HomeMy WebLinkAbout01-0027
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY G
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FILE NUMBER
&L-CL 000;;1,'1-
COUNTY CODE YEAR - NUMBER"':' -
SOCIAL SECURITY NUMBER
116 34
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D'Angelo, Quirino
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
December 16, 2000 January 27, 1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
[] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate ("\\am copy 01 Will)
o 9. Litigation Proceeds Received
7463
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-62)
o 7. Decedenl Maintained a living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (dateoldeatl1 between 12-31-91 and 1-1-95)
o 3. Remainder Return (date 01 death prior to 12-13-(2)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax. under Sec. 9113(A} (Attach Sch 0)
1. Real Estate (Schedule A) (1) 87.000
2. Stocks and Bonds (Schedule B) (2) Nnn~
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1,000
Z (Schedule E) 138,778
0 Jointly Owned Property (Schedule F) (6)
~ 6.
o Separate Billing Requested
None
::l 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
I- (Schedule G or L)
0:: Total Gross Assets (total Lines 1-7)
<( B.
(,) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,454
W
~ Debts of Decedent, Mortgage liabilities, & Liens (Schedule 1) (10) None
10.
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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NAME
David W.
Knauer,
Esquire
COMPLETE MAILING ADDRESS
411A East Main
Mechanicsburg,
street
PA 17055
OFFICIAL USE ONLY
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(8) 226.778
(11) 14,454
(12) 212.324
(13) None
(14) 212,324
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
212,324
x.O_ (15)
45 9,555
x.O_ (16)
x .12 (17)
x .15 (18)
(19) 9,555
FIRM NAME (II Applicable)
TELEPHONE NUMBER
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
20.0
Decedent's Complete Address:
STREET ADDRESS 821 North Walnut Street
Mechanicsburn. PA 17055
CITY I STATE I ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
9,555
None
Total Credits (A+ B+ C)
(2)
3. InteresUPenalty ~ applicable
D.lnterest
E. Penalty
4.00
TotallnteresVPenalty ( 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.
(5)
(SA)
9,555
4
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
9,559
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......... ......................... .......................... 0
b. retain the right to designate who shall use the property transferred or its income;.. ................ .................... 0
c. retain a reversionary interest; or..w..... ............................. ... 0
d. receive the promise for life of either payments, benefits or care? ................ ..."...................... ................ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........... ...................... ......... .............. ........................ ........ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...... ...............". ...................'" ...............................
No
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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 lhal J have €.llamined lhis return, including accompanying SChedules and statements, and to the best of my knowledge and belief. it is lme, correct
and complete
Declaration of preparer other Ihan the personal representative is bas €d on all information of which preparer has any knowledge.
ADDRESS
411A East Main Street. Mechanicsburq. PA 17055
OJu
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 Dr for the use of the surviving spouse is 3%
[72 P.S. 99116 la) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 991t8 (a) (1.1) (Ii)].
The statute does not exemDt 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 Juiy 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(I)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(I.3)]. A sibling is defined, under Seclion 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Quirino D'Angelo
FILE NUMBER
2001;:'00027
All real property owned solely or as a tenant in common must bf, reported at fair market value. Fair marKet ....alue 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
survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
821 North Walnut street,
PA 17055 (Tax parcel No.
Mechanicsburg
18-22-0519-339)
$ 87,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 87, 000. 00
(If more space is needed, insert additional sheets of the same size)
REV-1508EX.(1-97)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Quirino D'Angelo
FILE NUMBER
2001-00027
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Sch9dule F,
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Home Furnishings
$500
2
Jewelry
$500
TOTAL (Also enter on line 5, Recapitulation) $1, 000
(If more space is needed, insert additional sheets of the same size)
REV"""'''.''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Quirino D'Angelo
SCHEDULE F
JOINTL Y.OWNED PROPERTY
FILE NUMBER
2001-00027
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
ADDRESS
RELAT10NSH1P TO DECEDENT
A.
Santina Peterson
3503 Beech Run Lane, Mechanicsburg
PA 17050
Daughter
.
B.
c.
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY . %0' DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for iointly-held real estate. VALUE OF ASSET lNTEREST DECEDENT'S INTEREST
1. A. 5/95 Mellon Bank Acct # 100020329 1'1,.38<l.:Z2 50 5,692.11
A Mellon Bank; SD Box# 014-0015413 30,012.00 50 15,006.00
A 4/00 Mellon Bank CD # 1036513 35,196.22 50 17,598.11
A 5/00 Mellon Bank CD # 14-A49013 70,000.00 50 35,000.00
A 10/99 Mellon CD # 00770009 10,629.92 50 5,314.96
A 8/92 PNC Bank CD # 31900164443 120,334.43 50 60,167.22
138,778.40
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEe DENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Quirino D'Angelo
FILE NUMBER
2001-00027
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Myers Funeral Home, Inc $7,135.00
B. ADMINISTRATIVE COSTS:
1. Persona! Represelltati'Je's Commissions
Name of Personal Representative (5) Santina Peterson
Social Security Number(s) I EIN Number of PelSona, Representative(s)
Street Address 3503 Beech Run Lane
City Mechanicsburq StatePA Zip 17050
Yea~s) Commission Paid:
Murrel R. Walters, III, Esquire $180.00
2. Attorney Fees D . d W. Knauer, Esquire $6,670.00
av~
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) N/A
Claimant
Street Address
City Stale Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills $229.00
Inheritance tax filing fee $ 15.00
5. Accountant's Fees None
6. Tax Return Preparer's Fees Included in Attbrney Fees
Advertising - Cumberland County Law Journal $75.00
7. The Sentinel $84.11
8. HAFN Reporting Service, Inc. Deposition $65.93
transcripts
TOTAL (Also enter on line 9, Recapitulation) $14,454.04
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Quirino D'Angelo
FILE NUMBER
2001-00027
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Sarah Peterson Grandchild $10,000.00
2 Clifford Peterson Grandchild $10,000.00
3. Santina Peterson Daughter Remainder
of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Knauer & Associates, LSC
Attorneys-at-Law
411A. East Main Street, Mechanicsburg, PA 17055
Telephone: (717) 795-7790
Fax: (717) 795-7793
Email: knauer@earlv.com
David W. Knauer
March 14, 2002
Mrs. Santina Peterson
3503 Beech Run Lane
Mechanicsburg, PA 17050
RE: Estate ofOuirino D' Angelo
Dear Mrs. Peterson:
As you are aware, this office has been retained by the Estate of Quirino
D' Angelo to represent it in all matters arising during its probate.
In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last
Will and Testament and, when probate is concluded, will receive your bequest of
the rest, residue an remainder of his estate after payment of specific bequests to
your son and daughter that are in the amount of$IO,OOO each, the payment of the
Pennsylvania Inheritance Tax, and other costs of administration.
This letter serves as an official notice of your being named as one of the
Estate's beneficiaries. When probate is concluded, I will send another document, a
Release, to you for your review and execution so that I can then send your bequest.
If you have any questions as to this, please feel free to contact me.
Very truly yours,
D~~~~
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\company\d' angelo\03-14-02\Peterson.ltr
Knauer & Associates, LSC
Attorneys-at-Law
411A. East Main Street, Mechanicsburg, PA 17055
Telephone: (717) 795-7790
Fax: (717) 795-7793
Email: knauer@earlv.com
David W. Knauer
March 14,2002
Clifford Peterson
3503 Beech Run Lane
Mechanicsburg, P A 17050
RE: Estate ofOuirino D'Angelo
Dear Mr. Peterson:
As you are aware, this office has been retained by the Estate of Quirino
D' Angelo to represent it in all matters arising during its probate.
In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last
Will and Testament. In that Last Will & Testament, Mr. D'Angelo made a $10,000
bequest to you. Your mother, the Executrix of Mr. D'Angelo's estate, has
informed me that she made a $2,000 payment to you on that bequest.
Consequently, when probate is concluded, you will receive $8,000, the balance of
the bequest.
This letter serves as an official notice of your being named as one of the
Estate's beneficiaries. When probate is concluded, I will send another document, a
Release, for your review and execution so that I can then send your bequest.
If you have any questions as to this, please feel free to contact me.
?r~YO~p .
t2~auerfXJ'Ml/
DWK:bm
\company\d' angelo\03-14-02\Clifford.ltr
Knauer & Associates, LSC
Attorneys-at-Law
411A. East Main Street, Mechanicsburg, PA 17055
Telephone: (717) 795.7790
Fax: (717) 795.7793
Emaii: knauer@earlv.com
David W. Knauer
March 14,2002
Miss Sarah Peterson
3503 Beech Run Lane
Mechanicsburg, P A 17050
RE: Estate ofOuirino D'Angelo
Dear Miss Peterson:
As you are aware, this office has been retained by the Estate of Quirino
D' Angelo to represent it in all matters arising during its probate.
In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last
Will and Testament. In that Last Will & Testament, Mr. D'Angelo made a $10,000
bequest to you. Your mother, the Executrix of Mr. D'Angelo's estate, has
informed me that she made a $2,000 payment to you on that bequest.
Consequently, when probate is concluded, you will receive $8,000, the balance of
the bequest.
This letter serves as an official notice of your being named as one of the
Estate's beneficiaries. When probate is concluded, I will send another document, a
Release, for your review and execution so that I can then send your bequest.
If you have any questions as to this, please feel free to contact me.
Very truly yours,
2iw~~j~~
DWK:bm
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JRD/June30,1992117858
JAN 1 2 2005 d./
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In Re: Estate of Quirino D'Angelo
Late of Mechanicsburg Borough
ORPHANS' COURT DIVISION
COURT OF CONUWONPLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-01-0027
NO. 21-01-0027
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: Santina Peterson
Counsel for Personal Representative: None
Date of Decedent's Death: 12/16/2000
Date of Delinquency Notice: 01/10/2005
The undersigned, Glenda Famer-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 of the 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: 01113/2005
~
Glenda Famer Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Estate File
%oJt&... 4-, 2405 q;ool\M
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.
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G'd
STATUS REPORTlJNDER RULE 6.12
Na.'l1e ofDecedent: Q fA 114 ; /Va [Y (J,/ilCJi../{J
'I) J r7
Date ofDeath: 7V;r ~ c 'i:: "-" bin. I ( lOuD
'\~fto.ft hi ;}.J-i)/-(}d:!-7
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 &ther administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration 'will be complete:
3. If the answer to No. I is Yes, state the following:
a. Did the personal ~esentative file a final account with the CoUrt?
Yes _ No !Xl
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal~resentative s. tate an account informally to the parties
in interest? Yes JA;! No 0
c. Copies or receipts, releases, joinders and approval of rormal or
informal accounts may be filed '\'Vith the Clerk of the Orphans' Court
and may be attached to thisft,rt.. V
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Signature
J)/1-lIl(~ {j KIifA fA. ~~ ,fk1,
Nmne / (
. Date: I/t-f.las
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Address j U J7u S'l
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Telephone No.
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Capacity: g Person21 Representative
~ Counsel for personal representative
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SE1>O-GEl.-l.ll.
~ad E!'uJ~ues
dEO:Gl SO SG u"r
Estate of Quirino D' Anqelo
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No. ,;}./ - 0 I - ~?
To:
Register of Wills for the
Deceased. County of ~llmhprl ;:\nn in the
Social Security No. 11 6 - 3 4 - 7 463 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 rix
in the last will of the above decedent, dated March 9
and codicil(s) dated
named
, 198R-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiCiled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 821 Walnut street, Meehan; c~hllrg
PA 17055
.-
(list street, number and muncipality)
Decendent, then 78 years of age, died December 1 6 j2 00 0
at R?1 w;:\lnllt strppt. Mp("h;:\n;("c::hllr'J, PJ\ 17055
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsy]v::lni,\
situated as follows: Borough of
$ 2,000 00
$
$
$ 85,000.00
MQ'Chanic5iburg, Pennsvl vania
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentarv'
theron.
(testamentary; administration C.La.; administration d.b.n.c.La.)
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3503 Beech Run Lane
Mechanicsb'lP], PA 17055
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF CUMBERLAND J
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 affirm. ed and subscribed { .s<P~~ t:Y f~~ en
before me this 5th day of ~.
J~!AB.Y n2!lO..L :?
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/& -a~ ~~. . j) B.~egiSler :s:
N 21-01- 27
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Estate of
QUIRINO D'ANGELO
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
20011
AND NOW JANUARY 9 ~, 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 03-09-1988
described therein be admitted to probate and filed of record as the last will of
QUIRION D'ANGELO
and Letters TESTAMENTARY
are hereby granted to SANTINA PETERSON
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\ Register of vlills
FEES
Probate, Letters, Etc. ......... $
Short Certificates( l).......... $
Renunciation ................ $
x-pages $
JCP TOTAL _ $ 229~88
Filed......... ~1W~. .~,.~99.1.............
200.00
lS.00
A TIORNEY (Sup. Ct. J.D. No.)
9.00
ADDRESS
PHONE
lat the information here given is correctly copied from an original certificate of death d\}ly filed with me as
,Ie original certificate will be forwarded to the State Vital Records Office for permanent filing.
21-01-27
WARNING: It is illegal to duplicate this copy by photostat or photograph.
,r this certificate, $2.00
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6987621
No.
~L/J~~ 1{~.I0A~./ULTI
Local Registrar 0 r
J.9!u J2~LA. / 'I, 01 () 00
f
Date
H1U5 04JHev 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TVPEJPRINT
'N
PERWANfNT
BLACK INK
SlAn FilE :'illM8ER
NA"E ofoTcEOENiI'""-,,,~'Wl---- -~~;~.~o - ~'~;~eIO---=~~--"-' ----, ~EX'-~ale'-r:A; ~~UR:NUM~~ _ --- 7 463 '--'~:c:~~~r1-6, -2~;----
AGE 'LaS! B....tlOay) UNDER 1 YEAR UNDER 1 01<< GATE OF BIRTH BIRTHPLACE ie,ly;v.d PlACE ~ DEATH lCt><<:1t Oflly <)(>e -- __ ,nSlfuclul"J oname_ ':I....,
MontNi Dill.,. !-tow. MlOui;;" MOfllh nay "eall 31ale ()( fCU.'1tJI1 Counuvl HOSPITAL 0 - -
78 y" Jan 27 1922 Abruzzi, Italy, ,...,_,0 ='~IO
$. . I 1 ...
COUN!'Y OF DERH CITY, BORa. TWP OF DEATH FACilITY NAME (II no! ,n!.NuhOO. gIve slrHt and oumbell RACE. Am.nean IndiAn, B&ack, Whil.. etc;:
IS~I
....
Cumberland
Mechanicsburg
~s DECEDENT EVER IN
US NUllED FORCES?
y.. 0 No 5l
...
KIND Of BUSINESS/INOUSTRY
DECEOENl'S USUAL OCCUPAlION
'~t'::~~k;;';'~~~r~
.... Cook "..
DECEDENT'S MAILING ADDRESS lSt,eet C~f1Own, s.... ZlpCodel
Restaurant
DECEDENT'S
ACTUAl
RESIDENCE
lSeelfl5ltUCllOOli
OI'lOlflmSldeI
'0.
White
MARITAL STATUS. Mar-ned
He."..- M..-Ied, Ww:eow.d.
DNorced (Specly)
Widowed
SURV1VlNG SPOUSE
(II '.,., "... ~ OAme,
14.
l7c.O _.dIIcedenllNedin
821 Walnut Street
Mechanicsburg, Pa. 17055
17b. Coun
();d
-
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Cumberland -' "..[1:....00::,,";:::'..
MOTHER'S NAME ,Fur:. ....,ddIe. ....Oildeo Suman...)
"....-
17.. Slale
".
fNHER'S NA....E iFIIU. M.adIe, last)
Vincenzo D'Angelo
Santina Peterson
,.,
INFORMANT'S NAME (l ypaiPrlfll)
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Dec 21,2000
2le.
lICENSE NUMeER
FD-014318.L
24. 11 :00 A.M. " 20 December 16, 2000
27. MItT I; En'.' 1M olseases, injuries 01 complM:ahon5 whic-h causedlhe dealh 00 not enle, lhe mode 01 dyrng, such as ca'cSIaco, ,espo,aIOfy a"8sl, shock or heart lallur.
llSl only ON CilUWOfl eachlWle
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DUE IDtOR AS A CONSEOUENCE Of): ~
b l.f..-..--ll ~~~~",...i'!..,,_--.--.dL 4-~,,-<
t DUE 10 lOA AS A CONSEQUENCE OfJ.'
c.~__~_.~.~ ________. __.__.~
DUE TO(OO AS A CONSlOUENCE OF)
d.. ,_ __ ._.0 _ __. _. . .. ._.. . ..._... _ ....._ .._ '"
WEAE AUTOPSY FINDINGS - ....ANNEH Of OEATH
AVAILABlE PRMJR TO
COtolPLETION OF CAUSE
OF OERH7
DATE OF INJURY
(Uoolh,Oay.'fI8afl
-
Mechanicsburq
Unknown
SI. John's Cemetery
NAME AND AOORESS OF fACILITY
Camp Hill, Pennsylvania 17011
22c.
ORE SIGHED
(Morel. Day, 'lUll
23b. 23c:.
~S CASE REFERRED to MEOtCAl EXAMINERlCORONER?
....0
lICENSE NUMBER
20.
I ApproJlIII\aI.
linlI........~
: onMI and dHItl
,
:
...0:
PART I:
Other ~ c:oncMIona oonlrtbuling 10 ~.In, bull
nlIll'MUIing in 1M ~ ca.- grwiWllf'l PART I
~--
TIME Of INJURY
INJURY AT WOftK1
DESCAI8E HOW INJURY OCCURAE.O
Accld801
Pending In'4sllgilllon
o
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o PLACE Of INJURY. AI hom..I..r~~;e...lilCtOfY, ottica
buikIinQ.etc:,ISpeclIV\
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Couki not be detetmlned
Homocide
No L-::Ix
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.CERTIFYING PHYSICIAN (PhySICldfl u""ly.ng C.aU5e 01 "'edll'l .....nefl J"OIh~' ot'~!)>L"ull'ld:i PfOflOU1'ICt!O ue..lt1 aoac\-.npl(:ltKI Item23l
To 1M be., 01 mr knowMOIjte, death occurred dull so the cau.e(ll.lnd mann.r... II.ted,
. PRONOUNCING AND CERTifYING PHYSICIAN IPt'r!i.lCliirl llI!rt: ;)':)jluu,K;,ng <JoJdlt1 dlld <.:ert"I"nq 10 l,;3U:;<l! or aedrt,)
To Ih. ~t ot my knowledge, deAlh occ""ed .'!he Urne, d.le,.nd piKe, And due 10 the c."....) and mantle'" ,I.ted
...EDICAL EXAMINER/CORONER
On Ihe b..i. ot ..aminallon and/or inyestlgation, in my opinion, death occurred at the time, da.e, and place. i1nd due 10 the cause(s) and
manner a. 'tilted.. ..,. ...",.....,...,...,..................... ... ,. ".............,..... ........
'"
1-:lli ~^II ~I
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LICENSE NUM DATE SkJNEO tMo...... ea.... Veatl
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NAME AND AOORESSfJF PERSON WHOCOMPlETEO....cAUSE Of DEATH
jl1em271TVP8orPnnl ~ 7OrCJ,/~
o 2:;;? /loV./"e Av-C.
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DAlE t-llEO(MOtIIh Oav. 'Na', , ",
,;D-c' (' <?,,; j ~ .v /7;.,,{' <J 0 c>
\, /b-~-.;y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-16D7 EX AFP <01-05)
DAVID W KNAUER ESQ
KNAUER 8 ASSOCS
411A E MAIN ST
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-21-2003
DANGELO
12-16-2000
21 01-0027
CUMBERLAND
101
QUIRINO
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6'ifj-EX--AFP--foY--03Y------...--iNHERiYANCE--TA)CSTAYEME-N'T-'(fF'-Accoui.ff--...---------------- - - ---
ESTATE OF DANGELO QUIRINO FILE NO.21 01-0027 ACN 101 DATE 01-21-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-01-2002
P R I NC I PAL TAX DUE: ..........................................................................................................................................................................................................................
9,555.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-15-2002 CDOO0956 4.00- 9,559.00
11-22-2002 CDOO1881 362.13- 362.13
TOTAL TAX CREDIT 9,555.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE 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. )
L,
STATUS REPORT UNDER RULE 6.12
Name of Decedent:~ U(~;,v3
Date of Death: !J-/rc,(hJu,
OJ (()~
Will No.
Admin. No -(;2/ -0 I - :J-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 whether ~gministration of the estate is complete:
Yes NO-X-
2. If the answer is No, state when the personal
representative rea80nanlY ~lieves that the administration will be ,
c9mplete: ~ -/7-M. opfVJs.~ f:.'f'iM 'AIf 0# ('0.<ift%/ +, ()u of fR-.f - ,--x?..14 Si~( t- o..,;'CJ../,MS'/
c'9-c ~:-dVvt
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
Cerk of the Orphans' Court and m~ ~;;a~h)edJ:; this report.
Date:~(P-7( D( ( bu ~_ ~
Mgnature I
~ ( '1/.,.
vtU \0 0. {'-I!/t.. 4- l/l-
ame (Please type or P7int), (?
rW /I- f; Joe;.- Sf, I~ltlwv\ dJ0}-j . /-
Address L/ !
rJJ7) .~q[;'- 7'710
Te 1. No.
(MAH:rmf/AM3)
Capacity: Personal Representative
)< Counsel for personal
representative
July 9, 2001
Santina Peterson
3503 Beech Run Lane
Mechanicsburg, PA 17055
IN RE: ESTATE OF QUIRINO D'ANGELO
Failure to File Certification
Dear Ms. Peterson:
A hearing was set for July 6, 2001, at 9:30 a.m., in the Courthouse in Carlisle, at
which you failed to appear.
The certification must be filed in the office of Register of Wills.
We must hear from you within twenty-four hours; please phone Donna in the
Register of Wills office at 240-6409, if you have any questions.
Sincerely,
Sandra S. Gobrecht, Secretary
Judge Hoffer's Chambers
JRD/June 30, 1992/17858
In Re: Estate of Quirino D'Angelo
Late of Mechanicsburg Borough
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-01-27
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: Santina Peterson
Counsel for Personal Representative:
Date of Grant of Original Letters: January 8, 2001
Date of Delinquency Notice: April 18,2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
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 of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on April 9,2001, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
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.
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
Date: May 25, 2001
A hearing is scheduled for~~ ~;j.O in Courtroom No.3. If the Certification of Notice is
filed prior to the hearing d~e, {he hearing will automatically be c el d.
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
NmneofDeeooent ~ ))I~
Date of Death: _( d-. - (b - d-(J7TO
Will No.
Admin. No.
d-{ -0 (-d-'7
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
NC (J4~ ~)!JV
~~ f?~~AU)/
Address
)5"43
) 50 '3
&ic1)d~~~~)Q
& ffef,-- !2wv~ 4r~IC'ilvJ)
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
MIllL-
Da'ell~ 1/ Z-t4'
Qwl /J ;;;:;~
Signature
Name ~({ .bJ I ~
Address 3l' AS-. {Y)A1f\J 5T
JnedM~-- ItA- 17 oSr
TelephonQtl ~ _ 171 C/
Capacity: _ Personal Representative
4Counsel for personal representative
,
JRD/June 30, 1992/17858
In Re: Estate of Quirino D'Angelo
Late of Mechanicsburg Borough
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-01-27
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: Santina Peterson
Counsel for Personal Representative:
Date of Grant of Original Letters: January 8, 2001
Date of Delinquency Notice: April 18,2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
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 of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on April 9,2001, and that the ten
(10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e)
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: May 25, 2001
(
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for~~ ~;;o in Courtroom No.3. If the Certification of Notice is
filed prior to the hearing dite,~he hearing will automatically be c el d.
t\L {~..(LQ dL <6 - \ -C) I
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: QUIRINO D'ANGELO
Date of Death: December 16.2000
Will No. 2001-00027
Admin. No.
To the Register:
I 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 March 14. 2002
Name
Address
Santina Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050
Sarah Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050
Clifford Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6 (a)
except
Date: March 14. 2002
!f~(L4r I~
Signature
Name: David W. Knauer
Address: 411A E. Main Street
Mechanicsburg. PA 17055
Telephone:
(717) 795-7790
Capacity: _ Personal Representative
~ Counsel for personal
representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128.0601
REV.1162 EX(11.961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DAVID W KNAUER ESQUIRE
411 A EAST MAIN STREET
MECHANICSBURG, PA 17055
----~--- fold
ESTATE INFORMATION: SSN: 116-34.7463
FILE NUMBER: 2101-0027
DECEDENT NAME: D'ANGELO QUIRINO
DATE OF PAYMENT: 03/15/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/16/2000
NO. CD 000956
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
I 101 I $9,559.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$9,559.00
REMARKS: DAVID W KNAUER ESQUIRE
CHECK# 147
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
Knauer & Associates, LSC
Attorneys-at"Law
411A East Main Street, Mechanicsburg, P A 17055
Telephone: (717) 795-7790
Fax: (717) 795-7793
Email: knauer@earlv.com
David W. Knauer
November 21, 2002
Ms Anita McCully
Inheritance Tax Division
Dept of Revenue (280601)
Harrisburg, PA 17128-0601
RE: Quirino D'angelo, deceased
File Number 2101-0027
Dear Ms Anita McCully:
Please find enclosed my client's check in the amount of $362.13 in final
payment after your division's review of the Inheritance Tax Forms filed.
If you have any further questions, please contact me directly.
Very truly yours,
i, i '. / / 1/
'1.~~~.J< / 'U /S(~J~C {&.' /(/
David W. Knader
DWK:bm
Cc: Santina Peterson, Executrix
\company\D'Angelo\ 11-21-02McCully.ltr
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
KNAUER DAVID W ESQUIRE
411 A E MAIN STREET
MECHANICSBURG, PA 17055
_u_____ fold
ESTATE INFORMATION: SSN: 116-34-7463
FILE NUMBER: 2101-0027
DECEDENT NAME: D'ANGELO QUIRINO
DA TE OF PAYMENT: 11/25/2002
POSTMARK DATE: 11/22/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 12/16/2000
REV-1162 EX(11-96)
NO. CD 001881
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: DAVID W KNAUER ESQUIRE
CHECK#1023
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$362.13
$362.13
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, QUIRINO D'ANGELO, a resident of Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my LAST
WILL and TESTAMENT, hereby revoking any and all Wills and Codicils
previously made by me.
I
I declare that I am married to ANGELINA D'ANGELO, and
that I have one (1) child, SANTINA PETERSON.
II
I direct that my debts and funeral expenses be paid as soon
after my death as is practicable by my Executrix out of my
residuary estate, but not from any assets, funds, death benefits
or insurance proceeds which are otherwise excludable or exempt
from my gross estate for federal estate valuation or tax purposes.
III
I direct that all estate, succession, l-egacy, inheri tanc e
or other transfer taxes, however designated that shall become
payable by reason of my death in respect of all property
comprising my gross estate for death tax purposes, whether or not
such property passes under this LAST WILL, shall be paid by my
Executrix out of my residuary estate, but not from any assets,
funds, death benefits or insurance proceeds which are otherwise
excludable or exempt from my gross estate for federal estate
valuation or tax purposes.
IV
I give, devise and bequeath all my property, whether real
or personal, wherever situate, including any property over which I
may have a power of appointment to my wife, ANGELINA D'ANGELO,
provided that she survives me by thir.ty (30) days.
V
I give and bequeath Ten Thousand ($10,000.00) Dollars to my
granddaughter, SARAH PETERSON. This money shall be maintained in
a guardianship account by Commonwealth National Bank until SARAH
reaches the age of 18 years.
VI
I give and bequeath Ten Thousand ($10,000.00) Dollars to my
grandson, GIFFORD PETERSON. This money shall be maintained in a
guardianship account by Commonwealth National Bank until GIFFORD
reaches the age of 18 years.
VII
I give, devise and bequeath my house and the sum of Fifty
Thousand ($50,000.00) Dollars to Commonwealth National Bank, in
trust for my daughter, SANTINA PETERSON.
a) This trust shall continue for a period of five (5)
years from the date of my death.
b) If my daughter desires to maintain the house, its
ownership shall remain in trust until she desires
to sell it or until the expiration of the trust in
five (5) years, whichever shall occur last.
c) If my daughter does not desire to maintain the house
or if she desires to sell it prior to the termination
of the trust, the net value received from the sale of
the house shall be placed into the trust along with
the remaining Fifty Thousand ($50,000.00) Dollars.
d) All costs of maintenance for the house including
insurance, taxes and any other costs relating to the
house shall be paid for by my daughter during the time
that the house is maintained in the trust.
e) It is my desire that my daughter be paid the interest
accumulated on the Fifty Thousand ($50,000.00) Dollars,
plus the proceeds from the sale of the house, if any,
on a regular basis, but no less frequently than
quarterly.
f) At the end of the five (5) year period, the entire
principal shall be conveyed to my daughter. If the
house is still maintained by the trust, title to
it shall be conveyed to her.
2
VIII
All of the rest, residue and remainder of my property,
whether real or personal, wherever situate, including any property
over which I may have a power of appointment, I give, devise and
bequeath to my daughter, SANTINA PETERSON, per stirpes.
IX
I nominate, constitute and appoint my daughter, SANTINA
PETERSON, as Executrix of this LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, QUIRINO D'ANGELO, have set my hand
to this LAST WILL this 9th day of March, 1988.
.
~c ~ /? r .,,?-<:-o
IRINa D'ANGELO
3
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
I, QUIRINO D' ANGELO, Testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowled ed
D'ANGELO, Testator, this 9th day of
Q
..~
....,{~ "----, - ",\.
l~i/-- "':... _~\
..~' " . - '\
f./:.~' ~~ - ~J
;;~ ...... - -,
'\.. /
C\\:~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND :
we,(J/Ia- Feo/~7.5~/;e and ~~/~' tUC//~ ,
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and
say that we were present and saw Testator sign and execute the
instrument as his LAST WILL; that QUIRINO D'ANGELO signed
willingly and that he 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 Testator was at the time 18
years of age or more, of sound mind and under no constraint or
undue influence.
( / '7...-? I / .
;A_f a.-7~:J:--:;A c)-~-;~:' ~-./::.-<..~
Sworn or
this 9th
~~
:::i~:e~art~~~e
Notary Public
MURREL R. WALTERS, III, Notary Public
Mech~nicsburg, Cumberland Co., Pa.
'-.j,y Commission Expires November 21,1988
A~
, "~..~. ~--- .~~
_:~...~_ ;..-- --'p ".r~
_,~ r -,."...-.."-
:1:e: p. ,,\-
r\'t ./ -- ' ~I
'~~--~~/
.: --- ,', .< ,........~' y
4
\ /6 -026D -..2/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
"o.z
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JIL -u
-., ,
.(~ rj
DAVID W KNAUER ESQ
KNAUER & ASSOCS
411A E MAIN ST
MECHANICSBURG
L
('1, '. '.
PA 'ln55
07-01-2002
DANGELO
12-16-2000
21 01-0027
CUMBERLAND
101
Allount Rellitted
'*
REV-1547 EX AFP <01-02)
QUIRINO
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=iS'4j-EX-AFP-(Cff':02Y-NOYicE-OF-YNHEififANCE-YA'X-APpflA"isEifiNT-,--AiDiwANCE-ifi-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DANGELO QUIRINO FILE NO. 21 01-0027 ACN 101 DATE 07-01-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
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)
87.000.00
.00
.00
.00
1.000.00
138.778.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
14.454.00
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
226.778.00
14.454 00
212.324.00
.00
212.324.00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
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:
.00 X 00 = .00
212.324.00 X 045 = 9.555.00
.00 X 12 = .00
.00 X 15 = .00
(19)= 9.555.00
.. ....... . "..~.... . (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-15-2002 CDOO0956 4.00- 9.559.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-16-2002 TOTAL TAX CREDIT 9.555.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. 362.13
TOTAL DUE 362.13
. 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
.. RI'I'IIND_ SI'F REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No.
Vi ~f?6iO, Q U 1 (::/NO
. )
~ lb. d-tJ7m
,
~-;;too 1- (1)O~
Name of Decedent:
Date of Death:
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
~ UNA- CYe-(.eRSoN
3~o~ .~ ~UN ~J /Y}~~
(fly " i10tr
Notice has now been given to all persons entjtled thereto under Rule 5.6(a) except
Date:
I d-Ol-ol
ll;J( !,J, ~
Signature
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