HomeMy WebLinkAbout04-0830 Estate of Dorothy M. Lewis
Instructions for Getting Sworn in as the Executrix
q. 9 3o
Go to the Register of Wills office at the Cumberland County courthouse, located at
One Courthouse Square, Carlisle, PA 17013.
Tell the Register of Wills Agent that you want to be sworn in as the Executrix of your
aunt's estate and hand him/her the following documents: Original Will
Original death certificate
Petition for Grant of Letters w/Estate Information Sheet
You will also have to pay filing fees. Make a check for $177.00, payable to
Register of Wills, Agent.
The Register of Wills will process the paperwork and grant Letters Testamentary to you.
They will then issue 5 short certificates to you, which give you the authority to liquidate
assets, pay bills, etc. You m~y_h_av_e thems_e._.nt__e~her to you or to o~ office at:
.J~'L. Brown & Associates- ....... . -. .
'/' 845 Sir Thomas Court, Suite 12 "~ (--}/~) ~'~2C_
Harrisburg, PA 17109
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Dorothy M. Lewis
also known as
Dorothy M. Lewis
, Deceased
Dana E. Jefferson, Executrix
Social Security No. 130-18-4471
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
~ Decedent, dated 06/24/2003 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendenta lite, durante absentia; durante rninodtate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
residence at 46 Erford Road, East Pennsboro Township, Camp Hill
Residence
~:5 ....
County, Pennsylvania,'Witi~ his/her'last family or principal
(list street, number and municipality)
Decedent, then 95 years of age, died Au~lust 1 ,2004 , at Beverly Health Care Center
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $
(if not domiciled in PA) Personal property in Pennsylvania .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows:
65,000.00
65,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature
Typed or pdnted name and residence
Dana E. Jefferson
Circle, Harrisbur~h PA 17110
RW-7
Oath of Personal
Commonwealth of Pennsylvania
County of Cumberland
Representative
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of. the. Decedent,
Petiti°ner(s) will well and truly administer the estate acc°rding t~__~.jfj,Z
Sworn to and affirmed and subscribed Dana E. Jeffersoh - --
before me ~lis /O~-A~ day of ,~.~,
DECREE OF REGISTER Cumberland County
Estate of Dorothv M. Lewi~
Deceased
No.
also known as
Social Security N~o: 130-18-4471 Date of Death: 08/01/2004
AND NOW, ? ~'~x~t'. ~_/~ //~'~/~' , 2004 , in consideration of the Petition
on the reverse side hereon, sati~o~-proof having been presented before me,
IT IS DECREED that Letters [~ Testamentary I'-I of Administration
(c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate)
are hereby granted to .Dana E. Jefferson
in the above estate and that the instrument(s), if any, dated June 24, 2003
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters .................................... $
Short Certificate(s),~.._~.... $
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages (Will ) ..............$
Codicil ................................. $
JCP Fee ................................. $
Inventory & Tax Forms ............. $
Other ...................................... $
RW-7A
115.00
15.00
12.00
10.00
Register of Wills
U U Attorney ~f
Attorney: Jacqueline A. Kelly, Jan L. Brown & Associates
I.D. No: 91973
Address: 845 Sir Thomas Court, Suite 12
Harrisbur~l PA 17109
TOTAL ............................. $ '~1"/700 Telephone: 717-541-~50
/ .5-,~-~O DATE FILED:
his is to certify that the infl)rmation 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..~;
P 10592280
No.
~7
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
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LAST WILL AND TESTAMENT
Al. oq. l?3o
OF
DOROTHY M. LEWIS
I, DOROTHY M. LEWIS, now domiciled in Dauphin County, Pennsylvania, declare
this to be my Last Will and Testament.
previously made.
I revoke all other wills and c=~ils th83 1 may,~e
Article I ~"~ .~ii::::' ~.
My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executrix from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executrix has to claim
reimbursement for any such taxes which become payable as the result of any property over
which I have the power of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum, which I have either
handwritten or signed, located with my Will or with my valuable papers and found within thirty
(30) days of the probate of my Will. Gifts may only be to persons who survive me or to
organizations which exist at my death, and if there is a conflict, the memorandum having the
latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, ! give, devise and bequeath to my niece, DANA E. JEFFERSON, of Dauphin County,
Pennsylvania. In the event that DANA E. JEFFERSON predeceases me or fails to survive me
by thirty (30) days, ! give, devise, and bequeath the remainder of my estate, of whatsoever nature
and wheresoever situate to my niece, KIA E. JEFFERSON, of Prince Georges County,
Maryland. In the event that KIA E. JEFFERSON predeceases me or fails to survive me by
thirty (30) days, ! give, devise, and bequeath the remainder of my estate, of whatsoever nature
and wheresoever situate to WILI,IAM J. JEFFERSON, of Huntingdon County, Pennsylvania.
Article V
! nominate, constitute, and appoint my niece, DANA E. JEFFERSON, of Dauphin
County, Pennsylvania, as Executrix of my Last Will and Testament. In the event of the
renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate,
constitute and appoint my niece, KIA E. JEFFERSON, as successor Executrix of my Last Will
-2-
and Testament. I direct that my Executrix or successor Executrix be permitted to serve without
bond and in addition to those powers granted by law, I grant them power to distribute in cash or
in kind in like or in unlike shares and to file any qualified disclaimer I could have fried if living.
