HomeMy WebLinkAbout94-00694
No. 21-94-694
Estate of
Ruth D. Orner
t Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 10 19....2.L. 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 September 10, 1975
described therein be admllled to probate and n1ed of record as the last will of
Ruth D. Orner
and Lellers Testamentary
are hereby granted to Donald Paul Orner and Betsy Ann Keys
m/Jh(1 ~_UM flO1 Prl :;.!C;,.../i-t-o ~
~7 Resister or Wills
FEES
Probate, Lellers. Etc. ......... $ 25.00
Short Certlncates(2) .......... $ 6.00
~.....X.PAGES... $ ~.oo
JCP $ 5.00
TOTAL _ $ 39.00
Murrel R. Walters, III, Esq.
4 ATfOIlI'lEY (SUl!. Cl.I.D. 1'10.) #24849
5 East Main ~treet
Mechanicsburg. PA 17055
ADDRESS
(717) 697-4650
Filed
...................................
PHONE
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MILED LETTERS AND ORDER TO ATTORNEY AUGUST 10, 1994
Estate of Ruth D~rner
aim kllOIl'1I as
I)ETITION "'OR PIWUATE llnd GRANT OF LETTERS
~/- q'l-c.qt.j
No.
To:
Regi"er of Wills for the
Oecca....". Coumy of Cumberland In the
Sodal Secllrlty No. 161- 3q::T!l65 Commonwealth of Peonsylvanla
The pethlon of the undersigned rc.peclfully represents that:
Your pethloner(s), who Ware 18 years of age or older nn the cxeeUlors
In the last will of the above decedent. dnted Sen.t..ember 10
and eodleil(s) dated
Son, Michael D. Orner. died December 1 1992.
Husband. Donald L. Orner. died February 25. 1981.
(llal~ rC'lc\"unl dU:lllmIDIlC,,'). C.B. fCnundallol1. dcalh ur c\tcutor, ctc.)
named
,19 7<;
Decendenl was domiciled nt death In Cumberland County. Pennsylvania, with
hp" Inst family or prlnclpnl residence at 120 November Dr. I Ap t. '}
Camp ~i11, PA '701]
(Ibl r.lfttl, numher and mUl1cll":lIil~')
Deeendenl, then 75 yearsofage died June 14 .J994 .
at Holy Spirit Hospital. E. Pennsboro Twp., Cumberland CO" PA
Excepl as follows, decedent did notmnrry. was not divorced nnd did nol have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adJudlcaled
incompetent: nnnp
Dccendent nt denth owned property with estlmnted values as follows:
(If domiciled In Pa.) All personnl property $ 4.000 _ 00
(If not domiciled In Pn.) Personnl property In Pennsylvanln $
(If not domiciled In Pa.) Personnl property In County $
Value of renl estate In Pcnnsylvanla .1 . $ O. 00
situated as follows: NO III C"
WHEREFORE, petitloner(s) respectfully request(s) the probate of the last will and codlcil(s)
presented herewith nnd the grant of lellers tes tamen tary
(It''iliUllClIUU)'; mhnlnlmallon c.I.a.; administration d.b.n.c.t.a.)
theron.
t ~f (L.~ {~4-
~i -DanA1 rl Pf1111 Ornp,..
".9 1119 Dry Powder Circle
;~ M""hAni "..burg, FA 170<;<;
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--Be~RY Ann 1{P)'R
1403 Concord Rd.
Mechanicsbur~, FA 17055
OATH OF PERSONAL ImPRESENTATIVE
COMMONWEALTH OFI'ENNSYLVANIA }. 1:18
COUNTY OF CUMBERLAND
I If - ~:L~-
The petltioner(s) nbove.nnmed swenr(s) or nffirm(s) Ihntthe statements in the foregoing petition arc
true and coneclto the best of the knowledge nnd belief of petltloner(s) and that as personal represen-
tatlve(s) of the above decedent petitioner(s) will well and truly ndmlnlster the estale nceordlng to law.
Sworn to or affi~lcd and subscribed { J)~tf PJ &'-~1 '"
befo me this a. dJ!r pf Donald Paul Orner ~.
19~__ ~ ~
~'fj H"Rislcr Jef*"l\n'n'''Keys \").. \ C) ~
."0& 111 IIfV IN
l'lt: 'OR 1I1!1
CfHllflCA.n J:OIlt
WARNING: IT IS ILLEGAL TO ALlen TIllS COPY OR
TO DUPLICATE DY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTlt OF PENNSYlVANIA
OEPARTMENT OF HEALTH VITAL RECOROS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. 2169103
t - It- .. ~y
D...ull.....of ",..C..lIloUlllOll
.~
;CuT' IL /JLIL-G-L
, ---r1"1 t,l,(jJIt'
sex) Social Security No.1 t, /- ,3<1- 110. r
Date of B~rth()j- .,,( tj I r / /" BlrthPlaCe~JJ . .
7 'I
~~~ ~s~
Race LJIeJ; Occupa}lon '-4-~_ Armed Forces? (Yos or No) J tJ
Marital Statur.tJ~"~.< i ~:f'"":~~d"U I.;." It",,",. L...- 4 tY. ,dl,.,,!4 /( ~
~~~:=~tA~~;;-j~~.!~ ~l" J A ~J FU:::I ~irecl~;~:;~~/'l tfC"'~:~l/j
FunaraIEstabllshmentt.t.i..tk,.~ff, . ,./tvlll.A.X -;-. "l::f, 07\tJ/J/ I'/G" lfiT,lJT N.I::; Hi
: Interval Betwe
~art I: Immedlate}Jause / tC- i Onset and Death
(a) ~L-- c;z1:!:.tt d Ie. ~il..-(j~1/ -'.;<-<:, 7/tf/.. ~i/
(b) /
Name of Dacedent
/y /rYf/
(c)
(d)
Part II: Other Significant Conditions
Manner of Death:
Natural --r:r-- Homlcldo
Doscrlbe how Injury occurred:
Accident 0
Suicide 0
Pending Investigation
Could not be Determined
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This Is to ce tI that the Information here given Is correctly coplod from an original certlllcate of
death duly filed with me as Local Registrar. The original certificate will be forwarded to the State
Vital Records Office for permanont IIlIng. -"""/'.._ . . (7
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(M.D., D.O., Coroner. M.E.)
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LAST WILL AND TESTAMENT OF RUTH D. ORNER
I, RUTH D. ORNER, of the City of Harrisburg, Dauphin County,
Pennsylvania, being of sound and disposing mind, memory and understand-
ing, do make, utter, and publish this my Last Will and Testament, hereby
revoking all former wills by me heretofore made.
1. I order and direct that all my just debts and funeral
expenses be fully paid and satisfied by my Executors, hereinafter
named, as soon as conveniently may be after my decease.
2. I give, devise and bequeath all my property, real, per-
sonal, and mixed, whatsoever and wheresoever situate, of which I shall
die seized and possessed, or to which I shall be entitled at the time
of my decease, to my husband, Donald L. Orner.
3. However, in the event my said husband, Donald L. Orner,
shall predecease me, or shall die within thirty days after the date of
my death, I give, devise and bequeath all my property, real, personal,
and mixed, whatsoever and wheresoever situate, of which I shall die
seized and possessed, or to which I shall be entitled at the time of
my decease, to my three children, Michael David Orner, of Harrisburg,
Pennsylvania; Donald Paul Orner, of Lower Paxton Township, Dauphin
County, Pennsylvania; and Betsy Ann Keys, of Camp Hill, Pennsylvania,
in equal shares, per stirpes.
I hereby direct that the Four Thousand ($4,000.00) Dol-
lar advancement made to my son, Donald Paul Orner, shall be deducted
from his share.
4. I nominate, constitute and appoint my aforesaid husband,
Donald L. Orner, Executor of this my Last Will and Testament.
In the event that my said husband and Executor should
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedentl
Ruth D. Orner
Date of Deathl
6/14/94
Will No.
Admin. No.
1994-00694
To the Register!
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on-or mailed to
tB?lJ??towing beneC~ciaries of the above-captioned estate on
~
Betsy A. Keys
Address
Donald Paul Orner
1403 Concord Rd.
Mechanicsburg, PA 17055
1119 Dry Powder Circle
Mechanicsburg, PA 17055
Signature
Notice has now been given to all persons thereto
Rule 5.6(a) except none
Date I ( (- '.lti~ f v/
Name
Murrel R. Walters. III. ESQ.
