HomeMy WebLinkAbout04-0077 PETITION FOR PROBATE and GRANT OF LETTERS
Estate or' No. - Oq - --1-1
· To:
also known as
Deceasea.
Social Security No. [ ~(_o ' 0 ~ - ~a ~ "IL)
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the
in the last will of the above decedent, dated ~O c;babe~C ~. ?
and codicil(s) dated cx(']t~0~
Register of ~4ills for the
County of ~lt,~'~v/t. . in the
Commonwealth of Pennsylvania
named
,19
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~--u-n~g~'la-v~/k County, Pennsylvania, with
h'~. last family or principal reside, ncc at II /l~x~e i~ v~,~a.~.~-
(list street, number and muncipality)
Decendent, then ~(o years of age, died 36t~bt~/t'~ l/a, '2.004 , ~1 ,
at ISm }~/~x~le fi. vCn6cL /A)~l.~+ _P~,'~c~, ~/~ 0
Except as ~'ollows, d~cedent 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 $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
sitUated as follows:
WHEREFORE, petitioner(s) respectfully r~equest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY Or ~.u,-~/otc {z,t~ 88
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) an~l that as personal represen-
tves of the above decedent petitioner(s) will well and~r~ly administeydthe estate according to law.
tat () - ,¢.-,,'-y~ . / ~
S' n to or a~irme~ and subscribed ~~'~-,--~')A''[7/~ ~.
b~vf~r~e me this r~ ~ day of [ '/. ' . -.. VRVO~- ~
~ ~ .~~ ~eg~ter l
No. ,~l - oq - '1'1
Estate Of ~m~¢~ ~(, ~'vf
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated O
described therein be admitted to probate and filed of record as the last will of
and Letters "T',~.~t ~v~ e~.~ c
are hereby granted to ,~:t~. _ -~ 'o tS,, bgvvr
1~°°t4 , in consideration of the petition on
FEES
Probate, Letters, Etc .......... $_,~-,~--. Oo
Short Certificates( ) .......... $ cI .cBc>
$ lo. o~
TOTAL ~ $,,~,5"/. oO
Filed J .--.,,,q, TI.: P-...~W?.q. ......
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
l.ocal 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.
~ , ~,~cocal~eg~strar
P 9913202
No. ~ {J/- Date/
H105.144 Rev. 1/91
PERMANENT
BLACK INK
#29-187
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
ELATE FILE NUMBER
(Fils1, Mid, die. Last) SEX SOCIAL SECURR'Y NUMBER
Samuel K. Devor 3. Male s. 186-05-6470
UNDER 1 DAY DATE OF BIRTH 7 BIRTHPLACE (City and pLACE OF DEATH (Ch~ck only one -- see inslr uctmns on o~her s~a)
HOURS Minutes (Month. Day. Year) Stale or F~'eign Co~ntr y} HOSPITAL: OTHER:
S~_ep. 7,1917 .WalnutBottcm, PA ~,be, D ER~,i,,D ~[] ,"~.~S[]
South Newton I~. 15 Maple Avenue'
Mechanicsburg Nave 1 I was DECEDENT EVER INI
Supervisor ~th. Depot lZ re. 12 ~0-12) (1-4~5+)t4 Widowed
11 Maple Ave. RESIDENCE decedent
Walnut Bottom, PA 17266 on ~h~r side) tyb. co.~ Cumberland
AGE (Lasl Bltlhday) UNDER 1 YEAR
Mo~ths Days
86 v,,.
Cumberland
DATE OF DEATH {Month, Day. Year)
4. January 16, 2004
~Specily) []
~s. White
SURVIVING SPOUSE
(11 w~e. give maiden ~ame)
Southampton Twp.
FATHER'S NAME (First. M,~dle. La~) MOTHER'S NAME (First. M~dle. MaVen Surname)
Elden Hays Devor ~E. Clare Edna Wolfe
~.Richard E. Devor I~.P.O. Box 21, Walnut Bottom, PA 17266
BuMI ~ Cre~t~ ~ Re~lfmm~te~ ~th,~y.~ar)
~be.~ ~,m~[ ~ ~b. 1-22-04 or~herP~c,~,,. Spring Hill Cemetery 2~d. Shippensburg, PA
~SIG~U OFF ~L V, NEE R PERSON A~ING AS SUCH ~LICENSE NUMBER INAME AND ADDRESS OF FACIL~
1,4. l:O0 A, .. I". January 16, 2004
resufling in death) ----~ a Hvoothermia
bOB TO (OR AS A CONSEQUENCE OF):
~mnlkll,yli~l~ediUom b. Exposure to Extreme Cold
17257
17257
DATE SIGNED
(Monlh. Day.
23b. 23c.
WAS CASE HCPCRRCO TO MEDICAL EXAMINER/CORONER?
Dementia, AT
I
2~u,/icide DATE OF INJURY TIME OF INJURYINJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
AVAILABLEPRIORTO I(M°nlh'Day'~ar) Aprx. Dementia patient exposed
COMPLETION OF CAUSE
OFDEATH? Natural [] ,om~ [] Jan. 16,2004 ~' [] ~ to sub-zero wind chill
I~ while unclothed
Accident ~ PendmOln.stigatio. []Isde. ,o,. 1: O0 A M. ,o,. .
Yes
No
[] COUld ROI be determined PL~{~E OF INJURy - Al home, farm, street fac~oly, office LOCATION (Slreat. C~y~qown, Slale)
ESb. [] ~'~'°'~m~'f~) home I~.~t~e Avenue,Walnut Bottom,PA
'MEDICAL EXAMINER/CORONER
On the ball ~1 examlnaUon and/or investigation, in my opinion, death occurred ii lh~ time, dMe, lind place, and due to the ClUit(IJ end
~33.311~11anner &l iteted ........................................................................................... .- ~~-j --
SIGNATURE ANGE
DATE SIGNED (M~lh, Day, Year)
[] ]'lc. aid. January 16,2004
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type or Print Michael L. Norris, Coroner
6375 Basehore Road, Suite #1
~ 3E_~ Mechanicsburg, Pa. 17050
LAST WILL AND TESTAMENT
I, Samuel K. Devor, of South Newton Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the
administration of my estate.
ITEM II: I give, devise and bequeath all of my estate of every nature
and wheresoever situate to my son, Richard E. Devor.
I appoint Richard E. Devor executor of this my Last Will and
ITEM III:
Testament.
ITEM IV:
I direct that my executor or his successors shall not be
required to give bond for the faithful performance of his duties in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on /h~ sheets of paper, dated this /~ day of
October, 1988.
Samuel K. Devor
The preceding instrument, consisting of this and one other typewritten
page, each identified by the signature of the testator, Samuel K. Devor, was
on the day and date thereof signed, published and declared by Samuel K. Devor,
the testator herein named, as and for his Last Will, in the presence of us,
who, at his request, in his presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
COMMONWEALTH OF PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND :
We, Samuel K. Devor, ~ ~m .~~. and ~f~ ~, ~_~._~7/ ,
the testator and the witnesses, ~espectively, whose names are sign~'to the
attached or foregoing instrument, being first duly sworn, do hereby declare to
the undersigned authority that the testator signed and executed the instrument
as his Last Will and Testament and that he signed willingly (or willingly
directed another person to sign for him), and that he executed it as his free
and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testator, signed the will as
witnesses and that to the best of our knowledge, the testator was at that time
eighteen years or older, of sound mind and under no constraint or undue
influence.
Samuel K. Devor
Subscribed, sworn to and acknowledged,
by Samuel K. Devor, the testator and
swor~ to lbefor~ m~ by ~)~w~ ~F.~
and V~ ~ ~t~.Wz,--witnesses, this
/~ day of October, 1988.
Notar~u-b 1 ic
R. NOTARY PUBLIC ~
Name of Decedent:
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. A dmin. No. ¢~/'- 0 ~/-- 7 7
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 :
Nallle
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Name ~
Telephone
Capacity:
Personal Representative
__~Counsel personal representative
for
JRD/June 30, 1992/17858
In Re: Estate of SAMUEL K DEVOR
Late of SOUTHAMPTON
Estate No.: 21-04-77
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-77
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: RICHARD E DEVOR
Counsel for Personal Representative: SALLY J WINDER, ESQ.
Date of Grant of Original Letters: 01/27/2004
Date of Delinquency Notice: 05/07/2004
The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance
with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Cotat
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule
5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e),
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on MAY 7,
2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in
accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the
undersigned requests that a Court conduct a hearing to determine whether sanctions should be
imposed upon the delinquent personal representative or counsel for the delinquent personal
representative.
Date:
Glenda Famer Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for~/~r)?9 at ~ in Courtroom No. 3. I~e~erJifi~cation of Notice is
filed prior to the hearing dat'~'the hearing will automatically~//~?~
Georg~'E.ll~offe~:, P.J. W
Z
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECED~NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
DEVOR~ SAMUEL K.
DATE OF DEATH (MM-DO-Year)
01/16~2004
(IF APPLICABL~) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
~ [] 1. O~gina[ Return
.. e:~ I I I 4 Limited Estate
~oo
o ~ I [] 6. Decedent Died Testete (~Wach ~0~y~wa)
~ ~ [] 9. Li~galion Proceeds Received
DATE OF BIRTH (Mt~OD-Year)
09/07/1917
FILE NUMBER
2 1 -0 4 0 0 7 7
SOCIAL SECURITY NUMBER
1 8 6-0 5-6 4 7 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 2, Supplemental Retem
[] 7, Decedent Maintained a Living Trust (~t~ch c~yof'rr~
[] 10, Sedusal Poverty Credit (d~e oraeat~ bet~ee~ 12-31-91 and 1-1-95)
r-'~ 5. Federal Estate Tax Return Required
__ 8. Total Number of Sate Deedsit Boxes
[] 11. Elecaon te tex under Sec. 9113(A) {At~h Sch O)
NAME
SALLY J. WINDER
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717 532-9476
COMPLETE MAILING ADDRESS
9974 MOLLY PITCHER HIGHWAY
SHIPPENSBURG
PA 17257
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporalten, Pa~erah[p or Sole-Pmp~etorship(3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5, Cash, Bant( Deposits & M[scellanecus Personal Pmpar[y (5)
(Schedule E)
6. Jointly Owned Propad7 (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gmea Assets (total Lines 1-7)
9. Funeral Expenses & Administra'~ve Costs (Schedule H) (9)
10. Debts of Decedent, Mot[gage Liabili~os, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11 )
13. Charitable and Govemmentel Bequests/Sec 9113 Trusts for which an election to tax has not peen
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
2~757.60
160~356.80
OFFICIAL USE ONLY
(8)
16~963.00
314.66
(11)
163~114.40
(12)
(13)
17,277.66
(t4)
145,836.74
145~836.74
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, ortranstersunderscc. 9116(a)(1.2) X __ (15)
16. AmountofLine14taxableatlinealrate 145,836.74 X .045 (16)
17, Amount of Line 14 taxable et sibling rate X .12 (17)
18. Amount of Une 14 taxable at co~leteral rate X ,15 (18)
19. Tax Due (t9)
20,
6~562.65
61562.65
Decedent's Complete Address:
STREET ADDRESS
11 MAPLE AVENUE
P.O. BOX 21
CITY
WALNUT BOTTOM I STATE PA I zip 17266
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19}
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C, Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(t)
Total Credits (A + B +C)(2)
Total Interest/Penalty ( D + E )
(3)
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)
If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
6r562.65
6~562.65
6~562.65
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the dght to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d, receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate 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 Ratirement 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 O AND FILE IT AS PART OF THE RETURN.
SICi~ATU~E'CF PER'Si;~N~ESPONSIBI~E FOR,FrL~NG RETURN ~-, . .-'-, DATE
^DDRESS ' P.O. BOX 21
WALNUT BOTTOM PA 17266
SIGNATURE OF. PREPAREE OTHER THAN REPRESEi~TAT. IVE
9974 MOU-Y PITCHER HIGHWAY
SHIPPENSBURG
PA 17257
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §91 t 6 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax ratum 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 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedest's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
iddi'l'idual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE B
~ ;~,,~'~v~ STOCKS & BONDS
ESTATE OF
DEVOR. SAMUEL K.
AIl propelty jokdly..ow~ed with dgM of suntlvorshlp must be dlsdo~ed on Schedule F.
FILE NUMBER
;~1 04 0077
ITEM
NUMBER
DESCRIPTION
PRUDENTIAL FINANCIAL, PRUDENTIAL COMMON SHARES, NON CERTIFICATE
STATEMENT SHARES, 60 SHARES
VALUE AT DATE
OF DEATH
2,757.60
TOTAL (Nso enter o~ line 2, Recapltulation) $ 2,757.60
~TH OF PENNSYLVAMA
INHERITANCE TAX ~-'TU~N
RF.,SIOENT DECEDENT
ESTATE OF
DEVOR. SAMUEl. K,
SCHEDULE E
CASH, BANK DEPOSffS,& MISC.
PERSONAL PROPERTY
FILE NUMBER
Inc~udelhe
ITEM
NUMBER
2
3
4.
DESCPJPTION
PNC BANK, CHECKING ACCT 51-4043.-0806, IN THE NAME OF DECEDENT
DATE OF DEATH BALANCE
PNC BANK, MONEY MARKET ACCT 50-0326-.6333, IN THE NAME OF DECEDENT
DATE OF DEATH BALANCE
M&T BANK, ACCT NO. 31003914558928, REGULAR TIME DEPOSIT,
IN THE NAME OF DECEDENT
M&T BANK, MONEY MARKET ACCOUNT 98130579, IN THE NAME OF THE
DECEDENT
TOT,N. (Also ~ o~ line 5, Reca~ihd~)
(If rna*e sr~ace is needed, insert additional si,eels af tt~..~q ~i~'~
z mum be dlm:Jo~d on Scbedu~ F,
VALUE AT DATE
OF DEATH
32,845.82
20,047.52
65,999.29
40,564.17
160,356.Rq
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DEVOR. SAMUEL K.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
BRICKER FUNERAL HOME, FUNERAL ACCOUNT BALANCE
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative (s)
Sodal Seca ~,/Number(s) / EIN Number of Pemonal Representative(s)
Street Address
city State
Year(s) Commission Paid:
AttomeyFees SALLY J. WINDER
Family Exemption: (If decedent's address is not the same as claimant's, attac~ explanation)
Claimant
Zip
Street Addrece
Ci~/ Stata Zip
Relationship of Claimant to Decedent
PmbateFees REGISTER OF WILLS, PROBATE FEE, FILING RETURN
Accountants Fees
TaxRetomPreparefsFees JOHN MCCREA III, INCOME TAX RETURN
M&T BANK, FEE
8,951.00
7,675.00
272.00
55.00
10.00
TOTAL (Also enter on line 9, Recapitulation) $ 16,963.00
(If more space is needed, inser~ additional sheets of the same size)
Per formance Money Market Account Statement
' PNC Bank
For ~le pef~od 1211g/2~3 to e3/1g/2004
SAHUEL K DEVOR
PO BOX 21
HALNUT BOTTOH PA 17266-0021
aerform~noe Money IIIl~ket Aooount Summary
,ccount number. 50-0326-6333 Account Link O number. 0186056470
20,9.! 1.68 15.80 .00 20,957.48
20,952.50 .00
20,947.10
]5.80
~/21 5,8.i Imerest PaFment
~/18 4.81 Inlelx-s( P3Fment
~/19 5.15 lnlepest Pa~-ment
PNCBA!
Primary account numbec 50-0326-6333
Page I of 1
Number of enclosures: 0
~Fur 24-hour banking, customer servi~ and
interest rate information, sigmon to
Account Link ~ by Web on pncbank.osm
or call 1-888-PNC-BANK
MoMngi' i~ease contact us at 1-888-PNC-BANK
Wdte to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
~Vi~t us at pncbank.cum
i TDD terminal: 1-800-531-1648
Samuel K Devor
Please see the Activity D~t~il section for
additional information.
As of 03/19, a total of ~18Je in interest was
earned this year.
There were 3 Deposits and Other Additions
totaling ~;16.~.
',/19 20,9,! 1 .G8 0 I/2 ] 20,947.52 02/18 20,952.33 03/19 20,957.48
, hecldng Account Statement { PNCBAI K
For thepedodl~/2S~003 ~ 01/2~2004
SAHUEL K DEVOR
PO SOX 2I
WALNUT BOTTOH PA 17266-0021
terest Cheoldng Ao ount Summary
~unt nnmbec 51-4043-O806 Account Link ®numben 0186056470
Beginning Deposits and
31,764.67 2,538.tY2
1,456.87
33,O60.24
Ending
32,845.82
.00
Checks pai~V Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PiN Iransactlons
6 0 0
Total ATM PNC Bank Other Bank
O 0 0
~e~e=t
(L 1 (rz 33 33,060.24 2
· '~ Detail
~,,sits and Other Additions
02 2,535.O7 Direc{ Deposit - Civil Serv
US Trcasu~T 312 A 1608530 0 CSA
26 2.95 Interest PaTment
Primary account number: 51-4043-0806
Page 1 of 2
Number of enclosures: 6
~[~ For 24-hour banking, customer service and
interest rate information, sign-on to
~ Account Link ~ by Web on pncbank.c~m
or call 1-888-PNC-BANK
Moving? Please contact us at 1-888-P~IC-BANK
Write to: Customer Sew;ce
PO Box 609
Pittsburgh PA 15230-9738
~ Visit us at pncbank.com
W lDD terminal: 1-800.531- lr~18
Samuel K Devor
Please see the Activity Detail section for
additional information.
As of 01/26, a total of ~12.95 in interest was
earned this year.
There ware 2 Deposits and Other Additions
Ch~ck
2~41
2942
51.76 01/15
50.22 01/16
186.71 01/21
~p in check sequence There were 6 checks listed totaling
$1.4~4.B7.
ACCOUNT NO.
3100391~5S8928
REGULAR TXHE DEPOSTT
SAHUEL lC DEVOR
PO BOX 21
~/ALNUT BOTTOH PA 17266-0021
HATURZTY DATE OX-SO-RE CURRENT /Iff'ERE. ST RATE 1.040;~
ZNTEREST PA/D YEAR TO DATE 1G6.22 KZNO STREET
ACCOUNT ACTTVTTY
CULO CO
CU~T NO.
COID 06 SSN/TID: NO 186e.5847t)
N 8N4UEL K DEVOR
A PO BOX 21
C WALNUT BOTTOM PA 17266-~21
EHPLOYER
BK REL
BK SVC ALL
PLACED
PLACED
LZST HIST ACCTS? N
__ CUP1 I CIS INDIVIDUAL CUSTOMER PROFZLE ~4/~2/24 9.28.52
~6 OP EBRN MS 64282 [NDZVIDUAL CUSTOMER DISPLAYED
HOHE PHONE
BUS. PHONE
REMARKS
EXP. DATE
EXP. DATE
LIST CLOSED ACCTS? Y
CUST SEG
CD 0 COST CENTR
TI'E I OPENED
CLOSED
LST HAIN
BRTHDATE
DECEASED
BANKRUPT
OCCUP CD
CUST TYPE T3
LANGUAGE
~TIO~I~
STATUS--
6822 BRN-- 6822
981113 OFF~I
OFF~2
le3~7~4 ~IAR STATS
17~9~7 SEX ...... M
ADVERT[S?
EMPLOYEE? N
HH# 0
SEN~ CODE ~
REFER? N
NEXT: I
ACTN: ACPR ACDT A C C 0 U N T R E L A T I 0 N $ H I P S NEXT: 1
SEQ- OOID- PRDSP ACCOUNT ................ OPEN ST CURR ...... BALANCE ...... REL
~1 96 CDACK ~31~3914558928 9?03 15 65,894.~7 IND
~2 96 DDAG6 ~g813~579 9?05 9g 4~.~,~,.~ ZND
SCHEDULEI
DEBTS OF DECEDENT,
· MORTGAGE LIABILITIESr&LIENS
~AI'E OF FILE NUMBER
DEVOR. SAMUEL K. 21 04 0077
Include unrelmbumed medlnel expmtsim.
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
CARLISLE REGIONAL MEDICAL CENTER, OUTSTANDING ACCOUNT
CARDIOLOGY DIAGNOSTIC ASSOCIATES, MEDICAL ACCT BALANCE
SHIPPENSBURG FAMILY PRACTICE, LTD., BALANCE OF ACCOUNT, CO-PAY
CENTRAL PENN MED GRP EMERGENCY, BALANCE OF ACCT
262.07
35.00
15.00
2.59
TOTAl. (Nso ente' on line 10, Recapitula~on) $ 314.66
(If more space is needed, insefl additional sheets oHhe same size)
COI~J~ON~TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
E~TATE OF
DEVOR. ~AMUEL K.
NUMBER
I.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE OISTRIBUTIONS [~iude ought spou~l dbldt~ions, and ;~mfe~ under
Se~ 9116 (a) (12)]
FILE NUMBER
21 04
RELATIONSHIP TO DECEDENT
Do Not Mst Trimtex(s)
0077
AMOUNT OR SHARE
OF ESTATE
RICHARD E. DEVOR
P.O. BOX 21, WALNUT BOTTOM, PA 17266
SON
100% NET ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRL~TE, ON REV-15~0 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(ff more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 004342
WINDER SALLY J
9974 MOLLY PITCHER HIGHWAY
SHIPPENSBURG, PA 17257
........ fold
ESTATE INFORMATION: SSN: 186-05-6470
FILE NUMBER: 2104- 0077
DECEDENT NAME: DEVOR SAMUEL K
DATE OF PAYMENT: 09/03/2004
POSTMARK DATE: 09/03/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,562.65
REMARKS:
TOTAL AMOUNT PAID:
$6,562.65
' SEAL
CHECK//99
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DzVTSZON
PO BOX Z80601
HARRISBURG, PA 17128-0601
SALLY J WINDER
9974 MOLLY PITCHER HWY
SHIPPENSSURG PA 17257
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-l;47 EX &FP (~9-n4)
DATE 11-15-2004
ESTATE OF DEVOR
DATE OF DEATH 01-16-2004
FILE NUMBER 21 0q-0077
COUNTY CUMBERLAND
ACN 101
I Aeoun~ Reai~ed
SAMUEL K
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS -,~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DEVOR SAMUEL K FILE NO. 21 04-0077 ACN 101 DATE 11-15-Z004
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B)
$. Closely Held S~ock/Par~norship In~eres~ (Schedule C) ($)
q. Mortgages/No'es Receivable (Schedule D)
E. Cash/Bank Daposi~s/Nisc. Personal Proper~y (Schedule E)
6. Jointly Owned Propor~y (Schedule F) (6)
7. Transfors (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Deb~s/Nor~gage Liabilities/Liens (Schedule I} (10)
11. To,al Deductions
12. No~ Value of Tax Re~urn
2~757.60
.00
160~$56.80
.00
.00 NOTE: To insure proper
credi~ ~o your account,
subei~ ~he upper portion
.00 of ~his fore wi~h your
~ax payment.
.00
(8)
165,114.40
16,965.00
$14.66
(11)
(12)
~7.277.66
145,856.74
Chari~able/Gov®rnmon~al Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Ne~ Value of Es~a~e Subjec~ ~o Tax (14)
If an assessment Has lssued prev/ously, 11nes 14, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX: .00 x 00
15. Amoun~ of L/ne lq a~ Spousal ra~e (15) =
16. A.oun~ of L~ne lq ~axable a~ Lineal/Class A ra~e (16) lq5,8~6.7~ X Oq5 =
17. Amoun~ of Line 1~ a~ Sibling ra~e (17) . O0 X 12 =
18. Amount of Line It taxable at Collateral/Class B rate (18) .00 X 15 =
19. Principal Tax DU~ -~ ''r ~.1 ~..~ (19)=
TAX CREDITS: "~
INTEREST/PEN PAID (--)
D~TE "U'SE; '~ !70, · O0
og-os-zoo
15.
Iq.
NOTE:
AMOUNT PAID
6,562.65
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
145,856.74
18 and 19 wil1
.00
6,562.65
.00
.00
6,562.65
6,562.65
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
.00
.00
.00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY DE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
tn possession or enjoyment to Class 8 (collatara1) 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 laaful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 216`0 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S.
Section 916`0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1313). Applications are available
online at aaa.revenue.state.om.us, any Register of Hills or Revenue District Office, or from the Department's
Z6`-hour answering service for forms orders: 1-800-36Z-Z050; services for taxpayers with special hearing and/or
speaking needs: 1-800-6`6`7-3020 (TT only).
Any party in interest not satisfied with the appraiseent, allowance or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenuej Beard of Appeals. You may object by filing a protest online at
aaw.boardofappeals.state.pa.us on ar before the expiration of tho sixty-day appeal period. [n order for
an electronic protest to bm valid, you must receive a confirmation number and processed date from the
Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box ZSIOZ1, Harrisburgj PA 171ZS-lOZ1. Petitions may not ba foxed.
8) Election to have the matter determined at the audit of the account of the personal representative.
C) 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 Review Unit, P.O. Box Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation panaZty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appea! 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~ 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000166`. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which wi11 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO6` are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1982 207. .00056`8 ~'8-1991 11X , OO0301
1983 167. .0006`38 1992 97. · 00026,7
1986` 117. .000301 1993-1996` 7Z .00019Z
1985 137. .000356 1995-1998 97. .00026`7
1986 107. ,000Z76` 1999 77. .00019Z
1987 107. .000Z76` ZOOO 77. .00019Z
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9X .000Z6`7
200Z 6Z .00016q
2003 57. ,000137
2006` 6`7. .000110
X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after tho tax becomes delinquent ~ilX reflect an interest calculation to fifteen [15) days
beyond tho date of the assessment. If payment is made after the interest computation date shown on tho
Notice, additional interast must be calculatad,
cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 12/16/2005
WINDER SALLY J
9974 MOLLY PITCHER HIGHWAY
SHIPPENSBURG, PA 17257
RE: Estate of DEVOR SAMUEL K
File Number: 2004-00077
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by:
1/16/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
A U ~ I
1. / i I .. .. .~
~_ t,,?o~~~~!.1j )t.A/i~,...;
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
~y
,- " .- .;a
~
r.yr~~...~
'~~\"_\
~ ~J
~
~ _ ~ _....__,_.~. _ -,1..to"'!ffl 'T~]1J _ _ E ~...____:l_ _--.-,ii _..,_...:L! :f'i _....,....,--.~_
.!l"...~:::;!I.:silltt:Jr (VJ1 'If'!! l!.J!.1Li5i ((.JiJJ. \0tUill1l.JlIiJI\cjL'.Il.i:lL1LJJ.iUl v\UltUl.illUl.y
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
. SafVYVlA~ {( DtI\ltJ/
Date of Death:
Estate No.:
d-VD Lf - ()ZTVt1
.
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. Stat~ether administration of the estate is complete:
Yes r No 0
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.1 is Yes, state the following:
a. Did the person~esentative file a final account with -the Coui-t?
Yes 0 No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person~epresentative state an account informally to the parties in
interest? Yes ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to tbisreport. ,.A A .
Date:~ .~JW~
SIgnature
~" / l' IN: ;JLi
Name1~ . if yy\))~~ PI~
1}-~~rw.~5~~~
Address ~ \ 0 r l)
III <:~ d-- 1'tt1 b
~ ~"',J
Telephone No,
r:~TJ;:;(\~l'~LY". ur-! 0...............-.....1 DQ-~'Osc_+-....+-.;;-l''O
--......r.....- .1. c;l.;::'Vl..J.a..l,. l.'~""".tJ......... ........l..H~c..:....L v"""
~"'1-~"'1 +'~- '~e--"-.~l -"'--e~--+~"":Vo
;_ ,'JL~.:..:.>....._ .!..(.j! l-i L;:)U..!.la.._ l"-'}l..!. ;::.Cl..!.\..Q.\....!.......
if:;;