HomeMy WebLinkAbout04-0372 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ,.~//~l~ ~ ~ ~ ~ ~-- No.
also known'as ./ .... To:
Deceased.
Social Security No. /.~O'"'Z/~/--" ./~_~ .1._/.~,
Register of Wills for the
Co~l~t.y oI~, ~ ,-, n~a .1 -/ in the
con~on~ar)tl~ ~f lg~s'ylvania
The petition of the undersigned respectfully represents tha~:
Your petitioner(s), who is/are 18 years of age or older, appl
(~t.b.n.; l~e~ente lite; ~durante absentia; durante minoritate)
the above decedent.
for letters of administration
on the estate of
Decendent was domiciled at death in &~.~-~/.~_~/,.~
h ~ last family or principal residence at
(list street, number and municipality)
Decendent, then ~D ye~s of age, died ~~-~ ~. ,~~,
Decendent at death owned property with estimated values as folllows:
(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
situated as follows:
Petitioner.__ after a proper search ha.A7
the following spouse (if any) and heirs:
N_~e
ascertained that decedent left no will and was survived by
Relationship 7.~esidence . ~/v
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COtJNTY or ~ t0~ (~,~4 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
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed F 7~:~r-~-4' ~_.
before me this _//?T// d~ay of'. ! - / .-
/c~,o,~ ) i ' , ~~', j
Estate of h'3~ i'~ ~_~t~c~ I z~ , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~L\ I I C~ /lg/o.9~, in consideration of the petition on
the reverse side hereof, satisf~actory proofthavi~g~ b,een presented before me,
IT IS DECREED that ]--(~V~R l I . I ~ ~ ~¥~ ] ~
is/are entitled to Letters of Admlmstrataon, and in aceord with such finding, Letters of Administration
are hereby granted to
in the estate
FEES
Letters of Administration ..... $ /;~-t/,)<9
Short Certificates( ) .......... $~
~Renunciation ................ $
D $ /~,~
TOTAL $~
Filed/~/./..Z¢ ....... *.V-~~ ~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
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 certit~'~5,: $2i00
P
Local Registrar
DEC i 1 2003
Date
Rev 2m? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
ou ,~. : ] : May 11, New Cumberland,l,~,--~,,~Q
Cumberland ]~. Pennsboro ~ ~ /~ ~' ' =~=~' I~} white
I. ' ;. ~
,,~ Housewife ,,m Domestic
227 12th Street
New Cumberland, PA 17070
· ,3. 12 ,4. Married ,~ Henry J. Scholz
17m. hN Penn.~vlvani. a o~ ,ye. FI v,,. ~,~,,~,~,,. ·
,,. Elmer Hill ,,. Mary Moore
~,. Henry J. Scholz I~- 227 12th Street, New Cumberland, PA 17070
m.~[~ c,.,,~O .-~.m~.O I(U~.~y.~) I ~ I W.Hanover ~p., Dauphin Co.
~0 ~, Dl,,~pecember 12, 2003 I,,.Resurrection Cemetery ],,e PA
[ [ Parthemore FH & Cremation Svc.,
~,. FD 012 848L [m. 130~ BrJd~agtraet. New Cumberland PA 17070
~ ~ ~ ~. ~.. T.) I I~' ~,' ')
~ ~ ~ AC~E~E ~:
r~m~T d.
y ~,~'ge. oeem occu~ecI clue
'MEDICAL EXAMINER/CORONER
malmm. ~ St&ted...
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 07/01/2004
SCHOLZ HENRY J
227 12TH STREET
NEW CUMBERLAND, PA 17070
RE:
Estate of SCHOLZ MARY M
File Number: 2004-00372
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 07/29/2004
Your prompt attention to this matter will be appreciated.
Thank You.
CC:
File
Counsel
Judge
Sincerely,
cG~eENr~Ao[At~eERoSr~hans, Cou~/
CERTIFICATION OF NOTICE UNDER RULE 5.6(al
~,11 No. ~J-~-~& Admin. No.
To ~e Register:
I ~ffi~ ~m nofi~ of ~nefi~ in~) ~ a~trafion r~uked by Rule 5.6(a) of ~e ~h~s' Cou~ Rules was
se~ed on or m~led to ~e following benefici~es of the above-captioned estate on
Name Address
Mary Moore Scholz, 80, of
New Cumberland, died Wednesday,
December 9, 2003, at Holy Spirit
Hospital, East P~msboro Township.
