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REV-1500
\?h COM~IONWEAL TH OF
~*"-'\-: - PENNSYLVANIA
, ij.~ DEPARTMENT OF REVENUE
i'mi", , DEPT. 280601
"'d. " HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECECE.~rS ,\iA.\IE (LAST. FIRST, AND MIDDLE INITIAL)
MORACE, ANSEIMJ S.
DATE OF DEATH (MM.DD.YEAR) DATE OF BIRTH (MM.DD.YEAR)
12-22-00 10-02-17
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
N/A
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13 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Al\acIl ecpy cfWil)
[] 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale ofdealh after 12-12-82)
o 7. Decedent Maintained a living Trust (AlIachcopyofTrusl)
o 10. Spousal Poverty Credit (Gale ofdealh be~en 12.31-91 and 1-1-95)
FILE NUMBER
2 1 - 0 L
COUNTYCOCE 'fEN!
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NL'\ISER
SOCIAL SECURITY NUMBER
049 - 03
4980
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale 01 cealh pr.tll to 12-1J.a2)
o 5. Federal Estate Tax Return Required
Q. Total Number of Safe Deposil Boxes
o 11. Election to tax under Sec. 9113(A) (AlIachSchO)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Heather D. Royer, Esq. 2917 North Front street
FIRM NAME (If Applicable)
Smi 1
TELEPHONE NUMBER
717-234-2401
Harrisburg, PA 17110
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
74,513.13
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(8)
127,405.40
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3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule DJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointty Owned Property (Schedule F)
D Separate Billing Reqcested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(ScheduleG orL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debls of Decedent. Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (Iotal Lines 9 & 10)
(9)
(10)
23,906.22
774.18
(11)
(12)
(13)
24,680.04
102.725.36
52.892.27
(6)
(7)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election 10 tax has not been
rnade (Schedule J)
14. Net Value Subject to Tax (Line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rale, or transfers under Sec. 9116 (a)(1.2)
'.0_ (15)
, .0 -A.5 (16)
(14)
102,725.36
16. Amount or Line 14 taxable allineal rate
$102.725.36
4,622.64
(19)
4,622.64
17. Amount of Line 14 taxable at sibling rate
, .12 (17)
, .15 (IB)
200
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Line 14 taxable at collateral rate
19 Tax Due
Decedent's Complete Address:
STREET Ag~':,E~S '" ~- ,-,> ,
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CITY Enola I STATE PA TZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,622.64
Total Credits (A+ 8 + C) (2)
3, InteresUPenatty il applicable
O. Interest
E, Penally
TotallnleresUPenalty ( D + E ) (3)
4, II Line 2 is greater than Line 1 + Line 3, enter the di"erence, This is the OVERPAYMENT,
Check box on Page 1 line 20 to request a refund (4)
5, II Line 1 + Line 3 is greater than Line 2, enler the di"erence. This is the TAX DUE.
4,622.64
A. Enter the interest on the tax due.
(5)
(SA)
8. Enter the lotal of Line 5 + SA This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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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 transfelTed;.......................................................................................... 0
b. retain the right to designate who shalt use the property transfelTed or its income; ............................................ 0
c. retain a reversionary interest or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an ~n trust for" or payable upon death bank acccunt or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Acccunt, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
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 penalUes of petjury, I declare thai I have examined lhis retum, indudlng ac:companying schedules and statements. and to the best 01 my knowledge and belief, il is true, correct
and complete.
Dedaralion of preparer other than Iht j)er$OIIII representalivt is based on II Inrormation of which pt8Wtt has any knowledge.
SIGN E OF PERSON RE ONSIBLE FOR FlUNG RETURN
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REPRESENTATivE
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ADDRESS
2917 North Front
, Harrisburg, PA 17110
DATE
9 19 01
For dates of death on or after July 1, 1994 and before Janua!)' 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (ijJ.
For dates of death on or after Janua!)' 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are stiU applicable even if
the surviving spouse is the only beneficiary. .
For dates of death on or after July 1, 2000:
The tax rale imposed on the net value of ~ansfers from a deceased child twenty",ne years of age or younger at death to or lor Ihe use of a nalural parenl, an adoptive parent,
or a slepparent of the child is 0% [72 P.S. ~9116(a)(1,2)).
The lax rale imposed on the net value of ~anslers to or lor Ihe use of the decedent's lineal beneficiaries is 4.5%, excepl as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)).
The lax rale imposed on the net value of translers 10 or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined. under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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COMMQN'hW TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIOENT OECEOENT
SCHEDULE A
REAL ESTATE
ESTATE OF
ANSEU>O S. /JDRACE
FILE NUMBER
21-01-0057
All real property owned sol.ly or IS a tenantln common must be reported at fair man.t value. Fair market value is de~ned as the price al which property would be eJlchan!;ec
between I wilting buyer and a willing seller. neither being compelled :0 buy or sell. both hiving lII.son.ble knowledge of the relevanl facts. Real JlroJlerty which is jointly-own'd
with right (
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
'1.
DESCRIPTION
VALUE AT DATE
OF DEATH
5470 Wertzville Road, Enola, Cumberland County, PA
Parcel No: 10-13-0993-010
Property held jointly with spouse, Mary Jane Sebelist Morace
Insurance proceeds from fire received 3/01 in the total
amount of $111,026.27.
One-half reported for tax purposes *
(See PA File #21-01-0307 for Mary Jane Sebelist Morace Estate)
$
55,513.13
2.
Agreement of Sale dated August 11, 2001 for sale of lot
above (see attached).
Agreement of Sale for total price of $38,000.00
One-half reported for tax purposes *
(See PA File #21-01-0307 for Mary Jane SebelistMorace Estate) $ 19,000.00
*OUe to simultaneous death of decedent and decedent I s spouse
TOTAL (Nso enter on line 1. Recapitulation) S 74 , 51 3. 1 3
(If more space is needed. insert additional sheets of the same size)
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COMMONWEALTH OF P!:NNSYlVANIA
INHER.ITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ANSElMJ S. MORACE
FILE NUMBER
21-01-0057
Induce the proceeds of litigation and the dale the proceeds were received by the estate All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
ITEM
NUMBER
DESCRIPTION
1.
PNC Bank Checking Ac=unt - 115140313159
Anselrro S. Morace and Jane M. Morace, jtwrs
Date of Death Balance: $4,138.29
One-half reported for tax purposes *
2.
1 997 Mercury Sable - VG Wagon
$ 2,069.15
$ 6,850.00
$ 258.58
$ 31.13
$ 1.89
$ .67
$ 20.06
$ 98.00
$ 77.50
$ 4.20
3.
Sears Card overpayment refund
4.
AAA Central Penn Membership refund
5.
Comcast Cable refund
6.
Verizon Telephone refund
7.
Combined Insurance Company of America Insurance refund
8.
Keystone Health Plan Central (SeniorBlue refund)
9.
AFLAC - Policy IIOK839306 refund
10.
The Patriot News refund
11.
Household furniture and personalty
Insurance proceeds received in the
of $83,260.00
One-half reported for tax purposes
total. amount
*
$
41,630.00
12.
Cumberland Valley School District
Refund on school taxes received in
amount of $368.68
One-half reported for tax purposes
the total
*
$
184.34
13.
Settlement proceeds - wrongful Death Action
Garlock, Inc. 114502 S 2000
Release signed 05/01 - proceeds in the amount of
$25,000.00 less 1/3 Attorney Fees
PROCEEDS NOT YEI' RECEIVED
Net to be received
$
1,666.75
*OUe to simultaneous death of decedent and decedent's
spouse
TOTAL (Also enter on line 5. Recapitulation) $ 58,892.27
(If more space 1$ needed, Insert adCltlonal sheets of the same size)
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COMMON'NEALTH OF PENNSYLVANIA
INhERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ANSEIMJ S. MJRACE
FILE NUMBER
21-01-0057
Debts of decedent must e repo e on c e u e .
ITEM DESCRIPTION AMOUNT
NUMBER
A FUNERAL EXPENSES:
1. Cremation Society of PA $ 1,275.00
2. St. Paul's Lutheran Church (donation for luncheon) $ 100.00
3. Woodlawn Memorial Gardens $ 455.00
B. ADMINISTRATIVE COSTS: N/A
1. Personal Representaijve 5 Commissions
Name of Personal Representative (s)
Social Security Number(s} / E1N Number of Personal Represenlative(s)
Street Address
City Stale Zip
Year{s) Commission Paid:
2. AttomeyFees Smigel, Anderson & Sacks, LLP $ 15,000.00
3. Family ExempUon: (If decedent s address is not the same as claimant s, attach explanation)
Claimant NIA
SlreetAddress
City Stale Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills $ 255.00
5. Accountanl s Fees (Estimate) $ 500.00
6. Tax Return Preparer s Fees
7. The Sentinel - Legal Advertisement $ 80.87
8. Cumberland Law Journal - Legal Advertisement $ 75.00
9. OUt of pocket expenses for film, photographs, etc. $ 43.45
10. Fire Tech Services, Inc. - Demolition of house
One-half fee reported for tax purposes * $ 5,970.00
11. Automobile registration/inspection $ 51.90
12. Estim. of filing fees $ 100.00
*Due to simultaneous death of decedent and decedent's spouse
TOTAL (Also enter on line 9, Recapitulation) $ 23,906.22
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(If more space IS needed, Insert addltlonar sheets of the same size)
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COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
ANSELMO S. MORACE
FILE NUMBER
21-01-0057
Include un reimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
Allstate Insurance
(Autcrnobile insurance 4/16/01 to 10/16/01)
$ 236.80
2.
Kathryn W. Fetrow, Tax Collector
2001 County/Township Tax on lot
Total: $32.14
One-half reported for tax purposes
*
$
$
$
$
33.14
16.07
3.
PAWC - Final water bill
4.
AT&T - Final telephone bill
2.98
5.
PP&L- Final electric bill
47.17
6.
Family Eye Care
Re: Medical bill - eyeglasses
$
60.50
7.
Kathryn W. Fetrow, Tax Collector
2001-02 School Tax on lot
Total: $135.97
One-half reported for tax purposes
*
$
68.00
8.
Phar-Mor Phannacy/Giant Phannacy
Re: Prescriptions
$
309.52
*Due to simultaneous death of decedent and decedent I s spouse
TOTAL (Nso enter on line 10, Recapitulation) $ 774.18
(If more space is needed, insert additional sheets of the same size)
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COMMON'vVEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ANSE:J:.MJ S l-Y:>RACE
FILE NUMBER
. 21 01 0057
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
L TAXABLE DISTRIBUTIONS (include ouloghl spousal distributions)
1, Sandra M. Holie a/k/a Sandra M. Hoehl Daughter $ 2,000.00
1901 Parker Drive
Englewood, Florida 34223-4859
2. Nonnan A. Morace
1544 Seltzer Court
Mechanicsburg, PA 17055 Son 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 g113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 15QO COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
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LAST WILL AND TESTAMENT
/, ANSELMO S. MORACE, of 5470 Wertzville Road, Enola, Cumberland County,
Pennsylvania 17025, do hereby make, publish and declare this to be my last will and
testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient atter my decease.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by.me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as / could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
my death, for such period of time atter my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. $2,000.00 to my daughter, Sandra M. Holie; and all the
B. Rest, residue and remainder to my son, Norman A. Morace, or if he
does not survive me, then to his children, share and share alike, the child or
children of any deceased child taking the share their parent would have taken
living.
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4. I nominate and appoint Nonnan A. Morace to be the personal
representative of my estate, to serve without bond. If he cannot or does not serve, then
I appoint Sandra M. Holie to be the substitute personal representative with the same
powers and without the filing of any bond.
5. I suggest that my personal. representative retain the services of the Law
Offices of Harold S. Irwin, [II, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this f..(, day
of November, 2000.
d.64-~~a(SEAL)
ANSELMO S. MO CE
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
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ACKNOWLEDGMENT AND AFFIDAVIT
WE, ANSELMO S. MORACE, JOHN J. BARANSKI, JR. and HEATHER A.
BARBOUR, the testator and witnesses respectively, whose names are signed to the
foregoing instrument, being first duly swom, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his last will and that
he had signed willingly, and that he executed it as his free and voluntary act for the
purpose herein expressed, and that each of the witnesses, in the presence and hearing
of the testator, signed the will as a witness and that to the best of their knowledge the
testator was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence.
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A ELMO S. MO E
_~L 14. iJr'~
HEA HER A. BARB UR
COMMONWEALTH OF PENNSYLVANIA
:S5:
COUNTY OF CUMBERLAND
Subscribed, swom to and acknowledged before me by ANSELMO S. MORACE,
the testator herein, and subscribed and swom to before me by JOHN J. BARANSKI,
JR. and HEATHER A. BARBOUR, witnesses, his (iJ day of November, 2000.
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AGiU:EMEr.ii' .'uk tHE ~ALii ANU PUR(;HASE Of REAL ESTATE
. . This form recommended and approved fQr. but not restricted to,
use by members of the Greater Harrisburg Association of REAL TORSe
I ; fA:l,: ~: ;':, I- ! [SUB AGENT FOR SELLER] I (~,Z;:" ~~~::,< I
PA. LI;;}NSED BROKER PA. LICENSED BROKER PA. LI~ENSED BROKER
This.:Agreement made this /rtc-" day of .j;r!' . 1'9': c~;"rX:!1
1. PRINCIPALS Between, ..,-? ~I.. r C E:,-17'r{-----
(residing at :~,~170 l .I./'.'{ "r'.t/~~ .'C .....n-o-.......... \.'4:.~,
hereinafter called Seu~fl anf: . " ,.r"~.-t. ;t.!. (},'7--<:
(residing at I ~'(.d:- ~ ,r '~r ~1:. ., r__~lFI/.o~ .' U?, /70:2 ~
hereinafter called Buyer. ' 1
2. PROPERT'Y: Seller hereby agrees to sell and {:onvey to Buyer, who hereby agrees t.o purchase: ALL..lHA'f,<;:ERTAJN LQt or piece
O,f!~OU}~ 7.~t_~ ~i1dings and improvements thereon erected, if any. blown as: .s J..j 7 D (I ;./.1'7 ~r.-"t-u...; I d '/ f.ft$&~_ '.
3. ZONING: Zoning Classification
Failure of this Agreement to contain the zoning classification except in cases where the property (or each parcel thereof, if subdividable)
is zoned solely or primarily to permit single-family dwellings shall render this. Agreement voidable at the option of the Buyer and if voided
deposits tendered by the Buyer h be rned to the Buyer ithout a requirement of coqrt aClion."
TERMS:(a)PurchasePrice,_~r ' -.A1,^/~~ -1,.DU:N:2-..,...",' fA.."t-\. :~.1:; '-c(~::.:L,<.L.-
Elf. ($ ~._"7~VV 3'8,0110
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to be paid by the ~~yer as follows:
(bl DEPOSLT CMd. ~ CuI\ 0, NM~ 0 at \h~ $ianifta of Ihls
agreement, re<:clpt of whleh is h~r~by acknowlcdi~ ..
IfNale,toheredccm~onorbeforethe
(c) ADDITIONAL DEPOSIT due on or be(QI"~ the
day of
{dJ BALANCE OF PURCHASE PRICE at UlIlement
(cuh, cenirled cl\eo:;'4, mld/or monllal~ funch) ,
... $
day of
,19_.
19_.
$
$ ?)J;~ i(,,3lJ"">
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TOTAL ,..... $::-;,'"1/;,,,0 o0O,__vv
13'6- r; ~ I
Written approval of Seller to be on or before the day of ...~k4~_; ,..". ~
Seulemellt 10 be made on or before the :2.t{"':'_- day of -~! ....(It- ~~ ::z.C:C1
~d ~:=:,h~i~f~::rt ~r~-~~~~~~::rdS:~~~:ni~ ~~~~~~~:e~:e~i~h ~;~~~~ I~:=;"~~~~p~t:~~c: ~I~'~y~~~:;;~~~~~~~~~~ivi~e:d
evclIly unless olherwise providtd herein. ~ ..~.4-
~. PROtERTV SETTLEMENT CONTlNGENCVl This a,rcement is subject to the selllement of Buyer's property localed at Cl:. - f
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on or before
O. FINANCING CONTINGENCVl Thil aveemellt is subj<<t 10 the finandlll as rol1ows:
(al PRINCtPAL AMOUNT 1. :2 ZI t'f't) TYPE: ," /!7 MINIMUM TERM i~).., .
MAXIMUM INITIAL y' .
INTEREST RATE 1\ '" MAXIMUM TOTAL POI~. INClUD~~ lOA~ ORIGINATION FEE, TO BE PAID BY THE BUYER:
TERMINAL DATE (or Obl\linUtll. Fln'ill\d\\&Commi\mt.IlI ,,_, :f.'t+\ If..; '--~, ~""~J
Broker may advise Buyer of possible sourees of mortgage funds, bul cannot assume responsibility for obtaininll Buyer's mortpge. If said loan cannot be oblained
'ill herein provided, this Agreement shall be NUll AND VOID and all deposil monieJ Jhall be rcturned 10 the Buyer ('n or before date orsettlemenl as provided herem,
{b) ;::J:s~:;::k:oa t~:;::o:;p~~::-::~h:e:>n~~~e'}:~dinll instilution for the said loan within / /1 ealendar days from the Selltr's approval hereof.
Should the Buyer fail to make such completed applicalion within the $pecified lime, it shall be at the option of the Seller, within five (~J calendar days lhereaftef to:
(i) De<:lare this AlreefTlenl NUll AND VOID, at which time, all monia paid on account will be forfeited 10 Seller as liquidated damages, subject to the Rula and
Relulations of the Pennsylvania Real Estale Commiuion, or
(ii) III absence 01 wrillen notice to the Buyer by the Seller de<:larilll this Aveemcnt NULL AND VOID, the wndilion and contingency provided for in thil Paragraph,
together with any other finllflcing contingendes that may be herein or endorsed hereto. shall no lonaer prevail, and thit Alreement shall rem.in dfe<:tive ..:cordin&
to il$ terms in Ihe same manner as if the condition and con!inlCncy were not a p;ut hereof.
(c) Seller or Agent must re<:eive a wrillrn commitmrnl v8lid until tne claleof Kttkmcnt, {Of the uilS loan, Qll or briore tne terminal date as specified. If the said commitment
b nol furnisho:d with the lerms III $pedfied berein, or on otber terms accepted in writin/l: by the Buyer, on or before the specified dale, Seller sllallllave tile opuon,
at Ihat date, or any allier tIme thereafter, durlnlthe term of thb Apecmcnt, until, but not beyond the dale of receipt of the J;Qmmitment by the Seller, or Agent. to
declare this Agreemrnt r-IUll AND VOID, by written notice to Ihe Buyer of hiJ/her de<:ision to cancel, at whIch lime all deposit monies paid on accounl shall be relUrned
to the Buyer, subject to the psoy!l1rnt tequired, if mlY, provi<kd (0\" in PlUaaraph Illb): tl), (ii), and tiii).
(d) Seller nereby a,rees to permit in$pectlons by authorized appraiser., reputable certifiers and/or Buyer III may be required by the lendinl institution or inlurinl agencies.
(el Seller hereby a,reeslO pay additional mortple d;scount points and/or 106rl origin.lion fee in caseofa buyer obtaining financing from a lendinlin stitulionrequiriog
anyone or all of aforei8id feel, providinl the tolal of i8id fees does not exceed .i2....-.....l!'i o~ t~e aJnOllnt of thc mOrlgage, /' .
1. STATUS OF WATER AND SEWEJllSeller warranllthat Ihisproperty lsservicrdby i "':'.r:-: water and ,""': ',';,--
sewtf. Further, Seller warrants that these systems are fully paid for and. II of tnc date of this agreement are in Jadsfactory operatinl condillon. If either aforCJaid sy$lem
is private, Seller warranll that he/she has no notia: from the municipality or from munieipsol authorities that public waler and/or $eWer will be assessed or installed.
MUNICIPAL IMPROVEMENTS: ~1lt:r has 1\1'> no\ia:s of munlcipsol improvements (sucn as sidewalks, curbs, etc.) except
'It;t
::;~.
<P
SPECIAL CLAUSl!j.Sl
(} 0-l.d' . tJ'
4.
Access ~o. a)l~bllc ro&\:lmay require iSSU~Jl! a HillhwaY,occupanc. y permit. from the D~pannyIl~ o~Transpo"ation.
., . _ {(.c~/,~_..- ~- /'- <~. '.' r,<'z('J4,~._M~...( J:,r....,~'l.ot..
.-. ..../ .... /Jt.' ~ )\.... '_ ( i
(1;;< It ,v(, /)'),'1 Alii!! !<"PL"tfl ,iF '4ivrm:r ~"<!.IUnOiJ.
Jj...'i'Ei1
IS
11I.)a IU
10. ATTACHED ADDENDA are madc. pso" of this Alreernent: ttWood Infestation 0 Radon Disclcsute 0 PtI..a\o:Watt-rfOn.Site Sewage OFHA/VA
~Dual Agency Consent 0 Home IIlspection 0 Olher(s):
II. PERSONALT'k'l All exbtinl plumbinll, ncatillIl, air-conditioning and li,hting fixture$ (including chandeliers and ceilinl fans) and systems appurtellant thereto and forming
a part thereof, and other permanc:nt fixtures, as well as all ranlel, laundry tub" T.V. lI\\eona\, mas.ts a....d IOIOT s)'$\etns, lo,etner ...iln wall to wall carpetin&. Icreens, storm
sas.h and/or doors, shade$, awninp. venetian b!inds, eouplinas for automatic washers an~ dryers, ~te. radiator covers, cornlce$, water softeners, kitchen cabinets, drapery
~~;Pt~ainWIi~~;~:"~';~1~~u~s;ne:h:'::c::.s~:':~ ~~~o~eu~~~, :~:~~'::n~io~:~ i~~'::: s~~:~~~:::: :r~:b~~~~~'~:~~::~U::Yir~~~e=~~~~~~
date of this Aauemenl. Any remainlnt:lleatlnland/or cooldlll (ueIsltOl"ed on the Pfeml~ at time of settlement are also ine\uded under this Alrcement. Seller hereby warrants
~. ~~~ew~~~~~[ p'~~bit~t;~ ~~;'f~~~:n~~:I~n1::~=~i~~it~:i:~~rc~~y~t:: ~~~e~~~~~:~~~~e:'ii~:'~:~~::~~~ri~~~~:=r ':1 ~mi:~I~~~I~:~:~
T:hi,warranty docs not surviveclosfial. , 1 1 I' , r" \' 1." ,
._n" _ u.. ..___
(~j. -Th;'~;;";;--i;-e~ ~;~ to bHon~cycd in fee simple by special wam,mydeed. free and clear of an ticns, encumbrances and easemenl', EXCEPTING 1I0WI:VIOR. lb. foUo....;,,!
E~l$tjn& building rumCllans, ordinlRcc$. easemcms of roads, p,mleges ot "gilts of public serVllt compallln.tf any; Of ea\Crnmh In I.~\"':\".,,'I'> _mbl. IlPun the ground.
<Y.~rwi~ lbe litlt \0 the above described real tslalt shall be good and marketable or such as will ~ in,ured by a reputable 'illt insuunce company ill the rClular riles.
(b) The Buyer will pay for the followhl,:
(i) The premium for title insurance, mechanics lien insurance andlor title search, or fee for cancellation of same. if any.
(ii) The premium for flood insurance andlor lire insurance with ulellded co.era&", inS\lf~ bia<k( dll!.l,es Of \:l!.!'ri;e\lal\on (n, if any
tii\) A.ppralslll lees and cbaracs paid in advancc to mort,agee, irany.
(iv) Buyer's normal settlemenl coslsand accruals unless olberwise slaled herein.
(c) ~r~~f~:svi~r ~~I:~~r~~I~~~~e':':n~s~:~u~e~Jr~~e~~ds(;b~e I~~SJ~~~ H~:~:.~S~~yC~~,~:;I:~~:~;slg:lfr~~a:~~;~~:rn o~dr~~~i:~e::lh?$e~~~~~;:~~:~
be secured and paid fOf bYlhc Buyer.
(d) In IheCVenllheScllerisunabletoaiveagood and markelable lille or such as will be insured by. repulabLelitlecompany,subjecl as a!orC}aid, Buyer shall havelhe
oplion of laking sucll title as the Seller can aivewithoulabatelllenl of pricc or ofbein"epaid all monies paid by lhe Buyer 10 the ScU,c, on account of tile purchue
price and the Seller will reimhuttt lne Ruyet tOf any co.niincuued by the Bu~r for those items specified ul Paraar;tph 12(b) iteml (i), (II), (Iii) and in Paragraph 12(c):
- and in tile laller event there shall be no funher liabililY or objection on eilher of lhe parlies herelo and Ihis Aareemenl Ihall become NULL AND VOID.
13. FA ~El'IT OF DEPOSIT: Deposll5, regardless of Ihe form of paymenl and the per5(ln desianaled as payee, shall be paid 10 A,ent for the Seller, 10'110 sllall relain Ihem in
an eICrow accoUO\ until consummation or lerminalion of lhis A,reemenl in conformity witll all applicable laws and resulatians. Aae," (Of lilt; Sellel ma" at his Dr her lole
op\ion,lwldanyuncuhcdchtcktendercdasdepo$it,pendin,lheacceplanccof lhil offer.
