HomeMy WebLinkAbout03-0237 DEPARTHENT OF REVENUE ZNFORMATZON NOTZCE FILE NO. 21-~
BUREAU OF INDIVIDUAL TAXES ~
DEPT. 28060! AND
HARRISBURG, PA 17128-0601 '{l~ll~tll~ TAXPAYER RESPONSE ACN 05102575
DATE 02-07-2003
REV-~3 EX AFP cgg-ol)
TYPE OF ACCOUNT
EST. OF THOMAS A ECHELMEYER I~-ISAV~NgS
S.S. NO. 167-36-7055 [] CHECKING
DATE OF DEATH 12-07-2002 []TRUST
:'~ COUNTY CUMBERLAND [] CERT~F.
REMIT PAYMENT AND FORMS TO:
ANNA C KERR REGISTER OF HILLS
APT A CUMBERLAND CO COURT HOUSE
20 CONENANGO AVE CARLISLE, PA 17013
NARREN PA~.1.6365
NORTH#EST SAVTNgS BANK has provided the Department with the information listed below which has been used ]n
calcuXating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Lams of the Commonwealth
eT Pennsvlv=r.=,c. Question= may ba a.-.s~er=d by cal1~g
COMPLETE PART I BELON ~ # # SEE REVERSE SIDE FOR FILING AND PAYMENT ZNSTRUCTZONS
Account No. 020185678 Date 04-09-1993 TO insure proper credit to your account, two
Established (z) copies of this notice must accompany your
payment to the Register of Rills. Make check
Account Balance 5 · 211 . 55 payable to: "Register of Rills, Agent".
Percent Taxable X 16.6 6 7
NOTE: If tax payments ara made aithJn three
Amount SubSect to Tax 868.61 (.%) months of the decedent's date o~ death,
Tax Rate X .12 you may deduct a 52 dlscount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 104.23 nine (93 months after the date of death.
PART TAXPAYER RESPONSE
Ao ~ The above information end tax due is correct.
~o You may choose to remit payment to the Rmgister of RiZls aith two copies o~ this notice to obtain
a discount or avoid
- CHECK --] Rills and an officia~ assessaant will be issued by the PA Depertaent of Revenue.
ONE
BLOCK J B. [] The above asset has been or will ba reported and tax paid I~ith the PennsyIvania Inheritance Tax return
ONLY to be ~iled by the decedsnt's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART [] and/or PART [] below.
PART Tf yOU indicate a different tax rate~ please state your
relationship to decedent:
TAX RETURN - COMPUTAT]:ON OF TAX ON JO]:NT/TRUST ACCOUNTS
LI'NE 1. Date Established 1
2. Account Balance 2
:3. Percent Taxable $
~. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable 6
7. Tax Rate 7
B. Tax Due 8
PART DEBTS AND DEDUCTZONS CLAZMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
I
TOTAL (Enter on L/no .6 of Tax Computation) $
-- ,ORK
YAY,]:'AYER SIGNATURE / -.~ TELEPHONE'NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSMENT eith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death.
5. A joint account is taxable oven though the decedent's name ams added as a matter of convenience.
~. Accounts (including those held between husband and wife) mhich the decedent put in joint names mithin one year prior to
death ara fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. SLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, piece an
in block "A" of Part 1 of the "Taxpayer Response" section. Sign too copies and submit them with your check for the amount of
tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-15~8 EX) upon receipt of the return from the Register of Nills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 17128-0601 in the
envelope provided.
$. BLOCK C - If the notice information is incorrect and/or deductions ara being claimedj check block "C" and complete Parts Z and
according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payable to the Register
of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15~8 EX) upon receipt
of the return from the Register of #ills.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/1Z/&Z: Accounts which the decedent put in joint names within one (1) year of death ara
taxable fully as transfers. Hoeevarj there is an exclusion net to exceed $5~000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion
already has been deducted from the account balance es reported by the financial institution.
Z. Enter the toter balance of the account including interest accrued to the date of death.
5. The percent of the account that is taxable for each survivor is determined as folloas:
A. The percent taxabIa for joint assets established more than one year prior to the decedent's death:
I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT O#NERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR)
S. The percent taxable for assets created within one year of the decedent's death or accounts maned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUHBER OF SURVIV[NG JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the nome of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .SO X lO0 = SOZ (TAXABLE FOR EACH SURVIVOR)
~. The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions listed in Part 5.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) as leterained below.
Da~e of Death Spouse I Lineal Sibling I Collateral
07/01/9q ~o 12/$1/9q SX 6Z 15X
01/01/95 ~o 06/50/00 OX 6X 15X
07/01/00 ~o presen~ OX q.6Z~ 12X
wThe tax rate imposed on thc nat value of transfers from a dec .... ~ -k~l, ..o.~y-..o ye,re nS aaa or younger at
death to or for the usa of natural parent, an adoptive parent, or a stepparent of the child is OZ.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. 'Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes al1 other beneficiaries.
CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You ZegaZZy are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, usa plain paper & 1/2" x 11". Proof of
payment may be requested by the PA Department of Revenue.
Zip Code
Attention: T/C 340
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG PA 17128-0601
I,,,lll,,,I,,,ll,,I,II,,I,II,,,,ll,,ll,,,,,,ll,l,,ll
COHHDNNEALTH OF PENNSYLVANIA ~ ~
DEPARTNENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES FILE NO. 21 Z~ ~
DEPT. Z8060] ~' AND
HARRISBURG, PA ~7]Z8-0~0] TAXPAYER RESPONSE ACN 0~102572
DATE 02-07-200~
TYPE OF ACCOUNT
~ST. OF THOHAS A ECHELHEYER ~ SAVINGS
S.S. NO. 167-~6-7055 ~ CHECKING
DATE OF DEATH 12-07-Z002 ~ TRUST
-~*~ .. ~ COUNT~ CUHBERLAND ~ CERTES.
REHIT PAYHENT AND FORHS TO:
DOROTHY D ECHELHEYER REGISTER OF WILLS
109 CONENAN60 AVE CUH~ERLAND CO COURT HOUSE
HARREN PA 16~65 CARLISLE, PA 1701~
NORTHNEST SAVINGS BANK has provided the Department with the information listed boloa which has been used in
calculating the potential tax dUB. Their records indicate that at the death of the above decedent, you aero a joint eerier/beneficiary of
this account. Zf you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance eith the Inheritance Tax Laos of the Commonwealth
Af PPq~E~Iu~n(;. quo;t~on; m~v hA an;Meted bv calling (7]7) 787-8327.
CONPLETE PART ! BELOW # # # SEE REVERSE SZDE FOR FZLZNG AND PAYNENT ZNSTRUCTZONS
Accoun~ No. 020185678 Oa~a 0q-09-1995 To insure proper credit to your account, tea
Established (z) copies of this notice must accompany your
payment to the Register of NiII$. Naka check
Accoun~ Balance 5,211.55 peyabla to: "Register of NilIs, Agent".
Parcen~ Taxable X 16.667
NOTE: If tax payments are made eithin three
Aaoun~ Subjec~ ~o Tax 868.61 (3) months of the dacedent's date of death,
Tax Ra~a X .045 you may deduct a SZ discount of the tax due.
Any inheritance tax due wiI! become delinquent
Po~en~Ja! Tax Due 39.09 nine (9) months after the data of death.
PART TAXPAYER RESPONSE
A.
~ The abovm Jn(ormmtJon 8nd tax dug is correct.
1. You may choose to remit pa~mmn~ to the RmgJ~ter o( Wills with two copies o( this notJcm to obtain
CHECK , discount or avoid Jntmrmst~ or you ma~ chmck box "A" and return this notJcm
ONE ~ Wills and mn o~Jci81 ass, ssment Nil1 bm issued by the PA Dmpar~m,nt o( Rmvenu,.
~COCK J B. ~ The mbove asset has been or ~Jll be reported and tax paid with the Pennsylvania InhmrJtancm Tax return
ONC~ to bg (JXmd by thm decmdmnt's rmpresentatJve.
C. ~ Tho 8bore Jn(orma~Jon Js Jncorrmc[ and/ur debts and deductions were paid by you.
You must compJetm PART ~ and/or PART
PART If you indicate a dJffersn~ ~ax ra~., please s~a~e your
relationship ~o decedent:
TAX RETURN - COHPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
LINE 1. Da~e Established 1
2. Accoun~ BaZance 2
$. Percen~ Taxable $
q. A.oun~ Subjec~ ~o Tax
5. Debts and Deductions E -
6. Amoun~ Taxabl~ 6
7. Tax Ra~e 7
8. Tax Due 8
PA~T DEBTS AND DEDUCTIONS CLAZHED
DATE PAID PAYEE DESCRIPTION AHOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
~der penalties of perjury, Z declare ~ha~ ~he fac~s Z have repor~d aboye are ~rue, correc~ and
compl.*. *o *h, b.s, of my knowl.dg. ,nd b.11.f.
~'~TAXPA~
/ O TE
GENERAL INFORMATION
1. FAilURE TO RESPOND N~LL RESULT ZN AN OFFiCiAL TAX ASSESSMENT eith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decadant's date of death.
$. A joint account is taxable even though the decadent's name ems added as a matter of convenience.
&. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death ara fully taxable as transfers.
5. Accounts established jointly between husband and wife more than Dna year prior to death ara not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART ! TAXPAYER RESPONSE
l. BLOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an
in black "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1Sq8 EX) upon receipt of the return from the Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part i of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxssj Dept ZBO6OIj Harrisburg, PA 171gB-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions ars being claimed, check block "C" and complete Parts Z and
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15q& EX) upon receipt
of the return from the Register of Nills.
TAX RETURN - PART Z - TAX COMPUTATION
LXNE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after IZ/1Z/BZ: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 par transferee regardless of the value of
tho account or the number of accounts held.
Zf a double asterisk (xx) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to tho date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxabIe for joint assets established more than one year prior to the decedent's death:
I D~V~DED BY TOTAL NUMBER OF DI¥~DED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVXV~NG JOINT ONNERS
Example: A joint asset registered in the name of tho decedent and two other persons.
! D~V~DED BY 3 (JOINT ONNERS) DIYXOEB BY Z (SURVEYORS) = .~67 X 100 = 16.TX (TAXABLE FOR EACH SUR¥~VOR)
B. The percent taxable for assets created within one year of the dacadsnt's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I O~¥XOED BY TOTAL NUMBER OF SURg~V~NO JOINT X lO0 PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50g (TAXABLE FOR EACH SURVI¥OR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as etsrmined below.
Da~e of Death ] Spouse I Lineal Sibling Colle~era!
07/01/9q ~o ~2/$1/9q SX 6X ~5X 15X
0~/0~/9~ ~o 06/30/00 OX 6X ~X
07/0~/00 ~o presen~ OX q.~X~ ~X
wTha tax rate imposed on thl net ---~ .... ~ L,a~-z..~ t~= = ~a~;~ead child tuantv-one years of age ar younger at
death to or for the uss of a natural parent, an adoptive parent, ar a stepparsnt of the child is
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes ali children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood
ar adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART $ - DE~TS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper B I/Z" x ll". Proof of
payment aay be requested by the PA Department of Revenue.
F. ~..... -
E-143 EX {3-99) ~'~'~J"
Zip C~e
AEention: T/C .~
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG PA 17128-06~1
I,,,111,,,I,,,11,,I,I1,,I,I1,,,,1i,,11,,,,,,11,1,,11
COMMONWEALTH OF PENNSYLVANIA REV-1162 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 002306
KERR ANNA C
20 CONEWANGO AVE
WARREN, PA 16365
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold .......... - .......
03102573 $104.23
ESTATE INFORMATION: SSN: 167-36-7055
FILE NUMBER: 2103-0237
DECEDENT NAME: ECHELMEYER THOMAS A
DATE OF PAYMENT: 03/18/2003
POSTMARK DATE: 03/08/2003
COUNTY: CUM BERLAN D
DATE OF DEATH: 12/07/2002
TOTAL AMOUNT PAID: $104.23
REMARKS:
CHECK# 555
INITIALS: AC
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA REV-1162 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 002307
ECHELMEYER DOROTHY D
109 CONEWAGO AVE
WARREN, PA 16365
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
03102572 $39.09
ESTATE INFORMATION: SSN: 167-36-7055
FILE NUMBER: 2103-0237
DECEDENT NAME: ECHELMEYER THOMAS A
DATE OF PAYMENT: 03/18/2003
POSTMARK DATE: 03/08/2003
COUNTY: CUM BERLAN D
DATE OF DEATH: 12/07/2002
TOTAL AMOUNT PAID' $39.09
REMARKS:
CHECK//554.
INITIALS: AC
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA REV-1162 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 002454
RITZIE WALTER C
505 DEUBLER ROAD
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $6,500.28
ESTATE INFORMATION: SSN: 179-24-7863
FILE NUMBER: 2103-0337
DECEDENT NAME: RITZIE JULIA H
DATE OF PAYMENT: 04/16/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/28/2003
TOTAL AMOUNT PAID: $6,500.28
REMARKS: WALTER C RITZIE
CHECK//' 384
INITIALS: SK
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
I'~-1~.~- /.-~
COHHONWEALTH OF PENNSYLVANTA ~
BUREAU OF ZNDTVTDUAL TAXES
DEPARTNENT
OF
REVENUE
ZNHERXTANCE TAX DZVTSTON
DEPT. 280601
HARRISBURG, PA 17128-0601 NOT/CE OF /NHERTTANCE TAX
APPRAZSEHENT. ALLOHANCE OR DXSALLO#ANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS *Ev-~s4, EX AFP CeX-eS~
~S;~O'~ ~"f E&T~TE OF ECHELNEYER THOHAS A
DATE OF DEATH 12-07-2002
FXLE NUHBER 21 0:5-02:57
'03 AP~ ,28 ,~/'~D/~ CUMBERLAND
167-:56-7055
DOROTHY D ECHELHEYER ACN 0:3102572
109 CONEWANGO AVE
""i .... Amoun'l: Remit:~:ed
WARREN PA 16:565 (~,~rK-~ ~ ?'~ ~. ~jr~U?[
OUInb~a,qd E-o., PA
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-15~8 EX AFP [01-03)
NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLOWANCE OR DISALLOWANCE OF
DEDUCTZONS~ AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-28-2005
ESTATE OF ECHELHEYER THOHAS A DATE OF DEATH 12-07-2002 COUNTY CUHBERLAND
FILE NO. 21 0:5-02:57 S.S/D.C. NO. 167-$6-7055 ACN 0:5102572
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET ZNFORHATION
FINANCIAL INSTITUTION: NORTHWEST SAVINGS BANK ACCOUNT NO. 020185678
TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 04-09-199:5
Accoun~ Balance 5,211.55 NOTE: TO INSURE PROPER CREDIT TO
Percen~ Taxable X 0.166 YOUR ACCOUNT, SUBHIT THE
Amoun'c Sub.~ec~ 'co Tax 868.61 UPPER PORTION OF THIS NOTICE
Debts and Deduc~cions - .00 WITH YOUR TAX PAYHENT TO THE
Taxable Amoun:c 868.61 REGISTER OF WILLS AT THE
Tax Rate X .45 ABOVE ADDRESS. HAKE CHECK
Tax Due :59.09 OR HONEY ORDER PAYABLE TO:
**REGXSTER OF WILLS, AGENT.**
TAX CREDITS=
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
0:3-08-2005 CD002507 .00 $9.09
TOTAL TAX CREDIT 39.09
BALANCE OF TAX DUEI .00
INTEREST AND PEN. .00
TOTAL DUE .00
XF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" { CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR /NSTRUCTIONS. }
PURPOSE OF
NOTICE: To fulfill the requirements of Section Z140 of the Znheritanca and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 9140).
PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Hake chock ar money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Tnheritance and Estate Tax" (REV-1513). Applications are available at the Office of
the Register of Rills, any of the 25 Revenue District Offices or by calling the special 2~-hour answering service
for forms ordering: Z-800-$62-ZOr;O; services for taxpayers with special hearing and or speaking needs:
1-BOO-~,o,7-50ZO (TT only).
ODJECTTONS: Any party in interest not satisfied with the appraisement, alloaanca, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-lOZ~, OR
--electing to have the matter determined at the audit of ~e account of the personal represen~tJve, OR
--appeal to the Orphans' Court
ADHIN-
~STRATIVE
CORRECTIONS: Factual errors d~scovered on ~Js assessment ~ould be addressed in ~rJt~ng to: PA Department of Revenue,
~ureau of individual Taxes, ATTN: Post Assessment Rev[e~ Un~t, DEPT. Z80601, Harrlsburg~ PA 17128-0601
Phone (717) 787-6505. See page 5 of ~e booklet "Instruct~ons for [nherJtance Tax Re~rn for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
D~SCOUNT: if any tax due ~s pa~d ~[~Jn three (5) calendar months after the decedent's death, a five percent
discount of the tax paid ~s allo~ed.
PENALTY: The 15Z tax amnesty non-partlcJpatJon penal~ Js computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the f~rst day after the end of the tax amnesty per~od. Th~s non-part~c[patJon
penalty ~s appealable [n the same manner and in the the same t~me period as you ~ould appeal the ~x and interest
that has been assessed as [ndJcated on th~s not,ce.
ZNTEREST: ~nterest Js charged beginning ~Jth ~rst day of del~nquency~ or n~ne (9) months and one (1) day
from the date of death, to the date of payment. Taxes ~h~ch became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~.
A11 taxes ~h[ch became dellnquent on or after January 1, 1982 ~Jll bear interest at a rate ~hJch ~11 vary from
calendar year to calendar year ~th that rate announced by the PA Department of Revenue. The applicable
interest rates for 198Z through ZO0~ are:
interest Daily ~nterest Daily [nterest Da~ly
Year Rate Factor Year Rate Factor Yea~ Rate Factor
1982 ZOZ . 0005~8 ~987 9X . O00Zq7 1999 7Z . 00019Z
1985 16Z . 000~58 1988-~991 11X . 000501 ZOO0 8Z . 000219
198~ 11Z . 000~01 199Z 9X . O00Z~7 2001 9Z . O00Z~7
1985 15Z .000~56 1995-199~ 7Z . OO019Z ZOOZ 6Z .000~6~
1986 iOZ .O00Z7~ ~995-199B 9Z .O00Z~7 ZOO5 5Z .000~7
--Znterest Js calculated as folla~s:
ZNTEREST = BALANCE OF TAX UNPAZD X HUHBER OF DAYS DECZHgUEHT X DAZCY ZHTEEEST FACTOR
--Any Not,ce ~ssued after the tax becomes delinquent ~11 reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. [~ payment Js made after the ~nterest computation date ~o~n on the
Notice, additional ~nterest must be calculated.
CONNONNEALTH OF PENNSYLVAN~A
BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE
INHERITANCE TAX DIVISION ~'
DEPT. ZBO60Z '~
NOTICE OF INHERITANCE TAX ~&~
HARRISBURG, PA 17128-0601
APPRAISENENT, ALLO#ANCE OR DISALLONANCE~-*
OF DEDUCTIONS, AND ASSESSNENT O~ TAX ON
JOINTLY HELD OR TRUST ASgJ~ ~/ ~.~ ~,. REV-1Oq8 EX AFP C01-0S)
DATF~'.,,. '"'Tr'o.~- 28- 20 05
E ST,,~,_ ,~,,,.~l,. F ~HEYER THOHAS A
DA~D~ATH 12-~92
COUNTY ~/?,~BERLAND
SSN/DC
ANNA C KERR ACN ~57~
APT A Amount~ Remi~ed
20 CONEHANGO AVE
HARREN PA 16~65
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701~
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
REV-15~8 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE O~-Z8-ZO0$
ESTATE OF ECHELHEYER THOHAS A DATE OF DEATH 12-07-2002 COUNTY CUHBERLAND
FILE NO. 21 05-0257 S.S/D.C. NO. 167-$6-7055 ACN 0~102575
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET ZNFORNATION
FINANCIAL INSTITUTION: NORTHNEST SAVINGS BANK ACCOUNT NO. 020185678
TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TINE CERTIFICATE
DATE ESTABLISHED 0~-09-1995
Account: Balance 5,211.55 NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBNIT THE
Amoun~ Subject ~co Tax 868.61 UPPER PORTION OF THIS NOTICE
Debts and Deduct/ons - .00 NITH YOUR TAX PAYHENT TO THE
Taxable Amoun~c 868.61 REGISTER OF I/ILLS AT THE
Tax Ra4:e }( .12 ABOVE ADDRESS. HAKE CHECK
Tax Due 10~.25 OR HONEY ORDER PAYABLE TO:
**REGISTER OF NZLLS, AGENT."
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
05-08-2005 CD002~06 .00 lOq. Z$
TOTAL TAX CREDIT ] 10~.Z$
BALANCE OF TAX DUEl .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
PURPOSE OF
NOTICE: To fulfill the requirements of Section Z14O of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF HILLS, AOENT.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-1315). Applications ara available at the Office of
the Register of Mills, any of the 23 Revenue District Offices or by calling the special 2q-hour answering service
for forms ordering: 1-B00-362-2050; services for taxpayers aith special hearing and or speaking needs:
l-BOO-4qT-30ZO (TT only).
OBJECTTONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object mithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-IOZi, OR
--electing to have the matter determined at the audit of the account of tho personal representative, OR
--appeal to the Orphans' Court
ADMTN-
ISTRATIYE
CORRECTTONS: Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Tndividual Taxes, ATTN: Post Assessment Revise Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See paRe S of the booklet "Instructions for Tnharitance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid eithin three (3) calendar months after the decedent's death, a five percent (5Z)
discount of the tax paid is allowed.
PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
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 which became delinquent before January 1, 1982
bear interest et the rate of six (67.) percent per annum calculated at a daily rate of .O0016q.
AIl taxes ahich became delinquent on or after January 1, 1982 will bear interest at a rate ahich aiil vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
XQBZ 207. .0005q8 1987 97. .0002q7 1999 77. .000192
1983 167. .O00q3B 1988-1991 117. .000301 2000 87. .000219
198q* 117. .000301 1992 97. . O00Zq*7 ZOOI 97. . O002~*7
1985 137. .000356 1993-199q* 77. .000192 200 Z 67. .00016q*
1986 107. . O00Z7q* 1995-1998 97. .0002q7 2003 57. .000137
--Interest is calculatmd as follaas:
I'NTEREST = BALANCE OF TAX UNPA'rD X NUMBER OF DAYS DEL/NI;IUENT X DA/L¥ 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 shoan on the
Notice, additional interest must be calculated.
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Thomas A. Echelmeyer ~ No. (~/'0~- ~-~ 7
also known as Thomas A4=b~m~ Echelmeyer ~
, Deceased Social Security No. 167- 36- 7055
Debra A. Echelmeyer
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix named in the last Will of
the Decedent, dated 10/18/1990 and codicil(s) dated
- none
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
- no exceptions
B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.ta; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I Name Relationship Residence
(COMPLY- I~- IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family
or principal residence at 810 Creek Road, West Pennsboro Township
(list street, number, and municipality)
Decedent, then 56 years of age, died 12/07/2002 at Carlisle Regional Medical Center, PA
(Location)
Decedent 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: (litigation) TOTAL $
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
I .-, ,, Sianature Typed or printed name and residence
~ DeLta A.
~ ;~( _ 810 Creek Road, Carlisle, PA 17013
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ~/ day of
For the. Register
/
Estate of Thomas A. Eche].meyer Deceased
Social Security No: 167- 36- 7055 Date of Death: 12/07/2002
AND NOW, ~'/~ ~-:-:)/:~/~. Z.~- ~/': ~ , .~r'>_ _'~ , in consideration
( -" .
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary [~ Of Administration
(c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Debra A. Echelmeyer
in the above estate and that the instrument(s) dated 10/18/1990
described in the Petition be admitted to probate and filed of record as the last Will of Decedent
FEES
Letters ........... $ 18.00 _~/~.~ .~ ~ _,/~ ~i j~.,
( Register of Wills _~
Short Certificate(s)...1.. , 3. O0
,/
Renunciation ........ $ Attorney: Edward P. Seeberr Esq.
Affidavits ( ) .... $ I.D. No: 76084
James Smith Dietterick Connelly
Extra Pages ( 8 ) .... $ 24.00 Address: 134 Sipe Avenue
Codicil ........... $ Hummelstown, PA 17036
JCP Fee .......... $ 10.00 Telephone: 717/533-3280
Inventory .......... $
Other ........... $
TOTAL ......... $ 55. O0
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
105.905MS REV.(09/01!
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Robert S. (Zim4nerman, Jr., MPH Charles Hardester
Secretary of Health State Registrar
0229917 JAN 0 2 200]
No. Date
COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Thomas A. Echelmeyer ,.Male ,.167 -- 36 -- 7055 ~December 7, 2002
This is an original will.
Any alterations or erasures
may make i~ void. DO NOT
attempt to change it without
LAST WILL AND TESTAMENT
consulting your Legal
Assistance Officer or your 0F
Lawyer.
THOMAS ALBERT ECHELMEYER
Being of lawful age and sound and disposing mind and memory and not acting
under any duress, fraud, undue influence or inducement of any person, I, THOMAS
ALBERT ECHELMEYER, a domiciliary of Carlisle, Pennsylvania:
ITEM 1
Hereby make, publish, and declare this my last Will and Testament, revoking
and rendering null and void other Wills and codicils heretofore made by me.
ITEM 2
I direct that my Executor to pay the following as soon after my death as
may be practicable:
a. All of my just debts and the expenses of my last illness, funeral and
of the administration of my estate; but my Executor need not accelerate and pay
those unmatured obligations which, in his opinion, it might be proper and more
advantageous to retain or renew and pay as they be come due and payable.
b. All inheritance, transfer, estate and similar taxes (including interest
and penalties) assessed or payable by reason of my death, on any property or
interest in my estate for purpose of computing taxes. My Executor shall not
require any beneficiary under this will to reimburse my estate for taxes paid
on property passing under the terms of this will.
ITEM
TESTATOR - The term "Testator" as used in this Will refers to the maker of this
Will, whether male or female.
EXECUTOR - The term "Executor" as used in this Will refers to the person I
appoint to execute this Will, whether male or female.
SURVIVAL - Whenever a provision of this Will conditions a beneficiary's taking
by that beneficiary surviving the Testator, such condition of survival shall be
construed as a condition precedent to the validity of the gift, devise or
bequeath; and such condition shall be satisfied only upon survival by the
beneficiary for a period of thirty days after the date of death of the Testator
or until this Will is probated, whichever shall be the first to occur, unless
expressly stated otherwise in a provision of this Will.
SPOUSE - The term "Spouse" as used in this Will refers to DEBRA ANN MACOMBER
ECHELMEYER.
PAGE ONE OF EIGHT PAGES
CHILDREN - The term "children" as used in this Will shall include any children
hereafter born to or adopted by me, and any minor stepchildren living with me
at the time of my death, as well as the children I now have, THOMAS E.
ECHELMEYER, BRIAN W. ECHELMEYER, and STEPHANIE ANN ECHELMEYER, unless expressly
stated otherwise in some provision of this Will.
MINOR - The term "Minor" as used in this Will means a person under 2! years of
age.
DESCENDANTS - The term "Descendants" as used in this Will means the immediate
and remote lawful lineal descendants or offspring by blood or adoption of the
person referred to who are in being at the time they must be ascertained in
order to give effect to the reference to them.
PER STIRPES - The term "Per Stirpes" as used in this Will means that whenever
distribution is to be made per stirpes, the estate or portion of the estate, to
be so distributed, shall be divided into as many shares as there are surviving
heirs in the nearest degree of kinship to the decedent and deceased persons in
the same degree of kinship who left issue who survive the decedent. This
degree of kinship shall be termed the root generation. Each surviving heir in
the root generation shall take one full share. Those remaining heirs, i.e. the
surviving issue of the deceased persons in the root generation, shall take the
share of their deceased ancestor in the root generation, such share being
divided in the following manner: each surviving issue shall take the
fractional share that his or her immediate ancestor would have taken had he or
she survived; and when there are two or more such surviving issue in the same
degree of kinship they shall divide such fractional share equally among them.
PER CAPITA - The term "Per Capita" as used in this Will means that whenever
distribution is to be made per capita, the estate or portion of the estate, to
be so distributed, shall be divided into as many equal shares as there are
surviving issue, standing in the same degree of kinship to the decedent.
Distribution shall be made without reference to right of representation of the
surviving issue.
ISSUE - The term "Issue" as used in this Will means all persons who are
descended from the person referred to, either by legitimate birth to or
adoption by that person or any of that descendant's legitimately born or
legally adopted descendants.
INTENTIONAL OMISSION - ! have intentionally omitted to provide for any relative
or other person, not named as a beneficiary, under this my Last Will and
Testament, whether claiming to be an heir of mine or not, unless otherwise
provided for in this my Last Will and Testament.
PAGE TWO OF EIGHT PAGES
ITEM 4
It is my specific intention and direction that STEPHANIE ANN ECHELMEYER,
or her issue, not share in the ownership, possession or control of any portion
whatsoever of my estate. She is to be excluded from any further reference of
children in this will. In case such provision is invalid by law, it is my
specific intention and direction that STEPHANIE ANN ECHELMEYER share in my
estate only to the extent required by law.
ITEM 5
I hereby give, devise and bequeath all the rest, residue and remainder of
my said estate and property of which I may die seized and possessed, and to
which I may be entitled at the time of my death, of whatsoever kind and nature,
and wheresoever it may be situated, be it real, personal or mixed including any
power of appointment that I may have, absolutely and in fee simple forever to
my spouse, if surviving. I make this gift to my spouse, specifically excluding
any present afterborn, or adopted children.
ITEM 6
In the event that my spouse shall not survive me, I hereby give, devise
and bequeath all the rest, residue and remainder of my said estate and property
of which I may die seized and possessed, and to which I may be entitled at the
time of my death, of whatsoever kind and nature, and wheresoever it may be
situated, be it real, personal or mixed including any power of appointment that
I may have, absolutely and in fee simple forever to THOMAS E. ECHELMEYER AND
BRIAN W. ECHELMEYER, who shall survive me, in equal shares, and to the issue,
living at my death, of THOMAS E. ECHELMEYER AND BRIAN W. ECHELMEYER, if they
shall predecease me, per stirpes and not per capita.
ITEM 7
Notwithstanding the foregoing provisions, in the event that any Legatee or
Beneficiary named herein is a minor at the time herein affixed for distribution
of his or her share, I hereby give, devise and bequeath the share of said
Beneficiary to my Trustee, named herein, to hold and manage for said
Beneficiary in accordance with the provisions of the Will.
The named Trustee or any Trustee appointed by the court shall have all the
powers, rights, and privileges as the owner of such property would, subject to
the reasonably prudent individual rule with regard to investments and the
fiduciary responsibilities imposed upon Trustees.
PAGE THREE OF EIGHT PAGES
The Trustee, in his or her sole discretion, shall pay, either in cash or
in kind, all or any part of the net income or corpus of each Beneficiar¥'s
share in the trust estate to or for the benefit of such Beneficiary to provide
for his or her support, welfare, education, and health; and shall accumulate
and add to the corpus any undistributed income from each Beneficiary's share of
the trust estate. The Beneficiary's share of the trust estate shall be
distributed to him or her free of this trust when he or she is no longer a
minor.
