HomeMy WebLinkAbout04-0204 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' C'OFO/~//) ~0.6 ~Ce No. ~/- ~/- ~~
also known as ~] 'K)~J~tI [~1~ To: ~
Deceased., ]
Social Security No. ~ ~- ~ ~- ~ q ~y
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut
in the last wilt of the above decedent, dated ~ ~, / ~
and codicil(s) dated
Register of Wills for the
County of
Commonwealth of Pennsylvania
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decen_dent was domiciled at death in ~.~ Y~ ~.~ [~t~l d County, Peonsylvania,~ith __
h. ,~., last t~a_mily or~r!~cipal residence at c~-V~
t. bt, Vi I'~/~, I.,'I'+ I-lO I "~ '
- ! ' (list 'street', number and muncipality) '
then '7 <~ years of/g~~ {/~~)(~ T'd~,'J~-'H] , 1~ ~-O~,d
atDecen,~e[~ Ot/Jlrl ~ h t ',~ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania ~.~ ~?
situated as follows: 'ZIO ~> ~'~'
(.m,. h . . 1701 ~
$
$ 4oo] 0oo
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
req~est(sb the probate of the last will and codicil(s)
7es/-ara7
(testgmentary; administrati6n c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF I~EN/NSY~ANIA
.COUNTY OF C W'ed2~ !~V/~ 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 ~etitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and tru the estate according to law.
Sworn to or af[irmed and subscribed
before me this /,d2zt_. day of
er
No.
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~~¼ I
the .reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ~/~
described therein be admitted to probate and filed of record as the last will of
and Letters "-~t--.~T-~ x~~eI
are hereby granted to ~ Oq
)9'o'(a~ ~, in consideration of the petition on
FEES
Probate. Letters, Etc .......... $ l'-/I,'~. ~
Short Certificates( ) .......... $ q:,~6'" °~
enunc:ation ................ $ /~ ~O
TOTAL ~ $ M'~-% ~
Filed .~.~qA.c~.. J .... .~.~.~ .............
A'I'TORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Lq:Orr [-~b~ Iz0.
LAST WILL AND TESTAMENT
OF
CAROLYN R. ~LACE
I, CAROLYN R. GLACE, of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking and making void any and
all prior wills, codicils, or writings thereto, made by me at any
time prior to the making of this Will.
ITEM I: I direct that the payment of my debts and the
expenses of my last illness and funeral shall be paid from my
estate as an administrative expense as soon after my death as
conveniently may be done.
I direct that my personal representative be responsible for
making all necessary arrangements for my burial.
ITEM II: I give, devise and bequeath all of my household
goods to my daughter, CORINNE E. ROST, of Buffalo, New York.
ITEM III: I give, devise and bequeath all the rest, residue
and remainder of my estate to my children, JOHN M. GLACE, of
Mechanicsburg, Pennsylvania; THOMAS E. GLACE, of Camp Hill,
CAR-O~YN R. GL~CE
Page 1
Pennsylvania; and CORINNE E. ROST, of Buffalo, New York, IN EQUAL
SHARES, PER STIRPES.
ITEM IV: In the event that any of my children predecease me
and are survived by their issue, the share that would have passed
to my deceased child shall be divided equally among the deceased
child's surviving issue.
In the event that a grandchild under the age of thirty-five
(35) years is entitled to inherit from my estate, I direct that the
share for that grandchild or grandchildren shall be held in trust.
I name my surviving children as Co-Trustees for any and all assets
passing to said grandchild or grandchildren under the age of
thirty-five (35) years.
The Trustee shall have the following powers and duties:
a) The Trustee shall have full power and authority to
invest and reinvest the assets of the trust, including
the power to alter the form in which the assets are
received by the Trustee and to retain bank stock.
b) Until each grandchild attains the age of eighteen
(18) years, the income and then the principal shall be
used to provide for the grandchild's general maintenance
and well- being, including food, clothing, shelter,
health care and education. The guardian shall attempt to
Page 2
CAROLY~ R.
maintain each grandchild in a life-style similar to that
enjoyed by the grandchild during my lifetime. The
Trustee may also appropriate any and all funds necessary
to meet the special needs of each grandchild.
c) When each grandchild is between the ages of eighteen
(18) and twenty-two (22) years, the income and principal
of the trust may be used for the educational expenses of
the grandchild. Also, when each grandchild is between
the ages of eighteen (18) and twenty-two (22) years, the
Trustee shall allocate to the grandchild on a monthly
basis such funds from the income and principal of the
trust as the grandchild may require for the reasonable
maintenance of his or her well-being.
d) When each grandchild attains the age of twenty-five
(25) years, the Trustee shall pay to the grandchild one-
third (1/3) of the remaining share of the principal and
income of the trust to which the grandchild is entitled.
e) When each grandchild attains the age of thirty (30)
years, the Trustee shall pay to the grandchild one-half
(1/2) of the remaining share of the principal and income
of the trust to which the grandchild is entitled.
Page 3
f) When each grandchild attains the age of thirty-five
(35) years, the Trustee shall pay to the grandchild the
balance of the remaining share of the principal and
income of the trust to which the grandchild is entitled.
g) The Trustee shall have the power and authority to
accelerate the payment schedule specified above on behalf
of any grandchild, if that grandchild's needs and
circumstances reasonably justify such accelerated
payment.
h) Subject to the approval of Trustee, anyone may add
property, real or personal, to the principal of this
trust by deed, Will or otherwise.
ITEM V: No interest of any beneficiary under this Will or any
codicil shall be subject to anticipation or voluntary or
involuntary alienation.
ITA~VI: All taxes, interest and penalties thereon payable by
reason of my death with respect to property comprising my gross
taxable estate, whether or not passing under this Will, shall be
paid from the principal of my residuary estate.
IT~ VII: In addition to powers given to him by law, my
Executor and his successors shall have the following powers,
Page 4
" CAROLYN R. GLACE
applicable to all property held by him, effective without Court
Order and until actual distribution:
a) To retain any property received by him, in the form in
which it is received, until actual distribution;
b) To sell real estate for any purpose, publicly or
privately, for such prices and on such terms as he deems
proper, without liability on the purchasers to see to
application or the purchase monies;
c) To compromise controversies;
d) To distribute in cash or kind or both at such valuations
as he may fix.
ITEM VIII: I nominate, constitute and appoint my son, JOHN M.
GLACE, of Mechanicsburg, Pennsylvania, Executor of this my Last
Will and Testament. No fiduciary acting hereunder shall be
required to post bond or enter security in any jurisdiction.
Page 5
CAROLYN~ R. GLACE
IN WITNESS WHEREOF, I have set my hand and seal to this my
Last Will and Testament, consisting of this and five (5) other
pages at the end of which I have also set my hand and affixed my
seal for greater security and better identification, this ~ day
%~~ A.D., 2002.
of
.... CAROLY~ R. GLACE
WITNESS:
_~ ° .~~ .~~ residing at
~6t~~ ~ ~ residing~ at
Page 6
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, CAROLYN R. GLACE, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law,
do hereby acknowledge that I signed and executed the instrument as
my Last Will and Testament; and that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
Sworn or affirmed to ~d acknowledged before me,
Testator, this ~ day of/~~ , 2002.
N~t ary Public
My Commission 9xpires:
NOTAR'AL SEAL '
DIANE D. FRITZ, Notary Public
Hershey, PA Dauphin County
My Comml$~lo,n Explreil Nov, 8, ;~00~
by the
CAROLYN~R. GLACE
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
We, A. Mark Winter and Marilyn J. Cichelli, the witnesses
whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we
were present and saw Testator sign and execute the instrument as
her Last Will; 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 Testator signed the
Will as witnesses; and that to the best of our knowledge the
Testator was at that time eighteen (18) or more years of age, of
sound mind and under no constraint or undue influence.
Witness ' - - (SEAL)
Sworn to and subscribed
before ~~~
day of 2002.
Notary Public
My Commission expires:
NOTARIAL SEAL
DIANE D. FRITZ, Notary Public
Hershey, PA Dauphin County
My Commission Explreit Nov, 8,
Witness
(~~ ~~.~, (SEAL)
~DWqD '~ NAqO~D
~0
JRD/June 30, I992/17858
In Re: Estate of CAROLYN R GLACE
Late of MIDDLESEX TOWNSHIP
Estate No.: 21-04-204
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-204
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: JOHN M GLACE
Counsel for Personal Representative: JOHN M GLACE, ESQ.
Date of Grant of Original Letters: 03-01-2004
Date of Delinquency Notice: 06-11-2004
The undersigned, Glenda Famer-Strasbaugh, Clerk of the Orphans' Court, 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 Clerk of the Orphans' Court on JUNE
11, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in
accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the
undersigned requests that a Court conduct a hearing to determine whether sanctions should be
imposed upon the delinquent personal representative or counsel for the delinquent personal
representative.
Date: 07-13-2004
Distribution:
Glenda Famer Strasbaugh .~w C~.t~ -(~
Clerk of the Orphans' Court 0 ~~
Personal Representative
Counsel for Personal Representative
Estate File ~
A hearing is scheduled for at in Courtroom No. 3. If the Certification of Notice is
filed prior to the hearing date, the hearing will automatically~~.~t~.~
CERTIFICATION OF NOTICE UNDER RULE 5.6(at
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of theJD~?phans' .~ i "2-~)~'-]~
served on or mailed to the following beneficiaries of the above-captioned estate on ///./~ Co~urt Rules
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Name
Capacity~ Personal Representative
Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
ECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004483
GLACE JOHN M
132 BRINDLE ROAD
MECHANICSBURG, PA
17055
ESTATE INFORMATION: SSN: 256-38-0984
FILE NUMBER: 21 04-0204
DECEDENT NAME: GLACE CAROLYN R
DATE OF PAYMENT: 10/12/2004
POSTMARK DATE: 10/12/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 02/24/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $40,000.00
1
:REMARKS: JOHN M GLACE
CHECK# 141
'SEAL
TOTAL AMOUNT PAID'
$40,000.00
INITIALS: SK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1500
~", COMMONWEALTH OF
..'. . ~ PENNSYLVANIA
~'~""l'>.., DEPARTMENT OF REVENUE
~ .....~ DEPT 280601
~,~~ HARRISBURG. PA 17128.0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER A
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DE::EJEN' 'S t'<M":: i,L,.J.S-:- F',RST, ~NO M',ODLE NI,T!},,~ \
GLAce cA!?-O'-YN R.
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J4'(t2/~111cc'2~o 4 i. J.^,E r f'7147zyr
____. ___,____ . _____ _ ________L.._ ,___ __
':~ :\~PLlCABLEI SU~",/I"/~JG SP'JL.;SES ~,t,\':E (LAST FiRS- i\,\C \':DOLE '~,iT:,t.,L:
I SQC'P,L SECUR'! Y huMBER
_?~~~8~ oqgL__
TH!S RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCl..:l..L SECLRTy N\~\1BcR
N A
~ 1 O!~"diReturn
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LJ 4a. Fc:tv-e ','ie'8s: Co:rc/OITlISe -J,,:, ~'~f":'- :,it,.'. -'::-22
7 Jpcdent \-1ain:ained a Llvn~1 T"Jst~,::":" J;C', d r-J,l
3, Total N:..:mbe-:cf Safe Ceccs". B8~es
[_J l' E!e:~t:en:o tJx un~?r 2'2,: 91~3'A:
G Der~e,;e~t Died TestclP
9 L i~aticr Pco'~8eds Rect:i/ed
'i) Sp:JUS2! P:J',~'ty Credt ">i'." C~:.':0", L: '--,11 ,Jr,] 1-'
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
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NA\I.E -:ro H tV /1'). 9LIt c E E9:: UI j"e
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F:riawE ('JP>p'rCE JLL-;:rOqN M .' 6-LJCt__
TELEPHO~jE NUlvlBER
Real Estate (Schedule A)
(1)
4J (p 00 ()() () . Q2.
__JA~ 34 :3 . 3'"
StOCKS and Bonds I'Schedule B;,
12"
Closely Held Corporction. Pa1:',8'ship 0: Sote-Proprie'.orship
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4 Mo1gages & Notes Receivable I,Sc'ledule DJ
5 Cash Bank DeiJosilS & rv1isce!'aneous Personal P'operty
i,SChech.;ie E':
:41
7S. 9/4. 1(j:!J
f
(51
(6]
Jointly OW'i8C Property (Schedule F)
LSeparateBillingRequested
c'
(1')_
7 IfI\er-VvQS Transle's & lok.>Cellaneous No~-Probale Property
(Schedule G or L1
1fr 824 Ij-8. I q
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9 Funwal Expenses & Admlllistrat'I\/e Costs iSchedule H:,
(81
(9) ~J B24. 'J
(10!__$) 650. f~
(11,1
'If !!J-, G11. 7':1-
f
Total Gross Assets (total Lines 1-7)
10 Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I'!
11 Total Deductions (tota: Lines 9 & 10)
12 Net Value of Estate (Line 8 ninus Line 11)
(12)
13 Cnaritable and Governmental Bequests/See 9113 Trusts for wnlel a~ electio~:o tax !:as net been
made (Schedule JI
(13)
14 Net Value Subject 10 Tax ,:Llne 12 m;'1lis L;r:e 13'i
(14)
.~ 8 08 533.44
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15 .J\moGnt olUne 14 taxable at the spousal tax
'ate, or:ransfers un~er See 9116 (a:(1_21
x.O_ 1:15)
x oA!J (~ 6'1
x 12 (17)
x 15 !181
(19)
_~3~.jB~O_
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'6 Amount of Li',e 14 taxable at linear rate
17 ,lI,lTlourt of L'~f: :4 taxable at sibling rate
18 Amount cf Line 14 taxable at collateral rale
$'10r-1B-4.CD-
19 Tax Due
2011
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS 2/0 <;: elL./) 5 TDJo;EHO us r; tPo,4/)
(i.fiDbLE9E/C TOWNS'HfP)
CITY CARLI <JL E'" . -
STATE
fll/-
liP
/7013
Tax Payments and Credits:
1 Tax Due (Page 1 line 1 g)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
ft 3 If, j 81 . 00
--, --
Total Credits (A + B + C )
(2)
10, 000,00
I
3 Interest/Penalty if applicable
O. Interest
E. Penalty
TotallnterestiPenalty ( 0 + E )
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
5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4) . Cij~/h' 00)
(5)
A. Enter the interest on the tax due
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5B)
Make Check Payable to, REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Old decedent make a transfer and'
a retain the use or income of the property transferred:.
iJ retain the right to deSignate WtlO shall use the property tra:,sferred or "ts income
c retain a reversionary interest: or.
d rece've the promise for life of either payments. benefits or care'?
2 If death occurred after December 12,1982, did decedent ~ransf8r prJpe-ty '\V!thi'l one year of death
\Nithout receiving adequate consideration?
3 Did decedent own an "in trust for" or payable upon deat1 bank accou'lt ::Ir security at 'l'S or her death?
4 Did decede:lt mvn an Individual Retirement Account, annu,ty" elr 'X',er ['on-probate property which
wntains a beneficiary desrgnation?
Yes ~
~
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~---,
~
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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i~' ~:1sej on a' ""-x'n" c,,' :~f',\r:~r ~-2DJr8 ''::is C'f". ,,,,,coy'
SIGNATURE OF PERSO,.
FiLING RETURN
DATE I L
1;"" EC 11 TOtf 2 10 os-
/32-/51 WALNUT STt2En H/Jr€f!('7BVR6- (JA-l1iol-lb/2
) DATE -(
NNI, GLAcf'
REPRESENTATIVE
ADDRESS
For dates of death en or after July 1, "'994 afld before January 1 1995, the tax rate irnpesed on t~e ret ''ia!ue of trarlsfers to or for the use of the surviving spouse IS 3-':0
[72 PS 99116 (a, (:.1) (!)]
For dates of death on or after January 1, 1995, the tax rate iplPosed on the Ilet va:ue of tra'ls'ers to or for the use of the surv:vmg spouse is 0%:72 P.S, S9116 (ai (' 1) ':i':l
The statute does rot exemot a transfer to a surviving spouse from tax and tile statutory reculr'~rnt;nts for disclos:.Jre of assets and filing a tax return a;e still applicable even
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 paren
or a stepparent of the child IS 0% [72 PS 99116(0)(12)]
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 P.S S9116(1.2) [72 P.S, s9116Ia}(rl].
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 s9116(a)(1.3)], A sibling IS defined, under Section 9102 as a
IndiVidual who has at least one parent in common with the decedent whether by blood or adoption,
REV-1502 EX+ (6~98) .
-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Carolyn R. Glace
2104-0204
All 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 to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
t.
DESCRIPTION
VALUE AT DATE
OF DEATH
$600,000.00
Sale of2l0 Old Stone House Road
( Middlesex Township, Cumberland County)
Settlement Sheet attached hereafter
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
$600,000.00
A. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT C;:RTlt:l'-o.r; 0:-:: ;. -:::i '1= ~''D "~RREGT Ot.lBNo. 2502-0265 i
SETTLEMENT STATEMENT ~ . .c' '~U...n ,,,U_ ,,!\ l.:V.,
HERSHEY SETTLEMENT eGl'':' OF TI-!E ORiGlNftl. r=,
SERVICES, INC. ,
B. TYPE OF LOAN
310 West Chocolate Avenue9 P.O. Box 412 1.I1fHA 2-[ JFUHA 3$ I CONY. UNINS I
Hershey. Pennsylvania 17033 4./IVA 5.[ ICOfIN.INS. i
6.RLENUI.l8ER: I 7_~~~~~~~B4 1
Phone: (717) 533-4868 FAX: (717) 533.2582 3848 1
8. MORT. lNS. CASE NO 1
,
i
C. NOTE: This form is furnished 10 give you a statement 01 aC\lJaI settlllrTlent costs. Amounts paid to allct by the seUlemenl agent are shown. lIems marked i
"(p.o.c-l" were pail1 outside the closing: they arEl shown hera lor intormalional purposes and are not included in the tOlals
D. NAME AND ADDRESS OF BORROWER: E- NAUE AND ADORESS OF saUR: F. NAME AND AOOt'lESS OF LENDER: I
Stanley M. Tarka, Jr. Estate of CitiMortgage, Inc.
Laurell A. Tarka carolyn R. Glace by
John M. Glace, Executor 1000 Technolgy Dr.
O'Fallon, MO 63304
G. PROPERTY LOCATION: H. SETTlEMoENT AGENT, I. SETTLEMENT DATE:
Carlisle, PA 17013
210 Old Stonehouse Rd. Hershev Settlement Services, Inc. 05/21(04
Middlesex Township PlACE OF SEnl.EMENT:
CUMBERLAND 310 W.ChocolateAve, Hershey PA 17033 i
of. SUMM"'RY OF BORROWER'S TR...NS...CTION, 1(. SU......Ry OF SELLER'S TR"'NS"'CTION: ,
lOll. GROSS AMOUNT DUE FROM BORROWER 4llD.GROSS A"OUNT DUE TO SELLER
101. ConIract sales price I 600000.00 <<Il.Contracl: sales price I 600000.00
1ll2,Personalp ClZ.Pencnal p I
un. Selllemel11 dlar as to borrower {Une 14OO) 10746.98 .~ I
,~ I .~ I
,~ - I
Adjustments lor items paid by 58lIer in advance '" entslorilemspaidb seller in advanca
IOG.Ci (lawn la~ <0 406.CllyrrawnlaJ: " I
107 County la~ 05/21/0~012/31/041 662.47 -lII1.CounIYta:>: OS/21/04l012/31/04! 662.47
103. Assl!s5TlloolS " 408.AssessmenlS " I
,~ .<:cl>ool OS/21/0410 06/30/041 339.91 .t09. Sdwol OS/21 0""'06/30/0 339.91
1111. <0 "0 <0 I
," '" ,
112. 41".
120, GROSS AMOUNT DUE FRO.. BORROWER 611749.36 42D. GROSS .....OUNT DUE TO SELLER I 601002.38
2QO .....OUNTS PAID 81' OR '" BEHALF OF BORROWER SOlI. REDUCTIONS 1M ...IIOUNT DUE TO SELLER
201.0 osil or eamest mon 5000.00 501.Excessde sil (see instnJclio!'ls)
:!02, Principal amount of new Ioan{s) 480000.00 502.Setllemenl dl esloseller line 14{)O) 6100.00
lO3.Exislin toan{s)laken$Ub to ~ ban(s taken sub' to
~. ~ Payoff of FITS! Morlgage Loan
= SDS.Payon 01 Second Mortgage loan I
- ~ I
~, ~,
- - !
~ -
Adjustmenls for items I,npaid b ""~ menls for items ~paid b "'''''
210. CitylTown ta~ <0 I ~loCilyrrO'lOf\tax " I I
211,CounlylaX " , 511Coumylax " I
2l2.Assessml!nts " 512.AsSl>s.smaols <0 I
?'3 "k,hocl " ~13. School <0 I
'" I ."
'" I 515. I
'" I ".
'" I '" I
218 ... I
'" 519.
nIl TOTAL PAID BYIFOR BORROWER 485000.00 !.<'II.TOTAL REDUCTION AIIOUNT DUE SELLER 6100.00
""". CASH...T SETTLEMENT FROII OR TO BORROWER .1.LCASH AT 9mLEll.ENTTO OR FRO" SELLER
301. Gross arrlOl.-d due from borrower (line 120) 611749.36 &II1.Gross amounI du& 10 seDer (line 420 601002.38
3112. Less amount paid b '/for borrower (line 220) 485000.00 6OZ.~ redudion amount due ....lIor (line S20) 6100.00
303. CASH (00 FROM) ([ J TO) BORROWER 126749.36 (;UlCASH UXI TO) ([ I FROM) SELLER 594902.38
Bll'f'!ro,Borr<lWe'f'sSignaIUte
Scller'sSignatUfl!
HlJD-lRev. 5J96
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
PAIOFROII
BORROWER.S
FUNDS AT
l SETIlEIIENTCHARGES 3848
7~. TOTALSALE$I8ROKEA.SCO"lIlSSIOf'basHon~S 600000.00
DivisiOn ot Cornmission Ilimt700) as follows: Total: 0.00
701$ 10
7~ $ ~
703. Commission paid al Seltlemenl
''''
1lOO. ITEIIS PAYABLE IN COtlNECTlONWITlI LOAH
601 LoanO!igioalionFee %
802. Loan Discount %
llO3 Appraisal Fee to
1104. Credit Report ~
905. lenders InspeclionFee
806. Mort a elnsuranceApplicationFeelo
607. AssumPtion Fee
809. CommitFee
BC9.A Fee
'"
611.
900 ITEMS REOUIRED 8'1' LENDER TO BE PAID IN ADYANCE
901 lnleresllrom 05 21 04 to05 31 04 os
002. Mort a e Insurance Premium lor mo. to
903 HazardlnsurancePremiumlO! yrs.la
yTs.ta
CitiMort a e
CitiMort a e
Inc.
Inc.
565.001
500.001
41.10/day
452.10
001. Hazard Insurance
002. Mort a e Insuranca
003. City{Townlax
004. County lax
DOS Assessmenls
""
00'
'""
100, TrfLE CHARGES
1101. Settlemento.rclasin looto
102. Abslraclorhllesaarch 10
1103. TiUeaxaminalion 10
104.Hlainsurancebindur 10
105. Document preparation to
106, Nolarylees 10
107. AUamay'slees 10
(includes aboveilems No.:)
lOB.nleln!\Urance 10
(includes abova i1ems No :l
109 Lander'scoveraga$
110 O_'s coverageS
'"
mo,OS
mo.OS
me.OS
mo.OS
me.OS
mo.OS
mo.GS
mo.OS
!mo.
!mo
!mo.
!mo
!mo
!mo.
I~
!mo.
~.
..
000. RESERVES OEPOSITED WITH LEMOER FOR
100 300 8.1
480 000
600 000
HERSHEY SETTLEMENT SERVI
#102055395
100.00
A. Mark Winter Es .
Maril J. Cichelli
'"
'"
1200, G.OVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recordin lees: DeedS 38.50 MortgageS 68.50
202. Cily/coun l.alllslamps; DeedS 6000. OOMorfOage$
ZOJ. Slatelalllsl.amps: DeedS 6000. OOMort eS
""
""
300. ADDITIONAL SETTLElfENT CHARGES
301 Survey 10
302,Pasllnspeclian 10
$03 InsClsLtr
1304. Fe
Misc. $
107.001
6000.00
6000.00
First American Title Ins
Hershe Settlement Servid
35.00
15.501
"'"
400, TOTAL SETTLEMENT CHARGES (enlCtonino$ l03and502, SoctionsJandK)
10746.98
6100.00
"""iesagt...""'I""bblityilla_".,_..."""'I""....~.....kl"'u"i""lum_1IV"'~atS.....(IWI\....lIIaHUo-ls.,11l<lmllnlSta'_LS<Ilt\emeftlAganlh""'lIVftI<pfO_
'n'''~..,hftrigblladef'OSll....,_caIec1cd''''~;.,..._bnrinll-=caunl...f-.aRy_....._.ndk>Cfcdtt.''l'inI...IISl........-llIb(lWl\KCl>Uftl__iDnal
~....,,,,"..._..1tolol.-iuB
oI.al1rocoiptsaoddisburscmcnl$
9"Y"fO'"""....f.sSigna'u'e
9"y...'sA_&f'I!n""
ThltHlJO.,Sell_""'Sla~,..t.lehl"-a__..~ltUft;>ndIlCCWO'e~........,~""'.I_""used"'wilca....'J\e'W>Cbl<>be_iR""""'<laDcG....h".......,_
5-Z/-04-
SolI_"'genl [);ole
wAANING,nill.~'.....'ak~..._I"'""..a1......"lSI<>P>eUrl_$I;oI...""1I..."'....,_Iofm,Penab..."__conW:liDncanin<".Iu<l<>3l"""ondm"""""",,,nl fe'de1........
Trt.., '8,U.S. c..:lcS<:ct"'" 1IlO'''''''S4tdion '"10
IlUfJ-lR...-"Ill6
"-,
""'''''".,,'".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
-
Carolyn R. Glace
FILE NUMBER
2104-0204
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Merrill Lynch Security Accounts
(Acct # 872-47199 and Acct # 872-53085)
Value at Date of Death 2/24/04
$148343.36
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$148,343.36
REV.15Q7 EX+ (1.97) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Carolyn R. Glace
FILE NUMBER
2104-0204
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBEA
DESCAIPTION
VALUE AT DATE
OF DEATH
------
1.
Central Penn Appraisals, Inc..
$275-<10
S.W. Barrett Real Estate and Appraisal Services
275.00
Winding Hill Window Cleaning Service
127.20
Mechanicsburg Carpet Mart (Carpet Cleaning)
52.47
Shipley Energy (Heating Fuel, Aeet # 237212)
425.29
Pennsylvania Power & Light ( Acct # 27940-69008)
13.59
Sprint Telephone (Acet# 717-249-4507-12])
5.14
Direct TV ( Acet # 8156237)
34.43
Pennsylvania Power & Light (Acct # 27940-69008)
40.07
Diana M. Reed & Associates (2003 Tax Prep)
340.00
Sprint Telephone (Acct # 717-249-4507-121)
1Ol.69
Connnonwealth Corporation (House Cleaning)
404.46
Grace Smith (Housecleaning)
180.00
Brian Zappe ( Trash Removal)
100.00
Quality Lawn Care
127.20
Belmont/Crystal Springs Water (Acct6 # ]200957 14796211)
David Hartzell, MD ( balance Ophthalmologist)
Shipley Energy (Heating Fuel, Acet # 237212)
58.94
85.00
324.55
Shipley Energy (Heating fuel Aect# 237212)
126.24
Pennsylvania Power & Light ( Acct # 27940-69008)
40.60
TOTAL (Also enter on line 4, Recapitulation)
(II more space IS needed. msert additional sheets of the same size)
See Page Two as follows
REV~1507 EX+ (1-97) _
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
FILE NUMBER
2104-0204
Carolyn R. Glace
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
~
DESCRIPTION
.. .~.
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1.
Sprint Telephone (Acct # 717-249-4507-121)
36.82
Verizon (Cellphone, Acct # 215561320-00001)
Direct TV (Acct # 8156237)
34.97
41.50
Middlesex Township ( Personal Tax)
9.80
School Tax, Cumberland Valley School District
1,077.61
Verizon (Cellphone, Acct # 215561320-0000 I)
Sprint Telephone (Acet # 717-249-4507-]21)
Pennsylvania Power & Light (Acct # 27940-69008)
Shipley Energy (Heating Fuel, Acct # 237212)
Belmont/Crystal Springs Water (Acct # 12009557-14796211)
Direct TV (Acct# 8156237)
24.65
48.46
72.72
$375.00
58.94
41.50
Pennsylvania National Bank ( Visa balance)
112.56
Pennsylvania Department of Revenue, 2003 Taxes
738.00
Transfer Tax for Sale of RIE
6,000.00
Document Prep and Closing Costs for Sale ofRIE
100.00
TOTAL (Also enter on line 4, Recapitulation)
(It more space is needed, insert additional sheets of the same size)
$11,880.14
REV"""""""W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Carolyn R. Glace
2104-0204
ITEM
NUMBER
["dude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survrvorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
DESCRIPTION
1.
Checking Account M&T Bank (Acct # 414689)
$5,600.00
Refund AARP Health Insurance (policy # 0245021161)
148.75
Refund Middlesex Township (Escrowed fro 2003 Subdivision)
206.87
Erie Insurance( Death Benefit I Auto Insurance, Policy # Q09 68 03060 H)
5,000.00
Erie Insurance (Reimbursement for Destruction of Car, Policy # Q09 68 03060 H)
4,709.90
Erie Insurance (Refund for Pre-paid Insurance Premium Policy # Q09 68 03060 H)
64.00
Mid-Atlantic AAA Insurance, (policy# 000007839), Death Benefit
50,000.00
Erie Insurance Reimbursement for Funeral Expenses (policy # Q09 68 03060 H)
529.37
Crystal Springs! Behnont Water, Refund (Acct # 1200957 14796211)
58.94
Erie Insurance, Refund, Property ICatastrophe Insurance ( Policy# Q260750091 H)
76.00
Sale of Personal Property ( less commission to Rowe's Auction Service)
9,421.00
. TOTAL (Also enter on line 5, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$75,8114.83
'F'~"09EX'''~9^ .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
[MDLjN
~.
GLACE
FILE NUMBER
2101- 0201
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S} NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account numoor or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held realeslale VAlUE OF ASSET INTEREST DECEDENTS INTERES
1. A.
, ft
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
l;,~,!2.
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
2104-0204
Carolyn R. Glace
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES: -- ~
1 '. -
Funeral! Memoriai semel: Costs and-Expenses
$685,92
Cremation Society of Pennsylvania
1970,63
Obituary Publication
491,63
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
- .-
Name of Personal Representative(s)
$0,00
Social Security Number(s)/EIN Number of Personal Aepresentative(s)
Street Address
City State __Zip
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) $0,00
Claimant
Street Address
City Slate _Zip
Relationship of Claimant to Decedent -
4. Probate Fees $5]8,00
$0,00
5. Accountant's Fees
6. Tax Return Preparer's Fees $0,00
- -
7. Advertising Costs $]58,43
- - -
TOTAL (Also enter on line 9, Recapitulation) $ $3,824,61
Debts of decedent must be reported on Schedule 1.
(If more space is needed, insert additional sheets of the same siz.e)
REV-1513 EX+ (9-00)
~. /At ~, '~~.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
C/1ROL'IN
P.
G u1 CE
FILE NUMBER A .~, L1
2/0., - 02Crr
NUMBER
[
L NAME AND ADDRESS OF ~ERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outnght spousal distributions, and transfers under
Sec. 9116 la) 11.2)J
Jbh(i /v1, G Jacr;: J
1,:l2 8ril1Lt/f (t'OaCf
) fJA (10/--',7
MechCi/lliC5IoW:}) . nJ
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
.SON
I
-:5
1.
Thowlas E. GfClce, f
22f Norfh 24t"J Sirpp
Camp Hi/! j flit /1011
Co/'i(JV1(? E, Kosi,
100. 8rOrnfI0''l Rof' ,'A22{
WI Iii i)fY) s vil1e, Nj .,
/
SON
I
,-
:3
3.
QA U6-H7[f
J-
~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV.1500 COVER SHEET
II NON.TAXABLE DISTRIBUTIONS'
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 1I- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $
,
f2J
(If more space is needed, insert additional sheets of the same size)
STATUS REPORT UNDER RULE 6.12
C#"0L Y AJ .R.
r~f3Rf4f1RI 24:
'loo4- 00201
t9LAc<=
2004
Name of Decedent:
Date of Death:
Will No.:
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 of the above-captioned estate:
1. Stat~ether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. Ifthe answer to No.1 is Yes, state the following:
a. Did the personal rep.resentative file a final account with the Court?
Yes _ No ~
b. The separate OrPl).ans' Court No. (if any) for the personal representative's
account is: ~
c. Did the persona~resentative state an account informally to the parties
in interest? Yes)6i No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Cler of the Orphans' Court
and may be attached to this report.
Date: 1 II '3 J~-
L.L
c.) (./-)
W_I
C)
u"':
LL., ! .
c,.':'
c...-:.I
U..J
C)
CI~:
~:=)
0"1
U)
<0
::I!:
C%:
~
I-- CL.
r:r: "
:::::.JC
Ll..QC
o~)c
:;Ceo;;;;
cr.. <(
UJ~_.;
.....JIa:
(.)o..l'"
ill
cr.::z;
o:::;l
(.)
tace ;f51t1tte
/;2-13 tv'a( t?Vi' cJ-jI'~e f
Address 'Wr/S tiv.:j J /fJ/?- 171tJI-1G12
~fI1) 236-.,5""1'5
Tele one ~.
Name
M
-J
::::>
....,
t.r:>
<:::>
<:;;:)
'"
,~ ,j
UJ
cr
Capacity: 0 Personal Representative
'~ Counsel for personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/13/2006
GLACE JOHN M
132-134 WALNUT STREET
HARRISBURG, PA 17101-1612
RE: Estate of GLACE CAROLYN R
File Number: 2004-00204
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
2/24/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
Cumberland County - Reglscer ur wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240 - 6345
Date: 2/03/2006
GLACE JOHN M
132 BRINDLE ROAD
MECHANICSBURG, PA 17055
RE: Estate of GLACE CAROLYN R
File Number: 2004-00204
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
2/24/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
I~ yv/'; -.Ii, _U
1'4~~_ v~~j&~~
,~ . ~
GLENDA FARNER STRASBkUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
~l
.~.,U'l/""".
/"'/ Hi:=..:..,. ".....
l';, ~ -{!\
!g~ \~,
~..., 'ell
\~ .;;
~
~ _ ~ _."_ __, _,..:L"'~l\,..~l1ll_ _.:1: ..:'1_____::_ __,...ii ___..2 ,1\_....,...,.....,-.""---
Jr'",'CB'!!':S>I\.<CJl" (\JI! 'If'i .!!.JJ.1L:5J UJ!. \0li.li.J!.li..ilIUit;;;Ji'.!L6::lL1UlU "_AYiLiLli!liLJ
STATUS REPORT In'lDER RULE 6.12
Estate No.:
.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
C ~ROL 'IN f(. ,
febrl.1 ary 11 J
'Zco1- 00'201
GLAcf
1004
Name of Decedent:
Date of Death:
1. State!:'lether adrrrinistration of the estate is complete:
Yes 1pJ No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the person~presentative file a final account with the CoUrt?
Yes 0 No j)Sl
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person~presentative state fu"1 account infonnally to the parties in
interest? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the 0 hans' Court and may be
'J I i J I n attached to this report.
Date:~~
~...
&{oce
i3[-1,4 Wall4LJ '3tveef
Address 110V'v-isbi1r~J (.)4 il,OI-';~/2.
7'1- 1.'1/8- .55! ~-
,,\'p1 ~1"'\h^;"lp -1'1(\
... ---'r------- - '- ~
i.'
Cap;;..citi:
lxf ?e:tsQ:;}al Represen:a:ive
o C01..1.D.sel for personal representative
~~.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX ;~8060 1
HARRISBURG PA 17128-0601
REV-1607 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-01-2006
GLACE
02-24-2004
21 04-0204
CUMBERLAND
101
C
CAROLYN
JOHN M GLACE ESQ
J M GLACE LAW OFFICE
132-134 WALNUT ST
HBG PA 17101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
CUT ALONG THIS LINE
----.-----------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF GLACE
REV-1607 EX AFP (03-05)
CAROLYN
C FILE NO.21 04-0204
ACN 101
DATE 05-01-2006
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-02-2005
PRINCIPAL TAX DUE: 36,380.40
PAYMENTS (TAX CREDITS):
!PAYMENT
DATE
10-12-2004
04-10-2006
IE IF PAID AF
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I
L
I RECEIPT DISCOUNT (+) AMOUNT PAID
i NUMBER INTEREST/PEN PAID (-)
I CD004483 .00 40,000.00
I REFUND .00 3,619.60-
I i
I
I
I
I
i
I
I
TOTAL TAX CREDIT 36,380.
BALANCE OF TAX DUE
INTEREST AND PEN.
TER THIS DATE, SEE REVERSE TOTAL DUE
~
00 I
O~
-------j
00 :
~
( 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. )