HomeMy WebLinkAbout02-0437
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of~~o...r\ ~. \.-~s.~ No. 3/-&)-2,-1/3.7
also known as To:
Register of Wills for th~ \\ .
, Dlfeased. County of <...\....- \:'... r- '\ c.. '" ~ m the
Social Security No. ,""\ 'L -0 , - () L. 'rI Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of aRe or older an the execut <'" 'I-
in the last will of the abqw; d..e~dent, dated H:.........~. 1.. '\ \,Ci, ~'"L.
and codicil(s) dated ~ L ~ \
named
,19_
(state relevant circumstances, e.g. renunciation, death~f executor, etc.)
Decendent was domiciled at death in C~ "'-::......r\ tr.. - ounty, Pennsylvania, with
h elJ last family or .princiIlal res\tte~at \. ~ r .....
~b_~ c:......J..._..b' ~ ,~,~'"- _\:.
(list street, number a
~ ~;.S.
Decendent, then '\'\ ye.,ars of age, died , 13 , C ~
at ~ \:S:"" n- ~V_c.. ~ ~'-\- .. .....,..... C.:.... --\, . 0 "(('
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
\.:::)
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania '. -, W
situated as follows: '^ ~ ~ -cu
$
$
$
$
S GJ c;:....",. ~
1 D
6
o
50 <::0 '" ~
I
l!\.u
WHEREFORE, petitioner(s) respectfullY. r.equ!\"t(s) the pro te of the last will and codicil(s)
presented herewith and the grant of letters ~~ '-""-" <.... ("
(testamentary; administrati C.t a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWE~TH O~~~ANIA j' ss
COUNTY OF v.............. "-
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 admi
ister the estate according to law.
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~o. 21-2002-437
Estate ~f ':<~o._.\ \ ~.. \--0 ~ ~
, Deceased
DECREE OF PROBATE A~D GRANT OF LETTERS
AND NOW May 1st ~ 2002, 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 Auqust 29th 1992
described. therein be admitted to probate and filed of record as the last will 0 f < ~ c.... r \ ~
\- l! !.. ~
and Letters ~L.s.~ .~r~
are hereby granted to ~ ............ ~ ........ ........
Ol..~)r \
FEES
Probate, Letters, Etc. ......... $ 80.00
Short Certificates( 4) . . . . . . . . .. $ 12,00
Renunciation ................ $
x-Paaes 2 $ 6.00
JCP . TOTAL _ $ 5.00
Filed . .t:1a,y. .1$:1:.,.2002. . . . ... .$103...00. . .
AITORNEY (Sup. Ct. 1.0. No.)
'";3"\'-\l ~~-'Y;D ~ .
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PHONE
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MAILED LETrERS TO ATI'ORNEY ON 5/2/02
21-2002-437
'REGISTER OF WILLS OFCv..--\>\.AJ COUNTY
OATH OF SUBSCRIBING WITNESS
3C1 J'- '- ~ . ~ ~ ~ ~ \c ~ -< \.. ':)- Q.... C. \<,~&<.:':.
codicil
(each) a subscribing witness to the ~ill presented herewith, (each) being duly qualified according to
law, d~ose(s) anQ say(s) that ~'" "'.......... ~ c.. r present and saw
.~<:.... ....... r" 'v-/"'I. \.....,(:) ~ '" ~
,
the testat ~ __'-4-. , sign the same and that
request of testat~ in h ~ ~ presence and (in the p
other subscribing witness(es)).
['.,-,
.....
I
signed as a witness at the
ence of each other) (in the presence of the
fli/7/09
3 r& /.. e
~~:n
(Address)
k.$/1.3/5
~GIsrtR OF WILLS OF COUNTY
P .OATH OF NON-SUBSCRIBING WITNESS
-' .......
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
testat_ of (one of the subscribing witnesses to) the
presented herewith and
codicil
believes the signature on the will is in the handwriting of
that
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
Register
(Name)
(Address)
(Name)
(Address)
LAST WILL AND TESTAMENT OF PEARL M. LaSH
21-2002-437
I, PEARL M. LaSH, of New Cumberland, Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make and publish this my
Last Will and Testament, hereby revoking and making void all former Wills by
me at any time heretofore made.
ITEM 1. I direct that my funeral be conducted as outlined in
the attached codicil and that all of my just debts and funeral expenses be
fully paid and satisfied as soon as conveniently may be after my decease. I
further direct that my burial be in Rolling Green Cemetary.
ITEM 11. I give and bequeath all of my personal property including
furniture, clothing, dishes, glassware and all household items to my daughter,
Bette J. Clemens.
ITEM III. I give and bequeath any and all stocks, bonds, cash to
my daughter Bette J. Clemens.
ITEM IV. I give, devise and bequeath my real estate, commonly known
as 415 Sixth Street, New Cumberland, Cumberland County, Pennsylvania to my
daughter, Bette J. Clemens, providing she survives me. In the event that
she predeceases me, I give, devise and bequeath that said real estate to my
two brothers, Roger Daneker, White Haven, Pennsylvania and John Daneker of
Daytona Beach, Florida.
ITEM V. In the event my daughter predeceases me I give, devise and
bequeath stocks, bonds, cash, all household items to my brothers, Roger and
John. All household items will be sold and the money divided equally between
my two brothers.
PAGE One i:of Three pages
ITEM VI. I hereby empower my Executrix hereinafter named, to sell
any and all of my real estate at private or public sale and without Order of
Court at such time as she feels it to be for the best advantage of my estate
and I hereby authorize and empower her to give sufficient deed to the purchaser
or purchasers thereof as fully as I could do if living.
ITEM VII. I empower my Executrix, hereinafter named to dispurse
my estate in cash or in kind as she, in her own discretion sees fit.
ITEM VIII. I nominate, constitute and appoint Bette J. Clemens
to be and act as Executrix of this my last Will and Testament. In the event
that she cannot serve as Executrix for any reason, I then nominate, constitute
and appoint William T. Smith, 3747 Derry Street, Harrisburg, Dauphin County, Pa.,
to be and act as Executor of this my last Will and Testament.
x
X
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X
X
X
X
X
X
X
X
X
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X
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Page Two of Three Pages
o~
v~~
)
.... '.
day of
set my hand and seal
this
IN WITNESS WHEREOF,
~C;ti
, 1992. A.
The preceding instrument consisting of this and two other type-
written pages, each identified by the signature of the testatrix, was on
the date thereof signed, published and declared by Pearl M. Lash, the
testatrix therein named, as and for her last Will, in the presence of us,
who at her request, in her presence, and in the presence of each other
have subscribed our names as witnesses hereto.
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PAGE Three of Three Pages
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CLEMENS BETTE J
315 MARKET STREET
NEW CUMBERLAND, PA 17070
-------- fold
ESTATE INFORMATION: SSN: 172-01-0281
FILE NUMBER: 2102-0437
DECEDENT NAME: LOSH PEARL M
DATE OF PAYMENT: 05/16/2002
POSTMARK DATE: 05/15/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 02/16/2002
NO. CD 001185
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,800.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: BETTE CLEMENS
CHECK# 4752
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$1,800.00
MARY C. LEWIS
REGISTER OF WILLS
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: "Pearl N. LDSH
J - lit; - o;;}..
CQY31- ~d-
Date of Death:
Will No.
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6~e Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on t1.Af I! dO 0 .:l- :
Name
Address
~+k:. .5 . C l flVten S
3J~ fv1aru+S+., AiM OU(VlI:e~lattd(
.
Pit /707D
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
)J JA
.
Date:
<X I,f/DL
I ,
LJtJJJd1tvL 0' ~ /dMC-
S. I
19nature
Name
\'Villiam T. Smith
'J.747 Derrx St.
Ha.lrisburg, P 17111
Address
Telephone ()I,) 56 (- ~~ 17
Capacity: --+-=- Personal Representative
Y Counsel for personal representative
Postage
,--9
r"'l Certified Fee
I-'1 Return Reciept Fee
(Endorsement Required)
Restricted Delivery Fee
r--~ (Endorsement Required)
Total Postage & Fees
Postmark
Here
IT1
O.Ae~t
r'l Add, eeeee
Die of Oellvew
ONo
1'9 Insured M~ O C.O.D.
7003 1010 0001 1203 7703
JRD/June 30, 1992/17858
1 5 2004
In Re: Estate of Pearl M. Losh
Late of New Cumberland Borough
Estate No.: 21-2002-0437
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2002-0437
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative:
Counsel for Personal Representative: William T. Smith, Esquire
Date of Decedent's Death: 02-16-2002
Date of Delinquency Notice: 01-30-2004
The undersigned, Glenda Farner-Strasbaugh, Register of Wills, in accordance with Rule
6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court
of Common Pleas of Cumberland County, that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, was given by the Register of Wills on 01-30, 2004, and that the ten (10)
day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the
Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date: 03-11-2004
G enda Farner Strasbaugh, Register q:~vVills
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled at
in Courtroom No. 3. If the Status Report is filed
prior to the hearing date, the hearing will automatically be canceled.
WILLIAM T. SMITH
ATTORNEY AT LAW
3747 Derry Street
Harrisburg, PA 17111
(717) 561-2677
FAX (717) 561-2682
March 23, 2004
Glenda Famer Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Estate of Pearl M. Losh
No. 21-2002-0437
Dear Ms. Strasbaugh:
Sorry for the delay in the filing of the Stares Report under Rule 6.12. Please find enclosed
the Status Report in this Estate under Rule 6.12.
The inheritance tax was paid and the money in this estate was distributed to Bette
Clemens, the only daughter of the decedent, per Ms. Losh's Will.
Please contact me should you have any questions.
Sincerely,
William T. Smith
STATUS REPORT UNDER RULE 6.12
Date of Death:
Will No.:
Admin. No.:
'Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State w~.~he~_,,~tm~n~stration of the estate is complete:
Yes ~ No [-]
2. If the answer is No, state when the personal representative reasonably believes
that the adm{n~stration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal r~,~p,pres?~mtive file a final account with the Court?
Yes _ No ~
b. The separate O~phans' Court No. (if any) for the personal representative's
accountis: 1,~ l~
c. Did the personal r__epr~.~.tiv, e state an account informally to the pm'ties
in interest? Yes ~ No'
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orphans' Court
and may be attached to '
Signature
Name
Address
Telep"hone No.
Capacity:
Personal Representative
~sel for personal representative
REV-1500 EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I-.
Z
iii
W
LLI
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'SNAME(LAST, FIRST, ANDMIDDLEINITIAL)
Losh, Pearl M.
D~E OF DE~H (MM-DD-YEAR) D~E OF BIRTH (MM-DD-YEAR)
02-16-02 10-30-1.~04
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
OFFICIAL USE ONLY
FILE NUMBER
0437
21 - 02
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
172 - O1 - O437
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X]l. Original Return
[~4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
NAME William T. Smith, Esquire
FIRM NAME (If Applicable)
i.~w Ofifice.~ nF
IELEPHONE NUMBER
Willimm T. gmitH
-'-]2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82)
[] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required
]7. Decedent Maintained a Living Trust (Attach copy of Trust) __ 8. Total Number of Safe Deposit Boxes
[] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
3747 Derrv Street
Harrisburg, PA 17111
1. Real Estate (Schedule A) (1) 0 · OD
2. Stocks and Bonds (Schedule B) (2) 0. OD
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) O · OD
4. Mortgages & Notes Receivable (Schedule D) (4) O. O0
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 50,638.86
(Schedule E) O. O0
6. Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
O.OO
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,619.14
lO. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) O · OD
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)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
OFFICIAL USE ONLY
50,638.86
14,619.14
36,019.72
0.00
36,019.72
18.
19.
20.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax O. OD
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15)
36 ,O19.72
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate O · OD x .12 (17)
O. OD
Amount of Line 14 taxable at collateral rate x .15 (18)
Tax Due
0.00
1,620.00
0.00
0.00
(19)
1,620.00
Decedent's Complete Address:
STREET ADDRESS
315 Market Street
CIIY
New Cumberland
STATE PA
ZIP 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
1~800.00
81.04
Total Credits ( A + B + C ) (2)
0.00
0.00
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 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.
(1) 1,620.00
A. Enter the interest on the tax due.
(5)
(5A)
1,881.04
0.00
261.04
0.00
0.00
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
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 security 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 penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF..PE-'~SON RESPPCJSlBLI~ FOR FILING RETURN DATE
ADDRESS ~ ?..._ / _ r
SIGNATU~ OF P~P~O~ER-~~ENT~TIVE[ ~ ' '
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-1502 EX+ -
(6 98~,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Pearl M. Losh
All real property owned solely or as a tenant in common must be reported 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 retevant 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. None
TOTAL (Also enter on line 1, Recapitulation) $ O. O0
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER Pearl M. Losh
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. None.
TOTAL (Also enter on line 2, Recapitulation) $ 0. OO
(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 FILE NUMBER
Pearl M. Losh
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. None
TOTAL (Also enter on line 4, Recapitulation) $ 0. OO
(If more space is needed, insert additional sheets of the same size)
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
Pearl M. Losh
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
NUMBER
3
DESCRIPTION
Cash
PNC Bank, Pgh, PA
Checking Account 51-4003-8871
Savings Account 50-0088-1584
Hilliard Lyons, Louisville, KY
1,695.74
126.14
48,816.98
VALUE AT DATE
OF DEATH
O. 0O
TOTAL (Also enter on line 5, Recapitulation) $ 50,638.86
(If more space is needed, insert additional sheets of the same size)
EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Pearl M, Losh
If an asset was made joint within one year of the decedent's date of death, R must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. None.
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 identifTing number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES'
1. A.
0,00
TOTAL (Also enter on line 6, Recapitulation) $
(If mom space is needed, insert additional sheets of the same size)
'1:t~V-1510 EX + (1-~7) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Pearl M. Losh
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/es.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDETHE NAMEOFTHETRANSFEREE. THEIRRELATIONSHIPTO DECEDENTANDTHE OATE OFTRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST CF A~PUC^BLE)
1. None
TOTAL (Also enter on line 7, Recapitulation) $ O. O0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) ~,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Pearl M. Losh
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
5.
6.
7.
FUNERAL EXPENSES:
Stone & Murray Funeral Home
Rolling Green Cemetary
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
None.
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 William T. Smith, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Bette Clemens
Street Address 315 Market Street
City New Cumberland
Relationship of Claimant to Decedent
Probate Fees
~at~io~ N~w~
umoerlanQ ~o Reporter
Accountant's Fees
Tax Return Preparer's Fees
Daughter
State PA Zip 17070
TOTAL (Also enter on line 9, Recapitulation) $
6,085.00
2,275.00
2,500.00
3,500.00
103.00
31.14
25.00
14,619.14
(If more space is needed, insert additional sheets of the same size)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280401
HARRISBURG, PA 17128-0601
WILLIAM T SMITH ESQ
WILLIAM T SMITH LAW OF
5747 DERRY ST
HBG PA 17111
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE 06-21-2004
ESTATE OF LOSH
DATE OF DEATH 02-16-2002
FILE NUMBER 21 02-0437
COUNTY CUMBERLAND
ACN 101
Amount Remi:t ted
REV-tS47 EX AFP (01-05)
PEARL M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~" RETAIN LOWER PORTION FOR YOUR RECORDS -~
REV-1547 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEME~--~[[~-~-~'~' .................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LOSH PEARL M FILE NO. 21 02-0437 ACN 101 DATE 06-21-2004
TAX RETURN NAS: (X) ACCEPTED AS FILED C > CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSF
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I. Rea/ Estate (Schedule A>
2. Stocks and Bonds CSchedule B} (2}
$. Closely Held Stock/Partnership Interest (Schedule C) ($3
4. Mortgages/Notes Receivable CSchedule D}
5. Cash/Bank Deposits/Misc. Personal Property CSchedule
6. Jointly Owned Property (Schedule F)
7. Transfers CSchedule G}
8. Total Assets
APPROVED DEDUCTIONS AND EXENPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H} C9)
10. Debts/Mortgage Liabilities/Liens CSchedule I> (10)
11. Total Deductions
12. Net Value of Tax Return
.00
· 0O
.0e
50 r 638.86
.00
· 00
14,619.14
NOTE: To insure proper
credit to your account,
submlt the upper port/on
of this form ~ith your
tax payment.
50,638.86
Char/table/Governmental Bequests; Non-elected 9115 Trusts CSchedule J>
Net Value of Estate SubSect to Tax
.0U
(I2> ~&,019.72
(Is> .00
el4} 36,019.72
NOTE:
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wlll
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
1~. Amount of Line 14 at Spousal rate
l&. Amount of L/ne 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate C17)
18. Amount of L/ne 14 taxable at Collateral/Class B rate C18>
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+>
DATE NUMBER INTEREST/PEN PAID C->
05-15-2002 CD001185 81.00
. O0 x O0 = . O0
36,019.72 x 045 = 1,620.00
~ x 12 oo
,0o x l~_:-J= .00
(1c~> = 1,620. O0
AMOUNT PAID
1,800.00
TOTAL TAX CREDIT J
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
1,881.00 J
261.00CR
.00
2&I.OOCR
C IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR>, YOU MAY BE DUE~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT, 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVAN'rA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-i&O? EX AFP E01-05)
WILLIAM T SMITH ESQ
WILLIAM T SMITH LAW OF
$7q7 DERRY ST
HBG PA 17111
DATE 08-02-Z004
ESTATE OF LOSH
DATE OF DEATH 02-16-2002
F'rLE NUMBER 21 02-0457
COUNTY CUMBERLAND
ACN 10 Z
I Amoun~ Remi~ed
PEARL M
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper cred/~ ~o your account, submi~ ~he upper por~Lon of ~:his for..i~:h your ~ax payment.
CUT ALONG TH'rS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS ~
ESTATE OF LOSH PEARL M F'rLE NO. 21 02-0437 ACN 101 DATE 08-02-2004
TH/S STATEHENT 1S PROV/DED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELO#
'rs A SUMMARY OF THE PR/NC/PAL TAX DUE, APPL.rCATTON OF ALL PAYHENTS, THE CURRENT BALANCE., AND, IF APPL/CABLE,
A PROJECTED .rNTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-21-Z004
PR/NC/PAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
1,620.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-15-2002
07-12-2004
CD001185
REFUND
81.00
.00
1,800.00
261.00-
TOTAL TAX CREDIT
1,620.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
'rF PA'rD AFTER TH'rS DATE, SEE REVERSE
S'rDE FOR CALCULATION OF ADD'rT'rONAL 'rNTEREST.
( 'rF TOTAL DUE 'rS LESS THAN
NO PAYMENT 'rS REQU'rRED.
IF TOTAL DUE 'rS REFLECTED AS A 'CREDIT' (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH.rS FORH FOR INSTRUCTIONS. )