HomeMy WebLinkAbout03-0577PETITION FOR PROBATE and GRANT OF LETTERS
also known as
, Deceased.
Social Security No. !'7. Z -- ~-~'-
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or_olde[ an the~execut
in the last wilt of the above decedent, dated --
and codicil(s) dated
To:
Register of WiJ~s for the,,? ? ~
County of
Commonwealth of Pennsylvania
¢,,~X ,19 n~my~d
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~___..-~C h"X,~J~-~/~ ~ ,¢~ County, Pennsylvania, with
h '~ ~ last family or principal residence at lO.C)
(list street, numb'"'e-r 'a~d ~uncipSlity)
D¢cendent, then ~C/, years of age, died e.-~0~ S.¢ ~ ~
at d,.: ,t/O ,nm -
E~cept as %li~ws, 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 $
(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 request(s) the nrobate of tl~e_ last will and codicil(s)
presented herewith and the grant of letters teZen~ta~rr/5~min~i~r~2 c'~t~~'''
theron. ( y; ' '-~-' n . . .;¥administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -I
COUNTY OF f 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-
nd tr~.~ly the estate according to law.
tative(s) of the above decedent petitioner(s) will well a~// admin~ter
affirmed and subscribed r ,¢. ~.
before me this . __day of [ ....
19
/'7-,/,,5-o. - 9
STATUS REPORT UNDER RULE 6.15
Name of Decedent- Dana W. Ott
Date of Death' 12/5/2002
Will No.
Admin. No. 2003-00577
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 .
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 personal representative file a final
account with the Court ? Yes . No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is'
c. Did the personal representative state an
account informally to the parties in interest ? Yes 3[ 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.
Date · 11/17/2004
Sing ~latu~re ~//~ ae~.j -
Name (Please type or print )
14 North Main Street, Suite 200
Chambersburq PA 17201
Address
.( 264 ) - 6029
Tel. No.
Capacity-
Personal Representative
X
Counsel for personal
representative
No. b"7 7
Estate Of
DECREE OF PROBATE AND
, Deceased
GRANT OF LETTERS
AND NOW 19 ., in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
;
and Letters
are hereby granted to
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ..........
Renunciation ................
TOTAL
Filed ...................................
Register of Wills
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
60:~d 9t -t[!I' gO.
his is to certify that the information here given is correctly copied 6'om an original certificate of' death dub' filed with mc a,
Ix)cai Registrar. The original certificate will be forwarded to the State Vital Records Office (or pcrmal~cnt fi}i!v~,.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 8847468
No.
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
,. Dana W. Ott ........ ,.Malej~. 172- 05 -- 4559]". 12/05/2002
~ C~erland ~outhampton ~. 1~ 100 Nell Road I~~'~' ,. ~ite
,,.Laborer I,,~s~ ~a~,t~,. I,~ I,,. ~'~ s I ' .... ' /,. ~rried [,t Janice L. Miller
~]~ ,~ .Pennsylvania ,..~ ~.m~.,, Southampto~
100 Netl Road
,~ Shippensburg, PA 17257 '~ ,~.~ C~berland ~ ,~~ , .-~
,% Crawford Ott
~Janice L. Ott ~ 100 Neil Roadt' Shi~ens~r~ PA 17257
~ ~ ~~ ~'~) "~ ] Franklln County,
,~ ~ . _ . ~[~I~.~2/10~2002 ,,~ Mon~ul Cemeter~ I,,.Southam~ton Tw~., PA
~~ ~~ ~ 011776-L. I..~1~~ F.H., ~ ~ 3~,~~, ~ 17257
.... ' ........................................
or:Ed 9t 'Ifil~ gO.
JRZ 5.1 ott.1 August 28, 1998
LAST WILL AND TESTAMENT
I, Dana W. Ott, of 100 Neil Road, Shippensburg, Pennsylvania,
being of sound and disposing mind, memory and understanding, do
hereby declare this to be my will, hereby revoking any and all
former wills and codicils thereto by me heretofore made.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my wife, Janice L. Ott, providing
she shall survive me by thirty days.
III.
Should my wife predecease me or die on or before the thirtieth
day following my death I give, devise and bequeath the residue of
my estate of every nature and wherever situate to my son, William
L. Ott. In the event my son, William L. Ott, predeceases me or
dies on or before the thirtieth day following my death, I give the
residue of my estate of every nature and wherever situate to his
issue, per stirpes,living on the thirty-first day following my
death, and in default of any such then-living issue, such share
shall be added to the children of my first marriage, Garnet E. Ott,
Dorothy A. Whitney, and Judith Shearer, in equal shares.
IV.
In the event that anyone entitled to a share of my estate
shall be under the age of twenty-one years at the time for
distribution to such beneficiary, I constitute and appoint Lisa
Ott, as trustee of any property which passes either under this will
or otherwise to said beneficiary. Said trustee shall in the
trustee's sole discretion and without order of court, use principal
as well as income from time to time as may appear to be necessary
for the beneficiary's welfare, comfort, medical care, recreation,
support and education, without responsibility to the beneficiary or
to any person taking care of the beneficiary; and the remaining
balance in the hands of said trustee shall be distributed to said
beneficiary when the beneficiary attains the age of twenty-one
years. If such beneficiary dies prior to attaining the age of
twenty-one years, said trustee is authorized in the trustee's
discretion to pay part or all of the beneficiary's funeral expenses
and the remaining balance in the hands of said trustee shall be
Page 2
distributed to the beneficiary's personal representative. In the
event the funds held by the trustee for any beneficiary become in
the opinion of the trustee too small for proper and efficient
administration, the trustee, in the trustee's sole discretion, may
deposit such funds in a savings account in the name of the
beneficiary.
Ve
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C. To sell at public or private sale, to exchange or to
lease for any period of time any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
Page 3
Do
as they deem proper.
To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
To compromise any claim or controversy.
To distribute in cash or in kind or partly in each.
To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
VI.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VII.
I appoint my wife, Janice L. Ott, as executrix of this my
will. Should my wife predecease me, fail to qualify or cease to
act, I appoint my son, William L. Ot~, as executor of this my will.
Should my son predecease me, fail to qualify or cease to act, I
appoint my daughter-in-law, Lisa Ott, as executrix of this my will.
Page 4
VIII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of six typewritten pages, the
first four of which bear my signature in the margin for the purpose
of identification this /~day of ~_/~ ,
19 ~. /
(SEAL)
Signed, sealed, published and declared by the above-named
testator as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
r have hereunto set our
hands as attesting witnesses.
We, Dana W. Crt, ~ ~ Z~(,(.l~~ and
~0~ 8~06~ , the testator and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as
his last will and testament and that he executed it as his free and
Page 5
voluntary act for the purposes therein expressed and that each of
the witnesses, in the presence and hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Testator
tness
Witness U
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-named witnesses this /7~ day of
~ N~ Public
I",K)TAR~L SEAL
,Shippemburg Bom, Cumbedand Co., PA
Page 6
~~tam~nt
DANA W. OTT
LAW OFFICES Of
200 CHAMBERSBURG TRUST BLDG.
CHAMBERSBURG, PA. 17201
LAW OFFICES OF
ZULLINGER- DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, PA 17201
717-264-6029
Fax: 717-264-1884
zulngrlaw~earthlink.net
Dale F. Shughart, Jr.
of counsel
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, PA 17257
717-532-5713
Fax: 717-530-5222
davish~cvn.net
April 23, 2004
Commonwealth of Pennsylvania
Department of Revenue
Dept. 280601
Harrisburg, PA 17128-0601
Gentlemen:
RE: Estate of Dana W. Ott
File No. 21-03-577
Attached is REV-1500 for the above estate. The return reflects no assets held in the
decedent's name alone. The decedent's will was probated for the sole purpose of obtaining a
short certificate for processing claim for life insurance benefits. Thank you.
Very truly yours,
End.
REV-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
Z
o
X
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL
Ott, Dana W.
DATE OF DEATH (MM-DD-Year)
12/05/2002
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IOATE OF BIRTH (MM-DD-Year)
03/18/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ott, Janice L.
[~] 1. Odginal Return
r~4. Limited Estate
--16. Decedent Died Testate (At,ch copyofw~,)
El9. L~atJon Proceeds Received
--'1 2. Supplemental Return
[~] 4a. Future Interest Compromise (dae of death after 12-1282)
I---'17. Decedent Maintained a Living Trust (~ach copy of Trust)
r'-] 10. Spousal Poverty Credit (d~ofdeath between 12-31-91 and 1-1-95)
NAME
Joel R. Zullin.qer
FIRM NAME (IfApplicable)
Zullin.qer-Davis, P.C.
TELEPHONE NUMBER
(717)264-6029
OFFICIAL USE ONLY
FILE NUMBER
21-03,577
COUNTY COOE YEAR NUMBER"--
SOCIAL SECURITY NUMBER
1 7 2-0 5-4 5 5 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
5. Federal Estate Tax Return Required
O 8. Total Number of Safe Deposit Boxes
r-'Il 1. Election to tax under Sec. 9113(A) {At~ach Sch O)
COMPLETE MAILING ADDRESS
14 North Main Street, Suite 200
Chambersburg PA 17201
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 Properly (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
I-"] 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 LiabiliUes, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(11)
(12)
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)
OFFICIAL
USE ONLY
(8)
(13)
(14)
0.00
0.00
0.00
SEE INSTRUCTIONS ON REVERSE BIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) 0~00 X (15)
16. Amount of Line 14 taxable at lineal rate 0.00 X (16)
17. Amount of Line 14 taxable at sibling rate X .12 (17)
18. Amount of Line 14 taxable at collateral rate X .15 (18)
19. Tax Due (19)
0.00
0.00
0.00
Decedent's Complete Address:
ST~~RESS
100 Nell Road
CITY
Shippensburg
ISTATE PA
IZIP 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C )
(1) 0.00
3. Interest/Penalty if applicable (2) 0.00
D. Interest
E. Penalty
Total Interest/Penalty ( D * E ) (3) 0.00
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 (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 * 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the dght 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 perjur'/, I declare that I have examined this return, includ ng acco,7~panying schedules and statements, and to the best of my knowledge and belief, it is tree, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PE_,~ON RESPONSIBLE FOR. FILI~
~ Nell Road
Shippensburg
AD.SS 14 No~h~ ~r~et, Suit~O
Chamb~r~
DATE
PA 17257
DATE
,5-- 3 -02'
PA 17201
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 I'neal benefic aries 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.
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/10/2004
OTT JANICE L
100 NEIL ROAD
SHIPPENSBURG, PA
17257-9416
RE: Estate of OTT DANA W
File Number: 2003-00577
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: 12/05/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRTSBURG, PA 17128-0601
CONNONWEALTH OF PENNSYLVANZA
BEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENTj ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
REV-15,{i7 EX AFP C01-03)
JOEL R ZULLZNGER
ZULLZNGER DAVIS
lq N MAIN ST STE 200
CHAMBERSBURG PA 17201
CUT ALONG THZS LZNE ~
DATE 07-15-2004
ESTATE OF OTT
BATE OF DEATH 12-05-2002
FILE NUNBER 21 05-0577
COUNTY CUNBERLAND
ACN 101
Amoun'l: Rem/'l:'l:ed
DANA
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGZSTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLZSLE, PA 17015
RETAZN LOWER PORTZON FOR YOUR RECORDS *-~
DZSALLO#ANCE OF DEDUCTIONS ANB ASSESSNENT OF TAX
ESTATE OF OTT DANA WFZLE NO. 21 05-0577 ACN 101 BATE 07-15-2004
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: 0RZGZNAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Per~narshlp ln~eres~ (Schedule C) ($)
~. Not,gages/No,es Receivable (Schedule D) (q)
5. Cash/Bank Deposl~s/Nisc. 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 EXENPTZONS:
9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Deb~s/Nor~gega Liabilities/Liens (Schedule Z) (10)
11. To,al Deductions
12. Ne~ Value of Tax Re~urn
15.
1~.
Cheri~able/Governmen~eZ Bequests; Non-elected 9115 Trusts (Schedule J)
Na~ Value of Es~a~e Sub~ec~ ~o Tax
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 submi~ ~ha upper portion
of ~his for. wi~h your
~ax payment.
.00
.00
.00
.00
(8)
.00
.00
NOTE:
.00
(11) .oo
(12) .00
(15) .00
(1~) .00
Zf an assessment was issued previously, 11nes 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
18 and 19 will
ASSESSNENT OF TAX:
15. A,oun~ of Line lq e~ Spousal ra~e
16. A.oun~ of Line 1~ ~axable a~ Lineal/Class A ra~e
17. Amoun~ of Line 1~ a~ Sibling re~a
18. Amoun~ of Line 1~ ~axable a~ Colla~ceral/Cless B ra~e
19. Prlnci)al Tax Due
TAX CREDTTS
PAYHI~NT RECETPT DTSCOUNT
DATE NUNBER TNTEREST/PEN PA/D (-)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(is), .00 x O0 = .00
(16) .00 X 045 = .00
(17) ~*O'O x 12, = .00
(18) .00 x 1'5: = .00
(19)= . O0
AHOUNT PAID
.00
.00
.00
.00
( TF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT TS RE{~UZRED.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
XNTEREST AND PEN.
TOTAL DUE
ZF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR)~ YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coemonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such futura interest.
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TI P.S.
Section 9140).
Detach the top portion of this Notlca and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILLG~ AGENT
A refund of a 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-1315). Applications are available at the Office
of the Register of Rills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-S6Z-ZOSO; services for taxpayers mith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied eith the appraisement, allowance, or disallowance of deductions, ar assessment
of tax (including discount or interest) as shown on this Notice must object mithln sixty (60) days of receipt of
this Notice by:
--erittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17IlS-lOll, 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 wrlting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (5X) discount of
the tax paid is alloaed.
The 15Z 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 tho and of the tax amnesty per[od. This non-participation
penalty is appealable in the same manner and in the the same time per[od as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate ahich will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rata Factor
~ 20Z .000548 ~'~-1991 IIZ .000301 ~ 9Z .000247
1985 162 .000438 1992 92 .000247 ZOOZ 62 .000164
1984 112 .000501 1993-1994 7Z .00019Z 2005 5Z °000137
1985 I3Z .000556 1995-1998 9Z .000Z47 2004 4Z .000110
1986 IOZ .000Z74 1999 7Z .00019Z
1987 IOZ .000274 2000 7Z .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
l'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
A~m r:~"ANCE OR DISALLOWANCE
. oe~Puttt~$ ,'MiD ,ASSESSMENT OF TAX
!-....(_ ( .,' . L ~ ~ ',; . '
I" ' . ,
REV-1547 EX AFP (06-05)
10-17-2006
VANDERGHEVNST
06-26-2003
21 03-0557
CUMBERLAND
501
APPEAL DATE: 12-16-2006
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REv:is47-Ex-AFP-io3:osi-NOTICE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VANDERGHEVNST MARIE J FILE NO. 21 03-0557 ACN 501 DATE 10-17-2006
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
LAWRENCE B ABRAMS
RHOADS & SINON
PO BOX 1146
HARRISBURG
q~TE
2006 OCT 13 Ari II : r,~ATE OF
DATE OF DEATH
CLER;< OF FILE NUMBER
OPPI'\;\iI'S CC:URT COUNTY
ClJk'lC' ~. p~CN
MARIE
J
ESQ
PA 17108
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
3.900.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
3,900.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
15.00
.00
(11)
(12)
(13)
(14)
15 00
3,885.00
.00
3,885.00
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.OOXOO=
3,885.00 X 045=
.00 X 12 =
.00x15=
(19)=
.00
174.83
.00
.00
174.83
TAX CREDITS:
. ~...~... ..~-~-. . l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-14-2006 CD006981 .00 174.83
BALANCE OF UNPAID INTEREST/PENALTV AS OF 07-15-2006 TOTAL TAX CREDIT 174.83
BALANCE OF TAX DUE .00
INTEREST AND PEN. 1.71
TOTAL DUE 1.71
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~
IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR), YOU MAY BE D
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
REVIEWED BY
Marie Vandergheynst
Sandra J Eslinger
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
E 1
Interest is effective 05-25-2006.
ROW
FILE NUMBER
ACN
2103-0557
501
Page 1