HomeMy WebLinkAbout04-0586Estate of
also known as
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
PAUL DAVID RAFFERTY No. ~" j
, Deceased Social Security No. 162480203
Petitioner(s), who is/are 18 years of age or older, apply)les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated 3/4/94 and codicil(s) dated N/A
rix
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated 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 1122 Laurel Avenue, (Lower Allen Township/
(list street, number and municipality)
Decedent, then 40 years of age, died April 29 , 2004 , at Temple Universib/Hospital, Philadelphia
(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 ..................................................................................................................... $
60,000.00
60,000.00
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
DOROTHY ISABEL RAFFERTY
1122 LAUREL AVENUE
CAMP HILL, PA 17011
LAST W~T.T. AND TESTAMENT
PAUL DAVID R/~FER'I"J~
I, PAUL DAVID RAFFERTY, Social Security Number 162-4870203, of the
State of Pennsylvania, declare that I am a member of the United States
Armed Forces and that I am currently living in North Carolina pursuant
to Military Orders. I declare that this is my LAST WILL ~D TESTAMENT
and I revoke all other wills and codicils previously made by me.
FIRST: I appoint my mother, DOROTHY ISABEL RAFFERTY, as my
Personal Representative concerning this Will.
a. I request that my Personal Representative be permitted to
serve without bond or surety thereon and without the intervention of
any court, except as required by law. I direct that my Personal
Representative act in unsupervised administration so as to administer
my estate with a minimum of court supervision. If it becomes necessary
to have ancillary administration of my estate in any jurisdiction where
my Personal Representative is unable or does not desire to qualify as
ancillary legal representative, I appoint as such ancillary legal
representative such individual or corporation as my Personal
Representative shall designate, in writing.
b. I direct my Personal Representative to pay the expenses
of my last illness, the expenses of a funeral appropriate to my station
in life and custom of living (including a suitable monument or marker
for my grave), and written charitable pledges which I have made. I
grant my Personal Representative the power to extend or renew any debt
for such time as my Personal Representative shall deem appropriate.
c. Ail estate, inheritance, succession and other death taxes
with respect to all property passing under this my Will shall be paid
from and borne by the principal of my residuary estate, without regard
to reimbursement, as if such taxes were administration expenses. My
Personal Representative may pay such taxes at any time deemed
advisable, whether or not then due and payable.
d. My Personal Representative is requested to settle my
estate as soon after my death as may be practicable, and to pay or
deliver every legacy or bequest to my beneficiaries without waiting any
time that may be believed to be customary in probate matters.
e. I have served in the Armed Forces of the United States.
Therefore, I direct my Personal Representative to consult with a Legal
OF 4 PAGES
Assistance Attorney at the nearest military installation and with the
Department of Veterans Affairs and the Social Security Administration
to ascertain if there are any benefits to which my family members are
entitled by virtue of my military service.
SECOND: I give, devise and bequeath, absolutely and forever, all
of my estate and property of which I may be seized or possessed, or to
which I may be entitled, at the time of my death, wherever situated or
of whatever nature, be it real, personal, or mixed, to my mother,
DOROTHY ISABEL RAFFERTY, as her sole and absolute property if she shall
survive me.
THIRD: In the event that all previously named takers under this
will shall not survive me, I give, devise and bequeath, absolutely and
forever, all of my estate and property of which I may be seized or
possessed, or to which I may be entitled, at the time of my death,
wherever situated or of whatever nature, be it real, personal, or
mixed, to my daughter, ALEXA RHEA RAFFERTY, and to any child or
children that have been or may be born to or adopted by me, in shares
of substantially equal value to be divided as they may agree.
a. If any of my children shall not survive me, then the
share of that deceased child shall go to the descendants of that child,
who are to take per stirpes and not per capita. If any of my children
shall not survive me and shall not be survived by any descendants, then
the share of that deceased child shall be distributed to my surviving
children and the descendants of any of my other children who fail to
survive me, in the manner set forth above.
b. If they are unable to agree, the division among my
children and the descendants of any of my children who fail to survive
me shall be made by my Personal Representative, in that person's sole
and absolute discretion. I empower my Personal Representative to sell
any or all of such property, if such property is not distributed in
kind hereunder, and to distribute the proceeds among my said children
in substantially equal shares. Any determination of my Personal
Representative as to what should pass or be sold under this paragraph
and to whom it should pass or be delivered or at what price it should
be sold shall be conclusive.
