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Home My WebLink About03-0433PETITION FOR PROBATE and GRANT OF LETTERS Estate of Dorothy Sagman also known as Social Security No. Deceased. 068-10-653'2 No. To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated and codicil(s) dated in the named February 17 , 19 99 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with er last family or principal residence at 100 Mt. Allen Drive. Upper Allen Township (list street, number and muncipality) Decendent, then 85 years of age, died March 29 , ~9;__Z0.0_3__, at Messiah Village. 100 Mt. Allen Drive. Mechanicsburg. Pennsylvania . 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. request(s) the probate of the last will and codicil(s) to_ ~ t~amo_n r~ ry (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) :~ ~ Edie (Edith)/ Genden ~.~ (a/k/a Edie or Edith Hamilton) ~ 644 Valley View Dr~ve ~. Boiling Springs. PA 17007 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA '/. ss COUNTY OF Ctr~ERLA~D 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 administerxthg/gstate according to law. Sworn to or affirmed and subscribed ~~/~/~~(~~)~~ .~ before me this ~ ~ day of /fa/tl . ~n~//~ Reg~t~'~ No. p~ -o~-433 Estate Of DOROTHY SAGMAN ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS MAY 27th AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 17. 1999 described therein be admitted to probate and filed of record as the last will of Dorothy Sagman and Letters Testamentary are hereby granted to Edie (Edith) G~nd~n.. a/k/n l~.dl~ or Edith ~R_Z//~, in consideration of the petition on FEES Probate, Letters, Etc .......... $ 115.00 Short Certificates(3) .......... $ 9.9YO~ 0 xg~?.,__~di~:iO~ .~xl:r~, .page. a .5 $ 15.O0 Jc? $ ~.oo TOTAL __ $ 149.00 Filed ...1,~..Y..2 7.,. 2.0.Q3 ................... Registe~ or'ih - Bridget M. Whitley, q~33580 ATTORNEY (Sup. Ct. I.D. No.) Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108-1963 ADDRESS (717) 255-8027 PHONE PETITION FOR PROBATE and GRANT OF LETTERS Estate of Dorothy Sag~man also known as Deceased. 068-10-653'2 Social Security No. No. To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last wilt of the above decedent, dated February 17 and codicil(s) dated in the named , 19 99 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumher'l and County, Pennsylvania, with er last family or principal residence at 100 Mt. Allen Drive, Upper Allen Township (list street, number and muncipality) Decendent, then 8 5 years of age, died March 29 , ~9._.2.0_03~, at Messiah Village. 100 Mt. Allen Drive. Mechanicsburg. Pennsylvania . 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ~'g~ 000 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. request(s) the probate of the last will and codicil(s) ~- e.q ~- amen t:ary {testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Edie (Edith) Genden (a/k/a Edie or Edith Hamilton) 644 Valley View Drive Boiling Springs. PA 17007 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF Cmq3F. RL~qD The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 19~day of Register Estate Of DOROTHY SAG~ , 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 February 17. 1999 described therein be admitted to probate and filed of record as the last will of Dorothy Sagman and Letters Testamentary are hereby granted to Ed~a (Edith) Gmndmn_. n/k/m F.d~o nr g.d~-h t~_Z0_03, in consideration of the petition on FEES Probate, Letters, Etc .......... $~ Short Certificates(3) .......... $ q.0h Renunciation ................ $. $. TOTAL ~ $ Filed ................................... Register of Will~ Bridget M. Whitley, q~33580 ATTORNEY (Sup. Ct. I.D. No.) Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108-1963 ADDRESS (717) 255-8027 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. [~,~/'('C'~'~~~l'~--="\ Local RegistNr {/ Date TYPE/PRItel PERMANENT BL ACK INK 85 v,,. 1 Cumberland COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Dorothy Sagman :x Female JT'*~lr~E~""'~"uM~ -- 9463 · Aug10 1917 New York ~n ...... ~ ~.n .,~-,e ~, i I,- I,. I~ ......... I~ u ~=~ ,~,u Upper Allen Twp.I ..... , '~' fite Own Ho~ j us EO ~s? I m~w~.~~ I ~.w~ I 100 Mt. ve Te,~. MechanJcsburg, Pennsylvania 1705~.,~.~.~ Cumberland ,w..,. m~--. . J I~THER'S~iF..,~,M~ Celia Blickstein '~s~~'~'~i~priogs, PA 17007 =~ Conolite Cremato~ Schae~erstown, Apr 1,2003 Pa. 17088 FD-012662-L J~~uner~l~, Inc. 37 East Main Street Mechanicsburg, Pa 17055 I~. I~. --~ :'::::::.~.~-~---~=-=~.~,~.,. ~.~.~o,~.~.~.,~.~,.~.~.,,..~1610 - o3 J ~N RE TI E OF TIFI£R 'MEDICAL EXAMINER/CORONER On Ihe baei~ o! e=emln&tlon &nd/o! tnveMIgatien, in my opinion de~lh occurred ~! Ihe lime, dale. and place, and due to 21-03-433 21-03-433 LAST WILL AND TESTAMENT OF DOROTHY SAGMAN I, DOROTHY SAGMAN, of Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I direct my Executor to pay out of my residuary estate my legally enforceable debts and the expenses of administering my estate. SECOND: I give my tangible personal property and all casualty insurance that I am carrying on said tangible personal property to my daughter, Edie (Edith) Genden (also known as Edith or Edie Hamilton), or, if she does not survive me, I give said property to my nieces, Sara Klein and Hannah Klein, to be divided equitably among or between them as they may determine, or, if they are unable to agree, as my Executor shall determine, at~er considering the wishes of such beneficiaries. I have complete confidence that my daughter and my nieces, or my Executor will honor any written instructions that I may leave with regard to said tangible personal property. Any such property not so distributed shall be sold, and the proceeds added to my residuary estate to pass as herea~er described. THIRD: I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, absolutely in fee simple to my daughter, Edie (Edith) Genden (also known as Edie or Edith Hamilton), if she shall survive me. If she shall not survive me, then I give, devise and bequeath all of the property to my nieces, Sara Klein and Hannah Klein, in equal shares, or to the survivor of them. -1- FOURTH: If all the beneficiaries described in Article Third above are deceased and no other disposition of the residue of my estate is directed by this Will, then and in that event only, I give, devise and bequeath such rest, residue and remainder of my estate, real and personal, to those persons living at the date of my death who would be my heirs, their identities and respective shares to be determined in accordance with the law in eff'ect in the Commonwealth of Pennsylva- nia at. my death, as if I had died intestate. FIFTH: If any person under the age of twenty-one (21) years shall become entitled to any share hereunder, then such share shall immediately vest in such beneficiary, but notwithstanding the provisions herein, my Executor may distribute such beneficiary's share to any adult person standing in loco parentis, or to a legal guardian of such beneficiary, or to a custodian (to be selected by my Executor) under the applicable Uniform Transfers to Minors Act, without requiring bond of such adult person, guardian or custodian. The receipt of such adult person, guardian or custodian shall constitute a full release of my Executor for any property so distrib- uted. SIXTH: No person shall benefit hereunder unless such beneficiary shall survive me by thirty (30) days. SE~NTH: (1) I name my daughter, Edie (Edith) Genden (also known as Edie or Edith Hamilton), as my Executor. If she is unable or unwilling to serve, I name my nephew, Michael Klein, as my Executor. I direct that my Executor, herein referred to as my Executor regardless of number or gender, serve without bond in any jurisdiction in which called upon to act. -2- (2) Except as otherwise provided herein, if all of the above persons should fail to qualify as my Executor hereunder, or for any reason should cease to act in such capacity, the successor or substitute Executor shall be some qualified person, including an attorney, accoun- tant, trust company or bank with trust powers, which successor or substitute Executor shall be designated by the court having jurisdiction over the probate of my estate.- (3) My Executor shall receive reasonable compensation for services rendered. EIGHTH: (1) I give to any Executor named in this Will or any Codicil hereto or to any successor or substitute Executor all of the powers enumerated in this Will and all of the powers applicable by law to fiduciaries in the Commonwealth of Pennsylvania and in particular through the Pennsylvania Probate, Estates and Fiduciaries Code, as eff?ctive and as in effect on the date of my death, during the administration and until the completion of the distribution of my estate. I direct that all such powers shall be construed in the broadest possible manner and shall be exer- cisable without court authorization. (2) My Executor is authorized and empowered to acquire and to retain, either permanently or for such period of time as my Executor may determine, any assets, including the capital stock of any closely held corporation, whether such assets are or are not of the character approved or authorized by law for investment by fiduciaries and whether such assets do or do not represent an overconcentration in one investment. (3) My Executor is authorized and empowered to disclaim any interest, in whole or in part, of which I, or my Executor, may be the beneficiary, devisee, or legatee, by executing an -3- appropriate instrument (in accordance with section 2518 of the Internal Revenue Code of 1986, as amended, or such similar section as may then be in effect). (4) My Executor is authorized and empowered to sell at public or private sale, or exchange, and to encumber or lease, for any period of time, any real or personal property and to give options to buy or lease any such property. Additionally, my Executor is authorized and em- powered to compromise claims, to borrow from anyone (including a fiduciary hereunder) and to pledge property as security therefor, to make loans to and to buy property from anyone (including a fiduciary or beneficiary hereunder); provided that any such loans shall be adequately secured and at a fair interest rate. (5) My Executor is authorized and empowered to allocate property, charges on property, receipts and income among and between principal or income, or partly to each, without regard to any law defining principal and income. NINTH: All estate, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the residue of my estate, as if such taxes were expenses of administration, without apportionment or right of reimbursement. I authorize my Executor to pay all such taxes at such time or times as deemed advisable. -4- IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament this ?,.?,/ dayof ~..~ ~.c.~_~. , 1999. D OROTHy~S'/A~ (SEAL) SIGNED, SEALED, pUBLISHED, and DECLARED by DOROTHY SAGMAN, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -5- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. WE, DOROTHY SAGMAN and ar~agee M. w~e~ey , Patr±c±a D. Olyarn±k , and , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (willingly directed another to sign for her), 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, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. DOROTHY/SAGMAN, Testatrix Witness Subscribed, sworn to, and acknowledged before me by DOROTHY SAGMAN, the Testatrix, and subscribed and sworn to before me by Br±dget M. Wh±tle¥ Patricia D. Olyarnik and tls 17th day of February , witnesses, ,1999. -6- IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Dorothy Sagrnan, deceased, TO: Edie Genden 644 Valley View Drive Boiling Springs, PA 17007 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Dorothy Sagman, died on the 29th day of March, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is Edie Genden, 644 Valley View Drive, Boiling Springs, PA 17007, (717) 241-5513. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: June2,2003 & ,~d~'~- d)~/~/~-~ Bridget 1M. Whitley, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 244-8027 Capacity: Counsel to Personal Representative CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Admin. No.: To the Register: Dorothy Sagman March 29, 2003 21-03-0433 I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on June 2, 2003: Edie Genden, 644 Valley View Drive, Boiling Springs, PA 17007 Notice has now been given to all persons entitled thereto under Rule 5.6(a). ~ Whitley, Esq. Date: June 2, 2003 ' ~ ~ Keefer Wood Allen & Rahal, LLP P.O. Box 11963 Harrisburg, PA 17108-1963 Capacity: 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 003376 WHITLEY BRIDGET M KEEFER,WOOD,ALLEN & RAHAL P. O. BOX 11963 HARRISBURG, PA 17108-1963 ........ fold ESTATE INFORMATION: SSN: 068-10-6532 FILE NUMBER: 2103-0433 DECEDENT NAME: SAGMAN DOROTHY DATE OF PAYMENT: 1 2/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,374.45 TOTAL AMOUNT PAID: $3,374.45 REMARKS: EDIEGENDEN C/O BRIDGET WHITLEY ESQUIRE CHECK# 0928 INITIALS: VZ SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS HEATH L. ALLEN N. DAVID RAHAL CHARLES W. RUBENDALL ROBERT L. WELDON EUGENE E. PEPINSKY, ,JOHN H. ENOS 1-r'r GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE ,JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. LEWlSTIT BRIDGET M. WHITLEY JOHN A. FEICHTEL ANN MCGEE CARBON ELIZABETH ,J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEeFER WOOD ALLEN & RAHAL, 210 WALNUT STREET P, O, BOX 11963 HARRISBURG, PA 17108-1963 PHONE (717) ;~55-8000 EIN No. 23-0716135 www. keefe~Nood,com December 30, 2003 Donna M. Otto Deputy Register of Wills Cumberland County 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Dorothy Sagman 2003-0433 LLP ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY WEST SHORE OFFICE: 415 FALLOWFIELD ROAD CAMP HILL, PA 17011 I?17] 612-5800 WRITER'S CONTACT INFORMATION: (717)255-8027 E-mail Address: bwhitley~keeferwood, com Dear Ms. Otto: Enclosed for filing please find two copies of the Pennsylvania Inheritance Tax Return and one copy of the Inventory, together with a check in the amount of $25, in payment of your filing fees. I also enclose a copy of the receipt from the Pennsylvania Department of Revenue, indicating that the tax due with the return was paid on December 26, 2003. Please confirm this filing by date stamping the enclosed confirmation copies. I have provided a self-addressed, stamped envelope for your use in returning the confirmation copies to me. Thank you for your assistance in this matter. Very truly yours, KEEFER WOOD ALLEN & RAHAL, Lt~P By /~~O~ ~ ~~ Bridget M. Whitley Encl. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE 'FAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003376 WHITLEY BRIDGET M KEEFER,WOOD,ALLEN & RAHAL P. O. BOX 11963 HARRISBURG, PA 17108-1963 ........ fold ESTATE INFORMATION: SSN: 068-10-6532 FILE NUMBER: 2103-0433 DECEDENT NAME: SAGMAN DOROTHY DATE OF PAYMENT: 1 2/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,374.45 REMARKS: TOTAL AMOUNT PAID' EDIE GENDEN C/O BRIDGET WHITLEY ESQUIRE CHECK# 0928 INITIALS: VZ 93,374.45 SEAL " RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF: WILLS TAXPAYER REV-1500 EX (6:00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 2806O1 HARRISBURG, PA 17128-0601 REV-1500 FILE NUMBER 21 COUNTY CODE USE ONLY INHERITANCE TAX RETURN RESIDENT DECEDENT -- 03 0433 YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Sagman, Dorothy 068-10-6532 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEAR THIS RETI. J~N MUST BE RI.ED IN DUPUCATE WITH THE 03/29/2003 08/10/1917 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER z Z X I- ~ 1. Odginal Return --]4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) [--~9. Litigatio~ Proceeds Received b.__J 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-1382) [----] 4a. Future Interest Compromose (date of death after 12-12-82) [~ 5. Federal Estate Tax Return Required [~ 7. Decedent Maintained a Living Trust (Attach copy of T~Jst) __0 8. Total Number o~ Sa~e Deposit Boxes ~ 10. Spousal Poverty Credit ((~ate of oeam ~etween ~ 2-3~-91 and ~-~-S5) [--'"1 I 1. Election to tax under Sec. 9113(A} (^.a~ s~ o) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME i COMPLETE MAILING ADDRESS Bridget M. Whitley FIRM NAME (If Applicable) Keefer Wood Allen & Rahal, LLP TELEPHONE NUMBER 717-255-8027 P.O. Box 11963 Harrisburg, PA 17108-1963 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Sank Deposits & Misc~lanecus Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) r"--] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 0.00:. 0.00 0.00 43,480.21 27,157.71 13,910.66 0.00 USE ONLY (8) 84,548.57 4,579.00 4,981.82 (11) 9,560.82 74,987.76 0.00 74,987.76 (12) (13) (14) 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) 0. 00 x.00 (15) 16. Amount of Line 14 taxable at lineal rate 74,987.76 x.045 (16) 17. Amount of Line 14 taxabte at sibling rate 0,00 x.12 (17) 18. Amount of Line 14 taxable at collateral rate. 0, 00 x .15 (18) 19. Tax Due (19) 0.00 3,374.45 0.00 0.00 3,374.45 · · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH 2W4645 1000 Decedent's Complete Address: STREET ADORESS c/o Messiah Village 100 Mt. Allen Drive CITY Mechanicsburg ziP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 0.00 0.00 0.00 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 3~374.45 0.00 0.00 3,374.45 If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3 / 374.45 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 the right to designate who shall use the property transferred or its income; ......... [~] ~ c. retain a reversionary interest; or ................................ [~] ~ d. receive the promise for life of either payments, benefits or care? ................. ~ ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ ~ E~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [~1 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ r---I ~ 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 perjury, I declare that I haw examine,3 this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and compJete. Declaration of preparer o[nel{ than the personal representati~ is based on all information of whic~ preparer has any knowledge. SIGNATUJ~E OF PERSONIRESPONSIBLE FOR FILING RETURN ADORL:~-~ ~44~va£1ey- ~;~lew Dr~ve Boiling Springs, PA 17007 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE · ~ ' Rahal, .oo Harrisburg, PA 17108-1963 LL P.O. Box 11963 DATE 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.