HomeMy WebLinkAbout03-0615PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Deceased.
Social Security No. ] ~ - g2~ - ~ 9/ ? _.%
Register of X¥ills for the
County of ()A~,tA
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
who is/are 18 years of age or older an the execut .~/<~/
inYourthe lastPetiti°ner(S)'wilt of the above decedent, dated l~)t ~ /'_5-;. / ~ ~-- ~
and codicil(s) dated
in the
named
,19 ~%
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (~ tx.,',~[c~t <L \ tXth ~\ t
h i ~ last family or principal residence at ~ ~ '~oo~ .~ ~t~, Pennsylvania, with
) (list street, number and muncipahty) ~
Decendent, th<n W [ yea~ofagg, died ~~ ~ , ~~,
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 f? 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 $ 7~; I S~ . CB ~
(If not domiciled in Pa.) Personal property in Pennsylvania ~ $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsyl~ia .
situated as follows: '~7~ ~o.~ ~,~ . ~ c ~m~,r3~u~
WHEREFORE, petitioner(s) respectfully re.ques~t(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administranon c.t.a.; admimstrauon d.b.n.c.t.a.)
theron.
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~,~,_2~e~.,c.~,_Z . f
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
be~°~_m% t his ""'D-~ 77~/~ g.~.~,~ ' _ ~'~
~Y~'/~~ l~egist~
/
Estate Of ~-~ I~ ~~-r-
DECREE OF PROBATE AND GRANT OF LETTERS
, Deceased
~,t2Y.2.~, in consideration of the petition on
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated~-~"'2~
described therein be admitted to probate and filed of record as the last will of
and Letters ~ E~-r%~ ~-5-~ ~-~
!
are hereby granted to ~-~k~, t~
FEES
Probate, Letters, Etc .......... $
Short Certificates( ) .......... $
twn ................ $.
TOTAL
Filed ~.~e~, .,~,,ve:;~.
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to-~[l~, will presented herewith
law, depose(s) and say(s) that
the testat , sign the same and that
request of testat in h presence
other subscribing witness(es)).
Sworn to or affirmed and subscribe be~e
me this ay of
Register
being duly qualified according to
present and saw
signed as a witness at the
presence of each other) (in the presence of the
(Name)
(Name)
(Address)
]~GI~'~R OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to. law, depose(s) an,d say(s)that
~.4/~ O~gQ_ familiar with the signature of L. /--oL~'~ ,
codicil
testat ~ of (one of the subscribing witnesses to) the ~ presented herewith and
~odicil
that ~ believes the signature on the ~ is in the handwriting of
to the best of .~ ~ ~ .~ knowledge and belief.
Sworn to or affirmed and subscribed before ~~~ .~~q
me~., ~ ~ ~ day of , (Name)
L,
(Address)
]'his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
l,ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9154539
No.
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
Fouat ,. XaleI" 193-24-7473 ,.April 24, 2003
Jul.15,1931". t, lheatfieldJ:,.~O. ,~o~..a DO, O J~o ..... ~
Roe L
71
Cumberland Silver Spring
erv~ce ~ecn. Office Supply
(Sae~. Ce~e~. mae, z~ Co~a~) [t.=O~utaT'S
330 Hogestown Road J^CTU^'
Mechanicsburg, PA 17050 o.~)
FATHER'S NAME (First. M~:~k~, Laal)
330 Hogesto~n Road
,,.. s.,, Pennsylvania
,m.c~w Cumberland
Wilbert Emerson Foust
Edna M. Foust
[] 'M~'~'~)_ 2 8_ 0 3
121b.
MOTHER'S NAME (F~lt, iVlid,~. Malde~ ~name}
,,. Matilda B. McClarren
In~,330 Ito~estown Rd., Mechanicsburg,PA 17050
I Woodlawn Mem. Gdns. Harrisburg, PA
4:15 P. U. ,~. April 24~' 2003
Occlusive Coronary Artery Disease
DUE TO (OH ~ A CONSEQUENCE OF]:
INAME AND ADDRESS OF FACILITY
~.Myer: FH, 37 E. Main St., Mbg.,
JCENSE N~ M=C,q OATE SIGNED
PA17055
..
