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HomeMy WebLinkAbout96-00320 . ~ ...." ... I~ .j ~ I ...... ~ . \ O. ~ ~ .! I ~ , . .e 0 z '" 11.I 1 OATH 010' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY 0J0' CUllbCfl ilnd } 58 on c:~ '-1.' ...,~, ' p:i v:\ 'n:O .m CJ\ r. ("> 0 q, \, :;;:" . ., - N :n " (.' '-- r-.) (f> ~ 8. \0 , . '" ~ ~ 'tr - " ~ .. ;. iii The petitioner(s) above, named swear(,) or affirm(,) Ihal Ihe stalemenlS in the foregoillg petition are Irue and correct to the best of Ihe knowledge and belief of petitioner(s) and Ihat as personal represenlativc(s) of Ihe above decedent pelilioner(s) will well and Iruly administer Ihe eslate according 10 law, . . ., t, {' Sworn to or affirmed and ~efnte me this ," 12 , t", ~Pf i 1 ' .--"--!' 7!; a ~cl ",..2.Lil""" ./ Mary C. LC\ds 'j subscribed f , day of 19.9.6......... ' J/ ~.. ,"..-' .r... . Rcgis'frlv~'I.,/ ,. . I, ,. No. 21-96-320 Estllle of Melvin Harry Nailor, Jr. , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW Mril 16th, 19~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED Ihal Mary Ellen Nailor is/~ enlitled 10 lellers of Administralion, and in accord wilh such finding, lellers of Administration are hereby granted to Mary Ell~n Nailof ----_. -="~._-- -..~..._--- in Ihe estate of Me.lVlIl Harry NaIlor, Jr. ("'J. ' . . I", /,' ,-,,' (j/. ,I /.,{<' .....t : '. WUe; .;/ /'I:'.,\.;; /' /l/J./ ,- / Rrlistcr or Wills ' , /. 0 ~l( /. . -Mary C. Lewis / ., , FEES lellers of Administration ....' S 18.00 Short Certificates( 2) .. .. .. .... S 6.00 Renunciation .....' ( 1.).. .. ... S 5.00 JCP S 5.00 TOTAL _ S 34.00 Filed .. !lp'~g..l,f!~\1... .... A,D, 19..2L- ATTORNEY (Sup. CI. (,D. No.) ADDRESS PHONE M^ILED LE11'ERS /lND ORDER 'JO EXECUTIHX ON 4-17-96. This is tll ((.'nify lh.u Ihi, j, .1 Inll' lOp)' Iltllll' H'llIn' ",!lith i, IlII fill' ill IIll' I't'I1Il,)'h'.lIli.ll>l\,j,jlllllll VII.II Ht'lOIlI, ill ,lltllrtl.llIw wilh Atl (Kl. 1'.1.. ~().1. .lppro\'l'tl hy Iht. (il'lll'r.11 ""t.'l11hl)'. .I"Ill' 21). IW.,\ WARNING: Ills Illegal to duplicate this copy by photostat or photograph. Fcc fOf chi, It'rtific.lll:, $,,00 C:tJ-/l~ C:h.lrlt.',llanll"lt'f SI.l1l' Hc~j"lr.lr DEe 2 1 1995 3686508 ~._._---_._-_._--- l),lIl' Nil. .5' COMMONWEALTH OFPCNNSYLVANIA . DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH ICD'Dnerl 108558 HIMIUn.. ..., k,olJ...-. .. "'"tANllNt """... o ~ ~ ,'" ~'''f''f'''_. \0('.1 "l.\IMI".........",n I 20rJ-(J6-155) ,JR, ,Hille II "'."11I1.",.....-.,........ -..........,.....-....., ~;... - .- __rJ 11I,~_r) U'><!lIM"... V'OOf".u.o. i.o._ .r;..- -. ~ """""'.u.".... ~.....".'...,.r......1 (;,10'" '...1;1._....__.._.... "Ie"'" \/hlte , HI/[lIn ................ fI'_""_""'_ .,,"..'.1..1A1~."'._ ......-...~ ~..''\j...,' ["l.Il""" toelll.... IOfSlllf'ltf ..._._.,~..... #',........ .never I,.~J,...___", , Ill!Wn ".!';I... ... ~- ~., ........... ".n:::':='::::.. o,o()'I~"._'.................___ ,~~ C:':.lmhl'r.lm_l~1 Helvln 11. Nnllor. Sr. Hnry ~ai lor Hl1ry Vicrin ....~mtm1(:'c\'1t'~A~,f:-~~wvin~'.~..f'A 17241 '''I''~''''''N'' Oll):i!,)-l. "\.