Street, Camp Hill, PA 17011, and Two
Thousand Five Hundred Dollars ($2,500.00) to MT. CARMEL METHODIST CHURCH, Sf.
Peters, PA (P.O Box 208, Elverson, PA 19520).
c. The remainder to my daughter, CONNIE L BOENS, ifshe survives me. If
she does not survive me, but leaves descendants who survive me, her descendants shall receive,
per stirpes, the share which CONNIE L. BOENS would have received had she survived me. If
CONNIE does not survive me and leaves no descendants who survive me, then the remainder of
my estate shall be divided equally among those nephews and nieces of my husband and myself
who survive me. These nephews and nieces are the children of my and my husband's brothers and
sisters.
3. Lifetime Gifts: Any gifts made during my lifetime to any person or persons who
are beneficiaries under this will shall be considered to be lifetime gifts and shall not be advance-
ments made to that beneficiary or beneficiaries.
4. Survival: If any beneficiary should die within thirty (30) days after me, then he
shall be deemed to have predeceased me for all purposes of this will.
5. Spendthrift Clause: No interest of any beneficiary hereunder shall be subject to
anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have
power in any manner to charge or encumber his interest, nor shall the interest of any beneficiary
be liable or subject in any manner while in the possession of my fiduciaries for any liability of such
beneficiary, whether such liability arises from his debts, contracts, torts, or other engagements of
any type.
2
6. Facility of Payment for Minors or Incompetents: Any amounts or assets which
are payable or distributable to a minor or incompetent hereunder may, at the discretion of my
fiduciaries, be paid or distributed to the parent or guardian of such minor or incompetent, to the
person with whom such minor or incompetent resides, or directly to such minor or incompetent,
or may be applied for the use or benefit of such minor or incompetent.
7. Powers: In addition to such other powers and duties as may be granted elsewhere
herein or which may be granted by law, my fiduciaries hereunder shall have the following powers
and duties, without the necessity of notice to or consent of any court:
a, To retain all or any part of my property, real or personal, in the
form in which it may be held at the time of its receipt, including any closely held
business in which I have an interest and the stock of any corporate fiduciary
hereunder, as long as in the exercise of their discretion it may be advisable so to
do, notwithstanding that said property may not be of a character authorized by
law.
b. To invest and reinvest any funds held hereunder in any property,
real or personal, including, but not by way of limitation, bonds, preferred stocks,
common stocks and other securities of domestic or foreign corporations or
investment trusts, mortgages or mortgage participations, mutual funds with or
without sales or redemption charges, and common trust funds, even though such
property would not be considered appropriate or legal for a fiduciary apart from
this provision.
3
c. To sell, convey, exchange, partition, give options to buy or lease
upon, or otherwise dispose of any property, real or personal, at the time held by
them, at public or private sale or otherwise, for cash or other consideration or on
credit, and upon such terms and for such price as they may determine, and to
convey such property free of all trusts.
d. To borrow money from any person, including any fiduciary here-
under, for any purpose in connection with the administration hereof, to execute
promissory notes or other obligations for amounts so borrowed, and to secure the
payments of such amounts by mortgages or pledges of any property, real or
personal, which may be held hereunder.
e. To make loans, secured or unsecured, in such amounts, upon such
terms, at such rates of interest, and to such persons, firms, or corporations as they
may deem advisable.
f. To renew or extend the time for payment of any obligation, secured
or unsecured, payable to or by them as fiduciaries, for as long a period or periods
of time and on such terms, as they may determine, and to adjust, settle, and
arbitrate claims or demands in favor of or against them.
g. In dividing or distributing any property, real or personal, included
herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind.
h. Without limitation of powers elsewhere granted therein, to hold,
manage and develop any real estate which may be held by them at any time, to
4
mortgage any such property in such amounts and on such terms as they may deem
advisable, to lease any such property for such term or terms and upon such
conditions and rentals as they may deem advisable, whether or not the term of any
such lease shall exceed the period permitted by law or the probable period of
retention under this instrument; to make repairs, replacements and improvements,
structural or otherwise, in connection with any such property, to abandon any such
property which they may deem to be worthless or not of sufficient value to warrant
keeping or protecting, and to permit any such property to be lost by tax sale or any
other proceedings.
i. To employ such brokers, banks, custodians, investment counsel,
attorneys, and other agents, and to delegate to them such duties, rights and powers
as they may determine, and for such periods as they think fit.
J. To register any securities at any time in their own names, in their
names as fiduciary, or in the names of nominees, with or without indicating the
trust character of the securities so registered.
k. With respect to any securities forming a part of the estate, to vote
upon any proposition or election at any meeting of the corporation issuing such
securities, and to grant proxies, discretionary or otherwise, to vote at any such
meeting; to join or become a party to any reorganization, readjustment, merger,
voting trust, consolidation or exchange, and to deposit any such securities with any
+
committee, depository, trustee or otherwise, and to payout of the assets held
5
hereunder, any fees, expenses and assessments incurred in connection therewith, to
exercise conversion, subscription or other rights, and to receive or hold any new
securities issued as a result of any such reorganization, readjustment, merger,
voting trust, consolidation, exchange or exercise of conversion, subscription or
other rights and generally to take all action with respect to any such securities as
could be taken by the absolute owner thereof
I. To engage in sales, leases, loans, and other transactions with the
estate of my husband or any trust established by either of us, even if they are
fiduciaries or beneficiaries thereof
m. To exercise all elections which they may have with respect to
income, gift, estate, inheritance and other taxes, including without limitation
execution of joint income tax returns, election to deduct expenses in computing
one tax or another, election to split gifts, and election to payor to defer payment
of any tax, in all events without their being bound to require contribution from any
other person.
n. To operate, own, or develop any business or property held here-
under in any form, including without limitation sole proprietorship, limited or
general partnership, corporation, association, tenancy in common, condominium,
or any other, whether or not they have restricted or no management rights, as they
in their discretion think best
6
9. Taxes; I direct that all estate, inheritance, and succession taxes that may be
assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed,
other than generation-skipping taxes, shall be paid out of the principal of my general estate to the
same effect as if said taxes were expenses of administration, except that any suc!l additional taxes
(and interest and penalties thereon) imposed on account of my interest in or power over any trust
established by my husband shall be paid out of the property held in such trust, and all other
property includible in my taxable estate for federal or state tax purposes, whether or not passing
under this will, shall be free and clear thereof; provided, however, that my executor(s) may in the
discretion of my executor(s) request that any portion or all of said taxes (to be paid out of the
principal of my general estate) shall instead be paid out of the principal of any trust established by
me, to the extent expressly authorized under the terms of said trust.
10. Fiduciaries: I appoint as Executor hereunder my husband, JAMES P BOENS. If
he should be unable or unwilling so to serve or to complete the administration of my estate, then I
appoint my daughter, CONNIE L BOENS of New Cumberland, PA to be my Executrix. Ifshe
should be unable or unwilling so to serve or to complete the administration of my estate, then I
appoint the Trust Department of DAUPHIN DEPOSIT BANK AND TRUST COMPANY,
Harrisburg, P A to serve in her place. No individual fiduciary shall be liable for the acts,
omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary
No fiduciary named herein shall be required to furnish bond or other security for the proper
performance of his duties hereunder.
7
I I. Gender: Unless the context indicates otherwise, any use of masculine gender
herein shall also include the feminine gender.
IN WITNESS WHEREOF, I, ANNE G. BOENS, herewith set my hand and seal to this,
my last Will, typewritten on nine (9) sheets of paper including the self-proving attestation clause
and signatures of witnesses, this Z ,,1} day of 1114 ~CH 1996.
~ Jl8~
,
ANNE G. BOENS
(SEAL)
Witnessed:
"LL '~./
~' . J \ .
Vi,,!, 'l.('~~ residingat::)M~~L,tL'.d..t('1f ;'i.((lltfl.1/('i~/".,f1,4"7(r('
L'" I I I .,
1J1~-n, /tJ1tJ-11J,;yIA(J residing at 47// f3rda.JI'''A'r~-I,,' Htdt'J:rbIlO f'A
17///
residing at
ItJ.3,~- tft.f/fl"'~) ~Irf Iv j;1<'1d(,~ I'A
I 706-7
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
I,ANNE G. BOENS, (theTestatrix),and jUL,1f 11, S-rlA-~I(T
:JDj.<~ 1>. 6-(lOW; and nit rrlf"w fJ. I1JOI111tH II (the witnesses), whose
names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the
undersigned authority that the Testatrix signed and executed the instrument as her last will in the
presence of the witnesses and that she had signed willingly, and that she executed it as her free
and voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed the will as witness and that to the best of his
8
knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
y(t~
WIZ.~S: WITNESS
't~ ~ ); vJ- -m~"JYJ. vy()~ '
Subscribed, sworn to and acknowledged before me by ANNE G. BOENS, the Testatrix, and
t:.dk.u/-
TESTATRIX:
~JG.d Ii
ANN G. BOENS
I?; A-f--uJ
WITNESS:
subscribed and sworn to before me by J lA '- I .. /1. S'.,. v ,. M
.}...... P. G,.,oo/<!
