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HomeMy WebLinkAbout02-0070 PETITION FOR PROBATE and GRANT OF LETTERS Estate oS'e 4 Ot4 .1-. No. also known as To: Register of Wills for the " . , Deceased. County of C0'/t~;I~/,,,A~/D in the Social Security No. Iqg'~:~ 2 - 41025 ' i Commonwealth of Pennsylvania The petition Of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut O/~ named in the last will of the above decedeni:, dated /14,4 ~ ~.$'., , 19 and codicil(s) dated ..tVfiA (state relevant circumstances, e.g.r.e~nfi~ciation;'death of executor, etc.) · Decendent was domiciled at death in ~-,~//tS~8'g.L~dl~:" Cbunty, Pennsylvania, with h 1~. last family~r~rincipal residence at'. ~A t7Olt (~oR~U6 H (list street, number and muncipality) ~ , . ,tllll/, . Decend4nt, theft"71:',,,._ ~a~, or~.~, died ~~~ ~ , ~00J , Except as follows, deceden, t di~.not marry, was not divorced and did not have a child born or adopted after execution of ~he wi~offered~for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent ,at death owned.property with estimated values as follows: . (If domiciled in Pa.) ., All'personal property (If not domiciled in Pa.) :., ' P. ersonal property in Pennsylvania · (If not domiciled in Pa.) Personal property in County · Value of real estate in P6n_qsyivania ': sitd~'t&t' as' follow's~ ' WHEREFORE,'peiitioner(s) respectfully request(s) th_.e probate, of the last will and codicil(s) presented herewith and the grant of letters "/'-E'5"r'A.A,! [~NT'.A g.~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. P, t3, ~o-~ 157. / ! OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF U-..//A~F..LAt/D. f ss The petitioner(s) above-named swear(s) o?Laffirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledgeLand belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) ~ill well and truly administer th,e estate according to law. Sworn to or affirmed and subscrib.ed-~ r" ~~ before me this 18th daY-'of' | ..--,.]anuarv ~ ( 'Z52 9. t309.." J p /// /7-,Y3----/4 NO. 21-2002-70 Estate Of C/~4YI"OA/ L... '/') 6/A/~. ,JR. ' ;,Deceased 'DECREE OF PROBATE AND GRANT OE LETTERS January 22nd. AND NOW the reverse side hereof, satisfactory proof having been presented befpre me, IT IS DECREED that the instrument(s) dated /~,I~'Y ~.~: I~lq ~ described therein be admitted to probate and filed of record as the last will of ar~.hereby granted to _l~.fl,87 I~r~' L."~J'{~i,q.g Y ~0_0 ~ , in consideration c.!' ',',:.e ue:iric, T: on FEES Probate, Letters, Etc .......... $ 25.00 Short Certificates(..~) .......... $ 9.00 Renunciation ................ S x-Pages (6) $ 18.00 JCP 5. OO TOTAL __ $ Filed Jonuaxy. 2grid., 20r12 ..... 857.110... ATTORNEY (Sup. C:. I.D. No.) .aDDRESS lO I01 '717-33g-t731 PHONE MAILED LETTERS ]kNDORDER TO EXECUTO~ z 105.805 REV 9/86 ~lll~lalife Btol°gtst- ;.:, ,:' ,l~S. 21r2002-0070 LAST WILL kND TESTAMENT OF CLAYTON L. HEINEY, JR. I, CLAYTON L. HEINEY, JR., of the Borough of Camp Hill, County of Cumberland, Commonwealth of Pennsylvania, make this Last Will and Testament, hereby revoking all of my former Wills and Codicils. ITEM 1: My Executor shall~ offer, in writing, to seli my real estate in Weatherly Borough, .Carb6n~County, Pennsylvania, to my son, CHARLES L. HEINEY, at the fair market value of said real estate upon the date of my death. My son, CHARLES L. HEINEY, shall have a period of forty-five (45)~days~. commencing upon the date of receipt of the written offer, in which to execute a written agreement to purchase said real estate at its fair market value. The said agreement shall contain ~he customary terms and provisions for residential real estate sales agreements in Carbon County, Pennsylvania, and shall provide that settlement shall occur not later than seventy-five (75) days after the date of the agreement. If my son, CHARLES L. HEINEY, decides not to execute an agreement to purchase the said real estate, or fails to make payment of the fair market value thereof on or before the settlement date, his rights unde~ this provision shall terminate. ITEM II: I devise and bequeath all of my estate, real and personal, together with all insurance thereon, in equal shares to the following persons: A. My son, CHARLES L. HEINEY; B. My son, CLIFFORD L. HEINEY; Co D. E. F. G. H. My daughter, CYNTHIA L. HEINEY; My granddaughter, CARLA L. HEINEY; My granddaughter, CARISA L. HEINEY; My granddaughter, JORDAN A. MILLER; My grandson, NICHOLAS A. MILLER; and My granddaughter, HALEY A. MILLER. If any of the foregoing persons fails to survive me, the share of such deceased person shall be distributed equally among such of the foregoing persons who survive me. ITE~ III: If any beneficiary of my estate is under the age of twenty-two (22) years at the time at which distribution of any property devised and bequeathed by this Will would otherwise be made to such beneficiary, my personal representative shall distribute all such property to the Trustee hereinafter named. The Trustee shall hold, manage, invest and reinvest any property received by the Trustee (whether under this Will or. otherwise), shall collect the income thereof, and shall apply so much of the net income and, if the net income is"insufficient, so much of the principal of the property held for such beneficiary as the Trustee shall deem necessary or advisable for such beneficiary's medical care, maintenance, support and complete education, both undergradu- ate and graduate. The Trustee shall accumulate any surplus net income annually and shall add the same to the principal of the property held for such beneficiary. When such beneficiary attains the age of twenty-two (22) years, the Trustee shall distribute to such beneficiary all remaining property held by the Trustee for - 2 - such beneficiary. If such beneficiary dies before attainin9 age twenty-two (22) years of a~e, the Trustee shall distribute all property held by the Trustee for such beneficiary in equal shares to the trust accounts of any other beneficiaries hereunder who have not yet attained the a~e of twenty-two (22) years. If all other beneficiaries under this trust have attained the a~e of twenty-two (22) years at the time of the death of the beneficiary, then the Trustee shall distribute to the personal representative of such deceased beneficiary's estate all property held by the Trustee for such deceased beneficiary. IT~ IV: All shares of principal and income hereby ~iven shall be free from anticipation,~ aSsignment, pledge or obligation of the beneficiaries and any of them, and shall not be subject to any execution, attachment, levy or sequestration or other claim of creditors or said beneficiaries or anY of them. ITE~ V: No fiduciary under this Will shall be required to ~ive bond or other security for the faithful performance of the fiduciary's duties. Any such fiduciary/shall have the followin~ powers, in addition to those 9iven by law: A. To invest in, accept and retain any real or personal property, includin~ stock of a corporate fiduciary or its holdin~ company, without restriction to legal investments; B. To sell, exchange, partition or lease for any period of time any real or personal property and to 9ire options therefor for cash or credit, with or without security; - 3 - C. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; D. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregis- tered or in such other form as will pass by delivery; E. To engage in litigation and compromise, arbitrate or abandon claims; F. To make distribution in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; and G. To make elections, decisions, concessions and settlements in connection with all income, estate, inheri- tance, gift or other tax returns an~ the payment of such taxes, without obligation to adjust the distributive share of income and principal of any person affected thereby. IT~ VI: I appoint my son, CHARLES L HEINEY, Executor of this Will. If my said son is unwilling or unable to act or continue as Executor, for any reason whatsoever and whether before or after my death, I appoint my daughter, CYNTHIA L. HEINEY, successor Executrix. If my said daughter is unwilling or unable to act or continue as Executrix, for any reason whatsoever and whether - 4 - before or after my death, I appoint my son, CLIFFORD L. HEINEY, successor Executor. ITE~ VII: I appoint my son, CHARLES L. HEINEY, Trustee under this Will. If my said son is unwilling~or unable to act or continue as Trustee, for any reason whatsoever and whether before or after my death, I appoint-my son, CLIFFORD L. HEINEY, successor Trustee. If my said son is unwilling or unable to act or continue as Trustee, for any reason whatsoever and whether before or after my death, I appoint my daughter, CYNTHIA L. HEINEY, as successor Trustee. ITEM VIII: All estate taxes, ~inheritance taxes, transfer taxes and other taxes of similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to such tax, and any penalties thereon, shall be paid by my personal representative out of my residuary estate, and all interest with respect to any such taxes shall be paid by my personal representative out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of my personal representative, without reimbursement from or apportionment among the beneficiaries, recipients or owners of such property for any such taxes, penalties or interest; provided, however, that the personal representative shall not pay any such taxes, penalties or interest attributable to any property included in my estate solely because of a power of appointment thereover which I possess, and - 5 - such property shall bear its propOrtionate share of such taxes, penalties or interest. ITEM IX: I direct that my Executor arrange for the burial of my body in Weatherly, Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this ~Z~day of ~~ , 1998. ~ CLA~N ~.- ~EINEY, ~. ~/ The preceding· instrument, consisting of' this and five (5) other typewritten pages, each identified by the signature of the Testator, was on the date hereof signed, published and declared by the said Testator, CLAYTON L. HEINEY, JR., to be his Last Will and Testament, and, at his request, in his presence, and in the presence of each other, we, believing him to be of sound mind, memory and understanding, have hereunto subscribed our names as - 6 - COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF DAUPHIN : and We, CLAYTON L. HEINEY, JR., Testator, ~ ~/~ ~. ~{~L~, witnesses, respectively, whose names are signed to the attached or foregoin~ instrument, bein~ first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearin~ of the Testator, signed the Will as witnesses and that to the best of their knowledge, the Testator was at that time eighteen (18) years of a~e or older, of sound mind and under no constraint or undue influence. /~///~~~ Testator Subscribed, sworn to and acknowledged before me by CLAYTON L. HEINEY, JR., the Testator, and subscribed and sworn to before me by ~/~/~/J t~. ~dJ/0 and /~rt~ %". ~/%/~--- , this ~ day of ~a~ , 1998. NOT~Y ~LIC My Commission Expires: Notaria~ Seal Jenny A. Tobias Notary Public Harrisburg Dauphin county My Commission Expires Feb. 15, 2001 Member, Pennsylvania Assoclatton 0! Not~ies ]0 ....... CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Date of Death: Will No. Clayton L. Heiney, Jr. December 22, 2001 Admin. No. 21-02-00070 To the Register: I certify that notice of beneficial interest 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 April 9, 2002 Name Address Charles L. Heiney, P.O. Box 167, Loysville, PA 17047 Clifford L. Heiney, 91 N. Mondel Drive, Gilbert, AZ 85233 Cynthia L. Heiney, 2627 Logan Street, Camp Hill, PA 17011 Carla L. Heiney, 10402 Parkwood Drive, Kensinqton, MD 20895 Carisa L. Heiney, 1103-C4 Yverdon Drive, Camp Hill, PA 17011 Jordan A. Miller, 2627 Logan Street, Camp Hill, PA 17011 Nicholas A. Miller, 2627 Logan Street, Camp Hill, PA 17011 Haley A. Miller, 2627 Logan Street, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Signature Name Address Dennis J. Shatto, Esq. Cleckner and Fearen 119 Locust Street, P.O. Box 11847 Harrisburq, PA 17108-1847 Telephone (717) 238-1731 Capacity: Personal Representative X Counsel for personal representative JRD/June 30, 1992/17858 InRe: Estateof Charles L. Heiney Late of Estate No.: 21- 02-00070 ORPHANS' COURT DIVISION COURT. OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE PersonalRepresentative: Charles L. Heiney Counsel for Personal Representative: Dennis J. Shatto Esq. Date of Grant of Original Letters: danuary 22, 2002 Date of Delinquency Notice: MAY?2, 2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court. Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register' of Wills on .5-2 ,'20 02 , 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: May t5, 2002 Distribution: C. Lew~s, Register of Wills PersOnal Representative Counsel for Personal Representative Estate File A hearing is scheduled for o~-6~-~'~ at ~'~'~,~/d/'J/j~ Courtroom No. 3. Ifthe Certification of Notice is filed prior to the hearing date, the ~be cancelled. George~. i~offer, P.ff. " ~'~k. COMMONWEALTH OF ~~ PENNSYLVANIA .~~~:~bt, DEPARTMENT OF REVENUE F~'~~ ~ DEPT. 280601 '~~;,~¢' HARRISBURG, PA 17128-0601 U.i I- Z uJ Z 0 Q. 0 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) HEINEY, CLAYTON L. JR. DATE Of DEATH (MM-DD-YF_AR) I DATE OF BIRTH (MM-DD-YEAR) 12/22/2001 ] 04/19/1930 (If APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) HEINEY, JOAN L. : OFFICIAL USE ONLY / 7- 35-- /Z FILE NUMBER 21-02 O O .0 7 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 198 - 22 - 4025 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER E~I. Odginal Return --']4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) E~9. Litigation Proceeds Received r---] 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 death between 12-31-91 and 1-1-95) NAME Dennis J. Shatto, Esquire FIRM NAME (IfApplicable) Cleckner:-and Fearen TELEPHONE NUMBER ( 717 ) 238-1731 ['"-~ 3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Retum Required i 8. Total Number of Safe Deposit Boxes [-'-~ 11. Election to tax under Sec. 9113(A) (A,ach Sch O) COMPLETE MAILING ADDRESS 119 Locust Street P. O. Box 11847 Harrisburg, PA 17108-1847 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Mortgages & 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 7. Intar-Vivos Transfers & MiscbIlaneous 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 Decedeni, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductiohs (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. -O- - 0 -- =0: C -- 0 - Cs ~ · - 0 - )L ~ 7,703.94 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 35,244~21 "' 9,255.74 (8) · ,. (12) (13) (14) OFFICIAL USE ONLY ~3 42,948.15 -, 10,893.'41'. 