HomeMy WebLinkAbout05-22-08 (2)
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15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
File Number
County Code Year
INHERITANCE TAX RETURN 2 1 0 8
RESIDENT DECEDENT
.
05~O
Date of Birth
030 14 5432
02 27 2008
01 25 1920
Decedent's Last Name
Suffix
Decedent's First Name
JOHN
MULLENIX
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
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 0 2. Supplemental Return 0 3. Remainder RetUrn (date of death
prior to 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax RetUrn Required
(date of death after 12-12-82)
[K] 6. Decedent Died Testate [K] 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
MI
C
MI
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Num~.
B R E T T B. WE INS TEl N E S QUI R E 6 1 0 3 ~7 3 7 3 ~
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REGISTER OF'~S U~NL i :', .
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Firm Name (If Applicable)
WEINSTEIN LAW
OFFICES
PC
First line of address
C)
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705 WEST DEKALB PIKE
Second line of address
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City or Post Office
KING OF PRUSSIA
DATE FILED
State
PA
ZIP Code
19406
Correspondent's e-mail address:bbwatty@aol.com
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 PERSON RESPONSIBLE FOR ING RETURN TE
=:. 'e- Stephanie R. Gladden 0 ~
ADDRESS
DATE
Brett B. Weinstein Esquire
705 West DeKalb Pike, King of Prussia, PA 19406
Side 1
L
15056041147
15056041147
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15056042148
REV-1500 EX
Decedent's Name: J 0 h n C. Mull e nix
Decedent's Social Security Number
030 14 5432
RECAPITULA nON
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................
6. Jointly Owned Property (Schedule F) D Separate Billing Requested.............
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested.............
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).............................................................
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).................................................
10.
11.
12.
13.
14.
5.
127.78
6.
60,611.50
391,292.79
452,032.07
6,748.32
140.18
7.
8.
9.
6 , 888 . 5 0
445,143.57
445,143.57
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
o . 0 0
445,143.57
o . 0 0
o . 0 0
19. Tax Due..... .......... .............. ................................... ........... ............. ............................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
15.
16.
17.
18.
o . 0 0
20,031.46
o . 0 0
o . 0 0
20,031.46
D
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-
DECEDENT'S NAME
John C. Mullenix
STREET ADDRESS
Forest Park Health Center
700 Walnut Bottom Road
CITY 1 STATE IllP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,001.57
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
20,031.46
1,001.57
19,029.89
19,029.89
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................................... [!] 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
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; or..................................................................................................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?...... ............................. ........................... ................ ..................... ....................
Yes
[!]
[!]
o
o
o
o
No
o
o
[!]
[!]
[!]
[!]
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 three (3) percent [72 P.S. 39116 (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 zero
(0) percent [72 P.S. 39116 (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 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 zero (0) percent [72 P.S. 39116 (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 four and one-half (4.5) percent,
except as noted in 72 P.S. 39116 1.2) [72 P.S. 39116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 39116 (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.
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mullenix, John C.
FILE NUMBER
21-08-
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 GNMA Certificate #29725
VALUE AT DATE
OF DEATH
127.78
TOTAL (Also enter on Line 5, Recapitulation)
127.78
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner GrouP. Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rov-1509 EX... (8-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Mullenix, John C.
FILE NUMBER
21-08-
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Stephanie Gladden
ADDRESS
RELATIONSHIP TO DECEDENT
3 Brookside Lane
Burlington, MA 01803
Stepchild
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 12/28/2006 Middlesex Savings Bank CD #161862943 20.144.05 50.000% 10.072.03
2 A 12/28/2006 Middlesex Savings Bank CD #161862951 90.717.78 50.000% 45.358.89
3 A Several Orrstown Bank Acct. #106000072 10.361.16 50.000% 5.180.58
years ago
TOTAL (Also enter on Line 6, Recapitulation) 60.611.50
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-151D EX+ (6.98)
*'
SCHEDULE G
INTER~VIVOS TRANSFERS &
MISC. NON~PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Mullenix, John C.
FILE NUMBER
21-08-
ESTATE OF
This schedule musl be completed and filed if the answer 10 any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 American Equity Annuity Contract #079761 - 4.724.71 4.724.71
Beneficiary: Stephanie R. Gladden
John C. Mullenix Trust - The decedent created a
living trust during his lifetime which contained
the following assets on his date of death:
2 American Investors Life Annuity #473114 268.673.62 268.673.62
3 Middlesex Savings Bank Checking Acct. 15.594.82 15.594.82
#161862894
4 Middlesex Savings Bank Money Fund Acct. 1.00 1.00
#161862927
Smith Barney Acct. #54J-02674-13
5 Bank Deposit Program 18.821.68 18.821.68
6 157 units of Delaware Investments Dividend & 1,537.03 1,537.03
Income
7 $15,000 Fannie Mae Series 2002-5 Class LQ - 15.187.11 15.187.11
20290725 5.50000, CUSIP #31392EBV1
Accrued interest on Item 7 through date of death 59.60 59.60
8 $39,000 Federal Home Loan Mtg. Corp - 37,891.66 37.891.66
203410155.50000, CUSIP #31395RCP1
Accrued interest on Item 8 through date of death 154.91 154.91
Total of Continuation Schedule ee attached page
TOTAL (Also enter on Line 7, Recapitulation) 391,292.79
<'f more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
Rev-1510 EX+ (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Mullenix, John C.
FILE NUMBER
21-08-
ESTATE OF
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATIACH A COPY OF THE DEED FOR REAL ESTATE.
9 $4,000 FHLMC Gold 2961 CL MJ . 20350315 3.939.69 3.939.69
5.50000, CUSIP #31395TF90
Accrued interest on Item 9 through date of death 89.32 89.32
10 $20,000 General Motors Accept Corp -11/2016 14.510.08 14.510.08
7.3750%, CUSIP #37042GTG1
Accrued interest on Item 10 through date of 49.16 49.16
death
11 Washington Mutual Bank CD, CUSIP #030380P86 10.058.40 10.058.40
TOTAL (Also enter on Line 7, Recapitulation) 391.292.79
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Mullenix, John C.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-08-
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 1,748.32
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
I
2. Attorney's Fees Weinstein Law Offices PC 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) 6,748.32
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TIV< RETURN
RESIDENT DECEDENT
Mullenix, John C.
FILE NUMBER
21-08-
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Edwing Brothers Funeral Home, Inc.
1.748.32
Subtotal
1.748.32
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1512 EX+ (6-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Mullenix, John C.
FILE NUMBER
21-08-
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Outstanding Medical Bills: -
Graham Medical Clinic, PC
Carlisle HMA Physician
Mobile X-Ray Imaging Inc.
140.18
$ 92.98
9.15
38.05
TOTAL (Also enter on Line 10, Recapitulation)
140.18
(If more space is needed, additional pages Df the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Mullenix, John C.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee/s)
FILE NUMBER
21-08-
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Stephanie Gladden
3 Brookside Lane
Burlington, MA 01803
Stepchild
100% of the
residue
445,143.57
Total 445,143.57
Enter dollar amounts for distributions shown above on lines 15 through 18, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
H105.X05 REV ,OIIi17,
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
() Y; 5&0
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
Fee for this certificate, $6.00
Certification Number
~_ ~~~~~-A.~k.lFE~ 2 8 / '200a
Local Registrar 'Date Issued
P 14126040
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'H105-143 REV 1112006
TYPE I PAINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
1. Name 01 Oecedel1t(FIfSt,midlIe,last, suffix)
J)hn C. Mullenix
5432
4. Dat9 01 Dea\tI (Month, day, year)
Feb. 27, 2008
5. Age (Last Birthday)
6. Dale of Birth (Month. da ,year) 7. Birt.hp4et:e City aM slate QI" Sa. Place of Death (Check only one)
HospiUll: Other.
1/25/1920 . Sam Houston, Oln""en' OERIOulpatie"' OOCA [JiNursingHome OResldence
Bd. FaclIIly Name (If not klStituIlon, give street and number) 9. Was Decedent 01 Hispanic Origin? ~ No 0 Yes
(If yes, $p8Cify CLban,
Forest Park Health Center Mexk:an,Pu'rtoRk:an,,~.)
12. Was Oecedenl: everln the 13. Decedent's EducatIOn (SpecIfy only higheSf grade compIeledl 14. Marital Status: Married, Never Married,
U.S. Armed Forees? Elemen1la!y I Secondary (0-12) College (1-4 Of 5+) Widowed, Oivorced {Specif}1
i:&IVes DNa 'L WiClcMed
88 y~.
8b. County of Death
Cumberland
11. Decedenl"s Usual lion KW'ldofWOl'll:done
Km of Wort
Office Work
. 16. Oecedenfs Mailing Address (Streel, city f town, state, zip code)
Did Decedenl
live in a
Township?
Decedent's
ActualResidence 1711..StalII.
PA
Cumberland
17c. 0 Yes, Decedent Lived in
l1d'~Actua~~with~
Carlisle
17b. County
19. Molner's Name (First, middle, maiden surname)
Florence Parker
2Ob. Inrormant's MaHrrg Address (Street, city I town, state, zip code)
3 Brookside Lane; Burlin
21t. Plac&ol DIsposItian{Nameofcemeter1,~Ofo\hefp\ace}
Evans Crenation Services, Inc.
........,
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OOttler.Spe<;ly,
10. Race:.A.merican kldian, Black, White, etc.
{Sped'"
White
Twp.
City/Boro
21d. location (CiIy I town, slate, zip code)
Leola, PA
22c. Name and M1ress of Facility
flNin Brothers Funeral Hane, Inc., Carlisle, PA 17013
23b. License Number
IL\\ '35154 I
26. Was Case R81~51Medlcal Examlner !Coroner for a Reason Oth&r lIlan Cremation or Donation?
DYes ~
23c. Date Signed (Month, day, year)
2lLrl-z..Ob2
IIemS 24.26 must be compIeIed by person
WOOplOl'lOlJ"lC8Sdllath.
24. lime 01 Death
M.
CAUSE OF DEATH (See instructions and examples)
Rem 27. Part f; Enter the ~ - dseases, injuries, or corJllIications -thai directly caused the death. 00 NOT enter terminal events soch as cardiac arrest.
respiratory arrest, orventslcl.Urlibrillallon wiUlootshowinglheetlology.llstonl'fonecaLlSEl on each One.
~~~~i~l~ . ~ /~ ~~
Due'o~or'" nceo~, ~ ~
~Wsl~~'~~a. b. I
= UNDERLYING CAUSE Duelo~
Iclseaseor!>lw'l""....""ttle
iWenlsresLdflgln deaIh) LAST.
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Approximate interval:
Onset to Dealh
Part II: Enter other slmificant conditions contributioo 10 death 28. Did Tobacco J!,se_ ~ to Death?
buI not resulting in Ihe underlying cause given in Part I. 0 Yes ~
o No 0 Unknown
Due to (or as a consequence 01):
d.
JOb. Were Autopsy FindIngs
AvaUablePriortoCorlllfellon
01 Cause of Oealh?
OYes~
3Oa.WasanAulopsy
Pe"armed?
31.MamerofOealh
~, D_
O ^"""', 0 Pendng 'IIWSIIgation
OSu.'''' OCouldNoitieDele<mlned
M.
32tJ. Time 01 Injury
32.9. \..acatioo ollrV1 lSl.reet, ti\y I town, slale)
Dyes
33a.Cert~(cI1eck01lyon'l
Certifying physician (Physician certifying oause of death when another physician has pronounced death and completed Item 23}
To the best of my knowkfttge, death occulT8d due to the eause(s) and manner as stated.... _ _ _ _.. _ _...... _ _.. _ _ _.. _ _.... _ _.. _.. _.. _ __
. :::=:'~=7~ma~=::=":..~=IOIo~:_..s1a1ed.._________________ 0
. = =5'::~: and I or investigation, In my oplnlor1, death OCCWTed at the time. cli!lte, and place, and due to the cause(s) and manner as stateeL 0
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35.
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Ia- I I I;;l. I \ I () I
DiSposition Perm~ No.
Q\q~#I1
29. llFemale:
o NoIp<egnan1,"",',peslyea<
Op_"",..,,_
o NoIP"9"l"""'-'plOlPlant,",,,"42days
"dea'"
o Not pregnant, buI pregnant 43 days to 1 year
before""'"
o lMknown. pregnant within the past year
32c. Place of Injury: Home, Farm, ~reet, Faclofy,
Office Building,tItc. (Specify)
rWl
WEINSTEIN LAW OFFICES PC
01-500
705 WEST DEKALB PIKE
KING OF PRUSSIA, PA 19406
(610) 337-3733
FAX (610) 337-3240
April 22, 2008
FOSTER PLAZA, SUITE 300
651 HOLIDAY DRIVE
PITTSBURGH, PA 15220
(800) 859-9535
FAX (412) 928-4951
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
Re: John C. Mullenix, deceased
s.s. No.: 030-14-5432
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To Whom It May Concern:
Enclosed please find the following:
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. PA Inheritance Tax Return (two copies)
. A check for the tax due for the above-mentioned Decedent
. A separate check for the filing fee
. Estate Information Sheet to open the file
. Death Certificate
If you have any questions, or require additional information, please contact our office.
Sincerely yours,
t;)/jJf-
T~
&.
Brett B. Weinstein, Esquire
WEINSTEIN LAW OFFICES PC
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CUMBERLAND COUNTY
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INHERITANCE TAX PAYMENT/FILING FORM
WHEN ESTATE NOT PROBATED
O~ - 5r.oD
ESTATE FILE NUMBER:
To be assigned by the Register of Wills Office.
ESTATE OF:
JOHN C. MULLENIX
SOCIAL SECURITY NUMBER:
030-14-5432
DATE OF DEATH:
FEBRUARY 27,2008
LAST PRINCIPAL RESIDENCE:
FOREST PARK HEALTH CENTER
700 WALNUT BOTTOM ROAD
CARLISLE, P A 17013
TOWNSHIP/BOROUGH:
CARLISLE
CORRESPONDENT:
BRETT B. WEINSTEIN, ESQUIRE
705 W. DEKALB PIKE
KING OF PRUSSIA, PA 19406
PHONE NUMBER:
610-337-3733
(If applicable) Enclosed you will find: INHERITANCE TAX FORMS (REV-1500)
Any questions completing these forms, please call- 717-787-8327
When forms are completed, please send the following:
1. This form completed.
2. One original and one copy of the REV-1500 along with only one copy of any attachments
to support the return.
3. Death Certificate
4. Any payment (IF DUE) made payable to "Register of Wills Agent"
5. A separate check for the filing fee made payable to "Register of Wills"
Please mail (With Original Signatures) to: CUMBERLAND COUNTY COURTHOUSE
REGISTER OF WILLS OFFICE
1 COURTHOUSE SQUARE
CARLISLE, PA 17013-3387
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