HomeMy WebLinkAbout01-0492
Estate of' L C 'I'
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
;ll-O I - L/ G ~
i-L t~C s S'
No.
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
. Deceased.
Social Security No. I q 5- D 7- (> (2. '/
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executt-"I \?
in the last will of the above decedent, dated j)) ({ r()) :? ~" ) 9 7"3
and codicil(s) dated ~ .~. I, . J'-' I V...J ."
,
named
,19_
(state relevant circllmstanccs, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in eLl rn ht) r I Cell /-/ County, Pennsylvania, with
l:LS-_last family or princi al residenc;e at 0-'7-(, '..{u I'J if 'J R'G(},,i, ((] fry) FOoL /I FA, 1'1CJ{(-)S1jb
(! c .~f1""~~~ l.ir./-L/.c;~ /.
Decendent, then S~1 N
at :;-(i Sf- /1..' i) JI) S {>," TO I . n D
Except as follows, decedent di not marry, was not divorced an- tlid 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:
$ ...,
j
$
$
$
~ C t~ C ('!
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codici1(s)
presented herewith and the grant of letters Testamentary
(testamentary; administration c.La.; administration d.b.n.c.La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1- ss
COUNTY OF Cumberland J
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 and truly administer the estate according to law.
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~o. 21-2001- 492
Estate of
WY H. ROSS
, Deceased
DECREE OF PROBATE A~D GRANT OF LETTERS
AND NOW May 21st, D 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 30th, 1973
described therein be admitted to probate and filed of record as the last will of
Lay H. Ross
Testamentary
Janet B. Ross
and Letters
are hereby granted to
FEES
Probate, Letters, Etc. .........
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
x-Pages (I)
JCP
$ 25.00
$ 3.00
$
$ 3.00
. 5.00
TOTAL _ $ 36.00
. . ,t1qy. ~.J.f;lt, t.o.Ql. . . . . . . . . . . . . . . . .
AITORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
MAILED LETTERS TO A'ITORNEY
/,/
/
,/
REGISTER OF WILLS OF // COUNTY
.~ OATH OF SUBSCRIBING.,WITNESS
/
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///
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". codicil
(each) a subscribing witness to th~""'\V,ill prese~ted herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
"
the testat , sign the same and that signed as a witness at the
"
request of testat_ in h presence and (in't~'presence of each other) (in the presence of the
other subscribing witness(es)). '...""........
........"-.......
/
;'
Register
(Name)
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
21-2001-492
REGISTER OF WILLS OF C! (< M 0UCLf1 Aj I") COUNTY
OATH OF NON-SUBSCRIBING WITNESS
JA-!\)~T D" Ross
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
T familiar with the signature of L (j y' l-J, R c> s:. <)'
~
will presented herewith and
(; J' tt
believes the signature on the will is in the handwriting of
testat~ of (one of the subscribing witnesses to) the
r::= .J- 7J -OO,r.,'
that r) ( ') I? P ( 0. P. ~ .2. .2
L()~' H, R OS' C)'
to the best of /II.J knowledge and belief.
