HomeMy WebLinkAbout02-0688
PETITION FOR PROBATE and GRANT OF LETTERS
Estate ofJ?;rT~/CI.q Co FlGeLJ6~t~1(.<0. 21-02-688
also ~n as To:
i/'t'T FdC"i!JCA? {Co./<( Register of w.,iJls for t)le ..Jp
. Deceased. County of C,CI.u IJ...~ i.." In the
Social Security No. p. / I /8 II :6A Commonwealth of Pennsylvania
The petition of the undersigned respectfuJly represents that:
Your petitioner(s), who is/are 18 years of age 9<,older an the execut S 12. Z named
in the last will of the above dec ent, dated I'":t~t:l-s.r 2~ . _ 9 ~ ,19_
and,;:odicil(s) dated )V~k' ~ ?Plti. -ru~W':':" ,I
c-1yU_t..IAN . ,l/..tF.t1~tC,l:' :pre_~d _ Il(~g./
(state relevant circumstances. e.g. renunciation, death of execotor, etc.)
Decendent was domiciled at death in &../L1 Ac...e t:. AN LJ
her last family or principal residenc at
County, Pennsylvania, with
A/
De endent, then years of age, died u.t.- '-I ;2.
at A-I T
Except as follows, decedent did not marry, was not divorced and did no have a child orn 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.) AJI 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:
"0
'2 /) . ta) .:;;.
,
$
$
$
$
lOS, Ot!>o.~;
WHEREFORE, petitioner(s) respectfully requ
presented herewith and the grant of letters
(testamentary; administration c.l.a.; administration d.b.n.c.l.a.)
theron.
~
..,-
u
"
"
:g3
" "
",g
-g.g
c<;l";:::
3~
"~
;; 0
;;;
"
"
in
4. /lo/II~
</-/'D TlPtU,., /2.1)
"" ~<""""'lS ~"ttf, ,Pi4- 170,S-
. #
-
ul...-.j.c
E
..,..---
1.1
..
o C)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEA~H OF PENNSYL VANIA ~ ss
COUNTY OF 1.LM..M~ LJ. J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or M"='" ~d ,""",,,,,, .~ ft: ~ .
before me thIs 31 s t day of k ~
JUL Wx 7007 . .. '':;) ~
"
, . ~
~
/?- ?R-/Y
Estate of
~o. 21-02-688
?*FR/C iA t5. Hr::=Or5tt.rcK', Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW _ AUGUST 1st ., ~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that the instrument(s) dated 1ft-I.' {I ~ T :z. q {C(Cf {,
/
described therein e admitted to probate and filed of record as the last will of
Ifrtl (C 1.4 E. -LJe
and Letters TE-s.7')!f ~ 6V' 7?t1l Y .
are hereby grallted to ~ Gnp"cL 0/ Of.V67Y' .1-/ rM"TGj(? Vet1'7\! c::nR/e~
HI'^' rC-r< f'
FEES
Probate, Leuers, Etc. ......... S 235.00
Short Certificates( ).......... S 30.00
x-pages 15.00
Renunciation ................ S
JCP S 5.00
TOTAL _ S 285.00
Filed .... .J:I!LY..:U, . 2.0.02. .. .. . . . . .. . .. .
~"";.,17 ~m~ ~hJ<fYP J~.. -:z</
~ister of Wills a
~ ~&P-()(: --
c lJ Srm/ ~/~A-7{ L
ATTORNEY (Sup. Ct.!.D. No.) (1).. V"'f
10 r us i.f I.rJITIAT1i
'IA({$&"1lDJ!SS(J. /10 f?
'1/"7 1.{3:2.. QQ7'OJ.
PHONE
~&/<Z~~~/~n~
69 (- ..s.?~J7
i-\
H](I~.Rf1~ REV'l'W,
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R~gistrar. The original certificate will he t{.Hwarded [0 the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for [his cerri fi cue, $2.00
No.
,i;,~i~~'H'Orp;:~>__
\\I~\..I"--~~ C"'4'---
l~~r.:. '. !jjl..~.~.. "?~\
''Ii' ", ,'1",
~Q :a . ',~~
~ wi, u':. ::J::,.~
\*':;, <~ '~~j*f
l*- /~/'
'\.~',,-----_.-_.., /~/
...}'!MENT ~\ ~\:""
'~~"/'~~'N,,"{I"II'II'I
(~R~~L~
P 8483038
,J~
,3/. ~tiLJ .).
Date
21-02-688
H".l~ lOR.. 2'87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
YPEIPR'NT
.,
NA...EOFOEcEOENTtF".....,o.i.,l...1
...
S1AY~"l~NtJ"~~R
SGCIAlSECIJRlfYNUf,lBER
OIl.uN~Nr
~lACK .NK
Patricia E. Frederick
Female ~
211 -
18 -
1132
A,GEila..6.moay)
UNOER1YEAR
f,l""",- Olro
8~HPLACfrc".nd
,lol.OIfc,,,,,,,,C,,,muy,
PlACfOl'OI:ATHlCotc'OXlIy"".___.n..,,,,,,,,,,,.""ortlet_1
HOsPlTA.\-/
Inpot_.JIf f~_O
k
."""-Jmt.<.
OTHER
=.,w.;o
f1._n<<ID
~=.tyIO
,
COl.INfYOf'OEArH
75Y'"
A
Cumberland
k
SPIll. II HO.>PiTI'lL-
RA.CE.A,m.''''OIllndlAn,Blld,Whil.....
