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REV-1500 EX + (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA REV-1500 /6-~~- ~
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT c2/ 01 /07
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Westcoat Curtis G 172-07-1587
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
12/08/1997 02/21/1914 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- -
B 3. Remainder Return
CHECK ~' Original Return ~' Supplemental Return (date of death prior 10 12-13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
~ate of death after 12-12-82)
PRIATE 6. Decedent Died Testate 7. eeeden! Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) ~ltaCh a eopy of Trust)
BLOCKS 9. Litigation Proceeds Received 10. pausal Poverty Credit (date of death between D 11. Election to tax under Sec. 9113(A)
12-31-91 and 1-1-95) (Attach 5ch 0)
tfji$_iQNrMj)jftIi!I$QPMeMttll'P;Il('Q~~!l~l1UlNijp.INiitNlljlj~l!tlQiIi.llm~i!IlI!lm;it.!t9i
NAME COMPLETE MAILING ADDRESS
COR- Jered L. Hock, Esquire 3211 N. Front St. ; PO Box 5300
RE- FIRM NAME (If Applicable) Harrisburg, PA 17110-0300
SPON
DENT Metzger Wickersham
TELEPHONE NUMBER
717-238-8187
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) 0
2. Stocks and Bonds (Schedule B) (2) .,.,6
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) .0
4. Mortgages & Notes Receivable (Schedule D) (4) 0
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 1,626 ,
6. Jointly Owned Property (Schedule F) --..
D Separate Billing Requested (6) 2,358
RECA-
PITULA- 7. Inter - Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) 0
8. Total Gross Assets (total Lines 1-7) (8) 3,983
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 881
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 45,004
11. Total Deductions (Iotal Lines 9 & 10) (11) 45,885
12. Net Value of Estate (Line 8 minus Line 11) (12) (41,902)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (41,902)
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (aX1.2) 0 X .0 00 (15) 0
TAX 16. Amount of Line '4 taxable at lineal rate 0 X .0 0.06 (16) 0
-
COMPU- 17. Amount of Line 14 taxable at sibling rate 0 X .12 (17) 0
TATION 18. Amount of Line 14 taxsbleat collateral rate 0 X .15 (18) 0
19. Tax Due (19) 0
20. D lea~KH~ii!giftg)ij@j~~~A!l~ilIPQF~~!ll!l\Wi!~1
.. .. . .................................."'.""i'::','",,,:"":'}}~*a~.:$!Jlll;}Iq.AN$W~!M!4:QlJe$11pN!1tQI'lPA~:;!'ANQ.R~PHlre!'!'MAIHi!#':}::':'"
o PA 15001
NTF 29755
Copyrighl2000 Greatland/Nelco LP - Forms Software Only
Estate of
Name
Address
Tax ID
172-07-1587
Executors (Page 1)
Donna J. Anke
1692 West Lisburn Road
Mechanicsburg. PA 17055-
175-30-3028
PA REV-1500 EX (6-00)
Page 2
Decedent's Comolete Address:
STREET ADDRESS
c/o 1692 W. Lisburn Road
Cumberland County
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
o
o
o
o
Total Credits (A + B + C)
(2)
o
3. InteresVPenalty if applicable
D. Interest
E. Penalty
o
o
Total Interest/Penalty (0 + E) (3)
4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BAlANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
o
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......................PLEASEANSWER.THEFOLLOWINGOUESTIONSBYPLACINGAN';X:;...INTHEAPPROPRIATEBLOCKS...........
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. 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 behef, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of
which re arer has an knowled e.
SIGNAT' OF PERSO E~NSiSLE FOR FILING RETURN DATE _
lc ([.t,cl&- '72.!> :J.60;L
Yes No
~ ~
B ~
D
~
Lisburn Road
REPARER OTHER THAN REPRESENTATiVE
PA 17055
AD
3211 N. Front St.; PO Box 5300
Harrisburg, PA 17110-0300
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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 survivln9 spouse Is':3%' .
[72 P.S. 19116 (a) (1.1) {i)J.
