HomeMy WebLinkAbout97-00384
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IlflmllryR.gCllU No
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iff '1'/- 311~
-0.1801,
5896
SI.I.fll.Nn,
Ohio DOjlnrtmunt (If IInnlth
VITAL STATISTICS
CERTIFICATE OF DEATH
TYPE OR PRINT IN PIRMRNINT 'LACK IIjK
.
II.
.1.0 UII/ItIIIlltl'r,rull
_",,,_),<Q.f!I:;,__ -I ,--- -_M1... -, C ^ , - ..PJo:'-"!~~)'-'lfIl" "~~~I()___.Ul:Li.lb"..r:_.ll.L_J.21(>
~,,,(lC'Il! illlCUfllYNllm-fi.f -- ~1I IIQlll.., OnUulaV' ~ J b.flflof \1Il0 lilli' 'l~~ tlndIIU,!!U_ . ,___ ____ .WIIHMVl /41<<41. Ill'; rUt' TllirtIlP.'liOC. ffAylll4_. 'A'''fI'(f\;1'Iiry1
'Y'Iff) Mouth'ili'Y' 11'1"" I 11111'"
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lfW.. 11'",~'Tvo";;IrS Ariiiildfoi"'Trlt~~~:;!';'-xOll~llh IC";'tO;'lfO,';/V"o - ~-~~~~:=__^'~~]';fl~;~."~-~N~O~~I:~=L]~ 2 ~ ~~_oI ~L~)=i=:~_~~.~_
Yilt .., Nil ~. npalllol utpollont 00 lH11ng I Olll.. nllhJlnc. I Ihll /SPI:Jfy) . .
9kr8cli,iy'ffamtiHN~1l1rl, O/u Si".I.ndNlImbflJ ~----- OC.-eTiY;ViIfiQ.,Twp::ortnCli1O,rOrrrillfl----~'"fiiUiilV omlt.'lf; -. .
Clo.vcland C1 inic Foundntion Clovolnnd CUYllh()~1I
l~II~ISlftIUI',;j;!~;,;r I" urvl...1nO SPoUieliTw~,., e, lite onll IUI1JC"iiiip-;llon ((IN'tlndo'Wtlf'dmF;~ ffiilinJofRul nlli7lilrruitiy-'-'--"- .
W~, ()""'....d Ifmlrl Oivg M.ld.n N.m.l dllfln~ mO'1 u/ worM,,, 11ft lla lilt lilt R.lil.dl
married ~lbert Petro homemaker home
13ft. flolloenC&."Sti'I-n'- 13 ounly 30. ilV, own, Twp" or local on -----rrrnlfllGt.no Nur~iIr-.
Pa, Cumberland_. Mec~!l.J-c!Jb_urg____L~1 3 Wef!.~_K~ller st.. _____.
T:jlnil~iancilv-fiiii1t~l 13 ode 14 Wng OntOI',nl or HI~pnnll; Origin? Vel Wt-/ll fflfIlCjI.Anllrieenlnill.n,llIlc\:, 16 Ollc.donl', Educ~lioll ~;~'~,~~~~f"
(/I lu, S,,~.;u~ CI,IJdl', MUICl/I. PlItflo IIIC'f1, .r~.J Whit" ,t~ /SpUI!y/ ~men ,ryIS"ondlfyIO.' OJTiiilTTriil.r-
)(yOl N? 17055 white 10
11 FalhfH. dme {'JI.'. "lIddle, tflll ot Ir I ImQ /FI"', Mrddl" M,ldffl SlIm,m,}
Nichola"
19a.'n'orm8nt'~NiHl\9 (Typl/Priill}
AmoHn Aruffo
~lbert
813 West Keller st,
13tOO .potlllon INlllllofC.m,ro/v'CI.mmli',
oIOlh"PI,u}
Mechaniosbur Pa 170'5
c.oQ&honCirrorflM1l,St'II
Petro
othOtO IlposltIOn
)1'(1"1111 Cremation
DO~Dllon Othor (SJ)fcrM
20d.oiil"&cirolsposilion
'ReOlov.lr'llmS!IT.
cemetery_
Mechanicsbur ,pa.
lb. censo urn or
~
h,LiunsoNumber (ollie'lI1ul
23. ameond Addrll8l0 8Clljty
Walter Martens & Sons
9811 Denison Ave.
Cleveland, Ohio 44102
26bOi~OI
6081
'rr t996
C8r1ltylngPhYllclan
To lh~ busl 01 my knowla~g8, doalh occur/oLI alllla lirre, dalO, Gild pI8~e; Il1d due to The o'llle!s) 8ml meMOf at 11'1.d
--.----.--------------------------------------------".
)(Corona'
On Ih~ bU;1 ,,! euminallon Indior il\vu,llgll,on, in my opimon. Ju'lh llCCllIIOd 01 Iha lime, d'll, ,nr! pl,~.; .nd !iulto 11l1l1;'USDlsl Bnd mlnner II SIdled
2lii--TTmeoTOealh-~ato P,onounced Oo~\iCrI/Il Da~, Yur}
7:15 P. M I October 12, 1996
.___1_____-
28oS,gntllUrOandTitloolCertilior
~ 1;:-- .I!.-iA. K . H,D.. Coroner
au eorredlo oroner?
- No
034779
280, 818 Ignlld (MOrll/l,O.y,YUI}
ctober 16, 1996
emean
eet ITYP9/PlilII,
E i abe h Ba ra H.D. Coroner 2121 Adelbert Road Cieveland Ohio 44106
Xl. Part l. Enlar the di$ooau, injuries, or compllcalions lhat caused Ihe doath. Do not enter tho mode 0' dying, such as cardiac or respiratory arresl, llPtO~jm'lt rotlrvt
Shock, or heart leilurll.1I9tonlvona cau9oof'loechlino, T'IlleorprinlhIP.nnlln.nl bl.cklnk. IOnlll.ndOfllh
I~il~tt~'. a 1
/hilJldiUIUOfcorldilJOn ~ Pending. I
rlfultin~in dltlh} I
b, IHllolores e ;;ofl9oquoncoof) I
I
ef'men
Sequenll,ltyhllcondllions,
i' In~.loading to thl imm,dlele
tlun
fnttrlJlldttl'llnIC.llulul
/O,Jul,olinillryIlMtinit"I,d
IlV'nl~,uul"n~ind"'th/
c, DUolo or as II Consequence 0 )
d,Du810(oru II Consoquorulool)
Put U. Othlt .lgn/le'lIt condition. contributing 10 doelh bill nol mulling /n the undOllyi~Q cause Al....n n P'r! I,
32. Mnnner 01 Death
33a. Dele 01 Injury
(Month,D,y, rUt)
ucrl II
318. 1S8n utopsv
Pllrlormed?
:XYes <<-. t~o
ow nmy cClmed
31b,w.t.AutoplyfIMdingl
Av.II,bl,PFioFto COmlllt1ion
ofCauuolOlllh1
. - Yet X No
33c.nurY8lof
":Vn r~jNo
33e, laceo njury'l\llloml,rtnn.SUfl~h(lOo"f.Offic'~t", I~""J
::N,lIUF.1
. Ao~Jdenl
Silicide
IlQmicidl
X Pondlno
-~ InvUliOlljon
CouldNolbl
Odlt/mlnld
33. ocal on (SII..llnd Numbdl 01 Rllr.' f!Qull Numb.r, City 01 Town, Slllt)
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NOV 4 1996
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1543751
t~ U 8 F+G'
Un~ed States Fidelity end Guaranty Company
Pow.r .f Attorney
No 110311
KMW 811 men bv lho58 p'e~ell1s That Uflllld Sttt!li fid.Utf ud Gu~rlnty Comp.ftV, a eorpofil1OO OlOlnlllld Ind existing under Ihe lawl 0' lt1e Stlllft 01
Marylandlnd hlNlng Il~ ptinclplll olllt!! lithe Cltyo! BllllimOl'O. m't'{1 StAtu 01 Mltfylend, dOGS herabyconlll!\Jlllllndllppo!nl Ralph G. Viehman I Jr < .
Thomaa R, Viehman and D, Jean Rodriguez
of the Cily 01 Mechanicsburg ,SliUflOi PennElyl vantil IU lfUll and lawful Allofne'11'~ln.F8cl. 81Ch In, Ihlllr separate capacitY if mOfO than
one is nemed 8001,'(1, 10 lion !Is name as sUfety 10, and 10 f1~eclllfl. loalllnd Ilcknowiedge ROY and all bundS. under1llklf'!OS. cm'lllat:ts aOO other wrinin InstrumenlS in the
nature th"lof 00 bahfll 01 the COnlplnV in ils busirnlss 01 guufanteClIng ttwJ hdflhly ol per.ont 4Juat.nteemg the perlormancll 01 CMlf"cl..; and e~ltulmQ Of OUllllnlOOing
bond.,nd uoderuklf'lgS feQuifed or perMitted in JOy lIeltOllS 01 pl'oceedlngll1l1owed by IlIw
In Witness WhtulOl, th9sltld Unit.d S"'" fldllli~.nd OaulJutV Co",~.ny, has caused Inll InSltumonllo be sealed wilh its COfpOUlIe seal. duly Iltesled by
th6ligl'l!blrOS ollIS VIC(lPfftlidenl8nd AssiSl.llnl Secfntaf)', lhls 18th dayol April ,AO_19 97.
15igl18~1
lI.h.d s..,.. fld.llty ..d o."..tv c...,."". .'
Ry"pp_/fll!iA'1.i~""p.""
VlcePfllSlollnt
Dy~TL"",~,,(lLl:~, .~",.,,"'"
,.,.:~~:nlsecr8IaIY
(Signed)
Stall .t M."I..d )
55
,',
altdMf. City \.'\ 'i
~ \
On this 18th day 01. April . AD. 19 97 ,00010re m.Il'l"OIl\I!!.tOl11"r,;~ A Will.', V!'. Presid.nt of Unlt.d S..,.. fld.IIt/....
GUlrlfttV CoMP'ny, and Thomas E. HUlbulgue, A,slstanl sec. .(e~~.[v~1 faid Company. W..lth bo.,~__O':~um I,m pt'Iflooany. ~lIifmed, who being bV mo se'ielally duly SWOl'. n,
uld, th81Ih6y. \00 said G/lry A, Wilson and T~u E, t1u.I~~8 __te respectively tl1e,'J1ct+f(mident and the A5SP4\Ml!~tttary 01 the said Unk.lt Stltts fld.lity.n4
OUlf8Rty Cn..rry, the cmporat1on OOSCflbed In and wn.~'~u1f:Kl the foregollY,l ~0Yf* of Attomey. th811he~ ",:N-nw thE' seal 01 Jald corporatIOn: that the seal aHIKfld
IIJ Slid PCl'N'er 01 Attornev was IUCh,COfpol818 se'k~hb\;lN,a5 so alll.ad b..~Q!fff_ftt !he Board of Oli8.C~Of. ,s ftldio rorjlOf8110n, oM thai they 11IJned their name3 \hereto by
hk!! OUi6(.5 Vice Prelldent and luslstant Secre~:-fespecuvely, of 1h~,Cl(n~Ytv- ..~ '\ 1
MyCommllllOll.xpi,.,ltIa 1st dayol Al\{!Qst A.O.19?f[Y'" I . ,
I:~;~':: ISigned!, ';',y.. ::.r7.-:!Ln\I~,:,:"Y) .r,.,,'~,~p~i;;qi:t
',,"- \, -' ~,' ' , :j
.', -/.'1' ! -t
".t~~~ "-"
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Thi~ Powet' 01 Attorney IS granted under and hlllll~tfo';~ 01 the follOWing ResolutIOns adopted by the Board 01 Directors of the Untt.d Stlt.. fhl.lity lad
Ouoroilly Co..pony OIl S.ptemOOI 24, 1992 '. .
"'..Ivell.that in conNtcllon wllh the lidehtv and surelY msurance businets of the Company, /III bonds. und6rtakmg3. conlracU and othet mstrumenls Illlatlng to
$lid bulioeu may be Signed, e:<&cuted. And l\Ckllowlooged by persons or enllhes appomtdd as Attoroo'''(s~In-ract pursuant to a POW1,lr 01 Atto/fltly IS$ued In accordance with
theH '8101~llions. Said P(1W8rtsl of AtlomftV lor and on behalf 01 the Coml.'ilny may and shall bo O);lll;U18d In the nama and on oohal! ollho Company. elthel hv Ihe Chairman,
01 the President, or an hecutiwlJic(t PUJSIOtlnt. or 0 Semof VICfl PIO!icient, Of a Vlca President or on Asmtant Vice Plosldent. lomlly wilh the Secletarv (If an A!SI~tant
Secltllarv. under thellllUpeCtlY8 deSIgnations Tho Slgnatute 01 such oljlco15 may be f1ngra~. printed or IilhQ(jf!lphfld Thll Slynatule 01 oach olll1e h)legomg otllce" and the
leal oflhe Company may bo aUiod by lacsimile 10 any Powel of Attomoy or to any certificate lelatmg thelolO appomllng AnorneY\,Hn.facIIOf purposes unly 01 8,(l!CUlmy
IIrld attestmg bOnds and undertukings and olhel Wfilin~s obligatory In the nAtufa IheHlOf, and subJtlCtto any IimllallOOS 10\ forth theroin, any such Power 01 Attorney 01
cenlficalc bealing such faCSimile signature or faCSimile soal shall 00 valid and binding upon tho Company and any such powar so lIKeculed and cerulted by such fac$lmile
signature arid facsimile leal.hall be valid and blndmq upon lI1e Campan'/ Wllh ras~ct to any bond 01 undertaking 10 wIllch il13 validly attlchlld
"I"tv,., That Attomaylstln.Fact shall have tho powm and authorllV, and. In any caso, subjllct to the torms IInd limitations ollhe Power 01 Attorney Iswed 10
them, to eK8cutD and deliver on behalf of the Company and to Bnach the soal ot lh(l Company to any and all bonds IIntl undtlf1aking3. and other wllllnql obllgatOt'V in IhlJ
nature tMlen!. and any such inslI'umenl eJiecuted b'j' such AtlornoyisHn Fact shall 00 a,\ blndlnl) upon lhe Company as if Sl9nmf by an EKecuhw Officet and sealed and
att0slod to by the Secrotary of the Com~ny
I. Thoma' t. ~Iuibfegtso, an Asmlant SllCratary of 1h(J Unllld Stat.. F!d.Uty Inll GUIf.my Comp.,I'f, do hereby c6rtily that me IOfegoing are lIue flKC8rpts
flom the Resolutions ollha said Company as adopter! by lIS Board 01 Dlrectols on $e(ltember 24. 1992 and thai these Resolutions 81e In lull lOlce 31\d eHect
I. the UlldelllOned Assistant SeCIOlaf)' 01 tho United St,'1I Fld.lity Ind Guar.my Company, do heraby caMlty thaI me 1008g0lng Power of Attorney is in lull
100ce and etlect and has not baen r6\loked
In TeSllmony Whereof, I haV1'l hereunto sel m'iJland ond \ho seal of tho Unltld Sl..1I fld.llttand Ou-Iflnty Co",,,.ny,
onlll" 24th day 01 Apnl ,199/
_I ;j' -'/1-
fa' .7 (o,(~"4,1 L '~"'\''.1'~:;"t;;;S;;f;tary
~.,; ...'73
f5~121'l61
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPl 260601
HARRISBURG, PA 17126.0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICI^L USE ONl.Y
/0.; /-;)(, - ;<;?
I.'ILE NUMBE!L,
,2/ ~2
coLl/rlWlx: vr Nl
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tlMllUl
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITW)
PE:T!W, ROSE M.
DATE OF DEATH (f.MDOVEARI '-rDATE oiBiRifIIMMiio.YEAR)---.------
10/12/1996 O'J/OII/l y?fl
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST. FIRST, AND MIDDLE IN~~
['E:TRO, ALBERT c1.
[] I. O<lgIII.1 R~um
[] 4. limiledE.lllle
[:J 6. Deced.'ID1edTestale~ltadIcopyoII\lO
[] 9 Liliglllioo Procoed. Receive<!
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[Xl 2 3oppOmonI.1 R~urn
[] 4a FulurelnterestComplomISEl(d.t'oItJoJath'"~ 12.12-8'1)
[J 7. DocOOenl Malnl.ined . living Tru.1 I'''''' ''''' 0' T'~f)
o 10. Spousal PovertyCredh (dal' of d4~(hootw"n 12.]1.91 el'd 1.1.1)5)
SOCLo\L SECURrN NUMBER---------..---.
1 B 2 - 2 2 - -J B 0 6
THIS RETURN MUST BE FILED IN DUPLICATE wiTH THE'
REGISTER OF WILLS
socw. SECURITY NUMBER
188-14-0751
[) 3 HemalndorR6tum(daI,ordtllllhpliO/(Q(2.1l61j
o 5 Fedet~ Esl81e Tax R~um Requi'ed
_ B. ToIaI Numb<< of Safe o.po.n Boxes
o II. Electloolotaxl-l'/letSec 9113\AIIAll"hS<hO}
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THIS SECTION MUST BE COMPLETED, ALL CORRESPONOENCE AND CONFIDENTIAL TAX INFORMATION BHOULD BE DIRECTED TO:
NAME COMPLETE MAiliNG ADDRESS
DENICE P. BROWN 74 HONEYSUCKLE DRIVE
FIRMNAMEIII~) PORT DEPOSIT, MD 21904
TELEPHONE NUMBSR
410-378--2741
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1. ReaIE.laI.(ScheduleA) (I)
2. Stocl<. end Bond. (Schedule B) (2)
3. Closaly Held CO'p<<afloo, P8I1nerst1ip 01 ~..Prop<ielorshlp 13)
4. ""'Igages & Noles Recelvel>~ (Schedule D) (4)
5. Casl;, Bank D'PO'~' & '-lscellaneou. Pet.ooaI Properly (5)
(Schedule E)
6 Jolnt~ D-Nnod Properly (Schedule F) (6)
o Sop.."e ~lIIng Requasled
7 rlet,l1m Trllf\Sfet. & Miscell.._. Non-P,obale Property (7)
(Sched~e G or L)
8. Total G.... Asseta (lofaI U"", 1 . 7)
9. F\JIl8I'eI Expenses & Admlnl.~aflve Cost. (Schedule H) 19)
10. Delli. of Decedent, Mortgag. UeI>lIi1les, &lIens (SchedUle') (10)
11. Total Oedue1lon.(tofal Unes 9 & 10)
12 NoI Value 01 Eltale (Une8 minus Line 11)
13 Ch..i1able end Govenvnental Beque.Is/See 9113 Tru.t. 101 v.11lch all sledloo 10 lax has not been
mado (Schedule J)
14 Net Value Subject to Tax (line 12 minUS Line 13)
OFFICIAL USE ONLY
;.... .
';oj J
d
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II
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150,000.00
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(8)
52,374.01
150,000.00
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SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amiunl of L~.14Iaxable alll1e .poosallax
rate, OIlransle" uMet See. 9118 (.)(12)
16. Amoonl 01 Line 141axable allineal 'ala
48 , 813 . 00 xo 00 (15)
48 , 812 , 99 xo 60 (16)
17 Am,",,1 01 Lino 141axable aI .Ibling rale
X .12
\6 Amiunt of Line 141axable III coIlllletal 'ale
x .15
19 Tax Due
(11) ,==~~.= 5?~3}~4;~,1
(12) 97,625.99
(13) ==~.,~,.,.",~,..=c.O"""" ,.__..
(14)
97,625.99
D.OO
2,928.7B
(11)
(18)
119)
-2L9?~
20 [.J I OHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's ComplBte Address:
SfREETMDRESS fl]] w. KI':/'LI':I, S'I'I\EI':'I'
CITY---
MI':CIII\N IC~;BlJI\G
] STAlE . PA
,,,,,,: I
I ZIP
Tax Payments and Credits:
1. Tax DlW (page 1 Line 19)
2. Credils/Payments
A. Spousal Poverty Credit
B, Prior Paymems
C. Discouot
(1)
2,92fl,18
3. InteresVPenalty if applicable
D Inlarest
E. Penally
Tolal Credlls (A + 8 + C) (2).
TotallnleresVPenelty (0 + E) (3)_
4, If L10e 21s greater Inan Line 1 + Line 3, enter the difference. This Is the OVERPAYMENT.
Chetk box on Pago 1 Line 20 to request a refund (4)
5, IfLlnal + L1na 31sgrealerthan Line 2, enter the dlllerence, This Is the TAX DUE. (5)
0.00
2,928,78
A. Enter lhe Interest on the tax due,
(5A)
8. Enler the total of Line 5 + 5A, This Is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,928.7f2.
PLEASE ANSWER THE FOLLO'NING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1, Did decedenl make a transfer and: Yes No
a, retain the use or Income of the property transferred; "",'.... . . . . . . , . . , , . , . . , . . , . . , , . . ,. 0 [Z]
b. retain the oghl to designale who shall use the property transferred or Its income; . , , . . . , , , , , , . , . . , ,. 0 [Z]
c, retain a rever1llonarylnterest; or ................... .........,.......,....,0 [Z]
d. receive the promise for life of eilher paymenls, benefits or care? ........."..""...,..,.".", 0 IZI
2, If dealh occurred after December 12. 1982. did decedenllransfer property within one yeal of death
without receiving edequate conslderalion? . . , . . , , .. . .. .. .. . .. . .. .. . , , .. , .. . .. .. , .... 0 [Z]
3. Did decedent own an 'In lrust for' or payable upon dealh bank accounl or securlly al his or her dealh? , , , ,. 0 [XJ
4. Did decedenl own an Individual Retirement Account, annuity. or Olher non-probale property whicl1
contelns a beneficiary deslgna"on? .. . , . .. . .. , .. , .. . , , , .. . .. . .. .. .. , .. .. , , , .. .. .. . .. , .. ... 0 [XJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, XOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ur<I.. pooallies at Il"'i'-"/, I decl...1haI1 have examined lIIis r~um, Including ilCCOOlpan~ng _,Ias ood stalements, ood 10 the l>est at my kooovIedge ood belief, "IS true, CMecI ood ",",pl~e
1lecI..~ioo ~ prepar... clher iIIlv1 ~sooaI rOjlf""'l'aI..l, based 00 .lIlnformalioo at v.f1ic/l prep..ar has any ~.ooMedge.
SIG RE OF PERSON 'SPO ISLE FOR FILING RETURN ~~E J
~ ~3~~
ADDRESS
71/ /--to1.Jt,YSU(/C/k lX. PtJ..et'-llE/"'d$rT mb ~9oY.
J'IG OF PREPARER OTH THAN RE~RESENTATIVE '
,- "'" Z (.(.~-""I. (1'4
ADD S
7 WEST MAIN STREET, SHIREMI\NSTOWN, PA ]701]
DATE
l2-h, /01
, ,
For dales of death on or after July 1, 1994 and before January 1, 1995, Ihe tax rate imposed on the nel value of Iransfers to or for Ihe use of Ihe surviving spouse Is 3%
172 P,S. 99116 (a)(l,l)(I)I. .
ror dales of dealh on or after January 1, 1995, the tax rale imposed on Ihe nel value of Iransfers 10 or for Ihe use oflhe surviving spouse Is 0% 172 P.8. 19116 (a) (1.1) rii)l.
The statule ~~ a transfer to a surviving spouse from tax, and the statulory requiremenls for disclosure of assets and filing a tax relum are sfill applicable ewn
If Ihe surviving sp(luS81slhe only beneficiary.
For dales of death on or aner July 1, 2000:
Tha lax rale Imposed ~n the net value of transfers from a deceased child twenly-one years of Age or younger al dealh 10 or for Ihe u~e of a natural paren!. an ~doplive
parent. or a stepparenl of the child Is 0% 172 PS 99116(a)(I.2)1.
The lax rale in.posed on the Mt value of Iransfers to 01' for tho use oflhedecedent's lineal beneficiaoes is 4.5%, excepl as noled in 72 P.S. 99116(1,21172 P.S. 99116(a)(I)1.
The laxrale Imposed on the net value oflransfers 10 or for the use oflhe decedent's siblings Is 12% 172 P.S 99116(a)(1.3II. A sibling Is defined, under Seclion 9102, as an
Indi~dLlal who has alleasl one palAnlln common wilh Ihe decedenl, whelher by blood or adoption.
SlFf'A4202\1'2
/~.f') (. X'
\ BUREAU Of INOIVIOUAl TAXES
, INhERITANCE UK 1I1YllnON
llEPT, ltlD/o,Ol
HARRI5HUWU, PA 17128-0601
COMMONWEALTH OF P~NNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCE TAX
APPRAISEHENT, AllOWAHCE OR OISAll.LWANCE
Of DEDUCTIONS AND ASSESSHENT Of TAX
DATI!
ESTATE OF
DATE OF DEATH
FILE NUMDER
COUNTY
ACN
'\) ,
DENICE P aROWN
74 HONEYSUCKLE DR
PORT DEPOSIT MD 21904
L\
[
06-24-2002
PETRO
10-12-1996
21. 97-0384
CUMBEHLAND
101
Altount R...itt.d
.~
*
m-\Hl u U, 1'1-111
ROSE
M
]
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLANO CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: is'4'rEiC APi;-CoFiiifj- NoficE" -oF- YNHEififANcE - i'"Ax-jiP'piiiii SEitEN'f; -A Li. iiwiiiicE - oii-- - - - - - - --- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ROSE M FILE NO. 21 97-0384 ACN 101
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expenses/Ad... Costs/Misc. E~pans.s (Schedule H) (9)
10. Dabts/Hoduaua Liabilities/Ltens (Sch.dule 1) (10)_ .00
11. Tob1 D.d<Jctlons (11)
12. H.t Valua of Tax R.turn (12)
13. Ch.rU.bh/Govarnnenbl OpquolltSlJ Non-.lect.d 9113 Trusts (Sch.dul. JJ (13)
14. Hilt Va1u.. of Elihte Subject to Tax (14)
NOTE: If an assessment was issued previously. lines 14. 15 end/or 16. 17. 18 and 19 will
reflect figures tha't include the total of ill returns assessed to date.
ASSESSMENT OF TAX:
16, Altount of Unu 14 .t Spousal rat. U.6)
16. A.ount of Line 1('. illX8bh .t Lin..1/CIS5$! A rat. (If.)
17. A.aunt of Una 14 .t Sibling r..tQ (17)
18. AMount of Line 14 taxable at Coll.t.ral/Class 8 rete (18)
19. Principal rax DUB
AXJMW .
DATE
07;16-2001. .
04-13-2002
ESTATE OF PETRO
TAX RETURN WAS, (
) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l ERt.t. (SohedulD A)
2. stockv and Bonds (Schedula 8)
3. Closely Held stook/Partnership Int.rBst (Schedule C)
4. HortgBgas/Notes Racetvable (Schedule 0)
5. Cash/Bank Uaposlt$/Hlsc. Pnrsonal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Sch.dule G)
8, Total Assets
tlUltBER
WRITEOFF
CD001063
---DISCOUNT nr-
INTEREST/PEN PAID (-)
.00
.00
( X) CHANGED
(1)_-
(2)
(3)
(~)
(5)
(6)
(7)
,00
.00
.00
. 00.
150.000.00
.00
.00.
(B)
SEE
DATE 06-24-2002
ATTACHED NOTICE
52,374.01
48,813,00 K
(18,812.99 K
.00 X
.00 K
AHOUNT PAID
970.98
2,928.78
NOTE I To insura proper
cl'.dH to y(,ur Bocnt.!nt J
sub.it the upp.r portion
of this forn Nit... your
tl)( ply...nt.
150,000.00
~?374 0]
97,625.99
.00
97,625.99
00 "
06 "
00 "
15 "
.00
2,928.78
,00
.00
2,928.78
U9J=
TOTAL TAX CRE~'T _ ',"'.T' I
BALANCE OF TAX DUE .00
-- --
INTEREST AND PE~ 171.01
TOTAL DUE 171.01
--.- --~-
If TOTAl. DUE IS lESS THAN t1, NO PAYHENT IS REQUIRED.
If TOTAL DUE IS REFLECTED AS A "CREDIT" (CR I, YDU HAY BE DUE
A REFUND. SEE REVERSE SIDE Of THIS fDRH fDR INSTRUCTIONS.)
BAl.ANCE OF UNPAID INTEREST/PENALTY AS OF 04-14-2002
. If PAID AfTER DATE INDICATED, SEE REVERSE
FDR CALCULATION Df ADDITIONAl INTEREST.
"~.
RESERVATION I E.t.tl.'o' dla.dlntldying on or blforl Dlol.b.r 12, 1962 M_ if .ny futurl lnt.r..t In the ..tate J. trlnlf.rr.d
1n pa.....IQn ar enJoYlent to CII.. . (collet.rll) btnefJol.rJ.. 0' 'th. ~.o.d.nt ,ft.r tho 'Mplration of ,"y ..t.t. for
II'. or 'or 'y..r., thl Co..anw..lth h.rlby IMpr...ly r...ry.. the right to eppr.1.1 .nd ...... tr.n.f.r Inh.rltlnce T'M~'
.t the 1.wfuI CII" I (oolllt.r.l) ration Iny ~ch future lnt.r..t,
PURPOSE OF
HOTIC~1 To fulfill the r.qulr..ent. of 310tlon 2140 of th. Inherltlnoe Ind E.t.t, Ta~ Aot, Aat 23 of 200Q. (72 P.S.
S.otion 9140).
PA~HTI Dltloh tha top purtlon of thl. Notloe end .ub,lt with your ply,.nt to the R.gl,t.r of Will. printed o~ thl r.v.r'l .Id..
hHake tlhGck or ,0n1lY ordllr payable tOI REGISTER OF HILLS, AGENT
REFUND (CR), A r.fund of I h)( oredlt, whloh 101.' not r.quuhd on the h)( RlIturn, uy ha r'qu"hd by coitpltlUng Itn "Applla...Uon
for R.fund of Plnn'Vlvanl. Inhultano. and E.tat. Tall" (REY~UI3), ApplloaUon'l/ er. IvaU.blu at thtt O.ficI
of the Righter of Willi, Iny of thl 23 R'venuI Dlttrlot Offlau, or by o.l1lng th41 ,plolal Z4~hQur
.n.w.rln" ..rvlo. for forls orderlnOI 1-800~!62~20SD, .ervlo.. for tIMp.y.r. with .peolel hlerlng and I or
.p.tklng n..d., I-BOO-447~30Z0 lTT only).
~BJECTIOHSI Any p.rty In lnter..t not .etlsflud with the eppr.I...ont, .llowenooJ or dlg.llo~lnue of deduotlon., or .....'..nt
of tlM (InolYdlng dl.oouot or Int.re.t) .. .hown on this Notlo. ~Ult obj.ot within .IMty (60) day. of rlc.lpt of
thh Notloe bY,
~~wrltten prot..t to tha PA neplrt.,nt of R'venue. Ba.rd of Appe.l., Dept, Z8l021, Hlrrlsburg, PA 171Z8~1021, OR
-~.I.otlon to h.v. thl I.tt.r detur.ln.d It audit of the .ecount of the perianal repr..entatlv., OR
-~.pp..1 to the Orph.nl' Court.
AD"IN.
ISTRATlVE
CORRECTJQtr4S,
Fletual error. dl.cov.red nn thll .'......nt .hould be .ddr....d In ~rltlng tal PA C'Plrt.ent of RlvenUl,
lurllu of Indhddual laMI., ATTNI Po.t A.......nt RIVIIW Unit, nept. Z1I0601, ttlrrhburg, flA 171Z8~OhOI
Phone (117) 781-6505. S.e pag_ 5 of thl hookl.t "In.truetlonl for Inharlt.nc. T.x R.turn for I R..ldent
D.c.d.nt" (REY-ISO)) 'or .n 'Mpllnatlnn 0' .delnl.tratlvIIY oarr.otable grror..
DISCOUNT I
Jf .oy t.M due I. p.ld within thr.. (3) o.lend.r eonth. .ft.r thl dea.dent'. death, . flvl Plto.nt (SX) dl.count of
the tlM p.ld 1, Qllow.d.
PENAL TV I
The lfiX taM .'nl.ty non~p.rtlalp.tlon p.n.lty 1. o~MPutld nn thl totel of the tex and Int.r..t .......d, and not
p.ld "-for. Jenvar~ 18, 1996, th_ flr.t d.y .fter th. .nd of the bM lIItfl..ty pllrlod. Thit no"~pGrt1clpDtJofl
pln.lty I. .PPI.labla In the .... .snn.r end In the the .... tl.. period ea you would eppeal the tIll .nd Int.r..t
that h.. blDn a".s'ld a. Indicated on thll notloe,
INTEREST I
Intere.t I. ot~rDed b.glnnlng with first day of d.llnqu.noY, or nine (9) Bonth. .nd on. (1) day fro. thl dlt. of
d".th, to the dlt. of pay..nt. hlll" whloh beo..1iI delinquent bllforlil Jenuar~ I, 1911i2 blllr Int.re.t .t the ratl of
,1M 16X) pllrollnt per ennuI c.loul.t.d .t n d.lly rntl of ,000164. All t8Ma. which bea8.. dellnqulnt on .nd Ift.r
Jenuary I, 1911i2 wll1 ba." Internt at II rete whloh will Vllry frail a.lInder !lliIar to aeltnd"r y.ar with that ret.
IlMounoed by the PA n.part.lnt of Rlilv_nue, Tho IIpplloablR Int.rllt ratn far 191\2 through Z002 .rnl
V..r Int.rut Reta Olllly Interut feotor V.lr Inter..t Ret. Oally Intlrllft Feotor
19112 20:< .000548 1992 9% .!I00247
19115 16% ,000438 1993"1994 7% .000192
1984 11;( .000501 1995~199a 9% .000247
1985 13;( .00o:\~6 1999 7X .000192
1986 10:< ./lOOZ74 2000 IIX .000219
1987 9% .000247 ZOOI 9% ,000247
1988~1991 11:< .000301 zooz 6% .0OOIM
MMlnt.rlllt AI oalcul.tld .. fnUowtl
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTERBST FACTOR
~-AnY NoUo. Inu.d .fhr thlil t.M beOD.II. dellnqu.nt will rlUent In Int.rut oalo\Il.t1on to flltn'n ClSJ dlY.
b"yood tha date of thll .....u.nt. If ply..nt It IIld. after the Inter..t oOlpub,Uon dah .hown on the
Nothtll, ndd;Uon.1 Jnt.r..t .u.t blil euloultt.d,
COMMONWF.At,TII OF PENNr,YLV/lNIA
DEPARTMENT Of fIt.Vf.Nm
UUfU'AU Of INDIVIDUAL TAKES
DEr-r "SOIlOl
HAHI1!HLlUflO,I'A 1'11260601
P~NNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
DENICE P BROWN
74 HONEYSUCKLE DR
PORT DEPOSIT, MD 21904
ACN
ASSESSMENT
CONTROL
NUMBER
........ 1i)1d
101
ESTATE INFORMATION: SSN: '82.22.1808
FILE NUMBER: 2197-0384
DECEDENT NAME: PETRO ROSE M
DATE OF PAYMENT: 04/15/2002
POSTMARK DATE: 04/13/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 10/12/1996
TOTAL AMOUNT PAID:
REMARKS: DENICE P BROWN
CHECK#1004
SEAL
INITIALS: AC
RECEIVED BY:
MARYC, LEWIS
REGISTER OF WILLS
REGISTER OF WillS
Ij,V.l102 EXl11901
NO. CD 001063
I
I
I
I
I
I
I
I
I
AMOUNT
$2,928,78
$2,928,78
PAYIlhlIT,
Pet,a,h ..... "I.o,fi portion of thll MoUat Ilnd .ubllluwlth yuur PRIII,,,t .ldI p.ytibh hi the ,,-- and .ddr...
prlnt.d on' tn' rlyers, tllM;
If RESIDENT bECEPf.Nl 1IIlk' ohlCk Qr IIll1nlV or{4.r payooll tOI REGISTSR OF WILLS, AClIeNT.
If t","~AESIDEHT DEct!DEHT .ake chiC,,". or .on'~ ordlr "ay,ble tot cottHONWEALTH OF PEtltSVLVANIA.
REFUMD ((.1UI " r.fund of II hI( cr~d1t, whlClh 10101 not raquuted an the Tal( R.turn, illY ba ...quutlld b~ cOIIPI.UnO In
"Applloetlon for Rltund of Plnnlylvlnll Inh.rlt~nol .nd E.t~t. rIM" (RF.Y~111~1. APplloatlons ar' av,11tbl' at
the affine of the R.glst.r of Will', any of the 23 Rev.nuI nlatrltt Offioos or fro. th. Olplrt.ant'. ~4-hour
.n.~.rlng ..rvlcl f~r fur~' ord.rln~l 1-&00~36Z~Z060J ..r~loe. for t8Mpayar. ~Ith Ipsol.l h.~rlnu and I or
IpQllIklng nlldll 1~800~447~~020 (ll onlY),
REPLV 101
QUlltlons r."mrdlng attar. oontnlned ~n this notloe should b. .ddr....d tal p~ Oaport..nt of Revenue, Bur.'U
af Indlvldull r8M'., ATTHl Post AsseSSMent RIVI9W Unit, nept. Z80601, Harrisburg, PA 17128~0601, phone
(117) 181-6S05.
DISCOUNT I
If InY tall due I. pa\dwlthin three (3) oallndar .onths after the deaedent'. death, 8 flv. perc~nt (SX) dll00urlt
of thA taM paid Is allowed.
PEMALTVI
The Uii( taM alll'lnty non~pDrtlolpatlon PlI"",ltY It oOllPllbd on the total of the taM Bnd lntered .u....d, .,d not
p.ld beforh JanUBry 18, 1996, the fir.t da~ aftlr the end of the taM ..ne.ty period.
INTEReST I
Interl.t I. char;ud blginning with flr.t d~y of delinquency, or nlnl (9) lonth. and one (11 dBY froll thl det. qf
d..th, to the dlltfl of PBYrlent. TBMU which beclI.e dlUnqU8nt before Januar~ 1, 19112 bear int,rut at the r.te of
.1, ,oYo) p.,e.nt p.' .nnu. eoleulot.d ot . doll, ,ot. ef .00010.. All t.,.. which b.eo.. d.llnqu.nt en .nd ~ft.'
January", 19&2 IoIill b.ar internt Olt II reb whloh .,ill vllry frce oBhndar ylar to calendar year with that rute
Innounold by the PA nepart.ant of Revlnue. The BpplhlSbh Inhraut rates for lqr,z through Z002 arl'
Vur Interl.t R.tl DallY Int\lreyt factor VIer' Intel'ut Ratl DBlb Interut flotor
1982 20:( .00054,. 199Z 'X .000247
I~U 16i( .0004~!1 1993-}994 7Yo .000192
1984 11:< ,0UO;S01 1995~199a .Yo ,000241
1985 n% ,000356 1999 1Y. ,000192
1916 10% ,,000214 2000 .Yo .000219
1987 9% .1100247 2001 'X .00021\1
198a-1991 11:': .000301 Z002 OX ,000164
INTEREST = BALANCE OF TAX UNPAIO K NUHBER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
--Inter..t Is oBlcul.ted .. follow. I
nAny Hotloe issued aftar thll tnx blco.n del1nqullnt will 1'.Uuot Qn Interest calcuhtlon to flftnn US) d8VI
beyond the d.t_ of the ~s.e9s.9nt, If paY.lnt is .ade efter the inter..t co.putation dBte shown on the
HJ'Jt1~., additional tnterlst MUflt 1I11 caloulatlld.
~.
,
, "
. .
-_.__u_: .. .
Hegistcw ofWHls o{Cumbel'lltlld County
~D'~""~,"",,,,,,_,~_,__~, "-"-'-'--~-'~'''''''~-'~~~''----~~~''"'''''--'''"7'r.....-...~~*
Q'lA'l1J~ HElll11LLTNLThRRULlLtLU
Name ('fDeoedent~ ~~_ /11.fJt':"2')<e.() . ~~
bale QfDcath: --jt/J?:--!J!lfk_-'._~~
nR.Ulte No,~ -.---Lirr - t?o=~ 8, y_,
PurSUant to Rule 6.12 of the Stlprerne Court Orphans' COU!1Rulc9;rrepor1lhctqllp"'?~1f
witbicspeCI to cOmpletion oftlle administration of the above'oaptionO.d.Oslale: . , ,
I. SluteWhethcir. aq~stration of the osll\tli is. complete:
Yes IJ No ~
2, If the answer is No, state when the personal representative reus(l/lably bcHie\'esih~t
the adminiStration will be cDmplete; -'114:y. &Ooc..' ',.
lftbe answer 10 No. I is Yes. state the fOllowing;
a, Did the personal represenllttive file a finaluooountwith the QQU1;t?
Yes 0 No 0 , . ,'.
l'hesepartite Orphans' Court No. (ifa'I1)') for the personal'
aCO.OUnt is: __
Didthepersonal representative state qn aCCOUIll informally 10,the partl\lS ill
interest? Yes 0 No 0 , '
e'9opiosolreeeipts. releases, joinders and approval of f0l111aJ or informal
aeCOUnts may be filed with the Clerk of the Orphans I Court and may he
.attaohed to this report ~/. ." ''? '..' . ",
. ,.:..e-V:(J?~. . j
Ignature
7)(>.'0 " c <!;;... f. J3 "0<""1
Name .
71{ fh'1 "''1si.(('fc/e 2)r'
AL:C:j:l~<<!.tt;L?lD._,z-l9Q 7"
....ddress ,
I~L
C.
l.L!
~;
p:
(':'1
Cl
l.j:,
b;'
c::>
<'..:>
~.H
tH D: a 7 8>~?:] ~,____~ .
Telephone No; ,
!8:1'crsonaJ Representative
o Counsel for pcrscJl1:l' repre:;cl1tative
kG.-