HomeMy WebLinkAbout01-0443
PETITION FOR PROBATE and GRANT OF LETTERS
No.
To:
Register of Wills for the
, Deceased. County of CUMBERLAND in the
Social Security No. 157- 01- 219 2 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rix
in the last will of the above decedent, dated March 25,
and codicil(s) dated
21-01-443
Estate of DOROTHY M. HUGHES
also known as
named
19 91
,
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at Country Meadows
Hampden Town!'=;hip
(list street, number and muncipality)
Decendent, then 82 years of age, died Apr i 1 13. 2001 ,
at Holy Spirit Ho!'=;pital .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
390,000.00
$
$
$
$
None
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
pre.c;ented herewith and the grant of letters Testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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Grace A Sm
104 Spring Rn;:!t1
nillqburg, PA 17019
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1- ss
COUNTY OF CUMBERLAND )
The petitioner(s) above~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 a truly administer the estate according to law.
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No. 21-01-443
Estate of
DOROTHY M. HUGHES
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MAY 4 2001, 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 March 25, 1991
described therein be admitted to probate and filed of record as the last will of
Dorothy M. Hughes
and Letters Testamentary
are hereby granted to Grace A. Smyrski
Probate, Letters, Etc. .........
Short Certificates( )..........
ReRtt~a~tion ................
JCP
$
$
$
$ 5. 00
TOTAL _ $ 337.00
. . . . ~~ . ~.'. . ~g9.1. . . . . . . . . . . . . . . . . .
305.00
12.00
i).uO
'7//r~{~nn~~////fU) A.~~
, gister of Wills I
Edmund G. Myers (20558)
Johnson, Duffie, Stewart & Weidner
ATTORNEY (Sup. Ct. J.D. No.)
301 Market St'6 P. O. Box 109
Lemoyne, PA 17 43-0109
ADDRESS
FEES
Filed
(717) 761-4540
PHONE
~,4;; ~/U72LY
l,<
HIO).8U) REV 91R(,
This is to certifY that the information here given is com;ctly copied from.an original certificate of death duly filed with me as
Local R~gistrar. 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.
No.
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Local Registrar
Fee for this certificate, $2.00
P 7234711
a..~e /t,1tJcJ (
Date
21-01...,.443
HI05.143Re'tl 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
""YPEJPRIHl
IN
PEP.t.&ANEKT
BLACK INK
82 v..
UNDER 1 DAY
ttoura i.......
sex Female
a.
STAlt: Fllf NUMBER
SOCIAl SECURITY NUMBeR
.. 157 _ 01_
NAME Of DECEDENT (fK.. MIddle, 1..",
..
AGE (lase BrnhOay) UNDER t YEAR
MonIha Da,.
COVMTY Of DEJl3'K
Cumberland
White
lib.
...
DECEDENT'S USUAL OCCUPRIOH KINO OF BUSINESS/INDUSTRY
(Give klfldol,lWOIkdonl!lldur:';i.moIl
"-'"m~e1Krperator
11.. lU..
DECEDENT'S MAtLING ADOAESS (SIt-. CIlyIfown.~. Zip COdeI
355 South Sporting Hill Road
Mechanicsburg. Pennsylvania 170
MARtTAl. STATUS. Uamed.
Nevel......... Wldowecf.
"'i1OIlJOWed
SUAVI\llNQ SPOuSE
1M..... gNe~ rwnel
17..SlaI.
Cumberland
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MOTHER'S NAME If_51. MIddle. MaKMn SulnameJ
....
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FATHER'S NAME tF;,st. MiOdItt. LaSl)
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INFORMANT'S NAME (J )'p6IPnnl)
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Oscar Dobbins
Grace A. Smyrski
Edith Lucas
'0.
_OfWAHrsW~g~O'a1rt:m\~Il~~a. 17019
.....
PlACE OF DISPOSITION........ ~ CetMlery, c,~ L()(::.Q1OH. c~. SIal.. .lip Code
"""'"'~olling Green Memorial Park Camp Hill, Pennsylvania 17011
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NAME AND ADDRESS Of FACILITY
Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 1705
....
LICENSE NUMBER
DATE SKlHEO
(MonI1. Oay, 'Mar,
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OF OEATH?
MANNER Of O€ATH
DATE Of INJURY
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'CE"'IFYIMG PHYSlCIA" (Ph)'slC.an Cel'llIY\f\9 t:au$e~ dealtl wtl.... .i(l0lllef pflvSIC,...... h.r.$ pl'ooounced uealh ano I;Qmpleled Uetn 231
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To the tte.t at my know~.. death occurred.' the....... oat.. ~nCII pl.c_, and due to 11'1. cauH(.) and manila' <illS .1~led..
.UEDtCAL EX"UINEA/COROME:R
On the basis 0' exan-dna.lon andlor inv..tlu.1ion, in my opil1iOR. dealh occurred al the lim.. dale, and place, aild due to the cause(s) and
motnn.r.. .,aled.. , . , . . _ . . .. ... ... ........,...,......'....,'.......... - ... . . ' . . . . . . . . . . . . . . . .. -." '. . . . . . . . ,
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EGM/February 19, 1991/3705
21-01-443
jJI&st Bill &ub Wtst&ttttut
OF
DOROTHY M. HUGHES
I, DOROTHY M. HUGHES, of Silver Spring Township, Cumberland
County, Pennsylvania make, publish and declare this to be my Last
will and Testament, hereby revoking and making void any and all Wills
or Codicils by me at any time heretofore made.
ARTICLE I
I direct that the 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 direct that all taxes that
may be assessed in consequence of my death, of whatever nature and by
whatever jurisdiction imposed, shall be paid from my Residuary Estate
as part of the expense of the administration of my Estate.
ARTICLE II
I give and bequeath my automobiles, household and personal
effects and other tangible personalty of like nature (not including
cash or securities), together with any existing insurance thereon,
unto those of my children who survive me, to be divided among them by
my Executrix or successor with due regard for their personal
preferences in as nearly equal shares as practical. If there be
disagreement as to the disposition of any item or items, I direct
that the same shall be sold and the proceeds distributed in
accordance with Article III.
EGM/February 19, 1991/3705
ARTICLE III
I give, devise and bequeath all the rest, residue and remainder
of my estate, of whatever nature and wherever situate, as follows:
A. One-quarter (1/4) thereof unto my son, WILLIAM E. McKEE;
B. One-quarter (1/4) thereof unto my daughter, GRACE A.
SMYRSKI;
c. one-quarter (1/4) thereof unto my sonl DAVID C. HUGHES; and
D. One-quarter (1/4) thereof unto COMMONWEALTH NATIONAL BANK,
Harrisburg, Pennsylvania, in TRUST, however, to hold, manage, invest
and reinvest the share so received and to distribute the net income
therefrom in no less than quarterly installments unto my son,
FREDERICK J. HUGHES, and I direct the Trustee to distribute the
principal unto my son, FREDERICK J. HUGHES, as follows:
1. Five (5) years from the date of my death, one-quarter (1/4)
of the principal of the Trust;
2. Ten (10) years from the date of my death, one-third (1/3)
of the then-remaining principal;
3. Fifteen (15) years from the date of my death, one-half
(1/2) of the remaining balance of principal; and
4. Twenty (20) years from the date of my death, the balance of
principal, at which time this Trust shall terminate.
In the event my son, FREDERICK J. HUGHES, dies before receiving
his final distribution of the principal of the Trust, I direct that
the then-remaining balance of principal and undistributed income
shall be distributed to his then-living issue, per stirpes by
EGM/February 19, 1991/3705
representation;
distribute the
representation.
and if there be none, I
same unto my then-living
direct the
issue, per
Trustee to
stirpes by
ARTICLE IV
In the event that any beneficiary of my will shall not have
reached the age of twenty-one (21) years at the time for distribution
of his or her share, I give, devise and bequeath such share unto
COMMONWEALTH NATIONAL BANK, Harrisburg, Pennsylvania, IN SEPARATE
TRUST, to hold, manage, invest and reinvest the share so received,
and the accumulation of income thereon, 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, and vocational training) without regard to his or her
ability to provide for such support or education or to make payment
for these purposes, without further responsibility, to such
beneficiary or to any person taking care of such beneficiary. When
such beneficiary shall reach the age of twenty-one (21) years,
Trustee shall distribute the then-remaining principal and any income
accumulated thereon unto such beneficiary absolutely, and the Trust
as to that beneficiary shall terminate. In the event any beneficiary
dies before receiving his or her final distribution hereunder, such
beneficiary's Trust shall terminate and the balance of principal and
income shall be paid over to my then-living issue per stirpes by
representation.