If Ihere is a dispute belween lhe Buyer and lhe Seller OVer who is entilled 10 lhe deposit, Aaenl willnol be rnpon.ible 10 resolve lhal dispule and will nOl be liable 10 either
Buyer Dr lhe Seller ror refusing 10 release tile deposit without an adequate wrillen aareement between Buyer and Seller or a valid COUrt order. Buyel and Seller agree tbal,
in tile evenl the Agent and/or Sub_genl arc/is joined in litl&ation (Of tbe Te\Uln of Ikposil monies, \he AIcn\'S and/or Subaaent's rtallonable attorney's fccs and costs ...i11
be paid by tbe party joining lhe Agenl or Sub..ent.
14. POSSESSION AND TENDER:
la) Posse.sion is 10 be delivered by deed, keys and physical possession to a vacanl building (if any) at day and time of selllement, or by deed and aSs\I,J\R\Cn\ o( UiSlin,
lea.sc(sl <Mo time(l( RlllcmcM if ptem\$tl is ,cnant occupied altlle signina or tllis A,reement, unless olller....ise sped lied herein. Buyer will acknowlcd,e existinaleasets)
by inilialin, said le&5C(s) at time ofd,nina of this Agrcement or Sale i ftenantoccupicd.
(b) Seller will not enter into any new leaset.s), wdtten extension of CJlisting lease(s), if any, Or additionalleaiCfs) for the premises Wilhout CJlptess wriUen consent of the Buyer.
(c) f'ormallenderofan executc4dccd and purchase money is bereby waived.
~d) Bu~er rtscrVtl Ihe II'M to make a presettlemenl inspeclion of the subject premises, and will exeCUle appropriate documental ion of such inspeclion.
15. RISK Of LOSS:
(a) Seller shall maintain the property (lncludin, all Ilemsmenlionedinpar agraphlll herein)andanypcrsonalpropcnyspccilieallyscheduledhercininilspresenlcondition,
normal wear and tear excepted.
(b) SeUer shall bear risk of loss from lire or other casuallY until time of settlement. In the event or damage to the property by fire Dr other casualty, Buyer shall have tile
option of reseinding thisalJCemenland receivinahand money Pl'id on account or of accepting the propc:ny in ilSlhencondilion with the procceds of any insurance
recovery obtainable by Seller. BuyerisherebynolifiedthathemayinsurebiSCQuitableinterescinthisproperty~ofthelimeoftheacceptanceofthisa,rccment.
16, RE:PRESENTATlONS: II is UnlkfS\ood that Buycr has inspected Ille property, or llereby waives the ri,ht to do so and lie/she hu .grced 10 purchase il as a result of such
~~r::':t~ ~t~e~~l s~:::;s~~so~:: ~~~:o~ t~y ar~~e;~~~~~B~o~~~,brr ~hn~~:e~no; :rhi~~~~ ~~::r:~~n:~:~~~r.::!:: :d~~~et ~;s:~ ~~~ =~o~~~eu;;:~~:e~:
in its present condition unless otherwise specified herein and fUllher acknowledges thaI the aforemenlioned parlies arc not quaLirtcd to fea<kt an opinion on COn,IIUU\on,
ea~linl" (II el'ovimnnantal 'IIIa\\ers and that the buyer lias been advised Ihal he/she may require or wish to IoCCk lne assistance of upem in those fields. II is furtber undeutood
Ihatthis Agreement contains Ihe whole ..reement belWCCJ\ the Seller and Buyer and there arc no olher terms, obli,ation~ covenants, reprcs.cntations, statements or conditions,
oral Dr otherwise of any kind wllatsoever concerning tllis sale. Furthermore, this Agreement shall not be altered, uncnded, ch&llged Dr modified e.cept irl wrilina uecuted
by the pllTtiCc! hercto. .
l'l. RECORDING: This aaTeement shall not be recordea in tile Office for the Recordin, of Deeds Or in any Olher office Dr place of public record, and if Buyer shall record this
a,reement Dr cal/se Or ~rmitlhe same to be recorded, Seller may, at "is/her oplion, elecllo treat such act as a breach of this agrcement.
11. ASSIGNMENT: This Alfeemenl shall be binding upon the respeclive heirs, uc<;uton, adminislralors, successors and, to Ihe e.tenl assi&Rab1e, on the us"ns o( ItIc paftif;~
hereto, it bcillJ. expfessly Undcls\ood, n()WCvcr, t~ the Buyer shall nOI tralls!er or assign IbiS Aarccment without Ihe wrillen consent of the Seller beln' first obtained.
19. NON-LIABILITY OF AGENT: Except as may be provided by a seplorale agrtcmenl Dr addendum 10 this Agreemenl. Aatnt(s) or Sub-A,ent(s), if any, arc representin, Seller,
nOl the Buyer.
II is ellPrcssly underSlood and aarced between the parties hereto Ihat the herein named :aleM, his/ner sakspCfsoDS and emploYccs D1 any officer Dr parlner or .genl and
any cooperalin, broker and 1lls/iIl:r salespersons and employccs and any officerorpartneroftllecoopcralin,brokerareatlinaasaaentonlyinbringin,theBuyer.ndSeller
to,cther, and will in no case whalsoever ~ held liable jointly or severally to either party for the performance of any item Dr covenant of this Agrcemenl or for dama,es ror
the nonperformance thereof. .
10. DEFAULT _ TIME IS OF THE ESSENCE: 1'be wid lime {OT sC\llcment .nd all other llems referred to lor tbe performance of any of Ihe obligations of lhis Aareement
arc hereby a,reed to be of Ihe essence of Ihis Aareement. SlIouldthe Buyer;
(a) Fail to make any additional payments as spccified in Paragraph 4,
(b) Furnish false or incomplele information to tlte Seller, Ihe Seller's aaent, or Ihe mortgage lender, concerning the Buyer's lelal Dr flnancial. ~atUT, or {ail \0 coopc.a\e
in tbe ptoc<:ssin, {I( lbe monl.ac loan application, which aClS would result in Ihe failure to obtain lhe approval of a mOrlaage loan commllment, or
(c) Violale or fail to fulfill and perform an, of the terms or condillons of lhis A,rcement, then in such case, all deposil monies and other sums paid by the Buyer on account
of the purchase price, whether required by this Agreement Dr not, may be rel.ined;
(i) by tile Seller On accOl/nl of the purchase ptice, should the seller demand the lull putchau price. or
{ii} I>S monies to hc applied to the Scller's damagcs, Dr ,
(iii) as liquidated dama,cs for such breach,
as Ihe Seller may elect, and in the event that tile Seller elects to relain the monies as liquidaled damaacs in aC<<lrdance with Paraarapll 2O(cXiii), Ihe Selltr sllall be relel.$cd
from all liability Or obligation as this A,reement shall be r-IULL AND VOID.
11. RECOVERY rVND: A real eslate recovery fund .exists 10 reimburse any persons who has oblained a linal civil jud,ment ..ainst a Pennsylvania real eltate licensee owing
to fraud, misrepresenlation, or deceil in a real estate transa<:tlon and who has been unable 10 collect lhe judaemenl arter exhaustin, all legal and cquit"blt remedies. For com'
pleledetailsaboulthefund,call(717)18l-48S4.
11. DESCRIPT1\'E HEADING: The descriplive he"dings ulcd herein arc for convenience only "nd they arc nol intended to indicate all of the mailer in lhe setlions which follow
IlIem. Accordin,ly, they shall11ave no effect wharsoever in determining lhe rl,hts or obligations of the parlies.
ll, AGREEMENT: THIS AGREEMENT CONTAINS THE WHOLE ....GREEMENT BETWEEN THE SELLER "NO BUYER. THEkE All.E NO OTHER TERMS, OBUGA-
.IONS, COVENANTS, REPRESENTATIONS, STATEMENTS OR CONDITIONS, ORAL OR OTHERWISE, OF ANY KIND WHATSOEVER CONCERNING THIS
SALE, EXCEPT AS ATIACHED TO THIS CONTRACT.
(Do Not Write in This SpaceJ
This Is a legally binding contract; If nol underslood. consull your attorney,
r... Slaleme.l: This Document may be execllled by, the Buyer or Seller and tr.nsmilled to the other for execution by lelef..... When executed and delivered in such manner, this
Document wlll be binding as Ihougll exeClued by the partics on the oriainal documeD{.
w,
""
BUY
(SEAL)
APPROV /t.L BY B VIER; In witne", whereof, the parties hereto, intendlnlto be ]egally bound hereby. have he
w,n<
A
aYER
BUYE
/'-{1i d., ,f .Jt,'(}iJ.s1J
SEU-ER)( ~ /)'-M_._"
SELlER ~ I?~
SEAL)
.~")
?'k.. -.-.... mOS Ps\fA'J1C
f.lJ!t\IllJ Mp"t(..'f ~s~,.4
H"A, IIlf1 1/\16 ~
ADDENDUM TO SALES AGREEMENT
In reference to Agreement of Sale between
;t1;J, + /JJ.s, ~L.-rel/ M1/1.r1l
the Purchaser. and
/J'Z/l,Oof E.r#.477/
the Seller. Dated ? /(1 / ~()lll . covering the real property commonly known
as SLj;() tJ~/7ilz.t/Iu...r Rf/JD EN6L.A tJ/J /7 z> d~
the undersigned Purchaser and Seller hereby agree to the following:
"71, USE A-I ~J)('j1.e7f! LJVELIIJIr oP teJritnL p,(J.':[~(,
'/0 ;:: P"m ALL ~I( As~ ~71r -:;Jl
&(l.(J'P -rill (q d 13. \ -rt:5o 1/.J~tJD ~ 1,,,11 Ar<t1
f~1f! t'cLAnJ, ?f :S7'3(~ -rlJ. ,d- 1A),as ;N 'R---"-,,
LllL E .59L,I'~IOOO) fINO --r;Ji:>(/~A~~ ---;;; 1.ltr aiD 111
s.LU~i~;bti.J,str) AI>l~ (83&;7)) ldf<t' It",,,,,n ~ _
;:;0 -.L~ _1JA~ /o_€ 1111) LS~ 13ut/aU IJ/;;.-r/JIrlf. [JALtq(
~~~, .
.
The herein agreement, upon its execution by both parties, is herewith made an integral
part of the aforementioned Agreement of Sale.
tb
~f(j~ Jhct'11-c
AGENT
DATED 13 SePT 900L
J3Jl};:;,LM D 3, tflIIDILfl-(.E
( .~1/L a ~ t"VeCSELLER
c4y J"1'lV'Q ptt~
Y#m 0 /?!~" n0l11rVSELlER
AGENT
PURCHASER
.~, :;'
~PNCBAN<
Decedent Reporting
Firstside Center
P7-PFSC-4-F
500 First Avenue
Pittsburgh, PA 15219-3128
/SCP
March 14, 2001
Joanne A. Bradley
2917 North Front Street
Hanisburg, PA 17110-1260
RE: Estate of Anselmo S. Morace, Deceased
SSN: 049-03-4980
DOD: 12/2212000
Dear Ms. Bradley:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5140313159
Established 10/12/1990
ANSELMO S MORACE
JANE M MORACE
DOD Balance: $4,137.44 + $0.85 accrued interest
The decedent did not maintain a safe deposit box.
Page 1 0(2
A momb... of Tho PNC Fin_n.._. So",i"", Group
PNC Bonk NA. Pittsburgh P<nnsyIVini. 15265
i997.i-iERCliRY
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N.A.D.A. Base Trad...in
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Acces90ries
N.A.D.A. Trade-in Value
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Adlusted Vehicle Value
A"""..oM' Eaulpment :
.\.ccessor; T oto:U:
Alllll'ia.~1' Adiu.ln1~ob
Ali~i~t:.L Aclilbifut:i1i 7
N.A.D.A. Officiai Used Car Guide
Automated Vehide Valuation
3/17/2001
Liwde i:.dlllon: Eastern j.,Luui
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s
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Deceased
Garlock - Pennsylvania
049034980
JOINT TORTFEASOR RELEASE AND INDEMNITY AGREEMENT
KNOW ALL MEN BY THESE PRESENTS, that I/We, NORMAN A. MORACE,
personal Representative of the Estate of ANSELMO SAM MORACE, and on
behalf of the Wrongf\ll Death Beneficiaries (nBeneficiaries"), this
IS;'
.
.
day of
fYll1-v
I
and Indemnity Agreement
2001, enter
into
a
Tortfeasor Release
("Releasee") .
Whereas, a claim has been filed by or on behalf of Releasor
naming Garlock, Inc. (nReleaseen); and styled Norman A:."Morace,
4502 S 2000; and
Whereas, the Releasor and the Releasee desire to enter into a
full and final settlement and discharge of any and all present and
future action. demands and/or claims against the Releasee, which
are based in whole or in part on ANSELMO SAM MORACE's alleged
exposure and/or belief that ANSELMO SAM MORACE was exposed to
asbestos or asbestos-containing products, from the beginning of
time to the date of this Release; and
Whereas, Releasor, being of lawful age and sound mind, has
been promised consideration of Ten Dollars ($10.00) and other
valuable consideration by Releasee; and
Now, therefore, in consideration of the payment to Releasor by
Releasee in the amount specified in this Release, Releasor forever
Page 1
agrees as follows:
. .
