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PETITION Hm PlmnATE IIlId (;I{ANT 0... u:T'nmS
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LAST "ILL AND TBSTAMBNT
I, MARTHA A. BRICKER, a resident of Cumberland county,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my LAST WILL
and TESTAMENT, hereby revoking any and all wills and Codicils
prcviuualy made by me.
I
I direct that my debts and funeral expenses be paid as soon
after my death as is practicable by my Executor out of my residuary
estate, but not from any assets, funds, death benefits or insurance
proceeds which are otherwise excludable or exempt from my gross
estate for federal estate valuation or tax purposes.
II
I direct that all estate, succession, legacy, inheritance
or other transfer taxes, however designated that shall become
payable by reason of my death in respect of all property comprising
my gross estate for death tax purpoEes, I,'hether or not' such
property passes under this LAST WILL, shall be paid by my Executor
out of my residuary estate, but not from any assets, funds, death
benefits or insurance proceeds which are otherwise excludable or
exempt from my gross estate for federal estate valuation or tax
purposes.
III
I give, devise and bequeath all my property, whether real or
personal, wherever situate, including any property over which I may
have a power of appointment to the following people in equal
shares, per capita: my brother, CHARLES D. RITTER, my sister,
MIIlIHE 11. nI:1I0I:R, my sister, PEARL !. Hurms, my si,~ter M.", l'EL E.
BRICKER, my nephew, ROBERT o. BRICKER, and my nephew's wife,
MARGARET M. BRICKER.
IV
I nominate, constitute and appoint my nephew, ROBERT o.
BRICKER, and my brother-in-law, FRANCIS HUMES, as Co-Executors of
this LAST WILL, to serve without bond.
If either is unable or
unwilling to act in that capacity, then the other may act alone as
Executor.
IN WITNESS WHEREOF, I, MARTHA A. BRICKER, have set my hand to
this LAST WILL this 01/<:.7 day of November, 1990.
''/''/1 C....t--?7f c.. c... f:li-< d(eL
MARTHA A. BRICKER
2
'." oJ
ACKNOWLEDGBMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
J
,I
I
I, MARTHA A. BRICKER, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
J ) I ill. U;..; ,,'; .':/ '-, ,_ 1"'-1
MARTHA A. BRICKER
Sworn or affirmed to and acknowledged before me by MARTHA A.
BRICKER, Testatrix, this ,;21" day of November, 1990.
1 /-/ {t2,L ~:
(;'/.1.t~ ~/:t" - J, "'- ~,J _A.A.-'
Notary Publ c
~:'l~;;j't':~
Carl,) F. erO:~lj"shlro, f.1ot.1ry Pllblle
1ot:h3nic:ihurQ Er.ro, Cumb.:rlo1tY' Count
My Commi:l&:on Etjlirnn Ap.lll. 1091
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLANO
We, /J'l.:.'rr"J R vtf.t/~r::" {II and 7),'(1,t.,- /r). S,,,, VI-.. ,
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and
say that we were present and saw Testatrix sign and execute the
instrument as her LAST WILL; that MARTHA A. BRICKER signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing
and sight of the Testatrix signed the Will as witnesses; and that
to the best of our knowledge, the Testatrix was at the time 18
~~:~: i:f1;:::::'o~~ moro, of oound mind w# 1,;;;;:/0'
.It 0 t.t1 ,1~l
))1 J',,.u.-U(
Sworn or affirmed to and ~ckn~wlAdgert before me
this '-'-/ ,-'jl day of November, 1990.
,} A.
(0. /,,,_' ,
Notary Publ
Nt';..,"; ~j~.~,!1
Carl" F. erC~'l"shj"'f, t:.~~,1rY Pllblic
.frc:ll.lil;f;:;hl:rn ~.'rJ, C'Jmh,vJdn.1 C.:unt.
'Ay C:;IIl;r:;~!{'i~n S'''tir01 i\~:r;1 t. Hj~1
~
CERTIFICATION OF NOTICE UNDER RULE 5.61al
Name of Decedent:
Martha A. Bricker
Date of Death:
8/29/95
Will No.:
Admin. No.: 2195-0850
To the Register:
I certify that notice of beneficial interest required by RUle
5.6(a) of the Orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on November
22, 1995.
