HomeMy WebLinkAbout04-0497 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Paul E. Kieffer No. ~-(.50c- ~q~
also known as To:
Register of Wills for the
Social Security No. 203-20-402// Deceased. County of C,,mhorl mhd in the
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 execut or named
in the last will of the above decedent, dated Ap,--~ 1 77; 1 OR? ,19
and codicil(s) dated
Betty A. K~effer died December 20, 1990
(state relevant circ,mstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
his last family or principal residence at 7039 Wertzville Road
Mmehmn~e~qburg_. PA (Silver Spr~n~ Townsl,ip)
(list street, number and muncipality)
Decendent, then years of age, died May 17 ,19. 2004
at 14nlv .qn'lr'[t- ttn.qp-~enl; Em.~' Pmnn.qhn'ro Town.qh'lp
ExcePt a~ f-o~l~vs, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 100.000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 300,000.00
situated as follows: ~i!ver Spring Tc-;:nship ).nd
Washington To~-nship~ ~u,.utmmoc~&~.u
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
:"h (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
· 7 ?
~ ~/int Road
New' K~n~ston. PA
O
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -I
COUNTY OF ~--~.~,',~¢x~.~.~..~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best cf 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.
Sworn to or affirmed and subscribed ~ /) ~ ,-,~ r~
~ ~Q~'~~bgister ~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Paul E,Kieffer
Date of Death: May 17, 2004
Will No. 04-0497 Admin. No.
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:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. ! is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes~ No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
' ~_ Signature
John M. Eakin
Name (Please type or print)
· ~ Market Square Building, MechanicsburE, PA 17055
Address
.... ( 717 ) 766-3172
Tel . No.
Capacity: __Personal Representative
X Counsel f~,~' personal
represent~
(~H:rmf/~3)
No. o~t- Oq..- t4q-~
Estate of' ~.~ ~- ~3~.~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~X~-'~ ,_ .~-~L~. ~).00~c' )j// , in consideration of the petition on
the reverse side hereof,,~s~tisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
and Letters \-'--~:c~,~-~c,~ ~ '~
are hereby granted
FEES
Probate, Letters, Etc ..........
Short Certificates( ) .......... $ I ~_. ~ ATTORNEY (Sup. Ct. I.D. No.)
$ lO. ~ ADDRESS
TOTAL __ $ '--,~ · O O
................................. PHONE
;' REV a, sa WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
(fEE FORTq.~; TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
CERTIFICA~ E 52 00~ COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CE~. NO. T 5643568 *~,' 05-19-2004
21-Oq- qn
Name of Decedent Paul E. ~effer
Sex Male Social Secudty No. 203-20-4024 D~te of Denth 05-17-2004
Date of B~rth 08-12-1928 BiahCaoe ~1 Domsife, PA
Place of Death Holy Sp~t Hospital Cmberl~d Crop Hill pennsylvania
Race ~ite Occupation Mainten~ce C~enter Armed Forces? (Yes or No)
Decedent's
Marital Status Widowed Mailing Address 7039 We~ville Road Mechmcsb~g PA
Informant L~ P. ~e~er Funeral Director Stephen R. RoSe.el
Name and Address of
Funeral Establishment Stephen R. RoSe.el F~eral Home 113} ~dge Road, ~gerstom, PA
Intorval
Part I: Imme0iate Cause Onset an~ Death
(a) Acute Renal Faille
(~) H~okalemia
H~otension .....
Part Il: Ot~r ~i~nil~ant Oon~itions
~alac ~ass ~gew
Manner of Death Describe how injury occurred:
Natural ~ Homicide ~ ,',3
Accident ~_] Pending Investigation ~
Suicide ~ Could not be Determined
RobeA D. Eus~os, M.D.
Name and Title of Ce~fier
(M.D., D.C., Coroner, M.E.)
Address C~ ~ill, ~A
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Records Office for permanent filing/?~~,,q ,9..~A ~k"~ ~.~/~'J/zv~54-498
05-19-2004 ~4 W~t"S~8~''~ ~l~~'~ ~o
REGISTER OF WILLS OF Cumberland COUNTY
OATH OF SUBSCRIBING WITNESS
John M. Eakin ~_ Ar. ma M.
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that ~ ~ ~ ~ - present and saw
Paul E. Kieffer
the testat or , sign the same and that ~ ' ~ signed as a witness at the
request of testat or in h is presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)). '~?"tL ~/~'~(~
Sworn to or affirmed and subscribed before
me this 27th day of ~ / am
May 19. 2004 Marke~ Square Building Mechanicsburg
u ~ (Name)
319 S. Market Mechanicsburg
REGISTER OF WILLS OF O-__,ox,~x~w,6 COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified accordin~o law, depose{s) and say(s) that
codicil
testat tv~ of (one of the subscribing witnesses to) the ~ presented herewith and
codicil
that ,-~X~'~- believes the signature on the will is in the handwriting of
to the best of ,~xL,~ knowledge and belief. "~'-./~/~)t.4/ /) )/' /~;:
Sworn to or affirmed and subscribed before - r - -
~'~'x--%~(~~~ster3 (Name)
(Address)
O O ,
LAST WILL AND TESTAMENT OF PAUL E. KIEFFER
I, PAUL E. KIEFFER, of the Township of Silver Spring,
Cumberland County and State of Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking
and making void any and all prior Wills by me at any time
heretofore made.
I direct the payment of all my just debts .and funeral
expenses as soon after my decease as the same can conveniently
be done.
All the rest, residue and remainder of my estate~ real,
personal and mixed, of whatsoever kind and wheresoever situate,
I give, devise and bequeath to my w±fe, Betty A. Kiel£er.
3.
In the event my wife should predecease me or die within
thirty (30) days of my death, then I give, devise and bequeath
my entire estate, real, personal and mixed, to my son, Larry
Po Kieffer.
4~
I nominate, constitute and appoint my wife, Betty A.
Kieffer, to be the Executrix of this my Last Will and Testament
and shOuld she be unwilling or unable to act as such for any
-1-
reason, then in such event, I nominate, constitute and appoint
my son, Larry P. Kieffer, to be the Executor of this my Last
Will and Testament, in her place and stead.
IN WITNESS WHEREOF I have hereunto set my hand and seal
this~ ~ day of , 1982.
Signed sealed published and declared by the above named
Paul E. Kief£er, as and for his Last W±ll and Testament, in the
presence of us who have subscribed our names here to as witnesses,
at the request of said testator, in his presence and in the
presence of each other.
-2-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Paul E. Kieffer
Date of Death: May 17, 2004
Will No. 21-04-0&97 Admin. No.
To the Register:
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 :
Name Address
None - Larry P. M~mffmr: ~w~o,,~r im eho onlv hair
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None
Date: 6/9/04
~,: Signature
t Name John M, Eakin
Address Market Square Building
Mechanicsburg, PA 17055
Telephone (713 766-3172
Capacity: ~ Personal Representative
X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11 96)
PENNSYLVANIA
RECEIVED FROM: INNI::RITANCF AND EgTATE TAX
OFFICIAL RECEIPT
NO. CD 004273
EAKIN J MICHAEL
DISTRICT ATTORNEY'S OFFICE
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $6,000.00
ESTATE INFORMATION: SSN: 203 20 4024
FILE NUMBER: 2104-0497
DECEDENT NAME: KIEFFER PAUL E
DATE OF PAYMENT: 08/16/2004
POSTMARK DATE: 08/1 612004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2004
TOTAL AMOUNT PAID: $6,000.00
REMARKS:
CHECK# 1011
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
OOMMONW LTHOF REV'1500 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN
2 1 _ 0 4 0 4 9 7
'~HARRISBURG, PA17128-0601 RESIDENT DECEDENT couN coe
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I--
Z Kieffer Paul E. 203 - 20 - 4024
~J
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST DE FILED IN DUPLICATE WITH THE
LU
O May 17, 2004 August 12, 1928 REGISTER OF WILLS
iii (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIODLE INITIAL) SOCIAL SECURITY NUMSER
w [] 1. Onginal Return [] 2, Supplemental Return [] 3. Remainder Return (date of death pdor to 12-13-82)
Oa.o;~ ¢ ~[] 4. Limited Estate [] 4a. Future Interest Compromise (da~e ofdsath a~er 12-12~2) [] 5. Federal Es~ata Tax Return Required
~:oo
o ~ a~ [] 6. Decedent Died Testate (^~ch copy of Will) [] 7. Decedent Maintained a Living Trust (At'ach copy of Trus0 -- 8. Total Number of Safe Deposit Boxes
< [] 9. Litigation Proceeds Received [] 10. Spousal Poverb/Credit (dat. <~ldeath ~).tw~er, lz-31-Dl a,~d 1-195) [] 11, Election to tax under Sec. 9113(A) (A,a~ Sch O)
~u NAME
c~ COMPLETE MAILING ADDRESS
z John M. Eakin
o
e. FIRM NAME (IfApplicable) John M. Eakin
~ Market Square Building
o TELEPHONE NUMBER Mechanicsburg, PA 17055
o (717) 766-3172
1. Real Estate (Schedule A) (1) 166,000. O0 OFFICIAL USE ONLY
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 Proparty (5) 1 1 2,260.70 ;' I
(Schedule E)
6. Jointly Owned Property (Schedule F) {6) .5,697.56 ': :'
[] Separate Billing Requested '
=:~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Proparty (7) r,,
ii, (Schedu~ G or L)
~ 8. Total Gross Assets (total Unes 1-7) (8) 283,958.26
O 20,214.96
~.J 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 129.80
11. Total Deductions (total Lines 9 & 10) (11) 20,344.76
12. Net Value of Estate (Line 8 minus Line 11) (12) 263,613.50
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 263,613.50
~._ rata, or transfers under Sec. 9116(a)(l.2) x .0__ (15)
. 16. Amount of Line14 taxable at lineal rata 263,613.50 x .0 4~ (16) 11,862.61
~ 17. Amount of Line 14 taxable at sibling rate __ x .12 (17)
(.~ 18. Amount of Line 14 taxable at collateral rate __ x .15 (18)
19. Tax Due 11,862.61
(19)
~×l~0/ OFFICIAL USE ONLY
~?~. COMMONWEALTH OF REV'1500
~ PENNSYLVANIA
~~,~ DEPARTMENT OF REVENUE
DEPT. 28060 INHERITANCE TAX RETURN FILENUMBER
2 1 _ 0 4 0 4 9 7
~HARRISBURG, PA 17128'0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMaER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I--
Z Kief fer Paul E. 203 - 20 - 4024
I,M DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I,U REGISTER OF WILLS
O May 17, 2004 August 12, 1928
LLJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~=J[~] 1, Odginal Return ~ 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82)
[] 5. Federal Estate Tax Return Required
~ ~ ~ [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after
~OO
[] 6. Decedent Died Testate (A~ copy of Will) [] 7. Decedent Maintained a Living Trust (A~ch copy oITrust) __ 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
< [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death belween 12-31-91 and
m NAME COMPLETE MAILING ADDRESS
z John M. Eaktn
o John M. Eakin
a. FIRM NAME Of Applicable)
~ Market Square Building
a: TELEPHONE NUMBER Mechanicsburg, PA 17055
u ~717) 766-3172
1. Real Estate (Schedule A) (1) 166,000. O0 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) ~
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) r'¢ ~ C
4. Mortgages & Notes Receivable (Schedule D) (4) [: ~
5, Cash, Sank Deposits & Miscellaneous Personal Property (5) 112,260.70 ~"
(Schedule E) : "~
6. Jointly Owned Property (Schedule F) (6) 5,6 9 7.5 6 '::: ~
<~ [] Separate Billing Requested ~' '
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
I'-- (Schedule G or L)
~ 283,958.26
.1~ 8. Total Gross Assets (total Lines 1-7) (8)
O 20,214.96
LM 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 129.80
11. Total Deductions (total Lines 9 & 10) (11) 20,344.76
12. Net Value of Estate (Line 8 minus Line 11) (12) 263 ~ 613.50
13, Cbedtable and Govemmenfel Bequests/Sec 9113 Trusts for which an elect~on to tax has not been {13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 263,613 · 50
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable the
at
spousal
tax
~ rate, ortransfersunderSec. 9116(a)(1.2) x .0__ (15)
..~ 16. Amount of Line14 taxable at lineal rate 263,613.50 x.0 45 (16) 11,862.61
17. Amount of Line 14 taxable at sibling rate x .12 (17)
oOt~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) 11,862.61
Decedent's Complete Address:
STREET ADDRESS
272 Locust Point Road
CTY New Kingstown ISTATE PA I zIP 17072
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 11,862.61
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments 6, OOO. O0
C. Discount SOU. UU
Tota~ Credits (A + B + C ) (2) 6,300. O0
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 I Line 20 to request a refund (4)
5, If Line 1 + Line 3 is greater than Line 21 enter the difference, This is the TAX DUE. (5) 5,5 62.6 1
A. Enter the interest on the tax due, (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 5,562.61
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 properly transferred or its income; ............................................ [] []
c~ retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accempanyrng schedules and statements, and to the best of my knowledge and belief, it is true, comect and complete.
Declarahon of preparer has any knowledge
$~AT~ ~ P
A~£$$
For dates of death on or after July 1, 1994 and before January 1, 1995, : 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 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 blcod or adoption.
SCHEDULE
A
CO~ON~EA~. O~ PENNSVLVAN,A REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul E. Kieffer 2104-0497
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
~' House and lot of ground in Silver Springs Township, $ 145,000.00
see attached appraisal
Tract of mountain land in Washington Township Northumberland $ 21,000.00
County, see attached appraisal
TOTAL (Also enter on line 1, Recapitulation) S 166,000.00
(If more space is needed, insert additional sheets of same size.)
rF,~o. WE~t~vL~eq Paqe #~1
SUMMANY OF SALIENT FEATURES
Sale Price $ N/A
Date ol Sale N/A
Size (Square Feet) 1,452
Price per S~are Foot $
Leca6efl AVERAGE
Age 52 YEARS
Cor,,~on AVERAGE
Total Ro~ms
Bedrooms 3
Baths
~ ....... p un-'~lerlter Quantitative Analysis A~pralsal Repo~ ~.. ,~. WERT~L7039
~ ~A C~rent 0~er ~EF~ER ES~E ..... 0ccuoafli ~ Owner ~ Tenant ~ Vacant
BoiRup ~0~75% ~25-75% [ ]Undo25% Deman~supply ~Shodage ~ ]Pnbalance[ ]Oversupply ~) (yfs) l~RCE,applic. A~E
E~ ~ Water WELL
V~UE~USTMEmS OESCRI.ION ~SCRIP110N ' -~u~s:
~' ~ - ~ ~2~0o ~ ' I $ 3,~0 ~+ ~-~ 8,7~
?OT~ ~ * _.~
F~ ~Jo, WE~/LT0§§l Pafle~I
Underwriter Quantitative Analysis Appraisal Report r.o No, WERTZVLT039
Provide Ihe foflowing information for all Comfominium Projects:
RojeofTy~e: [~Prknar/Residence []Seco~HomeofRecrealional ~RoworTow~house [~Garden [~Midrise r~Highrfse []
STATEMENT OF LIMITING CONOITIONS AND APPRAISER'S CERTIFICATION
~ Underwriter Quantitative Analysis Appraisal Report P.. No. WERTZYL703G
APPRAISER'S CERTIFICATION: The Appraiser ce~ffies and agrees that:
1. I ~o~ Ibis apprals~ by (1) personally inspecting ~rom the stre~ the subject prope~ and neighborhood and each of the
repo~. I fu~er ce~y that I have adequate inlorma~ion abo~ the physical characteristics of the subject prope~y and the comparable sales to deverop
2. I have researched and analyzed the comparable sa~es and ogenng~lislings in the subject ma~ area and have reposed the
comparable sa~es in this repo~ that are the best dva~lable fo~ the subject pmpe~y I f~her codify that adequate
c~parable marka data exists In the general market ama lo develop a leliable sales comparison analysis for the subject properly.
the adverse condEiens on the markelabil~ of the sub,ecl prope~y I have .ct kuowingly w~hheld any significant i~fmmation from the apprais~
In the vicin~ M the subje~ propedy or on any other bas~s pruhibiled by law
comp~sagon an~or emplo~enl for pedormmg the ~pp~atsal I did ~ot base the appraisal ~po~ on a requested minimum valuation.
· e effective date of the appraisal (unless I have ~he~se md~cated in this roped that the appraisal is a comp~e appraisal, in ~ich
case. ~e Depaffure Provision does not ap~y)
10. I ackno~e lhat a~ estimate of a reasonable Pine Icl expusure m the open mmkel is a condfliofl in the dMIn~ion of manet value.
iff the Neigh~ section of Ibis repod The marketing peduO concluded Ior Ihe subject properly at the estimaed market value is
Date ~ RepoWSigna~re: 7-7~ Date ~t RepoWSignatme:
E~imtlon Date of Ce~fication or License: 6/3o/~5 Expiration Date of Codification or License:
A~RE~ ~ PR~ER~ APPliED:
MEC~I~BURG, PA 170~-1~3 SUBJECT PROPER~
~ED V~UE ~ SU~E~ PR~R~ $ t45,~o .... , Did not inspect subject properly
E~ DA~ ~ ~PRAI~C~N ~28-~ Did inspect e~edor of subject prope~ from s~
,, Old Inspect Inteflor ~d e~edor of subject prope~
Name: COMPARABLE SALES
- ~ Did inspect e~edor of comparable sa(es from ~re~
Company Address: ~RK~ SOUARE BUILDING
ISL~ND APPRAISALS
375 EAST DRIVE, SUNBUY, PA 17801
ReNo, KIEFFER-P.AUG
APPRAISAL OF
LOCATED AT:
DORN$1FE, PA, 17823
FOR:
ATTORNEY JOHN F. AKIN
MARKET SQUARE BLDG,
MAIN & MARKET, MECHANICSBURG, PA
:. BORROWER:
AS OF:
August t8, 2004
· ~ BY:
WILL~AM $TANKIE~NICZ, ASSISTANT
MAUREEN MILLER, RL~01981-L
ISLAND APPRAISALS
378 EAST DRIVE, SUNBUy, PA 17801
/
08/18/2004
JOHN I~AKIN ESQUIRE
ATTORNEY JOHN EAKIN
MARKET SQUARE BLDG.
MAIN & MARKET, MECHANICSBURG, PA
File Number: K~EFEER-P.AUG
DEAR ATTORNY EAKIN:
In accordance with your request, I have person]ally inspecled and appraised the real property at:
RD.
DORNSIFE, PA, 17823
The purpose of this appraisal is 1o estimate the market value of the subject property, as Yacant.
The property rights appraised are the fee simple interest in the site.
In my opinion, the estimated market value of the property as of August 18, 2004 is:
$21,000
Twenty-One Thousand Dollars
The attached report contains lhe description, analysis and supportive data for the conclusions,
final estimate of Yalue, descriptive photographs, limiting conditions and appropriate certifications.
RESPECll:ULLY SUBMITTED,
WILLIAM STANKIEWICZ, ASSISTANT
MAUREEN MILLER, RL-00198'I-L
ISLAND APPRAISAL§
LAND APPRAISAL REPORT F~ No KIEFFER-P.AUG
Address R.D. Census Tract 4297-9623 LENDER D~SCR~TIONARY USE
Comb/ NORTHUMBERLAN State PA 7JpCode 17823 SaleR.~ $
367 (ATTACHED) Date
PAUL E. KIEFFER ESTATE ~ Refermce SEE ABOVE Modgaga Amount $
RURAL AREA, WITHIN REASONABLE PROXIMITY TO AMENITIES SUCH AS SCHOOLS, SHOPPING, EMPLOYMENT, ETC.
Eimen~s SEE ATTACHED LEGAL DESCRIPTION Tago~aphy SLOPING
Site Nee 19.025 ACRES C~ner Lol ~NO Size TYPICAL FOR AREA
Z~lng C~;;',~ NO LOCAL ZONING Zoning C~nce N/A Shage IRREGULAR
HI(3HEST & BEST USE: r~t U~ X Otha~ Use Drainage APPREARS ADEQUATE
Gas NONE CL, t~utta' NONE Drk~'ay NONE
S~m Sewer NONS Alley NONE FEMA* MsFZone 4219450001 B
EASEMENTS, ENCROACHMENTS, SPECIAL ASSESSMENTS, SLIDE AREAS, ETC. THAT WOULD HAVE ANY NEGATIVE AFFECT
ON VALUE OR MARKETABILITY.
7 MILES 5 MILES 3 MILES
F~tl~ SITE 12000=1 24000~1 33000=1
INSPECTION MLS DRIVEBY MLS DRIVEBY MLS DRIVEBY
~ ~r Rmnd~ CASH : CASH CONY I
WATER NONE NONE : ON SI~ WELL NONE I
SEPTIC NONE NONE ; PERC TESTED PERC TESTED
TOPO SLOPING SLOPING ~ SLOPING ROLLING
AFFORDED SALE 1
Com~eeie end Conditions o! Appraiser: UNLESS OTHERWISE IND[CATED HEREIN THERE ARE NO SPECIFIC CONDITIONS TO WHICH
Fine~ Recon~atlon: THE SALES COMPARISON APPROACH WAS GIVEN THE MOST WEIGHT IN DETERMINING THE FINAL ESTIMATE
Review Aagreiee~ ~&~g~ ~"~,,,~ [~Oid [] D~ Not
SCHEDULE E
COMMONWEALTH OE PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
'NHERITANCE TM RETURN PERSONAL PROPERTY
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Paul E. Kieffer 2104-0497
Include We process ~ i~a~n and ~e da~ ~e process were receiv~ by ~e ~tate. All pm~ ~i~mwned with ~e rlgM of suwivomhip mu~ be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC Bank IRA =Accdunt'~# 52472966, See attached 39,034.80
2. PNC Bank Account # 50-7002-3286, See attached 3,407.39
3. 1987 Ford Truck, See attached appraisal 780.00
4. 1998 Pontiac Bonneville SE sedan 4D, See attached 2,010.00
5. 1984 Ronda Aspencade, See attached 2,485.00
6. 1973 Suzuki 185, Trail Bike TS185K, See attached 600.00
7. Patriot News - subscription refund 121.10
8. Retirement chec~ 5/1~ - PNC IRA Account 52472966 - uncashed 350.00
9. Evergreen Investments, Account # 340403, See attached 22,311.00
10. Evergreen Investments, Account # 150107, See attached 30,787.06
11. Miscellaneous furniture, See attached 5,385.00
12. Van Eck Global, Account # 36079, See attached 4,989.35
TOTAL (Also enter on line 5. Recapitulation) $ 112,260.70
(If more space is needed, insert additional sheets of the same size)
PNC 1, VESTMENTS Retirement Account Statement
Mcmb¢~ N^S~ a.~ S~VC May I - May 31, 2004 Page I of 5
P.O. Box 32760
Louisville, KY 40232
CONTACT INFORMATION Account Number 52472966
Your Financial Consultant (J20V) Office Servicing Your Accuunt
':~ r-Ol" ~? 1CZ I~-- :~ HAROLD BESHAW 4242 CARLISLE PiKE
HILLIARD LYONS CUST FOR (717) 730-2289 CAMP HILL, PA 17011
PAUL E KIEFFER IRA Customer Service Desk
7039 WERTZVlLLE RD 1-800-762-6111
MECHANICSBURG PA 17050-1543 Access your account online at www,pncinvestments.com
ACCOUNT VALUE
Cash Equivalents $39,034.80
Assets held at PNC Investments $0.00
Assets not held at PNC Investments $0.00
I N V E S 'r O R I N F O R M A T I O N Total Account Value as of May 31, 2004 $39,034.80
Investo~ Update Total Account Value as of April 30, 2004 $39,568.03
Many families spend all year planning their next vacation.
Total Account Value as of December 31, 2003 $41,041.10
How much time have you spent planning for your financial
future? PNC Investments can help you plan for your future
and reach your financial goals. Talk to your PNC
Investments Financial Consultant today.
ASSET MiX
Premium Plm Account Statement
I'NC I;;,nk ~. PNCBAN<
Primary account mlmber: 50-7002-3286
Page 1 of 2
For the period 04/22/2004 to O$/20/2004 Ntlmber of enclosures: 5
M
N PAUL E K~EFFER ~For24-hourb~nking, cos~omerse~iceand
~ interest rate in~ormalion, sign-on to
70~9 ~ERTZV~ LLE RD ~ Account Link ~ by Web on pncbank.com
HECHANICSBURG PA 17050-15q5 orcall 1-888-PNC-BANK
~Write to: Customer Se~ice
PO Box 609
Pittsburgh PA 15230-9738
~.Visit us at pncbank.com
~IDD terminal: 1-800~$31-1~48
Introducing Identity Theft Reimbursement Insurance
A Iiew ,~ccou]u Feature has heen added Io yotlr 1)remium Relationship Bankilig PJan at no addiliollal c.st to yot. ~ otr package
n.w I"-rides up to $5,000 in hlen~ity Theft Relmht.'scmenl hlsurat~ce*. If you become a viclim, this insurance will reimburse you
For cci htill oul-of-pocket cosls you it~cur 1o regain your iden y, such as legal tees, ]osl wages, long dislance phone calls~ filing fees,
IlOlal'y I~es, mid poslaffe. Idet~lil)' IheFl is a ffrowitlg problem and oCCtll'S whet; someone uses yotll' llallle OF I~ersotlal ilfformaliotl
Io assume )'our idetuily. Goluac( your local brm~ch lo ge~ a SlUlllllaFy O[ Benefits [O1'111, Of fur more h~formalion call
1-888 I'NG-BANK.
Premium Plan Paul E Kieffer
Interest Cheokillg Aecmmt Summary
Account numbe~: ~0-7002-3286 Account Link ~ number: 0203204024
~alance Summary Please see ll~e Activity Detail section for
additional information.
Average monthly Charges
2,720.68 .00
Transaction S.mmary
~ (.) 0
transactions ATM transactions ATM transactions
Illterest Summary As of 05/20, a total of ~.80 in i.terest was
Annual Percentage Number of days Average coge~ted Interest Earned earned this year.
Yield Earned (APYE} In interest period balance for APYE this period
o. Ioz 29 2,610.02 .22
FORM953R-0104
BLUE BOOK TRADE-IN VALUE
Pennsylvania · June 4, 2004
1987 Ford F250 Long Bed
See Loca LsUngsofThsCar Found thai
: List Your Car For Sale Online
Buy a NeW Car
_F_ _re e Le m~ n_ ~c h_e_.c~
Auto Loans from 3,85% APR
Engine: V8 5.0 Liter Znsurance Quote
Trans: 4 Speed Manual Payment Calculator
Drive: 4 Wheel Drive
Mileage: 132,000
Equipment
Custom Power Steering
Air Conditioning AH/FH Stereo
Consumer Rated Condition: Fair
"Fair" condition means that the vehicle probably has some
mechanical or cosmetic defects, but Is still in safe running condition.
The paint, body and/or Interior need work to be performed by a
professional In order to be sold. The tires need to be replaced. There '~'~ ,~/~i~
may be some repairable rust damage. The value of cars In this
category may vary widely. A clean title history s assumed. Even after ~'
significant reconditioning this vehicle may not qualify for the Blue ' I~ ~'~t~ J ~'~.~.~_~
Book Suggested Retail value.
Trade-In Value ~LJs~c_y~ouF C@r F~o[_Sale_On__ne $780 ~_.
Trade-in value represents what you might expect to receive from a
dealer for this consumer owned vehicle. Keep In mind that the dealer ~trr
must then absorb the cost of making the vehicle ready for sale,
advertising, sales commissions, arranging financing and Insurance
and standing behind the vehicle for any mechanical or safety
problems·
~a PrN~te Party Value
Get Znvolce & HSRp Qrl New Ca~
~ ~ ~u~J~,~4'/,~I '-t't.~tc/~_ in~.
BS20 Carlisle Pike · Mechamcsburg PA '17050 (717)-766-47S~ · www. mooafferty.~om
BLUE BOOK TRADE-IN VALUE
Pennsylvania · June 4, 2004
1998 Pontiac Bonneville SE Sedan 4D "i.,
See Local LisUngs of This Car
List 'four Car For Sue On ne
Buy a New~ Car
F r e_e_L_e _m_o~ _C h~e~c k
Auto Loans f~om 3.85% APR
Engine: V6 3,8 Liter Insurance Quote
Trans: Automatic Payment Calculator
Drive: Front Wheel Drive
Mileage: 99,000
Equipment
Air Conditioning Tilt Wheel Dual Front Air Bags
Power Steering Cruise Control ABS (4-Wheel)
Power Windows AM/FM Stereo
Power Door Locks Cassette
Consumer Rated Condition: Fair
"Fair" condition means that the vehicle probably has some
mechanical or cosmetic defects, but is still in safe running condition.
The paint, body and/or Interior need work to be performed by a
professional in order to be sold, The tires need to be replaced. There
may be some repairable rust damage. The value of cars in this
category may vary widely. A clean title h!s~ory is assumed. Even after
significant reconditioning this vehicle may not qualify for the Blue
Book Suggested Retail value.
Trade-In Value L_!st Your Car For Sale Onli.ne $2,010
Trade-in value represents what you might expect to receive from a
dealer for this consumer owned vehicle. Keep in mind that the dealer
must then absorb the cost of making the vehicle ready for sale,
advertising, sales commissions, arranging financing and insurance
and standing behind the vehicle for any mechanical or safety
problems.
Get * Private Party Value
6~20 Gadisle ~iko · Mechanicsburg · ~^ 17050 · (717)-7~0-4755
6427 Carlisle Pike ~* Mechanicsburg, PA 17055
tax (717} 79~-8605 -~ (717) 795-8604
b~[; I~e-r~ v~zu~ /] ~4p~5
ATV ~ SNOg~M~OBI~'E~ WATERCRAFT
07-16-04 08:54a,, "From-E V C INSTITUTIONAL SERVICES 6179102714 T-?06 P 01/O~ F-884
Pn~ Ottice Box ~4oo
vergreen Investments"
Inly 15, 2004
John M. Eakin
Fax: 717691-3281
RE: Crux#: 00142110
High Yield Bond-A
#646-~ 811340403
Mid Cap Growth Fund-A
#651-741150187
Paul E. Kieffer &
Betty A. Kieffer Jt Ten
Dear Mr. Eakin:
Thank you for your telephone call regm'ding the above account.
Below are the valuations you requested:
t : Date per Shire 4 Valae ~
,Account No. NO. Of Sh
651-741150187 ~ May 17,20~ [ 6,751.5481 $4.56 { $30,787.061
Please visit us online at www. evergreeninvestments, com, for more inl~m~ation about
Everlgeen Funds. Our website offers mx ~ray of help~l intonation including 2003 tax
information, ~ invea~ent education cent~, account h~fo~atiort, fired prices, fund
perform~ce ~d general info~ation about Ev~een F~ds.
MAY-i-2002 WED 01:56AM ID: PAGE:I
Appraiagl i")r Z':,t, nt, c of F~ul Kiefcr, '/(_3'? :,-'.[zville ,ia., :loch.
l_eq'.her re::lincr 25.00
r~covd circ.,ut 20.00
WoC~] rc, ck~ p 40.00
air 2on,'ti t, icner 2(; O0
wa ,~k.:,r 35 Od
drill i'.t.,;:~;:: 250 O0
i:~l. uc hand tools ~75 O0
s',. Ul.:rigi~t. freezer 65.0U
1~. Up]'ig?,% fz'ceze~' 80.00
Hcredles safe 65.00
Iver Johnsori :nod.50 ;*idewtnder 22 95.00
qb': Sidekick 22 mod 929 100.00
Hossber~ ~OOA '12~;(t :lod B37459 165.00
Hanger 22 I2od 103-13 375.00
g~PR-28-21EI02 SUtl 01:56PH ID: Pi:t~iE: 1
appraisal
Rc,"i,~d:~,r~ 760 (larie,,~a~t,'r ~0-C6
US ~evcloer Co. 22
}000 '.]enerator ~0. O0
Fama]] I W' ~c, rn wa%er
Far::a~l A 1716 4~0.00
Cub Ca,Ici 4? uowcr ~]~c': 2~0.00
Yard ~laci]i;le riding ~::owcr 200. O0
Push-hog O' 150.00
Tot~tl A?~:'aiz~]: $5385.00
Fe~ for
Consolidated Statement VanEck
Page 1 of 2 Reporting Period: 4/1/2004 to 6/30/2004
Consolid~mi ~m~to~: Van Eck Global
h,,llh,,llh..h hlh. h,,ll ~o. P.O. Box 218407
l~nsas City, MO
PA~ E ~E~R & O~CO~SDONOT ~121-8407
BE~ A ~E~R ~ T~ ~I~ABRO~D~ER
~ 4 ONYO~ACCO~ ~nd ~c~
MEC~CSB~G PA 17050 800-826-5~
800-826-1223
Divers~ng your po~olio ~ asset classes &at are not hi~y co.elated to gene~l financi~ ~ch~es
mmke~ can lower overa~ po~olio risk and provide gro~ oppo~ni~cs. Please speak to your
Fm~c~ ad.set about your risk tole~nce and an asset ~ocafion plan &at wor~ for you. 800-345-8506
Account
Income Summary Total Manet Value 800-544~653
as of 6/30/2004 u~m~ ~
~ts ~flod Year-W-~ ~nd ~o
Dividend $0. ~ $0.00 $ 5,302.25 800-826-1115
Short-t~rm g~Olt~l Oaln $0. ~ $0.00
Lono-tgrm capital Oaln $0. ~ $0.00 W~b ~m
·otal $0. ~ $0.00 ~.~eckcom
Portfolio Summary As of 613012004
Beginning Closing % of Share Shares
balance balance assets pdce owned
Van EcR International Investors Gold-A $6,502.65 $5,302.25 100.0% $9.32 568.911
Total Equity Funde $6,502.65 $5,302.25 100.0%
Total Market Value $6,502.65 $5,302.25 100.
~ SCHEDULE F
COMMO~W~^LT. OF P~.NSYLV^N,^JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Paul E.Kieffer 2104-0497
Joint tenant(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Patricia Adams 140 Auport Drive None
Carlisle, PA 17013
Bo
Co
Jointly-owned property:
LETTER
ITEM FOR DATE TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBEE JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 4/2~/03 Certificate of Dep. Ref#
31000237867 PNC Bank
Principle $ 7,133.60
Interest $ 12.96 $ 7,146.56 50% $ 3,~.28
A 4/24/03 Certificate of Deposit
31100233783 - PNC Bank
$ 4,246.17, .75% interest
Principle $ 4,246.17
Interest $ 2.40 $ 4,248.57 50% $ 2,124.29
TOTAL (Also enter on line 6, Recapitulation) S 5,697.56
(If more space is needed insert additional sheets of same size)
.EV-t tt r2-991, SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul E. Kieffer 2104-0497
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Rothermel Funeral Home 6,989.46
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Larry F. Kteffer 7,000.00
Social Security Number(s)/EIN Number of Personal Representative(s)
StreetAddress 272 Locust Point Road
FA 17072
City New Kingstown State Zip
Year(s)Oommission Paid: half fn 2004, half in 2005
2. Attorney Fees 4,900. O0
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Letters Testementary 336.00
8. Commonwealth of Pa, Transfer Auto title 3 titles @22.50 $ 67.50
9. Commonwealth of Pa, Transfer Auto Title Pontiac $ 64.00
10. Pa License Broker, Transfer Auto Title $ 48.00
11. Central Penn Appraisal~ Real Estate Appraisal (Item Al) ~ 250.00
12. Reserved for costs of conveying real estate $ 150.00
13. Frank Potteiger, personal property appraisals $ 60.00
14. Island Appriasals, REal Estate Appraisal (Item A2) $ 300.00
15. Reserved for release, notary $ 50.00
TOTAL (Also enter on line 9, Recapitulation) $ 2,0,214.96
more space is needed, insert additional sheets of the same size)
-, ~.l~b,~,~.', SCItEDULE I
(;O~,tMt,NWEAIIlIOr r~'~lusY[v^lll^DEBTS OF DECEDENT,
.rJnrml~ll,:F ,AX .I:,ur.I MORI'GAGE/IAltI/I liPS gl" lENS
ES1A1E OF FILE NUMBER
~au~ ~. K~e~e~
Include iiIil~llllJJlllS~(I IIledlcaJ
II~Y
NUMBER DESCRIPilOII AMOUfIT
1. Ve~oD $ 28.30
2. PPaL 64.80
3. Penn ~aste 36.70
I'O1AL (Also enler on llne 10, Recepilulalion) $ 129 o 80
(11 mole si)ace is needed, insed addilionel sheels of Ihe seine size)
REV-1513 EX+ (9-00~
SCHEDULE l
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul E. Kieffer 2104-0497
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List l~ustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Larry Kieffer son entire estate
272 Locust Point Road
New Kingstown, PA
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II 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 FART Ii - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT OF PAUL E KIEFEEK
I, PAUL E. KIEFFER, of the Township of Silver Spring,
Cumberland County and State of Pennsylvania, being of sound
'n publish
and disposing mind, memory and understandl g, do make,
and declare this my Last will and Testament, hereby revoking
and making void any and all prior Wills by me at any time
heretofore made.
1.
I direct the payment of all my Just debts and funeral
expenses as soon after my decease as the same can conveniently
be done.
2.
All the rest, residue and remainder of my estate, real,
personal and mixed of whatsoeuer kind and wheresoever situate,
I give, devise and bequeath, to my wife, Betty A, Kieffer.
3.
In the event my wife should predecease me or die within
thirty (30). days of my death, then I give, devise and bequeath
my entire estate, real, personal and mixed, to my son, Larry
p. Kieffer.
4,
I nominate, constitute and appoint my wife, Betty A.
Kieffer, to be the Executrix of this my Last Will and Testament
and should she be unwilling or unable to act as such for any
reason, then in such event, I nominatg constitute and appoint
my son, Larry P. Kieffer, to be the Executor of this my Last
Will and Testament, in her place and stead.
IN WITNESS WHEREOF I have hereunto set my hand and seal
· this~ ~ ~ day of '~*~i , 1982.
Signed, sealed, published and declared by the above n~ed
Paul E. Kieffer, as and for his Last Will and Testament, in the
presence of us who have subscribed our names hereto as witnesses,
at the request of said testator, in his presence and in the
presence of each other,
REV-1162 EX(11 96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-O601 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 004355
EAKIN J MICHAEL
DISTRICT ATTORNEY'S OFFICE
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $5,562.61
ESTATE INFORMATION: SSN: 203-20-4024
FILE NUMBER: 2104- 0497
DECEDENT NAME: KIEFFER PAUL E
DATE OF PAYMENT: 09/09/2004
POSTMARK DATE: 09/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2004
TOTAL AMOUNT PAID: ~5,562.61
REMARKS:
CHECK# 1013
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Inventory of the real and personal estate of
Paul E. Kteffer deceased
PERSONAL PROPERTY
PNC Bank Account # 52472966 $ 39,03~ 80
PNC Bank Account # 50-7002-3286 $ 3,407 39
1987 Ford Truck $ 78£ 00
1998 Pontiac Bonneville SE Sedan 4D $ 2,01C 00
1984 Honda Aspencade $ 2,48~ 00
1973 Suzuki 185, Trail Bike TS185K $ 60C 00
Patriot News - subscription refund $ 121 10
Retirement check 5/17 - PNC IRA Accuont # 52472966 $ 35£ 00
Evergreen Investments Account # 340403 $ 22,311 00
Evergreen Investments Account # 150107 $ 30,787 06
Miscellaneous furniture $ 5,38~ 00
Total $107,271.35
REAL ESTATE
House and Lot of groung in Silver Spring Township $145,00£1.00
Tract of mountain land in WAshington Township Northumberland County $ 21,00~1.00
Total $166,00~ ~00
Estate Total $273,271 35
COMMONWEALTH OF PENNSYLVANIA ~L ss:
COUNTY OF CUMBERLAND ~
Larry Kieffer
being duly sworn according to law, deposes and says that he ~
of the Estate of Paul E. Kieffer
late of S~ lv~r Sp~rin~ ~o~-~Ed~LD ., Cumberland County, Pa., deceased and that the
within is an inventory made by Larry K~ffer , the said exec,,tor
of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedenf's death.
~UO{v'~ and subscribed before me,~ / ~
isfrafor
~. COMMONWEALTH OFPSNNS~VANIA 272 Locust Point Roads New KtnKsto~, PA
~fial ~al Address
M~nni~t-g ~, Oum~ ~
My ~m~ ~j~ JU~ 27, ~7
Dele of Denfh
Day ~onfh Year
INSTRUCTIONS
I. An inventory must be filed wlfhin three months after appointment of personal represenfaflve.
2. A supplement inventory must be filed wlfhln fhlrty days of discovery of additional assets.
3. Addlflonal sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
COHMONWEALTH OF PENNSYLVANZA ~.
BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE
INHERITANCE TAX ~VISION
DEPT. 180~ '
HARRISBU~ 'A I7ZZ8-0601 NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX R£V-lS4?EXAFP(01-O$)
i- DATE 11-08-200q
ESTATE OF KIEFFER PAUL E
DATE OF DEATH 05-17-200q
FILE NUMBER 210q-Oq97
..... ~ COUNTY CUMBERLAND
JOHN M EAKIN ACN 101
MARKET SQUARE BLDG Amount Remitted
MECHANICSBURG ~pA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THXS LXNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-15~7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT; ALLOWANCE OR
DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KIEFFER PAUL E FZLE NO. 210q-Oq97 ACN 101 DATE 11-08-200q
TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 166z000.00 NOTE: To insure proper
2. Stocks end Bonds (Schedule B) (2) .00 credit to your account,
$. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 submit the upper port/on
q. Mortgages/Notes Receivable (Schedule D) (q) .00 of this form with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 112;260.70 tax payment.
6. Jointly Owned Property (Schedule F) (6) 5;697.56
7. Transfers (Schedule G) (7) .00
B. Total Assets (8) 285,958.26
APPROVED DEDUCTIONS AND EXEMPTIONS: 20,21q.96
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 129.80
11. Tote1 Deductlons (11) ~g.~qq.7&
12. Net Value of Tax Return (12) 265,615.50
15. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
lq. Net Value of Estate Sub~ect to Tax (lq) 26~,615.50
NOTE: Z~ an assessment ~as issued previously, lines lq, 15 and/or 16, 17, 18 and 19 ~111
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate (15) .00 X O0 = .00
16. Amount of Line lq taxable at Lineal/Class A rate (16) 257,915.9q X Oq5: 11,606.22
17. Amount of Line lq et Sibling rate (17) . O0 X 12 = .00
18. Amount of Line lq taxable at Collateral/Class B rate (18) 5,697.56 X 15 = 85q.65
19. Principal Tax Due (19)= 12, q60.85
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-16-200q CDOOqZ7~ $15.79 6,000.00
09-09-200q CD00~$55 .00 5,561.61
PAYMENT MUST BE MADE BY 02-17-2005~. TOTAL TAX CREDIT I 11,878.q0
BALANCE OF TAX DUEl 582.q5
TNTEREST AND PEN. .00
TOTAL DUE 582. ~5
~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS RE{~UIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. TF TOTAL DUE TS REFLECTED AS A 'CREDTT" (CR), YOU MAY BE DUE~/~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decadents 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 lawfuI Class B (collatarat) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S.
Section 91~0).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on tho reverse side.
--Make check or money order payable to: REG/STER OF NILES, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on tho Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at the Office
of the Register of Wills, any of the 22 Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers eith special hearing and / or
speaking needs: 1-BOO-~7-50ZO (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of race[pt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1011, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADmIN-
ISTRATIVE
CORRECTIONS: Factual mrrors discovmrad on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Rmv[aw Unit, Dept. 280601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of tho booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (2) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is allowed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the tote1 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 tho same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day frae the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (6Z) percent par annum calcuIatmd at a daily rate of .00016~. A11 taxes which became delinquent on and after
January l, 1981 mill 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 X98Z through ZO0~ ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .O005~D 1988-1991 XXZ .000301 ZOO1 9Z .0001~7
1962 161 .000q58 1991 91 .0001~7 ZOOZ 61 .D0016~
198~ 111 .000501 1995-199~ 7X .000192 2002 51 .000157
1985 15X .000~56 1995-1998 91 .0002~7 200~ ~Z .000110
1986 102 .00027q 1999 71 .000191
1987 iOZ .00017~ ZOO0 71 .000191
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
REV-1470 EX (6-88) *
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Paul E Kieffer 2104-0497
REVIEWED BY ACN
Deborah Washington 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
F 1&2 These accounts are taxable outright to the beneficiary before determining residue.
ROW Page 1
JOHN M. EAKIN
A'I-I'DRNEY AT LAW
MECHANICEJBURB, PA. 1'7055
November 10, 2004
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013 . ~ .:-'
Re: Paul E. Kieffer Estate No. 04-0497
Gentlemen:
Enclosed is a check in the amount of $582.45 shown on the attach_ed audit.
Very truly yours,
John M. Eakin
COMMONWEALTH OF PENNSYLVANIA REV 11 62 EX(11-96)
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004706
KIEFFER LARRY P
272 LOCUST POINT ROAD
NEW KINGSTOWN, PA 17072
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
....... fold ..........
101 $582.45
ESTATE INFORMATION: SSN: 203-20-4024
FILE! NUMBER: 2104-0497
DECEDENT NAME: KIEFFER PAUL E
DATE OF PAYMENT: 12/07/2004
POSTMARK DATE: 12/07/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2004
TOTAL AMOUNT PAID: $582.45
REMARKS:
CHECK//1018
INITIALS: MW
SFAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TARftC::r-;iJi crTj('C ()C INHERITANCE TAX
INHERITANCE TAX DIVISION ' J1.; ..' 'I, ,':/L ~,I STATEMENT OF ACCOUNT
PO BOX 280601 .," ,I ! "-:
HARRISBURG PA 17128-0601 '
*'
REV-1U7 E~ AFP 112-041
ZOD5 JI~N 21, AM 8: 21
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-10-2005
KIEFFER
05-17-2004
21 04-0497
CUMBERLAND
101
PAUL
E
CL"'I:,i( n,:
.L" ......-,
Oppl ,t, '. ','n ('~(\! If''''''''
"": n'\''''~ ,~) ;U\Ji.}j"", i
JOHN M EAKI6U!.' , . "
MARKET SQUARE BLDG
MECHANICSBURG PA 17055
Amount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this for.. with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~~:r&~~.!5r.~~J..rGl~.6J'.......i...:rA~!~e1r",A5r.~tA.,tA~.b1r.Aec:60~...j(i.....................
ESTATE OF KIEFFER PAUL E FILE NO.21 04-0497 ACN 101 DATE 01-10-2005
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SU""ARY OF THE PRINCIPAL TAX DUE, APPLICATIDN OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 11-08-2004
PRINCIPAL TAX DUE:,
12,460.85
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-16-2004 CD004273 315.79 6,000.00
09-09-2004 CD004355 .00 5,562.61
12-07-2004 CD004706 .00 582.45
TOTAL TAX CREDIT 12,460.85
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $l~
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)..
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
s-b
<+-
Commonwealth of Pennsylvania
Department of Revenue
Bureau oflndividual Taxes
PO Box 280601
Harrisburg P A 17128-0601
"
)":i i'{~
I~~
~<!
::.~~
'-'i.....
w<n
"''''
0.;;;
..~ ('
UL
",'-",
;..;, ...
At ,.tj
M4iLm ill R[AL,i'~G F'A.
H METER'7
MS GLENDA FARNER
REGISTER OF WILLS
CUMBERLAND CO COURTHOUSE
1 COURTHOUSE SQ
CARLISLE PA 17013
"
,
I
~ \)
"2;.
r-',,)
r<}
L.'.I._F:5t"I!s :l. 70:\. ::;:
1...111...111......11.,11".11...11.11...,..1111...,.,1111...1
--.~
> ",,'"
"
Patricia Adams
140 Ailport Dr,
Carlisle, P A 17013
I
-
I ,..;,\lRGp -
~ --
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG PA 17128-0601
('J
'-C) -,"t
'\',P
",\'- ~"~~;
;\ ."~"))I
" I: r') /" /
Jl-A/'
E-143 ex (3-99)
Zip Code
Attention: TIC 340
111.111.11111.11..1.11111.111111111111.1111111.11111
DEX55 (9.93)
'*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
Dear Register of Wills: /' . ,.,
Enclosed you will find: ~heck(s) Ddacuments(s) which were received by the D~p:arment ~:Revenu~in error.
These may be processed according to normal procedures. ., .,' i
_:) J
REMINDER: The POST MARK DATE on envelope attached to any checks enclosed mu:stJ appeOrcln your
Official Receipt. : h' I
Thank you.
Sincerely,
John Murphy, Chief
Inheritance Tax Division
(717) 787-6201
I'.J
N
f'..)
~._'_.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
.TAXPAYER RESPONSE
FILE NO. 21 04-0497
ACN 04130956
DATE 08-30-2004
REV-l!lU-UAFPI09.,DDl
TYPE OF
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
TO:
.-,'
,... .,-
::j'
Iii
EST. OF PAUL E KIEFFER
22s.s. NO. 203-20-4024
DATE OF DEATH 05-17-2004
COUNTY CUMBERLAND
** PATRICI ADAMS
7039 WERTZVILLE RD
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS
REGISTER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infor.ation is incorrect, please obtain written correction fro~ the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31700237867 Data 02-23-2004
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
4,144.36
100.00
4,144.36
.15
621.65
To insure proper credit to your account, two
(2) copies of this notice .ust accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are .ade within three
(3) months of the decedent's date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]li!i!i!~I~~.iiii.!i!!_lIiii!!j~~~!!!i!"~!!!!i~~ii!i~~1i!i~Ui~~!~Ij!!i!i~.!iii~n~ll_iii!Rali!iil!1!i!!.~~ii!ii~F~~I!!!iil
[CHECK ]
ONE
BLOCK
ONLY
A. D The above inforllation and tax due is correct.
1. You .ay choose to rellit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Department of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. 0 The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART @] below.
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
~. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship. to decedent:
OF
1
2
3
4
5
6
7
8
x
x
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicabh interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxabla even though the decedent.s name was added as a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint namas within one year prior to
death arB fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accaunts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the information and cOllputation in the notice are correct and deductions are not being claimed, place an "X"
in block "An of Part I of the nTaxpayer Response" section. Sign two copies and submit thell with your check for the a_aunt of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assess_ent
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. 8LOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent"s representative, place an nxn in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notIce in for_at ion is incorrect and/or deductions are being clailled, check block "C" and COllplete Parts 2 and 3
according to the instructions below. Sign two copies and submit the_ with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official asseSSMent (Form REV-1548 EX) upon receipt
of the return frog the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the _anner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint na_es within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the nu.ber of accounts held.
If a double asterisk (MM) appears before your first na_e in the address portion of this notice, the $3,000 exclusion
already has been deducted fro. the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than Jne year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exa.ple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100
16.7~ (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individualCs) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
)( 100
PERCENT TAXABLE
Exa.ple: Joint eccount registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is deter.ined by .ultiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The a.ount taxable (line 6) Is determined by sUbtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the apprepriate tax rate (line 7) as determined belew.
_The tax rate 1mposed on the net value of transfers fro. a deceased Ch1ld twenty-one years ef age or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether er not they have been adopted by ethers, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in com.on with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3Y. 6Y. 15Y. 15Y.
01/01/95 to 06/30/00 OY. 6Y. 15Y. 15Y.
07/01/00 to present OY. 4.5%- 12Y. 15Y.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deter.ined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish preof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" xII", Preof of
payment may be requested by the PA Depart.ent of Ravenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ADAMS PATRICIA
7039 WERTZVlllE RD
MECHANICSBURG, PA 17050
nn_n_ fold
ESTATE INFORMATION: SSN: 203-20-4024
FILE NUMBER: 2104-0497
DECEDENT NAME: KIEFFER PAUL E
DATE OF PAYMENT: 02/22/2005
POSTMARK DATE: 02/08/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2004
NO. CD 004976
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
04130956 I $621.65
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$621.65
REMARKS:
CHECK# 01190369
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2.80601
HARRISBURG, PA 17128-06Dl
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 04-0497
04130957
08-30-2004
REV.15lf3EXAFPIIl9-00}
?Z Pi] 2: 22 EST. OF PAUL E KIEFFER
5.5. NO. 203-20-4024
DATE OF DEATH 05-17-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
[,.
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PATRICIA ADAMS
7039 WERTZVILLE RD
MECHANICSBURG PA 17050
PNC BANK has provided the Depart.ent with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co~.onwealth
of Pennsylvania. Questions may be answered by callina (717) 787-8327.
COMPLETE PART 1 BELOW . .
Account No. 31100235783
. SEE REVERSE SIDE FOR
Date 04-24-2003
Established
FILING AND PAYMENT INSTRUCTIONS
Account Balance 4,280.22
Percent Taxable X 50 . 000
Allount Subject to Tax 2, 140 . 11
Tax Rate X .15
Potential Tax Due 321 . 02
PART TAXPAYER RESPONSE
[!] .i~~.ll!l!.!!!l*,_l!l!l~~~~!l!!!l!l.!.'i-! ii ~~!m!~l!l1I~'!!I!!!.l!'ij~~lj~~i!~iP!m'lm!l~g;!ml~!J~~!':!:':!:i:!:i:_'I'I*,~~~!I!I~I!1'~~~~'I'II!!~~CI!!!!!!!!1
~~,.~"',.~",.,.,.,.,.,.,.",.,.,.,.,.",.,.",.,.,,,.,.,.'.'.'.'n.""""""""""""""""''''''''''''''''''":':':'''~':''~~'''~ll!ili:~':::''''''''''~':'~''''~'''~'''~'''':'!l'':ii~::+:"~~."'''''''''''':':''''
',.,."'',.,.:,,.:.!.:.:.:.:.,,,.,.,.,.'.'.'.'.'.'.'.'.'.'''.'.'.'.'.'.'.'''.'.'.'.'.'''.'.'.'.'.'.'.'.'.'.""'.'.'.'.'".'''''''''''''''''''''''''''''''''
To insure proper credit to your account, two
(Z) copies of this notice ~ust accompany your
payment to the Register of Wills. Make check
payable to: "Register of WillS, Agent".
NOTE: If tax pay.ents are made within three
(3) ~onths of the decedent's date of death,
you .ay deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above information and tax due is correct.
1. You may choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART ~ below.
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Allount Subject to Tax 4
5. Debts and Deductions 5
6. Allount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate} please state your
relationship to decedent:
x
x
PART
I!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax COllputation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation
submitted by the financial institution.
Z. Inheritance tax beeo.us delinquent nine months after tha decedent's date of death.
3. A joint account is taxable even though the decadent's name was added as a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable.
6. Accounts hsld by a decedent "in trust far" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the information and co.putation in the notice are correct and deductions are not being Claimed, place an "X"
in block "A" of Part 1 of the "T8xpayer Response" section. SIgn two copies and submit them with your check for the a.ount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an officIal assess~ent
(For. REV-I548 EX) upon receipt of the return fro~ the Register of wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, plBce an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the pA Department of Revenue, BureBU of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and sub.it thell with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Departllent of Revenue will issue an official assess_ent (For~ REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the manner existing at date of death.
For a decedent dying Bfter 12/12/82: Accounts which the decedent put in joint names within one (I) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted fro. the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. Tha percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one yeJr prior to the decedent.s death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) ; .167 X 100
16.7~ (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exa~ple: Joint account registered in the name of the decedent and two other persons and est8blished within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50 X IDD 50~ (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The a.ount taxable (line 6) is deter~ined by SUbtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
MThe tax rate l.posed on the net value of transfers from a deceased child twenty-ane years of age or younger at
death to or for the use of a naturel parent, an adoptive parent, or a stepparent of the child is O~.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
nBtural parents and their descendents, whether or not they have been adopted by others, adoptad descendents and their descendants
and step-descendants. "siblings" are defined as individuals who have at least one parent in comman with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Dat. of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 1.5%
07/01/00 to present 0% 4..5%- 12% 15%
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deter~ined as follows:
A. You legally are responsible for pay~ent, or the estate subject to administration by a personal representative is insufficient
to pay the deductible ite.s.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being clai.ed .ust be itellized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x n". Proof of
paYllent .ay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ADAMS PATRICIA
7039 WERTZVlllE RD
MECHANICSBURG, PA 17050
u_nn_ fold
ESTATE INFORMATION: SSN: 203-20-4024
FILE NUMBER: 2104-0497
DECEDENT NAME: KIEFFER PAUL E
DATE OF PAYMENT: 02/22/2005
POSTMARK DATE: 02/08/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2004
NO. CD 004977
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
04130957 I $321.02
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$321.02
REMARKS:
CHECK# 01190368
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Paul E. Kieffer
Date of Death: 5/17/2004
Will No. 21-04-0497
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans I
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 . State whether administration of the estate is complete:
Yes X No
2 . If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete :
3 . If the answer to No. I is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
b. The separate Orphans I Court No. (if any) for
the personal representative's account is:
c . Did the personal representative state an
account informally to the parties in interest ? Yes X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date: 4/11/2005
Q=L
,~ b\
Signatur
~L
,'::>
John M. Eakin
Name (Please type or print)
Market Square Building
Mechanicsbura PA 17055
Address
'~
:... ~
( 717 ) 766- 3172
Tel. No .
Capacity :
Personal Representative
X
Counsel for personal
representative
cPf
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INDIV~(:~~(S
INHERITANCE TAX DIVito.'__,
PO BOX 280601 , .
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
jLr: --6
,..., ~,~
rJ j <:~: ,; D
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-07-2005
KIEFFER
05-17-2004
21 04-0497
CUMBERLAND
203-20-4024
04130957
AIoo...t R_itted
PAUL
E
PATRICI~U:.'- ADAMS
7039 WERTZVILLE RD
MECHANICSBURG PA 17050
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-;[I'1ri!sr~~.~GJ:-1nI'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-07-2005
ESTATE OF KIEFFER
PAUL
E DATE OF DEATH 05-17-2004
CDUNTY
CUMBERLAND
FILE NO. 21 04-0497
TAX RETURN WAS:
S.S/D.C. NO. 203-20-4024
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04130957
FINANCIAL INSTITUTION: PNC BANK
ACCOUNT NO.
31100235783
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 04-24-2003
Account Balance
Parcant Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
4,280.22
0.500
2,140.11
.00
2,140.11
.15
321.02
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER DF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-08-2005 CD004977 .00 321. 02
TOTAL TAX CREDIT 321.02
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU KAY BE DUE A REFUND.
S~E REVERSE srDE OF TNYS FORM FOR YNSTR~TTONS_ 1
C\ S"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU DF INDIV~LT...j(j;S
INI-ERITAHCE TAX DIYISIONu
PO BOX 280601
HARRISBURG PA 171Z8-D601
NDTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLDWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
,JU":-6 (;;2:35
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-07-2005
KIEFFER
05-17-2004
21 04-0497
CUMBERLAND
203-20-4024
04130956
A_...t R_i tted
PAUL
E
PATRICC3"-AMfliS
7039 WERTZVILLE RD
MECHANICSBURG PA 17050
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 ~
1~-:r.I'1ri!I:~~.~a~""....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-07-2005
ESTATE OF KIEFFER
PAUL
E DATE OF DEATH 05-17-2004
CDUNTY
CUMBERLAND
FILE NO. 21 04-0497
TAX RETURN WAS:
S.S/D.C. NO. 203-20-4024
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04130956
FINANCIAL INSTITUTION: PNC BANK
ACCOUNT NO.
31700237867
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 02-23-2004
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Daductions
Taxable Amount
Tax Rate X
Tax Due
4,144.36
1. 000
4,144.36
.00
4,144.36
.15
621.65
NDTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PDRTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCDUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-08-2005 CD004976 .00 621.65
TOTAL TAX CREDIT 621.65
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FDRH FDR INSTRUCTIONS. J
<::> c-..,,"-