Releasor, on behalf of themselves, their assigns, heir,
executors, administrators and successors, expressly covenants and
agrees forever to refrain frombrining any asbestos-related action,
and/or tort against the Releasee and hereby remises, acquits,
releases and forever discharges from any and all past, present and
future claims, dema~s, obligations and causes of action whether
presently known or uknown, which Releasor now has or which may
hereafter accrue or otherwise be acquired on account of, or in any
way relating to, any complaint and all related pleadings, for
1
ANSELMO SAM MORACE's alleged exposure or belief that ANSELMO SAM
MORACE was exposed on or before the date of this Release to any
asbestos or asbestos-containing products produced, manufactured,
sold, supplied and/or distributed by Releasee. The claims which
are being released include, although not limited to, any and all
known or unknown claims for bodily and personal injuries to ANSELMO
SAM MORACE, and the consequences thereof, wrongful death claims,
claims for loss of services, comfort, consortium, society or
support, arising out of exposure or fear of exposure to asbestos or
asbestos-containing products.
Releasor, shall indemnify Releasee, against, and hold forever
harmless from any loss, claim, demand, damage, liability,
obligation, cost, expense, lien, action or cause of action arising
out' of or relating to any asbestos-related demand, claim, lawsuit,
actions and/or complaint and related pleadings, including but not
Page 2
,
limited to those claims which were made or could have been made in
any and all lawsuits which were filed, commenced or instituted by
or on behalf of Releasor which arose/arise from alleged or actual
exposure to any asbestos, or asbestos-containing products,
including, without limitation, any and all such claims which may be
asserted against R~leasee, including but no limited to liability
for contribution andfbr indemnity by Releasor's insurance carrier,
employer, employer's insurance carrier or workers I compensation
carrier and/or any other manufacturer, producer or distributor of
asbestos and/or asbestos-containing products.
",
Releasor understands that Releasor may have suffered injuries
that are unknown to Releasor at present and/or unmanifested and
that additional complications, illnesses and diseases may arise in
the future, including, without limitation, asbestosis, mesothelioma
and other forms of cancer, Releasor acknowledges that the sum paid
in consideration of this Release is intended to and does forever
release and discharge any and all claims by Releasor and all past,
present, and future claims, demands, obligations and causes of
action in regard to such unknown injuries or future complications,
conditions, illnesses and diseases which arise out of or in any way
relate to Releasor's alleged exposure to asbestos or asbestos-
containing products.
Notwithstanding anything to the contrary herein, should I/We
be diagnosed with an asbestos-related disease, it is expressly
agreed that any claim or cause of action which I/we may have for
Page 3
.
any injuries or damage which I/we may suffer solely as a ~esult of
my/our personal exposure to asbestos or asbestos products is
reserved and unaffected by this Release.
,"
Releasor agrees and acknowledges that payment by the Releasee
of the surns specified in this Release is a full and complete
compromise of matters inVOlving disputed issues; that neither
payment of said su~by Releasee nor.statements made in connection
with the negotiations for this settlement shall be considered
admissions of liability; and that no past or present wrongdoing on
the part of Releasee, shall be implied by such payment or
-.
.
negotiations. Releasor further acknowledges that the sum paid by
Releasee to or on behalf of the Releasor is paid specifically to
avoid all present and future disputes regarding the matters which
directly and/or indirectly are the subject of this Release.
In entering into this Release, Releasor represents that
Releasor has relied upon the advice of Releasor's attorneys, who
are attorneys of Releasor's own choice, that the terms of this
Release have been completely explained to Releasor by Releasor's
attorneys; and that those terms are fully understood and
voluntarily accepted by Releasor.
Releasor acknowledges that
Releasor has not executed this Release in reliance on any
representation or statement not reflected herein made by Releasee,
its representatives or any other person.
With .the exception of claims as described in paragraph 4, as
to which this paragraph expressly does not apply, the Releasor
Page 4
.
agrees that if Releasor hereafter commences, joins in, ~r in any
,.
manner seeks relief through any suit arising out of, based' upon, or
relating to any of the Claims released hereunder or in any manner
assert against Releasee any of the claims released hereunder, then
the Releasor, will pay to Releasee in addition to any other damages
caused to releasee thereby, all attorneys' fees, costs, and
expenses incurred I?Y each and every Releasee in defending or
otherwise responding to said demand, suit or claim.
Releasor agrees that this Release shall be fully effective and
binding in favor of Releasee Garlock, In. that make the payment
specified in this Release, even if one or more of tn~ other
Releasees, including Anchor Packing Company, fails to make such
payment.
It is understood and agreed that the Releasor will hold
harmless Releasee from any and all liability arising from
subrogation claims under any compensation or medical payments due
or claimed to be due under any law, state or federal regulation or
contract.
In the event that other tortfeasors are responsible to us for
damages, as a resul t of the aforesaid asbestos exposure, the
execution of this Release shall not operate as a satisfaction,
credit and reduction to our claim against such other parties to the
extent of the pro-rated share of common liability or the
proportionate share of liability of the Releasee, unless it is
adjudicated that Releasee is a Joint Tortfeasor with said other
Page 5
.
person or organization.
Releasor acknowledges that Releasor is aware of the provisions
of Section 8132 of Title 5 of the United States Code, which
provides, among other things, that (a) upon a recovery from a third
party, any beneficiary entitled to compensation from the United
States shall refund to the United States the amount of compensation
paid by the UnitedStptes save for reasonable attorneys' fees, cost
.'
and one-fifth of th net amount of the funds received from the third
party tort feasor remaining after deduction of expenses of suit or
settlement and (b) "[nJo Court, insured, attorney, or other persons
.
shall payor distribute to the beneficiary of his designee the
proceeds of each suit or settlement without first satisfying or
assuring satisfaction of interest of the United States." The
attorney for Releasor represent that if this statute is applicable,
arrangements .have been made whereby the interest of the United
States had been satisfied. Releasor acknowledges that Releasee, is
relying on this representation.
This Release is entered in the State of Pennsyvlania and shall
be construed and interpreted in accordance with its laws.
This Release contains the entire agreement between the
Releasor and the Releasee and the terms hereof are contractual and
not a mere recital. The undersigned Releasor states that we have
carefully read the foregoing and know and understand the contents
and" meaning thereof, and sign the same as our own free act.
Page 6
. -.
-
WITNESSES:
~C-.~
~.t?~~~WLJ-
NORMAN A. HORACE,
Personal Representative of the
Estate of ANSELMO SAM HORACE
STATE OF
f1ef7t7.sr./W/n ,iq
OF ^IlULtJh,Al
,
, to wit:
CIY:/COUNTY
On this /5-+11 day of 7Yla-t , 2001, before
me, the subscriber, a Notary -PUblic of the State aforesaid,
personally appeared the above named individual (a) known to.me to be
the individual(s) described herein, and who executed the ~oregoing
COVENANT NOT TO SUE, RELEASE AND INDEMNIFICATION AGREEMENT, and
duly acknowledged to me that she executed same.
N~C~' '~~iJ .
My commission. expires:
NotartaI Seal
JOlIIII18 A. Bradley, Nola!Y PublIc
Hanfsburv. DaUphin COunty
My Commll8lan Expire. JInI 3. 2003
MtmllOr. Ponnsytvanl8 _ "'_
Page 7
~Et-l500 E~ i6.((lj
SUPPLJ;MEN1'AL
REV-1500
. COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
MORACE ANSEIMO S
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
12-22-00 10-02-17
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
N/A
o 1. Original Retum
o 4. limited Estate
o 6. Decedent Died Testate (A1lachcopyofW~I)
~ 9. litigation Proceeds Received
[!] 2. Supplemental Return
o 4a. Future Interest Compromise (dale ofdNlh after 12-12-82)
o 7. Decedent Maintained a living Trust (At\adl copy 01 Trust)
o 10. Spousal Poverty Credit (dale 01 (lealh beCween 12.31.91 and 1.1.95)
&
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FILE NUMBER
~i--2-1-
COUNTY CODE
13
5'7
Q 1
2
YEAR
-----
NUtolBER
SOCIAL SECURITY NUMBER
049 03
4980
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (daleofdeath prior 10 12-1).82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltachSch0)
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NAME
COMPLETE MAILING ADDRESS
4431 N. Front st.
River Chase Office Center, 3rd Fl.
Harrisburg, p...- 17119
FIRM NAME (lfAppHcatne)
8M!
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Sleeks and Bends (Schedule B)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Tota! Gross Assets: (total LInes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate tUne 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
'4. Net Value Subject to lax. (Line '12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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rate, or transfers under Sec. 911'6 ((1)(1.2)
x,O_ (15)
x .045... (16)
16. Amount of Une 14 taxable at lineal fate
$5,SR1.0R
17. Amount of Line 14 taxable at sibling rale
x .12 (171
18. Amount of Line 14 taxable al collateral rate
x .15 (18)
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>'> BI: SURI:'TO ANSWI:R A~L\:lUI:STlONS OIil'REVERSE'S 01: ANO RECHECK MATH < <.
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(11)
(12)
(13)
515.00
5,581.08
(14)
5,581.08
7<;1 14
(19)
251. 14
becedent's Complete Address:
STRE~~ ~~RESS '110 D~~'"
CIT'I I STATE PA I ZIP 17025
Enola
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
251. 14
Total Credits ( A + B + C ) (2)
3. JnteresUPenalty if applicable
D.lnterest
E. Penally
Total interesUPenalty ( 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 Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
251.14
A. Enter tt\e interest on the tal( due.
(5)
(SA)
B. Enter the totat of Line 5 + 51>.. This is the BI>.LANCE DUE, (5B) 251 .14
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income oflhe property transferred;........ .......,....................m.......................
b. retain the right to designate who shall use the property transferred or its income; ..................
c. retain a reversionary interest; or... ..........h..........h.h................ .................h .......................................
d. receive Ihe promise for life of either payments, benefits or care? .......h................. ..............................
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 UpOl'\ 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? ........'" ................... ..........................................
Yes
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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,
No
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Under penalties of pe~ury, I declare that I have examined this relum, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the persona! representative is based 00 all information of which preparer has any mowledge.
SIGNI>.TU PERSON RESPONSiBL OR FlU RN DATE
I>.DDRESS
C'<-J,,,,,,,,c,,b,,,n
t:- /7055
I,). 13-001..
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ADDRESS
4431 North Front st., River Chase Office Center, 3rd Floor, HarriSburg, PA 17110
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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 surviving spouse is 3%
172 PS 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the lax rale imposed on Ihe net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)}.
The statute does not exemol a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a lax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers f(Om a deceased child twenty-one years of age or younger at death 10 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)J.
The tax rate imposed on the net value of transfers to or lor the use of the decedeni's lineal benefICiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99118(a)(1)j.
The lax rale imposed on the net value of transfers 10 or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(t311, A sibling (s defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-150a EX' (6-9a) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF ANSElMO S. MORACE
FILE NUMBER
21-'-01-0057
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Settlement Proceeds - Estate of Anselmo S. Morace v.
Combustion Engineering dated November, 2002
(SEE SEl'I'LEJI1ENT AND DISTRIBUTION SHEEr ATl'ACHED)
$ 6,096.08
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheels of the same size)
6,096.08
REV.1511 EX' (12.991.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ANSEIMO S. MORACE
FILE NUMBER
21- 01- 0057
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _Zip
Year(s) Commission Paid:
2. Attorney Fees Smigel, Anderson & Sacks, LLP $
500.00
3. Family Exemption: (If decedent's address is not the same as c!aimal'lt's, attach explanation)
Claimant
Street Address
City State _Zip
Relationship of Claimant 10 Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Filing fee - Supplemental Inheritance Tax Return
$ 15.00
TOTAL (Also enter on line 9. Recapitulation) $ 515.00
Debts of decedent musl be reported on Schedule I.
(If mere space \s needed, insert additional sheets 01 the same size)
REV-15"EX'(WlI ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ANSEIMO S. MORACE
FILE NUMBER
21-01-0057
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS Dndude outright spousal distributions, and transfers under
Sec. 9116 (aJ (1_2)]
RELATIONSHIP TO DECEDENT
Do Not List Truste.(s)
AMOUNT OR SHARE
OF ESTATE
Nonnan A. Morace
1554 Seltzer Court
Mechanicsburg, PA 17055
Son
Remainder of Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL OISTRIBUTlONS UNOER SECTION 911HOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheels 01 the same size)
049-03-4900
P.A.50833
20% E
Check No.: 35859
LAW OFFICES OF PETER G. ANGELOS
SETTLEMENT AND DISTRIBUTION SHEET
01,2003-027 HBG
NORMAN A. MORACE, Personal Representative of The Estate of ANSELMO
SAM MORACE.
v. Combustion Engineering
SETTLEMENT:
10.000.00
Combustion Engineering
$
$
$
$
$
$
TOTAL:
10000.00 $
10,000.00
ATTORNEY'S FEE:
(33.33% of Settlement)
$
3,333.33
MEDICAL BILLS:
0.00
See Below
$
$
$
TOTAL:
0.00 $
0.00
CASE EXPENSES:
570.59
See Attached Sheet
$
$
$
$
TOTAl:
570.59 $
570.59
TOTAL DEDUCTIONS:
$
3903.92
BALANCE TO: NORMAN A. MORACE, Personal Reoresentative ofThe Estate of ANSELMO SAM
MORACE
$
6,096.08
I understand and acknowledge that the funds being paid to me in regard to this settlement have been maintained in a trust account
in a financial institution located outside of the Commonwealth of Pennsylvania, and that settlement monies payable to me from a
settling party in any future settlement, and / or monies payable to me as a result of any verdict or judgement in my case, upon receipt
by the LAW OFFICES OF PETER G. ANGELOS, P.C., will be placed into such a trust account and, less attorneys' fees and expenses, will
be paid thereafter to me as expeditiously as circumstances allow. I hereby give my consent to this in regard to this present settlement
and in regard to all monies payable to me as a result of any future settlements, verdicts, or judgements.
AND NOW, this J.. \ <;. , day of IJ 0 ~ /a...Qr- ?= ~ I / We do hereby declare that this Settlement and
Distribution Sheet has been read and is understood and approved and that the deductions for expenses and other items shown hereon
are true 'l.nd correct and re'rf'!1 a cop of this Settlement and Distribution Sheet is acknowledged.
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WITNESS NORMAN A. MORACE, Personal Representative of The Estate of ANSELMO S ORACE
WITNESS
WITNESS
WITNESS
WITNESS
REI/1500EXI6-OO1
ilo - ~()d - ~:s
REV-1500
*" COMMONWEALTH OF
, PENNSYLVANIA
.'iila1 DEPARTMENT OF REVENUE
DEPl 280601
'. HARRISBURG, PA 17128.0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
s
--
FILE NUMBER
2 1 - 0
COUNTY CODE YEAR
1
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-----
NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
MORACE ANSEIMO S.
SOCIAL SECURITY NUMBER
049-03-4980
DATE OF OEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEARI
12-22-00 10-02-17
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITW.)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 1. Original Return
D4,LirnitedEstate
o 6. Decedent Died Testale (Altadl copy of Win)
[X) 9. Litigation Proceeds Received
~ 2. Supplemental Return
o 4a. Future Inleres! Compromise (dale of death after 12-12082)
o 7. Decedenl Maintained a Living Trust (AJlach copy of TroSl)
o 10. Spousal Poverty Credit (dale of dealh be\Weefl12-31-91 and 1-1-95)
o 3. Remainder Relurn (daleofdealh prior 10 12.13-82)
o 5, Federal Estate Tax Return Required
8. Tolal Number of Safe Deposit Boxes
o 11. Election 10 lax under Sec. 9113(A) (Allath&::hO)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATlONSHOIILD liE DI~ECTED TO:
NAME COMPLETE MAILING ADDRESS
Heather D. Ro 4431 North Front street
FIRM NAME",,,.,,.,, River Chase Office Center, 3rd Fl.
SMIGEL, ANDERSOO & SACKS LLP
TELEPHONE NUMBER Harrisburg, PA 17110
717-234-2401
1. Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
26.640.41
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorsllip
4. Mortgages & Noles Receivable (Schedule D)
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SEE INSTRUCTIONS ON REVERSE SIDE fOR APPLICABLE RATES
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rate, or transfers under Sec. 9116 (a){1.2)
x.o_ (15)
x.o 45 (16)
x .12 (171
x .15 (18)
(19)
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(Schedule E)
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(Schedule G or l)
(7)
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16. Amount of line 14laxableatlineal rate
26,125.41
6. Joinlly Owned Property (Schedule F)
o Separate Billing Requested
(6)
17 AmounlofLine 14 taxableal sibling rale
8. Total Gross Assets (Iotal lines 1-7)
9. Funeral Expenses & Adminislrative Costs (Schedule H)
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11 Total Deductions \tolal lines 9- & 10)
12, Net Value of Estate (line 8 minus Line 11)
(9)
(10)
515.00
13 Charitable and Govemmental Bequests/Sec 9113 Trusls for wlllcn an eJection to lax has not been
made (Schedule J)
14. Net Value Subjecllo Tax (Line 12 minus Line 13)
(8)
26,640.41
(11) 515.00
(12) 26.125.41
(13)
(141 26,125.41
18 Amount of line 14laxable at collateral rate
1,175.64
1,175.64
19 Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
5470 Wertzville Road
CITY Enola I STATE 0" I ZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 1 g)
2. CreditslPayments
A. Spousal Poverty Credit
6. Prior Payments
C. Discount
(1)
Total Credits (A+ 8 + C ) (2)
3. InteresVPenalty if applicable
D, Interest
E. Penalty
Tolal InleresVPenally ( 0 + E ) (3)
4. If line 2 is grealer than line 1 + Une 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
1.175.64
5. !f line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
1,175.64
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
B. Enter Ihe total of Line 5 + 5A. This is the BALANCE DUE.
1,175.64
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..
b. relain the right to designate who shall use the property transferred or its income; .h..
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? . .....................
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.
Ves
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Under penaltes of pel]ury, J declare that I have examined tI1is relum, including accompanying schedules and statements. and to the best of my knowledge and belief. it is InJe, correcl
and complete.
Declaration of preparer olher than the personal represenlativeis based on alt information of which preparer has any knowledge
S~~ESPO IBL~N
ADDRESS
1554 Seltzer Court, Mechanicsburg, PA 17055
E F PREPARER OT ESENTATIVE
\
ADORE
4431 North Front st.,
sburg, PA 17110
DATE
J <)" tiNe.- aoc.8
OAT
~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS ~9116 (aj (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iill.
The statute does not exemot a transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptilJe parent,
or a stepparent 01 the child is 0% [72 P.S. 99116(a){1.2)).
The tax rate Imposed on Ihe 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. ~9t16(1.2) 172 PS. ~9116Ia)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.1508 EX. (6.98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISe.
PERSONAL PROPERTY
ESTATE OF
ANSEJ:MO S. MORACE
FILE NUMBER
21-01-0057
1l1dude the proceeds of litigation and the date the proceeds were recewed by the estate,
All property jointly~owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Settlement Proceeds - Estate of Anselrro S. Morace v.
Quigley Company dated May 23, 2003
(SEE SETl'LEMENr AND DISTRIBUTICN SHEET A'ITACHEDl
$ 26,640.41
TOTAL (Also enter on line 5. Recapitulalion) $ 26,640.41
(If more space is needed, insert additional sheels of the same size)
REV.1511 EX+ 112.991.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ANSErMO S. MORACE
FILE NUMBER
21-01-0057
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
,.
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Representative(s)
Sodal Security Number(s)lE1N Nllmber of Person<!1 Representative(s)
Street Address
City Slate _Zip
Year(s) Commission Paid:
2. Attorney Fees Smigel, Anderson & Sacks, LLP $ 500.00
3. Family Exemption: (If decedent's address is not Ine same as claimant's, attach explanation)
Claimant
Streel Address
City Stale_Zip
Relationship of Claimant to Decedenl
4. Probate Fees
5. AccQunlant'sFees
6. Tax Return Preparer's Fees
7. Filing fee-Supplemental Inheritance Tax Return $ 15.00
TOTAL (Also enter on line 9, Recapitulation) $ 515.00
(If more space is needed, insert additional sheets of the same slze)
REV.'S13 EX. 19-001 '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOEN'T DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ANSEIMO S. MORACE
FILE NUMBER
21-01-0057
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS ~r.clude Olltright spousal distributions, and transfers under
Sec. 9116 (.) (1.2)]
RElATIONSHIP TO DECEDENT
Do Not List Trustee{s)
Norman A. Morace
1554 Seltzer Court
Mechanicsburg, PA 17055
Son
AMOUNT OR SHARE
OF ESTATE
Remainder of Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 1S THROUGH 18, AS APPROPRIATE, ON REV.1S00 COVER SHEET
II NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1S00 COVER SHEET $
(If more space is needed. insert additional sheets of the same size}
049-03-4980
PA50833
20%E
Check No.: 36850
LAW OFFICES OF PETER G. ANGELOS
SETTLEMENT AND DISTRIBUTION SHEET
01.2003-027 HBG
NORMAN A. MORACE. Personal Representative of The Estate of ANSELMO
SAM MORACE
v. QUIGLEY
SETTLEMENT
QUIGLEY
$
$
$
$
$
40.000.00
TOTAL: $
40.000.00 $
40000.00
ATTORNEY'S FEE: (33.33% of Settlement)
$
13.333.34
MEDICAL BILLS:
See Below
$
$
$
0.00
TOTAL:
0.00 $
0.00
CASE EXPENSES:
See Attached Sheet
$
$
$
$
26.25
TOTAL:
26.25 $
26.25
TOTAL DEDUCTIONS:
$
13.359.59
BALANCE TO: NORMAN A. MORACE. Personal ReDresentative of The Estate of ANSELMO SAM
MORACE
$
26640.41
I understand and acknowledge that the funds being paid to me in regard to this settlement have been maintained in a trust account
in a financial institution located outside of the Commonwealth of Pennsylvania, and that settlement monies payable to me from a
settling party in any future settlement, and / or monies payable to me as a result of any verdict or judgement in my case, upon receipt
by the LAW OFFICES OF PETER G. ANGELOS, P.C., will be placed into such a trust account and, less attorneys' fees and expenses, will
be paid thereafter to me as expeditiously as circumstances allow. I hereby give my consent to this in regard to this present settlement
and in regard to all monies payable to me as a result of any future settlements, verdicts, or judgements.
AND NOW, this :l-S',r.-1_dayof (r),,-~ ,:2.003, II We do hereby declare that this Settlement and
Distribution Sheet has been read and is understood and approved and that the deductions for expenses and other items shown hereon
are true a,nd correct and recer5 of a copy of this Settlement and Distribution Sheet is acknowledged.
uJJlL;V^-- 9, (~~ - -?0~2 /1 ~/~
WITNESS NORMAN A. MORACE, Personal Representat.ve of The Estate of ANSELMO SAM MORACE
WITNESS
WITNESS
WITNESS
WiTNESS
Page 1
OS/22/2003
049-03-4980
LAW OFFICES OF PETER G. ANGELOS
SETTLEMENT DEDUCTIONS FOR ANSELMO SAM MORACE - PA50833
U Category
Description
20.00% TO ESTATE
80.00% TO WRONGFUL DEATH
Dale Check# Total
Amount
" COURT REPORTER
SPHERION CORPORATION (Inv. #4332043032)
... Subtotal U
... Grand Total .*
12/19/2002 9711
131.25
131.25
131.25
% OITotal
To Estate
26.25
26.25
26.25
% OITotal
To
Wrongful
Death
105.00
105.00
105.00
RfV.-HilXlEX(6-00)
f\j'. k P j) .
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.. COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
w
,..,
,,:!If!
ofo
woo
:z:"...
0....
..
'"
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
ffi. rY\ () (' CL Ce.- ----11r4~lmo-- 5.
o DAlE OF DEATH (MM-llll-YEAR) i DATE OF BIRTH (MM.DIl-YEAR)
~ -dd-6o I /()~_{)_9i- /7
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
o
o 1. Original Return
D4.LimitedEstate
D 6. Decedent Died Testate (AllachcopyofWUl)
9. Litigation Proceeds Received
D 2. Supplemental Retum
o 4a. Fuhire Interest Compromise (date rJdealt1 after 12-12-32)
D 7. Decedent Maintained a Living Trust (AltllchcopyolTI\I8I)
D 10. Spousal Poverty Credit {d8te of de8lh belWel!ln 12-3H11 and 1-1-95}
FILE NUMBER
;)....L-1l~
COUNTY CODE YEAR
Dll':i2_
NUNBER
~O~sr~ITYD3R_~.lf9 8'CJ...
I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dllll of de8Ih pilato 12-13-82)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under See. 9113(A) (A1I8ch Sch 0)
!Z
w
o
z
o
..
..
w
"
"
o
o
'lMlS8l;CTION.1lU8T.~.*COIW!~_~tA)(""""_ItlCMJ>.~to:
NAME N ~ l"'v-. COMPLETE MAILING ADORES' (l _ -+
.. () r rnOJ). ., 1/6rCI.Lc_ /5 IIII S-e. +2..f.- r LO tAr c
RRMNAMEI'''''_' fYl;~cmi csbUJ8 7ft 17C/5(J
(1)
(2)
(3)
(4)
(5)
z
o
~
;:)
...
ii:
<(
()
W
a::
1. Reel Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership (X SoIe-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Sd1edu~ E)
6. Join6y Owned Property (Sd1edule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross _ (101aI Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of lleceden\ Mortgage Lisbililles, & Liens (Schedule I)
11. Total Oeducliono (loIal Lines 9 & 10)
12. Net Value of estate (Line 8 minus Line 11)
13. Charitable and GovemmentalBequestsfSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
I (, t a l.D 9. 0 7
(6)
(7)
(g)
(10)
14. Net Value SUbject to Tax (Line 12 minus Line 13)
z
o
!;(
I-'
;:)
D..
