HomeMy WebLinkAbout03-0226PETITION FOR PROBATE and GRANT OF LETTERS
Estate of'
also known as
Social Security No.
,_ 8.Deceased.
No.
To:
Register of Wills for the
County of
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 executo&
in the last will of the above decedent, dated ,)/54/ ~-O
and codicil(s) dated
in the
named
,-tag-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (_'_i~m~q-e~Uqn,_~C9 County, Pennsylvania, with
h rS last faj;nily orprinqipal residence at '7 t~ ~/- ~a,~' ¢ 7- ~/gr~ o~ , ~,/Jzgze~-
Ta,~,~f~,r g~ i '70 i.~ ' '
(list street, number and muncipality)
Decendent, then ~[ years of age, ~ed p'l~ch / ~ Zd'a /
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
incompetent: ]V0,q~ e_
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ [ ~ 0 6:
(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
presented herewith and the grant of letters.
theron.
~ - j~
request(s) the probate of the last will and codicil(s)
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (~.~be([a,c,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
Sw°rn t° °r affirmed and subscribed F
before me this 25th day of
~ FEBRIIARY 20fl2 ~ ~~
- I
No. ,,q I-O;~-,,9. a. to
Estate Of SAMUEl_ H HENRY , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 13, 2003 ~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 1-20-2001
described therein be admitted to probate and filed of record as the last will of.
SAMUEL H HENRY ;
and Letters TESTAMENTARY
are hereby granted to JEFFREY KUTZ
FEES
Probate, Letters, Etc .......... $ ? ~_ fl f)
Short Certificates( ) .......... $ 3.00
>gm~'mmmicti~ ex.t.r.a.paoes... $ 3'~ an
jcp $ 10.00
TOTAL ~ $ 7'1.00
Filed ........ .3.-.q..37 ?.0.Q 3....~ .............
mailed to exec 3-~3-2003
" ~'. Register of Wills - K) ~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
LAST WILL AND TESTAMENT
OF
SAMUEL H. HENRY
I, Samuel H. Henry, of carlisle, Pennsylvania, revoke my former Wills and Codicilsand declare
this to be my Last Will and Testament.
ARTICLE I
IDENTIFICATION OF FAMILY
The names of my children from my prior marriage areSharon L. Dorsey, Mark S. Henry, and
Alice C. Kutz All references in this Will to "my children from my prior marriage" are references
to the above-named children.
The failure of this Will to provide for anydistributionto my child(ren), Alice C. Kutz is
intentional.
ARTICLE II
PAYMENT OF DEBTS AND EXPENSES
I direct that my just debts, funeral expenses and expenses of last illness be first paid from my
estate.
ARTICLE III
DISPOSITION OF PROPERTY
A. Specific Bequests. I direct that the following specific bequestsbe made from my estate.
1. A share of the estate equal to that of Sharon Dorsey and Mark Henry so as to have three
equal shares shall be distributed tojeffrey kutz. If this beneficiarydoes not survive me, this
bequest shall be distributed toAlice C. Kutz. If this beneficiary does not survive me, this
bequest shall be distributed with myresiduary estate.
2. My remainingtangible personal property shall be distributed tojef~ey kutz. If this
beneficiary does not survive me, thisbequest shall be distributed to Helen E. Henry. If this
beneficiarydoes not survive me, this bequest shall bedistributed with my residuary estate.
B. Residuary Estate. I direct that my residuary estate be distributed to my children from my prior
marriage in equal shares. Ifa child of mine from my prior marriage does not survive me, such
deceased child's share shall be distributed in equal shares to the children of such deceased child
who survive me by right of representation. Ifa child of mine from my prior marriage does not
survive me and has no children who survive me, such deceased child's share shall be distributed in
equal shares to my other children from my prior marriage, if any, or to their respective children by
right of representation. If no child of mine from my prior marriage survives me, and if none of my
deceased children from my prior marriage are survived by descendants, my residuary estate shall
be distributed to my heirs-at-law, their identities and respective shares to be determined under the
laws of the State of Pennsylvania then in effect, as ifI had died intestate at the time fixed for
distribution under this provision.
