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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 B ~/ '~. I ~,. ~ "~,~%, I ,=~m,o%%% g~:~%%~%, l~.g~o~.*.,~ ~ I ~ ~ o. ,~H I~<'u~°'~ ~'"'~ ~*'~** ~ ~w*s~.~ ........ ~ __ E~'S USU~ ~UPATION KIND ~ BUSI~$S t IN~STRY ~AS DE-- - [ t, ' ~0,~7_~,,~,,,,~..~.~..,.,..,,~,1~¢~.,.' [,.,. ~ I,,. ~-~ I ...... I,,. ~"- ~ ~~ ~-- I ._ ~ ~ ."~,~ ~MET~OFOIS~ITI~ / c--~ I~. /~ ~ SIG~TURE OF FU~ ~ UCENSEE OR pcRe~ ......... ' ~ ~ I C. /~ I I:: ......... ,.F , ,,.:,.., 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 ~q 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: $7,000.00 REMARKS: SEAL CHECK# 288441387-0 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 , I -' r~i 2: L}3 May 2, 2005 Telephone . ,r;,(]~h'7tl7~3,9~? F~~'717) 772-0412 Jan L. Brown & Associates Attorneys and Counselors at Law Olde English Gap 845 Sir Thomas Court Suite 12 Harrisburg, PA 1'7109 Re: Estate of Dorothy M. Lewis File Number 2104-0830 Dear Sir/Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate, In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 11/01/05. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division ~incereIY. ~~. ,*- ~~ 6"9!___ ___ ,II 'I " ~1 } u.J i Ct () I II :) I u. fi ], ! "" I J 0 ~ ~ .. \, ''. } ...... w < ~-:'" :}-' JCj <i -, I- I- I- N - ~(I) 1i~0) '(HI) ~ o -...... cn1::_ .!5<( 060n. c::fd~ ~g.& ~F'E ...J...tO c::i:i)J: to It) ...,~ -"~ - ~ CC0r;'""\'''' -'I 1 \'_\.J'j .- j ~ 1".~':"'. t" r' -.:' t~ '~I i", i ",' "-" - 2 , ,t~"'" = 0 r0 - )<J r, \..J I :T .- r:I.l ." ~ Q) v ..... Ul .- \ = ~ ::l .- Q .- i: .... 0 r- crl ~:s .... ..c: o ...~ :$ +J r:I.l-':~ I-l r:I.l V);;l Z ::l Q) < ~O ~ o I-l ...U 0..:1 UnlM "" rI:H"'~ ... ::l..- ~ ~~""rIl Ul:>-tO"O ;;;;, ~Z ..--l+JU)r-- = 8gE:=~ ..--l !:: ..- ~ ~E-<~Clo._ 'M ::l Q) :3=OUl Q ~ C U::lF'l:: '-~... ~ 4-l O~ "" rIl ;;l O'O..c: =~1I'l =:l !::+J , .C~ ; I-l nl I-l Q) ~~ Q)..--l::l..--l -.: +JI-lOUl = Ul Q) U 'M 'M .0 ..--l = t11E:Q)1-l ~ Q) ::l !:: nl ~UOU o F-< II 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 I CD -n :~l : ") , I ~;..) rJl ..>;j,"'._....""'"_;._.w 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 ;;J ; . 1 .., ~:~ ) ".: (~~ 1~ 726.33 .~~ (j , -~ 1-' -; " .'-] :~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 (.n N 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 I- Z W C W o W C 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) W l- ll:: :$ Ul o O::lI:: wo..o zOO .. 0::....1 ..., 0..11I 0.. c( [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) I- Z W C Z o 0.. Ul w 0:: 0:: o o 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 z o ~ <C -I ::::) l- n: <C o w a:: 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) z o ~ <C I- ::::) D.. :i o o >< ~ 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 --.. .. - OFFICIAL USE ONLY ,..., C::::) '::::> c,~r1 -- ) TJ ; iTI ;~3 ~o " -:J :'Tl ':::''J ---~ l'j - ,>-::; ,on (') 'J , ,-~ .., ") .1 'l I :.c.J 44,559.341 ~..~.~ 17,380.01 .J ')1 18,956.06 L_ 80,895.41 19,747.39 1 ,006.69 20,754.08 60,141.33 60,141.33 o d' t' C '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. 'fJ 21Q" ~ \)., < /.. .~~~ ~~/~~- . 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 ::; :;;.::: :rs;:",;:"~ ~:.:: -~.. .'-~I ,'",' ',.1 rr ""~.<," ~:~;~ ('[' previously made. (/) rr1 -0 -- o Article I l....) i~ d N 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 '~a . u/ Cbd ffi~Sr1ffinc,c+., H~ 1m \71CCj ?$I5 ~~ m1rufO a- .4 M/7/dj - 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 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 - ~-Hilijc(l Wi ess - 5 - \";:1,:'::;:1,1<:VV'+ I). I';; rl'o^ r It tlor '1oor t'i Y MI\,ll\l:itMt.N I ~IJ Ie:J VV<:i (It)" ",1 '", \ ' , C~nc()) UJI"se . Village inc. : In the Heart 775 cONCOURSE VILLAGE. EAST , aRO NX, NEW YORK 10451 iMANAGEM ENT OFFICE: (718) 588-2200 ~4 RE: ~(O+~~ tV'l, L~,^t;~ 'f8c, (nr'\{..J1vr!>4.. v,"llll..l. WdS",-t"'-/2P ~re.".., ,N'I 1r;:,~SI 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 ! , Cc: Files 'A LIMITED PROFIT CO-OPERATIVE HOUSING COMPANY FORMED PURSUANT TO ARTICLE Xli OF THE PUBLIC HOUSINGLAW OF THE STATE OF NEW YORK' ...... ;..., o 0.. il) ~ :>. ;..., 8 Q) o > il)+:; > u o~ - Q) z z z z z z zz z - w w w w w w w ww z zz 0 z ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~~ c- ';::: CD CD CD CD CD CD CD CD 10 10 10 10 10 10 LO 10 10 LO 10 10 10 10 ...,. ...,. ...,. ...,. ...,. ...,. ...,. ...,. ...,. ...,. ...,. M ...,. ...,. 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I ~co~x -- rJ) :><c:3:3:w .~ ~~wu.io Q) ~WWE ....J I 0)...."-"'0 c:: c:..... 00 Cl) 0 O--,c III "CzgJrJ)(f) ... ~ "C 'i:: .~ <3 & ~ ffi~~ (f) Q) J co -- a3C1lC03: U) ~ :s.!!1 ,!!1 "C I- z 3:Cii-g-g:5 w "C Oo.c ....J :5.!!1~.c ~ U ~"O lJ')* '-' -- U) (fJ ......c:~ W ctl u.8 I- - I ~ 0 Z I- :.:E U) l8 w -- o ell Q) 'E21tO ~ U ~o'o::t CO ? c:: J 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 I (' , , If I . lc '0 ~,t-- J .,,) Enclosures .) f.J....,. 1" e I ' "'." \, ,~.". \\ \\ it _N ~ (':E ' .~\I',...O ,-.' ~'I.", I,:"::' [ \1"\tt\) .11 '"' \\. .~ ll!@ <ll:rn:> '('~""'.\--' , ../(..,-' ')"''''''''4 ,-,. {73.nNfl 2. "..-. . ~ ~, -.c. "",' fl.:\ :".;!'; ~1 ti " 4:. "t'" -'- if; ~ U o ~ ~ if; ""5 r: if; <{ <.) ..... ..(3~<f)C\.IC:( ~ (f)<C.....n.. ~:J::EuJ ~ u>C)~'=~ ~~JJI- J, ili ~ u.J g; '!2 '-oef) a: O 4 ~ \.f) ~ 0"", :r:. ~ CO ~ ~ ~ -. (\) ([) ~ o -€ ~ (\) o ..... ()~ z: (f)cJ C'0 C ..,- ~(\)O ([)O(j)t'- ~,'\~..,- .- '-' 0 5-o.c<( ......C-eo.. o ro ~ ~ .....-CO(\) 0)(\),,\- .......o'-'([) .~ E (\):.c O)~cro ~()O() H"-::" ...- ...--:: ......;:: ~......-:: ~.....::: :-;:;.: ,..-::: ) .'1 -".,; .,. ......;:: ....0::: :::::: ~_n_ .-..:: :::;: :::::~ .~..- .~..- .-- .., ........- .......- -...-::: ....- ,'..\ iTI \:'.1 ,') ~ .}u ,':t .r.t '''\ t... roo .....1 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 X 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 o ~o :',. :::tJ .-r) "'D '::.!:co .!.! ;? r- >;---.:;gj (/)7: eYe) (.)'1 r- :u )2-'" f'-.) t:::> c.::.., C7' :r:- c: G') w :r- 3: en 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).