HomeMy WebLinkAbout03-0798PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~ o~ L, /gr'p~--,,,'n £_ ~ NO
Register of Wills for the
Deceased. County of in the
Social Securit.v No. '9 2._ 3 - -/t~ ~ ~ t{ ~ '7 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner{t~0, who is/are- 18 years of age or older, applt'~
for letters of administration
on the estate of
(d.b.n.; pendenle lile; durante ab~entia; duranle minorilalc}
the above decedent.
Decedent was domiciled at death in C' ~ ~ [, a,-~l~ _o,_~q~ ~ County, P.ennsylv_..ania, with
h~,r- last family or principal residence at (~6"-~,tff, Cox. t-~,?f ~[i~[-e~ ~d~o,ro ~
Ilist street, numb~er, Twp'. or Bor~.) C,~'l}-
Decedent, then ~? years of age, died ~c.~ j'f Z ? , ~l~Cr~ 3
Decedent at death owned property with estimated values as follows:
(if domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
t
$.
Petitioner.___ after a proper search ha.3'
the following spouse (if any) and heirs
Name
? ,,q.
· ascertained that decedent left no will and was survived by
Relationship Residence
ri? /ae
THEREFORE, petitioner{gj respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~C ss
COUNTY OF
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(s) 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 ~c~'q'~4 .da~
Estate of 0~, L .-~--_-~-~ nso ~ , Deceased
No.
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~'~_~T~i-~v- ~.~ ..1~, in consideration of the petition on
the reverse side hereof, satisfactory, proof having been presented before me, ' :.'
IT IS DECREED that ~ (~- _f~-~.,-~som '' ~
is/are entitled to Letters of A~ntfinistration, and in accord with such finding, Letters of Administration
are hereby granted
in the estate of ~%'~a~L[ {- [C3Cr'~',,~ger~
FEES
Letters of Administration .....
Short Certificates( ) .......... $
Renunciation · ~.~ ............. $
$
TOTAL $
Filed ~ ........ A.D.
ATTORNEY (Sup."~,. 1.6. N~.'g~
ADDRESS
PHONE
RENUNCIATION
In RE: Estate of Mary L. Atkinson, deceased.
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned Mother of the above decedent, hereby renounces the right to
administer the estate and respectfully asks that Letters of Administration be issued to
and appointment be made to
WITNESS her
Rog C. Atkinson :- ~ .
hand this ff,~,(-~/~ day of./:~ 2~ 2003.
(Signature)
Patricia G. Atkinson
18 Blue Mt. Vista
Mechanicsburg, PA 17050
his is to certi .fy that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The'original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
~ ~ Local Registrar
P 9g09591 SEP a 2003
No. ~ Da~e
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
L :kinson
54
Cumberland Carlisle
College
Carlisle, Penna.17013 ,ES,~
y C. Atkinson
C. Atkinson
Female 223 -74-9427
~t 29, 2003
I.patllr4 [] ER/O~tilnt [] [] I~lng [] RMIklMte~l~ ~Ctey) []
.~.~,~c~.. White
63 West Louther Street
Cumberland
,2003
L
Crematory
Carlisle
George
,Hechanicsburg,Po
Harrisburg, Pe'hna.
aprx i0:0~
~,e~.~l--~ .. Atherosclerotic Cardiovascular Disease
,o0
Ho•
Coroner
2, 2003
Michael L. Norris, Coroner
6375 Basehore Road, Suite ~!
Mechanicsburg, Pa. 17050
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
Mary L. Atkinson
August 29, 2003
Admin. No.:
21-03-0798
I certify that notice of estate administration required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
Roy C. and Patricia G. Atkinson
18 Blue Mountain Vista, Unit 31
Mechanicsburg, PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date:
none
Signature
Name: Roy C. Atkinson
Address: 18 Blue Mt. Vista
Mechanicsburg, PA 17050
Phone: 717-795-9798
Capacity:
X Personal Representative
__ Counsel for Personal
Representative
f' REV-1300 F.X~- (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl.
ATKINSON, MARY L.
DATE OF DEATH (MM-DD-Year)
08/29/2003
REV-I$00
INHERITANCE TAX RETURN
RESIDENT DECEDENT
04/20/1949
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 3 0 7 9 8
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
2 2 3-7 4-9 4 2 7
DATE OF BIRTH (MM-DD-Year)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[~-'1 1. Odginal Retum
r-14. Limited Estate
E~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
E~2, Supplemental Retum
[] 4a. Future Interest Compromise Idate of death after 12-12-82)
[-'-~ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
--'] 10. Spousal Poverty Credit (date of death he.sen 12-31-91 and 1-1-95)
E~]3. Remainder Retum (date of death prior to 12-13-82)
~]5. Federal Estate Tax Return Required
O 8. Total Number of Safe Deposit Boxes
E~]I 1. Election to tax under Sec. 9113(A) (A~ach Sch O
THIS SECTION MUST BE COMPLy- I ED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
JOHN H. BROUJOS, ESQUIRE 4 NORTH HANOVER STREET
FIRM NAME (If Applicable)
BROUJOS & GILROY~ P.C.
TELEPHONE NUMBER
717-243-4574
CARLISLE
PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Proper[7 (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
3,844.84 i'''J
OFFICIAL USE ONLY
(8)
3,914.63
550.95
(11)
(12)
(13)
(14)
3~844.84
4~465.58
-620.74
-620.74
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)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x __ (15)
x .045 (16)
x .12 (17)
x .15 (18)
(19)
0.00
0.00
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
ISTREET ADDRESS 65 W. Louther Street
ISTATE IzIP
OTY Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
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. (EA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (EB)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................[] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under pena t es of perjury I declare that 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 o,.t~--~an the personal representative is,based on all information of wh ch preparer has any knowledge. DATE
SIGNATURE OF'P~R E~E ON S,I ~
ADDRESS Roy C. Atklnson, Administrator, 18 Blue Mountain Vista
M"ech~¢hlc~bu rg ~
SIGNATURE OF PI~E'Ii~A _l:~r O~F:~ T~N"RExPRESdF,~ATIVE
ADDRESS 4~HanoverStreet- - -~ ~
Carl~ N~
PA 17050
DATE
PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a)(1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
The tax rate imposed On the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE E
I c^s.,
coM,~o.
__.L__ PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
ATKINSON. MARY L. 21 I;)~, 079~
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Commerce Bank checking acct # 0513251488
Cash on hand
Sale of 1992 Honda Accord LX Sedan, VIN: 1HGCB7653NA150030
Security deposit refund on apartment
Personal household property (see attached appraisal)
QVC credit on item returned
VALUEAT DATE
OFDEATH
477.04
34.48
1,500.00
420.00
1,320.00
68.89
Comcast refund
24.43
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size) 37844'8'1
REV-1511EX + (1-97]
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ATKINSON. MARY L.
Debts of decedent must be reported on Schedule I.
21 03 0798
ITEM
NUMBER
DESCRIPTION
FUNERAL EXPENSES:
Ewing Brothers Funeral Home
St. John's Episcopal Church - burial of ashes
St. John's Episcopal Church - meal after funeral
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees Broujos & Gilroy, P.C.; EIN: 23-2267691
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Register of Wills - Inventory filing fee
Register of Wills - Inheritance Tax Return filing fee
Register of Wills - Family Settlement Agreement filing fee
Zip
AMOUNT
2,525.00
500.00
350.63
450.00
52.00
10.00
10.00
17.00
TOTAL (Also enter on line 9, Recapitulation) $
i 3~914.63
(If more space is needed, insert additional sheets of the same size)
P~'V-15~2 Ex + ¢-~) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES,& LIENS
FILE NUMBER
ATKINSON, MARY L.
21 03 0798
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
Darlene Moyer, Tax Collector - personal county tax $11 and personal school tax $10
Bobby Rahal Honda - auto repairs
Sprint - telephone
AT&T - long distance telephone
Comcast - cable TV
TOTAL (Also enter on line 10, Recapitulation)
(If more, space is needed, insert additional sheets of the same size)
AMOUNT
21.00
167.16
174.09
61.79
126.91
550.95
REV-i513 F-.X + ['~-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ATKINS( 'N, MARY L.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
]. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Roy C. & Patricia G. Atkinson
18 Blue Mountain Vista, Unit 31
Mechanicsburg, PA 17050
FILE NUMBER
21 O3 0798
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
~arents
100%
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET r
(If more space is neededi insert additional sheets of the same size)
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
Mary L. Atkinson, deceased
File No.: 21-03-0798
Date of Death: August 29, 2003
1. Commerce Bank Checking account # 0513251488 $ 477.04
2. Cash on hand 34.48
3. Sale of 1992 Honda Accord LX Sedan, VIN: 1HGCB7653NA150030 1,500.00
4. Personal household property 1,320.00
5. Security deposit refund on apartment 420.00
6. QVC credit on item returned 68.89
7. Comcast refund 24.43
TOTAL $ 3,844.84
I, Roy C. Atkinson, Administrator of the Estate of Mary L. Atkinson, late of Carlisle,
Cumberland County, Pennsylvania, have made an inventory of the entire estate of decedent,
consisting of all the personal property and real estate, except real estate outside the
Commonwealth of Pennsylvania, and the figures opposite each item of the Inventory represent
the fair value as of the date of decedent's death.
y . ' on, Executor
March 16, 2004
BUREAU OF /ND/V/DUAL TAXES
ZNHERZTANCE TAX DTVTSTON
DEPT. 260601
HARRISBURG, PA 17128-0601
JOHN H BROUJOS ESQ
BROUJOS & GILROY
~ N HANOVER ST
CARLISLE
COHHONWEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOT/CE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
'O4
OF DEDUCTZONS AND ASSESSHENT OF TAX
-· DATE 0~-26-200~
ESTATE OF ATKINSON
DATE OF DEATH 08-29-2005
FZLE NUHBER 21 03-0798
~r'i :~ COUNTY CUNBERLAND
ACN 101
Amoun'l: Rmm.iA:~md
REV-IS47 EX AFP (OI-OS)
NARY
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LZNE I~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOT~CE OF ZNHERZTANCE TAX APPRAZSENENT~ ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF ATKINSON NARY L FZLE NO. 21 03-0798 ACN 101 DATE Oq-26-200q
TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE /NTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~m (Schedule A) (1)
2. Stocks and Bonds (Schedule B)
3. Closely Held S~ock/Par~nmrshAp /n~mrms~ (Schedule C) (3)
~. Nor~gages/No~es Receivable (Schedule D) (~)
5. Cash/Bank Depos~s/NAsc. Personal Propmr~y (Schedule E) (5)
6. Jointly O~nmd Propmr~y (Schedule F) (6)
7. Transfmrs (Schedule G) (7)
8. To~ml Assm~s
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expmnsms/Adm. Cos~s/Nisc. Expanses (Schedule H) (9)
10. Dmb~s/Nor~gaga LiabAIA~A®s/LAmns (Schedule ~) (10)
11. To,al Deductions
12. Na~ Value of Tax Rm~urn
3~8~.8~
.00
.00 NOTE: To insure proper
.00 crmdAt to your account,
.00 submA~ ~hm uppmr portion
.00 of ~his form w,A~h your
~ax payment.
.00
(8)
550.95
13.
14.
NOTE:
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
(2~) .00 X O0 = .00
(26) .00 X Or*5= .00
(17) .00 X 12 = .00
(18) .00 x 15 = .00
(19)= . O0
ASSESSHENT OF TAX:
15. Amoun* of LAne 1~ a~ Spousal ra~m
16. Amoun~ of LAne 1~ ~axablm a~ LAneal/Class A ra~e
17. Amoun~ of LAne 1~ at Sibling ra~a
18. Amoun~ of Line 1~ ~mxmblm a~ Collateral/Class B rm~m
19. PrAncApal Tax Due
TAX CREDZTS:
PAYHENT RECEZPT DZ$COUNT (+l
DATE NUNBER ~NTEREST/PEN PA~D (-)
ANOUNT PAZD
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REqUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.)
reflect flgures that include the total of ALL returns assessed to date.
.00
.00
.00
.00
Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) . O0
Na~ Value of Es~a~o Subjeck ~o Tax (lq) 620.
If an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
(11) ~ .~l;5. ;fl
(22) 620.7~-
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S.
Section 91q0).
Detach the top portion af this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office
of the Register of Rills, any of the Z$ Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-4~7-$010 (TT only).
Any party in interest not satisfied with the appraisement, alloaence, or disalloeance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA 17118-1011, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17118-0601
Phone [717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" [REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (33 calendar months after the decedent's death, a five percent ¢5X) 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 end in tho 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 from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOq are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
~ ZOZ .0005¢i.B ~'~'~- 1991 llZ .000301
1983 16Z .0004~8 1992 9Z .000247
1984 117. .000~01 1993-199~* 71 .000192
1985 131 .000356 1995-1996 91 .000147
1986 107. .000174 1999 77. .000192
1987 107. . O00Z7q ZOO0 72 .000192
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~'~ 9Z .OOOZ~7
ZOOZ 61 .OOO16~
Z003 5Z .000137
2004 4Z .000110
X NUHBER OF DAYS DBLZNI~UENT 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.
Family Settlement Statement ,-.:
File No. 21-03-0798
THIS is a statement made this 3 rd '04 tq)[Y -3 ? 2:41
day of ~ ,2004, by Roy C. Atkinson, 18 Blue
Mountain Vista, Mechanicsburg, PA 17050, Administrator and Benefici.ary of the Estate of Mary
L. Atkinson, Decedent, and Patricia G. Atkinson, Beneficiary, whose nah~,s.are set forth as
signatories at the end of this Statement.
WITNESSETH:
A. Mary L. Atkinson of 65 W. Louther Street, Carlisle, Cumberland County, Pennsylvania,
died on August 29, 2003.
B. On October 3, 2003, Letters of Administration were granted to Roy C. Atkinson, Father
of decedent, at File No. 21-03-0798 in the Register of Wills Office for Cumberland County,
Pennsylvania.
C. Administrator has administered the estate until the present time and has paid all debts of
the estate, including any inheritance tax owed.
D. Decedent died intestate.
E. The assets of the estate are set forth in Exhibit A attached hereto and made a part hereof.
F. Administrator has paid the debts of the estate as set forth in Exhibit B attached hereto and
made a part hereof. This is an insolvent estate, with balance of expenses paid by Father.
G. There remains to be distributed to the beneficiaries no assets as set forth in the Schedule
of Distribution in Exhibit C attached hereto and made a part hereof.
H. The parties desire to forego a formal account and schedule of distribution and desire to
conclude the estate by virtue of filing of this Statement.
NOW, THEREFORE, the said parties intending to be legally bound set forth the following:
1. Administrator of the estate of deceased will not file a formal accounting or schedule of
distribution.
2. No Inheritance Tax was owed.
3. There are no assets to distribute - insolvent estate.
4. The beneficiaries designate this Statement as a "satisfaction of award" and hereby
authorize and direct the Clerk of Orphans' Court to mark satisfied of record any award which
may subsequently be made by the Court with respect to the distribution made to the distributees
in this Statement.
5. The said beneficiaries acknowledge that this Family Settlement Statement shall be filed
with the Clerk of Orphans' Court in final settlement of the estate of decedent Mary L. Atkinson.
IN WITNESS WHEREOF, the Administrator and Beneficiaries, intending to be legally bound
hereby, set their hands and seals the day and year first above written.
WITNESS:
(~iy ~~ lk~ils~~ ~&"Benefic~a LS
Patricia G. Atkinson, Benetqci~
ITEM
NUMBER
EXHIBIT A - ASSETS
DESCRIPTION
VALUE AT DATE
OF DEATH
2.
3.
4.
5.
6.
7.
Commerce Bank checking acct # 0513251488
Cash on hand
Sale of 1992 Honda Accord LX Sedan, VIN 1HGCB7653NA150030
Security deposit refund on apartment
Personal household property
QVC credit on item returned
Comcast - refund for cable TV
TOTAL ASSETS
$ 477.04
34.48
1,500.00
420.00
1,320.OO
68.89
24.43
$ 3,844.84
ITEM NUMBER
EXHIBIT B - DEBTS AND DEDUCTIONS
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
1. Ewing Brothers Funeral Home
2. St. John's Episcopal Church - burial of ashes
3. St. John's Episcopal Church - meal after funeral
ADMINISTRATIVE COSTS
1. Personal Representative Commissions - Roy C. Atkinson
2. Attorney Fees - Broujos & Gilroy, P.C.; EIN 23-2267691
3. Family Exemption
4. Register of Wills - Probate Fees
MISCELLANEOUS EXPENSES
1. Register of Wills - Inventory
2. Register of Wills - Inheritance Tax Return
3. Register of Wills - Final Settlement Statement
MISCELLANEOUS DEBTS
1. Darlene Moyer, Tax Collector- personal county tax $11 and
personal school tax $10
2. Bobby Rahal Honda - auto repairs
3. Sprint - telephone
4. AT&T - long distance telephone
5. Comcast - cable TV
TOTAL
Inheritance Tax
TOTAL DEBTS AND DEDUCTIONS
$ 2,525.00
500.00
350.63
-0-
450.00
-0-
52.00
10.00
10.00
17.00
21.00
167.16
174.09
61.79
126.91
4,365.58
-0-
$4,465.58
Assets
Debts and Deductions
Balance for Distribution
EXHIBIT C - DISTRIBUTION
$ 3,844.84
$ 4,465.58
$ - 620.74
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Mary L. Atkinson
Date of Death: August 29, 2003
Will No. Admin. No. 21-03-0798
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:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
ao
Did the personal representative file a final account/statement with the
Court? Yes No X
bo
The separate Orphans' Court No. (if any) for the personal representative's
account is:
Co
Did the personal representative state an account informally to the parties
in interest? Yes X No
Date:
do
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be flied with the Clerk of Orphans' Court and may be
attached to this report.
Roy C. Atkinson
18 Blue Mountain Vista
Mechanicsburg, PA 17050
717-795-9798
Capacity: Personal Representative
· U.EAU OF OF
po BOX ZSoeoz
HARRISBURG, PA 171Z8-0601
DEC 29 AH 9:09
CLERK OF
"""" '"k!'C' ¢"',F'H,
REAGER ~- ADLER
255I MARKET ST
CAMP HILL PA tTOtt
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE 12-27-200~
ESTATE OF JONES
DATE OF DEATH 07-19-200~
FILE NUMBER 21 0~-0798
COUNTY CUMBERLAND
ACN 101
kmoun~ RemJ~ed
RE¥-1547 EX AFP
RICHARD C
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-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF JONES RICHARD C FILE NO. 21 0~-0798 ACN 101 DATE 12-27-200~
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON.' ORIGINAL RETURN
1. Reel Es*a~e (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held S~:ock/Per~:nership Interes~ (Schedule C) (3)
4. Mor~:gagas/No~:as RaceivabZe (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Proper~:y (Schedule E) (5)
6. Join~cly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9
10
11
12
15
Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
To,al Deductions
Ne{ Value of Tax Re*urn
(9)
(10)
Char/table/Governmental Beques*s; Non-elected 9115 Trusts (Schedule J)
Net Value of Es~a~e Subjec~ to Tax
.00
Z~650.60
.00
.00
.00
Z3~250.77
.00
(8)
8,~17.57
7.87
NOTE: To insure proper
credi~ ~o your account,
submi~ the upper portion
of th/s form w/~h your
~ax payment.
25,901
(12) 17,~75.93
(1=) . O0
(14) 17,~75.93
NOTE:
Zf an assess, ant was issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19
re~lect ~igures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amoun~ of L/ne 14 a~ Spousal re~:e
16. Amoun~ of Line 14 ~axeble a~ L/neal/CZass A re~a
17. Amoun~ of Line 14 a~ S/bling ra~e
18. Amoun~ of Line 14 ~axeble a~ Collateral/Class B rede
19. Princ/pal Tax Due
TAX CREDITS:
PAYMENT RECE.I.P I DT$COUNT
DATE NUMBER INTEREST/PEN PAID (-)
10-01-200~ CD00~53 105.26
10-22-200~ CD00~53~ .00
will
(~) .00 x O0 = .00
(16) .00 x OR5= .00
(17) .00 x 12 = .00
(18) 17,R75.93 x 15 = 2,621.39
(19)= 2,621.39
AMOUNT PAID
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
Z,O00.O0
521.~9
TOTAL TAX CREDIT ] 2,626.65
BALANCE OF TAX DUEl 5.26CR
INTEREST AND PEN. . O0
TOTAL DUE 5.26CR
( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A
REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )~%~"