HomeMy WebLinkAbout94-01046
Oeoember23, '1994
Roccwl.J:' r;'i, ti of
ROIlI.,lil (If V'lill!l I
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(II \', I,' ; ()L1r'll'fDelllvnnNA
OurnUIJI'l.lfiU ,;\1., f'A
Register of Wills
Cumberland County Courthouse "102
Carlisle, PA 17013
Estate of James at to ,:: I., (1 t/ - t:J 10 tf'6
Aooount "01-07013682
Dear Sirl
Below is our Proof of Claim to file against the estate of the
above-mentioned deceased James Otto and a check in the amount of.
$5.00.
Also, enclosed is a self-addreaJsed, stamped envelope. Please
return the copy of tht) claim w:Lth your stamp to verify it was
,filed. If there are quest.tons, please contact us at 1-800-833-
3012, ext 1715.
Enter the claim of Core8tates Bank of Delaware, N.A., 1523 Concord
Pike, Wilmington, DF. 19803, in the amount of $3,747.03, against
the abovo estate on date of 12/20/94. Finance charges will
continue to accrue at the applicable account rate until the balance
is paid in full. We understand that the decedent, who resided at
465 Brook Circle, Mechanicsburg, PA 17055, died on 10/4/94.
CoreStates Bank of Delaware, N.A., Claimant
1523 Concord fike '
Wilmington, DE 19803
~~Iy
Claim~nt's Counsel
Felix A. Cohen, ESQ
CoreStates Bank of Delaware, NA
1523 Concord Pike
Wilmington, DE 19803
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CERTIFICATION OF NOTICE UNDER RUl,E 5.6 ( a)
'~) nPR -3 PI: 1 5
Name of Decedent I
James Elias Otto
Date of Deathl October 4, 1994
Clo("
Curflll. I'
.lull
, PA
,
Will No.
1994-01046
Admin. No. 2194-1046
To the Registerl
I certify that notice of ben~ficia1 interest required by
Rule 5.6(a) of the Orphans' Court ~uleB was served on or mailed to
the following beneflc!aries of the above-captioned estate on
03/30/95
Name
James Ervin Otto
Address
Box 24, 3488 Carlisle Rd., Idavi11e, PA 17337
Notice has now been given to all persons entitled thereto under
Rule 5,6(a) except
//
/
Datel 03/30/95
/
,Signat~
/'
I
,Name P. Richard
Wallner, ESQ.
Address 2233 N. Front St.
Harriaburll'...EA. 17110
Telephone(711 234-7051
Capacity I
Personal Representative
Counsel for personal
representative
x
,.
OATH OF PERSONAL REPRESENTATIVE
(),. ,
COMMONWEALTH OF PENNS'YLV ANIA
COUNTY OF _ /rum:(, 1M" rI.
} ss
The petltloner(s) above-named swear(s) or afflrm(s) that the
statements in the foregoing petition are true and correct to the best
, of the knowledge and belief of petltloner(s) and that as personal
representatlve(s) ot' the above decedent petltloner(s) will well and
truly administer the estate according to law,
Sworn to or affirmed and
before ml' this 8
.:J25('!"'tW~
~'
RA.<. P f" ;f~
subscribed
day of
19J.iJ-
r~-~~
l-
-I
Register
No. 21-94-1046
Estate of. ..:Jitme':; tt.lf/ s. DTTcJ
I Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW Deoember. 14 19:t!/:-, In consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that SlImt..'; k:ul/s c, rr -
