HomeMy WebLinkAbout02-0175 PETITION ~FOR PROBATE and GRANT OF LETTERS
also known as __ To:
Register of Wills for th~ r
Deceased. County ofC~_~a~ De ff'~:r~,t4 _ in the
Commonweal~l~ (~f Pennsylvania
Social Security No. ~q_¢-- ~ '-~'~D
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execm ~:~fl' named
in the last will of the above decedent, dated z/.~p.-5 - 2o~;.// , 19
and codicil(s) dated
(slate relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~'~ "tO Jg~'r/~wv~ County, Pennsylvania, with
~ last family or princ~al residence at ~OW /~r~i,~a __ ~ ~,
"- ..... l/ ~reet, number and muncipality)
(list
Decende~t, then ~ __ years of age~died ~/~ff ~d/ ~ "
Except a[follows, decedent d~d 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 $
(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: . . . ~ ·
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
reqgest(s) the probate of the last will and codicil(s)
Sworn to or affirmed and subscribed
before me this 13t_h __ __ day of
\ FEBRUARY, 2 0..0 2 xx:q xxRx_x~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C-,4-:~'/]P"~e~ .~ ) 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.
Estate Of AUGUSTA M ROGOWICZ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
FEBRUARY it4, 2002
AND NOW* 19
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated_ APRTL 23, 200.~
described therein be admitted to probate and filed of record as the last will of AUGUSTA M
ROGOWICZ
and Letters 'l' ~: S'/'AME N'/'AR Y
areherebygrantedto CHESTER J ROGOWICZ
, in consideration of the petition on
FEES
Probate, Letters, Etc .......... $ 25.00
Short Certificates(2 )... '. ...... $ 6.00
RMrK~tYo~x)~:~..~.x.t.¥o..p.a.g~s 9.00
JCP $. 5.00
TOTAL $. 45.00
FHed FEBRUARY
ma 11 ed' '56' ' fi'f ~b'~h'~' '6 h" 2'-' ~ '4 -' 0'2"
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
l~ocal .Registrar. 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.
Fee for this certificate, $2.00
P 7691203
No.
Date
COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
,. Augusta Rogowzcz ,.Female ,. 194 -- 26 -- 9500 '.3ep}fiT,~,~,( ~9 t,~t.(q
,. 65 (- ; i ,04/28/1936 ~?ottsville PA. mO ~ [] ~O ,~,[]
~ Hm -~ ~w ~,~ "'~* ' Chester J R~lcz
.... .~ I .... t,,. I,,. ~2 I ' I,,.~i~ I,,. ·
Mechanicsburg, PA. 17055
Martin McLaughlin
Chester J.
,~,. m,, rennsy.van.a
,~. c,~land ....
Vera Petruska
5560 Moreland Court Mechanicsbur9 PA. 17055
,,~ast Harrisburq PA. 17109
Home
21-02-175
21-02-17~
LAST WILL AND TESTAMENT
OF
AUGUSTA M. ROGOWICZ
I, AUGUSTA M. ROGOWICZ, of the Township of Lower Allen, County
of Cumberland and State of Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all former Wills by me at any
time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after
my decease as the same can be conveniently done.
2.
I give, devise and bequeath all the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever the same may be situate, to
my husband, CHESTER J. ROGOWlCZ, absolutely and unconditionally.
-1-
In the event that my husband, CHESTER J. ROGOWICZ, should
predecease me, or should he die within thirty (30) days from the date of my death,
then in such event, I give, devise and bequeath my entire estate, of whatsoever
nature and wheresoever the same may be situate, to my two (2) children, to wit,
MICHAEL C. ROGOWlCZ and MARY E. HALL, share and share alike, or to
the survivor of said two (2) children, absolutely and unconditionally, should one of
them predecease me.
In the event that both of my children should predecease me, then in such
event, I give, devise and bequeath my entire estate to my grandchildren who are
living a the time of my death, share and share alike.
LASTLY, I nominate, constitute and appoint my husband, CHESTER J.
ROGOWICZ, Executor of this my Last Will and Testament and in the event that
my said husband should predecease me, or should he be unable or unwilling to serve
in such capacity for any reason, then in such event, I nominate, constitute and
appoint my two children, the aforementioned MICHAEL C. ROGOWICZ and
MARY E. HALL, Co-Executors of this my Last Will and Testament, in his place
and stead, and in all instances, I direct that my said personal representatives be
-2-
excused from posting bond or other security for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of April, A. D. 2001. ~~, ~Au~,~ ~./_.~2t.~.,~ ..
(SEAL)
Signed, sealed, published and declared by the above-named, AUGUSTA M.
ROGOWlCZ, as and for her Last Will and Testament, in the presence of us, who,
at her request and in her presence, and in the presence of each other, have hereunto
subscribed our names as witness/9C)
'
-3-
COMMONWEALTH OF PENNSYLVANIA )
· SS
COUNTY OF CUMBERLAND )
I, AUGUSTA M. ROGOWICZ, the 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 same instrument as my Last Will and
Testament; that I signed it willingly, and that ~gned it as my free and voluntary act and
deed, for the purposes therein expressed· / /
'- -dAh-gusta M R°g° ~/z'
Sworn and subscribed to before _
me this ~ ~ r~aay of April, 2001 [ Notarial Seal
· [ Madlyn E. Williams, Notary Pu~ic
'- [ M~ Commission Expires Nov. 6, 2001
Notary Public ~'~.~r, Pennsylvania .~s0ciaio~ ot Notaries
COMMONWEALTH OF PENNSYLVANIA )
· SS
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT STAUFFER and SUSAN A. McCOY, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
AUGUSTA M. ROGOWlCZ, sign and execute the instrument as her Last Will and
Testament; that the said testatrix executed it 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 the time,
eighteen (18) or more years of age, of sound mind, and under no constraint, duress or
undue influence.
Sworn and subscribed to before
me tla~s ,.,. '~ flay of Apnl,.~200j.
Notary Public
l" Notarial Seal
Maffiyn E. Williams, Notary Public
Ideohanicsbung Boro, Cumbedancl County
My Commission Expires Nov. 6, 200~
Menfeer, Pennsylvania All, ociation ol Nolades
I I I IIII I I II III I I I mmmllJ ll~ T
REV- 1 500
,~'~~~3~, DEPARTMENT OF REVENUE
~'~"~:~j~,~ DEPT. 280601 INHERITANCE TAX RETURN -
'AR..SBUR ,.A 7 2 -060 RESIDENT BECEBEN
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER
ILl
ILl
r~
I--
Z
U.I
Z
O
O
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[~'"~ Original Return [~ 2. Supplemental Return
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~-'-~ 3. Remainder Return (date of death pd~ to 12-13-82)
[~4. Limited Estate
---]6. Decedent Died Testate (Attach copy of Will)
r'~9. Litigation Proceeds Received
r~4a. Future Interest Compromise (date of death after 12-12-82)
~'~7. Decedent Maintained a Living Trust (Attach copy of Trust)
~---] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
FIRM NAME (,fApplicable) ~__t~-
TELEPHONE NUMBER
[]5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (~)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedure I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
(11)
(12)
OFFICIAL USE ONLY
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15)
16. Amount of Line 14 taxable at lineal rate x .0 (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at corlateral rate x .15 (18)
19. Tax Due (19)
20.~] ' ~ · - '08 ,' ' e! ,~ · ' I~D · ,,~ oY --,-v ,~
Decedent's Complete Address:
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
(3)
(4)
(5)
(5A)
(sa)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
BLOCKS
No
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; .......................................................................................... []
b. retain the right to designate who shall use the property transferred or its income; ............................................ []
c. retain a reversionary interest; or .......................................................................................................................... []
d. receive the promise for life of either payments, benefits or 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, [ 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.
SIGNATURE OF PF_aRSON RESPONSJ~{-E FOR FILING RETURN DATE
ADDRESS p ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The 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 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
STATE OF SOUT, .
COUNTY OF HORRY
ExErT YES NO
ASSESSOR --
Form No. 107 - Title to Real Estate
67890 Revised 1976
This deed prepared without benefit
of title examination.
KNOW ALL MEN BY THESE P~SENTS, THAT
SANDS BEACH CLUB HOA, INC.,
in the State aforesaid for and in consideration of the sum of NINE HUNDRED TWENTY AND NO~lO0
($920. 00), to it in hand paid at and before the sealing and deliver, of these presents by
CHESTER ROGOWICZ AND AUGUSTA ROGOWICZ,
P.O. Box 368,
Littleton, NC 27850
in the State aforesaid, acknowledged, have granted, bargained, sold and released, and by these Presents
do grant, bargain, sell and release unto the said
CHESTER ROGOWICZ AND AUGUSTA ROGOWICZ
the following real property, to wit:
An estate for years in UNIT 626, UNIT WEEK 44, in SANDS BEACH CLUB PHASE II,
A Horizontal Property Regime established by the SANDS INVESTMENTS NO. 2, INC.,
pursuant to the South Carolina Horizontal Property Act, §27-31-10, et seq., South
Carolina Code of Laws, as amended and submitted by Master Deed dated the 29th day
of June, 1982, and recorded in Deed Book 752 at Pages 703-777, in the Office of the
Clerk of Court for Horry County (hereinafter referred to as "Master Deed"). It being
the intent of this instrument that each Unit Week shall be considered a separate estate
held separately and independently by the respective Owners thereof for and during the
period of time assigned to each in the Master Deed. The real estate upon which the Unit
is situate is more fully described on a survey prepared by Floyd, Coleman, Askins &
Kellehan, dated the 3rd day of March, 1983, and plans of said Sands Beach Club Phase
II, recorded in Condominium Plat Book 2 at Page 33, records of Horry County. In the
year 2022 the estate for years converts to a tenancy-in-common unless extended as
provided in the Master Deed.
TOGETHER with the exclusive right to occupy the above described premises, and to use
all areas, improvements and other facilities located thereon and together with all the
rights and easements appurtenant to the premises during said Unit Week(s).
soo 1936 Ob2
- TOGETHER with an undivided remainder interest in fee-simple upon the termination of
the Unit Week(s) in and to the premises as described in said Master Deed in the
percentage assigned to said Unit Week(s) in Exhibit B-1 to the Master Deed.
Subject to all the provisions of the aforesaid Master Deed.
The within conveyance is subject to the aforesaid Master Deed and the Articles of
Incorporation and By-Laws of Sands Beach Club Homeowner's Association, Inc.,
(hereinafter referred to as Homeowner's Association) and all supplements and
amendments thereto.
THIS BEING A PORTION OF THE PREMISES conveyed to Sands Beach Club HOA, Inc.
by Deed of Fairfield Communities, Inc., as Beneficial Owner, and Lawyers title
Insurance Corporation, as Nominee for Fairfield Communities, Inc., dated January 16,
1996 and filed June 3, 1996 in Deed Book 1870 at page 449, Office of the RMC for
Horry County.
TMS #166-00-10- 0~
Map Btk Parcel
AC!~OWLEDGMEZ~ Az~ ~TIFICATION BY Gz~z~EE(S): The Grantee(s) by the
acceptance and execution of this Warranty Deed acknowledge that this conveyance is subject to the
provisions of the aforesaid Master Deed and the By-Laws and Articles of Incorporation of the
Homeowner's Association including the provisions of all exhibits and any Supplements and Amendments
thereto. The Grantee(s) acknowledge and agree that the said Master Deed, By-Laws, and Articles, and
exhibits, and the Purchase Agreement executed by the Grantor and Grantee (s), and any separate written
warranty given by Grantor, contain all of the warranties, representations, and inducements concerning
the purchase by Grantee(s) of the property and any improvements thereon, and all subsequent
purchasers or owners, are so hereby notified.
TOGETHER with all and singular, the Rights, Members, Hereditaments and Appurtenances to
the said Premises belonging, or in anywise incident or appertaining.
TO HAVE AND TO HOLD, all and singular, the said Premises before mentioned unto the said
CHESTER ROGOWICZ AND AUGUSTA ROGOWICZ, their Heirs and Assigns forever.
ood_936 053
.. And Grantor does hereby bind itself and its Successors and Assigns to warrant and forever
defend, all and singular, the said Premises unto the said CHESTER ROGOWICZ AND AUGUSTA
ROGOWICZ, their Heirs and Assigns, against itself and its Successors, and all persons whomsoever
lawfully claiming, or to claim the same or any part thereof.
IN WITNESS WHEREOF, the Grantor, SANDS BEACH CLUB HOA, INC., has caused these
presents to be signed by its authorized and designated officers and/or Agents, and the Grantee(s) have
caused these to be signed and sealed this ~ ? day cf January in the year our Lord (-)ne Thousand Nine
Hundred and Ninety Seven.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
!
SANDS BEACH CLUB HOA, INC.
/
(L.S.)
ACKNOWLEDGED Bt~r)THE GRANTEE(S):
CI~E~T~.~.~:~ ROGOWICZ h~/AUGU~.~A ROGOWICZ
ooK1936 P GE 054
..STATE OF SOUTH CAROLINA ) AFFIDAVIT
COUNTY OF HORRY )
PERSONALLY appeared before me the undersigned, who being duly sworn, deposes and
says:
bearing Horry County Tax Map Number
Sands Beach Club HOA, Inc.
Property located at Sands Beach Club Phase II, HPR, Unit 626, Week 44
, was transferred by
161-00-10-
tO Chester Rogowicz and Augusta Rogowicz
on Z ,zq-q-I
The transaction was (check one):
~an arm's length real property transaction and the sales price paid or to be paid in money
or money's worth was $ 920.00
not an arm's length transaction and the fair market value of the property is
$
The above transaction is exempt, or partially exempt, from the recording fee as set forth in S.C.
Code Ann. Section 12-24-10 et. seq. because the deed is (See back of Affidavit.):
As required by Code section 12-24-70, I state that I am responsible person who was connected
withthetransactionas: Purchaser
furor under'~tand 'that a person required to furnish this Affidavit who willfully furnishes a
S~v~srr !o.~.'f0re me th~s Q
My Co~ission Expires: n - ~ - q q
* The fee is based on ~e real proper~'s value. Value means ~e realW's hir market value. In arm's length real
properW transactions, ~is value is the sales price to be paid in money or money's wor~ (e.g., stocks, personal properV,
other real~, forgiveness of debt, mortgages assumed or placed on ~e realw as a result of ~e transaction). However,
a deduction is allowed from ~is value for ~e amount of ~y lien or encumbrance existing on land, tenement, or realW
before the transfer and remaining on it a~er ~e transfer.
affidavit is guilty of a misdemeanor and, upon conviction, must be fined not
~i~','i;~a': 6ne',tl)0~lsafid dollars or imprimned not rd6re than o3e year,, or both.
*h,~-pha~r ~ r)res¢titatlve me tmrcnaser, or
...... .,~_, Le,~al Re_ ~ ~ .
Resno~ible Person Co~ected w~ ~e Transact}on
[hester Rogowicz / Augusta Rogowxcz
The State of South Carolina, )
)
Horry County )
PERSONALLY appeared before me, the first witness and made oath that (s)he saw the within
named SANDS BEACH CLUB HOA, INC., by its duly authorized Officers and/or Agents, sign, seal,
and as its Act and Deed deliver the within written Deed, and that (s)he with the other witness subscribed
above, witnessed the execution thereof
SWORN to before me,
this/~j_~ay of January, A.D. 1997.
, ~ r i~ ,,,il '1 ~ :~
~Notd~ Public ~South Carolina
yCommi ,y pir x..
,, ~ '~
(SEAL)
055
DATE
ZF PAID AFTER DATE /HDICATED, SEE REVERSE
FOR CALCULATZON OF ADDITIONAL /NTEREST.
~ALTH OF PENNSYLVANZA
~THENT OF REVENUE
CE OF /NHER/TANCE TAX
aT, ALLOHANCE OR DISALLOWANCE
'/OHS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACH
R~V-I~? EX &FP C01-02)
04-ZZ-ZOOZ
RO;OWICZ AU6USTA
09-Z4-2001
Z! 02-0175
CUHBERLAND
101
fAmoun~ Rami~fed
HAKE CHECK PAYABLE AHD REHZT pAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I#ER PORTZON FOR YOUR RECORDS ~
DEDUCTZOHS AND ASSESSHEHT OF TAX
FZLE NO. 21 0Z-0175 ACH 101 DATE
M
04-22-2002
( ) CHANGED ------.
ACCEPTED AS F/LED
~VERSE
RTGINAL RETURN
t (Schedule C)
)
ar~y (Schedule E)
.00
(1)
.00
(2)
($) .00~
.00_
(~)
.00
.00
(6]
(7) .00~
(8)
NOTE: To fnsure proper
credif fo your account,
submif fha upper porffon
of ~h~s form ~ffh your
fax paymenf.
.00
.00
Bnsas (Schedule H) (9)_
.00__
edule /) (10) ,~
(ll) .00
(lz) _ .00
Non-elec~ed 9113 Trusfs (Schedule J) (15) .0~
(1~)
previousl.Y, lines lk, 15 and/or 16, 17, 18 and 19 will
~ the tala- of AL~L returns assessed to da~:e.
.00
.00~x O0 =_ -
(l~)_ .0u x 045 = .0~00
Class A rare (16} .00 X 1Z ~ .OO
.00
~ral/Class B rare (18)~ (19)~ --
~ AHO~~UNTPAID
EREST/PEN PA/D (-) ~
-'----'------ TOTAL TA~
LA.CE .00
~NTEREST ANDP--'~--~-~- .00 _
~ TOTAL DUE I .00
( /F TOTAL DUE ZS LESS THAN $1~ NO pAYHENT IS RE~U/RED.
IF TOTAL DUE /S REFLECTED AS A "CRED/T" (CR)~ YOU HAY BE Dt
A REFUND. SEE REVERSE S/DE OF THIS FORH FOR /NSTRUCT/ONS.)
RESERVATION: Estates cf decadents dying on or before December 12, 1982 -- if any futura interest in the estate is transferred
in pOSsession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
PURPOSE OF at the lawful Class B (collateral) rata on any such futura interest.
NOTICE: To fulfill the requirements of Section ZiAO of the Inheritance and Estate Tax Act, Act 23 of 2000. (?2 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your Payment to the Register of Nills Printed on the reverse side.
--Make check or money order payable to: REGISTER OF #ZEES, AGENT
REFUND (CA}: A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313}. ApPlications ara available at the Office
of the Register of #ills, any of the 25 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-382-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest} as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the 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
ADMXN- --appeal to the Orphans' Court.
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (?l?} 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident
Decedent- (REV-1SO1} for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is Paid within three (3) calendar months after the dacadsnt's death, a five Percent (SI) discount of
the tax paid is allowed.
The 152 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 thls notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one il} 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 (623 Percent per annum calculated at a daily rate of .000164. A/1 taxes
January l, 1gEE will bear interest at a rate which will vary from which became delinquent on and after
calendar Year to calendar year with that rate
announced by the 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
1982 2OZ .000548 ~ -- --
1983 162 1992
92
-000438 1993-1994 7Z .000247
1984 llZ .000301 1995-1998 .000192
1985 132 .000356 9Z
1986 IOZ 1999 -000247
7Z .000192
· 000274 ~000 8Z
1987 92 -000247 ZOO1 .000219
1988-1991 Ill -000501 9Z
2002 62 .000247
.000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen ilS} 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.
PENALTY:
INTEREST:
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6{a)
Date of Death:
Will No. Admin. No.
To the Register: ~//~ ~ -~)~9')--"-O~9t/"~ ~
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 :
maine
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Signature
Name ~ co/~'-'~_.
Address
Telephon~/
Capacit~e Personal Representative
Counsel for personal representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~/4. ~ ~,<j'"-'/~ ~70 l~--'O tX.0 {C_-'~---
Date of Death:
Will No.: r~/-~o~ ' ]7,~ Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion oft he administration of the above-captioned estate:
1. State.er administration of the estate is complete:
Yes ~ No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
ao
bo
Did the personal representative file a final account with the Court?
Yes _ No~
The separate Orphans' Court No. (if any) for the Personal representative's
account is: ~
c. Did the personal rep_~entative state an account informally to the parties
in interest? Yes ~ No [-~
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.
Signature
Name
Capacity: