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HomeMy WebLinkAbout04-1172 PETITION FOR PROBATE and GRANT OF LETTERS Estate of ' ~t.4t~ I~ ~~ No. To': also known as , Deceased. Social Security No. o~ 0 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or olde/an the execut in the last will of the above decedent, dated and codicil(s) dated Register of Wills for the, I County of ~ in the Commonwealth of Pennsylvania O /~-, named ,19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~ ~L~nty, Pennsylvania, with h ~.ast fa~mily or principal resigLence at ~ , PI~ lTotqO ~ ' (list street, number and muncipality) Decend~t, then ,~'~t years of age, died 19 ~Ooq 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 and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ / l.t ~ 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 $. situated as follows: WHEREFORE, petitioner(s) respectfully re.~.e~t.(_s!._th~__robate of the last will and codicil(s) presented herewith and the grant of letters ~~ ~ theron. (testamentary; a~ministration c.t.a.; adminlstratioff"tltl~na.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ,COUNTY OF (-~ r,&:~ it, ~ . The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affkated and subscribed baq~Ore me this [r~ day of ~ . Estate df . !) ~ ~ ~ ~, ~ ~ ~~ , Deceased DECREE OF FROBATE AND G~NT O~ LET~RS the reverse side hereof, satisfactou proof having been oresented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of and Letters '-~rs~yr,, ,._~ o-_'~,6 are hereby granted to [...),3~, ~ ..~, , ~ FEES Probate, Letters, Etc .......... $_~2~212~__ Shor~ Certificates( ) · ' ...... $~ $ jo, o...~ TOTAL . $~OCI 'O1~ ~ed . .~.&: .o?al.: .~....(~..4. .............. ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE 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 photostat or photograph. Fee for this certificate, $2.00 ~~,,...__. strJ P 10503471 No. Date 64- CERTIFICATE OF DEATH ~ ~ (Coroner) 89 Fogelsanger 2. Female 20~-20-1276 14 December 10, 2004 'cc 19,1914 ~or~Matilda '~,~[2 £~,,,[] ~[2 ~[2 ~"" Cumberland 60 Bear Hollow Rd. PA 17240 Hopewell Elsie Swartz 60 Bear Hollow Road Bessie Althea Moore White 2004 Shippensburg Cumberland 3:00 December'lO, 2004 , P~resumed Natural Causes December 10, 2004 Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 ~echantcsburg, Pa. 17050 LAST WILL A~I) TESTAMENT I, Lillian B. Fogelsanger, of Hopewell Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. IT~ I: I direct that all my just debts and funeral expenses, including my grav~rker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITU II: I give, devise and bequeath all of my estate of every nature and wheresoever situate to Faith Tabernacle Church, of Fort Street, Shippensburg, Pennsylvania. ITU III: I appoint William D. Fogelsanger executor of this my Last Will and Testament. Should he fail to qualify or cease to act as executor, I appoint Andrew F. Fogelsanger, Jr. executor of this my Last ~, and ~ Testament. ~%~ ~ cm --o r~ iw i d rect that my executors or their successors no e required to glve bond for the faithful perforraance of their .~s in_~ny-',i,~ / IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on / sheets of paper, dated this ~ day of April, 1989. The preceding instrument, consisting of this and one other typewritten page, each identified by the signature of the testatrix, Lillian B. Fogelsanger, was on the day and date thereof signed, published and declared by Lillian B. Fogelsanger, the testatrix herein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. COF~ONWEALTH OF PENNSYLVANIA: : COUNTY OF (J3~ERLA~D : SS We, Lillian B. Fogelsanger, John McCrea III and Paula M. Haller, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another person to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witnesses and that to the best of our knowledge, the testatrix was at that time eighteen years or older, of sound mind and under no constraint Or undue influence. an B. Fogels~g~/ ~/--' Subscribed, sworn to and acknowledged, by Lillian B. Fogelsanger, the testatrix and sworn to before me by John McCrea III andjPaula M. Haller, witnesses, this ___~__day of April, 1989. No[~ Public ~ SALLY J WINOER. NOTARY PUBLIC S,,, NSSU,G TWP.. CUMS , O CERTIFICATION OF NOTICE UNDER RULE 5.6tal Name of Decedent: Lillian B Foaelsanaer Date of Death: 12/10/2004 Will No. Admin. No. 21-04-1172 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 3/25/2005 Name Add ress Faith Tabernacle Church c/o Pastor Lon Feaser 1410 Good Hope Road Mechanicsbura PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions r-'"", ~ ,...,."/:ft' /" ....""." .' ,',',J ",,;'" ~.,A,. '. < .", .-""....-:"..."i,~ . ""---'- ~ ~,. ..... ." " ", () Signatur~ L '.0' --' Date: 3/25/2005 Name: Joel R. Zullinaer Address: 14 North Main Street Suite 200 Chambersbura PA 17201 Telephone(264) - 6029 ( , Capacity: x Personal Representative Counsel for Personal Representative g Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 03/17/2005 FOGELSANGER WILLIAM D 10398 OTTERBEIN SCHOOL RD NEWBURG, PA 17240 RE: Estate of FOGEL SANGER LILLIAN B File Number: 2004-01172 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.6 (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 is due by: 04/01/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~~ Clerk of the Orphans' Court cc: File Counsel Judge REV.1500 EX + {6-00)-,\ '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C w (.) w c W I- ~$(/) ull::~ w@jU J: II::g U !tal <{ DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF BIRTH (MM-DD-Year) II OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 1 1 7 2 ------1---- COUNTY CODE YEAR . NUMBER SOCIAL SECURITY NUMBER 2 09- 2 0 - 1 276 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER F WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (ate of death prior to 12-13-82) o 5. Federal Estate Tax Rjtum Required Q.... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under! Sec. 9113(A) (AttachSch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE REeTED TO: NAME COMPLETE MAILING ADDRESS Joel R. Zullin er 14 North Main Street, Suite 200 FIRM NAME (If Applicable) Zullin er Davis P.C. TELEPHONE NUMBER 717 264-6029 Chambersbur A 17201 z o ~ < l- => a.. :i o (.) >< < I- 12/10/2004 12/19/1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [X) 1. Original Return o 4. Limited Estate [X) 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrus!) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W C Z o Q. (/) W II:: II:: o U z o ~ < ..J => l- ii: < (.) w 0::: 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 (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 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) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) 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) X _(15) X _(16) X .12 (17) X .15 (18) 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 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ., 1 .~.,.., r:::; .- .-1-- It ".1 i'~ I t., t:: t? .r',,:-- ~ I I i I I I 11 ,698.86 --) I - , \1 11 ,698.86 '-:-") , -.n _ ~l:) C) r-n .' (-::-) -T1 (8) 7,888.50 (11) (12) (13) 7,888.50 3,810.36 3,810.36 (14) 0.00 (19) Decedent;s Com lete Address: STR ET ADDRESS 60 Bear Hollow Road CITY Newburg STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF WILLS, AGENT ZIP 17240 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 c. retain a reversionary interest; or ...................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ......... .................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....... ............. ........... ......... ..................................... .................. ........ 0 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS I i ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF HE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. I Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN A/~~ I). 7f~ ADDRESS 10348 Otterbein Sch I Road Newburq F PREPARER OT DATE 9- v-~~'- I i i 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 Sllrvivinn Ie","" 'M ;~ ')01 [72 P.S. S9116 (a) (1.1) (i)]. II 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 sun {\:) 'Pt P .D The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of asse the surviving spouse is the only beneficiary. ~ For dates of death on or after July 1, 2000: The las "'e Imposed '" Ihe 0" "',, of traosfern from a deceased child _',-one ,earn of age or ,ou09er at dealh 10 or I :5 " or a stepparent of the child is 0% [72 P.S. s9116(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 n (1 )]. I 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. s9116(a)(1.3)]. n "'UlII'\J':l uerrnea, uMer SeCtion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. :ii)]. fen if lrent, REV-1508 EX + \6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FogelsanQer. Lillian B. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 1172 ITEM lVALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Account #6100799034, Citizens Bank 11,698.86 TOTAL (Also enter on line 5, Recapitulation) $ 11 698.86 (If more space is needed, insert additional sheets of the same size) REV-1511 EX .. (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 'I FILE NUMBER ESTATE OF Fogelsanger Lillian B. Debts of decedent must be reported on Schedule I. 21 04 117~ ITEM I NUMBER DESCRIPTION ! AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger-Bricker Funeral Home, funeral services 6,739.50 2. Grave opening 133.00 3. Shull-Koontz, cemetery marker 682.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) 0.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Joel R. Zullinger 250.00 3. Family Exemption: (If decedent's address is not the same as clairnanfs, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills - JCP fee 10.00; letters 50.00; extra pages 3.00; 84.00 shorts 6.00; filing return 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. : TOTAL (Also enter on line 9, Recapitulation) $ 7 888.50 (If more space is needed. insert additional sheets of the same size) "v~":"". "_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ) I SCHEDULE J BENEFICIARIES FILE NUMBER Foaelsanaer l illian B. 21 04 1172 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright 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 C :)VER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Faith Tabernacle Church, C/o Pastor Lon Feaser, 1410 Good Hope Road, 3,810.36 Mechanicsburg, PA TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 3810.36 (If more space is needed, insert additional sheets of the same size) I' : J LAST WILL AND TESTAMENT I, Lillian B. Fogelsanger, of Hopewell Township, Cumberland County, Pennsylvania, declare this to be my Last will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, ~ncluding I my gravemarker and all expenses of my last illness, shall be paid f~om my I residuary estate as soon as practicable after my decease as a part olf the administration of my estate. ITEM II: I give, devise and bequeath all of my estate of every ~ature and wheresoever situate to Faith Tabernacle Church, of Fort Street, Shipfensburg, I Pennsylvania. i ITEM III: I appoint William D. Fogelsanger executor of this my ~ast will and Testament. Should he fail to qualify or cease to act as executo~, I i appoint Andrew F. Fogelsanger, Jr. executor of this my Last ~b and i ~ ::0 ;00:::0 I 0 fg f!j Testament. t,;g (") I,.., ~? <.;3 ",;2 ,.r>r- !n '.,,;:>::U ',,,2fT] iF',) '-( Cl ITEM IV: I direct that my executors or their successors .!S~g no~e S tB required to give bond for the faithful performance of their ~~;;J in~ny ~ ~ :;:;; ~ r- n, jurisdiction. ,~. t C/) ~ , IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last will and Testament, written on I sheets of paper, dated this (if.( day of Apri 1, 1989. '~/J~~'i rl;t . ~. ,11-11. ~EAL) Llllian B. Fogelsan I I The preceding instrument, consisting of this and one other typewr~tten page, each identified by the signature of the testatrix, Lillian B. ! Fogelsanger, was on the day and date thereof signed, published and dectared by Lillian B. Fogelsanger, the testatrix herein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in th~ presence of each other, have subscribed our names as witnesses hereto. I I \ I i I O~ A ,p~/V-, / lA. { Jil ~ j /(LU}O,- /l(. CV,>1 ~ '-- I; v (ij \! Ii Ii ! CLt2{/l residing at hlA"'-J.& ~, (i \! . / \ ! fr, i fl;(} , ;I i~ I H' I / I' ~ j .......-..... /,...J "".....J__, ....<J ......./ '-",....'""--,1 {. , U fA residing at 111 f'1 If- II ; ~ ~, ' COMMONWR~TH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND We, Lillian B. Fogel sanger , John McCrea III and Paula M. Hallerl, the testatrix and the witnesses, respe~tively, whose names are signed tol the attached or foregoing instrument, being first duly sworn, do hereby reclare to the undersigned authority that the testatrix signed and executed the~ instrument as her Last will and Testament and that she signed willin ly (or willingly directed another person to sign for her), and that she exe uted it as her free and voluntary act for the purposes therein expressed, an that each of the witnesses, in the presence and hearing of the testatrix" signed the will as witnesses and that to the best of our knowledge, the testatrix was at that time eighteen years or older, of sound mind and under no constraint or undue influence. r.&}~r? '~~C7~ tITrt-~n B. Fogels ng - ~_ M c Cua;-r~ jJad~ It(. ~~ Subscribed, sworn to and acknowledged, by Lillian B. Fogelsanger, the testatrix and sworn to before ffi: by John McCrea III an;c.paula M. Haller, witnesses, this day of April, 1989. '//1; Not'1 ' [~lf.V ~~"sEi~~:"'=' . SALLY J. WINDER. NOTi'.RV PUBLIC ~ J.~ oc:! =-;1""'" n;) "V.~::~( f, J~-! ('r;if<:'TV ..... Sr.l~ ....~~5,.hH\;j . N.. "' C. lh"'ItJ. ?,,;.."ftl,..... <:J,'~;I":j. .,..r.! r:.1Y CDM;iH5SiO~'l E'~P~P.ES ,!~pr::L 15 1'92f: ~ :; .~oII"'..~~:-::r-.'"~~,;:z;:::'Z\"~::;g~~~ MAY-23-2005 16:30 CITIZENS ~-I< . .~ CITIZENS BANK .:112 56656113 6100799034 LILT IAN B h'1>r.!:;,J <::! ""l\.Tr"'n . '--"-"~~'''Y-<ID''"'.f.--'-'--''-'''__'~~'_''''''~__=--_____.m____ .a. '-J...."......~~_~J. "i V J.;."-'. _ .! ~ f / ~ :.;,~ f"! .'''-:'IN i' .iH;.-~,_.o-:" ;:;;."": P. /03 -~~_. 1'~- 11-21-2005 FOGEL SANGER 12-10-2004 21 04-1172 CUMBERLAND 101 APPEAL DATE: 01-20-2006 ( See reverse side under Objections) Amount Remittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ,.. r\~ (,~(\r\-- ~)\ ....r.. I \\ f ,\).... ,'" ,..../"'\rrt'<\.--.) \~_'..\ . l '. BUREAU OF INDIVIDUASJ\~~~S"_-:-\ INHERITANCE TAX DIVISION \ PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE l~'\" ", to NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE .' r;... \\lif DEDUCTIONS AND ASSESSMENT OF TAX ('.'. _J \ .' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN r: JOEL R ZULLINGER ZULLINGER DAVIS 14 N MAIN ST STE CHAMBERSBURG 200 PA 17201 . REV-1547 EX AFP (06-05) LILLIAN B TO: CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FOGELSANGER LILLIAN B FILE NO. 21 04-1172 ACN 101 DATE 11-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !hh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: 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) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 11 ,698.86 .00 .00 (8) 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 (9) (10) 7,888.50 .00 (11) (12) (13) (14) NOTE: (15) (16) (17) (18) . DO X .00 X .00 X . DO X NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 11,698.86 7.888.IiO 3,810.36 3,810.36 .00 00 045 = 12 15 .00 .00 .00 .00 .00 (19)= PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .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.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Lillian B. Fogelsanaer Date of Death: 12/10/2004 Will No. 21-04-1172 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: I . 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: 3 . If the answer to No. I is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b. The separate Orphans I Court No. (if any) for the personal representative I s account is: c . Did the personal representative state an account informally to the parties in interest ? Yes X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans I Court and may be attached to this report. Date: 12/27/2004 o . Zullin er Name (Please type or print) 14 North Main Street, Suite 200 Chambersburg PA 17201 Address C.::l ...;:, .. -- ( 264 ) - 6029 Tel.No. C- ( , c-\ 0.J Capacity : Personal Representative X Counsel for personal representative ~~