My Executrix or successor Executrix shall receive reasonable compensation for services
rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executrix and successor
Executrix, in her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which ! specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(f) to t-fie any federal income tax return for any year for which ! have not fried such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
-3-
Last
Pennsylvania.
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executrix; and to pay from my estate reasonable compensation for all their
services,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, DOROTHY M. LEWIS, hereby set my hand to this my
Will and Testament, on ,~3~t~. ~- ~(-4 2003, at
Harrisburg,
DOROTHYM. LEWIS
In our presence, the above-named DOROTHY M. LEWIS signed this and declared this
to be her Last Will and Testament and now at her request, in her presence, and in the presence
of each other, we sign as witnesses.
Name Address
-4-
I, DOROTHY M. LEWIS, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that ! signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affm'ned and
acknowledged before me by
DOROTHY M. LEWIS, the Testatrix
on ~xzrxx~ ~C~ ,2003.
Notary Public
We, the undersigned wimesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute
this instrument as her Will; that she signed and executed it willingly as her free and voluntary act
for the purposes therein expressed; that each of us in her sight and hearing signed the Will as
wimesses, and that to the best of our knowledge, that she was at that t/me eighteen (18) years or
more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affm-ned and
subscribed to before me
and
~messes, on ~ ~
Notary Public -
,2003.
Wimess
Withers
-5-
Register of Wills, Cumberland County
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Dorothy M. Lewis
Date of Death: 08/01/2004
Will No. 2004-00830 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 09/30/2004 :
Name Address
Dana E. Jefferson
1944 Daybreak Circle
Harrisburf:l
PA 17110
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: 09/30/2004
Name: Jacqueline A. Kelly, Jan L. Brown & Associates
Address: 845 Sir Thomas Court, Suite 12
Harrisbur.q PA 17109
Te ephone(717). 5415550
Capacity:
X
Personal Representative
Counsel for Personal
Representative
JAN L. BROWN & ASSOCL~T~S
Ou~ ~. G~
845 S~R T~o~ C~T
Su~ 12
H~u~, PA 171~
Register of Wills
Cumbedand County Courthouse
One Courthouse Square
Carlisle, PA 17013
L :5
JAN L. BROWN, ESQUIRE*
JACQUEUNE A. KELLY, ESQUIRE
*ADMITTED IN PA AND DISTRICT OF COLUMBIA
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLDE ENGLISH GAP
845 S~R THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMA~L: jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BRENDA F. KEPHART, LEGAL ASSISTANT
PAUL~ K, WHITE, LEGAL ASSISTANT
JUDITH A. EBERSOLE, ADMINISTRATIVI-~ ASSISTANT
October 27, 2004
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re.'
Estate of Dorothy M. Lewis
Estate No. 2004-00830
Executrix: Dana E. Jefferson
To Whom It May Concern:
Enclosed please find official check No. 288441387 in the amount of $7,000.00 made
payable to the Register of Wills, Agent, for pre-payment of Inheritance Tax due for the Estate of
Dorothy M. Lewis.
Please fonvard the receipt of payment to my office.
Sincerely,
Enclosure: Ck. #288441387
O:3
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OF[NDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004558
KELLY JACQUELINE A
845 SIR THOMAS COURT SUITE 12
HARRISBURG, PA 17109
fold
ESTATE INFORMATION: SSN: 130-18-4471
FILE NUMBER: 2104-0830
DECEDENT NAME: LEWIS DOROTHY M
DATE OF PAYMENT: 10/28/2004
POSTMARK DATE: 1 0/27/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 08/01/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $7,000.00
TOTAL AMOUNT PAID:
$7,000.00
REMARKS:
SEAL
CHECK# 288441387-0
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
,
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May 2, 2005
Telephone
. ,r;,(]~h'7tl7~3,9~?
F~~'717) 772-0412
Jan L. Brown & Associates
Attorneys and Counselors at Law
Olde English Gap
845 Sir Thomas Court
Suite 12
Harrisburg, PA 1'7109
Re: Estate of Dorothy M. Lewis
File Number 2104-0830
Dear Sir/Madam:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate,
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 11/01/05. Because Section 2136
(d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be
granted that would exceed the maximum time permitted.
Claudia Maffei, Supervisor
Document Processing Unit
Inheritance Tax Division
~incereIY.
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JAN L. BROWN, ESQUIRE'
JACQUELINE A. KELLY, ESQUIRE
"ADMITTED IN PA AND DISTRICT OF COLUMBIA
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLOE ENGLISH GAP
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMAIL jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BRENDA F. KEPHART, LEGAL ASSI$TANT
PAULA K. WHITE, LEGAL ASSISTANT
JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT
September 30, 2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Dorothy M. Lewis
Estate No. 2004-00830
Executrix: Dana E. Jefferson
To Whom It May Concern:
Enclosed for filing are an original and two copies ofthe Inheritance Tax Return and an
original and one copy of the Inventory for the Estate of Dorothy M. Lewis. A check in the
amount of$I,346.62 made payable to the Register of Wills, Agent, for payment of Pennsylvania
Inheritance Tax due, and a check in the amount of $30.00 made payable to the Register of Wills
for the filing fee have also been enclosed.
