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HomeMy WebLinkAbout03-0244 PETITION also known as Social Security No. FOR PROBATE and GRANT OF LETTERS No. 2.t- o -Mq Deceased. 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 execut ~ s- in the last will of the above decedent, dated /'~ ,'-c ~ / '7 and codicil(s) dated ~J~q ~ /7- I q q ~ in the named ,19. qO (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~. u~4/~et-/a rzcd County, Pennsylvania, with h ~ r- last family or principal residence at (list street, number and muncipality) Decendent, then c/'~/ . years of age, died m/'-~Occ~ arc< .Z/ , '1~, £O0.z~., at A-,Jo I'~ ,~o, ,:-,/' A/or::, ,o,/-~ I, ~c~,-~ ,,~ l,,/_.~'zl. Except as t~ollo~s, decedent dic~ not marry, was not dtvorced 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ?D-D. oo0 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. 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 h COUNTY OF ~r,.~e_\o,r~-i f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief p~ petitioner(s)~and tha~t as personal represen- tative(s) of the above decedent petitioner(s) will well a~/l/truly ~dm¥¢fer the/~s~.J~ according to law. ~ ' // Sworn to or affirmed and subscribed ~ .g/~-- /~ /~--~ ~ before me this 1~ day of [ ' ~' Estate Of ~,',~ '-~ ~'~oc._~-,~.~,~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ ~-cV-x ~C) , ~)xt)0 ~ ~ , in consideration of the petition on the reverse side hereof, satisfacto~ proof having been presented before me, IT IS DEC~ED that the instrument(s) dated~X)',kk '..~-iq-qo ; C~,~,~ ~ ~' i~-q~ described therein be admitted to probate and filed of record as the last will of I ~d Letters ~ ~~ ~'~ eu ~e hereby granted to ~,& ~~~ O ct&', c', \FEES Probate, Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ ,3c~ TOTAL Filed ...~. 7~ ~.~3 .................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE RENUNCIATION In Re Estate of ~/<" To the Register of Wills of deceased. County, Pennsylvania. The undersigned c~.. ~ .---,7..~<~ ~ ~/c,~,,T.2,~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to /~~ WITNESS hand this day of , 19 (Signature) (Address) (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of deceased. To the Register of Wills of ~"//~ ~t~'/-- /~Q c~ County, Pennsylvania. the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters WITNESS hand this day of , 19 (Signature) (Address) (Signature) (Addrms) (Signature) (Address) FIRST CODICIL This instrument is a codicil to my will dated March 17, 1990. I, Ann P. Docherty of 824 Lisbum Road, Apartment #616, Camp Hill, Commonwealth of Pennsylvania, hereby annul, cancel and revoke the bequest made in paragraph second of my above described will: a one karat solitary diamond ring in a platinum setting bequeathed to my daughter, Joyce Docherty Stonis. I have knowingly and intentionally made this codicil so as to eliminate this bequest. I do hereby ratify and confirm my will in all other respects. In witness whereof, to this present writing, which I hereby declare to be a codicil to my will and which I hereby direct to be added thereunto and to be taken as a part thereof, I have set my hand this 12th day of June, 1998. Ann P. Docherty 0'~ We, the witnesses, sign this codicil and being duly sworn declare that the Testator signs and executes this codicil as the First Codicil to the Testator's Will executed on March 17, 1990, that the Testator signs and executes this codicil willingly, that each of us in the presence and hearing of the Testator hereby signs this codicil as witness to the Testator's signing, and that to the best of our knowledge the Testator is 18 years of age or older, of sound mind and under no constraint. William J. Evers, Esq. Attorney at Law, Commonwealth of Pennsylvania 55 West Clay Avenue Roselle Park, New Jersey 07204 Date Ar~d're~ J:. Docll~ - 824 Lisburn Road, Apartment #616 Camp Hill, Pennsylvania 17011 Date LAST WILL AND TESTAMENT OF ANN P. DOCHERTY I, ANN P. DOCHERTY, of the Borough of Munhall, County of Allegheny and Commonwealth of Pennsylvania, being of sound mind and memory, declare this to be my Last Will and Testament, revoking all prior Wills and Codicils. FIRST: ! direct my Executor or Co-Executors, hereinafter named, to pay the expenses of my last illness and burial as soon as convenient after my decease. SECOND: I give my one-carat solitaire diamond ring in a platinum setting to my daughter, JOYCE DOCHERTY STONiS. THIRD: ! give the residue of my tangible personal property, including furniture and furnishings that I own at the time of my death, to my husband, ANDREW J. DOCHERTY, if he survives me, but if he does not survive me, I give the residue of my tangible personal property, including furniture and furnishings that I own at the time of my death, to such my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DOCHERTY McCARTER, as are living at the time of my death, share and share alike. FOURTH: i give the residue of my estate to my husband, ANDREW J. DOCHERTY, if he survives me, but if he does not survive me, I give the residue of my estate to such of my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DOCHERTY McCARTER, as are living at the time of my death, and to the issue then living of such of my said children as may then be dead, per stirpes. FIFTH: I appoint my husband, AhDREW J. DOCHERTY, Executor of this my Will. If my husband, ANDREW J. DOCHERTY, is unable or unwilling to serve or to continue to serve os my Executor, I appoint my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DOCHERTY McCARTER, Co-Executors of this my Will. No bond shall be required of any fiduciary hereunder in any jurisdiction. SIXTH: My Executor or Co-Executors shall have, without leave of court, in addition to the powers granted by law, the right to retain for distribution, without duty of diversification, any and all property owned by me at the time of my death~ to sell any property which is a part of my estate upon such terms as he or they deem advisable~ to invest in property of any kind~ to lease any property for any period of time, whether real or personal, and to give options for sales or leoses~ to compromise any claim without leave of court~ to exercise all rights of security holders~ to borrow money~ and to make distribution in cash or in kind at current values, in undivided interests or non-pro rata shares. SEVENTH: ! direct my Executor or Co-Executors to claim any expenses of administration of my estate as income tax deductions upon an income tax return or returns whenever in his or their sole judgment such action will achieve an overall reduction in the total income and death taxes. No compensating adjustments between income and principal shall be made as a result of such action. I also authorize my Executor or Co-Executors to join with my husband or his personal representative in the filing of a joint income tax return for any period for which such o return may be permitted, without requiring him or his estate to indemnify my estate against liability for the tax attributable to his income, and to consent, for Federal gift tax purposes, to having gifts made by my husband during my lifetime treated as having been made half by me. (~.Z4/c./ ~~~ 2 IN WITNESS WHEREOF, I, ANN P. DOCHERTY, the said Testatrix, have to this my Last Will and Testament, contained in this and the preceding two sheets, set my hand and seal, to-wit, my hand to the bottom of the preceding two sheets, and my hand and seal to this last sheet, this ' ]'m~.t.. ~ day of ~ . ~ one thousand nine hundred and ninety (1990). ANN P. DOCFII~RTY gT The writing contained this and the preceding two sheets was signed by the within-named Testatrix, ANN P. DC)CHERTY, and by her published and declared as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses, at her request, in her presence, and in the presence of each other. COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF ALLEGHENY ) I, ANN P. DOCHERTY, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that ! signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. SWORN or affirmed to DOCHERTY, the Testatrix, this I~/~h COMMONWEALTH OF PElxlNSYLVANIA-'-~-=- ...... '"'"' " ) SS: COUNTY OF ALLEGHENY ) and acknowledged before me by ANN day of /!qn~rh , 1990. ANN P. DOCHE'~"j'Y - ~ ublic I Re WE, fimr~ul /). ~L~'k~'~'~ , and C~,,,h~r,~ ~ Jh~. /~ , the witnesses whose names are signori to the a~tached or foregoing instrum~t', 'being duly qualified according to law, do depose and say that we were present and saw Testatrix, sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. SWORN or by ('Lrnr'/~ ~ L) ¢,,~ this FI~¢~ day of ~ My Commission Expires: affirmed to and subscribed to before me and q:~P~,~,'t*:~r~ ~ ~lx'~,~,_~ /~ ~ witnesses, I~m'~zA 1990. ~ " Witness Notary Public I J NOTARIAL SEAL, J FRAN~I SHARP, Notary Public J Pittsburgh, Allegheny County, PA .k?v Commission Expires Sept. 19, 1992 4 LAST WILL AND TESTAMENT OF ANN P. DOCHERTY DATED: Lawrence S. May, Jr., Esquire MAY, LONG & SANDERS 670 USX TO~VER PrrrSBURGH, PA 15219-2782 REV-1500 EX (6-00) OFFIC~AL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT F-- Z UJ UJ LU LU Zoo ~,..j Z W Z o uJ o DECED~T'S NAME (LAST, FIRST, AND ~[U~DLE INITIAL) DATE OF DEATH (MM-DD-YEAR..)' DATE OF BIRTH (MM-DD-YEAR) FILE NUMBER 2, /- COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER /77 - (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER - _ ---]2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) ~']7. Decedent Maintained a Living Trust (Attach copy of Trust) E~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) r~l. Original Return [~4. Limited Estate r~6. Decedent Died Testate (A~ch copy of Will) E~9. Litigation Proceeds Received FIRM NAME (If Applicable) TELEPHONE NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS [~3. Remainder Return (date of death prior to 12-13-82) E~5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach Sch O) Ifil COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) (1) }k~ O ~ ~ 2. Stocks and Bonds (Schedule B) (2) ~ ~ O ~ .c;,~ C_( q...~ ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~ O I,q ~ 4. Mortgages & Notes Receivable (Schedule D) (4) ~ 0 ~ ~ OFFICIAL USE ONLY (5) 2.75.53 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) --}Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1 2) 16. Amount of Line 14 taxable at lineal rate (14) x .0_ (~5) x .o ¢",5" (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) (13) Decedent's Complete Address: STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE PA ZIP i -70 II Total Credits ( A + B + C ) (2) ~ ~ ~--~. d~ ¢ (3) j~© ~ ~_. 3. Interest/Penalty if applicable D. 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 (4) (5) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5A) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer.,~h~ er than the personal repr~sentative is based on all information of which preparer has any knowledge. SIGNATURE O~*~(ERSON RESPONS/[B~ FOR~ILING RETURN ADDRESS t.~ ) . SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE /o,/~ /'711Z. DATE ADDRESS III 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 exemot 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 RS. §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 RS. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ~I- ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. i, OO o,-/5 /24 7Y7, '77 ~/, 7 g'o. oo TOTAL (Also enter on line 2, Recapitulation) (if more space is needed, insert additional sheets of the same size) MorganStanley 4th And Walnut Streets PO Box 12053 Harrisburg, PA 17108 toll-free 800 676 0673 tel 717 255 6666 Ann P. Docherty 410-01 1770-101 Account Valuation as of February 21,2003 Mutual Funds MSDW Active Assets MoneyTrust Liberty Strategic Income Cl. A Van Kampen Prime Rate Inc. Trust Total Mutual Fund Value Shares NAV 1,267.52 1.00 630.35 5.70 2,210.00 7.71 Value $1,267.52 $3,593.01 $17,039.10 $21,899.63 Stocks Allstate Corp. Morgan Stanley Sears Roebuck Total StockValue Shares High Low 3,862.00 32.580 31.510 3,744.00 37.210 35.900 1,000.00 22.130 21.430 Average Value 32.045 $123,757.79 36.555 $136,861.92 21.780 $21,780.00 $282,39~71 Total Account Value as of 02/21/03 $304,299.34 THE PURCHASE DATES, AMOUNTS AND PRICES PROVIDED ARE FROM SOURCES CONSIDF_RED TO EE R~LI/~.BL.E. BUT ARE NOT GU^ RANTEED AS i'O ACCURACY. CHECK YOUR MONTHLY STATEMENT FOR VERIFICATION OF FIGURES REV-~508 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE,.OE~ p FILE NUMBER Include the pro~eds of li~tion and ~e date the pm~eds were re~ived by the es~te. All prope$ ~int~{~ed ~h ~e right of su~ivomhip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH fi .,.E, ~-:~..5'. o o /g'7~'. a~ TOTAL (Also enter on line 5, Recapitulation) $ L/~..~ 7...~.. ~'..~ (If more space is needed, insert additional sheets of the same size) R~-1510 EX* (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST I[~AP~_ICABLE) TOTAg (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) CITIZENS BANK 1-888-910-4100 CaU Citizens' PhoneBank anytime for account information, current rates and answers to your questions. Citizens Circle Account Statement OOF 2 Beginning Februan7 14, 2003 through March 13, 2003 Checking SUMMARY Balance Calculation Previous Batance Checks Withdrawals Deposits & Additions Current Balance 9,987.12 8,665.52 864.61 3,543.34 4,000.33 TRANSACTION DETAILS Checks* there ~ o O~ok ~ c*ec* sequence Check ~ Amount . Date 532 10.00/.02/20 534* 788.00/. 03/10 535 6,685.00 / 03~03 536 949.33,/03/10 Check 537 538 539 Amount Date 54.001,/'03/06 138.24/ 03710 40.95~,,,'03/12 Withdrawa~ Other Withdrawa~ Date Amount Description 02/14 80.60~iscover Direct Pay 030214 601100266025663 03/03 30.Olt/Att 800-222-0300 At&t Sews 030303 0714081758701 03/04 714.0Or'Debit Memo 03/05 40.O0,/~ears Ins Prem 030305 177402457 Deposits & Additions Date Amount Description 03/03 714.00 ~'~S Treasu~ 303 Soc Sec 030303 169079438d SSA 03/04 78.81,/~1org Stan Oiv Div Pymt 030228 410011770 03/11 2,750.53 ~Deposit Daily Balance Date Balance Oate 02/14 9 Qn~ ~2 03/04 c'02/20 9~ 896.52 ) 03/05 03/03 3, B95.51 03/06 I NEWS FROM CITIZENS B~ance Date 3,260.32 03/10 3,220.32 03/11 3,166.32 03/12 Balance 1,290.75 4,041.28 4,000.33 -- If you don't already have one, open a Circle Money Market Account and get rates that have consistently outperformed the average money market mutual fund. You also get the safety of FDIC insurance! Ca[[ us at 1-877-360CIRCLE or visit any Citizens Bank branch today to get ali the details and open your account. ANN P DOCHERTY DAVID A DOCHERIY ~ Citizens Circle Checking 610058-746-0 Previous Balance 9,987.12 Total Checks 8,665.52 Total Withdrawals 864.61 Oeposits & Additions 3,,543.3~ l~ fl*went Balance 4,000.33 Member FDIC 1~ Equal Housing Lender EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF~-O ~ Debte o! decedent muet be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. ?. FUNERAL EXPENSES: I.~ ~I - ~ e ~.~ ADMINISTRATIVE Personal Representative's Commissions Social Security Number(s)/EIN ~umber el Personal Representative(s) Street Address ~¢ ~'C.z'~::V-~f',~__~ t.C- ~-~-/'O~,'~.~ Year(s) Commission Paid: ~. Attorney Fees Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant b 0 ~,~_- Street Address City State Zip Relationship of Claimant to Decedent Accountant's Fees Tax Return Preparer's Fees ...~15, sc, TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) Attachment to SCHEDULE H Docherty, Ann P. 21-03-0244 George Irwin Green Funeral Home, Inc. Services of Funeral Director & Staff Embalming & holding of body Use of Facilities & Staff Viewing/Visitation Funeral Ceremony Use of Automotive Equipment Transfer of remains to funeral home Hearse Additional Mileage Merchandise as Selected Solid poplar casket Deluxe outer burial container Death notices Memorial cards Memorial book Other charges Out of town funeral director Beautician 10 Death certificates Total 1 Total 2 Total 3 $225 $3,120 $2,095 $750 $160 $40 $20 $3,065 $455 $25 $20 $500 TOTAL $6,685 REV-1512 EX * (~-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGELIABILITIES,&LIENS ESTATE OF,---~ FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1, TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTAT~OF NUMBER lAME ND ADDRESS OF PERSON(S) RECEIVING PROPERTY FILE NUMBER TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters WHEREAS, on the 20th dated March 17th 1990 No. 2003-00244 PA No. 21-03-0244 ESTATE OF DOCHERTY ANN P (L~'I', ~'1~'1', MIDDLe) Late of CAMP HILL BOROUGH ~UM~L_,q_ND COUN'I'Y, Deceased Social Security No. 177-40-2457 day of March & June 12th 1998 2003 instruments were admitted to probate as the last will and codicil of DOCHERTY ANN P (LAST, ~'iMS'I', MIDDLE) late of CAMP HILL BOROUGH , CUMBERLAND County, who died on the 21st day of February 2003 and, WHEREAS, a true copy of the will & codicil as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to DOCHERTY DAVID who has and has appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 20th day of March 2003. duly qualified as Executor(rix) agreed to administer the estate according to law, all of which fully -- - ~ ~egzsceroor- w~ils **NOTE** ALL NAMES i~BOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND TESTAMENT OF ANN P. DOCHERTY I, ANN P. DOCHERTY, of the Borough of Munhall, County of Allegheny and Commonwealth of Pennsylvania, being of sound mind and memory, declare this to be my Last Will and Testament, revoking all prior Wills and Codicils. FIRST: I direct my Executor or Co-Executors, hereinafter named, to pay the expenses of my last illness and burial as soon as convenient after my decease. SECOND: I give my one-carat solitaire diamond ring in a platinum setting to my daughter, JOYCE DC)CHERTY STONIS. THIRD: I give the residue of my tangible personal property, including furniture and furnishings that I own at the time of my death, to my husband, ANDREW J. DOCHERTY, if I~e survives me, but if he does not survive me, ! give the residue of my tangible personal property, including furniture and furnishings that I own at the time of my death, to such my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DOCHERTY McCARTER, os are living at the time of my death, share and share alike. FOURTH: I give the residue of my estate to my husband, ANDREW J. DOCHERTY, if he survives me, but if he does not survive me, I give the residue of my estate to such of my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DC)CHERTY McCARTER, as are living at the time of my death, and to the issue then living of such of my said children os may then be dead, per stirpes. FIFTH: I appoint my husband, Ahi)RE~/ j. DOCHERTY, Executor of this my Will. If my husband, AI~)REW J. DOCHERTY, is unable or unwilling to serve or to continue fo serve as my Executor, I appoint my children, JOYCE DOCHERTY STONIS, DAVID DOCHERTY, and BARBARA DOCHERTY McCARTER, Co-Executors of this my Will. No bond shall be required of any fiduciary hereunder in any jurisdiction. SIXTH: My Executor or Co-Executors shall have, without leave of court, in addition to the powers granted by law, the right to retain for distribution, without duty of diversification, any and all property owned by me at the time of my death; to sell any property which is a part of my estate upon such terms as he or they deem advisable; to invest in property of any kind; to lease any property for any period of time, whether real or personal, and to give options for sales or leases; to compromise any claim without leave of court; .to exercise all rights of security holders; to borrow money; and to make distribution in cash or in kind at current values, in undivided interests or non-pro rata shares. SEVENTH: I direct my Executor or Co-~xecutors to claim any expenses of administration of my estate as income tax deductions upon an income tax return or returns whenever in his or their sole judgment such action will achieve an overall reduction in the total income and death taxes. No compensating adjustments between income and principal shall be made as a r. esult of such action. I also authorize my Executor or Co-Executors to join with my husband or his personal representative in the filing of a joint income tax return for any period for which such a return may be permitted, without requiring him or his estate to indemnify my estate against liability for the tax attributable to his income, and to consent~ for Federal gift tax purposes, to having gifts made by my husband during my lifetime treated as having been made half by me. 2 IN WlTI~r__SS WHEREOF, I, ANN P. DOCHERTY, the said Testatrix, have to this my Last Will and Testament, contained in this and the preceding two sheets, set my hand and seal, to-wit, my hand to the bottom of the preceding two sheets~ and my hand and seal to this last sheet, this ' '? m-~ ~ day of ~.~c~. ~ oFle thousand nine hundred and ninety (1990). 'ANN P. DOCHF_FJTY 01' The writing contained this and the preceding two sheets was signed by the within-named Testatrix~ ANN P. DC)CHERTY, and by her published and declared as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses, at her request, in her presence, and in the presence of each other. 3 .......... ~- ,,'} ur- I-'r'NNSYLVAN/A ) ) SS: COUNTY OF ALLEGHENY ) . I, ANN p. DOCHERTY, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that i signed it as my free and voluntary act for the purposes therein expressed. SWORN or affirmed to DC)CHERTY, the Testatrix, this_ /TM by_ this My Commission Expires: and acknowledged before me by ANN p. _ day of_ ~narh __, 1990. ANN ~ My Commission Expires: ' COMMONWEALTH OF- P ) SS: COUNTY OF ALLEGHENY ) S i~a s. are s. lgn6U fo the aDached or f i t · ~ ~ the ~nf, being duly · g law, do depose and say that we were present and saw Testatrix, sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the that to the best of our knowledge the Testatrix was at that time 18 Will as witnesses; and of sound mind and under no constraint or undue influence, or more years of age, SWORN or affirmed to and subscribed to before me and o,P ........ . 11~4~ _ day of-~ - ~ . ' a~ ~,~ .... a witness s, 19 0. - ' e Notary Publ tc gheny County, PA FIRST CODICIL This instrument is a codicil to my will dated March 17, 1990. I, Ann P. Docherty of 824 Lisbum Road, Apartment #616, Camp Hill, Commonwealth of Pennsylvania, hereby annul, cancel and revoke the bequest made in paragraph second of my above described will: a one karat solitary diamond ring in a platinum setting bequeathed to my daughter, Joyce Docherty Stonis. I have knowingly and intentionally made this codicil so as to eliminate this bequest. I do hereby ratify and confirm my will in all other respects. In witness whereof, to this present writing, which I hereby declare to be a codicil to my will and which I hereby direct to be added thereunto and to be taken as a part thereof, I have set my hand this 12th day of June, 1998. Ann P. Docherty ~ We, the witnesses, sign this codicil and being duly sworn declare that the Testator signs and executes this codicil as the First Codicil to the Testator's Will executed on March 17, 1990, that the Testator signs and executes this codicil willingly, that each of us in the presence and hearing of the Testator hereby signs this codicil as witness to the Testator's signing, and that to the best of our knowledge the Testator is 18 years of age or older, of sound mind and under no constraint. William J. Evers, Esq. Attorney at Law, Commonwealth of Pennsylvania 55 West Clay Avenue Roselle Park, New Jersey 07204 Date 824 Lisbum Road, Apartment #616 Camp Hill, Pennsylvania 17011 Date COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002494 DOCHERTY DAVID 2604 OUTERBRIDGE CROSSING HARRISBURG, PA 17112 ........ fold ESTATE INFORMATION: SSN: 177-40~2457 FILE NUMBER: 21 03-0244 DECEDENT NAME: DOCHERTY ANN P DATE OF PAYMENT: 04/25/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/21/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,051.88 REMARKS: DAVID A DOCHERTY TOTAL AMOUNT PAID' $13,051.88 SEAL CHECK//545 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Name of Decedent: Date of Death: STATUS REPORT UNDER RULE 6.12 Will No.: Admin. No.: ,2/- O~ - 02-~/St 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 IXl No UI 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Dat~.. o If the answer to No. 1 is Yes, state the following: a. Did the personal ~esentative file a final account with the Court? Yes _ No b. The separateDrg, hans' Court No. (if any) for the personal representative's accoUnt c. Did the personal r.[.~presentative state an account informally to the parties in interest? Yes ~X] No [-] c. Copies of receipts, releases, joinders and approval of formal or infonnal accounts may be filed with the Clerk of~e Orphans' Court · and may be attached to this 7J~ Signature Name Address Telephone No. Capacity: [] Personal Representative [] Counsel for personal representative D~JREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DIVISION DEPT. 280601 HARRTSBURG, PA 17128-0601 DAVID A DOCHERTY 2604 OUTERBRIDSE XING HBG PA 17112 C~HHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-I~¢7 EX &FP (01-OS) DATE 06-09-2005 F;;!~,';~ ;'* ESTATE OF DOCHERTY !:~'~_~ ~ i DATE OF DEATH 02-21-2005 FILE NUHBER ZZ 03-0244 COUNTY CUHBERLAND '03 JUN 11 ~:26 lOl ANN P Aaoun* RaaL*~ad HAKE~HECK PAYADLE AND RENIT PAYNENT TO: REGISTER OF N~LLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP ~01-03} NOTICE OF INHERITANCE TAX APPRAISEHENT~ ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF DOCHERTY ANN P FILE NO. 21 05-0244 ACN 101 DATE 06-09-2003 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON.' ORTGTNAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bends (Schedule D) (2) $. Closely Held S~cock/Par~:narship Tn~aras* (Schedule C) ~. Nor~gagas/No~as Receivable [Schedule D) 5. Cash/Dank Daposi~cs/Hisc. Personal Propar~y (Schedule E) (5} 6. Jointly Otmad Propar~y (Schedule F) (6} 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expansas/Adm. Cos~:s/Hisc. Expenses (Schedule H) (9) 10. Dab~s/Hor~gaga Liabili~cias/Lians (Schedule 1) (10) 11. To'l:al Deductions 12. Nm"l: Value of Tax Ra~:urn $04~299.$4 .00 4~275.55 .00 .00 NOTE: To insure proper cradi~ ~o your accoun*, subei~ ~ha upper portion .00 of ~his fora wi~h your ~ax payment. 6~896.52 (8) $15,471.$9 9,760.59 15. 1~,. NOTE ~o$.95 (11) 10.16~.S~ (12) 305,307.05 Chari*abla/Govarnman~el Baques*s; Non-elected 911:5 Trusts (Schedule J) (1:5) Ne* Value of Es~a~a Subjac~ ~ Tax (1~) If an assessment ,as lssued previously, 1/nes 1~, 15 and/or 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. .00 ~05,$07.05 18 and 19 will IF PAID AFTER DATE ZNDZCATED~ SEE REVERSE FOR CALCULATION OF ADDITZONAL 1NTEREST. TOTAL TAX CREDIT 15,758.82 BALANCE OF TAX DUEI .00 INTEREST AND PEN. . O0 TOTAL DUE . O0 ( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT ZS REgU/RED. ASSESSNENT OF TAX: 15. Aaoun~ of Line 1~ 16. Amoun~ of Line 1~ ~axabZa a~ Lineal~Class A ra~e 17. Aaoun~ of Line 1~ a~ S1bling ra~a 18. Aeoun~ of Line lq ~axabla 19. Principal Tax Due TAX CRED/TS= PAYH~NT : R~C~1PT DISCOUNT DATE NUHBER INTEREST/PEN PAID (-) 0~-25-2005 CD002494 686.94 I IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCTIONS.) 15,051.88 AHOUNT PAZD (IS), .00 x O0 : .00 (16) :505,507.05 x 045 = 1:5,7:58.82 (17). .00 X 12 = .00 (18), .00 x 15 = .00 (19)= 13,7:58.82 BUREAU OF TNDTVIDUAL TAXES · [NHERTTANCE TAX DTVTSTDN DEPT. 18060! HARRTSBURG, PA 17118-0601 CONHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRA/SEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-l$47 EX AFP (01-05) *O3 DAVID A DOCHERTY Z60q OUTERBRIDGE XING HBG PA JUN 19 DATE 06-09-2005 ESTATE OF DOCHERTY DATE OF DEATH OZ-ZI-ZO0$ FILE NUHDER 21 05-02q~ :3~OUNTY CUHBERLAND ACN 101 ANN P Amoun~ Remitted HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF gILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~"~ RETAIN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF DOCHERTY ANN P FILE NO. 21 05-02~ ACN 101 DATE 06-09-2005 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE TNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) q. Nortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expansas/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Dabts/Nortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return $0~299.5q .00 ~275.53 .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of this form with your tax payment. 6;896.52 (8) 9,760.59 q05.95 15. lq. NOTE: ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal ra~a 16. Amount of Line lq taxable at Lineal/Class A rate 17. Amount of Line 1~ et Sibling rate 18. Amount of Line 1~ taxable et Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 0q-Z5-Z00~ CD00Zq9q 686.9q $15,q71.39 (11) 10.16q.~6 (12) ~505,507.05 Charitable/governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1S) Net Value of Estate Subject to Tax (lq) :;f an assess.ent was issued prevlously, 11nes 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 305,507.05 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 will (is) .00 x 00 = .00 (16) 305,307.05 x 0q5= 13,738.82 (17) .00 X 12 = .00 (lB) .00 x 15 = .00 (19)= 15,738.82 AMOUNT PAID 13,051.88 TOTAL TAX CREDIT 15,7~8.8Z BALANCE OF TAX DUEI .00 ~NTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Common.ealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the la.ful Class B (collataral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOOO. (TI P.S. Section 91~0). PAYNENT: REFUND (ER): OBJECTIONS: ADH/N- ISTRAT/VE CORRECTIONS: DISCOUNT: PENALTY: 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 NILES, AGENT A refund of a tax credit, which Nas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ara available at the Office of tho Register of Hills, any of the ES Revenue District Offices, or by calling the special Z~-hour ans.ering service for fores ordering: 1-BOO-$6Z-ZOSO; services for taxpayers .ith special hearing and / or speaking needs: 1-800-~47-50Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallo.ance of deductions, or assessment of tax (including discount or interest) as sho.n on this Notice must object .ithin sixty (60) days of receipt of this Notice by: --.ritten protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171Ia-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in .riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ravia. Unit, Dept. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid .ithin three (5) calendar months after the decedent's death, a five percent (aX) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jmnuary 18, 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 .auld appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning .ith first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at e daily rate of .000164. All taxes .hich became delinquent on and after January 1, 1982 will bear interest at a rate which .ill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOOS are: Interest Daily Interest emily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19AZ ZOZ .00054B 1987 9Z .O00Z~7 1999 7X .OOO19Z 1983 16Z .O00~SB 1988-1991 11Z .000301 ZOO0 ax .OOOZ19 198fi 11Z .O00SO1 1992 9Z .000Z47 ZOOZ 9Z .O00Z~7 19BS 1SI .000S56 1993-1994 7Z .000192 ZOO2 6Z .000164 1986 IOZ .000Z74 1995-1998 9Z .000Z47 ZOOS SZ .0001S7 --Interest is calculated as foXlows: XNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELINQUENT X DAZEY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of tho assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Will No. Admin. No. ~//- /--') '~ - O ~ att~ ~ To the Register: I certify that notice of (beneficial interest) estate _administration required by Rule 5.6(a) o~f the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ./--).t~ t-t'! ,9.d~ ~ O0 ..~ · Name Ad,ess 1711Z Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Address Telephone Capacity: X Personal Representative __Counsel for personal representative