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Home My WebLink About04-0772PETITION FOR PROBATE and GRANT OF LETTERS a~o known as Elin Winters Coughlan Elin W. Coug~lan · Deceased. SocialSecuriO'No. 579-14-7769 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated augus ts 26 and codicil(s) dated NONE To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania in the ,19n~med Decendent'was domiciled at death in Cumberland County., Penns~,lvania, with last familynTPrin~inalresidenceatChapelee, -*-vrtem Point 4905 East Trindle Rood, h Mechanicsburg, va rtuau (list street, number and muncipality) Decendent. then 90 year$.of~ge, died June 17 ,xt~ 2004 at 4905 E. trindle Roa~, ~tecnanlcs~urg, wA ~7050 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: NONE Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 27,000 (If not domiciled'in-Pa.) Personal property in Pennsylvania $ N/A (If not domiciled in Pa.) Personal property in County $ N/A Value of real estate in Pennsylvania $ - O - situated as follows: L-~ WHEREFORE, petitioner(s) respectfully request(s) the nrobate of the lhst will ~ codicil(s) presented herewith and the grant of letters_ TESTAMENTARY c ~ (testamentary; administration c.t.a.; admlnistra~ d.b.n.c.t.a.) theron. 1026 Walnut S~reet ~ Lemoyne, PA 17043 CONSTANCE E. COSTELLO OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF C.~.~ ¥ ~ i5~7~ LtM,~ 0 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 aqcorqling to law. Sworn to or affirmed and subscribed ~ (~/~ ~ ~. (bI-~d- ~ before me this t~ day of [ Elin Coughlan Estate of ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW A L,(6. I q ~9 , 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 ^.g,mt ?6. 1_.. Elin Coughlan described therein be admitted to probate and filed of record as the last will of and Letters ~ are hereby granted to Ccnstanc= E. Sou cello FEES Probate, Letters, Etc .......... Short Certificates(~)'. ........ Filed ................................... Michael Cherewka 3~07~ ATTORNEY (Sup. Ct. I.D. No.) 624 North F~-~ qtreet, ~D~SS 717-232-~701 PHO~ ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. JUN 2 1 Elin Coughlan Female 579-14-7769 June 17, 2004 May 5, 1914 Portland, OR Chapel Point Cumberland Carlisle Boro White Homemaker No Widowed 4905 E. Trindle Road, Mechanicsburg, PA 17050 Connie Costello Matthew L. Morris Heffner Funeral Chapel & Crematory, Inc., 1551 Kenneth Road, York, PA 17404 Respiratory Failure Chronic Interstitial Lung Disease ASHD XXX Belvedere Med. Ctr. 850 Walnut Bottom Rd. Lisa C. Myers, D. O. Carlisle, PA 17013 Drive, Dallastown, June 18, 2004 PA 17313 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, ELIN WINTERS COUGHLAN. currently residing in Lemoyne, Cumberland County, Pennsylvania, being in good health and sound and disposing memory, do hereby make, declare and publish this as nay Last Will and Testament, hereby revoking ali former Wills and Codicils heretofore made by me. FIRST: I direct that ail of my debts not barred by the statute of limitations, expenses of my last illness, funeral expenses, costs of administration, and claims allowed in the administration of my estate shall be paid by my Executrix hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: I give, devise and bequeath to my daughter, CONSTANCE ERL¥ COUGHLANCOSTELLO, any land, dwelling, all the contents of the dwelling and the cars I own at the time of my death. THIRD: I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situate, to my children, CONSTANCE ERIN COUGHLAN COSTELLO, CAROL YN RAY COUGHLAN PETTY, PATRICK DENNIS COUGHLAN, and MICHAEL EDWARD COUGHLAN,, in four equal shares, provided that the share of any child who predeceases me or dies before the complete distribution of his or her share shall be distributed to his or her issue per stirpes and in default of any such then living issue such share shall be added to the share or shares for my other children, per stirpes. '.-: FOURTH: Should there be any property of whatsoever kind and wheresoever situate whiCh ! haveT~e right to dispose of at the time of my death, including but not limited to any spe.cJal~or geF~'al powe~ of appointment or both, I hereby appoint the same to my beneficiaries set forth in Paragraph Third above. ~. FIFTH: I hereby nominate, constitute, and appoint my daughter, CONSTANCE E. COSTELLO, as Executrix of this, my Last Will and Testament. In the event that my said daughter shall predecease me, or be unwilling or unable to act as my Executrix, as aforesaid, then I nominate, constitute and appoint my daughter, CAROLYNR. PETTY, without necessity for posting security regardless of state of residence, as Executrix of this, my Last Will and Testament. All references to the Executrix herein shall be applicable to said substitute Executrix. SIXTH: My Executrix shall have, in addition to the powers and authority conferred upon her by law, the following additional powers and authority: 1. To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executrix shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities or other securities, or such property, real or personal, as the Executrix shall deem wise, without being limited by any statutes or role of law regarding investments by the Executrix. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as she may deem it wise, and even though such property is not the kind of property an Executrix would purchase as an investment; and even though to retain such property might violate sound diversification principals. 4. To cause any security or other property which may constitute a portion of my estate to be issued, held or registered in her own name, or in the name of a nominee, or in such form that title will pass by delivery. 2 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities ~vhich. in the opinion of the Executrix is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right to given to her as owner of any securities constituting a portion of my estate resulting from any reorganization, consolidation, readjustment, sale, conversion or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including such compensations to Executrix which shall be in accordance with established fees throughout the period of administration of my estate. 7. To determine what is "income" and what is "principal" hereunder, and her decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executrix may determine. 8. To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by her, at public or private sale, or otherwise. 9. To borrow money from any person, firm or corporation, including any corporation acting as an Executrix hereunder, for the purpose of protecting and preserving or improving my estate hereunder; to execute promissory notes or other obligations for mnounts so borrowed. 10. To employ legal counsel, accountants, brokers, investment advisors, custodians. managers and other agents and employees and to pay reasonable compensation out of my estate or any funds held hereunder to which said compensation is attributable. 1 i. To carry on any bFsiness owned or controlled by me at my death for whatever period of time she shall think proper, and she shall have the power to do any and ail things she deems necessary or appropriate, including the power to close out, liquidate or sell the business at such time and upon such terms as she shall deem best. 12. To do all other acts in his judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, to which such taxes are attributable pass under this Will. shall be paid out of my residuary estate; that my Executrix pay, or provide for payment of all such taxes at such time, or times, and in such manner as my Executrix deems best. I direct that ail transfer and inheritance taxes, state or federal, assessed because of my death, to which such taxes are attributable to property passing outside the Estate, that each beneficiary shall personal17 pay that portion of the tax attributable to those assets. IN WITNESS WHEREOF, I, ELIN WINTERS COUGHLAN, the Testatrix to this, my Last Will and Testament, typewritten on four sheets of paper which I have identified at the bottom of each page by my signature, hereunto set my hand and seal the ~ day of ~.~_~ /.c-d_, 1999. EL1N WINTERS COUGHLAN The preceding instrument consisting of this and three other typewritten pages, each identified by the signature of the Testatrix, ELIN WINTERS COUGHLAN, this day and date thereof signed, published and declared by ELIN WINTERS COUGHLAN, the Testatrix therein named. as and for her Last Will, in the presence of us who, at her request, in her presence, and in thc presence of each other have subscribed our names as witnesses. 4 COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : 1, ELIN WINTERS COUGHLAN, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and cxecuted 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 thereto expressed. EL1N WINTERS COUGHLAN Sworn or affirmed to and acknowledged before me, by ELIN WINTERS COUGHLAN, the Testatrix the ~_dayof ~ ,1999. (SEAL) Notary PuNic I Notarial Seal Michae~ Cherewka Notary Public Susquehanna Twp,. Dauphin County COMMONWEALTH OF PENNSYLVANIA My Commission Expires Feb 5. 2001 SS COUNTY OF CUMBERLAND We i,-' o/'/~),z,r,,,r,~ and -~'~,~,' ,i~'-~- , the witnesses 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; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by '~,¥v.h ¢~/~,~,c.,,£, and ~ ~ & .,' ~* ,2 Z/~' '~& "witnesses, this 2t'~t' dayof ~')1(./~ 1999. (SEAL) Notary Public 'Notarial Seal '1 Michael Cherewka, Notary Public Susquehanna Twp,, Dauphin ~County Cumberland County - Register Of Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Wills Date: 11/01/2004 CHEREWKA MICHAEL 624 NORTH FRONT STREET HARRISBURG, PA 17043 RE: Estate of COUGHLAN ELIN File Number: 2004-00772 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 11/29/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Judge Representative (s) Sincerely, GLENDA FARNER STRA~ Clerk of the Orphans' Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 11/01/2004 COSTELLO CONSTANCE E 1023 WALNUT STREET LEMOYNE, PA 17043 RE: Estate of COUGHL~Hq ELIN File Number: 2004-00772 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPPLANS, 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 11/29/2004 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: No. To the Register: Elin W. Coughlan June 17, 2004 21-04-0772 I certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above-captioned estate on September 23, 2004. NAMES Constance E. Costello Carolyn R. Petty Patrick D. Coughlan Michael E. Coughlan ADDRESS 1023 Walnut Street Lemoyne, PA 17043 1620 Belinda Way Sacramento, CA 95822 1000 Majestic Acres Road Linden, TX 75563 Post Office Box 1240 Citrus Heights, CA 95611 Date: September 23, 2004 The Law Offices of Michael Cherewka Michael Cherewka, Esquire 624 North Front Street Wormleysburg, PA 17043 (717) 232-4701 Capacity: Personal Representative X Counsel for personal Representative ;",.,) ~~~ (;.:;::) ~,.n ::0 rn G) (::J:j .~ !::;::J <,I 'c ~::5 .-j .. ~~i ;:::rrl <:/.>0 ""1 ~:- Nt The Law Offices of MUhael ChereWRa 624 North Front Street Wormleysburg, Pennsylvania 17043 TO: Honorable Mary C. Lewis Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 ...~ Law Offices of Michael Cherewka 624 North Front Street Wormleysburg, Pennsylvania 17043 (717) 232-4701 (717)901-3770 Fax (717) 232-4774 March 29, 2005 Honorable Mary C. Lewis Register of Wills Cumberland County Courthouse Carlisle, PAl 70 13 Re: Estate ofE1in W. Coughlan Estate No. 21-04-0772 Our File No. 2332.00 t.,:; Honorable Mary C. Lewis: Enclosed please find REV 1500, Inheritance Tax Return for Resident Decedent, Inventory and Estate check No. 101 in the amount of$I,003.01 representing the final payment of the Permsylvania Inheritance Tax in the above referenced Estate. Also enclosed are two checks in the amount of$15.00 each to cover the cost of filing the Inventory and the Return. We have enclosed a copy of the front page of the return and a copy of the Inventory. We ask that you time-stamp the copies and return them to us in the enclosed stamped envelope. If you have any questions, please call the undersigned. Thank you for your consideration in this matter. Very truly yours, ~~ Michael Cherewka MCIII Enclosures REV-1500EX(&-oO) \--J .~,r.j) . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04 0772 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W (,) W C OECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Coughlan, Elin W. DATE OF DEATH (MM-DD-YEAR) 06/17/2004 COUNTY CODE YEAR NuMBER DATE OF BIRTH (MM-DD.YEAR) 05/05/1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A w ... ~$~ 00"< w"-g ",0.- o8:(tI "- .. ~ 1. Original Retum o 4. limited Estate ~ 6. Decedent Died Testat9 (Afulch COpY otWill) o 9.lWgation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death alter 12-12-82) o 7. Decedent Maintained a living Trust (Mach copy of Trust) o 10. Spousal Poverty Credit (date of death balw$!n 12..11.\11 arid H-IlS) SOCIAL SECURITY NUMBER 579-14-7769 THIS RETURN MUST BE FILED IN DUPLICATE WI1H THE REGISTER OF WillS SOCIAL SECURITY NUMBER o 3. Remainder Return (data of deall1 prior to 12..13-82) o 5. Federal Estate Tax Return Required L 8. Total Number of Safe Deposit Boxes o 11. Election \o\ax under Sec. 9113(A) (Attach S<:h 0) COMPLETE MAILING ADDRESS 624 North Front Street Wormleysburg, PA 17043 0.00 0.00 0.00 0.00 0.00 ... z w C z o "- en w " " o o 'TL$I$ . NAME Michael Cherewka, Esquire FIRM NAME I' '_"'I The Law Offices of Michael Cherewka TELEPHONE NUMBER (717) 232-4701 27,270.76 0.00 ',,; 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) (8) 3,748.22 1,233.45 (11) (12) (13) 27,270.76 3. Closely Hekl COlpOrauon, Partnersl1ip or Sole-Proprietorship z o S ::::l l- ii: c( (,) W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule Gor l) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 1 Q. Debts of Decedent. Mortgage liabilities, & liens (Schedule I) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 4,981.67 22,289.09 0.00 (14) 22,289.09 (6). (7) (9) (10) 14, Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' ::::l Q. :::E o (,) ~ 15, Amount of line 14 taxable at the spousal tax rale, or transfers under Sec. 9116 (a)(1.2) ,.0_(15) 1,003.01 0.00 0.00 1 ,003.01 16_ Amount of line 14laxable at lineal rate 22,289.09 ,.0 ~ (16) 0.00 '.12 (17) __.___.~ _ 0.00 '.15 (18) (19) 17. Amount of Line 14 taxable at sibling rate 18. Amounl of Line 14 taxable at collateral rate 19, 'Tax Que 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT Decedent's Complete Address: STREET ~~FRESS Cha el Point 4905 East Trindle Road CITYM h . b I STATEpA I ZIP 17043 ec amcs urg Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,003.01 Total Credits (A + B + C ) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Une 3 IS greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,003.01 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 1,003.01 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;........ .................................... ........................... 0 [KI b. retain the right to designate who shall use the property transferred or its income; ........... 0 [KI c. retain a reversionary interest; or.., ,........................ ...,............"..................... 0 [K] d. receive the promise for life of either payments, benefits or care? ............. .......".,......".. 0 [iI 2. II death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......... ........m............................. .. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 [KI 4. Did decedent own an Indlviduai Retirement Account, annuity, or otha, non-probate property which contains a beneficiary designation? ....... .................... ...................... ................................. 0 [KJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN, Under penalties of pe~ury, I declare that I have examined lIIls return, including acccmpanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer o!her than the personalrepresenlative is based on all infor matlon ofwhich preparer has any knowledge. ~~~~:P~N~E:'LZ~/l 'u_ ______._____ ADDRESS 1023 Walnut Street, Lemoyne PA 17043 SIGNATURE p. ROTHE N REPRESENTATIVE DATE _ / '----~'f'-o..c ADDRESS ~~"-I'l()rthFron~treet,lJV.c>rl1ll19ysburg.'.PA_17.0.43 ______ DATE "'/. J "(1-3/0)- 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. 39116 (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. S9116 (a) (1.1) (ii)]. The statute does not exemot 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 sUNiv\ng spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-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. 39116(a)( 1.2)]. The tax rate imposed on the net value of transfers to or for the use 01 the decedent's lineal beneficianes is 4.5%, except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(a)(1)]. The \ax rate Imposed on the net value of transfers to or lor the use of the decadent's siblings is 12% [72 P.S. 39116(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-'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Coughlan, Elin W. FILE NUMBER 21-<34-0772 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 price at which property would be exchanged between a willing buyer and a willing seller, nelttler 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 NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None 0.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV.'5a3 EX+ (6.9_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX ReTURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Coughlan, Elin W. FILE NUMBER 21-04-0772 All property Jolntly-owned with rIght of survivorship must be disclosed on Schedule F. ITEM NUMBER ,. DESCRIPTION VALUE AT DATE OF DEATH None 0.00 TOTAL (Also enter an line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-IS0S EX. Is-sa. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Coughlan, Elin W. FILE NUMBER 21-04-0772 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Constance E. Costello ADDRESS RELATIONSHIP TO DECEDENT 1023 Walnut Street Lemoyne, PA 17043 Daughter B. C onstance E. Costello 1023 Walnut Street Lemoyne, PA 17043 Daughter c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY %OF OATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST ,. A. 08/03/1999 M & T Bank, Checking Account #3740875772 16.465.51 50 8,232.76 2. A 08/03/1999 M & T Bank, Checkin9 Account #3740875772 Acurred Interest 0.34 50 0.17 3. B 09/01/2003 M & T Securities, Account#C3X-041890, 38,075.66 shares 38,075.66 50 19,037.83 TOTAL (Also enter on line 6, Recapitulation) $ 27,270.76 (If more space is needed, insert additional sheets of the same size) Ma,. 22 05 05:08p:> p:>.1 rm M&I'Bank 499 Mitchell Road, Millsboro. DE (9966 Mail Code DE-MB-12 Pllone (888) 502A349 fa..'- (302) 934.295:5 Februat) 7,2005 Law Offices of Michael Cherewka '-_ 624 North Front Street Wormleysburg, Pennsylvania 17043 Re: Estate or Elin W Couflhlan Social Securitv: 579-14-7769 Date of Death: June 17. 2004 Dear Sir or Madam: Per your inquiry received JanuaJ)' 26, 2005, please be advised that at t'le rime of dearh. the .bove-named decedent had Oil deposit with this bank 1he following: i. Type of Account Checking Account Account Number 3740875772 Ownership (Names 01 E!in W Coughlczn Joint OwneJ's Constan~e E Costello, Jow Owners Opening Date 8/3/99 B,lance on Dare of Death $/6,4655/ Accrued In/erest $ 0.34 To!al ."