HomeMy WebLinkAbout03-0094PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Deceased.
Social Security No. / Sci- 09 '- '~ q
Register of Wills for the
County of _("u~be~[a ~tr_/,
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 execut,.,~
in the last will of the above decedent, dated,& ~-01-i [.. ~o ~c9o 9
and codicil(s) dated
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~' ~ ~ ~,. h_e c ~ ct t~ c{ County, Pennsylvania, with
hi ~ last family or principal residence.at ~? 'a. 5' {"v~,,~+~e,~ Ih ~-~'u-t ,q-~,'b- 35/3
K.... (list street, number and muncipality)
Decendent, then ~ ~ years,of age, died
Except ~s' (oll~/ws, deceder~t di~l not marry, Wa~ not divorce~l 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:
WHEREFORE, petitioner(s) respectfully request(s) the ~_~robate of the last will and codicil(s)
presented herewith and the grant of letters ~ administration ~.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEA/ TH/?F/PE INSYLVANIA } ss
COUNTY OF
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.
No. 21-03-94
Estate Of WILLIAM A. BLACKSMITH. aR , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 31, ~f2003 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated APRIL 20, 2000
described therein be admitted to probate and filed of record as the last will of
WILLIAM A. BLACKSMITH, JR ;
and Letters TESTAMENTARY
are hereby granted to JAMES E. BLACKSMITH
FEES
Probate, Letters, Etc .......... $. 200.00
Short Certificates(5) .......... $ 15.00
~a__m~_~_tt EXTRA. PAGES... $ 15.00
JCP $ 10.00
TOTAL ~ $ 240.00
Filed ...J..AI~..U..AR.Y...3.1.,,.2. .0.0.3. .............
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
MAILED TO EXECUTOR JANUARY 31, 2003
21-03-94
009387-00003/03.29.00/EGM/KLT/133081.1
2i-03-94
· lill anb e tament
OF
WILLIAM A. BLACKSMITH, JR.
I, WILLIAM A. BLACKSMITH, JR. of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts, and the expenses of my last illness and funeral
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
TANGIBLE PERSONAL PROPERTY
I give and bequeath my household and personal effects and other tangible personalty of like
nature (not including cash or securities), together with any existing insurance thereon, unto my
sons, WILLIAM A. BLACKSMITH, III and JAMES E. BLACKSMITH, to be divided
between them by my Personal Representative with due regard for their personal preferences in as
nearly equal shares as practicable. In the event that either of my sons predeceases me, I give and
bequeath the items described in this Article II unto the survivor of them.
009387-00003/03.29.00/EGM/KLT/133081.1
ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever
nature and wheresoever situate unto my sons, WILLIAM A. BLACKSMITH, III and JAMES
E. BLACKSMITH, or the then-living issue, per stirpes of either son who predeceases me.
ARTICLE IV
POWERS OF PERSONAL REPRESENTATIVE
My Personal Representative(s) and Trustee(s) shall have the following powers in addition to
those vested in them by law and by other provisions of my Will applicable to all property, whether
principal or income, including property held for minors, exercisable without court approval and
effective until actual distribution of all property:
mo
To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine.
Bo
To retain any or all of the assets of my estate, real or personal, without restriction to
investments authorized for Pennsylvania fiduciaries, as they deem proper, without
regard to any principle of diversification or risk.
Co
To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of
diversification or risk.
009387~3003/03.29.00/EGM/KLT/133081.1
Do
To sell at public or private sale, to exchange, or to lease for any period of time any
real or personal property and to give options for sales, exchanges or leases, for such
prices and upon such terms or conditions as they deem proper.
To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
F. To compromise any claim or controversy.
Go
To make such elections, decisions, concessions and settlements in connection with
all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes without obligation to adjust the distributed share of any
person thereby affected.
ARTICLE V
PERSONAL REPRESENTATIVE
I name, constitute and appoint my son, JAMES E. BLACKSMITH, Executor of this my
Last Will and Testament. Should my son, JAMES E. BLACKSMITH, fail to qualify or cease to
so act, I name, constitute and appoint my son, WILLIAM A. BLACKSMITH, III, alternate
Executor to complete the administration of my Estate. I direct that no fiduciary appointed herein
shall be required to post bond for the faithful administration of the duties required in any
jurisdiction.
IN WITNESS WltEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, this 2-0 ~ day of /4'ff/'~' ! ,2000.
WILLIAi~ ~,. BLACKSMITH, JR.
(SEAL)
009387-00003/03.29.00/EGM/KLT/133081. !
Signed, sealed, published and declared by the above-named Testator, as and for his Last
Will and Testament, in the presence of us, who at his request, in his presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
4
009387-00003/03.29.00/EGM/KLT/133081.1
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, WILLIAM A. BLACKSMITH, JR., ~¢c{ a.~ and
~) ( ~q a ('a.~- ~ , the Testator and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testator signed and executed the instrument as his Last Will
and that he had signed willingly and that he executed it as his free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
WILLIAM A. BLACKSMITH, JR.
Witness (~)
~Vitness
Subscribed, sworn to and acknowledged before me by WILLIAM A. BLACKSMITH,
JR., Testator, and /t~[~4/ ~ and ~)t~tt4c~ Ctt~d ,
witnesses, this 2,~ ~ day of ~ ,2000.
Edmund G. Myers
Pennsylvania Attorney I.D. No. 20558
009387-00003/03.29.00/EGM/KLT/! 33081.1
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
On this, the ~ c:~"~x day of ~ ,2000, before me, the
undersigned officer, personally appeared EDMUND G. MYERS, Attorney I.D. #20558, known
to me (or satisfactorily proven) to be a member of the bar of the highest court of Pennsylvania
and certified that he was personally present when the foregoing acknowledgment and affidavit
were signed by the Testator and witnesses.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public L_~
My Commission Expires:
(SEAL)
NOTARIAL SEAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
.My Commission Expires Dec. 21, 2001
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No. ~ / ' /~/~ 5 ' 0~ q t/ 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 ~_./!!_/~ :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~,~ ~ Ii.\ 03 ~~
Signature
Name
Address
Capacity: ..
Teleph°ne q/7)7b'/"~b[4'
X Personal Representative
Counsel for personal representative
MBNA America
P.O. Box ~.5~37
Wilmington, DE lg850-5~.37
877-767-g383
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
I COURTHOUSE SQUARE, #102
CARLISLE, PA 17013
O4/O3/O3
Re~
In the Estate of
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
Amount of Debt:
WILLIAM A BLACKSMITH
21-2003-94
189094988
946 INDIANA AVE C/O JAMES BLACKS LEMOYNE, PA 17043
MBNA AMERICA
4264297999299592
$ 243.00
Dear Sir or Madam
Enclosed please find a Creditors claim to be filed in the record with the above-referenced Estate.
Please retum a file stumped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for
your assistance. If you have any questions or concems, please call our firm toll free at 1-877-767-9383.
Cordially,
MBNA America
Enclosures
A check for $5.00 for the filing fee.
cc: Attorney for Estate
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter
is from a debt collector.
2815 4/1/2003 924197
AFFIDAVIT OF MAHING
I, John Lopez ., declare under penalty of perjury that I placed the envelope
for collection and mailing on the date and place shown below following our ordinary business
practices. On the same day that correspondence is placed for mailing, it was deposited in the
ordinary course of business with the United States Postal Service in a sealed envelope with postage
fully prepaid.
Personal Representative:
JAMES E BLACKSMITH
946 INDIANA AVE
LEMOYNE, PA 17043
Attorney for Estate:
Date
COMMONWEALTH OF PENNSYLVANIA
NO TICE OF CLAIM
Zn Re: The Estate of:
WILLIAM A BLACKSMITH
Deceased
COURT OF COMMON PLEAS
CUMBERLAND .COUNTY
ORPHANS' COURT DZV]:SZON
Court File No: 21-2003-94
TO: THE CLERK OF THE ORPHANS' COURT D]:V]:S]:ON:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: MBNA AMERICA
P.O. BOX 15137
2) Claimant's address:
3)
WILMINGTON, DE 19850--5137
8777679383
Creditor listed below is the owner and holder of a claim in the amount of
$. 243.00
4)
The facts upon which this claim is based is an account for credit evidenced by the
attached Affidavit of Account Stated.
5)
6)
7)
Decedent's address: 946 INDIANA AVE C/O JAMES BLACKS LEMOYNE, PA 17043
Date of Death: 01/26/03
That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, ! do solemnly declare and affirm under the penalties of
perjury that they !nformation and representations made herein are true and correct
to the best of my knowledge, information a.~elief. ~ /)
Dated: ~)/~[ ~'/O~.~u/')~,2~ (~~jZ'~~,i/~¢-~
r Kyle Frenzel/Lucille Roberts/Heatl~er K~nnedy- Authori~d Represen~e~For MBNA America
Written notice of claim was given to Personal IReOresentative/~nd/or hi~r counsel
as stated below: ~,/
JAMES E BLACKSMITH
Name
946 INDIANA AVE
Address
LEMOYNE PA 17043
City/State/Zi p
See attached Affidavit of Mailinq
Date notice mailed
IN RE ESTATE OF: WILLIAM A BLACKSMITH
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
Your Affiant is authorized by the Claimant as its Authorized Representative-
In-Fact to make this Affidavit.
Your Affiant has reviewed the account records of the Claimant with respect
to the decedent. Your Affiant is familiar with these records and accounts and
reviews them as a regular part of her duties.
The Decedent purchased merchandise in the amount of $ 243.00
evidenced by account number 4264297999299592
The unpaid balance does not include any post-death late payment charges,
accrued interest, collection costs or attorney's fees.
Further your affiant sayeth not
MBNA America.
One 4f its] Authorized R~l[resentatives: ~
Kyle ~Frejlzel __ . -- ',~
Lucillb'Roberts_
Heather Kennedy ·
MBNA America
P. O. Box 15137
Wilmington, DE 19850-5137
Subscribed and swom b~f~ore me1
This ,2~
~otap.
~- ~ Minnesota
,~v ~m~sslon Exoires Janu~r,,'q'~ o,~-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
002438
BLACKSMITH JAMES E
946 INDIANA AVENUE
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 189-09-4988
FILE NUMBER: 2103-0094
DECEDENT NAME: BLACKSMITH WILLIAM A JR
DATE OF PAYMENT: 04/1 4/2003
POSTMARK DATE: 04/1 2/2003
COUNTY: CUM BERLAN D
DATE OF DEATH: 01/26/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,930.84
TOTAL AMOUNT PAID:
$3,930.84
REMARKS: JAMES E BLACKSMITH
SEAL
CHECK# 1014
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
J. Blacksmith
946 Indiana Ave.
Lemoyne PA 17043
:EV-1500 EX (6-00)
' , ~ COMMONWEALTH OF
~ ~,~ PENNSYLVANIA
,~~.~,.~ DEPARTMENT OF REVENUE
p~.~,.,~,,~-~ DEPT. 280601
'.~,~,~ HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
R E S I D E N T D E C E D E N T
uJ
W
n,'
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DB-YEAR) DATE OF BIR-H (MM-DD-YEAR)
OI -0o-03 iI-o~-/q
SOCIAL SECURITY NUMBER
I~- 0~/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIEIDLE INITIAL) SOCIAL SECURITY NUMBER
~-"'[ 1. Original Return
[~]4. Limited Estate
E~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
FIRM NAME (IfApplicable)
TELEPHONE NUMBER
qlT-
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) O
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
O(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
I-"-] 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) /~,,,.~'~' ,
O 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)
--]2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82)
[] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required
~-17. Decedent Maintained a Living Trust (Attach copy of Trust) __ 8. Total Number of Safe Deposit Boxes
[] 10. Spousal Foverty Credit (date of death between 12-31-91 and 1-1-95) E~] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
* ~7, 70 7, 7q
13, Charitable and Governmental Bequests/Sec 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)
OFFICIAL USE ONLY
(11) g %lf . OO
(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) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate x .0 ,~,,,c-(16)
17, Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x ,15 (18)
19. Tax Due (19)
z-'/.,/3 7,
q~/3 7, 7,3
Decedent's Complete Address:
STREETADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2) ' ~O~', ~'¢/
Total Interest/Penalty ( D + E ) (3)
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 (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5A) ~
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ,~ .~.? .. g.~
Make Check Payable to: REGISTER OF WILLS, AGENT
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; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] '~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..................... ,-~.....,,-~.~/,4.1¢_,,...~ .................................................... []
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 return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparj~.o, lher than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR¢~ON. ~ FOR FILING RETURN DATE
ADDRESS / ~ t¢//~/~ ''~
SIGNATURE OF PREPARER OTHEI~ THAN REI~R-ESENTAT'fVE J )
DATE
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. §9116 (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 or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1)
The statute does not exempt 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
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 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(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. §9116(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-15'ilEX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL. EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
C~stodio~
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attomey Fees ¢~a'u''e'~'j'-
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ~f' ~ ~1~
Street Address
Zip
City State ~ Zip
Relationship of Claimant to Decedent
Probate Fees ~
Accountant's Fees P~¥iC('~ R~(dOf~VtC./~
TaxRetumPreparer'sFees ..~j,~ /iS ~bovP.,~-~"w~ ~ ~'~OO:C~
/5-0. P~
3S'~ a~
q 6". l~
/t OOO. oO
TOTAL (Also enter on line 9, Recapitulation) $ / & ~'<~, ~'~)
(If more space is needed, insert additional sheets of the same size)
COM~OflWEALTH OF PENNSYLVANIA
INHERITANCE TAX R~'URN
RE$IDE~I' DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIE,S, & LIENS
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMB. ER
TOTAL (Also enter on line 10, RecapitutatJon)
AMOUNT
(if more space is needed, insert add,oriel sheets of the same size)
REV-1113 EX+ (9-00~
'COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I
1.
II
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(if more space is needed, insert additional sheets of the same size)
RE'V- 15~8 EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
FILE NUMBER
PERSONAL PROPERTY
Include the proceeds of litigation and the date the proceeds were received by the estate. All property joiatly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
iL;, G78.0
17j
SqT,~
(If more space is needed, insert additional sheets of the same size) .
D J.J.O
Capital Division
Drovers Bank Division
Great Valley Division
Lancaster/Chester Division
EST OF WILLIAM A BLACKSMITH
JAMES E BLACKSMITH EXEC
946 INDIANA AVE
LEMOYNE PA 17043-1406
STATEMENT OF ACCOUNTS
3620-54112 X
STATEMENT PERIOD
FROM THROUGH
3-01-03 3-31-03 0
PAGE 1 OF 1
9 ENCLOSURES
ESTATE REGULAR CHECKING
PREVIOUS DEPOSITS/
STATEMENT BALANCE CREDITS 1
96,266.74 1,296.77
ACCOUNT: 3620-54112
CHECKS/ SERVICE
DEBITS 9 FEES
4,527.67 .00
ENDING
BALANCE
93,035.84
DEPOSITS/ CHECKS/
DATE ACTIVITY DESCRIPTION REFERENCE CREDITS DEBITS
03-01 BEGINNING BALANCE
03-14 DEPOSIT 02772300370 1,296.77
03-14 CHECK 1001 01658401250 1,872.00
03-18 CHECK 1003 00350903350 34.69
03-18 CHECK 1005 01001905590 1,345.00
03-20 CHECK 1006 00752805660 243.29.
03-20 CHECK 1009 00651406110 57.85
03-21 CHECK 1004 00651405070 32.98
03-24 CHECK 1008 01459400820 3.36
03-25 CHECK 1002 01766901330 40.00
03-26 CHECK 1007 01760906300 898.50
03-31 ENDING BALANCE
BALANCE
96,266.74
95,691.51
94,311.82
94,010.68
93,977.70
93,974.34
93,934.34
93,035.84
93,035.84
CHECK SUMMARY
INDICATES SKIP IN CHECK NUMBERS
CHECK NO AMOUNT CHECK NO
1001 1,872.00 1006
1002 40.00 1007
1003 34.69 1008
1004 32.98 1009
1005 1,345.00
tOTAL NUMBER OF CHECKS 9 TOTAL AMOUNT OF CHECKS
SERVICE FEE BALANCE INFORMATION FROM 3-01-03 THROUGH 3-31-03
AVERAGE LEDGER BALANCE 94,997.57 AVERAGE COLLECTED BALANCE
MINIMUM LEDGER BALANCE 93,035.84 MINIMUM COLLECTED BALANCE
AMOUNT
243.29
898.50
3.36
57.85
4,527.67
94,871.26
93,035.84
DIRECT
INQUIRIES TO:
FULTON BANK
CAPITAL DIVISION
DIRECT BANKING CENTER
i-800-~u~iON4
Member F.D.I.C.
www. fultonbank.com
Fultan
Capital Division
Drovers Bank Division
Great Valley Division
Lancaster/Chester Division
1001 03/14/03 1,872.00 1007 03/26/03 898.50
1002 03/25/03 40.00
~,~:----' ~3~_L~_.__
'J~. ~h ~-~ ~ . ,s~
II~ '~'-~-
1005 03/18/03 1,3~5.00
1008 03/24/03 3.36
~,_ -~ ~',~ t~. ~,,,k, , s~ J
1009 03/20/03 57.85
Member F.D.I.C.
www. fultonbank.com
J. Blacksmith
946 Indiana Ave.
Lemoyne PA 17043
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.
Admin. No. ~--(~3-O0~%/
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, ! report the following with respect to completion of
the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes X No__
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. ! is Yes, state the following:
a. Did the personal r~,p~esentative file a final
account with the Court? Yes No ~ .
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~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
Name (Please type or print)
Address
Tel. No.
Capacity:
/Personal Representative
(MAH:rmf/AM3)
__Counsel for personal
representative
BUREAtl OF. , tTVZDUAL TAXES
~ XNHERIT A~?~.~ % ~TVTSZON
DEPT. e~ e.
HARRTSBUR~ PA l?:IZB-0~D!
CONNON#EALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
JANES E BLACKSNITH
9~6 INDIANA AVE
LENOYNE
'03 JLIH30 1 ,7:D9
DATE 06-30-2003
ESTATE OF BLACKSNITH JR
DATE OF DEATH 01-26-2005
FZLE NUNBER 21 03-009~
COUNTY CUHBERLAND
ACN 101
Aaoun~ Reaitted
REV-I;~I7 EX &FP (OZ-OS)
WILLIAM A
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGZSTER OF WZLLS
CUNgERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LZNE ~ RETAZN LO#ER PORTZON FOR YOUR RECORDS -.~
REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF ~LACKSN/TH JR #/LLIAN AFZLE NO. 21 03-009~ ACN 101 DATE 06-30-2005
TAX RETURN gAS: ( ) ACCEPTED AS FZLED (X) CHANGED SEE ATTACHED NOTICE
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERS~
APPRAZSED VALUE OF RETURN BASED ON: ORIGTNAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B)
S. Closely Held Stock/Partnership .rntarast (Schedule C) ($)
4. Hortgagas/Notas Receivable (Schedule D) (4)
5. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H) (9)
10. Dabts/Nortgaga Liabilities/Liens (Schedule .r) (10)
11. Total Deductions
12. Nat Value of Tax Return
97~767.79
.00
· O0 NOTE: To insure proper
.00 credit to your account,
.00 sub, it the upper portion
.00 of this fora with your
tax payment.
.00
(8)
1,658.50
15.
14.
NOTE:
97,767.79
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
TAX CREDZTS:
PAYH~;NT
DATE
04-12-2003
REC~ZPT
NUNBER
CD002438
DZiCOUNT (t)
ZNTEREST/PEN PAZD (-)
205.41
reflect flgures that include the total of ALL returns assessed to date.
· O0 x O0 = . O0
91,291.09 x Oq5= q,108.10
· O0 x 12 = . O0
· 00 x 15 = . O0
(19)= 4,108.10
AHOUNT PAZD
3,930.8~t
ASSESSNENT OF TAX:
15. A.ount of Line 14 at Spousal rate (15)
16. Aaount of Line 14 taxable at Line,Z/CZ.ss A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Aaount of L/ne 14 taxable et Collateral/Class B rate (18)
19. Principal Tax Due
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
4,136.25
28.15CR
.00
28.15CR
( TF TOTAL DUE 'rs LESS THAN $1, NO PAYHENT TS REQUTRED.
'rF TOTAL DUE 'rs REFLECTED AS A "CRED'rT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE S'rDE OF TH'rS FORH FOR 'rNSTRUCT'rONS.)
Charitable/Govern.ante1 Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
Nat Value of Estate Subject to Tax (14) 91,291.09
Z~ an assessment was issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 wi11
4~818.20
(11) 6.~76.70
(12) 91,291.09
RESERVATION:
PURPOSE OF
NOT[CE:
PAYHENT:
REFUND (CR):
OBJECTIONS=
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- If any futura interest in the estate is transferred
in possession or enjoyment to Class B (collatara1) beneficiaries of the decedent after the expiration of any estate for
1ifa or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Crass B (collateral) rate on any such futura interest.
To ~ulfi11 the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S.
Section 91riO).
Detach the top portion of this Notice and submit mith your payment to the Register of #ills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #XLLSj AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling tho special Iq-hour
answering service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-$0Z0 (TT only}.
Any part~ in interest not satisfied with the appraisement, allowance, or disallowenca of deductions, or assessment
of tax (including discount or interest} as shown on this Notice must object within sixty (60} days of receipt of
this Notlce by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 251021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-15Ol) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the saaa manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became deIinquant before January 1, 198Z bear interest at the rata of
six (6Z) percent per annum calculated at a daily rate of .O0016q. A11 taxes which became delinquent on and after
January 1, 198Z will bear interest at a rata which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO5 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yea._._r Rate Factor Yaa.~r Rate Factor
198Z ZOZ .0005¢8 1987 9Z . OOOZ~7 1999 7X . OOOlgZ
1985 16Z .000~58 1988-1991 llZ .000301 ZOO0 BZ .OOOZ19
198~ 11Z .000201 199Z 9Z . O00Z~7 2001 9Z . O00Z~7
1985 132 .000356 199~-199~* 77. .O0019Z ZOO2 62 .00016~
1986 IOZ .O0027~ 1995-1998 9Z .000Z47 2003 52 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DEL/NQUENT X DA/LY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
REV-1470 EX (8-88)
COMMONWEALTH OF PENNSYLVANIA EXPLANATION
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDEN3'S NAME FILE NUMBER
William A Blacksmith 2103-0094
REVIEWED BY ACN
Sandra J Eslinger 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
I Total on Schedule I was not correctly carried forward to recapitulation page.
ROW Page 1