§ 9916 (a) (1.1) (i)]. For dates of death on or after Jan uary 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of 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 § 9116(a)(1.2)]. The tax rate imposed on the net value cf transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S, § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2w4646 1000 REV-1507 EX * (1-97) COMMONWEAL'IH OF PENNSYLVANIA INHERITANCE TAX RETURN I:a=--,S~DENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Sagman, Dorothy 21-03-0433 All property jointJy-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT NUMBER CESCRIP'I'ION DATE OF DEATH 1. 43,480.21 Demand Loan made to Michael R. Klein Face amount $25,000 Annual interest, payable quarter @ 7.5% Accrued interest: $18,480.21 TOTAL (Also enter on line 4, Recapitulation) $ 43,480.21 2W46AC 2000 (if more space is needed, inse~t additional sheets of same size) Rl~V-1508 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sagman, Dorothy 21-03-0433 Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinl]y-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Merrill Lynch CMA Money Fund Account Personal effects 26,907.71 250.00 27,157.71 TOTAL (Also enter on line 5, Recapitulation) $ 2W46AD 2.000 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (1-97) COMMONWEALTH OF PENNSY1LVANIA II~FERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Sagman, Dorothy 21-03-0433 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 ADDRESS RELATIONSHIP TO DECEDENT A. Genden, Edie Daughter 644 Valley View Drive Boiling Springs, PA 17007 JOINTLY-OWNED PROPERTY: u=, ,~.~ DATE DESCRIF"r]ON OF PROi-,t=i~ I ¥ % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution a~d bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET INTER~ST [~=C-E-nENT'S INTEREST 1. A 01/19/1999 Citizens Bank Checking 27,821.31 50.00 13,910.66 Account No. 610062-764-0 TOTAL (Also enter on line 6, Reca@itulation) $ 13,910.66 2W46AE 2.000 (If more space is needed, insert additional sheets of same size) REV-1511 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA IhHF-RYTANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Sagman, Dorothy 21-03-0433 Debts of decedent must be reported on Schedule I. ffEM NUMBER FUNERAL EXPENSES: 5. 6. 7. DESCRIPTION Myers Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Name: Keefer Wood ~].len & Rahal, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Register of Wills, C~mherland County Filing fees for return and inventory TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 1,405.00 0,00 3,000.00 0.00 149.00 0.00 0.00 25.00 4,579.00 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1512 EX .- (1-97) COMMONWEALTH OF PENNSYLVANIA 11*4"IERITANCE TAX RETURN Fa=_SIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE L~BILITIES,& LIENS ESTATE OF FILE NUMBER Sagman, Dorothy 21-03-0433 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Pharmerica Holy Spirit Hospital Messiah Village TOTAL (Also enter on line 10, Recapitulation) $ 165.42 28.40 4,788.00 4,981.82 2W46AH 2.000 (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 Sagmar., Dorothy NUMBER NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Genden, Edie 644 Valley View Drive Boiling Springs, PA 17007 FILE NUII~ER 21-03-0433 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter AMOUNT OR SHARE OFESTATE 74,987.76 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 MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 is 2W46AI 1.000 (if more space is needed, insert additional sheets of the same size) ~, BUREAU OF INDIVIDUAL TAXES /NHERI'TANCE TAX D1~VIS/ON DEPT. 280601 HARRTSBURG, PA 171Z8-0601 BRIDGET M WHITLEY KEEFER ETAL PO BOX 11965 HBG CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX RE¥-IE;q7 EX AFP (0~,-03) o.~DATE OZ-2~-ZO04 ESTATE OF SAGHAN DATE OF DEATH 05-Z9-2005 FTLE NUHBER 21 05-0455 '0~ FE~ 27 P1 .~UNTY CUHBERLAND *ACN 1 O 1 Amoun~ Remi~ed PA 1710~%,~ ....... ~ DOROTHY HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SAGHAN DOROTHY FILE NO. 21 05-0455 ACN 101 DATE 02-24-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED { } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a {Schedula A) (1) 2. S~ocks and Bonds (Schmdula B) (2) 3. Closely Held S~ock/Par~nersh~p ]:n~res~ (Schedule C) (3) q. Mortgages/No,es Receivable (Schedule D) (~) E. Cash/Bank Dmposi~cs/Nisc. Personal Proper~:y (Schedule E) (S) 6. Joln~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~aZ Asse~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos:~s/Misc. Expenses (Schedule H) (9) 10. Deb:ks/Mortgage L~abili~gies/Liens (Schedulm T) (10) 11. To~al Deduc~ ions 12. Ne~ Value of Tax Re~urn 27z157.71 15z910.66 .00 .00 NOTE: To insure proper .00 cradi~ ~o your account, .00 submi~ ~he upper portion of ~h~s form wi~h your ~ax payment. (8) 4,579.00 13. 