HomeMy WebLinkAbout04-0270PETITION FOR PROBATE and GRANT OF LETTERS
To
Register of Wdls for the
County of ~a/)/_]~
Commonwealth of Pennsylvanta
The pemlon of the understgned respectfully represents that
Your petmoner(s), who is/are 18 years of age or 91de. r an t,h~q execut ~ql X
tn the last wtll of the above decedent, dated '-4~7d/ ~., y ] / ~t ~ 7
and~-c-odreflt~ dated
tn the
named
(state relevant circumstances, e g renuncmuon, death of executor, etc )
Decendent was domtcded at death ,n (t (./[~ ~/~J...t~]0/,~ County, Pennsylvania, Kith
h~,last (amdy or pn[mpaLresidence at ~Og~t3 ~0~, qg~tMa~m
(bst street, number and munmpabty)
at
Except as follows,,defiedent did not marry, was not divorced and d~d not have a chdd born or adopted
after execution of ~he w~l 6ffered for probate, was not the victim of a kdhng and was never adjudicated
incompetent ~/~ 2~'
Decendent at death owned property wtth esttmated values as follows ~ t~
(If domicfledqn'Pa )x'".~ All personal property $_.~ 0~ 0 t 0 fO
(If not domtmlcd 16 Pa ) Personal property tn Pennsylvanta $ -
(If not do-rfi~ctl~d 1I)1 P'a ) Personal property tn County $
Value of real estate tn Pennsylvanta $
situated as follows
WHEREFORE, petmoner(s) respectfull~.reques[(s)t~hhe .pr. obate of the last wtll and~
presented herewith and the grant of letters'/-~
(testamentary, administration c t a, admlmstratlon d b n c t a )
theron
- 9 £,1) .....
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF~- ,'
The petitto.ne.r(s), above-named, swear(s) or affirm(s) that the statements in the foregotng petttton are
true and correct to the best of the knowledge and behef of petittoner(s) an~ that as personal represen-
tattve(s) of;th%above decedent pettttoner(s) will well a,od J~ruly a~dm~n}ste}vfhe estate according to law
Sworn to or' affirm d~x/and'subscnbed .- ~tO~{~
before me this /(~,2~ day of J -
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death: ~L~/f{.~/~y / ~yj o~004
W.l No. ~i-~ ~/- ~ 70
To the Register:
Admin. No
I certify that notice of (benefidal interest) estate adminL~tration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or. maile._...~d to the following beneficiaries of the above-captioned estate on
Nanle
!
Address c~a.7~ /30t~7'0Y0 /'1('~9~r~O(v /~b,
J
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
LL:~d L- Hdb' ~.
Capacity:
Signature
Counsel for personal representative
Estate of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, sat~fac~o~ proof hawng b~en presented before me,
IT IS DECREED that the instrument(s) dated ._//;/L// ~
described therein be admitted to probate and filed of record as the last wdl of
and Letters '-7--,~7-,z~/~?F~ /~,,.~ C/
are hereby grante'd to'~t3. ~-/d.'~,t'--~,~/ '~ /-7/-0./.~-~-c~ d'~
,M~&2~. in consideration of the petition.on
FEES
Probate, Letters, Etc... $~
Short Certificates( ) . . $ A_~,tO0
/ $ //9. ~('~
ATTORNEY (Su~ ~Ct I D No)
ADDRESS
PHONE
OATH OF SUBSCRIBING WITNESS
Estate of Edith F Brown
also known as
, Deceased
(each) a subscnb~ng w~tness to the r-I cod~cd(s) [~ w~ll(s) presented herewith, (each) duly quahfied according to
law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and
tphraets~hn~/eh~/~he~Yc~,ogtnheedr a;~n~l~nee;iSe;tetnh(: roefq/heeSto~3hf;rhe Tesu.~s,~tratOr(r,xlb.~g.w~tln heness~/hl)~/,r presence/~nd~ ,n the
~ 220 a e S et~Newport (S,gnature). / PA 17074
(Address)
(S~gnature)
(Address)
Sworn to or affirmed and subscnbed
before me this I ,~q(~ day of
,c (..)