$1'6.465.85.-.------.... Please be advised, toere was no safe deposit box found for the abcve decedent. For further account information, regarding ownership, closures and/or nimbursement of funds, etc., pleasi call the Trindle Road Omce# 717.737-2308. Sincerely, /7,., .;,/ /.-<' ; ':l:~~~"YCd.r;~-\.J Nancy CI.gett Records Management ~~R.24.2005 3:53PM M AI,D T SECLR! TI ES NO.39S PI M&rInvestmentGroup Mlr s.cllrtt:.lj, 11'1,0 Match 24, 200S Date of death valuation Law offices of Michael Cherewka 624 North Front St Wonnleysburg, PA 17043 Re: Account If C3X.041890 rJo Blin W. Cougll1an and COlUtance B. Costello Date of'Death- 06/1712004 Description of Security I Quantity Date of Death Price per share on I Valuation valuation date (NAY) MTB Money Market T 38,075,66 $38.075.66 $1.00 We have received the infonnation presented above from sources that we believe to be accurate. However, we do not guarantee their llllCU1'lOy. The price per share on vall!tltion date is the closing price on that date. Prepared by: r ~ ().~~ Tammy Case!!a M&T Securities Ine 1.800.724-7788 I . Invll4tnlont. ArG: . Not FD!Colneu'od -!-lavo No ~n~ Qu""'nt... . Mav L.osa ~". P.2 REV-15" EX+ (12-99. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Coughlan, Elin W. FILE NUMBER 21-04-0772 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Beaver Urich Funeral Home 2. Honorariums ,. 283.22 600.00 600.00 3. Funeral Reception B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Represenlative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year{s) CommiSSion Paid: 2. Attorney Fees 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City Stale . Zip Relationship of Claimant to Decedent 4. Probate Fees 100.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Legal Notice - Cumbertand Law Joumal 75.00 Legal Notice - Carlisle Sentinel 90.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,748.22 PHONE 717-938-6172 FAX 717-938-5732 JohnP. KaEOra, Supl:rvisor o BEL\~!~m~I~ICH Box 322, 305 W. Front 51. Lewisberry, PA 17339 Account No.BEA-204012 FUNERAL SERVICES FOR: Elin R. Couqhlan Date of Service: 06/22/04 TO: Connie Costello 1023 Walnut Street Lemoyne, PA 17043 $ AMOUNT FUNERAL GOODS AND SERVICES SELECTED 20.00 Death Certificates 104.22 Out-of-Town Newspapers 159.00 Flowers ..2.83~ TOTAL BILLED ~2~2// CASH RECEIVED 0.00 BALANCE DUE TERMS: Finance charge of ~8.00% per annum (1.50% per month) on the unpaid balance tor each month or fraction thereof commencing on the 1st day after Date of Service. ',illl ." \((\' , :'~ " -.' ! -"';':) ,. -" ~ /,,\1,'._" I ' ~ ' :~. Connie Costello 1023 Walnut Street Lemoyne PA 17043 6/29/04 Dear Connie: "... for God loves a cheerful giver. " ff Corinthians 9:7b We are grateful for your gift of love. Gifts such as yours provide care for residents who are financially unable to care for themselves, and they provide enhancements to our grounds and programs for residents that would not otherwise be possible. Thank you for caring for the needs of our Chapel Pointe residents. Your gift makes a difference in the lives of manyl /;:~f.' /> D"', Sincere.ly" ... ~1':Jjt:. '~~: ,1^,7;?':;/ K.:lthy Anderson-Martin Development Coordinator "_'___"_'>M"{ i $400.00 , I __",J it< ./'{ !- ;"'~ .. i\ 6/29/04 i ()!n \n1mml' c,......_.. \(' ','1 -,(>n,r.U:'<I.\t.h,'i .11;\\'1 'ill !ie! Ii;;, ',\ ,-,)\'!"'",,, 1,)1' rh)'; t"'i;irii1d!,I"L. Thank you Jin beillg a partner with this ministry I :.! ~ \('1 i !;U<! 'I't; C!tLc:~:'i f( :J!;,t', tin" end h ,".1<:1,,: II:Ui, ',f Cii<1C'CI Pnl!'f;\ i':;-W ~)(: (\bjdi;l(~d from the PA Dcpt. of Sf;')',;:;- i:v j,:ii 1'f"p(../vi;; LI! FA, 'i"EeO-1:?? n~)~,::;9 Fk;~~:i:::untlnn does not imp:v pndol'sen\(.;nt DETAC:-: HERr EXfrNSf.> Dc8fS Page 1 of 1 - ELIN W. COUGHLAN 1023 WALNUT ST. 71N175-3633 LEMOYNE, PA 17043 1284 Pay to the ~y Order of e. eII1. ~ ..!!!!- O"'-R... .'~t:> 11~'l~ -......... o 60-2961313 Date t/ ~ 7-~ 11>0'( 43>11 00 I $ 160:- "'-- Dollars ill:""-::"'" ForJl"Md1~":u_ - ov.~s+ L:2;:)_t24v:~!! 1:0:l 10:10 ~ q 5 51: 3? L,Oa? S?? ~1I' . ~aL, ."00000 .0000," l.___ ... -. --. -. ..~ ~ ..... .-".._r...... ....__ .... _0". _ ._.... ~._. _ '_I................ ... 'I...~..... t...... A '.'--. ....,....._ ''''~ -- ~WL;'''''''t.__ Posting Date 2004 lun 24 Research Seq # 3200884803 Account # 3740875772 Check/Store # 1284 DB/CR DB Dollar Amount $100.00 Bank # 096 Deposit Acet # 0 http://pc-ncrweb I.firstmd.comlinquiry/servletlinquiry 7/21/2004 Page 1 ofl EUIt W. COUGHLAN 1023 WJ\LNUT ST. 717-875-3633 lEMOYNE, PA 17043 1285 ""to"" -e ~ Oo:-[~:i:~ r:J~ ~ m~@.'t~ w.....tIIICII I For g0l10lr~':",,,{ - 1>'tL.-t<n I R 1:0 ~ I. ~O i! ~ 5 51: ~? t.DB? 5?? i!1I" I. i!B 5 ."0000010000," !.--- ---- ---- .-- ~.-._.-..- -..- ............-.- ...- ....._..-..~._.__ 0."_-.-.. ~ ...~~_,,_ ~ ...:,-.....:-:: _)I _ _ ~,~,IH......L...&. Dollars ~ =:.":: -~Q-1L_, Posting Date 2004 Jun 24 Research Seq # 3200884802 Account # 3740875772 Check/Store # 1285 DB/CR DB Dollar Amount $100.00 Bank # 096 Deposit Acct # 0 http://pc-ncrweb I.firstmd.comlinquiry /servlet/inquiry 7/21/2004 Page 1 ofl -- -- -- - --I 1286 EUN W. COUGHLAN 1023 WAlNUT ST. 717.975-3633 lEMOYNE, PA 171143 Date ~"""--... u; UJo<( ....2~ 1$ fOC22 ""'..... "". I 5 . Order of. oItc\.:t ~~ OIAR lu. .~ ,00 11~~ ........1IIiOI For /I..,.or.n:....., -I'",~ . Dollars ~ ~= -t:27)/1ill__~ 1:0:i 1020 ~ I:i 5 51: . :i ~ l.a~ ? ~?? .~.. ~ ~ab .manOD lnnOO..' ._. ~WL1'''''''"" ea-......_ ------ Posting Date 2004 Jun 28 Research Seq # 3200341004 Account # 3740875772 Check/Store # 1286 DB/CR DB Dollar Amount $100.00 Bank # 096 Deposit Acct # 0 http://pc-ncrwebl.firstmd.comlinquiry/servletlinquiry 7/21/2004 Page 1 ofl EUN W. COUGHLAN 1023 WA1Jt\lT ST. 717~ LBoIOYNE. PA 171143 1287 ~~ - /:1i:;~ -'" nVtfL L 7~ 1ft 1l...!'I'Bank . '~"'" ,'~ "'4 nno~ 536" .. '. r;;J"'''~ .~._" u,._~.u uo. co ... a =-:...~~.~~;;~w. CHRLIS~ r ,~,,~~~., .J. ) / // For /.t.rn61alllUMf - ~" .::;;:) ~-!! . .:0; 130 i!'i5 5': \___.....a_ ...... _..._ . . er:............__ D (), ".2 2 .. ~ ,J/0l0-ztS:?SOI3 ate {"..... _ ......,</" _ ?:J I I $ 100 ~ BoIlars ~ ~ ;?~Oa?5??i!~~2a? ~OOOaOl0000~ ~sN'U"IW!.wa. Posting Date 2004 Jun 24 Research Seq # 3100774883 Account # 3740875772 Check/Store # 1287 DB/CR DB Dollar Amount $100.00 Bank # 096 Deposit Acct # 0 http://pc-ncrweb l.firstmd.comlinquiry/servlet/inquiry 7/21/2004 Page 1 ofl EUN W. COUGHLAN 1023 WALNur sr. 717-87$-3633 LEMOYNE. PA 17043 1289 f..t.IL L,- '1 m~~~ -......... For 1-+0/1 ~1""11 ~ '\" Date J,,-c z..2,~Ol( , 10-1951313 4350 Pay to the Order of. I I · ':0:1 l:lO 2 q 5 51: :I? lo05? 5? ? 2"' l 25 q ,"00000 lOOOO," l..r- .u_ a:L..-:~- ..._ ._.. h. _ '.._~_'__'_ ...___~.~_ ~"!' ...._".._"..._-=-..~ t....__ _ _ ____ ~*'I[-'a....I;ftVt" $ loo'~ Dollars ~ ~':' -O::;)_Odjt__. Posting Date 2004 Jun 25 Research Seq # 3200283145 Account # 3740875772 Check/Store # 1289 DBICR DB Dollar Amount $100.00 Bank # 096 Deposit Acct # 482773 http://pc-ncrweb I.firstmd.comlinquiry/servletlinquiry 7/21/2004 Page 1 of1 --- - _. -. -. - " .,. Da 1292 EUN W. COUGHLAN 10123 WALNUT ST. 717-875-3833 LEMOYNE, PA 170-43 Pay to the ~ ~ <rnl.erof ~ 'f1JJ1- O~ fl. ~dU?J ,?j"o/ fI:;- III MalI'Bank au ----- ~ /7/ /., For r-:ir~-tw -l/..o1D.;='~ J~(--i5YJ-~~.. ':03 10 30 ~ Ii 5 5': 37 ..aS? 5? ? en" 10 ~ q i! ,"00000 100000," oy .2~ I()O~ Dollars {D ~ ~......- ~!NEn'ILUtft& Posting Date 2004 Jut 20 Research Seq # 5233662472 Account # 3740875772 Check/Store # 1292 DBICR DB Dollar Amount $100.00 Bank # 096 Deposit Acct # 0 http://pc-ncrweb 1.firstmd.comlinquirylservletlinquiry 7/21/2004 RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Of Wills Hanover and High StreeE Carlisle, PA 17013 COUGHLAN ELIN Estate File No. : Paid By Remarks: 2004-00772 C E COSTELLO VZ Fee/Tax Description PETITION FOR PROBA SHORT CERTIFICATE EXTRA PAGES JCP FEE Check# 1294 Total Received......... Receipt Date: Receipt Time: Receipt No. : 8/19/2004 10:55:53 1037579 Receipt Distribution ------------------------ Payment Amount Payee Name 60.00 18.00 12.00 10.00 ---------------- $100.00 $100.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D ~ ~ 33 ~ ~~ CUMBERLAND LA W JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, P A 17013 October 1, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Michael Cherewka, ESQUIRE Elin Coughlan, ESTATE RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. ------------------------------------------------- ---------------------------------- ------------ Advertisement inserted on following dates: SEPTEMBER 10,17,24,2004 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 $ 0.00 Payment received Total Amount Due $ 75.00 ------- ------- Payment received by REV.1512 EX+'\12-(3) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Coughlan, Elin W. FILE NUMBER 21-04-0772 Report debts Incurred by the decedent prior to death whIch remaIned unpaid as of the date of death, Including unrelmbursed medIcal expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sprint Telephone 20.25 2. Chapel Point Nursing Facility 1,213.20 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,233.45 Sprmt@ Monthly statement: July 10, 2004 10f 5 Customer service 1-800-829-8009 Internet address sprint.com/local Customer number 717-241-2707-775 Summary of Current Charges Local long Distance Total Partial Month Charges -9.63 .00 -9.63 Other Charges and Usage .21 1.51 1.72 Taxes and Surcharges .20 -.08 Previous charge~ 28.24 _00 Payment Past due balance -....--....-.-..--..---.,. Total charges due:. 28.24 ~~ . ...E:iJ .........,m._...'.____._n......._...._n._n......._n.....__n....'.......