HomeMy WebLinkAbout96-00291
Will
PETITION FOR PROBATE and GRANT OF LETTERS
l:.s/a/e ..... ~!I~'.Il.I:I:~ . :':. ~.1:~~1::~. . . . . ... . . . . . . . . . . . .
also known as . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No. .J..!. ~ /9Q.LP.-: .~Cl 1. ... . ..... .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. , Deceased.
S 'IS . N 204-01-7517
. oc/Q ecumy 0..................................
To: Register of Wills for the
County of j'J.~1I in thE'
CUMllf:RLANIl
Commonwea th 01 Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s) is/are 18 years of age and__lIl." .C;"~'. ~.r. tlu.'. ~~':":~l~l~).r:'.. named in Ihe last will of the
above decedent, dated. . . . . . . . ~!l1'l.E. .9. '. . . . . . . . 19 .~8 . . and codicil(s) dated. . . . ~9.N.I~ . . . . . . . . . . . . . . . . . . .
. .~~\I!~~. ~.'. .~\~YE~. .II~V~~~;. ~.E.~q~~~!,!). .^.~ .E~~~!l:r.~I.~..............................................
(Slale relevant Circumstances, e g Renunclahon. dOc1lh 01 exoculor, ele)
Decedent was domiciled at death in SIIIPPF.NSIlUHG. mUlEIUA\lJ County, Pennsylvania, with h I ~. . last famili
or principal residence at .. ..19.7. .I!91.'!.~~. .'\~~;~IJ~.,. .S.I!I.~I.)!,~~.il.~I!q I. !'i'. .IJ~~? . . . . . . . . . . . . . . . . . .. ..
. . . . . . . . . . .SHl PP.ENS.BURG. nOROUGH . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . .. . . . .. ...................
(lislllreel. numbel and municipality)
Decedent, then.. ?~.. years of age, died....... ..~~~;I!~~I~~Y. .2.~~........................... 19. .96.,
at . .~~~~~?Il.IW:; .I.l9?1'.r:I:i!J" . !1i'.R.Im~IJ!{r..,. .I~i!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Except as lollows, decedent did not marry, was not divorced and did nol have a child born or adopted alter
execution of the will offered for probate, was not the victim 01 a killing and was never adjudicated incom-
petent .. t'P. .E;l\GEPT.IPNs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Decedent at death owned property with estimated values as follows:
All personal property
Personal property in Pennsylvania
Personal property in County
$ .I{lO,m .&. .uPl",lrcls
$........... .
$............
$.. .I!<.>t:l!'.....
(II domiciled in Pa.)
(II nol domiciled in Pa.)
(1/ not domiciled in Pa.)
Value of real estate in Pennsylvania
situated as 101l0WJ: ..........................................
............. ............,...... .......... ......... ............,..................................
............. ......................................................................................
WHEREFORE, pelitioner(s) resp"ctfully request the probate ollhe last will !J"Mrlr/rli/;lIlli presenled here.
with the grant of letters.. .t."!~~,!I'1!'!,::."-rx. . .. .. ... . .... ... .. .. ., ... . .. . .... ............ ... ..... therecn.
ITm;l,lmlml.ny. .ldmmlslh1llon c I .1 . admlnlslrdllon db n c Ii))
(] SlrJn,lluldsl 'lnd RI'sldl'nn>{"l
. n ( 01 rl'llhuOt'II!';)
~. NA:~l~?tttr's :. ~ .U~~~ . . . . . .. .....................................
4J'li .Tlij~ty:..s.(:~~T;d. R;;,;ti .s;,;,ti,..........................,......................
. ........ .. ... ,... .................................... ,.. ......... ...............
Arlington. VA 22206
Will
OATH OF PERSONAL REPRESENTATIVE
COMMOMWEALTH OF PENNSYLVANIA 1
COUNTY OF . . .~~~!I!f.f.l!'~~P. . . . . . . I
The petitioner!s) above named. swear(s) or affirm!s) that the statements in Ihe foregoing pelition are true
and correct 10 the best 01 the knowledge and belief of petitioner(s) and that as personal representative(s) of
the above petitioner(s) will well and truly administer the estale~ according to la;(L
/ .;/)~/III!'~ (7, .
Sworn to or allirmea ana sub. v.....( '.'+.~(; '" ..... . !<I................. ......
NAN'Y C. AVIS
scrihed belore me this. .8. tlHay of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
'- .~I'Ru....p~' ;-~ 19t9/~j a ~
1l.tI,-.'::Y!.. . . . . u.1.l.,.t..WP/~t': . 'J,' 7f.(t{,
ARY c. L Wlrq:ortheRegisler v JYI'fy-
S5
.................................................
.................................................
No.~.I.~ .I.qqW::~q I
Estate 01. . . . . ~~(I.R.L.~~ . . '1: . . ~:r (I.V.E.~ . . . . . . . . . . . . . . . . . . . . . . Deceased
DECREE OF PRODA TE AND GRANT OF LETTERS
AND NOW. ....... !\.~~;r.~.~.............. 19. .QQ., in consideration 01 the petition on the reverse side
hereol. satisfactory prool having been presented before me, IT IS DECREED that the inshument!s) dated
JUNE 9. 1988
...................................................................................................
described therein be admilted to probate and filed of record as the last will of . . ~!IA.~I~~~. \-'... .S:I)WJ;I,(. . . . . . . . .
...................................................................................................
and lelters . . . .t.~f! ~1J1)lp.I1.t;\r.y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ............................
are hereby granted 10... . .~~t:I(:)'. .c....D~Y11l.................. ........ .............. ..... .............
.......... .r~kl.lm. .funr.".,V.,fI., ..IJAN.~1..r.])IHJ;?. /J/V)... /)/1.7.liE .$:,. f./.1J.('t; Er.SI??.:r:~
.. ......... ~~~~~~"!"'~II~~................ .CiJ~;;i~..;;f::::F!)j}lh~ jV
Oath 01 Subsc_1n WI ness(st'.J 0 'Uf~
Oath of Non's~!!tr Irlrtg Witne~JIlP [J
Oath 01 Wilness(s) to mark [)
Renuncialiortf1: 01\1 B- lldV 96. ~]
SIIW\ "r nl~!~el:l
10 ~,')!,;O p:lOJo:)OI:l
RICIIARD K. 1I0Si\IN~ON 1100100
.............................. ......
A'ITORNEY (Sup. Ct.!. D. No.)
232 LINCOLN WAY EAST
~UN!III.;~~!I.U.~~, .r~.. .f.7~Q!..................
ADDRESS
717..263-8535
............................................
PHONE
FEES:
TESTAMENTARY
X-PAGES
RENUNCIATION
SHORT CERTl
JC(J
TOTAL
$ 59.00
Will
PETITION FOR PROBATE and GRANT OF LETTERS
Will
Estate.... ~.II/\~~I.'~.. !~'.. .~T~Y.E.I{....,..............
a/so known as . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . . . . . .
No.. ;AI. ~ .Iqql.R.~.~q I.............
..................................................
To: Register 01 Wills lor the
County of K~in thl'
CUHIIERLAND
Commonwealth 01 Pennsylvania
. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deceased.
r . /S . N 204-01-7517
.,OCla ecurtly 0..................................
The petition 01 the undersigned respectfully represents that:
Your petitioner(s) islare 18 years of age and the execut '!r~.................. named in the last will 01 the
above decedent, dated. . . . ~.u.N.I; .~, . . . . . . . . . . . 19. ?8. . and codicil(s) dated. . . . .tiqt:lf.. . . . . .. . . . .. . . . . . . .
ESTHER G. STAVER HAVING RENOUNCED AS I,XECUTRIX. .
...................................................................................................
........................................................................,..........................
(Stalo relevant cltcumltances. e g, Renunclahon, death 01 executor, etc,)
Decedent was domiciled at death in SlIll'pa'SI\URG,lllnlERlA\1J County, Pennsylvania, with h~~. .lastlamilt
or principal residence at .. .l.q~ ".I~!+.A.~ .~Y~~~.E... .~~~~~.E.N.~~~~~.'. .P.~ . ~ ??"!? . . . . . . . . . . . . . . . . . . . . . . . . . . .
....................... .Sfl.lPl'.I;;f:Jp.aVRG. ~Q~Ql)(;H.................... ........... ........ . .... . .,
(hat .heel, number and mUnlclpahty)
Decedent, then. .7.4.. . years of age, died . . . . . ..1:~~J.lY~.R.~ . ~~ I .. . . . . . . .. . .. .. . . . . .. . . . . . .., 19.?~...
at . .11t'RR.I.~Il1)\l~. )l,Q~~tTM..,. .I!I!~\l)~)l.u.l\G. . Pt'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopled afler
execution 01 the will oUered lor probate, was not the victim of a killing and was never adjudicated incom.
petent . . . . .~~. ~~.C.~~~~~~~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Decedent at death owned propeTty with estimated values as lollows:
(II domiciled in Pa.)
(II not domiciled in Pa.)
(II not domiciled in Pa.)
Value 01 real estate in Pennsylvania
situated as follows: ............. V.\') II,. :<)o."",.r~. . . . . . . . . . . . . . .
All personal property
Personal property in Pennsylvania
Personal property in County
$1.~.'99.~ .U~rdR
$............
$............
$ .\J':I.t<.OO.ul.>:'\,
........................
....................................................................................................
...... ........... ................................................................................
WHEREFORE, pelilioner(s) respecllully request the probate of the last will /l#fclrt<ftt'Mf/I presenled here-
'th lh t f I It teRt.1mentarv lh
Wl e gran 0 0 ers............... (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ereen.
