HomeMy WebLinkAbout96-01063
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COllllONWEALTN OF PENNSYLVANIA. OEPARTllENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
JrW,COl'OlClDlHT,,", ......l_
I. Joseph C. Blocher
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21-96-1063
RENUNCIATION
In Re Estate of
'1 '
"!(".', I'
deceased.
To the Register of WlIls of ',. L" " . '"
County, Pennsylvania.
The undersigned
";, I r - '~\rll u
"
"I r_l-,L,.,.. .,; ",'
,
of
the above decedent, hereby renounce(s) the right to administer the estate alld respectfully ask(s) thaI Lellers
. (1. ill ; L' f"r';> i: i nYl
be issued to C. ich2.ill ::loc:H^lr
WITNESS
hand this
II
day of l)f'f"'~f,p
, 19.11.-.
Kved!~'~lur:)r3~
lJJZ I-/"""'<L ,wt L.f~Y"~ M-170'(~
, tAddres.)
(Signature)
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21-96-1063
RENUNCIATION
In Re Estate of
.iOH/'ll!1 ('. ') O('III'}'
deceased.
To the Register of Wills of
('l'fnbp}'l 'H1r!
County, Pennsylvania.
The ullderslgned
~ <'i ,-'r. It -;)'1 or>llr.r Ten))
of
the above decedent, hereby renouncc(s) the right to adminisler the estate and respectfully ask(s) that Letters
'dlllnl RtrntjOll
be Issued to
('.. :, i r'n;ifll ~11 n(.hrlr
WITNESS
;e.
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/? day of
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
ESTATE OF JOSEPH C. BLOCHER
Deceased
)
)
)
) NO: 1996-1063
)
RECEIPT AND RELEASE
I, C. Michael Blocher, do hereby acknowledge that I am
r.c.ivin. tb. suu of $0.00 as pavu.nt of any auount that I u,y b'
entitled to receive for any and all entitlements, due to me from
tba Estata of Jos.pb c. Blocb.r and ac,"..,.d.' tbat this is full
and cooplot. satisfaction of any and all d.visos, b...oatbS,
ri.bts, .ntitl.unnts or claiun of any kind tbat I b.v. a.ainst tho
I further acknowledge that I accept this distribution,
full disclosur. uf all administration of tho .stat., and
ac,"..,.d.' tbat this docs not includ' anY funda in joint bank
above referenced estate.
accounts.
Michael Blocher,
I
further hereby release C.
""ainistrator, froa any cl"un and liabilities whicb uny ariso
a.ainst hia as a result of tho adainistration of tb. E.tat. of
Jos.pb C. Blocb.r, and a.r" to bold bia baCOI'SS and r.iDbursu bia
ay pco rata sbar. of any sucb .,..ns. iucurrnd by bia as a r..ult
of tb. administration of tb. .stat., sbould a cbar.' be i..os.d.
Proof of Publication of Notite in The Patriot and The Evening News
and The Sunday Patriot-News
t'nc1fr .\('l No. 381. .\111IMu'rd ;\Ia)' 1ft. 10'_"8.
COlllmonwrallh af I'rrIlIRllh'"nia, }
Co,mlll of n,,"/:hi" ,.,:
.............................~H.r;.l)f.'.h'J...!..l.\~I!:.<:!>>:..........................b~inR duly sworll nccording to Inw, d"poseR IInd says:
Asst. Controller
That he is the ............................of TilE PATRIOT . 1\ (m's CO., a corporntion orll'llniwl and existing
under the laws of the Commonwealth of Pennsylvania, with its I.rincipal office and pi lice of business at
812 to 818 Market Street, in the City of IInrri.burl:, County of Dauphin, State of Pennsylvania, owner
and publisher of THE PATRIOT and THE En;~ING ~EWS Ilnd the SUNDAY PATRIOT - NEWS
newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City,
County and State aforesaid: that THE PATIUOT and TilE EVENING NEWS and the SUNDAY
PATRIOT _ NEWS were establbhed March 4th, 1854, and February 15th, 1917 and September 18th,
1949. respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto Is exactly as printed and
published in their regular)ltl'ttdn'A aWHs~ues which appeared on the ..J~!:.!..}.~.~~.!....~.~.~...~.~.~.~....
days of January 1997.
........................................................................................................................................................................................
That neither he nor said Company is interested in the subject matter of said printed notice or adver-
tising, and that all of the allegations of this statement as to the time, place and character of publication
are tnle; and
That he has personal knowledge of the facts at resaid and is duly authorized and empowered to
verify this statement on behalf of The Patriot-Ne s o. aforesaid by virtue and pursuant to a resolu-
tion unanimously passed and adopted severally b t e stock Iders and board of directors of the said
Company an~ 8ubsequently duly rD\:orded in the offi t ~he. ording of Deeds in and for said County
of Dauphin In Mi""ell.oeoll.lloll~ "~I". \'oluoll' II.I'.~, 3 X)!t I I~
Copy of Notice or Publication .................... L.....~....................................................................
Sworn 0 and s bs ribeclbefore me his ...,.:U.i;;J;......day of
J~.m,1.?.r.y... A. D. .--: / . . /-;
'-/ .1,j"'..L.,. '". fi ,,>
..... tDnyt:R~~~Nct.l;yiiUb:~.N: ~~.~1;r~.../.1
Hamshurg. C'3U;'lhtn Count, ry Pu I
:\. . . ...~. rnt!.li.';,i~n E,e.,"sJune G. I~Da
J..y commlSSl n'll:. I~ .........r......................... .......
Staterne~o~Jta~sin!iitosts
LItten 01 AdmlnlstrcUon have bHn orant.d
In ",I Estate 01 Jos,ph C. BIOCM to C. Mlthotl
Blochtron Dtctmbtr2A. 1996. Mr. BlochCrwasol
Cumberland Cqunl.,. All PtrlOns who wish to
makl a claim o<<Jln""" tstete or who art Indebl.
tdtotheet'attmall makt t!'lllr pOSlllO" knownby
contoctlng:
O.....,.,J. KlIbl'llrt. .'lIlIvlre
toO Mor1ttt StrHI
UmoYM PA 110Q
(7111761-1121
G:r:e.gur.y....J.....I.:.a.tshir...........................................
Lem'l.Y..r:\p.,/.....J~J:\.........l.7.D.~.J......................................
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication attached hereto on the
above stated dotes - $.......~.~..~.t?.........
Probating same $..........~..:.~~.~.........
49.15
Total $............................
Publisher's Receipt for Advertising Costs
THE PATRIOT.NEWS CO., publisher of TilE PATRIOT and THE EVENING NEWS and the
SUNDAY PATRIOT.NEWS, ncwspapers of I:eneral circulation, hcrcby acknowlcdll'e receil)t of the
aforesaid notice and publiclltion costs and ccrtifies that the same hove becn duly paid.
TIlE PATRIOT.NEWS CO.
By .....................................................................................
CUMBERLAND LAW .JOllRNAL
2 LIUElrrV AVENUE
CARLISLE, PA 17013
JANUARY 24 1997
Cumberland Law Journal is published every Friday by the ClUnband Counly Bar
Association and is designated by the Court ofCol11l11on Pleas as the olliciallegal publication lor
Cumberland County and the legal newspaper for publication oflegal notices.
TO:
Gregory J. Katshir, ESQUIRE
RE:
Joseph C. Blocher, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be paid
in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
JANUARY 10,17, 24,1997
Total Amount Due
$ 60.00
$ 0.00
$ 0.00
$ 60.00
..--....................
$ 0.00
Advertising Cost
Proof of Publication
Second Proof Request
Payment received
Payment received _Janual)' 7 1997
by Becky H MorgenthallExecutive Director
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
)
)
)
)
)
NO: 1996-01063
ESTATE OF JOSEPH C. BLOCHER,
Deceased
CERTIFICATION OF NOTICE UNDER RULE 5.6 (A)
Name of Decedent:
Joseph C. Blocher
Date of Death:
12/5/96
To the Register:
I certify that notice of beneficial 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 9, 1997:
Name:
Address:
Kathryn Blocher
412 Hummel Avenue
Lemoyne PA 17043
513 North Spring Street
Middletown PA 17057
C. Michael Blocher
James C. Blocher
118 Furman Drive
Dil1sburg PA 17019
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except: None
Date:
J/~/ct7
I (
Name: Gregory J. Katshir, Esq.
