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HomeMy WebLinkAbout04-0897 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: - - Register of~Wills fol' the. Dec a ed. County off~_,...,,.4x.~,~--~ in the Social Security No. 0~'~ I ~-~ ~'" ~'~('~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ~'6- named in the last wilt of the above decedent, dated OX3~r~ '~/~'t '?~,d.~t.~ and codicil(s) dated / / (state relevant circumstances, e.g. renunciation, death of executor, etc.} Decendent was domiciled at death in ~__~.~L~.~-~ County Penns,,lw,,io h ~t-~ _..~ast f,atmlly or pnnc~lpal residence at ~,-~:~ ~, T~,'~a _ ~~[ ,.) f (list s4et, number and muncipality) x.. .... ~ . Decendent, then ~'"l years ofgge, die.d (k/k.~-vl ~0 at ~4~t-'~_ ,, ~ k~_ k:,~f:~-, ' ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ iK-~/ (If not domiciled in Pa.) Personal property in Pennsylvania $ - (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ ~ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the;!:'iast will~_~nd codicii(s) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c. La.) .? OATH OF PERSONAL REPRESENTATIVE CO ONW A TU OV NNSY VAN COUNTY OF Q ~ ~..(b_~'~.,~..~]~..~ ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribedc M t-,*." . c~ before me this day of [ - " c~- 19 l ~ Register ~ .. . Family Settlement Agreement File No. 2004-00897 THIS is an agreement entered into this ~t::J day of June, 2007, by Ann G. Flatley, 303 South Ridge Road, Boiling Springs, PA 17007, Beneficiary of the Estate of Thomas W. Flatley, Decedent, whose name is set forth as signatory at the end of this Agreement, with the separate signature page returned with Release and Indemnification. WITNESSETH: A. Thomas W. Flatley, 303 South Ridge Road, Boiling Springs, PA 17007, died on May 10, 2004. B. On October 4,2004, Letters Testamentary were granted to Ann G. Flatley at File No. 2004-00897 in the Register of Wills Office for Cumberland County, Pennsylvania. C. The Executrix has administered the estate until the present time and has paid all debts of the estate, there was no inheritance due. D. Decedent died testate, providing for the residue of decedent's estate to pass to his wife, Ann G. Flatley. E. The assets of the estate total $14,038.00. F. The expenses of the estate total $4,557.24. G. Distribution to beneficiary is the entire assets minus expenses. NOW THEREFORE, the said party intending to be legally bound sets forth the following: 1. Executrix of the estate of deceased need not file a formal accounting or schedule of distribution. 2. No Inheritance Tax was due. 3. The beneficiary has taken possession of all assets in accordance with the will. 4. The said beneficiary acknowledges that this Final Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the estate of decedent Thomas W. Flatley. \ ~ (~) {.'~~ L1..J =--: <;2 :.~;: u- .-- u.... I ' .. C) C) c~ n:": u..J U.J C)~_--.:; %?] ~~, cc M N ::c: 0... IJ') I ...-J ::;) -, ,.... c::::>> c::::>> C'J (f; r- 0:: __.: . =)l~. U-OC 0(.) ~U) o::=-- u.J :2- -C:C' -1::I~L. U -LC &~:~: oS U L>'- IN WITNESS WHEREOF, the Executrix/Beneficiary, intending to be legally bound hereby, sets her hand and seal the day and year first above written. WITN ./... a",.. j1. 07..r'~~.LS Ann G. Flatley, Executrix & Ben ciary 303 South Ridge Street Boiling Springs, P A 17007 Estate of ~,~fs.<~ ~. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 19 , 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 described therein be admitted to probate and filed of record as the last will of and Letters are hereby granted to Register of Wills FEES Probate, Letters, Etc .......... $ ~0.00 John H. Broujos, Esq. ~06268 Short Certificates(~. ......... $ [ ~e~'-,OO ATTORNEY (Sup. Ct. i.D. No.) R~n ..~..-.~.~.~.... $ (~'OD 4 N.Hanover St, Carlisle,PA 17013 ~s,,~, ~ ~.a..e.z.._ $ {0. ~ ADDRESS TOTAL_ $ 717-243-4574 Filed ................................... PHONE This 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. P 203271 2© No. '~ ; ~]~ate I H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH ° VITAL RECORDS ~,~r CERTIFICATE OF DEATH STATE FILE NUMBER IN NAME OF DECEDENT (Fiat. Middta, La~t) [ SEX [ SOCIAL SECURITY NUMBER [ DATE OF DEATH (l~th. Day. Year) CKINK 1. Th(~ W. Flatley [2. Male 3. 081-- 32- 5086 4. Ma)/ 10, 2004 I Months IOl~ I Hou~ ] IVlnute* ] (Month, Dly, Year) [ Smta(xFMeignC~u, nby) IHOSPITAL: IOTHER: ~1 w, [ [ ] [ ~lav 26-1922 ] New York Czty [ ,.~.,.~ [] E,,,o,,~ [] oo~ [] [ .-~, r-~ _ m o,~ n s. -- ' I I I [ .~'~' ' I?. NY I 51 ~ Cumberland ~.Carlzsle ~.Sarah Todd Memorial Horae ~.x~..,'~,~.~. ~0. Whi~e .. Thomas William ~la~ley p~. Margare~ Cm'~ningham INFORMANT'S NAME (TyI~) INFORMAN'PS MAILING ADDRESS (S~eet, City.fromm. State. Zip Co~e) ~.. Ann G. F].at].e¥ ~. 303 South Ridge Rd. ~ Boilinq Sprinqs~ PA 17007 ~,~r'l ~, r~c~ [~.~,~s~ta [] I~,-~.~,.,-~ I~°~''"~" I ,,~ ~ o~.(s,~) _~ .-? .-? [][,,,. May 18, 2004 ],,¢.West Point Cemeter7 [,,,. West Point, NY 10996 ,e"~Ep~_~)U~SE~V,C~,C/~E~O~.~6j~T,N~SSUCH ]UCE"SENUMSE, ],~ME*NDXDORESSO~F*C,UTY Hoffman-Roth Funeral Home ~ ~'/~ ~-e,-~l~ I~,,. 010343 L 1,~. 219 North Hanover St., Carlisle. PA 17013 C~,'~#em~23a~e~he.~erm~.g ~' [;%~et~t~.W~de~h occ..~dm~m.e, datma.~ pmcem~. ] UCENSE NUMBER ]DATESlGNED PtYtM:Mnmnol~vlltabtamtiml~demth~o l(81gn.m..encllJl~l) _ D / / -- I ~ - ,..--*~ .. I(Iwmth'D'y,YMr) ~.AUSE ([XI, i~se oi' injury c. nmdlk~ on delth ) I..AST ~ To the be~t m' my knm,4e(Ige, d~.th ~cuwed ~ the tim*., d.a, ~ld ptace, e~ld due t~ th U On the bm~ta °f mmmlnatl°~ and/°~' InvNflgafl°~, In mY oplnl°~, dealh oe-cul~rmd at the time, da", and Nmoe, and dura to the ~au"'(') and ~3~~--:-~ - --'*- ~' '- '-'q--~ ........................................................................................................................................................... LI ~2. Will I, Thomas W. Flatley, of 303 S. Ridge Road, Boiling Springs, 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 gravemarker 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 lwo: I bequeath my household and personal effects, and other tangible personalty of like nature (not including cash, securities, or choses in action) together with any existing insurance thereon, to my three children Mary Alice Manser, Thomas Paul Flatley, and Margaret Flatley, to be distributed and conveyed to the three named children as to the ite~ns, value, and number as my wife Ann G. Flatley shall determine as she decides in her absolute discretion, which distribution may be of uneven value. This specific bequest is, however, subject to a license which I hereby grant to my wife Ann G. Flatley to the personal use and the enjoyment~,o/[ such items of my tangible property as she may select during her lifetime. Item Three: I give and bequeath my 2000 Chevrolet Impala to my wife Ann G. Flatley. 517>. Item Four: I give and bequeath the residue of my estate of every nature and wherever situate'-'5 to my wife Ann G. Flatley providing she shall survive me by 60 days. Shoul&fia,'~ wife Ann G. die before the 60th Flatley predecease me or on or day following my death, I the residue of my estate of every nature and wherever situate to my issue, sha~e and share alike: per stirpes, living on the 61st day following mY death. ~{ Item Five: I appoint my wife Ann G. Flatley Executrix of this my last will. Should~she fail ~'"~ to qualify or cease to act as Executrix, I appoint John H. Broujos, Esquire, to act as Executor with the same rights, powers, and duties. .:-~ Item Six: All estate, inheritance, succession, and other taxes, imposed 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 propert:/passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. Rem Seven: 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 Ei~lht: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executrix during the full time necessary for the administration of my estate the following rights and powers to be exercised in her sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as 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 ~ day of March, 2004. Signed JJ/5-° ~vt'~' kO C~'- '~' ~}-~-~,~>~\\ s.~x Thomas W. Flatley ~ g,~oco q.-jo/~x The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testator was on the day and date thereof signed, )ublished and declared by the Testator therein named as and for his last will, in the presen~ ( ~_.~.s, who ~.hi~quest, in his presence and in the presence ofeach other have subscribed o~'~ ~4_es..x \xx}x. j __ COMMONWEALTH OF PENNSYLVANIA : : ss COUNTY OF CUMBERLAND : We, John Iq. Broujos and ~x3~ ~ ~ ~"l"~u );'~, witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last will; that he signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at the time l 8 or more years of aae, of soun~d under no constraint or undue influence. ~ ~_~)=~_ x ~~ Sworn and subscribed to before '~~ )'/~ me this ~¢P' day of March, 2004. · N(~FARy ~UBLIC Notarial Seal Bridget Ann Corcorau, Notary Public Cealisle Boro, Cumberland County My Commission Expires June 10, 2006 Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA : : ss COUNTY OF CUMBERLAND : I, Thomas W. Flatley, 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. Thomas W. Flatley, Testator Sworn and affirmed to and acknowledged before me this c.~(afL day of March, 2004. Notarial Seal Bridget Ann Corm, Notary Public Carlisle Boro, Cumberland County My Commission Expires June 10, 2006 Member, Pennsylvania Association of Notaries Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 01/10/2005 BROUJOS JOHN ESQ 4 N HANOVER ST CARLISLE, PA 17013 RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 01/14/2005 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, GLENDA Clerk of the Orphans' Court Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 01/10/2005 ANN G FLATLEY 303 SOUTH RIDGE ROAD BOILING SPRINGS, PA 17007 RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 01/14/2005 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge Sincerely, GLENDA FARNER STRASBA~dGH Clerk of the Orphans' Court IMPORTANT NOTICE REQUIRED BY LAW 5.6 NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS EST ATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, P A In re Estate of Thomas W. Flatley, deceased, Estate No. 21-04-0897 TO: Margaret R. Flatley 320 Juniper Street Carlisle, PAl 70 13 Mary A. (Flatley) Manser 324 West Dewey Avenue Wharton, NJ 07885 Thomas P. Flatley 20 I Bradley Avenue Bergenfield, NJ 07621 Please take notice of the death of decedent and the grant of letters to the Personal Representative(s) named below. The Decedent, Thomas W. Flatley, died on the 10th day of May ,2004 at 303 S. Ridge Street, Cumberland County, Pennsylvania. The Personal Representative ofthe Decedent is Ann G. Flatley, 303 S. Ridge Road, Boiling Springs, PAl 7007 (717) 258-6845 The Decedent died testate (with a Will). The Will has been filed with the Office of the Register of Wills of Cumberland County, I Courthouse Square, Carlisle, PAl 70 13. No. 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. The assets of the estate were held jointly by Tom Flatley and Ann G. Flatley as tenants by entireties, which means by both husband and wife wit the survivor A . Flatley taking the entire estate by operation oflaw. \ Date: January 27, 2005 Signature: "" , '..J Name: John Broujos, Esquire #062 8 Address: 4 N. Hanover St., Carlisle, P A 17013 Telephone: (717) 243-4574 Capacity: Counsel for Personal Representative ,.... '7 U1 IT' U1 l:(J ~ L~::~i:;:tlIJ.W:'lljU1mE : --- -~~stag:T~- CJ Cllrtified Fee! g (End~~~u..:~~e~~~~i~~) L CJ Restr'cted ["3Iivery Fee F'"""=I (EndQfSemenj Required) CJ M Total Posta ,e & Fees $ .$. ~ostal SerWiCeTM I IFIED 'ILM RECEIPT ~ e MsiIOnly; 0 Insurance Coverage Provided) Postmark Here OL/-yn entT"1\: G V sr~;~:~~~:~C~-~\;\--~::::ra:;:::::::::: J Certified Mail Provides: . A mailing receipt . A unique identifier for your mail piece . A record of delivery kept by the Postal SeNiee ror two years Important RemInders: . Certified Mail may ONLY be combined with First-Class Mail" or PriorIty Mall$. . Certified Mail is not available for any class of international mail. . NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. 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Internet access to delivery Information is not available on mail addressed fo APOs and FPOs. (aSJaIl8H) zoo;:: aunr 'ooss WJO:;j Sd Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 ! Date: 3/29/2006 BROUJOS JOHN 4 NORTH HANOVER STREET CARLISLE, PA 17013 RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 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: 5/10/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 ANN G FLATLEY 303 SOUTH RIDGE ROAD BOILING SPRINGS, PA 17007 RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 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: 5/10/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugn Clerk of the Orphans' Court cc: File Counsel Register of VI ills of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 IllC j\\tt '~' \i\J{( (,-,;11 ,'c((liJ . IC, ~~C~~ <9uYI - L-C 'Sc (' ( F(o+(( ( \ ----/ Date of Death: Estate No.: 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 a~tration of the estate is complete: Yes 0 No IZI 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: A (([Jet /';>t (Ii i' -QcY)(, 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 0 No 0 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 c. Copies of receipts, releases, joinders d approv accounts may be filed with the Clerk of attached to this report. Date: {I \~L(} {tc, . {)((( /\ ..J /' ~- (C' . c; ~_, ot, \n Name 4 }\jDr~ h l-t~1CI{~\{~C' Sf , (\1 r ( I ;0 (c11 VA: I ~7 () I .~ Address t-( I f1' <,~Lt 3 ,,' Lf~) 7L/_ Telephone No. r os / Capacity: EdPersonal Representative o Counsel for personal representative nJ RE'v-1500 EX + (6/0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C w u w Cl w >- ~::!;CIl ~It:~ () a. () woo J: 1t:...J () a. lD a. <( DECEDENT'S NAME (LAST FIRST. AND MIDDLE INITIAL) Flatle , Thomas, W. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OFFiCIAL USE ONLY FILE NUMBER 2 -04 0 8 9 7 ~Ti""CCSE ~,{:,~ - - ~R-- SOCIAL SECURITY ~JUMBER o 8 1 - 3 2 - 5 086 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12.13.82) D 5 Federal Estate Tax Return Required _ 8 Total Number of Safe Deposit Boxes D 11 Election to tax under See. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN H BROUJOS, ESQUIRE 4 NORTH HANOVER ST FIRM NAME (If Applicable) BROUJOS & GILROY, P.C TELEPHONE NUMBER 717-243-4574 OR 717-766-1690 CARLISLE PA 17013 z o i= <x: -1 ::) I- 0:: <x: u w 0::: z o I- <x: I- ::) D.. ~ o u >< <x: I- 05/10/2004 OS/26/1922 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST A.ND MIDDLE INITIAL) Flatle , Ann, G. [XJ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of IJ!III) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death aher nI2-82; D 7. Decedent Maintained a Living Trust (Attach copy ofTru,,) D 10. Spousal Poverty Credit (dateofdeatll ber"een 12-31.91 and 1-1-95) OFFICIAL USE ONLY 5,78800 8,250.00 >- Z W Cl Z o a. CIl w a: It: o () 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 1 (\ \.U (8) 14,038.00 3. Closely Held Corporation. Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (6) (7) 4,55724 (11) (121 (13) 4,557.24 9,48076 9. Funeral Expenses & Adrninistrative Costs (Schedule H) (9) (14) 9,480 76 10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10) 11 Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) Surviving Wife - No Tax X -0- 16 Amount of Line 14 taxable at lineal rate X 17 Amount of Line 14 taxable at sibling rate X 12 18 Amount of Line 14 taxable at collateral rate X 15 19 Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <: <: c (15) 000 (16) (17) (18) (19) 0.00 Decedent's Complete Address: STREET ADDRESS 303 South Ridqe Road CITY I STATE I ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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 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 the interest on the tax due (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 000 0.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and 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? .. ............ Yes No .....0 0 0 0 0 0 0 0 0 0 0 0 0 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury I declare that I have examined this return, including accompanYing schedules and statements and to the best of my knowledge and bel,ef it IS true. correcl and complete Declaration of preparer other than the personal representative IS based on all Information of which preparer has any knowledge ADDRESS DATE 7/11/2006 PA 17007 DATE 7/11/2006 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 PS S9116 (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 PS S9116 (a) (1.1) (il)] 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 PS s9116(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 45%, except as noted in 72 PS S9116(1.2) [72 PS s9116(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 PS s9116(a)(13)]. 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 RE v-1503 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Flatley, Thomas, W. FILE NUMBER 21 04 0897 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 5,78800 Equitable Stocks, 136 Shares TOTAL (Also enter on line 2 Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 5,788 00 REV-15G8 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Flatley Thomas. W. 0897 FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION 2000 Chevrolet Impala Sedan 40 VIN #2G1WF52E7Y9166573 2 VALUE AT DATE OF DEATH 8.250.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 8,250.00 RCY1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Flatley. Thomas. W. FILE NUMBER 21 04 0897 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES 1 Hoffman- Roth Funeral Home, Inc. 6,908.80 98444 Insurance 5,824.36 County of Cumberland 1 00.00 5,92436 2 Wayne Noss Flowers 199.80 B. ADMINISTRA TIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Add ress City State Zip Year(s) Commission Paid 2. Attorney Fees Broujos & Gilroy, P.C, 4 N Hanover Street, Carlisle, PA 17013 750.00 3. Family Exemption (If decedent's address is not the same as claimant's, attach explanation) 2,50000 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 81.00 5. Accountant's Fees 6 T ax Return Preparer's Fees 7. 8. Register of Wills - Inventory filing fee 10.00 9. Register of Wills - Inheritance Tax Return filing fee 15.00 10. Register of Wills - Family Settlement Agreement 17.00 TOTAL (Also enter on line 9, Recapitulation) $ 4,55724 (If more space is needed. insert additional sheets of the same size) 08-28-2006 FLATLEY 05-10-2004 21 04-0897 CUMBERLAND 101 APPEAL DATE: 10-27-2006 ( See reverse side under Objections) A_aunt Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- iEV:is47-EX-AFP-ioi:osi-NOYiCE-OF-iNHEiiYANCE-YAX-APpiAiiEMENY:-AiioWANCE-oi--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX THOMAS W FILE NO. 21 04-0897 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 210601 HARRISBURG PA 17121-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE r;r(".'~"""'T''''''[['/'"\[ ("',. ';I':',j...' "I.)n' i..)rNOJ[CEii OF INHERITANCE TAX ,.'~ ~'PJAl:SEH~'; ALLOWANCE DR DISALLOWANCE , " 'oFDEDOc'TIoNS AND ASSESSMENT OF TAX 20D5 MJG 28 1='(112= 05 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JOHN H BROUJOS ESQ BROUJOS I GILROY 4 N HANOVER ST CARLISLE cc:: 01 I......", PA 17013 ESTATE OF FLATLEY *' I REV-1S47 EX AFP (06-05) THOMAS W TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED DATE 08-28-2006 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estete (Schedule A) 2. Stocks ~ Bonds (Schedul. B) 3. Closely Held Stock/Pertnership Interest (Schedule C) ~. Hortgeges/Note. Receivable (Schedule D) 5. c.sh/Benk Deposits/Hisc. Personal Property (Schedul. E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 5.788. 00 .00 .00 8.250.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expen.es/A~. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Ch8ritable/Gover~tal Bequests; Non-elected 9113 Trusts l~. Net Value of Estate Subject to Tex 41557.24 (9) (10) .00 (11) (12) (13) (l~) (Schedule .J) NOTE: To insure proper credit to your eccountl ~it the upper portion of this for. with your tax pey...,t. 141038.00 4.1;1;7 ~4 91480.76 .00 91480.76 NOTE: If an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. AIIount of Une 14 at Spousel rate (15) 91480.76 X 00 = .00 16. AlIOUnt of Line l~ texable at Lineal/Class A rat. (16) .00 X 045 = .00 17. AllDUnt of Une l~ at Sibling rete (17) .00 X 12 = .00 18. AlIOUnt of Line l~ taxable et Colleteral/Cless B rete (18) .00 X 15 = .00 19. Principel Tax Due (19)= .00 . . DATE INTEREST/PEN PAID (-) AMOUNT PAID NUMBER TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) 1 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) cumberland County - Register ur Wl~~o One Courthouse Square Carlislet PA 17013 Phone: (717) 240-6345 Date: 4/24/2007 ""',"1 ANN G FLATLEY ",) .. 303 SOUTH RIDGE ROAD BOILING SPRINGSt PA 17007 (!'1 ._,J RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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: 5/10/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 4/24/2007 r-,..3 BROUJOS JOHN j,) 4 NORTH HANOVER STREET CARLISLE, PA 17013 (,;1 -,-J RE: Estate of FLATLEY THOMAS W File Number: 2004-00897 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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: 5/10/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ~~ Pa. O.c. Rule 6.12~US REPORT REGISTER OF WILLS OFC.~ ~ I 'COUNTY, PENNSYLVANIA " Date of Death: ~i\~)~ "^-) \ G . ~- t?~ File Number: ~~ -Z -J 60-0 ~.::1 Name of Decedent: Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . ., . . . . . . . . .. DYes q. \)v..D m-No 2. If the 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?' . . . . . .. DYes 0 No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . DYes 0 No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. 5.3,07 .~~ :-- rson Filing this Form Dace c.., Capacity: [i,J.1ersonal Representative DCounsel c 0.... ~ ~ ~ ~ -4-- .?'I~/f'rt }!O> Name of Person Filing this Form \ t-t- N, ~.. AJA....Q..,J- 5J.-,. Address~ ~ ~..^^\~CQ /. \'1D\S ~,~~ ('..J ; .- Telephone FormRW-l0 rev. 10.13.06 <r;; L.u C) tJ_. U,. '-..--' C.::: ~~=-:'; cc r-- c:. ill c: Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS O~JVVV':: ~ ~tiLl COUNTY, PENNSYLVANIA Name of Decedent: '--, \\. "\A V""""7 ~ ~~ \ \ L..L>~ile Number: '-'2. 0 oa.\- 60 XC\ 7 Date of Death: pursuant to Pa. a.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . . . ~s ONo 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? . . . . . ., DYes IlI}N 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account ../:' 11 th .., ? . m~ Inl.orma y to e partIes In Interest. ............................... u.n es DNo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dale 7 S". () '( o Capacity: Personal Representative [jJcounsel J c \" , ,~. .~ t:? r" d~t::;.: Name of Person Filing this Form L:y' ~ ~~OAr-- ~. Address ~\-:.~\.c- ~ D()~$ I \/ -z.q-~ ,\ '--'7J.J- \ J : f...- ~ ~o..: 0:: =,)C.. LLOC OU,' ::>:::: '-:-C' cr:: Cf) ,: LlJ :::...,. <i -,:? c~; uIt;, o..u o:~ 0-'" B Telephone M %: ~ lJ') I -I ::::> -, l"'- e:::;, c= C"-l Form RW.IO rev. /0./3.06 a. ,