(Tesl,tmt-nIMY. .Hlmlnls,lrdhonct.. . ftdmlnlsltallon d b n c I .,1
HELLON B^!~ N. A. SIC)n,'lull~III.lnd Re!\ldt'nno(5J
_' /"1 r, / - ul P,'hflont>rlsl
By/;jf;::;!" ."I-L('(.............. o~!'. .~~~~. K.l)l~ .5~r~e.t...-Y ..l!,. !h'.h. AS!. 5hII'I'PT.'nhu....~ . .PA. .1?2.~7..0040
JOHN SCIlALL, TruRt Officer
. ........................................ .........................................................
....... .. ........................ ~~.1.7. :1:1'1 n Y.-S.'\': '11,\1. R.on.<! .5,.,!'.t.h. .A~11nl\.toT!!. YA. .2.2206....
NANCY C. DAVIS
. . . . . . . . . . . .~. . . . . . 4' . , . . '.' . ~ . . . . . . . . . , . . . . . . . . . . . . . . . . , . . . . . , . . . . . , . . . . . . . . . . , . . . . . . . . . . . .
t:r miLl,";' ~''l:t;;:.,~4 t::((~. . . . . . . ~O. L(~'~I\. L~ne... .N,,~llll"I\.' . PA. . Inl,O . . . . . . . . . . . .. ...............
KATIlF. S. HOCKERSm,.II
............. ............ ............ .......... ..... ...............,..........
OATH OF PERSONAL REPRESENTATIVE
COMMOMWEALTH OF PENNSYLVANIA ~
SS
COUNTY OF , . .~~~~E~~~\~,\J, . . . . , .
The petitioner(s) above named, swear(s) or allirm(s) thai the slatements in the loregoing petition are true
and correct to Ihe best ollhe knowledge and beliel 01 petitioner(s) and that as personal representative(s) 01
the above petitioner(s) will well and truly administer the estate according to law.
S II b HELLON JlANK. N.Ao
s:~~:d t:el::e :~r~~sd. ~a:gd:; 0; v :l;~ ilZbilill : : : : : : : '. : : : : : : : : . : : : : : : : : : : : : : :
~~~Vijj/}- <<) . "H',,',,'" ":,,'r~ :~.,
MA . LE ISFIJrt"e Register ~p~r .. .. ..~~~C:.. ~ .. ~~~~~.. .. " .,":" .. .. .. .. .. .. ..
v o. .?r::.(/,t/o ~ 0 o1l:;~I-"'.';L;lH~C!~.. 0 0 0 0' o. 0 0..0.
")l_log '-_ .....I)A..TlIE So 1I0CKERSHlTII
Noe<. ...'..w' ..oLY I
Estate 01. . . . . . . .C.lI,t\~~~~. . \'I,. . .S.T.t\~~l!. . . .. . . . . . . . . . . . . . . . Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, ..... ~P.~~.L.,?,............... 19 .~~. .. inconsideration 01 the petition on the reverse side
hereol. satislactory pTool having been presented belore me, IT IS DECREED that the instrument(s) dated
. ,.Jl,J!ll'. .9... .\ ~I;ll;l. . , . . . , . . . , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . . . . . . . . . . , . . . . . . . . . . . . . , . . . . . . . . . . . . . .
described therein be admitted to probate and filed 01 record as the last will 01 . .~I.I(\!\!.~.S. .,,!, . ~rl\y.E;~ . . . . . . . . .
....................................................................................................
and lellers . . .t.e,!! ~l)I!'~!l.t.n.~y. , . . . . . . . . . , . . . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . .. ............
are hereby granted 10,.. .~!r:~!.9~. .~~~~. ~..~.o.'" ,~(\~~:v. .Go. .J.l!lY.I.S. At)J.l, !<t',1:!i1U,. il.l1.r;;;I~~~~I.i:rli,.........
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Oath of Non.subscribing Witnesslm Il
Oathol.Witness(s)tomark i~ / 2 { .,/ k Lo
Renunclah8f(eOlV [- &IV 96. " . ..~ .', ?!-:~C:( ~'. ~.~. ..,. !/<-:~~.../
ATIORNEY (Sup. Ct.!. D. No.) i/OOtOO
232 LINCOLN WAY EAST
, .c;I!~~l~~!l;;,II.U,l!G I, . !'t', . ,\ ??Pl. . . , . . . . . . . . . . , .
ADDRESS
SlIiN, I:' ""r,:lja~
In ;"':;:0 ",:,,')IO:lGI:I
TESTAMENTARY 25.00
~~~~~Ct~TION li~~~
# 5(1.00
...............................
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I. Charles W. Staver. of Shippensburg. Cumberland County.
Pennsylvania. being of sound mind and memory. do make. publish
and declare this my Last Will and Testament. hereby revoking and
declaring null and void any and all wills and codicils by me at
any time heretofore made.
FIRST: I direct my Executors to pay my just debts. the
expenses of my last illness. and my funeral expenses.
SECOND: I give and bequeath all my jewelry. automobiles.
clothing and other purely personal effects. as well as all
household goods and equipment which I may own. to my wife. Esther
G. Staver. if she survives me. Should my wife predecease me. I
give and bequeath those items of personalty which I have set
forth on a memorandum previously prepared to be placed with this.
my Last Will and Testament. to the persons named therein: and all
of my remaining jewelry. automobiles. clothing and other purely
personal effects which I have not specifically included in the
,\
II
memorandum. I give and bequeath in equal shares to my daughters.
Nancy C. Davis and Kathe S. Hockersmith. if they survive me.
THIRD: I give. devise and bequeath all the rest. residue
and remainder of my estate to Commonwealth National Bank.
Shippensburg. Pennsylvania. as Trustee under that certain Funded
Revocable Trust Agreement dated the 9- (',( day of
Q?/~ . 1988 land as the same may be amended
to ~me) actually executed by me with the Trustee prior
from time
to the
Page 1 of a Six Page Will
execution of this. my Lust Will and Testament: said devise and
bequest shall be added to the principal of tIle trust to be held
and/or distributed as though an original part thereof.
FOURTH: If for any reason the said trust agreement is
ineffective as a trust at the time the assets of my estate are to
be added to it. then the property herein given. devised and
bequeathed to Commonwealth National Bank. Shippensburg.
Cumberland County. Pennsylvania. as Trustee under such trust
agreement. shall be held by it. IN TRUST. in accordance with the
provisions of the said agreement in its form immediately prior to
the execution of this. my Last Will and Testament.
FIFTH: In addition to the powers conferred by law. my
Executors and Trustee shall have the following discretionary
powers:
I
I
,
A. To retain as an investment for my estate and the
trust estate. without any duty of diversification. any and all
property. real or personal. received hereunder. which shall
specifically include the authority to retain any stock in The
Commonwealth National Bank. Shippensburg. Pennsylvania. or its
II
'I
parent corporation. without liability as a result of such
retention.
B. To invest and reinvest. including principal and
accumulated income. in stocks. bonds. mortgages. securities or
. I
i
I
other property. real or personal. without being limited to the
classes of securities or investments in which fiduciaries are by
Page 2 of a Six Page Will
---. .--......... --..
,
.'
law authorized to invest funds.
c. To sell any and all real estate held as an asset of
my estate and trust estate at such times. at public or private
sale. for such prices and upon such terms as deemed advisable.
and to make. execute and deliver any deed or deeds therefor.
conveying title thereto in fee simple absolute. or for any less
estate to any purchaser or purchasers. freed and discharged of
any and all trusts hereunder.
D. To sell. exchange. lease. encumber. option or
otherwise dispose of all or any portion of my estate. real or
personal. in such manner and upon such terms and conditions as
shall be deemed advisable. and to make. execute and deliver
I
(
deeds. mortgages. leases. assignments and other documents
necessary to effectuate any powers herein granted and which shall
specifically include the authority to grant leases extending
beyond the period authorized by law.
E. To make distribution of my estate and trust estate
. ,
I
to any person entitled therein in kind. in cash. or partly in
kind and partly in cash. and to this end. allocation of assets in
kind shall be in the sole discretion of my Executors.
F. To register or carry any investments held hereunder
in their own name or in the name of a nominee or nominees:
provided. however. that all such investments shall be so
designated upon the records of my fiduciaries that the trust or
estate to which said investments belong shall appear clearly at
Page 3 of a Six Page Will
all times.
G. To vote by person or proxy any and all stock held in
my estate and trust estate and to participate in any
or merger of companies or corporations whose stock
reorganization
is so held.
H. To
estate from any
borrow from any
borrow for the purposes of my estate or trust
source. which shall include the authority to
separate trust created herein. and as security
for repayment. to hold or pledge the whole or any part of my
estate or trust estate.
SIXTH: I direct my Executors to pay from the principal of
my estate. all federal estate. state inheritance. estate and
succession taxes imposed upon or with respect to my estate or any
property in which I may have an interest. including any property
not forming a part of my testamentary estate. but included in my
gross estate for tax purposes. in such manner as my Executors. in
their sole discretion. shall deem advisable: and no such taxes or
any portion thereof so paid shall be collected from or paid by
any other person. persons. or corporations by way of
reimbursement. proration. apportionment or otherwise.
SEVENTH: I name and appoint my wife. Esther G. Staver.
Executrix of this. my Last Will and Testament. Should my wife.
Esther G. Staver. fail to qualify or cease to act as Executrix. I
name and appoint Commonwealth National Bank. Shippensburg.
Page 4 of a Six Page Will
A ..
,
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,
UwLcueU( ~.:a
Richard K. Hoskinson. WitnesS
f)Lbi.w Iii ,;If/ whll ( ,"
J I Witness
Subscribed. affirmed and acknowledged before me by Charles W.
Staver. Testator. and subscribed and affirmed before me by
Ricl:lprd K. Hoskinson and ~lf G Hl'twr::4f!...1.... witnesses. this
q.lf.. day of 'jJ~ .191f-' :i J:-1 J!L ·
~'-A:o,Ht'PUBLI~ () ~.Qj
My Commission expires ~Ar. / I /9 CJ?
I maintain my office in '
Chambersburg. Franklin County.
Pennsylvania.
..-
Page 6 of a Six Page Will
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RENUNCIATION
Charles \','. Stavl'I'
deceased.
In Re Estate of
Cumberland
County. Pennsylvania.
To the Register of Wills of
The undersigned
Esther C. Stilvcr, stlr\'ivinJ~ spouse and first named executrix
the above decedent. hereby renounce(s) the right to administer the estate and respectfully ask(s) that LeUer5
Testamentary
'Icllon Rank ~.A,. :-;ancy r.. lJavis and Kathe S. lIockersmith
be issued to
WITNESS
my
15th
day of
!.Iarch
<1(,
.19_.
hand this
-r/ -~,r;,. ",,:..' ~jr;;r:;,--
(Slanlluro)
1'17 lIollar Avenue
Shippenshurg. P^ 17257
(Addr...)
{(t4n"- 9 ,q,I,I.,
. r~.~:';'I.j!P.~:l! ,
O!!V:J J. ,'.:;' "" lo..;'a';, Pit.::
S,,'r-r:-' '_'.: II . ~. L :~~~'-j' i -~, ':-';.~i
r.~/ l;nntrr::. ;.)', i ,";:':2':; ~.';i'j ;',', '...J
(Slanllure)
----~._------_.--... ..
Mc:ntJ~, Pl.'nn"'l\'~ '..0.;. i...:.:.c;.,.~~n c.l t .,:~'..;",..a
(Address)
(5Ianllure)
Vd "0:) ~11D:lOqwn~
"n""".:; ,"JO,'"
,... -oJ -","- '. ,-.", ..J
B (: OlV t - &111 96.
(Address)
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of
IlV-Ut21XIMII
146994 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.9:At.~
~g
D NO. AA
RECEIVED FROM:
i
ACN
ASSESSMENT I'!'
CONTROL IiII
NUMBER
AMOUNT
MELLON DANK
Ivl
~;), V=:ltt. let
1 WEST KING STREET
SHIPPENSBURG, Pf\
1"1257
ESTATE INFORMATION,
f:lI FilE NUMBER
g 21-1996-0291
I!:'I NAME OF DECEDENT (lAST'
~ STAVER CHARLES W
II DATE OF PAYMENT
EJ POSTMARK DATE
COUNTY
SSN 204-01-7517
(FIRSTI (Mil
CUMBERLAND
DATE OF DEATH
02/28/96
REMARKS MELLON BANK
m TOTAL AMOUNT PAID
$5,05B.74
CW
SEAL
CHECKl' 000001'7115
RECEIVED BY
SIGNATURE
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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Dummu OF INDIVIDllM.. 'l'1U:SS
DEPl\H'l'I13N'l' 200601
lli1nRlfiUURG, PA 17120-0601
L-.
Docember 9, 1996
Dear 110. Quay:
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!-IS SARA QUAY
~mLLOII BAliK
PO BOX 7R99
PIIILAIlZLPlllA PA 19101-7399
Re: Estate of Charles W. Staver
File !lo.: 2196-0291
This is in response to your request for an extension to file
the Inheritance Tax Return for the above-referenceu estate.
In accoruance with Section 9136(u) of tho Inheritance and
Estata Tax Act of 1995, the tIme for fi1in3 the return is axtenuau for
nn additIonal period of sIx (6) months. This el<tension will avoid the
Imposition of a penalty for failure to make a timely return. 1I0wever,
it does not prevent interest from accruine on nny tax remainine unpaid
after the delinquent date.
The return must be Hlad with the Reeistar of Wills on or
be foro lIay 28, 1997. Becaune Section 9136(d) of the 1995 Act allows
for only one oxtra period of six (6) montho, no auditional
extonoion(s) will bo eranted that would exceed the maximum time
permitted.
. .
(. Si,ncer7J' \lJbj ~ ~ :.,
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;J . .'
l John C. lIurphy, chi~f
Inheritance Tax Division
........
S-I1': IllllS3
12:omm:221
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D NO. AA
112865
'*
InLlI.2UI....)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
RECEIVED FROM:
i
ACN
ASSESSMENT r:'I
CONTROL ~
NUMBER
AMOUNT
MELLON BANK NA
Iv1
'i'.:J.q.:JC:.VV
1 WEST KING STREET
SHIPPENSBURG, PA 17257
'OtDHllf
ESTATE INfORMATION:
l!:'I filE NUMBER
Y 21-1996-0291
l!:'I NAME Of DECEDENT (LAST)
~ STAVER CHARLES W
II DATE Of PAYMENT
B POSTMARK DATE
COUNTY
SSN 20/,-01-751'7
(fIRSTI (Mil
CUMBERLAND
DATE Of DEATH
REMARKS
m TOTAL AMOUNT PAID
~3,432.00
CW
MELtON DANK NA
SEAL
n"", "
RECEIVED BY .' ;!.f,. J l.,. ..' .:, Y ,.j, '1./
i "QN.1U'~ I ',/, I
MAIW C. LEWIS /1'. I~','
REGISTER OF WILLS .' 'I' ;l~"..
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I
CHECKIl 00186937
REGISTER OF WILLS
.---
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nev-"om.,..." INHERITANCE TAX RETURN ~~~clIn~~~rlA~~J~ITER 12131/91
RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED
CO....ONWCALTltOlrtNN5nVAN>A (TO BE FILED IN DUPLICATE FILE NUMOEH
oerAn,..tN' 01 nevtNue 21 1996 0291
It.nnlS~~=~.':~~~:"_"o, WITH REGISTER OF WILLS) COUNTY CODE YEAH NUMBER
DECEDENrs NAME (LAST, FIHST. AND MIDDLE INITIAL) DECEOENrs COMPLETE ADDRESS
staver Olarles W 107 Hollar Avenue
SOCIAL SECURITY NUMOER Shippensberg PA 17257
DECEDENT 204-01-7517 02 28 96 10 17 1921 Couniy CUmberland
I" 'PPLI · L I SUIIV'V,"O SPoUS"S NA..e ILAS . SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
FIRST AND MIDDLE INITIAL I
staver Esther G 201-18-5651 242 240.83
1. Original ROlu," :J. Romaindor Return
o 40. Futuro Inforost Compromiso
(lor dolos 01 doolh ohm 12-12-B2)
IR B. Docodonl Diad Toslnlo !9 7. Docodonl Mninlolnod a Uvlng TruSl
(Anach copy 01 Wili) (Anach copy 01 Trusl)
AU: CORRESPONDENCE AND CONFIDENTIAL TAlC INFORMATION SHOUlD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Mellon Bank N.A. - 01 a Jakubowska Mellon Bank N.A.
TELEPHONE NUMBER PO Box 7899 Room #193-0224
215-553-2526 Philadel ia PA 19101-7899
1. Roal ESlalo (Schodulo A) ( 1 ) None
2. Slacks and Bonds (Schodu!o B) ( 2 ) None
3. Closoly Hold Slock/Partnorshlp Inlorost (Sch. C) ( 3 ) None
4. Mongagos and Nolos Rocolvablo (Schodulo 0) ( 4 ) None
5. Cosh, Bank Doposl'" & Mlscolianoous Porsonal ( 5 ) 6,546.71
Proporiy (Schodulo E)
B. JolnUy Ownod Proporty (Schodu!o F)
7. Translors (Schedulo G) (Schodulo L)
B. Tolal Gross Asso'" (total Unos 1-7)
9. Funoral Expansos, Admlnistratlvo Costs,
Mlscolianoous Exponsos (Schodulo H)
10. Dab"', Mongago UablllUos, Uons (Schodulo I)
11. Total DoducUons (lolal Unos 9 & 10)
12. NOl Valuo 01 Estato (Uno 8 minus Uno 11)
13. Cha,i1ablo and Govornmonlal Boquosts (Schodulo J)
15. SpouUI Tran.t.,. (for dat.. of duth a"., lS.30-1I"'~ 5..
Inlfruetlon,lof Applic.abla P,relnulI' on P.gI 2.llnthldl
valuultom Sch.dul. KOf Sch.dul. M.)
18. Amount 01 Une14 taxablo at 6% ralo
(Includo valuos from Schodulo K or Schodulo M.)
17. Amount 01 Uno 14 taxablo a115% ralo
(Includo valuoslrom Schodu!o K or Schodulo M.)
TAlC 18. Prlnclpal tax duo (Add tax Irom Unos 15, 16 and 17.)
COMPUTA.. 19. Crodits Spoul&lPowlrtyCredil Prior Payments DIscount
TIDN + 3,432.00+ 180.63-
20. "Uno 191s roalo, Ihan Uno 18, onlor lho dilloronco on Uno 20. This ISlho OVERPAYMENT,
Ii:. Cl1IClk'h.",lIou are re ueaUn arefund of our OVe ani.
21. "Uno 181s groator than Uno 19, ontor tho dllloronco on Uno 21. This Is tho TAlC DUE.
