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HomeMy WebLinkAbout04-0660PETITION FOR PROBATE and GRANT OF LETTERS also known as To: , Deceased. Social Security No.c~ c] D- ~ O-- ~ / q 0 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 '7 ~ 2. /~-- ~' ~,, and codicil(s) dated ~ Register of Wills for thc ~ County of~ in the Commonwealth of Pennsylvania named , 19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in/~.t~, ~,, ~ ~ ~. ,/m ~ ~/~ County, h --~V-- last fa~mily or principal residence at * ~-o n .... Pennsylvania, with (list street, number and muncipality) . De?~de~t, the.~n ~ y/ears of ag~, died ~.~ ~, ~ oc~ . ~_ e~ ~ t/ Except as ~ollo~s, dededer~t 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: ~Af.~. 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 "~,~-~,~ theron. (testamentary; administration c. La.~ administration d.b.n.c.t.a.) C OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF ~_~..,c~~ 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 affirc.~ and subscribed before me this I q~ ~ day of Estate0f ~n ~ ., Deceased DECREE OF PROBATE AND GRANT OF LETTERS the reverse side h~eof, satisfactory proof having been presented ~fore me, IT IS DECREED that the instrument(s) dated ~-~ - ~'~! n - Iqq~ as the last will of and Letters · · ~ --- are nereoy g - FEES Probate, Letters~ Etc~ ......... Short Certificates( ) · .. ....... $ ..__~.C~-- TOT^t~ . Filed ..... ~.T. ][ ~:. ~ ............... ATTORNEY (Sup. Ct. I,D. No.) ADDRESS PHONE his is to certify that the infom~ation 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. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 10331209 No. ~g;'~;"~ Date .2.1- oq- Local Registrar JUL 0 1 2004 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ..... ;,~.~.~ Ann g. quidort · 69 Cumberland Pennsboro Twp. Homemaker Domestic 504 Sharon Avenue Mechanicsbur~, PA 17055 , o30oV SEX female Toledo, OH .... [] ~'~'[~ =OAO ~D ..,~.~i-I~.~ D 4 tied William T. Backus~ DDS David G. guidort 2006 Sharo~ Yorktowne York PA 17404 n~.P.O. Box 431 New Cumber2 DATE OF INJURY TIME OF INJURY DESCRIBE MOWINJURY OCCURRED [] [] ~.,D .oD LAST WILL AND TESTAMENT OF ANN B. OU/DORT I, ANN B. QUIDORT, of 504 Sharon Avenue, Mechanicsburg, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils made by me at any time. ITEM I. I direct that all funeral expenses, legal debts, expenses of administration and inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate. My Executor/Successor Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by them, even on proceeds of insurance or other property not passing under this Will. In the absolute discretion of my Executor/Successor Executor, such taxes may be paid immediately or payment may be postponed on future or remainder interests until the time possession thereof accrues to the beneficiaries. ITEM II. I give, devise and bequeath alt the residue and remainder of my Estate to my husband, David G. Quidort Page I of 4 ITEM III. In the settlement of my Estate, my Executor and Successor Executor shall possess, among others, the following powers to be exercised for the best interests of the beneficiaries: (a) To retain any investments I may have at my death so long as my Executor/Successor Executor may deem it advisable to my Estate to do so. (b) To vary investments, when deemed desirable by my Executor/Successor Executor, and to invest in such bonds, stocks, notes, real estate mortgages, or other securities or in such other property, real or personal, as my Executor/Successor Executor deems wise. (c) In order to effect a division of the principal of my Estate or for any other purpose, including any final distribution, the Executor/Successor Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. (d) To sell either at public or private sale and upon such terms and conditions as the Executor/Successor Executor may deem advantageous to the Estate, any or all real or personal estate or interest therein owned by the Estate severally or in conjunction with other persons or acquired after my death by my Executor/Successor Page 2 of 4 A.B.Q. ' Executor, and to consummate said sale or sa~es by sufficient Deeds or other instruments to the purchaser or purchasers, conveying a Fee Simple Title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all Deeds, Assignments, Options or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor/Successor Executor in this Paragraph or elsewhere in my Will. (e) To mortgage real