Should any Beneficiary hereunder die while a minor~ then such
Beneficiary's share of the trust estate, together with any accumulated income
h~l pass free of this trust to this Beneficiary s issue who survive this
Beneficiary.
if any deceased Beneficiary fails to leave surviving issue, this
Beneficiary's share of the trust estate, together with any accumulated income~
shall be divided equally among and distributed to my then living descendants
and children; but provided further that if any such descendants or children
shall then be a Beneficiary under this trust~ such descendant's or child's
portion of the deceased Beneficiary's share shall not be distributed to him or
i~er outright but shall be added to his or her share of the trust estate.
Any Trustee named herein shall not be required to furnish bond or other
security. This provision does not apply, however~ to any court-appointed
Trustee.
t nominate and appoint the below-named individual as my Trustee, or
alternate Trustee should the named Trustee for any reason refuse or be unable
to serve or to continue serving as my Trustee. Except as otherwise provided by
law~ my Trustee shall not be required to qualify or file any account during the
administration of the trust~ but shall render, at least annually, to the
current Beneficiary or Beneficiaries, a listing of all investments and
~ransactions undertaken during that year.
a. Trustee: WENNONAH P. MACOMBER
b. Alternate Trustee: CHARLES H. ANDERSON~ JR.
ITEM 8
I hereby appoint DEBRA ANN MACOMBER ECHELMEYER as Executor of my Will.
my Executor fails to serve, or for any reason fails to continue to serve, i
then appoint EDWARD H. MACOMBER to serve as Executor.
PAGE FOUR OF EIGHT PAGES
ITEM 9
i designate my Executor to be an independent Executor to the fullest
extent permissible under the laws of the State of Pennsylvania. I direct that
no bond or other security be required. I further direct that no action be had
in any court relative to the administration of my estate other than to prove
and record this Will and to return an inventory, appraisal and list of claims
of my estate.
iTEM 10
In the event that my spouse should predecease me and I should die leaving
a minor child or children surviving me, I hereby appoint the below-named
individual to serve as designated guardian, or Alternate guardian should the
named guardian be unable or unwilling to serve, or to continue to serve, as
such, of the person and property of each minor child of mine who should survive
me~ during his or her minority:
a. Guardian: WENONAH F'. MACOMBER
b. Alternate Guardian: CHARLES H. ANDERSON, JR.
No Bond shall be required of any Guardian named in this Will.
ITEM 1t
My Executor and/or Trustee, if applicable, shall have the following
powers~ which are to be construed in the broadest manner consistent with the
validity of this Will and with their duties as fiduciaries. The powers stated
herein are r~ot intended to be exclusive, but shall be in addition to those
granted by law and shall also pertain to any administrators or trustees who
succeed the fiduciaries I have appointed. These powers are:
a. to take possession of property, to keep it safely, and to segregate it
from other property owned or held by the fiduciary;
b. to retain and to invest in property, or an undivided interest in
property, including residential real estate, for any period, whether or not the
property be of the character permissible for investment by fiduciaries;
c~ to sell, transfer, exchange, lease, rent, mortgage, pledge, give
options upon, partition and otherwise dispose of real or personal property, at
private or public sale~ for cash or upon whatever terms the fiduciary deems
advisable, without notice or order of court;
d. to render liquid my estate, in whole or in part, and to hold cash or
readily marketable securities of little or no yield for such period as my
fiduciary deems advisable;
PAGE FIVE OF EIGHT PAGES
e. to borrow in the name of my estate or of the trust, upon whatever
terms and conditions and for whatever periods my fiduciary deems advisable for
the purpose of preserving, protecting or improving property held by him;
f. to pay, compromise, adjust, settle, compound, renew or abandon claims
held by my fiduciary and claims asserted against my fiduciary, on whatever
terms he deems advisable, without prior court authority;
g. to distribute in cash or in kind, or partly in cash and partly in
kind, in divided or undivided interests, notwithstanding the fact that
distributive shares may as a result be composed differently;
h. to insure the property he holds as fiduciary against the risks, and in
the amounts he, in his discretion, deems expedient, and to obtain and pay for
life, health, liability and other forms of insurance for the beneficiaries of
the trust, in his discretion;
i. to employ attorneys, accountants, investment advisors and other
professional assistants including depositaries, proxies, agents, and
appraisers;
j. to enter into transactions with other fiduciaries including executors
or trustees of estates and trusts in which my beneficiaries have an interest,
and including him as fiduciary for other estates and trusts;
k. to engage in the powers necessary to the effective administration of
corporate securities, including, without limiting the generality of this power:
1. power to vote in person or by proxy upon all securities held by
the fiduciary:
2. power to engage in a voting trust or voting agreement with respect
to securities;
3. power to consent or become a party to , or participate in,
mergers, consolidation, sales of assets, recapitalization, reorganizations,
dissolutions or other alterations of corporate structure, including adjustments
in capital structure affecting securities held by the fiduciary, whether or not
these adjustments involve payments by or to the fiduciary; and
4. power to hold securities in unregistered form or in the name of a
nominee;
1. to pay himself reasonable compensation for his services.
PAGE SlX OF EIGHT PAGES
ITEM 12
If any part of this Will, or any trust hereby created, shall be invalid,
illegal, or inoperative, for any reason, it is my intention that the remaining
parts, so far as possible and reasonable, shall be effective and fully
operative. My Executor may seek and obtain court instructions for the purpose
of carrying out as nearly as may be possible the intention of this Will shown
by the terms hereof, including the term held invalid, illegal or inoperative.
ITEM
Either I or my spouse have served in the Armed Forces of the United
States. Therefore, I direct my Executor to consult the Legal Assistance
Officer at the nearest military installation to ascertain if there are any
benefits to which my estate or my descendants are entitled by virtue of such
service. Regardless of my military status at the time of my death, I direct my
Executor to consult with the nearest Veteran's Administration Office to
ascertain if there are any benefits to which my survivors may be entitled.
ITEM 14
My spouse and I may, at approximately the same time, execute similar Wills
in which each of us is the recipient of the other's bounty to a greater or
lesser extent; however, such Wills are not the result of any contract or
agreement between us, and either Will may be revoked or amended at any time at
the sole discretion of the maker thereof.
ITEM 15
I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific
persons. I urge my Executor and beneficiaries to respect these wishes. Such a
memorandum, if made, shall be stored in conjunction with this Will.
PAGE SEVEN OF EIGHT PAGES
IN WITNESS WHEREOF I have hereunto set my hand and seal in, the presence of
the wit_nes~es, whose names appear hereafter, published this x/~ ~----day
(SEAL)
ATTESTATION
Testator, personally Published and Declared the foregoing Last Will and
Testament, in the presence of each of us and all of us together, who, at the
Testator's request, personally witnessed the Testator Sign and Seal the same.
We then, at the Testator's request, and in the presence of the Testator and of
each other, also signed each page of the said document as witnesses. We
further state that each of us believes that at the time the Testator executed
the foregoing instrument said Testator was of sound mind and memory, of lawful
age, and did so execute it as a free act and deed and not under the unlawful
influence of any person.
PAGE EIGHT OF EIGHT PAGES
Commonwealth of Pennsylvania Self-Proving Clause
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, THOMAS ALBERT ECHELMEYER, 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 that I signed it as my free and voluntary act for
T~O~A~~ ~C~ERY ECHELMEYE~
Sworn or affirmed to and acknowledged befo~e~me, by_THOMAS
ALBERT ECHELMEYER, the Testator, this .~~ ~~ .
Notary
?mr~ ~ Pub~
S T~TE OF F'ENNSYL V~N ~ A ~m~ P~nsY~iaA~a~on of Nb~es
COUNTY OF CUmBERLaND
and ~.~.~ ~. ~~ J the witnesses whose names are signed to
the attached Or"~oreg~ing instrument, being duly qualified
according to law, do depose and say that we were present and saw
the Testator sign and execute this Will as his Last Will; that
THOMAS ALBERT ECHELMEYER signed willingly and that THOMAS ALBERT
ECHELMEYER executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the Will as witnesses; and that to
best o~ our Rnowledge the Testator was at that time eighteen (18)
or more years of age, of sound mind and under no constraint
undue influence.
WITNESS
.~worn or affirmed to and s~bscFibed to before me
~ P~ ~on of No~
estament
THO14AS ALBERT ECHELHEYER
OFFICE OF THE POST JUDGE ADVOCATE
CARLISLE BARRACKS, PA. 17013-5002
CBKS (SJA) FORM 1038-R
DEC 88
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Thomas Albert Echelmeyer
Date of Death: December 7, 2002
Wild No.: Admin. No.: 2003-00237
TO THE REGISTER OF WILLS OF CUMBERLAND COUNTY:
I certify that Notice of Estate Administration required by Rule 5,6(a) of the Orphans'
Court Rules was served on or mailed to the fbllowing beneficiary of the above-captioned estate
on September 12, 2003 ·
Name Address
Debra A. Echelmeyer 810 Creek Road, Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
- no exceptions -
Date: 77~/,) 5 Signature: ///~1/~~~( ~ j
Name: c Edward P. Seeber, Esq.
Address: James, Smith, Dietterick & Connelly LLP
134 Sipe Avenue
r-- Hummelstown, PA 17036
?~? Telephone: (717) 533-3280
~- .
~,,'-... Capacity: Personal Representative
~- X Counsel for Personal Representative
H 51 IOM E\ES E\Echelmeyer\Thomas06.doc
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 2002-00237
Estate of JAMES G. COX
PRAECIPE FOR WITHDRAWAL AS ATTORNEY
AND NOW, this l0th day of March, 2004, upon consideration that Brett B.
Weinstein, Esquire would request that his name be removed as the attorney for the
Estate of James G. Cox. It is therefore requested that this praecipe to withdraw, is
hereby approved.
BY THE COURT,
..mr. .
STATUS REPORT UNDER RULE 6.12
Name of Decedent: THOMAS ALBERT ECHELMEYER
Date of Death: December 7, 2002
Will No. Admin. No. 2003-00237
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 X
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: December 31, 2005
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 Orphan's 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
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and
may be attached to this report.
}~, ~Effward P. Seeber, Esquire
'- JAMES, SMITH, DIETTERICK & CONNELLY
~ 57 134 Sipe Avenue
Hummelstown, PA 17036
~:--~ (717) 533-3280
Capacity: __ Personal representative
X Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/10/2004
SEEBER EDWARD P
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
RE: Estate of ECHELMEYER THOMAS ALBERT
File Number: 2003-00237
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 12/07/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
SEEBER EDWARD P
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
RE: Estate of ECHELMEYER THOMAS ALBERT
File Number: 2003-00237
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/07/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~J /,C! ,/.S;::,... I k~ -' k#_fJ
~a:._. ''- ,,^',"<,2A../ ,,"'I/L'.:.<JA'-;::r'""
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
vt
J\\II.. ~\IIIII 1)111111,ll 1\ l\.:: ((\""111'\ Ill) 1 \11 ()/ I I( I" J.S.).(
November 1, 2005
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Thomas Albert Echelmeyer, deceased
No. 2003-00237
Dear Ms. Strasbaugh:
Enclosed are an original and one (1) copy of the "Status Report" to be filed in the
above-referenced Estate. Please time-stamp the copy and return it to me in the
enclosed self-addressed, stamped envelope.
If you have any questions, please feel free to contact me.
CJb-
Ch r . Baker, CP
Certified Paralegal
Enclosures
cc:
Debra A. Echelmeyer, Executrix
THE
ESTATE
SECURITY
FORMULA",
Cheryl L. Baker, CP
Certiflcd Paralegal
clb@jsdc.com
~--.)
c..:-:')
c-
C)
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
MAILING ADDRESS
PO. BOX 650
HERSHEY, PA 17033
TOLL FREE 1.800.942.3660
TEL. 717.533.3280
FAX 717.533.7771
www.jsdc.com
LLi
(_.~;l
\1
\
STATUS REPORT UNDER RULE 6.12
Name of Decedent: THOMAS ALBERT ECHELMEYER
Date of Death: December 7. 2002
Will No.
Admin. No.
2003-00237
Pursuant to Rille 6.12 of the Supreme Court Orphans' Court Rilles, 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 X
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: December 31. 2006
3. If the answer to No.1 is Yes, state the following:
----
Date: }JIll /0 ~
I I
co
L__
--
i
~
If ".~~
If:>
(:,-:-:'7
c=,
C"-l
a. Did the personal representative file a final account with the Court?
Yes No
b. The separate Orphan's 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
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and
may be attached to this report.
~
Sign
Edw d . Seeber. Esquire
JAMES. SMITH. DIETTERICK & CONNELLY
134 Sioe Avenue
Hummelstown. P A 17036
(717) 533-3280
Capacity:
Personal representative
Counsel for personal representative
X
V{;"
INRE:
ESTATE OF THOMAS ALBERT
ECHELMEYER,
Deceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISON
NO. 2003-00237
WITHDRAWAL OF APPEARANCE
To the Register of Wills and Clerk of the Orphans' Court of Cumberland County:
Please Withdraw the Appearance of Edward P. Seeber, Esquire, of James, Smith,
Dietterick & Connelly, LLP, whose address is 134 Sipe Avenue, Hummelstown, P A 17036 as
ATTORNEY for the Estate of Thomas Albert Ec 1 r, deceased.
Date: 10 '71) k.
/
By:
L----
ard P. Seeber, Esquire
JAMES, SMITH, DIETTERICK & CONNELLY LLP
P A Supreme Court ID No. 76084
134 Sipe Avenue
Hummelstown, P A 17036
(717) 533-3280
ENTRY OF APPEARANCE
To the Register of Wills and Clerk of the Orphans' Court of Cumberland County:
Please Enter the Appearance of Edward P. Seeber, Esquire, of PECHT & ASSOCIA%S,
PC, whose address is Suite 200, 1205 Manor Drive, Mechanicsburg, P A 17055 as ATTORNEY
for the Estate of Thomas Albert Echelmeyer, deceased.
Date: /iJ jq I () b
II
-^--
dward P. Seeber, Esquire
PECHT & ASSOCIATES, PC
P A Supreme Court ID No. 76084
Suite 200
1205 Manor Drive
Mechanicsburg, P A 17055
(717) 766-9431
\/'
STATUS REPORT UNDER RULE 6.12
Name of Decedent: THOMAS ALBERT ECHELMEYER
Date of Death: December 7, 2002
Will No.
Admin. No.
2003-00237
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:
Y~ No X
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: December 31, 2007
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 Orphan's 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
"'~I\
r 1 ',-\ _ I .~\ lJ
\'r ' " . '0
; w '~," ~, ~. ' ,', ," '
\ ,'V\C'>', ' ~ ' ,"-\ '\'d
lLi! \' " ,-",'", '-'
U\ \...,.'"... --," ~i\
'\ \]....lJ 10
j"J l\w.J
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and
may be attached to this report.
./>~~--
( Si,gnature
Edward P. Seeber, Esquire
PEHCT & ASSOCIATES, PC
Suite 200, 1205 Manor Drive
Mechanicsburg, P A 17055
(717) 766-9431
Date: iI/dyCb
/
X
Personal representative
Counsel for personal representative
L Z :2 \J.d OS hQN ~unL
Capacity:
I .
-~ r\; j. ;,;""1.
::.Iv'U.J,-,1
1:
PECHT & ASSOCIATES, PC
Suite 200
1205 Manor Drive
Mechanicsburg, PA 17055-4894
Wayne M. Pecht
Member of California Bar
CPAlLLM in Taxation
Rob Bleecher
Herbert P. Henderson, II
Edward P. Seeber
November 29, 2006
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PAl 70 13
Re: Estate of Thomas Albert Echelmeyer, deceased
File No. 2003-00237
Dear Ms. Farner Strasbaugh:
Telephone: 717-766-9431
Fax: 717-766-3361
e-mail: cbaker@.pechtlaw.com
Enclosed are an original and one (1) copy of the Status Report to be filed in the above-referenced Estate. Please
time-stamp the copy and return it to me in the enclosed self-addressed, stamped envelope.
If you have any questions, please feel free to contact me.
Very truly yours,
PECHT & ASSOCIATES, PC
~Q~~
Chear2. ~aker, CP
Certified Paralegal
Enclosures
J ' 1(.... /""', ,"", ._: ~
loa IU.) 3.1 Iv Hd!::iO
'.~ '. ,. '---I"
,]\) ;'i(jj IV
9 2 :2 ~td 0 S !\ON 9DflZ
Elizabethtown Office
55 West High Street
Elizabethtown, PA 17022
717-367-2800 office
717-367-9400 facsimile
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/14/2007
8
~~
co
~. p
r- m
~~:o
",,- (F> ^
OQo
8~'"
;;~
)i
~
c:::o
c:::o
-...
:z:
<=>
<e::
SEEBER EDWARD PETER ESQUIRE
SUITE 204
5020 RITTER ROAD
MECHANICSBURG, PA 17055
(J1
C) C)
-', ~ ~;::'1
~~j
>>-
:z
~
<=>
N
RE: Estate of ECHELMEYER THOMAS ALBERT
File Number: 2003-00237
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/07/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~J [~ . .Li-:: . L"d pi
,,(~;II<L t~~MA.JWZ~~./
/' /
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (71 7) 240 - 6345
810 CREEK ROAD
CARLISLE, PA 17013
2
~..o
0):0
m42(")
f2~r-
~. .2: ~
1Ii;;... -
~,:: C/)
0(")0
88"
:D~
:J>
,..."
=
<::::)
....,
z
o
-::
:"T.J
p~~:i t-1 ..~
c;-) C)
(>0>) ~.],-J
"~I CJ
f'";") r'j'J
::. i~) C:J
Date: 11/14/2007
ECHELMEYER DEBRA ANN MACOMBER
NKA
U1
:bIoo
:x
'!?
o
N
5;;~ S~i
...- .1
f~~
....?,"')
~'~t'~.
RE: Estate of ECHELMEYER THOMAS ALBERT
File Number: 2003-00237
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/07/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~J - ~ !t-J tl
),liU~6-t, t~;Zf'AJ .ldf~
/' ,1
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
STATUS REPORT UNDER RULE 6.12
Name of Decedent: THOMAS ALBERT ECHELMEYER
Date of Death: December 7. 2002
Will No.
Admin. No.
2003-00237
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 X
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete: December 31. 2008
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 Orphan's 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
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to
this report.
i ature
ward P. Seeber. Esquire
JAMES. SMITH, DIETTERICK & CONNELLY. LLP
Suite 200. 1205 Manor Drive
Mechanicsburg. P A 17055
(717) 533-3280
Date:~
'~id "'J
~ I ~J >:':.:<. rj ,J,' r.-:',' ; /, 'iI I
.....0' ItAI ,,"i\vl;ddO
jO )lbJJ:J
90 : /I WV 9- :130 LODl Capacity:
X
Personal representative
Counsel for personal representative
~':-j ~T'''''\_1.J:r, r'[u-'r ';,('\': "+>
,..,.1 .."J,J..lV u:Jud,J\.cC)
~
'. . ',
15056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year Flle Number
Bureau of Individual Taxes INHERITANCE TAX RETURN a 1 0 3 0 x 3 7
PO BOX.280801
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
167 36 7055 1a 07 aooa 11 03 1946
Decedent's Last Name Suffix Decedent's First Name MI
ECHELMEYER THOMAS A
(ff Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
ECHELMEYER DEBRA
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Retum
4. Limited Estate
8, Decedent Died Testate
(Attach Copy of Will)
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum ~ 3. Remainder Retum (date of death
prior to 12-13-82)
qa, Future Interest compromise ~ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
~_ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 p, Spousal PoveM Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and i-1-95) ~ (Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
EDWARD P. SEEBER 717 533 3x80
Firm Name (If Applicable)
JAMES, SMITH, DIETTERICK Sc
First line of address
SUITE C-400, 555 GETTYSBURG
Second line of address
City or Post Office State ZIP Code
MECHANICSBURG PA 17055
REGISTER OF~LLS USE O~Y
Tc7 ~~ _.
:~
~, n ~~
rr ; G.J
_-, c~
J ~ /\
DATF~II5ILED
c,-
C3~
1
i-'}
~-_~''
•.. 1
Correspondent's a-mail address: e P s Gl S d C. C O m
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 pre~arer other than the personal representative is based on all information of which preparer has any knowledge.
ADDRESS
Debra Echelmeyer
810 C Road, Carlisle, PA 17015
SIG R PREPARER OTHER THAN REPRESENTATNE pA~
Edward P. Seeber _ 6~ I ~ ~ U
"Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055
Side 1
15056041147 15056041147
J
REV-1500 EX
15056042148
oecedeorsName: Thomas Albert Echelmeyer
Decedents Social Security Number
167 36 7055
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4.
5• Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) ....................................................................... g,
9. Funeral Expenses i3< Administrative Costs (Schedule H) ......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
11. Total 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 made (Schedule J) ................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) x .o0 13 8 , 2 81.2 3 15.
16. Amount of Line 14 taxable
at lineal rate X .045 Q ~ Q Q 16.
17. Amount of Line 14 taxable
at sibling rate X .12 Q . Q Q 17.
18. Amount of Line 14 taxable
at collateral rate X .15 Q . Q Q 18.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
aao,ooo.oo
aao,ooo.oo
96,501.77
5,a17.oo
101,718.77
138,281.23
138,281.23
0.00
0 . 0 0
0 . o 0
o . 0 0
0.00
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-03-0237
DECEDENT'S NAME
Thomas Albert Echelmeyer
STREET ADDRESS
810 Creek Road
CITY
Carlisle STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
g. Prior Payments
C. Discount
3. InterestlPenalty if applicable
p, Interest
E. Penalty
0.00
Total Credits (A + B + C)
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 2 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.
q. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1) 0.00
(2) 0.00
(3)
(4)
(5) 0.00
(5A)
(56) Q . Q
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; .................................................................................. ^ ^x
b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x
c. retain a reversionary interest; or .................................................................................................................. ^ 0
d. receive the promise for life of either payments, benefits or care? .............................................................. ^ ^x
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?......... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which
contains a beneficiary designation? ...................................................................................................................... ^ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [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 zero
(0) percent [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 zero (0) percent [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 four and one-half (4.5) percent,
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 twelve (12) percent [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-7508 tJ(+ (8-88)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
corYaytoNwEA~rH of vENNSVI.vANw
INHERRANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF (FILE NUMBER
Echelmeyer, Thomas Albert 21-03-0237
Include the proceeds of Ikigatan and the date the proceeds were received by the estate.
All property Jolnty-owned with tM right of wrvNarship must bs dlselossd on uhedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Echelmeyer, Thomas Albert 21-03-0237
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorneys Fees James, Smith, Dietterick & Connelly, LLP 1,500.00
3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) 3,500.00
Claimant Debra Echelmeyer
Street Address 810 Creek Road
city Carlisle state PA zip 17015
Relationship of Claimant to Decedent SpOUSe
4. Probate Fees 405.00
5. Acx:ountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 91,096.77
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 96,501.77
Copyright (c) 2002 form software only The Lackner Group, Inc. Form P/~1500 Schedule H (Rev. 6-98)
Rev-1502 E)(+ (688)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H-BT
OTHER
ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Echelmeyer, Thomas Albert 21-03-0237
ITEM
NUMBER DESCRIPTION AMOUNT
1 Anapol Schwartz Weiss Cohan Feldman and Smalley PC -attorney fees attributed 84,000.00
to survival action
2 Anapol Schwartz Weiss Cohan Feldman and Smalley PC -attorney expenses 7,066.77
attributed to survival action
3 Register of Wills, Cumberland County -filing fee for Return & Inventory 30.00
Subtotal ~ 91,096.77
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PM7500 Schedule H-67 (Rev. 6-98)
Rw-7512 EX+ (8.95)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
coMMONwEUTr of PENNSnvANw
MNERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Echelmeyer, Thomas Albert 21-03-0237
loclude unrelmbureed medlcel experaee.
Form P/~1500 Schedule I (Rev. 6-98)
(If more space is needed, additional pages of Uie same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
. •~ ', ',
REV-7513 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Echelmeyer, Thomas Albert 21-03-02 37
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Tru s
I~ TAXABLE DISTRIBUTIONS [ndude outright spousal
d
f
ers
distributions, an
trans
under Sec. 9116(a)(1.2)]
Debra Echelmeyer Spouse Residue 138,281.23
810 Creek Road
Carlisle, PA 17015
Total 138,281.23
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropri ate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule J (Rev. 6-98)
June 27, 2008
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Squaze
Carlisle, PA 17013
Re: Estate of Thomas Albert Echelmeyer, deceased
File No. 2003-00237
Dear Ms. Farner Strasbaugh:
Enclosed are an original and two (2) copies of the Pennsylvania Inheritance Tax
Return and Inventory, along with a check for Thirty Dollazs ($30.00) representing the
filing fee, to be filed in the above-referenced Estate. Please time-stamp the extra
copies and return them to me in the enclosed self-addressed, stamped envelope.
If you have any questions, please feel free to contact me.
Very truly yours,
JAMES, SMITH, DIETTERICK & CONNELLY, LLP
C L. Baker, CP
ert' ed Pazalegal
THE
ESTATE
SECURITY
FORMULA,..
Cheryl L. Baker, CP
Certified Paralegal
clb@jsdc.com
Enclosures "~
r~
-
-O <
~,
cc: Debra Echelmeyer, Executrix _.
'- ~
~
~
,
-
t_. ~
- r , r, ca
-' O : f .
"
~' f.__i "
I~
.~U
.- d~V ~_. '
_
~ ~J
134 SIPE AVENUE
Reply to• Suite C-400
• HUMMELSTOWN, PA 17036
555 Ge sbur Plke
"
g MAILING ADDRESS
J P.O. BOX 650
Mechanicsburg, PA 17055 HERSHEY, PA 17033
Direct Dial: 717-298-2094 TOLL FREE 1.800.942.3660
Direct Fa%: 717-298-2095 TEL. 717.533.3280
FAX 717.533.7771
www.jsdacom
~odxso~ sn
~~
~ ~~
m °O. ~. e
r. ",
z ~
d
a ~
b3~lSb'H
t_ ~..
-:~ ..._
t_'
C_:
f
~o
c~ 2
F-~'-
c~i
---, .--;
4 L!_ (-;
.._ ._i :.
[: ' ~^. __
L:. ~ .:-.1~. _
~~ ^_
....3 ~ = "
C~
~.~
t`-J
-_
W
H
H
W
Q
x
0
0
a~i ~
~o
~~
a~
aaa
a~~
~1
~1
.~
N
yOr
i~
c~ U
~ ~
~.~ ~O
~ O ~ ~
N U N ~
~ ~
~ ~~a
~d ~ ~ ~
~ ..
~ U c~
C7U~U
r-;
REGISTER OF WILLS OF
INVENTORY
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland } File Number 2003-00237
Debra Echeimeyer
Personal Representative(s) of the Estate of Thomas Albert Echeimeyer
deceased, depoise(s} and say(s) that the items appear
situate and all of the real estate in the Commonwealth
item of said inventory represents its fair value as of the
outside of the Commonwealth of Pennsylvania except
I verify that the statements made in this Inven-
tory are true and correct. 1 understand that falser state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unswom falsecation to
authorities.
Attorney - (Name)
(Firm)
(Address)
(Telephone)
Edward P. Seeber
in the following inventory include all of the personal assets wherever
Pennsyyl~vania of said Decedent, that the valuation placed opposite each
ate of tfte decedent's death, and that Decedent owned no real estate
-t which appears in a memo dum at the end of this inventory.
rte;
c7
Debra Echeimeyer =} T~~ c--
;.~ ~ --
~ t-- . _ ,
_ . ;, ! ,
..... _, ~
{ , ,,.
-. ~.~ -
.. .
--~
~,
(Supreme C~rtl.D. No.) ~? 76084
James, Smith, Dietterick & Connelly, LLP
Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055
7171533-3280
DJ-TE of ~~+ LAST RESIl1EPICE 810 Creek Road t~ECEOErms roc. sec. No.
12/07/2002 Carlisle, PA 17015 167-36-7055
FIGURES MUST BE TOTALED
Personal Procertv
Cash ...............................................................................................
Personal Property .........................................................................
StockslListed .................................................................................
Stocks/Closely Held ......................................................................
Bonds .............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable ...............................................
All Other Property ..................................................................
Total Personal Property ..............................
Total Real Property ................................................
Total Personal and Real Property .........................
240,000.00
240,000.00
~4Q,f10#IQO
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended Into the total of the Inventory. (See 20 Pa. C.S. § 330t (b))
r-orm RW-09 Rey. Tat~.zooe
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } ~
COUNTY OF Cumberland } File Number 2003-00237
DATE OF DEATH LAST RESIDENCE g10 Creek Road DECEDENTS SOC. SEC. NO.
12/07/2002 Carlisle, PA 17015 167-36-7055
Cash
Litigation proceeds received on 6/17/08 -civil proceeding docketed to 2004-601 240,000.00
Civil with the Cumberland County Court of Common Pleas -survival action
Total Cash
240,000.00
(Attach additional sheets if necessary) Total Personal Property and Real Estate 240,000.00
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: Thomas Albert Echelmeyer
Date of Death: 12/07/2002
File Number: 21-03-0237
Pursuant to Pa. O.C. Rule 6.12, 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: ^X 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 ^X 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
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of Orphans' Court and maybe attached to this report.
Dale 10~-15/2008 / " v
_ ~-'- S' atur o(Person Filing this Form
'r
i_ ; .
C acity: ^ Personal Representative ~ Counsel
r--
_ Edward P. Seeber #76084
~~~~ ~ ~~ ~ '-~'-- Name of Person Filing this Form
C_- Ll..
~_, c~ .-;
Suite C-400, 555 Gettysburg Pike
_ ~-? c ~
- :::.'~
Address
Mechanicsburg, PA 17055
City, State, Zip
7171533-3280
Telephone
Form RW-'IO Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-- irOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES - pppRATSEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX 28D601 - -
HARRISBURG PA 17128-0601 ~~~ REV-1547 EX AFP (06-05)
~~~~~ ~L~ 2G ~.~i ~~; ~~ DATE 09-22-2008
ESTATE OF ECHELMEYER THOMAS A
DATE OF DEATH 1;?-07-2002
~~-~^~ ~ ~-~'r FILE NUMBER 2]l 03-0237
'~ ~ ~ 'n~ COUNTY CUMBERLAND
EDWARD P SEEBER ^'s,~ , '~~-~ ACN lUl
JAMES ETAL APPEAL DATE: 11-21-2008
555 GETTYSBURG PIKE (See reverse side under Objections)
MECHANICSBURG PA 17055 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND [;0 COURT HOUSE
CARLISLE, P~\ 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
-------------------------------------------------------------------------------------------
REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ECHELMEYER THOMAS A FILE N0. 21 03-0237 A(:N 101 DATE 09-22-2008
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 24 0,000.00
6. Jointly Owned Property (Schedule F) C6) .00
7. Transfers (Schedule G) (7) .00
B. Total Assets (g) 240, 000.00
APPROVED DEDUCTIONS AND EXEMPTIONS: 96,501.77
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 5.217.00
11. Total Deductions (11) 1 Ol .718.77
12. Net Value of Tax Return (12) 138,281.23
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule „I) C13) .00
14. Net Value of Estate Subject to Tax C14) 138,281.23
NOTE: If an assessment was issued previously, lines 14, 15 and./or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate C1H) 138,281..23 X 00 _ .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) . 00 X 045 = . 00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 _ .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 _ .00
19. Principal Tax Due C19)= .00
TAY r`DCTTTC.
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT F'AID
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF T.AX DUE .00
INTEREST ANII PEN. , 00
TOTAL DUE .00 '~
C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND_ SFF REVERSE srnG nr Turc CnDM rno TAICTDIII~T TA.IC ,