HomeMy WebLinkAbout03-0253 PETITION
state o/',,,so as
FOR PROBATE and GRANT OF LETTERS
No. ~21' a --~ - O.G ~
Deceased.
-'6
Social Security No. / ~ ~ - 3 0 - 7 / ~~-
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execute/~
in the last will of the above decedent, dated ~//-e_~.,~ t~ef
and codicil(s) dated
To:
Register of Wills for the
County of ~;e'/r~/Z] E'.~./~}/.3,/ in the
Commonwealth of Pennsylvania
named
,19 7/
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ rv~ ~ r- [~ ~ cd.. County, Pennsylvania, with
h last family or princ~val residence at
5'-o~ /-.~? /~ ~~ O~ ~'//'. ~/~c(~ /~,~.
(list street, number and muncipality)
Decendent, then Z~ years of a~e, died ~r'c.~ // ,~¢~'Z,
Except as~ollows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
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:
._'~ &,, ~oo. o 0
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF ~2'~,~F~.L,A~.J.Z) f ~s
Thc petitioner(s) above-named swear(s) or affirm(s) that the statements in thc foregoing pctition arc
truc and correct to thc best of the knowledge and belief of petitioner(s) and that as personal rcprcscn-
tativc(s) of thc above decedent petitioner(s) will well and truly administer t~c ~tatc ~cording to law.
Sworn to or affirmeaand subscribed ~~*,~-4% :C~o~/~ C
befo~ ~e this , /~ ~ day of / ~ ~, ~.Z ,., ' C./,~ ~/~ ) ~
~ ! ~ Register ~ ~
I 7 -f ~c/-//
NO. 21-03-253
Estate Of MILDRED A. GOODLING , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW. MARCH 24, ~ 200.3, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated SEPTEMBER 20. 1971
described therein be admitted to probate and filed of record as the last will of
MILDRED A. GOODLING ;
and Letters TESTAMENTARY
are hereby granted to GWENDOLYN E. GOODLING N/K/A GWENDOLYN E. DEVLIN
FEES
Probate, Letters, Etc .......... $ 70.00
Short Certificates(4) .......... $ 12.00
Renunciation ................ $
JCP $ 10.00
TOTAL __ $ 92.00
Filed...MA..R.C..H..2.4. ~..209.3. .................
- 'Register o~ Wills '
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
MAILED LETTERS TO EXECUTRIX MARCH 24, 2003
21-03-253
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat
request of testat__
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19
, sign the same and that signed as a witness at the
in h presence and (in the presence of each other) (in the presence of the
"-~(Name)
(Addre~.
Register
(Name)
(Address)
REGISTER OF WILLS OF C~E~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
I, GWENDOLYN E. DEVLIN
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
SHE IS familiar with the signature of MILDRED A. GOODLING .,
testator of (one of the subscribing witnesses to) the will presented herewith and
that SHE believes the signature on the will is in the handwriting of
MILDRED A. GOODLING
to the best of HER knowledge and belief. //'
Sworn to or affirmed and subscribed before ~/~/2~::~X~ : ~-~/~-.-
me this 18th day of / /
(~4?me)
(Name)
(Address)
21-03-253
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat
request of testat__
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19__
, sign the same and that signed as a witness at the
in h presence and (in the presence of each other) (in the presence of the
Register
(Name)
(Address)
(Name)
(Address}
REGISTER OF WILLS OF C~E~mD COUNTY
OATH OF NON-SUBSCRIBING WITNESS
ROBERT E. DEVLIN
{~/). a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
HE IS familiar with the signature of MILDRED A. GOODLING .,
testator of (one of the subscribing witnesses to) the will presented herewith and
that HE believes the signature on the will is in the handwriting of
MILDRED A. GOODLING
to the best of HIS knowledge and belief.
Sworn to or affirmed and subscribed before
me this 2 ls t day of
MARCH I{1f. 2003
Register
(Address)
(Name)
(Address}
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
Local Registrar
Date
,5.144 Rev. 1191
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
STATE FILE NUMBER
A /'~ ~ ..11 .~___ ISEX ~ ~ I,~IAL SECURfTY NUMBER [DmE O~ D~ATH (M~th. Day.
~t~ Oa~ I Hours Minul~ I ( . Y. ) [ Star ~ Forth C~ry) ~HOSPITAL ~ )
{. East Pennsboro I Holy Spirit Hospital =~.'~".,~.~.., ...
