HomeMy WebLinkAbout04-0041 PETITION FOR PROBATE and GRANT OF LETTERS
or' No.
also known as To:
· Deceased.
Social Security No. ! ~ ~.' lb' L~, q ~. !
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execu.t~l g
in the last will of the above decedent, dated ~-P'rE~IOgAq i q ~ t/~ t/q
and codicil(s) dated
Register of V3/ills for the ~
County of IL~LM~£R-L~)'I0 in the
Commonwealth of Pennsylvania
named
,19__
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in {ti/APl~F_/~L~it~ _~ Counly, Pe~n .n~lvaniq~ltith..~,, .,, ~
last family or principal residence a~ r~_0~ tQo~/A/qbt8 ,~. t)~, }(/~t0/~ HILL; ?gl /'[L///-LD-/~
(list street, number and muncipality)
De.cendent, then ~q years of ate, died Di~Et~J~ ~ ~'/'~ ,4~,,t~ ~)~q,
at ~O~.,V <~PliP.~T' Hr~P~rlq~; ~b-~.GT l~.),4.~t~t)~'"t'"/~p~/~/'Ol~f/~t.t.. [/t/J- '/r/~)~J
Except as follows, decedent did not marry, was not divorced and did no~ have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ..
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in P~enns¥1vania
situated as follows:
$ -., 0 ~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters tO g' -f"~7'/~ t~l~DT~ fi??
theron.
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF /q_, ~1 t3 EtO. Lgt D 0J~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well/and truly a~lminister tahe estate according to law.
Sworn to or affirmed and subscribed ~- ~Oj~. ~ ,~,1~, ~
,,~ before me this . 13th __ day of [ ~6 i~ i.g. D6 D ~ I~/J ~ ~ ' zx- ~ ~'
Glencta Farner Str~,baugh .~~x~- ~
No. 21-2004-0041
Estate Of Willia~ W, Gluck , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ,l~nn~ry 14~-h .1~, in consideration of the petition on
· the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated September 17th, 1974
described therein be admitted to probate and filed of record as the last will of
William W. Gluck ;
and Letters Tel~ltanentary_
are hereby granted to Susan Gluck Stathes, now, known' a~, 'SU~' J. Stathes
FEES
Probate, Letters, Etc .......... $ 235.00
Short Certificates(5 ) .......... $ 15.00
Renunciation .1 .............. $ 5.00
x=Pages 1 3.00
JCP Fee $ iO.OO
copies TOTAL __ $ 2.00
Filed .J..aO.u..aA'Y...1.4 .... .299.4. ..... s..77.o.:99,
Mailed Letters to Executrix on 01-14-2004.
Glenda Farner'strasbaugh ~ - ' -/-- ~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
REGISTER OF WILLS OF COUNTY
~OATH OF SUBSCRIBING WITNESS
k codicil
(each) a subscribing witness t6x,t, he will presented herewith, {~ach) being duly qualified according to
law, depose(s) and say(s) that
//' present and saw
the testat. , sign the same and that / signed as a witness at the
request of testat.~ in h presenc'~,,and (in"the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before'
me this day~6f
19. '
Register
(Name)
(Address)
(Nitrne)
(Address)
21-2004-0041
REGISTER OF WILLS OF CL~b~rlsnd COUNTY
' OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
They are familiar with the signature of William W. Gluck
codicil
testat.or of ~x~i~Xt¢o) the (will)presented herewith and
codic~
that thy believe :l~[ilmexthe ig~t~on~ ~~itingof
tO the best of their _ knowledge and belief.
Sworn to or affj~m~ and subscribed before
me this day of
-
~ ~ (Addrqss)
GIenda F~er Strasbaugh~
(NamO
(Addressj
RENUNCIATION
21-2004-004~
_ deceased.
To the Register of Wills of
County, Pennsylvania.
The undersigned ' '
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
WITNESS .~~ hand this ~77~ day e~~, _.
of ,20
(Signature)
(Address) /
(Signature)
(Address)
(Signature)
(Address)
his 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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9811729
No.
cal Registrar
2_OO3
Date
NAME OF DECEDENT (F ~r.~ Mg$~le.
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
William W. Gluck
6-4-19 ,~ Hi] ], PA
UH~)~R 1 DAY
84 ~.,.. : ;
Cumberland E. Pen~
ARMED FORCES?
17,. aa. Ppnn~?l~r~n; ~
C~berland
Cat. Tractor
2000 Columbia Avenue
Camp Hill, PA 17011
Walter Gluck
Susan Stathes
~.~n ~ 12-16-03
:lATE OF DEATH, MCa~Jt. D~y. '/la0
.~--~- 0 ,, rO~*'
17d'r~w4h~nictt~limaaM ~ .....~ ] 1
255 PA 17319
~l]~ng ~een ~. P~k H~]], PA 17011
FH 1903 Mkt St PA 17011
I~lk'~ATl CAUSE (Fma;
(Momh. Day. Y~)
21-2004-0041
LAST WILL AND TESTAMENT
OF.
WILLI~AMW. GLUCK'
I, WILLI'AM W. GLUCK of Camp Hill, Cumberland County.,
Pennsylvania, declare this to be my Last Will and Testament, here-I
by revoking any will previously made by me.
I - I direct payment of my just debts and funeral
expenses out of my estate as soon as practicable following my
death.
ARNOLD, SLIKE & BAYLEY
ATTORNEYS AT LAW
II - I devise and bequeath all of my estate of every
nature and wheresoever situate to my wife, Betty J. Gluck, pro-
vided she survives me by sixty (60) days.
III - Should my said wife fail to be living on the
sixty-first (61st) day following my death, then I devise and
bequeath all of my estate to my children, William R. Gluck and
Susan Gluck Stathes, in equal shares per stirpes.
IV'- Ail taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed
shall be considered a part of the ex~penses of the administration
of my estate and my personal representative or representatives
shall have the absolute power in her or their discretion to pay
the same at once whether or not the law under which they are
imposed permits the postponement of all or part of them to a later
time.
V.- I nominate, constitute and appoint my wife, Betty
J. Gluck, Executrix of this my Last Will and Testament. Should
my said wife fail to qualify or cease to act as such, I appoint
my children, William R. GluCk and Susan Gluck Stathes, to act
~/[;[~ .~~ Page 1
AILI~OLD, SLIKE & BAYLEY
ATTORNEYS AT LAW
in this capacity. My personal representatives shall not be re-
quired to post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on
this, the // day of '.~/~/'{~:~ , 1974.
William W. Gluck
(SEAL)
Signed, sealed, published and declared by WILLIAM W. GLUCK,
Testator therein named, on this and one (1) other sheet of paper
as and for his Last Will and Testament in our presence, who, in
his presence, at his request and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
Name
! Address/.
Page 2
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death: ~~~
Will No. ~~~ ~/ A dmin. No. ~/~ ~ ~/
To the Register:
I ce~ify ~at notice of (beneficial intent) ~te ~ministration required by Rule 5.6(a) of the O~h~s' Cou~ Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
]Name
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Capacity: ~//~Personal Representative
Counsel for personal representative
Register of Wills
Cumberland County Courthouse
Hanover & High Street
Carlisle, PA 17013
Subject: Estate of William W. Gluck
File No: 2004-00041
Enclosed is an estimated payment in the amount of $
for the PA Inheritance Tax.
~o DO0, aa
Check No.: 01~ _
Susan J. Stathes, Executrix
Susan J. St~thes
2~5 Fairway Dr
Etters, PA 17319
'Re~ister of Wills
Cumberland county Courthouse
_~_~iHanover and High Street
~-~arlisle, PA 17013
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 003627
STATHES SUSAN GLUCK
255 FAIRWAY DRIVE
ETTERS, PA 17319
NKA
........ fold
ESTATE INFORMATION: SSN: 184-12-2927
FILE NUMBER: 2104-0041
DECEDENT NAME: GLUCK WILLIAM W
DATE OF PAYMENT: 03/02/2004
POSTMARK DATE: 03/01/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 12/13/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $7,000.00
REMARKS:
TOTAL AMOUNT PAID'
$7,000.00
SEAL
CHECK#014
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEFARTMENTOFREVENUE
BUREAU OF~ND~VIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11 96J
NO. CD 004282
STATHES SUSAN GLUCK NKA
255 FAIRWAY DRIVE
ETTERS, PA 17319
ESTATE INFORMATION: SSN: 184122927
FILE NUMBER: 2104-0041
DECEDENT NAME: GLUCK WILLIAM W
DATE OF PAYMENT: 08/17/2004
POSTMARK DATE: 08/1 7/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/1 3/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $284.00
REMARKS: S J STATHES
TOTAL AMOUNT PAID:
$284.00
SEAL
CHECK#1010
INITIALS: VZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
OMMONWEALT,OF I REV- 1500
PENNSYLVANIA ~
DEPARTMENT OF REVENUE [
INHERITANCE TAX RETURN
[ RESIDENT DECEDENT
FIL-E NUMBER
COUhT~ CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
ECEBENT'S NAME {LASI, FIRST. AND MIDDLE INITIAL)
) SURVb/ING SPOUSES NAME (LAST FIRST. E INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
~OCIAL SECURITY NUMBER
Z
lt.]
n,
Z
0
(2)
2 Stocks and Bonds (Schedule B)
3 Closely Held Corporation Partnership or Sole-Proprietorship (3)
4 Modgages & Notes Receivable (Schedule D)
5 Cash. Bank Deposits & Miscellaneous Personal Properly
(Schedule E)
6 Jointly Owned Property (Schedule F) (6)
~_1 Separate Billing Requested
7 inter-Vivos Transfers & Miscellaneous Non Probate Properly (7)
(Schedule G or L)
8 Total Gross Assets (total Lines %7)
9 Funeral Expenses & Administrative Costs (Schedule H) (9)
10 Debts of Decedent, Modgage Liabilities, & Liens (Schedule I/ 1/0)
11 Total Deductions (tolal Lines 9 &
12 Net Value of Estate (Line 8 minus Line lt)
(4)
13 Charitable and Governmental BequestsfSec 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)
-£ )
(lt)
02)
113)
114)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15 Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec 9 6 (a)(1 2)
16 Amount of Line 14 taxable at lineal rate
1,7 Amount of Line 14 taxable al sibling rate
18 Amount of Line 14 taxable at collateral rate
x 0 _. ¢5)
x 12
x 15 118)
19 Tax Due
Decedent's Complete Address:
t la~ !.,,~,r trM!e 1 Lir'e 19)
,5 lfliqel+Line3i'~gre_qtertbanLh~e2, enerlhednference ~h~slsttleTAXDUE.
BEn ,.'r tie t:,!al of Line 5 4 T ~ J the B.. ANCE DUE.
%'tel Credits (A + B 4 C ) (2) ~.' .... ;
Tolal InteresbPenally ( D + E )
(~)
_ z.':
.
Make Check Payable to: REGISTER OF WILLS, AGENt
FLEASE ANSWER THE F'OLI.OWING QUESTIONS BY Pt. AC~NG AN "X" IN THE
a retain tho use or income (ff the propm[y transferred;
b retain tl~e right to desiePa!e who shall use the property transferred or gs income:
d receive the p~omise for lite of eithm payments, henefits oi care?
~,,iihoM ~ec{ivin i adeguale considem[iorl?
3 Old decmrent own an "in leust fo~" o~ payable upon dPath hank acco,mt or se~ urity at his o¢ her
contains a beneficiary designation?
~F ~tlE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU ~USf COf,IPLETE SCHEDULE
ADURES!
ADE
Fei dates of death on or after ,July 1, 1994 and before January 1, 1995, tile tax rate imposed on tho net value of transfers lo or for [he u,;¢ o[ i!n s ~Tev~n[~ rxx ,, i~ ~
{z2 PS. §9t1~ (a) (1,1) (i)l
For dates of death on or after January 1, 1995, the I~x rate imposed nn the net value of transR~rs to or for the use o1 lhe ~umiving sp,~use is 0% [/'2 P S §d !!
]he sla!ute does eel exempt a Iransfer lu a surviving spouse from ta~:, and the stalutory requirements far disclosule or ~?sols arv] ~,li, g ~ t;~: r~tum m s',l! upp~ic.¢fie e,,~n ir
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 transfera from a deceased child twenty one years of age or younger at death to or for the use ufa nature! parent, :m ad ~p',i~.e
or a stepparant of the child is 0% [72 RS §9116(a)(1
The tax re!e imp,~(d on the net v~lue of transfers to or for the use of the decedent's lineal benel[ciedes is ,4,5%, except 3s n,pted in 72 PS §9119(12) [?2 PS §91
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. §9116(a)(1 3)] A sibling is defined, under Section 9102, as an
individual who has et least one parent in common with the decedent, whether by blood or adoption.
REV 1502 EX~ (698)
9,!!. o
ES f/' [E OF
REAL ESTATE
FILE N'J~Z~3ER
Real p~opcrty whfch is iointfy-owned ~'4th right of survivorship must be dis¢l~)sed on Sohodule F
L
TOTAL (Also enter on line 1, Recapitulations) ~.,,,.! ,.~'
(If more space is needed, insed additional sheets of the same size)
TOTAL (Also enter on tir~e 5, Recapitulation) t --
I1 moie space s needed inset add ionaf see s o he same size)
SCHEDULE G
I~ITER-VIVOS .~ ¢., ~
]'RA,~oF,_RS &
NON-FROBATE PROPERTY
FILE ~ ......
OL¢~I¢ JW'EAL~H OF PEHH~'fl VANJA ~ FUNERAl. EXPENSES &
RFSff)ENF E~ E-rffrj[ ADMINISTR~EIVE COSTS
/-/~ ,~Z~.'-~ ~.~.~._ ~ ._ .~.. '"~:":'."
-~ ~ ........ TOTAL (Also enler on line 9. Recapitulation) $
TOTAL OF PART II - ENTER IOTA[ t~lON TAXA[31E DISTFIIBUTIONS ON LINE 13 OF REVdS00 COVER S IEET
SETTLEMENT STATEMENT PAN~ALONI I 7. LOAN NL}~t~:
211 City Tax to l-- ~a x -- to -- ~F
214 ~1~~.
~C GrOsS Amoun~ue Fron~ower (Line ~ 20) 1~552 44 ~ ~ount Due To Seller (Lin~ 420) ~
30. ITEMS REQUIRED BY LENDER TO BE pAID IN ADVANCE
1100. TIILE CHARGES
to PURITYABSIRACl COMp^NY
to
P oT175
)
35 OD
3500
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201 Record.lg Fees: Deed $ 3950; Mortgage $ 64 50; Releases
1204
1205
1300. ADDITIONAL SErTLEMENT CIiARGES
1,324 5C
& RADON lES% POC
Gl 12500
5,6831 9,87500
Certified to be a true copy
2003-04 HEAL ESTATE TAX NOTICE
CAMP RILL SCHOOL DISTRICT
MICHAEL W HARLING
206 S 17TH ST
CAMP HILL PA 17011
** SCHOOL ** JULY 1 2003 107,620 1006
ItWEDNESDAY 9:00AM TO 2:OOPM
4:00PM TO 6:00PM
PHONE 717-730-0230
Ii ~ ,iDiSCOUNT IjGLY - AUG 1,257.17
L, ~ FACE :SEPT - OCT I , 282.83
~ ,pENALTY NOV - DEC 1,411.11
~ ~ 2000 COLUMBIA AVENUE
~Hesidential Building
IF 0NPAID BY 12/12/03 TAXES WILL BE
TUHNED OVER TO CUMBERLAND CO.
FOR ADD'L HECEIPTS REQIIESTED
T}{IS BILL TO YOUH MOHTGAGE COMPANY $1.00 FEE
LAST WILL AND TESTAMENT
OF
WILLI~4 W. GLUCK
I, WILLIAM W. GLUCK of Camp Hill, cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, here
by revoking any will previously made by me.
I - I direct payment of my just debts and funeral
expenses out of my estate as soon as practicable following my
death.
II - I devise and bequeath all of my estate of every
nature and wheresoever situate to my wife, Betty J. Gluck, pro-
vided she survives me by sixty (60) days.
III - Should my said wife fail to be living on the
sixty-first (61st) day following my death, then I devise and
bequeath all of my estate to my children, William R. Gluck and
Susan Gluck Stathes, in equal shares per stirpes.
IV - All taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed
shall be considered a part of the e~+penses of the administration
of my estate and my personal representative or representatives
shall have the absolute power in her or their discretion to pay
the same at once whether or not the law under which they are
imposed permits the postponement of all or part of them to a late~
time.
V.- I nominate, constitute and appoint my wife, Betty
J. Gluck, Executrix of this my Last will and Testament. Should
my said wife fail to qualify or cease to act as such, I appoint
my children, William R. Gluck and Susan Gluck Stathes, to act
Page 1
in this ca~,acity. My personal representatives shall not be re-
quired to post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on
(SEAL)
William W. Gluck
Signed, sealed, published and declared by WILLIAM W. GLUCK,
Testator therein named, on this and one (1) ocher sheet of paper
as and for his Last Will and Testament in our presence, who, in
his presence, at his request and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
}" ~ ' ' ' ~ ( -- Address
Name Address
Page 2
~LEASE 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:
Estate 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:
State whether administration of the estate is complete:
Yes /~. No
Date
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 /~ _
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes ~ No
D. Copies of receipts, releases, joinders .and approvals of fora]al or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
tot sr po .
Name (Please type or print)
(MAH:rmt/AM3)
Telephone No.
Personal Representative
Counsel for Personal Representative
R..W. - §~
BUREAU OF INDiViDUAL TAXES
iNHERITANCE TAX DTVZSION
DEPT.
HARRTSBURG, PA 17128-0601
COHHONgEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF iNHERiTANCE TAX
APPRAZSENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
RE¥-15¢i? EX AFP C01-03)
SUSAN J STATHES
255 FA[RWAY DR
ETTERS
i:~::' WILLIAH W
'04 ~CT 13
BATE 10-11-2004
ESTATE OF GLUCK
BATE OF BEATH 12-15-2005
FiLE NUHBER 21 04-0041
COUNTY CUHBERLAND
ACN 101
I Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 170I$
CUT ALONG THiS LiNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 4
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF GLUCK WZLLZAH WFZLE NO. 21 04-0041 ACN 101 DATE 10-11-2004
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE iNTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORigiNAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership .rntarest (Schedule C) (3)
~. Nortgagas/Notes Receivable (Schedule D) (~)
$. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Dabts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Nat Value of Tax Return
15.
1~.
NOTE:
1521450.00
.00
.00
.00
251268.00
.00
41~656.00
(B)
29,505.00
CharitabXe/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
Zf an assessment was issued previously, lines 1~, 15 and/or
.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
199,$54.00
(11) 29.305. O0
(12) 170,049.00
(].$) . O0
(14) 170,049. O0
16, 17, 18 and 19 will
reflect figures that lnclude the total of ALL returns assessed to date.
.00 x
(16) 170,049.00 x
.00 x
.00 x
ASSESSHENT OF TAX:
15. Amount of Line 1~ at Spousal rate (15)
16. Amount of Line 1~ taxable at Lineal/Class A ra~a
17. Amount of Line 1~ at Sibling rata (17)
18. Amount of Line lq taxable at Collateral/Class D rata (18)
19. Principal Tax Due
R~C~ZPT
NUHBER
DISCOUNT
INTEREST/PEN PAID (-)
368.42
.00
ANOUNT PAID
7,000.00
284.00
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
O0 = .00
045 = 7,652.00
12 = .00
15 = .00
(19)= 7,652.00
TAX CREDITS:
PAYHENT
DATE
03-01-2004
08-17-2004
CD005627
CD004Z8Z
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
7,65Z.4Z
.42CR
.00
· 42CR
( IF TOTAL DUE 'rs LESS THAN $1, NO PAYNENT IS REQUIRED.
'rF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DZSCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonueelth hereby expressly reserves the right to appraise and assess transfer /nheritenca Taxes
at the 1aclu1 Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGXSTER OF NZLLS, AGENT
A refund of a tax credit, mhich ams not requested on the Tax Return) may be requested by completing an *'Application
for Refund of Pennsylvania Xnharitanca and Estate Tax" (REV-X$15). Applications are available at the Office
of the Register of gills, any of the 22 Revenue District Offices) or by calling the special lq-hour
ansasring service for forms ordering: 1-800-562-Z050~ services for taxpayers eith special hearing end / or
speaking needs: 1-800-447-3020 iTT only).
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 receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. lB1021, Harrisburg, PA 171Z8-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviaa Unitj Dept. 280601, Harrisburg, PA 1712B-0601
Phone [717) 787-6505. 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 within three iS) calendar months after the decedent's death, a five percent (52) discount of
the tax paid is allo~ed.
The 15Z tax amnesty non-participation penalty is computed on the totml of the tax and intersst 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 time period as you ~ould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (62) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 19BZ 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 1982 through 2004 arm:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor
~ ~ .00054& 1988-1991 llZ .000501
1962 162 .000q38 1992 92 .000247
1984 11Z .000501 1993-1994 72 .000192
1985 132 .000556 1995-199B 92 .000247
1986 lOZ .O00ZTq 1999 72 .OO019Z
1987 IOZ .OOOZTq 2000 72 .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAZD
Daily
Year Rate Factor
2001 92 .000247
2002 62 .000164
2003 SZ .000157
2004 42 .000110
X NUHBER OF DAYS DELTNQUENT X DATL¥ ZNTERBST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [tS] 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.