. . ~ ~ -
LAST WILL kND TESTA/~ENT OF ROE L. FOUST
I, ROE L. FOUST, of the Township of Silver Spring,
County of Cumberland and State of Pennsylvania, being of
sound, and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and. Testament-,
hereby revoking and making void all former Wills by me at
any time heretofore made.
I direct the payment of all my just debts and
funeral expenses as soon as conveniently may be after my
decease.
Ail the rest, residue and remainder of my Estate,
real, personal and. mixed, whatsoever and wheresoever situate,
I ~ive, devise and bequeath unto my beloved wife, Edna M.
Foust, to her own use and benefit absolutely.
In the event, however, that my said wife should pre-
decease me, or should die at about the same time as I die, such
as in a disaster common to both of us, I direct that my Estate
be distributed in equal shares between my daughter, Connie $.
Foust, and my son, Leonard S. Foust.
LASTLY, I nominate, constitute and aDpoint my wife,
Edna S. Foust, to be the Executrix of this, my Last Will and
Testament. If she should predecease me, or for any other
reason be unable to act as such Executrix, or to continue to
act as Executrix, I appoint my son, Leonard S. Foust, to be
the Executor in her place and stead.
IN ~ITNESS W}~P~EOF, I have hereunto set my hand
and seal this 15th day of December, A. D. 1980.
(SEAL)
Signed, sealed~, published and declared by the
above-named ROE L. FOUST, as and for his Last Will and
Testament, in the presence of us, who, at his request
and in his presence, and in the presence of each other,
have hereunto subscribed our names as witnesses.
LAST WILL AND TESTAMENT
OF
ROE L. FOUST
GEORGE M. HOUCK
ATTORNEY-AT-LAW
NATIONAL BANK BLDG.
ME:CHANICSBURG, PA.
Name of Decedent:
Date of Death:
Will No.
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Admin. No.
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Nalne
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Signature
Name
Address
Telephone (']/~) Yf~'~ ~ ~ 7 7 ~
Capacity: ~'/Personal Representative
Counsel for personal representative
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Harrisburg District Office; Lobby, Strawberry Square, Harrisburg, PA 17128-010 }
Phone: (717) 783-1405 FAX: (717) 7834447 Web: www.revenue.state.pa.us
October 13, 2004
ESTATE OF: ROE L FOUST
DATE OF DEATH: 04-24-2003
FILE NUMBER: 21 03-0615/2004-28
(Please remit top portion with your payment)
EDNA M FOUST
330 HOGESTOWN RD
MECHANICSBURG, PA 17050
Dear EDNA M FOUST:
A review of our records has disclosed that you are responsible for the settlement of the above
estate, or that you represent the responsible party.
This is to advise you that the above estate is in a delinquent status. According to our records,
as of this date, the estate still is not settled.
The Inheritance and Estate Tax Act, mandates the filing of a tax return and payment of all
outstanding liabilities by a personal representative of the estate or a transferee within nine
months of the decedent's death. The Department's records show that this estate remains open
because:
AN INHERITANCE TAX RETURN HAS NOT BEEN FILED.
If the return has been filed it is important that you contact us immediately. If th/s estate was
opened for the purpose ora lawsuit, please contact this office in writing with the term and docket
number of the lawsuit so that we may postpone any further action.
We are extending a thirt~ day courtesy period from the date of this letter to permit you to file
the return. If you fail to do so, the Department of Revenue will make a formal demand on you or
your client and, if necessary, institute legal action.
MAKE CHECKS PAYABLE TO:
REGISTER OF WILLS~ AGENT
Any questions regarding this estate, please
CONTACT: BRIAN BEAM
(717) 783-1405
lA
Sincerely,
A1 Forlizzi
District Administrator
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500 OF..C,A'USEO.LY
INHERITANCE TAX RETURN F~LE.UM.E.