Please return a time-stamped copy of each document in the envelope provided. Also,
Please forward the receipt of payment to my office.
Sincerely,
/_~'-l D l~?
o Jacqdeline A. Kelly '0!
Enclosures
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COMMONWEALTH OF PENNSYLVANIA
DEP ARTM ENT OF REVENU E
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
II
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005860
KELLY JACQUELINE A
845 SIR THOMAS COURT SUITE 12
HARRISBURG, PA 17109
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
____un fold
101
$1,346.€>2
ESTATE INFORMATION: SSN: 130-18-4471
FILE NUMBER: 2104-0830
DECEDENT NAME: LEWIS DOROTHY M
DATE OF PAYMENT: 10/03/2005
POSTMARK DATE: 09/30/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/01/2004
TOTAL AMOUNT PAID:
$1,346.62
REMARKS:
CHECK#153
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAliJGH
REGISTER OF WILLS
REGISTER OF WILLS
11
Register of Wills, Cumberland County
INVENTORY
Estate of Dorothy M. Lewis
, Deceased
No. 21 04 0830
Date of Death 8/1/2004
Social Security No. 130-18-4471
also known as
Dorothy M. Lewis
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 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 Decedent ownedl no
real estate outside 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 made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities.
Personal Representative:
Name of
Attomey: Jacqueline A. Kelly
I.D.No.: 91973
Dana E. Jefferson
Dated
PA 17109
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:~700.34 iOn
Description
Value' .n)
Greenpoint Bank,
1 Penn Plaza, New York, NY10119-0184
CD #6560264969
Greenpoint Bank
1 Penn Plaza, New York, NY10119-0184
CD #6560275544
Greenpoint Bank
1 Penn Plaza, New York, NY10119-0184
CD #6560241884
Personalty located at 780 Concourse Village West, #12F, Bronx, NY
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13,511.30
8,566.63
U.S. Treasury check payable to Estate
48.90
Life Insurance payable to Estate
2,005.84
Total
~4,559.34
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
,
REV-1500 EX + (~OO)
*'
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Lewis Doroth M.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
08/01/2004 06/20/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (AlIach copyofW~I)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Deoedent Maintained a Living Trust (Attach copy of TrusQ
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -04 0 8 3 0
COUNTYcooe ---vEAR- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 30- 1 8 - 4 4 7 1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AlIach Sch 0)
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COMPLETE MAILING ADDRESS
NAME
Jac ueline A. Kell
FIRM NAME (If Applicable)
Jan L. Brown & Associates
TELEPHONE NUMBER
717 -541-5550
Harrisbur
845 Sir Thomas Court, Suite 12
X _(15)
X _(16)
11,144.61 X .12 (17) 1 ,337.35
48,996.72 x .15 (18) 7,349.51
(19) 8,686.86
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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)
D 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/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11)
(12)
(13)
(8)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under See. 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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
PA 17109
0.00
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OFFICIAL USE ONLY
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17,380.01
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80,895.41
19,747.39
1 ,006.69
20,754.08
60,141.33
60,141.33
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'ece en s omplete Address:
STREET ADDRESS
46 Erford Road
CITY I STATE I ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
8,686.86
7.000.00
368.41
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
7,368.41
28.17
Total Interest/Penalty ( 0 + 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
28.17
0.00
1,346.62
1,346.62
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?................. .................................... ......... .... ...... ...................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 00 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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 pe~ury, I declare that I have examined this retum, includinQ 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 aU Information of which preparer has any knowledge.
SIGNA ~ E OF PERSON RESPONSIBLE R FI N RETURN . 9A TE, /
9/. )/(
PA 17110
DATE
9/ ';YJ/OS
1944 Daybrea
Harrisburg
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
~ft'sf/ ~ tt J&PP~
ADDRE~ 8 Sir Thomas Court, S e 12
Harrisburg
PA 17109
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)l.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P,S. ~9116(a)(1 ,2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 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-150B!=X + (6-98)
. '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lewis. Dorothy M.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 04
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0830
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
14,726.33
2.
3.
4.
5.
6.
Greenpoint Bank
1 Penn Plaza, New York, NY10119-0184
Individual CD account #6560264969
Greenpoint Bank
1 Penn Plaza, New York, NY10119-0184
Individual CD account #6560275544
Greenpoint Bank
1 Penn Plaza, New York, NY10119-0184
CD account #6560241884; POD to sister, Marjorie Lewis, who predeceased decedent
Personalty located at 780 Concourse Village West, #12F, Bronx, NY 10451
See attached statement of value
5,700.34
13,511.30
8,566.63
U.S. Treasury check payable to Estate
48.90
Office of Federal Employees' Group Life Insurance--payable to estate
2,005.84
.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
44 559.34
REV-1509 E;X + (6-98)
.
SCHEDULE F
JOINTL Y-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lewis. Dorothv M.
