HomeMy WebLinkAbout04-0211PETITION FOR PROBATE and GRANT OF LETTERS
Estate of FRANCES E. FALES
also known as
,Deceased.
Social Security No. 245-18-6837
No.
To:
Register of Wills for the
County of CUMBERLAND
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rix
in the last will of the above decedent, dated Oecember 13, 1989
and~c%dicil~s) dated ~ '
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h er . last family or principal residence at 525 Hardin!t Street, New Cumberland BorouRh,
Pennsylvania 17070
(list street, number and municipality)
Decedent, then 82 years of age, died 2tl 9104
at Holy Spirit Hospital, E. Pennsboro Township, Camp Hill, PA
Except as follows, decedent did not marry, was not divorced and did not have a child born or adg~ed
after execution of the will offered for probate; was not the victim of a killing and was ne~er ajudicated
incompetent: none .
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ ~0,000.0o
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ o.0o
situated as follows:
none
presented herewith and the grant of 19~ers
thereon
BC~RAH E. PAJA
/
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
TESTAMENTARY
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
985 Silver Lake Road
Lewisberry PA 17339
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ; 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the esta/~ according to law.
Sworn to or affirmed and subscribed
before~me~his ~ day of
//':/'.~./_,/. c:~Q~,'..~ ~'-"'DEBORAH E. ~A0/AK
ester
Estate of FRANCES E. FALES ~ Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW /~d_~ ~-'~, ~J , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 12113189
described therein be admitted to probate and filed of record as the last will of F~,NCES E. FACES
and Letters TESTAMENTARY
are hereby granted to
DEBORAH E. PAJAK
FEES
Probate. Letters, Ere ........ $~'~ ~
mort Ce?>ficates ( ) ...... $ ~
Kcnuncmtion ............ $ ~ ~' ~ ~
TOT~ $ ~ ~
Filed..~4 ~,..~ ..........
MURREL R. WALTERS III
24849
ATTORNEY (Sup. Ct. I.D. No.)
54 EAST MAIN STREET
MECHANICSBURG PA 17055
ADDRESS
717-697-4650
PHONE
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 certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 996;3769
No.
1 2004
Date
05143 Rev. 2/87
"
COMMONW~L~ OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
NAME OF DECEDENT (F~st, Middle. La,t) SEX SOCIAL SECURITY NUMBER DA~.~ O1~ DEATH {Month. Ca, Year) ~
4. Frances E. Fales 2. female 3. 245 -- 18 -- 6837
AGE (Lest Bldh~y) DATE OF BIRTH BIRTHP~CE Ci~ and P~CE OF D~TH fC~ only one - s~ Instructive ~ other si~ '
~. I .... D
82
F'
COUNTY OF DEATH ci~. BORO. ~ OF DEATH ~ FACILi~ ~ME (If not institute, gl~ street and numbs) [WAS DECEDENT OF HISPANIC ORIGIN> [RACE- Amed~n Indian Black. ~ite. e~
OECEDENT'S USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY ' ~AS D~EDENT ~VER IN [ DECED~NT*S EDUCATION ' [ MARITAL STATUS - Ma~ed. SUR~NG SPOUSE
~e nd~do.ed~nQ~ I US ~MED ORCES. I ~ ~ ¢ ~ } ~ , , m~enname
~,. bcnooz ~eacner I"~. m~ucat~on 112. 113. I / 114. Widowed
DECEDENT'S MAILING ADDRESS (Street ci~n State Zip Code)[DECEDENTS ~?~ ~, , Ponn~v]~tnn{n
525 Hardin~ Street /RESIDENCE ~"l --
~ New Cumberland~ PA 17070 [o, ot~,ipe~ ~m. ~t~ Cumberland ~.*,,, ~7~.~ .,,~.~=m~,~ti~of New Cumberland citymoro
~,. Oscar E. Culler ~,. Mattie Eunice Crews
~.~o.~A~rs~t g~.~,.,) ~. 985 Silver Lake Road. Lewisberry. PA 17~q
12~c. Emanuel Cemetery 12~.airview ~p., PA 17339
INFORMANT'S MAILING ADDRESS (Street. City/Town. State. Zip Code)
2ca, Deborah E. Pajak
METHOD OF OISPOSIT~ON - DATE DE DISPOSITION
3ona~o.l-IBuds, [~CrornationE]R ..... IfromStaler-[ I (~r~h.O ...... )
· F-II2,~.ebruary 22, 2004
21s Other (Specify)
LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY Par thereof e FH (~ CS ~ Thc o
mb. FS 012 849 L 22c. P.O. Box 491. New Cumberland. PA
y when cedifying To the bast of my kllowledge death occurred at the time. date and place stated. LICENSE NUMBER DATE SIGNED
physician is not available at tinle of death to } (Signature and Title)
(Month. Day. Year)
certify cause of death. 23a. 23b. 23c.
items 24.26 must be completed by[ TIME OF DEATH ~.~ [ DA~PRONOUNCED DEAD (M~nth. Day. Ye~)
person who pronounces death
WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONER?
125. YesD NoD
List only ~ mule on each
IMMEDIATE CAUSE (Final
disease or cocdifi0n
resulting in death) ----b S
~ -. * f.~ : onset and death
S~uentialiy list ~ditions
b
~use.~ any, leadingEnter UNDEEL~NGt° immediate ~[ ~ DUE TO (OR AS A CONSEQUENCE OD:
resoling ~ dea~ ) ~ST ',
PERFORMED? AVAI~BLE PRIOR TO D (M~. ~y. Ye~)
~ COMPLETION OF CAUSE Natural ~ H~lci~
OF DEATH? Ac~d~t ~ Peking In~sflgation
'(~E .R. TIFYING PHYI}ICIAN (Physician certifyir'~ cause of death when a0other ehysician has Orqnounced death and completed item 23)
/oma best of my ~mowle~g*l, death occurred due to the caueas(s)and n~anner as atofee ..............................................................
*PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death aed certifying to cause of death)
To the belt of my knowledge, death occurred at the time, date, and place, and due to the causes(s) and manner as stated ...................... []
*MEDICAL EXAMINER/CORONER
On the basle of eaamthstlon Bad/or thveeflgaflon, Ill my opinion, peath occurred at the time, date, and place, Bad due to the causes(s} and
mariner as stated .................................. ._. ........................................................................................................................ I ]
PART IhOther significant conditions contributing to death, but
~lot resulting in the underlying cause given in PART I
INJURY AT WORK? I DESCRIBE HOW INJURY OCCURRED
I
Yes[] No[]
30C. 1 3Od.
.CATION (Street. City/Town. State)
SIGNATURE AND TITLE OF CERTIFIER
LICENSE NUMBER ~' DATE SIGNED (Month. Day. Year)
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type or Pdnt "~ ~ ~.~ 7,~
DATE FILED (M_onth. Day. Year)
SECOND CODICIL TO LAST WILL AND TESTAMENT
OF
FRANCES E. FALES DATED DECEMBER 13, 1989
I, FRANCES E. FALES, 525 Harding Street, New Cumberland,
Pennsylvania, do make, publish and declare this to be my Codicil to my Last [Fill and
Testament dated December 13, 1989.
ITEM L
I make the following addition to my last }Fill and Testament
dated December 13, 1989, as modified by my first Codicil dated October 8, 1997;
I hereby give to my Executrix the power of app~ent~[~o
make such charitable contributions on beha estate
she, in her sole discretion, shah desire to mak~ Said pow~r .~.:.. ~'~:~.~
shall be ~erc~able in favor of charities which would entt~
my estate to a deduction for federal and state estate tax
purposes. The total contributions shah be made prior to
division of my residuary estate as set forth in Item II/' of my
Last Will and Testament, as modified by my first codicil dated
October 8, 1997. In no regard shah the full value of the total
charitable gifts exceed ten percent (10%) of my total net
taxable estat~
ITEM II: I hereby ratify and confirm ail of these terms of my Last Will
and Testament dated December 13, 1989 and my First Codicil dated October 8, 1997.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Codicil of my Last Will and Testament, consisting of this and the preceding one (1) pages,
at the end of each page of which I have also set my initials for greater security and better
identification thisa~day of~.¢~ ~ ,1998.
FRANCES E. FALES
We, the undersigned, hereby certify that the foregoing Codicil was signed, sealed,
published and declared by the above-named Testatrix as and for her Codicil of her Last
Will and Testament, in the presence of each other, have hereunto set our hands and seals
the day and year first above written, and we certify that at the time of the execution
thereof, the said Testatrix was of sound mind and memory.
Lisa Wasserloos
Residing at: 205A Tenth Street
New Cumberland, PA 17070
lOichael T. ~te~he~s
Residing at: 401C Radcliffe Dr.
Harrisburg, PA 17109
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
:$$.
COUNTY OF CUMBERLAND :
I, FRANCES E. FALE$, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Codicil for my Last Will and
Testament; that I signed it willingly, and that I signed it as my free and voluntary act for
the purposes therein expressed
Sworn/~o and subscribed
befor~ ~ne this~ day
of (~Z~/'" f ~(~1998.
My Commission ~pires:
FRANCES E. FALE$
AFFIDA~
COMMONWEALTH OF PENNS YL I/ANIA :
:$$.
COUNTY OF CUMBERLAND :
We, Lisa Wasserloos, and Michael T. Stephens, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw Testatrix, FRANCES E. FALE$, sign and
execute the instrument as her Codicil for her Last Will and Testament; that Testatrix
signed willingly and she executed said Codicil as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the Testator signed
the Codicil as witnesses; and that to the best of our knowledge the Testatrix was at that
time eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
Lisa Wasserloos
Sworn to and subscribed
b eforfi~. 9~s~ day
of //~ ~ff~j / ~, 1998.
~V~Y PUBLIC
My Commission Expires:
(SEnL)
Michael T. Stephens
CODICIL TO LAST WILL AND TESTAMENT
OF
FRANCES E. FALES DATED DECEMBER 1.3, 1989
L FRANCES E. FALES, of 525 Harding Street, New Cumberland,
Cumberland County, Pennsylvania, do make, publish and declare this to be my Codicil
to my Last Will and Testament dated December 13, 1989.
ITEM I: Paragraph IV of my Last Will and Tes(qment is hereby
amended to read as follows: ~ ~ o
I give, devise and bequeath all my property, whether real or personaLil wherever
situate, including any property over which I have a power of appointment"i~ follows:
Twenty five percent (2596) to my daughter, Janet E. Eye, or, in the event
she predeceases me, to her issue, per stirpes;
Twenty five percent (25~) to my daughter, Alice V. Harpster, or in the
event she predeceases me, to her issue, per stirpes;
T~ven~y five percent (25~) to my daughter, Deborah E. Pajak, or, in the
event she predeceases me, to her issue, per stirpes;
Twenty five percent (25~) to my son, John H. Fales, III, or, in the event
he predeceases me, to his issue, per stirpes.
In the event any beneficiary is less than the age of twenty one at the time of
distribution, his or her share shall be paid to the legal guardian for the beneficiary to
be used by the guardian for the benefit of the beneficiary as he or she deems
appropriate, in the sole discretion of the legal guardian. If at the time of my death,
there is no legal guardian for any beneficiary because said beneficiary is eighteen years
oM or older, a trustee for said funds shall be named and appointed by my Executor and
distribution shall occur as the trustee deems appropriate to meet the needs of the
beneficiary. In any event, all monies and interest thereon shall be distributed to the
beneficiary or for the benefit of the beneficiary no later than his or her twenty first
birthday.
ITEM II:
In all other respects, I hereby ratify my Last Will and
Testament dated December 13, 1989 and incorporate same herein by reference.
IN I~TNESS WI-IE~O~ I have hereunto set my hand and seal to this, my
Codicil of my Last Will and Testament, consisting of this and the preceding two (2)
pages, at the end of each page of which · have also set my initials for greater security
nd better identtfication this day of ~o~ , 1997.
FRANCES E. FALES
We, the undersigned, hereby certify that the foregoing Codicil was signed,
sealed, published and declared by the above-named Testatrix as and for her Codicil of
her Last Will and Testament, in the presence of each other, have hereunto set our
hands and seals the day and year first above written, and we certify that at the time of
the execution thereof, the said Testatrix was of sound mind and memory.
Lisa
Residing at: 205A Tenth Street
New Cumberland, PA 17070
Michael T. Stephens
Residing at: 313D Eden Road
Lancaster, PA 17601
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, FRANCES E. FALES, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Codicil for my Last Will
and Testament; that I signed it willingly, and that I signed it as my free and vol~ntary
act for the purposes therein expressed.
Sworn to and subscribed
befor/eff~e ~is ~~day
of (.~r._t_/-~~. _,~199 /'~.
NOTARY PUBLIC
My Commission Expires:
(SEAL)
NOTARIAL SEAL
Bart~ra Sumple-$ullivan, Notary Public
New Cumberland Boro, Cumberland Co.
My Commission Expires Nov. 15, 1999
FRANCES E. FALES
AFFIDA FIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, Lisa Zizis, and Michael T. Stephens, the witnesses whose names are signed
to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw Testatrix, FRANCES E. FALES, sign and
execute the instrument as her Codicil for her Last Will and Testament; that Testatrix
signed willingly and she executed said Codicil as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the Testator
signed the Codicil as witnesses; and that to the best of our knowledge the Testatrix was
at that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
Lisa Zizis~/
Sworn to and subscribed
before,~e~i, s ~~day
of
My Commission Expires: (SEAL).
NOTARIAL SEAL
Baroca Sumple-Sullivan, Nota~/Public
New Cumberland Boro, Cumberland Co.
My Commission Expnes Nov. 15. 1999
Michael T. Stephens
L~ST ~ILL ~I~D TESTAMENT
I, FRANCES E. FALES, a resident of Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my LAST WILL
and TESTAMENT, hereby revoking any and all Wills and Codicils
previously made by me.
I
I declare that I am not married, my beloved husband having
predeceased me, and that I have four (4) children, JANET E. EYE,
ALICE V. HARPSTER, DEBORAH E. PAJAK, and JOHN H. FALES, III.
II
I direct that my debts and funeral expenses be paid as soon
after my death as is practicable by my Executrix out of my
residuary estate, but not from any assets, funds, death benefits
or insurance proceeds which are otherwise excludable or exempt from
my gross estate for federal estate valuation or tax purposes.
III
I direct that all estate, succession, legacy, inheritance or
other transfer taxes, however designated that shall become payable
by reason of my death in respect of all property comprising my
gross estate for death tax purposes, whether or not such property
passes under this LAST WILL, shall be paid by my Executrix out of
my residuary estate, but not from any assets, funds, death benefits
or insurance proceeds which are otherwise excludable or exempt from
my gross estate for federal estate valuation or tax purposes.
IV
I give, devise and bequeath all my property, whether real or
personal, wherever situate, including any property over which I may
have a power of appointment to my children, JANET, ALICE, DEBORAH,
and JOHN, in equal shares, per stirpes.
V
I nominate, constitute and appoint my daughter, DEBORAH, as
Executrix of this LAST WILL, to serve without bond. If DEBORAH is
unable or unwilling to act in that capacity, then I nominate,
constitute and appoint my son, JOHN, as Executor of this LAST WILL,
to serve without bond.
IN WITNESS WHEREOF, I, FRANCES E. FALES, have set my hand to
this LAST WILL this /~ ~'~
day of December, 1989.
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
ss.
I, FRANCES E. FALES, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
FRANCES E. FALES
Sworn or affirmed to and acknowledged before me by FRANCES E.
FALES, Testatrix, this /3~W~ day of December, 1989.
Notary Public
l Nolarial Saal
Diane M Smilh, Notary Public
echanicsburg Boro, Cumberland County~
~My Commission Expires Ju?,e 22~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND :
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and
say that we were present and saw Testatrix sign and execute the
instrument as her LAST WILL; that FRANCES E. FALES signed willingly
and that she executed it as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to
the best of our knowledge, the Testatrix was at the time 18 years
of age or more, of sound mind and under no constraint or undue
influence.
?
Sworn or affirmed to and acknowledged before me
this t~ day of December, 1989.
Notary Public
Notarial Seal
Diane M. Smith, Notary Public
echanicsburg Boro, Cumberiand Counh,
Commission Expires June 22, 1cji.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
FRANCES E. FALES
FEBRUARY 19, 2004
2004-00211
To the Register:
Admin. No. 21-04-0211
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 February 18, 2004.
Name Address
Janet F. Morris 421 Gallaher Road, Elkton, MD 21921
Alice V. Harpster. 93 Oneida Road, Camp Hill, PA 17011 /
Deborah E. Pajak 985 Silver Lake Road, Lewisberry, PA 17/3'39
John H. Fales III 19004 Hempstone Court, Poolesvillel/~4D 20837
//
Notice has now been given to all persons entitled thereto/mder,~, e 5.6~d)/except: NONE
Date: March 12, 2004
Murrel R. Walters, III, Esquire
54 East Main Street
Mechanicsburg, PA 17055
(717) 697-4650
Capacity: __
Personal Representative
__ _ Counsel for personal representative
REV-1600 EX + (6-00)
I--
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ILl
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0
I.U
0
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FALES~ FRANCES E.
DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year)
02/19/2004 I 02/22/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 I -0 4
COUNTY COOL YE~
0 2 I
NUMBER
SOCIAL SECURITY NUMBER
2 4 5- I 8- 6 8 3 7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
r~l. Odginal Retum
D4. Limited Estate
r~6. Decedent Died Testate (Attach copy of Will)
r"-] 9. Litigation Proceeds Received
D2. Supplemental Retum
D4a. Future Interest Compromise (date of death a~r 12.12-82)
[--"~ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
O10. Spousal Pove~ Credit (dale of death between 12-31-91 and 1-I-95)
[~3. Remainder Return (dateofdeathpdorto12.13-.82)
D5. Federal Estate Tax Retum Required
__ 8. Total Number of Safe Deposit Boxes
Oll. Election to tax under Sec. 9113(A)(Attach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
NAME
MURREL R. WALTERS III ESQ.
FIRM NAME (If Applicable)
TELEPHONE NUMBER
71716974650
54 EAST MAIN STREET
MECHANICSBURG
PA 17055
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B)' (2)
3. Closely Held Corporation, Partnership 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)
D Separate Billing Requested
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 Govemmental 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)
19;125.90
914;688.15
0.00
0.00
(8)
27;677.00
1;970.00
(11)
(12)
(13)
(14)
933;814.05
29,647.00
904;167.05
904;167.05
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
20.
x ~ (15)
904~167.05 X .045 (16)
X .12 (17)
X .15 (18)
(19)
40?687.52
40;687.52
> · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
525 HARDING STREET
CITY
NEW CUMBERLAND
STATE PA
IZlP
17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
2~034.38
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
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 BUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
40;687.52
2;034.38
38p653.14
38;653.14
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 in~:ome of the property transferred; ........................................................................... [] []
b. retain the right to d~signate 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 secudty at his or her death? ................. [] []
4. Did 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 penallies of perjury, I declare that I have exa~'~iqed this retum, including accompanying scn~
Beclaration of preparer other than the personal re~es~lntative is based~on all infonnatien of which preparer has any knowledge.
S'IG~RE OF PERSON RF~°ONSI~. R'FILING.~f'URN
~GNATU RE/4~)~,I~.~P/~R (~l'f~TH.~l~ REPRESENTATIVE
ADDRESS MGI~REL R. WALTER~tll ESG
54 EAST MAIN STREET~ MECNANICSBURG
schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
DATE
5113/04
PA 17339
DATE
5113/05
PA 17055
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, 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. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §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.
REV-1503 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FALES. FRANCES E.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 O4
0211
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WR BERKLEY CORP 19,125.90
474 SHARES @ 40.35
TOTAL (Also enter on line 2, Recapitulation) $ 19~125.9n
(If more space is needed, insert additional sheets of the same size)
~hareowner bervices 4/5/2004 12:30 PAGE 2/2 RightFax
Shareowner Services
PO B~x 64874
St. Paul, Minnesota 55164-0874
Phone: 1-800-468-9716 or 651-450-4(~
www.wellsfargo.comla~ areownerse rvices
April 05, 2004
DEBPRAJ E PAJAK
214 SENATE AVE, SUITE 303
CAMP HILL PA 17011
Request Number:. 130686
Regarding: W R Berldey Corporal~on
Dear Ms Pa.iak,
Re: Finandal Confirm
Account Number: 3350000321
Registration: FRANCES ELIZABETH FALES
Creation Date: 03/1 9/1985
Issue Name of Stock: W R BERKLEY CORP
Balance: 474 Certificate Shares Balance of 2/1 9/2004:474 Certificate Shams
Dividend Amount Paid YTD: Year 2003 - $124.82 Year 2004 - $68.36
Dividend Rate: $0.070000
C1 osing Price per Share on 2/19/2004: $40.35000
Ticker Symbol for the Company is: BEE
It is exchanged or traded on: NYSE
If you have any que~ons, please call our Shareowner Relations Department at 1-800-468-9716 or
651-450-4064.
Sincerely,
Shareowner Relations
Enclosures:
Internal Use Only:
REV-15~8 EX + {1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
FALES. FRANCES E. ;21 ~)4 Q~11
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. 402,623.99
8
9
10
AMERICAN FUNDS
8569-01104/05/06107108109119/21
MASS MUTUAL 3248
MASS MUTUAL 0537
HARTFORD LIFE 7561
FRANKLIN TEMPLETON 2309
NUVEEN
1462
PSECU
SAVINGS
PSECU
CHECKING
PNC BANK
CHECKING
PNC BANK
SAVINGS
4,422.89
33,418.83
177,006.54
73,031.52
73,202.99
28,598.78
6,329.78
4,626.60
1,426.23
TOTAL (Also enter on line 5, Recapitulation) $ 914~688.1,~
(If mom space is needed, insert additional sheets of the same size)
American Funds'
DEBORAH PAJAK
MML INVESTORS SERVICES INC
W SHORE OFFICE CTR
214 SENATE AVE STE 303
CAMP HILL PA 17011-2336
Amedc:an Funds Sewice Company
Post Office Box 2280
Norfolk, Vlrgini~ 23501-2280
dmericanfunds.com
March 8, 2 004
Re:
Washington Mutual Investors Fund - A
The Investment Company of America - A
The Growth Fund of America - A
The Income Fund of America - A
New Perspective Fund - A
The Bond Fund of America - A
The Cash Management Trust of America - A
The Tax-Exempt Bond Fund of America - A
American High Income Trust - A
Account #5849-8569-01/04/05/06/07/08/09/19/21
FRANCES E FALES
Dear Ms. Pajak:
We recently received an inquiry regarding the balance of account #5849-8569-01/04/05/06/07/08/09/19721.
The table below reflects the share balance, per share net asset value (NAV), and total value of the account on the
date requested:
Date
Account Number Share Balance NAV Per Share Total Value
02/19/04 5849-8569-01 5,070.569 $2 9.76 $150,900.13
02/19/04 5849-8569-04 1,464.575 29.73 43,541.81
02/19/04 5849-8569-05 770.224 2 5.70 19, 794.76
02/19/04 5849-8569-06 1,473.669 17.56 25, 877.63
02/19/04 5 849-8569-07 932.944 2 5.57 23, 855.38
02/19/04 5849-8569-08 3,532.103 13.66 48,248.53
02/19/04 5849-8569-09 2,352.150 1.00 2,352.15
02/19/04 5849 -8569-19 4,902.240 12.68 62,160.40
02/19/04 5849-8569-21 2,089.847 12.39 25,893.20
Mutual fund share prices vary with the fluctuations of financial market share prices. The prices of the funds are
found in the financial pages of most metropolitan newspapers under American Funds in the Mutual Funds
listings.
FRO~-~A$$MUTUAL ANNUITY SVC CTR
T-543 P.03/O~ F-OS9
~ GROUP~'
FRANCES E FA_LES
985 SILVER LAKE RD
LEWISBERKY, PA 17339
March 9, 2004
RE: Contract: 15283248
Annuitant: Frances E Fales
The MassMutual Financial Group Companies value your continued business. Thank you for the
oppommiry to assist you in the pursuit of your financial goals.
The total value of Conu'act #15283248 as of February 19, 2004 was $114,422.89.
Please refer to your prospectus for further information.
