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Home My WebLink About01-0814 PETITION FOR PROBATE and GRANT OF LETTERS No. --8J -01- g I LJ-. To: Register of Wills for the _ J , Deceased. County of LUrl)hPI\ am in the Social Security No. 1(;'i~1Iu1/;j7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or oldt{r;an the:; execut r i 1- in the last will of the above decedent, dated fVdll~!xL / '-I and codicil(s) dated Estate of. Roy 1-1 fx?Je/ also known as 9.,<J.J11 ed , 192L- (state relevant circumstances, e.g. renunciation, death of executor, etc.) hiS County, Pennsylvania, with 1,;,-;/ _ Dece dent, then 55 at 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: N/1,. .. 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: years of age, died IllJrl) ; :':(0 , )1.1001 , $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~ '" ";1 u c: " -o~ .- '" "'~ ".... et:~ -00 C:";:: t'lS"';:: 3~ "'- 50 <U c: OIl en I/ffl; ~m6q #~ iJJ, (< etha IC./b;. . I'A 170-5"ZJ OATH OF PERSONAL REPRESENTATIVE COMMONWEALW.O..E~IA l..ss COUNTY OF J.,-t.tJY I ... 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 petitione,(s) will wellrand 'l~~,.dministe' the estate ac<:oro;ng to law. S orn to or ff d subscribed I~I / f1r~ ~ b r e t is / NrJ I , ~. 1 ~ ;:: ~ B: No. al ,01 - DIy- Estate ~~ '-/~ t.\ \BJ--J Ek' , , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~.lf1 . ~) - /J (~ ~onSideration of the petition on the reverse side hereof, satisfactory proof having been {x.e~ented Prfor~e, IT IS DECREED that the instrument(s) dated Ll=ll-t-- described ther~f\~ted to probate an rt:1lrd s the last will of and Letters are hereby granted to FEES ~ CO Probate, ~etters, Etc. ......... $~' _ Short cer~lficates~ .:.J{;:~' ;. $ . ltenunClatlOn .., .'P~ $ , f;U;~AL_~~ Filed .............. .1. . . . . . . . . . . . . . . . . . . mcU.LtD&-ec~~ ~ ---- ATTORNEY (Sup. Ct. l.D. No.) ADDRESS PHONE H105.905 REV. (09100' This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~~S.~/'6r' Robert S.<ZinJnerman, Jr., MPH Secretary of Health No. ~)/~ Charles Hardester State Registrar 1563545 JUL 2 4 2001 Date TYPE/PRINT IN PERIIANENT BLACK INK -. -EuJAL COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) O~7LftI Hl05.144 Rh. 1191 ~ z w @ u w c ~ w ,. < z H UNDER 1 DI<< Hours Minut.. Boyer ORE OF BIRTH (Month, Day._t) SEX 2. Male STATE F1lE NUMBER SOCIAfseCURITY HUMBER DATE OF DEATH (Month, Day, "r) April 20, 2001 Q N\ r\ BIRTHPlACE (City and State 01' Foreign Country) ~,D CITY, BOR RACE - American IncHn, Bleck, While. etc. (Spoody, White 1.. MARITAL STATUS. Married SURVIVING SPOUSE Never M8rrled. Widowed, (II wile. give maiden name) OI\101CIMI(Spec:ity) 1.. Married 15. Jane Mertz 17CjlJ Yes,decedentlivedin Hamoton Two. lWp. c:itylboro '. . c w en :> ~ :J < NoD 21. I~oximat. llmeN.1 between ! onset and death PART t1: Other significanl conditions contribuling 10 death, but not resulting in the undeftot'Ing cause given In PART I. DUE TO (OR AS A CONSEQUENCE ClF): b. DUE 10 (OR AS A CONSEOUENCE OF): DUE 10 (OA AS A CONSEQUENCE OF): ! d. WERE A.UTOPSV FINDINGS .uJLA8lE PRIOR TO COMPlETION OF CAUSE OF DEJrrH? MANNER OF DEATH DATE OF INJURY (Month, Day, Year) TIME OF INJUAY Coroner INJURY AT WORK? Nanni )l( D D Homlcldo D D 300. ,.... M. D PlACE OF INJURY. AI home, fatm, Slreet, laclory, oRice buiking, etc. {Spec~yl 300. :t: :>. 