HomeMy WebLinkAbout02-0637
REV-15DO EX 16.001
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
w
,..,
::.::~(I)
0""<
w"o
",00
0"'''''
....
..
'"
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
C
W
U
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITI1LJ
-ThomAs CjJAr loffE
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
05-28-02.. 05-03-2.0
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
;v/A
OFFICIAL USE ONLY
~
4.
~ 1. Original Return
D 4. Limited Estate
rKI 6. Decedent Died Testate {Attach copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale 01 death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
D 10, Spousal Poverty Credit (date 01 death between 12.31.91 and 1-1-95)
- 7.s:~
FILE NUMBER
eLJ.. - a J.. ___
COUNTY CODE YEAR
-------r
k3..1~
NUMBER
SOCIAL SECURITY NUMBER
20;' - 20 - 2 <-j{)J,.
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
----
/-/"
D 3. Remainder Return (date 01 death prior to 12-13.82)
D 5. Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Mach Sch 0)
,..,
Z
W
o
Z
o
..
U)
w
'"
'"
o
o
NAME
FIRM NAME {II Applicable)
COMPLETE MAILING ADDRESS ... +
(p'-/C't'-/ LINtO/AI (OUe;
S::A.$--t 7c-tE.C2SbV(J I pJ\ \ 75Z0
vV ~O\I''''~C'lV\.4\-S( --\R..
- r---.OFFICIAL USE ONLY
'1
I
I
,
!
,
!
TELEPHONE NU~BE~
-ij~e (7/ lj5t/l- 7'14-1
v-/<>e.K W'k>J'l5"f-fi7{J()
,
L.__
(8)
11/5 /P (PIP 2... ICf
)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
.:ti 1(7) 500.00
(11) jj 3D; q II , 3 'J.
(12) 41 / 2.5, 7-50 Sz.
,
(13)
(14)/1 /lS~ , 75'0 8l
,
15. Amount of line 14 taxable althe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
#/Z5, 15CJ. 82.
/
x.O_ (15)
xO tH.. (16) :It 5 &58.7-7
/
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
(19)-1l' 5,C,58.;t1
(1)
(2)
(3)
(4)
(5) Jj
z
o
!;(
...J
::::l
l-
ii:
<C
u
w
0::
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. Total Gross Assets (total lines 1-7)
(9) i/ /0>,7'1<1. <10
(10) $I 1'/ / (, to. q 1,
)
-
'2.0. Z05. 91-
/ - .
(6) --.
(7).$1 26."15(", Zz.
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 (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14 Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
I-'
::::l
c..
==
o
u
g
16. Amount of Line 14 taxable atl~ate
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
/71;'1 CaE-ie. vI~fA 7J~;vE ,
CITY N~vV C. i..>m !J.eI! fA.Nc1 I STATE IJIl I ZIP/707.1
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 41 5' &58. 7i
I
Total Credits(A+ B + C) (2) # - 0-
3.
InleresVPenally if applicable
D. Interest
E. Penalty
(3) .it
(4)
(5)41 5;t.-58, 11
(5A) it - 0 -
(5B).il5, (.,58. 77
Make Check Payable to: REGISTER OF WILLS, AGENT
4.
TotallnteresVPenalty ( D + E )
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
-0
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.
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. retain the right to designate who shall use the property transferred or its income; ..... ......... ........".....
c. retain a reversionary interest; or... ..
d. receive the promise for life of either payments, benefits or care?....
2. If death occurred affer December 12, 1982, did decedent transfer property w<hin 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? .
Yes
........0
o
......0
o
o
o
........0 IKI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
DATE
7- /5'-01..
tA511f!rts~ /A /75'2 tl
bATE
No
~
~
~
&J
00
IZJ
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Under penalties of perJury, I declare that I have examined !his relum, including accompanying schedules and statements, and to the bes f my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other lhan the personal represenlalive is based on all information of which preparer has an knowledge.
lj
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
llI___llIllllI!Illll!lll!ll!l\lllIlll!Illlllllill!l!lt'll!ltII!llB~ll!llIli~,,,,I:IlI. ,-~_ I !lll!~_ !rl!llB___.l!I\!
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995. the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (illl.
The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after 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. 99116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneffciaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(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. 99116(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.
""'''''''<'''''*
C~WEAl1H OF PENNSYLVANIA
INHERIT ANGE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Ch. ~R \6~E. ~. ~"'o'N\.~S
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer aoo a willing seller, nanner being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshiD must be dtsclosed on Schedule F.
ITEM
NUMBER
1.
FILE NUMBER
u,bcu.-) ~o,-,:SE .-
@
DESCRIPTION
17t, I Ce~~k. VI~A
!'IE"" C<>",'u:lE",I~Mil ptt /7070
(L6t.;\t8o~BEAl6".1 \A,\\ ^A\
\.. "'el/'d;(;,l<'b~I~AI ,..., ")
VALUE AT DATE
OF DEATH
-1t\Or 506
I
TOTAL (Also enteron iine 1, Recapilulation) $ 16 '7-, 500
(If more space is needed, insert additional sheets of the same size)
~'~~."").
COMMbNWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF C,j4~ ~r'k.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
. -n~M4S
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
~
VALUE AT DATE
OF DEATH
tJtJ{). OC-
t
L
7IiL~t> ~mnt(t^~f C,ldl t/Nt"~/_I/;/ .4t'(~/;'.d
4ectllWt# ooqt30
....., 1/ 3 130 "/'1
t
3.
75~1- 1'0 C"J#""""t; 7' {~,I t!N;A/ Sd.l/4! /ht'LW"I f
,4 {zov.v1:1f. ooQl3c,
~
/ Q71.. 3S"
,
'I
75EUo
/' . L c,.. ~II!N/~I Sll1u PM!I,4Cttk/tJi
L tJl11/11tJNt'i' /lM1
/lCLOIJ/# ODQl3D
~
//.
.dp,p/tdcl :j<',.fSjl:;WLfA~di~
~
Z / ()b. oU
I
TOTALIAlsoenteronline5,Recapitulation) $20205.91 .
(If more space is needed, insert additional sheets of the same size)
L.B. SMITH FORD, INC.
Buyer(s)
Salesperson
Date
Address
Home Phone
City, State
Zip Code Work Phone
Ft!>>t-v f~(.O'1.r Z,X'- 3FRk~Jl3X)( r<,U, /Z.q,s- 1~6:Jgy
Make Model Vin# Mileage ~
/9qq
Trade Yr.
Title
Payoff to:
Amount: $
Actual Over lOOK
I agree that this is the true and correct mileage._
Initials
EngJL Trans It- 4X4 _ TiltX Cruise.!:1..Plocks Nwindows Bbrake~ AlC hseat_
Pstrg_ AM!FM _ CassX- CD _ Moonroof~Ttops _Leather _ Wheels'^-.svc policy_
Interested in Stock#
Make
Model
NfU
Sale Price$
Cash Down$
,/L~ ~~ ~/r~v-'f..... of' ~t.- "l? t:55~T
/$ &l'4o-~o
Buyer SS# Cobuyer SS#
I authorize an investigation of my (our) credit history.
x
Date
x
Date
REV''''''''"9''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C.A4t. ffillk
A
FILE NUMBER
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
7J;pn4--j
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side 01 the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUOE THE Njl,ME OF It1ETRANSI'ER.EE,THEIR. RB.A1\ONSHI?TOOECEDEIH Al'lD"iI1E DJ\TEOf lR1\NSFER DATE OF DEATH DECD'S EXCLUSI~~ TAXABLE VALUE
ATTAGH A COPY OF TfIE DEED FORREALESTATE.
NUMBER - VALUE OF ASSET INTEREST IF APPliCABLE
1. 8.9";' iAhif 'f';:~..,,>Kl. P>......"'''';:-r, lCO'}'., "'fA 'fiLS '15 fen
'" <:<:o..".-f ti; C)OQO"lyo 18 ( I
TOTAL (Also enter on line 7, Recapitulation) $ 28J95t:P.22..
(If more space Is needed, Insert additional sheets of the same size)
EQUITABLE
W. Jobn Tbomas
6494 Lincoln Court
East Petersburg, FL 17520
August 29, 2002
Re: Charlotte A. Tbomas, Dec'd
Social Security #202-20-2402
Date of Death: May 28, 2002
Policy #37008501
Date of Issue: February 15, 1994
Contract #940181
To Wbom 11 May Concern:
We have prepared tbis letter in triplicate pursuant to your request for Federal Estate Tax
information in connection with the above numbered contract, since Form 712 is not readily
adaptable.
Supplementary Contract #940181 was issued in settlement of the proceeds of Policy #37008501 issued
iu the life of Charlotte A. Thomas, the insured which became payable by reason of the surrender for
cash value.
At the election of the decedent, the sum of $83,526.12 was applied to provide the decedent with
installment payments of $524.22 commeucing on February 15, 1994 and payable monthly thereafter
for her lifetime.
The contract further guaranteed that if the decedent died prior to receiving payments to equal the
proceeds applied, the remaining payments would be paid to a designated beneficiary as they became
due.
Tbe decedent had the right to designate a nominee to whom any amounts due upon tbe death of tbe
decedent shall be paid. The decedent bad no right to surrender the contract and to receive the
surrender value thereof.
By reason of the death of tbe annuitant on May 28, 2002, tbe remaining installments to complete the
contract guarantee are being continued to David C. Tbomas and W. John Thomas, in equal shares.
For Federal Estate Tax purposes, the val e ining installments calculated at the rate of
3.00% as of the decedent's date of deat is $28,956.22.
In the event that you have any questions regarding this letter, please call our Toll Free Number 1-
800-245-1230 and ask for Rutb Ferchland.
Sincerely,
~az~~~
Manager
Annuity Benefits Division
Equitable Life Assurance Snciety
of the United States
200 Plaza Drive
Seeaucus, NJ 07094
, REV-1511 EX+ (12-991
.'. W
/. COMMONWEALTH O~ PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF . / /
CA.4t: rp#E A '/JItf>>t45
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported 0 S h d I I
n c e u e .
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES: AMOUNT
1. A/c!1/ r""r/u.J/~F I-"'/ - 39',; /1'?A'AI.5/Hd tI ifGl~ L,t:>
-
/ . LAM/ 4,i~ /1'1 /lM ,
z,. f=1"wu~ "
- 2/B 31
3~ tlJtUe. (;;"4 ~ hfarA""",,~ "
1. ;::p~;;"" C.'/II'1 y/'1'f/IYl - q /. oS-
- I( I()d' ()t)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissionyb...st f),'SSO(t~w\ l:..CFt\, $A\f: J: i:'E.:S{cl~ - WIO <It.5.(/7-
i
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative{s)
Street Address
Clty___. Stale _~_ Zip
Year(s) Commission Paid:
2. Attorney Fees 7\ f:>.L'""'1 E ~1.€}hA- (31,,31 Aloe{+" ~rc.o\ S'I., I-l~. . PA) ~
- I'ID Db
3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _~Zip
Relationship of Claimant to Decedent
4. Probate Fees
;::'XEcv-\eo... ~'E-IE,'S ("'1<~-W. ..x,~<'\~bM;"'~ Jl.) ~3 'i<./:. 06
5. Accountant's Fees .- f~t~"'.,f., .4..tri: ]23.5' ;!!' . -
- Ib ~f"1':J_ Ii!. "'-
- ~e/'l","'ll"'/'M4.6lj). 5 ~p
6. Tax Return Preparer's Fees .- Sh~,f{ Gqttf;Jf.(i! i 2., ..,,!;
-JL!?rU ~ e
- ,,,,,,J.;rllwf/PVJ,,,,,"; 7'''''
7. (Y'I, $e "- i \"''''eo~> qp""'.....s: -rviI-J t3W.f>'
. C lEI'''" C:i:Io-pr.-l:s at -\o...co">,^(>,,"e.(tDP"f'I>~~L~) - J;/ 2.'/3'1
. K~ d\ ~""R t~e( -\0 ~ h~ cUs""~~) ilr' '3/ 86
-
. Z"P"'~ Jteppil>l!. S; \t.:.r;~ due. .\ot, d~... .- .l1.74:>3oc...
TOTAL (Also enter on line 9, Recapitulation) $ /& '1 '1'-1. 1./D
(If more s ace is needed
P , Insert additional sheets of the same size)
,",'.,",
3401 MARKET STREET
CAMP HILL, PA 17011
(717) 737-8726
www.neillfh.com
o/YdZ
FUNERAL HOME INC.
"For the Perfect Tribute"
ROBERT 1. PRAMIK, FO, SUPERVISOR
3501 DERRY STREET
HARRISBURG, PA 17111
(717) 564-2633
www.neillfh.com
.....~,
STEPHEN 1, WILSBACH, FO, SUPERVISOR
.
Mr. W, John Thomas Jr.
6494 Lincoln Court
East Petersburg, PA 17520
This is an itemized bill for the funeral of: Charlotte A. Thomas
PROFESSIONAL SERVICES AND MERCHANDISE SELECTED
20ga Casketw/ Crepe Interior(Earthto ;', . ,,','o"P,".. . ,;.. ' $,
Complete Traditional Service ..... . . . . . . , . . . . . . . . . . . .
Memorial Package B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sub - Total' $
CASH ADVANCES
Death Certificate .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
Newspaper Notice, Patriot-News .... . . . . . . . . . . . . . . . . .
Sub - Total '
Total Funeral Charges,
Payment Received
Balance Due on Account (Due date: 06/10/2002)
Ref No,: 1000831
.~~~:-;r....,.,;;,;,;;,'-"
;;'.."-;J.
June 12, 2002
'+::':
;,'
-
.!O
. "<.~
'i'i,
{:
"
<;. ,;..,~~',
. . '., ,,;,,""'i"'~~
","'j"",",..,1.280.00".~'"""",",\;,.~
3,100.00 'i,1;
155.00
4.535.00
30.00
61;20 '
'$ "
$
$
c;uo
. ." 4.~.2~
(500.00)
$
$4,126.20
"';"n.~
u'~ ~
- -w
f- ~
~ "
~, rJJ ~
,;,
Cl PE~ERS FLOWERS - TRINDLE ROAD o~
... Telephone No: 737-4506 =
... :a
f- Order No : 889961 Operator : 000 f-
~ Taken At : 06:00 "" ...
'"
~ister : 52 Clerk : 618 "
er Date: O6/06/OZ Sale Type : VI '"'
.~
-< Del Date : tI6/09/OZ Z
;:;J Sold To : ~IAM J 1lPIAS JR <l.I
U "xxxxxxxxxx0605 Auth: 874718 .=
Z f-
1 CASKET SPRAY - FULL CAS $200.00 ;..
0 IlAKELlI<E T142--4 "
.... PINX, illITE ~ FLOWERS rJ1
f- ::l
U r\.O\[ll~o~al : --;200.00 ~
:<
~.. ;:l,
1fJ Delivery Charge : $5.9S -
,"", Service/Relay Charge : $.00 ""
E- ::r;
-< Tax Roount : $12.36
'"
r.n :;
Total Alount : $218.31
Aoount Tendered ~ .
:;':':;1 Change : [Z,
0:
..;;., Oellver To: CHA~OTTE THOMAS
W Attn: NEILL .=
l-.. Address: 3401 MARI<ET STREET F'~
'7 ...
'--j City, st: CAMP HILL P!l ..
~ <J
'"'
-< i
;:J Signature " '~' ..... <l.I
U I ack_l e of sand/or .=
Z servicesagre!. '1:"= the obli- f-
0 gationssei forth in t,e cardholder's ;...
agr....nt with the issuer. "
.... rJ1
E-< Vis~~'i\<i~ At ::
U ~
;.e ww ers.com!
,"- ,~',
[/j ,..".
- Q)
f-< ::r::
~
/ '1'
/
,~
GIANT
STORE ~1 LITITZ. PA 17513
K,j)001 lS to t'n~;UI'f.' '-jour satisfactJon
>\e(',-\ h"H~ '1DU S\;Ili' with ~IS Ir then'
I::; dl\:11tlln'i 1 can U(I to illl,)t'ove IJOlJr'
experjence please {~al \ (717) 625-0303
NOI'I<;, Mi I] er- Slore Mon09l;>1-
l'
06/08102
MEO RELISH TRAY
FRUiT TRAY
UU TRX 2.31 BRL
THRNK YOU
18.95 B
19.95 B
11.21
18000902215
VF CREDIT CRRD 11.21
~*******************~********~********
GIANT FUOO SIONES << 0001
1008 LITlT2 PIKE
LIllTZ. PA 17513
CREOIT CARO
Exp 0506 Card
Pa~lIlent A~ount $
PAYMENT
************002~
*1i*Hr41 ,24
# 0317/5
'8/02125200043100704410
*~***~~*~***********~***********
CHANGE .00
L NUM~lR 0, ITEMS SOLO ~ 2
8/02 1252 PM 0001 31 0070 1410
VISlt us on the Internet
www ClianlPd COM
~***~*****f.*****f~*X~*****~f.****
I.. ~ONUSCRRD S..,nos
))2
Points Earrled ThiS Visit 39
Points Rodee.ed ThJS VJSlt 0
Points Redeemed Since Ma~ 5th 0
Previous Rede~ption Date 1/01/00
~~~*~*~~~~******~~~~~~~~~*~~~*********
NOW THROUGH ,JUNE 8. 2002
EARN ~XIRA REWARD POINTS FOR
UP 10 15% OFF YOUR NEXT PURCHASE
Ex.fro Reward
Points Available --)
r......_.....--~,
I 231 I
L..___..____.1
150 POINTS
250 POINTS
450 POINTS
600 POINTS
3% SAViNGS CER1IFICATe
5% SAVINGS CERTIFIeRTE
10% SAVINGS CER11FICA1E
151 SAVINGS CERrIFICRIE
All poin1s @Apjre 6/8/2002
\avtnqs CertIficates e~pire b/22/2007
" ~ ~ .. .. 1\ " .. " l< l< .. .. II II " -II II " .. " .. ~ " .. " .. " II II II II " "" " .. "
l'~ glarl YUu shoPI,~d her"e JudaH
Your Cashier BRIAN
..
'. nn.."..,........... -.-.,r .'''''' ....~
.
~
'_.
(
.J
.
Ii
,;
I
..
~
~
J
\
~.
,
~/..--------
~ I
1,)'>
~ 0\\
~
GIANT
STORE 11 LITITZ. PA 17513
H~ qaal is to ensu,'e YOUI' satl~j
ever~ tl~e 'JOU shop ~ltl, us. If
lS 81)y1hlng I can do to J~pr1Vt
experience please call (717.' 62~
Mark Miller, Store Manager
06/08/02
PARTY
*'11_. TAX
THANK YOU
TRAY
2.82
8Al
4
1
18000
1
5
.... TAX 2.82 BAL
CRSH
CHANGE
TOTAL NUMBER OF IIEMS SOLD
8102 12:51 PM 0004 31 nOb! .1
'hsit us On the ; (~rnet
'Www.CJiantpa.cofTI
*~~*~****x~*~~~~~~~****~~***
,tIfTle BONUSCARD SaVln~s
ds Earned This Visit
I{S Redee~ed This Visit
Its Redee~ed SInce Hay 5th
'jOU5 Redemption Da1e lJ
**~*****t.****f~**t~*~***t*~**
NOW lHROUGH JUN~ I. 2002
EARN EX1RA REWRRD POINTS lOR
UP 10 151 OFF YOUR NlXI PURCHA
Extra Re'W31'd
Points A.vallable --)
r-------
I 192
L_______.
1 SO POINTS ). SAVINGS CERIIFII
L~O POINIS "' SAVINGS C~Rl IFII
'50 POI NIS 10% SAVINGS eERI If II
600 POINIS 15% SAVINGS CERTIFlC
Al I pOints eXPll"e 6/8/2002
S3'1ln9~ Cer'tlflcates expil'e 6/'1'")i)
*~*t**********~f******* *~ .~
{' 1'1 91.ad :-lOll shfJPped tod;;:i
VO\II' Cashier ~RIAN
80NUSCARD-THE KEY TO
LOW PRICES AND HORE!
OPEN 24 HOURS
EVERY DAY
-0265 .,-.
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 10FHA 2.0FmHA 3.~CONV. UNINS. 40VA 5.0CONV. INS.
SETTLEMENT STATEMENT 6. ~I~~ ~Yt~,BER 17. LOAN NUMBER:
8. MORTGAGE INS CASE NUMBER
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not incfuded in the totals.
" 3196 (G/l.lOYANPfOJGAlOYANI9)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Nina R. Galoyan Estate of Charlotte A. Thomas Washington Savings BanI<
Konstantine A. Galoyan 4201 M\tche\\v\lle Road, Suite 300
5320 Oxford Drive Bowie, MD 20716
Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2015480 I. SETTLEMENT DATE:
1761 Creek Vista Drive Residential Commercial Abstract. Inc.
Camp Hill. PA 17011 August 30, 2002
PLACE OF SETTLEMENT
- 3631 North Front Street
Harrisburg, PA 17110
J. SUMMARY OF RR WER' TRAN ACTI N K. S MMARY 0 ELLER'S TRANSACTION
101- Contract Sales Price 107.500.00 401. Contract Sales Price 107.500.00
102. Personal Property 402. Personal Property
103. Settlement CharQes to Borrower (Line 1400\ 3.414.79 403.
104. 404.
105. 405.
106. CitvfTowfI Taxes to I 406. CitvfTown Taxes to I
107. CountvTaxes 08/31/02 to 01/01/03 109.39 407. County Taxes 08/31/02 to 01/01/03 109.39
108. School Tax 08/31102 to 07/01103 867.17 408. School Tax 08/31/02 to 07101/03 867.17
109. 409. I
110. 410.
111- 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 111,891.35 420. GROSS AMOUNT DUE TO SELLER I 108.476.56
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Oeoosit or earnest money 3.000.00 501. Excess Deposit (See Instructions) I /' "
202. Principal Amount of New Loan(s 86.000.00 502. Settlement Charges to Seller (Line 1400) II 10.405.67
203. ExistinQ loan(s) taken sub"eet to 503. Existina loan(s) taken subject to "-
204. 504. Payoff of first Mortgage to BELeO Credit Union I 12;E5D.29
205. 505. Pavoff of second Mortaaae
206. 506.
207. 507. (Denasit disb. as oroceeds)
208. 508.
209. 509.
Ad"ustments For terns Un aidB eller Ad'ustments For Items UnDaid Bv Seller
210. CitvfT own Taxes to I 510. CitvfTown Taxes to
211. County Taxes to r 511. County Taxes to I
212. School Tax to I 512. School Tax to I
213. I 513. I
214. 514.
215. I 515. I
216. I 516. Inheritance Tax Escrow I 16.125.00
217. i 517.
218. I 518.
219. I 519.
220. TOTAL PAID BY/FOR BORROWER I 89.000.00 520. TOTAL REOUCTlON AMOUNT DUE SELLER 39.380.%
30n. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEM~NT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) I 111.891.35 601. Gross Amount Due To Seller (Line 420\ . 108.476.56
302. Less Amount Paid By/For Borrower (Line 220) '( 89.000.00) 602. Less Reductions Due Seller (Line 520) ( 39.380.96
303. CASH ( X FROM) ( TO) BORROWER I 22.891.35 603. CASH ( X TO) ( FROM! SELLER I 69.095.60
OMS NO 2502 .-:0..
'IUU-' i:; 1\1;;. kE.sPA. fib-H')',
. Paoe2
L SETTLEMENT CHARGES
700. TOTAl:.. COMMISSION Based on Price $ rm 'f. PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701. $ 3,787.50 10 ERA~NRT, Inc. FUNDS AT FUNDS AT
702. $ 3,737.50 to Prudential Thompson Wood SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 7,525.00
704. to
ROO. ITEM~ PAYABLE IN ECTI N WITH lOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Underwriting Fee to Washington Savings Bank 75.00
806. Tax Service Fee to WashinQton Savings Bank 85.00
807. Flood Cert to Geo Tract 22.50
808. Doc Prep Fee to Washington Savings Bank 295.00
609. Application Fee to Washington Savings Bank 350.00
810. Federal Express Charges to Washington Savings Bank 30.00
811.
T N ADVANCE
901. Interest From 08/30/02 to 09/01/02 @ $ 15.020000/day ( 2 days %) 30.04
902. Mort lage Insurance-'Pfemium for months to
903. Hazard Insurance Premium for vears to
904.
~ 'WI ND
1001. Hazard Insurance months '" $ Der month
1002. Mortaaae Insurance months '" $ er month
1003. CitvfTown Taxes months 1) $ Der month
1004. County Taxes months 1) $ Der month
1005. School Tax months @ $ per month
1006. months Co? $ er month
1007. months @ $ per month
1008. months (ci) $ oer month
1100. T
1101. Settlement or Closina Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Deed Preparation to Placey & Wriaht 100.00
1106. Notary Fees to Residential Commercial Abstract, Inc. 10.00
1107. Attorney's Fees to
(includes above item numbers:
1108. Title Insurance to Residential Commercial Abstract Inc. 898.75
(includes above item numbers.11 01 1102 1104 )
1109. lender's Coverage $ 67,500.00
1110. Owner's Coverage $ 107,500.00
1111. Endorsements 100 300 8.1 to Residential Commercial Abstract, Inc. 150.00
1112. Closing Protection Letter to Old Republic National Title Ins. Co. 35.00
1113. Courier Fees to ResidenUal Commercial Abstract, Inc. 15.50 15.50
DING AND N R E~
1201. Recording Fees: Deed $ 30.50; Mortgage $ 62.50; Releases $ 93.00
1202. CitwCountvTa~Sffimps:Deed 1,075.00' Mortaaoe 1,075.00
1203. State Tax/Stamps: Revenue Stam s 1,075.00; Mortaaae 1,075.00
1204.
1205.
11300. ~AL SET EN HA ES
1301. Survey to
1302. Pest Inspection to Bowers Pest Control 35.00
1303.2002 School Taxes to Bonnie K. Miller, Treasurer 1,041.17
1304.
1305. See addit'j disb. exhibit to 215.00 /' 649.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section KI 3,414.79 I 10,405.67 J
By signing page 1 of this statement, the signatories acknowledge receipt of a complete age 2 of this Jwo page state.men!. '- ./
Certified to be 3 true copy.
.,// ' 7;::...
'/.' b '_
Resi en ial Commercial'Abstract.
Settlement Agent
--..,.-
---.,
-.
Inc
I
r cr,LUYAN cr,LC!YArJ 'j)
PLACEY &3 WRIGHT
RICHARD L. PLACEY
ATTORNEYS AT LAW
363 I NORTH FRONT STREET
HARRISBURG. PENNSYLVANIA 17110-1533
(717) 236-9577 FAX (717) 236,0843
July 29,2002
Mr. W. John Thomas, Jr.
Executor of the Estate of Charlotte Ann Thomas
6494 Lincoln Court
East Petersburg, P A 17522
WILLIAM K. WRIGHT
(1943-1999)
FOR PROFESSIONAL SERVICES RENDERED:
RE: 26-02
7/19/02
Office conference;
0.8 hrs. @ $175.00/hr.
TOTAL DUE
0.8 hrs.
$140.00
~) tJ A
n~~ \t\DV Q
\ ~ Jlrt~
{}
CUMBERLAND LAW JOURNAL
2 LIBERTY A VENUE
CARLISLE, P A 17013
AUGUST 2, 2002
Cumberland Law Journal is published every Friday by the Cumband County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
W. John Thomas, Jr.
RE:
Charlotte A. Thomas, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------------------------------
-------------------------------------------------
Advertisement inserted on following dates:
JULY 19, 26, August 2, 2002
Advertising Cost
$ 75.00
Proof of Publication
$ 0.00
Second Proof Request
$ 0.00
c! 75.00~
Payment Received
Total Amount Due
$
0.00
--------
-------
Payment received JULY 15.2002
by Beckv H. Mor!?enthalJExecutive Director
~
RECEIPT FOR PAYMENT
===================
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
THOMAS CHARLOTTE ANN
File Number 2002-00637
Remarks W JOHN THOMAS JR
JA
Receipt Date
Receipt Time
Receipt No.
7/15/2002
14:57:24
1029942
________________________ Distribution Of Receipt ------------------------
Transaction Description Payment Amount Payee Name
235.00
12.00
5.00
12.00
5.00
<iI69.~
Ii~. 0
PETITION FOR PROBA
EXTRA PAGES
RENUNCIATION EXECU
SHORT CERTIFICATE
JCP FEE
Check# 2705
Total Received..... ....
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
~
LDWE"S
(717)672-0300
-SALE-
SALES .: SI127HKI 260064 07-12-02
13384 19.99
13 2 RUG OR UPHOLSTRY/ 3.00
SU8TOTAL: 22.99
TAX38550:~;~.~
INVOICE 04396 TOTAL:~
8ALANCE DUE: 24.37
CHECK: 24.37
1127 TERMINAL: 04 07/12/02 18:30:37
! illl! II: 1I1I11111 ~!llllli I~ II1II ~I ill I! II! 11~ IIIII!IIII
THANK YOU fOR SHOPPING LGWE'S
RECEIPT RECUIRED fOR CASH REfUND.
CHECK PURCHASE REFUNDS RECUIRE
15 DAY WAIT PERIOD fOR CASH 8ACK.
STORE MGR: WILLIE SMITH
START A REWARDING CAREER AT ONE
OF TNE fRSTEST GROiING RETRIL CHAINS
APPLY AT Wii.LOiES.COM/CAREERS
;Y:I~ \
^VlA ~
[~V
(7)I~O AMERICAN PERIOD@
'--/!t~ LIGHTING
T~ Traditional and Period
LIGHTING FIXTURES For The
HOME and GARDEN~
~
_._ Date ~I
",-Lr 1- II - J..-.
Date Del.
I 7S .J-u
I
,
~
~A
(, V9t/
,
--r-+,J:}(.\ P. S,
Qly
Item Descripti
t
Bulbs
Phone
569-) bl
t
I Ship UPS
1
l Date Req.
Ownership of Mdse. is not transferred
until this invoice is paid in full.
Check No.
Ship/Handling
TOTAL
-'+,: --P.-.-;-'
~
~
"
"
,
PRICE
.-"
Sub-Total
Deposit
Check No.
,..Balance Due
if '7/ ~V
.::::;> j
r,jl
"{II
., ,
PENN CARPET SALES
.ENN
-...
ARPET
AL
-So \--.- ~\".o~u- '>.
\l0l C"ul. '-.j\S.1.-..... v~,""'--
New ~"'^ Io~ ~c...v-c\ 1 Vc"
Q"""\ ~ \'::,,,\\\~~ A.J6."--<.':.
\
68 SPRINGERS LANE
PHONE 732-2600 .
Sold to:
\ ('::'10
SALESMAN:
-C-\oo ,r
\
'"
\'^ u\\ (etA
OlJ.-t.A. ~. .., I\t>
'c. ,-; ~'. .,...._
*'
,::. OlL".>
I
I
l
i
j
I
I
f
TO CUSTOMER (READ BEFORE SIGNING)
I have read the above description of the order I placed.
There is no Guarantee that seams will, be invisible.
No conditions,' verbal or ,written, o:p'ressed or implied,
thardo,not'appea,r on the face of this order will be hano~ed.
. .; no refund
t'^-
· NEW CUMBERLAND, PA 17070
E-MAIL: PENNCARPETSALES@AOL.COM
VVO",-l<-
Telephone No, '60:), ':,.: i_ <;; q?o 2 f. LSU
Dare b \ \ \ 20 0 ~
0Dl.-.~<MC<< 50q- '14Co\
~ed - ,:, 'Z.. - q \ 0 \ - Lou.. \
'~O"'+"'<+ Lc.>.-tt..~;
U\. <;'-U \-
La
~\(
C lo~<~.
r",
Cd.&>. - C
{' (' \i\A N 11'..( S '1:1
vJ.C:\~.( C.lo~~
.. :f:; ~._'~. _
.~ .::";-..-- ,-:,,'.;,-- -- ~_...,-
( ~~ \~,' .0'\1 %'\ \
\ X q; 1~* ~
\" /
~ .-/'"
---....--'
$
$7(,3 ()'
We arc not responsible for cutting doors.
AU orders subject to company approval.
TERMS: Full payment due upon receipt of this invoice. Balances
past duc 30 days are subject to I 1/20/0 service charge per momh.
~.
7 fP 3 6G.
~EV-IS12 EX> (1_9Ij
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
-rJ#/I1~
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF L'j4tlo ~
Include unreimbursed medical expenses.
ITEM
NUMBER
z'
3
>t'
5'.
(p.
DESCRIPTION
/!70N-Mr /PtA.J;;Ji"vSe: #//INf",M"/~j' F~ (3rne"-3l\'~
AMOUNT
/!I Z 7'1 :5'D
1.
('f\&,^--\..hy L.A>~ (!,'iV'CV\.~...)
u 'I3~o
--rek-fJhDl'ie (z. <V\t,,--l4s)
_ .. 85. ~5'
LA.\)\'e (i vv-.6"~)
-1( 3'-' '1~
~~"-II.~' e."'-~'Z.(3.N\(\V\~S)
41'-7 -0
- <.P .::.
",--\<u-\L;',-- (3)'Y>C\A4\.t!.)
207- (H
"'~18.71
'1
( ,\M<;,,\- !l><:<"""'.s\ ~ ooQ/30
13E\...(D I-.q~ ~m6W '/
?"'i VV'<<,..~
+t!< () otll3.0
hOIY'1:;/>.\Ii\A(t. - p.. LLO"""
"61':. L.( '"
..,. ~ IZ,85C1..Z.q
8.
TOTAL (Also enteron line 10, Recapitulation) $ /Jf; /~{fl .91-
(If more space is needed, insert additional sheets of the same sire)
Monthlv Recurrin1! Bills Paid until Sale of Townhouse:
Monthlv Townhouse Maintenance Fee
Property Management, Inc. (PMI) -
P. O. Box 622
Lemoyne, P A 17043
(717) 730-4141
Acct. # HH-320-00-101761-01
$277.50 (3 months)
Montblv Water
- Pennsylvania-American Water Company
P.O. Box 578
Alton, IL 62002-0578
(717) 795-9801
Acct. # 24-0665013-1
$43.00 (3 months)
Teleohone
- Verizon
P.O. Box 28000
Lehigh Valley, PA 18002-8000
(800) 483-3000
Acct. # 717 7742211 631 69 Y
$85.35 (2 months)
Cable
- Corneast
4008 North DuPont Highway
New Castle, DE 19720-6328
(717) 540-8900
Acct. # 0502052796201
$36.93 (I month)
Sewer & Refuse
- Lower Allen Township
1993 Hummel A venue
Camp Hill, PA 17011
Acct. # 112 1250
$67.50 (3 months)
Electric
- PPL Electric Utilities
2 North 9th Street
Allentown, PA 18101-1175
Acct.# 04240-80008
$207.66 (3 months)
BELeo Loan Pavment
- BELCO Community Credit Union
Harrisburg, P A
Acct # 009130
$598.74 (3 months)
Mb;wjt
6 O. 2502-0265 ...
A. B. TYPE OF LOAN:
'U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 10FHA 2.nFmHA 3. !ElCONV. UNINS. 4.0VA 5.0CONV.INS.
6. FILE NUMBER: 17. LOAN NUMBER:
, SETTLEMENT STATEMENT
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "{POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3196 (GALOY AN, PFDIGALOY AN/9)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Nina R Galoyan Estate of Charlotte A. Thomas Washington Savings Bank
Konstantine A. Galoyan 4201 Mitchellville Road, Suite 300
5320 Oxford Drive Bowie, MD 20716
Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2015480 I. SETTLEMENT DATE:
1761 Creek Vista Drive Residential Commercial Abstract, Inc.
Camp Hill. PA 17011 August 30, 2002
PLACE OF SETTLEMENT
3631 North Front Street
Harrisburg, PA 17110
J. S MMARY OF B RR WER' TRANS CTIi'iN K. SUMMARY OF ELLER'S TRAN A TION
101. Contract Sales Price 107,500.00 401. Contract Sales Price 107,500.00
102. Personal Prooertv 402. Personal pronertv
103. Settlement Charaes to Borrower {Line 1400\ 3,414.79 403.
104. 404.
105. 405.
106. CitvITown Taxes to 406. CitvrTown Taxes to
107. County Taxes 08/31/02 to 01/01/03 109.39 407. Countv Taxes 08/31/02 to 01/01/03 109.39
108. School Tax 08/31/02 to 07/01/03 867.17 408. School Tax 08/31/02 to 07/01/03 867.17
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 111,891.35 420. GROSS AMOUNT DUE TO SELLER 108,476.56
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deoosit or earnest manev 3,000.00 501. Excess Denosit (See Instructions'-
202. princiosl Amount of New Loan(s~ 86.000.00 502. Settlement Cha-raes to SellerlUne 140m. 10,405,67
203. Existina Jaso(s) taken subiect to 503. E~b;ectto (~12~
204. . lllllECOO OIedtt Union
205. 505. Payoff of second Mortoaae
206. 506.
207. 507. (Deposit disb. as nroceeds \
208. 508.
209. 509.
d"ustments For Items Un aid e er ustments or Items Unnai ~el/er
210. Clty-Trown Taxes to T 510. CitvlTown Taxes to
211. CountvTaxes to T 511. County Taxes to
212. School Tax to T 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516. Inheritance Tax Escrow 16,125.00
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 89,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 39,380.96
300. CASH AT SETTLEMENT FROMn 0 BORROWER: 600. CASH AT SETTLEMFNT TO/FROM SELLER:
301. Gross Amount Due From Borrower tLine 120) 111,891.35 601. Gross Amount Due To Seller (Une 420\ I 108,476.56
302, Less Amount Paid Bv/For Borrower (Line 220) ( 89,000.00) 602. Less Reductions Due Seller (Line 520) II 39.380.96
303. CASH ( X FROM) ( TO) BORROWER 22,891.35 603. CASH ( X TO) ( FROM) SELLER I 69.095.60
OM N
.......
H\JD~1 n.8bJ RESPA, HEJ4'3U" 2
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of~AAlLIA .4~M /1tJH1~\ No. -2.)-02-u.3'
also known as To:
Register of Wills for th~
. Deceased. County of /!"WlbEL'4/n,,/ in the
Social Security No. 2112 -.:z 0- '2 Y"D L. Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who islare 18 years of age or older an the execut61.7
in the last will of the above decedent, dated m~vch //. 19f?;Z:
and codicil(s) dated /
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cvm}E,~j"""d County, Pennsylvania, with
hJ::'tZ. last family or principal residence at }.;:~ f:::-::;'I!!:v~ 'J:[;!t, '71)
(list street. number and muncipality)
Decendent, then 7"" . years of age, died ,/11;tI ~.J!C(jz.. ,
at I HE .
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 ';1 1>
situated as follows: :.t:: ;:~~/Y:.~~ ptl10 70
$ ~8 ~D{,~
$ /
$
$ 90) DDO
-;;;1-,4;128 7"6
,
WHEREFORE, petitioner(s) respectfully request(s) the pro ate of the last will and codicil(s)
presented herewith and the grant of letters --r i-4~ ~""
(testamentary; admin stration c.La.; administration d.b.D.c.l.a.)
theron.
.
.
u
C
"
'C~
.;;;~
.~
"'~
'Co
=.~
~'Z
3~
.~
50
;;;
c
"
Vi
dI ~ ~W
'\1\1.' ~l'>,^", D'vv>.A<. ~)\Z'
, I
1:12; JEs.r:~:: p~PIA~ir~"k-7
IR21'l(
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTj;I O~ PEN;?YLVANIA } ss
COUNTY OF CU'?70P~ .
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) d th s personal represen-
tative(s) of the above decedent petitioner(s) will well d ly min' r t e ate according to law.
affirmed and
10th
'"
,...
"
..
-
>:::
~
~
Register
. . ...Joh '" ~1\..MI.l. ~lre:
DFo.' '
')
}
\I-,5-l9
No. 2.'-O~
Estate of
CHAT.rYT'1'F. ANN 'l'HOMAS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JULY 15, 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 3-11- 1987
described therein be admitted to probate and filed of record as the last will of
, CHARLOTI'E ANN THOMAS
and Letters TESTAMENTARY
are hereby granted to W JOHN THOMAS JR
~.
EXTRA PA<fiES 12.00
Probate, Letters, Etc. ......... $ 235.00
$ 12.00
Short Certificates( )..........
Renunciation ................ $ 5.00
jcp $ 5.00
TOTAL _ $ 269.00
.1 7-15-2002
Fl ed IDitHed. Hi .att'i 7~ 1 5.":2002. . . . . . .
ATTORNEY (Sup. CL LD. No.)
ADDRESS
PHONE
RENUNCIATION
2.1 -oz.- "'3'1
In Re Estate of
CftAR..Lo7T~ A,
I ffO,r(k S
deceased.
To the Register of Wills of C. U 1Yl6 ~~ D
County, Pennsylvania.
The undersigned
DltvlD
c.
-
f tfO I'VlIt S
of
the above decedent, hereby renounce(s} the right to administer the estate and respectfully ask(s) that Letters
{€ S TA-/YI €,uf;tl!..Y
lU, JOtfJJ 7do~5 S-,..e.
be issued to
WITNESS
hand this
day of
,19_.
~ ~~ \rj) t , """"
I. t (' 1 A /\ A.NCJTARY F'IlBIJC RJI SAID
..auRV ANn ml\'tE. DO,~y littll" 1lW
j)F\v \ )- c'
0Q- ~u I.-} A ~~ M9t......
.. t.tE 1IIIS MY~_ 11IE ....
0~t? ~
(Signature)
hl.3 Che :Sfl.tr""- OR-I rJE
1(i1<.,v~IL~lJdle/;vc 7. 7 z.8'(
(Address) ( E'; G)".9 ~- 360 Z.
~---..'~~::':"~';'-;~
(Signature)
lUU'fi' ......
_"{ " c' _ - ~- '-1'
, , DFFlCIAl SEAL
NtftMV~AIN
COOlIIY (Jf8NlOOl~lJuNA
&ty~"'''~18;IIis 1.::)- (l.~-U'l
(Address)
(Signature)
"
.-_J
.'-.::J
'J
(Address)
p
'," .....:., \, ';.i
";,,^! \<','\..:,
... ~..; M-'" ~~'r~;' ;._.~:/ .~,.(;Ar'
.tn,:l;'''~ tJ.f:l: ~::;'(N....~~..--~,.,..
~?';~"(~ 7~.,' ~.~ :m.~ ~'CI' 2it'fr~;..: i,t~~:$
, . .'dfc}~...;';(;.;':.
v' ~",::..
,,,,.~~.,,..
"'". '" -.
,'e ".;',r.' ',~
-if: r~.~;<:- '
's a;;. 'J<
, , 'f''tf
~:ni:"'~~:,\!:: ""
i...., ,:.. "....'
"'n~,"n~ '.~".\' n.'N,
This is to certifY that the information here given is correctly copied from ;]11 original certificate of death dl~l~ fIled with me as
Local ~egistrar. The original certifIcate will be f()lWardcd to the State Vital Records Office for permanent t1lll1g.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
\1'11.'(~~1E&~~...~
l"#Y~4'v:;\.
".~~"' ""4O \.;;;"
~~(..:!!i'" - \?~
~~I -. ',~~
~c.>i /"-ll' /b~
~'*\ 'c~.' "*'
,d.."""~-" . !~ I
\.~~ //~,l'
'-_:;I?i"~"'c ~'" ",
'''''"":,,ENl \)'1""'11
"N/lfHII1I1J'
~~d ~~M&M
Local Registrar
Fee for this certif'lcuc, $2.00
P 8391635
COM~/(1,
;;(00:J...
Dare
>I"l~ \4~f\ey. 1191
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner}
rYPE,PHINT
"
P~H"'AN~NT
B'ACKINK
~
~
o
o
~
'"
STME filE NUr,tSER
SOCIALSECUAITYtlUMBEA
lMTEOFDtATH(Mu"Lll,U,y.Y.,'"
DATEOFBIRTH
(Mo"Itl,Day,Ya"1
2. Female 3.oZ0,;z. "a-r:Jo1~oCO::
P~J.CE OF DEATH IC~Ik:~ only one . _ "'..""""",, '-'" Dlher sdel
HOSPITAL
Inpali.nlO
7. -;q ,-1 y A. ...
