HomeMy WebLinkAbout04-0002PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of
also known as
Deceased
Soctal Securtty No _.~ q' _.~ {_., - ?''7 ..0 (..~
No ¥-
TO ~
Register of Wills for the --
County of ~[~tn the
Commonwealth of Pennsylvama
The pet]tton of the undersigned respectfully represents that
Your pent~oner(s), who is/are 18 years of age or older, appl
for letters of admmtstration
on the estate of
(d b n, pendente hte, durante absentla, durante m~nontate)'-
the above decedent
Decendent was domiciled at death ,n C~) ~)( ~011(hd Qounty, P_.e. lalas~lvaom,, with · ] I
h~'}" last family or pnnctpal residence at (3~1 ~ ..... ~t ~-~
(hst strut2 nu~r and muh,opahty)
Decendent at death owned property w~th estimated values as folIlows '"" ,,, ' '
(If do~cded ~n Pa.) AIl personal prope[t~
(lf not dom~cded ~n Pa ) Personal propert~ in Pennsylvama $
(If ~ot d~m~cfled ~n Pa.) Personal property m County $
V~ue of real estate in Pennsylvama $
s~tuated as follows
Pet]ttoner after a proper search ha ascertained that decedent left no wdl and was survived by
the following spouse 0f any) and he]rs
THEREFORE, petmoner(s) respectfully request(s) the grant of letters of adm]mstranon ~n the
appropriate form to the undersigned
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
SS
COUNTY OF Cumberland
The pem~oner(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 peUt~oner(s) and that as personal
representative(s) of the above decedent peUtloner(s) will well and
truly administer the estate ac~:ordmg to law.
Sworn to or affirmed and suhscr, hed
~ before me th~s 2nd ~ __ day of ]
~nna M. Ott6,1st ~ty-- I ~e~tster
Esi~te of;
No. 21-2004-2
Lena Jane Bztner
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
~ -:-~ czty~anu--' 2nd,
~- AND NOW '_.' ' ' >01 2004, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Deborah J. Wmkoq~c~l~
ls/~ enutl~d to Letters of Admm~stranon, and in accord with such finding, Letters of Admimstration
are hereby granted to Deborah J.Wakefield
Donna M.zOttg,~[ ~D~puty
FEES
Letters of Administration $. 18.00
Short Certificates(4 ) $ 12.00 ATTORNEY (Sup Ct I D No )
~.,~unciation (5) $ 25.00
$ 10.00
TOTAL __ $. 65.00 ADDRESS
Fded 01-02-2004 AD ~yxxx
PHONE
Ma~led Letters to Adm~nistratr~x
on 01-02-2004
RENUNCIATION
21-2004-2
In Re Estate of deceased
TO the Register of Wills of ('_,[ I m b e ~ Ij~J,'-~ & County, Pennsylvania.
· e above d~ent, hereby renounces) the right to ad~mster thc estate and r~p~tfully ~k(s) that Letters
WI,~SS ~'~ handthls ~ dayof AC. ,20 OZ
(Address)
(S~gnatur¢)
(Address)
(S~gnature)
(Address)
RENUNCIATION
21-2004-2
the above decedent, hereby renounce(s) the right to adm~mster the estate and respectfully ask(s) that Letters
WITNESS
(S~gnature)
(Address)
(Signature)
(Address)
RENUNCIATION
In Re Estate of .f~ ~ ~ o..~.g
TO the Register of Wills of ~e' ~x t~ ~
21-2004-2
deceased
County, Pennsy[vama
of
The undersigned ~oOee C Z tft~/~ ~/"~/~ ~C
/
the above d~mt, hereby renounces) the right to ad~mster the estate and resp~tfully ~k(s) that Letters
WITNESS ~ ~ hand this ~{ 1 day of "t).t.~..~ ,21) ~ 3
d;~S~gnature)
(Address)
(S~gnature)
(Address)
(S~gnature)
(Address)
RENUNCIATION
2]_-2004-2
In Re Estate of ~1~ ~"~('~ (~("~ ~'~O
Tothe Reglster of Wills of ~/~.)c~''~)~9 ~ ~0 ~
County, Pennsylvama
deceased
of
the above dec~d~t, hereby~..enounce(s)( ~(~T~the¥~'J~0[~(~r:ght to adm~mster the estate and resp~tfully ask(s) that Letters
WITNESS ~i~ handth,s ~V dayof ~e~' ,20Oa
(S~gnat~e)
(S~gnature)
(Address)
(S~gnature)
(Address)
RENUNCIATION
21-2004-2
of
the above decedent, he~y renounce(s) the right to administer the estate and respectfully ask(s) that Letters
WITNESS /~/' --%
hand th,s ~ '~ day of D~£ ,20 0-~
(S~gnature)
(Address)
(Signature)
(Address)
(S~gnature)
(Address)
his IS to certify that the information here given ~s correctly copied from an original cemficate of death duly filed w~th me as
Local Registrar The original certificate will be forwarded to the State V~tal Records Office for permanent filing
WARNING- It ~s tllegal to dupltcate th~s copy by photostat or photograph.
Fee for this certificate, $2 O0
P 9898775
No
Local Registrar
Date
Cu ber and
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDE
CERTIFICATE OF DEATH
Jan~. Bzt:r:,r ],Female J, 204 -- 26 --8726 ]~eo. i2, 2003
91 Doublzng Gap Rd "~'~
Deborah j Wakefzeld ~06 Middle Rd Newv~lle PA 17241
~.,~ c~,~ ....... ~.,.~ ~fi~/2003 ~ewvllle Cemetery
E3
JRD/June 30, 1992/17858
HAY 0 6 2004
In Re: Estate of LENA JANE BITNER
Late of NORTH NEWTON TOWNSHIP
Estate No.: 21-04-2
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-2
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: DEBORAH J WAKEFIELD
Counsel for Personal Representative:
Date of Grant of Original Letters: 01-02-2004
Date of Delinquency Notice: 04-12-2004
The undersigned, Glenda Famer-Strasbaugh, Clerk of the Orphans' Court, 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 Clerk of the Orphans' Court on APRIL
12, 2004, 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: 05-06-2004
~enda Farner Strasb,augh ~
Clerk of the Orphans Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is schedule at in Courtroom No. 3. If the Certification of Notice is
filed prior to the hearing date, the heating will automaticS/il~
Go~rg~l~./H~fe[' P.~.~ J
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
Will No. ,~_t~O ~/- _~}OtO,~.~
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Name. Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
t.ch
Signature
Telephone (7/-/)
Capacity: __
74
Personal Representative
__.Counsel for personal representative
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
WAKEFIELD DEBORAH J
306 MIDDLE ROAD
NEWVILLE, PA 17241
RE: Estate of BITNER LENA JANE
File Number: 2004-00002
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' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
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 is due by: 12/12/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
i~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
~{;
Register of Wills of Cumberland County
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
:J(-.J n c: ''Blffle,,:-
I
j e.I7CL
Date of Death: ~p (~ e.W\loer ) d. I ;)003
/
Estate No.: )()DL./ - (~0nD 'J.-
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes JfI No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 NO~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: / J-JO"-OS-
!()o)~ 9. tl~~fl/
SIgnature
V~oV\~, WOK:E-\/e..1c3)
Name
_c.J
."
....-"'-",.,
t ,f
l_
30b jiZ.d/tk€J rJJ.Lo~m/J-J7JL/!
Address (
~/ n '7 7(;,- ,') -Y::Z <}
Te epnone No.
c~..!
I
t ;~~
,
c.:.::.~
t-.J
Capacity: 1KJ Personal Representative
o Counsel for personal representative
~~
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
).1_ - J2 L\
COUNTY CODE YEAq
b 0 ()~
NUMBER
~ DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
I- .
Z 'f2' ..,', ,( L ;') ., a
~ DATE OF DEATH (MM-DD-YEAR)
W
U
W
o
W
I-
~::!;U)
()O::~
wa.u
J:OO
uO::....J
a. [0
a.
<
SOCIAL SECURITY NUMBER
:..q - d\..c. <31;;2lc
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~
DATE OF BIRTH (MM-DD-YEAR)
- Iq~?/
D 1 Original Return
D 4 Limited Estate
D 6 Decedent Died Testate Attact,
D 9 litigation Proceeds Recetved
D 2. Suppemental Return
D 4a, Future Interest Compromise (date of death after 12.12.82)
D 7, Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.9S)
D 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
D 11. Election to tax under See, 9113(A) (Attach Seh 0,
I-
Z
W
o
Z
o
a.
U)
w
0::
0::
o
U
tHIS. SECl'lONMUST BE COMPLETED. ALL CORRESPONDENCe AND CONFIDENTIALTA.X;i'f.lFc>RMAl'fON$I-lOULD BE DIRECTED to:
NAME \ \ /.. 1n,.,\ .Je, 0: {'", \ C, COMPLETE MAILING ADDRESS. ,
- -E.\::x){C\. '\ v'-"-.. I' -\ ,,- '~C)l0 ~,~ \Ct-\ \ e <"'Rc\
FIRM NAME (!(Appl!cable) ~ e \i'0 \) \ \ \e 'Fe" \'~l dL1 \
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3 Closely Held Corporation, Partnership or Sole-Proprietorship
4, Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Deposits & Miscellaneous Personal Property
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F)
~ D Separate Billing Requested
...J
:) 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L)
c.. Total Gross Assets (total Lines 1-7)
<( 8.
U 9. Funeral Expenses & Administrative Costs (Schedule H)
W
a::: Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
10.
11 Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
(1)
(2)
(3)
(4)
(5)
" !
.-.J
(- -"
(6)
(.'J
o
(7)
(9) $. q I )~O ,O()
(10)
(8)
(11) .1:\ C\' I \ <X (" . CJ(j
(12)
(13)
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)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
~
:)
c..
~
o
u
><
~
15, Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
x ,0 _ (15)
16. Amount of Line 14 taxable at lineal rate
x ,0_ (16)
17 Amount of Line 14 taxable at Sibling rate
x12 (17)
18 Amount of Line 14 taxable at collateral rate
x ,15 (18)
19. Tax Due
(19)
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
gu
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE.AND BEC...ce-1t MATH <<
Decedent's Complete Address:
I STREET ADDRESS
CITY N~~I \:?&~J b\ i rLCj
Ga-p
1<d
I STATE tu
] ZIP \~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
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
~
:E1
... D ~
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: 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 payments, 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? ...............................................................
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? ...... ......................... ..................
No
~
I
....... D
........... D
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
DATE
h -- / j-{) (;?
.
ADDRESS ,
.Jx'jlp \'v\ \dd \e \\eWV \ H€
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
YO
\\ ;)L\ \
DATE
ADDRESS
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 PS. 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)J.
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 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.
REV-15D8 Ex + P-!;!7}
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
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
1,
VALUE AT DATE
DESCRIPTION OF DEATH
~Of-A\ 0\=' S\c^~meD-\ 1'(\ \X}ck~e 1-
\X \<n'CiC t\\',~:::> C~YIC (4
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
~ ADAMSCOUNIYNATIONALBANK&
FARMERS NATIONAL BANK OF NEWVILLE
CHECKING STATEMENT
...,011'1.'11/11 IJIAtjd'/J) (,'Oilllt)' .V",101/I11 /ilinA'
Statement Date: 01/07/04
Account#: 189758
Enclosures: 7
801
LENA J BITNER
112 COUNTRY VIEW ESTATES
NEWVILLE PA 17241
Accounting services from your bank? It all adds up.
Adams county National Bank offers Tax and Accounting services
for individuals, partnerships and corporations.
Contact craig Showvaker at 717/338-2266 for more information or
to schedule an appointment for 2003 income tax preparation.
ESTEEM CHECKING
Account #
Account Summary
Page 1
189758
12/04/03
Beginning Balance
$3,300.38
Activity Ending Balance
7
.00
3,300.38-
.00-
.00
Previous Statement Balance
+ Deposits and Other Credits
- Checks Paid or Other Debits
- Service Charges
+ Interest Paid
Ending Balance
Days in Statement Period
34
Date
Account Detail
CheckslDebits
$.00
12-08
12-08
12-09
12-11
12-15
12-16
12-17
01-07
Activity Description
BEGINNING BALANCE
CHECK # 558
CHECK # 559
CHECK # 560
CHECK # 563*
CHECK # 564
CHECK # 561
CLOSING TRANSACTION
ENDING BALANCE
Deposits/Credits
222.00
379.00
46.16
44.30
100.00
133.34
2,375.58
Checks Paid -' Indicates skip in check number
Check #
558
559
Date
Amount
Check #
560
561*
Date
12-08
12-08
22 2 . 00
379.00
12-09
12-16
PO. Box 3129, Gettysburg, PA 17325 · 888/334-ACNB (2262)
www.acnb.com
Balance
3,300.38
3,078.38
2,699.38
2,653.22
2,608.92
2,508.92
2,375.58
.00
.00
Amount
46.16
133.34
Checks Paid (cont.)
Check #
Date
Amount
563 12-11
Total Number of Checks:
44.30
6
Interest Summary from 12/04/03 to 01/07/04
Days in Period
Interest Earned
Annual Percentage Yield Earned
Interest Paid This Year
Interest Withheld ThisYear
END OF STATEMENT
Check #
Date
564 12-15
Total Amount of Checks:
34
$.50
.50%.
$.00
< ',$.00
$924.80
Page 2
189758
Amount
100.00
REV-1511 EX+ (12-99)
~~~(~
.~,*,;;'tl!.>>r'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
DESCRIPTION
FUNERAL EXPENSES: -P'{ c,\='e%"'Oi)C\' ~\V 1<2..(
c.em,' ~" ~.,. ," 0, '. 7)p f\, i 0Cl"
Wh~\( ~.h\ \\\'~Cj'-' ,g (~ClU,('~{, C(\sYe+
Y:L\.f-tN VGl.d-t
\-t\\'("' b,essey-
\="Iowex-'"'j
CJefCJ'~ o.<0'C:( \ Y-'\Cj
,() \):--'0-:-\ \ '\ C~ y \ \-0\ cnA e '->
AMOUNT
4 ~I' t.t5 . ()('\
~ '-\-15 00
, r\()s ,C>D
~ l \..cFt. GO
~ "?T:> ()O
1\ '\ ('*-0 . 00
f>. '35,00
,1t ~) , 00
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City _________.____.____________ State __ Zip
Year(s) Commission Paid:
2. Attorney Fees
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.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
F. CHARLES EGGER, Supervisor
EGGER FUNERAL HOME, INC.
1 5 Big Spring Avenue
NEWVILLE, PENNSYLVANIA 17241
717-776-3414
FRANK C. EGGER, Funeral Director
December 30, 2003
Funeral bill for Lena Bitner
Date of death December 12, 2003
Professional Service
$3,145.00
Cemetery Opening
$415.00
White Sterling 18 Gauge Casket
$1,905.00
Burial Vault
$769.00
Hairdresser
$35.00
Flowers
$106.00
Clergy offering
$35.00
10 Death Certificates
$20.00
Total
$6,430.00
Check received 12/16/03
$2,405.65
lnsurance check received 12/29/03
$3,389.55
R e(""\~; l",; I~)
0>tdatj(fJ
-0-
rct~
0(,ctD
~J \ \~\O~
~\ {JJt"
fa6r
pArD
J6-~
$ ~O{) . (1) &-
3/J G/Oij '\
Remaining balance
AMElliclI
P.O. Box 13487
Kansas City, MO 64199-3487
(800) 256-2328
December 23,2003
EGGER FUNERAL HOME
15 BIG SPRING AVE.
NEWVILLE, PA 17241
Reference: 00150234
Policy Number: N2003436
Insured: Lena Bitner
Dear Funeral Director:
Again, we wish to convey our sincere sympathy to the family members in thE~ir recent loss.
As of the date of the insured person's passing, this policy has a death benent amount of $3,064.00.
The following adjustment has been made:
Excess Interest
$325.55
Enclosed is our check in the amount of $3,389.55.
If we may be of any further service, or if you have any questions regarding this payment or policy,
please feel free to contact our office at (800) 256-2328.
Sincerely,
Derk Hanna, J.D.
Claims Examiner
Enclosure(s): Check
AMERICa FINANCIAL LIFE AND ANNUITY INSURANCE CaMP ANY (FORMERLY THE COLLEGE LIFE INSURANCE CaMP ANY OF AMERICA) .
GREAT SOUTHERN LIFE INSURANCE CaMP ANY -THE OHIO STATE LIFE INSURANCE COMPANY .. UNITED FIDELITY LIFE INSURANCE CaMP ANY .
NATIONAL FARMERS UNION LIFE INSURANCE COMPANY' fINANCIAL ASSURANCE LIFE INSURANCE COMPANY
09-04-2006
BITNER
12-12-2003
21 04-0002
CUMBERLAND
101
APPEAL DATE: 11-03-2006
( See reverse side under Objections)
A.ount R.-ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~~!_~~9~~_!~~!_~~~~______~___!~!~!~_~P~~!_~g!!!P~_~P!_yp~!_!~~g!P!__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
LENA J FILE NO. 21 04-0002 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.IE ~INHERITANCE TAX
P . fl ~E OR DISALLOWANCE
'R"\..-jk~r~~ l'j~'I:l ~~ ASSESSMENT OF TAX
DEBORAH WAKEFIELD
306 MIDDLE RD
NEWVILLE
,.1JA TE
2006 SEP -8 AH II: I ~STATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACN
CLERK OF
ORPHAN'S COURT
CUM8FR1n/\ND CO, PA
PA 17241
ESTATE OF BITNER
w
I~
REV-1547 EX AFP (06-05)
LENA
J
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
DATE 09-04-2006
I~ an asses..ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
r~lect ~igures that include the total of ALL returns ass8ssed to date.
ASSESSMENT OF TAX:
15. AIIount of Une 14 at SpouS81 rat. (5)
16. AIIount of Line 14 taxable at Line.l/Class A rate (16)
17. AIIount of Line 14 at Sibling rate un
18. AIIount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedula B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Racaivable (Schedule D)
5. CashIBank Deposits/Hisc. Personal PrOPerty (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(I)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. CostslHisc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Valua of Tax Return
13. Charitable/Governaantal Bequests; Non-elected 9113 T~sts
14. Net Value of Estate Subjact to Tax
9,180.00
(9)
(10)
.DD
(Schedule J)
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
AHOUNT PAID
DATE
NUMBER
INTEREST/PEN PAID (-)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credl t to your account,
subait the upper portion
of this fora with your
tax pay..nt.
.00
UI)
(2)
(3)
(4)
9.180 00
9,180.00-
.00
9,180.00-
(9)=
.00
.00
.00
.00
.00
.00
.00
.00
.OD
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)