HomeMy WebLinkAbout09-04-13 (4) J 1505610105
R�v-isao���.,,,«}�,
PA Department aF Revenue P�Yt� o�FiCIA�u8E di�Y
Bureau of Indtvldual Taxes '"""�1°�""�"� County Cade Year File Number
vo eox zeosos INHERITANCE TAX RETURN j �j q �1 "°
HarrNSbixg,PA i7u8-o6pi RESIDENT DECEDENT � Oi� : �I�i . : �� ���
EN7ER�CEDENT INFORMATION BEL�H
Social Se�wwrity Number pate of Daeth MMWYYYY date of Birth MMPDYYYY
� _. _..._. _ . __._. _.. . .. _... _...
12114t2012 Q9l3911919
_.�. _. _ _ _..__ _._ .___. _ . ___ —.. . ___
f)eceden#'s Last Name ��� Sulflx Decedent's First Name MI
.__.. ..._. ....... ,.,..... ......... . .__.. ._._ ....._ __.. ........ . ...._.,....
! Cox Katherine ' C
_._ _.. __ _ _ _ _ __.
(t►Ap�lubiej Er#sr SarvivEnp Spoup's Infortnatlon BQIow
Spouse's Last Name Suflix Spouse's First Name MI
__ _._� ,m __ . ��...._,_._._.._ ,_.... � ____ .--- . — ' -- --_. . . :__. s
Spouse's Socisi Securtty Number 7HIS RETURN MUST BE FILEp IN DUPUCATE WITN THE
� < REGISTER OE WILtS
�u�+nr+�ROPeur�avn�s ee�aw
f� 1.Original Retum p 2.Supplemental Retum O 3. Remainder ReWm(Dete of Death
Prior W 12-13-82)
t� 4.Limtted fstete Q Aa.Future Intere�Cw�ranise{dete of p 5. Federei F.staua 7au Retum Requir�7
death�ter 12-12-82)
{� 6.pecedent Died Tesiete p 7.DecadeM Meintained e Living Trust 0 8. Tofal Numberr of Safe 6eposit Boxes
(ANech Copy of Wilq (Attach Copy M Truat.j -
C� 3.t.itigetion Proceeds Iteaeivad O 1Q Spotu3el Poverty t�dit(Date��ath p 11. Eladbn�Tax ura�r Sec.5113(A}
Batween l2-31-91 arM 1-1-95} (Attach Schedule O)
CORRESPOq�ENT- THIB SECTION MIl&T BE COMpLEiED,ALL CORRESPWIGENCE AND CpNFlDENTIAL TAX INFORMATION SHOULD BE DqtECTED T0:
Name QayEittre Telephone Number
___ ___... _.... .__.... .__ ......... ..__ ._. .._ .__. _._..__.
t Oavid G. Cox �; ;(717)58q§338 , �
_. .
_. _ �
. � ... . W�..... . _�. . ,w� _
REO FlNLt8 EO �
� 7s 1'�� �' t�7 .�1
I� First Line of Address �
. . __ A � rn __, Ca
;509 Jayce Road a �=' n � z` �
Second�LineofAddress .... ,..... .._ � ._ ... . n � 4 -b �. �
, .... .... .. .,.,.. .... _. O C '� � �t �'T
i � � ti, 'T I
; .��. -p —t y.,_, r;;_ cj
. _........ _..,..._ . ._ .....� � DA7E t•- �'''T
CitynrPaetOflice ...�. ..... .,.... ___ Stste ZiP,COde _ . �
. . _. . .. .... � '�7
j Camp Hill , PA =17011 �
Cormpond�nfs rmail addraar:dcox5l(�comcEist.net
Unaar OeneMktl of PMury�1 dsde/e Vwl I heve exrnlnetl We isWm�Mudrig accanPe�Yln6 salreaAee and elaMmxtls�ana to the baet of my WpvAedge antl beliei.
ft N We.sdt6et anC art�.OsdrBtllM at pepater atlfar�the Penonai repr�tl'�e N 6med on aN MamsYan�xfi�psparer hm a�+Kro+Ne�e.
3 RE�R9`Ati i� `IBIE FOR FiIIMC,RETURN �A 3 �
G�. ���� "'
AD SS
5Q9 Joyce Raad, Camp Flili, PA 17011
3IGNATtlRE OF PREPARE:R OTHER THAN REPRE3ENTATtVE DATE
ADDRESS
r��usE o�e�oiru�.Foier�oe�r
Slde 1
L 15056101C15 1505610105 �
Q'"'�
I
J 1SD5611]205
REV-1500 FJ((FI) piq�e�Ys Sociaf Security Num6er
oeceaams Narr�: Katherine C. Cox
RECAPRULATION
1. t2e�E�{sct�edcde A}. ............................................ i. D.00
2. Srodcs and Baas(schedu�e e) .. .... ................................. 2. 40�628.9�
3. ClcrseN F�Id Corpaation,P�tr�ership oT�rn�e�rship(Schedule C) ..... 3. 0.40
4. Martgagas ard Notes Rer.�ivable(Sdiedule D).................... ....... 4. ' 0.00
s. Cash.eardc Deposits atW MisceNaner.ws Personal Rioparty(Sdiedufa 6)....... 5. 10,287.23
6. Johitly Owiwtl P�operty(Schedule F) O Separate Bflling Raquested ....... 8. 0.00
7. ir�r-Yrvas Trarrsf�s& ti�-Probate Property
{Sdiedduie G} O Sepflrs[e BiRmg Requestecf..,,.... ?. 2$�$99.55
8. TaAN Cross Asaed(rotal unes 1 thrnugn 7)............................. 8. 79,615.75
s. Furrer�E�+nses az�d RdmirKSo-aiive coats{sd�eou�e H)................... s. 5,940.63
'lo. Uebts of Decedem.Matgaga Liabilitles and Liena(ScFiedule I)............... 10. 644.35
11_ Tow o.d�Ctwn�{whai tirres s ana ta)................................ . 11. 6,58t.9B
t2. Nat Value of 6sute(13na 8 minus Una 1t).............................. 12. 73.03077
13. Charifa6te and Govemmentel BecWestalSec 9113 7n�ats far which
an election ro tax has rwt bean made(Schedule Jj ........................ 13. 0.00
14. N�t Whr 8ud�et to T�ut(Une 72 minus L'me 13) ........................ t4. 7$.Q30.77
TAX CALCU(AT10N-SEE�TRUC7H7N�FOR APPtICABF.E RATES
15. fVtpunt of Line 14 ta�ble
at the spougal taz rate,ar
trarrefe's uMler Sec.9tt8
{ax12)X.4_„ 15.
