HomeMy WebLinkAbout96-00113
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. 2902107
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Name of Decedent 14-~?:!:,- &<.
Sex {':'W'l tt../...I.
Date of Birth :1".. P'1 :J../, 1'1/2 Birthplace
~,
Place of Death
p hc.~fy Nam. JJ J Oil""
Race 1,. h it..&.. Occupation ~~u ~2IJ; .J..,e. Armed Forces? (Yes or No) .N 0
MarltaIStatus.1JdDl,JIl."/ ~~lI~~;~~dress ...gO/ 1j;'l(bDHI ~ad )hi\Uslo_$ LI<L6 f'-
Numbef I ~ CJOf '+-1) Si]',
Informant e. Funeral Director -1Jtp. Ia,Ii U. 11 ,. (.
Name and Address of ' II} r J/ '/7 fi)
Funeral Establishment -Ll Ie...- fi)'lIl e" "I i/;11NH.., ,IA1u.flt), /J.., . ro.. 179!' I
: I nterval Between
: Onset and Death
,
,
,
Part I:
Immediate Cause
(a) /2??J S.../a-r...... {'1n/1;j"(j./UoL. hllDJt--I- t'u./....tt...
(b)
(c)
(d)
Part II: Other Significant Conditions
Manner of Death:
Natural ~ Homicide 0
Accident 0 Pending I nvestlgatfon 0
Suicide 0 Could not be Determined 0
Describe how injury occurred:
Address
'P.
(M.D., D,O" Coroner, M,E,)
b
This Is to certify that the information here given is correctly copied from an original certfficate of
death duly filed with me as Local Registrar, The original certificate will be forwarded to the State
Vital Records Office for permanent filing.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name or Decedent: ALMA G. KEIPER, Deceased
Date or Death: Decf!mbf!r 16. 1995
Will No. Admin. No. 21 - 96 - 113
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 April 03. 1996
Name Address
Shirley M. Nealy 301 Airport Road, Shippensburg. PA
Relationship
Daughter
Notice has not been given to all persons entitled thereto under Rule 5.6(a) except:
NONE
o.'W
s&f~ -Y)J~
SALLY J. WINDER, ESQ.
701 East King Street
Shlppensburg, PA 17257
(717) 532-9476
CAPACITY: _X_ Counsel for Personal
Representative
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
".,1500 IX+ 1'2"11
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PILI NUMBlR
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COMMONW1!ALTH O. PfNN5YLVANIA
DI'AJ:rMfNT o. llvt:Nur
DIn. 210601
HAAlIIIUla.,.. 1112'.0601
N'N ILA,. ,ANMI
KEIPER.
l INllAlI
G.
COUNTY CODE
D N . M l A
NUMaER
ALMA
21
96
113
YEAR
301 Airport Road
Shippensburg PA
17257
Original Return
t~OV"I' Cumberland
03.
05.
Remainder Return
(lor dOle. 01 neolh p,io, 10 12.13.821
Frderol Estal. To.
R.lur" Required
..Q. 8. T 0101 Number 01 Sofe Depo.il Bou.
(81 34,705.28
(II) _7.234.04
(121 27 ',~71. 24
(13)
(14)
M .06..
27.471.24
-.!.. 648.27
SALLY J. WINDER 701 East King Street
n"'HoHI HUM'" I Shippensburg PA 17257
532 - 9476 _L .