FOURTH: If any beneficiary to any share of my estate which is not
subject to the provisions of any trust which may be created by this
will is at the time of distribution of his or her share, a minor under
the laws of his or her domicile, I direct that the minor's share be
converted into qualifying property and delivered to my brother, WILLIAM
JAMES RAFFERTY, as Custodian for the minor under the Uniform Gifts to
Minors Act or the Uniform Transfers to Minors Act as may then be in
effect in either the state in which the beneficiary or the Custodian
resides, or any other state of competent jurisdiction.
PAGE 2 ~
a. The Uniform Gifts to Minors Act or The Uniform Transfers
to Minors Act, as may then be in effect in the state concerned, is
hereby incorporated by reference. The property affected by the Act
shall be managed, held, and distributed in accordance with the
provisions of the Act.
b. The financial custodian will serve without bond or surety
and without intervention of any court, except as required by law.
c. The receipt by the Custodian, for the minor, of any
principal or income transferred pursuant to this paragraph shall be a
full acquittance and discharge of my Personal Representative or
Trustee, as applicable, from liability with respect to such transfer
and from further accountability for the principal or income so
transferred.
FIFTH: Except as otherwise provided in this Will, I have
intentionally failed to provide for any other relatives or other
persons, whether claiming to be an heir of mine or not. Insofar as I
have failed to provide in this Will for any of my issue now living or
later born or adopted, such failure is intentional and not occasioned
by accident or mistake. I specifically intend to omit my wife, KALEN
CRUMPLER RAFFERTY.
SIXTH: Any beneficiary who fails to survive until one. hundred
twenty (120) hours after my death shall be deemed to have Predeceased
me, and the gift to that beneficiary shall be disposed of accordingly.
SEVENTH: The term "Personal Representative,, as used in this Will
means Executor, Executrix, Independent Executor, or any other title of
like import which is used to describe such a fiduciary.
EIGHTH: In the event that I shall die leaving a minor child or
children surviving me, I hereby appoint my mother, DOROTHY ISABEL
RAFFERTY, as Guardian of each minor child of mine, during his or her
minority. The Guardian shall serve without bond or surety and without
the intervention of any court or courts, except as required by law.
NINTH: In addition to any powers granted by the laws of the state
in which this Will is probated, I hereby authorize and empower the
fiduciaries named in this Will, to the extent of the discretion herein
granted, to sell, exchange, convey, transfer, assign, mortgage, pledge,
lease or rent the whole or any part of my real or personal estate, to
invest, reinvest, or retain investments of my estate, to perform all
acts and to execute all documents which my fiduciaries may deem
necessary or proper in regard to my property. If any of my fiduciaries
elect to receive compensation for services, such compensation will be
that allowed by law.
TENTH: If any part of this Will shall be invalid, illegal, or
inoperative for any reason, it is my intention that the remaining
o7 4 PAGES
parts, so far as possible and reasonable, shall be effective and fully
operative. My Personal Representative may seek and obtain court
instructions for the purpose of carrying out as nearly as may be
possible the intention of this Will as shown by the terms hereof,
including any terms held invalid, illegal, or inoperative.
IN WITNESS WHEREOF, I have at Yuma Proving Ground, Yuma,
Arizona, on March 4, 1994, set my hand and seal to this my LAST WILL
AND TESTAMENT, consisting of 4 typewritten pages, each page bearing my
handwritten signature.
This document was prepared under the authority of 10 U.S.C,
section 1044, and implementing military regulations and instructions,
by CPT David W. Starratt, who is licensed to practice law in
Pennsylvania. ~ ~b~C~ ~~~~ (SEAL)
PAUL DAVID RAFFERTY
The foregoing instrument was, at ~ ~:~ ~v~, ~ .~ ,
on March 4, 1994, signed, sealed, published and declared by PAUL DAVID
RAFFERTY, the testator, to be his LAST WILL AND TESTAMENT in the
presence of all of us at one time, and at the same time we, at his
request and in his presence and in the presence of each other, have
hereunto subscribed our names as attesting witnesses, and we do so
verily believe that the said testator is of sound and disposing mind
and memory at the date hereof.
PAGE 4
OF 4 PAGES
State of Arizona
County of Yuma
ACKNOWLEDGMENT
I, PAUL DAVID RAFFERTY, testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
PAUL DAVID RAFFERT~
AFFIDAVIT
We, ~ ~3. ~ {.~ , ~cc~ ie_~ ~. C~[ [~ , and
~ I/I/D~ ~_. ~~. , the witnesses, sign our names to this
instrument,-being duly qualified according to law, do depose and say
that we were present and saw the testator sign and execute the
instrument as his Last Will; that the testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence._
Witness Witness W~t~ness
Subscribed, sworn to and acknowledged before me by PAUL DAVID
RAFFERTY, the testator, and subscribed and sworn to before me by
~/~/ , the witnesses, on March 4, 1994.
/-%
NOTARY PUBLIC My Commission Expires: / ~J4
CERTIFICATE OF NOTICE UNDER RULE 5.6{a}
NAME OF DECEDENT: PAUL DAVID RAFFERTY
DATE OF DEATH: April 29, 2004
WILL NO.: ADMIN NO.: 2004-00586
TO THE REGISTER:
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 August 23, 2004:
NAME
Alexa Rae Rafferty
ADDRF_.~S
131 Harris Avenue, Raeford, NC 28376
Notice has now been given to all persons entitled thereto under Rule 5.6(a)
except: NONE
DATE: 08/23/2004
SIGNATURE
NAME
CHARLES E. PETRIE
ADDRESS 3528 Brisban Street
Harrisburg, PA 17111
TELEPHONE (717} 561-1939
CAPACITY:
__ Personal Representative
X Counsel for Personal Representative
Ford Motor Credit Company
P.O. Box 689007
Franklin, TN 37068-9007
Date: October 5, 2004
'Fo:
Cumberland County Clerk of Court
Probate Division
1 Court House Square
Caflisse, Penn 17013
Re~
Estate of Paul D. Rafferty - File #2004-0058 ~3
Account Number: 34539262
Customer's Name: Paul D. Rafferty
Vehicle Type: 2003 Ford Focus
Vehicle Identification Number: 3FAFP31333R 117887
Enclosed are documents supporting this claim in the amount of $13,344.02 against the Estate of
Paul D. Rafferty. Please acknowledge receipt of this claim using the enclosed postage-paid
envelope.
If you need further information, please contact me at 1 (877) 224-1262, ext. 52741.
FORD MOTOR DIT
ol
Customer Accounts Representative
Enclosures
SUBSCRIBED AND SWORN TO ME BY Linda Polk, who is known to me or identified
hin~elf/herself, on this 5 October, 2004.
Nohry Public
My Commission Expires: ~?~J~'~
(SEAL)
Ford Motor Credit Company
P.O. Box 689007
Franklin, TN 37068-9007
Date: October 5, 2004
Account Number: 34539262
Customer's Name: Paul D. Rafferty
Vehicle Identification: 3FAFP31333R117887
To: Estate of Paul D.Rafferty,
At your request, we are providing you with the amount required to pay the account in full, provided
payment is made on or before the expiration date of 10/15/2004. If payment is not made by the expiration
date, please request a revised pay-off amount.