For dates of death on or after January 1, 1995, the tax rate Is Imposed on the net value of transfers to or for the use of the surviving spouse Is 0% (72 P.S. 119116 (a) (l.l)(ii)].
The statute doFt!:: nnt .."..mnt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fillnga tax return are stili 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.li9116{aXl.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.li 9116(1.2) [72 P.S.1I9116(a)(1)].
The tax rate Imposed on the net value of transfers to or lor the use of the decedent's siblings Is 12% /72 P.S. 19118(aXl.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.
o PA 15002
NTF 29756
Copyright 2000 Greatland/Nelco LP - Forms Software Only
REV -1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
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 property 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.
SCHEDULE A
REAL ESTATE
FILE NUMBER
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
9 PA 15021 NTF 10871
Copyright 1999 Greatland/Nelco LP - Forms Software Only
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
REV -1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
9 PA15031 NTF 10872
Copyrighl1999 Greatland/NelcCl LP - Forms Software Only
TOTAL (Also enter on line 2, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
o
REV -1504 EX + (1-97)
SCHEDULE C
CLOSELY-HELD CORPORATION
PARTNERSHIP or SOLE-PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent,
other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships.
FILE NUMBER
ITEM
NO.
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
9 PA15041 NTF 10873
Copyright 1999 Greatland/Nelco LP - Forms Software Only
TOTAL (Also enter on line 3, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
o
REV-1507 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
Curtis G. Westcoat
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NO. DESCRIPTION
1.
VALUE AT DATE
OF DEATH
9 PA 15071 NTF 10874
Copyrighl1899 Greatland/Netco LP - Forms Software Only
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
REV-150B EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
Include proceeds of litigation & date proceeds were received by the estate. All prop. jointly-owned with right of survivorship must be disclosed on 5ch. F.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ITEM
NO.
11.
DESCRIPTION
VALUE AT
DATE OF DEATH
Penn State University -
reimbursement checks for
healthcare
1,626
9 PA 15081 NTF 10875
Copyright 1999 Greatland/Nelco LP - Forms Software Only
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,626
REV -1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Donna J. Anke
ADDRESS
1692 West Lisburn Road,
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Daughter
B.
C.
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
Include name of financial institution and bank
ITEM FOR MADE account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
JOINT
NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
11. A A. 06/24/1995 Allfirst Bank Account
Account #13-32114-5 4,715 50.000 2,358
TOTAL (Also enter on line 6, Recapitulation) S 2,358
9 PA 15091
NTF 10876
(If more space is needed, insert additional sheets of the same size)
CopyrIght 1999 Greatlal'ld/Nelco LP - Forms Software Only
REV-1510EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECD & DATE OF TRANSFER.
NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1.
TOTAL (Also enter on line 7, Recapitulation) $ 0
9 PA 15101
NTF 10877
Copyright 1999 Greatland/Nelco LP - Forms Software Only
(If more space is needed, insert additional sheets of the same size)
REV-1511EX+ (1-97)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reponed on Schedule I
ITEM
NO. DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
1 Raymond A. Westcoat, son -
reserve for reimbursement for
unpaid funeral/cremation
expenses 159
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number(s)/EIN No. of Personal Representative(s) - -
Street Address
City State Zip
Year(s) Commission Paid:
.2. Attorney Fees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) 336
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 36
5. Accountant's Fees
6. Tax Return Preparer's FeesMetzger, Wickersham, Knauss & Erb, P.C. 75
7.
1 Metzger, Wickersham, Knauss &
Erb, P.C. - reserve to pay
fees ( estimated) 175
2 Register of Wills - fee for
filing Inheritance Tax Return 15
3 Register of Wills - filing
Renunciations 15
Total from continuation pages 70
TOTAL (Also enter on line 9, Recapitulation) $ 881
(If more space is needed, insert additional sheets of the same size)
9 PA15111 NTF 10878
Copyright 1889 Grealland/Nelco LP - Forms Software Only
Estate of: Curtis G. Westcoat
Item
No. Description
4 Reserve for closing
5 Reserve for filing Releases
Schedule H part 2 (Page 2)
Amount
Total (Carry forward to main schedule)
50
20
70
REV -1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
Include unreimbursed medical expenses.
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
DESCRIPTION
AMOU NT
1.
1 Donna J. Anke - reimbursement
for attorney fees paid
412
2 Department of Public Welfare -
medical expenses within 6
months of death
13,108
3 Department of Public Welfare -
remaining claims
31,484
9 PA 15121
NTF 10874
TOTAL (Also enter on line 10, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
45,004
Copyright 1999 Greatland/Ne\co LP - Forms Software Only
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Curtis G Westcoat
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (a) (1.2)]
1
1. bonna J. Anke
~692 West Lisburn
kechanicsburg, PA
Road
17055
2
poreen W. Cronrath
960 Camelia Avenue
Baton Rouge, AL 70806
3
Laurel L. Westcoat
104 N E Coachman Road
Clearwater, FL 33765
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Daughter
Daughter
AMOU NT OR SHARE
OF ESTATE
o
o
o
ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV-1500 COVER SHEET
II NON- TAXABUE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN EUECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABUE AND GOVERNMENTAL DISTRIBUTIONS
1.
o PA 15131
TOTAL OF PART II -- ENTER TOTAL NON- TAXABLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
NTF 33293
Copyright 2000 Greatland/Nelco LP - Forms Software Only
o
Estate of: Curtis G. Westcoat
Item
No.
4
Description
Raymond A. Westcoat
1810 West End Avenue
Pottsville, PA 17901
Schedule J part 1 (Page 2)
Relation
Amount
Son
o
Total (Carry forward to main schedule)
o
REv-1514 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
ESTATE OF
Curtis G. Westcoat
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found
in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will 0 Intervivos Deed of Trust 0 Other
":;;:;;,,,"\)')"\ ,':,\: ','":;;:;;""",,,,')',,':,,: ,':)) ')',,",)):,)),:,':',:,IlI'FEnl!SlVliTliW.lNTEaISl?CAliCUIlATlON:,:,::;;:;;",,",.,.......................
(Check Box 4 on Rev-15llO Cover Sheet)
FILE NUMBER
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE is
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
D Ufe or n Term of Years
D Ufe or n Term of Years
n Life or D Term of Vears
n Ufe or D Term of Years
1. Value of fund from which life estate is payable $ 0
2. Actuarial factor per approriate table 0
Interest table rate -- 3 1/2% 06% 010% o Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) $ 0
"''''''''''''''''''''''''''''''''''''''}':':':':',:,:,:??"?,,,'?9\\NNlllITlt'lllttEaEST::CAliClIlIlATlON::?'} "...
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
n life or 0 Term of Years
o life or n Term of Years
o life or n Term of Years
o life or n Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corre[Onding (nUmbeB
Frequency of payout - - 0 Weekly (52) Bi-weekly (26) Monthly (12)
o Quarterly (4) 0 Semi-annually (2) Annually (1) Other ( )
3. Amount of payout per period
o
o
$
o
4. Aggregate annual payment, line 2 multiplied by line 3
5. Annuity Factor (see instructions)
Interest table rate 0 3 1/2% 0 6% 0 10%
o
o Variable Rate
%
o
6. Adjustment Factor (see instructions)
7. Value of annuity -- If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is: line 4 x line 5 x Line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x line 6) + Line 3
o
$
o
$
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NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G
of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
9 PA15141 NTF 10881
Copyright 1999 Greatland/Nelco LP - Forms Software Only
REV -1647 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST
COMPROMISE
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Curtis G. Westcoat
This schedule Is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
nW1I1 n Trust n Other
I. Beneficiaries
NAME OF AGE TO
BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1,1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
n Unlimited right of withdrawal n Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest. . . .. ............ ....................... ......... $ 0
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) . . . . . . . . . $ 0
3. Value of Une 1 passing to spouse at appropriate tax rate
Check One o 6%, 0 3%, 0 0% . . . . . . . , . ........... $ 0
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 Taxable at lineal rate
Check One 06%,045%. ..... ... $ 0
(also include as part of total shown on Une 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ...... $ 0
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) . $ 0
7. Total value of Future Interest (sum of lines 2 thru 6 must equal line 1) $ 0
o PA 16471
NTF33294
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 Greatland/Nelco LP - Forms Software Only
REV-1649 EX + (1-97)
COMMONWEALTH OF
PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Curtis G. Westcoat
Do not complete this schedule unless estate is making election to tax assets under Section 9113(A) of Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust(marltal, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the
election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property
is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of
the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable
asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement.
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
FI LE NUMBER
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION VALUE
Part A Total $
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
9 PA 16491
NTF 10882
Part B Total $
(If more space is needed, insert additional sheets of the same size)
o
Copyright 1999 Greatland/Nelco LP - Forms Software Only
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Curtis G. Westcoat
Date of Death: 12/08/1997
Will No. 21-01-0107
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 . State whether administration of the estate is complete:
Yes X No
2 . If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3 . If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
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 X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clcrk of "" """"'"' Co"" "'" ~y be _h'" ~
Date: ---d z-C5{O) .~
Sl
Jered L. Hock Esauire
Name (Please type or print)
3211 N. Front St., PO Bax 5300
Harrisbura PA 17110-0300
Address
en
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LLI co
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(717) 238- 8187
Tel. No.
Capacity :
Personal Representative
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Counsel far personal
representative
uJ
JRD/June 30, 1992/17858
JAN 1 2 2005
'fI'"
Estate No.: 21-01-0107
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYL V ANlA
In Re: Estate of Curtis G. Westcoat
Late of South Middleton Township
NO. 21-01-0107
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: Donna J. Anke
Counsel for Personal Representative: Jered L. Hock
Date of Decedent's Death: 12/08/1997
Date of Delinquency Notice: 01110/2005
The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk ofthe Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on
November 10, 2004, and that the ten (10) day notice to file the Status Report has expired.
Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and
the undersigned requests that a Court conduct a hearing to determine whether sanctions should
be imposed upon the delinquent personal representative or counsel for the delinquent personal
representative.
Date: 01/1312005
6-=~
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
'Y\\A.'<:.c.>>v If, 'J,60S q:~cAM
A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to
the hearing date, the hearing will automatically be cancelled.
od
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Curtis G. Westcoat
also known as
No. --.!lJ-O 1- 0 10-7
To:
Deceased.
Register of Wills for the
County of Cumber land in the
Commonwealth of Pennsylvania
Social Security No. 172-07-1587
The petition of the undersigned respectfully represents that:
Your petitioner(:a), who is/~ 18 years of age or older, appLies
for letters of administration
on the estate of
(d.b.n.; pendente lite: durante absentia: durante minoritatc)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 1692 West Lisburn Road, South Middleton. Township,
Mechanicsburg, Cumberland County, PA (list street, number, Twp. or Bora.)
Decedent, then 83 years of age, died December 8
at Carlisle Hospital. Carlisle. Pennsylvania
,19 97
.
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
situated as follows:
$
$
$
$
$4,500.00
Petitioner__ after a proper search ha~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
~Laurel L. Name Relationship Residence
Westcoat Daughter 2104 N E Coachman Rd. ; Cl
Doreen W. Cronrath Daughter 960 Camelia Ave.: Baton
Ravmond A. Westcoat Son 1810 W. End Ave.. Pottsv
Donna J. Anke Daughter 1692 W. Lisburn Rd.: Mec
earwat33'6SL
Rouge, LA
1.lle, pl0806
hanicsb~t2~lpA
176:>5
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
-
~
~
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Donna J. Anke
1692 West Lisb
Mechanicsburg, PA
Road
17055
ILP-,205 - 5-
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
} 55
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
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
~gQ,L
.-.
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...
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as
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Vi
a
No. ~ 1-01 -0/01
Estate of
Curtis G. Westcoat
, DeCeased
GRANT OF LETTERS OF ADMINISTRATION
'----... f\N. '2 S-
AND NOW t'\ ~ 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Donna J. Anke
is/at~ entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
Donna J. Anke
i;;the estate of -----curtis G'. Westcoat--
FEES
75.0D
Letters of Administration ..... $ '-
lo ' CJD
Short Certificates( ).......... $ -
-
Renunciation ..... ~ : 5.
