HomeMy WebLinkAbout02-0675
,..
PETITION FOR PRODA TE and GRANT OF LETTERS
M
Es/a/eo! AniceAl. Koontz No. jJ-o~-f.-16
also known as To:
Register of Wills for the
Deceased. County of C U f1l b e r 1 and in the
Social Security No. 1 8 1 - 0 5 - 3 642 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who islare 18 years of age or older an the execut r i x named
in the last will of the above decedent, dated No V e m b e r 1 8, 1 970
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of execillof, etc.)
Decendent was domiciled at death in Cum b e r 1 and County, Pennsylvania, with
h er la t amilY"hPri~gj'~re at ~~~ I :I~~~:\J ~t~~ tt~;3~H;i S LE
jVVR..5ifr<5 o~ IE: (liststree', numberandmUl1cipalitY)(&L'tb~&'ut;;;:r~/>
Decendent, then 94 years of age, died J u 1 V 1 3 , 2002
at r'H1i<;1f' Rf'ginn81 ~1f'rlir.8l r:f'nef'r
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(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:
si'lf
co,
$ 15,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of lellers t est am e n tar y
theron.
(testamentary; administration c.La.; administration d.b.R.c.l.a.)
..,
"if :;
.8_ ~ 1fr/ i/uuu ~~
.~~ R h M. anasdalan
"'u
19 110 Sycamore Drive
_u Me Hnlly Srring~, PA 17nh5
~~
~o
!
in
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF CUMBER.LAND S8
Sworn to or affirmed and
before me this L6th
Ma
I "
MARY CLEWIS
71-{ 'I
The petitioner(s) above-named swear(s) or aFfirm(s) that the statements in the foregoing petition are
tru:, and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tallve(s) of the above decedent ;>etitioner(s) will well and truly. administer the estate according to law.
. (!::dJ;{;l ;/tVtd4~~
.ft'I (7 ,/'1, i/O(/C/5r1'1/'1 n
subscribed
day of
2
/7-
Regis/er
'"
~.
"
-
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~
.s:
Estate of
~o. 21-2002-675
M
Anice j;Y. Koontz
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
NDNOW July 26 2002 . 'd' f h ..
A _. In consl eratlOn 0 t e petitIOn on
the reverse side hereof. satisfactory proof having been presented before me.
IT IS DECREED that the instrument(s) dated No v e m be r 1 8, 1 970
described therfMi be admitted to probate and filed of record as the last will of
Anice')1'! Koontz
and Letters t est amen tar y
are hereby granted to Ruth M. Vanasdalan
Will Book #
Page
~L'&::::~~~
MAllY C. LEWIS
FEES
Probate, Letters, Etc. .........
Short Certificates(2 ) . . . . . . . . . .
Renunciation ................
x-Pages (1)
JCP
$ BO.OO
$ 6.00
$
$ ~:BB
TOTAL _ $ 64.00
Filed .<Tv;Ly. .~9j:J1...~QQ;2.. . . . . . . . . . . . . . '"
stephen J. Hogg, Esquire 36812
ATTORNEY (Sup. Ct. l.D. No.)
19 S. Hanover st., Ste.
ADDRESS
101, Carlisle
PA 17013
(717) 245-2698
PHONE
i"
CALL ATI'ORN8Y STEPHEN J. HCXJG CX'I 7/26/2002
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)
21-2002-675
REGISl';eR OF WILLS OF (;~~E/(4/t1J COUNTY
OATH OF NON-SUBSCRIBING WITNESS
er hereto, (each) being duly qualified according to law, depose(s) and say(s) that
1.e -' familiar with the signature of AA/(CE ~. 1f'O<J'V'T?.
codicil
rwV presented herewith and
codicil
believes the signature on the @s in the handwriting of
Lutu ra-Mff)/f!fA/
testat~ of (one of
~
cvrcJ C/U-/U-Ef
1?1 /!/!"t,5 P /1~ Vl;v
that
the subscribing witnesses to) the
knowledge and belief.
1ra()A/~Z
Sworn to or affirmed and subscribed before
me this 26th day of
July ~ ~
ml'l.~ e.. ,<.4...1 ,hIE! Jj{~tf . ~I
Mary C eWlS ReglsteV
,'0 'J(".d?Jf /cUl/MdA~~
(Name) 4-
(ruS-yc~Ih'r1dfl ~r/rPc..
)< eLAk (t:d7Lo~ ./L-
(Name)
lit) 4-A"~ lJ/J.1t,Ut. f,(-!j~ ~.
(Address)
21-2002-675
LA.ST WILL A~'jD TEsrrAFE.1'IT
--
I, Anice M. Koontz, of Aspers, Adams County, Pennsylvania,
do hereby make, Dublish and declare this as and for my last will
and testarwnt hereby revoking any and all wills or testamentary
writings by me at any time heretofore made.
FIRST: I order and dipect that all my just debts and funeral
expenses be paid as soon as C(H1V81iient after my decease.
SECOJ.!D: I give, devise and bequeath all of my estate, of
whatsoever nature and wheresoever situate, to my beloved husband,
Paul E. Koontz.
THIRD: In the event my husband should predecease me, or if he
and I die at the same time or in a common disaster, or under such
circumstances that it is difficult or impossible to determine
which died flrst, then I devise and bequeath my entire estate to my
children in equal shares namely: Ruth M. Vanasdalan, or her issue
per stirDes, Paul R. Koontz, or his issue per stirpes, Ronald L.
Koontz, or his issue per stirpes.
L!'cSTLY: I nominate and appoint my hUS1:land, "aul E. Koontz,
as executor of this my la"t will and testament, and hereby autJ',orize
and empower' him to s ell all of my estate, both real or nersonal, at
either public or priVEtte sale. If my hus!)and predeceases me I anpoint
my daughter, Ruth M. Vanasdalan as executrix of my estate.
J
,
lIT '!':ITFESS W,nBEOF, I hereunto set my hand and seal to this
my last will and testament, containing two typewritten na',es to each
of which I have affixed rcry hand and ,-.eal, t'lis 18th of Novern~
in the year of our Lord One thousand nine hundred and seventy. (1970)
U'U/-,C0.Y.J!. ,/(t77:7J?f (S eal)
Signed, sealed, published and declared
by the wlove named testator, Anice M. Koontz,
as and for her last will and testament, in the
presence of us, wr,o, at her request and in
her presence and in the ,:;resence of each
other have hereunto subscribed our names as
tne~rc
J
l
CERTIFICATION OF NOTICE UNDER RULE 5,6(a)
Name of Decedent: An ice D. Koon t z
Date of Death: Ju I Y 13, 2002
Will No.
Admin. No.
21-02-0675
To the Register:
I certify that notice of (beneficial illterest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
~
Address
Ruth M. Vanas~alan
110 Sycamore Drive, Mt. Holly Sorings, PA
17065
Ronald Lee Koontz 22 Shawnee Court, Medford, NJ 08055
Paul R. Koontz 660 W. North Street, Spring Hill, Kansas 66083
Notice has now been given to all persoos entitled thereto under Rule 5.6(a) except
Date: 08/07/02
"'""""~p-
NameStephen J. 'Hogg, Esquire
Address 1 9 S. H a no v e r st., S t e. 1 0 1
r:8r1is1", PA
1701,
Telephone (7 1 t
245-2698
Capacity: _ Personal Representative
~Counsel for personal representative
/?- ;/1-/<7
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT. 280601
HARRISEURG~ PA 17126-0601
,/
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 02-0675
02142034
09-24-2002
RfY-l!iUfXAFP 1D9_DO>
EST. OF ANICE D KOONTZ
5.5. NO. 181-05-3642
DATE OF DEATH 07-13-2002
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIf .
RUTH VANASDALAN
11 0 SYCAMORE DR
MT HOLLY SPGS p~. 17065
REHIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has pro....ided the Departlllent with the information listed beloW which has been used in
calculating the potential tax dUB. Their records indicate that at the death of the above dQcedBnt~ YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction fro~ the financial institution, attach a COPy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
uf Pllil"insY~\iailia. QUiil~tio..-." millY ;;;.. a.-.=,wlillsd ulf <;idling (717) 767-03'-7.
COMPLETE PART 1 BELOW.
Account No. 31500221137
. . SEE
Date
Established
REVERSE SIDE FOR
07-01-1993
FILING AND PAYMENT INSTRUCTIONS
Account Balance 1 0 I 152 . 31
Percent Taxable X 50.000
Allount Subject to Tax 5/076.16
Tax Rate X .045
Potential Tax Due 228.43
PA~ TAXPAYER RESPONSE
[!](ili!i~i~~~II.li.~~I,I~~~~il~1Ii!~'mlll1~I~'il!i!I~~I...~._.t~III.I~~lmiil
To insure proper credit to your account~ two
(Z) copies of this notice must acco~pany your
payment to the Register of Wills. Make check
payable to: "Register of Wills~ Agent".
NOTE: If tax payments are made within three
(3) _onths of the decedent"s date of death~
YOU may deduct a 5~ discount of the tax dUG.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above infor~atlon and tax due is correct.
1. You may choose to re_lt payment to the Reglster of Wills with two copies of this notice to obtaln
a discount or avoid interest. or you may check box "A.. and return this notice to the Register of
Wills and an official assessment will be issued by the p~ Department of Revenue.
B. 0The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to, be filed by the decedent"s representative.
C. c=J The above information is incorrect and/or debts and deductions were paid by you.
'tau _ust co_plete PART 0 and/or PART 0 below.
PART
@]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Allount Subject to Tax
5. Debts and Deductions
6. Allount Taxable
7. Tax Rate
8. Tax Due
TAX ON JOINT/TRllST lICCOllNTS
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
x
x
PART
I!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL CEnter on Line 5 of Tax COllputation)
Under penalties of perjury I I d.cla~e that the facts I
cOllplete to the best of IIY knowledge and belief.
~{ffS1tN~~Adn~M--'
have reported above are true I correct
if';' H /'<LS-
and
HOME (7/7)
WORK ( )
TELEPHONE NUMBER
IO~.?--O.J....
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforllation
submitted by the financial institution.
2. Inheritance tax becomes delinquent ning months after the decedent's date of death.
3. A joint account is taxable Bvsn though the decedent's name was added as B lIatter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fUlly taxable as transfers.
S. Accounts established jointly between husband and wife lIore than one year prior to death are not taxable.
6. Accounts held by B decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
I
TAXPAYER RESPONSE
1. BLOCK A - If the infor.atien and computation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subllit thell with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(For. REV-]548 EX) upon receipt of the return from the Register of Wills.
z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania lnheritance
Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept Z80601~ Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice infor.ation is incorrect and/or deductions ara being claimed~ check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and subllit them with your check for the amount of tax payable to the ~egister
of Wills of the county indicated. The PA Depart.ent of ReVenue will issue an official assess.ent (Form REV-1548 EX) upon receipt
of the return froll the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the .anner existing at data of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (I) year of death are
taxable fuJJy as transfers. However~ there is an exclusion not to exceed $3~OOO per transferee regardless of the value of
the account or the nu.ber of accounts held.
If a double asterisk (..) appears before your first nalle in the address portion of this notice~ the $3~000 exclusion
already has been deducted froll the account balance as reported by the financial institution.
2. Enter the total balance of the account inclUding interest accrued to the date of death.
3. The percent of the eccount that is taxable for each survivor is determined as follows:
A. The percent taxable for joint aSSQts established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exa.pl&: A joint asset registered
DIVIDED BV TOTAL NUMBER OF X 100 PERCEHT TAXABLE
SURVIVING JOINT OWNERS
in the na.e of the decedent and two other persons.
I DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100
16.7X (TAXABLE FO~ EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual{s) (trust beneficiaries):
1 DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY Z (SURVIVDRS) = #50 X 100 SOX (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The a~ount taxable (line 6) is determined by SUbtracting the debts and deductions (line 5) from the amount subject to tax (line 4)#
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6Y. 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.SX* 12% 15%
.,he tax rate 1.poSfld on the net value o' transfers fro. a deceased Chlld twenty-one years.of ':Ige or y
ounger at
death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the Child ]S ax.
The lineal class of heirs includes grandparants, parents~ children~ and lineal descendents. "Children" includes natural children
whether or not they have been ~doptad by others~ adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents~ whether or not they have been adopted b~ others~ adopted descendants and their descandants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in com.on with the decedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for pay.ent~ or the estate subject to ad.inistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
c. Debts being clai~ must be ite.ized fully in Part 3. If additional space is needed~ use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Department of ~evenue.