1~. NOTE: 84,548.57 4,981.82 (1;) 74,987.76 Chari~:able/governmen~cal Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0 Ne~ Value of Es~a~:a Sub~ec~ ~o Tax (lq) 74,987.76 Zf an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 reflect figures that lnclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aeoun~ of Line 1~ a~ Spousal ra~a 16. Aeoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e 17. Aeoun~ of Line 1~ a~ Sibling ra~e 18. A.oun~ of Lina lq ~axabla a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT RECEIPT D/SCOUNT (+J DATE NUNBER INTEREST/PEN PAID (-) 12-26-2005 CD00~$76 .00 (15) .00 x O0 = .00 (16) 7~,987.76 x 045= 3,374.45 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (~9)= 3,374.45 IF PAID AFTER DATE IND/CATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. AMOUNT PAID 3,374.45 TOTAL TAX CREDIT I ~,$74.4~ BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT [S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest an the estate is transferred an possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfut Class B (collateral) rate on any such futura interest. To fulfill the requirements of Sect[on Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TI P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, may be requested bv completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). AppZ[cations are available at the Office of the Register of Hills, any of the Z5 Revenue District Off[cas, or by calling the special Z4-hour enamoring service for forms ordering: 1-800-36Z-Z050; services for taxpayers e[th special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, ar disalloeance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ZB-iOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphansw Court. Factual errors discovered on this assessment should be addressed an writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable an the same manner and an the the same time period as you would appeal the tax and [fltarast that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 ail[ bear interest at a rate which wi1! vary from calender year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO3 are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea.~r Rate Factor 1982 ZOZ .000548 1987 9Z .00024? 1999 72 .000192 1983 162 .000438 1988-1991 11Z .000301 2000 82 .000219 1984 llZ .000301 199Z 9Z .000Z47 ZOO1 9Z .000247 1985 132 .000356 1993-1994 72 .OO019Z 200Z 62 .000164 1986 lOX .O00ZT~ 1995-1998 9Z . 000247 2003 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELIN{IUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payeant is made after the interest computation date shown on the Notice, additional interest must be calculated. ~ . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name ofDecedent: ~~.JAo 4. - Date ofDeath: ~ ';9, ~ oaS , Estate No.: 0(063 - 001(.3 3 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 ~h~r administration of the estate is complete: . Yes I3' 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 person~esentative file a final account with the Court? Yes 0 No 1:1 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No g 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. Date: :J-( 'f I ()5 I fL- !JJ.~ s{gnature~ - ---:at-J~(;e;'r )(. WlIlniT'y Name ["- fl.") 2/() tJaJ"..:f Sf/, /-/a17l.r6"'i /) (7/Df Address , 7/?) 15'j-Jbq elephone No. Capacity: !d P~onal Representative L5Counsel for personal representative cI Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2005 WHITLEY BRIDGET M KEEFER,WOOD,ALLEN & RAHAL P. O. BOX 11963 HARRISBURG, PA 17108-1963 RE: Estate of SAGMAN DOROTHY File Number: 2003-00433 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: 3/29/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ,~~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge cJ ... ,~ ~ ~ o Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 NameofDecedent ~~~ Date of Death: ~ ';'1. ~O~ ." Estate No.: 0( db j - Golf 3 ~ 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 ~h~r administration of the estate is complete: . Yes r!r 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.1 is Yes, state the following: a. Did the person~esentative file a fmal 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 represen~state an account informally to the parties in interest? Yes 0 No 1!1 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. &.- ~~ S{gJJ1!.tJJre ~ . ~ t.-t~G,g--r )1.. WIII'TJ., IT}' Name Date: :ll'f IOS 2/() tJaJlJD Sf/ f./A./'Yi':r6"? !.I (7/CJ( Address '7/7) 15's-iD21 elephone No. Capacity: Q ~onal Representative 1...!tCounsel for personal representative "'y{ If .J /'1--l1 {(c4t - orpl( tC{/( \) J