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HomeMy WebLinkAbout02-0158 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Register of Wills for the Deceased. County of (-v ~ be,- la, tx d in the Social Security No. ~-6~. - c~ La - L~2~O ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, app[ ~*- ~-- 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 ,~ vv-.%¢~' k c~ ~. c~ County, Pennsylvania, with he~'- last family or principal residence at ~cic~ t~¢cYzv,~< ~..~ i'~ec_.V', ~ ~7o$0 (list street, number and municipality) G~.~ ~, la Decendent, then t-[~/ years of age, died ~..)c, rxvc~,./ c)~i ~t~C~ , 19. Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ ¥©(3, ~C~ (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: Petitioner.__ after a proper search ha -~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Residence .~e~-~(C¥ k¥~NLmebdr,~h~ ~c ~R~ationship /30 ~O. ~.v-, ~F /~ec_~ ~c,, 17os~'"' THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ._~ I'7-'tl-13 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ]~ ss COUNTY OF ~u ~¢r 1 ~.,,~ ~ 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. before me this 1 1 th day of/ Sworn to or affirmed and subscribed __r FEBRUARY 2002 ~K~x ~¢~ ~ ~-~ - ' ' 'Register/[ Estate of ROBIN M WRIGHT GRANT OF LETTERS OF ADMINISTRATION AND NOW FEBRUARY 11 ; 2002 :4~x , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that ~ JEFFREY L NRLGH~ JR is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ,~p~v T, WPT~m J~ in the estate of ROBIN M WRIGHT FEES Letters of Administration ..... $ 1 8.0 0 Short Certificates( ~ .......... $ 9 . 0 0 ATTORNEY (Sup. Ct. I.D. No.) Renunciation ................ $ JCP $ 5.00 TOTAL $ 3 2.0 0 ADDRESS Filed .~.E..B.R.U. &R..Y.. ] .1. ,.. 2. .0 ~9~x called adminstrat6~ on 2-12-02 PHONE This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local R, egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 8065922 No. mos ~,,~ Rev 2'87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Robin M. Wright ,.SEXFemale 202 46 _ 6206 ~Jan 10, 1955 ~. 47 Y~. Harrisburg, ~ ~.~ ~ ~ ~ · 7. Penn~vlvania Cumberland EastPennsboro ~ 5 ~ ~ '~) White Acnnunl~ M~naoer Warehouse ~ ~ e~ I~- ~3. I iwp. 69~ We~ville Road .es,~ Mechanicsburg, Pa. 17050 ~ .... ~ Cumberland ~ ,~..~ ~ Frank J. Herron ,~.,s ~,~,.. ~. ~ Ma~ Ann Felker ,.~.s~Eo~ Ter~ L. Uiduri ~~o~an~c~g, Pa. 17050 ~ [~ Conolite Cremato~ Schaefferstown, ~ ~. Jan 24. 2002 Pa. 17088 i~u~.~ ...... FD-014318-L I~'-- My~:F~nerr~'l~ome, Inc. 37 East Main Street Mechanicsburg, Pa 17055 I Dr. Andrzej Walker 21-02-158 JRD/June 30, 1992/17858 In Re: Estate of ROBIN M WRIGHT : ORPHANS' COURT DIVISION Late of SILVER SPRINGS TOWNSHIP : COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY Estate No.: 21-2002-158 : PENNSYLVANIA : : NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: JEFFREY LYNN WRIGHT JR Counsel for Personal Representative: Date of Grant of Original Letters: FEBRUARY-11-2002 Date of Delinquency Notice: MAY-21-2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on 05-21, 2002, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 06-12-2002 Iv~ary C/Lewis, Register of~¢ills ~/ ~/ Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for /'~~~ ~' 2.., at ~ ;~d//'4~, In Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. Geor~ August 2, 2002 Mr. Jeffrey Lynn Wright, Jr. 130 West Green Street Mechanicsburg, PA 17055 IN RE: ESTATE OF ROBIN M. WRIGHT Failure to File Certification Dear Mr. Wright: A hearing was set for August 2, 2002, at 9:30 a.m., in the Courthouse in Carlisle, at which you failed to appear. The certification must be filed in the office of Register of Wills. We must hear from you within twenty-four hours; please phone Donna in the Register of Wills office at 240-6409, if you have any questions. Sincerely, Sandra S. Gobrecht, Secretary Judge Hoffer's Chambers CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~xC>NO\ Vx ~. ~,( ~h/~ ~ Date ofDeath: 3¢X~J(2~-'('~- r~., % ~C,.)~- Will No. Admin. No. )0(233- O0 t ~-~ To the Register: I certify that notice of (beneficial interest) estate administration 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 O[ - ~-O ~ : Name ~: Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except · S igdatu~! J ~d~) ,,., Address i S O L~). G teem 5"~- Telephone (717 7q~- lT/q Capacity: ~ersonal Representative Counsel for personal representative Register of Wills Cumberland County, Pennsylvania INVENTORY Estateof MARY M. ANDERSON No. 2002-00158 also known as Date of Death December 13, 2002 , Deceased Social Secudty No. 201-16-3543 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate end all of the real estate in the Commonwealth of Pennsylvania of said, Decedent that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and th Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We vedfy that the statements made in this inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. I.D. NO.: 34832 Mi~~lE~cu~tor ~ (J/ O ; Address 355 N. 21' St., Ste. 205 Dated Camp Hill, PA 17011 Telephone: 717,761,3459 Description Value AT&T Corporation common stock $6,083.03 AT&T Wireless SVCS common stock $2,306.88 Bell South Corporation stock $27,034.38 Comcast Corporation New Class A common stock -: $8,319.92 NCR Corporation Now common stock $889.48 Quest Communications International common stock $1,750.86 SBC Communications common stock $50,479.10 Verizon Communications common stock $38,729.30 Vodafone Group PLC New common stock $10,503.80 Mink stroller $750.00 Cash - Money Market at Raymond Jones $38,289.13 Total from Continuation Page(s) $0.00 (Attach additional sheets if necessary) Total: $185,135.88 NOTE: ']'he Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. 12231208012002 Cumberland County - Register Of Wills Pa~e 1 ROW621 8/~1/2002 File No 2002-00158 PA File No 2102-00158 Decedent WRIGHT ROBIN M Docket Entries Date Filed 2/11/2002 PETITION FOR GRANT OF LETTERS OF ADMINISTR3tTION OATH OF PERSONAL REPRESENTATIVE DEATH CERTIFICATE 2/11/2002 DECREE OF PROBATE & GRANT OF LETTERS ADMINISTRATION Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 WRIGHT JEFFREY LYNN JR 130 W GREEN ST MECHANICSBURG, PA 17055 RE: Estate of WRIGHT ROBIN M File Number: 2002-00158 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 will become delinquent on: 1/22/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STP~ASBAUGH REGISTER OF WILLS cc: File Counsel Judge Estate No.: 21-02-00158 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate of WRIGHT ROBIN M Late of LOWER ALLEN TOWNSHIP Date: 2/11/2005 NO.: 21-02-00158 WRIGHT JEFFREY LYNN JR 130 W GREEN ST MECHANICSBURG PA 17055 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6. 12, SUPREME COURT ORPHANS I COURT RULE Personal Representative: WRIGHT JEFFREY LYNN JR Personal Representative Counsel: ** NO INFORMATION FOUND ** Date of Decedent's Death: 1/14/2003 Date of Delinquency Notice: 1/22/2005 The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans' Court, in accordance with rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor their counsel, have filed with the Register of Wills or Clerk of Orphans' Court, his/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk of Orphans' Court on 2/10/2005 and that the ten (10) day notice to file the status report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or their counsel. cc: File Personal Representative Counsel ~'L~~~ Glenda Farner Strasbaugh Clerk of Orhans' Court A hearing is scheduled for April 01, 2005 at 9:30 AM in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. cA,/ . .' : e Register of Wills of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 ':';ObiV\ fill. Wv:")hf Date of Death: 0 I - z. z.. -0 z. Estate No.: "2-/ - 0 z.. - 06 IS 8:> 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. Stat~ether administration of the estate is complete: YesA No 0 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 perso~epresentative file a fmal account with the Court? Yes 0 No~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal represe~e state an account informally to the parties in interest? Yes 0 No Jb'.... c. 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 report. ~LW"'fi'( 1 a e "5e++uf (. W rt j 1/\ T :s- V. Name Date:C)~- t-r-D~ \D ~~,., r- \ '5 () L<J. 0reeY\ ")-r Mec-0 ffA f7C0 Address "....... '"10 "tCfl.9-- rll'1 Telephone No. Capacity: ~Personal Representative o Counsel for personal representative uA 15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Dept. 280601 Harrisburg, PA 17128-O1i01 RESIDENT DECEDENT ~ ~ ~c~ ~ ~ 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedents Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI /v~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Firm Name (If Applicable) ~~ First line of address y i i r=G ~ ~cr ,~ Second line of address City or Post Office State ~~ ~ ~ ~ S6 U ~~ ,~~ Correspondent's a-mail address: ZIP Code REGISTER O~ ~1! LLS USE OI11LY ~ -? ~ 1 i T- -=~ ~. --i `L.a' 1~ DATE FILED ~ /~/l 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNlATUF~tlOF~P~~ 0, N RjSPON~SIBLE iO~ILN A ~ TURN D ~~ ~_/}~ t ~ /~/~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056041046 Side 1 15056041046 Y~~S 15056042047 REV-1500 EX ecurity Number Deced e nt's Social S ' nn lI ~ j ~ V ~ ~ "' s Name: Decedent RECAPITULATION 1. Real estate (Schedule A) . ........................................... . 1. • O 2. Stocks and Bonds (Schedule B) ...................................... . 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. `-~ 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. O 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. • /U 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) t= Separate Billing Requested....... . 7. 8 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. U 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which O an election to tax has not been made (Schedule J) ...................... .. 13. O 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 Q 15 (a)(1.2) X .0 . 16. Amount of Line 14 taxable O Q at lineal rate X .0 • 16. . 17. Amount of Line 14 taxable ~ j''~ at sibling rate X .12 • 17. `.J 18. Amount of Line 14 taxable ~ at collateral rate X .15 • 18. / ~ l.J 19. TAX DUE ....................................................... ..19. • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O ~~~ ~\°~ ~u~ ~~ ~-' Side 2 15056042047 15056042047 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME , ~a~~~ ~ ~~~~,~~ STREET ADDRESS ~ ~n~ _ `- CJC /1.,7Z L~11/P ~V _--- __ - CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ___ C. Discount Total Credits (A + B + C ) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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 + 5A. This is the BALANCE DUE. (1) (2) (3) /(.J (4) ~r' (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 N o/ a. retain the use or income of the property transferred :.................................................................................... ...... ^ , ~ l,4 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 care? ................................................................ ...... ^ 2. If death occurred after December 12, 198?, tlitl 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 death? ........ ...... ^ 4. Ditl 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. 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 three (3) percent [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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does 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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. USA NRST-CLASS I~...~E~I Iz (. a"'4 f.~i„ ''~a. KAyFIRST-CLASS I(tiR I.~.. . ~} I .. l r. N ~ h G r ^' '~ ~ Q'. C7 o p, ~w ~ ~^ .. ~-r.~ Q ~' :~ x; V i \~ V~ ~' .~ \a \ / o-, ~ \ ~l ~; ;~ ~ r ~ \ ~~ ,, `` .-^ V ~ ~L i \ ~ ~ \ V '~ 1 `J Ord ~~ ~ cy\\~ ~ \~ i;r} ~~ j .,.3 i "~ }' •r•} r `~,~{ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT~GE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APRRAISEM,ENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF IIEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 - ~'` REV-1547 EX AFP (12-OS) I' ~ 3~ P~ 12~ 2 ATE ol -z7-2oo9 ~~;ti~)' .~t•~< STATE OF WR'~IGHT ROBIN M DATE OF DEATH 01-22-2002 rr~ rr;-4~~ (~;~ FILE NUMBER 21 02-0158 ~ +, ~~~,)ti COUNTY CUMBERLAND pRPN a DEBBIE GARDNER CU^~~~ i "' ~ ~' P,AACN 101 411 FOX LANE APPEAL DATE: 03-28-2009 H BG PA 17112 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABL-E AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP C12-O8~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WRIGHT ROBIN M FILE N0. 21 02-0158 ACN 101 DATE 01-27-2009 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .0 0 8. Total Assets (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. .00 APPROVED DEDUCTIONS AND EXEMPTIONS: .00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions CL1) -~~ .00 12. Net Value of Tax Return (12J .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule .I) C13) .00 14. Net Value of Estate Subject to Tax (14J NOTE: If an assessment was issued previously, l ines 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. Amount of Line 14 at Spousal rate C15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) •0 0 X 045 = .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 = .00 19. Principal Tax Due T~V I•~CTTT[•- (19J= .00 r.. PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 i~ * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. ~`~ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED ~4S A "CREDIT" CCR), YOU MAY BE DUE ~' A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)