HomeMy WebLinkAbout05-01-07
V'-
II
IN RE:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ROBERT L. O'BRIEN, Sr.
ORPHANS' COURT
NO.21-07-0113
PETITION TO SETTLE
A SMALL ESTATE
1) Petitioner is Robert L. O'Brien, an adult individual,
residing at 18 East Oakwood Drive, Carlisle, Pennsylvania, 17015.
2) Petitioner is the son of Robert L. O'Brien, Sr., Mr.
O'Brien died December 5, 2006.
3) Mr. O'Brien's estate consists of an account with
Sovereign Bank # 1671011286 with a balance of $ 16,914.99.
4) All of Mr. O'Brien's bills have been paid and attached
hereto is the acceptance by the Department of Revenue in
reference to the inheritance tax return.
5) Attached hereto is Mr. O'Brien's Death Certificate.
WHEREFORE, Petitioner requests that the Court order
Sovereign Bank to close Mr. O'Brien's accounts and pay any
balance to Robert L. O'Brien.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
. ~~/U..L.
Robert L. O'Brien, Esquire
1.0. # 28351
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
By
rZ=lIli!1I_1
J'\
lGaz
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II
I verify that the statements made in the foregoing
Petition to Settle a Small Estate are true and correct to the
best of my knowledge, information and belief. I understand that
false statements herein are made subject to the penalties of 18
Pa. C.S. ~ 4904, relating to unsworn falsification to
authorities.
-~~L.~
~
Robert L. O'Brien
Dated: <...!:::.-/, {OJ
t Sovereign Bank
STATEMENT OF ACCOUNTS
1-877-SOV-BANK (1-877-~2265)
Statement PerIod 03112107 TO ~
GEN~~CtI .:''''''
>;<. ."-.;,~,~;:::r:~;\
Account' 167101128-t,>.' .
,;j~*\.".
Balances
:: .."J!:jl;.i'i/~;f;[J;~'t>..: ~~~ ,~i('~, r~. " <~~I"P'lfl L.." _ -" ::t ~f~ '~~.... :\~~'"
~. " ,~ < ~ - , '> ~ . - , "'........ '.>.... , - ,,~,~ ..""'~...""_. ~~.'__"'....I'" ",_--' ...... ,
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Deposits/Credits .
+ $0.75
Average Daily Balance
$18,933.1~
. ~ ~" . r ~ ~""~~....".. ~.........."'_ ,.....,.. ~ v-">- '" ,,,"-...,,,... ..._..,.........".,- ~ --.p, ~.. _~ ~... -... .._~
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- -- - ........ .. - - - - ~ - - - -. - ~ ....~. _..._w< ._""'~ ,~, _ A .-.......... ~ ~~..._-...-.~_~_~--...---....-.____..._____
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.:~. ',,',",;.> 1.:<. _'....h.. ._..;.. ..,~. '. ::,,,. ....._:.~::i".,. ." .~~:~:-~L_.~_.-:_~~):'~,_
Earned this Period
$0.75
Paid last Year
$10.52
~ . " ""'''''''''-''F>' """ ""-'f'''''''' ~ __,." ,_~, ~ ~ _ ~ ~
- .,
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*The interest earned and the intereSt .
Account Activity
D~te Descrlptlo~ . .
03-12. . Beginning Balance
~fde~@ng()~ when.interest is credited to your account
"-<< >..<'->'~
t'">
" :~~<
/"j';r;;,>;'"
. Additions .
" b , .t~~ ~ ,_,.'_ '-",'
Subtractions
Balance'
$19,353.74
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l\t l' I -:,' .
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04-09. . ':INTERESTCREDIT
04-09 Ending ~~race
'O"'"':}<'h.:,'\.::_,"O
$0.75
$16,914.99
$16,914.99
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(,
page 3 of3
1671011287
IUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO lOX 21"01
HARRISIURG PA 17121-0'01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASS~SSMENT OF TAX
*
REV-1S47 EX AFP (O'-OS)
DATE 04-23-2007
ESTATE OF OBRIEN ROBERT L
DATE OF DEATH 12-05-2006
FILE NUMBER 21 07-0113
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 06-22-2007
( See reverse side ullder Objections)
A.ount Re.ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS 4--
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF OBRIEN ROBERT L FILE NO. 21 07-0113 ACN 101 DATE 04-23-2007
ROBERT L OBRIEN
18 E OAKWOOD DR
CARLISLE PA 17015
TAX RETURN WAS: (X) ACCEPTED AS FILED
(
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and londs (Schedule I)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/lank Deposits/Misc. Personal Property (Schedule E)
,. Jointly Owned Property (Schedule F)
7. Transfers (Schedule 6)
8. Total Assets
(l)
(2)
(3)
(4)
(S)
U}
(7)
.00
.00
.00
.00
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for. with your
tax payment.
13,420.00
.00
50,000.00
(8)
63,420.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental lequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
ClO}
7,015.00
.00
(ll)
Cl2}
(n)
Cl4}
7.011;.00
56,405.00
.00
56,405.00
NOTE:
If an assess.ent was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
1'. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class I rate
19. Principal Tax Due
14, 15 and/or 1~, 17, 18 and 19 will
returns assessed to date.
.00 x DO .
56,405.00 x 045.
.00 x 12 .
. DO x 15 .
Cl9}.
.00
2,538.00
.00
.00
2,538.00
ClS}
(U)
Cln
(18)
DATE
02-05-2007
NUMIER
CD007776
+
INTEREST/PEN PAID (-)
126.90
AMOUNT PAID
2,412.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2,538.90
.90CR
.00
.90CR
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
HI05.905MS REV. 6106
This is to cenify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the G.eneral Assembly, June 29, 1953. -
WARNING: It 18 Illegal to duplicate this copy by photostat or photograph.
/2 J .d
vro ~ ~""-lf~L
No.
Frank Yeropoli
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
0996555
DEe 18 2006
I105.'GRI!Y.CI2nIXII
nft II'NIT"
-
lUCK-
,.
Date
~TH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
I
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18 East Oakwood Dr.
Carlisle, pa 17015
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Carlisle, Pa 17013
-Roth Funeral Bane & Crematory Inc.
Carlisle Pa 17013
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