~
Charles o. Ritter
Address
Minnie E. Bender
5283 E. Trindle Rd.
Mechanicsburg, PA 17055
5260 E. Trindle Rd.
Mechanicsburg, PA 17055
Pearl I. Humes
1119 Baldwin st.
Mechanicsburg, PA 17055
430 Sherwood Orive
Carlisle, PA 17013
Robert o. Bricker
Notice has now been
Rule 5.6(a) except:
430 Sherwood Drive
Carlisle, PA 17013
given to all pers"on , entit,l, &fti l,h ",/ <et
.eb.l E. BdCkep;i(1 I'lL/(
Murrel R. Walters, III, Esq.
54 E. Main Street
Mechanicsburg, PA 17055
(717) 697-4650
//
Margaret M. Bricker
Date: 11/,22/95
'"I
Capacity:
Personal Representative
Counsel for Personal
Representative
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'fOR DATISOFDIATH AnlR ,'/31191 CHICK HIRI
fl~:J~iC\ INHERITANCE TAX RETURN I' ~ot::~yU~:tDIT IS ClAIMIDI1.
-~'fIl_ RESIDENT DECEDENT Fill NUMBlRm-u-
COMMOtlwl.,,"0: ,It""",..". (TO BE FILED IN DUPLICATE, ','.I-I)"-H""
lHf'AIl1MI PH 01 ll(vltWI ,.J .J I}
".,,,;~J:6, ~~O\~:"O"" WITH REGISTER OF WILLS) IcolJlm coot YEAR
PltllJll4110 tfAMlllA~l, fl.lot.. Atlll ,..,(l!JlIl/jlll.lj 1f,11 WI"! \ (o...rllll "IJlli"~
BRICKER. Nnrthn ^. CUT,lhel"lnnd Go. NlIl"ulnJ\ lIome
~&iAi-~(CU";B wji;i.u'- lPAIl 01 III At.. 11'1.11 Of Ililtl 375 C 1 ~'r(lmun t Rd ^ .
306-34-8106 0/29/95 7/8/09 Cnr\11110, p^ 17013
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Ii: I. Original Return [] 2 Supplemental Return [ .-J 3. Remainder Return
Ifor dOIIl' 01 death prior 1012.13.821
[] 4. limited hiD'. f-] 40 Futurll Inletlll' Compromi'. [J S. Fed.ral hlDt. Ta.. Relurn Required
110' dolo1 01 dealh u'ler 17.11.821
[X b. Decedenl Died Te11nle [-.J 7, Decadonl Mainlained 0 li~ing Tru"
(^"ach copy 01 Willi (Attach copy 01 TrulII
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
UAM COM'I( I( MAllltlO AOOIl H
JI(V,UOO lIlf 11,11'1
l!!
"'....
~i!~
=09
u~..
is
lil
l:l
o
J,'"
wili
"0
"z
8le
I !J t..i.. - 1/
I.'
NUMBER
_ 8, Tolol Numbe, 01 Safe Dep01it 80..el
MYll!lLJ~ ._J-iilH~.t:!? ....J)1 .~."!;(h~__~_
flll'HON( NUMIU
_.J 71 7) 697 -II 65 0 o~"-=_c-,~~,=.==c ~ _"-C'~=~"~.='~~=O=='=~==~',
17055
z
o
;=
:l
~
..
u
w
..
1. Real E1tate (Schedule A)
2, Stach and Bondi (Schodule BI
3. Clolely Hold Slock/Partl1o"hip Inle,oll (Schedule q
A. Mortgage1 and Note1 Receivable (Schedule 01
.5. Calh. Bank Depolill & Miscellaneou1 PeHonol Properly
IS,hed,le EI
b, Joinlly Owned Property (Schedule f)
7, TranlleHISchodule GI(Schedule l)
8. TOlol Gran Anell (lolalUnel 1.7)
Q. funeral EJlpenlel, Admlnhlraliu COIU, MilCIIllaneoul
EApenlel (Schedule H)
10, Debu, Mortgage liabililiel. llenl {Schedule II
11. Tolal Dltdutlionl (IotalUnltl Q & IO)
12, Nel Valult 01 Eltale (line 8 mlnUI line 111
13. Chorilable and Governmental Boquelll (Schedule JI
lA, Nel Valuo Sublocllo TaJl (lino 12 mlnulllno 131
1.5. Spoulal Tron1'e,. (for dale1 of dealh nltor b.30.9.t}
50e Inll,uclloOl 'or Af,pllcablo Perunloge on Re~e"o
Side, (Include volue1 rom Schedule K or Schedule M,l
lb. Amounl of line 14 laaable 01 6% rale
(Include value1 from Schedule K 0' Schedule M.)
