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HomeMy WebLinkAbout01-0344 I Prepared By Francis A. 21111 i r F.~Cllli rp Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS I Date 3/30/2001 Estate of "R TTTl-f BRA CT(l<'N c: TnF also known as No. I Deceased Social Security No. 203-10-9391 (COMPLETE "A" OR "B" BELOW:) Cii A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execuTix named in the Last Will of the Decedent, dated 1 2/27 / 2000 I and codicil(s) dated NON E 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 incompetent: o B. Grant of Letters of Administration Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets, if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 3609-7 Kohler Place. Camp Hill, Hampden Twp., Cumb.erland County, PA 17011 Decedent, then 80 yearsofage,died March 23, 200lat Holy Spirit Hospital, Camp Hill, PA . Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property - - - - - - - - - - - - -$ 90. 000 . 00 (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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $ 90 , 000.00 Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the rant letters in the appropriate form to the undersigned: Typed or printed name and residence Karen B. Roberts 1802 Brid e St., New Cumber and, PA RW-7 / b - J~ 1- ~ Commonwealth of Pennsylvania County of Cumberland Oath of Personal Representative The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the decedent, Petitioner(s) will wel and ruly administer e estate according to law. Sworn to and affirmed and subscribed before me this MARCH 30th day of ,20~ \. /?jt'rr2!fU/J Y<~ U /Ao 4 "7" DECREE OF REGISTER Estate of RUTH B. BACKENSTOE , Deceased No. 21-01-344 also known as Social Security No. 203-10-9391 Date of Death: March 2~, 2001 AND NOW, APRIL 2 ,20 01 , in consideration of the ~ion on the reverse side hereon, satisfactory proof having been presented before me.- IT IS DECREED that Letters !Xl Testamentary 0 of Administration ~. are hereby granted to KAREN B. ROBERTS in the above estate and that the instrument(s), if any, dated 1 2/ 2 7 / 2000 Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters------------------ Short Certificate(s) - - - - - - - - - Renunciation - - - - - - - - - - - - - Affidavit ( )- - - - -- -- - -- -- - Extra Pages ( )- -- -- - -- - -- Codicil - - - - - - - - - - - - - - - - - - JCP Fee - - - - - - - - - - - - - - - - Inventory & Tax Forms - - - - -- Other------------------- TOTAL----------- RW-7a described in the $ 200.00 $ 21.00 $ $ o.uu $ $ 5.00 $ $ $ 109 Locust Street Address: Harrisburg, FA 17101 $ 232.00 Telephone: (717) 236-9301 DATE FILED: MARCH 30, 2001 ~ 4, (k~~/ Hl0SROS ~vh9:;r,is to certif)' that the information here given is correctly copied from an original certificate of death dul~ filed with Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. me as No. ~:1,~' Fee for this certificate, $2.00 p 7295047 MAR 2 ~ 2001 Date 21-01-344 Rev 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS CERTIFICATE OF DEATH NAME OF DECEDENT (flfst. Middle. l_1 .. SEX SWE FILE NUMBER SOCIAL SECURITY NUM8ER AGE(lall~ UNDER. VENI - Doyo IIHDfR . 0Itt -! ......... 10 80 Y... COUNTY OF DERH g:',:oIy)o AACE.__..__.OOl:. C....l White ~SI'OUSE ll....... QMtmMllnl\llf'All) Cumberland DECEDENT'S USUAlllCCUPlVlON c~.:!'.':.":.:."'=::r Dept. of Labor "Secretar ,,~ and lndustr DECEDENT'S MAll.ING ADORESS cs.... CoIylTcMn. -. Zip Coool DECEDENT'S ACTUAl Place RESIDENCE cSee_ on other SlOt) 3609-7 Kohler ... Cam Hill, PA f'RHER'S NAAlE (F... _. Lalli I.. Robert Henr -OIIMAHT'SNAAlE CT_intl 17a._ 17011 '710. Cumberland Did - _ill. _7 Twp. ...... Bearne -__.0 17070 17109 _IllATa CAUSIE (1'..... c:IIMMe or concIiIion l...-.g If'I dMIh)--.... II. l~ ::::-..== I I I NoD MIlT': ClIhorIignillconl_~.._..... not....... in 1M undIrtwing cauNgiwen in PART I. ~..- .....-...-. -_--.v_ CAUUCOiouM", ."... ...inItiaIed....... fla.llllng 1ft dNIh. LAST ~ ~..... ....~ 1'). , I .....J ~ "'.... I I I WOS AN AIJ1l)pSY PERFORMED? d WERE "U1OP$Y FIHIlINGS ~PfUORlO COUPlE1lON (7 CAUSE OF DERH7 MANNER OF DEATH ........ -.. IXJ o o DATE OF INJURY (Men.... Day, Yeatl TIMe OF lNJURY INJURY 1fr'M)RK? DESCRIBE HOW INJURY OCCURAED. _;cicio o o o PlACE OF INJURY. AI home. f.rm, S1.....lactorv. offic. Y. """""'a."', '_I _. Voo 0 NoD '1M 0 NoKl Pending 'n'tesligallon Y.. 0 No I1\) Suooido Could I'lOI be _.rn'llned ...EDICAL ex....INER/CORONER On the b..i. oIexamlnaUon andlor In'testigation, in my opinion. death occurred at the Ume. date. and place, and due 10 the c.u..(a) and manner..lr.ted.....,....... .............. _..... ............................................................... 31a. REGISTRAR'S SIGNATURE AND NUMBER o I~OI Ha. 2.... CERTJlfIEAICheck only onel -CERTIFYING PHYSICIAN (Ph'l'SlCICN\ cP.r""r1ng cause ~ death wh8f'l another phVSlC.an has ptClnOunced dealh ana comp6eled "em 23) To 11M..... ot my .nowledge. .ath occurrecll due ~ the cauu(.) and manner.. ....ted. . . . . . . . . . . . . . . . . . . . . . . .... .PRONOUNCING AND CERTIFYINQ PHYSIC1AH (Ph't'SIC&an boIh pronouncIng Oealh and c8l1JtYInQ 10 cause 01 (jealhl To the beM: 01 my knowtectge, death occurr" .101 U\e lime. da'e. and place. and due to the causeCs) and mann., a. atalad 33 I~ /I~/ ,II ':' .--. '-..~. 21-01-344 1Ea51 lUtll anb WCgl&lUcnt OF RUTH B. BACKENSTOE I, RUTH B. BACKENSTOE, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament hereby revoking all other Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all of my just debts and currently due debts and funeral expenses shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II: I give, devise and bequeath my entire estate, whether real or personal, or wheresoever the same may be situate or located, to my daughter, KAREN B. ROBERTS, only if she survives me. ITEM III: In the event that my daughter, KAREN B. ROBERTS, should predecease me, then I give, devise and bequeath my entire estate, whether real or personal, or wheresoever the same may be situate or located, equally among the following charitable organizations: MULTIPLE SCLEROSIS SOCIETY OF CENTRAL PENNSYLVANIA, 2209 Forest Hills Drive, Harrisburg, P A 17112-6039; HOSPICE OF CENTRAL PENNSYLVANIA, P.O. Box 266, Enola, PA 17025-0266; ARTHRITIS FOUNDATION, 17 South 19th Street, Camp Hill, PA 17011; and the AMERICAN LUNG ASSOCIATION OF CENTRAL PENNS YL VANIA, 6041 Linglestown Road, Harrisburg, PA 17110. ITEM IV: I nominate, constitute and appoint my daughter, KAREN B. ROBERTS, as Executrix of this my Last Will and Testament. In the event that she is unable or unwill~. . 1 to serve in this capacity, then I nominate, constitute and appoint my niece, ANDREA ~KNUDSEN, of 105 Roxbury Road, York Haven, Pennsylvania, as Executrix of this my Last Will and Testament. ITEM V: It is hereby directed that my Executrix shall pay all inheritance, estate, succession and legacy taxes to which my estate for the transfer of any property hereunder may be subject, and to charge such taxes as a part of the expense of the administration, payable out of my residuary estate. ITEM VI: I direct that no Executrix or other fiduciary named, nominated or appointed in this my Last Will and Testament shall be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of the Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. December, 2000 IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27th day of ~ L,~~vh Ruth B. Backenstoe Signed, sealed, published and declared by the said