HomeMy WebLinkAbout01-0158
PETITION FOR BROBATE and GRANT OF LETTERS
;~:t;n'twn }~cl ~IO~ f.tA/~~ ~~; 21-01-158
Register of W.Jlls fqr the; J
. Deceased. County of (--U../IJ,{ bf tr (l q (1 in the
Social Security No.~/ L'':'' C ~ CJT?, (J Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of ~..g,e.-or Ci>lder an .~~ execut{)t
in the last will of the above decedent, dated ,\ LL '1 J I
and codicil(s) dated
n~;ned
, 19, /;
(state relevant circllmstances, e.g. renunciation, death of executor, etc.)
Oecendent was domiciled at death in 1 bt'. ;~ It( /1)
he ,- _ !ast famp!, pr))rin~al resi nf;e ~t. . t'-f () -, a... .~ v
((L ~ VJ F ,t/-;. L.- 1 fL-" .'.
(list street, number and muncjPality)
Oecend~nt, then -3J~ years of age, died (1\]( t C b <2- r2;S'f- ,:::f9::c.t, (t"
at f,/ILL.7 [j- C~-V" e/
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of, the '1ill offered for r ba e; was not the victim of a killing and was never adjudicated
incompetent: ' .-
It " ,
( /1'/ (/(,
$ V>,l .,.-
$ /
$
$
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10 L-; L,i
Oecendent 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 'Vi ~ A
situated as follows: I J't
/
WHEREFORE, petitioner(s) respectfully. request(s) thtL probate of the last will and codicil(s)
presented herewith and the grant of letters -t1:: 5. IzLj'tJ f /-11' Lt. v~y
/
(testamentary; administration c. La.; administration d.b.n.c.La.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA l -.~
(- S:::i
COUNTY OF CUMBERLAND J
The petitioner(s) ab,~ve-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 i!!ld truly a~i 'ster the estate according to law.
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Sworn to or affIrmed ana subscnbed vi V' - /,' (,I /( 'V1. (I Vl
before me this 21 s t day of { ~.
~}p/:~E('~O;~'t <.,..;;;,~~-ifT~~ ~y ~
/ .' / / Register (/ ~
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16 -- r;2(']P - /1
~o. 21-01-158
Estate of
Viola M Vogelsong
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
and Letters
are hereby granted to
AND NOW February 8, 2001 IlJ_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JULY 11, 1986
described therein be admitted to probate and filed of record as the last will of
Viola M Vogelsong AKA Viola May Vogelsong
Testamentary
Vance V Vogelsong
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'!/ gister of Wills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
x-pageq
RenunCiation
JCP
$ 40. 00
$_ 6.00
. . . . . . . . . . . . . . .. $ 12.00
$ 5. 00
TOTAL_$ 63.00
... .P~~'" .?1.,. .?9P.l................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
Filed
PHONE
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WARNING: It is illegal to duplicate this copy by photostat or photo~~raph.
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P 6918245
OCT 2 f, 2000
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21-01-158
ITEM' t
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COMMONWEAL-otOF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
. He" 2187
Y,s
STATE FilE NUMBER
------------ --- --- ~-~l SECUR:';BER -97?IJ
BIRTHPLACE :C.ly dr-d PlACE OF DEATH (Ct>Ec1< ""'y 01'8 -- __ ,ost,ucl""", on "'''''' SlOeI
3""6 Of fc,eogn eounlly) HOSPITAl--
Inpal..nt 0 ERlOulpall.nt 0
7 Ia.
FACILlT'I' NAME (It 001 ,n",'IUIIOO, give SIree1 and oumtl6r,
DATEOF DEATH ,Mcn;;;:Ei;;;.:;';;~-~
NAME OF DECEDENT If"" M,dO.e, ,aso)
I..