Sworn to or affirmed and subscribed before
me this 10th
ay
~l (ll}.r i~ . 'RtrUJ
I
· / (Name)
D~o R lLr (e.LJ 'fCp cui, Chrn ff)( f l
(Address)
PR.) 1'"(0 11- }2L{C,
(Name)
(Address)
21-2001-492
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUBSCRIBING WITNESS
1< Q b f v' t- r.'r- flA..'~
~
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that .., F \.oI.6~ present and saw
La Y H. j~ 0 S S
the testat ~- It . sign the same and that HE signed as a witness at the
request of testat~ in h I 5 presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
-((
me this \~ - day of
~.I2..l-
NO RIAL SEAL R8g~t~r
MARGARET T. FOSTER. Notary Publi(; :
Camp Hm. Cl..lFlbetland Count"
My Commission EXf:llres [,II;c. 'Zi 2004 :,
~'J~,,"<,_.,,,_... "'"_'s..._r...""-'-'O"-..._~c____.-..",,,-":
2 ~ x :r-: ;;::" t...-
(Name)
J 3/ AI, 1.. 'i' I"?! S J'. C.4-M /1 /11 I../. ~J 1"10"
(Address)
(Name)
(Address)
"" REGISTER OF WILLS OF COUN
"'. OATH OF NON-SUBSCRIBING WITNESS
(each) being duly qualified acc ing to law, depose(s) and say(s) that
familiar with the s~fuure of
/,.// codicil
ubscribing ~sses to) the will presented herewith and
/~. codicil
/
./ believes the signature on the will is in the handwriting of
testat_
that
to the best of
./
<"r,F~
/,/
kowledge and be
"f""
//
Sworn to or affirmed/and subscribed before
me this // day of
19_
Register
(Name)
(Address)
This is ro certify that the information here given IS currectly copied horn an OrIginal certificate of death dul\' filed with me as
Local .~cgistrar. The original certificate will be forwarJed to the Stdte Vir,li Records ORiee tor pel nunent fiiing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fee t()r this certitlcatL', 52.00
P 7121365
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ate
21-2001-492
HI05 l.:l~. 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
TYPEJPAtNT
IN
PERMANENT
BLACK 1Nt(
NAME OF DECEDENT IF...~, Lr'
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AGE (l... -YI UNDER 1 YEAR
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DATE ~ INJURY
(UOOIl. O.V. 'Mat)
TIME ~ IN./UAY
INJURY I(T V\OAK7 DESCRIBE HOW INJURY occuRRED.
WERE AU10PSY FINIllNGS
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COOoIPlETlON OF CAUSE
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Homicide 0
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CERTIFIER tCh_ My onel
.aRTIFY1NG PHYSICIAN (Pf'lYSlC.atl C1ftf1"Y109 c.auM d dealh wtl." ~OIh.. ph...SIC.... has pfOnOllnced dealh am) comp'efed lIem l31
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To 11M bHt of My knowladgfl. death occurred at Ihe lime, da'I, and pIICI. and due '0 the cau..(a,and mann..... sl.ted.. , . . . . . . . . .
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.MEDICAL EXAMINER/CORONER
On the bul. 0' examln.Uon and/or fnvest'g.Uon,ln mv opjnion. death occurred I' the Ume, d.... and place. and due to the caul.(') and
manne, .. st.ted.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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LAST WILL AND TESTAMENT
I, LOY H. ROSS, of the Borough of Wormleysburg, County of Cumber
land and State of Pennsylvania, being of sound and disposing mind and memo
do hereby make, declare and publish this my Last Will and Testament, hereb
revoking any and all wills heretofore made by me.
FIRST: I give, devise and bequeath all of my property real, per
and/or mixed of whatsoever nature and wheresoever situate, to my wife, Janl
Ross, her heirs and assigns.
SECOND: In the event that my wife, Janet B. Ross, should predecl
me, I then give, devise and bequeath all of my property real, personal and,
mixed of whatsoever nature and wheresoever situate as follows:
(a). One-half to Larry L. Booda, his heirs and assigns.
(b). One-half to Katherine Copenhaver, and if she be
deceased at the time of my death, the one-half
share she would have taken shall be equally divided
between Kathie James and Kenneth James, their heirs
and assigns.
THIRD: I nominate and appoint Janet B. Ross to be the Executrix
this my Last Will and Testament and if she be deceased or unable to serve
that capacity I then nominate Katherine Copenhaver to be the Executrix of
my Last Will and Testament.
FOURTH: I direct that all estate, inheritance and succession ta
on property passing under this Will shall be paid out of the principal of
general estate to the same effect as if said taxes were expenses of admini
tration and all legacies and devises shall be free and clear thereof.
FIFTH:
(a). I authorize and empower my Executrix, for the paym
of debts orfor any purpose of administration or distribution, at any time
within two years from the date of my death, to sell all or any of my real
estate, at public or private sale, for such prices and upon such terms as
cash and credit as she may deem best,and to execute deeds of conveyance th
II
,
without liability on the part of the purchasers to see to the application of
the purchase moneys. This power shall not be construed to work a conversion
of my real estate, unless and until the power is actually exercised, nor shall
this power be construed to extend the lien of debts.
