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HomeMy WebLinkAbout03-0797 Register of Wills of Dauphin County, Pennsylvania PETITION FOR GRANT OF LETTERS also known as , Deceased Social Security No. ~-O~.-4~' 70C~1 (COMPLETE "A" OR "B" BELOW:) [ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut named in the Last Will of the Decedent, dated and codicil(s) dated State relevant c~rcumst~nces, e.g.. renunciation, death ol executoL etc Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Relationship Residence I Name L, Sc necessary. / Decedent was domic~ed at death in ~J,~ }~ County, Pennsylvania, with his/her last family or principal residence at ~_~.~'~,~ ~'~~~ ~ ~_ : ' ~ ~ , ~ ~ Decedent, then ~ years of age, died ~p~h~ ~, 20~, at 770 Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property .............................. ~ ~, ~ (If not domiciled in PA) Personal property in Pennsylvania ...................... $ (If not domiciled in PA) Personal property in County .......................... Value of real estate in Pennsylvania ............................................... Total Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence I 'PA 17110 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn ,o and affirmed and subscribed ~ ~~,, _ _ &o ~~ before me this day of : ~ 20 ~ DECREE OF REGISTER Estate o~-~_~ ~_. ~~ ~_~, Deceased No. also known as Social Security No: ~0~-~- ~Oq~ Date of Death: ~ AND NOW, ~~ ~ , 20~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters D Testamentary ~ of Administration are hereby granted to ~~__ ~ in the above estate and that the instrument(s}, if ang, OateO described in the ~otition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $ ~5.OO L- Register of Wills Short Certificate(s) .......... $ Renunciation .................. $ Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... $ JCP Fee ........................ $ ~O.oo Attorney:. Inventory & Tax Forms... $ I.D. No: Ot"'"~ ...........~c,~..\ ........ $ ,.~,~, O0 Address§? H TOTAL ................ $___._~ Telephone: DATE FILED: ~1~- ~-,.- (~ RENUNCIATION ~- To the Re~i,ter of wi~,s of C ~ ~,~,~ 1~. d County, Pennsylvania. the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters WITNESS hand this /g.'/" day of ~-{~-41~,A~..~ (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. ~ - - ~[ocal Registrar No. ~ - Date COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ~0 ~,~ ~~ ~. PA 17~ ~F~ I~ 118S. ~ ~ ~, PA 1~1 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: x.~<l_~l'~_.~rr%]-~.~' ~22 ~00 3 To the Register: I ce~i~ ~at notice of ~enefiei~ M~t) es~ a~Mst~fion required by Rule 5.6(a) of ~e O~h~s' Cou~ Rules was seined on or mailed to the following benefici~es of the above-captioned estate on ~ C ~ ~ ~ j ~g : N~e Ad&ess Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Address Capacity: ~Personal Representative Counsel for personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or prop- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, :CARLISLE, PA In re Estate of ~o--Q,JO_rn,~ O, SC-k~_.fff~>_..f- ,deceased, Estate No. (Name and Address) TO: L..5 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. -it The Decedent Ctl~ la'~ ' died on the lv~ani~a.'~?rngday t~:f'of , 2003 at~o ~P~ ~0~'~ , ounry, Pennsy ~e Decedent died testate ~ ~e Decedent died intestate~O~ The personal representative of ~e Decedent is (nme, ad.ess and telephone number). If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: Signature: J~)9~n~., //~. Name (print; - ~]~- Address ~~ ~m~ Telephone (71~) ~~ Capacity: Personal Representative COMMONWEALTH Of PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF ~NDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004061 SCHAEFFER GLENN A 3873 LARABY DRIVE HARRISBURG, PA 17110 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $90.84 ESTATE INFORMATION: SSN: 202-46-7091 FILE NUMBER: 2103-0797 DECEDENT NAME: SCHAEFFER BENJAMIN J DATE OF PAYMENT: 06/18/2004 POSTMARK DATE: 06/18/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2003 TOTAL AMOUNT PAID: $90.84 REMARKS: CHECK#0101 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS i~/O. ZOO3-- 00797 COMMONWEALTH OF PENNSYLVANIA '1. COUNTY OF CUMBERLAND j ss: PA No~ 21-03-. 074/7 being duly .~%V'0~'!% according to law, deposes and says that he ~u~(~c~ late of ~~_:~t~~e /~$hJp _ ., Cumberland County, Pa., deceased and fhaf fha within is an inventory made by ~A' ~~~ ~ .... the said of the entire estate of said decedent, consisting of ell the personal property ~nd reel estate, except real esfefe oufslde the Commonwealth of Pennsylvania, end fhef ~he figures opposite each item of the Inventory represent it's felt value es of +he d~fe of decedenf's de~fh. ~)~ and subscribed before me, ~~ ~, ~~~/ ~ P~ T~., ~in ~ Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appolnfmenf of personal representative. 2. A supplement inventory must be filed wifhln thirty days of d~scovery of additional assets. 3. Additional sheets may be attached as fo personalty or ready 4. See Article IV, Fiduciaries Act of 1949. , F) rto., ~ Inventory of the real and personal estate of Benjamin J. Schaeffer deceased 1. Checking account No. 513282863 at Commerce Bank/N.A Camp Hill PA. 62 33 2. Refund on Burial Account 29 45 3.1997 Ford Escort VIN 1FALP13P4VW301212 2,700 00 4. Refund on Automobile Insurance Policy No. QO91604197H - Erie Insurance Group 75 00 5. Ruger Model GP100 357 Mag. Revolver Serial No. 171-32796 200 00 6. U.S. Treasury Refund of tax withheld on disability IRA withdrawal prior to death. 232 08 3,298 86 REV- 1 500 PENNSYLVANIA DEPARTMENT OF REVENUE oE ,T. INHERITANCE TAX RETURN Fi,E HARRISBURG, PA 17128-0501RESIDENTDECEDENT c~CODE -- ~J *'"2 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~-- Schaeffer, Benjamin J. Z 202-46-7091 /-t DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I.U 09/22/2003 01/17/1961 C3 REGISTER OF WILLS LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER m ~ 1. Odginal Retum 2. Supplemental Return I I 3. Remainder Return (date of death pdor to 12-13-82) ,,,° =a. ='::o L._J 4. Limited Estate U 4a. Future Interest Compromise (date of death after 12-12-82} [----Ii I 5. Federal Estate Tax Return Required ~OO '" ~ ~-] 6. Decedent Died Testate tAt~ch copy o[ Will) [] 7. Decedent Maintained a Living Trust (At~ach copy of Trust) 6. Total Number of Safe Deposit Boxes OD. ED L._.J 9. Litigation Proceeds Received L_.J 10. Spousa~ Poverty Credit (date of death between 12-31-91 and 1-1-95) [-'--] 11. Election to tax under Sec. 9113(A)(^~ch Sch O) Z~ THIS SECTION MUST BE CCM~Lt: I r'-D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: "' NAME J ,', COMPLETE MAILING ADDRESS z Glenn A. Schaeffer o 3873 Laraby Drive " FIRM NAME (IfApplicable) ,,, Harrisburg, PA. 17110 o TELEPHONE NUMBER o (717) 545-4468 1. Real Estate (Schedule A) (1) 0.00 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 4. Modgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3,298.86  (Schedule E) c_ _~ 6. Jointly Owned Property (Schedule F) (6) 0.00 E~ Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 I'- (Schedule G or L) ,~ 8. Total Gross Assets (total Lines 1-7) (8) L.,,J 3,298.86 I,M 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,243.34 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 36.90 11. Total Deductions (total Lines 9 & 10) (11) 1,280.24 12. Net Value of Estate (Line 8 minus Line 11) (12) 2,018.62 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 2,018.62 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES  15. Amount of Line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) .~ 16. Amount of Line 14 taxable at lineal rate 45 X (16) 90.84 O~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) 0.00 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 0.00 '~ .