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Home My WebLink About03-0224PETITION FOR PROBATE and GRANT OF LETTERS also known as ., Deceased. Social Security No. o,7' dl 2F-- ~. 6e'- ~i(_ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age orloldgr an the e.xe_cut/o in the last wilt of the above decedent, dated and codicil(s) dated To: Register of Wills for the County of ff~7~_-- -..~ ~¢.,,/~/F/, in the Commonwealth of Pennsylvania named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~/'2~//q,d~r-/'~,4t'?' County, Pe04~sylyania, h ~ last family or principal residence at />/~X~ El. dJo,~/A ~ ~..~ ~ ~ ~L~/_~ 7~. / 7~_~ (list street, number and muncipality) D~ent, then ~ years of a~te, died Except as follows, decedent did not marry, was ndt fiivorced and did not have a child born or adopted ~fler execution of ~)offered for probate; was not the victim ora killing and was never adjudicated ~ncompetent: 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 foltows: ~ ~. ~~~ WHEREFORE, petitioner(s) respectfully re. quest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; ac~inistration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEAL~-I OF PENNSYLVANIA COUNTY OF ~~C_/.~/ } 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/~ truly administer the estate according to law. Sworn to or affirmed and subscribed ~- before me this //7-~/ day of [~ // /7 ~' Estate Of ~w~.yx ~ ~H',c:~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated / l ' described therein be admitted to probate and filed of record as the last will of and Letters / are hereby granted to 2~9~t;z~. in consideration of the petition on FEES P~ob3t~¢~ Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ TOTAL ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE' his is to certi ,fy that the information here given is correctly copied from an original certificate of death duly flied with me as Local Registrar. The original certificate will be. forwarded to the State Vital Records Office for permanent 'filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ?,,,";~/._ ~ ~/ ~~ ,~ Local Registrar MAR 1 0 2003 No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH !~E(t.~,~ ~ u.o~s,~t~ , ut~s,D~ , -^? ...... ],. =-emaie [3. zu~ -- 24 --2155 ~,. March 8, 2~3 ~- Evel~ A. Cohlck ~'- I : I (~ ~ ~k ~ ~ ~ ~O ~ ~SI~N~Ry ~DECE ~ ~R IN ~NT'S E~ ,,~ ~frb~[on~erk ,,~Coll~e Cibra~ ~ ,~ ~~ ~ ~'~' 423 West North S~. ~u~ ,?..~. PA ~rlisle, PA 17013 ~) ,~.~ C~rland ~? ,,,.~ ~-~ ~ ~rlisle ~ Tho~s Cohlck ~m,~,,~ ..... ~m 12 Sheeley Lane, ~llln Sprin s, PA 17~7 ,,~ ~ ~rch 11, 2~3 Me ' · ~FU~R~EL~~TI~H I~'~' lit ]21e. ~rlal ~rdens ~,,4 ~rllsle, Pa 17013 ~~~,~.~ - ~~ ~.,~,,,~ ~ ~_ i~. N. ~anover St., ~rl~sle, PA 17013 Yelkw Breeches Fan~/Practice Ce~er 1358 LutlleM'n Rd., Bo~g S~gs, PA 17007- LAST WILL AND TESTAMENT I, Evelyn A. Cohick, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking any and all other wills by me at any time heretofore made. Item I. I bequeath to my daughter, Judith A. Good, my China, my wedding ring, my mother's ring, my cross and ring necklace, and my chair with needlepoint seat. Item II. I bequeath to my son, Thomas C. Cohick, my wine bottle collection, my silverware, my goblet collection, and my antique washstand beside the couch. Item III. I bequeath to Christopher E. Good the sum of $1,500.00, in trust nevertheless for Robert T. Good. Item IV. I bequeath to Aiecia A. Good the sum of $1,200.00, my cut glass cake stand, and my vase with a painted lily. Item V. I bequeath to Christopher E. Good the sum of $1,200.00. Item VI. I bequeath to Rachael E. Cohick the sum of $1,200.00, my gold locket and pearl ring. Item VII. I direct that Judith A. Good, my daughter, and Thomas C. Cohick, my son, may select whatever furniture they want. The balance of the furnishings and the real estate is to be sold at public or private sale, in the discretion of my Executors. Item VIII. All the rest, residue, and remainder of my Estate, both real and personal, I device and bequeath to my daughter, Judith A. Good, and my son, Thomas C. Cohick, in equal shares. Item IX. I hereby appoint my daughter, Judith A. Good, and my son, Thomas C. Cohick, as Executors. Item X. I direct that my Executors retain the services of George F. Douglas, Jr., to act as the attorney to handle my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of July, 1993. Evelyn ~. Cohick Signed, sealed, published and declared by the above-named testatrix, as and for her last will and testament, who at her request, in her presence, in our presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses: COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) We,/J~~ and the witness whose'n'a~l~s ~re signed to the attached or foregoin~ ins~ument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last will, and that she signed willingly and that she executed it as her free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me _~J~ day of July, 1993. this NOTARIAL SEAL JANET M LAY NOTARY PUBLIC CARLISLE BORO., CUMBERLAND COUNTY MY COMMISSION EXPIRES JUNE 26, 1995 COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) I, Evelyn A. Cohick, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will, that ! signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn to and subscribed before me this /~ dayofJuly, 1993. Notary (d NOTARIAL SEAL JANET M. LAY NOTARY PUBLI(~ CARLISLE BORO, CU)/,BERLAND COUNTlt MY COMMISSION EXPIRES JUNE 26, 1995 LAST WILL AND TESTAMENT OF EVELYN A. COHICK DOUGlas. DOUGLAS & DOUGlas ATTORNEYS AT LAW :,7 w. HIGH STREET R O. BOX :'61 CARLISLE, PENNSYLVANIA 17013'0261 LOUIS R. HARTIN COUNSELOR AT LAW May 28, 2003 2 I 4 STATE STREET HARRISBURg, PA I 7 I 0 I (7 I 7) 230-97 I 5 FAX [7 I 7) 230-8534 Cumberland County Register of Wills Cumberland County Courthouse Carlisle, Pennsylvania 17013 Re: Inheritance Tax Payment - Evelyn A. Cohick Estate #20O3 -0024 Dear Register of Wills: Enclosed is a check in the amount of $5,935.00 as an estimated payment of Inheritance Tax for the above-referenced estate. Please feel free to contact me if there are any problems or if you have any questions. I have also enclosed a self-addressed stamped envelope for returning to me a receipt acknowledging receipt of the check. LRM:skj Enclosures Cc: Thomas Cohick Judy Good VeSmly ~ ~}..~ c~,~_,_.~j yours, Louis R. Martin, Esq. Louis R. MARTIN COUNSELOR AT I..AW HARRISBURG, PA I 7 I 0 I I,,,lll,,,llll,,,,,ll,,ll,l,,I,I Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 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 002627 MARTIN LOUIS R ESQUIRE 214 STATE STREET HARRISBURG, PA 17101 ........ fold ESTATE INFORMATION: SSN: 208-24-2155 FILE NUMBER: 2103-0224 DECEDENT NAME: COHICK EVELYN A DATE OF PAYMENT: 05/30/2003 POSTMARK DATE: 05/29/2003 COUNTY: CUMBERLAND DATE OF DEATH: 03/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,935.00 TOTAL AMOUNT PAID: $5,935.00 REMARKS: LOUIS R MARTIN SEAL CHECK# 1024 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~:oo Z 0 o REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST. FIRS'~ AND MIDDLE INITIAL) Cohick, Evelyn A. DATE OF DEATH (MM-DB-YEAR) DATE OF BIRTH (MM-DP-YEAR) 03/08/2003 104/07/1907 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FILE NUMBER NUMBER SOCIAL SECURITY NUMBER 208-24-2155 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I~jl. Original Return Iilj 4. Limited Estate [ii~[[.] 6. Decedent Died Testate [At~aci~ r,gpy of ~,',,,iii) [1119. Litigation Proceeds Recewed []2. Supplemental Return ~]4a. Future Interest Compromise (date of dec, r~ a~e,, 12-12-82i [~7. Decedent Maintained a Living Trust (kfL~c~ ,~'~y of T,~Jsl) i10. Spousal Pover~, Credit {date of death between 12-31-91 ar~(1 I-I-95) [1113. Rerriainder Return (dale ofdeafh prior fo 12-13-82) Iii5 Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11i Eledion to tax under Sec. 9113(A} '*~: .~ '-" THIS SEC~ON MU~ BE C~ETED;;ALL CORR~DENCE ~D ~~ TAX INFORMATION SHOULD BE DIRECTED TO: NAME I COMP[ ETE MAILING ADDRESS Louis R. Martin, Esq. 1 214 State Street FIRM NAME ~l¢^~r;l~.~b~ei I Harrisburg, PA17101 I TELEPHONE NUMBER (717) 230-9715 ! Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule D) (4) 5 Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6 Jointly Owned Property (Schedule F) (6) E~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines ! 9. Funeral Expenses &Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. 96,500.00 (3) ..................................................................................................................................................................... ~i · 62,379.86 (8) 158,879.86 8,447.39 63,797.75 (11) 72,245.14 (12) 86,634.72 Charitable and Governmental Bequests/Sec 91!3 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Lice 12 minus Line 13) 04) 86,634.72 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec 9116 (a)(1.2) 16. Amount of Line 14 taxable al lineal rate 17. Amount of Line 14 taxable a( sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Bue 20. x.0 86,634.72 x .o 45 x .12 x 15 (15) ....................................................................................................................... ............ (17) (18) ¢9) .................................................................................................................. 3,.898.~56 ............ > >BE SURE TO ANSWER ALL QUESTIONs oN REVERSE SiDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 923 West North Street ClTYCarlisle I STATEpA ZIP 17013 Tax Payments and Credits: I, Tax Due (Page I Line 19) 2, Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount interest/Penalty if applicable D. interest E, Penalty 5,935.00 194,93 (1) Total Credits ( A + B + C ) (2) Total Interest'Penalty ( D + E ) 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 (3) (4) 3,898.56 6,129.93 2,231.37 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Enter the interest on the tax due. (5A) IF THE ANSWER Enter 1he total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 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 ti~e 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 care? ...................................................................... [] [] if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Declaration of preparer other than the personal representative is based on all informaben of which Feparer has any knowledge. SIGNATURF~ERSON RESPOJ~BLE F~ FI[Z('I~G I:~URN/~! ,- DATE ADDRESS ' ~ 12 Sheeley Lane, Boiling Springs, PA 17007 SIGNATURE OF PJ~EPARER OTHER THAN REPRESENTATIVE DATE/ 214 State Street, Harrisburg, PA 17101 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a. (1.1) For dates of death on or after January 1, I995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (!.1) (ii)] The statute does not exem[~t a transfer to a surviving spouse from tax. and the statutory requirements for disciosure of assets and filing a tax return are stii! appiicable 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 vaiue of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chi!d is 0% [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 lineai beneficiaries is 4.5%, except as noted in 72 PS §9116(1.2) [72 P.S. 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 individuai who has at ieast 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 ESTATE OF Evelyn A. Cohick SCHEDULE A REAL ESTATE FILE NUMBER 2003-00224 All mai property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price 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 right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 423 West North Street, Carlisle, PA 17013 $96,500.00 TOTAL (Also enter on line 1, Recapitulation) $ 96,500.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn A. Cohick SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 2003-00224 ITEM NUMBER 5. 6. 7. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Burial Lot Gravestone Perpetual Care Opening Grave Funeral ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Tom Cohick, Judith Good 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 Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Retum Preparer's Fees State __ Zip 945.00 85.00 5117.38 2,000.00 300.01 8,447.39 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV. 1512 EX* (6-98) COMMONWEAi..TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Evelyn A. Cohick 2003-00224 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. Real Estate Appraisal Printed Estate checks Duplicating Charge Real Estate Commission Maintenance of home prior to sale Mowing Utilities (Feb.-May) Trash Exterminator Expenses of last illness 6/2002 to 3/2003 (congestive heart failure) Physician - Dr. Donald Kovacs Medications Nursing Home-Thornwald Nursing Home Sale of Home closing costs 250.00 27.50 15.00 3500.00 45.00 116.86 250.00 173.30 81.10 595.74 53123.09 5620.16 TOTAL (Also enter on line 10, Recapitulation) $ 63,797.75 (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 FILE NUMBER Evelyn A. Cohick 2003-00224 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I 2. 3. 4. 5. 6. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Robert T. Good Alecia A. Good Christopher E. Good Racheal E. Cohick Thomas C. Cohick Judith A. Good Grandson Granddaughter Grandson Granddaughter Son Daughter 1500.00 1240.00 1200.00 1300.00 40697.36 40697.36 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If mom space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, Evelyn A. Cohick, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sotmd mind, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking any and all other wills by me at any time heretofore made. Item I. I bequeath to my daughter, Judith A. Good, my China, my wedding ring, my mother's ring, my cross and ring necklace, and my chair with needlepoint seat. Item II. I bequeath to my son, Thomas C. Cohick, my wine bo'ttle collection, my silverware, my goblet collection, and my antique washstand beside the couch. Item IH. I bequeath to Christopher E. Good the sum of $1,500.00, in trust nevertheless for Robert T. Good. Item IV. I bequeath to Alecia A. Good the sum of $1,200.00, my cut glass cake stand, and my vase with a painted lily. Item V. I bequeath to Christopher E. Good the sum of $1,200.00. Item VI. I bequeath to Rachael E. Cohick the sum of $1,200.00, my gold locket and pearl ring. Item VII. I direct that Judith A. Good, my daughter, and Thomas C. Cohick, my son, may select whatever furniture they want. The balance of the furnishings and the real estate is to be sold at public or private sale, in the discretion of my Executors. Item VIII. All the rest, residue, and remainder of my Estate, both real and personal, I device and bequeath to my daughter, Judith A. Good, and my son, Thomas C. Cohick, in equal shares. Item IX. I hereby appoint my daughter, Judith A. Good, and my son, Thomas C. Cohick, as Executors. Item X. I direct that my Executors retain the services of George F. Douglas, Jr., to act as the attorney to handle my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this [(~ day of July, 1993. ~r~..s~f'.-,-r_ ~ ~z?..~.~" (SEAL) Evelyn ~. Cohick Signed, sealed, published and declared by the above-named testatrix, as and for her last will and testament, Who at her request, in her presence, in our presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses: COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) We,/. ~'~// and the witne~(e'~ whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last will, and that she signed willingly and that she executed it as her free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Swom to and subscribed before me this /~ day of July, 1993. Notary NOTARIAL SEAL JANET M. LAY NOlrARY PUBLIC CARLISLE BORO., CUMBERLAND COUNTY MY COMMISSION EXPIRES JUNE 26, 1995 COMMONWEALTH OF PENNSYLVANIA ) COLrNTY OF CUMBERLAND ) I, Evelyn A. Cohick, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Evelyn A(. Cohick (SEAL) Sworn to and subscribed before me this /~ dayofJuly, 1993. Notary NOTARIAL SEAL JANET M. LAY NOTARY PUBLIC CARLISLE BORO., CUMBERLAND COUNT? MY COMMISSION EXPIRES JUNE 26. 1995 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 APPLICATION FOR REFUND OF PENNSYLVANIA INHERITANCE/ESTATE TAX Official Use Only TO: FROM: PA Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 Official Representative Decedent Data ~G ri ¢ File Number ~ 0 0 s, ~. /?O~7Date of Death 03 Social Security Number Phone Number ('7j'7) ,~-'~ - 3~'? ~ The undersigned requests a refund in the amount of $ referenced decedent's estate. for the above REFUND REQUESTED ON: L""'J Original or Supplemental [~ Joint/Trust Assets [~ Remainder Return [~ Estate Tax Probate Return EXPLANATION OF OVERPAYMENT Signature Please allow four to six weeks for the processing of your refund request. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-060I COMMONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LOUIS R MARTIN ESQ 214 STATE ST HBG PA 171011 DATE ESTATE OF DATE OF DEATH F!LE NUMBER COUNTY ACN REV-1547 EX AFP (01-05) 12-22-2005 COHICK EVELYN A 05-08-2005 21 05-0224 CUMBERLAND 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO= REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETA[N LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP C01-05) NOT[CE OF INHERITANCE TAX APPRA[SEMENT, ALLONANCE OR D[SALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF COHICK EVELYN A FTLE NO. 21 05-0224 ACN 101 DATE 12-22-2005 TAX RETURN NAS: C X} ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNTNG FUTURE TNTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A) CZ) 2. Stocks and Bonds CSchedule $. Closely Held Stock~Partnership Interest CSchedule C) C$) .00 q. Mortgages/Notes Receivable CSchedule D) Cq) .00 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) C5) 62r579.86 6. Jointly Owned Property CSchedule F) C6) .00 7. Transfers CSchedule G) C7) .00 8. Total Assets C8) APPROVED DEDUCTIONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule H) C9) 8,447.59 10. Debts/Mortgage Liabilities/Liens (Schedule Z) C10) 65f797.75 11. Total Deductions Cll) 12. Net Va/ue of Tax Return 96r500.00 .00 NOTE: To insure proper credit to your account, submit the upper port/on of this form w/th your tax payment. 158,879.86 86,654.72 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) CiS) .00 14. Net Value of Estate Subject to Tax Clq) 8&,&54.72 NOTE: Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wi1! reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of L/ne Lq at Spousal rate C15) .00 X O0 = . O0 16. Amount of L/ne lq taxable at Lineal/Class A rate CI6) 86,654.72 X 045 = 5,898.56 17. Amount of Line lq at Sibling rate 18. Amount of L/ne lq taxable at Collateral/Class B rate 19. Princ~ om1 Tax Due TAX CREDITS: c].7) .00 x 12 = .00 cz8), .gO x 15 = .00 c].9)= 5,898.56 PAYMENT DATE 05-29-2005 RECEIPT NUMBER CDOO2627 DISCOUNT C+) INTEREST/PEN PAID 194.95 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 5,955.00 TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 6,129.95 2,251 .$7CR .00 2,231.37CR ~ IF TOTAL DUE IS LESS THAN 91, NO PAYMENT TS REQUIRED. IF TOTAL DUE IS REFLECTED AS A 'CREDTT' (CA}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B Ccollateral) beneficiaries of the decedent after the expiration of any estate for l/re or for years, the Commonwealth hereby expressly reserves the r/ght to appra/se and assess transfer Inher/tance Taxes at the lawful Class B Ccollateral) rate on any such future interest. PURPOSE OF NOTICE= PAYMENT= REFUND CCR)= OBJECTIOHS= ADMIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY: iNTEREST= To fulf/11 the requ/reaents of Sect/on 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. C72 P.S. Section 9140). Detach the top portion of this Not/ce and subm/t with your payment to the Reg/ster of Hills printed on the reverse s/de. --Make check or money order payable to= RBGZSTE:~ OF N~LLS, A~JT 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). Appl/cat/ons are available at the Off/ce of the Register of N/lls, any of the 25 Revenue District Off/ces, or by calling the special 2~-hour answering serv/ce for forms ordering= 1-800-562-2050; services for taxpayers w/th spec/al hearing and / or speaking needs= 1-800-447-$020 (TT only). Any party in interest not sat/sf/ed with the appra/sement, allowance, or d/sallo~ance of deductions, or assessment of tax (includ/ng discount or interest) as sho~n on this Not/ce must object w/thin sixty (60) days of receipt of this Not/ce by= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harr/sburg, PA 17128-1021, OR --elect/on to have the matter determ/ned at aud/t of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors d/scovered on th/s assessment should be addressed in wr/t/ng to= PA Department of Revenue, Bureau of Ind/v/dual Taxes, ATTN= Post Assessment Rev/mw Unit, Dept. 280601, Harr/sburg, PA 17128-0&01 Phone C717) 787-6505. See page 5 of the booklet "Instruct/ohs for Inher/tance Tax Return for a Res/dent Decedent'* CREV-1501) for an explanation of adm/nistratively correctable errors. If any tax due is pa/d w/th/n three (3) calendar months after the decedent°s death, a five percent CSX) discount of the tax paid is allo~ed. The 15~ tax amnesty non-participation penalty is computed on the total of the tax and /nterest assessed, and not pa/d before JanuarY 18, 1996, the first day after the end of the tax amnesty period. Th/s non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and /nterest that has been assessed as ind/cated on this not/ce. Interest /s charged beg/nning with first day of delinquencY, or n/ne ¢9) months and one C1) day from the date of death, to the date of payment. Taxes which became del/nquent before January 1, 1982 bear /nterest at the rate of s/x C6X) percent per annum calculated at a da/ly rate of .000164. All taxes wh/ch became delinquent on and after January 1, 1982 wil! bear interest at a rate ~h/ch w/ll vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Yea~ Rate Factor Year Rate Factor 1982 20X .000548 1987 9X .000247 1999 7X .000192 198~ 16X .000458 1988-1991 11X .000301 2000 8~ .000219 198~ 11X .000501 1992 9~ .000247 2001 9~ .000247 1985 13X .000356 1993-1994 7X .000192 2002 6~ .0001&4 1986 lOX .000274 1995-/998 9~ .000247 2005 5~ .000157 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Not/ce issued after the tax becomes delinquent wiZ1 reflect an interest caiculat/on to f/f/men C15) days beyond the date of the assessment. [f payment /s made after the interest computat/on date shown on the Not/ce, add/t/onal /nterest must be calculated. BUREAU OF ZNDZVTDUAL TAXES ]*NHER'rTANCE TAX DZVI'STON DEPT. 280601 HARRISBURG,, PA 171ZD-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT LOUIS R HARTIN ESQ Zlq STATE ST HBG ~; .... i _,, -; .... Wills ESTATE OF DATE OF DEATH FZLE NUMBER '04 FEB 13 ACN PA ~7]~<.-~ ~.· 01-Z6-ZOOq COHICK 05-08-2005 210$-OZZ~ CUMBERLAND 101 Amoun~ Rem.t 1:'l~ed REV-lC07 EX ~'FP (0],-03) EVELYN A HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit: 1:o your accoun1:, submi1: ~he upper por1:/on of 1:his fore wi1:h your 1:ax CUT ALONG TH'rS L:I:NE ~" RETAIN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~#~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF COHICK EVELYN A FZLE NO. 21 03-022q ACN ].01 DATE 01-Z6-Z00~ TH*rS STATEMENT ZS PROVZDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHONN BELON ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPLICABLE, A PROJECTED ZNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 1Z-22-2005 PRINCIPAL TAX DUE: 3,898.56 PAYMENTS (TAX CREDITS): PAYHENT DATE 05-29-2005 OX-08-ZOOq RECEIPT NUMBER CDOOZ627 REFUND DISCOUNT (+) ZNTEREST/PEN PAID C-) 19q.95 .00 AMOUNT PAID 5,935.00 2,231.37- ZF PA*rD AFTER TH*rS DATE, SEE REVERSE S*rDE FOR CALCULATZON OF ADD*rTZONAL /NTEREST. ( [F TOTAL DUE *rS LESS THAN $1, NO PAYMENT [S REQUIRED. ZF TOTAL DUE *rS REFLECTED AS A 'CREDZT' [CR), TOTAL TAX CREDZT 3,898.56 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF TN*rS FORM FOR *rNSTRUCT*rONS. ) 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 HILLS, AGENT. -- Zf NON-RESIDENT DECEOENT make check or money order payable to: COMHON#EALTH OF PENNSYLVANIA. REFUND [CR): A refund of a tax credit, which aaa not requested on the Tax Return, amy ba requested by completing an · 'Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of tho Register of Wills) any of the 23 Revenue District Offices or from the Department's Z~-hour ansmering service for forms ordering: 1-800-361-Z0501 services for taxpayers with special hearing and / or speaking needs: Z-80D-q~7-3010 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Dap[. 280601, Harrisburg, PA 17128-0601, phone (7173 787-6505. DXSCOUNT: [f any tax due is paid within three (3) calendar months after the decedant's death, a five percent (51) discount of the tax paid is alloNad. PENALTY: The 151 tax amnesty non-participation penalty is computed on the to[at 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 mhich became delinquent before January l, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~. Ail taxes which became delinquent on and after January l, 1982 will bear interest at a rate which wilZ vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Interest Daily Year Rate Factor Year The applicable interest rates for 1981 through 2003 ara: Interest Daily Interest Daily Rate Factor Year Rate Factor 1981 ZOX .0005~8 1987 9Z .O00Zfi7 1999 71 .000191 1983 161 .000~$8 1988-1991 11Z ,000301 ZOO0 8Z .000119 198q 111 .000301 1991 91 .0001~7 ZOO1 92 .0001q7 1985 132 .000556 1993-199q 72 .000191 EOOZ 62 .O0016fi 1986 101 .00027~ 1995-1998 91 .0002q7 2003 SX .0001~7 --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 be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2005 GOOD JUDITH A 854 W NORTH STREET CARLISLE, PA 17013 RE: Estate of COHICK EVELYN A File Number: 2003-00224 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: 3/08/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~l~~ . GLENDA FARN;;-~;RA~AUGH REGISTER OF WILLS cc: File Counsel Judge } ~. . . . : , Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Evelyn A. Cohick Date of Death: 0)/08/0) Estate No.: 21 0)-0224 Pursuant to Rule 6. I2 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 1!l No 0 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 0 No ~ 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? Y es ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. dOUAb~U~ SigniEe Date: 2/16/05 Louis R. Martin, Esq. Name 214 state st., Harrisburg, FA 17101 Address 717-2)0-9715 Telephone No. 0:1 Capacity: o Personal Representative ~ounsel for personal representative v