HomeMy WebLinkAbout01-0863
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VERIFICATION
This L3.& day of . )r;.Ld" ,AY/)MD , 2001, the foregoing petitioner hereby
verifies, subject to the penalties o~ 18 Pa.C.S. 4904 (relating to unsworn falsification to
authorities), that the facts set forth in the foregoing petition which are yvithin his/her knowledge
are true, and as to the facts based on information received, after dilige~t inquiry, he/she believes
them to be true. d ;(C1-~~
PetitIOn?
JOINDER
We, the undersigned, being all the parties, other than the petitioner, beneficially interested
in the estate of the foregoing decedent, do hereby certity that we have read the foregoing petition
and join the prayer thereof
fJ.~EQL
AND NOW, TO WIT: This , n Play of . 2001, upon consideration
of the foregoing petition and on moti~ attorney for the petitioner, it is ordered that the
property of the decedent be distributed under Section 3102 of the P-E-F code as follows:
~
Wiley, Lenox, Colgan & Marzzacco (reimbursement):
Wiley, Lenox, Colgan & Marzzacco (attorney fee):
Cocklin Funeral Home:
Kay Rahn:
Virginia L. Brydon:
Fay L. Fitton:
Amount
$ 288.30
$ 1,500.00
$ 150.30
$ 1,629.13
$ 1,629.12
$ 1,629.12
Total: $ 6,825.97
This decree of distribution shall constitute sufficient authority to all transfer agents,
registrars and others dealing with the property of the estate to recognize the persons named herein
as entitled to receive such property without administration, and shall in all respects have the same
effect as a decree of distribution after an accounting by a personal representative.
Judge
In the Matter of the Estate
of Helen E. Lucas,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, P A
Deceased
Orphans' Court Division
No. ~\-C\- oc~lc-:3
Petition for Settlement of Small Estate
TO THE HONORABLE, THE JUDGE OF SAID COURT:
The petition of the undersigned respectfully represents:
. '
(1) The name, address and relationship of your petitioner to the above decedent:
Name: Fay L. Bushey Fitton
Address: 48 Pine S1., DiIlsburg, PA 17019
Relationship: Daughter, and an Executrix named in Last Will & Testament dated
1/31/1976;
(2) The decedent died on June 30, 2001, a resident of Sarah Todd Memorial Home,
Carlisle Borough, Cumberland County, Pennsylvania;
(3) Said decedent died Testate, leaving a will, a copy of which is hereto attached, in
which the personal representative named therein is Kay Rahn, Virginia L. Brydon & Fay L.
Bushey ( now Fitton);
(4)
estate are:
The names, relationships and interests of all parties beneficially interested in the
a.
b.
c.
Kay Rahn, daughter, 132 Cringle Ave., Millsboro, DE 19966;
Virginia L. Brydon, daughter, 16848 Canal Rd., SE, Yelmi, WA 98597;
Fay L. Bushey Fitton, daughter, 48 Pine St., Dillsburg, PA 17019.
(5) The following person is entitled to, and claims, the family exemption of$3,500.00
by virtue of being a member of the same household as the decedent:
Name:
Relationship:
(6) Said decedent died owning property (exclusive of real estate and of wages, salary,
pension or vacation benefits) of a gross value not exceeding $35,000.00, which is itemized as
follows:
lWn
Amount
Mellon Bank, N.A. Acct. #00984271:
Mellon Bank, N.A. Acct. #224-000-4750:
Capital Blue Cross Reimbursement:
Yeagers Personal Care Home:
$5,368.06
$ 71.89
$ 318.45
$1,067.57
Total $6,825.97
(7)
(a)
following:
An itemized statement of all claims against the estate is as follows:
Claims heretofore paid by Wiley, Lenox, Colgan & Marzzacco, PC to the
Claimant
Register of Wills
Register of Wills, Agent
Nature
Filing Fees:
Inheritance Tax:
Amount
$ 58.00
$230.30
Total $
$288.30
(b) Claims remaining unpaid:
Claimant
Cocklin Funeral Home
Wiley, Lenox, Colgan
& Marzzacco, PC
Nature
funeral bill balance
Amount
$ 150.30
attorney fee
$1,500.00
Total $1,650.00
(8) The Petitioner will cause to be paid all Pennsylvania inheritance taxes due on all
property to be awarded.
(9) All parties beneficially interested in the estate other than the petitioner have (strike
inapplicable words)
a. Signed the joinder in this petition which is attached hereto.
b. Been mailed written notice of the date when this petition will be presented,
a copy of which notice is attached hereto.
WHEREFORE, your petitioner prays that the above property of the decedent be
distributed under Section 3102 of the P-E-F Code as follows:
(a) On account of the family exemption:
Name'
(b) In reimbursement of claims against the estate heretofore paid:
Name'
Wiley, Lenox, Colgan
& Marzzacco, PC
Wiley, Lenox, Colgan
& Marzzacco, PC
Filing Fees:
Inheritance Tax:
T otaI $
(c) For payment of claims against the estate remaining unpaid:
Name'
Cocklin Funeral Home:
Wiley, Lenox, Colgan & Marzzacco, PC (attorney fee):
Total $
(d) In distribution in accordance with the interests in the estate:
Name:
Kay Rahn:
Virginia L. Brydon:
Fay L. Fitton:
Amount.
Amount.
$ 58.00
$230.30
288.30
Amount.
$ 150.30
$1,500.00
1,650.30
Amount.
$
$
$
1,629.13
1,629.12
1,629.12
Total: $ 4,887.37
Plus Any Interest Earned will be equally divided
Between the 3 heirs.
,
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-
f11nsllIil1 ann m.egtam~nt
of
HELEN E. LUCAS
I, Helen E. Lucas, of.the Township of Carroll, County of
York and Commonwealth of Pennsylvania, being sound of mind, memory
and understanding, publish and declare this to be my last Will and
Testament, hereby revoking and declari~g null and void any and all
Wills and Codicils heretofore written by me.
...t-
ITEM 1. I direct that all my just debts and funeral ex-
penses be paid as soon after my decease as may be conve~ient to the
proper and complete administration of my estate.
ITEM 2. I give, devise and bequeath my entire estate re-
maining after payments of debts and expenses unto my da!lghters, Kay
Rahn, Virginia L. Brydon and Fay L. Bushey, to be divided among
them in equal shares per stirpes.
'I,...
ITEM 3. I nominate, constitute and appoint my said three
daughters, Kay Rahn, Vi~ginia L. Brydon and Fay L. Bushey, or the
survivors of them, Co-Executors of this, my last Will and Testament.
I hereby empower my said Co-Executors to sell, at either public or
,
private sale, and upon such terms as they shall consider desirable
and proper to the administration of my estate, any or all of the
assets comprising my said estate, and further empower them to make,
execute and deliver such documents as necessary to convey completely
and appropriately unto the purchasers thereof such property.
ITEM 4. I direct that neither of said Co-Executors shall
be required to post bond, other than their individual personal'surety
and. assurance, for the proper perfo~mance of their duties as such
Co':"Executors.
IN WITNESS WHEREOF, I, Helen E. Lucas,'have hereunto
Ex ~ · 10. + ~
-1-
subscribed my hand to this, my Last Will and Testament,
day of January, 1976.
}/(1~A''7 t:
~/./'~.
SIGNED, PUBLISHED and DECLARED by the above-named Helen E. Lucas as
and for her Last Will and Testament in the presence of us, who, at
her request and in .her presence and in the presence of each other,
have signed our names as attesting witnesses hereto.
residing
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P.O. Box 7899
Philadelphia, PA 19101-7899
Mellon Bank
August 10, 2001
The Wiley Group
1 South Baltimore Street
Dillsburg PA 17019
Attn: Jan M Wiley
Estate Of Helen E Lucus
Date of Death: 06/30/2001
SSN 181-10-1054
Dear Sir/Madam:
In accordance with your request, the attached infonnation sheet has been provided in the
above decedents name as of hislher date of death.
For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries,
please call (215) 553-1585.
(1j2on--
Mellon Bank, N .A.
Deposit Support Services 199-5355
Page 1 of 2
@ Mellon Bank
Friday, August 10, 2001
Account
Number Account Title
00984271
Helen E Lucus
224-000-4750
Helen E Lucus
Date Opened: 12/17/1999
Principal Sal Int from Last
as of DOD Posting to DOD
$5,330.06 $38.00
Date Opened: 11/29/2000
Principal Sal Int from Last
as of DOD Posting to DOD
$71.89 $0.00
Account Type: TO
Account Sal YTD Int to
as of DOD DOD
$5,368.06 $93.75
Account Type: DO
Account Sal YTD Int to
as of DOD DOD
$71.89 $0:00
Page 2 of 2
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coCKLIN. FUNERAL HOME, INC.
STATEMENT OF ACCOUNT
SERVICES OF: Helen E Lucas
ON: June 30, 2001
Statement Date: August 14,2001 06:36:44
Acct:753875 499714
ACCOUNT HISTORY
Posted
Description
Amount
Balance
07/30/2001 alance Forward
150.30
ACCOUNT SUMMARY
Account Unanticipated Late Payment Charge Amount Paid Amount Due
Total To Date to Date
7,252.28 7,101.98 150.30
DETACH AND RETURr\i THiS STUB 'tilTH YOUR PAYrv1Er~T.
Faye Fitton
48 Pine 8t
Dillsburg P A 17019
!'""..., MAKE NECESSARY CORRECTIONS
.' ". TO ADDRESS AND MARK BOX
Amount Due 150.30
ACCOUNT NUMBER PAYMENT DUE BY AMOUNT ENCLOSED
Credit Card Payment Information
Card Type Exp. Date
Account Number
753875 499714
SERVICES OF: Helen E Lucas
$
06/30/2001
Card Holder Signature
Make Checks Payable To: Cocklin Funeral Home, Inc.
Return To: Cocklin Funeral Home, Inc.
30 North Chestnut Street
Dillshurg, PA 17019-0424
'D,~
.%
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FEDERATED
'."IIbW:
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. AMt'il\
IF PAYMENT HAS BEEN MADE, PLEASE DISREGARD THIS STATEMENT.
WI
1111
1 __. ~'_A_':J!
THE WILEY GROUP
Attorneys at Lavv
September 10, 2001
Wiley · Lenox · Colgan · Marzzacco · P.C.
Virginia L. Brydon
16848 Canal Rd. SE
Yelmi, WA 98597
Kay Rahn
132 Cringle Rd.
Millsboro, DE 19966
In Re: Estate of Helen E. Lucas
Dear Virginia:
Enclosed please find a copy of the Petition for Settlement of Small Estate with regard to the
collection and disbursement of your mother's assets.
This letter serves as notice to you that I will be presenting and filing this Petition in the Office of
the Register of Wills, in and for Cumberland, County, Pennsylvania, One Courthouse Square,
Carlisle, Pennsylvania, on Thursday, September 20, 2001, at 12:30 p.m.
Should you have any questions or comments, please contact me. After a Judge has signed the
Order, disbursement of your mother's estate can be made.
Sincerely,
q~?v1.~~
JAN M. WILEY, ESQUIRE
JMW/sdg
encl.
cc: Fay Fitton
Jan M. Wiley · David J. Lenox · Timothy J. Colgan · Christopher J. Marzzacco · Christine J. Taylor
1 South Baltimore Street · Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 . Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
VERIFICATION
This day of , 2001, the foregoing petitioner hereby
verifies, subject to the penalties of 18 Pa.C.S. 4904 (relating to unsworn falsification to
authorities), that the facts set forth in the foregoing petition which are within his/her knowledge
are true, and as to the facts based on information received, after diligent inquiry, he/she believes
them to be true.
Petitioner
JOINDER(Helen E. Lucas Estate)
We, the undersigned, being all the parties, other than the petitioner, beneficially interested
in the estate of the foregoing decedent, do hereby certify that we have read the foregoing petition
and join the prayer thereof.
~ ~b.)
Ky- R~ -
Virginia L. Brydon
ORDER
AND NOW, TO WIT: This day of , 2001, upon consideration
of the foregoing petition and on motion of the attorney for the petitioner, it is ordered that the
property of the decedent be distributed under Section 3102 of the P-E-F code as follows:
Name
Wiley, Lenox, Colgan & Marzzacco (reimbursement):
Wiley, Lenox, Colgan & Marzzacco (attorney fee):
Cocklin Funeral Home:
Kay Rahn:
Virginia L. Brydon:
Fay L. Fitton:
Amount
$ 288.30
$ 1,500.00
$ 150.30
$ 1,629.13
$ 1,629.12
$ 1,629.12
Total: $ 6,825.97
This decree of distribution shall constitute sufficient authority to all transfer agents,
registrars and others dealing with the property of the estate to recognize the persons named herein
as entitled to receive such property without administration, and shall in all respects have the same
effect as a decree of distribution after an accounting by a personal representative.
BY THE COURT,
Judge
VERIFICATION
This day of , 2001, the foregoing petitioner hereby
verifies, subject to the penalties of 18 Pa.C.S. 4904 (relating to unsworn falsification to
authorities), that the facts set forth in the foregoing petition which are within hislher knowledge
are true, and as to the facts based on information received, after diligent inquiry, he/she believes
them to be true.
Petitioner
JOINDER(Helen E. Lucas Estate)
We, the undersigned, being all the parties, other than the petitioner, beneficially interested
in the estate of the foregoing decedent, do hereby certify that we have read the foregoing petition
and join the prayer thereof.
Kay Rahn
i~$~-(~'{ ~h
Virgi a L. Bryd n ...
ORDER
AND NOW, TO WIT: This day of ,2001, upon consideration
of the foregoing petition and on motion of the attorney for the petitioner, it is ordered that the
property of the decedent be distributed under Section 3102 of the P-E-F code as follows:
Name
Wiley, Lenox, Colgan & Marzzacco (reimbursement):
Wiley, Lenox, Colgan & Marzzacco (attorney fee):
Cocklin Funeral Home:
Kay Rahn:
Virginia L. Brydon:
Fay L. Fitton:
Amount
$ 288.30
$ 1,500.00
$ 150.30
$ 1,629.13
$ 1,629.12
$ 1,629.12
Total: $ 6,825.97
This decree of distribution shall constitute sufficient authority to all transfer agents,
registrars and others dealing with the property of the estate to recognize the persons named herein
as entitled to receive such property without administration, and shall in all respects have the same
effect as a decree of distribution after an accounting by a personal representative.
BY THE COURT,
Judge
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF cmIIlBUlD YORK
}
55:
FrlY L Bushey Fitton
being duly sworn according to law, deposes and says that she is the Feti tioner for
the settlement of Small Estate of the Estate of Helen E. Lucas
late of ~ar).isl~._ Bo~~~gb:__--,--_._ , Cumberland County, Pa., deceased and that the
within is an inventory made by Fay L. Bushey Fitton_ ., the said Petitioner
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
~ ..,:iOo I
Sworn
and subscribed before me,
48 Pine st.
Date of Death
S Oaw Notarial Seal
M . DiflS~~a:~~~~~~PUbliC
Y CommISSiOn Expires May ~ 2005
Me~ 5ennsylvaniaAssoc:iatlonot
Dillsburg, FA 17019
Address
2001
Day
Month
Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
.
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~nventory of the real and personal estate of
Helen E. Lucas
E
deceased
Mellon Bank, N.A. Acct. #000984271
Mellon Bank NA Acct. #224-000-4750:
Capital Blue Cross Reimbursement:
Yeagers Personal Care Home:
TOTAL:
/
5,368. 06
71. 89
318". 45
1,067.57
6,825. 97
)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96l
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
JAN M WILEY
POBOX 288
DILLSBURG, PA 17019
---.---. fold
ESTATE INFORMATION: SSN: 181-10-1054
FILE NUMBER: 21-2001- 0863
DECEDENT NAME: LUCAS HELEN E
DATE OF PAYMENT: 09/20/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/30/2001
NO. CD 000287
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $230.30
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$230.30
REMARKS: JAN M WILEY ESQUIRE
CHECK# 4795
SEAL
INITIALS: DO
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
I ?-?- j.;V
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-D601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP Uf-DD)
AecoraedOfHc6 of
Register ofWitfs
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-19-2001
LUCAS
06-30-2001
21 01-0863
CUMBERLAND
101
HELEN
E
JAN M WILEY 1)1 tlJY 26 All:48
1 S BALTIMORE ST
D ILL S B URG Ci.k-Ci';ft"3.~ 1,0 [~urt
Cllnberland Co. t PA
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iE-v =i6ifj-ix--AFP--ri'2-:ooi-------...--fNifiR'iTANC'E-y"X--STA-fEME-riy-oF'-"cCOUNY--.-..--------------- - -- ---
ESTATE OF LUCAS HELEN E FILE NO.21 01-0863 ACN 101 DATE 11-19-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
230.30
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-20-2001 CDOO0287 11.52 230.30
TOTAL TAX CREDIT 241.82
BALANCE OF TAX DUE 11.52CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 11.52CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ""CREDIT" (CRl,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
I?- R- /C:V
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JAN M WILEY
1 S BALTIMORE ST
DILLSBURG
PA 17019
11-05-2001
LUCAS
06-30-2001
21 01-0863
CUMBERLAND
101
*'
REV-1547 EX AFP Cl2-00>
HELEN
E
Allount Rellitted
) CHANGED
1I)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
6,825.97
.00
.00
(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-Y=is4"j-ix--iFP--li'2-:oo1--Ncffici--oF-'rtiHiifiTANcE-TAX-APPRA-iSiifENy-;-ii.'rOWAirci-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LUCAS HELEN E FILE NO. 21 01-0863 ACN 101 DATE 11-05-2001
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. 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
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (IS)
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
NOTE:
1,708.30
.00
lIl)
1I2)
1I3)
(14)
(9)
1I0)
.00 X 00 =
5,117.67 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
6,825.97
1 .708 30
5,117.67
.00
5,117.67
1I9)=
.00
230.30
.00
.00
230.30
TAX CREDITS:
PA YHTN-r RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY 03-30-2002*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 230.30
INTEREST AND PEN. .00
TOTAL DUE 230.30
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( 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.)
\
/?- R-/~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG~ PA 171Z8-0601
REV-16U7 EX AFP (12-00)
Recore,!,;:;,"
Reg!:-
of DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P 1 :440UNTY
ACN
12-31-2001
LUCAS
06-30-2001
21 01-0863
CUMBERLAND
101
HELEN
E
.02 FE8-1
JAN M WILEY
1 S BALTIMORE ST
DILLSBURG PA 170€~;~bei1d
Allount Rellitted
ri~\
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE} PA 17013
NOTE: To insure proper credit to your account} subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v:i6oj-Ex--AFP--fi2-:0(ir------...--iNitERI~fANcE-TAX--STATEMENT-o"F-Accouiif--...---------------------
ESTATE OF LUCAS HELEN E FILE NO. 21 01-0863 ACN 101 DATE 12-31-2001
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE} APPLICATION OF ALL PAYMENTS} THE CURRENT BALANCE} AND} IF APPLICABLE}
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001
P R I NCI P AL TAX DUE: ..............................................................................................................._.......................................................................................................
230.30
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-20-2001 CDOO0287 11.52 230.30
12-17-2001 REFUND .00 11.52-
TOTAL TAX CREDIT 230.30
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE} SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1}
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)}
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
E
-
'REV-15OCl EX + (6-00) REV-1500 0"'''''"'' 0=
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 OC~3
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Iucas , Helen E. 181-10-1054
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
06/30/01 04/18/1915 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
3. Remainder Return
CHECK ~ 1. O"gloo/ R",um ~2 Supplemental Return B (date of death prior to 12-13-82)
APPRO- 4. Umited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
~ate of death after 12-12-82)
PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach a copy of Trust)
BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 011. Election to tax under Sec. 9113(A)
12-31-91 and 1-1-95) (Attach Sch O)
.jji(~t$.J;!P.tiQ.N:MUiJ\ijljtNi!~I$~tKiUl:p'Qijjg..:'i::iQ.f#iPltftlAMt~JijffijMAjjQM$.H.QQm:~I'P."M_:~f.Q.~::
NAME COMPLETE MAILING ADDRESS
COR- Jan M. Wiley, Fsauire one s. Baltboore st.
RE- FIRM NAME (If Applicable) Dillsburg, PA 17019
SPON
DENT Wiley. lenox, Colaan & Marzzacco. PC
TELEPHONE NUMBER
717-432-9666
None OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 6,825.97
6. Jointly Owned Property (Schedule F)
0 Separate Billing Requested (6) None
RECA-
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) None
8. Total Gross Assets (total Lines 1-7) (8) 6,825.97
9. Funeral Expenses & Administrative Costs (Schedule H)(9) 1,708.30
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) None
11. Total Deductions (total Unes 9 & 10) (11) 1,708.30
12. Net Value of Estate (Une 8 minus Une 11) (12) 5,117.67
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 (Une 12 minus Una 13) (14) 5,117.67
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (aXl.2) X .0 (15)
-
TAX 16. Amount of Line 14 taxable at lineal rate 5,117.67 X .0 45 (16) 230.30
-
COMPU- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
TATION 18. Amount of Line 14 taxable at collateral rate 0.00 x.15 (18) 0.00
19. Tax Due (19) 230.30
20. 0 iQije.cKi~jFyQij:=;i~ijEijiQOE$tiiij'A:Refijijp':QFtifQve.a.liiivMErd'fl
........ ... ...... . ..... .................................
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....
............ ............
.............................. .
...... ...............................
o PA15001
r:',:':,))',~i!i,~aa:~$ORet(tAN$.WliiRAi$~QS$ti:ON~ttl:N::i'l'~S:lilANl)aSG.li(lECKMAtiiH@'r))~:
NTF 29755
Copyright 2000 Greatland/Nelco LP - Forms Software Only
-V-a)(. \)~-\.. \\-~ - \ ~
Estate of: Helen E. Lucas
SUMMARY OF ALIDCATIONS '10 BENEFICIARIES
Taxable at lineal rate
Fay L. Bushey Fitton
Virginia L. Brydon
Kay Rahn
21-2001-
1,705.89
1,705.89
1,705.89
5,117.67
Fstate of: Helen E. I.llcas
'!he followirg person (s) are signirg the return as representative (s) of the estate:
Fay L. Bushey Fitton
48 pine st.
Dillsburg, PA 17019
21-2001-
. PA REV-'1500 EX (6-00)
Decedent's Com lete Address:
STREET ADDRESS
Sarah Todd MeIoorial HOme
Page 2
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
PA
ZIP
17013
(1)
230.30
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E) (3)
4. If Une 2 is greater than Une 1 + Une 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B)
:~::??j:tI::::::fjj:jjj~:tttjtj:j:~:::jjj:~::j~j:j:j:::t:::::j:j~~:j~j:~:j~jjt:jj:~~:j~jjj::~jj::j:jtj:j::j:::::~:j::j::::j~:jrjj::::::::::j:::0j~j~:;::ij~i;:jj1~:~jtJIi:jjji~j::j::i:j;j~:;01ji:::0:j
::ji~:@tj:jji;jj[jf:j:jj:jj::jj:j:::j:j:j:~t:~\:::::::::::::j:~?j~j:':~:jj:j::j:::~::::::::::::::::;,:::::
0.00
230.30
0.00
230.30
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
",. ...........
... .......
.. ...... .... ....
................,.......
........................
.........................
......,.......................
..............................
..............................
..............................
.. ...................... ...
..............................
...............................
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .......................................
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . .
4. Did decedent own an Individual Retirement Account, annuity. or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
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 behef. it is true. correct and complete. Declaration ot preparer other tlian the personal representative is based on information of
which preparer has any knowledae.
SIGN URE OF P~ON REiSPONSI~ FOR FILING RETURN DATE
~ . -+'-. t
Yes No
~ I
B ~
~
...., .~ 01
Baltimore st. Dills
PA 17019
~~%~~~rJ~~:~Jl!~:~::J~::~~~::~~~~:DJ~~i:~t;~\~i;}~~:~~~:::~;;;~.;~ ~~n:~.~;.~:~::\:~~~.. th e tax;~t;.i mp oi:~~:b~;~: .~:.;:~~i:~:;:~~/;;~~:f:~l::Z:~;:.;::~::::~:::~::~::n~i::~::;;i~:;~:~:~;:~,~~~i;
:3% ....... . -... ..-
[72 P.S.. 9118 (a)(l.l)(i)].
For dates of death on or after January 1,1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Ii 91-16 (a) (l.l)(ii)].
The statute dnfll51: not 8XRmpt 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,
ora stepparent of the child is 0% [72 P.S.li9118(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.1i 9118(1.2) [72 P.S.1i 9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. Ii 9118(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.
o PA15002
NTF 29756
Copyright 2000 Greatland/Nelco LP - Forms Software Only
~~
funst lIill nnn ID-Piltnm-pnt
of
HELEN E. LUCAS
I, Helen E. Lucas, of the Township of Carroll, County of
York and Commonwealth of Pennsylvania, being sound of mind, memory
and understanding, publish and declare this to be my last Will and
Testament, hereby revoking and declaring null and void any and all
Wills and Codicils heretofore written by me.
-.\-
ITEM 1. I direct that all my just debts and funeral ex-
penses be paid as soon after my decease as may be convenient to the
proper and complete administration of my estate.
ITEM 2. I give, devise and bequeath my entire estate re-
maining after payments of debts and expenses unto my daughters, Kay
Rahn, Virginia L. Brydon and Fay L. Bushey, to be divided among
them in equal shares per stirpes.
".
ITEM 3. I nominate, constitute and appoint my said three
daughters, Kay Rahn, Virginia L. Brydon and Fay L. Bushey, or the
survivors of them, Co-Executors of this, my last Will and Testament.
I hereby empower my said Co-Executors to sell, at either public or
private sale, and upon such terms as they shall consider desirable
and proper to the administration of my estate, any or all of the
assets comprising my said estate, and further empower them to make,
execute and deliver such documents as necessary to convey completely
and appropriately unto the purchasers thereof such property.
ITEM 4. I direct that neither of said Co-Executors shall
be required to post bond, other than their individual personal surety
and assurance, for the proper performance of their duties as such
Co:"'Executors.
IN WITNESS WHEREOF, I, Helen E. Lucas,'have hereunto
-1-
.,..~I\;""",_",,,_,O_
~----~"'-"'~''''''''~-
~"<..",~~,,,.
subscribed my hand to this, my Last Will and Testament, this
day of January, 1976.
,3!/-
)1 ,h~:/~l t:
~/ _c-o~<L
SIGNED, PUBLISHED and DECLARED by the above-named Helen E. Lucas as
and for her Last Will and Testament in the presence of us, who, at
her request and in her presence and in the presence of each other,
have signed our names as attesting witnesses hereto.
/I) " /ff ,,~- /~)
'1'>":/1 j'~.:Z~/.:20
residing at ,t/ ~ I f'14.
-2-
'REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen E. lllcas
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-2001-
Include proceeds of litigation & date proceeds were received by the estate. All DrOD. 10lnUy-owned with rlaht of survlvorshlll must be disclosed on Sch. F.
ITEM VALUE AT
NO, DESCRIPTION DATE OF DEATH
1 Mellon Bank Acct. #00984271:
5,368.06
2 Mellon Bank Acct. #224-000-4750:
71.89
3 Capital Blue Cross (Refurxl):
318.45
4 Yeagers Personal Care Hare:
1,067.57
7 CPA81 NTF 10908
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)
6,825.97
fb Mellon Bank
Friday, August 10, 2001
Account
Number Account Title
00984271
Helen E Lucus
224-000-4750
Helen E Lucus
Date Opened: 12/17/1999
Principal Sal Int from Last
as of DOD Posting to DOD
$5,330.06 $38.00
Date Opened: 11/29/2000
Principal Sal Int from Last
as of DOD Posting to DOD
$71.89 $0.00
Account Type: TO
Account Sal YTD Int to
as of DOD DOD
$5,368.06 $93.75
Account Type: DO
Account Sal YTD Int to
as of DOD DOD
$71.89 $0.00
Page 2 of 2
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-''.'--'',''_'>_''''',_C'C;.'':''.'';",."";_,,,: _,._."
~EACER'S;PERSO'
717-766-7491
103 W KELLER ST.,.< ", <,
MECHANICSBURG, PA,t70S5.'
60:'8224/2313
17e)5
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'REV-15t1 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen E. Lucas
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-2001-
Debts of decedent must be reported on Schedule I,
ITEM
NO.
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1 Cocklin FUneral Home (balance due) :
150.30
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
City State
0.00
Zip
Year(s) Commission Paid:
2.
3.
Attorney Fees
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
1,500.00
0.00
4. Probate Fees 0.00
5. Accountant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
7 Register of Wills (filirg Fee for inheritance tax retmn & 25.00
inventory)
8 Register of wills (filirg fee for Small Estate Petition): 33.00
7 CPA11 NTF 10911
Copyright Forms Software Only, 1997 Nelco, Inc.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1. 708.30
cOqKLIN: FUNERAL HOME, INC.
STATEMENT OF ACCOUNT
SERVICES OF: Helen E Lucas
ON: June 30, 2001
Statement Date: August 14, 2001 06:36:44
Acct: 753875 499714
ACCOUNT HISTORY
Posted
Description
Amount
Balance
07/30/2001 alance Forward
150.30
ACCOUNT SUMMARY
Account
Total
Unanticipated Late Payment Charge
To Date
Amount Paid
to Date
Amount Due
7,252.28
7,101.98
150.30
DETACH AND RETURi'\i THiS STUB VviTH YOUR P A Vrv1ENT.
Faye Fitton
48 Pine St
Dillsburg P A 17019
l"''''''"f MAKE NECESSARY CORRECTIONS
" ". TO ADDRESS AND MARK BOX
Amount Due 150.30
ACCOUNT NUMBER PAYMENT DUE BY AMOUNT ENCLOSED
Credit Card Payment Information
Card Type Exp. Date
Account Number
753875 4997 14
SERVICES OF: Helen E Lucas
$
06/30/2001
Card Holder Signature
Make Checks Payable To: Cocklin Funeral Home, Inc.
Return To: Cocklin Funeral Home, Inc.
30 North Chestnut Street
Dillsburg, PA 17019-0424
'D/~
", 0-0
<( ,:'G>
FEDERATED
'..I~:
o~\>-
IF PAYMENT HAS BEEN MADE, PLEASE DISREGARD THIS STATEMENT.
6REV-15f3 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Helen E. Lucas
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Fay L. Bushey Fitton
48 pine st.
Dillsburg, PA 17019
2 Virginia L. Brydon
16848 Canal Rd. SE
Yew, WA 98597
3 Kay Rahn
132 cringle Ave.
Millsboro, DE 19966
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
daughter
daughter
daughter
21-2001-
AMOUNT OR
SHARE OF ESTATE
1,705.89
1,705.89
1,705.89
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
Copyright Forms Software Only, 1997 Nelco, Inc.
(If more space is needed, insert additional sheets of the same size)