HomeMy WebLinkAbout04-0684REV-346 EX (8-92)
PA DEPARTMENT OF REVENUE
FOR REGISTER'S OFFICE USE ONLY
County Code
Year
ESTATE INFORMATION SHEET
DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
File Number
?
eName (Last) (First) (Middle)
30 . qo?b
TYPE FILING: Enter check (~,) mark to indicate thee nature of the return to b ed with the department.
itla '
[] Probate Return []Joint Assets Only [] Estate Tax Only [] ti~ses (No Other Assets)
Enter check (~,) mark to indicate the nature of the proceedings at the Register of Wills
LETTERS GRANTED: Office. (Attach additional sheets if explanation is necessary.)
/
[] Testamentary [] Administration [] No Letters ~Other (Please Explain)
ATTORNEY/CORRESPONDENT Enter all data concerning the attorney or other individual to receive all
INFORMATION: tax information and correspondence.
Name (Last) (First) (Middle) Supreme Court I.D. #
;treet Address
City State Zip Code
Telephone Number
PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate
INFORMATION: authorized by the Register of Wills
Executor/Administrator
Name (Last) ~,} 0 HN '"~'~(Middle) Is°cial!hj SecuritY12_oNumber
State
Zip Code Telephone Number
I-/r~2.S- ISis.
Co-Executor/Administrator
Name (Last) (First) (Middle)
Street Address
-~ty State Zip Code
Co-Executor/Administrator
Name (Last) (First) (Middle)
Street Address
S~$ecurity Number
Social
I
City State Zip Code Telephone Number
[IPrepared By
Date
-zo o4
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of '~1~ ~ ~. .~ t LLF_.~ No.
also known as To:
Social Security No. q-_
Register of,3~/ills for tho
County of [~'.~.~ £.0/.t~/6_l')
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appall____
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in C kJ/Y~~/N]~ County, Pennsylvania, _with ~ ~,
hf:l~ last family or principalresidence at s5 [.4[-tdR~/~ fJOID~ ElqoLA.I~ ~_,P,V_..IOI~{:~6~ I~'
- (list'st~et, number and mu~r~icip~ity)C 0 ~~0~ ~'0.
Decendent, then ~ ~ years of age, died 5 / ~O ] 0 ~' ,19 .,
Decendent at death owned property with estimated values as folllows:
(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:
Petitione~., .At~fter a proper search ha 5 ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE,
petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF _(~ Uff)/~Efl, LA M ~) ss
The petitioner(s) above-named swear(s) or affirm(s)that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. __-,'4/_
worn ,o or a,,irm an,, X
before me this -2,~De*" day of / ' ti.
No.
Estate of , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 19.__, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
in the estate of
Register of Wills
FEES ~;~.Oo
Letters of Administration ..... $.
Short Certificates( ~ ) .......... $
Renunciation ................ $.
TOTAL __ $ ,9 I 09
Filed ........... .~ [ .~.O. ....A.D.
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
^--"._~-_.~._-~.."~-~.._..
r~:~ rn!:ir-'" ,'\
BUREAU OF IJalXVlIlUAl:UxES'.'.'
INHERITANCE TAX DIVISION L'-'
PO lOX 288601
HARRISBURG PA 11128-0601
COMMONWEALTH OF PEMNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAIS~EHT, ALLDHANCE DR DlSALLDHANCE
OF DEIlUCTIDIl$ AND A$$ES$HEHT OF TAX
'*
REV-1M1 EX AFP (13-05)
20051'iirt -9 Pii 2: 44
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-02-2005
MILLER
05-06-2004
21 04-0684
CUMBERLAND
101
_t _ltt...
JOANN
J
CLEEK OF
ORPHi' hi'", (Y'c' iPT
.- . ""\j,,..' ,-"\..'....,,
JOHN R ~~i(i~T.c ,.
5 LAUREl DR
ENOLA PA 17025-1514
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iI!r-"1'!4"Yf.""'.'\'\f.r-lm'.'lMftl!!.!JI!'.!..'l"t'J_.m.lWll'W!MMf~.yt[""JB.Mt'.............. ...
DI~LOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MILLER JOANN J FILE NO. 21 04-0684 ACN 101 DATE 05-02-2005
I
TAXRETUIIII HAS: I X) ACCEPTED AS FILED
RESERVATION CONCERMING FUlURl IMTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. _1 E.tat. ISc:hocIul. A.)
2. Stock. _ _. 1~1o B)
3. Clo..1y Hold Stock/Par_rship Int.rast IS_I. C)
'I. Hor*-sINot.. _.ivabla IS_I. D)
5. CS_ Deposlts/llbe. Par_I ","-rt" 1~1. E)
6. .Jointl" _ Praport" ISc:hocIul. f)
7. Trw.afer.(Sc:hedule (I)
.. Total A...ts
I ) C_ED
II)
(2)
(3)
I'j)
IS)
(6)
(7)
.00
.00
.00
.00
.00
.00
.00
(8)
NOTES!- T InllUre proper
creell t your IICCOW\t,
.-at _ portion
of tIIle for. with your
tax t.
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. F....ral e-..s/_. Costsllllsc. e-... ISc_la H) (9)
10. DabtslHort_ Uablliti.s/Uons 1~1. I) (10)
11. Total _tlons
12. Not Value of Tax Return
13. Charltablalllo_tal --'-sts; 1Ion-.loct... 9113 Trusts 1~1. J)
1'1. Not Va1uo of Est.t. Subjoct to Tax
.00
.00
(11)
(12)
(13)
11'1)
DO
.00
.00
.00
1911:1.11
I'f an .....R8nt II" issued prev:l.Dusly, l:l.ne. 14. 15 end/Dr 16. 17. 18 ,nd
reoflect 'figure. tha't :l.nclUde the tDt81 Dof au. return. a_s.ed tD date. i
ASSESSMENT OF TAX: i
15. _t of Uno 1'1 at Spou..l rat. (15) .00 X 00 = I
16. _t of Uno 1'1 t_lo at Uneal/Cla.. A r.t. (16) .00 X 045 =
17. _t of Uno 1'1 at Sibling rat. U7) .00 X .12 =
18. _t of Uno 1'1 t_l. at Collot.ral/Class B rata (18) .00 X 15 =
19. Principal Tax Duo (19)=
NOTE:
.00
.00
.00
.00
.00
DATE
IMIBER
IHTEREST /PEH PAm 1-)
~PAm
TOTAL TAX CREDIT
BALANCIE OF TAX DUE
INTEREST AND PIEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIDH OF ADDITIONAL INTEREST.
I IF TOTAL IlUE IS LESS TIIAII fl, NO I'A_ IS RElIUZRED.
IF TOTAL IlUE IS REFLECTED AS A "CREDIT" ICR), YCIlI IlAY BE DUE
" REFUND. SEE REVERSE SIDE OF THIS FDRII FOR ZIISTRllCTIDIl$.) ~
.....S