HomeMy WebLinkAbout04-0365Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of William C. Vassey
also known as
Marie C. Vassey
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
, Deceased
Social Security No. 207-30-2557
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut
the Decedent, dated and codicil(s) dated
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor,
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted affe~e~bcution o~he docgm~ e~ts
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration d.b.n. -u
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia;r.~rante mimoritate)
Petitioner(s)
after
a
proper
search
has/have
ascertained
that
Decedent
left
no Will and was survived by the following spouse (if any) and
heirs:
Name
Relationship Residence
Marie C. Vasse¥
Laura M. Vassey
Daniel J. Vassey
Nicole C. Vassey
Spouse
Dauqhter
Son ,, ,, ,, ,,
Dauqhter
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
701 Sunhaven Circle, Mechanicsburq, PA
6 Locksle¥ Ave., Apt. 2-C
San Francisco, CA
County, Pennsylvania with his/her last family
or principal residence at 701 Sunhaven Circle, Upper Allen Township, Mechanicsbur~, PA 17055
(list street, number, and municipality)
Decedent. then 59 years of age, died 02/23/2004 at Community General Osteopathic Hosp. , PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
7,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
Si~lnature Typed or printed name and residence
~'"~/.~.~ Marie C. Vassey
~/~ ~ 701 Sunhaven Circle, Mechanicsbur~, PA 17055
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
Commonwealth of Pennsylvania
County of Cumberland
Oath of Personal Representative
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me thi;~/,4//day of
Marie C. Vassey -/
No.
Estate of William C. Vasse~z Deceased
are hereby granted to
Social Security No: 207- 30- 2557 Date of Death: 02/23/2004
AND NOW, R'zJ'~ / /~-~ ,~, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters E~ Testamentary ~'~ Of Administration d.b.n.
(c.t.a.; d.b.n.c.ta.; pendente lite,~ante absentia; durante~..minoritate)
Marie C. Vassey
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Renunciation ........ $
Affidavits ( ) .... $
Extra Pages ( ) .... $
Codicil ........... $
JCP Fee .......... $
Inventor,. ......... $
/ / ~egiste,~-of Wills ., ---//" --
Attorney: Jennifer B. Hipp, Esquire
I.D. No: No. 86556
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Other ........... $
TOTAL ......... $ ~Z~, '/~0
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Register of Wills of Cumberland County, Pennsylvania
Estate of
a~so known as
William C. Vassey
RENUNCIATION
, Deceased
The undersigned, Chi ldren
of
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
Mar~e C. Vass.ey
Sworn to or affirmed and subscribed
before me this I~'~--~ day
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Shew date of
expiration of Notary's commission.)
( 'gnature~ Nicole C. ~fassey -
6 Locksley Avenue, Apt.
San Francisco, CA 94122
2-C
(Address)
(Signature) .'a ~/Vas s ey
701 Sunhaven Circle
Mechanicsbur~, PA 17055
(Address)
(Signature)
(Address)
Daniel J. ~Vassey Q
701 Sunhaven Circle
Mechanicsbur~, PA 17055
NOTARIAL SEAL
SUSAN J. MILLER, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires Sept, 19, 2005~
NOTE: Renunciations executed outside the Office of Register of Wills
in some counties are required to be notarized.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-4 (1991)
Register of Wills of Cumberland County, Pennsylvania
Estate of
also known as
RENUNCIATION
William C. Vassey No. ~/--i~F/--%.~~'''
, Deceased
The undersigned, Chi ldren
(Relationship) (Capacity)
the above Decedent. hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
Marie C. Vassey
WITNESS ~-~/~~ hand this , ~)1'~" dayof
of
Sworn to or affirmed and subscribed
before me this J O day
Notary Pul~lic'
My Commission Ex~pires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
6 Locksley Avenue, Apt. 2-C
San Francisco, CA 94122
(Address)
(Signature) Lau;a~Vas s ey
701 Sun-haven Circle
Mechanicsbur~, PA 17055
(Address)
(Signature)"- Daniel
701 Sunhaven Circle
Mechanicsburg, PA 17055
(Address)
SU~~SAN 7OTARIAL SEAL
~~. MILLER, Notary Public
Camp Hill Bore. Cumberland County
NOTE: Renunciations executed outside the Office of Register of Wills
in some counties are required to be notarized,
Prepared by the Pennsylvania Bar Associatiort
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-4 (1991)
105.805 REV 9186
This 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 9826121
No.