Amount to Pay in Full: $13,344.02
Expiration Date 10/15/2004
Please send the payoff with customer account number to the following address:
Ford Motor Credit Company
Attn: Dept A
P.O. Box 689007
Frankl!,~ 37068
1-877-224-1262 x52741
NORT~ CAR~}L~NA SIMPLE INTEREST VEHICLE RETAIL INSTALMENT CONTRACT DATE
YOUR CHOICE.
LIABILITY INSURANCE COVERAGE FO~
BODILY iNJURY AND PROPERT~
DAMAGE CAUSED TO OTHERS IS
INCLUDEO.
CREDIT LIFE, CREDfi' DISABILITY AN[
FEDERAL TRUTH4N-LEN~NG DISCLOSURES
ANNUAL I FINANCE I Amouflt Total of Total Sale
PERCENTAGEI CHARGE[ Financed Payme~ta Price
YOU ACKNOWLEDGE THAT YOU I
BY THE ARBITRATION PROVISION ON THE REVERSE SIDE OF THIS
NOT]CE TO THE BUYER
OTHER OPTIONAL INSURANCE ARE
NOT REQUIRED TO OBTAIN CREDiT
AND WiLL NOT BE PROVIDED UNLESS
YOU SIGN AND AGREE TO PAY THE
PREMIUM.
Prem~]~m~ Insure(i(s)
Signaiure
Program No. _
QUESTIONS?
MVR 191 (Rev 11/01)
CERTIFICATE OF TITLE
VEHICLEIDENTIFICATIONNUMBER
SFAFP3~303Rli7887
TiTLENUMBER
770~76f13L561080
YEAR MODEL MAKE BODYSTYL£
2005 FORD 2S
TITLEISSUE DATE PREVIOUSTITLENUMBER
06/07/2fl0~
h,lhlh,,,,Ih,h,lh,l,,I,hh,,llh,,,h,lll,,,,h,h,hll I
FORD MOTOR CREDIT COMPANY
000096
PO BOX I05706
ATLANTA GA 30048-5706 ODOMETER STATUS
F"'""~ " "" ~::"
OWNER(S) NAME AND ADDRESS
PAUL DAVID RAFFERTY
2100 JUNE JOHNSON RD
RAEFORD NC 20376-8171
BY
I IIIglllilllllllllfflllllllallllllllllllllllllllllllilllllllllillllllJi]ll
The Commissioner of Motor 'vehicles of lbo State orNorth Carolina hereby ccMJfics thai an application for a certificate of title for thc herein described *ehicle
has be~n filed porsuant Io the General Statutes of North Carolina and based on that application, the Division of Motor Vehicles is ~atisfied that the applicant
is the lawful owner, Official r~c,o~ds of the Dtviston of Motor X&hicles reflect vehicle is subject to the liens, il'any, herein enumerated at the date of issuance
of this certificate.
WITNESS, his hand and se. al of th~s Division of the day and year appearing in this certificate as the title issue date.
FIRSTLIENHOLDER:
FOR0 MOTOR CREDIT COMPANY
PO BOX ~05706
ATLANTA GA $0068-5706
DATE OF LIEN 05/20/2003
LIEN RELEASED BY:
SIGNATURE --
TITLE
DATE
SECOND LIENHOLDER'
DATE OF LIEN
LIEN RELEASED BY:
SIGNATURE _
TITLE
DATE
THIRD LIENHOLDER:
DATE OF LIEN
LIEN RELEASED BY:
SIGNATURE
TITLE , ,
FOURTH LIENHOLDER:
DATE OF LIEN
LIEN RELEASED BY:
SIGNATURE.
