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Home My WebLink About01-0765 PETITION FOR GRANT OF LETTERS Estate of Loy Paul E. No. 21-01-765 also known as , Deceased Social Security No. 209126281 Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) o A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or Decedent, dated 9/18/87 and codicil(s) dated Roberti L. Loy has signed a renunciation of his right to act as an executor named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: o B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 161 Shippensburg Mobile Estates, Shippensburg, Southampton Township, Cumberland County, Pa. (list street, number and municipality) Decedent, then 76 years of age, died July 27 I 2001 ,at 161 Shippensburg Mobile Estates, Shippensburg (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property......................................... $ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County.............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total.... ................ ........ ...... .......... ........ ........ ....... .......... ....................................... $ 31,500.00 31,500.00 Real Estate situated as follows: None Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence PaulE. Lo Jr. 8220 Michaux Drive Fa etteville Pa. RW-1 /7- 1- ~ Oath of Personal Representative Commonwealth of Pennsylvania County of 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 per al representative(s) of the Decedent, Petitioner(s) will well and truly administer tee according to I Sworn to and affirmed and subscribed before me this 17th day of Auaust. 2001 7')/ (I~uJ9'#~/fl L/)~ Estate of Lov Paul E. DECREE OF REGISTER Deceased No. 21-01-765 also known as Social Security No: 209126281 Date of Death: 7/27/01 AND NOW, AUQust 17 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary 0 of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to Paul E. Loy, Jr. in the above estate and that the instrument(s), if any, dated September 18,1887 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... Short Certificates(s) .... ........... Renunciation........................ .. Extra Pages ( ) ............... I. T. Roo..................................... J C P Fee ................................. Inventory ................................ Other .................................. .... TOTAL............................ .$ $ 70.00 ~NI(! ~'~P!jl~'I).-il~/ ~I"ay Register Wills $ $ $ $ $ $ $ $ 6.00 5.00 3.00 Signature 5.00 Attorney: Adams H. Anthony I.D. No: 25502 Address: 128 East KinQ Street ShippensburQ Pa 17257 84.00 Telephone: 532-3270 DATE FILED: R-/"/-;') / ~~~~~ RENUNCIATION Estate of Paul E. Loy No. 21-01-765 also known as , Deceased The undersigned, Robert L Loy, child and co-executor (Relationship) of (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamentary be issued to Paul E.Loy, Jr. -~ fV\ y- hand this I '> . day of Au~~st r/if' ~001 /?~t ~.~ (Signat e) Witness (Address) (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 I\~.C'I\; This is to certify that the information here given is correctly copied fron: an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fillllg, WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~~:c~~~~ Fee for this certificate, $2.00 p 7578157 JUl 3 0 2001 Date 21-01-765 H'05. '431'1... 2/87 COMMONWEALTH Of PENNSYLVANIA. OEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 'lINT 76 uNDER 1 YEAA MonIIII D.,. 8lR'THP~ (CoIy and SIal. '" F"'_ Councry, =ofylO .ENT IHI( N"'ME Of DECEDENT 1~'S1. Mod<l1e. "8'" " AGE (loti Borth<laYI YIS. 5, COUNT't Of DERH ~\ . DECEDENT'S USUAL OCCUPIlrION (~"'=:llt~:""= .:::~:r . ,';.011 Collector "... OECEOENT'S MAILING AOOAESS (SIrM!. C~. SIalol.l'll COdel DECEDEHT'S ACTUAL . 161 Shippensburg Mobil Es ~~~ I~hippensbury PA 17257 on__l FIITMER'S N......E IF".., M<ldI.. LIstI It. INFORMANT'S NAME (T ypelPrin~ 171. SIll. P P. MARITAL ST.~TUS . M_ SUIlVIVIHG SPOuSE N.... M...iecl, W_. In ..... QN8 ma-._I OMlf....lSoeeolyl ,Di vorced 17,e(_.__;" ~''1; pr~n!':.r\llr,: 1Wp. , 711, Cou ();d -- live in a -.;p7 ClIyiIlora 17241 M. 2S, 21. MRT I: Enter tn. di....... ittjuriM or compIic.ationl which c.used lhe deaEn. 00 not .m., the l.. onty one ca... on eacn line. PI.A1M: OlIle<.~_~lO."tlI...... _ -inO in",. Uflderlring _ g;.en in Po\RT I. \ :: d. WERE AlilOPSV FINDINGS AIolVl.A8l.E PRIOA 10 COMPLETION OF CAUSE OF OEAJ'H? DUE 10(00 AS A CONSEQUENCE Of): MANNER Of DEATH OI.TE Of INJURY (Monlll. Day, 'tIItarl TIME Of INJURY INJURY ~ WORK? DESCRIBe HC1N INJURY OCCURRED. Natural Hom;Qde 0 Pendtng Invoesl'qa1ion 0 Couk:l not be de-temuned 0 Yet D NoD _0 NoD _ 0 Suic:Mle 0 ;!.IIJ __ 21... "'. CERTIFIER Io-ec. oniy onel .CERlWYIMG PHYSlC1AN (PhySIC"" cert.tvtnQ cause ~ dfpalh wn." .1no1het onV$lCoan Me Pfonounced cJealh af'\O comQJeted Ilern 23) To !he tJHt of ""y know~. death occurred dtM 10 the cau"('1),nd ",alln.,.. s'.'ed. . . . . . .. . . . . . . .. . . . . . . . .. . . . .PfllONOUNCIHG AND CEATIFYING PHYSICIAN (PtIygc.an borf"l :lfOr'\OUnctng cl@.11h .and C@ffllVIl'\qlOcauu: at C1eatt\' To the beet of my kno'llf'N9~. deaU- OCCUf'red at.". time. date. and plac.. and due to 1M CIU.e(.) and "'anner.. slated. 'MEDICAL EXAMINER/COAONER c:..~~~:::i:,:::.:.~,:,in~U~~ .I.~~ ~~Y~~I~~~I.~ft: '.". my. GP'''I~'': ~~~~~ ~~~~:..~ ~~ I~~ ~I",~..~~I~: ~"~.~I~~~: ~~,~~~ ~~ ~~~ ~~~~~~~).~~ 0 "". REGISTRAR'S SIGNATURE "'NO b~l\ I~\ IDI J , . 21-01-765 LAST WILL AND TESTAMENT I, PAUL E. LOY, being of sound mind, memory and understanding, to make, publish, and declare this my Last Will and Testament, hereby revoking all prior wills and codicils made at any time before by me. FIRST. I direct that all my funeral expenses be paid as soon as practical after my death. SECOND. I direct, that all my property be sold, at private or public sale, whether said property be real, mixed or personal, whatsoever and wherever situate and the proceeds thereof shall be divided equally among Paul E. Lay, Jr., Robert L. Loy, James E. Lay, Joseph A. Loy and Linda P. Smiley in equal shares, share and share alike, per stirpes. THIRD. I nominate and appoint Paul E. Loy, Jr., and Robert L. Loy as the executors of this my Last Will and Testament. IN WITNESS WHEREOF, I, PAUL E. LOY, to this my Last Will and Testament set my hand and seal this ~ day of ~~__. 1987. a~b:fi/j (SEAL) Sworn to and subscribed, declared and published by Paul E. Loy, as his Last Will and Testament, and so done in the presence of we the witnesses, who sign at his request. and in his presence and in the presence of each other. {};{lVD 1J/J;r~fJ JLC%-~CC'J~ H. ANTHONY ADAMS - ATTORNEY AT LAW - 132 EAST KING STREET - SHIPPENSBURG. PENNSYLVANIA 17257 J 41 COMMONWEALTH OF PENNSYLVANIA: :ss COUNTY OF CUMBERLAND I, Paul E. Loy, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly; and that I signed it as my free and voluntary act for the P~~~' SHARON COLEMAN ADAMS, Notary Public Shippensburg, Cumberland Co., Pa. My Commission Expires June 5, 1989 COMMONWEALTH OF PENNSYLVANIA: :ss COUNTY OF CUMBERLAND We, H. Anthony Adams & Dawn M. Stanfield, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator, sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses, and that to the best of our knowledge the Testator was at that time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by H. Anthony Adams an~~Dawn M. Stanfield t witn ses, this ~lday of 19 Expires: SHARON COLEMAN ADAMS, Notary Public Shippensburg, Cumberland Co., Pa. My Commission Expires June 5, 1989 H. ANTHONY ADAMS - ATTORNEY AT LAW - 132 EAST KING STREET - SHIPPENSBURG. PENNSYLYANIA 17257 ~ Register of Wills of Cumberland County, Pennsylvania - CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Paul E. Lov Date of Death: 7/27/01 Will No. 2001-00765 Admin. No. 21-01-0765 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 9/28/01 Name Address Paul E. Loy, Jr. 8220 Michaux Drive, F avetteville Pa 17222 Robert L. Loy 161 Shippensburg