TOTAL_$ ~.~
Filed ..................... A.D. P9 2001
Jered L. Hock, Esquire (19211)
ATIORNEY (Sup. Ct. I.D. No.)
P.O. Box 5300
Harrisburg, PA 17110-0300
ADDRESS
(717) 238-8187
PHONE
1\~LE:b TO A TT"1.
II \ (h ~.n" \~ rv qf~(,
This is to certify that the information here given is correctly copied from an original certificate of death duly tlIed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~ fl? ~~~r-
Fee for this certificate, $2.00
Local Registrar
4689178
DEe 0 9 1997
Date
143 Rev. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
lb.
SEX
2. Mate
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
NAME OF DECEDENT (First. Middle. last)
1. CWl.ti-6 GM -i.ef.d We.-6te.oat
AGE (LasI8irlhday) UNDER 1 YEAR UNDER 1 DAY
Month$ Days Hours Minutes
3. 172
07 - 1587
DATE OF DEATH (Month, Day. Year)
.. De.e. e.mb eJt. 8, 1 997
1..
FATHER'S NAME (First. Middle. last)
18. J. C We.-6te. oat
INFORMANT'S NAME (Type/Plinl)
2~.Mk. Raymond We-6te.oat
METHOD OF DISPOSITION
. . Suria. 0 crem8tion~ Removallrom State 0
OonatlOll 0 her (Speedy
. 21a.
SIGNJIJ"URE 0
17b. Count
Did
decedent
liveina
lownship?
g~=lIY)O
83 Vrs
5.
COUNTY OF DEJIJ"H
CumbeJt.f.and
BIRTHPLACE (City and PLACE OF DEATH (Check only one see instructions on olhef side)
State or Foreign CountlY) HOSPITAL:
Me.Ke.e-6poftt, PA InpOlienl~ ERlO"'pa"en'O DCA 0
7. a..
FACILITY NAME (II not institution, give street and number)
RACE. American Indian, Btack, White, elc
(Specify)
Wh-i.te.
...
DECEDENT'S USUAL OCCUPATION
(~;v:~iki~~~I~~dri'::teu~(;~~r~Jr
. "0. Owne.ft j1bSeJt. v..i.e.e. station
DECEDENT'S MAILING ADDRESS (Street, CitvflOwn, State. Zip Code) DECEDENT'S
C/O 1692 We.-6t U-6bWl.n Road ~~~~D'tNCE
Mee.han..i.e.-6bWl.g, PA 17055 :;'~I~:,"~~~flS
WAS DECEDENT EVER IN
US. ARMED FORCES?
Ve.O NO~
DEC,DENT'S EDUCATION
S if onl hi hast rade com et
ElementsrylSecondaf'j eonege
(0.12) 8 (Hm5+)
13.
SURVIVING SPOUSE
(If wile, give maIden name)
12.
17.. State
PA
Cumbefttnad
17c.O Yes,decedenllivedin
'wp
LICENSE NUMBER
city/bora.
PA 17901
DJIJ"E OF DISPOSITION
(Monlh.DayYe..) 12-11-97
o
21b.
21c.
17109
230.
TIME OF DEATH
ORE PRONOUNCED DEAD (Month. Day. Year)
I;;J I B I
NoD
24. M. 25.
27. PART I: Enler the disea.ses. injuries or complications which caused the death. Do not enter the mode of dying, such SiS cardiac or respiratory arrest, shock or heart failure
Ust only one cause on each line
/\
PART I : Other significant conditions contfibu\ing \0 death, but
not resulting in lhe Underlying causa given in PART I
Natural
g-
O
o
DATE OF INJURY
(Monltl. Day. Year)
TIME OF INJURY
DESCRIBE HOW INJURV OCCURRED
Sequentialty Iisl conditione
il any, leading 10 immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury
. . thallnlllaled events
(esulting in dealh) LA.ST
d.
WEAE AUTOPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
MANNER OF OEATH
INJURY AT WORK?
Homicide
o
o
o ~~'ce OF INJURY - AI home, far~~:~eet, factory, office
buildil19. etc. (Specily)
3~.
Ves 0 NoD
No
ve.O
NO~
Accident
Pending In\/eSligalion
Could nol be determined
M. 3Ot:.
Suicide
o
2... 28b.
CERTIFIER (Check only one)
.CERTlF'VIMG PH"S~'AH \PhYSICian certllYlng cause of death when anolhef phYSICIan has pronounced death and completed lIam 23)
To the bellt of my knowledge, death occurred due 10 the cauN{a) and mannena.tated.........................................,..
29.
. PRONOUNCING AND CERTIFYING PHYSICIAN (Ptlysician both pronouncing death and cerhlYlng to cause 01 death)
To the beat of my knowledge, death occurredal theUme, data, andptace..nddull'o~c.uM(a)andm.nner.. a'.led...... _...........
"MEDICAL EXAMINER/CORONER
On 'he baal. of examination end/or Inve.tlgatlon, In my opinion, deeth occur," at the time, de'l, .nd place, and due to the ceu..(a) end
menner e. I'atect.. " . . .. . . . . . . . . ., . . . . .. . . . . . . . . . . . . . .. . ., . ..' . . " . . . . .,. . .. . . .. .. . .., . . .. ........ . . .... .. . . , . ... .
31..
REGISTRAR'S SIG.NATURE AND~
.:7/ . b<1/ ~I /1 /1
32
DATE FIlED (Month, Day. Yea.f)
90
34.
/0
1'17?
CUMBERLAND
Register of Wills of ~ County, Pennsylvania
RENUNCIA TIO.N
Estate of
Curtis G. Westcoat
No. 9./-01-D 101
also known as
, Deceased
The undersigned,
Laurel L. Westcoat, daughter
(Relationship) (Capacity)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration
be issued to
Donna J. Anke
Witness ~ hand t .
FL 33765
--- ---.-...------.---.----
(Signature)
(Address)
(Signature)
(Addressl
Sworn to or affirmed and subscribed
before me this ..23 U-- day of
~/~~ ,1cS: 2000.
"--tIllAJ a .~u /hr
Notary ~blic
My Commission Expires: 5.b%l
ISillruuure .,d llelt! 01 NOf.... 01 o,h~1 ollir.i....
NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
IIUIlf.livd Ie.l IIdrllinj.1t~1 (),Illh.. Show dlllt:: III
CllplIlIIUon (If NOla,v'. CQ(t1JTtlSlHCIfI.I
RW-13 (Rvsd 9/92)
NO'I'MV PUIUC. STATE OF FlORllM
CAROL J. BRADLEY
COMMISSION # CC649505
EXPIRES 512012001
BONDED THRU ASA 1-888-NOTARY1
CUMBERLAND
Register of Wills of ~ County, Pennsylvania
RENUNCIATION
Estate of
Curtis G. Westcoat
No. -21-0 }-o 101
also known as
, Deceased
The undersigned,
Raymond A. Westcoat, son
(Relationship) (Capacity)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully reQuest(s) that
Letters of Administration
be issued to
Donna J. Anke
Witness
hand this
~ d'V of J . .' U 2000
I~tr!i!: ~ ~----
Raymond A. Westcoat
1810 West End Avenue; _~~!:t:.?~~1J_e! PA.l L9gL___
(Address)
(Signature)
r~ ",
(Address)
(Signature)
(Address)
otary Public \ '}
y. Commission Expires:\ ~ Dh
tSigflllllllt: ftl'\d llCaI 01 No'.,... 01 O1hel ol1jcifll
NOTE: Renunciations executed outside the Office of Register of
Wills are requited in some counties to be notarozed.
'IUlllllted to .-dntinisltn o.8ths. SlIClW UtUIl 01
C'.p'fl'll'Ofl of Notary'tl C0I'1WTl1lS.,Ofl.1
__~=JUSTICt.
_- 5::.,..-
JAMES K. REILEY
DISTRICT COURT #21 S 01
200 NORTH CENTRE STREET
POTISVlLlE, PA 17901
RW-13 (R~~,9181
CUMBERLAND
Register of Wills of ~ County, Pennsylvania
RENUNCIATION
Estate of
Curtis G. Westcoat
No. ~1-OI-IOl
also known as
. Deceased
The undersigned,
Doreen Cronrath, daughter
(Relationship) (Capacity)
of
the above Decedent, hereby renounce{s) the right to administer the estate and respectfully request{s) that
Letters of Administration
be issued to
Donna J. Anke
Witness
h,od thi, d<, I~ d" of S- 'l~ be.e__ u 2000
~r. 0flmtUbL
W. (Signature I
Doreen Cronrath
1~27 B 3lLeet. LiReoln,
(Address)
~}:___~8_5Q2 ~{JO CorneliA. W~~
.13iilA-;-;tCU:~, LA IO~
(Signaturel
(Addressl
(Signature)
(Address)
(Stilnlllu,e N1d Kill 0' NOI.''l' Of oHIIl!'! oth<'.tRl
NOTE: Renunciations executed outside Ihe Olfice 01 Register of
Wills are required in some counties 10 be notarized.
c,vnhfl4fd 10 Adnlil"lislc, nalhs. SlI(lW dllle (II
tlkp""IIOfl (II NOlafr'. COftlflllSSlOfI.I
RW-13 (Rvsd 9/92)
E
---
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent
Date of Death
Will No.: 2001-00107
Curtis G. Westcoat
December 8, 1997
Admin. No.:
To the Register:
I hereby certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on February I ~001 .
Name
Address
Laurel L. Westcoat
2104 N E Coachman Road: Clearwater, FL 33765
Doreen W. Cronrath
960 Camelia Avenue: Baton Rouge, LA 70806
Raymond A. Westcoat
1810 West End Avenue: Pottsville, PA 17901
Donna J. Anke
1692 W. Lisbum Rd.: Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: February f":"2001
~~
SIgnature
Name Jered L. Hock, Esquire
Address 3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
Telephone
(717) 238-8187
Capacity:
Personal Representative
X Counsel for Personal
Representative
Document #: 196974.1
C-/
ST A TUS REPORT UNDER RULE 6.12
Name of Decedent
Date of Death
Will No.
Curtis G. Westcoat
December 8, 1997
Admin No.
2001 - 00107
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No. X
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: May 31, 2002
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No
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 Clerk of the Orph ' Court and may be attached to this report.
c~~-cL
Date: February ::Yl , 2002
Signature
Name Jered L. Hock, Esquire
M
'~:
Address 3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
...-
I
,....-
:::1:
::ii.::
Telephone
(717) 238-8187
d:
N
P
...'a.....i:
:r! ~
...,.r",:
~........
Capacity:
Personal Representative
X Counsel for Personal
Representati ve
Document #: 228094.1
'. I
G; ./
L"
STATUS REPORT UNDER RULE 6.12
Name of Decedent
Date of Death
Will No.
Curtis G. Westcoat
December 8, 1997
Admin No.
2001 - 00107
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion ofthe administration ofthe above-captioned estate:
1. State whether administration of the estate is complete:
Yes No. X
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: on or about April 30, 2004
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
b. 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 X No
Further informal account will be provided to creditorslheirs.
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the ~ may be attached to this report.
Date: December cr, 2003
Signature
Name Jered L. Hock, Esquire
Address 3211 North Front Street
P.O. Box 5300
Harrisburg, P A 17110-0300
Telephone
(717) 238-8187
Capacity:
Personal Representative
X Counsel for Personal
Representative
294071-1
~-b - .rQ, 06--..s-
'" BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
.,1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-10-2002
WESTCOAT
12-08-1997
21 01-0107
CUMBERLAND
101
JERED L HOCK ESQ
METZGER WICKERSHAM
PO BOX 5300
HBG PA 17110
'*
REV-1541 EX AFP 101-02>
CURTI S
G
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS __
REV=i5'4-j-EX-AFP--COY=02Y-NOTICE--OF-YNHERITAtfCE-TAX-APPRirisEirENT~--ALi-oWANCE-ori-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WESTCOAT CURTIS G FILE NO. 21 01-0107 ACN 101 DATE 09-10-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 = .00
.00 X 06 = .00
.00 X 00 = .00
.00 X 15 = .00
(19)= .00
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
1.626.00
2.358.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
881.00
45.004.00
(11)
(12)
(13)
(14)
NOTE: I~ an assessment was issued previOUSly, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
3,983.00
45.885 00
41,902.00-
.00
41,902.00-
.
nuncn K~[;EJ.f'1 l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/6 -c:;;oC-.,s-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BURtAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
DONNA WANKE
C/O 1692 W LISBURN RD
MECHANICSBURG PA 17055-0000
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
REY-16D4 EX AFP <12-00)
09-10-2002
WESTCOAT
12-08-1997
21 01-0107
CUMBERLAND
172-07-1587
98116339
Amount Rami Had
CURTIS G
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-l&04 EX AFP (12-00)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 09-10-2002
ESTATE OF WESTCOAT
CURTIS
G DATE OF DEATH 12-08-1997
COUNTY
CUMBERLAND
FILE NO. 21 01-0107
ADJUSTMENT BASED ON:
S.S/D.C. NO. 172-07-1587
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
98116339
FINANCIAL INSTITUTION: DAUPHIN DEPOSIT BNK S TR CO ACCOUNT NO.
13-32114-5
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 06-24-1995
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions -
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
.00
.00
.00
.00
(CR),
R.i~1470 EX (6-88)
--. *
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
CURTIS G. WESTCOAT 2101-0107
REVIEWED BY ACN
Phyllis Hoch 98116339
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
ADJUSTED ABOVE ACN TO ZERO. REPORTED ON PROBATE RETURN.
ROW
PaQe 1
v
\
STATE OF
PENNSYL VANIA
CUMBERLAND
COUNTY
STATEMENT AND PROOF
OF CLAIM
FILE NO:
2000-107
Estate ofB4 DESIGN INC
I, Howard A. Enders, Esq. on behalf of ADV ANTA BUSINESS CARDS located at 40 E
CLEMENTON RD, GIBBSBORO, NJ 08026 submit the following claim against the
estate
for the sum set forth.
DECSRIPTION VALUE
ADV ANTA ACCOUNT # 5477538671750018
AMOUNT DUE $6,358.76
OUR FILE # 190302
There is now due on the claim, above all legal set-offs, the sum of: $6,358.76
Notice to interested persons: This is a claim by a personal representative. This claim
will be allowed unless notice of an objection by an interested person is delivered or
mailed to the personal representative not later than
~
.
r-. ~)
.,
-:.1
. e and that its contents are true to the best
.
-'
I....
I
'.
Howard A. Enders, Esq., General Counsel
'Io.,t.':'-~fttell.tt:rp"" ~. PI itl~ "f lr v J YM JH_
J
The Creditor's Rights & Bankruptcy Group
A Division of Phillips & Cohen Associates, Ltd.
695 Rancocas Road
Address
.:;.
; "j - ~
Westampton, NJ 08060 609-518-9000
City, State, Zip Telephone
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c..)
\
PROOF OF SERVICE OF CLAIM
I served upon ATTY-JAMES FLOWERS
Name
fiduciary, a copy of this claim on September 23,2005 by REGULAR MAIL
Date State manner and address of service
~
.:
~.IJY
~
ACCEPTANCE OF SERVICE
Service of the attached claim is accepted.
Date
Signature
I'.)
C0
e
~
';-.,.)
J
.)
..
To whom it may concern,
Due to the voluminous nature of the documentation supporting this claim,
the following account summary is provided:
SUMMARY OF ACCOUNT
1. ACCOUNT NUMBER: 5477538671750018
2. NAME IN WHICH CARD ISSUED: DESIGN INC,B4
3. PRIMARY CARD HOLDER(S): WILLIAM C BREHM
4. OPEN DATE: JUNE 12, 2002
5. CREDIT LIMIT: $4,435.00
6. FINAL BALANCE: $6358.76
7. PRIMARY USE OF CARD: Purchases
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