Loading...
HomeMy WebLinkAbout04-0263Estate of' also known as PETITION FOR GRANT OF LETTERS Or ADMINISI~RATION To: j ReEister of Wills. for th - Decedsed. County of ~ ~ ~ in ~the Social Security No. ~ ~ ~- -~ ~ - ~ [ ~ ~ ~ ~ ' Commonwealth of~nsylv~a ~ ~ The petition of the undersigned respectfully represents that: ~ '{~ ~ ~ ~' o ~ Your petition~r(~), who is/are 18 years of age or older, appl for lgt. tiis of a~inistr~:~q~ :" _ r-'~ ~:" on the-esta~.~ 6fi (d.b.n.; pendente lite; durante absentia; durante minoritate) ~ ~ ~ ~ © the above decedent. O ~o · ,. ~,'2'.'. .. 6~ 0 Decendent was domiciled at death in ~.t tVk~~-t' ~. ~Coufity, Pennsylvania, with h I& lasf family or principal residence at 2~ d___o~.s~/k'q ~_ . (list street, number~_, and m¥icipality) Decendent, then ~ years of age, died [Nr[ Otq..-~[4 ' /.~ i , 't9- ~_c~q, at %'. Igo,~ ~-r t4o~ ~l:,t~t'l' ~I~'Ui"i~t__ P , Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All person, al property $ (If not domiciled in Pa.) Personal. property in Pennsylvania $ (If noti~0ini~ciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner after a proper search ha__ the following spouse (if any) and heirs: Name ! ascertained that decedent left no ~ill and was survived by Relationship / Residence THEREFORE, petitioner(~)respectfully request(s) the. grant of letters approPriate form to the undersigned. ~f administration in the · ..OATH OF ·PERSONAL REPRESENTATIVE 7., COMMONWEALTH OF PENNSYLV'ANIA ·~ COUNTY OF SS 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 r6Presentative(s) of the above decedent petitioner(s) will well and truly 'administer the estate~according to law. · ~ _.~ ..'-~ ~/./~ . - Sworn to or affirmed and subscribed c' befOre me this /~-~-/--~-- ~ day 'of' Is ...... No. Estate of ~_/j~.~/- /~__~/l/_/~,J Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW /~,~'~f,/-/ /.'? .,4~9~','in 'consideration of the petition on ' the reverse side'hereof, sati~factgry proof having ~presented before me, is/are entitled to Letters of Administration, andin accord with such finding, Letters of Admi~stration are hereby granted to ~ ~o[,~J ~ ~k~o~ - FEES Letters of Administration .... .. $ Short Certificates( ) .... - ...... $ iation ........ · ........ $ Filed/r~... ,Z'. ~ ........ A.D. ATTORNEY (Sup. ct'. I.D. No.) ADDRESS PHONE ~o5.805 ~v 9/,6 This is to certify that the information here given is ~o?rectly copie~t from an original cet;i~ificate 'of death duly "filed with me as' ~'. Local Registrar. The original certificate will be forwarded to the State Vital Records Office for )ermanent filing: , WARNING: It is illegal to duplicate this copy by photostat or ph0t( ]raph. Fee for this certificate, $2.00 P ~003972'8 HIO$.] 43 Re~ W87 Lpcal Registrar / ~ "Date No. ,,. Patricia Montegomery . IINFC)RMANT'S hlAIUNO/~(S~eoLC4y~Ow~ ~ ~4)C4~1e1 ~.. Judith A. McBttrnie ~ 3 Conway .Driv~ Mechanicsburg, PA 17055 ~..[3 ~.~.~ Ul,,,.March 12, 2004 I,,R. leasant Hill ~emetery ,;; Ten Mile, PA ~"~"-"'"' . ' I... J-J'~,~ .¥)/,','7- //,%/0 ra~. .; . t. ., ~ ~ ~ .... ~ ........ ~ .......~ ............ "~ ........................................ ll~~.w~o ......... ~. COMMONWEALTH OF PENNSYLVANIA ? DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH : .... Wl.l..Lla[n. ~. Mc~urn~e, dr. Ia. Male p-183 T-- 38 -- 6149 ~. 55' v,,.I I '1 ~ J..5/~0/1948 I,.%~%~=~h--g, m' I,..-~,,.,~ EmO,~.,,,[3 / ..O~S' ' I~'~ C~rland ' , , , . ~ ~.~. ~ L~st Pe~s~ro I Hol S lrlt HOSDi~I /1~--.--~ J whi~ ' ~CE~'SUSU~U.~ ' ' i~. Y P ~ qo. ]to. ,,.. Director [,,,.~velo~nt - I,,. 19. [ ,. ~i~ ,,.Judith A. ~rdon m.r, Pe~ylvania 3 Coney Drive ~ -..~ ~' ,=.~.~ Up~r Allen Mec~icsb~g, PA 17055 ~ ~m, JRD/June 30, 1992/17858 In Re: Estate of WILLIAM S MCBURNIE Late of UPPER ALLEN TOWNSHIP Estate No.: 21-04-263 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-04-263 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: JUDITH A MCBURNIE Counsel for Personal Representative: Date of Grant of Original Letters: 03-17-2004 Date of Delinquency Notice: 06-27-2004 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), Supi:eme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on JUNE 27, 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 heating to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 07-13-2004 Distribution: ~ G~enda Farner Strasbaug~'~' % ~ ~,3 Clerk of the Orphans' Couff 0 ~k,~ Personal Representative Counsel for Personal Representative Estate File A heating is scheduled for at in Courtroom No. 3. If the Certification of Notice is filed prior to the heating date, the heating will automatically ~~./~ Date of Death: Will No. Name of Decedent: · o the R¢~ster~ I~ERTIFICATION OF NOTICE UNDER RULE 5.6(a) Admin. No. oOY-d377 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: Capacity: __ Sit re /: Address .,_~ ~.,r~/.~,,¢.,7/ ~)~ . Personal Representative __Counsel for personal representative REV.1500 EX (6.00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500 ~ .~O' Iv\ FILE NUMBER cfi.. L - -'2 ':L COUNTY COOE YEAR OO~1t:>3 NUMBER SOCIAL SECURITY NUMBER /;'3 - 31 I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) WILL/PM 5 DATE OF DEATH (MM-DD-YEAR) 3- to - () 5-;/ tJ- l/ ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Jv [) /T 1-/ )J . Jl-1c U/!- N / E W I- ~:$Ul ull::~ wl1.U :z:00 ull::..J l1.a1 l1. < IX] 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received 6/Lf THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 59[/ - y, - 6 3cP~ D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12.82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior 1012-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 4. Mortgages & Notes Receivable (Schedule D) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 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 or L) 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) NAME Tu I- Z W C Z o l1. Ul w ll:: ll:: o U z o ~ ..J ::::) !::: Q. <( () w 0:: z o ~ I- ::::) Q. :t o u X ~ FIRM NAME (If Applicable) (tJ ~ -55"~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) COMPLETE MAILING ADDRESS 3 e.. 4NL(//? y j}~. h;; C)f/1,v 10. S.tJ I.-~~ ~ I 6? I 7 oS S t: (1) (2) (3) (4) (5) 135: b () () . , I -....J 7 iff) 53? So (6) c,.) (7) (8) 875S3J.StJ , (9) l' 5 I 3 . () tJ (10) I 3 ~:5 f ,. 5' 7 73'1 '1'1-3.13 , (11) I 'I l 0 '11/..57 . (12) 7 ?> <J, I.f I.f 3, 9 3 (13) (14) 73'1 t1't3.'f3 I x.O~ (15) () x.O_ (16) x .12 (17) x .15 (18) (19) 0 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. D Decedent's Complete Address: STREET ADDRESS /} .3 G 011/ CITY (; MEC Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) CJ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; .......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ............................................ D c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either 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? .............................................................................................................. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..................... ..... ... ................ ... ................................... ... .................................. D No lKJ [KJ ~ [&l ~ [ZJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P SON RESPONSIBLE FOR F)'=!.t'JG RETU N 7 '- a ~ 1"1/7 ADDRESS tJSS DATE DATE t./ - 7 -C) S- 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 P.S. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute Qiles 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 In 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 VJ!uc 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 W,IO has at least one parent in common with the decedent, whether by blood or adoption. REI(. 1502 EX + {12.65) *. <l:OMMONWEAlTH Of PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DEceDENT ,~",._..__._., ..~_._. ,_.~...." _'__".~_.'e.....__." .. .. '_."", ,_,____ _ '''''.' _... .. -'-'~'.~__' _'~'''..''" _ _.__._.._ _____. _~...m_......~,_.._.. _...~_ ESTATE OF wi L. LI,.:j1"1 SCHEDULE A REAL ESTATE .'_ . ... ..... ~ ............ . l..... . . .... ... ..... -"'.....-...-..---...-. '.'----"'PILE HUM'IEif '-ODY- O;;..~2:> S, Me,e vr!-Al; c IPropertYiointly-owned with Right of Survivonhip must be disclosed on Schedule f) AU real.state should be reported crt fair market value which ia defined os the price at which property would be exchanged between a willing buyer Gnd a willing seller, neith.r being c:ampelled t~buy or sen, bot~.~.r:'!i!,~r!l:I.s.onl:l~ICtkn!"",I~JI!~f_.!~.!rfll!lt'c:I!!!~!~!S~ ITEM NUMBER L f( € I> ID€N-r/~ L. DESCRIPTION .3 (! () tJ #/9 ':I j)~. 1'--11; C 1-1/1 All C S /fJ (/~ 6; ;1-4 /",07:l St?C.J.1 p~ IS I I I UffEtl- A~L.€A./ rWp, Lbr S/2-E /tJo,><'5 '3 18~f)r<t>oi'-1 I'jI'{ICK+- SIDINC PV~e)-l4SED J'lJ>l/- 17tJ.r6 PC;, / i i i I I 1 ;f' ,4,vCh'C' ~ I i \ i }- VALUE AT DATE OF DEATH /3~ 0,,0 ~_..,,~ '*' COMMONWEAlTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN NT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER WI L l. 111M S. ,.v?C 6u~'<")1 f ~ ~ 6 If - tJlJ ~ (p :? Include the proceeds of litigation and the date the proceeds were received by ltte estate, AIf property jointly-otlWlMd wfttt tilt right of .urvlvol'lhlp mutt i)e dIacIoHd on SchIduIt ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH 1. C,lt-Sj-/ tJ'-'/ I-I~,.v V /0. S-~ T{;w~t..~Y ;).00.01) CLtJ7f-fING '004, ()O ,,,4 I/TOMD{!; IL.E S 191:3 LltVC"t...J TOwN' eft If /117 ])tJP6E hfvel( CArlAV""'.J 350",1)0 '-I c.>oo. d () (! H- tFc t=:. I ",c/f C- c () ut<.l-r a p S ~ C /J ,,4 CCT. N/), /t.f'"J-3J'-ID I"; f I PIt), (JP S IH. .flit.. ~ ,A,v' IV I/A J.. I rJ (H /I)A '/ ..;- S Ie;::. P/I'I I OvG I 7, 7' () , 11.3J I ~9 pG tV'.s/ a#' \~ ..... '''' " ,,' ,~" 5" 3 I' . S'" D -.."..':.' '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE IDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS W/LLIIIM 5, l-1/JctJj/~/V')C FILE NUMBER ~/)()y-~OC). ,-3 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: }-/ c ,..., E l' ~O 1. M~LpEl-"2-1 Fvlf./~I'l..4~ 3'='3. (j,vc. L- j) D.:5. ~ E t!. V Ie t; 51 eJJ. S Ie;;~ ;:::L()W{;,.(S, ETC. ) /5 (). tJo 1 (/NC H.: eJ.J - ftt...t:.s -15 Y TEItI fiA.l e H u ~a H B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) SocIal Security Number(s) I EIN Number of Personal Representative(s) Street Address City Slate Zip Year(s) Commission Paid: 2. Attomey Fees 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accounlanfs Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ is/a.oD .. '" .............. ................... ,,.. ...^,,"'M .nlt'o........ ....,.,......1,,"'..,,1 ,..h^^ff., "'~ to"'" .to""""'''''' <ie"i...of'lo\ REV.1512 EX' ('.97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT WILLI;:J~ .5 . Me!. ItJUL tV I;; FILE NUMBER ~~OV-O~~~3 ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER 1. M 0 11. T 6A- 6 ~- DESCRIPTION 3 (!O!llWA-Y O~. M ~CI-iA")) c-s f!J U/Z " ;94. e.. i/ I F 111./ A AI c / J4 L fie e /. f., 7 3<1 ().), 7 'i - tJ.;? t) Y S '-15" AMOUNT fit. ()/c=tlTY r,4)1'i:S - .;?IJ03 (il-o/G.try rA)(~S - ~ Od" pE..l- ~4 f rr -4 ,..4)L -J. ~ () V I,;) 3 .3..7 3, 3 J I ~;}.ol{.77 3Stf.d1 I o. IJ tJ A V It>".., tJ,d I L..': L 0 ,4,v.$ /'193 L/I\/CbL"/ rfJtA/N" (JA-/'? 1197 V()j)(,';' c2/4~I4V/U/ 3i./OO,00 J :.l F'S. 0 0 TOTAL (Also enter on line 10, Recapitulation) $ 13 ~ 5 tP /.57 (If more space IS needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER I W/LL-IIl.^'1 S. tVJc.6()!t-/l.//~ FILE NUMBER ~ /)0 i ~ !J 0 J. Cp 3 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 5?IJUSE /~tJ h 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] -;)dD/7# 4. Me.-/.!;U,A..-Nlb 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. ~ TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ () 'If m"ro cn!lf"O ic noorlor4 Incort arl"itj"n~l choo.t~ nf tho. c"Jmo. C'-i..,o\ Glenda Farner Strasbaugh Register 01 Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy KirnS.Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 297 4/7/2005 WILLIAM MCBURNIE 21-04-0263 JUDITH MCBURNIE 3 CONWAY DRIVE CCP MECHANICSBURG, PA 17055 Qty 1 Fee Description Additional Probate Fee Total 430.00 $430.00 Total: ./ -J:/;- 37-1 $430.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. '0 06-20-2005 MCBURNIE 03-06-2004 21 04-0263 CUMBERLAND 101 APPEAL DATE: 08-19-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS +- REv:is47-Ex-AFP-io3:os3-NOTICE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX WILLIAM S FILE NO. 21 04-0263 ACN 101 BUREAU OF INDIVlDilA(.TAx~S INHERITANCE TAX DIVISIOlf PO BOX 280601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX '. !; i i: 54 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN r.. " r.,i rC~'1/ lu:,.\ Or'J:-J/,e-..1iC' .,11 1"--,,-\ -,) JUDITH .~U","BURNIE 3 CONWAY DR MECHANICS BURG PA 17055 ESTATE OF MCBURNIE *' REV-1547 EX AFP (06-05) WILLIAM 5 TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED DATE 06-20-2005 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~1gures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rat. (IS) 16. A.aunt of Line 14 taxable at Lineal/Class A rat. (16) 17. AIIOlmt of Line 14 at Sibling rat. (17) 18. A.aunt of Line 14 taxable at Collateral/Class Brat. (18) 19. PrincIpal Tax Due XC TS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule Cl 4. Hortgages/Not.s Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly ONned Property (Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets III 121 131 141 151 161 171 135.000.00 .00 .00 .00 740.538.50 .00 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/Misc. Exp8nses (Schedule HJ 10. Debts/Mortgage Liabilities/Liens (Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governaental Bequests; Non-elect.d 9113 Trusts (Schedule ~J 1~. Net Value of Estat. Subject to Tax 191 1101 8.513.00 132.581.57 1111 1121 1131 1141 NOTE: 734.443.93 X .00 X .00 X .00 X + AHOUNT PAID DATE NUH8ER INTEREST/PEN PAID I-I ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, sub.it the upper portion of this form Nith your tax pay_nt. 875.538.50 141.094 1;1 734,443.93 .00 734.443.93 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 1191= .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY 8E DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.I Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2006 MCBURNIE JUDITH A 3 CONWAY DRIVE MECHANICSBURG, PA 17055 RE: Estate of MCBURNIE WILLIAM S File Number: 2004-00263 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: 3/06/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~..~. V . ..0 If. E', . ,..n.,,; ... I .1 . tt4!~ (~J?14;?ct!A.,/ J GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge -~ . /o~.~ r.'';~''':\ ~.] ~ R~~~R:Sit(e;R~ tQtf~f\"li~1~ vf Cilililtlt)12rrlaJitd CG;li:iiJi'iL-~i c,' .,; STATUS REPORT Dl'\J"DER RULE 6.12 Name of Decedent: WI LLIIJ M ,(' & )// C L3 u R. ,.;' I~ Date of Death: 3 "" (,.- tJ t./- Estate No.: ~ /-~ tf-lJ~~ 3 0) 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 ~ No 0 2. Ifth~ ans~Ter is No st~t~ when the personal representative reasonably believes that the administration will be complete: 3. If an;'Vver ~01'k:. 1. i.s Y:,s, st?t~:he ~ol1owing~ a. Did the personal representative file a final account with the CoUrt? Yes ~ No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state all account informally to the pa.."iies in interest? Yes K1 No 0 c. Copies of receipts, releases, joinders and approval of fonnal or iLlformal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~// ~6 (jJa~(l~0~' SVgnature Tv)? JrH- McdtJ~,JJ; Name ~.'J ::f1 '="I J e {)!'J~'A y Dft. J1 ~CJ.l,4tt.l/c..(13 (J/t 6 A~' I r...oa.ress .717 ( 7 t;. , - 5'5-:l 7 ) . t -"c.' Telephone J:'..To. Ca.pacitj: fXl ?eL"sGilal RepresenIa:'Cive o C01..msel for persoTial representative c- Vi;