HomeMy WebLinkAbout01-1051
Estate 01
Register of Wills of County, Pennsylvania
PETITION FOR GRANT OF LETTERS
B~\ G k/l~A? No. ~\-O\-IG51
also known as
. Deceased
Social Security No. t~ -~, - 5~
Peli DoM!1 a), who is/are '8 years 01.0. or older. apply~..) lor.
(COMPLETE 'A' OR ~' BELOW:)
~
A. Probate and Grant of Letters Testamentary and aver chat Pelitioner(l) lal....1h. exec:ut .1!fLnamed in fle last Will of
tie Decedent. da led (\'\ fA. ,) '1
I~SS-
and c:od'lCil(l) d1111td
s...s. ,...,.,. drcuml~. ..f.. r.nunc:imion. cSech vi ueQ/lOt,-'
Except as foRows, Decedent did not marTY. was not divorced, and cld not have a child bom or adopted after execution of the doc:umenll
offered for probate; was not the victim of a killing and was never adjucleated inoompe."t:
o B. Grant of letters of Administration
(d.b.I\4L&.; penden1e lie; durante ,,"'Ia: durante rnnorble
P.titioner(l) .rter a proper search hashlaY8 ascertained hI Decedent Ie" no Will and wa. lurJi\'8d by the following lpouse [If any) and
heirs:
r
Name
Rela lion ship
Residence
I
(COMPlETE IN All CASES:) Aaa.c:tladdiDonaJ ","IS if nec:essaty.
Oeeedent was domiciled at death in C<J.-I.AJ...>-. \0 .a.^ \ ~
0( principal residence at f J..tMj S 16'- po "W<.1o..;L. S. d u...~ cM.. t ciJ. '\L -h-1V" 1U-J (l
(liar air numb<< and mll1ic:ipa/ity)
Decedent, then Q 3 yean of ag., cled A-~/l~ l s. . tela<=.\ . 'i LoN} r k~ . ''6J~ ~Illt-s k. /,.,
(LocaIIon)
. J SJ a6 0 .
.
$
$
County, Pennsylvania. with hish1er last family
Decedent at death owned property with eslimated valuel as followa:
(If domia1ed in PAl An peBonal property
(If not domiciled in PAl Personal property In Pennlytvw,1a
(If not domiCIled in PAl Personal property In County
Value of real estate in Pennsytvania
situated as foftOWl:
Wherefore, Petitioner(s) respectfuRy reque5t(s) the probata of the lasl Will and Codicil(l) presented with thl. Petition and the grant of
"ttB~ In the appropriate form to the undersigned:
dOl'
~ 1'761'3
Fonn ,RW., Paoe t of 2
Prepared by !he PeM,ylvan~ Bar Aasoc:ialion 100t
II ~)\ -- <{'
\ "\ \ ~ (\ \ \ - \ S - () \
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above.named swear(s) or affinn(s) that the statements In the foregoing Petition are true
and correct to the best of the knowledge and benef of Petitioner{s) and that, as personal representative(s) of
the Decedent, Petitioner{s) will well and truly administer the estate according to law.
Swom to or affirmed and subscribed
before me this 15TH day of
~OVEM@ z:. xn~ ~
'jDwv . ' 'Ulj ~1}jm
a For the R glster
MARY CLEWIS
.x~~
No. 21 - 01 - 1 O~ 1 tpt;ll'---- .
Estate of 'B ~ l (r- (~I: I j 1 L~~;r- s:. I:: It ~I ~ Deceased
Social Security No: J R 9, ()~ ..5~'r'X Date of Death: ltP/Lr'- ~ 3" Z-C\C I
AND NOW, NOVEMBER 16" ,XI~ ?n01 ,tn consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters UYTestamentary 0 Of Administration
~;pendenle I\e; dUfaftt. at..,..~ dllafta.~
are hereby granted to
et \.3~~.e~
kJ "II\,) +~(\. >
in the above estate and that the InstNment(s) dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ..................... $ 50.00
Short Certificate(s) ..(.1 0, 30.00
Renunciation ............ $
~7tcJ~~&{k~
c M~~;'~E:~~ . ,
Attorney:
Affidavits ( ) ........-... $
Extra Pages (3 ) ......... $
Codidl ...................... $
JCP Fee ................... $
Inventory .................. $
Other ....................... $
TOTAL ............. $ 94.00
LO. No:
9.00
Addr...:
5.00
Telephone:
fon'n ,RW.' P-o- 2 01 2
Prltp<d by d"4 Pennsylvania Bet A.uodalion 1881
Mailed letters to Executrix on 11-16-01
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 ~ ~ A
'44 \. ~
Local Registrar
No.
P 7438390
. v.7
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
~
NAME OF DECEDENT (F... _.l..,
Berl
,.
AGE (la. !Mt>cIay!
G.
K.line
STATE F'lE NUM8l!A
SEX SOCIAL SECURITY NUMBER
2Female 3. i 89 -.) ~
PlACE OF OE.<r'H fCtlectll 0I1fy I)f'8 -- iN Insl"lCI~ on 0It'et StOet
HOSPITAL:
.....- 0 E~_ 0
DATE OF DEATH ._. 0.,.. '_1
t. April J. 2001
UNDER 1 YEAA
- cay.
SURVMNG SPOUSE
1"-.___1
......
....,...,....
_ ~211_ ~ camplIIl8d by
---_.
M. AM. .3 ClODI
11'. NfIT I: Enter.... _. ...- or compIic:_ _ caused lhe death. 00 not .nler lhe mode of dyi"ll. such IS ca_ or ,eSJltlalory arrest. shoctI 0' hearl 'ailur.
lillOftly......-on__.
__c-.~
_or c:onclihon
r-..ng"_I_
ct<.~ tJ-~
PlUITA: OlftMsigtldlclllll_~to_.1lul
not reoutIing...... ~ _g;.. irllWlT I.
WSWA,rM.N:J d.unt.J~ ~ '
~.._ to
W_.-.glD_ ['
_.E__IIl.V_
CAUSI! (0.- err "'IU'Y c.
----
'-*'0" _llASV
d.
.s AN AUlOPSY WEAl! Al/'IOPSY FINDINGS lIANNER OF DEATH
PERFORUEO'P ~E PRtOA 10
COMPt.ETION OF CAUSE -...
OF DEATH'
Nor;! - 0
_0 Noel _0 - 0
DATE OF INJURY
(Man"'. o.y. ....)
TIME OF INJURY
INJURY 1J WORK? DESCRIBE HOW INJURY OCCURRED.
-
o
o
o PuicE OF INJURY. AI hOme. larm~_. factory. 0IIIce M.
bu~ ole. ISpec")
3Oe.
_ 0 NoD
Pe.-g~
'..DlCAL DAII....RlCOAONI!A
On 1M beel. of ..amlnatlon end/or InvtteUgat-.., In '"y opinion. d..'h occurred ., the time, d.'e, _net piece, _00 due to the ceuse(.).nd
manne, .. 'fated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
"..
REGISTRAR'S SIGNATURE AND NU
II q Ii f? 171
'0
Could..... t>e...._
-
CEJIT_~."."......
.CEJIT~ ~"" ~ ~......d ""'" _ an_""Vl.C.." !\aSP<"""""'*' dealh """ comlJleflld Item 23)
___oln.yk,--........___._UUM(.'.....m.............,..........,........................,................... .
29.
.~ ANO CERTlI'YINO PtfYSICIAN (PhvIic_ boIh "","oU"':>"9 "..."" and C8I101yong fa c..... 01 <lee""
To'he bNt Of...y k~. ......" occurNd a' .......... d.'.. 8nd piKe, and due to the c.uM(e) and manner.. ".'ed.. . . . . . . . . . . . . . . . . . . . . . . . .
33
1E&5t lIIi11 &ub Qft5btuttttl
of
BERL G. KLINE
I, BERL G. KLINE, of 532 Sand Lake Road, Onalaska, Wisconsin,
hereby revoke all of my former Wills and declare this to be my Last
will and Testament.
ARTICLE I
I hereby direct my Personal Representative to pay all my just
debts, taxes, funeral expenses and administrative expenses from the
residue of my estate as soon after my death as possible.
ARTICLE II
I give, devise and bequeath my residence located at 532 Sand
Lake Road, Onalaska, Wisconsin, and all of my furniture, household
goods, linens and other tangible personal property located therein
to my sister, ELIZABETH WINTERS, if she survives me.
Should
ELIZABETH WINTERS predeceases me, said real estate and items of
personal property as described in this Article are hereby given to
the descendants of ELIZABETH WINTERS who survive me by right of
representation.
c:f7 !:~
-Q a. ~ ~
~ Krpata JLf
~~4.~,'
Berl G. Kline
~
-
1
ARTICLE III
All of the res t and remainder of my es ta te, be it real,
personal or mixed, I hereby give, devise and bequeath to the
following persons in the following shares if they survive me:
A. To my sister, ELIZABETH WINTERS, one-fifth (1/5) thereof.
B. To my sister, MARY HESS, one-fifth (1/5) thereof.
C. To my brother, HENRY M. KLINE, one-fifth (1/5) thereof.
D. To my brother, ELMER P. KLINE, one-fifth (1/5) thereof.
E. To my nephew, ROBERT 1-10RD~~v, one... tenth (1/10) thereof.
F. To my grandniece, STEPHANIE ROWLAND, one-tenth (1/10)
thereof.
Should any beneficiary above-named predecease me, the interest
which he would have received had he survived me is hereby given to
the descendants of said beneficiary who survive me by right of
representation. Should any beneficiary above-named predecease me
without any descendant who survives me, my property is given in
such shares and to such beneficiaries as would have been the
distribution of this Will as if that person had never lived.
ARTICLE IV
If any beneficiary dies prior to the entry of an order, decree
or judgment in my estate distributing the property in question, or
wi thin five mon ths af ter the da te of my dea th, whi chever is
~~4~
Berl G. Kline
Krpata
2
earlier, any interests which would have passed to said beneficiary
under other provisions of this will are to be disposed of according
to the plan of distribution which would have been effective under
this will as if said beneficiary had predeceased me.
It is my
intention that any property or interest which is distributed from
my estate as a result of any court order, decree or judgment will
not be revoked or otherwise affected by the subsequent death of the
distributee.
_ ARTICLE V'
I hereby appoint my sister, ELIZABETH WINTERS, as Personal
Representative of this Will and request that no bond be required of
her in such capaci ty.
If for any reason, ELIZABETH WINTERS is
unable to so act, I hereby appoint my nephew, ROBERT MORDAN, as
Personal Representative of this Will also to serve without bond.
I empower my Personal Representative to sell, lease or
mortgage any of my property wi thou t an order of the Court and
wi thout notice to anyone upon such terms and condi tions which would
be in the best interests of my estate; and to settle, compromise,or
pay any claims, including taxes, asserted in favor of or against me
or-my estate.
zf~~t:t~
tl.
<?~4o~
Berl G. Kline
3
ARTICLE VI
In this Will, the use of the masculine gender includes the
feminine, and the use of the singular or plural case includes the
other where appropriate.
Dated this 9th day of May, 1995, at Black River Falls,
Wisconsin.
~~::t:r~
The foregoing instrument consisting of 4 pages, each of which
bears the signature of the testatrix and of each wi tness, was
signed and published by said testatrix as her Last Will, in the
presence of us, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
witnesses.
We each certify that at the time of the execution of
this Will the testatrix was mentally competent and acting
voluntarily.
~~~~
Eric F. Stutz
peg!mre~a ~:i
of Black River Falls, Wisconsin.
of Black River Falls, Wisconsin.
4
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: BERL G. KLINE
Date of Death:
APRIL 3. 2001
Will No.
2001-01051
Admin. No. 21-01-1051
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of
the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-
captioned estate on FEBRUARY 25.2002
Name
ELIZABETH WINTERS
SHELDON HESS JR.
JAMES HESS
JOHN HESS
ALICE POMEROY
HENRY M. KLINE
ELMER P. KLINE
ROBERT MORDAN
STEPHANIE ROWLAND
Address
4 Wexford C1.
1992 Rheam Rd.
13 Collegro Dr.
145 Willowmill Park Rd
5311 Highgate Green
2952 Green Creek Rd.
4016 Wax Wing Trail
Rt 1 Box 102
560 Fulton S1.
Carlisle, P A 17013
Clinton,OH 44216
Douglasville,PA 19518
Mechanicsburg, P A 17055
Williamsburg, VA 23188
Orangeville,P A 17859
Stow, OH 44224
Dakota MN,55925
Aurora CO,80010
Notice has now been given to all persons thereto under Rule 5.6(a) except
Date:
FEBRUARY 25. 2002
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Name ELIZABETH WINTER5-
Address 4 Wexford Ct
Carlisle. PA 17013
Telephone (717) 258-9729
Capacity: ....K- Personal Representative
Counsel for personal representative
~nventory of the real and personal estate of
()v/
BERL G. KLINE
deceased
1. 367.4910 shares AT&T Corporation @ $20.30/share 7460 07
2. 23 shar'es Avaya @ $11.7152/share 269 45
3. 283 shares Lucent Technologies @ $8.05/share 2286 20
4. Allfirst Bank
Money Fund Acct #98290525 17986 13
Checking Acct $38443155 1231 82
5. M & I Bank Checking Acct #551064 9415 14
6. American Republic Insurance Co. (Return of unused premium) 1939 J60
,
l~c)588 41
M <t
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COMMONWEALTH OF PENNSYLVANIA L
CO UNTY OF CUMBERLAND J
55:
ELIZABETH WINTERS
being duly
sworn
according to law, deposes and says that U Rhp ; R thp F.XPC'lltor
of the Estate of BERL G. KLINE
late of _Ca~1-isle --_____________0_ I Cumberland County, Pa.. deceased and that the
within is an inventory made by thp F.XPC'l1 tor " the said assets
of the entire estate of said decedent, ~onsisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
~~ 0 R. t-.J
and subscribed before me,
-"0
it:o{o-o3
,,: b?.Jd2" Yh. /J~
Executor . Administr.tor
Elizabeth Winters
4 Wexford Court
Carlisle, PA 17013
Address
Date of Death
NOTAR EAL
JUDITH D. KAUFFMAN, Notary Pubic
Borough of Carlisle, Cumberland ColIlly
My Commission Expires March 10, 2007
3
Day
April
Month
2001
Yur
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
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
ACN
10-21-2003
KLINE
04-03-2001
21 01-1051
CUMBERLAND
101
DAVID H RADCLIFF ESQ
20 ERFORD ROAD
SUITE 300A
LEMOVNE
i :2-j
PA ~:?043
*
REY-1547 EX AFP 101-05)
BERL
G
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
10,015.72
.00
.00
30,572.69
.00
202,657.16
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4-j-ix--AFP-((ff=03i--NOY-ici--OF-.rtiliiiiiTAifcE-TAjrAPPRAisEiiENT~--Ai:LowANcE-irR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KLINE BERL G FILE NO. 21 01-1051 ACN 101 DATE 10-21-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
+
INTEREST/PEN PAID (-)
.00
.00
.00
2,,334.97-
DATE
05-14-2003
06-06-2003
06-23-2003
07-15-2003
NUHBER
CD002563
CD002652
CD002717
CD002802
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
(10)
13,104.31
(19)=
NOTE: To insure proper
credit to your account"
subllit the upper portion
of this forll with your
tax paYllent.
243,,245.57
21.105 45
222,,140.12
.00
222,,140.12
.00
.00
17,067.08
11,,987.17
29,,054.25
29,,301.29
247.04CR
.00
247.04CR
( IF TOTAL DUE IS LESS THAN $1" NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
8.001.14
(11)
(12)
(13)
(14)
.00 X 00 =
.00 X 045=
142,225.68 X 12 =
79,,914.44 X 15 =
AHOUNT PAID
10,000.00
14,750.00
2,,100.00
4,,786.26
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DE~T.280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RADCLIFF DAVID H ESQUIRE
20 ERFORD ROAD
SUITE 300A
LEMOYNE, PA 17043
-------- fold
ESTATE INFORMATION: SSN: 189-26-5558
FILE NUMBER: 2101-1051
DECEDENT NAME: KLINE BERL G
DA TE OF PAYMENT: 05/14/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2001
NO. CD 002563
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $10,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$10,000.00
REMARKS: ALLFIRST BANK & TRUST CO NA
CHECK#158
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RADCLIFF DAVID H ESQUIRE
RADCLIFF LAW OFFICE P C
20 ERFORD ROAD, SUITE 300A
LEMOYNE, PA 17043
u__u__ fold
ESTATE INFORMATION: SSN: 189-26-5558
FILE NUMBER: 2101-1051
DECEDENT NAME: KLINE BERL G
DA TE OF PAYMENT: 06/06/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2001
NO. CD 002652
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $14,750.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DAVID H STONE ESQUIRE
CHECK#159
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$14,750.00
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RADCLIFF DAVID H ESQUIRE
20 ERFORD ROAD SUITE 300A
LEMOYNE, PA 17043
_n_____ fold
ESTATE INFORMATION: SSN: 189-26-5558
FILE NUMBER: 2101-1051
DECEDENT NAME: KLINE BERL G
DA TE OF PAYMENT: 06/23/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2001
NO. CD 002717
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,100.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,100.00
REMARKS: ELIZABETH M WINTERS
DAVID H RADCLIFF ESQUIRE
CHECK#162
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WINTERS ELIZABETH
4 WEXFORD COURT
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 189-26-5558
FILE NUMBER: 2101-1051
DECEDENT NAME: KLINE BERL G
DATE OF PAYMENT: 07/15/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2001
NO. CD 002802
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,786.26
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,786.26
REMARKS: ELIZABETH WINTERS
CHECK# 163
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
.
REV.,SOO EX !6-{)0)
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REV-1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
()FFiCr,AL us:: O::~,iLY
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FILE NUMBER
2 1 0 1 0 1 051
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DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
KLINE, BERL G.
DATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM-DD-YEAR)
04/03/2001 07/02/1917
(IF APPLICABLE) SURVIVING SPOUSE'S NM1E (LAST, FIRST, A"JD MIDDLE INITIAL)
COUNTY CODE
YEAR
-----
NUMBER
5558
I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
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i SOCIAL SECURITY NUMBER
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00 1. Original Return
o 4. Limited Estate
[!] 6. Decedent Died Testate (Attach ccpy of WiD)
o 9. Litigation Proceeds Received
D 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death afle. 12-12.B2)
D 7. Decedent Maintained a Living Trust (Attach ccpy of Trust)
D 10. Spousal Poverty Credit (dale of death belweeri 12-31.91 and 1.1.95)
I SOCIAL SECURITY NUMBER
! 189 - 26
D 3. Remainder Return (dale of dealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME COMPLETE MAILING ADDRESS
David H. Radcliff Es .
FIRM NAME (If Applicable)
Radcliff Law Office, P.C.
TELEPHONE NUMBER
(717 236-9318
20 Erford Road, Suite 300A
Lemoyne, PA 17043
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
30,572.69';
'DC
10 .015. 72~ ~
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
13,104.31
8,001.14
(6)
(7)
202,657.16
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate
x .0 _ (16)
17. Amount of Line 14 taxable at sibling rate
_____~~~~_~~~~~L_ x .12
79.914.44 x.15
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(12)
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:;:';)':BE 'sURElJO ~NSWER ALL:Q~ESTIONl)':bN'~EVE~SE'SI[lE:~N.O~6E:GHEGKiMATH,~ < :;::_"
243,245.57
21,105.45
222.140.12
0.00
222.140.12
17,067.08
11.987.17
29,054.25_
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(3)
(4)
(5) 29,054.25
(SA) 2,484.67
(58) 31,538.92
Decedent's Complete Address:
STREET ADDRESS
Cumberland Crossings Retirement
1 Longsdon F Way
CITY
STATE
Carlisle
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2)
TotallnteresVPenalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX. DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
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
a. retain the use or income of the property transferred;..................................................:....................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ !Xl
ZIP
17013
29,054.25
0.00
No
OCJ
OCJ
OCJ
o
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OCJ
D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SIGNAT RE OF PERSON RESPONSIBLE FOR FILING RETURN
)(
Under penalties of perjury, I declare thai J have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beijef, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
S - ICr -'()3
17013
17043
.... .. ..-........---...-........-...-.---.-.....-----.-.- -.------.------------------------.---..-.-...--.-.----...---.-.-.---.--...-..---.--...-.-..---.--.--....-...-..-.-- --...-.-.
....-..-.-..--........ -...-
DATE
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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. 99116 (a) (1.1) (i)l.
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. 99116 (a) (1.1) (ii)].
The statute does not exemDt 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 lax 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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.
REV-1503 EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF BERL G. KLINE
SCHEDULE B
STOCKS & BONDS
FI LE NUMBER
21-01-01051
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 367.4910 Shares
AT&T Corporation 20.3000 7,460.07
2 23 Shares
Avaya 11.7152 269.45
3 284 Shares
Lucent Technologies 8.0500 2,286.20
TOTAL (Also enter on line 2, Recapitulation) $ 10.015.72
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1997 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97)
REV-1508 EX + (1-97)
COM MONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
BERL G. KLINE
FILE NUMBER
21-01-01051
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Allfirst Bank
Money Fund Acct #98290525 17,986.13
2 Allfirst Bank
Checking Acct #38443155 1,231.82
3 M & I Bank
Checking Acct #551064 9,415.14
4 American Republic Insurance Co
(Return of unused premium) 1,939.60
TOTAL (Also enter on line 5, Recaoitulation) $ 3 0 . 5 7 2 . 6 9
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1997 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
REV-1510 EX + (1-97)
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER
1
BERL G. KLINE
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE THEIR
RELA~ION.S_HIP TO DECEDENT AND THE DAT.~ OLTRANSFER.
ATTAr;H A COPYOF THE DEED FOR Rt-A' ~"TATE.
Blake Winters (Cash Gift)
DATE OF DEATH
VALUE OF ASSET
4,000.00
%OF
DECD'S
INTEREST
100
100
100
100
100
100
100
100
100
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1997 form software only CPSystems, Inc.
2
Elizabeth Winters (Cash Gift)
5,000.00
3
Elmer Kline (Cash Gift)
10,000.00
4
Henry Kline (Cash Gift)
10,000.00
5
Mary Hess (Cash Gift)
10,000.00
6
Robert Mordan (Cash Gift)
5,000.00
7
Stephanie Rowland (Cash Gift)
5,000.00
8
New York Life Annuity Contract
#51 027 737
13,708.08
9
Prudential Annuity Contract
#E0221075
160,949.08
EXCLUSION
elF APPLICABLE)
3,000.00
3,000.00
3,000.00
3,000.00
3,000.00
3,000.00
3,000.00
0.00
0.00
21-01-01051
TAXABLE VALUE
1,000.00
2,000.00
7,000.00
7,000.00
7,000.00
2,000.00
2,000.00
13 ,708.08
160,949.08
202,657.16
Form REV-151O EX (Rev. 1-97)
REV-1511 EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF BERL G. KLINE
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
6.
7.
8.
9.
10.
FILE NUMBER
21-01-01051
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Paust-Bunnell Funeral Home
6,888.50
2.
Hayhurst Memorials
1,165.00
3.
Funeral Meal
300.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Elizabeth Winters
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 4 Wexford Court
City Carlisle State~Zip 17013
Year(s) Commission Paid: 2003
2,029.42
2.
3.
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _ Zip
Relationship of Claimant to Decedent
N/A
2,500.00
4.
Probate Fees
94.00
5.
Accountant's Fees
0.00
Tax Return Preparer's Fees
0.00
Register of Wills
Short Certificates
21.00
Register of Wills
Additional Probate
30.00
Register of Wills
Filing fee - Inventory &
Inheritance Return
25.00
EquiServe Trust
Lost Certificate Fee
10.00
Total miscellaneous eXDenses from continuation Daae(s)
41.39
TOTAL (Also enter on line 9, Recapitulation) $ 13,104.31
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1997 form software only CPSystems. Inc. Form REV-1511 EX (Rev. 1-97)
SCHEDULE H
MISCELLANEOUS EXPENSES (continued)
ESTATE OF: BERL G. KLINE
ITEM
NO
11.
12.
DESCRIPTION
Certified Mail (Stock
Transfer)
Certified Mail (Stock Transfers & redemptions)
FILE NUMBER: 21-01-01051
AMOUNT
23.25
18.14
Total. (Carry forward to main schedule) . . . $
41. 39
REV-1512 EX+(1-97)
COM MONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF BERL G. KLINE
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
FILE NUMBER
21-01-01051
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Cumberland Crossings
Retirement Community
4,795.53
2
Alert Pharmacy
Oustanding Ck #9819 on 4/3/01
194.71
3
John Hassler, P.C.
Outstanding Ck #9820
325.00
4
American Republic Insurance
Outstanding ck #9818 on 4/3/01
1,955.90
5
PA Department of Revenue
Outstanding ck #9820 on 4/3/01
170.00
6
PA Department of Revenue
Outstanding ck #9822
(2001 1st qrtr estimated tax)
560.00
TOTAL (Also enter on line 10, Recaoitulation) $ 8,001.14
(If more space is needed, insert additional sheets of the same size)
CoPyri9ht (c) 1997 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REV-1S13 EX+ (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BERL G. KLINE
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-01-01051
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
.
SEE ATTACHED
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DiSTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Beneficiary's Name & Address
Henry M. Kline
2952 Green Creek Road
Orangeville, P A 17859
Elmer P. Kline
4016 Wax Wing Trail
Stow, OH 44224
Elizabeth M. Winters
4 Wexford Court
Carlisle, P A 17013
Robert Mordan
Rt. 1, Box 102
Dakota, MN 55925
Stephanie Rowland
560 Fulton Street
Aurora, CO 80010
Mary Hess
20 Fieldcrest Drive
Mechanicsburg, P A 17050
Blake Winters
227 Springville Road
Boiling Springs, P A 17007
Sheldon Hess, Jr.
1992 Rheam Road
Clinton,OH 44216
James Hess
13 Collegro Drive
Douglasville, P A 19518
ESTATE OF BERL G. KLINE
FILE NO. 21-2001-01051
DATE OF DEATH: 4/3/2001
Schedule J
Relationship to Decedent
Brother
Brother
Sister
Nephew
Great Niece
Sister
Nephew
Nephew
Nephew
Taxable Share
of Estate
45,828.03
45,828.03
40,828.01
21,414.02
21,414.02
9,741.61
1,000.00
9,021.60
9,021.60
John Hess
145 Willowmill Park Road
Mechanicsburg, PA 17055
Nephew
9,021.60
Alice Pomeroy
5311 Highgate Green
Williamsburg, VA 23188
Niece
9,021.60
1lIa81 mill uno W:estum:ent
of
BERL G. KLINE
I, BERL G. KLINE, of 532 Sand Lake Road, Onalaska, Wisconsin,
hereby revoke all of my former Wills and declare this to be my Last
will and Testament.
ARTICLE I
I hereby direct my Personal Representative to pay all my just
debts, taxes, funeral expenses and administrative expenses from the
residue of my estate as soon after my death as possible.
ARTICLE II
I give, devise and bequeath my residence located at 532 Sand
Lake Road, Onalaska, Wisconsin, and all of my furniture, household
goods, linens and other tangible personal property located therein
to my sister, ELIZABETH WINTERS, if she survives me.
Should
ELIZABETH WINTERS predeceases me, said real estate and items of
personal property as described in this Article are hereby given to
the descendants of ELIZABETH WINTERS who survive me by right of
representation.
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Berl G. Kline
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ARTICLE III
All of the res t and remainder of my es ta te, be it real,
personal or mixed, I hereby give, devise and bequeath to the
following persons in the following shares if they survive me:
A. To my sister, ELIZABETH WINTERS, one-fifth (1/5) thereof.
B. To my sister, MARY HESS, one-fifth (1/5) thereof.
c. To my brother, HENRY M. KLINE, one-fifth (1/5) thereof.
D. To my brother, ELMER P. KLINE, one-fifth (1/5) thereof.
E. To my nephew, ROBERT MORDAN, one- tenth (1/10) thereof.
F. To my grandniece, STEPHANIE ROWLAND, one-tenth (1/10)
thereof.
Should any beneficiary above-named predecease me, the interest
which he would have received had he survived me is hereby given to
the descendants of said beneficiary who survive me by right of
representation. Should any beneficiary above-named predecease me
without any descendant who survives me, my property is given in
such shares and to such beneficiaries as would have been the
distribution of this Will as if that person had never lived.
ARTICLE IV
If any benefjciary dies prior to the entry of an order, decree
or judgment in my estate distributing the property in question, or
wi thin five months after the date of my death, whichever is
-6~~~
Berl G. Kline
Krpata
2
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earlier, any interests which would have passed to said beneficiary
under other provisions of this will are to be disposed of according
to the plan of distribution which would have been effective under
this will as if said beneficiary had predeceased me.
It is my
intention that any property or interest which is distributed from
my estate as a result of any court order, decree or judgment will
not be revoked or otherwise affected by the subsequent death of the
distributee.
ARTICLE V
I hereby appoint my sister, ELIZABETH WINTERS, as Personal
Representative of this Will and request that no bond be required of
her in such capaci ty.
If for any reason, ELIZABETH WINTERS is
unable to so act, I hereby appoint my nephew, ROBERT MORDAN, as
Personal Representative of this will also to serve without bond.
I empower my Personal Representative to sell, lease or
mortgage any of my property wi thou t an order of the Court and
wi thout notice to anyone upon such terms and condi tions which would
be in the best interests of my estate; and to settle, compromise, or
pay any claims, including taxes, asserted in favor of or against me
or my estate.
Ef ~~::~~~~- ~
a.
-;(?~4oL~
Berl G. Kline
3
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ARTICLE VI
In this Willi the use of the masculine gender includes the
feminine, and the use of the singular or plural case includes the
other where appropriate.
Dated this 9th day of May, 1995/ at Black River Falls,
Wisconsin.
~~:J:tY ~
The foregoing instrument consisting of 4 pages, each of which
bears the signa ture of the tes ta trix and of each wi tness / was
signed and published by said testatrix as her Last Willi in the
presence of us/ who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
witnesses.
We each certify that at the time of the execution of
this will the testatrix was mentally competent and acting
voluntarily.
~~~~
Eric F. Stutz
pegfmre;a ~;i
of Black River Falls, Wisconsin.
of Black River Falls, Wisconsin.
4
PLEASE FILE THIS REPORT WITHIN TW° YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION ~A~ '
STATUS REPORT UNDER RULE 6.12
Name of Decedent: BERL G. KLINE
Date of Death: April ~, 2001
Will No.: 6001-01051 _ 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 x No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
Date:
(MAH:rmt/AM3)
If the answer to No. 1 is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes No X
The separate Orphans' Court No. (if any) for the personal representative's account
is:
Did the personal representative state an account informally to the parties in
interest? Yes X No
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.
Name (Please type or print)
20 Erford Road, Ste 300A
Lemoyne, PA 17043
Do
Address
(717) 236-9318
Telephone No.
Capacity:
X
Personal Representative
Counsel for Personal Representative
R.W. - 27
- _
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 INHERITANCE TAX
HARRISBURG, PA 17128-0601
STATEMENT OF ACCOUNT
REY-1607 E% AFP (O1-OS)
DATE 11-17-2003
ESTATE OF KLINE BERL G
DATE OF DEATH 04-03-2001
FILE NUMBER 21 01-1051
- COUNTY CUMBERLAND
DAVID H RADCLIFF ESQ ACN 101
20 ERFORD ROAD Amount Remitted
SUITE 300A
LEMOYNE PA 17043
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1607 EX AFP (01-03) ~*~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~~(
ESTATE OF KLINE BERL G FILE N0. 21 01-1051 ACN 101 DATE 11-17-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-14-2003
PRINCIPAL TAX DUE„
PAYMENTS (TAX CREDITS):
29,054.25
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-) AMOUNT PAID
*** SUMMARY OF LL 005 PAYMENTS ***
10-29-2003 2,334.97- 31,389.22
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN 51,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
29,054.25
.00
.00
.00
PAYMENT: Detach the tap portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Applicaticn for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices ar frca the Department's 24-hour
answering service far farms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TD: questions regarding errors contained on this notice should be, addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%l discount
of the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9l months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar Year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computaticn date shown on the
Notice, additional interest must be calculated.