If we can be of further assistance, please call our Annuity Service Center at 1(800) 366-8226,
Monday through Friday bet-ween 8:00 a.m. and 8:00 p.m. Eastern Standard Time. You can also
visit us online at www. massmutuat, cor,~'c~c, or contact your Financial Representative, Deborah E
Pajak
Sincerely,
Kathlene Kielbania
Customer Service Representative
1-800-272-2216 (Option 8; Ex~. 72821)
Annuity products are issued by Massachusc[B Mutual Life Ir~ur'ance Company, C.M Life Insuranc~ Comping,, and MML Bay guru: Life
Insurance Compauy.
Registered Represenraive ofMMI_ Disu'ibulots., LLC a MassMutual Subsidiary.
Supervisory office: 1414 Main Street Springfield Ma, O1144-1013 (413) 73%8400
Ma~sachuse~s Mutual Life Insurance Company and al~lliared insurance companies Springfield MA 01111-0001
Massachuse'as Muaml Life tnsuranc~ Company and afliha~e~ · Spnngfi¢Ick NL~. 01111-0001 - (413) ')'81t-8411
k4A~-~-~4
F~O~-MA$SMUTUAL ANNUITY
T-843 P.02/02 F-Ogg
MassMutual
FINANCIAl. GROUP®
FRANCES E FALES
985 SILVER LAKE RD
LEWISBERRY, PA 17339
March 9, 2004
RE: Contract: 9340537 ·
Annuitant: Frances E Fates
The MassMutual Financial Group Companies value your continued business. Thank you for the
opportunity to assist you in the pursuit of your financial goals.
The total value of Contract #9340537 as of February 19, 2004 was $33,418.83.
Please refer to your prospectus for further information.
If we can be of further assistance, please call our Annuity Service Center at 1(800) 366-8226,
Monday through_ Friday bem, een 8:00 a.m. and 8:00 p.m. Eastern Standard Time. You can also
visit us online at www. massmu~ual, corn/asc, or contact your Financial Representative, Deborah E
Pajak
Sincerely,
Kathlene Kielbania
Customer Service Representative
1-800-272-2216 (Option 8; Ext. 72821)
Annui~ pro(luc~ are issued b). Massachusem Mutual Life Insurance CompanSt, (2 M. Life Iasurance Company, md MMI. Bay Smtc Life
Insurance Company.
Registered Representative ofMML Disu-ibmors, LLC a MassMutual Subsidiary,
Supervisory office: 1414 Main Street Spring'field MA 01144-1013 (413) 73%8400
Massaehusev. s lvlurual Life ln-suranee Company and affiliamd insurance ¢ompanim Springfield MA 011114)001
Ma~sachuscms Mutual l-rfe I,asm'anco Coml:~my and af:filbae,~ * Springfield, MA 01111-~301 · (413) 788-8411
March 23, 2004
Hartford Life
Deborah Pajak
Fax: 717-763-7684
REFERENCE: Hartford Annuity Account. # 710357561
Decedent: Frances Fales
Dear Ms. Pajak:
Thank you for your correspondence regarding ttm above annuity cor~tracL
The death benefit payable under this contract is not considered "life insurance': reportable
on IRS Form 712, (hfe insurance statement). Please find the below inf6rmation in
response to your request.
Contract Number:
Owner:
Decedent:
Owner's SSN:
Date of Death:
Date of Death Value:
710357561
Frances Fales
Frances Fales
245-18-6837
Febraary 19, 2004
$177,006_54
If you have any other questions or con~e~a,:please feel free to d,,on ..met.' ~dur investment
professional, or one of our annni, sp.e, ~iab..'S4s by calling 1-g00,-g62~.6..¢8,,,'.~Vioilday
throu~ Thursday 5om 8 mm to 7'p.m., F~day 5om 8 mm. to 6 p.m.,:and on.Saturday
5om 9 a.m. to 2 p.m. Eastern time. :We..w~,'ll be happy to assist you. Thai~ you for the
opporttmity to help provide for your fm'an~ial needs. I '. ,'
Sincerely,
C. DeLuca
Investmen[ Product Services
Contract Management
Hartford Life and Annuity Insurance Company
, ltlartford Life II~,uran~ Companies
Woll Fr~ 1. 800 862 ~68
ool~n~ha~fo~ife~m
FRANKLINoTEMPLETON.
INVESTOR SERVICES, LLC
Regular Mail
P.O. Box 997152
Sacramento, CA'95899-7152
Overnight Mail
3344 Quality Drive
Rancho Cordova, CA 95741-7313
tel 800/632-2350
April 13, 2004
Deborah E. Pajak
985 Silver Lake Road
Lewisberry, PA 17339-9117
SUBJECT:
Franklin Pennsylvania Tax-Free Income Fund - Class A
.&/C #129-12900402309 (closed)
Frances E Fales
A/C #129-12911662339 (closed)
Deborah E Pajak
EXEC EST Of Frances E Fales
Dear Ms. Pajak:
Thank you for your recent correspondence. We are writing to confirm that the shares held in
account #129-12900402309 were transferred to account #129-12911662339, and subsequently
liquidated according to the instructions that we received. Confirmation and a check for the
proceeds have been ma/led to you under separate cover.
Additionally, according to our records, account #129-12900402309 held 6,883.272 shares on
February 19, 2004. The net asset value of the Franklin Pennsylvania Tax-Free Income Fund -
Class A at the close of market on that date was $10.61 per share, for a total dollar value of
$73,031.52.
We welcome any questions that you may have regarding this matter. You may contact a
Shareholder Services Associate, Monday through Friday, 5:30 a.m. to 5:00 p.m. Pacific Time,
toll free at 1-800/632-2301 and refer to identification number: 21055-29MAR04.
Sincerely,
Franklin Templeton Investor Services, LLC
Rob Marty
Senior Associate
Shareholder Services
~4/27/2004 07:48 717730994~ WIENKEN ASSDCIATES PAGE 02/02
NUVEEN
Inues~men~$
Closed-End Exchange-Traded Funds
April 19, 2004
DEBORAH E PAJAK
985 SILVER LAKE ROAD
LEWISBERRY PA 17339-9117
FRANCES
ACCOUNT
Dear Ms. Pajak:
Thank you for your inquiry regarding the share balance of the above
oppommity to be of service to you.
2qSYLVANIA PREMIUM CEF
[ZABETH FALES
JMBER.' ~092-21462
eferenced account. We appreciate the
On February 19, 2004, account number 21462 held 4,589.5290 share:
$15.95 per share.
Should you have any questions, please call us at 1-800-25%8787.
Monday through Friday, 9 a.m. to 7 p,m. Eastern Standard Time. If
obtain additional information on products and services by visiting ouJ
us at Nuveen Investments, P.O. Box 43071, Providence, RI 02940.
· On that date, the closing price was
Sincerely,
telephone representatives are available
)u have internet access, you may also
~ website at www.nuveen.com or write to
Shareholde~
I Services Representative
Reference Number: 01372876
GE- 17 -LG
PSEC
the financial linkTM
March 15, 2004
Murrel R. Walters, III
54 East Main Street
Mechanicsburg, PA 17055
Frances E. Fales, Deceased
SS # 188-22-7489
Dear Mr. Walters:
The following are the Date of Death Balance's for Frances E. Fales' accounts with PSECU:
Primary Account Date of Death Balances Accrued Interest
Savings (S 1) $28,587.57 $11.21
Checking (S4) $ 6,328.93 $ .85
Visa Loan (L9) $ 196.12 (Now paid in full.)
Prefix Account Date of Death Balances Accrued Interest
Savings (SI) $ 500.86 $ .20
Checking (S4) $1,554.45 $ .20
The Primary account was opened August 24, 1982. The account was held individually. The
Prefix account was opened November 12, 2003 and was held jointly with Deborah Pajak.
If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-
7328, then press 6, extension 3120.
Sincerely,
Suzanne E. Fahr
Account Advisor
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: I Credit Union Place, Harrisburg, PA 17110-2990 · (717) 234-8484 · (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 · (717) 777-2100 (TDD) - (800) 472-1967 (TDD)
Web Address: www. psecu.com
Savings federally insured up to $100,000 by the National Credit Union Administration.
mNN-Z~-Z~4 0~:L5 PNCBRNK 4~2 ?6B 3458 P.OL/QL
PN CBAN
March 23, 2004
Murrel R Walters, HI
Attorney at Law
54 East Main St
Mechanlcsburg, PA 17055
Eat~e of FraneesEFalea(Decea~cl)
SSN:245-18-6837.
DOD: 02-19-2004
scp
Dear Mr, Wakers,IH:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checlfing Account
Acc~untO5140.0.19339
m Sc s F ss
DOD balance: $4,626.35 + $0.25 accrued i~terest
Savingg Account
Estabiished 06-01-1972
Accountg5130147281 Established 07-01-1979
FRANCES E FALES
DOD balance: $1,426.12 + $0.11 accrued interest
Please note that this office only provides d~t~'of death balances 'for deposit accounts
(IRA~, CDs, Check/ag and Savings accounts). We do not process any finaadal
transactions or provide staiem,ats. If you need assistance with any of these items, please
call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office.
Sincerely,
Helen A Cozad
1-800-762-1775
PT-PFSC-04-F
500 First Av~ 4~ Fl ElF
Pittsburgh PA 15219-3128
Memb~ FDIC
TOTAL P.O1
REV-1510 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
FALES. FRANCES E. gl (;;)4 Qgl 1
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is les.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUOETHE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTODECEDENTANDTHE DATEOF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLI~E)
1. PSECU 501.06 100. 501.0( 0.0{~
SAVINGS
2 PSECU 1~554.65 100. 1~554,65 0,0{~
CHECKING
TOTAL (Also enter on line 7, Recapitulation) $ O.OO
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD O03941
WALTERS MURREL R Ill
54 E MAIN STREET
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 245-18-6837
FILE NUMBER: 2104-021 1
DECEDENT NAME: FALES FRANCES E
DATE OF PAYMENT: 05/18/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/19/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $38,653.14
REMARKS:
TOTAL AMOUNT PAID:
$38,653.14
SEAL
CHECK//1006
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z&-0601
HURREL R WALTERS 111ESQ
5~ E HAIN ST
HECHANICSBURG PA 17055
CONNON#EALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE 07-13-ZOOq
ESTATE OF FALES
DATE OF DEATH OZ-19-ZO0~
FILE NUNBER 21 0R-0211
COUNTY CUHBERLAND
ACN 101
Amount RomAttod
REV-lS47 EX 4FP (01-05)
FRANCES E
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGTSTER OF WTLLS
CUH~ERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF FALES FRANCES E FILE NO. 21 0~-0211 ACN 101 DATE 07-13-200~
TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) 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)
$. Closely Held Stock/PartnershAp Interest (Schedule C) ($)
~. Hortgages/Notas ReceAvabla (Schedule D) (~)
$. Cash/Bank DaposAts/HAsc. Personal Property (Schedule E) ($)
6. Jointly O~ned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tote1 Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expansas/Adm. Costs/Nisc. Expanses (Schedule H) (9)
10. Debts/Nortgega LiebilAties/Lions (Schedule I) (10)
11. Total Deductions
12. Nat Value of Tax Return
19~125.90
.00
911/688.15
.00
.00 NOTE: To Ansure proper
credit to your account,
submit tho upper portAon
.00 of this fore with your
tax payeent.
.00
953,81~.05
13.
1~.
NOTE:
(8)
27,677.00
1~970.00
(11) 29.6~7. DO
(1~) 90~., 167.05
CharAtablo/Govarnmontal Bequests; Non-elected 9115 Trusts (Schedule J) (13) . O0
Net Value of Estate Subject ~o Tax (1~) 90~,167.05
Zf an assessment ~as issued prev/ously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
...OO x O0 = .00
90~,167-:05 x 0~5= ~0,687.52
.00 x 1'2 = .00
.00 x 1~ = .00
~.9) = ~.0,687.52
ASSESSHENT OF TAX:
15. Amount of LAne 1~ at Spousal rata (15)
16. Amount of LAne 1~ taxable at Lineal/Class A rata (16)
17. Aeount of LAne 1~ at SiblAng rate (17).
18. Amount of Line 1~ taxable at Collateral/Class B rate (18).
)al Tax Duo
RECEIPT
NUHBER
CD0059~1
DISCOUNT (+)
ZNTEREST/PEH PAID (-)
Z,05~.38
19. Princl
TAX CREDITS
PAYflENT
DATE
ANOUNT PAID ' I
I
38,655.1~.
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
~0,687.52
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT ZS RE;)UZRED.
05-18-200~
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CRED/T" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred
in possession ar enjoyment to Class B (collateral) beneficiaries of the decedent 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 D (collateral) rate on any such future interest.
PURPOSE OF
NOT/CE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act) Act 13 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REG/STER OF NILLS, AGENT
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" (REV-1313). Applications ara available at the Office
of the Register of Hills, any of the 23 Revenue District Offices) or by calling the special Iq-hour
answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-BOO-qq7-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions) or assessment
of tax (including discount or interest) as shown on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 181011) Harrisburg) PA 17118-1011) 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 ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes) ATTN: Post Assessment Raviaa Unit) Dept. gE0601, Harrisburg) PA 17118-0601
Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is all.wad.
The 151 tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and 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 rate of
six (6Z) percent per annum calculated at a daily rate of .O0016q, All taxes which became delinquent on and after
January 1, 198Z 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 19BZ through ZO0~ are:
Interest Daily Interest Daily Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1981 20Z .O005qB ~'~)'~'~-1991 llX .000301 ~'~ 9Z .0002~7
1983 161 .O00fi38 1992 9Z .OOOZq7 2001 61 .00016q
198q 112 .000501 1993-199q 71 .000192 2003 5Z .000137
1985 132 .000356 1995-1996 91 .0002~7 ZO0~ ~Z .O0011O
1986 10Z .00027~ 1999 72 .000192
1987 lOZ .O00Z7q Z000 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 wlll 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.
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. 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:
179
01-25-05
Frances E Fales
21-2004-00211
Murrel R. Walters III Esq.
54 East Main Street
"
Mechanicsburg, P A 17055
4.00
Total
$8.00
Qty
2
Fee Description
Short Certificates
Fee
Total:
$8.00
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.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent: FRANCES E. FALES
Date of Death: February 19, 2004
Estate No.:
2004-00211
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_X_ No___
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete
(date)
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_X_
B.
The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
c.
Did the personal representative state an account informally to the parties
in interest: Yes _X_ No
D.
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: January 17,2006
~/
..~ ./
1" l1'.v
MURREL R. WALTERS, III, ESQUIRE
54 East Main Street
Mechanicsburg, P A 17055
717-697-4650
Capacity:
Personal Representative
__X_ Counsel for Personal Representative
~1:
Cumberland County - Register Of Wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 1/13/2006
WALTERS MURREL RIll
54 E MAIN STREET
MECHANICSBURG, PA 17055
RE: Estate of FALES FRANCES E
File Number: 2004-00211
Dear Sir/Madam:
It has corne 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. I, for decedents dying on or after
July I, 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:
2/19/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge