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PETITION Io'on l'nOIJATE Illld GnANT 01" LETmns
No.~/r;- /0
To:
l{eKI51er of Wlllt for the
. Of<'f/l,Il";. COllllly of Cllm erland In the
Sorllll Sfmrlly No. -lli-03-876I CUllllnunwenllh of I'enn!ylvanla
The petlllun of the IImlel5lKned le511ectfnlly lelne5ent5 Ihal:
YUllr pellllonel(5). who Is/are 18 years of age or older all the execlIl r Ix
In the lasl will of Ihe a~u\'e decedent. daled .fuly 15.
nnd codlcil(!) daled
l:stlllf of w. Ka.t.hllr.1nLLQ,ml>..!11'.IL_
/11m k IW n'I/ liS
named
. 19.2.ll...-
(Unlc It1CVlml chClIlIISlrlllttl, (,II. ItllUllchulon, death uf (-.ecUlO', tiC.)
lJecendenl was dumiciled al dealh In Comber land County, Pennsylvania, with
I. er laslfamily or principal residence 01 2138 Yale Avenue. Camp lIill. PA
(list SlIccI, number and mundpalily)
lJecendent, then 7Q years of age, died Dec~mh~r 15 . 1995
al IIgly S~,r1t lIo~l. Camp 1111). PA .
Excepl 05 fol ows. decedenl did nol marry. was nol divorced and did nol have a child ~orn or adopted
after execution of the will orrered for prubate; was notlhe viclim of a killing and was never adjudicated
incompclent:
lJecendent 01 death owncd propcrty wllh eSllmated valllcs as folluws:
(If domlcilcd In 1'0.) All personal properly
(If not domiciled In Pa.) Personalpropcrty InPcnnsylvania
(If not domiciled In Pa,) I'trsonal property In County
Vallie of rcal est ale in Pcnnsylvanla
situated as follows: None
$50.000.00
$
$
$
WHEI{EFOI{E, pctilloner(s) mpectflllly rcqucst(s) Ihe probate of the last will and codlcll(s)
prcscntcd hcrcwith and thc grant of Icllers testamentary
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lIelen Forsber Dar v
2810 Yale Avenue
r.nmp lH 1 1 I PA
OATH OF I)EnSONAL REPUESENTATIVE
COMMONWEALTH OlII'ENNSYLVANIA }' 8S
COUNTY OF CUMBERLAND
The petitioncr(s) above. named swear(s) or affirm(s) thatlhe statemcnts In the foregoing pCllllon are
trlle and corrccl 10 thc ~cst 01 the knowlcdge ami bclief of pctitioner(s) and tlmt as pcrsonal represcn.
talivc(5) of Ihe abovc dcccdcntpclilioncr(s) will wcll and Iruly administer the eslate according to law.
Sworn 10 ~r affirmcd and sllbscrl.~ed ~jJ~~.~ fl-~ /J a.M.<1 "
~cfore me IllIs 2ND day of ~== ~ l- ~'
'717IL~~~~~~;;~ /LL{!)~~ / '~,. 1
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Thi, iil tn \crlify ,h,1l 111(' illflllll1.lIillll hnl' ,,:,i\l'11 I" \lIrfltdy ~llpl('lt 111I1H ,llIllli~llI,lllt'llI"l',II(' Ilf tlt'.1I1I duly lIIt'd willi lIle .1\
l.ucalltl'Hi\lrar, The Ilri~in.llltrlifi(.lll' wtlllw fIlIW.art!ld lu lht' ~Llll' VII..! Ht'lIlld,<< HIlll' 1111 I'UIIl,lIlt"1ll lilil1~.
WARNING: III' Illegal to dupllcato thl, copy by photo,tat or photograph,
Fl'C (or Ihi, \I'llili,':II", S21~1
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CO....ONWEALTH OF PENHSYLVANIA . DEPART"ENT OF HEALTH' VITAL RECOROS
CERTIFICATE OF DEATH
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catherine Fornadley
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LAST WILL AND TESTAMENT OF W. KATIIERINE FORSIlBRG
I, W. KATIIERINE FORSIlBRG, of the Borough of Camp lIill,
Countyof New Cumberland and State of Pennsylvania, being of sound
and disposing mind, memory and understanding, do moke, publish ond
declare this my lost Will ond Testament, hereby revoking and
making void all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently
be done.
2.
All the rest, residue and remainder of my estate, real,
personal and mixed of whatsoever nature and wheresoever the
same may be situate, I give, devise ond bequeoth to my sister,
HELEN FORSBERG DARCY.
3.
In the event my sister, Helen Forsberg D8fE"~ should
predecease me I give, devise ond bequeath my entire estate with
individual bequests executed as follows:
(a) My niece, Karen Forsberg Schumacher, is to receive
my gold pendant neckloce with three small diamonds, and the picture
of herself, "At the Fair," pointed by her fother.
. .
PnKe 2
WILL OF W. KATHERINE FORSBERG
(b) My niece, Christine Flail, is to receive my
Queen Anne's Cherrywood Desk.
(c) My brother,Wi1liom L. Forsberg, is to receive all
paintings he has given tome except those granted singly to
other persons by mys~lf and my Walnut Liquor CAbiet.
(d) My niece, Jeannette Forsberg Cook, is to receive
my Sterling Silver and my NoritakeChino dishes ond the
breakfront in which they ore housed. IOther dishes and
china therein to bv apportioned as the Executor of my Will
sees fit with the exception of my yellow Larkin dishes
which are to be given to my niece by marriage, Barbara C. Darcy,
if she wishes them.
(e) My niece, Suzanne Forsberg, is to receive my gold
chain with single diamond, plain gold chain and bracelet
to match and my stereo.
4.
All the rest, residue and remainder of my estate, real
persons 1 and mixed, I give, devise and bequeath as follows:
1. 1/3 (one-third) to my niece and godchild, Nina Kay
Byers Johnson.
2. One-third (1/3) to my niece and godchild, Karen
Forsberg Schumacher, and
3. One-third (1/3) to my nephew,WilliomDouglas Forsberg,
but if he fails to survive me, the gift shall lapse.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(8)
Name of Decedent: W. Katherine Fnrsh..r9
Date of Death: December I ~. I qq~
Will No. Jfqt w ()tJ 10 Admin. No,
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
Januarv 2. 1996 :
Name
Mrs. Nina Johnson
Mr. Charles Bvers
Address
2805 Maplewood Drive, Champaigne, IL 61821
2801 Maplewood Drive. ChRmpRian... IL 618'1
Mr. Robert C. Bvers 803 Bell Park. ChamDaiine. IL 61821
Mr. Michael Bvers 803 Bell Park. ChamDaiine. IL 61821
Mr. John W. Bvers 709 North Elm Street. ChamDai2ne. IL 61821
Notice has now been given to all persons entitled thereto under
Rule 5.6 (a) except none
Date: tr '2.1 /9 ?/J .
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Name
John M. Eakin
Address Market Square BuildinR
Mechanicsburg, PA 17055
Telephone ( 717) 766-3172
Capacity:
Personal Representative
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Counsel for personal
representative
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-INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
r,m61ll'
2138 Yale Avenuo
Camp Hill, VA 17011
c_ Cumberland
-flMoiJ'irrlIUiVlDllIIIHlllUCIIOUII
o 3. R.malnder R"v,"
Ifor dotll 01 d.olh prlo. 1012,13,(
05, Pod..ol Ellol. To. R.lurn R.qvlro,
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rO. DATI,O'DIATHAna.,"3lltl CHICKHII
, A IPOUIAL 0
POYI." CUDIf It CLAIMID
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COMMOHW,A!tt 0' "mmIVAHIA
D"AI M HI 9!!\VIHUI
ttAllllfJ & JAil 21 0601
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ForsborR' W. Knllterino
lot"III(Ul'" tfuMIIl ~DllIH
194-03-8761 12/15/95
,,""'ICAItIl tutwmHO \IOU'" "oUI' '''". "111 AND .1ClOt1 ,",11&11
2196'- 0010
COUNTY CODE YEA.
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o Aa. rulufI Inl.,II' Compromhl
110. dolll 01 d.a,h all.. 12.12,B2)
[!g 6. Olc,d,n' DI,d h,lol' 0 7. O,c,d.n' Maln/aln.d a living TruI'
(Atta,h ,opy al Will) IAllach ,apy a Trv.l)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO. Vi, ,"" ,,:,;.' ,
M (OM'I I MAlllUO ADOlt u .
John M. Enkin, Esquire Market Square Building
II '1I0HI HUM.IO Mecltanicsburg, VA 17055
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(2) 26.126.95
(3)
14)
(51 48,547.53
(6)
171
(8)$ 74,674.48
I. R.al Ellal. 15,h.dul. A)
2, 5t..k. and Bond. (S,hodvl. B)
3, Clollly H.ld Sto,k/Parln."hlp Int,,"' (S,h.dul. C)
4, Martgag.. and NollI R...lvabl. IS,h.dul. 01
5. Cash, Bank D,polllI & Mlle.llan,ouI Plnonal Proplfly
(S,h.dvl. EI
6, Jointly Own.d P,ap..ty ISch.dvl. FI
7. Y.anlf... ISch.dvl. G) 15,h.dvl. II
8, Total G'OIl AIIII' (Iotalllnll 1.71
9. Fun.ral b!'ll'n..., Admlnlstratlv. COlli, Mlte,lIon,oul
Eltp.n... ,Sth.ul1l, HJ
10, D.b", Mortgag. lIa.i11II.., 1I.n. (S,hodvl. II
11, T olal D.dudlan. (Iolalllnll 9 & 10)
12, N.I Valv. of E,lot. (lIn. 8 mlnv.lIn. 1'1
13. Charitable and Governmenlal Blquel" (Sch.dull JI
14, N.I Valu. Sub.d to Ta. (lIn. 12 mlnv.lIn. 13)
IS, Spavlal T.an.f... (10' datil al d.alh all" 6.30.941
S.. Inllrudlans for Appllcabl. Percentage on Rlv,n.
Sid., (Indvd. .alvlIl.am S,h.dvl. K a. S,h.dvl. M,)
16, Amaunl 0' lIn. 14 la.abl. al 6'110 '01.
(Indud. valu.. f.om S,h.dul. K ar S,h.dvl. M,)
17. Amount ollln. 14 la.abl. al 15'110 .al.
(Indvd. valulI f,om S,hodvl. K or S,h.dvl. M,)
18, Principal ta. du'IAdd 10' from lInll IS, 16 and 17,)
19. C,.dill Spousal Poyerly Credil P,lor Parm.nll
7,316.00
19)
(ID)
%6.27
111) 7,882.27
(12) 66,792.21
(13)
(14) 66.792.21
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K ,IS . $10,018.83
(18)
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(16)
(17)
$66,792.21
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+ + 500.94
20, 1I11n. 19 II gila'" Ihan lIn. 18, .n'" lho dill",n" an lIn. 20, Thlt It Ih. OVERPAYMENT,
a O..rr.r1!11l1iIlJala,j.ll.ill..loJi1Iratllili...hlmmna'ToIII..1',UUHil.'Jli,IiI,1 j
119) 500.94
120)
(21) $ Q,Ci17 RQ
(21A)
(2181 $ Qrc;17 RQ
21. If Un. 18 Is gr.al., Ihon L1n. 19, enl.r ,h. djff,r.nc. on lIn. 21. lhlll,th. TAX DUE.
A. Enl., the Intlf'I' on th. balance due on lIn. 21A.
B, Enl.. th.lotalallln. 21 and 21A an lIn. 218. Thlt It.ho 8ALANCE DUE,
Mok. ChiC" Payabl. tal R,g'I", of Will., Ag.nt
"~!,;,,\,,,'S,,;,. BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MAlH" '1 .. ,.!,.' ,..,', ,
Under Plnalll.. of perlury, I declor. tholl hove lJIlomln.d this "turn, Including accompanying schedule, and ,'ol.mlnll, and to th, b... of my knowledge and bl
It IItruI, corrlcl and cample... I dldor. thol 011 flat "Iolt hat btln "porled allrul marktl valu.. O.clarollon of pr.par.r other than Ih. plnonal rtpr.llnlati.
bal.d on olllnlormatlon of which pr.pare, hot an knowledge.
A UIU O' PUSON InrOHSIIll fOI flUNG IUIUlH "oaUSS DAIl tM.
f. 2810 Yale Avenue Carn Hill PA 17011 / v U!!d.,q/ ft,
"ODIUU DAIl
IInrl' nll.f',Hng. M",.hnn.f,.Qhll1'"g. PA 17nc;s /1- J1zu 9h
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SCHEDULE B
STOCKS AND BONDS
W, Katherine Foreberg
2196-0010
(All ....,.rty Ie""ly..wft" with RI,hl.IS.rvlv,"hl" 11I.1' ~. ..I"I......ft S.h....1e '.1
ITeM
NUMI!R DeSCRI'TlON
VAlue AT OAT!
0' DeATH
I, T. Rowe Price Bolonced Fund - Account 27-18800-2 - 139.085 uh.
@ $11.37 $1,581.40
2. Put nom Investments - Tox Free Il1gh Yield C1wB - Account
0027757547 - 939.671 sh. @ $14.50 13,625.23
3. U. S. Series E Bonds - See attsched 10,920.32
$ 26.126.95
TOTAL AI.o .nlor on IIn. 2, RICO lIulollon
III more .poc. i. noodod, In..rt odd/tiono' ,hoo/, of ,omo silO,)
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AIIIIUIII SlllltllllCml
Janua,y 1 - \Iecemh., J \, 1995
PUTNAM INVESTMENTS
Pulllnm 'J'lIx-Free High
Yield CI-B
ACCOUNT, AI2.I.194.0J.8761.1I11111
W KATHERINE FORSBERG
Conllnued 'rom prevlou. p'&o,
Amount Share Number Ihlrl
Olte Account ActivIty OetlU Per Shire Amount Price of Sbareo Blllnce
06/20/95 Dlvldondl RelnYOI.ed ,070773 6H6 14.20 HH 917887
Price 0..0: 06119195
07120/95 Dividend. Relnyelled ,068891 6121 14.15 4,469 922.356
Price 0..e:07/19195
08121195 Dividend. Relnyolled ,066631 61.48 1J,98 4.398 926,754
Prlco 01.0:08118195
09n0/95 Dlvldond. RelnYOI.ed ,069971 64.85 14.31 4,531 931.286
Price 0..0:09119195
10120195 Dlvldond. RelnvOlled ,066382 61.03 14,42 4,200 935,574
Prico O..e: 10119195
IIn0/95 Dividend. Relnvelled ,063453 59,37 14.49. 4.097 939,671
PrIce 0..e11ll17l95
12n0/95 Dividend. Relnyelled ,069811 6~.60 14,51 4,521 944,192
Price Date: IVI9195 "
IV31195 Endln& B.III1ce 14,70 944.192
~istribution options selected for your fund. Share. Held By You OrYour Reprelen.ldve'. Firm 0,000
Olyldend.. Relnyelled Capltll..ln.. Relnvelled Share. Held Ac Putnam 944,192
8
".O,II.,~120-1
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PLEASE SEE OEFINITIONS ON OTftEk SlOE
PAOE 1 Of 1
0021151\47
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u. 8. Beriss R Bonds.
All registered W. Katherine Forsberg or Helen F. Daroy
Denominat.ion
Date of Issue
Date of Death Value
$25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25,00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
25.00
12/67
3/68
2/68
5/68
6/68
7/68
9/68
1/69
2/69
4/69
5/69
6/69
11/69
1/70
3/70
5/70
7/70
8/70
10/70
11/70
12/70
2/71
5/71
6/71
7/71
9/71
10/71
12/71
1/72
2/72
7/72
9/72
11/72
12/72
1/73
3/73
4/72
5/72
4/73
6/73
7/73
8/73
10/73
$ 121.28
118.90
118.90
120.07
121.51
119.11
119.11
117.48
117.48
117.48
118.63
115.38
114.48
116.16
112.25
112.25 '
113.80
114.15
110.03
110.03
110.28
98.74
95.28
95.55
96.32
93.68
93.68
93.92
94.83
95.05
93.45
90.93
90.93
91.13
92.00
89.55
92.29
92.29
89.55
89.76
90.63
90.83
88.19
- 1 -
penomination Date of Issue Oats of Doath Value
25.00 11/73 88.19
25,00 12/73 88.24
25.00 2/74 85.70
25.00 3/74 85.70
25.00 5/74 86.52
25,00 6/74 86.73
25.00 7/74 84.20
25.00 9/74 84.20
25.00 10/74 84.20
25.00 11/74 85.01
25.00 1/75 82.72
25.00 2/75 82.72
25.00 4/75 82.72
25.00 5/75 83.52
25.00 6/75 83.71
25.00 8/75 81.27
25.00 9/75 81.27
25.00 11/75 82.07
25.00 12/75 82.25
25.00 1/76 79.87
25.00 4/76 79.87
25.00 3/76 79.87
25.00 5/76 80.62
25.00 7/76 78.44
25.00 8/76 78.44
25.00 10/76 78.44
25.00 11/76 79.20
25.00 12/76 79.43
25.00 2/77 77.11
25.00 3/77 77.11
25.00 4/77 77.11
25.00 6/77 78.04
25.00 7/77 77.75
25.00 9/77 75.75
25.00 10/77 75.75
25.00 11/77 69.47
25.00 1/78 67.63
25.00 4/78 64.41
75.00 3/72 276.87
75.00 10/72 272.79
75.00 5/73 268.65
75.00 12/73 264.81
75.00 7/74 252.60
75.00 2/75 248.16
75.00 9/75 243.81
75.00 4/76 239.61
75.00 10/76 235.32
75.00 5/77 233.64
75.00 12/77 208.98
- 2 -
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~;W
Franlc. l'oUelger
AucllulIIOI
. COll1lllu\tl AuullunulllllllI Galvlc\!
. Your luonlloll UI mlllu
. or 1'lIl>uy yuu' nllllllJ Inl
CR,II~ln. PA ,.,013
171'1) :.!43,lanO
1ll1bunJ'Y 5.1996
Apl','u:lrlllJ for VI Kathorinu Fornal1or!:. 21J8 'fnlo Avo., CRlDpll111,
I' n '. 1 " 011 , '
Hi,ll: ,lulln JJRruoy. ?J'/-~J97.
,
,
1I0uaahulrl itAmo1
,,'\ v:l TIf~ TUllIO I
I,tur,nnvux tv
VCIl
una oval uLRIIU
2 mn~R~jnu ruokn
npindlA stund
hookcRIIA
floor lump-Lnblu
1'111 d:l.n~~ ruoklll'
Croen couch
IP'IlUII ohn:! r
orunKc chulr & 81,001
1'1 (lOr J nmp
ond sl,Ctlldu
purtnble bAr (servor)
V:l,nt.ol'lnn floweJ'ud chair
uLurAO
i.v truya
1Ilwl'ry ReuI'etury uURk
fJ.ow(I)'ed lI1.uo1
m:luo (knlcknacku)
1)1 n in It MuOIO:
'J'C1bJu, I, chul!'u & hutch
\11 lie !'ur.
ImJJ runnur
Nor:!tukA djulI uut (Tree & water rleuign)
tlol'itnko- Rl'AOn vinu ReI,
J'of'rJ gerutOl'
$12!5.00
4~.00
10. Oil
8.011
10.00
5,00
~.OO
50.0U
75.00
:W.OO
10.00
15,00
4.00
'/5.00
30.00
5U.on
,.00
'/5.00
5.00
40.00
1;!5.00
;!5.00
25.00
175.00
50.00
;!5.00
Inllllll. ".., ,
.
sCHEDULI H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Pl.a.. Print .r T .
(OMMOtlWIA"" O. ..NNIYIVAUlA
IHtttaIlANC' tAl I"UIH
II\lOINIOICIOINI
w. Katherine Forsber
2196-0010
ITlM
NUMIIIR
AMOUNT
DESCRIPTION
A.
Fun"al bp.n""1
Myers - Harner Funeral Home
$5,120.00
I,
B. Admlnlltrallv. COlli I
I, Pe"onol Representative Commissions
Social Securily Number 01 Penonol Repr..enlollve:
Veor Commissions paid
2, Allorney Fe.. 2,000.00
3, Family Exemplion
Cloimanl Relallonshlp
Address 01 C1almanl 01 decedent's dealh
Slreel Address
Cily Slale Zip Code
A, Prabate Fe.. 106.00
C. Mlle.llan,oul bp.nllll
I, Frank Pottieger, Appraiser Fee $75.00
2. Filing Fee 15.00 90.00
3,
A,
5.
6,
7,
8.
TOTAL (Also enler on line 9, Recapitulation)
(II more Ipace II need.d, Insert addltlonallheell 01 lam. III'.)
S 7,316.00
LAs'r WILl. AND TI\S'I'MIEN'I' 01' W. KA'I'III\1l1NI\ l'ORSBEltG
I, W. KA'I'III\llINE FOIlSOI\RG, e[ the Ilerounh of Camp IIi 11 ,
Ceuntyof New Cumberland and Stote o[ Pennaylvonio, being of sound
ond dispeaing mind, memory nnd underatnnding, du make, publish and
declare this my lost Will end 'l'estament, hereby revoking ond
making void 011 former Wills by me at ony time heretofore mode.
1.
I direct the poyment of all my just debts and funerol
expenses as soon after my deceose os the same con conveniently
be done.
2.
All the rest, residue and remainder of my estate, real,
personal and mixed of whatsoever nature ond wheresoever the
same moy be situate, I give, devise and bequeath to my sister,
HELEN FORSBERG DARCY.
3.
In the event my sister, lIelen Forsberg DilFE,;"S should
predecease me I give, devise and bequeath my entire estate with
individual bequests executed as follows:
(a) My niece, Karen Forsberg Schumacher, is to receive
my gold pendant neckloce with three small diomonds, and the picture
of herself, "At the Fair," painted by her father.
"';.-<"""!-]
",.""'~
- ,,~:..'.t~.-;;.
-
I'ogo 2
WILL 0\" w. KATHERINE FORSIlERG
(b) My niece, Christino Floil, is to roceive my
Queen Anne's Cherrywood Desk.
(c) My brother,Williom L. Fersberg, is to receive 011
paintings he hos given tome except those gronted singly to
other persons by mys~lf and my Wolnut Liquor CAbiet.
(d) My niece, Jeonnette Forsberg Cook, is to receive
my Sterling Silver ond my NoritakeChina dishes and the
breakfront in which they arc housed. IOther dishea and
china therein to bv opportioned as the Executor of my Will
sees fit with the exception of my yellow Larkin dishes
which are te be given to my niece by morriage, Barbara C. Darcy,
if she wishes them.
(e) My niece, Suzanne Forsberg, is to receive my gold
choin with single diamond, plain gold chain and bracelet
to match and my stereo.
4.
All the rest, residue and remoinder of my estate, reol
personal ond mixed, I give, devise and bequeath as follows:
1. 1/3 (one-third) to my niece Dud godchild, Nina Kay
Dyers Johnson.
2. One-third (1/3) to my niece ond godchild, Karen
Forsberg Schumacher, and
3. One-third (1/3) to my nephew,WilliomDouglas Forsberg,
bu~ if he fails to survive me, the gift shall lapse.
~ ... -...... ..",
,
--- ---- -_.~ ----. --- --- --.- .... --.-. . -- -._-- ..... .--. ..--- -........--. ----- _. --- ._~ ..._- ...--.. -. .~---.
RECEIVED FROM:
&
ACN
ASSESSMENT P:I
CONTROL 1;1
NUMBER
AMOUNT
EAKIN JOHN M
MARKET SQUARE BUILDING
101
.9,:)17.89
MECHANICSBURG, PA 170~~
IOIDH,.r
lSTAT! INfORMATION.
!II I MI R
51 21-1996-0010
!II NAME Of DECEDENT lAST)
1;1 F RSBERG W
II E Of PAYMENT
SSN
IfIRST)
KATHERINE
194-03-B761
IMI)
EJ POSTMARK
OUNTY
llAl'E Of DUJH
REMARKS
m TOTAL AMOUNT PAID
.9.~17.B9
CW
SEAL
HELEN F DARCV
C/O JOHN MEAKIN
CHECK" 4739
ESQUIRE
.. ......-'
'jJ1/
I
MARY C. LE 'IS ,J)/lt1i.J
REGISTER OF WILLS j()f/j'
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RECEIVED BY
REGISTER OF WILLS
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RIVo1547 IX AFP (12095*
CDteOMAltH Of' PlHHIYL VANIA
DrPU"tlHf or Ittvnu:
IUlUU or INDIVIDUAL UXU
DOl. "UIl
ItAMllllUtG, PI 111t.....1 '
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ACN 101
HOTlCI OF IHItERITAHCI TAM
A~~RAISEHIHT, ALLOWAHCI OR DISALLOWAHCE
OF DlDUCTIOHS AHO ASSISSHEHT OF TAM
DATI 06-24-96
FILl NO.
DATI OF DIATH 12-15-95 COUNTY CUHBERLAND
HOTE. TO IHSURE ~RO~IR CRIDIT TO YOUR ACCOUNT, SUB"IT THI U~~IR ~URTIOH OF TItIS FOR" WITH YOUR TAM
~AY"IHT TO THE REOISTER OF WILLS, "AU CHICM ~AYABLI TO "REOIST!R OF WILLS, AOIHT"
REMIT PAYMENT TOI
JOHN H EAKIN ESQ
HARKET SQUARE BLDG
HECHANICSBURG PA 17055
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A.aunt R..ltt.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiili:is'47.EX-Aiip-nZ':9!;"j.NoTicEnciF.YNHEifii'AiicE.TAiD'PiiiiiiisEiiEN:r;.ALi."ciiiANci.jili.m..........m
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF FORSBERG W K FILE NO. 21 96-0010 ACN 101 DATE 06-24-96
If an allallmant wal illuad pravioul1Y, linal 14, IS andlor 16, 17 and 18 will
reflact figural that includa tha total of abh raturnl allallad to data.
ASSESSMENT OF TAXI
15, Aaount of LIne 14 .t Spou..1 r.t. (15)
16. Aaount of Lln. 14 t..~l. .t Lln..I/CI... A r.te (16)
17, Aaount of LIne 14 t..~I. .t Coll.t.r.I/CI... B r.t. (17)
IB, ~rlnclp.l T.. Du.
TAX CREDITS I
PAY"IHT
DATI
03-11-96
TAX RETURH WAS. I X) ACCEP~ED AS FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..I E.t.t. (Sch.dule AI (1)
2, Stock. ."d Bond. (Schedul. B) (2)
5, Clo..ly H.ld stock/P.rtn.r.hlp Int.r..t (Schedule CI (5)
4, "ort...../Hot.. R.c.lv~l. ISch.dul. D) 14)
5. C..h/Bank Depolita/Hllc. Parlonal Property (Schedul. E) (5)
6, JoIntly Owned Prop.rty ISchedul. F) (6)
7. Transfara (Schedule OJ (7)
8. Total A...t.
APPROVED DEDUCTIONS AND EXEHPTIONSI
9. Funeral EKpen.../A~. Coats/Hila. Expan... (Schedul. H) (9)
10. D.bt./Hort.... LI~llltl../LI.n. (Schedul. I) (10)
11, Tot.1 DeductIon.
12. H.t Value of Tax R.turn
13. Ch.rltabl./GoY.r~nt.l Beque.t. (Schedul. J)
14, Net V.lue of E.t.t. Subjoct to To.
NOTlI
RECEI~T
HUI1BIR
AAll 2598
DISCDUHT 1+)
IHTEREST (-I
500,94
I I CHAHCED
,00
26.126,95
,00
,00
48,547,53
,00
,00
(BI
74,674,48
7,316,00
566.27
(111
(2)
(15)
U41
7.RR' :07
66,792.21
,00
66,792,21
,00 X ,00.
,00 X .06.
66,792,21 X ,15.
UBI
,00
,00
10,018.83
10,018,83
AMOUHT PAID
9,517,89
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
10,018,83
,00
.00
.00
. IF PAID AFTER DATE IHDICATED, SEE REVERSE
FOR CALCULATIOH OF ADDITIDHAL IHTEREST,
IF TOTAL DUE IS LESS THAN tl, HO PAV"EHT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE
A REFUHD, SEE REVERSE SIDE OF THIS FOR" FOR IHSTRUCTIOHS,)
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RESERVATION. E,t.t.. of dlcadent, dvlng on ar before D.~..ber Il, 1982 -.. If any lutur. Int.r..t In the ..t.te 1. transferred
In poII..,lon or ,nJoyaent to Cl... . (coll,t.r,l) beneflclar... of the dlCldent .,t.t the Ixplratlon of any ..t.t. 'or
11'. or for v..r., the C~..lth hereby ,.pr..'ly r.l.tv., thl tight to .,pt,.,. ~ ...... tran.,.r I~rlt~. T....
at the l.w'ul Cl... . (co11,t.ta11 r.t. on any luch future lnt.t..t.
PURPOSE OF
NOTICE. To fulfill tM r....t....,t. 0' Section U4D of thl Inh.rltMeI IInd hbl, ... Act, Act ZZ of 1991. 72 P.$.
Section 214D.
PAMNTI o.tKh the top portion of thh NoUce and ,ublIlt with your p')<IIent to the Rlght.r of Wills prlntltd on the r.vlr.. slct..
......... check or ~y ardlr p'Webl. tal REGISTER OF MILLS, AGENT
AU paYHntl nulvlld shall flr.t be applied to eny Int.r..t which "Y M due .lth 8I'1W r...ind.r ~lIed to the t.x.
AEf'lJND (CAli A r.fund of . teM credit, which ... not requ..t.d on the r'M R.turn, ..y b. r.qu..t.d by cOIIPI.tlng 11I'I "Applic.Uon
for R.fund of pann.wlvani. Inherltanc. 8nd E.t.t. T.x" (REV-I)l)). Appllc.tlon. .r. .v.llabl. .t the Offlc.
of the Aegl.t.r of Will., any of the Z) R.venu. Di.trlct O'flc.', or bw c.lllng the .p.cl.1 Z4.hour
III'I..-rlnt ..rvlc. nuaber. for fori' ord.rlngl In Penn.wlvanl. 1.100.S6Z.Z0S0, out.ld. Penn.ylvanl. and
Mlthln loc.1 H.rrlsburg .r.. (717) 787.8094, TDDI (717) 77Z.Z252 (H.arlng lapalr.d Only).
OBJECTJONS, Any p.rty In Inter..t not ..thflN with the IIPpr.h..ent, .liowanc. or dhaUowlltlc. of deduction., or ........"t
of tax (Including dl.count or lnt.r..t) .. .hown on thl, Hotlc. .u.t obj.ct Mlthln .ixty (60) d.y. of rec.lpt of
thh NoUca byl
"wrltt.n prot..t to tha PA D.p.rt.ent 0' A.v.nue, lo.rd of Appe..., D.pt. 2U021, H8rrllburg, PA 17121.1021, OR
"alecUon to MV. the ..ttar detar.lned .t audit of the .ccount of the personal repr..ent.tlv., OR
....appe.l to the Orphen,. Court.
"'"1M
ISTRATJVE
CORRfCTJONSI
Factu.1 .rror. dl.cov.red on thl. ........nt .hould b. .ddr....d In writing tal PA D.p.rtaant of R.venue,
lur.au of Individual T.x.., ATTHI Po.t A.......nt Ravl... unit, D.pt. 280601, Herri.burg, PA 17121.0601
~ (717) 787.6S05. Saa p.g. ) 0' the bookl.t "In.tructlon. for Inharltanc. Tax Raturn for. Residant
Decedent" (REV.1SOI) 'or an ..pl..,.tlon of ~Inlstratlvaly correctabla .rror..
D ISCOlIfT I
If enw t.x due I. p.ld within three ()) c.landar aonths .fter the dec.dant'. d.ath, . flv. parcent (5~) dl.count of
the t.x p.ld is .llowed.
PEHAl TV I
The 15% tax ..,..ty non-partlclp.tion PBMltW It CDIIPUted on thll total of the t.M end int.rest .......d, and not
p.id b.for. J~rw II, 1996, the firat d.w I't.r the .nd 0' the tlX aana.ty period. Thl, non.p.rtlcip.tlon
peMltw II appe.labl. in the ... UlWMr and in the the .... tI.. p.rlod .. you would appell the taM and Int.r..t
that has bean ......ed .. Indic.tN on thlt notic..
INTEREST,
Int.r..t i. ch.rged beginning with flr.t d.W 0' delinquency, or nln. (9) aanth. and one (1) day froa the data of
de.th, to the data of p.w-nt. Tax.a which MC'" d.llnquent Mfor. J.,.,ary 1, 198Z b.ar Intar..t at the rata of
.ix (6X) parcent par ~ calculatad at . dallw r.t. of .000164. All t..e. which bee... d.linquent on and .'ter
J~rw 1, 191Z wIll be.r intere.t .t . r.t. whIch wIll v.ry froa cal.ndar year to calander ya.r with that rat.
announcN by the PA D.partaant of Revenue. The appllcabla int.r..t rat.. for 1912 through 1996 ar.,
'!!!! Int.r.st R.t. O.llv Inter..t Factor ~ Int.r..t Rat. Dally Int.ra.t Factor
1982 ZOX .000541 1917 OX .OODZU
1915 16:( .OOOUI 1981.1991 II~ .000301
19.4 II~ ,OOOsal 199Z OX .000Z47
1985 nx .000356 1995-1994 n .00019Z
I'" lOX .000274 1995.1996 'X ,000247
uJnter.st la c.lculatad .. followlI
INTEREST u BALANCE OF TAX UNPAIO X NUlIBER OF OAYS DELINQUENT X DAILY INTEREST FACTOR
-.Anw Notlc. Isaued aft.r the t.~ ~ ~~. d.llnquent will r.fl.ct an Int.reat calcul.tlon to flftaan (15) d.ya
beyond the data of the .........It. If p.yaant Is a.-t. aft.,. the Interut coaput.tlon data shown on the
Notice, additional Int.r..t ~at be calculated.
'"
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STATUS REPORT UNDER RULE 6,12
Name of Decedent I
W. Katherine For9berR
Date of Deathl 12/15/95
Will No. Admin. No. 21-96-0010
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 I
Yes x No
2. If the answer is 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 representative file a final
account with the Court? Yes No x
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes x No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: .Tilly", lQQf\
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John M. in
Name (Please type or print)
Market Square Bui~aing
Hechanicsburg, PA 17055
Address
o~
(717) 7f\(.,-"n
Tel, No,
fl ..;
U (j\
wU;
a:
Capacity:
v
Personal Representative
Counsel for personal
representative
(MAH:rmflAM3)