She was a member of thc 1941
graduating class of the former New
Cumberland High School; and a former
seereta~ a~ the Ame*ican Legion Post
143, New qumberland for over 20 yesrs.
Mrs. Schc~z was bom May I 1, 1923, in
New Cuml~land to the late Elmer and
Mary (Moore) Hill.
Her grandson, J. Tyler Lcfewe,
preceded her in death.
Surviving is her husband, Henry J.
Scholz; five sons, David E. of Phoenix,
AZ, John P. and wife Elaine of Newark,
DE, Thomas H. and wife Maurcen of
Bear, DE, Donald 1L and wife Joanna of
Plymouth Meeting, and James P. of
Mechaniesburg; two daughters, Carol A.
Markel and husband Richard of
Mcehanicsburg, Mary Sue Lefevre and
husband John of Conestoga; a sister,
Margaret Shahan of Mechanicsburg;
nine grandchildren, Heather, Don P.,
Joseph, Mary P., Hilary, and Mary E.
Scholz, Christopher and Ryan Markel,
and Megan Lefevre.
Mass of Christian Burial will be
celebrated 12 noon Friday in St. Theresa
Catholic Church, New Cumberland, with
the Rev. Msgr. William M. Richardson
as celebnmt. Burial will be in
Resurrection Cemetery, West Hanover
Twp.
Viewing will be held 6 - 8 pm
Thursday at Pasthemore Funeral Home
and Cremation Services, New
Cumberland, with a scripture service
beginning at 6 pm.
In lieu of flowers, the family requests
memorial contributions to St. Theresa
Catholic Church, 1300 Bridge St., New
Cumb~'land, PA 17070.
all persons entitled thereto under Rule 5.6(a) except
Signature
Name J~/~
Address- ' / /
Telephone (]/])
Capacity: ~ Personal Representative
Counsel for personal representative
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
/~7---~ ~'
RESIDENT DECEDENT / cou.-GooE
uJ
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DO-YEAR) - / DATE OF BIRTH (MM-OD-YEAR)
/.~- ~'--,z-~?o,p~ I/?/~,~,'~//-
(IF APPLICABLE) SORVIVING SPOUSE'S NAME (LAST, FIRST, AN~ MIDDI~E INITIALi '
[~'~. Odginal Return
[~4. Limited Estate
]6. Decedent Died Testate (Attach copy of Will)
r-~9. Litigation Proceeds Received
r-~2. Supplemental Return
E~4a. Future Interest Compromise la~ ~f deau~ ~ter 12-1z-sZ)
F"-] 7. Decedent Maintained a Living Trust [Attach copy of Trust)
F-11Q Spousal Poverty Credit (date o~ death between 12-3t-91 and 1-1-95)
NAM/~./
FI~M NAME
TELEPHONE NUMBER
~/~ -~. ~//
SOCIAL SECURITY NUMBER
/~ - o~ -~/~q?
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
/~Y -/~ -.z ~'~ ~/'
F-~3. Remainder Return (dele of deal~ ixio~to 12-13~2)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
F-1 11. Election to tax under Sec. 9113(A)
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~ t,~,,2 '"-'"'
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) .__..-- ~i.,
r-I 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.
(~)
(11)
(12)
(13)
Chantable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
15.
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a){1.2) x .0 (15)
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x ,12 (17)
18. Amount of Line 14 taxable al collateral rate x .15 (18)
19. Tax Due (19)
20. r~
Decedent's Complete Address:
STREET ADORESS~,~_ 7
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
I STATE /(:Z., IZIP
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
4. If Line 2 is greater lhan Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refa~
(3)
(4)
(5)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5A)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~0 --
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IH THE APPROPRIATE BLOCKS
IF THE ANSWER
Did decedent make a transfer and: Yes No
a. retain the use or income of the properly transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] J~
c. retain a reversionary interest; or ........................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
Did decedent own an "in trust for" or payable upo~ death bank account or security at his or her death? .............. [] []
Did decedent own an Individual Retirement Accotmt, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT
AS PART OF THE RETURN.
Under penal6es of perjury, I declare that I have examined this return, including accompan~ schedules and statements, and ~o the best of my knowledge and bdief, it is true, correct and c~te.
Declaration of preparer other than the personal represen~a[ive is based on all informatio~ o~ which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE ~/.¢)R F~NG RETURN
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
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 su~J 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 o~ the net value of transfers to or for the use of the surviving spouse is ~ [r2 P.S. §91t6 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutop/requirements for disclosure of assets and filing a tax mluaa 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 lhe decedents 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)1. 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-1648 EX (1-92) ~
.~,
COMMONWEALTH OF PENNSYLANIA
INHERITANCE TAX DIVISION
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DECEDENTS DYING AFTER 12151/91)
ESTATE OF
FILE NUMBER
This schedule must be completed and filed/if you checked the spousal poverty credit box on the cover sheet.
2.
3.
4.
5.
6a. Other Nontaxable Assets: List (Attach schedule if necessary)..
Taxable Assets total from line 8 (cover sheet) ....................................................................
Insurance Proceeds on Life of Decedent ............................................................................
Retirement Benefits .........................................................................................................
Joint Assets with Spouse ..................................... .' ...........................................................
PA Lottery Winnings ......................................................................................................
6a.
6b.
SUBIOIAL (Lines 6a, b, c, d) .........................................................................................
lotal Gross Assets ladd lines 1 thru 6) .............................................................................
Total Actual Liabilities ....................................................................................................
Net Value of Estate (Subtract line 8 from line 7) ................................................................
If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II.
TAX YEAR: 19
TAX YEAR: 19
+ (3f)
TAX YEAR: 19
Income:
a. Spouse ......................
b. Decedent ...................
c. Joint ..........................
d. Tax Exempt Income .....
e. Other Income not
listed above ...........
f. Total ..........................
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(lf) + (2f)
(+ 3)
4b. Average Joint Exemption Income .....................................................................................
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
Insert amount of taxable transfers to spouse or S 100,000, whichever is less ..........................
2. Multiply by credit percentage (see instructions) ..................................................................
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 1 8 of the cover sheet .............................................
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate ..................................................................................................
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonres dent Spousa
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet.
REV-I,5~ + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1. Name of Corporation
Address
C~ty
2. Federal Employer I.D. Number
3. Type of Business
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
State Zip Code
ProductJService
FILE NUMBER
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common /~/~./~,~_.. $
Preferred /,,,~,, .n,, ~:~ $
Provide all dghts and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? [] Yes [] No
If yes, Position Annual Salary $
6. Was the Corporation indebted to the decedent? [] Yes [] No
If yes, previde amount of indebtedness $
Time Devoted to Business
7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827
[] Yes [] No If yes, [] Transfer [] Sale Number of Shares
Trensferee or Pumhaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a wdtten shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement.
10. Was the decedenrs stock sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federel Corporete Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appreisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
REV-1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
FILE NUMBER
B.
C.
D.
1. Name of Partnership Date Business Commenced
Address Business Reporting Year
City State__ Zip Code
2. Federal Employer I.D. Number
3. Type of Business Product/Service
4. Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $
5.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. [] Yes E]"l~'o
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... [] Yes [~"No
If yes, Cash Surrender Value $. Net proceeds payable $
Owner of the policy
Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
Percentage transferred/sold
Consideration $
[] Yes ES'No If yes, [] Transfer [] Sale
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... [] Yes
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? ....................................... [] Yes
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................... [] Yes
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners?
If yes, explain
Date
la'No
I;a'lqo
I~No
.................................... [] Yes g'lqo
14. Did the partnership have an interest in other corporations or partnerships? .............. [] Yes Et"N~
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
Savings Account Statement
PNC Bank
For the period 0710112004 to 09~30~2004
MARY M SCHOLZ OR
HENRY J SCHOLZ
227 12TH ST
NEW CUMBERLAND PA 17070-1608
Savings Account Summary
Account number: 50-8053-0791
Balance Summary
Beginning
balance
830.21
Deposits and
other additions
.18
Checks and other
deductions
500.00
Ending
balance
330.39
Interest Summary
Annual Percentage
Yield Eamed (APYE)
0.20%
Number of days
in interest pedod
92
Average collected
balance for APYE
357.45
Interest Earned
this pedod
.18
Deposits and Other Additions
Date Amount Description
07/31 .07 Interest Payment
08/31 .06 Interest Payment
09/30 .05 Interest Payment
Other Deductions
Date Amount Description
07/06 500.00 Withdrawal
Tel 0400010102 0144
Primary account number: 50-8053-0791
Page 1 of 1
Number of enclosures: 0
r~_ For 24-hour banking, customer service and
~ transaction or interest rate information,
~ sign-on to Account Link ® by Web on
pncbank.com or call 1-888-PNC-BANK
Para servicJo en espanol, 1-866~HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
~ Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
,[~_ Visit us at pncbank.com
---~ TDD terminal: 1-800-531-1648
For headng impaired clients only
Mary M Scholz Or
Henry J Scholz
As of 09/30, a total of $1.13 in interest was
earned this year.
