HomeMy WebLinkAbout03-0716PETITION FOR PROBATE and GRANT OF LETTERS
Deceased.
Social Security No. <. ~
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the
in the last will of the above, decedent, dated PCt0.¢c_VI ~o
and codicil(s) dated ~]~
Register of V~ills for the. l
County of (-~ gq ~ ~[ t ~ CI
Commonwealth of Pennsylvania
in the
named
,19 O~K
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in CAo rn_~ ~¢\C~ ~3 County, Pennsylvania, with
h r._f?,,, last farqily or principal residence at k ~'10 M fYhc-~ c~ tc~ -.~t~ , K3 ~ Lc)
(list street, number and muncipality)
Dece~tent, the;n QO~_ ~2~ariofage, die¢ C3xOc4~ ~C444'~ ,19-
Except as follow~, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~ / ~
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ i (30: Oo o
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania ri .1~ O: 0 0 (~
situated as follows: t"lClq .I, Ic~ole. ,q,q- ~eu_t (,~r~¢~Ic~ : PA
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~c:, (-cc~en-br, / ~ ~
(testamentary; a~ministration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF ~_~r~ ,- ~c,.c,r[ _ ss
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirlnech and subscribed [~ ~ ~.
before me this ~ oo day of ~
Estate 0f MARY LYNN BORTEL A/K/A LYNN BORTEI , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
SEPTEMBER 2, 2003
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 3-6-1998
described therein be admitted to probate and filed of record as the last will of
MARY LYNN BORTEL A/K/A LYNN BORTEL
and Letters TESTAMENTARY
, in consideration of the petition on
are hereby granted to JENNIFER LYNN BORTEL AND JOAN LESLIE BORTEL N/K/A
JOAN LESLIE GREEN
FEES
Probate, Letters, Etc .......... $~t70,00
Short Certificates(to) ' $ /~, L)D
TOTAL __ $~1~,(90
Filed _ ~:~El:~. 9-2-2003
W~'~'T~ 'F'0~' L'ETT£~'S' '~-'~'--'~00Y ....
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
LAST WILL AND TESTAMENT
OF
MARY LYNN BORTEL
I, MARY LYNN BORTEL, of New Cumberland, Cumberland County,
Pennsylvania, do make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEM I: · direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executrixes out of the property passing under ITEM III
of this Will, as an expense and cost of administration of my estate. The Executrixes
shall have no duty or obligation to obtain reimbursement for any such tax so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II:. I direct the Executrixes to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an
expense and cost of administration of my estate.
ITEM III:
estate as follows:
· devise and bequeath all the rest, residue and remainder of my
One-half (1/2) to my daughter, JENNIFER L YNN BORTEL. In the event
she predeceases me, her share shall be paid to her issue.
One-half (1/2) to my daughter, JOAN LESLIE BORTEL. In the event
she predeceases me, her share shall be paid to her issue.
In the event any beneficiary above predeceases me and has no issue, her share shall
be paid to the other named beneficiary. If none of these beneficiaries survive me, I
devise and bequeath my estate in equal shares to my sisters, PHYLLIS ANN GLENN
and JEAN CAROL CAITO, or the survivor of them.
II'EM IV: In the settlement of my estate, my Executrixes shall poss, among
others, the following powers:
(a) To retain any investments · may have at my death, as long as the
Executrixes may deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and
conditions as the Executrixes may deem advantageous to the estate, any or all real or
personal property or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the E ' ' '
xecutn-xes judgment deemed necessary
or desirable for the proper and advantageous management, investment and distribution
of the estate.
ITEM ¥: Any person who shall have died at the same time as · shall have,
or in a common disaster with me, or under circumstance that the order of deaths
cannot be established by proof, or within thirty (30) days of my death, shall be deemed
to have predeceased me.
ITEM FI: I appoint my daughters, .IFAVNIFER LYNN BORlC~L and JOAN
LESLIE BORTEL, to be co-Executrixes of my Estate. Any Executrix is specifically
relieved from the duty or obligation of filing any bond or other security.
IN ~FITNESS I~ttEREOF, · have hereunto set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding two (2) pages, at the end
of each page of which I have also set my initials for greater security and better
identification this ~ day of~/~~/, 1998.
'3
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the
day and year first above written, and we certify that at the time of the execution
thereof, the said Testatrix was of sound mind and memory.
Residing at: 205A Tenth Street
New Cumberland, PA 17070
Residing at: $15D Eden Road
MICHAEL T. STEPHENS Lancaster, PA 17601
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, MARY LYNN BORTEL, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that · signed it as my free and voluntary act for the
purposes therein expressed.
Sworn to and subscribed
beforel t~ th~s ~ day
of //~/lO.~ct'-~, 1998.
- NOTARg~UBLIC
My Commission Expires:
(SEAL)
~ L YNN BORTEL
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, LISA ZIZIS, and MICHAEL T. STEPHENS, the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Testatrix, MARY LYNN
BORTEL, sign and execute the instrument as her Last Will and Testament; that
Testatrix signed willingly and she executed said Will as her free and voluntary act for
the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at
that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
Sworn to su/5? bea
befo ,ro. this
./NOTARY PUBLIC
My Commission Expires:
(SEAL)
6
MICHAEL T. STEttHENS
ESTATE OF
MARY LYNN BORTEL,
DECEASED
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2003-00716
ENTRY OF APPEARANCE
Please enter the appearance of Marc W. Witzig, Esquire, Kelly M. Knight, Esquire, and
the law firm of Cunningham & Chernicoff, P.C. in the above-designated matter on behalf of the
Estate of Mary Lynn Bortel, deceased, and its Co-Executrix, Jennifer Lynn Bortel and Joan Leslie
Bortel.
Date: Septeml~er 5, 2003
Respectfully submitted,
CUNNINGHAM & CHERNICOFF, P.C.
By: ///b/~ ~
Marc Vt. Witzig, Esquire
Pa. Atty. Ident. No. 29929
Kelly M. Knight, Esquire
Pa. Atty. Ident. No. 87365
2320 North Second Street
P. O. Box 60457
Harrisburg, PA 17106-0457
Attorneys for the Estate of Mary Lynn Bortel,
deceased, and its Co-Executrix,
Jennifer Lynn Bortel and Joan Leslie Bortel
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 003274
BORTEL JOAN LESLIE N/K/A
635 NORTH LIME ST
ELIZABETHTOWN, PA 17022
........ fold
ESTATE INFORMATION: SSN: 275-32-6498
FILE NUMBER: 2103-071 6
DECEDENT NAME: BORTEL MARY LYNN
DATE OF PAYMENT: 11/24/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/29/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $20,863.00
TOTAL AMOUNT PAID:
$20,863.00
REMARKS: RECEIVED OF JOAN LESLIE BORTEL
IN CO CUNNINGHAM & CHERNICOFF
SEAL
CHECK# 1029
INITIALS' AC
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV. lr~O EX +
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~FF:ICI~,L t lSEE CqJL 5
FILE NUMBER
21 03 716
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BoWel, M~ L~
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
08/29/2003 07/25/1938
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
z
SOCIAL SECURITY NUMBER
[] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82)
[] 4. Limited Estate [] 4a. Future Interest Compromise (date of death [] 5. Federal Estate Tax Return Required
after 12-12-82)
[] 6. Decedent Died Testate {Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
of Will) copy of Trust) --
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11 .Election to tax under Sec. 9113(A) (Attach Sch O)
12-31-91 and 1-1-95)
qAME COMPLETE MAILING ADDRESS
Marc W. Witzig, Esquire
:IRM NAME (If applicable)
Cunmngham & Chernicoff, P.C. 2320 North Second Street
rELEPHON[717/238-6570NUMBER - Harrisburg, PA 17110
1. Real Estate (Schedule A)
(1) 137,200.0~
(2)
(3) -0-
(4) -0-
(5) 108,099.07
(6) -0-
(7) 268,481.52
(9) 19,486.40
(10) 20,294.18
(8)
513,780.59
39,780.58
474,000.01
474,000.01
(11)
(12)
2. Stocks and Bonds (Schedule B)
(13)
(14)
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)
[] 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)
x .00 (15)
x .045 (16)
x .12 (17)
21,330.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate 4 7 4,0 0 0.0 ]
17. Amount of Line 14 taxable at sibling rate
~< 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) _2 ! ,~ 30. 0~0
Copyright 2000 form software only The Lackner Group, Inc. Form REV-I$00 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
1704 Maple Street
CITY
New Cumberland
STATE PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C, Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
20,863.00
1,066.50
ZIP 17070
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I 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.