Ruth B. Backenstoe, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, all being present at the smne time, Mve her~ro s SCri::~i:gn~:;u Residing !v~f) I P A COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, RUTH B. BACKENSTOE, Francis A. Zulli and Wendy S. Paul, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being du1y qualified according to law, do hereby declare to the undersigned authority that we were present and saw Testatrix sign and execute the instrument as her Last Will, that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed; that each of the witnesses, in the presence and hearing 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, and I, the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last Subscribed, sworn to and acknowledged before me by Ruth B. Backenstoe, the Testatrix, and subscribed and sworn to before me by Francis A. Zu1li and Wendy S. Paul witnesses, this 27th day of (ecemO~ ~_ _ ~U NOTARIAL SEAt ANN J, LONG. Notary Pub~c City of Harrisburg, Dauphin County M Commission Ex 'res Oct. 30, 2003 E- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ruth B. Backenstoe Date of Death: March 23.2001 Will No. 2001-00344 Administration No. TO THE REGISTER: I certify that Notice of Beneficial Interest 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 April 4. 2001. Name Address Karen B. Roberts. 1802 Bridge Street New Cumberland. P A 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Name: Addre Date: April 4. 2001 Telephone Number: (717) 232-1488 Capacity: Personal Representative X Counsel for personal representative r [ 1 I ~ ; \ \ i~1l'i \ \ 'i. \ - -+.\:;-~ \ I ,. '..... ''r'I' " (I ;:1''(."_ ,. '~".'. I ~' : : ' . - I .; , :" \ : ( '" \ / h,ilf 11" ,<~,.:'t, ',- Q) <n :i o ::0 ~ 3 g Q) 0 ...... o U "' t':l tr:::l ""'E Q:;< >-. ~ oC:2..~ :i...._ ~ocn~ :..- U Q) 2 :::"O~Q) ~~.8r;l; as ] t ~~ t;.LJ :i ,2Z ,.. e 0 i:: ~:i U t':l ~u......u t:t,.. 11'.\ tl~1 ,{",j tf';' f!-:' , ( ( , .. ,- :;.:.. tl':' ,r< 4';.'\ . "!t.. ,..., j ~ . ~ ~ !:: Iii ~ ll!~~ ffl ~ Iii ~ ~ ~~. Iii~~ ~ B ~ ~ ,.~ 00,,- ~ ~U\:Jg a: g ~ - I LAW OFFICES ~gulJ; ~ <@/~ DAVID A. WION FRANCIS A. ZULLI JEAN D. SEIBERT 109 LOCUST STREET P.O. BOX 1121 HARRISBURG, PENNSYLVANIA 17108-1121 (717) 236-9301 (717) 232-1488 FAX (717) 236-6100 Email: wzs@mindspring.com VICTOR A. BIHL ROBERT J. TRACE OF COUNSEL June 14, 2001 113 EAST MAIN STREET HUMMELSTOWN, PA 17036 (717) 566-2501 Register of Wills Office Cumberland County Court House 1 Courthouse Square Carlisle, Pennsylvania 17013 RE: Estate of Ruth B. Backenstoe No. 2001-00344 Gentlemen: Please find enclosed a payment on account of inheritance taxes in the amount of $15,000.00 in connection with the above captioned Estate. F AZ:wsp Enclosure t 1 I I I I I 1 I 1 I I I 1 .......i t 0: ...... N r- I ..... ~ i a.... I!~ ~~. ~ ~m w :ii a: >c ..J ~w C Zu - f~ ~ cu. a:: II. !I! 0 ~ I- Z ::> o :E c( I- ~5a: z:Ea:w OWl-CD c(wz:E wo::> ~oz c( '."'-r-- I I 8 . g .. ., .... . - o .... W II: W :x: ~ g ,;'" :: ..- ,. . " . .' .J , ,... '. 9 . 0:- ~. $f ~.~ 'J1,.,. I-- ," OJ '11"\fZti I "", >..... ::> ~ Q: t!) ~ c<tw c( ~ro: ...J iii g fd I- a: . '" ! .... D' 11l 0- f 0 .... I ~ (I) 0 a:: N ~ Z (.0 ol ~ to J: .... , .-- :J 4' 1='0: z 4' i 0 11l enw .... .... 0 .... ~ 0 ~o 0 0 z 0 I .... 0 0 <t 0 ~ .... !z~ OJ n.J J N a: 0 1-...... ...... 0:: ...... 0 0 ~w ffin w~ bJ J:(I) LL. a:: OJ w~ ::E.... !;;:... m !;;:OJ ~ wi frlu >-...... 0...... J: w...... w co_ 0([ ~.o ~.o :J 01") w ::EOJ lSol lL. ~u lL. ~ !;( <( a: =>. 0 ::E 0 Z w W I- Z W c( I- w ::E !;;: en => !;;: ::E en ...J <( 0 0 w W ii: z 0 c.. U 0 a: W 0:: ..... :J G (J) W ..... .J 3 N <t UJ -~ uo z.... <t 0:* IJ.~ U ow ......J: UU ...J c( W W LAW OFFICES ~gulJ; c? ~ DAVID A. WION FRANCIS A. ZULLI JEAN D. SEIBERT 109 LOCUST STREET P.O. BOX 1121 HARRISBURG, PENNSYLVANIA 17108-1121 (717) 236-9301 (717) 232-1488 FAX (717) 236-6100 Email: wzs@mindspring.com VICTOR A. BIHL ROBERT J. TRACE OF COUNSEL December 5, 2001 113 EAST MAIN STREET HUMMELSTOWN, PA 17036 (717) 566-2501 Register of Wills Office Cumberland County Courthouse Carlisle, P A 17013 RE: Estate of Ruth B. Backenstoe Dear Register of Wills: Enclosed please find a original and two copies of the P A Inheritance Tax Return and Inventory for filing in your office concerning the above-referenced estate. I am enclosing a check for the balance of inheritance taxes due in this matter. You will also find enclosed a check in the amount of $ 28.00 to cover the cost of filing the Inventory and Inheritance Tax Return. Please return one clocked in copy to me in the envelope which I have provided. Thank you. F AZ/kd Enclosures no ,.. ...,..... =Ctl = ::;1. O'~. ~!: ... :'~ ':. t::l CJ I U1 d ...... ::n~ roo {~~, 2- ,~<~ ;~:,'.' ;!3 ...... Ui N " .......-...............-....................._...__.....0", COMMONWEAL TH O~ REV 1500 OFFICIAL USE ONLY PENNSYLVANIA - .........L~...:.~~L-:-:...'=>.... . ............ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 co~ ~ODE I 01 I ~U:B;:Y HARRISBURG, PA 17128-0601 RESIDENT DECEDENT YEAR f- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z BACKENSTOE, Ruth 8. 203-10-9391 UJ DATE OF DEATH DATE OF BIRTH THIS RETURN MUST BE FILED IN DUPLICATE wrrH THE Cl ill March 23, 2001 February 7,1921 REGISTER OF WILLS () ill (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Cl . x 1. Original Return 2. Supplemental Retum 3. Remainder Return (dolt" of death pnor to 12+ ':':]al >--- e- I- 13-82) U"~ 4. Limited Estate 4a. Future Interest Comprise (dal" ol delJlh aiter 12-12.82) 5. Federal Estate Tax Return Required . "8 82- ~ e- L- ~" x 6. Decedent Died Testate (Attach copy pf Will) 7. Decedent Maintained a Living Trust (Attach a copy ClfTrustj 8. Total Number of Safe Deposit Boxes <l; ~ >- 9. Litigation Proceeds Received 10. Spousal PovertyCredit(dateofd ath betweerl 12-31-91 and 1-1-95) 011. Election to tax under Sec. 9113(A) L- L...- e <~ctlSchO) THIS SECTION MUST BE COMPLETeD. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: <= NAME COMPLETE MAILING ADDRESS <D -= Francis A. Zulli, Esquire 109 Locust Street c ~ FIRM NAME (If Applicable) Harrisburg, PA 17101 ~ Wion, Zulli & Seibert . .~. ........ <'3 .--'.. , S :0 TELEPHONE NUMBER , ::-o~ , ('0 717-232-1488 '10.0 1. Real Estate (Schedule A) (1) $0.00 C:;OFFICIA.[r~ ONLY " r.,..;.. 2. stocks and Bonds {Schedule B} (2) $255,295.89 I tJl 3. Closely Held CorpOlation, Partnership or Sole-Proprietot"$hip (3) $0.00 l Z --... 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 0 0 :,'li -~ i= 5. Cash, Bank Deposits & Misc. Personal Property (SChedule E) (5) $93,634.50 ,--' <( ...J 6. Jointly OWned Property (Schedule F) (6) $13.750.00 => D Separate Bill1ng Requested l- e... 7. Jnter~Vivos Transfers & Misc, Non-Probate Property (7) $0.00 <( () (Schedule G or l) UJ 0:: 8. Total Gross Assets (total Lines 1-7) (8) $362,680.39 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $3,626.91 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $1,916.97 11. Total Deductions (total Lines 9 & 10) (11) $5 54.~ 88 12. Net Value of Estate (Une 8 minus Une 11) (12) $357,136.51 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $357,136,51 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax Z rate, or transfers under Sec. 9116 (a)(1.2) X (15) $0.00 - 0 16. Amount of nne 14 taxable at lineal rate ;: $357,136.51 x .045 (16) $16,071.14 ~~ - ..." 17. Amount of line 14 taxable at sibling rate x .12 (17) $0.00 .. :; 18. Amount of line 14 taxable at collateral rale x .15 (18) $000 0 U 19. Tax Due (19) $16,071.14 20.0 e... > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Copyright 2000 David James Thorpe, Esq. Decedent's Complete Address: STREET ADDRESS 360e.. 7 Kohler Place CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditsIPayments A. Spousal Poverty Credit B. Prior Payment C. Discount $15,000.00 $750.00 Total Credits. (A + B + C) ISTATE IPA IZIP 117011 (1) $16,071.14 (2) $15,750.00 3. InteresUPenalty if applicable D. Interest E. Penalty (3) $0.00 4. To1allnterestfPenalty (D + E) 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 If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. A. Enter the interest 00 the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (4) (5) (SA) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 5. $321.14 $321.14 ,. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 2. Did decedent make a transfer and: a. retain the LIse or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary interest; or d. receive the promise for life of either payments, benerrts or care? If death occurred on or before December 12, 1982, did decedent within two yeait'> preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within otle year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her deaUl? Did decedent own an individual retirement account, annuity, or other non~probate property? Yes ~ No ~ 3. 4. B E8 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 that I have examined this return, including aocompanylng sct\edulet'o am::! statements, and to the best of my knowlEldge and belilrl, It is true, correct, and complete. Declaration of parer other than the personal representative is based on all the information of which preparer has any knowledge. ADDRESS 109 L.ocust Street, H For dates of death n r after July 1, 1994 and before Ja 3% [72P.S.~9116 a)(1.1) (i)j. DATE 01 l DATE 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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) (U)J. The statute does no exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the sUlViving 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 ohlld is 0% [72 P.S. ~9116(a) (1.2)J. 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. fi9116(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)J. 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. Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Ruth B. Backentoe All property Jolntly~wned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 1. Waypoint Bank stock, 30 shares @ $10.12 per share FILE NUMBER VALUE AT DATE OF DEATH $303.60 2. Essex Mutual Account No. 5EY-018389~1 65,451.79 3. Hartford Mutual Fund Account No. 710605592 65,009.27 4. Hartford Mutual Fund Account No. 710335239 46,759.66 5. New England Mutual Account No. V700715 57,771.57 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) $255,295.69 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ruth B. Backenstoe FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1,487.98 PNC Bank, savings account No. 5000878115 2. Waypoint Bank, checking account No.1 000000058 7,958.83 3. Waypoint Bank, checking account No.1 003022406 29,170.10 4. Waypoint Bank, CD No. 7100000563 52,283.25 5. 1993 Ford Tempo automobile 1,775.00 6. Household furniture and furnishings 961.34 TOTAL (Also enter on line 5, Recepttuletion) (If more space is needed, insert additional sheets of the same size) $93,834.50 Cop)Tight 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Ruth B. Backenstoe FILE NUMBER If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Karen B. Roberts ADDRESS RELA TrONSHIP TO DECEDENT Daughter 1802 Bridge Street New Cumberiand, PA 17070 B. C. JOINTLY-OWNED PROPERTY: ITEM LEiTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH NUMBER FOR JOINT MADE Include rtame of financial institution and banK account number or simUar ldetrtlfying {lumber. VALUE OF ASSET DECD'S VALUE OF TENANT JOINT Attach deed for jointly-held real ss;tate. INTEREST DECEDENTS INTEREST 1. A. 1-1987 Series HH Bond, V1316104HH 5,000.00 50% 2,500.00 2. A 1-1987 Series HH Bond, V13161 02HH 5,000.00 50% 2,500.00 3. A 1-1987 Series HH Bond, V1316103HH 5,000.00 50% 2,500.00 4. A 1-1987 Series HH Bond, V13161 01 HH 5,000.00 50% 2,500.00 5. A 1-1987 Serles HH Bond, V1316100HH 5,000.00 50% 2,500.00 6. A 1-1987 Series HH Bond, M6629S46HH 1,000.00 50% 500.00 7. A 1-1987 Series HH Bond, M6629547HH 1,000.00 50% 500.00 8. A 1-1987 Series HH Bond, D4656284HH 500.00 50% 250.00 TOTAL (Also enter on line 6, Recapitulation) $13,750.00 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. ,. COMMONWEALTH OF PENNSYLVANIA INHERfTANCETAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ruth B. Backenstoe Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. 2. 3. B. 1. 2. 3. 4. 5. 6. 7. FUNERAL EXPENSES: Cremation Society of Pennsylvania - cremation Rolling Green Cemetery - deed Harding's Restaurant - after funeral luncheon $25.00 50.00 619.41 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees - Francis A. Zulli, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 2,500.00 City Relationship of Claimant to Decedent State Zip Probate Fees - Register of Wills 232.00 Accountant's Fees - Wagner, Frutiger & Daub - CPA 100.00 Tax Return Preparer's Fees Advertising estate - Paxton Herald Dauphin County Reporter 35.50 65.00 TOTAL (Also enter on line 9, Recapitulation) (If more space IS needed, Insert additional sheets of the same size) $3,626.91 Copyright 2000 David James Thorpe, Esq. COMMONWEAL'TH OF PENNSYLVANIA INHERITANCE TAX RETURN RE$IDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Ruth B. Backenstoe FilE NUMBER Include unrelmbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT Ann O'Connor. Cleaning of carpets $75.00 2. L.B. Smith - car repair 43.46 3. Pulmonary and Critical Care - medical statement 100.00 4. West Shore EMS - ambulance service (4 trips) 159.60 5. Joseph A. GansHegler ~ apartment rental 1,01250 6. Suburban Cable. tv cable 2B.B9 7. AAA Life Insurance - premium payment 25.75 B. Verizon ~ telephone service 25.B9 9. Universal Card - credit card 2B9.14 10. AARP - Health Plan Option payment 13.00 11. PP&L - electric charges 143.74 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $1,916.97 Copyright 2000 David James Thorpe:. Esq. -' COMMONWEALTH OF PENNSYI...VANIA INHE.RITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Ruth B. Backenstoe FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RElATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER Do Not List Trustee{s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Karen B. Roberts Daughter Entire Estate 1802 Bridge Street New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 15QOCOVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DtSTR1BUT10NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAl. DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) CO'j)ynght 2000 David James Thorpe. Esq. " .. FORM 16 REG. WILLS INVENTORY of all real and personal estate of Ruth B. Backenstoe deceased, late of 3609-7 Kohler Place (Number and street) Hampden Township (Borough or Township) who died March 23, 2001 (date of death) ,Cumberland County, Pennsylvania, PERSONAL ESTATE SCHEDULE 1. 2. 3. Waypoint Bank stock, 30 shares @ $10.12 per share Essex Mutual- Account No. 5EY-018389-1 Hartford Mutual Fund - Account No. 710605592 4. 5. 6. Hartford Mutual Fund - Account No. 710335239 New England Mutual - Account No. V700715 PNC Bank - savings account No. 5000878115 7. 