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Address 54 E. Main Street
Mechanicsburg, PA 17055
Te1ephoneV17) 697-4650
CapacitYI
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Personal Representative
Counsel for personal
representative
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
*
CQMMONWr,t,UH Of PENNS'f'IVANIA
O(P,t,ATM(Nt Of R(V(NUE
DErT 180b01
HARRISIURG, PA 17U8-0601
OICIOINf'S ""AM! (LAS,!, IIUT. ....ND MIDDlt lHIll"'1
Orner, Ruth D.
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SOCIAl UCUI.T' t'UMIlI
61-34-1865
DAH Of DlATH
6/14/94
C" ,,".'UIII,'UIIfIIf'Nu "ovu' tl.&l~1 1111\' f'." lUlU ",C>Ollltj+l!Ioll
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foa DATES Of DEATH A"Ea 12/31/91 CHECK HEaE
If A SPOUSAL
POVEan CalDIT IS CLAIMED 0
fiLE NUMBEa
21
COUNTY CODE
OIClO(NI', (01.1"1 H "DOIU!.!.
94
YEAa
694
NUMBEi
120 November Dr., Apt. 2
Cnmp lIill, PA 17011
c.,", mbeI.land
AMOUNI R((lIVID ISIlIHSIltUClION!.1
10/24/18
10 I. Original Return
o 2. Supplemental Return
o 3. Remainder R.,urn
(for dal.s a. death prior to 12.13.82)
o 5. Federal Ellole Tax Return Required
o 4. limited e,lal. 0 40. fulure Inllre" Compromllll
(for doles of death afle, 12.12.821
10 6. Decedent Died Teslate 0 7. Decedenl Maintained 0 living Trust
(Alloch copy of Willi (Allach copy of T,usll
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOI
NAM COM'~11t MAILING AOORUS
Murrel R. Walters, III, Es . 54 East Main Street
""'HON' Nu.m Mechanicsburo PA 17055
697-4650 'n'
I. Real Estale ISchedule A)
2. Slacks and Bonds (Schedule BI
3. Closely Held Slock/Pa,tnenhlp Interest (Schedule C)
4. Mo,lgog.. and Noles Receivable (Schedule 0)
5. Cosh, Bonk Deposits & Miscellaneous Penonal Property
(Schedule E)
6. Jointly Owned Property (Schedule fl
7. Transfen (Schedule G) (Schedule Ll
8. Tolal Gran Auels (lotalllnes 1.7)
9. funeral ElIlpenses, Admlnlstralive CoslS, Miscellaneous
bpen..s (Schedule H)
10. Debu, Marlgoge liabilities, liens (Schedule I)
11. Total Deductions (tolallln.. 9 & 101
12. Net Value 0' Eslale (line 8 minus line 11)
13. Charitable and Gove,nmental Bequ..U (Schedule J)
14. Net Value Subject to Tax 11Ine 12 minus line 131
15. Spousal T,ansfen (fa, dates a' deoth after 6.30.94)
See Instructions for Ar,plicoble Percentage on Revene (15)
Side, (Include volues ,om Schedule K or Schedule M.)
16. Amount of line 14 lalllable at 6% role (16)
(Include volu.. from Schedule K or Schedule M.l
17. Amount of line 14 IOlllable at 15% role (17)
(Include values from Schedule K or Schodule M.)
18. Prlnclpaltalll due (Add taK from lines 15, 16 and 17.)
19. Credih Spousal Poverly Credit Prior Payments Discounl
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_ 8. 10101 Number of Safe Deposit BOllles
(1) -0-
(2) -0-
(3 ) -0-
14 ) -0-
(5) -0-
(6) 1,948.80
17 ) -0- 1.948.80
(6 )
(9 ) 5.385.77
(101 793.07
Intorell
(11) 6,178.84
(12) -0-
f?ij!ll \(1 .,,:rJ
(14) \.Ii '.-0-
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)C .06 IIZ ::.-\
)C .15 IIZ
y: ;. (.'\ ,,,
. 116) n
(19)
(20)
(21) -0-
121AI
(21B) -i)
+ +
20. If line 191s grealer Ihan line 18, enter the difference on line 20. This Is the OVERPAYMENT.
m 0 ...:T:n!'ll.III.._._...I'_...._I....I".~' ....,..I'I...mm 1r.'I....I.'......U:.&.:.l.........
21. If line 18 Is oreater than line 19, enler Ihe difference an line 21. This is the TAX DUE.
A. Enler thelnlere.. on Ihe bolonce due on line 21A.
8. Ente' the tolol of line 21 and 21A an line 21B. This Is the BALANCE DUE.
Molle Check Payobl. tOI A.ght., of WllI., Au.nt
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.. BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE ANP TO RECHECK MATH
Under penalties af perjury, I declare thai I have uamlnod this relurn, Including accampon't1ng schedules and statemenh, and 10 the b..1 of my knowledge and belief,
It Is I,ueo, correct and complete. I declare thot all real ..tale has been reported at Irue market value. Oeclarotlon of preparer other Ihan the penonal representaliYe Is
base n allln'otmation f which preparer has any knowledge.
SIG RIOtP! fll ~S18 fOR (TURN AODRESS 1 9 Dry POW{ cr Circl'lY -
(, Donald Paul Orner Mechanicsbur~. PA 17055 ~ J 5 ~~
It.." .N .00"" 1403 Concord Rd. om
Betsy Ann Kevs Mechnnicsburg, PA 17055 v;J 3 - '( .).-
Murrel R. Walters, III, Esq.
54 E. Main St.. Mechnnicsburg, PA
'Ju
,
Act '48 of 1994 p.ovlde. for the reduction of the tax rate.lmpo.ed on the net value of transfers to or for
the u.e of the .pou.e. The rate. a. pre.crlbed by the statute will bel
e 3% (.03) will be applicable for e.tate. of decedent. dying on or after 7/1/94 and before 1/1/96
. 2% (.02) will b. applicable for e.tate. of decedent. dying on or after 1/1/96 and before 1/1/97
. 1% (.01) will b. applicable for e.tate. of decedents dying on or after 1/1/97 and before 1/1/98
. Spau.al tran.fe,. occurring on or after 1/1/98 will be exempt from Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (v) IN THE APPROPRIATE BLOCKS.
YES NO
1. Old decedent make a transfer and:
x
o. retain the use or income of the property transferred, .......................................................
b. relaln the right to designate who sholl use the property transferred or lIs Income, ....,..........
x
X
X
c. retain a reversionary interest; or ...................................................................................
d. receive the promise for life of either payments, benefits or care9 ,.....................................,
2. If death occurred an or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate conslderatlon9 If death occurred alter
December 12, 1982, did decedent transfer property within one year of death wlthoul receiving
adequate consideration'... ........... ......... IO..... H' ........ .............. ..... ...... ........... ...... .t' .............
X
x
3, Old decedent own an 'In trust for' bank accounl at his or her death9........,............................,
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
IlYU09Uel)i..
SCHEDULE F I
JOINTLY-OWNED PROPERTY ~
FILE NUMBER
21-94-694
COM..-oNW(.m. Of 'INNU'I\I.NI.
INHIII'.N(I'.' "'UIN
_UIDIN'DICIOIN'
ESTATE OF
Orner. Ruth D.
Joint tononll.l.
NAME
A, Betsy Ann Keys
~- -.-.~....-- -.~..' _..-
ADDRESS
1043 Concord Rd.
Mechanicsburg, PA 17055
- ..- -.--..---.....
RELATIONSHIP TO DECEDENT
daughter
B.
C.
Jolntly-ownod proporty.
ITEM LEnER DATE
NUMBER FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF
JOINT OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 1987 Mellon Bank 3,897.60 50% 1,948.80
checking 0112-692-0014
TOTAL (AIlo on'er on lino b. Rocopltulollon) S 1,948.80
{II more space is n..cJ.d insert additional sh..,s of some sjze}
Mellon Bank
~"'II"" linn". N.^.
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I~O. 1111\ jt{lf!l
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December 27. 199~
Murrel R. Walters
5~ East Main Street
Mechanicsburg, PA 17055
Re: Estate Of Ruth Orner:
Dear Ms. Walters:
In accordance with your request. the following information
is provided as of June 1~. 199~. Please see attached letter.
Please contact tllis department if you have any questions.
Sincerely.
ex' [1..c,k.C;ti.-
Mellon Bank. N.A.
Written Communication (199-5380)
P.O. BOl< 7899
Phi1a.. Pa. 19106-7899
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SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONW(AUH 01 P(NN!lYlVANIA
INH(RllAN(( IAl( R(IURN
IlnlOWIOEClO(NI
STATE OF
Orner. Ruth D.
ITEM
NUMBER
A. Funeral Exponlul
l.
2.
DESCRIPTION
W. Orville Kimmel Funeral Homc
Rolling Grcen Cemctery
l.
B, Admlnlltratlvo Callll
2.
3.
Personal Representative Commissions
Social Securily Number of Penonol Repre.entotive,
Year Comml..lon, paid
Anamey Feel
Murrel R. Walters, III, Esq.
family Exemption
Clolmont
Addre.. 01 Cloimonl 01 decedent', deolh
Slreet Addre..
Relotlon,hlp
Clly
4. Probate Fee,
C, Mllcelloneaul Exponloll
1.
2.
3.
4.
5.
6.
7.
8.
Slole
Zip Code
l
Ploalo Print or Typo
NUMBER
21-94-694
TOTAL (AI,o enler on line 9, Recapllulollon)
(If mare Ipace II noeded, Inlerl addlllanallheetl allame sI.o.)
AMOUNT
2,745.00
2,040.77
rcnouncerl
550.00
50.00
$ 5,385.77
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COMMQNWtAltH Of PfN"'Sn""NIA
INHUnA"'Cr I.... _nul,..
'"IDINr OICIOfNI
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI.a.. Prlnl or T .
FILE NUMBER
21-94-694
ESTATE OF
Orner, Ruth D.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
World Vision - final payment for sponsored child
Cowley Associates - medical
Sammons - cable TV
A.Z. Ritzman - medical
100.00
32.50
12.65
14.35
50.00
25.45
339.10
200.00
19.02
2.
3.
4.
5.
6.
7.
Beth Bucher - graduation gift
PP&L - electric
Camp Hill Plaza Apartments _ rent
Camp Hill Fire Company - contribution
Bell Atlantic - telephone
8.
9.
TOTAL (AlIa enlor on line 10, Recopllulo'lon)
(1/ more 'pD,e is ne.rled, inse,t additional ,he.'s o( same size.)
i
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I
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$ 793.07
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COMMONWIAUH O' ,'NNUIVANIA
INHIIIIANClIU I"UIN
.nID,NI DleIDIN'
SCHEDULE J
BENEFICIARIES
fiLE NUMBER
21-94-694
ESTATE Of
Orner, Ruth D.
ITEM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
RELATIONSHIP
AMOUNT OR
SHARE Of ESTATE
A. Talilable alqullt.1
50:t
1.
Michael David Orner
1119 Dry Powder Circle
Mechanicsburg, PA 17055
Betsy Ann Keys
1403 Concord Rd.
Mechanicsburg, PA 17055
son
2.
daughter
50:t
ITEM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
AMOUNT OR
SHARE Of ESTATE
B. Charitable and Goyernmental Bequestsl
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o enler on line 13, Recopltulollon) S
(If morl .pace Is n..ded, In.ert additional .h.... of .ame .111)
I '1 .;),:}. '6. (.,
c.,
REV-1547 EX AFP (12-94*
CO""OHWUUH or PENNSYLVANIA
I)EP.ulHEHf Of R[V[JrAJE
BUREAU Of IHDIVIDUAL TAMES
DEP'. '1"01
HARRISBURG, Pi 11121'0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
ACN 101
DATE 09-25-95
FILE NO.
DATE OF DEATH 06-14-94 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FDRH WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
HURREL R WALTERS III ESQ
54 E HAIN ST
MECHANICSBURG PA 17055
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
"lIount R..U t.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiE'v:is4Tiicu"iip-n'2:94riiiificnWYNtiiififAifcn'-AX-iiPPRiiiiiEHEiir-;-"LLowANciriflim--m----m--
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ORNER RUTH D FILE NO. 21 94-0694 ACN 101 DATE 09-25-95
TAX RET\lRN WAS I I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONl ORIGINAL RETURN
1. Ra.l Eat.t. (Schedule A) (U
2. Stocke and Bonda (Schadule 8) (2)
S. Clo..ly Hald stock/Partner.hip Int.r..t (Schedul. C) IS)
4. "orta.g../Not.. Receivable (Schedula OJ I~)
5. C..h/D'" OapoaUa/Hho. Paraonal Property (Sch.dul. E) IS)
6. Jointly Owned Property (Schedule FJ 16J
7. Tran.fa,.a (Schedule 0) (7)
I. Total A...t.
I CHANGED
.00
.00
.00
.00
.00
1.94S.80
.00
(81
1,948.80
APPROVED DEDUCTIONS AND EXEMPTIONS I
t 5,385.77
9. Funeral b:pan.a./AdIl. COI ./Hl.c. bpan.a. CSchadula H) (9)
10. D.bh/Hortg.g. Llobll1U../LI..,. (Sch.dul. 1J 1101 793.07
11. Tot.1 D.ducUon. 1111
12. Hat Value of TaM R.turn (12)
13. Char1t.bla/GovarnManhl aaquad, ISchadula J) 113)
14. Hat Valua of E.t.t. Subject to Tax 114)
NOTEI If an assessm8nt was issuud previOUSly, lines 14, 15 and/Dr 16, 17 and 18
ruflect figurus that includa the tDtal of ALL ruturns assussud to date.
ASSESSMENT OF TAXI
1&. A.ount of Lin. 14 at Spou..l rat. lIS)
16. A.aunt of Lin. 14 taMabl. at Lin..lICl... A rat. 116)
17. A.ount of Lin. 14 taMabl. .t Collat.ral/Cl... 8 r.t. (17)
18. Principal TaM Du.
~.17R R4
4,230.04-
.00
4,230.04-
will
.00
.00
.00
X .00.
X.06.
X .15.
I1BI
,00
.00
.00
.00
TAX CREDITS I
PAYHENT
DATE
RECEIPT
NUHBER
DISCOUNT (+1
INTEREST I-I
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
J:
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FGR CALCULATION OF ADDITIONAL INTEREST.
IF TGTAL DUE IS LESS THAN t1. NO PAYHENT IS REQUIRED.
IF TGTAL DUE IS REFLECTED AS A "CREDIT" lCRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE GF THIS FGRH FGR INSTRUCTIDNS,I
,
no ~r; :rJ
c ;
\
, --,
~.:,-
"""
W
~J
\ "
i --
. '-'"
..SlRYATlOlh E...... ., __" d.l.. on .r ..'.r. o.._r 12, 1.11 -- If on. ,u'ur. In""" In .... ...... h 'ronof..rod
In po.....lon .r onJ...... .. CI... . lc.II...r.11 ....'Icl.rl.. ., .... d.codon' ,".r .... .,plr"lon ., ... ...... '.r
11'. .r '.r ...r., .... C........lth horob. ..pr...I. r...rv.. .... rlgh' .. ooor.I.. end ....,. 'ron.f.r Inherl..... r....
.t the 1...,ul Cl." . (coUat.reU r.t. on IInV such future In..,..t.
........ IIF
MOna: I
To fulfill the requlr..~t. of Section Zl~O of thl InherltBnCI end E,t.t. Tax Act, Act ZZ of 1991. 12 P.S.
$MUon 2nD.
....... .... 'op portion ., thh Motl.. end .....It .Ith ....r P...... .. .ho ...h'" ., Millo prln'od on .... ..v.". .10".
..-tt.kl c:heck Dr ......v ordu ply1lble tot REOISTER OF MILLS I AaENT
All p....... r...lvod ""'II II'" .. ooollod .. on. In'''''' ""Ich ... .. .... .Ith ... r_l....r ooollod .. .... ....
PAvttEHT I
REFUND (tA) I
A ro,.... ., . ... crodl', ""Ich ... no' roquo.'od on ,ho r.. R,'urn, ... .. r.......od .. c_l.tI.. on "Appllc.tlon
'or R.fund of p~.ylV8nl. l~rltBnC' end E.t.t. Tax" (REV61S1S). Application. .r. Ivallebl. at the OffiCI
0' the A-al.t.r of Will', 8nY of thl ZS Rlvenu- DI.trlct Of 'I c.., or by cIlllng tn. ,peel.l Z4-hoUr
IInsverlna ..rvlce nu-ber' for for" orderlngl In penn.vl~l. l_aOO_S6Z_ZD5D, outside p.nn,vlvenla ~
withIn loclt Harrisburg .r.. (717) 787-a094, lOOI (717) 772-2152 (H..rlno I~.lred Onlv).
DIJECTlDNSI
An. p,,'" In In'''''' no' .....lIod .Ith .... _ro........, .11...... .r dl..II...... ., -.etlon., .r ...........
.f .., Ilncludlno Ol.coun' .r In..r,'" .. '"'"" on .hl. H..lc. .... obJ..' .Ithln .1.', I'DI do.. ., r...lp' .,
thh HoUc. bVI
.-vrl"on pr.'''' .. .ho PA ....or..on. ., R......., ....d ., _..10, ...... 21ID2I. Ilorrh...r., PA 111'.-1021, OR
-...l.cUon ta hav. tM ..tt.r dat.r.lned .t lIucUt of the IICCount of the pars~l rlpruanhUv" OR
"-epp..1 ta tM Drph"'" Court.
AOHI"
ISTRATlVE
CORRECTIONS I
FlICtu.1 .rror. dl.cav.red on thl. .......-nt ShOUld be addr...ed In wrltlng tal PA Depart..nt of Rav~,
lurellU of 1ndlvldu.1 TaM'" ATTH' po.t A.......nt Review Unlt, Dept. Z10601, Harrl,burG, PA 17121-0601
Phone (717) 7.7-6505. Sa. peoe S of tM bOOkl.t ~In'tructlon. for Inherltance 'aM Return for a Ra.ldent
Decedant" (REV-1S01) for an eMP1anetlon of ed81nl.tratlve1V correctable error..
" on. ... duo I. p.ld .I.hln 'hr.' (s) c.lond.r oon.h. .'t.r .ho d..oden", d..th, . 'Iv. porcon' I'X) dleeoun' .,
the taM peld le .Uowed.
'n..r..' I. ch.r.od ...Innlno .I,h 'Ir.' d.. ., d.llnouonc" .r nino (.> oon.h. ond one III d.. 'r.' tho do" .,
do.th, .. .... do" ., p...on', To." ""Ich _ d.II_' ..,... J....... I, I'.' .... In'''''' .. tho ro" .,
.1. "XI porcon' por ..... c.lcul..od .. . d.U. ro.. ., ,DIDI64. All ..... ""Ich -- d.II_' on end .ft..
Jenuary 1, 1912 wl11 beer Intere.t at . rate whlch wll1 v.rv fr~ calendar vear to calendar v.ar with thet rate
lIMOU"'Cad bv the PA Oapartnnt of Revenu.. The applicabl. Inter..t rat.. for 191Z through 1995 ar.'
D1SCDUHT I
INTEREST I
~ Int.ra.t Rat. Oallv Int.r..t Factor ~ Int.r.d Rat. D.ll~ Int.rllt Faetar
191Z 20X .000541 1987 .X .000Z47
1915 I'X .0004" 19"-1991 IIX .Ooun
I'" IlX .0003n 199' 'X .000Z47
1915 nx .000SS6 1993-1990\ 7X .00019Z
I'" lOX .000Z74 199' 'X .D00247
--Int.rllt II ca1cuhtad .. follow"
IKTEREBT . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Anv Hotlce l.sued .ft.r the tax blC~a delinquent wlll r.flact an Int.r..t c.1cul.tlon to flft.en (15) dly.
beVond ttM data of the .......-nt. If PUMnt h .. .ft.r the Int.r..t c~t.Uon d.t. shown on thai
HoUc" .dcUUona1 Int.r.d .,at be calcul.ted.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:~~' il~ (~
Date of Deathl (r. ('-( c; L'/
Will No.
CJ ,f ,vC'/t!..
Admin. No.
'2 , . 9.(' (';'7 y'
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 estatel
1.
State~ether administration of the estate is complete I
Yes No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. I is Yes, state the following I
a. Did the personal representative file a final
account with the Court? Yes No j/'.
b. The separate Orphans' Court No. (if any) for
the personal representative's account iSI
c. Did the personal representative st~ an
account informally to the parties in interest? Yes No
d, Copies of receipts, releases, joinders and
app..rova~ olo. !p rmal or informal accounts may be'lt),ile with~ .~
ce?k ofrihe _ : ~hans' Court and may be .~ttached t . is, re . '5-1 /.
n.. " ,4"lrh-t~'-t... 'T .~~~..t,-c. ~~ IK..,/{
Date: rq'/c(.~... ~L ~
. ~ Sig~W~
M (C' '0 ,: . : 1(,,/ to' r.?lC r" W,I eiT t! ,,<:!S ~ S ..,'1
0: p> ~J Name (Please type or print)
5 t( c' /'1/1(#'( r/t'~/(tlIv(C)dV"f.-
Address
( -/l/7 "-"i 7 LIILJ)J
Tel. No.
Capacity: Personal Representative
~counsel for personal
representative
(MAH I rmf/ AM3)