ARTICLE V
During the time any portion of my Estate remains in Trust, the
same shall not be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of
any beneficiary prior to his or her actual receipt thereof. The
Trustee shall pay over income and principal as hereinbefore
determined to the parties designated, as their interest may appear,
EGM/February 19, 1991/3705
without regard to any attempted anticipation, pledge or assignment by
any beneficiary, and without regard to any claim thereto or attempted
levy, attachment, seizure or other process, provided that if any such
levy or seizure, or other process, shall be authorized by law or
specific order of any Court having jurisdiction, Trustee shall not be
liable to any beneficiary for violation hereof by reason of the same.
ARTICLE VI
If at any time during the continuance of any Trust created
hereunder, the Trustee in its sole and absolute discretion determines
that the size of any individual Trust account has become so small as
to be impractical to continue to hold in Trust and uneconomical to
continue to administer as a Trust, then in such circumstances, the
Trustee may without further authorization distribute the balance of
the principal and income in such Trust account to the Beneficiary
then-entitled to the income therefrom, and upon such distribution the
Trustee shall be released from further obligation with respect to
that account and shall not be subject to any claim from any person
who may have had a future interest in such Trust account had it been
continued in Trust.
ARTICLE VII
I name, constitute and appoint my daughter, GRACE A. SMYRSKI,
Executrix of this, my Last will and Testament. In the event my
daughter, GRACE A. SMYRSKI, fails to qualify or ceases to so act, I
name, constitute and appoint my son, DAVID C. HUGHES, alternate
Executor to complete the administration of my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this
25th day of ~~ , 1991.
J.fl '~Al ~ AL~4
Dorothy M t:" ughes L/
( SEAL)
EGM/February 19, 1991/3705
Signed, sealed, published and declared by the above-named
Testatrix, DOROTHY M. HUGHES, 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.
~>>~4
~~
EGM/February 19, 1991/3705
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
We, DOROTHY M. HUGHES, -:f aJp,i 1-1. W"!jJ.i' ~,... , and
~~~~ ~ers ' the Testatrix and the witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her Last will and that she had signed willingly and
that she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the will as witness and that to
the best of his/her knowledge the Testatrix was at that time eighteen
years of age or older, of sound mind and under no constraint or undue
influence.
f
~I' (}t4ii'/L- /;). JJLL
DOROTHY M. ,HUGHES (
r.;'
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~d-?/y4;;{.
fiv-f//i tJ ';/~
Witness '
Subscribed, sworn to and acknowledged before me by DOROTHY M.
HUGHES, Testatrix, and subscribed and sworn to before me by
a.tp.t /I. aJi..'.1At .j,.,. , and C'tiA'J/l1'Jd 3' /flyrs , witnesses,
'Chis ~ day of 11aM.h ' 1991.
~t:t.<<I fh..x:m
N t.ary ublic
---"NOtarial seai
Nina Ju~e Davis, Notary PublIe
Len.:."." 1.<0,'0, Cumberland County
MI' :>n; r'!s~~i;)p Exoims Oct. 31, 1994
Mem&;i;'ptij:,nsYlVarJa Association 01 Notaries
t:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: DOROTHY M. HUGHES
Date of Death: April 13, 2001
Will No.: 2001-00443
To the Register:
Admin. No.:
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
6{({ 0 I
Name
William E. McKee
David C. Hughes
Grace A. Smyrski
Address
13 Frederick Drive, Box X
Conyngham, PA 18219
335 Stoner Road, Mechanicsburg, PA 17055
104 Spring Road, Dillsburg, PA 17019
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None.
Date: 6(t;(.ot
~J;'
S' t ~
Igna ure
Name: Edmund G. Myers, Esq.
Johnson, Duffie, Stewart & Weidner
Address: 301 Market Street
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
Capacity: Personal Representative
X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
_~___u_ fold
ESTATE INFORMATION: SSN: 157-01-2192
FILE NUMBER: 21-2001- 0443
DECEDENT NAME: HUGHES DOROTHY M
DATE OF PAYMENT: 07/09/2001
POSTMARK DATE: 07/06/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 04/13/2001
NO. CD 000030
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $14,500.00
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TOTAL AMOUNT PAID:
REMARKS: EDMUND G MYERS ESQUIRE
CHECK# 95
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$14,500.00
MARY C. LEWIS
REGISTER OF WILLS
'COMMONWEALTH OF PENNSYLVANIA
COUNTY O.F CUMBERLAND
}
ss:
Grace A. Smyrski
being duly
sworn
according to Jaw, deposes and says that she i!=: F,YPf"'llt-r; X
of the Estate of DOROTHY M. HUGHES
Hampden Township
late of - . I Cumberland County. Pa., deceased and that the
within is an inventory made by Grace. A. Smyrski I the ~aid Executrj Y
of the e~tire 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.