TITLE
DATE
ADDITIONAL LIENS:
73542470
TLC080L
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SEP I 0 200¢
z, ~ENOA FA RNm srR~SaAUS~AOCT #_~_q_l~ ~
Register for the Probate of Wills and Granting
Letters of A~inistration in and for
C~D County, do hereb~ certify that on
~e 22nd day of June, ~o Thousamd and Four,
Letters TESTAMENTARY
in co~on ~o~ were granted by the Register of
said CoWry, on the
esCate of RAFFERTY PAUL DAVID , late of LOWER ALLEN TOWNSHIP
in said county, deceased, to RAFFERTYDOROTHY/SABEL
and ~hat s~e has not since been revoked,
IN TESTIMONY W~EREOF, I have hereunto set my hand and affixed the
sea/ of said office at CARLISLE, PENNSYLVANIA, this 22nd day of June
Two Thousand and Four.
File NO.
PA File No.
Date of Death
s.s. #
2004-00588
21-04-0586
4/29/2004
~'162-48-0203
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
his is to certify that this is a true copy of the record which is on file in the Penmylvania Division of Vital Records in accordance
with Act 66, P.L 304, approved by the General A~embly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Charles Hardester
State Registrar
0'4 8 5 4 1 1 ~A¥ 2 8 200~
No.
CERTIFICATE OF DEATH
(Comn~O
PA
~ / Philadelphia Philadelphia Temple U~i~
045196
April 29, 2OO4
"n~mmH~,~e~ ~ Com~lie~m 'pacw f
PA 17~04
September 30, 2004
Cumberland, Register Of Wills
One Courthouse Square
Carlisle, PA 017013
WELTMAN, WEINBERG & REIS CO., L.P.A.
ATTORNEYS AT LAW
323 W. Lakeside Avenue, Suite 200
Cleveland, Ohio 44113-1099
216.685.1000
www,weltman.eom
BURLINGTON, NJ
609.914.0437
CINCINNATI, OH
513.723.2200
COLUMBUS, OH
614.228.7272
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, ]PA
412.434.7955
Re:
Estate of Paul D Rafferty
Case No. 21-04-0586
Our Client: Bank of America, N.A.
Account No. 4356023004288209
Balance Due: $17,157.56
Our File No. 3762019
Dear Clerk of Courts:
This law firm represents Bank of America, N.A. in connection with its claim which we wish to file on our client's behalf into
the estate of Paul D Rafferty, deceased. Enclosed is our check in the amount of $5.00 which we understand is the filing fee for
this claim.
Our client's claim is based upon its account number 4356023004288209 in the amount of $17,157.56. As of the date of this
letter, this is the amount due. Included with this letter is the claim form which we wish to present to this court and which we
are forwarding to the attorney and/or fiduciary of this estate.
It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to
the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the
undersigned. Thank you for your cooperation in this matter.
Sincerely Yours.
Legal Assistant
DEJ:iar (216) 685-1030
Enclosures
cc: Dorothy Rafferty
Charles Petrie, Esquire
WELTMAN, WEINBERG & REIS CO., L.P.A.
ATTORNEYS AT LAW
323 W. Lakeside Avenue, Suite 2~
Cleveland, Ohio 44113-1099
216.685.1000
www.weltman.com
BURLINGTON, NJ
609.914.0437
CINCINNATI, OH
5 I3.723.2200
COLUMBUS, OH
614.228.7272
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, PA
412.434.7955
September 30, 2004
Dorothy Rafferty
1122 Laurel Hill
Camp Hill PA 17011
CERTIFIED MAIL
Estate of Paul D Rafferty
Case No. 21-04-0586
Our Client: Bank of America, N.A.
Account No. 4356023004288209
Balance Due: $17,157.56
Our File No. 3762019
Dear Sir or Madam:
This law f'n-rn represents Bank of America, N.A. with respect to the claim which we wish to file in the estate of Paul D
Rafferty. It is our understanding that you are the Attorney of the estate.
We are asking that you please accept our client's claim which is based upon its account number 4356023004288209 in the
amount of $17,157.56. As of the date of this letter, this is the amount due.