32,054.74 -- 0 32,054.74 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 32 ~054.74 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .0__ ¢5) x .0 45 (16) x .12 (17) x .15 (18) 1,442.46 1,442.46 (19) Decedent's Complete Address: STREET ADDRESS '~ CLAYTON L. HEINEY, JR. 115 NORTH 27 STREET CITY CAMP HILL I STATE PA ', I .ZlP'17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2~ Credits/Payments A. Spousal Poverty credit B. Prior Payments C. Discount · · (1) '-1,442.46 -- 0 T°tai Credits ( A + B + C ) (2) Interest/Pena!tY if applicable .. .. _.. D. Interest E. Penalty . Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, e~ter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter th~ difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) (5) (5A) 1,44 .46 -- 0 1', 442.46 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. . (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; ....i...2 ............ ' ......... i..' .......... [] ' ' [] 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 t~ansfer property within one year of death without receiving adequate consideration? ................... i .......................... : ............................................................... [] '['X'] 3. Did decedent own an "in trust for" or payable upon death bank account ~)r security at his or her death? ..............[] . [X'] 4. Old decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .... ' ' '" ' [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this retum, 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 ADDRESS Charles L. Heiney, Executor', P. O. Box 167, Lgysville, PA 17047', · . DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE . 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. {}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 the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets 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, 20001 The tax rate imposed on the net value of transfers from a deceased child twenty-one years o[ 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. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(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. §9116(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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE'E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER CLAYTON L. HEINEY JR. 21-02-00070 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi must be disclosed on Schedule F, ITEM NUMBER 2. 3. 4. 5. 6. 7. DESCRIPTION PNC Bank Checking Account No. 5003151982 Clot~ng and miscellaneous personal items Dell Computer, Printer and Desk Cross Bow and Accessories Remington Model 700 BDL Rifle and Scope Remington-Model 1187 12-~.~auge Shotgun Smith and Wesson 38 Special Pistol TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 5,238.94 500.00' 600.00 210.00 700.00 300.00 155.00 $ 7,703.94 EX * ('~97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER CLAYTON L. t;IEINEY, JR. 21-02-00070 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 ADDRESS RELATIONSHIP TO DECEDENT A. Cha~.']'es .5. Heiney Son P. O.i:.Box 167 Loysville, PA 17047 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joinfiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. Federal Employees Credit Union 70,488.41 50% 35,244.21 Investment Account N6. 075057 TOTAL (Also enter on line 6, Recapitulation) $ 35,244.21 (If more space is needed, insert additional sheets of the same size) REV-15'i1 E~X+ (12-99)~.%.~_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER CLAYTON L. HE,NEY JR. 21-02-00070 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERALEXPENSES: Philip J. Jeffries Funeral Home Union - grave preparation Lutheran Church - funeral refreshments ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Charles L. i :Heiney Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 639 Private Drive City Elliottsburq State PA Zip 17024 Year(s) Commission Paid: 2002 Attorney Fees -- ClecJcaaer and Fearen 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 Probate Fees -- Register of Wills Accountant's Fees Tax Return Preparer's Fees Filing Fees 2_ i~entory and Tax Return - Register of Wills 5,285.00 975.00 266.34 2,147..