HomeMy WebLinkAbout03-0725 Register of Wills of / , c_r County, Pennsylvania
PETITION FOR GRANT OF LETTERS
also known as
, Deceased Social Security NO.
(COMPLETE "A" OR "B" BELOW:)
[~ aver Petitioner(s) is/are the execut~_~ named in the Last Will of the
A.
Probate
aod
Grant
of
Letters
and
that
Decedent, dated ~.~0~'i~1.~'/,4 ;~:~ 1~4~ j and codicil(s) dated z~J~o~t~
J /
State l~evant dmumstm(.es, e.g, [efluncialion, deaLh ef executor, e[c.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional ,~ heets if necessary,
Decedent was domiciled,at deat, h in (~Jv~J3~i((~ County, Pennsylvania, with his/her last family or principal
Decedent, then ~ years of age, died ~~ 3 , 20~, at
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 ...............................................
Total -
Real Estate situated as follows: ~
. Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Oath of Personal Representative
Commonwealth of Pennsylvania
County of
The Petitioner(s) above-named swear(s) and 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 tha,~personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the e~..,~~ ~,
Sworn to and affirmed and subscribed f.
before me this /~:27'// day of
D[CR[[ OF
also known as
Social Security No: I~- ~- ~1 Date of Death:
AND NOW,~/~~ ~ , 2~ , in consideration of the
Petition
on the reverse side--hereon, satisfactory proof having been presented before me,
ITIS DECREED that Letters ~ Testamentary ~ of Administration
in the *above estate and that the instrument(s), if any, dated ~ -~/-
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters.. $ ~:::~:~, 0~::::) ~
Register
Short Certificate(s) .......... $ ~.z. zz',
Renunciation .................. $
Affidavit ( ) ................. $
Extra Pages ( ) ............ $ ~_~. ~0
Codicil .......................... $
JCP Fee. $ '/0' ~° At~t~'~ r ~ ~Y:
Inventory & Tax Forms... $ I.D. No:
Other ............................ $ Address:
TOTAL ................ $~ Telephone:
DATE FILED:
~l-7a
105.805 REV 9/86
This 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 Statc Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
Local Registrar~
P 9 5 0 5 3 1 0 AUG 0 2003
No. ~ Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT {F .......... } l~Ex lSOCIAk SECURffY NUMB£R I DATE OF DE~TH 0.¥, '~a,, .....
James W. Sheppaad .Male ,. 165-- 18 -- 2621 ,.8-$-03
83 ~,.. : ' 5-25-20 Hazelton,PA ~,~ ~,,..,
C~b~land ~. Upper Allen [
I00 Mount Allen Drive ~c~u~t ...s~,. PA ~ ,,..~ v..~,~. Upper A~en
Meehaniesb~g, PA 17055 ,s
~'~" ,~.c~ Cumb~nd ~,~ ~.~
~' oo . ~ ~ ~. -- MOTHER'S NAME FA~. ~. Ma~ ~e) c~,
· ~r~ yo~ 5~epp~ M~ ~u~nnan
J~es Powel Shepp~d ~ 1812 ~eep~r~ Road, ~ni~b~g, PA 17055
..... ~u~,~ .... ~,~ ~m,, ~ . . [ .4100 Jonestown Road~ H~r~ PA 17109
· ~. M. /~.
REGISTRAR'S SIGNATURE A~UM~ER ~,;/~/ 12.
I, JANES W. SH~PPARD, of 308 Benning Avenue, Gettysburg,
Pennsylvania 17325, do hereby make, publish and declare this to be my Last
Will and Testament, herby revoking and making void any and all former Wills
by me at any time heretofore made.
FIRST: I direct my hereinafter named executor to pay all of my just
debts, funeral and administration expenses as soon after my death as
practical.
SECOND: I give, devise and bequeath all of my property, of
whatsoever kind and nature, whether real, personal or mixed, of which I may
die seized or possessed, or to which I may be entitled, wheresoever
situated, unto my children, James P. Sheppard and Lynn S. Robinson, or their
issue per stirpes.
THIRD: I direct that all inheritance tax, death, transfer and
estate taxes, whether they be local, state or federal, be paid out of the
residue and remainder of my estate, so that all bequests made in this Will
shall be free and clear of said taxes.
W. ShepPar~ ~
FOURTH: I hereby nominate, constitute and appoint my children,
James P. Sheppard and Lynn S. Robinson, as co-executors of this my last Will
and Testament. I also direct that they shall not be required to give bond
for the faithful performance of their duties as such and I hereby authorize
and empower them to sell any and all property, real or personal, upon such
terms as they see fit, at public or private sale, and I empower them to
effect the necessary conveyances therefor as I could do if living.
IN WITNESS WHEREOF, I, James W. Sheppard, the testator, have to this
my Last Will and Testament, written on two (2) sheets of paper, set my hand
and seal this .2 ~ ~ day of ~'~ ~- ~-~ ~/ , 1991.
~-~ ~-~. <SEAL)
~ Jam~s W. Sheppard ~ ~
Signed, sealed, published and declared
by the above-named testator, James W.
Sheppard, as and his Last Will and
Testament, in the presence of us, who,
at his request, in his presence and in
the presence of each other have hereunto
subscribed our names as witnesses hereto.
-2-
COMMONWEALTH OF PENNSYLVANIA:
: ss.
COUNTY OF ADAMS :
We, James W. Sheppard, the testator, and the witnesses herein,
whose names are signed to the attached or 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 Testament, and that
he had signed willingly, and that he executed it as his free and voluntary
act for the purposes therein expressed, and that each of the witnesses, in
the presence and bearing of the testator, signed the Will as a witness and
that to the best of the knowledge of each witness the testator was at that
time 18 years of age or older, of sound mind and under no constraint or
undue influence.
Testator:
~/ James W. Sheppa~t~l
Witness:
Subscribed, sworn to and acknowledged
before me by James W. Sheppard, the
testator, and subscribed and sworn to
before me by th~ w~tbin witnesses, this
~7~ day of J~~ , 1991.
~-'--lgO t ary Public
NOTARIAL SEAL
Janet A. Cutshall. Notary Public
Gettysburl Boro. Adams County
My Commission Expires Sept. 19. 1994]
JANES T~. SN'I~PARD
HARTMAN & HARTMAN
ATTORNEYS AT LAW
126 BALTIMORE STREET
GETTYSBURG, PEN NSYLVAN IA
173~'5
JAMES P. SHEPPARD, ESQ.
ATTORNEY AND COUNSELOR AT LAW ELIZABETHVILLE OFFICE
85 EAST MAIN STREET
2201 NORTH SECOND STREET (717) 362-8651
GENERAL PRACTICE OF LAW HARRISBURG, PA 17110
GETTYSBURG OFFICE
(717) 232-5551 22 EAST MIDDLE STREET
FAX (717) 232-0888 (717) 338-1900
September 2, 2003
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17103
Re: Estate of James W. Sheppard
Renunciation of Co-Executor
Dear Sirs:
Enclosed, please find a Renunciation which has now been signed by
my sister, Lynn $. Robinson in the above referenced estate.
Please process the Letters and the Short Certificates and forward
the same to my law office in Harrisburg.
Any questions or problems regarding any of the above, please call
my law office. Otherwise, I thank you for cooperation in this matter.
Very truly yours,
James P. Sheppard
JPS/bw :,;
Enclosure
CC: Lynn S. Robinson
RENUNCIATION
In Re Estate of James W. Sheppard
. deceased.
To the Register of Wills of ~rland County, Pennsylvania.
The undersigned LvnnS. Robinson. named Co-Executor
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testarmn~
be issued to James P. Sheppard
(Signature)
(Signature)
(Address)
(Signature)
(Address)
JAMES P. SHEPPARD, ESQ.
ELIZABETHVILLE OFFICE
ATTORNEY AND COUNSELOR AT LAW 85 EAST MAIN STREET
2201 NORTH SECOND STREET (717) 362-8651
GENERAL PRACTICE OF LAW HARRIS BURG, PA 17110
GETTYSBURG OFFICE
(717) 232-5551 22 EAST MIDDLE STREET
FAX (717) 232-0888 (717) 338-1900
March 11, 2004
Register of Wills
Attn: Sue Koser
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17103
Re: Estate of James W. Sheppard
Docket Number 21-03-0725
Dear Ms. Koser:
Enclosed for filing, please find the original and copies of the
Inheritance Tax Return, the Inventory, and the Certification Under
Rule 5.6(a), in the above referenced estate. Enclosed, please find
the Estate's check for the Inheritance Tax.
Enclosed, please find the Estate's check for $28.00. This check
is to cover the filing fee for the Inheritance Tax Return, the
Inventory, and the preparation of a Short Certificate.
Enclosed, please find an envelope for the return of my copy of
the Inheritance Tax Return, the Inventory, Certification Under Rule
5.6(a), and the new Short Certificate.
Questions or problems regarding any of the above, please
telephone my office. Otherwise, I thank you for your kind attention
and cooperation in the handling of this matter.
JPS/bw
Enclosure
~ PENNSYLVANIA
.e~22,~~~,~. DEPARTMENT OF REVENUE
~'~,~,~,~A~"~'~ DEPT. 280601 INHERITANCE TAX RETURN
2 1 -~3
HARRISBURG, PA17128-0601 RESIDENT DECEDENT -- --
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Shep~, ~s W. ~65 ~8 262~
DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-MD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
8/03/03 5/25/20
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER
~e - -
~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (da(e of death prior to 12-13~2)
~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date o, dea,h afle~ 12-12-82) ~ 5. Federal Estate Tax Return Required
~ 6. Decedent Died Testate (A~ach copy of Will) ~ 7. Decedent Maintained a Living Trust (A~ch copy of T~st) ~ 8. Total Number of Safe Deposit Boxes
~ 9. Litigation Proceeds Received ~ 10. Spousal Pove~y Credit (date of death be~een ~2-3~-9~ and 1-1-95) ~ 11. Election to tax under Sec. 9113(A)(A,ach Sch O)
~,. ~'
NAME COMPLETE MAIUNG ADDRESS
~s 2. Shepp~ "
FIRM NAME (lfApplicable) 2201 N. Se~d St.
~lsb~9, 2A 17110
TELEPHONE NUMBER
(71~) 232-5551
= ~,; USE ONLY
1. Real Estate (Schedule A) (1) ~
2. Stocks and Bonds (Schedule B) (2) ~6 ¢ 635. ~3 ,~
3. Closely Held Corporation, PaKnership or Sole-Proprietorship (3) ..~
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Prope~y (5) 16 ~ 564.84
(Schedule E)
6. Jointly Owned PropeKy (Schedule F) (6)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Prope~ (7) 57 ~ 78~ · ~3
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8) ~90 ~ 98~ · 70
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 ~ 385 · 98
10. Debts of Decedent, Me,gage Liabilities, & Liens (Schedule ~) (10) ~ ~ ~72.3~
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Line 11) (12) 82¢92~.36
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE ~TES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 ~ (15)
16. Amount of Line14 taxable at lineal rate ~2~92~_~ x .0 ~ (16) ~,7~[.~8
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
RE%~-1510 EX + (1-91~'
SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMO.W~,TH OF PENNS¥'VAN,^
iNHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
James W. Sheppard 21-03-0725
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OFTHETRANSFEREE. THEIR RELATIONSHIPTO DECEDENT AND THE DATE OFTRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST
1. James W. Sheppard Profit Sharing Plan 19,217.78 100% 19,217.78
T. Bowe Price, Acct. #16106
Beneficiaries: Lynn S. Robinson, daughter
and James P. Sheppard, son
2. Deferred Income Insurance Annuity Contract 38,566.65 100% 38,566.65
MONY Life of America, Contract #B60078673
Beneficiary: James P. Sheppard, son
TOTAL (Also enter on line 7, Recapitulation) $ 57,784.43
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
James W. Sheppard 21-03-0725
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1. Cremation Society of PA, Jonestown Rd., Harrisburg, PA 160.00
(Viewing, death certificates, Coroner fee)
2. St. James Lutheran Church, Gettysburg, PA 250.00
(Church Services, Honorarium)
3. Blue Parrot Bistro, Gettysburg, PA 123.98
(Family and Friends meal)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State __ Zip
Year(s) Commission Paid:
2, Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Pr0bateFees Letters, filing fees, short certificates 280.00
5. Acc0untant'sFees Hamilton & Musser, PC, CPA 67.50
6. Tax ReturnPreparer'sFees Robert C. Boehner, PC, CPA, returns 2001,2002 215.00
Accountant's fees for 2003, fiduciary return (reserved) 200.00
7. Patriot News, Co., Harrisburg, PA
(Obituary notice) 18.50
8. Photocopy, Postage, Long Distance telephone tolls 71.00
(Reimburse James P. Sheppard)
TOTAL (Also enter on line 9, Recapitulation) $ 1,385.98
(If more space is needed, insert additional sheets of the same size)
R£V-1512 EX + {1-97) ~
SCHEDULE I
COMMONWEALTH OF PENNSYLV^N,^ DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
~'ames W. Shepp~ 2~-03-0725
Include unreimbumed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
- 200[ ~ ~es 96.00
10. ~A ~t o~ ~v~ue- 2003 [~ ~es (est~te~) 58.89
TOTAL (Also enter on line 10, Recapitulation) $ 6,672.36
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00). 1~'
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
James W. Sheppard 21-03-0725
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec, 9116 (a) (1.2)]
1. James P. Sheppard Son 50%
1812 Sheepford Rd.
Mechanicsburg, PA 17055
2. Lynn S. Robinson Daughter 50%
415 ~st Cecil St.
Winchester, Va 22601
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0. O0
(If more space is needed, insert additional sheets of the same size)
I, JAMES W. SHEPPARD, of 308 Benning Avenue, Gettysburg,
Pennsylvania 17325, do hereby make, publish and declare this to be my Last
Will and Testament, herby revoking and making void any and all former Wills
by me at any time heretofore made.
FIRST: I direct my hereinafter named executor to pay all of my just
debts, funeral and administration expenses as soon after my death as
practical.
SECOND: I give, devise and bequeath all of my property, of
whatsoever kind and nature, whether real, personal or mixed, of which I may
die seized or possessed, or to which I may be entitled, wheresoever
situated, unto my children, James P. Sheppard and Lynn S. Robinson, or their
issue per stirpes.
THIRD: I direct that all inheritance tax, death, transfer and
estate taxes, whether they be local, state or federal, be paid out of the
residue and remainder of my estate, so that all bequests made in this Will
shall be free and clear of said taxes.
~/'~' ~.~ff~/~ (SEAL)
James W. ShepParj~ ~
FOURTH: I hereby nominate, constitute and appoint my children,
James P. Sheppard and Lynn S. Robinson, as co-executors of this my last Will
and Testament. I also direct that they shall not be required to give bond
for the faithful performance of their duties as such and I hereby authorize
and empower them to sell any and all property, real or personal, upon such
terms as they see fit, at public or private sale, and I empower them to
effect the necessary conveyances therefor as I could do if living.
IN WITNESS WHEREOF, I, James W. Sheppard, the testator, have to this
my Last Will and Testament, written on two (2) sheets of paper, set my hand
and seal this ~ ~ ~ day of .../~ ~-~/ , 1991.
~ Jam~s W. Sheppard ~ ~ '
Signed, sealed, published and declared
by the above-named testator, James W.
Sheppard, as and his Last Will and
Testament, in the presence of us, who,
at his request, in his presence and in
the presence of each other have hereunto
subscribed our names as witnesses hereto.
-2-
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF ADAMS :
We, James W. Sheppard, the testator, and the witnesses herein,
whose names are signed to the attached or 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 Testament, and that
he had signed willingly, and that he executed it as his free and voluntary
act for the purposes therein expressed, and that each of the witnesses, in
the presence and bearing of the testator, signed the Will as a witness and
that to the best of the knowledge of each witness the testator was at that
time 18 years of age or older, of sound mind and under no constraint or
undue influence.
James W. Sheppa~d~,/
Subscribed, sworn to and acknowledged
before me by James W. Sheppard, the
testator, and subscribed and sworn to
before me by th~ ~t~in witnesses, this
~,~7~{,_ day of ~~.z.~.~, , 1991.
7~' tary Public
I NOTARIAL SEAL I
Janet A, Cutshall. Notary Public I
Gettysburg, Boro. Adams County I
My Commission Expires Sept. 19. 19941
Register of Wills of rland County, Pennsylvania
INVENTORY
Estate of Jam~s W. S~e~ No. 21-03-0725
also known as Date of Death 8/03/03
, Deceased Social Security No. 165-18-2621
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Personal Representative:
Name of
Attorney: James P. Sheppard, Esq.. ~mes P. S~ep~d
I.D. No.: ~4944
Address: 2201 N. Second St. Dated ~/~)7/~
F=rr~ =b,,_~, PA 17110
Telephone: (717) 232-5551 ~.
1. Fidelity ~V High In~ ~tage
2. ~sh 7.~
3. PNC check~ ac~. ~9,765.21
4. Lu~er~ ~cial ~i~s resid~t ac~. 52.~ '
5. ~levision ~7::~ ~ 50.0~ ~ ''
6. ~k~g c~ ...... 150.0~
7. ~t ~d ~ailer 300.00
8. T. ~ Price dis~ution ch~k 800.00
9. Fidelity ~ves~ts divided che~s 194.02
10. A~ El~ic ~rati~, ~c., Pa~onage check 11.19
11. F~al T~ ~f~ds for 2001, 2002, ~d 2003 5,234.60
12. J~s W. She--d Profit Shrug Pi~
T. ~ Price, ~ct. 916106 19,217.78
13. ~ Life of ~ri~ In~ce ~uity ~n~act
~B60078673 38,566.65
Total: $90,984.70
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
RW-8
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003676
SHEPPARD JAMES PESQ
407 NORTH FRONT STREET
HARRISBURG, PA 17101
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..................
101 $3,731.68
ESTATE INFORMATION: SSN: 165-]8-262]
FILE NUMBER: 2103-0725
DECEDENT NAME: SHEPPARD JAMES W
DATE OF PAYMENT: 03/15/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 08/03/2003
~:~ TOTAL AMOUNT PAID' $3,731.68
REMARKS:
CHECK# 1014
INITIALS: JA
,:"' SEAL RECEIVED BY' GLENDA FARNER STRASBAUGH
...... REGISTER OF WILLS
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. Admin. No. E. I '- ~9 ~ ---' aP 7Z.~---
To the Register:
I certify that notice of (beneficial interest) e~tate administration required by Rule 5.6(a) of ~e ~rphanl;' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~ l~_.t It~ ~ :
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
~" "~' a_~ .... ..' Name ,,,.~'~ p, ,~"' ~e..f~,a.,.,-/'~
~ Address ~ ~ ~ ~ ~
Telephone (~ ~ S Z -- ~ ~X I
Capacity: ~Personal Representative
~0unsel for personal representative
CONNONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. Z80601 NOTICE OF INHERITANCE TAX
HARRISBURG, PA 17128-0601
APPRA/SEHENT~ ALLOtfANCE OR DISALLONANCE
OF DEDUCTTONS AND ASSESSNENT OF TAX
DATE 05-05-Z004
ESTATE OF SHEPPARD JAHES
DATE OF DEATH 08-05-2003
FILE NUHBER 21 03-0725
COUNTY CUHBERLAND
JAHES P SHEPPARD ACN 101
Z201 N 2ND ST I Amount Remitted
HaG PA 17110
HAKE CHECK PAYABLE AND RENIT PAYHENT TO:
REGISTER OF WILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-l$47 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF SHEPPARD JAHES WFILE NO. 21 05-0725 ACH 101 DATE 05-05-2004
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 16;6~5.4~ credit to your account,
$. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 subEit the upper portion
~. Hortgages/Notes Receivable (Schedule D) (q) .00 of this fore w~th your
5. Cash/Bank Deposits/H~sc. Personal Property (Schedule E) (E) 16;~64.84 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 57;784.4~
8. Total Assets (8) 90,984.70
APPROVED DEDUCTZONS AND EXENPTZONS: 1,$85.98
9. Funeral Expensas/AdE. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 6~672.$6
11. Total Deductions (11)
12 Net Value of Tax Return (12) 82,926.$6
·
15. Charitable/GovernEentel Bequests; Non-elected 9115 Trusts (Schedule J) (15)
lq. Net Value of Estate Sub~ect to Tax (1~) 8Z,926.$6
NOTE: I~ an assess;ant ~as lssued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX: .00 x O0 = .00
15. Amount of Line 1~ at Spousal rate (15)
16. AEount of Line lq taxable at Lineal/Class A rate (16) 82,926.$6 x 045 = ~,751.68
17. AEount of Line 1~ at Sibling rate (17) .00 X 1~ = .00
18 Amount of Line 1~ taxable at Collateral/Class B rata (18) _~0,~ X 15 = .00
19. Principal Tax Due ~' )= .~:S,751.68
TAX CREDITS: "'
PAY~ REC~IPT DISCOUNT (+) AHOUNT ~AZD
DATE NUHBER INTEREST/PEN PAID (-)
05-15-2004 CD005676 .00
TOTAL TAX CREDIT I;~. $-7~1.68
BALANCE OF TAX DUE '~ .00
INTEREST AND PEN. .00
TOTAL DUE .00
~ ZF PAID AFTER DATE ZHDZCATED~ SEE REVERSE ( ZF TOTAL DUE ZS LESS THAN $1z NO PAYHENT ZS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU HAY DE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION: Estates cf decedents dying on ar 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 far
life or for years, the Coemonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collataral) rate on any such futura intarast.
PURPOSE DF
NOTICE: To ~ulfill the requirements of Section Z160 of the Inheritance and Estate Tax Act, Act ZS of Z000. (TI P.S.
Section 91603.
PAYNENT: Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGXSTBR OF #XLLS, AGENT
REFUND (CR): A refund of a tax credit, ahich ~as not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z6-hour
answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers ~ith special hearing and / or
speaking needs: 1-800-667-30Z0 (TT only).
OBJECTIONS: Any party in interest net satisfied ~ith the appraisaeent, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object within sixty (603 days of receipt of
this Notice by:
--arJtten protest to the PA Department of Revenue, Board of Appeals, Dept. ZelOZ1, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIYE
CDRRECTIONS: Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Dureau of Individual Taxes, ATTN: Post Assessment Ravie~ Unit, Dept. Z80601, Harrisburg, PA 1712B-0601
Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid aithin three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is a11o~ed.
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. This non-participation
penalty is appealable in the same manner and in tho the same tiao period as you ~ould appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning ~ith 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 l, 19aZ bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000166. All taxes ~hich became delinquent on and after
January l, 198Z mill bear interest at a rate ,hich ~111 vary from calendar year to calendar year ~ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 19&Z through ZOO6 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 20X .000S~8 1988-1991 iZZ .00030! 2001 9X .O00Zfi7
1983 I6X .000638 1992 92 .000Z67 ZOOZ 62 .000166
1986 112 .000301 1993-1996 72 .00019Z ZOOS 52 .000137
1985 132 .000356 1995-1998 92 .000Z67 ZOO6 62 .000110
1986 102 .OOOZ76 1999 72 .O00XgZ
1987 loZ .000Z76 ZOO0 72 .OOO19Z
--Xntarast is calculated as folloas:
XNTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELINQUENT X DALLY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~ill 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.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Estate No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
1. State wh. et~er administration of the estate is complete:
Yes~ No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
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 No /
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes ~ No
D. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
CD c,o co <:-. Name (Please type or print)
<Z~ c _,~ , Address
I
(M~:~~ Telephone No.
Capacity: ~ Personal Representative
Counsel for Personal Representative ~