HomeMy WebLinkAbout02-0379Estate of
COUNTY OF D~CJPHIN- Cumberland
COMMONWEALTH OF PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Henrietta M. Montoomery No. ql~ I "00~ '3 ?9
also known as
Henrietta M. Montgomery
, Deceased
Social Security No. 178182518
Maureen J. Placa (formerly known as Maureen McLaughtin) and Joan Graci (formerly known as Joan Montgomery),
Petitioner(s), who is/are 18 years of age or older, apply)les) for:
(cOMPLETE "A" OR "B" BELOW:) "
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors
Decedent, dated 2/12/72 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.ta.: pendente lite, durante absentia; durante minodtate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at Cumberland Crossings Nursing Home, Carlisle, Pennsylvania [4~~')
(list street, number and municipality) ~'
Decedent, then 81 years of age, died March 6 ,2002 , at Cumberland Crossings Nursing Home, Carlisle, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows: N/A
40,000.00
40,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
~//~--~ /1 &" Joan Graci
Typed or printed name and residence
506 Deubler Road, Camp Hill, PA 17011
Maureen J. Placa
6 Harwich Road, Morristown, NJ 07960
RW-1
11-,57-/
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petitidn are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this 15t: day of
April 2002
DECREE OF REGISTER
Estate of Henrietta M. Montgomery
Deceased No. 21-2002-379
also known as
Social Security No: 178182,518 Date of Death: 3/6/02
AND NOW, Apr11 18th. 2002 , , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I~ Testamentary I~ of Administration ~ --- r-~ .
..... ((c.t~a:, d~b.n.c.t.; p.,e~dente lit6i~ii~ur~nte absentia; durante mlnoriate)
are hereb,, ,~ranted,o Joan Graci~and Maureen J. Placa-( £ormerly known as Haureen NcLau~Llin
,~rmerTy known as ,!oan ~on%gomery)
in the above estate and that the instrument(s), if any, dated February 12, 1972 ... ~.,,:'~:2~
described in the Petition be admitted to probate and filed of record as the Last Will of Decede~Jt. L-5
FEES
Letters .................................... $
Short Certificates(s) ..... .~. ..... $
Renunciation .......................... $
Extra Pages ( i ) ............... $
I.T.R ....................................... $
JCP Fee ................................. $
Inventory ................................$
Other ...................................... $
TOTAL ............................. $
70.00
18.00
4.00
5.00
96.00
Signature
Attorney: Marielle F. Hazen
I.D. No: 68003
Address: 845 Sir Thomas Court, Suite 12
Harrisburg
PA 17109
Telephone: 717-541-5550
DATE FILED: April 1.8, 2002
MAIL LE~fE~ AND ORDER TO JOAN GRACI
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Henrietta M. Montgomery No. 21-2002-379
also known as To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 178-18-251 ~ 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 ors named
in the last wil} of the above decedent, dated 2/12/72 , 19.__
and codicil(s) dated
(state relevant circ.mstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Ct.~nberland County, Pennsylvania, with
h er last family or principal residence at Cumberland Cro.q.qin%q lq,,r~-ing ff__c3:pe_ _, C~,~!isle,
PA
(list street, number and muncipality)
Decendent, then 81 years of age, died March 6 , l~x_2.CI02_,
at CL~llberland Crn.q.q4ng.q ~,~ng~4crne, Carlisle, Pennsylvania (South Midd!eton Twp)
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: N/A
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(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: Total
40.000.00
4O,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Test-amontary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~> ss
COUNTY OF Cumberland
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this_ llth day of
_ April_ ~ - .~
NO. 21-2002-379
Estate Of Henrietta M. Montgomery , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
April 18th,
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 2/12/72
described therein be admitted to probate and filed of record as the last will of
Henrietta M. Montgomery
and Letters
are hereby granted to IOlaureen J. P~laca ( formerly
and Joan Graci (fo_rmerlv known as Joan
2002 in consideration of the petition on
known, as Maureen McLaug.hlin,)~
Montgomery)
FEES
Probate, Letters, Etc .......... $ 70 o 00
Short Certificates{6 ) .......... $ 18.00
Renunciation ................ $
x-Pages ( 1 ) $ 3.00
JCP TOTAL __ $ 5.00
Filed
.April.. 12th · · 20¢2. · · $ ....... 96.00
Re~ister of Wi~s Mary C. Lewis
Marielle F. Hazen
ATTORNEY (Sup. Ct. I.D. No.)
