HomeMy WebLinkAbout01-0535PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~ ~ ~. - S ~ ~ No. ~ l - ~, ~' S~
als known as v _• - ~. -~~~ /~O To:
l~-''X~'~~ ~~ ~ ~_/-~%~ ~ Register of Wills for the /
Deceased. County of ~ c,~ rv, 6 Pr 1~.~~.~/ in the
Social Security No. l~f"5= -~~.~ - /_S~O~ 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~ for letters of administration
on the estate of
(d.b.n.; pendente liter durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in _~-t~i~~~~(~'~~~ County, Pennsylvar~}a, with
h~ last family or principal residence at ~ .~ ~- ~ ~/ ,~/ /~,~,
(list street, number and municipality
De endent, then JT ~ years of a e, died ~(/ ~,~i/ ~ ~~~
~- ~ v
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $_ ~~~~~ L~~7~~
(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:
Petitioner after a proper search ham ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
game ~
~~ ~ ~elattonship ~ Residence ~1
J ~T, J
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 } 5S
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 affirmed and subscribed ~ ~'L%<'~ G~~G%~~~f''~1~~~
before me this 4TH day of o
h .~~MAy /~,X~( ,2001 o'V'
Y C L E W I S ~ Register
NO. 21 - 01 - 535
Estate of PATRICIA A DAWSON a/k/a Deceased
PATRICIA A MORAMARCO a/k/a PATRICIA A EKING
GRANT OF LETTERS OF ADMINISTRATION
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AND NOW JUNE 6 X~~c2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that JOHN A MORAMAR('D
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ]OHN A MOByMARCn
in the estate of _ PATRI .TA A DAWSON a/k/a PATRI('TA A MORAMARCO a/k/a
PATRICIA A EKING -
,,
~- '.`
/ Register of Wills .. ~ '
~~~ MARY C LEWIS '~~
FEES
Letters of Administration ..... $ 50.00_
Short Certificates( 1p.......... $ 3~ . QO
Renunciation ................ $
J C P _ $~~ - g(~_
ToT'AL $ R~ _ nn--
Filed ...JUNE .h,.......... A.D. >dQ ~nn1
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
Called Administrator on 6-6-2001
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
NAME OF DECEDENT (Fns't. Middle. LasO SEX
P STATE FILE NUMBER
SOCIAL SECURITY NUMBER DATE OF DEATH (MOn1D Day, Year)
I.
atricia A DAWSON 2Female
AGE ILasl Rrtlntla
J UNDER i YEAR UNDER
D 3. - 3 .. ~,SOh 4. May 25, 2001
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AY DATE OF BIRTH BIRTHPLACE ICuy end PLACE OF DEAT
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55 Yrs. July 19, 195 y mpahem ^
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COUNTY OF DEATH ~ CITY, BORO. P F DEATH FACILITY NAME (II not insleution, g.ve street and numDei) WAS DECEDENT Of HISPANIC DRIGIN7 R
Cumberland Esat Pennsboro Holy Spirit Hospital ACE ~ American Indian, Black, While, etc.
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- Items 24-26 muss be completed by TIME OF DEATH DATE PRONOUNCED DEAD (Monm. Day. Year)
person who prorniunces tlealh. 230. 23c.
WAS CASE REFERRED TO MEDICAL EXAMINERICORONER7
24 12:41 P
May 25, 2001 Ves~ N
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'CERTIFYING PHYSICIAN(Physcian ce,ulying cause ul deem when another physician has V 31
prnnuunced tleatll dnd cwn lelnd lt SIGNATUREA CER FIER
To the beat of my knowledge, tlealh occurred due to lhs ceuae(s)and manner ea elated ..................................... ...... .... .... . .
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'PRONOUNCING AND CERTIFYING PHYSICIAN Ph s¢mn Gulh ~
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y ge, dealhoccurredal lhell~e,dale,aMplaca, and due to lhecauaa(e)and mannarasalatad .......................... ^ 31c. 31d May 29,2001
NAME AND ADDRESS OF PERSON W HO COMPLETED CAUSE OF DEATH
'MEDICAL EXAMINER/CORONER (Item 27) Type or Print
Michael L. Norris, Coroner
On,ha basis a, examina,ton end/or lnves,lgation, In my oplnian, death occurred a„he,lma,data, and place, and due,o,ha causa(s)and
annaTass,a,ed , 6375 Basehore ROad
Suite ail
........................................................................... ...........
3,a. @ ,
Mechanicsburg, Pa. 17050
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REGI RAR'S SIGN UREA .
DAT FILED (MOnlh, Day. Year)
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J!'.D/June 30, ]992/17858
I:n Re: Estate of Patricia A. Dawson
Late of East Pennsboro Township
Estate No.: 21-O1-535
7C~ g ~ ?0f~~'
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO.
:NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: John A. Moramarco
(:ounsel for Personal Representative:
Date of Grant of Original Letters: June 6, 2001
Date of Delinquency Notice: September 16, 2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
er 2 2001 ~~ `
Date:Octob ,
Mary C Lewis, Register of Wills
]Distribution: Personal Representative
Counsel for Personal Representative
Estate File
.A hearing is scheduled for ~<._~~ ~~y ~ Z' ~-'~' gat ~~ - r ~~ In Courtroom No. 3. If the
Certification of Notice is filed prior to the hearing date, the hearing will automatically be
#'y °i
cancelled.
>'` ~~ ~~'
George . Ho er, .J.
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.TRD/June 30, 1992/17858
In Re: Estate of Patricia A. Dawson
Late of East Pennsboro Township
I3state No.: 21-01-535
OCT 0 2 2i~fl~J
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
:Personal Representative: John A. Moramarco
~r~t:ns°1 f^r Personal I? e^resentat~ve:
Y`
Date of Grant of Original Letters: June 6, 2001
Date of Delinquency Notice: September 16, 2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
,~,. ~. ~-.,.~,.e. ~,. ~ inn: ~"/ //!A . ~ ( " : /.~l~r,n d i, _ _ ~~7~ ?~~jp.~//w-
1lGiv: l.f ~. ~.lJ ~s ..I L., ..vVl V //
Mary C Lewis, Register of Wills U
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for ~C~- wv iat : ~ d In Courtroom No. 3. If the
Certification of Notice is filed prior to the hearing date, the hearing will automatically be
cancelled. /~~
Geo e . Ho er, .J.
09132611212001 Cumberland County - Register Of Wills 1121/2001
ROW621
File Info 2001-00535 PA File No 2101-00535
Decede°nt DAWSON PATRICIA A
Docket Entries
Date
Filed
6/04/2001 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
OATH OF PERSONAL REPRESENTATIVE
DEATH CERTIFICATE
6/06/2001 GRANT OF LETTERS OF ADMINISTRATION
~/_3a-6>
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November 30, 2001
John A. Moramarco, Jr.
316 Overbrook Drive
York, PA 17404
IN RE: ESTATE OF PATRICIA A. DAWSON
Failure to File Certification
Dear Mr. Moramarco:
A hearing was set for November 30, 2001, at 9:30 a.m., in the Courthouse in
Carlisle, at which you failed to appear.
The certification must be filed in the office of Register of Wills.
We must hear from you within twenty-four hours; please phone Donna in the
Register of Wills office at 240-6409, if you have any questions.
Sincerely,
Sandra S. Gobrecht, Secretary
Judge Holler's Chambers
JRD/June 30, 1992/17858
In Re: Estate of Patricia A. Dawson
Late of East Pennsboro Township
Estate No.: 21-01-535
OCT 0 2 2~8p,1
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: John A. Moramarco
Counsel for Personal Representative:
Date of Grant of Original Letters: June 6, 2001
Date of Delinquency Notice: September 16, 2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on August 24, 2001, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
Date: October 2, 2001
Mary C Lewis, Register of Wills
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for ~~~in ~ gat = ~ v In Courtroom No. 3. If the
Certification of Notice is filed prior to the Baring date, the hearing will automatically be
cancelled.
Geo e o er, .J.
JRD/June 30, 1992/17858
In Re: Estate of Patricia A.Dawson
Late of East Pennsboro Township
Estate No.: 21-2001-0535
JUN 0 ~ `t60~ ~'
~~~~
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2001-0535
NOTICE OF FAILURE TO RULE 6.12, SUPREME COURTT ORPHANSO OURT RULE
HEARING PURSUANT
Personal Representative: John A. Moramarco
Counsel for Personal Representative:
Date of Decedent's Death: OS-25-2001
Date of Delinquency Notice: 04-09-2003
The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, was given by the Register of Wills on 04-09, 2003, and that the ten (10)
day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the
Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date: 06-04-2003 / , r ~.~1~( /) ~ _ ~~' ~-;
~ . ) ~ ._.
Donna M. Otto, Register of Wills ~ ~~ 1 ~ ~ ~ , ;,
f '~z; ell ~ ~. ~' ~ f
`-r
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
7 ~ s'-v3 ~ ~~~,~'
A hearing is scheduled for at in Courtroom No. 3. If the Status Report is filed
rior to the hearing date, the hearing will automatically be cance d.
~ George ff . .
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Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone:(717) 240-6345
Date
4/09/2003
MORAMARCO JOHN A
316 OVERBROOK DRIVE
YORK, PA 17404
RE: Estate of DAWSON PATRICIA A
File Number: 2001-00535
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURToRULoESaf~Or
for decedents dying
103 SUPREME COURT RULES DOCKET NO. 1,
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 5/25/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~ Quo; ~~ ~~
~~~~
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: File
Counsel
Judge
14512206202003 Cumberland County - Register Of Wills 620/2003
ROW621
File No 2001-00535 PA File No 2101-00535
Decedent DAWSON PATRICIA A
Docket Entries
D/E Date
No. Filed
001 06/04/01 OATHTOFNPERSONALNREPRESENTATIVOF ADMINISTRATION
DEATH CERTIFICATE
002 06/05/01 GRANT OF LETTERS OF ADMINISTRATION
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JRD/June 30, 1992/17858
In Re: Estate of Patricia A.Dawson
Late of East Pennsboro Township
Estate No.: 21-2001-0535
JUN 0 ~ ~~0~ ~'
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO.21-2001-0535
NOTICE OF FAILURE TO FILE STATUS CREME COUR ORPHANSO OURT RULE
HEARING PURSUANT TO RULE 6.12, SUP
Personal Representative: John A. Moramarco
Counsel for Personal Representative:
Date of Decedent's Death: 05-25-2001
Date of Delinquency Notice: 04-09-2003
The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, was given by the Register of Wills on 04-09, 2003, and that the ten (10)
day notice to file the Status Report has expireand tthe undersigned requests th tla Court 6onduct a
Court is hereby notified of such delinquency
hearing to determine whether sanctionsUe ~uld bonalpepre entativee delinquent personal
representative or counsel for the dehnq p
~ F, ,.,
Date: 06-04-2003 ~ ~ n 1 ~~"¢ 1~-~` ~
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Donna M. Otto, Register of Wi=r s f~`~ , ~ ,~~~ ~ ,, ;
y"~
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Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for at ~~ ~d in Courtroom No. 3. If the Status Report is filed
prior to the hearing date, the hearing will automatically be cance d.
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� 15�5610105
REV-1500 EX�o2_��,�F�> �
enns lvania OFFICIAL USE ON�Y
PA Department of Revenue P p,,,Mt Y „ , County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX Z8o6oi /
Harrisburg PA 1'7128-o6oi RESIDENT DECEDENT � 1 � � ����
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
05/25/2001
DecedenYs Last Name Suffix Decedent's First Name MI
DAWSON PATRICIA A
(If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Atlach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
JOHN A MORAMARCO (717) 309-4602
REGISTER OF WILLS USE ON4Y
-.,�
n _-� .�� fil
First Line of Address - - `�, ' «
-„ __
� " _:;+3 , a �_�
1 E MAIN ST '' r ==�' � '
- y
Second Line of Address �� " ;
APT 11 ;
City or Post Office State ZIP Code DATE F,ILED -_ _,;
}_.� ::,
DALLASTOWN PA 17313 r�a : ,�f
c.n �:;3 �.._,
r--� `'�
CorrespondenYs e-mail address:
Under p�y�alties of pery'ury,I deciare lhat I have examined this ret�m,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is tru�;corr ct and complete. eclaration of preparer o[her than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU OF P� ONSIBLE FOR FILING RETURN D TE
,'i` ���'�--�--- 3 G /�'
DRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1,5056101�5 150561,�105 �
\
�
� 15�5610205
REV-1500 EX(FI)
DecedenYs Sociai Security Number
oecede�t's Name: DAWSON,PATRICIA A
RECAPITULATION
1. Real Estate(Schedule A). ... .. .. .. .. .. .. .. .. .. .. ... .. .. .... ...... .. .. 1. 0.00
2. Stocks and Bonds(Schedule B) . . .. .... .. .. .. .... .. ... .. .... .. .. .. .. . . 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedu�e C) .. .. . 3. 0.00
4. Mort a es and Notes Receivable Schedule D 4. 0.00
9 9 � ) .. .. ..... . . .. .. .. .... .. ....
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ... . . 5. 0.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . ... .. 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . .. .. 7. 0.0�
8. Total Gross Assets total Lines 1 throu h 7 8. 0.00
( 9 ).. .. .. .. .. .... .. ..... . .. .. . . .
9. Funeral Expenses and Administrative Costs(Schedule H). .. .. .. .. .. .. . . .... 9. 5,400.00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I).. .. .. .. .. .... . 10. 0.00
11. Total Deductions(total Lines 9 and 10). . . .. .. .. .. .. ..... .. .... .. ... .. . . 11. 5,400.00
12. Net Value of Estate(Line 8 minus Line 11) .. .... .. .. .. . . ..... .... ... .. .. 12. 0.00
13. Charitabie and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ..... .. .. .. .. .. . . .. .. .. . 13. �.00
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . .... . . .... . . .. .. . . ... 14. 0.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.0_ 16. 0.00
17. Amount of Line 14 taxable
at sibling rate X.12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 1g. �.��
19. TAX DUE ... .. .. ........... .. ...... .. .. .. .. .... ..... . .......... .. . 19. �.00
20. FIL�IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505610205 7,5�5610205 �
REV-�500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
DAWSON PATRICIA A
STREETADDRESS
PO BOX 7253
, _
CITY _ _ _ __ I STATE _ I, ZIP
YORK ' PA 17404
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did tlecedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
tl. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If tleath occurred after Dec.12,1982,did decedent transfer property within one year of tleath
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Ditl decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
For tlates of death on or after July 1, 1994,antl before Jan. 1, 1995,the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets antl
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 deceasetl child 21 years of age or younger at death to or for the use of a natural parent, an
atloptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)J.
• The tax rate imposed on the net value of transfers to or for the use of the decedent's linea�beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the tlecedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined,
untler Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blood or atloption.
REV-`1511 EX+ �08-13)
� ��p��� SCHEDULE H
� � �� pennsylvania
� DEPARTMENTOFREVENUE FUNERA� EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DAWSON PATRICIA A 2101-0535
Decedent's debts must be reported on Schedule i.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1� Heffner Funeral Home Of Jacobus Inc 1502 Mount Rose AveYork, PA 17403 5,400.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) .. _ __ __ __ _
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedenYs address is not the same as claimant's, attach explanation.)
Ciaimant _._ _
Street Address
City --..-- -- ----- -.--- -State ZIP _—
Relationship of Claimant to Decedent _ _ __.
4. Probate Fees:
5. Accountant Fees;
6. Tax Return Preparer fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 5,400.00
If more space is needed, use additional sheets of paper of the same size.
NOTICE OF INHERITANCE TAX pennsyLvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
OF DEDUCTIONS AND ASSESSMENT OF TAX
INHERITANCE TAX DIVISION __r REV-1547 EX AFP (11-14)
PO BOX 280601
HARRISBURG PA 17128fgUORDED OFFICE OF
REGISTER OF WILLS DATE 07-20-2015
DASO
7015 JUL 27 PM 2 09 DATEESTATE OFOF DEATH 05-W25-N 2001 PATRICIA A
FILE NUMBER 21 01-0535
CLERK OF COUNTY CUMBERLAND
MORAMARCOO QHtoUr�TA
RPHAtJ10 ACN 101
APT 11 APPEAL DATE: 09-18-2015
, &UMBERLAND CO
-, PA
1 E MA S1 (See reverse side under Objections)
DALLASTOWN PA 17313-2200 Amount Remittedi
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4-
---------------
REV-1547 EX AFP C11-14) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: DAWSON PATRICIA AFILE NO. :21 01-0535 ACN: 101 DATE: 07-20-2015
TAX RETURN WAS: CX) ACCEPTED AS FILED CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) Cl) .00 NOTE: To ens';r. proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) CS) •00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) C9) 5,400.00
10. Debts/Mortgage Liabilities/Liens (Schedule 1) C10) .00
11. Total Deductions (11) 5,400.00
12. Net Value of Tax Return (12) 51400.00-
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . 00
14. Net Value of Estate Subject to Tax (14) 5,400.00-
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will
reflect figures that include the total of all returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at spousal rate (15) .00 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) -Otl x 045 = .00
17. Amount of Line 14 at sibling rate (17) . 00 , x 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 x 15 = .00
19. Principal Tax Due (19)= 00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.