HomeMy WebLinkAbout03-0201 PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Register of Wills for the
Deceased. County of ~%..~. B,,~ L~,/:, in the
Social Security No. ~2o ~ ~ ~ 0 - 46 ~ ~ 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 oB named
in the last wilt of the above decedent, dated. .~ ~ 3'" ,19.
and codicil(s) dated
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~'>t;( ~n9 ~'c,,,~ L/~rv ;D County, Pennsylvania, with
h ~ last'tSamily or principal residence at ~',O.,r.~ ~,¢// ~/D<)
(list street, number and muncipality)
Decendent, then -~ 3 years of age, died fl/0 U I 0 , "~'J~' ,
at
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of ~r~0)n~ offered for probate; was not the victim of a killing and was never adjudicated
incompetent: · ,-/~'r' ,..
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) respectfull~.~requ~st(s) th~robate of the last will and codicil(s)
presented herewith and the grant of letters'
(testamentary; a~nistration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~_~r,axC~_ c ~c~r,c~ f
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 affirmed and subscribed -~~ A. '~_.~'~-~-
before me this ~2cx day of ~
- Ck-L~.(~,,x~{~g~ster
No.
Estate Of ~'L~k ~. ~'-~_-~_ ~ ~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW .~(30.;~' ~. ,~' ; ~C/kq l~ , in consideration of the petition on
the reverse side tiere0f, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated [-5- ~
described therein be admitted to probate and filed of record as the last will of ~lq0- [hq ~ .,%\
and Letters --~_-:.~-~cr~rna
are hereby granted to ~_~-.3 ~ ~f~k~c-~%
L Register of Wills ~.~
FEES
Probate, Letters, Ere .......... $. C~~C)' ~
Short Certificates( ) .......... $ /,, .~3L3 ^7rOaNE¥ (Suv. ct. LD. No.)
.3~t:~ $ /O-C~O ADDRESS
TOTAL ~ $ /o0'. ~O
Filed ...~...-. ;~...-. 0.~ ...... ~ ............. PHONE
This is to certify that the information here given is correctly copied fi'om 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.
Local Registrar
P 8 ? 0 3 8 0 g ~--?a'~.-'~-~------~,',~?:.;'~ NOV 1 3 2002
No. ~ Date
HmS.;,~ R~,. 2~B? COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT 0~ HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (F~rtl. Mid~. L~) ITM ISOClAL SECURIT~ NUMBER J D~E
'. Elva M. ~ihl I'. F~le ~,. 203 -- 10 -- 8689 l, Nov~,~ [0, 2~2
, ' , APr[ iling Spt. PA ,~,~ ~ E~,. ~ ~ D
m Cmrland I ~rllsle ~rah T~d Memrial Horn *~ *~,~--m ~ ' '
I ~ ~ I~'~l ~ "'~~
~rlisle PA 17013 ~ ~ '
~ Re~
~ey.,A. ~ers 6 Drive, ~rli~le PA 17013
~ ~ ~=~'~ '~ Nove~r 15, 2~2 C~rland Valley Mem. Gr~},~,. ~rlisle PA 170~3'
010343-L Hof fmn-Roth ~eral
=~.~==~, 17013
· .~o~t ~.~.~o.o.~.
............................................................................ 0 ~=
LAST WILL AND TESTAMENT OF ELVA M. DEIHL
I, ELVA M. DEIHL, of the Borough of Mount Holly Springs,
Cumberland County, Pennsylvania, declare this instrument to be my
Last Will and Testament, in manner and form following:
1. I hereby expressly revoke all Wills and Codicils
heretofore made by me.
2. I hereby direct my Executor to pay all my just debts,
funeral and administrative expenses out of my estate, as soon as
practicable after my death.
3. Should my husband, Wilmer E. Deihl, survive me for a
period of thirty days following my death, I devise and bequeath
the remainder of my estate to Wilmer E. Deihl.
4. Should my husband, Wilmer E. Deihl, predecease me or die
on or before the thirtieth day following my death, I devise and
bequeath the remainder of my estate to my grandchildren living on
the thirty-first day following my death in equal shares.
5. I nominate and appoint my husband, Wilmer E. Deihl, as
Executor of this my Last Will and Testament; and as substitute
Executor I nominate and appoint my son, Harvey A. Myers; and I
further direct that my personal representative shall not be
required to file bond or security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~ day of ~ , 198~.
Elva M. Deihl
WITNESS:
- 1 -
CO~40NWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
I, Elva M. Deihl, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
Sworn or affirmed to and acknowle~ed before me, by Elva M.
Deihl, Testatrix, this ~ day of ~ , 198~.
Testatrix
~.!~erl ....... ~ r-~,: m~-y Corlisle, PA
~issiqn Fx~i~es January 27, 1983
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
We, Tom H. Bietsch and Roger M. Morgenthal, the witnesses
whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we
were present and saw Testatrix, Elva M. Deihl, sign and execute
the instrument as her Last Will that she signed willingly and
that she executed it as her free and voluntary act for the pur-
poses therein expressed; that both of us in the hearing and sight
of the Testatrix signed the Will as witnesses; and that to the
best of our knowledge the Testatrix was at that time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me b~ Tom H.
B~etsch and Roger M. Morgenthal, witnesses, this ~"~-~ day of
, 198~.
WitKess
Co~ mey Carlisle, PA
:' ,, .-:~ission Expires January 27, 1983
- 2 -
Jltill
OF
ELVA M. DEIHL
COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002264
MYERS HARVEY A
6 DERBYSHIRE DRIVE
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..................
101 $81.77
ESTATE INFORMATION: SSN: 203-10-8689
FILE NUMBER: 21 03-0201
DECEDENT NAME: DEIHL ELVA M
DATE OF PAYMENT: 03/07/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11/10/2002
TOTAL AMOUNT PAID: ~81.77
REMARKS: HARVEY A MYERS
CHECK# 1401
INITIALS: JA
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
/~-/~-x// CONNON.EALTH OF PENNSYLVANZA
BUREAU OF ZND/V/DUAL TAXES DEPARTNENT OF REVENUE
ZNHER/TANCE TAX DZVZSZON
DEPT. 280601
HARRISBURG, PA 171Z8-0601 NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTZON~I~D ~SSE~SHENT OF TAX
Recorded ~.?t;,~ OT
fle~ ~E 0~-ZZ-Z0OS
ESTATE OF DEIHL ELVA H
DATE OF DEATH 11-10-Z00Z
'03 , R28 INUNDER ZZ 0=-0Z0Z
COUNTY CUH~ERLAND
HARVEY A HYERS '~' ....~ L.~..~N? 101
6 DERBYSHIRE DR ~:~'~ .... ~:~:~
CARLISLE PA 17015 Ctfl~behaF~d {~'~. PA Amoun* Rem/*~ed
I
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF ~ILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17015
CUT ALONG THZS LZNE ~ RETAZN LOHER PORTZON FOR YOUR RECORDS
REV-15~7 EX AFP [01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT~ ALLOHANCE OR
DZSALLOHANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF DEIHL ELVA HFZLE NO. 21 05-0201 ACN 101 DATE 0~-21-2005
TAX RETURN HAS: (X) ACCEPTED AS FZLED [ ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRA%SED VALUE OF RETURN ~ASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) [1) .00 NOTE: To Ansure proper
2. S~ocks and Bonds (Schedule B) (2) .00 cred1~ ~o your accoun~
3. Closely Held S~ock/PaP~nepship In~eres~ [Schedule C) (S) .00 submi~ ~he upper portion
~. Hot,gages/No,es Receivable [Schedule D) (~) .00 of ~h~s forB N~h your
5. Cash/Bank Deposi~s/Hisc. Personal Pnoper~y (Schedule E} (5) 1~886.52 ~ax payment.
6. Jointly Owned Propen~y [Schedule F} (6) .00
7. T~ansfe~s [Schedule G) (7} .00
8, To*al Asse~s (8) 1,886.52
APPROVED DEDUCTZONS AND EXEHPTZONS: 69.00
9 Funeral Expenses/Ada. Cos~s/H1sc. Exponsas (Schedule H) (9)
10 Debts/Hot,gage L1ab111~ies/Liens (Schedule Z) (10) .00
11 To~al Deductions (11)
12 Ne* Value of Tax Re~urn (12) 1,817.$2
1~ Char/*able/Governmen~al Bequests; Non-elected 911~ Trusts (Schedule J) (1S) .00
1~ Ne* Value of Es~a~e Sub~ec~ *o Tax (1~) 1,817.~2
NOTE: Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~111
reflect figures that lnclude the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amoun~ of L/ne lq a* Spousal ra~e (15). .00 X O0 = .00
16. Amoun~ of L/ne lq ~axable a~ L/heal/Class A ~a~e (16). 1,817.~2 x 0~5 = 81.77
17. Amoun~ of L/ne 1~ a~ Sibling ra~e (17). .00 X 12 = .00
18. Amoun~ of Line 1~ ~axable a~ Collateral/Class B ra~e (18). .00 X 15 = .00
19. Principal Tax Due (19)= 81.77
TAX CREDZTS:
PAYHENT RECEZPT D/SCOUNT (+~
AHOUNT PAZD
DATE NUHBER /NTEREST/PEN PA/D (-)
0~-07-200~ CD00226~ .00 81.77
TOTAL TAX CREDTT I 81.77
BALANCE OF TAX DUEl .00
TNTEREST AND PEN. .00
TOTAL DUE .00
TF PAZD AFTER DATE :ZNDTCATED, SEE REVERSE ( ZF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS RE~UTRED.
FOR CALCULATTON OF ADDTTTONAL TNTEREST. TF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE STDE OF THTS FORN FOR TNSTRUCTTONS.)
RESERVATION: Estates of decedents dying on or before December 1Z, 19BI -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collataral) rate on any such future interest,
PURPOSE OF
NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of gO00. (72 P.S.
Section 91q0).
PAYMENT: Detach the top portion of this Notice and submit ~ith your payment to the Register of Nills printed on tho reverse side.
--Make check or money order payable to: REGXSTER OF N[LLS, AGENT
REFUND (CR): A refund afe tax credit, ~hich ams nat requested an the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" CREV-l$13). Applications are available et the Office
of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-800-361-2050; services for taxpayers ~ith special hearing and / or
speaking needs: 1-800-qfi7-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object eithin 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.
ADMIN-
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 Reviaa Unit, Dept. Z80601, Harrisburg, PA 17118-0601
Phone (717) 787-6SOS. Sea page S 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 (3) calendar months after the decadant's death, a five percent (SI) discount of
the tax paid is allowed.
PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, end 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 ~ould appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: 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 ~hich became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .00016q. All taxes ~hich became delinquent on and after
January 1, 1982 will bear interest at a rate ~hich ~ill vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19BI through Z003 ara:
Interest Daily Interest Daily Interest Daily
Year Rata Factor Year Rate Factor Year Rate Factor
1982 202 .OOOSqB 1987 92 .0002q7 1999 7Z .000192
1983 161 .000~38 1988-1991 llX .000301 ZOO0 8Z .000119
198~ 112 .000301 1991 91 .0002q7 2001 9X .O00Zq7
1985 131 .000356 1993-199q ?Z .00019Z ZOOZ 61 .00016~
1986 10~ .000174 1995-1998 9Z .0002~7 2003 51 .000137
--Xnterest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNI;IUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must ba calculated.
PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
HARRISBURG,PA17128-0601 RESIDENT DECEDENT -- --
DECEDENTS NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER
~1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82)
~ 6. Decedent Died Testate (AUach copy of Wi~) ~ 7, Decedent Maintained a Living Trust (A,ach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes
~ 9. Litigatio~ Proceeds Received ~ 10. Spousal Povedy Credit (date of death be~een 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A)(A~ach Sch O)
NAME COMPLETE MAILING ADDRESS
FIRM NAME (IfAppli~le) I '
TELEPHONE NUMBER
1. Real Estate (Schedule A) (1) ~~-- OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, PaAnership or Sole-Proprietorship (3) ~ ~ ~
4. Mo~gages & Notes Receivable (Schedule D) (4) ~
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) /~. ~
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Prope~ (7)
(Schedule G or L) ....
8. Total ~ross A~set~ (tota~ U.es ~-7) (8) /~4.~
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of De,dent, Uo~gage Liabilities, & Liens (Schedule I) (10)
11. To~l Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE ~TES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfem under Sec. 9116 (a)(1.2) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate ~/~'~ x .0~~ (16) ~- ~ 7
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at ~llateral rate x .15 (18)
Decedent's Complete Address:
ISTREETAODRESS
CITY ~-----/~:~-~'~.5' ~' ~ STATE~ ZIP//
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) ~,/.
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C ) (2)
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. (5A)
B. Enter the total of Line 5+ 5A. This is the BALANCE DUE. (5B) 43C~'/. 7 7
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS ~
SIGNATURE OF PRL~ARER 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) (1.1) (i)].
For dates of deaih on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (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 if
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 parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (1-97)
~ SCHEDULE E
COMMONWEALTH~OF PENNSYLVANIA ----CASH, BANK DE?{3~5115,
&
MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOT AL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of 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:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
3. 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 ~'~-O O
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-151,13 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 PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
Iii NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART ]I- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ,/~,/~, 3 ~
(If more space is needed, insert additional sheets of the same size)
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ~r'2/~/~ ]r~ ~)~_c,/~L-
Date of Death:
Will No. c~ ~/t~ 3 ~ 0 / Admin. No. ~
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~- 7 - t59 '~ :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Signature
Name ~, ~.~~
Address t~ _/2~_~_~ ~
Telephone ~/7) ,~_1~..~
Capacity: /Personal Representative
Counsel for personal representative
........... ~ ~uu~uy ~egmster Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/24/2004
MYERS HARVEY A
6 DERBYSHIRE DRIVE
CARLISLE, PA 17013
RE: Estate of DEIHL ELVA M
File Number: 2003-00201
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 SUPRE
103 SUPREME CO T RULES fOURT ORPH S
July 1, 1992, the , · rot decedents'_,C~URT RULEs, NO
.(2) years of m~ ~per~onal represent . _ aymng on or afte~
Wills .... t~= ueceGent,s ~ ~t~ve or his c~ .... ~
· ~ ~aEus ~-- - ~=~, s~aTM ~.~ ~:, witm~ ~
~porE of comDle~ ~ ~l~e with the D .... ~ ~WO
r~U ~mlnlstration.
This filing will become delinquent on: 11/10/2004
Your prompt attention to this matter will be appreciated
Thank You. .
S~ncerel~z,
GLEN-DA FARNER S TRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~'~
Date of Death:
Will No.: ~ -O~- olt3 ~ 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 whether administration of the estate is complete:
Yes
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 r~resentative 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 1~ No [-'1
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 this report.
· Signature ~ ·
Name
· '~: · ~' Address
,~
Telephone No.
Capacity: [] Personal Representative
.- .~ '.~ r'7 [--1 Counsel for personal representative