HomeMy WebLinkAbout94-00856
PETITION FOR PRODA TE Ilnd GRANT OF LETTERS
21-94- 3~~
Estate of NATHAN WORMAN, JR.
also known as
No.
To:
Reglsler of Wills for the
Deceased. County of Cumberland In the
Saclal SecllrflyNo. -, ( ") - , 4 . ;.., t- 1# ,J Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petltloner(s), who Is/are 18 years of age or older an the execuprs
In the last will of the above decedent, daled MoV 28.
and codlcll(s) dated
Leona E. Worman predeceased Nathan Worman. Jr.. havlnll died oJ.
named
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(uatc relevanl clrcuR1sumccs, e.g. rcnunclallon. death or cJI<<ulor, etc.)
Decendent was domiciled al death In Cumberland
h Is last family or principal residence at 116 November
(~"mprlpn Tnwn<hip)
County, Pennsylvania, with
Dr. Camo Hill. Pa.
(list street. number and munclpalhy)
Decendent, then 78 years of age, died Sept. 26. ,19 q4
at .
Except as follows, decedent did not marry, was nOI divorced and did not have a child born or adopted
after execution of the will offered for probale; 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 S 50.000.00
(If not domiciled In Pa.) Personal property In Pennsylvania S
(If not domiciled In Pa.) Personal property In County S
Value of real estate in Pennsylvania S
situated as follows:
WHEREFORE, petltloner(s) respectfully request!s) the probate of the last will and codlcll(s)
presented herewith and the grant of lellers tes tarl1l!ntar,l:
theron.
(testamentary; administration c.I.a.; administration d.b.n.c.t...)
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Mlchnel Allen Wormnn
~U4 West Maln ~treet
Titusville. Pa, 16354
522 S~rlnghOUSe Road
Camp ill Pa. 17011
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } as
COUNTY OF CUMBERLAND
Sworn to or affirmed a.nd subscribed
before me this 27TH day of
So te ber 9 9;
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Estate of
Nathan Worman, Jr.
, Deceased
DECREE OF PRODA TE AND GRANT OF LETIERS
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AND NOW OCTOBER 6. 19-11.4-, In consideration of the petition on
the reverse side hereof, sallsractory proof having been presented before me.
IT IS DECREED that the Instrument(s) daterl May 28, 1976,
described therein be admllled to probate and n1ed of record as the last will of
NAthAn Wnrmnnr .Jr.
and Lellers TeRtnmentnry
are hereby granted to Jared Nathan Worman and Michael Allen Worman.
Real.tc, Dr Will.
MARY C. LEWIS
Prey and Tiley
By Robert M. Prey #06274
ATTORNEY (Sup. Ct. t.D. No.)
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FEES
Probate, Lellers, Etc. ......... S
Short Certlficates( 4)..... ... .., S
Rel11lnclatlon ................ S
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ADDRI!SS
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COMMONWIALTH or PENNSYLVANIA. DEPARtMeNt 0' flIAUU' VITAL RECORDI
CERTIFICATE OF DEATH
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LAST WILL AND TESTAMENT OF
NATHAN WORMAN, ,m.
I, NATHAN WORMAN, .m., of 830 Dartmouth Street, In the City of
Harrisburg, Dauphin County, Pennsylvania, bl1inll of sound and disposing
mind, memory, and understandlnll. do Iwrnhy malIc, publish. and declare
this as and for my last Will and Testument, hereby revoking and making void
any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executrix to pay all of my just debts
and funeral expenses as soon after my death as may be found convenient to do
so.
2. All the rest, residue, and remainder of my estate, real, personal,
and mixed, and wheresoever the same may be situate, I give, devise, and
bequeath to my wife, LEONA E. WORMAN, her heirs and assigns, to the
exclusion of my children born and unborn, provided my said wife shall
survive me by a period of ninety (90) days.
3. Should my said wife, Leona E. Worman, predecease me or fall
~ to survive me by the aforesaid period of ninety (90) days, then In such event
all the rest, residue, and remainder of my estate, real, personal, and mixed,
and wheresoever the same may be situate, I give. devise and bequeath in
equal shares to my two sons, their heirs and assigns. they being Jared
Nathan Worman of Camp lIllI, Pennsylvania and Michael Allen Worman of
Elizabethtown, Pennsylvania, but should either of them be deceased then to
his Issue per stirpes and If there be no issue then such share shall lapse and
bo added to tho other sharc.
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4. Should any person less than 21 ycars of agc be cntltled to distribu-
tlon from my estate, in such event I nominate, constitute, and appoint,
Cumberland County Nationnl Bank and Trust Company. New Cumberland,
Pennsylvania, as Guardian of thc estate of each such person and authorlzc
and direct it to invcst the same and puy the incomc arising thercfrom together
with so much of the principal thereof as in its opinion is necessary or disirabl
to bc expend cd for thc proper maintenance, support, and education of such
person, to the person having eustody of such pE:rson. and upon such person
obtaining 21 years 6f age to pay to him or her the then remaining principal
together with any undistributed incomc.
5. I hcreby ntminate, constitute, and appoint,my said wife, Leona E.
Worman, as Executrix of this my last Will and Tcstament, but should she
predecease me or fail to qualify, then in such evcnt, I nomlnatc. constitute,
and appoint my said two sons, Jared Nathan Worman and Michael Allen Worm
as Co-Executors of this my last Will and Testament and I further direct that
none of them shall be requircd to post any bond to securc the faithful perfor-
mance of her or his dutics in the Commonwcalth of Pcnnsylvania or in any
other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
my last Will and Testamcnt, consisting of three pages, this 2Rth
day of
May', 1976.
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Signed, sealed, published, and declared by NATHAN WORMAN, JR..
the Testator above named, as and for his. last Will and Testament, in our
presence, who, In his prescnce, at his request, and In the presence of each
other, have hcreunto subscribed our names as attesting witnesses.
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REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUDSCRIOING WITNESS
Robert M. Prey and Debornh .1. r.hrlRlophnr
~
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that they wern present and saw
Nathan Worman, Jr.
the testa' or , sign the same and that they signed as a witness at the
request of tests' or In "Is presence and (In the presence of each other) (In the presence of the
other subscribing wltness(es)).
Sworn to or affirmed a d subscribed before
me this day of
9 94
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Robert M. Prey (Name)
5 S. Hanover SQ:~llS1~ PA ~7013
~htH'AJ .~ d~A./
Deborah J. ct6!'stqMlwe)
631 Gutshall Rd., Bollln\t Sprln\ts. PA 17007
IAddress)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUDSCRIBING WITNESS
(each) a subscriber herelo, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codlc
subscribing wltnesses20) th will presented herewith and
codicil
believe th signature on the will is In the handwriting of
tests'
(Address)
that
to the best of
Sworn to or affirmed
me this
subscribed before
day of
19_
Register
(Name)
(Address)
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b~o:,~A"O?2621. COMMOND~:~~~~T~: :~~~:YLVANIA
:..I_II'2IJI~'I. . OFFICIAL RECEIPT . PENNSYLVANIA INHERITANCI AND ESTATE TAX
.~.t,L:o_
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RECEIVED FROMI
&
ACN
ASSESSMENT I!'
CONTROL ...
NUMBER
AMOUNT
FREY ROBERT M
~ S HANOVER STREET
101
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CARLISLE PA 17013
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ESTATE INfORMATION.
~ filE NUMBER
U el-199lt-OS:56
~ NAME Of DECEDENT (lAST)
~ WORMAN NATHAN JR
II DATE Of PAYMENT
EI POSTMARK DATE
COUNTY
CUMBERLAND
DATE Of DEATH
SSN.717-1e-e663
(fiRST) (MI)
REMARKS
JARED N. WORMAN
m TOTAL AMOUNT PAID
MAR V C. LEWJ
REGISTER OF WILLS
SEAL CHECKIt Oe6
REGISTER OF WILLS
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Ii' ~ ~ INHERITANCE TAX RETURN
'!::~lii?;~~ RESIDENT DECEDENT
(OMMONW[A\I"'1" 'IVAN,. (TO BE FILED IN DUPLICATE
OI'AMIMINI VI "I ~IIWl I
"ARRI,m:~.~:;",')laobOl. i WITH REGISTER OF WILLS) COUNIY~()DE.. . . YEAR
o ~~~~'~~,"~'~;;;;~:M~l;~': ",,"All :lommtil;~~::;~~~~ Dr.
,oeiAi-!1cU"I".-tiim,-- l"Allilt"'Ailt' j"AII 01 ,1.HI' .' Cllmp 11I11, I'A 17011
717-12-2663,Scpl.. 26,.!~~~July 12,.!916. (""'. Cumb(!rl.llnd.. _n__..__
Kll. Original Rt!urn '1 5uppll'monlol Rolurn !'j J. Romnindof Roturn
Ifor dulol 01 death prior 1012.13.82)
[J 4. limited hlolC i 140, Fuluro Inlolo\l Compromisu r J 5. Federal estate TOil
If or doles of doath nflor 12.12.821 Relurn Required
I J 6. Decedent Died Tenlale L J 7. Decedont Maintalnod 0 living Tru,l !L B. Tolal Number of Safe Depolil Bou,
(AlIoch co y 01 W;U) (AlIoch copy 01 Tru,')
ALL CORRESPONDENCE AND CONFIDENTIAL fAX INFORMATION SHOULD BI DIRICTED TO. .;"
NAM'" Prey and Tiley --.------. I:~::;~I"~~~:~~r S\PA8J
~lIDMil'- -------.- Cllrllsle, PA 17013~ if;
717 I 243-5838 . .~__ ~.; ".
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1. Real E,'ate ISchedule A) ( 1) 0'. ...
2. Slack, and Bond, (Schedule B) ( 2) .....-.---.-.
3. Clo.ely Hold SlocklPorlne"hip Inloro" (Sch.d,le q (3) ...___. ..__.. . ..___....
4. Marlgoge. and Nolo. Recel,oblo (Schedule DI I 4) ..0...__.. ..__0".'
5. Co,h, Bonk Dopo,i" & Milcollonoou, Po "anal Plaportyl 5) ._._... _..u_g_9.,;J~4. 33_.
(Scnodulo E)
6. Jalnlly Ownod Prop.rly (Schodulo f)
7. Tran.fo" (Schodulo G) (Schedulol)
B. To.al Gran Ano" (Iololllno' 1.7)
9. Funerol Expen..s, Adrnlnlstrollyo COlh, Miscellaneous I Q)
Expen... (Schodulo H)
10. Deb", Morlgoge liobllitlo" lion. (Schedule II
11. Totol Deducllons (lufallin.s 9 & 10)
12. Net Volue of Ellol. (Ilno B minus line 11)
13. Charitable ard Governmental Bequos" ISchedule JI
14. Nel Value Sub ecllo To. (line 12 minu.llne 13)
15. Amount of line 1A taxable at 6% rote
(Include value, from Schedule K or Schedule M.)
