HomeMy WebLinkAbout04-0649PETITION
Es,ale of., Edythe A. Foltz
also known as
Social Security No. 204-03-5559' Deceased.
The petition of the undersigned respectfully represents Il,at:
Yottr petitioner(s), who is/ate 18 years of age or older a,, lite executr-I x
in the last will of the above decedent, dated March 8; 200/,
aud codicil(s) dated
FOR i'ROIIATE and GRANT OF LETTERS
No.
1'o:
Register of Wills for Ihe
County of Cumberland
Commo,,wealth of Peru,sylvania
in the
named
(slate relevant citcmnslances, e.g. renunciation, death of executor, etc.)
Deceudent was dotuiciled at death in Cumberland County, Pennsylvania, with
h ar last family or prJucipal residence at 3305 Wesley Drives Mechanicsburg, PA 17055
Lower Alien To~sh~p
(list street, number and munclpnllty)
D?ceml¢.t, then 90 yems of ~g¢, died June 29. 2004 .19 ,,
at 3305 ~es[e7 gr~ve~ Hechan~csburg~ ~A 17055
Except as follows, decedent did not marry, was uot divorced and did not have a child born or adopted
after execution of Ihe will offered for probate; was not lhe victim of a killiug and was never adjudicated
i,,co,,,I,ete,,t: ~/]
l)eceudent at death owned property with eslimated values as follows:
(Ir domiciled in Pa.) All personal property . $
(if Ilol domiciled ill Pa.) Petsoual property hi Pennsylvania
(1[ no[ domiciled in Pa.) Personal property in Coun[y $
Value of real estate iu Pennsy[v~nla $
situated as follows:
WItEREFORE, petitiouer(s) respectfully request(s) tile probate of tile last will and codicil(s)
prenented herewitl, attd the grant of letters testamentary
(testamentary; administration c.l.a.| administration d.b.n.c.t.a.)
therou.
]~Ryan
706 GreensAire Street
Maohnn~ e.M+d~e. PA--~17055
.L~-.
OATII OF PERSONAL REPRESENTATIVE
COMMONWEAL'I'll OF, PENNSYLVANI~ '[ SS
COUNTY OF ~Lz_/rr t/..~.cY/~z4,~,,L... ' J --,
The petitioner(s) above-natned sw?ar(s) or affirm(s) that tile statenlents in the for~goit~g petition are
true a,td correct lo tile best of the knowledge aud belief of petitioner(s) and that as persoual represen-
tative(s) of the above decedent petitiouer(s) will well attd truly administ% the estate according to law.
Swo,n to or a[finned and subscribed ~ ~~//~~Y~ ~
before hie this I~-?~ day of J ~ ~ ~ // .
No. ~
DECREE OF PROBATE AND GRANT OF LETTERS
, Decessed
AND NOW ~ ~ ~ / ~ '-I'9o~ ~/, in consideration of the petition on
the .reverse side hereof, ~a ~t~sfac~ry proof having been presented before me,
IT IS DECREED that the instrument(s) dated '~0~/~, ~ ~ O~ 4
desc.ribed therein be admitted to probate and file~J of record as the last will of
.. . ~~ o.~~
are hereby granted to .'~L~-./O~ .~/~/~ _~f~ ~
FEES
Probate, Letters, Etc .......... $ //~'~ ~
Short Certificates(,.~) .......... $ c~,aT.)
A .TTORNEY (Sup. Ct. I.D. No.)
~,~ ~ ~,. ~ .~...: ........ ~. :..o .~ .
RENUNCIATION
In Re Estate of Edythe A. Foltz,
deceased.
To the Register of Wills of CumberLand
County, Pennsylvania.
The undersigned Carol G. Goodyear now hy mmrr±a~a Carol G. Blough of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to
Madeline Ryan
WITNESS my hand this
/ day of ,1-9~' .
(Signature) (=')
Carol G. Goodyear
(Address)
5887 Mountain Hawk Way
Santa Rosa, CA 95409
(Signature)
Carol G. Blough
(Addr~s)
5887 Mountain Ha~k Way
Santa Rosa, CA 95409
(Signature)
(Address)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed v. ith me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Local Registrar
:3 037238¢. 4o, te $oI
No. ~ Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Fdytho Fol~ . Female ,. 20~- 03 -- $559 ,. June 29~ 2004
90 ~,. J ! , Apr 16, 1 g 14 Delia, Pa. .~*, [] E"~,U,..,,*,. ~ ~ ~ -"~
' ' I i /,. I~ I~ I "~
~ Lower Allen Twp _ ~¢t~mY VdI~R ~ ~ .......... ' Wh,te
.~ Cumberland ' ~ ~ ~,~..~c~. ~s~
Homemaker I .... ~ ........... I,. ~x ],,, (~,,, li "'~'*) I,. Widowed
, ACTUAl. 1ts. Sial. PCnnqulw=ni~ · ~,1~...,~.,.,,~,.. Lower Allen Two
325 Wesley Drive ,~ ....... · ...... ~ ·
,. Mechanicsburg. Pennsylvania 1705 ~¢'~ ,~.c~.~ .... Cumberland ~"~ ~'~
,~ Nathaniel N. Norris J,,. My~le Parthree
~.~s~- Madeline Ryan J~. 706 Green Acres Street Mechanicsburg, Pa 17055
~ .... ~ ........ ~ J' ....... I ..... I
'"'--~"V* ~ J .... Jun 30, 2004 .... Conolite Cremato~ J .... Schaefferstown Pa. 17088
¢.~¢7 ~ I .... FD-012662-E [,.. Mfem Funeral Home, nc 37EaslMainStree Mochanicsburfl Pa 17055
.............................. ~ !~,. /~ / /
~,.~.~..* a~ ,t.~ ......... .' . ......................... ~ d. Hardy
~*. 207 House Ave Camp Hill, Pa. 17011
J ill anb e tament
OF
EDYTHE A. FOLTZ
I, EDYTHE A. FOLTZ, of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, dis hereby
make, publish and declare this my Last Will and Testament, hereby revoking and making
void any and all prior Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can conveniently be done.
2.
I direct that there shall be paid out of my residuary estate all estate, inheritance and
like taxes together with any interest or penalty thereon imposed by the Government of the
United States, or any state or territory thereof, or by any foreign government or political
subdivision thereof, in respect to all property required to be included in my gross estate
for estate, inheritance or like tax purposes by any of such governments, whether the
property passes under this will or otherwise.
I give, devise and bequeath the sum of Five Thousand ($5,000.00) Dollars to my
friend, MADELINE RYAN, of Mechanicsburg,
4.
All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, I give, devise and bequeath as follows:
-1-
A.)
B.)
C.)
D.)
E.)
One-fourth to my son-in-law, MARLIN GOODYEAR.
One-fourth to my granddaughter, CAROL G. GOODYEAR.
One-fourth to my grandson, STEVEN G. GOODYEAR.
One-eighth to my great-grandson, BRANDON G. GOODYEAR.
One-eighth to my great-grandson, JERED G. GOODYEAR.
5.
In the event MARLIN GOODYEAR predeceases me, I give, devise and bequeath
his share to my granddaughter, CAROL G. GOODYEAR.
6.
In the event any other legatee, specific or general, should predecease me, his or
her share shall lapse and fall into the residue of my estate to be divided equally among the
residuary legatees who survives me.
7.
Lastly, I nominate, constitute and appoint, MADELINE RYAN and CAROL G.
GOODYEAR to be Co-Executrices of this my Last Will and Testament. In the event
either should predecease me or for any reason by unable to act as such, I nominate,
constitute and appoint the other to serve as sole Executrix. I further direct that no bond or
other security be required of my personal representative to guarantee faithful performance
of her duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~¢[~, day of
March, 2004.
-2-
Signed, sealed, published and declared by the above named EDYTHE A. FOLTZ
as and for her Last Will and Testament, in the presence of us who have subscribed our
names hereto as witnesses, at her request, in her presence and in the presence of each
other.
-3-
COMMONWEALTH OF PENNSYLVANIA )
'SS
COUNTY OF CUMBERLAND )
I, EDYTHE A. FOLTZ, the testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the same instrument as my Last Will and
Testament; that I signed it willingly, and that I signed it as my free and voluntary act and
deed, for the purposes therein expressed.
Sworn and subscribed to before
me this 8 te~ day of March, 2004
· Nrotary Pfiblic
Heidl bt. Nalson, Notary Public
COMMONWEALTH OF PENNSYLVANIA ) ~,~~o~
'SS
COUNTY OF CUMBERLAND )
We, the undersigned, ~J0~~ H, ~OlOp/ and
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
EDYTHE A. FOLTZ, sign and execute the instrument as her Last Will and Testament;
that the said testatrix executed it as her free and voluntary act for the purposes therein
expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as
witnesses; and that, to the best of our knowledge, the testatrix was, at the time, eighteen
(18) or more years of age, of sound mind, and under no constraint, duress or undue
influence.
Sworn and subscribed to before
me this 2~r'~ day of March, 2004.
'" /27. ¢2d5-,
Notary Public
COMMONWEALTH OF PENNSLVANIA
Nolarial Seal
-4-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
NameofDecedent: Edyrhs A. Foltz
Date of Death: June 29, 2004
Will No. ?l-nA-n6/.q Admin. No.
To the Register:
[ certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on July 13. 2004 :
Name Addres~
Marlin Goodyear 5321 Cobblestone DRive. Mechanicsburm, PA 17055
Carol Goodyear nbm Carol Blough 5887 Mountain Hawk Way, Santa Roaa, CA 95409
Steven Goodyear 1917 Vista Drive, Modesto, CA 95355
Brandon Goodyear 974 Rathbone Circle, Folson, CA 95630-8535
Jered Goodyear 3490 San Marino Circle, Costa Mesa, CA 92626
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None
Date:
July 27, 2004
Capacity: __
Signature ~
Market Square Building
Address
Mechanicsburg, PA 17055
Telephone ~'17) 766-3172
Personal Representative
~'~ounsel for personal representative
Inventory of the real and personal estate of
Edythe A. Foltz
deceased
1.)
2.)
3.)
4.)
PNC Bank Account # 79052
Furniture
Captial Blue Cross, refund
AT&T, telephone refund
PERSONAL PROPRTY
Total
d
13,825
1,180
189
~49
15,243
14
00
14
21
49
COMMONWEALTtl OF PENNSYLVANIA ].
COUNTY OF CUMBERLAND J
SS:
..................... Made!_%n~. _Ry an_ .................
being duly ____s_~o___rn_ ............... according to law, deposes and Says that She is the executrix
.............................. of the Estate of Edythe Foltz
late of ---L-°wer..Allen Township . ...................... Cumberland County, Pa., deceased and that the
withi, is an inventory ,,,adp. by _ __H_a_de_lt_.ne__~ya_~ ......................... the said executr±x
of the entire estate of said decedent, consisting of all the personal properly and real estate, except real e~fate outslde
the Commonwealth of Pennsylva.ia, and that the figures opposite each item of the Inventory represent it's fair valUe
as of the date of decedent's death.
subscribed before me,
COMMONWEALTH OF PENNS~VANIA
Nol:arial Seal
I-leidi M. Nelson, Notary Public
~y ~m. mission Expi~ June 27, 2007
2.
3.
4.
Execu!or - A(dm~sfrafor
Madeline Ryan
.... 2_~_6_D~_e_e_n__Acre Street, Mechanicsburg, Pa_
Addre,
June 2004
Month Ye4r
:
INSTRUCTIONS
,~n inventory must be filed wifhh, three months after appointment of pertonal tepresenfaflve.
A supplement inventory must be filed within fhlrfy days of discovery of additional assets.
AddiHonal sheets may be attached es fo personalty or really
See Article IV, Fiduciaries Act of 1949. ,
IJJ
o
>-
COMMONWEALTH OF PENNSYLVANIA
DL:PARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
D[--PT, 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004409
RYAN MADELINE
706 GREEN ACRE STREET
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 204-03-5559
FILE NUMBER: 21 04-0649
DECEDENT NAME: FOLTZ EDYTHE A
DATE OF PAYMENT: 09/21/2004
POSTMARK DATE: 09/21/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 06/29/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,880.38
TOTAL AMOUNT PAID'
$3,880.38
REMARKS: FOLTZ ESTATE
SEAL
CHECK# 1017
INITIALS: CCP
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX (6.00) ~
· ~e, COMMONWEALTH OF
~ PENNSYLVANIA
,m~~~, DEPARTMENT OF REVENUE
,~'~.~L~.,~ ,~,,~ ~ DEPT. 280601
~~.q?~ HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 - 0 4 0 6 4 9
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z Foltz Edythe A. 204 - 03 - 5559
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
UJ 06/29/2004 04/16/1914 REGISTER OF WILLS
O
LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
ILl
I-
Z
r~
Z
O
UJ
O
X
~]1. Original Return
[~4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
r-~9. Litigation Proceeds Received
--]2. Supplemental Return
I'---] 4a Future Interest Compromise (date of death after 12-12-82)
[~7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
--"]3. Remainder Return (date of death prior to 12-13~2)
--]5. Federal Estate Tax Return Required
JL 8. Total Number of Safe Deposit Boxes
--]11. Election to tax under Sec. 9113(A) (Attach Sch O)
NAME
John M. Eakin
FIRM NAME (If Applicable)
TELEPHONE NUMBER
(717) 766-3172
COMPLETE MAILING ADDRESS
Market Square Building
Mechanicsburg, PA 17055
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(8)
58,944.12
4,076.85
(11)
(12)
(13)
(14)
58,944.12
7,142.96
51,801.16
51,801.16
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate 35,100.87
x ,o45
x .12
x .15
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
16,700.29
19. Tax Due
20. []
(15)
(16)
(17)
(18)
(19)
1,579.54
2,505.04
4,084.58
REV-1.SO8 EX + (1'-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Edythe A. Foltz 21-04-0649
Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~, jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
5.
6.
PNC Bank account, 7007-9052, see attached
Household furniture, sale price reported
Capital Blue Cross, refund
Verizon, refund
BEhtany tower, refund
American Express financial advisors,
account 01122895901-8-002
account 93001482699-2-009
inc. see attached
$14,137.86
$32,992.69
TOTAL (Also enter on line 5, Recapitulation) $
10,395.48
1,180.00
189.14
31.96
17.25
$ 47,130.29
58~944~!2
(If more space is needed, inser~ additional sheets of the same size)
, atca ent
Tolal Banldng
PNC
For th® poriod 06/05/2004 to 07/0712004
EDYTtlE FOLTZ
52_5 I//ESLEY I)R APT S305
141:CIIANICSIIURG ISA 17055-5505
Relatio.ship Overview
PNCBAN
Primary account number: 50-7007-9052
Page 1 of :2
Number of enclosures: 21
_For 24-hour banking, customer service and
-'transaction or interest rate information,
~ sign-on to Account Link ® by Web on
pncbank.com or call 1-888-PNC-BANK
Para servicio en espanol, 1-866-HOLA-PNC
Moving~ Please contact tis at 1-888-PNC-BANK.
Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
~_.~__4 Visit tis at pncbank.com
~]IDD te[minal: 1-800-531-1648
For hearing impaired clients only
Ba,~k Deposit Accomits
Des( ription Account Number
l~,eg ular Clwcki,g 50-7007-9052
'!'ol;~1 Deposik~
ileg.lar Ch-cki.fj Accou'it Sm.i,iary
Accotmt nun~ber: 50-7007--9052
Bala.ee S.mmary
Begi~ning Deposits and
Inlance clher additions
1 lye 19 5,757.91
Checks and other
deductions
3,529.9d
Average monthly
balance
! 1,0-H.23
Tral,sactio. S.ntmary
Check ~ paid/ C hack Card POS Check Card/Bankcard
withdlawals s~gne, I transactions POS PIN transactions
21 0 o
'rotral ATM PNC Bank Other Bank
transactions ,t,,-[ M lransactions ATM transactions
() ()
Ending
balance
13,825.H
Charges
and fees
.o0
Edytbe Foltz
Deposit Balance
13,825. I.t
13,825.14
Please see the Activity Detail section for
additional information.
Activity Detail
Deposits a.d Other Additioqs
Date Amount Description
06/23 j 2,2 ![5.00 Branch l)cposi~ Tel 0.t0000.'1702 0019
(~L 197.~;,'1 l)hect Dcpc,~- l'c.s i'mt
'l'he Traw.lers 38012522,'1
~][ f;9.27 l)i~ect DcpokL- RI'S 00 IJf
The 1 lm I h:,* d (b20360-0911
07/02 1,3tl6.00 Direct Dc~- Soc Sec
US Treasur) 303 183035645D
IDS Amex hIpIs Mn 01122895901
There were 5 Deposits and Other Additions
totaling $5,757.91.
FORM953R-0104
TotM Bmddng Stat.cment
~ For 24-hour customer service info~rnation, sign-on to Account Link
-/"~ by Web on pncbank.com or call 1-888-PNC-BANK
Account numher: 50-?007-g052 - continued
For the period 0G10512004 to O7/0712004
FDYTHE FOLTZ
Primary account number: 50-?007-90§2
Page 2 of 2
Checks
Check Date Reference
number Amounl / paid number
] 2g0 50.00 ~ It~ "'fi8 l!22~;92356
]291 2.()g v ('ll~/q)g 028898502
] 292 10.o0 ~ 06/1,I o25,;22a~,~
1293 1.1.95 d o6/'o9 o2s,Hsl~l
129.1 1(}.0(} / 06,,'1.1 ~sn2a~oa
] 295 I 1.56 / 06/07 o2555~;on$
1297 * 127.20/ 06/08 oas,;;.m;~
129g * 156.00/ 06./1 l 02;~;;71;~;
1300 1,036.50 Y o6/16 oaissIgS4
Gap in check sequence
Online and Electronic Banking Deductions
Date Amount
06/21 189.1,1
o7/o6 ! 1.75
07/'06 l 1.75
07/06 11.75
Description
Di~ecl Payment- Ins. Ptem
(_;apilalbh~ecross 201(135559
Direct l'av~nent - (;rn (h ti 303-920-1616
Di~ed Payment - Gin Gin 303-920-1616
Direct Paymcnl. - Gl 11 ('~'111 303-920-1616
Check
number
1302 *
1303
1304
1305
1306
1307
1308
1309
131()
1311
Date Reference
Amount / paid number
06/'22 02';)25044 _~
O010t) 06/29 0246924 .~
390.00 '. 06/22 02790170~
97_50 d 06/23 02609~709
521.63 f 06/22 024109539
113.75 d 06/99 0246924a9
78.00j, 0%/02 025448766
20.OOd/ Ot~/2g 024682490
21.1.51 -- 06/25 026544~9
55.00 ~ 0(~/'29 024682491
There were 21 checks listed totaling
$3,305.57.
There were 4 Online or Electronic Banking
Deductions totaling $224.39.
Daily Balance Detail
Date Balance
06/05 11,597.19
00/o7 11,578.(;3
06/08 11,3 ! 1.55
06/09 11,29.1.51
Date Balance
06.../11 11,138.51
06/'14 l 1,118.51
06/16 10,082.0 I
0(~/21 9,892.8'7
Date
06/22
06/23
06/25
06/29
Balance
8,781.24
10,898.74
10,684.23
10,395..18
Date Balance
07/01 10,632.39
07/02 11,860.39
07/06 13,825.14
881' 1 _%" WUUq
/AMERIC/411 EXPRESS
P/AGE 01/02
FACSIMILE COVER SIIEET
AMERICAN EXPRESS FINANCIAL AD VISORS INC.
COMPANY/FLRM:
PIIONE:
FAX:
FROM:
COMPANY/FIRM:
PHONE:
FAX:
Jerry Brittain
American Express Financial Advlsor$ Inc.
(717) 441-4801
(717) 441-4808
DATE:
COMMENTS:
PAGES INCLUDING COVER PAGE
JUN-4-~00~ TLIE EIB: Ii,Al'! ID: PI:I~E: 1
REV-i511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
EDythe A. Foltz 21-04-0649
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
1.
5.
6.
7.
8.
9.
FUNERAL EXPENSES:
Myers Funeral Home, Funeral
MiniSter Honorariums 225.00
Organist 75.00
Reception 499.85
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Madeline Ryan
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
StreetAddress 706 Green Acre Street
City Mechanicsburg State__Pa Zip
Year(s) Commission Paid: 2004
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
17055
Street Address
City State __ Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Frank Potteiger,
Filing fee
Reserved for release
personal property appraisal
TOTAL (Also enter on line 9, Recapitulation) $
454.00
799.85
1,700.00
850.00
148.00
60.00
15.00
50.00
4,076.85
(If more space is needed, insert additional sheets of the same size)
Ct)MM( !IIWFAI III or I'[ flflRYi
IIiillr IIII^IIfT IAv, I~f' IIIINI
RI.SIDEIII DLCEU[.I~I
ESIA1E OF
Edythe A. Foltz
SCHEDUI_E I
DEB'IS OF DECEDEN'r,
.... _¥9_. F
21-04-0649
h~clude Imlelmbll~ed medical
IIEM
NUMBER
2.
3.
4.
5.
6.
7.
8.
9.
DE$CI]IPIIOII
Alert Pharmacy, Pharmacy Bill (42.14 + 55.09)
Hummel STudio, unpaid balance of bill (21.95 + 44.94)
Bonnie Miller, tax collector, unpaid personal tax
Boscovs, book account (95.19 + 19.00)
Verizon, telephone (21.67 + 43.53)
Bethany Village, skilled nursing
MAT Bank, Credit Card
AT&T, Telephone (28.65 + 2.33)
Travelers Life & Annuity, return of overpaid annuity
101AL (Also e.ler on line 10, Rec~pitulalion)
AMOUI If
97.23
66.89
9.80
114.19
65.20
2,215.75
268.43
30.98
197.64
$ 3,066.11
(1! mom spat6 is needed, insed addilional sheets of Ihe same size)
REV;1513 EX+ (9-00~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Edythe A. Foltz 21-04-0649
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I
1.
e
II
1.
Madeline Ryan
~XABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtmnsfemunder
Sec. 9116(a)(1.2)]
706 Green Acre Street
Mechanicsburg, Pa
Marlin Goodyear
Carol G. Blough (
5321 Cobblestone Drive
Mechanicsburg, Pa
Goodyear)
5887 Mountain Hawk Way
Santa Rosa, Ca
Steven Goodyear 1917 Vista Drive
Modesto, Ca
Brandon Goodyear
Jered Goodyear
974 Rothbone Circle
Folson, Ca
3490 San Marino Circle
Costa Mesa, CA
None
son in law
granddaughter
grandson
greatgrandson
greatgrandson
$5,000.00 bequest
25% residue
25% residue
25% residue
12 1/2% residue
12 1/2% residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART I] - 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)
CERTIFICATE OF NOTICE UNDER RULE 5.6(a)
Name of decedent: ~-o~rxe, i~-
I
Date &Death: ~ Soc Sec number
Number assigned by Register of Wills ~O O 4-
Z.Z,3- o~- 66,-/?
TO THE REGISTER OF WILLS:
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
NOtice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: lO-Id' Zaoy
Signature
Name ~e~a.k{~ ¢2. ~---b~
Address V~'/ .5'h,~ ~Ao,.~. ~
Phone(~l7 ) Z~_~-O~
Capacity g Pc~nal Representative
~Counsct for Personal
Representative
Date:
Signature
Name
Add~ess
Capacity ~' Pc~ona] Representative
Counsel for Pemonal
Representative
Name ~o.~e-~ ~x~,
Address ~'7 ,.15~n~ /qotx&e- ~?~. .
Phone( "It"/ )
Capacity ~. Personal Representative
Counsel for Personal
Representative
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 180601
HARRISBURG, PA 17128-0601
JOHN H EAKIN
HARKET SQUARE BLDG
HECHANICSBURG
PA 17055
COHHONWEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLOHANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FZLE NUNBER
?COUNTY
~N
11-06-2004
FOLTZ
06-29-2004
21 04-0649
CUHBERLAND
101
Amoun~ Remi~ed
REV-154? EX AFP
EDYTHE A
HAKE CHECK PAYABLE AND REH'rT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF FOLTZ EDYTHE A FZLE NO. 21 04-0649 ACN 101 DATE 12-06-2004
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nersh/p Zn~eres~ (Schedule C) (3)
~. Mortgages/No,es Receivable (Schedule D) (~)
5. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) ($)
6. Jo/n~ly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTZONS AND EXENPT/ONS:
9. Funeral Expenses/Adm. Cos~s/M/sc. Expanses (Schedule H) (9)
10. Deb*s/Mortgage Liab/1/~ies/L/ens (Schedule 1) (10)
11. To,al Deduc*/ons
12. Ne~ Value of Tax Re~urn
58~944.12
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 subm/~ ~he upper pore/on
.00 of ~h/s form w/~h your
~ax payment.
.00
(8)
4,076.85
15.
1~.
NOTE:
ASSESSNENT OF TAX:
15. Amoun* of L/ne 1~ a~ Spouse1 ra*e
16. Amoun~ of Line 1~ ~axable
17. Amoun~ of Line 1~ a~ S/bling ra~e
18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~e
19. Pr/ncipal Tax Due
TAX CREDTTS:
PAYHFNT RI~cErpT DTSCOUNT
DATE NUHBER /NTEREST/PEN PAZD (-)
09-21-2004 CD004409 204.23
58,944.12
(L$) .00 x O0 = .00
(L~) 35,100.87 x 045= 1,579.54
(17) . O0 X 12 = . O0
(18) 16,700.29 x 15 = 2,505.04
(19)= 4,084.58
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
AMOUNT PA/D
3,880.58
reflect figures that include the total of ALL returns assessed to date.
(15) .00
(1~) 51,801.16
16, 17, 18 and 19 N'i11
TOTAL TAX CREDZT I 4,084.61
BALANCE OF TAX DUEl .05CR
ZNTEREST AND PEN. .00
TOTAL DUE .O~CR
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED. ~,. ~
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.)
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Ne~ Value of Es~a*e Subjec~ ~o Tax
If an assessment ,as lssued previously, 11nes 14, 15 and/or
$,066.11
(1~) 7.142.96
(12) 51,801.16
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADHZN-
ZSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lamful Class 8 (collateral) rate on any such futura interest.
To fulfill the requirements of Section ZZqO of the Inheritance and Estate Tax Act, Act 13 of Z000. (72 P.S.
Section
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS~ AGENT
A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available
online at mmw.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from tho Department's
Zfi-hour answering service for forms orders: 1-800-~61-ZOSO; services for taxpayers ~ith special hearing and/or
speaking needs: 1-600-qq7-30Z0 (TT only).
Any party in interest not satisfied with the appraismant, allowance or disallowance of deductions ar assessment of tax
(including discount or interest) as shown an this Notice may object within 60 days of the date of receipt of this notice
by filing one of the fallowing:
A) Protest to the PA Department of Revenue, Beard of Appeals. You amy object by filing a protest online at
wwm.boardofappaals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to ba valid, you must race[va a confirmation number and processed date from the
Board of Appeals websita. You may also send a ~rittan protest to PA Department of Revenue, 6oard of Appeals
P.O. Box 281021, Harrisburg, PA 17126-1021. Petitions may not be faxed.
B) Election to have the matter determined at the audit of the account of the personal representative.
C) Appeal to tho Orphans' Court.
Factual errors discovered on this assessment should be addressed in Nriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (5Z) discount of
the tax paid is aZloNed.
The 15Z tax amnesty non-participation penalty is computed on the tote! of the tax and interest assessed, and not
paid before January lA, 1996, the first day after the and of the tax amnesty period. This nan-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine
death, to the date of payment. Taxes mhich became delinquent before January 1, 1981 bear interest at the rate of
six [6Z) percent per annum calculated at a daily rate of .00016q. Al[ taxes which became delinquent on and after
January 1, 1981 Nil1 bear interest at a rate mhich mill vary from calendar year to calendar year ~ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1962 through ZOOq ara:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year
1982 207. .OOOSq8 ~'~'8 - 1991 11Z .000301 ~
1983 16Z .000q.'~8 1992 9Z . OOOZq7 ZOOZ
198~ 112 .000~501 1993-199q 7Z .OOO19Z 2005
1965 13Z .000356 1995-1998 92 . O00Zfi7 ZOOq
1986 102 .00027q 1999 7Z .00019Z
1987 107. , O00Z7~, ZOO0 7Z .000192
--Interest is calculated as folloms:
XNTEREST = BALANCE OF TAX UNPATD X NUI~BER OF DAYS DBLXNQUENT X DA'rLy TNTEREST FACTOR
Interest DaiXy
Rate Factor
91 .0002q7
6Z .00016q
5Z .000157
~X .000110
--Any Notlce issued after the tax becomes deXinquent ei11 rafXeot an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after the interest computation date shomn an the
Notice, additional interest must be catculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ed~ A. Foltz
Date of Death: 6/29/2004
Will No. 21-04-0649
Admin. No.
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:
3 . If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
b . The separate Orphans I Court No. (if any) for
the personal representative's account is:
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 I Court and may be attached to this report.
Date: 4/11/2005
~ "m, &L
Signatur
,C)
John M. Eakin
Name (Please type or print)
Market Square Building
MechanicsburQ PA 17055
Address
(717 ) 766- 3172
Tel. No .
Capacity :
Personal Representative
X
Counsel for personal
representative
vA