HomeMy WebLinkAbout02-0492
Estate of .::.. LI"l R A
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
R \N l T,;irE-f-Z.. No. 2.' - 0'2 - ll9 ~
To:
, Deceased.
o <1; 7 (C,
Register of Wills for the
County ofCvi"llOf'f\LAND in the
Commonwealth of Pennsylvania
Social Security No. I c.r (. 0 ,
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executo~
in the last will of the above decedent, dated _J v .'-' I< '2I~q"f:3
and codicil(sl dated
named
, 19_
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death inCU~eU;:t\ L-A~
h":~ last family or princ~al residelJt at i "1(00 MAl". K.ET
C 1'-\ F t t <-l.-- ell
(list street, number and muncipalilY)
County, Pennsylvania, with
S',
Decendent, then q 3
at
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:
years of age, died
fvtlf'j 't
2..0 c. d..
,19
Decendent at death owned property with estimated values as follows:
(I f 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:
$ 'l.iO060
$
$
$
WHEREFORE, petitioner(s) respectfully" request(s) the probat~ of the last will and codicil(s)
presented herewith and the grant of letters ,""'" LIt M. <2J"T/IR.t
(testamentary; administration c.La.; administration d.b.n.c.La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1 -
r s"
COUNTY OF CUMBERLAND J
Sworn to or affirmed and subscribed
before me this 20 17th 19 day')
'2{/~ ~ ~UWJ
MAR C IS Register
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 decedel1t petitioner(s) will well and truly administer the estate according to law.
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No. 2/- 0:> - l./q2.
Estate of CLARA R WINTER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MAY 20, 2002 19_, 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 6-8- 1993
described therein be admitted to probate and filed of record as the last will of CLARA R WINTER
and Letters TES'I'AMENT'ARY
are hereby granted to DAVID R WINTER
fl.
FEES
Probate, Letters, Etc. ......... $ 80,00
Short Certificates( ).......... $ 9 00
R~.~F.a,.~g!"s.. $ 3.00
jc;p $ 5.00
TOTAL _ $ 97.00
Filed .... .5::?9:-.2.o.QL .. .. . .... .. .. . .. . .
mailed to exec on 5-20-2002
ATIORNEY (Sup. Ct. 1.0. No.)
ADDRESS
PHONE
r"
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
qualified according to
present and saw
codici
(each) a subscribing witness to the will present
law, depos s that
the testat , sign the same and t
request of testat_ in h
other subscribing witness(es)).
signed as a witn at the
) (in the presence of the
Sworn to or affirmed an
me this
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
2.1-02 - 4q2
DAV;dk
AND
JERI\I F
c, j /lVTr=- I<
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
ih",. ARF familiar with the signature of ('f (R","'K \AI'^ITFf'..
\ OSGioil
testat c:::R--. of (one of the :m.b3GI ibiAg witfl8sses to). the will
that
---rh" , j
presented herewith and
GediGiI.
believe\the signature on the will is in the handwriting of
to the best of .' \ To"; '!L_ knowledge and belief.
Sworn to or affirmed and subscribed before 9~ G. u:J~,
me this 17th day of (Namp,
N MAY 2002/ . ---;-) 1 <Yo C Coov--t0 ';;;>t
~ll~r uZ. ~~d-,' n (Address) ~
. Register rru"J,v. n)u. (lOSS
( J0(t<0~~ RNat0vrThJl
(Address)
2/n~z 05/1t/93 willtercl.wll
WILL OF
CLARA R. WINTER
21-02-~q2
I, CLARA R. WINTER, of the City of Reading, Berks County,
Pennsylvania, hereby revoke all prior Wills and Codicils and declare
this to be my Will.
I. DISPOSITIVE PROVISIONS
A. Entire Estate.
I give all of my property of whatever kind and wherever
situate unto my son, David R. Winter, if he survives the date of my
death by thirty (30) full days.
In the event my son, David R. Winter, does not survive
the date of my death by thirty (30) full days, then I give all of my
property of whatever kind and wherever situate unto my daughter-in-
law, Jean E. Winter, if she survives the date of my death by thirty
(30) full days.
In the further event that both my son and my daughter-
in-law do not survive the date of my death by thirty (30) fully days,
then I give all of my property of whatever kind and wherever situate
unto my granddaughter, Sharon A. Winter.