U.I
I'-
Z
UJ
UJ
DECED~NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEA'~ (MM-DO-YEAR) I DATE OF BIRTH (MM-DD-YF. AR)
4- 7.-4. I
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Fou '
~1. Original Return [] 2. Supplemental Return
[] 4. Limited Estate [] 4a. Future Interest Compromise tdam of~h a~r ~2-12~2)
~ 6. De~ect Died T~ta (A~ m~ ~ ~) ~ 7. Bamdent Maintained a Living Trust ~ ~ ~Tma)
~ 9. Lifiga~on P~eds Re~ived ~ 10. S~usal Pove~ Credit (da~ ~ ~th ~ 12-3~.9~ a~ ~-I~S)
FIRM NAME (llApp,cable)
TELEPHONE NUMBER
COMPLETE MAILING CDDRESS
1. Real Estate (Schedule A)
2. Stocks and Bands (Schedule B)
3. Closely Held Coq~oration, Partnemhip or Bale-Proprietorship
4. Mortgages & Notes Receivabta (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Prope~
(Schedule E)
6. Joinlly Owned Property (Sch6dule F) ~U..,?'t/[ ~/t vt. ~
[~] Baparata Billing Requested ('~ ~0 O,~ )
7. inter-Vivos Transfers & Miscellaneous Non-Pmbata Property
(Scheclule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. 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)
(f) ~
(3) "~
(4) ~
(5) ~ -
(7)
(9)
(lO)
/ ~'"7
'75-7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not baen
made (Schedule J}
14. Net value Subject to Tax (Line 12 mines Line 13)
(11)
(12)
(13)
(1,)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of Line 14 taxable aHhe spousal tax
rate, or transfem under Sec. 9116 (a)(1.2) ~ x .0 (15)
16. Amount of Line 14 taxable at lineal rate x .0 (16)
17. Amounl of Line 14 taxable at sibling rate x .12 (17)
18, Amount of Line 14 taxable at collateral rate x ,15 (18)
19. Tax Bus (19)
¢OUNPt CODE ~ NU~aE~I
SOCIAL SECURITY NUMBER
175 -~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
n-'] 3. Remainder Return (date ~' death pr~ to 12.13.82)
~']5. Federal Eststa Tax Retum Required
__ 8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (At~:t ach O)
OFFICIAL U,SE ONLY
RESIDENT DECEDENT
Decedent's Complete Address:
Tax Payments and Credits:
I. Tax Due (Page 1 line 19)
2. Cred[ta/Paymsnts
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + E~ + C ) (2)
3. Intsrest/Pena~ if applicable ..
D. Interest
E. Penalty
Total IntereslJPenalty ( D '~ E ) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter th~ interest on the tax due.
(SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the properly banstsrmd; .......................................................................................... []
b. retain the right to designate who shall use the proper~ transferred or its income; ............................................ []
c. retain a reversionary interest; or .......................................................................................................................... []
d. receive the promise for life of either payments, benetits or care? ...................................................................... []
2. if death occurred after December 12, 1982, did decedent b'ansfer prepar[y within one year of death
without receiving adequate consideretion? ......................................................................................................
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ..............[]
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? ........................................................................................................................ [~*'/ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
U~'~er penaJlie~ of pedu~y, I declare Ihat I have examined this return, including accompanying scheddas and statements, and to the best of my knowledge and ~elief, ~t is tree, correc~ and con'pints,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
SI~NAyURE OF ~E~ER ~ER THAN REPRE{ENTATIVE~ ~ ff~ DATE
For dates of dea~ on or after July 1, I~ and before Januaq 1, 1995, ~e tax rats imposed on Se cet value of ~nsfom ~ or ~r the use of the suwiving spoose is 3%
F2 gS. ~9~1S (a) (~.1) (i)].
For da~s of dea$ on or after ~nuaq 1, 1995, the ~x rat~ imposed on ~e net value of ~sfem to or ~r ~ use of ~o suwi~ng spouse is
The statute d~s cot exemot a ~ansfer ~ a su~iving spouse ~m tsx,_and ~e s~tu~q mquimmen~ for disclosure of asse~ and tiling a tax return am still appli~ble even
· e su~Mng s~use is ~e only beneficial.
For da~s of dea~ on or after July 1, 2000:
~e ~ rots im~sed on Se net value of ~ausfers from a deceased ~]ld ~en~ne yearn of age or younger at dea~ to or ~ ~ use of a natural parent, an adoptive pamn
or a sts~amnt of ~e child is 0% ~2 P.S. ~9116(a)(1.2)].
~e ~ m~ im~ed on the set va[us of tmnsfom to or for the use of the dec~nt's lineal bese~iaries is 4.5%, except as ~tad in 72 P.S. $9116(1.2) ~2 P.S. ~9116(a)(1}].
~e ~x rote imposed on the net valus of ~nsfem ~ or for the use of Se de~enfs siblings is 12% [72 P.S. ~9116(a)(1.3)], A sibling is defined, under Se~ion 9102, as a:
indi~duaI who has at least one parent in ~mmon wEh the de.dent, whether by bl~ or adoption.
COMMON1NEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property ~lntly-owned with right of survivorship must be disclosed on ~chedule F,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
This scheduid must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM kNCLUr~'~'EN~MEOFTHE~N~f:EF~E'TFEJRRELATIC~'E~IpTOOECEDENT~'NDTHE DATE~TRN~SFEP~ DATE OF D~TH DECD'S EXCLUSION TA~B~ VALUE
NUMBER VALUE OF ASSET INTEREST {~ ~)
TOTAL (Also enter on l[ne T, Re~pitulation) S / ~ 7 ~ ~Tff
(If more space is needed, insert additional sheets of the same size)
REV-3511 EX+ (12-99)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
I
FILE NUMBER ~"/2--
iTEM
NUMBE~:
5,
6.
7.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s).
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
__ Zip
Attorney Fees
Family Exemption: (if decedent s address Is not the same as claimant s, attach exp anat on
Relationship of Claimant to Decedent
. Zip ~ -) 0 ,.~'0
Probate Fees
Tax Return Preparer's Fees
AMOUNT
/5 ,oo
TOTAL (Also enter on line 9, Recapitulation $ '7 ~' -'/ ~, ~ ~D
(if more space is needed, insert additional sheets of the same size)
Myers Funeral Home, Inc.
37 East Main Street
Mechanicsburg, Pa. 17055
Boyd L. Myers Jr., Supervisor
(717) 766-3421
A STANDARD OF EXCELLENCE SINCE 1910
Tuesday, May 13, 2003
Mrs. Edna M. Foust
330 Hogestown Road
Mechanicsburg, Pa. 17050
Dear Mrs. Foust,
Thank you for selecting our funeral home to 'provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the services for:.
Roe L. Foust
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED $5,632.00
LESS: Credits granted 1,740.00 3~,~ *~
LESS: Total Payments 1,300.00
CURRENT BALANCE $2,592.00
Credits Granted: $1,740.0 Package Price Discount
Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days.
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
Boyd L. Myers Jr.
I, ROE L. FOUST, of the Township of Silver Spring,
County of Cumberland and State of Pern%sylvania, being of
sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament,
hereby revoking and making void all former Wills by me at
any time heretofore ~ade.
! direct the payment of all my just debts and
funeral expenses as soon as conveniently may be after my
decease.
Ail the rest, residue and remainder of my Estate,
real, personal and mixed, whatsoever and wheresoever situate,
I give, devise and bequeath unto my beloved wife, Edna M.
Foust, to her own use and benefit absolutely.
In the event, however, that my said wife should pre-
decease me, or should die at about the same time as I die, such
as in a disaster common to both of ~ls, I direct that my Estate
be distributed in equal shares between my daughter, Connie S.
Foust, and my son, Leonard S. Foust.
LASTLY, I nominate, constitute and appoint my wife,
Edna S. Foust, to be the Executrix of this, my Last Will and
Testament. If she should predecease me, or for any other
reason be unable to act as such Executrix, or to continue to
act as Executrix, I appoint my son, Leo~ard S. Foust, to be
the Executor in her place and stead.
Signed, sealed, published and declared by the
above-named ROE L. FOUST, as and for his Last Will and
Testament, in the presence of us, who, at his request
and in his presence, and i~ the presence of each other,
have hereunto subscribed our names as witnesses.
Waypolnt Brokerage Svc Inc
2450 Eastern Blvd.
York, PA 17402
' USA
U.S. Cleadng
010
2,643 001 OF 001
EDNA M FOUST
330 HOGESTOWN ROAD
HECHANICSBURG PA 17050-3120
WE ARE PLEASED TO CONFIRM THE FOLLOWING TRANSACTION
HANCOCK JOHN FINL SVCS INC
UNSOLICITED
1-013546
08/11/03 08/14/03 08/11/03 A6947}l 1 1
186-28-3862 285-27704 1 7 620
41014S106000 H006633 JI{F S-07
772 0
YOU SOLD
QUANTITY 210
PRICE 30.35000
PRINCIPAL 6,373.50
COMMISSION 94.00
CONFIRM FEE 1.00
S.E.C. FEE .30
SERVICE CHGE 4.00
NET AMOUNT 6,274.20
WAYPOINT BROKERAGE
2450 EASTERN BLVD
YORK, PA 17402
FOR THE ACCOUNT OF
285-27704 1 7
Redemption Date:
U.S. Savings Bond Transaction
Customer Copy
11/17/2003
Issue Redemption Backup
Series Denomination Date Value Interest Withholding
! EE $50.00 No / 1991 $50.82 $25.82 $0.00
Total: 1 Bond(s) $50.82 $25.82 $0.00
The interest earned on Series EE bonds issued on or after January
1990 may be wholly or partially exempt from Federal income tax
under the provisions of the U.S. Savings Bond Education Benefit
Program. For further information concerning the benefits and
restrictions that apply, please contact the ];nternal Revenue
Service.
Allianz Life Insurance Company of North America
PO Box 59060
Minneapolis, MN 55459-0060
800/950-4036
Allianz
June 2, 2003
Edna Foust
330 Hogestown Road
Meehanicsburg, PA 17050-3120
Re: Roe L Foust, deceased
Policy Number: 52668 I2
FILE
Dear Mrs. Foust
We are sorry to hear of your recent loss. Please accept our sincere sympathies.
Listed below are the options available tO you as the named beneficiary:
l. Continue the Benefit Deposited with Interest Option. Continue receiving the monthly
interest payments until the last payment date of December 18, 2003. On that date you
would receive the accumulated benefit of $95,948.51.
2. Select the Spousal Option. The interest payments would be cancelled and the original
contract would continue in your name, accumulating interest at a competitive rate. This
option would also give you the time to decide upon a settlement option or the cash value'at a
future date. Please keep in mind that a future settlement option would begin a new payout
period.
3. Select an Alternative Annuity Option Settlement. Annuitize the contract receiving the
higher Annuitization Value of $95,948.51 · Please refer to the contract regarding ~ettlement
options and minimum payout periods.
4. Select the Guaranteed Benefit Account. Receive the reduced lump sum Cash Value in an
interest bearing account. See the enclosed question and answer sheet regarding this
program.
In accordance with IRS regulations, the policy must either be annuitized within one year from
the date of death or cashed out within five years from the date of death. Based on state
regulations, the policy proceeds must be claimed within two to five years from the date of death
or the proceeds may be paid to the appropriate state.
Please complete the enclosed Benefit Deposited with Interest Option Claim Form. Als0, please
attach one certified death certificate (must have raised state seal), and if available, a dated
obituary. Refer t° the Special Instructions Section for any specific requiremeuts necessary to
process your claim.
Please give this matter your PromlJtAttention and submit your claim forms as soon as possible.
Thank you, and again please accept our condolences.
Claims Examiner
C: Francis Gorman #14126
Allianz Life Insurance Company of North America
PO Box 59060
Minneapolis, MN 55459-0060
8001950-4036
Allianz
June 2 2003
.Edna Foust
330 Hogestown Road
Mechanlcsburg, PA 17050-3120
Re: Roe L Foust, deceased
Pohcy Number 2565293
FILE COPY
Dear Mrs. Foust
We are sony to hear of your recent loss.' Please accept our sincere sympathies.
Listed below are the options available to you as the named beneficiary:
1. Continue the Benefit Deposited with Interest Option. continue receiving the monthly
?
interest payments until the last payment date of:ts~a~ 18, _00.~. On that date you would
receive the accumulated benefit of $30,767.20.
2.: Select the Spousal Option. The interest payments would be cancelled and the original
contract would continue in your name, accumulating interest at a competitive rate. This
option would also give you the time to decide upon a settlement option or the cash value at a
future date. Please keep in mind that a future settlement option would begin a new payout
period.
3. Select an Alternative Annuity Option Settlement, Annuitize the contract receiving the
higher Annuitization Value of $30,767.20. Please refer to the contract regarding settlement
options and minimum payout periods.
4. Select the Guaranteed Benefit Account. Receive the reduced lump sum Cash Value in an
ihterest bearing account. See the enclosed question and answer sheet regarding this
pro,am.
In accordance with IRS regulations, the policy must either be annuitized within one year from
the date of death or cashed out within five years from the date of death. Based on state
· regulations, the policy proceeds must be claimed within two to five years from the date of death
or the proceeds may be paid to the appropriate state.
please complete the enclosed Benefit Deposited with Interest Option Claim Form. Also, please
attach one certified death certificate (must have raised state seal), and if available, a dated
obituary. Refer lo the Special Instructions Section for any specific requirements necessary to
process your claim.
Please give this matter your Prom£tAttention and submit your claim forms as soon as possible.
Thank you, and again please accept our condolences.
Si ely,
Claims Examiner
C: Francis German #14126
Allianz Life Insurance Company of North America
PO Box 59060
Minneapolis, MN 55459-0060
8001950-4036
Allianz
June 2, 2003
Edna Foust
330 H°gestown Road
Mechanicsburg, PA 17050-3120
FILE COPY
Re: Roe L Foust, deceased
Policy Number: 427268
Dear Mrs. Foust
We are sorry to hear of your recent loss. Please accept our sincere sympathies.
Listed below ar~ the options available to you as the named b}neficiary:
1. Continue the Benefit Deposited with Interest Option. Continue receiving the monthly
interest payments until the last payment date of December 18, 2003. On that date you
would receive the accumulated benefit of $17,852.01.
2. Select the Spousal Option. The interest payments would be cancelled and the original
contract would continue in your name, accumulating interest at a competitive rate. This
option would al~b-givo you the time to decide upon a settlement option or the cash value at a
future date. Please keep in mind that a future settlement option would begin a new payout
period.
3. Select an Alternative Annuity Option Settlement. Annuitize the contract receiving '~he
higher Annuitization Value of $17,852.01. Please refer to the contract regarding settlement
options and minimum payout periods.
4. Select the Guaranteed Benefit Account. Receive the reduced lump sum Cash Value in an
interest bearing account. See the enclosed question and answer sheet regarding this
program.
In accordance with IRS regulations~ the policy must either be annuitized within one year from
the date of death or cashed out within five years from the date of death. Based on state
regulations, the policy proceeds must be claimed within two to five years from the date of death
or the proceeds may be p.aid t9 the appropriate state.
Please complete the enclosed Benefit Deposited with Interest Option Claim Form. Also, please
attach one certified death certificate (must have raised state seal), and if available, a dated
obituary. Kefer to the Special Instructions Section for any specific requirements necessary to
process your claim.
Please give this matter your Prom£tAttention and submit your claim forms as soon as possible.
Thank you, and again please accept our condolences.
Claims Examiner
C: Francis Gorman #14126
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAlpTAXESi\~r) ncpt'r: OC NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION! 1'_~)Vn!.,!. i" ',." t 'U,-- IAPPRAISEHENT ALLOWANCE OR DISALLOWANCE
PO BOX 280601 (' '_I OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRISBURG PA 17128-0601 . , .
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-17-2005
FOUST
04-24-2003
21 03-0615
CUMBERLAND
101
2005 Ji1!l I!i Pi\ 3: 14
CLEFJ( OF
~c.....'.D.I_'!.'.. \I'~. i". n. ill.C'.T
Ii. I..", y' '.-"._' _.-' II
~~~A H~G~~~ ~~-~D ." . ".,
MECHANICSBURG PA 17050
Allount R...ltt.d
*'
REV-1541 EX 4FP (12~04)
ROE
L
J CHANGED
IlJ
121
[31
14J
(51
16J
(71
.00
6.325.02
.00
.00
.00
.00
187.685.75
[BJ
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' :r!1,".lx--AFP-.r~1":6~'.-N6Ti-cE.i:iF.i:NiilR-li'AN-c~-'tAx-APPRA'Isi''-ENi':..ALLi:iwANcE'-o'R--_._-_._-_.- - -.-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FOUST ROE L FILE NO. 21 03-0615 ACN 101 DATE 01-17-2005
TAX RETURN WAS: (X J ACCEPTED AS FILED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule HJ
10. Debts/Mortgage Liabilities/Liens {Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued prev1ously, lines 14, 15 and/or 16, 17, 18 and 19 w1ll
re~lect ~1gures that 1nclude the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15J
16. Amount of Line 14 taxable at Lineal/Class A rate (16J
17. Amount of Line 14 at Sibling rate (171
18. Amount of Line 14 taxable at Collateral/Class B rate (ISI
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule BI
3. Closely Held Stock/Partnership Interest (Schedule CJ
4. Kortgages/Hotes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EI
6. Jointly Owned Property (Schedule FJ
7. Transfers (Schedule GJ
8. Total Assets
NOTE:
(91
1101
7,576.00
.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax PRYllent.
194,010.77
1111
1121
1131
1141
7."76 00
186,434.77
.00
186,434.77
186,434.77 X
.00 X
.00 X
.00 X
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
119J=
TAlC CREDITS:
'" AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-I
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIDN OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYMEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CRJ, YOU MAY BE DUE -i-
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.J <<-~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/15/2005
FOUST EDNA M
330 HOGESTOWN ROAD
MECHANICSBURG, PA 17050
RE: Estate of FOUST ROE L
File Number: 2003-00615
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 is due by:
4/24/2005
Your prompt attention to this matter will be appreciated.
Thank You.
s}.rncerelr, , .
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
cJ
.,
Re~srerofVVillsofOwnbeclandCoun~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: 'R~;I, ~r
Date of Death: f- t5lr'- tJ:3
Estate No.: :l tJO.s - 0 0 ~ / ~
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
. Yes 111" No 0
2. lfthe answer is No, state when the personal representative reasonably believes that
the administration will.be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No m-
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 0 N lit
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~/O~
(,k~ ~
Signature '
11",,;j
, ,
E /)lJA- M. r;,1/~r-
.
Name
/)};~. ~, (70..>0
Address '.
(7 /~ tlt - b9'79
Telephone No.
Capacity: ~sonal Representative
o Counsel for personal representative
uX