Please direct all correspondence and disbursements with respect to this estate directly to our office. It would also be
appreciated if you contact us to advise us when you anticipate making disbursements in this matter so that we may mark our
file for follow-up at that time.
Thanking you in advance for your cooperation in this matter.
This law firm is attempting to collect this debt for our client and any information obtained will be used for that purpose.
Lastly, do not hesitate to contact us to further discuss this matter.
DEJ:iar
Enclosures
cc: Dorothy Rafferty
Charles Petrie, Esquire- regular mail
Sincerely Yours,
Legal Assistant
(216) 685-1030
WWR #3762019
ESTATE OF
COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY
ORPHAN'S COUR% DIVISI~ON
Paul D Rafferty, Deceased No.21-04-0586
Notice of claim by Bank of America, N.A.
filed pursuant to Section 3532(b) (2), of
the PEF Code.
To the Clerk of the Orphan's Court:
Enter the claim of Bank of America, N.A.
in the amount of $17,157.56, against the above entitled estate.
The decedent, who resided at300 Dahlia Ave WiRiamstown NJ 08094,
died on April 29, 2004 . Written notice of said
(date)
claim was given to Dorothy Rafferty & Charles Petrie, Esquire, if
known to claimant, at 1122 Laurel Hill Camp Hill, PA 17011 & 3528 Brisban St Harrisburg, PA
171 1 1 ~]
on September 30, 2004
(date]
Deju~b{ ~son, Agent for Claimant
323 West Lakeside Avenue~ Suite #200
Cleveland, Ohio 44113-1099 ta~,s)
, Claimant
Claimant's counsel
Scott S. Weltman
323 West Lakeside Avenue, Suite #200
Cleveland? Ohio 441131-1099
(address)
10.59 (Rev. 1/80)
O~
WWR # 3762019
STATEMENT OF ACCOUNTS
FOR:
Bank of America~ N.A.
DECEDENT'S NAME: Paul D Rafferty
ADDRESS: 300 Dahlia Ave
CSZ: _Williamstown, N[ 08094
SSN: 162-48-0203
ACCOUNT #: 4356023004288209
DOD: 04/29/04
BALANCE DUE: $17,157.56
EXHIBIT A
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RAFFERTY DOROTHY ISABEL
1122 LAUREL DRIVE
CAMP HILL, PA 17011
__nnn fold
ESTATE INFORMATION: SSN: 162-48-0203
FILE NUMBER: 2104-0586
DECEDENT NAME: RAFFERTY PAUL DAVID
DA TE OF PAYMENT: 03/11/2005
POSTMARK DATE: 03/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/29/2004
NO. CD 005045
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1 ,491 . 1 7
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: D RAFFERTY
CHECK# 511
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$1 ,491 . 1 7
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV.1500 EX + (6.00)
'* COMMONWEALTH OF
PENNSYLVANIA
, DEPARTMENT OF REVENUE
-. O. DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
FILE NUMBER
2 1 -0 4 0 5 8 6
COuNTYCciiiE ---VEAR- - - NUMBeR- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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RAFFERTY
DATE OF DEATH (MM-DD-Year)
PAUL
DATE OF BIRTH (MM-DD.Year)
DAVID
SOCIAL SECURITY NUMBER
1 6 2 - 4 8 - 0 2 0 3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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04/29/2004 02/29/1964
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o 3. Remainder Return (date of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
Q... 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A)(Attach Sch 0)
[X] 1. Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12.82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10, Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATtON SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
CHARLES E. PETRIE 3528 BRISBAN STREET
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717 561-1939
HARRISBURG PA 17111
OFFICIAL USE ONLY
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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)
o 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/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
I
I
I
I
!