lalare entitled to Letters of Administration, and In accord with such finding, Letters of Administration
are hereby granted to .::rA'm,,:,. E'<:v,J o,r<>
In the estate of ;:()r>?1 ~:> E't- ,;1.) trrp"
71Jlh.lj C-, 't,..w'-tn (),. P. 8:J/JJu-l '
U Realller of Will" q . ~
FEES
Letters of Administration .,," $ 5 0 . 0 0
Short Certlflcates(2) ..,..".,. $ h. nn
Renunciation ......,........, $
JCP '$ Ii - 00
TOTAL _ $61.00
Flied,." .D.eo.ember., 1.4 A.D. 19-.~L
-'iJC,dV<l.P (.J~n""" :If ~~/L03
ATIORNEV ISup, Cl, \,0, No,)
;:233 IU ':(.(;'1'>1 St- fI 0, g 17/1"0
ADDRESS
.-1''7 t 3 '1- '7<.'$"" 1
PHONE
mc4b.J ~.'IIt~, (,~, I~ -1'1 -01{
l!V,IlUO ix+ 1",011
~-:Ii:J,'~~ INHERITANCE TAX RETURN
,.'~lY.t.: RESIDENT DECEDENT
COMMONWeAlTH m PeNNlYIVANIA (TO BE FILED IN DUPLICATE
OIPA!r~INI Olllv/HUI
HA!mM6'. ~~t!I2I'0601 WITH REGISTER OF WILLS) COUNIV cooe
TiS NAMe jLA!lT, fIUT, AND MtODl! INITIAlI R'mml's COMPUTe ADORns
Otto, James Elias 465 Utook Circle
M ---rliillOTlfmH---p>-mCirmTH--- Mechanicsburg, PA 17055
172-12-0654 110/04/94 112/30/16 c",,, Cumberland
IU I, Original R.'urn 0 2, Suppl.menlal R.'u,n 0 3, R.malnd" R.lu,n
(for dol. I of d.alh prior 10 12.1 3.82)
o 4, L1mll.d E,la'. 0 40, Fuluro Inl".1I Comproml.. [) 5, F.d"al Ellat. Tax
Ifar datil a' d.a,h ok" 12.12.821 R.lurn R.qulrod
o 6, DIC.d.nt DI.d Tlllall 0 7, DIC.d.n' Malntaln.d a living Trull _ B, Tolal Nllmb" of Safe D.po.1I BoxII
(Mach caPLof Willi (Altoch copy of TrulIl
AU;.COIUSION&IINClANDCONPlIIINTlAliTAX INPORMAnON,SHOULD IIDIRICTID TOl< ' ',,'" -:-:":'~' ,'"I
N M MAI~AODRE5S
19, If IIn. 18 II groal" ,han IIn. 17. .ntll Ih. dln".nco on IIn. 19, Thll h Ih. OVERPAYMENT.
110
20, If IIn. 17 I. groa'" than IIn. 10, 'ntll th. dln".nco on IIn. 20, Thll h ,h. TAX DUE.
A, Enlll Ih. Inl""' on Ih. balanco duo on IIn. 20A,
B, Enl" ,h. 'alai of IIn. 20 and 20A on IIn. 20~, Thll I. ,h. BALANCE DUE.
Ma~o Choc~ Poyablo to, Rogl.t" of Will., Agont
....IIIU11TO.ANSWIR ALL QUUTIONS ON RMalI SlDI AND TO RICHICKMAYH.... '
Under Plnaltl.. of p.rlury, I declar. Ihall have IlComlned Ihh r.lurn, IncludIng accompanying lchldul.. and tlal.menU, and 10 ,hi bill of my knowledge and bllllf,
It I. truI, corrlct and compl.f.. I dlClar. ,hat all rial ..101. hal blln reported af trUI mark I' valul. Oeclarnllan of prlpar.r olher than th. p'rlonal r.pr...nlaflv. I,
bOlld on olllnlo,mollon of whlc. proporor hOI .ny knowlodg., J a me s E I' vi nOt t n 80 x ;;> 4
liON lU!1 Of PlllON !.mONlllllfOlPllINU l!TUlN AOOlm 3488 Ca r 1 i s 1 e Roacl OAT!
~ ~ Iclavi11e, flA 17337
A ~ s
2233 North Front Street
...Jiil.WElhll rll' PA 1"J 1 1 (J
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'0. DAflSOPDIAYH Am. 12/31/91 CHICK HIRI
~O~:~UmDIT II CLAIMID 0
PILI HUMII.
21
94
1046
yeAR
NUMBeR
..
!
P. Richarcl Wagner, Esq.
!L~PHON! NUMUA --
2233 North Front Street
Harrisburg, PA 17110
.j
-
234-7051
I. R.al Eltato ISch.dulo AI ( 11
2, Stock. and BondI (Schodulo BI ( 21
3, Clollly H.ld SlocklPortntrlhlp Intor..t ISch.dule q (31
4, Mortgag.. and Not.. Rocolvablo ISchodul. D) ( 41
5, Cnlh. Bank Depol'" & Mlteellanoou. P".onal Proportyl 5)
ISch.dulo E)
6, Jointly Owned Property (Schodulo F) I 6)
7, Trantl... (Schodule G) (Schedulo LI I 71
8, Total Gran Ano'.llotallln.. 1-7)
9, Funllal Expon.o., Admlnlttrativo COlli, Mlteollanoau. I 91
Exponll' ISchodulo HI
10, D.bll. Mortgag. l'abllltlll, lion. (Schodul. II 1101
11. T 0101 Doductlonl (Iotalllno. 9 & 101
12, Not Valuo of EI'nt'llln. 8 mlnu.llno 111
13, Char"ablo and Govllnm.nlal Boqu,," (Sch.dulo JI
14, Not Valuo Subjoct 10 Toxlllna 12 mlnulllne 131
15, Amaun' of IIno 14 laxablo at 6% rail
(Includo valu.. 'rom Schedulo K ar Schodulo M,)
16, Amaunt of IIno 14 laxabl. at 15% rato
(Includo valu.. from Sch.dulo K or Sch.dulo M,I
17, Principal tox duo (Add tax from IIno 15 and f,om IIno 16,1
18, Crodll. Spou.al Poverty Crod" Prior Paymon',
+
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19,472,28
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8,266.61
I 8)
19,472.28
17,627,85
{l51
(II)
{l21
1131
(141
x ,06 a
25,894,46
-6,422.18
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-6,422,18
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1161,
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CO/MlONWI~'I~ O' "NNmYANI~
INHUIIAN I lAA .,IITURN
mID.N DICID NI
SCHEDULE B
STOCKS AND BONDS
James E, Otto
1046-21-94
IAII p.....rlv lo'nllv..wn" with lltlt' 0' SUIVI.orllllp mud b. dllllolld on ScIt.dul. '.1
ITeM
NUMBeR DESCRIPTION
VALUE AT DATe
Of DEAT,H
1.
None.
TOTAL (Allo .nlor on IIn. 2. Roca Ilulollon
('I more Ipoeo i, n.....d, inlOr! additional .h"fI 01 10m. .ilO.)
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CO/olMONWIAlIH 0' PlHNIVlV.NIA
INHUITANCllAJIlIlURN
IUIDIN! DICI~INr
UT'" O'
James E, Otto
Jllnt "nanl(II,
N...MI
.... None.
I.
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Jalntlv..w..... ,,,,,"IIVI
SCHEDULE F
JOINTLY.OWNED PROPERTY
.,LI NUMIIR
21-94-1046
ADDRIU
ULATIONSHIP TO OICIDINT
-
ITIM LmlR DATI
POR ' TOTAL V"'LUI DICD'S DOLLAR VALUI o'
NUMli, JOINT MADI DUCRII'TlON O' .ROPIRTY o....un If, INT. DECEDENT'S INTlRIST
TlNANT JOINT
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TOTAL IAho Inl" on IInl 6, Rocopllula'lon) S
(/lmO/llpaCI i, nlldld in.." .ddiflonol ,h..ts 0/ 'oml ,i.,/
"
IlV.\1I0 IX. It.." *'
COWtlQN~lAlIH 0' "NH'YWAHIA
- 1H11s1tlWo'A,:,wIH
A 0'
SCHEDULE G
TRANSFERS
I PleAse PRINT OR TYPe
PI I NUMIIR
21-94-1046
James E. Otto
-
THIIICIIIDUU MUST II CDM'LlTID AND I'IUD IP THI ANIWIR TO ANV 0' Till QUUTIONI ON THIIIVIRSI 1101 0' Till COVIR IHEn 11 VII
111M onCRI'TlON 0' 'ROPlRTY eXCLUSION \ TOTAL VALue \ OI~D, 'r,~Lfc ~t~V.\
NUMIU I..""" _ 01 "', .......1Mw _.,.10......,. ... 01 "-,,,, 0' ASSIT I INT m
-
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TOTAL IAIIO ..,,, .. II., 1. ....pllolall..1 S
(H..... Ipoc,1I .....teI, ;...rl 0'-01 ,.1Oft ./ ,- till,)
frA"" ,.. "...
W
COMltlONWlAlfH Of ~N'Y\ll""4
INH""4HC.1IAll tmllN
tnlOINI OICIDfNT
SCHIDUU H
fUNERAL IXPENSRS,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
,,_ Print or r .
James E, Otto
21-94-1046
!TIM
NUMIIlll.
A, PUIMI'GI bfMtl_1
DISCRIPTION
AMOUNT
1.
Egger Funeral Home
6,1112,00
.. Admllllatratlve CottIl
1 I'tltOllal ~rtMIIlatI", Commlnlon.
Social Security Number of Ptnanal R.pr"""laIl""
Year Commlulan. paid 1995
2. Allam.,. Feet MClnc)c:e, Wagner I Hershey & 'l'ully
3. f'amlly !xempHan
C1al/l'Olnl R.lattonllllp
Add,.... of Clalmanl at d.ced'",,1 d~
StNet .Addrea
Oty SIall ZlpCodt
4. Probaf. Feet
C, MIte.lIaneou. bpeMetl
1. 'l'he Sentinel - legal advertising
2.
3.
4,
S.
6.
7,
8.
973.61
950.00
61. 00
100.00
TOTAL (AI.o emr 0" II". 9, Recapltulatlonl S8, 266,61
(If more .pan I, ""lied, In..rt addlllanal .h..l. of sam. 111'.1
,,""
arge
6 NESHAMINY INTERPLX
TAEVOSE PA 19053
1..,111,..111....1,1"1,1"1"1,11.,,,1,1,,1,1,11,,,1,1,1,,,11
JAMES E OTTO
465 BROOK CIRCLE
MECHANICSBG PA 17055-4622
TRANSACTIONS
Jan 17 I.ATECHARGE..................,..,............, $10,00
SPtiCIAL ACCOUNT INFORMA TION
We have pravlously asked you 10 pay the pasl due amount on
your accounr. yet wo havs no rscord 01 receiving payment. The
amoulIl uu. ~howll."uulu ~u ~81u Illllnuulah,lv,
VEAR END FINANCE CHARGE INFORMATION
Finance charge assessed durlllg Ihe calendar veer 1994 was
$285,20,
FINANce CHARGE
SCHEDULe
All
ANNUAL
PERCENTAGE
RATE
18,00/.
ACCOUNT SUMMARY
Prevloul belallca
TOlal paymlntl
TOlal chargas
TOlal credlll
FINANCE CHARGE
Now balaoca
$1,457,41
0,00
. 10,00
0,00
. 20,92
$1.488,33
-
Average
Dally
~alanca
over $0,00
Schadulld Paymanl:
Minimum due:
Due dale:
$42.00
, 5122,69
Februlry 12. 1995
.1 _ _..
-
-
-
-
..-
HELl'FUL INFORMATION
Available Cradll: 53.227
Ir the amount or Available Credit Is not
sufflclen1. or you have a quesllon. call:
'-800-347-8414
M - F 9.9 SA T 9-8 ET
Mail any bllllOg arror nOllces 10:
6 NESH INTRPLX _425
mEVosE PA 19053.0687
Pleale Include your account
number wllh any correlpondence,
SEARSCHARGE BONUS CLUB -
Greal Newsl Now the SaarsChergs
Bonul Club pays YOIl back In
money-saving certlrlcaleS every lime
your SaarsCharge purchases build up
10 $200 or more, You nsell only $8,29
more In chsrges to earn your bonus.
It peys 10 shop at Saarsl
Monthlv Average FINANCE
Parlodlc Dally CHARGE
Rala RalanC9
1.5% $1,394,~ _mll
Total $20,92
NOTE: See Olher side ror Imporlanllnformallon
---------------------------------
-........ ..... -. .' .....' , ..,..........-
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Te., all and malllhil coupon Wllh Vour pavmanlln
Ihe enclolod enveiope, Your pavmenl mUll arrive
bV Ihe duo dlle 10 avoid Iddlllonll Ilnlnce cha'gas,
Mike check pavable 10 S.." Ind Inclllde Vour
account number on Iho check, a414
1,1../..11..,1,1..,111"1",1,/..,11,1,,11,1,,,11,,1
SEARS PAYMENT CENTER
p, 0, BOX 182149
COWMBUS OH 43218-2149
JAMES E OTTO
Ar.counl Number: 5484087 86307 4
Billing dale: January 13. 1995
New balance:
Minimum due:
Due dale:
51.488.33
5122.69
February 12.1995
Amounl Paid $
Addre.. chin gel Chock III bOK ""low Ind
wrlle Vour nlw .ddre.1 on lhe blCk,
p 548408 7853074
148833 4200 12269
"
SEARSCharge
8 NESHAMINY INTERPLX
TRF.VOSF. PA 19053
~ ~-'iS'I.f; I?ir
~' :JV'
1",111,,,111,,,,1.1,,1.1,,1,,1,11,,,,1,1,,1,1,11..,',',111111
JAMES F. OTTO
465 BRUOK CIRCLE
MECHAHICSYG PA 17055-4622
>~
SPtiCIAL ACCOUNT INFORMATION
The amount duft shown above Includftl a past due amount.
You should send the entire amount due now, If payment has
been made recenlly, please disregard this requast.
VEAR END FlNANClI CHARGE INFORMATION
Flnanee charge aueaaed during the calendar yea, 1994 was
$265,20.
Account Number:
Billing dqle:
5484081 85301 4
December 13. 1994
ACCOUNT SUP/MARV
Previous balancft
TOlal payments
Tolal chargee .
j TOlel credits
FlNANClI CHARGE .
New balanCd
$1,438.49
roo
0,00
0,00
20,9"
$1,467.41
-
Scheduled Payment:
MInimum due:
Due dale:
$41.00
saO.69
Jlnuary 12, 1995
-
.,
-
-
HELPFUL INFORMATIOtr ..,..-.---.-
Available Credl!: S3,21l8
If the amounl of Available Credit ill' not,
sufficient, or you have a quesllon. call:
l.aoo.347.0414
M. F 9.9 SAra.a lIT
Mall any billing error 110llces to:
a NESH INTAPLX1425
TAEVOSE PA 19063.0687
Pleaee include your account
number wllh any correapondence,
SEARSCHARGlI BONUS CLUB -
Great Newsl Now the SearsCharge
Bonus Club psys you back In
monay.savlng certificates every lime
your SearsChargo purchases build up
to $200 or moro, You noed only $8,29
moro In chargos to earn your bonus,
It pays to shop at Soarsl
~INANCE CHARGE Avorage ANNUAL Monthly Avoragft FINANCE
SCHEDULE Dally PERCENTAGE Periodic Dally CHARGE
BalanC9 RATE RalO Balanc9
All over $0,00 10,00/. 1.5%_ $1,394,49 $20,92
Total $20,92
NOTIl: See other side for Important In/ormation
- - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ ~'- ~ -
CUST NUMBER 520-9736-600 0815~ 01(20~95
ID 51 ~ FINALLED ACCT RATE RSO AUX 00 REV C 0
. 1 OTTO*JAMES DUE 12/27/94 ELEC WATR HEATR
ESTATE OF DISC 12/05/94 APT GROUP ACCT
ACCT - ACCOUNT BALANCE 465 BROOK CIRCLE NO AREA LIGHTS BUOO BILLING
INFORMATION 4 MECBANICSBG 17055 SE~ EXTR FOR MAIL ADDRESS
PHONE 717-7631415 -DISCONNECT WAS FORCED-
DATE SOURCE CODE AMOUNT BALANCE
1/06/95 1J-LATE PMT CHG 3.30 268.34 ELEC SVC ~-100,OO' TAX EXEMPT
12/06/94 12-FIN KWlI BILL 51. 01 265.04
'12/06/94 06-AMOR BUD ADJ 41. 33 214.03
12/06/94 45-BUOOET ADJ 39.06- 172,70 CENTRAL WARM AIR
11/11/94 11-REG KWH BILL 59.94 211.76 HEATING ALONE
11/11/94 06-AMOR BUD AOJ 14.00 151. 82
11/11/94 25-BOOOET AOJ 39,06 137.82 ----NON-MONEy TRANSACTIONS----
11/11/94 13-LATE PMT CHG 1.22 98.76 f DATE AC
10/14/94 ll-REG KWH BILL 51,44 97,54 1 1/20 40
10/14/94 76-AMOR BUD ADJ 55.33- 46.10 2 1/20 46
10/14/94 25-ANNL SETLMNT 55.33 101. 43
10/14/94 25-BUOGET AOJ 47.56 46,10
9/19/94 30-FULL NET 75.00- 1.46-
#< DEPRESS ENTER KEY TO VIEW PRIOR TRANSACTIONS *
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" '..".,', ,'<:;;~". :,,;',: SO. 00 '.' ' PURCHASES CASH ADVANCES 1""""."""'"'' . '",
PIoI 011o'_. ~.~._,........ "IIPmlM....:;;;;...
t ~\", ..'" .~., \. ,OJ:,. '.;',:.":..... li."lit.-'.. .1;. 'j'
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COMMONWBALTH 0, PENNSVLVANIA
DEPARTMENT O~ REVBNUE
Iu~eAU OF INDIVIDUAL TAMES
IIOtERI1AHCE TAM DIVlSlotl
Ilt:PI. 110'01
HARRIIIURQ. PA 1112'-0'01
NOTICE OF INHE~ITANCE TAM
APP~AISEHENT. Al.l.OWANCE O~ DISAl.l.OWAHCE
OF DEDUCTIONS AND ASSESSHENT OF TAM
eU.UH II '" Itt,"1
P RICHARD WAGNER ESQ ,
2233 N FRONT ST
HBG PA 17110
DATE
ESTATE OF
DATB OF DBATH
FILE NUM8!R
COUNTY
ACN
02-09-98
OTTO
10-04-94
21 94-1046
CUMBERLAND
101
Anount ~.nltt.~---
E
JAME S
MAKB CHECK PAVABLE AND REMIT PAVMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiiIT: iiiiif .EX. AFP'lO"ri; 97"i - iiiiYi ci""eiji. i"liilEiii T ANCE' 'fAX . A iiiiilA' i SiHiiir;. A L UiWANCE' oli' ................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF OTTO JAMES E FILE NO. 21 94-1046 ACN 101 DATE 02-09-98
TAM RETURN WAS I I X I ACCEPTED AS Fll.ED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. (Sch.dul. Al
2, stock. .nd Icnd. (Sch.dul. ,)
S. Clo..ly H.ld St.ck/p.rtn.r.hlp Int.r..t (S.h.dul. Cl
4. Hort...../N.t.. ~...Iv.bl. ISch.dul. 01
I, C..h/l.nk D.po.lt./HI... P.r..n.1 Pr.p.rty (Sch.dul. E)
6. J.lntlY Dwn.d Pr.p.rty IS.h.dul. Fl
7. Tr.n.f.r. IS.h.dul. 0)
I, T.tol Au.to
I ) CHANGeD
NOTE. T. In.ur. prop.r
.r.dlt t. y.ur ....unt.
.ubnlt tho upp.r portl.n
of thl. f.rn with your
to. p.yn.nt.
.00
.00
,00
,00
19.472.28
; 0.2.-
,1l.2.
lal
III
121
(51
141
(11_
161
(71_
19.472.28
8.266.61
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Fun.rol E.p.n.../Adll. Co.h/HII.. E.p.n... (S.h.dul. HI 191
10. D.bh/H.rt.... l.h~" IH../U.n. (S.h.dul. II 1101 17,627.85
11. T.t.l D.du.tl.n. 111)
12, Not V.luo of T.. R.turn (12)
15. Ch.rlt.bl./Gov.rnll.nt.l a.qu..t., N.n-.I..t.d ~llS Tru.t. (S.h.dul. J) 1151
14. Not V.lu. of eot.to Subj..t to T.. 1141
NOTEI If.n ......m.nt wa. i..u.d previau.1Y, lin.s 14, 15 .nd/or 1&, 17 .nd 18 will
reflect figur.. th.t includ. the total of ~ r.turn. .......d to d.t..
ASSESSMENT OF TAXI
15. Allount .f Lln. 14 .t Sp.u..l r.to 1111 .00 M .03.
16. Alount .f Lln. 14 to..bll .t Un.ol/CI... A r.t. (16) .00 M .06.
17. A..unt .f 1.1". 14 t..obl. .t Coll.torol/ClI.. I r.t. 1171 .00 M .15.
la, Prln.lp.1 T.. Duo (lal
TAX CREDITS I
PAVHENT
DATE
?Ii.aq(, 4&
6.422,18-
,00
6.422.18-
.00
.00
.00
-
.00
Rf.CflPT
NUH8E~
DISCOUNT 1'1
INTEREST/PEN PAID 1-)
AHOUNT PAID
l
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
,00
.00
..~-
,O~
.00
. IF PAID AFTER DATE INDICATED. SEE ~EVERSE
'O~ CAl.CULATIOH 0' ADDITIONAl. INTE~EST.
IF TOTAL DUE 15 loESS TNAN .1. NO PAVHENT IS ~EquIRED.
IF TOTAL DUE 18 ~EFLECTED AS A "C~ED1T" (C~l. VDU IlAV BE DUE
A ~E'UHD. SEE ~EVE~SE SIDE OF THIS FORN FO~ INSTRUCTIDHS.I
I'lL.:
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RE8ERY~TIDNI E.I.'.. 01 doe.dlnl. dyIng on or beIer, OoeOOblr 12, 1982 .. II eny IUlur' lnl.r..1 In 'ho "1'1' I. 'renOI,rred
1n pOI....lon or .nJov..nt to Cl... . (0011.t.r.l) btntflol.rl'l of the dtc.d'nt .ft.r the 'Mplratlon of Inv ..t.t. for
llf. or for v..r., thl Co..onw,.lth hlrtbv .~r...lv r..,rv.. thl rllht to apprul., end "1'" trln.f,r lnh.rltenc, TIM"
.t the 1.wful Cl..~ . (coll.t.r.l) r.t. on ~nv .uch future tnt.r..t.
PIJIlPOIl!DI'
NOTlCEt To fu1f111 the requlr..",," of '.ctlon 2140 of thl Inh.rU.nc. end E.t.t. TIM Act, Aot Z1 of 1995. (12 P.'.
Stotlon 9UO).
PAY~HTI D.t.ch th, top portion of thl. Hotle. and .ub.lt with your PIVtent to thl R.gl.tlr of Will. prlntld on thl r.v.r., .ldI.
"HIIk, eho<lk er eon.. erdor PIV.bh tel REGISTER OF NULl, AGENT
REfUND (CA)I A refund of a tlM oredit, whloh wu not rlqUtlt.d on the Tu A.turn, .ay bl rlqu..t~ bv COIIPI.Ung an "AppUcltlon
for R.,und of Plon'vlvanl. Inh.rUane. and E.tat. hM" (AEY.1SU). Applioatlonl Ire .v.Habl. It the Offlc.
of the n.,hter of WUlt, any of the U A.v.nu. Dhtrlot Offloll, or bv o.11lhg the 1,..01.1 Z~"hour
"'I...rlng ..rlllo. nulberl 'or 'or.. ord4rlngl In P.nn'vlvanl. 1"800.562-2050, outd. P.nn.Vlvlnl, .nd
wUhin loc.1 H~rrhbur, .re. (111) 181"8094, TDDI (717) 112.2252 Wllrln, 1-.p.lt'1d OnlY),
OIJECTIOHSI Anv p.rty In Int.r'lt not ..tll,l.d with the .ppral....nt, .llowlnc. or dl.allowtnC. of dtduotlonl, or I"..I-.ot
of tlM (Intludlng dhoount or Int.rllt) II lhown on thlt NoUct INlt obJlClt wUhln .Ixtv ('0) d.VI of reo.lpt of
thlt NoUe. bYI
-.Mrlttln prat..t to thl PA D.partltnt of AIVenut, la.rd of .ppt.l., OIPt. 211021, H.rrl.bur" P. 17121.1021, DR
-.lltotlon to hlv. th. ..ttlr ri.t.r.ln.d .t .udlt of the .ceount 0' the p.r.on'l r"r..ent.tlv., DR
-"app.al to 'hi Orphan. I Cnurt.
AOIlIN
ISTRATlYI!
C_CTlOH1I
Faetutl .rror. dl.oav.r.d on thl, ......m.nt .hould be tddr'l.td In writing tOI PA DIp.rt..nt of A.vtnUl,
lur.au of Indlvldu.l T'M", .TTHI relt ........nt Aevi.w Unit, Dept. 280601, Harrlaburg, P. 11128-0'01
Phone (1l1) 117~'SOI. I.. p.g. 5 of the boo~l.t "tn.truetlon. for Inh.rltlno. TIM R.turn for. R.8idtnt
O.o.den'" (AEY"ISOI) for 1M IMplan.tlon of ad.lnl.tr.tlv.lv corr.etlbl. .rror.;
DIICOUIIT I
If .,V tax due I. p.ld within thrl~ (S) ,.lend.r .onth. .ft.r thl dec.dent" d..th, . flvl p.rcent (5~J di.count of
thO I'. p,ld II .llcood.
The IIX tlM -.nI.tv non"partlalpltlon Plnlltv 1. oo.,utld on the tot.l of the t'M end Int.r..t ......td, end not
p.ld blfore Jlnuary 11, 1996, the first day .fter thl tnd of th. tlM HMltV ptrlod, Thlt non"pertlalpltlon
p.nlltv I. .pp..ltbl. In the .... 'anner and In the the .... tllo plrlod .. YOU would app,.1 the t'M end lnt.r'lt
th.t ~.. b..n .......d .. Indlc.ttd on thl. ootlol.
PENAL TYi
INTEREIl.
Int.rllt It ohtr,.d b.,IMln, with flr.t dlv of dtUnqu,nov, or nln. (,) ItOMth. and OM (ll dlv fratl the d.t. of
dt.th, to thl det, of p.~t. T'MW' which b~... dtllnqu,nt blfor. JtnUlry 1, 1tlt bt.r Int.r..t .t the rlt. of
.IM ('X) peroent per ennui o.loullt.d .t I d.llv rat. of ,0001'~. All t.M.. which bto... dtllhqUent on end Iftlr
JtnU.ry 1, 191r will b..r Int.r..t It . r.t. which Mill v.ry 'rOlc.l.ndtr y.tr to otl'Md,r v..r with thlt r.t,
InnoUnotd bv the PA O'Plrt..nt of Rlv,nu.. Th. applloabl. Int.r..t r.t.. for 19'2 through 1'" .r'l
~ Int"..t A.te D.lly 1"1.r'lt F~otor X!!r Inhrut A.t, Olllv Int.r..t flOtor
1912 EU ,DOml 1917 91 .00D2~7
1911 III .DOOUI 1911-1991 III .000101
19" III .000101 1992 91 .0002"
1911 III .000156 1991-1~ 71 .000192
19M 101 .DOD27~ I99S-I998 ti .000U7
"~Inttrllt i. o.loulated .. 'ollow.1
INTEREST . IALANCE OF TAX UNPAID X NUNIER OF DAYS GELINQUENT X DAILY INTEREST FACTOS
"-Anv Notlo. I.IUId .ft.r the t.N btco.t. dellnqulnt will r.fltot In Int.r'lt c.lcul.tlon to flft.an (II) dlv.
bevond thl d.t.. of the ......ant. If P'YHnt II elde .fter the Int.rllt OO-..utIUon det. thown on the
~tlo., tddltl~l Int.r..t IUtt be olloullttd.
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STA,TUS REPORT UNDER RULE 6.12
Name of Decedent I "JA-'Tl~''-, e
Date of Deathl_JO - t..j -qtf
Will No.
() liD
Admin. No. Of o'/C . I <tC; 1.(
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. State whg{her administrat.lon of the estate is complet&1
YeS~-No__
2. If the answer fs 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 followingl
a. Did the personal reprpsentative file a final
account with the Court? Yes No v/ .
b. The separate Orphans' Court No. (if any) for
the personal representative's account iSI
, c. Did t.he personal representative s~ an
account informally to the parties in interest? Yes. No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphano' Court and may be attac ed to this report.
Date I q h'?/f t, ,
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Name (Please
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nt)
I-I()~
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1111) n'-fJ';))/(
Tel. No.
CapacitYI
Personal Representative
.........---
Counsel for personal
representative
(MAHl rmf/AM3.)
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