HomeMy WebLinkAbout96-00195
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IJETITION FOR IJROIIATE and GRANT m' LETTERS
E.Hal~ /If -ta:.LozIJ (") t!..l.txII$B6L No. __J..l::.J991o - 195
als/I kll/lll'lI as To:
RcgiMcr of Wills for Ihc
. IJl'cl'asl'd. ('llIl1l1y of in Ihe
Sodal S~l'Ilrity No'l-~ 3 -I? ... 'j'f? 16 Conllnonwellhh of Pennsylvania
The pelilionof Ihc nndcrsigned rcspcclflllly rcprcscnls Ihal:
Your pClilioncr(s), who h/arc 18 ye:m of agc or oldcr IInlhc CXCCIII 0 R
in Ihc la" will of Ihc ahove dcccdcl1l, dalcd
and codicil(s) dalcd -Ez12 2. ~ I '? 9~
named
. 19_
(\laIC rdCHlIll dfl:lIImlal1~'l'\. (',J!. 1l'lltIl1datinn, lIl';uh uf t'\t'l'ulnr, CIC.)
()cccndcnl WIIS domiciled III dealh in_r::.:.J.2Ju.E'. _ COIlIllY. Pennsylvania, wilh
h--:iJ2.- lasl family or principal rcsidence 111 -qD..~~...R.~/l (? ..
6,tt:-#(.a!?r-/'-/ s pA
tll\1 \lIl'('I, lllulIhrr UIll! lTlundr<llil)"J
Dcccndel1l, IhcII _~_I.-years of IIge, died 6 C' ~ 0 q. 9 '7' , 19 crt;"' ,
III_C.'U!:1.J3-~'TY AI uS I ~ /+e>tyv. .
Exccpl a, 1'011,)\\", dccedcIII did nOlmarry, was 1101 ~il'orccd IInd did nol have II child born or adopled
afler e,eclllion of Ihe will "ffered for probale; was nOllhe viclim of a killing and was never adjudicaled
iaCOlnpl!ICnl:
DeccndcllI al dcnlll owncd propeJ:ty wilh cSlimaled values as follows; d S';,o (90
(If don;iciled in Pu:) All personal properl)'. S (I , - C> C>
(I I' nOI doiniciled in ('a.): Personal properly in Pcnmyll'ania S
(If nol domicilell in Pa.) Personal properlY in County S
Vullle of real eslale ill P9lnsyll'ania S
silulllcll a, follows; '7~ r:t I~os ;l..~ R ME. /...E~, ,orlV l 7> c;- c> ,0 t:J-4
WHEREFORE, pelilioner(s) respeclfnlly
presellled hcrewilh und Ihe gralll of lellers
rcquesl(s) Ihe .prohule of Ihe IuS! will und codicil(s)
ADMINISTRATI~NC.T.A.
(h:\lillT1c:nlilty; ;hJmini\lraUOn c.I.a.; adminbtr3lion d.h.n.t.l.a.)
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OATH 01' PERSONAL REPRESENTATIVE
COMMONWEAI.TIt OJ-' J>ENNSYLV ANIA }::I::I
COUi'in' ()Io' ~.11MrU:llLAND
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1'1..:: pClilillncrls) abmc-nalllcd swcmls) or afnnn(s) Ihallhc S1atcmclIIs inlhe foregoing petilion ure
Irlle alld currecl Illlhc hcstof Ihe knllwledgc llltll he lief of pClilioner(,) and Ihal as personal represen-
IlU i\'l'h I Ill' Ihc aluwc llccellenl pClilillner(s) will well mid Irul)' allmini'ler lhe e'lale according 10 law.
511'''11I I" (\I.. affilmcd llltd '"h'CrihCllfle -(:dX/~ f U~ '"
het'Il". lit,' Ihi, ~.~E_____ lla) uf ;0'
FEBRU~Y., ~6 ~
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R"t . LEWIS 1'~i,\ler _ <,b,J) ~
/5-8Q<1. I '"
No. .aL::19.9..LD -IQS
Estate of
ELLEN O. MA'rTERN
I Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 4 19~. in consideration of the petition on
the reverse side hereof, salisfactory proof having been presented before me,
IT IS DECREED Ihatthe instrument(s) daled FEBRUARY 24. 19995
described therein be admilled 10 probate and filed of record as the InSI will of
ELLEN O. MATTERN
ADMINlSTARTION C.T.A.
WILLIAM E. MATTERN
and tellers
arc hereby granted to
~fUA-lr~1!!;IJwJ ."\
MARY C. EW S Rralll" or Will. ' ~
FEES
u);aol~""t.~.,.~ r.StJ
A TTORNIlY)(Sup. Ct. t.D. No.}
.:1 00 ~ YYVn ~.1: S::k- .
ADDRESS
(' A'l"""-f \-\. JL "7 R 1,O\~
PHONE
llol- 50\..\\
Probate. tellers, Etc. ......... S 18.00
Short Certlficales( 4) .......... S 12.00
x-pages ~
Renunciation ................ S
,lCP S 5.00
TOTAt_S 41.00
Filed ..... MARCH. .4.. .199.6. . . ... . . . . .
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LETTERS AND ORDER WERE MAILED TO THE EXECUTOR
MARCH 5. 1996.
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C. I give and bequeath the sum of One Thousand ($1,000.00) DOLLARS to the
LEMOYNE FIRE COMPANY, Lemoyne, Cumberland County, Pennsylvania.
D. I give and bequeath the sum of ONE THOUSAND FIVE HUNDRED ($1,500.00)
DOLLARS to CALVARY UNITED METHODIST CHURCH of Lemoyne, Cumberland County,
Pennsylvania.
E. I give and bequeath unto my daughters, JoANN M. DONOHOE, of Lemoyne,
Cumberland County Pennsylvania, and CINDY L. ARNOLD, of Lebanon, Lebanon
County, Pennsylvania, the items of personalty in my estate which they egree
to divide between themselves and I direct that all the rest, residue and
remainder of my estate be sold at auction or otherwise be converted into
money and I give, devise and bequeath the net proceeds derived from said
auction and conversions to my daughters, JoANN M. DONOHOE and CINDY L. ARNOLD,
in equal shares, per stirpes.
111.
I hereby appoint my friend, WILLIAM E. SANFORD, of R.D.Ol, Newport,
Pennsylvania, as Trustee of the Trust created by this my Last Will and Testament
and as Executor of this My Last Will and Testament. If my said friend should pre-
decease me, not qualify, or not accept the position of Trustee and Executor, then
I hereby appoint my daughter, JoANN M. DONOHOE, as Trustee and as Executrix.
IV.
No individual fiduciary hereunder shall be required to furnish bond or
other security for the proper performance of his or her duties. No individual
fiduciary shall be liable for the acts, omissions or defaults of any agent appointed
with due care or of any co-fiduciary.
Page Two of Four Pages
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older, of sound mind end under no
constraint or undue in~ce.
d!J.A,.. ( . :~:: r})1Jta.
~ ~ (SEAL)
Testatrix ) I
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Witness
(SEAL)
(SEAL)
Witness
Subscribed. sworn to and acknowledged before me by ELLEN O. MATTERN,
Testatrix, and aubscribed and sworn to before me bY~(]), ~
~a.' _~ . witnesses, this d-.'1tLday of ~
and
. 1995.
O-h. ~ ". ~ n..
Notary Public
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Page Four of Four Pages
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I\ENUNCIATlON
deceesed.