There were 3 Deposits and Other Additions
totaling $.18.
There was I Other Deduction totaling
$SO0.00
Daily Balance Detail
Date Balance
07/01 830.21
07/06 330,21
Date
07/31
08/31
Balance
330.28
33O.34
Date Balance
09/30 330.39
REV-1508 EX + (1-97} ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX* (1-97) ,~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on Rev-'1500 Cover Sheet)
ESTATE OF FILE NUMBER
This schedule is t-o be used for all single ~ife~-Jo nt ~'r.success ve life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax retum.
[] Will [] Intervivos Deed of Trust [] Other
NAME(S) OF ................................ N'EARE~'D' AGE AT" TERM OF YEARS LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
/~ ~,, ~., [] Life or [] Term of Years ~
[] Life or [] Term of Years ~
[] Life or [] Term of Years __
[] Life or [] Term of Years __
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - [] 3 1/2% [] 6%
3. Value of life estate (Line 1 multiplied by Line 2)
[] 10% [] Variable Rate %
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
,4.-" ~.' ,-,~ ~ [] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Monthly (12)
[] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other( )
3. Amount of payout per pedod
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate [--131/2% [--]6% r-'110% [] Vadable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if vadable rate and pedod payout is at end of pedod,
calculation is: Line 4 x Line 5 x Line 6
If using vadable rate and pedod payout is at beginning of pedod, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX+ (3-84)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE "L"
REMAINDER PREPAYMENT OR INVASION
OF TRUST PRINCIPAL
FILE NUMBER
II.
III.
Estate of ...~ ~_ ?/_.~./3 ,,~_ ,~ ~ ~., ~.
(Last Name) (First Name) ~Midarle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions
of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
Remainder Prepayment:
A. Election to prepay filed with the Register of Wills on
(attach copy of election)
B. Name(s) of Life Tenant(s) Date of Birth
or Annuitant(s)
(Date)
Age on date
of election
Term of years income
or annuity is payable
Co
Assets: Complete Schedule L-1
1. Real Estate $
2. Stocks and Bonds $
3. Closely Held Stock/Partnership $
4. Mortgages and Notes $
5. Cash/Misc. Personal Property $
6. Total from Schedule L-1
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities S
2. Unpaid Bequests S
3. Value of Unincludable Assets S
4. Total from Schedule L-2
E. Total value of trust assets (Line Co6 minus Line D-4)
F. Remainder factor (see Table I or Table II in Instruction Booklet)
G. Taxable Remainder value (Line E x Line F)
(Also enter on Line 7, Recapitulation)
Invasion of Corpus:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth
or Annuitant(s)
Age on date
corpus consumed
Term of years income
or annuity is payable
C. Corpus consumed
D. Remainder factor (see Table I or Table II in Instruction Booklet)
E. Taxable value of corpus consumed (Line C x Line D)
(Also enter on Line 7, Recapitulation)
S
REV-1646 EX+ (3-84)
,~ INHERITANCE TAX
SCHEDULE L-2
COMMONWEALTH OF ,ENNSYLVAN~A REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -CREDITS- FILE NUMBER
(Last Name) (First Nature) (Middle Initial)
II. Item No. Description Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L-1 (please list)
Total unpaid liabilities S
(include on Section II, Line D-1 on Schedule L)
B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests S
(include on Section II, Line D-2 on Schedule L) -
C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, Line D-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) S
(If more space is needed, attach additional 8Y2 x 11 sheets.)
REV-1647 EX + (1-97}
SCHEDULE M
COMMONWEALTH OF PENNSYLVANIA FUTU RE INTEREST COM PROMISE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
This schedule is appropriate only for estates of decedents'in,dy' g after December t2, 1982.
This schedule is to be used for all futura interasts whera the rate of tax which will be applicable when the futura interest vests in possession
and enjoyment cannot be established with certainty.
Indicate below the type of instrument which craated the future interest and attach a copy to the tax raturn.
[] Will [] Trust [] Other
Beneficiaries
II1.
IV.
NAME OF
BENEFICIARY
RELATIONSHIP
DATE OF BIRTH
AGE TO
NEAREST BIRTHDAY
For decedents dying on or after July 1, 1994, if a surviving spouse exemised or intends to exercise a dght of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right.