17. Amounl 01 line 141 laaoble 01 1.5% role
(Include value I from Schedule K or Schedule M.)
18. PrincipaltaJl due jAdd laJl from Line' IS, 16 and 17.1
IQ. Credit1 Spoulal Po~erty Credit Prior Paymontl
54 E. Nnin Street
NechnnlcshurR. P^
(8) __20--,309.01
(111__.~___~,.!.L61. 9L__,__,
(121 ,___J~~-,-8117_....QJl______
-0-
(1 J) __._______ u___.___
15 847.08
______..u___l1:l!..-".c"';:",.,' -- -- -" -,-
x,
.
z
o
~
~
~
..
o
u
S
-_.~-'-~.-"- +
III ~,O~
: ~ : '.--:,'-=:~:~=::::_,
14) -0-
151=2Q;J2__cj~lir_=::--
I I_/)-
6 '__~'_____"_.__._________u'__
(71 ,_.~__..._.___.~!!-=.____~.._.
1 620.00
(9) _______.. _L______~____..___~_~___
(10) .---2f 8U..9J__~_
1151
(16)
(17) ____J~__.81,Z.0.!.t
---------)(
.)( .06 lZ
,15 = ~___2~. 3ZL 06___._
(18J~,__2~fXl1. 06
(191
120)
121) ____._?.L~n__._~_.,.
121 AI _ ______,____.__________
121S) .__ 2,377.06
21. If line 18 il grealer Ihan line 19. enler Ihe difference on Uno 21. Thil h Ihe TAX DUE.
^" Enter lhe Inlerell on Ihe balance duo on Lino 21 A.
B. Enter tho 10101 of Line 21 and 21A on Line 218. Thil Illhe BALANCE DUE.
Mole. Ch.dl Payabl. t~1 R.ghl., of Willi, Ag.nt
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Unde, penall!., 01 perjury. I doclare .hol I have e..omined Ihi1 Hllurn, including accompanying uhodule1 and 1lalemontl, and to the bOlt 01 my knowledge and belie',
il11 'rue. correct and complele. I declare that 011 reale11ale hal beon reporled 01 true markol ~olue. Declarolion of prepare' olher Ihan Ihe pet10nal reprelentalive il
ba1ed on all information of which preporer ha1 any knowledge.
SIGN~fuU m PUSON RUPONSlll('OR 'I~!NG JlffU,itT"--1:D.6Ihs---.._~.--__m--'---11-r9----nnr(hlinst .--------- OAI(
SiO~r:f ~~ ~R~:;Jli{~,:~.~~:t~O~'/~iNTAil~T-J~l::.lPO~Ah~-JlUmG-S_..'u_. He_chHni,c_f?_b_!Jxgl~_J?b_._~_l]D_:L5__ [i '~J L "I '/ J..
;: f,L -(-' Z~;L;~ /_______Nurl:l!!,!t~\~'ll__t_er~I.-....EI ~\f --1---"-------t----------' f~. ,-1 ? /1 'f l;
D f-,. J. '. 10 il n .Jt:r.ee'
Nechnnicshul"R. P^ 17055
DilCounl
+ --.-------
Inluroll
20, If Une 1911 grealer Ihan line lB, enler Ihe difference on Line 20. Thi1 ilthe OVERPAYMENT.
aD
Chodl horo if you aro roque.llng 0 r.fund of your overpaymont.
Act #48 of 1994 provld.. for Iho roductlon of Iho lax rolo. Impo.od on Iho nol valul of Iranlfor. 10 or for
Iho UIO of Ihl "pOU.O. Tho ralo. a. pro.crlbod by Iho Ilalull will bit
I 3% (.03) will bo appllcablo for 0110101 of dlcodlnts dying on or oftor 7/1194 and boforo 1/1/96
· 2% (.02) will bo appllcablo for ollalol of dlcodlnts dying on or Dftor 1/1196 and boforo 1/1/97
o 1% (.01) will bo appllcablo for 0110101 of dlcodonts dying on or oftor 1/1/97 and blforo 1/1/98
· Spoulal Iransfo,. occurring on or oftor 1/1198 will bl oxompl from Inhorltanco lox.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS.
