HomeMy WebLinkAbout04-0114PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of
also known as
EDWARD DALE WEIBLEY
Deceased
Social Security No. 200-36-5939
No.
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner, who is 18 years of age or older applies for letters of administration on the estate
of the above decedent. Spouse, Janet R. Accorsi Weibley, and son, E. Robert Weibley, have renounced
the right to serve.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or
principal residence at 223 Forge Road, Boiling Springs, South Middleton Township.
PA.
Decedent, then 55 years of age, died January 30, 2004, at 223 Forge Road, Boiling Springs,
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: None
$ unestimated
$
Petitioner after a proper search has ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Janet R. Accorsi Weibley Spouse
E. Robert Weibley Son
Jason M. Weibley Son
600Latchmere Drive, Harrisburg, PA 17109
502 Zion Road, Carlisle, PA 17013
10 West Springville Road, Boiling Springs, PA 17007
THEREFORE, petitioner respectfully requests the grant of letters of administration in the
appropriate form to the undersigned.
Boiling Springs, PA 17007
(717) 448-2149
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
The petitioner above-named swears or affirms that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner and that as personal representative
of the above decedent, petitioner will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ~.~-~/-/ day of
. /-' t-- Register '/
nM. Weibley 0
Estate of Edward Dale Weibley, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW, ,/LT-.~,,~O, x2-~? ~ ,,_,~5/', in consideration of the petition on the
reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Jason M. Weibley is entitled to Letters of Administration, and in accord with such
finding, Letters of Administration are hereby granted to Jason M. Weibley in the estate of Edward Dale
Weibley.
Will Book #
Page
FEES
Letters of Administration
Short Certificates( )
Renunciation
TOTAL
f'-"Register o~Wills
George B. Faller Jr., Esquire (49813)
ATTORNEY (Sup. Ct. I.D. No.)
MARTSON DEARDORFF WILLIAMS & OTTO
10 East High Street
Carlisle, PA 17013
(717) 243-3341
F:~FILESLDATAFILE~ES TATES\ 10848-1 .petition Itt
RENUNCIATION
In Re Estate of Edward Dale Weibley, deceased.
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned spouse of the above decedent hereby renounces the right to administer
the estate and respectfully asks that Letters of Administration be issued to Jason M. Weibley, son
of decedent.
WITNESS our hands this
day of February, 2004
600 Latchmere
Harrisburg, PA 17109
//¢'
RENUNCIATION
In Re Estate of Edward Dale Weibley, deceased.
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned son of the above decedent hereby renounces the right to administer the
estate and respectfully asks that Letters of Administration be issued to Jason M. Weibley, son of
decedent.
WITNESS our hands this
day of February, 2004
E. Robert Weibley (Son)
502 Zion Road
Carlisle, PA 17013
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9990962
No.
~'/! Local Registrar
~. ~ ~;/..~/
Date
H105.145 Rev. 2/87
K INK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
1, Ed/~/"J ~ [11o/' ~ ~o ,, ] SEX [ SOCIAL SECURI~ NUMBER [ DATE OF D~TH (~n~, Day. Year)
~s ]u~s ] H~ ] Minutes [ (Month, Day. Year) ] State ~ F~e~n C~nl~) '~ nl n~ ee in t ti n t~r ' ~
cou~ o~ DEATH ' / ~. &~7 ..... ~
~U~EA~H ' ' J CI~O, ~p OF D~TH FACILI~ NAME {if .....iJution 9i ........ d ............ ~ ~ (S,~) ~
_ DES~DEN~S USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY ~AS DECEDe ......... J }. 10 .....
~ 9 p &rigs, FA I/UU/ Jo. oth.,,~.) ~. co..~ Cumbgr~and ,ow..~.? .d.~ withineauall.itsol
"- G£~nn D. Welb£eu
INFORMANT'S NAME (Type/Pr'hr) -
MOTHER'S NAME (First, Middle. Maiden Surname)
~, Ne££ie Ca££ama~
INFORMAN¥S MAILING ADDRESS (Street. City/Town, State, Ztp Code)
[~ob. 600 Latshmere Drive Harrisburq, PA 17109
DATE OF OISPOSITION r
DO~atiO~ ['-]B.rial r~ Cremation [~ .... I[romSlale [] J( ........... PLACE OF DISPOSITION. N .... fCemetery. C ...... ry LOCATION C~,/Tow. State Z, Ccde
or Other Place ' . ,
E OR PERSON ACTING AS SUCH LICENSE NUMBER
J22b. 011589L ' ~ '
NJ~ME AND ADDRESS OF F~CILITY
Tothebestofmyknowledgedeathoccu~reda,,hetime. data and place stated. IZ~cH°~'L~n°e'tF'H'gCrema'toruM:t-.Ho£,~u Sorinas. Pa 17(
physician is not available at lime of death to (Signature and 33tie) ~' ,~ / /) ¢
ce~ify cause o~ death. J ~CENSE NUMBER - DATE SIGNED-
TIMEOF DEATH - DATEPRON{~UNCEDDF_AD(Month Day Year) I23b.
= e .l. ~ [Bo(OOOy ' ' IWASC^SEREFERREDTO~t~g'DW'atLE~M'NER~CORONER?
,,.,A,T, ....... , ....... ~, ....................................... · I-. Y., ~ wLH. .o []
ms~lttng m death) -.---e, a, :
CAUaE (D~ ~ in~
~ ~ demm) ~T :
not resulting in the underlying cause gl~n in PART I.
WA~ AN AUTOPSY ~RE AUTOPSy FINDINGS MANNER OF DEATH
PERFORMED? AVAILABLE PRIOR TO
J COMPLETION OF CAUSE J N.,ural J~
Y"a"o,,',I Y..a []
Homicide
~j..~ IDATE OF INJURY } TIME OF INJURY
(MO~I~,Oi¥,YeIr) INJURYATWORK?DESCRIBE HOW INJURY OCCURRED
~.. I,o~. M. I ~:,D NoD
II PLACE OF INJURY - A home, farm slreel factory office 3 30d.
J 3~j.ng. e~c (S~cW) ' , , LOCATION (Street, City/Town. State)
IBa.
Pending Investigation
Could not be determined
LCENSE NUMBER [,~ '~-' i DATE SIGNI~D(Month, Day, Year)
DATE FILED (Month, Da~)
F:\FILES\DATAFILE\ESTATES\ 10848-1 .notice.cert
Name of Decedent:
Date of Death:
File No.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Edward Dale Weibley
January 30, 2004
21-04-0114
'04 APR 28
To the Register:
I certify that notice of 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 or
about April 28, 2004.
Ms. Janet A. Weibley
600 Latshmere Drive
Harrisburg, PA 17109
Mr. Jason M. Weibley
10 West Springville Road
Boiling Springs, PA 17007
Mr. Edward Robert Weibley
502 Zion Road
Carlisle, PA 17013
Date: April 28, 2004
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A
Signature ~Tf--.® ~~'
Name George B.~aller, Jr., Esquire(/
MARTSON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Personal Representative
F:\FILES\DATAFILE\ESTATES~ 10848-1 .notic¢.cett
Name of Decedent:
Date of Death:
File No.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Edward Dale Weibley
January 30, 2004
21-04-0114
To the Register:
I certify that a corrected notice of 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 or about May 3, 2004.
Ms. Janet A. Weibley
600 Latshmere Drive
Harrisburg, PA 17109
Mr. Jason M. Weibley
10 West Springville Road
Boiling Springs, PA 17007
Mr. Edward Robert Weibley
502 Zion Road
Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A
Date: May 3, 2004 Signature
Name
George B. Faller, Jr., Esqul
MARTSON DEARDORFB
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Personal Representative
VILLIAMS & OTTO
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WEIBLEY, EDWARD DALE SOCIAL SECURITY NUMBER
200-36-5939
DATE OF DEATH (MM DD-YEAR) ] DATE OF BIRTH (MM DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
L01/30/2004 I 04/03/i948
APPLICABLE) SURVIVING S?OUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL)
~WEIBLEY, JANET R.
[] 1. Original Return [] 2 Supplemental Return
SOCIAL SECURITY NUMBER
] 4 Umited Estate [] 4a Future interest Compromise (dale of death after
12 12 82) [] 5 Federal Estate Tax Return Required
[] 6 Decedent Died Testate (Attach copy [] 7 Decedent Maintained a Lfvfn§ Trust (Attach 0 8 Total Number of Safe Deposit Boxes
of Will) copy of Trusl)
,[ [] 9 Litigation Proceeds Received [] 10 Spousal Povedy Credit (date of death between [] 11 Election to tax under Sec 9113(A) (Attach Sch
HiS SECTION MUST BE COMPLETED. ALL CORReSPONDENcE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
O0
I George B. Faller, Jr., Esquire
bERM NAME-ill appr~
Martson Deardorff Williams & Otto
717/243-3341
COMPLETE MAILING ADDRESS
Ten East High Street
Carlisle, PA 17013
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
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
fi1. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(1) None
(2) None
(3) None
(4) None
(5) 42,151.55
(6) None
(7) 6,000.00
(9) 14,983.95
(10) 29,411.26
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13}
(8) 48,151.55
(1~) 44,395.21
(12) 3,756.34
(13)
(14) 3,756.34
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount o1 Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2)
x .00 (15)
16. Amount of Line 14 taxable at lineal rate ,7>6.a4 x .045 (16)
17.Amount of Line t 4 taxable at sibling rate x .12 (17)
18. Amount o1 Line 14 taxable at collateral rate
19. Tax Due
(19)
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
169.04
169.04
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX {Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
223 Forge Road
Boiling Springs
I SIATE PA
i ZIP
I 17007
Tax Payments and Credits:
1. Tax Due (Page 1 Line lO)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
(1) 169.04
(2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. IfLinel +Line3isgreaterthanLJne2, enter the difference. This is the TAX DUE.
(5) 169.04
A. Enter the interest on the tax due,
(5A)
B. Enter the total of L ne 5 + SA. This is the BALANCE DUE.
(5B) 169.04
Make Chock Payable to: REGISTER OF WILLS, AGENT --
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1~ Did decedent make a transfer and:
Yes No
a. retain the use or income of the property transferred ...................................................................... ~ []
b. retain the right to designate who shall use the property transferred or its income; ................................ []
c. retain a reversionaryinterest; or .................................................................................................................. [] []
d. receivethepromiseforlifeofedherpayments benefisorcare9
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate cons dera on?
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her dea h? ......... [] []
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficia des na on?
g ..................... . ............................................................. [] []
IF THE aNswEr TO ANY OF THE ABOVE QuEsTIONs Is YEs, You musT cOMPLETE scHEDuLE G aND FILE IT As ParT OF THE rETurN.
preparer other lh~n the personal representative is based on air in formation of which prepa ret has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
592 Gutshall Road
Boiling Springs, PA 17007
ADDRESS
DATE
ADDRESS
Ten East High Street
Carlisle, 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
surv~wng 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 or the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surwving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the sun/iving 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 fax 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 decedenfis 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,
DATE
DATE
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
WEIBLEY, EDWARD DALE I FILE NUMBER
21 -04-00114
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 VALUE AT DATE OF
DEATH
1 PNC Checking accoont #5140449275 (17261.35 less outstanding checks of 5119.80) 12,14155
2 Pinnacle Heahh, credit balance
35.00
3 2000 Ford F350 4x4 pickup truck (average condition)
19,225.00
4 1993 Riveria Cruiser boat (average condition)
10,000.00
5 I985 Plymouth Voyager (poor condition)
500.00
6 Personal and household property
250.00
TOTAL (Also enter on Line 5, Recapitulation) 42,151.55
COMMONWEALTH OF PENNSYLVANfA
INHER~TANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
iTEM
NUMBER
2
3
4
WEIBLEY, EDWARD DALE
This schedule must be completed and flied if the answer to?a~ of tkuest OhS 1
i! FILE NUMBER
21- 04- 00114
through 4 on page 2 is~yes,
DESCRIPTION OF PROPERTY IDATE OF DEATH
Include the name of the transferee their re[allonship to decedent and Ihe date of transfer
Attach a copy of the deed for real estate
IR,&., Scudder Money Market Fnnd, Account No.
6-666160286; beneficiaries: sons. Account is not taxable
due to age of decedent who was not making withdrawals
from account.
Cash to E. Robert Weibley, son, on 1/23/04
Cash to Jason M. Weibley, son, on 1/23/04
Cash to Nellie Weibley, mother, on 1/23/04
]VALUEOFASSET
46,439.61
5,000.0(
5,000.0£
5,000.00
%OF I
DECD'S I EXCLUSIOfx
iNTEREST (IF APPLICABLI
O%
100% 3,000.00
100% 3,000.0(
100% 3,000.0C
TAXABLE VALUE
2,000.00
2,000 00
TOTAL (Also enter on line 7, Recapitulation) 6,000.00
2,000 00
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
WEIBLE¥, EDWARD DALE ! FILE NUMBER
I 21 - 04- 00114
Debts of decedent must be reported on Schedule I.
ITEM
DESCRIPTION
FUNERAL EXPENSES:
NUMBER
A.
I
2
Hollinger Funeral Elome & Crematory Services
Wayne Noss Flowers
L&D Cateriog, funeral reception
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
AMOUNT
3,449.22
355.10
2,120.00
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Martsou Deardorff Williams & Otto
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant JANET R. WEIBLEY
Street Address 600 Latchmere Drive
City Harrisburg State PA
Relationship of Claimant to Decedent Spouse
Probate Fees Register of Wills, Cumberland COullty
Zip 17109
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Register of Wills, short certificates
Cumberland Law Journal, advertising Letters of Adm/nistration
5,000.00
3,500.00
76.00
21.00
75.00
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
387.63
14,983.95
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Schedule H
Funeral Expenses &
Adminis'..a~ve Costs continued
3
4
5
WEIBLE¥, EDWARD DALE IFILE NUMBER
~ 21- 04-00114
122.63
The Sentinel, advertising Letters of Administration
Register of Wills, filing fee, itflteritance tax return
Reserved for miscellaneous filing fees and expcnses
15.00
250,00
Page 2 of Schedule H
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
WEIBLEY, EDWARD DALE FILE NUMBER
21 -04-00114
Include unreimbursed medical expenses.
fTEM
NUMBER
Wayne Noss Flowers, account payable
DESCRIPTION
AMOUNT
7
8
9
2
3
4
5
6
Lab Cm~. Holdings, medical expense
Bronstein Jeffries
Internists of Cenn-al PA
Yellow Breeches EMS
Verizon Wireless
U.S. Treasury, 2003 income tax
Maryland Dept. of Revenue, 2003 income tax
Capital Tax Collect/on Bureau, 2003 income tax
49.29
33.00
296.89
370.00
73.35
265.73
23,109.00
5,12000
94.00
TOTAL (Also enter on Line 10, Recapitulation} 29,~411.26
ESTATE OF
WEIBLE¥, EDWARD DALE
NUMBER
SCHEDULE J
BENEFICIARIES
______NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Janet R. Weibley
Jason bi. Weibley
10 West Springvi! e Toad
Boiling Springs, PA 17007
E. Robert Weibley
502 Zion Road
Carlisle, PA 17013
Note: Deductible items which exceed estate assets will be paid fi'om fimds
of Jason and E. Robert Weibley.
I FILE NUMBER
~ 21 - 04- 00114
,1' RELATIONSHIP TO I -- --
I DECEDENT 11 AMOUNT OR SHARE
~ --~z~ ~OZLL~L~st~sL ~ __ OF_ ESTATE
i'Spoilse
SOIl
SOIl
Makes ilO clatnl
against estate
1/2 estate residue
1/2 estate residue
Enter dollar amounts for dislributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
IA. SPOUSAL D STRIBUT
?EING MADE iONS UNDER SECTION 9J 13 FOR WHICH AN ELECTION TO TAX IS NOT
B CHARITABLE AND GO
· VERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-J500 COVER SHEETI
ESTATE OF
WEIBLEY, EDWARD DALE
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 - 04- 00114
NUMBER
2
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO i AMOUNT OR SHARE
DECEDENT
~_~t lis, Tfusteel$) OF ESTATE
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Janet R. Weibley
[Spouse
Jason M. Weibley Son
i 10 West Springvi!Ie Road
Boili~rg Springs, PA 17007
E. Robert Weibley Son
502 Zion Road
Carlisle, PA 17013
Note: Deductible items xvhich cxcccd estate assets will be paid from funds !
of Jason and E. Robert Weibley.
]Makes no claim
against estate
1/'2 estate residue
1/2 estate residue
II.
i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BE NG MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART ti - ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET[
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFLNDIVIDUAL TAXES
DEPT 280601
HARRISBURG, pA171280601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11 96)
NO. CD 004271
FALLER GEORGE B JR
10 E HIGH STREET
CARLISLE, PA 17013
ESTATE INFORMATION: SSN: 200-36-5939
FILE NUMBER: 2104-01 14
DECEDENT NAME: WEIBLEY EDWARD DALE
DATE OF PAYMENT: 08/13/2004
POSTMARK DATE: 08/1 3/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 01/30/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $169.04
TOTAL AMOUNT PAID:
69.04
REMARKS:
SEAL
CHECK# 116
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WlLLS
BUREAU OF TNDZVTDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17118-06nl
COHHONHEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
GEORGE B FALLER'O,,~R ~ ]'}
HARTSON ETAL
10 E HI'GH ST
CARLTSLE f,-~[ ,,~A 1701:3
DATE 10-11-200q
ESTATE OF gEIBLEY EDgARD D
DATE OF DEATH 01-30-200q
FZLE NUHBER 21 0~-011~
COUNTY CUHBERLAND
ACN 101
Aeoun~ Rami'l:~ed
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF gILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF gEIBLEY EDgARD D FILE NO. 21 0~-011~ ACN 101 DATE 10-11-200q
TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORTGTNAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Znterast (Schedule C) (3)
q. Mortgages/Notes Receivable (Schedule D) (q)
.6. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funeral Expenses/Ada. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage LiabiZities/Liens (Schedule 1) (10)
11. TotaZ Deductions
12. Nat Value of Tax Return
~2~151.55
.00
.00 NOTE: To /nsure proper
.00 credit to your account,
.00 submit the upper portion
.00 of this fore wi~h your
tax payment.
6~000.00
(s) q8,151.55
lq,983.95
29,fi11.26
(12) 3,756.3q
13.
lq.
NOTE:
ASSESSHENT OF TAX:
Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) . O0
Nat Value of Estate Subject to Tax (lq) 3,756.3q
Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111
reflect flgures that lnclude the total of ALL returns assessed to date.
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TAX CREDTTS:
PAYMENT I RECEZPT
DATE NUMBER
08-13-200q CD00q271
· O0 X O0 = . O0
3,756.3q x Oq5= 169.0q
· O0 X 12 = . O0
· O0 x 15 = . O0
(19)= 169.0q
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
169.0q
TOTAL TAX CREDIT ~ 169.0q
BALANCE OF TAX DUEI .00
I
INTEREST AND PEN. I .00
TOTAL DUE I .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT- (CR)~ YOU MAY BE DUE.
A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.)
1E. Amount of Line lq at Spousal rata (15)
16. Amount of Line lq taxable at Lineal/CZass A rate (16)
17. Amount of Line lq at Sibling rata (17)
18. Aeount of Line lq taxable e~ Collateral/Class B ra~e (18)
19. Principal Tax Due
RESERVATION: Estates of decedents dying on or before December 12, 198Z -- if any futura interest in the estate is transferred
in possession or enjoyment to Class D (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.
PURPOSE OF
NOTICE:
PAYNENT:
--Make check or money order payable to: REGXSTER OF HILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ars available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: I-BOO-56Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-50Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-lOZ1,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section il40 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone C717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-ISO1) for an explanation of administratively correctable errors.
If any tax due is paid within three CS) calendar months after the decedmnt's death, a five percent CSX) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 1Dj 1996, the first day after the end of the tax amnesty period. This nan-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 from the date of
death, to the date of payment. Taxes which became delinquent before January 1~ 198Z bear interest at the rate of
six (Bi) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. Tho applicable interest rates for 198Z through 2004 ara:
Interest Daily Interest Daily Interest
Daily
Rate Factor
91 .000Z47
6Z .000164
5Z .000157
4X .DO0110
Year Rate Factor Year Rate Factor Year
FeT~ ~ .ooos4e' Ies~-1991 llX .0O0SOI ~
1985 16Z .000438 1992 9Z .000Z47 Z00Z
1964 llZ .000~01 1995-1994 7Z .OOOlgZ 2003
1985 132 .000556 1995-1998 92 .000247 2004
1986 lOX .000274 1999 7Z .O0019Z
1987 lex .000274 ZOO0 72 .O0019Z
--Xntsrest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DBLTNQUENT X DA:ELY TNTBREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen elS[ 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.
OR
REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12
(For Resident Decedents Dying After July 1, 1992)
Name of Decedent:
EDWARD DALE WElBLEY
Date of Death:
January 30, 2004
FileNo.:
21-04-0114
Social Security No.:
200-36-5939
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:
a. Did the personal representative file afinal account with the Court?
Yes No x
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account informally to the parties in
interest?
Yes x No
d.
Signature:
Name:
Address:
',.oJ
. Date: <4Iebruary 18, 2005
C,j
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F:\F1LES\DA:'J:.AFlLEIEST A TES\I 0848. I_srql
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