HomeMy WebLinkAbout03-0578PETITION FOR PROBATE and GRANT OF LETTERS
L, oZ/-
also known as To:
Deceased.
Social Security No. / ~ S - 0 ? '~ / 7 ~o
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut
in the last wilt of the above decedent, dated t'V'xa,/ '~,o. ~_ <303
and codicil(s) dated / t v
Register of WiOs for the
County of ~_o..~..~ e ~-~l~in the
Commonwealth of Pennsylvania
named
,19.__
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (~_q ~_._/, e_v-la.~. _J. County, Pennsylvania, with
h ¢ r last family or principal residence at I
(list street, number and muncipality)
Decendent, then q ~ years of age, died
Except as follows, decedent d~d not ~arryt, 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: 19
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.~/; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALT~H OF PENNSYLVANIA -I
COUNTY OF d'~Ze~,-,d~_.A ~.tt..t~7-._.. ~ 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 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 affirmecLand subscribed
before mf~at his' ~9~f--'~ day.of
No. 2003-~78
Estate Of ~.LSZ~. L. ~ERED~Ta
DECREE OF PROBATE AND GRANT OF
, Deceased
LETTERS
AND NOW JULY 18, ~9X2003_, 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 MAY 30~ 2003
described therein be admitted to probate and filed of record as the last will of
and Letters TESTAMENTARY
are hereby granted to ANITA L. POWELL
-' Re'steer of Wills '
FEES
Probate, Letters, Etc .......... $ 235.00
Short Certificates(2) ..........$. 6.00
~x.z~. PCS. 2 ..... $ 6_ aa
JCP $. 10.00
TOTAL ~ $ 2.~?.00
Filed .... .J.U.L.Y...1.8.,..2.0..0.3 ................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
CALLED EXECUTRIX JULY 18, 200.3
Z- 7FI? fO.
21-03-578
REGISTER OF WILLS OF COM~E~AND COUNTY
OATH OF WITNESS TO WILL EXECUTED
BY MARK
ELSIE L. MEREDITH
TATUM
L. HOCKENBERRY AND VERNICE GOSHORN
(each)
a subscribing witness to the will presented herewith, (each) being duly qualified accord(ag to law,
depose(s) and say(s) that: testatr_r_~_x was unable to sign h_~_r .... name thereto; tcstat_r.~_x__'s name
was subscribed thereto in testatx_i~x__'s presence; res(aLt3_X made h..er_ .... mark thereon;
testa(ri.x___ and deponent(s) w.,x~x(were) present when (cstat_.r_-i_x__'s name was subscribed and
codicil
when testat r___~Z__ made her mark; and testatr:i:_x .... was present when the undersigned signed ~he will as
witness(es).
Sworn to or affirmed and subscribed
befor Z ~' ~
day of
Register
(Name)
(Address)
(Name)
(Address)
21-03-0578
LAST WILL AND TESTAMENT
21-03-578
I, Elsie L. Meredith, a widow and single woman, presently residing at 111 South Prince
Street, Apartment, C-6, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind,
memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever
and wheresoever situate, to my beloved great niece, ANITA L. POWELL, provided that she survive
me by a period of thirty (30) days.
THIRD. In the event my said great niece, Anita L. Powell, should predecease me or is not
living on the 30th day following my death, I then give, devise and bequeath my said estate to the children
of Anita L. Powell, namely, CHANCE W. POWELL, NICOLE A. POWELL, and WADE W.
POWELL, in equal shares, on a per stirpes distribution basis.
FOURTH. I nominate, constitute and appoint my great niece, ANITA L. POWELL,
presently residing at 119 North Apple Avenue, Shippensburg, Pennsylvania 17257, to be the Executrix
of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate,
constitute and appoint JOHN W. POWELL, JR., to be the Executor of this my Last Will and
Testament.
FIFTH. I direct that my personal representative(s) shall not be required to give bond for
the faithful performance of their duties in any jurisdiction.
SIXTH. I direct my Executrix to retain the services of JERRY A. WEIGLE, ESQUIRE,
with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the
settlement of my estate due to his familiarity with my affairs.
IN WITNESS WHEREOF, I, Elsie L. Meredith, Testatrix, being unable to sign my name
because of illness, have had my name subscribed for me in my presence and at my direction by Jerry Ac,
Weigle, Esquire, whereupon I have made my mark unassisted, in the ,space between my name this~lr"~._
day of May, 2003.
ELSIE L. /'X MEREDITH
(SEAL)
MARK
WEIGLE & ASSOCIATES, P.C. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBUR6, PA 17257-1397
On this 28th day of May, 2003, Elsie L. Meredith, the above-named Testatrix, in our presence
declared the preceding instrument, consisting of this and two (2) other typewritten pages, to be her Last
Will and Testament and being unable to sign her name hereto because of illness directed her name to be
subscribed for her which the undersigned Jerry A. Weigle, Esquire, did subscribe as directed in the
presence of the Testatrix and in the presence of the undersigned, whereupon the Testatrix in our
presence unassisted made her mark or cross in the space provided between her name, and we, in the
presence of the Testatrix and in the presence of each other, at the request of the Testatrix, have
subscribed our names as witnesses.
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND ·
SS
I, Elsie L. Meredith, the Testatrix whose name is subscribed to the foregoing instrument at her direction
by Jerry A. Weigle, Esquire, and by affixing her mark unassisted thereto, having been duly qualified
according to law, do hereby acknowledge that I signed and executed the instnunent by my mark as my
Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
;HER
ELSIE L. , MEREDITH
Swom or affirmed to and acknowledged before
me by ELSIE L. MEREDITH, the Testatrix,
this 30°` day of ~ ,2003.
Notarial Seal .
,r,~r,~ ,, Notary Public
,-,herlandCounty
iNotarial Seal
_ Patrtcia L Tome, Notary Public
~nslx~ Bom, Cumberlaed County
My Uommission Expires June 7, 2004
ASSOCIATES, P.C.-- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND ·
We, '-1~ ~o V[~~xx~_~, and
the witnesses whose names are signed to the fore'g6ing instrument, being duly qualified according to
law, do depose and say that we were present and saw Elsie L. Meredith, the Testatrix, sign and execute
the instrument by her mark as her Last Will; 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 the
time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me
witnesses, this ~)~-~x day of '"Dqct~t
,2003.
Notarial Seal .
Patricia L. Tome, Notary Public
Shil;l:~_ urg Bo ro, Cumbeita~l County I
My Commission Expires June 7, 2004_~
WEIGLE & ASSOCIATES, RC. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397
ELSIE L. l~RgDIlqt
r--
WEIGLE & ASSOCIATES, P.C.
,~kTTOi::tNE¥$ &T LAW
lz~ ~AST ~'~ING STREET
SHIPPENSBURG, PA 17257-1397
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
·
INHERITANCE TAX RETUR
RESIDENT DECEDENT
DECEDENTS FIRS' AND MIDDLE INITIAL
}EATH (MM-OD-YEAR) DATE OF BIRTH (MM-DO-YEAR)
s - / - o /I - S--- //
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRSt, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
- 0 F o
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIALSECURITYNUMBER
1. Original Return
4. Limited Estate
['--~ 6. Decedent Died Testate
fAttach c~0y of W~i~
r~9. Proceeds Received
Litigation
[---~ 2. Supplemental Retum
[~4a. Future Interest Compromise (date of death afte~ 12-12-82)
'--]7. Decedent Maintained a Living Trust (Aaac~ cody of Trust)
[~10. Spousal Pover~ Credit (date of death between 12-31-91 and 1-1-95)
[~3. Remainder Return (dam of death ~ to 12-1382)
r---] 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
--]11. Election to tax under Sec. 9113(A)
FIRM NAME (If Applicable)
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 Prope~ (5)
(Schedule E)
6. Jointly Owned Properb/(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)
OFFICIAL USE ONLY
(13) /yO
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
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x.O
x .12
x .15
(15)
(16)
(17)
(lB)
Decedent's Complete Address:
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
STATE
(1)
Total Credits ( A + B + C )
(2)/; o?0o
Total InterestJPenalty ( D + E ) (3)
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.
(5A)
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 dght 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? .............................................................................................................. [] ,J~
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] J~
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 perNrT, 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 preDarer other than the personal representative is based on all information of which preparer has any knowteC~e.
SIGNATURE Of P~F~ON RF~S_~PONSIB.I.jE FO.~ClLII~G R~."~RN .,~
ADDRESS
/?//0
SIGNATURE OF'PREPARER OTHER THAN REPRESENTATIVE
DATE
.?_
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
RL=V-I~4 ~ + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY. HELD CORPORATION,
PARTNEESHIP or SOLE-PROPEIETOESHIP
FILE NUMBER
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
VALUE AT DATE
DESCRIPTION OF DEATH
ITEM
NUMBER
1.
TOTAL (Also enter on line 3, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-150~EX + (1~q7) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C-1
CLOSELY-HELD COEPORATE
STOCK INFOEMATIO. EEPORT
FILE NUMBER
Name of Corporation
Address
City
2. Federal Employer I,D. Number
3. Typo of Business
State Zip Code
Product/Service
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common
$
Preferred
$
Provide all dghts and restrictions portaining to each class of stock.
5. Was the decedent employed by the Corporation? [] Yes
If yes, Position
6. Was the Corporation indebted to the decedent? [] Yes
If yes, provide amount of indebtedness $
[] No
Annual Salary $
[] No
Was there life insurance payable to the corporation upon the death of the decedent? [] Yes
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
Time Devoted to Business
[] No
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31--827
[] Yes [] No If yes, [] Transfer [] Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax retums (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
REV-1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
3.
4.
5.
Name of Partnership
Address
City
Federal Employer I.D. Number
Date Business Commenced
Business Reporting Year
State__ Zip Code
Type of Business Product/Service
Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. [] Yes [] No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... [] Yes [] No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-827
[] Yes [] No If yes, [] Transfer [] Sale Percentage transferred/sold
Transferee or Purchaser Consideration $
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement. ' .....
11. Was the decedent's partnership interest sold?
If yes, provide a copy of the agreement of sale,'(;t~i ................................... [] Yes [] No
12. Was the partnership dissolved or liquidated after the decedent's death? ................... [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? .................................... [] Yes [] No
If yes, explain
Date
14. Did the partnership have an interest in other corporations or partnerships? .............. [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C~1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedenrs partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-150~ EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Indu.de the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomP_ip must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
/) c, o' g / o o ¢7',;
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size) '
SCHEDULE F
JOINTLY-OWNED PROPERTY
REV-154)9 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
JOINTLY-OWNED PROPERTY:
LE ~ i ~-~ DATE DESCR(PTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joinfiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. A.
TOTAL (Also enter on line 6, Recapitulation) $
si , insert additional sheets of the same size)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Bebts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
5.
6.
7.
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
Relationship of Claimant to Decedent
Probate Fees
State Zip
Accountant's Fees
TOTAL (Also enter on line 9, 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
ESTATE OF ,
FILE NUMBER
NUMBER
]!
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
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:
SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART il- 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)
REV-1513 EX+ (9-00~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF ,
NUMBER
!
1,
]!
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
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 ]! - 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)
REV-1514 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
sc. ou, .
LIFE ESTATE, ANNUITY/ O & TERM CERTAIN {
(Check Box 4 on Rev-1500 Cover Sleet)
I~:E-~ER
This schedule is to be used for all single life, joint or.successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
[] Will [] Intervivos Deed of Trust [] Other
UFE ESTA ~E I~EREST CAU
NAME(S) OF NEAREST ,AGE` AT' TERM oF'YEARS LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
[] Life or [] Term of Years ~
[] Life or [] Term of Years ~
[] Life or [] Term of Years __
[] Life or [] Term of Years ~
1. Value of fund from which life estate is payable $
2. Actuarial factor per appropriate table
Interest table rate- [] 3 1/2% [] 6% [] 10% [] Vadable Rate %
3. Value of life estate (Line I multiplied by Line 2) $
" NEARES~ AGE AT TERM OF YEARS
NAME(S) OF
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
[] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Monthly (12)
[] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other( )
3. Amount of payout per period $
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if vadable rate and pedod payout is at end of pedod,
calculation is: Line 4 x Line 5 x Line 6 $
If using vadable rate and pedod payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax retum. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
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 002998
POWELL ANITA L
119 NORTH APPLE AVENUE
SHIPPENSBURG, PA 17257
........ fold
ESTATE INFORMATION: SSN: 185-09-1720
FILE NUMBER: 2103-0578
DECEDENT NAME: MEREDITH ELSIE L
DATE OF PAYMENT: 09/10/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $20,717.49
REMARKS'
ANITA L POWELL
TOTAL AMOUNT PAID:
$20,717.49
SEAL
CHECK# 998
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6{a)
Will No. o,~t- 03 - ~'-ICc} Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of,-,----the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on y~//'/--
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 2--//D ~~) '--~
Signature
Name ~~'c~ ~,~ ~ ~~,.ff_
Address ,/
Telephone(
Capacity:
__ Personal Representative
Counsel for personal representative
BUREAU OF TNDZVZBUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 28060!
HARRISBURG, PA 17128-0601
ANITA L POWELL
119 N APPLE AVE
SHIPPENSBURG
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
PA 17257
10-21-2005
HEREDITH
06-12-2005
21 05-0578
CUHBERLAND
101
Amount Remitted
REV-1S47 EX AFP COl-OS)
ELSIE L
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~.~ RETAIN LOWER PORTION FOR YOUR RECORDS 4
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HEREDITH ELSIE L FILE NO. 21 05-0578 ACN 101 DATE 10-21-2005
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I Reel Esteto (Schedule A)
Stocks end Bonds (Schedule B)
$ Closely Held Stock/Partnership Interest (Schedule C)
Nortgeges/Notes Roco/veblo (Schedule D)
5 Cesh/Benk Deposits/Hisc. Personel Property (Schedule E)
6 do/ntly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Tote1 Assets
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funerel Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Nortgege Liabilities/Liens (Schedule I)
11. Tote1 Deductions
Nat Value of Tax Return
15.
14.
(2) .00
(2) .00
(5) .00
(4) .00
(5) 151/985.$5
(6) .00
(?) .00
(8)
6,597.42
(9)
(10) .00
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
NOTE: To /nsure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
151,985.$5
(11) & .597.42
(12) 145,385.93
(13) . O0
(14) 145,385.95
NOTE:
ASSESSHENT OF TAX:
15. Amount of Line 14 at Spouse1 rate
16. Amount of Line 14 taxable at Lineal/Class A rata
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Colleterel/C1ess B rate
19. Principal Tax Due
TAX CREDITS:
PAYflENT RECEIPT DISCOUNT (*)
DATE NUNBER INTEREST/PEN PAID (-)
09-10-2005 CD002998 1,090.$9
If an assessment was issued prev/ously, lines 14, 15 and/er 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to data.
(15) .00 X O0 = .00
(16) .00 X 045 = .00
(17) .00 X 12 = .00
(18) 145,$85.95 x 15 = 21,807.89
(19)= 21,807.89
ANOUNT PAID
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
20,717.49
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
21,807.88
.01
.00
.01
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collatmral) beneficiaries of the decedent after the expiration of any estate for
1ifa or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such futura interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 af ZOO0. (72 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: REgXSTER OF NILES, AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy bm 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 Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-aOO-36Z-Z050; services for taxpayers with specie1 hearing and / or
speaking needs: 1-800-447-30Z0 (TT onXy).
Any party in interest not satisfied with the appraisaaent, 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. ZalOZi, Harrisburg, PA 171Ia-lOll,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
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. Sea page 5 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 dacedsnt's death, a five percent (SI) 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 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 and one (1) day from 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 .000164. 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 rata
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 2OZ .000548 1987 9Z .000247 1999 7Z .00019Z
1983 16Z .000438 1988-1991 llZ .000301 ZOO0 8Z .OOOZ19
1984 llZ .000301 199Z 9Z .O00Z~7 ZOO1 9Z .000247
1985 152 .000356 1993-1994 7Z .O0019Z ZOOg 62 .000164
1986 lOZ .O00Z7q 1995-1998 9g .000Z47 ZOO3 5Z .000137
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPATD
X NUIIBER OF DAYS DELTNQUENT
X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) 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.
cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/03/2005
POWELL ANITA L
119 NORTH APPLE AVENUE
SHIPPENSBURG, PA 17257
RE: Estate of MEREDITH ELSIE L
File Number: 2003-00578
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
6/12/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~.l~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
;