Mobile Estates Shiooensbura Pa 17257 Joseph A. Loy 161 Shippensburg Mobile Estates Shiooensbura Pa 17257 James E. Loy 3454 Church Street Chambersbura Pa 17201 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 9/28/01 \\~~ ~ \ Signature Name: H. Anthonv Adams Address: 128 East Kina Street Shiooensburg Pa 17257 Telephone(717) 5323270 x Personal Representative Counsel for Personal Representative Capacity: 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 PAUL E LOY JR 27 W SIXTH STREET WA YNEWBORO, PA 17268 -------- fold ESTATE INFORMATION: SSN: 209-12-6281 FILE NUMBER: 21-2001- 0765 DECEDENT NAME: LOY PAUL E DATE OF PAYMENT: 11/28/2001 POSTMARK DATE: 11/27/2001 COUNTY: CUMBERLAND DATE OF DEATH: 07/27/2001 NO. CD 000566 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,183.24 I I I I I I I I TOTAL AMOUNT PAID: $3,183.24 REMARKS: PAUL E LOY JR CHECK# 7807 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS /~-/ - 'I 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 Reeo r C ..~'. . Re~~,l~cl,: ~TE ;Jdl~STATE OF DATE OF DEATH FILE NUMBER p~TY 01-21-2002 LOY 07-27-2001 21 01-0765 CUMBERLAND 101 ADAMS H ANTHONY 128 EKING ST SHIPPENSBURG .02 JAN 25 * r/ REV-1547 EX AFP U2-00> PAUL E Allount R_itted PA 17257 Clerk." CUf'nberl a;",,::,j CAt PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=is4-j-i3f-AFP--c12=oliY-NoTici--oF-'rNHiiiifANci-y-AX-APPRAisiifiNY-,--ALi.-OWANCi-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LOY PAUL E FILE NO. 21 01-0765 ACN 101 DATE 01-21-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 38,928.33 .00 42,607.87 (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 R.turn 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) 10,797.50 .00 lll) ll2) (13) ll4) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax payment. 81,536.20 10.797 50 70,738.70 .00 70,738.70 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ !bb ASSESSMENT OF TAX: lS. Allount of Line 14 at Spousal rate (lS) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = 70,738.70 X 045= .00 X 12 = .00 X 15 = ll9)= .00 3,183.24 .00 .00 3,183.24 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-27-2001 CDOO0566 .00 3,183.24 TOTAL TAX CREDIT 3,183.24 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.) Date of Death: ~Cl \J. \ E- 11~71()1 / I STATUS REPORT UNDER RULE 6.12 l01 CI; ()~ ~ ' ~ Name of Decedent: Will No.: Admin. No.: d-60 ( CO 76.5 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. Stat~ether administration of the estate is complete: Yes ~ No 0 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 wsentative file a final account with the Court? Yes _ No J2S\ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal~resentative state an account informally to the parties in interest? Yes ~ 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 report. :" . .. Signature &. I' ? IOJ ,~, I~ Namel./q W 7e S.fr,.,e~ ~u(~ 3 \\ . c., \^ \' ~,t0S ~( 1\\ r~ ,+-'=' I 7 d 57 Address )J7-S3d-3d70 Telephone No. Date: .bfill/113 r- ~ c::) L.:.:J !.::::: ("Y) p - -~ i r ~.. ...-i ............ Capacity: Qlersonal Representative ~ Counsel for personal representative . ~~ ~~~~'" -~~ ----..---. ~--.....---.....-- -- a...--nf,-c.~";4-fice of ~""'.i'!"'_.;,~__.____..;~!,. . ,.. A(~-i -:,~" , iN ills .01 ~JQV 2P 1')1 -II'") , J-4L C:-21 GUll ~ ;-, i -::t V lCl)Ne I'j~~ mli~ Ij~l; I ~~I "c" 1t:~fII 1"1'118 ! > e I i j i t ;kc , i -. ." -." ... .-- ~ "- ...-. -.. ....... ... .... Ita, --'" ~-. ,,-- ---. --'lit --"- ..~ lilt ~ ... ~ ... -, III .., lira III' III ')) ..~ ~. III ...~ ... ~.'.. :z o < f\) 'J F\.) o o ~ ,.I.";~ lJ .(' -"--~~-'--- -... " .. -- -- - .. -- ... .. .. .. .... ilia ~ ~ \ It ~ ~ lit \ ~ .. ~ ~\ -- -- .. .. . I; .- ,., .j .- .~ t;) U J'> t-I '-J ........ -0 ~ :t: )> .. :0 I'll ;:0 III~ ~. S 'II -u lit ""=" . REV-1S00 EX + (6-00) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 j i -/ - i/ REV-1'SOO INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY & FILE NUMBER ..d-L- ()~__J.&S COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W U W C Lo Paul E. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 2 09- 1 2 - 6 2 8 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER UJ I- :.:: :!!;en (.) Q:::.:: UJ ~(.) J: Q::g (.) 0.00 0. <I: 07/27/2001 09/29/2024 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) D 3. Remainder Return (date 01 death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch O) [KJ 1, Original Return D 4, Limited Estate [KJ 6. Decedent Died Testate (Attach copy 01 Will) D 9, Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (AttachcopyofTrust) D 10, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-9S) THIS SECTION MUST BE COMPLETED. ALL CORReSPONDENCE AND CoNFIDENTIAL TAX INFORMATION SHOuLD BE DIRECteD TO: NAME COMPLETE MAILING ADDRESS Adams H. Anthon 128 East King Street FIRM NAME (II Applicable) I- Z UJ C Z o 0. en UJ Q:: Q:: o (.) TELEPHONE NUMBER 532-3270 Shi Pa 17257 z o ~ <( ...J :J I- 0: <( u w 0::: z o ~ <( I- :J D. :! o U X <( I- 1, Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (1) (2) (3) (4) (5) or:- ,,-. ......... =<'P ~..., crr" ...I " n~' r . '0 -- ::D ('I) ,:") ,~3 1::Y"1 OFFICIAL USE ONLY z c:::J <: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, JOintly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) (9) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 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 not been made (Schedule J) iN 38,928.3300 -u "Uc, )". ' ,,b;. 1- 42,607.87 ! (8) 81,536.20 10,797.50 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19, Tax Due X _(15) 70,738.70 X .045 (16) X ,12 (17) X ,15 (18) (19) (11) (12) (13) 10,797.50 70,738.70 16. Amount of Line 14 taxable at lineal rate (14) 70,738.70 17, Amount of Line 14 taxable at sibling rate 3,183.24 3,183.24 18, Amount of Line 14 taxable at collateral rate 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 < < D,ecedel1t's Complete Address: STREET ADDRESS 161 Shippensburg Mobile Estates CITY I STATE I ZIP Shippensburg Pa. 17257 Tax Payments and Credits: 1. T ax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,183.24 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) T otallnterest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 3,183.24 3,183.24 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ............................................ ........ ...... ................. 0 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 0 c. retain a reversionary interest; or ...................................................................................................... 0 0 d. receive the promise for life of either payments, benefits or care? ........................ ..................................... 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.......... ............................................. ....................................... 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . .... ................................................................................... ............... 0 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 ed on all information of which preparer has any knowledge. SIGNATURE 0 SON RESPONSIBLE F, FILlN ETURN ("') C - ' DAT J \ ) ( ADDRESS of transfers to or for the use of the surviving spouse is 3% ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net [72 PS. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not 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 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 PS. s9116(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. ~9116(1.2) [72 P.S. S9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. :'"'~".,,;". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Loy Paul E. 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. FILE NUMBER ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 30,000.00 Orrstown Bank Certificate of Deposit 2 Refund from Hospital 25.83 3. Mobile Home 8,000.00 4. 1987 Chevrolet Caprice (sold privately) 902.50 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 38928.33 REV 1510 EX + {1 97) .w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY FILE NUMBER ESTATE OF Lov Paul E. 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. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Orrstown Bank Certificate of Deposit 29,633.93 100. 29,633.93 #30048166 2 Allfirst Bank 12,973.94 100. 12,973.94 Checking account TOTAL (Also enter on line 7, Recapitulation) $ 42607.87 (If more space is needed, insert additional sheets of the same size) ""W~''''''.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS EST ATE OF Lay Paul E. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Eggar Funeral Home 6,398.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Paul E. Lay Jr. 2,100.00 Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 8220 Michaux Drive, City Fayetteville State Pa. Zip 17222 Year(s) Commission Paid: 2001 2. Attorney Fees H. Anthony Adams 1,250.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of wills 99.00 5. Accountant's Fees 6. Tax Return Prepare~s Fees 7. Eby Granite works 950.00 TOTAL (Also enter on line 9, Recapitulation) $ 10797.50 (If more space is needed, insert additional sheets of the same size) REV.1513EX+(197) '*' . . . .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Lov Paul E. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Paul E. Lay, Jr child 20% 8220 Michaux Drive Fayetteville, Pa.17222 2. Robert L. Lay child 20% 161 Shippensburg Mobile Estates Shippensburg, Pa. 17257 3. Joseph A. Lay child 20% 161 Shippensburg Mobile Estates Shippensburg, Pa. 17257 4. James E. Lay child 20% 3454 Church Street Chambersburg, Pa. 5. Linda P. Smiley child 20% 6835 Spring Road Shermansdale, Pa.17090 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) I: LAST WILL AND TESTAMENT I, PAUL E. LOY, being of sound mind. memory and understanding, to make, publish, and declare this my Last Will and Testament, hereby revoking all prior wills and codicils made at any time before by me. FIRST. I direct that all my funeral expenses be paid as soon as practical after my death. SECOND. I direct, that all my property be sold, at private or public sale, whether said property be real, mixed or personal, whatsoever and wherever situate and the proceeds thereof shall be divided equally among Paul E. Loy, Jr., Robert L. Loy, James E. Lay, Joseph A. Loy and Linda P. Smiley in equal shares, share and share alike, per stirpes. THIRD. I nominate and appoint Paul E. Lay, Jr., and Robert L. Loy as the executors of this my Last Will and Testament. IN WITNESS WHEREOF, I, PAUL E. LOY, to this my Last Will and 4h !\ Testament set my hand and seal this ~_ day of ~~~ti~\ , 1987. /7 //. ;if;- fJ..,--;!/1#5!;.. __ (SEAL) Sworn to and subscribed, declared and published by Paul E. Loy, as his Last Will and Testament, and so done in the presence of we the witnesses, who sign at his request. and in his presence and in the presence of each other. ~1 V:@l~ !JJ T ~ r -A -,~ ~ H. ANTHONY ADAMS - ATTORNEY AT LAW - 132 EAST KING STREET - SHIPPENSBURG. PENNSYLVANIA 172S7 COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, Paul E. Loy, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~ SHARON COLEMAN ADAMS, Notary Public Shippensburg, Cumberland Co., Pa. My Commission Expires June 5, 1989 .I COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND We, H. Anthony Adams & Dawn M. Stanfield, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator, sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses, and that to the best of our knowledge the Testator was at that time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by H. Anthony Adams an~Dawn M. Stanfield thr witn sses, this ~ day of ~ Expires: SHARON COLEMAN ADAMS, Notary Public Shippensburg, Cumberland Co., Pa. My Commission Expires June 5, 1989 H. ANTHONY ADAMS - ATTORNEY AT LAW - ,32 EAST KING STREET - SHIPPENSSURG, PENNSYLVANIA 17257