HomeMy WebLinkAbout02-0348Estate of Julia M. Stevens
Cumberland County
PETITION FOR GRANT OF LETTERS
Estate of Julia M. Stevens
also known as
, Deceased
.o.
Social Security No. 168-36-9519
Marlin L. Stevens and Velva J. Rosenberry
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors
[ Decedent, dated 7/16/1984 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 507 Oakville Road, (North Newton Township, Cumberland County) Shippensbur~], PA 17257
(list street, number and municipality)
Decedent, then 79 years of age, died March 28 ,2002 , at 507 Oakville Road, Shippensburg~ PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $
(if not domiciled in PA) Personal property in Pennsylvania .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows:
21,000.00
55,000.00
76,000.00
507 Oakville Road, North Newton Township, Cumberland County, PA
Wherefore, Petitioner(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:
Signature Typed or printed name and residence
RW-7 I' -5H -Idr
Marlin L. Stevens, 1270 Brandt Rd.,Mechanicsbur,cj, PA 17055
Velva J. Rosenberry, 1466 Brechbiel Rd.,Chambersbur,cj,PA
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Franklin
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~~, ~
Sworn to and affirmed and subscribed
Marlin L. Stevens
before me this 8~h day of ~_.(_.x..,.~._., ,//~ .~
DECREE OF REGISTER
Estate of Julia M. Stevens
also known as
Deceased No. ~.1' 0,2. ',~'~8
Social Security No: 168-36-9519 Date of Death: 3~28~2002
AND NOW, April FI , 2002 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I~ Testamentary I~ of Administration
(c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Marlin L. Stevens and Velva J. Rosenberry
in the above estate and that the instrument(s), if any, dated July 16, 1984
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ....................................
Short Certificate(s) ............... $
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages ( ) .............. $
Codicil ................................. $
JCP Fee ................................. $
Inventory & Tax Forms ............. $
Other ...................................... $
$ 200.00
12.00
6.00
~23. oo
5.00
TOTAL ............................. $ _
NAILED ~ A,A-~FN~ 4-8-02
RW-7A
Attorne~ullm~
I.D. No: 17516
Address: 14 North Main Street~ Suite 200
Chambersburq
Telephone: (717)264-6029
DATE FILED: 4/8/2002
PA 17201
lAST WILL AND TESTAMENT
I, JULIA M. STEVENS, of R. D. 1, Shippensburg, South Newton Township,
Cumberland County, Pennsylvania, being of sound mind, memory and understanding,
do make and publish this my Last Will and Testament, hereby revoking and makinc
void any and all former wills and codicils by me at any time heretofore made.
FIRST. I direct my hereinafter named Executors to pay all my just debts
and funeral expenses as soon as conveniently may be after my decease; I furthe]
direct that all taxes that may be assessed in consequence of my death, of what-
ever nature and by whatever jurisdiction imposed, shall be paid as part of the
expense of the administration of my estate.
SECOND. I give, devise and bequeath all my estate, real, personal and
mixed, whatsoever and wheresoever situate, in equal shares, share and share
alike, to my following named children; one (1) equal share to my daughter,
VELVA J. ROSENBERRY, and one (1) equal share to my son, MARLIN L. STEVENS,
absolutely; provided, however, that in the event my said daughter, VELVA J.
ROSENBERRY, should predecease me, then in that event I give, devise and bequeatt
the share of my said daughter, VELVA J. ROSENBERRY, in equal shares, share and
share alike, one (1) equal share to ANGIE M. ROSENBERRY, my granddaughter, and
one (1) equal share to GREGORY L. ROSENBERRY, my grandson, or ~to the survivor
of them then living at the time of my decease; provided further, that in the
event my said son, MARLIN L. STEVENS, should predecease me, then in that event,
I give, devise and bequeath the share of my said son, MARLI~ L. STEVENS, in
equal shares, share and share alike, one (1) equal share to LISA M. STEVENS, my
granddaughter, and one (1) equal share to CORENA D. STEVENS, my granddaughter,
or to the survivor of them then living at the time of my decease.
THIRD. Provided further, that in the event any of my aforementioned
Legatees are not at least eighteen (18) years of age at the time of my decease,
then in that event, I hereby n~nJ_nate, constitute and appoint DAUPHIN DEPOSIT
BANK AND TRUST COMPANY, of Harrisburg, Pennsylvania, as the Guardian of the
minors' estates, my said Guardian to take and receive the share of the said
minor child or children and invest and reinvest the same in legal or non-legal
inveshnents, whichever in its discretion it deems proper, and the said Guardian
to have full power and authority, in its sole discretion, to pay such amounts
of inceme and principal as are necessary for the support, maintenance and
(SEAL)
education of the said minor child or children, and upon the said minor ct~ld
or children each reaching the age of eighteen (18) years, to pay the said share
to the said child.