Viola M. \Cg:iliulJ
AGE (Last B,(fMay)
UNDER 1 YEAR
Montha Days
4.oCt. 21 ,2000
84
OOAD
g':=~) 0
5_
COUNTY OF DEnH
DECEDENT'S USUAL OCCUPMION
(G..e Iund Oh'Olk done duong mosI
of working ~f.; do no! use ,ellled )
IlL housewife lib. own home
DECEDENT'S MAILING AOOAESS (St,..., CltylTOwn. SlaIe..lop Code) DECEDENT'S
ACTUAL
RESIDENCE
lSee InSlrucbOI\S
on oIt"le, ~de)
1700 Market Street
I.. Camp Hill, PA 17011
17a_ Slat.
MARITAL STATUS. Mamed
N8"e, ManMtd. W~.
OMl<ced (Specty)
14~idowed
17c.0 'IM._liYedin
RACE - Am.ncan Indian, 8la<:k. Wh~., ".e
(SpecIy)
10_ whi te
SURVIVING SPOUSE
III ""'e. gill" ma.oen name)
lb.
Cumber land Co.
Cumberland
Otd
-
-"I
lownship1
t~
LICENSE NUMBER
2lP 013163 L
""" No. CleC_1Ned Camp Hi 11
17~willun lClualltmds of
MOTHER'S NAME ,F'51. Moddle. Malden Surname)
I.. Viola Korh
INFP!l~ANT'S UAI),.INO AOOA~S ~.... C".)'QOwn. ~"'. lip Cqde'
2J.LU N. ~econa bt. ,wonTIleysnurg,PA17043
PlACE OF DISPOSITION. Name aI C_e'Y, Cremlto'Y LOCATION. CilyfTown, Sla'e. X", Code
Ol .91.... P~e
Langsdorf Cemetery Silver Spring Twp,PA17050
21c. 21d.
NAME AND AOOAESS OF FACILITY
F\IEral H:ne,324 Humel Ave. ,I..aTr::1yr'E,PA17043
cllylborc
FATHER'S NAME (Fit5l. Moddle, la5l)
Ear 1 Grubb
l?b. County
Shelly
LICENSE NUMBER
.. hems 24-26 must be compleled by
; per!mn who pronounces death
2311.
TIME OF DEATH
DATE PRONOUNCED DEAD (Monlh, Day. Yea')
DATE SIGNED
(MonIh, Day. Yeat)
2~. 2k.
WAS CASE REFERRED TO MEDICAL EXAMINEAlCORONER1
y..D
NoJa
24_ M 25.
...I 2f PART I: Enter the diseases. InJunes Of compJtcahons wh.ch caused tile death 00 not enter Ihe mode of dYing, such as cardiac 01 respiratory dOSSI. St\ock or heart faLJur.
LIS1 only one cause on eacn hoe
_DlATE CAUSE (F'na1
<IIS8iiS8 Ol condlllOO
__ '-.c;a on 08aIh) -
~
:: Sequene~ &I. condibons
: d any, IeedIng to 'mmedo.al.
:jj"-' Enter UHOERLYING
.. CAUSE (Otsease Of ,0JUlY
..1Nl1lllbaled e"",,1S
.::' esuIIng on death) LAST
..
;; WAS AN AUTOPSY
-!PEAFORMED1
~
c.... A /.f tJl 0 ~v tom a,.-yA A y'
DUE 10(00 AS ACONSEOUENCE Of):
As cv.o
DUE 10 (~ ~ A CONSEOUE NeE on
Nr,y _
DUE 10(00 AS A CONs..eOUENCE~:
d ~+O~/~ ~~o~
WERE AUlOPSY FINDINGS MANNER OF DEATH
AlAlLA81E PRIOR 10
co..IPlETION OF CAUSE
OF DEATH?
/f1l~~s7
21.
, Approximate
: lIllervalbelw..n
,0-- and duth
I
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PART II:
OCher significant c:ondilions contributing 10 dea.h. but
nol result"'ll in the uncIe/Iytng cause _ in PART I
DATE OF INJURY
(M()(lrtl, Day. Year)
TIME OF INJURY
INJURY AT INORK?
DESCRIBE HOW INJURY OCCURRED_
Natural
{g
o
o
HomICide
,!
Acctdent
Pending InvesUgaltOO
o
o
o :~:CE OF INJURY _ Al home, ta,;':;"... factory. offic. M.
building, .Ic, l$poclll/}
3Oe.