II. ADMINISTRATIVE PROVISIONS
A. Payment of Debts.
My personal representative hereinafter named shall pay
all my just debts and funeral expenses as soon as is convenient after
my decease.
B. Death Taxes.
All estate, inheritance and other death taxes which may
.
be imposed with respect to any estate or property passing by reason of
my death shall be paid by my personal representative and charged
against the principal of my residuary estate as though such taxes were
my debts.
C. Appointment of Personal Representative.
I appoint my son, David R. Winter, to be the Executor
of this my Will.
In the event my said son should be unable or
unwilling to act as Executor, then I appoint my daughter~in-Iaw, Jean
E. Winter, to be the Executor of this my Will.
In the further event
that both my son and my daughter-in-law should be unable or unwilling
to act as Executor, I appoint my granddaughter, Sharon A. Winter,
Executor of this my Will.
IN WITNESS WHEREOF, I, CLARA R. WINTER, have hereunto
subscribed my name and affixed my seal this
8 +h. day of Dt..L V) e.
A.D. 1993.
~~nA-a.-- rJ? ~ j;4k.J
(Clara R. Winter)
(SEAL)
Signed and Declared by CLARA R. WINTER to be her Will in the
presence of us, who at he request and in her presence and in the
presence of each other, subscribed our names as witnesses:
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
C.l.-ARR g \N\NTE:R
Date of Death:
MAt Ii ;;260d.-
Will No.
'J.l-o~-o'i9d--
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on MA1 '2. c.., ;;),00 d-
Name
Address
OA'no R V\hNTk:K'
705 E. CooIJe:H ~T MEC,HANIC'll3URE7 f1\ \105 S-
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
NA
Date:
Signature
,r.
, ,
Name~~ 'R-, W Affitan
Address 105" G. Coc,\j E' I<. ~T
M~c...tl6\;l\I\CSBtjR0 ~
Telephone n I]' G'1I- (; I 5":3
1,655
Capacity: L Personal Representative
_Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(l 1-96}
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WINTER DAVID R
705 E COOVER ST
MECHANICSBURG, PA 17055
______u fold
ESTATE INFORMATION: SSN: 196-07-0976
FILE NUMBER: 2102-0492
DECEDENT NAME: WINTER CLARA R
DATE OF PAYMENT: 07/17/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 05/04/2002
NO. CD001418
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $905.46
I
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TOTAL AMOUNT PAID:
REMARKS: DAVID R WINTER
CHECK# 554
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$905.46
MARY C. lEWIS
REGISTER OF WillS
flfV.l500"')(~)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280001
HARRISBURG, PA 17128-0001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
V\J If'l-r CLARA
DATE OF BIRTH (MM-DD-YEAR) ~
09-oa-\~CV
IIF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
DATE OF DEATH (MM-DD-YEAR)
o 5" ~o4- ;;tooOl
,... A
~ 1. Original Return
o 4. limited Estate
~ 6. Decedent Died Testate {A~acI1CDpyoJWIII)
o 9. Litigation Proceeds Received
R
o 2, Supplemental Return
o 48. Future lnterest Compromise (date of (fe8(h after 12.12-82)
o 7. Decedent Maintained a living Trust (AUach copy "f Trust)
o 10. Spousal Poverty Credit (dateoJooambelWee~ 12-31.91 alld 1.1.95)
OFFICIAL USE ONLY
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\ '1- lQ':J-
FILE NUMBER
at-OOl.
-- --
Oc>Y:4~
NUMBER
CO\.JNTYCODE
YEAR
SOCIAL SECURITY NUMBER
lq~ - <Yl - ocr7"
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return jdate of clealh plior 10 12.13-821
o 5. Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attacl1 SenO)
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NAME - Of\'\l~O \<, \N\
fIRM NAME (II Ap~icablei
COMPLETE MAILING ADDRESS
.91-0t5~
1. Real Estale(Sche<lule AI
2. Stacks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
o
o
o
()
1~3/1 a,
t3LfL\'o,.11
o
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages 8: Notes Receivable (Schedule OJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Sche<lule E)
6. JOintly Owned Properly (Sche<lule F)
o Separate Billing Requested
7. Inter-Vivas Transfers & MisceJJaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (lolal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabffities, & liens {Schedule I)
11. Total Deductions (total lines 9 8: 10)
12. Net Value of Estate (line 8 minus Une 11)
(6)
(7)
(91
(10)
~q, \()
o
13. Charitable and Governmental BeQuests/See 9113 Trusts for which an eleclion to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Line 131
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amounl of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}{1.2)
16. Amount of Une 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of Line 14 taxable at coUateral rate
19. Tax Due
20.01
o
,,0_ (15)
, ,0 ItS' 116)
o
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, ,12 (H)
, .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
OFFICIAL USE ONLY
(8)
a \ \ ~O... t.t4-
(11)
(12)
(13)
1. It:!. 1Q...
8.0 Lt''3 t,. 3It
o
a 0 ~l.. -ott
(14)
(19)
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CA~E
5
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CredilslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(')
9 0 5". Ii~
tt 1 . be:.
Tolal Credits ( A + 8 + C )
3.
InleresVPenal1y if applicabie
D. Interest
E. Penally
o
o
4.
TolallnleresVPenalty ( D + E )
If Line 2 is grealer than Line 1 + Line 3, enler the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 31s greater than Line 2, enler the difference. This Is the TAX DUE.
A. Enter the inlerest on the tax due.
8. Enter the tolal of Line 5 + 5A. This is Ihe 8ALANCE DUE.
(1)
'"
ZIP ItOI
C).l~t
12)
'953.l;;l..
(3)
14)
15)
15A)
(58)
o
33.,1
Make Check Payable to: REGISTER OF WILLS, AGENT
. c; ,"',}'X:""'Z,,=,',,,"';'. , ilIr. AI . I
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedenl make a lransfer and:
a. retain the use or income of the property transferred;,,>> . ............. ...... ......... .
b. relain the righllo designate who shall use the property transferred or ils income; "....
c. retain a reversionary interest; ar....... , .. ..", ... ......... ..
d. receive the promise for life of either payments, benefits or care?.. .. ...... ..........."....
2. If death occurred after December 12, 1982, did decedentlransfer property within one year of dealh
without receiving adequate consideration? . . ..... ............... . . .. ,.. ...... 'W'"
3. Did decedent own an "in trust for" or payable upon death bank acoount or security at his or her death? .....
4. Did decedent own an Individual Retirement Accoun\, annuily, or other non.probate property which
contains a beneficiary designation? ... ..
Yes
................0
..0
....................0
...0
..0
......0
. ............. 0 XI.
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 oj perjury, I declare that I have e~mi(\(lo \his return, including accompanying schedules and statements, and to me bes! of my knowledge and belief, it is true, correct
and complete
Oeclara~on 01 preparer other than the personat representative is based on all information of which preparer has any knowledge
ADDRESS
{Dn E Coo\)E:R ~T M~~~Ic":,~~I)t<& FA.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
0<=\-09.- 2.CaCL-
nO 5!J
DATE
ADDRESS
~:,it'Ii!.Wiw.;if:.~ll~.. T ... ~r~ L Iln~~. LiliUJilfllMi!iD m.
For dales of death on or after July f, 1994 and before January 1, 1995, the fax rale imposed on the nel vaiue of transfers 10 or for Ihe use of the surviving spouse is 3%
(72 P.S. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to orlor the use of the surviving spouse is 0% [72 P.S. 99116 (al (1.t) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are sM applicable even if
the surviving spouse is the only beneficiary.
For dales of dealh on or after July 1, 2000:
The tax rale imposed on Ihe nel vaiue of lransfers from a deceased child twenty-one years of age or younger at dealh to or for the use of a natural parent, an adoptive parent,
or a stepparenl of the child is 0% [72 P.S. 99116(a)(1.2)).
The tax rale imposed on the nel value oftransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !i911611.2) [72 PS. 99116(a)(I)].
The tax rate imposed on the nel value of Iransfers to or for the use of the decedenfs siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
indivlduai who has at least one parent in common with the decedent, whelher by blood or adoption.
REV...."'.,''" ~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTA.TE OF
C. LARA R, 'v\l \ N~ FL
FilE NUMBER
aU -oa - DLt'\a.
Indude the proceeds of litigation and the date the proceeds were received by the .,tete. All property jolnUy-owned with the right ohunrivorship mutt be distlosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
5~LC.O Cc>t'II.. Cf:<forr UNION -<:-lhc-\<.\N E:t
AU-oU~-r: ~O, 753(08-0
51.-{ a.t. 05
a
BE-LCO CotJ\, (t<<<=.Q\T 'VNION _5A-\I\t\l~5>
AL.Lo\JtJl ~O, \<ocr~~D
l03J.,b5
'3
e~lC..6 CoM, c.~~Oc\ \jNlO~ - Ct-\<2::c.t<\NQ
f1-UOOh-S\ NO. 169G80
:1.0 '83, 51
TOTAl (Also enter 011 line 5, Recapitulation) $ 7i 37. ;;;.:;
IIf mo", 'oace is needed, insert additional sheets of the same size)
~"":EX.(1'".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL V-OWNED PROPERTY
ESTATE OF
c.. L..I\ AA R
WI N"bER
FILE NUMBER
a\-oa-OLt9a.
If an IIset was made joint wtthin one year of the decedent's date of death. it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RElATIONSHIP TO DECEDENT
A. OA'Hl/ ~,\N \ ~R.
,4NP
j E: AN E
.J, T";N
\N l"-lTE\<'
W~DS
le>5 E:. C.oO\JE-R ST
ME-c..\-\A- ~\ cSeuR<;7z 8. l105~
S?N ANY'
ONJQItre:1(-I~-\.A'
&-
c.
JOINTLY.OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY %Of DATE OF DEATH
ITEM FOA.JDINT MADE Include n<me of financial institution and bCl'lk account number or simillr' identifying number. Alta:h DATE OF DEATH DECO'S VAlUE OF
NUMBER TENANT J<>NT deed for jointly.held real estate. VALUE Of ASSET INTEREST DECEDENT'S INTEREST
1. A. I 116/0< V tt~G;;>\.)J\t\D ~NlD
4D 3Q..V\'~ 33.3't l3ifLt3.1
,.Jo. 0'99' If Y ~~ IG sa
TOTAL (Also enter on line 6, Recapitulation) $ 131..flt3~ \l
1
/If mnrc <:.n::lol"'j:! jo;;: nRP.ded. insert additional sheets of the same size)
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REV-1S11 EX+ (12-99)
... '1~}i~;S-
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF rl
<-- LARA
1< V\l \ NTE1<
FILE NUMBER
a...\~Oa-O~~~
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 F=" l> N ~(.(A-L- D~f(ecro~ _ 'P~f'A-\ '0 O~OCJ
a.. F l> NeJ~ AL FlOW'<:.RS lq~l 10
3 /JJ IUC~ - c."E-F All..AS\) ";:> !-lMex< \q1 N 1915T't<-o '36\,00
't f(\ c. \-t f\ l< D 'f(\\oP-e~ Jt< t-f\EO"lvti\AL~ Q5,oc
--- I ~S::..<Rlrrlo IV
...-. k:?MB ~O~E.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Represenlalive(s)
Sodal Security Number(s)/EIN Number of Personal Representative(s)
Slreel Address
City ________ Stale __.____ Zip
Year(s) Commission Paid:
2. Altorney Fees Cl ~ 00
3. Family Exemption: (If decedent's address is noltha same as claimant's. attach explanation)
Claiman\
Street Address
City _________________ Slale ___ Zip
Relalionship of Claimant to Decedent
4. Probate Fees CJl,CV
5. Accounlant's Fees
Tax Retum Preparec's Fees 0
6.
0
7.
TOTAL (Also enter on line 9. Recapitulation) $ lLjq I 10
(If more space 'IS needed. insert additional sheets of the same size)
J
flE\I.1513 EX + (1.97)
'*'
SCHEDULE J
BENEFICIARIES
.,..
...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF /i
'- LARA 'K I \N \ t'lTE-f2.
AMOUNT OR SHARE
OF ESTATE
FILE NUMBER
d-.\-o<L- 0 4-~d-.
NUMBER
I.
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS (include Dutnght spousal distIibutions)
1.
DA\ll'P 1<. '\N\NTE1<- SON
165 E. Coo'\ltt< Sl.
,,^EC.j-\ftti)\c..:;)~\)f<.9~. llD55
loo ~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
N!A
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
N/ft
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If lT1O(e space is needed, insert additional sheets of the same size)
0.00
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: c-'LAFZA 'l-< \N l,i'JTER
Date of Death: 05" -01-{ -'C..OOd.-
Will No. '"2, I 0 d- -0 L-f ac~
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes V 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
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: \O/d.-l.-//c?d-.
. ,
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'" BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLDWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DAVID R WINTER
705 E COOVER ST
MECHANICSBURG
'[
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C~UNTY
ACN
10-22-2002
WINTER
05-04-2002
21 02-0492
CUMBERLAND
101
*'
REY-l!i41EKAFP[Ol-D2l
CLARA
R
PA 17055
Allount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i5'4-j-Ex-AFP--fiiFoiff-NiiYicE--.WYNHEifiTilircn:.!iinrpiiRA-isEi"-ENT~--Ai:.iowilirCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WINTER CLARA R FILE NO. 21 02-0492 ACN 101 DATE 10-22-2002
TAX RETURN WAS: (X I ACCEPTED AS FILED
I 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. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (IS)
19. Principal Tax Due
.00 X 00 = .00
20,431. 34 X 045 = 919.41
.00 X 12 = .00
.00 X 15 = .00
(191= 919.41
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds {Schedule BJ
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable {Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
III
(21
(31
(41
(51
(61
(7)
.00
.00
.00
.00
7.737.27
13.443.17
.00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(91
llOI
749.10
.00
(111
ll21
(131
ll41
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
21,180.44
749 1 n
20,431. 34
.00
20,431. 34
TAX CREnnS:
rR,n"", " '+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-I
07-17-2002 CDOO141B 45.97 905.46
10-15-2002 REFUND .00 32.02-
TOTAL TAX CREDIT 919.41
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 PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.]
'\.- //-6-.5--0
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-16D1EKAFP[Ol-D2l
DAVID R WINTER
705 E COOVER ST
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNl'Y
ACN
10-28-2002
WINTER
05-04-2002
21 02-0492
; CUMBERLAND
101
CLARA
R
Amount Rellitted
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account3 submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ...
R"E-y=i60Tix--AFi.--foT--ii2Y------...--iilifERii:ANC"E--YAlCSTATEH"E-N"Y-O-F"-AcciiuNT-...---------------------
ESTATE OF WINTER CLARA R FILE NO.21 02-0492 ACN 101 DATE 10-28-2002
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, 10-15-2002
PRINCIPAL TAX DUE,.. 919.41
PAYMENTS (TAX CREDITS),
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-17-2002 CD001418 45.97 905.46
10-15-2002 REFUND .00 32.02-
TOTAL TAX CREDIT 919.41
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
IN THE MATTER OF THE
ESTATE OF LOY H ROSS,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-0492
ESTATE SETTLEMENT AGREEMENT
THIS AGREEMENT, made this ol.qhL day of January 2003,
WITNESSETH:
THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows:
I. Loy H. Ross (the "Decedent"), a married man, died testate on February 7, 2001,
and Janet B. Ross duly qualified with the Register of Wills of Cumberland County, Pennsylvania
as Executor (the "Executor") of his probate Estate (the "Estate").
2. The Will provides as follows:
Article FIRST:
I give, devise and bequeath all of my property real, personal and/or mixed of
whatever nature and wheresoever situate, to my wife, Janet B. Ross, her heirs
and assigns.
3. Janet B. Ross (the "Beneficiary") desires the Executor to settle the Estate infor-
mally in order to avoid the expense and delay involved with the formal adjudication of a First
and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumber-
land County, Pennsylvania (the "Court").
4. The Beneficiary desires to forever settle and compromise any and all claims and
rights which she may possess, now or hereafter, in the Estate and to confirm her acceptance of
the Informal Account (the "Account") and the Schedule of Distribution (the "Schedule") which
are attached hereto as Exhibits "A" and "B", respectively, and incorporated herein by this
reference. The Beneficiary desires that the terms of the Schedule be in full satisfaction of her
rights in the Estate.