8! Yoo~ No D Accident Pending Investigation Could not be detefmined 2IIl. Db. CERTIFIER (Check only one) -CERTIFYING PHYSICIAN (Physician certiI'jIing cause of death when another physician has pronounced death and compIeIed l1em 23) To thit bMt 01 my knowtedgit, dnttl occurred ~ tolh....ullll(.).nd man....... mted..,........".,..,.........,................... Suicide 2.. D -PRONOUNCING AND CERTtFYlNG PHYSICIAN (Physician both pronouncing deaIh and certifying to cause of dealtl) To the bntat my ImowWdge, duCh occurred.t the time, dllte, and ptKe, .ndduela lhec.uM(.) and mIIn.......ststed.......,.,... ....,...... ,. DATE SIGNED (Month. Day, Veal) D 31c. "d. June 19 2001 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUse OF DEATH (lIem 27) T"",,,, Print Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 ... Mechanicsburg, Pa. 17050 ONE FILED (Month. Day, Year) JUN 28 2001 34. -MEDICAL EXAMINEAICOROHER On the bula of .xamlnatlon and/or Investigation, In my oplnlon, d.ath occurred .. the time, dIIte, and place, anet due to the cauM(.) and manner u etated.. ...........,...........,.....,......,...,.. .....,. ....... ..............,. ...."........... ....., 3ta. REGISTRAR'SSIGNiTXft OmCE 31-000 fUa%l mill ano m-e~tntll:ent OF f..~ RAY~. BOYER (LP I, RAY~. BOYER, of Hampden Township, Cumberland, County, Pennsylvania, declare this to be my last Will, hereby revoking all prior wills and codicils. FIRST: The expenses of my last illness and funeral shall be paid from my estate. SECOND: I hereby give and bequeath, abso- lutely and in fee simple, to my spouse, JANE M. BOYER, all my household furniture and furnishings, books, pictures, jew- elry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment, provided that if my spouse dies before the thirtieth (30th) day follow- ing the day of my death, this gift shall lapse or be divested and I make said bequest equally to my living children, to be divided among them as they shall agree. If they cannot agree for any reason, my Executor shall make the decision and their decision shall be final. My Executor shall represent any minor child in any division of such property and shall deliver to the person standing in the place of a parent to such minor, without bond, such portion of the minor's share as my Executor, after con- sidering the minor'S wishes, deem appropriate. l'JU1m : (a) I give and devise the residue of my estate, real and personal, to my spouse, JANE M. BOYER, if she survives me. If my spouse does not survive me, I give Page 1 ;! B', . and devise the residue of my estate, equally to my children. If any child of mine predeceases me or dies within thirty (30) days of the date of my death, that child's share shall be paid to his or her issue, per stirpes. (b) If no issue of mine survive the survivor of my said spouse and myself, my estate shall be divided into two equal shares and one share shall be paid to my heirs who would be entitled thereto under the Intestate Laws of Pennsylvania in effect at the death of the survivor of myself and my spouse; and the other share shall be paid to my spouse's heirs who would be entitled thereto under the Intestate Laws of Pennsyl- vania in effect at the death of the survivor of myself and my spouse as if my spouse had then died Intestate. FOURTH: No provision of this Will is in- tended to exercise any power of appointment, including any power of appointment granted me under my spouse's will. FIFTH: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation, and the personal receipt of such beneficiary shall be the sufficient and only discharge of my Executor unless otherwise provided herein. SIXTH: All taxes, interest and penalties thereon payable by reason of my death with respect to property comprising my gross estate, whether or not passing under this Will, shall be paid from the principal of my residuary estate. SEVENTH: In addition to powers given them by law, my Executor and her successor and any guardian acting Page 2 Kg , hereunder shall have the following discretionary powers applicable to all real and personal property held by them, effective without court order and until actual distribution: (a) To retain all property received by them including the stock of any corporate fiduciary acting hereunder, provided such property remains productive; (b) To sell real estate for any purpose, pub- licly or privately, for such