~. 19. TaxDue ..... ., .''., ~ ' ' ,', · .~., (19) 90.84 20 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS Gene L. Schaeffer, Father 3873 Laraby Drive ,arrlsDurg I STATEpA J ZIP 171 10 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 90.84 A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. Interest/Penalty if applicable Total Credits ( A + B + C ) (2) 0.00 D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 90.84 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 right 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 accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other ~han the personal representative is based on all ieformation of which preparer has any knowledge. SIGNATURE ~)F PERSON RESPONSIBLF~OR FalLING RE,TURN ADDRES~,,', ....... · .... _  REOF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 3873 Laraby Drive, Harrisburg, PA. 17110 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA I CASH, BANK DEPOSITS, & MISC. INHERITANCE T,~J( RETURN J PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Schaeffer, Benjamin J. FILE NUYBER 21-03-O'-7~ 7' Include the proceeds of litigation and the date the proceeds were received by the estate. All Property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Checking Account 0513282863 Commerce Bank/Harrisburg N.A., 100 Senate Ave., Harrisburg, PA. 62.33 2. Refund on Budal Account 29.45 3. 1997 Ford Escort VIN 1FLP134VW301212 2,700.00 4. Refund on Auto Insurance Policy, Erie Insurance Group -QO91604197H 75.00 5. Ruger Model GP100, 357 MM Revolver 200.00 6. U.S. Treasury Refund of tax witheld on disability IRA withdrawal 232.08 TOTAL (Also enter on line 5, Recapitulation) $ 3,298,86 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6.-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN J~ISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Schaeffer, Benjamin J. FILE NUMBER 21-03- O?'~'7 This schedule must be completed and filed if the answer to any of questions 1 thro h 4 on the rev . .............. ~,, ~ v,, ,,,,~ ,~,,,=,o~ :)~uu ul me r~,"v-louU L;UVI::H SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLUDEll'fE NAME OF THE TRANSFEREE. THEIRRELATIONSHIPTODECEDENTAND DATE OF DE. ATt % OF DECD'S EXCLUSION TAXABLE NUMBER THED^TEOFmANSFER. ATrACH A COPY OF I~IE DEED FOR REAL ESTATE. VALUE OFASSET INiE~:EST (IF APPLICABLE) VALUE 1. Dis[,ibution to uncle, Glenn A. Schaeffer within one year of date of death 900.00 100 900.00 0.0( 2. Distribution to niece, Melissa M. George within one year of date of death 2,000.00 100 2,000.00 0.0(~ 100 100 100 TOTAL (Also enter on line 7 Recapitulation) $ 0.00 , insert additional sheets of the same size) REV-1511 EX+ (12-99)~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Schaeffer, Benjamin J. 21-03- OT~r 7' Debts of decedent must be reported on Schedule I'. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. Denny's Lennies Restaurant - funeral meal 138.50 2. The Elizabethville Monument Co. - head stone 550.00 3. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Glenn A. Schaeffer 100.00 Social Security Number(s)/EIN Number of Personal Representative( Street Address 3873 Laraby Drive city Harrisburg . state PA Zip 17110 Year(s) Commission Paid: 2. Attorney Fees 0.00 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 58.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Dauphin County Reporter, advertisement of estate 65.00 8. Paxton Herald, advertisement of estate 35.50 9. Pep Boys, head lamp. ( prepare auto for sale ) 10.59 1 o. PA. Department of Transportation, license for 1997 Ford Escort, ( prepare auto for sale ) 36.00 11. Jack Williams Ti're and Service Co., state auto inspection ( prepare auto for sale ) 32.75 CONTINUED ON PAGE 2 of SCHEDULE H TOTAL (Also enter on line 9, $ 1,026.34 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) * SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT E$¥ATE OF FILE NUMBER Debts of decedent must be _repo~_~ed on Sc~du!e I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City . State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedenrs 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. PAGE 2 of SCHEDULE H SUB TOTAL CARRIED FOWARD FROM PAGE 1 of 2 - SCHEDULE H 1,026.34 12. Register of Wills, filing Releases 15.00 13. Reserved for closing cost 200.00 14. Notary fee on Oath of Subscribing Wittness 2.00 TOTAL (Also enter on line 9, Recapitulation) $ 1,243.3,1 (If r~o~e space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) ~ I ~ I SCHEDULE , COMMONWEALTH OF PENNSYLVAN A / DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORT '~E~I~E~E~TATE 0F EJ~CED~RN MORTGAGE LIABILITIES,-8~'LIENSI Schaeffer, Benjamin J. FILE NUMBER ITEM Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. NUM DESCRIPTION VALUE AT DATE OF DEATH ~. West Shore Health & Rehab Center, 770 Poplar Church Rd., Camp Hill, PA. 17011 - Balance for 36.90 Cenf~mk,~r TOTAL (Also enter on line 10, Recapitulation) $ 36.90 (If more space is needed, insert additional sheets of the same size) REV-l$13 EX+ (9-00) COMMONVVEALTH OF PENNSYLVAN A / BENEFICIARIES ESTATE OF Schaeffer, Benjamin J. FILE NUMBER 21-03- O7C~ 7 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDEfl AMOUNT OR SHARE I TAXABLE DISTRIB~ outright spousal distributions, and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2)] I Gene L. Schaeffer, 1901 North 5th, St. Harrisburg, PA. 17102 Father 100.00 (Mailing address is 3873 Laraby Drive, Harrisburg, PA. 17110) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert addilional sheets of lfle same size) "'<~ ~' CONHONNEALTH OF PENNSYLVANZA BUREAU OF /NDZVZDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DEPT. Z60601 HARRZSBURG, PA 17128-0601 NOT/CE OF XNHERZTANCE TAX APPRAXSEHENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-1S4?EXAFP¢02-03) ~DATE~f~ 08-02-200~ EST~]~E OF SCHAEFFER BENJAH[N J r~,~.,~::: DA~OF DEATH 09-22-2005 FZLE NUN~ER Z1 0~-0797 ~875 LARASY DR Amoun~ Ramified HBG PA 17110 HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGZSTER OF CUNSERLAN9 CO COURT HOUSE CARLZSLE, PA 17015 CUT ALONO THZ$ LZNE ~- RETAZN LOHER PORTZON FOR YOUR RECORDS REV-~7 EX AFP (0~-0~) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT~ ALLONANCE OR DZSALLONANCE OR DEDUCTZON$ AND A$$E$$NENT OF TAX ESTATE OF SCHAEFFER ~ENJAHZN J RZLE NO. 21 05-0797 ACN 101 DATE 08-02-200~ TAX RETURN ~AS: (X) ACCEPTED AS F~LED ( ) CHANGED RESERVATZON CONCERNZN~ FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN ~ASED ON: ORZGZNAL RETURN 1. Real Es~m~a (Schedule A) (1) .00 NOTE: To insure proper 2. S~ocks and Bonds (Schedule B) (2) .00 cradi~ ~o your accoun~ 5. Closely Held S~ock/Par~narship Zn~aras~ (Schedule C) ($) .00 submi~ ~ha upper portion ~. Not,gages/No,as Receivable (Schedule D) (~) .00 of ~hls fore ~i~h your 5. Cash/Bank Deposi~s/Nisc. Personal Propar~y (Schedule E) ($) ~l~98.8~ ~ax payment. 6. Jointly O~nad Propar~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. To,al AssaYs (8) $,Z98.86 APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/AdB. Cos~s/Nisc. Expanses (Schedule H) (9) 10. Dab~s/Nor~gaga Liabilities/Liens (Schedule 1) (10) ~6.90 11. To,al Deductions (11) 12. Ne~ Value of Tax Ra~urn (12) ~018.62 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 1~. Na~ Value of Es~a~a SubSec~ ~o Tax (1~) ~01B.~Z NOTE: Z~ an assessBent ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~a (15) .00 X 00 = .00 16. Amoun~ of Line lq ~axabla a~ Lineal/Class A ra~a (16) 2,018.62 x Oq5 = 90.8~ 17. ABoun~ of Line 1~ a~ Sibling ra~a (17) . O0 X 1~ = . O0 18. Amoun~ of Line lq ~axabla a~ Collateral/Class B ra~a (18) .00 X 15 = .00 19. Pr/ncipal Tax Due (19)= 90.8~ TAX CREDZTS: PAYNENT RECElYI DZSCOUNT (+) ANOUNT PAZD DATE NUNBER ZNTEREST/PEN PAZD (-) 06-18-200~ CDO0~061 .00 90.8q TOTAL TAX CREDZT 90.8q ]~ALANCE OF TAX DUEI . O0 ZNTEREST AND PEN. .00 TOTAL DUE .00 IF PA/D AFTER DATE ZNDZCATED~ SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REi)UZRED. FOR CALCULATZON OF ADDZTTONAL ZNTEREST. TF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTZONS. RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- 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 IawfuI CIass S (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Sactlon 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGZSTER OF NZLLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-56z-zeE0; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (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 receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. zaioz1, Harrisburg, PA l?lZ8-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNIN- ISTRATIVE CORRECTIONS= 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, Dept. la0601, Harrisburg, PA l?lZa-0801 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. DISCOUNT: If any tax due is paid within three (5) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and 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 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 (l) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 19aZ will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 '~"~)'"~-1991 XXX .000501 ~ 9Z .000247 1985 162 .000458 199Z 9Z .000247 ZOO2 62 .000164 198~ 1IX .000501 1993-1994 7Z .000192 ZOO5 5Z .000157 1985 15Z .000356 1995-1998 92 .000247 2004 4Z .000110 1986 102 .000274 1999 72 .O00ZeZ 1987 XOZ .000Z74 ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NUHBER OF DAYS DELINQUENT X DALLY XNTBREST 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. STATUS REPORT UNDER RULE 6.12 Name of Decedent: /~3~---~ Iccrn I fl Date of Death: x~.-t~ ~rn WillNo.: /~ar!.ca Admin. No.: ~,t-0:3- 07Cl7 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 [~ 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. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes_ No r~ 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 I~ No [-'] ofreceipts,~oinders and approval of formal or C. Copies informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~w~//0 5" ~t~_,,,,,,,~_//~_, ld~~, Signature Name 3 73 Lo. vot, v Dx',ve '- -' o- cD ©,---, Address ~.~(~ 2: a.c.'7~ Telephone No. LTx.2 ~ ~'~e-~ Capacity: ersonal Representative ['-] Counsel for personal representative RELEASE ESTATE NO. 21 03 -0797 KNOW ALl. MEN BY THESE PRESENT, that I. GENE L. SCHAEFFER, do hcreb.x, acknowledge that I have this da5 recoil'cd from GLENN A. SCHAEFFER, Administrator of thc Eslatc of BENJAMIN J. SCHAEFFER, late of Ihe Township of East Pennsboro. ('ountv of ('umbcrland and Commonwealth of Pennsylvania. ONE DOLLAR ($1.00) and other good a~d valuable consideration, in full settlement of any claim or claims that ! ma~' have by, under and because of Estate of BENJAMIN J. SCttAEFFER. And, THEREFORE, I, GENE L.SCHAEFFER, intend to be legally bound hereby, do. by these presents, rcmisc, release, quit-claim and forever discharge GLENN A. SC! IAEFFEI~, Administrator of thc t(statc of BENJAMIN J. SCHAEFFER, Deceased. and his heirs and assigns. of and from all actions, suits, accounts, reckonings, claims and demands ~:hatsoevcr. tbr tlr bv reason thcrcol; or of any other act. matter, cause tlr thing whatsoever, from the beginning of the world to thc day of the date of these presents. I, GENE L. SCHAEFFER, have bccn dub advised of my right to have GLENN A. SCHAEFFER, Administrator. file with thc ()rphans' Court l)ivision of thc Court of Common Picas ol'('umbcrland ('ounty. an Accounting of thc services hc has rendered, and I do hereby specifically waive my right to have an Accounting prepared and presented lo thc ('our1. IN WITNESS WItEREOF, I have hereunto set my hand and seal. this !~'. day of ()ctobcr. A. Ii).. 2004