A. Enler tho Intorasl on tho balanco duo on Uno 21A.
B. Entor tho total 01 Uno 21 and 21A on Uno 21B. This Is tho BALANCE DUE.
Make Check pa able to: Register of Wills, Agent
1'::~:!;i~"::!:i!i;:i!;ii!::i!~!!!HI1i!i!!;!!!!!i:H:i!'i!ii!!"l:H:":BE SURE TO ANSWER ALL auesnONs ON PAGE 2 AND TO RECHECK MATH ,,;" "'>.,', ' ',' ':' ::<, ,-,::;.,',i:,:',;ri
Undor penalties 01 porJury, I dodaro that I have examined this relurn. Including accompanying schedules and s1alcmonls. and 10 tho best 01 f!lY knowledgo
and bollor, h Is truD, torrael Bnd complate. I doclaro that all roal oslato has boon roponod al truo markot valuD. Doclaratlon 01 propacor other than tho porsonal
10 rosontaUvo Is based on all Information 01 which proparer has an knowlod o.
!jtO ATURE OF PERSON R PONSI L. FOR FIL.IflO f\ETURN ADDRESS
/ . .) .. -'J . L / II See Schedule attached
Aoo~l~iion Bank (EUlI) N.A.
CHECK
APPRO-
PRIATE
BLOCKS
o 4. Umitod Eslalo
CORRES-
PONDENT
RECAPIT -
ULATIDN
PA1S001 NTF18n
CopyrIGht Forml Sollwa" Only, 119. Nllco,lnc. N9.PAQOl
(lor dAtil 01 dlalh ~mor to 12.13-121
o 5. Fodoral Estalo Tax ROlurn Roqulrod
...!... B. Total Numbor 015.10 Doposlt Boxos
(8)
( 7)
None
398,328.18
(8)
404,874.89
(9)
16,892.16
(10)
1,219.01
(11)
(12)
(13)
18,111.17
386,763.72
None
(15)
(14
242,240.83 x.QQ.. .
386 763.72
0.00
(16)
144,522.89 x
8,671.37
.06 =
//
,15 =
0.00
(17)
0.00 x
(IB)
8,671.37
InlerDSI
(19)
(20)
3,612.63
(21)
(2M)
(21B)
5,058.74
0.00
5,058.74
'tllN 2 2 1991
CATE
t', U. tjox ,&&9
I'hllad.lphl., P..19101.789D
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PA REV-t500 EX (7-94) Pogo 2
Act "48011994 provides lor the reduction 01 the tax rates Imposed on the not value oltranslers to or lor the use 01
the spouse. Tho rates as prescribed by the statute will be:
. 3% (.03) will be oppllcablo lOT estates 01 decedents dying on or aller 7/1/94 and boloro 1/1/96
. 2% (.02) will bo applicable lor estates 01 decodents dying on or oller 1/1/96 and beloro 1/1/97
. 1% (.01) will be applicable lor estates 01 docBdents dying on or oller 1/1/97 and bolore 1/1/98
. Spousaltranslers occurrIng on or aller 1/1/98 will be exempt Irom Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (v) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did docodonl maIm a ~ansfor and:
a. rololn Iho uso or Incomo ollho proporty translorrod.... . .. .. .. . . .. . .. . .. .. .. . . . . .. .. . . .. .. . ... ... .. . .. . . .. .. .. .. .. .. X
b. rololn Iho rig hi 10 doslgnalo who sholl uso Iho proporty transforrod or lIS incomo,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
c. r01aln a rovorslonary Intorost; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
d. focolvD tho promise tor hfo of oither payments, benofits or carD? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
2. II doalh occurrod on or beloro Docomber 12. 1982, did docodonl wilhin two yoars procoding doalh translor proporty wilhoUI rocoiving
adoqualo consldoraUon? II doalh occurrod allor Docomber 12. 1982. did docodonl ~anslor proporty wilhln ono yoar 01 doalh wilhoul
rocolvlng adoqualo consldoralion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
3. Old docodonl own an 1n uustfo( bank accounlal his or hor doalh?. .. ........ .... .. .. .. . .. .. . ... ... ...... ...... .. ... .. . X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS XES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF-THE RETURN.
PA15002 NTF ISBO
Capy,t;'" Forms Soli...,. Only, ,99. Nllco,lnc. N9.PAOOl
REV-1~10 EX + (2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
TRANSFERS
PLEASE PRINT OR l'iPE
FILE NUMBER
Charles W Staver 21-1996-0291
THIS SCH. MUST BE COMPLETED & FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF COVER SHEET IS YES.
DESCRIPTION OF PROPERl'i DECO. DOLLAR VALUE
ITEM Includa nama ollho translereo, their EXCLUSION TOTAL VALUE % OF DECEDENTS
NO. relationship 10 docodont. dato 01 transfer. OF ASSET INT. INTEREST
The decedent created a trust for
his benefit per agreerrent dated
June 8, 1988. Assets of the trust
as follCfilS:
1 10,000 Pittsburgh PA 10,526.85
7% due 3/1/2006
2 25,000 Delaware River Jt Bridge Rv 27,591. 00
7% due 7/1/2008
3 1,877 DF PA Tax Exelrpt Fund 24,108.70
4 448 DF Stock Fund 45,742.91
5 200 Sprint Cbrp 8,612.50
6 74,809.75 Mtg of Hockersmith 74,809.75
7 58,182.39 Mtg of Joseph and Kathe 58,182.39
Hockersmith
8 Principal cash balance 6,534.10
9 National Life Insurance Cb 36,903.91
Annuity contract VL0060713
10 Safeco Life Insurance Cb 37,242.10
Individual Retirerrent Annuity
contract LP1001692 ./
//
Proceeds of the above reported
annuities are payable to Esther
G Staver, the surviving spouse.
11 The decedent C1o'Il1ed single premium 68,073.97
retirerrent annuity contract #328882
the annuitant being Esther G Staver
his spouse. The accumulative total
date of death value of the annuity
was diSMSed to the decedent's
daughters, Nancy Davis and Kathe
Hockersmith, who are the contin-
gent beneficiaries.
TOTAL (Also ontor on lino 7. Roc.pitul.tion) $ 398,328.18
(II moro spaco Is ncoded,insert additional shoots 01 :Jame slzo.)
PAlSl01
NTF '217A
CClpy"oht Forms SOlhil',1I.0nly, 19!i14 N.ltO,lnc. N94PA10I
"./
Inventory 01 the real and pOllanal eSlato of
Chari OR W. Stover
doceand.
Real Estate:
107 lIo11ar Avenue
Shippensburg, PA 17257
(Jointly held with spouse.)
Intangible Personal Property.
The decedent created a trust Cor his beneCit per agreement dated
June 8, 1988. Assets oC the trust as follows:
1. 10,000 Pittsburgh PA 7% due 3/1/2006
2. 25,000 Delaware River Jt. Bridge Rv. 7% due 7/1/2008
3. 1,877 OF PA Tax Exempt Fund
4. 448 OF Stock Fund
5. 200 Sprint Corp.
6. 74,809.75 Mtg. oC lIockersmith
7. 58,182.39 Mtg. of Joseph and Kathe lIockersmith
8. principal cosh balance
9. National LiCe Insurance Co. Annuity Contract VL0060713
10. Safeco Life Insurance Co. Individual Retirement Annuity Contract
LP1001692
Proceeds of the above reported annuities are payable to
Esther G. Staver, the surviving spouse.
11. The decedent owned single premium retirement annuity contract #328882
the annuitant being Esther G. Staver, his spouse. The accumulative
total date of death value of the annuity was disbursed to the decedent's
daughters, Nancy Davis and Kathe lIockersmith, who arc the contingent
beneficiaries.
12. Capital Blue Cross reCund and reimbursements
13. Amex Life Insurance, cancellation value of long term care inRurancc
14. Overpayment ro: 1995 Federal Income Tax
15. Charles W. Staver Trust U/Agrecment, income accrued to 2/28/96
Total
120,00 00
10,52 85
27,591 00
24,10 70
45,74 91
8,61 50
74,80 75
58,18 39
6,53 10
36,90 91
37,24 10
68,073 97
252 68
342 84
441 00
5,510 19
$524,874 89
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
l
J
51:
~~llon nank, N.A.
being duly. sworn .ccording to I.w, d.po... ond ..y. thot xl\ij thpv nrp
executor 01 tho E.t.te 01 _ --9.!i'! I pc, N. St,wer
lote oE 107 Hollar Avenue, Shippenc,burlJ . Cumb.rl.",; County, P'" d.c....d .nd th.t the
within i..n In.entory mode by Mellon nnnk, N.A. . the ..id ex"cutor
oE the .ntire estoto 01 ..id d.ced.nt. con.i.ting 01 .11 tho person.1 property ond ,..1 e.tate, exc.pt r..t e.tato ouhido
the Commonwealth 01 P.nn.yl.onio, ond th.t tho Iigure. oppo.ito eoch item 01 tho In..ntory repre.ent it'. E.ir ..Iue
.. DE ihe dote 01 d.ced.nt'. de.th.
rl<UJt'/l.L2v ~ TII
71zM~ .s( ~jJlI>"..c {(I
I t7 i/
I
1997
Mellon !lank, N.A. -.l.J-" j) /I J
ny: Stephanie R. Covahey~ "-frt-JU:rlllC!.... 'I' ~1.'Lt.~
Eucutar . Adminhl,.tor 0
.~'\:'A:ol,)
ond subscribod boEore mo,
10 South Spcond St.. P.O. nox 1010
Harrisburg, PA 17108-1010
"'deh...