8. 9. 10. Waypoint Bank - checking account No. 1000000058 Waypoint Bank - checking account No. 1003022406 Waypoint Bank - CD #7100000563 11. 1993 Ford Tempo automobile Household furniture and furnishings TOTAL c:2/-01-rf14./y (city) 17011 (Zip Code) 303.60 85,451.79 65,009.27 46,759.66 57,771.57 1,487.98 7,956.83 29,170.10 52,283.25 1,775.00 961.34 $348,930.39 n C; ~ a-- 9 :0 3 "'" CD 0- ".- n (1" 0 t::J ..... E. :::j ---'j C":l f'f'i ~,:> I .. \JI ;S; ..... :1J Ui )::,. N Copyright 2000 David James Thorpe, Esq. .... ...... '" AFFIDAVIT OF EXECUTOR OR ADMINISTRATOR Com.tn01'lMJeafth; of PA COUNlty of Dauphin } 55: Personally before me, the undersigned authority, a notary public in and for said County and State, appeared Karen B. Roberts who, being duly sworn according Ruth B. Backenstoe to law, deposes and says that he is the executor or administrator of the estate of , deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of Ruth B. Backenstoe deceased, except real estate outside the Commonwealth of Pennsylvania, that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be fair value of said items as of the date of the decedent's death. this Sworn and subscribed before me <]1 )1 day of November 2001 ~r/Y~ } > EXECUTOR-ADMINISTRATOR NOTARiAL SE.~ ' r.. KAY l DWUlET, NO~.:l1yPublic: ;\;~ of :1y,':~bt;rE' Daupr.:n County, PA DDITIONAL INSTRUCTIONS , ".J l,om:ms.:o.;OI1 c.~~e.ires March 19 2002 I The inventory shall be mea no ICl[c, t'h1m the date the account is filed or the due date, including any extension, for the filing of the Inheritance Tax Return (9 months from the date of death) whichever comes first. A Supplemental inventory must be filed within thirty days of discovery of additional An original and two copies must be Additional sheets may be attached as to personalty or See Section 3301 et seq. Of the Probate Estates and Fiduciaries Code of 1972, as amended. The inventory must be typed. 1. 2. 3. 4. 5. 6. Q )> ~ "TI "TI (") "-, ,"-"', ." < '-.., ,~ d 0' a. :::: CD cD' 0' ::0 <0 Q. a. 0 CD a: -,-"'" :") () '" Cil -. '" .... () 3 ::J 3 .: CJl CD Q (") c:~.\ 'Q Z CD CJl '< CD 0' 0' Z 0' 0 '" '" < '" Q Q 3 3 ....;. Q 0' 0' CD CD m me;. 0' '" '" ~ ::.,., '" 3 3 "...... Z ~;r 0 3 CD CD rrlJ:' -t ~ CD \"',) 0 -0 t\) <C ::u CD 0 -< Q. (I) 0' n '" (I) Dl en (I) a. Copyright 2000 David James Thorpe, Esq. ~ ~ 'lJ ~ i 51 ~ : c' ~~.~~ ~ ~1'~ ~~ *".. () I{) C"l (" EC I.il I c..::l CJ C,: ;J.; ~.~ 'Ell l) (l) &0: p '.~I >.Q -. ',-' j::: ~JJ ': fj(5 j ,.. ~ . ~ ~ ~ CJ) ~ ~ ~ w p:: N~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ZULLI FRANCIS A 109 LOCUST ST POBOX 1121 HARRISBURG, PA 17101 -----.-- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 203-10-9391 FILE NUMBER: 21-2001- 0344 DECEDENT NAME: BACKENSTOE RUTH B DATE OF PAYMENT: 12/05/2001 POSTMARK DATE: 1 2/04/2001 COUNTY: CUMBERLAND DATE OF DEATH: 03/23/2001 REMARKS: FRANCIS A ZULLI ESQUIRE CHECK# 112 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: AC RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 000605 MARY C. LEWIS REGISTER OF WILLS AMOUNT $321 .14 $321.14 '. /b-c2a2/-~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RecOl .Je ReG, of DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '02 FEB-1 P 1 :42 FRANCIS A ZULLI WION ETAL 109 LOCUST ST HBG ESQ Gterk . PA 1~\tlJi.b8; 01-29-2002 BACKENSTOE 03-23-2001 21 01-0344 CUMBERLAND 101 Allount Rellitted *' REV-1547 EX AFP 112-00) RUTH B 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=is'4-j-E3f-AFP--fi'2-:o0Y-NOY-iCE-OF-YNHEififAifci-yAX-A-PPRA-isEi'-ENT~--AL'rOWAifci-OR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BACKENSTOE RUTH B FILE NO. 21 01-0344 ACN 101 DATE 01-29-2002 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. 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 ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 255.295.89 .00 .00 93.634.50 13.750.00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage 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 I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL 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 TA CRED TS: PAY DATE 06-14-2001 12-04-2001 NOTE: EC PT NUMBER AA496727 CD000605 · IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 3.626.91 1.916.97 (11) (12) (13) (14) (9) (10) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 362.680.39 5.1;43 88 357.136.51 .00 357.136.51 14, IS and/or 16, 17, 18 and 19 will returns assessed to date. .OOXOO= 357.136.51 X 045 = .00 X 12 = .00 X 15 = (19)= AMOUNT PAID 15.000.00 321.14 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 16.071.14 .00 .00 16.071.14 16.110.61 39.47CR .00 39.47CR 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 ~ gull; <I <@akt v DAVID A. WION FRANCIS A. ZULLI JEAN D. SEIBERT 109 LOCUST STREET P.O. BOX 1121 HARRISBURG, PENNSYLVANIA 17108-1121 (717) 236-9301 (717) 232-1488 FAX (717) 236-6100 Email: wzs@mindspring.com VICTOR A. BIHL OF COUNSEL April 1, 2002 113 EAST MAl N STREET HUMMELSTOWN, PA 17036 (717) 566-2501 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Ms. Stainbrook: RE: Estate of Ruth Backenstoe {) 1- "=::;~ _*::.: = ~ ~ Please find enclosed a check in the amount of $3 .00 which represents the amount due for the Short Certificate regarding the above referred to estate. Please mail the Short Certificate to me in the enclosed envelope. FAZ/ss Enclosure \1{;-c:J.:2/-0 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (01-021 FRANCIS A ZULLI WION HAL 109 LOCUST ST HBG '02 APr< -1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-25-2002 BACKENSTOE 03-23-2001 21 01-0344 CUMBERLAND 101 Amount Rellitted RUTH B ESQ :~9 l;;S'H PA 1~~q~IL MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i6'ij':.rEX-AFP-('oY:02Y------...--iNirERITANCE--YAX--STATEHE-riY-OF'-AccoUiff--.-..---------------- ----- ESTATE OF BACKENSTOE RUTH B FILE NO.21 01-0344 ACN 101 DATE 02-25-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-29-2002 PR I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 16.071.14 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-14-2001 AA496727 789.47 15.000.00 12-04-2001 CDOO0605 .00 321.14 02-11-2002 REFUND .00 39.47- TOTAL TAX CREDIT 16.071.14 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l .' (} IO~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: fLrTJf B B I1LKf.tJ STuf Date of Death: AIJ /) /l (1-1 1. '3 "2 00 / Will No.: 2 00 / - (Yo 3 if 'i 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 l2r No 0 2. If the answer is No, state 'when the personal representative reasonably believes that the administration will be complete: 3. Ifthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 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? Y es ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this rep Date: ~rj 0 :3 ure ~ tlLlHJCI \ Name r~ 1 L 0 C {J J f 5 +- !-hr-tz iLr ~ 8 tL (l r; / Address /' fc:L ZJ2,-ILfRy Telephone No. Capacity: 0 Personal Representative ~ Counsel for personal representative Cumberland County - Register Of wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/07/2003 KAREN B ROBERTS 1802 BRIDGE STREET NEW CUMBERLAND, PA 17070 RE: Estate of BACKENSTOE RUTH B File Number: 2001-00344 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. I, for decedents dying on or after July I, 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: 3/23/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: ( File Counsel Judge