Loading...
HomeMy WebLinkAbout04-0730PETITION FOR PROBATE and GRANT OF LETTERS Estate of' Lt~pl I~. i3/~ I r'f~i~l No. also known as To: Sociai Security No. i 'l ,° ~O- ~ , ~e~eased' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age 9.r older an the executo.,~ in the last will of the above decedent, dated ,~/37 I~ and codicil(s) dated Register of Wills for the County of ~°~A~ez-%~'L~Z) Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~:~'.~A'~,,~L.~n~ ~ County, Pennsylvania, with last family_or pri~ipal resid~ce ~t ~ ~- ~Dd~/d ~ '~ (list street, number and muncipality) Decendent, then ~ . years of ~e, died Except as follows, decedent did not marry, was not divorced and did not have a child born or ~opted 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.) Al1 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 ~s~will ~d co ~d~i.'~ presented herewith and the grant of letters ~i' ' !:' .c~ ~,~. ~: ?~.~'~i.,! (testamentary; administration c.t.a4]' administra~n d.b.fi~¢..t~O ~~eron. OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 'l COUNTY OF f 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 an/fl truly admini, s~r the estate according to law. Sworn to or a ffirme~l_L, and subscribed ~- ~,.,~.,,~ ff~! ./~/.//]~ ~ befor~me thi~ . ~'~-~l~ day of ] ~ ' .... --' ~' '~. k'~.,-~ ~ 4 ~e-gfster [, ~ Estate Of , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented befoj~me, IT IS DECREED that the instrument(s) dated described therein be admitted to proba~ anslxfiled of record as the last will and Letters O ~ 2X-~~ are hereby granted to -~ ~~ ~'x A~gJ~IX)~ , in consideration of the petition on FEES Probate, Letters, Etc .......... $ ~o.OO Short Certificates(t~x) .......... $ TOTAL __ $ -~0- 01~) Filed ................................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ]Kegister of ~i!l~ of ~um!~ertan~ (~auntp OATH OF NON-SUBSCRIBING WITNESS Estateof L~',,q/~/ p, 17~,/~"~'-~/q No. Also known as ,Deceased (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~f~ familiar with the signature of ~4 ]~,/f/f'~lT"T-o/q' ,testat~/txof (one of the subscribing wimesses to) the codicil/will presented herewith and that/xJ~ believe,~ the signature on the codicil/will is in the handwriting of to the best of d~/J :~' knowledge and belief. Sworn to or affirmed and subscribed Before me this C--~ day of ~t~ Register ~~~' (Name) 105 112 RE/. 8,88 WEE FOR ThIS CERTIFICAT[ S2.00~ WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 571322 July 01, 2004 Date of Issue of This Certification Name of Decedent Leah R. Britton Female F .... 171_30_61z~dl~ Sex Social Security No, 07-20-1915 Brilliant, OH Date of Birth Birthplace 30 Blue Mountain Vista, Meehaniosburg PA 17050 Cumberland Place of Death Last 06-30--04 Date of Death Silver Spring Twp. Pennsylvania Facihty Name C dr)ty 11 a~"omcm U~der City Borough or Township White No Occupation Armed Forces? (Yes or No) Decedent's 30 Blue Mountain Vista, Mechanicsburg, PA 17050 Mailing Address Number S .....J. Charles Heat~y or T .... S .... Funeral Director Funeral Home, 701 Lingle St., Osceola Mills, PA 16666 Race Widowed Marital Status Myrna Granville Informant Name and Address of Heath Funeral Establishment Part I: Part I1: , Interval Between Immediate Cause ~ Onset and Death (a) Coronary Artery Disease (b) (C) Other Significant Conditions Manner of Death Natural ~ Accident [] Suicicle [] Homicide Pending Investigation Could not be Determined Describe how injury occurred: Name and Title of Certfier Lisa M. Davis, MD Address 4470 Valley Rd., Enola, PA 17025 (M.D., D.O., Coroner, M.E.) This is to certify that the information here given~ corra,~f~opie~m an original certificate .of death duly filed with me as Local Registrar. ~g-~l~l~ate will be forwarded to the State Vital Records Office for permanent filing. Denise A. Sherkel 17-183 July 01, 2004 Date Received by Loca~ Registrar CC egistral Vital Records DiSlrlct No. 98~ ~]am ~t. Houtzdale 16651 Street Address City, Borough Township FIRST: SECOND: THIRD: FOURTH: LASTLY: LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, LEAH R. BRITTON, of Philipsburg, Rush Township, Centre 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 null and void any and all former Wills and/or Codicils heretofore by me made. I do direct my Executor hereinafter named to pay all my just debts and funeral expenses as soon as may be found convenient after my decease. I do direct my Executor to pay all State and Federal transfer inheritance and estate taxes out of my residuary estate. I direct my Executor hereinafter c~amed to ~i!~ all my personal property at public auction and the proceeds t~ereof shall be added to the residue of my estate. Ail the rest, residue and remain: r o~ my es~tate, whether the same may be real, personal or mixed property, and wheresoever the same may be situate, I do give, devise and bequeath unto my children, DELORES J. HESS and MYRNA E. GRANVILLE, share and share alike. I do nominate, constitute and appoint my son-in-law, THOMAS W. GRANVILLE, to be Executor of this, my Last Will and Testament. I further direct that no personal representative shall be required to post bond for the faithful performance of his or her duties in any jurisdiction in which he or she may act. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the 2nd. page of my Last Will and Testament, the preceding page hereof being identified by my initials contained in the margin thereof, all done the / ~ day of LEAH R. BRITTON (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix as and for her Last Will and Testament in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. -2- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 ~HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY REV- 500 INHERITANCE TAX RETURN - RESIDENT DECEDENT D E C.,.~E NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEA~) DATE OF BIRTH (MM-DD-YEAR) SOCIAL SECURITY NUMBER 171- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER u.I 1. Odginal Return 4. Limited Estate [~6. Decedent Died Testate (Atbach ¢0py of WHI) [~9, Proceeds Received Litigation []2, Supplemental Return E~4a. Future Interest Compromise (date of death after 12-12-82) [~7~ Decedent Maintained a Living Trust (A~ach copy of Trust) ~]10 Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) E~3. Remainder Return (date of death prior to 12-1 [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (A~ch sch O) NAME...---'-- FIRM NAME (if Applicable) TELEPHONE NUMBER 7/'7- 7& - '-// COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule B) (4) 5 Cash, Bank Deposits & Miscellcaneous Personal Property (5) 6. Jointly Owned Property (SChedule F) (6) ~] Separata Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (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 Oaductione (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Nat Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY -..J · ~ ' (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)(l.2) x .0__ (15) t6. 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 Line 14 taxable at collateral rate x 15 (18) 19. Tax Due (19) /¢?7, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS& BONDS ESTATE OF FILE NUMBER All property jointly.owned with rigM of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, TOTAL (Aisc enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 2]00 10 016502508 00800000 00367680 80 2300 Sell your Prudential Financial, Inc. shares commission-free by October 29, 200~. You currently own 20 shares or Prude. ntial Fina~ncial, In.c. Common Stock .valued at $919.20, as of July 16, 2004. This va.~ue .may, nucmate oe, tw?en n. ow. an, a.the .date. on which your sales transaction is comp~etea ano your actual sa~e price Js aetenmnea. To sell ALL of your shares, sign and return this card in the postage-paid envelope provided. E Please use blue or black ink. I,,,lll,,,lll,,,,I,l,ll,,,,,,lll,,I,,I,l,,I,,I,,ll,ll,,,,ll,,I LEAH R BIUTTON 30 BLUE MOUNTAIN VISTA MECHANICSBURG PA 17050-1554 ACOOUNTNUMIER 0165 02508 T[LEPHOHE PiN INTERN~ PIN 3413 3791 3413 3791 E Rx '( ) E DAYTIME PHONE NO. SIGNATURE (ADDITIONAL SIGNATURES, IF APPUCABLE) DATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY 'FILE NUMBER Include the proceeds of I~ation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi ~ must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH TOTAL(Alsoenteron tine5, Recapitdation) $ /~// ! 7~/ . ~,.~ (If more space is needed, insert additional sheets of the same size) Statement of Accounts 1431337 26, 2004 0 1 of 2 Direct inquiries to: 814-342-1000 County National Bank 25 Irwin Ddve Philipsburg, PA 16866 I FAH R IBRll ION B~NI CR[EK (ROSSIN(i ~0t$1[lf MOUNTAINV[51A [','IF (it!AN I{ SI~I I1~( i PA Summary of Account Balances 50+ Free Interest Checkin,q ......... 0. 0_0_l fl3 ,~ , .~ Palanc"e '~% 531.03 County NaUonal Bank's Check Card Cash Back Bonus was pa~d on July JStl ., ~ ~lr~ t:o check your statement and adjust your balance accordingly. Don' t see a bonus? f~,l ', ]ustomer Service Center at 800-492-3221 to apply for your CNB Check Card HEATH FUNERAL HOME 701 Llngle Street O~eotn Mills, PA 16666 ~ATE: June 30, 2004 O: .-- Myma Granville ~JNERAL SERVICE FOR: ADDRESS: 30 Blue Mo,retain Vista~Me~h~nicsbur~PA 17050 BRITTON, LEAH ROBERTA I~fessionnl sefv~cs mCludM[ ca~e ise~snttiolt of the bed,/; consuHatiom with famil~ and cles~yman; nr~t di~cfion of ~ ~i~o~ mM f~n~n~ I~io~ 8nd fili~g °f funeral. Local transportation of~ body. Us~ of ~smbliJhm~t facilities and equilt~cm. MERCHANDISE SELECTED CAmket ( Bmdfonl Steel ) Outside ReCel~ncle (- ~ Con~t~ ) $760.00 Clothing ( ) S 125.00 .Peg Bk/M~m Fds/Ack Cds $65.00 CASH ADVANCES FOR YOUR CONVENIENC~ Additional untomotive eq~g~~t ............. Train, air or long distance funeral conch $328.60 Flowers ............................................... Cemete~ or crematory charges ..... $375.00 Newspaper notices ................................. Clergy honorarium ................................ $100.00 Transcripts .......................................... $12.00 Telegrams and long distunce telel~une Halrdre~er $35.00 L~t~ring H~tsMn~ $70.00 $50.00 TOTAL FOR MERCHANDISE $2,035.00 TOTAL OF CASH ADVANCES Total for Our Services nad Use of Facilities; For Merchnndise Selected; and for Cash Advanced For Your Convenience ..................................................................................................... $6,645.17 Fi~t Comm. Bk. 7/7/2004 $970.60 $5,970.60 NOTES: l~fm~d $674.57 to Myma Grunville on 7/7/2004 AMOUNT PAID: $6~645.17 BALANCE DUg: ($674.57) 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 Schedute ]. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s1 Street Address City State__Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State__Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (if more space is needed, insert additional sheets of the same size) HEATH FUNERAL HOME 701 Lingle Street Osceola Mills, PA 16666 DATE: June 30, 2004 TO: Myma Granville FUNERAL SERVICE FOR: ADDRg. S5: BRITTON? LEAH ROBERTA 30 Bluo Mo, mtnln Vistn,Mt'-chnnicsbm'~PA 17050 nec:ess~y notices, authneizatiom and cameras; ~d, other services and nt~mdnnc:e prior to, during and ~lowt~ the funeral. Loc~ tmmpm~at~n of thc body. Use of establishmcm facilities and ~quipmem. Sl,085.00 $76O.O0 $125.00 $65.00 CASH ADVANCES FOR Your CONVENIENCE Additional automotive equipment. ............ Train, air or leog distance funeral cc~h Flowers ............................................... $325.60 Cemetery or crematory C~S.. $375.00 Newspaper notices ................................. Clergy honorarium ................................ $100.00 Transcripts .......................................... $12.00 Telegrams and long distance telephone Hairdresser $35.00 Letmrin8 Headstone $70.00 $~0.00 TOTAL FOR MERCHANDISE $2,035.00 TOTAL OF CASH ADVANCES Total for Our Services and Use of Facilities; For Merdmmii~ Selected; and for Cash Advanced For Your Convenience ..................................................................................................... $6,645.17 First Cmr~. Bk. 7/7/2004 $970.60 $5,970.6O NOTES: AMOUNT PAID:. $6,645.17 BALANCE DUE: ($674.57) PAID Hq F~L Refunded $674.57 to Myma Granville on 7/7/2004 /~ ' ~/~ RECEIPT FOR PAYMENT Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA I7013 ReceSpt Date: 8/05/2004 Receipt Time: 16:07:20 Receipt No.: 1037446 BRITTON LEA/{ R Estate File No.: 2004-00730 Paid By Remarks: GRANVILLE THOMAS CP ........................ Receipt Distribution Fee/Tax Description PETITION FOR PROBA JCP FEE EXTRA PAGES SHORT CERTIFICATE Check# CASH Total Received ......... Payment Amount 50.00 10.00 4.00 6.00 $70.00 Payee Name CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0B01 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004314 GRANVILLE THOMAS WILLIAM 30 BLUE MOUNTAIN VISTA MECHANICSBURG, PA 17055 ESTATE INFORMATION: SSN: 171-30-6144 FILE NUMBER: 2104-0730 DECEDENT NAME: BRITTON LEAH R DATE OF PAYMENT: 08/27/2004 POSTMARK DATE: 08/27/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/30/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I ~497.86 TOTAL AMOUNT PAID: $497.86 REMARKS: SEAL CHECK# 534 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 11/01/2004 GRANVILLE THOMAS WILLIAM 30 BLUE MOUNTAIN VISTA MECHANICSBURG, PA 17055 RE: Estate of BRITTON LEAH R File Number: 2004-00730 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 11/15/2004 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge GLENDA FARNER STPJkSBAUGH Clerk of the Orphans' Court STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: Admin. No.: 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 w~ether 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: 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 ~] No F-] 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~rep~. ~ f,~/~ , ~ig~nat~l:e ........ Name Capacity: Address/'~'~.~./'~'~/~d/d'Yff~,,~_~, ~ 7/7- 74 -- Telephone No. Personal Representative Counsel for personal representative C_ ERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: '~ ~/]// :, ["~-~1 Date of Death: ~..,~Vl-"~'fi' 7~9I O~ Admin. No, To the Register: 1 certify that notice of (beneficial interest) estate admin'lstration required by Rule 5.6(a.~9.J' the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captinned estate on ~ ~-'~-/ // ~c, ~ : Name Address Notice has now been given to al1 persons entitled thereto under Rule 5.6(a) except Signature Name Telephone (717( 7&/'~Z'- fi~5': ¢ Capacity: / Personal Representative Counsel for personal representative / 7ps'b BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION COMMONgEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLORANCE OF DEDUCTIONS AND ASSESSMENT OF TAX THONAS g SRANVZLLE *0~ ~iOV -8 P2 :~4 $0 BLUE NOUNTAZN VZSTA MECHANICSBURG PA ~j7~50 DATE Zl-01-200q ESTATE OF BRITTON LEAH R DATE OF DEATH 06-$0-200q FILE NUMBER 21 0q-0750 COUNTY CUMBERLAND ACN 10! MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~'~ RETAIN LOgER PORTION FOR YOUR RECORDS REV-ISq7 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOgANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRZTTON LEAH R F~LE NO. ~1 0q-0730 ACN 101 DATE 11-01-200q TAX RETU~ ~AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN ~ASED ON: ORZGINAL RETURN 1. Real Es~e~m (Sche~le A) (1). .00 2. S~ocks lad BeNs (Sche~Xe B) (2),, 928. O0 ~. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) (~) . O0 q. ~r~ga~s/No~es Receivable (Sche~le D) (q) . O0 S. Cash/B~k D~os~s/H~sc. Personal Proper~y (SchoOl. E) (~) 16 176.20 6. Jointly O~ed Proper~y (Schedule F) (6) . O0 7. Transfers (Schedule 6) (7) .00 8. To~X Ass.~s (a) 17,10q.20 APPROVED DEDUCTZONS AND EXEHPTZONS: 9. F~mr~l Expenses/Ad~. Cos~s/Hisc. Expenses (Schedule H) (9) 6,0q0.60 10. D~s/Hor~ge~ L~ab~li~es/Liens (Schedule Z) (10) ~00 11. To~al De~c*tons 12. No~ Value of Tax Re~urn (11) (~2) 1Z,06~.60 lS. Char/~le/governmen~al Bequests; Non-elected 911~ Trusts (Schedule J) (15) . O0 lq. No~ Value of Es~a~e Sub~oc~ ~o Tax (14} ,, 11,06~.60 NOTE: ASSESSMENT OF TAX: 1.~. Amount: oF L/ne lq 16. Amoun~ of LAne 1¢ ~axable e~ Lineal/Class A ra*e (Z&) 17. Amoun~ of LAne 1¢ it Sibling ra~e (17) 18. Amo~ of LLne 1~ ~axabla a~ Cella*oral/Class B ra~e (18) NOTE: To Ansure proper credA~ ~o your account, submA~ ~hm upper por~ion oF thAs Fore wSth your ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TIONAL INTEREST. NUMBER INTEREST/PEN PA/D (-) CDOOq.$Zq 2q.89 19. PrlncSpal Tax Due TAX CREDITS: DATE 08-27-200q .00 X O0 .00 11,065.60 X Oq5= q97.86 · 00 X 12 .00 · 00 X 15 = .00 (19)= q97.86 AHOUNT PAZD l q97.86 TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEA~b] AND PEN. TOTAL DUE 522.75 2¢. 89CR ( ZF TOTAL DUE ZS LESS THAN 91, NO PAYNENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREBZT' (CR), YOU NAY BE DUE A REFUND· SEE REVERSE SIDE OF THIS FeRN FOR INSTRUCTIONS.) Zf an asssss;ent was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will faf/eot flgures that include the rural of ALL returns assessed to date. XNTERZST ~ BALANCE OF TAN UNPAID X NUNBER OF DAYS DELXNQUENT X DAILY XNTERZST FACTON BUREAU OF ZNDZVZDUAL TAXES TNHERZTANCE TAX DTV/STON DEPT. 18060! HARRTSBURG, PA 1711B-0601 COHHONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX REV-IG~i? EX AFP (01-05) THOHAS g iRANVZLLE $0 BLUE HOUNTAZN VZSTA HECHAN~CSBUR$ PA 1~050 DATE ESTATE OF DATE OF DEATH FZLE NUNBER COUNTY ACN 11-01-2004 BRZTTON 06-50-2004 21 04-0750 CUMBERLAND 101 Aeoun~ Rami*~ad LEAH R HAKE CHECK PAYABLE AND RENTT PAYNENT TO: REiTSTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLTSLE, PA 17015 CUT ALONG THZS LTNE ~ RETATN LONER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (:01-03) NOTTCE OF ZNHERTTANCE TAX APPRATSEHENT, ALLONANCE OR DTSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF BRTTTON LEAH R FZLE NO. 21 04-0750 ACN 101 DATE 11-01-2004 TAX RETURN gAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 1. Real Es~a~:e (Schedule A) 2. :5. .6. 6. 7. 8. ORZ$ZNAL RETURN (1) S~ocks and Bonds (Schedule B) (2) Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) ($) Hot,gages/No,es Receivable (Schedule D) (4) Cash/Bank Daposi~s/Hisc. Personal Proper~y (Schedule E) (5) Jointly Owned Proper~y (Schedule F) (6) Transfers (Schedule G) (7) To,al Asse~s APPROVED DEDUCTTONS AND EXENPTZONS: 9. Funeral Expensas/Adm. Cos~s/Nisc. Expanses (Schedule H) 10. Deb~s/Hor~gage Liabili:ties/Lians (Schedule Z) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn 15. 14. (9) (10) Charitable/Governmental Bequests; Non-alac*ad 9115 Trusts (Schedule J) Na~ Value of Es~a*a Subjec~ *o Tax .00 928.00 .00 .00 16~176.20 .00 .00 (8) 6,040.60 .00 NOTE: To insure proper cradi~ *o your account, submi~ ~he upper portion of ~h/s fora wi~h your ~ax payment. NOTE: 17,104.20 (11) ~. Od.O .~o (la) 11,065.60 (15) .00 (14) 11,065.60 Z~ an assessment was lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that lnclude the total of ALL returns assessed to date. (15) .00 X O0 : .00 (16) 11,065.60 X 045: 497.86 (17) .00 X 12 = .00 (lB) .00 X 15 : .00 (~9): 497.86 ANOUNT PAZD ASSESSHENT OF TAX: 15, Amoun* of Line 14 a* Spousal ra~e 16. Aeoun~ of L/ne 1~ ~axabla a~ Lineal/Class A ra~e 17. Aeoun~ of Line 14 a~ Sibl/ng ra~a 18. A.oun~ of L/ne 14 *axable a~ Collateral/Class B ra~e 19. Pr/nc/pal Tax Due TAX CREDZTS: PAYHEN1 REC~/PT DZSCOUNT (+) DATE NUHBER ~NTEREST/PEN PA~D (-) 08-27-2004 CD004514 24.89 ZF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATZON OF ADDZTZONAL INTEREST. 497.86 TOTAL TAX CREDZT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE 522.75 24.89CR .00 Z4.89CR ( IF TOTAL DUE TS LESS THAN $1~ NO PAYNENT 1'S REI~UTRED. TF TOTAL DUE TS REFLECTED AS A 'CRED'rT' (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF TH'rS FORN FOR 'rNSTRUCT'rONS. } RESERVATION: Estates of decedents dylng on ar before December 11, 1981 -- if any futura interest in the estate is transferred in possession or enjoyment to Class S (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 NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Hills, any of the 13 Revenue District Offices, or by calling the special Z4-hour ansearing service for forms ordering= 1-800-361-Z050; services for taxpayers with special hearing and / or speaking needs= X-800-447-3010 (TT only). 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 oust object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oept. 181011, Harrisburg, PA 17118-1011, 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. 180603, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sam 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 (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The iSZ 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 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 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 delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. Ali taxes ahich became delinquent on and after January 1, 1981 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 1981 through Z004 ara: Interest DaiIy Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548 ~'~-1991 111 .000501 ~ 91 .OOOZq7 1983 161 .000438 1991 9Z .ODOZ47 Z002 61 .000164 1984 11Z .000301 1993-1994 7X .000191 2003 52 .000137 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOZ .000274 1999 72 .000191 1987 101 .000274 2000 7Z .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY TNTEREST 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 ba calculated.