___..... Past. due amount --:. Please pay immediately ...__...__.._....._n..._n... __n_...,_....'......_.....___...,._...___.___............._,. .,-",-."-...-.......",-",--,,-...-----...,,,.,-.........n._n._.__'......__.....m........._._n.."......n...__.____,............_._n..._n._. -.,......--.--........... ......--.-.- .....-.-.---.........--.-.-..---......--.--........ - { C7'yA 1, J qC1. If. d \ "D-' II t * Please recycle NNNNNYYY 5 A~~_ ."'...,.,J.,........ ":'T'l4't;~>"l! IJl~~)~1~ 770 S. HANOVEi CARLISLE, PA I. (717) 249.136 DATE ~\/ 1B/2O')1214. 1 ../ .::~: t/ ~:~~ li1 I(j '~r 1- ./ ;\ j, .I ;:~ :!.)!;~'!.4. 4-/ 3(Z!./;.:~I~:.'!ILl..:} ::. 3i:..':1/~?Q)jZlil, ./ I?! 1--. (:. (:' / 1. f:.. /01---'4)6/3!Z1 ~:, / J b ./ Z~l2lel.!1 :,:, / :l. 6 /" E:i))(~il' 120 DAYS d !;~!0 J:'!lIW. at Co Hi I,). CDU'3HUil',.1 .ISTfClNCE CD:;:TCLLD ":3 t.;r.JLNl.JT ST d lDYl,IE~ pr~ 17~~ll+:?; .: EL I " hi. CDUGHU:IN C:IJ.E:"'''I:\ - DETACH AND RETURN UPPER PORTION WITH REMITTANCE- DESCRIPTION "-"trice F:u)'~vl<.::;.'('rJ ~ P~1T REC'D J~ IC}:"~L SUPPLY ';'ISt'lL CnNNULP j" : () r enL. ~3UP;::)t_ y . I~BULIZElm f~ :-\ [ C{.:jL SUPPLY' :1:1c;m. CrclNNUL.H I"; J: CAL SUPPL Y <;!:::BULI ZEF~;3 '!I-PRIVATE ROOM @ 5179a00 , "'IT .'PH I ViyrC RDDM ", .:~ 17'). 0\) "I' (.:)\lE~POHTf-iT ION C:1:~l~.ISLE HDSPITrlL F IDENT ESCORT SERVICE c:", _ISLE HOSPITAL 10:30-12~30 F" <,': EL I N \,,1. CfJUGHL.f.1r.1 01i::>--B 'HI DAYS " eu;~ 60 DAYS " \,,0 30 DAYS . ~)0 DEBIT ,..J., '11 '3 N E:!/..l 9" ,.:,f:::, J n ~,d:\ 6" ;::..<.~ ;::::, 86-4." Qi~~l 3" "lei c~E\ ~ illiZI CURRENT ~::~1 Lj.756" 3f:o- 7,9 TOTAL DUE STATEMENT DATE (./I}../ IZl i /;=~lZ!liJA. TOTAL AMT. DUE i~;56. 3f.,-'- CREDIT BALANCE 3~ 719 ~ ~~:~el--. 3 ~ ~?~. \). ;::~f;) .-,(!)i2i H 7E~ 10~ J A. 1- :i. " 7~:j J. -)'" 9"::~ ~::.::., 88t" 9.4 5,3.70..00- 2,488.06- ;~?,. l}[1.iJ." 36-~ E:~ .4~;~ib" 36.", ~ '\ C~'J L~564 3f,,'~. DATE DESCRIPTION DEBIT CREDIT BALANCE '"?'<:". J.nL:~' (.2 V.I ."::, L: OC' : ,;::" ,,,' ,-"', ,.., .'" ... ,n..".,.,.,_, r',:.,--"', ,-'i',."';" ':;C ...,.j,'- "",." ;"':;;;',,::) (:.;::::..)1:::: "",","1.1;::,' ,.,.... i.:"'":'i j..'J'1 ;;::'~::./ ,;).,~: ...., .. -c. l~" '~', ;:::':' \/ :: :~~ !._ " rlc,:Y'J ;-" C;t;Zl: .(:V.:V! ('J:.) ," """ r"" .;"::.}\ pnfi)i:~)"i j.-'('\ ~~~~lM0IZ' ? ~.._l.I~Ci-- ?t'::' :::'i/;!rJ"+ rF{('j!,,!:.::;por'~-rp,"(" ":i\j :,."7D: " , .,:',d." ~ l'-i(}:~;C 'T(iL ::., ~. t"-'j;' . ",., .i;-'::::.'.- -::;.) !"-"iEI)] c:nPF "7 C. 6" ',~:,~1Z[ ~:';Ii"i..,..,.... ....,.,..,...~ '''-'~! "'H"'L-::'{~J , i l?' ::3[:1'11 --.PF: '.' {-,"ce' "','-",.. :':-;U":ii'i' ,. ~ii() '::.' ";; ..;; C~" ;::'l~;:\ r \! cb"v. '" \0- t; \0 \0\ \ i'~- 0 ',.- ~ ELI;..J ., COU13HL,.l:~f..1 Ii! 1 ~:::- .p ~<" ~ 120 DAYS 90 DAYS 60 DAYs 30 DA Y$ CURRENT TOTAL .. 12HZ! .. 1l1,ID .. ~:l!Z1 ~~i>ZI .. 719~ ~~el DUE ~ . -7 ~ c, :~~~~l .~, ....;1 f .J. ~, , '~~~ ",.,",>1, R"EV.1513 EX~ (9-00) .. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Coughlan, Elin W. FILE NUMBER 21-04-0772 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Soc. 9116 (a) (1.2\1 1. Constance E. Costello, 1023 Walnut Street, Lemoyne, PA 17043 Daughter 25.00 2. Patrick D. Coughlan, 1000 Majestic Acres Rd., Linden, TX 75563 Son 25.00 3. Michael E. Coughlan, Post Office Boz 1240, Citrus Heights, CA 95611 Son 25.00 4. Carolyn R C. Petty, 1620 Belinda Way, Sacramento, CA 95822 Daughter 25.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MAOE B. CHARITABLE ANO GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Inventory of the real and personal estate of Elin W. Coughlan , deceased 1. No Probate Assets 0.00 r",'; 0.00 ~d~wm Commonwealth of Pennsylvania ss County of Cumberland r.nn"t~nrp R r.n~tpl1 n being duly sworn according to law, deposes and says thatshe is the Executor of the Estate of Elin W. r.nllghlan , late of Hampden Township, Cumbl'rland County, Pennsylvania, deceased and that the within is an inventory made by Constance E. Costello, the said Executor of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent its fair value as of the date of decedent's death. Sworn and subscribed before me, r:~CP r ~ Executor - Administrator Mar:ch 24, ,2005 Address Date of Death lilth Day June Month 2004 Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personality or reality. 4. See Article IV, Fiduciaries Act of 1949. ~ OJ ~ OJ <.J OJ e'S "Cl CI ~ " <t:" OJ OJ <ll OJ o..rg .-< p.., ~ 0 .<:: i ~ OJ 0 '" 00 p.., ~ o;9>1::~ ::l <ll 0 ~ ,,""]0; u ~ N ~ Oo~ 0 OJ .... U ... .... "'~ :3 OJ 0 ~~ .<:: I ... " u '" .r< "Cl 0 .-< " .-< I '" <ll OJ .-< """ .-< <ll N ... .<:: 0 OJ ~ ~ u 0 OJ .0 OJ 0 'r< .. g - 0 ::<: .