FACILlTYtlAMEillnu',n",juI'on, "...'eetananumba'l
.
May 28. 2002
A
UNDER 1 DAY
Houri "'I""'.
B,flTHP~ACE IC<lYlil1a
S'.leorF"''';g,'COOn1(1)
g'p':,ly)0
AACE-Am.,i<a"lnlli;l/l,alaclC,W~II.."C
iSJOec.,y)
CITY.BOR
May 3.
OEATH
k.
Lower Allen
1761 Creek Vista Drive
r'~
.
T1C,8"V.., <lOA<Ienl Iwe&ln
MA.AITALSTATUS.M""1e<l
No....~,~.
Oi""roedlSpecoy)
W,")DW
w#./e
SUAVIVltlQSP(lI.JSE
\~""e.\I""',"<l<l.nnama)
\\Il.SDEGEDEtlTEVEAltl
USAAMEDFOACES?
"".0 NoGr"
1111.C<lul1l
'"
_~m
~..
CU.Md,A!':~_b to"'IUI1llP? '1<t.D:~=\::<>l
1.40THEA'S tlAME(FiraI. Mddle,"'aden Su'""",a)
T'. erN ..../L"i. ~.
ItlFOfIMANT'S MAI~ma ADDAESS (SIf",",. CtOIlTo<ol\, SIeI<o, Z'Il C<I<l<I\
"/ ...e;:~ <.o(
PLAC OF[lIS SITIOI\I. ameolc..rnlHety, ,.mll","" ~ ION.CilyfTo"n. lata, Z",C<>d1I
orOl....'P,_ Ce-,'1p;.;y
-..r' /../. ,- T ..-#7...V.... Y;~".:/e .t'J.;:
NAMEANDAOOAE SOFFACIUTY I\./~.'~/ ,fc.--",,-";.A L' .....~_..i'.t;.J";:i~
V() <' ""'" 'J'
LlOENSENU~IIEA DATESIGNW
IMor~". [)d" Y~dti
/......1/...,. A.!Lc.....'"
"'
c'~ylboto
[1
"
"
.
,
.
<
"
<
I
"
t'Zl>.. "') .....!.L'
101M"'''' 01"'1' knowledge, doI.l~occ_atlM ,,,..., d~le.ndpl.C<I'""ea
(Sig""Maarl\lT''''1
" "
27, 'AIIT I: Enl...'h.dl...H..I""rieoo'oomp/lclllio"'....k:~cau...dln.a""'~. 00 nol,nte, Ihamt>deot""i"ll. 'uCh.scard;"" 0' 'e"ll~dLo<~ ""Q....ol\oc\Co<_l~"
U!IlOrrly_<IWI.oneld1bna
24. UNKNOWN
June 4. 2002
,~
WASCASEAEFEAREOTOMED.!SrLEXAMltlERlCOAONER1 ,
Ya'~ floe]
,
1Apf>l~~_. ~l": O1he.'l\ln-.nc'nICOl1~"""'.ronl"Ou"ny'od<l.'~,OOI
:..,.,..,b/I""...n """a'",';"\I,"'h.UM.rr,-'I'I\l","",~"",,"PAlnl
!O_'.nd""a1~
i
OA1EPRQNOUNCEDDEADIMonlll,O"y,v"d')
Pendin2 Investi~ation
DUElO(OHASACONSEOUENCEOf)
DUE TO 100ASACONSEOUENCE ot)
OUEro(OAASACQt./SE;OUENCEOfj
.
WEAEAI1TOPSYFINOltlGS
_ILAlllEPRlORTO
COloIPLETlOtlOFCAUSE
OFDI<ATH7
MANtlEFlOFOEATH
OrOJEOF ItlJURY
IM""'",Oay,Ytidrl
TIMEOFINJUAY
INJUFlYATWOAII?
DESCflIBE HOW INJURY OCCURRED
Ye.}fJ. NoD -YM 0
2... Hb.
CfIlTIFI!Il(Chec~<riIonaJ
'CUlTIFYINGPHY1llaAN(Phy"",ian""nilyingcou..,oIdealh..t",nanolh...,,r'y8lC..n,...prot,oun.o"ddttdlll'"o""npkll"dlla"'~JI
TOu....IO'...~kno........................_IOu..""lIPI.)_man...t.._, .
~~
-.
Ptr.dingl"""";~"ion
[]
J(J.. ".
[1 :t:;~C:;~~~':~t;,All>ome, tatm, .114", '.clot)'. p~l.,.
,_.
Ya,O NoD
NaIU'"
o
o
o
Homlc;".
,-
8.
Couldnolb/l""l.'m.oea
Coroner
o
.IIE~M. UM&\MERlCOltQNa\
OnllM ",...ortllUl>lnatlllll MllIorIllVflll"IIOIl, Inmwoplnlon, c!HIIIOCC<l...-.dellllt U...., ''_It,_nIl pr_. Inddu.loIIIIClun(.jlnd
m...n...._ed............................................................ .................,........,..........
311.
REGIS
101,/ e2.,I,-^I
lViJE SlGN-ED IMoolh. Day ""'"'I
o 31C. 3'<1. June 7, 2002
NAtdEANDAllORESSOF PERSOtl W!'fOCOMPlHEOCAUSEOF DtATH
(llem21\t~OIP,int Michael L. Norris, Coroner
tv' 6375 Basehore !toad, Suite 1/1
~n. Mechanicsburg. Pa. 17050
DAJEFlLEDIMon,n, o.y, ",",)
.PIlOHOlJMCl..oNolDC8tTIFYINOPHYtlClAH(P~y8IC""'llOlttpronounc"'g<l8a1/lan<lc..,""'ngioc.u...,.d".lI.1
Tou.. _Iolm'.....-.. _occ:~rtedelN_. ...te..""p......"" du.tou.....uM(.)."" ",.nne,...llIled..
~.
:; :.)...
II
"
I
LAST WILL AND TESTAMENT
OF
CHARLOTTE ANN THOMAS
I, CHARLOTTE ANN THOMAS, a resident of 305 Evergreen Road, Fairview
Township, York County, Pennsylvania being of sound mind and memory, do
make, publish and declare this to be my Last Will and Testament, hereby
revoking all Wills and Codicils heretofore made by me.
ITEM 1.
I direct that all of my just debts, my funeral
expenses including a suitable monument at my grave and the cost of
administration of my estate be paid as soon as practicable after my
death. I direct that my Personal Representative payout of my estate,
as a general charge thereon, all inheritance, estate, succession and
other taxes together with any interest or penalty thereon assessed by
reason of my death with regard to all properties and assets subject to
such taxes, whether or not such property and assets pass under this
will.
ITEM II.
I give, devise and bequeath all the rest, residue
and remainder of my property, real, personal or mixed, tangible and in-
tangible, of whatsoever nature and wheresoever located and all property
to which I may be entitled or over which I may have any power of disposition
(2) sons, namely, W. JOHN THOMAS, JR. and
or after my lifetime to my
...:~ '5/i7i Ii'
DAVID ~ THOMAS, absolutely
and
or appointment and whether acquired during
two
in fee simple, share and share alike with the share of either deceased child
to go to his children, then living.
ITEM III.