In Re Estate of ELLEN O. HATTERN
To the Register of Wills of CUHBERI.ANO
County, Pennsylvania.
of
The undersigned EXECUTOR
the above decedent, hereby renounce(s) the right to administer the estate and
o~ IJJI....nI.~t~:lI,pl,.
respectfully ask(s) that Letters 'l'.,nln",<"t."r CTA
be issued to WILLIAM E. MATTERN
IN WITNESS WHEREOF, the parties hove hereunto set their hands and
seals this.).1/- ~ay of + ~'~,'
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(Witness)
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(Address)
(Address)
IIENUNCIATlON
In Ro Estato of ELLEN O. MATTERN
deceased.
To tho Rogister of Wills of CUMBERLAND
County, Pennsylvania.
Tho undersigned alternate EXECUTRIX
the above decedent, hereby renounce(s) the right to administer the estate and
respectfully ask(s) that Letters
.
of J.h"''''s/~"I.,..
!fcnl...........L... y eTA
be issued to
WILLIAM E. MATTERN
. .
IN WITNESS WHEREOF, the parties have hereunto set their hands and
Beals thiS~ day of~nll(l/
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CEIl'1'IFICI\1'ION Of' NO'l'lC~ UNDlm IlUL~ 5. G la)
Name of Decedent I Ellen O. Mottern
Date of Death: October 4. 1995
Will No. 1996-00195
I\dmin. No.
To the Register!
I certify that notice of beneficial interest required by
Rule 5. G (a) of the orphans' Coua:t :Ilules was served on or mailed to
,the [allowing beneficiaa:ies uf Lhe above-captioned estate on
March . 1996 I
~ Address
William E. Mattern 904 Bosler Avenue. Lemoyne. PA 17043
'JoAnn Donoho 132 Hummel Avenue, Lemoyne. PA 17043
Cindy Lee Arnold' 208 Chestnut Street. Lebanon. PA 17042
Notice has now been given to all persons enl:itled thereto under
Rule 5. G (a) except No exceptions
I
Da te: March 't-c.. 1996
uJ~O::- Z"}Uc;J.X..
Signilture
---,
Nallle William E. Mottern
,
Addres s 904 Bosler Avenue
Lemoyne, PA 17043
..
'l'elephone 17l7l t63-9945
Capaclty: X
Personal Representatlve
counsel [or personal
representative
:
20. If line 1911 grla,., than Un. 18. .nt.r thl diff,r,ncI on line 20. This Is the OVERPAYMENT.
aD
21. 1I11n. 18 I. gr.ol.' Ihon lIn. 19, .nl.r Ih. dlll.r.nc. on lIn. 21. Thl. I.,h. TAX DUE. (21) 00.00
A. En'lr th,lnl.,,,, on Ih, balance due on lint 21A. (21A)
B. Enl.' ,h. 10101 a' lIn. 21 and 21A on lIn. 21B, Thl. I.,he BALANCE DUE. (21B)
Make Check Poyob1. '01 R.gI.,., 01 WlII., Ag.n. INSOLVENT ESTATE
\:,;r"'-,,;p,:"'~.'.BISURETO'ANSWlR ALL QUEmONS ON REVERSESIDE AND TO RECHECK MATH ,,,,, 0.. n,;
Under pinelli.. of perjury. I dedor. that I hav. .aamined lhi, relurn, including accompanying schedule, and ,Iatlmenl', and to Ih, bell 0' my knowl.dg, and beli,f,
it i. Iru., corrlct and compl.,.. I dIdo,. that 011 r.al .'1011 has been r.portea at IruI morbi value. Declaration of prepare' olh,r than Ih, penonal r'pr...ntotivl II
bOlld on 011 information of which prepare' hot any knowledg..