711
d!:i- day of /lJ/t~(! 1-/
,and /7:4 rr,,~.. JV ,ft,,.,no</. , the witnesses, this
, 1996
~~~
otary Public
My Commission expires:
Notarial Seal
Laure E. Kane, NOlary Public
Camp Hill 80ro, Cumberland County
My Commission Expires Nov. 15, 19!19
Member, Pennsylvania Association of Notaries
(SEAL)
9
m1 M&rBank
Manufacturers and Traders Trust Company, 344 South 10th Street, Lemoyne, PA 17043
7177373322 FAX?1? 737 6498
February 4, 2005
Connie L. Boens
1457 Maplewood Dr.
New Cumberland, Pa. 17070
Re: Checking Account Number 16250672
Dear Ms. Boens:
As we discussed yesterday, This letter is to provide confirmation of the ownership history
of the above listed account.
Checking account number 16250672 was opened in August of 1964. The account was
originally titled in the joint names of Anne G. Boens and/or James P. Boens. In
December of 2000, the name of James P. Boens was deleted due to his death. At that
time, we added Connie L. Boens as a coowner with Anne G. Boens. The account closed
in August of2004.
If you need any additional verification, please let me know.
Sincerely,
/~c0fJ<<J(~L
~eth A. Prough 0
Bank Officer
fJ7'1/lCt-/nEf..J7
6
m1M&rBank
16250672
M60T CLASSIC CHECK! toG w/r r-TEREST
MAY. 22-JUN22,2004
00 0 06113M N"l 017
774
A Nt\E G BOE r-s
CO NN: E L BOE r;s
342 MESSIAH CIR
MECHA N: CSBURG PA 17055
I t.TEREST PAID YEAR TO DATE
1.48
HIGHLA ID PARK
A MOU tiT
1 703.37
>0.
S
2668.16
pbSt'l'f<;
DATE
ACCOU "T ACTI VITY
OE?OtS{I:l>T:ER~$T:
Ii. H I 0
OS -22 -04 BEGI Nl\I rG SALA teE
05-28-04 CHECK NJMBER 0739
06 -01 -04 PRU A Nt-TY PYMr
06 -01 -04 DEPOSIT
06-02-04 CH!:CK NJMBER 0742
OE -03 -04 US TREASURY 303 SOC SEe
06 -03-04 CHECK !'UMBER 0740
06 -04 -04 CHECK NJMBER 0741
06 -14 -04 CHECK NJMBER 0744
06 -16 -04 REVERSE DIRECT DEPOSIT
06 -17 -04 DEPOSIT
06 -17 -04 CHECK NJMBER 0745
06 -17 -04 CHECK NJMBER 0743
06-18-04 CHECK NJMBEI', 0746
06 -22 -04 I "TEREST PAY ME 1-1'
34.19
405.49
81. 40
360.00
1,066.00
178.20
16.07
60.10
1,066.00
150.48
42.59
1B.96
351. 00
0.23
E I'D I tG BALA teE
1 OF 2
0.23
2 244.65
~
(-,=:.,_.~-~._~. ::~~.:~.
3,120.86
2,760.86
3,648.66
3,632.59
3,572.49
2,506.49
2,595.42
2,244.42
2,244.65
'daecf($>~A:i:i) sv~P::t
$2 244.65
739 05-28-04
742 06-02-04
745 06-17-04
140 06-03-04-
743 06 -17 -04
746 06-18-04
34.19
360.00
42.59
17B.20
1 B. 96
351.00
741 06-04-04
744 06 -14 -04
ANNJAL PERCE]\'l'AGE YIELD EARl'ED'" 0.10 %
16.07
60.10
~ AmeriChoic~
- 1 FEDERAL CREDIT UNION
Building Relationships For Life
July 28, 2004
S. Berne Smith
Attorney-at-Law
107 N. 24th Street
Camp Hill, Pa 17011-3602
RE: Estate of Anne G. Boens
Account #33642
SS #204-18-9054
The accounts are as follows:
Account Type
Date Opened
DOD Balance
Dividend @ DOD
Savings 01
Money Market 18
10/13/01
10/13/01
$ 25.82
$ 105,216.83
$ .02
$ 113.43
The deceased, does not have a safe deposit box.
Connie L. Boens is joint owner ofbotb Money Market (18) and Savings (01) account #33642.
Please call me at (717) 697-3474 if you need further assistance.
