HomeMy WebLinkAbout02-0543PETITION FOR PROBATE and GRANT OF LETTERI~~~"
Estate of EVELYN M. WAGNER No. Z ~ ~ O Z ~ 513
also known as To:
Register of Wills for the
Deceased. County of CUMBERLAND in the
Social Security No. 181052618 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executors named
in the last will of the above decedent, dated Asril 24. 1992
and codicil(s) dated none
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
her last Family or principal residence at 276 Bethany Village. Mechanicsburg
Lower Allen Township Pennsylvania
(list street, number and municipality)
Decedent, then 82 years of age, died 611/02
at Holy Spirit Hosoltal. East Pennsboro Township
Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted
after execution of the will offered for probate; was not the victim of a killing and was never ajudicated
incompetent: Husband. Kenneth L Wagner, died January 1 1997
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 200.000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ O.o0
situated as follows:
none
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the gran[ of letters testamentary
thereon. ~ ~ (testamentary; administration c.t.a.; administration d.b.n.c.ta.)
885 EMILY DRIVE
i
~ MECHANICSBURG PA 17055
v BAR L. WAG 46 WARRINGTON ROAD
~;, y `~ DILLSBURG PA 17019
a v 1 DA K. MARKEL
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF CUMBERLAND f SS
The petitioncr(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowled a and belief of etitione s a t t~ s personal represen-
tative(s) of the above decedent pettioner(s) will well and truly finis ~~ ~~State according to law.
Sworn to or affirned and subscribed i,~-----
before me this ~~ day of °~
JOKE 02
y ~ S" //~C/1~
MAR' C L S Re tster ~"
"7 -L7 X - 1 CV
No. z ~ - 0 2- 5~3
Estate of EVELYN M. WAGNER ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JUNE 7, 2002 , 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 a/za/92
described therein be admitted to probate and filed of record as the last will of EVELYN M. wAGNER
and Letters TESTAMENTARY
are hereby granted to
BARRY L. WAGNER 8 LINDA K. MARKEL
FEES
Probate, Letters, Etc......... $ 235.00
Short Certificates ( ) ...... $ ~ ~ nn
F!~C EXtrfl~ p3CJe5 . $ ~-
-~r~L $
TOTAL _ $ 258.00
Filed ... 6-7-02 ............... .
put in prothyatty box 6-7-02
MURREL dRSVlif//-~L
2484924849 F U
ATTORN Y (Sup. Ct. LD. No.)
54 EAST MAIN STREET
MECHANICSBURG PA '17055
ADDRESS
7171689.4650
PHONE
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"Phis is to certify that the information here given is correctly copied 6~om an original certificate of death duly filed with me as
Local Registrar. The original certificate will he forwarded to the &Htc Vital Records Olfice for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Yce hlr thi:: certificate, $2.00
P 8428193
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LABT WZLL AND TESTAMENT
2 r -0 2 - 5~3
I, EVELYN M. WAGNER, a resident of 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 any and all Wills and Codicils
previously made by me.
I
I declare that 2 am married to KENNETH L. WAGNER, and that I
have four (4) children, BARRY L. WAGNER, LINDA K. MARKEL, DONNA J.
JOHNSON, and MARCIA A. LAGANOSKY.
II
I direct that my debts and funeral expenses be paid as soon
after my death as is practicable by my Executor out of my residuary
estate, but not from any assets, funds, death benefits or insurance
proceeds which are otherwise excludable or exempt from my gross
estate for federal estate valuation or tax purposes.
III
I direct that all estate, succession, legacy, inheritance
or other transfer taxes, however designated that shall become
payable by reason of my death in respect of all property comprising
my gross estate for death tax purposes, whether or not such
property passes under this LAST WILL, shall be paid by my Executor
out of my residuary estate, but not from any assets, funds, death
benefits or insurance proceeds which are otherwise excludable or
exempt from my gross estate for federal estate valuation or tax
purposes.
IV
I give, devise and bequeath alI my property, whether real or
personal, wherever situate, including any property over which I may
have a power of appointment to my husband, KENNETH, provided that
he survives me by thirty (30) days.
V
If my husband, KENNETH, shall predecease or fail to survive
me by thirty (30) days, i give, devise and bequeath all of my
property, whether real or personal, wherever situate, including any
property over which I may have a power of appointment, to my
children, BARRY, LINDA, DONNA, and MARCIA, in equal shares, per
stirpes.
VI
I nominate, constitute and appoint my husband, KENNETH, as
Executor of this LAST WILL, to serve without bond. If my husband
is unable or unwilling to act in that capacity, then I nominate,
constitute and appoint my son, BARRY, and my daughter, LINDA, as
Co-Executors of this LAST WILL, to serve without bond. If either
BARRY or LINDA is unable or unwilling to act in that capacity, then
I appoint my daughter, DONNA, to act as Co-Executor of this LAST
WILL, to serve without bond.
IN WITNESS WHEREOF, I, EVELYN M. WAGNER, have set my hand to
this LAST WILL this ~[iL day of C~% , 1992.
EVEL~ M. WAGN~ft
Signed, sealed, published and declared by the above-named
EVELYN M. WAGNER, as and for her Last Will and Testament, in the
presence of us, who, at his request and in her presence, and in the
presence of each other, have hereunto subscribed o r names a
witnesses.
7
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2
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, EVELYN M. WAGNER, 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; that I signed it as my free and
voluntary act for the purposes therein expressed.
EVELY M.
~~~ I WAGNER~~~
Sworn or affirmed to and acknowledged before me by EVELYN M.
WAGNER, Testatrix, this ~y ~'~ day of /7~r,'/ , 1992.
i "~,~
/LLt~It~ ®~l. ~fnc-.~
Notary Public
Notarial Seal
Diane M. Smith, Notary Public
echanicsburg t3oro, Cumberland Count
tv7y Commission Expires June 22, 1992
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, py7u ~~y / ~ • Lckt /t~~s, ~ ana /~. /na ~,~ `i/~o ~rza s
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and
say that we were present and saw Testatrix sign and execute the
instrument as her LAST WILL; that EVELYN M. WAGNER signed willingly
and that she 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 18 years
of age or more, of sound mind and under constrain or d
influence.
~T/~<~'
Sworn or affirmed to and acknowledged before me
this .~ ~~ day of ~=}~,r,'/ , 1992.
~~~ ~ . ~~ ~
Notary Public
Notarial Soal
Diane M. Smith, Notar p
echanicsburg Boro, Cu Y ublic
MY Commission Ex iresmJbuneand Count
p 22, 7992
REV-1162 EX(11-961
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDI VIOUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 71 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 002475
WALTERS MURREL R III
54 E MAIN STREET
MECHANICSBURG, PA 17055
role
ESTATE INFORMATION: ssN: tat-o5-2stR
FILE NUMBER: 2102-0543
DECEDENT NAME: WAGNER EVELYN M
DATE OF PAYMENT: 04/22/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/01/2002
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 510,052.14
TOTAL AMOUNT PAID:
REMARKS: MURREL R WALTERS III ESQUIRE
CHECK#110
INITIALS: AC
SEAL RECEIVED BY:
S 10,052.14
DONNA M. OTTO _
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-150"~X+(6-00)
.
/,,)-6;!?-
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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QFFICIAL USE ONl.Y
FILE NUMBER
21-020543
"'Ccmi"TYCOOE ----y~ - - 'NliMBEFl--
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
WAGNER, EVELYN M
DATE OF DEATH (MM-OD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 8 1 - 0 5 - 2 6 1 8
THIS RETURN M.UST BE FILED IN DUPLlCATEWITH THE
REGISTER OF WILLS
06/01/2002 08/16/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
W
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[Xj1. Original Return
o 4. limited Estate
[&] 6. Decedent Died Testate (Attach c;opy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale o! deattl after 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit {dateofdealh betweell 12.31-91 and H-95)
o 3. Remainder Return (date of dealt'l prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Tolal Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} (AllachSch0)
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTEO TO:
NAME COMPLETE MAILING ADDRESS
MURREL R. WALTERS III ESQ
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717/697-4650
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgage. & Note. Receivable (Schedule 0)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property {Schedule F}
o 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)
MECHANICSBURG
PA 17055
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
226,374.82
8,600.74
(6)
(7)
(8)
234,975.56
(9)
(10)
10,774.68
819.99
(11)
(12)
(13)
11,594.67
223,3BO.89
13. Charitable and Governmental Bequests/Sec 9113 Trusts for wI1ich an election to tax has not been
made (Schedule J)
14. Net Value Subject to Ta~(U1l612 minusUf\e 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
223,380.89
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a){1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X _(15)
223,380.89 X ~ (16)
10,052.14
X .12 (17)
X .15 (18)
(19)
10,052.14
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
~
Decedent's Complete Address:
STREET ADDRESS
216 BETHANY VILLAGE
CITY I STATE I"l?
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 191
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
10,052.14
Total Credits (A + 8 + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
10,052.14
10,052.14
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; ........................................................................... D [g]
b. retain the right to designate who shall use the property transferred or its income; ........................................ D [g]
c. retain a reversionary interest; or .................".........................................."....................................... D 00
d. receive the promise for life of either payments. benefits or care? ............................................................. D [g]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............. n..........................".. .............,...............,'.... .............. D IXl
3. Did decedent own an "in trust for' Dr payable upDn death bank accDunt Dr security at his Dr her death? ................. D [g]
4. Did decedent Dwn an Individual Retirement Account, annuity, Dr other non-probate property which
contains a benefrciary designation? ........ .............................................. .......... ....................................... D [g]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ur.der pena~ties of perjury, I declare that \ have ex lned this retum, including accompanying schedules and statements, and to the best of my knowledge and bellef, it is true, correct
and complete.
Declaration of preparer other than person 'r erllaUve IS based on aU information of which preparer has any knowledge.
SIGNATURE OF PERSO PO OR FILING RETURN DATE
4/10/03
ADDRESS
DATE
4/10/03
ADDRESS
L TERS III ESQ
STREET, MECHANICSBURG
PA 17055
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 fDr the use Df the surviving spDuse is 3%
[72 P.S. ~9116 (a) (1.1) (iH.
FDr 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 (al (1.1) (liH.
The statute does not e)(emDt 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 Dr 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. 99116(a)(1.2)].
The tax rate imposed on the net value oftransfers tD or for \he use o/the decedent's lineal benefrciaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 9g116(a)(1)].
The tax rate imposed on the net value of transfers tD or for the use ofthe decedent's siblings is 12% [72 P.S. ~9116(al(1.3H. A sibling is defined, under Section 9102, as an
individual WhD has at least Dne parent in common with the decedent, whether by blood or adoption.
RO""roE"""".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R I NTO ED T
SCHEDULE B
STOCKS & BONDS
ESTATE OF
WAGNER EVELYN M
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 02
0543
ITEM
NUMBER
1.
DESCRIPTION
MERRILL LYNCH
CMA ACCOUNT
VALUE AT DATE
OF DEATH
226,374.82
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
226,374.82
:"''''''y''''w
COMMONWEALTH OF PENNSYLVANIA
INHERIT ANtE lAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
WAGNER. EVELYN M
FILE NUMBER
21 02
0543
Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
MEMBERS 1ST FEDERAL CREDIT UNION
SAVINGS
VALUE AT DATE
OF DEATH
7,421.16
2
MEMBERS 1ST FEDERAL CREDIT UNION
CHECKING
1,179.58
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needB<!, Insert additional sheets of the same size)
8600,
~","'''''",'''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
WAGNER EVELYN M
FILE NUMBER
21
02
0543
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. COCKLIN FUNERAL HOME DILLSBURG, PA 7,954.6B
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
City Stale Zip
Year(s) Commission Paid:
2. Attorney Fees MURREL R. WALTERS III ESQ 2,520.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State lip
Relationship of Claimant to Decedent
4. Probata Fees REGISTER OF WILLS 300.00
CUMBERLAND COUNTY
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 10.774.68
(If more space is needed, insert additional sheets of the same size)
.
REV-1512EX+(1-97)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WAGNER. EVELYN M
FILE NUMBER
21 02
0543
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
BETHANY SKILLED NURSING
PERSONAL CARE
685.20
2
ALERT PHARMACY
MEDICINE
97.80
3
ALERT MEDICAL SERVICE
TRANSPORTATION TO HOSPITAL
29.00
4
VERIZON
TELEPHONE
7.99
TOTAL (Also enter On line 10. Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
819.99
REV_,,,,.EX<I*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
WA(;NER FVEI YN M ?1 n? n"43
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
L TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116(a) (1.2)]
1- BARRY L. WAGNER SON 25%
895 EMILY DRIVE
MECHANICSBURG, PA 17055
2 LINDA K. MARKEL DAUGHTER 25%
46 WARRINGTON ROAD
DILLSBURG, AP 17019
3 DONNA J. JOHNSON DAUGHTER 25%
2712 L1SBURN ROAD
CAMP HILL, PA 17011
4 MARCIA A. LAGANOSKY DAUGHTER 25%
86 HOOVER ROAD
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
IL NON-TAXABLE DISTRiBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTiON TO TAX is NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PARTIl- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets 01 the same size)
/') -~y' ~ ~; ,
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, Pp 17128-0601
MURREL R WALTERS
54 E MAIN ST
M ECHANICSBURG
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
~~ ..
. :. 7:: .
'03 ~Ui'd 20
III ESp
PA 1705 `'_t.
~.{!! ~._
DATE 06-16-2003
ESTATE OF WAGNER EVEL YN M
DATE OF DEATH 06-01-2002
FILE NUMBER 21 02-0543
~~~ ~ •-RUNTY CUMBERLAND
ACN 101
Amount Remitted
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-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT
ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESS ,
MENT OF TAX
ESTATE OF WAGNER EVELYN M FILE NO. 21 02-0543 ACN 101
DATE 06-16-2003
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
ORIGINAL RETURN
1. Real Estate (Schetlule A)
(1)
2. Stocks antl Bontls (Schedule B) .00 NOTE: To insure proper
(2) 226.374.82 credit to your account
3. Closely Heltl Stock/Partnership Interest (Schetl
l ,
u
e C) C3)
4. Mortgages/Notes Receivable (Schetlule D) .00 submit the u
Peer portion
(4) .00 of this form wi Yh your
5. Cash/Bank Deposits/MSse. Personal Pro pa rty (Schedule E) (57 8
600
74 t
6. Jointly Ownod Property (Schedule F) .
. ax payment.
(6) .00
7. Transfers (Schedule G)
(7) .00
8. Total Assets
Is) 234,975.56
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (97 10,774.68
10. Debts/Mortgage Liabilities/Liens (Schedule I)
(107
11. Total Datluetions 819.99
12. Nat Value of Tax Return (11J 11 .694 67
13. Charitable/Governmental Bequests; Non-elected 9113 Tru
t
( 223,380.89
s
s
Schedu
14. Net Value of EsYata Subject to Tax le J) (13) .00
(14) 223,380.89
NOTE: If an assessment was issued previously, lines 14, 15
reflect fl
u
t and/or 16. 17 18 and 19
y
res
hat include the total of ALL returns
assessed to ,
will
date
ASSESSMENT OF TAX: .
15. Amount of Line 14 at Spousal rate (15) •00
00 00
X
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 223,380.89 X 045 _ .
_ 10
052
14
17. Amount of Lfne 14 at Sibling rate C17) 00
12 ,
.
18. Amcunt of line 14 taxable at Collateral/Class B rake (18) .
X
.00
15 _ .00
19. Principal Tax Due _
X .00
iAX CREDITS• u9)= 10,052.14
-20
00 I 10,
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-23-2003 TOTAL TAX CREDIT
10,052.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. 71.61
TOTAL DUE 71.61
* IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 61, NO PAYMENT IS REpUIREO.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR7, VOU MAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
AMOUNT PAID
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-1162 EX(17-9fi)
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA t 7128-Ofi01
RECEIVED FROM: PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 002762
WALTERS MURREL R III
54 E MAIN STREET
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
,o,a NUMBER
ESTATE INFORMATION:
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE O
SSN: 181-05-2618
2102-0543
WAGNER EVELYN M
07/03/2003
00/00/0000
CUMBERLAND
06/01/2002
TOTAL AMOUNT PAID:
REMARKS:
CHECK#10333
SEAL
INITIALS: SK
RECEIVED BY:
573.00
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
>~~~-<o
BUREAU DF INDIVIDUAL rpxES COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE
HpRRISBHRG UIPp I7IZa-osol INHERITANC E TAX
STATEMENT OF ACCOUNT
XEV-16 p) EX IFP (n-0X~
DATE 07-21-2003
ESTATE OF WAGNER EVELYN M
DATE OF DEATH 06-01-2002
FILE NUMBER 21 02-D543
MURREL R WALTERS III ESp O_f ~i~~_ (~ '~.,QO~MTY CUMBERLAND
54 E MAIN ST ACN 101
MECHANICSBURG PA 17055 Amount Remitted
[a' ._
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To 3nsura proper credit {o your account, submit {ha upper por{;pn of {his Porn Nith your tax payment.
ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS
1607 EX AFP (01-03] -- Mini -iu"urEi7~::.~~ -~_----------------------- ~1
ESTATE OF WAGNER EVELYN M FILE NO. 21 02-0543 _
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATETESNONN BELp 003
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-16-2003
PRINCIPAL TAX DUE :.....................-
PAYMENTS (TAX CREDITS):
04-22-2003 CD002475
07-03-2003 CD002762
(+)
PAID (-) AMOUNT PAID
.00 10,D52.14
71.61- 73.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
• IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
f IF T07AL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ^CREDIT•• (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF TNIS FORH FOR INSTRUCiions. .
10,052.14
10,053.53
1.39CR
.00
1.39CR
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent: EVELYN M. WAGNER
Date of Death: JUNE 1, 2002
Estate No.:
2002-00543
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 X No
If the answer is No, state when the personal representative reasonably believes that the
administration will be complete
(date)
If the answer to No. 1 is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes X No
Bo
The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
Date: May 13, 2004
Co'
Do
Did the personal representative state an account informally to the parties in
interest: Yes .X. No ~
Copies of receipts, releases, joinders and approvals of formaJ/or informal
accounts may be filed with the Clerk of the Orphans' Cou~nd may be
attached to this report. // //~ ~
MURREL R. WALTERS, III, ESQUIRE
54 East Main Street
Mechanicsburg, PA 17055
717-697-4650
~ [ .~151 tTOapacity:
Personal Representative
X
__ Counsel for Personal Representative