HomeMy WebLinkAbout02-0433
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of 1< L! r /I D [; /J /lJ!J&'? No. 21-02-433
also known as To:
Register of Wills for the
, Deceased. County of CUMBERLAND in the
Social Security No. 195-18-5736 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the ex~c}lt .
in the last will of the above decedent, dated .::rI9-/U UHF( ~ c;:;J A/
and codicil(s) dated
name~
19 ?L
,
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in t:/-t #J? Ilep /0 //cl County, Pennsylvania, with
he (' last family or principal residence at I tn / (V r- 7)4/C L ;::; /Uc
C! /} k: L/ 5 L E ;0/1 //;'/J/ .=3
(list street, number and muncipality)
I}/Ji?/L
at 12 '5 I L . S P -5 //
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
situated as follows:
900,(){j
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters -t..e.s+a mPn-ta(lV
/
(testamentary; administration c. La.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF CUMBERLAND J
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 administer the estate according to law.
~;XJY7ZLU~
Sworn to o. r affirmed and SUbscribedU
before me this 29th day of
~APRIL. U;; :~02
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No. 21-02-433
Estate of
RUTH D SANDER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW APRIL 30 ~ 200~ 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 JANUARY 23, 1984
described therein be admitted to probate and filed of record as the last will of
RUTH D SANDER
TESTAMENTARY
KIM MERLINO
and Letters
are hereby granted to
'?"'I(J y!:.,m~d R/ /,t;J/,u"'(
(,' . glster 0 f Ills
. .
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
tieJ'J1tft:~cftion ................
JCP
$
$
$
$ 5.00
TOTAL _ $ 29.00
. . . . A~InL. .30 J. :z.QOZ..... . . . .. . . . .
18.00
3.00
3.00
ATTORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
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21-02-43B
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
~ )AV)1F. S k f=\ \')~\ \<\ tli ~€R LI/\ ,(~
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
----rh~ I (\:xP-..F familiar with the signature of --=K? ,TN -1) ~/.4n("1 @ R ,
-codicil
testat~ of (one of lhc &tl6seribiRB witRe5~e~ t~ the will
presented herewith and
codicil
believe~he signature on the will is in the handwriting of
1-0 ~Tt-4 LJ &ncleR.
. ,
to the best of .lb., "" know ledge and belieL /J __
Sworn to or affirmed and subscribed before fJe/12ui:1 ;p ~L..d:r
me this 29th day of?7 (~ame)
~ APRIL ; pi){. 2002 cflJ /..vJ/lc-:>/7//..-,L/ j)~. L/;,ClL/J/-c' ///7,;)/3
----'u;t'o/m..j,Pnj4~r t~ ;."" UA94rp~) 4 ·
Register ~ / / ~~c.-O
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(Address)
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21-02-433
LAST WILL AND TESTAMENT OF:
RUTH D. SANDER
I, RUTH D. SANDER, of the County of Allegheny and
Commonwealth of Pennsylvania, being of sound mind and memory, do
make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils heretofore made by me.
FIRST: I direct my Executor to pay my lawful debts and
the expenses of my last illness and funeral.
SECOND: I direct that my remains be buried in a plot
owned by me in the Lakewood Memorial Cemetery.
THIRD: I bequeath all of my jewelry, automobiles,
clothing and other purely personal effects, as well as household
furnishings and equipment which I may own, including any policies
of insurance thereon to my husband,Waldemar L. Sander, if he
survives me by thirty (30) days. In the event my husband does not
survive me by thirty (30) days, then I devise and bequeath the
aforedescribed property to my surviving children, in equal shares"
per stirpes.
FOURTH: All the rest, residue and remainder of my
Estate, I devise and bequeath to my husband, Waldemar L. Sander,
if he survives me by thirty (30) days. In the event my husband
fails to survive me by thirty (30) days, then I devise and
bequeath the same under the same terms and conditions to those
"
SIXTH:
I appoint my husband, Waldemar L. Sander, as
Executor of this, my Will. In the event my husband is unwilling
or unable to serve as Executor, then I appoint my daughter, Kim
Merlino, presently of Gibsonia, Pennsylvania, as Executrix in his
stead.
SEVENTH: No fiduciary appointed in this Will shall be
required to furnish a bond or other security in any jurisdiction
in which he or she shall serve.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~ day Of~' 1984.
;{J~/ if J~/pu
RUTH D. SANDER
(SEAL)
SIGNED, SEALED, PUBLISHED and DECLARED by the above named
Testatrix, RUTH D. SANDER, as
Testament, in the presence of us,
presence and in the presence of
subscribed our names as witnesses.
and for her Last Will and
and at her request, in her
each other, have hereunto
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
Ji UtI! ]) S IJ fJ DcR.
.tj~ / s - () c;(
Name of Decedent:
Will No.
q;/- 0 01-0 1/3~
Admin. No.
To the Register:
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 "-/ ... IIfJ - t:) ~ :
Name Address
WCLldemar L: Sander, Jr. d-Y wDccl6'men Dr., ~meMp~ r-t, PeL_ / b 7~1
etCLiJ B ~,-<;al1der", "-1'17 fJaf'tndJe RU-fl, G,hsCJnt'Q/ J1a... /S-l5;/V
/}/(21J W,0a/Jder: It> 3 /YJo('JO-nRd,-, B t.L --I fer.' f;a., )~ 66/
t(;m Ii (Yler / I not' Old. wlJea.-L-Aeld Dr,; (1('11 $, ~ 1)A-.1'7~/3
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
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Signature
~j
Name *1m /I. me r// no
Address OJ~ LUAecd:-!)e)d D0
{!/)I2LISL6 p/J //ft)/.:3
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Telephone (?/~ '7 tJ tJ ~ 9.3' 5 L/
Capacity: ~ Personal Representative
_Counsel for personal representative
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
MERLINO KIM
22 WHEA TFIELD DR
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 195-18-5736
FILE NUMBER: 2102-0433
DECEDENT NAME: SANDER RUTH 0
DATE OF PAYMENT: 08/20/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/15/2002
NO. CD 001544
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $230.65
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TOTAL AMOUNT PAID:
REMARKS: KIM V MERLINO
CHECK# 677
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$230.65
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-00)1
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OECEOENTS NAME (lAST. FIRST, ANO MIDDLE INITIAL)
!z S'1l NDc R tJ TI-/ D,
~ OATE OF OEATH (MM.DO-YEAR) DATE OF BIRTH (MM-OO-YEAR)
~ t!) 5-c:?CJOc;) tJ -/~-/9c?o
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, ANO MIODLE INITIAL)
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~1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate lAttach copy (lImn
o 9. litigation Proceeds Receiyed
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12.a2)
o 7. Decedent Maintained a Living Trust (AtlachcopyofTrusl)
o 10. Spousal Poverty Credit (dale oldealh between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
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FILE NUMBER
,..( 6 - .J2 ,;{
COONTY CODE YEAR
SOCIAL SECURITY NUMBER
/9S-Il'
573
THIS RETURN MUST BE FILEO IN OUPlICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Retum (d8IeofdealhpmrlDt2.13-a2)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election 10 tax under Sec. 9113(A)(""",""01
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COMPLETE MAILING ADORESS
FIRM NAME 1'_1
TELEPHONE NUMBER
dO,) I>>flE/PTF/EL D DR.
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(1)
(2)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(3)
'71/"f- "790- 935.1/ {}fl7<L/5LE
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(6) /0, 19~ ij~
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4. Mortga9es & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Misoellaneous Pe<sonal Property
(Schedule E)
(4)
(5)
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6. JoinUy Owned Property (Schedule F)
o Separate Billing Requested
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. OFFICIAL USE ONLY
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1. Real Estate (Schedule A)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I)
11. Total Oeductions (Iotal Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Line 13)
(9)
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(8)
6%,'5, h 9
'7? f1.-.7'7 (J
(10)
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
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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 ofUne 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Oue
,-1. IdD: b' ~
x.O_ (15)
x.0~16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
(11)
(12)
(13)
h. /'$'5: b 9
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5: IdS. b -s/
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(14)
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(19)
eJ.3{). 65
Decedent's Complete Address:
STREET ADDRESS / ~ ,.f L"tJ. Ai E
CITY
E
7cj/3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credils/Payments
A. Spousal Poverty CredIT
B. Prior Payments
C. Discount
-0-
-0-
-t/-
Total CredITs (A + B + C) (2)
-0-
3.
Inlerest/Penalty if applicable
D. Interest
E. Penalty
-() -
-0-
4.
Totallnterest/Penalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enler the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on Ihe tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(1)
(3)
(4)
(5)
(SA)
(5B)
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-0-
-0-
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-0-
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Make Check Payable to: REGISTER OF WILLS, AGENT
[1.__< fiii!~_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves
a. relain the use or income of the property transferred;.......................................................................................... 0
b. relaln the righllo designate who shall use the property lransferred or ils income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................n. 0
d. receive the promise for I~e of either payments, benefils or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trusl fo~ or payable upon death bank account or security at his or her death?.............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probale property which
contains a beneficiary designation? ........................................................................................................................ 0
No
~
B'
IB'
IB'
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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 oj perJury. I declare lhall have examined this return, induding accompanying schedules and statements, and 10 the best of my kllCl'Medge and belief, it is true, COl'IllCl
and complete.
Dedaration of pre parer other than the personal representative is based on aH information of ."tlich preparer has any kno'Medge.
SIGNATURE OF P RSON ~SPONSIBLE FOR FlUNG RETURN
ADDRESS
c;(00J /.LJ#E,4TF/€LD
SIGNATURE DF PREPARER OTHER THAN REPRESENTATIVE
DR
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ADDRESS
afw!Hlnp'~ .-~'~I:I!Illi:i1'--~#':'1mrjE~W jJ t ~~~I!!I'~il:.-'!i
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 Ihe 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 exemot a transfer to a surviving spouse from tax, and the statu lory requirements for disclosure of assels and filing a tax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dates of dealh 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 Dr for the use of a natural parent an adoptive parent,
or a stepparenf of the child is 0% [72 P.S. ~9116(a)(1.2)).
The tax rale imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, excepl 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 ieast one parent in common with the decedent. whether by blood Of adoption.
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LAST WILL AND TESTAMENT OF.
RUTH D. SANDER
I, RUTH D. SANDER, of the County of Allegheny and
Commonwealth of Pennsylvania, being of sound mind and memory, do
make, pUblish an~ declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils heretofore made by me.
FIRST. I direct my Executor to pay my lawful debts and
the expenses of my last illness and funeral.
SECOND. I direct that my remains be buried in a plot
owned by me in the Lakewood Memorial Cemetery.
THIRD.
I bequeath all of my jewelry, automobiles,
clothing and other purely personal effects, as well as household
furnishings and equipment which I may own, including any policies
of insurance thereon to my husband,Waldemar L. Sander, if he
survives me by thirty (30) days. In the event my husband does not
survive me by thirty (30) days, then I devise and bequeath the
aforedescribed property to my surviving children, in equal shares,
per sU rpe s.
FOURTH:
All the rest, residue and remainder of my
Estate, I devise and bequeath to my husband, Waldemar L. Sander,
if he survives me by thirty (30) days. In the event my husband
fails to survive me by thirty (30) days, then I devise and
bequeath the same under the same terms and conditions to those
listed in THIRD above.
FIFTH.
I direct that all death taxes, whether Federal,
State or Local, payable because of my death, with respect to the
property forming my gross Estate for tax purposes, whether or not
passing under this Will, including any interest and penalty
imposed in connection with such tax, shall be paid out of the
assets of my Estate.
1
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SIXTH,
I appoint my husband, Waldemar L. Sander, as
Executor of this, my Will. In the event my husband is unwilling
or unable to serve as Executor, then I appoint my daughter, Kim
M~rlino. present~y of Gibsonia, Pennsylvania, as Executrix in his
stesd.
,
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SBVBNTH, No fiduciary appointed in this will shall be
required to furnish a bond or other security in any jurisdiction
in which' he or she shall serve.
IN WITNBSS WHBRBOF, I have hereunto set my hand and seal
this li day of ~~ ,1984.
;:!,.rrl JP J/I-u ~UU
RUTH D. SANDER
(SEAL)
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SIGNBD, SBALBD, PUBLISHBD and DECLARBD by the above named
Testatrix, RUTH D. SANDBR, as and for her Last will and
Testament, in the presence of us, and at her request, in her
presence and in the presence of each other, have hereunto
subscribed our names as witnesses.
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WHEREAS, on the 30th
dated January 23rd 1984
was admitted to probate as the last will of SANDER RUTH D
(LA~l, ~lK~l, M1UUL~)
late of MIDDLESEX TOWNSHIP CUMBERLAND County, who died on the
15th day of April 2002 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to MERLINO KIM
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF,
of my Office the 30th day
r
t )
1\
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2002-00433 PA No. 21-02-0433
ESTATE OF SANDER RUTH D
(LA~l, ~lK~l, M~UUL~)
Late of
MIDDLESEX TOWNSHIP
CUl~~KLANU CUUN!l,
Deceased
Social Security No. 195-18-5736
day of April
2002 an instrument
I have hereunto set my hand and affixed the seal
of April
2002.
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**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
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l~listed
in THIRD above.. ,. .
-:;t"'\~i~)i~g~~~'5iii d"""eath"taxE;s; whether pe(i:f~~
-..,,~(~'"\ '*'
COMMONWEALTH Of PENNSYlVAN(A
INHEfijTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF /) j 1 -Lh D
7'\ VI.- "L J Sa I?de ('
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
O?OO~ ~ () tJ 7"33
All property jolntlyoOWlled with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
;;;9)O.A~ (!ommol)j ~
:J~J~' je.tL~ /P#'1'1'/3d)O/{)~
~ - .3~. '7 d'1J.-W- .3 c:2, 0'/9
~- ..3~. 37-'1
93c? :?.s
TOTAL (Also enter on line 2, Recapitulation)
(H more space is needed, IOsert additional sheets of the same size)
$ 9Je, RS
r G
I.
~~~~~i
r- -~~,,:o.~.-4k;~Et'~eut::'
~~~~~~~~~~~~.
- --
~~~~~~=~
~ -~ - - ---
i - - >;; -'
~_- -~ ---:: - _ ;i
COMMON SrOCK
COMMON SroCK
NCORl'OAATID lNlf~ TK L1\wsa M
SWEOf~.f1!SFl'
tH:;nIllft:ATEISTRN<SFl'RAlllf
""'_YO'IK.t.EWYORt:..
JElI5tYOTY.N(W.(ltSFI.
.oNI)CANTO"l.~
PAil. VAlUE OF $.01
Prudential Financial, Inc.
1 96
2!
SH IfVEl!Sl' FOR
W'I.O.INCUNIION:'>
FUUY PAlO AN) t-ON-ASSESSABlE SHARES OF THE COMMON SrOCK OF
!l}.tldmtld JU,tlllaa!. s;,C. tr<Y~"k 011 tlte I~ glUU cmpOm"NI in}erSOll or & duY mtLhol'a:d
attoMf'!/I'fon Slirl'Cmf,.~ g/'t(uS',"Uf/ira.<e~, e1'lF~ .?l,i.l",.c1jl(-O/f"~/I~"aM anla-sCOU//LO>&zal ami
"''''')cUred /_.~. SiR. '-~";';;~*,{"inL W~"":~qw,,\ ;; ; ...(,.., ! L-> r. '.. '~.." ,
'U-- '(y' _,_ ;r~ty"'r:-""'~__ ,." J~~^ .__ .... '.___ _,,' ._", ~_ _
1fliRc.r-f.tlitfiu:.vnulc.seal,q/.said eotforatioa.a/UI tllf.!iLCfUlu!e..,fi!?uWUYJ.S e/itJ ttl(& tzildw-l'tied !J!jic.er,s.
C()lMT6I9G/'oI'DAl'VIlfGIS1ERED. Doted: June 17. 2002
EouLSERVETRtlSTCQMPAN't',N.A..1IW'fSFU...cfNlANOREGlSlRAJ: , /1. -~_
~ ---#-?k ~ ~ ~~ ~f'~
AUTliOllllEDOFfIC8! Sl:CRfW/Y ANOCHI[FlXOCl/lMOffICEi:
.. ~
"
il!!mll! ~ i5 Q <<- iil~ Q a 'i V')a...u;
Sf- 0 '" ~ ~ ^ . "
CL Z> m m ::r\!~
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. 0 m ..r .3 ~-a
S- a ~~ c Z m n
0' if n . z 0 ~~ :;; . '
0 0 ~~ ~ ~g~
S or 3 $: 8.0
3 ~~ r-
-0 , , -~ g..ij;
~ 0 .n ..l~
. " 0 'j> <; "0 e e ~oo
" a ~~ 0 ~,~ "0 <is
" 0:. ~ >. 0 " " i~ 5~Q
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CUSO FioonOOl Sel'lices, member NASD/SIPC
7220 Imde 51., STE 115
Son 1Mgo, CA 92121
858.530.4400
MllllllrNAlD.SIPC
.'1MUII1"':WZ;
for the account of
ESTATE OF AIJIH D. SANlER
KIN IlERUI<<l EXEQJT[Jl
22 lItEATFIELD lIUVE
CMLISLE PA 17013
trade and account Information
Account
Number
4882-9183
Trade SettlemMtType of
Date DQt~ Tn:rn.~
07/03/02 07/09/02 06
DescriPTion
Type of
Account
CASH
Buv/ -Symbol
sill
sell PIlLI
744320-10-2
Cusip
PIUlENTIAL Flit.. II'(;
l.NSDLICITED
trade confirmation
rap Information
MARIAN KINTER
LOCA TED AT PSECU
P.O.BOX 67013
HARRISBURG,PA 17106
QualltitJ.
Price
Money Type
Mone)' Amount
29
30.95
Pr-;nctpal
o::mni ss; on
SEC Fee
Net Am:urt
897 . 55
45.26
0.03
852.26
... DETACH HERE
Make checks payable to E*lRADE Securities, Im:oxporated, member
NASD/SIPC, and enclose your check and this deposit slip in the
envelope provided. Endorse securities by (I) appointing E*lRADE
Securities, lDcmporated as attorney and (2) signing exactly as name appean;
on certificBll:. Satisfactory proof of stock ownenhip is required on sale of
bearer securities. Please mail securities directly to E*lRADE Securities,
Incorporated, 10951 White Rock Road, Rancho Cordova, CA 95670.
o My address has changed as indicated on revone
QEOSF1 Rev: ~
DETACH HERE
use this deposit slip
to odd to this account: 4982-9183
Amount Enclosed
IS
E*TRADE SECURITIES INC
PO Box 8160
Boston MA 02266,8160
111,,,,,1,1,,1,1,11,,,11,,11,,,11,,.11,,,,,,11.11.,11,..1,,,11
070320029901 111498291835
_'''''''.1'''' *'
r
n
COI.tMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SIDENT DECEDENT
ESTATE OF
7{ u- -I:: h
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
'D. Stalder
FILE NUMBER
c::?6{Jd:?- t)6~3 3
Include the proceeds oIliligalion and the date the proceeds Wen! received by the estate. All properly jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
d,
3.
"TV
7C(epho()co
(2/othes
/ so. 60
o?S.06
50 (). 06
TOTAL (Also enter on line 5, Recapitulation) $ 0 t; 5- {) D
(If more space is needed, insert addlllonal sheets of the same size)
~.~.~*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 'J) 7\
7") ()-rH fJ,
SCHEDULE F
JOINTL Y.OWNED PROPERTY
S/J /lJ Dc R
FILE NUMBER
.d:?~O~ -60 .y 3..3
. In "181_ IIlIde joint within one yell of the decedenr. dati 01 death, "mull be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADllRESS
RElATIONSHIP TO DECEDENT
B. Sam es; R: 1Y1er) (nD
;;;~ wIJeCL-f-Pt e Id Vr,
(!o.(I/tg!e PC<.. /7tJ/3
J
d~ LUheCL-t-Pt e./ d D",
C!.Cl-1^ I i oS Ie) (.)(L /7613
J)Cli.<.8h-t e r
A--Kt M v. filer / J'n D
S6fl- ; VI - WiD
c.
JOINTLY-OWNED PROPERTY:
lETIER DATE DESCRIPTION OF PROPERTY "OF DATE OF DEATH
ITEM FOR JOINT MADE Include name offincn:ial institution and balk account nurriler or simila' identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed forjoinUy-held real eslate. VAlUE OF ASSET INTEREST DECEDENT'S MEREST
1. A. Z/;jzM PSf{! Lt.) P. 0. Box: (, 7013,
Harn 5bl.Lr~J Po. ./?/tJb-lJtJ/ 3
33~ /, b 'l
Set lJ /05S Ftcc-t.=P- / 9.5 J &'573'" .506
B. 7/r~ " d d
.;;{, R. ~~~~ Ched<i05 fk.d, 4f/95/r? 5''l'3 b g 1/5'1 g <2 S3'k ~'615. 3/
13 ]/~6~ JI " JJ
3. ft z)~o '9;;;J~ ~ F! 161 tJt) 5()~ '73go. S
/~'I. 70~ mP~
~',;7 ,,~
-,
7 17,.;t 5'~_.J. 1/9
TOTAL (Also enter on line 6, Recapitulation) $ 10; 197. "/f?
6
(If more space is needed, insert additional sheets of the same size)
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nafianwide)
website . http://_.psecu.com
PCI111sylV0l110 SIDle Employees Credit Union
GET YOUR FREE CREDIT REPORT!
SEE YOUR CREDIT RATING AND LEARN
HOW YOU CAN IHPROVE IT.
VISIT WWW.PSECU.COH FOR DETAILS.
1".111".111"""11.,11.1,1"11,,,11,,,,1,,1,,1,1,,1,1",111
RUTH D SANDER
ZZ WHEATFIELD DR
CARLISLE PA 17013-9004
JOWl' OWNER
KIM Y IERLINO
PAGE 1
nUIII:WUIY/l'" I' I..... ..-
webslte . http://www.psecu.com
GET YOUR FREE CREDIT REPORT!
SEE YOUR CREDIT RATING AND LEARN
HOW YOU CAN IMPROVE IT.
VISIT WWW.PSECU.COM FOR DETAILS.
JOINT OWNER
KIlt V HERLIltO
RUTH D SANDER
PAGE Z
I
J
__."0__ "::_~~:--.-
.~ -
-~~::s:2~.~~~~~~_;;~~;~~~~i~~~~~~~,t "-~~"~~~:~~-~
.:~~'M~~~i~~~
~...
. .
, ' TITLE NUMBER (AS SHONN ON ATTACHED TITLE)
- at ' 44978969401
i VEHICl.E IDENTIFICATION NUMBER
VAFLM19A30409CM
B. I LAST NAME lOR FULL BUSlNE5S NAMEI
; McBride,Dawn L
III Co-SEUER
\;
i
Ii
~
~
.
MAKEOFVEHaE ~r~YEAA PUACHASE
. CLAREMON I A. PACE ... ''''
(See note on 18'tIl!1'lMI) rI 1\1
CONDf11ON
LESS
Ol06D OF.'JR o POOR TRADE-IN O_I\~ l'L O(
FIRST NAME MIDDLE INITIAL. ""'ABLE
AMOUNT t'l I\~ " nr
c.
LAST NAtE (OR FULL ~S1NESS NAME)
Sander.,Ruth D
CD-PURCHASER
I
1. Sales Tax Due
'6~1.061'"
li: 7'" .07
See note al rewnel.
lAE_
Re8IaonCode.(rnust
~ A ~~ from 1 .,,-
!~/JI /' /,' ::::;:7.'-'
'--
..,.. ""
... n
t'l 1\'
ARST NAME
MIDDLE INITIAL.
DATE ACQUlREDI
PURCHASED
02/19/01'
Merlino,Kim V
smEET
COUNTY C
" rNJT
... n,
2. TltleFee
~ 161 Cedar Lane
CITY St\TE
Carl;~l~ 06 171\1"'1
D. LAST NAME (OR FULL BUSINESS NAME)
ZIP CODE
REFER 10 COUNTY CooES 3. Lien
USTlNGONRE~~1 Fee
.. n
~ ^,
ARST NAME
MIDDLE INITlAL. DATE ACOLRREDI
PURCHASED
/ /
4. Registralionor
_Fee
'" n"
.. IV
Ii
I .
. ~
.
~
~ ~
~
E.
~o
~~
F.
CO-PURCHASER
Fee Exert1't Number
asaasipnecf~lhe
""'""'
5. D.JpIicale Reg.
Foe
No. of Cards
6. Transfer Fee
,. ",.
STREET
I COUNTY CODE
"r I
,. ^
CITY
STATE
ZIP CODe
REFER 10 COUNTY CODES
l.lSTNGOORE'o'E~~o;"
,. ",.,
,. ",
I VEHICLE IOENTlFICATlON NUMBER
I BODY TYPE (CP, TK, ETC.) ICONomON
I 0 GOOD
ORIGINAL Pi-ATE d Check One 0
yo TRANSFER OF PREVIOUSLY ISSUED PlATE
o PLATE TO BE ISSUED BY 0 TRANSFER &. RENEWAL OF PLATE
BUREAU (PROOF OF IN-
SURANCE MUST BE AT. 0 TRANSFER & REPLACEMENT OF PLATE
TACHED.) 0 TRANSFER OF PLATE & REPLACEMENT OF STICKER
EXCHANGE PlATE TO BE
ISSUED BY BUREAU
TEMPORARY PLATE
ISSUED BY FUll AGENT
MAKE OF VEHICLE
7.lncreaae Fee
,. n,
,. ^"
MODEL YEAR
8. Replacement
Foe
o F.'JR
o POOR
,. n,
,. n"
9
10.
TOTAL PAID
,Add 1 thru8)
.,.... "",
,., n"
So"" One
Check in
This Amounl
~I
I~
o
o
11.GRANO TOTAL
(Add 9 &. 10)
I REASON FOR REPLACEMENT
I OLOST 0 DEFACEO 0 STQLfN
I ONEVER RECEIVED (LOST IN MAJL)
NOTE: If "NEVER RECEIVEO" block is checked a.......icanl musl .............u..te form MV-44.
I""
.
.
PLATE NO.
EXPIRES
Month Year
TRANSFERRED FROM TITLE NO.
G.
~TU\t,TEOF,S '~,'iJ1!' ~~ "SIGN >ERE T ..... T L E
FERRED UF OTHER THAN APf'LICANT) P .....
IUNLADEN WEIGHT I~U~~Gcr.~~ss WT.
I POLICY NO. (OR
I ATTACH BlNOER)
I CERTlFY THAT ON MONTH CAY YEAR
I HAVE CHECKED TO DETEAMNE THAT THE VEHICLE IS INSURED AND
~~E~ ~E~~~Jt:~~~vJ/.::J~~ COOE Iss;,;:r~G A-:lENi elGWmJRE
AND DEPARTMENT REGLJI..AllON5. ( )
I/WE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETION AND THAT THE INFORMATION GIVEN IS TRUE AND CORRECT. IF AN eXEMPTION
IS CLAIMED, THE PURCHASER FURTHER CERTlFES THAT HEISHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. l/WE ACKNOWLEDGE THAT llWE MAY LOSE MY lOUR OPERATING
PRlVILEGE(S) OR VEHICLE REGISTRATlOfi(.8) FOR FAILURE TO MAlNT.AJN FINANCIAL. RESPONSlBII.1TY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF
REGISTRATION. l/lNE ACKNOWLEDGE TH.(r I/WE MAY BE SUBJECT 10 A FINE NOT EXCEEDING 55,000 AND IMPRISOmENT OF NOT MORE THAN TWO YEARS FOR NlY
FALSE S'TA.TEMENT THAT I/WE MAKE ON THIS FORM.
1ST, ~"j)""-~.
~I~U'~~J~~~--~
1 RELATIONSHIP TO APPlJCANT
ONLYI
REO. REG. GROSS COMB
WT. (IF APPUCABLE)
POUCY EFFECTIVE
DATE
TEMP. PLATE NO.
VEHICLE PURCHASED .....GVWR
W'~~\ r
INSURANCE COMPANY NAME:
I ~UCY EXPIRATION
I DATE
AGENT NO.
ISSUING
AGENT
INFQR.
MA~ON
ISSUING AGENT lPRINT NAME)
TELEPHONE NO.
I
.
"
TELEPHONE NUMBER
( l
~~~'", ~ P1~{I.,^:..1 n
SignatureotCo-SelIer
Signature 01 Second Purchaser or AultJ:Jrized Signer
TELEPHONE NUMBER
( l
Signature of Seller
2ND
ASSIGN-
MENT
Signature 01 eo.PurchaserlTltIe 01 Authorized Signer
Signature Of eo.SeJler
H. I~~
.~
~
NOTE:. If a co-purchaser other than your spouse is listed and you want the title to be listed as "Joint Tenants With
Right of Survivorship. (On death of one owner, title goes to surviving owner.) CHECK HERE D. Otherwise. the title
will be issued as "Tenants in Common" (On death of one owner, interest of dBceased owner goes to his/her heirs or
estate),
NOTE: IF THE VEHICLE IS BEING lEASED, CHECK THIS BLOCK 0 . IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV.IL
xx
MESSENGER NUMBER:
: "UREltV6F'Mb~o~ WHT~i\)
054006
02/21/00
RI:iIlI.1511 ~ (12-99) .
,. '*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Ru....;6h P ..Sa. ndGJr
FILE NUMBER
c:J()6 ~- Dc) Y 3 .3
Debls of decedent must be reported on Schedule J.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES: 'R~ R. ~,~ :I~ctJt1771..L
02 &'.<; / tV!) 6cLetvwol. ~, t1LLuJthL Pa~ fi....
~~a.tizL~ /5/.:'/
~VO~
.:irMol~
:J-~
Juw-J- ~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
1.
Name of Personal Representative(s)
Social Security Number(s)fEIN Number 01 Personal Representative{s)
Street Address
City
State_Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
Cily
State _ Zip
Relationship of Claimant 10 Decedent
4.
ProbaleFees ~(i ti?J. ~ ~ ~
Accountant's Fees
5.
6. Tax Retum Preparer's Fees
7. ctU:11A.a::Qx;:12&mViCLvrJ) ~~
g, ~&-6~~~~(56%)
9, ~'#V~~j)Jue-~~
AMOUNT
~d9/. It!)
/.50.06
5'96. {)6
/55". I ~
8' &'. IS
/ R, {J,;j
?t?6o
QJO. CJC>
I ~ So. {)6
/js,d. 9
TOTAL (Also enter on line 9. Recapitulation) $ &:, 6 ~ s: t, 9'
(If more space is needed, insert addilional sheets of the same size)
_ . _.._._ __ ___...... ~....... oOII....."&""~ :N:L.I:\..'I:LI
Charges are only for those items that you selected or that are required. If we are required by law or by cemetery or crematory to use any items, we
wil~plain~ writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for
embalnfing. You do not have to pay for embalming you did not approve if you selected arrangements such as direct cremation or immediate burial. If
~
we charged for embalming, we will explain why below.
~ For the Service of: Ruth D. Sander
Charge to. Kim Merlino
Name
22 Wheat Field Dr.
Address
Carlisle,
aty
Date of Death,April15, zooz
PA 17013
State and Zip code
$ .m-...
$ included
$ 000
$ included
_ pil.'.luded
$ 000
$ included
$ 000
SUB-TOTAL OF FACIUllES &. EQUIPMENT
3. AUTOMOTIVE EQUIPMENT
Removal and transfer vehicle
Local.. . . . ................
Hearse ( Casket COach )
Local........... ..........
$ included
$indll.v..rl
~'.!I~~
$000
$ indll.v..rl
$ included
,"1_
$ 401000
$ 000
$ 0.00
$ 0.00
I
/
$ 0.00
$ 0.00
Acknowledgement cards. , .
Register book(s). . . . . . . . . . . . . . .
MemoryFolders.............. .
Prayer Cards. "......,........
Temporary grave marker. . . . . . . . .
Bur.aIClothlng............,.. .
Otherdothlng................ .
Cremation urn. . . . . . . . . . . . . , , , .
( DescrIption )
$ included
$ included
$ 000
$ 1000
$ 000
$ 000
$ 000
$ 000
SUB-TOTAL OF PROFESSIONAL SERVICES
2. FAQLJT1ES AND SERVICES
Use of fadlltles and serviCeS for
vieWlng(VlSltatlon/Wake). . . . . . .
Use of fadlltleS and services
for funeral ceremony. . . . . . ....
Use of fadllties and servIces for
Memorial Service. . . . . .. . . . ...
Use of equipment and servIces
for graveside service. . . . . . . . . .
Other use of fadlltieS
A. CHARGE FOR SERVICES SELECTED
1. PROFESSIONAL SERVICES
Seovlces of runeral dlrectollstaff. . .
Embalming.. ....... . . . . . . . . . .
Other preparation of the bOdy . . . . .
UmouSine
Local................. . . ..
Family Car
Local.. ...................
Flower car or floral disposition
Local........... ..........
Lead car I Oergy car
locaL............... , , , . .
Car for pallbearers
Local... . ... . .............
Out of town transportation. . . . . . . .
""""'-,
Casket package. ..............
{DE:SCrtptlon}
inrllJrI""th~r:lc:Il''''''r1P<:1TiI'\Pl1
:>JMVP :>Inri .::IrlrllHnn;a1 grvvlc: ;Inri q>rvtcP<;;
InrlJr;:atM nn thic: d";ilh'mpnt :>1<:' In.-II IrlM
(' )
Other receptacle. . . . . .
( DescrIption)
""...~ h.......l rn I
Ptttsburgh Post Gazette $ 14110
Tribune Review Newspaper $ 3500
&.itIef EaOe $ 30 00
TOTAL MERCHANDISE SELECTED. . . . . . .
C,SPECIALCHARGES
forwarding of remains to: $ 000
Receiving of remains from:
$ 000
$ 4246.10
Immediate burial. .............. $ 000
Dlrectcrematlon............. . $ ClOO
$ 000
TOTAL SPECIAL CHARGES. . . . . . , . . . . . . $ 0.00
D. CASH ADVANCED ITEMS $ 000
Grave OpenIng
Cemetery Equipment $ 000
Coroners Cremation AuthoriZation $ 000
Shipping or Airfare $~-
Oergy and/or Mass Offering $ 000
AoriSt expenses $ 000
Headstone Engraving or Purchase $ 000
Other Newspaper Notice $ 000
Other Newspaper Notice $ 000
ProfessJonal Hairstylist $ ''100
Certified Copied oftne Death Certificate $ :nloo
$ 000
TOTAL CASH ADVANCES. .. . .. . . . . . .. .
SUMMARY OF ALL CHARGES
A. ProfessiOnal services, Fadlitles and
Equipment, and Automotive
Equipment..... .............
B. Merchandise.................
C. Spedal Olargcs. .. .. .. .. .. .. ..
D. Cash Advanced Items. . . . . . . . . ,
$ 000
$ 424610
$ 000
$ 4500
$ 000
$ 000
$ 000
$ 0.00
SUB-TOTAL OF AUTOMOTIVE EOUIPMENT
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE
EQUIPMENT. . . . . . . . ., . . . . . ., . .. .
B. CHARGE FOR MERCHANDISE SELECTFn
Casket........,',........... ~ hKied
(Description) Batesvllle-Hardwood
TOTAL OF ALL SECTIONS. . . . . . . . .
DISCOUNTS AND ALLOWANCES. . . .
PAID AT TIME OF OR PRIOR TO
ARRANGEMENTS............... .
BALANCE DUE. . . .. . . .. .. .. .. ..
$ 45.00
$ 4291.10
$ 0.00
$ 0,00
$ 4291.10
REASON FOR EMBALMING
If arry law, cemetery, or crematory requirements have required the purchase of
any Items above, It is explained below.
Embalmina 8DDroved-VisitationJviewil1G
REV-~'S:('-S7\ :.~.
,.~
COMMOHWEALTH OF PENNSYLVANIA
INHERITANce TAX RETURN
RESIDENT DEceDENT
ESTATE OF :;(u:i; h .D ~
SCHEDULE J
BENEFICIARIES
(l/J er o?CJtJ 0) - t)C) '-/3.3
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Nol List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal dislributions)
1. iUa.ltkmtJUu::/ ~a/Y)~ ~. SO/J c:2s%
Sbc.Au.;/t') 9"/-30 -73 '7 /
.;;;..j lj)~c~ &.
~/fb..lp 7"19 ~
c2 ~v:~ <:9$%
It.. S-.J./O.d:l3'1/
dcX w~iQ/lJ.
~.J PCt-. /70/3
03, ~e.~
~61o ~ "-IJ../.02 7 3;;:;
~<l7P~bun, 06//) OiS'%
~,,6a.. /:S-Ol/V
1 ~ w. ~oUv 0b?G eX S o/.,s
I ~/. .J./~-c::)/J1?' ~
10.3 /Y)~&./ ,Pa. /660/
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- T AXABLIE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELlECTION TO T AA IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART D . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
d
FILE NUMBER
(n more space is needed, insert addITional sheets of the same size)
" /? - 60 - t<-.!3
)p BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND A~SESSHENT OF TAX
KIM MERLINO
22 WHEATFIELD DR
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-30-2002
SANDER
04-15-2002
21 02-0433
CUMBERLAND
101
'*
REY-1547 EX AFP (01-021
RUTH
D
Allount Rellitted
PA 17013
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=i5'4j-EX-AFP--('OY:02Y-No7ficE--OF-YNHEifiTANCE-YAirA" PPRA"isEi"-ENT~--A[rOWANCE-(rR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SANDER RUTH D FILE NO. 21 02-0433 ACN 101 DATE 09-30-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
938.85
.00
.00
675.00
10.197.48
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
6,685.69
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
11,811.33
6.685 69
5,125.64
.00
5,125.64
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ Abb
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX DITS:
.00 X 00 =
5,125.64 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
DATE
08-20-2002
NUHBER
CD001544
+
INTEREST/PEN PAID (-)
.00
AHOUNT PAID
230.65
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
230.65
.00
.00
230.65
230.65
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
Name of Decedent:
Date of Death:
Will No.:
STATUS REPORT UNDER RULE 6.12
(9~hD,,f~~ ,~._.~ 3 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 I~ No [-1
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:
Did the personal representative file a final account with the Court?
Yes_ No 1~.
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 ~] No ['-1
Date:
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 this report.
Si~gnature
Name
Address ~-~( r / /S,,/'~, / 7DI
Telephone No.
Capacity: ~ Personal Representative
[--] Counsel for personal representative