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Home My WebLink About04-0989 PETITION FOR PROBATE and GRANT OF LETTERS Estateof JACK V. KAUFMAN No. also known as To: Register of Wills for the Social Security No. ~ 74-208631 , Deceased. County of CUMBERLAND in the The petition of the undersigned respectfully represents that: Commonwealth of Pennsylvania Your petitioner(s), who is/are 18 years of age or older and the execut or named in the last will of the above decedent, dated Februa~/ 67 2002 and codicil(s) dated N.__ONE Decedent was domiciled at death in CUMBERLAND h Is last family or principal residence at County, Pennsylvania, with Mechanlcsbu Penns Ivanla17050 29 Rid ewe Drive $#ver $ tin Towns~hl (list street, number and municipalfiy) / / Decedent, then 77 yearsofage, died ~ - - ~ ~[/q/~o~,s/ at 29 Rid ewe Drive MechaniC, sbu - ~l-1~e-r~S~ i~n Townsh~-PA 170~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing arid was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 12 '100.O0 (If not domiciled in Pa.) Personal property in Pennsylvania $ a an (ff not domiciled in Pa.) Personal property in County . --- h(alue of real estate in Pennsylvania $ O~-an situated as follows: ~ $ 0.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) · ~ ,/~//9~/,~ 29 RIDGEWAY DRIVE ~ DEAN~. KAUI~MAI~ MECHANICSBURG PA t 7050 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA t ss COUNTY OF ~:U~aERLAnD The petitioner(s) above-named swear(s) or afl'u-re(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of thc above decedent petitioner(s) will well and truly administer the estate according to law. sworn to or a r e, and s,thscribed { before me this ~.?- day of ' ~' Q~=Register ~ No. =~z-o~-q~q Estate of JaCK v. nauPMan , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ ~\t'so-e v~--~,~ I ~,cyo q , ~ co~idemfion of ~e petition on · e revere side hereof, safisfacto~ proof M~g be~ presented before me, IT IS DEC~ED ~t ~e ~t(s) &ted ~1002 d~cfibed ~ere~ be a~ed to probate ~d filed ofreeo~ as ~e l~t ~ll of 4~ V. ~g~ ~d ~Re~ ~i~iAMENT~Y ' he.by ~ted to .. Rqist~r of Wi~r(.~. ,_~",- (J- FEES MURREL R. WALTERS III Probate, Letters, Etc ......... $ ~ .2484e Short Certificates ( ). ...... $ ~,OC~ ATTORNEy (Sup. Ct. I.D. No.) l~qo~ ~ ~. ~.. $ ,.~ M EA8T MAIN STREET · "~ P $ lO. o~ MECHANICSBUIIG PA 17055 TOTAL. $ ~ ^DD~SS Fi]ed.. )~7 .I: ~ o.o.~ 7t7-697-4650 PHONE m5~2 REV W88 WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR c~--/-(~1~__ (2~ {FEE FOR THIS TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. CERTiFiCATE $200) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CE . T 5707378 aoo4 Name of Decedent Jack V. Kaufman Sex_ Male Social Security No. _ 17,~-2(]-R631 Date of Death 8-19-2004 Date of Birth R~D~-. 1c~ lq~ Bidhplace_ f.emoy~e, ~A Place of Death Re~id~ncR Pnmh~tl R~ l~r~ ~ n~ Tv'p. Pennsylvania Race White Occupation Engineer PRR Armed Forces? (Yes or No) Decedent's Marital Status Mar~ ~d Mailing Address 29 Ridgeway Drive Mechanicsburg PA 170,5~ Info,ant Deanna M. Kaufman Funeral Director James F. Nickel Name and Address of Funeral Establishment Nickel Funeral Home, Loysville, PA 17047 Pa8 h Immediate Cause Inte~al Between Onset and Death (a) Coronary Artery Disease 15 Yrs. (c) , Pa~ I1: Other ~nifica~Condi~M-~ Ty~e -2 Dia~tes Mellitus, Hypertension, ASVD Manner of Death ~ Describe how injuW occurred: Natural ~.: Horde Accident ~ ;~. Pe~g In~ ation Suicide ~ Could not ~etermined Name and Title of Ce~ier Joseph A. Cincotta M.D. (M.D.. D.C., Coroner, M.E.) Address 2140 Fisher Rd., Me~hani~sbu~q: PA 17~5 This 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. August 20, 2004 101 Barnett St.. New Bloomf~]d. PA 17068 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, JACK V. KAUFMAN, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills a.nd Codicils previously made by me. I declare that I am married to DEANNA M. KAUFMAN, and that I have four (4) children, MICHAEL J. KAUFMAN, KATHLEEN A. CLIFFORD, TIMOTHY L. KAUFMAN, and MARK E. KAUFMAN. I direct that ail my just debts and funerai expenses shail be paid from my residuary estate as soon as practicable after my decease. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shail be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath ail my property, whether reai or personai, wherever situate, including any property over which ! may have a power of appointment to my wife, DEANNA, provided that she survives me by thirty {30) days. V If my wife, DEANNA, shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether reai or personal wherever situate, including any property over which I may have a power of appointment, to my children, MICHAEL, KATHLEEN, TIMOTI-i~,;hnd~MARK equal shares, per capita. VI I nominate, constitute and appoint my wife, DEANNA M. KAUFMAN, Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my son, TIMOTHY L. KAUFMAN, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, JACK V. KAUFMAN, have set my hand to this LAST WILL this /, ~ day of ~C'-e-~r~t~t~ ,2002. , Signed, sealed, published and declared by the above-named JACK V. KAUFMAN, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, ha.~/he~eunto subscribed our names as witnesses. ~~~, 2 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : I, JACK V. KAUFMAN, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. Swom or affmmed to and acknowledged before me by JACK V. KAUFMAN, Testator, this ~t. day of f--eJ~r~ ~ ,2002. Notary Public Notarial Seal Diane M. Smith Notary Public [ Mechanicsburg Bore. Cumberland ~My Commission Exti res JL tie 22, 2004 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLanD the witnesses whose names are si~;ned to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL, that JACK V. KAUFMAN signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our k~o)~,igdge, the Testator was at the time 18 years of age or more, ,cf sound mind a_p~[.z/nder no constraint or undue influence. Sworn or affirmed to and acknowledged before me this (~/~ day of ,L-~.~r~ ,2002. Notary ~blic I REV 500 COMMONWEALT. OFJ INHERITANCE TAX RETURN OF ,C,ALUSEO.L PENNSYLVANIA I ~" DEPARTMENT OF REVENUE DEPT· 280601 FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21-0 4 0 9 8 , COUNTY CODE YEAR NUt, fBER~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I-' SOCIAL SECURITY NUMBER Z KAUFMAN, JACK V. W DATE OF DEATH (MM-DD-Year) I 7 4 -- 2 0 -- 8 6 3 1 ~ DATE OF BIRTH (MM-DD-Year) UJ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 0 08/19/2004 09/19/t926 REGISTER OF WILLS t't (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DEANNA M. KAUFMAN "' IX--] 1. Odginal Retum ~- ['--] 2. Supplemental Retum -< ~ ['"'] 3. Remainder Return (date of death p~or to 12-1382) ~ "' ~' I-"-~ 4. Limited Estate "o r'"] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required ~.0o o ~ m IX---'] 6. Decedent Died Testate (Attach copy of wilo ["-] 7. Decedent Maintained a Living Trust (Attach copy of Trust) __ 8. Total Number of Safe Deposit Boxes < [""-] 9. Litigation Proceeds Received E:] 10. Spousal Poverty Credit (date ofdeaa ~t~een 12-31-91 and 1-1-95) E~ 11. Election to tax under Sec. 9113(A)(Attach Cch O) I.- z NAME LU ,-, COMPLETE MAILING ADDRESS z MURREL R. WALTERS III ESQ. 0 ~. FIRM NAME (If Applicable) ,,' 54 EAST MAIN STREET o TELEPHONE NUMBER -- 717/697-4650 MECHANICSBURG PA 17055 1, Real Estate (Schedule A) (1) i OFFICIAl- uSE ONLY 2. Stocks and Bonds (Schedule B) (2) 12;n_~$.90 i ,---' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) ! .... 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) i Z __.O 6. Jointly Owned Property (Schedule F) (6) i" <[ E~] Separate Billing Requested , , ::) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ! I'- (Schedule G or L) i 8. Total Gross Assets (total Lines 1-7) (8) 12,083,9n 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 319.0n 1.0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 319.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 11,764.90 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 0.0~ 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 11,764.9~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. ortransfersunderSec. 9116(a)(1.2) 11,764.90 X 0 (15) 0.00 16.. Amount of Line 14 taxable at lineal rate X ... (16) 17. Amount of Line 14 taxable at sibling rate X .12 (17) 18. Amount of Line14 taxable at collateral rata X .15 (18) ~. 19. Tax Due (19) 20 ~ Deceden{'s Complete Address: STREET ADDRESS. 29 RIDGEWAY DRIVE CiTY MECHANICSBURG I STATE PA I Z~P t 7050 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) 2. Credits/Payments (1) A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable Total Credits ( A + B + C ) (2) 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 I 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. E,nter the interest on the tax due. (5A) o.on B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) O.OO Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................[] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefic ary des (~nat on? 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 dectare that I have examined this return, including accompanying schedules and statements, and to the pest of my knowledge and belief, it is true, correct and complete. Declaration of prepa,er other than the personal representative is based on ail information of which preparer has any knowledge. SIGNATURE! OF PERSON RESPONSIBLE FOR FILING RETURN ~' DATE DATE ADDRESS MURREL R. ~ ~ ~ ~' ( 54 EAST MAIN STREET, MECNANICSBURG PA 17055 For dates of death on or after July 1, 1994 and before January 1 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. ' For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute ~.:loes 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P.S. §9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX'+ (6-98) MONW~L'r, o. PENNSYLVANIA I STOCK-~ & BONDS INHERITANCE TAX RETURN ESTATE OF FILE NUMBER KAUFMAN, ,)A(~K V. 21 ~)4 All property jointly.owned with right of sur~ivorehip must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1, MANULIFE FINANCIAL OF DEATH 298 SHARES COMMON STOCK @ $40.55 12,083.90 TOTAL (Also enter on line 2, Recapitulation) $ 12,083.90 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) SCHEDULE H OMMONWEALTH OF PENNSYLVANIA I FUNERAL EXPENSES & INHREER~TANCE TAX RETURN FILE NUMBER KAUFMAN, JACK V. ~1 04 0~)89 Debts of decedent must be reported on Schedule I. ITEM NUMBFR DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Pemonal Representative (s) DEANNA M. KAUFMAN RENOUNCED Sodal Secudty Number(s)/EIN Number of Personal Representative(s) Street Address 29 RIDGEWAY DRIVE City ,MECHANICSBURG State PA Zip 17050 Year(s) Commission Paid: 2. Attomey Fees MURREL R. WALTERS III ESQ 250.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ... Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS CUMBERLAND COUNTY 69.00 5. Accountants Fees 6. Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) $ 319.00 (If more space is needed, insert additional sheets of the same size) RE.V-1513 EX -. (9-qm CO~MONW~L'rH OF r~ENNSY,V^N;^ I BENEFICIARIES ~ BENEFICIARIES ESTATE OFFILE NUMBER 1 4 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY . Do Not List Trustee(s) OF ESTATE [. TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transfers under ""-----'"'-- Sec. 9116 (a)(1.2)] 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. DEANNA M. KAUFMAN 29 RIDGL=WAY DRIVE MECHANICSBURG. PA 17050 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, JACK V. KAUFMAN, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and ail Wills and Codicils previously made by me. I I declare that I am married to DEANNA M. KAUFMAN, and that I have four (4) children, MICHAEL J. KAUFMAN, KATHLEEN A. CLIFFORD, TIMOTHY L. ,KAUFMAN, and MARK E. KAUFMAN. II I direct that all my just debts and funerai expenses shail be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shail be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my wife, DEANNA, provided that she survives me by thirty (30) days. V If my wife, DEANNA, shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether reai or personai, wherever situate, including any property over which I may have a power of appointment, to my children, MICHAEL, KATHLEEN, TIMOTHY,:'. and MARK, in equal shares, per capita. VI I nominate, constitute and appoint my wife, DEANNA M. KAUFMAN, Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my son, TIMOTHY L. KAUFMAN, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, JACK V. KAUFMAN, have set my hand to this LAST WILL this (o ~ day of ~'~.~ 7'/x-e~ ,2002. ~JACKtV. KAUFMAN/ .:--,./ .... _.~ .. Signed, sealed, published and declared by the above-named JACK V. KAUFMAN, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have,, hereunto subscribed our names as witnesses. ~ / ~/~ ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND · I, JACK V. KAUFMAN, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for' the purposes therein expressed. JAC[,~V. KAUFMAI~ .... .'":' *' ''~ .... '" Sworn or affirmed to and acknowledged before me by JACK V. KAUFMAN, Testator, this 6Y¢, day of ~t'-~.ff2/~ac.A ~ , 2002. Not~ ~blic Notarial Seal Diane M. Smilh, Notary Public ~ Mechanicsbur~ aoro, Cumbel and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL, that JACK V. KAUFMAN signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our k4-!oycl'adge, the Testator was at the time 18 years of age or more,f)f sound mind a~fl~der no constraint or undue influence. /' ; / Sworn or affirmed to and acknowledged before me this d, Cr- day of ~'-¢_~r-az~40 ,2002. Notary Public COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXIjl!r:'~,,::rIT: (';:f:ei- n;: NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION ' l~\..":.J, 1:..1._...1:', ,'.A.ff~ISEI1ENT J ALLOWANCE OR DISALLOWANCE PO BOX Z8D60l ,.- : ',_. '-,'-':i Of; DEDUCTIONS AND ASSESSHENT OF TAX HARRISBURG PA 17128-0601" ,.' - ,-- ,. - 2005 JAM 10M" 9: l,9 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 KAUFMAN 08-19-2004 21 04-0989 CUMBERLAND 101 Allount Rellitted CLER:\ OF _SlRPH.AJ'-J'S COURT MURREL R WAL Tet<Jj!A~\t;!!,~('n . ['II 54 E MAIN ST MECHANICSBURG PA 17055 *' REV-1547EK lFP <12-D4) JACK v 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 ~ iiEV:iS4"nic--AFP--Ciii":oiY-Noi'"iCE--OF-i:'NHEififANCE-YAX-iippRAiSEiiENt~--Ai:i."owAircE-oii------------ - - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KAUFMAN JACK V FILE NO. 21 04-0989 ACN 101 DATE 01-10-2005 TAX RETURN WAS, I X I ACCEPTED AS FILED I 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 OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets III 121 131 141 151 161 (7) .00 12.083.90 .00 .00 .00 .00 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. 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 (Schedule J) 14. Net Value of Estate Subject to Tax 191 1101 319.00 .00 1111 1121 1131 1141 NOTE: I~ an assessment was issued previOUSly, lines re~lect ~igures that include the total of ALL ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal rate (IS) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS. NOTE: To insure proper credit to your account} submit the upper portion of this form with your tax payment. 12,083.90 319 00 11,764.90 .00 11,764.90 14, lS and/or 16, 17, 18 and 19 will returns assessed to date. 11,764.90 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = 1191= .00 .00 .00 .00 .00 . .. '" AMOUNT PAID DATE NUHBER INTEREST/PEN PAID I-I TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 <J1. IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I 5/\ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JACK V. KAUFMAN Date of Death: 8/19/04 Will No. 2004-00989 Admin. No. 21-04-0989 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 4, 2005 Name Address Date: February 4, 2005 170$0/ /~ / 'pt: NONE Deanna M. Kaufman 29 Ridgeway Drive, Mechanicsburg, P A Notice has now been given to all persons entitled thereto Murre! R. Walters, III, Esq 54 East Main Street Mechanicsburg, PAl 7055 (717) 697-4650 Capacity: _ Personal Representative _X_ Counsel for personal representative t'_ '- \,.0 (',~) r~", Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/01/2005 WALTERS MURREL RIll 54 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of KAUFMAN JACK V File Number: 2004-00989 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 I, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 02/11/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~=~21 Clerk of the Orphans' Court cc: File Personal Representative(s) Judge Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/01/2005 KAUFMAN DEANNA M 29 RIDGEWAY DRIVE MECHANICSBURG, PA 17050 RE: Estate of KAUFMAN JACK V File Number: 2004-00989 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 02/11/2005 Your prompt attention to this matter will be appreciated. Thank You. ;;:;;:~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge 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 Name of Decedent: Date of Death: Estate No.: STATUS REPORT UNDER RULE 6.12 JACK V. KAUFFMAN AUGUST 19, 2004 21-04-0989 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: yes__X____ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete ( date) 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_X____ B. C. in interest: D. Date: March 30, 2006 ,- :.., t) . ~ ; ~ The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties Yes__X No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the9rphans' Court and may be attached to this report. . If Ifill Jl l~ - MURREL R. W ALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 Capacity: Personal Representative _X_ Counsel for Personal Representative g