SIGN t l Of PUSON au If fO. flLlNO Il(fUlN S OAt(
" 04 Bosler Avenue, Lemoyne, PA 17043 SfjI/. 9) -96
DAIl
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MATTERN
ELLEN
.0. DA'ISO' DIA'H Ani. 12/31/91 CHICK HIli
I' A SPOUSAL
POVIRn ClIDIT IS CLAIMID 0
rill NUMIIR
21
COUNTY CODE
OlCIOfN'~ QMmU AOOlr$50
904 Bosler Avenue
Lemoyne, PA 17043
Co." Cumberland
AMOUNT .((lIVID 'SEE INST.UCTIONSI
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
96
YEAR
0195
NUM&ER
COMMONWEALTH O' PENNSYlVANIA
DE'AIIMENT or lEVENUE
DEPT. 210601
HAUISIURG,'A 17121.0601
Of lOIN' NAME (lAS . flU . AND MIDDIIINI IAll
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SOCIAL SleUlltT NUMIU
193-12-9070
DAll Of OUIH
10-4-95
OAf( O' III'H
4-4-23
(If ""'''CAILII SUIVlVlHO 'fOIIU., N.....r (V,". 'IUl AND "'ICOI.llHltlAl!
MATTERN WILLIAM E
204-03-6922
o 3. Remainder R,turn
(lor dol.. of d.olh prior 10 12.13.82)
o 5. Fed.ral Ellal. Tax Relurn Required
.!L e. Total Number of Safe Deposit BoxlS
[j 1. Original Return 0 2. Supplemental Return
o ... limited ellalt 0 AD. Future Inl".., Compromis.
('or dol.. 0' d.olh afl.r 12.12.B21
o 6. Olced.nt Died Te,tate 0 7. Oecedenl Maintained a living Trust
(A"och copy a' Will) (Anoch copy a' T rulll
INCI'AND CONflDENTlAL'TAXINFORMATION SHOULD BI DlRECTIDTOt i;'
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COMPlUl MAlllNG Aooun
3001 Market Street
Camp H111. PA 17011
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761-5041
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1. R.ol E.lol. (Schedul. A) ( I)
2. Slack. and Band. (Sch.dul. B) (2)
3. Clo..ly H.ld Slock/Portn."hlp Inl.,.II (Sch.dul. q (3)
4, Mortgog.. and Nol.. R.c.ivobl. (Schedul. D) (4 )
S. Cath, Bank Oepolits & Miscellaneaus Personal Property ( 5 )
(Sch.dul. E)
6. Jolnlly Own.d Prop.rty (Schedul. F) ( 6)
7. T,on.f." ISch.dul. G)ISch.dul. L) (7)
B. Total Grall At"" (tolal lines 1.7)
9. Funeral bpe.n"s, Administrative Costs, Mltcellaneout ( 9 )
Expenses (Schedule H)
10. D.bll, Mortgog. 1I0bllitl.., L1.n.(Sch.dul. I) 1101
11. Tolol D.dudion. 110101 lIn.. 9 & 10)
12. N., Volu. of E,'ol.llIn. B mlnu. L1n. II}
13. Charitable and Governmental Beques" (Schedule J)
U. Net Value Sub ed to Tax (line 12 minus line 13)
15. Spou.ol Tron"enl'o, dol.. 01 d.olh oh.r 6.30.94)
See Inttrudiont for Applicable Percenlage an Reverse (15)
Side. (Include values from Schedule K or Schedule M.)
16, Amaunl of L1n. 14 lo,obl. 016% rol. (161
(Include values from Schedul. K or Schedule M.)
17. Amounl of L1n. 14 lo,obl. 01 15% '01. (17)
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add lax from lines IS, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments
+ +
Discount Int. rest
$ 4,000.00
7,721.61
(B)
4,000.00
00.00
00.00
(11) 7,721.61
(121 00.00
(13)
(14) 00.00
X._= 00.00
X .06 = 00.00
X .15 . 00 00
(18) 00.00
(19)
(201
00.00
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Chl!C~ h('1l' ,f you 01(' ,cqu('!.ting (] refund of your oVNpoymenl.
Act .48 of 1994 provide. for the reduction of the tall rate. Impo.ed on the net value of transler. to or for
the u.e of the .pou.e. The rate. a. pre.crlbed by the .tatute will bel
e 3~ (.03) will be applicable for e.tate. of decedent. dying on or after 7/1/94 and before 1/1/96
e 2~ (.02) will be applicable for e.tate. of decedent. dying on or after 1/1/96 and before 1/1/97
e 1~ (.01) will be applicable for e.tate. of decedent. dying on or after 1/1197 and before 1/1/98
e Spou.al tran,"n occurrIng on or after 1/1198 will be ellempt from Inheritance tall.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK k) IN THE APPROPRIATE BLOCKS.
YES NO
1. Old decedent make a transler and:
x
a. retain the use or Income 01 the property translerred. .......................................................
b. retain the right to designate who shall use the property translerred or its Income, ...............
x
X
c. retain a reversionary Interest; or ...................................................................................
X
d. receive the promise lor lile 01 either payments. benelits or care' .......................................
2. II death occurred on or belore December 12. 1982. did decedent within two years preceding
death transler property without receiving adequate consideration' II death occurred alter
December 12, 1982. did decedent transler property within one year 01 deoth without receiving
adequate consideration'...................................................................................................
3. Old decedent own an 'In trust lor' 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.
X
X
ELLEN o. MATTERN
ITEM
NUMBER
A. Fun.ral bp.n...,
1. Musselmsn' s Funeral Home
B. Admlnlltratlv. Co.t.:
1. Personal Representative Com millions 204 - 03 - 6922
Social Securily Number of Personal Representative:
Year Com million. paid N/A
2. Attorney Fee.
3. Family Exemplion
Clalmanl William E. Mattern Relationship Husbsnd
U\l.1Ill I" ".111
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
*
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONW!AltH O' PENNSYLVANIA
INHUltANCI TAX UTUlH
UIIDIHT DICtDINT
PI.a.. Print or T p.
2196-0195
DESCRIPTION
AMOUNT
$
2,523.68
00.00
200.00
3,500.00
Addre.. of Cloimonl 01 decedont'. dooth
Slreol Addrell 904 Bosler Avenue
Cily Lemoyne Sloto PA
Zip Code 17043
Proboto Feo.
Probate of Will, Short Certificates, JCP Fee
MI.e.llan.ou. Exp.n....
Renunciation (heirs) to administer estate
41.00
10.00
Legal Fees deducted from recovery of $4,000.00 in lawsuit -
Decedent's Estate vs. Holy Spirit Hospital - See Exhibit
Costs of lawsuit sbove referred to
1,333.33
68.60
County Inventory and Inheritance Tax - filing fee
25.00
TOTAL (AI.o ontor on line 9, Rocopllulolion)
(If mar. .pac. I. n..d.d, In..rt additional .h.." of .am. .Iz..)
S 7,721.61
L,..' -A'i" ' .." ~, -:.': ,,:':'::<';_:,!'~:1:~'~4i"~',~N~:~-~
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lIy.tsUII. (1"7)
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CQrMMOHWIAtl" or ,'HNsnV,lHIA
IHMllnAHCI tAX IlJUIN
It1IOIN1D1C1t11Nt
SCHEDULE J
BENEFICIARIES
fiLE NUMBER
2196-0195
ISTAT. o'
ELLEN O. MATTERN
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE O' ESTATE
A. Ta.abll BlqU..11I
Husbsnd
00.00
1.
William E. Hattarn
INSOLVENT ESTATE
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE O' ESTATE
B. Charltabll and Ga..rnmlnlal B.qu..tll
I.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aha Inllr an lin. 13, Ro<apilulatlan) S
(II mare apacI la nlldld, Inalrt additional ,hllta .'aaml al.I'
COMMONWEALTH OF PENNSYLVANIA \.
COUNTY OF CUMBERLAND J
u:
William E. Mattern
beIng duly sworn eccording to law, dopos.. and soys that he is the Executor
___.__ of Iho Estale of Ellen O. Mattern
lele of ---"'!!moy_ne Bor()uglt ,.. h'_."---' Cumberland Counly, Pe., decI..ld .nd that thl
wilhln Is en Invenlory made by _11_eJ"~xe.!'-'!~-'1r ' thl saId William E. Mottern
of thl entire ..Iale of saId decedenl, consisting of all the personal prop.rly .nd rul ..I.tl, I,clpl rul "t.l. ouhlde
Ihe Commonweallh of Pennsylvania, and Ihal Ihe figu..s opposite each ilem of Ihe Invenlory "p..unlll's faIr valul
as of the dale of decedonl's dealh.
Sworn
and subscribed bofo" me,
!il~(Jt1~ t: )n~~A~
-..ntor . Adm1nbtr.tor
William E. Hattern
904 Bosler Avenue
5> P dypr-,b~l '1 19 96
7tI~' k~
'\
Lemoyne. PA 17043
Add....
NOTMIAl SEAL
WilLIAM A. YOCUM, Nolary Public
Camp Hili Bora. Cumberland CountY
My Commission Expires June 27. 2000
October
Month
1995
Vel'
Doll of eo
DIY
INSTRUCTIONS
I. An Invenlory must be flied within th..e monlhs after appolnlmenl of personal ..pr"enlatlve.
2. A supplement invenlory must be filed withIn Ihirty days of discovery of additlonal a"eh.
3. Additional sheah may be attached as to personally or ..ally
4. See Article IV, Flducl..ies Act of 1949.
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2196-0195
. -(y I ~&... '1-\\-%
Inventory of the real and personal estate of
ELLEN O. MATTERN
deceased
I
.
Gross Amount of recovery from Lswsuit - Decedent's Estate vs
Holy Spirit Hospital
. $ 4,00 00
$ 4,00 00
TOTAL
~;.....
,
. - .- -~-" '.-.--
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ellen o. Mattern
Date of Death: October 4, 1995
Will No.
1996-00195
Admin. No.
pursuant to Rule 6.12 of the Supreme court orphans'
Cour~ 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 THIS IS AN INSOLVENT ESTATE
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 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 iSI NIA
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:
Sf/:) I~ 'Cfh
I
/jCtlt/)Cjl_~rj:)'lJ ?t'!'f[f ~ -
!rtgnat,ure
WILLIAM E. MATTERN
Name (Please type or print)
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904 Bosler Avenue
Address
Lemoyne, PA 17043
( 717 I 763-9945
Tel. No.
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X Personal Representative
Counsel for personal
representative
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Capacity:
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COKKONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
c.
BUREAU 0' INDIVIOUAL TAXES
1MH<RITAHt[ TAX DIVIIION
DEl'T. nUDl
HARlISIUAO, Pi 1711'.0'01
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF OEOUCTIONS AND ASSESSMENT OF TAX
",.UUU""IU...'
12-16-96
KATTERN
10-04-95
21 96-0195
CUKBERLAND
101
AlIOUl'lt R..uted
WILLIAM A YOCUM
3001 MARKET ST
CAMP HILL
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ELLEN
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYKENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifili:iS47-iX-Aj:p-nZ:96Y-iiOfiCr-Oj:-Ytiiiiiiii'iiNCn:'Ai("APjiRAisiHEiii'-;-Ai'LOiiAiicE-oli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MATTERN ELLEN 0 FILE NO. 21 96-0195 ACN 101 DATE 12-16-96
TAX RETURN WASI C X I ACCEPTED AS FILED
C I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Eltoto CSchedulo Al C1I
2. stocko .-d Bondi ISchodUl. BI C21
S. Clol.ly Held Stock/p.rtnerlhlP Int.r.lt (Sch.dulo CI (51
1\. IIortg_"/Notol R_Ivelll. ISchedul. DI CI\I
5. Cosh/BeAK Dopolltl'HIIC. P.rlonel Prop.rty ISchedulo EllS)
6. JointlY Owned property ISchedulo FI 161
7. Tronoforo (Schedul. G) (7)
I. Total A...t.
o
HOTEt To Inlur. proper
crMlU to your account,
lubolt the uppor portion
of thlo foro with your
tax p8yt1ent.
.00
.00
.00
.00
4,000.00
.00
.00
IDI
4.000.00
7.721.61
.00
1111
1121
(15)
111\)
APPROVED DEDUCTIONS AND EXEKPTIONS:
9. Funerol ExPOnloo/Ado. COltI/HIIC. E.pan.oo ISchodul. HI (9)
10. Dobto/llortgogo LleIlllltlo./Llonl ISchedulo II 1101
11. Toto1 D_Hono
12. Het Vol... of To. Roturn
15. Chorltelll./Oovorn-ontol Bequolt. ISchodulo J)
11\. Het Vol... of Eotot. Subject to To'
7.7" 1.1
3,721.61-
.00
3.721.61-
If 8n 8.......n~ W8. i..u.d pr.viou.1Y, lin.. 14, 15 8nd"or 16, 17 8nd 18 will
refl.ct figur.. ~h8~ includ. ~h. ~0~81 of ALL r.~urn. 8......d ~o d8~..
ASSESSMENT OF TAXI
15. Aoount of Line 11\ ot Spou.ol rot. (15)
16. Aoount of Line 11\ to.oblo ot Llneol'Clo.o A roto (16)
17. Aoount of Line 11\ to.eIl1. ot Collotorol/Clolo B roto 1171
lB. Prlnclpol TIIlC Duo
TAX CREDITS I
PAYMENT
DATE
NOTEI
.00 X .00.
.00 X .06.
.00x.15.
I1DI
RECEIPT
HUHIlER
DISCOUNT Ctl
INTEREST C-I
ANOUNT PAlO
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATION DF ADDITIONAL INTEREST.
I IF TOTAL OUE IS LESS THAN 11, NO PAYMENT IS REQUIRED.
IF TOTAL OUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.I
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RUDtvATlDHI [,ht.. of dKedM\h dyinG on or Mfor. Dee..,.,. U, 1912 ... If In, future Int.,...t In U. ..tat. li"1r",".rred
In po.....lon or "'Jo~t to CI,.. I (colllt,ral) beneflelarl.. 01 the decedent .ft.r the Ixplratlon of ~ I.tata for
lU, or for )'Mr., tM C~.lth hertlby npr...b r...",e. tM rlllht to ...r.... Met ...... t,.In,',,, %m.r'itlnCe TUII
at the i_Jul Ct... I (coUat,ral) nt. on In, IIUCh future lnt.r..t.
w
"'- IF
HaTlCE. To fulfill tM r-.,Ir.....ta of Section 2140 0' the Int.dtencl Md Eat,t, Tax Act, Act ZZ of .991. 7Z P.S.
Section 2140.
PAYl'lENTI Detach u.. top portion of thll NoUel WId ,utMllt '11th YDUr PI,.."t to the R..htl,. of "11" prInted on u. rever.. IldI.
--Hllk, check or -r or.,. p.,Rb1, to' REGISTER OF MILLS, AGEKT
All ..-YMnh rHllved shell first be ."lIed to In, Int.,.ut whIch A" b, due .,Ith MY rMalnde,. .,lIed to ttM tax.
REfUrGI CCRlI A rllYnd of . t.. crlldtt, ....lch .... not ,.....ted on the T.. Return, uy be r....tect by CCMPhtlng .. "Appllutlon
for R.~ of PennlylvenS. Inherltenc. end Elt,ta T.xw (REV-ISIS). Appllc.tlonl .r. Ivallebl. at the Dfflca
of the Regl.tar of Will., any of the ZS R.venue DI.trlct DffSc'l, or by cllllng the spacl.l Z.-hour
an~rlng ..rvlc. nu.bar. far fora. orderlngl In Penn.ylvanla 1-100.362-Z0S0, out.lde Pennsylvania end
within local Harrisburg .r.. (717) 717-1094, TOOl (717) 77Z-ZZSZ (Haarlng Iapalred Only).
DlACTlDHSI Any p.rty In Inhr..t not .athfled with the appr.l...."t, .1Iowanca or dl..Uow.-.ca of deductlonl, or ........,t
of tax (Including dlacount or Intlra.t) .. .hown on thl. Hotlc. ~.t obJ.ct within .Ixty (60) dlYI of recalpt of
thh Katlel bYI
"wrlttan prota.t to the P' Depart.."t of Rev...., laard of Appeall, Dept. Z.10Z1, Harrhburl, PA l7UI-loZI, OR
ualectlon to have the ..ttar dIItar.lned at audit of tWi account of the peraonal r...r..antatlVtl, OR
........1 to the Orphan.' tour t.
AIIIIIN
ISWTlYE
CCIIRECTIDHSI
FeaMI .rrora dlscov.red on thIs .....MMt should be addra..ed In writing tal P' Depart..,..t of R.VMUII,
luraau 0' Individual T...., 'TTNI Po.t ,.......,t A.vlew unit, Dept. Z'O'OI, Harrisburg, P' 17121-0601
PhonI (717) 717.'505. Sea page 5 of the bookl.t wln.tructSon. for Inherlt~. Tax R.turn 'or. A..ldant
DacadantW (REV-lS01) for an 'kPlanatlan of adalnl.trltlv.ly corractebla .rror..
01 SCOlIfT I
If any tax due 11 paid ..lthln thr.. (S) ellandar aonth. .ft.r the decadent.. de.th, a flv. ,ere."t (5~) dlscOWlt 0'
the tax plld I_ .110If8d.
The Ig tax __It, non.p.rUoSpaUon penalty II caput~ on the tot.l of the tu and Intar..t ......ed, end not
p.ld belfor. January II, 1"', the first day .ft.r the end of the tax NMlty period. this non.p.rtlclp.tlon
IWMIlty 11 .....Iebl. In the ... ......r end In the the ... U.. period II YOU IfCMIld .....1 the tu Ind Inhr..t
that h.. been .....HCI " Indlc.t~ on this notlCl.
PENAL TYI
1NTtRE:ITI
Inhr..t 11 rhargad bagS,.,I,... ..Ith first day of delinquency, or nine (9) IIQftth. and CNMI (1) day froe the data 0'
dNth, to the data 0' p~t. Tu.. .....Ich bK.. delinquent before J-.uary I, nlz bear lnt.r... .t the rat. of
... (~) "rc..t per wn. cllculat... at . dalh rata of .000IM. All tu.. which bee... delinquent on end .ft.r
Janua,., I, I'IZ ..Ill bear Int.r..t .t . r.t. which ..Ill v.ry frOl calend.r yaar to c.lendar y..r with that rat.
announced by the PA Dapart-.nt of A.v..... The applScebla Inter..t r.t.. for .'IZ through 1997 .ral
!!!! Intar..t Rlt. Oally tnt.r..t Factor !!!r Int.r..t hta Oeltv Int.r..t Factor
1'12 lOX .OOOS.I 19A7 n .ooazo
I9IS 16% .OOUSI 19".1"1 IU ,000501
I'M IIX ,OOOSOI 1'92 'X .ooazo
ItIS IU .00OS56 I"S-I994 n .00019Z
ItN lOX .000Z74 1"5-1"7 n .oaazo
."Int.r..t t. calcul.ted .. fOUOM"
IHTERElT . BALANCE OF TAX UNPAID X HUKBER OF DAYB DELINQUENT X DAILY IHTEREBT FACTOR
uAny Notl" t..uad .ft.r the tax bK... daUnquant ..tll r.nKt an Int.r..t c.lculatlon to f 1ft.., US) day.
beyond the data of the .....MMt. If p~t Is ... .ft.r the Int.r..t coaputaUon data IhcNn on the
Notlc., Mdl \lanai Inter..t ~.t blI calcul.ted.