I. R.ol E,'ol. (Sch.dule A) ( I) ..2,0.3.13.,10,__._....._
2, Sloch ond 80nd. (Sch.dul. BI ( 21 _..._.n_oo_____
3. Clotoly Held Slock/Po"nonhip Inler.., (Sch.dul. q (31
4. MO"gog.. ond Nol.. Receivobl. (Schedul. 01 ( 41 m___
5. Co.h, 80nk Depo.ilt & Miscelloneou. Pononol P,operty( 5) ...J.A.1.!!J...5B____
(Scnedule E)
6. Joinlly Owned Property (Sch.dule FI
7, Tront/on (Schedule GI (Sch.dule II
8, T 0101 Gron A...1t (Iolollin.. 1.71
9. Funeral bpens." Adminls.rotiVII Cash, Miscellaneous ( 9) ~ R65. 96
Exp.nto. (Schedule HI
10, D.blt, MO"gog' liobilili... li.n. (Schedul. I) (10) _3..6..8.._08
11. Tolol Deduclion. (,olollin.. 9 & 10)
12, N., Volue 01 E,'ol.(lin. 8 minu.line II)
13. Choritobl. ond Governm.n.ol Bequ,,', (Schedule J)
14. N., Volu. Sublectlo Tox (line 12 minu.line 13)
15, Amounl of lin. 14 loxoble 01 6% ,olt
(Includ. volu.. from Sch.dule K or Schedule M.I
16. Amount of line 14 laAobl. 01 15% rale
(Includ. volu.. from Schedule K or Schedule M.I
17. Principollox due (Add lox f,om line 15 ond f,om line 16.)
IS. Credill Prior Payments Discount
---- + -------- -
19, II line 18 it greoler Ihon line 17, enlOr Ihe dill.rence on line 19, Thi. i. tho OVERPAYMENT.
aD
20. If lin, 17 is grealer than line 18, enl~r the difference on line 20. Thi. is ,he TAX DUE.
A. Ent.r the l"fe,est on the bolance due on line 20A.
B. En.er Ih. 10101 of line 20 and 20A on lin. 20B. Thi. i. .h. BALANCE DUE.
Mok. Check Payabl. 10: R.gbter 0' Will., Ag.nt
2012 r~~~:~~;_----1~';~;~~'1;
U 2. Supplemenlol Relu,n
[} AD. Fulure Inlero" Compromise
(lor dol.. 01 d.oth olter 12.12.82)
o 6. Olted.nl Died T o.taht [] 7. Oecodenr Maintained D living T tull
(Alloch copy 01 Will) (Alloch copy of Tru..)
COGISPONDEHCI AND CONFIDINTlAL TAX INFORMATION SHOULD liE DIRECnD TO..
NAM MPl MAlliN A illS
IAL SfCUlIllr NIJM3lii
162
Ill!.
04.
2/,
limited E,Iol'
(17) ~4B.27
(18)
(19)
(20)
120A)
(20BI _1.,6A..!!..;Z~
..111 SURITO ANSWER ALL QUlSnONS ON REVERSI SIDE AND TO RECHECK MATH....
Und., penal'i.. of perjury. I d.c1are thol I hav.. 'AomineJ this 'elurn, including accompanying tchedule, and stolomenll, and 10 the be" of my .nowledge and beli.f,
il is t ue, correct and complet.. I dedor. .hat all real IIslol. has been reported ollrue mark.1 value Oeclaralion of purparer other than the penonal repres.ntative is
bas on all information of Whi(h~t ar r has ony knowledge.
I " N A,n ;CiffUP,N AODAfSS OAtE
, . 'Pil. _ 301 Airport Rd., Shippensburg PA 17257 tJ.J.:uL/~f..
, III A T HiN i\tf1f!rrfJ AOOUSS o~
_. -.!..J. ~~ 0 701 East King St., Shippensburll PA 17257 ....!t~'}jt;1.
( 6)
( 7)
(151 ..11... 4 71. 24
(16)_,______M .15..
Inleresl
Chock hore, if you aro roquesting 0 refund of your ovo,payment.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (".) IN THE
APPROPRIATE BLOCKS.
YES N()
1. Did decedent make a transfer and:
a. retain the use or income of 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?.....................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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SCHEDULE A I
REAL ESTATE ..----J
, ..-'-'-'" - '===.-----.f[.-NUMBERu. --
ALMA G. KEIPER. Deceosed 21 - 96 - 113
_._0.__._.- ___.__,,___"+_____._.__________
I'",p.rtv lolatlv-own.d wllh RighI of Survivorship mu.t b. dl"lalld aa Sch.dul. FI AII..al.llat. .hauld b. ..pa.t.d at fol. ma.bl valu.
which I. d.nn.d 01 Ih. p.lco 01 which p.ap.rtv would b. ..chang.d b.twttn 0 willing buv.. and 0 willing 1111.., n.llh.. b.lng camp.lI.d
10 bu or 1111, both having ..a.aaobl. kaowl.dg. of Ih. ..I.,!a_~,-fad.. ",....... .._"" .. n.'.. ,. ........ .. '_'__'_
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
IIY,I50211+ 112'''1 .
W
COMMONWIALTN 01 P1NNIYlYANIA
INHUITANCI fAX _!TUlN
llllDIHt D!CIDIHr
ISTATI OF
1.
Real Estate situate in Schuylkill County, known and numbered as
1185 S, Lehigh Avenue, Frackville, Pennsylvania, improved with a rowhouse,
This property has an assessed value 01'3,130, The common level ratio for
Schuylkill County as established by the State Tax Equalization Board in
1994 is 6,49, This comon level ratio factor is applicable to documents
from July I, 1995 to June 30, 1996. Therefore, using the tax assessment
01'3,130 and multiplying by 6.49 yields a fair market value ofthis
real estate 01'$20,313,70,
$ 20,313.70
TOTAL (AI.a .nler on IIn. I, R..apllulollon)
(II more 'pot, js n..dld, ins." additional ,h..,. 01 lam. sill.)
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DUD. Ho. III
rrtnhd tor and Bold b7 John C. Clark Co., 1410 8. P.nn 8q., nUL
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26th day of
one thousand nine hundred and
February
sixty-eigllt (1968)
. ill the year of our Lord
lIefureen ALMA G. HElPER, ami FIVINH 1'. HElPER, Iter Imsballd, of the
Borough of Fraclwille, COl/llty of Scltuylkill ami state of Penl/sylvallia, jJUrlies
of the first /Jart,
AND
ALMA G. KEIPER, alld FRANK P. HElPER, her hl/sband, of tile Borol/gll of
Frackville, Coullty of Sclmylllill alUl State of Pellllsylvallia, /Iarties
.
01 the I<<OM port: DlIUnessetl1, That the solei parties
conslJeratlon 01 the sum 01 Olle ($1. 00) Dollar
01 the Ilrst part, lor OM III
lawful money 01 ihe UnllN States 01 AmerIca, well and truly paId by the solei parties 01 the SKOM part
to the sold parties 01 the Ilrst part. at onel belore the ensoallng anel dollrery 01 these present" the reeelpt
whereol 1, hereby acknowlNgN, Ita ve gronteel. bargalnN. solei, olleneel. enleolleel, re/easN, conreyecl and
conllrmecl anel by these present' do gront. bargaIn, soli. ollen, en/eoll, releose, conroy anel conllrm
unto the I(IIcI part ies 01 the sKanel part. tlleir Iteirs anel assIgns,
..
ALL TllA T CER TAIN lot or /Jiece of grol/lld sill/ate 011 tile West
side of Lelligll Avenl/e ill the Borol/gll of Fraclwille, Sclmylllill COlmty alld State of
Pennsylvania,."bolulded alld described as follows:
BEGINNING at a poillt twellty-five feet sevell (25'7") illches
Soulh of the northernlille of lot No.8 ill Blocll No. 11, tllellce Westwardly arId
at right allgles to Lelligll Avelll/e, Olle l/r/lldred Fifty (150) feel 10 a jJOillt 011 tile
East side of Pellll Alley;'tllellce SOl/tltwardly alUl alollg tile East side of Pelm Alley,
TweIJty-four feet five (24'5'~ illclles to a jloillt; Iltellce Easlwardly alUl at rigllt
allgles to Pellll Alley, aile Ilwldred fifty (150) feet 10 IlIe West side of Lelligll
Arf3llUe, twenty-fol/r feetfive (24'5'~ illcltes to the jlOillt of begilllling. I
./ CONTAINING ill front or width on Lelligh Avelll/e, twellty-fol/r
fiJf!t five (24 '5'~ illclles arid exteluling Westwardly of IlIatwidlh ill length or deMh
one Ilundredfifty (150)feet to Pellll Alley.