:i
o
()
~
SEE INSTllUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (aX1.2)
16. Amount of Line 14 taxable allineal rate
um__ X .0 (15)
U..II;),~9.:Q7mnm_ x.O LJ5 (16)
17. Amount of Line 14 taxable at sibling rate
x.12
18. Amount of Line 14 taxable at collateral rate
x .15
19. Tax Due
20.0
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
""8I8URI! TO ANIWIR AU.
c>
(8)
/&, "d/"'9,07
(11)
(12)
(13)
UOI dUJ q.D7
(14)
/(l, exu9.o7
,
,3d.11
(17)
(16)
(19)
73;)./1
elM _8lIle.'AHO RIICIIltCK _1M "'..
Decedent's Complete Address:
I ::'5~'i',61r; r-T:Lvi II e K.1lQ.d--
ISTATE pf+
Tax Payments and Credits:
1. Tax Due (paga 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Cred~
B. PriOf Payments
C. Discount
. I ~ /7(\;;> ()~
(1) '7 3 d- . II
Total Credits ( A + B + C ) (21
3. InterestlPenalty if applicable
D.lnterest
E. Penalty
Totai InteresVPenalty ( 0 + E 1
4. ~ Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 1 Line 20 to request a refund
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retein the right 10 designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.........................''''..........................'''..........................................................,...., 0
d. receive the promise for life of either payments, benefits Of care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate coosideration? .............................................................................................................. 0
3. Did decedent own an "in trust fo~ or payable upon death benk account or security at his Of her dealh?............. 0
4. Did decedent own an Individual Retirement Account, annuity, Of other non-probate property which
contains a beneficiary designation? ..................... ................................................................................................... 0
No
~
~
tii'J
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
\Jnderpenaltieldperjuly, ldedarelhall haYeexarrined thl6l11tum, induling ~ &Chftc1lj. and statements, and to theb8stofmyltrlaMedge and belief, it is true, tomICt and complete.
~of__1hanlhe........_._"".._of__""""knlM1edge.
SIGN~SIBL~ILlNG~ .... .... . lQ [YJ;~ ~COS
ADDRESS .
SiGNATU~E~ ~~RE~~E}~~fES~~ mecho Y"1lC"5b\'ri ,.yj~LtltL5 &~
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (III.
For dates of death on Of after January 1, 1995, the tax rate imposed on the net value of transfers 10 Of for the use of the surviving spouse is 0% 172 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a sUMving spouse from lax, and the statutory requirements for disciosure of assets and filing a lax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)1.
The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116{1.2) [72 P.S. ~9116(a)(111.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. ~9116(al(I.311. A si~ing is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REI'-1513 EX'(O<lO) ..
COMMON~TH Of PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
5'. m
RELATIONSHIP TO DECEDENT
Do Not Lilt Truafooil)
OOS7
AMOUNT OR SHARE
OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS pnclude oubight spousal distributions, and transfers under
See- 9116 (al (1.2)]
N orm.o...n A. mOf'ClL~
1'5 L!y ~H-?er Court
rn~cJ-Xlr\i C '5bm'O;}>A- JlO7JO
'Son
Rerno.-i Y\d e r
o~ e'S-0-b~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $
(lffTlOf8 space is needed, insert additional sheets of the same size)
RE'..l-1508 EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ffn 5eJ III ()
'3. m6rtl(~
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned wl1h right of IUrvlVOIWhlp mUll be dllClOlod on Schldul. F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I. Se.3:;,tlexnUL-t'PrOce.eci.S- 6St:.cL-be. 0-\= AnseJrn()
S. tvLOr-o.ce V. I-fQII ;bu.y--l::o(\.ll-ICl.rbi~n LLbJkerj
l)'I'essex -:::t.ndlts..lrie 'S dc~Led. F€-brl.tO-.r\.l
Q3, ~oo5 \.j
(Se.e. CI.-tbo.c.h.eJ "S~ -b-Llern.en-L CLnd D 1'5+r,bLL-/i6t1 1&, 'JiJ. q.()7
~ "'-e~-l ')
FILE NUMBER
cQI-OI-D057
TOTAL (Also enter on line 5, Recapitulation) $ 1[, I ;2l.r1 q . () 7
(If more space is needed, insert additional sheets of the same size)
LAW OFFICES OF PETER G. ANGELOS
SETTLEMENT AND DISTRIBUTION SHEET
049-03-4980
P A50833
20% E
COpy
Check No.: 649831
NORMAN A. MORACE, Personal Representative of The Estate of ANSELMO
SAM MORACE
v. HARBISON WALKER f HALLIBURTON PA YM 1A
SETTLEMENT:
HARBISON WALKER I HALLIBURTON PAYM 1A
24,403.60
$
$
$
$
$
TOTAL: $
24,403.60 $
24,403.60
ATTORNEY'S FEE: (33.33% of Settlement)
$
8,134.53
MEDICAL BillS:
$
$
$
0.00
TOTAL:
0.00 $___.. 0.00
CASE EXPENSES:
$
$
$
$
0.00
TOTAL:
0.00 $
0.00
TOTAL DEDUCTIONS:
$
8,134.53
BALANCE TO: NORMAN A. MORACE, Personal Representative of The Estate of ANSELMO SAM
MUKA(;t:
$
16,269.07
I understand and acknowledge that the funds being paid to me In regard to this settlement have been maintained in a trust account
in a financial institution located outside of the Commonwealth of Pennsylvania, and that settlement monies payable to me from a
settling party in any future settlement, and I or monies payable to me as a result of any verdict or judgement in my case, upon receipt
by the LAW OFFICES OF PETER G. ANGELOS, P.C., will be placed into such a trust account and, less attorneys' fees and expenses, will
be paid thereafter to me as expeditiously as circumstances allow. I hereby give my consent to this in regard to this present settlement
and in regard to aU monies payable to me as a result of any future settlements, verdicts, or judgements.
AND NOW, this day of ,_, II We do hereby declare that this Settlement and
Distribution Sheet has been read and is understood and approved and that the deductions for expenses and other items shown hereon
are true and correct and receipt of a copy of this Settlement and Distribution Sheet is acknowledged.
NORMAN A. MORACE, Personal Representative of The Estate of ANSELMO SAM MORACE
WITNESS
WITNESS
WITNESS
WITNESS
\/fITNESS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NORMAN A MORACE
1544 SELTZER COURT
MECHANICSBURG, PA 17055
______n 101<1
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 2101-0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 03/1 0/2005
POSTMARK DATE: 03/10/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 005038
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $732.11
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1163
SEAL
INITIALS: MW
RECEIVED BY:
REGISTER OF WILLS
$732.11
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
RETAIN LOWER PORTION FOR YOUR RECORDS ~
'n'I!t.W.!MMltrl"JMM.'IW.lWltlm"'~.'la:['lIIrJMM.IlW'.............. ...
ALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANSELMO S FILE NO. 21 01-0057 ACN 503 DATE 05-09-2005
I~ an assessment as issued previDuslY, lines 14, IS and/Dr 16, 17, 18 and 19 will
r~lect ~igures t at include the total D~ ALL returns assessed tD date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at S
16. A.ount of Line 14 tax le.t LIne.I/Class A rate
17. ~ount of Line 14 at S ling rate
18. ~t of Line 14 tax 1. at Collateral/Class B rate
19. Principal Tax Due
R S:
BUREAU OF INDIVIOUA.;:1)U$~ T
INHERITANCE TAX DIVISION "
PO BDX Z8D6DI
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
r'~APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
, OF DEDUCTIONS AND ASSESSHENT OF TAX
ZGUS rtW 16 P'l 2: 42
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-09-2005
MORACE
12-22-2000
21 01-0057
CUMBERLAND
503
Am.....t R...l tted
CLERK 0
ORPHAN'S C LJRT
NORMAN ~!'lR!AC!'\<)) ,PA
1544 SELTZER COURT
MECHANICSBURG PA 17050
CUT ALONG THIS LINE
It!V-"MI:"Yf.~.m~'1m'.
DI
ESTATE OF MORACE
RETURN HAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FU URE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. R..1 Est.t. (Schedule A (1)
2. Stocks _ Bonds ISche 1. B) (2)
3. Closely Held Stock/Part rship Interest (Schedule C) (3)
4. Mortgages/Notes Receiv Ie (Schedule DJ (4)
S. Cash/Bank Deposits/Mise Personal Property (Schedule E) (S)
6. Jointly _ Prop.rty Schedule Fl (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
16.269.07
.00
.00
(8)
APPROVED DEDUCTIONS AND E EMPTIONS:
9. Funeral Exp.nses/A~. C sts/Hisc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilit es/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tllx Ret rn
13. Charltable/GovernBB.l Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estete ubject to Tax
.00
.00
Ill)
112)
113)
114)
NOTE:
I1S)
116)
1171
118)
.00 X
16,269.07 X
.00 X
.00 X
INTEREST/PEN PAID (-)
.00
+
AHOUNT PAID
732.11
DATE
03-10-2005
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
00 =
045 =
12 =
15 =
119)=
*'
REY-1547 EX AFP (03-051
ANSELMO
S
NOTE: To insure proper
credit to your accountl
~it the upper portion
of this for. with your
tax paYlHInt.
16,269.07
on
16,269.07
.00
16,269.07
.00
732.11
.00
.00
732 . 11
732.11
.00
.00
.00
. IF PAID AFTER DATE INDICATE , SEE REVERSE
FOR CALCULATION OF AUDITI INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A nCREDIr' ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORK FDR INSTRUCTIONS.)
PETITION FOR PROBATE and GRANT OF LETTERS
No.
To:
21-01-57
Estate of ANSEIMO s. MORACF:
also known as
Register of Wills for the
, Deceased. County of CUmberland in the
Social Security No. 049-03-4980 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is~18 years of age or older an the execut or
in the last will of the above decedent, dated November 1 6, 2000
and codicil(s) dated N/ A
named
,~-
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
D~cendent was domiciled at death in CUmber land County, Pennsylvania, with
h 15 last family or principal residence at 5470 Wertzville Road, Enol a , Hampden lWP.,
CUmberland County I PA
(list street, number and muncipality)
Decendent, then 83 years of age, died December 22 ,~ 2000,
at 5470 Wertzville Road, Enola, CUmberland County, PA
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 Pennsylvania
situated as follows: 5470 Wertzville Road, Enola, PA
$ 30,000.00
$
$
$ 120,OOO_O~
WHEREFORE, petitioner(x) respectfully request(s~ th~obfte of the last will ~
presented herewith and the grant of letters es en ary
theron.
(testamentary; administration c.La.; administration d.b.n.c.La.)
-
VJ
Q)
u
t:
Q)
~3
Q) l-.
CJ:::Q)
t:
-00
c.O
cd ..=
3~
Q)<+-..
~ 0
~
t:
00
Vi
~t{~
1~44 Se~tzer Court, Mechan1c5burg,
PA 170SS
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1- ss
COUNTY OF awrn~ 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 administe~ estate according to law.
Sworn to or affirmed and subscribed ~~ ~
before me this 11 th day of Norman A. Morace ~
JANUARY ~ 200 1 ~
/ } , . ~
:L7 ~
Register ~
/6 '-c:20~-2
No. 21-01-57
Estate of
ANSEIMO S. MORACE
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 12 ~ 200.~ 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 November 16, 2000
described therein be admitted to probate and filed of record as the last will of
Anselmo S. Morace
Testarnentcrry
Norman A. Morace
and Letters
are hereby granted to
/?7)L/r~TA"'/~LJ #.c..J k~~~P-tL4
/ ! R gister of ills /
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
x-pages
Renunciation ................
JCP
$
$
$
$
TOTAL _ $
... .JA.~VA.~~. ~.1.,. .?9.o.~............
235.00
6:B8
Heather D. Royer, Esq.
ATTORNEY (Sup. Ct. I.D. No.)
No: 76327
2917 North Front street
5.00
255.00
ADDRESS
Harrisburg, PA 17110
717-234-2401
Filed
PHONE
~~L QZ~&-T
, -'1
Th lS is to certify that the information here given is correctly copied from an original ce~tificate of death du~~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records OffIce for permanent hlmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
""1111111""'",,,,,,,,,
11111111~,,\\H OF PE;f",,--_
\\I~~. '4'Jli~--='
~\--"" .. ,r:-
!f~ "'~.. \~\
~ ~l . : : . \~ ~
~ c:::I; :-- ,:a,~ _ ! _ ~
~ c.,.) i Iii . ;.:b. ~
l * _"c.>-. ~/ *~
\~~C~ ... /~l
'\. ~ " / ..~ 1\\
- ~ b :--- /'u~ 'r II
-=:. 'Y"'l~6---/(. ~'" ,I
----......,;" EN1 \)"/11#
"//"/"'11111
~~~R~
Fee r()[ this certifIcate, $2.00
P 7022590
DEe 2 7 2000
Date
21-01-57
144 Rev. 1/91
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
S .
Morace
SEX
2. Male
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
DATE OF DEATH (Month. Day. Year)
4. December 22, 2000
UNDER 1 DAY
Hours Minutes
3. 049-03-4980
BIRTHPLACE (City and
State or Foreign Country)
g'~ifY) 0
17a. State
PA
MARITAL STATUS. Married
Never Married. Widowed,
Divorced (Specify)
14. Ma)or.-i.ed 1. MaJl
17C.O Yes, decedentlived in Hampden Twp.
Wh.i..te
SURVIVING SPOUSE
(If wife. give maiden name)
8c.
Mnotd Fuel
DECEDENT'S
ACTUAL
RESIDENCE
(See instructions
on other side)
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
Yes~ NoD
Ja.ne. Sme.i..ah
17b. Coun
Cumb e.Jr. land
Did
decedent
liveina
lownship?
IWp
22a.
Completell
_ physician ill not avallable at time of death 10
-~ certify cause of death.
--
o Ilems 24-26 must be compleled by
._ person who pronounces death,
.=iII
12-28-2000
LICENSE NUMBER
22b.
To the best of my knowledge, dealh occurred af the time, dale and place stated.
(Signature and Title)
cily/boro
17050
21c.
23a.
TIME OF DEATH
24. M. 25.
-- 27. PART I: Enter the diseases. injuries or complications which caused the dealh. Do not enter Ihe mode of dying, such as cardiac or respiratory arrest, shock or heart failure.
- - .- ~ List only one caulle on each line.
December 23, 2000
23b. 23c.
WAS CASE REFERRED TO MED~L EXAMINER/CORONER?
Yes;.l;l. No 0
28.
.Approximate PART II: Other significant conditions contributing to dealh, but
: interval between not resulting in the underlying cause given in PART I.
: onset and death
!
DATE PRONOUNCED DEAD ~Month, Day, Year)
IMMEDIATE CAUSE (Final
disease 01 coootion
~ resulting in death)_
~.!!!!
= SequentiaUy list conditions
a~~.~~~=
~ CAUSE (Disease or injury
.....Jhal inltiated evenls
_:-:- reeulllng in death) LAST
~==F~R~~:SY
~
b.
Smoke Inhalation
DUE TO (OR AS A CONSEQUENCE OF):
House Fire
DUE 10 (OR AS A CONSEQUENCE OF):
c.
DUE 10 (OR AS A CONSEQUE NCE OF):
--
~
d.
WERE AUTOPSY FINDINGS
AVAILABLE PRIOR 10
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
(Month, Day. Year)
TIME OF INJURY
Aprx.
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED.
Natural
0 Homicide 0
J( Pending Invesligation 0
0 Could not be delermined 0
Dec. 22, 2000
30.. 30b. 11 : 15 P M.
PLACE OF INJURY - At home, farm, street, factory, office
~~~ing, etc. (SpecIfy) Home
SIGNATURE
Yes 0
NO~
Accidental House Fire
YMO
NO~
Yes 0
No ~
Accident
Enola,
Coroner
PA
. . _- 218. 2Gb.
_ CERTIFEA (Check only one)
,-- 'CERTIFYING PHYSICIAN (Physician certIfying cause of death when another phYSICian has pronounced death and completed Item 23)
- To ~ best of my knowledge, death oceurNd due to the cauM(a) and manner.. atated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.iI
.~
.~
-'......
-iI
,.~
Suicide
28.
o
1.21/ ~ ,/<
DJa'E SIGNED (Month. Day. Year)
o 31c. 31d. December 26,2000
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type or Print Michael L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
"~ Mechanicsburg, Pa. 17050
DATE FILED (Month. Day, Year)
. PRONOUNCING AND CERTIFYING PHYSICIAN (PhYSICian both pronouncing death and certifying to cause of death)
To the best of my knowledge, death oc:curNd at the tlme, data, and ptace. .nd due to the cauM(a) and manner.. atated.. . . . . . . . . . . . . . . . . . . . . . . . .
'MEDlCAL EXAMINER/CORONER
On the buIs of examination aneIIOf Investlvatlon, In my opinion, death occurred at the time, date, and place, and due to the cau..(a) and
manner .. stated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31a.
REG'
34.
~7
~~tJ 01
E
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Anselmo S. Morace
Date of Death: December 22, 2000
No. 2001-00057
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 Friday, February 2,
2001 :
Name
Address
Norman A. Morace
1544 Seltzer Court
Mechanicsburg, P A 17050
Sandra Hoehle aJk/a Sandra Holie
1901 Parker Drive
Englewood, FL 34223-4859
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: WAYNE
MORACE who predeceased decedent and GARY MORACE whose whereabouts are unknown.
SMIGEL, ANDERSON & SACKS
Date: February 2, 2001
By:
Heather D. Royer, Esquir
ID# 76327
2917 North Front Street
Harrisburg, ~A17110-1223
(71 7) 234-2401 "-'
Attorneys for Personal Representative
",-
c/
tlL
.. .
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Anselmo S. Morace
Date of Death: 12/22/00
Will No. Admin. No. 2001-00057
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 xx
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: When all class action suits have been settled.
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 may b attached to this report.
Date:
12/9/02
Heather D. Royer, Esq.
Name (Please type or print)
4431 N. Front st., Third Floor
Addres s Harrisburg, PA 1711 0
(717 ) 234-2401
Te 1. No.
Capacity:
Personal Representative
xxx Counsel for personal
representative
(MAH:rmf/AM3)
.
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
--
Date: 11/05/2002
NORMAN A MORACE
1544 SELTZER COURT
MECHANICSBURG, PA 17055
RE: Estate of MORACE ANSELMO S
File Number: 2001-00057
Dear Sir/Madam:
It has corne to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 12/22/2002
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
MARY C. LEWIS
REGISTER OF WILLS
cc:
JFile
Counsel
Judge
r\
() t if
01)
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ANSEIMO S. MORACE
Date of Death: 12/22/00
Will No.
Admin. No. 2001-00057
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 XX No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No XX
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 XX
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' ~ourt and may be attached to this report.
s~~~o
Heather D. Royer, Esq.
Name (Please type or print)
4431 N. Front st., 3rd Floor
Addres s liarrlsourg, FA 1 7110
9/1?(03
Date:
(717) 234-2401
Tel. No.
Capacity:
Personal Representative
XXX___Counsel for personal
representative
(MAH:rmt/AM3)
RW-27
BUREAU O~ INDIVIDUAL TAXES
INHERITANlE T~X U!VISION
DErT. Z8060l
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
HEATHER D ROYER ESQ
RIVER CHASE OFF CENTER
4431 N FRONT ST
HARRISBURG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
~~?2
08-11-2003
MORACE
12-22-2000
21 01-0057
CUMBERLAND
502
A.ount Re.itted
.03
....)"}
L_I_
REV-IM7 EX AF' (11-15)
ANSELMO
S
, I-\,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARlISlE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is'4;-EX-AFP--foi-:oii--NOT-ici:--OF-i-NHiififANCE-YAi-~~PPR~~isi:ifENT~--Ai:.l-owAircE-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANSELMO S FILE NO. 21 01-0057 ACN 502 DATE 08-11-2003
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOTICE
("\, '
ESTATE OF MORACE
I~ an assessment was issued p~eviou~lY: lines 1~, 15 and/or 16, 17, 18 a~~ 19 will
re~lect figures that include the total a~ ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. '-ount of Line 14 at Spousal ~.t. (IS)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. A.aunt of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule El (S)
6. ~ointly Owned Property (Schedule f) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
26,640.41
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expenses/AdB. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net V.lue of Tax R.turn
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule ~)
14. N.t V.lue of Estate Subject to Tax
(9)
(10)
515.00
.00
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
261125.41 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for. with your
tax pay..nt.
261640.41
515 00
261125.41
.00
261125.41
(19)=
.00
11175.64
.00
.00
11175.64
TAX CREDITS:
ft . II-.~II'W . ,,----, . rJ~ AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-18-2003 CD002691 .00 11175.64
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-19-2003 TOTAL TAX CREDIT 11175.64
BALANCE OF TAX DUE .00
INTEREST AND PEN. 4.19
TOTAL DUE 4.19
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SeE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
16-d2tJo1-.3
~ BUREAU ~ INDIVIDUAL TAXES
INHE~ITANCE TAX DIVISION
D[2T. 280601
HARRISBURG1 PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
'0.3
DATE
ESTATE OF
DATE OF DEATH
F.I~E NUMBER
COUNTY
ACN
08-11-2003
MORACE
12-22-2000
21 01-0057
CUMBERLAND
502
"uU 12
HEATHER D ROYER ESQ
RIVER CHASE OFF CENTER
4431 N FRONT ST
HARRISBURG PA 17110
*'
REY-1547 EX AFP (01-05)
ANSELMO
S
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 ~
RE-V =is4-j-i3f-AFP--('oi-:031--Noi"-ici--oF-.rNHiifiTAifci-i"-AX-A-ppi'jrisiirENT~--ALi-owAifci-(fR------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MORACE ANSELMO S FILE NO. 21 01-0057 ACN 502 DATE 08-11-2003
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
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
26,125.41 X 045 = 1,175.64
.00 X 12 = .00
.00 X 15 = .00
(19)= 1,175.64
.00
.00
.00
.00
26,640.41
.00
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage 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)
515.00
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(8)
26,640.41
515 00
26,125.41
.00
26,125.41
~ ._n K~l,;~~""1 I"":' III1N ( + J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-18-2003 CD002691 .00 1,175.64
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-19-2003 TOTAL TAX CREDIT 1,175.64
BALANCE OF TAX DUE .00
INTEREST AND PEN. 4.19
TOTAL DUE 4.19
· 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 IIICREDITIII (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December IZI 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for yearsl the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZI40 of the Inheritance and Estate Tax Actl Act Z3 of ZOOO. (7Z P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS.I AGENT
REFUND (CR): A refund of a tax creditl which was not requested on the Tax Returnl may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Willsl any of the Z3 Revenue District Officesl or by calling the special Z4-hour
answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-30Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisementl allowancel or disallowance of deductions I or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenuel Board of Appealsl Dept. Z810ZI1 Harrisburgl PA 171Z8-IOZ11 OR
--election to have the matter determined at audit of the account of the personal representativel OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenuel
Bureau of Individual Taxesl ATTN: Post Assessment Review Unitl Dept. Z806011 Harrisburgl PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administrativelY correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent.s deathl a five percent (5X) discount of
the tax paid is allowed.
PENALTY:
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessedl and not
paid before January 181 19961 the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquencYI or nine (9) months and one (1) day from the date of
deathl to the date of payment. Taxes which became delinquent before January II 198Z bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January II 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z003 are:
Interest Daily Interest Daily Interest
Rate Factor Year Rate Factor Year Rate
Year
Daily
Factor
198Z ZOX .000548 1987 9X .000Z47 1999 7X .00019Z
1983 16X .000438 1988-1991 11% .000301 ZOOO 8X .000Z19
1984 llX .000301 199Z 9X .000Z47 ZOOI 9% .000Z47
1985 13% .000356 1993-1994 7X .00019Z ZOOZ 6% .000164
1986 10% .000Z74 1995-1998 9% .000Z47 Z003 5X .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Noticel additional interest must be calculated.
.
REV-1470 EX (6-88)
t '* INHERITANCE TAX
~of . ,
~~ EXPLANA TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
MORACE, ANSELMO 2101-0057
REVIEWED BY ACN
LARRY SZOLLOSY 502
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
E 1 I nterest is effective 05-24-2003.
ROW
Page 1
\. / ,0-020.;2--.8
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
HEATHER DROVER ESQ
SMIGEL ETAL
2917 N FRONT ST
HBG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-05-2001
MORACE
12-22-2000
21 01-0057
CUMBERLAND
101
*'
REV-15li7 EX AFP (12-00)
ANSELMO
S
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 ~
RE-V :i54-j-i:x--AFP--fi2-:0(jr-No'~ficE--oF-.rtiHi:ifiTAircE-T-AjC-jrpPRA-isEi'-ENT~--ALi-OWAtfCE-OR----------- - -- - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MORACE ANSELMO S FILE NO. 21 01-0057 ACN 101 DATE 11-05-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ 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
102,725.36 X 045 = 4,622.64
.00 X 12 = .00
.00 X 15 = .00
(19)= 4,622.64
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
74,513.13
.00
.00
.00
52,892.27
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage 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)
23,906.22
774.18
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
127,405.40
?4.680 04
102,725.36
.00
102,725.36
PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 11-20-2001 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4,622.64
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 67.37
TOTAL DUE 4,690.01
. IF PAID AFTER DATE INDICATED, 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" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 121 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for yearsl the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Actl Act 23 of 2000. (12 P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
REFUND (CR):
A refund of a tax creditl which was not requested on the Tax Returnl may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Willsl any of the 23 Revenue District Officesl or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-441-3020 (TT only).
OBJECTIONS:
Any party in interest not satisfied with the appraisementl allowancel or disallowance of deductionsl or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenuel Board of Appealsl Dept. 2810211 Harrisburgl PA 11128-10211 OR
--election to have the matter determined at audit of the account of the personal representativel OR
--appeal to the Orphans" Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenuel
Bureau of Individual Taxesl ATTN: Post Assessment Review Unitl Dept. 2806011 Harrisburgl PA 11128-0601
Phone (111) 181-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent"s deathl a five percent (5%) discount of
the tax paid is allowed.
PENALTY:
The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessedl and not
paid before January 181 19961 the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquencYI or nine (9) months and one (I) day from the date of
deathl to the date of payment. Taxes which became delinquent before January II 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January II 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 207- .000548 1992 9% .000241
1983 167- .000438 1993-1994 17- .000192
1984 117- .000301 1995-1998 97- .000241
1985 137- .000356 1999 1% .000192
1986 107- .000214 2000 87- .000219
1981 97- .000241 2001 9% .000241
1988-1991 117- .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Noticel additional interest must be calculated.
..
BUR'~ OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEMENT I ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 EX AFP (01-05)
HEATHER DROVER ESQ
RIVER CHASE OFF CENTER
4431 N FRONT ST
HARRISBURG ~A 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-17-2003
MORACE
12-22-2000
21 01-0057
CUMBERLAND
501
ANSELMO
S
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V: is'4-j-ix--AFP--fol-:oii--Ncffici--oF-.rNHiifiTAifci-i"-Ajc-A-PPRA-isii'-ENT~--ALi-oWANci-c'-R------------ - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MORACE ANSELMO S FILE NO. 21 01-0057 ACN 501 DATE 03-17-2003
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION
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
RETURN
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
6,096.08
.00
.00
(8)
NOTE: To insure proper
credit to your accountl
subllit the upper portion
of this forll with your
tax paYllent.
61096.08
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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
515.00
.00
(11)
(12)
(13)
(14)
515 00
51581.08
.00
51581.08
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(15) .00 X 00 = .00
(16) 51581.08 X 045 = 251.14
(17) .00 X 12 = .00
(18) .00 X 15 = .00
(19)= 251.14
,. . I ........ l'u:"E::~r I T+T AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-16-2003 CD002051 .00 251.14
BALANCE OF UNPAID INTEREST/PENALTV AS OF 01-17-2003 TOTAL TAX CREDIT 251.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.20
TOTAL DUE 2.20
. IF PAID AFTER DATE INDICATEDI SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~J
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoy_ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS.. AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent.. (REV-150l) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of
the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest DailY Interest Daily Interest
Rate Factor Year Rate Factor Year Rate
Daily
Factor
Year
1982 20% .000548 1987 9% .000247 1999 n .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
.
REV-1470 EX (6-88)
'* INHERITANCE TAX
EXPLANA TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
MORACE, ANSELMO 2101-0057
REVIEWED BY ACN
LARRY SZOLLOSY 501
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
E 1 Interest is effective 11-22-2002.
ROW
Page 1
/~.~do~ :3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
)~*
REY-U07 EX AFP (12-00>
Recoraecf
Register
of
VViUs
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-19-2001
MORACE
12-22-2000
21 01-0057
CUMBERLAND
101
ANSELMO
S
HEATHER D ROYER E;~l NOV 26 All :47
SMIGEL ETAL
2917 N FRONT ST Clerk~(:>'-' JTj':'~; Court
HBG Qtn'iJili~d Co.) PA
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 ~
RE-V = i60-j-ix--AFP--fi'2-:ooi-------...--iNifERI'i"-ANc"E--TAx--sTA-fE~iE-NT-o-F-Aifcouiff--.-..---------------- - - ---
ESTATE OF MORACE ANSELMO S FILE NO.21 01-0057 ACN 101 DATE 11-19-2001
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 PRO~ECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
4,622.64
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-20-2001 CDOO0281 .00 4,622.64
TOTAL TAX CREDIT 4,622.64
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
II 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. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS" AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department"s 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent"s death, a five percent (5Z) discount
of the tax paid is allowed.
PENALTY:
The l5Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Year
Interest Rate
Daily Interest Factor
Year
Interest Rate
Daily Interest Factor
1982 20Z .000548 1992 9Z .000247
1983 16Z .000438 1993-1994 n .000192
1984 HZ .000301 1995-1998 9Z .000247
1985 13Z .000356 1999 n .000192
1986 10Z .000274 2000 8Z .000219
1987 9Z .000247 2001 9Z .000247
1988-1991 HZ .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
~-BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANT-
DEPARTMENT OF REVENUE
REV-1547 EX AFP (DI-DU
/ 10-- d. ();l-t3
NOTICE OF INHERITANCE TAX
APPRAISEHENTI ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
HEATHER DROVER ESQ
RIVER CHASE OFF CENTER
4431 N FRONT ST
HARRISBURG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-17-2003
MORACE
12-22-2000
21 01-0057
CUMBERLAND
501
AItount R..itt.d
ANSELMO
S
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=is47-ix--AFP-('oi-':oii--NOTici--OF-.rNHEifiTAifCE-YAX-APPRA-isiMENT~--ALi-owii'-CE-(ri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MORACE ANSELMO S FILE NO. 21 01-0057 ACN 501 DATE 03-17-2003
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. R.al Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
6,096.08
.00
.00
(8)
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for. with your
tax pay.ent.
6,096.08
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
515.00
.00
(11)
(12)
(13)
(14)
515 DO
5,581.08
.00
51581.08
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A~unt of Line 14 at Spousal rate (15)
16. A.uunt of Line 14 taxable at lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. A.aunt of line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
19 will
.00 X 00 =
51581.08 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
.00
251.14
.00
.00
251.14
TAX CREDITS:
.-" 1""''1' "~""".A. . (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-16-2003 CD0020S1 .00 251.14
BALANCE OF UNPAID INTEREST/PENALTV AS OF 01-17-2003 TOTAL TAX CREDIT 251.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.20
TOTAL DUE 2.20
. 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 HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~/~-d20;2- Y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP (01-03)
RecaroeG
,.......;..
U~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-14-2003
MORACE
12-22-2000
21 01-0057
CUMBERLAND
501
ANSELMO
S
RE1igistEH'
\MiBs
HEATHER D ROYER ESQ
RIVER CHASE OFF CENTER
4431 N FRONT ST Gl~rt.>
HARRISBURG PA l~benand
.03
APR 28 P2 :59
Allount Rellitted
Co.,
PA
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 ~
RE-V: i6ifj-ix--AFP--fo1-:o3i-------...--iNifERIY-ANCE--fAx--STA-fEME-tif-ifF-AC-COUNY--.-..--------------- - - - - --
ESTATE OF MORACE ANSELMO S FILE NO. 21 01-0057 ACN 501 DATE 04-14-2003
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: 03-17-2003
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
251.14
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-16-2003 CD002051 .00 251.14
03-31-2003 CD002358 2.20- 2.20
TOTAL TAX CREDIT 251.14
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 $l~
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIP' (CR) ~
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS~ AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit~ which was not requested on the Tax Return~ may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills~ any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue~ Bureau
of Individual Taxes~ ATTN: Post Assessment Review Unit~ Dept. 28060l~ Harrisburg~ PA l7l28-060l~ phone
(7l]) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death~ a five percent (5%) discount
of the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed~ and not
paid before January 18~ 1996~ the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency~ or nine (9) months and one (1) day from the date of
death~ to the date of payment. Taxes which became delinquent before January 1~ 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1~ 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 n .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice~ additional interest must be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROYER HEATHER
2917 NORTH FRONT STREET
HARRISBURG, PA 17110
____un fold
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 21-2001- 0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 09/20/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 000281
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,622.64
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: HEATHER D ROYER ESQUIRE
CHECK#1014
SEAL
INITIALS: CW
RECEIVED BY:
$4,622.64
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF 'WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROYER HEATHER D ESQUIRE
4431 N FRONT STREET
HARRISBURG, PA 1 7110
____uu fold
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 2101-0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 06/18/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 002691
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $ 1, 1 75.64
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$ 1, 1 75.64
REMARKS: NORMAN MORACE
C/O HEATHER D ROYER ESQUIRE
CHECK#1063
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROYER HEATHER
2917 NORTH FRONT STREET
HARRISBURG, PA 17110
-------- fold
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 2101-0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 08/22/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 002930
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4.19
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4.19
REMARKS: NORMAN S MORACE C/O
HEATHER D ROYER ESQUIRE
CHECK#1065
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROYER HEATHER 0 ESQUIRE &
SMIGEL ETAL
2917 NORTH FRONT STREET
HARRISBURG, PA 17110
__u____ fold
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 2101-0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 01/16/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 002051
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $251 .14
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$251.14
REMARKS: NORMAN A MORACE
C/O HEATHER 0 ROYER ESQUIRE
CHECK#1053
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROYER HEATHER 0 ESQUIRE
2917 NORTH FRONT STREET
HARRISBURG, PA 17110
___n___ fold
ESTATE INFORMATION: SSN: 049-03-4980
FILE NUMBER: 2101-0057
DECEDENT NAME: MORACE ANSELMO S
DATE OF PAYMENT: 03/31/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2000
NO. CD 002358
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
501 I $2.20
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: HEATHER 0 ROYER ESQUIRE
CHECK# 1059
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$2.20
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA 'L
COUNTY OF CUMBERLAND J
55:
r
I'
Norman A. Morace
being duly SlAnrn according to law, deposes and says that he is the Executor
of the Estate of Anselmo S. Morace
late of ___-2i.?Q w~t?_yiJJe Roaq, Enola, , Cumberland County. Pa., deceased and that the
within is an inventory made by Norman A. Morace , the said Executor
of the entire estate of said decedent, consisting of all the personal propdrty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
Sworn
and subscribed before me,
~
d~
Executor . Administrator -
~ 2001
1 544 Seltzer Court, Mechanicsburg, PA 17055
Date of Death
Notarial Seal
Joanne A. Bradley, Notary blic
Harrisburg, Dauphin Cou ty
My Commission Expires June 3, 2003
Member. Pennsylvania ASsoclatIO'})'~
Aclclre..
22
00
Day
Month
Ye.,
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personaHy or realty
4. See Article IV. Fiduciaries Act of 1949.
.
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tnventory of the real and personal estate of
ANSElM) S. MORACE
deceased
, .
I'
1 .
5470 Wertzville Road, Enola, Cumberland County, PA
Parcel No: 10-13-0993-010
Property held jointly with spouse, Mary Jane Sebelist Morace
Insurance proceeds from fire received 3/01 in the total
amount of $111,026.27
One-half reported for tax purposes
(See PA File #21-01-0307 for Mary Jane Sebelist Morace Estate) *
2.
Agreement of Sale dated August 11, 2001 for sale of lot a.}:x)ve.
Agreement of Sale for total price of $38,000.00
One-half reported for tax purposes
(See PA File #21-01-0307 for Mary Jane Sebelist Morace Estate) *
3. PNC Bank Checking Account - #5140313159
Anselmo S. Morace and Jane M. Morace, jtwrs
Date of death balance: $4,138.29
One-half reported for tax purposes *
4. 1997 Mercury Sable - VG Wagon
5. Sears Card overpayment refund
6. AAA Central Penn Membership refund
7. Comcast Cable refund
8. Verizon Telephone refund
9. Combined Insurance Company of Americxa Insurance refund
10. Keystone Health Plan Central (SeniorBlue refund)
11. AFLAC - Plicy #OK839306 refund
12. The Patriot News refund
13.
Household furniture and personalty
Insurance proceeds received in the total amount of $83,260.00
One-half reported for tax purposes *
14.
Cumberland Valley School District
Refund on school taxes received in the total amount of $368.68
One-half reported for tax purposes *
Setlement proceeds - Wrongful Death Action
Garlock, Inc. #4502 S 2000
Release signed 05/01. Proceeds due in the amount of $25,000.00
less 1/3 Attorney fees - PROCEEDS Nor YET RECEIVED
*Due to simultaneous death of decedent and decedent I s spouse.
15.
TOTAL :
$ 55,513 13
$ 19,00 .00
$ 2,06 . 15
$ 6,85 .00
$ 258 58
$ 31 13
$ 1 89
$ .67
$ 20 Op
$ 98 00
$ 77 50
$ 4 20
$
$
4
$ 1,66 .75
$127,40 .40