HomeMy WebLinkAbout03-0687PETITION FOR PROBATE and GRANT OF LETTERS
also known as ~ ~ dl'~/-[ To:
Deceased.
Social Security No. 20 g /0 (.,[_~.(,,
Register of Wills for the
County of
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execute r-
in the last will of the above decedent, dated
and codicil(s) dated
in the
named
,1999'
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ("ac, ~,~.~ ,-/,~ ,, d _ County, Pennsylvania, with
h I ,.s last fam~y or prinl:ipal residence at ] ~o- /~2./~-ed- ~/~
J ((~st street, number and muncipality)
Decendent, then ~ years of age, die0 A~qr //~, ,~ ~' 60~,
Except as follows, decedent did not marry, was not divo~ed and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: /~ o ~ C__ . -
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ o~0 d) t~
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully/ re~luest(s) }he probate of the last will and codicil(s)
presented herewith and the grant of letters '-t.t~s-4
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF ~x~,~w,_xc,_~x. f ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before, me this 1 ~ t~ day of
No. o~l-&%-
Estate Of FRANCIS J FISHER AKA FRANICS JOHN FISHER ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 19, 2003 I~ .......in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 9-21-1999
described therein be admitted to probate and filed of record as the last will of
FRANCI J FISHER AKA FRANCIS JOHN FISHER ;
and Letters TESTAMENTARY
are hereby granted to JOHN:
FEES
Probate, Letters, Etc .......... $ ~,5. Cx2)
Short Certificates( ) .......... $ 3 .c.~.~
~n',C~o,- C~.'~ .... s q .~'
TOTAL __ $ q q. ~3
Filed ........ "..: ~...8~ ~ %2003 ..........
~AILED T0 EXEC 8-~9-~003
ATi'ORNEY iSup. Ct. I.D. No.)
ADDRESS
PHONE
LAST WILL AND TESTAMENT
OF
FRANCIS J. FISHER
I, FRANCIS J. FISHER, of 5 South High Street, Mechanicsburg Borough, Cumberland
County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all
Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made.
FIRST: DIRECTIVE FOR BURIAL - I direct that I be buried in the Westminister Cemetery,
Carlisle, Pennsylvania, at Location 197D, Lots 3 and 4.
S_E_C,_Q_N__D_t PAYMENT OF EXPENSES - I direct that all my just debts and funeral expenses,
including my headstone and engraving and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the administration of my
estate.
THIRD: RESIDUE OF ESTATE - I give, devise and bequeath all the rest, residue and
remainder of my estate, be it real, personal, or mixed, of whatsoever kind and wheresoever
situate, unto my wife, LILLIE M. FISHER, provided she shall survive me by thirty (30) days.
In the event my wife fails to survive me by thirty (30) days, I then give, devise and
bequeath all the rest, residue and remainder unto my stepchildren, MYRTLE CALAMAN, JOHN
HUTCHISON and JAMES HUTCHISON. However, if a child does not survive me and leaves
children who so survive me, such children shall receive, per stirpes (by representation), the share
my child would have received had he or she so survived me.
PAGE ONE OF FOUR
F__O_URT__Hx TAXES RESULTING FROM MY DEATH - All federal, estate and other death
taxes that may be assessed as a consequence of my death, whether or not the assets pass under
this Will, shall be paid from the residuary estate of my probate estate just as if they were my
debts, and none of those taxes shall be charged against any beneficiary or joint owner.
~ EXECUTOR - I appoint my stepson, JOHN HUTCHISON, Executor of my Will. In
the event that he predeceases me or is unwilling or unable to serve as Executor, I then appoint my
stepson, JAMES HUTCHISON and my stepdaughter, MYRTLE CALAMAN, Co-Executors of
my Will. Neither my Executor nor any successor shall be required to give bond for the
performance of their duties.
I grant to my Executor and successors the power to compromise claims without court
approval and without the consent of any beneficiary.
~ PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual
payment to a beneficiary or to his or her account, no interest in income or principal shall be
assignable by a beneficiary or available to anyone having a claim against a beneficiary.
IN WITNESS WHEREOF, I hereunto have signed my name to this, my Last Will and
Testament, consisting of a total of FOUR (4) typewritten pages, this ol/~day of ~/,~/'~ ,
1999. ,
W<..~ . '~...~ .z-/- ,--'~2,~,%' (SEAL)
'"FRANCIS J. FI~E~' ~estator
PAGE TWO OF FOUR
In our presence, the above-named Testator signed this and declared it to be his Will, and
now, at his request and in his presence and in the presence of each other, we sign as witnesses:
STATE OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
I, FRANCIS J. FISHER, having been duly qualified according to law, acknowledge that
signed the foregoing instrument as my Will and that I signed it as my free and voluntary act for
the purposes therein expressed. ..~
:-FRANCIS J. FISH~.ax~, TeStator
PAGE THREE OF FOUR
We, having been duly qualified according to law, depose and say that we were present
and saw FRANCIS J. FISHER sign the foregoing instrument as his Will; that he signed it as his
free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing
and at his request signed the Will as witnesses; and that to the best of our knowledge he was at
the time 18 or more years of age, of sound mind and under no constraint or undue influence.
Subscribed, swom to or affirmed,
and acknowledged before me by the
above-named Testator and by the
witnesses whose names appear
opposite on this o) ! ~ day of
--~'/~- ~'--- ,1999.
Notary Public
PAGE FOUR OF FOUR
V-1500~X(6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
LU
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR
NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
xo0-
(IF APPEICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[---~ 2. Supplemental Return
~-] 4a. Future Interest Compromise (date of death after 12-12-82)
~'-~ 7. Decedent Maintained a Living Trust (Atlach copy of Trust)
r---t10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
r--~ 3. Remainder Return (date of death prior to 12-13-82)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
r--1 11. Election to tax under Sec. 9113(A) (Attach Sch O)
1. Original Return
4. Limited Estate
---]6. Decedent Died Testate (Attach copy of Will)
[~9. Litigation Proceeds Received
FIRM NAME (IfApplicable)
COMPLETE MAILING ADDRESS
TELEPHONE NUMBER
717-
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Grose 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.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
Y",2o b-~. $ 7
OFFICIAL USE ONLY
¢) ;~'.z_ob-?. $ 7
(11)
(12) ~,~(),D-~' 3 7
(13) ~
(14/ ~.0 ~. 3 7
SEE ,.STRUCT~O.S O..EVERSE S.DE fOR APP.,C^BtE RATES
15. Amount of Line14 taxable at the spousal tax ~_C.~';, ~ 7
rate, or transfers under Sec. 9116 (a)(1.2)
× .o_
16. Amount of Line 14 taxable at lineal rate
x .0_ (16)
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due (19)
20. []
Decedent's Complete Address:
STREET ADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
STATE//L~z.
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
(5)
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] [~
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] r~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~c'~OF ~PERSON RESPON_SI,BLE FOR FILING, RETURN
ADDRE~,~'/
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a)(1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1)
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paten'
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 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
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV,-1502 EX+ (6-9~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F,
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 1, Recapitulation) $
{If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
RE~-1503 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insed additional sheets of the same size)
REV'-1504 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-15~* (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
FILE NUMBER
Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
State ~ Zip Code
Product/Service
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all dghts and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation?
If yes, Position
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
[] Yes [] No
AnnualSalary $
[] Yes [] No
Time Devoted to Business
7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827
[] Yes [] No If yes, [] Transfer [] Sale Number of Shares
Transferee or Pumhaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedenrs death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
REV-'1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
FILE NUMBER
1. Name of Partnership Date Business Commenced
Address Business Reporting Year
City State__ Zip Code
2. Federal Employer I.D. Number
3. Type of Business Product/Service
4. Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $
5.
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. [] Yes
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... [] Yes
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
[] No
[] No
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
[] Yes [] No If yes, [] Transfer [] Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... [] Yes [] No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? ....................................... [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................... [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? .................................... [] Yes [] No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? .............. [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
RE~-1507 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX +'(1-97) ,~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation) $ .~0.~2"'~- '~7
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
JOINTLY-OWNED PROPERTY:
Lb I I~-K DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held rea estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. A.
TOTAL (Also enter on line 6, Recapitulation)$
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
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 % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIPTOOECEDENTANDTHE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST CF AP~.~C~LE)
1.
TOTAL (Aisc enter on line 7, Recapitulation) $
(If more space ~s needed, insert additional sheets of the same size)
REV-'t 511 EX+ (12-99)~.~.~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
5.
6.
7.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
__ Zip
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
__ Zip
TOTAL (Aisc enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX * (1 9~') ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1.
TOTAL (Also enter on line 10, Recapitulation $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
REV-~ 513 EX+ (9-00~
'~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
1.
II
1.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Tr,,~t,~.(s)
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(if more space is needed, insert additional sheets of the same size)
REV-1514 EX + (1-97) ,~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on Rev-1500 Cover Sheet)
FILE NUMBER
This schedule is to be used for all single life, joint or.successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
[] Will [] Intervivos Deed of Trust [] Other
LIFE ESTATE INTEREST CALCULATION
NAME(S) OF "NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
[] Life or [] Term of Years ~
[] Life or [] Term of Years
[] Life or [] Term of Years ~
[] Life or [] Term of Years ~
1. Value of fund from which life estate is payable $
2. Actuarial factor per appropriate table
Interest table rate- [] 3 1/2% [] 6% [] 10% [] Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) $
ANNUI~ INTEREST CALCU~TION
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
[] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
[] Life or [] Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Monthly (12)
[] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other( )
3. Amount of payout per pedod $
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity- If using 3 1/2%, 6%, 10%, or if vadable rate and pedod payout is at end of pedod,
calculation is: Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of pedod, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax retum. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
NalTle
Address
/7055-
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Sig~a~'ure
Name
Address
TelTne ( )
Capacity:L/ ~Personal Representative
Counsel for personal representative
Date ofDeath: ./~r .//, ,2 O0 3
Will No.:
Admin. No.: .2 [ 0 ~ -
'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:
State whether administration of the estate is complete:
Yes ~ No [-]
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:
bo
Did the personal representative file a final account with the Court?
Yes _ No
The separate Orphans' Court No. (if any) for the personal representative's
account is: ~
Date:
c. Did the personal.representative state an account informally to the parties
in interest? Yes 1~I No [-] -
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be film with the Clerk of thc Orphans' Court
and may be attached to this report.
Signf)~e.'
Address
Telephone No.
Capacity: .i~ Personal Representative
[~1 Counsel for personal representative
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
JOHN H HUTCHISON
4 STRANBERRY DR
CARLISLE
PA 17013
COHHONNEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE 12-29-2005
ESTATE OF FISHER
DATE OF DEATH 08-11-2005
FILE NUNBER 21 05-0687
COUNTY CUHBERLAND
ACH 101
Amount
REV-1647 EX AFP (01-05)
FRANCIS J
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR. RECORDS
REV-1547 EX AFP [01-03} NOTICE OF ZNHERXTANCE TAX APPRAZSEHENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF FISHER FRANCIS J FILE NO. 21 03-0687 ACN 101 DATE 12-29-2003
TAX RETURN #AS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1) . O0
2. S~ocks and Bonds (Schedule B) (2) . O0
3. Closely Held Stock/Partnership Interest (Schedule C) (3) . O0
~. Nortgagas/Notas Receivable (Schedule D) (~) .00
$. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5) 21059.
6. Jointly Owned Property (Schedule F) (6) . O0
7. Transfers (Schedule G) (7) .00
8. To,al Assets (8)
APPROVED DEDUCTzONS AND EXENPTZONS:
.00
9. Funeral Expanses/Ada. Costs/Nisc. Expanses (Schedule H) (9)
10. Dabts/Nortgaga Liabili~cias/Lians (Schedule T) (10) . O0
11. Total Deductions (11)
12. Nat Value of Tax Return (12)
1~. (lI)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
NOTE: To insure proper
credit to your account,
submit the upper portion
of this fora with your
tax payment.
2,059.37
.00
2,059.37
.00
Z,059.37
DISCOUNT
INTEREST/PEN PA/D (-)
AHOUNT PAID
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
.00
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
.°°I
.00
.00
( TF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS REQUXRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
TAX CREDITS:
PAYflENT
DATE
RECEZP1
NUNBER
ASSESSNENT OF TAX:
15. Amount of Line lfi at Spousal rats (15). 2,059.37 x O0 =
16. Amount of Line lr, taxabXa at Linaal/CXass A rats (16). . O0 X 045 =
17. Amount of Line 1~ at Sibling rata (17) . O0 X 12 =
18. Amoun~ of Line 14 texabXe at CollataraX/CXass B rata (18) . O0 X 15 =
19. PrincipaX Tax Due (19)=
NOTE: X~ an assessment was issued previously, 1/nBs 14, 15 and/er 16, 17, 18 and 19 ~i~1
reflect figures that 1nclude the total of ALL returns assessed to date.
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 19aZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance Taxes
at the lawful Class B (cotlataral) rats on any such future interest.