D.te oE Death
.20-
DIY
:,'::brut:r\:
Month
1~96
Y..,
INSTRUCTIONS
I. An In.entory must bo filed within three months .lter oppointmenl 01 personal repre.entoti.e.
2. A supplement in.entory must b. filed within thirty doys oE di.cov.ry 01 oddilionol osseh.
3. Additionel sheeh m.y be .tt.cl,.d .s to person.lty or re.lty
4. See Artlcl. IV. Flduci.ries Act oE 1949.
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BUREAU Dr INDIVIDUAL TAXES
(HlllRIIANe( IAIl DIVISIU~
DIP'. :801101
IIAHAI5BLmG. J1A I/lla.Obol
CDHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
"
NOTICE Dr INIlERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
Dr DEDUCTIONS AND ASSESSMENT Dr TAX
OLGA JAKUBOWSKA
HELLON BANK NA
PO BOX 7899
PHILA PA 19101
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
04-28-97
STAVER
02-2B-96
21 96-0291
CUHBERLAND
101
\b.t~~,
~ft}~~'
'..a,'1I "' IH-tll
CflARLES
W
f====== Anaunt R.nltt.d
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
jj"ftj:is4TEif"iij:p--iiii":m-"Nor-icE--OF-i"NHEifii'AN-CE"TAx..jiPPRAYsEifENT..,--,\L.L'oWAtic'nfli------....---..m....
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF STAVER CHARLES W FILE NO. 21 96"0291 ACN 101 DATE 04"28"97
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST .. SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Eat.t. (Schedule AJ (1)
2. stock. and Bond. (Schedule 8) (2)
3. Closely Held stock/Partnership Int.re.t (Schedule C) (3)
~. Hartg.g../Not.. Raceivable (Schedule DJ (4)
5. Cash/Bank Deposits/Hilc. Parlonal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule FJ (6)
1. Transfers (Schedule GJ (7)
a. Tot.l Alut.
APPROVED DEDUCTIONS AND EXEHPTIONS:
9, Funeral Expans../Adm. Costl/Mlsc. Expanse. (Schedule H) 19'
10. D.bts/Hortgag. liabilities/Liens (Sch.dul. I) (10)
11. Tot.l D.ductions
12. N.t V.1u. of Tax R.turn
13. Ch.ritab1./GoY.rn~ent.l aequests (Schedule J)
14. Net Va1u. of Est.te Subject to Tax
NOTE:
J CHANGED
.00
.00
.00
.00
6 . 546 . 71
.00
398.328.18
(8)
16.892.16
1,219.01
(11)
(2)
(3)
(4)
NOTE: To in sur. p~op.~
c~edit to your .ccount,
sub~it the upper portion
of this for~ with your
tax p.y~ent.
404,874.89
18.111 T7
386.763.72
.00
386,763.72
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. AMount of Lin. 14 at Spousal ~ata (IS)
16. AMount of line 14 taxable at Lin.al/Class A rat. (16)
17. A.aunt of Lin. 14 t.xabl. at Coll.t.ral/Clasl a rata (17)
18. Pr1nc1pal Tax Du.
242.240.83 X .00:
144,522.89 X' 06:
,00 X .15:
UB)
AMOUNT PAID
TAX CREDITS:
PAYMENT
DATE
05-22"96
11"29"96
RECEIPT
NUMBER
AA1l2865
AA146994
DISCOUNT (.)
INTEREST/PEN PAID (-)
180.63
1.25..
INTEREST IS CHARGED THROUGH 05..13"97
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORH
3,432.00
5,058.74
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
.00
8,671.37
.00
8.671.37
8,670.12
1.25
,05
1.30
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.)
(; ':"J
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RESERVATION: E.t.t.. of d.c.dent. dying on Dr b.for. O.c..b.r IZ, 198Z .. If any future Int.r..t In the ..tate I. tran.f.rr.d
In Po.....lon or enJoy..nt to Cia.. . (coll.t.r.l) b.n.flcl.rl.. of the d.c.d.nt .ft.r the ..plratlon of any ..tat. for
Ilf. Dr for y.er., the Co..anw..lth her.by ..pr.s.ly r.s.rve. the right to .ppr.ls. and a.s... tran.f.r Inh.rltanc. Ta.I'
.t the lawful CI... . Ccollat.ral) ratg on any .uch future Int.r..t.
PURPOSE OF
NOTICE1
To fulfill the requlr...nt. of S.ctlon ZI40 of the Inherltancl and E.tet. Ta. Act, Act ZI of 1995. (1Z P.S.
S.ctlon 9IUJ.
PAYMENT:
aetech the top portion 0' thl. Notice and .ub.lt with your Plv..nt to thl R.glst.r uf Wills prlnt.d on the rlv.r.. .Id..
""ale. check or .on.y order paYabl. tot REGISTER OF MILLS, AGENT
REFUND (CA):
A r.'und 0' a ta. credit, which wa. not r.qu..tld on the Ya. R.turn, .ay b. r.qu..t.d by co.pl.tlng an "Application
for Re'und 0' PlnnsYlvanla Inhlrltanc. and Estat. Ta." (REV.I]I]). Application. .r. avellable at thl Offlc.
of the Rlglst.r 0' Wills, any of the Z5 Alv.nue Ol.trlct O"lc.., or by c'lllng the .p.clal Z~-hour
en'Wlrlng ..rvlc. ~b.rs for for.' ord.rlng: In P.nn.vlvanla 1.800.56Z-Z05D, out.lde P.nnsylvanla and
within loc.l HarriSbUrg ar.. (717) 787-8094, TOO' (717) 77Z.ZZ5Z CH..rlng I~alr.d Only).
OBJECTIONS:
Any party In Int.r..t not s.tl.fl.d with the .ppr.I....nt, allow.nce or dlsallowanc. of d.ductlons, or ........nt
of t.x (Including dl.count or Int.r..t) as .hown on this Notlc. DU.t obJlct within sl.ty (60) day. 0' r.c.lpt of
thlt NoUce bY2
.."rlthn protnt to the PA D.part..nt of R.v,nu., Board of App.als, D.pt. Z81azl, HarrisbUrg, PA I7I28.1OZI, OR
...lact1on to have tha .atter d.ter.ln.d .t audit 0' the account of the per.onal rlprnentaUv., OR
..app.al to the Orphans' Court.
ADMIN
ISTRATIVE
CORRECTIONS:
Factual .rror. dlscov.r.d on thl. a.......nt .hould b. .ddr....d In "rltlng to: PA a.part..nt 0' A.v.nue,
Bur.au 0' Indlvldu.1 Ta..s, ATTNI Po.t A.......nt A.vl." unit, O.pt. Z80601, H.rrl.burg, PA l11ZI.e601
Phone (117) 787.6505. 5.. page 5 0' the bookl.t "In.tructlon. 'or Inh.rltanc. T.. R.turn 'or a R..ld.nt
Dec.d.nt" (REV.1501) 'or an ..plan.tlon 0' ad.lnlstratlv.ly corr.ct.bla .rror..
DISCCUlT1
If any tax due I. paid "Ithln thr.. (]) cal.ndar eonth. a,t.r the d.c.dlnt's d.ath, a 'Iv. p.rcent (5X) dl.count of
the t.x paid I. allowed.
PENALTY:
The ISX t.x a~.ty non.partlclpatlon plnalty I. coaput.d on the tot. I of tha t.x and Int.r.st .......d, and not
paid ba'or. January 18, 1996, the 'Ir.t day aft.r the .nd 0' thY t.. aana.ty plrlod. Thl. non-p.rtlclpetlon
penalty I. epp..labl. In the .... .ann.r .nd In the the .... tl.. plrlod a. you "ould app..1 the t.x end Int.rl.t
that hat bI.n .......d .. Indlcatad on thl. notlcl.
INTERESTs
Int.r..t Is charg.d bag Inning with flr.t day of d.llnqu.ncy, or nine (9) ~ths and ana (I) day fro. the data 0'
death, to the data of par-ant. T..I' which baea.. d.llnquent bafor. Janu.ry I, 198Z bear Int.r.st .t the rat. 0'
six ('X) percent p.r ennue c.lculat.d at . d.lly rat. of .000164. All ta... which b.c... d.llnquent on and .ft.r
Jenu.ry I, 198Z will ba.r Int.r..t .t . rat. which will vary 'roe cal~.r y.ar to c.landar y..r "Ith that r.t.
ennouncld by the PA Dep.rt..nt of R.v.nue. Th. appllcabl. Int.r..t r.t.. for 1982 through 1997 .r.:
"!!!! Interllt Rat. Dally Inhr..t Factor !!!! Inter..t R.t. O.lly lnt.rllt Factor
1982 ZDX .OGD5U 1917 'X .Uaz.7
198] 16X .oooua 1981-1991 11;( .ounl
I... IIX .ounl I99Z 'X .OOOZ.,
1965 In .000556 199].1994 n .000192
1'86 IDX .UOZ7tt 1995-1997 ox .OOOZ"
--Int.rnt .. calculatld .. followll
INTEREST = BALANCE OF TAX UNPAID X NUNDER OF DAYS DELINQUENT X DAILY INTEREST FACTDR
.-Any Hotlc. I.sued .ft.r thl t.x baco... d.llnquant "III r.'lact an Int.r.st c.lculatlon to ,Ift..n liS) dayS
ba:;oond the data of the ........nt. If P.y.."t .. .ad. "It.r tha Inter..t coaputatlcn dIlt. .hown on lhl;
Notice, addltlon.1 Intarnt .....t ba calculat.d.
! 1-) _it,)" . II
1 ~., ~
BUREAU OF INDIVIDUAL TAXES
l".RITAHCE fA)( DIVISION
DEPt. :80601
ttAARlSBU$lC, PA 111:8-0601
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
l'/*,
1I,.IU'U ".1...."
OLGA JAKUBOWSKA
MELLON BANK NA
PO BOX 7899
PHlLA
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-02-97
STAVER
02-2B-96
21 96-0291
CUMBERLAND
101
CIlARLES
W
Anount Renltt.d
PA 19101
MAKE CHECK PAVABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE. To Insue. peop.e ce.dlt to youe .ccount, sub.lt tho upp.e paction of this foe. with yaue t.. p.y..nt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifiv:ii.Oj-EX-AW-ni:i:ij'ri------iiil.-iilHE'iiiTAiicE-;:;.x-si,'iiTEtiiliT"bT;.cciii:itir-.iii---------------------
ESTATE OF STAVER CHARLES W FILE NO. 21 96-0291 ACN 101 DATE 06-02-97
THIS STATEMEHT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-21-97
PRINCIPAL TAX DUE: 8,671.37
PAYMENTS (TAX CREDITS).
PAYMENT
DATE
05-22-96
11-27-96
RECEIPT
NUMBER
AA112865
AA146994
DISCOUNT (+)
INTEREST/PEN PAID (-)
180.63
.00
AMOUNT PAID
3,432.00
5,058.74
TOTAL TAX CREDIT
8,671.37
BALANCE OF TAX DUE
.00
INTEREST AND PEN.
TOTAL DUE
.00
,00
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN ll,
NO PAYMENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI,
YOU MAY BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
"j,
:-1
PAYHENT I
1-. ..: :._,
I'G
~-Oet.ch the top parttdn-af thl. Notice and .ub.lt with your pay.ent .ad. payable to the nae. and addr...
printed on t~ r.v.rs. sid..
If RESIDENT DECEDENT .ake ch.ck or eon.y ordu payable to: REGISTER OF WILLS, AGENT.
If NON"RESIDENT DECEDENT .ah ch.ck or .on.y ord.r pllyable to: COHHONWEALTH OF PENNSYLVANIA.
REFUND (CR): A r.fund of a ta. cr.dlt, which wa. not r.qu.sted on the la. Return, Bay b. requ.sted by co.pletlng an
-Application for R.fund of P.nn.ylvanla Inherltanc. and E.tat. la.- (REY.l)I)). Application. ar. avallabl. .t
the Dfflc. of th. R.gIst.r of Wills, any of th. 23 R.venu. DI.trlct Offlc.. or fro. th. D.part..nt.s 2..hour
answ.rlng ..rvlc. nuab.rs for for.. ordering: In P.nnsylvanla 1.800-!6Z.Z0S0, out,lda P.nn.ylvanla
and within local Harrisburg ar.. (711) 781.809~, TOOl (711) nZ.ZZ5Z CHe.rlng I.palr.d only).
REPLY TO:
Qu.,tlon. regarding errar. contaln.d on thl. notice .hould b. addre...d to: PA Oepart.ent of R.venue, Bur.au
of Individual Tax.., ATTN: POlt A.......nt Review Unit, Dep\. Z80601, Harrisburg, PA 11IZ8-06111, phOM
(711) 787.6505.
DISCOUNT:
If any ta. due I, paid within thr.. ()) calendar .onth. .fter the d.cedent.s death, a flv. p.rcent (5X) dl.count
of t~ tax p.ld Is allowed.
PENal TV I
Th. 15X teM .-n..ty non-participation penalty I. coaputad on the total of the tax and Int.re.t .......d, and not
p.ld befora January 18, 1996, the flr.t day after the end of the ta. a8n..ty p.rlod.
INTEREST:
Int.re.t I. ch.rg.d b.glnnlng with flr.t day of d.1Inquency, or nln. (9) eonth. and on. (1) day froe tha d.te of
da.th, to the data of pay..nt. Taxe. which bacaa. d.llnquent bafora January I, 198Z baar Inter..t at the rat. of
.1. (6X) p.rcent p.r annua calculat.d at . dally rata of .00016~. All tax.. which b.ca.. d.llnquent on and .ft.r
January I, 198Z will bear Int.re.t at a rat. which will vary fro. calendar y.ar to calandar y..r with that rat.
announc.d by tha PA D.part.ant of Revenua. The ftPP1lcabl. Intar..t rat.. for 1982 through 1997 ara:
Vaar Intar..t Rata Dally Inter..t Factor
Vellr
Intare.t Rat.
Dally Intere.t Factor
1982 20X .000548 1987 9X .0002~7
198) 16;( .000U8 1988.1991 llX .000301
198. IU .000301 1992 9X .00OZ~7
1985 UX .000156 1991.1994 7X .000192
1986 lOX .000Z7~ 1995.1997 9X .000Z~7
--tntar..t .. c.lcul.tad .. folloWIS
INTEREST = BALANCE OF TAX UNPAID X NUNDER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
~.Any Notlc. I..u.d .ft.r the tax baco..s dallnqu.nt will rafl.ct an Inter..t calculation to flft..n (IS) d.y.
b.yond t~ dat. of the .......ent. If pay.ant Is aad. aft.r the Intar..t co.putallon dat. .hown on the
Nollea, additional Inter..t IN.t b. c.lculat.d.
,.,.,?j -q~ -c;? CJ I
-
Internal Revenue Service Center
Mid.Allanllc Region
Departmenl JI Ihe Treasury
IJO-:'3/lNU
,
Ii'
Dill; AUG 1 1 1991
EIUt. of'
CHARLES W. STAVl:R
o.ced.nl'. Social ~(U'lIy ~umber.
2011-01-7517V
011' 01 0..1"';
FEBRUARY 28, 1996
Penon to Conllct:
BARBARA F1JNK
ContlCl Tet.phon, Humber:
215-516-39116
- i
~
,.., ~
. I.IELLON BAliK, !LA. (:l;
% FRANCIS A. BOYLE, TRUST OFFICER
P.O. BOX 7899, ruM. #193-02211
PHILADELPHIA, PA 19101-7tl99
Eaute Tu Cloa.lng lefter CThil II nol I bill tor III due)
Our compu~at1on at the Federal tax llab1l1ty tor the above estate 1s shown below.
It does not 1nclude any 1nterest or late payment penaltieS that may be charged, but other
penalties have been CaDS ide red in the computation. You should keep a copy at this letter
as a permaaent record because your attorney may need it to close the probate proceedings
tor the estate. This letter 1s evidence that the Federal tax return tor the estate has
either been accepted as tiled, or has been accepted atter an adjustment that you agreed'
to.
This is not a tormal clo~ing agreement under section 7121 at the Internal Revenue
Code. We will not reopen this case, however, unlesS Revenue Procedure 94-68, reproduced
on the back at this letter, applies.
. It you have any questions about this letter, please wr1te or call the person whose
name aad telephone number are shown at the top ot this letter. It you write to us with
questions about this letter, please provIde your telephone number aad the most convenIent
time tor us to' call it we need addItional intormation. Please attach thIs letter to aay
correspondence to help us 1dentity your case. Keep the copy tor your records.
Thank you tor your cooperatIon.
Enclosure:
Copy ot thIs letter
'''0
96,750.06
Tentative tax .........................,.............................. S
Less: Aggregate gift taxes payable (lor gifts made after 12-31-76) ............ S -0-
Unified credit .......................,.............., S 192, 800.00
Crecjt lor Slale dealh taxes ............................... S -0-
Crecjt lor Fedenll gift tax ( ills' S -0-
es on g poor 10 1-1-77) . . . . . , . . . . . . . . . . .
Credit lor loreign death taxes .............................. S -0-
Credit lor lax on prior transters - . 0 . . . . . . . . . . . . . . . :. . . . . . . . . . . S -0-
T olal subtractions
Net aslate tax
Penalties. il any
............ .
. ~92.800.00
. s -0-
o . S -0-
. . . . . . . . . . .
. . . . . .
........., .
10"")
Letter 627(SCI (Rev, s-66)
P.O. Box 33t, Benaalem. PA 19020
PURPOSE OF
NOTICE:
To fulfill the r.qulr.~.nt. of S.ctlon 2145 (b) of the Inh.ritanc. and E.tat. fa. Act, Act 21 of 1995. (7Z P.S.
$Ic\lon 9145), ;, ,
PAVI1ENT;
Oltach th. top portion of this Notlc. and sub.lt with your pay.ent to th. Rlgl.ter of Willi printed on the
revlrse side.
.. Halo.l chick Dr loney order payabll to: REGISTER OF' HILLS, AGENT.
REFUND (CR): A rlfund of a ta. crldlt May b. r.queltld by cOMpleting an "Application for Refund of Pennlylvanla
Inherltanc. and Estate Ta." (REV-1313). Application. ar. available at thl Office of the Rlglster of Wills.
any of the 23 RIVlnUI District Offlcls or frOM Ihl CIPartMlnt"s 24-hour answlrlng Slrvlcl nUMblrs for for.. ord.rlng:
In P.nn.ylvanla 1-800-362'2050. out.ldl Plnn,ylvanla and within local Harrisburg aria (711) 7a7-aO?4,
TOOl (17) 77Z-2252 Ollarlng I.palud Only).
OBJECTIONS: Any party In Inter.,t not .atl.fled with thl a.sess'lnt of ta. as .hown on thl. notice .ay objlct within
sl.ty (60) days of r,cllpt of thl. Not lei by:
"wrlttln prot..t to thl PA Dlpart.lnt of RevenuI, Board of Applals. DIP\' 281021, Harrisburg. PA 17128-1021, OR
--lllctlng to have thl .att.r dlter.lnld at audit of thl Plrsonal rlprl.lntatlvl, OR
--app.al to thl Orphans' Court
AOI1IN-
ISTRATlVE
CORRECTIONS: Factual error. dlscovlrld on thl. a..es..ent .hould bl add,e"ld In writing tOI PA Clpart.lnt of Revlnul,
Bur..u of Individual Ta..., ATTN: Po.t An.....nt Ravilw Unit, Dlpt. 280601. tlarrlsburg. PA 17128-0bOI.
Phonl (717) 787-6505. SII page 5 of thl book lit "In.tructlon. for Inhlritancl Ta. Rlturn for a RI.ldlnt
Olcldlnt" (REV-I501) for 8" I.planatlon of ad.lnl.t,ativlly corrlctabll Irror..
PENALTY:
Thl 15~ ta. a.n..ty non-participation plnalty I. co.puted on the total of the ta. and Intlrlst a..I"ld. and not
paid beforl January 18, 1996, thl flr.t day aftlr the Ind of the ta. aIMe.ty plrlod. Thl. non-participation
plnalty I. appealabll In thl .a'l .ann.r and In thl thl .a'l tl.. plrlod a. YOU would appeal thl ta. and Intlrest
that ha. bien a.....ed a. Indlcatld on thl. notlcl.
INTEREST:
Additional Plnnlylvanla E.tate Ta. assl.l.d a. a rllult of a changl on thl Flderal E.tate Ta. clo.lng
Ilttl' baco'I' d.llnqulnt at thl I.plratlon of onl (I) .onth fro. thl dati thl final notlcl of thl Incr'.'1
In Flderal [,tat. la. I. 'Icllvld.
Ta.I' which blca.1 dlllnqulnt b.forl January 1. 1982 blar Intlrl.t at the rat. of sl. (6~J p.rct"t plr annul
calculated at a dally rate of .000164. All ta.ls which blca.1 dlllnqulnt on or afttr January I. 1982 will blar
Inter.st at a rate which will vary fro. callndar Ylar to callndar y.ar with that rate announcld by thl PA
Olpart..nt of Rlvlnue. Thl appllcabll Intere.t ratl' for 198Z through 1997 ar'l
V.ar Int.,I" Ratl Dally Inter..t Factor :!!!!' Intlrl.t Ratl Dally Intlrelt Factor
198Z ZO~ .000Slt8 1987 .~ .000247
198J 16:< .000438 1988-19?1 11~ .000301
1984 IU .000301 1992 .~ .000247
19a5 13~ .000356 1993-1994 7> .00019Z
1986 IO~ .000274 1995-1997 .~ .000Z47
..Intlr..t Is calculatld .. follow.:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlcl I..u.d after the ta. blco"s dlllnqulnt will rlfllct an Int.rl,t calculation to flfte.n (IS1 days
blyond thl date of thl al,..,..nt. If paY'lnt I. .ad. aftlr the Int.r.st co.putatlon dati shown on the
Notlcl. additional Intl,..t ~It bl calculat.d.
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF DETERHINATION AND
ASSESSHENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
;. I ,,' .
BUREAU Of INOIV,OUAl TAMES
IHllINI1ANCl lAX O'v1510N
DIPI. lahal
IIAIl1I1SIlUNC, IIi 1/1:801,01
OLGA JAKUBOWSKA
MELLON BANK NA
PO BOX 7899
PHILA
PA 19101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
,
,--
~~.'~4~~
t'lj~~
fl,-.IIII&IJ.U"1
09-15-97
STAVER
OZ-ZB-96
Zl 96-0Z91
CUMBERLAtlD
ZOl
CHARLES
REG1STER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your lecount, lub~lt the upper portion of this forn with your tB. ply",ent.
W
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
R-EV:4Si--EX--AFP-,'oi-:97j-----.-.-NCiiicif-OF--DETifRHiiiAiib-N-AiiD-AS-SESllHENif----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
Amount hlllltt.d
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
ESTATE OF STAVER
CHARLES
W FILE NO.21 96-0291
ACN 201
DATE 09-15-97
ESTATE TAX DETERMXNATXON
1. Credit For Stete Death Taxas as Verifiad
2. Pannsy1vania Inheritance Tax Assessad
(Excluding Discount and/or Interest)
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
TAX CREDITS:
PAVMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
8.490.74
.00
8.490.74
AMOUNT PAID
.00
.00
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YDU HAY BE
DUE A REFUND, SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
PUQPOS( OF
HOTlCEI
To fulfill the r.qulr...."'. of Section Zlto!>> lb. of th. InherUftnc. and [.Iat. 'ftll Act, Act ZI of I'J'J!>>.
III P.S. S.ctlon 'J145). ,
PAVHEN'1
D.tach the top portion of thl. Notlc. and .ub_lt with your pay.ent to the Revl.ter of Will. printed on the
r.ver.e .Ide.
.. Hake check or .oney order Pftyftbl. tOI RECISTER OF MILLS, ACENT.
REfUND lCA)1 A r.fund of a tall credit 8ay b. r.que.ted by co.pletlnv 8n -Application for Refund of Penn.ylvanla
Inherlt.nc. and [.t.t. T.." (REV.I]I]). Application. ar. avallabl. at the Office of the R.gl.ter of Will..
any of the Z] Revenue District Offlc.s or fro. the Depart.ent". Z4-hour answering .ervlce nu.b.r. for for.s ord.rlng:
In P.nn.ylvanla 1.800.]6Z.Z0!>>0. out,lde P.nn.ylvanla and within local Harrl.burg area <<717) 761-80'J4.
TOO' (711) 77Z.ZZSZ IH.",rlng I.palr.d Only).
OIJECTIONS: Any party In Int.rest not s.tlsfl.d with the .s......nt of tall a. ,hown on thl. notice ..'1 objact within
.lllty (601 day. of r.celpt of thl. Hotlc. by:
"wrltt.n prot..t to the PA Depart.ent of R.venu.. lo.rd of Appuls. aept. Z810ZI. lIarrlsburg. PA 171Z8-1QZI. OR
....I.ctlng to hava the .att.r datar.lned at audU of the p.rsonal r.pr.santaUve. OR
.-app..1 to the Orphan,. Court.
AD"IN.
ISfAATlVE
CORRECflONSI
factu.l .rrors dl.cover.d on this a.s..s..nt .hould b. address.d In writing tal PA Depart.ent of Rev.nue,
Bur.au of Indlvldu.l fa.e., AflNI Post A.s."..nt R.vl.w Unit, Oept. Z&0601, lIarrlsburg. PA 17IZ8'0601,
Phone (7171 787.6S0S. S.e page S of the bookl.t "In,tructlons for Inherltanca T.. R.turn for a Residant
Oecadent" (REV-IS01) for an ..planatlon of .d.lnlstratlv.ly corr.ctabl. .rror..
PENAL TVI
Th. ISX ta. a.ne.ty non.partlclpatlon panalty .s co.putad on tha total of the t.. and Int.r..t as.essed, and not
paid b.for. January 18, 1996. tha first day aft.r the end of the t.. aan..ty period. This non.partlcipatlon
p.n.lty 1. .pp.alabl. In the s... .ann.r and In tha the .... tla. period a. you would app.al tha ta. and Int.r..t
that ha. b..n as.es..d a. Indlcat.d on thl. notlca.
INTEAEST:
for dat.. of daath on or after 10-]-91, Penn.ylvanl. [.tat. Ta. ba..d on the f.daral E.tata T..
r.turn baco.as dallnquant .t tha ..plratlon of nlna (09) .onths fro. the date of d.ath.
for d.t.. of daath prior to 10..]-91. pann'Ylvanla [.tat. Ta. b..ad on the f.deral [stat. TaK r.turn
baco.e. d.llnqu.nt at the ..plratlon of .Ight..n 118) .onth' fro. the data of daath.
Ta... which b.ca.a dallnquent be fora January I, 1982 b.ar lnt.r..t at the rata of .1. (6XJ percent par annu.
calculated .t a dally rat. of .000164. All ta... which b.ca.a d.llnqu.nt on or after Janu.ry I, 1982 will b.ar
lnt.r.st at . rate which will v.ry fr08 calendar y..r to calendar yaar with that rat. announcad by the PA
O.part..nt of Revanue. fhe applicable Int.rest rat.. for 198Z through 1997 are:
Vaar Intar..t Rat. Dally lnter..t factor V.ar Intere.t Rate Dally Internt factor
196Z zO:C .OOOS48 1967 9Z .000247
l"U ax .000418 1988'1991 lIX .000]01
1914 HZ .0OOlOI 199Z 9Z .0OOZ47
1985 UX .000lS6 199]-1994 IZ .OOOI9Z
1966 lOX .00OZ7" 1"S'l'J'J7 9Z .000247
-.lntar..t It calcul.tad OJ followSl
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
".Any Notice I..u.d .fter the ta. baco..' dellnqu.nt will raflect .n lnter..t calculation to flft.an IISJ day.
beyond the d.t. of the ........nt. If pay..nt I. .ade aft.r tha Inter..t co.put.tlon data .hown on the
Hotlc.. additional Int.rest au.t ba calculat.d.
STATUS REPORT UNDER RULE 6.12
Name of
Decedent:~C\.f' \-e So
Death: J).../ d- f L 9 {...
/9 9& -00:;9 /
Lu. 'S ~-C\ \J C:' -r'
Date of
Will No.
Admin. 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 wgether administration of the estate is complete:
Yes \L 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 following:
a. Did the personal rep;esentative file a final
account with the Court? Yes No Y; .
b. The sepal-ate Ol-phans' C()urt No. (if any) for
the personal representative's account is:
c. Did t.he personal l'eprescntative staye an
account informally to the parties in interest? Yes V 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:
L/ /;t, /99
I '
ilflqfjr 1J~1~
Slg ature
f.1,'Z"b,,+~ (\1",+~(,~,~
Name (Ple~se type or print)
'''el\o", \-:'~CL\..lK i\Jr1 \
HD. P..t.'1 'Diu J 1,\o.f<{~I~b<-.~c,?A-
Address ,) \-'IC~
("]11) 7 ~(; - 3D3 'I
Te 1. No.
