HomeMy WebLinkAbout03-0248PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Deceased.
Social Security No. 3(}0 "3 ,~' '-~'(~0 ~
Register of Wills for thl . --
County of (2 U mD,O'ldii~/the
Commonwealth of Pennsylvania '
The petition of the undersigned respectfully represents that:
is/are 18 years of older an the execut ~ nam,~d/
Your petitioner(s), who
in the last will of the above decedfi0t, dated a~?r
and codicil(s) dated
- I
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ O ~//_J0~ J 04- f0d C, ounty, Pennsyl~vania, with
h I~ last familyor principal residence at
(list street, number and mun~i~
, Decendent, then ~_ ygarsofgge, died ~~,
Excel as follows, decehent di~ not marry, ~as n~t ~ivorced 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:
WHEREFORE, petitioner(s) respectfully requ~.t~s~tJ3e probate o.f the last will and codicil(s)
presented herewith and the grant of letters
theron. (testa~L.~m__~Btary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
r
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this 20th day of J - -
Donna ~. 0t~o, lst' fibp~ ~i~ter~
No. 21-20°3-248
Estate Of Wayne A Salisbury
· , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW March 21 s t, 19d~_2_(1Diit consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated August 17th, 2000
described therein be admitted to probate and filed of record as the last will of
Wayne A. Salisbury ;
Testamentary
Letters
Glenn Salisbury
~eherebygrantedto
FEES
Probate, Letters, Etc .......... $ 25.00
Short Certificates(4) ...' ....... $12.00
~m~~ .. x~P.agas..2. $ 6.00
JCP $-'.10.00
TOTAL __ S 53.00
Filed .M..a.r..cD..2..1 .s.~;, .2. O.0..3 .............
. Re.glster of/Wdls
Donna M. Otto,lst Deputy
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Mailed Letters to Executor Glenn Salisbury on 3-21-03
21-2003-248
LAST WILL AND TESTAMENT
I, WAYNE A. SALISBURY, of P. O. Box 104, Orrstown, Cumberland County,
Pennsylvania 17244, do hereby make, publish and declare this to be my last will and
testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this Will,
shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my daughter Freda Ulsh and my son, Glenn Salisbury, share and
share alike, the child or children of any deceased beneficiary taking the share their
parent would have taken if living.
4. I nominate and appoint Freda Ulsh and Glenn Salisbury to be the co-
personal representatives of my estate, to serve without bond.
5. I suggest that my personal representative retain the services of the Law
Offices of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 17th day of
August, 2000.
WAY,~I'E A. SAI'iSBURY
(SEAL)
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, WAYNE A. SALISBURY, AMY S. CASEY and HEATHER A. BARBOUR,
the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testator signed and executed the instrument as his last will and that he had signed
willingly, and that he executed it as his free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the testator,
signed the will as a witness and that to the best of their knowledge the testator was, at
that time, eighteen years of age or older, of sound mind and under no constraint or
undue influence.
WA ~Y~IE A.-SALISBUR~Y ~/
AI~( S. C-~S'EY v ...- //
HEATHER A. BARBOUR
COMMONWEALTH OF PENNSYLVANIA ·
:SS.'
COUNTY OF CUMBERLAND ·
Subscribed, sworn to and acknowledged before me by WAYNE A. SALISBURY,
the testator herein, and subscribed and sworn to before me by AMY S. CASEY and
HEATHER A. BARBOUR, witnesses,
Notariai Seal
Harold S. Irwin i!1, Notary Public
Carlisle Bore, Cumberland County
My Commission dx:)ires Sept. 23, 2002
Member, Pennsylvania A~o,s~a,[on et Notaries
this 17th day. of August, 2000.
Notary Public ~
II
WAYNE A. SALISBURY
WILL
LA W OFFICES
HAROLD S. IRWIN, III
A TTORNEY-A T-LA W
35 EAST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
717-243-6090
Name of Decedent:
Date of Death:
Will No. _~ 0
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orpllans'tCourt Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
?IiI~
Name Address
~',4 /~ ~ e-~ . A . ~;,4 1:'.5 £ u ~V
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature ~~/*~4~ ~ ~
Name
Address
Telephone(
Capacity: ~_ Personal Representative
Counsel for personal representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be deter-
mined wholly or partly by the decedent's will. If the decedent
died without a will, whether you will receive any money or prop-
erty will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA
InreEstateof ~k/ I4 y ]~l ['~ Id} ~.~ 0 ] ;~ t~ 0 ~ r
Estate No. ~ O0 2-
(Name and Address)
, deceased,
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent
dayof J~'O"'
Pennsylvania.
County,
, died on the .~/'~ ~
~LThe Decedent died testate (with a Will); or
The Decedent died intestate (without a Will).
The personal representative of the Decedent is
(name, address and telephone number).
!
, If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1
'Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the
Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges l~or dul~lication.
Date: q/ j]/'O00~ Signature: ~?
Name(print) ~-----~ J" ~'~ .I~
Address ?/0 --~ ~:1)~. J'~'_u~ -_(~.l;-a~--C//.~ /
Telephone (-7[~ ~
Capacity: Personal Representative
Counsel for personal representative
;~EV-1500 EX (640)
COMMONWEALTH OF
· PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I--
Z
LU
LLI
ILl
ILl
Z
W
Z
r~
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR)
OO.-o.y- ¢,oo3 | /;t-i2-1?lff
(IF APPLIOABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
E~]2. Supplemental Return
[---~ 4a. Future Interest Compromise (date of death after 12-12-82)
[~7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~10. Spousal Poverty Credit (date of death between 12-3141 and 1-1-95)
[~1. Original Return
--]4. Limited Estate
[-~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
FIRM NAME (IfApplioable)
6 77-/1,,1, 7
q?
OFFICIAL USE ONLY
FILE NUMBER
(12)
(13)
(14)
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) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18, Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
(8)
(11)
SOCIAL SECURITY NUMBER
] 3, Remainder Return (date of death priorto 12-13-82)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
12, Net Value of Estate (Line 8 minus Line 11) ,.'.'.'.'.'.'.'.'.~ ¢') 50
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)
/
4 3 ¢'?, '?x,'
USE ONLY
H 7
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(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, 8, Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
TELEPHONE NUMBE~7/7)
SOCIAL SECURITY NUMBER
3, oO- ~lg - .%008
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
COUNTY CODE YEAR NUMBER
Decedent's Complete Address:
ISTREET ADDRESS
STATE P¢"~ ZIP
/?¢
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of ~ine 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 useor income of the property transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] ~]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] [~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that i have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
A__TE30.- O 3
SIGNATU/~ OF,I~RSON RESPONSIBLE F(~FILI~G RF_~TURN
ADDRESS(~/O .~ C~ (~ '~'~"' -~-'-' !7 ~"'~""~
SIGNATURE OF PREPARER~)THER TH~REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a)(1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §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
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 paten
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 a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 E~X* (1-97)
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,~,:r ~ ~O~oqz40 ,
· ~, ~,~¢e/I,e,,,¢o~,~ C/67'~,'~?/e r~- ,~0, o~
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ES??E Or
Deb~ of dec~ent must be reposed on Sch~ule I.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State __ Zip
Relationship of Claimant to Decedent
Probate Fees .~ ?"i'/"7'0//, ,.~'/q 0.~' C¢*'""/",' ~-'r,-..V~.:'/~ '~,
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
FILE NUMBER
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
.Co,,-/
AMOUNT ORSHARE
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 II- 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)
Print Key Output
5722SS1 V5R1M0 010525 ACNBANK
Page 1
04/01/03 13:07:27
Display Device ..... : NVMTEL02
User .......... : WISERH
4-01-2003
13:07:25
WAYNE A SALISBURY
210 BIG SPRING ROAD
GREENRIDGE VILLAGE
NEWVILLE PA 17241
Checking Account Inquiry Next display: 13
Prior Statement for: 2060930
Bal as of 1-29-03
+Dep/CR: 2
-Chks/DR: 1
-Service charge:
+Interest paid:
Current balance:
Pst Dt
X Eff Dt
013003
013103
020303
022603
Serial Number TC Description
241 079 PRIORITY CHECK
018 US TREASURY 310
018 US TREASURY 303
997 INTEREST PAYMEN
Amount
Str/Run/Bat/Seq#
53.00-
346.30
620.00
1.69
20-0700-11
NVMTEL02
1,422 79
966 30
53 00
00
1 69
2,337 78
Balance
1369.79
1716.09
2336.09
2337.78
Bottom
F3=Exit F8=Recent trans
F13=Inquiry window
F16=Print research stmt
F15=Restart
Fll=Fold/unfold
F24=More keys
GLENN SALISBURY
910 SPRING CIR
MECHANI CSBURG PA
17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
June 09, 2003
Re: WAYNE SALISBURY
CIS #: 200150454
SSN: 200-22-5008
Date of Death: 02/05/2003
Dear Mr. Salisbury:
Please be advised that the Department of Public Welfare is attempting to
recover the monetary value of any and all eligible assets in the subject
estate. Although the amount in the estate may be considerably less than that
which is owed to the Department, our claim is against the estate, no one
else. Your responsibilities, as the primary next of
kin/administrator/executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the amount of
$44,690.16 against the above-mentioned estate. This claim is for restitution
of medical assistance granted on behalf of the decedent for which the Probate
Estate is now responsible to reimburse the Department according to Act 49, 62
P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June
30, 1995. Enclosed is the Department's itemized statement of claim.
A portion of this medical expense, namely $.00, was incurred during the
last six months of the decedent's life; therefore, it is a Class 3.claim
pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20
Pa. C.S.A. 3392(3). The balance of the claim, namely $44,690.16, is to be
entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise when payment may be
expected. If the estate accounting is complete, please provide a copy. If
the estate contains real estate, please provide copies of the deed, the
latest tax assessment and a current appraisal, if available.
Sincerely,
Enclosure
Linda C. Price
Claims Investigation Agent
717-772-6741
717-705-8150 FDuX
ph,
Aging and Health Care Services
Apfil17,2003
Estate of Wayne Salisbury
C/O Glenn Salisbury
910 Spring Circle
Mechanicsburg, PA 17055
RE: Wayne A Salisbury (Swaim Health Center)
Account #: 200225008AL
Dear Mr. Salisbury:
It has come to my attention that there is an outstanding balance at Swaim Health Center
(Green Ridge Village) in.the amount of $2,659.22. I have attached a statement showing
these charges for your records. If there is an issue of which we are unaware, please
contact me at your earliest convenience. There is a possibility that we will be able to set
up payment arrangements, if you are unable to pay the invoice in full at the present time.
Otherwise, please remit payment in full within 15 days from the date of this letter.
Please forward your payment to my attention for prompt credit to your account. If you
have any questions, please do not hesitate to contact me at (717) 303-4929.
Sincerely,
Valerie K. Fishel
Credit and Collections Coordinator
PHI - Corporate Office
Cc: Tina Arnold, Swaim Health Center (Green Ridge Villa~e~
Valerie K. Fishel
Credit & Collections Coordinator
1217 Slate Hill Road
Camp Hill, PA 17011
(717) 303-4929
fax (717) 737-4819
e-mail: vfishet@phi-preshomes.org
wwv. phi-preshomes.org
Aging and Health Care Services
1217 Slate Hill Road Camp Hill, Pa 17011 (717) 737-9700 fax (717) 763-7617
BUREAU OF ZNDZVZDUAL TAXES
TNHERTTAHCE TAX DTVTSTON
DEPT. 180601
HARRZSBURG, PA 17128-0601
CONNONNEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
REV-1547 EX AFP (oI-OS)
GLENN SALISBURY
910 SPRING
HECHANICSBURG
PA 1705~.
DATE 08-11-2005
ESTATE OF SALISBURY
DATE OF DEATH 02-05-1005
FZLE NUHBER 21 05-02q8
i"}':i~UNTY~/ CUHBERLAND
ACN 101
I AIount Riaittid
NAYNE
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
A
CUT ALONG THZS LZNE ~'- RETAIN LONER PORTZON FOR YOUR RECORDS -,~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF SALISBURY NAYNE AFZLE NO. 21 05-02q8 ACN 101 DATE 08-11-2003
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORTGTNAL RETURN
1. Real EstIte (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Pirtnership Tnterast (Schedule C) ($)
q. Nortgiges/Notes Receivebli (Schedule D) (~,)
S. CIsh/Bank Deposlts/Hisc. Personal Property (Scheduli E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9)
10. Debts/Nortgage Liabilities/Liens (Schedule !) (10)
11. Total Deductions
12. Net Value of Tax Return
3~$87.78
.00
.00 NOTE: To insure proper
.00 credit to your account,
· 00 subIit the upper portion
.00 of this forI with your
rix pIyIInt.
.00
(8)
68. O0
~7~349.38
(11)
(12)
3,387.78
qq,029.96-
CheritabZe/eovarnIenti1 Bequests; Non-elected 9113 Trusts (Schedule J) (13)
Net Vilue of Estate Subject to Tix (lq)
Zf an assesseent ,as issued previously, lines 1~, 15 and/or 16, 17,
13.
1~.
NOTE:
reflect figures that include the total of ALL returns assessed to date.
.00
ASSESSNENT OF TAX:
15. Aaount of Line 1~ at Spousal rate
16. Aaouflt of Line lq taxable et Lineal/Class A rate
17. Aaount of Line 1~ at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDZTS:
PAYHENT RECE~P1 DZ$COUNT
DATE NUHBER ~NTEREST/PEN PA~D (-)
q~,029.96-
ZF PAZD AFTER DATE INDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZT/ONAL ZNTEREST.
18 and 19
(15) .00 x O0 = .00
(16) .00 x 0c~5= .00
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= . O0
ANOUNT PAZD
TOTAL TAX CREDZT
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT XS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTZONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collatara1) beneficiaries of the decedent after the expiration of any estate for
life or for years, the CommonNealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfi11 the requirements of Section 1140 of the Xnheritanca and Estate Tax Act, Act ZS of ZOO0. (72 P.S.
Section 9160).
Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
A refund of e tax credit, ehich gas not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z6-hour
answering service for forms ordering: 1-800-S61-2050; services for taxpayers eith special hearing and / or
speaking needs: 1-800-q67-SOZO (TT onXy).
Any party in interest not satisfied with the appraisement, allowance, ar disallowance of deductions, or assessment
of tax (including discount ar interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booktot "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid mithin throe (3) calendar months after the dacedent's death, a five percent (5Z) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax end interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free tho date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent par annum calculated at a dally rate of .00016q. All taxes which became delinquent on and after
January l, 1981 will bear interest at a rate ehich mill vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z003 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .000568 1987 91 .000267 1999 71 .000192
1983 162 .000638 1988-1991 Ill .000301 lOgO 82 .000219
1986 111 .000S01 1991 91 .000167 2001 91 .0002~7
1985 132 .000S56 1993-1996 71 .OOOlgZ 2002 61 .000166
1986 102 .00027q 1995-1998 91 .000267 ZOOS 51 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.: ~ 190
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ 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. I is Yes, state the following:
ao
Did the personal representative file a final account with the Court?
Yes _ No I~]
The separate Orphans' Court No. (if auy) for the personal representative's
account is: ~
Did the personal representative state an account informally to the parties
in interest? Yes J~] No I-'-I
c. Copies of receipts, releases, joinders and approval of fom~al or
informal accounts may be filed with the Clerk of the Orphans' Court
Date:/~/03
and may be attached to this report.
Signature
Name
Capacity:
Address
Telephone No.
._. (717) 7
12~ Persoual Representative
F-] Counsel for personal representative