HomeMy WebLinkAbout94-00841
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PETITION fOR PROBATE and GRANT OF LETTERS
&/ale of .cJJl:\Q1:lf..LlClttlEJtiQ-bfu. ....C),l~(l_tf - _8!IJ
a/so knoll'lI as .__.__________._..._.... To:
________._u.______ ._..Jti'~w.~(';i ~'~I~:I~~~,r (';r ~:~~~W~C~_ in the
Sc~'lul S~.l'lIrlty..N~:..]bQ:..~l[.-L':1bj--~ ('omlllonwealth of I'ellnsylvllnla
TIll' pel It Ion of Ihe undersigned respeclfully reprcscut.s Ihlll:
Your pelllioller(s), who i.s/tuc IH yellrs of IIge or older lIulhe c),fcu1.c.w.-- nlllJ1~d
in Ihe IIISI wlllollhe IIbove de,'edel\l, dllled ._..............._.... .. t:..L1r:J.. l' .. , 19~
IInd codlcll(s) dilled .____.__.___._._.u...mm_.._.._ ..---..........-.------..-.-----
--------_..---------~_._._+-_.._---~---.--_.._--_.__.
----------_._-~---~_. -----...-.__.__._~ --------
('Ull~' rCIc\'lllll f.:irl'l1lmll1IKC\, c,~. r~'11I1ndali(ll1, tlCillh Ill' C'CClIlnr, CII.',)
Decendenl was domlcll,'d III delllh III ___c. umb.lL~..m. .__._. ('OlUllY, Pennsylvllnla, with
h~_ IUSI flllllily or pr\1n~111 residence IlI_LEActC..!-iUl~?lOb..1:l0r::nf.....-..
__ .... et E\ .sL_(ArnehllL\_.ccUR.k~_eA----l.2.Q.1L.
(li\1 'lr~l'l, 11ulIlh..'r and 1IH111I.'ipality)
III Deeelldenl, Ihen...9~rtk'll~ Of~r;j~Yf}~~:~L_~:_=:_IL9A:--:
Excepl as follows, decedenl did nolmarry, WIIS nol dil'orced and did nOI hal'e II child born or adopted
lifter execution of Ihe will offered for prohale; wa" lIot Ihe I'ictim of a killillg alld was lIever adjudicated
IlIeol11pelenl: .________.___...___.._......_.. ............. ....-.-.......-----
Deeendental dealh owned propcrty wilh eSlilllllled I'alues as follows:
(If domiciled in Pa.) All persolllll property
(If 1101 domiciled in I'u.) Persollul property ill I'ennsylvullia
(If not domiciled ill I'll.) Personal properlY in ('ollllly
Value of real eSlale In Penllsyll'lIl1la
silualed as follows: ....____.__~__.______......
$ ..Jbhffi. 00_
$
$
$
WHEREFORE, petilioner(s) rcspeclfully IN\lel~J(sl tile .prohllle of the IlIst will and eodlcll(s)
presemed herewilh alld the grlllll of lellers_J!:.sJ.':I.~~.N AR y
(1\:,lllIllCllliU)'j itdl11lnl\lrlllilll1 C.l.ll.j udl11lnlmllllon d.h.n.c.I,Il,)
Ihcron.
~
5
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~ 0
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iil
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_S.LJO.~lI.. 6.jf/-l.L~
__.. W/2..fidLf/i; _..L.7.!HL__
...__712.':'_':'Z l...:..._'i.Q.lL___....
..._...___.._____ ..__._.____~___ _.__.._.____."__n ,..___ ~_~__.___
_._-.----~----------~_..._._- -------... - -------..-- -- .._-
OATH 01<' PERSONAL IU<:IJRESENTATIVE
COMMONWEALTH OF PENNSYLV ANI A I l:ll:l
COUNTY OF CUMBERLAND _...._u..... r ..
The petllioner(s) IlhOl'e'lIl1med swear(s) or uffirm(s) Ihllt the sllllemenls inlhe foregoing petilion arc
Irue IInd corrcellothe hest of Ihe knowledge alld helieI' of pelilioner(s) nnd thai as personlll represen.
latil'c(s) of Ihe ahol'e decedent pelilioner(s) will weiland Irllly adl11illi~ler the eslale lleeording to IIIW,
,/) /:,jJ /\ I ; / 1 d J.) )
SW~lHl 10 (~r arrirm3~ ~"d .suh.scrihed t .y..d{JJt..).L.(^..ultJL~ ~.
helore me 11\1.1... ..... Tu ..... day 01 .... .. .. ..........--~- ~l
~~~~ ~~~~LS. ~)~;.~ftf (l~~ . ... ..:~~~.~::.==~-..:== !
I ~(-. ;..);) ,\\.. Lt",
REV.llOO EX. 1'.941 I
~.:.~~.' INHERITANCE TAX RETURN
,~W RESIDENT DECEDENT
COMMONWEAlTIl OF PENNImAN,. (TO BE FILED IN DUPLICATE
nfPARTMENT Of REVENUE (J 1...(
IlAR.RIlf~:bJ~\9h~~60!. _.WITH REGISTER OF WILLS) u COUNIY CO)>E .J.-L YEAR.. NUMBER
OtClDU! '$ NAMfllA!ll. 'lit!!', AJW MIDOlf INITIAII OfctO NT'!. COMPlHf ADDRESS
t: -_.-.-.....hLdl.h.t."b..\.:y~e::LI--...u-.cLLhl.lJs.-..[.... 1.1.\,1,., IVU"""l /lvlll('
to !OCIAL SECURitY NUMIU . O,,1t Of DEAlt. DAIf (If ftlRTtl .
~ _lie. ?...I?.._.(~:(LL2___n.L'd..~~_ XlL[__.!.tJ.!.~, I_(!~~. .'. c:,:,'(I'II('_~~::;J~~I'll!l~~u__..____.___
Q {II U'\I(~llIJ 'Uhl~"lc. \'O\JU' IWIIIlJ,~', II~U MH> ~loDilllllrlJ,11 SOCIAl SECURITY NtMIER AMOUW RfCfIVlO ISH INSTRUCTIONSl
--____ _____________ _ ~ __ __ ___ _ _ .__n __ ________ ~__ ___..._ "no.. ._u..______...__._.__,________._____~____._
~ I. Original R.turn [] 2. Suppl.menlal R.turn [ I 3. R.malnder R.turn
..!i::! Ifar dot.. of d.ath prior 10 12.13.B21
bllEu [] 4. L1mll.d Ellal. 1..140. Fulure Inler..1 Campramh. 1.15. F.deral E'lal. To. R.turn Roqulred
5li! il Ifor dol.. 01 d.ath aftor 12.12.B21
!i [] 6. D".donl DI.d 1"'0" [I 7. Decedenl Maintained 0 living TrUll ._ B. 10101 Number of Saf. D.palll 8axII
(Allach copy of Willi IAllach copy of Trulll
ALL CORRIIPONDSNCI AND CONPlDINTlAL TAX IN.ORMATION IHOULD II DI.1eT11) Toi
J..... N:rnr- COMPLnf MAIliNG AOORf S
~i ._-=8Br~Qt<-'~.J,:S[{Jf.Fe.K___H____..__. (.)~/; ~.I T,J,n' SD11 V('
Bf lHfPttONf NUMlHA - - r!?: Cl ..
---..- __'JaJ]Gd;~'/0L._ ...c..~~~.=..=~~~=~~~~ill1.HL.l:b~~. 4ll7C~-.~l-
I', "'}.)
1. R.al Ellal.ISch.dul. AI 11 I. ........:.-..:....~..m.......'....-...... .,.,' ';,
2. Slock, and Band'ISch.dulo B) 12 I ..-...../-1,_:.>./l,-"'.'(......... :.:: .' I.
. ,.