FOURTH. I hereby nc~inate, constitute and appoint my said daughter,
VELVA J. ~OSENBERRY, and my said son, MARLIN L. STEVENS, or the survivor of
them then living at the tim~ of my decease; as the Executors of this my Last
Will and Testament, my said E~ecutors to have full power and authority to do
any and all things necessary for the complete administration of my estate,
including the power to sell any and all real and personal property of which I
may die seized, at public or private sale, in their discretion, and without
any order of any Court; and I further direct that my said Executor not be
required to file any Bond in connection with the settlement of my said Estate.
IN WITNESS WHEREOF, I, JULIA M. STEVENS, have hereto set my hand and seal
to this my Last Will and Testament, written on three (3) sheets of paper, this
16th day of July, 1984.
Signed, sealed, published and
declared by JUT.IA M. S~S, the
Testatrix as and for her Last Will
and Testament, written on three (3)
sheets of paper, in the presence of
us who have, at her request, signed
our names as witnesses hereto ~n the
of the said Testatrix and of
each other.
(SEAL)
-2-
CQS~ONWEALTH OF PEN/NSYLVANIA
SS
COU/~fY OF C%~BERLAND
I, JULLR M. STEVENS, Testatrix, 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 ~'~ill and
Testament; that I signed it willingly; and that I signed it as my free and
voluntary act for tile purposes therein expressed.
Julia ~. Stevens -
Sworn or affirmc~ to and acknowledged before me by JULIA M. STEVENS,
the Testatrix, this 16th day of July, 1984.
COMM~~ OF PENNSYLVANIA
SS
COU/~2Y OF CL~LBERLAND
We, ROBERT J. YOC/I~ and TERESA J. BUPJ<HOLDER, the witnesses whose names
are signed to .the attached or foregoing inst~l~nent, being duly qualified acc-
ording to law, do depose and say that we were present and saw the Testatrix
si~p~ and execute the instrument as her Last Will and Testament; that the
Testatrix signed willingly, and that the Testatrix executed it as her free
and voluntary act for the purposes therein expressed; that each of us, in
hearing and sight of t~e Testatrix, signed the Will as Witnesses; and that to
the best of our knowledge, the Testatrix was at t~hat time 18 or more years of
age, of sound mind, and under no constraint or undue influence.
J. Burkholder
Ne~burg, PA
Sworn or affirmed to and subscribed before me, this 16th day of July, 1984
-~' ' Notary Pub~-lc -
MY COl~MISSlOll EXFIItE$ SEPT. 1~, 1957
Mamber, Pennsylvania At~o~ of flot,ar~
-3-
Estate of Julia M. Stevens
Franklin County
Name of Decedent: Julia M. Stevens
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death: 3/28/2002
Will No. 2002-00348 Admin. No. 21-02-0348
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 4/12/2002 :
Name Address
Marlin L. Stevens
Velva J. Rosenberry
1270 Brandt Road
Mechanicsburq PA 17055
1466 Brechbill Road
Chambersburq PA 17201
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
no exceptions
Date: 4/12/2002
Capacity:
Signature
'? - -i -'! u
Name:
Address: 14 North Main Street, Suite 200
Chambersburq PA 17201
Telephone(264) ~ 6029
X
Personal Representative
Counsel for Personal
Representative
LAW OFFICES OF
ZULLINGER- DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, PA 17201
717-264-6029
Fax: 717-264-1884
zulngrlaw~cvn.net
Dale F. Shughart, Jr.
of counsel
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, PA 17257
717-532-5713
Fax: 717-530-5222
davish~cvn.net
June 27, 2002
Mary C. Lewis, Register
Cumberland County Courthouse
Carlisle, PA 17013
Dear Ms. Lewis:
RE: Estate of Julia M. Stevens
File No. 21-02-0348
Enclosed is check in the amount of $3,291.75 representing prepayment on the PA
Inheritance Tax for the above estate. The payment is based on an estimated estate of
$77,000.00 taxable at 4.5% or $3,465.00 less discount of $173.25, for prepayment of $3~291.75.
Thank you.
cc: Velva Rosenberry
Marlin L. Stevens
yours,
· - ::3 ~
Joel R. Zullinger
14 North Main St., Suite 200
Chambersburg, PA 17201
Mary C. Lewis, Register
Cumberland County Courthouse
Carlisle, PA 17013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001347
JOEL R ZULLINGER ESQUIRE
14 NORTH MAIN STREET
SUITE 200
CHAMBERSBURG, PA 17201
........ fold
ESTATE INFORMATION: SSN: 168-36-9519
FILE NUMBER: 2102-0348
DECEDENT NAME: STEVENS JULIA M
DATE OF PAYMENT: 06/28/2002
POSTMARK DATE: 06/27/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 03/28/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,291.75
TOTAL AMOUNT PAID'
93,291.75
REMARKS: JOELRZULLINGERESQUIRE
SEAL
CHECK# 105
INITIALS: JA
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Julia M. Stevens
Date of Death: 3/28/2002
Will No. 2002-00348
Admin. No. 21-02-0348
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 4/12/2002 .
Name Address
Marlin L. Stevens
Velva J. Rosenberry
1270 Brandt Road
Mechanicsburq PA 17055
1466 Brechbill Road
Chambersburq PA 17201
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
no exceptions
Date: 4/12/2002
Signat rL~
Joel R. Zullinger
Name:
Address: 14 North Main Street, Suite 200
Chambersburq PA 17201
Tele~t-~o, ne(264) - 6029
Capa,cit~;_~,~ Personal Representative
4~(L Counsel for Personal
Representative
LAW OFFICES OF
ZULLINGER- DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, PA 17201
717-264-6029
Fax: 717-264-1884
zulngrlaw~cvn.net
Dale F. Shughart, Jr.
of counsel
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, PA 17257
717-532-5713
Fax: 717-530-5222
davish@cvn.net
October 10, 2002
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Gentlemen:
RE: Estate of Julia M. Stevens
File No. 21-02-0348
Enclosed for filing in your office are an original of the inventory and an original and
one copy of the PA Inheritance Tax Remm for the above estate along with the following
checks: Mary C. Lewis, Agent $261.66 balance of PA Inheritance Tax due and Mary C. Lewis,
Register $28.00 for filing fees. Thank you.
~Very truly yoprs, ~
Ends.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
OO1719
ZULLINGER JOEL R
14 NORTH MAIN STREET,SUITE 200
CHAMBERSBURG, PA 17201
........ fold
ESTATE INFORMATION: SSN: 168-36-9519
FILE NUMBER: 2102-0348
DECEDENT NAME: STEVENS JULIA M
DATE OF PAYMENT: 10/11/2002
POSTMARK DATE: 10/10/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 03/28/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $261.66
REMARKS:
TOTAL AMOUNT PAID:
JOEL R ZULLINGER ESQUIRE
$261.66
SEAL
CHECK# 114
INITIALS: JA
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
R~E~1500 EX + (6-00)
Z
LU
I--
Z
U.I
Z
O
C~
LU
O
Z
Z
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl
Stevens, Julia M.
DATE OF DEATH (MM-DD-Year)
03/28/2002
REV-1500
INHERITANCE TAX RETURN
EESlDENT DECEDENT
DATE OF BIRTH (MM-DD*Year)
09/18/1922
(IF APPLICABLE} SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 2 0 3 4 8
COUN3Y CODE YEAR ~ NUMB'~'~R
SOCIAL SECURITY NUMBER
I 6 8-3 6-9
5 1 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 1. Odginal Return
E~4. Limited Estate
[~'1 6. Decedent Died Testate (At,ch copyofWill)
~] 9. Litigation Proceeds Received
-'-]2. Supplemental Retum
~]4a. Future Interest Compromise (date of death arer ~2-12-82)
[~J7. Decedent Maintained a Living Trust (Attach copy of Trust)
[-~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1-95)
r-j3. Remainder Return (date of death pdor to 12-13-82)
D5. Federal Estate Tax Return Required
~ 8. Total Numberof Safe Deposit Boxes
[~ 11. Election to tax under Sec. 9113(A) (Atach Sch O)
NAME
Joel R. Zullinqer
FIRM NAME (If Applicable)
Zullin.qer Davis, P.C.
TELEPHONE NUMBER
(717)264-6029
COMPLETE MAILING ADDRESS
14 North Main Street, Suite 200
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mo~ages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6)
E~ 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)
Chambersburg PA 17201
72~500.00
OFFICIAL USE ONLY
26~376.07
(8) 98,876.07
15,593.97
467.46
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/Sec 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)
(11) 16,061.43
(12) 82,814.64
(13) 0.00
(14) 82,814.64
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
X ~ (15)
82,814.64 X .045 (16)
X .12 (17)
X .15 (18)
(19)
3~726.66
3~726.66
Decedent's Complete Address:
STREET ADDRESS
507 Oakville Road
C~TY Shippensburg J STATE PA J z~P 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3,291.75
173.25
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
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)
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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
3~726.66
3~465.00
0.00
261.66
261.66
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 dght 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? ............................................................. [] []
If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?. .............................................................................................. [] []
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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.