Sworn to
~
.
~J a.~:CJacJ-~
Executor. Administrdor .
Grace A. Smyrski, Executrix
104 Spring Road
and subscribed before me,
2001
Dillsburg, PA 17019
Addrus
NOTARIAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21, 2001
13th
April 2001
Date of Death
OilY
Month
Year
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.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT 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
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
____n__ fold
ESTATE INFORMATION: SSN: 157-01-2192
FILE NUMBER: 21-2001- 0443
DECEDENT NAME: HUGHES DOROTHY M
DATE OF PAYMENT: 11/02/2001
POSTMARK DATE: 11/01/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 04/13/2001
NO. CD 000470
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,627.26
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TOTAL AMOUNT PAID:
REMARKS: GRACE A SMYRSKI
C/O EDMUND G MYERS ESQUIRE
CHECK# 99
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
$1,627.26
MARY C. LEWIS
REGISTER OF WILLS
Inventory of the real and personal estate of
DOROTHY M. HUGHES
deceased
~~~
1. Household Goods - date of death value
520 00
2. Waypoint Bank - Checking Account No. 500010644
Date of death balance, plus accrued interest
3. Waypoint Bank - Savings Account No. 1860006816
Date of death balance, plus accrued interest
4. Waypoint Bank - Certificate of Deposit No. 1855319817
Date of death balance, plus accrued interest
5. Prudential Command Investment Account No. 044-226588-28
Date of death value
6. Allfirst Bank - Certificate of Deposit No. 8-2174470
Date of death balance, plus accrued interest
2.,720 68
30,876 83
31,485 88
1311,483 63
I
21, 399 27
7. Time Share - Treasure Lake Subdivision, Sandy Township,
Clearfield County, PA
Date of death value
1,470 00
8. Metropolitan Life - Policy No. 25 075 378 A
Proceeds paid to Estate
9. Internal Revenue - tax rebate
1,977 28
300 00
10. Blue Cross - premium refund
158 45
11. Blue Cross - prescription drug reimbursements
648 67
12. Country Meadows - refund
302 65
TOTAL
403,343 34
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
/h-;).~~-q
REV-1500
OFFICIAL USE ONLY
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FILE NUMBER
2 1 0 1 0 0 4 4 3
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-- -- -----
COUNTY CODE YEAR NUMBER
I-
Z
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C
W
(,)
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HUGHES, DOROTHY M.
DATE OF DEATH (MM-DIJ.YEAR) DATE OF BIRTH (MM-DD-YEAR)
April 13, 2001 April 22, 1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
157 - 01
- 2192
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
D 4. limited Estate
[] 6. Decedent Died Testate jAllllChcopyofWilll
D 9. litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromis~ (date ofdealh after 12.12062)
D 7. Decedent Maintained a Living Trust (Mach copy orTrust)
o 10. Spousal Poverty Credit (dale 01 dealt1 between 12-31-91 and 1-1-95)
D 3. Remainder Return (dale of death prior to 12.13-82l
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113{A) (AltachSch0)
...
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:Trll~:,SEC1(ollM(JS,'BE'Cbil/l~L.ETED; ALL CORRESp6NDE'NcEANPCOi'l~IDEN:rIAli'TAJ( l.rIIFORMAi10N sHOQLlfBE' :OIRECTED~ TO:
NAME COMPLETE MAILING ADDRESS
Edmund G. Myers, Esq.
FIRM NAME (UAppllcablel
Johnson, Duffie
TELEPHONE NUMBER
717
Stewart & Weidner
301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
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::::l
l-
ii:
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(,)
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D::
t Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Soie-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (Iotallines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has nol been
made (Schedule J)
(11)
(12)
(13)
26,023.47
375,342.59
-0-
401,366.06
(6)
(7)
(8)
401,366.06
(9)
(10)
20,554.69
5,468.78
14. Net Value Subject to Tax (line 12 minus Line 13)
(14)
375,342.59
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 laxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15) -O-
X.o 45 (16) 16,890.42
x .12 (17) -O-
x .15 (18) 0
(19) 16,890.42
16. Amount of Line 14 taxable at lineal rate
375,342.59
17. Amount of line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
". ~ > > BE SURE.TO ANSWER ALl.QUESTIONS ON REVERSE.SIDE AND RECHECK MATH < <
i;' i":,,:;:j\':;:;:.':', ",
Decedent's Complete Address:
STREET ADDRESS Country Meadows
355 S. Sporting Hill Road
CITY Mechanicsburg I STATE PiP 17050
PA
Tax Payments and Credits:
1, Tax Due (Page 1 Une 19)
2, CreditslPayments
A. Spousal Poverty Credit
B, Prior Payments
C, Discount
(1)
16,890.42
14,500.00
763.16
Total Credits (A + B + C )
(2)
15,263.16
3, InteresUPenalty if applicable
D, Interest
E, Penalty
TotallnteresUPenaity ( D + E ) (3)
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is the OVERPAVMENT.
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)
-0-
A. Enter the interest on the tax due.
(SA)
1,627.26
-0-
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
it!ir~~'_illf.~I!il;~~.r;[~
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 ~
b. retain the right to designate who shall use the property transferred or Its Income; ............................................ 0 ~
c. retain a reversionary interest; or.......................................................................................................................... 0 IX)
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 IX)
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 IX)
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IX)
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designalion? ........................................................................................................................ 0
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
1.627.26
IXI
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 panamas of peljury, I declare thai I have examined this return, Including accompanying schedules and statements, and 10 the besl of my knowledge and belief, It is true, correct
and complete.
Declaralion of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PE ON RESPONSIBLE Fa FiLING RETURN DATE
d. /-0
PA 17019
ADDRESS
DATE
Ii - /)( - /) I
ADDRESS
Box 109, Lemoyne, PA 17043-0109
~;ztI?]!r~(~&ii~i~t~.l~~~A.~jTIili~~~~f2W?m'~~Im~~~f_..~fi'~~lt~:
For dates of death on or after July 1, 1994 and before January 1, 1995, tha tax rate imposed on the net value of transfers to or for the 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 rale imposed on the nel value of transfers to or for the use of the surviving spouse Is 0% [72 P.S. ~9118 lal (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 if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P,S. ~9116Ia)(1 ,2)1,
The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's lineal beneficleries 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 decedenl's siblings is 12% [72 P,S. ~9116Ia)(1,3)J, A sibling is defined, under Section 9102, as an
individual who hes at least one parent in common with the decedent, whether by blood or adoption.
REV-15Cl8 EX + It-97)
ESTATE OF
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-01-00443
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.
HUGHES, DOROTHY M.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
Household Goods - date of death value
Waypoint Bank - Checking Account No. 500010644
Date of death balance, plus accrued interest
Waypoint Bank - Savings Account No. 1860006816
Date of death balance, plus accrued interest
Waypoint Bank - Certificate of Deposit
No. 1855319817 - Date of death balance, plus
accrued interest
Allfirst Bank - Certificate of Deposit No. 8-2174470
Date of death balance, plus accrued interest
Prudential Command Investment Account
No. 044-226588-28 - Date of death balue
Internal Revenue - tax rebate
Blue Cross - premium refund
Blue Cross - prescription drug reimbursements
Country Meadows - refund
Time Share - Treasure Lake Subdivision, Sandy
Township, Clearfield County, PA
Date of death value
VALUE AT DATE
OF DEATH
520.00
2,720.68
30,876.83
31,485.88
21,399.27
311,483.63
300.00
158.45
648.67
302.65
1,470.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
401,366.06
REV-1511 EX. (12-99) .
. ~"ii'~
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
AESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
HUGHES, DOROTHY M.
FILE NUMBER
21-01-00443
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home, Inc. 6,476.00
2. Rolling Green Cemetery - Interment Fees 760.00
3. Old Country Buffet - funeral lunch 212.88
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Grace A. Smyrski
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 104 Spring Road 5,000.00
City Dillsburg State ~Zip 17019
Year(s) Commission Paid: 2001/2002
2. Attorney Fees - Johnson, Duffie, Stewart & Weidner 7,500.00
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 337.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal - advertise letters 75.00
8. The Patriot-News - advertise letters 93.81
9. Register of wills - file Inv. & Inh. Tax Return 25.00
10. Reserve for close-out costs 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 20,554.69
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV.tSl2EX.lI.97j
ESTATE OF
."'.
...~.:.
,
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-01-00443
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
HUGHES, DOROTHY M.
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4 .
5.
DESCRIPTION
AMOUNT
Connor-Rich-Kearney-Torchia Assocs.
Account balance, not covered by insurance
13.89
West Shore Emergency Medical Services
Transport charges not covered by insurance
85.46
PA Department of Revenue - tax due on decedent's
PA 40 - 2000
362.00
Internal Revenue Service - tax due on decedent's
Form 1040 - 2000.
2,744.00
Country Meadows - decedent's account balance -
March and April
2,263.43
TOTAL (Also enteron line 10, Recapitulation) $ 5,468.78
(If more space IS needed, insert additional sheets of the same size)
,R~.''''''',''.'1).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
HUGHES, DOROTHY M.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outnght spousal distributions)
1.
william E. McKee
13 Frederick Drive, Box X
Conyngham, PA 18219
FILE NUMBER
21-01-00443
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Daughter
Son
AMOUNT OR SHARE
OF ESTATE
One-third
tangible
personalty; One-
third residue.
One-third
tangible
personalty; One
third residue
One-third
tangible
personalty; 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
2. Grace A. Smyrski
104 Spring Road
Dillsburg, PA 17019
3. David C. Hughes
335 Stoner Road
Mechanicsburg, PA 17055
(Frederick J. Hughes, son, died
on September 8, 1996).
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART IT, ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space Is needed, Insert additional sheets of the same size)
\ /t. -c2c:2R- 9
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
of
RecoroeCJ
Register
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
VViils
"01
ole 27 Al0 :12
EDMUND G MYERS ESQ
JOHNSON ETAL Cterk-'
PO BOX 109 Cumbenaiid
LEMOYNE PA 17043
12-17-2001
HUGHES
04-13-2001
21 01-0443
CUMBERLAND
101
*'
REY-lS41 EX AFP 1l2-DOl
DOROTHY M
Allount Relli Hed
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'4j-i3f-AFP--fi'2-':ooY-NoTlci--oF-iNHEififANCE-TAX-APPRAisii'-€NT~--Ai:i-oWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HUGHES DOROTHY M FILE NO. 21 01-0443 ACN 101 DATE 12-17-2001
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdII. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. AlIOunt of Line 14 at Spousal rate (15)
16. AIIount 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 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
NOTE:
> CHANGED
n>
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
401,366.06
.00
.00
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
401.366.06
26.023 47
375.342.59
.00
375.342.59
00 =
045 =
12 =
15 =
.00
16.890.42
.00
.00
16.890.42
(9)
(10)
20.554.69
n9>=
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+> AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (->
07-06-2001 CDOOO030 763.16 14.500.00
PAYMENT MUST BE MADE BY 01-13-2002*. TOTAL TAX CREDIT 15.263.16
BALANCE OF TAX DUE 1.627.26
INTEREST AND PEN. .00
TOTAL DUE 1.627.26
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
5.468.78
(11)
n2>
n3>
(14)
.00 X
375.342.59 X
.00 X
.00 X
( 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.>
"\ /b-:2~'-;;
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
J:NHERJ:TANCE TAX
STATEMENT OF ACCOUNT
'*
REY-U07 EX AFP 112-0Dl
Recor Uf)Q -~8 of
RegistQ'
EDMUND G MYERS
JOHNSON ETAL
PO BOX 109
LEMOYNE
ESQ
"01 Ole 27 Am :07
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-17-2001
HUGHES
04-13-2001
21 01-0443
CUMBERLAND
101
DOROTHY
M
Allount Rellitted
Clerr\-\--
P A Q.lfttil;nw:u PA
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 =i61fj-Ex-AFP-fi2"=ooY------...--iNHERiTANCE-TAx--sTAfEMENT-OF-Accouiif--....------------------ ---
ESTATE OF HUGHES DOROTHY M FILE NO.21 01-0443 ACN 101 DATE 12-17-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001
PR I NCI P AL TAX DUE: ......................................."..........................................................................................................................-..................................................
16.890.42
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-06-2001 CDOOO030 763.16 14.500.00
11-01-2001 CDOO0470 .00 1.627.26
TOTAL TAX CREDIT 16.890.42
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
iii
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ.
---- -.... -- -..- "...:r.....n <:'1'1' Il!J:UJ:RSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
C//
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: DOROTHY M. HUGHES
Date of Death: April 13. 2001
Will No.: 2001-00443 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 X No
D. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans'
Court and may be attached to this report.
Date: !f1-t!dY Si9~jJ~
"i'
Edmund G. Myers. Esq.
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemoyne. PA 17043-0109
Address
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(717) 761-4540
Telephone No.
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Capacity: Personal Representative
X Counsel for Personal Representative