HomeMy WebLinkAbout97-00540
PETITION FOlt PRonATE and GRANT (U' I,ETIEltS
No. __~-21=~tl::-2~ 0
To:
Estate of _.J.'illdl'ocl--l~~_~3\1I'~_---__-.-
also known as __-_--_"._-- u'__ u__'
___,,__________'_..'_______'_ _______ Register of Waills fobr thQ d
__ ,,___ __,'_ De('I'Il.led, County of __,_1J-J!,-,_~rle.n In the
Social Securltv No. ...1NI.~_Q2:::23\1--.- _ ,___ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represcnts that:
Your petltloner(s), who is/arc 18 ycars of age 0\' oldcr al?thc cxecuLr.1JL ~~med
In the last will of thc abovc decedent, datcd _~ll.2..l-.------------'-' 19
and codlcil(s) dated -,-----------...------------'- ---------,,-------
_.,~~_____.,__.___._~____.~_~.__._T_..__......,_____
_..._------~-_._-_..~---_._~._.~_._-"------_..__.~-'_.~
"--~._---~._---------~--~'~._--~----
(stale relevlllll circ\lnlSlllllCCS, e.g. renullclation, dcalh of e:w;ecutor, etc,)
Decendent was domlcilcd at death in ___Q}.\lnborlo.nd - ,Co~nlJLPenn~YlvaQla, wire t
h..ar-, la~t fqmily fr r,[inclpal resldcm;e,,1'6 .l2tl 1:T_E!.:9.~ 1:.o-:rlinnc1 ,-,upeet, lIpo.r men
No. ~_ II100llnn c.Jb~~L_L~{\___:L._L,~___I1LLl.!ltfrNJU?B!1,(&;7D(JI\I'--
(list ~treel, number and n\\llldpallty)
DeH~~1~~ NJcg s 1m;: (~---1Y~~il gr,i~t'~PI"flo:_ll~!.l.Q.JL----------' 19 97
at ~--------"----,-,---,------'-'-----'---' .
Except as follows, deccdcnt did not marry. was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a kiliing and was never adjudicated
Incompetent: - --,----------------'----
Decendcnt at death owned property with cstlmatcd values as I'oliows:
(If domlclicd in Pa.) All personal properlY
(If not domiciled in Pa.) Pcrsonal propcrty in Pcnnsylvania
(If not domiciled in Pa.) Pcrsonal propCrlY in County
Value of real estatc in Pennsylvania
situated as follows:
35,00.9.00
s
S
L
$
llano
-.-.-----.----
WHEREFORE. pctitioncr(s) respcctfully requcst(s) thc probate of the last will and codlcll(5)
pr..entcd hcrcwlth and thc grant of IcttcrL____ '1' e f\ t nl!'QJlt IH'JL____-
(testamentary; administration c,t.a.; admlnl5lradon d,h,n.c.t,a.)
---
theron.
i 4~",~ Y-f,;",:f-
'6~ DorfSJ: Mst
.. c -12ll 1,Jest porlli:Da-"'Sl;.-----
l~ lilA;'i",Anl('lfib~J1> -1'!0r,r,____:
7i~
11.... ._~--
$0
a -----,------------'-"
iii
--0_.----
----
.~.~ . -:=-~.:::=:.=.=.;--::=..--:=._._~ -
The pctitioner(s) abovc-namcd swcar(,) or affinn(s) that the statemcnts in thc foregoing petition are
truc and correct 10 the bcst 01' the ki\Owledge and belieI' of petitloner(s) and that as personal represen.
tative(s) of thc abovc decedcnt pctitioncr(<) \Viii weli and truly administcr the cst ate according to law.
Sworn to or al'f\rmed and subscribcd I" _--,,1.~/,;. ,d o.Ll- ('.-J-I ~
~3l\:~ce mc)~is VI,,! ----,..1Q, TH" -(-,---\9~'If 01', (-,-,'----'-------' ~
-.il./~ _"-'~7fJ;--'f';;--f.T;~{(~!JJll(/WT~-' -:::::::----.--- i!
~RY C LEWIS Re~isle/' L U__j__,____________ ~
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\ [::, - \ CJ t - I
OATH 01' PERSONAL REPRESENTATIVE
COMMONWEALTH (n' PENNSYLVANIA } 88
. COUNTY OF CmIill'.alLilJlD .
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This is 10 IT.My IIt,1I dl<' Illrllllll.llillll hl'I<' 1',i"('1I is ,"'II'lIlI "'1"".1 1,,,", ,II' ""1'.11','\ I<'llil'""I<' III d('.lIh dilly Iiii'd wid, 1\11' "s
LOl,,1 \(I'~i\II"IL Till' mil')Il,,1 n'llili, "ll' will h,. r""v.,,d,'d '" .1\1' '1.'1" \',1.'\ \(", ",.I,. (\111,,. I", 1II'1l 11,11 1<'11' liliol'"
WARNING: It 19 \IIellalto duplicate this copy by photostat or phOI09raph,
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No,
tIlOloH3,"d/t1
COMMONweALTHO' f1iHt6avL'JANIA ~ DiPAATMIIHT or HEALTH. v,'AL AICOROI
ceRTIFICATE OF DEATH
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I gi vo unO. bequeath ten (la,[,) per cant. 01' my eatat€i
to my greutgNmcleh:1.1dren l'lho are livinr; (It the tirClo of l'IY deoease,
share and shapo nlDeo, [1m' ir! thls l^eSpoot, I direot that thelr
respeotive.oho.l'es in my estate be plaoed in a,p!l.vings and/oX'
lntereat bearlng aooount Hlth a looal ba\1kinf~ institution, ,.rhere
the same shall remain on deposit until each suoh grCH\tgro.ndohild
attjains the afr,e 01' eighteen (10) 1'eo.rs, upon Hhioll ovent;, tlw
'proceeds 01' s aiel account, togethel' .Ii th the intereBt Hhioh has
aooumu1o.ted the!'eon, shall bt, pn:td ovor to h1m or her, whiohever
the oane ma1' be, absolutely unO. \1.l1oondi tiontllly.
LASTLi:, I nominate, constitute nnd nppoin'b nl1' ,do.l.l,lf,htel',
DORIS J. KOST, }J;:x:eoutl'ix of thin my Trust 1,oJ:ll1 nnd r,rostament, and
in the event th[\'b l~y said daughter ahould predeceo.se me, ox' should
,
she be .unable or umd.11ing to nel've tn SllCh capaoi t.,V for uny
renDo:!), then in such evoht, I llori.:lllato, confltituto nnd appoInt lilY
granddaughter', KA'l'HLi.:m,] I.. })gB1U01( j l':xe(lUtrilc of thla my Lust \<1ill
and Testament, in hor place and sterAd, [md in eIthel' instanO(l, I
direc t that my s ald personal l'ElpNIS€lntat:L vall be excused from
posting bond or other f!oc1.lrit;;r 1'or' tho fEl:ttbful pori'ormo.noe of
their cluUea 0
IN Vln'NBS8 \o/}[mrmoP, I have hor€l\.mto lJEl'b my hand and .sel;ll
this2("'~ do.y of April, A. Do, 1993.
!),~~e ~-
J S~;AlJ)
-----
....---_.
Hlldroc\ }\. 1311!'d
n ! (}
.o.'Jl,\I. 'OR DAT~ 0' DIATH AmR 12/31/9' CHICK HIRI
W INHERITANCE TAX RETURN ~O~::g.mD'TIS.CLAIMI.D.IL._.... .....
(QMMONW!AlII~Of PHm'YlVA'''A (TOR::I~~~J I~E~~~~~lATE 'Ill HUM'" 2/' f 1 - d .'-Y-d
Df''''~'MfNl ('If R!VfNur
. '!mlSfJl~. t10fi.h~ ~60'=~..__._ .o..._~!!_~~~E~I~~E'!..OF \!I~~~. ~~N_'V co~~'172..v.eA~,1,f,(~~f!..~!,E.R
IH I ti^Mr~f. MHI MIIHHf ItTlTIAlI JIlE(flj"N.l ~ COM'I,ffAOfjR r -
nUTm 1111(1I'od I':. 1;'11 II. !'oJ'j; I1n,1 ~;I;..' 1\1~t;. r)
jocIAm(lI~iYNUM.ii - - - [O"'IiiJFOfAitl /Ii^" O;eIRTtI t.loohnn.lcAln.11'g, PA 110~,!;
..1Bl1':".~)2~;';311 ('!'J!n . V?5l!or) 'oom' . . U! IlIi],O 1'1 n.nc!.... .nn . .....
''''''~~~t''';.;/~'~ .."""'"':''''' ""'""'"",,,,, '''''''II I '0' IA , '''''''IV 'HIM'" r AMOUN' '''''''".'''' IN".UCllO'''I..... ..___.~___
1&1 1. O,lgln.1 Relurn [ I 2, S"pplem.nlol Relurn 1 I 3, ~emolnd" R.lurn
_ , (10' dol.. of doo,h p,lor 10 12.13.B21
LJ 4, IIml"d hlol. 1.1 40, Fuluro In',,,,' C"mpromllO 'I 5, fod"ol hlo.. To. R,'urn R.qulrod
(10' do... 01 deo.h alt" 12-12.B2)
6t..1 6. ptced.nt DI.d ,-.101. 1--1 7. O,cedenl MU1nlolned a living Tru.t _Q.8. Tolal Number of 5af. O.po.1l 8011:..
I""ach copy of Will) IAllach capy 0 Tru.t)
L .' COUIS OND.NeE AND CONFIDINTIAL TAlC INFORMATioN SHOULD 81 DIRICTIDfOI
it NAM. ;1. H01>O:'-;:-;-:';~~~-(~;l,,-"~~;~,';~"---I-OMPlm\~~\i:~~tDN~;u[\l''' !ll,lg.. ."
B '''''''O",''UM;!. ' . .... liouho.nlcflbtlrg, 1'1\ l'lO~"
___ ...J.}~7.'-._}(~0,~:)()IJ._..m.~=~._=.c=~_=.. "'~===="_'
1. R.al Ellal. ISch.dul. AI { I I u.m ".... ...Q,.!. 99"
2, Slock. ond Bond. (Schedul. B) 12 I . ..,m.__' ___._m..O . 09__
3, ClolOly H.ld SlacklParlnor,hlp Into,.., (Sch.dul. q {3 I ....__m_..___.___Q... 00_._
4. Mo,tgog.. and Nol.. R".lyohleISch.dule 0) 141 ,,_._.,,___~~Q...9p-,
5. Ca.h, Bank O,po'II' & Mi."lIonoou. Por.onal Proporty 15) ...__....,}.Q 1.2;;> 1.1J-_
ISch.dul. EI
6. Joln'ly Own.d P'oporly ISch.dul. F) 161 ___ 1,;; 00.00
7. Tranlior'ISch.dul. GIISch.dul. L) (71 ,__..Q...OO"
8. Total Ora.. A..." l'olallln.. ,.7)
9. Fun.ral hp.n.... Admlnhtratlve Co,". MlscellaneouI
hpenull ISchedul. HI
10, O.bto, Mortgag. lloblllll.., lI.n'ISch.dul. II
11, To'al O.ducllon. (1010111... Q & 10)
12. Net Value of e.late Illne 8 mlnul line III
13. Charltabl. and Governmenlal Blquetll 15chedull J)
___ 14. N.t Volu. Sub oc"o To. IlIn. 12 minu. ~In. ]3)
15. Spuulal Transf.r. Ifor dol.. of dtath afttr 6.30.94)
S.. Inl!rucllon. for Ar,plicabl. P.rc.ntag' on Rever..
Sid.. (1.c1ud. valuo. ,om Sch.dul. K or Sch.dul. M,)
16. ArTlounl of line 14 laKable 01 6% role
(Include valu.. From SChedule K or Schedule M.I
17. Amount of line 14 10 Kable 01 15% rale
Ilnclud. yalu.. from Sch.dul. K 0' Sch.dule M,)
18. Prlncipollo, duo (Add ladrom L1n.. 15. 16 and 17,)
19. Credlll Spou.al Poverty Credlt Prior PObmenh Discount
__.__._QJ.QCL. + ...__9,_CL_ +___.....J).OO -..__...._
REV.Il00 IX. 11.9'1
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(B I
......E1 051.!!lt.
1101
Ju.207.68
27,543.46
0.00
27, 5/+3 ;Ij])
1111
1121_.__
(131
1141 .
115) __._____ 0.00 ..__-
(16) _.___._.27 ,-?4~,-4~".. .06 - __
0.00
1,652.61
117) ___....___.__u_C?.!.QQ.. .15 -
0.00
IIBI._________..b62.2.61
Inl.ttl!
IIQ) _____~_____.O.OQ.
(20) ___.____ Q.L9..Q
1,(,52.61
121) ___nn..__un...____<:J.l.jU
121 AI.-.--...---.br.--~-
121B) ._..._u_____.1.ln2..?J
20. "L1n. 191. g,oa'.. thon lln. IB, enl.. the dlll..enco on L1n. 20. Thill. tho OVU'AYMIHT.
110
21. If lint lB It greater than lint 19. .nter ,he dlfft'enc. on line 21. Thh h the TAX DUE.
A. Enttr the Int.r..' on th. balanc. due on line 21A.
B, E,,'" tho total of ll.. 21 and 21" 010 lln. 21B, Thl. It Iho BALANCe Due.
Mako Chock Payabl. I" Rogl.." ef Will., Ag.nl
, :J.'I\'):'li! i ~" . E UIITO A~SW!RALL QUISTlQ.NS' O!U'VIRil.~I~~ AND TO RlCHICK_ MATH <II( 00(' .
Un IF ptnalll.. of perlury, I declar. thai I have ell:amlned thll return, lncludlntl o((omponr1ng If.hedul" and .10lemenll, and 'f) ,hi bell of my knowl.dg" and b.lI,f,
1111 Iru" corr.ct and complete. I d.dare Ihal all rlnl .1101. hal bltln reporled nltrue markel valve. Declaration 01 preparfH other than the p'''Clnal reprtllntatlve II
~t~=:,::e ~~ ~~~~~~a~~~~o~s~l~~~~~~rN~~rf;u~kanyj,!1-~A~~R~~:~'-' 2);. .'16: It .- 'Port1 f),fliT ::; t -~-~;-.--.Af)t-;.--9----- O"'E.---;-;::~--I-~
'.< ('~L {',,_.f...: ;/ _____ .m.J'lOcJlO.lil.OQbl,\l'gj.J'^ 17.9;:;;; ._. _ n.n.._ 7'1) , '/1
~1UR9or."I'A/' on". "'??''''''"IA11'W AO',"'" ] ll\ rl~o t :; <]\1 IU'O Bl"I/:. ," r~ ....'____._n._____'
( , ,I tJ. 11'1/ :..Y.....:LL~_L ____.. ___!IOO_lf1.l11.c:H'..ure;, Jil 179::>/. -. .--~ ,j/.-L.J:l.'Ll---
Chl'{k fH I!' II you {III' li'qlll'\111l1J (I lI,fund of YOUI UVl'lfH1YIlll'1l1
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COMMONWlAIlIt 01 P1NNmVANIA
INIIU"ANC! lAM mURN
MUIO!Nl D!CIP'Nl
~. .
IU...TI O'
SCHEDULE F
JOINTLY.OWNED PROPERTY
lur,JJHlilD Ii:. nUllD
~ '.",:.l:;.-_=:;:','.:;:;;'=== -- ~-.IU"-"':;;:;:-;:C-"::-' ~
"_Mm._J:'L:~~MB:~ i~i~~~~:t~:~~~~~
-,---....-----...---.-.
~_..._..""---_.~._------'_.,..__.._~- ....
Joint tonan'(.)'
:_.~__.~.~_~._ N~ML_______,__..__jn- .__...._~I>DRESS.._ ...... .
.... Doris J. Kost 12[\ \'Ient l'ol'tll1nd :3t.
Apt. 9
MeohaniosburG, PA 170~5
. ....I!!LATlON~~1P TO.. D'CI~~.
j)l1u(~hter
..
c,
Jolntly-awn.d praporty,
ITEM LInER DATE
'OR TOTAL VAWE DECO'S DOLLAR VALUE O'
NUMBE JOINT MADE DESCRIPTION OF PROPERTY OF ASSET 0/0 INT. DECEDINT'S INTlRIST
TINANT JOINT
1. A. 1/19/ 1990 Buick "Glcy1arl,"
1990 four door sedan auto~ 5Cf/o $ 1,SOO.00
mobile. $ 3,000.00
.----'.---.--.
-,.>TAL (AI.o onlor on IIno 6, Rocapilulallon)
$
1,~00.OO
(II mar. 'poco I. nood.d 1..0" addlllona' ,,,..I, of 10m. .Ize)
.__,__u__~_, ..., ,-_._~---~-_._,._---~-----
...a." SCHEDULE H
~ FUNERAL EXPENSES,
COMMONWI^~1l Of ;'NNIYOV^,"^ ADMINISTRATIVE COSTS AND
mlff~l~i~\~~~1~D~^1.~~mJI'~ '"' o=~=_.c- ~~~~E~~Al'.~O~~, ~~p~~.S~S -=" mf'RUM::ia:~l P!:;:/ :rO~rl~~iJt n ~
___" _'" _ .IIU,!)1\>:1l I':. IHfllD ,,_" "". l.,,-- ,,_~~.91:"oo51~.2~a~~~!!~y
IllltU"...t"",
ITEM
NUMBER
_.._~~4"._'_"~
A.
1.
2.
8.
I.
2.
3.
4.
C.
1.
2.
3.
4.
5.
6.
7,
8.
DESCRIPTION AMOUNT
..".._____".,_____....____.... __... ..__.n._____._ _,_ __,_____ . _.__... _, __.___..____,_,...~_...____.__.__.~........._._~_....,__..~.____n -~-~,~----.----
funeral Exponle.1
0.00
Nono - Prepaid.
li'irst J.lethodist Church of Hechaniosburg, Ponnsylvani ,
f'uner{ll luncheon. ill
244.10
Admlnlltratlve COlt"
Personal Representative Commissions - None
Social Securily Number of Personal Representallve, --
Yeor Commissions paid ,,----'"
Attorney Fees J. I10bert Sto.uffer, Esq., attorney's ree.
500.00
family Exemption
Clolmanl J2.()l'!.~....i[...J"o ~L___ Relallonshlp De,ught er
Addre.. 01 Claimant 01 decodenl's death
Street Address ..-1_..?(:Ulest.._r~J:'Jland~J;~.L.ill2t. 9
City _J:1eQhQ,1)~t.Q.[;LP.1,lr~_.--.-,-_~-,Slale .J>A~__ Zip Code 1705)
3,500.00
Probate Fees l1er;istor of \'/J.lls of Cumberland Cotill'by,
Pennsylvania, Letters 'festamentary.
Mllcellaneoul bponlosl
Pennsylvania Auto License BroJ\:ers, tl'ansferring
reglstrntlon and title to automobilo.
Cumberland I,aw Journal, Estate Nottc)e.
93.00
26.00
60.00
~9.58
The Sentinel, Esto.te Notice.
Register of Hills, riling Inventory and Pennsyl-
vania Inhoritance '1'(()(, l1eturn.
25.00
. ----------"---
TOTAL (Also enter an line 9. Recopltulotlan)
s
4,507.68
----~_.._----,._-~--~_..~,-_._--_.............~_._~--------."-~~_.
--
tlf more Ipaco II nooded, Insort addltlonallh..tl of lame 1110,)
, .
,UYUl1lltllll'l l
_<~=Jt~F:~'~~~8:~~'~~~~II~s ~~~ ___ ___-
UTATIOF fill NUMIIIR 21M97MO~I,.OMStl\te
J.lJ.I~DllI';]) J':. ntllm 199'1..O~5Jl?::,.c..?unty
AMOUNT OR
SHARE OF ISTAn
ITEM
NUMIIER
NAME AND ADDRns OF BENEFICIARY
RELATIONSHIP
-~_._-_.-- ---_.,..---- - ---_....------ ____~_u.r..______.__.______.~_ -. --_._~~.._...~--_.__._~--
A. lOl(able Bequ.'''l
1. DonIS J. Kos'r Daughtor [JO;;' of eatate.
120 \'1. porotl1md St., Apt. 9
Hechaniosbur'g, PA 170~5 5%
2. l~A TJIT,mJi:ll L. ]lImn I 01, ,raUddnul.r,htor of estateo
3560 Sootlnnd noud
Chambersburg, FA 1.7201
3. KAnTI:N s. 1\:OB'.11 l'D.nddaughtor 5% of estate.
101+9 Oystor Jo1ill Houd
Camp Hill, PA 17011
It-. DAVID lot. K03~L' ,rl'flate;randson 2% of estate.
219 South Yorlc St.
Neohaniosburg, FA 17055
5. 'L'U10TllY P. I\OS'l' reatgrandson 2/b of estate.
219 South York st.
Meohanlosburg, PA 17055
6. JESSICA L. lCOS'r reatgrand- qi oi' eotute.
219 South Yorlr. nt. laughter
Heohaniosburg, PA 17055
7. ,TENNI Fgn T,. lCOST ,reutgrnnd- 2" of estate.
f'J
219 South Yorle St. laughtor
Me(lhanl osburg, PA 17055
8. HIIClrET, )), DEnHICJ]( 'freutgrund- Zf~ of estate.
3560 Scotl1md Hood 'aughtsr
Ohll,mbersburoB.LRLlliQl..
ITEM
NUMIIER
NAME AND ADDRESS OF llENEflCIARY
AMOUNT OR
SHARE OF ESTATE
...---------------..
8, Charitablo and Gavornmental Boqu,.IIi
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAI,a enlor on IIno 13, Rncapilulatlon) S
(II ;';;';.po,;" n..i;d,i~~~rt,:;ci-ciition.;j';hoo" ., .om. .I..t
COMMONWBALTH 0.. 'BNNSYLVANIAl
COUNTY 0.. CUMB..LAND J
HI
,.__, _n_....J2Qr,!.JL,L.. 1\ () [I L..._ . n__' _____._.~..__..n.__ .__m___ _ ____nn.~ __un. ....
being duly .__61:101'11... __. .ccordlng to I.w, depolO' end ,.ys th.t a he _ ""n"._._'.u_,.___._.."".u .n _ __.n
tLLHll:l.J~}((l.OlJtJ'JJ( of Ihe Estete of II:lld1'0d ji:LntlI'd .__..___..__~.____
I.t. 01 .,,_J'loollllnlo u b\ll'g _nn..' Comborl.nd County, P.., d.o....d .nd th.+ the
within Is .n inv.nlory medo by . DU1!lo,. J.ICuu.t.~._.. ..,..., the s.;d....i~M.QJJ.t,l~i~_____
of the entire .,t.te of ..Id do.od.nl, ..n,lstln9 .1 .11 tho p...on.1 prop.rty .nd r..1 .st.te, ....pt real ost.to outside
th. Commonwo.llh 01 P.nnlylvenl., and Ihel Ih. "9ure, opp.slto ..oh It.m of tho Inv.ntory r.pr.sont II's f.lr v.lu.
u of the d.te of dec.dent', dealh.
SW01"'n
/1
./t_ -/->-,;: ,'ll /;// /(d"'~,t--
~.~_._~._-~-~.~~~-.--
E..cul,. . KlIIlblI(oIIf
120 \'I. PUI'tlntJCI ~t., Apt. 9
1.1l:J..2ho.t1!I;l~I!..u~tl.L..!'A lLO~~__
.nd subscribed before me,
f:leptomboI'
.19 n
Add....
0.1. of O.dh
9.
Day
1997
Vu,
June
Monlh
INSTRUCTIONS
I. An Invmltory must be flied within three months after appointment of p.rson.1 represent.tiv.,
r.....{~
2. A supplom.nt Inv.ntory must be lIIed within thirty d.ys of dll.overy of .dditlonel.ssot(.-/
3. Addition.1 sheets m.y b. .thched as to plflon.lty or really
4. Sea Artl.l. IV, Flduol.rles Act of 1949.
vi
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1-.0(
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
.~
(I,
IU"!AU OF INDIVIDUAL TA~EI
INUUIl.Met: u,1t 'tJlVlIiloM
nIllt. 110_01
".'UfUtURO, PA lrlU'OUl
NOTICE OF INNE"ITANCE TA~
A"RAIIENf.NT. ALLOWANCE ow DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT Of TAM
Ui (\./111" H.,.II
12-15-97
BURD
06-09-97
21 97-0540
CUMBERLAND
101
f- ~~~~~:~C~~J
MAKE CHECK PAVAILE AND REMIT PAVMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ... RITA IN LOWER PORTION FOR VOUR RECORDS ....
iiiV' = iii;i - ix -AFP - (0,=9'7"1" -Nori cr "oF - i"tiHiR if ANC! -r AX - 'A-PPRAi siifiN'f; "AI. LOWANCE" oli- --" - - -- - - - - -" _.-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MILDRED E FILE NO. 21 97-0540 ACN 101
J ROBERT STAUFFER ATTV
MARKET SQUARE BLDG
MECHANICSIURG PA 11055
DATE
I!STATE OF
DATt: OF DEATH
FILE NUMIER
COUNYV
ACN
MILDRED
E
DATE
12-15-91
ESTATE OF BURD
( I CHANDED
TAX RETURN WAS, ( X) ACCE'TED AS FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN lASED ONl ORIGINAL RETURN
1. Rool !.toto (Schodulo A)
2, stock. and londl (Schedule 8)
S. Cla..ly Hald stock/Plrtnarlhlp Inter'lt (Schedull C)
4. "ort",../Not.. Rlc.ly.bla eSohedull 0)
5. Ca.h/Blnk Dlpolltl/Hll0. Parlonal Property eSchedull E)
.. Jolntl~ Owned Property (Sohedull f)
1. Tron.foro (Schodulo 0)
a. Totol A..oh
NOTE I To inlurl proper
cradit to your Iccount,
sub.it the upp.r portion
of thia farM with your
ta. p."..ent.
.00
--:.1.Q.
.00
.00
30.551.1'L
1 . iQ.,W..Q..
.00
(II
(1)
(2)
(3)
(4)
(II
(6)
1,)
32.051.14
APPROVID DEDUCTIONS AND EXEMPTIONS I
4.501.68
.. Funer.l EMpens.s/AdM. COlh/HiIC. Exp4tn..' (Sohedull H) (9)
10. Dobh/Nort...O llobllltlo./llon. (Sch.dule II (10)- .00
n. Total hductlono Ill)
12 . Hot Value of Tox Roturn (12)
13. Ch.rltoblo/Oc.ornMontol 10quo.t.) Non-oloctod .113 Tru.t. (Schodulo J) 1131
14. Hot Velue of E.toto Subjoct to Tax 1141
NOTEl If an ......m.nt w.. i..u.d previou.ly, lin.. 14. 15 .nd/or 1.. 17 and 11 will
r.flect figur.. th.t include the tot.l of ~ r.turn. .......d to date.
ASSISSMENT OF TAXI
1.. AMOUnt of Llno 14 ot Spcu.ol roto (ISI
1.. AMount cf LSno 14 toxoblo ot LlnooI/Clo.. A rote (I.)
11. AMOunt of Llno 14 toxoblo ot CcllotoroI/Clo.. I roto (11)
11. 'r1nolpol Tox Duo
TAX :~rf .:~C
__J-
"'.1\01 Its
21.543.46
.00
21.543.46
.00
21.543.46
.00
X .00,
x .06.
X .15.
11ft I
,00
1.652.61
.00
1.652,61
--< ----.
DISCOUNT ("
INTEREST/'EN 'AID 1-)
.00
ANOUNT 'AID
1.652.61
-_.._~_.~"._--. -------..."..~--_.
- - ~
1,652.61
.00
-----~;~ -
TOTAL TAX C~EDIT
-~.----..._~--
~ALA~_~.E OF TAX DUI
INTEREST AND PEN.
TOTAL DUI
,------
. 1f 'AID AFTER DATE INDICATED. SEE "EVERSE
FOR CALCULATION OF AODIT10NAL INTER!ST.
IF TOTAL DUE IS LESS TNAN II, NO 'AYNENT IS REQU1"ED.
IF TOTAL DU! IS R!FlECTED AS A "C"EDIT" (CRI. YOU NAY ftE DUE
A REFUND. SEE REVERS! SID! OF THIS FDRN FOR INSTRUCTIONS.)
(oi
RflERVAUONl E.tat.. of dlo"nt. dvlnll on or b.for. Olo..b.r 12, 1912.~ If anv future lnter..' In the ..tat. h tren,f.rred
In po..."lon or .njov.ant to Chn . (colLa'eral) beneflciarie. of thl dH.d-"t .ftar U~I IMPlr.Uon of '"v ..t.te for
11flor for ~Iar', the co..onwa'lth hlraby eMPrl..lv r...rv.. the ri.,t to .ppral.. and ...... tran.f.r lnh.rltanoa TaMI.
at the Iflwful CI... . (coll,tlral) rata on anv suoh futurl Int.....t.
PlIAPOSE Of
MOneEl
To fulfill tM rlqulrelllln'. of s.oUon 2140 of thl InherAtanoe And E.t.,. TRIC Act, Act 21 of 1995. <12 P.S.
Seotlon 91itO).
Oltftch the tup portion of this Hotlel and .ubalt with vour pav.ent to the Rlgl.t.r of Will. printed on thl rlv.r.. ,ida.
--"Ikl chick or laney ordlr pavabl. tal REGISTER OF MILLS _ AGENT
PAV~NTl
REFUND (CR) I
A r.fund of . t,M cr.dlt, which wa. not rlqul.tad on tha TaM Return, May bl rlqul.tld bV co.pletln. an "Application
for Refund of P.nn,v1vanIa InheritancI and E.t.tl TaM" (REY-UU). Application. ,ra IIVIlllllbll lit thl Offlu
of thl RI,ht.r of Will., .nv of thtl n RIVlnul Dlstriot DUlro." or bv callIng thl ,plclal 24-l1our
InlwlrlnO 'Irvlc. nuablrl for for.. ornlrln,1 In penn.vlvanla 1-100-362-2050, out.ldl Plnn.ylvania .nd
within local H.".hburll ar.. (717) 181-'094, TOOl (111) 712-22'!i2 Hlearlnll IIlP.irad Onh/1.
Any p.rtv in intarl.t not ..ti,flad with the .pprai....nt. allow.ncl or di.alloNlne. of dlductlon.. or 1......lnt
of tIll (Including dheount Dr Int.rattl II .hown on this HoUc:a .Ult objlct within 11Mb (60) d.y. of r.c.ipt of
thlt NoUc. bVI
~~wrlttan protl.t to the PA Depa, teent of Rlvlnue, lo.rd of Appft.l., n.pt. ZI\021, Harrl.burg, PA
-~.llOtlon to have the ..tter dlt.r.tMd at ludlt of tha account of tM p.rlonal rapr.'lntativ.,
--'PPlal to the Orphan.' Court.
1112'-1021,
OR
OR
OIJECTlONSI
AD"IN
tSTRATll/E
CORRECTlOHSI
F.ctu.l .rror. dllcov.rld on this 1......lnt .hould bl .ddr....d in writing tal PA Deplrt~.nt of Rlvlnua,
luruu of lndlvldu.l T.x.., ATTHI po.t A.......nt ".vi.w Unit, Ospt. ZI060\, Harrltburg, PA 11128-0601
Phon. (111) 111-6505. S.. p.g. S of the boo~l.t "In.tructlon. for Inhlrltanc. T.x Rlturn for. R..idlnt
Olc.dent" (REV-lSOl) for In Ixplanltion of 1a-lnl.tratlvI1Y corr.ctlbl. .rror..
tf any tlX ~ i. p.ld Nlthln threl ()) cIllnd.r ~th. aftlr the d.cld.nt., dllth, I flvl plrclnt (S%) dl.count of
thl tax p.ld II allow.d.
Thl \s% tlM .-na.ty non-p.rtlcIP.tion penllty I' eoaputld on the totll of the tlx end Intlrl.t .......d, and not
plld b.for. Janulry 1',1996, the fir.t dlv .ft.r the Ind of tM tax (I."lIty p.riod. Thl. non-p.rticlp.tion
panaltv I. app..labll in the .... ..nnlr and In tM thl '0.' tl.e p.rlod a. you would app.al the t,M and Inter..t
thlt hi' blan .......d .. Indicatld on thl. notic..
lnt.,...t it ch.rll" blllnnlnl with fir.t day of dlllnqulncy, or nln. (,) II\Oflth. 1M one (1) d.y frol the dlt. of
de.th, to the d~tl of pay.",t. lax.. which blc'" d.Unq\l.nt b.for. Janu.ry 1, 19az bur Int.n.t .t the r.tlof
.Ix (61.) p.rc.nt p.r .nnu. calcul.tld .t . d.lly rat~ of ,000164. All taxa. Nhlch baCIlli' dlllnqulnt on .nd after
January I, 1911 will blllr lntarnt lit a ratl which will Vllry frotlll cllllndltr year to callnd~r y..r IOlth thut ratl
Innouncld by the PA D.p.rt.ant of R.v.nu.. Th. appllcabl' Int.r..t rat.. for 191Z through 199. arll
'!.!!!: Int.,...t Rite O.lly Int.,...t Factor :!!!r Intarllt Rat. Ullly lntlr..t FICltor
1912 20% .000S41 1981 9% ,000241
1913 161. .000438 l'III-1C}IH 11% ,00UOI
1"4 11% .0OUOl 19'2 9% .000241
1"5 13% .00nS6 1993-1994 1'1. .00019Z
1')16 10% .000214 19I1S-1911' 11% .OO021t1
..tnt"..t II calculated .. follow'l
DISCOUNT I
PENAL TV 1
INTEREST I
INTEREST' IALANCE or TAl< UNPAID X NUNBER OF OAYS OELINQUENT X DAILY INTEREST FACTOR
--Any Motlc. luu.d 11ft.,. the tax b.co..' del1nquent will r.fl.ct itn Int.r.,t calculation to flUI.n nSI dav_
beyond th. d.tl of the ..u....nt, If pav..nt I. ..dl aft.r thl lnt.r..t coaput.tlondatl ,hown (in the
Notice, IddHionll Int.f'lIt .u.t b. calcul1ltla.
I!.TATUU-'~POR1' UNDER RULE 6.12
Name of Decedent I
I,J1LUlu':U ;1:. :HJPD
Date of Deathl
.1l\no (j. 1 <)f.I'(
Will No.
1. 'Y'J7 - ()()1;11.0
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate I
1. State whether administration of the estate is complete I
Yes x No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete I
3. If the answer to No.1 is Yes, state the followingl
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 x No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Datel June r.:. lqg8
lfl
(..
("()
I
lD
,,,-]
?6 ,,-, "
CC c:c fji. ~~ .~
u8
'.f I. /
/,cu l'-/L.J' // ,;) (~~J.I-'
Signature j ,
,
Doris .J. Lont
Na~e (Please ty'pe or print)
l?U H. POl',tlunrJ cHi., 7~pt. 9
i'Inchnnlonbul'g, 1'1\ 170~;~
Address
( 71"/1 7U)-(,,3')O_
Te l. No.
Capacity: x
Personal Representative
_____Counsel for personal
representative
(MAH Irmf/ AM3)