'1M 0
NoD
_0
NO~
Yes 0
NoD
Suacode
Could 001 boo delermlned
(/.0.
21a. 2.b.
CERTIFIER IC~&Ck OOly one)
.CERTlfYING PHYSICIAN (,PhYStClcln cerllfYlog cause 01 ceathNtlefl doolher phys..c,an has pronounced dealtl ana comlJtele<1 lIem 23l
To the _t ot mr knowledge, deeth occurred _10 the eause(slend mann.r... slated. _
29_
'MEDICAL EXAMINER/CORONER
On Ihe baei. of examination and/or Invesligallon. on mr opinion, deelh occurred allheUme, dl'e, and place, and due to Ihe ceuse(.) end
menner .. stlled. ' .. . ... ,. .. .......,.., _, _. _.. .. _ _ . . . _ . . . . . . . . , .. .. _ . .. _. _... _. .... _ . _ . _ _ . . . .
31a
REGISTRAR'S SIGNATURE ANO NUMBER
""""77 -------
Ur~~ ~ ~
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o 31b_
LICENSE NUM_BER DATE SIGNED \M.,."Day. _y
o 31c tJ6 (.J~ 6!J'3 ff-~ 31d. /0/ 2.1/ (CJ't;)
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 271 Type or PII"7:' $. C!.., ~ ~ ~ -"11 tJ. o.
[J ZD;ZND""~ AvE..
32_ c::~_'" /01' '~.A. p,q
DAl E fOLED (Monlll Da~ Yea"
34. Ie ~'/ao
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.PRONOUNCJNG AND CERTIFYING PHYS'CIAN tPh'iS'Clo3n tx)lt: ~(onouflclng Oflodth dnd CeflllYlng 10 cause 01 dealt'll
TO the Wet of my knowledgft, de.th occurred ...the Ume. date, ind place, ~nd due to the cause(s) and m.nner al.lilted..
:13
21-01-158
3Enst lIill nub Qrtstnnttut
I. VIOLA M. VOGELSONG, of Middlesex Township, Cumberland County,
Pennsyl vania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my Last Will and Testament,
hereby revoking all other Wills and Codicils heretofore made by me.
ARTICLE I.
I direct payment of all my legal debts and the expenses of my last illness and
funeral from my Estate as soon after my death as conveniently may be done. I
authorize my Executrix to expend funds from my Estate for the purchase, erection
and inscription of a suitable grave marker. All the foregoing shall be considered
expenses of the administration of my Estate.
ARTICLE II.
I give and bequeath my automobile, household and personal effects and other
tangible personalty of like nature (not including cash or securities), together with
any existing insurance thereon, to such of my children who survive me, to be divided
among them by my Executor with due regard for their personal preferences in as
nearly equal shares as practical.
ARTICLE III.
All the rest, residue and remainder of my Estate, of whatever nature and
wherever situate, I give, devise and bequeath unto my children, VANCE V.
VOGELSONG, Mechanicsburg, Pennsylvania; EUGENE F. VOGELSONG, York Haven,
Pennsylvania; and GWENDOLYN J. SHELLY, Wormleysburg, Pennsylvania, share and
share alike. Should any of my children predecease me, I direct that such child's
share shall pass to his or her issue per stirpes by representation.
. ,
ARTICLE IV.
Should any person entitled to a share of my Estate not have reached the age of
twenty one (21) years at the time for distribution to him or her, I devise and
bequeath the share of such person unto DAUPHIN DEPOSIT BA1~K AND TRUST
COMPANY, Harrisburg, Pennsylvania, IN TRUST, to hold, manage, invest and reinvest
the share so received, and to use and apply the income and principal, or so much
thereof as, in Trustee's discretion, may be necessary or appropriate for such
beneficiary's support and education (including college education, both graduate and
undergraduate) without regard to his or her parents' ability to provide for such
support or education, or to make payments for these purposes, without further
responsibility, to such beneficiary or to such beneficiary's parents or to any person
taking care of such beneficiary. Any principal or income not so applied shall be
distributed to such beneficiary absolutely when he or she attains the age of twenty
one (21) years. In the event the beneficiary shall die before attaining age twenty
one (21), the principal, accumulated and undistributed income remaining at the time
of the beneficiary's death shall be distributed to the personal representative of the
beneficiary's estate or to his or her estate.
The interest of any beneficiary hereunder shall not be subject to anticipation or
to voluntary or involuntary alienation.
I
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I IN WITNESS WHEREOF
I i' _ '
I / ~... day of -)..-; , 1986.
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ARTICLE V.
I name, constitute and appoint my son, VANCE V. VOGELSONG, Executor of
this my Last Will. Should he fail to qualify or cease to so act, I name, constitute
appoint my son, EUGENE F. VOGELSONG, Executor of this my Last Will.
I have hereunto set my hand and seal on this the
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(SEAL)
"
Signed, sealed, published and declared by the above-named Testatrix, as and for
her Last Will and Testament, in the presence of us, who, at her request in her
presence and in the presence of each other have hereunto subscribed our names as
witnesses.
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CU1VIBERLAND
I, VIOLA M. VOGELSONG, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
(SEAL)
Sworn or affirmed to and acknowledged before me, by VIOLA M. VOGELSONG,
this 1 \ -L\I day of ")t-'''::L_y- , 1986.
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\)M "Nclary ~~~.'-*- 'C\'
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My CC::lIi:::;bn Expir~s D\lcemter 21. 1989
I "'mo' PA Cur berland Count't
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
, f'11 (~
We, (\~Q."-U"'<-_'_-~" \-vv.~~'\.-<_) and Lu,~',,-,,,,,~~, y..~,' .........."j
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whose names are signed to the foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testatrix sign and
execute the foregoing instrument as her Last Will and Testament; that she signed
willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix signed
the Will as witnesses; and that to the best of our knowledge, the Testatrix was at
that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
the witnesses
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'C"'.:"\-"v...,;;;' ,~,(\~~.witnesses, this
Sworn or affirmed to and subscribed to before me by ('0-tM_~~~" y.,.~v), and
\ \ i',t\ day of v-~'--'r-::- '" , 1986.
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CERTIFICATION 0
Name of Decedent: j,!; 6/ tl
/ti- 1- ..11) ~)~
Date of Death: CJ~C- 7 ' I- L
Will No.;2/ - J c' C I-I ;-:J
NOTICE UNDER RULE 5.6 a
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1 () f::')~ tJ21
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Admin. No.
To the Register:
I certify that notice of (beneficial interest) 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
Name / ^ / '
VeU1 (~ V. 1/ 6 9 eJs:OJ1j
C U 1f!-t1 e- F
G- L{) e ~1 d ~z./ ':r-
Address
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Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Dale riA II J If it {! I
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SIgnature .. ",,-
Ldt1ce 1/ Ie re/SCJ1j_
Address /tta--A'Plorf })iZ !fHL,/
/70S0
Name
Telephone (7/7 "7 '3.2-5 / L/ (:2,.
Capacity: _ Personal Representative
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~Counsel for personal representative
('OlIRT OF COMMON PLEAS OF CUMBERLAND COUNTY. PI':NNSYLV ^NI^
ORPIIANS' COURT DIVISION
I ',SIAl\': OF
VioL.! Vogelsong
NO. 21-01-158
Notice or claim hy IICR Manor Care
10 Ihe ('lerk or the Orphans' Court:
I ,:NTI.:R the claim or IICR Manor Care (claimant) in the amount or $4.284.]5 (Four Thousand
I \\iO Ilul1llred I.:ighty-Four and 35/100 Dollars). against the above entitled estate. The Decedent.
whose last known address was ]4 Buttonwood ^ venue, Carlisle. Cumberland County.
1\,'llllsylvani<1 1701]. and who died: October 21.2000.
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Amy F. W~ IIson. Esq. !>
Attorney tor Claimant. '
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IICR Manor Care
267 E. Market Street
York. Pennsylvania 174()]
(717) 846-1252
l.D. No. X7062
RE'b1500 EX (6-00)
COMMONWEALTH OF
. PE~NSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
If.., - ::(d~ - /Lj-
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
VOGELSONG, VIOLA M. a/k/a
VI Y
DATE OF DEATH (MM-DD-YEAR) DATE DF BIRTH (MM-DD-YEAR)
October 21, 2000 October 10, 1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFIC~,~,L USiE ON1..Y
,...._.._----~-,-,~-~...__.~.~-----~_.,--,._.
FILE NUMBER
21_01
o 0 1 5 8
-- -- -----
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
09 9730
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
001. Original Return 02, Supplemental Return D 3. Remainder Retum (dala of dealh prior 10 12-1U2)
o 4. Limited Estate D 4a. Future Interest Compromis~ (dale ofdealh sl'ler 12-12.-82) 0 5. Federal Estate Tax Return Required
GU 6. Decedent Died Testale (Attach copy 01 Will) 07. Decedent Maintained a Living Trust (A\lIIch ccpyofTrust) 8. T01al Number of Safe Deposn Boxas
o 9. Litigation Proceeds Received 0 10. Spousal POl/erty Credit {date 0( l!eatll bt\ww\ 12.31-91 and-1-1-95) 0 11. Elec\ion to tax under Sec. 9113{A) {AlUleh 5th 0)
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COMPLETE MAILING ADDRESS
301 Market st.
P. O. Box 109
Lemoyne, PA 17043-0109
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(II) 39,205.31
(12) (::l2.254.1g1
(13) -0-
(14) -0-
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x.O_ (16) _0
x .12 (17) -O-
x .15 (18) -0-
(19) -0-
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NAME Edmund G. Myers, Esq.
FIRM NAME Qr Applicable)
TElEPHONE NUMBER
(717) 761-4540
OFFICIAl.. USE ONI..Y
(8)
6.951.12
(1)
(2)
(3)
(4)
(5)
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1. Real Eslate (Schedule A)
2. Stocks and Bonds (Schedule B)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedul, G or L)
8. Total Gross Assets (total LInes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Uens (Schedule I)
11. Total Deductions (iotal Unas 9 & 10)
12, Net Value of Estate (Line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been
made (Schedule J)
''"'','' ).1;::AY&l~jf:(,i~'{ii?:,~\~fXm0!i:~~;r~~1:~'?r:?;';'e~t$g~~'::lo.X~~$~'B7"~'~41,q(f ~~'frpN~%Ql;j,:."ft,~~~$'_$~_$lP'~::'~'r:;,'rt':Re~B~c'g:~:MATH:;~;W~l:.:i.,..,j,:,;S~;;?~..,~;\(j':,14'(
W#!tW~,~t::;~:~~:':;;':!;::~~;;1,1i,
6.951.12
(6)
(7)
(9)
(10)
833.00
38 , 372.31
z
o
~
....
:J
a.
:2E
o
u
~
14. Net Value Subject to Tax (Line 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rale, or transfers under Sec. 9116 (a)(l.2)
16. Amount of Una 141axable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18, Amount of Lina 141axable at collateral rale
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS Manor Care Health Services .
1700 Market St.
CITY Camp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page Hine 19) (1) - 0-
2. CredilslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A+ B+ C) (2) -0-
3. InlerestlPenaity if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( D + E ) (3) _ 0 _
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. n Line 1 + Line 31s 9reater than Line 2, enter the difference. This Is the TAX DUE. (5) - 0-
A. Enter the Interest on the tex due..
(5A)
(5B)
Make Check Payable to: REGfSTEROF WILLS, AGENT
8liil!llr.!!l!i'-~.~~-'--~"-~~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS.
1. Did decedent make a transfer and: Ves No
a. retain the use or income of the property transferred;.......................................................................................... 0 [XJ
b. retein the right to designate who shall use the property transferred or its income; .......................................,.... 0 ~
c. retain a reversionary Interest; or.......................................................:.................................................................. 0 ~
d. receive the promise for life of either payments, benetits or care? ...................................................................... 0 [XJ.
2. If deeth occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probata property which
contains a beneticiary designalion? .................................................................................""'"'''''''''''''''''''''''''''''''' 0
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
-0-
[XJ
!Zl
~
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 pe~ury, I declare that I have examined this return, including accompanying schedules and statements. and to the lresl at my knowledge and be>>ef, n Is true. correcl
and comple\e.
Declaration of preparer other than the personal repre tlve Is based on slllnformation of which peeparsr has BrlY krlowledge.
SIGNATURE 0 SON RES 0 SIB FOR F NG RETURN
"~.
ance
1662 Airport Drive, Mechanicsburq, PA 17050
SIGNATURE OF P~HAN REPRESENTATIVE
ADDRESS Edmund G. Myers, Esq.
301 Market St., P. O. Box 109, Lemoyne, PA 17043-0109
;ci',,\.':lil.~F-~Jl~I;li'P',.~~~~~'I!I\'~M\I'lliiiBr~'!'.'}l
For dates of death on or after Juiy 1, 1994 and before January 1, 1995, the tax rate imposed on the nat vaiue of transfers to or for the use of the surviving spouse is 3%
[72 P.S. g9t16 (a) (1.1) (i)).
For datas of death on or after January I, 1995, the tax rate imposad on the net value of transfers 10 Dr for the use of the surviving spouse is 0% [72 P.S. g9116 (a) (1.1) (im.
The statute does not examot a transfer to a survivin9 spouse from tax, and the statutory reqUirements for disclosura of assets and tiling a tax return are still applicable avan if
the surviving spousa is tha only beneticiary.
For dates of death on or after July I, 2000:
The tax rate imposed on tha net value of transfars from a deceased child twanty-one years of age or youngar al daath to or for the use of a natural parent, an adoptive parenl,
Dr a stapparent oflhe child is 0% [72 P.S. g9116(a)(1.2)].
The lax rate imposed on the nel vaiua oftrans!ers 10 or for the use of the decedent's lineai beneticiaries is 4.5%, except as notad in 72 P.S. g9116(1.2) [72 P.S. g9116(a)(I)].
The tax rale imposed on tha net valua of transfers to or for the use of the decedanfs siblings is 12% [72 P.S. g9116(a)(1.3)J. A sibling Is detined, under Section 9102, as an
individual who has at laast one parent in common with the decedent, whather by blood or adoption.
ADDRESS
DATE
il(7(o(
DATE
[I/'7/0t
.
REV"~""["97I..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
VOGELSONG, VIOLA M. ajkja
VOGELSONG, VIOLA MAY
FILE NUMBER
21-01-00158
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Allfirst Trust - Checking Account
No. 00875-0340-9
Date of death balance, plus accrued interest
5,231.12
2.
First Union - Savings Account NO. 3083366562073
Date of death balance, plus accrued interest
1,720.00
TOTAL (Also enter on line 5, Recapitulation) $ 6, 951 . 12
(If more space is needed, Insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
J;~i~
"'~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
VOGELSONG, VIOLA M. a/k/a
VOGELSONG, VIOLA MAY
FILE NUMBER
21-01-00158
Debts 01 decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1-
Prepaid -0-
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s}
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees - Johnson, Duffie, Stewart & Weidner 750.00
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 - Register of wills - Cumberland County 63.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of wills - file Inventory and Inheritance
Tax Return 20.00
TOTAL (Also enter on line 9, Recapitulation) $ 833.00
Of more space is needed, insert addil10nal sheets of the same size}
REV'1512EX.(l.S7).,~:~_,. '
_ n -
::.--,
";12. ~
COMMONWEALTH OF PENNSYL VAI.II.A.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
VOGELSONG, VIOLA
VOGELSONG, VIOLA
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
M. a/k/a
MAY
FILE NUMBER
21-01-00158
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
2.
3.
4 .
1.
Manor Care, Camp Hill - 583 - decedent's account
balance due to decedent's Social Security and
pension payments not being forwarded to Manor
Care per Agreement.
(Transition from Dauphin Deposit to Allfirst
created the problem regarding the forwarding
of the Social Security & Pension to ManorCare).
4,284.35
440.00
12,428.85
21.219.11
Camp Hill Fire Co. No. 1 - emergency transport
balance due
Department of Public Welfare - Class 3 Claim
(See attached)
Department of Public Welfare - priority Class 6
Claim
(See attached)
TOTAL (Also enler on line 10, Recapitulation) $ 38. 372 . 31
(If more space is needed, insert additional sheets of the same size)
-
*'
cc co u'~\)f
RECENEO
QC1 , 5 20Q\
OUf'f'I\:
~OHNSO~l-itl 'NE\Dl'lER
Si\:'N"Rl'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 6486
HARRISBURG, PA 17105-8486
October 11, 2001
JOHNSON DUFFIE STEWART & WEIDNER
EDMUND G MYERS ESQUIRE
301 MARKET ST
POBOX 109
LEMOYNE PA 17043-0109
Re: VIOLA VOGELSONG
CIS #: 190192908
Co/Rec: 21/0086310
Date of Birth: 10/10/1916
SSN: 205-09-9730
Dear Mr. Myers:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $33,647.96 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $12,428.85, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $21,219.11, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
~lLc.-- ~, f6~I?
Jessica L. Bupp
TPL Program Investigator
717-772-6617
717-772-6553 FAX
Enclosure
HCR.ManorCare
Statement
MANORCARE CAMP HILL 583
1700 MARKET STREET
CAMP HILL, PA 17011
(717) -737-8551
/7"\ rr~~
!: \ i 1.-':' 1J
VANCE VOGELSONG
FOR VIOLA VOGELSONG
1662 AIRPORT DRIVE
MECHANICSBURG, PA 17055
MEDICARE A
PRIVATE
ROOM 221 -B
Please Return This Portion
With Your Payment
__ _ __ ~~~~'-:.S_O_N~.!. _ ~~~'-:.A_ _M___ __ _ _ __ _ _ _ _ _ _ _ _~1}J-.?_ _ _ _~~}.?!~~ _ _ ~~/_2}lE'~ _ _ ~~/_3}!~~ _ ___
DATE OF
SERVICE
SERVICE RENDERED
CHARGES
CREDITS
05/01/01
BALANCE FORWARD
4,284.35
(C(Q)[P)f
PAYMENT DUE BY THE 10TH
OF THE MONTH
4,284.35
AMOUNT DUE
VIOLA VOGELSONG
C/O VANCE VOGELSONG
1662 AIRPORT RD
MECHANICSBURG, PA 17055
] CHECK HERE FOR ADDRESS CORRECTiON Local: (717) 214-6018
ON BACKOFTHIS FORM TOll Free:1(877) 214-6018
Fax: (717) 214-6020
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT.
.
- -
Camp Hill Fire Co No 1
Billing Office TIN: 23-6266703
P.O. Box 726
New Cumberland, PA 17070-0726
Address Service Requested
QUANTITY
,~"'"
//..," '
1/
'I
'.
PATIENT NAME: VOGELSONG, VIOLA'':::
DATE OF SERVICE: 08/31/00 9:50 am
Dx:578~9 787.03 789.0
INVOICE DATE: OS/20/01 INVOICE; NUMBER: 1770
FROM: HOME/RESIDENCE
TO:HOLY SPIRIT HOSPITAL
AMOUNT ENCLOSED: $
CHARGE TO: 0 VISA 0 MC 0 DISCOVER
CARD NUMBER
EXPIRATION DATE
CARDHOLDER NAME (PLEASE PRINT)
SIGNATURE
2.0 BLS MILEAGE (LOADED ONLY)
DESCRIPTION OF SERVICE
AMOUNT
Late Pay Charge
TOTAL CHARGES THIS CALL
, UNIT PRICE
A0380
10.00
20.00
0.00
$ '440.00
I ,
MEDICARE DENIED YOUR CLAIM BECAUSE THEY ARE REQUESTING A MEDICARE
!
SIGNATURE. PLEASE REMIT SIGNATURE
This account is 90 days past due! If we do not teceive your payment
within 10 days, the account may be referred to aicollection agency.
Please call us with insurance information or to arrange time payments.
,
DESCRIPTION OF PAYMENT REFERENCE PAYMENT DATE AMOUNT
----------
TOTAL PAYMENTS THI CALL $ 0.00
1770 -113 (P1) PAY THIS AMOUNT 1111" I 440.00
AMBULANCE alLLlNG OFFICE: P.O. BOX 726, NEV'1 CUMBERLAND, PA 17070-0726
""""".".,'.'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
VOGELSONG, VIOLA M. a/k/a
VOGELSONG, VIOLA MAY
FILE NUMBER
21-01-00158
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not UslTrustee(s) OF ESTATE
NUMBER
L
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outnght spousal distributions)
1.
Vance V. Vogelsong
1662 Airport Drive
Mechanicsburg, PA 17050
Son pne-third personal
~ffects; one-third
jresidue,
2.
Eugene F. Vogelsong
165 Hykes Mill Road
York Haven, PA 17370
Son )ne-third personal
"ffects; one-third
residue.
3.
Gwendolyn J. Shelly
420 N. Second Street
Wormleysburg, PA 17043
Daughter )ne-third personal
8ffects; one-third
residue.
ENTER DOLLAR AMOUNTS FOR DiSTRIBUTiONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 DF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
l
j
ss:
Vance V. Voqelsonq
according to law, deposes and says that he is Execu tor
of the Estate of Viola M. VOGelsonG a/k/a viola
late of Camp' Hill Borough , CumberlanJ1ed'un~?~t~~~2e~sed and that the
OthO" . t d b Vance V. Vogelsong th '"d Executor
WI In IS an Inven ory ma e y , e sal
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death 0
baing duly
sworn
,1/J t0rz'~ i./
/1
/
,
2001
r
r- ~/ .'
11 /} ,1/ /
. t~~lvtL/,..t" 1~4-tLtiM; '~
EXlIcutJr . Administrator
Vance V. Vogelsong, Executor
1662 Airport Drive
Sworn to
and subscribed before me,
M~-' ~
! NC:'-ir\HID!. , - ~
\ nL~N;:f-" ,':-' l::t2C,/ Pubi Ie i
I LCrlloynr', L'!:: [:"'!"': i, Co I
I My Commi~iocn~E~plr~"s' ~ 200jj
Mechanicsburg, FA 17050
Address
Day
October
Month
2000
Date of Death
21st
You
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of disc;overy of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
M
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......... P-l
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0 t:l. l- OU) CO u E
0 C). ID
I 0 W en u)...:l C 0" ;1000)
~ w .....:l~ r-l
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0 J- t:l. ~l9 r-l 0.. H
Z )-eo ..J U. \.90 IU ...
I ..J -< 0 ..-; c.. (1) 0 ...
rl W U. -< w 0> ::r: '~O"I
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\.. /6 - c~;'(/- ;,/!- / 7'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
R-::'" ,
C' '
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-31-2001
VOGELSONG
10-21-2000
21 01-0158
CUMBERLAND
101
.02
EDMUND G MYERS ESQ
JOHNSON ETAL
PO BOX 109
LEMOVNE
JAN -4
P1 ') .05
IlL. .
C:E.'ri,
(~gnrrtJ#3
REV-1547 EX AFP el2-DDl
VIOLA
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv; iS47-EX-AFP-fi"2-':ooj--tioYicE--oF-YNHEififANcE-YA>ri(ppRA-isEMENT:--Aii-oWANCE-O"R------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VOGELSONG VIOLA FILE NO. 21 01-0158 ACN 101 DATE 12-31-2001
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)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
6.951.12
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
833.00
(9)
(10)
NOTE: To insure proper
credit to your account 1
submit the upper portion
of this form with your
tax payment.
6,951.12
3Q.201i 3]
32,254.19-
.00
32,254.19-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00
.00
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID I
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
38.372.31
(11)
(12)
(13)
(14)
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
. IF PAID AFTER DATE INDICATED 1 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.)
sit
~
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: VIOLA M. VOGELSONG
Date of Death: October 21.2000
Will No.: 2001-00158
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:
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:.
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 No X
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:
1/16/0 v
~-
.~J;;r4U
Signature '
Edmund G. Myers, Esq.
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemoyne. PA 17043-0109
Address
(717) 761-4540
Telephone No.
r-
Capacity: Personal Representative
X Counsel for Personal Representative
('-.I
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