HomeMy WebLinkAbout04-0900Estate of
Register of Wills of CUMBERLAND County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Deceased Social Security No. 183-12-1798
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of
the Decedent, dated June 26, 2003 and codicil(s) dated
State relevant circumstances, e.g. renunciation, death of Executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b,n,c.t.a.: pendente lite: durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following
spouse (if any) and heirs:
Name Relationship Fl~,iilen ce ~;~ ~
, :
COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~
Decedent was domiciled at death in Cumber]and County, Pennsylvania, with his last family or principal residence at
Bethany Village, 325 Wesley Drive, Lower Allen Township
(List street, number and municipality)
Decedent, then 82 years of age, died July 21~ 2004 at Bethany Village
(Location)
105~000.00
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ..................................................................... $
(If not domiciled in PA) Personal property in Pennsylvania ..................................... $.
(If not domiciled in PA) Personal property in County .................................................... $
Value of real estate in Pennsylvania ...................................................................................................................... $ None
Total ......................................................................................................... $ 105,000.00
Real Estate situated as follows:
Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature Typed or printed name and residence
Brian R. Richey
547 Lovell Court, Hnmmeistown, PA 17036
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photo.stat or photograph.
Fee for this certificate, $2.00
P 1052811G
No.
JUL 2 2 2004
Date
-
CERTIFICATE OF DEATH
"R. Ross Richey ~ ,amle
~,L.,~..,.,, I um~.,~ ~ ~ 98 . 7-21-2004
~ [ ~ I
~2 .. : : "] 11-25-1921 fewer t sto~ PA
Cumberland wer Allen
,lEaf ftc engineer ,,[o~unic~t ions
325 Wesley Drive
,*Mechanicsbur~ PA 17055
'L Harry Richey
,.,. c~-¢ Cumberland ~-~v' ,?,.El ,~ ~,,~ ~,,~d
,,. Madolyn Sponsler
a~[~ o~,.~.,,,~n*~om~men~'~ ~f] 23=2004 oiling Green Memorial Park Lower Allen
Jgill anl e tament
OF
H. ROSS RICHEY
I, H. ROSS RICHEY, of Upper Allen Township, Cumberland County, Pennsylvania,
being o£ sound and disposing mind, memory and understanding, do hereby make. publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts and the expenses of my last illne~ and funeral
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
BEQUEST OF TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicle(s), household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto those of my children who survive me, to be divided between them by my Personal
Representative with due regard for their personal preferences in as nearly equal shares as
practicable. I£ there be disagreement as to the disposition of any item or items described in this
Article, I direct that the same shall be disposed of in accordance with Article III hereof.
Estate of
Register of Wills of CUMBERLAND County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No. O'4-qO0
Deceased Social Security No. 183-12-1798
Petitioner(s), who is/are 18 years of age or older, apply{les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of
the Decedent, dated June 26, 2003 and codicil(s) dated
State relevant circumstances, e.g. renunciation, death of Executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b.n.c.t,a,: pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following
spouse (if any) and heirs:
Name Relationship [~nce ~
I
COMPLETE IN ALL CASES:) Attach additional sheets if necessap/, r-.) ·
Decedent was domiciled at death in Cumherland County, Pennsylvania, with his last family or pr~:~cipal residence at
Bethany Village, 325 Wesley Drive, Lower Allen Township
(List street, number and municipality)
Decedent, then 82 years of age, died July 21, 2004 at Bethany Village
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ..................................................................... $ 10§~000.00
(If not domiciled in PA) Personal property in Pennsylvania .....................................
(If not domiciled in PA) Personal property in County .................................................... $
Value of real estate in Pennsylvania ...................................................................................................................... $ None
Total ......................................................................................................... $ 105~000.00
Real Estate situated as follows:
Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature
Typed or printed name and residence
Brian R. Richey
547 Lovell Court, Hnmmelstown, PA 17036
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photo,stat or photograph.
Fee for this certificate, $2.00
P 1052811G
No,
JUL g g 2004
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECOrDs
CERTIFICATE OF DEATH fi::5 .=
325 Wesley Drive "ES~ ,,..s,.,. P-.cnncylvcnia ~ "..~'~.,,.,=.~- ? ..... ~11____
,~echanicsbur$ PA 17055 '~ ~"
,a Harry Richey ,,. ~dolyn Sponsler
~m m~'"'O m [-23-2004 olling Green Memorial Park ~ower Allen ~p.
:~~ a~FD 012 848 1.