.5pe<....J
\Nhite
OI:CEDfNT'SliSUAlOCCU_IQt\I
'~i~k';~Ah;'~';;%.<l~;~~-r
". Claims examiner lib.
DECfOl:NrS..A,IUNGADORESS($IrOll.C,ryfli>w<1,S.",Z>\lCodel
KINOOfElUSINESSIINDUSTAY
..
..
'A1HfA'SNA"'E!F">I."'_..USll
1115 Florabunda Lane
Mechanicsburg, Pennsylvania 170
DECEDENT'S
ACTUAL
RfSIOENCf;
."""",,....-,.
01.....' ~""I
H.. State
~
-.
~..
Cumberland _noIIOp? 17d.D :Oithi,,~~ar
MOTHER'SNA"'f.~...1. .._,.._Sut.....",.)
MA.R11AlS1ATUS....I"'...
N_I,lOf1'~.Wi_,
O"""""'r.>pecO'y1
1. Widowed
17C.~.~__.. Upper Allen
SURVIVING SPOUSE
'i "'c..,r'e"'~'o""n"'.,'"1
Healthcare
-
17b.Cou
'.-
.J
..
INFOR......Ny.SNA,f,lffTyP6'Ptn)
'k
"'ETHOOOf'OISPOSI1JON
II-unaIOXC'......lionO
OIh.'lS"""'f'
Milford Fisher
Geoff Minter
R_6I'",,,,81al.O
DATfOl'OISPOSITlON
(I,l""m.OaY._l
o
Aug 2, 2002
..
INFOR...ANT'S ......IUNG A,OORESS (SIr.. Cry/Tolofl. s.-. Zip coo..)
201> 410 Daria Road Mechanicsburg, Pa. 17055
PlACf OfOlsPOSlTION. iII_alc.m.,I<y.C,_1afy lOCATJON.CifylTawn.S1al..lipCOOl
o<OINIPlaeoo
Mechanicsburg Cemetery
Elizabeth Wike
21C.
,..
Mechanicsburg, Pennsylvania
lK:ENst:NUI,lBER NA...fA.NOAOORESSOFFACllIfY
FD-012662.L :l2c. M ers Funeral Home, Inc. 37 East Main Street Mechanicsburg. Pa 1705
LIC.E:NSENUUllER OA,lESIGNEO
(M","",o.y,_,
23fo. :I::k:.
~CASEREFfRREOlO"'EDlCA.lEx.o."'INfRICORQt\lER?
~O
H.
IAppto.omate
'Inl__
!a.-an<I_
i
~q
PART II:
Ol""'.ogo:"_""",*"","COnl,It>uIirlg'o,,-.,n.lluI
..,....IIllIl<IQ...I.....~.....IlN......PARTI
erO~c...~~L G.<.l.d..o.. C't'rt.~v......)(.lJ,~({\('l..:>A,1
Out; lO(ORASA CONS!iQUHICf Of)
OUflO(ORA$ACONSEOUfNCEOFj
~~(c.\lV\('("'u-..
\JA.?.l -G..,,,,('...
.
WERl1AIJ'IOPSYRNOlNGS
_ILABl.E PRIOR 10
COIoIPlEllONOI'CAuSE
~~,
f,lANN~ROfDEATIi
T\....--.l......"'<.>l"ib('i'''-,'-
R....J.- <....L-
DUf1U(ORAS"CONSEOUENCEOFj
DAr~O~I"'URY
iMonltl,D.ay,\l!a',
Tl"'E01' INJUAY
'HJUFlYATWOfIK?
E$CRIBf HOW IN./URY OCCUAflEO
""1"'61
~
o
[J
Homici/U
[]
[]
[] P~CE.6FINJURY.AI""""','.'m,OI"."tl<lo<Y,OIll<.....
bollding.I'e,Sp.,.c"vl
'k
_ 0 NoD
~~.
P.nd'''lII_II''JOUon
~O
~O
~<~
c.:..o 001'" """"m,n,d
[J
:I... :I_
CERlIFrEA,CnllC"""yn".1
.CfRTlFYINGPHYliICrANIP",""""c..'d,,,,qcau"''''oe.ln''"$''.,,,,,r,., """;'L'~nn.>u",n<)Uf)("'''d.'''''"n'Jcon'pd.d''.'''''~'
yo...._'or...,k"".._lI',""'''''''''''''''.-.cldu.lolll.c.uH(ljl''''....nn.'.a.'a'...
"
.PROHOUH(:'HOANOCERllfYIHOPHYSIC'.aN,Pt,y"',""tJul"~''''''''-''''''ng<le.",.,,",.er1"y"'Y"'''''''.''''''''''''1
1010. _, 01 my k""..I'<I9_. "".'h OCeU"N at 11l..1m1. d_I.. ar><! pl'c" and d....'o 'h. <_u..(.) .""m'M.'.. "al~
."'EOIC4lUAMJNER/CORONER
~~~~:,b::~l::';:."'~"~"~~ and/or 1~'.~I~~~li~n: In "'.' ~pln.'on: d~.'~ ~~~U~~.d.t t~~ Hm~..~~I_, .nd plac.: ~n~ dU"~ r~~ .<~~'~~.l.~~~ [.J
'"
S'GNATUREA,NONU~6ER*
. / 0 "l)y1uL7f J;("',:>,/uJ
_1l..:?"'.V%/J........l..o, ~~_____~__ ~.
cc
CERTIFICATION OF NOTICE UNDER RULE 5.6{a)
Name of Decedent: Patricia E. Frederick
Date of Death: 7/27/02
Will No. 2002-00688
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule
5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries
of the above-captioned estate on August 16,2002:
Name
Address
Geoffrey O. Minter
John S. Minter
410 DarIa Rd, Mechanicsburg, P A 17055
14 White Birch Ave., Mechanicsburg, P A 17050
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 August 27, 2002:
Name
Address
Shane Minter
Travis Minter
Aaron Minter
4182 Antelope Ct. Apt. 105, Mechanicsburg, PA 17055
284 Michelle Drive, Hedgesville, WV 25427
2708 Sagebrush, Bldg 10, Apt 102, Ann Arbor, MI48103
Notice has now been given to all persons entitled thereto . der Rule 5.6(a) except: None
Date: 1,-9' 0/
Signature
Name:
Address:
Telephone:
Dusan Bratic
101 South U.S. Route 15
Dillsburg,PA 17019
717-432-9706
Capacity: Personal Representative
X Counsel for Personal Representative
Last Will and Testament of
21-02-688
PATRICIA E. FREDERICK
I, PATRICIA E.
FREDERICK, of 1115 F10ribunda Drive,
Mechanicsburg, Cumberland County, Pennsylvania, being of sound
mind, memory and understanding, do hereby make, publish and declare
this as and for my Last Will and Testament, hereby revoking all
other Wills and Codicils heretofore made by me.
FIRST
I direct the payment of my debts and expenses of my last
~
~\ \
<;:0., '-...J
<"\
l\
"
illness and funeral from my estate as soon after my death as \~ .
conveniently may be done. If there be no cemetery lot available '~
for my interment, owned by me at the time of my death, I authorize
my personal representative to purchase such cemetery lot with a
contract for perpetual care, using therefore funds from my estate,
in such amount as my personal representative shall consider
necessary and desirable and I authorize my personal representative
to cause title to or ownership of such lot so purchased to be
vested in such person as my personal representative shall
designate.
Further in this connection,
I authorize my personal
representative to expend funds from my estate, in such amount as my
personal representative shall consider necessary and desirable for
the purchase, erection and inscription of a suitable marker for my
grave.
1
~(
,,)
"-
,,-'
R
1>
. .
SECOND
I give, devise and bequeath all my estate, whether the same be
real, personal or mixed and wheresoever situate, unto my spouse,
William A. Frederick, provided my spouse survives me by sixty (60)
days.
THIRD
In the event my spouse fails to survive me by sixty (60) days,
I give, devise and bequeath the following sums:
$5000 to my grandson Shane Minter, of Morgantown, WV, per stirpes.
$5000 to my grandson Travis Minter, of Morgantown, WV, per stirpes.
$5000 to my grandson Aaron Minter, of Morgantown, WV, per stirpes.
These sums are to be held in trust until they reach the age of 25.
I give, devise and bequeath all the rest, residue and
remainder of my estate whether the same be real, personal or mixed
and wheresoever situate, unto my two sons, namely John Steven
Minter and Geoffrey Owen Minter,
both of Mechanicsburg,
Pennsylvania, in as nearly equal shares as practicable, per
stirpes.
FOURTH
In addition to the powers conferred by law, I authorize my
personal representative, in his or her absolute discretion:
A. To retain in the form received and to sell either at
public or private sale, any real or personal property; and
B. To manage real estate; and
C. To invest and reinvest in all forms of property without
being confined to legal investments and without regard to the
2
o
'S>\ \ ,_!
t
C\..
~,
~
,
,
\\
R<"
~
~
~~
principal of diversification; and
D. To exercise any option or rights arising from ownership of
investments; and
E. To compromise claims without court approval and without
the consent of any beneficiary, but not limited to claims by the
Commonwealth of Pennsylvania with respect to inheritance taxes on
any future interest passing under this will.
F. To continue the operation of any business that I may own
at the time of my death for the period of time and in the manner
that he, she or it considers advisable and to be in the best
interest of my estate, or to sell, or to liquidate the business at
the time and on the terms and conditions that he, she, or it
considers advisable and in the best interests of my estate.
FIFTH
All shares of principal and income herein given shall be free
from anticipation, assignment, pledge or obligation of any
beneficiary and shall not be subject to any execution or
attachment.
SIXTH
I direct that any and all inheritance, estate and transfer
taxes imposed upon my estate passing under my Will or otherwise,
shall be paid out of the principal of my residuary estate.
SEVENTH
I willfully and voluntarily make it my desire that my life
shall not be artificially prolonged under the circumstances set
forth below and do hereby declare:
3
~"
t'-,\,j
"
\ .
\'.
'-::\
"'J
\""
~'\
~ ~,
~
f',. ,
~"
,\
A. If at any time I should have an incurable injury, disease
or illness certified to be a terminal condition by two physicians,
and where the use or application by any person of artificial,
extraordinary, extreme or radical medical or surgical means or
procedures calculated to prolong my life would serve only to
artificially prolong the moment of death and where my physician
determines that my death is imminent, whether or not life-
sustaining procedures are utilized, I direct that such procedures
be withheld or withdrawn, and that I be permitted to die naturally
and with dignity.
B. In the absence of my ability to give directions regarding
the use of such life-sustaining procedures, it is my intention that
this directive be honored by my family and physicians as the final
expression of my legal right to refuse medical or surgical
treatment and accept the consequences of such refusal.
C. I execute this directive with the understanding that any
person, hospital or medical institute which acts or refrains from
acting in reliance on and in compliance with this directive shall
be immune from liability otherwise arising out of such failure to
use or apply artificial, extraordinary, extreme or radical medical
or surgical means or procedures calculated to prolong my life.
D. I understand the full import of this directive and I am
emotionally and mentally competent to make this directive.
EIGHTH
I nominate, constitute and appoint my spouse, William A.
Frederick, as personal representative of this my Last Will and
4
~
~'" '-
R.
.....
f'.y.,
. \
<:LI
(
~.
i,~:~
~.
'"
~.<
Testament. In the event of the renunciation, death, resignation or
inability to act for any reason whatsoever of my said spouse, I
nominate, constitute and appoint John Steven Minter and Geoffrey
Owen Minter as personal co-representatives of this my Last will and
Testament.
I hereby relieve my personal representative from the
necessity of posting security in connection with duties as such in
any jurisdiction in which my personal representative shall be
called upon to act insofar as I am able by law to do so.
IN WITNESS WHEREOF, I, PATRICIA E. FREDERICK, have hereunto
set my hand and seal to this my Last Will and Testament, consisting
of six typewritten pages, the first four of which bear my signature
rc(
in the margin for the purpose of identification this 13 day of
()dUJ.l."k,
J
, 19 'fl .
)
PAl;~~f~ .
/',
(t .i..
L' "\ '/u /t.tu; A
FREDERICK
SIGNED, SEALED, PUBLISHED AND DECLARED BY THE ABOVE NAMED
PATRICIA E. FREDERICK as and for her Last Will and Testament, in
the presence of us, who at her request, in her presence and in the
sight and presence of each other, have hereunto subscribed our
names as witnesses.
J~~ t:;L
cfrto .ih/J th<)JvY~
of
m D-YL(' f. ,,[ sv,
7l72d /- ff{ ,
J
~;fJ
of
gg:~~~~T~ O&l~rNSYLVANIA ~ ss
PATRICI)JE. FREDERICK, the Testatrix, whose name is signed to
the foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed this
instrument as my Last will and Testament; that I signed it
willingly and that I signed it as my free and voluntary act for the
purposes therein expressed.
5
Sworn or affirmed to and aCkno:t)dged before me by PA~IA E.
FR~,.ERICK the Testatrix, this .:3'=1 day of fn~ l A.. I
19::tk-. ) ~ .
~ /,) ./..' ,
-_./""-.- .. (" ' / ' !
ak<<,,~ /. .... .7i/t/4 ~t&c/~ .
Testatrix, PATRICIA E. FREDERICK
~~QO
Nota Public
-
\ Notanal Seal P bUe
Deborah L Graham, Notary ntU
'\~ D;,lISburg 80ro, Yo1\< fOU 2 Y 1999
My Commission Expires an. ,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF,\C:f~ SS
We, ~<>"^,,H-~ ~\J u and 2'i..!t..~C;yt.c-Q..o.--- , the
witnesses whose names are signed to the foregoing instrument, being
duly qualified according to law, depose and say that we were
present and saw the aforesaid Testatrix sign and execute the
instrument as her Last Will and Testament; that she signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing
and sight of the Testatrix signed the Will as witnesses; and that
to the best of our knowledge, the Testatrix was at the time
eighteen (18) or more years of age, of sound mind and under no
constraint or undue influence.
:J. ~orn or ~irmed to ~nd subscribesl;"to before
1Ar\) day of ~J\r--~-;r- , 19~.
\ ~~
Witness
me,
this
.2#<fi *1 ~4../WL-.
l.tness nf\
&)Q~ 9---
No ary public
r- Notarial Seal .
l Oebo~ah L Graharn, Notary Public
Di'llsbiJ~Q Bo~_o, York County 9
~ My Commiss'cn Expires Jan. 2, 199
'-
6
--,
~
::--:-i
~~\
~
~
~,
k~)
>
-'Q
~
t<$
'S
S~:
= ~ ~
- ~ q
~
lS
~)
u
o
~ '" ~
C""'" t..:l u, ~
=: f- ~
:. - '" '"
o '" i7! b ~
Q.,"'-Jcio~
~ ~ ~ c::;;:
"""'f 1.1) 2': lfJ rn
Z~ij;;;;~
~",., "''''
0..; ....... E-< 0..
us;::2 ~r':
..... ... ~ '-'
~ '" '- ~, ""
~ 0 -<_
~ ,.., offl
c ~ ,
- j
~ is
~
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
f(.lHl'~'A 7- ftLlo-Dt='Y1-IU<
., -~, - "2-00<"-
Date of Death:
Will No.:
;}oo). - 00" Ir'if'
Admin. No.:
'Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration ofthe above-captioned estate:
1. State whether arlministration of the estate is complete:
Yes c;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 personal representative file a final account with the Court?
Yes No 0
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 0 No 0
c. Copies of receipts, releases, joinders and approval offormal or
informal accounts may be filed with the Clerk of the. Orphans' Court
and may be attached to this report.
Date:~-()Y IiI/<J' ~
Signatur't'"
{, E tJ It',ze 'f O. J"l1 I...J 7l:-(t
Name
'-/10 D,4tLt..A fl,)
Address 111l;t:..f14^"tS($<.t/tt, { 1'4 /7.S1>'
In - ~qf-~S?28
Telephone No.
Capacity: %rsonal Representative
o Counsel for personal representative
\~.
"~.,
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO CD 00 297
. 7
BRA TIC DUSAN
101 SOUTH U.S. ROUTE 15
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 I $6,950.75
ESTATE INFORMATION: SSN: 211-18-1132 I
FILE NUMBER: 2102-0688 I
DECEDENT NAME: FREDERICK PATRICIA E I
DATE OF PAYMENT: 10/10/2006 I
POSTMARK DATE: 10/09/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 07/27/2002 I
I
TOT AL AMOUNT PAID: $6,950.75
REMARKS: BRA TIC AND PORTKO
CHECK# 2191
INITIALS: AJW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
- I
BRATIC AND PORTKO
Attorneys at Law
101 OFFICE CENTER, SUITE A
101 SOUTHD.S. ROUTE 15
DILLSBURG, PENNSYLVANIA 17019
DUSAN BRATIC, ESQ.
STEPHEN K. PORTKO, ESQ.
(717) 432-9706
(717) 432-2538
FAX (717) 432-9220
October 6, 2006
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of Patricia E. Frederick
No. 21-02-00688
Dear Register of Wills:
Enclosed please find an original and two copies of the Inheritance Tax Return for the
above referenced estate, along with a check in the amount of $1 5 for filing fees and a
check in the amount of $6950.75 for inheritance taxes.
Please return the clocked-in copy in the enclosed self-addressed, stamped envelope.
Thank you.
Very truly yours,
~
Ronnetta Rider
DB/RSR
Enclosures
(j
:;~
-"0
ril
:n
:.~
(-.-;
::~l=i
t-...;)
=
=
<.:T"
o
("'"")
-4
c::>
-0
::x
U1
N
i;:~~
CJ
(~
~:'CJ
(-J
rn
o
~J
--i-i
cc.:)
ITl
c:-:-)
--'-I
\~
ooReV'l500 ex. (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~
:ll: -I/)
(.) a::ll:
w@l8
:J:a:....I
(.)Q.lQ
~
t-
Z
W
C
W
o
W
C
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Frederick Patricia E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -02 0 0 6 8 8
COUNiYcODE -YEAR- - - "'NiiiER- -
SOCIAL SECURITY NUMBER
2 1 1-18-1132
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
CJ 3. Remainder Retum (dale of death prior to 12-13-82)
;"",0 5. Federal Estate Tax Retum Required
~:.,\p':'
,L;,~;' 8. Total Number of Safe Deposit Boxes
[litD 11, Election to tax under See. 9113(A) (Attach Sch 0)
A~~?i~;'; :-
.
z
o
~
....I
i=
~
o
w
0::
z
o
~
I-
::)
0..
::=E
o
o
S
07/27/2002 02/25/1927
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[R] 1. Original Retum
D 4. limited Estate
D 6, Decedent Died Testate (Attach copy ofWoII)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (dale of death after 12.12.82)
D 7. Decedent Maintained a living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (dale of death between 12.31.91 and 1.1.95)
I-
Z
W
Q
Z
o
Q.
I/)
W
a:
@S
(.)
NAME
Dusan Bratic
FIRM NAME (If Applicable)
Bratic & Portko
TELEPHONE NUMBER
717-432-9706
COMPLETE MAILING ADORE ,ff:'"
-tJ~ "'_':i:;~
101 South U.S. Route>1'~
DiIIsburg, PA 17019
X _(15)
130,993.34 X .045 (16)
f 1;.
X .12 (17) .. '-~
"
X .15 (18)
(19)
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
,~i :\~\:J :.' :;~'
~.3.00
;1~i"097 .33
OFFICIAL USE ONLY
r-.,:)
,;.:;;:>
c.::>
CJ"'\
C.,:)
C)
--i
:'0
:D I"r"l
rrl C--;J
(;-) ('-j
fj[3
[" I T1
::00
C")O
"i 'J -'il
~~ --n
~:~~ ~
(/) C)
-1'1
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
o
-0
:x
i":;?"
--:;'.1
i~" '.
;i:'7~~f '
, ,:j):~
,~
U1
(8)
146.336.04
to.;~;~7 .04
A~:~S5.66
~-; "
15,402.70
130,933.34
(11)
(12)
(13)
1,'\';';" ,
.~ -' .:
,i!>,
"
5.894.70
(14)
130 933.34
5,894.70
~
Decedent"s Com lete Address:
STREET ADDRESS
1115 Floribunda Lane
CITY
Mechanicsburg
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,894.70
Total Credits (A + B + C) (2)
3.
InteresVPenalty if applicable
D. Interest
E. Penalty
1 ,056.05
4.
TotallnteresVPenalty ( 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
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
1 ,056.05
to: REGISTER OF
(4)
(5)
(SA)
(5B)
AGENT
6,950.75
5.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check
6,950.75
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; ........................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00
c. retain a reversionary interest; or . .............. ........................ ............. ................................... ............... D 00
d. receive the promise for life of either payments, benefits or care? .... ......................................................... D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ... .......................... ................................ .......................................... D 00
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 retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS 410 D
Mech
SIGNATURE OF PREPA
PA
ADDRESS
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. 99116 (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 orfor the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P,S. 99116(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. 99116(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.
, ~-.
.__.~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE A
REAL ESTATE
ESTATEOF
FILE NUMBER
Frederick Patricia E
AU real property owned solely or as a tenant In common must be reported at fair market 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 knowledge of the relevant facts. Real fH'OI*lY wblch Is jointly-owned with right of
survlvorshlD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1115 Floribunda Drive, Mechanicsburg, PA
75' x 134' lot with single family dwelling
See attached settlement sheet
VALUE AT DATE
OF DEATH
130,333.00
\IT "''''''''' -J"'
I tn5eU
TOTAl. (Also enter on line 1.. Recapitulation) $
<>>..~.. VI \.."" <>>Cl1"""~
130333.00
&_a._ '*
COt.t.1ONWEAl TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
SCHEDULE.S
STOCKS & BONDS
ESTATEOF
Frederick. Patricia E
All property joInt1y-ownec1 with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
FILE NUMBER
DESCRIPTION
American Express Mutual Fund Accounts Client #178413043001
VALUE AT DATE
OF DEATH
7,097.33
TOTAL (Also enter on line2.~n) $
Of more space is needed. insert additional sheets of the same size)
7097.33
'--~.- '*
COt.t.1ONWEAL TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Frederick Patricia E
Include the proceeds of litigation and the date the proceeds were received by the estate. AU property )oInlty-owned wlth the right of survivorship IIHISt be dIsdosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC Account # 50-7009-7824 - $3426.75 6,649.22
PNC Account # 50-3007-0045 - $3222.47
2.
Verizon Refund
8.03
3.
Comcast Refund
29.16
4.
Net sale & proceeds of household goods Haar's Auction
2,219.30
TOT Ai. (Also enter on line 5, Recapitulation) $
(If Ill<X"e space is needed. insert additional sheets of the sane size)
8.905.71
...
.~~8.~ .
COWONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REf URN
RESDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMlNISTRAnvE COSTS
ESTATE OF
Frederick Patricia E
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,. Myers Funeral Home, Mechanicsburg, PA 7,675.00
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Convnissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Dusan Bratic, Esquire 2,000.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills $285, Cumbertand Law Journal Advert $75, Sun Sentinal 492.04
Advert $132.04
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Reserve for contingent liabilities 250.00
TOTAL (Also enter on line 9. Recapitulation) $ 10417.04
(If more space is needed. insert additional sheets of the SllITle size)
._a.~ .
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
FILE NUMBER
Frederick Patricia E
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1.
PP&l payments of $102.51,84.50,75.52,44.07,116.83,167.10 & 196.15
2.
AT&T payments of $26.47 & 17.50
3.
Comeast Cable
4.
Verizon payments of $32.84 & 56.09
5.
S & T lawn Care
6.
United Water Co. payments of $6.85, 6.85, 26.45, 10.75, 9.20 & 9.20
7.
Donagallnsurance Co.
8.
Citi Financial Retail Services
9.
Upper Allen Township - per capita tax
10.
Marlin Y ohn Tax Collector - school taxes
11.
lawn Doctor
12.
Waste Management
13.
Monogram Credit - payoff credit card
14.
Upper Allen Township Sewer Authority - 2 payments $100 each
15.
Patriot News Co. - advertising to sell house
AMOUNT
786.68
43.97
34.99
88.93
148.40
69.30
347.00
500.00
9.80
1,779.74
44.11
36.52
228.94
200.00
295.68
TOTAL (AJsoenteron line 10, Recapitulation) $
Of mae space is needed, insert additional sheets of the sane size)
4 985.66
Rev-'513Ell> _
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDI!NT Dl!CEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
., F
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include OIJtright S~I ast/i)Utions, and transfers under
Sec. 9116 (a)(1. )]
1. Shane Minter Grandson $5000
4182 Antelope Court, Apt. 105
Mechanicsburg, PA 17055
2. Travis Minter Grandson $5000
284 Michelle Drive
Hedgesville, WV 25427
3. Aaron Minter Grandson $5000
2708 Sagebrush, Bklg 10, Apt 102
Ann Arbor, MI 48103
4. GeOffrey O. Minter Son 50% Residual
410 Daria Road
Mechanicsburg, PA 17055
5. John S. Minter Son 50% Residual
14 White Birch Avenue
Mechanicsburg, PA 17050
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET
n. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR VVHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS
1.
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-l500 COVER SHEET $
(If more space is needed. insert additional shee1s of the scme size)
JAN. 23. 2003 9:02AM
CRAIG A IDIEHL ESQ
NO. 134 P.2/3 n-
OMR NO. 2502.028.5 '"Ii'"
A.
U,S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1. []FHA 2, ]FmHA
6. FILE NUMB'i\ AR
e, MORTGAGt: I ~S CASE NUMBER:
B. TYPE OF LOAN:
3. [ ]CONV, UNINS. 4. []VA
17. LOAN NUMBER~
5. []CONV. flqS.
SETTLEMENT STATEMENT
:.
C, NOTE: This form is fumislleritlJ giYs W#,I a IUitsment of actual settlement costs. AmOll{1ts paid to ant:( by thG sefllement ~llt are sfloWIJ. _
Items marked '(POOl" WfJrB paid owfde the closing; they are shown hare fOr ;nfOrmstlOna/ pu~, and art not i'19..UderJ in the tots/so
1.0 3ICle CCAOO802a_SMR.Pf'UICADOatnS st.flI2l
D. NAME AND ADDRESS OF BORROWER: E. NAME ^ND ADDRESS OF SEL\.ER: F. NAME AND ADDRESS OF LENDER:
JEFFREY A. LUNDEEN and
BONNIE E. L.UNDEEN ESTATE OF PATRICIA E. FREDERICK
G. PROPERTY LOCATION:
1115 FLOR18UNDA L.-.NE
MECI-tANICSBURG. PA 17055
CUMBERLAND County, PennsylvanIa
H. S~EMENTAGENT:
CRAIG A. OIEHL. ESQUIRE
PLACE OF SETT'LEMENT
34S4 TRINOLE ROAD
CAMP I1IL1-, PA 17011
J.I::I 'OF
, DO DUE
101. Contract $a183 Price
102. Per9Of1li1ll PrODertv
103. Settlement Chargee to Borrower (Une 14(0)
104.
105.
IIUN
132,000.00
1.830.00
1 06. Ci~/BOrO\lgh Taxes
107. CountylTWP Taxes
108. Sdlool Taxes
109.
110.
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER
200. AMOUNTS PAID BT UR IN Bt:HAl F OF BORROWER:
201. D8Doslt or earnest money
202, Pr'incipal Amount of New Loan(sl
203. Existing loan(s) taken subject to
204.
205,
206.
207.
20B.
209. Closlna Costs Paid By Seller
AaJusrmenrs ro, Irlms un
210. CltvlBorough Taxes
211. CountvlTwp Taxes
212. School Taxes
213. Sewer 01101103 to 01/23103
214.
215.
216.
217.
218.
219.
220. TOTAL PAID BYIRJR BORROWER
3Dfl CASH A'T SETT~
301. Gross AmoU/'1t Due From Borrower (Une 120)
302. Less Amount Paid BylFor Bol'l'OWlr (Line 220)
303. CASH ( X FROM) ( TO J BORROWER
to
to
01123103 to 07/01103
791.11
134,821.11
7 500.00
r
to
01101103 to 01/23/03
tD
22.53
24.44
7,546.97
134,621.11
7,546.97)
127,074.14
25-1638737
I. SETTLEMENT DATE:
January 23, 2003
~TU"~
.AM r.:Ans::~~nJ~~
<401. Contract Sales Price
402. Pe~naIP~nv
403.
404.
405.
IIUN
132.000.00
406. Cltv/Borouah Taxes
407. CounttfTwP Taxes
40e. School Taxes
4119.
410.
411.
412.
420. GROSS AMOUNT DUE 10 SELLER
500. REDUCTIONS IN AMuUN r Out: TO SELLER:
501. Excess OeD08lt (SeelnslrudlOl'ls)
502. Setuel1l8nt Ctlaraes Ie Seller (Une 14(0)
503, Exlsting 1080(8) Iaken subject to
504. Payoff or first Mortgage
505. PSV01'f of second MOMal1e
~.
501. (Deooslt dlab. as D/'OceedsJ
508.
509. Closiog Costs Patel By Seller
. /"'tJ/' IlfIffIS UnDIJIO t:SV :::;'SIIer
!i10, CltvlBorouatl Ta)Ces to
511. CountvfTWD TalC8$ 01101/08 to 0112310a
512. Sctlool Taxes to
513. Sewer 01101103 to 01123103
514.
515.
516.
517.
518.
519.
~ TOTAL REDUCTION AMOUNT Due SEU.E~
~ ~H AT SETTLEMENT TOIFROM 9ELL.J;!R:
601. G/'066 Amount Due To Seller (Une 420l
602, Lus Reductions Due Seller (LIne 520)
603. CASH ( X TO) ( FROM ) SeLLE~
to
to
01129103 to 07101103
791.11
132,191.11
9 411.50
22.53
24.44
9.456.47
I(
132.791,11
9,"58.~7)
123,632.64
JEFFREY A. LUNDEEN
TIle undersIgned hereby ael<nowledge receipt of a completed crJpy of pages 1 &2 of this statement & any attadlments referred to herein,
Borrower Seller
BONNIE E. LUNDEEN
ESTATE OF PATR1CIA E. FREDERICK
HUo.1 C'-/l!ll RESf'A. HB4S06.2
JAN 23 2003 9.03AM
CRAIG A IDIEHL E5Q
NO 134
P 3 3
" ~~2
, . L. SETTLEMENT CHARGES
700. TOTAL C .ed on Prlc:. J; /Ii) IlL PAlO FROM PAID PROM
Dlvfsion of ComnUs8ion (IIns 700J as FoIfows: BQAAOWeR'S SEllEI's
701.$ to FUNOSAT FUNDS AT
702$ to SETTl.EMeNT SETTLEMENT
703. Comml&lilol1 Paid at SeUJemenl
704. to
Ann ITFM~ DAVAAII:: IN I W1TW LnAN
a01.LoanOnalnatlon~ee % 10 . .
802. Loan OlscQunt % to
SQ3 ApPrtlisal Fee to
BO-4. Credit Repon to
805. l.el"lder's Inspectiol1 Fee to
806. MortaaRelns. App. Fee to
B07. AHumRUol1 Fee to . .
808.
B09.
e10.
611.
1900. ITEMS REI BYI I R~ PAlO I~
901. Interesl From to @ $ Iday ( days %)
902. MIP Totlns. for LlfaOfLoan for mont/1s to
903. Hazard Insurance PremIum for '.0 ...ears fO
904.
905.
1nnn : DEPOSITED I:.......~a
1001. Hazard Insurance months $ Der mClf'lth
1002. Mort:lace Insurance months S oermonth
1 003. Ci~orough Taxes months :ji per month
1004. Countyrrwp Taxes monltls I S Def man lh
1Q05. School Taxes months CD $ per month
1006. months @ $ Der month
1007. months @ $ plr monttl
1008. montl1s @ S oerrnonth
i 11 00. TITLE CHAAr.I;J:;
1101. Closing Service Letter 10
1102. Courier Fee to
1103. Wire Transfer Fee to
1104. Title Searcl1 lI:l ABeO OF CUMBERLAND COUNTY 135.00
11 05. AttorneYs FeesJDee Prep to REAGER & AOLER,PC 400.00
1106. Notary Fees to CASH 4.00
1 107. Altofney's Fees to CRAIG A, DIEHL, ESQUIRI: Attorney Csrt 510.00
(includes llbove lfem numbers: J .
1108. Title to
(Includes above item n/.lmbers: J
1109. Lender's Coverage S
1110. OWner's Coverage S
1111.
1112.
1119.
1200.
1201. Reoordlng Fees: Deed $ 38,50: Mortgage $ : Release6 $ 38.50
12-02. City/County Tax/StamDs: Deed 1320.00' Mortgaae , 320.00
1203. State Tax!StamDs: Revenue Stamos 1 820.00; MortQaa8 , 320.00
1204,
1205, Recording Service Fee to CRAIG A. DIt:HL. ESQUIRE 10.00
11 'lnn
1301. Survey to
1302. Pest Inspection to
1303. Tax Certlflcatlon Fee to MARLIN A. YOHN SR 4.00
1304. Esqow for Inherttance Tex to BRATIC AND PORTKO 7,500.00
1305.
1400. TOTAL SETTLEMENT CHARGES {Enter an Lines 103, Section J and 502. Section K) 1,830.00 9.411.50
By sIgnIng page 1 of ttlL9 statement. the sIgnatories ~cknowledge receipt of a completed copy of page 2 of this two page statement.
Certified to be a lrLII copy,
CRAIG A. DIEHL, ESQUIRE
Settlement Agent
..
( CADQ~_gMFlI CAOO302L1_SM~ /2 I
--
\' ,~.' .
~ ~\\.."
, ~ ~~\
~\~ -
.o~~
0'%_ ::
.. -
C' ~
~
o
l:3
r~
"
..
f:J
r1
--
(:1
,.:3 -
-
-
~ :.
-
". :.
-
,A~
("
tC .
.;',h.
0 -- () ~
~ r to
" ? '15" ~
-
"
"," vl
~ (
,-- 'A- "'I
~ -
-r p
')
C"1 ~ t Q- 0
U> ..JP
.. "
- :P ~
~ G
p- \f\
. 0.-
.- ~
0 r 3 ~
- ...j
r- 0 f \;\
c....). ~
0 - r>
...r:> \N ~
c;:?
~ t Q
~
C
~
"'"
r
-,
~
-;t:
.....
(fl
C3.
C
:.,
t,"''i . A
~ " ~J
-0
~
~
~,j
~J
~.
fJI
,~~
t[:~l
t"
,
~,
"'"'0
~
,:"~y.,,
t:;~
,:
o ~
( )
--\
_/'"
'1;;..~1i
~,
,.:1
. ~)'A
~,aJ.~"'.""'............' .' %'. ..'
.. ' "
-' ( ~
"'~' ~
. .
.-' ':, (',
r:;;
~ _..5~"
tI'};.," ' ' - ,', to
'~*'" .' -':>~1
,.............. 4~.t'
,
$.
1~ '.'~
lII;
11-27-2006
FREDERICK
07-27-2002
21 02-0688
CUMBERLAND
101
APPEAL DATE: 01-26-2007
( See reverse side under Objections)
Amount Remitted [: .. I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9~!_~~9~~_!~~~_~~~~______~___~~!~!~_~g~~~_~g~!!g~_Eg~_!g~~_~~~g~~!__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
PATRICIA E FILE NO. 21 02-0688 ACN 101 DATE 11-27-2006
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
r'::::rn::n\liPr~\fr~ ALLOWANCE OR DISALLOWANCE
:\;:-':.'::';.'::'::::or.:J)~~p:ONS AND ASSESSMENT OF TAX
1'~~LCJ;:~.. ; t.:-~: i"-,:"'.' T~'i,}:!. ~'__':;
2006 DEe -4 PM 3: 21
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
DUSAN BRATIC
BRATIC S PORTKO
101 SOUTH US RTE
DILLSBURG
CLERK OF
ORr-'Hi' ~,I'(I rn\ lilT
I' I\I~..) ....j.)I.1
CU~/i"'" .,..
15
PA 170".
ESTATE OF
FREDERICK
REV-1547 EX AFP (06-05)
PATRICIA
E
If an assessment was issued previously, lines 14, 15 and/or 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)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line l~ taxable at C~llateral/Class B rate (18)
19. Principal Tax DUE
TAX CREDITS: ..
.. . .n... . "........u 'T+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-09-2006 CDOO7297 1,051. 04- 6,950.75
TOTAL TAX CREDIT 5,899.71
BALANCE OF TAX DUE 7.71CR
INTEREST AND PEN. .00
TOTAL DUE 7 . 71 CR
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)
(2)
(3)
(4)
(5)
(6)
(7)
130,333.00
7.097.33
.00
.00
8.905.71
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
10,417.04
4.985.66
Ul)
(2)
(3)
(4)
NOTE:
.00 X
130,933.34 X
"00 X
,,' 11.!!. X
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
146,336.04
15.402 70
130,933.34
.00
130,933.34
00 =
045 =
12 :.... c
15 =
.00
5,892.00
.00
.00
5,892.00
U9 ) :....
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A '.CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
ClJ
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
REV-1470 EX (6-88)
'*
REVIEWED BY
ITEM
SCHEDULE NO.
.. ~
INHERITANCE TAX
EXPLANATION
OF CHANGES
PATRICIA E FREDERICK
FILE NUMBER
John Kealy
ACN
2102-0688
101
EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1