HomeMy WebLinkAbout03-0997REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Estate of ANNA R. WOLGEMUTH
also known as
MARY KUHNS AND MILDRED GORETZKE
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
, Deceased
Social Security No. 173-32-0820
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut RIXES named in the Last Will of the
r~ Decedent, dated 5/20/97 and codicil(s) dated
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante rninodtate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal
residence at 117 SHELTERED CARE, MESSIAH VILLAGE, UPPER ALLEN TWP., MECHANICSBURG, PA (list stree;., number and municipality)
Decedent, then 100 years of age, died OCTOBER 9 ,2003 , at MESSIAH VILLAGE, MECHANICSBURG, PA
Decedent at death owned property with estimated values as follows: (Location)
(if domiciled in PA) All personal property ......................................... $ .~ o ~, · ,,~
(if not domiciled in PA) Personal property in Pennsylvania .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $ .,~: o o~. ~
Real Estate 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:
J Typed or printed name and residence
Signature
RW-7
X' ~Y) ~..J~' ~ ~"--~.' MARY KUHNS
736 OAK OVAL~ M.V., MECHANICSBURG, PA 17055
MILDRED GORETZKE
2112 BAINBRIDGE ROAD~ ELIZABETHTOWN~ PA 170~3~ z-.
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and afffirm(s) that the statements in theif'oi:egoing..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 and affirmed and subscribed MARY'KUHI~ ' ' ' :
before me this 2ND dayof
. //24,r~. ILDRED GORETZKE ~ - '
DECREE OF REGISTER
Estate of ANNA R. WOLGEMUTH
also known as
Deceased
No.
Social Security No: 173-32-0820 Date of Death:
AND NOW, A/~'-~'~- ""~/~"-r ,) ~J , ~ , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters [~"1 e'~estamentary I~1 of Administration
(c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate)
are hereby granted to ~'~_RR~ ~,'{[ ~ ~, ~,, ¢J~<~ ~ ,J~y-~ ,.(
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of recor~as~e last Will of Decedent.
FEES
Letters .................................... $
Short Certificate(s) ............... $
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages ( ) ..............$
Codicil ................................. $
JCP Fee ................................. $
Inventory & Tax Forms ............. $
Other ...................................... $
TOTAL ............................. $
RW-7A
Register of Wills
Attorney: GERALD J. BRINSER
I.D. No: 09655
Address: 6 E. MAIN STREET, P.O. BOX 323
PALMYRA PA 17078
Telephone: (717)838-6348
DATE FILED:
WILL
OF
ANNA R. WOLGEMUTH
I, ANNA R. WOLGEMUTH, currently of Upper Allen Township, Cumberland
County, Pennsylvania, realizing the uncertainty of this life, but with com~dence in God and
trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and
rose again to redeem me and give me eternal life, do hereby make, publish and declare this
to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils
made by me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath my dresser unto my niece, Marian Musser. If she predeceases me, this
bequest shall lapse and pass as part of my residuary estate below.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I devise and bequeath
unto Messiah Village, Mechanicsburg, Pennsylvania, to be placed in its Endowment Fund.
V. I appoint my sister, Mary Kuhns, and my niece, Mildred Goretzke, Executrixes, or
the survivor of them as sole Executrix, of this my Will.
VI. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, ANNA R. WOLGEMUTH, herewith set my hand to this
my Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures ofwimesses, this 20th day of May, 1997.
(SEAL)
ANNA R. WOLGEMUTH
Signed by ANNA R. WOLGEMUTH, by her declared to be her Will in our presence,
who have hereunto subscribed our names as wimesses in her presence and at her request, this
20th day_of May, 1997.
///~_ ~?x~_/~/~~.~ residing at
residing at
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
WE, ANNA R. WOLGEMUTH, GERALD J. BRINSER and
, the testatrix and the wimesses, respectively, whose names are signed to the
attached or foregoing instrument, being first duly affmned, do hereby declare to the
undersigned authority that the testatrix signed and executed the instrument as her Will and
that she signed willingly (or willingly directed another to sign for her), and that she executed
it as her free and voluntal3, act for the purposes therein expressed, and that each of the
wimesses, in the presence and hearing of the testatrix, signed the Will as wimesses and that
to the best of our knowledge the testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
ANNA R. WOLGEMUTH
ITNESS ~
WITNESS
Subscribed, sworn or affirmed and acknowledged before me
WOLGEMUTH, the testatrix, GERALD J. BRINSER and
wimesses, this 20th day of May, 1997.
by ANNA R.
(SEAL)
No'tm:y Pt~filic ~
f','f;:'~,' L. ~t3.~;k~\;. i",:ot~:r¥ Public
er ,.'~lt~q '?,~<',3., Curi'~bed~r)d County
omm'issio¢~ E~'pires Jan. !3. 1998
-3-
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ANNA R. WOLGEMUTH
Date of Death: 10/9/03
Will No. 2003-00997
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 2/3/04
Name
Address
MESSIAH VILLAGE
P.O. BOX 2015
MECHANICSBURG PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: 2/3/04
Signature
Name: GERALD J. BRINSER, ESQUIRE
Address: 6 E. MAIN STREET, P.O. BOX 323
PALMYRA PA 17078
Capacity:
Telephone(717) 838- 6348
Personal Representative
X Counsel for Personal
Representative
R~:V-1500 EX + (6-00)
Z
ILl
Z
uJ
C~
Z
0
o.
uJ
0
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAl.
WOLGEMUTH~ ANNA R.
DATE OF DEATH (MM-DD-Year)
10~09~2003
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-Year)
11/13/1902
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 3 0 9 9
COUNTY CODE YEAR NUMBER
SOClALSECURITYNUMBER
1 7 3-3 2-0 8 2 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIALSECURITYNUMBER
~-'~1. Original Return [] 2. Supplemental Retum
E~ 4. Limited Estate [--'] 4a. Future Interest Compromise (date of~eath after 12-12-82)
[~] 6. Decedent Died Testate (Attach copy of Will) E~ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~] 9. Litigatlon Proceeds Received [] 10. SpousalPovertyCredit(dateofdea~betwee, 12-31-91and f.1_95)
SIS SECTION MUST BE COMPL~i~D; ~L CORRESPONDENCE ~ )CONFir,~NTiAL TAX !NFC~..'--'~TION SH~LD BE DIReCTeD TO'
NAME
COMPLETE MAILING ADDRESS
r--] 3. Remainder Return (date of death pdor to 12-13-82)
n~5. Federal Estate Tax Retum Required
~ 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (^~-ch Sch O)
GERALD J. BRINSER~ ESQUIRE
FIRM NAME (If Applicable)
BRINSER~ WAGNER & ZIMMERMAN
TELEPHONE NUMBER
(717)838-6348
6 E. MAIN STREET
P.O. BOX 323
PALMYRA
PA 17078
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Pemonal Properbj (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
r--] Separate Billing Requested
7. Inter-Vivos Transfem & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9, Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12, Net Value of Estate (Line 8 minus Line 11)
13. Charitable and 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(8)
1,172.38
(11)
(12)
(13)
(14)
2,399.16
1,172.38
1,226.78
1,226.78
0.00
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
0.00 x __ (15)
0.00 x __ (16)
0.00 x .12 (17)
0.00 x .15 (18)
(19)
"' SI ' SI lad S ,,a S~ ', ! a
> > E SURE TO ANSER < ~
Decedent's Complete Address:
STREET ADDRESS
117 SHELTERED CARE
CITY
MESSIAH VILLAGE
MECHANICSBURG
ISTATE PA
ziP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C ) (2)
Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B)
Make Check Payable to: t EGISTEi OF WILLS, AGENT
0.00
0.00
0.00
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 secudty at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I dec are that I have examined this return, ecluding 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 wh ch preparer has any knowledge.
DATE
PA 17055
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS 736 OA~OVAL, MESSIAH VILLAGE
MECHAI~ICSBURG
SIGNATURE Of PRIER OTHER THAN/~,,~SENTATIVE
ADDRESS 6 E. MAIN ST~F:~, P.O. BOX 323
PALMYRA
DATE
PA 17078
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-1508 EX + (1-97)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAX RETURN
RESIDENTDECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
WOLGEMUTH. ANNA R. 2:1 03 0997
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
1.
DESCRIPTION
MESSIAH VILLAGE - PERSONAL ACCOUNT
CASH ON HAND
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
2,371.06
28.10
(If more space is needed, insert additional sheets of the same size) 2,399.16
REV*1511EX * (1-97) j~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
WOLGEMUTH. ANNA R.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2.
21
03
0997
DESCRIPTION
FUNERAL EXPENSES:
COCKLIN FUNERAL HOME
HONORARIUMS
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees BRINSER, WAGNER & ZIMMERMAN
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS
Accountant's Fees
Tax Return Preparer's Fees
State Zip
TOTAL (Also enter on line 9, Recapitulation) $
AMOUNT
250.38
250.00
625.00
47.00
(If more space is needed, insert additional sheets of the same size) 1,172.3~
REV-1513 EX + (g-nm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
WOLGE /1UTH, ANNA R.
NUMBER
1.
1.
II.
1.
1.
FILE NUMBER
21 03
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
Do Not List Trustee(s)
0997
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
1,226.78
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
MESSIAH VILLAGE ENDOWMENT FUND
P.O. BOX 2015
MECHANICSBURG, PA 17055
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) 1,226.70
WILL
OF
ANNA R. WOLGEMUTH
I, ANNA R. WOLGEMUTH, currently of Upper Allen Township, Cumberland
County, Pennsylvania, realizing the uncertainty of this life, but with corffidence in God and
trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and
rose again to redeem me and give me eternal life, do hereby make, publish and declare this
to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils
made by me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath my dresser unto my niece, Marian Musser. If she predeceases me, this
bequest shall lapse and pass as part of my residuary estate below.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including properly over which I hold a power of appointment, I devise and bequeath
unto Messiah Village, Mechanicsburg, Pennsylvania, to be placed in its Endowment Fund.
V. I appoint my sister, Mmy Kuhns, and my niece, Mildred Goretzke, Executrixes, or
the survivor of them as sole Executrix, of this my Will.
VI. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jm'isdiction.
IN WITNESS WHEREOF, ANNA R. WOLGEMUTH, herewith set my hand to this
my Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this 20th day of May, 1997.
.(SEAL)
ANNA R. WOLGEMUTH
Signed by ANNA R. WOLGEMUTH, by her declared to be her Will in our presence,
who have hereunto subscribed our names as witnesses in her presence and at her request, this
20th day_of May, 1997.
residing at
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
WE, ANNA R. WOLGEMUTH, GERALD J. BRINSER and 1~ 6,et: x/c~ ,~,,1 ~c~,6~/
, the testatrix and the wimesses, respectively, whose names are signed to the
attached or foregoing instrument, being first duly affmned, do hereby declare to the
undersigned authority that the testatrix signed and executed the instrument as her Will and
that she signed willingly (or willingly directed another to sign for her), and that she executed
it as her free and voluntaW act for the purposes therein expressed, and that each of the
witnesses, in the presence and heating of the testatrix, signed the Will as wimesses and that
to the best of our knowledge the testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
ANNA R. WOLGEMUTH
~k'ITNESS '~' '
WITNESS
Subscribed, sworn or affirmed and acknowledged
WOLGEMUTH, the testatrix, GERALD J. BRINSER and
wimesses, this 20th day of May, 1997.
before me by ANNA
(SEAL)
No'tar Pti lic
-3-
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. ZBOBO1
HARRISBURG, PA 17126-0601
COHNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-i~¢i7 EX AFP C01-03)
GERALD J BRINSER ESQ
BRINSER ETAL
PO BOX 525
PALMYRA
'04 APR 14
DATE Oq-12-ZOOq
ESTATE OF NOLGEMUTH
DATE OF DEATH 10-09-2005
FILE NUMBER 21 05-0997
COUNTY CUMBERLAND
ACN 101
I Amoun~ Rami~od
ANNA R
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF NOLGEMUTH ANNA R FILE NO. 21 05-0997 ACN 101 DATE 0q-12-200~
TAX RETURN HAS: (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)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Sch®dula C) (3)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits~Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Exponsos/Adm. Costs~Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilltims/L/ens (Schedule Z) (10)
11. Total Deductions
12. Net Value of Tax Return
lq.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Sub,oct to Tax
2~$99
.16
O0
O0 NOTE: To /nsura proper
O0 crod/t to your account,
O0 submit the upper port/on
O0 of this form w/th your
tax payment.
O0
1,172.38
(8) 2,399.16
.0O
(11) I, 172.38
(12) 1,226.78
(15) 1,226.78
(lq) . O0
NOTE:
If an assessment Nas issued previously,
reflect figures that include the total of ALL returns assessed to date.
lines 14, 15 and/or 16, 17, 18 and 19 ~ill
(15) .00 x O0 = .00
(16) .00 X Oq5= .00
(17) .00 X 12 = .00
(18) .00 x 15 = .00
(19)= . O0
AMOUNT PAID
ASSESSHENT OF TAX:
15. Amount of L/ne lq at Spousal rata
16. Amount of L/ne lq taxable at L/noel/Class A rate
17. Amount of L/no lq at S/bl/ng rata
18. Amoun~ of L/no lq taxable at Collateral/Class B rate
19. Pr/nc/pal Tax Due
TAX CREDITS:
PAYMENT RECEIP1 DISCOUNT
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULAT/ON OF ADDITIONAL INTEREST.
.00
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT XS REQUIRED.
XF TOTAL DUE 'rs REFLECTED AS A **CREDIT** (CR}, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCT'rOMS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any futura interest in the estate is transfarrad
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coamoneealth hereby exprassly reserves tha right to appraise and assess transfer Inheritance Taxes
at the laafut Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section Zl~O of the Inheritanca and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the revarse side.
--Make check or money order payable to: REGXSTER OF MILLS, AGENT
A rafund of a tax credit, ahich aaa not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inhsritanca and Estate Tax" (REV-1313). Applications are available at tha Offica
of tho Register of Wills, any of tha 23 Revenue District Offices, or by calling the special 2~-hour
answering service for fores ordering: 1-800-362-Z050; services for taxpayers aith special hearing and / or
speaking needs: 1-800-~q7-$020 (TT only).
Any party in interest not satisfied with the appraiseaent, allowance, or disalloaanca 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 Notica by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of fha account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dapt. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after tha dacedent's death, a five percent (52) discount of
tha tax paid is allowed.
Th~. 15X tax aanasty 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 nan-participation
penalty is appealable in the sams manner and in the tha same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from tha date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at tha rate of
six (6X) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZO0~ are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
~ ZOZ · 00050,8 1988-1991 llZ .000301
1985 162 . 000~38 1992 92 . OOOZ~7
198~ llX .000301 1993-199q 72 .000192
1985 132 .000356 1995-1998 92 .OOOZ~7
1986 lOX . 00027~ 1999 72 . 000192
1987 lOX .00027~ 2000 72 .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9Z .0002~7
2002 62 .000161
2005 52 .000157
ZO0~ ~Z .000110
X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the 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.
STATUS REPORT UNDER RULE 6.12
Name of Decedent' ANNA R. WOLGEMUTH
Date of Death' 10/9/03
Will No. 21 03-0997
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate'
State whether administration of the estate is complete'
Yes X 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:
account with the Court ?
Did the personal representative file a final
Yes ~ No X
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 X No ~
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date' 4/24/04
Signature
GERALD J. BRINSER
Name (Please type or print )
6 E. MAIN STREET, P.O. BOX 323
PALMYRA PA 17078
Address
(717) 838-6348
Tel. No.
Capacity:
Personal Representative
X
Counsel for personal
representative