(b). I authorize my Executrix to retain all stocks, bonds
and other investments made by me for distribution in kind, or in her discretion
to sell and transfer the same, either in person or by attorney, without lia-
ti
!I bility on the part of the purchasers to see to the application of the purchase
II moneys.
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SIXTH: This Will consists of two (2) pages.
i:
!I
Ii day of March, 1973.
II
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th
II Signed, sealed, published
Ij and declared by the Testa-
\, tor above named, as and for
'I his Last Will and Testament,
I in the presence of us who
\1 have hereunto at his request
I subscribed our names in his
i presence and in the presence
of each other as witnesses
hereto.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Loy H. Ross
Date of Death: February 7,2001
Will No.: 2001-00492
To the Register:
I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
August 29, 2001:
Janet B. Ross
550 Rupley Road, Camp Hill, PA 17011-1840
Notice has now been given to all persons entitled theret under Rule 5.6 ).
Date: August 29, 2001
ayne M. cht, Esquire
Keefer Wood Allen & Rahal, LLP
415 Fallowfield Road, Suite 102
Camp Hill, PAl 7011-4906
Capacity:
Counsel for Personal Representative
...
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the decedent
died without a will, whether you will receive any money or
property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, P A
In re Estate of Loy H. Ross, deceased,
Estate No:2001-00492
TO: Janet B. Ross
550 Rupley Road
Camp Hill, PA 17011-1840
Please take notice of the death of decedent and the grant of letters to the personal representative named below.
The Decedent, Loy H. Ross, died on the 7th day of February 2001, at East Pennsboro Township, Cumberland
County, Pennsylvania.
The Decedent died testate (with a Will).
The personal representative of the Decedent is:
Janet B. Ross
550 Rupley Road
Camp Hill, PA 17011-1840
The Will has been filed with the Office of the Register of Wills of Cumberland County, Hanover and High
Streets, Carlisle, P A 17013. Phone number 717-240-6345.
A copy of the Will may be obtained by contacting the Register of Wills and paYing the charges for duplication.
Date: ~ /3rJ~ oj
Wayne M. cht, Esquire
Keefer Wood Allen & Rahal, LLP
415 Fallowfield Road, Suite 102
Camp Hill, PA 17011-4906 17108
Capacity:
Telephone 717-612-5802
Counsel for Personal Representative
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Lov H. Ross
also known as
No. 21-2001-00492
Date of Death Februarv 7,2001
, Deceased
Social Security No. 195-07-0127
Janet B. Ross
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal
assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite
each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside
of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the
statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of
18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
1.0. No.: 38904
Q-4/77 0 t: -e f( b-d4:/
(J
Dated: eJ-QlfC-eJt/ }'/) :tPO J
Name of
Attorney: Wayne M. Pecht
Address: 415 Fallowfield Road, Suite 102
Camp Hill, PA 17011-4906
Telephone: 717-612-5802
Description
Value
Waypoint Bank Certificate of Deposit #8000015034 dated 8/07/95
$3,598.97
Total: $3,598.97
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election ofthe personal representative, include the value of each item,
but such figures should not be extended into the total of the Inventory.
Form RW~7 (Dauphin County ~ Rev. 9/92)
\,
/6-,;2.3/-/6
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
Recorct: .
Reb<i..;
Dr DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P12 :03 COUNTY
ACN
12-10-2001
ROSS
02-07-2001
21 01-0492
CUMBERLAND
101
.01 DIG 17
WAYNE M PECHT
KEEFER ETAL
415 FALLOWFIELD RD 10 Cterk.;
CAMP HILL PA 17b1lfTIbE:fia;
t PA
*'
REY-lS47 EX AFP (12-00>
LOY
H
Allount Rellitted
CHANGED
ll)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
3.598.97
.00
30,032.05
(8)
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 ..