estate and to make leases of real estate. (f) To borrow money from any party, to pay indebtedness of mine, or of my Estate, expenses of administration or inheritance, legacy, estate or other taxes. (g) 'Fo pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executor/Successor Executor shall pay expenses of my last illness and funeral expenses. (h) To vote any shares of stock which form a part of the Estate, and to otherwise exercise all the powers incident to the ownership of such stock. Page 3 of 4 ITEM IV. Any person other than my husband, David G. Quidort, who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. If I and my husband, David G. Quidort, die at the same time, or in a common disaster, or under such circumstances that it is difficult or impossible to determine who died first, I shall be deemed to have predeceased my husband, David G. Quidort. ITEM V. I nominate, constitute and appoint my husband, David G. Quidort, to be Executor of my Estate. Should my husband, David G. Quidort, fail to qualify for any reason or cease to act as Executor, I hereby appoint James E. Reid, Jr., Esquire, of the firm of Connelly, Reid & Spade, as my Successor Executor. My Executor and Successor Executor are specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I, ANN B. QUIDORT, duly set my hand and seal to this my Last Will and Testament this ~ c~ day of ~C~ L ~" , 1994. Ann B. Quidort ~ Page 4 of 4 The preceding instrument, consisting of this and four (4) other typewritten pages, initialed at the bottom of each page for security purposes, was on the date thereof signed, published and declared by ANN B. QUIDORT, the Testatrix herein named, as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses whereof. COMMONWEALTH OF PENNSYLVANIA : :SS. COUNTY OF ~ : We, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of our knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, ' WITNESS Sworn to and subscribed before me this ~ day of ~.~_~, 1994, dEAN L MORIN. Not&r.v Pu§lio ~,J Harrisbu¢~,. Dauphi~ County ' , Co~missio,1 Expires Se~. 15, ~995 Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 QUIDORT DAVID GEORGE 504 SHARON AVE MECHANICSBURG, PA 17055-6662 RE: Estate of QUIDORT ANN B File Number: 2004-00660 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 10/24/2004 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge Sincerely, GLENDA FARNER Clerk of the Orphans' Court Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a1 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the O.,rphans' Court Rules was served on or mailed to the following beneficiaries Of the above-capfioned estate ~ ~ ~ -Z ~.o ~ : N~rne Address Notice has now been given to alt persons entitled thereto under Rule 5.6(a) except Signature Name ~ ~ ~o/}~J / Capacity: ~ Personal Representadve Counsel for personal representative ',~- .,~ COMMONWEALTH OF ~ ~ ~ ~ PENNSYLVANIA ,¢',~ ,~_~ ~.K~."~ '~ t DEPT. 280601 ~'~'~. ~'.'~ HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDE~LT S NAM~ (LAST, FIRST AND MIDDLE INITIAL) LU DATE OF DEATH IMM DD-YEAR) ' DATE OF BIRTH (MM-DD YEA% F APPLICABLE) SURVrVING SPOUSE S NAME (LAST, FIRST, AND MIDDLE INITIAL) m L-~_J 1 Original Return ~oo, Litigation Proceeds Received X FILE NUMBER SOCIAL SECURITY NUMBER , THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF V~ILLS SOCIAL SECURITY NUMBER __ 8 Total Number of Safe Deposit Boxes THIS SEC~11oN MUST BE COMPLETED:.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE I~iRECTED TO: NAME~ - COMPLETE MAILING ADDR SS FIRM NAME ilfA2phca~lel (13) (18) 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) 1. Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Propdetorship (3) 4 Mortgages & Notes Receivable (Schedule D) (4) 5 Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6 Jointly Owned Property (Schedule F) (6) [~ 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) 10 Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) 11 Total Reductions (total Lines 9 & 10) 12 Net Value of Estate (Line 8 minus Line 11) ¢5) (16) ¢7) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, ortransfersunderSec. 91t6(a)(12) _ /~Y/¢ ') 2-Z_ ~! 0 16. Amount of Line 14 taxable at lineal rate 0 17 Amoum of Line 14 taxable at sibling ra[e 12 18 Amount of Line 14 taxable at collateral rate 15 19 Tax Due I ! > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH Decedent's Complete Address: STREET ADDRESS Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B Prior Payments C. Discount 3 Interest/Penalty if applicable D. Interest E, Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page t Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Total Credits ( A + B + C ) (2) (3) (4) (5) (5A) (5B) Total Interest/Penalty ( D + E ) 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 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ..................................... L~ [] b retain the right to designate who shall use the properly 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 properly which contains a beneficiary designation? ~ L~i IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART QF THE RETURN, DenlAratior of p eparer ofhe hah he pe serial representative is based on ail information of which preparer has an~ knowledge SIGNATURE OF PERSON RESPO_~BLE FOR FILING RETURN SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE DATE ADDRESS For dates of death on or after July 1, 1994 and bebre 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 PS. §9116 (a)(1.1) (i)] For dates of death on or after January ! /995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% I72 PiS §9116 (a) (1 t) (ii)} The statute ~19~ not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filin9 a tax return ara still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July ~, 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 pardnt, an adoptive parent, or a stepparent of the child is 0% [72 PS. §9116(a)(1 2)1 The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 PS §9116(1.2) [72 PS §9! 16(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 RS §9116(a)(1 3)] A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF Include the FILE NUMBER mceeds of litigation and the date the proceeds were received by the es~te All prope~ jointly-o~ed web the right of su~ivorsh must be disclbsed on Schedule F. ITEM NUMBER DESCRIPTION Vt~LUE AT DATE i OF DEATH TOTAL (Also enter on line 5, Recapitulation) $ / ~. C' Cc L~ more space ~s needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF- FILE NUMBER )n n This schedule must be completed and filed if the answer to an,/of questions 1 through 4 on the reverse side of the REVq 500 COVER SHE£T is yes DESCRIPTION OF PROPERTY % OF ITEM INCLU~£ THE NAME OF I H£TRANSFERFF THEIR RE~ATICNSNIP TO DECEDENT AND TH£ F~ATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER VALUE OF ASSET INTEREST TOTAL (Also enter on line 7, RecapituLation) $ (If more space is needed, insert additional sheets of the same size) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule 1. 2 3 FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Represen[ative s Commissions Name o! Personal Representative(s) Social Security Number(s) EIN Number of Personal Representative(s! Street Address City Year(si Commission Paid Attorney Fees Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant State Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountants Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9 Reca (Il more space is needed insert additional sheets of the same sizel LAST WILL AND TESTAMENT OF ANN B. QUIDORT I, ANN B. QUIDORT, of 504 Sharon Avenue, Mechanicsburg, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils made by me at any time. ITEM I. I direct that all funeral expenses, legal debts, expenses of administration and inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate. My Executor/Successor Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by them, even on proceeds of insurance or other property not passing under this Will. In the absolute discretion of my Executor/Successor Executor, such taxes may be paid immediately or payment may be postponed on future or remainder interests until the time possession thereof accrues to the beneficiaries. ITEM II. I give, devise and bequeath all the residue and remainder of my Estate to my husband, David G. Quidort.. Page 1 of 4 ABO[f ITEMIII. In the settlement of my Estate, my Executor and Successor Executor shall possess, among others, the following powers to be exercised for the best interests of the beneficiaries: (a) To retain any investments I may have at my death so long as my Executor/Successor Executor may deem it advisable to my Estate to do so. (b) To vary investments, when deemed desirable by my Executor/Successor Executor, and to invest in such bonds, stocks, notes, real estate mortgages, or other securities or in such other property, real or personal, as my Executor/Successor Executor deems wise. (c) In order to effect a division of the principal of my Estate or for any other purpose, including any final distribution, the Executor/Successor Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. (d) To sell either at public or private sale and upon such terms and conditions as the Executor/Successor Executor may deem advantageous to the Estate, any or all real or personal estate or interest therein owned by the Estate severally or in conjunction with other persons or acquired after my death by my Executor/Successor Page 2 of 4 /% L~ ~ Executor, and to consummate said sale or sales by sufficient Deeds or other instruments to the purchaser or purchasers, conveying a Fee Simple Title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all Deeds, Assignments, Options or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor/Successor Executor in this Paragraph or elsewhere in my Will. (e) To mortgage real estate and to make leases of real estate. (f) To borrow money from any party, to pay indebtedness of mine, or of my Estate, expenses of administration or inheritance, legacy, estate or other taxes. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executor/Successor Executor shall pay expensas of my last illness and funeral expenses. (h) To vote any shares of stock which form a part of the Estate, and to otherwise exercise all the powers incident to the ownership of such stock. Page 3 of 4 A.B.Q. ,i ITEM IV. Any person other than my husband, David G. Quidort, who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. If land my husband, DavidG. Quidort, dieatthe same time, or in a common disaster, or under such circumstances that it is difficult or impossible to determine who died first, I shall be deemed to have predeceased my husband, David G. Quidort. ITEMV. Inominate, constitute and appoint my husband, DavidG. Quidort, to be Executor of my Estate. Should my husband, David G. Quidort, fail to qualify for any reason or cease to act as Executor, I hereby appoint James E. Reid, Jr., Esquire, of the firm of Connelly, Reid & Spade, as my Successor Executor. My Executor and Successor Executor are specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I, ANN B. QUIDORT, duly set my hand and seal to this my Last Will and Testament this ~Z C-_, day of ,/~( '~ ' ;' -,-_ ,.- ~, , 1994. Ann B. Quidort x. Page 4 of 4 The preceding instrument, consisting of this and four (4) other typewritten pages, initialed at the bottom of each page for security purposes, was on the date thereof signed, published and declared by ANN B. QUIDORT, the Testatrix herein named, as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses whereof. WITNESS COMMONWEALTH OF PENNSYLVANIA : ~ ~ , :SS. COUNTY OF ;'"-='~'-'._c~.*.~c',~ : -; ;,"*' - ,z 3 C?,-, a n d ?c,,~,, ,,*,, r(< .... the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of our knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Ann B. Ouidort L i' 'WITNESS l WITNESS Sworn to and subscribed before me this ~,,¢.._~.~,~ day of ---_,~.i~,/, ~;- , 1994. C/ NOTA~Y'PUBLIC NOTARIAL SEAL - JbAN L. MORfN, N~t~ry PuSIic '~.' My C~m;~sio~ Exo~r~s Se~, 1~, 1995 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8060! HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLD#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-15~7 EX AFP (01-03) *04 25 ELIZABETH J GOLDSTEIN ESQ KEEFER ETAL 415 FALLOWFIELD RD ~0~ CAMP HILL PA~i7OZ1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN IO-Z5-ZO04 BIRD 12-II-ZOO2 Z1 05-0660 CUMBERLAND 101 Amount Remitted BONNIE D HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF BIRD BONNIE D FILE NO. 21 05-0660 ACN 101 DATE 10-25-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) ~. Hortgages/Notes Receivable (Schedule D) (~) E. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgaga Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return l~g8z.44 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your tax payment. 1,982.44 10,877.70 271.15 (11) ll .lq8.8t (la) 9,166.59- 15. 1~. NOTE: reflect figures that include the tote! of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line Ii at Spousal rats (15) .00 X 00 = 16. Amount of Line lq taxable st Lineal/Class A rats (16) .00 X 045 = 17. Amount of Line lq at Sibling rate (17) .00 X 12 = 18. Amount of Line lq taxable st Collateral/Class B rats (18) .00 X 15 = 19. Princi)el Tax Due (19)= TAX CREDITS PAYNENT RECEIPT DISCOUNT DATE NUNBER INTEREST/PEN PAID (-) ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. Charitable/governaental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (lq) 9,166.39- If an assess;ant was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will .00 .00 .O0 .00 .00 .00 ANOUNT PAID TOTAL TAX CREDIT 3ALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 o00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .O0 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (coZlateraZ) beneficiaries of tho 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 1aclu1 Class 8 (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nllls printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLSj 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-Z313). Applications are available at the Office of the Register af Wills, any of the 23 Revenue District Offices, or by calling the special Iq-hour answering service for forms ordering: 1-800-$6Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloeance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-lOZ1, 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 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 S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. The 15X tax amnesty nan-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 and 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 appeaZ 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 delinquent before January 1, 1982 bear interest at the rate of six (6Z) 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 198Z through 2004 are: Interest Daily Interest DaiZy Year Rate Factor Year Rate Factor 1982 207. .000548 ~)'~'& - 1991 llZ .000301 1983 167. .0004.~8 1992 92 .000247 1984 112 .000301 1993-1994 77. .00019Z 1985 13Z .000356 1995-1998 92 .000247 1986 IOZ .000274 1999 72 .000192 1987 IOZ .000274 ZOO0 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~ 9X .000Z47 2OOZ 6Z .000164 2003 5Z .000137 2004 42 .000110 X NUNBER OF DAYS DELINgUENT X DAILY XNTEREST 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 tho Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~(~ ~ 9. (~/~I.I~[~'-3F Date of Death: ~ "'- Z ~r'--- e c( WillNo.: ~ODq- &D/:,~,LD Admin. No.: ~ l- © ~( '- ~ F~ ~ O Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [] 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. 1 is Yes, state the following: a. Did the personal representative 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 Co Date: 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 this report. Sig~'~a~ure J- Na~e' ' Address Telephone No. Capacity: ~-] Personal Representative ['--] Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .....--",-.,~"'...T' ('\;~i'""jl""'C rr BUREAU OF INDIVIDUAL TAX~=U,-),'~lX '.,' ;,,::Tl )L.., ,3" NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION \,'~rPRr~ISEHENT, ALLOWANCE OR DISALLOWANCE PO 80K 28'001 '. "ut DEDUCTIUNS AND ASSESSMENT DF TAX HARRISBURG PA 17128-0601 2005 JMl I 0 Mi 9: [; 9 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 QUIDORT 06-28-2004 21 04-0660 CUMBERLAND 101 CLER'rZ OF ORPHAN'S C:Qum , DAVID G QUIDOONpr:p'/\ii !,.:!1 p,~ 504 SHARON AVE MECHANICSBURG PA 17055 *' REV-1547 EX AFP [12-041 ANN B Allount Re..itted 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 ~ n"y :iS4"riif-AFii-Coi"-"03Y-NoYici--OF-i:iiiiiiiifAi.jCE"YAX"iipjiiiA'iSiiiiNi:--ALrowAiicE-oii----------- --- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF QUIDORT ANN B FILE NO. 21 04-0660 ACN 101 DATE 01-10-2005 TAX RETURN WAS: I X) ACCEPTED AS FILED ) CMANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rat. (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (IB) 19. Principal Tax Due I S: 18,722.51 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 .00 X 15 = .00 (19)= .00 AMOUNT PAID 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. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) B. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 16.000.00 .00 5.568.12 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad~. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax (9) (10) 2,845.61 .00 Ill) (12) (13) (14) + DATE NUMBER INTEREST/PEN PAID 1-) ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYllent. 21,568.12 ?84~ 61 18,722.51 .00 18,722.51 .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIDNAL INTEREST. IF TOTAL DUE IS LESS TMAN $1, ND PAYMENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FDRM FOR INSTRUCTIONS.) ~