HomeMy WebLinkAbout96-00850
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OATIl OF PERSONAL I~EPRESENTATIVE
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COlIlIONWEAllHOF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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. October 7. 1996
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126 - B W. Portland St.
,. Wuohaniouburg. PA 17055
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VII - 1 devise and hequeilth i1ll of the rest, residue and remainder of my
estate of whatever nilture ilnd "herever situate as follows:
A. 'l'wo-thirds of Haid residue shilll be l1ilid to my daughter,
Suszan Z. 1warogowski or her issue per stirpes.
D. One-third of said residue ",hall be pilid to my son, Ralph W.
Zollers, or his issue per stirpes, provided that the balance
owed by him on a certain lIortgaqe in the original arount of
$60,000.00 shall be treated as an advancement on his share.
VIII - I appoint my Bon, llalph 1/. Zollers, and lilY daughter, Susan Z.
Twarogowski, Co-Executors of this, my c.ast Will and Testament. Neither of my
personal representatives shall Ue required to post bond in this or any
jurisdiction.
IN Wl'lNESS WHEREJJF. 1 have
day of _~AJ!j--
hereunto set my nand and ~eal on lhis the
dS 1-4
, 1995.
QPa ~, /)) '-:J~Ur uJ (SEAL)
ALICE W. ZOLLERS (J
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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COMMONWfAlTH Of PENNSYlVANIA
DEPARTM[NT Of R(V[NUE
OUT. 21060 I
HARRISBURG. p" 11111,0601
O((IO(NI'$ NAMII\ASI. ItIU. AND MIODlI INlttAII
Zollers, Alice, W.
$OCIAlllCU'"Y NUMIU DAlf Of O(A1H
204-32-8908
10-7-96
tlr ...."1(..."" SU.....'IHG lPOuSl" N.ull n"''', I'''! AND MI00\1IIllIl&11
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FOR OATIS OF DEATH AnER 12/31191 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED 0
flU NUMBER
COUNTY CODE
dl
Clip
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YEAR
NUMBER
OICIOlNnCOMPUIl AOOUU
126-8 Portland
Mechanicsburg,
cOO', Cumberland
AMOUNt UC(I\ltD I~H IN$UUClIONSI
17055
St.
Pa,
04.
[]6.
limited hlale
o 2, Supplemenlal Relurn
o 3. Remainder Return
(for do". of deo,h prior 10 12.13.B21
o S. Fed,ral ElIot. Tax Return Required
o 40, Futur. Inl.rl.1 Compromise
(for dol.. of deolh alt.. 12.12.B2)
O.ced.nt Died Tellol. 0 7, Oeudenl Maintained a living TruI'
(Alloch copy 01 Willi (Alloth copy 01 Tru")
ORRESPONDENCE ~ND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:"""~ ~.,
(OMPUl[ MAlltNG AOORUS
1915 Hickory Dr.
Harleysville, Pa.
+
20. lllino 19 i. grooler Ihon line 18, onler ,he dill..ence on line 20. Thi. Is Ihe OVERPAYMENT.
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21. II line lB I. grooler Ihon line 19, en'er ,he dill....ce on line 21. Thi. Is ,he TAX DUE.
A, Enl.r th,lnl,r.,t on the balonc. due on lIn. 21A.
B. Enl..'he 10'01 of line 21 and 21A on line 21B. Thi. Is ,he BALANCE DUE,
Make Check Payable tal Regl.ler a' Will., Agent
OJ 1. Original Return
'AL
NAM
Edward J.
Ozorowski Esq.
THHHONE HUMtflt
234-0721
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1. Real E,'a'e (Schedule A)
2. S'ock. and Bond. (Schedule BI
3. Cla..ly Held SlocklPartnonh;p Inl....1 (Sthedule C)
... Mortgage. and Not.. Receivable (Schedule 0)
5, Caah, Bank Deposits & Miscellaneau. Perlona1 Property
. (Schedule EI
6. Joinlly Owned Property (Schedule f)
7. Tron,l... (Sth.dule G)ISchodule LI
8. Total Gron Au," (folollines 1.7)
9. Fun.ral Ellpln"., Administrative CosII, Mi1Clllanlous
Expen... (Schedule H)
10, Debh, Mortgagl liabilities, li.n. (Schedule I)
11. Talol Oeduoion. ('olallin.. 9 & 101
12, Net Value of ElIote (line 8 minus lino 111
13. Charitable and Governmental BequlIlII (Schedule JI
U. Net Value Subject to Talt (line 12 minus Line III
15. Spousal Tron,fen (for dat.. of deolh aft., 6.30.94)
Se. Instructions for Applicoble Percenlag. on Reverse
Sid., (Include volues ham Schedule K or Schedule M,I
16. Amount of line 14 tOlloble 01 6% role
(Include values from Schedule K or Schedule M.)
17. Amount of line 1.4 tOllobl, 01 15% role
(Include volulS from Schedule K or Schedule M,I
1 B. P,incipalloo due (Add lox from Lin.. 15. 16 and 17.)
19. C"dill Spousal Poverly Credit Prior Paym.nll
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_ 8, T alai Number of Safe D.polif B0ll81
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19438
(11 $62,000.00
(2) $ 163,556.52
131 -0-
(4) $38,806.92
(5) $7,878.11
(6) $1.043.66
(7) -0-
(9) $9,496.30
(101 $844.45
(B) $273,285.21
(11) $10,340.75
(121 $262,944.46
(13) $2.500.00
(14) $260,444.46
(151
(16)
(17)
$257,944.46
$2,500.00
X,_II
X ,06 = $15,476.67
X .15 II $375.00
(IBI $15,851.67
(191 $15,059.09
(20)
(21) $15,059.09
(21AI
(2IB)
Discount
+ $792.58
Int. rill
-0-
Check hero if you oro rcquc\ting 0 u.,fund of your ovefpayment. ..
) R SWER 1<LL'QUESTIONS ON ,REVERSE SIDE AND JO..REQlECKMAl
Und.r p.nahi" a' p.rlury. I d.c1ar. thai I have txomin.d thi. r.turn, including accampank'lng ICh.dul.. and stat.m.nll. and fa the bllt a' my ~nowl.dg. and b.li.f.
It Is truI. corr.ct ond campi.!.. I d.c1ar. that 011 real .1101. hot bltn r.port.d of true mark.t volue. Declaration of pr'por.r olh.r thon the p,nonol repr...ntativ. I,
ba..d on 011 Information of which pr.par.r hot ony ~nowl.dg.,
DAn
1-3-97
OAII 97
1-3 -
lIV.I!Ollh 1'1 III
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COMMONWIALTH O' '!NNSYlYANIA
INHUnANCf lAX U1UlH
1II10lNT OICIOINT
ESTATI OF
SCHEDULE A
REAL ESTATE
J
-FILE NUMBER
Alice W. Zollers
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IPtoptrty Jolnlly-own.d with RighI 01 Survivorship mu.t b. dl"lo..d on Sch.dul. FI All ..ol..to'. .hould b. ..port.d 01101, marht valu.
which I. d.fln.d a. tho p,l.. at which prop.rtv would b. ...hang.d b.twttn a willing buy.. and a willing ..II.., n.lth.. b.lng camp.lI.d
10 bu or ..II, bath having ..o.anabl. knowl.dg. 01 tho ..I.van"ael..
ITEM
NUMBER
DESCRIPTION
1.
ALL THAT CERTAIN tract of land together with the
improvement thereon consisting of a single
family dwelling situate and known as 126-8
West Portland street, Mechanicsburg, in the
County of Cumberland, Commonwealth of Pennsylvania.
The above dwelling is a two bedroom condominium.
The fair market value of this realty as of the
VALUE AT DATE
OF DEATH
( See real estate appraisal attached to this
owner's date of death is.......................... $62,000.00
Schedule "A" )
TOTAL Ailo 'nl.. on lin. I, R.co il.lollon
(II mort .poc, ;s n..eI.d, inslrt aclJilionof Ih..rs o( 10m. size.
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COMMONW(AllH Of 'INN,nVANIA
INHU"ANC! lAI IUUIN
_!SIDtH'DIClDINf __
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE Of
fiLE NUMBER
Alice W. Zollers
Joint 1'0001(.).
NAME
A. Ralph W. Zollers
ADDRESS
386 Main Stl Trappe
Collegeville, Pa. 19426
RELATIONSHIP TO DECEDENT
Son
B.
C,
Jolntly-own.d property:
ITEM LmER DATE ,
fOR
NUMBER JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF
TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST
1. A CheCking Account # 142-
110-6053 lodged with
Mellon Bank,Mechanicsburg,
Pa. 17055 . . . . . . . . . . . . . . $2,087.32 50% $1,043.66
( see attached Exhibit
IIBII to this SchedUle)
,
I
TOTAL (AlIa enle' on line 6, Recopitulalian) 51,043.66
(II motl spoce is "ndvel insert ocldilionol shuh o( some s;n)
. '.
1''#\11111. pll,
ITEM
NUMBER
~
COMlo\ONWIAIJH OII1NNIYLYAN'A
INHIII1AHCI W .nUIN
1I11DINT DICIDINT
SCHEDULE H
fUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
, .
......
Ploa.. Print or T .
Alice W. Zollers
DESCRIPTION
A. Funeral Exponl'll Malpezzi Funeral Home
I. otterbein United Methodist Church-honorariam
2. Loyal Bible Class- honorariam
3. Pamela's pantry- funeral repast
4.' Tombstone inscription
B.
4.
C.
1.
2.
3.
4.
5.
6.
7.
B.
I.
Admlnlllrotlv. COIIII
Pononal Reprllentative Cammiuianl
Social Security Number 01 Penanal Representative:
Year Cammiuians paid
2.
Attorney Feel
3. Family Exemption - None claimed
Claimant RelatianJhip
Addreu 01 Claimant at decedent's death
Street Addreu
City
State
Zip Code
Probate Fell Register of Wills cumberland County
Mlsc.llanooul Expenses:
Patriot News- estate advertisement
Patriot News-notice
Cumberland Law Journal - estate advertisement
Pinnacle Health - last illness
Health America- accrued bill
TOTAL IAlsa enter on line 9, Recapitulation)
III _. IPOC' II Med.cI, In.." addltlOtlol oh,oll of lam. IIz..)
AMOUNT
$7,936.70
$50.00
$300.00
$434.60
$75.00
$299.00
$200.80
$6.00
$60.00
$120.00
$15.00
S9,496.30
. "
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(()t,lMONW'AUH o. ,tN...\nVANIA
INN'IIt.NU..... ,nUIN
.nIDI'" DletDINI
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Alice W. Zellers
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. TOKobl. B.qu.llI:
B.
Wesley E. Zellers
445 Peach Glen-Idaiville Rd.
Gardners, Pa. 17324
grandsen
$500.00
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Goyernmental 8equelh:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS lAlla .nle, on lin. 13, Recopi'ulol;on) S
(II mo.. .poc.1s n..d.d, In..rt oddltlonol .h.... 01 .ome .In)
..
. - "
SMITH BARNEY
A MtmbcrorTtd\'tltnGnJup .,.
October 22, 1996
Ralph Zollers
386 W. Main St. - TRAPPE
collegeville PA 19426
re: Estate of Alice Zollers
Dear Mr. Zollers:
As discussed with Bob please find enclosed the values on
Alice's accounts as of 10-7-96.
In order to distribute the assets in her single name account
we will need the following:
1. Short certificate dated within 60 days
2. Affadavit of Domicile (form enclosed)
3. Letter of authorization, signed by the co-executors
telling us how to divide assets and what to do with
the assets.
For her IRA account we will need:
1. Short certificate dated within 60 days
2. Affadavit of Domicile (form enclosed)
3. Letter of authorization, signed by the co-executors
telling us how to divide assets and what to do with
the assets.
--4. IRA distribution form (enclosed)
Do you happen to have anything that shows the breakdown of
how the assets are to be distributed? The beneficiary form
we have on file names both you and Susan but it does not
clarify the portion you are to get.
Should you have any questions please let me know.
my'
Debbie Koons
Registered Sales Asst. to
Robert L. Beard
EXHIBIT "e"
SMITH BARNEY INC. 11 NOIlh 31d Stroet. 2nd FI, Halrlsburg. PA 1710'.1702
800-237-1700' FAX 717-233-2090
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
'*
IINo.AA 185041
RECEIVED FROM:
f3
ACN
ASSESSMENT 'l'
CONTROL ...
NUMBER
AMOUNT
EDWARD J OZOROWSKI ESQUIRE
101
$15,059.09
1915 HICKORY DRIVE
HARLEYSVILLE, PA 19438
IOIDHflE
ESTATE INFORMATION:
fa FILE NUMBER 21-1996-0850
E1 NAME OF 2'6t~l!RS ILtWI CE W
II DATE OF p~~ErJ6/97
I!I POSTMARK DATE
1;1 1/01,/97
COUNTY CUMBERLAND
SSN 204-32-8908
(FIRST)
(Mil
DATE OF Di"6H/07 196
$15.059.09
CW
fa TOTAL AMOUNT PAID
REMARKS
L W LL
c}!)'~lRll~~l ES(1JIRE
CHECKll 1007
..' (- "
RECEIVED BY,' 1,'/' ~, "'.,,,;) /...'.........L
SIGNATURE I ... J
MARY C. LEWIS . i' I. ,/.....;.
REGISTER OF W1LLS -
SEAL
REGISTER OF WillS
_.., .._.. - .. _.-_,' _._... __ _'d ._.__ 0 __ _0..
-.-- ~
..---
,
-..-.
-.."7'.M4~ ~-:'T 41:.
/5-'/.15'-~~7
BUREAU OF INDIVIDUAL TAXES
INHERltANC[ lAX DIVISION
D[P!. ZlOba.
tlARA1SBURC, Pi HU8-0bOI
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
c_
NDTICE OF INHERITANCE TAX
APPRAISEHENT. AllDWANCE OR DISAllOWAHCE
OF DEDUCTIDNS AND ASSESSHENT DF TAX
EDWARD J OZOROWSKI ESQ
1915 HICKORY DR
HARLEVSVILLE PA 19438
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-28-97
ZOLLERS
10-07-96
21 96-0850
CUMBERLAND
101
Al'lount R...1tt.d
~.
r~.
11'.1'" ..,., III.".
All CE
W
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:is'47-EX--AFP--ni3':97T"NoYicE--OF-YNHEiiiTANCE-YAx-jiPPRiiisEHENT-;-ALLOWANCE-iili-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ZOLLERS ALlCE W FILE NO. 21 96-0850 ACN 101 DATE 04-28-97
If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A.aunt of Lina 14 .t Spous.l rat.
16. AMount of Lina 14 t.xable at Lina.I/Cle.1 A rat.
17. A.aunt of Lina 14 taxable .t Collat.raI/Cla.1 Brat. el"
1&. Principal Tax Due
TAX CREDITS:
PAYHENT
DATE
01-04-97
TAX RETURN WAS, I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Eatet. ISch.dul. Al III
2. Stock. and Bonda (Schadule BJ (2)
3. Closely Held stock/Partnership Int.r..t (Schadule C) (3)
4. Hartg.gas/Hot.. Receivable (Schedule DJ (4)
5. Cash/Bank Deposits/Hi'c. Parsonal Property ISchedule E) CS)
6. Jointly Owned Property ISchedule F) (6)
7. Transfars ISchedule G) (7)
8. Total A.sets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expansa./Ada. Costs/Hisc. Expense. ISchedule H) (9)
10. D.bt./Ho,tg.g. ll.bllltl../ll.n. ISch.dul. II 1101
11. Total Deduction.
12. Het Velua of Tax Return
13. Cheritable/Govern.ent.l aequ..t. ISchedule J)
14. Het Value of E.t.te Subject to T.x
NOTE:
lIS1
1161
RECEIPT
NUHBER
AA185041
DISCDUNT 1+)
INTEREST/PEN PAID I-I
792.58
I CHANGED
62.000.00
163.556.52
.00
38.806.92
7 .878.11
1.043.66
.00
IBl
9,496.30
844.45
Illl
1121
1131
1141
.00 X .00=
257.944.46 x.06=
2.500.00 X .15=
1181
AHDUNT PAID
15,059.09
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
HOTE: To insure proper
credit to your eccount,
.ub.it the upper portion
of this forn with your
bx p.y..ent.
273.285.21
10.340 7~
262.944.46
2.500.00
260.444.46
.00
15.476.67
375.00
15.851.67
15.851.67
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION DF ADDITIONAL INTEREST.
IF TDTAl DUE IS lESS THAN 'I, ND PAYHENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" ICRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FDR INSTRUCTIDNS.l
r...'.....
~~" ..
-:)
, ,
(-)
,_U
RESERYA1IDNI E.tat.. of d.c.d.nt. dying on or b.for. D.c..b.r 12, 1982 -. If any future Int.r..t In the ..tal. 1. tran.f.rr.d
In Po.....lon or .nJoy..nt to Cl... a (collal.ral) ben.flclarl.. of Ih. d.c.d.nt a't.r the .xplratlon 0' any ..tat. 'or
III. or for y..r., Ih. Co..onw.alth h.raby .xpr...ly ra..rva. the right to appral.. .nd a..... tran.f.r Inharltanca T.x..
at the lawful CI... 8 (collat.ral) rat. on any .uch future Int.r..t.
PURPOSE OF
NOTlCEI
To fulfill tn. r.qulr...nt. of Sactlon 21~0 of the Inherllanc. and E.t.t. Tax Act, Act 21 0' 1995. (72 P,S.
S.ctlon 9140).
PAVKENh
Det.ch tha top portion 0' thl. Hotlc. and .ub.lt with your p.y..nt to the Ragl.t.r of Will. prlnt.d on the r.v.r.a .Ida.
".".ke check or .on.y ord.r payabla tal REGISTER OF MILLS, AGENT
REFUND (CR):
A r.fund 0' a t.x cr.dlt, which wa. not r.qu..t.d on tha rax R.turn, .ay be r.qu..t.d by co.pl.tlng an "Appllc.tlon
'or R.,und of P.nn,ylvanla Inharltanca and E.tat. Ia." (REY-1313). ApPlication. ara avallabla at the O'flc.
of the R.gI.tar 0' Will., any of the 23 R.vanu. DI.trlct Offlca., or by calling the .paclal 2~-hour
an.w.rlng ..rvlc. nuBb.r. for for.. ord.rlngl In P.nn.ylvanla 1-800.362-2050, outslda P.nn'Ylvanla and
within loc.1 Harrl.burg area (717) 787-8094, 1001 (717) 77Z-2252 (Haarlng lapalrad Only).
OBJECTIONS I Any party In lnt.r..t not .atl.fl.d with tha appral...ent, allowanc. or dl'.llowance 0' daductlon., or .'......nt
of ta. (Including dl.count or Int.r..t) a. .hown on thl. Notlc. .u.t obJ.ct wllhln .Ixty (60) day. of r.c.lpt of
thlt Notice by:
AOHIN
ISTRATlVE
CORRECTIONS:
.-wrltlan prot..t to the PA n.part..nt of R.v.nue, Board of App.al., n.pt. 281021, Harrl.burg, PA
....I.ctlon to have the ..tt.r d.t.r.ln.d .t audit 0' the account of the p.r.onal r.pr..ent.tlv.,
"-app..1 to tha Orphan.' Court.
17128-1021,
OR
OR
Factu.1 .rror. dl.cov.rad on thl. ........nt .hould b. .ddr....d In writing tal PA D.p.rt..nt of R.v.nue,
Bur.au of Indlvldu.l Ta.e., AITNI Po.t A......ent R.vl.w unit, n.pt. 280601, Harrl.burg, PA 17128-0601
Phone (117) 787-6505. 5.. p.g. 5 of the bookl.t "In.tructlon. for Inh.rltanc. lax R.turn 'or. R..ld.nt
Decadent" (REV-1501) for an e.plan.tlon of adalnl.tr.tlv.ly corraclabl. arror.,
DISCcu.TI
If any t.. due I. p.ld within thr.. (]) c.l.ndar .onth. aftar the dac.d.nt'. d.ath, . flv. p.rc.nt (5~) dl.count of
the t.. paid I. .110w.d.
PENal TV,
The 15~ t.. ~.ty non-p.rtlclp.tlon panalty I. co~t.d on the 10t.1 of the t.. and Int.re.t .......d, and not
p.ld b.'or. Janu.ry 18, 1996, the flr.t day .'t.r the and 0' the I.. .an..ty p.rIOd. Ihl. non-p.rtlclpatlon
p.nalty I. app.al.bl. In tha .... eann.r .nd In the the .... tla. p.rlod a. you would .pp..1 the t.. and Int.r..t
that has b.an .......d .. Indlc.tad on thlt notlc..
INTEREST'
Int.r..t I. chargad baglnnlng with flr.t day of d.llnqu.ncy, or nlna (9) eonth. and on. (I) day 'roe the data of
d..th, to the d.t. of pay.ant. T.... which b.c... delinquent bafor. January I, 1982 baar Intar..t at the r.le of
.Ix (6~) percent par ennuI calculat.d at . dally rat. of .000164. All tax.. which baca.a d.llnquent on and a't.r
January 1, 1982 will b.ar lnl.r..t at a rata which will vary 'roe cal.ndar y.ar to cal.ndar y..r with that ral.
announc.d by the PA Dapart..nt 01 R.vanu.. Th. appllcabl. Int.r..t rat.. for 1982 Ihrough 1997 .ra:
!!!! Inl.r..t Rat. Dally Inl.r"l Factor !!!r Int.r..t Ret. Dally [nlar..t F..ctor
1982 20X .0005~8 1987 .~ .OO021t7
1983 IU .000U8 1988-1991 In .00OSOI
1984 11;( .000301 1992 .~ .000247
1985 U~ .000356 1993-1"4 7~ .000192
1... lOX .000214 1995-1997 .~ .000241
....Int.r..t 11 calcul.lad .. follow.:
INTEREST = BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
".Any Notlc. I..ued a't.r the ta. b.coa.. delInquent wIll r.flact en Int.r..t calculation to flft..n (IS) day.
beyond the det. of the ........nt. If payaant I. .ada .ftar the Int.r..t co.put.tlon data ~ on the
Notice, additional Int.r..t au.t b. C8lcul.tad.
12/01/94
COURT OF COMMOIl PLEAS OF
ORPHANS' COURT DIVISIOIl
STATUS REPORT UNDER RULE 6.12
ESTATE OF : \ \ \ ( , ' \ \ ,',
FILE NUMBER: j {- clC:- - S'b-u DATE OF DEATH
,DECEASED
. "~I '\'" ,. II'/t.
Pursuant to RULE 6.12 of the Supreme Court Orphans' Court Rules, I
report the following with respect to the completion of the
adainistrat~on of the above captioned estate:
1. State whether administration of the estate is complete:
YES: ~'-.. HO:
. 2. If HO, state When the personal representative reasonably
believes that the administration will be complete:
3. If YES, state the following:
A. Did the personal representative file a final account
wi th the Court: YES HO "
B. Has final distribution to the beneficiaries been made:
YES)( NO
C: Has an account been stated informally to the parties in
interest: YES" NO
11 OJPD'S Of l!aIP1S, mwrs, JOIIDPlS 01 J.mOVlIS OF POmI. 01 IIl'OWL lCXXlOlTS w: mlClllD JS tmIllrrs
to ms l!POiT, m OiICIillS!IIST msr BE lIL!Il1/ml m em or m OJPWS' amr lID iUlmlCE mST BE
IlDE ro m: Dm or YlLIiG 011 tlCll OJPY.
.'/ - -?,
,. / / L / / . ,
, (1-tr-<1 .,. (... Lt./~..~
(SIGNATURE )'
/Ii. (Ii, t...'. r-.' d,'
( NAME) PLWE mt OR PiIliT
/' I J.
l" -".:.,.1' DATE:
:,'/,,)., J
I 'I I
.~\,',
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.';', / i(/ ) j,',."" ,/'1.
( ADDRESS)
... " 1/ / .. _ I
/ t . / "/ 'r .',i ,'_
'" "" .~ J . .. .
(CITY, STATE, ZIP CODE)
i- ,',' 1'1' /\/
,. ," 1/:..' .' II
,: "
;. (l.' 't.",' (/- ''J.. 'J /
(TELEPHONE NUMBER)
l-~r('6,fr:.'-
CAPACITY:
F..-.-,.I,:"
PERSONAL REPRESENTATIVE
COUNSEL FOR PERSONAL REPRESENTATIVE