YES NO
1, Old decedent mDko 0 transfer Dnd:
x
a. retoln the ule or Income of the properly tronsferred, .........,..........................................,..
b. retoln the right to designate who shall use the properly transferred or its Income, ,..............
x
c. retain a reversionary interest; or ...................................................................................
x
X
d. receive the promise for life of either poymentl, benefits or care9 .......................................
2, If death occurred an or before Docember 12, 1982, did decedent within two years precodlng
deoth transfer property without receiving odequote conslderatian9 If death occurred ofter
December 12, 1982, did decedent tronsfer property within one year of death without receiving
adequote consideration' ,..."....".."....,....,..,...........,.......,.........,...".."..,..,.., ,..,........"...,.,..
X
3. Old decedent awn an 'In trust for' bank account at his or her death9.............."........""...."....
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
. I.VISOI..!.. In,,'
*
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Pllall Print or 1 I
FILE NUMBER
21-95-850
COMMONWfAl1H O. PfNN'YlYANIA
INHII"ANCI 'AX lnulN
IISIOINt OICtOIN'
ESTATE OF
BRICKER, Martha A.
(All property leln,ly-own.d wl'h the Ilghl .1 Survlv."hlp ",,,.t be dlul..ed .n Sch.dul. '1
N~T~~ER DESCRIPTION
1. Farmers Trust Certificate 8116420
2. Farmers Trust Checking 01080563
VALUE AT
DATE OF DEATH
14,560.73
5,748.28
.
TOTAL AlIa Intor an IIn. 5, RICo lIulatIan S 20 309. 01
(Anath additional 8Y," x II" ,h..tsl' more 'POt. I, n,.ded,)
11\11'"1..,1'111
SCHEDULE H
FUNERAL EXPENSES,
A~I~~~~~1"::~Js C&WN~~r Imn P)!a.e Prl"t or Type __ .-
In NUMBER
A. 21-95-850
.---.----.------ ,---,---- .-----,-- --
DESCRIPTION AMOUNT
.
~~V1.~"
. ~IW"h
COMMOHWfAlIH Of PfNN~nVAN'A
INH(RI'''UCf fAil: RtfUIN
1l!~~P_f~.1 DfCfOfNI
ESTATE OF
BRICKER, Martha
ITEM
NUMBER
A. Funeral Expe".e..
1.
B. Admlnl.tratlve Caltll
1.
Personal Repre.enlatiye Cammllllons
Social Security Number of Personal Reprosenlatiye, __
Year Commissions paid 1996
500.00
01 - 8740
2.
Attorney Fees
Murrel R. \~alters. III, Esq.
1,000.00
3.
Family Exempllon
Claimant
Address of Claimant 01 decedont's death
Slreet Address
Relationship
City
4. Probate Fees
C. Mlscella"eoul Expen.e..
1.
2.
3.
4,
5.
6.
7.
B.
Stole Zip Code
120.00
TOTAL (Also entor on line 9, Rocopitulation)
(If more .poce I. needed, I".ert addltlonallhee" of some 1110.)
s
1,620.00
"''''''!''''''''.
(OUt,OQtIW'AthIOf PI Htdn.AWA.
"1I~""A"CI 1A1 'IfU"~
'UI(lI,.I(lI(l01.,1
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Ploa., Print a!"!yp"
FILE NUMBER
21-95-850
ESTATE OF
BRICKER. Martha A.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1,
Cumberland County Nursing Home
- residential care
2,841.93
TOTAL (AlIa .ntor on lin. 10, Recopltulallon)
(II more space Is needed, inlert addifional ,h..1s 01 some size.'
$ 2,8111.93
UVlllJlI. U"I '
'~ ~~~
(OI,lI,lON....'...IIH Of HNN"IY"'NI'"
I..,HI.I1....,C.'....nu....
.nID,,,,, D.ClDIHI
- - -
SCHEDULE J
BENEFICIARIES
ESTATE OF
BRICKER, Martha A.
FILE NUMBER
21-95-850
ITEM
NUMBER
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
I.
A. Ta.l.able Beque"s:
Charles D. Ritter
5283 E. Trindle Rd.
Mechanicsburg, FA 17055
Minnie E. Bender
5260 E. Trindle Rd.
Mechanicsburg, FA 17055
Pearl I. Humes
1119 Baldwin St.
Mechanicsburg, PA 17055
Robert O. Bricker
430 Sherwood Drive
Carlisle, PA 17013
Margaret M. Bricker
430 Sherwood Drive
Carlisle, PA 17013
niece
2,694.00
brother
2,694.00
2.
sister
2,694.01
3.
sister
2,694.01
4.
nephew
2,694.00
5.
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Beques'sl
I.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS lAlla onlor on lino 13, Rocophulo'lon) S
(If more 'pan I, n"d,d, In..rt additional shut. of lame ,In)
/ '; r, (
REV-1547 EX AFP 112-95.H~ ~
CO""OHWUl HI or P(NNSYlVANIA ACN
D[PART"lHT or ftlV(HUl NonCE of INHERITANCE TAX
BUREAU or INDIVIOUAl tAXIS APPRAlSEHEHT, ALLOWANCE OR DISALLOWANCE
~~:~is~:~~lp, l1ua-0601 II or DEDUCTIONS AND ASSESSHENT or TAM DATE 06-24-96
ESTATE OF llRTmR --mRTIA ^ '-=~-~"~~~~FnEiiO. 219570850
DATE OF DEATH 08-29-95 COUNTY CUMBERLAND
!",
//
,f
101
NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT TltE UPPER PORTION OF THIS rORH WITH YOUR TAN
PAYHENT TO THE REOISTER OF WILLS. HAKE CtlECK PAYABLE TO "REOISTER OF WillS. AGENT"
REMIT PAYMENT TO:
MURREL R WALTERS III ESO
54 E MAIN ST
MECHANICSBURG PA 17055
REGISTER OF WILLS
CUMBERLAND CD CDURT HOUSE
CARLISLE. PA 17013
A.aunt H..itt.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE'v: iscii-Eii-AFi>--mr:9SY- NOW CE- -ciF"i-NH Eiif TAiicE-TAX-iiJi PRAY 5 EHENi'-.- -Ai. i"ciiiANcE - jili- - - - -- - - - -- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRICKER MARTHA A FILE NO.21 95-0850 ACN 101 DATE 06-24-96
TAN RETURN WAS, I X I ACCEPTED AS rILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l Eat.t. CSchedultl A) (1)
2. stocks and Bonda (Schedule 81 (2)
5. Clo..ly Held stock/Partnership lnter..t (Schedule CI (5)
4. Horta_D.I/Not.. Receivable ISchedul. 01 (4)
5. C..h/Bank Deposita/Hisc. Parlonal Property ISchedule E) 15)
6. Jointly ONned Property ISchedule F) 16.
7. Tren.fer. CSchedule GI C71
a. Total A..et.
APPROVED DEDUCTIONS AND EXEMPTIONSI
9. Funerd hpen.e./Ad". Co.h/Hhc. hpenu. CSchedule H) UI
10. Debt./Hortgage Liabilitie./Lien. ISchedule X) CI01
11. Total DeducHan.
12. Net Value of Ta~ Return
15. Cheritable/Gavern"ental Baque.t. CSchedul. JI
14. Net Value of E.t.t. Subject to Te~
If an assessment was issued praviously, lines
reflect figures that include the total of ahh
ASSESSMENT OF TAX:
15. AMount of Line 14 at Spou.al rata
16. AMount of Line 14 t.~abla at Lin.al/Cle.. A rate
17. AMount of Lina 14 t.~abl. at Call.taral/Cl... B rate
18. Principal Ta~ Due
NOTEI
1151
1161
1171
TAX CREDITS I
PAYHENT
OATE
03-01-96
RECEIPT
NUHBER
AA112582
DISCOUNT Ctl
INTEREST C-I
.00
I CHANGEO
.00
,00
.00
,00
20.309,01
.00
,00
IBI
20.309.01
1,620.00
2,841.93
III I
1121
U:i)
1141
4.461 q3
15.847.08
.00
15.847.08
14. 15 and/Dr 16, 17 and 18 will
returns assessed to date.
.00 x .00.
,00 x .06.
15.847,08 x .15.
1181
,00
,00
2.377.06
2.377,06
AHOUNT PAID
2.377.06
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2,377.06
,00
,00
,00
. IF PAID AFTER DATE INDICATEO. SEE REVERSE
FOR CALCULATION or ADOITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN ll. NO PAYHENT IS REQUIREO,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRI. YOU HAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,I
N
(l tt\
,-
"
t~ ~(
, l ~ _
. -
ta:
N
'.
!" a~
~
I, '" V) 1 t=
,~ c:: P' ~ :1
RESERVUIDHfJ.f,'ah. of d'C'd.nt~ on or b.for. Pauabu Ilt nil n If any future Int.teat In the I.t.t. Is tran.f.rr.d
In po.....lon or .nJo.....nt to Cl... . (colll..r.l, blnetlela,l.. of thl dludlnt sfl't thl I.plntlo" of any I.tet. for
II" or for y..r., thl Co_onw..lth hlt.by ..pr...I" t...tv.. thl rloht to appr,.,. and ...... ,rM.,.r Inh.rltanc. ,....
at the h,,'ul CI... . reaUs,.t.U nt. on WI" such lutur. Int.r..\.
PURPOSE OF
HOJJeEI 10 fulfill thl u""I,...nh of Sectlon 21ftO of 'hI Inheritance and E,t". ,.. Act. Act U of 1991. 12 P.s.
Sactlon 21~D.
PAYHEHII Oetlch the top portion of thh Hotlce and .ubIIlt with your pay.ant to thl RIghtar of Wills printed on thl r."u.. .Id..
".Makt check or lonay ord.r pI'ubla tal REGISTER OF MILLS, ADENT
All ply.ent. taCIIVld .hall flr,t be appllad to anv lnt.r.,t which .'v b. due with InV r...lnder appll.d to the taM,
REFUND (CRlI A nfund of . taM cr.dlt, which wu not requut.d on the 'aM R.turn, .ay be requ..ted bv coapl.tlnG an "Appllc.tlon
for Rlfund of Penn.vlvanla Inh.rlt.nn end Eltate TaM" UEV"UUJ. Application. .r. .vall.ble at th.Offtea
of the R.GItt.r of "Uh, InV of the ZJ R.v.nu. DIttrlct Olllc.., or by ulllnG the .p.cl.l Z4-hour
an.werlnG ..rvlc. nueb.r. for for.. orderlnGI In P.nnsvlv.nl. 1..eOO-J6Z"ZOSO, out.lde Penn.vlv.nla .nd
within local HarrisburG ar.. (7171 787.1094, 'DOl 1717J 77Z"ZZSZ We.,.lng I.pel,..d Onlyl_
OBJECTIONS I Anv pe,.tv In Intan.t not ..thfl.d with the Ilppral....nt, allow.nca 0,. dluUowanu of deduction" 0,. ........nt
of t.. C InclUding discount 0,. Int.,...U ., .hovn on thlt Notlc. .u.t obJ.ct within IIMtv 1601 day. of ,..nlpt of
thlt Notln bVI
uw,.ltten P,.otelt to the PA O.pa,.t..nt of R.v.nua, Boa,.d of App..", Dept. 28IDZI, tta,.rhbu,.g. PA 17128-1021. OR
_....ctlon to have the ..tt.r d.te,..ln.d .t audit of the account of the p.,..onal ".pr..ant.tlv., OR
.-app.al to the O,.phan,' Court.
AD"IN
ISlRATlVE
CORRECTIONS,
r.ctu.1 .,.ro,., dlscov.r.d on thll ........nt Ihould b. .dd,.....d In w,.ltlng tal PA D.pa,.t..nt of Anlnu.,
Bu,...u of Indlvldu.1 T...., AlTNt Po.t A.......nt R.vl.w Unit, Dept. 180601, l<u,.l.bu,.a, PA 17118"0601
Phon. (7171 7.7-6S0S, S.e plgl 5 of the bookllt "In.tructlon. far Inh.rltance TIM R.tu,.n fa,. a R..ld.nt
O.c.d.nt.. (REV-il,Ol) fa,. an .Ilplanatlon of Ildelnl.tratlvllv correctable .rror.,
DISCOUNT'
If any teM due I. p.ld within thr.. (5) calendar eonth. att.,. the dlc.den". d..'h, a flv. p.runt CUI discount of
the taM paid I. allowld.
PENAL TVl
th. ISX hM .ene.tv non.partlclp.tlon plnaltv It cOlIPuhd on the total of the t8M and Int.r..t .......d, and not
paid b"ora Janulrv 18, 1996, tha fi,..t dav aHu the .nd of the talC a.n..ty plrlod. 'hit nan.p.,.tlclpatlon
pen.ltv It .pp.alabl. In thl .... .lIlV1a,. .nd In tha the .... tI... plrlad III YOU would appaal tha taM and Int.r..t
that hal b..n .......d .. Indlcetad on thl. notlc..
IHTEREST I
Intlr..t I. charg.d blglnnln; .,Ith flr.t au of dellnquancv. or nln. (9) aonth. and ana C11 dav f,.oa the dala of
d..th, to the data of pay.-ant. Ta... which blc... d.llnqu.nt bafor. January I, 198Z be.r Int.r..t .t the rat. of
.IM C6:cJ plrc."t p." .MU. calcula'.d at . dallv ,..t. of .00016". All t..... ...hlch b.c... d.lInqu.nt on and att.r
January I, 19" .,111 b.ar Int.r..t at a "ata which will V."Y fro. ulendar ye.,. to cal.ndar v.a,. with th.t rat.
announc.d by the PA Dlpart.lnt af R.v.nu.. 'h. appllcabl. Int.,...t rat.. for 198Z through 1996 .".1
'!!!! Inlar..t Rat. Dally In'ar..t ractor !!!r Inta,...t Rata Dally 'nter..t Fllcto,.
19U ZO:C .00OS41 1981 .. .000147
1985 ,6> .000U8 19&6.199' 1l:C .000501
1984 IlX .000501 199Z .. .000247
1985 U:C .0005S6 1995.1994 1> .ODOI"
19U I Oil: .00021,. 1995-1996 .. .0001107
"'Inl.r..t I. calcuhl.d .. follow'l
INTEREST' BALANCE or TAX UNPAID X NUNBER or DAYS DELINQUENT X DAILY INTEREST rACYDR
--Any Hotlc. I..u.d aft.r the t.1l b.ea... d.llnquant will ,..fl.ct an Int.ra.t calcul.tlon to flft..n CIS) day.
b.yond the d.'. of the ........nt. If plyllnt I. ..a. .fta,. the Intar..t co.putatlon data shown on the
Hotlc., .ddltlDnal Int.rut ltU.t bl celcula'ad.
Name of Oecedentl f1// /~ r It ,(
..
Oate of Deathl ~,)C, ~r ,
Will No,
STATUS, R~!,O~IT UNDIi.!l HUI,E 6. 12
It {;fa '<.." < ,'l'
AdmIn. No.
-/ '. <':J' !-'~ 1
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administratiulI of tho iluovo-captioneu estate I
1.
State ~hether administration of the estate is complete I
Yes \( No
2. If the anawor is No, state when the personal
representative reasonably believes that the administration will be
completel
3. If the answer to No. I is Yes, state the followingl
a. Did the personal re~resentative file a final
account with the Court? Yes No .
b. The sopal'ilte OI'philllS' Court No. (if any) for
the personal representaLive's accollllt is:
c. Did t.he personal I'epresentative state an
account informally to the )l'HUes ill inten~at? Yes \( No
d. Capios of receipts, rele~ses, joinders and
approvals of formal or informal accounl.~m y be fi~~W h the
Cerk of the O~Phalls' Court and may bo a, '5-~(OV ~' isyeport.
cy, 1..) - Q 7 vt{ (; f/ "-- --
Date:
Signat.ure
;t.r tl!?;.::n .V,Ii.-Vi..' ;<,r
Name (Please type or print)
5..( ;: ,M,t,,J I ,tft 7:(r';1'V({J~./.{ C
Address '
(1t'/) uti'! t(uiu
'I'el, No.
,"-I
(ii
,- . ~ -~.
~'-J
Capacity: Personal Representative
~__counsel for personal
l'epresenta t i va
(MAH: rmfl AM3)