HomeMy WebLinkAbout04-1143 CUMBERLAND
Register of Wills of / County, Pennsylvania
PETITION FOR GRANT OF LETTERS
also known as
, Deceased Social Security No. 179-18-3306
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut named in the Last Will of the
E~ Decedent, dated and codicil(s) dated
. ~,f the~cum*nts:¢ffered
J Name Relationship Residence m
~.O. Box 23
New~n K ~h~r~ SP~]~ N~w K~nas~own. PA 17072
' 9029 J6rdan ~oad
Lynn P. Deibert Daughter Fai~p]~y~ MD
(COMPLETE JN ALL CASES:) Attach additional sheets if necessary
Decedent was aomici)ed at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at~_._(}~.~g~Y- 23 25~.~idae_ B±11 Road. New K±nqstown, PA 17072
; ,,,.,.~ ......... ,.7.,,,,.~.,.~.,,,~ Silver Spring Township
Decedent, then 82 years of age, died October 27 , 200~, at Holy Spirit Hospital
Decedent at death owned property wi~h estimated values as follows:
(if domiciled in PA) All personal property ....................... $ 1 5 O , 0 O 0
(if not domiciled in PA) Personal property in pennsylvania ................... $
(If not domiciled in PA) Personal property in County ..................... $
Value o~ real estate in Pennsylvania ......................................... $
$ 150,000
Total ......................................................
Real Estate situated as follows:
Wherefore, Petitione¢(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
. Lynn P. Deibert
~ ~, 9029 Jordan Road. Fairplav, MD 21733
BOND
REGISTER OF WILLS OF Cumberland COUNTY
BOND AND SURETY FOR PERSONAL REPRESENTATIVE
KNOW ALL BY THESE PRESENTS, That Lynn P. Deibert
as principal(s) and
Pennsylvania National Insurance Company
as surety (sureties) are held and firmly bound unto the Commonwealth of Pennsylvania in the sum of
Three Hundred dollars ($ 300,00(~ to be paid to the Commonwealth, for which payment we
Thousand
do bind ourselves, jointly and severally, our heirs, executors, administrators and successors, the
condition of this obligation being that if Lynn P. Deibert
as (state fiduciary capacity) Administratrix
of the estate of Eleanor R. Deibert , deceased.
or any of them, shall well and truly administer the estate according to law, then this obligation shall
be void as to the personal representative or representatives who shall so administer the estate and his
or their surety or sureties; but otherwise it shall remain in full force.
Signed and sealed this 14th day of December ., 19 2006 , each
intending to be legally bound hereby. ,
t= _ - (Seal)
AdminXstratrix,//7/) ~ // -~-'~ ./ ~
?/~r/- ~i/ ~ttorney~
{ t~ 0~ ;-. (Seal)
~ (Seal)
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY
Harrisburg, Pennsylvania
POWER OF ATTORNEY
Know .4.11 Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY. a
corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
JEFFREY L. SCOTT, OF CARLISLE, PENNSYLVANIA (EACH)
its tree and lawful Attomey(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed:
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKiNG
EXCEEDS THE SUM OF SEVEN HUNDRED FIFTY THOUSAND DOLLARS ($750,000.00)
ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT NOTl(
AT MIDNIGHT OF THE 30TM DAY OF NOVEMBER 2009, AS RESPECTS EXECUTION SUBSEQUENT THERETO.
And the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to all
intents and purposes, as if they had been duly executed and ackamwledged by the regularly elected officers of the Company at its
office in Harrisburg Pennsylvania, in their own proper persons.
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on
October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and effe
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY iNSURANCE COMPANY has caused these
presents to be signed and its corporate seal to be affixed on NOVEMBER 15, 2004
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPAI'
Kenneth R. Shutts, Executive Vice-President, Secretary & General Cour el
Commonwealth of Pennsylvania, County of Dauphin - ss:
On NOVEMBER 15, 2004, before me appeared Kenneth R. ShuUs to me personally known, who being by me duly sworn, did say
that he resides in the Commonwealth of Pennsylvania, that he is Executive Vice-President, Secretary & General Counsel of
PENNSYLVANIA NATIONAL MUTUAL CASUALTY iNSURANCE COMPANY, That he is the individual described in and wl~
executed the preceding instrument, and that the seal aftLxed on said instrument is the corporate seal of said Company, and that said
instrument was signed and sealed on behalf of said Company by authority and direction of said Company, and the said oflice
ac ~knowledged said instrument to be the free act and deed of said Company.
Notary Public
Notarial Seal
Commonwealth of Pennsylvania, County of Dauphin ss: Jacquelinc A Ellis, Notary Public
City Of Harrisburg, Dauphin Comity
My Cornmission Expires Dec. 19, 2005
Member, Pennsylvania Association of Notaries
I, Michael F. Greet, Vice President, Surety & Fidelity of the PENNSYLVANIA NATIONAL MUTUAL CASUALTY iNSURANC[
COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certify that the above and foregoing is a ;uae ;arid cox~re~
copy of a Power of Attorney, executed by the said Company, which is still in full force and effect.
In Witness Whereof, I haYe hereunto set my hand and affi×ed the corpor3t~ea3 of~aid~Tfo~pany on D e c ernb~ r 1 4 th. 2 ¢, 4
78-190 (Rev 05/02)
Register of Wills of County, Pennsylvania
RENUNCIATION
, Deceased
(Relationship) (Capacity)
· e aJ:)ove Decedent, hereby renounce(s) ~e right t~ administer the estate and respectfully request(s) that
Letters be issued t~ ,~-~/0, ,") P
(Signature)
~-' "~ *-- J (Address)
:: ~ L~ ~..- ! (Signature)
eL- ~-~ ~ (Address)
(Signature)
Sworn to or affirmed and subscn'bed (Address)
before me ~is ~ L~-
· ' DE~.A A ~EUSR
~~~ ~ ~IN C~
~Ot~ Publ~ ~
~ ~mmission Expires:
~u~i~ ~ ~mi~ ~. ~ ~: Renunciations ex~ed o~side the ~ of R~ister
a~a~ ~ ~'s ~.} in ~me ~unties are requir~ ~ ~ ~ta~.
F~ ~W~
,.~ CERTIFICATE OF DEATH
~""' [NOE Ro :~"emaleI,. 179--18 -3306 ,.c.,/C~-ob~r2.?~oQ~.~
' / ~p Hill ~,y...~c~ ~s~>
P~i~i ~ 23 - 225 Ridge *ESiDENCE
~<s~ , 11/01/2004 z,~.Fr~ ~ch Pa. ' 17961
012015 - L
.................. ~ ~S oo ~ ~ [~ I~
Oath of Personal Representative
Commonwealth of Pennsylvania
County of
The Petitioner(s) above-named swear(s) and 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 Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
I
before me this I / __ day of , ~.,.,
DECREE OF REGISTER
also known as
Social Security No: i-~fl-I~'53~0j Dateof Death:
AND NOW, b~C~lT~ I~ 20 0~ ,in consideration of the Petition
on the reverse aide hereon, satisfactory proof h~ing been presented before me,
IT IS DECREED that Letters ~ Testamentary~ of Administration
in the abovo estate and that the instrument(s), i~ an~,
Oescribod in tho ~etition be admitted to Orobato and filod o~ record os the last Will of
FEES
Letters ........................... ~. 255. O0 dlf~L ~t'V~t~_~ ;~.~
Short Certificate(s) .......... $ G0,0[) ~
Renunciation .................. $ -~ ~ ~
Affidavit ( ) .................
Extra Pages ( ) ............
Codicil ..........................
JCP Fee ........................ ~ I~0 Attorney: Steven ~.
inventorN& Tax Forms... $ I.D. No: 25488
cth~..~.~-~''' ............... ~ IDOL) Address: 2080 ~nq~esto~n ~d.. Suite 201
~a~sbu~q, ~A 17110
TOTAL ................ ~ ~OL~U m~pho~: ~7~
DATE FILED:
~-Ta
._...Jco
LL1-:
~~~~
Cst)
0:
L' ,
,
-....
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Eleanor R. Deibert
Date of Death:
10-27-2004
Will No.
Admin. No. 2004-01143
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the foUowing on I-~-() S- at the below listed addresses:
Name
Address
Lynn P. Deibert. 9029 Jordan Road. Fairolav. MD 21733
Newton K. Deibert. P.O. Box 23. New Kingstown. PA 17072
Notice has now been give to aU persons entitled thereto under Rule 5.6(a) except: nla
Date: /-:)- 06-
;xft:AJ-t ~L!lAA",-L
Signat re /
Steven J. Schiffman. Esq.
Name
2080 Linglestown Rd., Suite 201
Harrisbur~. PA 17110
Address
(717) 540-9170
Telephone No.
Capacity: _ Personal Representative
In
C")
~
...x.- Counsel for Personal Rep.
Lo....
tD
I
"'.:-::Cl)
c'~z-
LLl <c __
--1:CL'"
uo....u,J
rr:SSi
--
~::::
J
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DEIBERT l YNN P
9029 JORDAN ROAD
FAIRPlAY, MD 21733
uuun fold
ESTATE INFORMATION: SSN: 179-18-3306
FILE NUMBER: 2104-1143
DECEDENT NAME: DEIBERT ELEANOR R
DATE OF PAYMENT: 01/20/2005
POSTMARK DATE: 01/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/27/2004
NO. CD 004866
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,600.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,600.00
REMARKS:
CHECK# 1257
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
.....
L..
#SfiUR)Q'
{ .~PQ' 2 '05 ..
\ r",l
\"
-'-~'
vz~~'=.
",?,'~-"'<O.&~
r'f.J~~~"tl.'i). 'i"3~lJl.t'kC:d' ~
~~ \ l Jt
==-.c;:;?-~L 1 "
~w..-?'\~ LQ Jt
~._-~. ..
... ".. " .... ~ ":' t R ..
'? It'F:i, :~~S91 ~ 1t
'"::"......,\eo~ '
FIRST CLA:SS MAIL
Sum 20\
2080 LINGLESTOWN ROAD
HA.RRISBURG, PA
1711 0-9670
............
Register of Wills
cumberland county courthouse
1 courthouse square
Carlisle, PA 17013
1111111l!I'!'IIIII'fll'f1I'III'lll'II'I.IJII"lltlll,uii
".-".-.. " ,', ...".-........ "
.. ,', .-......,-.... .,-........... .." .. .....
.. .... .........".. .... .', ,..... ,.,',,,.-
...~~
'..."',.._,).._,',._.'..._.;.).,c_,,<_,_..,"':"""'"""...,........ .... .. ',-: .....:.,.......'....:.,..'..:.:..:.....::",......:,.....
(,,;J
~
'-~'
:.:l~)
...."7
23
q~
~ ~ '-fJ
.'
,;:)
,,""
,,~
, ,
";T'I
LAW' OrrlCES
SERRATELLI
SCHIFFMAN
BROWN &
CALHOON, Pc.
L,)h:! K. ScRfV\lTiU
Slhf';).SU-JlFF\'\!\N
Mi(H.'\lL F. Bf\OVVN
Rl)~>\1 [) L. CALHOON
F. R. MARTSOLF
Sl'HxO T. LAPPAS
SThU-; O. SPAHR
]COH"-J D. SHERIDAN '"
DFllOlxAH L. PACKER
April 12,2005
Register of Wills
Cumberland County Courthouse
I Courthouse Square
Carlisle, P A 17013
Re: Estate of Eleanor R. Deibert
No. 2004-01143
'"I
Dear Sir/Madame:
Cc)
C\ii.\ A. BOYANOWSKI Enclosed for filing, please find the original and three copies of the
Inheritance Tax Return with regard to the above captioned matter. Also enclosed
C;'iiil; A. S"PHENSON is a check in the amount of$163.00 representing the additional tax owing.
1)1 ('lIl1h(.i
",I \ ,', I\( 1'.11' (),\1I1
",III,i! i',\ ,\ "i'
.'1\1
I;',,)
,)\".",
i'\
(1(,1\
;1
S 4 O. () 1 70
,Iii'";.j;il
Please time and date stamp the extra copies and return them to me in the
enclosed self-addressed stamped envelope.
Thank you, in advance, for your assistance in this matter.
Very truly yours,
SERRATELLI, SCHIFFMAN,
BROWN & CALHOON, P.e.
l~j ~~1t
Debra A. Evangelisti,
Paralegal
/dae
Enclosure
cc: Lynn P. Deibert, Administratrix
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,28Q601
HARRISBURG, PA 17128.0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SCHIFFMAN STEVEN J
2080 L1NGLESTOWN RD
SUITE 201
HARRISBURG, PA 17110-9483
__n____ fold
ESTATE INFORMATION: SSN: 179-18-3306
FILE NUMBER: 2104-1143
DECEDENT NAME: DEIBERT ELEANOR R
DATE OF PAYMENT: 04/13/2005
POSTMARK DATE: 04/12/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/27/2004
NO. CD 005198
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $163.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1310
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$163.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1500 EX ~-OO)
r\)APD
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
F1LErr _ () ~ LU:Ll_
COUNTY CODE
YEAR
NUMBER
I-
Z
W
C
w
U
w
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Deibert Eleanor
DA'IE OF DEATH (MM.OD- YEAR) DA'IE OF BIRTH {MM. DO-YEAR)
10/27/2004 12/3/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Newton K. Deibert
CXJ 1. Original Retum
D 4. Limited Estate
[] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
180-16-6032
R
SOCIAL SECURI1Y NUMBER
179-18-3306
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURI1Y NUMBER
w
...
::.:::!:<n
u"""
wo.u
",00
u"'-'
o.<n
0.
'"
D 2. SupplemenlalRetum 03. Remainder Retum (date of dealh prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
o 7. Decedent Maintained a Living Trust (Atlach copyofTrust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 0 11, Election to tax under Sec. 9113(A)(AuachSchOJ
>-
z
w
Cl
z
o
a.
'"
w
"
"
o
u
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Steven J. Schiffman, Es . 2080 Linglestown Road, Suite 201
FIRM NAME (If Applicable)
SERRATELLI, SCHIFFMAN, BROWN & CALHOON
TELEPHONE NUMBER
Harrisburg, PA 17110
717-540-9170
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly Owned Property (Schedule F) (6)
0 D Separate Billing Requested
i=
:5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
:J (Schedule G or L)
l-
e:: 8 Total Gross Assets (total lines 1-7)
<(
U
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
a::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
o
8,397
o
o
151,793
1,544
OFFICIAL USE Ofl!L Y
94,162
255,896
(8)
17 , 778
0
(11)
(12)
(13)
(14)
17,778
238,118
o
12. Net Value of Estate (Line 8 minus Line 11)
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)
238 , 118
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 173,836 L(15)
z rate, or transfers under Sec. 9116 (a){1.2) x .0
0
>= 16. Amount of Line 14 taxable at lineal rate 64,282 x .0 ~(16)
'"
...
::> 0
0. 17 Amount of Line 14 taxable at sibling rate x.12 (17)
"
0 0
u 18. Amount of Line 14 taxable at collateral rate x .15 (18)
X
'" T ax Due
... 19. (19)
o
2,893
o
o
2,893
20. [KJ
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W46451.000
o
Est,ate' of
Executors (Page 1)
179-18-3306
Name
Address
Tax ID
Lynn P. Deibert
9029 Jordan Road
Fairp1ay, MD 21733-
211-52-8191
Decedent's Complete Address:
STREET ADDRESS
P'.O. BOX 23
CUMBERLAND
CITY I STATE TZ'P
NEW KINGSTOWN PA 17072-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2.893
o
2.600
130
Total Credits (A + B + C) (2)
2.730
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
Total Interest/Penalty (D + E) (3)
o
4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
o
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
163
A. Enter the interest on the tax due.
(SA)
o
B. Enter the total of Line 5 + SA
(5B)
163
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 property transferred;. . . . . . . . . . . . . . . D
b. retain the right to designate who shall use the property transferred or its income; . []
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . []
d. receive the prom ise 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? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . , . . . . . . . , . . . . . . . . . . . . .. IX] 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,
Yes
No
[Jg
[Jg
[Jg
[Jg
[Jg
[Jg
L./'
DATE
ap;.-i 6, )...oDS
Fairp1ay, MD 21733
DAlf
'(-Y;-70V"-S-
2080 Li
For dales 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. '3 9916 (a) (1.1) (i)l.
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)]
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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. '3 9116(a)(1.2)].
The tax rale imposed on the net value of Iransfersto or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. '3 9116(1.2) f72 P.S. 99116(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. 9 9116(a)(1.3)], A sibling is defined, under Section 9102, as an
individual who has alleast one parent in common with the decedent, whether by blood or adoption.
3W46461.000
REV-1503EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 8
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Eleanor R. Deibert
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.16 Shares
General Motors Corporation
DESCRIPTION
VALUE AT DATE
OF DEATH
609
2 34 Shares
M & T Bank Corporation
3,436
3
200 Shares
Sovereign Bancorp, Inc.
4,352
TOTAL (Also enter on line 2, Recapitulation) $
8,397
3W46961.000
(If more space is needed, insert additional sheets of the same size)
REV-t508EX+ (?-98)
COMMONWE.A.L TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Eleanor R. Deibert
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be dIsclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
2000 Buick Century
(See Attached Appraisal)
6,225
2
PNC Bank Certificate of Deposit
54,529
3
PNC Bank Checking Account
#51-4024-0455
30,179
4
Waypoint Bank CD Account
#565291986
50,231
5
Waypoint Bank CD Account
#566235864
10,629
3W46AD1.000
TOTAL 'Also enter on line 5 Recanitulation' $
(If more space is needed, insert additional sheets of the same size)
151,793
-rfu=. YAlk f'Of/. G. ~= -BiJid( ~~I( GJd.
'f.r.'l.1 .QGl/LlIS5o.trnVI/<tl/llf. IY(k4ji'i
~. JlJ/;iJ. JlG,m6oo
Qg.~
SA1.c.s "Igi..
OSOLL lid '8~nSS::JINIIH::J3V>l
3>11d 31SI1~II::J L Sl9
)lOins OW9
OYIJ.NOd 1l39NISA31l~
::J'VllNOd
='II\IEl
xame
lc::t9-09S-001N 99J::l t1o.l
LoaL'S6L (HLl "";
9O~ lX3lZ1r9-99l (HL) eUOlId
'1,) N '1-\'\ il,) X;] _0 :li 11 V 11
19UO!ts9jOJd 6u!Swal ~ S1QlgS
'Hr AYHHnW " OHYHOIH
0.
REV-1509EX+(\>-98)
CDMMDN\lVEALlH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST ATE OF
Eleanor R. Deibert
SCHEDULE F
JOINTLY -OWNED PROPERTY
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
AOORESS
RELA TIQNSHIP TO DECEDENT
A.
Deibert, Lynn P
9029 Jordan Road, Fairplay, MD
21733
Daughter
B.
c.
JOINTLY-OWNED PROPERTY:
<EmR DATE CESCRJPTlON OF PROPERlY %Of DATE OF DEA lH
ITEM FOFlJQINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION A~ BMK ACCOLNT DATE OF DEATH DECD'S VALUE OF
N...M8EROR S1MILAA IDENTIFYING Jll.JMBER, ATTACH DEED FOR
NUMBER TENANT JOINT JOINfLY-I-ElDREALESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A.
1 A 12/30/1899 Contents of Jointly Held
Safe Deposit Box
(See Attached Inventory) 75 51. 0000 38
Tangible Personal Property
in Safe Deposit Box
consisted of:
1. 7 $2.00 Bills
2. $1.00 Canadian Coin
3. $1 Franc (1945)
4. $50 Cash
5. 1986 Statute of Liberty
Medallion
The contents did not
warrant the cost of an
appraisal and value has
been estimated at $75.00.
2 A 12/30/1899 Waypoint Bank CD Account
#56295705 3,011 50.0000 1,506
TOTAL (Also enter on tine 6, Recanilulatlon\ $ 1 544
3W46AE 1,000
(If more space is needed, insert additional sheets of the same size)
LA\~' OFI'ICES
SERRATELLI
SCHIFFMAN
BROWN &
CALHOON, P.c.
LORI K. SERRATELLI
STEVEN J. SCHIFFMAN
MICHAEL F. BROWN
RONALD L. CALHOON
F. R. MARTSOLF
SPERO T. LAPPAS
STEVEN O. SPAHR
JOHN D. SHERIDAN ·
DEBORAH L. PACKER
CARA A. BOYANOWSKI
GARTH A. STEPHENSON
Of Counsel
(MD & DC Bars Only)
* (:\dmitted PA & N))
SUITE 201
2080 l!NGLE5TOWN ROAD
Ht,RRISBURG, PA
17110-9670
(717) 540-9170
FAX 1717) 540-5481
Pennsylvania Department of Revenue
Harrisburg District Office
Attn: Beverly Reigle
Lobby, Strawberry Square
Harrisburg, PA 17128-0101
Re: Estate of Eleanor R. Deibert
Dear Ms. Reigle:
January 26,2005
Enclosed is the original safe deposit box inventory which was
conducted on January 25, 2005, with regard to the above captioned matter.
Thank you for your attention.
SJS/dae
Enclosure
cc: Lynn P. Deibert, Administrator
Very truly yours,
/
REV.48S EX+ (1.921
_"hlt,~
~W
SAFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 1712B.o601 Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
DECEDENT'S NA (LAST, FIRST, MIDDLE)
Deibert, Eleanor R.
ADDRESS OF DECEDENT (STREET) (CITY)
P.O. Box 23, Ridge Hill Road, New Kingstown
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
DATE OF DEATH
10/27/2004
(STATE)
PA
(ZIP CODE)
17072
Steven J. Schiffman, Esq.
(CITYj
2080 Linglestown Road, Suite 201, Harrisburg_
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
a. (NAME) (RELATIONSHIP) Co-Owner,
Lynn P. Deibert Administrator, Daughter
(STREET ADDRESS) (CITY) (STATE) (ZIP CODE)
9029 Jordan Road, Fairplay MD 21733
(RELATIONSHIP)
(STREET ADDRESS)
(STATE)
.PA
(ZIP CODE)
17110
b. (NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. (NAME)
(RELATIONSHIP)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(NAME)
M & T Bank
(STREET ADDRESS)
6560 Carlisle Pike, Suite #500,
. NAME OF PERSON MAKING LAST ENTRY
73
NAME AND ADDRESS OF PERSONtS) HAVING ACCESS TO BOX
a. (NAME)
. 2 m
TITLE UNDER WHICH BOX IS REGISTERED
Eleanor or L nn Deibert
JCITY} (STATE) (ZIP CODE)
Mechanicsburg, PA 17050
DATE AND TIME OF LAST ENTRY
Eleanor R. Deibert
(STREET ADDRESS)
P.O. Box 23
b. (NAME)
Lynn P. Deibert
(STREET ADDRESS)
9029 Jordan Road
(CITY)
(STATE)
(ZIP CODE) (CITY)
17072 Fairplay
(STATE)
(ZIPCODEI
21733
New Kingstown PA
NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
MD
N/A
WAS A WILL IN THE BOX? DYES }ONO If yes, a. Date of will:
b. Name and address of personal representative, if named in the will
(NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. Name and address of attorney, if any
(NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: list in detail every common or preferred certificate, warrant or other rights found in box. Stocks are
to be designated by name of company, certificate number, date of certificate, name in which stock is registered,
and number of shares and class of stock.
(3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered
and type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in
book, name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: list and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: list and describe as
fully as possible.
(B) All other contents.
Page 2
of 2
ITEM
NO.
I
L
ITEM DESCRIPTION
.-fjrC/Vl S' C/.u?>O ;
<3lU>1.< v
<J
9
[0
II
1'1..
(3
.'(
I)'
ou...II'CV
/tlci/ ~/ ~0~ Z'3rOII)-
bl?1' '7 ~G
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
THE BEST OF MY KNOWLEDGE AND BELIEF, SAFE DEPOSIT BOX INVENTORY,
SIGNATURE
PRINT NAME AND CHECK APPROPRIATE 80X 8ElOW:
PRINTTtTlE
Schiffman
CHECK PPROPRIATE 80X:
o Executor{trix) [XIAdministrotor{trix)
o Estate Representative C3cJoint owner of sofe deposit box
Attach additional 81/2" x 11 II sheet (s) if necessary or use duplicates of this page of form.
Attorney for Estate
NOTE:
REV-1510 EX + (6-9S)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eleanor R. Deibert
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTlON OF PROPER1Y
ITEM IN:LLDE Tl-EN'lMEOFTI-€ TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBEr:; n-E DATE OF TRMlSFER. ATTACHACOPV OF Tf-E DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF APPLlCABLEI VALUE
1. Waypoint Bank Checking Account
#100651934 88,211 100.0000 3,000 85,211
This account was transferred to
Husband within a year of the
date of death
2 Waypoint Bank Retirement CD
Account #586523661 6,532 100.0000 0 6,532
Beneficiary: Lynn P. Deibert
Relationship: Daughter
3 Waypoint Bank Savings Account
#100013418 2,419 100.0000 0 2,419
This account was transferred to
Husband within a year of the
date of death.
TOTAL (Also enter on line 7, Recapitulation) $ 94 162
(If more space is needed, insert additional sheets of the same size)
3W46AF1.000
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
Eleanor R. Deibert
Debts of decedent must be reported on Schedule I.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hamilton Funeral Home, Inc. 8,494
2 Headstone 3,253
Total from continuation schedules . . . . 505
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 3,500
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 295
5. Accountant's Fees 262
6. Tax Return Preparer's Fees
7.
1 Carlisle Insurance Services
(Sure ty Bond) 1,110
2 Commonwealth of Pennsylvania
(Vehicle Registration Fee) 29
Total from continuation schedules . . . . . 330
TOTAL (Also enter on line 9, Recapitulation) $ 17.77B
JW46AG1.000
(If more space is needed, insert additional sheets of the same size)
Estate of: Eleanor R. Deibert
179-18-3306
Schedule H Part 1 (Page 2)
Item
No.
Description
Amount
3
Orwigsburg Inn
Funeral Luncheon
505
Total (Carry forward to main schedule)
505
Estate of: Eleanor R. Deibert
179-18-3306
Schedule H Part 7 (Page 2)
3
Cumberland Law Journal
75
4
Deed Transfer Fees
77
5
Equiserve & Seaboard Surety
Company
(Stock Certificate Replacement
Fees)
71
6
Lynn Deibert
(Administratrix Expenses)
39
7
The sentinel
68
Total (Carry forward to main schedule)
330
REV.1513 EX. (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERlTANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eleanor R Deibert
NUMBER
I
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DJSTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Lynn P. Deibert
9029 Jordan Road
Fairp1ay, MD 21733
General Bequests: 8,076
50% Residue: 56,206
2 Newton K. Deibert
P.O. Box 23
New Kingstown, PA 17072
General Bequests: 117,630
50% Residue: 56,206
RELATIONSHIP TO DECEDENT
00 Not List Trustee(s)
Daughter
Surviving Spouse
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
64,282
173,836
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
3W46AI 1 000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(Jf more space IS needed, Insert additional sheets of the same size)
$
D
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
pC!'I1Dnr::n rn)!'!: 0C NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL .trMU!SJ '-", ,'.' - > APPRAISEHENT ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION ,~:~.'-',~,~ -. - _-" " OF DEDUCTIONs AND ASSESSHENT OF TAX
PO BOX 280601 to-'_ ,~
HARRISBURG PA 17128-0601
07-25-2005
DEIBERT
10-27-2004
21 04-1143
CUMBERLAND
101
APPEAL DATE: 09-23-2005
(See reverse side under Objections)
Amount Remitted I I
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 _
REY:is4:;-EX-AFP-io3:0S')-NOTicE-OF-iNHERiTANCE-TAX-APPRAiSEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ELEANOR R FILE NO. 21 04-1143 ACN 101
2r~5 Jl",'L 2:: pr~ 2: 28
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
C~~::!< Cy~
rV:l::'- ,'"'
,
STEVEN J (SCHIFFMAN ESQ
SERRATELLI ETAL
2080 LINGLESTOWN
HBG
RD20
PA 17110
ESTATE OF
DEIBERT
*'
REV-lS47 EX AFP (06-05)
ELEANOR
R
TAX RETURN NAS: I X) ACCEPTED AS FILED
DATE 07-25-2005
) CHANGED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fune~al Expenses/Ad.. Costs/Hisc. Expenses (Schedule Hl
10. Debts/Korte-88 Llabilities/Liens lSch8dule Il
11. Total DadueUons
12. N.t V.lus of Tax Return
13. Chari'tab18/80ver.,.lInt.l Bequests; Non-elected 9113 Trusts (Sch8dul. .J)
14. Net Value of Estate Subject to Tax
I~ an assess_ent was issued previously, lines 14, 15 and/or 16, 17, 18 and
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. A.ount of Una 14 at Spousal rat. (15)
16. Amount of Line 14 taxable at Lineal/Class A rat. (16)
17. AlIOUI1i of' Line 14 at Sibling rat. (17)
18. Amount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
D S:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.1 Est.t. (Schedule A)
2. stocks and Bonds (Schedule BJ
3. Closely Held Stock/Partnership Interest (Schedule C)
4. HortgageslNotas Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Parsonal Property (Sc~dul. E)
6. Jointly Owned Property ISchedul. F)
7. Transfers (Schedul. G)
8. Total Assats
(9)
(10)
NOTE:
.
DATE
01-20-2005
04-12-2005
07-18-2005
IlIlHBER
CD004866
CD005198
REFUND
INTEREST/PEN PAID 1-)
136.84
.00
.00
(1)
12)
(3)
(4)
IS)
(6)
(7)
.00
8.397.00
.00
.00
151. 793.00
1.544.00
94,162.00
(8)
17,778.00
.00
Ill)
(12)
(13)
(14)
173,836.00 X
64,282.00 X
.00 X
.00 X
AI1lIWIT PAID
2,600.00
163.00
6.84-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DIIE IS LESS THAN $1, NO PAYIlENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.)
00 =
045 =
12 =
15 =
(19)=
NOTE: To insure proPer
creel! t to your lICcount I
sub.it the upper portion
of this for. with your
tax P8yaent.
255,896.00
17.77R nn
238,118.00
.00
238,118.00
19 will
.00
2,893.00
.00
.00
2,893.00
2,893.00
.00
.00
.00
s:,""'!.'cry::r''l r\c::('c no:
BUREAU OF INDIVIDUAL :'TA'lIl!S"occJ '0 ''',-'~ "
INHERITANCE "TAX DIVISION .. -,,-'-- ,-,
PO BOX 280601 ')
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1607 EX AFP (05-05)
2005 r,UG ! 2 PH I: 10
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-01-2005
DEIBERT
10-27-2004
21 04-1143
CUMBERLAND
101
Anount R_HtllCl
ELEANOR
R
GE;'\.
OFF--':" (--"-::,.,':-::T
STEVEN J (SCHIFFMAN ESQ ':',
SERRATELLI ETAL
2080 LINGLESTOWN RD20
HBG PA 17110
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account~ sub.it the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
... RETAIN LOWER PORTION FOR YOUR RECORDS
.....
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF DEIBERT ELEANOR R FILE NO. 21 04-1143 ACN 101 DATE 08-01-2005
THIS STATEHENT IS PROVIOEO TO ADVISE OF THE CURRENT STATUS OF THE STATEO ACH IN THE NAHEO ESTATE. SHOWN BELOW
IS A SunKARY OF THE PRINCIPAL TAX OUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 07-18-2005
PRINCIPAL TAX DUE, 2,893.00
PAYMENTS (TAX CREDITS),
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-20-2005 CD004866 136.84 2,600.00
04-12-2005 '" CD005198 .00 163.00
07-18-2005 REFUND .00 6.84-
TOTAL TAX CREDIT 2,893.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAlO AFTER THIS OATE, SEE REVERSE TOTAL DUE .00
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~
YDU HAY BE DUE A REFUND. SEE REVERSE SmE OF THIS FORN FOR INSTRUCTIONS. )
0"::>""-
Ll\w OFFIC[S
SERRATELLI
SCHIFFMAN
BROWN &
CALHOON, :P.C.
LI ),,1 K, 5FRRATELli
S i !\if." j, SCHiFFMAN
i'v1\UI,\f-1 F, BROVVN
October 17,2005
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013
F, R, MAlnSOLF
RI )'J\! D L. CA,LHOON Re: Estate of Eleanor R. Deibert
No. 2004-01143
SPERl) T. LAr'PAS
Sr!\,!, O. SPAHR
10"", D. SHERIDAN *
DfRORM-j L. PACKER
Dear SirlMadame:
Enclosed for filing, please find the original and three copies of a
Supplemental Inheritance Tax Return with regard to the above captioned
matter. Also enclosed is a check for $15.00 representing the filing fee and a
check in the amount of$258.00 representing the additional tax owing.
(,\R:\ i\. BOYM"OWSKi Please time and date stamp the extra copies of the document and ret
them to me in the enclosed self-addressed stamped envelope.
CAR 111 A. S TEf'HENSO'"
II ( IJlIINI Thank you, in advance, for your assistance in this matter.
i)( ()III\
\1 i'lli!i(\(1 1)\ ,\ "\J
1:11
\\', 1\, i-Ii
i I
1),\
I! ,1_lill )
-~!7) 540-9170
it (l- ). \!) ~
Very truly yours,
SERRATELLI, SCHIFFMAN
BROWN & CALHOON, P.c.
~jr k!
Debra A. EVange~
Paralegal
/dae
Enclosure
cc: Lynn Deibert
REV-15OC:'EX (6-00)..
OFFICIAl USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
-.lL
COUNTY CODE
-94-
YEAR
I-
Z
W
o
W
U
w
o
DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
Deibert Eleanor
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
R
SOCIAL SECURITY NUMBER
179-18-3306
THIS RETURN MUST BE FILED IN DUPLICA E WITH THE
10/27/2004 12/3/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
Newton K. Deibert
o 1. Original Return
o 4. Limited Estate
06
REGISTER OF WIL S
SOCIAL SECURITY NUMBER
180-16-6032
uu
I--
~~CI)
uO::~
uu c..u
:J:OO
uO::...J
c..CO
c..
<(
[X] 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Requ red
o 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit oxes
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-9S) 0 11. Election to tax under Sec. 91 3(A) (Allach Sch 0)
Decedent Died Testate (Attach copy of 'Mil)
o 9. Litigation Proceeds Received
I-
Z
w
o
z
o
c..
Ul
w
0::
0::
o
U
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Steven J. Schiffman, Es
FIRM NAME (If Applicable)
SERRATELLI, SCHIFFMAN, BROWN & CALHOON
TELEPHONE NUMBER
2080 Ling1estown Road, Suite 201
Harrisburg, PA 17110
717-540-9170
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation. Partnership or Sole-Proprietorship (3)
4, Mortgages & Notes Receivable (Schedule D) (4)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly O\M1ed Property (Schedule F) (6)
0 o Separate Billing Requested
i=
<:
-l 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
:J (Schedule G or L)
!=
n. 8. Total Gross Assets (total Lines 1-7)
<:
U
w 9, Funeral Expenses & Administrative Costs (Schedule H) (9)
a:::
10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
OFFICIAl USE ON
.~,"}
")
5 742
15
5 727
0
5 727
0
258
~
I 0
I ~
I
<<
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
z rate. or transfers under Sec. 9116 (a)(1.2)
o
~ 16. Amount of Line 14 taxable at lineal rate
I--
::J
~ 17. Amount of Line 14 taxable at sibling rate
o
u 18. Amount of Line 14 taxable at collateral rate
X
~ 19. Tax Due
X.a ~(15)
X.a ~(16)
x .12 (17)
x .15 (18)
(19)
20.
[K]
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH
3W4645 1.000
Decedent's Complete Address:
S EET A~DRESS
P.O. BOX 23
CUMBERLAND
CllY
NEW KINGSTOWN
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
PA
ZIP
170 2-
(1 )
258
o
o
o
Total Credits (A + B + C) (2)
o
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
TotallnterestlPenalty (0 + E) (3)
o
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
o
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
258
A. Enter the interest on the tax due.
(5A)
o
(5B)
258
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;. . . . . . . . . . . . . . . D []I
b. retain the right to designate who shall use the property transferred or its income; . D []I
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D []I
d. receive the promise for life of either payments, bene!lts or care? . . . . . . . . . D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . " D []j
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D []I
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [X] D
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE
SIGNATURE 0
~Cl
ADDRESS
Fairp1ay, MD 21733
Harrisburg, PA 17110
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 I 3%
[72 P.S. 99916 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfer:
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory require
the surviving spouse Is the only beneficiary.
(j'(lG.-pD
Sj.~\
2P.S.!j9116(a (1.1) (ii)]
rn are still applica Ie even if
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 a!
or a stepparent of the child is 0% [72 P.S. 139116(a)(1.2)].
,/ parent. an adoptive parent.
I
5(1.2) [72 P.S. S ?116(a)(1)].
, under Section 91102, as an
I
I
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal bene~
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 1:
individual who has at least one parent in common with the decedent, whether by blood or adoptl
3W4646 1.000
REV-151\J EX + (6-~8)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eleanor R. Deibert
ITEM
NUMBEF
1.
3W46AF 1.000
FILE NUMBER
21 04 1143
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHE T is yes.
DESCRIPTION OF PROPERTY
IN:LLDE H-E f\W.;lE OF Tft: TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND
Tf-E DATE OFTRNSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
% OF DECO'S
INTEREST
Sovereign Bank (previously
Waypoint) IRA Account
#0578113938
Beneficiary: Lynn P. Deibert
Relationship: Daughter
5,742 100.0000
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
EXCLUSION
IIF AFPUCABLE)
TA>iABLE
VI LUE
o
5,742
5.742
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eleanor R. Deibert
FILE NUMBER
21 04 1143
Debts of decedent must be reported on Schedule I.
ITEM NT
NUMBER DESCRIPTION AMOU
A. FUNERAL EXPENSES:
1.
I
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
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
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7.
1 Register of Wills
(Filing Fee for Supplemental
Inheritance Tax Return) 15
TOTAL (Also enter on line 9, Recapitulation) $ 15
(If more space is needed, insert additional sheets of the same size)
3W46AG 1.000
4,
REV-15,13 EX+ L9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eleanor R Deibert
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Lynn P. Deibert
9029 Jordan Road
Fairplay, MD 21733
1
General Bequests: 5,727
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
II
FILE NUMBER
21 04 1143
AMOUNT ~R SHARE
OFE$TATE
5,727
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 C( VER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46A/l.000
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space IS needed, Insert additional sheets of the same size)
$
o
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT.280601
HARRISBURG, PA 17128-0601
REV-1162 X(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD OO~903
A
ACN
SSESSMENT AMOU~ T
CONTROL
NUMBER
--------
101 I $258.( 0
I
I
I
I
I
I
I
I
AID: $258.( 0
GLENDA FARNER STRASBAL GH
REGISTER OF WILLS
SCHIFFMAN STEVEN J
2080 L1NGLESTOWN RD
SUITE 201
HARRISBURG, PA 17110-9483
__nun fold
ESTATE INFORMATION: SSN: 179-18-3306
FILE NUMBER: 2104-1143
DECEDENT NAME: DEIBERT ELEANOR R
DATE OF PAYMENT: 10/18/2005
POSTMARK DATE: 10/17/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/27/2004
TOTAL AMOUNT P
REMARKS:
CHECK# 319
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
~
~ \1\11: i ;
Ill..."...
;>1)'":::
\ '\~~" ~ ,. If ~ ., ~.. :
~\:'~0;--;:~- ~ '7 ?
~J:;~: r.."~_ t..
._-i
-
.-
ca
:E
(/)
U)
as
-
o
....
en
...
.-
u.
<:
:." .,.,
.~
~>
',.l._
/..---.
./ ",
1;J.:r If". \
;.,. co '.
';j.J
'~~ :: eLl
\?~ ~-s i
.y /
r{
,-."t..
oa..,
....
'. 1
~ 0
c:i r--
'" ~
~ 6
on
02 -
'" r--
-<
;I:
Q)
Ul
::l
o
.c
.j.J
~
::l
o
UQ)r"l
~~
Ul:><cdo
r-i.j.J::ll-
r-i ~ O'~
..-i ::l tJ)
8: 0
UQ)JCt
lH Ul 04
o ro ::l
~ 0 ..
~cd.cQ)
Q)r-l.j.Jr-l
.j.J ~ l-l Ul
Ul Q) ::l ..-i
..-i ..0 0 r-i
troEUl-l
Q)::l ctl
P:::U~U
,.
'~
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006113
SCHIFFMAN STEVEN J
2080 L1NGLESTOWN RD
SUITE 201
HARRISBURG, PA 17110-9483
______n fold
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
$2.90
ESTATE INFORMATION: SSN: 179-18-3306
FILE NUMBER: 2104-1143
DECEDENT NAME: DEIBERT ELEANOR R
DATE OF PAYMENT: 12/15/2005
POSTMARK DATE: 12/14/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/27/2004
TOTAL AMOUNT PAID:
$2.90
REMARKS:
SERRA TELL! ET AL
CHECK# 039885
SEAL
INITIALS: RSK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
w
Ux
< Z<c
.... ::~
Z gll..
<ILl X....lO
>;:) <C<C~
-IZ ~ ~ z
~g! W Q W
ZILI Ua::~
ffilll: ~013
a.LL t:4WCIl
a::UCIl
LLO W Z <C
01- ~::Q
I-IQZ
::cZ.;J <C
~~ ~!Q.
<III: LiI:."o
ILl c:c C"U- I:!
311. ~~ U
ZILI O~6
OA ~CIlW
::E '1-1 Q
~ :1l1..
(.) . to
'"Ie
CIl
W
x
<C
~
....Iz
<Co
;:)>-<
QlIl
1-1>-<
>i::
I-Ic
Q)(
Zc
t-I~.....c
00.
LI.~:;gt!l
oz""",
CN::::J
~t::4x~
~ffi~~
lII::", '"
::)zcc
m....c.:r:
.
~
Ll1
o
I
'"
o
~
0.
~
C
)(
lIJ
....
...
Ll1
...
I
>
lIJ
'"
...
o
'"
o
I
""
N
...
....
...
Dl::
Dl::
o
Z
<t
LLJ
...I
LLJ
Lt'l
C
C
~~I
NLLJ
.....l:Q
I 1-1 I
NLLJ
.....~
.....
N
::c\
I-
;:j1Ll
LLAIQ
OLL~
1LI0Z>
I- I-
ILI~~~~Z
1-(1)<....0(.)
~ILIALL(.)<
C)
f--
cc
-"-
(':1-
(~5(.
(.:
:< C/: "
8::i>,
~~::'
'-..J cC
C,..
c5
lr)
,--)
;,_~ .1
c.:;
-.0 ______
C'""
c==
N.~
I '"
c,,~
.....~
IQ
Na..
c<ll
~
==
.. ;:
1LI{j
.....1- "..
c< '""
.....A <ll
~
~ ~
ILl a..
a. <ll
a. <ll
<~
"--
.....
0' C
V'IN
LLJLLJ~<t
ZI-Dl::l1.
<tV'l
~ Z
LL...I3
LL<tO
1-11-1-
:Z::LLJV'I
U LLJ
V'I~~
"'...IZ
LLJI-I
ZI-...I
LLJ<t
> Dl:: Ceo C.!l
LLJDl::
I-LLJCl:Q
V'IV'1N:Z::
o
l-
I-
Z
ILl
::E
>
<
a.
I-
....
::E
ILl
III:
A
Z
<
ILl
-I
IQ
'tJ<
Ql >
+'<
+'11.
"rI
E ~
Ql (.)
III: ILl
::c
+'(.)
r:
::::J ILl
o ~
E <
<z:
C
.....
.....
.....
.....
1-1'0')
Dl:: .....
V'I;:)C
...10.....
...IU.....
1-1
38<t
LL l1.
O~
Z
Dl::<tLLJ
LLJ...I...I
1-Dl::V'1
V'ILLJI-I
1-Il:Q...I
C.!l~Dl::
LLJ;:)<t
Dl::UU
LLJ
V'I
;:)
o
:z::
I
I
I
I
1
1
1
I
I
I
I
I
I
I
I
!:
I
I
(1)1
AI
11I:1
01
(.)1
ILl I
11I:1
I
11I:1
;:)1
Oi
>
III:
o
LL
Z
o
....
I-
III:
o
a.
III:
ILl
3
o
-I
Z
....i
<I
1-1
ILl I
11I:1
I
I
t:
I
I
I
I
I
I
ILl I
ZI
....1
-II
I
(1)1
....1
::CI
1-1
1
01
ZI
0,
-II
<I
I
1-1
;:)1
(.)1
f.Jt:,
..-->..
~,
i;'" ..
l~: -:E
.i+' ....'.,
<1: t~\
,a._:1-~ ~
.....,
,.,..:.,;~
~,
",)r~\
lit: I' '.. \) $... ".'1>' ":
Ill: j~. /
. . ....,.=~';(.....e""
-r1
lio!..
;.....
FA!
,d
f1]
1J~
J-.
~~
>;"
tL
-~~
hb
:J
dJ
'r.
~
Ct
ct:
~
I
WI
Q
':-~
1"4
f,)
UJ
o
T
M
- U
- :i z ~ ~
...I <: Z
- \.IJ ::is z
~ .,. ~ ~
.,. 'wi
- ~
~ :2 'wi
c::: ~ =
~ \.IJ W ~ ...I
en en <:
-.: U
....I
Q)
en
~
o
.r:.
t
~ Q)
o ....
()~
>- 0" C0
C(/).,...-
~Q)O
enOenl'-
=()~.,...-
S-o~<{
-CtQ..
OCU~ ~
.... -.:: 0 Q)
2Q)oU;
en .D ._
.- E Q)-'::
Ol~CCU
&000
'[\',J \...i \'t..i'
'..' 0'" c:: ",'"
, I;\, J --;;'rJ-O
. ,J() '; ICl:J
, \ JjG ~~.~
"-=,\ \
).J
-\\
~: ..
...-
.....-
--
.-
CI
ft)
(,)
(I)
:'1..
f:)
.r.f
."\
I...
r...
.,..1
BUREAU OF INDIVIDUA(~AXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENTJ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-1547 EX AFP (06-05)
12-12-2005
DEIBERT
10-27-2004
21 04-1143
CUMBERLAND
101
APPEAL DATE: 02-10-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEJ PA 17013
9Yr_~~9~9_r~!~_~!~~-_____~___~~!~!~_~9~~~_~9~!!9~_~9~_Y9~~_~~~9~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ELEANOR R FILE NO. 21 04-1143 ACN 101
'1(:
LL
J 6 PICl "). ~o'
I Ii,,' v'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ELEANOR
R
f"i ~'-..
\.....L~,
OW::-:_!,i"';\;':'~: -"\(--i; '1)1
~~~~;~E~!e~~=[M~1~~~tf
2080 LINGLESTOWN RD
HBG PA 17110
ESTATE OF
DEIBERT
TAX RETURN WAS: (X) ACCEPTED AS FILED
DATE 12-12-2005
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
I. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
) CHANGED
NO. 01
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
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
.00
.00
.00
.00
.00
.00
5J742.00
(8)
NOTE: To insure proper
credit to your accountJ
submit the upper portion
of this form with your
tax payment.
5J742.00
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 ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
15.00
.00
(1)
(2)
(3)
(4)
15 on
5J727.00
.00
243J845.00
,.-.. , n~. -. . I+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
01-20-2005 ~ CD004866 136.84 2J600.00
04-12-2005 CD005198 .00 163.00
07-18-2005 REFUND .00 6.84-
10-17-2005 ........ CD005903 .00 258.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-18-2005 TOTAL TAX CREDIT 3J151.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.90
TOTAL DUE 2.90
173J836.00 X 00 = .00
70J009.00 X 045 = 3.151.00
.00 X 12 = .00
.00 X 15 = .00
(9)= 3J151.00
· IF PAID AFTER DATE INDICATEDJ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $lJ NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)J YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
~
-
L A \V () F FIe E S
SERRATELLI
SCHIFFMAN
BRC)WN &
CALH()()N, F!C.
Bi':i
"':l \i iF:
_ F't\:.'r<tR
'\<()\V\~,!
March 7, 2006
Register of Wills
Cunlberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Eleanor R. Deibert
Date of Death: October 27,2004
File NU111ber: 2004-01143
Dear Sir/Madame:
Enclosed for filing, please find the original and one copy of the final
Status Report with regard to the above captioned matter.
Please time and date stamp the additional copy and retunl it to me in the
STi;;H;',!SOi'~ enclosed envelope.
!'-
Thank you for your assistance in this matter.
Very truly yours,
SERRATELLI, SCHIFFMAN,
BROWN & CALHOON, P.C.
#kI1 - iJ:~71",'l
. {..- V .I
, j .' /r- ~(: ./ /
Debra A. Evangel ti,
Paralegal
/dae
Enclosure
I
0;)
cc: Lynn P. Deibert
\:)
1',.)
",.)
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ELEANOR R. DEIBERT
Date of Death: 10-27-2004
Will No. Admin. No. 2004-01143
Pursuant to Rule 6.12 of the Supren1e 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 adn1inistration 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 COlui? Yes_ NO-K-
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in interest?
Yes...K No_
d. Copies of receipts, releases, joinders and approvals of formal or informal accoun!cS',may
be filed with the Clerk of the Orphans' Court and e a ed to this report. ':~V:~
Dated: ;j - 7.. Of;;>
STEVEN J. SCI-IIFFMAN. ESQ.
\
C)
r;~
fo",)
2080 Linglestown Road, Suite 201
Harrisburg. P A 1 7110
Address
(717) 540-9170
Telephone Nun1ber
Capacity: _ Personal Representative
--K.. Counsel for Personal Representative
Representative
~~