Local Registrar
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
William C.
vassey
AGE (t asl 8ttlnOay} UN~R I D~
944 ,.Johnstown
z
Lower Paxton General
701 Sunhaven Circle ...s,.. Pennsvlvani~
PA 17055 Cumberland
Julius
Marie C. Vassey
FDa014889
PERFORMED?
~ite
~ ,,~.~ ~.~, U~ Allen
701 Sunhaven Circle
Mechanicsburq, PA 17055
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 07/01/2004
HIPP JENNIFER B. ESQ.
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
RE:
Estate of VASSEY WILLIAM C
File Number: 2004-00365
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 07/26/2004
Your prompt attention to this matter will be appreciated.
Thank You.
CC:
File
Personal Representative(s)
Judge
Sincerely,
GLENDA FARNER STR3tSBAUGH ~J
Clerk of the Orphans' Court
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 07/01/2004
VASSEY MARIE C
701 SUNHAVEN CIRCLE
MECHANICSBURG, PA 17055
RE:
Estate of VASSEY WILLIAM C
File Number: 2004-00365
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 07/26/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
Sincerely,
c~eEr~Ao [At~eERo Sr~a SnBsA, UcGHou r tQ'J
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: William C. Vassey
Date of Death: February 23, 2004
Will No. 21-04-3~65
Admin. No.
To the Register:
I certify that notice of 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
July 12, 2004:
Name
Address
Marie C. Vassey
701 Sunhaven Circle,
Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date: July 12, 2004
Capacity:
Jenn~f~r B.J~ipp, Esquire
One West Main Street
Shiremanstown, PA 17011
(717) 737-8761
Personal Representative
X Counsel for Personal
Representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: William C. Vassey
Date of Death:
Will No.
February 23, 2004
Admin. No.
21-04-~ 0565
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 XX No
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 XX
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 XX No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Sign~a~ure
Jennifer B. Hipp, Esquire
Name (Please type or print)
One West Main St.
Shiremanstown, PA 17011
Address
(717) 737-8761
Tel. No.
Capacity:
Personal Representative
(MAH:rmf/AJ~3)
Counsel for personal
representative
EV- 1500 EX + (6-00}
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 28O6O1
HARRISBURG, PA 171Z8-06O 1
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, F[RST, AND MIDDLE INITIAL)
Vassey William C.
Limited Estate
DecedentDledTestate
DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-OD-YEAR)
02/23/2004 08/26/1944
(IF APPLICABLE} SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Vassey, Marie C.
~247! Supplemental Return
· Future Interest Compromise (date of death after lZ- 1Z-62)
Decedent Maintained a Living Trust
(Attach copy of Trust)
(Attach copy of Will)
I----']9. LltlgatlonProceedsReceived I--]10. SpousalPovertyCredit
(date of death between lZ-31-91 and 1 - 1-95}
OFFICIAL USE ONLY
FILE NUMBER
2i-04-0365
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
207-30-2557
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
160-40-1610
e . (date of death
,3. Remainder Return prior to tZ- 13-8Z)
5. Federal Estate Tax Return Required
0 8. TotaJ Number of Safe Deposit Boxes
---] 11.ElecflontotaxunderSec. gl13(A)
(Attach Sch O)
NAME
Jennifer B. Hipp Esquire
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
One West Main Street
Shiremans=own, PA 17011
(1) None OFFICIAL USE ONLY
(2) 7,633.08
(3) None
(4)
TELEPHONE NUMBER
717/737-876i
I. Rea[ Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
co <-~ iD
· . ~;~o_~7 633 08
0.00
7,633.08
(14) 7,633.08
14.
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) None
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) None
11. Total Deductions (total Lines 9 & 10) (11).
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13).
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
19. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2) 7,633.08 X
16. Amount of Line 14 taxable at lineal rate X
17. Amount of Line 14 taxable at sibling rate X
18. Amount of Line 14 taxable at collateral rate X
19. Tax Due
.0 0 (15) 0.00
.0 45 (16) 0.00
.12 (17) 0.00
.15 (18). 0.00
(19) 0.00
Copyright (c) Z000 form soflware only The Lackner Group, [nc. Form REV-1900 EX (Rev. 6-00)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. ZB060!