3. ClalO'y H.ld SlacklPartnerlhlp Intor"IISch.dul. q 13 I .--....-----___.. ,.J
4. Martgag.. and Not.. Recelvabl. ISch.dulo D} 14 I ._.. .._..._....._.......,.._._..__..... . .L"
5. Ca.h, Bonk D.pa.III & MI".lIaneoUl Po"anal Properly 15 I ..._........~~IH.L.2.z...___ . cr.,:
ISch.dul. E) '.J
"i,
6. Jointly Ow nod Properly ISch.dul. FI 16 I ......_.__..____....___ :", '
7. Tro"III' ISch.dul. GI ISchudul. LI 17 I .___...30,.~.lf.J.!.ll!L_
B. T 0101 Grall AIl.II (10101 lln.. 1.71
9. Funeral Expens"" Admlnhlralivo COlli, Mlscollaneoul
E'pen,o, ISch.dulu II)
10. D.bll, Martgag. lIablllll.., lien. ISch.dul. I}
11. Iota I D.duetia" I'atallln.. 9 & 10}
12. NO! Value of Ellalolllne B mlnUl line III
13. Charltabl. and Governmental B.~u..l. ISch.dul. JI
14. N.t 'yalue SuLi"lla 10' Illne 12 mlnUl line 13}
15. SpoUlal T ran"er. Ifar dot.. 01 d.ath afler 6.30.94)
See Inllrucllonl for Applicable Percenlage on Reverte
Sid.. Ilnclud. valu.. !rom Sch.dul. K or Sch.dul. M.I
16. Amount of line 14 taxable 01 6% rate
Ilncludo valu.. Iram Sch.dul. K or Sch.dul. M.I
17, Amount of Une 14 taxable 01 15% rale
I'nclud. valu.. from Sch.dul. K or Sch.dulo M.I
lB. Principal to, due IAdd 10' from lln.. 15. 16 and 17.1
19. Credill Spoulol Poverty Credit Prior Poymenh
.........._..._..._..... + ....._..__ +____n... -._.._____.
20. If line 19 I. grealer Ihan line I B, enlOr Ih. dlfferen" on line 20. Thlt I. Ih. OVIRPA YMENT.
riD
21. If line lB II grealer than line 19, .nler Iho dlfforen" on line 21. Thl,I.lh. TAX DUE.
A. hler Ihe Inlerell on th" balance due on line 21A,
B. En"r Ih.latal of line 21 and 21A on line 21B. Thh h Ih. BALANCE DUE.
Mak. Check Pay~bl. ~OI Re!l.t,,_ o! V'!!"', ~!~...
I, .. . II IUIlI TO ANIWIII ALL QUIITIONI ON RIVIIIII IIDI AND TO RICHICK MATH <II( <II(
Under penallll1 of perlury. I declare Iholl hove e)(omlned Ihls relUln, IncludIng accompany'lng schedules and stoltlmenll, and 10 lhe best of my ~nowl.dge and bell.f,
It Is IruI, correct and complete, I declare thai all reall1lole hOI been reported otlrue markel value. Dflclarallon of preparer olher than Ihe plnanal reprlltnlallve II
baled on.olllnlormollon of which prepOfer has any knowledge.
'ION Al . / PI~'gN .. ~'O~Y'fiJ;:\I':'j"U:N -......AilD(TIS-~-:--.I-~-...;.--_.- ----(..,----// if (fI -- OAlI.) I. II \ C
SIONA"~"' 0; Pltt'PARElt o~ Ttf~r~..RE,h{(~\l~v.f...J_.~-~ODiilf~S~~)~~~-----.-.-.I~!..~~.~.+j2LL~_t._... .._.._(Ji!..y~__J.___~______ DAii"5J.-~~-~Li..~-
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'OR OATIS 0' DIATH AmR 12/3' /91 CHICK HIRI
I' A SPOUSAL
POVERTY C~"!lI'ill_~!.AIM!.!l_Q......._._.._
P1Li'Nu'M--'u .
Q3 g... t..,
;.;',-/ (
~. ,(' \
'.
,~ .')
. .'
: <\1
~'; C'J
.....
19 I__....__.tlD..5 LI....QQ_
i>:
\0
/'1 C/.I 'Yf',
I B} .......:?_,,~LiL__
1101 ______..________
1111 __l1~;L', 00.__.
lJO 7Q''''' 10
1121 ..--LI,_. CJ.' .
1131 ______.____
Ll<l 001 '1 r,
1141 ....,...!..\,....I.L......
1151 ._.__..___._..._.._.___~._..
1161 __.___.__.____~ .06.
1171 HnLj3,~klJ~7_0 _.__.~ .15. _....:.Z!:l.zhd~; ._.__
i 1 BI ..___L~_8(a.:..~~_______
Dhcounl
lnleroll
1191 ___...__.______
1201__..__________
(l!I'd!. liNt' if you Ot(, 11'CJlIl'\lIllg CI H,fllne! of you, UV(''1lUynH'1l1
.__J~.i.'KCo-,-U~; ..._._
1211
121AI
(21BI
I . , c:
It.- .S/oLL2.._..__..
.-.-__~____+__+__.._.__.___.._~___..____._.___H_~___ _..__________________. ..__~_.__..._ .._._...____.__+_.___._~____~___.___
""""" I"" ..J." SCHEDULE H
~ FUNERAL EXPENSES,
COMMONWEAL". 01 PENNIYLV.II" ADMINISTRATIVE COSTS AND
_ ... INtm:li'i~~lo~tM.U!r'~ ...._..._..__M..IS.~ELL.~~.~C?Us. ~.XPENSES ___ PI. a.. Pllnt or T'lI!.!....
ESTATE OF l1IIl NUMBER
___....... J:~bJt.lf'g_._t:....Llc.bte.\:\.be.y_geL_..-_.__.l.-_-
ITEM
NUMBER DESCRIPTION AMOUNT
~.-.--- -~.-_..._---_._---_.._-_. -. ~-_.--~---_._.~-----~-.~-----_.-
A. . Funllal IMp.nt.1I
1. Nus's(.,lmClYl F'unl'Y()/ !-!ume,:1i1('.
,
32l{ /-Iumh1~1 f'V~Y1\1e,
l,~h'''l\1n (', 'l'A . /7043
GViI"fSiJI' $l',vil'(! ('yo "I {
I .-In" '1011, Ur/l, COIL ilt'~le\"
/5<07. 00
B. Admlnlttratlv. Co.lI,
1.
Per.onal Repro,onlallvo Commllllon,
Social Socurlly Numbor of POllonal RoprolOnlollvo'
Yoar Commlllion, paid ..__.
2. ^"ornoy FO.I
4.
C,
1.
2.
3.
4.
5,
6.
7.
8.
-'
3.
Family exomptlon
Clalmanl ___.:.....__.
Rolallon,hlp
. Addroll of Clalmanl 01 docod.nl/ doath
Slrool Addroll _.._____.'
Clly ..____.___
.51010
. Zip Codo
Probalo F.o,
1.07,00
MI.e.llan.ou. hp.n.",
----_.__._.-~-_.._..._-_..---_..--_._----_._.-
TOTAL (Alia onl.r on IIno 9/ Roeapllulallon) S I Co 5 4. C10
(If more 'pac. I. n..d.d, In..rt additional .h..tt of .am. .1...1
RIVj.lB47 IX AFP (12"94'.
C AlIH Of P!HIlIYLVAHIA
PARlNEH! Of REVENUE
UREAU Of IHDIVIDU" IA'EI
DEPI. 210601
HARRIIIURO, PA 17121-0601
ISTATI! OF LICH1rnERGtIf'-cfIARL FILl NO.
DATI! OF DIATH 09-22-94 COUNTY CUMBERLAND
HOTE. TO INSURE PROPER CREDIT TO VOUR ACCOUNT, SUBNIT THE UPPER PORTION OF THIS FORN WITH VOUR TAK
PAYNE NT TO THE REGISTER OF WILLS. NAKE CHECK PAVABLE TO "REDISTER OF WILLS, ADENT"
REMIT PAVMENT TOI
1 L/. :J3K ~ 7
NOTICE OF INHERITANCE TAK
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAK
ACN
C;o1-)
101
DATI! 05-08-95
BROOKE L SHIFFER
655 S1 JOHNS DR
CAMP HILL PA 17011
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE, PA 17013
r
A.ount.-R..ltt.d
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ...
iiiV''- iS47 "Ex-Ai: p" il2":94"i -iiiiYici" -oil- "fNHEifi f A;fcE "YAx - A-P'iiiiiii sEMEiii'"; - ALi."ri'wANcE- iiA' --- -- - -" - -- - _.."-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LICHTENBERGER CHARLES F FILE NO. 21 94-0841 ACN 101 DATE 05-08-95
APPROVED DIDUCTIONS AND EXEMPTIONS I -
1,654.00
9, Funerol E.ponlu/Ad.. COlh/Nho, E.ponl.. lSohodulo H) (9)
10, Dobh/Nort.o.1 LllblllUu/Lllnl CSchodule I) 110) .00
11. Totol Doductlon. Ill)
12, Net Volue cf To. Roturn (12)
13, Chlr I hblo/Dovorn.onhl Blquo.h C Schodulo J) US)
14, Net Voluo of E.toto Subj.ct to To. 1141
NOTEI If.n ......mlnt w.. is.ued previou.ly, lin.. 14, 15 .nd/or 16, 17 .nd 18
rlfl.ot figur.. th.t inolud. the tot.l of abh r.turn. .......d to d.t..
ASSESSMENT OF TAXI
Ii. AMOUnt of Llno 14 ot Spou.ll roto (15)
16, A.ount of L1no 14 to.obl. It L1n..l/Clo.. A roto 116)
17, A.ount of Llno 14 to,"bl. It Collot.rll/Clo.. Brito (17)
IS, Prlnclp.l TI. Du.
TAK RETURN WAS. I X) ACCEPTED AS FILED
I ) CIIANOED
RISERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAI9I!D VALUE OF RETURN BA9I!D ONI ORIGINAl. RETURN
1, Rill Eatoto (Schldulo A) U)
2, Stock. ond Bond. CSchodul. B) (2)
S, Clo..ly Hold Stock/Portnlrlhlp Intoro.t CSohldulo C) CS)
4, Nort.o.../Notl' Rocolvobll lSchodulo 01 14)
i, CI.h/Bonk Olpc.ltI/HI.., Plr.onol Proplrty ISchldulo E) Ci)
6, Jointly Ownod Proporty ISchldulo F) 16)
7, Trln.foro (Schedulo 0) 17)
S. Totll A..ot,
()lJ
r: ri", \ri
:-, \11
I. . .00
.1
17.577,59 :\.:
,00 I
.00 (}l
3.141.27 .
, J!.!L: .
30 J8~-2.84 "/1
IN
IS)
,00 X .03.
.00 K .06.
49 , 907 . 70 K ' 15.
US)
TAX CREDITS I
PAYNENT
DATE
02-23-95
DISCOUNT Ct)
INTEREST 1-)
.00
RECEIPT
HUNBER
AA022864
ANOUNT PAID
7 ,486 . 15
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
-n
"qCl;
"
.,
111
S1,561.70
1 . ~G4 Q.Q...
49,907.70
,00
(,9,907,70
will
,00
.00
7,486.15
7,486.15
7,486,lS
.00
.00
,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN fl, NO PAVNENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), VOU NAV RE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS,)
\, ,
RESERYATION. E".,.. of dle'dlnt. dying on or blfor. Dla"b" 12, 1982 .. If .ny future Int.r..' In thl I.,.te I, tren'flrred
In po.....lon or enjov..nt to CI... . (0011,t,rtl) hen,flal,rl,. 0' the dlcld.nt .'t,r thl IMpAr.tlon 0' any I.tet. for
llf. or 'or v..r., thl Couon.tllth htr.'bY .lCpr.lIlY r...rVII thl rlllht to appr.ltl and 1"1" tranl'.r InhtrUenel TIIIII
It the I.w,ul Cl.~. a (00111',ra1) rlt. on any luch future I"t.r..t.
PIJRPOSE Of'
NOTICE I To 'ulflll thl r.qulr..."t. of Stotlon 2UO of thl Inherltlnci' Ind Elt." Tile Aot, Aat 12 of 1991. 72 P,S.
BlOtlon 2UO.
PAVMENTl Detlch thl top portion of thlt NoUn Ind 'ubllt with your Ply..nt to the Nlght,r of WHit prl"tld on thl river.. ,Id,.
-'"IIl. chick cr 110M' crdor po,olll. ,., REDISTER OF HILLS, ADENT
All ply-.nt. r,cliv.d ,hill ,Irlt bl applied to tny Int.r..t which "Y b, Out with any r....~r appl.ed to the tax.
REFUND (CR)I A r.fund of a t,~ orldlt, whlen w., not r'qulltld on thl T'~ Rtturn, .,y be rlqU.,ttd by ou.pl,tlng en "App.lcltlon
for Rlfund of PIMlylvanl1 IntlerltMCI and Eltltt T.~" (REV-UU), Appl1cltlanl I,. .vIUlbh .t the Offlo.
of the Rlgllt,r of Willi, tny of th~ 25 Rlvlnul Dlltrl~t Off 1011, or bv ollllno thl .peol.1 Z4-haur
tnlwlrlng ..rvlel nlAb,r. for for.. ord.rJngl In PIMIYlvant. 1'100-562-2050, auttlde PtMlylYlnl1 end
within 10011 Herrhburll erll (717) 717'1094, IDD' (717) nZ-lzn (twlrlng IlPllred Only),
08JE:CTtOHtI Any Plrty In Inhrllt not IIthUed with till IIf)prlhl..nt, ,UOWIflOI or dlllUOWtnol of dlduotlun., or ......tent
of tax (Including dhooUllt or Int.rut) II lhovn on thlt Notice tu.t obJlot within .lxt" HiO) din of rlellpt of
thh NoUc. bYI
uwrlU.n prottlt to the PI nlplrt.lnt of AIYenut, laird of APPIlIII, Olpt, 211021, Htrrhbur., PA 17121-1021, 0"
....lIcUon to hlVI the ..ttlr dlt"lln.d at luctlt of thl IcOOunt of thl perlon.1 rtprl"nt_UY., 0"
"-'PPIIl to the Orphln,' Court.
ADltIN
IITRAlIvt:
CORRfClIlIIII.
FtctuII errorl dhcoY".d on thlt ......lttflt ,Mold be .ddr...td In NrltI~ tal PA Deplf"tHnt of RIYenue,
luf"l.u of Indlvldull TlMII, ATTNI POlt A......Jnt A,yl.w Unit, D,pt. 210601, I'"rhburg, PA "121.0601
Phone (717) 717-6505. SII p.g, 3 (If the bookl,t "In.truotlonl for InhtrltlnCl TlIC Alturn for. Allldent
I*lldent" (REY-tsOl) for to upllNltlon of IdIlnlurltllllly corrtctlbll If"rort,
DISCOUNT I
If II1V tlM dUI II Plld Nlthln thrll (31 callnd.r lonthl Iftlf" the dle.dlnt'l dlftth, I flYI perclnt CliO dlsoount of
thl tlM Plld II 1110Ntd,
INTERUT I
Intarllt It chergld belllmlnll with fl"t dl'l of dllln~.noY, or nlntl (9) IKKlthl and OM (1) dlY frM thl dltl 0'
dI.th, to thl dltl of pIYlent. TllC" which He... delinquent blfo" Jll"IUer~ 1, 1981 beer Inttrlllt It the rttl of
.IIC (6:() ptrOlnt per tnnUI cllcullted It I d.llY rlt. of .000164. All tSM" which blo... delinquent on Il'ld Ift,r
JtnUlry 1, 1911 wUI bill" Int,,"t It I rite which wlIJ VlrY fro. o_l.nd" '1111" to a.hndtr 'III' with thlt retl
~Id bV thl PA D.p.rtltnt of RIYlnu.. The appllntbl. Intlr'lt rfttll for 1982 through 1995 Irll
'!!!!: Int,,"t R.tl DillY Int.rllt F"~'or !!!! Intlrllt Alt. D.11y lnt.rllt Fletor
1911 m .0001\1 1911 91 ,0001~1
1915 161 .0001S1 1911-1991 11:( ,000501
.9" III .000501 1992 9l ,0002\1
1915 m .000316 1993.19~ IX .000192
19" 101 ,00011\ 1991 91 ,0002\1
--Int,,"t I. c.leul_t.d .1 folluWl1
INTEREST . 'ALA NeE OF TAX UNPAID X HUHSER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
uAny Hotlel IlIued Ifter thl tl~ blCOMI d.llnquent will rtfll~t In Intlrl.t CllcullUon to fifteen (11) dlYI
beYond thl dlt. of U~ ........nt. If PIYHn' It .tdl .fhr thl Intlrut COllPUtlUon dltl lhown on thl
NoUn, tdcIltlon.1 Inttrllit IkJlt bi cllcul.ttd,
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Name of Decedent I ( 'r h ri r ~)2.J'~~
Date of Deathl (i- :<::< Yil
Will No.
STATUS REPORT' UNDER RULE 6.12 t.
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Admin, No. ~ . f 0_
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 I
1.
Stat? yhether adminl.stration of the estate is complete I
Yes.-x--. No
2, If the answer is No, state when the personal
representative reasonably believes that the administration will be
completel
3, If the answer to No, 1 is Yes, state the followingl
a. Did the personal representative file a final
account with the Court? Yes-></ No .
b, The separate Orphans' Court No, (if any) for
the personal representative's account iSI
c. Did the personal representative ~t.ilte an
account informally to the parties in interest? Y9S~ 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.
Datel ;;2120 19.5
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Name (Please type or print)
(.,S~'S1 :rC,j,V) \ [). C~l)~/!Lli/I (1/
Address ~ I
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're 1, No.
Capacity' ~personal Representative
(MAH Irmf/AM3)
_____Counsel for personal
representative
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