E-143 EX (3-99)
RlldJVfJ1UlSdolrm
V llOSyctllflo"Dr
MJ HollySprs. PA 17065-1819
Attention: TIC 340
Zip Code
~t
PA DEPARTMENT OF RE~ENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG PA 17128-0601
II
-..-."",-,~
-
1",111",1,"11"1,11,,1,11,11I11"1111I11I11.1"11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
AEV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
V ANASDAlAN RUTH M
110 SYCAMORE DRIVE
MT HOllY SPRINGS, PA 17065
_nnu_ fOld
ESTATE INFORMATION: SSN: 181-05-3642
FILE NUMBER: 2102-0675
DECEDENT NAME: KOONTZ ANICE M
DATE OF PAYMENT: 10/09/2002
POSTMARK DATE: 10/03/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 07/13/2002
NO. CD001710
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $217.01
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$217.01
REMARKS: RUTH M V ANASDALAN
CHECK# 996
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. lEWIS
REGISTER OF WillS
REV_1500EX+(8-00}
.
I-
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W
C
W
(,)
W
C
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
Koontz Anice D.
DATE OF DEATH (MM-DD-Year)
\"-t - ~t- -\l\--
REV -1500 0
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
=-
FILE NUMBER
21-020675
COONrrCOOE ---vE....r- - - 'NuMiiER- -
SOCIAL SECURITY NUMBER
QATE OF BIRTH (MM-OO-Year\
1 8 1 - 0 5 - 3 642
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
07/13/2002 12/25/1907
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or SoJe-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
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 o.duC\ions (total Linesg & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an ejection to tax has not been
made (Schedule J)
[X) 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
THIS SECTION MUll
NAME
Ste hen J. Ho Es uire
FIRM NAME (If Applicable)
TELEPHONE NUMBER
7172452698
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromlse {dawoideatllaft6r 12-12-S2)
o 7. Decedent Maintained a Living Trust (Attach copy cITruS!)
o 10. Spousal Poverty Credit (date of death belWeen 12-31-91 and 1-1-95)
03. Remainder Return (date of death prklrto 12.1J-82j
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 Ql
eORRElIPOND
-ON SHOULD BE. .IRECTED'TO:
Suite 101
Carlisle
PA 17013
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
14,071,00
5,076.16
(8)
19,147.16
8,855,13
3,775.42
(11)
(12)
(13)
12,630.55
6,516.61
14, Net Value Subject to Ta.x (Une 12 minus Line 13}
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
6,516.61
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 Une 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X 0_(15)
6,516_61 X .04,5 (16)
X .12 (17)
X .15 (18)
(19)
293.25
0.00
293.25
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
CHECK~ATH,' <
'e,;>>'BE SURE TO ANSWER ALL'ell
Decedent's Complete Address:
STREET ADDRESS
".-
)
CITY
I STATE
I ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
293.25
217.01
Total Credits (A +B +C)
(2)
217.01
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty (D + E I (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. (51
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
76.24
76.24
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; ........................................................................... 0 !XI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 !XI
c. retain a reversionary interest; or ...................................................................................................... D lXl
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 !XI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 !XI
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 !XI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare thai j have examined this return, includinq accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of pre parer other than the personal representative is based 00 allmformation of which pre parer has any knowledge.
DATE
:1- 3-63
ADDRESS
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
~Jd.>11J" ;//lAUM~
110 Sycamore Drive
Mt. Hol in
SIGNATURE OF PREP
/,' ,h
19 S. Ha ov
Carlisle
NT A TIVE
ADDRESS
PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (al (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (li)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(al(1)].
The tax rate imposed on the net value of transters to or tor 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.
Re",~"X'I""*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDEN1 DECEDEN1
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Koontz Anice D. 21 02 0675
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Personal Property 231.00
2. Gettysburg Times - Refund 6.87
3. Fidelity Mutual Insurance 38.71
4. Housing Authority - Refund 1 00.43
5. Adelphia - Refund 40.29
6. Unity. Refund 9.75
7. Redding Auction 690.00
8. Checking Account #5180083255 6,626.08
9. Certificate of Deposit #31600229531 6,327.87
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, Insert additional sheets of the same size)
14071.00
'EV'~EV.I"7)..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Koontz Anice D.
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
21
02
0675
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELA TrQNSHIP TO DECEDENT
A. Ruth M. Vanasdalan
110 Sycamore Drive
Mt. Holly Springs, PA 17065
Daughter
B
c
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUED'
NUMBER TENANT JOINT deedforjoil'llly-heldrealestate. VALUE Of ASSET INTEREST DECEDENT'S INTEREST
1. A 012099 Certificate of Deposit 10,152.31 50. 5,076.16
Account# 31500221137
TOTAL (Also enter on line 6, Recapitulation) $ 5,076.16
(If more space is needed, insert additional sheets of the same size)
REV.1511EX+{1.97)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENl DECEDENl
ESTATE OF
FILE NUMBER
Koontz Anice D.
21
02
0675
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Dugan Funeral Home. Inc. 6.349.06
2. Possum Hollow Inn (Funeral Buffet)
215.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5) Ruth M. Vanasdalan 957.36
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 110 Sycamore Drive
Cily Mt. HolIV SprinQs State PA lip 17065
Year(s) Commission Paid:
2. Attorney Fees Stephen J. Hogg, Esquire 957.36
3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
Cily State Zip
Relationship of Claimant to Decedent
4. Probate Fees 64.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Advertising: Cumberland Law Journal 75.00
The Sentinel 87.35
8. Tax Return and Inventory 25.00
9. Accounting (Est.) 125.00
TOTAL (Also enler on line 9, Recapitulation) $ 8855.13
(If more space IS needed, Insert additional sheets of the same size)
"".'''''~..'''''..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEr
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Koontz Anice D.
FILE NUMBER
21 02
0675
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Met Ed Electric
12.45
2.
Sprint
3.47
3.
Claremont Nursing Home Bill. June 2002
2,436.00
4.
Claremont Nursing Home. Final Bill July 2002
1,116.50
5.
Auction Fees
207.00
TOTAL (Also enter on line 10, Recapitulalion) $
(If more space IS needed, Insert additional sheets of the same size)
3 775.42
,
. ,
.
'--'
INVENTORY
Estate of Anice D. Koontz
No.21
02
~ v;15
, Deceased
Date of Death 07/13/2002
Social Security No. 181-05-3642
also known as
Anice D. Koontz
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. I/We
verify that the statements made in this inventory are true and correct. I/We 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: Stephen J. Horm, Esquire
!.D. No.: 36812
Ruth M. Vanasdalan
Address: 19 S. Hanover Street, Ste. 101
Carlisle
Dated
PA 17013
Telephone: 7172452698
Description
Value
Personal Property
231.00
Gettysburg Times - Refund
6.87
Fidelity Mutual Insurance
38.71
Housing Authority - Refund
1 00.43
Adelphia - Refund
40.29
Unity - Refund
9.75
Total
(Attach Additional Sheets if necessary)
19,147.16
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
Anice D. Koontz
21
02
0674
Page 1
Description of Inventory
Description
Value
Redding Auction
690.00
Checking Account #5180083255
6,626.08
Certificate of Deposit #31600229531
6,327.87
Jointly Owned Property of Decedent at 50% value:
Certificate of Deposit Account #31500221137
Value: $10,152.31
5,076.16
Subtotal $
18,720.11
Grand Total $
19,147.16
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712.8-0601
REV-l 162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HOGG STEPHEN J ESQUIRE
19 S HANOVER STREET
SUITE 101
CARLISLE, PA 17013
___n___ told
EST A TE INFORMATION: SSN, 181 -05-3642
FILE NUMBER: 2102-0675
DECEDENT NAME: KOONTZ ANICE M
DATE OF PAYMENT: 02/06/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/13/2002
NO. CD 002135
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $76.24
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: STEPHEN J HOGG ESQUIRE
CHECK# 08
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$76.24
DONNA M. OTTO
DEPUTY REGISTER OF WillS
'" 17- 7')- /"'/
" BUREAU OF INDIVIDUAL TAXES
INHERITANCE TA~ DIVISION
DEPT. 260601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLDWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
STEPHEN J HOGG ESQ
STE 101
19 S HANOVER ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
~OUNTY
ACN
03-31-2003
KOONTZ
07-13-2002
21 02-0675
CUMBERLAND
101
Allount Remitted
'*
REV-1S~1 E~ ~FI' tU1~n)
ANICE
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i5'4-j-iif"AFi'-[iiFo3Y"NOTICin6rrNHiififAN-CE-'1'AX-A"PPRA"isiiiEN:r-;-AL.i-oWANCe-.OR--mm-----n--
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KOONTZ ANICE M FILE NO. 21 02-0675 ACN 101 DATE 03-31-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16J
17. Allount of Line 14 at Sibling rate {17l
18. Allount of Line 14 taxable at Collateral/Class B rate (18J
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate {Schedule AJ
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule GJ
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
17J
.00
.00
.00
.00
14,071.00
5,076.16
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule HJ
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governaental Beques~s; Non-elected 9113 Trusts (Schedule JJ
14. Net Value of Estate Subject to Tax
(9)
(10)
8,855.13
3,775.42
(11)
112)
113)
(14)
NOTE:
.00
6,516.61
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
NOTE: To insure proper
credit to your account I
submit the upper portion
of this forM with your
tax paYllent.
19,147.16
1:>.630 ';5
6,516.61
.00
6,516.61
19 will
(19)=
.00
293.25
.00
.00
293.25
TAY CR"DITS:
. UM.N I <T (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-03-2D02 CDOO1710 11.42 217.01
02-06-2003 CD002135 .00 76.24
TOTAL TAX CREDIT 304.67
BALANCE OF TAX DUE 11 .42CR
INTEREST AND PEN. .00
TOTAL DUE 11. 42CR I
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, 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.)
LAW OFFICES OF
STEPHEN]. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE. PA 17013
,
PROPOSED DISTRIBUTION
Disbursement Amount: $6,516.61
Third paragraph of Will:
Ruth M. Vanasdalan
Paul R. Koontz
Ronald L. Koontz
...
$2,172.21
$2,172.20
$2,172.20
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
IN RE:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
ANICE D.
KOONTZ
ORPHAN'S COURT DIVISION
NO. 21 02-0675
FIRST AND FINAL ACCOUNTING
Of the Estate of Anice D. Koontz, Deceased, Late of
Cumberland County, Pennsylvania.
Filed on behalf of RUTH M. VANASDALAN, Executrix
Date of Death:
Letters Testamentary Granted:
July 13, 2002
July 26, 2002
Letters Advertised:
The Sentinel: 08/12/02, 08/19/02 and 08/26/02
Cumberland Law Journal: 08/30/02,09/06/02,09/13/02
Accounting filed: May 2003
ACCOUNT FINAL AS OF:
LAW OFFICES OF
STEPHEN J. HOGG
19 S, HANOVER STREET
SUITE 101
CARLISLE, PA 17013
IN RE:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
ANICE D,
KOONTZ
ORPHAN'S COURT DIVISION
NO, 21 02-0675
Purpose of the Account: Ruth M, Vanasdalan, Executrix of this
Estate files this Accounting to acquaint interested parties with the
transactions that have occurred during his execution,
The Account also indicates the proposed distribution of the
estate,
It is important for the Account to be carefully examined,
Requests for additional information or questions or objections can be
discussed with the undersigned Attorney for the Estate,
Stephen J. Hogg, Esquire
19 S, Hanover Street, Suite 101
Carlisle, PA 17013
(717) 245-2698
Attorney for Estate
LAW OFFICES OF
STEPHENJ. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
RECEIPTS OF PRINCIPAL
CASH
Personal Property
Redding Auction
PNC Bank
Checking Account #5180083255
Certificate of Deposit #31600229531
REFUNDS
Gettysburg Times -Refund
Fidelity Mutual Insurance
Housing Authority - Refund
Adelphia - Refund
Unity - Refund
JOINTLY OWNED PROPERTY
Certificate of Deposit#3150022113 7
50% of total value of $10,152.31
Jointly owned property with
Ruth M. Vanasdalan
TOTAL GROSS ASSETS
$ 231.00
$ 690.00
$6,626.08
$6,327.87
$ 6.87
$ 38.71
$ 100.43
$ 40.29
$ 9.75
$ 5,076.16
$ 19,147.16
LAW OFFICE'S OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
DISBURSEMENTS OF PRINCIPAL
EXPENSES AND DISBURSEMENTS
Med Ed Electric
Sprint
Claremont Nursing Home Bill - June 2002
Claremont Nursing Home - Final Bill July 2002
Auction Fees
Total
ADMINISTRATIVE EXPENSES
Dugan Funeral Home, Inc.
Possum Hollow Inn (Funeral Buffet
Personal Representative's Commissions
Attorney fees
Probate fees
Advertisement: Cumberland Law Journal
The Sentinel
Accounting (Est.)
Inventory and Tax Return
Total
$12.45
$3.47
$2,436.00
$1,116.50
$207.00
$3175.42
$6,349.06
$215.00
$957.36
$957.36
$64.00
$75.00
$87.35
$125.00
$25.00
$8855.13
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
TOTAL EXPENSES AND DISBURSEMENTS $ 12630.55
TOTAL GROSS ASSETS $ 19,147.16
LESS EXPENSES AND DISBURSEMENTS 12,630.55
NET ESTATE AMOUNT FOR DISBURSEMENT $
6,516.61
2
LAW OFFICES OF
STEPHENJ. HOGG
'9 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
DISBURSEMENT
Disbursement Amount: $6,516.61
Third paragraph of Will:
Ruth M. Vanasdalan
Paul R. Koontz
Ronald L. Koontz
$2,172.21
$2,172.20
$2,172.20
LAW OFFIC~S OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
VERIFICATION
I Ruth M. Vanasdalan, do hereby verify that I am the Petitioner herein,
and that the facts set forth in the aforegoing Petition to Settle an Estate
are true to the best of my knowledge, information and belief, upon
information supplied. I understand that false statements herein are
subject to the penalties of 18 Pa. C.S.A. ~4904, relating to unsworn
falsifications to authorities.
Date: 7- % '6-3
~,d:1{/. 1~-1td.-1 dd?~
RUTH M. VANASDALAN
Sworn to or affirmed and subscribed to before me by witnesses,
this 8-+b day of 3( 1\\1"" ' 2003.
~~\\QQ,,1\*
Notary Public ~
My Commission Expires:
Notarial Seal
8nlnda K. Bishop, Notary Public
C8IllIIe Bora, Cumbe~and County
"" Commission Expires Mar. 14, 2005
Member.PennsytvaniaA.<;soclationotNotalies
LAW OFFICES OF
5TEPHENJ. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
CONSENT TO DISTRIBUTION
I, the undersigned party in interest in the Estate of Anice D.
Koontz, aver I have received and read a copy of the attached First and
Final Accounting with a proposed final distribution schedule. I
understand the proposed distribution and have no objection thereto.
Date: 7~ ~'-tJ3
cj /
7(,a,/,il/1. ,iltMtMd1b4t'/
RUTH M. VANASDALAN
'.
LAW OT=F1CES OF
,TEPHENJ. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
"
. "
CONSENT TO DISTRIBUTION
I, the undersigned party in interest in the Estate of Anice D,
Koontz, aver I have received and read a copy of the attached First and
Final Accounting with a proposed final distribution schedule. I
understand the proposed distribution and have no objection thereto,
Date:
7/;y/63
~ /," ~
K~~,pq ~'"
RONALD L. KOONTZ
. .
LAW OFFICES OF
,TEPHEN J. HOGG
19 S, HANOVER STREET
SUITE 101
CARLISLE, PA 17013
"
. '.. ..
CONSENT TO DISTRIBUTION
I, the undersigned party in interest in the Estate of Anice D,
Koontz, aver I have received and read a copy of the attached First and
Final Accounting with a proposed final distribution schedule, I
understand the proposed distribution and have no objection thereto,
Date: }-/& ~03
'Z~~JZU
, PAUL R. KOONTZ -
STATUS REPORT UNDER RULE 6,12
Name of Decedent: Anice D, Koontz
Date of Death: 7/13/02
Will No,
Admin, No, 21 02-0675
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:
I ' 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, I is Yes, state the following:
a,
account with the Court?
Did the personal representative file a final
Yes X No
b . The separate Orphans' Court No, (if any) for
the personal representative' s account is:
c , Did the personal representative state an
account informally to the parties in interest? Yes No
d ' Copies of receipts, releases, joinders and
approvals of formal or mformal accounts may be filed W~lth the
Clerk of the Orphans' Court and may be attached to thIS repo ,
Date: 9/12/03 ::;
SIgnature
Steohen J, Hoac, ESQuire
Name (Please type or print)
19 S, Hanover Street, Ste, 101
Carlisle PA 17013
Address
( 717 ) 2452698
Tel, No,
Capacity :
Personal Representative
X
Counsel for personal
representative
tv
dK
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