HomeMy WebLinkAbout03-0863 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ROSEMARY C. LOZIER No.
also known as To: Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 006-26-6765 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner is 18 years of age or older and the Executor named in the last will of the above
decedent, dated May 9, 2002 and codicil(s) dated July 31, 2002.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or
principal residence at 718 Olson Drive, Carlisle Borough.
Decedent, then 82 years of age, died October 17, 2003, at Cumberland Crossings Retirement
Center, Carlisle, Pennsylvania.
Except as follows, decedent did not marry, was not divorced and did not have a child bom or
adopted after execution of the will offered for probate; was not the victim of a killing and was never
adjudicated incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ unestimated
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ unestimated
situated as follows: 718 Olson Drive, Carlisle Borough
WHEREFORE, petitioner respectfully requests the probate of the last will and codicil(s) presented
herewith and the grant of letters testamentary thereon. ~~;7~~~q...'
52 Wilson Street
Carlisle, PA 17013
(717) 249-5600
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
The petitioner above-named swears or affirms that the statements in the foregoing petition are true
and correct to the best of the knowledge and belief of petitioner and that as personal representative of the
above decedent, petitioner will well and truly administer the. es/~ according to law)..D
Sworn to or affirmed and subscribed
before me tlqs .-L2~ day of Donald C. Lozier
No.
Estate of ROSEMARY C. LOZIER, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
,,'")il
AND NOW, Cc¢-de~,z--~ -~9-o_.. -9~-<~ ~ , in consideration of the petition on the reverse side
hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated May 9, 2002 and July 31, 2002, described therein be
admitted to probate and filed of record as the last will of Rosemary C. Lozier and Letters Testamentary
are hereby granted to Donald C. Lozier.
Page Re~ister of Wills/x~z~z.~
FEES John B. Fowler III, Esquire (06273)
Probate, Letters, Etc. $ ~'-7.<5~O ATTORNEY (Sup. Ct. I.D. No.)
eeO2,~.~ificates( ) $ /~9. oo MARTSON DEARDORFF Wr. LL1AMS & OTTO
nc~auon $ /,O. ~'"o 10 East High Street
- · $ /~. ~;,<-. Carlisle, PA 17013
TOTAL $ ~,~x~ (717) 243-3341
Filed
F:~FILES~DATAFILE~ESTATES\ 10110- l.lettemtes
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 filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Local Registrar
P 9749693 OCT I ? 2003 ,
No. ~ Date
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
~. u~.,~ ................... " :' ~ 006 -- 26 -- 6765
82 ,,A ~ I ~ I ~/~/~oo, I ..- ....T ..... I~s"'~ ~ m~m --~ -
,. , .,~ I,,. I 5+' ' /,t Wi~ J,t -
718 Olin ~i~ [~"" ,7~ PA
~rlisle, PA 17013 ~ ~ '
~ ~rl~d ~-=~ ,,~ ~ ~rlisle
X. ~les~ Mis~icz
~zier 52 Wil~n St~t, ~rlisle, PA 17013
10/20/2003 ~st ~Crm. H~ris~g, PA 171~
F&FILES\DATAF1LE~Estate Planning\lO1 lOl-eodicik 1
CODICIL
I, ROSEMARY C. LOZlER, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and
declare this to be a Codicil to my Last Will and Testament dated May 9, 2002.
1.
ITEM IV of my Last Will is hereby revoked and in lieu thereof replaced with the following:
ITEM I¥: I devise my undivided one-half interest in my residence at 718
Olson Drive, Carlisle, Cumberland County, Pennsylvania, to my son, DONALD C.
LOZIER, provided he shall survive me by thirty (30) days. Should my said son
predecease me or die on or before the thirtieth day following my death, then said real
estate shall be distributed to my granddaughter, JENNIFER K. McWILLIAMS.
Should my said granddaughter predecease me or die on or before the thirtieth day
following my death, then said real estate shall be distributed to her issue, per stirpes,
living on the thirty-first day following my death.
2.
In all other respects, I hereby ratify, confirm and republish my last Will dated May 9, 2002,
together with this Codicil, as and for my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~/.5~ day of
Rc~semary C. ~(~ier a
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for a Codicil to her Last Will and Testament dated May 9, 2002, in the presence of us, who at her
request, have hereunto subscribed our names as witnesses thereto, in the presence of the said
Testatrix and of each other.
Page 1 of 2 Pages
COMMONWEALTH OF PENNSYLVANIA )
· SS.
COUNTY OF CUMBERLAND )
We, RosemaryC. Lozier, .~[q,",.,~cc ~., [")..~d£~ ,and i/~rz~ar-,t ~'. ~:]~,
the Testatrix and the witnesses, respectively, whose nines ~e si~ed to the foregoing instrument,
being first duly sworn, do hereby decl~e to the ~dersi~ed authohty that the Testatrix si~ed and
execmed the ins~ent as a Codicil to her last Will dated May 9, 2002, ~d that the Testmfix has
signed willingly, and that the Testatrix executed it as her ~ee ~d volunt~ act for the pu~oses
therein expressed, ~d that each of the witnesses, in the presence ~d he~ng of the Testatrix, signed
the Codicil as a witness ~d that to the best of hisser ~owledge the Testatrix was at that time
eighteen ye~s of age or older, of sold mind ~d under no cons~aint or ~due influence.
R~s~ma~ ~Lozier, Test~hx
Witness
Subscribed, sworn to and ac~owledged before me by Rosem~ C. Lozier, the Testatrix, and
subscribed ~d sworn to before me by ~~ k. ~c~ and
~'&~,-& ~. ~,'/~ , the witnesses, t~s~dayof-- (I~ ,2002.
Not~ Public ,~
Co NOTARIAL SEAL ]
anlsle uoro. uumberlandCoun~
remission E~p~ros May 27, 2~03
Page 2 of 2 Pages
F:~FILES\DATAFILE\Estate Planning\lO1 lO.will.2
LAST WILL AND TESTAMENT
I, ROSEMARY C. LOZIER, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke all Wills and Codicils
previously made by me.
ITEM I: I direct that all my legally enforceable debts and funeral expenses, including
all expenses of my last illness, 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 II: I bequeath my diamond ring to my granddaughter, JENNIFER K.
McWILLIAMS.
ITEM III: I bequeath the sum of One Thousand Dollars ($1,000.00) to my sister,
DOLORES MULVEY, of Marlboro, Massachusetts, providing she shall survive me by thirty (30)
days; otherwise, such bequest shall lapse and be added to and distributed as a part of the residue of
my estate.
ITEM IV: I devise my undivided one-half interest in my residence at 718 Olson Drive,
Carlisle, Cumberland County, Pennsylvania, to my granddaughter, JENNIFER K. McWILLIAMS,
provided she shall survive me by thirty (30) days. Should my said granddaughter predecease me or
die on or before the thirtieth day following my death, then said real estate shall be distributed to her
issue, per stirpes, living on the thirty-first day following my death..
ITEM V: I devise and bequeath the residue of my estate, of every nature and wherever
situate, in the following manner:
A. One-half(I/2) thereof to my son, DONALD C. LOZIER, providing he shall
survive me by thirty (30) days. Should my said son predecease me or die on or before the
thirtieth day following my death, then his share shall be added to the share of my
granddaughter, JENNIFER K. McWlLLIAMS, pursuant to subparagraph B herein.
B. One-half(I/2) thereof to my granddaughter, JENNIFER K. McWILLIAMS,
providing she shall survive me by thirty (30) days. Should my said granddaughter
[initials]
Page 1 of 4 Pages
predecease me or die on or before the thirtieth day following my death, then her share shall
be distributed to her issue, per stirpes, living on the thirty-first day following my death.
ITEM VI: In the event my said son, granddaughter, or her issue shall predecease me or
fail to survive me by thirty (30) days, then I devise and bequeath the residue of my estate, of every
nature and wherever situate, as follows:
A. One-third (1/3) thereof to my goddaughter and niece, ALICE MULVEY, of
Marlboro, Massachusetts;
B. One-third (1/3) thereof to my godson and nephew, JOSEPH MULVEY, of
Marlboro, Massachusetts; and
C. One-third (1/3) thereof to my godson and nephew, CHRISTOPHER
HECKER, of Colorado Springs, Colorado.
ITEM VII: I appoint MANUFACTURERS AND TRADERS TRUST COMPANY, a
New York banking corporation, with offices in Carlisle, Pennsylvania, or its successor, guardian of
any property which passes, either under this Will or otherwise, to a minor and with respect to which
I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this
appointment of a guardian shall not supersede the fight of any fiduciary in its discretion to distribute
a share where possible to the minor or to another for the minor's benefit. Such guardian shall have
the power to use principal, as well as income, from time to time for the minor's support, health and
medical care, and education (including college education), or to make payment for these purposes,
without further obligation or responsibility to see to the proper expenditure thereof, directly to the
minor or to the minor's parent or to any person taking care of the minor.
ITEM VIII: All Federal, State and other death taxes payable because of my death, with
respect to the property forming my gross estate for tax purposes, whether passing under this Will or
otherwise, including any interest or penalty imposed in connection with such taxes, shall be
considered a part of the expense of the administration of my estate and shall be paid out of the
principal of my residuary estate without apportionment or fight of reimbursement.
ITEM IX: I appoint my son, DONALD C. LOZIER, Executor of this my Last Will and
Testament. Should my said son fail to qualify or cease to act as Executor, I appoint my
granddaughter, JENNIFER K. McWILLIAMS, Executrix of this my Last Will and Testament.
[initials]
Page 2 of 4 Pages
Should my said granddaughter fail to qualify or cease to act as Executrix, I appoint the said
MANUFACTURERS AND TRADERS TRUST COMPANY of Carlisle, Pennsylvania, Executor
of this my last Will.
ITEM X: I direct that all fiduciaries acting under this Will, whether or not named herein,
shall not be required to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~ day of
~ '~', 2002.
o~erhary C. I//o/zier 3/
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each other.
J
Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, RosemaryC. Lozier, JohnB. Fowler, III, and ~Q,tt-C~,X ~. ~-ofT,,w~ ,the
Testatrix and the wimesses, respectively, whose names are signed to the 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 the Testatrix has signed willingly, and that the
Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and heating of the Testatrix, signed the Will as wimess and that to
the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound
mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged before me by Rosemary C. Lozier, the Testatrix, and
subscribed and sworn to before me by John B. Fowler, III, and "'}/~.X
the witnesses, this q ~ay of m~ , 2002. (/
Noi3ry Public
-- NOTARIAL SEAL
CORRINE L. MYERS, Notary Public
Carlisle Boro. CumberlandCoun
My Commission Expires Ma)/27, ~/03
Page 4 of 4 Pages
ROSEMARY C' LOZIER
PREPARED BY:
MARTSON DEARDoRFF WILLIAMS 6~' OTTO
ATTORNEYS B~ COUNSELLORS AT LAW
TEN EaST HIGH STREET
CA~.klSL£, PENNS~V~'~IA 17013
TELEPHONE (717) 243-3341
F:\FILES\DATAFILELESTATES\ 10110-1 .notic¢.¢ert
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Rosemary C. Lozier
Date of Death: October 17, 2003
File No. 21-03-0863
To the Register:
I certify that notice of 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 or
about January 16, 2004.
Mrs. Dolores C. Mulvey Mr. Donald C. Lozier Mrs. Jennifer K. McWilliams
120 Edinboro Street 52 Wilson Street 718 Olson Street
Marlborough, MA 01752 Carlisle, PA 17013 Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A
Date: January I~,, 2004 Signature ~ ~° ~~
Name ~Ti Fowler I~~
SON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Personal Representative
OO"MONWEALTHOPP~NNSYLV*N,A INHERITANCE TAX RETURN F"ENUMBER
DEPARTMENT OF REVENUE
OEPT 28o6o, RESIDENT DECEDENT 21 03 00863
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
LOZIER, ROSEMARY C. 006- 26- 6765
~ DATE OF DEATH (MM*DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ 01/01/1921
~ l 0/17/2003 REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82)
~m [] 4. Limited Estate
~ ¢J [] 48. Future Interest Compromise (date of death after
¥ ~: ~' 12-12-82) [] 5. Federal Estate Tax Return Required
~ [] 6. Decedent Died Testate (Attach copy [] 7. DecedentMaintainedaLvngTrust(Attach
Total Nurnber of Safe Deposit Boxes
q: [] 9. ~fit;;)tion Proceeds Received [] 10. 7;oYL~;~:~verty Credit (date of death bet .... [] 11. Election to tax under Sec. 9113(A)(Attach SohO)
12-31-91 and 1-1-95)
ITHIS SECTION MUsT BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
~AME COMPLETE MAILING ADDRESS
~ John B. Fowler, III, Esquire
i ~ fIRM NAME (If applicable)
Martson Deardorff Williams & Otto Ten East High Street
-ELEPHONE NUMBER Carlisle, PA 17013
717/24%3341
1. Real Estate (Schedule A) (1) 58,023.00 ~:~r:: c; ~ ;::~ c '?
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4 4,6 3 4.7 6
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) 21,645.79
z
_o [] Separate Billing Requested
,~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 61,91 l. 33
~ (Schedule G or L)
<~- 8. Total Gross Assets (total Lines 1-7) (8) 18 6,214.88
a: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,314.46
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 9,1 47.88
11. Total Deductions (total Lines 9 & 10) (11) 23,462.34
12. Net Value of Estate (Line 8 minus Line 11 ) (12) 1 6 2,7 5 2.5 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 162,752.54
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of L ne 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
~ 16. Amount of Line 14 taxable at lineal rate 161,231.74 x .045 (16) 7,255.43
F-
= 17. Amount of Line 14 taxable at sibling rate 1,000.00 x .12 (17) 120.00
~ 18. Amount of Line 14 taxable at collateral rate 520.80 x .15 (18) 78.12
19. Tax Due (19) 7,453.55
20. []
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
JSTREET ADDRESS 718 Olson Drive
CITY Carlisle STATE PA zn, 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 7,453.55
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 372.68
Total Credits (A +B+C) (2) 372.68
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 7,0 8 0.8 7
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 7,0 8 0.8 7
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? ....................................................................................................................... [] []
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.
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE ~:~ERSON RESPONSIBEE)FOR FILING RETURN ADDRESS
Do n al~d/~: ~ozier .../// . DATE
,,[/ / /~ ., ....... · 52 Wilson Street
/ ;,,.r '~ ~:'/,' ::?.,~::~:'~'.-, Carlisle, PA 17013
SlGN.~k).....~-/OI~'~ERSON RESPONSIBLE.,~OR FILING RETURN ADDRESS DATE
SIGNATURE OF PRE'PARER OTHER THAN REPRESEI~ATIVE ADDRESS '
JohnB. Fowler, III, Esquire DATE
Ten East High Street
Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. {}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 of 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.
>_~ SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LOZIER, ROSEMARY C. FILE NUMBER
21 - 03- 00863
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willMg seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF
DEATH
1 One-half interest as tenant in con2non with Donald C. Lozier in real estate at 718 Olson Drive, CaMsle, 58,023.00
PA, Parcel #06-19-1641-091; Deed recorded in Cumberland County, PA, Deed Book "T", Volume 26,
Page 269. Value based on one-half of assessment of 110,520 x 1.05 common level ratio (116,046.00)
TOTAL (Also enter on Line 1, Recapitulation) 58,023.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF LOZIER, ROSEMARY C. FILE NUMBER
21 - 03 o 00863
Include the j~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF
DEATH
1 PSECU Account #0006266765 8,916.46
2 M&T Checking #526363 21,373.42
3 Deposit to M&T account posted after death 444.00
4 Estate ofPetronella Covalesky (sister), partial distribution 11,690.45
5 Estate ofPetronella Covalesky, final distribution 1,038.50
6 Erie Insurance, refund 273.00
7 Sprint, refund 11.37
8 MEGA Life, required IRA distribution for 2003 678.00
9 Cash in safe deposit box 9.56
10 One 1901 $10 gold piece, fair condition 200.00
11 Note: Diamond ring bequeathed in Item II has not been discovered 0.00
TOTAL (Also enter on Line 5, Recapitulation) 44,634.76
~ SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN JOINTLY'OWN ED PROPERTY
RESIDENT DECEDENT
ESTATE OF LOZIER, ROSEMARY C. FILE NUMBER
21 - 03- 00863
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 Donald C. Lozier 52 Wilson Street Son
Carlisle, PA 17013
B Jennifer K. Lozier McWilliams 718 Olson Street Granddaughter
Carlisle, PA 17013
C Christopher Hecker 224 North Chestnut Street Nephew
Colorado Springs, CO 80905
see continuation
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF
NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTERES
TENANT JOINT estate.
