HomeMy WebLinkAbout03-0125 PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Register of YVills for the
. ~ -- Deceased. County o~_l_/dffl~l~lgP[,,) in the
Social Security No. ,t/_/~,'-/9~_ girL/O/.4: 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/~/~' named
in the last wilt of the above decedent, dated '
~, 19___
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
D.e~ndent was domiciled at death in dvm6 A '4 -
co .unt.,v.~
pennsylvania,
with
h~"' '~,c: tRst family orl~.rincipal$gsidence at ~..5.ff~ fgCgl/fflJI/~*CJ ,/~-~ .-.
(list street, number and muncipality) !
Decendent, then years of age, died~'~//'~/~//~.. /~'~g f~3 ,
at
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
~ncompetent: .
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 probate of the last will and codicil(s)
presented herewith and the grant of letters e'ff~/J]_~?/~r/tfit ./~ .~.
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF p~ENNSYLVANIA 3
COUNTY or ~L_~ J/~-~ y 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn tO or afflirmed and subscribed r 'v~ ~-q/L"~ ~
b~.efore me this ~ ~ day of | ~'
_Kd....,,..I E'
..... , ..... 7 ter7[ ~
No.
Estate Of ~~, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW /~ _~e.g/~,~./~ /O ,)/~ in consideration of the petition on
the reverse side hereof, satisfactory proof having l~en presented before me,
IT IS DEC~ED that the instrument(s) dated Q~'~fl ~ /qqo
described therein be adm~ to probate ~e~r~cord as the last will of
~d Letters ~~1~~ ~.
~e hereby granted to ~t iq./L ~g~ ~
FEES
Probate, Letters, Etc .......... $ e~, OO
Short Certificates( ) .......... $ ~ .e~5 ^~rORNEY (Sup. Ct. I.D. No.)
.Renunciation ................ S '
$ _~_~..~..~ ADDILESS
TOTAL ~ $~
Filed . .~.-:../(g. · ': ...~ ................... PHONE
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (eash) being duly qualified according to
law, depose(s) and say(s) that--'x,,,_ '~x, present and saw
the testat x'~, sign the same and that~ sl'~.~s a witness at the
request of testat x,. in h presence affd,.(in the presence of each other) (in the"presence of the
'-~her subscribing wi~)). ~
Swoi~ to or affirmed and s/Ih. scribed before ",,,
me thisX'Xx ~. day of ~.~ (Name)
i'~'' ~ Register ~.~....... (NamO
: (Address)
~
REGISTER OF WILLS OF Cllnberlarlcl COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified accordi.~9.~law, depose~) and say(s) that
~. 'l~., familiar with the signature of ~u L k~¢~t~ ,
testato~ of (~e o~ tk~ subscribing w~tno~e~ t~) the will presented herewith and
codicil
that ~ believes the signature on the will is in the handwriting of
Sworn to or affirmed and subscribed before ~ ~ .
me this /~ day of / /~ _~ /~Name) / ~ /
(Address)
REGISTER OF WILLS OF Cumberland COUNTY
OATH OF SUBSCRIBING WITNESS
Roger B. Irwin
codicil
(each) a subscribing witness to the (will} presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that He was present and saw
the testat rLx ., sign the same and that He signed as a witness at the
request of testatrL~ in her presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before ~/'44.] /'~ ~
me this ~TTb/ day of (/~) (Name)
~)'ff~-~'.J ~ /~ff~ /~zL }~.~-nfT~' (Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of .,
codicil
testat.__ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of (Name)
19.__
(Address)
Register
(Name)
(Address)
This is to certify that the information here given is correcdy copied fi'om an original ce,'tificate of death duh' filed with mc as
I.ocal Registrar. The original certificate will be.forwarded to thc State Vital Records Ot'fice for permanent, fiiing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 8 8 7 0 215 ~C~a~i~ JAN 1 7 2003
No. ~ l)atc
H~S.~ ;~,. 2~7 COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH * VITAL RECORDS
'"""* CERTIFICATE OF DEATH
"~ '- Ruth Lillian Burkkolder ~ ~o,~.,~.~.~
~,t~ s~.. ..~., ~ ~.,~ o~.~~ .... ~04 j*. 1/16/2003
. 91 '-.I i I ~ 15/12/1911 I e~,~¢ ~ 17~~~~--~
~t~u ~ . ~'~ ~rlisle
He~ - ~ntzer
B. Gr~ 2832 PA 17011
-~ 1/20/2003 ,,~es~ster ~rial ~rlisle, PA 17013
~. FD 012633 L Brothers ~eral H~, ~rlisle, PA 17013
I, RUTH L. BURKHOLDER, of the Borough of Carlisle, Cumberland
]ounty, Pennsylvania, declare this instrument to be my last will and
testament, hereby expressly revoking all wills and codicils heretofo~
made by me.
1. I authorize and empower my executor to sell any realty owned
by me at my death, at either public or ~rivate sale, and to give good
and sufficient deeds therefor, in fee simple, as I could do if living.
My executor is authorized and empowered to continue to engage in any
business in which I may be engaged at my death, for a period of one
year after my death.
2. I devise and bequeath all of my estate of every nature and
situate to my husband Melvin J. Burkholder, providing he
shall survive me by sixty days.
3. Should the gift in Paragraph No. 2 not take effect, I devise
and bequeath all of my estate of every nature and wherever situate to
my daughter, Marilyn L. Green, and should neither of the above gifts
take effect, to the children of Marilyn L. Green, share and share
~like.
4. I nominate and appoint Melvin J. Burkholder to be the execu-
of this my last will and testament; he is to serve as such without
bond. Should he die before my death, renounce or refuse to serve for
reason, or die leaving any of my estate unadministered, I nomin
appoint Marilyn L. Green as substitute executrix, also to serve a~
such without bond, with the same powers as are given herein to my
executor.
5. I hereby direct my executor to retain the services of Irwin,
& Irwin, as attorneys in the settlement of my estate.
d Ia- WITNESS WHEREOF, I have hereunto set my hand and seal this
y of June, 19 70.
RUTH L. BURKHOLDER (SEAL
Signed, sealed, published and declared by Ruth L. Burkholder, thc
tatri× above named, as and for her last will and testament, in the
presence'of us, who at her request, in her presence and in the pres-
snce of each other have subscribed our names as witnesses hereto.
RUTH L. BURKHOLDER
IRWIN, IRWIN & IRWIN
44 SOUTH H~IOVER STREET,C:ARI*ISL. E, PENNSYI. VANIA
· ' d
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. ,<~ OT..b~ - CO O / &~ Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orvhans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on .t~/ /' ~/O~ ·
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ,~/ ,iq /03
Signature
Name
Address
..~ ~ .... Telephone (~[~
Z ~ Capacity: ~ Personal Representative
Counsel for personal representative
",,~. ~ .e~ COMMONWEALTH OF --
PENNSYLVANIA ~
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN
RRISBURG' PA 17128-060'1' RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDOLE INITIAL) SOCIAL SECURITY NUMBER
III DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR)
~ THIS RETURN BUST BE RLED IN DUPUCATE wrrH THE
U.I ~/Y--//& "~'~> I ~-'--/~-' - / / REGISTER OF WILLS
I!1 (IF APPLICAELE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
./~,z,~_-'" -' -
'~' ~ ~: ~] a. Limited E[t~te [--] 4a. Futura Interest Compromise {d~ o~m a~ ,~-,2-0~) [~ 5. F~ll E~ato Tax Return
Required
[--1
,.,, ..a 6. Decedent Died Testate (Attach copy of wiul 7. Decedent Maintained a Living Trust (Attach co~y of Trust) 8. Total Number of Safe Deposit Boxes
< ~ 9. Litigalton Proceeds Received F-'-] 10. Spousal Poverly Credit (data o~ death ~ 12.3'~.9, a~d ,.1-95) ~ 11. F_JeclJon to tax under Sec.
9113(A)
(.~a,:~
Sch
O)
Ii
Z
=="' ,Z. COM,L EMA,L,NG DRESS
O
a. FIRM NAME
n,
n. TELEPHONE NUMBER
OFFICIAL USE ONLY
~. Real Estate'(Schedule A) (1) ,,,,~,,,f_,,"~'-'
2. Stocks and Bonds (Schedule B) (2) ,,~C::~ ,,~,~-
3. Clo~ly H~ Co~oration, Pa~nemhip or Sol~Pmpnetomhip (3) ~~
4. M~&NotesR~ivable(Sch~uleD) (4) ~~'~:..
5. ~sh, ~nk De~si~ & Mis~llaneous Pe~nal P~ (5) ~ ~ ~:~ ~"
(~ula E)
6. JoinW ~ Prope~ (Sch~ule F) (6) ~ ~/~ ~ ~
~ S~te Bilfin~ ~uest~
7. Intar-~v~ Tmnsfem $ Mis~tlan~us ~on-~m~te ~m~ (7)
(S~u~ G or L)
~. ~m, s~ ~ (to~ unes ~-7) (8) ~¢ ~/~,~g
9. Funeral ~n~s & Adminis~ative Cos~ (~ule H) (9) ~ ~ ~ ~
10. D~ of O~ent, Mo~gage Liabilities, &Uens (S~edule I) (10) ~ ~
11. T~I ~ons (total Lines 9 & 10~ (11)
12. Net Value ~ ~te (Line 8 minus Line 11) (12)
13. Cha~ble and ~vemmen~l B~uest~S~ 9113 T~s~ for which an election to ~x has n~ ~n (13)
made (~ula J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVEI~E SIDE FOR APPLICABLE RATES
15. AnxxJnt 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 ~ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Une 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20.
De,:eden.t's Complete Address:
I STREET ADDRESS
S?A~',~¢¢',¢- I zip/? 7,~/'/
I [
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
Total Credits ( A + B + C ) (2) ~ O --'"
3. Interest/Penalty if applicable
D. Interest
E. Penalty '""
Total Interest/Penalty ( D + E ) (3)
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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SAt
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE,
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'. 3id decedent make a transfer and: Yes No
~. retain the use or ~ncome of the property transferred;
b. retain the right to designate who shall use the property transferred or :ts ,ncome:
a. retain a reversionary interest: or
d. receive the promise for life of either payments, benefits or care? ...................................................................
2. :f death occurred after December ;2. 1982. did decedent transfer property within one ,,,ear of death
.,vithout receiving adequate consideration?
3. Did decedent own an "in trust for" or payable upon death bank account 3r security a[ "',s .Dr ~er .Neath? ...........
Did decedent own an Individual Retirement AccounL annuity, or other non-protDa[e proce~y ,vmcn
contains a beneficiary designation? .............................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~qder penalties of gerju~ I declare that I have examined this return. :nclucing accompanying schedules and statements and to t~e test 'Df my ~c..,ledge and betief: 's :~e. :orrect and comoiete
Declaration of preparer other than :~e 0ersonal represet~ve ts based on all information of ..'¢nlcn ~reoarer nas any ~(nowledge
SlONAT, I,~E,e~ PEFJS@N RESPO~q'~SJ~L,¢¢~ FILING RETURN DATE
ADDF~ES§ ! I/ -
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE 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.!) (i)].
For dates of death on or after January 1. ~995, the tax rate imposed on the net value of transfers to or for the ,.se of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)
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)].
-'he 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.
~.,~,.,,.9~ /~~ SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
'"HECTA"CE T~<
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
All ~m~/~oin~-own~ ~h ~ht of ~uwNor~hip mu~t I~ di~lo~ on ~h~u~ ~.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF D~TH
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
~ SCHEDULE E
COM~U.'~~OF PE..S~,VAN,^ CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
.ES,O~ OECEDE.T PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Include the proceeds of IffJga~n and the date the proceeds were received by the estate. All propen'y jointly-owned with the rigM of sun~ivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also eater on line 5, RecapitulalJon) $
(If more space is needed, insert additional sheets of the same size)
REV-1737-5 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA ,~~~ ~
INHERITANCE TAX RETURN
NONRESIDENT DECEBENT
ESTATE OF FILE NUMBER
Part 1 must include jointly-owned real estate and tangible personal property located in Pennsylvania. Complete Part 2. on reveme side to
Include all other jointly held property whenever Im:ated ONLY WHE~I THE PROPORTIONATE METHOD OF TAX COMPUTATION IS
ELECTED. If an asset was made joint wtthin one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
LETTER DATE % OF DATE OF DEATH
ITEM FOR JOINT MADE DESCRIPTION OF PROPERTY DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for jointly-held real estae. VALUE OF ASSET INTEREST DECEDENT'S INTERES1
~ (N~ enter on Ii~ 6, R~pKu!etion) $
(If mom spa~ is needed, in~d add~al sh~ts ~ the same size)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ABMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
!, Personal Representative's Commissions
Name of Personal Representative (s)
3ociat Security Number(s) / EIN Number of Personal Re~resentafive!s~
,~treet Address
City State ;~-
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach exmanatJon)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4, Probate Fees
5. Accountant's Fees
Tax Retum Preparers Fees
7.
TOTAL (Also enter on tine 9, Recapitulation
(If more space is needed, insert additional sheets of the same size)
~.~.,,,2~,.~,.,~ ~ SCHEDULE I
COMMONWEALTH OFPENNSYLVANIA DEBTS OF DECEDENT,
iNHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
REV-15~13 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONISi RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS
,,:' SPOUSA_ DISTRIBUTIONS UNDE: ~E-"- Dr., 9113 ~O~ WHICH AN ELESTIOf" TO TAX IS NOT BEING MADE
i
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(It more space ~s needed, inserl additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003119
GREEN MARILYN L
2832 FAIRVIEW ROAD
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
101 9557.83
ESTATE INFORMATION: SSN: 189-09-4404
FILE NUMBER: 2103-01 25
DECEDENT NAME: BURKHOLDER RUTH L
DATE OF PAYMENT: 1 O/15/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2003
TOTAL AMOUNT PAID: 9557.83
REMARKS' MARILYN LGREEN
CHECK# 1875
INITIALS: JA
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
~BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
~INHERITANCE TAX DIVISION
DEPT. 280&OI
~RRISBURG, PA 17128-0&01 NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE 12-08-2005
ESTATE OF BURKHOLDER RUTH L
DATE OF DEATH 01-16-2005
FILE NUMBER 21 05-0125
, .:. COUNTY CUMBERLAND
MARILYN L GREEN · ~'-- ACN IO1
2852 FAIRVIEW RD
CAMP HILL PA 17011 I Amount Remitted I
I
I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA I7015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-IS47 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURKHOLDER RUTH L FILE NO. 2I 05-0125 ACN IOI DATE 12-08-2005
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A} (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) C2) .00 credit to your account,
$. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) C~) .00 of this form w/th your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 20t006.50 tax payment.
&. Jointly Owned Property (Schedule F) C6)
7. Transfers (Schedule G) (7) .00
8. Total Assets C8) 24,419.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
7,586.70
9. Funeral Expenses/Adm. Costs/H/sc. Expenses (Schedule H) C9)
IO. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 41656.17
11. Total Deductions Cll)
12. Net Value of Tax Return Cf2) 12,596.I5
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) C15) .00
14. Net Value of Estate Subject to Tax C14) I2,596.15
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that Include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L/ne 14 at Spousal rate (IS) .00 X 00 = .00
16. Amount of L/ne 14 taxable at Lineal/Class A rate C16) 12,596.15 x 045 = 557.85
17. Amount of Line 1~ at Sibling rate CI7) .00 x 12 = .00
18. Amount of L/ne 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due C19)= 557.85
TAX CREDITS:
PAYMENT ~ RECEIPT DISCOUNT
DATE I NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
10-15-2005 CDO05119 .00 557.85
TOTAL TAX CREDIT { 557.85
BALANCE OF TAX DUEl .00
INTEREST AND PEN. .00
TOTAL DUE .00
~ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN el, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR}, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.}
RESERVATION= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTXCE= To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S.
Section 9140).
PAYHENT= Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to= EEGZSTE]! OF NZLLS, AGENT
REFUND (CR)= 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-1515). Applications are available at the Office
of the Register of Wills, any of the 25 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering= 1-800-$62-2050; services for taxpayers with special hearing and / or
speaking needs= 1-800-447-$020 (TT only).
OBJECTIONS= Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by=
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021,OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADNIN-
ISTRATIVE
CORRECTIONS= Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue,
Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (SX) discount of
the tax paid is allo~ed.
PENALTY= The 15% 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 same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
XNTEREST: 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 delinquent before January 1, 1982 bear interest at the rate of
six (SY.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Yea..__r Rate Factor
1982 20% .000548 1987 9~ .000247 1999 7% .000192
1985 16~ .000458 1988-1991 11~ .000501 2000 8~ .000219
1984 11% .000501 1992 9~ .000247 2001 9~ .000247
1985 15~ .000356 1995-1994 7~ .000192 2002 6~ .0001~4
1986 10~ .000274 1995-1998 9% .000247 2005 5% .000157
--Interest is calculated as follows=
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAXLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent wil1 refZect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RIFLE 6.12
NameofDecedent: ~U~/~ ~//./..//'~/~
win No.: - f No.:
P~su~t to Rule 6.12 of the Supreme Cou~ OChans' Co~ RMes, I repo~ the
followfl:g with respect to completion of ~e ad~s~ation of the above-captioned estate:
1. State whe~er ad~istration of the estate is complete:
Yes ~ No ~
2. If~e ~swer is No, state when the personal representative reasonably beheves
that the a~s~afion will be complete:
3. ~ the ~wer to No. 1 is Yes, state the f011ow~g:
a. Did the personal representative ~e a ~al accost wi~ ~e Coum?
Yes' _ No '~
b. ~e sep~ate OCh~' Corox No. (if ~y) for the personM representative's
accost is:
c. Did the personal representative state an account informally to the parties
in interest? Yes ~] No F-]"
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to th.is report.
Signature ~/ ' _~
Name
Address
Telephone No.
C~¢acity: [] Personal Representative
}5 , ,4 ~-] Counsel for personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
GREEN MARILYN L
2832 FAIRVIEW ROAD
CAMP HILL, PA 17011
RE: Estate of BURKHOLDER RUTH L
File Number: 2003-00125
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 uncom'~leted administration.
This filing will become delinquent on: 1/16/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASB~3GH
REGISTER OF WILLS
cc: File
Counsel
Judge
Estate No.: 21-03-00125
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate of BURKHOLDER RUTH L
Late of LOWER ALLEN TOWNSHIP
Date:
2/11/2005
NO.: 21-03-00125
GREEN MARILYN L
2832 FAIRVIEW ROAD
CAMP HILL PA 17011
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: GREEN MARILYN L
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 1/21/2003
Date of Delinquency Notice: 1/16/2005
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 2/10/2005
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
~L~~
Glenda Farner Strasbaugh
Clerk of Orhans' Court
A hearing is scheduled for April 01, 2005 at 9:30 AM in
Courtroom No.3. If the Status Report is filed prior to the
hearing date, the hearing will automatically be cancelled.
GEO
~