[] Unlimited right of withdrawal [] Limited right of withdrawal
Explanation of Compromise Offer:
Summary of Compromise Offer:
1. Amount of Futura Interast
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One [--16%, ['-13%, [] 0%
(also include as part of total shown on Line 15 of Cover Sheet) $
4. Value of Line 1 Taxable at 6% Rate
(also include as part of total shown on Line 16 of Cover Sheet) $
5. Value of Line 1 Taxable at 15% Rate
(also include as part of total shown on Line 17 of Cover Sheet) $
6. Total value of Futura Interast (sum of Lines 2 thru 5 must equal Line1)
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX * (1-97) ~
COMM~)NWE~LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
/
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 3, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1502 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
All real property owned sol~l~ ~; a-~ ~ tenant in rted at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1505 EX* (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
.-5~-.,(c, Z z_ /-~.? _.-, ~-z--_ ./a/-
All property jointly-owned with right of survivorship must be diSClosed on Schedule F.
FILE NUMBER
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX+ (1-97)
coMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
All property jointly-owned wffh right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
FILE NUMBER
DESCRIPTION
TOTAL (Also enter on line 4, Recapitulation)
VALUE AT DATE
Of DEATH
(If more space is needed, insert additional sheets of the same size)
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
/
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 yes,
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST {~FAPPLICADLE)
1. ,,//,~.,~ ~.~
TOTAL (Also enter on line 7, Recapitulation) $ '~ - -
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
FILE NUMBER
SCHEDULE F
JOINTLY-OWNED PROPERTY
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. ~/~'/.~ x'~
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 jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. A.
TOTAL (Also enter on line 6, Recapitulation)$
(If more space is needed, insert additional sheets of the same size)
2t Family
PARTHEMORE Funeral Hqlll
Mr. Henry J. Scholz
227 Twelfth Street
New Cumberland, PA 1
Tradition Of Caring
Cremation Services, Inc.
12/10/2003
1303 Bridge Street
P.O. Box 431
New Cumberland, PA 17070
(717) 774-7721
(Fax) 774-5546
www. parthemore.com
Gilbert W. Parthemore,
Founder
Gilbert J. Parthemore,
Supervisor
Stephen K. Parthemore,
CFSP
Bruce R. Parthemore,
Pre-Need Coordinator, CPC
Professional Memberships:
NFDA · PFDA
DCFDA · CCFDA
The Rule You Knom
The People You TFltx!
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way
we can. Please feel free to contact us if you have any questions in regard to this statement. The following
is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected
when making the funeral arrangements.
Terms I Due Date Account #
Net30 [1/9/2004 2003102.0
Description Amount
Traditional Funeral Service 4,795.00
Solid Oak with Cross Comers Casket 2,450.00
Crucifix, Inside 13.00
Total Services and Merchandise 7,258.00
Death Notice, Harrisburg Patriot 162.80
Certified Copies of Death Certificates 24.00
Hairdresser 35.00
Clergy Honorarium 200.00
Organist Honorarium 100.00
Soloist Honorarium 75.00
Altar Servers 15.00
Flowers, Casket Spray 140.00
Total Cash Advances 751.80
Immediate Pay Discount - Thank you! -145.96
Total $7,863.84
Payments/Credits $-7,863.84
Balance Due $0.00
REV-1511 EX+ (t2-99)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State__Zip
Year(s) Commission Paid:
Attorney Fees
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
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)~2~
COI~IMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I
1.
II
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
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 $ - ~ "---"'
(If more space is needed, insert additional sheets of the same size)
RE%'-1512 EX * (1-97) , ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
//
Include unreimbursed medical expenses.
FILE NUMBER
ITEM
NUMBER
DESCRIPTION
/¢/ d A-/ (~,
AMOUNT
TOTAL (Also enter on line 10, Recapitulation) $ .~ CC -~
(If more space is needed, insert additional sheets of the same size)
REV-1649 EX + (1-97) _~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE O
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Do not complete this schedule unless the esta{e i's mal~ing the'election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule O, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or pementage) to be included in the election to have such trust or
similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the
personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to
the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION
VALUE
Part A Total $ - c~ '-
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
Part B Total
(If more space is needed, insert additional sheets of the same size
----Or
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
SCHOLZ HENRY J
227 12TH STREET
NEW CUMBERLAND, PA 17070
RE: Estate of SCHOLZ MARY M
File Number: 2004-00372
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/09/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~d!
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
v~