HomeMy WebLinkAbout02-0126PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as. To:
Register of ~fills for the
Deceased. County of td, l, tml-,e.~,-/ant~ in the
Social Security No. / ~ ~t. ~ ~'~ ~ ~. _f~'~ 3 ~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who'{are 18 years of age or older, appl
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in C bt n't ~t.- [tt rt t~ County, Pennsylvania, with
hO.e- lastfamilyorprincipalresidenceat ~1~.~ ~ri~t~. ~-~lt~[e.o t~ I']p/3
· (list street, number and mumcipahty)
Decendent, then 39 ye~ars of age, died'~Ct.t~n ~r ~$ ll',~0o !
at ~9,,~? ./~.. 7J o ~ ~.t) ~a(_ , ~ It ~-' l t ~ / L / tOUr ' '
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
& G S-'O. oo
Petitioner.__ after a proper search ha a ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
_Name Relationship Residence
THEREFORE,
appropriate form to the undersigned.
petitioner(s) respectfully request(s) the grant of letters of administration in the
1'7-39-10
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s)that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this 3 ] ST day of I
,.JAI~UARY ~ 2002~ _
M~y ~ LE~S / Register
No.
Estate of
BRENDA R PENNABAKER
, Degeased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW FEBRUARY 4, 2 0 0 2 ~9~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that JESSE A PENNABAKER
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to JESSE A PENNABAKER
in the estate of BRENDA R PENNABAKER
MAt~¥ C/EW-I ~//8~ter of Wi, sl~ ' ~
FEES
Letters of Administration ..... $ 4 0.0 0
Short Certificates~ 3 ) .......... $ 9.0 0
Renunciation ................ $
JCP $ 5. O0
TOTAL__ $ 54.00
Filed JANUAR.Y...3.% ;.-200&.D.~x -
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
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.
~ :; Local Registrar
,,~ ·
P 7 9 1 3 2 7 3 I)E C 2 6 2001
No. Date
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
STATE FILE NUMBER
SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Month Oay Ye.t)
R Pennabaker 2. Female 3. 184-58-8834 ,.December 23, 2001
I UNDER 1 DAY I DATE OF BIRTH BlflTHPLACE (C~y and [ PLACE OF DEATH (Check O~ly o~e -- see ms, ructions 0~ o~he~ ~cle}
Hour. Minu{e. (MO~th. Day, Yeef) Stale or Fore~n Co,Jnlry) HOSPITAL: I ._...OTHER'
cFrY,
DEATH
FACIL TY NAME Ii not ,ns~it u~on. give swee a,~i numb.f) V%~S DECEDENT OF HISPANIC ORIGIN? IRACE - American Indi&n Black W~ffe etc
I Lower Frankford ] 259 Mt Zion Road INo~ ~,,D,,,.~c~,, I~"~1 ' ' '
Cumberland ' ..,~.,,..o n~...,~.·
I-. I,.
KIND OF BUSlNES~NDUSTRY. ] WAS OECEDENT EVER IN~;~;nr~'S EDUCATION 14. 1
(~r~, C~n. Stale, Zip ~F 13. (~1~12 {1-4 ~ fl+) Divorc~
31~ Spring R~d <TUAL '7..S,.,. PA D~ ,7=.~.,.~.,,~.,. Middlesex
~rlisle PA 17013 ~.~,~,~,
I,,. ~eline Holloway
~,~. 3174 Sprinq R~d, ~rlisle PA 17013
P~CE~OIS~SITlON.NameofCemet.~,C~ma~,? 21~ York PA
~'~"Q ~s~ ~ce~r 26, 2~1 ,,~. Yorkt~e Cr~tion
"*"u~o*°°"~ssoF~°U~Hoff~n-Roth ~eral H~
010~3 L J~. 219 N. Hanover St. ~rlisle PA 17013
2:45 A. December' 23, 2001 ~,~
~.~,h)~ ..__Gunshot to Head
~.? E ~ ~m~ ~ ] ' Aprx. ..
~ ...,. ,~. ~. ~1 ~ec.23.200[ ~. ~ .o~ Se[~-~[$c~ed Sunsho~
~ ~ - ~ - ~ ~ '~ ~ ~{~ ~ 2'45 A
~ ~ __ __ ~ ~me__ ~. · ~o~rlisle, PA
'MSOm~L~*~N~mCO.ON~, ' 11~27)TypeotPr~t Nlchael ~. Norr$s, Coroner
~" ' ............................................................................... ~ ~ Hechanlcsburg, Pa. 17050
H105 144 Rev, 1/91
.R,.T I0 r. "
~NENT
INK NAME OF DECEDENT (FJr~. MiOclte
Brenda
39 v~,
21-02-126
OF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
BRENDA PENNABAKER
, Deceased
No. 2102126
of 2001
To the Clerk of the Orphans' Court:
Enter the claim of CAPITAL ONE
Acct. 5291151929208336
In the amount of $333.85
, against the above entitled estate.
The decedent, who resided at 3144 SPRING ROAD CARLISLE PA 17013
died on 12/23/2001
· Written notice of said claim was given
to JESSE A PENNABAKER
(Personal Representative or counsel)
3144 SPRING RD, CARLISLE, PA 17013
,if known to claimant, at
on
March 27, 2002
(Date)
(Claimant)
Claimant's Counsel
Address:
5330 East Main Street, Suite 200
Columbus, Ohio 43213
Address
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STATE OF VIRGINIA )
_ ) SS;
INDEPENDENT CITY )
LIMITED POWER OF ATTQR~EY
Now comes Mike Stevens, a representative of Capital One,
and hereby appoints Estate Information Services, Inc. as its attorney-in-fact for the
purpose of executing, filing, amending, and/or withdrawing estate claims with probate
courts and/or executors throughout the United States on behalf of Capital One.
Be it known that this Limited Power of Attorney will be abolished upon the
termination of the contractual agreement between Estate Information Services, Inc. and
Capital One.
DATED this I'hO'-B'' day of ~tq~::~' ''' , 2001.
CAPITAL ONE
By:'
Its: Director
Printed Name: Michael Stevens
Sworn to an subscirbed before me this
Public in and for the State of Virginia.
day of September, 2001, a Notary
OF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
BRENDA PENNABAKER
, Deceased
No. 2102126
of 2001
To the Clerk of the Orphans' Court:
Enter the claim of CAPITAL ONE
Acct. 5291151929208336
In the amount of $333.85
, against the above entitled estate.
The decedent, who resided at 3144 SPRING ROAD CARLISLE PA 17013
died on 12/23/2001
· Written notice of said claim was given
to JESSE A PENNABAKER
(Personal Representative or counsel)
3144 SPRING RD, CARLISLE, PA 17013
,if known to claimant, at
on
March 27, 2002
(Date)
(Claimant)
Claimant's Counsel
Address:
5330 East Main Street, Suite 200
Columbus, Ohio 43213
Address
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STATE OF VIRGINIA )
INDEPENDENT CITY )
LIMITED POWER OF ATTORNEY
Now comes Mike Stevens, a representative of Capital One,
and hereby appoints Estate Information Services, Inc. as its attorney-in-fact for the
purpose of executing, filing, amending, and/or withdrawing estate claims with probate
courts and/or executors throughout the United States on behalf of Capital One.
Be it known that this Limited Power of Attorney will be abolished upon the
termination of the contractual agreement between Estate Information Services, Inc. and
Capital One.
DATED this Ir~''~'
day of ~~:~ '~
,2001.
CAPITAL ONE
Its: Director
Printed Name: Michael Stevens
Sworn to an subscirbed before me this
Public in and for the State of Virginia.
day of September, 2001, a Notary
Conmfission'Expkes: rfqCI~ '51i c9C[3~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Brenda R. Pennabaker
Date of Death: December 23, 2001
Will No. 2001 -001 26 Admin. No. 21 -02-01 26
To the Register:
I certify that notice of (beneficial interest) estate _administration required by Rule 5.6(a) of the Qrpha..nsj _Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on May z · Z002 :
Name Address
Samantha Jo Moore
31 44 Spring Rd., Carlisle, PA 17013
Jesse A. Pennabaker 3144 Spring Rd_: Carli.q] a _ PA I 7~1 3
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signa~re ~
Name Tricia D. Naylor
Address 104 S. Hanover St.
Carlisle, PA 17013
Telephone( 71)7 243-7437
Capacity: __
Personal Representative
X Counsel for personal representative
CUMBERLAND COUNTY PROBATE COURT
ATTN: REGISTER OF WILLS, 1 COURTHOUSE SQUARE ROOM 102
CARLISLE PA 17013
In the Estate of BRENDA PENNABAKER, Deceased
Case No. 2102126
Release of Claim
The claim filed in the above-captioned estate on behalf of
CAPITAL ONE in the amount of $333.85 for
Account No. 5291151929208336, has otherwise settled or been compromised for
$200.00, and this Release of Claim is executed to acknowledge discharge of the claim,
and to release the estate and the Personal Representative of the estate from all further
liability with respect thereto.
Agent of Claimant
Address: 5330 East Main Street, Suite 200,
Columbus OH 43213
i~eiephone: (87'/) 7 i'4-3 739
Date of Release: 06/14/2002
EISI Matter No. 756454
CS HANDLER1 CJM
rINHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 _ 02 00126
COUNTY C(X~ YEAR NUMBER
SOCIAL SECURITY NUMBER
184-58-8834
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Pennabaker, Brenda R.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR
12/23/01 12/09/62
(IF APPLICABLE) SURVNING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 1. Original Return
[~]4. Umitad Estate
[---~ 6. Decedent Died Testata (A~ao~ ~ of wa)
[~9. Litigalion Proceeds Received
--'32. Supplemental Return
r~4a. Future Interest Co~ (date of deah after 12-12-82)
7. Decedent Maintained a Living Trust (Alta:h cepy ol'Tnj~)
r'~l o. Spousal Poverly Credit (d~e ~ ~ ~ 12-.31.01 and 1.1.~5)
NAME
Tdcia D. Naylor
FIRM NAME
Law Office of John C. Oszustowicz
TELEPHONE NUMBER
(717) 243-7437
COMPLETE MAILING ADDRESS
104 S. Hanover St.
Carlisle, PA 17013
--'13. Remainder Return (dae o~ d88~ p~x ~o 12-~3-82)
I-"] 5. Federal Estate Tax Retum Required
O 8. Total Number of Safe Deposit Boxes
--']11. EleclJon to tax under Sec. 9113(A) (~,d~ s~ o)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Coq3oratbn, Palnemhip or Sole-Proprietorship (3)
4. Morlgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
11 &q~ata m,ng Req~
7. Inter-Vivos Transfers & Miscellaneous Non-Probata Pmpedy (7)
(Schedule G or L)
8. Total Gross Assets (lotal Lines 1
9. Funeral Expenses & AdminislmlJve Costs (Schedule H) (9)
10. Dems of Decedent, Mortgage Lia~mies, & Liens (Schedule i) (10)
11. Total I:kKluclioue (total Lines 9 & 10)
12. Net Value of Estat~ (Line 8 ~nus Line 11)
t3. Cheritabta and Govemmefltal Baquests/sac 9113 Trusts for which an ebction to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
0.00
0.00
0.00:
0.00
11,386.73
0.00
0.00
(8)
11,386.73
6,032.26
4,714.49
(11)
10,746.75
(12)
639.98
(13)
0.00
(14)
639.98
SEE INdUCTioNS ON REVERSE SIDE FOR APPLICABLE RATES
15. Arno(mt of Line 14 taxable at Ihe spousal tax
rata, or transfers under Sac. 9116 (aX1.2) ................................ x .0 .... (15)
16. Nnount of Une 14 taxable at lineal rata ....... 639.98_ x .0 _45 (16)
17. Amount of Une 14 taxable at sibling rate x .12 (17)
18. Amount of Une 14 taxable at collataml rate .............. x .15 (18)
19. Tax Due (19)
20.[] -~: ------ : -- =---: ,-,-- ==~-~:- .~eim ,a e~ --, ,~
28.80
28.80
Decedent's Complete Address:
STREETADDRESS
3144 Spring Rd.
Cl~YCarlisle
I STATEpA
IZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
28.80
0.00
0.00
28.80
0.00
28.80
Interesl/Penalty if applicable
D. Interest
E. Penalty
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 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 + 5A. This is the BALANCE DUE.
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
(4)
(5)
(5A)
(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 shell use the property transfen'ed or its income; ............................................ [] []
c. retain a mvemionary interest; or .......................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
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 lrust for" or payable upon death bank account or sacudty at his or her death? .............. [] []
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 ~==m;;~ of peru,, I declae that I have ex~,~,~ this return, including a~w,~ ~L~ ~ ~ a~ ~ ~ ~ d ~ ~ ~ ~, ff is ~, ~ a~ ~.
Dedara~n of preparer olher than the personal repmsenta~ve is based on all infonna~ of which preparer ~ a~ ~.
104 9. Hanover St., Ca '~ 17013
DATE
DATE
For dates of death on or alter July 1, 1994 and before January 1, 1995, the tax rata 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 dales of death on or after January 1, 1995, the tax rate imposed on the net value of lmnsfers to or for the usa of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)].
The stalute does not exemDt a Iranefer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return am still applicable even if
For dales of death on or alter July 1, 2000:
The tax rate imposed on the net value of transfers ~m a deceased child Iwenty-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 RS. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the usa of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)].
The tax rata imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. §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.
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Pennabaker, Brenda
Re
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 -02-00126
ITEM
NUMBER
2.
3.
4.
5.
6.
7.
8.
9.
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.
VALUE AT DATE
DESCRIPTION OF DEATH
Automobile: 1991 Geo Tracker LSi Sport Utility Convertible 2D
Automobile: 1990 Mercury Topaz GS Sedan 4D
Members 1st Federal Credit Union Checking Account #211869-00
Uncollected Wages from The Sentinel
Uncollected Mileage Reimbursement from The Sentinel
2001 Federal Individual Income Tax Refund
Miscellaneous personal property
Domestic Support Payments
Reimbursement from Medical Insurance
TOTAL (Nso enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2630.00
1145.00
42.37
1356.59
5.72
5184.00
300.00
288.13
434.92
11,386.73
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVAN~
INHERITN~CE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Pennabaker, Brenda
Re
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILmES, & LIENS
FILE NUMBER
21-02-00126
ITEM
NUMBER
e
Include unreimbursed medical expenses.
DESCRIPTION
Providian Visa Card #4559501900555735
Fingerhut Credit Card #8050051802435345
Capital One Credit Card #5291151929208336
Northwest Consumer Credit Discount Company #335143
TOTAL (Nso enter on line 10, Recapm,lafion) $
(ff more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
1661.90
222.59
200.00
2630.00
4,714.49
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Pennabaker, Brenda R.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-02-00126
ITEM
NUMBER
5.
6.
7.
8.
Debts of decedent must be reported on Schedule [.
DESCRIPTION AMOUNT
FUNERAL EXPENSES:
Hoffman Roth Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Repreeentative(s)
Social ,Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State . . Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
C~man! Jesse A Pennabaker and Samantha Jo Moore
Street Address 3144 Spring Rd.
C~y Carlisle smmpA
Relationship of Claimant to Decedent son and daughter
Probate Fees
Accountant's Fees
Tax Return Pmparer's Fees
Filing fee for claim release
Advertising fees for Estate Notice
z~17013
TOTAL (AJso enter on line 9, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
2065.00
3500.00
209.63
100.00
5.00
152.63
$ 6032.26
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Pennabaker, Brenda
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
R. 21-02-00126
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET ,s
DESCRIPTION OF PROPERTY
ITEM
INCLUDE THE NAME OF THE ~,*~ISFEREE, THEIRRELATIONSHIPTODECEDENTANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER mE~mmm~ ATrACH A COPY OF 'IHE DEED FOR REAL ESTATE. VALUE OFASSET INTEREST (IFAPPUCABLE VALUE
1. Howard Publications, Inc. Tax Deferred Savings Plan, 2518.6; 100% 0.1
#(3)76538
Jesse A. Pennabaker, son of decedent, and Samantha Jo
Moore, daughter of decedent, are the beneficiaries of this
retirement account.
Decedent was under the age of 59 1/2 therefore this account
is exempt from PA Inheritance Tax.
, , TOTAL (Also enter on line 7 Recapitulation) $ O.OC
(if more space is needed, insert additional sheets of the same size)
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 001611
NAYLOR TRICIA D
104 S HANOVER STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 184-58-8834
FILE NUMBER: 2102-01 26
DECEDENT NAME: PENNABAKER BRENDA R
DATE OF PAYMENT: 09/12/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/23/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $28.80
REMARKS:
ANGELINE KITNER
C/O TRICIA D NAYLOR
TOTAL AMOUNT PAID'
$28.80
SEAL
CHECK# 3349
INITIALS: SK
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
ZNH£RTTANCE TAX DTVTSTON
DEPT. 18n601
HARRISBURG., PA 17118-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
RE¥-I;~i? EX &FP (01-02)
TRICIA D NAYLOR
OSZUSTOWICZ LAW OFFICE
104 S HANOVER ST ~
CARLISLE PA 17015
BATE
ESTATE OF
BATE OF DEATH
FILE NUHBER
COUNTY
ACN
10-28-2002
PENNABAKER
12-25-2001
21 02-0126
CUHBERLAND
101
Amount Remitted
BRANDA R
HAKE CHECK PAYABLE ANB REHZT PAYHENT TO:
REGISTER OF NZLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LZNE ~ RETA'rN LONER PORTION FOR YOUR RECORDS *~
REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR
BZSALLOgANCE OF BEBUCTZONS ANB ASSESSNENT OF TAX
ESTATE OF PENNABAKER BRANDA R F'rLE NO. 21 02-0126 ACN 101 DATE 10-28-2002
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE 'rNTEREST - SEE REVERSE
APPRAZSEB VALUE OF RETURN BASEB ON: ORIGINAL RETURN
1. ReaZ Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
4. Nortgages/Notes Rece/veble (Schedule D) (4)
5. Cash/Bank DeposAts/N/sc. Personal Property (Schedule E) (5)
6. JoAntly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEBUCTZONS AND EXEHPTIONS:
9. Funeral Expenses/Adm. Costs/H/sc. Expanses (Schedule H) (9)
10. Dabts/Nortgaga LAabA1/tAes/LAens (Schedule 1) (10)
11. TotaX DaductAons
12. Nat Value of Tax Return
11~$86
O0 NOTE: To /nsure proper
O0 credAt to your account,
O0 subm/t the upper portAon
O0 of thA$ form w/th your
tax payment.
75
O0
O0
(8)
6,052.26
13.
14.
NOTE:
11,386.73
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATZON OF ADDITIONAL INTEREST.
. O0 x O0 = . O0
659.98 x 045= 28.80
.00 x 12 = . O0
. O0 x 15 = . O0
(19)= 28.80
ANOUNT PAID
28.80
TOTAL TAX CREDIT 18.80
BALANCE OF TAX BUEI .00
INTEREST ANB PEN. .00
TOTAL DUE .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.)
ASSESSHENT OF TAX:
15. Amount of LAne 14 at Spousal rata
16. Amount of L/ne 14 taxable at Lineal/CZess A rate
17. Amount of L/ne 14 at SAblAng rate
18. Amount of LAne 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREBZTS:
PAYHENT RECETpT DTSCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
09-12-2002 CD001611 .00
CharAtable/Governmantal Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
Nat Value of Estate Sub~ect to Tax (14) 659.98
Zf an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
4~714.49
(11) 10.7~;- 75
(12) 659.98
RESERVATION:
Estates of decedents dying on or before December 11, 19DZ -- if any futura interest in the estate is transferrad
in possession or enjoyment to Class D (collateral) beneficiaries of tho decedent after the expiration of any estate for
life or for years, the Common#aalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collataral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 21qO of the Inheritance and Estate Tax Act, Act 25 of 2000. (7Z P.S.
Section 91q0).
Detach the top portion of this Notice and submit with yqur payment to the Register of Wills printed on the ravarse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which ams not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Iq-hour
answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-~qT-30ZO (TT only).
Any party in interest not satisfied with tho appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount ar interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--arittan protest to tho PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. 180601, Harrisburg, PA 17118-0601
Phone (717) 787-650S. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1SO1) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (51) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from tho date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .OO016q. All taxes ahich 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 tho PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1981 ZOZ .0005q8 1991 91 .O00Zq7
1983 16Z .O00q38 1993-199q 7Z .O0019Z
198q 11Z .000301 1995-1998 9Z .0002~7
1985 131 .000356 1999 71 .000191
1986 X0Z .O0027~ ZOO0 8Z .OOOZ19
1987 9X .O00Zq7 Z001 91 .O00Zq7
1988-1991 llZ .000301 2002 61 .O0016q
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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 computation date shown on the
Notice, additional interest must be calculated.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
1N RE: ) ORPHANS' COURT DIVISION
)
Estate of Brenda R. Pennabaker, )
Deceased ) NO. 00126 OF 2002
)
FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE
THIS AGREEMENT, by and among Jesse A. Pennabaker, Administrator of the Estate of
Brenda R. Pennabaker, Deceased, and Jesse A. Pennabaker and Linda Rebert, the Guardian of
the Estate of Samantha Jo Moore.
WHEREAS, Brenda R. Pennabaker died December 23,2001, intestate, a resident of
Cumberland County, Pennsylvania; and
WHEREAS, the intestate estate of Brenda R. Pennabaker, was duly probated in the
Office of the Register of Wills of Cumberland County, Pennsylvania as appears of record at
Number 21-02-00126; and
WHEREAS, Letters of Administration were issued to Jesse A. Pennabaker on February 4,
2002; and
WHEREAS, said AdministratOr had duly administered the estate according to the laws of
the Commonwealth of Pennsylvania; and
WHEREAS, Jesse A. Pennabaker and Samantha Jo Moore are the decedent's children
and the estate has been distributed according to the intestate laws of the Commonwealth of
Pennsylvania; and
WHEREAS, Jesse A. Pennabaker and Linda Rebert, Guardian of the Estate of Samantha
Jo Moore have been furnished with a complete listing of the estate assets, receipts and
disbursements; and
WHEREAS, it is the desire of the parties to this Agreement that final distribution of this
estate be accomplished without a formal accounting to the Orphans' Court Division of the Court
of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense,
delay and publicity of a formal accounting.
NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements
recited herein, the parties do agree as follows:
1. Jesse A. Pennabaker and Linda Rebert, Guardian of the Estate of Samantha Jo Moore do
hereby release and forever discharge Jesse A. Pennabaker, Administrator, from any and all
liability which he had or may have or which may from time to time arise in connection with
his service as Administrator of the Estate of Brenda R. Pennabaker, Deceased, and hereby
authorize and request the Orphans' Court Division to charge the same against his share of
said estate, and in consideration for said distribution, hereby agree to refund any amounts so
distributed which may be required to fully discharge any tax liability of the estate, debts of
the decedent, or administration expenses.
Each party to this Agreement acknowledges that this Agreement shall be indexed and
recorded in the estate proceedings and that the terms hereof shall be binding upon their
respective heirs, successors, executors, administrators and assigns.
This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania.
Witn'~ss
day of
., 2003.
By:
Linda Reber0, Guaraian ot me t:state
of Samantha Jo Moore, Beneficiary
~4~sse A. Pennab~k~r~-~dministr--"ator and Beneficiary
Date of Death:
Will
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 w~,he~er administration of the estate is complete:
Yes 1~'[' 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:
Did the personal representative file a final account with the Court?
Yes _ No 1'~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal repr/esentative state an account informally to the parties
in interest? Yes
Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed^with the Clerk of the. Orphans' Court
and may be attached tO this re,_rt. ~.~x,d f~'
Address
Telephone No.
~'~ Personal Representative
[~ounsel for personal representative
Capacity:
RECEIPT FOR PAYMENT
Cumberland_CounDy - Orphans Court
Hanover and Hiqh Streen
Carlisle, PA I7013
Receipt Date
Receipt Time
Receipt No.
3/05/2003
14:59:38
1021186
PENNABAKER BRENDA R
File Number
Remarks
2002-00126
OSZUSTOWICZ
JA
Transaction Description
FAMILY SETTL AGREE
Distribution Of Receipt ........................
Payment Amount Payee Name
17.00 CUMBERLAND COUNTY GENERAL FUN
Check# 8
Total Received .........
I7.00
7 00