Loading...
HomeMy WebLinkAbout02-1042PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~- ~~- ~ • ~ No. also known as To: eceased. Social Security No. t g ~ - ~ ~ -~~ ~ c1 21-02-1042 Register of ~lls or the County of u'~t ~"~~-.~ a.in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl v e-S for letters of administration on the estate of (d.b.n.; pendente liter durance absentia; durante minoritate) the above decedent. Decendent was domiciled at death in ~ i~~e ~ ~ ~- ~~ County, Pennsy)vania, with h ~ ~ last family or principal residence atq ~`~ `~ ~'~ ~e `j ~ '"`G ~ ''~ ~~~ (list street, number and municip lity) ~~O°-iN~ ~ ~='L'`'~~~"l- Decendent, then `~ ~ years of aY~e, died i ~ ~ at '~ Q 1 ~--Sr ~L-'v~ ~ e.,, E-~~~ ~ ~ ~u r~ Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ~ ~~ \'7 G 19 , $ ~U~C? v C7 Petitioner after a proper search ham- ascertained that decedent left no will and was survived by the following svouse (if any) and heirs: Name P ~~ ~-. ~ , ~ ~ ~~~5 Relationship ~~~..~~- Kestaence 8 ~~~-l~-t-- S-~ c~ l~ t ~<<Ipl~'17c~ ~ THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. .~ N vv ~~ ~.o ~~ La ~ o oq ic9c~,~ ~ ~~s1z~ .S C~.~.~~ Q.~ ~~~ ~ ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss -- COUNTY OF CTTMrRFAr erTD _ 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 representative(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 20th day of 2002 ~' ~ NOVEMBER ~~ ~ ~ ,~ ~ ~ JO ~ ~~ ~~~~ Registe~ ~ `" No. 2I-20-IO42 Estate of JEFFREY L ROSS ,Deceased GRANT OF LETTERS OF ADMINISTRATION NOVEMBER 22 xpq 2002 ~ in consideration of the petition on AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration PATRICIA A ROSS are hereby granted to in the estate of JEFFREY LROSS - Register of Wills ~Ji~~ FEES Letters of Administration ..... $ 25.00 Short Certificates( ) .........: $ 6.00 Renunciation ............... JCP $ 10'00 TOTAL $------ Filed ... NOV, 22 , , ........ A.D. 1~ 2002 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ;i1 ,r ',~ _~ -. 4(.. ~-:` _..:~~.__>:i I~:tc .V."P_ TS COt'CCCtIy CU~1Zd ~;'OCI, ~.t) Cl1~oYTt;~i :.~.-5-i~9t 3iC r.: 1,;~ ~, .• <~±z ti il, Pic' (Nb~al~riC'L~ Io Cilc ,~iC3CC i t:dl ivcl.Cr?'Clt t~/~-it:c .')i. i~,_ „ 1- i t ~ _ . ~~ ~' ~r t3~1~,~, ~ ~ =:lie~~l t~ du~ii~ate this coc~P~' by ph~tr~st~t ra~ ~.t~lyl~i~:_3 r ~ 86430__4 1105.1./4 Rev. 1 /91 rJT NT r ~. \C~ s.A P ~ 'i ~. ~~ `~ lu.~ -- * , ~~v` ~~ C&7T ~;~'~~.~.., ~~ OV 1 i X002 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Coroner) K __-___ - NAME OF DECEDENT (Post Middle. Last) SEX SOCIAL SECURITY NUMBER -_-- -- DATE OF DEATH It.tunth, Day Year) 1• Jeffre L Ross 2. Male ,. 181 - 38 - 9769 4. November 4, 2002 AGE (Lass 8rtthday) UNDER 1 YEAR UNDER 1 DAV DATE OF BIRTH BIRTHPLACE (City and PLACE OF DEATH (Check Doty cne -~ see uislructiuns on other slue) - -- - - Months Days Hours Minutes (Month, Day, Vear) Stetew Foreign COUnhy) HOSPITAL. OTHER: 49 Yrs 1953 ar. 4 arrisburg, PA Inpabem~ l ERrOutpatient ^ DOA^ Homeg other ^ ~ ^ . 5. , 6. 7. fie. Residance (Spacity) COUNTY OF DEATH CI BORO P OF DEATH FACILITY NAME (It riot instnul~on, give sheet anu number) WAS DECEDENT OF HISPANIC ORIGIN? RACE -American Indian, Black, White , X Not-~ Yes^Ityes, spewty Cuban, ISpecdy Cumberland Lemoyne 914 Hummel Avenue Me ~lhite i P Rf a can, aerto can.eto eb. ec. ed. g. ,a. DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVERIN DECEDENT'S EDUCATION MARITAL STATUS-Married SURVIVING SPOUSE C ES2 S eut un1 hi, nest trade cwo leteu Never Married, Widowed. pl w,i. yive maden name) (Give kind of work done uunny n, a U.S. ARMED FOR ~ V ' M pl porkirlg Iija~AO11cy_use rellre Yaa ^ NoLJ Elememary'Secondary College Divorced (Spe,~Jyl ) Amp I n e Gl l.Illn Sl a 1 5 Divorce(] . . , ~ ) ( - oi r) ' lta. lib. 12. 13. 11. 15. DECEDENT'S MAILING ADDRESS(Sheet, CnycTuwn, Slate. Zip Code) DECEDENT'S i7a Sl t ^ 91 4 Hummel Avenue, Apt 1 . a Yes, decedent livetlm m 17c. e a qES DENCE a d Lemoyne, PA 17043 e e e o~oln ~lisains ~ow~sh,? No, MCedem kved Cumberland p Lemoyne ~ ,fi. ,,,. ,Th.c°°nt whhinacwalhmnsol city FATHER'S NAME (Post. Miduie Lase MOTHER'S NAMEiFu st. Midule Maiden Sumamel Jack A. Ross Patricia A Hager ,fi 19 . INFORMANT'S NAME (Typ61Pnm) INFORMANT' MAILING ADDRESS (Street GryROwn, Stale Lp Cude) - Patricia A. Ross 160 B, Market Street Camp Hill PA 17011 2 206 , , METHOD OF DISPOSITION DATE OF DISPOSITION PUCE OF DISPOSITION-Name of Cemetery,Crematory LOCATION-CityRown, State,Zp Ci. Je -- Burial ^ Crematory ® Removal Irom State^ (Month, Day, Year) Other Place ° - Donalion^ othar(Specityt ^ November 9, 2002 Con -o-Lire Crematory Schaefferstcrwn PA 170 21 a. 21b. 21c. , 21tl. • SIGN E OF FUNERA~CEN OR P SON ACTING CH LICENSE NUMBER NAME AND ADDRESS OF FACILITY __ ~7n n~~ FO 012342--L 22a. t ?~'Y~ 22b. tone&MurrayFH408 3rd St New Cumlterla PA 2c. Co to items 23a-c ~~ry when certitying To a krgwledge, tleath occurred al the time, dale and place statetl. LICENSE NUMBER DATE SIGNF. - - iotan is not available al time of death to ~ (S n rid Title) (MOnttl, Day ,r) ~ cenity cause o1 death. 2 23b. 23C. ___ Itema 24-28muW De Completed Dy TIME OF DEATH DATE PRONOUNCED DEAD(Monlh, Uay, Vear) WAS CASE REFERREDTO MED C pp IC LEXAMINER/CORONER? _ ---- AprX. , aI ~~ - person who pronounces death. vea/y~p, ~^ 2002 November 7 00 A 8 , : . M. 25. 24. 26 27. PART I: Enter the diseases, injuries or compecauons which caused the tleath. Do not enter the node of dying, such as cardiac or respiratory arrest, shock or heart lailure. r Approximate PART II: Other sgniM1cant wndhans comribu0ng to death, Dut List only one cause on each line. ;interval between not resWbng in the underlying cause given to PART I. t onset and death IMMEDIATE CAUSE (Final disease w condition res,hirg in death)-. a. Pending Investigation DUE TO (OR AS A CONSEQUENCE OFg ~ -- _ Sequemially list condnbns D. it any, katlirg to immediate DUE TO (OR AS A CONSEQUENCE OF): I _ _ --' cause. Enter UNDERLYING I i CAUSE (Diseasewinjury c. ' that inaiated events DUE TO IOR AS A CONSEQUENCE OF): I _ _. --- _ resulting in death) LAST d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OFINJIIRY TIME Of INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERFORMED? AVAILABLE PRIOR TO (Month, Uay. Y,. u, COMPLETION OF CAUSE OF DEATH? Natural ^ Homiwde Ll Ves ~-. ~ No ^ I~/~ l Y ^ N V ^ N ~ 1 Accident ^ Pending lnvesligation ~ 30a. _ __ _ 306. __M. 30c. __ 30tl. _ _ _ P ACE OF U a es o / _ o ._ es Suicide ^ C° ld rwt be dete mi ed ^ L INJ RY-At home.I , snaet, I tury, nflice LOCATION (Shoal GlylTuwn State) b ld t l ' 2fia. 2fih. u r n 29. ui ing e c.t yl t~ :~ 30e. 301. CERTIFIER fCheck only one) SII~NATURE AND TITL TI 'CERTIFYING PHYSICIAN (Physician cerlitytnU cause of death when another phy9wan has pronourx:eU dealt, anu completed hem 23j i ' I C O To the Daat of my knowledge, Math ocwrred dw to the cause(s) and manner as slated .................................................. .. .. T O ne T 31 b. - ~ t I( FUSE NUMBER - - - DATESIONED(Mc.~ Uay. Yeeq 'PRONOUNCING AND CERTIFYING PHYSICIAN(Physician GNh pronwrnctng dealt antl cerntying locauseW death) . To iM best of my knowledge, death occurred at the lima, date, and plus, and tlw to the cause(s) and manner as stated ....................... ~ I 3 t c ___ _ _ ___ __ 310. N O V . r; ,. 2 00 2 'MEDICAL EXAMINER/CORONER On the baste of eaaminatbn and/or Investigation, In my oplnlon, death oecurred at the time, date, and place, antl due to the cauu(s) and manner as statad .................................................................................................. rv wnu ~uMrit t to must ur oral rt dr Pri"'Michael L. Norris, Coroner 6375 Basehore Road, Suite 4~1 Mechanicsburg, Pa. 1i-050 ~i // 33. /1sJ/.~t'i:~1 /°f L ~~,=lr( J~e~,•iiti a:Y t~.r CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. ~~ ~~ ~ To the Register: ~~e ~G ~ E~~~~~~ ~ Admin. No, 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 Name Address Ca~~~.l~, ~ ~~dc ~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: ©~ I ~ J Signature Name ~~ ~~~~~ Address ~~~j ~ ~~.~ ~~ ~-~- Telephone ('( ~~ "~ ~ ` j .._. ~ j ~~' ~~ ~~~~~ ~ Capacity: ~ Personal Representative ~~-. r l ~ ~4' ~ ~.oC~ ~ Counsel for personal representative Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/24/2004 ROSS PATRICIA A 1605B MARKET STREET CAMP HILL, PA 17011 RE: Estate of ROSS JEFFREY L File Number: 2002-01042 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death shall file with the Register of Wills a Status Report of complete~ or uncompleted administration. This filing will become delinquent on: 11/04/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge _STATUS REPORT UNDER RULE 6.12 Name of Decedent: ..'~ ~_~~__~ Date of Death: ~.q~ ~ ) ~ P~su~t to Rule 6.12 of the Supreme Cou]~ O~hans' Com~ Rules, I repo~ the following with respect to completion of the admi~sCat/on of the above-captioned estate: 1. State whether a~istration of the estate is complete: Yes '~ No ~ 2. If the ~swer is No, state when the personal representative reasonably believes that the a~i~stration will be complete: 3. If the ~swer to No. 1 is Yes, state the follow~g: a. Did tke personal ~resentative file a ~al accost wi~e Corn? Yes ~ No b. The sep~ate O~h~s' Co~ No. (if any) for the pers~al cn . repr~ntat~ve'S accost is: c. Did the personal representative state ~ accost ~o~ally to ~-~. · .... ~p~es ~ ~terest? Yes ~ No ~ ~ .... '" c. Copies of receipts, releases, jo~ders ~d approval of focal or i~o~al accosts may be filed with the Clerk of the OChans' Co~ ~d may be a~ached to tbs repo~. Si~at~e ~me Telephone No. Capacity: ~Personal Representative LA Counsel for personal representative ~ 1505610101 REV-1500 ex (oi ro) ~!1i' OFFICIAL USE ONLY PA Department of Revenue pennsylvarda Bureau of Individual Taxes ~""`"`"~ " ""°` County Code Year File Number PO Box z8D6ot ~ INHERITANCE TAX RETURN ~ I Q /1 ~ ~ ~~ HarrisburD, PA i~iz8-0601 RESIDENT DECEDENT o1 ENTER DECEDENT INFORMATION BELOW Social Security Number ~ ate ~ eat MZ Date of BirUI _ I ~ ~YYYY Decedent's Last Name Suffix D~ ent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Narne ~ S ~~~ C ` Daytime Telephon umber o Cj yr} ~ l • ` \ J .l - REGISTER O SE O r-"' ' "~ --~t' r First line of address ~~{- ~--~-S-e e~ ~ S f3 ~~ l-~, t qty, ~ ~, -- Ch ~ `- ~ f A a r" i:. . . ~ ~~ 3 Second line of address ~-i ~ r - ' - G,t't ` ~ City Or POSt,,InO,A~ffice ll State ZIP Code ( DATE FILED /l \ ~ Correspondent's a il dd s ~ -ma a ~(~, ~ r~~ ress: _ L~ I n ~ 4 Under nalties of y, ' ' pe perju I declare that I have examined this return, including accompanying schetlules 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 basetl o ll i f n a SIGNAT E OF P RSON RESPONSIBLE FO LING R N n ormation of which preparer has any knowledge. ~ ADDRESS 9DATE `, t~ 0 5 ~?, M m~-K~~ ~~- ~ ~~~~11oc( SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE n nnoroc DATE PLEASE USE ORIGINAL FORM. ONLY 1505610101 Side 1 1505610101 J ~i J 1505610105 REV-1500 EX t Decedent's Name: E Decedent's Social Security Number '_~_97~ RECAPITULATION 1 . Real Estate (Schedule A) ......................................... .... 1' 2 . Stocks and Bonds (Schedule B).. _ ............................... .... 2. Lj 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. -~ 4 Mortgages and Notes Receivable (Schedule D) ................ 4 ........ ... . 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 2~~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - - -- - (Schedule G) O Separate Billing Requested..... ... 7. "~ 8. Total Gross Assets (total Lines 1 through 7) ........... _ ............. ... 8. ~ "~~ c ~ ~> 9. Funeral Expenses and Administrative Costs (Schedule H) ........... g, ~i ~ ~~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. ~~~ 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ! 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - - -- an election to tax has not been made (Schedule J) ............... ...... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ' TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 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. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 O REV-1500 EX Page 3 Decedent's Complete Address: File Number STREETADDRESS CITY STATE. _ ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 79) 2. CreditslPayments (1) A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. Ii Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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: a, retain the use or income of the ro Yes No P PertY 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, benefds or care? .......................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for' orpayable-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. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [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 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)j. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 PS. §9116(a)(1.3)j. Asibling 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-1511 EX+ (10-09) pennsylvarria DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMEER ..'.. Decedent's debts must be reported an Schedule I. A• FUNERAL EXPENSES: I. ~ i~~~~~ ~m~ C S ~~~~~ B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representatlve(s) _ Street Address --- Gty-- --------- --State--- ZIP Year(s) Commission Paid: 2. Attorney Fees: 3• Family Exemption: (IF decedent's address is not the same as ciaimaM's, attach explanation.) Claimant Street Address ----- - ----- ~ - ---- _ State _--ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5• Aanuntant Fees; 6• Tax Return Preparer Fees: 7. a,y~~. ~~ ~1~.~~ TOTAL (Also enter on Line 9, Recapitulation) If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (8..ga~ scNEOU~ ~p C~+ COMMONWEALTH OF PENNSYLVANIA ~+/'~.7~'1~ BANK DEPOSITS, 8c MISC. INHERRANCE TAX RETURN ~Rc~y, •, p~~~ RESIDENiDECEDENT ~ViL r~cVrC ESTATE OF ~ txocaeaa a titigedon and ub date the procsads alete nzoetved ny dla . joMltltrownad wMh dYM of sundrorahip aaat ba diaelaad as SehadaM F. AT ~~ TiDTAL (Abo enter on tine 5. Rec~pit~dation) (N maro space is needed, hlwt addivonal sheets d the stone size) ~3~ ~0~ co 0 0 N r H • ~ OTC n ~ *'~ ry N t ~4~ .` ~ g ~ ~~ c am d L7 .~ .~ ~ M=` oC y N y ~~ .-. ~ te r ~' O ~ m Vl .. r ~ N m Q d O l0 ~ ` ~ w, ~ _ U ~ a d fC a ~ ~- ¢ N v C •~ O U c 0 y ~ ~', m. "' 0 N M ' M d ~ ~ N ~ ~ 7 N C7 ~" .-~ ~ o° °o o° C O !O ~ ~ 'd3 69 EA ~ ~ ~ ~ m D a ~ O ~o m O e ~ o o MMO ~ "~i T~~ ~ LL ~~jj T~'~W~' ~~~~~ .. ~~~~ ~~~ ~ u s ~ vj z W ~ o o a q 4 4 f~so• ~tm ~ ~ ~V ~~° m ~ ~ ~ ~ m ~ e o r '~ ~ M ~ ~ ~~~• a ~ a~~,~oacett~«3 3 W ,~~-m ~a mya e c ct.ffi W ~~c~n ~.oc~ v Itl ~ ~ ~ ~ ~ aO1 « - ~ l7-a d ~ w°c°mSg ~~ ~ ~'~. v • ; D a~Y °'9E_asy-E ~~ ~~~cg~ ~~ S~~tw~E~ • ~~ ~ .~y~~ y ~ F ~ ~m~ •_ = O t~~ .~. C7 H IL ~ S O 3 n FN. W~ O~ M ~4 M M C d P y ~ V ti ~I~I ' U W ~ C7 ::==a~ • U ((~~ C < ~ ~`0 r O U ~ Lgffiy y m m LL =(J b ~ V O N m f"i < V it ~ E ~ ~ r ~.. Ec~Gc~ :~ q 0 O Z 6 z ~ •~ _ ~ _~ :.~ :~ . c o W •~ U ~ z~ > ~ ~ ~ a '- 0 N ~ U LL m O ~ ~ < v m O m U f- 3 ~ ~ ~ 8 ~.$ . g q ~ :..; • ~~° ~~ ; ~o gggpp LL G ~ F ~ W ~. .7 ~ ~ :t Q ~ ¢ W 'ALL ~ ~ ~ ~ Z 1 l/~ J 1 1~ ` ,Q 1 i` ~ ~1~ V ~ ~ ~\ W K N y N : 1: `J~ :::: V ~, w ... ~ ~ ~ ~ U .. r E c ~ `a ~ ~ ~ ~ ~ x 4. •~~ y~~ 4! 4W g ~ ~ m o , ~ m ~ ~ ~ ~ ~ ~~ : V O ~ O ~ ~ C ~ Y ~ G N O ~ C O ~' , , , J I~ ~ ~ ~ ~ V O ~ a ¢ ~ U U O Q A A ~~g' U .'~! ~~ a ~ ~ a W ~ Q ~ ~ W ~~ ~$ .~ $~~.~~ v Cn ~c ~~°~€m~ ~ ~~•~ ~~~ ~ ~~• r fig, s~~a~ ~ ~3 8 =~ ~~.~- a ~~ ~ ~~ ~ ;~ ~~ ~ ~~~ ~ o~~.~ N WW W a H ~ ~ E d ~ ~~<pp Q ~ F ~ ~ C NOTICE OF INHERITANCE TAX pennsylvan~a '~ ~ t P~ BUREAU OF INDIVIDUAL TAXES ~ Rl~'I~SE^MEM~~,t~~LLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE r ~a _._.....: ,~ ,; ~ ~ INHERITANCE TAX DIVISION OF- DETJU•C,r,l; ~ S AND ASSESSMENT OF TAX REV-1547 EX AFP (12-09) PO BOX 280601 i i;_ `_;'...; :__; ._~ ~ ; , ;. , HARRISBURG PA 17128-0601 ~~~~ ~-~~Y L9 ~~~~ ~~ {;~ DATE 11-22-2010 ESTATE OF ROSS JEFFREY L DATE OF DEATH 11-04-2002 ~~.~.~~+~ ~~~~ FILE NUMBER 21 02-1042 CSi °~~-±,°-'.~~`~j '_~~`~-~~~ COUNTY CUMBERLAND ~ ~ ~~ ,. r. nr, PATRICIA A ROSS ~~,+ ,,., ._, ~ _, : , ~ ;~ ACN 101 16058 MARKET ST APPEAL DATE: 01-21-2011 CAMP H I L L PA 17 011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --~ --RETA_IN LOWER POR_TION_ FOR YOUR RECORDS f-- _ _ _____________ REV-1547 EX AFP C12-09~-NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR - DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: ROSS JEFFREY LFILE N0.:21 02-1042 ACN: 101 DATE: 11-22-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED 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. Mortgages/Notes Receivable (Schedule D) 5. CashlBank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) cl) .00 c2) .00 C3) .00 c4) .00 c5) .00 C6) 300.00 c7) .00 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) c8) 300.00 c9) 3,091.00 clo) .00 C11) 3, 091.00 11. Total Deductions 791.00- 2 12. Net Value of Tax Return (12) , 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 te Subject to Tax f E t l V t14) 2,791.00- 14. s a ue o a Net NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to d ate. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 = .D 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 0 4 5 = .0 0 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0 19. Principal Tax Due t19)= .0 0 TAY CRFiITTS- PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~3