Declaration of preparer other than the personal representative is based on all in~rmation ofwh ch preparer has any knowledge.
SI~ATURE OF PER~ON RESPONi~B}..E FOR FILING RETURN
AbDRES'S~ 1270 Bran~ Ro~d, Mechanicsburg, PA 17055
1466 Brechbiel Road, Chambersburq
SIGN.~,T-k:~E OF PREPARER O..T.[-IER THJ~I. REPRESEI~TAT_IVE .
ADDR~7~ 14--North Mair~'t-~et, Suite 200 4~f --
Chambersburq"-" PA
, ~ / ~ DATE __
PA 17201
DATE
17201
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) ti)].
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 does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stiff 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 decedenrs 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.
R~-1~2EX + {1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Stevens. Julia M, 21 02 0348
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properly would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properly which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
VALUE AT DATE
DESCRIPTION OF DEATH
72,500.00
Gross proceeds from sale of real estate situate at 507 Oakville Road, Shippensburg,
Cumberland County, Pennsylvania, to Oakville United Methodist Church, copy of HUD
attached
TOTAL (Also enter on line 1, Recapitulation) $
721500.00
(If more space is needed, insert additional sheets of the same size)
R, EV-1508 EX + (-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Stevens. Julia M. 21 02
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorehi
ITEM
NUMBER
1.
DESCRIPTION
Received on proration of real estate taxes, sale of residence
Checking Account #0097538086, AIIfirst Bank, including interest accrued to date of
death
Money Market Account #0094165130, AIIfirst Bank, including interest accrued to date
of death
Gross proceeds from sale of decedent's personalty and automobile
Refund, Chambersburg Hospital
Refund, Erie Insurance
Commonwealth of Pennsylvania, property tax rebate
TOTAL (Also enter on line 5, Recapitulation)
0348
must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
672.71
5,158.34
15,604.41
4,585.50
81.86
38.00
235.25
(If more space is needed, insert additional sheets of the same size) 26,376.07
R~V-1511EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Stevens. Julia M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 02
0748
ITEM
NUMBER DESCRIPTION
8.
9.
10.
11.
12.
13.
14.
15.
16.
FUNERAL EXPENSES:
Fogelsanger Bricker Funeral Home, funeral expenses
Grave opening and closing
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative (s)
Social Secudty Number(s) / EIN Number of Pemonal Representative(s)
Street Address
c~/ state
Year(s) Commission Paid:
AttomeyFees Joel R. Zullinger
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Mary C. Lewis, Register - Probate 200.00; short certificates 12.00; extra
pages 6.00; JCP fee 5.00; filing return and inventory 28.00
Accountant's Fees
Tax Retum Preparer's Fees
BK Real Estate Appraisals, appraise real estate
Sprint, telephone service
PPL Electric Utilities, utility service
Charge for estate checks
PPL Electric Utilities, utility service
Whisler's Well Drilling, well drilling on real estate prior to sale
News-Chronicle, advertise sale of real estate
Cumberland Law Journal, advertise letters
News-Chronicle, advertise letters
Recorder of Deeds, transfer tax on sale of real estate
TOTAL (Aisc enter on line 9, Recapitulation)
AMOUNT
6,147.90
850.00
0.00
4,500.00
0.00
251.00
0.00
0.00
250.00
44.33
17.14
9.00
15.04
2,588.44
25.52
75.00
95.60
725.00
15~593.97
(Ifmorespaceisneeded, insedadditionalsheetsofthesamesize)
REV-1512 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Stevens. JuliaM.
FILE NUMBER
21 02
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Sprint, telephone service due at death
O348
AMOUNT
48.92
Roaring Spring Water, water service bill due at death
Chambersburg ALS-West Shore EMS, ambulance transport
PPL Electric Utilities, utility service due at death
Kough's Oil Service, fuel oil service due at death
Chambersburg Hospital, balance due for medical services
Shippensburg Family Practice, balance due for medical services
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
7.90
135.00
83.22
40.82
95.04
56.56
$ 467.46
R,EV-1513 EX + (9~)0)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Stevens Julia M.
NUMBER
II.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
Marlin L. Stevens
1270 Brandt Road
Mechanicsburg, PA 17055
Velva J. Rosenberry
1466 Brechbiel Road
Chambersburg, PA 17201
FILE NUMBER
21 02 0348
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Bo Not List Trustee(s) OF ESTATE
son
daughter
one-half of residue
one-half of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART ]! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
0.00
0.00
0.00
(If more space is needed, inser~ additional sheets of the same size)
LAST WILL AND TESTAMENT
I, JULIA M. STEVENS, of R. D. 1, Shippensburg, South Newton Township,
CU~.i ~a~?~.. Co_unty.~ Pennsy!vania~,~ b~ing of sound mind, memory and understanding,
do nw~ke and publish this my Last Will and Testament, hereby revoking and makin~g
void any and all former wills and codicils by me at any time heretofore made.
FIP~qT. I direct my hereinafter named Executors to pay all my just debts
and funera_[ expenses as soon as conveniently may be after my decease; I further
direct that all taxes that may be assessed in consequence of my death, of what-
ever nature and by whatever jurisdiction imposed, shall be paid as part of the
cm~[~nse of the administration of my estate.
SECOND. I give, dev~se ~3]d bequeath all my estate, real, personal and
mixed, whatsoever and wheresoever situate, in equal shares, share and share
alike, to my following named children; one (1) equal share to my daughter,
VELVA J. ROSENBERRY, and one (1) equal share to my son, MARLIN L. STEVENS,
absolutely; provided, however, that in the event my said daughter, VELVA J.
ROSENBERRY, should predecease me, then in that event I give, devise and bequeath
the share of my sai¢i daughter, VELVA J. ROS.ENBERRY, in equal shares, share and
share alike, one (1) equal share to ANGIE M. ROSENBEP4RY, my granddaughter, and
one (1) equal share to GREGORY L. ROSENBERRY, my grandson, or 'to the survivor
of tJlem then living at the time of my decease; provided further, that in the
event my said son, MARLIN L. STEVENS, should predecease me, then in that event,
I gi.ve, devise and bequeath the share of my said son, MARLIN L. STEVENS, in
equal shares, share and share alike, one (1) equal share to LISA M. STEVENS, my
granck~aughter, and one (1) equal share to CORENA D. STEVENS, my granddaughter,
or to the survivor of t~]em~ then living at the time of my decease.
']?HlllD. Provided further, -that 5n tJ~e event any of my aforementioned
I~-~3atees are not at least eighteen (18) years of age at the time of my decease,
then in that event, I hereby ncwainate, constitute and appoint DAUPHIN DEPOSIT
bANK AND 'I~I{UST CC~d?ANY, of Harrisbum-g, Pennsylvania, as thc Guardian of the
minors' estates, my said Guardian to take and receive the share of the sa[.¢].
minor child or children and invest and reinvest the same in legal or non-legal
investments, whichever in its discretion it deems proper, and the said Guardian
~o have full pcb'er and aut~]ority, in _its sole discretion, to pay such amounts
of income and principal as are necessary for the support, maintenance and
(SEAL)
education of the said minor child or cb_ildren, and upon the said minor child
or children each reaching the age of eighteen (18) years, to pay the said share
· to the said child.
F~JRI~]. I hereby nominate, constitute and appoint my said daughter,
VELVA J. ROS~NBERRY, and my said son, MARLIN L. STEVE%IS, or the survivor of
tl~em then living at the time of my decease; as the Executors of this my Last
Will and Testanent, my said Executors to have full power and authority to do
any and all things necessary for the complete administration of my estate,
including the t~Dwer to sell any and all real and personal prqperty of which I
may die seizerS, at public or private sale, in their discretion, and without
;:~y order of any Court; and I further direct that my said Executor not be
required to file any Bond in connection with the settlement of my said Estate.
IN WITNESS }~RF~DF, I, JULIA M. S~IS, have hereto set my hand and seal
to this my Last Will and Testament, written on three (3) sheets of paper, this
16t~ day of July, 1984.
~ Signed, sealed, published and
declared by JULIA M. S~S, the
· Testatrix as and for her Last Will
and Testament, written on three [ 3)
sheets of paler, in the presence of
us who have, at her request, signed
our names as witnesses hereto in the
presence of tile said Testatrix and of
each other.
,;
(SEAL)
-2-
~C~'IM(~V~LnI~{ OF PE~%ISYLV~NIA
SS
COL~I~Y OF CUMBERLAND
I, JULIA M. STEVENS, Testatrix, whose name is signed to the attached or
foregoing instr%~nt, having been duly qualified according to law, do hereby
acknowledge ti]at I signed and executed the instrument as my /last Will and
Testan~,nt; that i signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
_--t~-~, ~ ~.~
~ jUlia M...~J.~u,..~Stevens
Sk~orn or ,~ffirmax~ to and acknowledged before me by JULIA M. SR]LVENS,
the Testatrix, this 16th day of July, 1984.
C~I~{~7WEALTH OF PE~SYLV~R.~IA
SS
C~)rNrLAf QF CUMBERLAND
We, ROBERT J. YOC~4 and TERESA J. BUt~[Q-{OIIJER, the witnesses whose names
are signed to the attachod or fore~joing J ns~z~umont, t~ing duly ~[ua.] J fled acc-
ording to law, do depose and say tlnat we were present and saw the Testatrix
si.~% and execute the instrument as her Last Will and Testament; that the
Testatrix signed willingly, and that the Testatrix executed it as her free
and voluntary act for the purposes therein expressed; that each of us, in the
hearing and sight of t/]e Testatrix, signed the Will as Witnesses; and that to
tJ~e l~}st of our knowledge, the Testatrix was at that time 18 or nTore years of
age, of sou3]d mind, and under no constraint or undue influence.
V i ~o]~rt J. 'Yocum
116 East King Street, Shippensburg, PA
Ter6sR J. Burk/~o-fder
N~burg, PA
Sworn or affirmed to and subscribed be'fore me, this 16th day of July, 1984.'
-3-
~,, HUD-t UNIFORM SETTLEMENT STATEMENT
B. Type of Loan
ID~ P,~I
(OMB ~
4.[I VA 5[] Co~v, Ins,
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p,o c.f' were paid outside the closing; they are shown for informational purposes and are not included in the totals,
D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F, Name'& Address of Lender;
Marlin L, Stevens & Volvo J, Rosenberry
Exeo.
OakvJlle United Metilodist
G. Property Looatmn:
Julia M Stevens, Estate
North Newton Township
Cumberland County, PA
Summary ~f Borrower's Transaction
TIN of Setler:
Place of Settlement
49 W. Orange Street, Suite 3
Shippensburg, PA 17257
H. Settlement Agent:
H, Anthony Adams
I. Settlement Oate: I October 4, 2002
Summary of Seller's Transaction
100. Gross Amount Due from l~orrower:
101. Coptrac! sales price
t02, Personal Property
103. Borrowers settlement charges (line 1400)
t04.
105,
Adjustments for Items paid by seller in advance
106. City/town taxes to
107. County taxes to
108, Assessment9 to
109. School taxed to
110.
111.
112,
113,
120. Gross Amount Due from Borrower
200.
201,
400, Gross Amount Due to Seller:
72,500.00]401. Contract sales
price
'404~3, Personal Property
1,233,50 , ,
t404.
1405,
74,406,2'
72,500,00
54,78
617.93
Adjustments for items paid by sailer'in advance
54,78' 406. City/town taxes to
'407. County taxes to
408, Assessments to
617.93409. School taxes to
410,
411,
413,
420. Gross Amount Due to Seller
500. Reductions'In Amount Due to Seller:
50t. Exces~ deposit (see instructions)
502. Settlement charges to seller (line 1400)
503, Existing loan(s) taken subject to
504. Payoff of first mortgage
505. Payoff of second mortgage
506.
507.
508.
509.
Adjustments for Item~ unpaid by seller
510. City/town taxes to
511. County taxes to
~12. Assessments to
513, to
514.
515,
516.
;17,
518.
519.
520. Total Reduction Amount Due Seller
'600. Cash at Settlement To/from Seller
60t, Gross amount due to seller (line 420) [
602. Less reductions in amount due seller'¢ine 520)'
603. Cash ~ to I~]from Seller
73,172.71
Amounts Paid by or in Behalf of Borrower:
Deposits or earnest money 100,00 100.00
202, Principal amount of new loan(s) 725.00
203, Existing loan(s) taken subject to
294, Deposit
205,
206.
207
208,
209.
Adjustments for Items unpaid by seller
210. City/town taxes to
211, County taxes to
212. Assessments to
2t3
to
214,
215,
216.
217.
218.
219
220. Total Paid By/for Borrower 100.00
74,406,21
300, Cash at Settlement From/to Borrower
301. Gross amount due from borrower (tine 1201
302. Less amounts paid by/for borrower (line 220)
303. Gash ~_._~from.-[_~.LtoBorrowe,r
100,00
74,306.21
825.00
73,172.21
825.00
72,347.71
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H, I & line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax Information and is being
furnished to the Internal Revenue Service, If you are required to file a return, a sanction will be imposed on you if this item is required to be
"ported and the IRS determines that it has not been reported. If this real estate is your principal residence, file Form 2119, Sale or
Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form
4797, Form 6252 and/or Schedule D (Form 1040), You are required to provide the Settlement Agent (named above) with your correct
taxpayer identification number, tf you do not provide the Settfement Agent with your taxpayer identification number, you may be subject to ·
civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct
taxpayer identiflcatJon number.
(Seller) (Seller)
.'Settlement Char~
7'00. Total Sales/Broker's Commission: (based on price}
Paid from
P.82
Division of Commission~line 700) as follows:
701
702.
703. Commission paid at Settlement
704.
800. Items Payable in Connection with Loan
801, Loan Or.i§ination Fee
.802, Loan Oiscount
~raisal Fee
_804. Credit Report
805, Lender's _inspection Fee
806. Mortga,qe Insurance A_~ication Fee
507.
808.
809,
810.
811,
812.
813.
814.
900. Items Reguiredby Lender to Be Paid in Advance
901. interest from to
902, Mortgage Insurance Premium for
903. Hazard Insurance Premium for
904.
905,
per day
Boffrower's
Funds at
Settlement
Paid from
Seller's
Funds at
Settlement
per month
per month
per month
per month
_.__p_~.month
per month
1000, Reserves. L~po$ited with Lender
1001, Hazard insurance mont~
1002. Mort. fL~e insurance months
1003, City property taxes month~ ~ $
1004, Count~taxes months
1005. Annual assessments months..~_~
1006. School Tax
1007, m°nths-L~
1008.
1009. A re ateAccou-ntin Ad'ustment
1100. Title ~
1101, Settlement/closinq fee
1102. Abstract/title search
· [ 103. Title examination
1104, Title insurance binder
1105. Document rE.~aration
1106. Notar~ fees
1107. Attorney's fees
_._..~includes above item numbers
1108. Title insurance
.___(.includes above item numbers
110g. Lender's covera, g_e
1110, Owner's coveraj~e
1111.
1112.
1113.
1200, Government Recordin_ac[. and Transfer Char e.~_
1201, Recordin9 fees: Deed 28,50
1202, Cit /coun tax/stem s:
1203, State tax/stamps.'
1204,
1205.
1206.
1300, Additional Settlement Char~leS
1301. Survey
1302, Pest inspection
1303. Wire Transfer Fee
1304,
~ 305.
1306.
1307,
1308,
Mortgage Release 28.50
Deed 725.00 Mo~_..~[~ 725.00
Deed 725.00 Moaa~
350.0,
725,00
1400. Total Settlement Char(jea (This Number Transfers to Lines 103 & 502 Above) 1,233,5--~-"~ 725.00
CERTIFICATION
{ have carefu{iy reviewed the HUD-1 Settlemen! Statement and to the best of my knowledge and belief, it is a true and accurate statement of ail receipts and
disbursements made on my account or by me in this transaction. I further cetlJfy that I have received a copy of tile HUD-1 Settlement Statement,
Seller Borrower
Seller Borrower
Ta the be~t of my knowledge the HUD.1 Settlement Statement which I have prepared is true and accurate account of the funds Which were received and
have been or will be disbursed by the undersigned as part Of the settlement of this transaction,
Settlement Agent Date
Code SeCliO~ 1~;~01 a~d Se~ti~rl 1010,
allfirst
April l8,2002
Law Offices
Zullinger - Davis
Professional Corporation
14 North Main Street
Suite 200
Chambersburg, PA 17201
Allfirst Financial Center N.A.
140. Box
Millsboro, DE
Estate of Julia M. Stevens
Date of Death: March 28, 2002
Social Security Number: 168-36-9519
Dear Mr. Zullinger:
In response to your request, please be advised that at the t/me of death, the above-
named decedent had on deposit with this bank the following accounts.
Account Type ........................... Checking Account
Account Number. ...................... 0097538086
Ownership (Names oj') .............. Julia M. Stevens or Wilbur W. Stevens
Opening Date ........................... 01/28/80 {account closed 04/17/02)
Balance on Date of Deatl~ .........$5,158.23
Accrued Interest $ O. 11
Total ....................................... $5,158.34
These accounts were converted from the acquisition of another financial institution. Unfortunately, we are
unable to access any information pertaining to the date the account was made joint
Page 2
April 18, 2002
Account Type ........................... Money Market Account
Account Number. ...................... 0094165130
Ownership (Names oJ) ..............Julia M. Stevens
Opening Date ........................... 01/28/83 (account closed 04/17/02}
Balance on Date of Deattt .........$15,600.14
Accrued Interest $ 4.27
Total ....................................... $15,604.41
This letter does not include any accounts in which the deceased may have been listed as power of attorney,
custodian of uniform transfers, representative payee, or trustee under a written trust agreement.
For any additional information on these accounts, please contact our branch at:
35-39 East King Street
Shippensburg, PA 17257-3539
Phone: (717) 532-4132
Sincerely,
Charlene Warrington, Associate I
(302) 934-2722
Estate of Stevens Julia M.
also known as_
INVENTORY
--, Deceased
No. 2._11 02 0348
Date of Death 3/28/2002
Social Security No. 1._68369519
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe the
verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative:
Name of
Attorney: ~
I.D. No.: ~
Address: 14 No~h Main Street Suite 200
Telephone: ~
Description
PA 17201
Value
Stocks & Bonds
Closely-Held Corporation, Partnership or Sole-Proprietorship
Mortgages & Notes Receivable
Cash, Bank Deposits, & Misc. Personal Property
Received on proration of real estate taxes, sale of residence
Checking Account #0097538086, Allfirst Bank, including interest
accrued to date of death
672.71
5,158.34
Total 98,876.07
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
Stevens, Julia M.
Continuation of Inventory
Paqe 1
Description of Inventory
Description
Money Market Account #0094165130, AIIfirst Bank, including interest
accrued to date of death
Gross proceeds from sale of decedent's personalty and automobile
Refund, Chambersburg Hospital
Refund, Erie Insurance
Commonwealth of Pennsylvania, property tax rebate
Real Estate
Subtotal
Grand Total
Gross proceeds from sale of real estate situate at 507 Oakville Road,
Shippensburg, Cumberland County, PA, to Oakville United Methodist
Church
21 02 0348
Value
15,604.41
4,585.50
81.86
38.00
235.25
72,500.00
$ 93,045.02
$ 98,876.07
BUREAU OF TNDZVZDUAL TAXES
ZNHERTTAHCE TAX DTVZSZON
DEPT. 280601
HARRISBURG, PA 17128-0601
COHHON#EALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RE¥-1;47 EX &FP
JOEL R ZULLINGER
ZULLZNGER DAVIS
14 N HAIN ST STE ZOO
CHAHBERSBURG PA 17201
DATE 1Z-OZ-ZOOZ
ESTATE OF STEVENS
DATE OF DEATH 05-28-2002
F/LE NUNBER 21
- ;COUNTYi CUHBERLAND
ACN 101
Amoun~ Remi~ed
JULIA H
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHZ~ERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF STEVENS JULIA H FILE NO. 21 02-0348 ACN 101 DATE 12-02-2002
TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Es*a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nership Zn~aras~ (Schedule C) (3)
~. Hor~gages/No~as Receivable (Schedule D) (~)
$. Cash/Bank Deposi~s/Hisc. Personal Propar~y (Schedule E)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Assa*s
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expansas/Adm. Cos~s/NAsc. Expenses (Schedule H) (9)
10. Deb~s/Nor~gage Liabilities/Liens (Schedule 1) (10)
11. To,al Deductions
12. Na~ Value of Tax Re~urn
721500.00
.00
.00
.00
26~$76.07
.00
.00
(8)
15,593.97
467
NOTE: To insure proper
cradA~ *o your account,
submi~ ~he upper portion
of ~his for. wi~h your
~ax payment.
15.
1~.
NOTE:
98,876.07
(11) 16 .O&I
(Xa) 82,814.64
Chari~;abla/Govarnmen~cal Beques~cs; Non-elect:ed 9115 Trusts (Schedule J) (1;;)
Ne~c Value of Es~a~e Sub~ec~ ~co Tax (1~)
Zf an assessment ~as issued previously, lines 14, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Aeoun~ of Line 1~ a~ Spousal ra~e
16. Aeoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e
17. Aeoun~ of Line 1~ a~ Sibling ra~e
18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~a
19. Principal Tax Due
TAX CREDZTS:
PAYHENT ; RECEZP1 DZSCOUNT (+)
DATE NUHBER INTEREST/PEN PAZD (-)
06-27-2002 CD001547 175.25
10-10-2002 CD001719 .00
.00
82,814.64
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
18 and 19 will
(15) .00 x 00 = .00
(~6) 82,814.6~ x 045= 3,726.66
(17) .00 x 12 : .00
(lB) .00 x 15 = .00
(19)= :3,726.66
AHOUNT PAID
3,291.75
261.66
TOTAL TAX CREDIT 3,726.66
BALANCE OF TAX DUEI .00
ZNTEREST AND PEN. .00
TOTAL DUE . O0
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REi)UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)