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HomeMy WebLinkAbout03-0214 PETITION FOR PROBATE and Estatff'o7 ' /[I/q t~ [t/L ~I4 WA/ No. also known as t41qAI~a' tbS., (-gltt~:t~ To: Deceased. Social Security No. 17 ~'-//_J, - ~'~ 9 ] GRANT OF LETTERS 21-03-21/~ Register of Wills for the County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner4~, who is/a.r~ 18 years of age or older an the execut Rix. in the last wilt of the aboveflgcedent, dated and codicil(s) dated in the named ,1987 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C0~$~-~0./.-~/}//:> County, Pennsylvania, with he,r last family or principal residen£e at ~1 /~. O2~-.~TCq~,OD t~t>- .9 (l~st street, number and muncipality) Decendent, then ~ I years of age, died P:~/Bt~.0/~ h/ ,7~ ~ , .18' 2003, Except as follows, decedent d~d 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: 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 Penns}~Ivania $ situated as follows: A//~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~'e$-b'~ t~a~ Pa-r ~f theron. (testamentary; adffninistration c.t.a.; administration d.b.n.c.t.a.) cr~P Ac/O... ?Pr- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF CotnO~ngbf 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 tr~y administer t~e estate according to law. Sworn to or affirmed and subscribed F ~.~'.//~t{ :4/J.A~C( ~ before me this 7th day of / - -' ~' ~ mu~cH a~ ?nn'~ J ~ No. 21-03-214 Estate Of iV/4A// /t4. ~H~/v/ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MARCH 7 ~II~200q , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated PAY 12, lq87 described therein be admitted to probate and filed of record as the last will of NAN M COIqEN ; and Letters TESTAMENTARY are hereby granted to Sally Cohen Capp FEES Probate, Letters, Etc .......... $ 2_~3..5_,_~ Short Certificates( ) .......... $ 24.00 x-pages Renunciation ................ JCP $. 10.00 TOTAL __ $ 2~9.00 Filed . .... . .y~..R.C.H..7....2.0.Q3 .............. ATTORNEY (Sup: Ct. I.D. No.) ss/ o/ 71~ 737~ PHONE RENUNCIATION In Re Estate of /'~"/~ ~ /"]/7. ~' C7~-/ ~','~' deceased. To the Register of Wills of. Cr~y/~O/~-/~' ~'4-/~?~:~' County, Pennsylvania. The undersigned '-fT~O ~-7'~'r~ ~-~, C~/-~/L//~ t~A~ ~::~L~;'---~)~'Z' of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters WITNESS hand this ~ ~'t~ day of ,,q~,d~ c.,z~, ~'<,~-~ (Signature) (Address) (Signature) (Address) (Signature) (Address) WILL OF NAN M. COHEN I, NAN M. COHEN, of Cumberland County, Pennsylvania, declare this to be my will and hereby revoke all prior wills and codicils made by me. 1. I direct that my body be cremated and that my ashes be interred at our family plot in the Monongahela Cemetery in Allegheny County. 2. I bequeath and devise all of my property of whatever nature and wherever situated to my children, Sally Cohen Capp and Thomas S. Cohen, and to their issue per stirpes. For all purposes under this will and under any insurance policy or policies and for all other purposes, adopted children shall be regarded as issue. 3. If any beneficiary should die within sixty (60) days after me, then he or she shall be deemed to have predeceased me for all purposes of this will. 4. No interest of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries for any liability of such bene- ficiary, whether such liability arises from his or her debts, contracts, torts, or other engagements of any type. 5. In addition to such other powers and duties as may be granted elsewhere herein or which may be granted by law, my executor hereunder shall have the folllowing powers and duties, without the necessity of notice to or consent of any court: (a) To retain all or any part of my property, real or personal, in the form in which it may be held at the time of its receipt, as long as in the exercise of his discretion it may be advisable so to do, notwith- standing that said property may not be of a character authorized by law. (b) To invest and reinvest any funds held here- under in any property, real or personal, including, but not by way of limitation, bonds, preferred stocks, common stocks and other securities of domestic or foreign corporations or investment trusts, mortgages or mortgage participations, mutual funds with or with- out sales or