HomeMy WebLinkAbout02-0357PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~'~o~,G-~ ~-----~{a.% ..
also known as
Deceased.
,,_,/'
Social Security No. I ~0-'7, - ¢-) l- ~ c~ o, ~,~
$0.
21-02-357
To:
Register of Wills for the
County of 0
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut o rs
in the last will of the above decedent, dated ,IL, !,~, lB
and codicil(s) dated
in the
named
, 19
(stale relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in O, ,~-~ ~= ~ {~, ~.ol County, Pennsylvania, with
h_ last family or principal residence at %~ iV {~)~T %~
{list street, number and muncipality)
Decendew then ~ yea[s of agq,.die~ ~p-', t ~ ' ~ ~o~,
Except as follows, decedent d~d 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 $
(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:
OlD
WHEREFORE, petitioner(s) respectfully_~equest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters I~w~m ~ ~x- ~,~
(testamentary; a/dministration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF __ctr~BERL~qD
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 affirmed and subscribed [ ~/~/__~~~,~
before me this 9th __ __ day of
APRIL
3r2~z,~, x5 ~, ,..~ ~,,.../.~' .;/ ..ab
' '/-- [7 f~ -- / - - - Re~ster//[
NO. 21-02-357
Estate Of GEORGE FOURLAS , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW APRIL 9 xl~ 2002, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JULY 13, 1984
described therein be admitted to probate and filed of record as the last will of
GEORGE FOURLAS ;
and Letters TESTAMENTARY
are hereby granted to JOHN FOURLAS AND JAMES FQURLAS
FEES
Probate, Letters, Etc .......... $ 235.00
Short Certificates( ) .......... $ 6.00
l~nPuar~a~io n ................ $ 18.00
JCP $ 5.00
TOTAL ~ $ 264.00
Filed ... Ap.r. $ .l . '.9. ,. . .2 0.0.2. ................
(f ~egister of Wills
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
21-02-357
WILL
I, GEORGE FOURLAS, of 818 North West Street, Carlisle, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously
made by me.
ITEM ONE: I direct that all my debts and funeral expenses, including my grave-
marker shall be paid from my residuary estate as soon as practicable after my
decease as a part of the expense of the administration of my estate.
ITEM TWO: I direct that my estate be distributed as follows:
A. I direct that Five Thousand Dollars ($5,000) should be placed in trust to be
held under the following conditions:
a. Trustees shall take from the income income as required, from the corpus
of the trust for the purchase of a memorial contribution in the name of myself
and my deceased wife, HARRIET G. FOURLAS, at the following times:
40 days from the date of my death
Six months from the date of my death
One year from date of my death
Five years from the date of my death
Ten years from the date of my death
Fifteen years from the date of my death
Twenty years from the date of my death
Twenty-five years from the date of my death
b. Upon payment of the last memorial contribution on the twenty-fifth
anniversary of my death, the trust shall terminate and the Holy Trinity
Orthodox Cathedral in Camp Hill, Pennsylvania, shall receive all remaining
corpus and any accumulated income.
c. Trustees may hold the corpus of ithe trust and invest corpus as the
trustees deem appropriate.
B. I give, devise and bequeath the rest, residue and remainder of my estate to
my children, equally, share and share alike, per stirpes.
ITEM THREE: I appoint my sons, JOHN FOURLAS and JAMES FOURLAS, as Co-Executors
of.%his my last will and as co-Trustees under the trust created under this
instrument.
ITEM FOUR: I appoint my son, JOHN FOURLAS, guardian of any property which
passes to any person under the age of 21 years and with respect to which I am
authorized to appoint a guardian and have not otherwise specifically done so.
Said guardian shall have the power to use income from time to time for the
beneficiary's education, support and welfare without regard to his or her
parent's ability to provide for such education, support or welfare, or to
make payment for these purposes~ without further responsibility, to the
beneficiary or to the beneficiary's parents or to any person taking care of
the beneficiary. Said guardian shall administer the separate and equal share
of each beneficiary until he or she becomes 21 years of age, at which time
the share of each beneficiary remaining in the guardianship account shall be
paid to said beneficiary in full. In the event of the death of any beneficiary
after my decease and prior to reaching the age of 21 years, his or her share
shall be distributed equally to the surviving children or child to be adminis-
tered in accordance with this guardianship provisions.
PAGE ONE OF THREE PAGES
ITEM FIVE: Ail estate, inheritance, succession and other taxes, imposed or
payable by reason of my death, and interest and penalties thereon, with respect
to all property comprising my gross estate for tax purposes, whether or not
such property passes under this will, shall be paid out of the principal of my
residuary estate, without apportionment or right of reimbursement.
ITEM SIX: I direct that my personal representative or guardian shall not be
required to give bond for the faithful performance of their duties in any
jurisdiction.
ITEM SEVEN: In addition to the rights and powers given to the fiduciaries by
law or elsewhere in this will, I give to my Executor during the full time
necessary and for the administration of my estate the following rights and
powers to be exercised in his sole discretion.
A. To retain any real or personal property which may at any time form a part
of my estate so long as he or she deems it advisable.
B. To invest in any real or personal property without restriction to legal
investments.
C. To repair, alter, improve or lease for any period of time any real or per-
sonal property and to give options for leases.
D. To sell at public or private sale, for cash or credit, with or without
security to exchange or to partition real or personal property and to give
options for leases.
E. To make distribution in kind.
F. To compromise claims.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~ ~ day of ~u~n/ff1984.
The preceding instrument, consisting of this and two other typewritten pages
each identified by the signature of the Testator was on the day and date
thereof signed, published and declared by the Testator therein named as and
for his last will, in the presence of us, who at his request, in his presence
and in the presence of each other have subscribed our ~kames.
PAGE TWO OF THREE PAGES
2OMMONWEALTH OF PENNSYLVANIA :
: SS
,COUNTY OF CUMBERLAND :
We ~J ~-,~-a'~>~-~'~-~ ~' '~ ' and (~~ ~ ,~ witnesses
whose names are signed to,he attached or foregoing instrument being duly
qualified according to law, do depose and say that we were present and saw the
Testator sign and execute the instrument as his last will; that he signed
willingly and executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator
signed the will as witnesses; and that to the best of our knowledge, the Testa'
was at the time 18 or more years of age, of sound mi~nder no constraint
or undue influence.
Sworn and subscribed
j ['to before me this /g¢~
i day o~ Jun61984.
/ Notary Public ~ My Term E:??as ~-:eo. 23, 1987
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
: SS
I, GEORGE FOURLAS, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my last will; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes therein
expressed.
GEORGE F~ttIFLAS ..... ~ '~-
Sworn and affirmed to and acknowledged before me this/~Y~Say of July 1984.
Notary Publi~-
PAGE TttREE OF THREE P'AGES
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: d~0~ ~ ~]~,~
Date of Death: f.~t~
Will No. o~/--P ~"~' 0 ~ J'"7 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate .administration required by Rule 5.6(a) of.the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~,]~/,,~,,~ ·
Name
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Name ~'~
Address 0~
Telephone (~/,2)
Capacity: / Personal Representative
Counsel for personal representative
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 0013O7
FOURLAS JOHN
PO BOX 66
PLAINFIELD, PA
17081
........ fold
ESTATE INFORMATION: SSN: 127-01-5095
FILE NUMBER: 2102-0357
DECEDENT NAME: FOURLAS GEORGE
DATE OF PAYMENT: 06/1 9/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 97,169.80
TOTAL AMOUNT PAID:
97,169.80
REMARKS: JOHN FOURLAS
SEAL
CHECK# 110
INITIALS: JA
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
REV-150(~PX (6-00)
- ~, COMMONWEALTH OF
~ PENNSYLVANIA
~~~.~ DEPARTMENT OF REVENUE
~ ~1~"~,,~1~ ~ DEPT. 280601
~HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
CATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, IRST ITIAL)
OFFICIAL USE ONLY
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[~/1. Original Return
~14. Limited Estate
r---16. Decedent Died Testate (Attach copy of Will)
r--19. Litigation Proceeds Received
J~2. Supplemental Return
J~4a. Future Interest Compromise (date of death after 12-12-82)
J--J 7. Decedent Maintained a Living Trust (Attach copy of Trust)
J~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
J~3. Remainder Return (date of death pdor to 12-13-82)
J~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
J~l 1. Election to tax under Sec. 9113(A) (Atlach Sch O)
FIRM NAME (IfApplicable)
TELEPHONE NUMBER
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)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~ 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 6 minus Line 11)
13.
14.
COMPLETE MAILING ADDRESS
~ ,,~- ~, 7~ ~ ' ~ OFFICIAL:USE ONLY
(8)
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14)
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 .0 __ (15)
16. Amount of LJne 14 taxabJe at lineal rate /~'7~'?tLj'' y? x .0 ~ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
Decedent's Complete Address:
STREET ^DDRESS £/,¢ /¢,
CITY ~/~,~ ,~,~ STATE f~i~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(4)
Total Credits ( A + B + 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.
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
IF THE ANSWER
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] ~
c. retain a reversionary interest; or .......................................................................................................................... []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
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? ........................................................................................................................ []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 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 information of which preparer has any knowledge.
SIGNAT[,,~OF P~N RESPONSIBLE FOR FILING RETURN
AD/~I~E"S§- '
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate i~l~osed 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 still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
-C Y7
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 pdce at which properb/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 property which is jointly.owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation) $ g~, ~'~'o g~
(If more space is needed, insert additional sheets of the same size)
WAYNE ULSH
REAL ESTATE EXCEL
403 N. Hanover Street
Carlisle PA 17013
Bus: (717) 258-8934
Fax: (717) 241-4406
Res: (717) 258-1461
April 30, 2002
The George Fourlas Estate:
I have made a Comparative Market Analysis of the home at 818 N. West Street in Carlisle, Pa.
Based upon this analysis I can conclude that this home should sell for $50,000.
This analysis has not been performed in accordance with Uniform Standards of Professional Appraisal
Practice which require valuers to act as unbiased, disinterested third parties with impartiality, objectivity in
independence and without a combination of personal interest. It is not to be construed as an appraisal and
may not be used as such for any purpose.
Sincerely,
Realtor Consultant
REV-1508 ~ * (1-9~ ~
COMMONVVEALTH OFPENNSYLYANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~'y jointly.oWned with the ri~M of sun~ivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
I I~=~
lOl~m
STMT CO
ACTION
PROD CODE CDA
CURR CODE
ACTN
POST EFFECTIVE CHECK NUMBER TRANAMOUNT D/C
TRACE ID DESCRIPTION
05/15 52.50 C
I-GEN102051500002883 INTEREST PAYMENT
05/15 52.50 D
I-GEN102051500002884 INTEREST PaID BY CHECK (DEBIT)
06/14 06/15/02 54.25 C
I-GEN102061500002009 INTEREST PAYMENT
06/14 06/15/02 54.25 D
I-GEN102061500002010 INTEREST PAID BY CHECK (DEBIT)
06/I7 3.50 C
I-GEN102061700000001 INTEREST PAYMENT GENERATED
06/17 168431973 25,838.82 D
6ZN PAYOFF ACCOUNT - WITHOUT PENALTY
STFT 1 THF TRANSACTION STMT FORMAT 02/06/17 14.01.11
96 0P EBRN ~ MS 50861 LAST PAGE OF TRANSACTIONS
COID
ACCT 31003910476330 SHORT NAME FOURLAS GEORGE
PAGE 6 SEARCH FROM A00/10/06 THRU 102/06/17
BALANCE
25,887.82
25,835.32
25,889.57
25,835.32
.00
PF: i-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ll-CUTO ..-STSM
Date: 6/17/ 2 Time: 02:02:19 PM
Manufacturers and Traders Trust Company · One West High Street, Carlisle, PA 17013 · (717) 240-4536 · Fax: (717) 240-4518
STMT CO
ACTION COID
PROD CODE CDA ACCT
CURR CODE
ACTN POST EFFECTIVE
TRACE ID
05/28
STFT i THF TRANSACTION STMT FORMAT 02/06/17 13.53.42
96 OP EBRN ' MS 50861 LAST PAGE OF TRANSACTIONS
31003910457869 SHORT NAME FOURLAS GEORGE
PAGE 6 S~A~CH FROM A00/10/06 THRU 102/06/17
CHEC~ N~mER Tm,~AMo~' D/c BALANCE
DESCRIPTION
33.45 C 15,033.45
I-GEN102052800003857 INTEREST PAYMENT
05/28 33.45 D
I-GEN102052800003858 INTEREST PAID BY CHECK (DEBIT)
06/17 22.29 C
I-GEN102061700000001 INTEREST PAYMENT GENERATED
06/17 168431973 15,022.29 D
6ZN PAYOFF ACCOUNT - WITHOUT PENALTY
15,000.00
.00
PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ll-CUTO ..-STSM
Date: 6/17/ 2 Time': °1:54:41 PM
Manufacturers and Traders Trust Company · One West High Street, Carlisle, PA 17013 · (717) 240-4536 ° Fax: (717) 240-4518
TD003001
BEECHEDL
Waypoint Bank
Certificate Inquiry
4/19/o2
14:38:53
Account Number 8000036022
Product Type ~-~2-4--~ump-Up CD
Branch Number 045 CARLISLE
Short Name
FOURLAS, GEORGE
BALANCES
Avail £nt
Cur Bal
Accrued
Penalty
Pend W/H
Close Out
Hold Amt
YTD Int
YTD Fed
YTD St
Last Ren
Per Diem
DATES CODES
.0o Orig Issue 08/06/199¥~ Rate/A~Y 4.2700% 4.33%
~,258.7~ Orig Open 08/06/1997 Maturity Term 24M
25.0: Nxt Maturity 08/07/2003 Interest Period 1M
237.08 Lst Renewal 08/07/2001 Interest Type Fixed
.00
11,046.72
.00
118.53
.00
.00
11,258.78
1.31712
Nxt Int Pay 04/30/2002 Index S06 24 Month Bump-U
Lst Int Pay 03/31/2002 Status O Open
Lst Activity 08/07/2001 Pen Type 04 180 Days Simple
Lst Maint 04/09/2002 GL Type 01 GL Type 01
Cust Contact 09/09/1999 Spc Attn
Redeemed Officer 1 NULL CHAR FIELD U
Officer 2 NULL CHAR FIELD U
Serial Nbr
F3=Exit F4=Field Help F7=History F8=Display Holds/Alerts F9=Title Inq
F10=Inquiry Options F12=Previous F14=Add Note F15=ALLView
(c) 1998 ALLTEL Information Services, Inc.
TD003001
BEECHEDL
Waypoint Bank
Certificate Inquir~
4/19/02
14:39:46
Account Number 8000044236
Product Type C20 20 Month CD
Branch Number 045 CARLISLE
Short Name
FOURLAS, GEORGE
BALANCES
Avail lnt
Cur Bal
Accrued
Penalty
Pend W/H
Close Out
Hold Amt
YTD Int
YTD Fed
YTD St
Last Ren
Per Diem
DATES CODES
.0u Orlg Issue 06/26/199u Hate/AP¥ 6.6900% 6.90%
~4,000.0~ Orig Open 06/26/1998 Maturity Term 20M
Nxt Maturity 04/26/2002 Interest Period 1M
Lst Renewal 09/30/2000 Interest Type Fixed
Nxt Iht Pay 04/26/2002 Index C20 20 Month CD
32,996168 Lst Int Pay 03/31/2002 Status O Open
.00
560.84
:00
.00
.00
6.23178
Lst Activity 06/29/1998 Pen Type 04 180 Days Simple
Lst Maint 04/11/2002 GL Type 01 GL Ty~e 01
Cust Contact 06/29/1998 Spc Attn
Redeemed Officer 1 NULL CHAR FIELD U
Officer 2 NULL CHAR FIELD U
Serial Nbr
F3=Exit F4=Field Help F7=History
F10=Inquiry Options F12=Previous
F8=Display Holds/Alerts F9=Title Inq
F14=Add Note F15=ALLView
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
ff an asset was made Joint within one year of the decedant'a date of death, It muat be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
JOINTLY-OWNED PROPERTY:
~ DA11; DESCRIPTION OF PROPERTY % OF DATE OF DEATH
iTEM FOR JOINT MADE INCLUDE NAME OF RNANC~AL IN~llTUTION ANO BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO~ VAUJE OF
NUMBER TENANT JOINT IOEI~NG NUMBER. KITACH DEED FOR JOINI1.Y44ELD REN. ESTATE. VALUE OF AESET INTEREST D ~_. INll;REST
TOTAL (NSO enter on line 6, Recapitulation) $ ,.~ ~ ;,,~.~, ~ ~
(If more space is needed, insert additional sheets of the same size)
PSEC
J JiJl IIiI,Yi ¥~ Ill I If [i~J ~ ~il Iii fl [~i'l~l~lJJJ~.JJ ~Jl I][fl ] ]
GEORGE FOURLAS
C/O JOHN FOURLAS
PO BOX 66
PLAINFIELD PA 17081187
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - hflp://www, psecu.com
GET YOUR FREE CREDIT REPORT!
SEE YOUR CREDIT RATING AND LEARN
HOg YOU CAN IMPROVE IT.
VISIT WWW.PSECU.COM FOR DETAILS.
JOINT OWNER
JOHN FOURLAS
0127XXXXXX
040102]045002 ~
PAGE
0~i/01 ZD O1 REGULAR SHARES BEGZNNZNG BALANCE 38.32
04/24 PAYMENT: DIVIDEND O, 05 $8, $7
.............................................................. ,.A..N!~.U.A....L.,.P.ER.C....E:N.,.T.,A~E....¥.!.~LP...,,E.....A..~NE,.D... ....... .2.........,.O.,.~,~....~..R...pM.........O....~p....L/...p.,~ ..T,.H.......R.P.,.U.....6.....H....Q.~,./,..~..]./...~.a~:
DIVIDEND YTD: YEAR TO DATE 0.26
........ ,o.4~Q! ~l) .50...24.. MONTH ~.ERT.I. FZC..**A. TE.~Z BEgiNNiNG BALANGE ~p.O..PO,O,.O.
TO FOURLAS~JOHN XXXXXXXXXX SHARE 57 ~
04/23 ZD 50 2~ MONTH CERTZFZCATE-I CLOSED '
................................................. P.!.~/Z PENP...YTP.;.. YEAR...T~...PA..~ .................................................................................................. X.g..7,96 ..... ....
ANNUAL PERCENTAGE YIELD EARNED 7.26~. FROM 04/01/02 '02
04/2~ WITHDRA#AL TRANSFER O. O0
FOURLAS JOHN XXXXXXXXXX
0~/01 ZD 52 24 MONTH CERT'rFTCATE BEGZNNZNG BALANCE 34850.94
04/25 PAYMENT: DIVIDEND 145,57 $4996,51
.......................................................................... AH~.!~.AL...P,.E...~.E.NTA~E....Y]:.ELP...EARNED. 7,, XG~ E~P.,. O~!.qX./.O.a THinZ ·
D~VIDEND YTD: YEAR TO DATE 7q1.08
~OaSllq
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
Pemonal Representative's Commissions
Name ct Pemonal Representati4e(s)
Social SecuriN Number(s}/EIN Number of Personal Representative(s)
Street Address
City State__Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State__Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
(Also enter on line 9, Recapitulation)
TOTAL
(If more space is needed, insert additional sheets of the same size)
RE~'-1513 EX* (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DO Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include ou~ght spousal distributions, and Imnsfers under
Sec. 9116 (a) (1.2)]
1
EN~R DOL~ ~OUNTS FOR DISTRIBUTIONS SHOWN ~OVE ON LINES 15 ~ROUGH 18, AS ~PROPR~, ON R~-I~ CO~R SHE~
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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If mom space ,~ needed, inse~t additional sheets of the same size)
BUREAU OF THDTVTDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. ZSO60Z
HARRI*SBURG, PA 171Z8-0601
JOHN FOURLAS
PO 80X 66
PLAINFIELD
CUT ALONG THZS LINE
COHHON#EALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF ZNHER/TANCE TAX
APPRA/SEHENT, ALLOWANCE OR D/SALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RE¥-I;~i7 El(
DATE 08-05-2002
ESTATE OF FOURLAS
DATE OF DEATH 0~-05-Z002
F~LE NUHBER 21 02-0557
,;~pUNTY CUHBER LAND
ACN 10!
I lmoun~ Remi~ed
GEORE
HAKE CHECK PAYA]~LE AND REHTT PAYHEFI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701.3
RETATN LOk/ER PORTTON FOR YOUR RECORDS 4
APPROVAL OF ACCOUNT, RELEASE AND
INDEMNIFICATION AGREEMENT
The undersigned, John Fourlas, is one of the beneficiaries of the Estate of George
Fourlas, deceased, and desires that the Estate be distributed without the formality of a court
accounting.
The Executors of the Estate, John Fourlas and James G. Fourlas, are willing to consent
to such a distribution upon receipt of a release and indemnification from each beneficiary in the
form of this document. In consideration of the willingness of the Executors to make
distribution without a court approved accounting and petition for distribution, and with the
undersigned agreeing to be legally bound hereby and knowing the Executors are relying
hereon, the undersigned individually and on behalf of the undersigned's heirs, personal
representatives, successors and assigns, does hereby:
1. Waive any and all rights or powers to request or require a filing in court of an
account of the administration of the Estate and/or a petition for distribution of the Estate, and
all like and similar filings and documents;
2. Declare that the undersigned has examined the attached Informal Account (and
Statement/Schedule of Distribution) of the Executors; finds it to be true and correct in all
particulars to the best knowledge and belief of the undersigned; accepts and approves it with
the same force and effect as if it had been prepared and filed with, audited, adjudicated and
confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal
and income had been awarded by the Court in accordance with the Statement/Schedule of
Distribution;
1 of 3
3. Warrant that to the best knowledge and belief of the undersigned, the
beneficiaries named in the Informal Account and Statement/Schedule of Distribution are the
sole parties in interest in the Estate and same are entitled to receive the entire distribution
thereof in accordance with the Informal Account and Statement/Schedule of Distribution;
4. Warrant that the undersigned knows of no outstanding and unsatisfied claims
against the Estate or liabilities of the Estate, and the undersigned approves the distribution of
the balance of principal and income shown in the Informal Account and Statement/Schedule of
Distribution to the persons and in the amounts set forth therein;
5. Absolutely, unconditionally, and irrevocably release and discharge the
Executors, and their respective heirs, personal representatives, successors and assigns, of and
from any and all actions, liabilities, claims and demands arising out of or relating in any way
to the administration of the Estate and distribution of the Estate in accordance with the
Informal Account and Statement/Schedule of Distribution, without a court accounting and
adjudication;
6. Agree to refund to the Executors the portion of any distribution made to the
undersigned which exceeds the amount the undersigned was properly entitled to receive as the
Executors f'mally determine or redetermine.
7. Agree to indemnify and hold harmless the Executors, and their respective heirs,
personal representatives, successors and assigns, from and against any claims, liabilities, loss
or expense (including without limitation litigation costs and attorney's fees) arising out of,
resulting from or in connection with the administration of the Estate and its distribution in
accordance with this document, including, but not limited to, any liability for any Federal
Estate and Gift Tax, Pennsylvania Inheritance tax or any other death taxes, and any federal or
2 of 3
Pennsylvania income taxes, and any penalties and costs incidental to any or all such taxes, and
also including, but not limited to, any assets received or payments or distributions made by
reason of any negligence or mistake of law or fact.
Dated: q ~ ~- c> ~2-.
JO/hn Fourlas
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAo_PMIN
On this, the ~t day of ~/i~e-/Z-..
,2002, before me a Notary Public, the
undersigned officer, personally appeared John Fourlas, known to me (or satisfactorily proven)
to be the individual who executed the foregoing instrument, and duly acknowledged to me that
he executed the same for the purpose therein.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
NOTARIAL SEAL-'
Janolle L. Hersh, Notary Public
Harrisburg, PA Dauphin County
My Commission Expires March 4, 2004
3 of 3
APPROVAL OF ACCOUNT, RELEASE AND
INDEMNIFICATION AGREEMENT
The undersigned, Nickolas G. Fourlas, is one of the beneficiaries of the Estate of
George Fourlas, deceased, and desires that the Estate be distributed without the formality of a
court accounting.
The Executors of the Estate, John Fourlas and James G. Fourlas, are willing to consent
to such a distribution upon receipt of a release and indemnification from each beneficiary in the
form of this document. In consideration of the willingness of the Executors to make
distribution without a court approved accounting and petition for distribution, and with the
undersigned agreeing to be legally bound hereby and knowing the Executors are relying
hereon, the undersigned individually and on behalf of the undersigned's heirs, personal
representatives, successors and assigns, does hereby:
1. Waive any and all rights or powers to request or require a filing in court of an
account of the administration of the Estate and/or a petition for distribution of the Estate, and
all like and similar filings and documents;
2. Declare that the undersigned has examined the attached Informal Account (and
Statement/Schedule of Distribution) of the Executors; finds it to be true and correct in all
particulars to the best knowledge and belief of the undersigned; accepts and approves it with
the same force and effect as if it had been prepared and filed with, audited, adjudicated and
confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal
and income had been awarded by the Court in accordance with the Statement/Schedule of
Distribution;
1 of 3
3. Warrant that to the best knowledge and belief of the undersigned, the
beneficiaries named in the Informal Account and Statement/Schedule of Distribution are the
sole parties in interest in the Estate and same are entitled to receive the entire distribution
thereof in accordance with the Informal Account and Statement/Schedule of Distribution;
4. Warrant that the undersigned knows of no outstanding and unsatisfied claims
against the Estate or liabilities of the Estate, and the undersigned approves the distribution of
the balance of principal and income shown in the Informal Account and Statement/Schedule of
Distribution to the persons and in the amounts set forth therein;
5. Absolutely, unconditionally, and irrevocably release and discharge the
Executors, and their respective heirs, personal representatives, successors and assigns, of and
from any and all actions, liabilities, claims and demands arising out of or relating in any way
to the administration of the Estate and distribution of the Estate in accordance with the
Informal Account and Statement/Schedule of Distribution, without a court accounting and
adjudication;
6. Agree to refund to the Executors the portion of any distribution made to the
undersigned which exceeds the amount the undersigned was properly entitled to receive as the
Executors finally determine or redetermine.
7. Agree to indemnify and hold harmless the Executors, and their respective heirs,
personal representatives, successors and assigns, from and against any claims, liabilities, loss
or expense (including without limitation litigation costs and attorney's fees) arising out of,
resulting from or in connection with the administration of the Estate and its distribution in
accordance with this document, including, but not limited to, any liability for any Federal
Estate and Gift Tax, Pennsylvania Inheritance tax or any other death taxes, and any federal or
2 of 3
Pennsylvania income taxes, and any penalties and costs incidental to any or all such taxes, and
also including, but not limited to, any assets received or payments or distributions made by
reason of any negligence or mistake of law or fact.
Dated:
Nickolas G. Fourlas
COMMONWEALTH OF PENNSYLVANIA '
COUNTY OF I~^uPt4 ~ ~4 ~ '. SS:
On this, the '~¢ day of .-~/mtetnJ'~/'z'-'
,2002, before me a Notary Public, the
undersigned officer, personally appeared Nickolas G. Fourlas, known to me (or satisfactorily
proven) to be the individual who executed the foregoing instrument, and duly acknowledged to
me that he executed the same for the purpose therein.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
F NOTARIAL SEAL-' '"]'
~ Janolle L. Hersh, Notary Public
/ Harrisburg, PA Dauphin County
lMy Commission Expires March 4,
3 of 3
APPROVAL OF ACCOUNT, RELEASE AND
INDEMNIFICATION AGREEMENT
The undersigned, James G. Fourlas, is one of the beneficiaries of the Estate of George
Fourlas, deceased, and desires that the Estate be distributed without the formality of a court
accounting.
The Executors of the Estate, John Fourlas and James G. Fourlas, are willing to consent
to such a distribution upon receipt of a release and indemnification from each beneficiary in the
form of this document. In consideration of the willingness of the Executors to make
distribution without a court approved accounting and petition for distribution, and with the
undersigned agreeing to be legally bound hereby and knowing the Executors are relying
hereon, the undersigned individually and on behalf of the undersigned's heirs, personal
representatives, successors and assigns, does hereby:
1. Waive any and all rights or powers to request or require a filing in court of an
account of the administration of the Estate and/or a petition for distribution of the Estate, and
all like and similar filings and documents;
2. Declare that the undersigned has examined the attached Informal Account (and
Statement/Schedule of Distribution) of the Executors; finds it to be true and correct in all
particulars to the best knowledge and belief of the undersigned; accepts and approves it with
the same force and effect as if it had been prepared and filed with, audited, adjudicated and
confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal
and income had been awarded by the Court in accordance with the Statement/Schedule of
Distribution;
1 of 3
3. Warrant that to the best knowledge and belief of the undersigned, the
beneficiaries named in the Informal Account and Statement/Schedule of Distribution are the
sole parties in interest in the Estate and same are entitled to receive the entire distribution
thereof in accordance with the Informal Account and Statement/Schedule of Distribution;
4. Warrant that the undersigned knows of no outstanding and unsatisfied claims
against the Estate or liabilities of the Estate, and the undersigned approves the distribution of
the balance of principal and income shown in the Informal Account and Statement/Schedule of
Distribution to the persons and in the amounts set forth therein;
5. Absolutely, unconditionally, and irrevocably release and discharge the
Executors, and their respective heirs, personal representatives, successors and assigns, of and
from any and all actions, liabilities, claims and demands arising out of or relating in any way
to the administration of the Estate and distribution of the Estate in accordance with the
Informal Account and Statement/Schedule of Distribution, without a court accounting and
adjudication;
6. Agree to refund to the Executors the portion of any distribution made to the
undersigned which exceeds the amount the undersigned was properly entitled to receive as the
Executors finally determine or redetermine.
7. Agree to indemnify and hold harmless the Executors, and their respective heirs,
personal representatives, successors and assigns, from and against any claims, liabilities, loss
or expense (including without limitation litigation costs and attorney's fees) arising out of,
resulting from or in connection with the administration of the Estate and its distribution in
accordance with this document, including, but not limited to, any liability for any Federal
Estate and Gift Tax, Pennsylvania Inheritance tax or any other death taxes, and any federal or
2 of 3
Pennsylvania income taxes, and any penalties and costs incidental to any or all such taxes, and
also including, but not limited to, any assets received or payments or distributions made by
reason of any negligence or mistake of law or fact.
Dated: q- '~o - 07..-
J~es G. Fourlas/
COMMONWEALTH OF PENNSYLVANIA '
SS:
COUNTY OF _I;:~o0}q-~M''~'-
On this, the '~'~ day of ~ee4en/~,e--- , 2002, before me a Notary Public, the
undersigned officer, personally appeared James G. Fourlas, known to me (or satisfactorily
proven) to be the individual who executed the foregoing instrument, and duly acknowledged to
me that he executed the same for the purpose therein.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
NOTARIAL SEAI~
Janelle L. Hersh, No{ary Public
Harrisburg, PA Dauphin County
My Commission Exp[res March 4, 2004
3 of 3
APPROVAL OF ACCOUNT, RELEASE AND
INDEMNIFICATION AGREEMENT
The undersigned, Gust G. Fourlas, is one of the beneficiaries of the Estate of George
Fourlas, deceased, and desires that the Estate be distributed without the formality of a court
accounting.
The Executors of the Estate, John Fourlas and James G. Fourlas, are willing to consent
to such a distribution upon receipt of a release and indemnification from each beneficiary in the
form of this document. In consideration of the willingness of the Executors to make
distribution without a court approved accounting and petition for distribution, and with the
undersigned agreeing to be legally bound hereby and knowing the Executors are relying
hereon, the undersigned individually and on behalf of the undersigned's heirs, personal
representatives, successors and assigns, does hereby:
1. Waive any and all rights or powers to request or require a filing in court of an
account of the administration of the Estate and/or a petition for distribution of the Estate, and
all like and similar filings and documents;
2. Declare that the undersigned has examined the attached Informal Account (and
Statement/Schedule of Distribution) of the Executors; finds it to be true and correct in all
particulars to the best knowledge and belief of the undersigned; accepts and approves it with
the same force and effect as if it had been prepared and filed with, audited, adjudicated and
confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal
and income had been awarded by the Court in accordance with the Statement/Schedule of
Distribution;
1 of 3
3. Warrant that to the best knowledge and belief of the undersigned, the
beneficiaries named in the Informal Account and Statement/Schedule of Distribution are the
sole parties in interest in the Estate and same are entitled to receive the entire distribution
thereof in accordance with the Informal Account and Statement/Schedule of Distribution;
4. Warrant that the undersigned knows of no outstanding and unsatisfied claims
against the Estate or liabilities of the Estate, and the undersigned approves the distribution of
the balance of principal and income shown in the Informal Account and Statement/Schedule of
Distribution to the persons and in the amounts set forth therein;
5. Absolutely, unconditionally, and irrevocably release and discharge the
Executors, and their respective heirs, personal representatives, successors and assigns, of and
from any and all actions, liabilities, claims and demands arising out of or relating in any way
to the administration of the Estate and distribution of the Estate in accordance with the
Informal Account and Statement/Schedule of Distribution, without a court accounting and
adjudication;
6. Agree to refund to the Executors the portion of any distribution made to the
undersigned which exceeds the amount the undersigned was properly entitled to receive as the
Executors finally determine or redetermine.
7. Agree to indemnify and hold harmless the Executors, and their respective heirs,
personal representatives, successors and assigns, from and against any claims, liabilities, loss
or expense (including without limitation litigation costs and attorney's fees) arising out of,
resulting from or in connection with the administration of the Estate and its distribution in
accordance with this document, including, but not limited to, any liability for any Federal
Estate and Girl Tax, Pennsylvania Inheritance tax or any other death taxes, and any federal or
2 of 3
Pennsylvania income taxes, and any penalties and costs incidental to any or all such taxes, and
also including, but not limited to, any assets received or payments or distributions made by
reason of any negligence or mistake of law or fact.
Dated:
COMMONWEALTH OF PENNSYLVANIA ·
· SS:
COUNTY OF 12~UPH IN ~ ·
On this, the ~:gr.g day of
,2002, before me a Notary Public, the
undersigned officer, personally appeared Gust G. Fourlas, known to me (or satisfactorily
proven) to be the individual who executed the foregoing instrument, and duly acknowledged to
me that he executed the same for the purpose therein.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
NOTARIAL SEAL-. -" 'l
Janelle L. Hersh, Notary Public
Harrisburg, PA Dauphin County
My Commission Expires March 4, 2004
3 of 3
/BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX DTVTSXON
DEPT. 2806D1
HARRXSBURC, PA 17128-0601
JOHN FOURLAS
PO BOX 66
PLAINFIELD
COHNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
PA 17081
DATE 08-05-2002
ESTATE OF FOURLAS
DATE OF DEATH 0~-05-2002
FZLE NUNBER 21 02-0557
COUNTY CUNBERLAND
ACN 101
Amount Remitted
GEORGE
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGTSTER OF WTLLS
CUHBERLAND CO COURT HOUSE
CARLTSLE, PA 1701:5
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-154? EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF FOURLAS GEORGE FILE NO. 21 02-0:557 ACN 101 DATE 08-05-2002
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
1. Real Estate (Schedule A)
2.
$.
4.
6.
7.
8.
ORIGINAL RETURN
(1)
Stocks and Bonds (Schedule B) (2)
Closely Held Stock/Partnership Zntores~ (Schedule C) (5)
Hortgages/Notos Receivable (Schedule D) (4)
Cash/Bank DoposLts/HLsc. Personal Property (ScheduZo E) (5)
Jo/ntly Owned Property (Schedule F) (6)
Transfors (Schedule G) (7)
Total AssaYs
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expanses (Schedule H)
10. Dobts/Nortgago L/eb/lit/os/L/ens (Schedule Z)
11. Total Deduct/ons
12. Net Value of Tax Return
15.
14.
(9)
(10)
Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Net Value of Estate Subject to Tax
50zO00.O0
.00
.00
.00
106z:550.51
2~z95:5.68
.00
(8)
8,569.60
.00
NOTE: To /nsure proper
credit to your account,
subm/t the upper port/on
of th/s form with your
tax payment.
NOTE:
X'P an assessment was lssued previously, 11nes 1~,, 15 and/or
181,Z8~.19
(11) 8.5~9. &fl
(~2) 172,71~.59
(15) 5,000. O0
(~) 167,71q. 59
reflect figures that include the total of ALL returns assessed to date.
16, 17, 18 and 19 will
7,169.80
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
7,5~7.16
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
ASSESSHENT OF TAX:
1.6. Amount of L/ne 14 at Spouse1 rate
16. Amount of L/ne 14 taxable a~ L/neaX/CXass A rate
:17. Amount of L/no 14 at S/bl/ng ra~e
18. Amount of L/ne 14 taxable a~ CoXXataral/Class B ra~e
19. PrinclpaX Tax Due
TAX CREDXTS:
PAYH~NT KECE/PT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID
06-19-2002 CD001:507 :577.
AHOUNT PAID
(~5) .00 x O0 = .00
(16) 167,71~.59 x 0~5= 7,5~7.16
(17) . O0 x 12 = . O0
(18) .00 x 15 = .00
(19)= 7,5~7.16
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will .o.
Admin. No. ~-- dJ-~"7
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State w~ether administration of the estate is complete:
Yes_~ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal rep~e/sentative file a final
account with the Court? Yes Now'-.
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.~/ No
d. Copies of receipts, releases, joinders and.
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 4/GP/vA
77
Hgna~ur~
Name (Please type or print)
Address-
Tel. No.
Capacity:
Personal Representative
(MAH:rmf/AM3)
__Counsel for personal
representative