HomeMy WebLinkAbout03-0709Estate of
also known as
Register of Wills of ~ County, Pennsylvania
PETITION FOR GRANT OF LETTERS
, Deceased
No.
Social Security No.
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s),J,r,/are the executo¢'
Decedent, dated -,}'o [,-~ '2~ ~ _ Q-Co '~-~ and codicil(s) dated
named in the Last Will of the
State relev~t e~rcumstances, e.g., leounciatio~, death of executm, 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:
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 J
(COMPLETE IN ALL CASES:) Attach additional., heats if necessary.
Decedent was domiciled at death in
residence at ~.L-[ ~-~ ~'~"~--e~ r"-
Decedent, then ~ [ years of age, died
Decedent at death owned property with estimated values as follows:
County, P, cn,,nsylvania, with his/her last family or principal
, 20 O___~ at
(If domiciled in PA) All personal property .............................. $ '" -~'~ ~)~ 0
(If not domiciled in PA) Personal property in Pennsylvania ...................... $
!
(If not domiciled in PA) Personal property in County ......................... ,. $
Value of realestatein Pennsylvania ............................................... $ j C.3g~! OO~ CO
Total .............................................................. $
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition ancl t~e grant of letters in the
appropriate form to the undersigned:
Typed or printed name and resi,~ence
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Dauphin
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) a/o~ that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate accordin~ 1/o law. '
Sworn to and affirmed and subscribed
before me this S't;::~\ day of
DECREE OF REGISTER
Estate of FI I7ARFTH H LAWSON AKA ELTZABETH LAWSON Deceased
also known as
No. _,-21- 0 --q oq
Social Security No: 185-18-3391
Date of Death: 8-6-200.3
AND NOW, ~,l,J~ll.q;T 2R: 2003 , 20 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters tx-I Testamentary [] of Administration
are hereby granted to `]UDY A FERRANTE F.K.A. ,JUDY LAWSON FERRANTE AND ,]ON LAWSON
in the above estate and that the instrument(s), if any, dated 7-21-2003
described in the Petition be admitted to probate and filed of record a,§~he last Will of Decedent.
FEES
Letters ........................... $
Short Certificate(s) .......... $
Renunciation .................. $
Affidavit ( ) ................. $
Extra Pages ( ) ............ $
Codicil ..........................$
JCP Fee ........................
Inventory & Tax Forms... $
Other .....~.~LD ................
RW-7a
235.00
45.00
TOTAL ................
3 .OO
$ 10.00
$ 1.5.00
Address: ~0
Telephone:
DATE FILED:
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 8505603
No.
Local Registrar
Date
:, t43 Rev. 2/~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
NAME OF DECEDENT (First, Middle, Last) SEX ~ SOCIAL SECURITY NUMBER J DATE OF DEATH (Month, Day, Year)
I M~s J Days J H~m J Minutes J (~, Day, Year) I State ~ F~e~n Count~) I HOSPIT~: I OTHER-
COUN~ OF DEATH I CI~, B~O, ~P OF D~THIFACILI~ ~ME (If not ths~tu~n, give strut and numar) IwA~ qECEDENT ~ HIS~IC ORIGIN? I ~CE- Amain I~ian, BiaS, W~le, el
Cumberland I E ~enn ' ~ I .... I ~ Y..~*~yBE, ~ CO~n.
". I-. ' ~o~o -~p. I- /~o/~/ Op,~,//Yo~h~l I~~'~"~"' ..... ,c. [,0 "~ -
O~ ~ of ~ ~ du~ m~t U.S. ARMED FO~ES?J {Sp~ ~y hi~e~ ~e ~mp~} Never Merited, W~,
~b. Domestic 1~.12 (o-~) o~.~ ~4. Is.
11a. Homemaker
DECEOENT'S MAILING ADDRESS (Street, City/Town, State, Zip Code) J DECEOENT'S
ACTUAL
24 Center Drive RESIDENCE
(See instructions
,6. Camp Hill, PA 17011 Ionmersido)
FATHER'S NAME (First. Middle, Last)
~a. Walter Holmes
INFORMANTS NAME (Type/Print)
20a. Judy A. Ferrante
METHOD OF DISPOSITION
Donation [] Budal ~ Cremalid~ E~ .... Iff'om State []
21a. Other (Specie)
Oivo~cdd (SpeCliy)
widowed
~Ta. stata Pennsylvania md We. ~ Yes. pecddent ~dd ~n Lower Allen .~p.
decedent
17b. County Cumberland township? 17d. [] No, decedent lived
wilhin actual limits of city/bcxo.
¥ wde~ ce~fying
physician is not a to
camh
Items 24-26 must bo completed by
person who pronounces death.
', onset and deatl
IMMEDIATE CAUSE (Final
disease or condition
resulling in death) ·
Sequentially list conditions ~ b.
~ any, leading le immediate /
r. ause. Enler UNDERLYING
CAUSE (Disease or injury c.
Ihat initiated everds
resulting on death ) LAST d.
MOTHER'S NAME (First, Middle, Maiden Surname)
'~g. Evelyn (unknown)
INFORMANT'S MAILING ADDRESS (Street, City/Town, State, Zip Code)
zgb. 1245 Pallister Lane, Lake Mary, FL 32746
I OATE OF DISPOSITION I PLACE OF DISPOSITION* Name of Cemetery, Crematory I LOCATION - City/Town, Sta e, Z p Code
(MonUl, Oay, Year) or Other Place
[] 2~b.August 8~ 2003 Rolling Green Memorial Park[ Lower Allen Twp., PA 17011
21c. J 21d.
S SUCH LICENSE NUMBER
22b. FS 012 849 L
NAME AND AODRESS OF EAClLl~VParthemore FH & CS, Inc
I~. P,O,.Box 431, New Cumberland, PA 1707~-0431
To the best of my knowledge, death occun'ed at the time, date and place staled. I LICENSE NUMBER IDATE SIGNED
Title) I I(Mooth, Day, Year)
DATE PRONOUNCED DEAD (Month, Day, Year) I WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONER?
.'0 o ,~. ~ - 4. - '~, 12J. Yes [] No ~
PART Ih Other significant conditions conthbuting le death, but
not resulting in the underlying cause given in PART I.
DUE TO (OR AS A CONSEQUENCE OF):
DUE TO (~O/~AS A CONSE~EN~F):
~E TO [OR AS A CONS~UENCE OF):
WAS AN AUTOPSY I WERE AUTOPSY FINDINGS I MANNER OF DEATH
PERFORMED? I AVAILABLE PRIOR TO
COMPLETION OF CAUSE Natural ~
Homicide
J OF DEATH? Accident [] Pending Investigation
Yes [] No [] Yes [] NO [] Suicide [] Could not be d ..... ined
2ea. 128b. 29.
CERTIFIER (Check only One)
..
~ DATE OF INJURY(~, Day, Year) TIME OF INJURY INJURY AT WORK? I DESCRIBE HOW iNJURY OCCURRED.
30a.
~IP~CE OF INJURY 30b, M. 30c. 30d.
I buildmg, elc (S~ci~) ' AI h~e, farm, strut, faclo~, Office LOCATION (Street, Ci~own, Stale)
130e. 30f,
'CERTIFYING PHYSICIAN 0~hysician ca,trying cause o~ death when another physician has pronounced death and completed item 23)
To the beM of myknowledge, death occun'ed due to the causes(s) and manner as statecL- ............................................................... []
*PRONOUNCING AND CERTIFYING PHYSICIAN (Physician bogl J~Onouncing death and certifying tO cause of death)
'MEDICAL EXAMINER/CORONER
~n ~he ba~i~ ~ ~x~m~nati~n and~r inve~at~n' ~n my ~pini~n~ death ~ccurred at the ~me~ data~ a~d p~ace' and due t~ the cau~es~) and r-~
manner al itated ..................................
SIGNATURE AND TITLE OF C RTIFIER
LICENSE NOMBER DATE SIGNED (Month Day, Year)
(ll~m 2/)T~ ~ P~nl
DATE FILED (Month, Day. Year)
BOND
RF~GISTER OF WILLS OF CUIVI~:~LAND COUNTY
BOND ~ ~TY FO~ P~R$ON.~L REPI~$~NTATIV~
~I(~NOW ALL BY TI-IF_,SIg PRESENTS, that Jon Lawson and Sudy A. Ferrantc, formerly
khown as Judy Lawson Fen'ante, as principals and Ohio Casualty Insurance Company as
s ~urety are held and firmly bound unto the Commonwealth of Pennsylvania in the sum of
I FIFTY THOU$^ND. ~,ND NO/100 .... ($ 50,000.00 .00)
I:!ollars to be paid to the Commonwealth of Pennsylvania, for which payment we do bind
o~,rselves, jointly and severally, our heirs, executors, administrators and successors, the
condmon: of this obligation being that if as Co-]Executors of the Estate of Elizabeth H. Lawson,
deceased, or any of them, shall well and truly administer the estate according to law, then this
o~ligation shall be void as to the persoaal representative or representatives who shall so
administer the estate and his or their surety or suretie$~ but otherwise it shall remain in full
f0.'£C¢.
Signed and sealed this
bound hereby.
14th,dayof August
,2003, each intending to be legally
(SEAL)
'~, ~ ~.V,.~-~h~\/~1~Z.t~,., (SEAL)
iu x. -
(fon~rly l~iown as Judy Lawson Ferrante)
OHIO CASUALTY INSURANCE COMPANY
attorney-in-fact
(L ,S269070 1}
CERTIFIED ~PY Ob~POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
WEST AMERICAN INSURANCE COMPANY
No. 33-561
Know ~xll. ~en by ~heae l~=eaent.: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN INSURANCE
COMPANY. an Indiana Corporation, in pursuance of authority granted by Article VI, Section 7 of the By-Laws of The Ohio Casualty Insurance Company and Article VI, Section 1 of
West American Insurance Company, do hereby nominate, constitute and appoint: Ralph G. Viehman, Jr., Thomas R. Viehman or D. Jean Rodriguez of Mechanicaburg,
Pennsylvania its mae and lawful agent (s) and attorney (s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS.
LrNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance ONE MILLION ($1,000,000.00) DOLLARS, excluding, however, any bond(s) or undertaking(s)
guaranteeing the payment of notes and interest thereon
And the execution of such bonds or undertakings in pursuance ofthesa presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had
been duly executed and acknowledged by the regularly elected officers of the Companies at their admin/strativc offices in Hamilton, Ohio, in their own proper persons~
The authority granted hereunder supersedes any previous authority heretofore granted the above named attomay(s)-in-fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company has
hereunto subscribed his name and affixed the Corporate Seal of each Company th/s 30th day of October, 1998.
Sam ~awrence, Asalstant Secretary
STATE OF OHIO,
COUNTY OF BUTLER
On this 30th day of October, 1998 before the subscriber, a Notary Public of the State of Ohio. in and for the County of Butler, duly commissioned and qualified, came Sam Lawrence,
Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY, to me personally known to be the individual and
officer described/n, and who executed the preceding insmament, and he acknowledged the execution of the same, and being by me duly sworn dcposeth and saith, that he is the officer
of thc Companies aforesaid, and that the seals affixed to thc preceding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and his signature as off~cer
were duly affixed and subscribed to the said instrument by the authority and direction &the said Corporations.
IN TESTIJIONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above written.
Notary Public in and for County of Butler, State of Ohio
My Commission expires August 6, 2002.
This power of attomey is granted under and by authority of Article VI, Section 7 of the By-Laws of The Ohio Casualty Insurance Company and Article VI, Section I of West American
Insurance Company, extracts bom which read:
Article VI, Section 7. APPOINTMENT OF ATTORNEYS-IN-FACT, ETC. "The chairman of the beard, the president, any vice-president, the secretary or any assistant secretary
of each of these Companies shall be and is hereby vested with full power and authority to appoint attomeys-in-fact for the purpose of signing the name of the Companies as surety to,
and to execute, attach the corporate seal, acknowledge and deliver any and all bends, recognizances, stipulations, undertakings or other instnmaents of suretyship and policies of
insurance to be given in favor of any individual, fro'n, corporation, or the official representative thereof, or to any county or state, or any official board or boards of county or state, or the
United States of America, or to any other political subdivision."
Article VI, Section 1. APPOINTMENT OF RESIDENT OFFICERS. "The Chairman of the Board, the President, any Vice President, a Seereta~ or any Assistant Secretary shall
be and is hereby vested with full power and authority to appoint attorneys in fact for the purpose of sigmng the name of the corporation as surety or guarantor, and to execute, attach the
corporate seal, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or other insttuments of surety-ship or guarantee, and policies of insurance to be
given in favor of an individual, rum, corporation, or the ofi%ial representative thereof, or to any county or state, or any official board or boards of any county or state, or the United
States of America, or to any other political subdivision."
This msmunant is signed and sealed by facsimile as authorized by the following Resolution adopted by the respective directors of the Companies (adopted May 27, 1970-The Ohio
Casualty Insurance Company; adopted April 24, 1980-West American Insurance Company):
"RESOLVED that the signature of any officer of the Company authorized by the By-Laws to appoint attorneys in fact, the signature of the Secretary or any Assistant Secretary
certifying to the correctness of any copy of a power of attomay and the seal of the Company may be affixed by facsimile to any power of attomay or copy thereof issued on behalf of the
Company. Such signatures and seal are hereby adopted by the Company as original signatures and seal, to be valid and binding upon the Company with the same force and effect as
though manually affixed."
CERTIFICATE
I, the undersigned Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby certify that the foregoing power of attomay, the
referenced By-Laws of the Companies and the above Resolution of their Boards of Directors are tr~e gnd.correct copies and are in full force and effect on this date.
1N WITNESS WHEREOF, I have hereunto set my hand and the seals ofthe Companies this 14th dayof August, 2003
Assistant Secretary
,%4300
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF ELIZABETH H. LAWSON
Deceased
Date of death:
August 6, 2003
ORPHANS' COURT DIVISION
No. 2003-00709
PA File No. 21-03-0709
CERTIFICATION OF NOTICE UNDER RULE 5.6{a)
To the Register,
I certify that Notice of Beneficial Interest 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 December 24,
2003:
(attach additional sheets, if necessary)
Nanle
Judy Lawson Ferrante
Jon Lawson
George Irvin
Marcia Irvin, a/k/a Marcy Irvin
Saint Theresa's Church
Ann-Made Lawson
Address
1245 Pallister Lane, Lake Mary, FL 32746
1205 Converse Drive, NE, Atlanta, GA 30324
26 Center Drive, Camp Hill, PA 17011
26 Center Drive, Camp Hill, PA 17011
1300 Bridge Street, New Cumberland, PA 17070
31 Center Drive, Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under R.~.ule 5.6(a)..~p/t~
Date: 12/24/2003 (Signature) /
Name Thomas P. Gacki, Esquire
Address 213 Market St., 8thF1, Harrisburg, PA 17101
- .... Telephone 717.237.6093
Capacity: [-'-] Personal Representative
[~]Counsel for Personal Representatives
{L0274592.1 }
ECKERT SEAMANS CHERIN & MELLOTT, LLC
21_3 .'~lark, ct Street
F~(~llth Floor
H,m'islm% PA 17101
,dddrcss corrcstwndcncc to:
Post Q~cc Box 1248
HarrisburA~, 1~4 17108-1248
'lNcphom': 717.23 7.6000
Facsilnilc: 717.237.6019
Haddo~?Md, ~J
P]d/adc[phi,~
] ~itts[m ~;~h
May 5, 2004
VIA FEDERAL EXPRESS
Glenda F. Strausbaug Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re:
Estate of Elizabeth H. Lawson
File No. 2003-00709
Dear Ms. Strausbaug:
Enclosed please find Check No. 533 in the amount of $28,000 made payable
to "Register of Wills, Agent". Please apply this amount for payment of the
inheritance tax due on May 6, 2004 in the above-referenced estate. Feel free
to contact me if you have any questions.
Very truly yo~ (/~/)
Thomas P. Gacki "
TPG/kmo
Enclosure
ECKEP,.T SEAMANS
{L0279783.1}
Thomas P. Gacki
717.237.6093
tpg~escm.com
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 0O3909
GACKI THOMAS P
213 MARKET STREET
8TH FLOOR
HARRISBURG, PA 17101
ESTATE INFORMATION: SSN: 185-18-3391
FILE NUMBER: 21 03-0709
DECEDENT NAME: LAWSON ELIZABETH H
DATE OF PAYMENT: 05/06/2004
POSTMARK DATE: 05/06/2004
COUNTY: CUMBERLAND
)ATE OF DEATH: 08/06/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $28,000.00
REMARKS:
- SEAL
CHECK# 533
TOTAL AMOUNT PAID:
$28,000.00
INITIALS: JA
RECEIVED BY'
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
For FedEx Express shipmen~ only.
The World On Time
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
May17,2004
Eckert Seamans Cherin & Mellott, I.~C
P. O. Box 1248 ~,t I~.:~.
Harrisburg, PA 17108-1248
Telephone
(717) 787-3930
FAX (717) 772-0412
Dear Sir/Madam:
Re:
Estate of Eliazabeth H. Lawson
File Number 2103-0709
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 11/06/04. Because Section 2136
(d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be
granted that would exceed the maximum time permitted.
Sincerely,
Claudia Maffei, Supervisor
Document Processing Unit
Inheritance Tax Division
COMMONV~-ALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
_ HARRISBURG, PA 17128-0601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
OFFICIAL USE ONLY
21 03 00709
_CO~U N'F~ COdDlE YEAR NUMBER
~_L_awson, Elizabeth H
' 08/06/2003 I 10/13/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
N/A,
SOCIAL SECURITY NUMBER
185-18-3391
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 1. Original Return [-'] 2. Supplemental Return
] 3. Remainder Return (date of death pdor to 12-13-82)
< ~n ['-] 4. Limited Estate
'" E: ,.' [] 4a. Future Interest Compromise (date of death after
~ a. O 12-12-82)
,,' .~ [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach
~. of Will) copy of Trust)
~ [~] 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between
~IAME
Thomas P. Gacki
~FIRM NAME (If applicable)
Eckert, Seamans, Cherin & Mellott
~ELEPHONE NUMBER
_~ 717/237-6093
1. Real Estate (Schedule A)
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
r-~ 11.Election to tax under Sec. 9113(A) (Attach Sch O)
[ MAILING ADDRESS
213 Market Street
8th Floor
Harrisburg, PA 17101
(1)
100,000.00
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions(total Lines 9 & 10)
23,592.50
None
None
83,047.41
None
None
21,362.74
2,097.48
12. Net Value of Estate(Line 8 minus Line 11)
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)
':OFFICIAL USE ONLY
(8)
206,639.91
23,460.22
183,179.69
5,000.00
178,179.69
(11)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2)
16.Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
178,179.69
x .00 (15)
x .045 (16)
x .12 (17)
x .15 (18) 26,726.95
(19) 26,726.95
20. []
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
ISTREET ADDRESS 24 Center Drive
STATE l ZIP
Camp Hill i PA 1701
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable D. Interest
E. Penalty
(1)
26,726.95
28,000.00
Total Credits (A + B + C) (2)
28,000.00
0.00
1,273.05
0.00
Total Interest/Penalty (D + E) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT (4)
Check box on Page I Line 20 to request a refund
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ............................................................................. ~ ~
b. retain the right to designate who shall use the property transferred or its income; ...........................
c. retain a reversionary interest; or ..............................................................................................
d. receive the promise for life of either a ments benefits or care9 ........................................
PY ....
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?. ................................................................................................................ [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ....... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?. ............................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, con'ect and complete. DecJaration of
preparer other th_an the ~ntative is based_on all information of which p~eparer ha~
SIGNATURE OF PERSON RESPONSIBLE FO/P~ILI~G RETURN ADDRESS
J/~P~ig Lawsoa/~} , /"
(~JJerrante ! 245 Pallister Lane
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Decedent's Complete Address:
ISTREET ADDRESS 24 Center Drive
~- Camp Hill
[ ZIP
STATE PA ~ 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
28,000.00
(1)
26,726.95
Interest/Penalty if applicable D. Interest
E. Penalty
Total Credits (A + B + C) (2)
28,000.00
0.00
1,273.05
0.00
Total Interest/Penalty (D + E) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is th(OVERPAYMENT (4)
Check box on Page I Line 20 to request a refund
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5)
A. Enter the interest on the tax due. (5^)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(5B)
Make Check Payable to: REGISTER OF 14qLLS, 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 reversionary interest; or ..................................................................................................
d. receive the promise for life of either payments benefits or car ? .....................
2.If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate cons derat on'~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ....... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary des gnat on~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pequry, I declare that I have examined this return, inclucling accompanying schedules and statements, and to the best of my knowledge and belief, it is true, con'ect and complete. Declaration of
preparer other than the~e_rsonal re~_presentative is based on all information of which prep~~
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Jori Craig Lawson
1205 Converse Drive, NE
Atlanta, GA 30324
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
DATE
~p_~e~.. ~. ~//._7 ........ ~y-., 213 Market Street
8th Floor
ry 1 1995 the tax rate imposed on the net value of
surviving spouse is 3% [72 P.S. §9116 (a) (1 1) (i)] ' ' transfers to or for the use of the
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempta transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lawson, Elizabeth H
SCHEDULE A
REAL ESTATE
FILE NUMBER
21 - 03 - 00709
aAtll rea! prope .r~y owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
whicn propertY/would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell both having
~:ahSeOc~ualbel~=.knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must b~ disclosed on
ITEM
NUMBER
DESCRIPTION
24 Center Drive, Camp Hill, Cumberland County, PA (Sale Price--settlement sheet attached)
TOTAL (Also enter on Line 1, Recapitulation)
VALUE AT DATE OF
DEATH
100,000.00
100,000.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Lawson, Elizabeth H
FILE NUMBER
21 - 03 - 00709
All property jointly-owned with Hght of survivorship must be disclosed on Schedule F.
ITEM ~
NUMBER~
] -~ 200 shares Exxon
500 Shares GE
50 Shares Medtronic
DESCRIPTION
TOTAL (Also enter on line 2, Recapitulation)
UNIT VALUE
VALUE AT DATE OF
DEATH
7,150.00
13,840.00
2,602.50
23,592.50
/il
COMMONWEALTH OF PENNSYLVANIA i
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lawson, Elizabeth H
FILE NUMBER
2 ! - 03 - 00709
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivomh,p must be disclosed on schedule F.
ITEM
NUMI
1
2
3
4
5
6
7
8
DESCRIPTION
Reimbursement of Couny Tax paid at settlement
Reimbursement of SchoolTax paid at settlement
Reimbursement of Sewer paid at settlement
Reimbursement of Trash paid at settlement
Waypoint Bank Retirement Account (Robert Lawson owner, Ellizabeth Lawson sole death beneficiary)
Smith Barney account
M & T Bank Checking Account
Miscellaneous household goods
TOTAL (Also enter on Line 5, Recapitulation)
VALUE AT DATE OF
DEATH
96.40
906.62
0.26
0.54
57,014.57
2,705.51
21,723.51
600.00
83,047.41
COMMON~'~cALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN :
RESIDENT DECEDENT
j
ESTATE OF
Lawson, Elizabeth H I FILE NUMBER
i 21 - 03 - 00709
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER ' DESCRIPTION i AMOUNT
A. ~ FUNERAL EXPENSES:
1
2
3
Funeral Home
~ Cemetery
Flowers
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Eckert Seamans
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees Register of Wills of Cumberland County
Probate Bond
Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Real Estate Transfer Tax paid at settlement
Tax Certification fee paid at settlement
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
7,245.00
910.00
42.00
7,500.00
308.00
208.00
1,000.00
4.00
4,145.74
21962.74
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lawson, Elizabeth H
ScheduleH
, FILE NUMBER
21 - 03 - 00709
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Insurance
Tree Removal
Electric
Water
Phone
Water
PA Revenue
IRS
Co-executors Airfare (two trips each)
Locksmith
Car Rentals
Hotels for co-executors
Fed Ex
Shipping Costs
Packing Supplies
Dumpster Rental
Airport Parking
Postage
Phone
Page 2 of Schedule H
159.34
300.00
180.44
24.56
103.15
96.94
21.00
60.40
1,481.00
95.00
176.22
708.67
16.46
159.60
5.39
460.00
32.00
40.57
25.00
COMMONI~r-ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE :
LIABILITIES, & LIENS
ESTATE OF
Lawson, Elizabeth H
FILE NUMBER
21 - 03 - 00709
Include unreimbumed medical expenses.
ITEM
NUMBER
1 Caregiver
2 Citibank Platinum Card
3 Newspaper
4 Lifeline
5 Johnson Duffle Stewart and Weidner
DESCRIPTION
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
177.00
1,475.33
11.15
74.00
360.00
2,097.48
REV-1$13 EX+ (g-00) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Lawson, Elizabeth H
!FILE NUMBER
21 - 03 - 00709
NUMBER
2
II,
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Ann-Marie Lawson
31 Center Drive
Camp Hill, PA 17011
George Irvin
26 Center Drive
Camp Hill, PA 17011
Marcia Irvin
26 Center Drive
Camp Hill, PA 17011
Judy Lawson Ferrante
1245 Pallister Lane
Lake Mary, FL 32746
RELATIONSHIP TO I
DECEDENT
Niece
Friend
Friend
Niece
See Continuation Schedule(s) attached
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover she(
NON-TAXABLE DIS I HIBUTIONS:
IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
I BEING MADE
AMOUNT OR SHARE
OF ESTATE
1,000.00
5,000.00
5,000.00
half residue
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
St Theresa Catholic Church
5,000.00
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~ 5,000.00
' ~ SCHEDULE J
COMMONVVEALTH OF PENNSYLVAN,A j BENEFICIARIES continued
'NHER)TANCE TAX RETURN I
RESIDENT DECEDENT
ESTATE OF
Lawson, Elizabeth H FILE NUMBER
21 - 03 - 00709
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE
De N~t UstT~ OF ESTATE
I. [include outright spousal distributions, and transfers under
Sec, 9116(a)(1.2)]
$
TAXABLE DISTRIBUTIONS
Jon Lawson
1205 Converse Drive, NE
Atlanta, GA 30324
Nephew
half residue
Page 2 of Schedule J
I:S. I)I!I'A R'I'MI'.N I' ()F HOI. ISIN{; ANI) I;RI]^N III.!VI.~I.OI'MI.~.N r File Numl~r'
SETTLEMENT STATEMENT
L. SE~LEMENT CHARGES
COUM,SmO,
Division ol ~mmission (ilne 700)
'O'. $
..-7.-0-3-:_-C°--"]!?ss~en paid at setllement
BOQ IIEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan 0_r;q]!,ation Fee %
802. Loan Discoun[ %
80__3:_ Apprai.s._a.?ee
804. Cledil Rep?t
805. Lender's Inspec. t'.mn Fee
800 ..M_o_.d.g_a. ge~Eplicalion Fee
807. T;sx Service Fee
808. Document Pre_j~aration__
809. Flood Cedificafior)
810.
511
900. ITEMS REQUIRED BY LENDER TO [:IE PAID IN ADVANCE
901 Inleresl From Io
PAll') FROM
SELLER'S
FUNDS AT
SETTLEMENT
.._9._02.___.M_ort_gage Ins,rance Premium for lo
g03 Hazard Insurance Premium lot to
%304.
905.
1000. RESERVES DEPOSITED WITH LE NJ)ER FOR
1001. Hazard Insurance__ mo. _~_.S_ /mo
_.]_0_02 Mo.?l,.,.qa[~e Insmance mo. ~ S ;mo
_ 100.__.3~_ Ci~ P r_.~p~ _dy...T a x es mo. ~ ................ /mo
l__O_0.5_.~.l~ropeny_Texes m11. ~._$ __31' 5.3 /mo
100.5 $ClmOl la,es mo. ~ $ 100,28 !mo
__.1_0.~9. Aggregele A. na_l,v~is Adjus_lmen! ......... 1100. TITLE CHARGES
0.00 0.00
1101. $etllemen! o~ cJosinq lee __
1102. Abstract or title search
1103. Tills examination
1104 Tills insmonce binder
1105 Docoment Preparalion
, _ _H ~ Z_;__A] f_o_m e.~]~s fees
__ lincludes above items No;
1108. Tills Insurance
..... ._.[inck~des above ilem9 No:
1109 _Lender's C__.overage $
t 11o. Owner's Coverage $
1111.
1112
1113
to Cash
Ia Cent:rs1 Penn Agents for Chicago Title Insu
1101, 1102,1103,1104 Reissue Rate
:LO0,000. O0 772.88
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.
. ~202.
1203,
1204.
Recording F&es Deed $ 40. S0 . :..M_.?.~q~Q.e._$. : Release $
.C_il~oun__~ty tax/s, la_T~s_.- .... Deed $ .t, 0 0 0.0 0 ; Mortgage $ ._
__ Sfele Tsxlstar~l_PS. Deed $ :L, 000,00. ; Morlgag?._$.
1205.
1300. ADDI I IONAL SEI-rLEMENT CHARGE:3
40,50
1,000,00
.. 1302_:_?._e..~_t I_nspection
~303. /axCed lo CPSS
1304.
1305
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES
[enter.on lines 103, Section J and 502, Section
HUD CERTIFICATION OF BUYER AND S~LLER
I have carefully reviewed fha I IUD- ! Selllement ,~itsteffkt~lt 8nd to Ihs bast of my knowledge and be ief ! s ~ tnie aTld acct~rMe ~lale~fll of ~11 t~eipls end disbtwsemenls n~
~ t s ensa~ On. I furth~ cedify that I ha~ recel~ a CO[~ of the HUD [ ~etlleme~l ~lalen~nl.
t~ITED STA lES ON ~IIS OR ANY SIMILAR FORM. PENAL'FIES IJPOH CO~ICTIOI4 I ~avff caused ~ v~ll ~llso the lu~s Ia be alL, based in e~dance ~ff~ It~ st~)toment.
CAN I~ICLUOE A FIN~ AND IMPRISONMENT FOR OEIAII,S SEE 11TLE 18:
U.S, CODE ~ECTION 1001 A~ SECT~N 1010.O~ ......~~
1,813.38 1,004,00
~J.[J CfllC Ilt $|ltJ. c113 ell t u s. Oeparlment of Hot, fin,
B ...T.)[pe of t.oan ........ and Urbe,Develol~ment ............................. O~4B No. 2502-07.65
~. lS,'a s. ~,:~,,,.,,~." /o3-5oo /
/
I). N.4~.tl.~ ¢31; I~ORROVd.'.'R
A
I-'. NAM[! ('IF $ 3..I I:,R:
AI)IIII. 13~;:
J UD ¥ l; I:[R ILA N'I'E a,d .1ON 1_.^ ~[/~ON, CO. E×Efl JTORS OF 'rtl I:!; I~$TA'I E
I; r,l.,'~Ml;, Ill,' I I~.NI)I!I,? Cash
6. P Rflr'l'~R'l Y
I I. SI;. I'TI ,I]~ll!.:N I' AC il;.N'l';
J'I.ACE OI.' SI'['FTI.131EN T:
24 Center Drive LOT 10 I. [.OWEI( AliEN TOWNSHIP, Camp Hill, PA 17011
Cold~vell Banker llSO, 3435 Mai'kd Street, Camp Hill, Pa 17011
I. SI.; "I'I..I].Mt,;NT DA'ri;.: 0 P~ 3()/200_,
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACT ON
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER:
.... !_ok__co,jIr_a.c_.L sa~es price
M .o_?=__ .Pe[~?a!Rroparty' ............
._l~0.3=___S._e/llem_e.n/~es lo borrower
104
100,000.00
105.
107. Counly taxes
108 School Taxes
Ad uslmenls fm'..!te_ms p~j_d_by._sel/e__r In advance.
09/30/03 Io 1~/:!1/03
09/30/03 Io06/30/04
_2~0.1. Del~___s/I o??nesl manev
202 Pfincip¢ amounl ol new
96.40
906.62
401 Conhact sales, price 1 0 0,00 0.0 0
402. Personal Property.
403.
404.
405.
........... Adjushtrenls for Ilerr~. paid 12y..s. elle[. In..~.d.v_a_nc.._e. ...........
407. Courtly laxas 09/30/03h~.12/31/03 96.'t0
408 SchooITaxes 09/30/03 lo 06/30/Oa'
906.6.2
109. Sewer 09/30/031o09/'10/03 ,26 409. Sewer 09/30/031009/30/03 .26
110. Trash 09/30/03to09/30/03 .54 410. Trash 09/30/03to09/30/03 .5~
111. 411.
112. 412.
120. (;ROSS AMOUNT DUE FROM BORROWER 102 , 817 . 20 J 420. GROSS AMOUNT DUE TO SELLER: 3.01,003 . 82
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELl_ER
203. Exislinq. l_o_al_l s~l...Ieken subjecl Io
2O4
205.
206.
207.
208. I
209
............. Adjustments for items u__n.p_a. Ld.by seller __
213.
214.
215.
2111.
217
218
219
220. qOI*AL PAID BY/FOR BORROVVER
300. CASH AT' SETTLEMENT FROM OR TO BORROWER
301. Gross amount due from borrower (line 1201_ } .1.02,817.20
302. Less amount_n_ts_pa__i.d..b, yllo~ borrower (line 220~~ .....
303. CASH FROM BORROWER J 102 , 817 · 20
SOL Excess Oeposil (.Lee in~lru~_lo._n_s_!'
502. Seltlemenl. cherges lo se. ll~e__14_,._0~.) _ ..... 1,004. O0
503=._.E?~isli2jt IoanJs)taken S~Lbjecl to
50,[__ P._~ayoff of Firsl Mortgage Loa¢~
505.
506.
507.
508.
509.
Ad~slments for iJe.m.s Un.l~.a_l..d_by seal. er
513.
514.
510.
TOTAL REDUCTION AMOUNT DUE SELLER 1
520,
602. Less reduclio,I amounl due seller (line 520) · ~-,"~-'~'4.~'~'~' J
~o3. CASU TO SEt, LER
Sl)BSTITI/TE rOI~'M 1099 RELLER RTATEMENT: The Infonnalton conlein¢l h~in ~ t~ant ~i !fl~tion and IS ~ng furnished lo the Inl~al Re~m~e ~ce. If ~ ere r~l
SELLER IH~UCT~NS' ff this r~l ~lale ~s ~Jr~fl ~eSld~ce. f e F~ 2119 Sa · ~ E~nge ol P~opal Res~nce fm ~y ~in ~ ~ ~ lax rekm~ Im ~he~ I~ll~s
co~lele the ap¢cahle pa~ls of Fo~m a797. Fo~ 6252 an~ Sc~dule O IFo~m 10403 ' ' ......
SELLER(~1 NEW MAILIN(;
I'illJ;F,.~pte,,~s Sdll¢l~nl gystum Pr hied 09,"25120{)) at 14:52
BUREAU OF TNDZVZDUAL TAXES
'rNHER'rTANCE TAX DI*V];S'rON
DEPT. 280601
HARRISBURG.. PA 1712:8-0601
THOMAS P GACK!
ECKERT ETAL
215 MARKET ST 8TH FLR
PA 17101
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEMENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF
DATE OF DEATH
'04 JUL 30
COUMTY
ACN
08-02-Z00q
LAWSON
08-06-200:5
21 0:5-0709
CUMBERLAND
101
Amoun4: Remi4:~ed I
ELIZABETH H
MAKE CHECK PAYABLE AND REM'rT PAYMENT TO:
REGTSTER OF W'rLLS
CUMBERLAND CO COURT HOUSE
CARLZSLE, PA 1701:5
CUT ALONG TH'rS L'rNE ~* RETA*rN LONER PORT'rON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOT'rCE OF ZNHER'rTANCE TAX APPRAZSEMENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCT'rONS AND ASSESSMENT OF TAX
ESTATE OF LAWSON ELTZABETH H FZLE NO. 21 0:5-0709 ACN 101 DATE 08-02-200q
TAX RETURN HAS: (X) ACCEPTED AS FZLED ( } CHANGED
RESERVATZON CONCERNZNG FUTURE 'rNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1 Real Es~a4:a (Schedule A)
S4:ocks end Bonds (Schedule B)
$ Closely Held S4:ock/Par4:narship Zn4:eras4: (Schedule C)
Nor4:gages/No4:es Receivable (Schedule D)
$ Cash/Bank Deposits/Misc. Personal Proper4:y (Schedule E)
6 Join4:ly Owned Proper4:y (Schedule F)
7. Transfers (Schedule G)
8. To4:al
APPROVED DEDUCTZONS AND EXEMPTZONS:
9. Funeral Expenses/Ada. Cos4:s/Nisc. Expanses (Schedule H)
10. Deb4:s/Mor4:gaga Liabili4:ies/Lians (Schedule I)
11. To4:al Deductions
12. Ne4: Value of Tax
(1)
(2)
(5)
(S)
(6)
(7)
100~000.00
2:5~592 50
O0
O0
8:5~Oq7.q1
O0
O0
(9)
(8)
21,:562.7q
(lO)
NOTE: To insure proper
credO4:4:0 your accoun4:,
submi4: 4:ha upper por4:ion
of 4:h~s fore w~4:h your
15.
lq.
NOTE:
206,6:59.91
2~097.q8
(11) 23.460.22
(12) 183,179.69
5,000.00
178,179.69
Chari4:eble/Governmen4:al Bequas4:s; Non-elec4:ed 9115 Trus4:s (Schedule J) (1:5)
Ne4: Value of Es4:a4:a Subjec~ 4:0 Tax
Zf an assesseent was issued previously, 11nes 14, 15 and/or 16, 17,
reflect f/gures that lnclude the total of ALL returns assessed to date.
.00
18 and 19 w111
(15) .00 x O0 = .00
(16) .00 x Oq5 = .00
(17) . O0 x 12 = . O0
(za) 178,179.69 x 15 = 26,726.95
(19)= 26,726.95
AMOUNT PA'rD
ASSESSMENT OF TAX:
15. Amoun4: of Line lq a4: SpousaZ ra4:e
16. Amoun~ of Line lq 4:axable a4: Lineal~Class A ra4:e
17. Amoun4: of Line lfi a4: Sibling ra4:a
18. Aeoun4: of Line lq 4:axable a4: Colla4:aral/C1ass B ra4:e
19. Principal Tax Due
TAX CREDZTS:
PAYMENT RECEZPT DZSCOUNT (+J
DATE NUMBER ZNTEREST/PEN PAZD (-)
05-06-200q CD00:5909
ZF PAZD AFTER DATE /NDZCATED, SEE REVERSE
FOR CALCULATZON OF ADD/TZONAL ZNTEREST.
28,000.00
TOTAL TAX CREDZT
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
18,000.00
1,27:5.05CR
.00
1,17:5.05CR
( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REiiUI'RED.
'rF TOTAL DUE TS REFLECTED AS A 'CRED'rT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
[NTEREST:
Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred
in possess[on or enjoyment to Class B (collatmra13 beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby exprassZy reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateraZ) rate on any such future interest.
To fulfill the requirements of Section 216`0 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S.
Section 916`0).
Detach the top port[on of this Notice and submit eith your payment to the Rag[star of Hills printed on the reverse side.
--Make check or money order payabZe to: REgiSTER OF N~LLg, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of PennsyZvan[a Inheritance and Estate Tax" (REV-ISZ3). AppZ[cat[ons are avaiZabZa at the Off[ce
of the Regis[ar of N[llsj any of the 23 Revenue District Offices, or by ceiling the spec[aZ Z0`-hour
answering service for fores ordering: 1-800-$61-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-0`6`7-3020 (TT only).
Any party in interest not satisfied eith the appraisement, alloaanca, 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
th[s Not[ce by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Un[t, Dept. 280601, Harr[sburgj PA lT1Z&-060!
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
[f any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of
the tax paid Ks aZlowed.
The 151 tax amnesty non-participation penalty Ks 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 par[od. This non-participation
penalty Ks appealable in the same manner and in the the same time per[od as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest Ks 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 deZ[nquant before January 1, 1982 bear interest at the rate of
six (6X) percent par annum calculated at a daily rate of .000166`. All taxes which became delinquent on and after
January 1, 198Z w[11 bear interest at a rate which w[11 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates far 1982 through Z006` are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
~ 201 .00056,8 ~)'~'8-1991 XXZ .000301
1983 161 .0006`38 1991 91 .00020`7
198°, 111 .000301 1993-1996` 7Z .000192
1985 X3Z .000356 1995-1998 9Z .00016`7
1986 XOZ .000276` 1999 7Z .000191
1987 101 .000176` ZOO0 71 .OOOX9Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~'~ 91 .00016`7
ZOOZ 61 .000160`
2003 5Z .000137
2006` 6`Z .000110
X NUHBER OF DAYS DELINQUENT X DA'rLy INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment Ks made after the interest computation date shown on the
Not[ce, additional interest must be calculated.
BUREAU OF TNDZVTDUAL TAXES
TNHERTTANCE TAX D'rVTSTON
DEPT. Z80601
HARRZSBURG,~ PA 171z8-060!
CONHONNEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
REV-2607 EX AFP (D1-03)
THOHAS P GACKI
ECKERT ETAL
Z1:5 HARKET ST 8TH FLR
HBG PA 17101
DATE 09-07-ZOOq
ESTATE OF LANSON
DATE OF DEATH 08-06-200:5
FILE NUHBER 21 0:5-0709
COUNTY CUHBERLAND
ACN 101
Amoun* RemiC*ed
ELIZABETH H
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF NILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
NOTE: To insure proper credi* ~o your account:, submi~ ~:he upper portion of *his form wi~h your ~ax paymen~c.
CUT ALONG THIS LINE ~- RETAIN LONER PORT'rON FOR YOUR RECORDS ~,~
REV-1607 EX AFP (01-03)
### INHERITANCE TAX STATEMENT OF ACCOUNT Ni(N
ESTATE OF LANSON ELIZABETH H FZLE NO. 21 05-0709 ACN 101 DATE 09-07-200q
TH'rS STATENENT ZS PROVZDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHONN BELON
ZS A SUNNARY OF THE PRZNCI'PAL TAX DUE, APPLZCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE,
A PROJECTED ZNTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 07-26-Z00~
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
26,726.95
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-06-ZOOq
08-16-200q
CD00:5909
REFUND
.00
.00
ZF PAZD AFTER THZS DATE, SEE REVERSE
SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR),
28,o ?oo
t,2 3 ::os-
TOTAL TAX CREDZT 26,726.95
BALANCE OF TAX DUE .00
ZNTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THTS FORH FOR TNSTRUCTTONS. )
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
) ORPHANS' COURT DIVISION
)
) No. 2003-00709
Estate of Elizabeth H. Lawson
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Elizabeth H. Lawson
Date of Death:
August 6. 2003
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:
I. State whether administration of the estate is complete:
Yes
---1L No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: 60 days
3. 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
No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be attached to this report.
0''';:JO''222005 '-1) ~
Thomas P. Gacki, Esquire"
Eckert Seamans Cherin & Mellott, LLC
P.O. Box 1248
Harrisburg, PAl 7108-1248
717.237.6093
tr)
('"J
-.- .;
Attorneys for Personal Representatives
cA
{L0298452\ }
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (71 7) 240 - 6345
Date: 7/13/2005
LAWSON JON
1205 CONVERSE DRIVE, NE
ATLANTA, GA 30324
RE: Estate of LAWSON ELIZABETH H
File Number: 2003-00709
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/06/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~.~~~
GLENDA FARNE~;~~~
REGISTER OF WILLS
cc: File
Counsel
Judge
oft
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE:
) ORPHANS' COURT DIVISION
)
) No. 2003-00709
Estate of Elizabeth H. Lawson
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Elizabeth H. Lawson
Date of Death:
Au!!ust 6. 2003
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:
-L Yes
No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties In
interest:
X Yes
No
~~ ~'I .
d. Copies of receipts, releases, joinders and approvals of formal or informal
~~ accounts may be filed with the Clerk OfO~Court and be
July 7, 2006 I L-- r ~
Ll_
omas P. Gacki, Esquire
Eckert Seamans Cherin & Mellott, LLC
P.O. Box 1248
Harrisburg, P A 17108-1248
717.237.6093
:. ~ ..
,.- -,
1--__.1"
Dat~';::
r=-,
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("
Attorneys for Personal Representatives
(L0315064.1l
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
GACKI THOMAS P
213 MARKET ST 8TH FL
HARRISBURG, PA 17101
RE: Estate of LAWSON ELIZABETH H
File Number: 2003-00709
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July I, 19921 the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
8/06/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
SincerelYI
~~~
,._1
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
\(
Cumberland County - Register Of Wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
FERRANTE JUDY A F/K/A
1245 PALLISTER LANE
LAKE MARY I FL 32746
RE: Estate of LAWSON ELIZABETH H
File Number: 2003-00709
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/06/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
11, (/~ ...~J<~#..J1
,d~~ f~c/J}~~7t~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~.
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 7/05/2006
FERRANTE JUDY LAWSON
RE: Estate of LAWSON ELIZABETH H
File Number: 2003-00709
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/06/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
,t...''')L..i~ i ~, l' ~ !'-?,,.~. f)
^i/I/~.J~ X~~
, ' //
; "j
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
Cumberland County - Register Of wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
LAWSON JON
1205 CONVERSE DRIVEl NE
ATLANTA I GA 30324
RE: Estate of LAWSON ELIZABETH H
File Number: 2003-00709
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/06/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
rA'~. . t
& ,-?"v..'.. .. ... ". . . .'/
): tt1'~ ~~.AJ., ..,..
f l
C./
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE:
) ORPHANS' COURT DIVISION
)
) No. 2003-00709
Estate of Elizabeth H. Lawson
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Elizabeth H. Lawson
Date of Death:
August 6, 2003
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:
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
C. Did the personal representative state an account informally to the parties m
interest:
X Yes
No
d. Copies of receipts, releases, joinders and approvals of formal or informal
~ :::::::o~:y beliled with the Clerk of o;;:ourt7 be
Date:::
'-.L_
M
omas P. Gacki, Esquire
Eckert Seamans Cherin & Mellott, LLC
P.O. Box 1248
Harrisburg, P A 17108-1248
717.237.6093
'---'"')
C:>
, .
C"-..!
Attorneys for Personal Representatives
(L0315064.1l
,..
L-