845 Sir Thomas Court, Suite 12
ADDRESS
Harrisburg PA 17109
PHONE
(717) 541-5550
(2) Note Two Petitions
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat. ., sign the same and that signed as a witness at the
request of testat in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
~.~ 19.__
Register
(Name)
(Address)
(Name)
(Address)
21-2002-379
REGISTER OF WILLS OF ~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(eacn) a subsc ', , ( ch) being duly qualified according to law, depose(s) and say(s) that
testa~ of (one of the
that
to the best of ~ kno
Sworn to or affirmed and subscribed before
me this 1 s t day of ~ (Name)
April ~ · ~ lltJx 2002 ~/~
'Ma;~C. Lewis/ ~ Register(
(Address)
familiar with the signature of
codicil
subscribing witnesses to) the ~ presented herewith and
codicil
believe~the signature on the ~)is in the handwriting of
21-2002-379
LAST WILL AND TESTAMENT
OF
HENRIETTA M. MONTGOMERY
I, Henrietta M. Montgomery, a legal resident of the Commonwealth
of Pennsylvania, being of sound and disposing mind and memory and
understanding, do hereby make, publish and declare this my Last Will
and Testament, hereby expressly revoking all other wills and writings
in nature testamentary by me at any time heretofore made.
FIRST: I direct that all my lust debts and funeral expenses
be paid as soon after my decease as may be practicable.
SECOND: I give, devise and bequeath all the rest, residue
and remainder of my estate and property, real, personal and mixed, of
whatsoever nature and wheresoever situated, of which I may die seized
or possessed or to which I may be entitled or of that which I may have
the right to dispose at the time of my death, absolutely and in fee
simple forever to my husband, Paul E. Montgomery, providing he shall
survive me by thirty days I have complete
. confidence that he will
provide for the best interests of our children.
THIRD: Should my husband, Pmul E. Montgomery, predecease
me or die on or before the thirtieth day following my death, I give
devise and bequeath all the rest, residue and remainder of my estate
and property, real, personal and mixed, of whatsoever nature and
wheresoever situated, of which I may die seized or possessed or to
which I may be entitled or of which I may have the right to dispose
at the time of my death, absolutely and in fee simple forever in
equal shares to my daughter, Mauregn McLaughlin and my step-daughter,
Joan Montgomery,
FOURTH: Except ~s otherwise provided in this my Last Will
and Testament, I have intentionally omitted to provide herein for
any other relatives or for any other person, whether claiming to be
an heir of mine or not.
FIFTH: I appoint my husband, Paul E. Montgomery, as Executor
of this my Last Will and Testament. Should by husband, Paul E.
Montgomery, fail to qualify or cease to act as Executor, I a~oint
Maureen McLaughlin and Joan Montgomery of Broomall, Pennsylvania, as
substitute Executrixes of this my Last Will and Testament.
SIXTH: I further direct that the said Executor or substi-
tute Executrixes, hereinbefore named, shall be relieved of the
responsibility of filing any returns or accountings not specifically
required by law, and shall have the fullest power and authority in
all matters and questions and to do all acts which I might or could
do if living, including without limitation, the complete power and
authority to sell (at public or private sale, for cash or credit,
with or without security,) mortgage, lease and dispose of and
distribute in kind all property, real, personal at such time and unon
such terms and conditions as the said Executor or substitute Executrixes
Page 1 of 2 Pages
may determine, all without court order and shall be held blameless
for any and all losses resulting from a matter of personal Judgment.
SEVENTH: I direct that the Executor and substitute
Executrixes, hereinbefore named,
for the faithful performance of shall not be required to give bond
their duties in any Jurisdiction
wherein proceedings may be held in connection with my estate.
~IN WITNESS ?HEREOF, I have here
this ~ay of,d~ ~ ~' unto set my hand and seal
- ......... , A.D. 1972.
in The foregoin instr~ent
.cluded, was this ;~-~ da--~ ~:-? ~onsist~ng of two pages
~ g _d, sealed, published and d~-, A D 1972
. ' =ulare~ by e s .... '
r~r her Las~ Will and T ..... ~~Y ~e said ~statr=__ .
