HomeMy WebLinkAbout02-0432
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Fred Evans Hershey
also known as
No.
To:
21-02-432
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 204-28-7780 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executC i x
in the last will of the above decedent, dated June 3
and codicil(s) dated N / A
named
, 19--B.9-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C11wberland County, Pennsylvania, with
his' lastfamilyorprincipalresidenceat 315 N. 29th St., C.:lmp Hill, PA 17011
(list street, number and muncipality)
Decendent, then 71 . years of age, died l2 /30 'X~ 2001'
at Bryn Mawr HosPltal, Bower Merlon, 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 Pt;nnsy1vania .
situated as follows: prl~~l~~l ~;-0 :;,-~~
Calli/:-, I1..~ I It.... , ~ I - }6
$ 5,000.00
$
$
$
:; ~:.~' ~.~.tll Sl.
,.. C' / ~o//7<f'"/
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.I.a.; administration d.b.n.c.La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA !.. ss
COUNTY OF _~UMBERLAND 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 cf the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
f~I/;(H~
Sworn to or affirmed and subscribed {
before me this 25th day of
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i Regl er
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No. 21-02-432
Estate of
FRED E HERSHEY
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW APRIL 30 Ji, 2002, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JUNE 30. 1989
described therein be admitted to probate and filed of record as the last will of
FRED E HERSHEY
and Letters 'T'F.~'T'AMF.N'T'ARY
are hereby granted to PATRICIA R HERSHEY
'>>;h/j/rJ ~./.u~~jtp e /,{)Y--V"y'
. . glster 0 f Ills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
~rRt1&Mion ................
JCP
$
$
$
$ 5.00
TOTAL _ $ 72.00
...... .~?R);I;,. J.o.,. .?P'O.4...........
25.00
30.00
12.00.
ATTORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
MAIL TO ATTORNEY
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21-02-432
lagt lli11 an~ Q[t~tCtttt~1tt
OF
FRED E-:-HERSHEY
I, FRED E. HERSHEY, presently residing and domiciled at 345 North 29th
Street, Camp Hill, Cumberland County, Pennsylvania, being of sound mind and
body, attest that this is my Last Will and hereby revoke any and all wills
which I have previously made including the Will executed May 24, 1974
appointing Commonwealth National Bank as Trustee.
ITEM I: I appoint my wife, Patricia R. Hershey, Executor
of my estate. If Patricia is unable to serve in this capacity, then my
children, David E. Hershey and Christell E. Hershey shall serve as co-
executors.
ITEM II:
For purposes of information, I wish to state that
the members of my immediate family as of this date are as follows:
My wife - Patricia R. Hershey
Our son - David Evans Hershey
Our daughter - Christell Elizabeth Hershey
ITEM III:
I give Patricia R. Hershey, all right, title and
interest I may have in real estate and in tangible personal property, including
but not limited to household furniture and furnishings, books, pictures,
jewelry, watches, wearing apparel, automobiles, tools, equipment, and items of
like nature.
ITEM IV:
In the event that my wife, Patricia predeceases
me, or fails to survive me by thirty days, then I give devise and bequeath all
J
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~
of my property both real and personal, be disposed at Public Sale, the net
proceeds of which are to be distributed equally to my children, except as
designated in ITEM V.
