HomeMy WebLinkAbout01-0247
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of mlL,.l>~eJ> F: AI-L.el/' No. a..J-OJ-~"''1
also known as To:
Register of ~ills for the
County of UI1l~t.AAI {) in the
Commonwealth of Pennsylvania
~eceased.
Social Security No. .a 01- I ~- -:5. 3 8
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rix
in the last will of the above decedent, dated Augt ]Rt 1m, ?()()()
and codicil(s) dated
named
,ML-
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
her
{J
(list street, number and muncipality)
Decendent, then '1(, years of age, died FG6~ullA.t/ ~
at 101 CoC'kl eys Drive. MeC'haniC'sb11rcr. PA '7()()C)
Except as follows, 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:
~D(:) I
, ,
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:
I~ O()(J. ~
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamenta:r:y
(testamentary; administration c.La.; administration d.b.n.c.La.)
theron.
.1(:
VJ
'6
h ~1~~z~~~~~
~.~ ~ 70s 6
~~ .
(l)<..,.
= 0
Cil
c
OJ)
US
~Lul-UL~~ /J~
/
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I S'"
COUNTY OF Cumberland f ~
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.
k3tuh(Lu1 Of { () ll..u.-
affirmed and
1st
CoI")
~.
:::!
l::l
-
::::
~
~
/b-d/5 -j
~o. 21-2001-247
Estate of
Mildred F. Allen
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW March 6th, N,X2001, 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 August 3m, 2000
described therein be admitted to probate and filed of record as the last will of
Mildred F. Allen
and Letters Testamentary
are hereby granted to Barbara L. Allen
FEES
Probate, Letters, Etc. ......... $ 50.00
Short Certificates(l) . . . . . . . . .. $~~
Renunciation ................ $ C) nn
x-Pages (5) $ 15.00
JCP TOTAL _ $ 5.00
Filed . .~~7=:Gl). 6t.l11. 200.1: . . . . .$. 7f3...QO. . .
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
MAILED LETTERS AND ORDER TO EXECUTRIX
RENUNCIATION
21-2001-247
In Re Estate of
MILDRED FALLEN
deceased.
To the Register of Wills of
CUMBERLAND
County, Pennsylvania.
The undersigned
RONALD F ALLEN, SON
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
TESTAMENTARY
be issued to
BARBARA L ALLEN
WITNESS
hand this
day of
,19_.
~/.1 '7' 4fl- .
(Signature)
0'Of(!/lUit.# ~T 1'4 ~f fJ;,i
IAL/Jt~rro((;,4 \3Mv;f
(Address)
(Signature)
(Address)
(Signature)
(Address)
Thi.' is to certify that the information here given IS correctly copied from an original certificate of death dlJly filed with me as
Loul R~gisrrar. The original certificate will he forwarded to the State VitJl Records Office for permanent hling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
/-liiii77H;,,; ;',,:;-,0...
/1';\1. i~~\.l~Qtei~';'~--:..
/\\\~ /" ,-,It r~~-:..
/.,' ~/ "U'~~
/1~.~/ liIIo.Io.~\./?-:..~::.
~~... .~ (";..~
~ C)l -~; !!7:~
~ <-' \ _ '. d' . _ ~ ,"~ \i
\\ * \- . .~- . - :! * i
~~A . . .~~\'
.':.."...,..... .,/~\\
~~_ :f//I~'I._.._/~~~ \I~
~%,~~ENl \\, "II!!!!,.
~~
JA. .)~ /
... '[..iUd-.LI j Ll'jD-LLi::Jd'"
'--'" . I
Local Reglstr:n .
~ee for this certificate, S2.00
P 7121342
c?&'Ulj'jX;9J ~I
)ate
21-2001-247
H,05.;43R..2187
COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
TYPEiPRINT
IN
PERMANENT
BLACK INK
NAME Of DECEDENT (F"... MIddl.. Lasll
SEX
a. Female
STATE FILE NUIoI8ER
SOCIAL SECURITY NUMBER
3. 201 16
4. February 8, 2001
AGE (LaSl Bvlh<layl
UNDER I YEAR
MonIIII Oaya
UNDER 1 DItI
Hwn l Mlnul"
BlRTHPUCE IC"" and PUCE Of DEATH IC~e<k only ooe - "'" "'..,uelo"'" on - -I
Stale Of FOflltC}ll Country) t-tOSPITAL:
Palmyra, Pa. Inpalo.nlO
1. eo.
FACILrT"t NAME (II nollOsNutlOll, give streel aocJ numbefl
:;0;:""10
5
COUNTY OF !lEArH
76 y,.
RACE. Amonc:an Indian. _, WII~.. Ole
(Spoc.Iy) .
....
Cumberland
10.
White
DECEDENT'S USUAL OCCUPATION
(~v:o,~_~"=u~~:f
Clerk
SURVIVING SPOuSE
Ill_.ljMI ma"*> nomoI
17b. Coun
Oicl
---
IMl in .
Cumberland _"""",7 t1d.o ::=~0I
MOTHER'S NAME IF.., Mod<llo. Malden Surname)
II. Laura Hartman
INFORMANT'S MAIlING ADDRESS (Slroo.. CoIyIlOom. ~. Ztp Code)
2Gb. 101 Cockle s Drive Mechanicsbur Pa. 17055
PLACE Of DISPOSITION. N..... 01 Ce"""ry. C,.....""Y LOCATION. CilylTown. Slat.. Ztp Code
or OthiN PliK:e
~
101 Cockleys Drive
11 Mechanicsburg, Pennsylvania 1705
FlllHER'S NAME IF.SI. Moddlo. LaSl)
C<OyIbowo
II.
INFORMANT'S NAME (TypetPllnI)
Charles Coffman
Barbara Allen
z
w
8
~
o
:,
~
z
Removallrom Slale 0
Feb 12, 2001
LICENSE NUMBER
Gravel Hill Cemetery
21c1.
Palmyra, Pennsylvania
icsbura. f'a.17D5~
238.
TIME OF DEATH
DATE PRONOUNCED DEAD 1M"""'. Day. Year)
Noj!Q
24. 6:15 A.M. M as. February 8,2001
21. PART I: En..r the diseases. inturtes Of ~a"ons whtch caused lhe death 00 not .nt... ,"'. ~ ot Oying, such as caraiac or resptratory aUElst, shock or heart flUlure
LISt ooty one caUM on each...
I :
Lt/l.l77Z4J /I./Pl)/?J{d .5.'iS~
~O(ORASACONSEQUE~
-1::- ~ l:?t"/ . .
/blU~1~;fCONC_OU~~c.7L ~___.
DUE TO (OR AS II CON5EOUENCE OF)
.fJt1::~~<3
a.
f Approximate
; interval between
,onMI__
I .
\(~
PART I':
01"', sign;l!eont_ conltOJlingl" do"~. but
noc 'MUIIinlI"' Ihe ~..... QMIn "' PtoRT I
! S Il<i
k)ft,{f
!
WERE AUlOPSY FINDINGS MANNER OF DEATH
A\!o\ILA8LE PRIOR 10
CQUPlETKlN Of CAUSE tatun.. [1' HomICide 0
Of !lEArH7
AccMienI 0 Pern:hng Invesugatlon []
No r::( _0 No 0 Suw:ide 0 Couki 001 be determined 0
DATE OF INJURY
IMonlt1. Day. Yea')
TIME OF INJURY
INJURY I<f WORK7 DESCR'6E HOW INJURY OCCURRED
_ 0 NoD
'"
~... 2ab.
CERTifiER ICneck My one)
"CERTIFYING PHYSICIAN 1PhvSCtGO cerlllywlg cause ul dealh wtl~(' dl10ther pf1\1SK:,~n hd5 ptOOOllOCed .tedlt'> anCI complt:led lIell\ 231
To IIwt ..... ot my knowledge, de.th oc;cUfT-' d~ 10 the c;au..e(a) end menner.. ateted. . .
30a 3Gb.
PLACe Of INJURY. AI home. 'arm, street. lactory. office
building. etc, ISpec,t,,'
300.
,,~~&::u~
lal~L~
o 31b
II NSE NUMBER DATE SIGNED 1M""'" Day >earl
o 31cfitDP 3/3 / c;-r 31d 02' CC/" 01
NAME AND ADDRESS OF PERSON WHO COMPlETE.?f5U Of DEATH
(lteml7)TypeOfPllnl ~I-If-vt-{) IZ- v :,~;r(;---rr....
[] Ko E/f<rr -~LC: I.>r-c.-
32 ~?r5 /4~ ~/f (7~1 (
DATE FilED (Month Day 'feall I I
FelJruvy ~, c)<<J/
,......{)
.PRONOUNCING AND CERTIFYING PHYStclAN IPh,s.(:lan tQltl j.)fO',o...(o(:;ng IJOdlt1 d.nd celh1Ylng 10 C.3U$e of .Jedlt\)
To the beat ot my knowled9., death occurred at the Ume, date, and piece, .and due to the CilUS.,.J and manne,... alaled
.MEDICAL EXAMINER/CORONER
On the basi. 0' .xamination and/or investigation, in my opinion, death occurred at the time. dale, and place. and due to 'he cause(l) and
manner .. 'tated, .
3'.
LAST WILL AND TESTAMENT
OF
MILDRED F. ALLEN
I, MILDRED F. ALLEN, of 101 Cockleys Drive, Mechanicsburg, Upper Allen Township,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this to be my Last Will and Testament, hereby revoking and making
void all previous Wills and Codicils heretofore made by me.
I order and direct nlY personal representative hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the adluinistration of my estate as soon
after IUY death as is reasonably possible. However, my personal representative need not accelerate
and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more
advantageous to retain or renew and pay as they become due and payable. If I do not own a burial
plot or a grave marker at the time of IUY death, I authorize my personal representative, in his, her or
its sole discretion. to purchase a burial plot and to erect a suitable grave marker at my grave, and to
expend sums from my estate for this purpose.
2
I give, devise and bequeath all of my estate, together with all insurance proceeds thereon of
whatever nature and wheresoever situate in equal shares to my children, RONALD F. ALLEN,
JUDITH M. JOHNSON, CAROL A. MANN, ROBERT H. ALLEN, BARBARA L. ALLEN,
DEBRA K. ROYE, and CHARLES D. ALLEN who survive me by sixty (60) days per stirpes. It
is further my desire that my personal representative, after consultation with any heir or heirs of mine ,
1
LAST WILL AND TESTAMENT OF MILDRED F. ALLEN
who survive me, and in his, her or its own discretion, choose such articles from my tangible personal
property (exclusive of cash, stock certificates, bonds, and all other tangible evidences of intangible
personal property) as he, she or it believes will be useful to such heir or heirs or desirable for him
or her or them to have, either from a sentimental point of view or otherwise, and to deliver such
articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the
further exercise of his, her or its discretion, provided no other heir objects to the distribution. All
tangible personal property not so distributed is to be sold, either publicly or privately, by my personal
representative, adding the proceeds of such sale or sales to my residuary estate and to be disposed
of in equal shares among my surviving heirs after payment of my estate debts, taking into account
the tangible personal property otherwise provided to them.
3
I grant my personal representative the following powers in addition to and not in limitation
of such powers as my personal representative shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary acting
hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger, reorganization or
voting trust plan; to delegate authority with respect thereto; to deposit investments
under agreements and pay assessments; and generally to exercise all rights of
investors, including but not limited to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate
held or owned by my estate.
(d) To operate any business that I may own at my death.
( e) To invest any funds of my estate in any stocks, bonds, notes or other securities or
property, real or personal, without regard to the principle of diversification or any
other statute or general rule of law in his, her or its absolute discretion, it being my
2
~
LAST WILL AND TESTAMENT OF MILDRED F. ALLEN
intention to give my personal representative the broadest investment powers possible,
providing such investments do not unnecessarily prevent the prompt settlement of my
estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or intangible,
at any time forming a part of my estate in any manner and on such terms and
conditions as my personal representative shall see fit in his, her, or its absolute
discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in the
administration of my estate, and to mortgage or pledge estate assets as security.
(h) To comprOlnise claims without court approval including, but not limited to, any
controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may pass
under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
(j) To undertake any and all acts deemed necessary and proper by my personal
representative for the proper, advantageous and prompt management of the
settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his own
right, upon such terms and conditions as to him, her or it may seem best and to
execute and deliver all instruments and to do all acts which he, she or it deems
necessary or proper to carry out the purposes of this, my Last Will and Testament.
4
No interest of any beneficiary of my estate, either in income or in principal, shall be subject
to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have
3
~
~
LAST WILL AND TESTAMENT OF MILDRED F. ALLEN
the power in any manner to charge or encumber his interest either in income or principal, nor shall
the interest of any beneficiary be liable or subject in any manner while in the possession of my
personal representative for the liability of such beneficiary.
5
I nominate, constitute and appoint my daughter, BARBARA L. ALLEN, and my son,
RONALD F. ALLEN, as Co-Executors of this my Last Will and Testament. I direct that my
personal representative shall not be required to give or post bond for the faithful performance of his,
her or its duties in this or any other jurisdiction.
6
I hereby declare it to be my expres's desire that my personal representative employ the law
firm of Michael J. Hanft, Esquire, of Cumberland County, Pennsylvania, for legal advice and
assistance regarding this my Last Will and Testament, they having considerable knowledge of my
affairs, views and wishes respecting any Inatters that may arise at the probate of this instrument, the
administration of my estate, and the execution of the powers herein mentioned. Any mention of
Michael J. Hanft, Esquire in this my Last Will and Testament, is my free and voluntary act and
through no influence by any person.
IN WITNESS WHEREOF, I have hereunto set Iny hand to this my Last Will and Testament
this 3(~ay of August, 2000.
WITNESS:
~~
~ .:r: t2v~11' /
Mildred F. Allen
7Ny <;;J. CAu A)
4
x
~
LAST WILL AND TESTAMENT OF MILDRED F. ALLEN
ACKNOWLEDGMENT
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
I, Mildred F. Allen, 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 instrument as my Last Will and Testament; that I signed it willingly, and that I signed
it as my free and voluntary act for the purposes therein expressed.
7>>~~~ .L ...x ~~
MftJ~"'tneii '
rJ- Sworn or affirmed and acknowledged before me by Mildred F. Allen, the Testatrix, this
L day of August, 2000.
~vf~
Notarial Seal
Denise l. Nye. Notary Public
South Middleton Twp., Cumberland County
My Commission Expires Feb. 26, 2001
Member, Pennsylvania Association of Notaries
5
~
t
LAST WILL AND TESTAMENT OF MILDRED F. ALLEN
AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
WE~ fl1lchael j. </. h.n-Ct-
~eJl~ 8. ~
~ the
and
witnesses whose names are attached to the foregoing document, being duly qualified according to
law~ do depose and say that we were present and saw Mildred F. Allen, the Testatrix, sign and
execute the instrument as her Last Will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and
that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound
mind and under no constraint or undue influence.
~f1VP
7 <.I'd <;A. ~JLvJ
Sworn or affirmed and subscribed before me by M.l~ "j" NM+t- and
4f~II<j \\S. r6..iU- this ~~ day of August, 2000.
~04~
Notarial Seal
Denise l. Nye, Notary Public
South Middleton Twp.. Cumberland County
My Commission Expires Feb. 26, 2001
Member. Pennsylvania Association of Notar1es
F\User Folder\Firm Docs\Wills\1754-1mfawillwpd
6
~
~
.
\
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
/Y!/LPRI3D f. JlLL€J
Date of Death: ~~ - tJ ? - () /
Will No.
;'00/- (jOt/, f 7
To the Register:
Admin. No.
4 I -0 1- (Jd 4 7
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 t..5 -...3tJ .-() I :
Name
tfoIllALl> t. /ll:LEJ
:::fit b'l Jo H tV ..5 () AI
(!IlI(IJL mANA!
.;(o~l3a r H. IhLtd
~6/!1l /lL-LE,j
(l1/,4,fLt;".5 b. ALLE,)
Address
(:j. 60 K tJ. ~ St)J ~1-I/)~ell.Ji IIJL/fl~?7TD, bit dt)~~t
10. 60'/ 8~5 --:t:SUl/J76/(I/M,?L ..33(j~~
/6.3 (! J: ~ /Y{) 5T DILL.5(5ti,l(6, A4 //}()! r
433 /r;{).tJJtJa LA/..DI'-LS&t~~, JJA 1~(J19
~11 vNAlI/tfVE.e.5r. (ill(t 1.51 E /J/I /10U
,
1/~1 !lIiNiJtlc'Z .5r. C t}(LISLe; I~ /1(J1.3
N/,q
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~ - /" -tJ /
'ttllr Mi tt ,j{ J2Lh V
. Signature
Name 01J~ (34/(/-I IlLl. eN
Address /{J! (OCKLEy'S D<
/l!~(!II,t)A//(",:5~Ue4 IA 11tJ!25
Telephone (7/7J !JJ 9 1- (,59-5
Capacity: / Personal Representative
_Counsel for personal representative
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 OO3939
BARBARA L ALLEN
101 COCKLEYS DRIVE
MECHANICSBURG, PA
17055
fold
ESTATE INFORMATION: SSN: 201-16-5838
FILE NUMBER: 2101 -0247
DECEDENT NAME: ALLEN MILDRED F
DATE OF PAYMENT: 05/17/2004
POSTMARK DATE: 05/1 4/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 02/08/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $460.44
REMARKS:
TOTAL AMOUNT PAID:
$460.44
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-15~O EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I-
Z
Z
o
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
DECED[NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
/--tz.z TF, /'ff
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE INITIAL)
/L//,4 '
[~2. Supplemental Return
[~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 beb~en 12-31-9t and 1-1-95)
,.~. Original Return
r~4. Limited Estate
F-~6. Decedent Died Testate (^ttech copy of Wi~)
~'~9. Litigation Proceeds Received
FIRM NAME (~App~icaUe)
TELEPHONE NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) <~, 0 ~--~
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~) r ~) ~
4. Mortgages & Notes Receivable (Schedule D) (4) - ~j ,. ~) ~
5. Cash, Bank Deposits& Miscellaneous Personal Property (5) '-~ /'~ ~ ~), ~'.zT/
(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)
SOCIAL SECURITY NUMBER
-
[~3. Remainder Retum {date o~ death ~o~ to 12-13-82)
[~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
(8)
(lO) ,~. ~ 0
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election Io tax has nol been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14) ~'
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax ,~/~f._
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) ~). ~ {~)
16. Amount of Line14 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 collateral rate '/~//~ x .15 (18) i~), ~__,,~)
19. Tax Due
20.
(19) ~~~
Decedent's Complete Address:
STREET^OO.ESS /
CITY
ISTATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
(1)
Interest/Penalty if applicable Total Credits ( A + B + C ) (2)
D. Interest
E. Penalty
Total Interest/Penalty ( D * E )
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.
z,P/.2d
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... []
b. retain the 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 cons derat on'~
3. Did decedent own an "in trust for" or payable upon death bank account or sacudty at his or her death? .............. [] ~"
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under peF, ard~s o~ perjup/, I ded__~m thai I have exa.ii~.~.d this return, including accumFanying sch~.!es and ~,,~, and to the best of my know'.~je and belief, it is lrue, con-ect and ~ompieta.
O~a~aiion of preparer other than the personal representative is based on all information of which preparer has any knov,~eG~.
SIGNATU~E~_ F~E_RSC~N RE..S .PON_.SIB LE F~.~ FiLiNGxR~T~iR~ DATE -
/ 9 .5Z
DATE
ADDRESS
For dates c f 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) (1ll) (i)].
For dates of death on or after January 1, lg95, 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 RS. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)].
The tax rat(; imposed on the net value of transfers to or for the use of the decedenrs 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.
REV-1508 EX+ (6-98) ,~
'~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
$¢I'IEDUI, E E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
. FILE NUMBER/
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate,
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER ///~
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
5.
6.
7.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative(s)
Sodal Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State __ Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address /D/ C~' ~"-Y~'~ b/~t / ~./~7"'
City /~A~//C~/~U~ ~ State ..
Relationship of Claimant ,o Dec~en, ~ ~ ~ ~~
Probate Fees /~/r//~..
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
PNCBAN~
®
PNC Bank, NA. 040
Central PA
DATE
60-1273/313
DOLLARS
~0~ cOCKCE¥S DR
HECH~H~CSB~R$
TARCE TkX
IHHER~ ~0 DiSkLLO~HCE
og-ZT-Z00~
DATE ~LLEH
ESTATE OF 92-08-2001
9ATE OF ~E~TH
CUH~ERLA~D
OCT -7 F!2:59 Ac.
H~LDRED
pA
cUT ALONG THT, S L'r"t{E
RETAXH COMER poRT/ON FOR yoUR RECORDS
F
couHT~ ~
HAKE cHECK PAY~LE AND REHIT pAyRENTTO:
REB~STER OF wILLS
CuR~ERLARD CO cOURT RouSE
cARL[SLE' PA 17015
_ ·
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFINDrWDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11 96}
NO. CD 004478
BARBARA L ALLEN
101 COCKLEYS DRIVE
MECHANICSBURG, PA
17055
...... fold
ESTATE INFORMATION: SSN: 201-16-5838
FILE NUMBER: 2101-0247
DECEDENT NAME: ALLEN MILDRED F
DATE OF PAYMENT: 10/07/2004
POSTMARK DATE: 1 0/05/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 02/08/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
$63.45
REMARKS:
TOTAL AMOUNT PAID:
$63.45
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PNCBANK
®
PNC Bank, N~A. 040
Central PA
PAY TO THE
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSZON
DEPT. 280601
HARRTSBURG, PA 17118-0601
BARBARA L ALLEN
101COCKLEYS DR
MECHANICSBURG
CUT ALONG THIS LINE
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RE¥-1547 EX &FP (01-05)
PA 17055
DATE 09-27-200q
ESTATE OF ALLEN
BATE OF BEATH 02-08-2001
FILE NUMBER 21 01-02q7
COUNTY CUMBERLAND
ACN 101
Amoun~c Reai*~ed
MILDRED
HAKE CHECK PAYABLE~I~D REI~;T PAYHENT TO:
REGISTER OF W~£LS
CUMBERLAND CO COURT F[I~JIJSE
CARLISLE, PA 17013
I
RETAIN LONER PORTION FOR YOUR RECORDS ~"~
F
REV-1547 EX AFP (01-03)
ESTATE OF ALLEN
NOTICE OF ZNHER'rTANCE TAX APPRAZSEMENT, ALLONANCE-uDR
BZSALLONANCE OF DEDUCTIONS AND ASSESSMENT O...F. TAX .~
MILDRED F FILE NO. 21 01-02~7 ACN~ 101 :_:DATE~ 0'~..T17-200~
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Roe1 Es~a~e (Schedule A)
~. S~ocks end Bonds (Schedule B)
3. Closely Held S~ock/P~r*nership Interest (Schedule C)
~. Mor~cgages/No~ces Receivable (Schedule D)
5. Cash/Bank Deposit:s/Misc. Person~l Proper~y (Schedule E)
6. Jointly Owned Proper~y (Schedule F)
7. Transfers (Schedule G)
8. To'ca1 Asse~s
APPROVED BEBUCTZONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Cos~s/Hisc. Expenses (Schedule H)
10. Dab,s/Mortgage Liabilities/Liens (Schedule T)
11. To,al Deductions
12. Na~ Value of Tax Re~urn
1:5.
lq.
(1)
(2)
(3)
(~)
(;) lqz390
(6)
(7)
O0 NOTE: To insure proper
00 credi~ ~o your account,
O0 submi~ ~he upper portion
O0 of ~his form wi~h your
O0
O0
(8)
q,158.qO
(9)
(10) .00
lq,390.qq
(11) ~. 1;8.~.0
(12) 10,23:52. Oq
(~3) . O0
(1~,) 10,23Z. Oq
Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J)
Ne~ Value of Es~a~e Sub~ec~ ~o Tax
Z~: an assessment .as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill
NOTE:
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX: O0 x O0 O0
15. Amoun~ of Line lfi a~ Spousal ra~e (15) ' = '
16. Amoun~ of Line lq ~axable a~ Lineal/Class A ra~e (16) 10,232.0q X Oq5 =
17. Amoun~ of Line lq e~ Sibling ra~a (17) .00 X 12 =
18. Amoun~ of Line lq ~axabla a~ Collateral/Class B re~e (18) .00 X ~5 =
19. Princi:)al Tax Due (19)=
TAX CREDITS
PAYMENT RECEIPT DISCOUNT (+J
DATE NUMBER INTEREST/PEN PAID (-)
05-1q-200~ CD005959 .00
AMOUNT PAZD
q60 .qq
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~ALANCE OF UNPAID INTEREST/PENALTY AS OF 05-15-200q
q60.qq
.00
.00
q60.qq
q60.qq
.00
63.q5
63.q5
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADD/TIONAL INTEREST.
( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR /NSTRUCTZONS.)
RESERVATION:
Estates of decedents dying on or before December 11, 1981 -- 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 Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawfut Class 8 (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTZONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 21fiO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Ni118 printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, 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-IS13). AppXications are availabXe at the Office
of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-~62-Z050; services for taxpayers with special hearing and ! or
speaking needs: 1-800-447-~010 (TT only).
Any party in interest not satisfied mith the appraisement, allowance, or disalXowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17128-1011, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeaX 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 Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See 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 (3) calendar months after the decedent's death, a five percent (52) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period 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, 1982 bear interest at the rate of
six (613 percent per annum calculated at a daily rate of .000164. All taxes ehich became delinquent on and after
January 1, 1981 will bear interest at a rate mhich ail1 vary from calendar year to calendar year .ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rata Factor
~ ZOZ .000548 '~'~"~&-1991 111 .000301 2001 9Z .OODZ~7
1983 162 .OOOq38 1992 91 .OOOZq7 ZOOZ 61 .00016~
198~ 112 .000~01 1993-1994 72 .OO0192 2003 5Z .000137
1985 I$Z .000356 1995-1998 91 .000247 2004 41 .000110
1986 ZOZ .000174 1999 71 .000191
1987 101 .000274 ZOO0 71 .000191
--Interest is calculated as foZlees:
TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELINQUENT X DA/LY 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 sho.n on the
Notice, additional interest must be calculated.
BUREAU OF TNDZVZDUAL TAXES
TNHERZTANCE TAX DTVTSTON
PO BOX 280601
HARRTSBURG, PA 171Z8-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
RE¥-Z&97 EX AFP
BARBARA L ALLEN '0:~
101 COCKLEYS DR
MECHANTCSBURG PA 17055
DATE 11-15-200q
ESTATE OF ALLEN
DATE OF DEATH 02-08-2001
FILE NUMBER 21 01-02q7
~.~.~::~COUNTY CUMBERLAND
*-~ACN 101
Amoun~ Rmmi~*md
MILDRED F
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account, submi~ ~hm upper portion of ~his form wi~h your ~ax payment.
CUT ALONG TH'rS L'tNE ~ RETA'rN LONER PORTION FOR YOUR RECORDS -',RI
~d':f~SY 'g~"E~' '~51'-'~]3 ......'~' 'f~rig~ ~ rA'R~"TA~' '~?AYgRAq~f ' ~1~ '~r~orff" ~'; .....................
ESTATE OF ALLEN MILDRED F FILE NO. 21 01-02~7 ACN 101 DATE 11-15-200~
THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHO#N BELO#
TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APpLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPLTCABLE,
A PROJECTED TNTEREST FTGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-Z7-Z00q
PRINCIPAL TAX DUE: ................................................................................................
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-1q-ZOOq
10-05-Z00fi
CD00~959
CDOOqfi78
.00
65.q5-
q60.qq
65.q5
IF PAID AFTER TH/S DATE, SEE REVERSE
SZDE FOR CALCULATION OF ADD/TZONAL INTEREST.
( IF TOTAL DUE 1S LESS THAN $1,
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CRED/T" (CR)~
TOTAL TAX CREDIT
q60.qq
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS. ]
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF HILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA.
REFUND (CA): A refund of a tax credit, which was nat requested on the Tax Return, may be requested by completing an
'Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-1513). Applications are available
online at www.revenue.state.Da.us, any Register of Nills or Revenue District Office, or from the Department's
2q-hour answering service for forms orders: 1-800-36Z-20S0; services For taxpayers with special hearing and/or
speaking needs: 1-BOO-qqT-302O (TT only).
REPLY TO:
DISCOUNT:
PENALTY:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
If any tax due is paid within three (3) calendar months after tho decedent's death, a five percent (SZ) discount
of the tax paid is aIlowad.
The ISZ tax amnesty nan-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January IB, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to tho date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .OOO16q. Ail taxes which became delinquent on and after
January 1, 198Z wiII bear interest at a rate which wit1 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rata Factor Year Rate
1982 20Z .0005q8 1988-1991 llZ .000301 gOOl 9Z
1983 16Z .000q38 1992 9Z .O00Zq7 ZOOZ 6Z
198q llZ .000301 1993-199q 7Z .O0019Z ZOO3 SZ
1985 13Z .000356 1995-1998 9Z .O00Zq7 ZOOq qZ
1986 XOZ .O00ZTq 1999 72 .O0019Z
1987 92 .O00Zq7 ZOO0 BZ .000219
Daily
Factor
,O00Zq7
.O0016q
.000137
.000110
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUltBER OF DAYS DELINQUENT X DAILY INTEREGT FACTOR
--Any Notice issued after the tax becomes delinquent wilt reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additionat interest must be caIcuXated.