16. AmourR of L'me 14 taxabie
at IG�eal rate X.0 45 73,030.77 �g, 3,286.3$
1T. Amount d i.in9 14 taxeMB
� �s�reg rote X.12 17.
� 18. MI%wM of Litle 74 taxaWe
� at adlaferal rate X.15 18.
19_ TJ47C WIE.............. ......................... �9. �.286.�
..................
20. fl119i iHE OYAt�'Y<N!ARE REQUE$TING X REFClNO OF AN OYERPAVIi�NT Ci
Side 2
� 1505610205 15Ll561�2175 J
REV-75W EX(FI) Page 3 Ffls Numher
t)ecedenYs Ca»piete Addt�sess:
�
lCatherine C. Cox
srREEtnoottESS -_ _ _ ------- —
CouM�y Meadoyrs�Vltest Shore
4905 E. Trindle Road,Apt. 35, Bldg 1
-. � _
� STA'(E —Z
�cF�e�+c�bur$ PR 17050
Tax Payments and Gredits:
t. Tax Due{Page 2,Line 19} {t} 3,286.38
Z. Credits/Payments
A.Priw PaymeMS _. 3,100.00
B.Discamt 174.00
7otal CrediGS(A+8} (2) 3,274.00
3. Interest
(3} 0.44
9. tf I.�2�greater ft��r�1+lir�e 3��ter the�ifer�e. Shis is#!�4VERPAVk�NT.
FlII in ovai on Paps 2,Line�0 W requeM a retund, i4) 0.00
5. It Line 4+Une 3 is greaUSr t!�Lme 2,entar the diflerence.Th�is the iAX pUE. {5} 12.38
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE AHSWER THE fOtLOVMIN�QUEST#QNS BY PEACING AN"X"IN THE APPROPRIATE B��KB
1. 6id decedeM make a firamfer and: Yes No
a. retain the use a incMne of the prpperty trerrsf�rred................................................................................._....... ❑ �
b. retain the ttght M desi�na�wha shaA use the proparty tr�s�rred or its ina�me................_.......................... � �
c. retain e reversionary intersst..............................................................................._......_...................,................. 0 �
d. receive the promise for liFe of either payments,be�fiGS a care?....................................................... ❑ �
2. If deatlf UCCUrted aiFer Dec.12.t982,did dece�leM hansfer pfaperty w�lhin one year ot death
witlwutreceiving2dequ8�catsider�tion?...............__.....................................__._....._......__.................,_.......... ❑ �
3. Did decedeM oxm an"in trust tor"or payable-upon-death bank account a securiry at his or her death7.............. � ❑
4. Did decedent own an individual retfrement account,annuiry ar other non-probate property,which
� ca�tains a ba�fiaary t�ignatmn? ............................ � ❑ i
IF THE 11NSNIER TO ANY OF TNE ABOVE WES'CIONS IS YES,YW MUST COMPLETE SCHEDULE G AND FlLE IT AS PART OF THE RETURN.
. '� C .
Fot dstes af d�h on or�r Juiy t,7�J4,�rd before Jan.t,t996�tlre ta�c rate imposed on the r�et vaWe aFfr�s#ers ta�fw the use of the surviving spause
is s per�en�p2 P.s.gs��s(a)(�.�)i�)]
for dates ot death on or after Jan. t, 1995, the tax rate impased on the net value of transfers ro or for tl7s use of the survlving spouse fs 0 percent
(72 P.S.§911fi{a)(1.1}(a)].The staiu�tbes rwt rrater�t a tranafer�a survivir�g spouse fran t�,and Me statutay requiremeMs#or discbsure of as,gets and
fiNng a tax retum are still appiicaWe even ff the surviY�ng spouse is the oniy b�rietciary.
fa dates M deaUi on w after Juy 1,20(%1:
. The t�r�impased on tl�e r�eE v�e�trsns(ers tr�a deceased ch�#2S ye�s��w at�ath ro or�ttse use of a naWrai�t,�
adoptive parent or a stapparertt af the driid is 0 perceM[72 P.S.§9116(a}(12)].
. The Tax rate imposed on tlie net value of hansfers ka a for the use of the decedenPs lineal benefidaries is 4.5 peroant,except es noted in�72 P.S.§9116(a)(1)j.
. The t�rate imp�sed on tlse net va�re of to ar far the use of the deced�fs�b�gs�12 perce�it(72 PS.§91f6{s}{S.3)�.A�ing�de�,
under SecOar 9102,as an individuai who has at ieest one parer�in common with ihe decedent,wheMrer by biood or adoptlon.
- I ����IIII
F�Y-t5o3IX+{8.yt)
�pennsylvania SCN�pYL� B
���� ST�3CKS ,& BONDS
INHERITANCE TA7t RE7l7RN �
RESICIENT 6ECEOENT
ESTA'TE OF FILE NUMBER
Kafherine C. Cax 2412-d1319
A11 propa�ty�olMiy owned wRh riqM of survivonhip must be dledaed on SclbduNe F.
ITEM VALUE AT DA7E
NUMBER 4ESCRIFTION OF 6ERTH
. _ . __. _._ . .,�_ .._,. . . . _ g. , „ ..,
1' 32 sh Dow Chemical Common 5tock(CU31R 260543103)@$31.2601 sh. 1,000.32 '
. _. . .w . ,� . . .... .. ._ �. � � ���, ,.� � ,,;����,�
2: 1834 sh Generai E�Cammon Stadt(CUSIP 3696d�103}�$2i:655!sh. 39,628.85 ;
,e e e , . , aM, , ..,. , . _ . �. , � r.� . � ���
- ooa , ,�. . . .. .. . . .... ♦ �.�. . . ... . .� , _. ._ � Av ., n... . �w1�.
. .<. r e... �s. r, . v new e .m... � .w., r ae . ... . � .... Y .,. , i. a. ..
- .m , . ...�..e. ..... ..5,:a�,.e.. > . . u r¢ .... ...;.�.. .,,i , s,s. a• . "rv. .')F„JC..:l
. r.. -.�. . . :.:. . . . .. . ... .s . ...� � . <.i_ � --,. . -- ) .. . . "�.eni: �.�...�
r
..a .o . a.�� .. > .. • . . .. . . ..ev �
.. em ..�. .rn... .m ee . ....v.... . > .,r.. . � ..., ep.+.."
. ..... . . , c "� . . .i.
`.r..� . -. � . . ... ye > .....:: e'r erv ..� au.... e. , . ..v.... R .m. . .. .. . .......
. .���e.a . .erc. >v ..... ..... .. . � SZ 6I • �
... . u . .. . :ae n u. . .. .. . ... . i M�Y': .
�. ,n '� nr ., �
a. „ ; ... ... _. . ... ... ... ... � .
... e �L l., a. J a. .S�". .`- :
je.+, , a«, . > .. �, xc . .,,sa s, x.. „rvu.u. .. ..arc. , ,., ....�:e. ,. . .a-..m. .. :.,.s., . ,,,,.., . � ,.Sh..�� ,f,,.
TOTAL(Nso enter on Line 2, RerapRulatlon) ¢ . 40,628.97 '
if mae Space I5 needed,in5ert txfditiatal sheCts o€the same si�e
T
REV-i5o8 EX+(p8-iz)
�pennsylvania �N�DULE E
��*+�'��e CASH, BANR DEPOSIi�'i 8� MISC.
INNERITANCETA%RETURN p��pNp�papPERTY
RESiD[Nf OEC.x-0Et1T
ESTAT£Of: PII.E Ml�IBER:
Katherine C. Cox 2012-01319
Inciude the proceeds M Iftigatlon and the date the proceeds were received by the estate.
All prop.rty�aintly owned wkh riyM ot wnhrorship muat 6e ditdatad on Sdfedule f.
ITEM VALUE AT DATE
NUMBER DESCRIFTION Of DEATH
1.; M�T Bank Checking Acct.#28849795 _ ° ' 1,288.30 >
�_ .. .. .�.ee . .. e .. ...., .. �.. , .� .. .. . . . . �: • .�. ,-
�,' M�T Bank Savings Acct.�0150Q4208557396 39.90 ;
. . , . . ., ,.. . . � tt.
3.� Verizon Wireless Reindwrsement � � � 78=92 ?
e � � .... .r. .. ..� .. � . . e,,w,_, , e.: .. ..,
4, ,Nati�wide inswance Rei�rsement 43.Q0
5.��� Country . Reimbursement�� ,�� � _ . 3,171.15
. � : .
6. `2012lRSincomeTaxRefiund 4,8�9.00
�..� PSERS Death Beoefit�� .. � � � � . � � ��
�� � � ` 84$.18 �
� a. .. �>. . .. � �. �.. .:: .�, =
�'� . . ... ��. ,. , o�... ._,.�� ,,�� . � ,,. .. �.., .� ..,,. �. .. . . . ... .. . . , ���� e.
e . �,r�� . ... . � �R. e . . .; �., � . �.. �, -o . _, ..�,. ;�. �_,
f
TMAL(Also enter on L1ne 5, Recapitulatlon) ; , 10,287.23
�� .._. , �
If mpre space is needed,use additibnai sheets of paper of khe same size.
REV-1510 EX+(p8-09)
�pennsytvania SCHEDULE G
�w�n�E�ocx�� INTER-YNf�STFtANSFERSAND
'""B"T""�T"'�"�T""" MISC. NON-PROBATE PROPERTY
aesmexr otc�rrt
ESTATE QF FIGE XI�IBER
Katherine C. Cox 2012-01319
This schedule must be completed and filed if the answer to any of questions i through 4 on page three of the REV4500 is yes.
� DESCRtPRON tlF PROPERTY
�nEwvfumeTCrse�,nerava�np�iptc�r,wn DA'EEOFDEAtH %OFDECDS IX{lUSION TAXABLE
NUMBER ntuaeormw�stai. unn�acmran[o�raaasuan�tF. VALUEOFASSEf INTERES7 RrwuaxE VALUE
1. Diacover Bank•MM Cert.#524�170846-2-Jt.w/David C.Coa 4,6't4.1d 100 3,fl0(}.OQ 1,02d.9d
7 Distxwer B�k-MM Cerf.�t52(F174571-6-JC w1 David C.CpX d,015.12 100 O.W 4,015.12
3 f}i�er Bardt-MM fi.ert.#52417$438-3-P�David C.Co7t 4,006.� 100 0.W 4,006.69
d. T�CO+rer Bar�t-G�A Savrrgs�Ct.;952&16T589-0-POD QaVk!C.Cox d,52325 100 4.00 4,523.25
� Discover B�k-Onbne Sawings Acct.#522-1670'19-3-POD Oavid C.Cox
2,068.82 100 O.OQ 2,pG6.82
6 Pentagon Federal CU-Reg.Accf.#358Ad55-07-6-POD DavW C.Cox 5.01 100 O.IXI 5.01
7 �P�agon Fede�CU-k�tSava�gs Aa:t.#41A64+�1-03-7-P�D Oavid C.
33.66 1U0 0.00 33.b�i
8. Perdagon Federa�CU-MM 2 YR Cert.#4342707,56-7-POD pavid C.Cox t,144z0 144 O.IX7 1,144.26
� Pe�ltagon Feder�CU-MM 1 YR Cext#4707469�56-7-POD David C.Cox 4,041.42 100 0.00 4,041.42
t0. �Fe�ral CU-(u�wl 1 XR Cert.#d707479-5Cs&-�David C.Ccsx 4,Od4.d2 100 O.Op 4,041.42
11. PA Sfaie Empbyees Cted'A Union Regl�ar Share Acct iY8441464584-Jt wl 5.OD t04 6.IX} 5.IX}
�a e.c�
t2. W�nut Street S�Money Market Accf.#33W079063- POU David G.
�x 3,790.82 100 0.00 3,79p.82
�
TOTAL{Aiw enter on line 7,Recapitulakion} # 2$,ssg.65
If more spgte Is needed,use additlonel sheets of paper of the same size.
REV-I511 EX+110-09J
�,�„�y�� SCH�DULE H
�ruxnl�roFae+�«ve FUNERA! EXPENSES AND
m"a"T""�T'"'�"E"'"" ADMINISTRATI!/E COSTS
RESIDENf DECEUEM
E5TA7E QP FILE NUMBER
Katherine C. Cox 2012-01319
�euAent'�debtt muat be roported on Schedule i.
EfEM
NUMBER 6ESCRIPR6N AMOUNi
A. PUNERAL EXPfN5E5:
1' Funetal Services-Payment for minister and pianist 55�.04
Partliemas F�Hane t Cremation 3,469.65
e���►ram c�ne�err,sn�roridse,aass�row�o�s�urn�dse) 250.00
8uri��Na'Ut Cer�ary,Sii�6�idge.M�s Trave�E�tses SQ4.99
Gr'ave M2�ker Lettering(P�in Cxarpte) 135.00
&. ADMIN[S7RA'F1VE C0515:
I. P�nai Representa6re Cpmmissiom:
Name(s)of Persanal Represpnkative(s)�. . _
Street Address--- - --- - --
Cq' � _..SWte_.�—ZiP---�- -�
Year(s}Commission Paid:�
2• Attomey F'ce5:
d06.11
3. Fymiiy Exeniptinn:{If decedeM`s address is��the sartre as ti8imank's,etf�h ery�naYtla�.)
Claimant
Street Address_ _ _ - --- --
CitY. .,._.- --- -_ . .._—stMe-----ztP__ _,
RelBtinnship of peimant to Decedent� �__ _,
-0. Prabate Fees: 273.50
5. nccou�tant Fees: 4.4Q
6. Tax RMUm Preparer PC25: Q.�O
7. C2ti8IB S8t1�1ei-Fst�C Nogce 1 D4.5$
PatriM Nevrs-EsFa�e NWice 149.60
Maslend 8 6artick Aa�tr�Transfet Fees 55.00
M8T Bank-E�ate At�oud Checks 25.20
J1M Notary Pce 2.4Q
Register of VYils-F�g Fce fior 1�7'ax ReWm 15.Q0
TOTAL{Alw enter qn tine 9,Recapituiadon) $ $•�4•S3
If more space is needed,use additional sheets of paper of the same size.
REV-1512 ER+{S2-?2}
�p,����y��� SCHEDULE I
DEBTS OF DECEDENT,
'm'�e'T""ce r^x R�w'" MQRTGiAGE LIA,BItITIE'S&CIEIiS
flESIDENf DECEpENT
ESTATE OF �����
Katherine C.Cax 2012-Q1319
Report dabb i�urred by tha de�bdent prbr bo datlh that ramsined unpald M tlie date M daelh,Includinp unrolmbunsd medical azpensa,
rrEM 4ALUE AT DATE
hWMBER DESCRIPT[QP! OF DEATH
._.. . , ..,.. . .._.., . .. __� ., ... m e.,., ..�., ,.
i. "'Diamond Phartnacy•Phartnaceudcal Bill 180.61 '
.. ,. ; ..' . .<<�.
2 Pubtk 8s�ooi Empioyees'Redr�raent System-Partiai Re�ursemeot of decemis�Pension . 335.32
_ � ; ,.° .,.
3 'Verizon Wirele&s-Cell Phone Bill 37.61 '
„ ,� ,
4, M&T Bank-Service Charge . 1 d.00 .:
5 Comcast-Cable N Bill ` 6.81 :
_ . ... :
8 ITtustArttbulance � � � � 70.00 �
� � : _., ,. � . . __ �.,.;
� �.., �_,,_. _ �
� w.- . _ :�_<: .. �y.�
� '
. . ... .. _ ,_ ,. . � ,. . ..� '
�: F
, _: �� ,._ �_- : , , .���..9,.. ....�s: �e N�.:
� . _ _ _ _ n . e, ,s , .
TOTAL(Also enter on Lfoe 10, Recapitulation) ; 644.35
2f more space is needed,i�ett additionat 5heet5 of the Same size.
REV-1513 EX+(p1-10)
�penitS�ttVertia SCHEDULE 1
DEi*MTi4EXT OF AFVENUE
,,,�,,,,,,,�,,��,,,�, BENEFICiAitIES
nesmarr u�ceo�r
ESfATE#: FAE .
Katherine C. Cox 2012-p1319
NUMBER NAME AN[T ADpFESS�PERSt)N(S)NECEIVSNG RltOPER7Y Do Not UR TO DECEDEM AMOUNT OR SHARE
Trwiaa(sJ OF EStAiE
i TAXAStf DISTRIBtlRWYS[t�dude outright spousai diskfbutiau aml trarahrs under
Sec.9116(a)(1.2).]
1. David C.Cox Son 700%
5Q9 Joyce Road,Cemp H�I PA 17011
ENTER DOILAIt AMOUNTS FOR DISTRIBUT{ONS SNOWN qgOVE QN 1.[NES 15 THHOUGH IB OF REV-I500 COVER SHEEf,AS APPROPRUTE.
A t!�N-FAiCA9tE Dl'�ONS
A. SPWSILL pISTWBUftONS UNDBt SECTION 9113 fOR WHICH AN ELECRON TO TAX IS NOT TAKEN:
1.
'
6. CHARiTABIE AND GOVERNMENTAL p1STRi8UTI0NS:
i.
TOTAL OF PART II-EtiTER TOTAt NON TAXABLE pISTRIBU170N5 ON LiNE 13 OF REV-1500 COVER SHEET. �
If more space is needetl,use additinrral sheets ot paper of the same size.
, , �
LAST WILL A.NI} TES'TA1�iElvT
OF
KA'1'HERINE C. CQX
I, KATHERLNE C. COX, now domiciled in Curnberland County, Pennsylvania, declaze
this to be my Last Will and Testament. I revoke a11 ather wills and codacils that I may have
greviously made.
'cle I
My just debts mnd expenses of my last illness, fvneral, and administration of my estate
sfiall be paid by my Executar from the grincipal af my residuary estate as saon as practicable
after my death.
Article II
All inheri#ance, estate, and suocession taxes {including inferest and penalties#herean, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
�
and be chazged generally against the przncipal of my residuary estate without reimbursement
from any person. This pravisian is not a waiver of any right which my Executor has to claim
reunbursement for any such taaces wtuioh became payable as the result of any property over
which I have the power of appointment.
Artiele III
I give, devise and bequeath my tangible personal property to my husband, J.
FRELIERIC COX, II. In the event J. FREDEY2IC Ci71X, II predeceases me or fauls to survive
4
me by thirty (30) days, then I give, devise and bequeath rny tangible personal proparty in
accardance with any memorandum I have handwritten or signed, located with my wiil ar wit}r
my valuable papers and found within 30 days of the prabate of rny will. Gifts rnay only be to
persons who survive me or to arganizatians which exist at my death, and if there is a conflict, the
memarandum having the Iatest date shall govern. Ta the extent no such memorandum is found,
or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal
property sha11 be added to my residuary estate and pass under Article IV hereof.
Articie N
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situata, I giva, devise and bequeath to my husband, J. k'ItEDERIC COX, II, of Cuxnberland
County, Pennsylvania. In ttie event J. I+'REDERFC COX, II predecaases me or fails ta survive
me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder o£my
estate„ of whatsoever nature and wheresoever situate to my son, I1AVID C. CC1R, of
Cumberland County, I'ennsy2vania,per stirpes.
Artiole V
I nominate, ctrnstitute and appoint my husband, J. FREDERIC COX, II, as Executor of
� my Last Wi12 and Testament. In the event of the renunciarian, death, or ivabitity to act, for any
reason whatsoever of my Executor, I norninate, constitute and appoint my son, DAVID C. COX,
as successor Executor af my Last Will and Testament. I d'uect that my Executor or suocessor
Executor be permitted to serve withaut bond In additian to thase powers granted by Iaw, I grant
them power to distribnte in cash or in kind, in like or in unlike shares, and to file any qnalified
disclairner I oould have filed if living. My Executar or suocessor Executor shall receive
reasonable comgensa#inn for services rendered ta my esta#e.
2
.Article VI
In addition fa the powers cpnfened by law, I autharize my Executor or snocessor
Executor, in his absolute discretian:
(a) to retain in the form received and to sell either at public ar private sale, any real
estate or persanal property except thae which I specifically bequsath herein,
{b} to manage real estate,
(c) to invest and reinvest in all farms of properiy without being canfined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option ar right arising from the owners2�ip of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
{f} to file any federal income tax retum for any year for whioh I have nat filed snch
return prior to my death,
{g} to make distribntions in cash or in kind, or in both, and to determine the value of
any such praperty,
(h) to emplay any attorney, inveshnent advisor, or other agent deemed necessary by
imy Executor or successor Executor; and to pay from my estate reasonable compensation for ail
their serrices,
(i) to conduct alone or with others, any business in which T am engaged in, or have
an interest in at time of my death, and
3
'•
{j) to receive reasonable cnmpensation in accordance with their standard schedule of
fees in effect while their servioes are perforxned.
IN WITNE3S WHEREOF, I, KATF�ERINE C. COX,hereby set my hand ta this my
Last Will and Testament, on .r.-hnf I__ .��, 2009, at Harrisburg, Pennsylvania.
� t
�C.��z.+�n,�rn.�C' �C�A�.
KATHERINE G COX
In out presenoe, the abpve-named KAT�IERIIVE C. COX signed this and declazed this
to be her Last Will an8 Testament and naw at her reqaest, in her presence, and in the presence of
each ather, we sign as witnesses.
Nazne 1 Address
��1������ 2000 Lin�xestown Rd.. Suite 202.Harrisburg, PA ]7110
��� 2000 Ling�estown Rd., Suite 202. Harrisburg, PA I'7110
I, KATFIERINE C. COX, Testatrix, who signed the foregoing instrument; having been
duly qualifiefl according to law, acknowledge that I signed and executed this insirument as my
� Witl, and that I signed it willingly as my free and voluntary act for the pur�wses therein
i expressed.
Sworn fa or affrmed and
Acknowlerlged before me by
KATHERIN�+ C. COX, the Testatrix
an i�,dR:j �� ,24Q9.
�'�"' �.���---9�. ��. �C'���� � �
Notary Public KATHERIIVE C. COR
corwr�orow�aur�o�FE;vrvsvivaura
Noi�iai Ses1 ��
Melisse M.K�in,Notary Public
�ehanna 7wp.,Dauphin Coap(y
�Y�SiQn E�res Aug.St,ZOYO
�
,
We, the undersigned witnesses who signed the foregoing instnzment,being duly qualified
accarding to law, depase and say that we were present and saw #he Testatrix sign and elcecute
this instrument as her Will; that she signed and executed it willingly as her free and voluntary act
for the purposes therein expressed; that each of us in her sight and he2ring signed the WiIl as
witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) yeazs or
more of age, of sound rnind, and under no consiraint or undue influence.
Sworn to or a ffirmer2 and
Subscribed ta before me /
bY�(�G�1t i� �-"(��C�. � '!/
and�1��� �ryvs. � itn s �
wi#nesse , on f 2009.
� � a i`r��tYV��
wz�a� _._
,
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Notazy Pubiic
COMMONWEALTH OF PENNSYLYANIA .
Notarial S�1
Melissa M.Kain,Notary Public
Susquehanna Twp..Dauphin County .
� MyCommissionErpiresAug.11,20f�
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COMMONWEALTH OF PENNSYLVANIA
� PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM
PSERS To/FFree-1-866-773-7748 (1-88&PSERS4U)
� 5 N 5Ui Sbeet Lxal-717-787-8540
�� . Hart'sburg PA 7 71 01-1 905 WpbAddress: w�vvw.p�rs.st�e.pa.us
January 24, 2013
DAVID COX
509 JOYCE RD
CAMP HILL, PA 17011
RE: Katherine Cox
SSN: XXX-XX-7044
Dear Mr. Cox:
The Public School Empioyees' Retirement System (PSERS) is processing the death benefd of
Katherine Cox.
Katherine Cox was entided to an estimated benefd of 5848.16. This amount is now payable to
the estate or next of bn.
If an estate has already been estabiished, PSERS will need both of the folbwing items before
payment can be made to the estate:
• A Short Certificate sfiowing tfie appointment of the executor or administrato�of the
esbte. A photocopy of the Short Certifiqte will be accepted, 'rf the official seal is
v' ' e.
- • The Empbyer ldentiffcation Number (EIN)for the estate. You may pll the Intemal
Revenue Service (IRS)at 1-800-829-4933 to obtain the EIN number or apply online at
www.irs.gov. Once you have obtained the EIN, please complete and retum the
enclosed Estate Information Cer(if+cation (PSRS-1304).
If a fortnal estate has not been established, the endosed Next-of-Kin Affidavit(PSRS-85) must
be completed in the presence of a Notary Public and retumed to this office at the above
address.
If you have any questions, please contact the PSERS Member Service Center by califng
tol!-free 1-888-773-7748 (1-888-PSERS4U). Hartisburg local callers, please use
717-787-8540. To contad PSERS by e-mail, use the folbwing address:
contactPSERS�pa.gov. For your convenience, the Member Service Center is staffed each
business day from 8:00 a.m. to 5:00 p.m. For moce general infortnation, you may 4isit PSERS
online at www.psers.state.pa.us.
Sincerely,
/
;�� Se�(aal��.x�l.�ea� ,�ctvu�re.rt Syate.,�c
� �� � ���
«�,�,�,o • .
� � D
PENTAGON FEDERAL CREDiT UNION - � Box 247009,Omaha,NE 681247009 800.247.5626 PenFed.ag
Marc6 27,2013
Mr.David C.Cox RE: KatlreriBe C.Coi
509 Joyce Road
Camp Hill,PA 170ll
Dar Mr.Co::
�- -� --'-.. _ ...,. ..-- - - .. . .. __. ._ . _ . .___._. ..__ _.. _ .
, -- -- _ _ . ... -- - -� . . . .. .. . .
Pkase fvd Ydow the date of daM wlra for KatYeriae Coi'�aaor Ws per your roqaek
Aceoeot Plr�ber Priaeiwl Bahea �vi�p�1 Aecrucd ToW DOD Hahaee
::nu1-03-7 533.66 50.00 533.66
ussssSO1�L 55.01 50.00 SS.Ol
:mu7-361 Sl,ll3.20 S1.OD S1,1M.]A
zmn9.46-7 54,038.13 5319 54,841.42
:m�S6-6 54,038.13 53.29 54,611.42
Agaie,we weald 6ke to exprms oor sy�p�tYy oa ywr loa.
Yoy,w��'9�. ull�s bll-fra at 1•89�247 5626.
A
IvIASLAIVI)
; �AR�t1�K
—ADVLSORY,INC.—
. . Irvno�a�Fuannan�Aot�7rs
lanuary 16, 2013
Mr. David C. Cox
509_Joyce Road ____ _
_ _ _ _ _
, Camp Hfll, PA 17011
Re: Estate of Katherine C. Cox
Dear David:
Per our phone conversation, please find below the requested date of death information
on Katherine C. Cox.
- Account Number: 33W079083
Registration: Katherine C. Cox
Shares High Low
December 14,2012 Owned Price Price
Dow Chemical Co(D01N� 32 $31.64 530.88
General Ek�ctrk Co(GE) 1830 $21.76 $21.55
Morrey Market 3790.82 $1.00 $1.00
If you have any further questions, please let me know.
;
nc eiy,
I; ..
e M.Howarth
Office Manager
. . �- 3600 Trindk Road,Gmp Hill,PA l101 li Tel.'717-761-6606/ Fmc 717-761-7524,� www.maslandandbatrick.wm
. . . Securides offercd throug6 Walnut Sueec Sea�riti«,Inc! Member FINRA,S[PC
.. Muimd&Barridc Adviwry,Iac.and Walnut Saeet Securitia are unal}'iluttd rntities.
�°
� ren�sy�vaMa srate Fmp�oyees crede l�ion
P.O.8ox 67013 Ffarrtsb�r�, PA 17106-7013 �N�mbs� 8441•,,,,,
800137.7328
�•� StatMnsnt P�riod: 01f01N3 to Otl31/13
Diect ir�tiies rege�di�g Preautlia�imd dectraric
transter a aooant enors ro Me abwe ade�ess. �Numbs►: RepWar 7 of 1
Account Balances at a Glance
Total8huss: Eo.00
28282 1 AV 0.380 00.447 00.039 T99 Pt 202 Total CMtlflqbs: $0.00
� KATHERINE COWNS COX T����- $0.00
DAVID COLLINS COX '
• 509 JOYCE RD
CAMP HILL, PA 17011-2043
�IIIP�phhu��lnlu.�.in�iphq��yp����y�u���inui,�p
000682 OB 003184 007 D
�a NO AINWAL FEE
� ��. A�R N091ACTIYITI'FEE
11C p�Iv'�
r��w
SHARES
Pasttnq ENsethe Trans�edon Naw
Dab Dats TransaeUo�DssuiPtla� Amount Balanw
REGULAR SHARE(S1) ID 01
07/Ot Beyinning Balance S,pp
07/08 WHhdrewel By Check 5.00 0.00
OtlOB ID 01 REGULAR SFL4RE(S1)Cbsed
��9��e 0.00
Dividend YTD: Year to Date 0.00
CHECKING ID 04 "
otrot Beginning Belance 0.00
Ot/OS �D 04 CHECKING Cbaed
En�n9� _ _ _ . . __ __ . .. 0.00
Dividend ttD: Year to Date O.G�
�
._ _
_ _ _ __
DISC�VER'
March 6, 2013
David C Cox
509 Joyce Road
Camp Hill PA 17011
RE: Katherine Collins Cox
Dear Sir/Madam:
Thank you tor your recent inquiry. The folbwing is the information you requested�nceming the above
referenced estate:
Account Number ending in: 5890
Acxount Type: Money Market
Account Status: Cia�sed
Account Title: KaEherine Cox-Sole Owner
David Cox-Payable on Death
Balance as of Date of Death: $4,523.25
Current Balance: $0.00
Axrued Interest ihrough 12/14/2012 $3.61
Safe Deposit Box: No
• Note: I�est is secrued daily and pafd monthly. Due to ioterest bel�paid mornhy,ir►breat
reportlng for income tax purposes is based on hlbrsst paid.
If ya�would like to obtain additlonal informetion or have questions conceming your acxourd, you may contact us
by wlling 1-800-347-7000(TDD 1-800�47-7454). Our automated voice response system is available 24 hours
a day 7 days a week or you may visit our Web site at www.discoverbenk.com. Axount Ma�agers a2 also
available to personally assist you 24 hours a day, seven days a vreek.
Sincerely,
Deposit Produds
Customer Service
Discover��
DBLTR.OI l3
DISC�VER
March 6, 2013
David C Cox
509 Joyce Road
Camp Hill PA 17011
RE: Katherine Collins Cox
Dear Sir/Madam:
Thank you for your recent inquiry. The folbwing is the infomiation you requested con�ming the above
referenced estate:
Account Number ending in: 0793
Account Type: On-Line Savings Account
Account S'tatus: Closed
Account Title: Katherine Cox-Sole Owner
David Cox-Payable on Death
Balance as of Date of Death: 32,068.82
Current Balance: a0.00
Accrued Inbetest through 12/14/2012 $2.04
Safie Deposit Box: No
• lWte: int�rest k accrued dafy a�d paid monthly. Dw to irKer�t be�g pald monthyr,UMerest
►ePwtlnp for income tax purposes Is bssed on intsrsst paid.
If you would like to obtain additional information or have questions con�ming your account, you may contact us
by calling 1-800-347-7000(TDD 1-500-347-7454). Our automated voice response system is available 24 hours
a day 7 daya a vireek or you may v�it our Web site at www.disooverbank.com.Acoount AAanagers are also
available to personalty assist you 24 hours a day,seven days a week.
Sincerely,
Deposit Produds
Customer Service
Discover�� DBLTR.0113
DISC�VER
Ma�h 6, 2013
David C Cox
509 Joyce Road
Camp Hill PA 17011
RE: Katherine Collins Cox
Dear SirlMadam:
Thank you for your recent inquiry. The following is the infortnation you requested conceming the above
referenced esfate:
Hccou�t Number ending in: 8402
Axount Type: Certficate of Deposit
Acxount Status: C�osed
Account Title: Katherine Cox-Primary
David Cox-Joint
No Beneficiaies
8alance as of Date of Death: $4,024.14
Current Balance: $0•�
Accrued Interest through 1?J14/2012 54.37
Safe Deposit Box: No
• Note: Inte�t is accrued daily and pafd moMh�y. Due to inbrest being paid moMhly,interest
reporting for income tax purposes is based oe IMerost paid.
If you would like to obtain additional informafan or have quesHons conceming your account,you may contact us
by calling 1-800-347-7000('TDD 1-800-347-7454). Our autometed voice re.gponse system is available 24 hours
a day 7 days a week or you may visit our Web site at+Zrww.discovetbank.com.Account Managers are a�o
available to personaity assist you 24 hours a day, seven days a week.
Sincerely,
Deposit Products
Customer Service
Dixwer� DBlTR.0113
DISC�VER
March 8, 2013
David C Cox
509 Joyce Road
Camp Hill PA 17011
RE: Katherine Collins Cox
Dear SirlMadam:
Thank you for your recent inquiry. The foibwirg is tlie iniom�atio�you requested concerning the above
referenced e.siate:
Account Number ending in: 5716
Account Type: Certifx;ate of Deposit
Axount Status: Closed
Account Title: Katherine Cox-Primary
David Cox-Jant
No Beneficiaies
Balance as of Date of Death: $4,015.12
Current Balance: 50.00
Accrued Interest thtough 12J14J2012 53.56
Safe Deposit Box: No
• Note: �rKerest�accrued da�y and psw monehy. Due to i�srest being paW monthy, ��rest
rePorti�9 tor i�come tax purpwes is based oo i�Nerest paid.
If you vrould like to obtain a�itional infom�atiort or have questions wnceming your accouM, you may contact us
by caNi�g 1-�-347-7000(TDD 1-800-347-7454). Owr automated vace response system is available 24 hours
a day 7 days a wcek or you may Ysit our VUeb site at�vww.discovetbank.can.Account Managers are also
available to personally assist you 24 hours a day, seven days a week.
Sincerely,
Deposit Products
Customer Service
Diseover� DBLTR.0113
DISC�VER
March 6, 2013
Oavid C Cox
509 Joyce Road
Camp Hill PA 17011
RE: Katherine Collins Cox
Dear Sir/Madam:
Thank you for your recent inquiry. The folbwing is the infortna8on you requested conceming the above
reierenced estate:
Account Number ending in: 4383
Account Type: Certif�ate of Deposit
AccouM Sfatus: Clased
Account TRIe: Katherine Cox-Sole Owner
David Cox-PayaWe on Death
Balance as of Date of D�th: $4.006.69
Current Balar�: $0.00
Accrued Interest through 12/14/2012 $4.06
Safe Deposit Box: No
• Note: lnbrest b accrued daily and paid moMhy. Due to Interest beMg paid monthy,interest
repoRing for income tu purposes is based on interest paid.
If you would like to obiain additionai iniomiation or have questions concemirg your account, you may contact us
by calling 1-800-347-7000(TDD 1-800-347-7454). Our automated voice response system is available 24 hours
a day 7 days a week or you may visit our Web site at Www.discoverbank.c�m.Accaunt Managers are also
available to personally assist you 24 hours a day, seven days a week.
Sincerely,
Deposit Products
Customer Service
Dixover�Dl�ter DBI.TR.0113
� � � �� ���
From: Mercer,Valarie on behalf of DATE OF DEATH REQUESTS
Ser� Friday, February 15,2013 1222 PM
To: Thompson, Margaret
Subject: RE: prod- Date of Death Request
Per your request, ptease find the Date of Death Values !
Acrnunt Number BatanceAccrued Interest Total
1. 28849795 1288.30 .O3 128831
2. 150042085573% 39.30 .00 39.90
3. 12044454085726001 DOD Balance-0.00 Current Balance-$29.04
let me know'rf there's anything else you need :-)
Thanks
V Mercer
--Original Message—
From:Thompson,Margaret
Sent: MorxJay, February 11,2013 9:57 AM
To: DATE OF DEATH REQUESTS
Cc:Thompson,Margaret
Subject: prod-Date of Death Request
Account Information
Date of death: 12/14/2012
Account Number:28849795
Product Type: DeposR Account
Account Number: 150042085573%
Produd Type:Deposit Acwunt
Account Number: 12044454085726001
Producc Type: LOC/Busineu VISA/ODL
1