ITEM V:
I hereby specifically bequeath the following
personal property items to my son, David:
1. Hitchcock Chair (black, decorated on yellow)
2. Pecan China Closet
3. Secretary Desk with Bookcase Top
4. Antique Rocking Chair
5. Judges Chair
6. Book: Hershey Family History
7. Round Cherry Drop-Leaf Dining Table
8. Staffordshire Pitcher (blue and white)
9. Man's Rolex Watch
10. Hitchcock 4-Drawer Chest (black decorated)
11. Pine Rope Bed Frame and Mattress
12. Dining Room Ceiling Light Fixture
13. Cedar Chest
14. 12-Inch Cream and Green Crock Plant Holder
15. Gold Coin (John Hershey)
16. Green and White Columbia Bridge Plate
17. Small End Table (Maurice Hershey)
18. Framed Wyeth Print of Hans Herr House
19. Peacock Plate (Samuel Hershey)
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20. Framed Photograph of Barbados Fishing Boats
I hereby specifically bequeath the following
items of personal property to my daughter, Christe11:
1. Willet China Closet
2. Antique High Chest of Drawers
3. Decorated Rocking Chair
4. Yellow Arrowback Chair
5. Si1verp1ate Knives and Forks and Sterling Spoons
6. Pennsylvania House Desk
7. Glass Decorated Pitcher (brown)
8. Women's Ro1ex Watch and all other jewelry previously
belonging to my wife, Patricia
9. 4-Drawer Chest in Living Room
10. Pennsylvania House Dressing Table, Chest and Bed
with Cherry Hitchcock Chair (in my bedroom)
11. Large Umbrella Stand
12. Decorate Vase (Samuel Hershey)
13. Console Piano
14. Walnut Wall Card Table (Samuel Hershey)
15. Walnut Server with Folding Slate Top
16. Silver Coin (Menno Hershey)
17. 4-Piece Glass Set of Spoon Holder, Covered Sugar,
Pitcher and Covered Butter
18. Coffee Table (Anderson)
19. Framed Photograph of St. Michael's - Chesapeake
IN WITNESS WHEREOF, I have hereunto set my hand this
'10
-
day
of -r~
, 1989
6r~
Fred~ Hershey f !~~
The preceding instrument, consisting of this and three other typewritten
pages, each identified by the signature of the testator, was, on the date
thereof signed, published and declared by FRED E. HERSHEY, the testator therein
named, as and for his Last Will, in the presence of us, who, at his request, in
his presence and in the presence of each other, have subscribed our names as
witnesses hereto.
'~;~1I:/!!~@fll
Residencek)IJ??{}(/tl/) P/1
Residence 177L(f/u~~/;21
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF GmiBERLAND oJ~:"'"
SSe
On this, the ,:,-SQkk.day of t"N..- , 1989,
before me, a Notary Public, the undersigned officer, personally appeared
Fred E. Hershey, known to me (or satisfactorily proven) to be the person whose
name is subscribed to the attached or foregoing instrument, acknowledged that
he signed and executed the instrument as his Last Will; that he signed it
willingly; and that he signed it as his free and voluntary act for the
purposes therein expressed.
IN WITNESS WHEREOF, I hereunto set my hand and notarial seal.
~.Wtu f/f;
Notary Publ c f
riNOTARtALSEAL
SHELLY J.FETTERHOFF,NoIaIyPublc
Harrisburg, PA Dauphft CoIIIty
_ Mv Col11l'lissiOn Exoi~ July 11,1992 .
.. , --............
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF QJMBERL.\ND oJ~
we,k:tJrJ JL2I~ &d {lo,n /~nd illuAit ,JJJJ17lfi'J
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the witnesses whose names are signed to the attached or foregoing instrument,
ss.
being duly sworn according to law, do depose and say that we were present and
saw the Testator sign and execute the instrument as his Last Will; that he
signed it willingly and that he executed it as his free and voluntary act for
the purposes therein expressed; that each of us in the hearing and sight of
the Testator signed the Will as witnesses; and that to the best of our
knowledge the Testator was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
, ~ It.
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I ESS
IjjlLw /hrYla
WITNESS
SWORN and subscribed to
bef~. e, this ~OtA..day
of l..vr--L , 1989.
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Notary Pub i
NOTARlAlSEAI.
SHElLY J. FETTERHOFF, NoIalyPublic
Harrisburg, PA DauphilCounty
My Co~ssion Expire!; July 11, 1 ~
DlsceVER@
FINANCIAL SERVICES
E
-
P.O. Box 8003
Hilliard, OH 43026-8003
AUGUST 27,2002
PATRICIA HERSHEY
345 N 29TH ST
CAMP HILL, PA 17011
RE: ESTATE OF: FRED HERSHEY
DISCOVER CARD ACCOUNT #6011 0023 9033 2567
CASE NUMBER: 21-02-432
SATISFACTION AND RELEASE OF CLAIM
To Whom It May Concern:
Discover Bank, formerly known as Greenwood Trust Company, issuer of the above referenced
account, acknowledges receipt of the sum $3204.00 in satisfaction of all amounts owed by the
above referenced estate on the above referenced account. Discover Bank hereby releases and
forever discharges the above referenced estate of and from any and all claims relating to the
above referenced account.
The undersigned certifies that Discover Bank has appointed Discover Financial Services, Inc. as
its servicer and Attorney-in-Fact for purposes of executing this Satisfaction and Release of
Claim, and that the undersigned is authorized to execute this document on behalf of Discover
Financial Services, Inc. for Discover Bank.
4l
D' cover Bank
: Terry Callowa
s: Attorney-in-fact
MR25PRB
Discover Financial Services, Inc.
A Morgan Stanley Company
33578.0801
~
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
FRED HERSHEY
, Deceased
No. 21-02-432
of 2001
To the Clerk of the Orphans' Court:
Enter the cleim of DISeOVE.R FINANCIAL SERV:CES, INC.
Accl. 60.1100239033256-'
In the amount of
$3,204.00
, against the above entitled estate.
The decedent, who resided at 345 N 29TH ST, , CAMP HILL PA 17011
died on
12/30/2001
. Written notice of said claim was given
to PATRICIA HERSHEY
,if known to claimant, at
(Personal Representative or counsel)
345 N 29TH ST, CAMP HILL, PA 17011
on
May 29, 2002
(Date)
r'l
xJ;k
(Claimant)
r
Address:
P.O. BOX 8003, HILLIARD, OH
43026
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Claimant's Counsel
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CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: FRED E. HERSHEY
Date of Death: DECEMBER 30, 2001
Estate Number: 21-2002-432
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
AUGUST 2, 2002:
Name
PATRICIA R. HERSHEY
Address
345 N. 29TH STREET
CAMP HILL, PA 17011
Notice has now been given to all persons entitled thereto under
Date: 9/16/02
Name: DAVID J. LENOX, ESQ.
Address: One S. Baltimore St.
Dillsburg, PA 17019
Telephone: (717) 432-9666
Capacity: Counsel for personal Rep.
;~
<...-
Estate No. 21-02-432 '
*
*
*
*
*
ORPHANS COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
In Re: Estate of FRED E. HERSHEY
Late of CAMP HILL BOROUGH
* NO. 21-2002-432
ENTRY OF APPEARANCE
TO THE CLERK OF SAID COURT:
PLEASE enter my appearance on behalf of the Personal Representative, Patricia R. Hershey, in the
above-referenced matter.
9/16/02
Respectfully submitted by:
Q~f' (L
ill NO.: 29078
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
1 S. Baltimore Street
Dillsburg, PA 17019
WITHDRAWAL OF APPEARANCE
TO THE CLERK OF SAID COURT:
PLEASE withdraw my appearance on behalf of the Personal Representative, Patricia R. Hershey,
in the above-referenced matter, AND note the above entry of appearance by my associate, David J. Lenox, Esq.
9/16/02
David E. Hershey, Esq.
ID NO.: 43092
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
1 S. Baltimore Street
Dillsburg, PA 17019
I
THE WILEY GROUP
Attorneys at La""
November 13,2002 Wiley. Lenox · Colgan · Marzzacco · P.c.
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Fred E. Hershey, deceased
File Number 21-02-00432
Dear Register:
Enclosed for filing please find the inheritance tax return in duplicate, a check in the amount of
$15.00 representing the filing fee, and the status report with regard to the above captioned estate.
This estate was opened by a well meaning family member, however upon my involvement it was
determined that because all property was jointly owned with the spouse or passed to the spouse
via beneficiary designation from the decedent's life insurance and Pennsylvania retirement plan,
that no probate was actually needed and no property is subject to tax.
Nevertheless, I have been informed that in order to close the file a tax return is required. Thus I
hereby submit a form 1500 containing only debt's and administrative expenses.
Similarly, no Inventory is being filed, in that the estate contained no probate assets.
Thank you for your cooperation.
Sincerely,
O-CfH
David J. Lenox, Esq.
encl.
jan M. Wiley · David j. Lenox · Timothy J. Colgan · Christopher j. Marzzacco . Christine j. Taylor
1 South Baltimore Street · Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 . Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
CJK
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: Fred E. Hershey
Date of Death:
December 30. 2001
Will No.
2002-00432
Admin. No.
Pursuant to rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
A. Yes J 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 J
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 J No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts
may be filed with the Clerk of the Orphans' Court and may be attached to this report.