HARRISBURG, PA 171Z8-0601
COHNONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
RE¥-1547 EX AFP C01-05)
DATE 09-27-200q
ESTATE OF VASSEY
DATE OF DEATH 02-23-200q
~- ' FILE NUMBER 21 0q-0365
~r COUNTY CUMBERLAHD
JENNIFER ~,__HIPP ESQ ACN 101
ONE WEST MAIN ST I Amoun~ Ram~ad
SHIREMANS~-~WN PA 17011
'~ ~.2
WILLIAM C
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOT/CE OF ZNHER/TANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX
ESTATE OF VASSEY WILLIAN C FILE NO. 21 0~-0565 ACN 101 DATE 09-27-200~
TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/PartnarshAp Interest {Schedule C) ($)
~. No~tgagas/Notas Receivable (Schedule D) (~) .00
$. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00
6. JoAntly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8)
APPROVED DEDUCTZONS AND EXEHPTZONS: .00
9. Funeral Expanses/Ada. Costs/H1sc. Expenses (Schedule H) (9)
10. Debts/Nortgage L1abAlitlas/Lians (Schedule I) (10) .00
11. Total Deductions (11)
12. Not Value of Tax Return (12)
15, Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
1~. Nat Value of Estate Subject to Tax (lq)
NOTE:
7 ~633.08
.00
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form with your
(1.6) 7,633.08 X 00 = .00
(16) .00 X 0~5= .00
(17) .00 X 1Z = .00
(18) .00 x 15 = .00
(19)= .00
ANOUNT PAID
ASSESSNENT OF TAX:
15. Amount of Line lq at Spousal rata
16. Amount of L/ne 1~ taxable at Lineal/Class A rata
17. Aaount of Line 1~ at Sibllng rata
18. Amount of L/ne 1~ taxable at Collateral~Class B rata
19. PrJncJ }al Tax Due
TAX CREDITS
PAYHENT RECEIPT D/SCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19
reflect figures that include the total of ALL returns assessed to date.
7,633.08
.no
7,633.08
.00
7,633.08
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
will
TOTAL TAX CREDIT
BALANCE OF TAX DUE
XNTEREST AND PEN.
TOTAL DUE
.00
.00
o00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
tax payment.
RESERVATION:
Estates of decadents dying on or before December 1Z, 198Z -- if any futura 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 Commonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class S (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILES, 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-1315). Applications are available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
ansaering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers aith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-IOZIj OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time 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 (SI) percent per annum calculated at a daily rate of .000164. A11 taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which w111 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are:
Interest Dally Interest Dally Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .0005~8 ~)'~-1991 11Z .000301 ~ 9Z .o0oz47
1985 16Z .000438 1992 9Z .000247 ZOOZ 6Z .000164
1984 112 .000301 1993-1994 72 .O0019Z 2003 52 .000137
1985 132 .000356 1995-1998 9Z .000Z47 ZOO4 42 .000110
1986 IOZ .000274 1999 7Z .00019Z
1987 iOZ .000Z74 ZOOO 7Z .00019Z
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DATLy INTEREST FACTOR
--Any Notice issued after tho tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Decedent's Complete Address:
STREET ADDRESS
701 Sunhaven Circle
CITY
Mechanicsbur~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE ZIP
PA 17055
Total Credits ( A + B + C ) (2)
3. InteresVPenalty if applicable D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................... [] []
b. retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionar~ 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 secur~y at his
or her death? .............................................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
a benefic[ar~ 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.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Uncter penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, It is true,
correct and complete. DecJaratfon of preparer other than the personal representative Is based on all information of w hlch preparer has any knowledge.
$1GNATUREOFPERSONRESPONSISLEFORFILINGRETURN Marie C. Vassey DATE
-~'-/~6ZzZF~ C' ~//'z~3~.c/.__ 701 Sunhaven Circle
SIGNATUREOFPREPAREROTHERTHANREPRESENTATIVE 3ennifer B. ~ipp Esquire DATE
//~ ,/, One West Main Street
For dates of death on or after July 1, 1994 and before Janua. I, '1095, the ~x rate imposed o; t~e ;et v;lue ;, transfers to or for the use of the
sullying spouse is 3% [72 P.S. 9116 (a) (1.1)
For dates of dea~ on or after Janua~ 1, 1995, the ~x rate imposed on the net value of transfem to or for the use of the su~iving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. ~e statute does not exempt a tran~er to a surviving spouse from ~x, and the ~tuto~ requiremenm for disclosure of assam
and filing a ~x return are still applicable even if the sullying spouse is the on~ beneficial.
For dates of death on or after July 1, 2000:
~e ~x rate imposed on the net vaJue of transfers from a deceased chi(d twang-one years of age or younger at death to or for the use of a naturaJ
parent, an adoptive paren~ or a stepparent of ~e child is 0% [72 P.S. 9116 (a) (1.2)].
~e ~x ate 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(aXl)].
~e ~x rata imposed on the net vaJue of transfers to er for the use of the decedem'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 com~n with the decedent, whether by blood or adoption.
Copyright (c) Z~ form so.are only The Leckner Group, Inc. Form REV- 1 ~00 EX (Rev. 6-00)
REV-IS03 EX * (1-97)
COMMONWEALTH Or: PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
William C. Vassey SSf/ 207-30-2557 02/23/2004
FILE NUMBER
21-0/-r-0365
All property iointly-owned with right of survivorship must be disclosed on Schedule F.
iTEM DESCRIPTION U~IT VALUE VALUE AT DATE
NUMBER OFDEATH
1 182 shares John Hancock Financial Services - Common 41.94 7,633.08
Stock
TOTAL(Alsoenteronline 2, Recap~ulation) 7,633.08
(if more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Ir~c. Form REV-1503 EX (Rev. 1-97)
JOHN HANCOCK FINANCIAL SVCS INC
c/o EQUISERV~ TRUST COMPANY, N.A.
Transaction Advice
Please retain for your records
April 27, 2004
Page 1 of I
WILLIAM VASSEY
C/0 MARIE C VA$SEY
701 SUNHAVEN (::IR
MECHANICSBURG, PA 17055-7501
Shareholder's Account Number 8226648
Account Access PIN/Password 52617852
JOHN HANCOCK FINANCIAL SVCS INC
Date Issue ID Class CUSIP
04/27/2004 120010 COMMON 41014S106
Book Entry Share Balance
Shares Transaction Description
-182.0000 NORMAL TRANSFER
0.0000
To obtain information about your account, sell shares, request a stock certificate or receive transfer of ownership
instructions:
By Internet:
Go to http:/hNww.equiserve.com, click on Account Access, and follow the instructions. Please have your PIN/Password
available. Your PIN/Password is confidential and should not be shared with anyone.
By Telephone:
Call 1-800-333-9231 and follow the instructions. Please remain on the line until your transaction is processed.
By Letter write to:
IIIilll Ill Iii Ill! II1 ill Ill
JOHN HANCOCK FINANCIAL SVCS INC
o/o EQUISERVE TRUST COMPANY, N.A.
P O BOX43015
PROVIDENCE RI 02940-3015
The Corporation will furnish without charge to each shareholder who so requests a statement of the applicable
designations, relative rights, preferences and limitations of the shares of each cla~s and aeries of stock of the
Corporation authorizgd to be issued and of the authority of the Board of Diractol~ of the Corporation to divide the
shares into cla~es or seHee and to determine and change the relative rights, preferences and limitations of any
class or series of stock of the Corporation. Such request may be made to the b'anafer agent or the Office of the
REV*1513EX*(9-00) I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
William C. Vasse¥ SS# 207-30-2557
NUMBER
SCHEDULE J
BENEFICIARIES
02/23/200&
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [I,clude outright spousal distributions, and
t~nsfers under Sec. 9116(~1.2)]
Marie C. Vassey
701 Sunhaven Circle
Mechanicsburg, PA 17055
I1.
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-04-0365
AMOUNT OR SHARE
OF ESTATE
First
$30,000.00,
plus one-half
(1/2) of the
balance of
intestate
estate
ENTER DOLLAR AMTS. FOR OISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DiSTRIBUTiONS UNDER SEC. 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 $ 0 . 00
(If more space is needed, insert additiona~ sheets of the same size)
Copyright (c) 2000 form software o~lly The Laci(ner Group. Inc. Form REV- 1513 EX (Rev. 9-oo)