1 A 06/03/1983 M&T Market Index #15004200019881 8,290.97 50% 4,145.4~
2 A 09/03/1999 M&T C.D. #31003910414653 16,001.41 50% 8,000.71
3 A 1974-1982 U.S. Savings Bonds as sho~vn on attached Savings 10,550.75 50%i 5,275.38
Bond Calculator
4 B 1982-1992 U.S. Savings Bonds as shown on attached Savings 7,406.81 509 3,703.41
Bond Calculator
5 C 06/1973 $100 Series E Bond issued 6/1973 520.80 50% 260.4C
6 D 06/1973 $100 Series E Bond issued 6/1973 520.80 50% 260.40
TOTAL (Also enter on line 6, Recapitulation) 21,645.79
~ SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINT OWNERS
~NH~.,~-ANCE ?~×.E~'U.N
ESTATE OF FILE NUMBER
LOZIER, ROSEMARY C. 21 - 03 - 00863
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
D Joseph Mulvey 129 Roundtop Road Nephew
Marlboro, MA 01752
~ SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA
,..E.,TA.CE T~X RETUR. MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LOZIER, ROSEMARY C. 21 - 03 - 00863
This schedule must be completed and filed if the answer to any of questions '1 through_ 4 on page 2 ._/es.
DESCRIPTION OF PROPERTY DATE OF DEATH % OF
ITEM include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE
NUMBER Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE)
1 M&T Savings #15004198134329, opened 3/7/2003, in trust 709.69 709.69
for Jennifer McWilliams, granddaughter
2 Cash gift on 11/2002 to Brian McWilliams, grandson-in-law 14,000.00 3,000.00 11,000.00
3 MEGA Life & Health Insurance Co., IRA Policy No. 10,378.12 10,378.12
E0259049; beneficiary-Donald C. Lozier, son
4 Polaris II Variable Annuity, AIG Sun America Account 39,823.52 39,823.52
#P3798554680; beneficiary-Donald C. Lozier, son
TOTAL (Also enter on line 7, Recapitulation) 61,911.33
.~ SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
'N"ER~ANCE T'~ RETUR. ADMIN~TNE COSTS
RE$1D~'NT DECEDENT
ESTATE OF LOZIER, ROSEM,~R¥ C. FILE NUMBER
21 - 03- 00863
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Ewing Brothers Funeral Home, Carlisle, PA 4,329.00
2 Quinet Monument Company, Bentleyville, PA, monument 1,148.00
3 BW Garden Inn, Bentleyville, PA, lodging for burial 150.42
4 Food expense for reception for funeral service and burial 332.54
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Martson DeardorffWilliams & Otto (estimated) 7,800.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills of Cumberland County 279.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I Register of Wills, filing fee, Inheritance Tax Return 15.00
2 Register of Wills, filing fee, Inventory 10.00
Total of Continuation Schedule(s) 250.00
TOTAL (Also enter on line 9, Recapitulation) 14,314.46
Schedule H
COMMONWE^,m OF PENN$¥,VAN,A Funeral Expenses &
RESIDENT DECEDENT
ESTATE OF LOZ[EE, R. OSE~h~.R¥ C. FILE NUMBER
21 03-00863
3 Reserved for additional filing fees and miscellaneous expenses 250.00
Page 2 of Schedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMO"WEALT. OF.E.NSY~VAN~ LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LOZIER, ROSEMARY C.
21 - 03 - 00863
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 M&T Checking #526363, outstanding checks clearing after date of death 5,494.71
2 Alert Pharmacy, account payable 174.60
3 West Shore EMS-BLS, account payable 88.66
4 Continuing Care-RX, account payable 205.27
5 Cumberland Crossings Retirement Community, account payable 2,812.64
6 Note: The above expenses are not covered by insurance
7 Martson Deardorff Williams & Otto, account payable for estate planning 372.00
TOTAL (Also enter on Line '10, Recapitulation) 9,147.88
· REV-1513 EX+ (9-00)
SCHEDULE J
COMMONWE^LT, OF PENNS¥,VA,I^ BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF LOZIER, ROSEMARY C. FILE NUMBER
21 - 03- 00863
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
Do Not L;..t Trusteo(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Dolores C. Mulvey Sister $1,000 cash
120 Edinboro Street
Marlborough, MA 01752
2 Christopher Hecker Nephew $260.40 (Sch. F,5)
224 North Chestnut Street
Colorado Springs, CO 80905
3 Joseph Mulvey Nephew $260.40 (Sch. F,6)
129 Roundtop Road
Marlborough, MA 01752
4 Brian McWilliams Grandson-in-law $11,000.00 (Sch. G,
718 Olson Street 2)
Carlisle, PA 17013
See Continuation Schedule{s) attached
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
~ SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LOZIER, ROSEMARY C. FILE NUMBER
21 - 03 - 00863
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE
Do Not List Trusteeis) OF ESTATE
[include outright spousal distributions, and transfers under
~. I'AXABLE DISTRIBUTIONS Sec. 9116(a)(1.2)]
5 Donald C. Lozier Son $125,646.22 (Sch. A,
52 Wilson Street F-l, 2,3; G-3,4)
Carlisle, PA 17013
6 Jennifer K. McWilliams Granddaughter $4,412.24 (Sch. F-4;
718 Olson Street G-l)
Carlisle, PA 17013
7 Donald C. Lozier Son $10,086.64-1/2 estate
residue
8 Jennifer K. McWilliams Granddaughter $10,086.64-1/2 estate
residue
Page 2 of Schedule J
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of LOZIER, ROSEMARY C. No. 21 - 03 - 00863
also known as Date of Death 10/17/2003
, Deceased Social Security No. 006-26-6765
Donald C. Lozier
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Personal Represent, ~
Attorney: John B. Fowler, III, Esquire Signature: ,/~/'/~ ~
~&l~ld C. Lozier
I.D. No.: 06273 Signature:
Signature:
Address: Ten East High Street Address: 52 Wilson Street
Carlisle, PA 17013 Carlisle, PA 17013
Telephone: 717/243-3341 Telephone: (717) 249-5600
Dated: ///0/~ zt
Personal Property
PSECU Account #0006266765 8,916.46
M&T Checking #526363 21,373.42
Deposit to M&T account posted after death 444.00
Estate of Petronella Covalesky (sister), partial distribution 11,690.45
Estate ofPetronella Covalesky, final distribution 1,038.50
Erie Insurance, refund 273.00
Sprint, refund r '
11.37
MEGA Life, required IRA distribution for 2003 ~ .~ ~. 678.00
Cash in safe deposit box 9.56
One 1901 $10 gold piece, fair condition 200.00
Total Personal Property $ 44,634.76
(Attach additional sheets if necessary) Total Personal Property and Real Estate $10 2 ~ 657.76
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of LOZIER, ROSEMARY C. No. 21 - 03 - 00863
also known as Date of Death 10/17/2003
, Deceased Social Security No. 006-26-6765
Real Estate
One-half interest as tenant in common with Donald C. Lozier in real estate at 718 Olson Drive, 58,023.00
Calrisle, PA, Parcel #06-19-1641-091; Deed recorded in Cumberland County, PA, Deed Book
"T", Volume 26, Page 269. Value based on one-half of assessment of 110,520 x 1.05 common
level ratio (116,046.00)
Total Real Estate $58,023.00
COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003444
DUPLICATE
FOWLER JOHN B III
10 E HIGH STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $7,080.87
ESTATE INFORMATION: SSN: 006-26-6765
FILE NUMBER: 2103-0863
DECEDENT NAME: LOZIER ROSEMARY C
DATE OF PAYMENT: 01/1 6/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 1 O/17/2003
~-' TOTAL AMOUNT PAID' $7,080.87
REMARKS:
CHECK# 1 O4
INITIALS: AC
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF [HD[V1.DUAL TAXES DEPARTHENT OF REVENUE
I'NHER]'TANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA ]7128-0601 HOT[CE OF THHER]'TAHCE TAX
APPRAI'SENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTTONS AND ASSESSMENT OF TAX REV-~?EXA¢~ ¢o~-o~
DATE 05-22-2004
i:~': :~ ESTATE OF LOZIER ROSEHARY C
DATE OF DEATH 10-17-2005
FILE "UNBER 21 0:5-0863
'0~ [~R 19 ,/~]] :~.2 COUNTY CUMBERLAND
JOHN B FOWLER III ESQ ACN 101
MARTSON ETAL Amount Remitted
10 E HIGH ST
CARLISLE PA 1~,0~1~2:.; ,~ ~ ~
HAKE CHECK PAYABLE AND RENIT PAYNENT TO;
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF LOZIER ROSEHARY C FILE NO, 21 0:5-086:5 ACN 101 DATE 03-22-2004
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON.' ORIGINAL RETURN
1. Real Estate (Schedule A) C1) ~8t02:5.00 NOTE: To insure proper
2. Stocks and Bonds CSchedule B) C2) .00 credit to your account,
$. Closely Held Stock/Partnership Interest (Schedule C) C$) ,00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) Cq) .00 of this form w/th your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) CS) ~63~.76 tax payment.
6. Jointly Owned Property CSchedule F) C6) 21r645.79
7. Transfers (Schedule G) C7) 61~911.3:5
8. Total Assets C8) 186,214.88
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H)
10. Debts/Mortgage Liabilities/Liens CSchedule 1') (].0) 911~7.88
11. Total Deductions Cll) ~.~- ~
12. Net Value of Tax Return C12~ 162,752.5~
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) C15) .00
14. Net Value of Estate Subject to Tax C14) 162,752.5~
NOTE: If an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 wtll
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L/ne 1~ at Spousal rate C15) .00 X O0 = .00
16. Amount of Line 1~ taxable at Lineal/Class A rate C16) 161,2:51.7~ x 0~5 = 7,255.~:5
17. Amount of Line 14 at Sibling rate C17) l,O00,O0 x 12 = 120.00
18. Amount of L/ne 14 taxable at Collateral/Class B rate C18:} 520.80 X 15 = 78.12
19. Principal Tax Due C19)= 7,45:5.55
TAX CREDITS:
PAYNEHT RECE ~'PT DI'SCOUHT C+)
AHOUNT PAID
DATE NUHBER I'NTEREST/PEN pATD
01- 16-2004 CD003444 :572.68 7,080.87
TOTAL TAX CREDIT I 7,45:5.55
I
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
[F PA1.D AFTER DATE INDICATED, SEE REVERSE ( [F TOTAL DUE [S LESS THAN ~1, NO PAYHENT [S REQU1.RED.
FOR CALCULATION OF ADD[T1.0NAL 1.NTEREST. [F TOTAL DUE [S REFLECTED AS A 'CREDIT' (CA}, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12
(For Resident Decedents Dying After July 1, 1992)
Name of Decedent: ROSEMARY C. LOZIER
Date of Death: October 17, 2003
File No.: 21-03-0863
Social Security No.: 006-26-6765
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 x No
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 personal representative file a final account with the Court?
Yes No x
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 x No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts
~ may befiled with the Clerk o, fthe Orphans'Court and may be attached to this report.
ta_,~ Oa~' DecOr 2~/, 2004 Signature: . ,/~
t._,_ t,. ~a: c>c.' ,--. Name: ...... '"' JO~-'"l~. 16owler, HI, Esquire
C~ el;L:, ~- c,o ~:-~q Address.','"' .' MARTS ON DEARDORFF WILLIAMS & OTTO
k~: -~ ~ uq ~ :,:: ~, .... ..,' Ten East High Street
c_)~_~ (/: Carlisle, PA 17013
~ ~ ~ O~ (717) 243-3341
~ Counsel for personal representative
F:~ILES~ATA~LE~STATESXI0110. l.sr~