#-((Ol'''' 1l)IO"'._oIC_.C>_...... l.Ti1!llJ'to'rII1lHt Volley Nemorl"l , (,nrdcns ...........I.tL"'tUoruc'l.,. n 2lfJ N.llnnnv('r St. Il(t..~o,u_" tOt..,IQtoI. Py' ....- N. 111,ldelnn Twp. . Cumb('rln",1 Co. "A man- 0 1 un('ra orne Cor Usle Ph 17103 ~. " ........1..._1 -....,...-!.....-.....-.....-......... .. r""llI,..I" Aprx. ".,...,.........",....'1)1".."...... ,,,,-, f 4:10 A. .. November 9. 1995 ,. . N< (;'!<II~ f_DIl.1""I~.....I..__'l~~A ~x. ..[1 -.. tlI_...-_f__'.--......._~ - ""'''.......'''...._'''"''c_.....'''.....'' II J'AJlT' lrt.....__ ........."................-'........I.............--~'~...'1-~.....-.,.,.........,.,,- ...........,....... :.....".-... ,.....-.-..-".... .-..- .--- i .___.s.l~nfJhp_~.JQ....]~ild______~----_____-l_- l......ro.'...;UI....-".......I..1 : .--tliii~~"~---- -1-- ,---..--------.--.--.---------.-.............---- I"" m~.'.\.u..'~''''".. t 'II I _ _ J V.'fI" "'/IJOI' \'.....0'......... "I""".' ""JIll.' 0I1o(;"'M_...NfI.OC(..IIVIID '~." 1'0....' Aprx. Self-InUictcd Gunshot ~~ ~ov. 9,1995 4:10 A.", OM U ...;4 Wound _ __n__u__..___ *___ ._ A_ -- pttoII I J "A(II.~'n. -.-......,......-.-. ItlO,:.I~JlI'.,........~_.._ r__,..__ . ;::........'.~#,' lIome Shed Newville . M......lJ"...~".."-I~ _~.llllrHWIRIO Crouf'l,"~""OI r.111l ~tf..,.., 1ol...."AOI(lt.:J.. ..... .. II IJ X ..........-....- .-. '-~ ...L1 ..II ,,- I" fA U;II ..It"~._"'"'''' 'allt..,..a""'tttl..",,N,.,. _ .....,.,., ......._, ......' ........ ,.... -' "1" ........ ... .",.rl_l_ ~... ...............~......__.....&_.1.....--1&..- =..,IJ Ph I b J ....I"l",..... '".:9' Of "" n I" /--;/ Coroner l."-(it~......,, -- - 1~i:""I'OIO'';:'''I'''~ [J J'_t_._~_____-~.,,.---___ 1!~-NoYlI!mb.e.r 10. 1995 .......'C'.j"()Mf"Of"...........O'(JtoH'\IIIO(;.U\!.t"f...,.. ....~1'Jl~fW"... Mlch.1el t.. NorrtR, Coroner 40S Fa t rW.1y Or! ve HcchllnlcRhur I'n. 11055 'fn~ a ~.HOUIl'..'IIIOPII"tU."'~,.....I..,...rt....'Q_.. ..............,.._...-1 h..............-... ........'-......._._................._"'......_.1....._...._ 'II,OlC"lU..",INfI\COftOltfR CIot.........et.........-......'........"'"........"",...-....".'''.n'''''HII'''-I-.tl..........''.....N1..................I.... ""_H.'...... ... x.. r..."''''U.......I..,...' ,..~t~..""...JOlI".....'II'..._~ ( ,-, . "" ( r' "Cu'C,--.u~\"" _ . ~p"\...!.J,~"I, ~~ ~~,\ IJ:.\,QI . ",.:>:> ~ ,\. Cf\S .'-' 21-96-320 OQ ~ :oil? CCll :1 ::-. on c: ".: a:": 0 ..-.-.. !~ , , ;g '4.c:. F' .~ ~ . ~;.. 1: ") ... eta , N c," ~.:l. p ~) :!l =:fi' tJ N iI)" 0 :oc b:. - )>;:1. \0 21-96-320 RENUNCIATION In Re Estale or 'j)/r'/I':) I 1/ t, II", !lie, '. J( f\ ,J t:. deeeased. To the Register or Wills or [' (f -J; ) I) r" 11' J Ci '71 d Counly, Pennsylvania. The undersigned 'h't'L,ro'~' /./- <;;;"./ ,'l.,u ~) 1\' or the above deeedent, hereby renounce(s) the right 10 administer the estate and respeelrully ask(s) that Letters be issued to (Ylel'? F //"'1 -7/ll~;J~/t WITNESS ),,, y ./ hand this I {P' day or clL;';;} I C:l/ ,19~, , 0~~ e,y/~) /~ '%0 ,1o'J7/SR (Signature) (Addr...) --_.-- 01 (Signature) - O,,,! :<r ~~ ~'~$ N r> a. (j d (,:- .. N .' ' .:) -- - (Addre..) ~ ~ ~' ~ lj ..: I . ,i.-. (5,;J l , 0", " QJa; ~ 1::.~ a; ~::> (Signature) UU (Addre..) 11('0'1.500(1+ I'Q", w .... ~:!'" ...",.. w...... :>:00 ...",~ ...", ... '" F- ~~ ,~ - (; -/ -- I::.,> INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) YEAR I fOR DAllS ef DEATH AnER 12131191 CHECK HERE If A speU5AL ' 1 POVERTY CREDIT 15 CLAIMED [ i __._ fiLE NUMBER c.? I COUfllY CODE "1~ 3,~u NUMBER .... z w o w ... w o COMMONW(A\lH Of PWN!:tUVANIA DEPARTMENT Of R(VWUf DEPI :180601 HAIIRI!lIUIIG, PA._111.~~_~.t!J1 DlCfOfNl'S NAMllIASl. 'IRSl, "".0 MIDOII l'IIIIAII -~'Jc>r::----~II\(JUI""---'l- H_ ,._ j..lQ, SOCIAL SlCURln tlUMIU OA1I ()' [HAiti VAn ut 11111111 '),Oq ~_~~.=.J~.L---- -U)-Qtg'3>l- _1:l.11\ I'll I" ...",..,,, "'''''''"''0"'' '~=' ~'~"~~~ ~~_=:'_..=_ __ '~(~I ~~ul,~", .,,, ~ 1, Original Relurn r-J 2 Supplemental Return D 4. limited Eltale f] do. future IntlHelt Campfamile (for datel of death after 12.12.82) 06. Decedent Died Te'tale [J 7. Decedent Maintained 0 living TrUll (Allach copy of Willi (Allach copy of Tru'l) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO. NAME (OM PUlE MAILING AOOIUS ~ Q. U,,, t 1'1ot~~\lor SCil '>r\'<.:) ~ lflfPHONENUMUI N~~.;...l\t .... '0_' U'" -Yl)(" ( 1_, . OlllOltl,'.(o".rlllt AO(JIlI',S () 'i" I <;,'':I~ K" tJq";"';"l~ VA 11.)l.j I (~"~'f OI.J"'O~~l..A"-'D____.___________ __ ~.OIH""" .10 "" "~,,,u"'Ot'" [ ] J, [-J 5 Remainder Rlllurn (for dole' of death prior 10 12.13.82) Federal Elfole Tal( Return Required _ 8. Tolal Number of Safe Deposit Boxes ..... "'z Ww "''' "'z 8~ '1.1.41 , - ,v~ .. ., (' r.l --.' . ., ,., z o 5 ::> .... ii: '" ... w '" 1. Real Esfole (Schedule A) 2, Slolk. ond Bond, (Schedule BI 3. Closely Held Sloc~/Partnenhip Inleres' (Schedule q 4, Mortgages and Nole' Receivable (Schedule D) 5. Cosh, 8an~ Deposit' & Miscellaneous Per,onal Properly ISchedule EI 6. Joinlly Owned Properly (Schedule f) 7, Tron"onlSchedule GllSchedule II 8. Tolal Gran Anell (10101 line, 1.7) 9. Funeral e.plInses. Administrative CO"" Miscellaneous Expen,es (Schedule H) 10. Debls, Mortgage liabilitie" liens (Schedule II 11. Tolol Deduction, (10101 line I Q & 101 12. Net Value of Eslale (line 8 minus line 11) 13. Charitable and Governmental Boque,u (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) IS. Spou,al Tlanlfers (for doles of death ofter 6.30.9AI See In,tructions for Applicable Percentage on Reverse Side. (Indude value, from Schedule K or Schedule M.) 16. Amount of line 14 laKable 01 6% role (Include ...olue, from Schedule K or Schedule M,I 17. Amount of line 14 tallable at 15% rote (Include valu", from Schedule K or Schedule M.) 18. Principal 101. due (Add lox from line I 15, 16 and 17.) 19. Credill Spou,al Paverly Credit Prior Paymenh (11 ____N~tJ~__________ 121 -----+----~---, --, (J I __-.:~--------- :: : ~~;).~~~-gg=-~.:--= 161 j!__\~9]..5_Q.........-_ 17) ___I\)CNQ.._____ 191_~lDl&:n~CL--- (lOI~;)._(,J_O_.j3____ If:; q3o<i. ~ _MQ/JG. ----i --.' t..;:1 ;u '-' \D , ~, ,', ,j . ~ ,':" >:n i.J I""l -~ (81 Vl~ ___".3~qO,4q (II) (121 (lJ) (141 (151 ~.____~__x. = (161 ," .06 = (17) , ______" ,15 = z o ;: '" .... ::> ... '" o ... >< '" .... (181 -c,- Intore,' DilCounl - C)- +- (191 1201 -0- ---------- + Th;,;, ,he OVERPAYMENT, If Une 19 jl grealer than line 18. enter Ihe difference on line 20. folD 20, Check here if you ore requesting 0 refund of your averpaymenl. (21) ,__=.0. -. ,_ (21AI - 0. (21B) _~_c.: 21. If line 18 is greoter than line 19, enler the difference on line 21. Thil il Iho TAX DUE. A. Enter the intereU on Ihe balance due on line 21A. B. Enter Ihe 10101 of line 21 and 21A on line 218. Thi, i, the BALANCE DUE. Mak. Check Payable to: Regllter of Will., Agent ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~ ~~der penalties of perjury. I doclare thol I hove uamined thil relurn, including accompanying "hedulel and .'talement', and to Ihe bell of my ~nowledge and b,eliel. II II true, correct and complete. I declare that all real ellale hOl bpen reported 01 true markel voluo. Declorotlon of prepare' other than the personal reprosenlotlve is bOled on 011 informalion of which preparer ha' any ~nowledge. !.IGN"'TUlllOJ PEfl!lON IlfSPONSI!LlIOfl filiNG lllTUIlN .6oIlTi~.~- --- -----, --- -- --- --- .n. - ----- _._._-.---~._-----~_._- OAf,--- ~J2.2~,"1.;'T,.."ZI.?~ '1'0"" o"C-).9'u-r.t'.- Act #48 of 1994 provides for the reduction of the tox rates Imposed on the net value of transfers to or for the use of the spouse. The rates os prescribed by the statute will be: . 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 . 2% (.02) will be applicable for estates of decedents dying on or ofter 1/1/96 and before 1/1/97 . 1% (.01) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 . Spousal transfers occurring on or after 1/1/98 will be exempt from Inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (.....) IN THE APPROPRIATE BLOCKS. YES NO_ 1, Did decedent make a transler and: a. retain the use or income 01 the property transferred, ...........................................,..,........ b. retain the right to designate who sholl use the property translerred or its income, ............... c. retain a reversionary interest; or .........................,.........,............................................... d, receive the promise lor Iile 01 either payments. benefits 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 aher December 12, 1982, did decedent transler property within one year 01 death without receiving adequate consideration'...."..."....,....., ,..,. ..... ,..,.,..",..,....",.........,..,.,...".,.. ........,..., .....,." 3. Did decedent own an 'in trust lor' bank account at his or her deathL...................................' IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,.,;,!MJqIt. lU1I1 ~'J~'9(\ ~~ COMMONWEAltH Of PENNSYLVANIA INHERITANCE tAX REtURN R[SIDENT DECEDENT __,_,._~ ______,...u__~_.____..________'_____..__.~___... SCHEDULE F JOINTLY.OWNED PROPERTY ----.-.~_._--------'- fiLE NUMBER ESTATE Of ,~\O~ \\h~~_JiL_- ----- \\. Jolnl tlnonll.l. RELATIONSHIP TO DECEDENT NAME A. llula. A, Ur \o-o..:.I!..' ADDRESS ---. \'05 \?"'1 ~'I\'i \-uC'Q.~~ lJwu.lk .~... \1')..4\ ..--. +n~D B. C. ITEM LmER DATE fOR TOT AL VALUE DECD'S DOLLAR VALUE Of NUMB'EI JOINT MADE DESCRIPTION Of PROPERTY Of ASSET % INT. DECEDENT'S INTEREST TENANT JOINT 1. A lolq~ \<,..,\ -,-, SC>~ 14Q), ISO IQA\l..e..~ ';).qq-r.oo , , \ 1 1 , ---_.- - TOTAL (Aha enlor on lino b, Recapitulation) , :_\lflJ . CJO - Jolntly.ownld proplrly: (II more space is needed inserf oddilionor sheels 01 some sile) U,,'~ll f'. 11111 ESTATE OF ITEM NUMBER A. 1. ~, .~).;1 ~4 ::;,...t\ . ~l!'f"" COMMONW( AlTli or PENNS'fl"ANtA INti(AITMK( TAX M(tURN R(~IDtNT D(CfDHH SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSES , I . PI.,,,. .Prlnt. or Typ. .. [~E NUMBER ~\)\~~_.._-~~~~~-- ~~..._...._.. AMOUNT DESCRIPTION Fun.rDI Exp.ns.., 13"~IQl 'S~<'o!., \faul ~ , lI1\tMCJ"lC> \ ,Op~I\I"S II. \='\,)M.r<\ \ '5t.e IJ'c.C!.S -1I'3."31ca.40 \tec.c..~4...' ,j.\ &::J:J, 0 0 c.~OT'~'L~J {I~o.co Cj.G~1<.'U'j · ~4Cj * 3d-1S, cC i 33 1'1 .~O 1\ 50,00 i I <.)C. bO B, AdmlnlstrDtlv. Costs: 1. Porsonal Represenlativo Commissions SociDI S.curity Number of PenonDI Repr.s.nIDtive: u Year Commissions paid ______ ._.~--_..__. ---- 2, Attorney Fees 4. C. 1. 2. 3, 4, 5. 6, 7. 8. 3, FDmily Exemption CIDimDnt Addr.u of CloimDnt Dt decedent's death St,eet Addreu City Stal. __._ Zip Code Relationship Pro bat. Fe.s f '0'-1. cO 31-1.00 Mlsc.IIDn.ous Exp.ns.., ~\.k-.o,,--L~ Ie ("0 QQ..~..~,b__0 't '-L,d,Jw ,fnt..<> (Ylvv...t. ~~G___":"" l1A( Q..a.u.....",j \ D 00 ID.Ou TOTAL (Also ente, an line 9, Recapitulation) (If more SpDC. Is n..ded, insert additional sheets of sam. sl...) S \,l#11,40 CERTIFICATION OF NO'rlCE UNDER H1JL.E 5.6(a) Deceden t:.,d,4 (' , f) 1'71 tI N4..l.) A -- Name of ,} /~ . (J q tJ'S ,/ Date of Death: /1- , , , , Will No. rOqt; - r>6 "3 ) cJ Admin. No. /C/fJC -,,~ ~2c) , . - . I I ! i ,I , To the RegisLer: I certify that notice of beneficial interest required by Rule S.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of Lhe above-captioned estate on ~ Address r /' , ~ ,(.h I ' IV'" " I C;:. f3 : "i S ,P /I ,''"}J c, -' / T~I1A''::c 'l!:... , j)4qo!,/r"); Notice has now been given to all persons entitled thereto under Ruie S.6(a) except Date: 7, ~" C/r; . 7~~e f' J1~~ '/d L' Name 77l~7 7" ?1r- J ;//C- Address ~ (i7 5/, ~,.../ I?,t , ,AI-Pu~(): l)p P Cj ,un:) lI, , ryl:) Telephone r717) 77 I., Y 7 7"-:- ~!&.apacity: ~ersonal Representative - ZI: ld E- 1m ~I '.' !:! ~\ I d :l:jU Counsel for personal representative REV-lS47 EX AFP 112-9S1*, CO""OHwt "1111 (If III NHSYI VANIA DlPAN'"I"I Of NI VI HUt . BUlUAU or INDIVIDUAl JAktS ; ,,' VIP!. ..60&01 IlAIUUSlnJUG, l'A lll:a.DttOI /I ESTATE"OF=IlAILoR~':'" DATE OF DEATH 11-09-95 ACN 101 NOTICE or INIIERITANCE TAX APPRAISEHENI. ALLOWANCE OR DISALLOWANCE or DEDUCTIONS AND ASSESSHENT or TAX DATE 08-19-96 il ." -_.' '"-=" FitCNO:-~'~2nK:'032o=== COUNTY CUMBERLAND HHVltl NOTE I TO INSURE PROPER CREDIT TO YOUR ACCDUNI. SUBHIT IIIE UPPER PORTION OF TIllS FORH WITII YOUR TAX PAYHENT TO TIlE REGISTER OF WILLS, HAKE CIIECK PAYABLE TO "REGISTER OF WILLS. AGENT" REMIT PAYMENT TO: MELVIN NAILOR 507 SilEO RD NEWVILLE PA 172't! REGISTER OF WILLS CUMBERLAND CO COURT 1l0USE CARLISLE. PA 17013 Anount Ren1tted CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiEv:is4""i'EiCiiFi>--flFiisrNoYicE'-oF--fNHERiiiiNcE-YAiO\'PPRiiisEHENT";'ii[DiwAN-cE-ifli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NAILOR MELVIN H FILE NO. 21 96-0320 ACN 101 DATE 08-19-96 If an assessment was issued previously, lines 14, 15 and/or 1&, 17 reflect figures that include the total of abh returns assessed to ASSESSMENT OF TAX: 15. Anaunt of Line 14 at Spousal rat. (15J 16. Anount of Line 14 taxable at Line.I/Class A rat. (16) 17. Anount of Line 14 taxable at Collet.ral/Class 8 rat. Ill) 18. Principal Tax DUB TAX RETURN WAS: I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. (Schedule Al (1) 2. stocks and Bonds (Schedule B) (2J 3. Closely Held Stock/P.rtne~ship Interest (Schedule C) (3) 4. Hortgages/Not.. Raceivable (Schedule D) (4J S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ (5) 6. Jointly Owned Property (Schedule F) 16J 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9J 10. Debts/Mo~tgage liabilities/liens (Schedule U (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental aequests (Schedule J) 14. Nat Value of Est.t. Subject to Tax NOTE: TAX CREDITS: PAYHENT DATE RECEIPT NUHBER DISCOUNT 1+) INTEREST 1-) CHANGED .00' ,00 .00 .00 2,4B2.99 1,497.50 ,00 IB) 3.9BO.49 6.677.40 2.630,99 Ill) 112) 113) 114) 9.308 39 5.327.90- .00 5.327.90- and 18 will date. ,00 .00 ,00 X .00= X ,06= X .15= 118) ,00 .00 ,00 .00 AHDUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL flUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TNIS FORH FOR INSTRUCTIONS.' ,. " t:: ':, RCSERVATION: 00 ' [.tate. of dlcedent. dyinG on or before Dec,.bet IZ, 1982 -- If Bny future Inter..t In the ..tate I. transferred In pOI.a.llon or enJoy..nt to Clal. B Icol1at.ral) ben.flclar... of the decedant aft't the expiration of any ..tat. for 11f. or for year., the Co..onw_8lth hereby .~pr..sly r...rv.. the right to apprals. and 8S.... transf.r inherltancl Tax.. at the lawful CIa,. B (coI18t.ra1) rate on any such future Inter..t. PURPOSE OF HOTlCE: To fulfill the reqult...nt. of Sactlon 2140 of the Inheritance and [.tate Ta. Act, Act ZZ of 1991. 12 P.S. Section 2140. PA't'HENT: Detach the top portion of thl. Hot Ice and sub,lt with your pay..nt to tho Reglst.t of Will. prlntad on the rever.. ,Id.. --Hllk. check or aonoy order payable tal REGISTER OF HILLS, AGENT All pay.ent. received shall first be applied to any Inter.st which .ay be due with any re.alnder'applled to th~ taM. RErUND (CR): A refund of a tax credit, which wa. not requested on the TaM Return, .ay be roque.ted by co.pletlng Qn "Jppllcatlon for Refund of Penn'Ylvanla Inheritance and Estate Tax" (REV-1313), Applications are available at the Office of the Register of Will., any of the 23 Revenue District Offices, or by calling the special 24-hour answ.rlng ..rvlce nu.ber. for for.s ord.rlng: In Penn.ylvanla 1-800-362-2050, outslda Pennsylvania and wJthln local tlarrlsburg area (717) 187-8094, TOOl (7171 772-2252 (Hearing lopalred Only). OBJECTIONS: Any party In Interest not satl.fled with the appralse.ent, allowanco or dlsallowanc. of dOductlons, or a..ess.ent of taM (Including discount or Inter.st) as shown on thl. Notice oust object within .Ixty (60) day. of receipt of this Notlc. by: --wrJtten protest to the PA O.part.ent of Revenue, Board of Appeals, Dep\, 281021, Harrisburg, PA .-el.ctlon to havo the .attor dotorolned at audit of the account of tho personal ropresontatlvo, --appoal to the Orphan.' Court. 11128-1021, DR OR ADHIN ISTRATIVE CORRECTIONS: ractual errur. discovered on thll aSless.ent should be addr.ssod In writing to: PA Depart.ent of Revenue, Bureau of Individual Tax... ATTN: Post Ane...ont Review unJt, Cop\, 280601, ttarrlsburg, PA 11128-0601 Phono (7171 187-6505.. Soe pago 3 of the booklet "Instructions for InherJtance Tax Roturn for a Rnldant Docedent" (REV-1501) for an eMP)anatlon of od.lnl.trntlvely correctablo orror.. DISCOUNTl If any taM duo I. paid within throe (3) calendar .onths aftar tho decodent's death, a flvo porcont e5X) dllcount of tho taM paid I. allow.d. PENALTY: Tho ISX taM aano.ty non-participation penalty I. co.putod on tho total of the taM and Intoro.t assossod, and not paid boforo January 18, 1996, the first day aftor tho ond of the taM a.nosty p.rlod. This non-participation penalty I. appoalable In tho sa.o .ann.r and In tho the sa.e tl.e periOd al you would appoal the taM and Intore.t that ha. b.en asse.sed a. Indlcatod on this notlco. INTEREST: Intorost I. charged beginning with first day of delinquency, or nine (9) .onths and ono el) day froB tho dat~ of death, to the dat~ of payoent. Taxe. which bec..e dellnquont boforo January I, 1982 boar Int.ro.t at tho rato of .Ix (6X) p.rcont per annu. calculated at a dally rato of .000164. All taxas which boca.o delinquent on and aftor January I, 1982 will b..r Intorest at Q ,.to which will vary fro. calendar yoar to calendar yoar with that rate announcod by tho PA Dopart.ont of Revonue, Tho applicable IntGrost rato. for 1982 through 1996 8ro: '!!!! Intaro.t Rate Dally Intarost ractor !!!!! Intarast Rnto Daily Intorost rnclor 1982 20X .00051fl!1 1987 97- .000241 1983 167- .000U8 1'J88-1991 117- .000301 1984 llX .000301 1992 .~ .000247 1985 137- .000356 :993-1994 1~ .000192 1986 107- .000214 1995-1996 .~ .000241 --Intoro.t I. calculatad at followlI INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notic. i.sued 8ftor tho taM beco.o. dollnqu.nt will ...floct an intorost calcul8tlon to flftG.n (151 days boyond tho d8te of the a.s..s..nt. If pay.ont Is .ado nfter tho int.re.t co.putatlon dale shown on tho Hotlc., additional Intorost lU.t bo calcul8tod. STATUS REPORT UNDER RULE 6,12 Name of Decedent: /;,4 c' I u , I") 1-1 Or/- Y f.../ ('i.' I (I r, -:iF, , Date of Death: /J/" II" 111 h t' f- e;- / '/ '/ ~ ~ , Will No. ~' . , Cllr .' 32.0 Admin. No. !J/ .' t' t Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 1 report the following with respect to completion of the administration of the above-captioned estate: 1. State;hether administration of the estate is complete: Yes I 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 Ves, state the following: a. Did the personal repyesentative file a final account with the Court? Ves 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. Date:/O . N- p~ 7lJ.~ C J10/~/C -1l4 CI ill F 1:/.4:) A j/" Name (~lease type or print) -SCi 7 51, ~ ,.1 Address 'pd ll&ILv/ lIe ,?~ ~7h) 77~.t; 77C el. No, Capacity: ~personal Representative Counsel for personal representative (MAH:rmf/AM3)