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Home My WebLink About02-0567.rr Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of RUTH W. BOYD No, ~~'~ ~'S~ also known as ,Deceased Social SecurOy No. 112-01.9456 Iheeoeld nUO 4'n 1 B pi d ¢ a dtl r, pp',f s) tr ICOMPIETE'A' OR ~' BEtOWa (~ A Probate and Grant of letters and aver that Petitaner is the executor named in the last Will of the Decedent, dated 3125193 Sma Mean darta4re, `&. mrdem hd~ d wp~0, do 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 rat the vxtim of a IdlGng and was never adjudicated iraanpetent [i 6. Grant of letters of AGministration ~M1.A.L.LS: 0 ~~: aisin dorms; Oim rt~md W Petitionerls) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse lif anyj and heirs: Deced¢m at death wined propwly with estimated values as follows Iff domiciled in PAI NI personal property .................. $ 9,000.00 PaperryinPen vania ................................................................................................................. Iff mt danialed in PAJ Personal r nsyi . ............... . .................................................. $ (g not danial¢d in Pql Personal property in Counry ........................................................................................................................ $ Value of r~l estate in Penrxyivartla ....................................................................................................................................................... . .. . ........................... $ Total ..................................................................................................................................................................................... $ 9,000.00 Real Estate situated as fdbws: None Wherefore, Petitionerjsi respectfully requestisi the probate of the last Will and Codicillsi presented with this Petition and the grant of letters in the appropriate fan to the undersigned: Si nature T or printed name aM residence E W. Bassett 3409 S.E.18"'Place Cape Coral, R 33904 wmax-i a,xi a~ ma~corc,~ a~.aa l?-~G--3 Decedent was domiciled at death in Cumberland County, Pennsylvania, with hislher last family or principal residence at do The Woods at Cedar Run, 824 Gsbum Rd„Camp Hill, PA 11011 ~~~~ Decedent, then 88 years of age, died April 23 , 2002, at The Woods at Cedar Run s«>~i Commonwealth of Pennsylvania County of Cumberland Oath of Personal Representative The Petitioner(s) above named swear(s) and 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 th t, as personal representative(s- of the Decedent, Petitioner(s- will well and truly administer the estate according to law, Swom to and affirmed and subscribed before me this 17 thday of June 20 0 2 ,- o~~u-.moo /uc~ B~-c~ Mary .Lewis No. 21-2002-567 Estate of Ruth W. Bond Deceased Social Security No: 172-01.9456 Date of Death: ___ _423102 AND NOW, June 17th , 20 02 , in consideration of the Pethion on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ®Testamentary ^ of Administration dAn ~.i; gdnu Nt dmx tlf ew; dmu vrailep are hereby granted to Eugene W. Bassett who is appointed executor in the above estate and that the instrument dated 3125193 described in the Petition be admitted to probate and fled of record as the last Will of Decedent. ;. ; .~- rv FEES ~... ~::- Letters ........................... $ 50.00 -~; Ma C. Lewis Reglsierd;hSUs Short Certificate~sl (~•••~ 3 $ 9.00 Re~unciation.....,,.,,~,... $ 5.00 Affidavit i Ezira Pages ~ -....,~,,. $ 9.00 Codicil .......................... $ JCPFee ........................ $ 5.00 Attorney: Bradford Dorrance Inventory ....................... $ I.D. No; 32141 Other ............................ $ Address: KEEPER WOOD ALLEN D RAHAI, LLP 210 Walnut St, P 0 Boz 11963 Harrisburg PA 17108-1963 TOTAL ................ $ 78 - 00 Telephone: 11111 255-8014 ~~v.ir,~za:m~o~cer~.a~ssi MAILED LE'3fiERS TO A'I'i'C~Y ; cn: ~ ~cr, This is to certify that the information here given is correctly copied from an original cerrificate 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. Fee for this certificate, $2.00 ~ ` Loc egistrar P 8187871 No. Nlos :uR.r i'e, PE/PRINT NI iYANENT ACK INK ~~ ~.~ ~ ~- Date COMMONW EALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL REI;ORDS CERTIFICATE OF DEATH NAME OF DECEOENTIrrv MdSe.:aal ~~~- M m>ssaa ~f SEx r_ 5('.CW SECURITY HUMBER DALE OF OFXN. Oar. hirl ~ ° 7. Ruth W. Boyd :.Female ~. 172 - Ol - 9456 ~. . '(,~ 2~ ;2~U AGE!laa Baa`oaYl VNOERIYFAR UNDER IOAY DATE OF BtlITN BWTMPIACE:CJy a PLACE OF DERNICMca mr"ra.-,e..nsurwaunwr,mw ,alal --_ lapnar ) Data Ngaa ) M'arWM `MaraP Oay Mrl 31a1ao- yd+yn l:aaarYl 88 ^ HOSPITAL~-,/ OTHER: " ° ec.15,1913 Woodstown, NJ rra • , ~ InpMrd~ ERIOUPMrd ~ Dw^ , Q Paadaw~J ,~,,,^ COUNTY Di OERN CT', BORD. TWP Oi OERM fACKffY NAME 111 nd rnnnarn. 9rr 4PM and nrM«~ vMS DECEDEM OF HISPANC ORIGIN? RACE ~ Arrr«rcan Mrorarl Brca, M11W. aIc No® YM^ay...w«MCuWn, ISpaulyl N~, L S ~~ R B I }}U5~ I i G}l.;'•'~"•P""'°""an•'N 10 White East Pennsboro Cumberland ,~ k w DECEOEM'S USUK OCCUPRION KBKI OF BUSMaESSIMDUSTRY NNS DECEDE TEVERIN DECEDENT'S EDUCRION IAARITAI STRUS. Marro SURVNDIO SPOUSE rdP iwd. In wa. y.a maoarr nanW MMED ORCES? c Nar« S U ~~~ M . . IG.r Nnod rorA GOrrM moo a r,r,nB w: ao ra w rairad 1 ~ ha ^ No ® ErmaMMpSacdwry CoMga Ip 121 IIad 5.1 ,,. ,,. 12 ,a. D ,,. „~ Homemaker ,,., Own Home - DECEDENT'S MAKWG ADDRESS ISaM. CdYl6,rr. 5Mr. ZO Lrwel OECEDENT•s Penns lvania Lower Allen w P • ® a rr. d.cw.N,ratln a•P Ac,uAL ..... Y u, I,a 824 Lisburn Road s; ~ ~" . ,„„a ,damp Hill, Pennsylvania 17011 °n°"""°°' .-,. Cumberland N•'"'"°i ,,..^ ~Nr~wa ~. FRNER'S NAME Ifi9. M1dga. Lav) .. MOTHER'S NAME IFa,I. Ma W. Mran Swnm,) ,e, Warren Wollaston ,,, Clara Bassett oaFOIMIN,T'S NAME RrD«PrM WFORMANi'S MAKBq A00t1ES31S,ao. Cp/TO.n. SIw. Zip Canal Eu ere W. Bassett !,,.3409 S.E. 18th Place, Cape Coral, FL 33904 METHOD Of dSPO51TKk1 ORE OF pSPOSITKIN PLACE Of pSPOS1TION.NarMacanoarr. Cr«nau,y LOC/BION.CAyTOrrl.9wa. Zp Coaa R«,rR1 Y«a SIMa ^ ^ Cr«aum LL luaan. DaK wrl « OUrr PMp ^ 7C O,IyNr,n^ Our IS ~„ aril 29, 2002 ~on-O-Lite Crematory ~r~heafferstown, PA OF FUNERAL SE LK E SUCH LK:ENSE NUMBER NAME AND ADDRESS OF FACILITY ,,,. FD-010649-L ~H.Geigle F.H.Inc.2100 Linglestown Rd, Hbg, Pa. 17110 AaAy, wMncMdy,p tlra pa«dm„rowl,op,, aaNn ouvrW al pr urM. o«, anadw valM LICENSE NtAABER DRE STONED Wrylrnanrnda uum.awuna aaro Tdal IMddt Dav. `\arI arty Yauw N Wan. ~, 7x. na. • E~ ~~ .Day. !Iw~ M CASE REFERRED TO MEDICAL EIUMINEWLORONERi ~ 2~~~ pF =ME OF DERV ~ E~RONOU 3 QO w,X]^! No^ N ~ ~ tT. PART 1: EnW dr 6Mraaa, aMPr+« cMrpacalp0 NK~ Grnad ur Gan Do roI anl« IM nrw d , loco as Cirtl4t ralpa«ory UraR, sNa7t «Man 1iaW a i Approaantla PART N: QMr liBraecaM oordaorr wrrOMq raver, w LrN OM,aM Carlaa Pn aaG,M. ~aA«vYbarwaM nd laau,n, nyM drwly,gralrgwrn PMRT 1. arN alt orn I YIE047E CAUEE d+ro Y -~ aa N r DUE 7OK7F1 AS A CONSEQUENCE Oft: ~ ,an,.waneraranaaMa OUE TOR ASAC OVE OF1: I dr. 6r« IIIOl/ILr1110 ~ CAIelElDraaa,d •4aY <. ,ro araalao arar,s OIIE 70108 AS A CONSEQUENCE OFT I raYrpnpNn)LABT d MMSAN Al1R)PSY MERE AUTOPSY FYaDBMa$ WNNER OF DERH DATE OF ODURY TIME OFINJURY IIUURYRYgRK, OE$CRIBE YIOV/4UURr OCCURRED. PEIi011YE0'7 MJaKAB1.E IRION 10 Mrnn. Day, Y•ary COMPLETION a CAUSE N i ^ NYVaI JG om• ... qa ^ No^ Accrcrnl ^ P,nC•ya rrraapl„ ^ Y YYa ^ N, 1~, Yw ^ Np 10 SucWa ^ Ca+Y'. n • 1a ON«mna0 ^ . PLACE OF INJURY . Al lanr,. Mn, araN. IaaWry, aNC, LOLRpN 15ty. Ch/TOVL SOSN 4raltlrq aN. ISpacNl 3M. 71. Ma. ]Ia. fiATERER ICIru aar onN SIG U AND TITIEa 'CES7TIFYMO PNrSK:IAN IPnyscrarr c«Myrrq raw d Oran .Irr arr«« Dnrvoan naa pMdKad wan ano comanao Mm z71 Te Er Oaal a Ar tnerroBa. aatlr oeewratl tlva r tlN CauMq arW nuarrr N WIaG .................................................... ^ „ LIC R ORE .Dar. ~I r , •PRONOUNCadD AND CERTVraq PNYSK7AN IPMvcwr nor::aarrurcM rein aMC«VYr', roca.dad vaaml I aM aw to or fawNN and Mannar as wlad . To Ilra,aM,1 mY arorlad,a aam acew.w at w 11na dale ana Waco L ]tc. ~ rJ ~ • -~ 116 '1 ~. n _ ...... , ................. . . . NAME AND AOORE55OF PERSDN WNO COMPLETED CAUSE Of OER 'MEDICAI E1fAMINER/CORONER wam zn ryp. d Prud ~ Q~ S ~.pTdV \C L ~- On Ur WM, of yaminalrn aM/w inra,IlyaUOn, n m, oDinron, tlaNlr xcuNW al IM Ilm,, OaN, aM place, ano tlue Ip lna uuaal,l and i I tl ^ . f5 S[o - fa < e1t~J : oa~ R. Vt3" ........ ..................................................................................... m,mar a„ a a ~,a. aa. . REGISTRAR'S SKsNATURE AND NUMBER ~ ~7,Q I,~, ,1 > DRE FILEO:Mwn Oar I >. - ~- ~ ~ - ?_1-7_002-567 WILL OF RUTH W. BOYD I, RUTH W. BOYD of Camp Hill, Cumberland County, Pennsyl- vania, declare this to be my will and revoke any wills or codicils previously made by me. MARITAL STATUS AND CHILDREN I. I declare that I am not now married and that I have no living children. BIIRIAL INSTRUCTIONS II. I direct that no funeral or memorial service be held, and that my remains be cremated and interred in my family's plot at the Friends Cemetery, Woodstown, New Jersey. GIFTS iiI. Tangible Personal Property and Household Effects. I give my tangible personal property and household effects as follows: A. My collection of antique lamps and dishes, which I intend to mark appropriately, I give to Mrs. Virginia Gritman, of 365 Valley Road, Enola, Pennsylvania. B. My antique music box I give to Allen L. Cupp and Vera H. Cupp, his wife, of 1855 Holly Drive, Camp Hill, Pennsylvania 17011, or to the survivor of them. C. My gold American Waltham Co. key wind watch (with engraved initials WTW) and two gold masonic watch fobs I give, devise an bequeath to Allen L. Cupp, of 1855 Holly Drive, Camp Hill, Pennsylvania. D. I direct that the balance of my tangible personal property and household effects be disposed of by my executor as part of my residuary estate. IV. Cash Lecaaies. I give the following cash legacies: A. To my cousin, Frances Gates, of 3790 Wisteria Way, Corvallis, Oregon 97330, I give the sum of One Thousand Dollars ($1,000.00). If Frances Gates should not survive me, this gift shall lapse and become part of my residuary estate. B. To my cousin, Sarah H. Wollaston, of R.R. 1, Box 74, Cummington, Massachusetts 01026, I give the sum of One Thousand Dollars ($1,000.00). If Sarah H. Wollaston should not survive me, this gift shall lapse and become part of my residuary estate. O. Residuary Estate. I give the residue of my estate, real and personal, jointly to my cousin, Eugene W. Bassett and Muriel ~~, r~, ,.W: Bassett, his wife, or to the survivor of them, or, if both ~' should predecease me, to their intestate heirs. VI. Death Taxes. All federal, state, and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the principal of my probate estate so that the burden thereof falls on my residuary estate, and so that none of those taxes shall be charged against any beneficiary or any outside fund. -2- EBECIITOR VII. I appoint my cousin, Eugene W. Bassett, and Dauphin Deposit Bank and Trust Company of Harrisburg, Pennsylvania, as Co-Executors of this will. If, for any reason, Eugene W. Bassett fails or is unable to qualify, or refuses or ceases to act, I direct that Dauphin Deposit Bank and Trust Company act as sole Executor. I further direct as follows: A. In the administration of my estate, my executor shall have those powers prescribed by the Pennsylvania Probate, Estates and Fiduciaries Code, or any successor legislation. B. Any individual executor may resign at any time without court approval. C. No executor of this will shall be required to give bond or other security in any jurisdiction. IN 11ITNE88 1PHEREOF, QI have executed this will on the ~_4;~ day of ~~,~~i , 19 9 3 . ~' ( SEAL) RUTH W. BO In our presence the above-named Testator signed this three-page document on the date indicated above and declared it to be her will; and now, at her request, in her presence, and in the presence of each other, we sign as witnesses. ~~ ~ ,1~~. Witness Res/i~ding at • ~ /z ~ ~..~.~•a ~ ~ °j- laT.~"i~ ~eft~GG'/ ~ 1 ~-~ / 7 4 ~ °!~ ~~ ~ ~ Witness Residing at: ~"~.~- ~~~ 1~~ ~ ~ ° ~ -3- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA • SS. COUNTY OF ei1mBERryt~c~ WE, RUTH W. BOYD, and ~ ~- V ~ S. l~~ ~A f ~ U ~ , and ~ L G~ R ~"D 0 LQ ~ ~ 5 , the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. ~ ~ a ~. RUT W. BOYD, stator Witness ~ ~~ Witness Subscribed, sworn to, and acknowledged before me by RUTH W. BOYD, the Testator, and subscribed and sworn to before me by E~yA S. 1~oN~NU~ and E~IVA A~o~t'NUS witnesses, this ~5 day of I'h~~~y 1993. Notary Public t„G f 1,R~r~~~ 5~1~ ~~ 5iEu'~~e ~., ~,~ ~ ~~do+~ry~u~liC ~ ~,,~ ~ . ,...~_._ . _.. ..~.~_..-__._~_..as -4- Register of Wills of cumberlana County, Pennsylvania RENUNCIATION Estate of Ruth fwl. Boyd No. 21-2002-567 also known as ,Deceased Allfirst Trust Company of Pennsylvania, NA formerly knpwn as The undersigned, F1rIB Bank, Successor b~ merger to Dauphin Deposit Bank and oTrust Company (Relationship) ICapacityl the above Decedent, hereby renounce(s) the right to administer the estate and respectfully requc~sttsl chat Letters Testamentary be issued to Eu>;ene Bassett Witness-~~_ hand this ~! day of / _• ~-?~~ Allfirst T C ny o vania, NA ;~-- t9 J ampbell, Vice esiden =~ 2 _~k~~_~__ Harr3~sburg,__PA _.____1710.5-2961 (Address( ^, --- _ ~., (Signature) (Address) (Stgnaturel Sworn to or affirmed and subscribed n before me this ~(~~ day of ~~-~ (Address) f~tary Public Notadalueal My Commission Expires: Deanna L• Weld, NOtary Public Harrisburg, Dauphin County f1Ay Commission Expires Dec. 6, 2004 ,~.,v.,,.,.,,r.,a~•~n,H,.,..y,,,.,,~,r,.,u,~.,:. ~~ I nunciaUOns executed outside the Office of Reyi,ter ~t sy vania Asf;ocratlon of Notarrgg~ 4„d,,1tl1,,,,,,,,,,,,,,,,e, o,,,,, ,,,,,„,,,,.,;,,, -~V1/IIIS are required in some counues to be notarized. •~,~. ,,.w, .,, N.n n, y'a cu.~.~vw.,i, i RW-13 (Rvsd 9/92) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ruth W. Boyd Date of Death: Apri123, 2002 Will No.: 2002-00567 TO THE REGISTER: I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 2, 2002: Mrs. Virginia Gritman 365 Valley Rd., Enola, PA 17043 Mr. and Mrs. Allen L. Cupp 490 Brentwater Rd., Camp Hill, PA 17011 Ms. Frances Gates 3790 Wisteria Way, Corvallis, OR 97330 Ms. Sarah H. Wollaston R.R. 1, Box 74, Cummington, MA 01026 Mr. and Mrs. Eugene W. Bassett 3409 S.E. 18~' Place, Cape Coral, FL 33904 Notice has now been given to all persons entitled thereto under Rule 5.6 (a). Date: Z , 2002 adford rrance, Esquire Keefer Wood Allen & Rahal, LLP P.O. Box 11963 Harrisburg, PA 17108-1963 Capacity: Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002068 DORRANCE BRADFORD ESQUIRE 210 WALNUT STREET P O BOX 1 1963 HARRISBURG, PA 17108-1963 ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: sSN: 772-oi-9456 FILE NUMBER: 2102-0567 DECEDENT NAME: BOYD RUTH W DATE OF PAYMENT: 01 /22/2003 POSTMARK DATE: 01 /21 /2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/23/2002 AMOUNT 101 ~ S 1,200.00 TOTAL AMOUNT PAID: REMARKS: EUGENE W BASSETT C/O BRADFORD DORRANCE ESQUIRE SEAL CHECK#101 INITIALS: SK RECEIVED BY: DONNA M. OTTO S 1, 200.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS HEATH L. ALLEN N. DAVID RAHAL CHARLES W.RUBENDALLII ROBERT L. WELDON EUGENE E. PEPINSKY, JR. JOHN H. ENOS ja GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L.GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. LEWISIi.'I BRIDGET M. WHITLEY JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEEPER WOOD ALLEN &RAHAL, LLP 210 WALNUT STREET P. O. BOX l 1963 HARRISBURG, PA 17108-1963 PHONE (7171 255-8000 EIN No. 23-0716135 www.keeferwood.com January 21, 2003 VIA FEDERAL EXPRESS Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 s ,Y ', Re: Estate of Ruth W. Boyd, Deceased File No. 2002-00567 Dear Sir or Madam: ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY WEST SHORE OFFICE: 415 FALLOWFIELD ROAD CAMP HILL, PA 17011 17171 612-5800 WRITER'S CONTACT INFORMATION: (717) 255-8014 Enclosed is a $1,200.00 check representing the estate's estimated inheritance tax payment. Please date-stamp the copy of this check and return it to me in the envelope provided. Thank you. Sincerely, BD/ral enclosures KEEPER WOOD ALLEN & RAHAL, LLP By : -~~ dford Dorrance cc: Mr. Eugene W. Bassett a~~" ~° ~ ~~ ~~ <i ~~i~ ~' O 4`~ ?m ~ ~ a- m /~~ #~ i Owl ~n ~ ~ . o ~o ~ , ~ ?4m ~ ~ ~Z ~~a o A Cy a C m ~ 4 ~ On O k~ ~~~ ~~ ~ ~. ~ n .tip' a,~ ~~ o° T~ ~2 ~~ ~~ b N i n i ~.J` i ~ ,~ /~_ ~'D -3 January 24, 2003 Law Offices of Keefer, Wood, Allen & Raha1 210 Walnut St. P.O. Box 11963 Harrisburg, Pa.17108-1963 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 1712$-0601 Telephone (717) 787-3930 FAX (717) 772-0412 Re: Estate of Ruth W. Boyd File Number 2102-0567 Dear Mr Dorrance: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before July 23,2003. Because Section 2136 (d) of the 1995 Act allows for on{y one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. ~,. ,_ Sinter` ~"°'~ Jeffrey Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DORRANCE BRADFORD ESQUIRE 210 WALNUT STREET P O BOX 11963 HARRISBURG, PA 1 71 08-1 963 fold ESTATE INFORMATION: SsN: 172-0~-9456 FILE NUMBER: 2102-0567 DECEDENT NAME: BOYD RUTH W DATE OF PAYMENT: 07/23/2003 POSTMARK DATE: 07/22/2003 couNTY: CUMBERLAND DATE OF DEATH: 04/ 23/ 2002 101 ~ 5436.36 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) NO. CD 002833 AMOUNT TOTAL AMOUNT PAID: 5436.36 REMARKS: BRADFORD DORRANCE, ESQUIRE C/O KEEPER WOOD ALLEN & RAHAL CHECK# 7091 1 INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS HEATH L. ALLEN N. DAVID RAHAL CHARLES W.RUBENDALLII ROBERT L. WELDON EUGENE E. PEPINSKY, JR. JOHN H. ENOSIII GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSS R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. LEWISIII BRIDGET M. WHITLEY JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEEPER WOOD ALLEN &RAHAL, LLP 210 WALNUT STREET P. O. BOX 11963 HARRISBURG, PA 17108-1963 PHONE !7171 255-8000 EIN NO. 2 3-071613 5 www.keeferwood.com July 22, 2003 VIA FEDERAL EXPRESS Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Ruth W. Boyd, Deceased File No. 2002-00567 Dear Sir or Madam: ESTABLISHED IN IB78 OF COUNSEL: SAMUEL C. HARRY WEST SNORE OFFICE: 415 FALLOWFIELD ROAD CAMP HILL. PA 17011 1717) 612-5800 WRITER'S CONTACT INFORMATION: (717) 255-8014 ..~ s +" r i', ~ p ~_ W t:rt - c._. I--' N w ~~ :- I~ "S^, Enclosed for filing is the Pennsylvania inheritance tax return for the above estate. Also enclosed are: (1) our firm's $25.00 check representing the additional probate and inheritance tax filing fees; and (2) our firm's $436.36 check, representing the final inheritance tax payment. We will file the inventory in the near future. Please date-stamp the additional copy of this filing and return it to me in the envelope provided. Thank you. Sincerely, KEEPER WOOD ALLEN & RAHAL, LLP By: dford Dorrance BD/ral enclosures cc: Mr. Eugene W. Bassett (w/enclosures) FedEx ~ Ship Manager ~ Label ?908 4653 5363 From: Bradford Dorrance {717255-8000 REVENUE BARCODE NEEFER WOOD ALLEN & RAHAL, LLP 210 WALNUT STREET HARRISBURG, PA, 17101 To: Register of Mills X717)255-8014 Cumberland Caunty Courthouse ~U3sH~t.~A~322~~~0~~~~ 1 Courthouse Square WEIGHT: 1 LBS Carlisle, P,4, 1?013 `~" Ref:28t129 L+l~li?`t~,`: DELIVERY ADORE558ARCODE~FEDEB-EDRJ FedEx PRIORITY OVERNICaHT TR K # 7908 4653 5363 ~~~ 17013-PA-US MDT 16 GTYA III@~I I~I I~ ~I~ Shipping Label: Your shipment is complete WEQ >~ Deliver by: 23JUL03 Page 1 of 1 ~~t 1. Use the'Print' feature from your browser to send this page to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned Warning: Use only the printed original label for shipping. 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Maximum for items of extraordinary value is $500, e.g. jewelry, precious metals, negotiable instruments and other items listed in our Service Guide. Written claims must be filed within strict time limits, see current FedEx Service Guide. https://www.fedex.com/cgi-bin/ship_it/unity/4Bf(JrSFgVv2DaQx4HfQt9JeSq?BaQz2HiQ... 7/22/2003 Register of Wills of Dauphin County, Pennsylvania Cf~ INVENTORY 2002-00567 Estate of Ruth W. Boyd, Deceased Np, (PA File No. 21-02-0567) also known as Date of Death 4/23/02 Deceased Social Security No. 172-01-9456 Eugene W. Bassett 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/1Me verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. I _ 'LQL/'(~~~,I ~J Personal Representative: Name of Attorney: Bradford Dorrance Eugene W. Bassett I.D. No.: 32147 ~u~-Lc+~ ~~ Address: 210 Walnut St. , P. 0. BOX 11963 Dated / / ~~ ~ ~ Harrisburg, PA 17108-1963 Telephone: (717) 255-8014 Description 1. Haar's pre-death auction proceeds of personal effects 2. Gold ring with small diamonds and Timex watch 3. Uncashed PennMutual annuity checks 4. Uncashed Allfirst checks 5. Allfirst checking account 6. Safe Deposit Box refund 7. Cash Value $ 857.55 910.00 425,64 696.86 20,635.47 9.50 160.00 .-., ,~ ..,x.. - a `=s w ~_;- r- W Total: $23;695.02 (Attach Additional Sheets if necessary) ~~' ,~, (VOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal rep~entative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-8 /~ ~~'-_? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2B06D1 HARRISBURG, PA 17128-D6D1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _. NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-15f7 EX ~PV (O1-OS) BRADFORD DORRANCE ESQ KEEPER ETAL PO BOX 11963 HBG PA 17108 DATE 09-09-2003 ESTATE OF BOYD RUTH W DATE OF DEATH 04-23-2002 FILE NUMBER 21 02-0567 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-031 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOYD RUTH W FILE N0. 21 02-0567 ACN 101 DATE 09-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate [Schedule A) [1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Hald StocklPartnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) [5) 23.695.02 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) ,00 8. Total assets (g) 23,695.02 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 3,529.45 (9) 10. DebtslMortgage Liabilities/Liens (Schedule I) (10) 9.256.51 11. Total Deductions (11) _ 17.78.96 12. Net Value of Tax Return (12) 10, 909.06 13. Charitable/Governmental Bequests; Non-elected 4113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 10,909.06 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. Amount of Line 14 at Spousal rate (15) ..00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate [16) .00 X 045 . .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 10,909.06 X 15 - 1,636.3b 19. Principal Tax Due TAV AACf.T Te._ ( lq)= 1 , 636 .36 ~ DATE ~ NUMBER ~ INTEREST/PEN PAID (-) ~ AMOUNT PAID ui-u.-cuus GLUULU6S 07-22-2003 CD002833 i,~uu.uu 00 436.36 BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-23-2003 TOTAL TAX CREDIT 1,63b.36 BALANCE OF TAX DUE .00 INTEREST AND PEN. 10.76 TOTAL DUE 10.76 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128A601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DORRANCE BRADFORD ESQUIRE 210 WALNUT STREET P O BOX 1 1963 HARRISBURG, PA 17108-1963 fold ESTATE INFORMATION: ssrv: 172-oi-9456 FILE NUMBER: 2102-0567 DECEDENT NAME: BOYD RUTH W DATE OF PAYMENT: 09/23/2003 POSTMARK DATE: 09/22/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/23/2002 REV-1162 EX(11-961 NO. CD 003048 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 510.76 TOTAL AMOUNT PAID: REMARKS: EUGENE W BASSETT C/O BRADFORD DORRANCE ESQUIRE CHECK#102 INITIALS: VZ SEAL RECEIVED BY: 510.76 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS W ~ -~~ N' w -h (J W a ' m C! ~34 7 r bD H m ~mv~ n - N 70 --1 ~ _ r r m - mZ~ a d O ~ - ~ „ a _ an ~ C - H i ~ _ a V O r ~ C V! ~ W -~ 1 ~ x m - p 3 N ~ m ~ - a ~ _ m z - ~ __ ~ 0 .. _ ~ ~ ~) w o m ~ c~ m a bD ~1 d X ~ O ~md ~o a o~ r W ~ m{ a rn i ~ ~i V r 0 _. Q 00 caioHaya zcr-~~~ zlnmanl ~3C701~ Oid701 70 --1 ~"'' f~ N o W o ~ 3 ~' i~ o ~p b0 O N d O m N W ~p ~ 1 I ~ r o N N a v~ o 0 Z o~ 0 0 d V N W c x z s r~i z C w~~ T Cd> C 6YP C=fO • omT ~~~~ s xD .~ r -~i M N 6 Oo N O a oy ~~~ ~, = r x ,~ m N n o w ; Cm= d3 ~ZN ~$ b~~m m = a rnso r a ~ '~ -i = O M = Hn7TO 071 N T H ~ N ~ Z 1~1 z z -°~ m ~ ~ o~x Cr r~ ma 0 X Z ~ ~ a m A HEATH L. ALLEN KEEPER WOOD ALLEN &RAHAL, LLP ESTABLISHED IN 1878 N. DAVID RAHAL 210 WALNUT STREET CHARLES W. RUBENDALL II OF COUNSEL: ROBERT L. WELDON P. O. BOX 11963 SAMUEL C. HARRY EUGENE E. PEPINSKY, JR. HARRISBURG, PA 17108-1963 - JOHN H. ENOSIII WEST SHORE OFFICE: GARY E. FRENCH PHONE 17171 255-8000 415 FALLOWFIELD ROAD DONNA S. WELDON CAMP HILL, PA 17011 BRApFORD DORRANCE EIN NO. 23-0716135 17171612-5800 JEFFREY S. STOKES www.keeferwood.com ROBERT R. CHURCH WRITER'S CONTACT INFORMATION: STEPHEN L. GROSE R. SCOTT SHEARER September 22, 2003 WAYNE M. PECHT ELYSE E. ROGERS (717) 255-8014 CRAIG A.LONGYEAR DONALD M. LEWISICI BRIDGET M. WHITLEY JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER Register of Wills Cumberland County Cou rthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Ruth W. Boyd, Deceased File No. 2002-00567 Dear Sir or Madam: Enclosed is the final inheritance tax payment for the above estate. Thank you. Sincerely, KEEPER WOOD ALLEN & RAHAL, LLP By: radford Dorrance BD/ral enclosure cc: Mr. Eugene W. Bassett COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. z8obol INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REY-1607 EX ~FP (O1-OS) BRADFORD DORRANCE ESQ KEEPER ETAL PO BOX 11963 HBG PA 1710~l;s, DATE 10-06-2003 ESTATE OF BOYD RUTH W DATE OF DEATH 04-23-2002 FILE NUMBER 21 02-0567 !':BOUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subeit the upper portion of this fore with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-03) *~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~(~(~( ESTATE OF BOYD RUTH W FILE N0. 21 02-0567 ACN 101 DATE 10-06-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-09-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 1,636.36 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 01-21-2003 CD002068 .00 1,200.00 07-22-2003 CD002833 .00 436.36 09-22-2003 CD003048 10.76- 10.76 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l 1,636.36 .00 .00 .00 r PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ruth w. Date of Death: 4/23/02 Estate No.: 2002-00567 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 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: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes x No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: !7 w.v~-+~-,.-ems Signature Bradford Dorrance, Esquire Name (Please type or print) KEEFER WOOD ALLEN & RAHAL, LLP P.O. Box 11963, Harrisburg, PA 17108-1963 Address (MAH:rmt/AM3) Capacity: (717) 255-8014 Telephone No. Personal Representative x Counsel for Personal Representative R.W. - 58 - EV.1500EX:6-DOI /7-70-3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- ~~cn u"'>: w,,-u ",00 u"'~ "-" "- '" INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o W U W o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) BOYD, RUTH W. DATE OF DEATH (MM-DD-YEAR) 4/23/02 OFFICIAL USE ONLY / I DATE OF BIRTH (MM-DO-YEAR) 12/15/13 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE INITIAL) N/A ~ 1. Original Return o 4, Limited Estate D 6. Decedent Died Testate {AltachcopyofWill) o 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12-82) o 7. Decedent Maintained a Living Trust (Anach copy 01 Trust) D 10. Spousal Poverty Credit {date ofdeath lletwet!n 12.31.91 and 1-1-95) FILE NUMBER 21_02 o 0 5 6 7 COUNTYCOOE YEAR NUMBER SOCIAL SECURITY NUMBER 172 - 01 9456 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return {date of death prior to 12.13.82) o 5, Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o < I- ::l Q. :::E o u ~ I- Z W o Z o "- '" W '" '" o u NAME Bradford Dorrance, Esquire FIRM NAME (If Applicable) KEEFER WOOD ALLEN & RAHAL LLP TELEPHONE NUMBER (717) 255-8014 COMPLETE MAILING ADDRESS 210 Walnut St., P.O. Box 11963 Harrisburg, PA 17108-1963 x.o_ (15) x,o_ (16) x .12 (17) x .15 (18) 1,636.36 (19) 1,636.36 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) {I} (2) (3) (4) (5) 23,695.02 r OFFICIAL USE ONLY z o !i ...J ::l !::: Q. <C u w c::: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested (6) (8) 23,695.02 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) (11) (12) (13) 12,785.96 10.909.06 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10, Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (9) (10) 3,529.45 9,256.51 (14) 10,909.06 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus line 11) 13. Charitable and Governmental BequestslSec 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) 16. Amount of Line 14 taxable at fineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 10,909.06 19, Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS c/o The Woods at Cedar Run 824 Lisburn Road CITY I STATE PA 17011 Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,636.36 I ZIP 1,200.00 Total Credits (A + 8 + C) (2) 1,200.00 3. InleresUPenalty if applicable D.lnterest E. Penalty TotallnteresUPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is Ihe OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. 436.36 (5) (5A) (58) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT '~-.'.",,~'~;Y;:l'::i" ';,,"~:~~~~'l!~j~~~~~~i~~'Jl'ii';;"'i.>a;::Jj'r 1l1r.Ml_,~~~,~'~~~~,,:.,;;;;~;~D>:;0'*~.! 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 .....0 ...0 .........0 ..........0 .........0 .........0 ........0 No [Xl [Xl [Xl [Xl [Xl [Xl [Xl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. StGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Under penalties of pe~ury. I declare that I have examined this return. including accompanymg schedules and statements, and to the best of my knowledge and belief, it is lnJe, correct alld complete. Declaration of preparer other than the personal representative i$ based on all i[lformatioll of whiCh pre parer has any knowledge DATE ADDRESS ~.~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Bradford Dorrance, Esquire ADDRESS KEEFER WOOD ALLEN & RAHAL, LLP, 210 Walnut St., P.O. Box 11963, Harrisburg, PA 17108-1963 l:=~'- :.~f~ifJ~~~$:-':1'~tE,;;~;.~::r~~;:,~rjf}~::~~:;I.::':;3;:';~~S{~~?!~ !_~.r- ~~7"~W~~~:ft\- ~~:2t<;:(rk1~~:~., 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. 99116 (a) (1.\) (ill. =J/-~ ~t) "( DATE For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to orlor the use of the surviving spouse is 0% [72 P.S. 39116 (al (1.11 (ii) The statute does not exemnt a transfer to a sUNiving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 paren ora stepparent of /he child is 0% [72 P.S. g9116(a)(1.2I1. The tax rale imposed on the net value of transfers to ortor the use of the decedent's lineal beneficiaries is 4.5%, except as noted In 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)], A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1508EX+12.871 w SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER 21-02-00567 COMMONWEALTH OF PENNSYLVANIA INHERllANCE lAX W:ElUfl:N RESIDENT DECEDENT ESTATE OF BOYD, RUTH W. (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule FJ ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Haar's pre-death auction proceeds of personal effects 857.55 2. Gold ring with small diamonds and Timex watch 910.00 3. Uncashed PennMutual annuity cheeks 425.64 4. Uncashed Allfirst cheeks 696.86 5. Allfirst checking account 20,635.47 6. Safe Deposit Box refund 9.50 7. Cash 160.00 TOTAL (Also enter on line 5, Recapitulation) S 23,695.02 (Attach additional 81fz'" x 11'" sheels if more space is needed.) II REV-1511 EX. (12-991. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BOYD, RUTH W. 21-02-0567 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1- Funeral $1,727.00 J. H. Geigle Home B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions N/A Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representalive(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees (Keefer Wood Allen & Rahal, LLP) 1,100.00 3. Family Exemption: {If decedent's address is not the same as claimant's, attach explanation} Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 77 .00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Executor's travel expenses 424.97 8. Legal Advertising Fees 172.07 9. Keefer Wood Allen & Rahal, LLP Out-of-Pocket Disbursements 28.41 TOTAL (Also enter on line 9, Recapitulation) $ 3,529.45 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) ReV.l.512 ex. (7.88) .. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE L1ABLITIES AND LIENS Please Print or Type FILE NUMBER 21-02-0567 COMMONWEALJH OF PENNSYWANIA INHERITANCE TAX Il.ETURN iU$IDINT DECEDENT ESTATE OF BOYD, RUTH W. ITEM DESCRIPTION AMOUNT NUMBER 1. Verizon phone bill 130.34 2. West Shore EMS 109.35 3. Bonnie K. Miller, Tax Collector 11. 00 4. Pinnacle Health Hospital 286.00 5. Weis Pharmacy 358.08 6. Bank charges 45.00 7. The Woods (nursing care charges) 8,316.74 TOTAL (Also enter on line 10, Recapitulationl (If more space is needed, insert additional sheets of same size.) $ 9,256.51 REV-1513 EX. (9-00* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 la) (1.2)] 1. Sarah A. Wollaston Legatee $ 1,000.00 2. Frances Wollaston Gates Legatee 1,000.00 3. Eugene W. Bassett Residuary 8,909.06 Beneficiary ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ,. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ BOYD, RUTH W. FILE NUMBER 21-02-0567 ESTATE OF (If more space is needed, insert additional sheets of the same size) ,