Date: November 13. 2002
Signature
fJ~ J+/JJ_~_
Patricia R. Hersh~~
Name (Please type or print)
345 N. 29th Street
Camp Hill. PA 17011
Add ress
(717) 761-2908
Tel. No.
Capacity: J
Personal Representative
Counsel for personal representative
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FILE NUMBER
'V:"--""'; ,!'-':: '}" ~
//) _ 60- ::"/.Y
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT 21 02
__ ___ _ _____ _+ ~U~T'fCO~YEAR __
I
-1_
~THOFPENN5Yl.\lANIA
DEPARTMENT OF REVENue
OEPT.2e0801
HARRISBURG. PA 1712B-OeOl
00432
NUMBER
----- --- --'----
! SOCIAL SECURITY NUMBER
I
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hershey, Fred E.
~A~;~~~~(~M-DD-YEARI ~_ ~ ~~:S:';;~~:DD-YEA:_-= ~===_-
I
1____ REGISTE:R OFWILLS_~"
! SOCIAL SECURITY NUMBER
204-28-7780
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Hershey, Patricia R.
1. Original Return
- ---03":'- Remainder Return (date -of death-prior to 12-13-82) -~
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
il!
'-'--n ~Supple~ental Return
o
o
o
4. Limited Estate
48. Future Interest Compromise (dale of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copyotTrust)
6. Decedent Died Testate (Attach copy
ofW~I)
9. Litigation Proceeds Received
II
ME
David J Lenox, Esq.
IRM NAME (If applicable)
The Wiley Group
ELEPHONE NUMBER
717/432-9666
I S. Baltimore Street
Dillsburg, P A 17019
. -- ---~
---- - ~--~
~
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1. Real Estate (Schedule A)
2. Stocl<s and BDnds (Schedule B)
3. Closely Held CorporatiDn. Partnership Dr Sole-ProprietDrship
4. Mortgages & NDtes Receivable (Schedule D)
5. Cash, BanK Deposits & Miscellaneous Personal Properly
(Schedule E)
6. JDintly Owned Properly (Schedule F)
o Separate Billing Requested
7, Inter.VivDs Transfers & Miscellaneous Non-Probate Property
(Schedule G Dr L)
8. Total Gross Asseta (total Lines 1-7)
g. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabiltlies, & Liens (Schedule I)
m-'-'" .:'LUSEC;,l_Y
(1)
(2)
(3)
(4)
None
NDne
None
None
(5) None
(6) None
(7) None
(8)
(g) . __4,575.00
(10) 9,082.14
11. Total Deductions (total Lines g & 10)
(11)
13,657.14
I 12. Net Value of Estata (Line 8 minus Line 11)
(12)
insolvent
13. Charitable and GDvemmental Bequests/See 9113 Trusts for which an election to tax has nDt been (13)
made (Schedule J)
14_ Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15,Amount of Line 141axable at the spousal tax rate,
Dr transfers under Sec. 9116(a)(1.2)
x .00
(15)
~
B
~
x .045
(16)
16.AmDunt of Line 14 taxable at lineal rate
(17)
17.Amount of Line 14 taxable at sibling rate
x .12
18. Amount Df Line 14 taxable at collateral rate
x .15
(16)
~
_ _______--0
20. 0 .
l4~~~.~~i*'E:1ll,~~~
(19)
E IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Copyrlghl2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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,becedent's Complete Address:
STREET ADDRESS
345 N. 29th Street
CITY
Camp Hill
-~ --..--..----,---
i STATE PA
IZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CredilslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) _ ____.
Total Cred~s (A + B + C)
(2) 0.00
3. InlerestJPenal\y ij applicable
D. Interest
E. Penally
TotallnlerestJPenally (D + E)
4. If Line 2 is grealer than Line 1 + Line 3, enterthe difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to reqlMSt a nefund
5. If Line 1 + Line 3 is greater than Line 2, enter the dITference. 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.
(3)
(4)
(5)
(5A)
(5B)
0.00
0.00
0.00
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: Yes No
a. retain the use or income of the property transferred;.................................................. ~ I
b. retain the right 10 designate who shall use the property transferred or its income;...
c. retain a reversionary interest; or........................................... ....................
d. receive the promise for lije 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?................ .....".""..............,.......................................................... 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 0 181
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.......................... ................................ ........................................... ~ 0
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 penaItie8 of perjury, I declare that I have examined this return, including accompanying scheduleS and atatemerns, end to the best of ffi'j \l.I"lt1Medge and belief. it is true,
correct 8l'1d complete. DeclaratiOn of
prep.rer othllf th8'l the personal repruentative is based on all information of ~ich preP8_rer haS any ki1ClWIedge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
pa& R.. He-:slley
SIGNATURE OF PERSON RESPONSIBlE F.- Llt'ffi RETURN
2~RiERTHA-.-;f.~TAT,VE --- ADDR~------
David J Lenox, Esq.
DATE
345 N. 29th Street
Camp Hill, PA 17011
----;;OOREss----- --- .--
_____Ll-! O__-O==-_
OATE
t,-I'!-O'"
- -- ----~----.~-DATE ~-
1 S. Baltimore Street
Dillsburg, Pa 17019
For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse Is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed ootha net value of transfers to or for the use oftha surviving spouse is 0%
(72 P.S. 59116 (a) (1.1) (ii)]. The statute does not exemct a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax. rate imposed Oil the !let value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)).
The tax rate imposed on the net value of lransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted In 72 P.S. ~9116
1.2l [72 P.S. ~9116 (a) (l)l
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings Is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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______~_~n ._J _________
_._____.______ _______..___ ___ ____ __.._ _.-___--0______-- _______._
sct-EIll.E H
RI'SW.. EXPENSES &
ADIINSlRAT1VE u.JS 1:S
~THOfPENN$YlVANIA
INHERITANCE TAX RETURN
RESIDENT DEceOENT
ESTATE OF H h F dE
ers ey, re .
FILE NUMBER
__~_L_ ~_ - 02_- 004~_____.
Debts of decedent must be reported on Schedule I.
--------------".--
ITEM j
NUMBER
A.
DESCRIPTION
n___ -~--n\AMOUNT---'
FUNERAL EXPENSES:
Myers Funeral Home, Mechanicsburg, P A
4,085.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
Attorney's Fees David J. Lenox, Esq.
State
Zip
2.
350.00
3. Family Exemption: (If dece<lent's address is not the ..me as claimant's, allacl1 explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
4. Probate Fees
State
Zip
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Legal Advertising Fees 125.00
2 Tax return filing with Register of Wills 15.00
i
----+-_._----~
. 4,575.00
TOTAL (Also entsr on line 9, Recapitulation)
~ "'
... ... __ ..". 'i
SCHEDULE I II
DEBTS OF DECEDENT, MORTGAGE
1 LIABILITIES, & LIENS I
. -- - - ------ ______--1_______
.----- --- -- ----- - I FILE NUMBER
! 21 - 02 - 00432
*'
~THOFPENNSYLVANIA
INHERITANCE TAX RETURN
RE8lOENT DECEDENT
ESTATE OF
Hershey, Fred E.
Include unrelmbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
3,204.00
Discover Financial Services Ace!. #6011 0023 9033 2567
2
Chase Credit Account 5491040510510424
4,595.14
3
Unreimbursed Medical Bills
348.00
4
Credit Card Debt
935.00
TOTAL (Also enter on Line 10, Recapitulation)
9,082.14
/"/-60 - /.:V
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP (D1-D5)
DAVID J LENOX ESQ
THE WILEY GROUP
1 S BALTIMORE ST
DILLSBURG PA~7019
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-20-2003
HERSHEY
12-30-2001
21 02-0432
CUMBERLAND
101
FRED
E
,; OJ
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4j-Ex-AFP-foY:03Y-NoTlcE--oF-YNHEifITANCE-TAX-A-PPR'jrIsEi'-ENT~--AL1-owANcE-oi------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HERSHEY FRED E FILE NO. 21 02-0432 ACN 101 DATE 01-20-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. 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 NOTE: To insure proper
. 00 credi t to your account,
. 00 sublli t the upper portion
. 00 of this forll with your
. 0 0 tax paYllent.
.00
.00
(8) .00
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)
4,575.00
9.082.14
(11)
(12)
(13)
(14)
13.657 14
13,657.14-
.00
13,657.14-
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
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
(19)=
.00
.00
.00
.00
.00
TAX CREDITS:
. ~.. ._n. ..----. (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)