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HomeMy WebLinkAbout94-00797 PETITION FOI{ PIWUATE lInd GI{ANT OF LETTERS d{1-:"~91n-~ _7_1_7___ i \ 1:.:""1(1 01 ~-:.~ \ '. '_i,___t_J~\\~'-. '" fll.m kilo"''' ell ____~_____~~__"___"_.__~_ ,. Nu. To: llegi'lel ur "'tll' I'm Ihe _______~=~~_===~___:~_=~.~lj,~(.(;;,~;~i- ('uIIIllY ur u._1J1~BJ_8LlINl!_- ill Sorial S('CII,ity No. .-i....i~_.:::..^:...:....L__:.:.....-~:2.LL_., ('ummullwcalth of IIcl1I\\)'I\'ul1ln The pctilioll of Ihe unllcl\igm.'d Ic\pcl,.'lfully fl'IH\.'WIII\ Ihut: Your pctiliuncl(\), who h/urc IN )'Cilf!rl of a~c m:_utdcr an tl!c c.\CCUb'~, illlhe h"l willuf Ihc Ilhmc decedelll. dilled __,:., ~-1~'~ . - '.' - lllld ,'tKiioil(,) dilled ~ ~ -",-- . ~~-~---------~---~---- Ihe numctl .19..:2L .-------~ (\1lI1~'I~h:\iUlI dr!.'lIl\1\I;II1~'C\. ,',V. 1l.'l1lllldilliulI. lkalh uf 1.'\\,1,:111111, el\',) i \ ' I>ecclldelll Wll' dOllliciled III delllh ill._-----'::c.~-'_f. \ ... 'cl...L.:.JL_\CUUUIY. !!~nm)'lvallln. wilh h~:-..- In" fllmily or princip"1 re,idcllce,nl __~.'-l:':~.~_-,,- ,,)' \ ,- -- \- .-\. ,., "f' 'r---.,- .->:'-JI"" \.l'.~, \-.:w..\' IIi'l \IU.',,'I, 1I1111111~1 illhllllllll,,'if1;tlil)) DeC,-,"d~lll. Ihell , ;),''-'' . )-CII" "I' agc. dkd _';~C\'.l~'\, \~. 19 ',,\L\ UI d' 'I \. \) )), \< ,,\ ."'\ \'L\-~........:u.=S-,_u \';,:;. . ExCCpl '" r"lIow,. dccedenl did nul mil II)'. was ""1 divlIrced IlIIlI did 11111 havc a child born or IIdupled aflcr cxeculiulI or Ihc willllrfercd ror pruhale; wa' IIUllhc viclim "I' a killillg aud was IIcver adjudiealed ina:ompclcnt: I>ccclldclllal dClllh oWllcd prul1erl)' with c>lillllllcd vuluc' '" f"ll"w,; (If dnmlcilcd III I'a.) All pe"nllallllol1erl)' $ \'e '">'"> (I I' ""1 dllllllcilcd ia I'a,) I'c"oual pruperl)' III I'cuu,)'lvaula $ (11'1101 dOllllcilcd lu I'a,) I'c"olllll prupCrlY ill CUUIII)' $ Vulue of rcal cMU1C ill Pcnnsyl\,ill1iu $ silullled '" follow;: WllEREFORE. pClitiullcr(,) rcspeclfnll)' rcque>\(;) Ihe prnhlllc of Ihc lasl will lIad eodicll!s) pre'clllcd hcrcwith nlld Ihc grmll or Icllc,,_--I.ESIAMENIAR'f lI~"HIUII.'lIlill). .Hhnini\1rlllltlll ('.I.n.: udminlMlullnn d.h.II,c.l.a,) Iheroll, i: 5 -0- 'G~ ",n c -00 !:':: .-- ~~ l!~ .0 ;; c ", Vi " I l ,::; \I \ I.' '0... 1\-) , ~ >~II'f\1 _\:.\.:::'1' \\ ,\i.'J'" . j . (, \ \ ~_.. " i. \ \,' ~ .:" ~_----.__~_,J.-., _ .-~ 'H:""-'\''.:J'~\' -I{.J \ --,-.0.-:\:.'w'-'- - -::;:---::- ,'---~ ":-:- -,- - -...--- \\ ,.. \-'Jf,." \d, ,l.. OATI-I OF I)EI{SONAL Iml'l{ESENTATIVE COMMONWEALTH OF I'ENNSYLVANIA l::ls COUNTY OF CUMBERLAND f ' The pelilioner(,) ahuvc.nllmcd 'WCIlI(S) or arfirm(,) Ihlll Ihc '1II1emCIIIS illlhc rorcgoillg pClltloll IIrc nue alld currccl 10 Ihe he>lnr Ihe knuwlcdge alld hdicr ur pelil!nllerl') alldllall '" pcrsollal rcprcscn. IIIlive(') or Ihc ah"vc deccdelll pClilioncr(,) will well alllllruly adminblcr Ihc cSlale according 10 law. '\ \ , . \'1 I It. ~ _' .. Swurn 10. or affirme'\ fW'. SUh,crll~Cd.~ ) '~.~-..'.., , ~'cfmf~c ~~~/j' 3 _ 9 dj]. of ===::--~_. ~7-crnk~LLf.l.~(bJi~ .fji--------------- 7M~ C. LEWIS 1I(.~is((./ (;---~- I L/_c:? 3.~- -.S '" <iQ' " '" ~ :: ~ E: ;".",., -" - --~:-;~i~': - ': " (,'- .- " ~ ;-.:-! d: ~:' , . _ i ,..::. ;:j- Ue..> l6l - V6 - LZ ,. }o'or tho PUl'POSO 01' fuolli tutillg tho sottlomont nnd ullltl'ihut:l.on of my ostute, I uuthol'izlI nnd ompowor my Exeoutl'ix, herolnnftol' nnmod, to Roll /lilY and ull 1'0111 os tate whioh I may own nt the timo of my doceuoo, ut oither public or privute sulo or oaleo. LASTLY, I nominate, conntitute and oppoint my dllue~htel', AIlII A. SULLIVAN, Executl'ix of this my Lust \-1111 and Testument and direct that sho ho oxcused fl'om posting bond or othel' oocurity 1'01' tho faithful p01'fOrmllllce of hel' dutios. III HITNESS ,.n!EREOF, I have hereunto oot my hand and seul this 83....1 duy or Moy, A. D" 1991. fA ^~ ) II} , ~. . /.' 1/ P Z( 'f-1t'~ .-' 'hz . /~,.(!tA--' . Hilmo M. Dille1' (SEAL) Signod, sonlod, publ in heel l\l1el doclnr'od by the abovo nomod, IHLr1A M. DILT,EH, 00 Ilnu 1'01' hel' ,L/lst I-Illl Ilnd '['elltamont, ill l;lw pl'llUOnCO of uu, who have ullbucl'ibeu 0\11' names hOl'eto us Hitnonuell, at the roqnoot of' onid test;/ltl'ix, in hor pl'ooonco Hnd in tho pmm, or ",oh 0,""_ C ~P# ~ ;I i':Jd' ,R' "", /- .,t.,<<;<Y.J xC!,'......-,'-" ./ -2- . .;','. ~: ,':j; ; .:., ., . ~ t,',~.;f:~;.i;'.,.:- '.;~: ...; " .~ : . . '<: '. ;'l-, -~ '. .-..~-...'>'~ "~,-,.rL' , ~1'!> "~~! 'f ~\~ ."':.'~ .~~}~~}..:}~~' "~. , .,",.:'-.. . ' ,~~, ..' - . ~ -':... "'! ~. '". .'~~~,; /:B-:,; .(~S:;,~,;J::~_~~, ~',:~ ,~:-, ,- .}.;,-)... j, _ ~~., ;., ",t,.. ,t~->"'" ;~, -,:.' '\"'}'~""-~;'-":-f. ~t~;~,\".1~'ii~~{'~r' ,'- r~~/~" ,;;',~' '.:';"': ;~'/~~, ': ~";;:, ~.,; &r.\ 'r .,'M ,', ,En< " . ',j , ~ r, ,. \. :>,.'t....':'44'>'" Of ... " "'._:":>' _' .:~;_'i ,_ -" .'_ " ",~~~~; ?~~t;;~i17it , . , ., ~c;'h'-"'}.r,~, '. ,!_:I.. ,,".V '$~' \\7".' ';;"...~)lr.,,, . , j, \\if>(*' '~ ,":" I... .'1.JI"1"~ \:J11:..--J:, I .., I . . f;\ "v.... t ,1 . ~" ~~'.- " ~.,.. :' .;"-..........< ;,.. ~ ~. - .. '. . .,' ,r, -,,' ,,, '" ,,:.,,',ll , 1,,\ );;;.,! . "'F '~", .' \ ~<:...~~;':, ~?: (,~~~:~:;g'tl~~t:~;?~:~:::~~.~,~~_~~~.\~' ~~ \.~:~ ~,~:. -j' ,.....~' ",.~."t.~ ).~"t;~I',,'~t.:Jr~n:F.~;;...,. ',::"" , ;f:~\~.::',:::,';:X~yf:~J~:~~~~~~~;~~::::,:;,::~.,; :;:.~ .J ,__ . ,~. ...: ~. ::... ": :'" .1 '.,' :l '~' .;. ::';-" ~.> < ~;'li-=l .:.:. "~' , . ;E', ~. ~ ;:t ~ l:l. .: .,\\;~~~::f~;;i,t;~'::~~FJ/J\;f~~;;f::;:::,:~:i;,? " ~i~"1(~;" ..' :".-:.:!~~'I~":,"I' ;.::". '...;;....~'~ i'd-",.' ...... '." "~:;'mll!@iIB'_ .I':"t~ -::>~'.~~ ~_' ~. ",-, :. ~ ;,t. . J' ." ,. I I .....' - " .~ '.: .; " 'r-;.,' ,0 , . " :E: <~:, ... ;3: '.' " " .'...(t,. -"j, , " . ',:.',' , '~ . .'. '.' ,.,"," . "'X ,,-.' :,;!::i~;i:~:,';~j;: .. , ..: :c~. .,. .(i ;~i,~l1~~1\~f!};",.~ ..... E;:'i:~f,> K~!:(;'" ~,"J' . -' i.t.: .'. -.;.";' .' : ~ ',' .'1, \:-- .' . . . .' . ..,':-', " :',( ~ R(V-UOO .1. "qAI w ... ~~~ w~u ",0" u<C~ ~.. ~ .. .... ~ffi <c" ""z 8~ ,,~:J~:~(\ -Jt.\fIJu.- (OMMQUWfAlhi 01 rINP4!l'lvAWA OIPAAlMfut Of "(Vft.lU( III PI 1MOt,.Q1 tlARIII!lBUIlG_ PA 111,. OtJOl /1/, .J.~:,. ~ INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) FOR DATES OF DEATH AnlR 12/31/91 CHECK HERI IF A SPOUSAL - POVl.RU. CREDIT IS CLAIMED. [] Fill NUMBER f)lClDltl ~ t~A.y1 (1"~1 ll&~ "'''0 M,OOII 1,..11"11 CbLNIY (ODr WA~" OIJJM'lti7R OI(lllf'll ~ (0....'1111 "0011 U Dlllor Wilma M. '~;~~(~~;'~U~'~'6 I __ID:~;';O'I';''l'1 Il"'~; ;~'; 0 . ., .", (H., "-.... ff ,V'.d' \"."1 [,HI' III .....[ ",I,{ '. I." 1:0(1,1,1 ~1(Ulllt "ll..."ft ..DJ~l1qJ', _~.EQII G, .__ .. . 106-=26.-25.'16 ! X 1. Original Relurn I.] 4. limited ESlale r)/ 6 209 E. Walnut StrDot ShlrDman~town, P^, 17011 '0""1' .Cumbcrlill1O --~--~-_.----_.~ "...{JU'I! &IClllrIO 1~III't~lIlU(!IOt~il _ SC'D__il~tt'!..cl!9~__YJ 11 L J 3, Remainder Relurn (for date. af death prior 1012.13.82) [I 5. federal h'ale Tall Return Required .J) 8. TOlol Number 0' Solo Depo.it Bou. ... z w fll u w co I L j 40. Futuro Inleres' Compromi50 Ifor dol" of dealh alter 12.12.821 DeClden' Died leilolo r J 7, Decedent Maintained a Living fru,' (Attach copy of Will) (Alloch copy of Trusl) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOI .4,......( (O""llH MAIlI.H~ "rIO_Hi 2 Supplemenlol Relur" . iili'-H6tjf-'-~u;;;eii------~~._'- ------ 22 Glnndaln Dr. Nnchanlcsburg, "A, o~J-_o~~l-J,- ~2~:~"-;l-2.lc{L"=,=,,.,,:~,-_,=,~~~ _.~~'~_'O"."~".. ~""-,==c=,~ ,=,~ _,. 17055 Ann ^, SUllivan 20. II line Iq is greoler than Line 18. enler the difference on LIne 20. This i. Iho OVERPAYMENT, aD 21. If Line 18 i. oreoter ,hon lino lq, enler tho difforence on line 21. This is tho TAX DUE. A. Enter Ihe in'ere,' on tho bolonce due on Line 21 A. B. Enter 'he total of line 21 and 21A on line 218. Thi. It the BALANCE DUE. Mole. Ch.ck Povobl. tOI bgllt.r Df Will., Ag.n' ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-< Under penollies 01 porjury, I doclore Iho' I hove e..omined thi. return, includino accompanying uhedule. and .Iolemenh. and to the beSl 01 my Itnowledge and belief, it I. 'ruo, correcl and complele. I declare Ihot aU real estale hal beon roporled atlruo morket value. Declarotion of preparer olher than the penonal represenla'ive Is baled on all informalion 01 whith preparer hot any Itnowledge. SIGNA'URi Of PfR~Ot4 Ill!iPOtf~llIlIIOIl 'IUNCi Il.LTURt4 "'OOIlI~"f.' O,.lf ( ) ',- I. {~.__u .-J.....!.~_jJ..!.!_L..;;.__..:. -/'\1\' _ .___1_--L-L-_.L:.___--l.....:..-..:..:.... \, I ' . ~" - 0"\11 ~IGN"'UR( 0' PRtp"RfIl QIHI& tH"trT[P&f!iItH"IlVl Ao6ll.l!iS \" \ OAII z " ;: :5 => ... 0: .. u ... '" 1. Real h'ole ISchedule AI 2. Sloch and Bond. ISchedule BI 3. Clo5lly Held Sloclt/Por.nership Inler05t (Schedule CJ 4. Mortoag" and Noles Receivoblo ISchedule D) 5, Cosh, Banlt Deposih & Mileellonoous Penonol Plopefly (S,hodulo E) 6. Join'ly Owned Prope,Iy (Schedule F) 7. Trons'en (Schedule G) (Schadull'l l) 8. Total Gron Anah (10101 Unes 1.7) Q. Funeral hpenstt.. Administrative Cosh. MiICellanoous bponl" (Schedule HI 10. Oebh. Mortgage lIobilili... liens (Schedule I) 11. Tolal Deduction. (Iololllnel Q & 101 12. Net Value of Etlalo {lino 8 minus line 11) 13. Chnritoble and Governmen'al Boques" ISchedule 1) 14. Nel Value Subiectlo To. lline 12 minu. lino 13) 15. Spousol Translo" (for dotel of dealh altar 6.JO.Q41 Seo Inilfuctian. for Ar,plicable Percentage on Hoveno Side. (Include yalu.. rom Schodule K or Schodule M.) I b. Amount 01 line 14 ta.llable 01 6% lole llnclude volu.. from Schedulo K or Schedulo M,l 17. Amount of line 14 lalloble 01 15% fate (Include yolues 'rom Schedule K Of Schedulo M.) 18. Principal lOA due (Add 10. from linos 15. 16 and 17.) lQ. CfodilS Spousol Povorty Credit Prior Paymonh + ~~--_...~- + z " ;: .. ... => ~ '" " u >< .. ... 111 121 131.__ (A) _... (5) 10,6'16,35. ( 61 . ~,_____ 17)_____,... (8 I _.10~,~0!16..3.5_.__.~_ (91 ____3,.'13.5,63._______ 110) ..~___.___________~. (II) ---3,.435-.63 (12) _l.?L'1.IO, 7 2 (131 (1AI _. .1~5 ! '11 Q~, 7_2 (151 .)rL_ I: (161 15,'110,72 92'1,64 )C .06. (17) _ )C .15 .. (18) _~.__,__.9.211.,.6.4_._._______ Discounl Inlorost (19) 1201 Checll: here If yau are roqulltlng a re'und of your overpayment. .. _-----'J.21.'-~_____ (211 121A) 1218) ----.J!.24 . 6 '1 tj~ COMMONW(AUtt Of p(NN!ln\lANIA INHlRltANCI1'AX 'fTU.N 'U1DIH_!~~~ID1~! SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Ploa.o P,lnl 0' l 0 FilE NUMBER 1994-00797 11'f'..oelltlllrj ESTATE OF Diller, Wilma M, (All prop.,ty lolnlly.own.d with thl Righi of S",ylvonhlp mu.1 b, dlulo..d on Sch.dul. FJ ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH savings Account Christmas savings Account Checking Account Blue cross/Blue Shield Premium Refund Interest on Checking Account (10-11-94) Interest on Checking Account (11-8-94) 14,091.77 376,00 4,112,13 228.20 16,08 22,17 TOTAL AI.o onlo' on IIno 5, Roea S 18,846.35 (Alloth additIonal BVlI' )( II" sh..h If more 'pace I, needed.) 'I'IUIII" 11"1 J!~:~" -~J1.u.- COMMONW(AlTH Of P(NNSYlVANIA INtHRITA-NCf 'AlC R(TURN R(!lIDEN' PECfO(NI SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSES -- TATE OF Diller, l'Iilma M, ITEM NUMBER A, DESCRIPTION 1. Funeral Expen.e.. Funeral Director and Cremation Grave Opening Flowers Organist Minister Funeral lunch B. Admlnlllratlve COlli' 4. C, 1. 2. 3. 4, 5. 6. 7. e. 1. Personal Representative Commissions Social Securily Number 01 Peroonal Represenlalive, 171 Yeor Comml..lons pold 2. Allorney Fees 3. Family Exemplian Clalman' Addre.. 01 Claimant at decedent's dea,h S'ree' Addre.. Cily Zip Co do Relalianshlp S'a'e Probo'e Fees Mllcellaneoul ExpenlOll p, p, & L (electric) Bell Atlantic ABC Fuel (Oil supplier) _ Pleale Print or}vpe F E NUMBER 19901-00797 30 6 T6:L TOTAL (Also enlor on line 9, Rocopllulolion) (If more Ipace II needed, Inlerl addltlonallhoo" ..I lamo size.) AMOUNT 1,677,00 360.00 55,00 50.00 50,00 30,00 942,32 67,00 79.22 23.41 101,68 5 3,435,63 . ....- - - . -'_. .....- -.-. _._-- '---- __ __.... ..____ '~'.u_ ..__~ .__~_ _..._ ,,--- -"'-' >>-- -_.~ .--.. ^-- ~ _..~. -- ,'" ~OM~~NWEALT~ci~:p~~NSYLVANIA-' ......; .'W~.. '.' DNa: M913265., ". .DEPARTMENTOFREVEtlUE .. , " " , "'''t' .. l""i OFFICIAL RECEII'T . PENNSYLVANIA INH.ERIT~NCE AND ESTATE TAX RECEIVED FROM, i3 ACN ASSESSMENT '=' CONTROL ~ NUMBER AMOUNT ANN A. 5ULLl VAN 22 GLENDALE DR. 101 $92'. . 64 -- MECl-tANICSElURG PA 17055 10/0 HUt 'OIO"UI SSN 208-41:1-6581 FIR T Mil REMARKS r:a TOTAL AMOUNT PAID ,___,-"'9~!!-'~g!. '" CW '--Il~ /} O?' . , RECEIVED BY ,~_._ ~. , JJ:/__."" / . "t/J./ rtATUIlE , MARY C. LEl--l . , REGISTER OF WILLS ANN A. SULLIVf\N SEAL CHECKlt I. REGISTER OF WILLS - - - .-._. -- -- _._- --- - - -- .,-.- --- -- --'.'~~' .."-. --- ---- ...- ~-'_. ..- ...- -- .- - -- - - -.."""r ~- -- -- ._- ,', - - ..........."",.,..- ...-----.....4>:l.~~ 4'" "_v "..' / ~' Ann Sullivan , 22 Glond31o Dr. Uochttnicaburg, PA - .........-. ......U/it ,':;.1- _"'" 11':' ~" ~ "[;:' ", ;'"'1A" ,,/ \ .....~-~.T1 \,1, ;2.iJr')-T~,'(:i-\ C'wr., \:c .(, r\('-C\' 17055 ...---.._~,.-" ~ .....-...._--_.~ ---.."..-..-"'-' ._.A'~.~",_, "..--' ",,--~' ""-."'...~ _:.._.w.<e......-.. ':l .--~ '-_."'-~~"-...~".." "-,',,. ,J.) . \\ .::. ~~'~" \ , '. ""'. L"l_j\,.)!\ \t~\ .~ . '\ I" '1' ~i\- -. .. ,~, to. L~ ,..J \ \.. .- :\ ~~ VJ\'.:\ \\ ell ::, \-\ fu\\ -", .. -f ,~ , r r I '1 1 . I "'i ,- , -\ I ! , ,- - -- ..............,..",.-- . ....~---__ ------,- .....---....-4.~ ..,jl:r-j-".r-" ~-'-. '- ^",'''' .,. .~, ~ . (J{,"f''-i ,~ \ \ " i <-!. .1 , '.L t\ n 4 . ' ---- . '- -;" .:;-- --.,; ~.-.... --4. ~ .-_. .'_ r -'.. ..... . 1 ~ . ... .-. .. ~ is:-- J S3IN\ld~O:::>031VI1I::l:lV ONV~. ' " ap., U~!lodOJla... W . \. <.1> " - ~,\l " " " i' r. , -- ,J 4'''' I . , II,t , , " " -~~ I v -.. ..,.....,...~.,..,-- I "'-~-'--"'---~".-""'~-4.~ .._,...",......-l.-..'" /REV-1S47 rEX i ~;P : 12-941 ~I I( ! COtlHONWrA\ HI or P[NNSYlVANIA ~. ACN mPARIHlNI or PIVrNU[ .J r. ~\.. 'I NOTICE OF INHERITANCI:. TAM I 8UNIAU or INDiViDUAL TAlll5 ... ~. '., APPRAISEMENT, ALLOWANCE DR DISALLOWANCe I ~~:~i5~~~~~'.'A 111:a-obol .},. ! Of DEDUCTIONS AND ASSESSMENT OF TAX I DATE 02"28-95 ErfTATE=ili,-j)'fCTI!ll ItrrnA H -~=--~~~~FiLE- tiO-:=Zl-lj"4"::'irf97--- --- DATE OF DEATH 08-11-94 COUNTY CUM8ERlAND I. , -:, ',1'- / I. 101 NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT TIlE UPPER PORTION OF TMIS FORM Willi YOUR TAX PAYMENT TO TIlE REGISTER OF WILLS. MAKE CHECK PAYA~LE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: ANtl A SUlLIVAtl 22 GlEtlDAlE DR MECHAtlICS8URG REGISTER OF WIllS CUM8ERlAtlD CO COURT HOUSE CARLISLE, PA 17013 PA 17055 "nount R.",ithd - -- CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .. ifE"v: is'4-j -EiC AF p-- i i z: 94 Y -Heir i CE - -ci F-YNHEij if ANCE- TAX -X" PPRii is EH€Hi" -;-AL.i"ciWAtfcE- oR" -- -- - on - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DILLER WILMA M FILE NO. 21 94-0797 ACN 101 DATE 02-28-95 TAX RETURN WAS, I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGItlAl 1. R..l Est.t. (Schedule AI 2. Stocks and Bonds ISchedule OJ 3. Closely Held stock/P.~t".rship Inter..t (Schedule CI 4. Harig.g../Not.. R.c.ivable ISchadula 0) S. C.sh/Bank Daposits/Hisc. Pa~lonal P~ope~ty ISchadul. E) b. jointly Ownad Proparty ISchadula Fl 7. Transf.rs CSchadul. Gl 8. Total Ass.t. CItANGED (')0 S r-. 00 ~')~ .00 ,00 ..:, .00 W I" 18.846.35 'J] .00 . , . DO r _) ), '. 18)'" -,' 0 3,435.63 :0 ",nill . " III 121 131 141 151 Ibl 171 V' 18',846.35 APPROVED DEDUCTIONS AND EXEMPTIONS: q. Fun.~.l Expensa./Ad", Cost./Hisc, E.pen... (Schedule Hl Cq) 10. D.bh/Hodgag. Liabilities/Liens ISchedul. II 110) ,00 11. Total Deductions Ill) 12. Het Value of Tax Return 112) 13. Ch.rihbl./Gov.~nlltant.l Bequests .Schedule J) 113) 1... Het Vdua of Estat. SUbject to Tax 11..) NOTE: If an assessment was issued previouslY, lines 14, 15 and/or 1&, 17 and 18 will reflect figures that include the total of All returns assessed to date. ASSESSMENT OF TAX: 15. AMount of Line 1.. at Spous.l lb. Anount of Lina 1.. t.~.bl. at 17. Anount of LinB 1.. t...bl. at 18. P~i"cip.l Ta. Due 3.43, 63 15,410.72 .00 15,410.72 ~.h Line.I/Cla.. A rata CDllata~al/CI... B rate 1151 IIbl 1171 .00 X .03. 15,410.72 X .06. .00 X .15. 118) .00 924.64 .00 924.64 TAX CREDITS: PAYMEN~ DATE 12-07-94 I DISCOUNT 1'1 INTEREST I-I RECEIPT NUM8ER MM913265 AMOUNT PAID .00 924.64 TOTAL TAX CREDIT I BALANCE OF TAX DUEl I INTEREST I : TOTAL DUE 924.64 J .00 i .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR) J YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I t- :;-15--/ ""-t! Ii, I , I j ,~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: \~llma N. Dl llnr 'er ~I.) flf'll 20 '010 :0'_' Date of Deathl O/11/9~ elL CUIllL!., 219~-0797 ,,;rt " PA Will No. Admin. No. 199~-00797 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration o[ the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer Js No, state when the personal representative reasonably believes that the administration will be complete I 3. If the answer to No. 1 is Yes, state the following: a. Did the personai representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) [or the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. , '\ ":~" ,\\) .,", ','- Date: ~/17/95 , ( ) " " Signature Ann A. SUllivan Name (Please type or print) 22 Glnnc1aln Dr. --l4t:lchanl~~h"r'J, t'~ '7055 Address ( 717) 766-1~36 ')'el. No. Capacity: X Personal Representative Counsel for personal representative (MAli: rmUAM3)