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit eith your payment to the Raglstar of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may bm requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at tho Office
of the Register of Nills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour
enamoring service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: l-BOO-~qT-3OZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice oust object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dapt. ZBiOZ1, Harrisburg, PA 17lIB-lOll, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Ravenue~
Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17lIB-0601
Phone (717) 787-6505. Sea page 5 of tho booklat "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (JZ) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and net
paid before January lB, 1996, the first day after the and of the tax aanasty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .00016~. AIl taxes which became delinquent on and after
January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rata
announced by tho PA Department of Revenue. The applicable interest rates for 19AZ through ZOO3 are:
Interest Dally Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .0005~8 1987 92 .OOOZ~7 1999 7Z .OOO19Z
1983 16Z .000¢38 1988-1991 llZ .000301 lOgO 8Z .goal19
198~ llZ .000301 199Z 9Z .OOOZ~7 2001 9Z .DOOZ~7
1985 13Z .000356 1993-199~ 72 .O0019Z ZOOZ 62 .00016~
1986 IOZ .00027~ 1995-1998 92 .O00Z~7 2003 52 .000157
--Interest is calculated
INTEREST = BALANCE OF
as folloms:
TAX UNPAID X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
/NHERTTANCE TAX DIV/SION
DEPT. ZB0601
HARRISBURG, PA 17128-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCT/ONS AND ASSESSNENT OF TAX
JOHN N HUTCHISON
q STRANBERRY DR
CARLISLE
PA 17015
DATE 12-29-2003
ESTATE OF FISHER
DATE OF DEATH 08-11-2003
FILE NUNBER 21 03-0687
'COUNTY CUMBER LAND
ACN 101
I Amoun~ Rem/ttad
FRANCIS J
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGTSTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTTON FOR YOUR RECORDS ~
REV-15&7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF FISHER FRANCIS J FTLE NO. 21 05-0687 ACN 101 DATE 12-29-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interes~ (Schedule C) (3}
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank DeposLts/Hisc. Personal Property (Schedule E) ($)
6. Jo/ntly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/MLsc. Expanses (Schedule H) (9)
10. Debts/Mortgage LLabLlitLes/LLens (Schedule I) (10)
11. Total Deductions
12. Nmt Value of Tax Return
15.
lq.
Char/table/governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
O0
O0
.00
O0
Z~059.37
O0
O0
(8)
.00
.00
NOTE: To /nsure proper
credit to your account,
subm/~ the upper port/on
of th/s form with your
tax payment.
NOTE:
2,059.37
(11) .Off
(12) 2,059.37
(15) .00
(lq) 2,059.37
Zf an assessment Nas issued previously, lines 14, 15 and/or 16, 17,
reflect figures that lnclude the total of ALL returns assessed to date.
18 and 19 will
ASSESSNENT OF TAX:
15. Amount of L/ne lq at Spousal rate
16. Amount of L/ne lq taxable at Lineal/Class A rate
17. Amount of L/ne lq at SLbling rate
18. Amount of L/ne lq taxable at Collateral/Class B ra~e
19. Principal Tax Due
TAX CREDTTS:
PAYMENT RECE/PT DTSCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15) 2,059.37 x O0 = .00
(16) .00 x Oq5= .00
(~7) .00 x 12 = .00
(18) . O0 X 15 = .00
(19)= . O0
ANOUNT PAZD
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEI .00
INTEREST AND PEN. . O0
TOTAL DUE . O0
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR)~ YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR}:
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 198Z -- if any future intarast in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
lira or for years, the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the 1aclu1 Class B (collateral) rate on any such future interest.
To fulfill the requirements of Saction Zl~O of the Inheritance and Estate Tax Act, Act ES of ZOO0. (TZ P.S.
Section 91qO).
Detach the top portion of this Notice end submit eith your payment to the Register of Mills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
A refund of a tax credit) which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Mills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour
ansaering service for fores ordering: 1-800-36Z-2050; services for taxpayers with special haaring and / or
speaking needs: Z-800-qfiT-3OZO (TT only).
Any party in interest not satisfiad with tha appraisaaent, allaeance) or disallowanca of deductions) or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 17128-lgZ1, OR
--election to have the matter datsrminad at audit of the account of tha parsonal representative) OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Oapartmant of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. gB0601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-la01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not
paid before January 18, 1996, the first day after the end of the tax amnasty period. This non-participation
penalty is appealable in tha same manner and in the the same ties period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death) to the date of payment. Taxes which became delinquent before January 1) 19BI bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January l, 19BI will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19BI through Z003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .0005~8 1987 9Z .O00Z~7 1999 7Z .000192
1983 16Z .000q38 1988-1991 11Z ,000301 ZOO0 8Z .000Z19
198q 11Z .000301 199Z 9Z .O00Z~7 ZOO1 9Z .O00Zq7
1985 132 .000356 1993-199~ 72 .00019Z ZOOZ 62 .00016~
1986 IOZ .O00Z7~ 1995-1998 92 .O00Z~7 2003 SZ .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.