21,330.00
21,929.50
0.00
599.50
0.00
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
'."?..?.//..¢~.~ ~ ~.~ ~ ~.4 "':< '-': '//.":/-.¢.~ ~ ~ ~ ~-"~'/..'~ ~ ¢..'.¢'..:.x '..:.~..'~.~ :-: '..'..'..'..'x :.::.:.: ~ ,..:.::.:.:
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 [~
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, benef ts 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 trust for" or payable upon death bank account or security 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 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.
S~ PERSON R~_.~SIBLE FOR FILING RETURN ADDRESS DATE
'~T~'RE OF-PERSbN RE--~5~ON;5"TB~"t~--F'"O~ ~IL'I~G R'I~'~RI¥' - -~DDRESS ' ~ -
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
Marc W. Witzig, E quire
~l~ /,O /' ~} ri_ 2320 North Second Street
/-[~,44,~ Ld,/,~.LtL/t'I~ H~sb~g, PA 17110 /~[~ / Zi
For dates of death on or aEer July 1, 1994 an~e Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
su~iving spouse is 3% [72 P.S. {9116 (a) (1.1) (i)].
For dates of death on or a~er Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 0%
[72 P.S. {9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a sullying spouse from t~, and the statuto~ requirements for disclosure
of assets and filing a tax return are still applicable even if the su~iving spouse is the only beneficial.
For dates of death on or aEer July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child ~enty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {9116
1.:) [72 P.S. ~9~ 16 (a)
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at [east one parent in common with the decedent, whether by blood or adoption.
COMMON~NEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF 'FILE NUMBER
Bortcl, Mary Lynn 21 - 03 - 716
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market va ue s defined as the price
at which propertY/would be exchanged between a willing buyer and a willing seller neither being compelled to buy or sell, both hav ng
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I 137,200.00
1704 Maple Street
New Cumberland, Cumberland County, Pennsylvania
(copy of 1992 Deed and Form HUD- 1 are attached)
TOTAL (Also enter on Line 1, Recapitulation)
137,200.00
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
Bort¢l, Mary Ly~m 21 - 03 - 716
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE OF DEATH
NONE
TOTAL (Also enter on line 2, Recapitulation)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REllJRN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the
decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-propnetorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
NONE
TOTAL (Also enter on Line 3, Recapitulation)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES RECEIVABLE
ESTATE OF FILE NUMBER
Bort¢l, Mary Lynn 21 - 03 - 71~
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
NONE
DESCRIPTION
TOTAL (Also enter on Line 4, Recapitulation)
VALUE AT DATE
OF DEATH
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
Include the proceeds of litigation and the date theproceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
3,700.00
9
10
11
12
13
1997 Mercury Sable (61,000 miles)
(NADA valuation is attached)
Comcast reimbursement
PP&L reimbursement
Valley National Bank - - return of escrow
VNB Mortgage Services, Inc. - - return of surplus escrow
Holy Spirit Hospital - - reimbursement of overpayment
American Water Company - - reimbursement of overpayment
Miscellaneous items of personal property
(see attached list complied by Co-Executrix)
Miscellaneous items of jewelry (see attached appraisal)
M&T Bank - - Checking Account No. 98176315
M&T Bank - - Money Market Account Number 00981-7631-5
Penn Treaty -- Long term care insurance reimbursement
Erie Insurance Group -- Insurance policy refund
TOTAL (Also enter on Line 5, Recapitulation)
20.04
44.45
2,207.22
576.91
82.78
2.14
7,374.00
3,260.00
45,774.42
40,305.11
4,341.00
411.00
108,099.07
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A NONE
JOINTLY OWNED PROPERTY:
DESCRIPTION Of ProPErTY
LETTER DATE % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERESl
1 NONE
TOTAL (Aisc enter on line 6, Recapitulation)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
This schedule must be completed and filed if the answer to any of questions I through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY % OF
ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH EXCLUSION
DECD'S TAXABLE VALUE
NUMBER Attach a copy of the deed for real estate. VALUE OFASSET INTEREST (IF APPLICABLE}
U.S. Office of Personnel Management 53,299. l l 100% 53,299. l 1
Thrift Savings Plan
Roth IRA account at Smith Barney Citigroup 722.33 100% 722.33
(Pumam Fund)
Pacific Life Insurance Company 49,021.96 100% 49,021.96
Annuity Contract VA 99622290
UBS Financial Services, Inc. 165,438.12 100% 165,438.12
Account Number LV 4445371
TOTAL (Also enter on line 7, Recapitulation) 268,481.52
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RE'TURN
RESIDENT DECEDENT
~-IEDULE H
FUNERAL EXPF_NSE~ &
ADMIN~~~
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
Ao
1
2
3
4
5
6
B.
1.
FUNERAL EXPENSES:
Parthemore Funeral Home & Cremation Services, Inc.
County Coroner - Cremation authorization
United Methodist Church - luncheon
Reverend Scott Ogden
Eileen Prowant - orgamst
Memorial Book
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Cunnmgham & Chernicoff, P.C.
Family Exemption: (If decedent's address is not the same as claimant's, affach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
State ~ Zip
Accountant's Fees James Minder, CPA
Tax Return Preparer's Fees
Other Administrative Costs
Estate Notice - Carlisle Sentinel
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
1,070.00
25.00
229.63
200.00
100.00
24.85
5,500.00
313.00
95.00
129.47
11,799.45
19,486.40
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bortel, Mary Lynn 21 - 03 - 716
8
9
l0
11
12
13
14
15
16
17
18
19
20
21
22
Death Notice, Harrisburg Patriot
Certified copies of Death Certificate
Henderson Jewelers - - appraisal fee
Cedar Springs Self Storage Center
Expenses relating to maintenance of, and sale of, 1704 Maple Street,
New Cumberland, Pennsylvania (HUD-1 is attached)
Termite Inspection
Robin Gasperetti - tax report
Realty Transfer Tax
Seller assistance (per sale contract)
Trash bags
Trash hauling
Truck Rental
Short certificates
Expenses of Jennifer Bortel, Co-Executrix
AirFare (9/6/03)
AirFare (9/12-9/20/03)
Airport Parking
Bulk mailings
Pennsylvania Inheritance Tax Return - - Filing Fee
Estate Notice - Cumberland Law Journal
188.32
40.00
82.00
137.80
50.00
8.00
1,381.00
8,232.00
11.99
120.00
702.28
8.00
332.98
336.00
61.00
18.08
15.00
75.00
Page 2 of Schedule H
COM MONWEAL'I3-1 OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Bo~tc], Mary Lyrm 2l - 03 - 716
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
Valley National Bank (residential mortgage)
Hospice of Central Pennsylvania
Quantum Imaging
UGI Gas
AT&T
Verizon
PP&L Electric
Pennsylvania American Water Company
TOTAL (Also enter on Line 10, Recapitulation)
17,937.12
2,100.00
7.70
26.99
49.74
30.55
123.40
18.68
20,294.18
REV-1513 EX+ (9-00) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Bortel, Mm7 Lynn 21 - 03 - 716
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
II.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Joan Leslie Bortel
635 North Line Street
Elizabethtown, PA 17022
Jennifer Lynn Bortel
4508 North Delaware Street
Indianapolis, IN 46205
RELATIONSHIP TO
DECEDENT
Da Nat Li~t Tru~-t~e~.~)
Daughter
Daughter
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
AMOUNT OR SHARE
OF ESTATE
0.50
0.50
REGISTER OF WILLS OF CUMBERLAND COUNTY
IN RE: Estate of Mary Lynn Bortel, Deceased
Estate No. 00716 of 2003 State File No. 21-03-716
FAMILY AGREEMENT
THIS AGREEMENT is by and among Jennifer Lynn Bortel and Joan Leslie Bortel,
Co-Executrix of the Estate of Mary Lynn B ortel, of Cumberland County, Deceased, and Joan
Leslie Bortel, a/k/a Joan Leslie Green, of Lancaster County, Pennsylvania, and Jennifer Lynn
Bortel, of Indianapolis, Indiana, each in their individual capacity.
Background
A. Mary Lynn Bortel, who resided at 1704 Maple Street, New Cumberland, Cumberland
County, Pennsylvania, died on August 29, 2003. She left her Last Will and Testament dated
March 6, 1998, which was duly admitted to probate by the Register of Wills of Cumberland
County on or about September 2, 2003.
B. Jennifer Lynn Bortel and Joan Leslie Bortel were duly appointed and serve as
Co-Executrix of the Estate of Mary Lynn Bortel, Deceased.
C. The sole beneficiaries and parties in interest under the Last Will and Testament of
Mary Lynn Bortel, Deceased, are her surviving daughters, Joan Leslie Bortel, aYk/a Joan Leslie
Green, of Lancaster County, Pennsylvania, and Jennifer Lynn Bortel, of Indianapolis, Indiana
(collectively, the "Beneficiaries"), each of whom is a party hereto.
D. Each of the Beneficiaries is entitled to a one-half (lA) distributive share of the residuary
estate, after payment of the Decedent's debts, administrative expenses, and Pennsylvania
inheritance tax.
E. Each of the parties to this Agreement has been furnished with a complete listing of the
Estate assets, receipts, debts and disbursements summarized in the Accounting attached hereto
and marked as Exhibit "A", herein incorporated by reference.
F. It is the desire of the parties 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, and thereby avoiding the expense, delay, and publicity of a formal
accounting.
G. Each of the parties has received fi.om the Executor a proposed Schedule of
Distribution attached hereto and marked as Exhibit "B", herein incorporated by reference.
Agreement
NOW, THEREFORE, in consideration of the above Background, herein incorporated by
reference, and of the mutual promises, covenants and agreements contained herein, the parties agree as
follows:
1. Joan Leslie Bortel, a/k/a Joan Leslie Green and Jennifer Lynn Bortel, being all the
beneficiaries of the said decedent's estate do, hereby release and forever discharge Joan Leslie Bortel
and Jennifer Lynn Bortel, Co-Executrix, from any and all liability that, from time to time, may arise in
connection with service as Co-Executrix of the Estate of Mary Lynn Bortel, Deceased. The parties
shall indemnify and hold harmless said Joan Leslie Bortel and Jennifer Lynn Bortel, Co-Executrix, from
any and all liability that may arise against the Estate from creditors or other claimants.
2. Each of Joan Leslie Bortel, a/k/a Joan Leslie Green and Jennifer Lynn Bortel, beneficiaries,
hereby acknowledges receipt of the assets described on the Schedule of Distribution attached hereto.
3. Each party acknowledges that this Agreement shall be indexed and recorded in the Estate
proceedings and that the provisions hereof shall be binding upon the parties and their respective heirs,
administrators, representatives, successors and assigns.
4. This Agreement may be signed in one or more counterparts, any of which may contain all or
less than all contemplated signatures, but all of which shall constitute one and the same Agreement.
Any counterpart signature page may be attached to another edition so as to compile a composite
containing all contemplated signatures.
disregarding any rules relating to the choice or conflict of laws.
Dated as of the ~/~ day of
This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania,
)
~ ,2004.
Jefa~ifer ~'ynn Bortel, Co-Executrix
WITNESS:
J~.~an Leslie Co-Executrix
Bo~el~
.?ennifer ~ynn~Bortel, Beno~,ficiary
Joan Leshe Bortel,
aYk/a Joan Leslie Green, Beneficiary
2
II.
III.
EXHIBIT "A
ACCOUNTING OF THE ESTATE OF MARY LYNN BORTEL, DECEASED
ASSETS, RECEIPTS~ DEBTS~ AND DISBURSEMENTS
Assets as o£Date o£Death (August 29, 2003)
A. Real Estate $137,200.00
B. Cash, bank deposits, and $108,099.07
miscellaneous personal property
C. IRA balances $268,481.52
TOTAL GROSS ASSETS
$513,780.59
Debts, Liabilities, and Liens
Total Debts
Disbursements
A. Funeral Expenses
1. Parthemore Funeral Home & Cremation
Services, Inc.
2. County Coroner - Cremation Authorization
3. United Methodist Church - luncheon
4. Reverend Scott Ogden
5. Eileen Prowant - organist
6. Memorial Book
B. Cunningham & Chernicoff, P.C. (attorneys)
C. Register of Wills (probate fees)
D. James Minder, CPA
$ 20,294.18
$1,070.00
$ 25.00
$ 229.63
$ 200.00
$ 100.00
$ 24.85
$5,5OO.OO
$ 313.00
$ 95.00
3
Eo
H.
I.
J.
K.
Other Administrative Costs
1. Estate Notice - Carlisle Sentinel
2. Death Notice, Harrisburg Patriot
3. Certified copies of Death Certificate
4. Henderson Jewelers - appraisal fee
5. Cedar Springs Self Storage Center
6. Pennsylvania Inheritance Tax Return
Filing Fee
7. Estate Notice - Cumberland Law Journal
Expenses relating to maintenance of, and sale of,
1704 Maple Street, New Cumberland, Pennsylvania
1. Termite Inspection
2. Robin Gasperetti - tax report
3. Realty Transfer Tax
4. Seller assistance
Trash Bags
Trash Hauling
Truck Rental
Short certificates
Expenses of Jennifer Lynn Bortel, Co-Executrix
AirFare (9/6/03)
AirFare (9/12-9/20/03)
Airport Parking
$ 129.47
$ 188.32
$ 40.0O
$ 82.00
$ 137.80
$ 15.00
$ 75.00
$ 50.00
$ 8.OO
$1,381.00
$8,232.00
$ 11.99
$ 120.00
$ 702.28
$ 8.00
$ 332.98
$ 336.00
$ 61.00
4. Bulk mailings
Estate Notice - Cumberland Law Journal
$ 18.08
$ 75.00
Total Gross Assets
Less:
Less:
Total Expenses and Costs
Debts and Liabilities
Disbursements
Subtotal
$ 20,294.18
$513,780.59
($ 19,486.40)
($20,294.18)
$474,000.01
5
Value of the Estate
Less: Pennsylvania Inheritance Tax
Tbtal available for distribution to
residuary beneficiaries (after
Pennsylvania inheritance tax)
Distributed in equal shares of
$226,335.00 to each residual beneficiary
EXHIBIT "B"
Schedule of Distribution
$474,000.01
(21~330.00)
$452,670.01
JORDAN D. CUNNINGHAM
ROBERT E. CHERNICOFF
MARC W. WITZIG
HENRY W. VAN ECK
JOHN M. HYAMS
KELLY M. KNIGHT
CUNNINGHAM & CHERNICOFF, P.C.
ATTORNEYS AT LAW
P.O. BOX 60457
HARRISBURG, PENNSYLVANIA 17106-0457
TELEPHONE (717) 238-6570
FAX (717) 238-4809
July 7, 2004
HERSHEY TELEPHONE
(717) 534-2833
IRS NO. 23-2274135
Street Address:
2320 N. 2nd Street
Harrisburg, PA 17110
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
VIA HAND DELIVERY
Re-'
Estate of Mary Lynn Bortel, Deceased
File No. 21-03-716
Ladies and Gentlemen:
The Pennsylvania Department of Revenue has accepted and approved the Pennsylvania
Inheritance Tax Return filed as concerns the above-referenced decedent estate. Enclosed
herewith is a photocopy of the Notice of Inheritance Tax Appraisement issued this month.
Also enclosed for filing is the Family Agreement among the estate, its Co-Executrix, and
the Beneficiaries of the decedent; and the Status Report required under Rule 6.12. We believe
these filings are sufficient to warrant closing of probate, and we so request.
Sincerely yours,
CUNNINGHAM & CHERNICOFF, P.C.
Marc W. Witzig ( )
MWW/sas
Enclosures
PLEASE FILE THIS REPORT WITHIN TWO 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
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mary Lynn Bortel
Date of Death: August 29, 2003
Estate No.: 0071 6 of 2003
Admin. No. 21 -03-716
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:
State whether administration of the estate is complete:
Yes × No
Date: July
(MAH:rmtYAM3)
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
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
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes × No
D. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
Signature
Marc W. Wit~, Esquire
Name (Please type or print)
2320 North Second Street
Harrisburg, PA 17110
Address
(717) 238-6570
Telephone No.
R.W. - 58,
Capacity:
X
Personal Representative
Counsel for Personal Representative
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 180601
HARRTSBURG, PA 17128-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-lSd7 EX AFP C01-0S)
NARC W WITZIG ESQ
CUNNINGHAM & CHERNICOF
ZSZO N 2ND ST
HBG PA 1711~,
DATE 07-05-200q
ESTATE OF BORTEL
DATE OF DEATH 08-29-2003
FILE NUMBER 21 03-0716
COUNTY CUMBERLAND
'iACN ZO!
Amoun~ Remi~ed
HARY L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
- - - .................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BORTEL MARY L FILE NO. 21 03-0716 ACN 101 DATE 07-05-200~
TAX RETURN NAS: (X) ACCEPTED AS FILED ( } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (SchaduZa A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nership Zn~ares~ (Schedule C) ($)
q. Mor~gages/No~as Receivable (Schedule D) (q)
5. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage L~abili~ies/Liens (Schedule Z) (10)
11. To,al Deductions
12. Ne~ Value of Tax Re~urn
137~200.0{0
· o{o
· 0{0
· 0{0
108z099.07
· 0~0
NOTE: To insure proper
cradi~ ~o your account,
submi~ ~he upper portion
of ~h~s fora w~h your
~ax payment.
Z68~q81.5Z
(8) 513,780.59
19,q86.q0
1:5.
lq.
NOTE:
20~Z9q.18
(11) ~9.780.58
{12] q7q,000.01
Charitable/Governmental Bequests; Non-elected 911:5 TrusSes (Schedule J) (1:5)
Ne~ Value of Es~a~e Subjec~ ~o Tax (lq)
Zf an assesseent ~as issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
.00
q7q,000.01
ASSESSMENT OF TAX:
1.;,. Amoun* of LAne lq a~ Spousal ra~:e
16. Amoun~ of L/ne 1~. ~:axable a~ Lineal/Class A ra~e
17. Amoun~ of L/ne lq a~ Sibling ra~e
18. Amoun~ of Line lq *exable a* Colla~:eral/C1ass B ra*e
19. PrincA )al Tax Due
TAX CREDZTS
PAYMENT RECEIPT DTSCOUNT (+J
DATE NUMBER INTEREST/PEN PAID (-)
11-2q-2003 CD003Z7~ 1,066.50
18 and 19 will
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADD/TZONAL /NTEREST.
(1~) .00 x O0 = .00
(16). q7q,O00.01 x Oq5= 21,330.00
(17) .00 x 12 = .00
(18) .00 x 15 : .00
(19)= 21,330.00
AMOUNT PAID
20,863. O0
TOTAL TAX CREDIT I 21,929.50
BALANCE OF TAX DuE 599.50CR
[NTEREST AND PEN. .00
TOTAL DUE 599.50CR
( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CRED/T" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE S/DE OF THIS FORM FOR ZNSTRUCT/ONS.) ~
RESERVATION:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the CoaaonNealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawfut Class B (collaterat) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S.
Section 91~0).
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NZEESj AGENT
A refund of e tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office
of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special Z~-hour
ansaering service for fores ordering: 1-800-56Z-ZO50~ services for taxpayers with special hearing and / or
speaking needs: 1-BOO-~q?-3OZO (TT only).
Any party in interest not satisfied with the appraisement, alloaance, or diselloaance of deductions, or assessment
of tax ¢including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appealsj Dept. Z81021j Harrisburg, PA 17128-10Z1~ 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 Revise Unit~ Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-150i) for an explanation of administratively correctable errors.
If any tax due is paid eithin three (5) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is alloued.
The 15X 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 tiaa period as you ~ould appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning ~ith first day of delinquency, ar nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of
six (SZ) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rats ahich wi1! vary from calendar year to calendar year ~ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZO0~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20X .O00Sq8 "J-9'~'8-1991 11Z .000301 ~ 9x .O00Z~7
1985 162 .000~58 1992 92 .0002~7 ZOOZ 62 .00016~
19B~ llZ .000301 1995-199~ 72 .O00lgZ 2003 5Z .000157
1985 ISZ .000556 1995-1998 9Z .O00Z~7 ZO0~ ~Z .000110
1986 IOZ .O0027~ 1999 7Z .O00Zgz
1987 10Z .00027~ 2000 7Z .O00lgZ
--Interest is calculated as follows:
ZNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAZEY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~i11 reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,-,C(\'\c;\~D OFFICE (iNHERITANCE TAX
f\,~_,A/IU'-- c': '.'STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
2uU5
28 PH 3: 01
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-31-2005
BORTEL
08-29-2003
21 03-0716
CUMBERLAND
101
MARY
L
MARC W WITZIG ESQ ('1:
CUNNINGHAM 8 CHERNlCOF
2320 N 2ND ST
HBG PA 17110
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF BORTEL MARY L FILE NO.21 03-0716 ACN 101 DATE 10-31-2005
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-28-2004
PRINCIPAL TAX DUE: 21.330.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-24-2003 CD003274 1.066.50 20.863.00
10-14-2005 REFUND .00 599.50-
TOTAL TAX CREDIT 21.330.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR).
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
G\il'