redemption charges, and common trust funds, even though such property would not be considered appropriate or legal for a fiduciary apart from this provision. - 2 - (c) To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and for such price as he may determine, and to convey such property free of all trusts. (d) To borrow money for any purpose in con- nection with the administration hereof, to execute promissory notes or other obligations for amounts so borrowed, to secure the payments of such amounts by mortgages or pledges of any property, real or personal, which may be held hereunder. (e) To renew or extend the time for payment of any obligation, secured or unsecured, payable to my estate, for as long a period or periods of time and on such terms, as he may determine, and to adjust, settle, and arbitrate claims or demands. (f) In dividing or distributing any property, real or personal, included herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind. (g) With respect to any securities forming a part of my estate, to vote upon any proposition or election at any meeting of the corporation issuing - 3 - such securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, merger, voting trust, consolidation or exchange, and to deposit any such securities with any committee, depository, trustee or otherwise, and to pay out of the assets held hereunder, any fees, expenses and assessments incurred in connection therewith, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any such reorganization, readjust- ment, merger, voting trust, consolidation, exchange or exercise of conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (h) To exercise all elections which my estate may have with respect to income, gift, estate, inheritance and other taxes. 6. I direct that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration. - 4 - 7. I appoint as executor hereunder my son, THOMAS S. COHEN. If he should predecease me or should be unable or unwilling to serve or to complete the administration of my estate, then I appoint my daughter, SALLY COHEN CAPP, to serve in his place. IN WITNESS WHEREOF, I, NAN M. COHEN, hereby set my hand to this, my last Will, typewritten of six (6) sheets of paper including the self-proving attestation clause and signatures of witnesses, this i~ day of May, 1987. NAN M. COHEN ( SEAL ) Witnessed: COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF DAUPHIN : NAN M. COHEN (the testatrix), RICHARD S. KAHLBAUGH , MAURICE A. FRATER , and KEVIN J. FREDERICK (the witnesses), whose names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the testatrix signed and executed the instrument as her last will in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, - 5 - signed the will as witnesses and that to the best of his knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. WITNESS: TESTATRIX: Subscribed, sworn to and acknowledged before me by NAN M. COHEN, the testatrix, and subscribed and sworn to before me by RICHARD S. KAHLBAUGH and KEVIN J. FREDERICK of May, 1987. MAURICE A. FRATER , the witnesses, this /~ day (SEAL) Notary' ~ublic Ma~lene A. Staub, Notary Public My Commis~ ~cplre~ July 28, 1987 - 6 - STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: File No.: COHEN, NAN M. 2/14/03 2003-00214 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: State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3-1-05 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 Orphans' Court No. (if any) for the personal representative's account is: parties in interest? Did the personal representative state an account informally to the Yes No Date: 3-5-04 do 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. ,~ Signature G. PATRICK O'CONNOR, ESQ. Name (Please type or print) 3105 OLD GETTYSBURG RD. CAMP HILL, PA 17011 Address 440-951-8175 Tel. No. Capacity: __ Personal Representative X Counsel for Personal Representative IN RE ESTATE OF NAN M. COHEN, DECEASED : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : : ORPHANS' COURT DIVISION : : NO. 2003-00214 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: NAN M. COHEN Date of Death: 2/14/03 Will No. 2003-00214 PA. No. 21-03-0214 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 04/14/03 : Name Address Thomas S. Cohen 63 Scobie Rd., New Boston, NH 03070 Sally Cohen Capp 434 Parkside Rd., Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except __ None Date: 4-14-03 /Signature Name G. Patrick O'Connor, Esq. Address 3105 Old Gettysburg Road Camp Hill, PA 17011 Telephone _ (717) 737-7760 Capacity: X Personal Representative Counsel for personal representative 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. REV-1162 EX(11-96) CD 002612 O'CONNOR G PATRICK 3105 OLD GETTYSBURG RD CAMP HILL, PA 17011-7208 ........ fold ESTATE INFORMATION: SSN: 175-16-5891 FILE NUMBER: 2103-0214 DECEDENT NAME: COHEN NAN M DATE OF PAYMENT: 05/27/2003 POSTMARK DATE: 05/23/2003 COUNTY: CUMBERLAND DATE OF DEATH: 02/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,700.00 TOTAL AMOUNT PAID' $4,700.00 REMARKS: SALLY COHEN CAPP C/O G PATRICK O'CONNOR SEAL CHECK# 1001 INITIALS: VZ RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS G. PATRICK O'CONNOR, ESQUIRE 3105 OLD GETTYSBURG ROAD CAMP HILL, PA 17011 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 coot i,'llh,,ili,,,,,,ll,,Ih,,ih,,Ihi,l,,,,hlhi,,i,h,,,lhi JRD/June 30,1992/17858 Date: January 10, 2005 O'CONNOR G PATRICK ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY 'PENNSYLVANIA RE: Estate of COHEN NAN M File Number: 2003-0214 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. CC2 This filing will become delinquent on: 02/24/2005 Your prompt attention to this matter will be appreciated. Thank you. File Counsel Personal Representative Judge Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: FileNo.: COHEN, NAN M. 2/14/03 2003-00214 Pursuant to Rule 6.12 of the Supreme court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. parties in interest? Did the personal representative state an account informally to the 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 r~~ _ ~~ Date: 2-16-05 /Signature It.... G. PATRICK O'CONNOR ESQ. Name (Please type or print) 3105 OLD GETTYSBURG RD. CAMP HILL P A 17011 Address 717-737-7760 Tel. No. Capacity: _ Personal Representative -L Counsel for Personal Representative ufi ~wao~~ .~ .~..CQMMQNWEAt.TH OF ~ "~ v ~ 1 ~ ~ O OFFICIAL USE ONLY P~gd.SYLYANIA .. I~PAtZi"MENT QF REVENUE _..~ D~PT.28Q601 INHERITANCE TAX`RETI~RN FILE NUMBER HAEIS®URG, PA 17128-0601 RESIDENT DECEDENT ~ ~ -- .,.Q. ~ .~ ~..~ 1_ 1. . COU~o«>E ,~ DECEDENTS NAME (LABT, FIRST, AND MIDDLE INITIAL} SOCIl1t SECtEtITY NUIr~ER Z COH`EN,'''N N M. 175 -' 16 - - 5891 LN . ~ DATE Of DF.aTH (MM-0O+YEAR) DATE OF BIRTH (NAM-DD-YEAR) TH1g REnJpN M{,t$T p,E FILEp MI pUpUCATE )IVITH THE W V _ tJ2/~~1/~4Q3 11/21/1921 R~GtS~TER OF WILLS W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ . ~ ~ 1.Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (aw a aan gior a tti3d~ 4. Limned Estate ~ 4a. Future Interest Compromise (aw a a.n aw ~z-~z~ ~ 5. Federal E.ata~e Tax Return Recwired ~ ~ 6. DeaadeM Died Teetaie qwa- Dopy a wu- ~ 7. Decedent Maantaitaed a t.iving Trust (~ad- Dopy a 7naA- 0 8. Total Number of Sale DepoaAt Boaces . ,., , 8. Ldiga~orrPtoceodx Received ~ 70. Spousal Poverty Credit (dw or aaa~ aaw..n u•3»t and t•t•ay ~ 11. Elecsion to tax Wader Sec. 9113(A) Wow, aa- o- ~ ~ G. PATRLCK 0' CONNOR, ESQ. t:oMPLETtMAluAIGADDR~Ss FIRM NAME arI 3105 GETTYSBURG RD . , TELEPHONE NUMBER CAMP RILL, PA 17011 ~ 717-73.;7-7760 1. Real Estate (Sr~adulaA) (1} Q~FIC A US~ON Y 2. Stocks and Bonds. (...Schedule B) (2) _ 3. Cbsely Hid Gorporetion, R~srtneast-ip or Sole-Rroprietaship (3) 4 AAort R4ceivable (Schedule D) (4) es 8 Note a t... ,~ ~~- ~ ~ ~~-~ ~.. . g g : C"F'i tV ~" 5. Cash, Bsnk d~ Mfsoellaneous Personal Property (5) ~ 114 , 6 0 6.6 6 ~ ~..,, . ~ ~ /~,~ / 8. Jantly OMnled ' '"_I'_'! (sa-edvle F) (s) / wF'~iy y~ ~, Ii' ~ 'Y' .AA~Ls T. Inter•Yi voe Trer~erb $ Mneous Non-Probate Property (7) 14 ~ 14 6.0 2 ~ .., a <'C C? W OC t~cxreaura y a ~) a. Taw c ~e..~ (cal L 1.n . ,_. ,. { 9. Funeral Expanses8 Administrative Costs (schedule H} (9) 11, 0 2 5.00 to. Debia of Decedent, lalortgage l.~abiuties, 8 Liens (Schedule 1) (10) 1,154.34 11. Toth Dam (total Lines 9 8~ 10) 12. Met Varlue of Estate (Line 8 minus tine 11) 13. Cixele and Gavemmental BequestslSec 9113 Trusts for which an adec~aal to tax ties not been made (Schedule J) 14. Net Valw to Tax (Line 12 minus Une 13) (11) ~- 12 ,17 9.34 (12} 116,5?3.34 (13) 116573.34 (14j BEE !N$TRUt:TI0N8 ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amaant of tine 14 cable at the spousal tax Q rate, or trarrsfer~s under Sec. 9118 (a)(t.2) 1 1 F 8 d S 7 3 ount ' x .0 (15) ~ 5 2 8 _ , _ 16. Am of Lins 14 taxable at kneai rate ._ 4 5 . 