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HomeMy WebLinkAbout12-13-06• ~, ,,. FAMILY SETTLEMENT AND FINAL RELEASE ~ ~. In Re: Estate of RUTH B. COPE, Deceased c, ..r; No. 2105-1086 ~° ~ G KNOW ALL MEN BY THESE PRESENTS, that ~'' t,a c.~ =~~ r WHEREAS, Ruth B. Cope, Late of North Middleton Township, C~~erlar~ -=" ~"'' ., County, Pennsylvania, died testate on December 12, 2005, having firs ~ade h~ '=~"-' last will and testament, which was duly executed on April 7, 2003, aid is dul~a recorded in Cumberland County, PA, to No. 21-05-1086. WHEREAS, the said Ruth B. Cope, by the aforesaid last will and testament, named her brother, Marlin L. Bloser, as Executor of said last will and testament. WHEREAS, Letters Testamentary on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, PA. to the said Executor hereinafter called the personal representative; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent and the assets consist of cash, real estate and stocks and bonds, for a total value of $713,769.24, as set forth in the attached Exhibit A. WHEREAS, the debts and deductions including the payment of inheritance tax in the said estate, amount to $73,447.95 (See Exhibit B) and inheritance taxes of $82,603.35 (See Exhibit C), thereby leaving a balance for distribution of $557,717.94 to be distributed in accordance with the attached Exhibit D. Total Assets $713,769.24 Total Debts $156,051.30 Balance for Distribution $557,717.94 Distribution Items distributed are in accordance with Item Two of the Last Will and Testament of Ruth B. Cope, attached as Exhibit E. Ruth Bloser, sister in law $ 1,000.00 Steve Bloser, nephew 10,000.00 Tom Bloser, nephew 10,000.00 Robert Coburn, nephew 10,000.00 First Presbyterian Church, Carlisle,. PA. 1,000.00 Pre death cash per direction of Ruth Cope 35,000.00 Dorothy H. Bloser, sister in law, ifi residue 245,358.97 Marlin L. Bloser, brother, i~ residue 245,358.97 Total Distributed $557,717.94 r .~ WHEREAS, the balance for distribution has been distributed in accordance with the terms of the last will and testament of the decedent as set forth in the schedule of distribution. NOW, THEREFORE we, the undersigned Legatees, being all of the legatees of the said decedent and being those persons entitled to inherit under the last will and testament of Ruth B. Cope do hereby, each of us, acknowledge that we have received from the aforesaid estate, in full satisfaction ,the sum or sums of money set forth above. AND, each of us does hereby stipulate and agree that in order to avoid the expense and time involved in he filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, PA. THEREFORE, each of us does hereby remise, release, quitclaim and forever discharge the said personal representative, her heirs, executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and each of us does further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, we and each of us do hereby covenant and agree with each other that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate after signing, sealing and delivery of this settlement agreement, and final release. IN WITNESS WHEREOF, we have hereunto set our hands and seals this _ ~'o day of _~'l,e•./ ~w$~-~- , 2006. Marlin L. Bloser, individually And as Executor of the Estate of Ruth B. Cope Dorothy H. oser, individually __ Robert Coburn, individually STATE OF MARYLAND ) ~~ ~~ ~~ ~~ SS:, County of ~/l1t''~'n~wt'Y`' ) On this, the~of OP 2006, before me, a Notary Public, the undersigned officer, personally appeared Robert Coburn, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. N tary KAREN KNIGHT NOTARY PUBUC STATE CAF MARYtAND My Commission Expiresluns 1, 2008 . ', . ~~ To B oser, indi ' ually Steve~BlosQer, individually ~ ~k,~ Ruth Bloser, individually Commonwealth of Pennsylvania) SS:, County of Cumberland ) On this, the ~ of 2006, before me, a Notary Public, the undersigned officer, personally appeared Marlin L. Bloser, individually and as Executor of the Estate of Ruth B. Cope; Dorothy H. Bloser, Tom Bloser, Steve Bloser, and Ruth Bloser, known to me to be the persons