I
63,132.021
i
I
I
(J'~
(.-l'~,'
(8)
63,132.02
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)(1.2)
19. Tax Due
X _(15)
33,137.15 X .045 (16)
X .12 (17)
X .15 (18)
(19)
10,023.98
19,970.89
(11)
(12)
(13)
29,994.87
33,137.15
(14)
33,137.15
16. Amount of Line 14 taxable at lineal rate
1,491.17
1,491.17
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
o
d I C
Add
ece ents omplete ress:
STREET ADDRESS
1122 LAUREL AVENUE
CITY I STATE I ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,491.17
Total Credits (A + 8 + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to 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)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
1,491.17
1,491.17
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; ........................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? ............................................................. D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this retum, 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.
DATE
3/9/2005
PA
PA 17111
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-<>ne 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(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.
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC,
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RAFFERTY
FILE NUMBER
PAUL DAVID 21 04
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0586
ITEM
NUMBER DESCRIPTION
1. FEDERAL INCOME TAX REFUND
2. US SAVINGS BONDS
3. INSURANCE REFUND
4. NORTH CAROLINA TAX REFUND
5. BLACK TRAILER
6. FEDERAL CREDIT UNION
7. MISCELLANEOUS
8. RECREATIONAL VEHICLE & TRAILER
9. USM INSURANCE REFUND
10. DEBT OWED BY MICHAEL ELLIOTT
11. PROCEEDS FROM SALE OF RAEER TANDEM RIG
VALUE AT DATE
OF DEATH
5,969.25
1,928.76
93.46
163.54
200.00
1,075.22
119.70
50,000.00
582.09
1,000.00
2,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
63.132.02
REV-1511 EX+(12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RAFFERTY
PAUL
Debts of decedent must be reported on Schedule I.
DAVID
21
FILE NUMBER
04
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
0586
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. CRUMPLER FUNERAL HOME 1,545.00
2. FOOD AFTER FUNERAL - VFW 209.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees CHARLES E. PETRIE 3,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00
Claimant GEORGE & DOROTHY RAFFERTY
Street Address 1122 LAUREL AVENUE
City CAMP HILL State P A Zip 17011
Relationship of Claimant to Decedent PARENTS
4. Probate Fees 115.00
5. Accountanfs Fees
6. Tax Retum Prepare(s Fees
7. REPAIRS TO MOTOR HOME FOR SALE PURPOSES 1,154.98
TOTAL (Also enter on line 9, Recapitulation) $ 10,023.98
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RAFFERTY
PAUL
DAVID
FILE NUMBER
21 04
0586
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. SPRINT
VALUE AT DATE
OF DEATH
54.45
2. FORD MOTOR CREDIT
5,829.21
3. BANK OF AMERICA
13,352.23
4. TEMPLE GENERAL SURGEONS
425.00
5. TEMPLE PATHOLOGY
60.00
6. TEMPLE PHYSICIANS
75.00
7. ALLIANCE ONE
175.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19970.89
O<EV-"" ",. 'w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
DOROTHY RAFFERTY
1122 LAUREL AVENUE
CAMP HILL, PA 17011
1.
MOTHER
AMOUNT OR SHARE
OF ESTATE
100% OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of RAFFERTY PAUL
also known as RAFFERTY, PAUL DAVID
DtN8.l~004
00586
, Deceased
Date of Death 4/29/2004
Social Security No. 162480203
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IMle
verify that the statements made in this inventory are true and correct. IMle understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: CHARLES E. PETRIE
1.0. No.: 29029
Address: 3528 BRISBAN STREET
HARRISBURG, PA 17111
Telephone: (717) 561~1939
Af~~JJ,~(~
DOROTHY I. RAFFERTY .
Dated 03/08/2005
Description
FEDERAL INCOME TAX REFUND
value
5,969.25
US SAVINGS BONDS
1,928.76.
INSURANCE REFUND
t , ";~
'.- 93.46
NORTH CAROLINA TAX REFUND
163.54
BLACK TRAILER
200.00
FEDERAL CREDIT UNION
1,075.22
Total
63,132.02
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
RAFFERTY
PAUL
Continuation of Inventory
DAVID
PaQe 1
2004
00586
Description of Inventory
Description
Value
MISCELLANEOUS
119.70
RECREATIONAL VEHICLE & TRAILER
50,000.00
USAA INSURANCE REFUND
582.09
DEBT OWED BY MICHAEL ELLIOTT
1,000.00
PROCEEDS FROM SALE OF RAEER TANDEM RIG
2,000.00
Subtotal $
Grand Total $
53,701.79
63,132.02
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE
STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE 6.12 FORM YEARLY UNTIL
COMPLETION.
STATUS REPORT UNDER RULE 6.12
NAME OF DECEDENT: PAUL DAVID RAFFERTY
DATE OF DEATH:
April 29, 2004
5~L,
ESTATE NO: ~-2004
~\- 0\..\ - 5~lo
WILL NO:
Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I report the
following with respect to completion of the administration of the above-captioned
estate:
1. State whether administration of the estate is complete: Yes X No_
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
b. The separate Orphans' Court No. (if any) for the personal
representative's account is: (Not Applicable in Dauphin County)
c. Did the personal representative state an account informally to the
parties in interest? Yes X No_
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and
may be attached to this report.
DATE: March 10,2005
Ld~ r/:fL
SIGNATURE
CHARLES E. PETRIE
NAME (PLEASE TYPE OR PRINT)
3528 Brisban Street
Harrisburg, PA 17111
ADDRESS
(717) 561-1939
TELEPHONE NO.
CAPACITY: _ Personal Representative X Counsel for Personal Representative
cI
r-.,-.'" ..~.,-,,-\,.-:-.
BUREAU OF INDIVIIlllAt'.JAxES: <~
INHERITANCE TAX DIIIISIOIf.,.
PO BOX ZS0601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DtSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
,
^/on' "'" "0 p',\J,~ I"'.' Ii 0
_UU0 ni-11 t. 'L
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-23-2005
RAFFERTY
04-29-2004
21 04-0586
CUMBERLAND
101
Aooount R..1 Heel
CLERK OF
ORPHAN'S COURT
CHARLEsC~/Mfusn CO.
3528 BRISBAN ST
HBG PA 17111
*'
REV-1547 EX AFP (03-05)
PAUL
D
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 4t
It!V-"MC,."ft.~.'l'\l!~'1I!1.1Mtm.b'I!".!wtI'l'TlM!\!'.'IW.lWl1lTftrd'm'~.'la:tfMlM!\!'.l\rr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RAFFERTY PAUL D FILE NO. 21 04-0586 ACN 101 DATE 05-23-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14. 15 and/or 16. 17. 18 and 19 will
reflect ~igures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. A~t of Line 14 at Spousal rate (IS)
16. A.ount of Line 14 taxable .t Lineal/Class A rate (16)
17. A.aunt of Line 14 at Sibling rate (17)
18. Amount of Line l~ taxable at Collateral/Class B rate (18)
19. Principal Tax Due
X
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(ll
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
63.132.02
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilitie$/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax R.turn
13. Charltabl./Gover~ntal Sequestsi Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
10,023.98
(9)
(10)
19.970.89
(11)
(12)
(13)
(14)
(Schedul. J)
NOTE:
.00
33,137.15
.00
.00
x 00 =
X 045 =
X 12 =
X 15 =
INTEREST/PEN PAID (-)
.00
A/1OUNT PAID
1,491.17
DATE
03-11-2005
NUMBER
CD005045
~
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-12-2005 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
crBdi t to your account,
submit the upper portion
of this for. with your
tax pay_nt.
63,132.02
?Q.QQ4 A7
33,137.15
.00
33,137.15
(19)=
.00
1,491.17
.00
.00
1,491.17
1,491.17
.00
8.38
8.38
( IF TOTAL DlIE IS LESS THAN $1, NO PAYMENT IS RElIUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.)