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PETITION !2~ PRO~ATE and GRANT OF LETI'ERS
Estate of -L1 n 1~ o~ "T-:b () z- JS No. 21-01-994
also known as To:
Register of Wills for the /
Deceased. County of C..".., b,.../o" in the
Social Security No. Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut tlr,
in the last will of the above decedent, dated N , u t. o"T"\. h ~ -" -I- to
and codicil(s) dated . (_
I-.~k.... E. Po ~/.. ~...<e.. t!'<....c't.i!<.u.l S;/..<r/ L..<:ts2
named
, 19-X.S-
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in rr- 1> e.- 'ct...,
h last family or principal residence at J" l' J () tG DI {
~j 0-....... p J-l ~ 'I PA r7eJ ) ( _D':!d.ft.:::...4"'1
(list street, number and muncipality)
Oc~b<L.y .2-0
ZO(;) 1
,t9
year~ of age, died
at I/, ~
Except as follows, decedent did not m , was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: J.....e. 0"..\1 ~.r ,)"L ~ of'.1 ) 17 $.3 9.
$ Olfl (jLl.D. ()O
71.:1) ~ .
$
$
$ 63 ., a ,0 . 0 0
1$.3) 0'(.1,-,.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters t~ '" }o,_.......co> ~ -fq .-~
(testamentary; admi stration c.t.a.; administration d.b.n.c.t.a.)
theron.
b ~:~~~ ~~~q
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en
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF CUl1BERLAND
The petitioner(s) above-named swear(s) or affmn(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well truly administer the estate according to law.
affirmed and
29th
C'2
OQ'
::a
Q
-
s::
~
~
~o. 21-01-994
&tate of r:i h H Q ~ d J . ~ Z- ~ S , Deceased
DECREE OF PROBATE A~D GRANT OF LE'ITERS
AND NOW OCTOBER 31 )f1l200 1 ,in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated NOVEMBER 16, 1989
described therein be admitted to probate and filed of record as the last will of
ANTHONY BOZIS
and Letters TESTAMENTARY
are hereby granted to RONALD BOZIS
7?ur 9f!:/hJ:"'~) ~
eglSter of ills
FEES
Probate, Letters, Etc. ......... $
Short Certificates( ).......... $
z-pag~s .
Kenunaation ................ $
copies $ 1.00
JCP ).uu
TOTAL - $ ]g/l . gg
Filed ...... .10,;,,29.-;20.0.1. . . . . . . . . . . . . . . .
235.00
60.00
J.uu
t1jry ? ~h IlL
31:f 7 g>~
ATIORNEY (Sup. Ct. 1.0. No.)
~'j S;, ~ -H- S-}
ADDRESS
c..-):\)~ ?fl )'70/3
J~r 9-~ ~~
PHONE
aU/QcQ;~
21-01-994
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF Cn-1 t~r~"'/ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
1<. 0 h.AJJ 1) Q2.. ~ 5 ~ G fA leV"") =K. w 0.. ) +'''2-
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of An fL.. (j..... ""l 13 0 Q..: ~
€6dieH-- .?
testat-lLC.- of (one of the subscribing witnesses to) the will presented herewith and
codicil
that t..J C2- believes the signature on the will is in the handwriting of
IL---7),Q""3- .~ ~.~.~ S
to the best of _ & u ~ knowledge and belief. )
Sworn to or affirmed and subscribed before C~
me this __ 29th day of (N ~
\ OCTOBER .JfJ 2001 -:::lir 5 ~./+i ~ T. c..... J:J Ie .f'f.]
~/o/~e<jAu)p:''t;y Q~dresS)
(Namel
rl(~ s....e.WlSk\~~ kLu~~,,"j:YA
(Address)
170,3
I ?;)3q
4' nc;.p;(\c; ~FV o/p.(.,
This is to certify that the information here given is correctly copied fro~ an original certificate of death d~l~ filed with me as
Local R~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filIng.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for rhis certificate, $2.00
p
7691673
No.
21-01-994
H1Q!i_14JAev 2187
~~.;. ~nLl~.IOn
Local Regi trar
(9~d:J ~(-'O 1
,
Date
NAME OF OECEOENTjF;Sr~.dOi;~-- -..-.----.
J:
COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
iYPEJPRINT
IN
PERMANENT
BLACK INK
AGE (La5f t:k1hOay)
UNDER1DA'!/
Hour. ! MOA..
STATE FilE :~MBEA
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PlACE OF OEATHlCt>edI ~ llf'e'~ -;ee oflSlfUCloOll$OO _..-.el ":i.o.l
HOSPITAL
Inpaloent 0 ERIOucpall4lnt 0
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FACIUT'f" NAME(iI~l "'Y'IlJl<CAl !f'''I! S1f~ and nombel' I
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COUNTY OF OEATH
CrTY.
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DECEDENT'S USUAl. OCCUPATION
t~;V:o..~~~~~:f CI'ry /)F-
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DECEDENT'S MAILING ADDRESS ($INt. CltyITown,~. ZlpCooeI
1"11~ ....bOobS AT" en..... ~"N
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11 <:AM~ ).J/. L. f'.. '70"
FATHER'S NAME jFitst WoOdIe LaSl)
II. VIe. Tof< /30Z/o5
INFORMANT'S NAUE (T ypelPnnl)
. 1(ptl,...>> A. 130Z-iS
METHOD OF [)tSPOSITtOH
Bwnal ~ c,......tIOII 0 Removaf"'om Stille 0
Other ISpec4yl
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RSON ACTING AS SUCH
21e.
DATE OF ClEA)"H;Mcl"Mtl. Oa~. 'NIl
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RACE, Amenc.n lndlilA. Black. White eIc
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MARITAL STATUS' Yarned
Never Man*" W....
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17..Il!1.....__in 1.0,""",,,- 4/.Le.N
SURVIVING SPOUSE
(It'''''''e,9''''<ndoCJen~1
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To the buI of my kO(M~, dlialh occurred illlhe bme, dale ilnd piKe ~"led
(SogneIv1.ano Tlllel .')
(1..11.v.... PL!
lllR1S 24.28""* be compteted by TIME OF DEATH .- DATE PRONOuNCED DEAD IMoo .ltl. DdY. \'t!alj
..- """""""""'" <loa.. ... I.:s:> / =----_ t'" Me ~___ i.~'L i:f'M .
Enl.,the diseas... '"fUf"S Of compk:ahDMwhiCh caUSed the aealh 00~'1h8 mode 01 aVmg. such ilSCiUckiiJC or respualory .irrdsl. shock Of l\earl fadure
l." ollly 0fW CilUM on ellc.h line
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2.b. 2ft. 30.. . 30f
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To the beal 01 my knowledgll. duth OC'c;"ned ill lhe Ume, a"le. .nd place. ilnd auelu Ihe uuse(llilnd fTlilrmel.., 11.led NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
-MEDICAl. EXAMINER/COAONER {llem271TypeQf~.,.t ~r" t( ,~ ...,..,;1....,-'4<t (,1
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flue OF IN.JURY
DESCRIBE HCM"NJURY ocCURReD
INJURY AT WORK?
y.. 0 No []
p
21-01-994
LAST WILL AND TESTAMENT
OF
ANTHONY BOZIS
I, ANTHONY BOZIS, of 942 Oakhill Road, Lewisberry,
County of York, Commonwealth of Pennsylvania, being of sound
mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking and making void any and all
Wills and Codicils thereto heretofore made by me.
1. I direct that all my just debts and funeral expenses
be paid as soon after my decease as may be found convenient.
2. All the rest, residue and remainder of my estate,
real and personal, of whatsoever constituted and wheresoever situate,
I give, devise and bequeath unto my wife, HELEN E. BOZIS, provided,
however, that if my wife should fail to survive me for a period of
thirty (30) days, then, and in such event, the foregoing gift, devise,
and bequest in favor of my wife shall be and become null and void and,
in lieu' thereof, I do provide as hereinafter set forth.
3. In the event that my wife fails to survive my death
for a period of thirty (30) days, then I give, devise and bequeath all
the rest, residue and remainder of my estate, real and personal., of
whatsoever constituted and wheresoever situate unto my son, RONALD
BOZIS, per stirpes.
Page 1
-' ~
4. I hereby authorize, empower and direct my Executor
to sell and to convert into cash, any or all personalty and real
estate, without Order of Court, and without Bond, and for such
price or prices as my Executor shall deem appropriate.
5. I hereby nominate, constitute and appoint my wife,
HELEN E. BOZIS, to be the Executrix of this, my Last Will and
Testament, and do hereby empower her to service the administration
of said estate, without Bond. In the event my said wife should be
unable or unwilling to qualify and act and continue to act as
Executrix, then I hereby nominate, constitute and appoint my son,
RONALD BOZIS, to act in her stead.
IN WITNESS WHEREOF, I, ANTHONY BOZIS, have to this, my
Last Will and Testament, hereunto set my hand and seal this ~ Ib - J: (
day of
, 1989.
7l&-v. I b ~f? Y
a~~~
Anthony B . s
THIS INSTRUMENT, consisting of two (2) typewritten pages,
bearing the signature of ANTHONY BOZIS, was by him on the date hereof,
SIGNED, SEALED, PUBLISHED and DECLARED by him to be his Last Will and
Testament, in our presence, who, at his request and in his presence,
and in the presence of each other, we believing him to be of sound
and disposing mind and memory, have hereunto subscribed our names as
wi tnesse;; . J./! - .. .')
~i t\ r- \ ~ - c-~. h/
~dn:;/(V r' . , .' ~""'-. ~ddr: ss ~~ ;; 4'J., v ~
IJJ~ fA .~~ ~ C?~.
~tness:7 dress ' /7/11
(SEAL)
Page 2
I
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Bozis, Anthony J
also known as
, Deceased
No. 21 - 01 - 00994
Date of Death 10/20/2001
Social Security No. 172-01-3760
Ronald Bozis
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of
said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedenfs death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. IlIJIIe verify that the statements made in this Inventory are true
and correct. lIVVe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
I.D. No.: 39789
p~aIRepresen~~~
Signature:
Ronald Bozis
Signature:
Attorney: Galen R. Waltz
Signature:
Address:
28 S. Pitt St.
Carlisle, P A 17013
Address: 1216 Lewisberry Road
Lewisberry,PA 17339
Telephone: (717) 245-9688
Telephone:
Dated:
Jt2~I-o'
Personal Property
U.S.Savings Bond, D3107611HH
500.00
U.S.Savings Bond, M4309500HH
1,000.00
U.S.Savings Bond, M4309501HH
1,000.00
U.s.Savings Bond, M430950lHH
1,000.00
U.S.savings Bond, V882246HH
5,000.00
First Union National Bank: Checking Acct. # 1000643308100
11,240.33
Waypoint Bank: Certificate of Deposit #1600004685
1l,743.31
Postmark Credit Union: Savings Account #4116
5,825.08
Allfirst Financial Center: Passbook Savings Account # 87004600160150
1,082.18
Fulton Bank: Certificate of Deposit #121-0015798
2,050.78
First Union National Bank: Certificate of Deposit #247022062154463
2,076.49
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$207,472.28
'-
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of Bozis, Anthony J
also known as
. Deceased
No. 21 - 01 - 00994
Date of Death 1012012001
Social Security No. 172-01-3760
First Union National Bank: Certificate of Deposit #247022081634042
First Union National Bank: Certificate of Deposit #247022041634051
First Union National Bank: Certificate of Deposit #247022051634047
First Union National Bank: Certificate of Deposit #247022062154455
PNC Bank: Certificate of Deposit #21001028857
PNC Bank: Certificate of Deposit #210010288559
PNC Bank: Certificate of Deposit #21001028860
Deposit return from the Woods
30,000.00
10,000.00
10,000.00
2,076.49
14,269.82
18,472.89
14,209.91
2,025.00
Total Personal Property
$143,572.28
2
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALTZ GALEN R ESQ
3857 ELDER RD
HARRISBURG, PA 17111
ACN
ASSESSMENT
CONTROL
NUMBER
______h fold
101
ESTATE INFORMATION: SSN: 172-01-3760
FILE NUMBER: 21-2001- 0994
DECEDENT NAME: BOZIS ANTHONY
DATE OF PAYMENT: 12/21/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/20/2001
TOTAL AMOUNT PAID:
REMARKS: RONALD BOZIS
CHECK# 95
INITIALS: DO
SEAL
RECEIVED BY:
REV-1162 EX(11-96)
NO. CD 000674
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
AMOUNT
$8,638.31
$8,638.31
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
tll'llH ~d
/lJ/ z.. 0) 0)
~ 0Cl \ - <0 ~ q q J.
-rs I\) -Z,..,'I S
Date of Death:
Will No.
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of ~ O~hans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on /t!.Qy, ~} :
Name
Address
K ~ YHA. (J g. to L.: S
/Z(~ Lewt)S0-:;J et'~ Le.w-;~~d fA J?3>3a,9
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
1-1( /01-
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l!'"l
Name ~.Ir~
Address ~3' S f, J-}. S-J,
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYL VANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALTZ GALEN R ESQ
,28 SOUTH PITT STREET
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 172-01-3760
FILE NUMBER: 2101-0994
DECEDENT NAME: BOZIS ANTHONY
DATE OF PAYMENT: 02/06/2002
POSTMARK DATE: 00/00/0000
COUNTY; CUMBERLAND
DATE OF DEATH: 10/20/2001
NO. CD 000831
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $161.96
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: GLEN R WALTZ ESQUIRE
CHECK# 98
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$161.96
MARY C. LEWIS
REGISTER OF WILLS
;Ll- O\-'i'i4-
FAMILY SETTLEMENT AND FINAL RELEASE
ESTATE OF ANTHONY J. BOZIS
KNOW ALL MEN BY THESE PRESENTS, that Anthony J. Bozis, late of Lower
Allen Township, Cumberland County, Pennsylvania, deceased, died testate on October
20, 2001, having first made his Last Will and Testament, which was duly executed on
November 16, 1989 and probated in the Office of the Register of Wills of Cumberland
County, on October 31,2001.
WHEREAS, the said Anthony J. Bozis, by the aforesaid Last Will and Testament,
named Helen E. Bozis, his wife, as Executrix of said Last Will and Testament; however,
Helen E. Bozis predeceased testator on May 24, 1990; Ronald Bozis, testator's son,
was named Alternate Executor;
WHEREAS, Letters Testamentary on the Estate of the said decedent were duly
issued by the Register of Wills of Cumberland County, Pennsylvania, to the said
Alternate Executor, hereinafter called personal representative;
WHEREAS, the personal representative has gathered the assets of the Estate of
the said decedent and the assets consist of personal and real property with the total
value of $205,664.77 as set forth in Exhibit "A", which is a copy of the Pennsylvania
Inheritance Tax Return filed and approved by said personal representative, and which is
attached hereto and made a part hereof, and marked Exhibit "A";
WHEREAS, the debts and deductions, including the payment of inheritance tax
in the said Estate, which have now been paid, leave a balance for distribution of
$196,409.85;
WHEREAS, the balance for distribution has been reduced to cash and has been
distributed as herein indicated in accordance with the terms of the Last Will and
Testament of the said Decedent;
NOW, THEREFORE, Ronald Bozis being all of the heirs under the Last Will and
Testament of the said decedent, and being those persons entitled to inherit under said
Last Will and Testament, does hereby acknowledge that I have this day received from
the aforesaid personal representative, in full satisfaction and payment of all sums of
money, legacies, bequests, and devises as are given, devised and bequeathed to me
by the said Last Will and Testament, the amounts due me under said Last Will and
Testament, which amounts I have received this day or prior to this day; and, I do hereby
stipulate that in order to avoid the expense and time involved in the filing of a formal
account and schedule of distribution, I agree that no account is necessary and I do
hereby agree that I consent to distribution being made without the filing of an account
and schedule of distribution, the same to be with the same force and effect as if they
had been filed and confirmed by the Orphan's Court Division of the Court of Common
Pleas of Cumberland County, Pennsylvania.
THEREFORE, I do hereby remise, release, quitclaim and forever discharge the
said personal representative, Ronald Bozis, his heirs, executors, administrators and
assigns, of and from the said estate and from all actions, suits, payments, accounts,
reckonings, claims, and demands whatsoever for or by reason thereof, or for any other
use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent,
and I do further hereby covenant and agree that should any liability come due to the
estate of the said decedent after the signing of this Agreement, I do hereby covenant
and agree with the aforesaid personal representative, that I will contribute my share of
the Estate to satisfy any and all claims, demands, suits or causes of action which may
be successfully prosecuted against the said Estate or the aforesaid personal
representative after the signing, sealing and delivery of this Family Settlement
Agreement and Final Release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and
year noted below.
2-9-0z.
Date
~
:)~ h.fqu
Wl1'Y<t4t)
Date
Witness
/1-/7-g
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BU'~~ OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
.,llEPT. Z8D6Dl
HARRISBURG. PA 171Z8-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
Recc'(
Re'
.02 FEB 13 f\~D :49
GALEN R WALTl
TURO LAW OFFICES
28 S PITT ST
CARLISLE
C;S:I~,
PA l(jlm~)'::'
02-04-2002
BOllS
10-20-2001
21 01-0994
CUMBERLAND
101
Allount Relli tted
C/'*
REY-15~7 EX AFP IIZ-aal
ANTHONY
J
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=is4-j-ix-AFP-fi'2-:ooY-Norici--oF-YNHiifiTANci-rAX-AppRA-isiHENy-,--AL1-owANci-oR'------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOllS ANTHONY J FILE NO. 21 01-0994 ACN 101 DATE 02-04-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
63.900.00
8.500.00
.00
.00
135.072.28
971 .44
7.198.16
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 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:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
12 21-2001
NOTE:
RECEIPT
NUMBER
CD000674
DISCOUNT (+)
INTEREST/PEN PAID (-)
454.65
(9)
(l0)
9.875.05
102.06
(llJ
(l2)
(l3)
(4)
.00 X
205.664.77 X
.00 X
.00 X
AMOUNT PAID
8.638.31
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
PAYMENT MUST BE MADE BY 07-20-2002~.
(8)
00 =
045 =
12 =
15 =
(9)=
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
215.641.88
9.977 11
205.664.77
.00
205.664.77
.00
9.254.92
.00
.00
9.254.92
9.092.96
161. 96
.00
161.96
. 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.)
REV-1470 EX <';-'1> '*
" INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
ANTHONY J BOZIS 2101-0994
REVIEWED BY ACN
John Kealy 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
G 1 Annuities are fully taxable with no exclusion.
ROW
Page 1
/~-/?- 9
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1U7 EX iFP 101-021
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-11-2002
BOllS
10-20-2001
21 01-0994
CUMBERLAND
101
ANTHONY
J
he;'_
GALEN R WALTZ
TURO LAW OFFICES
28 S PITT ST
CARLISLE
'02 MAR 18 I) 2 :1 6
Allount Rellitted
C:'E,
PA 17Ol1i1tlbs,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE3 PA 17013
NOTE: To insure proper credit to your account3 subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6Cfj-E3f-AFP-foY=02Y------...--fNifiiiYANC'E--YAX-STA-fEM'E-NY-OF'-AC-coUiff--.-..------------------ ---
ESTATE OF BOllS ANTHONY J FILE NO. 21 01-0994 ACN 101 DATE 03-11-2002
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE N~ED ESTATE. SHOWN BELOW
IS A SU""ARY OF THE PRINCIPAL TAX DUE3 APPLICATION OF ALL PAY"ENTS3 THE CURRENT BALANCE3 AND. IF APPLICABLE3
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-04-2002
P R I NC I PAL TAX DUE: ......................._.........._........................._._......._......_.........._................................................_........................................-...............................
93254.92
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-21-2001 CDOO0674 454.65 83638.31
02-06-2002 CDOO0831 .00 161. 96
TOTAL TAX CREDIT 93254.92
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
II IF PAID AFTER THIS DATE3 SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $13
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)3
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
STATUS REPORT UNDER RULE 6.12
Name of Decedent: A NT HOd, .:J. D~..z.. 5
Date of Death: /6 /-::> f) /0 I
Will No. ...;?e 0 J - D 0 99'-1 Admin. No.
~
lr)~
\
a--
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned
estate:
1. State whether administration of the estate is complete:
Yes V- No ~
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: lEiI.i ..Ie': 7' _ ~.~~
3. If the answer to No. 1 is Yes, state the following:
Did the personal representative file a final account with the Court?
No
a.
Yes
b.
account is:
The separate Orphans' Court No. (if any) for the personal representative's
c. Did the personal representative state an account informally to the
parties in interest~
Yes ~ No
d. Copies of receipts, releases, joinders
informal acounts may be filed with the Clerk of the
attached to this report.
Date:
t?~ & -3
JSp ~ /..-;-
(
and approvals of formal or
Orphans' Court and may be
-s~~
ah~ 1(. ~//L-
Name (Please type or print)
~? S, f7, 'H S 1-. C~,...I:~ J..... e A -
,
Address
(717) ~ t.(5- 96 f{2
Telephone No.
Capacity: _Personal Representative
......-e-ounsel for Personal
Representative
-,
--,../
'---.
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
.
Date: 9/09/2003
BOZIS RONALD
1216 LEWISBERRY ROAD
LEWISBERRY, PA 17339
RE: Estate of BOZIS ANTHONY
File Number: 2001-00994
Dear Sir/Madam:
It has come to my attention that you hav.
Report by Personal Representative (Rule 6.1
estate.
not filed the Status
in the above captioned
As per the AMENDMENTS TO SUPREME C RT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, or decedents dying on or after
July 1, 1992, the personal representa ive or his counsel, within two
(2) years of the decedent's death, s all file with the Register of
Wills a Status Report of completed r uncompleted administration.
This filing will become deli quent on: 10/20/2003
Your prompt attention to t~s matter will be appreciated.
/
Thank You.
Sincerely,
L/
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:J File
Counsel
Judge
REV-1fJOOEX+lI-OOJ
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAc USE ONLY
/ /7. Y
FILE NUMBER
21 01
COUN1Y CODE YEAR
SOCIAL SECURITY NUMBER
COMMONWEALTH OF P~VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
00994
NUMBER
....
Z
W
o
W
o
W
o
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INmAL)
Bozis, Anthony J
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
172-01-3760
10/20/2001
07/16/1913
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
VF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE IN mAL)
1. Original Return
2. Supplemental Return
3. Remainder Return (date of death priorm 12-13-82)
o 4. Limited Estate
181
o
th....
l:!ffi
0::0
OZ
o~
o 4a. Future Interest Compromise (date of death
after 12-12-82)
o 7. Decedent Maintained a Living Trust (AlIach
copy of Trust)
o 10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTW.. TAX INFORMATION mtOULD BE DIRECTED TO:
AME COMPLETE MAILING ADDRESS
Galen R. Waltz
o 5. Federal Estate Tax Return Required
1
6. Decedent Died Testate (AlIach copy
of Wil~
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
o 11.Eleclion to tax under Sec. 9113(A) (AlIach Sch 0)
IRM NAME (~ applicable)
Turo Law Offices
28 S. Pitt St.
Carlisle, P A 17013
ELEPHONE NUMBER
717/245-9688
'OQ
1 . Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
63,900.0cg
8,500.00~:
(1 )
(2)
(3)
Cl
CJ
N
None
Z
o
5
::I
....
ii:
<
o
W
0::
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
9,977.11
202,065.69
(4) None
(5) 135,072.28::-1
<
(6) 971.44
(7) 3,599.08
(9) 9,875.05
(10) 102.06
-0
l.,j
\0
(8)
212,042.80
(11 )
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/Sec 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)
(13)
(14)
202,065.69
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
ts 16. Amount of Line 14 taxable at lineal rate 202,065.69 x .045 (16)
j::
<
....
::I
lL 17. Amount of Line 14 taxable at sibling rate x .12 (17)
:liE
0
0
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
....
19. Tax Due (19)
9,092.96
9,092.96
20. 0
CHECK HERE IF YOU ARE REQIJE'STING A REFUND OF AN OVERPAYMENT
>> lIE" TO ANSWER ALL QUI!IS1IONaON REVERSE _AND RECHECK MATH cc
Copyright 20M fOhn software only The Lackner Group, Inc.
Fonn REV-1600 EX (Rev. 6-40)
Decedent's Complete Address:
STREET ADDRESS
824 Lisburn Road
CITY
Camp Hill
STATE PA
-r.--~--_-m__-
IZIP ]70]]
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal POIIerty Credit
B. Prior Payments
C. Discount
(1)
9,092.96
454.65
Total Credits (A + B + C)
(2) 454.65
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3) _~_______
(4)
0.00
(5) 8,638.31
(SA)
(5B) 8,638.31
Make Check Payable to: REGISTER OF WILLS, AGENT
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;..................................................................................... n 15<1
~: ~:::~ ~h~:=:,=;ii~t':e:~~.~.~.~~~.~~.~~.~r~~.~~~~~.~~.:.~~..i.~.~~~::::::::::::::::::::::::::::::::::::::::: ~ ~
d. receive the promise for life of either payments, benefits or care?.................................................................. t:I ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................... ...................................................................................... D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... ~ D
4. Did decedent own an IndMdual 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 peljury, I declere 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.
!l!",laration of preparer other than the personal represe"!ative is based on all information of which preparer h~ any knowledge. _..___~_...
SIGNA PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
IlING RETURN
1216 Lewisber:ry Road
~wisberry, P A 17332.
,j ().2/0 I
ADDRESS
DATE
'"""ru", c:;1~'""'" ""'~ TAM
ADDRESS
DATE
28 S. Pitt St.
Carlisle, P A ] 70 13
~';I..~J
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (il]'
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. 99116 (a) (1.1) (ii)]. The statute does not exemDt 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 cteceased child twenty-one years of age or younger at death to or for the use of a natUtal
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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. ~,,~
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the 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.
.
I
i
I
.... J..
SCHEDULE A
REAL ESTATE
COMMONIIIEALTHOF PEIfilYLVANA
ItHORlTANCE TAX RETlRN
RESIDENT DECEDENT
_~____m.____._ .
ESTATE OF .
BOZIS, Anthony J
I FILE NUMBER
I 2~- 01 - 009~4
All real properw 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 survivorship must be disclosed on
schedule F.
ITEM
NUMBER
1
VALUE AT DATE
OF DEATH
_.~_._-----_._."-~-~- _._._--~-~._- -~~'-_.'-',._----
63,900.00
DESCRIPTION
A Lot known as Oakhill Road, York County, Lewisberry, P A
Account # 270613712, Map # 270000-QE0069COOOOOO
TOTAL (Also enter on Line 1, Recapitulation)
63,900.00
I
-~-J
1N-alITANCE TAX RET1.IlN
RESIDENT DECEDENT
- - ..~...._,. - - ------- -
I
I
SCHEDULE B I
STOCKS & BON.DS _ 1 _ .... _ .
.-~._.,~.~---.
i FILE NUMBER
.___--.L. 21 - 01 - 00994
ESTATE OF
Bozis, Anthony J
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I,
NUMBER
1 I D.S.Savings Bond, D3107611HH
I
I
2 I D.S.Savings Bond, M4309500HH
I
3 I D.S.Savings Bond, M430950lHH
.---r--~--j._.VALUE AT DATE
....- ...t. _UNIT VAL"=-I OF D~:~OO
I 1,000.00
I
I
I
I
I
DESCRIPTION
1,000.00
4 D.S.Savings Bond, M4309501HH
1,000.00
5
D.S.Savings Bond, V882246HH
5,000.00
.1- _
.-+-
I
8,500.00
TOTAL (Also enter on line 2, Recapitulation)
I
I
--~
*' I
COMMOI'MIEALTHOFPE!>HlVlVMlA I
IN-ERITANCE TAX RETl.RN J
RESIDENT DECEDENT
- -, ._._---_._-~---~-_._--,.
~-,--.__.-
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
I FiLE NUMBER ---
~__~~1-00994
ESTATE OF .
BOZls, Anthony J
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
I
DESCRIPTION
VALUE AT DATE
OF DEATH
.._-~-_._.,-----_.. ._--~"-_._--_.~ ----
11,240.33
First Union National Bank: Checking Acct. # 1000643308100
2
Waypoint Bank: Certificate of Deposit #1600004685
II,743.31
3
Postmark Credit Union: Savings Account #4116
5,825.08
4
Allfrrst Financial Center: Passbook Savings Account # 87004600160150
1,082.18
5
Fulton Bank: Certificate of Deposit # 121-00 15798
2,050.78
6
First Union National Bank: Certificate of Deposit #247022062154463
2,076.49
7
First Union National Bank: Certificate of Deposit #247022081634042
30,000.00
8
First Union National Bank: Certificate of Deposit #247022041634051
10,000.00
9
First Union National Bank: Certificate of Deposit #247022051634047
10,000.00
10
First Union National Bank: Certificate of Deposit #247022062154455
2,076.49
II
PNC Bank: Certificate of Deposit #21001028857
14,269.82
12
PNC Bank: Certificate of Deposit #210010288559
18,472.89
13
PN C Bank: Certificate of Deposit #2100 I 028 860
14,209.91
14
Deposit return from the Woods
2,025.00
TOTAL (Also enter on Line 5, Recapitulation)
135,072.28
. I
COMMONWEALTH OF PENNSYLVANIA 1
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-~--~_.._-----~--_.- -- ---- - -- - --
I
!
_J
.-- -----~--.---
SCHEDULE F
JOINTLY-OWNED PROPERTY
'I FILE NUMBER
__ 21 - 01 - 0~94
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
ESTATE OF
Bozis, Anthony J
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Marlin J. Bozis
B Ronald A. Bozis
3158 Sycamore Street
Harrisburg, Pa. 17111
1216 Lewisberry Road
Lewisberry, PA 17339
Son
Son
JOINTLY OWNED PROPERTY:
ITEM LETTER
NUMBER FOR JOINT
TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY-r---- . ~~~--- DATE OF DEATH
Include name of financial institution and bank account number or I DATE OF DEATH I DECD'S VALUE OF
similar identifying number_ Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
I
- -..... '-1 - -- 1,301.711
I 641.16
50%
650.86
--------
1
08/23/1990 Certificate of Deposit #247022055830575
2
08/23/1990 Certificate of Deposit
#247022066233178
50%
320.58
TOTAL (Also enter on line 6, Recapitulation)
971.44
.'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETIJRN
RESIDENT DECEDENT
L
SCHEDULE G
INTER-VIVOS TRANSFERS & I
MISC. NON-PROBATE PROPE~T~J_~____~~____
I FILE NUMBER
!
21 - 01 - 00994
ESTATE OF
Bozis, Anthony J
ITEM
NUMBER
Thi~ s~lledule must be cOI!!~leted and filed if the answer ~J!~f questions 1 throu, 4 on page 2 is ~es.
I DESCRIPTION OF PROPERTY I DATE OF DEATH % OF !
I Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECD'S I EXCLUSION I. TAXABLE VALUE
Attach a copy of the deed for real estate. ! INTEREST I (IF APPLICABLE)
---.-j- ---_.~-- ... ~---
Annuity Contract # 685090, Lincoln Financial Group, Lincoln I 7,198.16 50% : 3,599.08
Life i
I
,
.._--_.~._-----
!
!
I
I
I
I
I
m~
i
I
I
~
i
I
!
I
L
TOTAL (Also enter on line 7, Recapitulation) I
3,599.08
'W
SCI-EI:U..E H
FlJERALEXPENSES&
Al:WNSTRATlVECOSTS
L
COMMONWEALTH OF PENllSYL VANA
II+ERlTANCE TAX RETLfiN
RESIDENT DECEDENT
--------------.-'-
I FILE NUMBER ..
_2L - 01 - 00994
ESTATE OF
Bozis, Anthony J
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Neill Funeral Home
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
C~ S~e
Year(s) Commission paid
Attorney's Fees Turo Law Offices -- Galen R. Waltz
Zip
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
C~
Relationship of Claimant to Decedent
Probate Fees Letters testamentary
Short certificates (20)
Pages, J&P,copies
5. Accountant's Fees
State
Zip
4.
6. Tax Retum Preparer's Fees
7.
I
2
3
Other Administrative Costs
The Sentinel, legal advertisement
Cumberland law Journal
Family Settlement Agreement and Release
~,.,~-- -~"----'--'----~-,,-
TOTAL (Also enter on line 9, Recapitulation)
7,886.94
1,500.00
235.00
60.00
9.00
84.11
75.00
25.00
9,875.05
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONIVEAL TH OF F'ENlSYLVA!>IA
I~ITANCE TAX RET1.RN
RESIDENT DECEDENT
~-_._.__.-
~::- ..
FILE NUMBER
21 - 01 - 00994
ESTATE OF .
BOZIS, Anthony J
Include un reimbursed medical expenses.
DESCRIPTION AMOUNT
26.07
ITEM
NUMBER
~~-~---I------~~-
1 Verizon
2
Brockie-Paramatech medical supplies
TOTAL (Also enter on Line 10, Recapitulation)
75.99
102.06
'w
COMMO. ..N. WEAL 1H OF PENNSYLv:JNIA
INHERITANCE TAX RETIJRN
RESIDENT DECEDENT
_........ -..,..., --..- ~'-
-------- - ---~--
I
I
SCHEDULE J
BENEFICIARIES
ESTATE OF
I FILE NUMBER
21 - 01 - 00994
_.~-~---
RELATIONSHIP TO
DECEDENT
...---Do..Nol List TnJlll8A(ll1
Bozis, Anthony J
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
AMOUNT OR SHARE
OF ESTATE
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Ronald A. Bozis
1216 Lewisberry Road
Lewisberry, P A, 17339
Son
iEntire estate
2
I
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
_.~_~~~L OF PART II-ENTER.~OTAL NON-TAXA~LE DISTRIBUTIONS O~UNE 13 OF REV-15OO COVER SHEETI
-~-._~_._--
r
__.....~....._...'-i.o_ ---- ....
-
LAST WILL AND TESTAMENT
OF
ANTHONY BOZIS
I, ANTHONY BOZIS, of 942 Oakhill Road, Lewisberry,
County of York, Commonwealth of Pennsylvania, being of sound
mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking and making void any and all
Wills and Codicils thereto heretofore made by me.
1. I direct that all my just debts and funeral expenses
be paid as soon after my decease as may be found convenient.
2. All the rest, residue and remainder of my estate,
real and personal, of whatsoever constituted and wheresoever situate,
I give, devise and bequeath unto my wife, HELEN E. BOZIS, provided,
however, that if my wife should fail to survive me for a period of
thirty (30) days, then, and in such event, the foregoing gift, devise,
and bequest in favor of my wife shall be and become null and void and,
in lieu - thereof, I do provide as hereinafter set forth.
3. In the event that my wife fails to survive my death
for a period of thirty (30) days, then I give, devise and bequeath all
the rest, residue and remainder of my estate, real and personaL, of
whatsoever constituted and wheresoever situate unto my son, RONALD
BOZIS, per stirpes.
Page I
4. I hereby authorize, empower and direct my Executor
to sell and to convert into cash, any or all personalty and real
estate, without Order of Court, and without Bond, and for such
price or prices as my Executor shall deem appropriate.
5. I hereby nominate, constitute and appoint my wife,
HELEN E. BOZIS, to be the Executrix of this, my Last Will and
Testament, and do hereby empower her to service the administration
of said estate, without Bond. In the event my said wife should be
unable or unwilling to qualify and act and continue to act as
Executrix, then I hereby nominate, constitute and appoint my son,
RONALD BOZIS, to act in her stead.
IN WITNESS WHEREOF, I, ANTHONY BOZIS, have to this, my
Last Will and Testament, hereunto set my hand and seal this 11cv-./b - t '(
day of
, 1989.
~.J6~f-~
I'?~ f3A->~
Anthony B~S' ~-~C:i
THIS INSTRUMENT, consisting of two (2) typewritten pages,
bearing the signature of ANTHONY BOZIS, was by him on the date hereof,
SIGNED, SEALED, PUBLISHED and DECLARED by him to be his Last Will and
Testament, in our presence, who, at his request and in his presence,
and in the presence of each other, we believing him to be of sound
and disposing mind and memory, have hereunto subscribed our names as
witnes~e . J.' ~ ,~
. .----::> /, r-- ,I il - . / \..../
~'-J-: "fl(tA v. I' IA..J,lk~ --u4 t~" V~ .
Wi tness d :iddI: SS -c7
~ fA MMA~ ~ C?~r
~tness 7 (f dress d-' I '7/11
(SEAL)
Page 2
0t~._~'~vVl lJ:JO 711 764 568~
fer ~~IGSV~LL3,PA.
#4868 ? 002/002
July 02., 20001
TAX NonCE
TAXJ:'~-W.n.L Iij! 5ENT-..J:O.~--IAX .fLAIM..BUREAU 12/31101
THEse TAXES ARE oue ANO PAVAa~..:..{. ._D'.~C:O~~. j ___~:..._~.~i:NAL ~ ~..-l ACCOUNT #
CH REAL IS 11. ZOOOI 701. 31' 71S. 681 787. ~5 OAK HILL HI)
~I _'" .1..';"- -.'"""tJ' _... . ......1 MAP (I %10000 llEOO'.COOOOOO
W..L-2.1J...'._._ .7.1.5_.$a~. '7.8.7..Ui As Slit 63, SO 0
Pay Above Amount Due en L Due 2b e Afterl
--.----...--9101l.JCn' 2. lllL Moke Chocks poyoblo To.
__."....~_- --- ------.-.., PATRICIA A CQRDON
! 4ge SPRUCE ROAD
~1~41 "lrO NEW CUMBERLAND FA 17070
aOZI S ANTHONY .:I IS< ... Q
ATTN RONALD BOZIS 71'S.&' (7 J. 7) 939-0459
L ._. _. t~QM~mBERRY ~::~~A. _173.39~-16"(J ~~l!:I~gil:~~g~e~i:D: ::-lPM
CLOSED 7/2/01-7/11/01, 11Z6-a7
111 2:3 10 1. U 11 7 /01 TO 2/2 10 Z
WEST SHORE SCHOOL DISTRICT
FAIRVIEW TOWNSHIP
REAL ESTATE TAX
I~"....I
ZOOl-200Z I. 012772.!
. . . . . .
. ,..--.--..-.-.-
Z70613112
TAX PAven
,JulV 01. 2000
TAX NOTICE
UI\FAIDIeX~ ~I 13E
THEse jAAeS.F\E O\JE AND ~"YA8LE
. lQUO
2000-2001 I: *011;7;:1
** '* .. .. ..
.......---.-.-
SENT TO THE TAX CLAIM BUREAU 12/31/00
ACCOUNT 4*
OAK HILL. RO
. .
WEST SHORe SCHOOL DISTRICT
rAIRVIEW TOWNSHIP
REAL ESTATE TAX
I
I
I
b A..v.
r"
I BOllS ANTHONY ~
ATTN RONALD BOZIS
I 1216 LEWISBSRRY ROAD
L___.~:~SBERRV PA
DISCOUNT NET ,PENAL TV
.032 ':-4'S~'-"6~:"3ii' I"' . "'70'7."
270613712
MAP * 270000 GE0069COOOOOO
632.49 645.39 709.93 A'$mt
...-.."'lfi----- .- --"11-"'" "... "'.'A"P"t:.r'
_"~_-=!--l(Jt.~QQ.::~~~.!?~(~g ~~~~ Ig~~c ~ s Gs~~a~l P. To:
495 SPRUCE ROAD
NEW CUMBERLAND PA 17070
(717) 938-0~59
MONDAY. WEDNESDAV. THURSDAY
FRXDAY 9:00AM-1:00PM THURSDAV
EVENINg 5~OOPM-7:00PM OTHER
HOURS BY APPT. CLOSED TUESDAV,
HO~IDAVS ~ ELECTI~ DAV
CLOSED ~ULY 1-11, OV 24, ~OOO
DEe is, 2000 TO ~A 3, 200~
b3.900
PAID
TAX PAYER
~U"" 0 ! .....f':
1 733~~ . 1./iV
L.
A("',,~.....'-
Turo Law Offices
RON TURO, Esquire
ROBERT J. MULDERIG, Esquire
GALEN R. WALTZ, Esquire
JAMES M. ROBINSON, Esquire
CAROL L. CINGRANELLI, Esquire
GERARD J. FOULKE, Esquire
www.TuroLaw.com
28 South Pitt Street
Carlisle, Pennsylvania 17013
(717) 245-9688
(800) 562-9778
Fax (717) 245-2165
December 19, 2001
10i~ts'r
Pennsylvania Inheritance Tax Dept.
Commonwealth of Pennsylvania
Department of Revenue
Dept. 280601
Harrisburg, PA 17128-0601
Re: Estate of Anthony J. Bozis I Safe Deposit Box Inventory
No. 21-01-00994
Dear Inheritance Tax Representative:
Attached is a copy of the Safe Deposit Inventory that was performed on or about
November 21, 2001. The inventory reflects at items 4 and 5, $500 Certificates of
Deposit. These items are not Certificates of Deposit, but receipts indicating interest for
renewal. No Certificate of Deposit numbers were identified nor can any be located.
As proof of this assertion, I have enclosed First Union's response to this law
office's inquiry for all accounts held by the decedent as well as the date of death
balances. Therefore, even if a $500 Fulton Certificate of Deposit existed, a record of it
would have been maintained by Fulton Bank.
In addition, Hamilton Bank was purchased First Union National Bank several
years ago and, likewise, any CD's that would have existed would have been identified in
First Union's disclosure to this law office's inquiry. Also enclosed is a copy of the two-
page response to this law office's inquiry to First Union National Bank.
Please examine the attached Fulton Bank and First Union Bank disclosures
which evidence nonexistence of the alleged Certificates of Deposit.
GRW /jge
Enclosures
~Y;r1!P
GALEN R. WALTZ, ESQUIRE
GWaltz@TuroLaw.com
Page _n_Bu____ of n_ u_
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cosh: Report total only.
(2) Stocks: list in detail every common or preferred certificate, warrant or other rights found in box. Stocks are
to be designated by name of company, certificate number, dote of certificate, name in which stock is registered,
and number of shores and closs of stock.
(3) Obligations of U. S. Government: Number of items, dote of issue, face value, names in which registered
and type of ownership, Le., jointly held, payable on death, etc.
(4) Bonds: Designate by nome, amount, serial number, or other designation. (Bearer Bonds)
(5) Bonk and Savings and Loon Pallbooks: State name of depositor, number of book, last date appearing in
book, name of bank and branch, and balance.
(6) Jewelrv, Coins, Stomps, Manuscripts, etc: list and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidence. of Indebtedne..: List and describe as
fully as possible.
18) All other contents.
ITEM DESCRIPTION
.~ .;JJ
PRINT NAME AND CHECK OPRIATE BOX BELOW,
'l<OY'lQ l~ A .1"Bo I~
IhdN4fl!/I-- CHECK APPROPRIATE BOX,
" I. f) li!Execulor{t,ixl o Administratorflrixj
(ljJCI{jjj}/b cOfii)' OEstote Representative 0 Join' Owner 01 sole deposit box
NOTE: Attach additional 8112" x 11" ~heet (s) If necessary or use duplicates of this page of form.
F~N'
Reference ID: 213723
First Union National Bank
Attn: Account Verifications
POBox 40028
Roanoke VA 24022-7313
November 21,2001
TURO LAW OFFICES
28 SOUTH PITT STREET
CARLISLE, PA 17013
SUBJECT: Verification / Confirmation of Account and Balance Information provided for:
ANTHONY J BOZIS (SSN# 172-01-3760)
Date of Death: October 20, 2001
Deoosit Account Information
Account Account Date of Death Average Date Maturity Interest Accrued YTD Date
Type Number Balance Balance* Opened Date Rate Interest Interest Paid Closed
CERTIFICA TE OF DEPOSIT 247022062154463 $2,076.49 9/10/1981 9/10/1981 $7.54 $125.73
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A. BOZIS - POA
CERTIFICATE OF DEPOSIT
247022066233178
$641.16
1l/11/1997 11/11/2003
$25.70
$0.00
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A. BOZIS - POA
CERTIFICATE OF DEPOSIT
247022081634042
$30,000.00
9/17/2001 9/15/2005
$148.76
$0.00
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A. BOZIS - POA
CERTIFICATE OF DEPOSIT
247022041634051
$10,000.00
9117/200 I 3/15/2002
$30.96
$0.00
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A . BOZIS - POA
CERTIFICA TE OF DEPOSIT
247022051634047
$10,000.00
9/17/200 I 8/1512003
$39.81
$0.00
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A . BOZIS - POA
CERTIFICATE OF DEPOSIT
247022055830575
$1,301.71
8/23/1990 8/23/2002
$7.17
$51. 86
LEGAL TITLE: ANTHONY J. BOZIS
MARLIN J. BOZIS
RONALD A. BOZIS - POA
ACCOUNT JOINT SINCE OPENING
CERTIFICA TE OF DEPOSIT
247022062154455
$2,076.49
9/10/1981 9/10/2002
$7.54
$125.76
LEGAL TITLE: ANTHONY J. BOZIS
RONALD A. BOZIS - POA
001032
F~N'
Reference ID: 213723
CHECKING
1000643308100
$11,240.33
1/16/1973
LEGAL TITLE: ANTHONY J. BOZlS
RONALD A. BOZlS - POA
THIS IS A NON-INTEREST BEARING ACCOUNT.
* Due to system limitations, we can only provide a twelve month average balance on depository accounts.
Other Account Information
Account
Type
Account
Number
Date of Death
Balance
Date
Opened
Date
Closed
Title(s)
ANNUITY
LNCHB685090
5/19/1993
ANTHONY J. BOZlS
PLEASE CALL LINCOLN NATIONAL AT 1-800-248-6301 EXT. 387
SAFE DEPOSIT BOX
07585398B0054
5/24/1996
ANTHONY J. BOZIS
RONALD A. BOZIS - POA
LOCA TlON:
FUNB
5201 SIMPSON FERRY RD.
MECHANICSBURG, PA 17050
717 -795-8731
* Date of death balance does not include accrued interest.
* If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during that time period.
r{}~Jv J~
Signature of Depository Representative
November 21, 2001
Date
Brenda Allen
Depository Representative
Servicenter Associate
Title
(540)563-7323
Phone Number
sss;
001032
FUlton Bank
CAPITAL DIVISION · LANCASTER/CHESTER DIVISION
DROVERS BANK DIVISION · GREAT VALLEY DIVISION
(717)291-2437
November 21, 2001
Turo Law Offices
28 South Pitt Street
Carlisle, Pennsylvania 17013
Dear Mr. Waltz:
RE: Anthony J. Bozis, deceased October 20,2001.
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
CD # 121-0015798, open 1/28/1990, rollover 1/28/2000, matures
7/28/2002, balance $1,964.51 and accrued interest $86.27;
paying 5.92%, in his name only.
If you should have any further questions, please do not hesitate to contact me.
Very truly yours,
~~~~
Karen D. Hillegas
Credit Inquiry Processor
\OCN\\~\.. \
~\C ~ 'fl~~
. 0 \ " { \W orOU$\ ~ t\ Ust!.
\J ,.\ a<:> ,\1\' r ccr,\,oet' ~ .~., o~,
. ';)"~\l 'oIO~\ ." 0' \\.,,) ,
. Q(\ ,~'\j~~ '0(\0 \';) \O~ J ,(\~ Q( at' J \\\"\oOt~.. .
.. \(\\Q{t',a\\ QU{ \\\C\u\{'i \ e6 'o~ \~~ \~ c",(\~e ~
"s'fl\:'.{ \~ ~'\'hl \s assu~~ \s sub'
,I ~\\)\ \>., ......~v
. ~es\)O~" ~{e\(\e1-Y'
... 0\')\\'1\0(\
POBox 4887 . Lancaster, PA 17604
www.fultonbank.com
1-800-FULTON-4