HomeMy WebLinkAbout03-0590PETITION FOR PROBATE & GRANT OF LETTERS
Es~ of G. ROBERTUMBERGER
also known as
Social Security No. 195-16-4078
, deceased.
No.
21-03- k_~'~O
To: Register of Wills for the
County of Cumber/and
Comrnonwea/th of Pennsylvania
The Petition of the undersigned respectfully represents that:
Your Petitioners, who are 18 years of age or older and the Executrix named in the Last Will of the above
decedent dated December 6, 2001 , and codicils dated none The Executor
named none died Renunciations for none attached hereto.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal
residence at 111 Locust Way, Carlisle, Middlesex Township
Decedent, then 79 years of age, died June 30
East Pennsboro Township, Cumberland County, Pennsylvania
,2003, at
Holy Spirit Hospital,
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:
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 PA
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania, situated as follows:
111 Locust Way, Carlisle, PA 17013
$45,0OO.OO
$
$120,000.00
WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented
herewith and the grant of letters testamentary thereon.
Signature(s) and Residence(s) of Petitioner(s):
Nancya~n Sheaffer Il
486 N. Locust Point Road
Mechanicsburq, PA 17055
717-691-7552
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS
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 representative of
the above decedent, petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this 02/ day of
July ,2003.
- ~
N'ancyann Sheaffer
Estate of G. ROBERT UMBERGER
, deceased.
DECREE OF PROBATE & GRANT OF LETTERS
AND NOW, July ~ , 2003, 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
December 6, 2001 described therein be admitted to probate and filed of record as
the Last Will of G. Robert Umberqer ; and Letters Testamentary are hereby
granted to Nancyann Sheaffer
FEES
Probate, Letters, Etc ........ $ 235.00
Short Certificates(-3- ) .... $ 9.00
Renunciation(s) ........... $
JCP .......... ' .......... $. 10.00
Other Will Pages (-2-) .... $6.00
TOTAL: .... $ 260.00
Filed ............................
(
,iq~,~T'(25476)
ATTORNEY (Sup. Ct. LD. No.)
60 West Pomfret St., Carlisle, PA 17013
ADDRESS
717-249-2353
PHONE
I.E: £ ~ LZ ']Fir' ~0.
Z~Z:[~t LZ 'Iff? ~'0,
LAST WILL AND TESTAMENT
I, G. ROBERT UMBERGER, of Middlesex Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
ONE: I direct my personal representative to pay all of my debts,
administrative expenses as soon as may be done conveniently after my decease.
funeral and
TWO: I give, devise and bequeath all of my estate of every nature and wherever situate
in equal shares to my daughter, NANCYANN SHEAFFER and my son-in-law CHARLES L.
SHEAFFER. If one of them has predeceased me, the survivor of them will receive the balance
of the sum of my estate.
THREE: I nominate and appoint NANCYANN SHEAFFER to be the Executrix of
this my Last Will and Testament. Should she die before my death, renounce or refuse to serve
for any reason, or die leaving any of my estate
CHARLES L. SHEAFFER, as substitute Executor..
unadministered, I nominate and appoint
Should he die, renounce or refuse to serve
for any reason, or die leaving any of my estate unadministered, I nominate and appoint the
FIRST NATIONAL BANK OF MARYSVILLE, Marysville, Pennsylvania, as the Executor of
my estate. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain
property for such length of time as he may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as he may deem proper; and invest estate property and
income without restriction to legal investments.
FIVE: No Executor or Executrix, acting hereunder shall be required to post bond or
enter security in this or any jurisdiction.
SIX: In the event of a common disaster causing the death of myself, my daughter and
my son-in-law, all within a period of sixty (60) days, then I give, devise and bequeath the rest,
residue and remainder of my estate to the CARLISLE FIRST CHURCH OF GOD, which, at
this writing is located at 705 Glendale Street, Carlisle, Pennsylvania 17013 or the successor of
that church.
IN WITNESS WHEREOF,
December 2001.
I have hereunto set my hand and seal this __
~ ~day of,
.(S~AL)
Signed, sealed, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, G. ROBERT UMBERGER, CHERYL L. CLELAND and SHARON L.
SCHWALM, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his last will and that he had signed willingly, and
that he executed it as his free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to
the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
~HARON L. SCHW~LM
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by G. ROBERT UMBERGER, the
testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and
SHARON L. SCHWALM, witnesses, this t_~% day of December, 2001.
Mombr~r o~nn~vlv2tnir., ~ssoc, iation Ot Notaries
LABT I~LL AND
TI~ST~ OF
G. ROBERT UI~BF.~GER
LAW OFFICES
IRWIN, MCKNIGHT & HUGHES
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE, PENNSYLVANIA 17013-3222
(717) 249-2:353
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Estate No.:
G. ROBER'[i UMBERGER
JUNE 30, 2003
21-03-0590
To the Register:
I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on August 27, 2003 .
Name
Nancyann Sheaffer
Charles L. Sheaffer
Address
486 North Locust Point Road, Mechanicsburg, PA 17050
486 North Locust Point Road, Mechanicsburg, PA 17050
Notice has now been given to all persons entitled thereto und~,l~le 5.6(~except _none.
Date: ' 08/27/03 ~'//~{~Y//~A ~
IRWIN, McKNIGHT &'"Iq~GHES
Name Marcus A. McKnight III, Esquire
Address 60 West Pomfret Street
Carlisle, PA 17013
Telephone (717) 249-2353
Capacity:
X
Personal Representative
Counsel for Personal Representative
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 003071
MCKNIGHT MARCUS A III ESQUIRE
60 W POMFRET STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 195-16~4078
FILE NUMBER: 2103-0590
DECEDENT NAME: UMBERGER G ROBERT
DATE OF PAYMENT: 09/30/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/30/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $7,500.00
REMARKS:
TOTAL AMOUNT PAID:
MARCUS A MCKNIGHT III ESQUIRE
$7,500.00
SEAL
CHECK# 020286
INITIALS' JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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 003328
MCKNIGHT MARCUS A III
60 W POMFRET STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 195-1 6-4078
FILE NUMBER: 2103-0590
DECEDENT NAME: UMBERGER G ROBERT
DATE OF PAYMENT: 12/11/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/30/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $478.21
TOTAL AMOUNT PAID:
$478.21
REMARKS: MARCUSA MCKNIGHT
SEAL
CHECK# 020594
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-03-0590
COUNTYCODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Umber~er G. Robert
DATE OF DEATH (MM-DD-YEAR) J DATE OF BIRTH (MM-OD-YEAR)
06/30/2003 12/09/1923
(IF APPLICABLE) SURV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
cAPB
upRL
~=lO
~AC
ES
SOCIAL SECURITY NUMBER
195-[6-4078
Co.
R 5.
E
C
A 6.
P
I
T
U 7.
L
A
T 8.
I
O 9.
N 10.
11.
14.
C
O
M
mr,
T
I
O
N
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. OrigirlalReturn ~ 2~! SupplementalReturn H
4. Limited Estate · Future lnterest Compromlse (date of death after 12-12-82)
8. Decedent Died Testate Decedent Maintained a Living Trust 0
(Attach copy of Will) (Attach copy of Trust)
~ 9. Litigation Proceeds Received ~] 10. Spousal Poverty Credit ~
(date of death between 12-31-91 and 1 - 1-95)
NAME
Harcus ^. McKnight Esq.
FI R M NAM E (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717/249-2353
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Jointly Owned Property (Schedule F) (6)
~ Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11 )
(date of death
3. Remainder Return prior 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
60 West Pomfret Street
West Pomfret Professional Bldg.
Carlisle, PA 17013
140,000.00
None
None
None
67,699.24
None
None
20,251.06
823.30
· * OFFICIAL USE ONLY
(8) 207,699.24
(11) 21,074.36
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13) (14)
(12) 186,624.88
186,624.88
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00
16. Amount of Line 14 taxable at lineal rate 186,624.88 X .0 45. (16) 8,398.12
17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00
18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00
19. Tax Due
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
111 Locust Way
CITY
Carlisle
ISTATE
?^
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
7,500.00
419.91
(4)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable D. Interest
E. Penalty
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 I 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. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
8,398.12
7,919.91
0.00
0.00
478.21
0.00
478.21
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
;i retain the use or income of the property transferred; .........................
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 consideratiol3? ................................ J--J J~l
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. J"--J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designatior{? ................................ J---J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Nancyann Sheaffer DATE
,/~/~/~ /+86 N. Locust Point ...........
SIGNATUREOFP~OTH~HANR~SENTATIVE IRWIN & Mc~IG~ DATE
_~~~/,/t ~ ~ 60 West Pomfret Street
/" % ...........................
For dates of death on or after July 1, 1994 and before Janua~ 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 aher Janua~ 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 s~tute does not exempt a transfer to a surviving spouse from tax, and the statuto~ requiremen~ for disclosure of assets
and filing a tax return are ~ill applicable even ~ the surviving spouse is the only beneficial.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twen~-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(I
[72 P.S. a~ ~ 6(a)( ~ )].
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(aXl.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.
Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-lSD0 EX (Rev, 6-00)
REV- 1502 EX'+ (1-97)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
G. Robert Umber~er SS~; 195-16-4078 06/30/2003 21-03-0590
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
knowledcje of the relevant facts. Real property which is iointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
ITEM
NUMBER
111 Locust Way, Middlesex Township, Cumberland County -
(settlement sheet attached)
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 1, Recapitulation)
VALUE AT DATE
OF DEATH
140,000.00
$ 140,000.00
Copyright (c) 1996 form software only CPSysterns, Inc. Form REV-1502 EX (Rev. 1-97)
RE"V- 1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
F. SYATE OF
G. Robert Umber~er SS~/
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
195-16-4078 06/30/2003
FILE NUMBER
21-03-0590
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1
2
3
4
5
Cornerstone
Cornerstone
Cornerstone
First National
Miscellaneous
Federal Credit Union - savings
Federal Credit Union - checking
Federal Credit Union
Bank of Marysville - checking
personal property sold
TOTAL (Also enter on line 5, Recapitulation)
18,842.50
855.50
21,132.82
6,446.42
20,422.00
$ 67,699.24
(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)
REV- 1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
G. Robert Umber~er SS#
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
195-16-4078 06/30/2003
FILE NUMBER
21-03-0590
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
2
1
2
3
4
DESCRIPTION
FUNERAL EXPENSES:
Carlisle Memorial Service
Michael J. Shanolis Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / ElM Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees IRWIN & McKNIGHT
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal
estate notice publication
Magee Auctions - commission
Register of Wills filing fee
The Sentinel - Legal - estate notice publication
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
456.80
5,234.40
8,290.00
260.00
75.00
5,807.75
25.00
102.11
$ 20,251.06
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REv-1512 EX' + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
F. STATE OF
G. Robert Umber~er SS~/
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
195-16-4078 06/30/2003
FILENUMBER
21-03-0590
Includ~
ITEM
NUMBER
1
2
3
4
5
unreimbursed medical expenses.
DESCRIPTION
Armesto Eye Associates
Middlesex Township Municipal Authority
Penn Power & Light Co.
Sprint Telephone
York Waste Disposal
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 10, Recapitulation) $
AMOUNT
200.00
157.50
370.08
58.13
37.59
823.30
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REv-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
G. Robert Umber~er SS~/
NUMBER
I.
2
II.
SCHEDULE J
BENEFICIARIES
195-16-4078 06/30/2003
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Ss. 9116(a~1.Z)]
Charles L. Sheaffer
486 N. Locust Point Road
Mechanicsburg, PA 17050
Nancyann Sheaffer
486 N. Locust Point Road
Mechanicsburg, PA 17050
RELATIONSHIP TO DECEDENT
De Not List Trustee(s)
Son-in-Law
Daughter
FILE NUMBER
21 - 03- 0590
AMOUNT OR SHARE
OF ESTATE
1/2 remainder
1/2 remainder
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
(If more space is needed, insert additional sheets of the same size)
$ 0.00
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
I, G. ROBERT UMBERGER, of Middlesex
Pennsylvania, declare this instrument to be my Last Will
revoking all Wills and Codicils heretofore made by me.
Township, Cumberland County,
and Testament, hereby expressly
ONE: I direct my personal representative to pay all of my debts, 'funeral and
administrative expenses as soon as may be done conveniently after my decease.
'TWO: I give, devise and bequeath all of my estate of every nature and wherever situate
in equal shares to my daughter, NANCYANN SHEAFFER and my son-in-law CHARLES L.
SHEAFFER. If one of them has predeceased me, the survivor of them will receive the balance
of the sum of my estate.
THREE: I nominate and appoint NANCYANN SHEAFFER to be the Executrix of
this my Last Will and Testament. Should she die before my death, renounce or refuse to serve
for any reason, or die leaving any of my estate unadministered, I nominate and appoint
CHARLES L. SHEAFFER, as substitute Executor.. Should he die, renounce or refuse to serve
for any reason, or die leaving any of my estate unadministered, I nominate and appoint the
FIRST NATIONAL BANK OF MARYSVILLE, Marysville, Pennsylvania, as the Executor of
my estate. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain
property for such length of time as he may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as he may deem proper; and invest estate property and
income without restriction to legal investments.
FIVE: No Executor or Executrix, acting hereunder shall be required to post bond or
enter ~ecurity in this or any jurisdiction.
SIX: In the event of a common disaster causing the death of myself, my daughter and
my son-in-law, all within a period of sixty (60) days, then I give, devise and bequeath the rest,
residue and remainder of my estate to the CARLISLE FIRST CHURCH OF GOD, which, at
this writing is located at 705 Glendale Street, Carlisle, Pennsylvania 17013 or the successor of
that church.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~day of,
December 2001.
(SEAL)
Signed, sealed, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, G.' ROBERT UMBERGER, CHERYL L. CLELAND and SHARON L.
SCHWALM, the testator and witnesses respectively, whose names are signed to the £oregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his last will and that he had signed willingly, and
that he executed it as his free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to
the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
CHERYL,. C~LELAND
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by G. ROBERT UMBERGER, the
testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and
SHARON L. SCHWALM, witnesses, this l~% day of December, 2001.
Notarial Sea-'~
Martha L. Noet, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Sept. 18, 2003
~lemr, er .:',~nn~v~v~ni~ ~.,~soc. iatJorl Of Notaries
LAW OFFICES
IRWIN, MCKNIGHT & HUGHES
14lEST POMFRET PRQ~:ESSIONAL BUILDING
60 VVE S T PQ~fFRET STREET
CARLISLE, PENNSYLVANIA 17013-3222
C. Note:
A. Settlement Statement
U.S. Department of Housing and Urban Develo0ment
OMB No. 2502-0265
_B. TYPE OF LOAN
I. [~FtIA 2. L~Fm}IA 3. E]Conv. Unins.
4, ~VA _5. [:]Conv, b~s.
6. FILE NUMBER T 7. LOAN NUMBER
CHAPLINSKIN11/0M. AM __ [ 10959
8, MORTGAGE 1NSUILANCE CASE NUMBER
This form is furnished to g va you a statement of actual settlement costs Amounts paid to and b the se
terns marked "(p o c "were aid ou ' ' ' y [1lament agent are shown·
· · .} p tside the c oalng; they are Ihown hare for lnfomlatlen purpoles and are not included in the totall.
WARNING:)tisacrimetoknowinglymakefaleeatatementslotheUnrmdStalesonthisoran otherst i
D. NAME OF BORROWER:
__ ADDRE.~L~:
E NAME OF SELLER:
__~ADDRES$:
F. NAME OF LENDER:
ADD~?~ESS;
G. PROPERTY ADDRESS:
H SE/TLENtENT AGENT:
PLACE OF SETTLEMENT_. _-___
I. SE'ITLEMENT DATE; __
11/14/2003
_ J. SUMMARY O~F BORROWER'S TRANSACTION:
100. GROSS AMOUNT DUI:~:ROM BORROWER
101. Contract sales nrlce [ 14 0 ~ 0 0 0 · 0 0
102. Personal P~ertv
~. Settlement charoes to borrower [line 1400} zl. · 8 8 5 · 14
--104,
NATHANIEL L. CHAPLINSKI and JENNIFER L. CHAPLINSKI
3276 SPRING ROAD. CARLISLE. PA. 1__7013
ESTATE OF G. ROBERT LrMBERGER
111 LOC_UST WAY, CARLISLE, PA 17013
WAYPOINT BANK
101 S. GEORGE STREET. YORK. PA, 17401
111 LOCUST WAY, Carlisle, PA 17013
LOT 12 EVERG~REE~N_ ESTATES, Middlesex Township
IMH REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717-249-6354
West Pomfret Profe~_sional Bldm 60 West Pomfret Street,~_Carlisle, PA 17013
~Q0~-MOUN~SJ°AID BY OF{ ON BEHALF OF BORROWER 201. DePosit or eari3est money
-~J~, Principal amount ofnew IOaQ~ __ 112 · 000 . 00
~,~0~.~a loan(s) taken sut~JTJ;_t~
J04. S ~¢ond Mort _ueg. e_ _ 21,000.00
WAYPOINT BANK
207.
L
/~;[j~J:~n~.,.i for items unoaid by selllr
215.
217,
..~18.
~.20. TOTAL PAID BY/FOR~,~OWER 133,000.00
_~ CASH AT SE'I-rLEMFbJT~OM OR TO BORR(~WER
._.~01. Gross afflOunt due fro~.borrower [line 120J ~ 145 ~ 618.25
302. Less amounts oald bv/fo]:jza[rJ3~er [llne ~Oj I 133,000.00
L_303. (;A.~-LFROM BORR_Q~R / 12 , 618 . 25
K=SUMMARY OF SELLER'S T_PANS_ACTION:
400. GROSS AMOUNT DUE TO SELLER:
401~ Contract sales ~
40-~, Personal Prooer~
403.
404.
407,
408.
409.
410,
Ad_iustments fpr items paicLt~/A I~
~.mtv taxes 11/14/03t01~2/31/_03
8cl,,,ul Tax 11/14/031006/30_0~_~_
411, ~
412·
'420. 'GROSS AMOUNT DUE T~) SELLl~R~__.
500. REDUCTIONS IN AMOUNT DUE T~$J~I. LER
501. Excess Den~-~*,[see InstructionsI
502. Settlem~rtt charoes to seller [line 14001
503. Existing_ Ioan(s}laken subject to
5q4~ Payoff of FJ)'at MortGage Loan
501~.
509
513.
514.
516.
517.
518.
519.
_ Ad!ustments fQLJ/ems uno)aid b~/sell~r___
140~000.00
48.79
684.32
140,733.1_~1.
1,438.94
520. TOTAL REDUCTION AMOI JNT DUE ,$J~LLER .. 1,4_3 8.94
600. CASH AT SETTLEMENT TO OR FF~OM SELLEI~
601. Gross .... nt due t ~ sellp, j'_(Jlne 42o1 t 1~0,733.1~
602. L ..... dueflon ~t d .... I'., flirt. ~ ~
603. CASH TO SEI I~R ~ 139.294.17
TitleExpress Settlement Syslem Printed 11/13/2003 at 16:01
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iN3tfldOq~A~O NV~N QNV ONI~NOH dO lN~fll.~Vd~lCl 'S'N
MAGEE AUCTIONS
FINAL SETTLEMENT
SELLER NAME/xIA,.<v4,.,~
ADDRESS ///
DATE OF SALE
PHONE ~9/-"
ZIP /7~ / ~
LOCATION OF SALE
AUCTIONEER
PHONE
SELLER'S EXPENSES
RECEIPTS
PROFESSIONAL FEES
AUCTIONEER A ~'r~
PERS PROP
REAL ESTATE
CLERK
CASHIER
OTHER EXPENSES
EXPEDITER
RUNNERS
PREP LABOR
TRUCK
TENT
ADVERTISING
A~v. £~ /~t~.~ ~4~.~
DATE SIGN BAR
$ lee ~ee
$
s J55.~o
$
$ /3.2~
PORT-A-POT
MISC
TOTAL EXPENSES
CASH $
CHECKS $
TOTAL RECEIPTS $ ~.~q ~-
LESS TOTAL EXPENSES $
NET PAY TO SELLER $ j L-IL( £/~L.
I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net
proceeds fi.om the auction of my goods and property sold on the above date. I accept all
respo~iblli~ for providing merchantable title to all goods, and property sold, and for delivery of
tit]e/to]the ,Prlrchajcr, '
Auetloaeer / ~ashier's Signature (Sell~r's Sigaall~e)
Date Date
(Seller's Signature)
MAIN OFFICE:
101 Lincoln Street
Phone: (717) 957-2196
Fax: (717) 957°4578
of ~arysville-'~-
P.O. Box B Marysville, PA 17053-0017
RIDGEVIEW OFFICE:
500 S. State Road
Phone: (717) 957-2114
Fax: (717) 957-4678
SEPTEMBER 30, 2003
IRWIN MCKNIGHT & HUGHES
WEST POMFRET PROFESSIONAL BUILDING
90 WEST POMFRET STREET
CARLISLE PA 17013-3222
RE: ESTATE OF G ROBERT UMBERGER
HERE IS THE iNFORMATION YOU REQUESTED:
CHECKING 30-595-2
G ROBERT UMBERGER
OPENED: 10-31-80
IN-T RATE: .60%
DOD BAL: $6,446.42
DOD INT: .74
OCT - 7 2003
IRWIN & McKNIGHT
IF YOU REQUIRE ANY FURTHER INFORMATION, PLEASE FEEL FREE TO CONTACT US.
SINCERELY,
BARBARA RECHER
CUSTOMER SERVICE
CORNERSTONE
RO. Box I 18 I, 5 East Gate Drive, Carlisle, PA 17013
F e d e r a I C r e d i t U n i o n Telephone (717) 249-1661 FAX (717)249-8208
3dember founded-- Service based www. cornerstonefcu.org
July 28, 2003
Irwin, McKnight, & Hughes
60 West Pomfret Street
Carlisle, PA 17013
Dear Sir:
JUL ,"50 200~
Robert Umbe~N' McKNIGHT & HUGHES
An account, number 643, was opened with our financial institution on September
15, 1976 in the name of G. Robert Umberger, individually.
The following is his account information:
Account Type
Balance 06/30/03'
Interest Earned
thru 06/30/03
Date of Death
Balance
Savings $18,842.50
Checking $ 855.50
Certificate $ 21,103.33
$ 29.49
$18,842.50
$ 855.50
$ 21,132.82
*Date of last dividend posting.
Per our records there have been no changes in the account ownership since
opened and no accounts have been closed in within one year.
Please let me know ifI can be of further assistance.
Sincerely,
Molly L. Frohm
Members Service Rep./Admin.
MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $100,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION
Inventory of the real and personal estate of
G. ROBERT UMBERGER
deceased
1. 111 Locust Way, Middlesex Township, Cumberland County ............
2. Cornerstone Federal Credit Union - Savings .................
3. Cornerstone Federal Credit Union - Checking .................
4. Cornerstone Federal Credit Union ......................
5. First National Bank of Marysville - Checking ................
6. Miscellaneous personal property sold ....................
TOTAL .................
140,000
18,842
855
21,132
6,446
20,422
207,699
00
5O
5O
82
42
00
24
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Nancyann Sheaffer
being duly sworn according fo law, deposes and says that she is the Executrix
of the Estate of G. Robert Umberger
late of ..... Mi.d_dl_es_ex _To ~wnship _ , Cumberland County, Pa., deceased and fhaf fha
within is an inventory made by Nancyann Sheaffer __, the said Executrix
of the enflre estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedenf's death.
this
Sworn
nd subscribed before me,
/
,y ~f Deg~m~er, ~ ~003
' I1, _ _/'1_ I
~ ~, ~~ ~n~ I
, ~~ ~~. 14~7 ]
Date of Death
Nancyann~Sheaffer, Excgc~utr'x
486 North Locust Point
Mechanicsburg, PA_____17055
Address
30 06 2003
Day Month Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as +o personalty or realty
4. See Article IV, Fiduciaries Act of 1949. ,
O
0
0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
MCKNIGHT MARCUS A III
60 W POMFRET STREET
CARLISLE, PA 17013
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003522
........ fold
ESTATE INFORMATION: SSN.' 195-16-4078
FILE NUMBER: 2103-0590
DECEDENT NAME: UMBERGER G ROBERT
DATE OF PAYMENT: 02/03/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/30/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $25.17
REMARKS:
CHECK# 020723
SEAL
TOTAL AMOUNT PAID:
$25.17
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. 280601
HARRTSBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ZNHERTTANCE TAX
STATEHENT OF ACCOUNT
R6c!7~3~- :" ~f DATE 05-08-2004
~- ' ESTATE OF UMBERGER
DATE OF DEATH 06-50-2005
FILE NUMBER 21 03-0590
COUNTY CUMBERLAND
ACN 101
Amoun~ Rem/~ed
'04 12 P1:47
MARCUS A MCKNIGHT ES~
IRWIN 8 MCKNIGHT
60 W POMFRET St
CARLISLE PA I
RE¥-1607 EX AFP COl-OS)
G R
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper cred/~: ~:o your account, submi~ ~he upper portion of ~his form wi~:h your ~ex payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-03) ### INHERITANCE TAX STATEMENT OF ACCOUNT
ESTATE OF UHBERGER G R FILE NO. 21 03-0590 ACN 101 DATE 05-08-2004
THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELO#
ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROdECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-02-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
8,398.12
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
$94.74
09-30-Z005
1Z-11-2005
0Z-0~-2004
CD00507!
CDOO$$Z8
CDOO~5ZZ
.00
.00
7,500.00
478.21
25.17
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN
NO PAYMENT IS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT
8,398.12
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
PAYNENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGTSTER OF #TEES, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHNON#EALTH OF PENNSYLVANTA.
REFUND (CR): A refund of a tax credit) which Nas not requested on the Tax Return) may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at
the Office of the Register of Nills) any of the 23 Revenue District Offices or from the Department's Z4-hour
ansaering service for forms ordering: 1-SOO-36Z-ZO50~ services for taxpayers with special hearing and / or
speaking needs: 1-SO0-qq7-30ZO iTT only).
REPLY TO:
questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes) ATTN: Post Assessment Raviea Unit, Dept. 280601) Harrisburg) PA 17IZS-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid aithin three ($) calendar months after the decadent's death) a five percent (SZ) discount
of the tax paid is alZowed.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning aith first day of delinquency) or nine (9) months and one (1) day from the data of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6X) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate Nhich ail1 vary from calendar year to caZendar year with that rate
announced by the PA Department of Revenue. The appZicable interest rates for 1982 through ZOOq arm:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year
198Z 2OX .0005q8 1988-1991 11X .000301 ZOOX
1983 16Z .OOOq38 199Z 9Z .O00Z~7 ZOOZ
198q 112 .000301 1993-199q 7Z .00019Z 2003
1985 13Z .000S56 1995-1998 9Z .O00Z~7 ZOOfi
1986 lOX .O00Z7q 1999 7Z .00019Z
1987 9Z .0002q7 ZOO0 8Z .000Z19
Interest Daily
Rate Factor
9Z .O00Z~7
6Z .00016~
SZ .000137
qZ .000110
--Interest is calculated as folloms:
I'NTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAZEY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice) additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
G. ROBERT UMBERGER
Date of Death:
JUNE 30, 2003
No. 21-003-0590
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: X Yes ~ No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
~ Yes X No
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? X Yes No
Date:
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphan's Court and may be
3/25/04attached to this report~(~~~.~~
' '~' IRWIN & McKNI"G?}¥-~
~ ~ M~cus A. Mc~ight m, Esquire
~ Name (please type or print)
~ 60 West Pomfret Street
~ .. Address
~ C~lisle, PA 17013
~ _ ¢~ City, State, Zip
D ~ (717) 249-2353
Telephone Number
Capacity:
X
Personal Representative
Counsel for Personal Representative
BUREAU OF ZND/VTDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
MARCUS A MCKNIGHT ESQ
IRWIN & HCKNIGHT
60 W POMFRET ST
CARLISLE PA 17013
CONNONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAISEHENT, ALLONANCE OR D~SALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
F/LE NUMBER
COUNTY
ACN
OZ-OZ-ZOOq
UMBERGER
06-50-2005
21 05-0590
CUMBERLAND
101
Amount Roe'ltted
REV-I~G? EX AFP
G R
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~.~ RETA/N LOWER PORTION FOR YOUR RECORDS ~"~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF UMBERGER $ R FILE NO. 21 03-0590 ACN 101 DATE O2-OZ-Z00q
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REV~kSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A)
2. Stocks end Bonds (Schedule B)
$. Closely Held S~ock/PartnorshAp Interest (Schedule C) ($)
q. Mortgages/Norms Receivable (Schedule D) (q)
$. Cash/Bank Deposits~Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers {Schedule G) (7)
8. To,al Assets
APPROVED DEDUCTIONS AND EXENPTXONS=
9. Funeral Expenses/Ado. Costs/M/sc. Expenses (Schedule H) (9)
10. Dobts/Hortgago Liabil/~es/L~ons (Schodulo 1) (10)
11. Total Deduct/ohs
12. Not Value of Tax Return
1~0~000.00
.00
.00
.00
67~699.2q
.00
.00
(8)
20,251.06
823.30
NOTE: To insure proper
credit to your account,
submit tho upper portion
of this form w/th your
tax payment.
13.
lq.
NOTE:
207,699.2q
(11) 21.07~.36
(:].2) 186,62q.88
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15)
Not Velum of Estate Subjoc4: to Tax (lq)
Zf an assessaent was issued previously, lines 14, 15 and/or 16, 17,
reflect figures that /nclude the total of ALL returns assessed to date.
.00
186,62q.88
18 and 19 will
ASSESSNENT OF TAX: 15. Aeoun~ of Line lq et Spousal rate
16. Amount of Line lq taxable mt Lineal/Class A rata
17. Amount of Line lq mt S/bling rata
18. Amount of L/no lq taxable et Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT D/SCOUNT (+)
DATE NUMBER INTEREST/PEN PAZD (-)
09-30-2003 CD003071 39~.7q
12-11-2003 CD003328 .00
PAYMENT MUST BE MADE BY 03-30-Z00q~.
ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATION OF ADDZT/ONAL INTEREST.
(26) .00 x O0 : .00
(16) 186,62q..88 x Oq5: 8,398.12
(~7) .00 x 12 = .00
(28). .00 x 15 = .00
(19)= 8,398.12
AMOUNT PAID
7,500.00
q78.21
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
8,372.95
25.17
.00
25.17
( ZF TOTAL DUE 1S LESS THAN $1, NO PAYMENT KS REgUZRED.
ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE ./)
A REFUND. SEE REVERSE SIDE OF TH/S FORM FOR INSTRUCTIONS.) ~ ~
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR)
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1981 -- if any futura 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
life 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 11~0 of the Inheritance and Estate Tax Act, Act ZS of ZOOO. (7Z P.S.
Section 91q0).
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 mas not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office
of the Register of Rills, any of the ZS Revenue District Offices, ar by calling the special Z~-hour
answering service for forms ordering: 1-800-S6Z-ZOSO; services for taxpayers eith special hearing and / or
speaking needs: 1-DOO-~qT-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--Nritten protest to the PA Departd~ent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-10Z1, 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 bo addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB06Ol, Harrisburg, PA 17118-0601
Phone (717) 787-6503. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (S) calendar months after the decadent's death, a five percent (5Z) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time 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 free the date of
death, to the date of payment. Taxes ahich became delinquent before January l, 19DZ bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .OOOl6q. Ali taxes ehJch became delinquent on and after
January 1, 198Z 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 ZOOS are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yaa._._r Rate Factor Year Rate Factor
1982 ZOZ .0005¢8 1987 91 .OOOZq7 1999 71 .00019Z
1983 161 .000~58 1988-1991 llZ .O00SO1 ZOO0 81 .000219
198q llZ .OOOSO1 1992 92 .O00Zq7 2001 92 .0002~7
1985 152 .000356 1993-199q 71 .000191 Z002 62 .00016~
1986 102 .000274 1995-1998 92 .OOOZq7 ZOOS 51 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
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.