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REV ~OJ'EX (6-00)
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REV-1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
/Ce_~=__~ ~~..=/~
INHERITANCE TAX RETURN FILENUMBER -'
RESIDENT DECEDENT ~ykE- ~1- - NUMBE?:1;3
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
51~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Willi
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Atlach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Atlach Sch 0)
TELEPHONE NUMBER
7- 7J~-3
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(6)
(7)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
COMPLETE MAILING ADDRESS
It>bYIl4< R-6AO f1 7?V
Ne~ G,...~~L.1Wf). r~ J 0
--
OFFICIAL USE ONLY
---
---
~
__~").b. CJ 10
-
(9)
(10)
q.51f,. It>
(8)
5'\U.'\b
(11)
(12)
(13)
q fi1J. /. ., 1)
p-.: peC I r
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
(14)
x .0_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) 0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
/ ~
ZIP l')~
(1) '.... ~
Decedent's Complete Address:
STREET ADDRESS
()
el1~
CITY
~"f
\..-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C ) (2)
~
3. Interest/Penalty if applicable
D. Interest
E. Penalty
---
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
...---
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
--
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payme~ts, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury. I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PEf70N RESPONSIBLE FOR FILING RETURN
~~- X3tuM
ADDRESS ()
jf) 115 A~OP\OQ.t:: f1A.~D~ nRU)6' J f1rT~etl~JJc 111\.': JG'~'J..\
SIGNAT PREPARER OTHER THAN REPRESENTt;~E
/00 'fpftl< (tfl.Oj O'OEw c..~E,.t...AlJ O. fi--
,. .
17071>
DATE
h-/~"OI
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. S9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. s9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
- . ~V-1508 EX + (2-87)
.
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
AlGC1 A6L ~ #~~~fJ
(All property jointly-owned with t e Right of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
I, C.f'( Cc.~ fN'" NtJo 6v", B2'fL W\ 1J 0 r f.Deul.\L. (fiffDI r ijpjl~AJ tt ti''f.) )
1. f(€fV.ND C t-l e (.1<. _ U ~<;(.lo\. L.I\ fL t\ <; 5 OC , f\ 1 ~.s ~O\6)
), GL.. A. \M. \~~C\. INCb Y'B-IA'1- ~ i-t-v. NO D?J.t ~ u
1-0 i) V t" N Co {\o- e fA". f c f' V< f'/ D U 't.?.. o~
'1. C~f\ I IV\.
TOTAL (Also enter on line 5, Recapitulation) S
.., r.J..b .~l.
(Allach additional 8Y2" x 11" sheets if more space is needed.)
REV-1511Ef. (1-97)
, '
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
d\'\. \ Gttr..E L
FILE NUMBER
fh. H ~SS D
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1_
s.
1.
2,
3.
4,
5,
6,
7,
~.
,.
I ().
1/.
I~.
I) t
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
tJt\((''T\tf: /'11> ~e
F \A. IV 6fU\.L.
Hf>I'\C
~<i'J.O.~ 1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) -.!::l t p: ^' e R ~~ ft
Social Security Number(s) / EIN Number of Personal Rep e entative(s)
Street Address 0
p, Ti 5~({~~
City
J1..
~"uJ
Zip 15"'- '). )
State
~()b\
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant flJ [ A
Street Address
3M ,D \)
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
~ ~6c.)r~A. "f IN.\..\..S - fiLe ~tU~~~\"~& M'" ~7\4,"1U
It II \1 ... f?t.t( J 1'\.A) ~GgTT~ f$rA"l'f:'
I\1A.Q~ ()~p.. I-lJkf "fUth"'l-~ <tj.Df> ~.srAbe (9.J"O
M~IOt>fl CA~E NlA,,~s,tJ' Jl;~'
/W'I~Q.c.c AN Gt:1U,.-.~.... FlftJA~
fJJe~ ~ F\G, J\ L. f "" ~Ak. C
CIT' FUH\tJClp..L.
L~,j)0
!9b' A1)
13.l>i:>
?~.1f'
ILI",6,j)~
L SliT. 0-1
/1>SV" t>~
TOTAL (Also enter on line 9, Recapitulation) $ t{ q ~ 7. ? f)
(If more space is needed, insert additional sheets of the same size)
.
.
REV:1513 E/.+ (1.97)
.
'*
SCHEDULE J
BENEFICIARIES
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MIL~~F..L ~. U ASC;O
.
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. ANNA ~ I f~I"\.f\IV""1 b,b 1-\~p(1\Oftt:. D~~lIe
PI TfS (l)u. ~Li . R\. . I ;"d-').,\
~1~TeR..
~.
J-l'E.L..C)J fbftA ~ -iLl ~~bNOSjA) AIl&
M 'lGe G S f6~ 1" { Rv ~ 1513.3
)(Evet(;NO l~Eoe jflJSD
J~() FU''6'ft. Pl.\~t. UA5e ~~O,
L~\~b8e. ~-- J 5'~~D
[] f20Tij GZ VL
AMOUNT OR SHARE
OF ESTATE
~/,
.) )J
~
L/)
5 t~"'~ it
J.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
~
IN RE: ESTATE OF WILLIAM B. HAStO.
deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA
ORPHANS COURT DIVISION
NO.21-01-593
DECREE
AND NOW, ~~ z,.,'" , 2001, upon consideration
of the petition of Helen Bur, niece of decedent, and on motion of
Robert E. Myers, Attorney, it is hereby ordered and decreed that
the Estate of william B. Hasso, deceased, be awarded as follows:
Cost of administration as set forth in Petition
$ 602.00
Parthemore Funeral Home - upon cashing
of existing checks
4136.98
Manor Care - upon cashing of existing
checy::
65.98
parthemore Funeral Home - upon receipt of
Federal income tax refund
684.00
Manor Care - upon receipt of Federal
Income tax refund
10.90
American General Finance - upon receipt of
Federal Income tax refund
116.39
Beneficial Finance - upon receipt of
Fede~al Income tax refund
125.19
CTI Finane.tal - upon receipt of
Fede?C"al income tax refund
85.52
IT IS FURTHER ORDERED AND DECREED that Helene Baur is hereby
authorized to endorse the decedent's name to existing checks from
New Cumberland Federal Credit Union of $4784.33 and Vascular
Associates of $20.63, receive funds therefor and distribute as
above set forth.
IT IS FURTHER ORDERED AND DECREED that Helene Baur is hereby
authorized to draft and sign decedent's name for his 1999 and 2000
Federal income tax returns, to receive and endorse any and all
refund checks for same and distribute the proceeds therefor as
above set forth.
IT IS FURTHER ORDERED AND DECREED that Helene Baur, upon payment in
accordance with this Order is discharged from her responsibility.
By the court:~
J.
IN RE: ESTATE OF WILLIAM B. HASSO,:
deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA
ORPHANS COURT DIVISION
NO. 21-01-593
PETITION FOR SETTLEMENT OF SMALL ESTATE PURSUANT TO 30 PA.
CONS. STAT. ~ 3102
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
1. William B. Hasso ("Decedent") died on February 2, 2001,
and resided at 1700 Market Street, Camp Hill, Cumberland County,
Pennsylvania.
2. Your Petitioner, Helene Baur, whose address is 1045
Ardmore Manor, Pittsburgh, Pennsylvania 15221, is the niece of
decedent and has assisted deceased in financial matters prior to
his death.
3. Decedent was not married on date of his death.
4. Decede~t died intestate on February 2, 2001, survived by
Helen Brady, sister, 811 Edmondson Avenue, McKeesport, Pennsylvania
15133; Anna Hoffman, sister, 1030 Ardmore Manor Drive, Pittsburgh,
Pennsylvania, 15221; and Reverend Bede Hasso, brother, 300 Fraser
Purchase Road, Latrobe, Pennsylvania 15650, his sole heirs at law.
5. No local inventory was filed.
6. A State Inheritance Tax return was filed on June 21, 2001.
7. Funeral expenses of $4820.98 is owed to parthemore Funeral
Home, 1300 Bridge Street, New Cumberland, Pennsylvania 17070.
8. Nursing home care and medical expenses of $76.88 is owed
to Manor Care, J.700 Market Street, Camp Hill, Pennsylvania 17011.
9. No family exemption has been claimed and it is averred
that no one is entitled to claim the family exemption.
10. The property owned by decedent at time of his death and
the value thereof consists of two checks payable to decedent as
follows:
Check for account at New Cumberland
Federal Credit Union
$4,784.33
Refund check - Vascular Associates
20.63
Claim for Income Tax refund, 1999
524.00
Claim for Income Tax refund, 2000
498.00
Total
$5,826.96
11. The following disbursements being costs of administration
having been paid or to be paid from the estate are as follows:
Register of Wills - File Inheritance tax return
$15.00
Register of Wills
Petition to Settle Small Estate
21.00
Register of Wills - File Affidavit of Service
5.00
Mary Ver Hage - Notary
6.00
Postage
5.00
Petitioner Helene Baur
200.00
Attorney fees - Robert E. Myers
350.00
TOTAL
$602.00
12. The af.'sets of the decedent's estate including claims for
Federal Income Tax refunds amount to $ 5,826.96 less the costs of
administration of $602.00, leaving a balance of $5,224.96 to be
distributed to the creditors of decedent as prescribed by 20 P.S.
3392.
are:
13. The unpaid creditors of decedent known to your petitioner
Parthemore Funeral Home, New Cumberland, PA,
Class III claim
$4820.98
Manor Care Nursing Home, Camp Hill, PA,
Class III claim
76.88
American General Finance - General creditor
Class 6 claim
1440.00
Beneficial Finance - General creditor
Class 6 claim
1548.84
CTI Financial - General creditor
Class 6 claim
1058.00
Total
$5224.96
14. Petitioner has drafted the 1999 and 2000 income tax
returns showing refunds due of $524.00 and $488.00 but needs Court
approved authorization to sign and file same.
15. The two checks available for cashing amount to $4804.96
less cost of administration of $602.00 leaves $4202.96 available
for Class III claims bing .858%.
16. After payment of Class III claims and costs of
administration $327.10 remains for Class 6 creditors of $4046.84
which amounts r.o payment of .08092% of claims.
17. A twenty days' written notice of petitioner's filing this
petition with copy of petition has been given to all persons named
in paragraph 13 hereof and heirs named in paragraph 4 hereof, by
regular mail an~ copy of notice and certificates of mailing being
attached hereto.
17. A death certificate is marked Exhibit C, attached hereto
and made part hereof by reference.
WHEREFORE, Petitioner requests that the Court award the net estate
of William B. Haso, deceased, as follows:
Costs of administration $602.00
parthemore Funeral Home - upon cashing of
existing two checks
4136.98
Manor Care Nursing Home - upon cashing of
exist.lng two checks
65.98
Parthemore Funeral Home - upon receipt of
Federal income tax refund
684.00
Manor Care Nursing Home - upon receipt of
Federal income tax refund
10.90
American General Finance - upon receipt of
Federal income tax refund
116.39
Beneficial Finance - upon receipt of
FedeIdl income tax refund
125.19
CTI Financ:al - upon receipt of
Feder~l income tax refund
85.52
Respectfully submitted:
fL" J .. (/L
~ .)C7~
Helene Baur
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (U~J~
Helene Banr, being duly sworn according to law, does depose
and say that she is the Petitioner and niece of William B. Hasso
deceased, that she is the Accountant in the foregoing petitiGn for
Settlement of Small Estate, that the foregoing Petition is true
and complete as to all items of credit and debit; that no party has
given notice of any claim that has not been herein noted; that the
facts set forth in the foregoing Petition and in this Affidavit are
true and correl't to her knm,,Tledged, information and belief.
SS
,-f/~f X7~
Helene Baur
Petitioner and Niece
Sworn to and sutscribed
me this .3 nf)_ day of
~f"k-__ ~J
'l'~ LRQ(~
Notary P~ic
My Commi~on Explres:
before
5~j
, 2001.
Notarial Seal
MefY E. Keane, Notary Public
Forest Hills BorO, Allegheny County
My Commission Expires Nov. 30, 2002
,...,.,., f"8nllIYIVarllll ~ 01 Not8r1'8S
..
IN RE: ESTATE OF WILLIAM B. HAS'O,
deceased
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA
ORPHANS COURT DIVISION
NO. 21-01-593
AFFIDAVIT OF MAILING
Commonwealth of Pennsylvania
County of
SS
Before me, the undersigned officer, personally appeared Robert
E. Myers, Esquire, who after being duly sworn according to law, did
aver that he mailed a copy of the Petition for Settlement of Small
Estate pursuant to 20 Pa. Cons. Stat. ~3102, attached Notice and
copy of suggested Decree of Court on July 19, 2001, by regular
mail, postage prepaid, receipt forms being attached hereto, to the
following parties in interest:
Parthemore Funeral Home
1300 Bridge Street
New Cumberland, PA 17070
Manor Care
1700 Market Street
Camp Hill, PA 17011
Helen Brady
811 Edmondson Ave.
McKeesport, PA 15133
Anna Hoffman
1030 Ardmore Manor Drive
Pittsburgh, PA 15221
Rev. Bede Hasso
300 Fraser Purchase Road
Latrobe, PA 15650
American General Finance
125 Gateway Dr., Ste. 100
Mechanicsburg, PA 17050
Beneficial
4910 Carlisle Pike, Ste. 104
Mechanicsburg, PA 17055
CTI Financial
P.O. Box 13
~~4P~17001-0013
Robert . M rs
Sworn to and subscribed before
me this 19th day of July, 2001.
LIk;~ i1-u~/ ~
Notary Pub lC e ~
My Commission Expires:
.. . ...r' .
July 19
, 2001
parthemore Funeral Home
1303 Bridge Street
New Cumberland, PA 17070
Anna Hoffman .AAllIui"t
1030 Ardmore/Drive
Pittsburgh, PA 15221
Manor Care
1700 Market St,
Camp Hill, PA 17011
Rev. Bede Hasso
300 Fraser Purchase Rd.
Latrobe, PA 15650
American General Finance
125 Gateway Dr. I Ste. 100
Mechanicsburg, PA 17050
CTI Financial
P.o. Box 13
Camp HIll, PA 17001-0013
Beneficial
4910 Carlisle Pike, Ste. 104
Mechanicsburg, PA 17055
Re: William B. Hasso
1700 Market St"
Camp Hill, PA .7011
Died: Februar~ 2, 2001
Social Security No.197-14-9512
Peti tion for Se':.tlement of Small Estate of Helene Baur, Petitioner
and niece 0 i= William B. Hasso, deceased, will be filed on or' before
July 25 I 2001, in the office of the Clerk of the Orphans
Court, Cumberland County Court House, Carlisle, Pennsylvania, 17013
to No.21-01-593. This Petition is filed pursuant to the Probate
Estates and Fiduciary Code.
You are hereby notified that if you have any objections or
exceptions to the enclosed Petition, the facts set forth therein or
the prayer the~eof that you must file same with the said Clerk of
Orphans Court 'f Cumberland County, Pennsylvania, within 20 days
from the mailL.,g date hereof as the said Petition will after 20
days have expi.: E~d be presented to the Court for Confirmation and
Decree attached to the Petition.
Dated:
July 19
, 2001
-II ~ ~'XJc~
Helene Baur, Petitioner and
Niece of Decedent
I b - 023 .P~ ;<2
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ROBERT E MYERS
100 YORK RD
NEW CUMBERLAND
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COW<lTY
ACN
08-06-2001
HASO
02-02-2001
21 01-0593
CUMBERLAND
101
*'
REV-1547 EX AFP nZ-DDJ
WILLIAM
B
PA 17070
Amount 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 ~
REv=is'4j-EY-AFP--ri'2=ooY-NoTicE--oF-YNHEifiTANcE-TAX-XPPRAySEMENT-,--ALrOWAifcE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HASO WILLIAM B FILE NO. 21 01-0593 ACN 101 DATE 08-06-2001
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 Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
Cl)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
5,826.96
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
ClO)
9,547.70
.00
(11)
Cl2)
Cl3)
Cl4)
NOTE:
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this forll with your
tax paYllent.
5,826.96
9.541 10
3,720.74-
.00
3,720.74-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
Cl9)=
Cl5)
Cl6)
Cl7)
Cl8)
.00
.00
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, 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" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERYATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoy.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Co.monwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140),
PAVMENT:
Detach the top portion of this Notice and submit with your pay.ent to the Register of Wills printed on the reverse side.
--Make check or 1I0ney order payable to: REGISTER OF HILLS, AGENT
REFUND (CR):
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REY-13l3). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forlls ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS:
Any party in interest not satisfied with the appraisellent, allowance, or disallowance of deductions, or assessllent
of tax (including discount or interest) as shown on this Notice IIUSt object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Departllent of Revenue, Board of Appeals, Dept. 281021, HarriSburg, PA 17128-1021, OR
--election to have the .atter deterllined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIYE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REY-150l) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar 1I0nths after the decedent's death, a five percent (5%) discount of
the tax paid is allowed.
PENAL TV:
The 15% tax a.nesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax a.nesty period. This non-participation
penalty is appealable in the same .anner and in the the salle tille period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) 1I0nths and one (1) day froll the date of
death, to the date of p~.ent. Taxes which beca.e delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which beca.e delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Vear Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 n .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 n .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 97- .000247
1988-1991 11% .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If pay.ent is .ade after the interest co.putation date shown on the
Notice, additional interest .ust be calculated.
Law Offices (~l
Craig A. Diehl
3464 Trindle Road
Camp Hill, Pennsylvania 17011-443h
Cl-
Telephone (717) 763-7613
Telecopier (717) 763-8293
December 20, 2002
In Spring Grove. Pennsylvania
119 West Hanover Street
Spring Grove. PA 17362
Telephone: (717) 225-1929
Craig A. Diehl. Esquire. CPA
Linda A. Clotfelter. Esquire
Cumberland County Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Charles R. Reininger
File No: 21-01-0953
Dear Register of Wills:
Please find enclosed for filing with your office an original Family Settlement and Final
Release in the Estate of Charles R. Reininger, eight additional copies and the requisite filing fee for
same. We ask that you time-stamp the extra copies and return them to our office in the envelope
provided.
If you require further information or if you have any questions or concerns whatsoever,
please direct them to the undersigned at your earliest convenience.
Very truly yours,
LAC/sap
Enclosures
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FAMILY SETTLEMENT AND FINAL RELEASE
IN THE
ESTATE OF CHARLES R. REININGER
KNOW ALL MEN BY THESE PRESENTS, THAT WHEREAS, Charles R. Reininger,
late of Camp Hill, Cumberland County, Pennsylvania, deceased, died on
September 25, 2001, testate.
WHEREAS, Letters Testamentary were granted to Michael G. Vajdic.,
Jr. on October 15, 2001, with same having been filed in Cumberland
County, Pennsylvania, to Estate No. 21-01-0953;
WHEREAS, the said personal representative has gathered the assets
of the estate of the said decedent and the assets consist of real and
personal property to a total value of $315,780.39, as set forth in
Exhibit "A", which is a statement of account of the said personal
representatives, and which is attached hereto and made a part hereof,
and marked Exhibit "A";
WHEREAS, the debts and deductions, including the payment of
inheritance tax in the said estate, amount to $59,627.07, leaving a
balance for distribution of $254,253.32 plus personal property valued
at $1,900.00, also as set forth in the statement of the said personal
representatives, which is attached hereto and made a part hereof, and
marked Exhibit "B";
NOW THEREFORE, KNOW YE, that we, Donna J. Santangelo, Ellamae
Vajdic, Claire G. Hoffman, Michael G. Vajdic, Jr., Thomas E. Vajdic,
Anthony J. Vajdic, Christine M. Johnson, Joanne M. Vajdic, Gregory A.
Vajdic, Diane E. Vajdic, Mark W. Vajdic, Robert E. Vajdic, and Hospice
Preferred Choice of Harrisburg, being the heirs of the said decedent,
and being the individuals entitled to inherit under the Last Will and
Testament, do hereby acknowledge that we have this day had and received
from the aforesaid personal representative, in full satisfaction and
payment of all sum or sums of money, legacies, bequests, and devises as
are given, devised and bequeathed to us by the said Last Will and
Testament, which amount we have received this day, and which is the
amount set opposite our names in the table and schedule of distribution
in said statement attached hereto and marked Exhibit "C";
AND, we do hereby stipulate that in order to avoid the expense and
time involved in the filing of a formal account and schedule of
distribution, we agree that no account is necessary and we hereby agree
and consent to distribution being made without the filing of an account
and schedule of distribution, the same to be with the same force and
effect as if it had been filed and confirmed by the Orphan's Court
Division of the Court of Common Pleas of Cumberland County.
DEBITS:
FIRST AND FINAL ACCOUNT OF THE
ESTATE OF CHARLES R. REININGER,
LATE OF LOWER ALLEN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA
DATE OF DEATH: SEPTEMBER 25, 2001
PRINCIPAL ACCOUNT
Your Accountants charge themselves with the following:
(1)
(1 )
(2)
(3)
(4 )
(5)
( 6)
(7 )
(8 )
( 9)
(10)
(11)
(12 )
(13)
(14 )
Real Property
Personal Residence
1106 Laurel Avenue
Camp Hill, Pennsylvania 17011
(per appraisal - sold for fair market
value on April 16, 2002)
Personal Property
Checking Account - Allfirst Bank
Account No. 0071137955
Savings Account - Waypoint Bank
Account No. 606669108- date of death value
$83,987.25 and $391.33 interest earned before
deposit in estate account
Stocks - Salomon Smith Barney
Account 724-10282-11
Proceeds of sale of 68 Shares of Prudential
Financial, Inc. Stock
Miscellaneous Household Goods
Savings Bonds (see attached table) Interest
Earned was $7,815.02
Nuveen Stocks - Gross proceeds of sale of 170
shares of NPP and 194 shares of NQP -
$5,411.68 and interest earned $2.49
Refunds:
a. Veterans death benefit for funeral
expenses $100.00
b. Comcast cable $34.65
c. Verizon $0.05
d. Travelers Insurance $91.00
e. Internal Revenue Service $184.00
Dividend checks from Nuveen
Proceeds from sale of Coin Collection
guns
Proceeds of sale of 1996 Oldsmobile
Reimbursement by purchaser of prorated school
taxes at sale of residence
Interest Earned from Estate
TOTAL PRINCIPAL DEBITS:
E X H I BIT
A
$ 82,000.00
$ 119,090.31
$ 84,378.58
$ 2,801. 43
$ 1,991.67
$ 1,500.00
$ 9,821.27
$ 5,414.17
$ 409.70
$ 294.19
$ 76.25
$ 400.00
$ 5,000.00
$ 183.73
$ 2,419.09
$ 315,780.39
CREDITS
Your Accountants ask credit for payments made from Principal Account as
follows:
Check Date
No.
91 10/21/01
92 10/21/01
93 10/21/01
94 10/26/01
96 10/26/01
97 10/26/01
98 10/27/01
Description
Brenda Turner - Nursing care expense
Donna Rayson - Nursing care expense
Special Care - Nursing care expense
Law Offices of Craig A. Diehl - Retainer
for Attorney's fees
Fackler Wiedman Funeral Home - Funeral
expense
Lower Allen Township - Sewer and Refuse
fees
Michael G. Vajdic, Jr. - Reimbursement of
Probate fees paid to Register of Wills of
$370.00 and Cumberland Law Journal estate
advertisement fee of $75.00
10/31/01 Allfirst Bank - Fee for estate checks
(automatic debit from account)
1001
11/03/01
1002
11/03/01
1003
1004
11/03/01
11/03/01
1005
11/05/01
1006
1007
1008
1009
11/20/01
12/06/01
12/08/01
12/08/01
1010
12/08/01
1011
12/17/01
Law Offices of Craig A. Diehl -
Professional fees for estate planning
Pennsylvania-American Water Co. - Water
bill for residence
Verizon - Telephone bill for residence
PP&L Electric Utilities - Electric Bill
for residence
U.S. Postal Service - Postage fees for
estate mailings
Verizon - Telephone bill for residence
Sentinel - Estate Advertisement
Verizon - Telephone bill for residence
Pennsylvania-American Water Co. - Water
bill for residence
PP&L Electric Utilities - Electric bill
for residence
PP&L Electric Utilities - Electric bill
for residence
SUBTOTAL THIS PAGE:
E X H I BIT B
Amount
$ 271.25
105.00
106.75
2,000.00
6,967.50
67.50
445.00
49.06
596.25
20.38
40.01
196.60
13.60
18.52
97.07
16.38
11.76
53.32
22.70
11,098.65
1012
1013
1014
1015
1016
1017
1018
1019
1020
1021
1022
1023
1024
1025
1026
1027
1028
1029
1030
12/18/01
01/01/02
01/01/02
01/01/02
01/24/02
01/31/02
02/01/02
02/21/02
03/03/02
03/07/02
02/21/02
03/21/02
03/21/02
04/07/02
04/07/02
04/15/02
04/11/02
Register of Wills - Pennsylvania
Inheritance Tax
Eshenour Fuels Inc. - Fuel bill for
residence
PP&L Electric Utilities - Electric Bill
for residence
Lower Allen Township - Sewer and refuse
bill for residence
Verizon - Telephone bill for residence
PP&L - Electric bill for residence
L.G. Connor Real Estate Appraisers, LTD -
Bill for appraisal of real estate
Pennsylvania American Water Company -
Water bill for residence
PP&L - Electric bill for residence
Eshenaurs Fuels, Inc. - Heating oil bill
for residence
Verizon - Telephone bill for residence
Verizon - Telephone bill for residence
Pennsylvania American Water Company -
Water bill for residence
PP&L - Electric bill for residence
Lower Allen Township - Sewer and refuse
bill for residence
Verizon - Telephone bill for residence
Pennsylvania American Water Company -
Water bill for residence
04/16/02 Cumberland County Recorder of Deeds -
Transfer tax for sale of residence
04/16/02 Law Offices of Craig A. Diehl - Notary
fees for sale of residence
04/16/02 Bonnie K. Miller, Tax Collector - Fee for
tax certification for sale of residence
04/16/02 Grace Stoner - Reimbursement for prorated
county/township taxes for sale of
residence
05/15/02 PP&L - Electric bill for residence
05/15/02 Pennsylvania American Water Company -
Water bill for residence
SUBTOTAL THIS PAGE:
E X H I BIT B
34,000.00
59.57
42.76
67.50
16.58
41. 32
275.00
8.47
32.47
121.58
16.39
16.39
11.44
29.06
67.50
16.39
11. 04
820.00
4.00
4.00
100.13
27.65
8.77
57,995.31
1031
1032
06/25/02 Register of Wills, Cumberland County,
Agent - Pennsylvania Inheritance Tax
Payment
06/25/02 Register of Wills, Cumberland County -
Filing fee for Pennsylvania Tax Return
08/06/02 Salomon Smith Barney, Inc. - Fees to
liquidate Nuveen stock ($129.22
commissions, $10.17 SEC fees, and $60.00
legal transfer fee)
08/20/02 Register of Wills, Cumberland County,
Agent - Pennsylvania Inheritance Tax
Payment
08/20/02 Register of Wills, Cumberland County,
Agent - Filing fee for Supplemental
Pennsylvania Inheritance Tax Return
VARIOUS Allfirst Bank - Service fees and analysis
fees for sweep checking account
VARIOUS Allfirst Bank - Management fees for sweep
checking account
08/20/02 Orphan's Court, Cumberland County -
Filing fee for Family Settlement
Agreement
08/20/02 Law Offices of Craig A. Diehl -
Attorney's fees for estate
08/20/02 Law Offices of Craig A. Diehl -
Reimbursement of Certified Mail Fee
SUBTOTAL THIS PAGE:
TOTAL:
E X H I BIT B
1,214.35
15.00
199.39
797.09
15.00
1,020.90
279.94
17.00
9,167.80
3.94
12,730.41
59,627.07
Principal
Debits
Minus
Remaining
Balance
Minus:
(A)
(B)
RECAPITULATION
Household goods
Guns
Administrative Expenses
Last Debts of Decedent
Subtotal:
TOTAL BALANCE FOR DISTRIBUTION
E X H I BIT B
$ 315,780.39
($ 1,500.00)
($ 400.00)
$ 313,880.39
$ 58,547.82
$
1.079.25
$ 59,627.07
$ 254,253.32
PROPOSED DISTRIBUTION
The Personal Representative proposes distribution of the Total Balance
for Distribution to the following heir as described:
DONNA SANTANGELO
ELLA MAE VAJDIC
CLAIRE G. HOFFMAN
MICHAEL G. VAJDIC, JR.
THOMAS E. VAJDIC
ANTHONY VAJDIC
CHRISTINE M. JOHNSON
JOANNE M. VAJDIC
GREGORY A. VAJDIC
DIANE E. VAJDIC
MARK W. VAJDIC
ROBERT E. VAJDIC
HOSPICE PREFERRED
OF HARRISBURG
Specific bequest of
$20,000.00
$20,000.00
Specific bequest of
$25,000.00 and 50%
of rest, residue
and remainder
$56,799.66
plus personal
property
Specific bequest of
$50,000.00 and 50%
of rest, residue
and remainder
$81,799.66
plus personal
property
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
Specific bequest of
$10,000.00
$10,000.00
$10,000.00
$10,000.00
$10,000.00
$10,000.00
$10,000.00
$10,000.00
Specific bequest of
$7,104.00
$ 7,104.00
Specific bequest of
$8,550.00
$ 8,550.00
Specific bequest of
$10,000.00
$10,000.00
TOTAL DISTRIBUTED
$ 254,253.32
plus personal
property
E X H I BIT C
THEREFORE, we do hereby remise, release, quitclaim and forever
discharge the said personal representative, his heirs, executors,
administrators and assigns, of and from the said estate and from all
actions, suits, payments, accounts, reckonings, claims and demands
whatsoever, touching upon the estate of said decedent, and I do further
hereby covenant and agree that I will contribute my share of the estate
to satisfy any and all claims, demands, suits, or causes of action which
may be successfully prosecuted against the said estate or the aforesaid
personal representative after the signing, sealing and delivery of this
family settlement agreement and final release.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this
20th day of August, 2002.
WITNESS:
cf~,/a a~
~),~
DONNA SAmANGELO ...
J.
WITNESS:
~~_fJ . a~L-
~N2 V~ot4
ELLA MAE VAJDIC
WITNESS:
d~~~ t2 Ctf~
ITNESS:
~Cj' ~~
CLAIRE G j'HOFFMAN
c1~~ a. af1~-
WITNESS:
~f4 f2i/C.~
MICHAEL G. VAJ~C, .
~J2,O~
~ -m a~'
JO.NNE M. VAJDIC
WITNESS:
fJA/QO~
WITNESS:
~LLa Ct~
WITNESS:
~o D1f~
cf~ a. CufJ~
W TNESS:
~,~() ~~
W TNESS:
(f~4 ,Q ()~
rTNESS:
Cf-1~/A / (2. ('~
,~ C/)/~
THOMAS E. VAJDtC /
9fj 1(1~
ANTHON VAJ C
~~~~~
CHRISTINE M. JOHNSON
~,1~
GREGOR A. VA DIt
~~~ \\9 ~
DIANE E. VAJD -
~~. iJJ,)/ ,-:-
MARK W. VAJDIC ~
~
ROBERT E. VAJDIC
WITNESS:
~~u~ :J/~
./ /
5:J~J J)~, E (I: e u~y-"-' ~c&?zrr
..0u.Stt1'\ S. Ge-Atd, fli(Mt~,'*d-,.r (name)
HOSPICE PREFERRED CHOICE OF HARRISBURG
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
On this ;).Dth day Of~USt" ,2002, before me, the
undersigned officer, personally appea ed Donna J. Santangelo, Ellamae
Vajdic, Claire G. Hoffman, ~chael G. Vajdic, Jr., Thomas E. Vajdic,
Anthony J. Vajdic, Christine M. Johnson, Joanne M. Vajdic, Gregory A.
Vajdic, Diane E. Vajdic, Mark W. Vajdic, Robert E. Vajdic, known to me
(or satisfactorily proven) to be the individuals whose names are
subscribed to the foregoing instrument, and acknowledged that they
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
k;))t\bU(,u tn. ~
~ Publlc
NOTARIAL SEAL
Stephanie M. Rider, Notary Public
Camp Hill, Cumberland County
My Commission Expires Oct. 31, 2005
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 0 Q '^-ph; Yl
SS
On this -'.J.J:h day of DeUw\~, 2002, before me, the
undersigned officer, personally appeared S a VI S. 6e.rharf-
of Hospice Preferred Choice of Harrisburg, known to me (or
satisfactorily proven) to be the individual whose name is subscribed to
the foregoing instrument, and acknowledged that she executed the same
for the purposes therein contained and that she is authorized to do so.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
9--11 /)~ m. W/~
,~~ Public
(SEAL)
NOTARIAL SEAL
Stephanie M. Rider. f\Jotary Public
Camp H,II Cumberland County
My Commission Expires Oct. 31, 2005