HomeMy WebLinkAbout03-0123 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' P~/_,~- ~ -.x~a~/~e.~x NO. ,,11-03-123
also known as To:
Register of Wills for the
, Decea~sed. County of ChlmJ3~_r] ,~nc]
Social Security No. o21'./ - / ?~. zOtO~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executrix
in the last will of the above decedent, dated
and codicil(s) dated
in the
named
,19 q~'
Decendent, then
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~----~4_/~//~6/~-/~.~ Cqunty, Pennsyl.,vania; with
e. ~ last family or principal residence at -~Y~,~ ~__ ]q~,~/-/-In ,.~'~;,,,/Jl~m,¢ ....
(list street, number and muncipality) 7~/~'
Decendent 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 $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ]
COUNTY OF Ct~berland f ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affi~.~d and subscribed
~efore me this~ .... day of 1
[' / F~~iz/ /~ ~ 2003 J.z
~nna M. Otto,lst ~ty /- /~gister
No. 21-2003-123
Estate Of PAULINE M. BOOHER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
February 7th
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated Morch 12~h: lqq7
described therein be admitted to probate and filed of record as the last will of
Paul Lne M, L:~oher
and Letters Test~nentary
are hereby granted to Er±c F. Booher
2003, in consideration of the petition on
FEES
115.00
Probate, Letters, Etc .......... $
Short Certificates(3) .......... $ 9.00
Renunciation (~-.) ............. $ 5.00
x-Pages (8) $, 24.00
JCP 10.00
TOTAL __ $
Filed .F.e.b..ru~..7.'Cb, 2.003,... $..1.6.3.: O..0...
Register of Wills ,'
Donna M. Otto, 1st Deputy ~ ~ -/-~.
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
MAILED LEGTERSANDORDER TO EXECLG~R ON 2-7-03
RENUNCIATION
21-2003-123
the above d~edent, hereby renounce(s) the ri~t to admi~ster the estate and resp~tfully ~k(s) that Letters
be issued to ~'~"l~.~ ~. ~00 A~._.~'''' ,
WI=SS .~/~-~_ ~,~ ~~1 hand this ~.D day of
(Address) " --
(Signature)
(Address)
(Signature)
(Address)
105 112 REV 8,88
(FEE FOR THIS
CERTIFICATE S200)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5257497
January 14, 2003
Date of Issue of This Certification
Name of Decedent Pauline Mae
Booher
First Middle
Sex. fe~.le Social Security No. 211-18-4,005
Date of Birth July 18, 191.5 Birthplace Pi%cairn, Pa,
Place of Death Manor Health Care Services, Cumberland,
Last
Date of Death January 9, 2003
Carlisle, Pennsylvania
Race white Occupation laborer
Decedent's
Marital Status never ~arried Mailing Address
Informant Eric Booher
Name and Address of
Funeral Establishment
County City Borough or Township
Armed Forces? (Yes or No)
Manor Health Ca~e Services, Carlisle,
Number Street OJty or To~,n
Funeral Director Douglas R. James
Martin R. Brown Funeral Home, O~bisonia, Pa. 17243
no
Pa. 17013
State
Part h
Immediate Cause
(a)
Cardiac arrest
Interval Between
Onset and Death
(b)
Multiple diseases of aging
(c)
(d)
Part Ih
Other Significant Conditions
Manner of Death
Natural ~
Accident []
Suicide []
Homicide
Pending Investigation
Could not be Determined
Describe how injury occurred:
Name and Title of Certfier
H. Fineburg, M.D.
Address
356 E. Penn Dr., Enola, Pa. 17025
(M.D., D.O., Coroner, M.E.)
This 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. MRS. DO~Yl'HV N. OTr
0 R~l~ey Street
mi=o.m, Pa. ~7243 , 31-287
Local Regisbar of V~tal Records Disu~ct i'Jo
Janua,r~DaN, ,eceivect'~oy L~ Street Add .... ¢,ity Borough [ ....... t ....
21-2003-123
LAST WILL AND TESTAMENT
OF
PAULINE M. BOOHER
I, PAULINE M. BOOHER, of Harrisburg, Dauphin County, Pennsylvania,
being of sound mind and disposing memory, though I realize the uncertainty of this life, I have full
confidence and trust in my Lord and Savior, Jesus Christ, in His death on the cross for my sins and
in His shed blood as an atonement for my soul; and I know by faith that because of His sacrifice on
the cross for me I have eternal life, do hereby make this Will, hereby revoking all my former Wills and
Codicils:
Article One: Tangible Personal Property:
§ 1.1 I bequeath all my tangible personal property in accordance with the terms of
a personal property memorandum I may prepare. If no such memorandum is located or received by
the Executor within 60 days after being appointed as such, after conducting a reasonable search for
such memorandum, the Executor shall be held harmless for distributing such property as hereinafter
provided.
§1.2 I bequeath such tangible personal property not disposed of by such
memorandum, as a part of my residuary estate.
Article Two: Residue:
§2.1 I devise and bequeath all the residue of my estate of whatever nature and
wherever situated, to be divided and distributed as follows: Fifty percent (50%) as a charitable
bequest to my local church, The First Assembly of God, Harrisburg, PA, to be allocated at the
discretion of The Ladies Bible Class in accordance with the pro,~4sions of {}2.2 hereat~er; Ten percent
(10%) to my nephew, Eric F. Booher, of Camp Hill, PA, per stirpes; Ten percent (10%) to my
nephew, Carl Eugene Booher, of Orbisonia, PA, per stirpes; Ten percent (10%) to my nephew, Gary
B ooher, of Adamsburg, PA, per stirpes; Ten percent (10%) to my niece, Donna B. Litzinger, of
Pensacola, FL, per stirpes; and Ten percent (10%) to my niece, Shirley B. Drakulic, of Pitcairn, PA,
per stirpes; provided, however, that I give to the Trustee hereinafter named any such share passing
hereunder for the benefit of any beneficiary of mine who shall not have attained the age of eighteen
(18) years, to be held, administered and disposed of in accordance with Article Three hereof (the
"Beneficiary's Trust") for the benefit of such beneficiary. If any of the individual bequests should
lapse, then the lapsed share shall be given as a further charitable bequest to my church, The First
Assembly of God, Harrisburg, PA.
{}2.2 I request that the bequest to my church be used for the support of the
following Foreign Missionaries in their Mission work:
(a) Gene Kummerer and Norma Ruth Kummerer, presently serving in Belgium;
(b) Richard Mark Ridings and Patricia Joy Ridings, also presently serving in
Belgium; and
(c) James Arthur Sabella and Shirl Lee Sabella, presently serving in the Czech
Republic.
In the event these named Missionaries are no longer serving in the Mission Field of the Church at
the time of my death, then the bequest shall be allocated, at the discretion of The Ladies Bible Class,
to such other Missionaries as the Class is supporting at that time.
Article Three: The Beneficiary's Trust:
{}3.1 The Trustee shall hold, manage, invest and reinvest the assets of the
B eneficiary's Trust, collect the income thereof and:
{}3.1.1 While the beneficiary of the Beneficiary's Trust (the "Beneficiary")
is under eighteen (18) years of age, the Trustee shall apply to or for the benefit of the
Beneficiary so much of the net income and, if the net income is insufficient, so much
of the principal of the Beneficiary's Trust, as the Trustee shall from time to time deem
2
necessary or proper for the Beneficiary's health, maintenance, support and complete
education, including preparatory, college and graduate education, and professional,
vocational or technical training, taking into account other available funds, including
the Beneficiary's assets. The Trustee shall annually accumulate any net income not so
distributed and add the same to the principal of the trust property.
§3.1.2 After the Beneficiary attains eighteen (18) years of age, the Trustee
shall distribute to or for the benefit of the Beneficiary the net income of the
Beneficiary's Trust in quarter-annual installments, or more frequently if the Trustee
deems it advisable, and so much of the principal as the Trustee shall from time to time
deem necessary or proper for the Beneficiary's health, maintenance, support and
complete education, including college and graduate education, and professional,
vocational or technical training, and to assist the Beneficiary with reasonable wedding
expenses, in the purchase of a principal residence or in the establishment of a
profession or business considered a good risk by the Trustee, taking into account
other available funds, including the Beneficiary's assets.
§3.1.3 At any time after beneficiary attains eighteen (18) years of age, the
Beneficiary may withdraw any or all of the principal of the Beneficiary's Trust.
§3.1.4 If the Beneficiary dies before the complete termination of the
Beneficiary's Trust, the Trustee shall distribute the property then held in trust to such
persons or corporations, (including the Beneficiary's estate), in such amounts and
upon such trusts, terms and condition, as the Beneficiary by last Will may appoint by
specific reference to this general power of appointment; provided, however, any
portion of the trust property not subject to the Beneficiary's power of withdrawal
immediately prior to the Beneficiary's death may only be appointed to one or more
of the Beneficiary's issue, in such amounts and upon such trusts, terms and conditions
as the Beneficiary by last Will may appoint by specific reference to this special power
of appointment. Any property not so appointed shall be distributed to the
Beneficiary's then living issue, per stirpes, or if none, to my church, The First
Assembly of God, Harrisburg, PA.
Article Four: Appointment of Fiduciaries:
§4.1 I appoint my nephews, Eric F. Booher of Camp Hill, PA and Carl Eugene
Booher, Jr. of Orbisonia, PA as Co-Executors of this Will. If either of them should be unwilling or
unable so to serve, then the other shall serve as Executor. All references herein to the "Executor"
shall mean my originally appointed Co-Executors or any successor Executor, as the case may be.
{}4.2 My Co-Executors, or either of them, shall also be the Co-Trustees or Trustee
of any trust and Co-Guardians or Guardian of any property interest which may be created under this
Will for minor children or persons who are incapacitated.
Article Five: Powers of Fiduciaries:
{}5.1 No fiduciary under this Will shall be required to give bond or other security for
the faithful performance of the fiduciary's duties.
{}5.2 Any such fiduciary shall have the following powers, in addition to those given
by law:
{}5.2.1 To invest in, accept and retain any real or personal property, including
stock of a corporate fiduciary or its holding company, without restriction to legal
investments;
{}5.2.2 To sell, exchange, partition or lease for any period of time any real or
personal property and to give options therefor for cash or credit, with or without
security;
{}5.2.3 To borrow money from any person including any fiduciary acting
hereunder, and to mortgage or pledge any real or personal property;
{}5.2.4 To hold shares of stock or other securities in nominee registration
form, including that of a clearing corporation or depository, or in book entry form or
unregistered or in such other form as will pass by delivery;
{}5.2.5 To engage in litigation and compromise, arbitrate or abandon claims;
{}5.2.6 To make distributions in cash, or in kind at current values, or partly
in each, allocating specific assets to particular distributes on a non-pro rata basis, and
for such purposes to make reasonable determinations of current values;
{}5.2.7 To make elections, decisions, concessions and settlements in
connection with all income, estate, inheritance, gift or other tax returns and the
payment of such taxes, without obligation to adjust the distributive share of income
or principal of any person affected thereby;
{}5.2.8 To allocate, in the Executor's sole and absolute discretion, any portion
of my exemption under Section 263 l(a) of the Intemal Revenue Code to any property
as to which I am the transferor, including any property transferred by me during my
lifetime as to which I did not make an allocation prior to my death;
{}5.2.9 To create, except when the fiduciary is a beneficiary of the subject
trust, with respect to all or any part of the principal of any trust hereunder, including
a pecuniary amount, by a written instrument a general testamentary power of
appointment within the meaning of Section 2041 of the Internal Revenue Code in any
beneficiary thereof and to eliminate such power for all or any part of such principal
as to which such power was previously created and to divide trust principal into two
fractional shares based upon the then portion of the trust that would be includable in
the gross estate of the beneficiary holding such power if he died immediately before
such division (in which case the power shall be over the entire principal of one share
and not the other), with each share being administered as a separate trust, unless such
fiduciary shall thereafter elect to combine such separate trusts into a single trust; to
exercise the foregoing discretion to create or eliminate a general testamentary power
of appointment when such fiduciary determines that the inclusion of the property
affected thereby in the beneficiary's gross estate may achieve a significant savings in
transfer taxes by having a federal estate tax in lieu of a Chapter 13 tax imposed by the
Internal Revenue Code on the property subject to such power of appointment or may
achieve significant income tax benefits;
{} 5.2.10 To disclaim any interest I may have in any estate if the Executor
deems such disclaimer to be in the best interests of my estate and the beneficiaries
thereof;
{}5.2.11 To terminate any trust created herein, the principal of which is or
becomes too small in the Trustee's discretion to make the establishment or
continuance of the trust advisable, and to make immediate distribution of the then
remaining trust property to the beneficiary then entitled to the income of the trust
property or, if there is more than one beneficiary, to the beneficiaries then entitled to
the income of the trust property in proportion to their respective interests therein
or, if such interests are not defined, in equal shares to such beneficiaries; provided,
however, no Trustee shall participate in any decision to terminate such trust if by
reason of such termination such trustee could receive a distribution of trust property
from such trust as aforesaid. The receipts and releases of the distributee(s) will
terminate absolutely the right of all persons who might otherwise have a future
interest in the trust, whether vested or contingent, without notice to them and without
the necessity of filing an account in any court; and
{}5.2.12 To merge any trust created hereunder with any other trust or trusts
created by me or my spouse under will or deed, if the terms of any such trust are then
substantially similar and held for the primary benefit of the same person or persons.
Article Six: Provision for Taxes:
{}6.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar
nature payable by reason of my death to any government or subdivision thereof upon or with respect
to any property subject to any such tax ("Death Taxes"), and any penalties thereon, shall be paid by
the Executor out of the principal of that portion of my estate disposed of by Article Two of this Will,
and all interest with respect to any such taxes shall be paid by the Executor out of the income or
principal or partly out of the income and partly out of the principal of such portion of my estate, in
the absolute discretion of the Executor, without reimbursement from or apportionment among the
beneficiaries, recipients or owners of such property for any such taxes, penalties or interest; provided,
however, the Executor shall not pay any such taxes, penalties or interest attributable to any property
included in my estate solely because of a power of appointment thereover which I possess but have
not exercised or any qualified terminable interest property; provided further, however, the Executor
shall not pay any supplemental federal estate tax, or any penalties or interest related thereto, imposed
by Section 4980A(d) of the Internal Revenue Code, which supplemental federal estate tax, together
with any penalties or interest related thereto, shall be borne by the recipients of the qualified plan
benefit (including my estate if it is a recipient of any such benefit) giving rise to such supplemental
federal estate tax in proportion to their respective interests therein.
Article Seven: Provision for Debts and Expenses:
{}7.1 I direct that any of my legally enforceable debts, any expenses of my last illness,
funeral and burial, and any of the administrative expenses of my estate shall be paid from the principal
of that portion of my estate disposed of by Article Two of this Will.
Article Eight: Miscellaneous Provisions:
{}8.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal
6
Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent
law..
{}8.2 Whenever the Trustee is directed to distribute property to or for the benefit of
any beneficiary who is under (a) eighteen years of age, or (b) a legal disability or otherwise suffers
from an illness or mental or physical disability that would make distribution directly to such
beneficiary inappropriate (as determined in the Trustee's sole discretion exercised in good faith), the
Trustee may distribute such property to the person who has custody of such beneficiary, may apply
such property for the benefit of such beneficiary, may distribute such property to a custodian for such
beneficiary, whether then serving or selected and appointed by the Trustee (including the Trustee),
under any applicable Uniform Transfers to Minors Act or Uniform Girls to Minors Act, may
distribute such property directly to such beneficiary's estate, or may distribute such property
directly to such beneficiary (except if any of the conditions hereinbefore described in (b) apply),
without liability on the part of the Trustee to see to the application of such property. This provision
shall not in any way operate to suspend such beneficiary's absolute ownership of such property or
to prevent the absolute vesting thereof in such beneficiary.
{}8.3 Except as otherwise may be provided in this Will, during the continuance of any
of the trusts created under the provisions of this Will, and thereafter until the property is distributed
to and received by any beneficiary hereunder, the principal sums thus held in trust for any beneficiary,
respectively, and the income thereof shall not be subject to or liable for any contracts, debts,
engagements, liabilities or torts of such beneficiary now or herearler made, contracted, incurred or
committed, but shall be absolutely free from the same, and such beneficiary shall have no power to
sell, assign or encumber all or any part of the principal sums or such beneficiary's interest therein,
respectively, or the income thereof, or to anticipate the income.
{}8.4 If any beneficiary hereunder should die within thirty (30) days after me or within
thirty (30) days after any other person the survival of whom determines his rights hereunder, then
such beneficiary shall be deemed to have predeceased me or such other person for all purposes
hereunder.
IN WITNESS WHEREOF, I, PAULINE M. BOOHER, have hereunto 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 B day of /t'l/9/*. c ts ., 1997.
PAULINE M. BOOHER
(SEAL)
Signed, sealed, published and declared by the above named PAULINE M. BOOHER as and
for her last Will, in the presence of us and each of us, who, at her request and in her presence and in
the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year
last above written.
///~)' ~'-'--" //~W Residing
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS.
We, PAULINE M. BOOHER, the testatrix, and
~. tX' ,q Iq' /4
and
8
~--~ t. t ts. ,~. 5' 7 a ~ ^ r , the witnesses, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her last Will; that the testatrix signed willingly
and executed it as her free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix signed the Will as a witness and that to
the best of his or her knowledge the testatrix was at that time eighteen (18) years of age or older, of
sound mind and under no constraint or undue influence.
PAULINE M. BOOHER
Witness
Witness
~Witnes%
Subscribed, sworn
the testatrix, and subscribed
1997.
to and acknowledged before me by PAULINE M. BOOHER,
and sworn to before me by
,. L [.C ,O 1,4 /o d t..c m and
, the witnesses, this / z. rD day of
Notary Public
My Commission expires:
SEAL
Notarial Seal
Laure E. Kane Notary Pub ic
Camp Hill Boro, Cumberland County
My Commission Expires Nov. 15, 1999
Member, Pennsylvania Association of Notariaa
S. B~:a~r~ S~IrH
ATTORNEY AT LAW
107 N. i~4TH STREET
GA.HP HILL, PA 17011-~602
717 737-6789
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
To the Register:
I 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 :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Z£: tLb~ 6 [ I1/[4 tO.
Capacity: .
Signature
Name
Address ?_,'5 q ,~'_//~ !~ .~. ,
Teteph°ne VffD '7 ~,~ '~"--
jPersonal Representative
__Counsel for personal representative
CUM[:~ERLAND COUNTY REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE $.6(a)
Name of Decedent: Pauline M. Booher
Date of Death: 1/9/2003
Will No. 21-03-1~3 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules w
served on or mailed to the following beneficiaries of the above-captioned estate or6/2/2003. :
Name Address
The First Assembly of God Church 4100 North Progress Ave.
Harrisburg PA 17110
Shirley B. Drakulic P.O. Box 144
Pitcairn PA 15140
Donna B. Litzinger 2347 San Juan Grande
P~rl~gl{l FL 32507
Gary Booher Box 290
Adamsburo PA 15{~11
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except;
None
Date: 8/2/2003
~,~-' , ~ Capacity:
Signature Edward M. Brown
Name: Edward M. Brown
Address: HC 60. Box 531
Orbisonia
PA 17243
Telephone(814) 4473455
Personal Representative
Counsel for Personal
Representative
Pauline M. Booher
Continuation of Certification of Notice Under Rule 5.6(a)
Page 1
1/9/2003
Names and addresses
Name
Carl Eugene Booher
Address
HC 71, Box 385
Orbisonia
PA
17243
Eric F. Booher
109 North 20th St.
Camp Hill
PA 17011
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
003008
BROWN EDWARD M ESQUIRE
HC 60 BOX 531
ORBISONIA, PA 17243
........ fold
ESTATE INFORMATION: SSN: 211-18-4005
FILE NUMBER: 2103-0123
DECEDENT NAME: BOOHER PAULINE M
DATE OF PAYMENT: 09/12/2003
POSTMARK DATE: 09/11/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 01/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,319.99
TOTAL AMOUNT PAID:
$3,319.99
REMARKS: ERIC F BOOHERC/O
EDWARD M BROWN ESQUIRE
SEAL
CHECK# 115
INITIALS: AC
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 171280601
I.-
Z
UJ
al
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAl. USE ONLY
FILE NUMBER
2 1 -0 3 1 2 3
COUNTY CODE Yr~q NUMBER
DECEDEN'PS NAME (LAST, FIRST, AND MIDDLE INITIAL
Booher, Pauline M.
DATE OF DEATH (MM.DD-Year) I DATE OF BIRTH (MM.DD-Year)
01/09/2003 I 07/18/1915
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
2 I 1-1 8-4 0 0 5
THIS RETURN MUST BE FILED IH DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~-'~1. Original Relurn
['-"~ 4. Limiled Estate
r~6. Decedent Died Testate {Nta~ c~w~fwa)
[~9. Litigation Proceeds Received
~]2. Supplemental Return
r"] 4a. Future Interest Compromise (d~. ~f ~ ~r 12-12.82}
[--~ 7. Decedent Maintained a Living Trust
r--~ 10. Spousal Poverty Credit (,~. ~f a~,h ~ 12-31-,1 =~ I-1-~}
Edward M. Brown
FIRM NAME (ifAppicabb)
Edward M. Brown, Esq., P.C.
TELEPHONE NUMBER
814-447-3455 or 814-643-9787
r'-~ 3. Remainder Return (daeofdeathpdorto 12-13-82)
[]5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (AUach s~ o)
COMPLETE MAILING ADDRESS
HO 60, Box 531
Orbisonia PA 17243
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Padnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposils & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Inler-Vives Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses 8, Adminislrative Costs (Schedule H} (9)
10. Debts of Decedenl, Modgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject te Tax (Line 12 minus Line 13)
17,500.00
44,794.95
OFFICIAL USE ONLY
(11)
(12)
(13)
17,090.49
937.97
62,294.95
18,028.46
44,266.49
22,133.24
(14)
22,133.25
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 laxable at lineal rale
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 laxable at collateral rate
19. Tax Due
20.
X __ (15)
X __ (16)
X .12 (17)
22,133.25 X .15 (18)
(19)
3,319.99
3,319.99
- D. ecedent's Complete Address:
STREET ADDRESS
Manor Health Care Services
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
ISTATE PA I ZIP 17013
(1)
3~319.99
Total Credits ( A + B + C ) (2)
Total Intsrest/Penalty ( D + E )
3,319.99
If Line 2 is Fester 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 I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 37319.99
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income.; ...................................... [] []
c. retain a reversionary interest;.or .................................................................................................. [] []
d. receive the promise for life of either payments, benefits or cam?. ......................................................... [] []
2. If death occurred alter December 12, 1982, did decedent transfer pmporty within one year of death
without receiving adequate consideration? .......................................................................................... [] []
3. Did decedent own an 'in trust for" or payable upon death bank account or secudty at his or her death2 ............... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation2 .................................................................................................. [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
bund?- penali?s of pe~ju~.., I d.ecla~., that I hav~. examined this m.t?m, incbdi.ng accompanying schedubs an.d stale .merits, and to the best of my knowledge and belef, it is line, correct and compbte.
ecbralio~ oi ixepanw omer man me pass,xtra mpmsentatbe is =am~ on al mformatio~ of whid~ pmp~ n~ ~y ~ge.
SIGNATURE OF P,~;;~SON RESPONSIBLE FOR FILI.~ RETURNs)
ADDRESS 109 North 20th Street
Camp Hill
SIGNATURE OF PREP~J;~-'~R T~[/~N~,~PRESENTA,~
ADDRESS HC 60, Box 531
Orbisonia
DATE
PA 17011
(~f7ATE /
/t/o
PA 17243
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rats imposed on the net value of lransfors 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 lmnsfers 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 lax rate imposed on the net value of Imnsfors 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-1502 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
R LESTATE
ESTATE OF FILE NUMBER
Booher. Pauline M. 21 03 123
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the pdce at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is Jointly-owned with rktht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. The decedent's one-half (1/2) interest in ALL those two certain adjoining
lots of ground situated in the Borough of Rockhill, Huntingdon County, PA,
to wit:
Parcel #1: Being Lots No. 33 and 35, each situated on the Eastern side of
Valley Street and each having a frontage on Valley Street of thirty-three (33)
feet and four (4) inches, and extending in depth at dght angles to said Valley
Street a distance of one hundred fifty (150) feet to a twenty (20) foot alley.
Having thereon erected a two-story frame house.
Parcel #2: Being Lot No. 37 situated on the Eastern side of Valley Street,
fronting 33 feet 4 inches thereon and extending back at right angles thereto
150 feet to a 20 foot alley.
BEING Tax Parcel No. 39-01-49.
AND BEING the same premises title to which vested in Carl E. Booher, Sr.
and Mildred L. Booher, husband and wife as tenants by the entireties as to a
one-half interest and Pauline M. Booher, a one-half interest, as tenants in
common.
The said Mildred L. Booher departed this life on June 2, 1995; the said Carl E.
Booher, Sr. departed this life on April 26, 2003.
Sold at public sale. Gross proceeds (decedent's estate receives one-half).
See attached copy of Settlement Statement.
TOTAL (Also enter on line 1, Recapitulation) $
VALUE AT DATE
OF DEATH
17,500.00
17~500.00
REV-I$08 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Booher. Pauline M. 21 03 123
Include the proceeds of litigation and the date the proceeds were received by the estate.
All prope~y Jointly-owned with right of aurvivomhlp must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking account #2906110802, Waypoint Bank 17,999.94
10.
Checking Account #1100833, Community State Bank of Orbisonia.
Certificate of Deposit #1110261, Community State Bank of Orbisonia.
Public sale of personal property.
Net proceeds.
Prorated 2003 school real estate taxes.
See attached Settlement Statement; one half of total shown for decedent's one
half ownership of the real estate.
Prorated 2003 county/borough real estate taxes.
See attached Settlement Statement; one half of total shown for decedent's one
half ownership of the real estate.
Cash on hand.
Refund, Manor Health Care Services.
Department of Treasury, IRS refund.
Final annuity payment.
TOTAL (Also enter on line 5, Recapitulation) $
9,469.36
10,019.86
476.00
118.19
40.55
163.00
3,679.88
2,448.00
380.17
44,794.95
(Ifmorespaceisn~ded, inseHa~itionalsheeisofthesamesize)
EV-1511 EX + (12-99)
CONIVK3NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Booher, pauline M. 21 03
123
Debts of decedent must be reported on Schedule i.
ITEU
NUMBER DESCRIPTION AUOUNT
A.
1.
8.
9.
10.
11.
12.
13.
FUNERAL EXPENSES:
Martin R. Brown Funeral Home, Inc., professional services, facilities, automotive
equipment, merchandise, opening grave, newspaper notices
Martin R. Brown, Funeral Home, Inc., death certificates
Hetrick Funeral Home, death certificate for Ruth Rinker
ADMINISTRATIVE COSTS:
Personal Representalive's Commissions
Name of Personal Representative (s) Eric F. Booher
Social Securily Number(s)/EIN Number of Personal Representative(s)
Street Address 109 North 20th Street
171-40-8741
City Camp Hill State PA
Year(s) Commission Paid: 2003
Attorney Fees Edward M. Brown, Esq., P.C.
Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation)
Claimant
Zip 17011
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills, grant of letters, short certificates, JCP fee, renunciation
Accountant's Fees
Tax Retum Pmparer's Fees
Cumberland County Register of Wills, copies of filed estate documents
The Patriot News, estate advertisement
The Cumberland Legal Joumal, estate advertisement
UPS, overnight delivery of real estate closing documents
Cumberland County Register of Wills, additional Short Certificates
Filing fee for Inheritance Tax Return and Inventory
Reserve for filing fees and estate closing costs
9,359.80
37.00
5.00
3,114.75
3,864.75
163.00
6.50
205.69
75.00
16.00
18.00
25.00
200.00
TOTAL (Nso enter on line 9, Recapitulation) $ 17~090.49
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
COIVMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
$CH~=DULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Booher. Pauline M. 21 03
123
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Rockhill Borough Tax Collector, 2003 real estate taxes (1/2 total due). 146.64
.5.
10.
Dr. Ouirico Magbojis, medical expense.
West Shore EMS, medical expense.
Dr. Hal Fineburg, medical expense.
Carlisle Regional Medical Center, medical expense.'
H & R Block, income tax preparation.
PA Department of Revenue, income tax.
Guistwife Family Practice, medical expense.
Cumberland County
Mobile X-Ray Imaging, medical expense.
25.00
63.45
63.52
118.50
166.00
68.00
52.86
18.00
216.00
TOTAL (Also enter on line 10, Recapitulation) $ 937.97
(If more space is needed, insert additional sheets of the same size)
REV'-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Booher. I ~auline M.
NUMBER
I.
1.
2.
3.
4.
5.
]1.
NAME AND ABDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Shirley B. Drakulic
P.O. Box 144
Pitcairn, PA 15140
Donna B. Litzinger
2347 San Juan Grande
Pensacola, FL 32507
Gary Booher
Box 290
Adamsburg, PA 15611
Carl Eugene Booher
HC 71, Box 395
Orbisonia, PA 17243
Eric F. Booher
109 North 20th St.
Camp Hill, PA 17011
FILE NUBBER
21 03
RELATIONSHIP TO BECEDENT
Do Not List Trustee(s)
niece
niece
nephew
nephew
nephew
10%
10%
10%
O%
O%
123
AMOUNT OR SHARE
OF ESTATE
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 MABE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
The First Assembly of God Church
4100 North Progress Avenue
Harrisburg, PA 17110
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
22,133.24
22,133.24
(If more space is needed, insert additional sheets of lhe same size)
A Et, TYPE OF LGAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.ir~,FHA 2,[~FmHA 3 ~]CONV. ~JNINS. 4.['lvA 5.
SE~LEMENT STATEMENT 03SNA~A[ ,.
8. MORTGAGE INS CASE"Nu'~:.
D NAME AND ADDRESS OF BORROWER: E. NA~E ANC ~DDRESS OF SELLER: F, NAME AND ADDRESS OF LENDER:
A,Jd? L 5na~r eno Estate el Cad E Bocner. Sr.
P,O, ~o~ 134 Orb~sonla PA 17243
~oc-km;[ Fun~ace. ~A 1 ~249 J
G. P~OPEETY LOCAT!ON' H. S~I'TL~'NTAGENT: 25.1741454 ~i. SETTLEMENT DATE:
Rockhi,i Furnace. PA 1724~ ..... Septombe¢ 3, 2003
HUT tint,on County. Pe,y"~ylva¢~;a PLACE O,= SETTLEMENT
Tax ~ar~ 3~-01-49 ~ 225 Wa~hi~gic. r~ SL
J. SUMMARY OF BORROWER'S TRANSACTION K, 8UM~RY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWE~: 400 GRO~S AM00NT ~UE TO ~ELLER:
10% Conl~ac[ Sates Price 35,000 O~ 401. C~lract Sa~S Price
~02. P9;~nal Pro~ 402. Pers~al Prepay
!03. Seul~men[ Char~s to ~orrowe¢ [;.;¢~ 1400~ I,~ 50 403.
1G4 .~ .... 404 ,,,]
'05 405
~u~t~enls For ;terns ~e~d By 5ofle~ /n a~'a~ce A~us~nt~ ~ar ttem~ ~e~ By Softer ~ e~ance
'05 5c~oc! D9/~4;'03 [o 0T/01/04 ~36,37 4G~. ~cho~ 09t04t03 Io 07~01/~ [ 23637
77 Counly;6o~o -- 09~04~03 to 01/01/04 8%09 40A C~uflty~Boro 09104/03 to 01~011~ ...... ~ B1 0g
~. Asses~enls to 4~Br A~,~n~ to
I'i. 411.
120. GR'OSS AMOUNT DUE FROM ~ORROWER 35.51796 420. GROSS ~MOUNT DUE TO &ELLER ~ 35.3~7.45
200. AMOUNTS PA{D BY OR IN BEHALF OF BORROWER: 500. R~DUCTIONS IN AMOUNT DUE TO. SELLER:
201 De~osil or ea~[.mon~ 3~ 00 501. Excess ~s~l [See Instmct~s~
Z02. prmcipa=~m~un: of New Loan?) __ 28,000,00 502. 8etOe~,CPa~s to
204. ~ 504, ~ayoff of firsl
205 ~ 505.~ay~ff.o~d M~age .....
2O6 50~.
20z. 507, [Deposit Dish. as
2~9, 50~, L .....
2~C Sci~ ~o ~1~ Scna~ to
2' 2. As~e~smenls ....... to ' .... 512. Assess~n~
2' 3. 513.
2; 7 517. Finer water & ,ewer to ORJMA 63.00:
2~ 8 ' .............. 518. 20O3~cn~ Tax lo RockhiLI Bead T~Cf39.01.49I '~93.28
220 TOTAL PAfD BY~OR BORROWER ~ aLS00.00 520, TOTAL REOUCTtON AMOUNT DUE $ELLER~ 37228i
300, CASH AT SE~LEMENT FROMIT~ ~RR~'~E~':" ' 600.~ASH AT 8E~LEMENT TO/FROM SELLER;
301 GfossA:~lountDueF~omBorrower,;Lme120~ 36,617.~6, 6C1. G~s~A~unIDueTo~e~(Li~420~ I 35.3!7.48
302 Less Amen[ Psid B~¢F~ Borrower [Line 2Z~)Iii 31.509,00', 692. CAsH(L'ess Reducli~STo)fDUeFROM)SELLERSeIler (Li~e 520) ( ' 372~
303 CASH( X ~OM)( ?'O/BORrOWeR ] 5,11796 503 X 34,9451~1
The unaers~gaecl hereDy acknowle:;ge race/p: o! a comple:ea copy of pages I&2 of this statemenl & a~y attachments ~'e[erred to r, erein,
J HAVE CAREFULLY REVIEV'.~D THE HUD-; SETTLEMENT STAT-7-ME~T AND TO THE ~EST CF MY KNCWLEDGE AND BELIEF, IT tS A TRUE AND
ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME ~N TH!S TRANSACTION, I FURTHER
CERTIFv THAT I HAVE RECEIVED A COPY OF THE HUD-! SETTLEMENT STATEMENT.
, I f ./://
BY:
? O l'Mb_ SI&:~ r Or= MY K.~d;;P.A/L,.EyOGE, THE HUD,'~ S~LEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCU~TE ACCOUNT
THg FUNDS ',V~IC, '¢RE, R~EiVED AND HAV~EN OR W~LL BE D~BURSED BY ~E UNDERSIGNED AS PART CF THE SE~LEMENT OF TH~S
Cenlrai ~.]~S~l[lef~nt CO
WARNING: [T IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO ThE UN[TED STATES ON THiS OR ANY 5I~i~R FORM PENAL~IES
~ i.i t L. SETTLEMENT CHARGES
700, TO~L COMMISSION Based on Price
"O~visibe of Corn'mi.~$"o~ I!tne 700) as ,=olluws'
701 ~ ,: ,'~ to
702 $ r ' ~0
7~. Commissio~ P~ at Se~leme~l
?04. to
BOO, ITEMS P~AYABLE IN CONNECTtON W~TH LOAN
B01 Loa~ Or~inaUon Fee % tO
~03 Appraisal Fee
B04. Credit Report tO
605. Lender's Inspection Fee
806. M0rtgagp ins, App. ~ee lo ~
807. AsS,Jrflp~0f*~ Fee Io
908 Applicafio.'~ Fee to Community S!a~e Ban~
809.810. Document Prep Fee lo Community State Bank
75.00
25.0Q
811, j
900. ITEN~S REQUIRED BY LENOER TO ~E PAID IN ADVANCE
901. inlerest From 09:03/03 lo 10!01/03 ~ $ /day { 280sys %)
902. Mortgage Insurance Premiumfor monl~l$ to
Hazard I~surar'ce Premium for ! 0 years tO
904.
1000. RESERVES DEPOSITED WITH LENDER
1001 Hazard I~surance ~ths I~r$ per f~orlh
;:02. Mod~a~ In~rance ~s ~ S per monlh
!903 SChool ~S ~ S ~r mO~th
~ )04. C~t~t~om ~ths ~ S per m0nlh
!005. Asse~m~ls m~lhs ~ S ~r momh
1007. ~ths ~ S q~r month
i008 A~re~ate Adlus~e~t Ct. ~s ~ S ~r mor~lh
11~. TITLE CHARGES
~10~ SetdementorClasr,~ Fee to Central Penn Settlement Co,
1102 Abstract or Tille Searc~ tO
1103 Tille Examin~tio~ lo Oepllal Penn Setlle"nermt Co.
1104 Ti~e Insurance Bio~et lo
1105. Document °reparation lo CenlraJ Pe~n SeUJement CO.
1106. Nota~' Fees IO Notar'Z.
107 Altomey's Fees
0,.3. Lender's Coveral~e
27500
60,00
2.00~
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
:201 Re~ording ;eec: Deed $ 57.00; Mortgage $ 46.50; Releases $ { 1~3.50]
~2~2. Ci~,Coum~ Tax/Stamps:Re'eerie stamps 350.00; Mort~e I
12~3 Slate Ta~,'Slamps: Revenue Stamgs 350.00; Me,t~e
350.00
1~6'8. ADDITIONAL SETTLEMENT CHARGES
t1305304 1,3OD, 5
1600
Cell lied to be a trge COpy
C, entfal Penrl Settlerrlect Co
See[amen! Agent
Cumberland County Register of Wills
INVENTORY
Estate of Boohert Pauline M.
also known as
, Deceased
No. 21 03 123
Date of Death 1/9/2003
Social Security No 211184005
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. I/We
verify that the statements made in this inventory are true and correct. I/We 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:
Attorney: Edward M. Brown _ _,~ _
LD. No.: 59018 Eric F. Booher
Address: HC 60, Box 531 Dated
Orbisonia PA 17243
Telephone: 814-447-3455 or 814-643-9787
Description
Cash, Bank Deposits, & Misc. Personal Property
Checking account #2906110802, Waypoint Bank
Checking Account #1100833, Community State Bank of Orbisonia.
Certificate of Deposit #1110261, Community State Bank of Orbisonia.
Public sale of personal property.
Net proceeds.
Prorated 2003 school real estate taxes.
(Attach Additional Sheets if necessary)
Total
Value
17,999.94
9,469.36
10,019.86
476.00
118.19
62,294.95
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
Booher, Pauline M.
Description of Inventory
Continuation of Inventory
Page 1
21
03
123
Description
Prorated 2003 county/borough real estate taxes.
Cash on hand.
Refund, Manor Health Care Services.
Department of Treasury, IRS refund.
Final annuity payment.
Real Estate
The decedent's one-half (1/2) interest in ALL those two certain adjoining
lots of ground situated in the Borough of Rockhill, Huntingdon County, PA,
to wit:
Parcel #1: Being Lots No. 33 and 35, each situated on the Eastern side of
Valley Street and each having a frontage on Valley Street of thirty-three (33)
feet and four (4) inches, and extending in depth at right angles to said Valley
Street a distance of one hundred fifty (150) feet to a twenty (20) foot alley.
Having thereon erected a two-story frame house.
Parcel #2: Being Lot No. 37 situated on the Eastern side of Valley Street,
fronting 33 feet 4 inches thereon and extending back at right angles thereto
150 feet to a 20 foot alley.
BEING Tax Parcel No. 39-01-49.
AND BEING the same premises title to which vested in Carl E. Booher, Sr.
and Mildred L. Booher, husband and wife as tenants by the entireties as to a
one-half interest and Pauline M. Booher, a one-half interest, as tenants in
common.
The said Mildred L. Booher departed this life on June 2, 1995; the said Carl E.
Booher, Sr. departed this life on April 26, 2003.
Sold at public sale. Gross proceeds (decedent's estate receives one-half).
Value
40.55
163.00
3,679.88
2,448.00
380.17
17,500.00
Subtotal $ 24,211.60
Grand Total $ 62,294.95
Edward M. Brown, Esq., P.C.
HC 60, Box 531
Orbisonia, PA 17243
(814) 447-3455 or (814) 643-9787
September 11, 2003
Cumberland County Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re:
Estate of Pauline M. Booher
#21-2003-123
Dear Madam:
Enclosed:
1. An original and copy of the Pennsylvania inheritance tax retum.
2. An original and copy of the inventory form.
3. Check #115 in the amount of $3,319.99 for inheritance tax due.
4. Check #116 in the amount of $25.00 for inheritance tax return and inventory filing fees.
5. Return envelope for receipt.
Please comact me if you have any questions or need any additional information (or fees).
Thank you for your assistance.
Sincerely,
Edward M. Brown
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT) ALLOWANCE OR DISALLOHANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-I$ii7 EX AFP CD1-05)
EDWARD M BROWN ESQ
HC 60 BOX 531
ORBISONIA
PA 172~$ ~
DATE 11-10-2003
ESTATE OF BOOHER
DATE OF DEATH 01-09-Z003
FILE NUMBER 21 03-0123
COUNTY CUMBERLAND
ACN 101
Alnount Rae'i ~:ted
PAULINE M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETA/N LOWER PORT/ON FOR YOUR RECORDS ~
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOOHER PAULINE M FILE NO. 21 03-0123 ACN 101 DATE 11-10-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE XNTEREST- SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Hold Stock/Partnorsh/p Interest (Schedule C) (3)
q. Hortgagos/Notos Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6, Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule O) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Lions (Schedule I) (10)
11. TotaX Deductions
12. Nat Value of Tax Return
17~500.00
.00
.00
.00
qq/79q.95
.00
.00
(8)
17,090.q9
937.97
(11)
(12)
NOTE: To insure proper
cred/t to your account)
submit the upper portion
of this fora w/th your
tax payment.
62,29q.95
~,266.~9
13.
lq.
NOTE:
ASSESSMENT OF TAX: 15. Amount of L/no lr~ at Spousal rate
16. Amount of L/no lq taxable at Lineal/Class A rata
17. Amount of L/no lq at S/bl/ng rata
16. Amount of Line lq taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
09-12-2003
Charitable/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15)
Nat Value of Estate Sub.~ect to Tax
'r.l' an assessment Nas lssued prev/ously, lines lq, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
22,133.2q
22,133.25
18 and 19 Nill
(lB) .00 x O0 = .00
(16) .00 x Oq5= .00
(17) . O0 x 12 : . O0
(18) 22,133.25 x 15 = 3,319.99
(19)= 3,319.99
RECEIPT
NUMBER
CD003008
IF PAID AFTER DATE INDICATED) SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
3,319.99
TOTAL TAX CREDIT
BALANCE OF TAX DUE
XNTEREST AND PEN.
TOTAL DUE
3,319.99
.00
.00
.00
( XF TOTAL DUE IS LESS THAN $1) NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SXDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 11, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (coZZatara1) beneficiaries of the decadent after the expiration of any estate for
life or for years, the CoeaonaeaZth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collateral) rate on any such future interest.
To ~ulfill the requirements of Section 2ZqO of the Inheritance and Estate Tax Act, Act ES of 2000. (71 P.S.
Section 91q0).
Detach the top portion af this Notice and submit with your payment to the Register of gills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office
of the Register of Rills, any of the 25 Revenue District Offices, or by calling the specie1 Z4-hour
answering service for fores ordering: 1-800-361-Z050; services for taxpayers eith special hearing and / or
speaking needs: 1-800-447-3010 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA ZT1ZS-IOZI, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. AlL taxes which became delinquent on and after
January 1, 198E will bear interest et a rate which mill vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Yea__r Rate Factor Yee.__r Rate Factor Year Rate Factor
1981 lOX .000548 1987 97. .000247 1999 71 .000192
198S 16Z .000~,38 1988-1991 llZ .000301 ZOO0 81 .000219
1984 llZ .000301 1992 97. · 0002~,7 ZOO1 91 . O00Za,7
1985 132 .000356 1993-1994 7X .000192 Z002 62 .000164
1986 IOZ .000274 1995-1998 91 .OOOZq7 Z00:5 SZ .000137
--Interest is calculated es follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNI~UENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
~ Reply to:
HC 60, Box 531
Orbisonia, PA 17243
(814) 447-3455
Fax (814) 6434616
Edward M. Brown, Esq., P.C.
__ llcply to:
225 Washington Street
Huntingdon, PA 16652
(814) 643-9787
Fax (814) 6434616
December 6, 2003
Cumberland County Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Pauline M. Booher
#21-03-00123
Dear Sir or Madam:
Enclosed is an original and a copy of the Supplemental Inheritance Tax Remm for the
Booher Estate, check # 120 in the amount of $1,263.09 for inheritance tax and interest due, check
#121 in the amoum of $15.00 for the filing fee and a remm envelope for a receipt.
If you have any questions or need additional information, please feel free to contact me.
Thank you for your assistance.
Sincerely,
/
Edward M. Brown
Edward M. Brown, Esq., P.C.
HC 60, Box 531
Orbisonia, PA 17243
Cumberland County Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD OO3319
BOOHER ERIC F
109 NORTH 20TH STREET
CAMP HILL, PA 17011-3803
........ fold
ESTATE INFORMATION: SSN: 21 1-18-4005
FILE NUMBER: 2103-0123
DECEDENT NAME: BOOHER PAULINE M
DATE OF PAYMENT: 12/09/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,263.09
TOTAL AMOUNT PAID:
91,263.09
REMARKS: RECEIVED OF ERIC F BOOHER,EXEC
IN CO EDWARD M BROWN ESQ.
SEAL
CHECK# 1 2O
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT· 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REV-1500
INHERITANCE TAX R, ETUEN
RESIDENT DECEDENT
Booher, Pauline M.
DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DO-Year)
01/09/2003 I 07/18/1915
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUBBER
2 1 -0 3 0 0 I 2 3
COUNTY C~E ~ N~
SOC~LSECURITYNUMBER
2 1 1 -1 8-4 0 0 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITYNUMBER
r'~l. Original Return
r'-] 4. Limited Estate
r"-~ 6. Decedent Died Testate (~a~h copy of wa)
r-'l 9. Litigation Proceeds Received
r-~2. Supplemental Return
["'"~ 4a. Future Interest Compromise Ida. of ~eam ~ter 12-12-e2)
-"]7. Decedent Maintained a Living Trust (~ach copy of Tru~)
[] 10. Spousal Poverty Credit (da. of dealh beh~en 12-31-91 and 1-1-95)
NAME
Edward M. Brown
FIRM NAME (if Appiceble)
.Edward M. Brown, Esq., P.C.
TELEPHONE NUMBER
814-447-3455 or 814-643-9787
1. Real Estate (Schedule A) (1)
2. Slocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Padnership 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)
] Separale Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
cj. Fu,:.eral Expenses & Administrative Costs (Schedule H) (9)
!0. Oebt.~ .~f Dec. eden*, I'.to:tgags Liabilities,., ~ I_,...;~,,,~ ~'~,-~.,.~ ,,~,,~._,~ ,,,~ ~lw/m
11. Total Deductions (tolal Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
r--~ 3. Remainder Return {dae of death pdor to 12-13-82)
]5. Federal Estale Tax Return Required
8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) tAttac~ s~. o)
COMPLETE MAILING ADDRESS
HC 60, Box 531
Orbisonia . PA 17243
8,342.04
15.00
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)
OFFICIAL USE ONLY
8~342.04
(11)
(12)
(13)
(14)
15.00
8~327.04
8~327.04
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9! 16 (a)(12)
__ (15)
16. Amounl cf Line 14 taxable at lineal rate
__ (16)
17. Amount of Line 14 taxable al sibllng rate
18. Amount of Line 14 taxable at collaleral rate
19 Tax Due
X
8,327.04 x
.12
.15
(17)
(18)
(19)
1,249.06
1 ~249.06
1--
20. ~1
' Decedent's Complete Address:
STREET ADDRESS
Manor Health Care Services
CITY
Carlisle
ISTATE PA
IZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Cradits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest 14.03
E. Penalty
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
(4)
(,5)
(5A)
(5B)
1 ~249.06
14.03
1 ~263.09
1 z263.09
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a lransfer and: Yes No
a. retain the use or income of the properbj ~nsfarred; ......................................................................... [] []
b. retain the right to designate who shall use the property IransfaTed or its income; ...................................... [] []
c. retain a reversionary interest;.or .................................................................................................. [] []
d. receive the promise for life of either payments, benefits or care? .......................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate considera~n? .......................................................................................... [] []
3. Did decedent own an "in ~st for' or payable upon death bank account or secudty at his or her death2 ............... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.. .................................................................................................. [] []
IFTHE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN·
Under p~nallies of pedury, I declare that I hm~, examined .~.'s .m,~, ' ,mcbdin. g .accompanying. . .s~edu~ an,d =tat~, ts,, ~d to the best of my knowledge and bofef, it is line, correct and comp~e.
Declaration of preparer other than the personm representative ts oasee on al tntorrne~on o~ wmon prepam~ nas any
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS 109 North 20th Street
Camp,Hill
SIGNATURE OF P, REIS.A .~R OTHEP/TI-lAN REPR~ATIVE
DATE
PA 17011
· DATE
ADDRESS
HC 60, BOX 531
Orbisonia PA 17243
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rote 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 rote 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 am 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 lmnsfars 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 steppamnt of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of ~ansfers to or for the use of the decedenfs 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 fransfers to or for the use of the decedent% 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-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Booher. Pauline M.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule ].
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1.
FILE NUMBER
21 03
00123
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number{s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees Register of Wills, filing fee for Supplemental Return
Accountant's Fees
Tax Return Preparer's Fees
Zip
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
15.00
$ 15.00
An Int~stment That Works
4651 Westport Drive · Mecbanicsburg, PA 17055
Telephone: 71 ~/795-5921 · Fax: 717/795-5928
£-mail.' pddca g@aoL eom
November 12, 2003
Edward M. Brown, Esq., PC.
HC 60, Box 531
Orbiaoma, PA 17243
Re: Estat~ of Pauline M. Booher
SS8 211-18-4005
Dear Mr. Brown:
In re~xm~ to your letter dat~ November 11, 2(103 regarding aa~ held by om organization Iht the above-
r~eazag~l 6ezaxlemt, pl~aa¢ be advised that all aaso, s were in the form of Umzcamxl Prmniaaory Te, tm Not~.
No accounts remain ~ in th~ mun~ of the decedent. The following table diaphys tl~ information you rezlueCaxl
for ~h Not~:
I' Date of Death
Note # Date Principal Joint Interest Balance
Originally Amount Tenant(s) Rate
Opmed JTROS
1001729 ! 1/13/91 $11,000.00 Fire Assembly 7.00% $11,018.99
of God Rcgi~tralion
Harrisburg, PA was changod to
Ladie~ Bible sole ownership
Ciass-cffe~tiv~ of JTROS
11/05/96
on 03/10/2003
1003.56i 10/13/93 $$,000.00 Paulm~ M. & 3.50*/, $5,004.80
r~ultiag fnma Erio F. Boohcr; Rcgistmtio~
transfer of l~lmd Eric F. was changed to
$5,000.00 from Booh~ as sole Own~ip
No~ # YrROS on of JTRO$ o~
1002,%6 05/15/2000; 03/17/2003
Add~ Erie F. und~ ~ Not~
Boo~ aa # 1006974 and
10/15/2001 imluding
disbursed to
foF $~,021 .~7
Pennsylt.,ania-Delaware District Council
of the Assemblies of God
HC 60, Box 531
Orbisonia, PA 17243
(814) 447-3455
Edward M. Brown, Esq., P.C.
~ Reply to:
225 Washington Street
Huntingdon, PA 16652
(814) 643-9787
January 24, 2004
Cumberland County Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re.'
Estate of Pauline M. Booher
#21 03-0123
Dear Sir or Madam:
A supplemental inheritance tax return along with tax check in the amount of $1,263.09
was filed in your office on December 9, 2003 (copy of receipt enclosed). I had included enough
money in the tax check to pay interest through December 31, 2003 to allow sufficient time for the
tax return and check to arrive in your office by mail. Based on the receipt date of December 9,
2003, I would expect a small refund from the Department of Revenue.
I just received Notice from the Department (copy enclosed) that indicates that the tax
check was not received and calls for the tax plus interest through February 3, 2004.
Please advise.
Sincerely,
Edward M. Brown
Enclosures
BI~REAU OF ZND~rVIDUAL TAXES
Z~ITANCI~ TAX DIVISTON
II(PT. Za06gz
H&RRZSBURG, PA
EDWARD N BROWN ESQ
HC 60 BOX 531
ORBISONIA
CONNONWEALTH OF PENHSYLVANZA
OEPARTNENT OF REVENUE
PA 17Z43
NOTICE OF TNHERTTANCE TAX
APPRATSEHENT, ALLOWANCE OR DISALLOHANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
JiV-li¢7 EJ LiP (il-il)
DATE 01-19-2004
ESTATE OF BOOHER PAULINE H
DATE OF DEATH 01-09-2005 /~, /~% ~-~--~ /?
FZLE NLMBER 21 03-0123
COUNTY CUMBERLAND
ACN 101
HAKE CHECK PAYABLE AND REHZT PAYMENT TO:
REGISTER OF WILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-X547 EX AFP (01'03) HOTZGE OF %NI~RXTA.NC~ TAX APPRAZSLqENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS'AND ~Lq~rr-oF TAX
ESTATE OF BOOHER PAULINE N FILE NO. 21 05-0125 ACN 101 DATE 01-19-2004
TAX RETURN MAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATZOH CONCERNING FUTURE INTEREST ' SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON; SUPPLEMENTAL RETURN HO.
1. Roll Eitmte (ScheduXe A) (1) ...
2. Stocks end Bonds (Schedule B) (2)
$. CloNly HeZd Sto~k/Pir~norohlp
q. Hortglgsm/Notel Rocetvlble (S~hodule 0) (~)
S. Ci.h/Benk Del)osits/Nisc. Por.o~ll Property (ScheckJIO E) ($)
&. Jointly Owfl~ PPop~rty ISchedule F) (&)
7, Trihsfors (S~hldulo G) (7)
8. Tote/ Assets
APPROVED DEDUCTIONS AND EXEHPT~ONS:
9. Funorul Expo~les/&ck,. Costs/#ls=. Expenses (Schedule H) (9)
11. Debtl/~orts~e L~eb~l~t~ei/LLefli (Schodull T) (11)
11. Totl!
12. I~t Vtl,u~ of TJX Return
01
.QQ
.QQ
8,342.04
(8)
15.00
NOTE: To insure prol~r
=r~dlt *o your ~oount,
of this fo~ wt~ y~r
8 341.,0 ,
.00
(11) 1~. flO
(12) 8,327.04
.00
13. Ch~rLt~le/~ovorrmental Bequests; Non-elated 9113 Trusts (~10 J) (23)
14. bi Vml~ of Estito ~J~t ~o Trax (14) 30,460.29
r~le~ fl~res th~ inGlude the t~ml ~ ~ r~urnl llleliOd tO a~e.
ASSESSMENT OF TAX:
15. ~t of Ll~ 14 i~ ~ rote (15) .00 X O0 = .00
17. ~ DY Cl~ ~4 ~* Sibling rets [17) .00 X 12 , '0~
18. ~t of LI~ ~4 tull( it Co111tirll/C11ss B rlti (18) 30,460.29. x lS . 4,569.05
(19)s
19. Prln~lp81 T~x Due
TAX CREDITS:
PAYMENT
DATE
/NTEREST/PEN PAID ( - )
.00
4,569.05
3,319.99
1,249.06
18.87
1,267.93
AHOUNT PAZD
3,319.99
INTEREST Z$ CHARGED THROUGH 02-03-2004 TOTAL TAX CREDIT
AT THE RATES APPLICABLE AS OUTLXNED ON THE BALANCE OF TAX DUE
REVERSE SIDE OF THIS FORM z--N~k~'EST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATZOfl OF ADOITZONAL INTEREST.
( IF TOTAL DUE %S LESS THAH ~1, NO PAYHENT 1S RE~JIRED.
ZF TOTAL DUE ZS REFLECTED AS A ~CREDIT" (OR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTIKJCTZONS.)
BUREAU OF TNDZVZDUAL TAXES
TNHERITANCE TAX DIVTSION
DEPT. 280601
HARRTSBURG., PA 171Z8-0601
COHMONHEALTH OF PENNSYLVANTA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
RE¥-I6D? EX AFP COl-OS)
EDHARD M BROHN ESQ
HC 60 BOX 551
ORBISONIA PA 17Z~$
DATE 01-20-200~
ESTATE OF BOOHER
DATE OF DEATH 01-09-2005
FILE NUMBER ZI ~i~,~6~ ~
~OUNTY CUI~ERLAND
ACN 101
I Amount Remi~ed
PAULINE M
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~:o your account, submi~ ~:he upper por~:ion of ~:his form wi~:h your ~ax payment.
CUT ALONG THIS LTNE II).* RETAIN LONER PORTTON FOR YOUR RECORDS
REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT
ESTATE OF BOOHER PAULINE H FILE NO. 21 05-0125 ACN 101 DATE 01-20-200~
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHO#N BELO#
ZSA SUHHARY OF THE PRZNCZPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 01-19-ZOOR
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
q,569.05
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID
09-1Z-ZOOS
1Z-O9-ZO0$
CD005008
CD005519
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
.00
10.~-
5,$19.99
1,Z65.09
TOTAL TAX CREDIT
~,57Z.6~
3.59CR
YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS. )
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE 3.59CR
PAYNENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- Tf RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT.
-- zf NON-RESIDENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at
the Office of the Register of Nills, any of the Z$ Revenue District Offices or from the Department's Z4-hour
ansmering service for forms ordering: 1-800-SaZ-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-SOZ0 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Dureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (SI) discount
of the tax paid is allowed.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after
January 1, 198Z wi11 bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOS ara:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor Year__ Rate
Daily
Factor
198Z ZOZ .000548 1987 9Z .000247 1999 7Z .00019Z
198S 16Z .0004S8 1988-1991 11Z .000S01 ZOO0 8Z .000219
1984 llZ .000501 1992 9Z .000Z47 2001 92 .O00Z~7
1985 152 .000S56 1995-1994 7Z .O0019Z ZOOZ 62 .000164
1986 lOZ .O0027~ 1995-1998 92 .000247 ZOOS 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bm calculated.
E. M. Brown, Esq.
HC 60, Box 531
Orbisonia, PA 17243
Cumberland County Register of Wills
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DTVZS'm'ON
DEPT. 280601
HARRTSBURG, PA 17128-0601
CONMONHEALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
'~ NAR 12 P*I:45
EDNARD M BRONN ESQ
HC 60 BOX
PA
ORBISONIA
DATE 0Z-Z3-Z00q
ESTATE OF B00HER
DATE OF DEATH 01-09-2005
FILE NUMBER 21 05-0125
COUNTY CUMBERLAND
ACN 101
Amoun'l: Rem/~ed
REV-IGG7 EX AFP C01-03)
PAULINE M
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF gILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credL~ ~o your account, subm/~ ~he upper por~:/on of ~:h/s form w/~h your ~:ax payment:.
CUT ALONG THTS LZNE ~,~ RETATN LO~/ER PORTTON FOR YOUR RECORDS -~1
REV-Z607 EX AFP (01-03)
##s ZNHERZTANCE TAX STATEMENT OF ACCOUNT sss
ESTATE OF B00HER PAULINE M FILE NO. 21 03-012:5 ACN 101 DATE 02-Z3-Z00q
THZS STATEMENT ZS PROVIDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHO#N BELON
ZSA SUMMARY OF THE PRINCIPAL TAX DUE`' APPLICATION OF ALL PAYMENTS`' THE CURRENT BALANCE,, AND,, ZF APPLICABLE`'
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-19-Z00q
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
q,569.05
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
09-1Z-Z00$
1Z-09-2005
0Z-09-Z00q
CD005008
CD005319
REFUND
.00
lO.qq-
.§0
3,319.99
1,265.09
3.59-
ZF PAID AFTER THIS DATE`' SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A 'CREDIT'
TOTAL TAX CREDZT
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .00
q,569.05
.00
YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THZS FORM FOR ZNSTRUCTTONS. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND ECR): A refund of a tax credit, mhich was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iSIS). Applications are available at
the Office of the Register of gills, any of the Z$ Revenue District Offices or from the Department's Iq-hour
answering service for fores ordering: 1-800-562-2050; services for taxpayers mith special hearing and / or
speaking needs: 1-BOO-qqT-50ZO (TT only).
REPLY TO:
guestions regarding errors contained on this notice should bm addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17liB-g601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (5) calendar months after the decadant's death, a five percent (52) discount
of the tax paid is Bile#ed.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, ar nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of
six (62) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z005 are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rata Factor Year Rate
Daily
Factor
1982 202 .0005q8 1987 92 .O00Zq7 1999 72 .000192
1985 16Z .000q$8 1988-1991 llZ .000501 2000 82 .000219
198~ XIZ .00050X 1992 92 .0002~7 ZOO1 92 .OOOZ~7
1985 lSZ .000556 1995-199q 72 .000192 ZOOZ 62 .00016q
1986 IOZ .00027~ 199S-1998 92 .0002~7 2005 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELIN~IUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
BOOHER ERIC F
109 NORTH 20TH STREET
CAMP HILL, PA 17011-3803
RE: Estate of BOOHER PAULINE M
File Number: 2003-00123
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/09/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX DIVISTON
DEPT. ZBflGO1
HARRISBURG, PA 171ZB-0601
EDWARD M BROWN ESQ
HC 60 BOX 551
ORBISONIA
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1;~i? EX AFP (01-03)
PA 172q3
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-19-200q
BOOHER
01-09-2003
Z1 03-0123
CUHBERLAND
101
Amoun~ Remitted
PAULINE M
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 ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOOHER PAULINE MFZLE NO. 21 03-0123 ACN 101 DATE 01-19-200q
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Es~a~o (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nership Zn~eras~ (Schedule C) ($)
q. Mor~gages/No~as ReceAvable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Persona:1 Property (SchoduZe E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7}
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ada. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schodu:1e Z) (10)
11. To,al Deductions
12. Net Value of Tax Return
NO. 01
.00
NOTE: To insure proper
.00 credit to your account,
.00 submit tho upper portion
.00 of this form with your
.00 ~ax payment.
8/3qZ.Oq
.00
(8)
15.00
.00
8,$q2.0q
(11) 1;. 00
(:12) 8,327. O~
15.
NOTE:
ASSESSMENT OF TAX:
15. Amount of Line lq a* Spousal ra~o
16. Amount of Line lq taxable a~ Lineal/Class A rate
17. Amoun~ of Line lq a~ Sibling rote
18. Amount of Line lq ~axable at Colla~eral/C:1ass B rate
:19. Principal Tax Due
RECEXPT DXSCOUNT
NUMBER INTEREST/PEN PAID (-)
CD003008 .00
TAX CREDITS
PAYHENT
DATE
09-12-2003
Chari~cable/Governmen~cal Bequests; Non-elected 911:3 Trusts (Schedule J) (15)
Not Value of EsSence Sub.~ac~c to Tax (lq)
Zf an assesseent was issued previously, lines 14, 15 and/or 16, 17,
.00
30,q60.29
18 and 19 will
reflect figures that include the tote! of ALL returns assessed to date.
(:15) .00 x O0 = .00
(:16) .00 x Oq5= .00
(:17) .00 x 12 = .00
(:18) 30,q60.29 x 15 = q,569.05
(:19)= q,569.05
AMOUNT PA/D
3,319.99
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZMTEREST AND PEN.