~0, 500.00 57.00 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 9,255, 74 (If mom space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGELIABILITIES,&LIENS ESTATE OF FILE NUMBER CLAYTON L. HEINEY JR. 21-O2-00070 Include unreimbursed medical expenses. ITEM NUMBER ..DESCRIPTION AMOUNT Discover Card General Motors Card U.S. Department~"of Labor - overpayment of disability benefits 252.85 499.53 885.29 TOTAL (Also enter on line 10, Recapitulation) $ 1,637.67 (If more space is needed, insert additional sheets of the same size) · EX+ - REV-i'5'I 3. (9 00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER CSAYTON ,E. HEINEYJJR. 21-02-00070 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DO Not List Trustee(s) OF ESTATE I 1 Se o [1 1. ~XABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Charles L. Heiney P.O. Box 167 Loysville, PA 17047 ~Clifford L. Heiney 91N. Mondel Drive Gilbert, AZ 85233 Cynthia L. Heiney 2627 Logan Street Camp Hill, PA 17011 Carla A. Heiney 10402 Parkwood Drive Kensington, MD 20895 Carisa L. He~ngy 1103-C4 Yverdon Drive Camp Hill, PA 17011 [CONTINUED) Son Son Daughter Granddaughter Granddaughter 1/8 Residue 1/8 Residue 1~8 Residue i~/8 Residue 1/8 Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ - O - (If more space is needed, insert additional sheets of the same size) S~4E~JLE J - BH~E~ICIARIES [cc rmu ] Estate of Clayton L. Hein~yJr. 6. Jordan A. Miller 2627 Logan Street Camp Hill, PA 17011 7. Nicholas A. Miller 2627 Logan Street Camp Hill, PA 17011 8. Haley A. Miller 2627 Logan Street Camp Hill, PA 17011 Granddaughter Grandson Granddaughter 1/8 Residue 1/8 Residue 1/8 Residue LAST WILL AND TESTAMENT OF CLAYTON L. HEINEY, JR. I, CLAYTON L. HEINEY, JR., of the Borough of Camp Hill, County of Cumberland, Commonwealth of Pennsylvania, make this Last Will and Testament, hereby revoking all of my former Wills and Codicils. IT~! 1: My Executor shall offer, in writing., to sell my real ~9~sotate in Weatherly Borough, Carbon County, Pennsylvania, to my n, CHARLES L. HEINEY, at the fair market value of said real estate upon the date of my death. My Son, CHARLES L. HEINEY, shall have a period of forty-five (45) days commencing upon the'date of receipt of the written offer, in which to execute a written agreement to purchase said real estate at its fair market value. The said agreement shall contain the customary terms and provisions for residential real estate sales agreements in Carbon County, Pennsylvania, and shall provide ~hat settlement shall occur not later than seventy-five (75) days after the date of the agreement. If my son, CHARLES L. HEINEY~ decides not to execute an agreement to purchase the said real estate, or fails to make payment o~ the fair market value thereof on or before the settlement date, his rights under this provision shall terminate. ITEM II: I devise and bequeath all of my estate, real and personal, together with all insurance thereon, in equal shares to the following persons: no My son, CHARLES L. HEINEY; My son, CLIFFORD L. HEINEY; C. My daughter, CYNTHIA L. HEINEY; D. My granddaughter, CARLA L. HEINEY; E. My granddaughter, CARISA L. HEINEY; F. My granddaughter, JORDAN A. MILLER; G. My grandson, NICHOLAS A. MILLER; and H. My granddaughter, HALEY A. MILLER. If any of the foregoing persons fails to survive me, the share of such deceased person shall be distributed equally among such of the foregoing persons who survive me. ITEM III: If any beneficiary of my estate is under the age of twenty-two (22) years at the time at which distribution of any property devised and bequeathed by this Will would otherwise be made to such beneficiary, my personal representative shall distribute all such property to the Trustee hereinafter named. The Trustee shall hold, manage, invest and reinvest any property received by the Trustee (whether under this Will or otherwise), shall collect the income thereof, and shall apply' so much of the net income and, if the net income, is insufficient, so much of the principal of the property held for such beneficiary as the Trustee shall deem necessary or advisable for such beneficiary's m~dical care, maintenance, support and complete education, both undergradu- ate and graduate. The Trustee shall accumulate any surplus net income annually and shall add the same to the principal of the property held for such beneficiary. When such beneficiary attains the age of twenty-two (22) years, the Trustee shall distribute to such beneficiary all remaining property held by the Trustee for - 2 - such beneficiary. If such beneficiary dies before attaining age twenty-two (22) years of age, the Trustee shall distribute all property held by the Trustee for such beneficiary in equal shares to the trust accounts of any other beneficiaries hereunder who have not yet attained the age of twenty-two (22) years. If all other beneficiaries under this trust have attained the age of twenty-two (22) years at the time of the death of the beneficiary, then the Trustee shall distribute to the personal representative of such deceased beneficiary's estate all.property held by the Trustee for such deceased beneficiary. ITEM IV: All shares of principal and income hereby given shall be ~free from anticipation, assignment, pledge or obligation of the beneficiaries and any of'them, and shall not be subject to any execution, attachment, levy or sequestration or other claim of creditors or said beneficiaries or any of them. ITEM V: No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. Any such fiduciary shall have the following powers, in addition to those given by law: A. To invest in, accePt and retain'any real or personal property, including stock of a corporate 'fiduciary or its holding company, without restriction to legal investments; B. To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; - 3 - C. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; D. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregis- tered or in such other form as will pass by delivery; E. To engage in litigation and compromise, arbitrate or abandon claims; F. To make distribution in cash, or in kind at current values, or partly in each, allocating specific assets to particula? distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; and G. To make elections, decisions, concessions and settlements in connection with all income, estate, inheri- tance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income and principal of any person affected thereby. ITEM VI: I appoint my son, CHARLES L. HEINEY, Executor of this Will. If my said son is unwilling or unable to act or continue as Executor, for any reason whatsoever and whether before or after my death, I appoint my daughter, CYNTHIA L. HEINEY, successor Executrix. If my said daughter is unwilling or unable to act or continue as Executrix, for any reason whatsoever and whether - 4 before or after my death, I appoint my son, CLIFFORD L. successor Executor. HEINEY, ITEM VII: I appoint my son, CHARLES L. HEINEY, Trustee under this Will. If my said son is unwilling or unable to act or continue as Trustee, for any reason whatsoever and whether before or after my death, I appoint my son, CLIFFORD L. HEINEY, successor Trustee. If my said son is unwilling or unable to act or continue as Trustee, for any reason whatsoever and whether before or after my death, I appoint my daughter, CYNTHIA L. HEINEY, as successor Trustee. ITEM VIII: Ail estate taxes, inheritance taxes, transfer taxes and other taxes of similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to such tax, and any penalties thereon, shall be paid by my personal representative~out of my residuary estate, and all interest with respect to any such taxes shall be paid by my personal representative out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of my personal representative, without reimbursement from or apportionment among the beneficiaries, recipients or owners of such property for any such taxes, penalties or interest; provided, however, that the personal representative shall not pay any such'taxes, penalties or interest attributable to any property included in my estate solely because of a ~ower of appointment thereover which I possess, and - 5 - such property shall bear its proportionate share of such taxes, penalties or interest. ITEM IX: I direct that my Executor arrange for the burial of my body in weatherly, Pennsylvania. IN WITNESS W~EREOF, I have hereunto set my hand and seal to this my Last Will and Testament this f:?.. '~ day of 1998. The preceding instrument, consisting of this and five (5) other typewritten pages, each identified by the signature of the Testator, was on the date hereof signed, published and declared by the said Testator, CLAYTON L. HEINEY, JR., to be his Last Will and Testament, and, at his request, in. his presence, and in the presence of each other, we, believing him to be of sound mind,. memory and understanding, have hereunto subscribed our names as witnesses. of of - 6 - COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF DAUPHIN : We, CLAYTON L. HEINEY, JR., Testator, ~ '- ~7~ , and _ ~,~ ~/~ y. ~-"f~-~, witnesses, respectively, whose names are Signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and.hearing of the Testator, signed the Will as witnesses and that to the'best of their knowledge, the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. CL~¥T , . HEI EY~,~i R ~ .... Testator Subscribed, Sworn to and acknowledged before me.by CLAYTON L. HEINEY, JR., the Testator, and subscribed and sworn to before me by DOTARY ~BL~C My Commission Expires: Notarial Seal Jenny A Tobias, Notar.v Public Harrisburg, Daupl'~i~ r.;ounty My Commission Expires Feb. 15, 2001 MP, mher, Pennsylvania Assoclatlo~ of Notaries DENNIS J. SHATTO ANN E. RHOADS CLECKNER AND FEAREN ATTORNEYS AT LAW 1 19 LOCUST STREET* p.O. BOX 11847 HARRISBURG, PENNSYLVANIA 17108-1847 TELEPHONE: {717) 238-173!'- FAX: {717! 238-8481 August 30, 2002 OF COUNSEL ROBERT D. HANSON RETIRED RICHARD W. CLECKNER WILLIAM FEAREN Office of the Register of Wills for Cumberland County Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Clayton L. Heiney, Jr. No. 21-02-00070 Dear Sir or Madam: ~ I enclose for filing the original and two (2) copies of the Inheritance Tax Return for the above-referenced estate. Also enclosed are a check in the amount of $15.00 to cover the filing fee, and a check in the amount of $1,442.46 in payment of the inheritance tax shown due on the return. Please date-stamp-the extra copy and return it to me along with the payment receipts in the self-addressed, stamped envelope provided. Thank you for your assistance. Very truly yours, CLEC~ DJS/mkz Enclosures cc: Charles L. Heiney,.Executor (w/o encl.) Dennis J. Shatto ;,<' .c; .:" m d COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 CEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001601 ........ fold SHATTO DENNIS J ESQ 119 LOCUST STREET PO BOX 11847 HARRISBURG, PA 17108-1847 ESTATE INFORMATION: SSN: 198-22-4025 FILE NUMBER: 2102-0070 3ECEDENT NAME: HEINEY CLAYTON L JR DATE OF PAYMENT: 09/09/2002 ' %STMARK DATE: 09/06/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/22/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT '101 $1,442.46 I REMARKS: DENNIS J TOTAL AMOUNT PAID: SHATTO ESQUIRE ,442.46 SEAL CHECK# 165439 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS 41 fiX 4~? `~Z.w~ 1 ttP SJ~V P~Y ~Ed.15 MpN~ ~ ~~N'~ R11 pNG O,iSP u4 t aX ,1.200 Cp~`~EQP DF 1N pNGE °S N~N~ 10" NE`s 001 N°~1°~' p~ o ~D pssE RED 22.2 0~ 0 Es peegp VE~~ pNS 9P~~ ~~ p 9EP~N Z $~R~PND 3~- ~ ~p~. ~pX °F E~ ~E °~ DER G1M tted ~ ,gyp: 1ND11Vi5S°N ~~E i! Ol { RB,ai VM,~N- `PV ~~ ta'a ° lZa~ob°l Cput~-'fV pa~o`' M,~,~ QP GRtjp °6°l a 17 G~ 9 ~j~ RRLS~VR6 r a p` ? PV P,$L~~ ~'S R~ EOUgE EGR ~F COV 3 `'~,~,. 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'i~' ar t ~~9 SP°`'S t ~,lre `lass 1' 's, e~lec SPX; 1u at aple a Cate terali taa,~~: r ~ pF { ~i~e 1~ tax Sib1in9 Golla x ~-l N o e t at SD 0 PSS~~'~MpAa'O ~ to°{y4i re 1 ta~a~10 N'CER~S~ip~N ep 0 'SPX cR X s 1 ~, q P 16' peovo o{ ~- Du® 'CP 1~ • o~nt Sax 't° P GE OF Qa9 1a. PQ irGipal N~N~~601 q,P-- NaEgt P ~~ 1CR ~ ~5 ~ co001 ,SC1~f~ ~p~ p1. 2002 NE PN '~ D~.•c Zoo2 10.29" ~ ON ~ ~~ss ~~ ~D 09"O6" ~RRO~,GH Ov~41RE ~ py DDV SS ~ ERS~ SSt PRGEU B~-E PS ~ 1F ~~~ P D sE~ R EREg~ '(ESNPee ~ 15 FARM R~v~RSE Sp B~F~ 1N~ RP OF s~ti Est ' PQEVER E S1~E ", tt,1DS.Gp-~~p ` l~~R t: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rata on any such future interest. 7o fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 20D0. C72 P.S. Section 914D). Detach the top portion of this Notice and submit with your payment to the Register of Wi12s printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the lax Return, may be requested 6y completing an °Applicatian for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: I-800-362-2050; services far taxpayers with special hearing and / or speaking needs: 1-SOD-447-3020 tTT only). by party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment tax (including discount or interest) as shown an #his Notice must object within sixty (b0) days of receipt of :Notice by: "ten protest to the PA Department of Revenue, Soard of Appeals, Dept. 281021, Harrisburg, PA 17228-1021, OR .ion to have the matter determined at audit of the account of the personal representative, DR ' to the Orphans' Court. 'ors discovered on this assessment sheuld be addressed in writing to: PA Department of Revenue, +dividual Taxes, ATTN: Post Assessment Review Unit, Dept. 280b0I, Harrisburg, PA 17128-0601 '87-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident j '-1502) for an explanation of administratively correctable errors. `~ 's paid within three C3) calendar mon#hs after the decedent's death, a five percent CSX) discormt of y'~.7' ~llowed. non-participation penalty is computed on the total of the tax and interest assessed, and not d4 18, 1996, the first day after the end of the tax amnesty period. This non-participation in the same manner and in the the same time period as you would appeal the tax and interest ~~A as indicated on this notice. mining with first day of delinquency, or nine C9) months and one (I) day from the date of ~~ ~eent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of ~~ calculated at a daily rate of .000164. All taxes which became delinquent on and after ~[.tb ' Merest at a rata which will vary from calendar year to calendar year with that rate ~ ~t of Revenue. The applicable interest rates for 1982 through 2002 era: iterest Factor 548 LS b ZI~Z • ~ Q 1~ x`53 ~ y3 OV SS R~~~1 ~~S NS ' tG~Q S~`'.(R Year Interest Rate 1992 9!. 1993-2994 7% 1945-1998 9% 1999 7~ 2000 g/ 2001 9~ 2002 6'L Daily Interest Factor .000247 .000192 .000247 .000192 .000219 .000247 .000164 NUMBER OF DAYS DELIN$UENT X DAILY INTEREST FACTQR Linquent will reflect an interest calculation to fifteen [15) days payment is made after the interest computation date shown on the .:alculated. .,.~ .. REV-1470 EX (6-88) r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 INHERITANCE TAX EXPLANATION OF CHANGES DECEDENTS NAME FILE NUMBER Clayton L. Heiney, Jr. 2102-0070 REVIEWED BY CHARLES WRIGHT AcN 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ,; Row Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHATTO DENNIS J ESQ 1 19 LOCUST STREET PO BOX 1 1847 HARRISBURG, PA 1 71 08-1 847 fold ESTATE INFORMATION: ssN: i 9s-22-no25 FILE NUMBER: 2102-0070 DECEDENT NAME: HEINEY CLAYTON L JR DATE OF PAYMENT: 01 /09/2003 POSTMARK DATE: 01 /08/2003 couNTY: CUMBERLAND DATE OF DEATH: 1 2/ 22/ 2001 REV-1162 EX111-96) N0. CD 002026 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 54.60 TOTAL AMOUNT PAID: REMARKS: DENNIS J SHATTO ESQUIRE CHECK# 008225 SEAL INITIALS: VZ RECEIVED BY: DONNA M. OTTO 54.60 DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX -IVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DENNIS J SHATTO ESQ CLECKNER & FEAREN PO BOX 11847 HBG PA 17108 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-16 P7 E% AFP [01-03) DATE 02-18-2003 ESTATE OF HEINEY CLAYTON L DATE OF DEATH 12-22-2001 FILE NUMBER 21 02-0070 - COUNTY CUMBERLAND ACN 101 Ae~ount Rewtitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-03) *~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~* ESTATE OF HEINEY CLAYTON L FILE N0. 21 02-0070 ACN 101 DATE 02-18-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-14-2002 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 1,446.96 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 09-06-2002 CD001601 .00 1,442.46 01-08-2003 CD002026 .08- 4.60 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. TOTAL TAX CREDIT 1,446.98 BALANCE OF TAX DUE .02CR INTEREST AND PEN. .00 TOTAL DUE .02CR IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l PAYMENT: Detach the top portion of this Notice and submit with your payment matle payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money ardor payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable ta: COMMONWEALTH OF PENNSYLVANIA. 2EFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Application for Refund of Pennsylvania Inheritance and Estate Tax^ CREV-13137. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY T0: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280681, Harrisburg, PA 17128-0601, phone (7177 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%7 discount of the tax paid is allowed. PENALTY: Tha 15% 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. INTEREST: 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, 1982 bear interest at the rate of six (6%7 percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .OOD164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (157 days beyond the date of the assessment. If payment is made after the interest computation date shaven on the Notice, additional interest must be calculated. Name of Decedent: Date of Death: STATUS REPORT UNDER RULE 6.12 ~ ~A ~To ~ /L'~Z-ol L. ~~~nl~Y Will No.: 2 4 ~ 2. " 0 0 0 7d 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: State whether administration of the estate is complete: Yes ~ No n 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 _ 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 ~ No n c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Cl k of the. Orphans' ourt and maybe attached to this report. Date:1~2rs~6~j Signature ~ ~,~ ~ is J . S1-f-~t ~t"o Name ~~q Locust s~• G~~R~ s~/r2.6' . ~~ I ~/ol Address 7/?- ~3~-1731 Telephone No. ' /J 1 Y ~.,/ ~'~~~ Capacity: Il Personal Representative Counsel for persor.~al representative