whose name are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Ne1~W 1~N Met M. Cox, Mir FubNc Q~MM 6~s +1~ x,'00! aevysooex+li-g» COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 290601 C ~o p ~e ;R ju {t social sECUanv NuuaEa U 1*~7 7 2 4 6'3 €5~9 W I QF APPLICABLE) SUAVNING SPOUSE'S NAME (LAST, FlPST, A 0 R~`V-1500 INHERITANG~ 7AX RETURN RESIDENT DECEDENT OFFICIAL USE OMY 2 ~1 0 ~5 ~1 (0 8 {6 a N ®1.Originai Retum ^ 2. Supplemental Retum ^ 3, Remainder Retum tdete arkatl,plora is-feast ~ ~ ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (sate a dean Baer tats-ez) ^ 5. Federal Estate Tax Retum Required m ^ 6. Decedent Died Testate (Nteon ~ a w,y ^ 7. Decedent Maintained a Loring Trust tAttea, coP, a Trust) _ 6. Total Number of Safe Deposit Boxes q ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit torte a deem uehveen iz-3t-at and t-t-s~ ^ 11. Election to tax under Sec. 9113(A) (ASarn sd, o) F- c NAME COMPLETE MAIUN(3 ADDRESS o William P. Dou las 27 W. High St. N FlRMNAME (MAppliceble) ~ Dou las Law Office ~ c°~ TELEPHONE NUMBER 717-243-1790 Rarlisla on avnre 1. Real Estate (Schedule A) (1) 1 8 1 4 9 1 0 0 0 O OFFICIAL U5E ONLY 2, Stocks and Bonds (Schedule B) (2) 4 1? 4 8 7 4 S 3. Ciosety Held Corporation, Partrtership orSole-Proprietorship (3) : j 4. Mortgages & Notes ReceNable (Sc~tedule D} (4) i 5. Cash, Bank Deposits & Miscellaneous Personal PropeAy (5) Z (Schedule E) 1 1) 3 9 9 4 2 6 6. Jointly Owned Property (Schedule ~ (6) 4 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property Ch ` (Schedule G or L) }- 8, Total Gross Assets (total lines 1-7) (8) 7 1 3 7 6 9 2 4 a (4j 9. Funeral F~rpenses d Admnisttative Costs (Schedule H) (9) 6 ; 4 5 ? 9 5 1 4 W ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) i 11. Total Deductions (total Lines 9 & 10) (11) 6 4 , 5 19 5 , 1 4 12. Net Value of Estate (L'me 6 minus Line 11) (12) 6 4 9 1 ~~ 17 4 1 0 13. Charitable and Govetrttnantel Bequests/Sec 9113 Trusts for which an electlon to tart has rat been (13) ~ ~ made (Schedule J) j i 0 1 0 0 0 0 14. Net Value Subject to Tax (Line i2 minus Line 13) (14) 6 4 8 1 ~ 7 ) 4 1 0 Z 15. Amount of line 14 taxable at the spousal tax rate 3 ': 0 8 5 ~ 8 7 0 5 X (15) 3 7 O i 3 ' 0 4 5 ~ See instructions on reverse side fora liable ercen e F 16. Amount of line 14 taxable at 6% rate ; X .O6 (i6) j a g 17. Amount of line 14 taxable 3 3' 9 5 at 15°'e rate 8 7 0 5 X .15 (i~ 5 0 9 3 I 1 8 0 6 O v 16. Tax Due (1a) 8 7 9 (6 ~8 5 1 19. n ~~ br penaltles of perjury, I dedaro that l have exatNrtedll~s return, statements, end to tlta best M mY lataNedga and belief, it is tore, correct and complete. Oeclaw7ion of preparer other ~~.rn vn~ yr r ~n.avrv ncar v~~pro~p rVn rlUlYU riC 1 VI't1Y Ruurttss 100 Barnstable Rd. - - DATE Carlisle PA 17013 7/24/06 NATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE William P. Douglas, Esquire, 27 W. High St., Carlisle, PA 17013 Decedent's Complete Address: STREET ADDRESS 915 Hamilton St. .._ .. cnv Carlisle srArE PA vP 17013 - - -- Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 80.000.00 C. Discount 4.000.00 3. InteresUPenalty ifapplicable D. Interest E. Penalty (1) 87,968.51 Total Credits (A + B + C) (2) 84,000.00 Tots{ InteresUPenalty (D + E) (3) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 19 to request a refund 5. If line 1 + line 3 is greater than lino 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF (4) {5) 3,968.51 {5A) (56) 3,968.51 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 : ............................:................................. ^ 0 b. relain 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, 1f death occurred on or before December 12, 1982, did decedent within two years preceding death transfer properly without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... ^ 3. Did decedent own an "in trust for" 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'? ..... ^ IF THE ANSWER TO ANY OF THE ABOVE OUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. §9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. 72 P.S. §9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving spouse from 3°f° to 0% for dates of death on or after January 1, 1995. 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 retum are still applicable even if the surviving spouse is the only beneficiary. FOR DATES OF DEATH ON OR AFTER JANUARY 1,1995 -Please answer the following question by placing an "x" in the appropriate space. Dld the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire lifetime? Yes ^ No ^ If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second spouse, at which Gme it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on Schedule J, Part ll, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule O in order to make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the `first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate, find the remainder is taxed at the rates} applicable to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule O to atimely-filed tax return, along with Schedule(s) K andlor M in order to show the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). atv~iso2fx.Ii-~ .. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FlLE NUMBEfl Cope Ruth B 21 05 1086 All real property owned solely or as a tenant in common must be reported at fair market value. Fa'u market value is defined as the pace at whkh property would be exchanged between a wilting buyer end a wiH6ig seller, ne'Ither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jointly-owned wfth right of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. 915 Hamilton St., Carlisle, Pa 17013, se{ling price, see attached settlement sheet 184,900.00 V T07AL (Also enter on line 1, Recapitulation) ~ S more space is needed, insert additional sheets of the same size) __ _. _ M. r -.~._ ~.... .yz y...~., _._ _ _ REV-4503IX a 1/9'~ • SCHEDULE B COMMONWEALTHGFPENNSYLVANIA STOCKS & B4ND3 1NHEAtTANCE TAX RETURN (DENT DEC DENT ESTATE OF FILE NUMBER Comae. Ruth 13. _ 21 0 1086 All property jointly-owned with right of survivorship must 6e discbsed on Scheduie F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MFS municipal bonds 89,207.78 v 2. MFS municipal bonds 31,853.00` 3. Putnam American Govt. Class A 15,787.61 ~ 4. Putnam Tax Exempt Class A 43,335.30 ~''~ 5. Van Kampen U.S. Mortgage Fund 12,165.51 / 6. Van Kampen MVA lncome Fund 8,137.27 ~'` 7. Franklin lncome Fund, Class A 71,357.42 ~ 8. Alliance, redemption of SGA 14,178.97 / 9. Alliance Gov. Ins.A 6,580.61 l/• 10. Pershing Funds 36 420.56 17 . Met Life Investors 52,074.98 ~,+''~ 12. Carlisle Corp stock/Computershare 27142 98 ~,. 13. Homestead Trust No. 5 -See attached Release 6,632.99/ TOTAL (Also enter on line 2, Recapitulation) I $ 41 (lf more space is needed, insert additional sheets of the same size) pEV-t508IX a (1411 SCHEDULE E COMMONWEALTH OF: PENNSYLVANIA ~+ASflr BANK DEPOSITS, & MI$lr. INHRES DEN DECEDENTRN PERSQNAt PF~OPERTI( ESTATE OF FILE NUMBER Cope. Ruth B. _ _ _ 1 0 1086 Include the proceeds of litigatlon and the date the proceeds were received by the estate. Alt property lointtyawned witlr the right of survlvorshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T checking 77,180.83 ti 2. State Farm Mutual, refund 86.39 v' 3. Met Life, withdrawal 137.33 ~/ 4. Pershing Funds, withdrawal 159.56 / 5. Pershing Funds, withdrawal 55.99 /~ 6. Alliance Funds, withdrawal 120.00 ~ 7. Pershing Funds, withdrawal 115.97 ~ 8. Tax proration received on safe of 915 Hamilton St. 915.04.x` 9. Cash given to nephews, Thomas, Aaron, Steven Bloser on October 31, 2005 25,000.00 ~' 10. Cash given to brother, Marlin, on October 31, 2005 10,000.00 ~` 11. North Middleton Township, refund water and sewer 12. AARP, refund on insurance TOTAL (Also enter on line 5, Recapitulation) , $ 11 more space Is needed, Insert addlbonal sheets of the same size) 79.90 '~ 143.25 ,! EXPENSES Cumberland Crossings, Nursing home bill $ 8,552.81 Register of Wills, additional probate fees $ 300.00 Schedule H Expenses b4 595.14 Total Expenses $73,447.95 EXHIBTT B REV-1470 EX (&8~ INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDNIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME COPE, Ruth B. FILE NUMBER 2105-1086 REVIEWED BY Kath LEO ACN 101 y ITEM SCHEDULE NO, EXPLANATION OF CHANGES H Accepted additional expense submitted by the correspondent, $8,552.81, Cumberland Crossings Nursing Home bits. ORIGINAL Page 1 aEVn si iEx. (t-en CAMMONWEALTH OF PENNSYLVANIA INHERITANCE 7AX RETURN SC~~D'ULCrI FUNERAL EXPENSES & ADMINISTRATIVE COSTS c~ r H i c yr FILE NUMBER Gooe. Ruth B. _ _ _ _ 1 05 ~ 1086 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth 2. Grave Opening B. 1 2. 3. 4. 5. 6. CdY State Zlp Relatlonship of Claimantto Decedent ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Soda) Security Numbers}! EIN Number of Personal RepresentaWe(s) _ Street Address City state Year(s) Commission Pa(d: AttomeyFeas Douglas Law Office Family Fxemptlon: (It decedents address is not the same as claimants, attach explanation) Claimant Street Address Probate Fees Register of W ills Accountants Fees John Klingler & Associates, filing Decedent`s tax return Tax Retum Preparer's Fees 7,550.50' 1,045.00 / 35,681.00 / 370.00 ~` 600.00 7. PP&L 166.95/ 8. Gilbert Landscaping 79.50 / 9. Realtor's Commission on sale of real estate, 915 Hamilton St., Carlisle 11,094.00 " 10. Realty Transfer tax on sale of real estate 1,849.00 11. Joseph Breitenbach, svc. of house, 915 Hamilton St. 100.00/ 12. PP&L i 94.99 f/ 13. North Middleton Twp. Authority, Water and Sewer 79_gp/ 14. West Shore EMC 60.62 15. Sentinel, estate ad 151.55' 16. M&T Bank Charge 00 / 40 17. Cumberland Law Journal, estate ad . 75.OOe/ 18. North Middleton Tw .Water and Sewer 101.21 ,d'`" TOTAL (Also enter on fine 9, Recapitulation) $ 64 595.14 (If more space is needed, insert additional sheets of the same size) Zip Continuation of REV-1500 Inheritance Tax Return Resident Decedent Cope, Ruth B. 21 05 1086 Paoe 1 Schedule H -Funeral Expenses & Administrative Costs - 67 ITEM NUMBER DESCRIPTION AMOUNT 19. Cumberland County Tax Claim Bureau, 2005 School Taxes 1,956.06 v 20. Tax proration on sale of 915 Hamilton St., 2006 county real estate 13,31/ 21. Continuing Care Rx 616.27 22 Cumberland Crossings 33.28 23. U.S. Treasury, 2005 income tax 836.00 ~ 24. PA. Dept. or Revenue, 2005 income tax 1 630 00 / 25. Computershare, brokers fee , . 41.00 ~ 26. Reserved for filing final account and inventory and appraisement 230.00 SUBTOTAL SCHEDULE H-B7 ~ 5,355.92 B.iREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PD aox zeobol HARRISBURG PA 17128-8b01 WILLIAM P DOUGLAS DOUGLAS LAW OFFICE 27 W HIGH ST CARLISLE PA 17013 DATE 09-18-2006 ESTATE OF COPE RUTH B DATE OF DEATH 12-12-2005 FILE NUMBER 21 05-1086 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 11-17-2006 (See reverse side under Objections) Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --~ RETAIN LONER PORTION FOR YOUR RECORDS t- REV-1547 EX AFP [03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF COPE RUTH B FILE N0. 21 05-1086 ACN 101 DATE 09-18-2006 TAX RETURN HAS: ( )ACCEPTED AS FILED [ X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (ScMdula A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D] 5. Cash/Bsnk Deposits/Misc. Personal Property [Schedule E) 6. Jointly ONned Property (Schedule F) 7. Transfers (Schedule 6) 8. Total Assets (1) 184,900.00 NOTE: To insure proper (2) 414.874.98 credit to your account, (3) 00 subait tM upper portion . of this fors with your (4) .DO tax paywent. (5) 113,994.26 (6) .00 (7) .00 (g) 713,764.24 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Ftmeral Expenses/Ada. Costs/Misc. Expanses (Schedule H) 73,147.95 (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Il [10) .00 11. Total Deductions (ll) 73 . 147. 9~ 12. Net Value of Tax Return (12) 640,621.29 13. Charitable/Goverrwental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) 1,000.00 14. Nat Value of Estate Subject to Tax (ly) 639,621.29 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rats (15) •00 X 00 __ .00 16. Anount of Line 14 taxable at Lineal/Class A rats (16) •00 X 045 . .00 17. Amount of Line 14 at Sibling rate (17) 304,310.65 X 12 36,517.28 18. Amount of line 14 taxable at Collatarel/Class B rate [18) 335,310.64 X 15 50,296.60 19. Principal Tax Due (lg)= 86,813.88 TAX CREDITS: DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 03-0 -2006 CD006340 4,210.53 80,000.00 07-31-2006 CDD07026 .00 3,968.51 COMMONWEALTH OF. PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AfP C86-85) TOTAL TAX CREDIT 88,179.04 BALANCE OF TAX DUE 1,365.16CR INTEREST AND PEN. .DO TOTAL DUE 1,365.16CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIOF(AL INTEREST. n IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE (` A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Cope Estate Inheritance Tax Payments Tax Due: Credit received from state for Early payment $86,813.88 - 4,210.53 $82,603.35 Tax paid by estate Tax paid by estate Refund due estate Actual amount paid by estate $80,000.00 3,968.51 - 1,365.16 $82,603.35 REV-1313 EX I1-93) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 APPLICATION FOR REFUND OF.PENNSYLVANIA INHERITANCE/ESTATE TAX OTiICICI{ U$e ~n{y TO: PA Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 FROM: Official Rreprlesentntive\ Name ~N I ~.1~ ~4~ ~ Uy~~ ~ °'-,~ Address Z~l I-(J • -~ ~p5~` S r ~~,51e f #~- ~~1v~3 ~-- Phone Number ~~ 11) 2`f 3 11 `~ o The undersigned requests a refund in the amount of $ ' 3 ~' ~ ' I t° for the above referenced decedent's estate. REFUND REQUESTED ON: Original or Supplemental ~loint/Trust Assets ~ Remainder Return ~ Estate Tax Probate Return ~~ou must enclose a copy of the latest assessment received from the Department of Revenue. EXPLANATION OF OVERPAYMENT ~A Decedent Dntn Name of Decedent i~`J~ ~ ~ Ca~~- File Number Z1 of _ tog ~' Date of Death ~ Z - ~ ~-~ ~ ~ Social Security Number ,A-11 _ Z`~"-f'''~~ ~.. , . ~is~o ~, 1pp~~ D to ~J/~v~~ Please allow Four to six weeks for the processing of your refund request. PEV~/513 pl ~ (1A7) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Ruth Bloser sister in law $1,000.00 135 Heron Way Carlisle, Pa 17013 2. Steve Bloser nephew $10,000.00 150 Barnstable Road Carlisle, PA 17013 3. Tom Bloser nephew $10,000.00 210 Barnstable Road Carlisle, Pa 17013 4. Robert Cobum nephew $10,000.00 10024 Preswich Terrace Jansville, MD 21754-9601 5. Dorothy H. Bloser sister in law 1/2 of residue 100 Barnstable Road Carlisle, PA 17013 6. Marlin L. Bloser brother 1/2 of residue 100 Barnstable Road Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE5 15 THROUGH 17, 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. First Presbyterian Church, Carlisle, PA 1,000.00 TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV 1500 COVER SHEET $ 1400.00 p. mv~o uNaw w ncaVOU, macn aWn1u11C1 ~I ICGW UI II W SCI~1B 5126 D Will I, Ruth B Cope,.of 915_ Hamilton _S..treet,_Carlisle,_Cumberland County, Pennsylvania, declare. .. this to be my last will and revoke any will previously made by me. Item One: I direct that all my debts and funeral expenses including my gravemazker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. Item Two: I give and bequeath the following to the named beneficiary: A. The sum of $1,000 to the First Presbyterian Church of Carlisle, Pennsylvania. B. The sum of $1,000 to Ruth Bloser, wife of my deceased brother Deemar Bloser. C. The sum of $10,000 to my nephew Steven Bloser, per stirpes. D. The sum of $10,000 to my nephew Tom Bloser, per stirpes. E. The sum of $10,000 to my nephew Robert Coburn. F. I give, devise, and bequeath the rest, residue, .and remainder of my estate to Marlin L. Bloser and Dorothy H. Bloser, equally, share and share alike, or to the survivor thereof. In the event that both Marlin L. Bloser and Dorothy H. Bloser predecease me, then I give, devise, and bequeath the rest, residue, and remainder of my estate to the sons of my brother Marlin L. Bloser, equally, share and shaze alike, Steven Bloser, per stirpes, and Tom Bloser, per stirpes. Item Three: I appoint my brother Marlin L. Bloser Executor of this my last will. Should he fail to qualify or cease to act as Executor, I appoint the sons of my brother Marlin L. Blower, Steven Bloser and Tom Bloser, to act as Co-Executors, or