HomeMy WebLinkAbout01-0181
REV.1500 EX+ (S-OO)
.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 - 0 1 1 8 1
""'C5O'NTY""C05E -YEA~ - - NUMBER--
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
MCGRAW RICHARD D,
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
204-28-0009
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
02/06/2001 10/11/1935
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dateofdeath alter 12-12-(2)
o 7. Decedent Maintained a Living Trust (Attach copyofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-(2)
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)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
MURREL R. WALTERS III ESQ
FIRM NAME (If Applicable)
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54 EAST MAIN STREET
TELEPHONE NUMBER
717/697-4650
MECHANICSBURG
PA 17055
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1. Real Estate (Schedule A)
(1)
81.986.09
OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(5)
43,452.98 I
I _
(6)
(7)
(8)
125,439.07
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
19.794.95
20.301.09
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
(11)
(12)
(13)
40,096.04
85,343.03
13. Charitable and Governmental Bequests/See 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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(14)
85,343.03
X _(15)
85.343.03 X .045 (16)
X .12 (17)
X .15 (18)
(19)
3.840.44
3,840.44
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN DVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
16 LAUREL DRIVE
CITY T STATE I ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,840.44
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the totai of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,840.44
3,840.44
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; .......................................... ................................ D IZI
b. retain the right to designate who shall use the property transferred or its income; ....................... ................ D IZI
c. retain a reversionary interest; or ...................................................................................................... 0 [Xl
d. receive the promise for life of either payments, benefits or care? ............................................................. D IZI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.. ............................................................................................ D IZI
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D IZI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D IZI
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 10 the best of my knowledge and belief, it is true, correct
and complete.
Declaratioo of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS N RES ISLE Fa LING RETURN DATE
/Q-/)-Ol
PA 17050
DATE
ADDRESS KEL~Y KOON
18 RASPBERRY DRIVE, MECHA
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
MURREL R. WALTERS III
54 EAST MAIN STREET, MECHANICSBURG
PA 17055
For dates of death on or after July 1, 1994 and betore January 1, 1995, the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (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 tor the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
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 jf
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 offhe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(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. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individuai who has at least one parent in common with the decedent, whether by blood or adoption.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE I NT T
ESTATE OF FILE NUMBER
MCGRAW RICHARD D. 21 01 181
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a wHJing buyer and a willing seUer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
16 LAUREL DRIVE, UPPER ALLEN TOWNSHIP, MECHANICSBURG, PA 17055
NET SALE PRICE 8/24/01
VALUE AT DATE
OF DEATH
81,986.09
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
81 986.09
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MCGRAW. RICHARD D.
FILE NUMBER
21 01
181
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. WAYPOINT BANK CD #516073903 17,177.53
2 PNC BANK CHECKING # 50-0100-5041 4,720.90
3 MELLON BANK # 310-052196-C 1,021.14
4 1989 BOUNDER RECREATIONAL VEHICLE 14,000.00
PER SALE PRICE TO GLADYS ETTER
5 1995 MERCURY COUGAR 3,000.00
PER SALE PRICE TO KERRY TAYLOR
6 1962 FORD GALAXIE 1,800.00
PER SALE PRICE TO EDDIE SUTLIFF
7 HONEYWELUNORTHERN TRUST 894.46
ONE MONTH PENSION
8 HAAR'S AUCTION 838.95
NET SALE PRICE OF HOUSEHOLD ITEMS
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
43 452.98
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
MCGRAW RICHARD D.
FILE NUMBER
21
01
181
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME 7,470.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) KELLY KOONTZ 6,000.00
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 18 RASPBERRY DRIVE
City MECHANICSBURG State PA Zip 17050
Year(s) Commission Paid: 2001
2. AttomeyFees MURREL R. WALTERS III 5,740.00
3. Family Exemption: (If decedent's address is nol 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 300.00
5. Accountanfs Fees
6. Tax Return Prepare(s Fees
7. FORRESTER AND CO. REAL ESTATE APPRAISAL 275.00
8 ESTATE CHECKS 9.95
TOTAL (Also enter on line 9, Recapitulation) $ 19 794.95
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
MCGRAW RICHARD D.
FILE NUMBER
21 01
181
Include unreimbursed medical expenses.
ITEM
NUMBER
1. HOUSE INSURANCE
DONEGAL MUTUAL
2 MBNA AMERICA
CREDIT CARD PAYOFF
3 BANKCARD SERVICES
CREDIT CARD
4 MELLON BANK
INSTALLMENT LOAN PAYOFF
5 UNITED WATER
6 UPPER ALLEN TOWNSHIP
SEWER
7 DONEGAL MUTUAL INSURANCE
AUTO INSURANCE
8 ATT WIRELESS
TELEPHONE
9 PNC BANK
HOME EQUITY LOAN
10 RODALE BOOKS
SUBCRIPTION
11 KERRY TAYLOR
HOUSE REPAIRS
12 LAURIE O'BRIEN
HOUSE REPAIRS
13 ERIC KING
HOUSE REPAIRS
14 CVLC
REFUSE REMOVAL-DUMPSTER
15 VERIZON
TELEPHONE
DESCRIPTION AMOUNT
200.00
2,605.26
184.10
2,396.63
181.92
305.53
227.50
179.16
2,429.46
37.43
423.43
195.75
315.20
324.90
484.56
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
20 301.09
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MCGRAW, RICHARD D.
21
01
181
Paqe 1
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16 PPL 1,022.83
ELECTRIC SERVICE
17 MARLIN YOHN 239.40
REAL ESTATE TAX
18 KELLY KOONTZ 1,921.34
HOUSE REPAIIRS
19 HOME DEPOT 9.46
HOUSE REPAIRS
20 TAMMY RICHWINE 375.00
POWER WASH HOUSE
21 CLEARWATER POOL CARE 659.14
22 J.L. RUTH ELECTRIC 70.00
HOUSE REPAIRS
23 PATRIOT NEWS 14.00
SUBSCRIPTION
24 WASTE MANAGEMENT 89.28
REFUSE REMOVAL
25 DONALD PECHART 857.00
HOUSE SPOUTING REPAIRS
26 STEVE MCGRAW 112.08
HOUSE REPAIRS
27 ROBERT RANCK 2,665.00
HOUSE PAINTING
28 JEFF MCFADDEN 950.00
HOUSE DRYWALL REPAIRS
29 HERITAGE DIAGNOSTIC CENTER 25.17
MEDICAL
30 QUANTUM IMAGING 11.42
MEDICAL
SUBTOTAL SCHEDULE I
9,021.12
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MCGRAW, RICHARD D.
21
01
181
PaQe 2
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
31 WAYPOINT SETTLEMENT SERVICES 59.00
HOUSE SETTLEMENT ERROR
32 HOLY SPIRIT HOSPITAL 174.28
MEDICAL
33 PHYSICIANS OF REHAB 129.70
MEDICAL
34 APRIA HEAL THCARE 117.18
MEDICAL
35 SHEPHARDSTOWN FAMILY PRACTICE 45.20
MEDICAL
36 CONNER, RICH, KEARNEY 263.78
MEDICAL
SUBTOTAL SCHEDULE I 789.14
GRAND TOTAL SCHEDULE I $ 20,301.09
REV-151~ EX.i.
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
)/1' M RI(",I-IAnl""\ n 21 01 11\1
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 (a) (1.211
1. KELLY KOONTZ DAUGHTER 1/6
18 RASPBERRY DRIVE
MECHANICSBURG, PA 17050
2 RICHARD D. MCGRAW SON 1/6
9701 SOUTH AVENUE "J"
CHICAGO,IL 60617
3 STEPHEN R. MCGRAW SON 1/6
2547 ALESSANDRO BOULEVARD
HARRISBURG, PA 17110
4 LAURIE A. O'BRIEN DAUGHTER 1/6
21 LILAC DRIVE
MECHANICSBURG, PA 17050
5 KERRY A. TAYLOR DAUGHTER 1/6
11 TRUDY CIRCLE
MECHANICSBURG, PA 17055
6 CARL Y MCGRAW DAUGHTER 1/6
26 RIFE DRIVE
MECHANICSBURG, PA 17050
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
..
(If more space Is needed, Insert additional sheels of the same size)
PETITION FOR GRANT OF LETTERS
Estate of RICHARD D. McGRAW No.~ -(JJ - /YI
also known as n/a
, Deceased
Social Security No.204280009
Pelilioner(s), who islare 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
Gl
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rlx
Decedent. dated 8/27/97 and codicil(s) dated none
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor. etc
Except as follows, Decedent did not marry. was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
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B. Grant of Letters of Administration
(c.I.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
r
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County. Pennsylvania. with his/her last family or principal
residence at 16 Laurel Drive, Upper Allen Township, Mechanlcsburg, PA
(list street, number and municipality)
Decedent, then 65 years of age, died February 6 . 2001 . at Health South Rehab
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total . .......... ................. ................ ............... ........ .................. ....... ............ ............. $
10,000.00
100,000.00
110,000.00
Real Estate situated as follows: 16 Laurel Drive, Upper Allen Township, Mechanicsburg, PA
Wherefore, Petilioner(s) respectfully request(s} the probate of the last Will and Codicil(s} presented with this Petition and the grant of lelters in
the appropriate form to the undersigned:
Signature
Typed or printed name and residence
.....M. f /' _ ") /A _ 9
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this
15th
day of
~ Lf7~~
Estate of RICHARD D. McGRAW
also known as nla
Deceased
N 21-2001-181
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Social Security No: 204280009 Date of Death: 2/6/01
AND NOW, February 16, 2001 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary a of Administration
are hereby granted to Kelly Koontz
((c.I.a.. d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
in the above estate and that the instrument(s), if any, datedAugust 27, 1997
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters ...."...............................
Short Certificates( s) .. .~...........
Renunciation ..........................
Extra Pages ( 2 ) ...............
I.T.R.......................................
JCP Fee .................................
Inventory................................
Other. .....................................
$
235.00
$
$
$
$
$
$
$
$
15.00
6.00
Signature
5.00
Attorney: Murrel R. Walters, III
1.0. No: 24849
Address: 54 East Main Street
Mechanlcsburg
PA 17055
TOTAL .............................$ 26)..00;
Telephone: 717.697-4650
DATE FILED: February 16,2001
MAILED LE'ITERS AND ORDER 'TO ATTORNEY
HI05,80'; REV 9/B6
This is to certify that the information here given is correctly copied from an original certificate of death duJy filed wirh me as
Locall~(lgistrar. 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, $2.00
p
7121293
No.
21-2001-181
~M~&J~./~
Local Registrar
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I ate
NAME Of OECEDENT If~SI M.ddie~-~----'----- .-----------.----- ----. --'--- SEX--~
COMMONWEALTH Of PENNSYLVANIA. OEPARTMENT Of HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
STAlf filE mJMBER
SOCIAL SECURITY NUMBER
DATE OfDfAfH-,M~~o;;.-;;,--.-"
0009 .. February 6, 2001
Hl05.i43Re\l 2187
T'l'PEJPRINT
IN
PERMA.NENT
BLACK INK
Richard D. McGraw
AGE' (La" BwwoaVl
uHOER 1 rEAR
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BIRTHPlACE rCf',;,u;d PlACE OF DEATH lCt>ec1o ~ QI'e ~- ->ell "l$lfUl;lOrs on urt"eI 'SOl>>1
'j1ate;OI FCf~CoonuYI HOSPI1Al:
Middletown, '...,- 0
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lee! and numtlefl
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65 v"
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COUNTY OF OERH
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Cumberland
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DECEDENT'S USUAl OCCUPIJION
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. .... Technical Representativ ..o.
DECEDENT'S UAtl.fHG AOORE'SS (SIr_. CllylTOwn. SlaM. ZrpCOdeI
..
Male
.. 204 - 28-
RACE . Amencan k1CNn.~. WtlCe, Me
,-,
10.
White
MARltA1. STATUS - Yarned
N..- ....... w.......
--
Widowed
Ilppp.r Allen Twp
SURViVING SPOuse
I...... gn.emaooen nM'Iel
,..
FIOliER'S NAME {Fifst. MKldIe. LaSl)
II.
IHFOAMAHT'S NAME (T ypelPfiol)
Old
........
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Cumberland -' "..0 :..."':':"..':::'..
MOTHER'S NAME iFlIst. hlodl;Ie. Maden Suroame)
II. Ma A. Zimmerman
IHFORMANrs MAIUNG ADORESS jStrMl. Ot)o/Jorlrlfl. SIMI. rip CodeI
,.... 21 Lilac Drive Mechanicsbur Pa. 17050
PlACE OF OISPOS1TIOHI. Nemeot~ Cremalory lOCAnON .CitwfIOwn, s..a..llpeoa.
Of O&hef Ptace
1lb. County
John N. McGraw
Laurie Anne O'Brien
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I\emoqIlJorn SlaleO
Feb 9, 2001
lICENSE NUMBER
ate.
FD-012662-L
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-
17055
CATE PAONOUNCeD DEAD (A.b>>h, Day, Year)
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27. PART I: EntIN the diM..... in,....-sOf compM;a11Of\1o wtwchcaUSfldlhe dealh Do nole",_ lhe mode oj dying. such as cafcSiOlCOf re$piralOf) all.st. $hOd(Of he.., faituJe
llSl '""" one CMJM on NCh W.
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1 c DUE ~,s,c,"",ourNCE=-- __~c_-:_
OUE. 10 (OR AS A CONSEOUENCE Of)
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WERE AUTOPSY FINDINGS UANNEA Of DEATH
IoIOUlAIIlE PRIOR 10
COMPlETION OF CAUSE ....w.. g- O
OF PERM? HomICide
"""donl Pending Inwsti9i1taon 0
v_ 0 No 0 ....... 0 Coukt not b8 (Je1.rr.ul'Wld 0
DATE OF INJURY
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0INt~ ~c:onultluMgtode."', buI
110I fMUIing in 1M ~,.... QMtn in FWfI" I
rtME OF lHJUAY
IH..WRY Ar 'NOAk7 DESCRIBE HOw' INJURY OCCURRE:D.
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PlACE OF INJURY. AI home. farm. III"'. ladOfy. office
buiklinl),etC.1Spel;.,v)
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loth.- b.Mt 01 ffty ~Iedge, deathoccumtd due to Ihe cau.",) and manne, ... _'eted. .
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"PAONOUNCtHG AHD CERTlfVING PHYStClAH lPt'lySCJan boIt1 ;'1I0nOU/JC"ng lJt!41rl and cellt1YIIl9 10 cause 01llL>41tll
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.IIEDlCAL EXAMtNER/COROHEA
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....nn.'..5t.t............. .
)'a.
REGISTRAR'S StGNATURE ANO NUf.lleER
rJj, nJ..u "" Ii /1 ,~ 1t ~'" .,+-,
D....
lICENSE NUM8ER DATE StGNEOtMorll'l, Day. VealI
bl 'c. Mf)#/p91..r& .."- ~J , ~,p.,1
IItAME ANO ADDRESS IJF PERSON WHOCOMPLETEO CAUSE OF DEATH
(l..m21)T_"pr'/(~o{..+/.r; .j. C,..,,,.,.Ir ....P
o AI J H~*-4.Je ~"'''A
... ~~,<I //.,. II, /... I hE.L__
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1fiut ~nu ~lm~ 1t~blmt11d ~
1Rk~nb ~* ~~nfu
I, RICHARD D. McGRAW, of the TOWNSHIP of UPPER ALLEN, COUNTY
of CUMBERLAND, COMMON\VEAL TH of PENNSYLVANIA, being in good
bodily health and of sound and disposing mind and memory, and not acting under
duress, menace, fraud, or undue influence of any person whomsoever, merely calling
to mind the frailty of human life, and being desirous of disposing my worldly goods
while I have the strength and capacity so to do, I do make, publish and declare this
my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my
former Wills and Testaments, including codicils thereto, by me at any time made, and
declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME
WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1. I direct that my Executors hereinafter named, pay and discharge all of
my just debts, funeral and testamentary expenses.
ITEM 2. I order and direct that my bodily remains be buried in a lot which I own
situate at the Gate of Heaven Cemetery, Mechanicsburg, Pennsylvania.
ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and
in fee, to my dearly beloved children, share and share alike, per stirpes.
I nominate and appoint LAURIE O'BRIEN as GUARDIAN AND
TRUSTEE over the person and property of CARLEY McGRAW, provided that she
is a minor at the time of my death. LAURIE O'BRIEN will use her discretion, to
do those things that are in the best interests of CARLEY McGRA Wand distribute
to her her share when CARLEY McGRA W reaches the age of twenty-one.
ITEM 4. I nominate and appoint KELLY KOONTZ as Executrix of this my
LAST WILL and TESTAMENT. Should the Executrix named fail to qualify or
~& JyJ.~
RICHARD D. McGRAW
Page 1 of 3
cease to act as Executrix then I appoint STEPHEN McGRAW as Co-Executor in her
stead.
ITEM 5. I hereby direct that all my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my death in respect
of all property comprising my gross estate for tax purposes, whether or not such
property passes under this LAST WILL, shall be paid by my Executrix out of my
residuary estate.
ITEM 7. I order and direct that my representative(s) named herein use the law
offices of JAMES M. BACH as attorney for my Estate.
ITEM 8. I grant to my personal representatives herein named, in addition to, but
not in limitation of those powers vested by law, to be exercised without prior
application to or approval of any court, the power and authority to retain
indefinitely any property, to invest and reinvest any assets or the proceeds derived
from the sale of assets, although said investments may not be of the character
prescribed by law, to sell, convey, assign, transfer and encumber any property, to
pay, settle or compromise all claims, to make distribution or divisions in cash or in
kind, and in general to exercise all powers in the management of any property
hereunder which any individual could exercise in the management of similar
property owned in his own right, and to execute and deliver any and all instruments
and to do all acts which may be deemed necessary and proper.
~d' )t~
RICHARD D. McGRAW
WITNESS
('
WITNESS
vJ'~7~
======================END==================
Page 2 of 3
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA)
) ss
COUNTY OF CUMBERLAND )
I, RICHARD D. McGRAW, the TESTATOR, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the instrument as my LAST WILL;
that I signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
Sworn to or affirmed and a~wledged b,re me, by: RICHARD D. McGRA W,
the TESTATOR this 3 day of ~ ,1997.
~,J? "1J/V
RICHARD D. McGRAW
NOTARIAL SEAl
ATTORNEY JAMES M. BACH, Notary Pubtlc
~U~berland County
My CommIssIon &pires May 13,1999
~.....~
~ES M. BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, P A 17055
My Commission Expires: 05/13/99
~
AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA)
) ss
COUNTY OF CUMBERLAND )
We, JASON J. MAZZEI and YURI GASPAR, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to law,
do depose and say that we were present and saw the TESTATOR sign and execute
the instrument as his LAST WILL; that the TESTATOR signed willingly and that
he executed it as his free and voluntary act for the purpose therein expressed; that
each witness in the hearing and sight of the TESTATOR signed the WILL as
witnesses; and that, to the best of our knowledge, the TESTATOR was, at the time,
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and acknowledged before me, by: JASON J. MAZZEI and
YURI GASPAR, witnesses, this'; 7"'day of ~ ,1997.
WITNESS ' _' WITNESS _~ ~'7
;j JAS ZZEI I PAR
AnoANIY.,~TAR/A( SEAL -.
","",es M BACH Nota
Ou~ ' ryPubrlc
~ComniI.'lon~~~ .
-....w ....,. 13. '999
~
ES M. BACH, ESQUIRE
NOTARY PUBLIC
Mechanicsburg, P A 17055
My Commission Expires: 05/13/99
Page 3 of 3
f-
CERTIFICATION OF NOTICE UNDER RULE S.6(a)
Name of Decedent: Richard D. McGraw
Dllte of Death: February 6, 2001
Will No. Admin. No. 21-01-0181
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 February 22, 2001.
Name Address
Kelly Koontz 14 Round Ridge Road
Mechanicsburg, P A 17055
Richard D. McGraw 1351 West Greenleaf A venue
Chicago, IL 60626
Stephen R. McGraw 2547 Alessandro Boulevard
Harrisburg, P A 17110
Laurie A. O'Brien 21 Lilac Drive
Mechanicsburg, P A 17055
Kerry A. Taylor II Trudy Circle
Mechanicsburg, P A 17055
Carly McGraw 16 Laurel Drive
Mechanicsburg, P A 17055 /
Signature
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
/ //~;~l%~'". ;;//
/ /I;
'I
. t . '\-
Date: 02/22/01
Name:
Murrel R. Walters, III, Esquire
Address:
Telephone:
54 East Main Street
Mechanicsburg, P A 17055
717-697-4650
Capacity: _ Personal Representative
,-'>
~ Counsel for personal representative
\ /b -o1/tO- j?
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
Recmoecl ,c€ of
Rer;i;;:t,.,;,r "',.1 '.tVil...ls
.b~<...#'- -" ...f; ..
REY-15~7 EX AFP 112-DDl
12-17-2001
MCGRAW
02-06-2001
21 01-0181
CUMBERLAND
101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
RICHARD
D
.01 me 27 AlO :11
MURREL R WALTERS III ESQ
54 E MAIN ST
MECHANICSBURG
C ~./
P ""I
"C~ gIla; kJ
Allount Rellitted
, PA
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=is4j-E3f-AF'P--n'2=OOY-NOTicE--OF-YNHEiiiTANCE-YAX-jrppRAiSEMENy-,--AL1-oWAifcE-oi-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MCGRAW RICHARD D FILE NO. 21 01-0181 ACN 101 DATE 12-17-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
CHANGED
81, 986.09
.00
.00
.00
43.452.98
.00
.00
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
U)
(2)
(3)
(4)
(5)
(6)
(7)
125.439.07
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
19.794.95
20.301.09
(11)
(2)
(3)
(4)
(9)
UO)
40.096 04
85.343.03
.00
85.343.03
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
.00 X 00 = .00
85.343.03 X 045 = 3.840.44
.00 X 12 = .00
.00 X 15 = .00
(9)= 3.840.44
.
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
10-12-2001 CDOO0383 .00 3.840.44
TOTAL TAX CREDIT 3.840.44
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE
... R....IIND. s.... R"""RS" SID!; OF THIS FORM FOR INSTRUCTIONS.)
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALTERS MURREL R III
54 E MAIN STREET
MECHANICSBURG, PA 17055
__nn__ fold
ESTATE INFORMATION: SSN: 204-28-0009
FILE NUMBER: 21-2001- 0181
DECEDENT NAME: MCGRAW RICHARD D
DATE OF PAYMENT: 10/12/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/06/2001
NO. CD 000383
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,840.44
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: MURREL R WALTERS ESQUIRE III
CHECK#183
SEAL
INITIALS: AC
RECEIVED BY:
$3,840.44
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/06/2003
WALTERS MURREL RIll
54 E MAIN STREET
MECHANICSBURG, PA 17055
RE: Estate of MCGRAW RICHARD D
File Number: 2001-00181
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/06/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~JuatJ/~4e-ffU;!(
DONNA M. OTTO ~
DEPUTY REGISTER OF WILLS
cc: File
JPersonal Representative(s)
Judge
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 0 ;/
0('-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Richard D. McGraw
Date of Death: February 6,2001
Estate No.: 21-2001-0181
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 ( 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 f1le a final account with the court?
Yes No .,(
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 V No
D. Copies of receipts, releases, joinders and approvals of fo I or informal
accounts may be f1led with the Clerk of the Orphans' C rt and may be
attached to this report.
Date: January 6, 2003
MURREL R. WALTERS, III, ESQUIRE
54 East Main Street
Mechanicsburg, P A 17055
717-697-4650
Capacity:
Personal Representative
_X_ Counsel for Personal Representative
Cumberland County - Kegls~er UL W~~~O
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 12/13/2006
WILLARD RAY L
32 FLEETWOOD DRIVE
NEW FAIRFIELDI CT 06812
RE: Estate of WILLARD ADELINE M
File Number: 2001-01181
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/18/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
~~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
ca