HomeMy WebLinkAbout04-0612PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' ~gt~ ~:. S3xt~t~ No. 21-0g-Otz
also known as To:
Deceased.
Social Security No. 2. ~ 0 - ~ q - '.~ '-t ~1
Register of Wills for the
County ofC~-~-~ ~ c~.
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execute,
in the last will of the above decedent, dated ~ (.to g7 2--
and codicil(s) dated ~]/~
in the
named
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Co
last family or principal residence at
County, Pennsylvania, with
(list street, number and muncipality)
Decendent, then ~'~ years of age, died ~)~c.z ~/ , ~) 2~a_~ ,
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: A~/~
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ /3 t °° o o . o o
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: ~
WHEREFORE, petitioner(s) respectfully .request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters 7'~'-trt ~t44 ~ r~, -; ,,' .
(testamentary; administration c.t.a,; 'administ~on d.b.n.c. La.)
theron.
C2~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALXH OF PE._N~ NSYIeYANIA
COUNTY OF ~,.~.c,c,,~ \~cxc~k . 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 p.et~o, ner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well//fl/~.. ~ / a~nd ]cru~.aO~/7"-P ~ ] the estate according to law.
Sworn to or affirmed and subscribed ,~ I/[L4ZL.4eI2~' ~
before me this ~0MN'x day of [ ~ c ~ / ~.
~:~ ~ ~ - ~Regist~J [ ~
Estate Of 'Y-~eXe~ ~ ~.%c~ % , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW 1~
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated '~- o~- OI
described therein be admitted to probate and filed of record as the last will of
and Letters '"~'~.<~-k'o~cx.~-~-c~c..~
are hereby granted to ~'~'~,~'-, ~'---7")~ c,.~rx., ~- 0 ~
, in consideration of the petition on
Filed
FEES
.Probate, Letters, Etc ..........
Short Certificates(.3) '
~ .~.~u._.
,TOT~Lo_q._
...~..--.~ -
Register of Wills
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
Fee for this certificate, $2.00
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 9450763
No.
H105.143 Rev. 2/87
PERMANENT
BI.ACK INK
o
o
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
STATE FIlE NUMBER
SEX SOOAL .~ECURITY NUMEER DATE OF ~H iM~. ~y. '~r)
~. Female ~. 230 -- 14 --4489 4. ~ 9, 2~3
t I
Chambersburg .. Manorcare ~ealth' Services ~"~*~"~'~' ,~ White
NAME OF DECEDENT (Fnt Middle, L~)
,l. Helen E. Smith
AGE (Last Bu'iflOay) I UN~R 1 YEAR
86 Ytt ;
~. Franklin
KIND O{: BUSINESS*INDUSTRY
DECEOENT'S MAILING Al.~u~t=ba (Still{, C~/ow¢ St~e. E~ C~1 /~CE~'S
201 East Burd Street Apt. "204~[,%%u
~,.Sh~ppensburg, PA 1725~ [m¢*,~,~
WAS DECEDENT EVER tN OECEDENT'S EDUC£1ON
I ~ ~ ~ i E~~ I
~?,.~ ~m~,m~ Shippensburq
l~.~Cumberland ~,,~?
FATH E R'S NAME (First. Mid~. La~) MOTHER'S NAME (First. M~ie. Mal(~n ~)
~m. Gerald E. Pentz ~m. Nilva Wagner
~. Edwin L. Pentz, Jr. ~.13102 ~ ~. %8, ~ ~e, ~ 9~
~'~ ~'(~ ~ ~,~. 12-11-03
~'.. ~c. Lincoln Cemetery ~,. Chambersburg, PA 17201
DUE TO [OR AS A CONSEQUENCE 0~): ~
[] I~,. lae~. M.
I
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
LAST WILL AND TESTAMENT
I, HELEN E. SMITH, presently residing at 201 East Burd Street, Apartment H 206,
Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition,
do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void
all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I give and bequeath those items of tangible personal property listed on a certain
one (1) page typed list dated August 2, 2001, entitled "Personal Property List for Last Will and
Testament of Helen E. Smith, Testatrix", signed by me, attached to this my Last Will and Testament and
incorporated herein by reference thereto, to those persons named on said list. Items have been marked
with an "item number" as reflected on the aforementioned Personal Property List. Any costs of
temporary storage and/or shipping said personal property to Karen Carr shall be borne by Karen Carr.
With respect to the other persons named on the list, the cost of shipping said personal property to the
designated beneficiaries shall be borne by my estate.
THIRD. I direct that all of the rest and residue of my tangible personal property be sold at
either public or private sale as soon as may be convenient, expedient, and in the best interest of my
estate, as determined solely by my hereinafter named executor. I then give, devise and bequeath the net
proceeds of sale, together with my liquid or cash assets, all of which constitute my entire estate, in equal
shares as follows:
A. One (1) share to my great-grandson, JACOB MATTHEW CARR; and
B. One (1) share to my grandson, TOMMY E. CARR.
FOURTH. In the event that any beneficiary named in Paragraph Third of this my Last Will
and Testament is under the age of twenty-three (23) years, I then give and bequeath said beneficiary's
share to and appoint as Trustee of any property which passes under this Will or otherwise, EDWIN L.
PENTZ, JR., of 379 100th Avenue, NE, Unit C, Bellevue, King County, Washington 98004, AS
TRUSTEE, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches thc
age of twenty-three (23) years, with the following powers in addition to those presently given by law:
A. The power to expend the income towards the education, including a college (both
undergraduate and graduate), trade, business or technical school education, of the
said ben~ ~ciary;
B. The power to expend the principal, within the discretion of the said Trustee, if the
income is insufficient, towards the education, including a college (both
· i'~und~rgfa~l.uate and graduate), trade, business or technical school education, of the
said beneficiary;
WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397
Co
The power and obligation to distribute the balance of principal and interest, if any
remaining, when the said beneficiary reaches the age of twenty-three (23) years,
without the necessity of a formal adjudication of the Trustee's Account in the
Court of Common Pleas of Cumberland County, upon the receipt of a good and
valid release;
Do
The principal of the Trust and the income therefrom shall be free from the debts,
liabilities, and engagements of those beneficially interested therein, and shall not
be subject to assignment by him or her, nor to attachment or execution under any
legal, equitable or other process for the enforcement of judgments or claims of
any sort against them, either individually or collectively; and
Eo
In the event the above-mentioned person is tunable to accept the position of
Trustee, I then name, constitute and appoint JANET H. PENTZ, of 379 100th
Avenue, NE, Unit C, Bellevue, King County, Washington 98004, as Trustee, with
the same powers hereinbefore stated.
FIFTH. I nominate, constitute and appoint my nephew, EDWIN L. PENTZ, JR., to be
the Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then
nominate, constitute and appoint JANET H. PENTZ, of 379 100th Avenue, NE, Unit C, Bellevue, King
County, Washington 98004, to be the Executrix of this my Last Will and Testament.
SIXTH. I direct that my personal representatives shall not be required to give bond for the
faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, HELEN E. SMITH, have hereunto set my hand and seal to this
my Last Will and Testament, written two pages, the first page signed for identification only,
this ~ ~/d day of ,q'~.~_.r~' on ,2001.
(SEAL)
WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397
PERSONAL PROPERTY LIST FOR LAST WILL AND TESTAMENT OF
HELEN E. SMITH, TESTATRIX
Dated: August 2, 2001
To: My granddaughter, KAREN D. CARR, 1303 Blake Avenue, Glenwood Springs,
Colorado 81601-3919
Item #:1. Pfaff electric sewing machine - complete "as is." Located in bedroom.
2. Black antique high chair. Located in living room.
3. My mother's cedar chest with key. Located in living room.
4. Picture of me in a white dress together with white frame. Located on living room wall.
5. Baby picture of me at age six (6) months old together with gold oval frame. Located on
bedroom wall.
6. Baby picture of my mother and her twin together with oval frame. Located on
bedroom wall.
7. Black antique rocker- "as is." Located in living room.
8. My one and one-third (1-1/3) carot Tiffany setting diamond ring. There is a note in the
bank deposit box describing the location of the ring.
11. Hand painted antique bronze pitcher and five (5) matching glasses. Located on the
bookcase in the living room.
18. Seth Thomas antique clock with key. Located on the plant stand in the living room.
To: My grandson, TOMMY E. CAR_R, 734 Ahukini Street, Honolulu, Hawaii 96825
Item #:9. Dick's tool box. Located in hall closet.
10. Dick's wooden magazine stand. Located in the living room.
To: My nephew, EDWIN L. PENTZ, JR., 379 100th Avenue, NE, Unit C, Bellevue,
Washington 98004
Item #: 12. Secretary desk. Located in living room.
13. Two (2) antique pictures. Located on living room wall. One picture is with pink dress
and other picture is with yellow dress.
14. Two (2) religious pictures. Located on bedroom wall. One picture is of The Angelus and
one picture is The Lord's Shepherd.
15. Two (2) antique plant or lamp stands. Located in the living room.
16. Three-legged antique end table. Located in the bedroom.
To: My
Item #: 17.
nephew, CHARLES PENTZ, 5101 Bellvale Avenue, San Diego, California 92117-4002
Navy blue glass vase with flowers and picture of Carlisle Barracks on front. Located in
the living room.
To:
Item #: 19.
20.
21.
My cousin, CONNIE SHIVELY, 807 North Arch Street, Mechanicsburg, Pennsylvania 17055
Glass globe lamp with roses on front. Located in the living room.
White antique oval mirror. Located standing on the dresser in the bedroom.
Antique gold plaster of Paris lamp with green shade that depicts picture of girl holding a
tulip. Located in the living room.
22. Round brass wall plaque with ship on it. Located in the living room.
(SEAL)
WEIGLE, PERKINS ~ ASSOCIATES -- ATTORNEYS At LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257~1397
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
We, .~)IX,~t~D P, ~t;'t~.~.~v4 ~-- and ,a,,~dg_, /~d?~._ ,
the witnesses wl~)se names are signed to the foregoing ins't~'ume~t, being qualified a~'cording to
law, do depose and say that we were present and saw HELEN E. SMITH, the Testatrix, 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 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 and of sound mind and under no constraint or undue influence.
Swom or affirmed to and subscribed before me
witnesses, this
day of,,~Ct~U~'{ ,2001.
Notarial Seal .
Patricia L. Tome, Notary Public
Shippensburg Boro, Cumberland Co~1_ ty
My Commission Expires June 7, 2004
WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, Pa 17257-1397
This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her
Last Will and Testament, in our presence, who at her request and in the presence of each other, we
believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as
witnesses.
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND ·
SS
I, HELEN E. SMITH, the person whose name is signed to the foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last
Will; 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 and acknowledged before
me by HELEN E. SMITI-J, the Testatrix.
this ~r~ day of,/-~tz ~ ~-] ,'2001.
J Notaria Seal
! Patricia L. Tome, Notary Public
| ShipPensburg Boro, Cumberland County
~ My Commission Expires June 7, 2004
WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 E/~ST KING STREET -- SHIPPENSBURG, PA 17257-1397
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
PENTZ EDWIN L JR
1116 MAPLEWOOD PL
ORANGE, CA 92866
RE: Estate of SMITH HELEN E
File Number: 2004-00612
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans, Court his/her Certification of Notice.
This filing will become delinquent on 10/10/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
GLEN]DA FARNER STRASBAUGH
Clerk of the Orphans, Court
JRD/June30, 1992/17858 NOV 0 8 20~ ~
In Re: Estate of Helen E. Smith
Late of Shippensburg Borough
Estate No.: 21-04-612
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-0612
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: Edwin L. Pentz, Jr.
Counsel for Personal Representative:
Date of Grant of Original Letters: 06-30-2004
Date of Delinquency Notice: 10-10-2004
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 October
10, 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: 11-08-2004 ~ )~L~a-xrka~'4o, o,.nx .,~ ~x.~e,x<:~:~,~
Glenda Famer Strasb~ug~ ~ ~. ~
Clerkofthe O~hans Cou~ ~ ~
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
filed prior to the hearing date, the hearing will automatical~~~
Geor~ ~;ffg, ffJ. ' ' I
Name of Decedent:
CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
DateofDeath: ~ ~, x-oo.g'
WillNo.: '2-1- 7.-'~>'~ULO(olX..~ AdminNo.:
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 tbllowing beneficiaries of the above-captioned estate on
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name
Address
Telephone
Capacity: ~rsonal Representative
[] Counsel for personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
PENTZ EDWIN L JR
1116 MAPLEWOOD PL
ORANGE, CA 92866
RE: Estate of SMITH HELEN E
File Number: 2004-00612
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: 12/09/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~ UP 4-:...~
..L., _ , , ,/~. '! ~-~iI
o ,~ l/"/'/.{'<:~/i~;' J ~..,,/u.......~ .
. _, '-l;.,.I .~<I,. (,;T. c.. "'.
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
\1 ~--'
/1:'\
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IDi\.l
Estate of SMITH HELEN E
Late of SHIPPENSBURG BOROUGH
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
'y,
.Y
Estate No.: 21-04-00612
Date:
1/06/2006
NO.: 21-04-00612
PENTZ EDWIN L JR
1116 MAPLEWOOD PL
ORANGE CA 92866
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6. 12, SUPREME COURT ORPHANS I COURT RULE
Personal Representative: PENTZ EDWIN L JR
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 12/09/2003
Date of Delinquency Notice: 12/09/2005
The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans'
Court, in accordance with rule 6.12, 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 their counsel, have filed with the Register of
Wills or Clerk of Orphans' Court, his/her Status Report required by
Rule 6.12, Supreme Court Orphans' Court Rule, and that the
requisite notice, pursuant to Rule 6.12, Supreme Court Orhans'
Court Rules, was given by the Clerk of Orphans' Court on 11/28/2005
and that the ten (10) day notice to file the status report has
expired. Accordingly, in accordance with Rule 6.12 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
their counsel.
cc: File
Personal Representative
Counsel
V'
~WiAJj$-~
Glenda Farner StrasbauSV
Clerk of Orphans' Court
A hearing is scheduled for February 27; 2006 at 11:00 p~ in
Courtroom No.2. If the Status Report is filed prior to the
hearing date, the hearing will autom~~! be cancelled.
,/ l~
,../' "...:/ "l
-~II:':'I',r" ,/, '~ (r \,/:... " ' "~~
-.... t ~'-'" . '> l'.. ;~,/, "-''\ ~~
Edgar' B Bayley PJ' \
COMMONWEALTH OF PENNSYLVANIA
DEPARTEyENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES A_PPRAISEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX 280601
HARRISBURG PA 17128-0601 REY-1547 EX AFP (06-05)
~:'~~~ ~~~~ ~ ~ ~iz'`~ ~' 4~ATE 08-18-2008
• ESTATE OF SMITH HELEN E
~;I ~(; ~ ~,J;- DATE OF DEATH 12-09-2003
Q~~~"1~:,~~!;j?,_;v;~Rj FILE NUMBER 21 04-0612
EDWIN L PENTZ Cur` ~,~-'' "~ ~-.~1•, p~ COUNTY CUMBERLAND
ACN 101
1116 MAPLEWOOD PL APPEAL DATE: 10-17-2008
ORANGE CA 92866 (See reverse side under Objections)
Awount Re~itted~
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND C:0 COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
-------------------------------------------------------------------------------------------
REV-1547 EX AFP C03-05~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH HELEN E FILE N0. 21 04-0612 ACN 101 DATE 08-18-2008
TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE
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
APPROVED DEDUCTIONS AND EXEMPTIONS:
cl) .00
c2) .00
c3) .00
c4) .00
t5) .00
c6) .00
c7) .00
cB)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
.00
.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens cSchedule I) (10) .00
11. Total Deductions cll) .DO
12. Net Value of Tax Return C1P) .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le .1) C13) .00
14 Net Value of Estate Subject to Tax (14) .00
.
NOTE: If an assess~ent was issued previously, l ines 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 C15) ~ •00 X 0 0 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00
19. Principal Tax Due
rwv r•ocnrrc.
c19)= .00
PAYMENT
DATE REC I T
NUMBER DISCO N (+)
INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE D
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 Ex (8-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
Helen E. Smith
D BY
Eunice Baker
INHERITANCE TAX
EXPLANATION
OF CHANGES
ILE
2104-0612
101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
This is a Commonwealth Appraisement to waive the filing requirement of the above estate.
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