HomeMy WebLinkAbout97-00888
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LOCAl, REGISTRAR'S CERTIFICATION OF DEATH
CERT, NO. 3 5 8 3 9 9 0
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CERTIFICATION OF NOTICE UNDER RULE 5.6(~)
~
Name of DeceQent. b I!)/V O.f!..r-J
Date of Death. S~PT, ~
Will No. ~11
J... A,oI!31.:;";(!..T5
/~<j'7
Admin. No.
"'d 1-'7''7 -?'i"i"
To the Re'l).l.st,erl
.. I certify that notigG of beneficial interest required by
Rule 5.6 (al o~ the Orphans' Court Rules was served on..or. ma.l.led to
the follow n<<;l. beneficiaries of the ilbove~captioned estate on
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HAm!
":J f:) I+W
r<.o61:~~ Ts
Address
C, YJ~ 'W,v.,!S/,d
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Notice has now been given ~o all persons entitled thereto under
Rule 5.6(a) eKqept
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d2 ~~~
,(1gnl1tu~e
Name~"lflV, Ko/jJ:t" ~Ts.
Mdress G> '1/:;' G,frtJ..,,S1. 1;.' ?,tt.
!tIt! (:, 11.4 /II C I ~ IS (/ Ie. 6- n...
TelephoM(~)l &, '1'/- /C, 6 S-
~br o#"?
l/tJs:s-
Datel .).... -- /0 - )~.?
'/(:1
Capacity.
Personal RepresehtatiY$
Counsel for personal
representative
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9''1-8~l?
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11lY!ll~b
SURROGATe'S COURT OF THI: STATE OF PlInn..ylvanla
COUNTY OF CUM8ERLAND
~***~..**...*.*.~.~.~*..*.*.~**~~...~....~.....
In Rua
THE ESTATE OF S ROBERTS
,
VEIHFIED STATEMENT
OF CLAPl
091-03897
Da'cum.ed.
*.**~**.*..**..**.*.........~.~...~.~.*...*.....
TO' SURRO~ATE'S CO~RT, COUNTY OF CUMBERLAND
F IDUC IAR Y OR ESUr E Rl!PRES ENUT IVE AND ATTORN ev FOR
THE ESTATE OF 5 ROBERTS .
YOU ARE HEREBV ~otlfllld that THE CHASE MANHATTAN B~NK(USAI
NATIONAL ASSOCIATION
It a creditor of the aboYlI captlo~8d ~..tate of which you aru the
attorney or ettlltll rellrunntllthoo Thl' claim (.!rUn out of
a retail In'ta1l111ent credit ayntement.
provided to the Decedllnt under account number 4226610751577012, havlny a
balance due to Plaintiff of .10001.65. All p8ymunt. have been
credl tea to .thh account and no uf',.ets or other crudl ttt Me to be applied
to thlt accou,.t.
S T" TE OF New York
COUNTY OF NA 5S AU
I
I nol
THE CHASe MANHATTAN BANK(USAI
NATIONAL "/,?UCIATrON
6!R~n~frf~~~----
DONNA SL UTSK Y , be InlJ du.l y ,wor n. depouli and lIa Y" That
deponent III ASSISTANT VICE PRESIDENT of THE CHASe MANHATTAN BANK( USA)
NATIONAL ASSOCIATION
Plalntlff. na~d In the within Inlltrument. that deponent has read the
foregoing S tatellKlnt of C lal In and know. the content!> thereof, that the !Uill8
Istr ue tD deponant'. own knowl ltdgll 8Kcept as to thu mathr!> t.herel n stated
to be alleged on information and belief and as to those m~tter' deponent
believes It. to be tr~lI. The grounds of deponent's bsltef 8S to all.atters
not.stat.ed upon deponent'.. knowlodge an bOO~S a d rllcard, In potunlon of
lIald c.orporatlon. . ~ ~1f'.
ii6NRX u~---------- ---
Sworn .
Offl VINCENT DIAMOND
f Noltry Publ Ie, StH., of New York
No, OIOI5CIZ720 '
QII.II( Icd In N."." Counl r.c
Comml 55 Ion ~'p"u Jun. IS, {eLL
Thl' i, an attempt to collect a debt. Any Information obtained will
be used for that p~rpou. This. cDIllNnlcat.l on I s from a debt col lector.
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COMMON;~8VLVANIA
DUPAR1MENl OF I1EVENVE
OEflT.28OO())
15-.).11"/~1
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~MP" worda
5.e>1'IJ'/ ~I
I OlE f l! It
t.f . J... ~'. 9' 5 I 9 " l!> ? 10 ~; II'
I ~~NO Sr>o\ISE'O ~IJjE MST. FIRSI. AND MIDDle INI1LllI SOCLll SECURIlY NWOER
;r.,{ftt l ;.. ( o.:z 'i. ? f 7 "7
o 2. 8upp~mental ROlUm 0 3. Remlllndor Retum (dOl" dt.. PJl>' ~ \1.13.121
o 4e, FUlurellltersstCompromlseld..~dtMil"'" 12.\10121 0 6. Federal eSUlte To, Retum Required
o 7. Decedent Malnlelnsd B LNlng TrualIAl\oo'''llYO''''''' _ B, Total Number 018sla Deposit 80xss
010. 8pouaal Povarty Credit Id...,dtMill>t"", \1.31011,,,, 101.811 0 11, E~cllon to tax under 880. 0113(A) 1"""'6<'01
B T R AT 8 0 TOI
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t., '1/."- Ct1ehsNi ?r 1(/..:
11'1 t:" ~ Ifdt(C-,/'; ;3 Ci iC 0; I
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1, Reel Bstale (Sbhedule A) (11 1'( Oft c
2. stooke end Bonda (Schedule B) (2) /'y'?lryc
3. Clol8ly Held Qorporellon,Partnorshlp or Sole.Proprletorshlp (3) IV tJ 1'1 IE
4, Mortgegos & Notes Receivable (Schedule D) (4) l(oI,V~
5. Cesh, Sank Daposlta & Mlscellsneous Personal Property (5) 'i, CP " 5' , I.{t.(
~ (Schedule B)
6. Jolnlly Owned property (Schedule F) (6) Nddl.:
7. Inter.VNos Tronole" & Mlscelleneoua Non.Plobate Property (7) IV ~(o/C
(Schedule G or L) .'
B. Total GJOIl Allete (tollll Linea HI (61
O. Funerel E'penl8s & Admlnls~aUve COSIl (Schedu~ H) (0) 5,1-1 '" .::J o.
10. Debta 01 Docedent, Mortgage Llobllllles, & Liens (Sahedulel) (10) ,. ..AVO/Yk,
11, Total Dsduotlone (total Lines 0 & 10) (11)
tI,t.. c::; ,). 'f 'f
~
12. Net Vllue 01 Eetate (Llno 6 minus Line 11)
,
13. ChaNtab~ and Govemmantal Baquest8lSec 0113 Trusts lor which en election to Ill, hRS not been
mede (Schedu~ J)
14, Net value SubJeot to TIX (Line 12 minus Line 13)
15, Amoun1ofllnel4laXeble. ( u r- .') U' I
at the opouselteKf8le , I ,,, r' -,"'" X.O
See InstlUct~ns on reverse side lor epplloablepercentage
16. Amountolllno 14 U1xeble
et6%18te I I X
17. Amount 01 IIno14 18,abla
el 16% role X
16. Tax Due
19.
(121 "
(13)
(14)
(15)
.06 1161
.15 (17)
11BI
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Alp (v'L::i
( , If ..5~ Ii L(
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'apo IBLE FOR FILING RETURN
~._.._-
R OTHER THAN REPReSENTATIVE
DATE
/.pT~<1 11- 17-'11
Il1C;4fArV('I~11v,!.':>- DATE
f"h I?,) S'S-
Decedent's Completo Address:
STREETA RESS I /' 1 f..)., c:. ~ -
;J... '-> I" r.
f::I('/
;',1' t.... (
~ITY
Tax Payments and Credltsl
1. Tsx Pus (psgs Wne 18)
2, Crsdlls/Paymanls,
A, Spou8s1 Poverty Credll
8, Prior Peymenls
C, Dlscounl
10
.- C)
falRI Credll81 ^ . D. C) (2)
3, InleresVpsnslly If epplloable
p, Inleresl
E, PenellY
~
...
c..:> .-
TolsllnlsresVPenelly ( 0 , e ) (3) ~ 0"-
4, If line 2 18 grealer Ihen line 1 + line 3, enler Ihe dlffersnco. Thl811 Ihe OVI"PA VMINT,
'Oh80k boK on Page 1 Line 1110 reqUltla r,'und . (4) b ~
6. If line 1 + line 31s greel8r Ihen line 2, enler Ihe difference, TIIII10 IlIe T~)( DUI, IC) '" 0
A, Enler Ihe Inlere81 on Ihe leK due, (M) ~ (1) ,-
a, Enter Ih810lel 01 Line 6 + eA, Tlllllllhe "ALANe I DUI!, (Ca) ,- " ,r-
Mak, Oh'ck Pa abl, 10: RIOIBTIRO" WIl.l.S AG NT
IV PLAOINQ AN ")(" IN THI APP"OP"IATlII~OOK8
1, Old dacadent make a tran.ler and: Vee
a, relaln ma use or Incoma 01 the property trenlfarr.d: """""""""",,,,,,,,,,,i,,,,,,,,,,,,,,,,,,',,,,,,,,,, ~
b, r.laln the right 10 dlllgn.t. who ahall uaelhe prop.rty Iranlf.rr.d pr It I Income:.",,,,,,,,,,,,,
o. r',taln 8,reverllon.ry Inter..t; or""H""""'lH,''''''''''fi'''''','''''''''''''''''''''''''''''''',,,,,,,,,,,,,,,,,,,,,,,',, '
d, r.celve'lh. promll. lor III. 01 ellh.r paymentl, baneml or car.? """"",,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,
., 2, If dealh occurred on or belor. D.cember 12, 19a2, did d.cedent wllhln two yeara
pr.cedlng death tranller proparty wlthoUI receiving .aaquata cOnllderatlon? If d.alh occurred
aftar December 12, 1 982, did decedent tranafer property within ona year of dealh wllhout
receiving ad.quate conslder.tlon?-",,, ";,...jj"",,,,,,,'I' '" ,."" '" !I"'"'''' ;"" ,,,,I ,,,,,,,,ijj;" ,', """'I'" ";,, I 0
3, !:lId (feced,nl own en 'In Irual lor' or payabla upon dellh blnk account or IScurlty
4, ~\;I~a~e~~n~~~~~'ri' l~d;~id~'~'I' ';~il~~;;;~~; '~~~~~~l:' ~~~~it;;: '~;' ~ih~;' ~~~:'~~~b~'i~' '~;~~;;~;;?::::' 8
No
t
a-
&-
FOR DATBS O~ DIlATH ON OR A~TB" ~ANUA"V 1, me. PltlalS InaWtlr thl following qUllllon by plaolng an 'K' llitha
approprlete aplcl,
Old tha decedant orelll I trult or ellllUer erranllemlnl whloh Ie 1011ly for Ihl lurvlvlng IpoUIS'a blneflt for hll or /:ltr entire
lifetime? VII 0 No .er .
II you anlwered yel to the IIbov. quolllon, thtllaK onlhe trUlt or Ilmll..r arranglment II poatpondd unlll the dlSlh of Ihe lecond
apoule, It Which lima II Will btl lully I,Kabll at 11'8 rltl(l) Ippllcabll 10 tllS ramal"der benenclary(lel), Enler the value ollhe truat on
Schedule J. Part II, In ordlr 10 r.mova Illrom thl oOloul,lIon of Ihe tlK due In thlaallate,Y9u may wllh to m, Schedule 0 In ordar 10
make thl elacllon av,nlbla under ."lotlQ,' 0113, IIlhe Illcllon la madl, thalruat or Ilmlllr ,rrang,mant II laKed In thee.,tal, of Iha
flrlt daoedant apoulS, the portion 01 \l\IIIUI' or Ilmllar arrahOlment whloh banaml the IUNlvlng apoullla ,liKed al the zero.IIK rate,
and Ihe remainder la leKed .1 till, rlt.(I) appllcel1lllo.lhlt remainder benlncllry(lee), II you choo8e to make Ihl 11,otlonJ you mUlt
attach SchedUle 0 to e IImely,mld 'IK return, Ilong wllh Bchedule(a) K and/or M In ordar 10 Ihow thl apportlonmant of Iha lrull or
almllar Irrlnglmanl batw.an III. lu/Vlvlng apaulS Ind the remainder btlnenclary(laa).
MAKI CHICK PAVA.~I AND RIMXT PAVMINT TOI
REBI$TER OF WI~LS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONll THXIl LXNII.. ~. RITAIN ~OWIR PORTION POR YOUR RICCRDIl .
~ W: UW"l'lC "ATrp"r ~'9-:m" "NoY{Ol" "cS~ "WHiRff 1if.fcSi.;rAX.A.p~~Ai'iil<<t.lr;.Atr6wA'IJ'6i.b1i. - .........."". --
DIIA~LOWANOI 01' DIDUCTIONI AND A8SIIIHINT 01' TA~ '
IITATI 01' ROPERTS SONORA L PXLI NO. 21 97-0888 ACN 101 DATI 03-02-98
TAM ReTURH WAIl I X I ACCErTHD AI FILED () CHANGED
RIISIIRVATION OONOIRNINO PUTURIl xNTIRIST - SII RIVIlRSIl
APPRAISIP VALUI 01' R.aTURN BAIIDONI ORIBINAL RETURN
1. R..l alt.te ISohl~ule A)
2. atook' Ind 10n~1 (80h,dul. I)
h Clo"h tteld Itook/rertnlr.hlp Int.rut Ilohldul. C)
A. Hortglgll/Hot,1 Rlo.lvlblo IlokldUll DI
I. Cloh/alnk Depolltl/Hllo. r.rlonol Proplrt~ ISohldull H)
6. Jolntl~ Ownld Proplrty ISchld~ll FI
7. Trlnlflrl Ilchldull 01
I. Tot_I AI"to
APPROVID DIDU0110NS AND IXIMPTIONII
9. Funlrll aMpOnl,./Ad~. COltl/Hllc. EMPlnl.1 llohldull HI (9)
10. D.bh/Hortg.gl LllbUIUu/Llenl Ilohldull II' (10) .00
11. Total Dlductlonl 1111 ' ~ . ~ 1 ~ , nil
12. Hit Velu, 01 TIM Rlturn 1121 1, 4112 , 44
11. Ch.rltlblI/Goy.rn~lntol al,Uutl) Non-llIoted 911S Trulh IlohldUl1 Jl lUl .00
lA. Het VIlll1 of Bltlte lubjlOt to TIM I1A) 1,4112. AA
NOTII. If.....n ......m.nt 1'1" b.ued pr.v:l.ou.ly, Un.. 14, 18 .nd/or 16, 17 .nd 111. w:l.11
r'Tl.ot f:l.gur.. th.t :l.nolude the tot.l of ~ r.turn. .......d to d.t..
ASSISSMINT 01' TAXI
1I...A~0\lntof Llnl lA.t SpouIIl rltl 1111 I,A52.AA
16. Alount of Linl lA tlM.bll It Llnlll/Ch.. A rite 1161 ,DO
17. Alount of Llnl lA tlMlbll It Colhtlrll/Cl..1 S rite 1171 .00
18. Prlnolpll TIM DUI
TAX ORIDtTII
PAVHaHT
DATH
/h',,;{ 1/. /II
BUREAU OF INDIVIDUAl. TAXes
IHIiERllAHCC TAX DIYIIION
DepI. 18060 I
IiARRIUURD, PA 11118'0601
OOMMONWIALTH 01' PENNSVLVANXA
DIPARTHINT 01' RIVENUa
NOTICE OF INHERITANCE TAM
ArPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAM
JOHN ROBI!RTS
LOT 9
6A12 CARLISLI! PIKE
MECHANICSBURB PA 170115
DATI
IITATI OF
DATI 01' DIATH
PX~I NUMBaR
OOUNTV
ACN
03.02-98
ROBERTS
09-03-97
21 97- 0888
CUMBERLAND
101
A~ount RI~1 H.~
(1)
12)
(Sl
lAI
III
161
(7)
.00
.00
.00
,DO
4J66!L44
.00
.00,
III
3,213.00
RaCUPT
NUHaSR
bUCOUNT 1+1
INTSRa8T/PEN rAID 1-)
AHDUN1 rAID
TOTAL TAKORID1T
aALANOI OP TAX DUE
lNTlRI8T ANDipIN.
TOTAL DUI
--
*,
m.IIt'1I &It lltotU
SONORA
L
NOTE' To Inlurl prop.r
orldlt to ~our .ooount,
lub~lt th. uPPlr portion
of thll fori wlth~our
t.M p.Y.lnf.
4,665,AA
K ,00.
M ,06.
M . lB.
1111
,00
.00
.00
.00
,00
.00
.00
.00
M IF PAIP AFTER DATa INDICATao, SSS REveRIE
FOR CALCULATION OF ADDITIONAL INTBREIT.
I IF TOTAL Due II LSSI THAN U, NO PAVHENT IS REQUIRED.
IF TOTAL DUS II REFLECTED AI A "CREDIT" leRI, YOU HAV IE DUE
A RaFuND. aea REVERIe StDE OF THIS FORH FOR INSTRUCTIONS.)
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