~ Z ....:I u ~ fA ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1l62 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CHEREWKA MICHAEL 624 NORTH FRONT STREET HARRISBURG, PA 17043 unnn fald ESTATE INFORMATION: SSN: 579-14-7769 FILE NUMBER: 2104-0772 DECEDENT NAME: COUGHLAN ELlN DATE OF PAYMENT: 04/07/2005 POSTMARK DATE: 04/07/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/17/2004 NO. CD 005173 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,003.01 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 101 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $1,003.01 GLENDA FARNER STRASBAUGH REGISTER OF WillS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Elin W. Coughlan Date of Death: June 17,2004 No. 21-04-0772 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether the administration of the estate is complete: --X- Yes No 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: If the Answer is "Yes" to No.1, state the following: a. Did the personal representative file a final account with the Court? Yes --X- 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? --X- 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. Datef'" May 16, 2005 I.>J THE LAW OFFICES OF MICHAEL CHEREWKA ~~. By: Michael Cherewka, Esquire Capacity: _ Personal Representative ~ Counsel for Personal Representative ~ \ ' \ L i j j II @: '., ~J '.....') - ~ C:' I-<~ 1 \ _ 1 ,-./ ~ ~ \0 -', / .~~. ~ ('.1 in t:,) i') '. '. f,:i or'J "., I.~ r'" .".f - 1 .;_'__1 ~ >>- Q !:i']!J:IUd ~ ~ --- 1 r. 4.r ~~! -) 9 Z -lilr SOOl 20"-:~~~RTt~FI: 03 ~~~~~~~~05 ~~r~./9f: DEATH 06-17-2004 FlI:,"~'~~",~~ 21 04-0712 COUNTY" CUMBERLAND ACN 101 APPEAL DATE: 09-10-2005 ( See reverse side under Objections) Amount Remitted I z. aq I 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:is47-ix-AFP-io3:osj-NoTIcE-OF-INHERiTANCE-TAX-APPRAIsEMENT:-ALLowANcE-oi--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ELIN W FILE NO. 21 04-0772 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIOH PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF ,"JNH~:t-TAHe1tr'\iAlc- nc. APPRAISEMENT, ALLOWAi(CEi-cm"tfisAlt.OWANCE OF DEOUCTIONS Atm. AS"$'Essti$Ni;}Q()"AX MICHAEL CHEREWKA ESQ M CHEREWKA LAW OFFICES 624 N FRONT ST WORMLEYSBURG c PA 17043 ESTA TE OF COUGHLAN REV-1547 EX AFP (06-05) ELIN W TAX RETURN WAS: I x) ACCEPTED AS FILED ) CHANGED DATE 07-12-2005 NOTE: IT an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reTlect Tigures that include the total of Cbh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 22,289.09 X 045 = 1,003.01 .00 X 12 '" .00 .00 X 15 = .00 (19)= 1,003.01 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A)- 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest ISchedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers ISchedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 27,270.76 .00 un APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens ISchedule I) 11. Total Oeductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 3,748.22 1.233.45 Ill) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 27,270.76 4.981 67 22,289.09 .00 22,289.09 TAX CREDITS: ,-,,,,...::" , ,,~" I+T AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-07-2005 CD0051T5 .00 1,003.01 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-08-2005 TOTAL TAX CREDIT 1,003.01 BALANCE OF TAX DUE .00 INTEREST AND PEN. 2.89 TOTAL DUE 2.89 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CO 005614 CHEREWKA MICHAEL 624 NORTH FRONT STREET HARRISBURG, PA 17043 ACN ASSESSMENT AMOUNT CONTROL NUMBER ____un fold ---------- ----.--- 101 I $2.89 ESTATE INFORMATION: SSN: 579-14-7769 I FILE NUMBER: 2104-0772 I DECEDENT NAME: COUGHLAN ELlN I DATE OF PAYMENT: 07/26/2005 I POSTMARK DATE: 07/25/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 06/17/2004 I I TOTAL AMOUNT PAID: $2.89 REMARKS: CHECK# 2303 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS BUREAU OF INDIVlnlIC~ CFRCE CT INtERITANCE TAX DIVISIQN,-,....,;~,"t.:-.." ,'_" PO BOX 280601 '-<r-I,-!I' 1,___: . HARRISBURG PA 17128-0601 ~ .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-16D7 EX AFP (03-05) cn~~' MICHAECCAEREWKA ESlI "- M CHEREWKA LAW OFFICES 624 N FRONT ST WORMLEYSBURG PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-22-2005 COUGHLAN 06-17-2004 21 04-0772 CUMBERLAND 101 ELIN W ZDQ5 we 30 Pi! l:: 27 A.aunt leni tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, sub.it the upper portion of this forn with your t.x paynent. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS - --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF COUGHLAN ELIN W FILE NO. 21 04-0772 ACN 101 DATE 08-22-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-12-2005 PRINCIPAL TAX DUE: 1,003.01 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (- ) 04-07-2005 CD005173 .00 1,003.01 07-25-2005 CD005614 2.89- 2.89 TOTAL TAX CREDIT 1,003.01 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER TNIS DATE, SEE REVERSE TOTAL DUE .00 . ~ SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIY" (eRl, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )