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HomeMy WebLinkAbout02-0214PETITION FOR GRANT OF LETTERS Estate of DAVID E. RITTNER also known as n/a , Deceased Social Security No.716-09-7188 Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix r~ Decedent, dated 9/8/89 and codicil(s) dated none named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland residence at 512 Lexin,qton Avenue~ Upper Allen Township~ Uechanicsbur,q, PA (list street, number and municipality) Decedent, then 85 years of age, died November 6 ,2001 , at Carlisle Hospital, Carlisle, PA (Location) Decedent 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 ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: County, Pennsylvania, with his/her last family or principal 2,400.00 2~400.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I Typed or printed name residence Signature and Patricia D. Shelton 512 Lexin,qton Avenue Mechanicsburg~ PA 17055 Oath of Personal Commonwealth of Pennsylvania County of Cumberland Representative The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed DECREE OF REGISTER Estate of DAVID E. RITTNI~R also known as .n/~ Deceased No. ,~/' I~-,~JZ'/' Social Security No: 716-09-71~8 AND NOW, FEBRUARY 27, 2002 reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary ~ of Administration are hereby granted to.Patricia D. Shelton Date of Death:.11/6/01 , in consideration of the Petition on the ((c.t.a., d.b.n.c.t; pendente lite; durante absentia; durante minoriate) in the above estate and that the instrument(s), if any, datedSeptember 8, 1989 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... Short Certificates(s) ............... Renunciation .......................... Extra Pages ( ) ............... ITR JCP Fee ................................. Inventory ................................ Other ...................................... TOTAL ............................. $ ~ 9.0 0 call attorney and put i~to proth box Signature Attorney: Murrel R. Walter% Ill I.D. No: 24849 Address: 54 East Main Street Mechanicsbur,§ Pa 17055 Telephone: 717-697-4650 FEBRUARY 27, 2002 DATE FILED: I05.805 REV 9/88 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local R,egistrar. The original certificate will be forwarded to the State Vi.t.~l. Records Office for, permanent ~iling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7691890 No. Date 85 Cumberland 512 Lexington Avenue Mechanicsburg, Pennsylvania 1705~-'~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH David E. Rittner . Male ~. 716 -- 09 --.~. 7188 ,. November 6, 2~01 : Oct20, 1916 Harrisburg, m~,,.~E~ E~e.,~,.[] ookl--1 ~ ~ Carlisle I Carlisle Hospital ~.~.~ Railroad I ~U -~ [ ~,~ 11i ..-.., I Married I,, Fay M. Klinger ~..s,. Pennsylvania , ~ ,~..~.~= Upper A,en Cum~rland ~ .~~.. ~ John Rittner Morah Rolf ~,,=~--=:..~_ .s ~,~ ~m~. ss ~s~.**. c,,~. s~. z~ .c~ ...... 55 Pat D. Shelton ~ 512 Lexington Avenue Mecnanmsourg, ~.0 O1,,~. Nov 9. 2001I,,,.l'~lling Green Memorial Park 1,,.-I Camp Hill, Pennsylvania 17011 iL=,~~"UM~A FD-014318-L I~- Myem Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055 I"~ O, F ~ ~ 0 ~ 0 ~ ~ ~"~'~'~ '~" "'~ .............................................. ~NS 21-02-214 L~ST WILL ~ TEST~ENT BE IT REMEMBERED THAT I, DAVID E. RITTNER, a Pennsylvania, being of sound resident of Cumberland County, 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 I am married to FAY RITTNER, although we have not resided together for a number of years, and that I have three (3) children, PATRICIA D. SHELTON, MYRL V. BUSLER, and JAN H. A. RITTNER. ~ II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executrix 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 Executrix 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. V If my daughter, PATRICIA, 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 granddaughters, KIM L. NESS and DEBRA ECKSTINE LONG, in equal shares, per stirpes. VI I nominate, constitute and appoint my daughter, PATRICIA, as Executrix of this LAST WILL, to serve without bond. If my daughter is unable or unwilling to act in that capacity, then I nominate, constitute and appoint MURREL R. WALTERS, III, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, DAVID E. RITTNER, have set my hand to this LAST WILL this day of September, 1989. DAVID E. ,RITTNER ACKNO#LED~EHENT COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND- : SS. I, DAVID E. RITTNER, Testator, 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. Sworn or affirmed to RITTNER, Testator, this DAVI-D E. RITTNER - - " and acknowledged before me by DAVID E. F~7 day of September, 1989. Notary Public~- Notarhv Seal Carla F. Brokenshire, Notary Public Vlechanicsburg Boro, Cumberland County~ My Commission Expires Apr, i! 1, 1,991 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : We, /?~o,Fr~_~"/~ W~L~/'~/~i and ~/~'~ /~. C~f~,'~ , the witnesses whose names are signed to the attached or foregoing instNument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that DAVID E. RITTNER signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at ~he time 18. ~ears ~f" age or more of sound mind and under no , cons~:~i..,nt ~or~n~ iRf~uence. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. To the Register: DAVID E. RITrNER November 6, 2001 Admin. No. 21-02-0214 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 August 4, 2000. N2lne Address Patricia D. Shelton 512 Lexington Avenue Mechanicsburg, PA 17055 Notice has now been given to all persons entided 5.6(a) eX~: none thereto under Rule Signature · Name: Murrel R. Walters, III, Esquire Address: Telephone: 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I-- Z UJ LM LLI LU Z I- Z uJ z o I.U O~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) RITTNER, DAVID E. DATE OF DEATH (MM-DD-Year) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 0 2 1 4 COUNTY COO£ YEA~ ' NUMBER SOCIAL SECURITY NUMBER 7 1 6-0 9-7 1 8 8 DATE OF BIRTH (MM-DD-Year) 11/06/2001 10/20/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ['~-"J 1. Original Return 4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) r'-~ 9, Litigation Proceeds Received NAME r"~ 2. Supplemental Return O4a. Future Interest Compromise (date of death after 12-12-82) ~'~7. Decedent Maintained a Living Trust (Attach copy of Trust) r'~ 10, Spousal Poverty Credit (dateofdeath beh~een 12-31-91 and 1-1-95) REGISTER OF WILLS SOCIAL SECURITY NUMBER ~]3. Remainder Return (date of death prior to 12-13-82) r"-~ 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes [~]11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: 2;315.25 ICOMPLETE MAILING ADDRESS 54 EAST MAIN STREET MECHANICSBURG PA 17055 OFFICIAL USE ONLY (8) 2~315.25 (11) (12) (13) 802.00 1~513.25 (14) 1~513.25 802.00 MURREL R. WALTERS III ESQ FIRM NAME (If Applicable) TELEPHONE NUMBER 717/697-4650 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) O Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 (a)(1,2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X ¢5) 1~513.25 X .045 (16) X .12 (17) X .15 (18) (19) BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 68.10 68.10 Decedent's Complete Address: S'I ~-I: f ADDRESS r 512 LEXINGTON AVENUE CITY MECHANICSBURG ISTATE PA zip 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 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. (EA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. {ED) Make Check Payable to: REGISTER OF WILLS, AGENT 68.10 68.10 68.10 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 right to designate who shall use the property transferred or its income; ........................................[] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? 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 benefic ary des gnat on? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury I declare that I have exam ned th s return, including accompanying schedules and statements, and to the best of my knowledoe and belief, it is true, correct and complete. Dec aration of preparer other than the personal representative is based on all information of which preparer has any knowledge. " ' SIGNATUR~.,-~c PERSON RESPONSIBLE ROR FILING RETURN 3/22/02 ADDRES'~"/ PA~'RICIA D,,SHE, L//I'ON ,~:Y~.LE'Y~71,~'r,,~OJ~AVE., MECHANICSBURG PA 17055 SIGNATURE O¢~,~'R~'I'JiI~/~'AN REPRESENTATIVE DATE J///'~Z f f V//L/ 3/22/02 ADDRESS MURREL R. WALTERS III, ESQ 54 EAST MAIN 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 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 theon y beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (1-97) COMMONWEALTH OF: PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER RITTNER. DAVID I~. 21 02 0gl4 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 disclo_.ed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CLAREMONT NURSING AND REHABILITATION CENTER 375 CLAREMONT DRIVE, CARLISLE, PA REFUND OF PERSONAL ACCOUNT/GIFT FUND TOTAL (Also enter on line 5, Recapitulation) $ 2,315.25 (If more space is needed, insert additional sheets of the same size) 2,315.25 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RITTNER, DAVID E. Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. FUNERAL EXPENSES: ROLLING GREEN CEMETARY SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS DESCRIPTION GRAVE MARKER Zip Zip ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of PersonaI Representative (s) RENOUNCED Social Secudty Number(s) / FIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees MURREL R. WALTERS III ESQ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS FILE NUMBER ;~1 02 Accountant's Fees Tax Retum Preparers Fees TOTAL (Also enter on line 9, Recapitulation) 0214 AMOUNT 267.00 480.00 55.00 $ 802.00 (Ifmorespaceisneeded, inse~additionalsheetsofthesamesize) REV-1513 EX +~9-nm COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN I RESIDENT DECEDENT J ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousa distributions, and transfers under Sec. 9116 (a)(1.2)] PATRICIA D SHELTON 512 LEXINGTON AVE MECHANICSBURG, PA 17055 II. FILE NUMBER 21 02 0214 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE DAUGHTER 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheei.~ of the same size) 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 001010 WALTERS MURREL R 54 E MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 716-09-7188 FILE NUMBER: 2102-0214 DECEDENT NAME: RITTNER DAVID E DATE OF PAYMENT: 03/27/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1/06/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $68.10 REMARKS: TOTAL AMOUNT PAID' PATRICIA SHELTON C/O MURREL R WALTERS III ESQ $68.10 SEAL CHECK//2454 INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS 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: DAVID E. RITTNER Date of Death: November 6, 2001 Estate No.: 21-02-0214 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 No X Bo The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Date: 3/25/02 D0 Did the personal representative state an account informally to the parties in interest: Yes X No ~ Copies of receipts, releases, joinders and approvals of focal or informal accounts may be filed with the Clerk of the O),phans'"/~ourt and may be attached to this report. .z '.: MURREL R. WALTERS, III, ESQUIRE :-:' c5 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative X Counsel for Personal Representative BUREAU OF TNDZVZDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. 280601 HARR/SBURG, PA 17118-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX &FP (01-02) HURREL R WALTERS 5q E HAIN ST HECHANICSBURG PA ~7Q55 DATE 05-13-ZOOZ ESTATE OF RITTNER DATE OF DEATH 11-06-2001 FZLE NUNBER 21 02-0214 COUNTY CUHBERLAND ACN 101 I Amoun~ Rem~ed DAVID E HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG TH/S LINE ~ RETATN LOWER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF RITTNER DAVID E FILE NO. 21 02-021~ ACN 101 DATE 05-13-2002 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1. Real Es~a~e (Schedule A) 2. S. 5. 6. 7. 8. ORIGINAL RETURN (1). S~ocks and Bonds (Schedule B) (2) Closely Held S~ock/Par~nership Zn*eres~ (Schedule C) (3) Nor~geges/No~es ReceivabZe (Schedule D) (~). Cash/Bank D~posi~s/Hisc. Personal Proper~y (Schedule E) (5) Jointly O~nad Propar~y (Schedule F) (6). Transfers (Schedule G) (7) To,al Asse~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ado. Cos)cs/Nisc. Expenses (Schedule H) 10. Deb~s/Hor~gege Liabilities/Liens (Schedule Z) 11. To,al Deduc~/ons 12. Ne* Value of Tax Re~urn 1:5. 1~. (9) (10) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Ne~ Value of Es~a~e Subjec~ ~o Tax O0 O0 O0 O0 2z315 25 O0 O0 (8) 802.00 .00 NOTE: To insure proper credi~ ~o your account, submi~ ~ha upper portion of ~his form ~i~h your ~ex payment. NOTE: 2,315.25 (11) ,602. O0 (la) 1,513.25 (15) . O0 (1~) 1,513.25 Z~ an assessment Nas issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amoun~ of L/ne 1~ at Spousal ra~e 16. Amoun~ of L/no 1~ taxable a~ Lineal/Class A rate 17. Amoun~ of L/no 1~ a~ Sibling re~a 18. Amoun~ of L/no lq ~axable a~ Collateral/Class B ra~e 19. Principal Tax Duo TAX CREDITS: PAYNENT RECEIPT DISCOUNT (+) DATE NUHBER TNTEREST/PEN PAID (-) 03-17-Z001 CDO01010 .00 18 and 19 w111 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 x O0 = .00 (16) 1,513.25 x 045 = 68.10 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 68.10 ANOUNT PAID 68.10 TOTAL TAX CREDIT 68.10 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decadents dying an or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class D (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such future interest, PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Make check or nancy order payable to: REGISTER OF RILLS, AGENT A refund of a tax credit, which ems not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are availabIe at the Office of the Register of Rills) any of the Z$ Revenue District Offices) or by calling the special Z4-hour anseering service for forms ordering: 1-800-56Z-lOS0; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied mith the appraisement) allowance) or disallowance of deductions, or assessment of tax (including discount er interest) as sheen on this Notice must object eithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg) PA 171Z8-1011, 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 ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes) ATTN: Post Assessment Rsviee Unit, Dept. Z80601, Harrisburg, PA 17118-060! Phone (717) 787-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid eithin three (5) calendar months after the dscedent's death) a five percent (5Z) discount cf the tax paid is a11oesd. 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 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 es indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) 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 (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which 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 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 198Z ZOZ .000548 199Z 9Z .000Z47 1982 16X .000458 1995-1994 71 .000191 1984 1IX .OOOSOl 1995-1998 9Z .OOOZ47 1985 15Z .000556 1999 7Z .000192 1986 lOX .000274 ZOO0 ex .O00Zl9 1987 9Z .000Z47 ZOO1 9Z .000247 1988-1991 112 .O00~Ol 200Z 62 .000164 --Interest is calculated as follows: ZNTERESI' = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAZLY ZNTEREST 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 shown on the Notice, additional interest must bm calculated. JRD/June 30, 1992/17858 Date: January 10, 2005 CAPP SALLY ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA RE: Estate of COHEN NAN M File Number: 2003-0214 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: 02/24/2005 Your prompt attention to this matter will be appreciated. Thank you. File Counsel Personal Representative Judge Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS