HomeMy WebLinkAbout04-0171 ~ ~ Cumber_land
h ,eg ster of Witis of Cour ty, Pennsyh, ar ia
PETITION FOR GRANT OF LETTERS
Estate of WZT,T,Z&M W. D&T,BR¥, OR. No. ~-~_/...,,~- / "~/
, Deceased
also known as
Petitioner(s) who is/are 18 years of age or older apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
Social Security No. 1 81 - 0 7- 3 4 2 9
~ A. Probate and Grant of Letters Testamentary and aver that¢.~t~t~o~e/(~)9i~/~re the execu~.e named in the last Will of the
decedent, dated ? / 2 4/1 9 81 and 'codicil(s) dated / / '
**Matthew S. Dalbey and William W. Dalbey, III, are renouncing their
ri'ght to serve as co-executors, in favor of Paul D. Dalbey & Deborah E.
Enders
( State relevant circu,~stances, e.g. renunciation, death of executor, etc.)
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:
[2] B. Grant of Letters of Administration .....
(d.b.n.c.t.a.; pendente lite; durante.absentia; durante minoritate)
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 add!ticnal sheets if necessary
Decedent was d6micited at death in Cumberland
County, Pennsylvania, with his/her last family
or principal residence at 103 Hillside Rd.~ Mechanicsburg~ Silver Spring Twp. , PA (list street, number, and municiPality)
Decedent, then ' 84 years of age, died Feb. 5, ,2004
· 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
.... at Holy Spirit Hospital
(Location)
$ 100,000.00
$ 300:000.00 -
situated as f011ows: Residence at 103 Hillside Rd., Mechanicsburgt PAt and a cabin
in Cumberland County, PA
Wherefore, Petitioner(s) respectfully request(s) the prdbate of the last Will and Codicil(s) presented with this Petition and the grant
of letters in the appropriate form to the undersigned:
Typed or pdnted name and residence
I
Signature
~ '-~'-X/~- .~ ~?' j Paul D. Dalbey
~.~/~~ ..... ,!70 N. Loo[~ Rd., Mechanicsburg, PA 17055
~ '/~~-~ IDeborah E. Enders aka Deborah E. Dalbey
37 White Oak Dr., Carlisle, PA T'TU~3
Oath of Personal Representative
Commonwealth of Pennsylvania
County of York
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 or Petitioner(s) and that, as personal representative(s) of the
Decedent, Petition(s) will weJI and truly administe/.tbe estate according to law.
before me this ~<~(b. z-/,, day of PA~f~ D.. DA~BEY~,.//",~ _ ·
Estateof William W. Dalbey, Jr.
Social Security No.: 1 81 07 - 3429 Date of Death: 2/5/2004
AND NOW, ~~~ ~
of the Petition on th'~everse side here~ satisfacto~ proof having been presented before me,
IT IS DECREED that Le~em ~ Testamenta~ ~ Of Administration
d,b.n,c,ta.; pendehte lite; du~nte absenfia; duta~te ~i~oHtate
are hereby granted to Paul D. Dalbey & Deborah E, Enders aka Deborah E, Dalbey
Deceased
,20 _¢~V , in consideration
in the above estate and that the instrument(s) dated 7 / 24 / 81 and 7 / 18 / 83
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ............ $
Short Certificate(s)...$_
Renunciation ....... $
Affidavits ( ) ....... $.
Extra Pages ( ) ..... $
Codicil ............ $
JCP Fee ........... $
Inventory ........... $.
Automation Fee ..... $
Other .............. $
TOTAL ........ $
1(-~. (~(o
Attorney: David J. Lenox, Esquire
I.D. No: 2.9078
Address: 130 W. Church St., Suite 100
Dillsburg,' PA 17019
Telephone: 71 7-43229666
L~': L d 0Z 83J
sn aceJW111sPetGrantLt/20,01
105.805 REX,' 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 State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9962737
No.
Local Registrar
FEB 0 7 2004
Date
H105.143 Rev. 2/87
lINT
NAME OF DECEDENT (First, ~W., Last)
14.
84
COUNTY O~ D~.ATH
Cumberland
~CE~
103 Hillside Road
~,. Mechanicsburg, PA 17050
FATHER'S NAME (F~. Middle, Last)
W. Dalbey~ Sr.
Deborah E. Enders
21e. ~ (spec~)
SIGNATURE OF
22,l.
c~n~y cause of ~eat~.
result~g th G~e. th) ----~
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH ° VITAL RECORDS
CERTIFICATE OF DEATH
I SEX I SOCIAL SECURITY NUMBER DATE OF DEATH (Month, Day, Year)
Dalbe Jr. Iz male l=.lSl -- 07 -- 3429
DATE (~c B~RTH ~.R. THPI~_ CE (City ~ IPLACE OF DEATH (Check oolv o¢~ - I~e ine~.*,'~!ons o~ o~
~mm ~ ~orstg~ Count/) I ~OS~TA~ / I om~.
CITY. BORO. TWP OF DEATH FAClUTY NAME (1! mX kmtllullo~, give street and numbe¢) WAS DECEDENT OF HISPANIC ORIGIN?
IR&DE - Amedcan Indlatl, B~...k, V~nite. e
Nol~] Y~ [:],y~. ~pe~y C.~n. I (Spec~/)
E. Pennsboro .SPIRIT' r~q/_ u,~r~. P~,~.~.,~. I t0 white
KiND OF BU.~NESM I INDUSTRY DECEDENT'M EDUCATION MARITAL STATUS - M41~e~, I SURVIVING SPOUSE
U.S. ARMED FORCES? NevetE~t~3rcedMamed(~pec~y)Wk~owed, I
Sale Y.~3 No[] (~'~) 1 ('4~'~+~ widowed I
ACTUALDECEDENrS ~.. S~e Pennsylvania , .=. ~ Silver Sprin8
RESIDENCE ~Klent Ye~, decedent #ved in
onolhe~lk~) t?b. Cou~ Cumberland Iownship? 17d. rl No, de~edent~ve~
r MOTHER, S NAME (F~rst. Mid(le, Ma~den Surname)
~. Helen Schaubla
INFORMANT'S MAILING ADDRESS (Str~, Qly/Town, Slate. Zip Code)
~. 37 14hire Oak Drive, Carli$le~ PA [7013
•]z~b.February Il, 2004 ,,. Slate Hill Cemetery Ih~.wer Allen Twp., PA 17011
SS•CH [UCEHSENOMSER HAM~ANOADORES$OFFA~tlIy Farthemore Ffl & CS, Inc.
~.~. FS 012 849 L -=. P.O. Box 431, New Cumberland~ PA 17070-0431
To the best ~ my knowledge, death occurred al the tree, ~ate and place stated. I LICENSE NUMBER IDATE SIGNED
(s~a~ a~ mo) I ~04o~, Day. Yo.~)
I '~' I
TIME OF D~ATH DATE PRONOUNCED DEAD (Month, Day, Year) ~ WAS CASE REFERRED TO A ME[~DAL EXAMINER/CORONER?
I~,. Y*'[] .o~
, .um~..hoek m- haan ~lum. : Ap~xox~e PART I1:
', offset ancI deaU no~ relultthg In the undecfythg cause given kl PART i.
RENUNCIATION
In Re Estate of
William W Dalbey, Jr
deceased.
To the Register of Wills of
C~mh~'r- 1 ~qd
County, Pennsylvania.
The undersigned w~ I I ~m w r~]h~y: III of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Debroah E Enders
hand this
1691 Walnut Bottom Road
Newv~lle, PA 1724]
(Address)
Notarial Seal J
Timothy J. Co, gan, Notary Public
Dillsburg Boro, York County
My Commission Expires Oct. 3, 2006
Member P,~r, nm~,.~n~ '~sodatio~ Of Notaries
(Signature)
(Address)
(Signature)
(Address)
RENUNCIATION
In Re Estate of
William W Dalbe¥, Jr
deceased.
To the Register of Wills of Cumberland County
County, Pennsylvania.
The undersigned M a t t h e w S D a 1 b e y
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
testimentary
beissuedto Paul D Dalbe¥ and Deborah E Enders
WITNESS
hand this~-0'/~ day of ~---~;~'o~7 , I~.DtD~.~'
Timothy J. Colgan, Notary Public
M Dillsburg Boro, York C~unty
Y Commission Expires Oct. 3, 2006
Member. Pennsylvania Association Of Notaries
145 Willow Glenn Road
Dillsburg,(Address) Pa 17019
(Signature)
(Address)
(Signature)
(Address)
JAMES M. BACH
LAST WILL OF WILLIAM W. DALBEY, JR.
I, WILLIAM W. DALBEY_~JR., of the Township of Silver
Springs, County of Cumberland, State of Pennsylvania, being in
good bodily health and of sound and disposing mind and memory
and not acting under duress, menace, fraud, or undue influence of
any person whomsoever, merely calling to mind the frailty of
human life, and being desirous of disposing of my worldly goods
while I have the strength and capacity so to do, I do make, publish
and declare this my Last Will and Testament. I hereby revoke,
cancel and annul all my for~er Wills and Testaments, including
codicils thereto, by me at any time made, and declare this alone
to be my Last Will and Testament.
ITEM 1.a I direct that my executors hereinafter named pay and
discharge all of my just debts and funeral and testamentary
expenses.
I_TEM 2. I order and direct that I be buried in a lot which
I own situate at Slate Hill Cemetery, Shiremanstown, Pennsylvania.
ITEM 3. All the rest, residue and remainder of my entire
estate, wheresoever situate and whatsoever it may consist of, I
give, devise, and bequeath, absolutely and in fee to my dearly
beloved wife, LUCILLE M. DALBEY. In the event my wife dies with
me in a simultaneous disaster or fails to survive my death by
thirty (30) days, then I give, devise and bequeath my entire estat.
absolutely and in fee to my dearly beloved children, per stirpes,
share and share alike.
ITEM ~t I hereby nominate and appoint LUCILLE M. DALBEY
Executrix, of this my Last Will. Should the Executrix herein
named fail to qualify or cease to act as Executrix then I appoint
PAUL D. DALBEY, Executor, in
her ste?.
JAMES M. BACH
ATTORNEy AND
ITEM 5. I direct that my personal representatives, as well
as their successors, shall not be required to give bond for the
faithful performance of their duties in any Jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
day of July, 1981.
WILLIAM W. DALBEY, JR:'" '
The preceding instrument consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testator was on the date thereof signed, published and declared
by WILLIAM W. DALBEY~ JR., the Testator therein named, as and for
his Last Will and Testament, in our presence of each other, have
hereunto subscribed our names as witness.
Residing at
107 St. John's Church Rd.
Residing at
Suite #2, Camp Hill, PA 17011
836 Magaro Road
Enola, PA 17025
COMMONWEALTH OF PENNSYLVANIA :
SS
COUNTY OF CUMBERLAND :
On this the ~ day of July, 1981, before me, the
undersigned, personally appeared WILLIAM W. DALBEY~ JR., known to
me to be the person whose name is--~bscribed-t~-~be within Last
Will and Testament and be acknowledged that he executed the same
for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
/NOTARY PUBLIC
My Commission~/Expires: March 20, 1982
-2-
JAMES M. ]~ACH
ATTORNEY AND COUNSELOR AT LAW
107 ST. JOHN'S CHUFICH ROAD
CAMP HILL. PA. 17011 {
I hereby nominate as executors in addition to Paul D. Dalbe~ the
the following, Deborah E Dalbey, Matthew S. Dalbey and Willzam W.
Dalbey III.
William W. Dalbey Jr.
MARY E. CONRAD, NOJARY PUBLIC
NEW IJ!J~B~U~D BORO,
LAST k~ILL
AND
TESTAME~NT
OF
WILLIAM W. DALBEY, JR.
ATTORNEY AND COUNSELOR AT LAW
10'7 ST. JOHN'S CHURCH ROAD
SUITE .~ 2
CAMP HILL, PA. 17011
TELEPHONE (7~7) 7S7-2033
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 003875
LENOX DAVID J ESQ
305 ROBIN HOOD RD
DILLSBURG, PA 17019
........ fold
ESTATE INFORMATION: SSN: 181-07-3429
FILE NUMBER: 2104-01 71
DECEDENT NAME: DALBEY WILLIAM W JR
DATE OF PAYMENT: 04/28/2004
POSTMARK DATE: 04/28/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 02/05/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $ 18,500.00
TOTAL AMOUNT PAID:
8,500.00
REMARKS:
SEAL
CHECK# 127
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Jan M. Wiley
David J~ Lenox
Timothy J. Colgan
Christopher J. Marzzacco
April 27, 2004 THE Vg-ILEY GROUP
Attorneys at Law
Wiley, kenox, Colgan & Marzzacco, P.C.
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
In Re: Estate of William W. Dalbey, Jr.
Number 21-04-0171
Dear Register:
Enclosed please find a check from the Estate of William W. Dalbey, Jr. in the amount of
$18,500.00 for prepayment of inheritance tax.
Please return a receipt to my office in the envelope provided.
Thank you for your assistance.
Sin/~ely,
DJL/sdg
encl.
David E. Hershey
Diana Woodside
Bradley A. Winni( k
Jennifer L. Frechette
130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
www.wileygrou plaw. com
THE %VILEY GROUP
Attorneys at Law
Wiley · Lenox
Colgan · Marzzacco · P.C.
130 W. Church Street · Suite 100
Dil[sburg, PA 17019
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
R ~gister of Wills of Cumberland County, Pennsylvania
Estate of D~!bey,
also known as Willi;
Paul D. Dalbey
The Personal Represe
include all of the perso
of said Decedent, that
Decedent's death, and
which appears in a me
and correct. I/We und6
relating to unsworn fal.,
Attorney: David J.
I.D. No.: 29078
Address: i S. Balti
Dillsbm
Telephone: 717/435
Personal Propel
M&T Bank Acl
Sale of persona
Fulton Bank CD
Citizens Bank C
Citizens Bank A
Sale of Saturn w
iRS Refund (20(
Social Security c
1996 Masca truc
Aetna Insurance
(Attach additional sheel
/illiamW.
am W. Dalbey, Jr.
INVENTORY
, Deceased
Deborah E. Enders
No. 21 04-00171
Date of Death 2/5/2004 !
Social Security No. 181-07-
ltative(s) of the above Estate, deceased, verify that the items appearing in the following
Iai assets wherever situate and all of the real estate located in the Commonwealth
he valuation placed opposite each item of said inventory represents its fair value as of ti
that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania
I~orandum at the end of this Inventory. I/~Ne verify that the statements made in this Inve~
rstand that false statements herein are made subject to the penalties of 18 Pa. C. S. Se¢iol
ification to authorities.
Lenox
Personal Representative
S,gnature:
Signature'
more Street
,Pa 17019
~666
,unt No. 1066145:
property (Hardy's Auction Service):
t253-0134956:
recking Account No. 6201167637:
:comlt No. 6240853890:
hicle:
3 taxes):
aeck:
~,fund):
Signature:
Address:
Deborah E. Enders
170 N. Loop Rd.
Mechanicsburg, PA 17055
Telephone: 717-796-1368
Dated:
if necessary)
Total Personal Property and Real Estate
of the
hat
e true
15, 13.60
33,: 39.00
13, 82.96
1,I 83.74
157 29.81
8,~ 00.00
1,]53.00
75.00
4, 00.00
02.39
$291 18.80
R,;gister of Wills of Cumberland County, Pennsylvania
Estate of Dalbey, ~
also known as Willi~
Real Estate
Property situate
INVENTORY
continued
;/illiamW. No. 21-04-00171
m W. Dalbey, Jr.
, Deceased
Date of Death 2/5/2004
Social Security No. 181-07-3429
103 Hillside Road, Mechanicsburg, PA. (Assessed Value: $179,220 x
188,1
common level
Sale of cabin sit
on factor of 1.05):
~ate in Cooke Township, Cumberland County, PA:
3
Total Real Estate
8,(
$196,1
81.00
00.00
gl .00
R6
Estate of Dalbey,
also known as
Pemion
Aetna Insurance
Misc. refunds:
Verizon
ister of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
liamW. No. 21 -04-00171
W. Dalbey, Jr.
, Deceased
Date of Death 2/5/2004
Social Security No. 181-07-3429
Total Personal Property
~9.52
;8.37
}5.79
2
' C~ I Odginal~eturn ....
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
i DECEDENTS NAME (I-&ST, FIF ST, AND MIDDLE INITIAL)
[ Da[bey, William W.
(IF APPLICABLE) SURVIVING S ~OUSE'S NAME ( LAST, FIRST AND MIDDLE iNITIAL)
[] 2 Supplemental Return
[] 4 Limited Estate
[] 6 Decedent Died Te~
' David J. Lenox
i The Wiley Group
717/432-9666
DATE OF BIRTH (MM-DD-YEAR)
09/19/1919
] 4a Future Interest Compromise (date of death after
late (Attach copy [] 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
Received [] 10. Spousal PovertyCredit(dateofdeathbetween
12 31~1 and 1-1-95)
FILE NUMBER
21 04
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
181-07-3429
THIS RETURN MUST BE FILED IN D[JF
REGISTER OF W
SOCIALSECURITYNUMBER
] 3 Remainder Return dale of death pdt
] 5 Federal Estate Tax Return Rec
8 Total Number of Safe Deposit I
] 11 Election to tax under Sec. 9112
COMPLETE MAILING ADDRESS
1 S. Baltimore Street
DilIsburg, PA 17019
lie A)
~chedule B)
stion, Partnership or Sole-Proprietorship
qeceivable (Schedule D)
~ & Miscellaneous Personal Property
Idy (Schedule F)
t Requested
~ & Miscellaneous Non-Probate Properly
(total Lines 1-7)
Administrative Costs (Schedule H)
~lortgage Liabilities, & Liens (Schedule I)
Dtal Lines 9 & 10)
_ina 8 minus Line 11)
(1) 196, 181.00
(2) None
(3) None
OFFI(][AL USE
(8)
(11)
(12)
(13)
(4) None
(5) 94,837.8O
)0171
NUMBER
JCATEWITH THE
LLS
~2.~3 82)
oxes
!47,879.66
44,580.96
1. Real Estate (Sched
2, Stocks and Bonds
3 Closely Held Corp(
4. Modgages & Notes
5, Cash, Bank Deposil
(Schedule E)
6. Jointly Owned Prop,
[] Separate Billin
7. Inter-Vivos Transfer
(Schedule G or L)
8 Total Gross Asset.,
9. Funeral Expenses
I0. Debts of Decedent
11. Total Deductions
12. Net Value of Estaf
13. Charitable and Gow
made (Schedule J)
14. Net Value Subject
SEE
15. Amount of Line 141
or transfers under ~
16 Amount of Line I4~
17 Amount of Line 14 t;
18 Amount of Line 14 t~
19 Tax Due
Copyright 2000 form software onh
(6) None
(7) 156,860.86
(9) 39,836.90
(lO) 4,?44.06
imental Bequests/Sec 9113 Trusts for which an election to tax has not been
Tax (Line 12 minus Line 13)
(14)
403,298.70
103,298.70
INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
xable at the spousal tax rate, x ,00 (15)
~c 9116(a)(1.2)
xable at lineal rate x .045 (16)
xable at sibling rate x .12 (17)
xable at collateral rate x .15 (18)
(19)
The Lackner Group, Inc.
Form REV-1500 E
103,298.70
18,148.44
18,148.44
(Rev. 6-00)
Decedent's Compl Rte Address:
STREET ADDRESS
1( , tlillside Road
CiTY M ~'chanicsburg STATE PA I 17050
Tax Payments and Credits:
1. Tax Due (Page l Lir 19) (1) 18,148.44
2. Credits/Payments
A. Spousal Pc mrty Credit
B. Prior Paym rots 18,500.00
C. Discount 907.42
TotafCredits (A +B+C) (2) 19 407.42
3 Interest/Penalty if ap licable
D. Interest
E. Penalty
Total Interest/Penalty (D + E} (3) 0.00
4 ff Line 2 is greater th m Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 1 25 8.9 8
Check box on Page I Line 20 to request a refund
5. If Line 1 + Line 3 is renter than Line 2, enter the difference. This is the TAX DUE (5) __
A. Enter the in erest on the tax due. (SA) __.
B. Enter the to al of Line 5 + 5A This is the BALANCE DUE (5B) 0,0 0
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEAS [ ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 Did decedent ma [ea transfer and: Yes No
a. retain the u le or income of the property transferred; .......... [] [~
b. retain the ri iht to designate who shall use the properly transferred or its income;
c. retain a rev ~rsionary interest; or .......
d. receivethe romsefor feofe herpaymens, benefts or ca e? []
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequa consideration? .......................... [] []
3. Did decedent owr an"intrust for" orpayableupondeathbankaccountorsecur ya hsorherdeath? ...... [] []
4 Did decedent owr an Individual Retirement Account, annuity, or other non-probate property which
contains a benefi~ arydesgna on? ................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FiLE iT AS PART OF T HE RETURN.
Jnder penalties of per~uqt, I declare that I ~" ~¥e exacnined this return, including accompanying sChedules and statements, and to the best of my knowledge and belief ~t is true, correct and omplete Declarati
lreparer other than the personal represent; [i~'e is based on ali information of which preparer has any knowqedge
~IGNATURE OF PERSON RESPONSIBLi FOR FILING RETURN ADDRESS DATE
~-~r' I70 N. Loop Rd.
Mechanicsklurg, PA 17055 ,'//. -/
i~8~TU~'OF PERSON ~E~P~NSIBLI FOR F~ING RETURN ABDRESS
~-?AL(..~-~- Carlisle, PA 17013 '5 ~ '/'
~I~NATUR'L OF PREP~f[ER OTHER TH/ N REPrESENTATiVE ADDRESS TE
~----¢-?~2/ / l S. Baltimore Street
Dillsburg, Pa 17019 / · / ~ /~ t/
rOT dates of death on or after Jt , 1. 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use ~ ,f the
;urviving spouse is 3% [72 P.S. 9116 Ca) (1.1) (i)]
:or dates of death on or after Js auary 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 0%
72 PS §9116 Ca) (1.1) (ii)]. Th ~ statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disc osure
>f assets and filing a tax return ~ re still applicable even if the surviving spouse is the only beneficiary.
:or dates of death on or after J ' 1, 2000:
-he 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; natural
latent, an adoptive parent, or a ltepparent of the child is 0% [72 P.S. §9116 Ca) (1 2)].
-he tax rate imposed on the net ~,alue of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 P.! §9116
2) [72 P.S. §91116 Ca) (1)].
-he tax rate imposed on the net calue of transfers to or for the use of the decedent's siblings is 12% [72 PS. §9116 Ca} (1.3)]. A sibling is, lefined,
~nder Section 9102, as an indivi lual who has at least one parent in common with the decedent, whether by blood or adoption.
I
n bf
L~ST WILL OF WILLIAI{ W, DA_L!~_~ JR
I, ~_ILL!f~.._.DA..L~__~_~R., of the Township oi' Silver
~prtngs, County of Cumberland, State of Ps.sylvania, being ~
good bodily health ~nd of so,md and disposin~ mind and memory
m~y ~eeson whomsoever, me~ely calling ~o mind the F~ailty of
human !~fe, ~nd being desirous of disposing of my worldl~ goods
while I have th~ ssr, ength and capacity so to do, I do make, pub!
sn~ declape ~his m% Las2 Will and Tes%a~nent. I hePeb~ peyote,
cancel and al~ul all my forme~ Wills and Testaments, including
codicils thereto, by me at any tim9 made~ and declare this alone
~o be ~y Last Will and
IT~'[ ~. I d~rec~ that my ex~cu~ors h~rsinafter named pay
discha~E~ all of ~y .just debts and f~eral and
IT~i 2. I order and direc~ that I be bupled in a lo~ which
o~ s].Buat~ a9 Slat~ Hill Cemetemy~ Shipsmansfo~, Pe~nsylvani~
ITE~ 3. Ali the Posh, residue and ~msinder of m~
s~ate, wheresoeve~~ situate and whatsoever it may sonsis9 of~
siva, devise, ~nd bequeath, absolutely and in fee ~o ~
beloved wife, LUCIL~ M, DAZEY, In the event my wife dias with
~e in a slmul~eous dlsast~r or fails to supvive my dsa~h b~ '
thirty (30) days, ~ben I Stve~ devise and bequeath my entire
absolutely ~d in fee tc my dearly beloved children~ per stl~pes
share ~nd sh~re alike.
tT~ .~. I hereby nom~aSe and appoint LUCIL~ M. D~A~
Execu~t~ix, of this my Last Wlll~ Should the Ex~c~trix herein
named fa~l to qualify o~ cease to act as Executrix then I appoin
PAUL D. DAZEY, Executor, in hs~ ste~l~
iTeM ~. I direc~ that my p~rsonml representatives, ~s wei1
their succe.~sors, sba!l not be req~air~d to give bond fo~ ~he
fai~hfuI perfo~ance of their 8nties !n any ~urlsdic.tlon.
IN WITNESS ~0F, I hav~ he~e[mto set my hand this ~
The preceding instrument consisting of this and one (1)
other typewritten page, ~ach identified by the signature of
Testator was on the date thereof stgned, published and declared
by WILLIAM W. DALBEY JR,, the Testator therein named, as and fo:
his La~'~_~--~nd ~t, in our' presence of each other, have
hereunto subscribed our names as witness.
Residing at
!07 St. John's Church Rd.
ufte~C~amp_ Hill~ PA 1701
Residing at
836 M~a_g~ro Hosd
C024J~ON~PEALTH OF PENNSYLVAN;A :
SS
COU~VfY 0F CI~iB~RLAND :
On this the ~ day of July, 1981~ before me, the
~dersigned, pers~l~ appeared WILLI~! W, DA~EY~ JH,, know~, t,
me to be the person whose name is su~scrib~ to {I~e within Last
Will and Testament and he acknowledged that he executed the same
for ~he purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and Official
seal,
l'ty Colnmissiont/Expires Ma?cb 20 '1
x,~$,e as e×e~utors in addition ~ Paul ~.. I}.~lbe~/ ~
/ :
William W. Dalbey ~r. ~ /
SCHEDULE A
REAL ESTATE
ESTATE OF
Dalbey, WilIit a W. FILE NUMBER
~ 21 -04-00171
All real property owned sole
at which properly would be ex
reasonable knowledge of the ~
schedule F.
ITEM
NUMBER
Properly situate
ration factor of 1
ly or as a tenant in common must be reported at fair market value. Fair market value is del ned as the pric~e
;hanged between a willing buyer and a wilting se er neither be ng compelled to buy or sell bott having
elevant facts. Real property wh ch s jointly-owned with right of surv vorship must be di~ on
DESCRIPTION
~t 103 Hillside Road, Mechanicsburg, PA. (Assessed Value: $179,220 x common level
05):
ate in Cooke Township, Cumberland County, PA:
Sale of cabin sitt
.UE AT DATE OF
DEATH
188,181.00
8,000.00
TOTAL (Also enter on Line 1, Recapitulation) 196,181.00
THIS
The William
Pennsylvania
Deborah E. ]
IT IS MUTL
to purchase.
Pennsylvania
the furniture
cottage situat
Forest Camp
as the full pm
is otherwise
Marzzacco, P
time of settle
herein shall 1~
and inspectio
that the propg
and tear exce
For the perfo~
their heirs, p~
above writte~
WlTNESS:
SALES AGREEMENT
AGREEMENT made this {firb~ dayof OCA~.~ ,2004BYANI
W. Dalbey Estate. by the Executor, Paul D. Dalbey, of 170 N. Loop Rd.,
hereinafter called SELLER,
riders, an individual, residing at 27 White Oak Drive, Carlisle, Pennsylvania
hereinafter called PURCHASER,
kLLY AGREED AS FOLLOWS:
The SELLER agrees to sell, grant and conveyto PURCHASER, and the PURC
md accept the conveyance of the cottage erected on the land of the Con
and currently leased to the Seller by the Commonwealth of Pennsylvania, tog¢
md furnishings now in the said cottage, and any other improvements erected
in Cooke Township, Cumberland County, Pennsylvania, and is situate on la
~ease No. 1-C-249, and more fully shown on a drawing attached hereto as "E
The PURCHASER agrees to pay the stun of ($ ~, 000.07.2) DOLLARS
:hase price and consideration for said premises, pa~a~ole by reduction from the
mtitled to as a distribution from the Estate of William M. Dalbey
Final settlement of this transaction shall be made at the offices of Wiley, Le
,C., 130 West Church Street, Dillsburg, Pennsylvania, on the date of estate Settl
Rent the SELLER shall tender to the PURCHASER possession of the said cc
revent PURCHASER from entering the cottage for purposes of enjoyment or
ns before the date of settlement.
The SELLER assumes the risk of loss by fire or other casualty until final settle]
rty shall remain in substantially its present condition until date of settlement,
,ted, and if it is not, the PURCHASER may rescind this contract.
In ali respects the PURCHASER agrees to purchase the property in an "AS
nance of this Agreement and intending to be legally bound hereby, the parties
rsonal representatives, successors and assigns, as witness their hands and seals
The Estate of William W. Dalbey
~/D Z) D (SEAL)
By: Paul D. Dalbey, Executor
Deborah E. Enders
(SEAL)
BETWEEN:
echanicsbutg,
lASER agree~
Lmonwealth o:
ther with all o:
thereon. Sak
id described a:
(hibit A'
:o the SELLEF
;hare purchase
lox, Colgan, 8
;ment, at whicl
ttage. Nothin1
making repair
nent and agree
:asonable wea
IS" condition.
[nd themselves
he day and yea
COI~MONWEALTIt OF PENNSI"LYANIA
DEPARTMENT OF FORESTS AND WATERS
State Forest Distri _ _~.. ~ ¢ ~ a ~4 ~ _.
.......... ~'" ....................................................................... Forest Camp Site No ...... (..~ _~....~ ................
: Compartment No ................................................
County .~._C...~....,m..J ,~[~.EL.~...... Township .......... ..~...Q..9.....~,~., ........................... Warrant No ..............................
Scale 1 inch = $ o ft. ' ...............................
Survey Book No ............ 19. ........................ Page ........... ~.[ ................. Area (acres) ......
North
NOTE~Piot draft a~
courses to nearest degree c
~o scale, with reference to ,
Tie one coraer ~o a ~]
a eonYenlent land corner, o
with a survey coraer by be
lea.se line ,be cloSer than
nor I~ ~eet from other road
Surveyed ........
oundings~Oive
fly as poasible
ling and tie ~2
>~
CI
'-4
X
qD
-<:
0
ESTATE OF
Dalbey, Willi~
Include the proceeds of litigati
survivorship m,ust be disclo
ITEM
NUMBER
M&T Bank Acc,
2 Sale of personal
3 Fulton Bank CD
4 Citizens Bank (
5 Citizens Bank /
6 Sale of Saturn vc
7 IRS Refund (20{~
8 Social Security c
9 1996 Masca tmc
10 Aetna Insuranc~
11 Pension payment
12 Aetna Insurance
13 Misc. refunds:
14 Verizon (refund
SCHEDULE E
CASH, BANK DEPOSITS,& MISC,
PERSONAL PROPERTY
FILE NUMBE~
21-04-00171
)n and the date the proceeds were received by the estate. All property jointly-owned with th right of
~ed on schedule F.
DESCRIPTION DATE OF
DEATH
~unt No. 1066145: 15,113.~0
>roperty (Hardy's Auction Service): 33,539.00
1253 ~0134956: I 3,182.96
recking Account No. 6201167637: 1,883.74
;count No. 6240853890: ! 5,429.8 /
hicle: 8,500.00
taxes): 1,153.00
eck: 875.00
4,000.00
:fund): 102.39
699.5:2
38.37
295.79
add'l refund);
TOTAL (Aisc enter on Line 5, Recapitulation)
24.62
94,837.80
COMMONWEALTH OF PENNSYLVAI
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dalbey, Willi~
This schedule m,
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
E
ITEM Include the name of the I
NUMBER
Fulton Bank IRA
3 Waypoint Ba~
nW.
2 Hartford Life - anuity Contract No. 210271307:
FILE NUMBER
21 - 04- 00171
DECD'S
INTEREST
Ist be completed and filed if the answer to any 9[Ru~e~ti~ons I throu~c
SCRIPTION OF PROPERTY DATE OF DEATH % OF
nsferee, their relationship to decedent and the date of transfer
~tach a copy of lhe deed for real estate VALUE OF ASSET
#391-1908015: 64,324.15 100%
27,949 28~ 100%
JlA No. 1300042213: 64,587.39 100%
4 on pag~ ~is yes
EXCLUSION[ TAX/BLEVALUE
IF APPLICABLE
64,324.19
27,949.28
64,587.39
TOTAL (Also enter on line 7, Reca'pitulationFl 156,86018~61
To:
Fax #:
From:
Subject:
COMMENq
Attaching c(
today I am a
and forms ~
If you are u~
number.
Sincerely,
David J. Le
FAX TRANSMISSION
WILEY~ LENOX, COLGAN & MARZZACCO~ P.C.
Hartfor& Claims and Decedent Date: April 6, 2004
860-843-6098 Pages: 3, . including this cover she,
David J. Lenox
William W. Dalbey, Deceased
'S:
,py of March 8th letter. And having talked with your beneficiary claims depm
[so attaching a copy of the death certificate. Please r~fer to the letter for all th
e request.
able to comply with the requests please notify me immediately at the above pi
~ox, Esq.
:ment
data
tone
ELLE
OCATION OF
FINAL
SETTL
OF SALE
DATE
PHONE
ZIP
kUCTIONEER
PROFESSIONAL FEES
AUCTIC
CLERK
CASHIE
OTHER EXPENSE
qEER 90~05
gq. gO
$ 153.5~
$ /gO. qY
/OOOO
CASH
CHECKS
OTHER RECEIPTS
TOTAL RECEIPTS
LESS TOTAL EXPENSES
I (or we), the:
from the auction ¢
merchantable title
? Auction
accept th s selt ement and acknowledge receipt of the above specified net
my goods and property sold on the above date. I accept all responsibility for
<:) all goods, and properly sold, and for delivery of t fie to the purchaser.
~er or Cashier ~'S'gnature (~'eller~s ~Sign~r~)
Date
Date
iding
Date
(Seller's Signature)
3/2/2004
WILEY GROUP
130 W CHURCH ST STt
DILLSBURG PA 17019
The information which yo
(Social Security Number
Account Number 13000422
Class of Account RETIRE1V
Date Opened 021695
Principal Balance 64576.17
Accrued Interest 11.22
Balance at Date of 64587.39
Death
Account Owngrshtp SOLE
Name of Joint
Owner, if any
Date Ownership 021695
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
infomaation
Requested
LOOK FOR US. WE'LL GET YOU THERE.
100
requested on the accoum(s) of WILLIAM W DALBEY
31-07~3429) is/are as follows:
3
ENT
SENIOR SERVICES REP.
RO. Box 1711. HARRISI~URG. PENNSYLVANIA 1710~;-1711
Toll Fre61-81~6-W, fPOINT (I-866-9;~9-7646) · IN YORK AREA 717/815-4S00 · www.waLlpointbar k.com
~,~ CITIZENS BANK s2s William Penn
Suite 153-~
Pittsburgh, PA 1
March 2, 2004
THE WILEY G
130 W CHURC
SUITE 100
DILLSBURG, t
Estate of WILL
Date of Death: t
SSN: 181-07-3z
Dear Sir/Madan
In accordance
name as of his/h,
For IL or LC acc
call 412-867-385
Sincerely,
?,OUP
STREET
17019
[AM W. DALBEY, JR.
'eb 05, 2004
29
your request, the attached information sheet has been provided in the above deced
~r date of death.
runts, contact our Loan Department at 1-800-708-6680. For a other inquiries, plea~
8.
lace
510
219
Arianna Luce
Operations Servi~ ,es
Account Numb{
Account Title
Date Opened
Account Type
Principal Balan~
Interest from La
Account Balan,
YTDInterest to
ITIZENS BANK
~.e as of DOD
6201167637
William W Dalbey
3/11/2003
Checking
$1883.74
st Posting to DOD $ .00
~ as of DOD
$1883.74
DOD $ .47
IICITIZENS BANK
Account Numb ~'r 6240853890
Account Title William W Dalbey
3/i 1/2003
Date Opened
Account Type
Principal Balan
Interest from L~
:e as of DOD
Time Deposits
$15391.78
st Posting to DOD $38.03
Account Balance as of DOD $15429.81
YTD Interest to DOD $40.55
The Wiley G~
130 W. Churct
Suite 100
Dillsburg, Pern
Dear Mr. Leno
In response
the decedent,
If you she
CAPITAL DIVISION ° LANCASTER/CHESTER DIVISION
DROVERS BANK DIVISION ° GREAT VALLEY DMSION
(717)291-2437
)04
Street
~sylvania 17019
RE: William W. Dalbey, Jr., deceased February 5, 2004
to your recent inquiry concerning the accounts maintained in the name of
sase be advised that the following accounts were open at the date of death:
;D # 253-0134956, open 1/9/2001, rollover 3/9/2003, matures 4/9/2004,
)alance $13,010.90 and accrued interest $172.06; paying 1.44%, joint
~vith Lucille M. Dalbey. ~ i~ t~'Jt.
iRA # 391-1908015, open 3/27/2002, matures 9/12/2004, balance
t64,106.33 and accrued interest $217.86; paying 3.44%, in his name only.
Lucille M. Dalbey and children on file as beneficiaries. A'Oq, 3:aq.I q
d have any further questions, please do not hesitate to contact me.
Very truly yours,
.... '_n D HiJleg?s
Credit Inquiry Processor
Box 4887 Lancaster, PA 17604
wvvw. fuJtonbank.com 1-800 FULTON 4
L CILLE M D~BEY
1 )3 HILLSIDE RD
ACCOUNT SU~RY
~.~..,~.~.~ ~.~.~.~ ~ ~.~ ~;~;~ .................. ' ...........
ACCOUNT ACTIVITY
ESTATE OF
Dalbey, Willia]
Debts of decedent mu
ITEM
NUMBER '
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
A. ! FUNERAL EXPE
I Parthemore Fun~
2 Parthemore Fum
3 Melissa Dalbey
4 Deborah Endet
5 Eby Granite W
ADMINISTRATIV
Personal Represe
aW.
~t be reported on Schedule I.
DESCRIPTION
]SES:
~ra[ Home:
IraI Home (grave opening):
reimbursemcnt for funeral services):
reimbursement for grave site):
:. COSTS:
~tative's Commissions
Social Security Nu ~ber(s)/EIN Number of Personal Representative(s):
Street Address
Cfty State Zip
FILE NUMBER
21-04 ~00171
Year(s) Commis
Attorney's Fees
Family Exemption:
Claimant
Street Addre.,
City
Relationship ~
Probate Fees
;ion paid
The Wiley Group:
f decedent's address is not the same as claimant's, attach explanation)
State Zip
Claimant to Decedent
~egister of Witts:
Total of Continuation Schedule(s)
tr's Fees
~ Costs
Journal (advertise):
,enisc):
TOTAL (Also enter on line 9, Recapitulation)
8,643.00
125.00
532.56
425.00
226.00
376.50
75.00
170.51
10,363.33
39,836.90
Ta>( Return Prepar,
Other AdministratN
Cmnberland Lay
The Sentinal (ad
AMOUN-
18,900.00
ESTATE OF
Dalbey, Willia
9
10
1[
12
13
14
15
16
17
3 Filing Fee:
4 Postmaster:
5 William W. D~
6 Cordier Anti~
7 Richard Zamo~
8 Deborah Ender
GT Watts (awn
Hardy's Auctio
Faimloth Plum~
Deb Zella (horn
Jeremy Barnes t
Debra Baseborn
Janet Frantz, Ta
Charles Hocken
Melissa Dalbey
Schedule H
Funeral Expenses &
Admini=&,~;ve Costs continued
Jbey, III (reimbursement for Mazda Inspection):
~s (appraisal):
,ski (chimney repair):
: (reimbursement for lock smith):
ngs):
t Service:
lng & Heating:
cleaning):
,ouse repairs):
Wiest (real estate taxes):
Collector (real estate taxes on cabin):
erry (Landscape biII):
:eimbursement for trash pick up):
FILE NUMBER
21 -04-00171
25.00
37.00
197.11
75.00
871.39
87.28
55.00
5,324.0i
258.90
400,00
75.00
1,791.83
339.81
556.00
270.00
Page 2 ofSchcdui~ H
ESTATE OF
Dalbcy, Willia
Include unreimbursed medic
ITEM
NUMBER
1
2
3
4
5
6
7
8
9
I0
11
12
13
14
15
16
17
18
19
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
21 - 04- 00171
expenses.
DESCRIPTION
Service Oil Co.
AAA Financial
Matthew Dalbey
Bank One (credit :ard):
(Mazda):
Janet Frantz, Collector (cabin):
Penn Waste, Inc.
Dr. illness):
MS Hershe
Verizon I
Kunkel Surgical, > (last illness):
Debra Basehore ' Tax Collector:
(auto insurance - Saturn):
prescriptions):
MSHMC Physici
Stat,
PA Dept.
PP&L (electric):
Met Ed (cabin):
(last illness):
):
ervation (cabin lease):
AMOUNT
9s .o5
25.73
401.49
117.78
184.04
320.14
93.08
110.10
394.66
75.10
186.46
84.11
528.31
117.00
10.82
569.00
200.00
271.62
99.60
TOTAL (Also enter on Line 10, Recapitulation) 4,744.06
REV 1513 EX+ {9-00} ~
COMMONWEALTH OF PENN~
ESTATE OF
Dalbey, Willi
NUMBER NAME
~. TAXABLE DISTF
1 Matthew S. Da
145 Willow Gl
Dillsburg, PA
2 William W. Da
169l Walnut B
Newville, PA
3 Deborah E. Em
37 White Oak 1
Carlisle, PA
4 Paul D. Dalbe
170 N. Loop 1~
Mechanicsbur
Enter dollar amou
NON-TAXABLE DI
A. SPOUSAL DIS]
BEING MADE
lB. CHARITABLE A
TOTAL OF PART II
SCHEDULE J
~v^N,^ BENEFICIARIES
RN
tm W.
kND ADDRESS OF PERSON(S) RECEIVING PROPERTY
IBUTIONS (include outright spousal distributions)
bey
m Road
[7019
[bey, III
)ttom Road
7241
lers
)rive
013
md
PA 17055
!FILE NUMBER
21-04-00171
RELATIONSHIP TO AMC
DECEDENT
resid
son one-fc
residu
daughter one-fo
residu
son one-fo
residu:
TRIBUTIONS: ~ for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
tlBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
GOVERNMENTAL DISTRIBUTIONS
ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET i
NT OR SHARE
F ESTATE
urth of
try estate
~rth of
try estate
]rth of
Lryestate
]rth of
rycstate
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death: ...~/
Will No. ~1-~-/- O0 ./'"7
Admin. 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 whether 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:
If the answer to No. I 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:
c. Did the personal representative state an account informally to the parties in
interest? Yes V/ 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.
Date:
Nam~ (Please type or' print)
Address ' ' - '
Tel. No.
Capacity:
Personal Representative
Counsel for personal
representative
OF
200q DEC 29 AH 9:I0
CLERK OF
ORPHAN'S COURT
WILEY GROUP
I S BALTIMORE ST
DILLSBURG PA 17019
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACM
12-27-2004
DALBEY JR
02-05-2004
21 04-0171
CUMBERLAND
101
Amount Remitted
WILLIAM W
CUT ALONG THIS LINE
REV-1547 EX AFP C01-05)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
~ RETAIN LOWER PORTION FOR YOUR RECORDS -,~
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
ESTATE OF DALBEY JR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
WILLIAM W FILE NO. 21 Oq-O171 ACN lO1
DATE 12-27-2004
TAX RETURN WAS: C X} ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A]
C1}.
2. Stocks and Bonds (Schedule B}
$. Closely Held Stock/Partnership Interest CSchedule C}
q. Mortgages/Notes Receivable CSchedule D}
5. Cash/Bank Deposits/Misc. Personal Property CSchedule
6. Jointly Owned Property CSchedule F}
7. Transfers CSchedule G}
8. Total Assets C7}
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) C9}
10. Debts/Mortgage Liabilities/Liens CSchedule I} (10}
11. Total Deductions "
12. Net Value of Tax Return
196 r 181. O0
.00
.00
.00
94r857.80
.00
NOTE: To insure Proper
credit to your account,
submit the upper port/on
of this form with YOUr
tax Payment.
156r860.86
¢8} 447,879.66
59,856.90
Cll)
405,298.70
DATE I NUMBER
04-28-2004 CD005875
INTEREST/PEN PAID
907.42
AMOUNT PAID
18,500.00
TOTAL TAX CREDIT
BALANCE OF TAX OUE J
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
19,407.42
I ,258.98CR
C IF TOTAL DUE TS LESS THAN ~1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR}, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.}
15. Amount of Line lq at Spousal rate
(15} .00 X O0 = . O0
16. Amount of L/ne lq taxable at Lineal/Class A rate Cl&} 405,298.70 X 045 = 18,148.44
17. Amount of L/ne lq at Sibling rate (17} .00 X 12 = .00
18. Amount of L/ne lq taxable at Collateral/Class B rate C18} .00 X 15 .00
19. Principal Tax Due ' =
TAX CREDITS: (19)~ 18,148.44
PAYMENT RECEIP1 DISCOUNT C+}
C12}
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J} C1S) .00
lq. Net Value of Estate Subqect to Tax
Clq) 405,298.70
NOTE: If an assessment was issued Previously, lines 14, 15 and/or 16, 17, 18 and 19 wi1!
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX: '
BUREAU OF INDIVIDUAl,','tAx6S:_
INHERITANCE TAX DIVISIOIIC:::"
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
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REY-ln1 EX AFP 112-04)
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DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-31-2005
DALBEY JR
02-05-2004
21 04-0171
CUMBERLAND
101
WILLIAM
W
DAVID JlENOX
WILEY GROUP
1 S BALTIMORE ST
DILLSBURG
Allount Rellitted
PA 17019
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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ESTATE OF DALBEY JR WILLIAM W FILE NO.21 04-0171 ACN 101 DATE 01-31-2005
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-27-2004
PRINCIPAL TAX DUE:,
18,148.44
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-28-2004 CD003875 907.42 18,500.00
01-14-2005 REFUND .00 1,258.98-
TOTAL TAX CREDIT 18,148.44
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
1I!
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR),
vnu MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )