HomeMy WebLinkAbout03-0822COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF BUTLER
I, JUDITHMOSER, Register of Wills and Clerk of
Orphans' Court for said County, and being the
custodian of the records thereof, do hereby certify
that the above and foregoing is a true and correct
copy of the original LAST WILL & TESTAMENT OF
Leonard A Green, Deceased~
and which was filed and probated in said office on the 14 day of
Said Estate can be found at Estate Number 10-2000-259 .
April, 2000.
WI T NE S $ my hand and seal of this office at Butler, Pennsylvania,
this 03 day of August ,2000
JUDITH MOSER
Register of Wills & Clerk of Orphans' Court
My Commission Expires First Monday, January, 2004.
STATE OF PENNSYLVANIA
COUNTY OF BUTLER
estate of GREEN LEONARD A
(~.~'l', ,'-YS',',
in said county, deceased, to
MILLER MARY (GREEN)
(id~$'i', ~'i~u'i',
SHORT CERTIFICATE
I, JUDITH MOSER
Register for the Probate of Wills and Granting
Letters of Administration &c. in and for said
County of BUTLER do hereby certify that on
the 14th day of April A.D.,
Two Thousand.
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
· late of CHICORA
GREEN THOMAS C
(LAS'i', ~'~'~', ~o~)
and
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of said office at BUTLER, PENNSYLVANIA, this 3rd day of August
A.D., Two Thousand.
2000-00259
10-00-0259
3/28/2000
204-22-6928
File No.
PA File No.
Date of Death
s.s. #
Register
Deputy
NOT VALID WITHOUT ORIGINAL SIGNATURE AND RED SEAL
Estate of
REGISTER of ~ __LS of B, UTLER COUNTY, PENN~/LVANIA
PETITION FOR GRANT OF LETTERS
LEONARD A. GREEN
also known as
Estate No.:
10-2000-259
, I)~e~ Social S~i~ No. 204- 22- 6928
Petitioner(s), who Ware 18 yem of age or older, respectfully represents and apply(les) for:.
COMPLETE 'A' OR 'B' and if necessary, Part 'C' BELOW
{~A. Probate and Grant of Letters [~J[Testamentary ~ of Administration
(c.t.a. or d.b.n.c.t.a.)
and aver that Petitioner(x) is/a~entifled to the aforementioned Letters
-,~terthel-astW'flloftheabove-namedDecedentdated Oct. 28 ~ 1995 .naCodicils(s)dated
(complete Pan 'C' also)
Stole relevant circum~ac~, c.g., mmncialion, death ofexectm~r, g~c:
Except as foUows, Decedent did not marry, was not divorced, and did not have a child born or adopted after, cxecntion of thc docu-
ments offered for probate; was not the victim ofa idllin~ ~ was never adjudicated incapacitated: NONE,
(d.b.a.; pemie~e li~ duffle abamda; dmame~).
;. r 4~ ~
Peddoner(s) a-~er a proper seamh has/have ascenaiz~ that Decedcn~ left no W~U ~-a was sunred b~ d~¢'*£O~ow~ spouse (~ any)
and hc~s as set £onb below in p~n '¢'. · · = '~
~)C. Decedcm's bc~zs and next o~ ~
Name R~tiomhip Residmce
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedem was domiciled at death in But ler County, Pennsylvania, with his~h~r last family or principal residence
~ 695 Chicora Road, Oakland Townshipt Butler County, Chicora, PA
D~c-2d~n~fl~n. 70y~ofagc. d~d March 28 ?1~2000 ,m home
(location)
Clf domiciled in PA) All personal property $ 5 0 0 ~ 0 0 0.0 0
si ~ma~ed as follows:
O.f not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in Cottmy
Value of real estate in Pennsylvania
3470 Waggoners Gap Road, Carlisle,
$100,000.00
Cumberland County, PA
W~cforc, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and thc grant
of ~tters in the appropriate form to thc undersigned:
Signature
}2Jffhomas C. Green
)
Typed or Printed Name and Residence
105 N. Oakland Dr., Chicora, PA, 16025
BARBARA H. GREEN DIED 10/20/99.
~ ~ C /~/ c o ,f ~/ ,~ o,,,r'.~ ,C'/.2 / c c, ,.e ,~ ~ ..~'.~ .. /~, o.~ _r
Oath of Personal Representative
Commonwealth of Peansyivania
County of Butler
Sworn to or affirmed and subscn%ed
~ v Thomas C. Green
before me this 14~~~
/ / ~ ofw~ ~
~ Cl~k of Orpham' Court~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements m the foregoing Petition arc true and correct to the
best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the D__~_ ent, Petitio .n~s) will well and
truly admimster the estate according to law. ~
Estate of
Social Security. No:
AND NOW, API~TI. 14 2000
satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary
LEONARD A. GREEN
204-22-6928
Deceased
are hereby granted to THOMAS C. GREEN
, in consideration ofthe Petition on the reverse side hereon,
~ Of Admini.~ration
m the above estate and that the instrument(s) dated October 28, 1995
described in the Petition be admitted to probate and filed of record as thc Last Will of De~lcnt.
/ .... /0 ~"' c) '--" / [-- - ' Judith Moser
/.~3hon Cerdticate(s )$ / / Register ofWiiis & ~~/~
. of own'
Affidavits( ) ..... $ Attorney's Signature
Other ~....~..~. ..... $~ Attomey's Name Robert 5. Stock, Esq.
· 0~ ........... $ .~-~ m So.06044
603 Nat±one1 City Bank Bldq.
JCPFee ........... $ ,~ ~ Address Butler, P~ 16001
Telephone
(724) 283-3370
IN THE COURT OF COMMON PLEAS OF BUTLER COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
REGISTER OF WILLS OFFICE
RENUNCIATION
The undersigned 7~/-/~,r~ ~.~ ~", <,<~ 4/, of the above-
captioned decedem, emitled to LeRers on his estate, do hereby renounce my sole right to
LeRers on ~is estate ~d request that Le~ers be issued to ~v ~ ~. ~ ~
and ~e/~~) ~~
as co-personal representatives in ~is estate.
WI T N E S S my h~d this x4 day of APRIL ,2000.
Orphans' Court
My Comm£ssion Expires First
Monday, January, 2004
LEONARD A. GREEN
I, LEONARD A. GREEN, of North Middleton Township,
Cumberland County, Pennsylvania, hereby declare this to be
my Last Will and Testament and revoke all Wills which I have
previously made.
FIRST: I order and direct that my Executors herein-
after named pay all my just debts, medical expenses, and funeral
expenses as soon as conveniently possible after my decease.
SECOND: I order and direct that my Executors convert
all assets owned by me at the time of my death, into cash,
at the best available prices, and distribute it as hereinafter
set forth. In conducting this conversion I direct that they
dispose of my extensive wildlife and nature art collection,
including limited edition, numbered and signed prints by
renowned artists, by sale through professional galleries to
obtain the best available amounts, except items of tangible
personal property hereinafter specifically bequeathed.
THIRD: I give and bequeath the following items
of tangible personal property to those persons hereinafter
named, if living at the time of my death, but if not, such
bequests shall lapse:
A. To each of my dear friends, JACK HUGHES, DALE
LINABERGER, HUBERT FERGUSON, RONALD FREED, and PATSY
FREED, I give and bequeath one item of tangible personal
property to be selected by them from my personal collection
of art, guns, paintings, etc., as a memento of our
friendship. If any should predecease me, such bequest
shall lapse.
FOURTH: I give and bequeath to my Executors,
hereinafter named, the sum of Five Thousand Three Hundred
Fifty ($5,350.00) Dollars, to be used by them in accordance
with that letter of instruction found with this Will titled
"Celebration of Life".
FIFTH: I give and bequeath the following amounts
to the following:
A. The sum of Twenty-Five Thousand ($25,000.00)
Dollars to ST. WENDELIN'S ENDO~ENT FDND, ST. WENDELIN
CBURCH, 210 St. Wendelin Road, Butler, PA, 16001, if
it is still in existence at the time of my death,
otherwise, I give and bequeath said amount to the ST.
FIDELIS DEVELOPMENT FUND, operated by the Province of
St. Augustine of the Capuchin Order, 125 39~h Street,
Pittsburgh, PA, 15201;
B. The sum of Five Thousand ($5,000.00) Dollars
to the PENNSYLVANIA FEDERATION OF SPORTSMENS CLUBS, INC.,
ENDOWMENT FOUNDATION, 2426 N. Second Street, Harrisburg,
PA, 17110;
C. The sum of Five Thousand ($5,000.00) Dollars
to the WILLIAM L. BAER CONSERVATION SCHOLARSHIP FUND,
presently in care of James Ferguson, 114 McConnell Drive,
Butler, PA, 16001;
D. The sum of Five Thousand ($5,000.00) Dollars
to the SCOTT ECKERT CONSERVATION SCHOLARSHIP FUND,
presently in care of Ronald Freed, 421 Grahams Woods
Road, Carlisle, PA, 17103;
E. The sum of Five Thousand ($5,000.00) Dollars
to the RALPH W. ABELE CONSERVATION SCHOLARSHIP FUND,
presently care of the Pennsylvania Fish and Boat
Commission, P. O. Box 67000, Harrisburg, PA, 17106-7000;
F. The sum of Five Thousand ($5,000.00) Dollars
to SCAAN (SOUTH CENTRAL AIDS ASSISTANCE NETWORK), 2A
Kline Village, Suite A, Harrisburg, PA, 17104;
G. The sum of Six Thousand ($6,000.00) Dollars
to my brother, PETER GREEN;
Page Two of Will of Leonard A. Green
H. The sum of Five Thousand ($5,000.00) Dollars
to my sister-in-law, BERTHA GREEN;
I. The sum of Six Thousand ($6,000.00) Dollars
to my sister, VERA M. GEIBEL;
J. The sum of Five Thousand ($5,000.00) Dollars
to my sister-in-law, IRENE GREEN;
K. The sum of Ten Thousand ($10,000.00) Dollars
to my sister, SISTER MARY ZITA GREEN, O.S.F., or, if
she cannot accept it personally, to the SISTERS OF ST.
FRANCIS;
L. The sum of Five Thousand ($5,000.00) Dollars
to my sister-in-law, DELORES RESIDENCE GREEN CORN~TTI;
M. The sum of Twenty-Five Thousand ($25,000.00)
Dollars to my sister, BARBARA GREEN;
N. My Park Model Trailer presently situate in Lee
County, Florida, and the sum of Ten Thousand ($10,000.00)
Dollars to help with the lot rent, taxes, and insurance
for the future years, to my sister, BARBARA GREEN;
O. The sum of Fifteen Thousand ($15,000.00) Dollars
to my sister, MARY MILLER;
P. The sum of Five Thousand ($5,000.00) Dollars
to each of my living nieces and nephews, with an additional
One Thousand ($1,000.00) Dollars to my godchildren, as
follows:
1. JOYCE T. GREEN CROYLE;
2. PETER M. GREEN;
3. JUDITE A. GREEN HILDERERAND;
4. GAIL M. GREEN HUNGERMAN;
5. DAVID C. GREEN;
6. BECKY S. GREEN WILBERT;
7. LUANN M. GREEN;
8. BRUCE J. GREEN;
9. JEROME PETER GREEN;
10. LOUIS LEROY GREEN;
Page Three of Will of Leonard A. Green
11. DIANA M. GREEN HESIDENCE;
12. SHIRLEY R. GREEN SHURTLEFF;
13. KAREN L. GREEN MITCH~
14. BONNIE LOU GEIBEL BENNINGER, my godchild,
an additional One Thousand ($1,000.00)
Dollars;
15. BARBARA ANN GEIBEL DAVIDSON;
16. MARY ALLEN GEIBEL LEECH;
17. SANDRA LEE GEIBEL CONTI;
18. BEVERLY S. GEIBEL MILLER;
19. TERRY GEIBEL;
20. STEPHEN P. GREEN, my godchild, an additional
One Thousand ($1,000.00) Dollars;
21. EILEEN GREEN HARTLE;
22. LINDA M. GREEN WARNER;
23. SHARON ROSE GREEN ZANG;
24. VICTOR CHAD GREEN;
25. PATRICK J. GREEN;
26. THOMAS C. GREEN;
27. LINUS C. GREEN;
28. REGIS G. GREEN;
29. CHAD EDWARD GREEN;
30. DARLENE GREEN KILEY;
31. HARVEY p. GREEN;
32. LARRY GREEN;
33. DENNIS J. GREEN;
34 . KATRLEEN GREEN;
35 . NANCY GREEN BURNS;
36 . DONALD GREEN;
37. DONNA MARIE GREEN SCHAFFNER;
38. PATRICIA GREEN TACK;
39. MARY GREEN;
40. ELAINE GREEN MAKULA, my godchild, an
additional One Thousand ($1,000.00) Dollars;
41. BRENDA SUE MILLER WOLFE;
Page Four of Will of Leonard A. Green
42. LUCINDA LUE MILLER;
43. JULIEANNMILLER STOWITZKY;
44. CAROL JEAN MILLER MITCE;
45. BETH ANN MILLER SKIBICKI.
Q. The sum of Five Thousand ($5,000.00) Dollars
to my good friend, JOSEPH GREENE;
R. The sum of Five Thousand ($5,000.00) Dollars
to my good friends, RONALD and PATSY FREED, or if either
should predecease me, then to the survivor thereof.
In the event any of the aforenamed institutions
or charitable organizations should no longer be in existence
at the time of my death, or any individuals above named should
predecease me, such gift shall lapse and be and become part
of my residuary estate.
SIXTH: I give, devise and bequeath all the rest,
residue, and remainder of my estate, of whatever nature and
wherever situated, to all persons hereinbefore named, in the
same proportion as the cash bequeathed to them, without
reference to any tangible personal property bequeathed.
Further, in the event my estate should be insufficient to
pay all bequests, in full, I order and direct that such bequest
should adeem in the same proportion as the cash bequeathed
to them, without reference to any tangible personal property
bequeathed.
SEVENTH: I authorize my Executors and their
successors to exercise the following powers, in addition to
those given by law, to be exercised in their sole discretion:
(a) To repair, alter, improve or lease for any period
of time not in excess of one-year terms, any real or
personal property.
(b) To retain any real or personal property which
at any time form a part of my estate as long as they
deems advisable.
Page Five of Will of Leonard A. Green
(c) To sell at public or private sale, for cash
or credit, with or without security, any real or personal
property.
(d) To compromise claims.
(e) To make distribution in kind.
EIGHTH: I appoint my nephew, THOMAS C. GREEN, and
my sister, BARBARA H. GREEN, Co-Executors of this Will, but
upon condition that the Executors' fee of Five (5%) Percent
shall be payable, in full, to my nephew, THOMAS C. GREEN,
who is a C.P.A., and because I have otherwise provided for
my sister, BARBARA H. GREEN, by bequests in this' Will. I
have selected said two Executors because of our close family
ties and of BARBARA's understanding of my wishes and values.
Neither Executor shall be required to enter bond nor furnish
sureties in any jurisdiction. All decisions not specifically
covered in this Will shall be made by my Co-Executors, in
consultation with my attorney, scrivenor of this Will.
IN WITNESS WHEREOF, I have hereunto set my hand
and seal this ~, day of Ot]-O~,_ , 1995.
........ ' Leonard~/G~e~r{
SIGNED, SEALED, PUBLISHED AND DECLARED by the above
named, LEONARD A. GREEN, as and for his Last Will and Testament,
in the presence of us, who, at his request, in his presence
and in the presence of each other, have hereunto subscribed
our names as witnesses.
Page Six of Will of Leonard A. Green
Register of Wills of Butler County, Pennsylvania
OATH OF SUBSCRIBING WITNESS
Estate of LEONARD A GREEN
also known as
, Deceased
No. 10-2000-259
ROBERT J STOCK
(each) a subscribing witness to the Q codicil(s) ~ will(s) presented herewith, (each) being duly
qualified according to law depose(s) and say(s) that ~Ne/he/ff~y was/were present and saw the
above Testator(~ sign the same and that ~[l~/he/ff~y signed as a witness at the request of
Testator(z~) in tmdhis/tlxeJr presence and Q in the presence of each other Q in the presence
of the other subscribing witness(es).
(Signature)
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this 14
of APRIL
STAM p l
'---I~ISTER OF ~ILLS
Form # PBA-RW-2-5-93
Prepared by the Pennsylvania Bar Association 1991
NOTE: To be taken by officer authorized to administer
oaths. Please have present the original or copy
of instrument(s) at time of notarization.
UNAVAILABLE SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF BUTLER
SS:
I, the undersigned, being duly sworn according to law, depose and say that I am the Attome~tti
Representative in the Estate of ~ ~;'~
Deceased, and declare that ~,~ff'~,/2~',,9 ,/'/, ~',4'ff~'-~/ and
who signed as subscribing witness(t~) to the Will/(Jott~[ of the aforesaid Decedent is/~c not readily
available to attest to same by reason of
Sworn to and subscribed
this -z~ day of aoo,~
~ Judi~ Mbser
~~Mm Expir~ Fire Monday in l~u~~
OATH OF NONSUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF BUTLER }
SS:
We, the undersigned, being duly qualified according to law, depose and say that we are familiar with
the signature of ~' ~'~ ,~,~o~ ~ ,r~f. ~ ,~,~r.~ , TestatOR
of the Will/~t[~tlfi~resented herewith and that we believe the signature on this Will/~ilfil;~ in hisJlil[r own
handwriting to the best of our knowledge, opinion, and belief.
Sworn to and subscribed bef~
ORDER OF PROBATE
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF BUTLER }
SS:
RW NONSUB Rev (9- 9 5 )
AND NOW, this 14 day of APRIL Xl~2000the proof of the attached
being deemed sufficient, it is ORDERED, ADJUDGED, and DECREED that th~[l~f
LF. ONARn A GREEN , ~]~~~ttcd
to probate and recorded as such in my office. ~~.~
Rcgistcr of Wills & Clerk of Orphans' Coun~
. .. , ,,~My Commission Expires First Monday in lanuary, 2000.
Register of Wills of BUTLER County, Pennsylvania
Certificate of Grant of Letters
WHEREAS, on the 14th
dated October 28th 1995
No. 2000-00259 PA No. 10-00-0259
ESTATE OF GREEN LEONARD A
Late of CHICORA
~U'I'~ CUUN'I'~,
Deceased
Social Security No. 204-22-6928
day of April
2000 an instrumen
was admitted to probate as the last will of GREEN LEONARD A
late of CHICOP~A , BUTLER County, who died on the
28th day of March 2000 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, JUDITH MOSER , Register of Wills in and for
the County of BUTLER in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to GREEN THOMAS C and MILLER MARY(GREEN)
who have duly qualified as Executor(rix)
and have agreed to administer the estate according to law, all of which fully
appears of record in my Office at BUTLER COUNTY COURT HOUSE,
BUTLER, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 14th day of April 2000.
~egl~Eer OE
"JUDITH MOSER'
REGISTER OF WILLS
AND
CLERK OF ORPHANS' COURT
My Commission Expires Flint lion in Jan S004
**NOTE** AT.T, NAMES ABOVE APPEAR (LAST, FIRST, MIDDT.R)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FOLD HERE
RECEIVED FROM:
STOCK ROBERT J
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
603 NATIONAL BANi<,.
BUTLER° PA 16001
ESTATE INFORMATION: I
FILE NUMBER
10-2000--0259 SSN 204..-22-6928
NAME OF DECEDENT (LAST/ (FIRST) (MI)
GREEN LEONARD A
DATE OF PAYMENT
6 ! 26 / 2000
POSTMARK DATE
612312000
COUNTY
BUTLER
DATE OF DEATH
~ ~/2000
REMARKS 2~ - 0.~5~_
CHECK# 1 t i
SEAL
REGISTER OF WILLS
101 ~213o 750.00
$213, 750.00
"
FOLD HERE
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF BUTLER I SS.
I, Judith Moser, Register of Wills,
in and for said County and State, do hereby certify
that the foregoing is a true and correct copy of the
Original L~st Will and Testament and the
Probate Proceedings in the Estate of
.............. ~..E.Q~..A....P&......A.,.....a....~...E..~ ...........................
................................................................ deceased,
so full and entire as the same remains of record
in my office at Butler, Pennsylvania, in volume ......... ' ..... .5...5. ......................... page ............... 5.5._.1. ........................
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed the seal of this office this
......... iL3. ................. day of ....... A~J.6..U.$..T. ............... ,~1~ .... .2..O..0.0.
/~ '~" Judith Moser
ESTATE OF
LEONARD A. GREEN
LATE OF
CHICORA, PA.
EXEMPLIFICATION
Judith Moser
Register of Wills
P.O. Box 1208
Butler, PA 16003-1208
OFFICIAL USE ONLY
REV-7500 E×, (6-00) REV-- 1 500 D U P L I CATE
COMMONWEALTH OF PENNSYLVA.,A INHERITANCE TAX RETURNFILE NUMBER
DEPARTMENT OF REVENUE
DEPT. 280601 RESIDENT DECEDENT 10- 00- 0259
HARRISBURG, PA~7128-0601 ~ COUNTYCODE YEAR NUMBER
D DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) ~
E GREEN LEONARD A
C DATE OF DEATH (MM-CD-YEAR I 204- 22 - 6~28
E DATE OF BIRTH (MM-DO-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
D 03/28/2000 09/26/1929 REGISTER OF WILLS
E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
N
T
~__~ 1. OriginalReturn ~ 2~! SupplementalReturn ~_.~ 3. RemaJnderReturn priortolZ_13_8Z)
(date of death
4. Limited Estate · Future Interest Compromise (date of death after 12-12-821 5. Federal Estate Tax Return Required
6. Decedent Died Testate Decedent Maintained a Living Trust i 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
~ 9. Litigation Proceeds Received E~ 10. Spousal Poverty Credit ~ 11. Election to tax under Sec. 9113(A)
~ (date of death between 12-31-91 and 1-1-95) (Attach Sch O)
NAME
C g COMPLETE MAILINGADDRESS
O Robert J. Stock
R DN FI RM NAM E (If Applicable)
R 603 National City Bank Bldg.
E NE Stock & Patterson Butler, PA 16001
S T TELEPHONE NUMBER
I724/283-3370 ~ ~ '~'I
[1. Real Estate (Schedule A) (1) 124,000.00 OFFICIX[;~rSE ONLY
2. Stocks and Bonds (Schedule B) (2) 1,535,549.85
3. Closely Held Corporation, Partnership or (3) None -~-'~---
Sole-Proprietorship o~
4. Mortgages & Notes Receivable (Schedule D) (4) None ~_~:
R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 169,929.81 --
E
C (Schedule E) ~
A 6. Jointly Owned Property (Schedule F) (6) 4,960.42
P
I ~ Separate Billing Requested
T
U 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
L (Schedule G or L)
A
T 8. Total Gross Assets (total Lines 1-7)
I (6) 1,834,440.08
O 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 130,515.32
N 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) 8,049.34
11. Total Deductions (total Lines 9 & 10) (11) 138,564.66
12. Net Value of Estate (Line 8 minus Line 11) (12) 1,695,875.42
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 161 ~ 381.86
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ,534,493.56
C
O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
M
T UP 15. Amount of Line 14 taxable at the spousal tax
A AT rate. or transfers under Sec. 9116(a)(1.2) 0.00
X X .0 0 (15) 0.00
T 16. Amount of Line 14 taxable at lineal rate 0.00 X .0 6 (16) 0.00
OI I 17. Amount of Line 14 taxable at sibling rate -~.~' X ~2 (17) -~.~'-~'
N / 18. Amount of Line 14 taxable at collateral rate 1,534,49~..~-~' X .15 ' (la)' 230,17~--~
/ 19. Tax Due .... (19) 230,174.03
*-cAPB
HpRL
EplO
cRAG
KOTK
ES
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
Decedent's Complete Addre.,5:
STREET ADDRESS
695 Chicora Road
CITY
Chicora
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
Z. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
213,750.00
11,250.00
STATE
PA
(~)
Total Credits ( A + B + C ) (2)
ZIP
16025
230,174.03
3. Interest/Penalty if applicable D. Interest
E. Penalty
Total Interest/Penalty ( D + 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. (SA)
'B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB)
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, benefts or care? .....
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ r-'-m ~-]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. [---] E~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? ................................ E~ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS )'ES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of periury, I declare that I have examined this return, including accompanying scheclules and statements, and to the best of my knowledge and belief, It is true,
225,000.00
0.00
0.00
5,174.03
0.00
5,174.03
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON I~ESPOI~IBLE FOR FILING RETURN
THOMAS C. GREEN DATE
105 N. Oakland Dr.
Chicora, PA 16025
S~~_~ATURE-OF-..~EPA.~ER OTHE. B-'F'R~ RF--~PRES~ENTATIVE., Stock& Patterson DATE
~~~//' 603 National Ci_t~ Bank Bldg.
............................. /
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (J)]. o or for the use of the
For dates of death on or a~er Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a)(1.1 )(ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statuto~ requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficia~.
For dates of death on or a~er July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twen~-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
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.
Copyright (c) ~OOO form software only The Lackner Group, Inc. Form RE~- 1 ~00 ~X (Rev. 6-O0)
ADDITIONAL Personal Representatives
Estate of LEONARD A GREEN SS# 204-22-6928 03/28/2000
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Signature
Ms_me
Address Line 1
Address Line 2
City, State, Zip
Date
MARY (GREEN) MILLER
695 Chicora Road
Chicora, PA 16025
REV-1~;02 EX + (1-97)
COMMONWEA[TH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
LEONARD A GREEN SS¢/ 204-22-6928 03/28/2000 10-00-0259
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 willin9 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.
DESCRIPTION
Real Estate known as 3470 Waggoners Gap Road, Carlisle,PA -
ITEM
NUMBER
TOTAL (Also enter on line 1, Recapitulation) $
Situate in North Middleton Township, Cumberland Co., PA
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
124,000.00
124,000.00
Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1502 EX (Rev. 1-97)
REV-lC, 03 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENTDECEDENT
ESTATE OF
LEONARD A GREEN SS¢/ 204-22-6928
SCHEDULE B
STOCKS & BONDS
03/28/2000
FILE NUMBER
10-00-0259
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION UNITVALUE
OF DEATH
1 1,738 Shares ALLI'~L Corp 61.50 106,887.00
2 American Mutual Fund, IRA, 442.17 shares 10,019.66
3 Capital World Growth & Income, 712.80 shares 22,061.10
4 Capital World Growth & Income, IRA, 219.18 shares 6,783.71
5 3,000 shares D & E Communications Inc. 19.50 58,500.00
6 Fundamental Investors, 1226.30 shares 41,706.50
7 Fundamental Investors, IRA, 797.56 shares 27,125.08
8 48 shares Hancock Financial Services 23.71 1,138.08
9 Income Fund of America, IRA, 645.47 shares 9,849.80
10 1,200 shares JLG Industries 8.8125 10,575.00
11 New Perspective Fund, 509.44 shares 16,240.98
12 New Perspective Fund, IRA, 260.14 shares 8,293.17
13 4,000 shares North Pittsburgh Systems Inc. 13.125 52,500.00
14 11,533 shares Sprint Corp 60.375 696,304.88
15 5,830 shares Sprint Corp. PCS Group 63.5625 370,569.38
16 Washington Mutual Investors Fund, 637.60 shares 18,107.84
17 Washington Mutual Investors Fund, IRA, 1284.23 shares 36,472.25
18 Federal Reserve Bank - Series HH Bond Redemption 6,500.00
19 United States Series E Savings Bonds 35,915.42
TOTAL (Also enter on line 2, Recapitulation) 1,535,549.85
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1503 EX (Rev. 1 -97)
REV- 1508 EX + {1-97)
ESTATE OF
LEONARD A GREEN SS~/ 204-22-6928 03/2___8/2000 10-00-0259
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.
NUMBI DESCRIPTION VALUEATDATE
1 Trailer in Florida Proceeds of Sale commenced by decedent OF DEATH
to death 20,000.00
2 Travelers Checks
300.00
3 AARP Health Care Options Refund unearned premium 7.50
4 AARP - Refund
86.40
5 American Express Refund for Airline Tickets 305.20
6 BottomLine - Magazine Subscription Refund 30.88
7 CNA Insurance Refund unearned premium 25.48
8 Comm. of Pa. Real Estate Tax Rebate 100.00
9 Cornerstone Federal Credit Union - Accounts 89,413.22
10 Donegal Mutual Refund unearned house insurance premium 122.00
11 IRS 1999 Personal Income Tax Refund 1,967.00
12 John Hancock Refund unearned premium for long-term care 481.25
13 Keystone Insurance Co. Refund unearned premium 32.39
14 Legionnaire Insurance Trust - Refund travel ins. premium 2.75
15 National Audubon - Magazine Subscription Refund 20.00
16 National Geographic - Magazine Subscription Refund 12.25
17 National Geographic Magazine Subscription Refund 49.00
18 National City Bank - Certificate of Deposit 1,221.36
19 Omega Insurance Co. Refund unearned premium - Florida propert 403.00
insurance
20 Pennsylvania Magazine Subscription Refund 19.97
21 Penn-Wild Publications Magazine Subscription Refund 14.95
22 Peterson Publishing Magazine Subscription Refund 6.74
Total of Continuation Schedule(s) 55,308.47
TOTAL (Also enter on line 5, Recapitulation) $ 169,929.81
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1508 EX (Rev. 1-97)
Estate of: LEONARD A GREEN
Soc Sec #: 204-22-6928
Date of Death: 03/28/2000
Continuation of Schedule E
(Cash, Bank Deposits & Miscellaneous Personal Property)
Item Description
Value at Date
of Death
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
PNC Bank - Certificate of Deposit
PNC Bank - Savings Account
RD Publications Magazine Subscription Refund
Reader's Digest ~ Magazine Subscription Refund
Real Estate Taxes refunded at sale of Real Estate
Time, Inc. Magazine Subscription Refund
Times Mirror Magazine Subscription Refund
York Federal Savings and Loan - Accounts
1995 Mercury Grand Marquis Automobile Sold for:
Cameras Sold for:
File Cabinets
Freezer - Sold for:
Lamp - Sold for:
Laptop Computer Sold for:
Lawn Tractor - Sold for:
Miscellaneous Coins and Jewelry - Sold for:
Ned Smi{h Dutch Country Bluebirds Framed Picture
Remington Gamemaster Model 760 30-06 Rifle
Roger Tory Peterson Bluebirds Framed Picture
Roger Tory Peterson Snowy Owl Framed Picture
Rowe's Auction - Net Proceeds, House Contents Auction
Utility Trailer Sold for:
3,216.86
805.85
19.96
12.38
1,292.66
72.59
22.48
19,316.50
6,500.00
110.00
60.00
50.00
10.00
1,000.00
700.00
465.47
3,200.00
400.00
300.00
500.00
10,781.00
150.00
Estate of: LEONARD A GREEN
Soc Sec #: 204-22-6928
Date of Death: 03/28/2000
Continuation of Schedule E
(Cash, Bank Deposits & Miscellaneous Personal Property)
Item Description
Value at Date
of Death
45 Wildlife Patches, Game and Fishing Decals Sold for:
46 Wildlife Print Collection, Sold at Auction, Net Proceeds
450.00
5,872.72
55,308.47
REV- ? $09 EX + (12'97)
SCHEDULE F
COMUONWEALTH OF PENNS~,VAN~A JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LEONARD A GREEN SS~/ 204-22-6928 03/28/2000
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
10-00-0259
SURVIVINGJOINTTENANT(S)NAME ADDRESS RELATIONSHIPTO DECEDENT
A. Mary Green Miller 695 Chicora Road Sister
Chicora, PA 16025
B. Peter S Green
860 Bonniebrook Rd.
Butler, PA 16002
Brother
JOINTLY-OWNED PROPERTY:
L~- l ~ F-H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM :OR JOINT MADE Include name of financialinstltution and bank
account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attachdeedforjointly-heldrealestate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1 A 04/01/78 ll $100.00 U.S. Series E 4,032.36 100.00% 4,032.36
Savings Bonds dated
6/77 -4/78
2 B 10/01/65 3 $50.00 U.S. Series E 928.06 100.00% 928.06
Savings Bonds dated
2/65-10/65
TOTAL (Also enter on line 6, Recapitulation) $ 4,960.42
(If more space ~s needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1509 EX (Rev. 1-97)
REV-~,511 EX + (I"-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COM'MONWEAL'TH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LEONARD A GREEN SS# 204-22-6928 03/28/2000 10-00-0259
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
1
2
3
4
5
FUNERAL EXPENSES:
C.K. Steckman - Stone Grave
C.K. Steckman - Stone Grave
Funeral Repast at Church
Marker,
Marker,
Geibel Funeral Home Funeral Services
Part payment
Final payment
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) TI-lOMAS C, GREEN
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address ]_05 N. Oakland Dr.
City Chicora State PA
Zip 16025
Year(s) Commission Paid:
Attorney's Fees Stock & Patterson
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
StreetAddress
City State Zip
RelationshipofClaimantto Decede~
ProbateFees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Butler Co. Legal Journal - Estate Advertisement
Butler Eagle Estate Advertisement
Butler Eagle Ad for Estate Auction
Clerk of Orphans Court - File First & Final Account
D.E.W. & Sons Septic Certification - Necessary for sale of Real
Estate
Dorgate Auction Gallerie - Art Appraisal
Total of Continuation Schedule(s)
320.00
315.00
200.00
7,475.00
49,639.00
49,639.00
488.00
60.00
87.00
136.00
95.00
85.O0
35.00
21,941.32
TOTAL (Also enter on line 9, Recapitulation) $ 130,515.32
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
ESTATE OF
LEONARD A GREEN
SS# 204-22-6928
Include unreimbursed medical expenses.
ITEM
NUMBER
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
03/28/2000
DESCRIPTION
Capital Tax Collection Bureau - 1999 Wage Tax Due
Discover - Credit Card Statement
Gastro Associates of SWFL, PA - Medical Statement
IRS 1040-ES, 2nd Qtr. Estimated Tax Payment
Media One - Cable Statement
North Middleton Twp. Trash Statement
PPL Electric Utilities Corp. - Electric
PPL Electric Utilities Corp.
PPL Electric Utilities Corp.
PPL Electric Utilities Corp.
Electric
Electric
Electric
PPL Electric Utilities Corp. - Electric
Sprint/United Management - Refund overpayment of pension
Sprint/United Management - Refund overpayment of pension
Sprint - Telephone Statement
Sprint - Telephone Statement
Sprint Telephone Statement
Sprint - Telephone Statement
Sprint - Telephone Statement
Sprint Telephone Statement
Florida
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Tax Collector - 2000 School Real Estate Tax
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
10-00-0259
AMOUNT
10.00
35.79
113.25
4,400.00
28.72
19.98
78.91
58.14
41.28
40.55
26.48
921.64
914.66
10.53
10.62
13.45
14.35
1.51
0.29
1,309.19
$ 8,049.34
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
*.~URt:Ak: OF INDIVIDUAL TAXES
INHERIIINCE TAX DIVISION
%'EPT. 180601
HA~'~.ISBURG, PA 17128-0601
ROBERT d STOCK
STOCK & PATTERSON
603 NATL CITY BANK BL
BUTLER PA 16001
COHHONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-12-2001
GREEN
03-28-2000
10 00-0259
BUTLER
101
LEONARD A
Amount Remitted ~ I
MAKE CHECK PAYABLE AND REMTT~AyMENT TO:
REGISTER OF WILLS ~
BUTLER CO COURT HOUSE ::~'
BUTLER, PA 16001 ~ ~ .:~.
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ ~
REV-lSd7 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAZSEMENT~ ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GREEN LEONARD A FILE NO. 10 00-0259 . ACN IOZ DATE 05-12-2001
T~ REARM NAS: (X) ACCEPTED AS FILED ( ) CHA~ED
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) (2)
3. Closely Held Stock/Partnership Interest (Schedule C)
q. Mortgages/Notes Roceivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I] (10)
11. Total Deductions
12. Net Value of Tax Return
12qzO00.O0
lt535;Sq9.85
.00
.O0
169t929.81
6t960.q2
.00
(8)
130,515.32
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
15.
lq.
NOTE:
1,836,660.08
069.36
(11) 138. 564.66
(12) 1,695,875.42
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13)
Net Value of Estate Subject to Tax (Iii
If an assessment was issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
161,381.86
1,534,493.56
18 and 19
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
230,176.03
.00
.o0
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REOUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rate
17. Amount of Line 16 at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rate
19. Princiael Tax Due
TAX CREDITS
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-
06-23-2000 AAqZlq53 11,250.00
12-26-2000 AAqqq~83 . O0
213,750.00
5,176.03
AMOUNT PAID
(is) .00 x 00 = .00
(16) .00 x 06 : .00
(17) .00 x 00 = .00
(18) 1,536,693.56 x 15 : 230,176.03
(19)= 230,176.03
BUREAU OF INDIVIDUAL TAXES
INHERITAHCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
ROBERT J STOCK
STOCK & PATTERSON
603 NATL CITY BANK BL
BUTLER PA 16001
COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE 05-25-2002
ESTATE OF GREEN LEONARD
DATE OF DEATH 05-28-2000
FILE NUNBER 10 00-0259
COUNTY BUTLER
ACN 202
I Amoun~ Remi~*md
MAKE CHECK PAYABLE AND REMZT~A~:":
REGISTER OF MILLS
BUTLER CO COURT HOUSE
~UTLER, PA 16001
A
NOTE: To insure proper credit: ~o your account, submit: ~he upper por~ion of ~his fora wi~:h your ~:ax payment.
CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR FILES ~
REV-736 EX AFP (01-02) xx NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANTA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~
ESTATE OF GREEN LEONARD A FILE NO.iO 00-0259 ACN 20Z DATE 05-25-?00Z
ESTATE TAX DETERMINATION
1. Credi~ For S~a~e Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
5. Inheritance Tax Assessed by O~her S~a~es
or Territories o~ ~he United Sta~es
(Excluding Discoun~ and/or Interest)
To~al Inheritance Tax Assessed
5. Pennsylvania Es~a~e Tax Due
6. Amoun~ o~ Pennsylvania Es~a~e Tax Previously Assessed
Based on Federal Es~a~e Tax Re~urn
7. Addi~iona! Pennsylvania Es~a~e Tax Due
TAX CREDITS:
218,92~.05
.00
.~6,358.00
Z18~92~.05
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX CREDIT [
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
.0O
.00
.00
.00