~:~ <~ ~ament at /~-~ ~ ~ -~' ~x, as an~
a~ net re~~~~~n~~ "'~,
~ ~ a~ i~ her Dresen~m ~-~ ~_ ~ u= o~ ~s~ who~ ther~Do~
other, hereunto subscribed ..... , ~'u z- ~ne Presence of each
our names as w~tn~sses thereto, we
each or,us belfev~n~ the sa~d Testatrix to be of sound an4 4~sDosins
m~nd and memory at the date hereof.
Witnesses:
,, ' x' Residing at:
Pa~e 2 of 2 Pages
x o ~
0 ~
o ~
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE $,6 a
Name of Decedent: ~
Date of Death: ~
Will No. ~
Admin. No.
To the Register:
I certify that notice of (beneficial interest) .estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 07/10/2002
Name
Address
Joan M Graci
Maureen J Placa
506 Deubler Rd
6 Harwich Rd
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:.
Date: Q7/10/2002
Signature Marielle F Hazen
Name: Jan L Brown & AsSociates
Address: 845 Sir Thomas Court Suite 12
Telephone(717)~ 541- 5~5
Personal Representative
Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
MAIRELLE F HAZEN ESQUIRE
8445 SIR THOMAS COURT
HARRISBURG, PA 17109
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
00191 7
........ fold
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
ESTATE INFORMATION: SSN: 178-18-2518
FILE NUMBER: 2102- 0379
DECEDENT NAME: MONTGOMERY HENRIETTA M
DATE OF PAYMENT: 12/06/2002
POSTMARK DATE: 12/05/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 03/06/2002
REMARKS:
TOTAL AMOUNT PAID:
MARELLE F HAZEN ESQUIRE
101 I $633.O8
$633.08
SEAL
CHECK# 23
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
REv-15~'~ EX + (6-00)
COMMONWEALTH OF I I:~ I= %1.4
P[:::NNSYLVANIA / I.~-- I500
IHERITANCERETURN
RESIDENT DECEDENT
Z
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~etta M
DATE OF DEATH (MM-DD-Year) ~ (MM-DD-Year)
03/06/2002 ~/1921
{IF APPLICABLE) SURVIVING SPOUSE'S NAME {LAST, FIRST, AND MIDDLE INITIAL)
I-
Z
LU
LU
n~
0
[~1. Original Return
['"-~ 4. Limited Estate
~1-~6. Decedent Died Testate (Attach copyofWill)
~'--j 9. Litigation Proceeds Received
"-]2. Supplemental Retum
J"-] 4a. Futura Interast Compromise (dam of~eath after 12.12.82)
r-}7. Decedent Maintained a Living Trust (Altach copyofTrust)
r'-] 10. Spousal Poverty Credit (dam ofdeam ~et~ee, 12-31-9~ and 1-I-95}
OFFICIAL USE ONLY
/~P- ~-?- /
FILE NUMBER
2 1 -0 2 0 3 7 9
1 7 8-1 8-2 5 1 8
~LICA~E I~"EH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
E'~3. Remainder Return (dam o~ deam prior to 12-13-82)
J~5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes '
r'-]11. Election to tax under Sec. 9113(A) (A~ch Sch
/larielle F Hazen
(If Applicable)
1-5550
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2).i
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Sank Deposits & Miscellaneous Personal Properly _
(Schedule E) (5)
6. JointJy Owned Properly (Schedule F) (6)
J---J Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probata Properly
(Schedule G or L) (7) ..
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9).
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)
845 Sir Thomas Court Suite 12
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
PA
OFFICIAL I
49,711.3Z
(8) 53,746.37
14,983.20.
24,694.82
(11) 39 678.02
(12) 14,068.35_
(13)
(14)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
14~068.35
x (15)
x .04~5 (16)
x .12 (17)
x .15 (18)
(19)
633.08
633.08
Decede______~nt's Com.~lete Address:
STREET ADDRESS
__.__._._ 11 West Wiltshire Court
South Mi..__~ddleton Township
C~TY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
(1) _ 633.08
Interest/Penalty if applicable Total Credits (A + B + C ) (2)
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.
A. Enter the interest on the tax due.
B. Enler the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(5^)
633.08
(5B) 633.08
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. reta n the rght to des gnate who sha use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ..................................................................... : ......................... [] []
d. receive the promise for ~ife of either payments, benefits or care?..i'i ......................................................... [] []
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' n trust for' or payab e 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 SCHEBU
~'~er penallJes of r'u I"d~lare ...................... ' ~ LEG AND FILE IT AS PART OF THE RETURN.
. pe ] ~y, Ihat I have examined tbs return, inclu~in accom anying schedules ~f ~
~~e:~rn~ any knowledge. , it is true, correct and complete.
SIGNATURE OF ~ERSON RESPONSIBLE EOR FILING RETURN
c,- 506 Deubler Road
DATE
SIGNATURE OF PR~N REPRESENTATIVE ~ PA 1701
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)
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 onty 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)('~)!.
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.
REV-1503 EX + (1-97) ~
I SCHEDULE B
COMMO.W~LT. OFPE..S*LV^m / STOCKs & BONDS
/"I"tE.IT^.6¢ TAX RCTUR. I
~ FILE NUMBER
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. John Hancock Financial Services Inc (JHF)
100 shares @ $40.35
VALUE AT DATE
OF DEATH
4,035.00
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (1-97) ~ ~ /
coM o.w LT. CASH, BANK DEPOSITS, & MISC.
Include ~e premeds of litiga~n and the date ~e premeds were r~ived by ~e es~te. All pmpe~ jointly-o~ed ~th ~e right of su~borship must be disclos~ on Schedule F.
ITEM
NUMB,
DESCRIPTION VALUE AT DATE
1. Bank (formerly Mellon Bank) OF DEATH
Checking Account 100-011-9667
6
7
8
10
11
12
13
14
Citizens Bank (formerly Mellon Bank)
Savings Account 00355-238238
Citizens Bank (formerly Mellon Bank)
Checking Account 000-101-9058
Navy Federal Credit Union
Share Savings Account 0239609100
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0006
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0007
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0009
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0010
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0011
Upper Darby BellTelCo Federal Credit Union
Account 8405-00
Upper Darby BelITelCo Federal Credit Union
Certificate of Deposit Account 8405-63
Upper Darby BellTelCo Federal Credit Union
Account 8444-00
Upper Darby BellTelCo Federal Credit Union
Certificate of Deposit Account 8444-62
1998 Ford Escort
60.75
2,602.35
16,547.17
16,728.48
1,585.37
1,467.27
1,467.27
1,233.74
1,120.23
68.93
1,369.63
85.31
1,383.59
15
Sierra Military Health Services Inc
Health insurance benefit checks
3,095.00
896.28
TOTAL (Also enter on line 5, Recapitulation $
(If more space is needed, inset)
'11.37
+ o
Debts of decedent must be reported on Schedule I. "~-'--'--'-~'--'--~-
ITEM
NUMBER
A.
1.
2
3
FUNERAL EXPENSES:
DESCRIPTION
Donohue's; funeral expense
Leary & Sons; funeral flowers
Drexelbrook; funeral luncheon
AMOUNT
11,355.02
556.50
816.89
8
9
10
1_1
11
ADMINISTRATIVE COSTS:
Personal Representalive's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City
State _
Year(s) Commission Paid:
Attorney Fees Jan L Brown & Associates
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
city.
State _
Relationship of Claimant to Decedent
Probate Fees Reg of Wills, Cumberland County
Accountant's Fees
_ Zip
_ Zip
Tax Return Preparer's Fees
The Sentinel, legal advertising
Cumberland Law Journal, legal advertising
Reg of Wills, additional short certificates
Reg of Wills, filing fee Inventory and Inheritance Tax Return
Reg of Wills, additional fee Letters
Reg of Wills, filing fee Family Settlement Agreement
1,881.00
96.00
106.79
75.00
9.00
25.00
45.00
17.00
TOTAL ('Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
33.20
10
11
12
13
14
OMMONW LT. OFPENNS ,VAN,^ DEBTS OF DECEDENT
INHERITANCE TAX RETURN
Include unreimbursed medical expenses.
ITEM
NUMBEF
DESCRIPTION
Citizens Bank Checking 000-101-9058
Check 6690 to Cumberland Crossings; cashed after death 3/15/02
Defense Finance and Accounting; Reclamation of benefits Paul E Montgomery
Deducted from Citizens Bank Checking 000-101-9058
Cumberland-Goodwill Fire Rescue EMC
outstanding medical bill
Dennis D. Diaz MD
outstanding medical bill
Alert Pharmacy Services Inc
outstanding medical bill
Associated Cardiologists
outstanding medical bill
Masland Associates Inc
outstanding medical bill
Carlisle Imaging Associates
outstanding medical bill
Cumberland Crossings Nursing Home
outstanding medical bill
Carlisle Hospital
outstanding medical bill
Quantum Imaging & Therapeutic Assoc
outstanding medical bill
Central Penn Medical Group
outstanding medical bill
Central Penn Medical Group
outstanding medical bill
Central Penn Medical Group
outstanding medical bill
AMOUNT
5,704.61
12,125.60
24.46
13.46
284.46
1.74
426.09
5.61
5,243.32
792.00
1.75
35.86
17.93
17.93
TOTAL (Also enter on line 10, Recapitulation)
more space is needed, insert additional sheets of the same size)
REV-1513 EX +/@-O0I
OMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
[include outright spousal distributions and transfers under
Sec. 9116 (a)(1.2)] '
Maureen J Placa
6 Harwich Rd, Morristown, NJ 07960
Joan M Graci
506 Deubler Rd, Camp Hill, PA 17011
Do Not List Trustee(s) OF ESTATE ,RE
~faughter
step-daughter
50% residue
50% residue
II.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
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
(If more space is needed, insert additional sheets of the same size)
' "~ ....
$4~1 We.~t tT. hes~r Pike
Upper Darby, PA 19~2
Fax: (610) 449-2503
Mos, Shaw. Joan Graci
~0d Deui'{er Road
Camp ~,i]. PA 170{ {
Dcccm bet ~{, 2002
Funeral Expenses of: Mrs, Henrietta M. Montgomery
SERVIC'TES
Pro:fi;~sional Set vi~,~s
Facilities & Fxluipm~mt
Automative &lUJpment
TOTAl. SERVICES
MRRCHA.NDISE SELECTED:
CASKET
Vault
Prayer Cards
TOTAL MERCHANDISE
CASH ADVANCES Opening G%ve
Cemetery Equipment (Tent)
Ncwsoaper Notices - Inquirer
Clergy/Church Offering
C)rganist / Singer
^ltar Servers
Certified Copie.~ of the r)ca~h Certificate
[ Ia/rdrcaser
TOTAL CASII ADVA,N('~
SUBTOTAL;
]HSTOR¥:
03/12/2002 ck-Mcjlon i~k-Joan M. Gracj
03/12/2002
TOTAL, HISTORY
BALANCE DUE
The s~atemcnt is net and payable iix full on t)r betbre April 1,5, 2002.
March 6, 2002
2,575,00
500.00
700.00
$ 4,25000
$ 1,595.00
$ 40.00
9O0.0O
150O0
413,22
150,00
150.00
30.00
55.00
$ -1],355.02
$ -193.20
$ 3,775.00
$
$
$
5,885.00
1,888.22
11,548.22
-11,548.22
21-2002-379
LAST WILL AND TESTAMENT
OF
HENRIETTA M. MONTGOMERY
h
:: I, Henrietta M. Montgomery, a legal resident of the Commonwealth
.~ of Pennsylvania, being of sound and disposing mind and memory and
understanding, do hereby make, publish and declare this my Last Will
and Testament, hereby expressly revoking all other wills and writings
i in nature testamentary by me at any time heretofore made.
FIRST: I direct that all my Just debts and funeral expenses
be paid as soon after my decease as may be practicable.
SECOND: I give, devise and bequeath all the rest, residue
and remainder of my estate and property, real, personal and mixed, of
whatsoever nature and wheresoever situated, of which I may die seized
or possessed or to which I may be eneitled or of that which I may have
the right to dispose at the time of my death, absolutely and in fee
simple forever to my husband, Paul E. Montgomery, providing he shall
survive me by thirty days. I have complete confidence that he will
provide for the best interests of our children.