0 x .(?~_ (16} 4' 17. Amount of line 14 taxable at sibling rate x .12 (17) ~ V 18. ArnoWtt o1 line 14 tsuawbte at cdlatsrai rate x .15 (18} 19. Tax Dw .. ,. (19) 5.245.80 M ~ ./q~~ cwt ~4 ($) 128.752 _ 68 Decedent's Com~Eete Address: zIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditstPayments A. Spousal Poverty Credit B. Pt1cu' Payments 4 , 7 00.00 C. Discamt 3.~.~~QQQ_ a x Amnesty Payment ~'~~II`ZTi'i`ir'I'IIZi e s I n tiegltk /l + B+ C) interesti'Penalty iF appii+cab~ ~ ~ . D. Interest E. Penalty Total interest/Penalty { D + E ) 4. ft Line 2 is greater than Line 1 + Lime 3, enter the rfil~erenc~. This is the OVERPAYMENT. Check box on Page 1 Lime 20 to ngtrest a reliund 5. If Lire 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 + 5A. This ~ the 6ALANCE DUE. (1) 5 , 245.80 (2) 5.3.05.00 (3) 0 (4) f6) 0 (~+) (5B) 0 Make Check Payable to: REG1STEiR OF ILLS, AGENT -PLEAgE Ail~lt ' Fl7Li.O~fiNC -Q~#EST18M~ B-'~-PL-ACH~G A-hl "X"' ~N TFIE -APPR~Pfti"f - BtflEiES 1. .Did deeedertt rr.ake a transfer and: ~ Yes No a. retakt the use or income of the property transferred :......................................................................................... ^ b. retain the r~ht to designate wtx9 shaA use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits ar care? ...................................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" ~ payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which ........................................................... contains a benefraary designation? ........................................................... .. Q ^ . IF THE ANA T© ANY OF THE A84VE QUEST110NS ~ YES, YOU MUST CfIETE SCHEQ~I.E G AND F1LE IT AS PART OF THE REi'Ui~N. tlndar d per, t dec~e thed t have lexemined this nom, indudinD aeoampanyirg schaduks Arid stettemaMs, snd to tt-e bast of my and bafiat, ~ is tfue, cvrted and oon~ptate. t~srafoe d txat~na- a~ than rie t> is txaiad on al irdom+ation o<which pdpaerc has any icnowkdpe. ~. S ~R~ ~SPdN51BLE Ft~R FILING RETURN ADDRESS HILL, PA 17011 SIGNATURE OF OTIiER 7 PRESENTATIVE DATE ADDRESS ~ 3105 OLD GE'1'TYSBURG ROAD, CAMP HILL, PA 17011 ~` rya. -.. .r1.lYy~ .~.,_.S ~' ~Y`.' 4 ~Ey~.~ ~...' ~ I~" For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% i72 P,S. F9Tt6 Via) ~1. ~) (i}}. For dates of death on or after January 1, i ~°5, the tax. ,ate imposed a ~ t?~~e r,ei vGiue of transfers to or f~~~ ;~e use of .~e SuNivifl~ spousQ is G`7° j72 f'S. §9116 (a) (:. i) ~i,; 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 the surviving spouse is the only benefiaary. For dates of death on or after Jtdy 1,2000: The tax rate imposed on the net value of transfers from a deceased gild twenty-one years of age or younger at death to or for the use of a natural parent, an ad~tive paten or a stepparent of the child is 0°Yo [72 P.S. §9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's 6rWea1 benefiaaries 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 transfiers to or for the use of the decedents st~lings is 1296 (72 P.S. §8116(a}(1.3)). A s~'ing is defined, urxier Section 9102, as a individual who has at least one parent in common with the decedent, vvfteth~ by blood or adoption. 1~~91E~(~ (tom cowwcx~~,1~ aF pnv~- DUt~~ -- F~.E MUMMER ~ ~, M. ;, 2103-0214 ~,de as p~ac aI ~t ana°uie d~ the prooeeda were renewed by the eo~e. AN t~P~-~~ w~h ew o[ ~~r~p a~at a, e~caWd on a F. ~~ VALUE AT D TE NUMBER DESCRIPTION ~ DEATIi 1. . Geer, 'of t~aposit #50 at PSECU 2 • Curt "of posit #51 at PSECU 3 Cerk !of t3~epoait #52 at PSECU 4 Regular Shar®s at PSECU 5 Ct~~ Shares at PSECU 6 Annuity Payment due from Thrivent Financial 7 Annuy Payment due from Thrivent Financial s Annuy- Payment due from Commonwealth of PA s tiCli~ata Payment du® from CMS to Misc.' Furnishings, incl. Sofa, Recliner, TV set, cor~put~~, dining table, hutch and two chairs ~ ~ Misc. costume jewelry t2 199? "foyota Corolla (trade-in value) ~3 Sev~r~gs Account ~1~f0078061 at Waypoint Bank ~a Gnsdi( Bal6ncs at Lord 8~ Tabor Acct.157042499 ~ s Fed. Income Tax Refund 13,515.36 :22,260.03 22,097.'f5 35,224.51 14,509.74 843.70 179.17 226.53 103.86 200.00 200.00 4,075.00 435.12 8.49 728.00 TOTAL (Also enter on line 5, ~? i 114,606.66 (lf mone space ~ needed, ~~ert additlonal of tl~e same airs) REV 1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sr~~~1~1~LE t~ INTER-VIVOS TRANSFERS & MISC. tVQN-PROBATE RROPERTY ESTATE OF FILE NlfMBER Cohen, Nan M. 2013-0214 This schedule must ~ completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION QF'PRQPERTY INCLUDE THE NAME t7F THE TRANSFEREE, THEIR iiELATIDNSHIP TO DECEDENT AND 1FIE DATE OF TRAwsFER. aTTACH A coPr bF THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLEi TAXABLE VALUE ~• Thrivent Financial for Lutherans -Contract 82159714 14,f46.02 100 14,146.00 TOTAL. (Also enter on line 7 Recapitulation) S I 14,146.00 (If more space La needed, insert additions sheets of the same size) REV-1511 EX+ (12-99) ~~E~~~ COMMONWEALTH OF PENNSYLVANIA FUiIERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NU~ABER ~~ M• 2103-0214 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. P1[JSSELMAN FUNERAL HOME $ 2,749.50 OPENI11~1GG & CLOSING OF GRAVE 200.00 FUNERrbiL LL'INCHEON AFTER SERVICE 300.00 TRAVEL EXPENSES 200.00 CE~I+'IET~Y HEADSTONE 1,345.80 MUSSELMAN FUNERAL HOME 11.28 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 5 , 690 • DD 3. Family Exemption: (1f decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Gaimant to Decedent 4. Probate Fees REGISTER OF WILLS- ~7~03 289'00 REGISTER OF WILLS_ D TIONAL SHORT CERTIFICATES 30.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~• ESTATE ADVERTISING -CUMBERLAND LEGAL JOURNAL 75.00 8. ESTATE'. ADVERTISING -HARRISBURG PATRIOT NEWS 111.67 TOTAL (Also enter on line 9. RecaoitulatioN ~ ~ , , n~c nn (If more space is needed, insert additional sheets of the same size) REY•1512 EX + (1.97) COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RESIDENT DECEDENT RN MORTGAGE LIABILITIES & LIEMS ESTATE OF FILE NUMBER COHEN, N~1 M. 2103-0214 Include unreimbursed medical expenses. ITEM NUMBER 1. PSECU VISA Account 2 PP& L 3 ATT 4 VerlZOrl s Comcast s BOSCOV'S ~ The Bon Ton 8 Grandview Laser Surgery 9 The Ban Ton 10 PP& L 11 Verizo~ DESCRfPTION $ 250.94 168.17 8.80 50.35 127.12 122.29 22.94 100.00 15.00 267.27 21.47 TOTAL (Also enter on line 10, Recapitulation) I ~ 1,154.34 (If more space (s needed, insert addltlonal sheets of the same size) REV-1513 EX+ (9-00) SCl~~dllLE J COMMONWEALTH OF PENNSYLVANIA gENEFIC1~tR~Eg INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER COHEN, NAN M. 2103-0214 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ' NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Da Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. SALLY GC)FiEN LAPP DAUGHTER 50$ 50$ REMAINDER INTEREST 2 II 1. THOMAS S . G~OHEN 50$ REMAINDER INTEREST sON I 50$ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1'500 COVER SHEET NON-TAXABLE DISTRIBUT~NS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PAiGtT II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (if more space is needed, insert additional sheets of the same size) I, NAN M. COHEN, of Cumberland County, Pennsylvania, declare this to be my will and hereby revoke all prior`wills.and codicils made by me. 1. I direct that my body be cremated and that my ashes be interred at our family plot in the Monongahela Cemetery in Allegheny County. 2. I bequeath and devise all of my property of`whatever nature and wherever situated to my children, Sally Cohen Capp and Thomas S. Cohen, and to their issue per stirpes. For all purposes under this will and under any insurance policy or policies and for all other purposes, adopted children shall be regarded as issue. 3. If any beneficiary should die within sixty (60} days after me, then he or she shall be deemed to have predeceased me for all purposes of this will. 4. No intexest of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the .interest r • .... ,,. of any beneficiary be lia ~ ~~ bl e 0 r s ub e _ ~ ct in any manner:, `w-hile in the possession of my fiduciaries for an y liability of such bene- ficiary, whether such liability arises f rom his or her debts, contracts, torts, or other engagements of an ~t Y ype. 5. In addition to such other powers a nd duties as may be granted elsewhere herein or which ma be y granted by law, my. executor hereunder shall have the f olllowi . n g powers and duties, without the necessity of notice to or con sent of any court: (a) To retain all or any part of my pro ert P Y. real or.,personal, in the form in which it ma y be held at the-time of its receipt, as long as in~th e exercise of his discretion it may be advisable so t o do, notwith- standing that said property may not be of a character authorized by law. (b) To invest and reinvest any funds he ld here- under in any property, real or personal ~.nc lading, but not by way of limitation, bonds, preferred s tocks, common stocks and other securities of dom stir ~ or ~' foreign corporations or investment trusts m ortgages or mortgage participations, mutual funds with or with- out sales or redemption charges, and common trust funds, even though such property would not be consider ed appropriate or legal fora ffiduciary a art fro p m this provision. - 2 - _- __ _ _. • (c} To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and for such price as he may determine, and to convey such property free of all trusts. (d) To borrow money for any purpose in con- nection with the administration hereof, to execute ~, promissory notes or other obligations for amounts so borrowed, to secure the payments of such hmounts by mortgages or pledges of any property, real or personal, which may be held hereunder. (e) To renew or extend the time for payment of any obligation, secured or unsecured, payable to my estate, for as long a period or periods of time and on such terms, as he may determine, and to adjust, settle, and arbitrate claims or demands. ~ - ~" (f) In dividing or distributing any property, real or personal, included herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind. (g} With respect to any securities forming a part of my estate, to vote upon any proposition or election at any meeting of the corporation issuing 3 _ such securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, .merger, voting trust, consolidation or exchange, and to deposit any such securities with any con~ittee, depository, trustee or otherwise, and to pay out of the assets held hereunder, any fees, expenses and assessments incurred in connection therewith, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued . as a resa~lt of any such reorganization, re~djust- ment, merger, voting trust, consolidation, exchange or exercise of conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (h) To exercise all elections which my estate may have with respect to income, gift, estate, inheritance and other taxes. 6. I direct that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by_whatever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as f~ said taxes were expenses of administration. ,~ • 7• I appoint as executor her . eunder my son, `T1~OMAs ~, COHEN. If he should predeceas m e e or should be unable or unwilling to serve or to .complete the adminis tration of my estate, them I appoint my daughter, SALLY CORE N CAP'P, to serve in his place. IN WITNESS WHEREOF, I, NAN M, COHEN, here hand to this m by set my y last Will, typewritten of six (6) sheets o including the self-proving attes f paper tation clause and signatures of witnesses, this ~'~ day of Ma Y, 1987. ~~~ (SEAT,) NAN M. COHEN Witnessed: .ng at :_ ng at ,/~ • .- ..- .._._..- rasiding at ,~~' _.-~? COMMOpvWEALTH OF PENNSYLVANIA `; COUNTY OF DAUPHIN = SS: . NAIN M• COHEN (the testatrix) RIC MAURICE A. FRATER ~ HARD S. KAHLBAUGH (the wtn+ss~es) , whose namesacre siKnedN J~ FRED. being first duly sworn, each g tO the foregoing instr authority that the testatrix sirned aeClare to the undersigned ent, as her last twill in the. presence of tnd executed the instrument had signed willin 1 he witnesses and that she voluntary act forgthe and that she executed it as her free and of the witnesses, in therposes therein expressed, and that each presence and hearing of the testatrix,.. 4 signed the will as witnesses and that ,g the testatrix was at that time ei hteeno the best of his kn~~~~d~e of sound mind and under no constraint oryundueof age car alder, influence. WITNESS: TESTATRIX: f ~. ^r~ WI • • r-------.~ WITNESS • ~--_ Subscribed, sworn to and acknowled ed bef 4 ore, me by NAN M. COHEN, the testatrix, and subscribed and sworn to before me by RICHARD S. KAHLBAUGH ~ MAURICE A. FRATER and KEVIN J. FREDERICK ~ the witnesses, this f day of May, 1987. Notary u lic (SEAL) A. St~wli, ~' ~ ~ ~ Jnt~r 2S f9d7 ~~ - ~,,~ ,Thy ~al..artce .Owed plus interest was paid 5/17/10. via PA TAX AMN~3TY PROGRAM. ~~-,.._ --___--- r G. PA7R~K.O'GONN4R ~y!'l ~(y~s '}D(f~a~f~~ 4i~ .~ 3588 -~ A'~"T'!ARNi~Y AT' LAIN ~jv; tq~3~8'~3vz, eo-e»>rrs~s PH 1 n 7$?•7780 31QI~ oLD t3ETtYSBUR{i ROAD ~ ~! ~d'~/~ ~ Ham., Pa ,7a„ ~.zL~. ~g ~p DATE OR~t OP l ~ ~ ~~ r ,~~' (/t Haw+a ` ; w~Y~ c~~o~rt~i~~oa . ~ ~ ~ ~ M. Cohn n~'• I6~5'~Qt ,= ,~~:'3 ~-38 L 1. i6~:3588 0450 246 L6Ou• i ,~ ~ - DBPT uss .oNlr TA~C'AMNESTY PAYWI EN'Y' VOUCH ~R •- kEV~l#~46 (01.10 ` '' a, AMNESTY. NUMBER: 4000044248 9 , ~.SSN/FEIN; 199348302 TA~PAY~R NAME: G. Patrick O'Connor - AQDRESS: 3105 Gettysburg Rd. PAYM4ENT AFtOUNT CITY~STATElZIP: Camp Hill PA 17011 $ 370.4? PHONE ;NUMBER: 7177377760 Molts Ch3Ck/lnatlEy order payable w For:. Est~-~e `Qf Nan M. Cohen Decedent's 3ocialP~`ecuri ~yR'~~'~-16-5.8191 File`~,NQ°21-03.00214 ~et~ginal Amnesty Pin: 487010032 40000442489 --- '~' P~~Y~vania DE-MTMENT OI IIEVENUE Office of Tax Amnesty PO Box 28isoi HaMsburq, PA ~~328-ssos ********~*******~t****AUTO**5-DIGIT 17011 G P OCONNOR 3105 GETTYSBURG RD CAMP HILL PA 17011-720b NOTICE fJF PA T~-X Ah~INESTY PRC1G`R14M Pennsylvania is offering a tax amnesty period from April 26 to June 18, 2010. During this lim#ed, 54-day timefratne, the Pennsylvania Department of Revenue will waive 100 percent of penalties and half of the accrued interest for, anyone who. files and pays his/her delinquent state taxes, with the promise of no prosecution. The PA Tax Amnesty program applies to all state. taxes delinquent as of June 30, 2009. In accordance with Act 48 of 2009, this document serves to officially notify you, a taxpayer with known unpaid state tax .liabilities or non-filed returns, of the PA Tax Amnesty program. If you are currently under bankruptcy protection, please:: disregard this notice, as the PA Tax Amnesty program does not apply to you. TO QUALIFY FOIL TAX A-1~INESTY YOU MUST: 1. Visit the PA Tax' Amnesty Web site at www.PATaxPayUp.com. a. Create an Amnesty User ID and Password and log intothe Amnesty application. b. Access your account information using your Amnesty PIN and complete Taxpayer ID [employer identification number (EIN), Social Security number (SSN), etc.), which is partially provided above. NOTE: You may receive multiple Amnesty notices and PINs if delinquencies exist for multiple tax types. c. Review PA Department of Revenue records and compare them to your own. d. Complete the online PA Tax Amnesty application. e. Pay by June 18, 2010, all taxes and half of the interest due for all periods for which Tax Amnesty is available. ~ -~ 2. If applicable, prepare and file state tax returns for all tax periods for which you did not file previously, or file amended' returns for all underreported tax. Failure to ~ alCe advantage of this limited-time opportunity to resolve your state tax debt will result in an additional 5 percent non-participation penalty and other enforcement actions. For more information, visit the PA Tax Amnesty Web site at www.PATaxPayUp.com or call, toll-free, 1-877-34-PAYUP.(1-$77-347-2987). Office hours are 7:30 a.m. to 7 p.m., Monday through Friday.. See reverse side of this notice for commonly asked questions and answers. Thank you for your prompt attention and cooperation. Sincerely, PA Department of Revenue Office of Tax Amnesty I PO Box 281101 I Harrisburg, PA 17128-1101 11.877.34.PAYUP ~ www.PATaxPayUp.com ~" REV-1149 AM (01-10) ~ s 281412 REV-1182 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712BA601 RECEIVED FROM: O'CONNOR G PATRICK 3105 OLD GETTYSBURG RD CAMP HILL, PA 1 701 1-7208 ~ ----''-- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT njp, CD 013412 ESTATE INFORMATION: ssN: t75-is-5ast FILE NUMBER: 2103-0214 DECEDENT NAME: COHEN NAN M DATE OF PAYMENT: 09/27/2010 POSTMARK DATE: 06/18/2010 COUNTY: CUMBERLAND DATE OF DEATH: 02/24/2003 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5370.47 TOTAL AMOUNT PAID: REMARKS: AMNESTY INITIALS: WZ SEAL RECEIVED BY 5370.47 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Pennsylvania ~iT DEPARTMENT OF REVENUE REV-1ISA RRCEYEC (AS-IAf September 23, 2010 To the Register of Wills of the County of CUMBERLAND RE: INHERITANCE TAX CREDIT MEMO Estate of: File Number: Decedent's SS#: ACN Number: Payment Amount Postmark Date: NAN M. COHEN 2103-0214 175-16-5891 101 $ 370.47 06/18/2010 ~ecei~~-.~ ~3~1~ An Amnesty payment on the above-referenced inheritance tax liability has been received and transferred to the inheritance tax fund. Please issue an official inheritance tax receipt for the Tax Amnesty payment and postmark date above. Make the payment date on the receipt the date the receipt is prepared by your office. Also, type "AMNESTY" in the remarks area of the receipt. Mail the receipt to: Name: G. PATRICK O'CONNOR Street: 3105 GETTYSBURG RD. City/State/ZIP: CAMP HILL PA 17011 The department's copy of the Official Receipt should be mailed using the postage paid Inheritance Tax bulk mail envelope (E-136) within five (5) business days after receiving this credit memo. Attach an "AMNESTY" cover sheet to the front of the receipt, or if multiple amnesty receipts are being submitted, attach the cover sheet to the top of the group. The amnesty cover sheet will help expedite the processing of the receipt when i arrives in the Inheritance Tax Division. Please keep- the amnesty receipts sorted and bound separately from the other Inheritance Tax documents when placing them in the bulk envelope. On your next Register of Wills Monthly Report, REV-714, include the payment amount in the monthly inheritance tax collections reported on Line 5, and claim a credit on Line 7. Your monthly inheritance tax collections, less the credit for this payment, should equal the Total Amount Deposited on Line 12. Your efforts in expediting the issuance and mailing of the Department of Revenue's copy of the tax amnesty payment receipt is greatly appreciated. Thank you for your timely attention to this matter. If you have any questions, please call 717-787-7031. Individual Taxes I zBDSD3 I Harrisburg, PA 17128-0603 1717.787.7031 I www.revenue.state Da us ,._. ,~ r ~'~RCC ~;rt-lt~E ~r REa;,..~ :,. ,,,,~,:~,c ~ ~!L~`~ '.ii ~.`~ Z0{O SEP 2~ AM I1 ~ 52 CLERK OF pRptiAN'S COURT ~JMRERL,~ND C0 , PA. ~~`!•` ~ ,°-~' ; '~ '':NOTICE OF INHERITANCE TAX pennsylvania ~~ ;~ .A~P~~EMENT, ALLOWANCE oR DISALLOWANCE DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXIS _;., ` INHERITANCE TAX DIVISION - ~ - ` -' ' ~ ~ 't~F - bEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP C12-09) PO BOX 28D601 HARRISBURG PA 17128-0601 ~] ~~~ ~~C _3 ~ ~~ ` ~~ DATE 11-29-2010 Lr~~~i~ r,r- ~~,. G PATRICK O'CONNOR ESQ 3105 GETTYSBURG RD CAMP HILL PA 17011 ESTATE OF COHEN NAM M DATE OF DEATH 02-24-2003 FILE NUMBER 21 03-0214 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-28-2011 (See reverse side under Objections Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE _ ----_RETAIN-LOWER-PORTION-FOR_YOUR_RECORDS_ ~ ___________________ REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: COHEN NAM MFILE N0.:21 03-0214 ACN: 101 DATE: 11-29-2010 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C1) .00 c2) .00 c3) .00 C4) .OD ~5? 114,606.66 C6) .00 c7) 14, 146.02 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. c8) 128 , 752.68 c9) 11 , 025.00 clo) 1 , 154.34 C11) 12, 179.34 11. Total Deductions 573.34 116 12 . Net Value of Tax Return C 12) , 0 0 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) . 14. Net Value of Estate Subject to Tax (14) 116,573.34 NOTE: If an assessment was issuedpreviouslY, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to d ate. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 1 1 6 . ~i73 . 34 x 045 = 5, 245.80 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .0 0 19. Principal Tax Due c19)= 5,245.80 rw~r r~~nrTC. PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 05-23-2003 CD002612 247.37 4,700.00 06-18-2010 CD013412 57.33- 370.47 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX PAYMENT 5,2b0.51 BALANCE OF TAX DUE 14.71CR INTEREST AND PEN. .00 TOTAL DUE 14.71CR IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.