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HomeMy WebLinkAbout02-0716* ' Register of Wills of County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of also know Social Security No. E' 7! _ 2$ " S ~~? Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or'B' BELOW:) ^X A. Probate and y rant of Letters Testamentary and aver that Petitioner(s) is/are the execut ort ~~ named in the last Will of the Decedent, dated ~ ~2.'f (!9l s~ and cod'+cil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as foNows, 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 (c.t.a.; d.b.n.c.t.a; pendente life; durante absentia; durante minoritate) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in G, U~') ~'(~~~ ~ County, Pennsylvania with-hnlher last family or principal residence at PA (.,c~:;~}~ry (~Qcic r„~ 1J~.;,t'~ny ~~~n~-t, j ~-{Q~..`nex,n~->~j~;~c~ p~ f~-OS ~_ (list street, number, and municipality) ~ p,>~~ ~,~ ~ wp Decedent, then NA years of age, died at PA (Location) Decedent at death owned property with estimated values as follows (If domiciled in PA) All personal property $ ~?ZOC~ ~ ©d (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) .Personal property in County $ Value of real estate in Pennsylvania $ ~/ ,~ (~C7Q, ~Q i 1 t situated as follows: c5 \~.'~C~~"~ Qbcxc~ i1~2 C~V~G~s~L_S ~y's ~ ~~ \~~, Wherefore, Petitioners} respectfully request(s) the probate of the last Wi{I and Codicils} presented with this Petition and the grant of letters in the appropriate form to the undersigned: 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: Prepared by the Pennsylvania Bar Association / ',~ ~U,. // Copyright (c) X996 form software only CPSystems, Inc- Form RV/-1 (1991) Commonwealth of Pennsylvania County of Oath of Personal Representative 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 representative(s) of the Decedent. Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 9thday of August 2002 /~~ , ,~,' C.~U For Mary O. Lewis ~_ No. 21-2002-716 Estate of Anne M. Brandt, aka Anne Marv Brandt Deceased Social Security No: 171-28-5087 Date of Death: 07-27-?.002 AND NOW, August 9th 2002 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~X Testamentary ~ Of Administration (c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate) are hereby granted to ~ Polly S Foster- : aka and .Margaret A~ Sneath Paulette S. Foster in the above estate and that the instrument(s) dated 9-24-1968 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters . $ 235.00 ~"</'~- ~-' Short Certificate(s). 3. $ 9.00 .,~~~ Register of Wills Mary C. Renunciation. $ Attorney: Kar~ M. Lederbohm Affidavits ( ) $ LD. No: 59012 Extra Pages (0 ) .... $ -0- Address: 2109 Market Street Codicil. .. ..... ... $ Camp Hill, PA 17011 JCP Fee . $ 5.00 Telephone: (71) 737-3405 Inventory. $ Other $ MAILED LETTERS AND ORDER 10 ATf i~6~tta'Y"; TOTAL. $ 249.00 on 8-9-02 Prepared by the Pennsylvania Bar Association Copyright {c) 1996 form software only CPSysiems, Inc. Form RW-1 {1991) IUS.SOi REV 9/4fi 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 Stare Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this eerrificare, $2.00 ~ 8482997 N o. rlll)] IJy Hav 2+tl] rYPE,PRDIT IN PERMANENT NAME OE DECEDEN BucIIINK ,. Anne AGEI :. coup sb. 91 Y" IF DEATH Cumberland ;EDENT'S USUM OCC ve kale d wwk dwra rka I working kN', Oo rot use ., Local Registrar r r) f' .r? f Pate /, COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER Lave SE% SOCIAL SECURITY NUMBER DATE OF DEATH IMmin. Day, rear) Brandt 2. Female q 171 - 28 ~ 5087 a. Jul 27 2002 I YEAR UNDER IDAY DATE OF BIRTH BIRTHPLACE 1GIy and PUCE OF DEATH Ipheck oNy one-see,nsbuclbns pn dhm l;bB) Deys Noun i Mlnuln lMOMh. Day. Year) Slatew Fweiyn Coumryl HOSPITAL'. OTHER: WilkenSburg, PA 1rWaliaM ^ ERiOuIDYNn1 ^ DOA ^ y"~~r :"q ® R.aaanca ^ s~ny) ^ ,_ 5/23J1911 T w, CITY, BORO. TM/P OF DEATH FACILITY NAME pl nM insxNliwl qwa Shoat and Mmberl CEDENT OF HISPANIC ORIGIN? VNS D E RACE ~ Ameriten lnden, Black, W 1 pp 1 apeciry Cuban No KY Yea ^ H Yas ISpechYl Hampden 14~p, Country Meadows Nursing Center , , ~ ••~•^•Pw^pR'p'^'Yp ,g White 1PATION k KIND OF BUSINESS/INDUSTRY w WAS DECEDENT EVER IN DECEDENT'S EOUCATN]N MARI7ALSWUS~Manied SURVIVING SPOUSE ~p ~ U.S.ARMEDFOR CEST h sl c ~ I C• EY n e NewrMYrNd, Widowed, lv ort W (S pacrtY) D pr w,te, yva ma,den name) ~r• ) 1~ Yee ^ No t4 I.a ga r^• •7i2 ry ) y-.,~ Education ( p 2 ( ~ ~ ,]( y ~ Wl`^""„" te 15 Itb. 12. 19. . . DECEDENT'$MAHING ADDRESS ISbeel. Gly]bwn, Stale. 2,pCode) DECEDENT'$ pennsvlvania 1h.f ~l Y... d.c.danl liy.d in_ Hampden Iwp re AcruAL n.. seta Dm 4905 East Trindle Road RESIDENCE d.cawm rsee ~nalrudiw,a hw ~. ,other vde) Cumberland township? No. daceanl l'wed McChanlCSbUrga PA 17055 lm.cpenm t7a.^ tninamwllimnaol tip/burp Paulette S. Foster 2gb1700 Wyndham Road Camp Hill, PA 17011 zM. NETHOD OF DISPOSTIOCgqN ~r~--1t DATE OF DISPOSITION PUCE OF OISPOSRNkI-Named Cemata7~Cnmpory LOCATION-ClryR wn, Stale, DP Code Buriall4 Cremalbn LJ flamoval lrom $nte^ (MOnlh, Day Pearl or Olhar Plan Dpnal"nl _1 DlMrespH:,ry ^ 21p, July 31 , 2002 „Rolling Green Cemetery ,,,, Cam Hill, PA 17011 iIGNN URE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESSOF FACILITY >.IT_(11 dAA9_r. __ MaIcTP~z4 A Nf~rk~t Playa 4~v N~dranirst~taa. E~ 17055 C pWle items 23at only when cenilyinp To1M M91dmy krbwied e, death occurred al lha lima. dare and plan sl ued. LICENSE NUMBER DATE SIGNED VhYSician,s nd avaAable al lints pl death to camty causeddaaln (9gnahUO and TiNe) 1 C ~~71 ~ pp /I ))JJ /n /- r l n ~._` ~ I (MOn lh. aY. Year) .{!. it / /,/.) , /' ~ 27a. ~ /7N • V 2qb. 27< . . y hems 2J 25 must M cpmplene by erson who ronowlces death - TIME OF DE TN DATE PRONOUNCE PEADIManlh, pay Year) J f VMSCASE REFERRED TO MEDICAL E%AMINER/CORO Y ^ 1 r No ` ~ p V s - ` ~ / ~ ] " ~ C 1 Q~ as . L F N. ! M / 25. .~. ,y 26. 2T. pART 1~. EMer lho eisaasea, lnlwies or complkalbna which ceuaae ma seals WMlanler lne moos or ayVrg. s,cmm~ru,acm respnerpry I isl Dory one cause on aeon tun / 1 IYYEDIATE CAUSE If mat 1/ y ) . :kscax: u. cuun,xon /)~ / , ~ ~ C Zi1Y '`~~L /~( C~ s~ /`/ ~esuau,q,n dears)-~ i / ~e-5LL_pf/ DUE IOR ASA (%lSEOUE CE ) Savuenuahr kv .:onenrona e J any. lead,ny la unnndiaY DUE TO IOR ASAGONSEOVfNCE OF): Gauss Enlel UNDERLYING CAUSEIDiscase w,nyny e.. Ihal inxui W events DUE TOIOR AS A CONSEOIIENCE OF I . nx,hu g u. ,x~um) LAST e _~~_.. _.~_-_ _.___.. __~-_. ~~ VMS AN AU iOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJUR i Z PERFORMED? AVAILABLE PIUOR SO (Mwhl, OaY Pearl COMPLETION OF CAUSE OF DEMH9 Natural Homicide ~_~ ~-' Acwdanl ^ Pend+ng Mvestigalion ^ ^ Np Q. Y.e ^ Np ~' sa,cld. ^ cpple rwtMnlermbae f 7 qo.. a b. Yaa PLACE OF INJURY ~ Al Mme. Iarm.akeN bwldirrg, etc ISpenly) 2M. 2ab. 2a. 3tN. CERTIFIER VCnecx oMy are) 'CFRTIFYINO PHYSICIAN (Pnyyaan cenayup cause of Uwm when annhie, VI iys.Ian nos uiuna,ncao deals unJ cnn,yl,;lu,] ha~n 2J1 Tu the Mal of my krowledpe, rMatll occwrW thY to IM ousels) arts manner u stand ..................................................... 'PRONOUNCIHD AND CERTIFYING PHYSICIAN IPhy;cun Dols tvunnuncaiy deals ar,d ce,IJyinq to cause eX <x;aa,1 To1M Mal of myYrowMdge,GaM OCCUned a/the time,dab, arts p4ca, arq dw lolM cauae(eT andmmwraa ata4d .... ........ .............. ^ •YEDICAL E%AMINEIUCORONER Oniha beats o/eaaminatlon and/or lnveallgatlon, In my oplnlon, dsath xcwred al Mellme,dale, and P4cn, and dw to lM causalal an0 ^ manner as atated ................................................................................ .. ... ... .......... dta. REG~ISTyR/~AR('S SIGNATURE AND NUMBER )y~ / /~ .f~. ~11) ~~ ~~ '''' 1`~ 'kaervv bYween I n0l rasuelnq lnlw urWarlying nose green In PAHII. ~ anaN and death I URY INJURY AT WORN? DESCRIBE NOW IN. _~ Yse ^ No ^ M. ~ 70d. Dry, oHKa LOCATION (Sirael, peynown. Seale) F CER NFIER ~/~/l DAVE'$'17GNE IM<ryMn Du 'rear) ,> yet 7 ' G 71 d. / Z y/~i PERSON wH0 COMPLETED CAITSE OF DEATH L7Y ~ Dtr•i t d A . t o~; u ~ 1'" ~~ yL~Tlo ma, Kz ~ S1 set ~- I 1 r' u i I cal .~ %.AST L7ILL AI~7D TI~STAM'i~~?T 21.-2002-716 I, AP~r"v~ '~. B:ZAP~.ytT, of ~iampc?en Township, C;umber.lz:~nd r'„un}y, i'enns; ls.ran_:~_a, heina o'~ sound mi nd, memory grid understanding, coo make, ~>~~blis~,. and declare this as ar~d {or. my last wi~.l ~Tnd testament, r~?reby revokin an.~ r~laki.r,~; vo~c~ a_1 ~ormer~a_lls 1~y .~ at an4~ time heretofore madF~. rIT'S`T. ? direct all my Ji1st debts and ~unera]_ F:~.xrenses be f,,1ly ~G~r.? and satisfied out of my estate b~, my pe.rsc:,pal. represent- ai:ive(s) !~ereznafter named as soon as ccnvenient_1}~ may he after my decease. SECC~Pt~v. I give, ~lev?.se and bequeath a7_l of my estate, real and norsonal, '-o ~~ny/husband, tim<~non L.. Brandt, absolutely. T~II?'J~. In tho event that my said husband nreder_eases me, then I ~i.ve, devise. and beque~ all of ~riy estate, rea]_ and i~ersonal, to my t~~o daughters, Mar7arer_ A. Sheath and. golly S. roster, i_n equal sharps or their. issue. LASTLY, I nominate, constitute and appoint_ my said husband, Anli-non l.. Brandt, executor, i_f living, othercaise my said t~~ao dauhters, Margaret A. Sheath and Po-1~._y S. Foster, E,.ecEitri_r.es, or the survivor,~xecutrix., of this my last wi1!1 and testament. ~~`: ~t'ITNESS ;~IiER~Qr, I have here>>nto sel: my hand and seal this __ _~ ginned., sealed, published and declared by the above named Testatrix, <~nne M. Brandt, as and f.or her last will <~nd testament i_n the presence of us, who, at her. request and in her presence and in the presence o:E each other, as witnesses thereto. have hereunto subscribed our names / n ~__ ~_~ ~ ..~, z .~.~ _____~._ ,. _ __ _- ,,/ ~: -----7--- _---~- 21-2002-716 REGISTER OF WILLS OF CUMBERLAND COUNTS.', PENNSYLVANIA OATH OF NON-SUBSCRIBING WITNESS I'GC ~~ ~C l-Ut,~ai Subscriber hereto, being duly qualified according to law, deposes and says that ire/she is familiar with the signature of ~ y~~(~ /-~, ~j;~~~~c~~- , testator/testatrix of the Will presented herewith and that ~-'she believes the signature on the Will is in the handwriting of 4~e t~1, i'~~ ct.~ ~- to the best of -~ri-~~her knowledge and belief . Sworn to or affirmed and subscribed before me this th day of Auctust 2002. ~Z~2~~~ ~ . ~~~ ~~.> For t Register Mary C. Lewis /''~ ,~ may- (~~ /-~s ~ , r .. _ ~ t ~-/~C~GG~C ~J ~~}fie ~`~-''' 21-2002-716 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA OATH OF NON-SUBSCRIBING WITNESS C M~~-9~,Q~-- ~~°-~E' , Subscriber hereto, being duly qualified according to law, deposes and says that he/she is familiar with the signature of J.~,/~n,~_ ~. (~,n~.,~c.~~- , testator/testatrix of the Will presented herewith and that he/she believes the signature on the Will is in the handwriting of ~,~,~ ~~, ~;~t~M C to the best of his/her knowledge and belief . Sworn to or affirmed and subscribed before me tr~is 9th day of August 2002. For th. Register Maly C. Lewis .7' CERTIFICATION OF NOTICE UNDER RULE 5.6(a~ Name of Decedent: ature Date of Death: _ ~ ' ~ T ' o~ Will No. o ~ ` ~~ ~ (D Admin. No. _~ 1 " ~o(.,' ~ ~~~Q To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) o the Orph s' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on f Q Z, ~.,r4A.re,~ ~. ne:Q`~~i 8l~ ,Dor~Sec ~o/ La.ncas~er ~ 1 ~~D/ Name Address ~o~~v cS . ~ s ~e~ a1k~Q ~a u 1e~e s ~o ~~er ~OV h l~~`l~, ~- «- ~~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. N~~ ~ Date:~LT~ (1-f~Z a Name ~ ~ ~ ,r1. L F l~ F gCa 1-}y~l , '- 5 ~, + Address ~~~aw ~~~ New ~^r''~2~'~a..,.~~ ~~} 1`~-O~-L Telephone (~j ~j _~ 3 `~ ~. 6 ~2 Capacity: Personal Representative Counsel for personal representative ~J JRD/June 30, 1992/17858 In Re: Estate of ANNE M BRANDY Late of HAMPDEN TOWNSHIP Estate No.: 21-02-716 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2002-716 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: POLLY S FOSTER A/K/A PAULET'TE S FOSTER AND MARGARET A SNEATH Counsel for Personal Representative: Date of Grant of Original Letters: 08-09-2002 Date of Delinquency Notice: 11-19-2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court 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 Register of Wills on NOVEMBER 19, 2002, 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: 11-19-2002 A~4ai~-~av~s, Register of`Will~(~ ~I~~p,~ Distribution: Personal Representative f V Counsel for Personal Representative Estate File A hearing is scheduled for %-/~ " ~'~ at ~.'~a/~,.~In Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. . .~~ George E. o ~ .~?~ '~' - . Rl\j'1'.[,H"lo-:;~) W 0- ,,:$W "tr" wOo" :tOO "a:.. Oo" Oo " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT.2Bll601 HARRISBURG, PA 17128-0601 / '/-cft) - / / REV-1500 / OFFICIAL USE ONLY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ..21- - Q2 _ 0--. LL..6_ COUNTY CODE YEAA NUMBER I- Z W C W U w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INlTfAL) Brandt, Anne M. DATEOFDEATHIMM-:-DDYEARi-- - - --IDATE OF BIRTH (MM[;O:YEAR)~~- _ 7/27/~2____ _ __J_5/_:3!1911 _ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST~ FIRST, AND MIDDLEINrnAl) ----. .---- I SOCIAL SECURITY NUMBER 171-28-5087 --t: --~- --_..~.--- ---- -- THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS N/A ~ 1. Original Return [J4.limitedEstate [J 6,l}ecedentDied Testate IAttaChr.apyofWiIl) C 9, Litigation Proceeds Received I SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. Future Interest Compromise Idate ofcieathaller 12.12-ll2) o 7. Decedent Maintained a living Trust (AttaChcapyoITrust) o 10. Spousal POl/erty Credit \l;\ateD1~ea1hbe:wel"fi 12-31-91 and ,_1_95) o 3. Remainder Return (date 01 death pJior to 12-13-82) [J 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to lax under Sec. 9113(A) (Attarh Sch at 0- Z '" <> z o Oo w W tr a: o " THIS seCTION MUST 81: COMP~erI:O, A~L CORRI:SPONOI:NCIlANP COlilFIOI:NTlAL TAX INl'OllMATION SKQU~O 81: DIRECTED TO; NAME COMPLETE MArLING ADDRESS FIRMNA~;t~",!;'.-LedehoJun- - ~~~'c~~~e~i~nd, PA TELEPHO~iE-NU-MBER ---- - ---- 717 938-6929 1 Real Estate (Schedule A) 17070-0173 (1}ll4+5.0.0_M____.________.___ (21. (3) 14) (5) .. _5.8_9_,_';13 OFFICIAL USE ONLY 2 Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnersl1ip or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) z o ~ ..J :;) !:: D. c:( U w 0:: 6. Jointly Owned Property (Schedule F) [J Separate Billing Requested (6) __.__ .___...._._ 17) ~8...Ji20. 09 7. Inter-Vivos. Transfers & Miscellaneous Non-Proba'le Property (Schedule G or L) 5, Total Gross Assets (total Lines 1-7) (8) ---..113, 7L~_g_z...... 9. Funeral Expenses & Administrative Costs (Scl'1edu\e H) 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (9) __il-,- 902_,.17___. (10) 11 Total Deductions (total Lines 9 & 10) 12, Net Value 01 Estate (Line 8 minus Line 11) (11) 18,907.37 (12}_..lQ.4, 80_2. 65____~_._ (13) 13. Charitable and Govemme(1tal Be<:j'JestsISec9ll3 TfUsts for which an election to tax has not been made (Schedule J) 14, NetValue Subject to Tax (Line 12 minus Line 13) (14) 104 , 802 .65 SEE INSTRUCTIONS ON REVERSE SIDE fOR APPLICABLE RATES z o i= ~ :;) D. :iE o U g 15 Arnount of Line 14 taxable atthe spousal tax rate. ortra'lSfers under See 9116 (a)(1,2) 16, Amau(\t of Li\1e 14 ta)(able a\ lineal rate 17 Amount of Line 141axable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 2D.['-1 > > BE SURE TO ANSWER ALL QUI:STfONS ON Rl;IIERSE SIDE AND RI:(;HECK MATH < < 104,802.65 x 0 (15) x 0 4.5(16) _..____'l.-L.21.6.J_12.. ___ x .1L 117) x.15 (18) (19}'1.L:U.2_...J.2_. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS . ___CQ11nj:.!"y _~e~(jo~Elu_N~r~~ng Center 4905 East Trindle Road Tiff - - ,,- - - --'--- - - - - - - - - - --- -- 'csbur STATEpA-- ZIP17055 Tax Payments and Credits: 1. Tax Due (Page Hine 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4716.02 Tolal Credils ( A + B + C ) (2) 3. Interest/Penally if applicable D. Interest E. Penally 4. TOlallnleresUPenally (D + E) 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 (3) (4) (5) (SA) (58) 5. If Line 1 + line 3 is greater than Line 2. enter the difference. This is the TAX DUE. 4716.02 A. Enter the interest on the lax due, B Enler Ihe lolal of Une S + SA, ThIS IS Ihe BALANCE DUE. 471n.0? Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRiATE BLOCKS No [] [] [] ex o G: ..........0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS is YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Did decedent make a transfer and: a. relaln the use or Income of the property transferred;.. b. retain the right to designate who shall use the property transferred or its income: ..... c. retam a reversionary ir\terest; or.. d. receilJe the promise for lite of elther payments, benefits or care? ".. . ........ ,... . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without rece'lvlng adequate consideration? .. .. 3. Did decedent own an "in trust for" or payable upon death bank account or security al his or her death? .. 4. Did decedent own an Individual Retirement Account, annuity. or other non-probate property which contains a beneficiary deSignation? Yes .......0 ....0 .......0 ...0 .... Ga ........0 Under penalties of perJury, I declare tl1at I have examined this retLJrn, indLJding accompanying schedules ood statements, and 10 \lie best oi my knowledge and belief,rlrs IllJe, correct and complete Declaration of preparer oll1er than the personal representative is based on all informaton of which prepare! has any knowledge ~;;;R:ZES~I~:~~~N~RE~UR~ ~olly ~Foster ____li2'1;~~ __ 17~O yndham Ro Camp Hill, PA 17011 SIGNATU;foRE ' ", P " 6~ERlfl(NrERES TATIVE DATE ,I ADDRESS- -NP~' , :Karl-H-.L-ede'D9hm,---ES~_-)jL~~ _ ___ ~Q. _BQxlVcl'Le", .Q.ultlberland,_Pi\ .!_7070-012-~___ For dates of death on or after July 1, 1994 and betore January 1, 1995. the tax rate imposed on Ihe nel value of transfers to or for the use of the surviving spouse is 3% [72 PS \9116 (a) (11) (ill For dates of dealh on or ailer January 1, 1995, the tax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 0% [72 P,S, ,s9116(a) (1.1) {Ii)} The statute does not exempt a transfer 10 a surviVing spouse from lax. and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even If the survIving spouse IS the only beneficiary For dales of death on or atter July 1, 2000 The tax rate imposed on the nel value of transfers from a deceased child twenly-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% 172 PS \9116(a)(1.2)1 The tax rate Imposed on the net value of transfers 10 or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S. S9116(1.2) [72 P,S. 99116(a](1)]. The tax rate Imposed an the net value of transfers to or for the use ot the decedent's siblings is 12% [72 P,S, 39116(a)(1.3)), A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, wllelher by blood or adoption REV-15Q2 EX" (6-98) t' ,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Brandt, Anne M. FILE NUMBER 21-02-0716 All real properly owned solely Of as a tenant in common must be reported at fair mar1l:et value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled 10 buy or sell, both having reasonable knowiedge of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Residence) 18 Skyport Road, Mechanicsburg, Hampden Township, Cumberland County, PA. Decedent acquired title by Deed from Ammon L. Brandt and Anne M. Brandt dated 11/5/66 and recorded in the Cumberland County Recorder of Deeds Office at Deed Book E-22, page 1. Property was sold on 10/31/02. A copy of the HUD-1 is attached and made part hereof by reference. 114,500.00 TOTAL (Also enter on line 1, Recapitulation) $ 114, 500 . 00 (If more space is needed, insert additional sheets of the same size) U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1-DFHA 2-DFmHA 3.DCONV. UNINS. 4.0VA 5. [J{)CONV. INS. ro.FTlJO I I I. LUAN, : SETTLEMENT STATEMENT 02668 217711710012556544 8. MORTGAGE INS CASE NUMBER: 0229016038 C. NOTE: This form is furnished to give you a statement of actual settlement costs, Amounts paid to and by the settlement agent are shown. Items marked "(POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. to 3/98 (02668/02666/20) D. NAMe AND ADDKe~~ OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: T onya M. Hoffman Estate of Anne M. Brandt Citizens Mortgage Corporation 71 Willow Mill Park Road, Apt. 3 18 Skyport Road 10 Tripps Lane Mechanicsburg, PA 17050 Mechanicsburg, PA 17050 Riverside, RI 02915 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25.1878915 I. SETTLEMENT DATE: 18 Skyport Road Keystone Land Transfer, Ltd. Mechanicsburg, PA 17050 October 31, 2002 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 3421 Market Street Camp Hill, PA 17011 J. VrtlV IIUN ". " vr SELLEH'S IIUN 100. GRuS" AMUUNT DU~ .RUM liuRROWER: 400. GRO"" AMUUNT DUE TO SELLER: 1U1. \..,;on faCt ti3les nce 114,500.00 401. Con raCI ;::>a es t"'r1ce 114,500.00 1 UL. I-"ersona I-"roper y 402. Personal I ropeny 1UJ. ~ememem l...inarges to Borrower (Line 1400) 4U3. lU4. 404. 'IUO. -.m>. AOjUSCments For Items Paid Hy Seller In advance AdjUstments ror Items PaId By Seller In advance "I Ui:>. L.HY/I own axes to 406. Cltyl lawn Taxes to -IUf. voumy Taxes to 01101103 41.B1 4OT'COunty Taxes 10131102 to 4U1 108. School I ax to vuv I 4UB. ~Chool I ax \0 020.10 109. Sewer 10131102 to 01101103 47lT 4Ul1.SOwer 10131102 to 0 1IU 1 103 47.11 110. 41U' 111. 41T. 112. 'IlL 120. GROSS AMOUNT DUE FROM BORROWER 119,253.22 420. GROSS AMOUNT DUE TO SELLER 115,209.14 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: n. ueposlI or earnest money 1,000.00 501. Excess ueposH l;,ee nsrruc lonSJ LVL. t"nnclpal Amount of New Loan(s) 111,050.00 tiO~. :::;~ttlement vnarges to ;::,eller (Line 1400) 8,552.00 203. EXisting loan(s) taken SUbject to :m:l: ~XIS Ing loan(s) taken Subject to 204. Citizens Grant 3, '04. ~ayott of first Mortgage 205. OU5. t-'ayo orseconolvlongage 206. -soo: 207. our. (Ueposit dlsb. as proceeds) 208. -soo: LU!;J. Gloslng costs tram seller -z;sD1JW --smr.- erasing costs trom seller 2,'00.00 AdjUstments rOf /tems unpaid Hy ~eller Adjustments I-or Items Unpaid By ::ieller L1U. cltYJlownraxes to 5fO:-CitYII own I axes to m. <coumy axes to 511. Coun y laxes 0 ;'::1;'::. ;,cnoo I ax to 512. SchOOl I ax 0 "J. 513. :14. 514. :10. 515. 116. ,,10. 117. 101 . 218. Iora: 119. I:rrg:- 220. TOTAL PAID BY/FOR BORROWER 117,985.00 520. TOTAL REDUCTION AMOUNT DUE SELLER I 11,052.00 'UU. : 'OUlJ. CJ\"M ' : jUl. brass Amoum uue t-rom tjorrower {LIne 120T 119,253.22 601. Gross Amoun uue 10 ;,eller (Line 4LU) 115,209.14 .:lUL. Less A.moum t-'alQ !jYll-or Borrower (Line 220) \ 117,985.00) 602. Less KeaUCllons uue ~eller tune OL.U) 11,052.00 303. CASH ( X FROM) ( TO) BORROWER 1,268.22 603. CASH ( X TO) ( FROM) SELLER 104,157.14 The undersigned hereby acknowledge receipt of a completed copy af pages 1 &2 of this statement & any attachments referred to herein. Tonya M. Hoffman Seller 1~d.hy1~ Estate of An M. Brandt Borrower ..............,....L..,.,....,'1. .......1""\,".........__ 700. TO I AL COMMISSION Based on Price $ 114,500.00 @ 6.0000 % 6,870.00 PAID FROM PAID FROM U/VI,'ifOn or l-ommlSSIOn (lme IUUJ as rOIlOWS: BORROWER'S SELLER'S Ilv\..o,omuv '0 KelMax KeallY ASsOciates, inC. FUNDS AT FUNDS AT IIVL. . '0 SETTLEMENT SETTLEMENT I fU~, 'uommlSSlon t"31U al ueUlement "-"Iv.ve IIU4. I ransaCIlon r-ee to He/Max KeaJty ASsOC. Inc. lLO.vU l000.UU 800, ITEMS PAYABLe IN CONNECTION WITH LOAN ~UI. Loan ungma Ion r-ee U.UUUU "I, to I rJUL. Loan ulscoun1 "I, to I tlU~. Appraisal ee to National K e Inro ~ervlces ""V.UC I ~u<\-. 'urBun Kepon to I ne IAeOIl NetworK 10.UC I tlU::J. Lenuer s nspec Ion ree to I auo. Mongage Ins. ,""pp. ee to I OUI. .....ssumpllon ee to I auo. unuerwnting t-ee to 'vI Izens IV\ongage 'uorpora\lon "3UO.OC 10vo. ax .:lervlce ee to t-IrSI AmeriCan 1 ax ~ervlce -I;WO a IV. r- OOu verl to t-lrSt Amencan 1"'1000 uam ~ervlce -'0.00 0". 900. ITEM:; ReQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10/31/02 to 11/01/02 @ $ 15.590000/day ( 1 days %) 15.59 ::tv..::. Nlorlgage nsurance remlumlOr monms \0 fJUJ. Hazara Insurance t-remlum or I.' years Wene Insurance ljroup ~04. ~OO. 1000. RESERVES DEPOSiTED wiTH LeNDER 1001. Hazard Insurance 3.000 months ~ 20.83 per month 62.49 1002. Mortgage Insurance L.UUU monms ~ (jtj.tl4 per montn 177.68 100:3. Cityllown 'axes montt~s ~ per monm 1004. Covnty 'axes lj .uuu manInS . Lu.::n per momn 164.08 1000. ~cnool 'ax L.UUU monms . 11.0" per month 155.26 IUVO. monUlS ~ per momn 100/. momns . per month I UUO. Aggregate AdJvstment months ~ per montn "L'.~" 1100. III LE "MARGES 1101. Settlement or Closing Fee to 110L. Abstract or IllIe ~earcn 0 11 UJ. Title Examination 0 11U4. r ltIe Insurance tunaer 0 11U:,. uocument r- reparation o ~alaIS, GUlaO, bnurr &. MaSlan 11 00. NOtary "ees o "A"H lL.UV 12.00 11Uf. AttOrneys t"ees to mc uaes aDove /Cern numoers: ) IIUO. I e Insurance o Keystone Lan Transfer, Ud. o ICY #0521 02 933.75 InCluaes aDove Irem numoors: ) II U::t. LenUer s \..-overage . I I I,VOV.Uv . IIU, uwnersuoverage . I ",ovv.uv ;'1 I. r:::nuorsemen(s IUU,,)UU.o. o t\.eyslone Lana ranSIer, LIU. 10U.VV IlL 'uloslng t"rolecuon Letter o "eYSlone Lana ranSIer, LIU. "O.VV "0. ax ro;ecelplS KeYStOne L.anU ransier, LIU. 11"+. uvernlg/lt 'u eueral express H.UV I I;). ro;auon IVlllga Ion to ~leGnler & 'u,ery Lbo.UU 4UU:UO "u. 1111. 1110. 1200. GOVERNMEN I "~,,vRDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 64,50; Releases $ 103.00 1 LUL. ;ItYIl..;oumy I aXf'=itampS:ueea " 140,UU; Mortgage I, 'O,VU, lLUJ. ~ta e I aX/~tamps: Kevenue ~!amps 1,140.UU; Mortgage 1,145.00 lLO'. '''VO. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to '"UL. est inspection to '''U''. eruse l.1 Hl-1LfJl J to Hampaen owns nIp 18.16 1304. eSI, Kauon, Mome nspec Ion tjlecnler & IlIlery $:3"0 PUC 1:300. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 5V2, :;ectlon K) 4,044.08 8,552.00 By signing page 1 of this st"tement, the signalories acknowledge receipt of a comple\etl copy of page 2 ollhls two page Slalement Certified to be a true copy. / / l.-r,...; .'1 ." ~ Keystone ~ai1d ) ransfer," Ltd. Settlement Agent f' REV.1508 EX, (6.98) .. COMMON\lVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISe. PERSONAL PROPERTY ESTATE OF Include the proceeds of litigation and the date the proceeds were receil/ed by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F FILE NUMBER 21-02-0716 Brandt, Anne M. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. PNC Bank, PNC Decedent Reporting First Side Center $389.93 500 First Ave., 4th Floor, Pittsburgh, PA 15219-3128 Acct.: *5140006546 EstabliShed: 09/01/1966 (statement attached) 2. Household furnishings and personal property 200.00 TOTAL (Also enter on line 5, Recapitulation) $ $589.93 (It more space is needed. insert additional sheets of the same size) JA~~-15-200.3 2'0: 5,,':) F'rICBAhV, 412 '7S8 ::::',4:::~: F. Lll ~::';l o PNCBAN< January 16, 2003 Karl M Ledebohm Attorney at Law POBox 173 New Cumberland. P A 17070-0173 scp RE: Estate of ArUle M Brandt (Deceased) SSN: 171-28-5087 000: 07-27-2002 Deal Mr LedebohllY In response to your request for Date of Death balan"es for the customer rIOted abe,ve, OUI records show the folJowing: CheduDg Account Accountll514oo06546 Established 09-0 1-1966 ANNE BRAf\TH DOD balance: $389.87 + $0,06 accrued interest The decedent did not maintain !lny safe deposit box at PNC Bar.k, Please note that this office only provides date of death balances for deposit accoWlts (mAs, CDs. Checking and Savings accoWlts), We do not process !Ill> financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (J -888-762-2265) or stop by your local PNC Bank bnL'1Ch office. Sincerely, ~;l,~ Erica L Schlt:gel PNC Decedent Reponing Firstside Center 500 Fil"St Ave, 4" FI elF Pm,burfh PA 15219.312, ).800.762-1775 :>lemi>er FDIC TC:""~~ REV-151O EX' (6-98. COMMONVVEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Brandt, Anne M. FILE NUMBER 21-02-0716 This schedule must be completed al1d flle;j if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes ITEM DESCRIPTION OF PROPERTY TAXABLE :NGlUOE THE. NAME Of 'l\1E TRANSFEREE. Tl1EIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION NUMBER THE DATE OF TRANSFER ATTACHACOPYOFlliEOEEO tOR. REAlESTATE VALUE OF ASSET INTEREST IF APPLICABLEl VALUE 1 Foster. Decedent's daughter Polly s. Transfer date: 1/28/2002 8,620.0 100% $8,620. TOTAL (/\150 enter on line 7 Recapitulation) $ $8,620.0 09 9 (If more sp<lce is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Brandt, Anne M. FILE NUMBER 21-02-0716 Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1 (a) ROlling Grave opening to Green Cemetary $870.00 (b) Malpezzi Funeral Home 5,994.20 (c) Food 250.00 B. ADMINISTRATIVE COSTS: 1 Personal Represerltative's Commissiolls Name of Personal Representative(s) Social Security Numbe~s}!EIN Number of Personal Representative(s) Street Address City State_Zip Year(s) CommissiOIl Paid'. 2 Attomey Fees 3 family Exemption: (\i decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State_Zip Relationship of Claimanlto Decedent 4 Probate Fees to Cumberland County Register of Wills. $ 249.00 5. AccoulltSrl!'s Fees 6 Tax Return Preparer's Fees 109.00 7. Verizon 33.08 8. PP & L Electric 68.34 9. Liberty Mutual (Homeowner's Insurance) 80.08 10. Expenses from sale of 18 Skyport Rd. , Mechanicsburg, PA 17055 (a) Notary 12.00 (b) Radon mitigation to Biechler & Tillery 400.00 (c) Transfer Tax 1,145.00 (continued) TOTAL (Also enter on line 9, Recapitulation) $18,907.37 (If more space is needed, insert additional sheets of t'ne same size) SCHEDULE H CONTINUED Estate of Anne M Brandt File No 21-02-0716 Expenses from sale ofSkyport Road, Mechanicsburg, PA 17055 continued (d) Real Estate Commission & Fees to ReMax Realty Assoc., Inc. $6,995.00 (e) Seller's closing cost help to Buyer 2,500.00 11. Advertisement of Grant of Letters- Cumberland Law Journal 75.00 12. Advertisement of Grant of Letters- Patriot News 11167 13. Inheritance Tax Return filing fee to Register of Wills 15.00 Total $18,907.37 REV"1511 EX... {9.QQ) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA IN.HERlTANCE TI\):. RETURN RESIDENT DECEDENT 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (aJ (1.211 Margaret A. Sneath 819 Dorsea Road Lancaster, PA 17601 FILE NUMBER 21-02-0716 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not ListTrustee(s) OF ESTATE ESTATE OF Brandt, Anne M. NUMBER I Daughter 50% 2. Polly S. Foster a/k/a Paulette S. Foster 1700 Wyndham Road Camp Hill, PA 17011 Daughter 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON liNES 15 THROuGH i 8, AS APPROPRIATE, ON REY-1500 COYER SHEET " NON-TAXABLE DISTRIBUTIONS: A- SPQUSALOlSTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II _ ENTER TOTAL NON. TAXABLE OISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ (If more space isneeded,insertadditionalsheelsoflhe same siz e) LAS T ~';ILL Al\1]) TES TAI1E1JT / I, ANNE N. BRANDT, of Hampden Township, Cumberland County, P 1" b" f 1 'r1 ennsy VanJ.8, e"Lng 0.. soune m:UL, memory and understanding, do make, publish and declare this 8S aod for my last will and testament, hereby revoking and making void all formerVJills by DC at any time heretofore made. FIRST. I direct all my 1U8t debts and funeral expenses be ~ 4 fully paid and satisfied ont of my estate by my personal represent- ative(s) hereinafter named as soon as conveniently ff,ay be after my decease. SECOND. I give, devise and bequeath all of my estBte, real [wd personal, to m~usband, Ammon L. Brandt, absolutely, THIRD. In the event that my said husband predeceases me, th.en I give, devise and beque<th all of my estate, real and personal, to my t,.;o daughters, Margaret A. Sneath and Polly S. FQster, in equal shares or their issue. LASTLY, I nominate, constitute and appoint ffi" . J said husb8nd, Ammon L. Brandt, Executor, if living, otherwise my said two daughters, Hargaret A. Sneath and Polly S. Foster, Executrices, or the survivor, Executrix, of this my last will and testament. I..N WITN~EREOF' I have hereunto set my hand and seal this . J;t ,"- U_day of ~/-u-, 1968. -4:20d/ _'/7J.;Ji~a.?"-Lt- (SEAL) Signed, sealed, published and declared by the above named Testatrix, Anne M. Brandt, as and for her last will and testament in the presence of us, who, at her.request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto. /L'f~./~-'~ FROM :PENN WIRE PRODUCTS CORP FAX NO. :7173937091 Jun, 17 2004 08:02AM P2 P~u~t ~ ~e 6.12 of~¢ Sup~ Co~ ~' Co~ R~es, fo~o~g ~ r~ to compl~on of~e ~mi~s~fion of~e abov~fion~ 1. S~te wh¢~ ~sMafion of ~e ~tate is complete: Yc, ~ No ~ m Did ~ p~o~ r~r~nmtive ~e ~ ~ ~t Y s_ No b. ~ s~c ~' Co~ No. (if ~y) for ~ c. Did ~e p~ r~ma~ve sm~ ~ a~t ~o~y ~o ~e p~ ~. C~i~ ofmcMp~, mle~, jo~d~ ~d a~rovM of ~o~M accosts ~v . b~ ~ ~ ~e ~rk of~e. 0~' Court 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 N0. CD 002338 LEDEBOHM KARL M ESQUIRE P O BOX 173 NEW CUMBERLAND, PA 17070-0173 ,old ESTATE INFORMATION: ssN: ~7~-2$-5087 FILE NUMBER: 2102-0716 DECEDENT NAME: BRANDY ANNE M DATE OF PAYMENT: 03/26/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 07/27/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 54,716.12 TOTAL AMOUNT PAID: REMARKS: MARGARET A SNEATH C/O KARL M LEDEBOHM ESQUIRE CHECK# 13 SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO REV-1162 EX(11-96) 54,716.12 DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~~- alb - // COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 288601 HARRISBURG, PA 17128-0681 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% OFP coi-o3~ DATE 05-05-2003 ESTATE OF BRANDY ANNE M DATE OF DEATH 07-27-2002 FILE NUMBER 21 02-0716 COUNTY CUMBERLAND KARL M LEDEBOHM ACN 101 PO BOX 173 Amount Remitted NEW CUMBERLAND PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER 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 BRANDY ANNE M FILE N0. 21 02-0716 ACN 101 DATE 05-05-2003 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) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) 114,500.00 (2) .00 (3) .00 (4) .00 (5) 589.93 (6) .00 (n 8,620.09 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 123,710.02 APPROVED DEDUCTIONS AND EXEMPTIONS: 18,907 .37 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 18.907.37 12. Net Value of Tax Return (12) 104,802.65 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 104,802.65 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) •0 0 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 104,802.65 X 045. 4,716.12 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) •0 0 X 15 - .00 19. Principal Tax Due (lq)= 4,716.12 TAY 1'QCt1TTC. DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 03-26-2003 CD002338 .00 4,716.12 TOTAL TAX CREDIT 4,716.12 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) :? C :~ _ (~' ~ p ~ ~ ~? t w ,~ . ~;> n ~,., ~,. .... ~ ~o ~ , o _ M ~ _~+ r.r A ~. RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession ar enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: Ta fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF WILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax^ CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount ar interest) as shown on this Notice must object within sixty (60l days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, 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 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. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent^ (REV-1501) far an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same Wanner and in the the same tine 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 (17 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 (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER 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. FROM : PEhdN I,J I R..E PRODUCTc CORP FAX P ~O. : 71 7 9;7t~91 Jun. 17 2GG~4 `78: O2AM r~ STATUS REPORT UNDER ULE 6•.12 Name of Decedent: ~ ~ r^ n ~" Date of Death: ,~ ~.,~~,..~ ~~- ..~ Will No.: , - j Admin, No.• " ~~~ -' ~~(C~ Pursuant to Rule b.I2 of the Supreme Court Orphans' Court Rules, Z z~eport the following vuith respect to completion of the administration. ofthe above-captioned estate: ? . State whether administration of the estate is complete: Yes j~ No D 2. If the answer is N'o, state when the personal representative reasonably believes that the administration will be complete: 3. If the aaswer,to N'o. 1 is Yes, state the following: a. Did the personal representative file a fin31 account with the Court? Yes 4 No r] b. The separate Orphans' Court No. (if aay) for the personal representative"s account is• c. Did the personal x resentative state an account informally to tha parties in interest? Yes ~ No j~ e. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the C~rk ofthe. Orp,~ans~ ourt and maybe attached to this report. ~ iJ~) „ / J Date: ~--0 y Name ~ G 1 ~~ l~c%v~` ~~~~~ l~' 1 ~~~U -Oj ~~ Address Telep one No. Capacity: n Personal Representative ,Counsel for personal representative