prices and on such terms as they deem proper, without liability on the purchas- ers to see to application of the purchase moneys; (c) To compromise controversies; (d) To distribute in cash or kind or partly in each at valuations fixed by them; (e) To hold investments in the name of a nom- inee; (f) To assume continuance of the status of any beneficiary with reference to marriage, divorce, ill- ness, incapacity or other change in the absence of in- formation deemed reliable without liability for dis- bursements made on such assumption; and (g) To undertake any and all acts deemed neces- sary and proper by it for the proper and advantageous management of any trust and the settlement of my estate. EIGHTH: Any beneficiary hereunder who dies at the same time as me, within ten (10) days of me, or under Page 3 Kg circumstances wherein it shall be difficult or impossible to determine who died first shall be presumed to have predeceased me. NINTH: If I survive my wife, JANE M. BOYER, I nominate, constitute and appoint my daughter, KIMBERLEY R. BOYER, to be the Guardian of the person of my minor child, STEPHANIE J. BOYER. TENTH: I appoint my daughter, KIMBERLEY R. BOYER, as Executor of this my Will. No fiduciaries acting here- under shall be required to post bond or enter security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 14th day of November, 1988, to this and the preceding three (3) pages, and I have also placed my initials on each preceding page for better identification and gr:;d,r secU;i~ \ .~..- ~/ /5~~ RA H. BOYER 7 ~.B (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by the above- /2.8 named Testator, RAYMeNn H. BOYER, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto sub- scribed our names as witnesses: Oyf~()7J~S tJ .. <bu~ Residing at //;J t;t'ft.Ld ~d."lf./;'~ ()]I 1;/d53- / , r:JI Res id ing at / q 1 (f CD VlvOn) I'-'\d -M ~/ lI\ LA V\ ,'W bv Zj-rEft-~'5 ~ G\j' -cr - ]jl-/-- REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to t law, depose(s) and say(s) that ---, codicil will presented herewith, (each) being duly qualified according to _ present and saw --, the testat , sign the same and that request of testat_ in h presence and (in t other subscribing witness(es)). signed as a witness at the resence of each other) (in the presence of the Sworn to or affirmed and subscribed before me this day of 19_ (Name) ~-- ""- -~ (Address) Register (Address) REGISTER OF WILLS OF r/ILJYlBriR.L/11I1l COUNTY OATH OF NON-SUBSCRIBING WITNESS ~ane M. Boypy (each) a subscriber hereto, (each) being duly qualified accordin , depose(s) and. ar~~at/r-j') WE ftkr~ familiar with the signature of \.J].lljL.t<-.. testat~ of (one of the subscribing witnesses to) the ~ pr~s~nted herewith and that -W E believef the signature on th~the handwriting of 'KA~JD ~ .(RJtE1~i to the best of ~_ knowledge and belief. OIij}U/n tn/llf r, (Nam~) FI/z ('m C 0.( (j Pvi. I fVfa bel T M c:rU- --, Sworn to or affirmed and s,!3bscribed before this /7&50 JO/-II (j),'IJ(IJf ('?o;1t ~ PI) /7#55 J (Address) ~ HURLEY STATE BANK Goodyear Credit Card Plan PO Box 7004 Sioux Falls, SD 57117 1-800-767-3460 Cumberland Co. Register of Wills 1 Courthouse Sq. Carlisle, P A 17013-3387 October 1, 2001 Proof of Claim State of South Dakota IN CIRCUIT COURT SSN: 164-36-3637 File Number:21-01-814 County of Cumberland Judicial Court IN THE MATTER OF THE ESTATE OF Ray H Boyer, Deceased STATE OF South Dakota COUNTY OF Minnehaha Wanda Handevidt, being duly sworn, deposes and says that the amount of the annexed claim against the estate of Ray H Boyer, deceased, is justly due and owing to said claimant, Goodyear, whose post office address is PO Box 7004, Sioux Falls, SD 57117 that no payments have been made thereon which are not credited upon said claim, and that there are no offsets or counterclaims against the same to knowledge of claimant or affiant. Acct#7753010060412825 ~~lfIDce: $3912.60 * See attached sheet ~Q-.nc-b \ciD..rdQL/1ol:t Subscribed and sworn to before me this / ."t)rf day of IJd. OILJtJ / 0/2/1,....1;) t1, 1r1t:LlJ~ My commission Expires: .3 - </-~ 7 ~ffice) ~ The within claim was presented to me for allowance 20 and , 20_, allowed by me for dollars. of the Estate of Deceased. Allowed and approved by me 20_, at the sum of Dollars. Judge of the Circuit Court HURLEY STATE BANK Goodyear Credit Card Plan PO Box 7004 Sioux Falls, SD 57117 1-800-767-3460 Kimberly R Boyer-Eger 1260 Timberview Dr Mechanicsburg, P A 17050 October 1,2001 Proof of Claim State of South Dakota IN CIRCUIT COURT SSN: 164-36-3637 File Number:21-0 1-814 County of Cumberland Judicial Court IN THE MATTER OF THE ESTATE OF Ray H Boyer, Deceased STATE OF South Dakota COUNTY OF Minnehaha Wanda Handevidt, being duly sworn, deposes and says that the amount of the annexed claim against the estate of Ray H Boyer, deceased, is justly due and owing to said claimant, Goodyear, whose post office address is PO Box 7004, Sioux Falls, SD 57117 that no payments have been made thereon which are not credited upon said claim, and that there are no offsets or counterclaims against the same to knowledge of claimant or affiant. Acct#7753010060412825 c-t3~I~ce: $3912.60 * See attached sheet . Y\hrtdo t{() tlrJfJ1JI 0li Subscribed and sworn to before me this / ~ day of iJaf', dt)~ / (2.nA.lI) a. ??1~MycommissionExpires: 2-<l-~7 ~fice) '-..a- The within claim was presented to me for allowance 20 and , 20_, allowed by me for of the Estate of dollars. Deceased. Allowed and approved by me 20_, at the sum of Dollars. Judge of the Circuit Court Account Statement Payment Due Date MAY 01 2001 New Balance $3,912.60 Your Account Number 7753 0100 6041 2825 Minimum Payment Due Amount Enclosed $87.00 $ 1237. 1237. CI 1 oe gA GY Make checks payable to: GOODYEAR CREDIT CARD PLAN 7753010060412825039126000000000008700 RAY H BOYER 1412 CONCORD RD MECHANICSBURG PA 17055-1956 1",11111,1111111111,11,111,1111,111,1111111,,11111111,11111,1 12374 9A AVGY GOODYEAR CREDIT CARD PLAN PO BOX 9025 DES MOINES IA 50368-9025 111,1.11",,1111111,,1,,111,11,11,,11,1,1,1,11,,111,1,1111,1.1 Print addr... changes above. .. PI.a.. d.taeh hor.. Send Notice of Billing Errors to: GOODYEAR CREDIT CARD PLAN PO BOX8181. GRAY TN 37615 Customer Service: 1-800-767-0291 Clasln Date APRIL 06, 2001 THIS K;COUNT ISSUED BY HURLEY STATE: BIWK Account: n53 0100 6041 2825 Credit Available $0.00 Previous Balance $3,926.76 Pa ments & Credits $100.00 New Balance $3,912.60 CURRENT ACTIVITY Transaction Date Transactions 00000015150315956201280 03/15 PAYMENT 17777777770406000694150 04/06 "BILLED FINANCE CHARGES" THANK YOU FOR YOUR RECENT PAYMENTl Amount $ 100.00- S 85.84 CREDIT PLAN SUMMARY REVOLVING CREDIT PLAN Previous Balance $3,926.76 Billed FINANCE CHARGES $85.84 Payments & Credits $100.00 Plan Balance $3,912.60 Minimum Monthly Pavment $87.00 Accrued FINANCE CHARGES Expiration Dete RNANCECHARGESUMMARY Current Billing Period REVOLVING CREDIT PLAN Average Daily Bal8nce DAILY Periodic Rate Corresponding ANNUAL PERCENTAGE RATE Days In Billing Period ANNUAL* PERCENTAGE RATE FINANCE CHARGES Miscellaneous Fees $3,893.35 0.07112% 25.96l\sV 31 25.96%V $85 . 84 Previous Billing Period REVOLVING CREDIT PLAN 0.07112% 25 . 96l\sV 28 "Include. periodic finance charge and transaction charges. ACSNCl V = RATE MAY VARY PAGE 1 OF 1 llO3010 1~~..'" fl~1 -":' ~ I , ~ lr"'''' ~ ..") ft (J1. ~ \ 10' . . I ;."\. ~ ,-,) i . i i' I~! ...~._........j -,~:,~;:,~.."~ ,:',) '~i1':\{C ~,..,,~! " ~; ( \ ! <.:.' :" ~~/: 'r, .:~ -, JJ (~' , ./' .._~-- r ~fr'~~'~. '., t ?y ~ ~ /':. o ~ r~ c ~ ~ C/) ~~~ ~~ ~ ~ '- ,,- 3 ~ s:::: d ---"'" \....- ~ f: .:) ~ - ~ (') CD co :t:: ..- ::J ~ en I ~ ~ ..- Ci5 m 1J ~ ~co~ " .c:~-i 'S z ~ x _ Oat ..-mij ~ . E ..-~o - - \O~ - -= - <J t-.l '-" -= - - - s::t: :: ~= - - ~-= VJJ ,,- -.l -c O I\) N .... .... I') '1 ~ o r- .... " E ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: J 0... Y H~ 01 e. (' tJ/2.0101 Date of Death: Will No. '2. ()O I .... 00 g ,'-/ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6~rphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on q t.f 0 I : Name Address l~Qne ~13oyer ~heU1ie d. Bowen ;~ 12 eonC1Jrd R d 503 t1iJ1 er Ave MechQr1jc~~A /1050 l"\echanieshu.yJn 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except 0 .- ~ () ;i.? CL 0 ..- J ':.: " l:...) ..~1 .1 1,..1 {~::r ",.,.-", c:J '''' ' ;;5 0 ;:1) , .0 ,~ (l) -~~ !; ro 0:: ..- ..... p oJ) 0: G .... 0 Sign'~ f ~ N,m, Kim b<< ~ R. EcrP Address II 01 u'rJd~ Cr, fti {J(Y~ (f7e.~ht1nJi8IvfJ I IA /7OSS- Telephone 0/]) &97 - L!/5"7 Date: I~/& /01 Capacity: ~ Personal Representative _Counsel for personal representative .." )., I?-~;; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX Recorcc:,c Regis.~~~~"::" c_: of DATE '/J i !Is ESTATE OF DATE OF DEATH FILE NUMBER PJ2 :03 COUNTY ACN '01 ole 17 BRIAN K ZELLNER ESQ D C DETHLEFS LAW OFFIC~ . .~ 3805 MARKET ST Clerk. ( CAMP HILL PA 17Q.,nberiand JL,/! , PA 12-10-2001 BOYER 04-20-2001 21 01-0814 CUMBERLAND 101 Allount R_i tted '* REY-15~7 EX AFP 1I2-0Dl RAY H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is'4-j-i3f-AFP-n'2-::00Y-NoYici--OF-YNHiiiiTANCE-TA;c-A-PPRAisiMiNT~--ALi-oWAifCE-(fR-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOYER RAY H FILE NO. 21 01-0814 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 9.976.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 6,437.50 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 9,976.00 43.847 66 33,871.66- .00 33,871.66- NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX RED ITS : YHENT RECEIPT DATE NUHBER (-) 37.410.16 (11) (12) (13) (14) (15) .00 X 00 = .00 (16) .00 X 045 = .00 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= .00 AHOUNT PAID . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ., ~ FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: ESTATE OF } } } } } } No. 21-2001-814 of 2001 RAYHBOYER (Deceased) CLAIM To the Clerk of Orphans court Division: Index and make proper entry in your official records of the claim of ADV ANT AGE RECEIVABLE SOLUTIONS for HOUSEHOLD FINANCE CORPORATION (Claimant), account # 71171412500848, in the amount of $8,800.73 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 101A WYNCOTE CT, MECHANICSBURG, PA 17055-5652, died on April 20, 2001. ^,.'~, ' \ " ',\ '>-' \\ ,i " Written notice of this claim was given to , " (Personal representative, if any, or counsel). J<irn.k(l~ Eaj~A"J Id.-& 0 -r;mb~( UitW U)r, JneCMn l0;b~ ) P4 /1050 N s:? f/} , ('.,1 Januarv~ 00 N 2 <::r: J ,''''''\ o ill a: ,2002 ~J ; V ff Lt JaliJu! U(Clairnant) ADV ANT AGE RECEIVABLE SOLUTIONS 1941 SOUTH 42ND STREET SUITE 380-25 PO BOX 6618 OMAHA, NE 68106-0618 800-999-3778 (Claimant's Address) ~ '~.') " ..Q ,,- j:: 03= '. .- ()(J CLIENT: BENEFICIAL LOAN - ONGOING _ ACCOUNT: 66220188 STATUS: ACTIVE STATUS CLI REF#: 71171412500848 REASON: OO-ACTIVE PACKET: More. =~ ~~RMATION U ~~~=~~TION I : PRMCON L : F.NGT ISH PHONE TYPE: RESP: PRMRSP AREA CODE: ADDRESS TYPE: PRMHOM PREFIX: STREET: 1412 CONCORD RD FIRST NAME: RAY PREFIX: MIDDLE NAME: H NUMBER: CITY: MF.CHANICSRURG LAST NAME: BOYER STATE: PA EXTENSION: EXTENDED: ZIP CODE: 17055 -195 ANSWER CODE: SSN: 164363637 CALL CODE: COUNTRY: US MAIL SUFFIX: CODE: MAIl. ADJUSTMENTS I I BALANCE: 0.0000 ~ ~EVE~ w;:; 'LLAN:: I I C STATISTICS CURRE~~:~~C : 8800.73000 US TED o LISTING BALANCE: 8800.73000 r ...D co Ul c:J ru ...D co Ul Postage $ Certified Fee Postmark Return Receipt Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees $ ...D C) c:J C) c:J r-'l Ul ru LJ. ~"., J.. "____m_h__fjuh___mu u^-,u~.,.