.S. ARMED F~ES? I (S~iN ~y ~ Qr~ ~ M~L 8T~US - ~i~ SU~IVI~ 8~SE
17i.~te ~nnsylvania ~ 17e.~ Yet~Gv~ln ~en
l,~U~ ~ ~ ~e,~ Hi11, PA 17011
Cumberland
DECE~NT'S USUAL OCCUPATION
ltress Res taurant
505 Lamp Post Lane ACTUAL
r~,~ *. d~,,th)-----.- . Intracerebral Hemorrhage
s.~.~,~,~ b. Closed Head Injury
c*usa(~ ~i~,~ ~. Fall
~ ~ ~t ~ ~lermi~
DATE OF INJURY T ME O~INJURY
I(Month, Day. Year) { Aorx
~JMar. 3,2003 J ' '
~1~. ~. 3:30 P .
[] [?L~E OF INJURy- ~ ~. larm. ~,~,. f,~. o~ '
l~T~..c.(s~,,y) Home
CERTIFIER (Check only one)
'CERTIFYING FH¥$1ClAN (Physician ce~t ~ng cause ol death whe~ another physic*an has p~oum:ed (~eath and ccmp~eled ~tem 23)
IIN,IURY AT WORK~ I~ESCmBE HOW ,N~URy OCCURRED.
~ [] No Fell in driveway
T° the best °f mY kn°w&edOe, delth OC~UeTed due to the CILMe) and mam~e~ is stated.,, . ....................... []
~ ~ o~ my knewledge, dlalh oeeun, ed at the time, date, and place, and due to the oaule(s) and man~tnheh)r a~ ~mted ............. []
*MEDICAL EXAMINER/CORONER
Onthebl~leofexamlnetlonend/orlnveetlgation, lnmyoplnlon deethoccurrndatthetme date and ace acdduetoth
manner aa crated ............................ , , , P , · cache(e) and
REGIST 'S SIGNATURE AND NU~"-,~
DATE SIGNED (Month. Day, ~r)
,,,. },,d. March 12, 2003
~IAME AND ADDRESS O~ PERSON WHO COMPLETED CAUBE OF DEATH
:ltem 27) Type or Pdnt Michael L. Norris, Coroner
6375 Basehore Road. Suite #1
i,. Mechanicsburg, Pa. 17050
DATE FILED (Month, Day. Yea~)
_~~p poATION (sua~' co/T°wn' sm~e)
st Ln,Camp Hill, PA
SIGNATURE AND TI
31b. :~ Coroner
LICEN
21-03-253
21-03-253
I, MILDRED A. GOODLING, of the Borough of Camp Hill, County
of Cumberland and State of Pennsylvania, make, publish and declare this
to be my Last Will and Testament, hereby revoking and making void any
and all Wills by me at any time heretofore made.
1. I direct the payment of my just debts and funeral expenses
as soon after my death as may be convenient to my Executor hereinafter
named.
2. Ail the rest, residue and remainder of my estate, real,
personal and mixed, I give, devise and bequeath unto my husband, Victor
A. Goodling, if he survives me for a period of thirty (30) days.
3. In the event my husband shall fail to survive me for a
period of thirty (30) days, I give, devise and bequeath all the rest,
residue and remainder of my estate to my daughter, ~wendolyn E. ~.
4. I name, constitute and appoint my husband, Victor A.
Goodling~ to be Executor of this, my Will. Should my husband predecease
me or for any other reason be unable or unwilling to act in this capacity,
I appoint my daughter, Gwendolyn E. Goodling, to be Executrix of this my
Will. I direct that my Executor or Executrix shall not be required to
give bond for the performance of his or her duties.
IN WITNESS WHEREOF, I hereunto set my hand and seal this~
Mildred A. Goodling /'
Signed, sealed, published and declared by the above named
Testatrix, as and for her Last Will and Testament, in the presence of
us, who, at her request, in her presence and in the presence of each
other, have hereunto subscribed our names as witnesses.
MILDRED A. GOODLING
MYERS. MYERS. FLOWER & JOHNSON
ATTORNEYS AT LAW
LEMOYNE. PENNSYLVANIA
CARLISLE. PENNSYLVANIA
COHHONREALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 171Z&-0601
REV-I$~iS EX AFP C09-00)
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
ACN 03115791
DATE 04-17-2005
GHENDOLYN GOODLING
505 LANP POST LANE
CANP HILL PA 17011
TYPE OF ACCOUNT
EST. OF MILDRED A 600DLIN6 [~SAVZNGS
S.S. NO. 165-:50-6718 [] CHECKING
DATE OF DEATH 05-11-2005 [] TRUST
COU1~¥ CUHBERLAND [] CERTTF.
RENTT PAYHENT AND FORNS TO:
REGISTER OF HILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
PENNSYLVANIA STATE BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you foal 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 Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-83Z7.
CONPLETE PART 1 BELOH x # ~ SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS
Account: No. 105:55 Det:e 10-05-Z000
Est:ablished
Account: Balance 38,047.99
Percent: Taxable X 5 0.0 0 0
Amount: Subject: t:o Tax 19,024. O0
Tax Rat:a X .045
Pot:ant:ia1 Tax Due 856.08
To insure proper credit to your account, two
(2) copies of this notice must accompany your
peyeent to the Register of Rills. Hake check
payable to: "Register of Rills, Agent".
NOTE: If tax payments ara made within throe
(5) months of the dacedent's date of death,
you may deduct a SZ discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "'A" and return this notice to the Register of
CHECK -~ Rills and an official assessment will be issued by tho PA Department of Revenu..
ONE
BLOCK J B. [] The above asset has been or will be reported and tax paid with tho Pennsylvania Inheritance Tax return
ONLY to be filed by the dacadsnt'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.
1. Dat:e Est:ablished 1
2. Account: Balance ~
3. Percent: Taxable $ ~
4. Amount: Subject: t:o Tax ~
5. Debt:s and Deduct:ions ~ -
6. Amoun~ Taxable 6
7. Tax Rat:e 7 ~
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTZONS CLAZNED
PAYEE DESCRIPTION AHOUNT PAID
TOTAL (Ent:er on Line 5 of Tax Comput:at:ion) $
Under penalt:ias of perjury, I declare t:hat: t:he fact:s I have report:ed above are t:rue, correct: end
co.lp]~et:a t:o t:ha bast: ofmy knowledge and belief.
TAXPAYER SZG~TURE TELEPHOHE NUHBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND #ILL RESULT IN AN OFFIC/AL TAX ASSESSNENT eith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the dacodent's date of death.
5. A joint account is taxable even though the decedent's name was 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 are 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 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee ~ith 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-lSd8 EX) upon receipt of the return from the Register of Hills.
Z. BLDCK B - If the asset specified on this notice has been or will be reported and tax paid ~ith 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 Tndividual Taxes, Oep[ ZB0601, Harrisburg, PA 171Z8-0601 in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and
according to the instructions bales. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Nills of the county indicated. The PA Department of Revenue mill issue an official assessment (Fora REV-lSd8 EX) upon receipt
of the return from the Register of Mills.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or tit[ad in the manner existing at date of death.
NOTE: For a decedent dying after IZ/iZ/8z: Accounts mhich the decedent put in joint names within one (l) year of death are
taxable fully as transfers. Hoeever, there is an exclusion not to exceed $5,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk lmm) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted fram the account balance as reported by the financial institution.
Enter the total 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 follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 5 (JOINT ONNERS) DIVIDED BY g [SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
]n trust for another individual(s) (trust beneficiaries):
I DIVTDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARTES
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) = .SO X 100 = SOl (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line q) is determined by multiplying the account balance (line Z) by the percent taxable (line
S. 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 q).
7. Enter the appropriate tax rate (line 7) as determined below.
De~e of Death Spouse Lineal I Sibling Collateral
07/01/9q ~o 12/$1/9q SZ 6Z 15X 15X
01/01/95 ~o 06/30/00 OX 6X 15X
07/01/00 ~o presen~ OX q.EXx 12Z
xThe tax rate imposed on the net value of transfers from a y-one years age younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparant of the child is OZ.
The lineal class of hairs 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, she[her or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals mhd have at least one parent in common with the decedent, aha[her by blood
ar adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED
Alloaable debts and deductions are determined as follows:
A. You legally 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, use plain paper B L/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
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 O02496
GOODLING GWENDOLYN E N/K/A
505 LAMP POST LANE
CAMP HILL, PA 17011-1430
........ fold
ESTATE INFORMATION: SSN: 163-30-6718
FILE NUMBER: 2103-0253
DECEDENT NAME: GOODLING MILDRED A
DATE OF PAYMENT: 04/25/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/11/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03115791 $856.08
TOTAL AMOUNT PAID:
$856.08
REMARKS' GWENDOLYN GOODLING
NKA GWENDOLYN DEVLIN NO CK #
SEAL
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ;~. ,~ ' /L/£ ~d 4. (/~V,'),~ d/~4 ~4
Date of Death: /~/'~ftg~C/'~ //~ ,~ZOO~
Will No. ~(90 3 0 (9 7 ~" ~ Admin. No. P/~ /t)0. ~-/~ D,Y - 02 ,q'3
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of, the Or, hans' Court ~ules was
served on or mailed to the following beneficiaries of the above-captioned estate on f a ~, c¼ /2, -2 cC: i~3 ·
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Sigrlature
Name
Address
Telephone C.7/~
Capacity: __ Personal Representative
Counsel for personal representative
BUREAU OF INDIVIDUAL TAXES
TNHERITANCE TAX DI¥ISTDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRAZSEMENT. ALLOHANCE OR DZSALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
'O3
GWENDOLYN GOODLING
505 LAMP POST LANE
CAMP HILL PA 17011
DATE 08-04-Z005
ESTATE OF GOODLING
DATE OF DEATH 03-11-2005
FILE NUMBER 21 03-0253
r-, ~ .~. COUNTY CUMBERLAND
~ · '~ ~ SSN/DC 163-30-6718
ACN 03115791
I Amoun'~
REV-i~it8 EX AFP
HILDRED
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
REV-IS48 EX AFP (01-03)
RETAIN LOWER PORTION FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-04-2003
ESTATE OF DOODLING
MILDRED A DATE OF DEATH 03-11-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0253 S.S/D.C. NO. 163-30-6718 ACN 03115791
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET ZNFORHATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT NO. 10535
TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 10-03-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
38,047.99
X 0.500
19,0Z4.00
- .00
19,024.00
X .45
856.08
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
04-IS-ZOO3
RECEIPT
NUMBER
CD002496
DISCOUNT (+)
INTEREST/PEN PAID (-)
42.80
AMOUNT PAID
ZF PAZD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDZTZONAL ZNTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT'( CR}, YOU MAY BE DUE A REFUND.
SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.
856.08
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
898.88
4Z.8OCR
.00
4Z.8OCR
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF RILLS, AGENT.
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" (REV-1313). Applications ars available at the Office of
the Register of #ills, any of the Z3 Revenue District Offices er by calling the special 24-hcur ansearing service
for fores ordering: 1-800-362-Z050) services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disellowanca of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of
this Notice by:
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decadent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (52)
discount of the tax paid is allowed.
The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine [9) months end one C1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six :6X3 percent per annum calculated st a daily rate of
All taxes which became delinquent on or after January 1, 1982 mill bear interest at a rate which mill vary from
calendar year to calendar year with that rate announced by the PA
interest rates for 198Z through Z003 ara:
Interest Daily
Year Rate Factor
1982 ZOZ .000548
1983 16X .000438
1984 IlZ .000301
1985 131 .000356
1986 102 .000274
Department of Revenue. The applicable
Interest Doily Interest Doily
Year Rate Factor Year Rate Factor
1987 92 .000247 1999 72 .00019Z
1988-1991 112 .000301 2000 82 .000219
1992 92 .000247 Z001 92 .000247
1993-1994 72 .000192 2002 62 .000164
1995-1998 92 .000247 2003 5X .000137
--Interest is calculated es follows:
TNTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAgS DELINQUENT X DAILY 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 sust be calculated.
BUREAU OF ZNDZVZDUAL TAXES
/NH£RITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601
CONHONNEALTH OF PENNSYLVAN'rA
DEPARTHENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
REV-i&07 EX ~FP
GNENDOLYN GOODLING
505 LAMP POST LANE
CAMP HILL PA 17011
DATE 09-02-2005
ESTATE OF GOODLING
DATE OF DEATH 05-11-2005
FZLE NUHBER 21 05-0255
COUNTY CUMBERLAND
ACN 05115791
I Amoun~ Remi~ed
MILDRED A
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF t/ILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credit: ~o your account, submi~ ~:he upper portion of ~his fore wi~h your ~ax payeen~.
CUT ALONG THZS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) ~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT ~
ESTATE OF GOODLING HILDRED A F'rLE NO. 21 03-0253 ACN 05115791 DATE 09-02-2005
TH'rS STATEMENT TS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELON
TS A SUMMARY OF THE pRINCIpAL TAX DUE, APPLTCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE., AND, TF APPL'rCABLE,
A PROJECTED TNTEREST FTGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 08-04-2005
PR/NC/PAL TAX DUE: .........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
856.08
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
04-25-2005
08-18-2005
CD002496
REFUND
42.80
.00
856.08
42.80-
ZF PAID AFTER THIS DATE, SEE REVERSE
S/DE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT
BALANCE OF TAX DUE
856.08
.00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TH/S FORH FOR TNSTRUCT/ONS. )
PAYNENT:
Detach the top portion of this Notice and submit aith your payment made payable to the name end address
printed on the reverse side.
-- Tf RESTDENT DECEDENT make check or money order payable to: REGISTER OF #ZLLS~ AGENT.
-- Tf NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANZA.
REFUND (CR): A refund of a tax credit, mhich mas not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at
the Office of the Register of Nills, any of the 25 Revenue District Offices or frei tho Department's 24-hour
answering service for forms ordering: 1-B00-362-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calender months after the decadmnt's death, a five percent (52) discount
of tho tax paid is allomod.
PENALTY:
The 152 tax amnesty non-participation penalty is computed on the total cf the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
TNTEREST:
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 l, 1982 bear interest at the rate of
six (62) percent par annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after
January 1, 1982 ail1 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 1982 through 2003 are:
Znterast Daily Tntorest Daily Interest
Year Rate Factor Year Rate Factor Year Rate
Daily
Factor
1982 ZOZ .000548 1987 92 .000247 1999 72 .000192
1983 161 .000458 1988-1991 112 .000301 ZOO0 82 .000219
1984 llZ .000301 1992 92 .000247 Z001 92 .000247
1985 13Z .000356 1993-1994 72 .000192 Z002 6X .000164
1986 102 .000274 1995-1998 92 .000247 2003 52 .000157
--Tnterast is calculated as follows:
XNTBREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELXNt~UENT X DAXLY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of tho assessment. Tf payment is made after tho interest computation date shown on tho
Notice, additional interest must be calculated.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.:
MILDRED A. GOODLING
March 11, 2003
2003-00253
Admin. No.:
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
October 3, 2003.
Name
Gwendolyn E. Devlin
Address
505 Lamp Post Lane
Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None.
Date: October 3, 2003 ~.~~
Signature
Name EDMUND G. MYERS
Johnson, Duffie, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
Capacity:
Counsel for personal representative
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 OO3247
MYERS EDMUND ESQUIRE
301 MARKET STREET
P O BOX 109
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 163-30-6718
FILE NUMBER: 2103-0253
DECEDENT NAME: GOODLING MILDRED A
DATE OF PAYMENT: 11 / 18/2003
POSTMARK DATE: 11/17~2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/11/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~2,815.05
TOTAL AMOUNT PAID:
$2,815.05
REMARKS: GWENDOLYN EGOODLING
C/O EDMUND MYERS ESQUIRE
SEAL
CHECK# 103
INITIALS: VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GOODLING, MILDRED A.
DATE OF DEATH (MM:DD-YEAR~ ] DATE OF BIRTH (MM-DD-YEAR)
03/11/2003 [ 10/08/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
REV-1500 it '7 -'''
INHERITANCE TAX RETURN 'F.LE.UM.E.
RESIDENT DECEDENT 21 03 00253
:: COUNT'( CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
163-30-6718
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 1~ Original Return [] 2. Supplemental Return
[] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after
12-12-82)
[] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1-95)
NAME
Edmund G. Myers
FIRM NAME (If applicable)
Johnson, Duffle, Stewart & Weidner
TELEPHONE NUMBER
7 ! 7/76 ]-4540
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)
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)
] 3. Remainder Return (date of death prior to 12-13-82)
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
COMPLETE MAILING ADDRESS
11. Total Deductions (total Lines 9 & 10)
P.O. Box 109
Lemoyne, PA 17043-0109
None
None
None
None
36,751.29
None
36,558.03
OFFICIAL USE ONLY
(9) 9,254.55
(10) 1,498.01
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) · (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x o00 (15)
or transfers under Sec. 9116(a)(1.2)
(8) 73,309.32
(11) 10,752.56
(12) 62,556.76
(13)
62,556.76
16.Amount of Line 14 taxable at lineal rate
62,556.76 x .045 (16) 2,815.05
17.Amount of Line 14 taxable at sibling rate x /12 (17)
18. Amount of Line 14 taxable at collateral rate x .1§ (18)
19. Tax Due (19) 2,8 1 5.05
20. [] ......
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00}
Decedent's Complete Address:
· STREET ADDRESS
c TY Camp Hill
505 Lamp Post Lane
sTAT~ PA
ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line I + Line 3, enter the difference. This is theOVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B)
2,815.05
0.00
0.00
2,815.05
2,815.05
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, benef ts or care? ...........................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate considerat on? ............................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ....... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a benef c ary des gnat on2 ............................................................................................................... [] []
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
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~E OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
__~Gw~olyn E. Devlin _ /'~ / ~/DATE
(- ,/... . 505 Lamp Post Lane
/4' /Y
Camp Hill,, PA 1701
~51~ATURE OF PEJ~i~SON RESPONSIBLE FOR FILING RETURN ADDRESS
SIGNATURE OF PREPARER oTHER THAN REPRESENTATIV~ ADDRESS
DATE
Edm u n~l~G. Myers . ~ .... ~nn
¢,~~ ,~ ~ Eb~ot~%~,'mU2~ 17043-0109 f'{r[ ~/0~
For dates of death on or after July 1, 1994 and before Januaw 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 Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statut~oes not exempta transfer to a su~iving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the sullying 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 ~enty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the de,dent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GOODLING, MILDRED A.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 - 03 - 00253
Include the proceeds of litigation and the date the proceeds were received by the estate~JI property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
l
2
3
4
DESCRIPTION
Waypoint Bank Certificate of Deposit Account No. 04-66-247178
Waypoint Bank Certificate of Deposit Account No. 04-66-252418
Allfirst Bank Checking Account (Now M&T Bank) Account No. 37877755
Eric Insurance Group
TOTAL (Also enter on Line 5, Recapitulation)
VALUE AT DATE OF
DEATH
9,345.49
12,919.70
14,483.10
3.00
36,751.29
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT L
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
, FILE NUMBER
GOODLING, MILDRED A.
i 21 - 03 - 00253
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER
DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent and the date of transfer
Attach a copy of the deed for real estate.
American Express IDS Fixed Life Retirement Annuity
Contract Date: 5/15/1996 Account Number: 0930 0522
6750 5 004
Beneficiary: Gwendolyn E. Devlin, Daughter
DATE OF DEATH
VALUE OF ASSET
36,558.03
%OF
DECD'S EXCLUSION
INTEREST (IF APPLICABLE)
/
TAXABLE VALUE
36,558.03
TOTAL (Also enter on line 7, Recapitulation) 36,558.03
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GOODLING, MILDRED A.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1 Myers-Hamer Funeral Home
SCHEDULE H
FUNERAl_ EXPENSES &
.N3MINISIRATIVE COSTS
i FILE NUMBER
21 - 03 - 00253
AMOUNT
4,939.00
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
Attorney's Fees Johnson, Duffle, Stewart & Weidner
Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation)
Claimant Gwendolyn E. Devlin
Street Address 505 Lamp Post Lane
City Camp Hill State PA
Relationship of Claimant to Decedent Daughter
Probate Fees Cumberland County Register of Wills
Zip 17011
500.00
3,500.00
92.00
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
The Cumberland Law Journal - Notice of Estate Adminsitration
The Patriot News - Notice of Estate Adminsitration
75.00
123.55
Total of Continuation Schedule(s) 25.00
TOTAL (Also enter on line 9, Recapitulation) i 9,254.55
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~H
FuneraJ Expenses &
Admi~ ~ continued
GOODLING, MILDRED A.
Cumberland County Register of Wills Filing Fees
Inheritance Tax Return - $15.00
Inventory - $10.00
FILE NUMBER
21 03-00253
25.00
Page 2 of Schedule H
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
GOODLING, MILDRED A.
FILE NUMBER
21 - 03 - 00253
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
7
8
DESCRIPTION
PA Department of Revenue-Pennsylvania Income Taxes
Susquehanna Internal Medicine
Neurological Surgery, Ltd.
Holy Spirit Hospital
Quantum Imaging
Associated Cardiologists
Kunkel Surgical Group
Retina & Oculoplastics Consultants, P.C.
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
111.00
140.03
68.59
865.22
96.12
68.59
43.05
105.41
1,498.01
REV-1513 EX+ (9-00) .~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
NUMBER
I.
1
SCHEDULE J
BENEFICIARIES
RESIDENT DECEDENT
GOODLING, MILDRED A.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Gwendolyn E. Devlin
505 Lamp Post Lane
Camp Hill, PA 17011
FILE NUMBER
21 - 03- 00253
RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT OF ESTATE
~ N~t List Tr. usJ:ee(s.
Daughter Entire Estate
II.
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee~t
/
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 SHEEp
!
LISTING OF EXHIBITS FOR
ESTATE OF MILDRED A. GOODLING
EXHIBIT A
Last Will and Testament of Mildred A. Goodling signed
and dated on the 20th day of September, 1971.
EXHIBIT A
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVZSION
DEPT. 280601
HARRTSBURG,, PA 17128-0601
EDHUND G HYERS
JOHNSON ETAL
PO BOX 109
LENOYNE
COHHONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLO#ANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
'04 FEB25 A8:3Q
REV-1547 EX 4FP ¢01-05)
DATE 01-12-2004
ESTATE OF GOODLING HILDRED
DATE OF DEATH 03-11-2003
FILE NUHBER 21 03-0253
COUNTY CUHBERLAND
ACN 101
Aaount Remitted
A
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF GOODLING HILDRED AFILE NO. 21 03-0253 ACN 101 DATE 01-12-2004
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
$ Closely Held Stock/fartnarship Zn*erast (Schedule C)
Hortgages/Notas Receivable (Schedule D)
5 Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6 Jointly O~nad Property (Schedule F)
7 Transfers (Schedule G)
8 Tote1 Asse~s
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral Expensas/Adm. Costs/Nisc. Expenses (Schedule H)
10. Debts/Nortgaga Liabilities/Liens (Schedule I)
11. Total Deductions
12. Nat Value of Tax Return
(1) .00 NOTE: To insure proper
(2) . O0 credi* to your account,
($) . O0 submit the upper portion
(q) .00 of this form with your
(5) 36~751.29 ~ax payment.
(6) .00
(7) 36~558.03
(8) 73,309.32
(9)
(10)
9,254.55
1,498.01
(11) 10.752.56
(12) 62,556.76
1S.
1~.
NOTE
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15)
Nat Value of Es*ate Subject to Tax (1~)
If an assessment #as issued previously, 1/nas 14, 15 and/or 16, 17,
.00
62,556.76
18 and 19 ~ill
reflect flgures that include the total of ALL returns assessed to date.
(is), .00 x O0 = .00
(16). 62,556.76 X 045 = 2,815.05
(17). .00 x 12 = .00
(lG), .00 X 15 = .00
(19)= 2,815.05
AHOUNT PAID
ASSESSHENT OF TAX:
1S. Amount of Line 1~ at Spousal rata
16. Amount of Line lq taxable at Lineal/Class A ra*a
17. Amount of Line 1~ at Sibling rata
18. Amount of Line lq taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYNENT RECEIPT DISCOUNT
DATE NUHBER INTEREST/PEN PAID (-)
11-17-2003 CD003247 .00
2,815.05
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT [ Z,815.05
BALANCE OF TAX DUEl .00
INTEREST AND PEN. .00
TOTAL DUE . O0
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND ¢CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
D[SCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December IZ, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 21qO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (7Z P.S.
Section 91qO).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILES, AGENT
A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Nills, any of the Z3 Revente District Offices, or by calling the special 2q-hour
answering service for forms ordering: 1-800-$6Z-2050~ services for taxpayers eith special hearing and / or
speaking needs: 1-BOO-qq7-3OZO [TT only].
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or 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. 281021, Harrisburg, PA 171Z8-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to tho Orphans' Court.
OR
1982
1983
1984
1985
1986
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three {3) calendar months after the decedent's death, a five percent (SZ) 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 not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period es you would appeal the tax and 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 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 a daily rate of .00016q. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Oepartaont 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
ZOZ .OOOSq8 1987 9Z .O00Zq7 1999 7Z .O0019Z
16Z .000q38 1988-1991 llX .000301 ZOO0 8Z .000Z19
llZ .000301 199Z 9Z .O00Zq7 ZOO1 9Z .000247
132 .000356 1993-199q 72 .O0019Z 2002 62 .O0016q
lOX .O00Z7q 1995-1998 92 .O00Zq7 ZOO3 5Z .000137
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days
beyond the date of the assessment. If payment is sade after the interest computation date shown on the
Notice, additional interest must be calculated.
21-03-253
lill
I, MILDRED A. GOODLING, of the Borough of Camp Hill, County
of Cumberland and State of Pennsylvania, make, publish and declare this
to be my Last Will and Testament, hereby revoking and making void any
and all Wills by me at any time heretofore made.
1. I direct the payment of my just debts and funeral expenses
as soon after my death as may be convenient to my Executor hereinafter
named.
2. All the rest, residue and remainder of my estate, real,
personal and mixed, I give, devise and bequeath unto my husband, Victor
A. Ooodling, if he survives me for a period of thirty (30) days.
3. In the event my husband shall fail to survive me for a
period of thirty (30) days, I give, devise and bequeath all the rest,
0~ ~'/,',~
residue and remainder of my estate to my daughter, Owendolyn E. O~.
4. I name, constitute and appoint my husband, Victor A.
GoodlinG, to be Executor of this, my Will. Should my husband predecease
me or for any other reason be unable or unwillin9 to act in this capacity,
I appoint my daughter, G~endolyn E. Goodling, to be Executrix of this my
Will. I direct that my Executor or Executrix shall not be required to
give bond for the performance of his or her duties.
IN WITNESS WHEREOF, I hereunto set my hand and seal this~_o~
day of~-~ lO71.
{sEw)
~ildred A. Goodling
SiGned, sealed, published and declared by the above named
Testatrix, as and for her Last Will and Testament, in the presence of
us, who, at her request, in her presence, and in the presence of each
other, have hereunto subscribed our names as witnesses.
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of GOODLING, MILDRED A.
also known as
No. 21 - 03- 00253
Date of Death 3/11/2003
, Deceased
Social Security No. 163-30-6718
Gwendolyn E. Devlin
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Personal Repre%ta~¢¢
Attorney: Edmund G. Myers Sign atu re ¢- 2~4¢.¢~ ~_~._/¢.t ~_~&..
"C~n~oo~yn E. D~lih
I.D. No.: 20558 Signature:
Address:
Signature:
P.O. Box 109
Lemoyne, PA 17043-0109
Address: 505 Lamp Post Lane
Camp Hill,, PA 17011
Telephone: 717/761-4540 Telephone: 717-975-3392
Dated: / !
Personal Property
Waypoint Bank Certificate of Deposit Account No. 04-66-247178
Waypoint Bank Certificate of Deposit Account No. 04-66-252418
Allfirst Bank Checking Account (Now M&T Bank) Account No. 37877755
Eric Insurance Group
Total Personal Property
9,345.49
12,919.70
14,483.10
3.00
$36,751.29
(Attach additional sheets if necessary) Total Personal Property and Real Estate $36,751.29
JOHNSON, DUFFle, STEWARt & WEIDNER
ATTORNEYS AT LAW
MARKET STREET
P.O. BOX 109
LIEMOYNE. PENNSYLVANIA 17043
Fimt
REGISTER OF WILLS OFFICE
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
ATTN: CHERYL
JERRY R. DUFFLE
RICHARD W. STEWART
C. ROY WEIDNER, dR.
EDMUND G. MYERS
DAVID W. DELUCE
RALPH H. WRIGHT, dR.
MARK C. DUFFLE
MICHAEL d. CASSIDY
MELISSA PEEL GREEVY
ROBERT M. WALKER
WADE D. MANLEY
LAW OFFICES
JOHNSON, DUFFIE, STEWART & WEIDNER
A Professional Corporation
301 MARKET STREET
P.O. BOX 109
LEMOYNE, PENNSYLVANIA 17043-0109
WEBSITE: www.jdsw.com
HORACE A. dOHNSON
COUNSEL TO THE FIRM
TELEPHONE 71%761-4540
FACSIMILE 717-761-3015
E-MAIL: mail~jdsw.com
March 10, 2004
WRITER'S EXT. NO. 114
E-MAIL dlw@jdsw.com
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
ATTN: CHERYL
Re:
Estate of Mildred A. Goodling
SSN: 163-30-6718
Date of Death: March 11, 2003
Your File No. 21-03-0253
Dear Register:
Enclosed for filing please find the Status Report for the above referenced
decedent. Should you have any questions, please do not hesitate to contact our office.
Thank you f~r you assistance in this matter.
Very truly yours,
JOHNSON, DUFFLE, STEWART & WEIDNER
Dana L. Wieseman
Legal Assistant
c: Gwendolyn E. Devlin, Executrix
#224993
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
MILDRED A. GOODL1NG
Date of Death:
Will No.
MARCH 11, 2003
21-03-0253
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, 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 X 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 No X
b. The separate Orphans' Court No. (if any) for the personal
representative's Account is:
Co
parties of interest?
Did the personal representative state an account informally to the
Yes No X
Executrix was sole beneficiary
to this re~rt. ,,:
: Date: M~'ch 10, 2~04
co d. Copies of receipts, releases, joinders and approvals of formal or
'intbrmal/a~countS: may be filed with the Clerk of the Orphans' Court and may be attached
EDMUND G. MYERS
JOHNSON, DUFFIE, STEWART & WEIDNER
301 Market Street
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
Capacity: ~Personal Representative
(x) Counsel for Personal
Representative
LAW OFFICES
JOHNSON, DUFFIE, STEWART 8 WEIDNER
301 MARKET STREET
P. O. BOX 109
LEMOYNE, PENNSYLVANIA 17043-0109
REGISTER OF WILLS OFFICE
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUSE SQUARE
CARLISLE, PA 17013
ATTN: CHERYL
17013+330 i 02 i,,,lli,,,llt,,,,,,li,,ll,,,li,,,Ihli,,,,,,lli,i,,I,I,