./
:lDill anl e tament
OF
H. ROSS RICHEY
I, H. ROSS RICHEY, of Upper Allen Township, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do hereby make. publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
Wills or Codicils at any time heretofore made by me. ~, ~
ARTICLE I : c-~
I direct the payment of all my legal debts and the expenses of my .iast illne~ and flm~ral
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
BEQUEST OF TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicle(s), household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto those of my children who survive me, to be divided between them by my Personal
Representative with due regard for their personal preferences in as nearly equal shares as
practicable. If there be disagreement as to the disposition of any item or items described in this
Article, I direct that the same shall be disposed of in accordance with Article 1II hereof.
ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate, in three (3)
equal shares as follows:
A. One (1) equal share thereof unto my son, BRIAN R. RICHEY, provided that
should my son, BRIAN R. RICHEY, predecease me, I give and bequeath his share unto his wife,
DONNA L. RICHEY;
B. One (1) equal share unto my Trustee hereafter named for the benefit of my daughter,
SUZANNE FECHTER, provided she survives me. If my daughter, SUZANNE FECHTER,
predeceases me, I give and bequeath her share outright unto her then-living issue, per stirpes; and
C. One (1) equal share thereof to my Trustee hereafter named for the benefit my son,
JAMES THOMAS RICHEY, provided he survives me. If my son, JAMES THOMAS
RICHEY, predeceases me, I give and bequeath his share outfight unto ANNETTE RICHEY, his
wife, if she survives me; and if neither survives, I give and bequeath his share outright unto my son,
BRIAN R. RICHEY and his wife, DONNA L. RICHEY, or the survivor of them.
ARTICLE 1V
TRUST FOR THE BENEFIT OF SUZANNE FECHTER
The share for the benefit of my daughter, SUZANNE FECHTER, shall be held, managed,
invested and reinvested by my Trustee subject to the following terms and conditions: My Trustee
shall pay the sum of Five Hundred ($500.00) Dollars per month unto SUZANNE FECHTER,
for and during her natural life, regardless of the size of the corpus or income earned in the Trust. In
addition, the Trustee is author/zed, in the exercise of his or her sole discretion, after taking into
2
account her other readily available resources to pay from principal and/or income such additional
amounts as Trustee deems necessary and appropriate to meet her extraordinary needs such as
catastrophic illness or any other emergency need for housing, transport or health care.
At the death of my daughter, SUZANNE RECHTER, the balance of the undistributed
principal and/or income shall be distributed unto her then-living issue, per stirpes, and in case of
failure of same, then unto my son, BRIAN R. RICHEY, and his wife, DONNA L. RICHEY, or
the survivor of them.
It is my intent to provide a steady stream of payments to the beneficiary, regardless of the
rate of retum of the investments in the Trust.
ARTICLE VI
TRUST FOR THE BENEFIT OF JAMES THOMAS RICHEY
The share for the benefit of my son, JAMES THOMAS RICHEY, shall be held, managed,
invested and reinvested by my Trustee subject to the following terms and conditions: My Trustee
shall pay the stun of Five Hundred ($500.00) Dollars per month unto JAMES THOMAS
RICHEY, for and during his natural life, regardless of the size of the corpus or income earned in
the Trust. In addition, the Trustee is authorized, in the exercise of his or her sole discretion, at, er
taking into account his other readily available resources to pay from principal and/or income such
additional amounts as Trustee deems necessary and appropriate to meet his extraordinary needs
such as catastrophic illness or any other emergency need for housing, transport or health care.
3
At the death of my son, JAMES THOMAS RICHEY, the balance of the undistributed
principal and/or income shall be distributed to ANNETTE RICHEY, provided she is then my
son's unremanSed surviving widow; and should she not be his unremanSed surviving widow or no'
be living at such time, then unto BRIAN R. RICHEY and DONNA L. RICHEY, or the survivor
of them.
It is my intent to provide a steady stream of payments to the beneficiary, regardless of the
rate of return in the investments of the Trust.
ARTICLE VI
POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE
My Personal Representative(s) and Trustee(s) shall have the following powers in addition to
those vested in them by law and by other provisions of my Will applicable to all property, whether
principal or income, including property held for minors, exercisable without court approval and
effective until actual distribution of all property:
To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine.
To retain any or all of the assets of my estate, real or personal, without restriction to
investments authorized for Pennsylvania fiduciaries, as they deem proper, without
regard to any principle of diversification or risk.
To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of
diversification or risk.
4
To sell at public or private sale, to exchange, or to lease for any period of time any
real or personal property and to give options for sales, exchanges or leases, for such
prices and upon such terms or conditions as they deem proper.
To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
F. To compromise any claim or controversy.
To make such elections, decisions, concessions and settlements in connection with
all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes as my Personal Representative and/or Trustee shall deem
appropriate, without obligation to adjust the distributive share of any person thereby
affected.
ARTICLE VII
TAXES
I direct that all estate, inheritance, transfer and other taxes of similar nature payable by
mason o£my death, together with any interest or penalties thereon, and imposed with respect to any
property, whether or not disposed by this Will, shall be paid out of the residue of my Estate as an
administrative expense so that no beneficiary hereunder, or any other person, shall be charged with
or required to pay any part of such taxes.
ARTICLE VIII
TRUSTEE
I name, constitute and appoint my son, BRIAN R. RICHEY, Trustee of any Trust created
under this Will. In the event that my son, BRIAN R. RICHEY, fails to qualify or ceases to so act
as Trustee, I name, constitute and appoint my daughter-in-law, DONNA L. RICHEY, successor
Trustee. I direct that no Trustee shall be required to post bond for the faithful administration of the
duties required in any jurisdiction.
ARTICLE IX
PERSONAL REPRESENTATIVE
I name, constitute and appoint my son, BRIAN R. RICHEY, Executor of this my Last Will
and Testament. Should my son, BRIAN R. RICHEY, fail to qualify or cease to so act, I name,
constitute and appoint my daughter-in-law, DONNA L. RICHEY, alternate Executrix to complete
the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post
bond for the faithful administration of the duties required in any jurisdiction.
IN WITNESS WItEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this 2K'tt't~day of ~ ,2003.
H. ROSS RICHEY
(SEAL)
6
Signed, sealed, published and declared by the above-named Testator, 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 wimesses.
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
We, H. ROSS RICHEY, ~ F'~. ~ ~ and
~'-~,~-~.0.--~ ~. ~ ~l~x., the Testator and the wim?sses, respectively,
k~' '
whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed the instrument as his Last
Will and that he had signed willingly and that he executed it as his free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
ROSS mCHEY
Subscribed, swom to and acknowledged before me by H. ROSS RICHEY, Testator, and
subscribed and sworn to before me by ~ .r--~.--x-,c-,_x,~ and
, witnesses, this ~ ~a~y of
Edmund G. Myers
Attorney I.D.#20558
,2003.
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
SS:
On this, the O ~'x.~ day of ~ ,2002, before me, the
undersigned officer, personally appeared EDMUND G. MYERS, Attorney I.D. #20558, known
to me (or satisfactorily proven) to be a member of the bar of the highest court of Pennsylvania
and certified that he was personally present when the foregoing acknowledgement and affidavit
were signed by the Testatrix and the witnesses.
:2124202
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public
LQ" NOTARIAL SEAL J
DIANNE LEHI6, Nolary Public J
Lemoyne Borough Cumberland Co. J
?mission Expires Dec. 21, 2005 J
(SEAL)
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: H. ROSS RICHEY
Date of Death: July 21, 2004
Will No.: 21-04-00900
Admin. No.:
To the Register:
I certify that the Notice of Beneficial Interest 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 October //7/ ,2004.
Name
Suzanne Fechter
James Thomas Richey
Brian R. Richey
Address
3974 Brookridge Drive
Mechanicsburg, PA 17055
3300 Union Deposit Road
Apartment 205C Governor's Place
Harrisburg, PA 17109
547 Lovell Court
Hummelstown, PA 17036
Notice has now
Date: Octobe~
been given to all persons entitled thereto under Rule 5.6(a) except
IV 2004
None.
Signature
Name: Edmund G. Myers, Attorney
Johnson, Duffie, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone: (717) 761-4540
Capacity: Personal Representative
X Counsel for personal representative
TO
Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
SUBJECT: Estate of H. Ross Richey
No. 21-04-00900
DOD: July 21, 2004
FROM
3OHNSON, DUFFIEt STEWART & WEIDNER
Attorneys at Law
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
Fax: (717) 761-3015
DATE: October 20, 2004
Enclosed is a check in the amount of $1,900.00 as a payment on account of Inheritance
Tax for the above-captioned Estate, being made within the 90 days to allow for the 5% discount.
SIGNED: Cynthia S. Hubler, Estate Legal
COMMONWEALTH OF PENNSYLVANrA
DEPARTMENTOFREVENUE
BUREAU OFINDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11
NO. CD 0O4526
MYERS EDMUND G
301 MARKET STREET
P O BOX 109
LEMOYNE, PA 17043
ESTATE INFORMATION: SSN: 183-12-1798
FILE NUMBER: 2104-0900
DECEDENT NAME: RICHEY H ROSS
DATE OF PAYMENT: 10/21/2004
POSTMARK DATE: 10/20/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 07/21/2004
TOTAL AMOUNT PAID:
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1,900.00
$1,900.00
REMARKS:
SEAL
CHECK#O001
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
LAW OFFICES
Jonson
DUFFLE
501MARKETSTREET
PO BOX 109
LEMOYNE, PA
17045 0109
o~ ~ $ 00.370
0004368025 CCT20 2004
MAILED FROM ZiP CODE 1 70,~ 3
'04 L',fff 2t [-~'_3:5 i
REGISTER OF WILLS OFFICE
CUMBERLAND COUNTY COURTHOUSE
1COURTHOUSESQUARE
CARLISLE, PA17013-3387
E. ROBERT ELICKER, II
Attorney at Law
20 Stone Spring Lane
Camp Hill, PA 17011
717-240-6535
December 7, 2004
Heather J. Vance-Rittman
Deputy Attorney General
Charitable Trusts and Organizations Section
14th Floor, Strawberry Square
Harrisburg, PA 17102
RE: Estate of Edith M. Girardi, 1994-00900, Cumberland County,
Pennsylvania
Dear Ms. Vance-Rittman:
I am executor of the above referenced estate; the Will has been filed with the
Register of Wills of Cumberland County (a copy of which is enclosed) providing for
bequests to St. Joseph's Indian School and St. Labre Indian School. A copy of letters are
enclosed from the schools showing their addresses and the name of a contact person that I
can communicate to as I proceed with the settlement of the estate.
Letters testamentary were issued to me on December 7, 2004. My address is as
stated above in the letter-head. It is my understanding that upon completion of the final
account and schedule of distribution, a copy should be provided to your office.
Very truly yours,
Enclosure: Letters and Will
E. Robert Elicker, II
Attorney at Law
Name of Decedent:
Date of Death:
Will No.:
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Edith M. Girardi
November 19, 2004
1994-00900
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 December 7, 2004:
St. Joseph's Indian School, Chamberlain, SD 57326
Attention: Deacon David Nagel, SCJ
Director
St. Labre Indian School, Educational Association, P.O. Box 216, Ashland, MT 59003
Attention: James M. McDonald, CPA
Financial Director
Date Signature
E. Robert Elicker, II
Attorney at Law
20 Stone Spring Lane
Camp Hill, PA 17011
Telephone (717) 240-6535
Personal representative
REV. 1500 EX+ (".001
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
I
04
00900
___NUMBER
rgr- Original Return ---0 2. Supplemental Return
o 4. Limited Estate 0 4a. Future Interest Compromise (date of death after
12-12-82)
1:81 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust {Atlach
of Will) copy 01 Trust)
o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
i]!l!$!li__~III!IIIII_---"--
NAME I COMPLETE MAILING ADDRESS
EDMUND G. MYERS '
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG,PA 17121J.-0601
---- --
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
RICHEY, H. ROSS
~
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DATE OF DEATH (MM-DD~YEAR)
- - DATE OF--S[RTH (MM-i::ID-'lEAR)
21
COUNTY CODE YEAR_
---- -
SOCIAL SECURITY NUMBER
183-12-1798
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I
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o
REGISTER OF WILLS
- ----
SOCIAL SECURITY NUMBER
07/21/2004
04/2311925
--_.--
3. Remain-aer Return (date of death prior to 12-13-82)
5. Federal Estate Tax Return Required
8 Total Number of Safe Deposit Boxes
301 Market St.
Lemoyne, P A 17043-0109
(1) None
(2) None
(3) None
(4) None
(5) 40,552.53
.'
(6) 56,506.84
(7) None
(8)
(9) 11,793.72
(10) 852.85
"',
=
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CD
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'Y1
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL)
97,059.37
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FIRM NAME (II appiicable)
JOHNSON, DUFFIE, STEWART & WEIDNER
(11)
12,646.57
84,412.80
TELEPHONE NUMBER
7171761-4540
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(12)
(13)
13. Charitable-and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax(Line 12 minus Line 13)
(14)
84,412.80
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
16.Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .00
(15)
84,412.80 x ,045
(16)
3,798.58
x .12
(17)
x .15
(18)
(19)
3,798.58
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET MJDRESS
Bethany Village
325 Wesley Drive
CITY
Mechanicsburg
I STATE PA ZIP 17055
(1) 3,798.58
1,900.00
100.00
Total Credits (A + B + C) (2) 2,000.00
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If line 2 is greater than line 1 + Line 3, enter the difference. This is theOVERPA YMENT.
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 theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3) 0.00
(4) --'-
(5) 1,798.58
(5A)
(58) 1,798.58
Make Check Payable to: REGISTER OF WILLS, AGENT
iI..1I111!lIir
1. Did decedent make a transfer and:
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; 0[............ .................... ................ ................
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?.. ............... ................... ...............--
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?.... ............... ................
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
~ I
D ~
D ~
D ~
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 t-~t I have examin-;;d this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, co~rect
and complete. Declaration
preparer olher than the personal represent~~ive is_~ased o~ all inf_or~_~li(J:n_ of which_p~eparerhas any k_n_o~!e~ge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
BIUA~ R. RICHEY, EXEClITOR . 4-A- ~,\}r!I~t[~lr~~~lA 17036
S1GN~~ONe~~.~~G~RN'--- ADDRESSU-- . _m ---
~~~THAN REPRESENTATIVE AbbRESS
EDMUND G. MYERS
DATE
1/IY6C'
'+ DATE
I/O/oS
DATE
._~-"'--
301 Market St.
Lemoyne, PA 17043-0109
-
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. 99116 (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. 99116 (a) (1.1) (ii)l. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent. or a stepparent of the child is 0% [72 P.S. 99116 (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. 99116
1.2) [72 P.S. ~9116 (a) (1)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. 99116 (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.
,*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH 01= PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
L_
ESTATE OF
RICHEY, H. ROSS
I FILE NUMBER-
21 - 04 - 00900
Include the proceeds of litigation and the date the proceeds were received by the estatEAII property jointly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM
NUMBER
1 West Shore EMS/ALS - refund
DESCRIPTION
VALUE AT DATE OF
DEATH
--
508.32
2
Verizon - refund
11.99
3
Cash in decedent's possession
6.36
4
Bethany Village - refund unused prepaid days
1,696.25
5
GE Capital Assurance - Long Term Care Insurance - benefit check
2,000.00
6
GE Capital Assurance - refund of premium
130.62
7
Bethany Village - refund due to decedent's death occurring less than 5 years
after he purchased his living accommodations at Bethany.
36,191.00
8
Belco Community Credit Union - balance to close account
7.99
TOTAL (Also enter on Line 5, Recapitulation)
40,552.53
.'
SCHEDULE F
JOINTLY -OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
__R~_~!~ENTDE~_EqENT,~_.___,_ ___ ___ _ _________'_________.n_.._._._.
--.-_.-.__0--_-_- ____ _____ ___......__. _______ ...______._____ ____.__ ____
ESTATE OF
RICHEY, H. ROSS
FILE NUMBER
---'- ~~~04 ~ 00900
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 Bnan R. Richey
547 Lovell Court
Humme1stown, P A 17036
Sou
JOINTLY OWNED PROPERTY:
----r--- -OESCRIPTIONOF PROPERTY-----,-- . r--; O~r--DATE OF DEAT;-
ITEM IF5~TJJf~Ti ~~b~ IlnCIUde name of financial institution and bank account nUmber! ,DATE OF DEATH, DECO'S J VALUE OF
NUMBER , TE~:~T-rm:3~1::03 :~~:~~::n~i:::c;~::c::::t ::d~::;;~';:::;;a' ~ALU~0:,:;:;1NTERE~IDECEDENTS '::;E;;
A i 02/03/2003/ PNC Bank - Money Market Account No. 25,342.11/ 12,671.06
50-0378-3488 : I
102/03/2003 Beleo Community Credit Union 1,577.891 I',
Account No. 032750 - Sl Savings Ii
I ,
02/03/2003)' Beleo Community Credit Union 9,064.24,1'
, Account No. 032750 - S4 - Checking
~ 02/03/2003/ PNC Bank - Certificate of Deposit
I ' No. 31200239845 -Joint with son,
, i Brian R. Richey. (Proceeds from the sale of
I decedent's home in 2/2003 were deposited in PNC
Accl. No. 5003783488 - joint with son Brian as of
12/3/2003. Cash from this account was withdrawn to
purchase the $75,000.00 certificate on 4/23/2004 also I
I in joint names with his son.
(See copy ofPNC statement attached for period '
. 2/19/2003 to 3/19/2003). !
2
3
A
788.95
4
A
4,532.12
5
A
75,065.871
37,532.94
,
I
I
--~--
TOTAL (Also enter on line 6, Recapitulation)
56,506.84
Total Banking Statement
1r
For 24-hour customer service:
Call: 1-888-PNC-BANK
For the period 021'9/2003 to 031'9/2003
BRIAN R RICHEY
Primary account number: 50-0321-8243
Page 2 of 3
Account number:_ 50-0321-8243 ~_ continued
Activity Detail
Depositll and Other Additions
Date l; Amount Description
02/20 200.00 Deposit Reference No. 029452219
02/25 10,000.00 Branch Deposit Tel 04000047010018
03/06 10,000.00 Deposit Reference No. 024367514
03/19 1.44 Interest Payment
There were 4 Depos,its and Other Additions
totaling $20.20'.lJta.
Checks
Check Date Reference
number Amount paId number
1001 92.00 03/06 028444158
1002 345.87 02128 028433128
1003 45.00 03/II 02808287~
1005 * 31.51 03/06 024258612
1006 10.97 03/04 025468798
1007 34.23 03/06 028477989
1008 231.09 03/12 025190182
Check bate Reference
number Amount paid number
1009 T 200.00 03/06 024367543
1010 10,000.00 03/07 028691274
1012 * 1,206.23 05/18 024012907
1014 * 75.00 03/14 028888245
1015 14.36 03/17 025614911
1016 10.97 03/13 028651114
* Gap in check sequence
'T" Teller Cashed Check
There were 13 checks listed totaling
$12,297.23.
Daily Balance Detail
Date J! Balance
02/19 10.00
02/20 210.00
02/25 10,210.00
02/28 9,864.13
Date
03/04
03/06
03/07
03/II
Balance
9,853.16
19,495.42
9,495.42
9,450.42
Date
03/12
03/13
03/14
03/17
Balance
9,219.33
9,208.36
9,133.36
9,II9.00
Date
03/18
03/19
"
Balance
7,912.77
7,914.21
Are you taking advantage of all the benefits you get with your PNC Bank Premium Plan@?
As a Premium Plan customer, you can benefit from the most comprehensive set of account services and features PNC has to offer.
You can link all your accounts to your Premium Plan and receive one combined monthly statement; up to 3 free savings or money
market accounts plus one additional free checking account; Free Select Style Checks; a free Gold Check Card that give.s you free
ATM transactions, including no fee from PNC when you use another bank's ATM*; Free Travelers Checks for I, discount on
travelers checks for 2; Free Online Banking with Account Link@ by Web or Quicken@** Bill Payment; Free Stop Payment orders;
Safe Deposit Box Discount; and free and unlimited auto transfers to your savings or money market accounts to help you save.
Make sure you're not missing out on these great features. Stop by your local PNC branch office or call 1-888-PNC-BANK today to
sign up for any of the accounts and services you don't already have. Thank you for being a most valued customer.
"Other fmancia1 institutions and/or ATM operators may charge for using their ATMs.
"""Quicken is a registered trademark of lntuit@ Inc.
'i't
't,,('
Premium Plan
Performance Money Market Account Summary
Account number. 50..0378-3488 Account link@ number: 0183121798
H Ross Richey
Brian R Richey
Beginning
balance
340.40
DepOSits and
other additions
138,452.87
Checks and other
deductIons
10,200.00
Ending
balance
128,593.27
Please see the Activity Detail section for
additional information.
Balance Summary
Average monthly
balance
101,629.51
Charges
and fees
.00
Total Bariking Statement
'It
0. PNCBAN<
For 24-hollr customer service:
Call: 1-888-PNC-8ANK
ACColmt number: 50-0378-3488 - continued
For the period 02119/2003 to 03/19/2003
BRIAN R RICHEY
Primary account number. 50-0321-8243
Page 3 013
Transaction Summary
Checks paidl Bank card/paS Account Information Teller
withdrawals transactions assistance calls transactions
2 0 0 4
Total ATM PNC Bank MAC Other MAC A 1M other A TM
transactions ATM transactions transactions transactions
0 0 0 0
Interest Summary
Annual Percentage Number of days Average collected Interest Earned
Yield Earned (APYE) in interest period balance for APYE this period
0.85% 29 97,205.83 65.07
As of 03/19, a total at $85.07 in interest was
earned this year.
Activity Detail
Deposits and Other Additions
Date Amount Description
02/25 128,387.80 Deposit Reference No. 027445438
03/07 10,000.00 Deposit Reference No. 028691273
03/19 65.07 Interest Payment
There were 3 Deposits and Other Additions
lolaling $138.452.87.
There were 2 Other Deductions tQtaling
$10,200.00.
Other Deductions
Date
02/20
03/06
Amount
Description
Withdrawal Reference No, 029452220
Withdrawal Reference No. 024367515
200.00
10,000.00
Daily Balance Detail
Date Balance
02/]9 340AO
02/20 140AO
Date
02/25
03/06
Balance
]28,528.20
118,528.20
Date
03/07
03/19
Balance
128,528.20
128,593.27
FORM953R
Total Bllllking Statement
Pl"iC Bank .'
~PNCBAN<
--
---
Primary account number: 50-0321.8243
Page 1 013
Number of enclosures: 0
'--
For the period 02119/2003 to 03/19/2003
--/
tr For 24-hour customer service or
current rates: Call1-888-PNC-BANK
BRIAN R RICHEY
H ROSS RICHEY
325 WESLEY DR APT 129
MECHANICSBURG PA 17055-3500
Moving7 . Please contact us at 1-B88-PNC-BANK
I2!5J Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
Q Visit us at www.pncbank.com
II TOO terminal: 1-800-531-1848
For hearing impaired clients only
Relationship Overview
Bank Deposit Accounts
Description
Interest Checking
Perfonnance Money Market
Total Deposits
Account Number
Deposit Balance
7,914,21
128,593,27
136,507.48
5Q-0321-8243
5Q-0378-3488
Start saving today with a PNC Bank IRA
Now's the time to start saving for your future, Open or contribute to a PNC Bank Individual Retirement Account (IRA) today.
It's easy to get started and you still have until April 15th to make a contribution for tax-year 2002. Increased contribution limits
make it even easier to save for the future. So don't delay, contact a retirement specialist at 1-888-PNC-lRAS (1-888-762-4727) and
start saving today.
Brian R Richey
H Ross Richey
Premium Plan
Interest Checking Account Summary
Account number: 50-0321-8243 Account link@ number: 0165382480
Balance Summary
Please see the Activity Detail section for
additional information.
Beginning
balance
10,00
Deposits and
other additions
20,201.44
Checks and other
deduction!;>
12,297,23
Ending
balance
7,914.21
Average monthly
balance
Charges
and fees
7,881.17
,00
Transaction Summary
Checks paid!
withdrawals
13
Total ATM
transactions
o
Bank card/PaS Account Information Teller
transactions assistance calls transactions
0 0 4
PNC Bank MAC Other MAC ATM other ATM
A TM transactions transactJons transactions
0 0 0
Number of days Average collected Interest Earned
in interest period balance for APYE this period
29 7,88Ll7 1.44
As of 03/19, a total of $1.44,in interest was
earned this year.
Interest Summary
Annual Percentage
Yield Earned (APYE)
0.23%
FORM953R
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINlSTRAllVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 04 - 00900
RICHEY, H. ROSS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
AMOUNT
DESCRIPTION
FUNERAL EXPENSES:
Parthemore Funeral Home
2
Rolling Green Cemetery - interment charges
,
-,
Kmart - clothing items for funeral
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City
Year(s) Commission paid
Attorney's Fees Johnson, Duffie, Stewart & Weidner
Zip
State
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills - Cumberland County
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
Cumberland Law Journal - advertise letters
2
The Patriot-News - advertise letters
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
7,399.68
695.00
194.74
3,000.00
275.00
75.00
109.30
45.00
11,793.72
'*
Schedule H
Funeral Expenses &
MninislralNe Cos1s continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RICHEY, H. ROSS
,
"
Register of Wills - file Inventory and Inheritance Tax Return
4
PNC Bank - account service charges
FILE NUMBER
I 21-04-00900
Page 2 of Schedule H
25.00
20.00
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDE:CEDENT
ESTATE OF
RICHEY, H. ROSS
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Connor Rehab Associates
2
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE !
LIABILITIES, & LIENS
DESCRIPTION
3
East Pennsboro Ambulance Service
4
Alert Pharmacy
Verizon - final telephone charges - Bethany Village
5
Holy Spirit Hospital
6
Moffitt Heart and Vascular Associates
i FILE NUMBER-
21 - 04 - 00900
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
16.89
29.00
27.00
689.78
29.20
60.98
852.85
REV.1513 EX..- (9-f)D/
ESTATE OF
NUMBER
I.
'.
SCHEDULE J
BENEFICIARIES
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropri~te, on Rev 1500 cover sheJt
RICHEY, H. ROSS
! FILE NUMBER
21 - 04 - 00900
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
r&Not_Ust Truslee(sL
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Brian R. Richey
547 Lovell Court, Humrnelstown, PA 17036
Son
,-
AMOUNT OR SHARE
OF ESTATE
----- - -- -- -- --
T
I
I
I
I
I
I
I
I
I
I
I
I
One-third Residue
One-third Residue
in Trust.
One-third Residue
in Trust.
2
James Thomas Richey
3300 Uuion Deposit Rd
Apt. 205C Governor's Place
Harrisburg, P A 17109
Son
3
Daughter
Suzanne Fechter
3974 Brookridge Rd., Mechanicsburg, PA 17055
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
!
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
, Deceased
No. 21 - 04 - 00900
Date of Death 7/21/2004
Social Security No. 183-12-1798
Estate of RICHEY, H. ROSS
also known as
BRIAN R. RICHEY, EXECUTOR
---- ---
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the vaiuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made In this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
I.D. No.:
20558
Personal Representative
Signature: BRI~H~XtfUT~ 4<.C.
Signature:
Attorney:
EDMUND G. MYERS
Signature:
Address:
Address: 547 LOVELL COURT
HUMMELSTOWN, PA 17036
301 Market St.
Lemoyne, P A 17043-0109
Telephone: 717/761-4540
Telephone: (717) 566-6705
Dated: /1/7/2 tltJl)-
Personal Property
Lt..
o~
v
LJ.I -,
~}
~ Shore EMS/ALS - refund
508.32
.. .-.:
"'i ~_r:;-
V."Dzon - refund
,..--
c.'_ ,,-._,.-
~h in ~~<ilenf s possession
Cr- ,
11.99
I
6.36
i--,;
C,-
,_Lj.--
IlethaniiYiUage - refund unused prepaid days
:~ ~~~,~ ~ '-
~ Capit&>~urance - Long Term Care Insurance - benefit check
.'" '0-
1 ,696.25
2,000.00
GE Capital Assurance - refund of premium
130.62
Bethany Village - refund due to decedent's death occurring less than 5 years
after he purchased his living accommodations at Bethany.
36,191.00
Belco Community Credit Union - old account closed ~ balance
7.99
County of Cumberland - burial benefit
100.00
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$40,652.53
P.r"(ir-,...,...,,-,.,
~,Cj~):";..;::i_;'
SUBJECT:
Estate of H. Ross Richey
No. 21-04-00900
000: Jul 21, 2004
_1il0C I p.I 19 D" '). r'8
FRumuJ,Ji,(j f!iL'i
JOHNSON, DUFFIE, STEWART &. WEIDNER
1'1 ['C'!/ "'L-. t L
0...J ".....,,,,rneys a aw
\' C~.QT Box 109
Lemoyni!l; PA 17043
(717) 761-4540
Fax: 717 761-3015
DATE: January 18, 2005
TO Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Enclosed for filing in the above-captioned Estate are the following:
1. Original Inventory.
2. Original and copy of Inheritance Tax Return.
3. Check in the amount of $30.00, filing charges.
4. Check in the amount of $1,798.58, Inheritance Tax payment.
SIGNED: Edmund G. Myers
csh
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL 1 AXES
DEPT. 280601
HARRISBURG, PA 17128.0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MYERS EDMUND G
301 MARKET STREET
POBOX 109
lEMOYNE, PA 17043
nn__n lold
ESTATE INFORMATION: SSN, 183-12-1798
FILE NUMBER: 2104-0900
DECEDENT NAME: RICHEY H ROSS
DATE OF PAYMENT: 01/19/2005
POSTMARK DATE: 01/18/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/21/2004
NO. CD 004862
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,798.58
t
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 0015
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$1,798.58
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
.
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BUREAU OF INDIVlDUAI.!'(AXE$
INHERITANCE TAX DIVISION,,: '
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
'*
REV-1547 EX AFP (03-05)
12
I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-04-2005
RICHEY
07-21-2004
21 04-0900
CUMBERLAND
101
H
R
(Y:, ,',
EDMUND G-MVERS
JOHNSON ETAL
301 MARKET ST
LEMOYNE
Allount Rellitted
PA 17043
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1t!~-.t!~"Yf.m.m~'U!1.wtm.W.U~'ftlrr4M.'r.m.lmlmJMtr~.~tw~M:Y.OI'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RICHEY H R FILE NO. 21 04-0900 ACN 101 DATE 04-04-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
n)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
40.552.53
56.506.84
.00
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this for.. with your
tax payment.
97.059.37
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
(9)
nO)
11.793.72
852.85
nu
(2)
(3)
(4)
12.646 57
84.412.80
.00
84.412.80
(Schedule J)
I~ an assessment was issued previOUSly, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
lS. Allount of Line 14 at Spousal rate (lS)
16. ~ount of Line 14 taxable at Lineal/Class A rate (16)
17. AlIOunt of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
T X C S:
NOTE:
(9)=
.00
3.798.58
.00
.00
3.798.58
.00 X
84.412.80 X
.00 X
.00 X
00 =
045 =
12 =
15 =
DATE
10-20-2004
01-18-2005
NUtlBER
CD004526
" CD004862
+
INTEREST/PEN PAID (-)
100.00
.00
AI10UNT PAID
1.900.00
1.798.58
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
3.798.58
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE A 6.12 FORM
YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: H. ROSS RICHEY
Date of Death: JULY 21. 2004
Will No.: 21-04-00900
Admin No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No
2_ If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: .
3. If the answer to NO.1 is yes, state the following:
A. Did the personal representative file a final account with the Court?
Yes No ~
B. The separate Orphans' Court No. (if any) for the personal
representative's account is:.
Did the personal representative state an account informally to the
parties in interest? Yes ~ No
Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans'
Court and may be attached to this report_
~j;vr-
Edmund G_ Myers, Attorney
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O_ Box 109
Lemovne. PA 17043-0109
Address
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Telephone No_
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Personal Representative
~ Counsel for Personal Representative
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