FILE NUMBER
21 04
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
0830
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Elizabeth Glass
Townhouse Apartments
660 Boas Street, Apt. 807
Harrisburg, PA 17101
sister
B Dana E. Jefferson
1944 Daybreak Circle
Harrisburg, PA 17110
niece
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 06/1967 Greenpoint Bank 22,289.21 50. 11,144.61
1 Penn Plaza, New York, NY 10119-0184
Savings Account #6560002294
2. B. 10/2002 Fleet Boston Financial 12,470.80 50. 6,235.40
Checking Account #0863000451
TOTAL (Also enter on line 6, Recapitulation) $ 17 380.01
(If more space is needed, insert additional sheets of the same size)
-
, REV-1510 EX + (6-98)
. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lewis. Dorothy M.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 04
0830
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes,
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DE CD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPliCABLE) VALUE
1. U.S. Savings Bonds, Series E, 18,956.06 100. 18,956.06
POD to niece, Dana E. Jefferson
See attached Inventory Report
TOTAL (Also enter on line 7 Recapitulation) $ 18 956.06
(If more space is needed, insert additional sheets of the same size)
REV-1511 ~X + (12-99)
. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lewis. Dorothy M.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
04
0830
Debts of decedent must be reported on Schedule I.
ITEM
NUMB~R DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hooper Memorial Home, Inc. 5,651.00
2. funeral flowers 95.92
3. funeral luncheon 328.15
4. Hooper Memorial Home: gravemarker, opening/closing of grave, cemetery fee 1,874.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Jan L. Brown & Associates 5,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills, Cumberland County 152.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees William Jefferson 30.00
7. Register of Wills, Inventory and Inheritance tax filing fees 30.00
8. Legal advertising-- The Sentinel 106.79
9. Cumberland Law Journal 75.00
10. Register of Wills, Inventory and Inheritance Tax Return filing fees 30.00
11. Reimburse Executrx for out-of-pocket expenses, including transportation and lodging
to travel to New York to liquidate estate assets 692.35
12. Concourse Village--rent for co-op in New York for September and October, 2004 1,105.90
13. Concourse Village--maintenance expenses to renovate co-op to prepare for sale 4,326.28
14. Parks & Company--preparation of estate income tax returns 250.00
TOTAL (Also enter on line 9, Recapitulation) $ 19747.39
(If more space is needed, insert additional sheets of the same size)
.REV-1512 tx + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lewis. Dorothv M.
FILE NUMBER
21
04
0830
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1, Riverside Anesthesia Associates--outstanding medical bill
VALUE AT DATE
OF DEATH
30.88
2. Susquehanna Internal Medicine--outstanding medical bill
15.00
3. Beverly Health Care--outstanding medical bills
284.72
4. Heritage Cardiology--outstanding medical bill
320.39
5. PharmAmerica--outstanding medical bill
134.34
6. PA Department of Revenue--2004 individual income taxes
13.54
7. Department of Treasury/l RS--2004 federal income taxes
60.49
8. Department of Treasury/IRS--2002 federal income taxes
147.33
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,006.69
''?''-''''~.w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Lewis. 0 lrothv M. 21 04 0830
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Dana E. Jefferson niece 100% of residue;
1944 Daybreak Circle POD U.S. Savings Bonds
Harrisburg, PA 17110
2. Elizabeth Glass sister Joint Savings Account
Townhouse Apartments, 660 Boas Street, Apt. 807
Harrisburg, PA 17102
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
ATTACHMENT TO SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lewis, Dorothy M.
FILE NUMBER
21 040830
Legal fees reflected on Schedule H were incurred in connection with the
administration of the decedent's estate and were incurred for the estate's benefit. Fees
covered estate administration and work involved with non-probate property. Additional
complex issues include liquidating personalty located outside the Commonwealth of
Pennsylvania and the possible filing of a federal estate income tax return (Form 1041).
The attorney's fees are reasonable in amount considering the legal time required
and expense involved in these matters.
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.
LAST WILL AND TESTAMENT
OF
DOROTHY M. LEWIS
.2/,04- ~3o
I, DOROTHY M. LEWIS, now domiciled in Dauphin County, Pennsylvania, declare
this to be my Last Will and Testament. I revoke all other wills and cc["dGhs thfl!; I may"ltiiVe
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previously made.
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Article I
l....)
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My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executrix from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executrix has to claim
reimbursement for any such taxes which become payable as the result of any property over
which I have the power of appointment.
..
Article III
I give, devise and bequeath in accordance with any memorandum, which I have either
handwritten or signed, located with my Will or with my valuable papers and found within thirty
(30) days of the probate of my Will. Gifts may only be to persons who survive me or to
organizations which exist at my death, and if there is a conflict, the memorandum having the
latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my niece, DANA E.JEFFERSON, of Dauphin County,
Pennsylvania. In the event that DANA E. JEFFERSON predeceases me or fails to survive me
by thirty (30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever nature
and wheresoever situate to my niece, KIA E. JEFFERSON, of Prince Georges County,
Maryland. In the event that KIA E. JEFFERSON predeceases me or fails to survive me by
thirty (30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever nature
and wheresoever situate to WILLIAMJ.JEFFERSON, of Huntingdon County, Pennsylvania.
Article V
I nominate, constitute, and appoint my niece, DANA E. JEFFERSON, of Dauphin
County, Pennsylvania, as Executrix of my Last Will and Testament. In the event of the
renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate,
constitute and appoint my niece, KIA E. JEFFERSON, as successor Executrix of my Last Will
- 2 -
.'
and Testament. I direct that my Executrix or successor Executrix be pennitted to serve without
bond and in addition to those powers granted by law, I grant them power to distribute in cash or
in kind in like or in unlike shares and to fIle any gualified disclaimer I could have flied if living.
My Executrix or successor Executrix shall receive reasonable compensation for services
rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executrix and successor
Executrix, in her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically begueath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(f) to fIle any federal income tax return for any year for which I have not flied such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to detennine the value of
any such property,
- 3 -
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executrix; and to pay from my estate reasonable compensation for all their
servIces,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death, and
G) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, DOROTHY M. LEWIS, hereby set my hand to this my
Last Will and Testament, on~, \,) ~l\
2003, at Harrisburg,
Pennsylvania.
I
~L~
DOROTHY . LEWIS
In our presence, the above-named DOROTHY M. LEWIS signed this and declared this
to be her Last Will and Testament and now at her request, in her presence, and in the presence
of each other, we sign as witnesses.
Name
Address
~.cb>~n
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ffi~Sr1ffinc,c+., H~ 1m \71CCj
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- 4 -
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I, DOROTHY M. LEWIS, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affmued and
acknowledged before me by
DOROTHY M. LEWIS, the Testatrix
on~~~ '~L\ ,2003.
~>- ~\~\ ~,-f"r, C \( ~>--
Notary Public
~ \\(l~
DOROTHY . LEWIS
stoal
IATtIIMI .. ~ NOTARf PUBLIC
LOWER PAllO" TWe,: DAUPHIN COUNlY
MY COMMISSION BPlRES APRIL 30 2007
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute
this instrument as her Will; that she signed and executed it willingly as her free and voluntary act
for the purposes therein expressed; that each of us in her sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or
more of age, of sound mind, and under no constraint or undue influence.
~c:LL u). t2au;'
Witness
,2003.
"\L",~ -.f"f\ (\ '( C".-
Notary Public -
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Wi ess
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C~nc()) UJI"se . Village inc.
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In the Heart
775 cONCOURSE VILLAGE. EAST
, aRO NX, NEW YORK 10451
iMANAGEM ENT OFFICE: (718) 588-2200
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To 'Whom It May Concern:
Please be advised that the above mentioned shareholder is the owner of the above
apartment since 3 ~ (, ~ , The equity accumulated fOT this apartment
is $ 8. $' f.r t.. ~ I and the shares allocated to this unit are ) a, 98 ,
,
Should you have any questions~ please contact me at the number above.
Sincerely,
~7/~
I Shemika Smith
; ASSistant Manager
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL Tmlir':::i~;-:-'~: (,~i='(;:: ~PRAISEI1ENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION ! ',",1 '",' ,.1, '-1- . OF DEDUCTIONS AND ASSESSI1ENT OF TAX
PO BOX 280601 _.., _ .
HARRISBURG PA 17128-0601
REV-1547 EX AFP (06-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-05-2005
LEWIS
08-01-2004
21 04-0830
CUMBERLAND
101
APPEAL DATE: 02-03-2006
( See reverse side under Objections)
Amount Remitted I ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHY M FILE NO. 21 04-0830 ACN 101
,..
{' -. 9
r: . ~
,'~ ! i
, .,
0. O,g
\.".-: . ~
;'j
DOROTHY
M
r.,-.'
JACQUELINEA\.KE'LL Y
JAN L BROWN-& ASSOCS
845 SIR THOMAS CT 12
HBG PA 17109
ESTATE OF
LEWIS
DATE 12-05-2005
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
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)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. 110rtgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/l1isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
44.559.34
17.380.01
18,956.06
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
80,895.41
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/l1isc. Expenses (Schedule H)
10. Debts/l1ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
14,315.21
(9)
(10)
1.006.69
(11)
(12)
(13)
(14)
lli.3n 90
65,573.51
.00
65,573.51
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
.00 X 00 = .00
.00 X 045 = .00
11,144.61 X 12 = 1,337.35
54,428.90 X 15 = 8,164.34
(19)= 9,501.69
.
.1:1:1,;1:.1.,., l +J AI10UNT PAID
DATE NUI1BER INTEREST/PEN PAID (-)
10-27-2004 ~ CD004558 368.42 7,000.00
09-30-2005 CD005860 .00 1,346.62
INTEREST IS CHARGED THROUGH 12-20-2005 TOTAL TAX CREDIT 8,715.04
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 786.65
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 53.15
TOTAL DUE 839.80
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED. ~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU I1AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
~
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
Dorothy M. Lewis
FILE NUMBER
Anita McCully
ACN
2104-0830
101
REVIEWED BY
ITEM
SCHEDULE NO.
H 8-12
& 13
EXPLANATION OF CHANGES
The deductions claimed for expenses related to property outside Pennsylvania have been
disallowed. Debts secured by property situated outside of Pennsylvania are not allowable
for Pennsylvania purposes, unless the secured debt exceeds the value of the property.
ROW
Page 1
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
JEFFERSON DANA E
1944 DAYBREAK CIRCLE
HARRISBURG, PA 17110
RE: Estate of LEWIS DOROTHY M
File Number: 2004-00830
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/01/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
,. ~
~ '1Aj;;..:.'
. . i' '., ,,' . , ".;j
'.. "'.' .:1i/.:' /' " b"" '. '
",J~"';/'-' ./v' ~~ .....
" .~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
o
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
KELLY JACQUELINE A
845 SIR THOMAS COURT SUITE 12
HARRISBURG, PA 17109
RE: Estate of LEWIS DOROTHY M
File Number: 2004-00830
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
8/01/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
(* &" ~~
"-P""" ,"' .
(; ,~/~EA / L,~ " 1 ,'.
_" .1."_, ~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: :DOROTHY ~E V\J lS
Date of Death: ~;;).()() 1..\
Estate No.: ~ODY- DO 83D
Pursuant to Rule 6.12 of the ~upreme 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 0 No ur due. 10 (l.-ppeo.-l of ,'nherf--fance -Ia;<f5.
2. Ift.~e answer is No, state when the personal representative re~sqnably believes that
the administration will be complete: on or be-Fnrp~ <6l\4aoo'1
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 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: 1.1 l 0 \~()()~
~eh;;1 tl. '141ft!
JACQUFLJN6 A. }{&LL~ ESQ.
Name
?, '-IS S 1R,7+JCJMIt-s ecu 1<.7, SrE I;; H IJ-R-RJ S BU(6; fA
Address . J 17 }V9
717- 5tJl-5550
Telephone No.
[!:; :,..j
i I
Capacity:
o fersonal Representative
IMCounsel for personal representative
-~ -' .
COMMCI':WE"L THJF ?ENI'JSYLV ANIA
DEPARH.'1Ef'lT or::: P~\/EI~UE
BUREnlj Of iNDIIJI[lIj,n,L TAXES
CEFT
H,..1RF:ISEJRU, ~::. 1 -: 1 28-060 ')
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
JEFFERSON DANA E
1944 DA YBREAI< CIRCLE
HARRISBURG, PA 17110
ESTATE INFORMATION: SSN: 130-18-4471
I FILE NUMBER: 2104-0830
DECEDENT NAME: LEWIS DOROTHY M
DA TE OF PA YMENT: 07/28/2006
POSTMARK DATE: 07/27/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/01/2004
NO. CD 007022
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $693.63
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DANA JEFFERSON
CH ECI<# 3288
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$693.63
GLENDA FAFlNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JACQUELINE A KELLY
JAN L BROWN & ASSOCS
845 SIR THOMAS CT 12
HBG PA 17109
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-06-2006
LEWIS
08-01-2004
21 04-0830
CUM.BERLAND
101
Amount Remitted
REV-1593 EX AFP (03-05)
DOROTHY
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT Hr-'SE
CARLISLE, PA 17013
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECOR:DS 4-
NOTE: To insure proper credit to your account, submit the upper portion of this form with your ~~~ ~'_~~~o~<
REV-1593 EX AFP (03-05)
3(3( INHERITANCE TAX RECORD ADJUSTMENT 3(3(
ESTATE OF LEWIS
DOROTHY
M FILE NO. 21 04-0830
ACN 101
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
PROTEST BOARD DECISION
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
44,559.34
17,380.01
18,956.06
(8)
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected
14. Net Value of Estate Subject to Tax
(9)
(10)
15,lj.21.11
l,llI06.69
(11)
(12)
(13)
(14)
9113 Trusts (Schedule J)
TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
.OOX 00
.OOX 045=
11,14lf.61X 12 =
53,32~1.00X 15 =
(19)
(15)
(16)
(17)
(18)
DATE
07-06-2006
80,895.41
16,421'.80
64,467.61
.00
64,467.61
.00
.00
1,337.35
7,998.45
9,335.80
/(I::l..Cl.r l .) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-27-2004 CD004558 368.42 7,000.00
09-30-2005 CD005860 .00 Jl,346.62
EREST IS CHARGED THROUGH 07-21-2006 TOTAL TAX CI~EDIT 8,715.04
THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 620.76
ERSE SIDE OF THIS FORM INTEREST AND PEN. 72 .87
TOTAL DUE 693.63
INT
AT
REV
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
JAN L. BROWN. ESQUIRE'
JACQUELINE A. KELLY, ESQUIRE
. ADMITTED IN PA AND DISTRICT OF COLUMBIA
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLOE ENGLISH GAP
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMAIL jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BREND/\ F. KEPHART, LEGAL ASSISTANT
PAULA 1-<'. WHITE, LEGAL ASSISTANT
JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT
July 27,2006
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Dorothy M. Lewis
Estate No. 2004-00830
Executrix: Dana E. Jefferson
To Whom It May Concern:
Enclosed is a check in the amount of $693.63 made payable to the Register of Wills,
Agent, for payment of Pennsylvania Inheritance Tax due.
Please forward the receipt of payment to my office.
Sincerely,
'0 ,LCtitlLlt ,d U
Jacquttline A. Kelly
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Enclosures
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: Dorothy M. Leiws
Date of Death: 8/1/2004
Will No. 2004-00830
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 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.
account with the Court?
Did the personal representative file a final
Yes No X
b . The separate Orphans' Court No. (if any) for
the personal representative's account is :
c . Did the personal representative state an
account informally to the parties in interest? Yes X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans I Court and may be attached to this report.
c.~i'\.\(t, tZ~1?-i( PC\SSc'.;) -rz;. .s)\~ \)(Y\e,(1'clCL,Lj L~'ho \'s Q\SO
'I'v'\\( \).2' ('s,( ,\(.,l\ Ie ~ "c:;:,nrr~.tIVt ' .~. , ~,,' 0 ,. ,.~' , /I,!"
Date: 8/30/2006 0 -JUr1 J lLl' 1.t/l.<-{ _
Ign~l1re
--7/',. '," .
1< I~/ t ij_
J
Jacaueline A. Kellv
Name (Please type or print)
845 Sir Thomas Court, Suite 12
Harrisbura P A 17109
Address
(717 ) - 5415550
Tel. No .
Capacity :
Personal Representative
Ii ," 'J'", c':;:;:'JI'If"\
",d U j ",'oj iC.Lt.JV ,I IJ
v 18(leX)'S.'t-,NH&IO
:10 >\t.ElI8
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Counsel for personal
representative
9 I : \I H~ I E 8f\\f 900l
-;
JAN L, BROWN. ESQUIRE*
JACQUELINE A. KELLY ESQUIRE
*ADMITTED 1\1 PA AND DISTRICT OF COLUMBIA
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
QLOE ENGLISH GAP
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMAIL jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BRENDA F, KEPHART. LEGAL ASSIST ANT
PAULA K. WHITE LEGAL ASSISTANT
JUDITH A. EBERSOLE ADMINISTRATiVE ASSISTANT
August 30, 2006
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Dorothy M. Lewis
Estate No. 2004-00830
Executrix: Dana E. Jefferson
To Whom It May Concern:
Enclosed for filing is a Status Report Under Rule 6.12 for the Estate of Dorothy M.
Lewis. Please time stamp and return our file copy of this document. A return envelope is
provided. Thank you for your time and attention to this matter.
Sincerely,
I'
f. . "__-1/' I
il(~":"/)_&'IL-( tr /(iLU(
'J.Jt".~\..(..~ IF ,
I' . ./'
rJacqq,eline A. Kelly, Esq. j/
JAK/jak
Enclosures
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXE~r:rnqD):n nFF\CE O~ INHERITANCE TAX
INHERITANCE TAX DIVISION 1\'_vJi. L._ r~~' STATEMENT OF ACCOUNT
PO BOX 280601 , .
HARRISBURG PA 17128-0601
*
(,~
JACQUELINE A KEkty
JAN L BROWN & ASSOCS
845 SIR THOMAS CT 12
HBG PA 17109
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
REV-1607 EX AFP (03-05)
f." \.1' 4 1
20~~ i~, I ir.: I 8 .,~\I .
\J U f~'i ...~, ,.;
08-14-2006
LEWIS
08-01-2004
21 04-0830
CUMBERLAND
101
AIIourit R_1 ttec:l
DOROTHY
M
t
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
_E, To "'-0...... ....... to ..... o""""'t, ....... .... _. ....tlon of .... f.... .... ..... ... _to
CUT ALONG THIS LINE
... RETAIN LOWER PORTION FOR YOUR RECORDS +--
... INHERITANCE TAX STATEMENT OF ACCOUNT ...
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
ESTATE OF LEWIS DOROTHY H FILE MO.21 04-0830 ACH 101 DATE 08-14-2006
THIs STATEIIENT IS I'MWDlED TO - .. TIlE _ STArus .. TIlE STA... ACN IN TIlE ""- ESTATE. __ "1.01I
IS A ...... .. TIlE PRINCIPAl TAX ...., .....Il:An... .. All PA,-", T1tE CU...... BAlAHcE, _, IF APPl%CAILE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-05-2006
PAYMENTS (TAX CREDITS):
PRINCIPAL TAX DUE, 9,335.80
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (_)
10-27-2004 CD004558 368.42 7~000.00
09-30-2005 CD005860 .00 1~346.62
07-27-2006 CD007022 72.87- 693.63
TOTAL TAX CREDIT 9~335.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. .71
IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .71
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN tl~
NO PAYtlENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
,-
~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
q~9013~lf! Or:r.:CE · INHEkITANCE TAX
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
", C'I
. < RECORD ADJUSTMENT
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-06-2006
LEWIS
08-01-2004
21 04-0830
CUMBERLAND
101
?unr, I! f! ':Ii
;,." ,] l".... 'J I."," ~' ~_ c:. "'J
I':' fl. "7
Hi J ~;. J
oq-
JACQUELINE A KEL~Y
JAN L BROWN & ASSOCS
845 SIR THOMAS CT 12
HBG PA 17109
! 'r'. ~~-
Allount Rellitted
REV-1593 EX AFP (03-05)
DOROTHV
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
--+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
---------------------------------------------------------------------------------------------------------------------------------------
ESTATE OF LEWIS
DOROTHY
.. INHERITANCE TAX RECORD ADJUSTMENT ..
ACN 101
M FILE NO. 21 04-0830
REV-1593 EX AFP (03-05)
DATE
07-06-2006
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
PROTEST BOARD DECISION
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adllinistrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governllental Bequests; Non-elected 9113 Trusts
Net Value of Estate Subject to Tax
10.
11.
12.
13.
14.
TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
44,559.34
17,380.01
18,956.06
(8)
80,895.41
16,427.80
64,467.61
.00
64,467.61
.00
.00
1.337.35
7,998.45
9.335.80
, ~. Uk... nkVk6. . l1'J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-27-2004 CD004558 368.42 7,000.00
09-30-2005 CD005860 .00 1,346.62
EREST IS CHARGED THROUGH 07-21-2006 TOTAL TAX CREDIT 8,715.04
THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 620.76
ERSE SIDE OF THIS FORM INTEREST AND PEN. 72.87
TOTAL DUE 693.63
INT
AT
REV
(9)
(10)
15,421.11
1,006.69
(11)
(2)
(3)
(4)
.
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~
(Schedule J)
US)
(6)
(7)
(18)
.OOX DO =
.OOX 045=
11.144.61X 12 =
53.323.00X 15 =
(19)
BOARD OF APDEALS
DEPT.~81021 '\
HARRISBURG, PA 17128-1021
COMMONWEAL T~ OF PENNSYLVANIA
DEPARTMENT OF REVENUE
JACQUELINE A KELLY ESQ
JAN L BROWN & ASSOCS
845 SIR THOMAS CT STE 12
HARRISBURG PA 17109
IN RE ESTATE OF:
LEWIS DOROTHY M
DOCKET NO.:
TAX TYPE:
APPEAL TYPE
FILE NUMBER:
ACN:
APPRAISEMENT:
PETITION FILED:
EXAMINER:
MAILING DATE:
DECISION AND ORDER
0523377
Inheritance
Protest
2104-0830
101
12/5/2005
12/7/2005
JEFFREY HOLLEN BUSH
Direct Dial: (717) 783-7891
Fax: (717) 787-7270
Email:jhollenbus@state.pa.us
June 28, 2006
On December 5, 2005, the Department issued an appraisement and assessment of
the original inheritance tax return which disallowed two Schedule H deductions related to
property located outside of Pennsylvania. The Department reasoned such claims are not
allowable for Pennsylvania purposes "unless the secured debt exceeds the value of the
property." Petitioner is protesting that action by arguing the property was a cooperative
investment and not real estate. Petitioner further states the September and October 2004
rent expense in the amount of $1 ,105.90 and the maintenance renovation expense of
$4,326.28 were incurred in order to dispose of the property.
Section 2127(1) of the Inheritance and Estate Tax Act of 1991,72 P.S. S 9127(1),
states "All reasonable expenses of administration of the decedent's estate and of the
assets includible in the decedent's taxable estate are deductible." In Peterson Est., 649
A.2d 1007 (Pa.Cmwlth. 1994), the Court stated "It is well settled that expenses necessarily
incurred in preserving and distributing the estate may be deducted and that expenditures
l:EWIS"DOROTHY M
BOARD DOCKET NO. 0523377
Page 2 of 2
not essential to the proper settlement of the estate, but incurred for the benefit of the heirs,
legatees, or devisees, may not be taken as deductions." In Anderson Est., 1 Fiduc. Rep. 449
(O.C.Phila. 1951), it was held that the cost of one year of public liability insurance is a proper
administrative expense. However, it has also been held that expenditures for current repairs,
fire and other property insurance, and real estate taxes following the year of death are items
which inure to the benefit of the heirs and are not payable out of the general estate.
I n the opinion of this Board, the estate is entitled to the Schedule H Item B-12
deduction for September and October 2004 rent. However, as it was not necessary to
dispose of the investment to satisfy obligations or effect distribution, the Schedule H Item B-
13 renovation expenses inure to the benefit of the heir.
Accordingly, it is hereby Ordered that the protest is sustained-in-part. The Department
is directed to issue an amended appraisement and assessment increasing the allowable
Schedule H Item B-12 deduction to $1,105.90.
FOR THE BOARD OF APPEALS
JOSEPH R. SLEEK, MEMBER
A STATEMENT OF ACCOUNT WILL BE MAILED TO YOU BY THE BUREAU OF
INDIVIDUAL TAXES.
ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE ORPHANS' COURT
WITHIN SIXTY (60) DAYS OF RECEIPT OF THIS DECISION.
IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATE FORMAT UNDER THE
PROVISIONS OF AMERICANS WITH DISABILITIES ACT OF 1990, PLEASE CALL (717)
783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND
SPEAKING NEEDS: 1-800-447-3020 (TT ONLY).