~~.~
Amanda C. Lyon
Member Service Representative
/JrTPtc.nhEfVT
c
Total Balance
$ 25.84
$ 105,330.26
Main Office: 2175 Bumble Bee Hollow Road. Mechanicsburg, PA 17055 . Phone: (717) 697.3474
~ l]f.uA"1
LIND'R ...--
Website: www.americhoice.org
. Fax: (717) 697-3713
o
emiT uN'ioNs'
MetLife'
July 16,2004
S BERNE SMITH
ATTORNEY AT LAW
IO! N ~4TH ST
CAMP HILL PA 17011
(:(U?,y,_:J:Q,:
IA YLOR RANKLR
Wi\I.NUT STRLET SECLRITIES
801 E PARK DR. STE 10.\
IL-\RRJSBI.'R(; PA 171 11
RE: Contract Number 3201125307
Anne G Boens
Dear Mr. Smith:
We have received your request for information on the annuity contract referenced above.
This variable annuity contract was issued to Anne G Boens, solely, on April 26, 2004, in the amount
of $226,729.69. The post-tefra principal was $50,000.00. Any amount over $50,000.00 is taxable.
As of the date of death, May 30, 2004, the account value was $224,599.67, the death benefit was
$226,729.69. The death benefit as of the date all requirements to pay the claim were received, June
30,2004, the death benefit was $227,870.18
We hope this information will be beneficial and if there are any further questions, please contact a
Variable Annuity Service Representative at (800) 343-8496. Our staff will gladly assist you
between the hours of 7:30 a.m. and 5:30 p.m., Central Time, Monday through Thursday, and
from 7:30 a.m, until 5:00 p.m., Friday.
Sincerely,
~/ -7"-_~-'
/' ~_.. __..;;h~'
Tom Smithson
Variable Annuity Customcr Service
Enclosures
II rTAL r-fn6',,"'T D
Rev. 02/2001
Metlife Investors USA Insurance Company
Please Send All Correspondence To:
;) r.',_, ,-1:;9;; };-.'. i/..';''''', If ""'10:' ~5'):;
For Express Moil Only:
117(\) \,'Vf,_'Ir;w,; hHk".",l' '-,uiit. '):")(,\ \\e:i: D(,,; ;\\e,ir""o 1/\ ,)(!'266c-./; d
:)~I SOD )/:L" ,-!YL',
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF' INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17\213-060'
REV.1162 EX(11.96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SMITH S BERNE ESQ
107 N 24TH ST
CAMP Hill, PA 17011-3602
fOld
ESTATE INFORMATION: SSN: 204-18-9054
FILE NUMBER: 2104-0565
DECEDENT NAME: BOENS ANNE G
DATE OF PAYMENT: 02/28/2005
POSTMARK DATE: 02/25/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/30/2004
NO. CD 004995
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $15,107.78
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$15,107.78
REMARKS:
CHECK#1022
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
DF DEDUCTIONS AND ASSESSHENT OF TAX
BUREAU OF INDIVIDUAPTA)[eS:"
INtERITANCE TAX DIVISION'-:-'
PO BOX 280601
HARRISBURG Pi 17128-0601
'( rn N' I'" L I
,,-U rrl C, 4
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CLERK OF
ORPHANS COURT
S BERNE O>J.~TIf'!E$q; "() . 81,
107 N 24TH ST
CAMP HILL PA 17011
05-23-2005
BOENS
05-30-2004
21 04-0565
CUMBERLAND
101
A""""~ R_iUad
*'
REV-1547 EX AFP (03-05)
ANNE
G
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LIME ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
11~V-~4"Yl.X\!'J.m!'U!'.mtm.w.!FMI!Ilrt'~wt.m.lWl1lTftwm':.'X'I:r.!III'~wt.l)r.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOENS ANNE G FILE NO. 21 04-0565 ACN 101 DATE 05-23-2005
TAX RETURN liAS: I X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. S~ocks ..... Bonds (Schadul. B)
3. Closely Held Stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. ~ointly Owned Property (Schedule F)
7. Transfers (SChedule G)
8. Total Assets
ll)
(2)
(3)
(4)
(5)
(6)
(7)
.00
11.828.10
.00
.00
2.032.71
91. 025.67
226.729.69
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governll8l'ltal Bequests; Non-elected 9113 Trusts (Schedule ,J)
14. Net Value of Estate Subject to Tax
(9)
IlO)
9,157.47
I~ an assessment was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. ~ount of Line 14 at Spousal rat. (IS)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. Aaoun~ of Line 14 ..~ Sibling r..~. (17)
18. Amount of Line 14 t.xable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX DI S'
NOTE:
5.063.48
Ill)
112)
113)
114)
.00 X
302,395.22 X
.00 X
10,000.00 X
.
DATE
02-25-2005
NUIIBER
CD004995
INTEREST/PEN PAID (-)
.00
AHOUNT PAID
15,107.78
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
00 =
045 =
12 =
15 =
(19)=
NOTE: To insure proper
credit to ~O\Ir account,
s~it the upper portion
of this form with your
tax pay......t.
331,616.17
14.2:1'0 'l'i
317,395.22
5,000.00
312,395.22
.00
13,607.78
.00
1,500.00
15,107.78
15.107.78
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
"
PENNSYLVANIA
REV - 1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE QNL Y
COMMONWEALTH OF
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
FILE NUMBER
21
COUNTY CODE
0565
NUMBER
f-
Z
W
o
W
U
w
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOENS, ANNE G.
DATE OF DEATH DATE OF BIRTH
May 30,2004 March 10, 1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
None
SOCIAL SECURITY NUMBER
204-18-9054
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
.
':'::~<fJ
u"~
. ~u
..ce.2
o ~ro
~
~
Original Return
X 2. Supplemental Return
3. Remainder Return (date of death prior to 12-
13-82)
4 limited Estate
4a. Future Interest Comprise {dale of death aller 12-12-82)
5. Federal Estate Tax Return Required
9 Litigation Proceeds Received
1 D. Spousal Poverty Credit (dale of death between 12.31.91 and 1.1-95)
o 8. Total Number of Safe Deposit Boxes
D 11, Election to tax under See 9113(A)
(Attach Sch 0)
6 Decedent Died Testate (Attach copy of Will)
7, Decedent Maintained a Living Trust (Mach a copy of Trusf)
c
=
~
=
'"
=
~
~
C5
C>
THIS SECTION MUST BE COMPLETED.
NAME
S. BERNE SMITH. ESO
FIRM NAME (If Applicable)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
107 N, 24TH STREET
CAMP HILL, PA 17011-3602
TELEPHONE NUMBER
717-737-6789
Real Estate (Schedule A)
(1)
$0.00
OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B)
(2)
$0.00
3 Closely Held Corporation, Partnership or Sole-Proprietorship
(3)
$0.00
c_
z
o
I-
<{
--l
:::l
I-
0...
<{
U
W
~
4. Mortgages & Notes Receivable (Schedule D)
(4)
$0.00
5 Cash, Bank Deposits & Mise, Personal Property (Schedule E)
(5)
$18,812.48
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
(6)
$0.00
9 Funeral Expenses & Administrative Costs (Schedule H)
(9)
$000
(8)
$15.00
$0.00
(11)
(12)
(13)
(14)
r,",
7 Inter-Vivos Transfers & Mise Non-Probate Property
(Schedule G or L)
(7)
8 Total Gross Assets (total Lines 1-7)
$18,812.48
10 Debts of Decedent, Mortgage Liabilities & Liens (Schedule I)
(10)
11. Total Deductions (total Lines 9 & 10)
$1500
12 Net Value of Estate (line 8 minus Line 11)
$18,797.48
13 Charitable and Governmental Bequests/See 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)
$18,797.48
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)
x 0,00 (15)
$0,00
z
o
~
X~
~~
~~
~
~
o
o
16 Amount of line 14 taxable allineal rate
$18,797.48
x 4,5% (16)
$84589
17 Amount of line 14 taxable at sibling rate
x 12 (17)
$0.00
18 Amount of line 14 taxable at collateral rate
x .15 (18)
$(] (](]
19 Tax Due
(19)
$845.89
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Copyright 2000 David James Thorpe, Esq
Decedent's Complete Address:
STREET ADDRESS
342 Messiah Circle
CITY
Mechanicsburg
] STATE
IPA
IZIP
117055
(4)
(5)
(5A)
(5B)
REGISTER OF WILLS, AGENT
Tax Payments and Credits:
1 Tax Due (Page 1 line 19)
2 Credits/Payments
A. Spousal Poverty Credit
S. Prior Payments
C Discount
Total Credits (A + B + C)
3 Interest/Penalty if applicable
D. Interest
E Penalty
4
TotallnterestlPenalty (0 + E)
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
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the lax due.
5
B Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to:
(1)
$845.89
(2)
$0.00
(3)
$0.00
$845.89
$845.89
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
2
Did decedent make a transfer and
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 revisionary interest; or
d, receive the promise for life of either payments, benefits or care?
If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer properly without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Did decedent own an individual retirement account, annuity, or other non-probate property?
3
4
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLE
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Connie l. Boens, Executrix
ADDRESS
1457 Map\ewood Drive, New Cumberland, PA 17070
SIGNATURE OF PREPARER OTHER THAN REPRESENTAT.IVE 1) /1 ().
S,BERNESMITH,ESQ. .................J I fi3~ /r~\
ADDRESS
107 N. 24TH STREET, CAMP HILL, PA 17011.3602
Ye,
~
No
;
B
~
fmyknowledgeandbelief, it istrue,correcL and complete
,2005
DATE
May 3( ,2005
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3% [72 PS. 39116 (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.
59116 (a) (1.1) (ii)]. The statute does no 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 a1
adoptive parent, or a stepparent of the child is 0% [72 P.S. 59116(a) (1.2)J.
n APD
nt, an
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4S
PS 39116(a) (1)].
)[72
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.
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood 0
er
T,~1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ANNE G. BOENS
FILE NUMBER
21-04-0565
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
$362.48
Refund _ (Waiver of Premium) from Penn Treaty Network American Ins. Co., 3440 Lehigh Street, Allentown, PA
18103 -long term care premium
2
Payment from long term care company ~ Penn Treaty Network American Ins. Co., 3440 Lehigh Street. Allentown,
PA 18103 - for nursing home care
18,45000
TOTAL (Also enter on line 5, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$18,812.48
Copyright 2000 David James Thorpe, Esq
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF ANNE G. BOENS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
FILE NUMBER
21-04-0565
DESCRIPTION
AMOUNT
A
FUNERAL EXPENSES:
B
1.
2.
3
4.
5.
6.
7.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s} Commission Paid:
Attorney Fees:
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
Accountant's Fees -
Tax Return Preparer's Fees-
Additional Administrative Expenses - Filing fee for Supplemental Pennsylvania Inheritance Tax return
$15.00
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$15.00
Copyright 20()() D<lvid James Thorpe, b(j
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ANNE G. BOENS
Date of Death: May 30, 2004
File No. 2004-00565 Admin. No. 21-04-0565
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: Yes _X_ No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: Not applicable.
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: Not applicable.
C.
Did the personal representative state an account informally to the parties in
No X
interest? Yes
D. Copies ofreceipts, releases,joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attacked to this report.
Note: Releases of all specific bequest beneficiaries are attached hereto.
Date: July I 2.... , 2005
-J
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Signature
S. Berne Smith, Esq.
Name (Please type or print)
Address: 107 N. 24th Street
Camp Hill, P A 17011-3602
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Telephone No. 717-737-6789
Capacity:
Personal Representative
_X_Counsel for personal representative
~
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF
ANNE G. BOENS, DECEASED
ORPHANS' COURT DIVISION
No.2 I -04-0565
RECEIPT FOR DISTRIBUTION AND RELEASE OF EXECUTRIX
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Jane O. Vu, being beneficially interested in the above titled estate, hereby acknowledges to
have received from Connie L. Boens, Executrix of the Estate of Arme G. Boens, Deceased, the
following distribution:
Payment of a specific bequest in the amount of Five Thousand Dollars ($5,000.00)
and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be
entered in said Estate.
In consideration of this distribution being made prior to the filing and audit of a Final
Account, Jane 0 Vu hereby agrees to refund on demand, all or any part ofthis distribution which
may be determined to have been improperly made. She further acknowledges that the distribution
made is in full payment under the Will of Alme G. Boens, Deceased; that she by signing this
document does hereby release and forever discharge Connie L. Boens, Executrix, from any and all
liability which may from time to time arise in connection with her service as Executrix of the Estate
of Arme G. Boens; and does further agree to indemnify and hold ham1less said Cormie L. Boens,
Executrix, tram any and all liability which may arise against the estate from creditors or other
claimants to the extent of the distribution made to her.
This release and declaration shall be made part of the final, informal or formal settlement or
account of the estate proceedings and indexed and recorded as sLlch, and it shall be binding upon
her respective heirs, successors and assigns, and governed by the laws of the Commonwealth lJf
Permsyl vania.
Dated this ~ day of AUJus+ ,2004.
WITNESS: JANE O. VU
/' .,1/'
BY,-,I/%If.J. () IL--
I
By:
.- I d
.""""t.~-~.
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF
ANNE G. BOENS, DECEASED
ORPHANS' COURT DIVISION
No. 21-04-0565
RECEIPT FOR DISTRIBUTION AND RELEASE OF EXECUTRIX
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Laura T. Vu, being beneficially interested in the above titled estate. hereby acknowledE'es to
have received from Connie L. Boens, Executrix of the Estate of Anne G. Boens, Deceased, the
following distribution:
Payment of a specific bequest in the amount of Five Thousand Dollars ($5,000.00)
and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be
entered in said Estate.
In consideration of this distribution being made prior to the tiling and audit of a Final
Account, Laura T. Vu hereby agrees to refund on demand, all or any part of this distribution which
may be determined to have been improperly made. She further acknowledges that the distribution
made is in full payment under the Will of Anne G. Boens, Deceased; that she by signing this
docmnent does hereby release and forever discharge Connie L. Boens, Executrix, from any and all
liability which may from time to time arise in cOlUlection with her service as Executrix of the Estate
of Anne G. Boens; and does further agree to indemnify and hold harmless said Connie L. Boens,
Executrix, from any and all liability which may arise against the estate from creditors or other
claimants to the extent of the distribution made to her.
This release and declaration shall be made part of the final, informal or formal settlement or
account ot the estate proceedings and indexed and recorded as such, and it shall be binding upon
her respective heirs, successors and assigns, and governed by the laws of the Commonwealth of
PelUlsy I vania.
Dated this ",;)(b day of Ju./ 't
WITNESS: G/el') Slr'flle
,2004.
LAURA T. VU
By: X2L 41
By:
/~ T Yv.-
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYLV ANIA
IN RE: EST ATE OF
ANNE G. BOENS, DECEASED
ORPHANS' COURT DIVISION
NO.2] -04-0565
RECEIPT FOR DISTRIBUTION AND RELEASE OF EXECUTRIX
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Jane O. Yu, being beneficially interested in the above titled estate, hereby acknowledges to
havc received from Connie L. Boens, Executrix of the Estate of Anne G. Boens, Deceased, the
following distribution:
Payment of a specific bequest in the amount of Five Thousand Dollars ($5,000.00)
and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be
entered in said Estate.
In consideration of this distribution being made prior to the filing and audit of a Final
Account, Jane O. Yu hereby agrees to refund on demand, all or any part of this distribution which
may be determined to have been improperly made. She further acknowledges that the distribution
made is in full payment under the Will of Anne G. Boens, Deceased; that she by signing this
document does hereby release and forever discharge Connie L. Boens, Executrix, from any and all
liability which may from time to time arise in connection with her service as Executrix of the Estate
of Anne G. Boens; and does further agree to indemnify and hold ham11ess said Connie L. Boens,
Executrix, from any and all liability which may arise against the estate from creditors or other
claimants to the extent of the distribution made to her.
This release and declaration shall be made part of the final, informal or formal settlement or
account of the estate proceedings and indexed and recorded as such, and it shall be binding upon
her respective heirs, successors and assigns, and governed by the laws of the Commonwealth of
Pennsylvania.
Dated this ~ day of AUJ liS+ , 2004.
WITNESS: JANE O. YU
By
/' fYI'
'-'fC%!U It.-
By:
. Id
'~'---<,v--~
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNS YL VANIA
IN RE: ESTATE OF
ANNE G. BOENS, DECEASED
ORPHANS' COURT DIVISION
No. 21-04-0565
RECEIPT FOR DISTRIBUTION AND RELEASE OF EXECUTRIX
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Laura T. Vu, being beneficially interested in the above titled estate. hereby acknowJedres to
have received from Connie L. Boens, Executrix of the Estate of Anne G. Boens, Deceased, the
following distribution:
Payment of a specific bequest in the amount of Five Thousand DoIlars ($5,000.00)
and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be
entered in said Estate.
In consideration of this distribution being made prior to the filing and audit of a Final
Accowlt, Laura T. Vu hereby agrees to refund on demand, all or any part of this distribution which
may be determined to have been improperly made. She further acknowledges that the distribution
made is in full payment under the Will of Anne G. Boens, Deceased; that she by signing this
document does hereby release and forever discharge Connie L. Boens, Executrix, from any and all
liability which may from time to time arise in connection with her service as Executrix of the Estate
of Anne G. Boens; and does further agree to indemnify and hold harmless said Connie L. Boens,
Executrix, from any and all liability which may arise against the estate from creditors or other
claimants to the extent of the distribution made to her.
This release and declaration shall be made part of the final, informal or fomlal settlement or
account of the estate proceedings and indexed and recorded as such, and it shall be binding upon
her respective heirs, successors and assigns, and governed by the laws of the Commonwealth of
PelU1sylvania.
day of Jtt / if
WITNESS: Gle/l 5I-r'y/e
Dated this ,;)&;;
,2004.
LAURA T. VU
By:
By:
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S. BERNE SMITH
Attorney-at- Law
107 N. 24th Street
Camp Hill, PA 17011-3602
PHONE: (717) 737-6789
FAX: (717)737-6783
September 21,20105
In re: Anne G. Boens; DOD May 30, 2004; SS# 204-18-9054
PA File No. 21-04-0565; File 2004-00565
My File: 3004
Ms. Glenda Farner Strasbaugh
Register of Wills
Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
Dear Ms. Strasbaugh:
Please find enclosed my check in the amount of $11.01 to pay the additional Pennsylvahia
Inheritance Tax due on the above Estate. The check is payable to Register of Wills, Agent. Th~nk
you for your attention to this. !
Sincerely yours,
~ f310 -~l
S. Berne Smith
Enclosures:
cc: Connie L. Boens, Executrix
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 008833
SMITH S BERNE ESQ
107 N 24TH ST
CAMP HILL, PA 17011-3602
ACN
ASSESSMENT
CONTROL
NUMBER
I
AMOU~T
____un fold
101
$ 1 1 .011
I
ESTATE INFORMATION: SSN: 204-18-9054
FILE NUMBER: 2104-0565
DECEDENT NAME: BOENS ANNE G
DATE OF PAYMENT: 09/23/2005
POSTMARK DATE: 09/22/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/30/2004
TOTAL AMOUNT PAID:
I
$11.q1
REMARKS:
CHECK# 676
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
09-19-2005
BOENS
05-30-2004
21 04-0565
CUMBERLAND
101
APPEAL DATE: 11-18-2005
(See reverse side under Objections)
Amount Rem:i.tted[ ]
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +-
iE.:iS"-E'-AFP-'.':.';-"T;CE-.F-;"E.;TANCE-TA'-APP";'EMENT;-ALL.WANCE-OR----------_____
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANNE G FILE NO. 21 04-0565 ACN 101
BUREAU Of INDIVIDUAk'irA:icE~
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT DF TAX
: ~ 1 :
'i I
Ii
';,.1. ~r
::.... ,~.'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
S BERNE SMITH ESQ
107 N 24TH ST
CAMP HILL
PA 17011
ESTATE OF
BOENS
REV-1547 EX AFP (06-05)
ANNE
G
TAX RETURN WAS: (X) ACCEPTED AS FILED
DATE 09-19-2005
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST _ SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (SchedUle E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
.00
.00
.00
18.812.48
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExpenseS/Adm. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage LiabilitieS/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate SUbject to Tax
15.00
. OQ..
(11)
112)
113)
114)
NOTE: I~ an assessment was :i.ssued previoUSly, l:i.nes
re~lect ~:i.gures that :i.nclude the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at SPousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Cless B rate (18)
19. Principal Tax Due
NOTE: To insure proper
credit to Your account,
submit the upper portion
of this form with Your
tax payment.
18,812.48
lEi nn
18,797.48
.00
331,192.70
14, 15 and/or 16, 17, 18 and 19 w:i.ll
returns aSseSsed to date.
TAX CREDITS:
.. n"..".Lr , I+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (_)
02-25-2005 ,,' CD004995 .00 15,107.78
06-03-2005 CD005392 .00 845.00
06-03-2005 " CD005399 .00 .89
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-04-2005 TOTAL TAX CREDIT 15,953.67
BALANCE OF TAX DUE .00
INTEREST AND PEN. 11.01
TOTAL DUE 11.01
.00 X 00 =
321,192.70 X 045=
.00 X 12 =
10,000.00 X 15 =
119)=
· IF PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST.
.00
14,453.67
.00
1, 500.00
15,953.67
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR), YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS fORH fOR INSTRUCTIONS.)
pJ-
BUREAU OF INDIVIDUAir~~~~
INHERITANCE TAX DIYISIcIM::'" '. "
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REY-1607 EX AFP (03-05)
'..'~ ':..)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-11-2005
BOENS
05-30-2004
21 04-0565
CUMBERLAND
101
ANNE
G
"... ,
, , ~:""l.- '"!. n
r'
S BERNE "S'MITH
107 N 24TH ST
CAMP HILL
ESQ
Allount Rellitted
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
---------------------------------------------------------------------------
.-.
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF BOENS ANNE G FILE NO.21 04-0565 ACN 101 DATE 10-11-2005
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-19-2005
PRINCIPAL TAX DUE: 15,953.67
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-25-2005 CD004995 .00 15,107.78
06-03-2005 CD005392 .00 845.00
06-03-2005 CD005399 .00 .89
09-22-2005 CD005833 11.01- 11.01
TOTAL TAX CREDIT 15,953.67
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l
C b"v