the survivor as Executor, with the same rights, powers, and duties. Item Four : All estate; inhertanee, succession, azd other taxes, ii-rposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the- principal of my residuary estate, without apportionment or right of reimbursement. Item Five: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Item Six: In addition to the rights and powers given to the fiduciaries bylaw or elsewhere in this will, I give to my Executor during the full time necessary for the administration of my estate the following rights and powers to be exercised in Ivs or her sole discretion. C A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions as to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition, to mortgage or pledge real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this 7"' day of April, 2003. ~r ~ ~ Signed Ruth B. Cope The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the pr ence of us, who at her request, in her presence and in the presence of each other have subscrilur names. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We, John H. Broujos and ^J LAY Sf e ~w ,witnesses whose names are signed to the attached or foregoing instrumen being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last will; that she signed willingly and 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 the time 18 or more years age,~.of sound mind and under no constraint or undue influence. (~ .-..ti\~:.~.--~-- ~ ~ 1 ~ . k ~ `~ Sworn and subscribed to before mie,~tl>~i_s.-7~' day of April, 003. NO ARY P LIC Notarial seal Bridget Ann Cotcoran, Notary Public Carlisle Born, Cumberland County My Commission F.~tpims Jnne 10, ?A06 Member, PenrxyAvania Pssoaation of Pbtaries COMiVtONWEAL'I'ri OF PE1VI~ISYLVANfA ss COUNTY OF CUMBERLAND I, Ruth B. Cope, whose name is signed to the attached document, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. Ru ope, Testatrix Sworn and affirmed to and acknowledged bef me this 7~' da April,/2'003. OTARY PUBLIC Notarial Seal Bridget Ann Corcoran, Notary Public Car iak Baro, Cumberland County My Comtttission Expires Jane ]0, ?A06. Member, PennSylvanfaAesoaationotNolaries M -- _ _ .~y 1 ~ , WHEREAS, the balance for distribution has been distributed in accordance with the terms of the last will and testament of the decedent as set forth in the schedule of distribution. NOW, THEREFORE we, the undersigned Legatees, being all of the legatees of the said decedent and being those persons entitled to inherit under the last will and testament of Ruth B. Cope do hereby, each of us, acknowledge that we have received from the aforesaid estate, in full satisfaction ,the sum or sums of money set forth above. AND, each of us does hereby stipulate and agree that in order to avoid the expense and time involved in he filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, PA. THEREFORE, each of us does hereby remise, release, quitclaim and forever discharge the said personal representative, her heirs, executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and each of us does further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, we and each of us do hereby covenant and agree with each other that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate after signing, sealing and delivery of this settlement agreement, and final release. IN WITNESS WHEREOF, we have hereunto set our hands and seals this _ ~ day of ~.e~en-~, , 2006. i~~i?~12x-c.YV ~ ~tu%~~W Marlin L. Bloser, individually And as Executor of the Estate of Ruth B. Cope Dorothy H. oser, individually .~ ~~ To B oser, indi ' ually Stev~ ,individually Ruth Bloser, individually c:ommonwealtri of Nennsylvania) . SS:, County of Cumberland ) On this, the ~ of 2006, before me, a Notary Public, the undersigned officer, personally appeared Marlin L. Bloser, individually and as Executor of the Estate of Ruth B. Cope; Dorothy H. Bloser, Tom Bloser, Steve Bloser, and Ruth Bloser, known to me to be the persons whose name are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ..ems Ne1MW i~N AaAt M. Caac~ NQ1My PubNe ~~~~