Address: 900 Market Street
Lemoyne PA 17043
Telephone: (717) 763-8133
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bolng duly -- ...---. _ according 10 low, dopo,ol and UY' Ihot h. ~DI-'IY;l1("/l c._ _.__, _'
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'01.0' _. L'~\OY"'''', Cumborland County, Po., d.c....d ond Ihal Ihe
within II an Inv.nlory modo by. (. ."",n~IL t!"<.'1\.~ __. Iho uid~~E.-._
of the ontiro olloto 0' uid d.c.dont, con lilting 0' all tho p...onal prop.rty and roal ..fal., oxc.pl rOIl estol. ouhlde
the Commonw.alth 0' Ponnlylvonla, ond Ihal tho figuro. oppollt. oach it.m 0' tho Invontory ropro.ont It'. 'olr voluo
.. 0' tho dolo of d.codont', dooth. '! .~ .
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eucutor . Admlnldr.tor
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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Nolaltal Sual
Tmcy K. Kalshl,. Notary Public
lumoyno Boro. CumlJu~and County
My Commission ExpI,os .Iuno 21. 1999
Dol. of OOlth
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INSTRUCTIONS
I. An inventory mu.t be filed within three month, ofter oppointment of pe..onal represontolive.
2. A supplement inventory must bo filod within thirty daYI 0' discovery of additionolo..eh.
3. Additional,hoeh may be atlached II to personalty or roalty
4. See Article IV, Fiduciaries Act 0' 1949.
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I'OR DA11501 0lA1H AnlR 12131191 CHICK HIRI
INHERIT ANCE TAX RETURNi \ ~o"v::~,U~:~OI1IS CLAIMIO I \
RESIDENT DECEDENT IILI NUMBIR
(TO BE FILED IN DUPLICATE /(}(.-~
WITH REGISTER OF WILLS) COUNIV COOl) I VIAR 1/ tt NUMBER
III ".'IJllll'> (()"'~llll "1l11.1~"
Ill,' ltlllli!Lel ^venllO
1,(!liIoYI1() I'i\ l'{U4';
,......~ .. ~ 81 SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ..c:
Undo, ponalH" of perjury. I dodaro ,ha' I ha'o oxam;nod ,hi, return. ;ndud;ng accompanying "hodulo, and ,.a.omon". and '0 .ho bo,' 0\ my knowlodgo and b.!;ol,
i' IIlrUO, carroct and campl..o. I doclaro ,ha' 011 '0010"010 ha. b.on repor'ocl a' truo ma,h' ,alu.. OotloroHon 0\ prepa'" o,h" .han.he pononal ropro,on.a.;'o iI
bas.d on alllnlorm tion 01 whkh pr.por., hos any llnowledgll.
" . A '. O' "0 . ",,"0" ,,'NG "'U'N ADD"" OA"
>:l- _ " '-, '~\ ~31cl'ill!.:_~j.U1LJ)1
AOOUSS
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\ 1 3 Remainder Relyr"
tlor dole\ 01 deolh prior 10 1 '2-13.821
\ J ~. federal e,tale To.. Return Required
1 40 FuMe Inlef.,t Compromiut
(lor dot., 0' deolh oher 12,12.82)
06. Oocod.n' O;od To,.a.o j 7. o",don' Moin.a;n.d 0 Li,ing 1M'
(Attoch copy 01 Will) tAllo(h (Opy of T,u.')
ALL CORRESPONDINCE AND CONFIDENTIAL TAX INfORMATION SHOULD BE DIRECTED TO.
NAM' COM'L1" MA",,,G ADD""
Grer:ory ,j. r.atuhir, "aquire ')00 t arket street
III'TY'l' HO.I\?63-S133 -----------.- ],Cl:ioyne 1';, 170qJ{"
o A. limited E,ta'l
_ 8 10101 Numbe, 01 Sol. Depo\it Bo...'
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L R.al E,.a.o (Sch.dulo Al
2. 5.och and 8and. (Schodul. Bl
3. Closely Held SlacklPartnenhip Inler01' (Sc.hodule q
A. Mortgages and NoloS Reuivable (Schedule 0)
5. Co,h. Bank Oeposit' & Mis(ellaneous Penonol Property
(Schodul. EI
6. Jointly Owned Property (Schedule F)
7. lranll.n (Sch.dulo GI(Schodul.ll
8. 10101 GroSS An.'s (10101 line" 1.71
9. funeral bpen,os, Admini,lrati~e COI'I. Milullaneou1
Expen"s (Schedule H)
10. Dehtt, Mortgage liabilities_ liens (Schedule I)
1 t. lotol Deductions (10101 line, Q & 10)
12. Net Value of eslole (line 8 minus line 11)
13. Charitoble and Go....rnmental Beques's (S(hedule J)
U. Net Value Subject 10 Tox (line 12 minus line 131
15. Spousal Trantfen ((or dolo' 01 dealh oh,r 6.30.Q4)
See Instructio"s for Applicable Percentage on Revene
Side. (Include vo\uI\ from S(hedule K or S(hedule M.l
16. Amount of line 14 talloble 01 6% role
('ndude values ham Schedule K or Schedule M.)
17. Amount 01 line 14 taxable at \5% rate
(Include values ham Schedule K or Schedule M.)
18. Principal tax due (Add lox from line, 15, '6 and 17.)
19. Credits Spousal Poverty Credit Prior Paymenh
+ ---+
(191
1201
\)\
181
)'02 '"
-~- '
.00
(ql_______a6444.1~-----
S5230.00
(10) ______.___..__------
(111 _..:t.1hf.74. 15
(121_$81,217.85
(131
(141
081,217 .u5
(151 __t81.2L7.B5--x..D-= --SCl.OO
(161 ________._____------x .06 =
(171
.____---X .15 =
(1BI --$0.00
Intere,t
Oiuount
20. If lino 19;' groa'o, .hon line 18. .nlor ,ho dill..onco on lino 20. lhi. ;.,ho OVERPAYMENT.
aD
21. If Lino 18 i. grootor .hon lino 19. on' or .ho dill..onco on Lino 21. Thi. i"ho TAX DUE.
A. Enter the inlerest on the balance due on line 21A.
e. Enter the tolal 01 line 21 and 21 A on line 21 B. Thi' j, the BALANCE DUE.
Make Check Payable tal Reglstlf of Wills, Ag,n'
to.ao
(211
(21AI
(2IBI
---0;00
L'~ 'I"''' ,,., _.9~!--------~-'
~ J 7,/97
0"11 '
_-9~t ? 7
(Prop.rty lolntly.own"r;';lth Rlghi-oIS';r~i.~..hlp mu,l b. dlIClo..d on S,h.dul,'1 Allreol tllol. Ihould bl.r~p~ri-;d-~i.'-;;lr mork".tv;;i;.
whl,h II d.fln.d OIlh. prl<l 01 whl,h proporly would bl ..,hangld b.lwltn a willing buy.r and a willing ..lIor. n.lthor b.lng <omp.lI.d
10 buy ar 1111. bath ha!.!.n_g_'.!a~o!,...bl!kn.wl.dg. a' Ih. r.I..anl 'ad'. ...---.--------.
ITEM
NUMBER
1I..1l0, ,.. 11).1S) 9:~'9.
'l....sJ'
COMMONwlAl1H o. PfNN,nvANIA
IN~ll~I~~jlDft~ ~~;1~~~-=~~~. <-
ISTATI OF
Joseph C. Blocher
1.
None
I
\
SCHEDULE A
REAL ESTATE
---.....-.-.------- ..".-
..---..--....-... -_.-~-
FILl NUMBER
DE~CRIPTlON
VALUE AT OATE
OF DEATH
- ----..--.- .-..--.-.---.- --_._,._-~.
___--.------...----..---.-.----.---- -0-'00---
TOTAL (Also .nlor on Iin. I, Rt<opilulolionl S .
(Ir more space is n..ded, ins,;;;;;;iitionolshte's 01 some sin.) -
1,IVIWlIIU 1'17)
\_ SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
- - -~ ..-..-,.- .-- .. .. .....'
ESTATE OF J oao1>1I C. Blocher
~j;g.
Ploa.o Print arTy!,!
FilE NUMBER
COMMONWEAltH Of 'ENNSVl"ANIA
INH.lnANCt 'AX InUIN
IlIlDINt DICIDINl
----.--.-.--..-----
IAII pfOp.rty lolntly.own.d wllh the Righi of Su,,,I,,onhlp mutl b. dlulot.d on Sch.dul. FI
----.--- ~_.-
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
3.
1980 Honda ffiotorcycle
.H ,000.00
$750.00
$500.00
1.
1988 Buiclt
1970 Cldan.obile
2.
TOTAL (AIoo enter on line 5, Recapitulation) S 5 . 2 50 .00
(Aflach addilional BY-" l( 11" ,h.." if more 'pac, i, n"dld,)
.lV-U1D [U IJ 11]
1I~:'~'~l\
.~
COMMOHW(AtHt Of "UH~Y1YAHIA
INHllnANe. 'AX .nUI"
III11DIN' OlelDl"'
SCHEDULE G
TRANSFERS
\
PLEASE PRINI OR IVPE
fiLE NUMBER
ESTATE Of
Joaeph G. Blocher
THIS SCHEDULE MUST BE COMPLETED AND FILED IF tHE ANSWER to ANY Of tHE QUEStiONS ON tHE REVERSE SIDE Of tHE COVER SHEEl IS YES.
ItEM OESCRIPIION 01 PROPERlY \ TOTAl VAlUE DECO. DOllAR VALUE
NUMBER Incl.d. nom. a' ,h. IIon.,.'N.'hoi".Io"o",h".'0 oI".d.n', oIu', olr",n.',' EXClUSION 01 ASSEt I~'. 01 mfl~w"S
1 .
Integon Life Insurance corp.
Retirell,en t Deferred Annuity
Death benefit transferred to
surviving apOuse.
Surviving spouse(Kathryn Blocher)
named' as beneficiary of
account.
$B7,642
100% $87,642
__.____".n.-.~ -----
. TC?~-,,~_l~ho enter on_lin~ 7..RM(Jpitulalion1
'II mor. 'pace is nNded. in,ert odJilionollhH'1 0' lomlt liz..J
s 87~642-~ 00-
-----.--..- + ------- .. -- ."
~.,
Jr... . :r~
_. J,..
COMMONWIAllU 01 Plt"'\~lVAUIA
IHttUUANcr IAllUtUIH
.nIDtHIOlCIDINt
ESTATI! OF J ooepl;- C .u_~l~~l;~r
'IVltllll,I'UI
ITEM
NUMBER
A.
1.
2.
B.
1.
2.
3.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
\
I
1-... _. _ _ .PI!a.e Print or Type
FILE NUMBER
L___
----.
DESCRIPTION
AMOUNT
Funeral Expen.u,
1:,UBBelDlan' 0 Funeral Home
$2,433.00
Prospect Hill Cemetary
$350.00
Administrative CO.tl:
Personal Representalive Commissions
Sociol Securily Number of Persono\ Represenlalive:
Veor Commissions poid
Allorney Fees Gregory J. Katshir, Esquire
$1,500.00
Family Exemption
Cloimanl Kathryn Blocher
$2,000.00
Relalionship
wife
Address 01 Cloimant 01 decedenl's deolh
412 Hummel Avenue
Street Address
Lemoyne
Zip Code 17043
Slale
PA
Cily
Pr~~~lt~on, Short Certs, Renunciation
$52.00
Mlscellaneoul Expenle..
Advertising (Patriot News)
Advertising (Cun:berland IJaw Journal)
849.15
$60.00
TOTAL (Also enler on line 9, Recapilulotion)
(If more Ipace II needed, In.ert additional Iheetl of lame Ibe.)
56,444.15
"':"''''1''''*
(()MMONWIA\lH OI'INNsnw.NIA
IN....n.He. fA.lnUIN
.nIOIN,DICtDINI
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
L. PI.... hi", .. .".
FILE NUMBER
ESTATE OF
Joseph C. Blocher
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Joe Ruth Electric (debt)
$5,230.00
e.ee-
TOTAL (Also ente' on line 10, Recapitulation)
(If more space is needed. insert additional sheels of some size.'
s
110 T,'ll"ll"l
~.!fjj-
(O""""Ot;.....'..'ltt<>> 'fIlN\'I'fAt;'A
INHIIII.Net IoU "1U'"
. __ _~ .l'.l~~'" O~~~OI..t
\
SCHEDULE J
BENEFICIARIES
\
FILE NUMBER
ESTATE OF J oaeph C. Blocher
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF ESTATE
------- -
A. T aaable BoqUISt';
1. Kathryn Blocher wife 100% *
2. C. loiichael Blocher son 0%
3. James Blocher son 0%
---~..._--_._.-~----..--- --'.'-~-.
*pursuant to Section 2102(3)
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charilable and Governmenlal Beque,U:
1.
TOTAL CHARITA8lE AND GOVERNMENTAL 8EQUESTS (AI.a enter on line 13. Recapitulation) S
(II mar. Ipac. II no.d.d, Inl.,t addltlonallh.." of lam. lill)
/S -ISO-if
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
(/ ~1~
"ftfJ~~
BUREAU OF INDIVIDUAL TAXES
I Nlll III IANct IAll DIVISION
DlPI. "BObOI
IIARRlsaUNC, I" l/IO'II'O..OI
NOTICE OF INIlERITANCE TAX
APPRA1SEHENT. ALLOWANCE OR alSALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
fll-I'" It tUIII."1
GREGORV J KATSHIR ESQ
900 MARKET ST
LEMOVNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-29-97
BLOCIlER
12-05-96
21 96-1063
CUMBERLAND
101
JOSEPH
C
I~
Anount Ranltt.d
----" -.. --
MAKE CHECK PAVABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEii=i54'j-Ex-jii:iQoPi;Y-NoYicEuoj:uitiHEiiiTiiN-cE-YAx-APPR'A-iSEiofENT-,--jiLi.-OWANCE-OR'----------m-m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BLOCHER JOSEPH C FILE NO. 21 96-1063 ACN 101 DATE 09-29-97
TAX RETURN WAS: (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. CScheduh Al 11)
2. Stocks and Bonds (Schedule 8) (2)
3. Closely Held stock/Partnership Interast (Schadule CJ (3)
4. Harts.gas/Notal Receivable (Schedule DJ (4)
5. Cash/Bank Oeposits/Hisc. Parlonal Property (Schedule E) 15)
6. Jointly Owned Property (Schedule FJ (6)
7. Transfars (Schedule G) C7J
8. Total Auats
CHANGED
NOTE: To insure proper
credit to your account,
subnit tha UPP.~ po~tion
of this fo~m with you~
tax paymant.
.00
.00
.00
.00
5,250.00
.00
87.642.00
(8)
92,892.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. fune~al Expensas/Adn. Costs/Hisc. Expensas (Schedula H) (9J
10. Dabts/Ho~tg.ge liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Valua of Tax Ratu~n
13. Cha~it.ble/GoYe~nnental Bequests (Schedule J)
14. Net Value of Estate Subject to Tax
6,444.15
5.230.00
Ill)
1121
1131
1141
11.674 1~
81,217.85
.00
81.217 .85
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ahh returns assessed to date.
ASSESSMENT OF TAX:
15. Anount of Line 14 at Spousal ~at. (15)
16. Anount of Lina 14 taxable at Lineal/Class A ~.te (16)
17. Amount of Line 14 taxable at Collate~al/Clas. B ~at. (17)
18. P~lnclpal Tax Due
TAX CREDITS:
PAYHENT
DATE
NOTE:
81,217 .85 X .00=
.00 X .06=
.00 X .15=
1181
.00
.00
.00
.00
RECEIPT
NUHBER
DISCOUNT It)
INTEREST/PEN PAID (-I
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAlO AFTER DATE INDICATEO. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
'-:;(;
RESERV'TIDN' E.I.I.' of d.c...nl. d,ln. on or b./or. D.c..b.r 12. 10.2 -- I' on. fulur. Inl.r..1 In Ih. ..1.1. I. Iron...rr.d
In po.....lon or .nJo...nl 10 tl..' I 'coll.l.r.ll b.n./lcl.rl.. o' tho d.c.d.nl .fl.r tho .,plr.llon o' .n. ..1.1. for
Ilf. or f.r ...r.. Ih. Co.......llh h.r.b. .,pr...l. r...r..' Ih. rl.hl I. .ppr.I.. .nd ...... tron.f.r Inh.rll.nc. T.,.'
at the lawful CIa" B (collatlrel) rata on any .uch futura Int.r..t.
PlmpaSE OF
N01lCE1
To 'ulflll Ih. r.oulr...nt. of s.ctlon 21.D of Ih. lnh.rlt.nc. .nd E.t.t. T., .cl. 'ct 21 o' 100S. (72 P.S.
Sactlon 9140).
PAY"ENT 1
D.t.ch Ih. t.p porllon o' Ihl. Nollc. and .ub.11 wllh .our p....nt to tho ...I.t.r o' Will. prlnt.d on Ih. r...r.. .Id..
.."ake ch.ck or aon.y order payable tOl RECISTER OF MILLS, ACENT
REFUND (CAU
A r.'und of . t.. cr.dll. which w.. nol r.qu..t.d on Ih. To' ..turn. ... b. r'ou"I.d b. co..l.lln. .n "'ppllc.llon
for ..fund of p.nn..I.onl. Inh..II.nc. ond E.lot. T.'" "E'-l'l". ,ppllc.llon. .r. ...Il.bl. .t Ih. Df'lc.
of the Rlgl.t.r of Will., any of the Zl A.venu' DI.trict Offlc'" or by calling the .p.clel 2~.hour
en.w.rina ..rvlc. nuab.r. for fora. ord.rlng: In P.nn.ylv.nla 1.8DO~162.20S0, out.ld. P.nn.ylv.nl. and
within 10c.1 Harrl.burg .r.. (717) 787.809~, TODe (717) 772~2Z5Z (H.arlng Iapalred Only).
OBJECTIONSl
An. p..I. In lnt.r..1 nol ..II.fl.d wllh Ih. .ppr.I....nl. .llowonc. 0' dl..ll.w.nc. o' d.ducllon.. 0' ........nl
o' I.. 'Includln. dl.counl 0' Int.r,'ll .. .hown on thl. Notlc. .u.1 obj.cl wllhln .1.1. (6Dl d..' of ..c.lpl o'
this NoUce byI
OR
.~wrltt.n prot..t to the PA alpart..nt of R.venu., Board of APp.al., a.pt. 281021, Harrl.burg, PA
-~el.ctlon to have the .att.r d.t.reln.d at audit of the .ccount of the plr.onal r.pre..ntatlv.,
.~app..1 to the Orphan.' Court.
171za~lOZl,
OR
AD"IN
lSTRATlYE
caRRECTIONSl
factual .rror. dl.cov.r.d on thl. ........nt .hould be .ddr....d In writing tOI PA a.part..nt of R.v.nu.,
lu'." of Indl.ldO.l T.,". 'TTN, po.1 ........nl ...1.. Unll, D.pt. 21D6DI. H...I.bu... P. 17121-DODI
phon. (7171 717-6SD5. S.. p..' 5 of tho bookl.1 "In.l.ucllon. for Inh..II.nc. To' '.Iurn for . ...Id.nl
o.c.d.nt" (REY~1501) for .n ..plan.tlon of .delnl.tratlv.ly corr.ctebla arror..
DISCOUNT:
If .n. I.. duo I. p.ld wllhln th... '" c.l.nd.. .onlh. .ft.. tho d.c.d.nl'. d..lh. . fl.. p.rc.nl (5Xl dl.counl of
the ta. p.ld I. .llOWld.
PENALTY:
Ih. 15X I.. .on..I. non-p.rllclp.llon p.n.ll. I. co.put.d on Ih. 10t.1 of Ih. I.' ond Inl....1 .......d. .nd nol
p.ld b.fo.. J.nu." II. 1006. tho fl..1 d.. .fl.. Ih. .nd of Ih. I.' .on..I. p..lod. Thl. non-p..llclp.llon
p.n.II' I. ..p..I.bl. In Ih. .... ..nn.' .nd In Ih. Ih. .... II.. p..lod .. ... w..ld ..p..l Ih. t.. ond Inl....1
that ha. b..n .......d .. Indlcat.d on thl. notice.
INtEREST:
Inl.r..1 I. ch.r..d b..lnnln. wllh .1..1 d.. of d.llnqu.nc.. 0' nln. '0' oonlh. .nd on. (II d.. fro' Ih. d.t. of
d..lh. 10 Ih. d.l. of p....nl. T.... which b.c... d.llnqu.nl b.fo.' J.nu." I, 1012 b... Int.r..1 .t Ih. ..1. of
.1. (OXl p.rc.nl p.. onnu' c.lcul.t.d .1 . d.ll. ..t. of .DDDI6', All I.'" which b.c..' d.llnqu.nl on ond .fl..
J.nu." I. 10.2 will b..' Inl.r..1 .1 . ..t. which will.." fro. c.l.nd.' .... 10 c.l.nd.. .... with th.1 ..1.
announc.d by the PA Dapart..nt of R.v'nu.. Th. .ppllcabl. Int.r..t rat.. for 1982 through 1997 .r'l
~ tnt.r..t Rate D.lly Int.r..t ractor !!!! tnler..t Rat. DallY Inl.rnt ractor
19U lOX .OOOS~8 1967 oX .OD02~7
19U 16X .DOOU8 19118.1991 lIX .000301
I9I~ lIX .00nOI 1992 oX .000247
1985 UX .00nS6 1995~I99~ n .00019Z
1986 lOX .000274 1995.1997 oX .OOOZ~7
.~lnterl.t is calculat.d .. follo...1
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--An. Hollc. I..u.d .ft.r tho t.. b.co... d.llnou.nt will ..fl.cl on Inl.r..1 c.lcul.llon 10 .Ifl..n (151 d...
b.yond thl datI of the ........nl. If pay..nt I. ead. afl.r the Int.r..t coeput.tlon data .hown on the
Notlc., additional Int.r..t au.t b. c.lcul.t.d.
rersonal Representati~~
_i~ ...counsel for personaL
representative
E5lJ\TE. IF ESTATE IS NOr ~PU;JE), FIlE ^ 6.11. FORM 't\WU.'i urU'u. W'\t'1.t.lLU'l.
ST/D'U5 ItEPOIlT UllDJ;R RU!&_.i.:ll
pursuant to RuLe 6.12 of tha supreme court Orphans'
court flu les, I l'eport the to L lowLnq w Lth respect to con,p1etion 0 t
Lhe adnlinistration of tha above-capL loned estate I
.
1. State whether. administration ot the estate is COll'ple~e:
'{es', NO
2. 1f the anllWer Is No, st.lte when the personaL
representative reasonablY believes that the administration wili be
complet.el
3. If the answer to No. l is '{es, state the followinq:
a. Did the personal representative file II final
account with the court? Yes No
b. The separate Orphans' Cuurt No. (if any) [or
the personal representative's account iSI
c. Did the personal representative state an
account informally to the parties in interest? '{es " No
d. copies of receipts, releases, joinders and
approvals of formal or informal acCounLS may be filed with the
c.r' of the or,"."'- C.o",c ."d '.Y "i,".ChOd co chi' ,opor<.
0"co.lIllg/18 Wb4 ~
I ' Signaturp flV
-r;
{'1"" l'nY",r -~ '" r ,.....; r ",-, , 1'; ,...."
llame (Please type or print)
_: ;1-, : ..,1" ,""? t 't- t. . .
_" _ ,_ ~: t-e.,' ;.C: o.vn(.~ /.'~
A.ddress
L..:.:.,J "I'~~ n.'.'~
'fe I. No..
.-;\
-~ :;
.....,..
~~.
Cdpaclt...:
;,#
(AAHI rmt/ AM3)
1'/043
--
".....2'