BEING the same jlremises wllich Alma G. I(eijler, Execl/trix
of the Last Will alld Testamellt of Mal/de Sltirey, deceased by Decd dated FebrllU1'y
20, 1968 and recorded ill tile Office for tile Recm'ding of Deeds ill alld for
Schuylkill COl/nty ill Deed Booll No. , jlaKe I grmlled ami conveyed
WltO Alma G. Heijler. Also being tlte sallie jll'elllises wldch Emily Sobey by her
Last Will aud Testalllellt dl/ly jn-obated al/(l J'ecorded iI/ tlte Office of tlte Register
of Wills ill Will Booll No. 53, jlUge 510, did dellise al/(l beql/eathlllllo Aima G.
lCeipe". The /J//r/Jose of lIlis deed is to vest title ill the j}(/rlies as tellmlts by tile
entireties.
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BOOK1.095 rAGE 434
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"ults,b. '11'"11 01 tll. dot. 01,1Ie abol,.lnd.ntur. 01 M. above namecCALMA G. [(EIPER,
alliI FRANl( P. KEIPER, l1er l1usballd, tl1a cOllsidaratiollmanticJ//ed willli ill
/till. " C
C;'-J'L"..,/ ~'":""'. /
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ColIn" 01
Pennsylvallia
SC/lIlylllill
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On ,lie " 26tll dOli 01 February
a Notary.~blic ill and/or said COllllty allli stata
, 1968 , b./oreIM,
'11. tIlldmignfd oDiur, plrlonaUII app.ar.d ALMA G. KEIPER, alUi FRAN/( P. KEIPER, :
her "l/usba!ul
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Titl. 01 Offierr
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klUltllll '0 m. (or ,atillacton/ll prov.n). to b. th. perlon S wholl nomOS
tDitllin inttrum.nt, and oeknowledg.d that t h.y
JlIIl1IOfl. thrrein contain.d, and d,nr,d th, ,am, might b. record,d a' ,ueh.
. In Wltneu Wh.reo', 1 her,unto lit mil hand and offinal ..01.
The addreu 01 the within-named Oronlce
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. n. b"half of th. Grante.
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In the Omce 'or the Recordlnll 0' Duds In and (or
In Dud Book
SCHUYLKILL COUNTY
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No. 1095
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pGlle 434 &c.
.Itn,.. my hand ond s'o( o( omce thi, . 2,7th.
r . .; l .
day 01 FEBRUARY. Anno Domini III' 6,8
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Dauphin Deposit Bank
and Trust Company
MAIN OFFICE: 213 MARKET STREET. HARRISBURG, PEHNSYLVANIA 17101
117 2$$.2'21
Decedent Confirmation
Name: Alma G. Keiper
Social Security No.: 162-24-2012
Date of Death (ooD): 12/16/95
Accolllt No. 0017770971
Type aJecking
Date Opened
or IlI8UId 01/23/95
Date Closed
or Matured
Date of Death
Bal.x:e '11,925.96
PUS
Date of Death " .
Accrued Int. ..98
Joint OMlera
(if any) None
Date of Joint
OMlership
Special ()
nte: N/A
Addlttonal Inr_tlon avanabl. at UO.OO per hoUr. OM hoUr .tnt_.
Date Prepared: February 22. 1996 Prepared by: carolyn A. Berkebile
custaner Management Information Dept. (CHI)
Page 1 of 1
Telephone No. (717) 255-2054
,.... 00-010-21. (1l!V 1/11)
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t.,-y...",~*"l;",'Oix:,...~t--; ,:,~.,,'}'" ..-,
, Meridian Bank
The Meridian Center a\ Spring Ridgo
P.Q, Box 1102
Raading, PA 19603-1102
(610) 655-2477
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Peler J, Strunk
VICO Prosldont
Corpornlo Rocords Monayoment/
Regulatory I\ppllcolions
el Meridian- Bank
February 26, 1996
Sally J. Winder, Esquire
701 East King Street
Shippensburg, PA 17257
Dale of Dealh: 12/16/95
Re: Estate of: Alma G. Keiper
Dear Attomey Winder:
We received your letter daled February 9, 1996. Our records indicate the following
accounts and balances as of the date of death:
Account # Account Title
CK 04880811 Alma Keiper
Interest paid 1/1195 to 12/16/95: $28.89
MO 650540002556i t'. Alma Keiper
. . or Frank' Keiper .
Date
9pened
10/19170
Dale
!;losed
Accr.
lnt.
0.00
~rincipal
2436.73
0,00
10/28/89
"
sv 8272573809
Alma Keiper
11/4/92
6/28/95
Should you have any questions, please contact Deborah Mengel, Compliance Specialisl, at
(610) 655-4212.
, .
... Sincerely,
\\-~ Q. ~~
Peter J. Slrunk, Vice President
Corporale Records Management
PJS/dm
CK = Checking SV'= Savings' CD = Certificate of Deposit SO = Safe Deposit
MO i,:'Open:LirieofCredit "
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ITEM
NUMBER
A.
B.
4.
C.
1.
2,
3,
4.
5.
6,
7.
8.
*
COMMONWEALTH O' PENNSYlVANIA
INHUllANCE lAX _nUIN
_!SIOlNT DfCIOINT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PI. a.. Prln' or T .
ALMA G. KEIPER Deceased
DESCRIPTION
1.
Funeral Exp.nll"
Nice Funeral Home, funeral bill
1.
Admlnl.'rallv, CO"'I
Personol Representolive Commissions
Sodol S.curlty Numb.r 01 Personol Represenlalive:
Year Commissions paid
2.
Altarney FilS
Sally J. Winder, Esquire
Family Exemplion
Clolmant Shir1ev ~I. Nealy
Relalianshlp nnllgh...r
3.
Addre.. 01 Clalmonl 01 decedenl's dealh
AJd 301 Airport Road
Slreel,.", ress
Shippensburg
Zip Code 17257
City
Slote P A
Probol. Fees
Register of Wills, Letters of Administration and Short Cert.
MIIe.llan.au. Exp.n....
Cumberland Law Journal, Advertise Letters of Administration
Robert Berg, Tax Collector, Real Estate Taxes due
TOTAL (Also enter on line 9, Recopilulolion)
(If more .pace I. n..d.d, In..rt additional .h.... of .am. .11..)
AMOUNT
$ 1,817,00
$ 1,235.26
$ 3,500.00
$
81. 00
60.00
172.70
s
6,865.96
uv.UIJ 1It'-III
'*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE L1ABLlTIES AND LIENS
Plea.. Print a' T e
PILI NUMBIR
21 - 96 - 113
COMMQNWlAlfN Of "NHI1'l'llI'N1A
IHMIII1AHCI 'Ill l,tvlN
1.1IDIN1 DKlDfN1
==-
ISTATe 0 F
Kl TPER, ALMA
G.
ITIM
NUMIIR
DISCRIPTION
AMOUNT
2, Dell Atlantic Telephone; March bill $ 11.53
3. P.P. & L,; 01/04/96 bill $ 18.53
4. P,P. & L,; 0'}j0'}j96 bill $ 19,60
5, P.P. & L.; March '96 bill $ 6.08
6. Frackville Area Municipal Authority; sewer bill $ 37.50
7. Hawranick's Oil; fuel bill $ 65.00
8. HBwranick's Oil; fuel bill $ 65.00
9. Water Authority bill $ 8,00
Hawranick's Oil; fuel bill $ 65.00
Water Authority bill $ 8.38
1 Frackville Area Municipal Authority; sewer bill $ 37.50
1 Bell Atlantic Telephone; bill $ 48
TOTAL (Aho Inter on linl 10, Recopitulotlon)
(11100" 'POCI i. nooclod, inllr! additionol .""" o/.aml .i.,,)
s
368.08
I
-- -. ----.
.
-- - - ~--- - -. - - --- -- -- -- -- - -_..
------- ._---~----______I
~;~.~.."i""'! ':Tl.t"~1IJt --'-'.~l;"",Vt';~'.\,> " 'J.~" I" .;"... '..;: .......;-0: .. ....:. "'1"1;',,;...,...;:1.";~""::,"~.ii
~r~V"" ~l("fr.:"""'\I'."r'..,...:'lo; J)~>' .;. -. ,"', ("(1':"'-' :J'''-:' ,ft_'I,...".,'-'tt"lJt:J..
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}l r'!IP';"~;;'j,"'I'~H-" <,.';,", ;!,;.~iD"m'.. ;a'....~.i.~;;:.;,';:,.y;"/,.
,YAn'" ,. .......-.... ..........J~ '.' ", ","',
... . ~~II!I~. _~rt;'..-,.,..IOl:",.,....
~
,;
RECEIVED fROM,
&
ACN
ASSESSMENT '!I
CONTROL ~
NUMBER
J
AMOUNT
WINDER SALLV J
701 E KING STREET
lul
.1,b'tl:l.i:!'/
SHIPPENSBURG, PA 172~7
"
ESTATE INFORMATION,
!II IL N MI R
U 21-1996-0113
EJ NAME Of DECEDENT (LAST)
I E Of PAYMENT
EI POSTMARK
COUNTY
S5N 162-24-2012
(fiRST) (Mil
D
DATE Of DEATH
I REMARKS SHIRLEY M NEALY
I CIO SALLY J WINDER ESG
, SEAL ( .
I, RECEIVED BY ;'-$f.., ,
'u .
I // 11" J
I REGISTER OF WILLS MARY C. LEIn S I 'lf~'l' ,
I REGISTER OF WILLS /, J-
1 m~
~__ __ _ _ _ _ _ _ _ _ _ - ,...- --- -- -- - -- - -- - - - - - -___- ~-r-:-::
. ' ,.I. ." '-~''''t'00i,l
, It .....
.. ~ " i' ..""'
m TOTAL AMOUNT PAID
.1.648.27
PB
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REV-1547 EX AFP (12095*
CQtIIlItMAL TH Of' PE:leCSnVANIA
DUUTMDCT OF R[V[JU:
Il.IIUU r1F INDIVIDUAL "xn
DlPT. ZlUD1
HARRIIIURG, Pi 1711'."01
ACN 101
c~
NOTICE Of INNERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESS"ENT Of TAX
DATE 07-29-96
DATE OF DEATH 12-16-95
FILE NO.
COUNTY
CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUB"IT TNE UPPER PORTION Of THIS fOR" WITH YOUR TAX
PAY"ENT TO THE REGISTER Of WILLS, "AKE CHECK PAYABLE TO "REGISTER Of WILLS, AGENT"
REMIT PAYMENT TO:
SALLY J WINDER
701 EKING ST
SHIPPENSBURG
PA 17257
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
bount Re.Utod
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
ii!'y:isW-EX-"Fji-ii'Z':9sY-iioi"icniF-YNHEifii'ANCE-i"Ain-PPRA'iSEHEii'r-,--,HrciwANCnfRuuuu-umm
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTA-TE OF KEIPER ALMA G FILE NO. 21 96-0113 ACN 101 DATE 07-29-96
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.rel Expen.../Ad.. Coatl'HiIC. Expen... (Schedul. H) (,)
10. Debh/Hado_ Llebllit1e./Lhn. ISchedule II UO) 368.08
11. Totel Deduction. Ill)
12. Net Vel... of TllX Return (2)
U. CherUeble/Oo~er......hl B.......h ISchedule .I) Us)
14. Net Velue of E.t.t. Subjeot to T.x (14)
NOTE: If an a.sass.ant wa. issuad praviously, linas 14, 15 and/or 16, 17 and ls will.
reflect figura. that includa tha total of ~ ratur.ns assassad to data.
ASSESSMENT OF TAX:
15. ~ount of Li... 14 .t Spou..l r.t. 1151
16. Aaount of LI... 14 t.xeble .t LI....l/Cl... A r.te (16)
17. Aaount of LI... 14 t.xable .t Coll.terel/Cl... B r.t. (17)
18. Principe! Tex Du.
TAX RETURN liAS. I X I ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. (Schedul. A) II)
2. Stock. and Bond. (Schedul. B) (21
5. Clooaly Hold Stock/Pert...rlhlp Intere.t ISchedul. Cl (5)
4. Hart_./Not.. Reo.habl. tSchodule Dl (4)
S. .Calh/Bonk Depo.it.IHi.o. Per.on.l Property ISchedule E) (5)
6. .Jointly Owned Property tSchedule F) (6)
7. Tran.f.r. (Schedul. G) (7)
e. Tohl boah
TAX CREDITS:
PAYMENT
DATE
04-25"96
RECEIPT
NUHBER
AA1l27S0
DISCOUNT l+ I
INTEREST (-I
.00
( ) CHANGED
20.313.70
.00
,00
,00
14.391. 58
.00
.00
II)
34,705.2S
6,S65.96
7.n4 04
27,471.24
.00
27,471.24
.00
27,471.24
,00
X,OO.
x.06.
X .15.
uel
.00
1.648.27
.00
1.64S.27
AIKlUNT PAID
l,64S.27
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND,PEN.
TOTAL DUE
1,648.27
.00
.00
.00
. If PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST.
If TOTAL DUE IS LESS THAN .1, NO PAY"ENT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRl, YOU HAY BE DUE
A REfUND. SEE REVERSE'SIDE Of THIS fOR" fDR INSTRUCTIONS. I
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AEstRYAUOHI 1i16iU. of dtndentt Ul, on or billa,.. o.cMbe,. 12. 1911 .. 11 MY lutur. lnte,.ut In the ut.t. I. tnn".r".
~\t po.....lon Dr enj~ to C1... . (colll'.r,l) ~flcl.rl.. of the decedent .'t,r the ..p.r.tlon 0' eny ..t.t. for
II'. or for v..r., thi ~lth her~Y expr...lv r...rv.. the right to .",..1.. end ...... tren,'.r Inherlt8nC1 ,....
It the l~ful Cl... . (collat.r,l) r.ta on MY luch lutur. lnt.r..t.
PUAPOSI! Of'
NOTlCEI
PAYMENT I
RUlJND(CAh
alJECTIONSI
'''''N
laWTlW
CORRECTIONS I
DISCOUNTs
PENALTYI
INTEREST I
To fulfill the requlr..-nt. of Section 2140 of the Inherlt8nC1 end E.t.t. Ta. Act, Act zz 0' 1991. 72 P.S.
Section 2140. .
IMtKh the top portion of thl. Hotlu end Iw.lt .,Ith your PIYNn' to the Regls',r of WUh printed on ttMI r.v.r.. ,hili.
....... check or ~y order ptV_h tal REGISTER OF MILLS, ACENT
AU p,pent, recelyed ...11 first be ..-lIed to ."y Inter..t which MY tM dull wlth IInY ,....ln$r ..,plied to the t...
" r.h.nd of . to crMSIt, which WII, not r......ted on the To R.turn, ..y be r......ted by cOllPI.tlng Iln "Appllc.tlon
far A.fund of Penn.vlvanl. Inheritance end E.t.t. To" (REY-IJIJ). Appllc.tlon. .r. .v.llabl. .t the Office
of the Aagl,tar of Will., any of the 23 A.v~ DI.trlct Offlc.., or bv c.lllng the .peel.l 24-hour
."...rlng ..nlc. nu-bers for fa,... orderIng I In Pannlvlvanl. l-IU"UZ-Zaso, out.let. Penn.vlvanl. end
wlt~lr loewl Hlrrllbur, .r.. (717) 717-1094, TDD. (717) 77Z-ZZ52 (Ha.rlng 1.,.lrad Onlv).
Any p"tv In Int.r..t not ..tllfled wIth the ..",r.lI-.nt, .UOtfanc. or dl..UOtfanc. of deduction., or .......ent
of tu UnclucUng dl.count or Inter..t) ,. .hawn on thll Notlc. ..,.t object within .1lcty (60) dey. of ne.lpt 0'
this Notice bVI
......rttt., prot..t to the PA o.p.rt.."t of A.venue, Board of 'pp...., Dept. ZllGZI, Harrisburg, PA 17UI-lGZl, OR
....Iectlon to have the ..tt.r dIIt.relNd at IlUdI t of the eccount of the ,.rsonel repr......t.Uv., OR
-.......1 to the Orphan.' Court.
F8Ctuel .rrars dlscov.red on thl. ........"t .hould be eddt...ed In ..,.sting tOI Pi Dep.rt.."t of Rev.,.,.,
Bur.au of Individual T...., ATTNI Po.t a......."t A.vl... unit, Dept. ZIO'OI, Harrl.burg, PA 171ZI.0601
Phone (717) 717-'505. Sae page 3 of the bookl.t "In.tructlon. for Inherltanc. T.. A.turn for. A..ldent
Decedent" (REV-ISOI) far an ,xplan8tlon of ~Inl.tratlv.ly correctabl. .rror..
If _IV to dull II p.ld within thr.. (J) c.lendar aonth. .ft.r the decedent'. duth, . flv. percent (5%) discount of
the tu paid I. .llowed. .
The 151: tn __.tv non-partlclp.tlon penal ty Is co.puted on the total of the. te. and Int.r." ........., end not
p.ld before J~ry II, 1996, the flr.t d.V .ft,r the end of the t.. -.na.ty p.rlod. Thl. non-participation
,..,.1 tv Is appe.labl. In the .... utWMIr and In thl the .... tI.. p.r loci .. you would .....1 the t.. and Inter..t
that h.. been ......ed .. Indlc.ted on this notlCI.
Int.r..t .. charged beglmlng with first dey of dlllnquency, or nine (,) ...nth. and OM U) day frOll the d.t. of
....th, to the dIIt. of PIIv-nt. Tax.. which bee... d.lInquent before Janullry 1, 1912 bear Intar..t .t the nt. "of
.1lc (,1:) percent ,.r ..... c.lculated .t . d.lly ntl of .aGOI64. AU t,xe. which bec... dIIl1nquent on and .ftar
Janullry 1, l'IZ .,111 bear Int.r..t .t . r.t. which .,111 vary frOll calendar y..r to c.lendar y..r with that rat.
announced by the PA Dapartaent of Alvenue. The appllcabl. Int.r..t r.t.. for 1'.Z through 199' .r'l
!!!! Int.r." A.t. o.llv Intar..t Factor !!!! Inter..t Rat. D.lly Inter." Factor
I9IZ ZOX .ODD541 1917 9X .aauu
l,n 16% .aDDU. 19M-I"1 IIX .000101
1914 IU .DOnn 199Z 9X .000Z47
19as ISX .00OS56 1995-1994 7X .OD0192
1916 lOX ~OOOZ74 19'1-1996 9X .OaoZ47
--Inter..t I. c.lcul.ted .. follOtf'1
INTEREST . BALANCE OF TAX UNPAID X NUHeER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
--Any Kotlc. I..ued .ft.r thl ta. bac~' d.llnquent will ,.fl.ct en Int.r..t calcul.tlon to fifteen (15) days
b.yond the data of the ......-.nt. If P.~t 1. .ada .ft.r the Int.r..t coaputatlon date shown on the
Notlca, IIddI tlonal Inter.., ..,.t be calculated.
~_L"._
,
,
STATUS REPORT UNDER RULE 6.12
Date of
Decedent:-.fjln'\A 6. ke/~/
Death: I 2.}' ft, Jq~
{ q
Admin. No. 2.1- f.:,-DOJ/3
Name of
Will No,
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:
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
complete:
3. If the answer to No. 1 is Yes, state the followingl
a. Did the personal r)fresentative 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 representative state 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 Orphans' Court and may be attached to this report.
D.t.'~ Sl.~JW~-
Sail .J uJ,~Y
Name (p1ease type or print)
701 G I<,~ ~r
Address Shl'~t\ ~i,.,JA. ex IA-
Un) c:::-~ ~ -1+ Z-f::,
Tel. No.
(HAHlrmf/AM3)
Capacity: Personal Representative
~counsel for personal
representative