My Commission Expires
(S~gnature and seal of Notary or other
official quahfied to administer oaths Show
date of expiration of Notary's commission )
N~y~ NotarlaJ Seal I
UNDAJ HAJ.LNOTARYFUBUC I
BOROUGH PERRYCO. PAl
m ss on Ex,o res Nov ~9,~7I
NOTE To be taken by officer authorized to adm~mster oaths P[ease have
present the ong~nal or copy of ~nstrument(s) at time of notarization
RW-2
o r'-
REGISTER OF W'~LS OF COUNTY
., OATH OF ~t~CRIBING~'% ,
(each) witness to the presented herewith, (~) being duly
that ~. and saw
of testat_ tn presence of each othch~m :e of the'
Sworn to fore
(Name) ~
Regtster ~
,,.5
REGISTER OF WILLS OF ~./;t/~6',L~/~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) bemg duly quahfied according to law, deEose(s) and_sa~(s) that
~al fam,har w,th the signature of ~]~ F~ 0'~0~
testat~ of (one of the subscnbmg wnnesses to) the will presented herewith and
cod~cd
that ~ ~O behev~ the signature on the will IS In the handwriting of
to the best of ~/~./ knowledge and belief ~. t., ./
me this ~ day of tName)
(Address)
" R_ecoraed. Off,,_ .
Heg~ste~ o~ Wills
~/04 I~? 15 P1:35/
/
/
/
./
his 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 cemficate will be forwarded to the State Vnal Records Office for permanent filing
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2 O0
P 10159151
No
FEB 1 8 200~
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
~ Cumberland
,,~ Sch(]ol Teacher
442 Walnut BottQm Road
Carlisle, PA 17013
(R?
I, EDITH F. BROWN, of Savllle Townshzp, Perry
County, Pennsylvania, being of sound mznd, memory and
understanding, do hereby make, publish and declare thzs
to be my Last Will and Testament, hereby revoking any and
all W~lls by me heretofore made.
FIRST: I dmrect payment of the expenses of my last
zllness, funeral and burial costs from my residuary
Estate, as an expense of my Estate, as soon after my
death as convenzently may be done. Ail Federal, State
and other death taxes payable because of my death, with
respect to the property formzng my gross Estate for tax
purposes, whether or not passing under thzs Wzll,
lncludzng any znterest or penalty ~mposed ~n connection
w~th such tax, shall be considercd a part of the
admmnmstratmon of my Estate and shall be pamd from my
residuary Estate without apportionment or rmght to
rezmbursement.
I hereby direct that my Executor and next of k~n
make all necessary arrangements to donate any and all
usable organs or body parts pursuant to the Pennsylvania
Anatomical Gift Act or s~m~lar statute.
I dzrect my Executor and next of k~n engage the
services of the James Nzckel Funeral Home to make ali
arrangements as hereinbefore dzrected, handle the
disposition of my remains, and arrange and coordinate a
memorzal servzce at the Carlzsle Frmends Meeting House.
SECOND: I gzve and bequeath my automobiles and
personal effects, furnzture, and household goods, if any,
as may be my ~ndzvzdual property and not the property of
my spouse, FRANCIS A. BROWN, or owned 3olntly by me w~th
my spouse, FRANCIS A. BROWN, and other tangzble
personalty of lmke nature, not zncludlng cash or
securities, together w~th any ex,sting insurance thereon
to my spouse, FRANCIS A. BROWN, provided my spouse shall
survive me by s~xty ~60) nays.
THIRD: I hereby give to my spouse, FRANCIS A.
BROWN, during hzs lzfetlme, ail the znterest, d~vzdend,
and other zncome from my Altantlc Rzchf~eld secur~tzes or
holdzngs as well as my holdzngs zn the Value L~ne Funds.
Upon his death I gmve these secur~tmes and holdzngs to my
four chzldzen as set forth ~n the residuary clause of my
w~ll, as provzded zn Paragraph Fifth below.
ALt. EN E HENCH
AT'['ORNEY AT tAW
2~ MAR)~T ST
NEWPORT. PA 17074
TEl- (717) 567-3139
LOYS'VlLLE OFFICE
WEST MAIN ST
(RT ~74)
LOYSVILLE, PA 17047
TEL (717) 789-3847
Ail the rest, residue and remainder of my estate,
whether real, personal or m~xed, of which I shall dae
seazed and possessed, and to whzch I may be entatled at
the t~me of my decease, and wheresoever the same may be
satuate, I gave, devise and bequeath unto my spouse,
FRANCIS A. BROWN, provaded my spouse shall survave me by
sixty (60) days.
FOURTH: If my spouse, FRANCIS A. BROWN, shall not
survave me by saxty (60) days or af my spouse shall have
predeceased me, then,
1. I give and bequeath to Deborah B. Hammack
Grandmother Farley's diamond rang and my gold bracelet.
2. I gave and bequeath to Pamela B. Gibney, my
engagement r~ng, the handcrafted salver dogwood pan whach
was a gift from Grandmother Farley, the large bureau an
attic, the oak roll-up desk, th~ ~ntaque trunk in attic,
the Intaglao necklace, the double leaf cherry table, the
walnut bookcase wath glass door and antique and other
books therean.
3. I g~ve and bequeath to Thomas A. Brown the
sangle leaf cherry table, the Chappendale chair, the H.
Herzog pacture of Delaware, the large 4' wade oai
paantlng, and the Pendulum wall clock.
4. I g~ve and bequeath to Tamothy F. Brown Great
Great Great grandfather Brown's coat of arms, my
barthstone rang, the cedar chest and antaque cake stand,
the glass chana closet, the oak danang room table wath
claw feet, and the oak buffet.
5. I gave and bequeath grandma's china wath pink
and red roses and sterlang s~lverware to Elly Brown and
Galllan Brown, share and share alike.
6. I g~ve and bequeath the Lark motorazed cart to
Katherane B. Hammack.
7. I gave and bequeath ~he black walnut loveseat
and thrce ~__.~ to ~-'~ ~ B~wn ~a 1-I~'~
Brown, share and share alake.
8. I gave the marble top wash stand and marble top
bureau and m~rror to Melassa S. Gzbney and Jessaca S.
Glbney, share and share alike
9. I direct that all the artwork of Deborah B.
Hautmack be returned to her.
10. I darect that the tools an the woodshop and
the house tra~ler be sold and the proceeds d~strabuted
among my four children as part of my resaduary.
LO¥SVI~.LE OFF~CE
WEST ~AIN ST
(RT 274)
LOYSVILLE, PA 17047
T~I. (717) 789~3847
11. I direct that my Executor give each of my
granddaughters one item as may be chosen under the
guidance of my Executor, with the condition and
understanding that the item chosen be used by such
granddaughter and not sold.
FIFTH: Ail the rest, residue and remainder of my
estate, whether real, personal or mixed, of which I shall
die seized and possessed, and to which I may be entitled
at the time of my decease, and wheresoever the same may
be situate, I give, devise and bequeath to my four
children Timothy F. Brown, Thomas A. Brown, Deborah B.
Hammack, and Pamela B. Gibney, in equal shares, share and
share alike; provided, however, that any portion of the
Twenty Thousand ($20,000) balance (as of the date of this
will) of that loan made previously to Timothy F. Brown,
no? repaid as of the date o~ ~y death, ~hs~l be deducted
from his share.
SIXTH: In addition to all powers granted by law, I
give my Executrix, hereunder, the followIng powers, which
may be exercised without leave of court: to retain and
to invest in all forms of real and personal property; to
compromise claims and to abandon any property which is of
little or no value, if deemed appropriate to my
Executrix; to sell at public or private sale, to
exchange, or to lease for any period of time, any real or
personal property, or interest therein, and to give
option for sales or leases, and to give a good deed of
conveyance or bill of sale for the transfer thereof; to
allocate any property received or charge incurred to
principal or income or partly to each, without being
obliged to apply the usual rules of Trust accounting; to
distribute in cash or in kind (according to the fair
market value prevailing at the time of distribution) or
partly in each.
SEVENTH: I nominate, constltute and appoint
DEBOkAp P, H}M~ACW es ~he Evecu~r]x cf th~s my L~st W3_!!
and Testament and my Es%ate. In the event DEBORAH B.
HAMMACK is unable or unwilling to serve, then I nominate,
constitute and appoint PAMELA B. GIBNEY as Executrix of
this my Last Will and Testament and my Estate.
(UT 274)
EIGHTH: I dzrect that no Executrzx actzng under
this Will shall be required to enter bond for the
faithful performance of duties, in any 3urlsdlctlon.
IN WITNESS WHEREOF. I, the said EDITH F. BROWN,
have hereunto set myj~ and seal, to this Last
my Will
and Testament, this y day of July, 1997.
(SEAL)
EDITH F. BROWN
The writing contained in this and the preceding
three (3) sheets was signed and sealed by the above
named, EDITH F. BROWN, and by her publIshed an/ declared
as and for her the L,ast Will and Testament, 1;4 the
p;-,*-sence of US. who qa e her~ i -_~u,~s~' _oe~o-r n:~es as
wztnesses at her request, ~n hor~~/~ /
E: kCOMMONkBRO~.WIL ' ~ / /
Vd ' oo PUBiJ,~qu. lllO
~.Jno.g sv~ j'_g-~.lj,~l,.,,g
stirM .~o Jelsi,~lJ
~o -oo~)0 psoiooelj
REV-f 500 EX (6-001
COMMONWEALIH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
uJ
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LU
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
OFFICIAL USE ONLY
FILE NUMBER
2: -_o4- 2-2o
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SU,~,/~ SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~"~. Odginal Return' [] 2. Supplemental Return
-'-] 4a. FutUre Interest Compromise (date of death after 12-12-82]
--]7. Decedent Maintained a Living Trust (Attach copy of Trust)
~--'] 10. Spousal Poverty Credit (date of deeth between 12-31.91 a~d 1-1-95)
SOCtAL SECURITYNUMBER
~"~ 4. Limited Estate
[-'--~ 6. Decedent Died Testate (Attech oopy of Will)
F'~9. Litigation Proceeds Received
(1)
(2)
(3)
COMPLETE MAILING ADDRESS
~--~ 3. Remainder Return (da~e of ~eath pda' to 12-13-82)
r--~ 5. Federal Estate Tax Rebm Required
____8. Total Number of Safe Deposit Boxes
r~l 1. Election to tax under Sec. 9113(A)
,FfR...~.'. .".'."..".' ~ .......... .~/
TELEPHONE NUMBEP,.-- tJ
1. Real Estato {Schedule
2. Stocks and Bonds {Schedule B)
3. Closely Held Corporation, Partnemhio or Sole-Proprietomhip
OFFICIAL USE ONLY
C
C]
!
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
--']Separate Billing Requested
(8)
(11)
(12)
(13)
(14)
I
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. 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)
13. Charitable and Governmental Bequests/Sec 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)
O,o0
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) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate x ,0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
Uecedent's Complete Address:
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payme..~., ~
C. Discount ,..~;
3. Interest/Penalty if applicable
D. Interest
E. Penalty
I STATE/~J.~
(1)
Total Credits ( A + B + C ) (2)
Izl"/$? 03
Total Interest/Penalty ( D + E )
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUF_
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
IF THE ANSWER
(3)
(4)
(5) ,
(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 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; 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? .............................................................................................................. []
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 Retimmant Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUI
Under pena~ ~ penury,
Dedaratton,of prepame other than the personal rel~tafive is based on all infom~ation of which preparer has any knov~edge.
SIGNATURE OF RE N BL OR FILlNG RE RN
ADDRESS.. ~__
c/ , /$?03
ADDRESS
declare that I have examined this mum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and compete.
,
DATE
For dates of death on or after July 1, 1994 and before January i, 1995, the tax rate imposed on the net vaiue of tra~nsfers to cx for the use of the surviving spouse is 3%
[72 P.S. §9116 (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 ~ surviving spouse is 0% [72 RS. §9116 (a) (1.'
The statute does not exem_Dt a transfer to a surviving spouse ~om tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable E
the su~iving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on ~ 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 I:
or a stepparent of the child is 0% [72 RS. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5%, except as noted in 72 FS. §9116(1.2) [72 PS. §9t16(a)(1)].
The tax rate im~sed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. §9116(aX1.3)]. A sibling is defined, under Section 9102,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
)-o Z
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5.
6.
7.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) ~.~"~ff;f~7~ do
Social Security Number(s)/EIN Number of Personal Representative(s)c~{00O'- ¢C~ -~'~"-~
Street Address ~' /~,~' 7'~/t)
City (¢{/,/[.~/..~/,~ State/~y Zip
Year(s) Commission Paid:
A~orney Fees
Family Exemption: (If ~2edent's address is not the same as claimant's, attach explanation)
Claimant /4~-~
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees ~t/)/~:~'~jLJb ~t.~/.,(.J,J~//~[.,~~,~_4,~'~/,~r~,.~ ¢ ~/~
Accountant's Foes
Tax Return Preparer's Fees ~~ /¢¢1--~00~
TOTAL (Also enter on line 9, Recapitulation)
b, bO
O, bO
{If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE !
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1.
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, inse~ additional sheets of the same size)
DEBORA/~ B HAMMACK EXECUTRIX
ESTATE OF EDITH F BROWN
9 PENSTON RD
BINGHAMTON NY 13903
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-84S6
June 1, 2004
Re: EDITH BROWN
CIS #: 170143178
SSN: 141-16-3393
Date of Death: 02/17/2004
Dear Ms. Hammack:
Please be advised that the Department of Public Welfare is attempting to
recover the monetary value of any and all eligible assets in the subject
estate. Although the amount in the estate may be considerably less than that
which is owed to the Department, our claim is against the estate, no one
else. Your responsibilities, as the primary next of
kin/administrator/executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the amount of
$109,466.20 against the above-mentioned estate. This claim is for
restitution of medical assistance granted on behalf of the decedent for which
the Probate Estate is now responsible to reimburse the Department according
to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95,
effective June 30, 1995. Enclosed is the Department's itemized statement of
claim.
A portion of this medical expense, namely $15,430.42, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $94,035.78, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise when payment may be
expected. If the estate accounting is complete, please provide a copy. If
the estate contains real estate, please provide copies of the deed, the
latest tax assessment and a current appraisal, if available.
Enclosure
Sincerely,
Janet L. Brown
Claims Investigation Agent
717-772-6612
717-705-8150 FAX
BUREAU OF INDIVIDUAL TAXES
TNHERTTAHCE TAX DZVTSTON
DEPT. 180601
HARRTSBURG, PA 1711B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RE¥~1547 EX AFP
DEBORAH B HAMHACK
9 PENSTON RD
BINGHAHTON NY 15905
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-50-200q
BROWN EDITH
02-17-200q
21 Li~jr~.,:~ 2 7 0 ~
CUM~ERLANDC~ :': =:
0
MAKE CHECK PAYABL~ AND REMIT PAYMENT TO:
REGISTER OF WZL:LS _., :::~
CUMBERLAND Co~CQURT ~USE
CARLISLE, PA ...... i~015
CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BROWN EDITH F FILE NO. 21 0~-0270 ACN 101 DATE 08-50-200q
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXEMPTZONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule T) (10)
11. Total Deductions
12. Nat Value of Tax Return
9~q11.72
.00
.00 NOTE: To insure proper
.00 credit to your account,
.00 submit the upper portion
.00 of this form with your
tax payment.
.00
(8)
666.75
13.
NOTE:
9,qll .72
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
DISCOUNT (+)
INTEREST/PEN PAID (-)
19. Principal Tax Due
TAX CREDITS:
PAYMENT ] RECE/PI I
BATE NUMBER
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rata (15)
16. Amount of Line lq taxable at Lineal/Class A rata (16)
17. Amount of Line lfi at Sibling rata (17)
18. Amount of Line lfi taxable at Collateral/Class B rata (lB)
· O0 x O0 = . O0
· 00 x 0~5= .00
. O0 x 12 = . O0
.00 x 15 = .00
(19)= . O0
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEI .00
INTEREST AND PEN. . 00
TOTAL DUE .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REI)UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR), YOU HAY BE DUE_~
A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS.)~..~_..,
reflect flgures that include the total of ALL returns assessed to date.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) . O0
Net Value of Estate Sub~ect to Tax (lq) 100,721.21-
If an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 #ill
109~q66.ZO
(11) 110.132,95
(12) 100,721.21-
RESERVATION:
Estates of decedents dying on or before December 12) 198Z -- if any future interest in the estate is transferred
in possession er enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years) the Coaaonmealth 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:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit mith your payment to the Register of Nills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available et the Office
of the Register of Nills) any of the Z5 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-36Z-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloeance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--mritten protest to the PA Department of Revenue, Soard of Appeals, Dept. Z810Z1, Harrisburg) PA 17126-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue)
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty 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 amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rata of
six (6Z) percent per annum calculated at a daily rate of .000164. Ali taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary free calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are:
Interest Daily Interest Daily Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .000548 ~'~'8-1991 111 .000~01 ~ 9Z .000247
1983 161 .0004~8 1991 9Z .000247 ZOOZ 6Z .000164
1984 112 .000501 1993-1994 72 .000192 ZO0~ 52 .000157
1985 132 .000556 1995-1998 92 .000247 2004 42 .000110
1986 IOZ .000274 1999 7Z .000191
1987 IOZ .000274 ZOO0 7Z .000192
--Interest
is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER 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 payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Will No.: o9./- 0 ¢-~ ~'~70 Admin. No.:
'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 w_~ther administration of the estate is complete:
Yes LU No []]
2. If the answer is No, state when the personal representative reasonably believes
that thc admlnis~ration v¢[11 be complete:
o
If the answer to No. 1 is Yes, state the following:
a. Did the personal r~csentative file a final account with the Court?
Yes _ No '
b. The separate Orpb,n~' Court No. (if any) for the personal representative's
account is: __
Did the personal representative state an account informally to the parties
in interest? Yes ~ No' I-]
Copies of receipts, releases, joinders and approval:;~f f°rmaf'br
informal accounts may be fried with the Clerk of the. Orp~' Court
mad may be attached to this report. . /
Signature
Address
Telephone No.
[~]] Co ,tinsel for personal representative
POSTAGE WILL BE PAJD BY ADDRESSEE
COMMONWEALTH OF PENNSYLVANIA
BLIC WELFARE
NO POSTAGE
NECESSARY
IF MAILED
tN THE
UNITED STATES
HARRISBURG PA 17105-9095