~t1' E;h ()uM~~~_;)~_~__ - _~___uu_ /7e6(j r-'l C) C) ('- ; -. " " -~ JRD/June 30, 1992/17858 MAY 0 6 2003 ~ 0{v< .. In Re: Estate of Ray H. Boyer Late of Hampden Township ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-2001-0814 NO. 21-2001-0814 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Kimberley R. Boyer, Now Known As Kimberley R. Eager Counsel for Personal Representative: Date of Decedent's Death: 04-20-2001 Date of Delinquency Notice: 3-10-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 03-10,2003 and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 05-05-2003 Distribution: Personal Representative Counsel for Personal Representative Estate File . . 0--/3 43 9.-"3~ JIt, . A heanng IS scheduled for - at III Courtroom No.3. If the Status Report IS filed prior to the hearing date, the hearing will automatically be cancell .~~'J ~\~t ~ l\ Q/\."\ 'V1.1f\ '\ George . JRD/June 30, 1992/17858 MAY 0 6 2003 ~ ---- In Re: Estate of Ray H. Boyer Late of Hampden Township ORPHANS' COURT DIVISION COURTOFCO~ONPLEASOF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-2001-0814 NO. 21-2001-0814 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Kimberley R. Boyer, Now Known As Kimberley R. Eager Counsel for Personal Representative: Date of Decedent's Death: 04-20-2001 Date of Delinquency Notice: 3-10-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 03-10, 2003 and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. " Date: 05-05-2003 Distribution: Personal Representative Counsel for Personal Representative Estate File 0--/3-113 ~'3~ #1, A hearing is scheduled for at r in Courtroom No.3. Ifthe Status Report is filed prior to the hearing date, the hearing will automatically be cancell George . r :)- ,....::,~ < ~~ ru .J] cO Ul \& ~ .J] CJ CJ CJ CJ ....=I Ul ru ....=I CJ CJ ['- ~/" ~ - l-//20 I- a: ;:) o o UJ~ ...JUJ C') ...Jz ,.... -o(wR ;:::1: CJ),.... u..D. ::::l<( Oa: 0 a.. OI. a: I-W WW ~!Q 1-::1: O..J UJI- uct -u.. <( CJo u ~~ a: W ...J o aa o LO Q)O >1"- .C~ . 0 m -1-3=a.. =Q)Q) ~ -:: >-.- 0> = 0> I- =CCI-::l -= . Q).o : 0::: .0 ~ :: >.-E.c ="'i::i=m -:: Q) ..c: =.oou EcoQ) ii~~ , 1 , I a: w :c ..... e o fil (I) (I) w ~g; (I)~~~c (1);::0..... (I) a: ~il~<~ CllO:a:~a: ~:;:::::~ .....z:Ea:e zc~w..... ~WZ::LLI (..).....:c.......... :E~g~: ~W(l).....Z (I).....ee~ !:~zz, DD~ (5 ~ .~ ~C"{) ~'~ ri ~~ ~ ,~ ~ "~ ~ ~ .- ,- .- .-:: .- .- .- .- ("! (~.! ('l') "01"1 (b.: .:;t..j "!~.':l ( .) ;; "::; u\ C) ".. .... Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 qq 4QC;- f/9CC Date: 3/10/2003 BOYER KIMBERLEY R NOW 1260 TIMBER VIEW DRIVE MECHANICSBURG, PA 17050 RE: Estate of BOYER RAY H File Number: 2001-00814 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 4/20/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~JJl.fh-;444~.~ p~-<-. - DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: File Counsel Judge r tn ,..,. W'I a tit l.u C .... at o 0.. CI) :) ~ &; , -- ~ \ - ~ ~ ,~ . ~ ~ ~t> ~1 '- . ~ a: ::>> o o cnen -Iz (') -I..... ~ ;;..... w 0 ;:> J: en I'- u.D. ::::>~ oa: 00. OI. a: I-w wwa:..J ~J: ::::>S{l cn~ Oo! -u.uc( fao u a:~ a: w -I o oa o L!) Wo >~ a::a::<(l wOo... '~s<5 : co' w a:: -::. >:J -= Q!. a:: co ==>-w(/) :wcou :....J ~ Z -=a::_<( -:WI-I :COou =~c.ow :\L~~ 4-. !~ i ry/ rx I \",1.1 \il o a: .... ::c .... o o o .... "" "" .... ....a: ....0 Z....C1 :=:a::co ""0"" ""a:: a::z""cc C1:.o:~....=: C1...........Ia: Comma ....z::Ecu. zCl:)ffio !!::!....z>.... ~Ii:::c:i~ l:t::Egl!::~ :)....""....z ~l=oo:) -czz. ooQR!l... IW II ....1 '"of) ft ..... ~ ~t lI5t' ~ N" ....... 410 ? OF IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF RAY H BOYER , Deceased No. 21-01-814 of 2001 To the Clerk of the Orphans' Court: Enter the claim of ALEGIS GROUP L.P. Accl. 0468221643636373 In the amount of $4,201.74 , against the above entitled estate. The decedent, who resided at 1412 CONCORD RD MECHANICSBURG PA 17055 died on 04/20/2001 . Written notice of said claim was given to KIMBERL YEAGER ,if known to claimant, at (Personal Representative or counsel) 1260 TIMBER VIEW DR, MECHANICSBURG, PA 17050 on May 20,2002 (Date) (Cla~\nn~ Y\. Wut Address: 5330 East Main Street, Suite 200 Columbus, Ohio 43213 ~\~ Claimant's Counsel Address DE ?O. . () r )> )> "'U )> s: ~ I 0 )> 0 0 z m z ;:0 ~ en 0 m m en ~ 0 en z ;:0 ..-... en -f "'U ~ )> m I Q) ..-... c.n s: 0 )> "0 CO W m Z "0 ....... W "TI en ....... o. .......... 0 )> ?; Q) ....... m r () cr ...... s: m -< 0 CD ~ G) 0 I C ':-:'" )> .... ;:0 w z en )> OJ -f Z ....... G) 0 0 w en s: -< z CO ~-f ;:0 0 -f 0 m )> en c ;:0 I\.) "'U -f "'U 0 ...... I "'U m r m 0 C I\.) () ...... "'U I () 0 m CO )> 0 )> ...... OJ () en ~ r m m 0 0 r C s: OJ c en 0 I ~ w I\.) ...... W IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF RAY H BOYER , Deceased No. 21-01-814 of 2001 To the Clerk of the Orphans' Court: Enter the claim of ALEGIS GROUP L.P. Accl. 0468221643636373 In the amount of $4,201.74 , against the above entitled estate. The decedent, who resided at 1412 CONCORD RD MECHANICSBURG PA 17055 died on 04/20/2001 . Written notice of said claim was given to KIMBERL YEAGER ,if known to claimant, at (Personal Representative or counsel) 1260 TIMBER VIEW DR, MECHANICSBURG, PA 17050 on May 20, 2002 (Date) $nVp~ Y\J1W (Claimant) Address: 5330 East Main Street, Suite 200 Columbus, Ohio 43213 ~\~ Claimant's Counsel Address . . () r )> )> "'U )> s:: ::j ::r: 0 )> 0 0 z m -< z ;;0 -I en 0 m m cjj ~ 0 en ......... en z ;;0 ::;; )> -I "'U Q) ......... s:: m ::r: "0 (Xl 01 0 )> "2- ...... w m ...... w "TI Z o. ........- 0 )> ~ en Q) ...... m cr r () ...... m CD .J:>. s:: -< 0 ........- )> G) 0 ::r: c en r- ;;0 z w Z )lo OJ ...... -I 0 w en G) 3: 0 Z -I co .-1 ;;0 -< )> 0 m 0 "'U en c ;;0 I\.) -I "'U "'U m 0 ...... r r m I I\.) 0 () 0 "'U () ...... )> 0 m I (Xl OJ )> ...... r () en .J:>. m 0 m r 0 C s:: OJ c en 0 ::r: .J:>. w I\.) ...... w REV-1500 EX (6-QOl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 w I- ::.:::$cn l..ll:t:::':: wll..l..l J:oo l..ll:t:...J lI..al II.. <( INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER r:2L-DL COUNTY CODE YEAR .... Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Boyer, RQ.y H. DATE OF DEATH (MM-DD-YEAR) 04/20/01 SOCIAL SECURITY NUMBER 164 - 36 __~L3L NUMBER - 3637 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER COMPLETE MAILING ADDRESS 3805 Market street Camp Hill, PA 17011 [] 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death atter 12-12-82) 07. Decedent Maintained a Living Trust (Attach copy 01 Trust) o 10. Spousal Poverty Credit (dateoldeatn between 12-31-91 and 1-1-95) o 3. Remainder Return (date of deatn prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Scn 0) NAME Brian K. Zellner Es uire FIRM NAME (If Applicable) Law Office of D rr TELEPHONE NUMBER ., n - Q7$"" - Cf&.(I{b 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) 0 (2) 0 (3) 0 (4) 0 (5) 9,976.00 (6) 0 (7) 0 DATE OF BIRTH (MM-DD-YEAR) 01/23/46 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Boyer, Jane M. 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o !;;: -I ~ !::: Q. <( U w 0::: 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 (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (9) 6 , 4 3 7 . 5 0 (10) 37, 41 0 . 1 6 r--------- OFFliCIAL USE ONLY L (8) 9, 9 7 6 . 00 (11) 43 . 847 . 66 (12) 0 (13) 0 (14) 0 x.O_ (15) 0 x .0_ (16) 0 x .12 (17) 0 x .15 (18) 0 (19) 0 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ~ Q. :E o u ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 20.0 REV-1502EX + (1.907) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RQ.y H. Boyer FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshi must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION None TOTAL (Also enter on line 1, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-l503 Ex .(1-97; SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SIDENT DE DENT ESTATE OF Ro-y H. Boyer FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION None VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) REV-1504'EX+ (1-97) ~"'" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ H. Boyer SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER 1. None DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-1507 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RD-y H. Boyer SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER ITEM NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH None 1. TOTAL (Also enter on line 4, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97)' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hey H. Boyer FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 1996 Dodge Grand Caravan VALUE AT DATE OF DEATH 9,976.00 TOTAL (Also enter on line 5, Recapitulation) $ 9, 976 . 00 (If more space is needed, insert additional sheets of the same size) REV-1509 EX. (~-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ro.y H. Boyer FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. None B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-'5l0 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ H. Boyer 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. 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 ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE) NUMBER 1. None TOTAL (Also enter on line 7, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF R~ H. Boyer FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 6,399.50 B. ADMINISTRATIVE COSTS: o 1. Personal Representative's Commissions Name of Personal Representative(s) ~ I..... !", ~ fe '{ R.. G ~ s~ ('" Social Security Number(s)/EIN Number of Personal Representative(s) Street Address <It) L c""" ote{<A.... of 00.--.11 C. ~-h.~ h }n,)- lkulGttJr , City C&- r H" State f/i- Zip 11'" 'I Year(s) Commission Paid: 2. Attorney Fees o 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees to Cumberland CountY:oiRegister of Wills 38.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 6, 437 . 50 (If more space is needed, insert additional sheets of the same size) REV.1S12E',.("~') ~ ..ro..", ~ '- ~ . '" ::~~ .. --:i. . :.- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RQ.y H. Boyer SCHEDULE) DEBTS OF DECEDENT, MORTGAGE LIABILITIES. & LIENS FILE NUMBER ITEM NUMBER Include unreimbursed medical expenses. I DESCRIPTION AMOUNT 1. Hurley state Bank, P.O. Box 9025, Des Moines, IA 50368 4,356.31 Acct # 7753010060412825 2. 3. Farmer's First Bank, P.O. Box 1000, Lititz, PA 17543 1996 Dogdge Grand Caravan, Loan # 0313135160 9,718.41 National Revenue Corp.,2323 Lake Club Drive, Columbus, OH, 43232 396.01 4. Goodyear Credit Card,P.O. Box 2016, Omaha, NE 68013-201 , 4020.37 Acct # 7753010060412825 5. Lowe's, P.O. Box 105980, Dept. 79, Atlanta, GA 30353- 5980, Acct # 81602216090551 14,300.26 6. American Express, P.O. Box 1270, Newark, NJ 07101-1270, 2,631.28 Acct# 3720-114349-02000 7. 8. 9. 1 O. Beneficial Finance, P.O. Box 4153 Carol stream, IL 60197-4153, Acct # 711714-12-500848-8 7,671.74 Rozman Bros., P.O. Box 105981, Dept50, Atlanta, GA 30353-5981, Acct # 6905078048175802 1,059.06 Three Diamond Card, P.O. Box 703, Wood Dale, IL 60191-0703, Acct # 0468-2216-4363-6373 ,037.59 Home Depot, P.O. Box 9771, Macon, GA 31291-9771 Acct # 517460023381 ,214.60 11. Jerre Wirt, Blake Funeral Home, 395 state street, Sunbury ,024.90 PA, 17801, Mother's Funeral Bill TOTAL (Also enter on line 10, Recapitulation) $ 3 7 , 41 O. 1 6 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RQ.y H. Boyer SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. None ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 (If more space is needed, insert additional sheets of the same size)