TOTAL DUE
3,$19.99
1,Zq9.06
INTEREST IS CHARGED THROUGH O2-O$-ZOOq
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
IF PAID AFTER DATE ~NDZCATED~ SEE REVERSE
FOR CALCULATZON OF ADDITIONAL /NTEREST.
18.87
1,267.93
( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYMENT ZS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE ~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~l~~
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA
Name of Decedent: BOOHER, PAULINE M.
Date of Death:
1/9/2003
SSN: 211-18-4005
File No.
~1-03-0Q~
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES __
NO _)(
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete: Maf(~h 15. 2005
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_
b. The separate Orphan's 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 _ 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.
~~r~
Date: 1/22/2005
LJ._
0(/)
LU ---'
c.)
C1::"
~~.~.'~' ~
0>
Signature
Edward M. 6rown, .E:J;!L_
Name (Please type or print)
HC 60. Box 531
Address
f--
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t-:: t~L -
~:C (j,
cc::......:.-.
U.J"':".
G:l2
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o
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GJ:~ :
C',
er.::
C)
fl1
814-447-3455 or 814-643-9787
Tel. No.
z
""...,-
-=0
'-?
~-"
c;:::J
""
PA 17243
Orbisonia .
Capacity: Personal Representative
_~ Counsel for personal representative
J
STATUS REPORT UNDER RULE 6.12
Name of Decedent: BOOHER PAULINE M.
Date of Death: 1/9/2003
Will No. 21-03-00123
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:
I . 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. I is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No x
b . The separate Orphans' 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' Court and may be attached to this report.
C(~.~
Date: 2/21/2005
Signature
Edward M Brown
Name (Please type or print)
He 60, Box 531
Orbisonia PA 17243
Address
( 814 ) 6439787
Tel. No.
Capacity :
Personal Representative
x
Counsel for personal
representative
v'
CC(Q)~Y
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA
ORPHANS' COURT DIVISION
IN RE: ESTATE OF PAULINE M. BOOHER,
DECEASED
: File No. 2003-0123
FAMILY SETTLEMENT AGREEMENT
8:-
THIS AGREEMENT made this ~ day of ;tiC.'!' HI f,t'Y~
, 2004, by
and between ERIC F. BOOHER, Executor of the Estate of Pauline M. Booher, deceased,
hereinafter referred to as "Executor", party of the first part, and SHIRLEY B. DRAKULIC,
DONNA B. LITZINGER, GARY BOOHER, CARL EUGENE BOOHER, ERIC F.
BOOHER and THE FIRST ASSEMBLY OF GOD CHURCH, hereinafter referred to as "the
Heirs", party of the second part,
WITNESSETH THAT:
WHEREAS, Pauline M. Booher died a resident of Cumberland County, Pennsylvania, on
January 9, 2003, leaving a Will; and
WHEREAS, Pauline M. Booher left to survive her the following as her sole heirs at law:
1. Shirley B. Drakulic, P.O. Box 144, Pitcairn, PA 15140;
2. Donna B. Litzinger, 2347 San Juan Grande, Pensacola, FL 32507;
3. Gary Booher, Box 290, Adamsburg, PA 15611;
4. Carl Eugene Booher, HC 71, Box 385, Orbisonia, PA 17243;
5. Eric F. Booher, 109 North 20th Street, Camp Hill, PA 17011; and
6. The First Assembly of God Church, 4100 North Progress Ave., Harrisburg, P A
17110.
WHEREAS, Letters Testamentary were duly issued to the Executor by the Register of
Wills of Cumberland County, Pennsylvania on February 7, 2003; and
WHEREAS, the Executor has advertised the grant of letters, prepared the inheritance tax
return, paid all taxes and paid all debts of the Estate from the assets of the Estate, and there
remains cash in the amount of$48,797.77 for distribution; and
WHEREAS, the Executor desires to make distribution of the available assets of the
Estate to the heirs of Pauline M. Booher in accordance with the decedent's rill and to be
released from all further duties, liabilities and responsibilities with respect to the Estate and
Estate assets; and
WHEREAS, the Heirs and Eric F. Booher, in his capacity as Exec~tor, have agreed to
the amounts and to the terms whereby the shares of the Heirs will be distributed to them and they
will release the Executor of all further duties, liabilities and responsibilities with respect to the
Estate; and
WHEREAS, the Heirs and the Executor desire to reduce the terms of their agreement to
writing.
NOW, THEREFORE, in consideration of the sums herein stated, and intending to be
legally bound hereby, the parties hereto have agreed and by these presents 10 hereby agree as
follows;
1. It is acknowledged and agreed by the Heirs that their total distribttive shares of the
Estate of Pauline M. Booher are as set forth on the Schedule of Distribution marked "Exhibit B",
attached hereto and made a part hereof.
2
2. The aforesaid share of each Heir shall be paid to him or her by the Executor upon the
execution of this Agreement by all of the parties and receipt by the Executor of an executed and
notarized copy of this Agreement.
3. Each Heir hereby acknowledges that he or she has had all questions relating thereto
satisfactorily answered by the Executor; and that he or she has no objections to any action taken
in connection therewith by the Executor.
4. Each Heir hereby acknowledges that he or she has reviewed the Informal account
prepared by the Executor, and is satisfied that said account fully and accuratelY states the
inventory, income and expenses of the Estate of Pauline M. Booher, and tJt it proposes the
correct distribution of the remaining Estate assets. A copy of said account, marked "Exhibit A",
is attached hereto, incorporated by reference and made a part hereof.
5. Each of the Heirs does hereby fully and unconditionally release and discharge the
Executor from any and all liability , claims or demands of any nature whatsoever arising in
connection with or in any way relating to his duties as Executor for the Estate of Pauline M.
Booher.
6. This Agreement constitutes the entire agreement between the parties hereto.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seals
the day and year first above written.
3
Pallline M. Boolter F lIIIIily Sl!ttleltU!1lt Agreement
#~4 ~~
/Sfiirley B. rakulic, Heir
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
COUNTYOF ~f' : ss
On this the ~3 day of (\J ~ 0c:. WI b-t R., ,2004, before me a notary public, the
undersigned officer, personally appeared Shirley B. D",kulic, Heir of the Estate of Pauline M.
Booher, known to me (or satisfactorily proven) to be the person whose name is subscribed to the
within Family Settlement Agreement and acknowledged that she executed the same for the
purposes therein contained, and desired the same to be recorded as such.
WITNESS my hand and official seal the day and year aforesaid.
~LQ tbH~
otary blic -
l ' Notaria! Seal
Josephine Higgins, Notary Public
Pitcairn Bora, Allegheny County
My Commission Expires Feb. 24, 2005
MEliT'DSr. Pennsylvania Association of Notaries
4
PlJIIlille M. Booher FamJJy St!t/leme/lt Agreeme/lt
//~ 5~&?V
Donna B. Litzinger, ir (f
(SEAL)
ST ATE OF FLORIDA
COUNTY OF [,5 Cfl\Y\b\ CA
h .
On this the ~ day of -1\ JOUPmhe( ,2004, before me a notary public, the
undersigned officer, personally appeared Donna B. Litzinger, Heir of the Estate of Pauline M.
Booher, known to me (or satisfactorily proven) to be the person whose name is subscribed to the
within Family Settlement Agreement and acknowledged that she executed the same for the
purposes therein contained, and desired the same to be recorded as such.
SS
WITNESS my hand and official seal the day and year aforesaid.
Notary Public
~.
!.,>>""~ MYCOMMtSStIIJMIC1- ~ 364391 ~
Q .i EXPiAE$: 0CIcIlII20, 200Il \\
i~.P.i::,' ......1'hN_--. .
5
--
Pauline M. 8IHJlter FomUy Sf?tIlement Agreement
~ ~4vv
Gary ooher, Heir
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF . \. \1 (~+ mO'fe 1(1 L1 {(
On this the ~ day of _f\\\Ji? cIY\ ~yJj ,2004, before me a notary public, the
undersigned officer, personally appeared Gary Booher, Heir of the Estate of Pauline M. Booher,
known to me (or satisfactorily proven) to be the person whose name is subscribed to the within
Family Settlement Agreement and acknowledged that he executed the same for the purposes
therein contained, and desired the same to be recorded as such.
WITNESS my hand and official seal the day and year aforesaid.
"
, ".'
"_~ \J)- \ L_ AI .J.r~ l J h ~
Notary Public! ". "
" ~ COMMONWEALTH OF PENNiYLVANIA
Notarial Seal
T flOCJ' M. Shellon, Notary Public
Irwin Bore, Westmoreland County
My Commission expire, Aug. 13, 2007
Member, PennS~"'''i8 Association of Notal1es
6
Pauline M. Boulter Family Settlement Agreement
'0a#l-&: &~
Carl Eugene ~ Heir
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF HUNTmGDON
On this the~ day of J\l Ollomh: (" ,2004, before me a notary public, the
undersigned officer, personally appeared Carl Eugene Booher, Heir of the Estate of Pauline M.
Booher, known to me (or satisfactorily proven) to be the person whose name is subscribed to the
within Family Settlement Agreement and acknowledged that he executed the same for the
purposes therein contained, and desired the same to be recorded as such.
WITNESS my hand and official seal the day and year aforesaid.
~ ~%f)~1JflI)
No ublic
.,
NOTARIAL SEAl \
.. R ,.. r 14'7' 1\~l"t'J ,
PE(;GI. ,1cklM,J, ",v._ r, Publlc
Or~w. .Id .:Qi"0, HLintingdc." County _ _
My ~ Expiro:.a "'.t.Il;,~ 21, 2005
,,"'"
7
-
-
PflMline M. Boohe, FtUtIily SeIt/ement Ag,eement
COMMONWEALTH OF PENNSYL V ANlA
COUNTY OF Uurnbe.rlClJ1d
On this the (1 th day of .}\rll,>e.mbef ,2004, before me a notary public, the
undersigned officer, personally appeared Eric F. Booher, Executor and Heir ofthe Estate of
Pauline M. Booher, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within Family Settlement Agreement and acknowledged that he executed the
same for the purposes therein contained, and desired the same to be recorded as such.
55
WITNESS my hand and official seal the da~ an year aforesaid.
NOfA!'\\AL SEAL
SUZANNE M. DEDERER. Notary Public
Camp Hill 8ora. Cumberland County
My CommISsion Expires Aug. 20. 2005
8
F ami/y SeJtlemellt Agreemelll
The First Assembly of God Church
~'~
. 1
. .'. (SEAL)
By: ~:f;" l G I'.U.Q.rint name)
COMMONWEALTH OF I'ENNSYL VANIA
COUNTY OF bAv pll 'tV
On this the L day of ~ ce..
undersigned officer, personally appeared
acknowledged himself/herself to be the 0 lC I of The First Assembly
of God Church, Heir of the Estate of Pauline M. Boo er, known to me (or satisfactorily proven)
to be the person whose name is subscribed to the within Family Settlement Agreement and, being
authorized to do so, acknowledged that he/she executed the same for the purposes therein
contained, and desired the same to be recorded as such.
SS
WITNESS my hand and official seal the day and year aforesaid.
NO&Ub~
Roy C. Bridges, D1striot Justice
District COurt 12-3-05, DauphIn ColI1Iy
My 00rnmI8II0n &pI....-...ry a. 2006
9
EXHIBIT A
INFORMAL ACCOUNTING IN THE ESTATE OF PAULINE M. BOOHER,
DECEASED
LATE OF CUMBERLAND COUNTY, PA
DR.
The Accountant charges himself with the following receipts:
RECEIPTS OF PRINCIPAL
Cash:
Waypoint Bank, checking account
Community State Bank, checking account and certificate of deposit account
Manor Health Care Services, refund
Life Insurance proceeds
Treasury Department, IRS tax refund
Final annuity payment
Inheritance Tax Refund
$ 16,304.55
19,469.78
3,679.88
3,282.05
2,448.00
380.17
3.59
45,568.02
Tan2ible personal propertv:
Net from sale of household personal property in Rockhill
($476.00 less payment for estate ad in Cumberland County
Law Journal $75.00 and in Patriot News $205.69)
195.31
Realtv:
Net proceeds from sale of one-half interest in residence on
Valley Street, Rockhill Borough, Tax Parcel No. 39-01-49.
17,496.09
---
-------
TOTAL RECEIPTS
$ 63,259.42
10
CR.
DISBURSEMENTS OF PRINCIPAL
The Accountant takes credit with the following disbursements:
Debts of Decedent:
03/07/03 Dr. Quirico Magbojis
03/12/03 West Shore EMS, medical expense
03113/03 Dr. Hal Fineburg
03/21/03 Carlisle Regional Medical Center
04/07/03 Carlisle Regional Medical Center
04/25/03 Guistwife Family Practice
05/03/03 Mobile X-Ray Imaging
10/26/03 Kundel Surgical Group
10/14/04 Carlisle Regional Medical Center
Administration EXDenses:
04/09/03 Hetrick Funeral Home, R. Rinker death cert.
04/16/03 H & R Block, income tax preparation
P A Dept. of Revenue, income tax
Bank service fee
Cumberland County Register of Wills, Short Certs.
Martin R. Brown Funeral Home, death certificates
Martin R. Brown Funeral Home, death certificates
Register of Wills, filing fee
Register of Wills, filing fee
04/30/03
05/01103
OS/20/03
09/10103
12/04/03
Fees and Commissions:
09/10/03 Edward M. Brown, Esq., partial estate legal fee
and costs advanced
Eric F. Booher, partial Executor's commission
Edward M. Brown, Esq., partial estate legal fee
Eric F. Booher, balance Executor's commission
Edward M. Brown, Esq., bal. estate legal fee,
plus the following costs advanced:
11/02104, Cumberland Co. Reg. Wills $67.50
11/02/04, Postmaster certified mail $4.42
11105/04, Huntingdon Co. Reg. Wills $30.00
09/10/03
03/11/04
03/11104
/ /
---
Pennsvlvania Inheritance Tax:
09/10/03 Register of Wills, Agent
12/04/03 Resister of Wills, Agent
\I
$ 25.00
63.45
63.52
59.25
59.25
52.86
216.00
9.18
15.25
563.76
$
5.00
166.00
68.00
5.00
18.00
20.00
17.00
25.00
15.00
339.00
1,954.88
3,114.75
405.47
810.94
2.439.77
8,725.81
3,319.99
1.263.09
4,583.08
Reserve for final minI!: fees and estate c1osinl!: costs:
-! -! _ Edward M. Brown, Client Trust Account
Any remaining balance in Reserve will be distributed
to estate heirs in accordance with Article Two of
decedent's Last Will and Testament
250.00
TOTAL CREDITS
$ 14,461.65
TOTAL RECEIPTS
LESS TOTAL CREDITS
$ 63,259.42
-14,461.65
BALANCE FOR DISTRIBUTION
$ 48,797.77
12
EXHIBIT B
SCHEDULE OF DISTRIBUTION
The Accountant proposes the following Distribution in accordance with Article Two of
decedent's Last Will and Testament:
BALANCE FOR DISTRIBUTION CONSISTING OF:
A. Cash. total $48.797.77
TO:
I. The First Assembly of God, 50% residue
4100 North Progress Ave.
Harrisburg, P A l7110
24,398.88
2. Eric F. Booher, 10% residue
109 North 20th Street
Camp Hill, PA 17011
4,879.78
3. Carl Eugene Booher, 10% residue
HC 71, Box 385
Orbisonia, P A 17243
4,879.78
4. Gary Booher, 10% residue
Box 290
Adamsburg, PA 15611
4,879.78
5. Donna B. Litzinger, 10% residue
2347 San Juan Grande
Pensacola. FL 32501
4,879.78
6. Shirley B. Drakulic, 10% residue
P.O. Box 144
Pitcairn, P A 15140
4,879.77
TOTAL DISTRIBUTIONS
$ 48.797.77
BALANCE IN HANDS OF ACCOUNTANT
$
0.00
13
EST A TE OF P AULlNE M. BOOHER, DECEASED
File No. 2003-0123
NOTE: Cost to prepare final personal income tax return andfiduciary (estate) income tax
return exceeded the initial escrowed estimate of$250.00 by $298.00 (total to H & R Blockfor tax
preparation = $548.00). Thus. each benertciarv's initial calculated share set forth on the
Familv Settlement Aereement is reduced orooortionallv bv the amounts shown below to oav
the additional estate exoense associated with oreoaration of the income tax returns. A copy of
the tax preparation invoice will be made available upon request.
FINAL DISBURSEMENT SUMMARY & SUPPLEMENT TO FAMILY SETTLEMENT
AGREEMENT
Escrow from Family Settlement Agreement Account
Plus the following amounts from initial calculated shares:
From share of The First Assembly of God Church
From share of Shirley B. Drakulic
From share of Donna B. Litzinger
From share of Gary Booher
From share of Carl Eugene Booher
From share of Eric F. Booher
Total for preparation ofincome tax returns
$ 250.00
148.99
29.80
29.81
29.80
29.80
29.80
548.00
Disbursements:
02/05 H & R Block, personal & fiduciary income tax returns
548.00
Total disbursements
$ 548.00
BALANCE REMAINING
$ 0.00
0:~. ~1.
Edward M. Brown, Esq., P.C.
HC 60, Box 531
Orbisonia, P A 17243
Counsel for personal representative
Date: February 21, 2005
.
COWMONWEALTHOF PENNSYlVAN\A
DEPARTMENT OF PUBlIC WELFARE
BUREAU OF FINANC!Al OPERATIONS
OMSIQN Of' ll-IR) PARTY llA8tllTY
ESTATE RECOVERY PROGRAM
PO BOX lM88
IiARR'SBURG. PA 17105-8486
August 12, 2003
EDWARD M BROWN ESQUIRE
HC 60 BOX 531
ORBISONIA PA 17243
Re, PAULINE BOOHER
SSN, 211-18-4005
Dear Attorney Brown:
Pursuant to your letter dated August 03, 2003, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewea the information you
provided regarding the above-referenced individual.
It has been determined that this individual did not receive any type of
assistance during the questioned periOd.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate.
If you have any questions, please feel free to contact me.
Sincerely,
~\\&Q
Ronald D. Hill, Manager
TPL - Casualty Unit
(717)772-6604
(717)772-6553 FAX
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth 01 Pennsylvania, County of Dauphin) ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Ass!. Controller of The Patriot News Co., a corporation organized .and existing under the laws
of the Commonwealth 01 Pennsylvania, with its principal office and place of business al 812 to 818 Market Street, in
the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and~
Sundav Patriot-News newspapers 01 general circulation, printed and published at 812 to 818 Market Street, in the
City, County and State aloresaid; that The Patriot-News and The Sunday Patriot-News were established March 4th,
1854, and September 181h, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in
their regular daily and/or Sunday/ Metro editions which appeared on the 5th. 12th and 19th rl,,~(s) of August 2003.
That neither he nor said Company is interested in the subject matter 01 said printed notiCe or advertising, and that
all 01 the allegations 01 this statement as to the time, place and character of publication are true: and
That he has personal knowledge 01 the facts aforesaid and is duly authorized and empowered to verity this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and
adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in
the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
EslaIe Notices
..........d:.r;])~......................
o and subscribed before. e t Is 25th ~~003 A.D.
Tll<1YL.==aryPubic l// /-v, (ft(~f~
ClIyOlHamsbutg,~Coun\'i No:rARY PUBLIC
My eo...,...... EllIIires June 6. 2006
Mombor._yNMIll~OI_rIo.
PUBLICATION
COPY
My commission expires June 6, 2006
ESTATE N01'teE
Lettfra Testamentarv on the Eltot. of
PGulIMM.B4IcItIW, kM'otthe~...Car-
II.... CUmller.... CeJurtty. PtmtflvGnla,"
UOIIJd. havllIG bHn ...__ to:h undM'-
....... all............... .....~ar.
r......... fD make ImrnedJcrM PGYment and
thotI hcNlng claim.. will Clf'Qlftt "*" fw ..to
ttenwnthl:
tIrk.......
-
_Nwth..........
c:.nn.HUI,PA'Jl11
or";
........ M. ltowR. aM.
Me__at
(k-' ... PAl"" /
EDWARD M. BROWN, ESQ., P.C.
He 60, BOX 531
ORBISONIA, PA. 17243
Statement of Advertising Costs
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication altached
hereto on the above stated dates $
Probating same Notary Fee(s) $
Total $
203.94
1.75
205.69
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sundav Patriot-News. newspapers 01 general
circulation, hereby acknowledge receipt of the aforesaid notice and publicalion costs and certifies that the same have
been duly paid.
By....................................................................
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
STATE OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND :
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law J ouma!, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Joomal, a 1egal p8riQdi~al published in4e-&mugh of Carlisle in the Counliy and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
AUGUST 15,22,29,2003
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Booher, Paullae 11[., dec'd.
Late of the Borough of Carllsle.
Executor: Eric F. Booher. 109
North 20th Street. Camp Hill, PA
]70] 1.
Attorney: Edward M. Brown, Es-
qutre, HC 60, Box 53], OrbIBo-
nla, PA 17243.
SWORN TO AND SUBSCRIBED before me this
29 day of AUGUST, 2003
-- ARlALSEN.
,NOT. NlID
lOOE.S\'MlER~~.
~S\l;ll,CuI1 5
My ~ ElcpireI Mud! ,