16. Amount of line 14 loxablo 01 15% role
(Include values from Schedule K or Schodule M.)
17. PrincipolloK due (Add taK from/ine 15 and from line 16.)
1 B. Credill Prior Poymenll DllCount
57.58
+ -.---
19. II line IB I. greoler Ihon lin. 17, enler Ihe difference on line 19. Thl, I. .he OVERPAYMENT.
aD
20. If line 17 is g,.oler than Hne 18, .nler the difference on line 20. This Is ,he TAX DUE.
A. Enler Ihe inlerell on lhe balance du~ on line 20A.
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fiLE NUMBlR
21-94-856
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(6)__
( 7).
( B)
10,171.05
(10)_-
(II)
(12)
(13)
(14)
(15)
1!!.,193.28
)( .06 =
116)
)( .15..
(17)
Inleres'
(18)
(19)
Chock hare jf y~1J arc roques.ting 0 refund of your overpaymonl.
(20)
(20AI
(20B)
~.
B. Enler Ih. 10101 of line 20 and 20A on line 20B. Thl. I. Ihe DALANCE DUE.
Mak. Check Payable to: R.gllt.r of Willi, Agent
... ...BI SURITO ANSWER ALL QUISTIONS ON RIVIRSIIIDE AND TO.RECHECK MATH.... .' ,c.'." ....
Unde~ plnohil. of porj\.lry. I d.,clare Ihatl hovft ellamined lhil relurn, including accompanying Hhoduhll and Ilalemenll, and to Ihe bell 01 '"I I.nv:':;t.uu, ond belill~
.1 .1 !rue. co,r.cl and complele. I declare thai 011 rlal.sloll hcn been reporlld 01 hUI mar~el yolue. O.c1arallon of prepa,., Olh,r thon the p.rlonol repr"enlolive j,
bal.d on Olllnfori)'on of which pr.par., hal any ~nowl(ldge
\IGNAfUAf,Oi ~ASON iiTfpcH.UIBU fOA filiNG RnUAN AOOA(!IS n_ _____h__~____~____ nAn----- ...
~ N~.t AR[.~"1fmNTAliVl-..-.~~bMi'rl!lg!!<>.us-e .nO~!!,..Qllmp.llj!1.J~L\..17_01.L._. 6.PrcCL21,.1994
.. __.~~. It" "'!'7-- ... 5 S~ Ilnn~v~r .!>.I~e~~,_~llrllsle_""~~.~ 701~._ .____.. nD~:~I_,.~994
NUMBER
'0 :o~
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C"':l "1.Il
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... :.11
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10 ~. ~(tJ
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.. 0
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29,364.33
___...!.!!.t!71.05.
19.113...28
1 9,.lll:L.2.8
1.151.60
1.094'.02.
1,D94.02....
..._~,09~..02
.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (...) IN THE
APPROPRIATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use ar income af the property transferred, .......................................
b. retain the right to designate who shall use the property transferred or its income,
c. retain a reversionary interest or ....................................................................
d. receive the promise for life of either payments, benefits or care? .......................
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death
occurred after December 12, 1982, did decedent transfer property within one year of
death without receiving adequate consideration? .................................................
3. Did decedent own an 'in trust for' bank account at his or her death?......................
J'E~ .NO.
x
X
X
X
X
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1~"J\t.(). ~ SCHEDULE E
W CASH, BANK DEPOSITS AND
COMMQI<WfAUH 0' P1NNmVAI<IA MISCELLANEOUS
IHWII:,'l.C,'Jtc~~:~~'H PERSONAL PROPERTY
ESTATE OF
IlYUOflltlJl11
.,
Plea,e Print or T e
FILE NUMBER
NATHAN WORMAN, JR.
21-94-856
(All prop.rtv lolntly-owned with th. Righi of Survlvonhlp mull b. dlldo..d on Sch.dul. PI
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE Of DEATH
1.
Balance PNC Bank Checking accounl 1# 5140156536 opened 10/1/73
In names oC Nalhan Worman, Jr. nnd Leona Worman (died Jan. 1987)
Accrued Interest to Seplember 26, 1994
Balance Harris Savings Bank Certificate 1# 10-66-211365 dated
9-3-91, revocable trust Cor Jared N. Worman
Accrued Interest to September 26, 1994
Balance Harris Savings Bank Certificate 1#10-66-211366 dated
9-3-91, revocable trust Cor Michael A. Worman
Accrued Interest to September 26, 1994
Social security and retirement checks
Blue Cross check
1,116.82
101.37
443.57
71.00
39.00
8,500.98
9.39
2.
8,000.00
41.10
3.
8,000.00
41.10
4.
5.
6.
Blue Cross-Blue Shield check
7.
Erie Insurance, auto policy reCund
Erie Insurance, fire Insurance policy reCund
8.
9.
1986 Ford automobile
3,000.00
S 29,364.33
(Anoth additIonal 8Y-" )( 1110 .hUll If mor. .pot, I. n..d.d.)
I'NG l1.nll, N.A.
.I~.I~ C ~lllhh' I'i",'
(~I"'I"IiIl.I'A 171111
PNCIBANK
October 19, 1994
Frey & Tiley
5 South Hanover Street
Carlisle, PA 17013
RE: Nathan Worman, Jr.
Date of Death: September 26, 1994
Social Security No.: 717-12-2663
Dear Mr. Frey:
As per your request for information on accounts the above referenced
decedent held with us, the information is as follows:
- Checking Account No. 5140156536 opened 10/01/73 in the names of Nathan
Worman, Jr. and Leona Worman. Balance at date of death: $8,500.98.
Accured interest: $9.39.
If I can be of any further assistance, please do not hesitate to contact
me at (717) 730-2313.
Sincerely,
~Q~/
Drew J. Kishbaugh
Assistant Vice President
Bank Operations
DJK/es
.
. .
lDHARRIS'"
U SAVINGS BANK
11;lrris S;I\'ill).tS ()llC1rillillllS Cl'nlc',.
(;:15 Nnrth 121h Slreel
l.t~mll)'III!. l'l'llllsyl\'l1llia 1704:4
7l7l7:1I.1.\.l1l
717/7:11.1I~ .,11 FilS
October 13, 1994
Frey & Tiley
5 South lIanover Street
Carlisle, PA 17013
Thll information
Jr. Deceased
which you TllqUllctllri on the
(Zodnl Z,nr.urity llumb'lT
Account(o) of
717-12-2663
Nathan Worman,
) is as follown.
Sincerely,
~-_. '(/.~ /(:' /
.....(,.,..~-.-r.='"'1. AA.JI
Or tchen L. Calc
Customeer Service Technician
1IV.lSlIlltl'.UJ
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Ploa.o Print ar T 0
B
~:J~'91\
-~j);
COMMONW[Altll Of PfNN$VlVANIA
INHUITANC[ 'AllII:[Iu~';
lUIDfNIOlClDlNI
E
NATHAN WORMAN, JR.
21-94-856
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
Funoral bpon.o.,
Neill FunderlllHome, Inc., fllnerlll sCI'vlccs
Stephenson's Flowers, fllnerlll sprllY
6,795.00
178.08
1.
B. Admlnlstratlvo Call.,
1. Po"onal Roprelentollve Comml..lon. 0.00
Social Security Number 01 Pe"onal Reprelenlollve.
Vear Comml..lon. paid
2. Allorney Feel 1,468.22
3. family Exemption 0.00
Clalmanl Relotlonlhlp
Addr... 01 Clolmanl al decedenlr, dealh
Slreel Add,e..
City Slole Zip Code
A. Probale Fee. 103.00
C. Mlscollanoou. Expon.o.,
1. Camp Hill Plaza Apart men Is, October rent 535.00
2. Neurology Cenler, P.C., account 12.74
3. Montgomery Ward, account 25.48
A. East Pennsboro Ambulance Service, Ilccount 25.78
5. Orthopedic Surgeons, LId., accounl 5.04
6. A. Z. Ritzman, Assoc., account 6.65
7. Boscov1s, chllrge account blllance 14.95
8. Moffitt, Pense &: Llm Assoc., Inc., Ilccount 2.16
TOTAL (Allo enle' on line 9, Rocopltulatlon) S
,
(If mo,o .paco I. neoded, In.o,1 additional .hoeh 01 .ame .lle.)
. ,-....
. .
IlSTATIl OF
SCIIIlDULIl H
FUNIlHAL IlXi'ENSIlS,
ADMINISTHA'I'IVE COSTS AND
MISCHLI,ANEOUS IlXi'ENSES
NATIIAN WOltMAN, JIt.
FII,1l NUMIIIlR 21-94-856
ITEM DIlSCRII'TION AMOUNT
NUMBER
9. Pi'&L, eleclrlclty 10.81
10. Returned Socllll Security check 632.00
11. Beane & Assoc., Ilccount 4.44
12. A. Z. Ritzman Assoc., account 55.12
13. Inners-Davis Assoc., accounl 27.65
14. Bell Atlantic, telephone 33.58
15. Innes Chiropractic, account 8.38
16. Assocla ted Cardiologists, accoun t 192.46
17. PP&L, electricity 3.11
18. Missing Policy Services, account 4.00
19. A. Z. Ritzman Assoc., account 5.38
20. The Patriot-News Co., account 2.70
21. EKG Associates, account 4.32
22. Register of Wills, filing Pa. Inheritance Tax Return 15.00
TOTAL
10,171.05
-~~-----~~-:--~
,...--_.................\--.._'''....,~...."''.''''-''''...-~~,.=..'-<',.....,-~...<~
."
IIY,1I1111111111
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~
.JIlwU,lu Of ,hlll\ll."
IHHU.'...n ,.. 111111',
~.!~~~IN! O'CI~~H.I
SCHEDULE J
Ul:NEFICIARIES
ESTATE OF
FILE NUMBER
NATHAN WOllMAN, JIl.
21-94-856
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Talltobl. eequ..U:
2.
Jared Nalhan Worman
522 Sprlnghouse Road
Camp HI11, PA 17011
Michael Allen Worman
204 W. Main Street
Titusville, PA 16354
Son
1/2 residue of eslate .
1.
Son
1/2 residue of eslate
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests;
1. NONE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o onlor on Iino 13. Rocapilulollon) S
II' more spac' II n,.d,d, In,.rt addltlonol.h..t. of lam. 1111)
, '.",
~~'''.o..,*""",,,-,~''':'~~A,''''~
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It
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11
~
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e
,
,.
CERTIFICATION OF NOTICE UNDER RULE 5.6(0)
Name of Decedent:
..:r I) "".7
Nathan Worman, ,Jr.
Date of Death:
Scolember 26. 1994
Admin. No.
C.,
.,
C~
, :
'.\
Will No.
21-94-856
t,'.
~~,
,
"
,
To the Regisler:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court ~ules was served on or mailed to
the following beneficiaries of the above-captioned estate on
October 11. 1994 :
I
t.
J
Name
Address
Jared Nathan Worman, 522 Sprlnghouse Rd., Camp Hili, Pa. 17011
Michael Allen Worman, 204 West Main Streel, Titusville, Pa. 16354
Notice has now been given to all persons entitled thereto under
Rule 5.6 (a) except no exceptions
Date: October 11, 1994
~-t... "-"H 7
Signatur'3
Name
Robert M. Frey
5 South Hanover St.
Cllrllsle, PA 17013
Telephone 1117) 243-5838
Address
Capacity: Personal Representative
X Counsel for personal
representative
~"'5YEi';.. 2-
REV-1543 EX AFP rB-~'4)_
J CO"HONWEAlTH DF PEHHSYIVANJA
V DEPARTHEHT OF REVENUE
BUREAU or INDIVIDUAL JAMES
OEPT. 210601
HARRISBURO, Pi 17118.0601
/ y. .:L"g . /0
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE ND. 21 94-0856
ACN 9415562B
DATE 12-22-94
t(L
/
MICHAEL A WORMAN
APT 3
116 NOVEMBER DR
CAMP HILL
TYPE OF ACCOUNT
~ SAVINOS
CHECKING
TRUST
CERTIFICATE
REMIT PAYMENT AND FDRMS TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ESTATE OF NATHAN E WORMAN
5.5. NO. 717-12-2663
DATE OF DEATH 09-26-94
COUNTY CUMBERLAND
PA 17011
HARRIS SAVINGS DANK hu provided thl Dlpert.,nt with thl tnlor..tlo" lI,tld bllow which h.. bun und In c:elculltlnG the
potenttal tlX du.. Th,I, rlcordl Indlcet. thlt at thl d..th of the abov. dlCldlnt, yOU Wit. a Joint owner/beneflel.ty of thl. account.
If YOU '..1 thl, I"'or..tlon I. Incorr.ct, pl.... obleln wrltt.n corr.ctlon fro. thl fln.nclal Inltltutlon, _ttach . copv to thl. for.
and r.turn It to thl _bov. .ddr.... This ICCOunt la '...bll In accordanc. with th. Inh.rltanc. faM laws of thl Co..onwlalth of P.nn'vlvanla.
QUI.tlon. ..y b. &h.w.rld by calling (717) 7a7.a127.
CDHPLETE PART 1 BELDW M M M SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIDNS
Account No. 10-66-211366 Doto 09-03-91
Establhhed
Account Dalenca
Pe"cent TelCabl.
AMount Subj.ct to
Tal( Rat.
Pot.ntial Tal( Du.
To In.ur. prop.r cradlt to your account, two
ez) cop I.. of this notlc. .ust acco.Plny your
pay..nt to the A.glst.r 0' wills. Hak. chIck
payabl. tal "Rlglstar 0' Wlllo, Agsnt".
PART
ill
B.041.10
100.00
8,041.10
.15
1,206.17
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT BASED ON THIS NDTICE
K
To.
HOTEf Jf taM pay.ant. ara .adl within thr..
(1) lonth. of the dacadant.. datI of daath,
yoU .ay daduct a 5~ dl.count 0' tha taM du..
Any Inharltanca taM dUI will blco.a d.llnquent
nine (9) lonth. aftar tha dlt. of d.ath.
K
[CHECK ]
ONE
BLOCK
ONLY
A. c:J Th. abov. Infor.atlon and taM due la corr.ct.
1. You .ay chao.. to r..lt pav.ent to the R.gl.tlr of Will. with two copl.. of thl. notlc. to obtain
. dl.count or avoid Int.r..t, or YOU .ay ch.ck box "A" and r.turn thl. notlc. to the A.glltlr of
Will. and an o"lclal a.......nt will ba I.,uld by the PA D'part.ent of Rlvanu..
a. ~ Th. above as..t ha. be.n or will b. rlPort.d and ta. paid with the P.nn.ylvanla Inh.rltanc. TaM r.turn
to b. fll.d by the dlcad.nt., r.pr.'.ntatlv..
C. c:J The above In'or..tlon I~ncorr.ct and/or d.bts and daductlons wlr. paid by yOU.
You .u.t co.~let. PART ~ and/or PART [!] b.low.
If you indicat. . diff."ent talC "ate, pl.... .t.t. your
r.lationship to dec.d.nt,
PART
~
TAX RETURN . COMPUTATIDN
LINE I. Doto Eotobllohod
2. Account Dalenc.
5. Percent TalCable
4. Anount Subj.ct to T.l(
5. D.bt. .nd D.ductions
6. Anount Taxabl.
7. T.l( R.t.
8. Tal( Du.
CIAldJ5E ay~ 0 AAF
~PARTH~~ OF.~~~ENUE
Ki:j .; .. :, ~
~
PA
DF TAX ON
1
2
3 K
4
5
6
7 K
8
JDINT/TRUST ACCOUNTS
DEBTS AND
PAD
1
2
3
4
5
6
7
8
DEDUCTIONS CLAIMED
.... Ij_,
0
.
," ..~. ...... r
:, .~
~
"'r-~ ~ .." :.;::.,
r'."
u,
PART
[!]
DATE
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnt.r on Lin. 5 of Tal( Conputation)
I
.
Und.r panalti.. of par jury, I declare that the fact. I
conpl.t. to the b..t of ~y knowledge and b.li.f.
hava ".ported abov. .re tru., corract .nd
HOME (
WORK (
TELEPHONE DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFfICIAL TAX ASSESSHEHT with IPpllclbll Int.r..t bl.ld on Infor..Uon
lub,ltt.d by thl 'lnancl,l Institution.
2. Inherltancl t.. blco'" dlllnqulnt nln. lonthl .,t.r thl dlCldlnt', dlt. 0' d.,th,
5. A Joint Iccount I. ".Ibls aWln though thl dlCldlnt's n... WI' addld .1 . ..It.r of cORwln'lncl.
ft. Account. (InCluding tho.. hlld bat...." hUlband Ind vU.) which thl dlcedant put In Joint n.... within ana v..r prior to
d.ath .r. fullv t...bl. I' trlns'.r..
5. Account. ..t_bll.had Jolntlv bltw..n hu.band and wlf. lor. than onl v..r prior to d..th .r. not tl.lbla.
6. Account. hlld bV . dacldant "In trult for" anoth.r or oth.r. .r. t..,bl. fullv,
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A . If thl lnfor..tlon and coeputatlon In tha notlca ara corract and d.ductlon. .ra not b.lng clale.d, placa an "XM
In block MA" of Part I of tha "Te~payar Ra.pon.a" .actlon. Sign two copl.. and .ubelt tha. with your chack for the a.ount of
t.~ to the R.gI.t.r of will. of the county Indlc.t.d. Th. PA D.part..nt of R.~.nua will I..u. .n offlcl.1 ........nt
Cfore REV.15~e EX) upon racaipt of tha r.turn froe tha Ragl.t.r of Will..
2. BLOCK. - If the ....t .paclfl.d on thl. not lei ha. b..n or will b. r.port.d and ta~ paid with tha p.nn.vlvanla Inh.rltanca
T.~ R.turn fll.d bv tha dacad.nt'. rapra..ntatlv., plac. an "X" In block "I" of Part I of tha "T.~p'var RI.pon.a" .actlon. Sign ona
copy .nd raturn to the PA D.part..nt of Ravanu., ~ureau of Indlvldu.1 Ta~.., Dapt 210601, Harrl.burg, PA 17121"0601 In tha
.n~alop. provldad.
S. BLOCK C . If the not Ie. Infor..tlon I. lncorract and/or daductlon. ara baing clal.ad, ch.ck block "e" and coeplata Part. 2 and S
.ccordlng to the In.tructlon. below. Sign two copla. and .ub.lt tha. with your ch.ck for the .eaunt of taK pavabla to the Ragl.t.r
of Wills of tha county Ind.c.t.d. In."A U.part.ant at M.vanua will IlIua an o"lolal ........WI' (fu,. REV-15';O []n ~pvt, I.""I.,L
of tha r.turn fro. tha Raglat.r of Willi.
,
TAX RETURN - PART
2
- TAX COMPUTATION
lINE
I. Entar
HOtEl
the data the account originally wal a.tabll,hed or titled In the .annar ._I.tlng at data of d..th.
for a d.c.dant dvlng after 12/12/IZI Account. which the d.c.d.nt put In Joint n.... within on. (1) y..r of d..th .ra
ta..bl. fully.' tran.f.r.. tlow.var, thar. I. an ._clullon not to ._c.ad IS,OOO p.r tran.f.r.. r.gardl.'. of the value of
the account or the nueb.r of account. h.ld.
If . doubl. e.t.rl.k (..) eppear. b.fore your flr.t naea In the addr... portion of thl. natlc" tha 15,000 ._elu.lon
.Ir.ady ha. ba.n d.dueted fro. tha account balanca .. raported by tha financial In.tltutlon.
2. Entar the total balanca of the account Including Int.r..t accruad to the data of death.
S. Tha parc.nt of tha .ccount th.t la taMable for .Ich .urvlvor I. deter.lned a. lollow'l
A. Tha par cant t.~able for Joint ....t. .,tabll.h.d .or. than on. ya.r prior to the dac.dant'. d..th.
I
DIVIDED IV TOTAL NUHIER Of
JOINT OWNERS
E~aepl.1 A joint ....t r.gl.tar.d
DIVIDED IV TOTAL NUHIER Of X 100 - PERCENT TAXABLE
SURVIVING JOINT OWNERS
In tha na.a of the dac.dent .nd two oth.r par.on..
I DIVIDED IV 5 (JOINT OWNERS) DIVIDED IV Z (SURVIVORS) - .167 X 100 - 16.7X (TAXAILE fOR EACH SURVIVOR)
I. tha p.rc.nt te..bla for ....t. cr.atad within on. y..r of the d.cadant'. d..th or account. ownad by tha dacedant but h.ld
In tru.t,for anoth.r Indlvldual(a) Ctru.t b.naflclarle')1
1 DIVIDED IV TOTAL NUHIER Of SURVIVINO JOINT
OWNERS DR TRUST BENEFICIARIES
X 100 - PERCENT TAXABLE
E~a.pl.1 Joint account r.gleter.d In the nae. of ttl' daced.nt and two athar p.r.an. and e.tabllsh.d within one y.ar of d.ath by
tha dacad.nt.
I DIVIDED IV Z (SURVIVORS) - .SO X 100 SOX (TAXAILE fOR EACtl SURVIVOR)
~. Th. aeaunt .ubJ.ct to te~ (1lna ~) la detaralned by .ultlplylng the account balance (1In. Z) by tha parc.nt ta_.bl. (lln. S).
S. Entar the total of tha dabt. and daductlon. II.t.d In Part 3.
fo. The ....Ollllt "''OIlIhl11 flln_ "1 I_ rfat"r..ln.rf hv .ubtrlllcUnCl tha d.bts and daductlon. (lIna 51 fro. the ...ount SUbject to taM (1lna ~).
7. Ent.r the approprlat. taM rata (1In. 7) a. deter.ln.d balow.
A. for data. of daath occurring .ft.r 6/30/9~, tha ta. rat.. for tran.f.r' to .pou.e, ar. a. follow'l
1. Datel of d.ath on or aft.r 7/1/94 and b.fora 1/1/96 tha rat. Is 3X.
Z. Dat.. of d.ath on or aft.r 1/1/96 and b.fore 1/1/97 tha rat. Is 2X.
3. Dat.s of d.ath on or aft.r 1/1/97 and bafore 1/1/98 the rat. Is I~.
4. O.t.. of d.ath on or after 1/1/91 tran.I.r. to 'POUSI. wlll ba .~e.pt froe ta..
Notal For dat.. of d..th prior to 7/1/94 tran.f.r. to ,pOUs.. ar. t._abl_ .t 6X.
B. Tran.far, to Ilna.l de.c.ndant. Including fath.r, eoth.r, son, daughter, grandchlldr.n, .on.ln.law,
daught.r-In-Iew, ahpchl1d and th.lr luu. ara tauble .t .lK percant 16XI.
C. Tran.far. to all oth.r. Including broth.r, .Ist.r, unci., aunt, naph.w and nlec. ar. taKable at flft.an parc.nt lI5X).
D. If you chang. tha t.M rat., pi.... spaclfY your r.latlon'hlp to the dac.dant In the ar.. provldad.
e. The .eount of ta~ due (llna I) I. d.t.r.ln.d by eultlplylng the aeount taKabl. Clln. 6) by the ta~ r.ta (lln. 7).
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
AIlow.bl. dabta and d.ductlon, .ra d.tar.lnad a. folloWl1
A. Vou I.gally .r. ra,pon.lbl. for pay..nt, or tha ..tat. .ubJ.ot to ad.lnl.tratlon by . per.onal rapra..ntatlve I. In.ufflelant
to pay tha d.ductlble It....
B. Vou actuallY paid the debt. I'lft.r d.ath of the dac.dant and carl furnl.h proof of pay..nt.
C. Dabt. baing cl.le.d .u.t be Ita.lzad fully In Part 5. If additional .pac. I. na,d.d, u.a plain pap.r B I/l" M II". Proof 0'
payeant eay be raqua.tad by th. PA nap.rt.ant of R.vanu..
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDDI (717) 772-2252 (HEARING IMPAIRED ONLY)
L/l~1,\:i- \ . //
/ J /7'~
{tV-lS47 EX AFP (12"94*
COHHONW(AlTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE:
BUREAU Of INDIVIDUAL TAMES
DEP'. ll0601
HARAISIURO, PA 171'.'0601
(i3C/ -10
,
l 0"-'
ACN
101
NOTICE OF INIIERITANCE TAX
APPRAISEHENT. ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
03"06"95
FILE ND.
DATE DF DEATH 09-26"94 COUNTY CUMBERLAND
NOTE, TD INSURE PRDPER CREDIT TD YDUR ACCOUNT. SUBHIT THE UPPER PORTIDN DF TillS FDRH WITII YDUR TAX
PAYHENT TD TilE REDISTER OF WIllS. HAKE CIIECK PAYABLE TO "REDISTER DF WILLS. ADENT"
REMIT PAYMENT TO:
FREV 8 TILEV
5 S HANOVER ST
CARLISLE
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
PA 17013
AMount h..ltt.d
CUT ALDNO THIS LINE ~ RETAIN LDWER PORTION FDR VDUR RECDRDS ~
REWis4j"EX"AFP-"nZ:94"i"iiii'ficE--OF"i"tiiiEiiii';.;icE"YA'x"7iP"pii7iisEifEiiT~".Ai.i."oii;'NCE"ORm"mmmn."
DISALLDWANCE OF DEDUCTIDNS AND ASSESSMENT DF TAX
ESTATE OF WORMAN NATHAN FILE NO. 21 94"OB56 ACN 101 DATE 03-06-95
TAX RETURN WAS, I X I ACCEPTED AS FILED
RESERVATION CDNCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE DF RETURN BASED ON: ORIGINAL
1. R..l Eat.t. (Schedule AJ
2. Stock. and Bonda (Schedul. BJ
5. Clo..ly Hald stock/Partnership Int.r..t (Schedul. CJ
4. Horta.ga./Not.. Receivabl. (Schedule DJ
5. C..h/Bank Depoaita/Hilc. Parlonal Property (Schedule EJ
6. Jointly Owned Property (Schedul. FJ
7. Transfare (Schedule OJ
8. Total A...t.
CHANDED
00
~ "".00 ~
(" . DO
DO -,.
. ~
,DO ..~
29 .364.33 J,
~. .00
-0
:00
~L (81"
..-;4 ..,.
10.171.05
:0
:T.lm
~ r. 1")
-l ':
U)
(2)
(5)
14)
151
161
171
::_:'0;
~9'. 364.33
APPRDVED DEDUCTIONS AND EXEMPTIDNS:
,. Funaral E~pan.a./Ad.. Caat./HI.a. E~pan.a. (Schadul. H) I')
10. Dabt./Hartgaga Liabllitl../Lian. (Schadula I) 110) .00
11. Tabl Daduotion. (11)
12. Hat Valua of T.~ Raturn 112)
IS. Ch.rlt.bl./GoYarn~ant.l a.qua.t. (Schadula J) (13)
14. Hat Va1u. of Eat.t. Subjeot to Ta~ 114)
NDTE: If an aBBaBBmant waB 1BBuad prav1oUB1Y, I1naB 14, IS and/or 16, 17 and IB will
raflact f1guraB that 1ncluda tho total of ~ raturnB aBBaBBad to data.
ASSESSMENT OF TAXI
15. A.ount of Lina 14 .t Spou..l rat. (15)
16. A.ount of Lin. 14 t.~.bl. at Lina.l/Cl... A r.ta (16)
17. A~ount of Lin. 14 t.~.bl. .t Call.t.ra1/C1a.. a r.t. (17)
18. Principal T.~ Du.
TAX CREDITS:
PAYHENT
DATE
12-22-94
In.171 n~
19.193.28
.00
19.193.28
.00
19.193.28
.00
X .03_
X .06_
X .15_
(8)
.00
1.151.60
.00
1.151.60
RECEIPT
NUHBER
AA022621
DISCOUNT
INTEREST
AHDUHT PAID
1+1
1"1
57.58
1.094.02
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
1.151.60
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS TNAN .1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREon" (CRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
RESERVATION. e.t.t.. of d.c.d.nt. dying an or b,'or. D.c.~.r 12, 19'2 -- I' any 'utur. lnt.r..t In th. ..t.t. 1. tr~".rr.d
In po.....lon or .njoY..nt to Cl... . (coll.tlr.l) blnl'lcl.rl.. a' thl dlcld'nt .,tlr thl .xplrltlon a' any ..t.t. 'or
11'. or 'or y..r.. th. Co..onw'llth h.r.by ..pr...ly r...rv.. th. right to Ippr.I.. and ...... tran,'.r Inherltsnc. T.x..
.t th. I.wful Cl.,. . (coll.t.ral) r.t. on .ny such 'utura Int.ra.t.
PURPOSE OF
HOT ICE I To 'ulflll th. r.qulr..ent. of S.ctlon ZI~O of th. Inh.rltsnc. and E.t.t. Ta. Act. Act 2Z a' 1'91. 72 P.S.
S.ctlon 2140.
PAYHENTI D.t.ch th. tap portlon of this Notlc. Md .ub.1t with your p.y..nt to th. R.ghtlr 0' Willi prlnt.d on tlMl "vir.. .Ide.
H"akl ch.ck or ,only ordu p.yabl. tal REGISTER OF HILLS. AOENT
All p.y.ent. r,cllvld .hlll flr.t b. appll.d to InY Int.r..t which ..y b. du. with any r...lnd.r .ppll.d to th. t...
REFUND (CR)a A r,'und a' . t.. cr.dlt. which w.. not r.qu..t.d on th. T.. R.turn. 'IY b. r.qu..t.d by co.pl.tlna an "Appllcltlon
far R.'und of P.nn.vlvlnl. Inh.rlt.ncl and E,tat. T.." (REV-11IS). Appllc.tlon. '1'" .v.ll.bl. .t th. o"lc.
a' th. R.gl.t.r 0' Will.. anv a' th. 2S R.v.nu. DI.trlct Of'lc... or by call1na th. .p.cl.1 24-hour
an,w.rlng ..rvlc. nu.b.r. 'or for.. ord.rlnal In P.nn.ylvanl. 1-800-36Z.20S0, out,lde P.nn.vlvlnl. and
within 10c.l Harrl.burg '1"" (717) 787-80", TOO' (717) 772.2252 (H..rlng 1~.lred Only).
OBJECTIONSI Any p.rty In Int.r..t not ..tl.,t.d with the .ppr.I....nt, ,110wlnc, or dl..llowsnc. 0' d.ductlon., or .......ant
of t.. (Includlna dl.count or Int.r..t) .. .hown on thl. Notlc. .u.t obj.ct within .I.tv (60) d.y. of r.c.lpt of
thh Notlc. bYI
--wrltt.n prot.,t to the PA a.p.rt.ent of A,vlnu.. loard 0' AppI.I., alpt. 281021, H.rrl.bura, PA 17128-1021, OR
-..I.ctlon to hlv, thl ,.tt.r d.t.raln.d .t ludlt 0' th. ICCount a' th. p.r.on.l r.pr..entltlv.. OR
--.pp..1 to ths Orph.n.' Court.
AOftIN
ISTAATlVE
CQRRECTIDHSa
INTEREST.
F.etu.l '1"1"01'" dl.cov.r.d on thl. ........nt .hould b. .ddr....d In writing tal PA a.psrt'lnt 0' A.v.nu..
lur.eu of Indlvldu.l T..... ATTHa po.t A.......nt P.vl.w UnIt, a.pt. 28a60l, H.rrl.burg. PA 17128.0601
Phon_ (711) 181-6505. S.. p.a. S of tlMl bookl.t "In.truotlon. for Inh.rltsne. T.. R.turn 'or a R..ld.nt
D.c.dent" (REV-IS01) far .n ..plan.tlon 0' .d,lnl.tr.tlv.lv correctsbl. '1"1"01"'.
I' any ta. duI I. p.ld within thr.. CSJ cII.nd.r lonth. .ft.r the d.c.d.nt'. d..th, . flv. p.rclnt (5~J dl.count 0'
th. t.. plld I. .llowld.
Int.r..t I. ch.ra.d blalnnlnD with flr.t dlv 0' dlllnqu.ney, or nln. (,) 80nth. and on. (1) dlY '1"08 the d.tl of
d.ath, to th. date 0' pay..nt. T.... which ble... d.llnquent b.for. Janu.ry I, 1982 b..r Intl,...t .t the rat. of
.Ix C6~) p.rclnt p.r annu. e.lcul.t.d at a dallv rat. 0' .00016'. All t.... Which b.e..s d.llnquant on and .ft.,.
Janu.ry I, 198Z wIll b..r I~t'r..t .t I rata which wIll v.rv fro. cal.ndar y.ar to e.llndlr y..,. wIth th.t ret.
ennauncad bV tha PA D.part..nt of Alvenu.. The Ippllclbl. Int.r..t r.t.. 'or 1982 through 1995 11"'1
OISCOUNT I
'!!!! Inter..t Rat. Oel1y Int.,.ut Fie tor !!!r Intl,..t Ret. O.lh Int.rut heto"
l'U ..~ .000S"8 1981 .~ .000"7
1985 16~ .000U8 1988.1991 lU .000sal
1914 ll~ .000l01 1992 .~ .000241
1985 IS~ .000lS6 1995-1994 7~ .000192
1916 lOX .000274 1995 .~ .0002U
--Jntullt I. c.l~ul.tld a. 'ollow'l
INTEREST a BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. I..~.d .,t.r the t.. b.co... dsllnqu.nt will r.fl.ct an Int.r.,t Clleulltlon to flft..n (IS) dlY.
b.yond thl d.t. 0' the ........nt. I' pay..nt I. ..d. .,t.r th. Int.r..t co.put.tlon data .hown on the
Hotlcl, addltlon.1 Intlr..t .ust b. e.lculltld.
/ II .j 3 rr -It
CDMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
:J:NHER:J:TANCE TAX
STATEMENT OF ACCOUNT
c*
v
BUREAU OF INDIVIDUAL TAMES
INHERITANCE TAM DIVISION
DEPT. r806Gl
HARAISIURa, PA 17.2.-0601
IINtll"'".'','''
MICHAEL A WORMAN
522 SPRING HOUSE RO
CAMP HILL PA
DATE
ESTATE OF
DATE DF DEATH
FILE NUMBER
CDUNTY
ACN
08-05-96
WORMAN
09-26-94
21 94-0B56
CUMBERLAND
94155628
Anount Re..itt.d
NATHAN
17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTEI To Inaur. proper credit to your account, sUbnit the upper portion of thl.rorn with your t.K p.ynent.
CUT ALDNG THIS LINE ~ RETAIN LDWER PDRTION FOR YDUR RECDRDS ~
R'Ey:i(;iWEX-"Fji-COp}l.y--m-...--iNHiiiii:iiiic'E-fiiif-STATEHiftif-ii"-ACCoriN"T--jili.mm--mmmm-
ESTATE OF WORMAN NATHAN FILE NO.21 94-0856 ACN 9415562B DATE 08-05-96
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARV OF THE PRINCIPAL TAM DUE, APPLICATION OF ALL PAVHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT. 04-08-96
PRINCIPAL TAX DUE ._.
1,206.17
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
INTEREST IS CHARGED FROM 06-27-95 TO 08-20-96
AT THE RATES APPLICABLE AS ~UTLINED ON THE
REVERSE SIDE OF THIS FORM.M
TDTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST AND PEN.
TDTAL DUE
1,331. 60
.00
1,206.17
125.43
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN tl,
NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR),
YOU HAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. )
- t'":<It
't5 If) Jr.\..,
'iJ f'I
l'. (
'"
-
,.
ffi
1
d\ Ut:
to~ PDrtlo~o~thl' Notlcl
the rav.r.. .Id..
end lub.lt with your ply..nt ..de pIYlbla to thl n'" end addr.,'
PAYHENTI
"
(~; .1
<1JL:.:
0:
Detach thl
prlntad on
If RESIDENT DECEDENT .Ik. chick or lonlY ordu payabla tOI REGISTER OF WILLS, AGENT.
If HOH-REStOE:HT DECEDENT ,oka chick or lonay order pIYebl, tal COHHONWEALTH OF PENNSYLVANIA.
All ply..nt. r.caived ahall ba ,pplled flr.t to any Int.r..t which ..y bl due with any r...lnd., applied to thl tlM.
REFUND (CR), A r.fund of . tlM credit, which wa. not r.qua.tld on thl '1M Rlturn, ..y ba raqua.tad by coaplltlna an
"Appllcltlon for Refund of PannlYlvanla Inheritance and Elt.t. 'IKR CREY-lS1J). Application. .r. IVIllabla at
the OffICI of thl Rlgls'ar of Willi, any of thl ZS R.v.nu. DI.t~IGt O"lc.. a~ 'ra. th. Depart..nt'. 24~haur
IMsw.rlna ..rvlce nu.ber. 'a~ for.. ard.rlngl In pannsvlvanll 1~80a~562~ZD50, out. Ide P~svlYanll
and within local H.rrhburg Irla (711) 7a7~a09", TOOl (717) 77Z~ZZ5Z [fl..rlng IlIPalr.d onh).
REPLY TOI
Qua.tlan. reg.rdlng .r~ar. cantaln.d on thl. notice should be addr....d tal PA D.partllnt 0' R,vlnu" Bureau
of Individual TIM", ATTN. Post '....s..nt R.vl.w Unit, D.pt. 280601, H.rrl.burg, Pi 171,a-0601, phon.
(711) 717-6505.
DISCOUNTI
I' any taM due I. paid ~Ithln thr.. (5) Clllndl,. .onth. aftl~ thl dlc.dlnt'. d.ath, a flv. Plrelnt (5:<) dl.count
of tha taM plld la ellaw.d.
PENALTVI
Th. 15:< te. .an..tv non.pertlelpetlan p.neltv I. eOlputld on thl totll of th. t.. and Int.r..t .s.....d, and not
paid b.far. Januarv 18, 1996, thl fl~.t dey a,t.r th. .nd of thl tl. ..n.sty plrlad.
INTEREST.
Int.r..t I. cherg.d big Inning with flr.t dlY 0' d.llnqulncy, or nln. (9) .onths and onl (1) dav 'ra. th. d.t. of
d..th, to th. data 0' paVI.nt. T.... which b.e... d.llnqu.nt b.for. Januarv 1, 1982 b.ar Int.rlst at th. r.t. of
.IM t6X) parc.nt p.r ennuI calculat.d at a dallV ~et. 0' .000164. All t.... which b.c... d.llnqu.nt on,and .,tlr
Jenuarv 1, 198' will b..r Int.r..t et e rat. which will varv fro. cII.nder va.r to c.llndar v.ar with that rat.
announc.d bV the PA D.part..nt of Rlvlnu.. Thl appllcabl. Int.r..t r.t.. 'O~ 198' through 1996 Irl,
V.ar Intar..t Ratl Oellv Intar..t Factor V.a,. Intl,...t Rlt. Dallv Intlr..t Factor
1982 ZO~ .000548 1987 .~ .000'47
1985 16X .000458 1988.1991 11:< .OOOSal
1984 II~ .aOosal 1992 .~ .0ODZ47
1945 ..~ .000556 1995-199'" 7~ .000192
1916 lOX .00027'" 1995.1996 .~ .0002".7
ulntar..t I. c.lcuS.tld .. 'ollowlI
INTEREST a BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Anv HotScl I"uld aft.r the te. b.co... d.llnqu.nt will r.fl.et en Int.,.I.t c.lculation to ,I,tl.n (15) dav.
b.vond the d.t. 0' th. ........nt. If p.v.ant 1. aad. a,tlr the Int.,..st eo.putetlon dlt. Ihown on the
Hotlc., .ddltlonal Int.r..t ault b. c.lcuS.t.d.
v
/ '/.-013 Cj' _ 10
L
REV-1548 EX AFP (12'94*
COHMONWEAlTH Of PENNSYLVANIA
DEPARTHEHT Of Jt[V[NUE
BUREAU OF IHDIVIDUAl TAME I
DEPT. Zl060l
ItARAlsaURG, PA 17U..0601
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLDNANCE DR DISALLDNANCE
OF DEDUCTION .. AND ASSESSKEIfT OF TAX ON
JOINTLY "ELD DR TRUST ASSETS
DATE 11-20-95
COUNTY
ESTATE OF WORMAN
NATHAN
DATE OF DEATH 09-26-94
ESTATE OF WORMAN
NATHAN
DATE OF DEATH 09-26-94
COUNTY CUMBERLAND
CUMBERLAND
FILE NO. 21 94-0B56
S.S/D.C. NO. 717-12-2663
ACN
9415562B
MICHAEL A WORMAN
APT 3
116 NDVEMBER DR
CAMP HILL PA 17011
REMIT PAYMENT TDI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A.ount R..1tt~
CUT ALDNG THIS LINE .. RETAIN LDWER PORTlDN FDR YDUR RECDRDS .....
RE\i:i54-i-Ex--AFP--riif:94i.....------------.-........----.-------------_....-.----------....-..-..........----
NOTICE DF INHERITANCE TAX APPRAISEMENT. ALLDWANCE OR DISALLOWANCE DF
DEDUCTIDNS. AND ASSESSMENT DF TAX ON JDINTLY HELD OR TRUST ASSETS
DATE 11-20-95
ACN
9415562B
FILE NO. 21 94-0B56
TAX RETURN WAS,
S.S/D.C. NO. 717-12-2663
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT DR TRUST ASSET INFDRMATIDN
Account Bd.nce
Percent Texeb1e X
A',:Qunt Subject to Tex
Debt~ end Deductions
Texeb.\e Amount
Tex Rete X
Tex Duo
8.041.10
1.000
8,041.10
.00
8,041.10
.15
1,206.17
FINANCIAL INSTITUTIDN. HARRIS SAVINGS BANK
ACCOUNT NO.
10-66-211366
TYPE OF ACCOUNT, () SAVINGS ( ) CHECKING (~ TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 09-03-91
TAX '':REDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TD,
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST
TDTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
I IF TOTAL DUE IS LESS THoN II, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOn" I CRII YOU "AV SE DUE A REFUND.
SEE REVERSE SIDE OF TNIS FOR" FOR INSTRUCTIONs. I
INTEREST IS CHARGED FROM 06-27-95 TO 11-28-95
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
.00
1,206.17
46.18
1,252.35
PUIII'OSE Ol'
NOnCE.
PAYlEHTI
REf\ICD (CR>> I
OIJlCTZOHS I
ADftIH-
IITAAnVE
CDARECTZOHSI
blSCCUtTa
INTEREST.
e)l',
r:' ~,'.
:11
.,
,.
".
~
,',
..
, .'
[]'I
To fulfill the r~lre.ent. of I~tlon 2140 of ~ Inherlt~. ~ E.t,t. 'u Act, Act zz of 1"1. e" P.I.
IeoUon rUD).
Debch the top portion of ttlll NoUc. Md we.1t with your PI,.."t to the R..I.br of Willi printed on thIi
r.wr.. .Ide.
.. .... check or ...., or.r p._h tOf REGIITER Dr' VILLI, AGOfT.
All plw-'lb r.clty.. ....11 flr.t be ..-l1ed to MV Int.r..t .....tch MV be due, ..ath ....y r__Indlr ..,Ultd to the tax.
A r.fund of I tax credit, WItch .... not nque.tlld on the to return, _y _ ,....ted by cOIIPhtlng ... "'a,pllCIIUon
far A_lint a. ......."'1.,.,1. Inher'bnc. .. E.hlt, hll"' (REV-IUI). application. Ir. aV1Il1lbl. .t the QUieti of
the A....t.' of NUh, MY of tt.. ZJ Rwenue DII'rlot Dlflc.. or by caUlng the I9M1'l Z4.hour .,,.,.,1,,. ..rvlel
~r. for fa,.. ordering, In Penn.rlvenSa l-aaO-)6I.,050, out.lde penn.rlv"., .. within laclt
H.rrtabur, .,.. (717) 7.7..D~, TODI (711) 771-1151 ("--r1ng 1.,.lred Onl>>).
An>> party In Intar..t not ..ttlfled .,lth "'- ...nl...."t, aUOWWtCII or dl..lIow.nca of deduaUan. or ..........t
of t.. Unoludlne dlscCIU1t or Intar..U a. Ihawl an thl. Notlc. NY abJeot .,Ithln Ibty (6D) dey. of receipt of
th1l NoUu bYI
_.wriU., protut to the PA Dep.rt....t of R.v......, IcMlrd of Appeals, Dept. ZI1021, H.rrlsbUrg, PA 17UI-UU, OR
--.INtI", to hava the ..U.r deteralned .t the audit of the acc~t a' U. personal restr...,teU"., OR
--.....1 ta the Orph..... Caurt
F.ctulll "ran dllKlOV.red an this ..........t ahoUld tJ. IIddnued In .,,.11I,,. tal PA o.p.rt.."t of A.venue,
Bureau a' Individual'...., ATTN. Pa.t A.........t A."I.. unit, DEPT. Z10601, Harrl.burg, PA I1IZI.0'01
Phone (111. 717-'505. S.. page 5 a' the bookl.t "In.truatlan. far Inherltanc. ,.. Aaturn far. A..ldlnt
Decedent" CREV-ISDI) far an .Mplan.tlon of ~lnl.tr.tlv.l>> corr. t~l. .rrarl.
I' ...w t.. due I. p.ld within thr.. (5) c.lendar eonth. .,t.r the decedent.. death, I 'Iv. p.rcent ClX)
dhcDU1t a' the tu p.ld II .Uowed.
lnt"..t II charged beGI,.,lng .,lth flrlt d.y of dlUnquwMlW, or nine (t) aonth, end one U. d.y
f,.,. the data a' death, to the det. a' p'raent. ,.... which bee_ d.l1~t befora Januarw I, 191Z
bur Int"..t .t the rlt. of .he C'X) perclnt pi" ...... uloul.tlld .t . dellY rat. of .000164.
All t.... which bee.-. delinquent an or aft.r JWIUII,.>> I, 191Z will belr-Int"..t .t a r.t. whIch .,111 VIr>> fr_
e.I.....,. YMr to cllander Y"" with tMit rat. announced by thl PA Dep.rt.."t a' A...,anua. ThI ...lIe_l.
Intar..t r.t.. 'or 19.2 through 1995 .r'l
l:ur Int.r..t R.t. n.'lv Int.r..t FaatD" l:ur Int.rut R.I. D.llv Int.r..t FMltDr
1982 ZOX .00054. 191' OX .000247
1915 IIoX .0DD45' 1911-1991 m .000501
1914 IIX .000sal 19" OX .0aUU
1915 In .OOOSS6 1"5-1994 7ll . GaOltz
19" lOX . GaU7' I'" OX .aOOZ47
--lnt.r..t I. calcul.ted ., fall,"",
IIlTEIIEBT . BALANCE OF TAX UNPAID X HUKlER OF DAYI DELINQUENT X DAILY IIlTEIIEBT FACTOR
_.Any Notlea I..uad .ft.r the ta. blcoaa. delinquent will rafleat an Int.r..t calcul.tlon to 'I,t.." CIS) dlYI
beyond the dlt. of the ..........t. If papant II .-de .It.r the Int"..t cOlPUtatlon dIIt. Ihown on tM
Notle., IIddlt1on.l Int.,...t au.t b. calculated.
,",., ;,
... ,_'-~,""'''''--''''--,^,~.''-'''-';
,
..
. ,
.,-
L
1?',..,.. I~ ,,(/. M~~-r-'
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7I-u."j/,. II?' r~357
~
;:-, r'Jr",..t
i.~"'~"JL<1...........-.:,,.."~
\;Jd .,r.... pU\Jlloqwn::>
lm()~.;.IiO:lllll::>RcGoo's+~~ oj; w:fl.f
92;tliiOlllJU r,6. C~.-- (;:~/4Hd a..,....." O..nf.--/A du J'C.
, ,~,e;::r~ (/A /~a
. I
. SI\IM 10 J~\!;II"i1
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e,..
. r,
, ."
J./,qH'/St.
University of Pittsburgh
at Titusville
OjJicl! of77J1! Pl'l'Sitll!lIt
&O~ E. M.I"SI<..'
P,O. DOl 281
Tllu.yU'.. p~ t03~H281
81~.821.~~20
F..: 8IH21.~~~e
August 22, 1996
Register of Wills
Cumberland County Court House
Carlisle, PA 17013
This is in response 10 your letter to me dated August 5, 1996 (copy attached) informing
me of inheritance tax due on the eslale of my falher, Nalhan Worman, who died on
Seplember 26, 1994, As you can see, the letter stales that there is a balance due of
SI,331.60 which is composed ofSI,206.17 principal and S125.43 inlcrest and penalty,
Please be advised lhal this amounl was paid 10 your office on December 22, 1994 in the
amount ofSI,094.02 which represents the principal minus S58.58 for early payment. 1
have attached a copy oflhe inheritance tax return which was filed with your office as well
as a copy oflhe check in lhe amounl ofSI.094.60. I lrusl this sellles this claim.
Should you have further need 10 conlacl me. my address is 204 West Main Street,
Titusville, PA 16354. My office phone is 814.827.4420. Thank you for your attention to
lhis matter.
Sincerely.
~~
00 ~ ~:o
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I'" Jo8
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~j. .-+ ......
Michael A. Worman
'/hmsfol7l1illg tbr I'mrlll - Dircovrrillg tbr Flllllrr
-~Y"'ri>1~i\'::f(<:"T''i,:;>i!/'r,t:0'~~''';''-'
,
BUREAU OF INDIVIDUAL TAXE~
INHERITANCE TAX DIYISION
DtPT. 210601
HAlRJIIURa, PA 17121-0601
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT DF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
In.,,.,.. U'III.'"
MICHAEL A WORMAN
522 SPRING HOUSE RD
CAMP HILL PA 17011
DATE
ESTATE DF
DATE DF DEATH
FILE NUMBER
COUNTY
ACN
08-05-96
WORMAN
09-26-94
21 94-0856
CUMBERLAND
9415562B
Allount R..Ht.d
NATHAN
. I
MAKE CHECK PAVABLE AND REMIT PAVMENT TDI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE I To In.ur. propar oradit to your account, aub.lt tha upper portion of thl. for. with your tax pay..nt.
CUT ALDNO THIS LINE ~ RETAIN LOWER PDRTIDN FOR VDUR RECORDS ~
iiiV'=iliiri"Ex-"Fji-fjii-:96y------.iiii-iNifiiiiTANC'E--;:iiiCSTiifEH'E-ti;:-ii'F-liifcouiif--iii.--------------- ------
ESTATE OF WORMAN NATHAN FILE ND.21 94-0B56 ACN 94155628 DATE 08-05-96
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN TNE NAHEO ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE;
A PROJECTED INTEREST FIOURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 04-08-96
PRINCIPAL TAX DUE.. 1,206.17
PAVMENTS (TAX CREDITS),
PAVMENT
DATE
RECEIPT
NUMBER
DISCOUNT C+)
INTEREST C-)
AMOUNT PAID
INTEREST IS CHARGED FROM 06-27-95 TO 08-20-96
AT THE RATES APPLICABLE AS 'OUTLINED ON THE
REVERSE SIDE DF THIS FORM.K
TOTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST AND PEN.
.00
1,206.17
125.43
. IF PAID AFTER THIS OATE, SEE REVERSE
SIDE FOR CALCULATION OF AOOITIONAL IHTEREST.
I IF TOTAL DUE IS LESS THAN '1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOn" ICRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
TDTAL DUE
1,331.60
-'
.. ,
Ilv'toOl.. '1''',
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'(\AUUV",,j"'" 0' ""',I"VANIA (TO BE FILED IN DUPLICATE
~C''''"'''lu1 ~..~I ,at.""
.^,,,.fJU.. ;.-'il:" *' . WITH REGISTER OF WILLS) COUNIYCODI YIA~ NUMIU
I G?;::~~~~~~~:;:~;:~::,.."" 1"'"":';':-- -[-b~~~~~~~b:~ ~~O'I-:-== ..
. 717-12-266.3. .____~Pt. 26.. 199~gu.!1.12. J.~6. ~". Cumberland
~ ~ 1 ()"9 nol RC'urn C. 2, ~\lppr,,",'uQI R,rurn ~'1 3 R.",ginder Rt"",...
~I<C"S I [.' . t" (la, do'.. 01 dtolh P';OI'O 12.13.82)
. lu"",d hlo!. .0. f",f\ll' l"'f.,.1I Cvmpromiu O.s. ftd.ral f"ol' ro~
I (lor dolO, 01 d.o,h ohll 12.12.821 R.,.,. R.q.i"d
;: l . 0 Dtud,nt Dl.d "UOI, 0 7. D'(ldtl\l Moinloln.d 0 LiVing T,uI' !Le. Tolol Numb., of Soft O.poIl18olC"
<c (Alloeh (0 , of W;l1 (""och '0 y 01 T'."I
;. --~'t: CO.il~!.'~~DI~~!....~~~_-'~P1DfNT1AL TAX INFO.R ATlO HOULD' I _
i i . "AM' Frey and Tiley 5 sout~ Hanover Street
~ ~ r/l"H6N"iMilTr .-....----. Carlisle, PA 17013
._.. .. :...Ll~7.=.1._.J43-56~~ _ ... _.................,.._ "._,__.
I.. R.ol [,'0" {Sch.dul. AI . ( I) __".'"
I 2. S'oeh o.d Bo.d, (Sch.d.l. B) I 2)
J C10,,1. H.ld S'oCI/PO".."hlp I.'tI." (Sch.dul. CJ I 3) ..... _. .'__ '_
A MortW"9" and No". R.ul.obl. (Sch.d.l. DI ( 4) .._
5 en,.., Bo"~ O.po,ill & Mhullon.o"". P"lonol Prop.f1,1 ~t,
ISrl,'dul. e,
6. 10,MI, Owned Prop""r (Sch.dull fJ
7. lro..I." (Sch.dul. Gl (Sch.dul. lJ
II 10101 G'OH Atll't (toIQllin., 1.71
9 ,,-"'lefol E.p.,....., AdminilllOlly, Co,I.. Milt.llon,oul ( 9J_.
!.P'.'" (Sch.d.I. HI
10 Deb". MOflgbg. Lloblli1il'. Li.". r~ch.d"". I)
; 11 10101 D.duclion, I'olollln,. 9 & 10)
II? N,' \101", of Eliot. (IIn. 8 ",In II' Ii", II)
I ~ 3. Charirabl. orld Oo'urnm,ntol liquet" (Schldul. J)
_' tl~"~!!.. Volu'J.bj." 10 To. (U~_'2 ml.o, Ii.. 13)
IS Amo... 01 U.. 14 lonobl. Of 6,. rot. (15' ____ J 0 .103.28
(1I\c1\,ld. valu., "0,", 5ch.dlll. I( or 5chdult M.J
I' 6. Amount 01 Ii". 1. la.obl. ot 15% rQt.
(I.cl.d. .olu., fro.. Sch.d.l. K or $,h.dul. M.I
,.,. PunclpallOI du'IAdd to.. from lin. 1.5 and from lint 16.)
C',d.II Prio, Poym.ntl 01"0\1"1
_... 67.58
i 18 I.IO::I~_
119 ill,.. 18;. 1t0l., Iho. Ii.. 17, ..1., Ih. diH.,..ct o. Ii.. 19. Thll Ilrh. OVU''''VMINT,
foJI;1
1'0. If I.n. 111. gr,ol., Ihon Ii". 18. en'" the diff",nc. On IIn, '0. ,J,il I. the TAX DUI.
A f nl" the Ill'''''' on lh, balance du. on line 20A
BEnte, Ih, fOlol of lin, '0 ol\d 70A on IIn, 70e Thi. iI'h, DALANCE DUE.
M.~. Cht<k Pav."I. '01 II._h'., of WillI. A~.",
._ -'~~_~'-' .~I TO AN'Wn ALL QUa.nO,.. oN'ltiVau_IIDI ~PJ'~~~. ._ .._... ___
'lId" p.rtohih of P"I"")', I d,do" .hol I hove lJIomln,d 'hit 'f',,,n, InCrlo'CU"'j QCtompon)'i"D Ull,d",I'I o"d .tol.m,n',. Ipnd to I~. b'lllpf m)' ~no...ltdg, and b,lt,I,
i. "w., (Olllel and lo"'pl.,. I d.cla,. thai 011 ,.01 11101. hOI bun "po,,, a' t,,,,. morht yolue 0,,10'0110" 0' p,.po," olh., Ihon Ih. p.'lonol "pr..,nlaliv. i.
al,d 0" 011 i"'O,,,,oliol'l of whi,h p"par., hen a")' bowl.d",
"NAn,.. Of "'\n';,;fbr,.~..iJ.r, ,(\. fII.,.1'\.....tu..~ jl[tP~... ._~- . ...-- ......--. -- U..If----.........
~@j.'
II'.
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IIU HUMIIR
21-94-856
-.
.,...~':"
--..---:.
20.3UJL
( 61__
I 7)
10. 17.!.!.!1.L
(81_
2~.1_~64. 33
(101__.
1111 .......__~.0,~71~.05_
(121 ___..1JI.193.28
(131 _...... .._...
11 A I I 9.1Jl 3...2..ll.-
" .06. 1.151.60..
(16)
I( .15.
(17).---ctteCt:.. ~-G"
(1') 12.12.~tl_.1.094.0~...,
(19) __.____ .....
12DI
120AI
(20B)
.--.__..4o.U.Jl2 '"
"---"--1,094.0'2
......--.---..
t.m:TV.rt:t' .'~i'A"lt-o:",..fk '..,,;;-J"emrrh")'ittV. .
._522 SDrln~l1o~se Road. Cam\l.IUlh.f.A .7011
ADp.(u
.. ._5 S. Honovc~ _S_I~ec:~~~rllsl(l~!.~70~. ...._
~L.lHL
Dec. 21, 1994
"' . ".. . . .., -- .
,
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.
\
:"C:N"T:. r5Tgrq1c7~1:$ 7
K .."
0'2.
~'273/3t3
1
NAMI Eatat' of Nathan Worman, Jr. DATE
PAY 10 THE
ORDER 0/
Doc. 22, 1 ee4
Relrlster of WIUs I $ ['is,oo.. ._..1
Tbesumof ~~
PSC U.ftk, N,lion,1 Anoell,lon
~nU'hCC"lr'Ffilng lnh Tax Return
lAElAO .
21-94-868
.:0 U 3 ~ ~ Hal:
--..-. .-
coo JMOOCl6C --..,. ...,
ACCOUNT NO.
C ICK NUMalR
028
NAM! Estate of Nathan Worman, Jr'bATI
PAY 10 THE
ORDER or RORlster of WlUs, Allent
eGo12731313
$ r.... ~.'t...._.o#.
I '._~.t!!~~.~2... J
The sum of ~.Q2,t.s
PNC Dank, Natlon.1 Alloellllo"
Soulhctn\r.I..lA
lAllAO ~tato No. 21-94-~
1:0 ~ ~ 3 ~ ~ H81:
""..,-.--- -....... .-..-.. . , . <<........
CHECK NU ,."
027
00.'213/313
:"C=N"T':~. [1'# a(f;)'l~8.J 7~""
NAME Estllte Or Nathan Worman, JrOATE Dec. 22. le94
PAY 10 Tttl
ORDER Of
Frey and Tiley 1 S , 1;468.2.CJ
TheStlmo~mJ~~GUs
'NC Sank, Nlllon.1 A"ocl..lon
Sou,hccn'n' 'A
lAllAO Attorney'S foe
1:0 J , :t ~ ~? 3BI:
00l) INOQOt.& "'"'. ..,
ACCOUNT NO.
rS-?1 ~ IJcR ~c.f g.J 7 I
CH!C HUMSIIl
028
eGo'2731313
NAMe Eatate of Nathan Worman, Jr.
PAY TO tHE
ORolR or
DATE
Dec. 22. 1994
I $ , 2,133.63
The sum of 21 ~ ~ and 5 ~"t,S
J
Jared N. Worman
,
,
V /1./-- 6139 -jtJ
BUREAU OF INDIVIDUAL TAHES
l,*IERlTAHCE Uk DIVISION
";'-"JoT. ZlDU.
U'''lRlSIURO, PA 17UI-0611
MICHAEL A WORMAN
204 W MAIN ST
TITUSVILLE
COMMDNWEALTH OF PENNSVLVANIA
DEPARTMENT DF REVENUE
INHERITANCE TAX
RECDRD ADJUSTMENT
JDINTLV HELD DR TRUST ASSETS
DATE
ESTATE DF
DATE OF DEATH
FILE NUMBER
CDUNTV
SSN/DC
ACN
e.
*'
....111411'''111.11I
04-10-97
WORMAN
09-26-94
21 94-0B56
CUMBERLAND
717-12-2663
94155628
A.ount A..Hi.d
NATHAN
PA 16354-0000
MAKE CHECK PAVABLE AND REMIT PAVMENT TOI
REGISTER OF WILLS
CUMBERLAND CO CDURT HOUSE
CARLISLE. PA 17013
P~_!_ ~~.!I_t!~_!_'!!~__':.!tl.!L_____~____!l_~!~~!!._~.!I-'!.~~_!.!~~!_I_l!tl_!.l!~__~l!~!l__~~P_~~~.!l______:'!!.____________________
REV-1604 EX AFP (03-97)
__ INHERITANCE TAX RECDRD ADJUSTMENT JDINTLV HELD DR TRUST ASSETS __
DATE 04-10-97
ESTATE OF WORMAN
FI LE NO. 21 94- 0856
ADJUSTMENT BASED ONI
NATHAN
DATE OF DEATH 09-26-94
CUMBERLAND
COUNTY
S.S/D.C. NO. 717-12-2663
ADMINISTRATIVE CORRECTION
JDINT DR TRUST ASSET INFORHATIDN
94155628
ACN
FINANCIAL INSTITUTIONI HARRIS SAVINGS BANK
ACCOUNT NO. 10-66-211366
TVPE OF ACCOUNT, () SAVINGS () CHECKING (X) TRUST () TIME CERTIFICATE
DATE ESTABLISHED 09-03-91
Account Be1ence .00 NDTEI TD INSURE PRDPER CREDIT TD VDUR
Percent Texeble X 0.000 ACCDUNT, SUBHIT THE UPPER PORTION
Amount Subject to Tex .00 DF THIS NOTICE WITH VDUR TAX
Debts end Deductions .00 PAVMENT TD THE REGISTER DF WILLS
Texeb1e Amount .00 AT THE ADDRESS SHDWN ABDVE.
T ex Rat. X .06 MAKE CHECK OR HONEV ORDER PAVABLE
Tex Due .00 TDI "REGISTER DF WILLS, AGENT."
TAX CRED:tTS:
PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TDTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER TNIS DATE. SEE REVERSE FOR CALCULATION OF AOOITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN 11, ND PAY"EHT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CRfOIt" eCRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. I
.00
.00
o
"\
~
,
.
.
,
,/
PAYttEHTI
o.tKh the top portion of this NoUee Md 1ub4l1t with ytM.Ir Plyant ,Mia p.vable to u,. "... Md eddr...
prSnted on the rlv,,,,, .Ida.
.._ "M. chad( or RMY order p.vlttlla tOI REGISTER OF WILLS, AGENT.
REf1JHD (CAJI A refund of I t.. cr.ct1t, which w.. not nquutld on thl Ta. R.turn, ..y bl nquutld by CDlIPhUnt WI
RAppllcltlon far A.~ of Pennavl".".' I~rlt.nc. Md Elt,t, TI.- (REV-ISIS), application. .r. aval1~1. at
u,. OfficI of the Alllhta,. of ..Uh, 1In>> of the ZS Rlvenue Dhtrlot afflul or 'rOIl the D~.rtMntt. Z4-hour
en~rJnt ..rvicI ~r. for for.. ordering I In pennav!v."la 1-8DD-S6Z-ZDSD, out.ld. Pennlvlvenl.
Md within locl1 Harrl,burg .r.. (717) 7'7-1094, TOOl (717) 772.2252 (Helrlna I.alred only).
RfPLV TOI Due.tlon. nalrdlng .rror. cont.l".d on \hit noUe. ahould be ..sdnued tal PI Deplrtaent of RIVlInUtI, lur."
0' Indlvlduli Tlx", ATTHI POlt ,.....Mnt RIVII'" unit, Dept. ZID6Dl, H.rrl.burg, PA 17121-0601, ~
(717) 717-6505.
DISCOLIU.
If any t.M due I. p.ld within thr.. (,) c.I~.r ~th. .ft.r the dacedent'. d..th, . flv. p.rcent (SX) dl.count
of the t'M p.ld I. Illowed.
PENALTY.
The 15X t'M .-n..ty non-p.rtlclp.tlon pen.l~ 1. coeput.d on the tot.l o' the t.M and Int.r..t ......Id, ~ not
p.ld be'or. January 18, 1996, the flr.t d.y .ft.r the end of the t'M ..ne.ty ~rlod.
INTEREST .
Inter..t 11 charged bea1rw,sna with flrat d.y of delinquency or nine (9) aonth. and OM (1) day 'roe the d.ta a.
~.th to the dlta a. p.y.ent. TaM" which bac... d.1lnquent b,'or. Janu.ry 1, 1911 ba.r lnt.r..t .t the r.t. of
.IM (6X) percent p.r ~ caloul.tad .t a d.lly r.t. of .000164. All t.x.. which bee... d.llnquent on and ..t.r
Janu.ry 1, 191Z will b..r Int.r..t .t . r.t. which will v.ry fro. e.l.nd.r y..r to e.land.r y.ar with that rate
WWMM.InCed by the PA Dep.rt.."t a. A.venue. The appUcabl. Int.r..t rat.. 'or 1912 through 1997 .r'l
V..r Int.,..t A.t. D.l1y Int.r..t Factor y..r Inter..t Rat. D.Ily Int.r..t Factor
1982 ZOX .000541 1917 .. .000247
1915 1.. .ODOU. 19..-1991 llX .00OSOl
.... 11X .00OSOl 1992 'X .000247
19.5 In .00OS56 199'''1994 7lI .000192
1'" 10' .001274 1995-1997 .X .0In47
--Inter..t 1. c.lculated .. followsl
INTEREST . BALANCE OF TAll UNPAID X HUKBER OF DAYB DELINQUENT X DAI~Y IN.~EBT FA~DR
--Any Hotlc. I..u.d .,t.r the tlM b.co..s d.llnqulnt will r.'I.ot an Int.r..t c.lcul.tlon tv ,lft.en (IS) d.ys
beyond the dlt. of thl ........"t. If p.yant 11 lied. .U.r tM Inter..t co....t.tlon d.ta shown on the
Hotlel, addltlon.l lnter..t ....t be calculated.
.
.
_-I '_ _~._. '_'~_ __.,_'-.. _~
"V.1470"~"1
-
INHERITANCE TAX
EXPLANATION
OF CHANGES
. I
,
.
.
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
IURIAU 0' INDIVIDUAL TAXIS
DEPT. 2B0601
HARRISBURG, PI. 1712B.0601
DECEDENT'S NAME
'/11/1,.
Ai" I hI{ N
filE NUMBER I Y' - /
/ ('j ( . (u~ (,.
ACN .} .....:-/ (-
... '-I /,::J ......> /.5)2 ('5
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
m~& _-~'-~&2-"1-g, d~mm
---.-.,A1?-~~ty/.y..~..< <....4 . :,~. .._.(/'.2l.._~!-:~._~.
Vi? ';{'~
.. .----..---lf~~:t.-:. .{~f"(~.n. ..'" ,_I. ..,_,/j;/:::tb.~~.,____n-'_"--
._.._______._.__..~*_.._.. ,'_.". .'_ r ._____.__~__._ _."'.' ~ .-.- ".~_. -----.. -.-...-.... "- -- .- . .-- ._.---~.~._. ....-..._-...-._.~-_._-~--_. . .-_.~...'I'
.____~_._. ~ ___~.~... .__~__ .___~~. ._....~ *~ .~.__. ".,,__'> ...-__ _____ __ ~____... .._ ~. _._ __~. ____._._~_____._..._ ..__.~..._-.o-____".'_.'_"-~'_'~____
...._ ___. 4 ..__.._____________ _._.... ~....... _ _.., _..,._____~___..._,__.__,.____.___~ _.4.. .._ ~ *_.._._ _____~_._....K_...W...__.______.__
... _.-~..._----~ -----..... .~...~~-~._-- .._-~---------~_...,. ...,.'"'--~.... ~-~--------~.,._-._....--"'-----~--_.. ...-...-..."'....------ ~.....-.
__._____~_.__~~____...___~._....___...___~~___....__......_...__.~____.__._..____..~~....._________......._...____"'._'~__. ,,'_0/
- .. ----, - -...
_~___~_..........._..____..____.____~~~~_.r__...'._'_-_,.,.......__.__._...__..._~':-__,-,.,......'-_.............~-~_.__..__.......
.
-------~_.---....~ ----~-_..._-_..._....,..........--.-----+_......~~~------_..-------.-~_._._--""..._-.-----...:...-....----~._-~~- .-.-
"
.. '. ..... .,-." .--...'.
.._.___~.___,~_.~.__--:-__..:':'__.__...._...~.,___.".....;,_____~_...-'--~_....~....~.....'"'_~....__..o.--.-_~_~_...~. -""-_________----;--....,:~...,,-- --_...--
~_.__ ..__ __.~_.__~....~_~.__ _..~_._~..._~._~_._____._ ____~._..~...__... 4____~_____,..,...""..........4....__. _..c-.,-________-O;-..-:'"..;~__ -- ---.--.. ~~-
_ _ __~.__._.__,,".~. _~__"__. ~.___ __ __.;._.+_..~._" '_ _.. ~. ~ ..~__._ .___--:-__~____.~.,.,~ ..._.__~_.:~:.:..-~_ ~.. ,___.~.,__....4.__::.~:.....^_~__ _.___... .._"~
_~~.___ _._~~_~_...._... ___, ~.~._...__~__..._.. ~~,.. ,--___,.. _ _.._~.__,__ .~_________~.. _~~'C ...____..._____...--->__;~ __..'__.~,__~~.4~._ _ .__..._ ~ _~~.. .._~ ... -_. T
-" .~..." ....---..._-'_.. ~_. ".., -,..,..
. ". - .." -.- .~-."'- ._.",~_..--._'-~._' _.~ -. ...-.~~--
, ,~..~.
... _.~._ ___~_.__ ~_. _ ._.__~ u +.., H" . .____~______ .._ __ ~. ^
~ ...,.. __ _._._ _.~___ +____.~_. _'_'.~" . __ _____. ~._~..".. ~_' ~ ~__" ~ '." '.".~'. .,.._.. _ _ .__ .._.._.... _ .__. __h_
-- --< -_.__.. < -_.--~."'...._,..__._---_.------~._..---'~--,._--~._..- '''~---''-.'~._~'
....-.---------.--. ..",.., .~-----.....__._..._-_.- .-- ~--
..~ .~.___..__~__ __.~,,_. .._ ~.., T' +".'~._ ,-.' ~,. --~_._.-..-~ -."..- -.." ,,".,- .-.~ --
... ~__ ~ . ~'___.__ . v .. . ____~...._ ~..."~~~._"_~,,_~_ .... ~ ~ _..~....._..__._.,.
,_,..____..,..._..~~_'~'".r..w..._
- --~--_.. ~ "." ~..- - - -.~_...._.~, -.. .~.. ---.-.--- -- -.*.+.'. ~
TAX EXAMINER,
..:::J7'n tJ/~ /)/ / (/
PAGE
,
l
. to ~~-78~ a.-
./
c,.
.
~,
STATUS REPORT UNDER RULE 6.12
Date of Death:
Nathan Worman, Jr.
September 26, 1994
Name of Decedent:
Will No.
Admin. No.
21-94-856
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 whether administration of the estate is complete:
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 following:
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 is'
c. Did the personal repreb3ntative state an
account informally to the parties in inter,~st? 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.
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Signature I
Robert M. Frey
Name (Please type or print)
5 South Hanover Street
Cllrllsle, PA 17013
Address
Datel
August 17, 1995
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( 717 1 243-5838
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Capacity:
Personal Representative
X Counsel for personal
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