ARTICLE IV
NOMINATION OF EXECUTOR
I nominate jeffrey kutz, of carlisle, Pennsylvania as the Executor, without bond or security. If
such person or entity does not serve for any reason, I nominate Mark S. Henry, of carlisle,
Pennsylvania and Sharon L. Dorsey, of carlisle, Pennsylvania as Co-Executors (the "Executor"),
without bond or security.
ARTICLE V
EXECUTOR POWERS
My Executor, in addition to other powers and authority granted by law or necessary or
appropriate for proper administration, shall have the right and power to lease, sell,mortgage, or
otherwise encumber any real or personal property that may be included in my estate, without
order of court and without notice to anyone.
My Executor shall have the right to administer my estate using "informal", "unsupervised", or
"independent" probate or equivalent legislation designed to operate without unnecessary
intervention by theprobate court.
ARTICLE VI
MISCELLANEOUS PROVISIONS
A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for
reference purposes only and are not to be considered as forming a part of this Will in interpreting
its provisions. All words used in this Will in any gender shall extend to and include all genders,
and any singular words shall include the plural expression, and vice versa, specifically including
"child" and "children", when the context or facts so require, and any pronouns shall be taken to
-2-
refer to the person or persons intended regardless of gender or number.
B. Common Disaster. If my spouse and I die under circumstances such that there is no clear or
convincing evidence as to the order of our deaths, or if it is difficult or impractical to determine
which person survived the death of the other person, it shall, for the purpose of distribution of my
life insurance, property passing under any Trust or other contracts, if any, and property passing
under this Will, be conclusively presumed that [predeceased the death of my spouse, and
notwithstanding any other provision of this Will, my spouse (or my spouse's estate as the case
may be) shall receive the distribution to which my spouse would otherwise be entitled to receive
without regard to a survivorship requirement, if any.
C. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence offraudulent
conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall
indemify such natural person from any and all claims or expenses in connection with or arising
out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or
nonactions which constitute fraudulent conduct or bad faith.
D. Beneficiary_ Disputes. If any bequest requires that the bequest be distributed between or
among two or more beneficiaries, the specific items of property comprising the respective shares
shall be determined by such beneficiaries if they can agree, and if not, by m/Executor.
IN WITNESS WHEREOF, I have subscribed my name below, this ~074 day of
Testator Signatur~~,~.z~v~~F.- ~-
"~ Samuel H. He '~ ~ ............ ~ .............. ~
-3-
We, the undersigned, herebycertify that the above instrument, which consists of: q pages,
including the page(s) which contain the witness signatures, was signed in our sight and presence
by Samuel H. Henry (the "Testator"), who declared this instrument to be his/her Last Will and
Testament and we, at the Testator's request and in the Testator's sight and presence, and in the
sight and presence of each other, do hereby subscribe our names as witnesses on the date shown
above.
Witness Signature:
Name:
City:
State:
Witness Signature:
Name:
City:
State:
Witness Signature:
Name:
City:
State:
-4-
PENNSYLVANIA
Serf-Proving Clause
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (.~ ~ {~dr.~ ~
I, Samuel H. Henry, the Testator, 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 as my flee and voluntary act for the
purposes expressed in the instrument.
Swom to or affirmed and acknowledged before me by Samuel H. Henry, the Testator, this
dayof ~,¢~7 ., 7-c~ ~
Testator Signature
Official capacity of officer
Initi~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF '~-r'~ ,r~~
and ~//~,.~g/.~5 ,&. ~49~ ~. the witne~sses whose nanie~ are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that
we were present and saw the Testator sign and execute the instrument as the Testator's Last Will;
that the Testator signed willingly and executed it as the Testator's f~ee and voluntary act for the
purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as
a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of
age, of sound mind and under no constraint or undue influence.
Swom to or affirmed and subscribed to before me by
and ~'~/)~ /~ ~7'~,~g-e5 and
witnesses, this ~7'* day of ~
Witness Signature:
Name:
City:
State:
Witness Signature:
Name:
City:
State:
Witness Signature:
Name:
City:
State:
P/Ct
-2-
Initi~-
and offic~a ' ~
-3-
Initials~~"
~lttachment to my will
This is a statemem of my wishes as to the disposition of my equity in the property located at 7
Melron ct. in the township of Middlesex in the county of Cumberland PA
Upon my death it is my wish that My currem wife Helen Henry be permitted to remain in the
household until her death, remarriage or the sale of the property. Upon her death, remarriage or
sale of said property I instruct the executor of my will to work with the executor or legal
representative to an equitable distribution of the proceeds to those designated in my will.
There is to be no limit as to how long this attachmem will remain in effect except for the
provisions listed above.
Initial~-'
Attachment to my will #2
This is a statemem of my wishes pertaining to any loans due me.
All loans are to be continued with the terms agreed to on the signing of that loan. With the
paymems to be paid to the executor and distributed to my beneficiaries as provided in my will.
Initial~s:~
attachment to my will #3
This attachment sill solely pertain to any vehicle(s) that I own either wholely or jointly
It is my wish that my wife Helen E Henry retain the free use of any such vehicles until such a
point in time as she no longer needs them even if this period of time exceeds that point in time
where she cannot operate such vehicle(s) by herself.
This estate will not be held liable for any claims against it as a result of operating this vehicle.
Initia~
sam henry
7 melron ct
carlisle, PA 17013-
November 26, 2000
Mark S. Henry
52 bonnybrook rd
carlisle, PA 17013-
Dear Mark:
agreement to extension of loan payments due.
This is a letter declaring my intent to extend the current terms of the loan for the mobile home
located at the above residence by a period of no less than six months as we agreed to verbally,
this in no part changes the monthly payment or the interest rate in the original agreement. Further
extensions may be granted but not guaranteed by either myself or legal representative. This is also
to be my statement of my agreement to allow the terms of this loan to continue after my death.
Please comact me at the above address if you have any questions of need additional information.
Sincerely,
sam henry
7 melron ct
carlisle, PA 17013-
November 26, 2000
Mark S. Henry
52 bonnybrook rd
carlisle, PA 17013-
Dear Mark:
agreement to extension of loan payments due.
This is a letter declaring my intern to extend the current terms of the loan for the mobile home
located at the above residence by a period of no less than six months as we agreed to verbally,
this in no part changes the monthly payment or the interest rate in the original agreement. Further
extensions may be granted but not guaranteed by either myself or legal representative. This is also
to be my statement of my agreement to allow the terms of this loan to continue after my death.
Please contact me at the above address if you have any questions of need additional information.
Sincerely,
EV-1500 EX (6 00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
(-_02 02
COUNTY CODE YEAR NUMBER
i.-.
Z
Z
0
O.
0
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
.[~. Decedent Died Testate (Attach copy of Will)
[~9. Litigation Proceeds Received
FIRM NAME {IfApplicable)
~-'] 2. Supplemental Return
[~] 4a. Future Interest Compromise (date of death after 12-12-82)
E~7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
TELEPHONE NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
]3. Remainder Return (date of death prior to 12-13-82)
~-]5. Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
--]I1. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
.~ 8.
LU g,
10.
11.
12,
13.
14.
18.
19.
20.
Real Estate (Schedule A) (1)
Stocks and Bonds (Schedule B) (2)
Closely Held Corporation, Partnership or Sole-Proprietorship (3)
Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Jointly Owned Property (Schedule F) (6)
--]Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
Zz. ?5'. ¢o ,,,,
'~ 000, oD
~OFFIC.~SE ONLY
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .o_ (15)
Amount of Line 14 taxable at lineal rate
x .0_ (16)
Amount of Line 14 taxable at sibling rate
x .12 (17)
Amount of Line 14 taxable at collateral rate x .15 (18)
Tax Due (19)
Decedent's Complete Address:
STREETABBRESS 7 (~')E/- ~¢_...¢~.," ~...."'~'
¢
CITY C.t~-.C,$~.- STATE pvZ2 ZIP /70 / 3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C )
3, Interest/Penalty if applicable
B. Interest
E. Penalty
Total Interest/Penalty ( D + E )
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
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.
(2)
(3)
(4)
(5)
(EA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (ED)
Make Check Payable to: REGISTER OF WILLS, AGENT
IF THE ANSWER
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
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? ........................................................................................................................ []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT
No
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~n the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE 6F~ RESF)ONSIBLJ~:OCFIUi~'F~ETURN DATE
ADDRE~//,,~/ // -- ~
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) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (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.
RL~/-I,~)3 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
(..~s,f' '7 q '-I 3 ~o I o z
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
REV-1511EX + (1-97} ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
FUNERAL EXPENSES:
TOTAL (Also enter on line 9, Recapitulation) $
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
5.
6.
7.
(If more space is needed, insert additional sheets of the same size)
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attomey 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 Retum PrepareCs Fees
'7 5"'7.
FILE NUMBER
AMOUNT
?/-oU
DESCRIPTION
Name of Decedent:
Date of Death:
Will No. '~
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Of,.) ~ -- 00 2 2~ Admin. No.
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 .,~..t9~t~ ? 'Z..C)Oi ·
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 7'~'] ~" 'O~
Address 36 ~'~" .5~::9/(",¢1/) FQJ~
Capacity: -~Personal Representative
Counsel for personal representative
rn
rn
[::3
nj
r-~ Postage $
~-~
r-I Certified Fee Postmark
r--t Here
I--'1 Return Reclept Fee
(Endorsement Required)
f--t Restricted Delivery Fee
~ (Endomement Required)
r-1 ~Sent To
[o..~~.._~ ..... ~--~- ............... 1
UNITED STATES POSTAL S
Please~me, add -- '~ ~ '- : '-'- "--
"'~EG~ST'E IZ O~ U~u.~
Postage
Certified Fee
Return Reciept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
Postmark
Here
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· · Print your name and address on the reveme
· o that we can return the card to you.
· Attach this card to the back of the mailpiece,
If YES, enter daiive~, ~ below:
~"~C, ertffied Mall
[] Registered
[] Insured Mail
[] F-xproe~ M~I
[] Retum Rece~ for Merchandise
[] C.O.D.
4. Restricted Delivery? (Ex~ra Fee)
I-lyes
Ps Form 3811, August
7003 1010 0001 1203 7543
Domestic Return Receipt
JRD/June 30,1992/17858
JUL 2003
In Re: Estate of SAMUEL H HENRY
Late of MIDDLESEX TOWNSHIP
Estate No.: 21-03-226
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2003-226
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: JEFFREY KUTZ
Counsel for Personal Representative:
Date of Grant of Original Letters: 03-13-2003
Date of Delinquency Notice: 06-23-2003
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
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
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on JUNE 23, 2003, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
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 counsel for the delinquent personal representative.
Date: 07-11-2003
Distribution:
~ p~e-gister'of~ills(3 r 0
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for C~ '- ~ 9- 03 at ~7;3a ,4 ~ In Courtroom No. 3. If the
Certification of Notice is filed prior to the hearing date, the heating will automatically be
cancelled.Geor~
/BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 17128-0601
CONNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOHANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-16,~7 EX &FP ¢01-05)
JEFFREY KUTZ
3675 SPRING RD
CARLISLE
'03 :5i::?-9
PA 17013~
DATE 09-09-2003
ESTATE OF HENRY
DATE OF DEATH 03-01-2001
FILE NUMBER 21 03-0226
:!iT~NTY CUMBERLAND
ACN 101
Amount Reei'l:ted
SAMUEL H
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF NZLLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HENRY SAMUEL H FILE NO. 21 03-0226 ACN 101 DATE 09-09-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERN]:NG FUTURE INTEREST ' SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
1. Real Estate (Schedule A)
2.
3.
q.
E.
6.
7.
8.
ORIGINAL RETURN
(1)
Stocks and Bonds (Schedule B) (2)
Closely Held Stock/Partnership Interest (Schedule C) (3)
Mortgages/Notes Receivable (Schedule D) (q)
Cash/Bank Deposits~Misc. Personal Property (Schedule E)
Jointly Owned Property (Schedule F) (6)
Transfers (Schedule G) (7)
TotaZ Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses~Adc. Costs/Misc. Expanses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule Z)
11. Tote1 Deductions
12. Net Value of Tax Return
1:3.
lq.
NOTE:
(9)
(10)
Charitable/governmental Bequests; Non-elected 911:3 Trusts (Schedule J)
Net Value of Estate Sub,act to Tax
:If an assessment was issued previously, lines 14, 15 and/er
.00
ZIZ95.00
.00
.00
31000.00
.00
.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of th~s fore wi~h your
tax payment.
(8) 5,295.00
8,00q. O0
.00
(11) 8.oo~.oo
(~2) 2,709.00-
(1:3) . O0
(1~,) Z,709.00-
16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
(1~) .00 x O0 = .00
(16) .00 x Oq5= .00
(17) .00 x 12 = .00
(t8) .00 x 15 = .00
(19)= . O0
AMOUNT PAID
ASSESSMENT OF TAX:
1.6. Aeount of L~na lq at Spousal rata
16. Amount of Line lq taxable at Lineal~Class A rata
17. Aaount of Line lq at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DTSCOUNT (+}
DATE NUMBER INTEREST/PEN PAID (-)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEI . O0
INTEREST AND PEN. .00
TOTAL DUE . O0
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE~UTRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYRENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (cellatarel) beneficiaries of tho decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the Zawful Class B (collatarel) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of 2000. (72 P.S.
Section 91q0).
Dstsch the top portion of this Notice end submit with your payment to the Register of #ills prlntad on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which wes not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications ars available at the Office
of the Register of #ills, any of tho 23 Revenue District Offices, or by calling the special gq-hour
answering service for fores ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-q47-3020 (TT only).
Any party in interest not satisfied with the appraisement, elloeance, or disallowance 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:
--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 tho personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered an this assessment should be addressed in wrlting 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-1501) for an explanation of administratively correctable errors.
If any tax duo is paid aithin three (3) calendar months after the docedent's death, a five percent (5Z) discount of
the tax pald is allowed.
The 152 tax amnesty non-participation penalty is cosputad on the tatar 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 end in the the same ties period es you mould appeal the tax end interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith 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 calculatad at a daiZy rate of .000164. A11 taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate ahich will vary from calender year to calendar year eith that rate
announced by tho PA Department of Revenue. Tho applicabl® interest rates for 1982 through 2003 ere:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 gOZ ,000548 1987 92 .O00Zq7 1999 72 .000192
1983 162 .000438 1988-1991 ilZ .000301 2000 82 .000219
1984 112 .000301 1992 92 .0002~7 2001 92 .000247
1985 152 .000356 199~-199~ 72 ,000192 ZOOZ 62 .00016~
1986 102 .00027q 1995-1998 92 .0002q7 2003 52 .000137
--Interest is calculated as follows:
XNTEREST = BALANCE OF TAX UNPAID
X NUNBER OF DAYS DELINQUENT 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 shown on the
Notice, additional interest must be calculated.
..
. .
..
o .
Re~srerofVVillsofCwnbeclandCountr
STATUS REPORT UNDER RULE 6.12
Name of Decedent: !;/J 1'1 u e L 1-1 fJ efl/rt V
I
Date of Death: '3 - 0 f - Z O() /
Estate No.: 21- 03 - 'J 2-6
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 .I.&- No 0
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~esentative file a final account with the Court?
Yes 0 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 J8l No 0
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.
si~~7
J-ef(lei L KvTz-
Name
Date:
l..l- /2- zoo '-}
3(; 717 S/},Z/fV'~ ~?J U/ZL;.>/e f/t 1/03
Address
7] [) . i :,:.J
-!! ,
7 / 7 /' 2--'-19 - I 3> 0 L-
Telephone No.
Capacity: j21Personal Representative
o Counsel for personal representative
vJ
[, ; c ~
Estate No.: 21-03-00226
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate of HENRY SAMUEL a
Late of MIDDLESEX TOWNSHIP
Date:
4/08/2005
NO.: 21-03-00226
KUTZ JEFFREY
3675 SPRING RD
CARLISLE PA 17013
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS I COURT RULE
Personal Representative: KUTZ JEFFREY
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 3/05/2002
Date of Delinquency Notice: 3/01/2005
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 3/03/2005
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
~~~
Glenda Farner Strasbaugh
Clerk of Orhans' Court
A hearing is scheduled for June 03, 2005 at 9:30 AM in
Courtroom No. 03. If the Status Report is filed prior to the
hearing date, the hearing will automatically be cancelled.
j"
i if t-
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Geor~e /1"
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