Capacity:
vi Personal Representative
Counsel for personal
representative
(MAH:rmflAM3)
i
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CIIAllt.ES W. STA V.:1l .:STATE
ACCOIINT NO. JIIIIIIN
WAIVEIl OIl,\CCOlJNT. IlECEII'T
IlELE,\SE ANII AWlEEI\IENT OIlINIIEI\INITY
A. BACKGIlOIINII: The cilcumstlll1CeS lellllil1ll to Ihe signing of this instrument are as
follows:
I. On Febnlllry 2ll, 191)6, C1l1ules W Stllver passed IIway. Mellon Bank, N.A. is selVing
as Co-ExeculllT with Nllncy C I>lIvis IInd Kllthe S. Hockersmith. Mellon Bank, N.A.
was granted letters on April I), 11)1)6
In addition, Mellon Bank, N.A selVes as trustee under a trust created by
Charles W. Slaver dated June!!, 19!!!!
2. "I give, devise IInd bequeath 1111 Ihe rcst, residue and remainder of my estate to
Commonwealth National Bank (now Mellon Bank, N.A.), Shippensburg,
Pennsylvania, as Trustee under that certain Funded Revocable Trust Agreement dated
the 9th day of June, 19l1ll (and as the same may be amended from time to time)
actually executed by me with the Trustee prior to the execution of this, my Last Will
and Testament; said devise and bequest shall be added to the principal of the trust to
be held and/or distributed liS though an original part thereof."
3. Nancy C. Davis, the undersigned, has periodically received and examined statements
of income and principal cash receipts and disbursements and wishes to agree to waive
an accounting of the administration of the subject estate or the filing of such an
account for court audit
B. TERMS: In consideration of the foregoing the undersigned:
]
@
I.
. Represents and warrallls that the undersigned has read and understands this
instrument IInd that the Iilcts set forth above are true and correct to the best of the
undersigned's knowledge, informatinn and belief.
2.
Waivcs the liIin!lof an IIccounlin!l of the administration of the estate before the court
havin!l jurisdiction oveT this estate. Declares that the undersigned has received and
examined Ihe periodic statements of income and principal cash receipts and
disbuTSel1lenlS The undersi!lned linds them to be correct in all particulars and accepts
thel1llll\llllllproves thel1l, liS if a complete income and principal accounting had been
duly Iiled, audited, adjudicated and conlirmed absolutely by the court having
jUTisdiclion ovclthis est ale
Ilcquesls the execu\l l1Iake distribution 0 alance shown 0 attached sheet
(adjusted (ill ' .11I!l costs) and em . e upon delive e undersigned of the
II1110unl vn liS distributable 'nowledges recei such property.
,I
1\lllees 10 lelinlllto Mellon Bank any amount which may at the time be determined to
hllve heen IIn erroneous distribution to the undersigned regardless of the cause of such
erroneous distribution. Agrees that any period for the limitation of actions and the
collection of any erroneous distribution to the undersigned shall commence only at
such time as Mellon Bank shall have obtained the actual knowledge of such erroneous
distribution and that in no event shall the period for collection of an erroneous
distribution be less than two years after the actual discovery thereof by Mellon Bank.
5. Absolutely and irrevocably releases and forever discharges Mellon Bank in its capacity
as executor of the estate and in its corporate capacity from any and all actions,
payments, accounts, liabilities and claims relating in any way to the administration of
the estate.
6. Agrees to indemnifY and hold harmless to the extent of the funds received by the
undersigned hereunder, Mellon Bank, in its capacity as executor of the estate and in its
corporate capacity, from and against any nnd all claims, losses, liability or damage
(including legal fees and costs in connection therewith) which it may suffer or to which
it may be subjected by reason of its administration of the estate, the seulement of its
account and a distribution of the assets of the trust without having the formal approval
of the court having jurisdiction over this estate.
7. Declares it to be the undersigned's intention that this instrument shall be governed by
the law of Pennsylvania and shall be legally binding as an agreement upon the
undersigned and upon the undersigned's heirs, executors, administrators and assigns.
Dated c0(!t~ I I , 19 J.fg
STAT~9FL ;' /" ! I. :
.},J;r~''''1 0---tu.. ,,J;...~: SS
COUNTY OF . :
On this, the 1/dJ. day of r~r:,L-L.....'o . 19.ft..., before me the undersigned
officer, personally appeared Nancy C. Davis. known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and acknowledged that he/she executed
the same for the purpose therein mentioned.
IN WITNESS WHEREOF, 1 have heTeunto set my ha~d and ~fficial ~t.
/~~a~ Aj~ .
(. J. , Notary ~ublic .. J
'? ...~~~,,------ --~. iJq )
,C -3)-16'
-,
My commission expires: (- 3/ - 9 G
2P116/jdf
~
-:_~'-:- 4---...-.---.,...J\4. t.. r'/-,T ~:.
JRD/Junc 30, I 'J'l2/l1K~K
APR 0 2 199B V1
Estate Nn.:
),1_' qqh.().~q I
OIU'IIANS' COUltT U1VISION,
COUltT 01' COMMON PLEAS OF
ClJMIIEItLAND COUNTY
PENNSYLVANIA
In Re: Estalc of ['11.\111.1.:; W, :;:'.\VI<II
Late of HIIII'I'I':N:;l\lIll1; IlllllIl\llal
No ..1926'0.2'l I
N01'ICI~ (JIf FAIl.lJlm 1'0 I:JLE !>'TATUS REPORT AND REQUEST 1'0
CONI>UCI' A III(AIUNG l'UltSUANT 1'0 ItULE 6,12, SUPREME COURT
OlU'lIANS' COURT RULE
Personal Representative:
m:I.I,ON II,\NK, N.,\.
Counsel fnr Personal Rcprc.\cntativc:
Date of Decedcnt's Dcath:
.2'.2[1. 'l(,
Date of Delinqucncy Noticc:
J'17.<)[I
'lllc nndcrsil:ned. Mary C. I.cwis. Rcgislcr of Wills. in acconlance with Rulc 6.12, Supreme
Court Olllhall.\' Court Rulc.~. hcreby notifics thc Orphans' COllrt Division. COllrtof Common Picas of
Cumherland Counly, that neilher the above named personal representative nor the above named counsel
for the personal reprc.\entative have liIed with the Register of Wills or Clerk of the Orphans' Court his,
her or ils Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite
notice, pursuant to Rule 6,12, Susreme Court Orphans' Court Rules, was given by the Register of Wills
on J. I 7 , 19~, and that the ten (10) day notice to liIe the Status Report has expired.
Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the
undersigned reqUc.\1s that a Court conduct a hearing to determine whether sanctions should be imposed
upon the delinquent personal reprc.\.entat:v.e or coun~el for~~ delinquent pcr~onal rePlJI entative.
Date: 4' .2' 'l /l ) l 'LI (- \ " . I 'i I I: I U' ~ ~l/~
. ry . L wis, Registe of Wills ' r
Distrihntion: Pcrsonal Rcpresentative
Counscl for Personal Rcprescntative
Estate File
." c..
,\ m:,\IlING IS SET FOil '1', ".. (I ,
IN COlJlfl'llooM NO. J. II' '1'H\; STATUS HEPOlfl' IS FII,ED
,
1>,\,1'1-:, TilE 1I1';,\HING WII,1. ,\UTOM,\'l'TC\I,I, DE C,\NCEI.I.ED.
., '
/ 9i~f, AT /:1 - (--:1 /3 /<'l
PIHOH TO TilE HE,\!t.l:NG
i I r l
, 'Lil/!i.U .
U~;---
JRDlJune 30, 1992/17858
nEGlSfEn OF WILU;
CUlllberlund Counly Courthouse
One Courtbouse Slluare
Carlisle, PA 17013
NOTICE PURSUANT TO nULE 6.12
PENNSYLVANIA SUPREME COURT ORPI/ANS' COURT RULES
To:
Personal Representative
Counsel:
MJ::I,I,ON B,\NK, N.,\.
RE: Eslute of CHAHLJ::S W. S'l'AVJ::H , DccC<1sed, Lule of
SHIPPENSBUHG BOHOUGH
EstaleNo.: 21-1996-0291
Dale of Decedent's Death: 2 - 2 8 _ 9 6
Pursuant 10 Rule 6.12, the above named personal representative or the above named allorney, if
applicable, within two (2) years of the decedent's dcath, and annually thereafter until administralion is
completed, is required to file with the Register of Wills a Status Report as required by Rule 6.12, in
substantially the prescribed form, showing the dale by which the personal representative. or attorney, as
applicable, reasonably believes administration will be completed. TIle purpose of this Notice is to advise
you that unless the requisite Status Report is filed with the Regisler of Wills or Clerk of the OlJlhans'
Court, as appropriate, within ten (10) calendar days after the date of this NOlice that the Register of Wills
is required to notify the OlJlhans' Court Division, Court of Common Pleas of such delinquency and to
request that said Court conduct a hearing to determine whether sanctions should be imposed upon the
delinquent pelSOnal representative and the delinquent personal representalive's counsel, if any.
ACCOrdingly, if the requisite Status Report is not filed by J _ 10 , 19...9..1l you are hereby
advised that a request will be submitted to the Court in accor~\ll1C~lh Rule 6.12.
Date: J -17 - 98 a..
Deput Register of Wi Is
Distribution to Eslate File
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