HomeMy WebLinkAbout01-0231
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of 3"~...N~ A.... \(~\s\'\~a
also known as \
No.
To:
21-01-231
Deceased.
Social Security No. '20\"\ -L..\ ~ - 5 v \'~
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl I <i?~
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Qu ,,^~~,\o...N~ County, Pennsylvania, with
h e~ last family or principal residence at ~'L~ \Y\o..r(o...rb RJ, Ec)..os t- PQAJ~~oro T-v-:-p.
(list street, number and municipality)
Decendent. then S l
at \-\ lo~. ~':?~\ \0-.\
years of age, died '"'SOJV\., L'L..
, tS 10~ \,
Decendent at death owned property with estimated values as foIllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: N / ^
SaO~. oc
$
$
$
$
Petitioner_ after a proper search ha-5- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
\...
Po.... 1702~
I
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or a.ffirmed and subscribed f
before me this 27th day of
FEBRUARY ~,2001
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No. 21-01-231
Estate of JEANNE ANN KEISLING
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW FEBRUARY 28 ~200 1 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that LARRY D KEISLING
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to LARRY D KEISLING
i~he estate of-.-----'-~ANNKEISLING
t
~////c?~LO-:.c>"U! Y2u~~
, gister of Wills /
FEES
Letters of Administration $ 25.00
Short Certificates( ).......... $ 3.00
Renunciation ................ $
JCP $ 5.00
TOTAL _ $ 33.00
Filed r€..e. . . ~ ?: . . . . . . . . .. A.D. )9 c:2('yJ (
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
j I il'iSO'i R r\' ,,' ,~"
This is to certify that the information here given is correctly copied from an original cerritlcate of death duly fIled with me as
Local Registrar. The original cerrificate will be forwarded to the SLue Vital Records Office fOI permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
_-..0"',
No.
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Fee for this cerritlcdte, $2.00
Local Registrar
P 7202978
;.>~ -1{Jr)1
' ,.;" 'j ;: ." l ,
Date
.J Rh 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
ACE it JS! 8ortt\Qavl
UNDeR 1 vEAA
00'"
'1'''11 ~Ilf -'U""'8lA
J e ann ~---'-----~-~~~ :~~ ma 1 ;no'~:R:"U:~(6 - 5 0 1 J
uNQf:R IDb- 8~r""PLAC(:C.I~"".o P\....ACEOFOEATHfr.~t'(:..Of'I"<'Y'e.. .ot"e-"'!>"\lI:t"'''ri'")OUI~' ">ooel
)taleOl ~c.~Coun<<~l 110SPI1Al__/ -- - ~- - -- -- Ol~ER -
J u n i a t a Coo P a Jnpoo_ L!f HII"""""'''':= ~ _
7 ..,
FACILITY NAME (I' r'IOl ,f"\',.NVovn 9l",e Si.~..no rlu(nOef'
. y Pt.lPAIN '{
PERMANENT
BL.ACK INK
NAME: OF DECEDE.NT {~ot'),l MI(JOl~ " J.SlI
51
.
COUNfYOF OE.,.(1H
Dauphin
DECEDEN1'S USUAL OCCUP,oJiON
\c.~.;..r.o oI.~'" QOI"'oI; 0UI>f'9 JTICI5I
ol fIlI()fll.lOQ if.. do n(l( v$C '''"eO I
SU ervisor
E.
823 Magaro Rd.
" En 0 1 a. P a 0 1 1025
F,Q'HER'S NAuE {FliSS "'o()(Jle last}
Cumberland
17d.O ::h::c,-:7":::: 01
17b. Counry
Earl Hoffman
MOTHER'S NAME If'IIS1 ~.oO'e ""'ai08f"l Sulnamel
It Gladys Goodling
INfQAMANT'S J.lAILlNO ADORESS 1$11..., CIf't/'Towof'l. SLIfe l.o Cooet
>Ob,8 23M a a r 0 R doE n 0 1 a
PLAce: OF OtSPOSIT\ON . N~ Of c.~,.t), C{.m~\Oi"1
01 Q;,..., Pt.lC.
Pa.11025
I..OCAT'ON .Clty~. Stale lloc.oo.
PQ 17062
RK~ Mill.erstown
21.
o
Vl
::J
NAME ~O AOORESS OF FACIUrt
..Blank Funeral Hmo
lICeNSE NUMBER
Sunbur Pa.17801
OAJ'E SIGNED
(~o..y"eat'l
dClI
1)0. 2lc:
~SCASE REFERRED to ~.~OOAl E)(AU(NE~OP.ONER? NiQ~
>I,
:~Io..,m"l.
\ ",,1......,aI berw.. n
I ~ ..nd o..tl'l
I
Otr...( S'Qf'''(l(;VlC ~ c;onIrOufin9 co o.ath Due
nol. r.W"~ on I"'" ~~ qnr.n'" PART I
DuE TQ{OAo\S/I4CON5EOuE.NCE. Of)
.
WfRE AUTOPSY FINDINGS
AVAIl.ABlf PRIOR ro
COMP\.f1'ION OF CAUs.€
OF ~H7
",,0
~
[J
[J
DATE OF INJURY
(MOt'ItI O..y ~an
riME or INJU~Y
IN,JUAv 41 .......oAK7
DE SCRlaE HOW t"'JuAv oc.cURAED
IrII4ANNfFl Of Of.AfH
P.nd1f'lQ ln~l"pllOn
o
rJ
o ~ce OF INJUAY "'-I ;;;;;;-,a,~O:'nl IKtOf"'Y. office M 10c
DutldlnQ. ele lSoecIl'll
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o ",,0
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IhJ/G1 ! 70; '.
1.. lib
CUrT IFIEA let-tIC. on., onel
.CEAlIFYIHG PHV SICIAN lp.-,vSoe...,.. Cf>fh'y'''G c.aU!Ioe QI c.ea\t'I ....r..ef" .J.f~"e< 0I"'1~ ,ar. "a~ pt()f'o()Vf'I(.eO Oeall" .)l'IO corn()eleo \1em 1'31
To UW b..1 01"'1 "no""~, 1;1..1" occurre<t due 10 ttl4 '.\Js~(') and m.nf'\4'r .I. ,'aiM
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-PRONOUNCING AND CERTIFYINC PHY$ICIAH Ir'tly<O.lC...,., bl').r ;J'";}I'l)Vnc,,--.q uedln..no cet"ltlYIflQ 10 c~vse 01 oe,JIf'l1
To th. bewl ot my "f'IO""l.dQ~. d4'.lth o<cu"ed ., ~ 11m.. ".llt, and pl.c.. and .,.... \g \~ ~au~(s. and mannt' .s s'ale<S
'''EOIC''l EX"MIH~RICOROHER
On ,1'\. b..is 0' w..a'n1na,ion .nd/or InveSfI9~II()n. In my opln.on, d.ath occurred ..t the time, date. ~nd place, .nd due to the c.use(sl.nd
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: '-S~o..t-h.~e ~ NN ~ci\s\~~~
Date of Death: \ - 1.. L - C \
Will No.
NO to\'-~
Admin. No.
d I - (JI - ~ 31
To the Register:
I certify that notice of (beneficial interest) estate administration 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
Name
Address
~c t.O\LL -NO ONe \,0 CONI~CT
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Co-\4-~\
~OJ\J\U ~I. ~
, Q
Signature
Name
\..-.o...~~ 1::> ~ \(~.\ '5 \~~C)
) \
Address
'h 1... '::> \'f\~9o.....~o R: ~ .
t..N 0\ 0.... . Po... ~ t ,0 1. S
,
Telephone (
Ir1-1~'l-os~q
Capacity: ~ Personal Representative
_Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01- 0231
ACN 01117228
DATE 04-09-2001
REV-1545 EX AFP (U9-UUJ
EST. OF JEANNE KEISLING
5.5. NO. 204-40-5013
DATE OF DEATH 01-22-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!XJ CERTIF.
GLADYS G HOFFMAN
RR 1 BOX 345
MCALISTERVILLE PA 17049
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
OMEGA BANK NA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania, QU9stions may be answ9red by callir:g (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 172-0014815 Date 02-25-1999
Established
x
21,768.82
50.000
10,884.41
.045
489.80
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
":HXS1W:N01TIICEiiii:1
.................h............_._._._._....._._._._._._.
...........-.........................................-.".-
...........................................................
..... ... ...
~The above information and tax due is correct.
~ 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART 0 below. .'
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX
LINE
RETURN - COMPUTATION OF
1- Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
x
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
I
$
1
have reported above are true, correct and
HOME (.. (f ) "f.C,A - 2. f'9Q
WORK ( )
TELEPHONE NUMBER
o;r;~q-a 1
It- --;2/ 3 ..-- IV'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~i ~
c/~
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (12-00>
GLADYS G HOFFMAN
RR 1 BOX 345
MCALISTERVILLE PA 11049
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-18-2001
KEISLING
01-22-2001
21 01-0231
CUMBERLAND
204-40-5013
01111228
JEANNE
A
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iifv=is4-s-E)f-AFP--fi1f:ool------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-18-2001
ESTATE OF KEISLING
JEANNE
A DATE OF DEATH 01-22-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0231
TAX RETURN WAS:
S.S/D.C. NO. 204-40-5013
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01117228
FINANCIAL INSTITUTION: OMEGA BANK NA
ACCOUNT NO.
172-0014815
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (x> TIME CERTIFICATE
DATE ESTABLISHED 02-25-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
21,168.82
0.500
10,884.41
.00
10,884.41
.45
489.80
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-) I
04-20-2001 AA496502 24.49 465.31
TOTAL TAX CREDIT 489.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT"' ( CRl, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
COMMONWEALTH OF PENNSVlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0231
ACN 01140628
DATE 09-06-2001
REV-15l\S EX AFP (U9-UU)
EST. OF JEANNE A KEISLING
S.S. NO. 204-40-5013
DATE OF DEATH 01-22-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
00 CERTIF.
GLADYS G HOFFMAN
RR 1 BOX 345
MCALISTERVILLE PA 17049
REMIT PAYMENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JUNIATA VALLEY BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (7l7J 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 40-455377-2 Date 05-16-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
14,670.91
50.000
7,335.46
.045
330.10
TAXPAYER RESPONSE
~iJll1l1i1;;'
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
[CHECK ]
ONE
BLOCK
ONLY
A. IQ1 The above information and tax due is correct.
~ 1. You lIay choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
c. c=J The above information is incorrect and/or debts and deductions were paid by you.
Vou must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX
LINE
RETURN - COMPUTATION
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I
my knowledge and belief.
I
$
have reported above are true, correct and
HOME C1Cl) 'f~~ -LJf~
WORK ( )
TELEPHONE NUMBER
()t1-1( -0)
DATE '
/tv~.JI3.-/<I
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
f
)C/
*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLOWANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (ll-GO>
GLADYS C HOFFMAN
RR 1 BOX 345
MCALISTERVILLE PA 17049
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-18-2001
KEISLING
01-22-2001
21 01-0231
CUMBERLAND
204-40-5013
01117227
JEANNE
A
Allount Rellitted
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 ~
REfv=i5~8-E)f-AFP--(i2-:oo1------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-18-2001
ESTATE OF KEISLING
JEANNE
A DATE OF DEATH 01-22-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0231
TAX RETURN WAS:
S.S/D.C. NO. 204-40-5013
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01117227
FINANCIAL INSTITUTION: OMEGA BANK NA
ACCOUNT NO.
008-0004172
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (>0 TIME CERTIFICATE
DATE ESTABLISHED 11-12-1994
x
27,564.31
0.500
13,782.16
.00
13,782.16
.45
620.20
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-20-2001 AA496501 31.01 589.19
TOTAL TAX CREDIT 620.20
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT"' ( CRJ, YOU "AY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0231
ACN 01117227
DATE 04-09-2001
REV-154S EX ~FP (Q9-QQ>
EST. OF JEANNE KEISLING
S.S. NO. 204-40-5013
DATE OF DEATH 01-22-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF .
GLADYS C HOFFMAN
RR 1 BOX 345
MCALISTERVILLE PA 17049
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
OMEGA BANK NA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a COpy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
uf Penn::.".l"ai,ia. Que:otions IUd)' be answt!r..d by calling (717) 7378327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 008-0004172 Date 11-12-1994
Established
Tax
27,564.31
50.000
13,782.16
.045
620.20
TAXPAYER RESPONSE
.....'::.':l]lmm~RESOOT!:mlN:m:ANmiolFFIC;I~' ";~H:~:TAXm~:
................................._____._..._....._._._._._..........................................._........'"0 .......-...............
.............-...-...............-................................................................................. ..............,.........
........................................-.........................................-................................ ...............................
. .. -..... . .... ...... - .... . . . . . - - . - - . . . . .
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
IT] !i!I!I~~~~~~;i:ll!llm::.:T"".
,:~~g~!!!!!~~~!i!!!~~il!li~::
[CHECK]
ONE
BLOCK
ONLY
A. ~ The above information and tax due is correct.
~ 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
T j).X
lINE
RETURN - COMPUTATION
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
have reported above are true, correct
HOME ( ., " ) ,+cp ~ - '2YS''ilJ
WORK ( )
TELEPHONE NUMBER
and
).j.-/q -tJ/
DATE
/b-~/~-/.y
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
S'~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG~ PA 171Z8-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOWANCE OR DISALLOHANCE
OF DEDUCTION~~ AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-15~a EX AFP (12-00)
GLADYS G HOFFMAN
RR 1 BOX 345
MCALISTERVILLE fA 17049
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-12-2001
KEISLING
01-22-2001
21 01-0231
CUMBERLAND
204-40-5013
01140628
Allount Rellitted
JEANNE
A
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 ~
REfv;i5~i-E3f-AFP--(i:i:ooj------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-12-2001
ESTATE OF KEISLING
JEANNE
A DATE OF DEATH 01-22-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0231
TAX RETURN WAS:
S.S/D.C. NO. 204-40-5013
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01140628
FINANCIAL INSTITUTION: JUNIATA VALLEY BANK
ACCOUNT NO.
40-455377-2
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (>0 TIME CERTIFICATE
DATE ESTABLISHED 05-16-1997
x
14~670.91
0.500
7~335.46
.00
7,335.46
.45
330.10
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT~ SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS~ AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-12-2001 CDOO0260 .00 330.10
TOTAL TAX CREDIT 330.10
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR)~ YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CLYDE R BOMGARDNER ESQUIRE
10 SOUTH MAIN STREET
POBOX 166
MIFFLlNTOWN, PA 17059
hu_n_ fold
ESTATE INFORMATION: SSN: 204-40-501 3
FILE NUMBER: 21 - 2001 - 0231
DECEDENT NAME: KEISLING JEANNE A
DATE OF PAYMENT: 09/13/2001
POSTMARK DATE: 09/12/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 01/22/2001
NO. CD 000260
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
01140658 I $330.10
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$330.10
REMARKS: CLYDE R BOMGARDNER ESQUIRE
CHECK#1318
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 496 501 REV-1162 EX (11-96)
RECEIVED FROM:
I
I~J ~._ :~ L. \{ S F:; ;_..: l_t f:'~' r~ !"1 A~..J
r',~ F:~ "} Li- LJ :',- "_. " !" ~_~J'
>'~~~. r"~:.._ I ~31":':,;~{~../lt_~...E~", f-:-~i:) 1 ~:?()i+":/-"'(7i"? ;:'}
- FOLD HERE
ESTATE INFORMATION: I
FILE NUMBER
-~-; i ,),. .' .'.') (-~ ~3 , ~::~ ~: r~J i?;)/-+ ..' .;,t 0.- ~S (. 1
-- " ,
NAME OF DECEDENT (LAST) (FIRST) (MI)
c, t i L ] ~: t:1 J E ~~:-'J!\JE {:,
j
DATE OF PAYMENT
'..~ --, .. ;" ;H:'~ (} ()
~_. ~" ..
POSTMARK DATE
\.'. : -. -, I .~ :" i'~: ('t i..) ~
COUNTY
C~ iH} ~"-1 :} L: i-.: :.. ri i'l 1.:
DATE OF DEATH
" L_ l " ~. (f{ ~
;'~' -- .. .-'. ..
REMARKS \JI.. 11 r) r
rlLll !.. 1.1HI\;
c:.
l~ ~ i~> f:~ ::~-!
SEAL
REGISTER OF WILLS
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
....~ " t..... ~... '-
~.I ~,~~~! ::3 (7 .. .l r.,
FOLD HERE
~~: ::~~ ~,:; (.'"
TOTAL AMOUNT PAID
RECEIVED BY
fl-1Anv C. LEhl I S
r,-~ f'~ C., I ~:} T t-=: r~ 0 f~~ 4'1 I
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 496502 REV-1162 EX (11-96)
RECEIVED FROM:
ACN
I ASSESSMENT
CONTROL AMOUNT
NUMBER
t3L. ~4 L) \l S ~!OF F' !'-1f.,!"J () 1 .. .. 7 t.~ ,2 E-J 1.1-+65 . ::! 1
F~ r', t BOX :?:i t.+ 5
r~
!"lC ?iL I ~; t F': f-";: \,- 1 Ll_E . Pt~ 1 fW? () i:" 9.... '-"-;J ,-/ ~ D
.
FOLD HERE FOLD HERE
ESTATE INFORMATION: I
FILE NUMBER
2 i --C:'.ii.) \ 0,23 1 ssr\J E~04 -__':tOM~jO 'I ~:~
.l .4
NAME OF DECEDENT (LAST) (FIRST) (MI)
t<C:: 't ::':-.!l" v f'lG J E Al\Ji\lF {~
1 ...
DATE OF PAYMENT
'.... i E:? ,/21:)'::; ...
POSTMARK DATE
~4 /;:"0 .' c.~ () () \
1
COUNTY S:' t:~. ~"1 ::~ ~.~
. ..J ..
t~~ L! f'.j E~ E ~: L_ '4 f\J [} TOTAL AMOUNT PAID
DATE OF DEATH ;.. '"I
l....~. ..- ...
1 /2E~ / 2 ()(} i
.. ;
REMARKS G L. f~ \[,1 Y ':-;> F) Hf]FF:Mf~i"l RECEIVED BY
f"'1f.~PY C . LEt.,) I 5
l..._,,~:- r" J-" 1 ..... ;~ ~ ,. - , t~~. ".- - ~. i ,.
L, ,t..__., ** Lc.d,..,
SEAL
. <LlJ l-~) T::..R CJ. \iJ.. L.L..J
REGISTER OF VVILLS
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'/-
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: JEANNE A KEISLING
'2...1.
Date of Death: JAN., 2001
Will No.
Admin. No. 21-01-231
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:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
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 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.
Da te: \ ...1_'~ -0 "l.
"'& ~
oJ\. ~.
Signa~re
fV)
~~j
'f., be>.," '\" ~ l> . \<~t;:!; \.- MQ..
Name (P ease type br print)
X ~~ M~(l/b RJ. El\lo\tA., P~. 1102.S'
Address
C::,.C
~.
i:) t?;'
G.;la:
a:
tn
C"J
2
o;:;c:
J
X (1\' ) ,~"2.-05~~
Tel. No.
Capacity:
K Personal Representative
~
,:.; t€
J)==
'.]U
Counsel for personal
representative
(MAH:rmf/AM3)