RE-V =is4-j-Ex-AFP--fi"2-':ool--NoTicE--oF--rNHEifiTAifci-TAx-APPRAisEi'-ENT~--Ar.l-owAifci-cri------------ - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ROSS LOY H FILE NO. 21 01-0492 ACN 101 DATE 12-10-2001
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. 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
APPROVED DEDUCTIONS AND ~EMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
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
NOTE: 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
TAX CREDITS:
.00
.00
(11)
ll2)
ll3)
ll4)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
33,631.02
on
33,631.02
.00
33,631.02
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
33,631.02 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
ll9)=
.00
.00
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
--~-
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: Loy H. Ross
Date of Death: 02/07 /01
Will No.
21-01-0492
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
Cerk of the Orphans' Court and may be attached to this report.
Date:
01/29/03
~fifRp-;W/
ifnature
Janet B. Ross
Name (Please type or print)
550 Rupley Road, Camp Hill, PA 17011
Address
(717) 763-4286
Te 1. No.
Capacity:
X
Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
.
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date:
1/06/2003
JANET BROSS
550 RUPLEY ROAD
CAMP HILL, PA 17011-1840
RE: Estate of ROSS LOY H
File Number: 2001-00492
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 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: 2/07/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
L;w~-/,d44:,~
DONNA M. OTTO ~
DEPUTY REGISTER OF WILLS ~.
cc: File
Counsel
Judge
REV-1500 EX + (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA REV-1500
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 00492
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Ross, Lav H. 195-07-0127
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
02/07/01 12/31/1917 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Ross, Janet B.
3. Remainder Return
CHECK ~' Original Return ~' Supplemental Return B (date of death prior to 12~13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
(dale of death aftar12-12-82)
PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 00 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Anach a copy of Trusl)
BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (dale oj death between D 11. Election to lax under Sec. 9113(A)
12-31-91 and 1-1-95) (Attach SehO)
D-I!$'il~fiMQ$'JI;!j$QPi\W!itTI*P;A@QQljjjmlPQliIQ!I~~9Qfi~jtii!Ift'\Wt~jNffil!MATjQN;$IiQ!lAi!$i:i1!!~qfjjpfQi
NAME COMPLETE MAILING ADDRESS
COR- WaYne M. Pecht 415 Fallowfield Road, Suite 102
RE- FIRM NAME (If Applicable) Carrp Hill, PA 17011-4906
SPON
DENT Keefer Wocx:1 Allen & Rahal, LLP
TELEPHONE NUMBER
717-612-5802
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, PartnslShip or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 3,598.97
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested (6) None
RECA-
PITULA- 7. InterMVivos Transfers & Miscellaneous
TION NonMProbate Property (Schedule G or L) (7) 30,032.05
8. Total Gross Assets (total Lines 1-7) (8) 33,631. 02
9. Funeral Expenses & Administrative Costs (Schedule H) (9) None
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) None
11. Total Deductions (total Lines 9 & 10) (11) 0.00
12. Net Value of Estate (Line 8 minus Line 11) (12) 33,631. 02
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 33,631. 02
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount 01 Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) 33,631. 02 X.O 0 (15) 0.00
TAX 16. Amount of Line 14 taxable at lineal rate 0.00 X.O 45 (16) 0.00
-
COMPU- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
TATION 16. Amount of Line 14 taxable at collateral rate 0.00 x.15 (18) 0.00
19. Tax Due (19) 0.00
20. D Igfl~GKlB$ii~jltt!:wAij~ij~q!l!($'ijf#lAi'l~NpQf#~.q~!lpA~NJI
o PA15001
.. ....................... .................................................A"..1im..$!.IRl!;tQ.AWlWl!;l!I!\MlQQ!$$]IPll$PNR!\Gl!;.?1\NI'lIll!;QH!'$KM!'\tHIiii....}..........
NTF 29755
Copyright 2000 Greatland/Nelco LP - Forms Software Only
PA REV.1500 EX (S.OO)
Decedent's Com lete Address:
STREET ADDRESS
550 R ley Road
Page 2
CITY
STATE
PA
ZIP
17011
Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
~C~~~g!!~!g~+Ag!brrb!i!~~5g~+i~~~~~~t!8i~a~~;;~j~I!+Ag!!~~~~~i!+g~r~8k~{
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .................... ............. ~ I
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................ D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................ 0 ~
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 accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of
which preparer has any knowledge.
SIGNA URE OF PERSON RESPONSI8LE FOR FILING RETURN DATE
11:1 I Of
(3) 0.00
(4)
(5) 0.00
(5A) 0.00
(58) 0.00
ADD SS
See Schedule attached
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
415 Fallawfield Road, Suite 102, Camp Hill, PA 17011
..'..-,.-,-.-.-,.'..,.'...'....-.,.'.,--.--,....,..,..'...,--.,.......'...'.........--,-,.-.-.,....,...,..,.......,-,-.-.,...,.."..,..,-,.--.,-".,.,."..,........,-,-,.,-,-,.-,......"........,.._,-,..
.".,.,.".,.'...-.'..--,-'....'.'.........--.-.-,.,.,..,..,.,.."-..
":-:"-,-,-",-",-,,,.,...,,,.,:-.,:,.,.,.,.,.;.,,:.....,:':,.,.,':".,',.;',.;.,.,.,.,.,.,-,',-,-,-,.,:,."::":-:':';':-";';""""':-"'-:-""','"",:,"',:.,.:-,.:.,.,-:.:.,',.,-,.,-,-,.",-,.,;....:".:.:-,.;
,;""""""':""-;"':'.':::"'.":'::."",.,.",-:""-":-"":-"",,,,,,::,,_...,...,-:.:-,,:.:.,,,.:-,.:-":-";-",;:",::"""",,,.::,.,.,,,.:.,.,.,.:-,-,-,-,;,-,:,.:".,:,.",.:.",.:".:.",-",-,.,.:.,:,.,':"::':-",":
";-"":""-"'-'-'-"
""';""""-'-';'-"';":"':""''''''''''':-''''':'""-,-"",-"::":,:"":":,,,,,;-,,:-,,,-,,,,,.,,:"':';""':"""""""""-;""-:-',..,,:,..,.:,-"::,:,:",:",;"""""-:-",-,-,;,,.-,:,,,.,,:,:.,.",.,.,.,.,.:-",.,-:.:.:
.""..,,::::-.,.:,:.;.,::.;';""-:"-"'-:""-"';':"""':":':"':':',"':':.",.:"-",-:-,-,...,:,._.,:,..:,.",...,,,.,.,:,-,.,""-:""-,-"""",,..,.,.,-:.;.,:,.,,,.:.,.,-,-,-,.".-,:,.:,_.,:,.,.,...",.;.,.,.:.,.,
-:-,.
For' ~r~tes 'of"d"eat'h-'-o~"o'r-'~i1er' J~'jy"-'f"-1-994"and'-b;I~~~ -::ia~ua';Y",':"'i-~j'95''''lhEI'tax-'rai~\;:npos9d''on' ih~'-~'ei'::'-;aiue' 0i"i'ran'~'i~ii"i~"6'r'fo'r'tfi'e-'u~~"oj"ihe-
~'u;Vj~i'~g-'s'pouse"is"3%-"'-'
[72 P.S. Ii 91 16 (a) (1.1) (I)].
For dates of death on or after January 1, 1995, the tax rate Is imposed on the net value of transfers to orforthe use of the surviving spouse is 0% [72 P.S. 19116 (a) (1.1) (ii)].
The statute rlnA'" nnt Ay"'mm a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 01 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. 89116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S. 191 16{1.2) [72 P.S. %9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use 01 the decedent's siblings is 12% [72 P.S. 191 16(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 biood or adoption.
o PA15002
NTF 29756
Copyright 2000 GreatiandlNelco LP . Forms Software Only
Estate of: Lay H. Ross
21-2001-00492
The following person(s) are signing the retUIIl as representative(s) of the estate:
Janet B. Ross
550 Rupley Road
Carrp Hill, PA 17011
WHEREAS, on the 21st
dated March 30th 1973
was admitted to probate as the last will of ROSS LOY H
(LAbl, tlKbl, M1UULbi
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2001-00492 PA No. 21-01-0492
ESTATE OF ROSS LOY H
(LAbl, ~lKbl, M1UULb)
Late of
WORMLEYSBURG BOROUGH
~UM~~KLANW CUU~lYl
Deceased
Social
No. 195-07-0127
day
Security
of May
2001 an instrument
late of WORMLEYSBURG BOROUGH
CUMBERLAND County, who died on the
7th day of February 2001 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to JANET BROSS
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 21st day of May 2001.
s
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
--.._~ ,--'--- {--........- -
- ..j .J .....
. .
LAST WILL AND TESTAMENT
21-2001-492
I, LOY H. ROSS, of the Borough of Wormleysburg, County of Cumber-
land and Sta}e of Pennsylvania, being of sound and disposing mind and memory,
do hereby make, declare and publish this my Last Will and Testament, hereby
reVOking any and all wills heretofore made by me.
FIRST: I give, devise and bequeath all of my property real, personal
and/or mixed o~ whatsoever nature and wheresoever situate, to my wife, Janet B.
Ross, her heirs and assigns~
SECOND: In the event that my wife, Janet B. Ross, ,should predecease
me, I then give, devise and bequeath all of my property real, personal and/or
mixed of whatsoever nature and wheresoever situate as follows:
(a). One~half to Larry L. Booda, hia heirs and assigns.
(bJ. One-half to Katherine Copenhaver, and if she be
deceased at the time of my death, the one-half
share she waul d heve taken shall be equally divided
between Kathie James and Kenneth James, their heirs
and assigns.
THIRD: I nominate and appoint Janet B. Ross to be the Executrix of
this my Last Will and Testament and if she be deceased or unable to serve in
that capacity I then nominate Katherine Copenhaver to be the Executrix of this
my Last Will and Testament.
FOURTH: I direct that all estate, inheritance and succession taxes
on property passing under this Will shall be paid out of the principal of my
general estate to the same effect as if said taxes were expenses of adminis-
tration and all legacies and devises shall be free and clear thereof.
FIITH:
(8). I authorize and empower my Executrix, fo~ the payment
of debts arfar any purpose of administration or distribution, at any time
within two years from the date of my death, to sell all or any of my real
estate, ~t public 0r private sale, for Duch prices and upon ~uch terms as to
cash and credit as she may deem best,and to execute deeds of conveyance
,
,
thereof'l
I
without liability on the part of the purchasers to see to the application of
the purchase moneys. This power shall not be construed to work a conversion
of my real estate, unless and until the power is actually exercised, nor shall
this power be construed to extend the lien of debts.
(b). I authorize my Executrix to retain all stocks, bonds
and other investments made by me for distribution in kind, or in her discretion
to sell and transfer the same, either in person or by attorney, without lia-
bility on the part of the purchasers to see to the application of the purchase
moneys.
SIXTH: This Will consists of two (2) pages.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th
day of March, 1973.~'
Sdgned, sealed, published
and declared by the Testa-
tor above named, as and for
his Last Will and Testament,
in the presence of us who
have hereunto at his request
subscribed our names in his
presence and in the presence
of each other as witnesses
hereto.
/~~~
~,e.:7',,4..t....
. /.D
Y~IIr )
. _~I
(SEAL),
I
WHEREAS, on the 21st
dated March 30th 1973
was admitted to probate as the last will of ROSS LOY H
(LJ\.bl, <,'lKb'l,
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2001-00492 PA No. 21-01-0492
ESTATE OF ROSS LOY H
(LJ\.bl, <,lKbl, MlDDL~)
Late of
WORMLEYSBURG BOROUGH
~UM~~KLN~D ~UUN1Y,
Deceased
Social
No. 195-07-0127
day
Security
of May
2001 an instrument
MlDDL~)
late of WORMLEYSBURG BOROUGH CUMBERLAND County, who died on the
7th day of February 2001 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to JANET BROSS
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF,
of my Office the 21st day
I have
of May
hereunto set my hand and affixed the seal
2001.
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
~ ,- ~ ~.- ~.............'---'--
--'- . J ,If ,,".
. .
LAST WILL AND TESTAMENT
21-2001-492
I, LOY H. ROSS, of the Borough of Wormleysburg1 County of Curnber-
land and Sta~e of Pennsylvania1 being of sound and disposing mind and memory 1
do hereby make, declare and publish this my Last Will and Testament 1 hereby
revoking any and all wills heretofore made by me.
FIRST: I give, devise and bequeath all of my property real, personal
and/or mixed of whatsoever nature and wheresoever situate, to my wife, Janet B.
Ross, her heirs and assigns.
SECOND: In the event that my wifel Janet B. Rossl . should predecease
me, I then give, devise and bequeath all of my property real, personal and/or
mixed of whatsoever nature and wheresoever situate as follows:
(a). One-half to Larry L. Booda, his heirs and assigns.
(b). One-half to Katherine Copenhaver 1 and if she be
deceased at the time of my death, the one-half
share she would have taken shall be equally divided
between Kathie James and Kenneth James, their heirs
and assigns.
THIRD: I nominate and appoint Janet B. Ross to be the Executrix of
this my Last Will and Testament and if she be deceased or unable to serve in
that capacity I then nominate Katherine Copenhaver to be the Executrix of this
my Last Will and Testament.
FOURTH: I direct that all estate, inheritance and succession taxes
on property passing under this Will shall be paid out of the principal of my
general estate to the same effect as if said taxes were expenses of adminis-
tration and all legacies and devises shall be free and clear thereof.
FIFTH:
(a). I authorize and empower my Executrix, for the payment
o~ debts orior any purpose of administration or distribution1 at any time
within two years from the date of my death, to sell all or any of my real
estate, ~t pUblic 0T private sale1 for uucb prices and upon ~uch terms as to
cash and credit as she may deem best,and to execute deeds of conveyance thereOf~
I
without liability on the part of the purchasers to see to the application of
the purchase moneys. This power shall not be construed to work a conversion
of my real eslate, unless and until the power is actually exercised, nor shall
this power be construed to extend the lien of debts.
(b). I authorize my Executrix to retain all stocks, bonds
and other investments made by me for distribution in kind, or in her discretion
to sell and transfer the same, either in person or by attorney, without lia-
bility on the part of the purchasers to see to the application of the purchase
moneys.
SIXTH: This Will consists of two (2) pages.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th
day of March, 1973,~'
Sdgned, sealed, published
and declared by the Testa-
tor above named, as and for
his Last Will and Testament,
in the presence of us who
have hereunto at his request
subscribed our names in his
presence and in the presence
of each other as witnesses
hereto.
/~~.~
~ ~- :7'".w.....
/)
/- ,
_~~l~)
'_~I
(SEAL) I
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lay H. Ross
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-2001-00492
Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with rIght of survJvorshl~ must be disclosed on Sch. F.
ITEM VALUE AT
NO. DESCRIPTION DATE OF DEATH
1 Waypoint Bank Certificate of Deposit #8000015034 dtd 8/07/95
3,598.97
7 CPA81 NTF 10906
Copyright Forms Software Only, 1997 Nelco, Inc.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,598.97
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LDy H. Ross
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
ThiS schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
21-2001-00492
DESCRIPTION OF PROPERTY %OF EXCLUSION
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECO'S (IF TAXABLE VALUE
RELATIONSHIP TO DECO & DATE OF TRANSFER.
NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE)
1 Waypoint Bank Certificate of 30,032.05 100% 0.00 30,032.05
Deposit #8000059027 dtd 9/12/00
registered to LDy H. Ross as
Trustee for Janet B. Ross
TOTAL (Also enter on line 7, Recapitulation) $ 30,032.05
7 CPA01
NTF 10910
Copyright Forms Software Only, 1997 NeICQ, Inc.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYL VAN IA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
lDy H _ Ross
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
21-2001-00492
RELATIONSHIP TO DECEDENT AMOUNT OR
Do Not List Trustee(s) SHARE OF ESTATE
1 Janet B _ Ross
550 Rupley Road
Carrp Hill, PA 17011
Surviving spouse
33,631. 02
ENTER DOLLAR AMTS. FOR DISTRIBS. 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
None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
None
7 CPA13 NTF 10913
TOTAL OF PART II.. 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)
Copyright Forms Software Only, 1997 Neice, Inc.