S. The Beneficiary wishes to release the Executor and to indemnify her against any
and all claims that may be asserted against the Estate or the Executor after the date hereof.
6. The Executor is willing to settle the Estate informally in consideration of the
indemnifications hereinafter provided by the Beneficiary.
NOW, THEREFORE, in consideration of the foregoing and intending to be legally
bound, jointly and severally, the Beneficiary, for herself, her heirs, personal representatives,
successors and assigns:
I. Represents and warrants that she has read and understands this Agreement
and confirms that the facts set forth above are true and correct, to the best
of her knowledge, information, and belief.
2. Acknowledges receipt ofa copy of the Account and a copy of the Sched-
ule.
3. Declares that she has had the opportunity to review the Account and based
upon an examination (or on her decision not to make such an examina-
tion), she is satisfied that she has sufficient information to make an in-
formed waiver of her right to a formal accounting with the Court, and does
hereby waive the filing and auditing of the same.
4. Accepts the Account, examined or not, as if the same had been duly filed
with and audited, adjudicated, and confirmed absolutely by the Court.
-2-
5. Acknowledges that the distributive share or amount received shall be in
full satisfaction of her respective entitlements under the Will, and ac-
knowledges that she has received her respective share.
6. Releases, remises, quitclaims and forever discharges the Executor, her
heirs, personal representatives, successors and assigns, from and against
all claims that she, as residuary legatee and heir had, now has, or may in
the future have, in connection with the Estate.
7. Agrees to refund on demand, all or any part of any aforesaid distribution,
which has been determined by the Executor, or by the Court, or by any
court of competent jurisdiction to have been improperly made.
8. Agrees to indemnify and hold harmless the Executor, her heirs, personal
representatives, successors and assigns, from and against any and all
claims, loss, liability or damage (whether or not related to the negligence
of the Executor) that may hereafter be asserted against the Estate or against
the Executor.
9. Consents to the Court exercising personal jurisdiction over her in any suit
or action arising out of the enforcement of this Agreement.
IN WITNESS WHEREOF, and intending to be legally bound, the Beneficiary has placed
her hand and seal on the attached Consent to this Estate Settlement Agreement.
-3-
CONSENT TO ESTATE SETTLEMENT AGREEMENT
I, JANET B. ROSS, hereby consent to and join in the Estate Settlement Agreement
relating to the Estate ofLoy H. Ross, deceased, a copy of which Estate Settlement Agreement has
been provided to me.
~ 8:1? ffd/'
~T B. ROSS
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the~q h<.. day of M= 2003, before me, the undersigned officer,
personally appeared JANET B. ROSS, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that she executed the
same in the capacities and for the purposes therein contained.
IN WITNESS WHEREOF, I hereunder set my hand and official seal.
NO~cr LL
NOTARIAL SEAL
CYNTHIA J. RULE. Notary Public
Camp HIM 80<0.. Cumberland
[q9E,,'E,!.e.s J 24,
-4-
Exhibit "A"
Accounting for the Estate of Loy H. Ross, Deceased
Receipts of Principal
Assets Listed in Inventory
(Valued as of Date of Death)
Waypoint Bank Certificate of Deposit
#8000015034 dated 8/07/95
Total Inventory
Receipts Subsequent to Inventory
(Value When Received)
Total Receipts Subsequent to Inventory
Total Receipts of Principal
-1-
$3.598.97
-0-
$3,598.97
-0-
$3.598.97
Disbursements of Principal
NONE
TOTAL EXPENSE DISBURSEMENTS
-0-
Principal Distributions to Beneficiaries
To: Janet B. Ross
Waypoint Bank Certificate of Deposit
#8000015034 dated 8/07/95
$3.598.97
Total Principal Distributions to Beneficiaries
$3.598.97
-2-
Receipts of Income
NONE
Total Receipts of Income
-0-
Income Distributions to Beneficiaries
NONE
Total Income Distributions to Beneficiaries
-0-
TOT AL ASSETS AVAILABLE FOR DISTRIBUTION
-0-
-3-
EXHIBIT "B"
SCHEDULE OF DISTRIBUTION
1. To: Janet B. Ross
TOTAL ASSETS DISTRIBUTED
. .
-0-
-0-