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HomeMy WebLinkAbout02-0343 PETITION FOR PROBATE and GRANT OF LETTERS ....._, l~).pr~. L~T~-Z-4~ ~ ~_. ~./ _o, .. Estate of '-.~.~loJV'Fttl ~__~'~c~-3 (J,~)DJ~g_~O ~ No. ~4 ~_ ~:~- ' ~,-.-' [ r,j .~ - also known ~P CJ To: Register of Wills for the Deceased. County of (~iT'I _~:>I~C.,/~IJ0 in the Social Security No. r~ I ~, ~r3~ '- ~ :,'~ ~. 3 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 execut ct >h% named in the last wilt of the above decedent, dated ~Y'CX-o~ g~.r~,/__,~ [~ ~ ~ , 19 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~.,~--,rJ[ (~ County, P, ennsylvan~a.,,with last family or principal residence at ~q3~3~_,,x~ ("_~x,~_.~_ C___ctm~.~© _0~..._~ ~ /~:~,_ (list street, number and muncipality) Decendent, then ~'~ years of age, died .-~¥'C~ t ~2~ , t~r ~3~OO ~ Except as follows, decedent did n'~t m~rr-y, ~v~s n~)t 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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters e (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ ,-, ~ c~FJ~t_~t,-~ E) 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 lhe above decedent petitioner(s) will well an~ly~dminister the e~tate according to law. before me_,this a~ day of ~ Regtste~ No. 21-02-0343 Estate Of D. M. LEITZELL A/K/A DEMASCUS LEITZELL , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 4th the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated MAY 2, 1998 described therein be admitted to probate and filed of record as the last will of D. M. LEITZELL A/K/A DEMASCUS LEITZELL and Letters TESTAMENTARY 2002, in consideration of the petition on are herebygranted to NANCY J. HERRMAN AND SHIRLEY A. NEIDIG FEES Probate, Letters, Etc .......... $. 200.00 Short Certificates(5) .......... $ 15.00 ~ .~.xx.P,A. ?AO.~..s..4. $ 12.00 JCP $ 5.00 TOTAL ~ $ 232.00 Filed . .A.P.R.!.L..4.~..2p.o.2. .................. Register of Wills ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE MAILED TO EXECUTRIX WITH ORDERS APRIL 4, 2002 04/03/2002 09'38 FAX 94418583 ~001/001 21-02-343 1244 Roberts Valley Rd. Harri~imrg, PA 17110-1764 21-02-0343 LAST WILL AND TESTAMENT OF DEMA$CU$ M, LEITZELL I, Demascus M. Leitzell, of Harrisburg, County of Dauphin, in the State of Pennsylvania, being of sound mind, do make and declare this to be my Last Will and Testament expressly revoking all prior wills and codicils at any time made. ARTICLE I EXECUTOR I appoint, Nancy J. Herrman, of Harrisburg, Pennsylvania, and Shirley A. Neidig, of Dauphin, Pennsylvania, as Co-Executors, of this my Last Will and Testament. My Executor shall be authorized to carry out all provisions of the Will and from my estate shall pay my just debts and funeral expenses, estate, administration and legal fees, expenses of last illness and any estate or inheritance taxes. I further provide my Executor shall not be required to post surety bond in this or any other jurisdiction, and direct that no expert appraisal be made of my estate unless required by law. ARTICLE H PAYMENT OF DEBTS AND EXPENSES I direct that my just and legally enforceable debts, estate administration and legal fees, funeral expenses and expenses of last illness be first paid from my estate. I also direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ARTICLE III DISPOSITION OF PROPERETY I direct that all the rest, residue and remainder of my estate be distributed to my children in equal shares. If a child of mine does not survive,, such deceased child's share shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation. If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be distributed in equal shares to my other children, or to their respective children by right of representation. If no child of mine survives me, and if none of my deceased children are survived by children, my residuary estate shall be distributed to my heirs-at-law as determined under the laws of the State of Pennsylvania. ARTICLE IV EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone. ARTICLE V MISCELLANEOUS PROVISIONS Paragraph Titles and Gender are given to the paragraphs of the Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders and in numbers when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. A thirty day (30) survival requirement is imposed for the purposes of determining the appropriate distributions under this Will, no person or organization shall be deemed to have survived me, unless such person or entity is also surviving on the thirtieth day after the date of my death. The names of my eight (8) children to share equally in my estate are as follows: Roger A. Leitzell Shirley A. Neidig Nancy J. Herrman Dennis J. Leitzell Kenneth L. Leitzell David L. Leitzell Michael R. Leitzell Larry R. Leitzell IN WITNESS WHEREOF, I have subscribed my name below, this 2nd day of May, 1998. We, the undersigned hereby certify that the above instrument, was signed in our sight and presence by DEMASCUS M. LEITZELL (the "Testator"), who declared this instrument to be his Last Will and Testament and we, at the Testator's request and in the Testator's presence, and in the presence of each other, do hereby subscribe our names and addresses as witnesses on the date shown above. Witness Signature:~ ~' ~ Witness Name: ~/J~' h ''~ ~. f~ ~~ Witness Name: .,5~ ~-~ ff"/.¢ .<~ ~( Witness Address: AFFIDAVIT STATE OF PENNSYLVANIA, COUNTY OF DAUPHIN Before me, the undersigned, on this day personally appeared DEMASCUS M.. LEITZELL, '~ ~" ~' 5~/~ar$ and "~co e~ ~r~ ., ~o~ to m~ to b~ ~ T~smtor ~ ~mess~s, whose nmos ar~ si~d to th~ foregoing inst~ent. Demasous M. Leitzell, ~e Tes~tor, deol~ed to me ~d to the wim~ss~s ~at the for~go~g inst~ent is ~e Testator's Will ~d ~at th~ Testator will~gly si~ed ~d executed such ~st~ent ~ ~e presence of the wimesses, as ~e Testator's ~ee ~d vol~ta~ act for the p~oses expressed ~ ~e ~s~ent. Each of · e wimesses decl~ed ~ ~e presence ~d he~g of~e Testator ~at ~e forego~g ~stmem was executed ~d ac~owledged by the Testator as ~e Testator's Will ~ their presence ~d that they, at ~e Testator's request, ~d ~ ~e presence of each other, did subscribe ~eir nines to ~e ~st~ent as a~est~g witnesses on the date of the instmem. The Testator, at ~e time of execution of such ~st~em, was of ~11 age, of so~d m~d, ~d the wimesses were sixteen years of age or older ~d othe~ise competent to be witnesses. DEMASCUSM. Testator , Witness Name , Witness Signature ., Witness Name , Witness Signature 4 Subscribed, sworn to and acknowledged before me by Demascus M. Leitzell, the Testator; and subscribed and sworn before me by ~j'~ta ~. ff'~/~t~g,~r-r' and ,~ ~'~ ~t ~t~ , wlmesses, tl~is 2nd day of May, 199~. o.ta{'y/Public, or other offi~uthorized to take and certify acknowledgments and administer oaths Notarial Seal Karen L. Shugars, Notary Public East Pennsbom Twp., Cumberland County My Commission Expires Jan. 3, 2000 Member, Pennsylvania Association of Notaries JOHN M. SHUGARS ATTORNEY AT LAW 2459 WALNUT STREET HARRISBURG, PA 17103 5 JOHN M. SHUGARS ATTORNEY AT LAW 2459 WALNUT STREET HARRISBURG, PA 17103 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a} Date of Death: Will No. ,_~. To the Register: 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 )gQ ~/~ £/9 ..ff..~ /q4 rv/: Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Address Telephone (q/?) ~-qq ~g Capacity: /W.., Personal Representative Counsel for personal representative If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland Cou~.~,, ! Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 A copy of the Will or Petition may be:obtained by contacting the Register of Wills and paying the charges for duplication. Date: '02 ~' ........ ~ ~ Signature: Name (print) Address iavtt Capacity.( P~r~sonal Representative .::~ Couh~'i-~5~' ~e~0iial representative CONNONHEALTH OF PENNSYLVANIA DEPARTNENT DF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-l;43 EX 4FP (09-00) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 02-05qS ACN 02121776 DATE 05-06-2002 NANCY J HERRNAN 1Zq~ ROBERTS VALLEY RD ', .' EST. OF DEMASCUS M LEITZELL S.S. NO. 716-09-55q$ DATE OF DEATH 05-18-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT [] SAVINGS [] CHECKING [] TRUST [] CERTTF. REHZT PAYHENT AND FORNS TO: REGTSTER OF NTLLS CUMBERLAND CO COURT HOUSE CARL£$LE, PA 17015 CIT- ~NS ~,~.~ has provided the Department .ith the information listed below which has been used in ca~zculating f.e potential tax due. Their records indicate that at the death of tho above decedent, you Hera a joint oener/beneficiary of this accoun*- ZF you Feel this information is incorrect, please obtain ~ritten correction From the financial institution, attach a copy re. this ~ore and return ]t to the above address. This account is taxable in accordance eith the inheritance Tax Le~s of the Commonwealth o~ Pan~.=ylvanie. Questions may ba answered by ceiling (7[7) 767-83Z7. CONPLETE PART 1 BELON x # # SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 100-007-1558 Date 05-11-1996 Established Account Balance 8,$18.16 Percent Taxable X 50.000 Amount Subject to Tax q,159.08 Tax Rate X .15 Potent/al Tax Due 6Z5.86 To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Nills, Agent". NOTE: IF tax payments ara eada within three (3) months of the dacadant's date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due Hill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~zTh. e above information and tax due is correct. You lay choose to remit payment to the Register of Rills eith tho capias of this notice to obtain CHECK · discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE q Hills and an official assessment Hilt ba issued by the PA Department of Revenue. BLOCK J B. [] The above asset has bean or Hill ba reported and tax pald Hith the Pennsylvania [nharitance Tax return ONLY to be Fated by the dacedant's representative. C. [] The above information is incorrect and/or debts and deductions mere paid by you. You must coepiata PART [] and/or PART [] beloH. 6 7 8. Percent Taxable Amount Subject to Tax Debts and Deductions Amount Taxable Tax Rate Tax Due PART DATE PAID DEBTS AND DEDUCTTONS CLAZNED PAYEE DESCRIPTION ANOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under plnaltii$ of perjury, T declare that the facts I have reported ibove itl true, correct and comple*e to the best of my kno.ledge end belief. HONE ( /'llq ) ~/{~--'~ TAXPAYER S~G~URE ~ TELEPHONE NUH~ER ~ATE~ GENERAL [NFORHATZON 1. FAILURE TO RESPOND NZLL RESULT [N AN OFFICIAL TAX ASSESSNENT eith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the dacadent"s name was added as a matter of convenience. 4. Accounts (including those held between husband and mile) ahich the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly beteeen husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART I - TAXPAYER RESPONSE 1. BLOCK A - If tho information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Nills. Z. BLOCK B - If the asset specified on this notice has been or Nil! be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dart z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-154D EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COHPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after lZ/12/BZ: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (aa) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. $. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to tho decedent's death: 1 DIVIDED DY TOTAL NUNBER OF DIVIDED BY TOTAL NUNDER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.77. (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decadent. I DIVIDED BY 2 (SURVIVORS) = .SO X lOO = SOX (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts end deductions (line S) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined beloa. Date of Death I Spouse Lineal Sibling Collateral 07/01/94 to 12/$1/94 3Z 6X 01/01/95 to 06/30/00 OZ 6Z 07/01/00 to present OZ aThe tax rata imposed on th{ 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 OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ehether or not they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants end step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes all other beneficiaries. CLATHED DEDUCTTONS - PART 5 - DEBTS AND DEDUCTTONS CLATHED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. D. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, usa plain paper 8 l/Z" x Il". Proof of payment may be requested by the PA Department of Revenue. _N~ncy $. Herrman _1244 Roberts Valley Rd. Harrisl~urg, pA 17110 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 001164 HERRMAN NANCY J 1244 ROBERTS VALLEY ROAD HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 716-09-5343 FILE NUMBER: 2102-0343 DECEDENT NAME: LEITZELL D. M. DATE OF PAYMENT: 05/10/2002 POSTMARK DATE: 05/09/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/18/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02121776 $592.67 TOTAL AMOUNT PAID: $592.67 REMARKS: NANCYJ HERRMAN SEAL CHECK# 858 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV-~500 EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 LU o INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) /..A:/TzEJ. L /)3. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~---~1. Original Return E~4. Limited Estate [~]6. Decedent Died Testate (Attach copy of Wilt) ~'l9. Litigation Proceeds Received [---~ 2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) D7. Decedent Maintained a Living Trust (Attach copy of Trust) ~--'~ 10. Spousal Poverty Credit (date of death between 12-31-91 and %1-95) (1) (2) (3) (4) (5) (6) (7) OFFICIAL USE ONLY FILE NUMBER COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ] 3. Remainder Return (date of death pdor to 12-13-82) ]5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [--'~ 11. Election to tax under Sec. 9113(A)(Attach Sch O) COMPLETE MAILING ADDRESS PA O.FFICIAL USE ONLY I~AME FiRM NAME (If^pplicabqe) N/A 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) ---]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . . ,,er ~ 8. ILl 9. 10. 11. 12, 13. 14. 17. (Schedule G or L) Total Gross Assets (total Lines %7) Funeral Expenses & Administrative Costs (Schedule H) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) (10) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) Amount of Line 14 taxable at lineal rate Amount of Line 14 taxable at sibling rate Amount of Line 14 taxable at collateral rate x .12 x .15 Tax Due (15) (17) Decedent's Complete Address: STREET ADDRESS ~ ~ P H I'L L. STATE 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) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) (5A) Ail/,/',] (5B) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare lhat I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN - DATE ADDRESS SIGNAtUrE OF PREPARER OTHER T~N REPRES~NTATIVE~ ' ' - DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the 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 RS. {}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 RS. §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 RS. {}9116(1.2) [72 RS. §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 RS. {}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-1E~8 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi ITEM NUMBER DESCRIPTION 1, TOTAL (Also enter on line 5, Recapitulation must be disclosed on Schedule F. VALUE AT DATE OF DEATH (If more space is needed, insert additional sheets of the same size) X 0 0 0 0 O0 0 ~.~ 0 0 o 0 -~ o o ~, r~ ('} 0 0 C; ,COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O01164 HERRMAN NANCY J 1244 ROBERTS VALLEY ROAD HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 716-09-5343 FILE NUMBER: 2102- 0343 DECEDENT NAME: LEITZELL D. M. DATE OF PAYMENT: 05/10/2002 POSTMARK DATE: 05/09/2002 COUNTY: CUM BERLAN D DATE OF DEATH: 03/18/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02121776 $592.67 TOTAL AMOUNT PAID: $592.67 REMARKS: NANCY J HERRMAN SEAL CHECK# 858 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS TAXPAYER COHHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUreAU OF INDIVIDUAL TAXES DEPT. Z80601 H~RRISBURG, PA 171Ze-O60Z REV-I~5 EX AFP C09-00) NANCY J HERRMAN 12qq ROBERTS VALLEY RD HBG PA 17110 ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 02-05q$ ACN 02121776 DATE 05-06-2002 TYPE OF ACCOUNT EST. OF DEMASCUS M LEITZELL [] SAVTNgS S.S. NO. 716-09-55q$ [] CHECKTNG DATE OF DEATH 05-18-2002 [] TRUST COUNTY CUMB£RLAND [] CERTTF. REHTT PkYNENT AND FO~IS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLI'SLE, PA 17015 CITIZENS BANK has provided the Department with thm information listed balom calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account, if you feel this information is incorrect, please obtain Hritten correction from the fin~ulcia[ institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the [nhmritance Tax Laws of the Commonwealth c~ P~nsyiv3nia. Questions may ba answ=rad by c=111=g COMPLETE PART 1 BELOW x # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 100-007-1538 Date 03-11-1996 Established Account Balance 8,318.16 Percent Taxable X 50.000 Amount Subject to Tax q,159.08 Tax Rate X .15 Potential Tax Due 6Z3.86 To insure proper credit to your account, twa (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: if tax payments are made within three (5) months of the decedent's data of death, you amy deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX L/NE A. '~The above information and tax due is correct. You may choose to remit payment to the Register of NiZls with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Hills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or wil! be reported and tax paid with tho Pennsylvania Inheritance Tax return to be filed by the dacadent's representative. C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must co~q=lete PART [] and/or PART [] below. '-~ ~" if you indicate a different tax rate~ please state your relationship to decadent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established 1 2. Account Balance 2 3. Percent Taxable 3 X q. Amount Subject to Tax ~ 5. Debts and Deductions S. - 6. Amount Taxable 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, T declare that the facts ! have reported above era true, correct and complete to the bast of ay kno.ledge and belief. HOME (q I~1 ) .~-C~ q 5 ~ w0. c ) TAYPAVFg &TRNA~I~ t - TELEPHONE NUMBER DATE c Herrman 1244..B.' ~_ ~A 1'/110-1764 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 001271 HERRMAN NANCY J 1244 ROBERTS VALLEY ROAD HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 716-09-5343 FILE NUMBER: 2102-0343 DECEDENT NAME: LEITZELL D. M. DATE OF PAYMENT: 06/07/2002 POSTMARK DATE: 06/06/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/18/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,129.52 TOTAL AMOUNT PAID: $3,129.52 REMARKS: SEAL CHECK# 861 INITIALS' CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDTVZDUAL TAXES TNHERXTANCE TAX DXVTSTON DEPT. Z80601 HARRXSBURG, PA 171Z8-0601 NANCY J HERRMAN 1Zqq ROBERTS VALLEY RD HBG PA 2.7110 CONNONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRA/SENENT, ALLOHANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-01-2002 ESTATE OF LEITZELL DEHASCUS DATE OF DEATH 05-18-2002 FILE NUNBER 21 OZ-OSq5 COUNTY CUNBERLAND SSN/DC 716-09-55~5 ACN 02121776 Amoun~ Rmmi~md HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LXNE ~ RETAXN LOHER PORTXON FOR YOUR RECORDS ~ REV-15gi8 EX AFP (01-0~) NOTICE OF XNHERXTANCE TAX APPRATSENENT, ALLOHANCE OR DXSALLOHANCE OF DEDUCTTONS, AND ASSESSNENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS DATE 07-01-2002 ESTATE OF LEXTZELL DENASCUS N DATE OF DEATH 05-18-2002 COUNTY CUHBERLAND FILE NO. 21 02-05q5 S.S/D.C. NO. 716-09-55~5 ACN 02121776 TAX RETURN HAS: eX) ACCEPTED AS FILED ( ) CHANGED JOXNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: CITIZENS BANK ACCOUNT NO. 100-007-1558 TYPE OF ACCOUNT: ( ) SAVINGS (~ CNECKZNG ¢ ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-11-1996 Accoun~ Balance 8,518.16 Percent Taxable X 0.500 Amoun~ Sub~ec~ ~o Tax R,159.08 Debts and Deductions - .00 TaxabZe Amoun~ ~,159.08 Tax Ra~e ~ .15 Tax Due 625.86 TAX CREDZTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORT[ON OF THIS NOTICE H[TH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, ASENT." PAYMENT DATE 05-09-2002 RECEIPT NUMBER CDOOll6q DISCOUNT (+) INTEREST/PEN PAID (-) 51.19 AMOUNT PAID 592.67 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 625.86 .00 .00 .00 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171ZB=0601 NANCY J 12~ ROBERTS VALLEY RD HBG PA 17110-0000 COHNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX RECORD ADdUSTHENT dOZNTLY HELD OR TRUST ASSETS DATE 07-16-2002 ESTATE OF LEITZELL DENASCUS N DATE OF DEATH 05-18-2002 FILE NUHBER 21 02-05~$ COUNTY CUHBERLAND SSN/DC 716-09-53q$ ACN 02121776 Amoun'l: R~,mi'l:'~ed I HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF NILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 REV-I&04 EX AFP CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1604 EX AFP (12-00) ## INHERITANCE TAX RECORD ADdUSTHENT dOZNTLY HELD OR TRUST ASSETS DATE 07-16-2002 ESTATE OF LEITZELL DEHASCUS N DATE OF DEATH 03-18-2002 COUNTY CUHBERLAND FILE NO. 21 02-03~3 S.S/D.C. NO. 716-09-53~3 ACN 02121776 ADJUSTNENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORNATZON FINANCIAL INSTITUTION: CITIZENS BANK ACCOUNT NO. 100-007-1538 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 03-11-1996 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions - Taxable Amount Tax Rate X Tax Due TAX CREDITS: .00 0.500 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNZT THE UPPER PORTION OF THIS NOTICE NZTH YOUR TAX PAYHENT TO THE REGISTER OF NZLLS AT THE ADDRESS SHONN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: 'REGISTER OF gILLS, AGENT." PAYNENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .00 .00 .0O ,00 REV-1470 EX (6-88)  INHERITANCE TAX COMMONWEALTI'C'OF PE.NNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER demascus m leitzell 2102-0343 REVIEWED BY ACN Robert Wilkerson 02121776 ITEM SCHEDULE NO. EXPLANATION OF CHANGES PER ESTATE EXAMINATION THE ABOVE MENTIONED JOINT BANK ACCOUNT HAS BEEN ADJUSTED TO ZERO DUE TO BEING REPORTED PREVIOUSLY ON THE PROBATE RETURN ROW Page 1 BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVZSLON DEPT. 280601 HARRZSBURG, PA 17128-n601 '02 JdL 2~; NANCY J HERRHAN 124~ ROBERTS VALLEY RD ~" PA 17110 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT~ ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FZLE NUNBER COUNTY ACN REV-15¢7 EX AFP C01-02) 07-22-2002 LEITZELL DEHASCUS H 05-18-Z002 21 02-05~$ CUHBERLAND 101 Amount Remitted I HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WZLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-15&7 EX AFP (01-OP} NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR D~SALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF LEITZELL DENASCUS HF~LE NO. 21 02-03~3 ACN 101 DATE 07-22-2002 TAX RETURN #AS: { X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNT~REST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORZGZNAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B} (2) 3. Closely Held Stock/Partnership Znterast (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) $. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Costs/Hist. Expenses (Schedule H) (9) 10. Debts/Hortgege L/abilities/Liens (Schedule Z) (10) Total Deduct/ons Not Value of Tax Return 11. 12. 13. 1~. NOTE 0O O0 O0 O0 73/205 15 O0 O0 (8) .00 Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Not Value of Estate Sub,act to Tax :Zf an assessment ~as lssued previously, 1ine$ 1~, 15 and/or reflect figures that include the total of ALL returns assessed to date. NOTE: To /nsure proper cred/t to your account, sube/t tho upper port/on of th~s form fi/th your tax payment. 73,205.15 .0O (11) . OD (1~) 73,205.15 (15) . O0 (1~) 73,205.15 16, 17, 18 and 19 w111 TOTAL, TAX CREDZT 3,886.90 BALANCE OF TAX DUEI 592.67CR ZNTEREST AND PEN. .00 TOTAL DUE 592.67CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR)z YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.) ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ASSESSNENT OF TAX: 15. Amount of L/no lq at Spouse1 rote 16. Amount of L/no 1~+ taxable et Lineal/Class A rata 17. Amount of L/no lq et S/bling rate 18. Amount of L/no 1~ taxable et Collateral/Class B rate 19. Pr/ncipal Tax Duo TAX CREDTTS: PAYHENT R~CETpT DTSCOUNT DATE NUNBER INTEREST/PEN PAI'D (- 05-09-2002 CDOOl164 31.19 06-06-2002 CD001271 1~3.52 592.67 3,129.52 AHOUNT PA~D (15) .00 X O0 = .00 (16) 73,205.15 x 0~5= $,29~.23 ('17) .00 X 12 = .00 (18) .00 x 15 = .00 (zg)= 3,29~.23 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG:, PA 171Z8-0601 NANCY J HERRMAN 1Zqq ROBERTS VALLEY RD HBG PA 17110 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT DATE 08-19-2002 ESTATE OF LEITZELL DATE OF DEATH 03-18-2002 FILE NUMBER 21 02-0343 COUNTY CUMBERLAND ACM 101 I Amoun~ Remitted REV-1607 EX AFP (D1-02) DENASCUS H HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit tho uppor portion of this form with your tax payment. CUT ALONG TH'rS L'rNE ~ RETA'rN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-02) #~ 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF LEITZELL DEMASCUS M F'rLE NO. 21 02-03~3 ACN 101 DATE 08-19-Z002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHONN BELON IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATI'ON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED *rNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-15-2002 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 3,29~.23 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-09-2002 06-06-2002 07-30-2002 CDOOll6q CDO01271 REFUND 31.19 133.52 .00 592.67 3,129.52 592.67- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CRED'rT 3,29q.23 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) Name of Decedent: STATUS R ?O T U Dm rtULS 6. 2 Dine of Death: ./yS~ Re6 ].~ ~ oo ~L 'Pursuant to Rule 6.12 of the Supreme Court Orph~n¢' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~] No ['-] 2. If the answer is No, state when the personal representative reasonably believes that the adralni~trafion will be complete: 3. If the answer to No. I is Yes, state the following: Did the personal representative file a final account with the Court? Yes _ No [~ 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' ~ Copies of receipts, releases, joinders and approval of formal or informal account~ nmy be filed with the Clerk of the. Orphans' Court and may be attached to this rePort. si ture O Address' Telephone No. Capacity: [-] Personal Representative [~] Counsel for personal representative