HomeMy WebLinkAbout97-00250
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21-97-250
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4018037
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No.
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, +.... 1M' i " . ."1'X",,')," '. .... COIlMONWIALTH OF PINNIVLII'NIA . DEPAlITMINT OF HIALTN . VITAL AlCORDI, ' , '
'~.' ,_. 1",-->.!!, _>.",,~~i.Mr.,._,.- """"....- . CERTIFICATE OF DEATH,; I~"'"''~.'-''' .", ,-" "'"",,"" " '.,"'
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,"'~~':~""::"L"i~"I"""'"'''' ~""'Collins. Ma1e"~'" ..177-60-0754' .- Februery 9. 1997
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Lonnie
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A....24.1966
21-97-250
RENUNCIATION
In Re Estate of _~M~_41_~2'!!--_,_
deceased.
To the Reglstef of Wills of
~4,~ ~ ~_,___________ County, Pennsylvania,
The undersigned
/..O~~J. r.._~~__~~~'-^::_~, S If. /
FA 1?+fI1t
of
the above decedent, hefeby fenounce(s) the right to administer the estate and fespectfully ask(s) that Letters
0;: ~ oS rl'\.A 111'J .:; _____________
belssuedto__~VSA~,.-tt. I/A-z.'Y/'/"2.~()-nft:t1 01--_ J~'-NJ~.
WITNESS
~_ hand this
day of _~II.Uf , 19-1L_.
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-;1.3(,. A 04f'lI.ttD~T't.lCf..~'
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(Address)
(Slgllature)
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CERTIFICATION OF NOTICE UNDER RULE 5.6(at
Name of Decedent 1_ Lonnie L. Collins. Jr,
Date of Death:
Februarv 9. 1997
Will No.
Admin, No, 1997-002<;0
To the Regis ter:
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
March 24. 1997
Name
Address
Lonnie L. Collins, Sr.
236-A OberhoH"er Road. Eli ?Rbet hi nwn..------EcL 17077
Susan M. Vazquez
19 Shadv Lane. Eno1a. PA 1702<;
Notice has now been given to all persons entitled thereto under
Rule 5.6 (II) except None
Date I March 24, 1997
JliktfJxt
Signature
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Name Ronald D. Bul1er"~u.ir.lL
Address 300 N. Second SI.. P.O. Rox 410
'Q ,~1
HarrisburQ. FA 17108
Telephone (71 71 236-148<;
Capacity:
Personal Representative
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Counsel for personal
representa t i ve
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RONALD D. BUTLER, P. Co
A I HlnNIlY AT LA'"
.
'(~U~ 2. '$~1
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liability portion of the driver's automobile insurance policy. That amount Is the full amount of
coverage available to the driver under the Dairyland policy,
5, Counsel for the Administratrix obtained consent to settle from State Farm
who provides underinsured coverage applicable to the Decedent. Negotiations are ongoing with
State Farm to either sellle or arbitrate what amount shall be paid in underinsured benefits to the
Estate,
6, The Administratrix desires to execute the said release, whereby Dairyland
agrees to pay the Estate of Lonnie L. Collins, Jr, the sum of Fifteen Thousand Dollars ($15,000),
and Petitioner, as Administratrix of the Estate of Lonnie L. Collins, Jr" agrees to release
Dairyland from any further claims arising out of the accident. A copy of the proposed Release
is attached hereto and incorporated herein by reference as Exhibit "A".
7. Petitioner and Dairyland have no authority to compromise and settle this
claim without tile authority and consent of this Court as provided in 20 Pa. C.S, ~3323,
8. The only parties in interest herein other than Petitioner, Mother of
Decedent, is Lonnie L. Collins, Sr" Father of the Decedent. Lonnie L. Collins, Sr. has
disclaimed his interest in the Estate pursuant to 20 Pa. C.S. ~6202, A copy of the disclaimer is
attached as Exhibit "B".
7. Lonnie L. Collins, Sr, acknowledges that ,under the intestate
laws of the Commonweal th of Pennsylvania Susan M, Vazquez will be the sole
beneficiary of the Estate of Lonnie L. Collins, Jr.
8. Lonnie L. Collins, Sr. intends to file this Disclaimer with the
Clerk of the orph~ns' Court Division of Cumbe,rland County, Pennsylvania and
deliver a copy of the, Disclaimer to Susan M. Vazquez as Administratrix of r.he
Est.ate of Lonnie L. Collins, J~'. ,pursuant to the rsquirements of 20 I(a, .Con.
Stat, ~6204.
IN WITNESe WHEREOF, the undersigned has signed this Disolaimer this
1 C'r)
~day of April, 1997.
,/Z.<,L,j, l
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Lonn.ieL, Co 1 l'I::ns , Sr,
236-A Oberholtzer Road
Elizabethtown, PA 17022
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WJ;TNESS,
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REV. 1500 Hi 17"~ 9,.~~. j INHERITANCE TAX RETURN
~- RI:SIDENT DECEDENT
COMMONWEAlTH Of PINNSYlVANIA (TO BE FILED IN DUPLICATE
D1PARmWWJ.MV!NUE WITH REGISTER OF WILLS)
HARRIUUR~!.- PA '?12_8 O_~l._ . "o.__~... _ ~_ COUNTY (ODE
O~ E NT'S N"Mf ItASl, flll!f'AND MIDOlf INltlAtl - ~;.-=;.;;:.=;~~~.;.::...;.:;._.;.._.,.,:.~.._-.~~,.;. 5f(ffi[Nl;~ (O-M-l'l~-Tr~iiliRfi,f-~"~:.;=;';"'-
Collins, Lonnie L., Jr. 19 Shsdy Lane
~i:::~~.r::;~,,:r~~i~ l~r~;Zi;,;~,. . "'I.."";.:~k~:::::~.u _==
IX] 1, Orlglnal Return [.J 2. 5upplemon!ol Return L J 3. Remolnder Relurn
Ifor dul.. of death prior 10 12.13.821
[1 A. limlled EIlote [.140, Fulumlnteresl Compromile [] 5. Foderal Ellahl Tux Return Required
110' dOle. of d.alh ofter 12.12.82)
[] 6. Decedent Died fetlale 1"1 7. DtClldtHIl Molfllolned 0 livlng TruI' Q_ e, TCltol Numb.r of Saf" Deposit 8011.8'
IAIIClch copy of Will) IAltoc;h copy of Trult)
." I) toNPlDINrIMTAX INfoOllM~..!fON !!fOULIi II DlMlC1'Ill fOl ,.. '';' ",c,if:l!l;l,~We) ~. .~
NAM' rOMPl'" MAILlNO ADD"SS
Ronald D. Butler, Esquire 300 N. Second Street, P.O. Box 430
j""tlON'''"'''',-------- . Harrisburg, PA 17108
.71LL__~?~.::.~~82_=c,_=_____=.,~ _ -............m....- _ '_
12, Net Vallie of Estate lline 8 minul line 11)
13. Charitable and Go....ernmental Roquelh (Schedule Jj
___ 1~_Net Value Subject 10 .!~~J~~_~_~~lnu5~.]]L.
15. Spousal Transfers (for dates of dealh after 6.30.94)
Sue Instructions for Applicable Perr.enloge on Reverie
Side. (Indudo values from Schedule K or Schedule M.l
16. Amount of line 14 tax<:1ble al 6% rale
(Indude values from SchedulE'l K or Schedule M.J
17. Amount of Line 14 IOll,oble al 15% rale
(Include ....alues from Schedule K 01 Schedule M.I
18. Prlndpollox due (Add 10K from Unel 15, 16 ClOd 17.}
19. Credih Spousal Poverty Crodlt Prlor P"ymenls
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1. Reol EIlale IS,hedul. A)
2. Stocks and P,onds (Schedule 8)
3. CIOhtly Htlld Stock/Parlnership Interest (Schedule q
4, Mortgoges and Noles Recei....able (Sch"dule D)
5, Cash, Bonk Deposits & MilcoUuneous Personal Property
(S,hodul. EI
6, Jointly Owned PrOpotly ISchedul.. F)
7. Tron.I... IS,h.d"l. G)IS,hedul. l)
8. lotal GrOll Aueh (10101 lines 1.7l
9. funerol Expenses, AdministroU....e COSIS, Mlscellaneoul
EX~(lnlos (Sch&dule HI
10. Debts, MoIIgoge Liabilitlei, liens (Schedule I)
11. Total Deductions (total Unes Q & 10)
J5 -/~f.
3
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+
FOR DATES OF DEATH AFTER 13/31191 CHECK HERE
IP A SPOUSAL
POVERTY CREDIT IS CLAIMED l
fill NUMBER
21
97
250
o~.. N.UIt\.B.~~.
YEAR
( I) um____________
(2) .._
(3) __... _...._~~..~___
14) ___....
15 I __.....2'-~~L.}L__
(6) ..____....._~~~_._
(7) _.._.
5,267.31
191 ~_!0.44:L..2L
110) ..
(8)
(11)
(12)
113)
114)
_~L442 :~..._____
_~]_~.~8}______
~)75.68)
115) __...
_._-~_I<._.
116) _...... .. ...___..___...._x .06 ..
(17) ._.....___..,........_............._. .15 m
(181
DlscO'unl
Inleren!
+
(19)
120)
20, If line 19 Is grea!er thon line 18, enter the differ8nce O'n line 20. ThIs ilthe OVERPAYMENT,
me]
Clw( "lIre If you CHI;l roque!>'lng n H,.fund of yOU! oval 'o')lmenl .
21. If Line' 8 h greater than line 1 Q, (tnler Ihe diffBrenco on UnO' 21. This is Ihe TAX DUE, (21)
A. Enter the IOlerell on lhe bolcJnc8 due on linll 21 A, (2\ Al
B. Enter Ihe 10101 of line 21 ond 21 A on line 218. This II rha BALANCE DUE. 121 B)
_ '!'~~~.,~~.c_k__PQy~bl_!_,!C!t,_R..~,I.~~!_~f WIll.,_ A,~!~,! ....m. _. ._,_.~__
L__"_.~~_aE S~~.~l_O ANSWIR AL~.~u..E.s!IONS_ONR!y~R$E 5101 AND TO REC_~ECK MATH ..i( <(
Under penohlet 01 porjvry, I declare Ihall ha....e exomined Ihl~ return, induding Cl(compol1ying I<hadulel and stalemonll, and 10 Ihe best of my knowledge and belief,
II IIlruo, corred and complelo, I daclorlllhClllllf (,,018Itolo hl.l' beon ropor!od C1ltruc mmkat value. Doclaration of preparer other than the perlonal representative il
baled on all informallofl of which prepmor hca any knowlodga.
SiGNA.--.'Rr-O'f"Pi.RS..-6FrR.fSP6N5i~'-IE'FOit"~iN 6 Rr':lj,ki',-':'.. Arl[)Ht~S 19 Slwdy Lane ---------------.--.. DAtr-...-;a~'------'._-'---'-
... "/1. ~. '77), . ..zrfh (,t".,=:., Enola. fA 170?5_!Y(y7
A l" on "'Y" :?':!1"~ ,'"'''' 6'1" I' }^,,,,,'" 300 N. Second St... P. O. Box 430 OA" T"r
.{~ b/<; 0<:>< Harrisburg, I'A 17108 /l!0!'i7
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.
.
COMMONWIALTH m HNN6"lvANIA
INt4UlfANCf TA)( u:ru.~
mNlINT UfCIOlNT
l SCHEDULE H
fUNERAL EXPENSU,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
.= .---
1'1._ P,lnt or T .
ISTATI O~
Lonnie L. Collins, Jr.
2197-250
ITEM
NUMIIR
A. 'u_al "',..n...'
2.
8.
DISCRIPTION
1.
Mussslman Funeral Horns - Funeral
Rolling Green Cemetery Company - Headatone
1.
Administrative Cost.,
P.FIOnal Roprelontali.. Cornmllllon.
Social S...,lty Numb., of "","onal Repre.entatl..,
Yea, Comml..lon. paid
2. AlTo,n")' Fvo. Ronald D. Butler - Estate
Robert F. Claraval - LawsuH (1/3 contingency)
3. Family hemption
Claimant Susan M. Vazquez R.latlon.~lp Mother
4.
C.
1.
2.
3.
A.
5,
6.
7.
8.
Addre.. of Claimont ot decedent'. death
19 Shady Lsns
SI""t Add.... _
Enola
Stote ~_ Zip Coda 17025
City
Probot. ,,",
Mlsc.llanoClll' Exp."...,
Register of Wills - Filing fees
Register of Wills - Short certificates
Register of Wills - Inheritance Tax Return and Inventory
TOTAL (Alia ""'., on II", 9, Rocapltulatlon)
(If mo,. .pace I. n.....d, In..rt add/tlonol.h..ts of 10m. silO.)
AMOUNT
6.282.00
1,238,99
1,350,00
1.500,00
28.00
21, 00
3.00
20,00
S 10,442,99
Is-/t:>S"-3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
l._._.~
aU~EAU OF INDIVIDUAL TAKES
Utlf.AITAHCE lAM DIVISION
()[flT, 160001
HARRISBURG, Pi 111Z8.0601
NOTICE OF INHERITANCE TAK
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAK
03- 23-98
COLLINS
02-09-97
21 97-0250
CUMBERLAND
101
[~~~ :..ltted - J
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WXLLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
R ifV: is;,-j" iif"A Fp. f (IF 9'fi -NoYi CE" "(iF" i"tiiiER"i f AilC E. 'i"rA"pjiiiA" i sEifENT -; -A L i"!iiiAN"c E '''ClA - -."" -". -"" - - - - -"
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
LONNIE L FILE NO, 21 97-0250 ACN 101
DAn
EBTA TE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
RONALD D BUTLER ESQ
300 N 2ND ST
PO BOX 430
HBG
PA 17108
ESTATE OF
COLLINS
TAK RETURN WAS I (X) ACCEPTED AS FILED
~ESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. (Sch.dule Al
2. stock. and Bond. (Sohedule 8)
3. Clo.Ily H~ld stock/Partnership lnt.r..t (Sohedule C)
4, Horta.g'I/Not.. Receivable (Schadul. OJ
S. C..h/Bank Oepooit./Hilc. Paraon.l Property (Soh.dul. EJ
6. Jointly Owned Property (Schadul. FJ
7. 1',..aoI1.,..1 (SClhaduh G)
8. Totll1 A".t.
) CHANGED
11)
C21
(5)
(4)
(5)
(6)
(7)
.00
....l!!..
,00
.00
5,267.31
,..Q!..
,00
II)
APPROVED DEDUCTIONS AND EXEMPT~ONSI
9. Fun.ral Exp.n.../Ad.. Cost,/Hilc. Exp.n,.. (Schedule H)
10. Debt,/Hortgag. Liabilities/Liana (Schedule X)
11. Total Dadu(.;t ion.
12. Net V.luft of Tax Return
15. Chari~ab18/GoY.rnnantal 8aque.tw; Non-elected 9115 Trust. (Sch.dule J)
14. Net Valu. of E.t.t. Subject to T.x
If an as....m.nt was i..U.d pr.viou.ly, lin..
reflect figur.. that includ. the total of ~
ASSESSMENT OF TAX:
1&. AMount of Lina 14 .t Spou..l rat. US)
16. AMount of Lina 14 t.xable at Lined/Chu It. r.te (16)
17. AMount of Lina 14 taxable at Collatara1/Cle.. 8 r.te (17)
1a. Prinoip.l Tax Du.
NOTE I
"AX CREDITS I
PAYHENT
DATE
RECEIPT
NUHBER
DISCOUNT C+)
INTEREST/PEN PAID C.)
. IF PAID AfTER DATE INDICATED, SEE REVE~SE
FO~ CALCULATION OF ADDITIONAL INTEReST,
10,442.99
.00
U1I
112)
CU)
114)
191
110)
*
UW-lhl fl U, 109-'/1
LONNIE
L
DATE
03-23-96
NOTE I To insure prop.r'
oradit to your account.
IUb"it the upper portion
of tht, for. with your
tax pay".nt.
5,267.31.
1 n . 44~ 99
5,175.68-
.00
5,175.68-
14, 15 and/or 16, 17 and 18 will
return. a...s.ed to date.
.00 K .00=
.00 K .06=
.00K.15=
UI)
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
--.-..----
TOTAL DUE
.00
.00
.00
.00
_____~~:i~ .
.00
.-----
IF TOTAL DUE IS LESS THAN II, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" eCRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INS'rRUCTlONS.)
:":.".1
;~~
.,~
,50
RESERVATION I Elt.... of declHfenU dying on Or be for. Deeub.r lZ, 1912 -- if '"~ f"tur. Int.r..t In the ..t.tll It tun.flrrlld
In Pll.....lo" or "'Jay..nt 10 CI... I ((I(l11Itlrl1) b.nlflol.rl" nf the dlClde"t IIftlr the cucplrlUon of .n~ utlte 'or
11'. or '0,. Yllr., thl CDIIIIClnW.,lth her.bv 'lCprl"h r...r,," thl right to eppr.l" and ...... tren,'lr Inherltanol Tiki.
It tM 1,w'lotl CI...S (c:olllter-' J ,..t. em MV luen futu". lnt.rllt,
PURPOSE Of
HOTlCE I
PAVttENTI
REFUND (CA),
OIUECTlONSl
ADMIN
ISTAAflVE
CORRECT IOH'S,
DISCOUNT I
PENAL TV ,
!tHEREBT I
To fulfill thl requlrl..nh of SloUon 21"00' the Inhlrltanol end ht,tl hl( Act, Aot 21 of 1995, (12 P.I.
S.atlon 9140),
nltleh the top portion of thlt NoUc. ltnd tub,it with VrM.Ir pevunt to the Reahtlr of Wl1lt printed !ton thl rlVlr.. .Ia,
HHlkl oh.o~ or 10nIY ordlr Pll'illbl, tal REGISTER OF MILLS, AGENT
A r.'und of . taM cr.dlt, whlflh w.. not requllted on thl TaM Alturn, .IV bl rlql~..tld by oOlplltlna an "Appllcet1on
for RI'und of Plnnt~I".nlll Inh.rttancI Gnd E't,tl TIM" (REV-I!H3), Appllo.t1on. Irt .Ylihblt It thl OfficI
of tM RIghtlr of Willi, Itl'i of the Zl AIYlnul District Offloll, or by clllIng thl .p.elal 24-hour
Inldrlng .."vlo. nultbers for for., ordlrlngl In Penn.vlln,nl. 1-800-)62-2050, outsldl Pennlvlyanla Ind
within loul Harrh-burg ar.. 0'17) 787.&094, TDnl (71'1) 772.2252 OlurlnA hapalr'd Only).
Any plrh In Int.,..,t not IIIthfl.d with the appr."...,t, 1110~ancI or dh.llonncl 0' deduction., or ....ltll'.nt
of t.M (Including dhcount or lnt.rllt) II Iho",n on thh Notice IUlt Object within .!Mtv (60) diY' of rlClJpt of
thl, Notlo. bYI
--wrltt.n pratllt to the PA D.partllnt of RlyanulI, lo.rd of Appul., Dept. 281021, Harrltburg, PA 17ilS-IOll, OR
'--lllctlon to hay. the .Ittar deter.lned .t audit of the account of the plr.on.1 r.pr.untetlv., OR
--appul to the Orph.n,' Court.
Factual .rrort dltco.....,..d on thh ."....aant Ihould b. .ddr....d In writing tOI PA Olpart.ant of Rlvlnue,
.uruu of IndlyldulIIl hWII, ATTNI Po.t A..IIII..nt Revl.w Unit, D'Pt. 280601, H.rrhburg, rA 17128-0601
Phona (117) 187-6505. SI' pagl 5 of the bo,",kl.t "In.tructlont for Inherltanc. Tali Raturn 'or . Rltidlnt
DoCldent" (REV.150lJ fof' an Ikf)hn.Uon of IIId.lntst,..U....ty corr.ctabl. errors.
If any taM due II p.ld within thr.. (5) cal.nder Hnth. aftar the d.cldent', dllth, a flv. Plro.nt (n) discount of
the tlM paid It Illowed.
lh. 15le teM Hnllty non-plrthdp.t Ion p.n.l ty h cl!IIput.d on thl total of the tlli and Intar'lt .......d, end not
paid bl'or. Jenu.rv II, 1996, the flr.t a.v .fter thct and of the hI( unaltv Plrlod. This non-p.rtlclp....lon
p.nllty It applahbl. In thl IH. IIt1nn.r and In thl the 'lII.a tI.. plrJod II you wculd app.,1 the tftM end Int.,...t
that ha. bien .......d a. IndJc:etad on thit notlCI.
Intlr..t it chargld baglnnlng with 'Irlt dav of d.II"'wlncv, or nJn. (9) Month. 1M on. (1) dlY frOll thl datI of
dt,th, to thl date of ply..nt. TIMU which b.ca.. dellnquttnt b,'ore Januery 1, 1912 bill' Intarelt at the rate of
11M (61:) p.rClnt p.r annua cllculahd at I d.llY rate of .000164. All tlM" which bin.. dlllnquent on end Ifter
Janulrv 1, 19l1t wUI bur Interut lit . retl which will very fro. calandlr Yllr to CIJ.ndar veer with th,t r.ta
IMOuntld by thl PA n.pertlllnt of RIYlnUa, The .ppUc.tJI. Inbr..t rat., for 1982 through 1998 arel
\:!!( Interllt A.t. OftlIY Int.,...t FlIctor !!!r Intlrl" A,tl Dally Inter..t Flotor
I'.IIZ 20;( .D00548 1917 9~ ,000241
1981 16;( .0004]1 1"18-1991 11;: ,000101
1914 lli1 .000501 11J92 9~ ,000241
1985 13:< .000356 19?]-1994 7~ .0001'Z
1916 lOX .000~74 1'9!t-1991 9~ .000247
ulntlrllt It cIJcuht.d .. follow.,
INTEREST a BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINqUENT X DAILY INIEREST FACTOR
.-Anv Natlca luued aftlr tht tlM baco... deUnqulnt will refllct '" Int.rut calculation to flU..n (15) d.YI
beyond thl dltl of tM .1lI.....nt. If ply.ent It ..de aftar the Intlrllt cOllPutatlon dati thawn on thl
Notlo., Iddl Hon.1 Int.,...t Butt b. cllculat.d,
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7. Lonnie L. Collins, Sr. acknowledges that under the intestate
law. ot the Commonwealth of Pennsylvania Susan M. Vazquez will be the sole
beneficiary of the Estate of Lonnie L. Collins, Jr.
8. Lonnie L. COllino, Sr. intsnds to file this Disclaimer with the
Clerk of the Orphans' Court Division of Cumberland County, Pennsylvania and
deliver a copy of the Disclai.mer to Susan M. Vazquez as Administratrix of toe
Estate of Lonnie L. Collins, Jr. pursuant to the rsquirements of 20 Pa. Con.
Stat. ~6204.
IN WITNESS WHEREOF, the undersigned has signed this Disclaimer this
'-11,
lS[:: day of April, 1997.
';l6-~~) .I
..../.My! -lJ(
Co 7/ ! t\.~
'Lonnie L. Coll ns, Sr.
236-A Oberholtzer Road
Elizabethtown, PA 17022
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{(~ (SEAL)
WITNESS,
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