HomeMy WebLinkAbout04-0383Register of Wills of
Estate of Douglas E.
also known as
Lisa S. McCormick
Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
McCormick No. ~,~l -' ("~'{ ' .~:~,:..~
, Deceased Social Security No. 204- 50- 9996
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut
the Decedent, dated and codicil(s) dated None
named in the last Will of
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 incompetent:
B. Grant of Letters of Administration -~
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia~.~urante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp~._u~, e (if any) and
heirs: Cc
I Name Relationship Resi~eence
Lisa S. McCormick
spouse
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
4125 The Burns Road, Mechanicsbur8
County, Pennsylvania with his/her last family
or principal residence at 4125 The Burns Road, Lower Allen Township, Mechanicsburs,
(list street, number, and municipality)
Decedent, then 47 years of age, died 04/05/2004 at Camp Hill, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
PA 17055
(Location)
5,000.00
150,000.00
situated as follows: 4125 The Burns Road, Mechanicsbur~
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 undersi~lned:
nature Typed or printed name and residence
Lisa S. McCormick
4125 The Burns Road, Mechanicsbur~, PA 17055
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
his, is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
Local Registrar
Date
' 1-04-
PER~ANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORB$
CERTIFICATE OF DEATH
,47. '"'l I I I~'8'1056 I.~st~' PA [~ ~m
,~hauics~rg, PA 17055 ~ ,~.~ ~rland ~m
· Susenne
,,. ~(~) um,~apr~ lO, Z~4 I-~Bimh Hill ~ege~ I=d. Bu~ham, PA 17~9
S~ ~ ~E~~ ~ ~ ~ ~ ~M~R m ~E ~O~ ~ FACmL'W ~ ller-Hoens~n~ F~i
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
DOUGLAS E. McCORMICK
April 5, 2004
21-04-0383 Admin. No:
I certify that notice of beneficial interest (estate administration) required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned
estate on April 22, 2004:
NAME
Lisa S. McCormick
ADDRESS
4125 The Bums Road, Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none.
(717) 730-7310
Capacity: Counsel for Personal Representative
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
DEPT. ZB0601
HARRiSBURG, PA 171Z8-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-04-0383
COUNTYCODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AN{:} MIDDLE INITIAL)
D
E McCormick Douglas E.
C~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
ED 04/05/2004 11/08/1956
N IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
T NcCormick, Lisa E.
~..~ 1. Original Return ~ 247! Supplemental Return
CAPB I 4. LlmitedEstate . FuturelnterestCompromise(dateofdeathafterlZ-1Z-8S)
HpRL I J'--'~
EP~cO JL._J 6. Decedent DiedTestate Decedent Malntalr~daLivingTrust
C R T K (Attach copy of Will) (Attach copy of Trust)
KOEs [] 9. LitlgatlonProceedsRecelved [~]10. SpousalPovertyCredlt
(date of death between 1Z-31-91 and 1 - 1-95)
c
o
M
T
I
0
N
SOCIAL SECURITY NUMBER
204-50- 9996
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return prlorto 12-13-8Z)
6. Federal Estate Tax Return Required
6. Total Number of Safe Deposit Boxes
] 11. Election to tax under Sec. 9113(A)
(Attach Sch O)
NAME
Michael L. Ban~s
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717/730-7310
COMPLETE MAILING ADDRESS
429 South 18th Street
Camp Hill, PA 17011
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
So[e-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E}
6. Jointly Owned Property (Schedule F) (6)
] 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)
(1) 148,000.00
(2) None'
(3) None
(4) None
6,410.76
None
None
11,147.20
954.87
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)
(6) 154,410.7~
(11) 12,102.07
(12) 142,308.69
(13)
(14) 142,308.69
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2) 142,308.69 X .00
16. Amount of Line 14 taxable at lineal rate X .045
17. Amount of Line 14 taxable at sibling rate X .12
18. Amount of Line 14 taxable at co~lateral rate X .15
19. Tax Due
(16) O. O0
(16) O. O0
(17) 0.00
(16) O. 00
(19) 0.00
Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
4125 The Burns Road
CITY
Mechanicsbur8
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable D. Interest
E. Penalty
STATE ZIP
PA 17055
(1)
O. O0
0.00
0.00
0.00
0.00
0.00
0.00
Total Credits ( A + B + C )
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or incon~ of the property transferred; ......................... [] []
b. retain the right to designate who shall use the property transferred or ~ts 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 peri ury, 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.
SIGNAT~.~iFPERSONRESPONSIBLEFORFILINGRETURN [,isa .~'. McCormick DATE
~ / /7 /3 4125 ~he Burns Road
SIGN~TUREOFPREPARE~THERTHANREPRESENTATIVE Michael L Bangs
//Id //~//~ ~ 429 South 18th Street / .
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after Januau 1, 1995. the tax rats imposed on the net value of transfem 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 statutou require~nts for disclosure of assets
and filing a tax return are still applicable even ~ th, surviving spouse is the only beneficiau.
For dates of death on or a~er July 1, 2000:
The mx rate imposed on the net value of transf,~ from a deceased child twen~-one years of age or younger at death to or for the use of a natural
parent, an adoptive pa~ent, 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 deced,nt's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1
[72 P.S. 9116(aXl)].
Th~ tax rate imposed on the net value of transfers to or for the use of the dec,d,nt's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under
Section 9102. as an individual who has at least one parent in com~n with the decedent, whether by blood ot adoption.
Copyright (~) 2000 form software only The Lackner ~roup, Inc. Form ~-1~ ~X (Rev.
REV- 1502 EX + (1-97)
SCHEDULE A
COMMONWEALTH OF PEN NSYLVANIA REAL ESTATE
INHERITANCE T~( RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Douslas E. McCormick SS~/ 204-50-9996 04/05/2004 21-04-0383
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 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 4125 The Burns Road, Mechanicsburg 148,000.00
TOTAL (Also enter on line 1, Recapitulation) 148,000. O0
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 19961ora software only CPSystems, Inc. Form REV- 1502 EX (Rev. 1-97)
ii, No McC0rm~ck
~ ~ P~be~9 aPPmi~ I
L i Rii KI G WATER j
r 9 LClITAI IAIT~ }
! A9 ESl1S ]
~ I~ls (I~LTI HLI IqIATEI I mia[IlLS) 'r
Filll
MU.TI-~SE ~IJ:i~EI~NTAL AM]Eta)laM
FOI~FEDE I~.LY I~LATED TI;ilNSACTIOMS
Th~]apprai al~,l~. I ml~l~Of'thll'~ibI hgieflrt~il:n: j
~,cI'~er tlIm ~.andidI
SrATEKNT Ol~ LMITNO OONDITIONSAII) AFe-~DI~I~SCEI~'F rATION
REV- ~508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
IN HERITANCE TAX RETURN
RESISENT DECEDENT
ESTATE OF
Douglas E. McCormick
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
FILE NUMBER
SS# 204-50-9996 04/05/2004 21-04-0383
Include the proceeds of Jitigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 166.04
Members First FCU Savings Account
Members First FCU Checking Account
6,244.72
TOTAL (Also enter on line 5, Recapitulation) 6,410.76
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, inc. Form REV- 1508 EX (Rev. 1-97)
st
MEMBERS 1"
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
LOAN ACCOUNT:
Account Number/Suffix
Primary Borrower
Date Loan Established
Principal Balance at Date of Death
Name of Co-Borrower
Collateral Securing Loan
128894-00
09/24/1992
$166.04
$.02
$166.06
None
128894-11
10/16/1992
$6,244.72
$.17
$6,244,89
None
33555 -04
Lisa M, McCormick
10/17/2001
$12,601.37
Douglas E. McCormick
Co-Borrower, Contractual Pledge of
Shares, 2001 Toyota Tacoma
MIj~(IBERS 1ST FEDERAL CREDIT UNION
nlse A. Wolfe // .
Insurance SupervisoF
May 25, 2004
Estate of: DOUGLAS E. MCCORMICK
Date of Death: 04~05~2004
Social Security Number: 204-50-9996
5000 Louise Drive · P.O. Box 40 · Mecharficsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org
REV-1511 EX +(1-97) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
iN HERITANCE TAX RETURN ADMINISTRATIVE
COSTS
RESIDENT DECEDENT
ESTATE OF
Dou$1as E. McCormick SS~/ 204-50-9996 04/05/2004
FILE NUMBER
21-04-0383
Debts of decedent must be reported on Schedule I,
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
Heller-Hoenstine Funeral Homes, Inc.
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's Fees Michael L. Bangs
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal
The Sentinel
State Zip
TOTAL (Also enter on line 9, Recapitulation)
7,182.73
3,500. O0
260.00
75.00
129.47
$ 11,147.20
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-9?)
REV- 151Z EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Douglas E. McCormick
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSf/ 204-50-9996 04/05/2004
FILE NUMBER
21-04-0383
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
5
6
Lower Allen Township (sewer/refuse)
Danone Waters of North America
Comcast Cable
Verizon (final bill)
PP&L
2004 County/Township Real Estate Taxes
80.69
2.40
80.01
29.28
241.73
520.76
TOTAL (Also enter on Dine 10, Recapitulation) $ 954.87
(If more space is needed, insert additional sheets of the same size)
Copyrlg ht (c) 1996 form software only CPSystems, Inc. Form REV- 151 ~* EX (Rev. 1-97)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Douglas E. McCormick SS~ 204-50-9996 04/05/2004
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9 t 16(a)( 1,2)]
1 Lisa S. McCormick
4125 The Burns Road
Mechanicsburg, PA 17055
r
RELATIONSHIP TO DECEDENT
De Not List Trustee(s)
Spouse
I1.
FILE NUMBER
21-04-0383
AMOUNT OR SHARE
OF ESTATE
Entire
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
0.00
(if more space is needed, insert additional sheets of the same size)
Copyright (c) Zg00 form software only The Lackner Group, Inc. Form REV-l$13 EX (Rev. 9-00)
Register of Wills of
CUMBERLAND
INVENTORY
Estate of Douglas E. McCormick
also known as
County, Pennsylvania
No. 21- 04-0383
Date of Death 04/05/2004
, Deceased Social Security No. 204- 50- 9996
Lisa E. McCormick,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the fo~owing Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/~Ne verify that the statements made in this ~nventory are true and correct. I/~Ne understand that false statements herein
are mede subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
Michael L. Ban~s
LD. No.: 41263
Address: 429 South 18th Street
Camp Hill, PA 17011
Telephone: 717/730-7310
Description
Personal Representative
].isa ~. McCormic~
Signature:
Address: 4125 The Burns Road
Mechanicsbur~, PA 17055
Telephone: 717/732-8798 ~
Dated: ~'~ --'~ '~ ~J~
(See continuation page(s) attached)
Total:
154,410.76
(Attach additional sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Sar Association Form #RW-7 (199z)
Copyright (c) 1996 form software only CPSystems, Inc.
Estate of:
Date of Death:
County:
INVENTORY
Douglas E. McCormick
04/05/2004
Cumberland
CASH:
Members First FCU Savings
Account
Members First FCU Checking
Account
166.04
6,244.72
REAL ESTATE/PA:
4125 The Burns Road,
Mechantcsburg
148,000.00
TOTAL RECEIPTS OF PRINCIPAL ...............
6,410.76
148,000.00
154,410.76
-1-
IN RE:
ESTATE OF
DOUGLAS E. McCORMICK
Deceased
)
)
)
)
)
)
) NO. 21-04-0383
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
RECEIPT AND RELEASE
I, LISA S. McCORMICK, the undersigned, being a benefimary tmde~ the Ej~te o~, ~
Douglas E. McCormick, deceased, do hereby: ~
1. State and acknowledge that I am an adult individual; "~
2. Waive the filing of an Account or Schedule of Distribution by the persona~_ :; .~.
representative of the Estate;
3. Acknowledge that I have received all sums of money and personal property to which I
am entitled as a beneficiary of the Estate of Douglas E. McCormick;
4. To the extent of said distribution, release Lisa S. McCormick, Administrator, of'the
Estate of Douglas E. McCormick, and her heirs and personal representatives, from all liabilities,
whether due to her negligence or otherwise, which she may have by reason of her administration
of the Estate;
5. Agree to refund to the Estate and to the said Lisa S. McCormick, Administrator, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify her and the Estate for claims made against her and to reimburse her
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 0'''~
~/~')o~t'J~.,a~., ,2004.
I~ISA S. McCORMIC~
.. day of
COMMONWEALTH OF PENNSYLVANIA )
(SS:
On this, the ~.~ day of 2004, before me, the
undersigned officer, personally appeared LISA S. McCORMICK known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that she executed same for the purposes therein contained.
IN WITNESS WHEREOF~rli~Iv~ hereunto s~ ~,band and official seal.
h'q ~ a~ ~-~bli~
REGISTER OF WILLS OF CUMBERLAND COUNTY
REPORT OF STATUS OF ADMINISTRATION
(For Resident Decedents Dying after July 1, 1984)
ESTATE NO. 21 - 04 - 0383
Name of Decedent:
Social Security No.:
DOUGLAS E. McCORMICK
204-50-9996
Date of Death:
April 5, 2004
Name of Personal Representative:
Lisa S. McCormick
Capacity Executor
(check one) Administrator __X__
Administrator c.t.a.
Administrator d.b.n.
Is the administration of the estate complete? Yes X__ No
If "Yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the
personal representative? yes
Other (explain)
X
Total amount paid to date to creditors and for funeral and $3,913.08
administrative expenses
Total value of distributions to date to beneficiaries
$2,849.83
If administration is not complete, estimated value of assets $
still in administration
NOTE: This status report is due no later than the due date for filing of the Pennsylvania
inheritance tax return or, if no inheritance tax return is required, nine (9) months after the
date of death; if the administration of the estate has not been concluded, a summary report
shall be filed annually thereafter until the administration is complete.
I certify under penalty of perjury that the foregoing information is correct to the best of my
knowledge, information and belief.
Date:
Attorney for Estate
BUREAU OF TNDTVZDUAL TAXES
TNHERZTANCE TAX DTVISTDN
DEPT. Z80601
HARRISBURG, PA 17128-0601
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-154? EX AFP COt-OS)
MICHAEL L BANGS
qZ9 S 18TH ST
CAMP HILL
PA 17011
DATE 09-20-200q
ESTATE OF MCCORMICK
DATE OF DEATH Oq-O5-200fi
FILE NUMBER 21 04-0585
COUNTY CUMBERLAND
ACN 101
Alnount Rain'; t'l:ed
DOUGLAS
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
E
CUT ALONG THZS LZNE ~ RETAIN LOWER PORTION FOR YOUR RECOR96~. ~ ~
................................................................................. ~ ..... ~ ....... ~ .........
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, A~LO~ANCi~OR ~'
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT r~/:TAX ~ .~':~.
ESTATE OF MCCORMICK DOUGLAS E FILE NO. 21 0q-0585 ACH:" 101 ~DATE:!!:O~-20-2OOq
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNING FUTURE ZNTEREST- 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/Partnersh~p /nterest (Schedule C) (3)
q. Mortgages/Notes Receivable (Schedule D)
$. Cash/Bank Deposits~Misc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6}
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Mist. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule ]:) (10)
11. TotaZ Deductions
12. Net Value of Tax Return
lq8/0~,0~00
.00
.00
6/q10.76
.00
.00
(8)
11,1q7.20
95~.87
hl~OTE: T~ ~nsura proper
~radit to~*~our account,
submit the upper port/on
of this form wi~h your
tax payment.
15.
lq.
NOTE:
ASSESSNENT OF TAX:
15. Amount of L/ne lq at Spousal rata
16. Amount of L/ne lq taxable at Lineal~Class A rate
17. Amount of Line lq at S~bling rata
18. Amount of Line lq taxable at Collateral/Class B rate
19. Prlnc] ~aZ Tax Due
TAX CREDITS
PAYMENT RECE]:PT DI$COUNT (+)
DATE NUMBER TNTEREST/PEN PAID (-)
15q,q10.76
(11) 12.102.07
(12) lqZ, 508.69
Char/table/governmental Bequests; Non-elected 911:3 Trusts (Schedule J) (1:3) . O0
Nat Value of Estate Sub,oct to Tax (lq) lqg,508.69
Tf an assess;ant ~as ~ssued previously, lanes 14, 15 and/or 16, 17, 18 and 19
reflect f~gures that include the total of ALL returns assessed to date.
ZF PAID AFTER DATE ZNDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDZT/ONAL INTEREST.
(1.;) lqZ,508.69 x O0 =
(lc) .00 x Oq5=
(17) .00 X 12 =
(lB) .00 X 15 =
(19)=
AMOUNT PAID
.0O
.00
.00
.00
.00
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEI .00
INTEREST AND PEN. .00
TOTAL DUE .00
( ZF TOTAL DUE 1S LESS THAN $1~ NO PAYMENT ~S REQUIRED.
ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR]:
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
1ifa or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S.
Section 91qO).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-I313). Applications arm available at the Office
of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special 2q-hour
answering service for fores ordering: 1-600-362-Z050~ services for taxpayers aith special hearing and / or
speaking needs: 1-800-qqT-3OZO iTT only].
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty [60] days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ZS-10Z1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty nan-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of
six (6Z] percent par 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 with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 200q are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1982 ZOZ .0005q8 ~'~- 1991 llZ .000301
1983 167. .000q38 1992 9Z .0002~7
198~ llZ .000301 1993-199q 7Z .O0019Z
1985 132 .000356 1995-1998 9Z . O 00Z~7
1986 iOZ .00027q 1999 7Z . Ooolgz
1987 iOZ .00027q ZOOO 7Z . OO019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9X .O00Zq7
200Z 6Z .00016~
ZOO3 SZ .000137
ZOOq qZ .000110
X NUHBER OF DAYS DELINQUENT X DAILY 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.