HomeMy WebLinkAbout96-01057
PETITION "'Ol{ GHANT 01' I.ETTEI{S ()to' AI>MINISTHATION
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Ilcgislcr Ill' WiI" fur Ihc
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ounl)' n _I.-'.._----'-:___,:__.____!.....__~ In t tC
Cllllllllllnwcallh Ill' I'cnnsylvania
.O('('('aSI'tI,
Sol'iaIS"(,/lrilyNo.
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Thc pelilillnllf Ihc nndcrsigncd rcspcclfully rClllcscnls Ihal:
Your pClilioncrl'it, Whll is/m IS ycaf\ of agc or oldcr. appl~t..()-'L-- fur IcIlCf\ of adlllinivlnllion
on Ihc csUIIC of
(&.I.b.II.; pt'lldC:lIlC' Iile; "hU,1lI1C nh\l'lIIi;l; Llmilllh,' milltllilillC)
Ihe above decedenl.
ConnlY. l'enns)'lvania. wilh
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(Ii" \IU,'cl, nUl1Ihcr lIIullllunidpalit)') linnpq~ll_To~.,nallip
Deeendenl was dOllliciled al dcalh in C',,, ':-_"l'lr.nrl
h J n last family or principal residenec al
i-:cc:~o.ntc:1Lul'tj, rA 170:;5
Decendenl.lhen I,:. yeaf\ of age. dicd
at ~~()'~.. SJ-i":1~t: ~;o~~r:i"'-', (:'l:"\j'
n'
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DOCU:1U1.;P 1.1,
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Decendenl al death owned propcrlY wilh cslimated valucs as fol1lows:
III' domiciled in Pa.) AllpCfSonalpropcrly
(If nOI domiciled in Pa.) PcrsonalpropcrlY in I'cnnsylvania
(If nol domiciled in I'a.) Pcrsonalpfllperty in Coumy
Value of real eSlalC in Pcnnsylvania
situaled as follows: ':":10
$
$
$
$
20 ~)iJQ .JO
Pelitioncr_ after a proper search hal!.- ascerlained Ihal decedenllcft no will and was survived by
Ihe following spouse IiI' any) and heirs:
Name Relalionship Residcnce
,Ann!:l. w.
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S":.stcr
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Garli~lo,
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:,..LLI--nvIm'l ilJ'lva, ili11sburg,
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1;10;;;. ~:al1in ::it....l'. o"'OUo:: 2371
. ('Cl1lJn '.n::J Ul"-~ .I,'i~ ! ( ;,5
of Ichers o( Iflll11llllSlfdtllm m Ihe
Clc..lr G. ~):~crs
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THEREFORE. pelilionerls) respectfully requesl\s) Ihe gran I
appropriate form 10 Ihe undersigned.
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OATH OI<'I)I<:RSONAL RJ<:I)RESENTATIVE
COMMONWEALTH OF JJJ<:NNSYLV ANIA
COUNTY 01<' ,; "::'.:;:',\'1)
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The petitioner(s) abovc-namcd swear(s) or arrirm(s) Ihat thc
statcmcnls in the forcgoing petition arc truc and corrcCllO the bcst
of Ihe knowledgc and belief of pClitioncr(s) and that as pcrsonal
rcpresentative(s) of the above dccedent pctitioncr(s) will well and
Iruly administer Ihe estale a:::rd~::~~ril:: ~ ", " \, 1
day of =TI
19()(
'[ '1f) .<9du_
Register ~
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No. 21-96-1057
Estate (if
,~,\T."~'" n",~n':;
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ucce::bcr 23 19~, in consideration of the petition on
the reverse side hereof, salisfactory proof having been presented before me,
IT IS DECREED that .Tn'l"~ ~, ry,,,,,,\,,q
is/~ entitled to Lellers of Administration, and "in accord with such findins, Lellers of Adminislration
are hereby granted to
.Tnp'1n<"l (~ :1:r('\'YH~
in the estate of
(}n' ()n ~:~. Bvoro
~
c. Lewis Af/J-?-
FEES
Lellers of Administration..... S 60.00
Short Certifieates( 1) . .. . .. .... S 9.00
Renunciation....( i.\......... S 5.00
JCP S__l.gO
TOTAL _ L1J_.00._
Filed . .q~~~~~. ?-.~,..... A.D. 19!JL
J. liohcrt ;';tnllf'fol"!O(-,C;(,
ATTORNEY (Sup. Ct. 1.0. No.)
:.al'l:ct ~(11;ni~C Slub_
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ADDRESS
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1- { - ,j:-;l, ( )
1'1I0NE
CALL A'ITORNEY FIRST, 11lEN MATI, LETTERS /\ND ORDER TO A'ITORNEY J.ROBERT STAUFFER
ON DECEMBER 23, 1996
RENUNCIATION
21-96-1057
In Re Eslale or
G~HJ>::! ;',. -j"_r:,::1:.l
deceased.
To the Register or Wills or
CU'r.bf'rlr_nll
CounlY, Pennsylvania.
The undersigned
hntn'4 n1' tho hoil"n-:\t-lnH
l
or
the above decedenl, hereby renounee(s) the right to administer Ihe eSlate and respeetrully ask(s) Ihat Letters
of Adminintrntion
be issued 10
.Tm.1C:J c. n;rers
WITNESS
our
hand{hiS~daYOr Docembor.19-.2L.
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Cl/)1./, _
121 ;;orth 30Q1'01'U 3t.
Cnr1i310, PA 17013
(Add....)
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(Signaturc)
304 ilorth Arch St.
Hochnnic:.Jburc, PA 170;;;;
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CERTIFICATION Of' NOTICI; lHlDER IltJl,l~ 'i. 6 ( ,] l
Name of Decedent: Gr'.lcn ~. . 1\7.'orn
Date of Death: ;;0 cll:~bor 13, 1 (11)r,
will No. Admin. No. 1996-010~7
To the Register:
I certify that notice of beneflcial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to
the following beneficiaries of the above-captioned estate on
January 3, 1997
~ Address
Anna E. ::epner-121 I:. Bedforu st., Carli:;le, FA 17013
James C. Byers-523 Ridr,evicH Drivc, DillsburG, PA 17019
Ruth V. Fostor-JOlt 11. Arch St., rochan'ccsuurg, l'A 17055
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rA 17055
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except ~ono
Date: January 6, 1~q7
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Capacity:
Personal Representative
,. Counsel for personal
n~presentative
COMMONWEALTH Of PENNSYLVANIA
COUNTY Of CUMBERLAND
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IS;
sworn--------;--- ---.. -----------. io tlill-i\dl1ilni-stro:toZ;-"
___ accordIng 10 row, dapasOl and .oys that ho - ------..- .--.-
____.______ of tho Estate of Galon E. !3yors
lote of _ J{al!l'p.den rO\:lnohip .._ .._ .____, Cumberland County, Po,. doceOled and thot tho
within Is on invontory mode by __. Jam.!l.!l_9. !3yoro _._ ___, the said Adminiotrator
of tho entire estota of said docedent, consisting of all the pOllanol prop.rly and rool OItotO, oxcopl real ostole auhido
Iho Commonwealth of Pennsylvania, end thet the figures opposite eech Item of the Invontary repre.ent it's fair value
.. of the data of decedent's deelh,
Jame 0 C. !3yers
being duly
Sworn
ond sub.cribed before me,
March
19 97
~ . Administrator
523 Ridgeview Drive
Dillsbur~, PA 17019
Addrlu
Dote of Doeth
13
Day
December
Month
1996
Vu,
INSTRUCTIONS
I. An Inventory must be filed within three months oller eppointment of pellonol reprosentoti...
2. A supplement Inventory must be filed within thirty deys of di.covery of additional ....h.
], Additionel .heets mey be ettoched es to persanelty or really
4. See Article IV, Fiducleries Act of 1949.
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Invontory of tho rool onllllorsonol oolnlu 01
GALEN E. l3Y'illlS
dOCllooud
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I>le11on l3anlt, N, A., Cheolc1ng Aooount 110, 11,1-201-0553.
Mt. Royal Auotion, net PI'ouoodo rl'OIn Dolo oj' rl11'nlohlngD,
Prooeeds from snlo or 1982 "Atlnntio" 501 x 1.21 Hobllo IlDlno.
Sold to Edward Mioeli, Solo pl'1oo,
Tri-County Memori 01 Gordono, I'a!'und on grllve oponing oho1'go.
Blue Cross/Blue Shield, modionl oxponno rflilnhul'UOITlont.
16,522 10
1~14 37
Totnl........... 20 9
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FOR OATIS OF DEATH AFTER 12/31/91 CHECK HEHI
INHERITANCE TAX RETURN ~o~::~yU~:~DITISCLAIMED 0
RESIDENT DECEDENT FlilNUMBiR 21 96-1057
(TO BE FILED IN DUPLICATE -
WITH REGISTER OF WILLS) COUN1Y CODE 1996 yEAR01057 NUMBER
Ol(fOUlT'S (OMfUlE AccIlU!t Lot 15
Brandy Lane Trailer Court
Mochanicsburg, PA 17055
Coo" _Cumberland.
AMOUtH IllcllVlD ISlE INSTIlUcllOfHI
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COMMONW(MlIlor P(NNSYlVAUlA
O[PARIMENT or R(VENUE
Drn 280601
ttARRISIURG,'.... 17128,0601
cEUO(N1'!t NAME IlAST. fIIlST. AUD MIODll IWIIAl)
BYERS Galen E.
'OC~~~~';Y6:5~50 o~:;/~~/%r~2/26/32
llf ."11(.""111 SU'~IVltlG "ouSB flAMIIIAS!, Ill" "'0 MI~';;I- SOCiAiS(cuiiii"Y'Nu"Mirll
o 3. Remainder Return
. Ifor dalel 01 doalh prio, 'a 12.13.B2)
o 5. Federal Eslate TaJ!. R,turn Rlquirld
<2.... 8. Tolal Number of Safe Deposit Boxes
IliA
o 2. Supple menial Return
. ~ ~
II)
(2)
(3)
(4)
(S)
(6)
(7)
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0.00
O~OO
_0;00
0;00
20,935~
O~OO
0000
6,283.12 (B)
0.00
(11)
(12)
(13)
(14)
0000 X._=
0.00 X .061:1:
14,652.52 X .IS =
(16)
Discount Interest
6,283012
14,652052
0000
1l~, 652.52
0000
0.00
2,197.87
2,197087
0.00
0.00
2,197.87
0000
2,197.tiT
tKI 1. Original Return
o A. limited Estate 0 040. Future Inlerest Compromise
(lor dalol of doath oller 12.12.62)
06. Decedent Died Testale 0 7. Decedent Mainloined a living Trust
(Alloch copy of Will) (Allach copy 01 Trull)
ALL CORRESPONDENCE'AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED.TO..',.. :.,~,;.:_. !~M-I'_'.'ll:r',."
NAME cOM'LE..'~ MAIl,JNG AcOPJ.SS
J. Robert Stauffer, Atty. MarKet ~quare Bldg.
",,'HON' NOM'" Nechanicsburg, PA 17055
20. If Line 191s grealer than line 18, enler Ihe difference on Line 20. This is the OVERPAYMENT.
SO
21. If line 18 is greater than line 19, enler the diUerence on line 21. This is the TAX DUE.
A. Enter the interest on the balance due on line 21 A.
B. Enter tho 'atal olUne 21 and 21 A on Uno 21B. Thil is tho BALANCE DUE,
Makl Cheek Payabll tal Rlgllt" of Will., Aglnt
Check here if you ore requesting a refund of your overpayment.
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I. Roal Ellate (Schedulo A)
2. Slockl and BondI (Schodulo B)
3. Closely Held Slack/Partnership Inlerest (Schedulo q
4. Morlgages and Notes Receivable (Schedule D)
5, Cosh, Bonk Deposits & Miscellaneous Personal Properly
(Schodulo E)
6. Joinlly Ownod Praporly (Schodule F)
7. Transfers (Schedulo G) (Schodulol)
8. Total Gross Assets (Iotallines 1.7)
9, Funeral Expenses, Administrative CosIS, Miscellaneous
Expen.el (Schedulo H)
10. Debts, Mortgage liabilities, liens (Schedule I)
1" TOlol Deductions (10101 lines 9 & 101
12, Nel Value of Estale (line 8 minus line II)
13, Charilable and Governmental Bequests (Schedule J)
lA. Nel Value Subject to Taxlline 12 minus line 13)
15, Spousal Transfers (for doles of death after 6.30.904)
See Instructions for Ar,plicoble Pereenlage on Reverse
Side. (Include values rom Schedule K or Schedule M.)
16. Amounl of line 14 loxoble at 6% rate
(Include values from Schedule K or Sehedule M,I
17. Amounl of line 1.4 taxable al 15% rote
(Include values from Schedule K or Schedule M.)
18. Principal to. due IAdd 10J!. from lines IS, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments
0.00 + 0.00
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~;l\'<<"h', B' SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH '~""i''''~) .",:.~ ,
Undlr penalties 0' perjury. I declare thaI I hove uamined Ihis return, induding accompanying schedules and Ilalemenh. and 10 Ihe best of my knowledge and belief,
il is Irue, correct and complele. I dedare Ihal 011 real eslale hos been repofted at true market value, Declaration of preparer other Ihan Ihe personal repuuenlative is
b sed on 011 Information of which preparer has any knowledge,
51 ....lUlEO"USONIlUPONS~'O. NG.l1URN AOORUS 23 Ridgeview Drive OA1!-. \...., ~
__ 94-l";'. illsbur PA 17019 ;5-.)/'71
51G U E I': lR THU HA~' II t "'DORUS Narko Square dg.
I Nechaniosburg, PA 17055
DAn
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Buyer's Name
Or Number
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lot Noolber
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@ $/)It1-~,"",f ~~'~'c/.5-5"d;!-
REMARKS:
This receipt verllies payment and delivery ollhe above
Soid IS Is, where Is. All sales final. Thank you.
~.. Form cr w"ourtAucUon School ,.eOG-83SoIOS5
_._______.______ _ .' u u.__ -- - -*
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Or Number
hem or
lotNumber
@ $
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REMARKS:
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Or Number
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This receipt verifies p.~menl and delivery ollhe abOv..
SOld Isis, where Is. AlI.lles finll. Thank 'tau
. n~..FOImCTM".c.uIIA~8dloo1 t.JOG.83&.1t65
Buyer's Name
Or Number
lIemor
lot Number
REMARKS'
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Buyer's Name
Or Number
lIem or
lol Number
@ $
REMAntC.S
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This receipt verllles paymenl and delivery at the abOv!t,
Sold IS la, where Is, All s.les IInal. Thank you,
. R~.,FOfmCTMI..ouriA\tCtionBchool '.1OG-835-'155
Buyer's Name
Or Number
Item or
lot Number
@ $
"EMAnKS.
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$
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This receipt verities payment and delivery 01 the abOve.
SOld .sla, where la. Allaales Ilnal. Thank you,
. Reord., fOl'mCT MillourlAlICtlon Scho~ ,-8OG-835-'OSS
Thla receipt vel Illes payment and delivery 01 Ihe above.
Sold as la. whore Is. All sales Ilnal. Thank you.
. ReotdefFom'ICTM.llourlAuctlonSchool '.800-835-'055
__L________________________
.... ~._- .-- .-~- - -- .~ ------ -- - - --.- -.-
4
Buyer's Name
Or Number
hem or
lot Number
@ $
REMARKS'
9 156
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/ .3,9
$
Thll receipt verities payment and delivery 01 the above.
Sold alii. where Is. All aales Ilnal. Thank you.
l · ReordtfformCTMluOUIIAualon Sc:ho~ '-800-835-'0&6
1- ~==--~ -------------------- ;(;-;s
hem or r )
lot Number \.:5 ~~~
@ $ - $
7~
REMARKS'
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@ $
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$
Thla receipt veri lies payment and delivery 01 the abOve.
Sold as Is. where Is. All sales final, Thank you.
. Reorde, FOfmCT Mit'OUfIAuction Scho~ '-800-835-'055
Buyer's Name
Or Number
Item or
lot Number
REMARKS:
REMARKS:
SALE NO
......nATt:
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f This receipt verllles payment and delivery at the abOve. ; This receipt vll,lfIes payment and delivery 0' Ihe above.
Sold .a la. where Is. All sales tlnal. Thank you. I Sold as Is. where Is. All sales tlnal. Thank you. .
. ReordtfFOfmCTMlllourlAuction School ,.aoo.835-te65 I . RltOfdefFClfmCTMluourlAuetiOnSChooll.800-835-I065
._______.. ______. __ _________________.-1-_____________________________..
, Buyer's Name '7 / () 6 : Buyer's Name '1 I '7 ='2
I Or Number - I Or Number _ _ J
: ~: ~ .~.4/ l ~~~N~ber '!/'Jj a.."r4,.w
3.;... 03 I T g> u~
, @ $ - $ I @ $ = $-
\: REMARKS' :
1. I
I' Thll ,ecelpt verllies payment and delivery 0' the above. I'
SOld as II, where II. All .ales final. Thank you.
I
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@ $
$
/7 tL2-
This receIpt verllles payment and delivery 0' the lbove.
Sold as Is, where Is, All Slles IInal. Thank you.
PAGE PAGE SALE
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Sold"'I,,,,,,,,,I, All III" hNI IllInkyou . ......,_C,...--''''''*".....-eoo....I... _____
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hem.. ~{--:!;k/U<, ,..:z;:;-~..Lu i Lo'_ &.a.vu.v ?",2
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@ $ I MWohit.
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Buyllt"S Name
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. AeorderFOI'mCTMitlourlAUdIonBdIOoIl.aoo.I3S.IOSS
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Sold as II. where II. All sales IInal. Thank you,
. ~FormCTMiI'lMIAuction Sc:hooll.aoo.835-tD65
Buyer's Name
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REMARKS'
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Sold 1.11. where Is. All ,aiel final. Thank yau.
. ~FOImCTMilloutlAuctionSchool 1.&00-836-11165
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REMARKS
ThiS receipl verllles paymenl ind delivery ollhe above,
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This recelpl verlUel payment and delivery 01 the above,
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. R.otd... FOlmCTMillourlAuction School 1-8O().835-1055
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FILE NUMBER
21':'96':'1057
1996-010
AMOUNT OR
SHARE OF ESTATE
SCHEDULE J
BENEFICIARIES
*
COMMOHwlAl1H Of "NHS'IV.llllA
INHltnANU I'" IllUIH
II"~~
ESTATE OF
OALEII E. BYERS
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
1. ANNA E. KEPNER Sister A one-fourth
121 North Bedford St. of Estate.
Carlisle, PA 17013
2. JAMES C. BYERS Brother A one-fourth
,23 Ridgeview Drive of Estate.
Dillsburg, PA 17019
3. RUTH V. FOSTER Sister A one-fourth
304 North Arah st. of Estateo
Meahaniasburg, PA 17055
4. CLAIR C. BYERS Brother A one-fourth
106 East Nain st. of Estate.
l1eohanlasburg, PA 17055
A. Ta.able Bequesls:
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B, Charitable and Governmental Bequesls:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter an lin. 13, Recapitulationl 5
III maro .paco I. n.odod. In.ort addlllonal .hool. 01 .umo .1.0\
._ _ _~ _ _." _ _J_'~_~ ----" .----~
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DNo.AA 185274 COMMONWEALTH OF PENNSYLVANIA
DlPARTMINT O. RIVINUI
....1;., "'.....1 OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
I ACN
e2 ASSESSMENT r:t
RECEIVED FROM: U CONTROL ~
NUMBER
'*
AMOUNT
J ROBERT STAUFFER ESQ
101
.~ , J'" I . t:J I
MARKET SQUARE BUILDING
MECHANICSBURG. PA
17055
ESTATE tNFORMATION:
~ FilE NUMBER
Ii1 21-199b-l057
1:1 NAME OF DECEDENT (lAST)
~ BYERS GALEN E
II DATE OF PAYMENT
EJ POSTMARK DATE
COUNTY
SSN 210-26-5750
(FIRST) (Mil
CUMBERLAND
DATE OF DEATH
m TOTAL AMOUNT PAID
$2. 197 . 87
VZ
REMARKS
JAMES C BYERS
CIO J ROBERT STAUFFER ESQ
CHECKtl 010
SEAL
REGISTER OF WillS
H _ .__ _ ~--- ~- ..-- ---+ ---- ---
,
------ -- -- --- -- -- --- -- ---- -._- ..--- -~-
<<.
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t. - ...,:.
,
-:-. _.._....~.-.--..........
.oj ,
,
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,-
,/
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BUREAU OF INDIVIDUAL TAMES
INlltRlllHCI: laIC PlvlSI014
DlPl, 110110 a
tIARRISIUMC, fl" I1UI.OIlOI
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INIlERITANCE TAM
APPRAISIMENT, ALLOWANCE DR DISALLOWANCE
Dr DEDUCTIONS AND ASSESSMENT OF TAM
J ROBERT STAUFFER ATTV
HARKET SQUARE BLDG
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
.1
(.
06-16-97
BVERS
12,13-96
21 96-1057
CUMBERLAND
101
A.,ount Re.,itted
.
1".l\d ...,. 111.'"
GALEN
E
MAKE CHECK PAVABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS lINE ~ RETAIN lOWER PORTION FOR YOUR RECORDS ~
iiEV:is4i-EX-"FP'(oJ:ijfi-NOYicEuOF-YNHERiTAiicE-YAX-'A-PPiiiiisEHENT-.--"L'LoiiANcE'iiliumuumu---
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF BVERS GALEN E FILE ND. 21 96-1057 ACN 101 DATE 06-16-97
If an assessMent was issued previously, lines 14, IS and/or 16, 17 and IB will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 taxable at Collateral/Clas. 8 rat. (17)
18. Principal Tax Due
TAM RETURN WAS, I X I ACCEPTED AS FILED
RESERVATION CDNCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rool Est-to ISchodu10 Al III
2. Stock. and Bond. (Schedule 81 (2)
3. Closaly Hald Stock/Partnarship Intar.st (Sch.dula C) (31
4. Hortgagal/Nota. Recaivable (Schadule D) (4)
5. Cash/Bank Oapolits/Hilc, Parsonal Proparty (Schedule E) (5)
6. Jointly Ownad Proparty (Schedula f) (6)
7. Transfers (Schadula G) (7)
8. Total Anats
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. funaral Expansas/Adm. Costs/Hilc. Expansas (Schadula H) (9)
10. Debts/Hortgage Liabilities/Lianl (Schedule I) (10)
11. Total Daductions
12. Nat Value of Tax Raturn
13. Charitabla/Governnantal eeqUasts (Schadula J)
14. Nat Value of Estat. Subject to Tax
NOTE:
TAX CREDITS:
PAYMENT
DATE
03-18-97
RECEIPT
HUMBER
AA185274
DISCOUNT I + I
INTEREST/PEN PAID I-I
.00
) CHANGED
.00
.00
.00
.00
20.935.64
.00
.00
IBI
6.283.12
,00
IllI
1121
1131
1141
.00 M .00=
.00 M .06.
14,652.52 M .15.
llBI
AMOUNT PAID
2.197.87
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
HOTE: To insure propar
cradit to your account,
subnit tha uppar portion
of this forn with your
tax pay"ent.
20.935.64
6 .'R:I "
14.652.52
.00
14.652.52
.00
.00
2.197.B7
2,197.87
2.197.87
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN Sl. 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
I )(j
RESERVATION: E.tat.. of d.c.d.nt. dying on or b.for. D.c..b.r IZ. 198Z .- If any future Int.r..t In tho ..tat. I. Iran.f.rr.d
In Po.....lon or .nJoy..nt 10 Cia.. a (collat.ral) b.n.flclarl.. of tho dlc.d.nt aft.r the .~plrallon of any ..tat. for
Ilf. or for y.ar.. tho Co..onw.alth h.r.by .~pr...ly r...rv.. Ih. right to appral.. and a..... tran.f.r Inh.rltanca Ta.a.
at tha Inwful Cln.. B (collntarall rata on any .uch futura Intara.t.
PURPOSE or
NOTICE:
PAYHENT:
REFUND (CA):
OBJECTlDNSI
AD"IN
tsTRATlVE
CDRRECTIoNSI
DISCOUNT:
PENAL TV I
INTEREST I
To fulfill tha rlqulra..nl. of Sactlon 214D of tha Inharltanca and E.tall Tn. Act. Act 21 of 1995. (12 P,S.
S.ctlon 'IUD),
Datach thl top portion of thl. Notlcl and subalt with your pay..nt to tho Rlgl.tlr of Will. prlntld on tha rlvlr.1 .Ida.
"Mak. ch.ck or .oney ord.r pnyabl. to: REOISTER OF' lULLS, AGENT
A r.fund of a tax cr.dlt, which was not r.questld on tha T.. Return, .ay bl rlqul.tld by cOlplltlng an "Appllc.tlon
for Rlfund of P.nn.ylv.nla Inhlrltancl and E.latl I.." (REV-1313). Appllc.tlon. ara .vallabla at tha OffiCI
of the R.gl.t.r of Will., any of tha 23 Rlvanua Ol.trlct OffiCI., or by calling thl ,plclal 24-hour
an.w.rlng ..rvlcl n~blr. for fori' ordlrlng: In Pennsylvania 1-800-36Z-2050, out.lde P.nn.ylvanln and
within local H.rrl.burg .r.a (111) 181-8094. IDOl (111) 112-Z251 (Hlarlng I.palr.d Only),
Any party In Int.rl.t not .atl.fl.d wllh tha .pprals...nt. allowanca or dlsallowanca of d.ductlon., or ........nt
of tax (Including dl.count or Int.r..t) a. shown on Ihl. Notlcl .u.t obJ.ct within sl.ty (60) d.y. of r.c.lpt of
thl. Notice by:
.-wrltt.n prot.st to the PA Dep.rt.ent of R.venua, Bo.rd of App.al., Dept, Z81011, Harrl.burg, PA 11128-1021, OR
."al.ctlon to h.vI tho ..tt.r d.teraln.d at audit of tho account of tha p.rson.1 rapr...nt.tlv., OR
-.app..1 to tho Orph.n.. Court,
Factual .rror. dl,covlr.d on thl. a......ant .hould ba .ddrl.sld In writing tal PA alpart..nt of A.V.nul,
Bur.au of Indlvldu.1 T..ls, ATlN: Po.t A,I..sI.nt R.vl.w Unit, O.pt, 280601, Harrisburg, PA 11128-0601
Phon. (111) lal.6505, S.. pagl 5 of tho bookl.1 "In.lructlon. for Inh.rltanc. Ta. R.turn for. A..ld'nt
D.c.dent" (REV.1501) for an ..plan.tlon of ad.lnl.tr.tlv.ly correctabl. Irror..
If any tn. due I. paid within thr.a (3) cal.ndar .onth. aft.r tho d.cld.nt'. d.ath, a flv. p.rclnt (5~) dl.count of
thl te. paid I. allow.d.
Th. 15~ ta. aan..ty non"Plrtlclp.tlon penalty I. co.putld on the tot.1 of the ta. and Int.r..t e......d. end not
paid b.fora January la, 1996, the flr.t day .ft.r tho and of the ta. nan..ly p.rlod. Thl. non-pnrtlclpatlon
p.nalty I. .pp..labla In tho .... ..nn.r .nd In tho tho .... tl.. p.rlod a. you would .pp.al the ta. and Int.r..t
that ha. b..n .....s.d e. Indlcat.d on thl. notlc.,
Intlr..t Is charg.d b.glnnlng wllh flr.t day of dlllnqu.ncy, or nln. (9) .onth. and on. (I) d.y fro. thl date of
d.eth, to tho date of p.y..nt. T.... which blca.a d.llnqulnt b.for. J.nuary I, 1981 b..r Int.r..t at tho rat. 0'
.1. (6~) porc.nt p.r annul calculat.d at a d.lly r.t. of ,000164. All t.... which b.c... d.llnqu.nt on and .ft.r
January 1, 1982 will b.lr Int.rl.t at a r.t. which will vary fro. c.l.ndar y..r to c.l.nd.r y.er with th.t rala
announc.d by Ihe PA alpart..nt 0' R.v.nu., lhl .ppllcabl. Int.r.st r.t.. for 1981 through 1991 .r.:
!!!! Inter..t Aatl Dally tnlornt Fector !!!! Int.r.st Aat. Deily Inter..t fllctor
1982 In .000!i4a 1981 .. .0001U
1983 16~ .000438 1988-1991 11:< .000301
1984 11~ ,000301 1992 .~ .OD0241
1985 In .0003!i6 199]-1994 7~ .00019l
1986 1O~ ,000214 1995-1991 .. ,000241
ulnternt It calcul.t.d .. followtl
INTEREST = BALANCE Dr TAX UNPAID X NunDER Dr DAYS DELINQUENT M DAILY INTEREST rACTDR
.-Any Notlc. 1.lu.d .ft.r Ih. t.. b.co'I' d'llnqu.nt will r.fllet an Intar..t c.lculatlon to flfte.n (IS) day.
b.yond tho d.t. of tho ........nt, If pay..nt I. .ed. aft.r tho Int.r..t co.put.tlon det. shown on tho
NOllc.. addltlon.l Int.r..t au.t b. calcul.t.d,
S1'ATUS REPORT UNDEH HU!&.6~1
Namc of Deccdcnt: ... .. . . ,._J
Date of Death: ,l; l'>:'-':'" .1' ,-, , .,,)(,
'.)'
Will No. Admin. No. , ',(,-')' ,..,......,
,'-' \ . ,I
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rulesr I report the following with respect to completion of
the administration of the above-captioned estate:
1, State whether administration of the estate is complete:
Yes x No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No, 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No x
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes , No
d. Copies of receiptsr releasesr joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may Qe attached to this report.
Date:
(I'~
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Address
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Tel. No.
Capacity: x
Personal Hepresentative
Counsel for personal
--- l'f'pr'esentat ive
(MAII:rmf/AM3)