THIRD: Should my husband, Paul E. Montgomery, predecease
me or die on or before the thirtieth day following my death, I give
devise and bequeath all the rest, residue and remainder of my estate
and property, real, personal and mixed, of whatsoever nature and
wheresoever situated, of which I may die seized or possessed or to
which I may be entitled or of which I may have the right to dispose
at the time of my death, absolutely and in fee simple forever in
equal shares to my daughter, MaUreen McLaughlin and my step-daughter,
Joan Montgomery.
FOURTH: Except es otherwise Provided in this my Last Will
and Testament, I have intentionally omitted to provide herein for
any other'relatives or for any other person, whether claiming to be
!i an heir of mine or not.
FIFTM: I appoint my husband, Paul E. MOntgomery, as Executor
of this my Last Will and Testament. Should My husband, Paul E.
Montgomery, fail to qualify or cease to act as Executor, I appoint
Maureen McLaughlin and Joan Montgomery of Broomall, Pennsylvania, as
.~! substitute Executrixes of this my Last Will and Testament.
SIXTH: I further direct that the said Executor or substi-
tute Executrixes, hereinbefore named, shall be relieved of the
~. responsibility of filing any returns or accountings not specifically
required by law, and shall have the fullest power and authority in
al/ matters and questions and to do all acts which I might or could
i do if living, including Without limitation, the complete power and
authority to sell (at publi
distribute in kind all -) ---g-~=, zease and dispose of and
property, real, personal at such time and upon
such terms and conditions as the said Executor or substitute Executrixes
Page 1 of 2 Pages
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Montgomery, Henrietta M
also known as
Henrietta M Montgomery
, Deceased
No. 2002 00379
Date of Death 03/06/2002
Social Security No. 178182518
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 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 Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe
verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Marielle F Hazen Joan M Graci
I.D. No.: 68003 Maureen J Placa
Address: 845 Sir Thomas Court Suite 12 Dated 12/5/02
Harrisburg PA 17109
Telephone: 717-541-5550
Description
John Hancock Financial Services Inc (JHF)
100 shares @ $40.35
Citizens Bank (formerly Mellon Bank)
Checking Account 100-011-9667
Citizens Bank (formerly Mellon Bank)
Savings Account 00355-238238
Citizens Bank (formerly Mellon Bank)
Checking Account 000-101-9058
Navy Federal Credit Union
Share Savings Account 0239609100
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0006
(Attach Additional Sheets if necessary)
Total
Value
4,035.00
6O.75
2,602.35
16,547.17
16,728.48
1,585.37
53,746.37
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
Continuation of Inventory
Montgomery, Henrietta M
2002 00379
Pa,qe 1
Description of Inventory
Description
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0007
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0009
Navy Federal Credit Union
Sham Certificate of Deposit 0239609-167 0010
Navy Federal Credit Union
Share Certificate of Deposit 0239609-167 0011
Upper Darby BeliTelCo Federal Credit Union
Account 8405-00
Upper Darby BellTelCo Federal Credit Union
Certificate of Deposit Account 8405-63
Upper Darby BellTelCo Federal Credit Union
Account 8444-00
Upper Darby BellTeiCo Federal Credit Union
Certificate of Deposit Account 8444-62
1998 Ford Escort
Sierra Military Health Services Inc
Health insurance benefit checks
Subtotal
Grand Total
Value
1,467.27
1,467.27
1,233.74
1,120.23
68.93
1,369.63
85.31
1,383.59
3,095.00
896.28
$ 12,187.2~
$ 53,746.37
FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE
IN THE
ESTATE OF HENRIETTA M. MONTGOMERY, DECEASED
KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, HENRIETTA M.
MONTGOMERY, late of South Middleton Township, Cumberland County, Pennsylvania,
deceased, died testate on March 6, 2002, having first made her Last Will and Testament, which
was dated February 12, 1972, and is duly recorded in Cumberland County Courthouse, Register
of Wills, File No. 2002-00379;
WHEREAS, the said HENRIETTA M. MONTGOMERY, by the aforesaid Last Will
and Testament, named JOAN M. GRACI and MAUREEN J. PLACA as Co-Executrix of said
Last Will and Testament;
WHEREAS, Letters Testamentary on the estate of said decedent were duly issued by the
Register of Wills of Cumberland County, and Letters were granted to JOAN M. GRACI and
MAUREEN J. PLACA, hereinafter called Personal Representatives;
WHEREAS, the said Personal Representatives have gathered the assets of the estate of
the said decedent, and the assets consisted of personal property to a total value of $53,746.37 as
set forth in Exhibit A, which is a statement of account of the said Personal Representatives, and
which is attached hereto and made a part hereof and marked Exhibit A;
WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A
will be distributed as herein indicated in accordance with the terms of the Last Will and
Testament of the said decedent;
NOW, THEREFORE, KNOW YE, that we, JOAN M. GRACI and MAUREEN J.
PLACA, being all of the beneficiaries of the said decedent and heirs under the Last Will and
-1-
Testament of the said decedent, and being those persons entitled to inherit under said Last Will
and Testament, do hereby, each of us, acknowledge that we have this day had and received from
the aforesaid Personal Representatives, in full satisfaction and payment, all sum or sums of
money, legacies, bequests and devices as are given, devised and bequeathed to each of us
respectively by the said Last Will and Testament, which amounts we have received this day, and
which amounts are in the amount set opposite our respective names in the table and schedule of
distribution in said statement attached hereto and marked Exhibit A;
AND, each of us does hereby stipulate that in order to avoid the expense and time
involved in the filing of a formal account and schedule of distribution, we each agree that no
account is necessary, and we do hereby agree that we do consent to distribution being made
without the filing of an account and schedule of distribution, the same to be with the same force
and effect as if it had been filed and confirmed by the Orphans' Court Division of the Court of
Common Pleas, Cumberland County Branch.
THEREFORE, we and each of us do hereby remise, release, quit claim and forever
discharge the said Personal Representatives, JOAN M. GRACI and MAUREEN J. PLACA,
their heirs, executors, administrators and assigns, JAN L. BROWN & ASSOCIATES, attorneys
at law, and JAN L. BROWN, ESQUIRE of and from the said estate and from all actions, suits,
payments, accounts, reckoning, claims and demands whatsoever for or by reason thereof, or for
any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent,
and each of us do further hereby covenant and agree that should any liability come due to the
estate of the said decedent after the signing of this agreement, each of us do hereby covenant and
agree with each other and the aforesaid Personal Representatives that we will contribute pro rata
-2-
our share of the estate to satisfy any and all claims, demands, suits or causes of action which may
be successfully prosecuted against the said estate or the aforesaid Personal Representatives after
the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~Z~
day of ~ ,2003.
Witness ....
-3-
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF DAUPHIN ·
SS:
On this the 8th day of August, 2003 before me, a Notary Public, the undersigned officer,
personally appeared JOAN M. GRACI and MAUREEN J. PLACA, known to me or
satisfactorily proven to be the persons whose names are subscribed to the within instrument, and
acknowledged that they executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~'N~ry Public
STATEMENT OF ACCOUNT OF THE ESTATE OF HENRIETTA M. MONTGOMERY
Securities (using date of death values)
John Hancock Fin Services 100 shs
Personal Property (using date of death values)
1998 Ford Escort
Citizens Bank Ckg 100-011-9667
Citizens Bank Svgs 00355-238238
Citizens Bank Ckg 000-101-9058
Navy Fed Credit Union accounts
BellTelCo Fed Credit Union accounts
Health insurance benefit checks
Total Assets
Income/loss since date of death
Realized loss on sale of securities
Dividend income
Interest income
Total Income/Loss
Expenses
Funeral
Legal fee; Jan L Brown
Administrative costs
Outstanding medical bills
Reclamation of benefits; P. Montgomery
Inheritance Tax
Total Expenses
Net Assets Available for Distribution
$4,035.00
$3,095.00
$60.75
$2,602.35
$16,547.17
$23,602.36
$2,907.46
$896.28
-$1,160.30
$115.48
$523.65
-$13,250.41
-$1,881.00
-$395.92
-$11,798.06
-$12,125.60
-$633.08
$53,746.37
-$521.17
-$40,084.07
$13,141.13
DISTRIBUTION TO BENEFICIARIES
ACCORDING TO TERMS OF WILL*
Joan M. Graci, 50% of residue
1998 Ford Escort
Cash distribution
Maureen J. Placa, 50% of residue
Cash distribution
Total Distribution
$3,095.00
$3,475.57
$6,570.56
$13,141.13
*Actual cash distribution may be increased or decreased based on interest accrued, market value
of assets, presentation of an obligation and/or payment of additional charges. After final distribution,
if an obligation is presented, the residuary beneficiaries will be responsible for payment of the obligation
as set forth in the Family Settlement Agreement.
08/25/2003 Exhibit A
STATUS REPORT UNDER RULE 6.17,
Name of Decedent: Henrietta M Montaomerv
Date of Death- 03/06/2002
Will No. 2002-00375
Admin. 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:
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
Family Settlement Agmt and Final Release filed with Reg of
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
Date · 08/25/2003 ~g ~~'~
Signa~i~
Wills.
Jan L Brown
Name (Please type or print )
845 Sir Thomas Court Suite 12
Harrisburq PA
Address
17109
~ 717 ) 541-5550
Tel. No.
Capacity'
Personal Representative
Counsel for personal
representative
BUREAU OF /NDTVTDUAL TAXES
TNHERTTANCE TAX DIVTSTON
DEPT. 280601
HARRISBURG, PA 17128-0601
HARIELLE F HAZEN ....
JAN L BROWN & ASSOCS
Sq5 SIR THOHAS CT 12
HBG PA 17.1~09
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAISEHENT, ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE 01-28-2003
ESTATE OF HONTGOHERY
DATE OF DEATH 03-06-ZOOZ
FZLE NUHBER 21 02-0379
COUNTY CUHBERLAND
ACN 101
I Amount Remitted
REV-16q7 EX &FP (Dl-O$)
HENRIETTA N
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR
D/SALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HONTGOHERY HENRIETTA HFTLE NO. 21 02-0379 ACH 101 DATE 01-28-2003
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSR
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rmal Estate (Schmdule A)
2. Stocks and Bonds (Schmdulm B)
3. Closmly Hmld Stock/Partnership Zntmrmst (Schedulm C) ($)
~. Nortgagms/Notas Rmceivable (Schmdule D)
$. Cash/Bank Deposits/Hisc. Pmrsonal Propmrty (Schmdulm E)
6. Jolntly Owned Propmrty (Schmdula F) (6)
7. Transfers (Schedulm G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funmral Expansas/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Dabts/Nortgagm Liabillties/L~ens (Schedulm
Tote! Dmductions
12. Net Velum of Tax
00
4t035 O0
O0
O0
49~711 37
O0
O0
(8)
14,983.20
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form with your
tax payment.
53,7q6.37
19. Principal Tax Due
TAX CREDITS:
PAYMENT J DATE
12-05-2002
RECEIP1 DISCOUNT (+J
NUMBER INTEREST/PEN PAID (-)
CD001917 .00
ZF PA/D AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(~9)= 633.08
AHOUNT PAID
653.08
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
633.08
.00
.0O
.00
( KF TOTAL DUE KS LESS THAN $1, NO PAYHENT ZS RE~UKRED.
KF TOTAL DUE KS REFLECTED AS A 'CREDKT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SKDE OF THKS FORM FOR KNSTRUCTZONS.)
13. Charltmble/Governmantal Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0
1~. Net Value of Estate Subject to Tax (1~) 14,068.35
NOTE: Z~ an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that lnclude the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amoun~ of L/ne lq a* Spousal ra*e (15) . O0 X O0 = . O0
16. Amoun~ of L/ne 1~ ~axable a* Lineal/Class A ra~e (16) 1~,068.$5 X 0~5 = 655.08
17. Aeoun* of Line lq at Sibllng ra~e (17) . O0 X 12 = . O0
18. Amoun~ of Line lq *axable a~ Collateral/Class B ra~e (16) . O0 X 15 = . O0
24,694.82
(11) :59.678.02
{la} 1~., 068.35