I direct that the legacy or share of the real estate
or personal estate going to any person under 21 years of age under the
provisions of this Will shall go to CCNB BANK, N.A. in trust, u~til such
II
"
Ii
,
person attains the age of 21 years, with said Trustee in its discretion,
after consideration of other income of the child to use the income and
corpus of the estate for education and occupational training and the
welfare, care and maintenance of said child during said age period. My
said Trustee shall give the highest regard and credibility to the adult
person with whom said person resides and upon request or demand of such
adult person for payments or reimbursement for present or future expenses
that involve the said items for the good and welfare of the said child,
said Trustee or its successors is authorized to pay such requests or
demands for present or future expenses without any further investigation
or order of Court and without any further liability or responsibility
for the application of such monies paid.
ITEM IV.
The purpose of the provisions of this Will for the
benefit of the aforesaid beneficiaries is to secure them from want, free
from the accidents of mismanagement or improvidence and free from the
interest of any present or future spouse of any beneficiary hereunder.
I direct that all legacies, shares or interests in my estate, whether
principal or income, while in the hands of my personal representative
or trustee, shall not be subject to execution, attachment sur judgment,
sequestration or any other process for any debt, obligation, contract or
engagement of any beneficiary, and shall not be subject to pledge,
assignment, conveyance or anticipation, and the personal receipt of the
beneficiary shall be the sufficient and only discharge of my personal
representative or trustee for payment of either principal or income.
ITEM V. I hereby nominate, constitute and appoint W. JOHN THOMAS,
L#. ~1I ]Jr,:,
JR. and DAVID ct. THOMAS as sole Executors of this my Last Will and
Testament; and I direct that no bond be required of my Executors,
ITEM VI,
I authorize and empower my personal representative
-2-
II
I' and/or said Trustee to compromise, adjust, release and discharge in such
manner as my personal representative may deem proper, all debts and
claims owed by or to me or my Estate; to sell, lease or exchange at
public or private sale or in such manner, at such prices, and upon such
terms of credit or otherwise, as my personal representative or said
Trustee may deem proper, all or any part of my property, real or personal;
to execute, acknowledge and deliver instruments of conveyance, including
deeds in fee simple; to borrow money for the purpose of paying estate,
inheritance or other taxes which are required to be paid and to secure
any such loan by pledge or mortgage of all or any part of my property
and to execute the necessary instruments to carry out such powers; to
distribute my estate in kind or partly in money or partly in kind, and
to determine the fair value at which any property so distributed in kind
shall be received by the distributees; to conduct any business in which
I have an interest at the time of my decease, for such period as my
personal representative may deem proper, power to borrow money and
pledge assets of the business and the power to do all other acts that r,
in my lifetime could have done, to delegate such power to any partner,
manager or employee without liability for any loss occurring therein and
to organize a corporation to carryon said business as capital to such
corporation and accept stock in the corporation in lieu thereof and hold
such stock for the uses of this my Will, and to vote said stock or to
sell the same as to my personal representative may seem best; to retain
all stocks, assets, bonds and investments owned by me without being
confined to what is known as legal investments; to execute any options
to purchase, to apply for stocks, bonds or other investments, to purchase
or otherwise acquire real estate and to execute the same powers thereover
as hereinbefore provided; to retain indefinitely any part of my assets,
-3-
II
real or personal which is or may become unproductive or to make sale
thereof; to pay carrying charges and expenses of the property out of
other principal or income of my estate. The powers herein conferred
shall be to my named personal representative and said Trustee and all
successors thereto and shall be in addition and not in limitation of
other powers conferred on said fiduciaries.
IN WITNESS WHEREOF, I CHARLOTTE AJ<N THOMAS, have, to this my Last
Will and Testament, typewritten on 5 sheets of paper, numbered consecutively,
signed my name at the bottom of all pages hereto for the purpose of
identification and at the end hereof ,n page 4 have set my hand and seal
this f\ day of ,\"l)\~~.'4...' 19~1 .
~~~h,""\-\~U\~AL)
OTTE ANN OMAS
Signed, sealed, published and declared by CHARLOTTE AJ<N ~OMAS the
above named Testatrix on the II day of ~'}Yi&.JlJ' / 19J1],
as and for her Last Will and Testament, in the presence of us, who in her
presence and in the presence of each other, have, at her request, subcribed
our names as witnesses thereto~
~atUpph1/~j(A~ -
{) "me -r~
~?~
Nam
'--n~ J\LclU-r ~ Q ~
ame ()
!)mfR fl
tJJ:d~ l-c
Address
1 f
~, '/
11fi~~' iJ./
Addr
,
-4-
II
I
,I
I
I CO}!MONWEALTH OF PENNSYLVANIA
COUNTY OF
?~/L
SS.
WE, the undersigned, the Testatrix and the witnesses, respectively,
whose names are signed to the foregoing instrument, being first duly
sworn do hereby delcare to the undersigned authority that the testatrix
signed willingly (or willingly directed another to sign her), and that she
executed it as her free will and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing
of the testatrix signed the will as witnesses and that to the best of
their knowledge the testatrix was at that time eighteen years of age or
older, of sound mind, and under no constraint or undue influence.
~ IS 1 JclJJS\~~~kJ I ~
Testatrlx
t
J2-};;/L-:. J
\Vitness
LthAu'1 AY.iN// ~-
Witnessl
Subscribed, sworn to and acknowledged before me by the Testatrix, and
sUb8cri~and sworn to befor~~e by three wi,tnesses, this II~
day of 7)Ce~ ,19-C2 &fIl-jJ~~,IL
, Notary Public
My Commission EXPires:/~/vJ!Z 19J7
l
-5-
g
. .
~
t:
~.
't'"
~
~
----
~
~
\-.
'^
...........
~
.......
\~\1
'" ~~
'" "
'" < ~
o ~~
-
-
~
-=
i, _
- --
w ~
=
=-
~~
'Dr.......
-" -
->-
.'
September 25, 2002
Attn.: Cheryl A. Winters
Register of Wills
I Courthouse Square, Room 102
Carlisle, PA 17013-3387
- --.-""
Dear Ms. Winters,
As per our phone conversation, I have included a check ($15.00 addressed to The
Register afWills) to cover the filing fee, an original and a COpy of the Inheritance Tax
Return (REC-1500), and a check ($5,658.79 addressed to The Register afWills Agent) to
cover the inheritance tax due.
In addition, I have included a self-addressed/stamped envelope to have the certified
receipt of payment for the inheritance tax due returned to my attention:
W. John Thomas, Jr.
6494 Lincoln Court
East Petersburg, PA 17520
Again, Ms Winters, I would like to thank you for your assistance.
!:tt="
c'
Letter Reg Wills~wjt
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
THOMAS W JOHN JR
6494 LINCOLN COURT
EAST PETERSBURG, PA 17520
nn~_~_ fold
ESTATE INFORMATION: SSN: 202-20-2402
FILE NUMBER: 2102-0637
DECEDENT NAME: THOMAS CHARLOTTE ANN
DATE OF PAYMENT: 09/30/2002
POSTMARK DATE: 09/25/2002
COUNTY: CUMBERLAND
DATE OF DEATH: OS/28/2002
NO. CD 001670
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,658.79
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$5,658.79
REMARKS: W JOHN THOMAS JR
CHECK# 2853
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
t
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
/:'./1.4/)11& d/YA/ MtJhuf<
/}'JAv 28 200Z
/ /
Date of Death:
Will No. hit; No. - 2OD2-00~37
Admin. No. fJ,4 rlO.' Z/-02-0t:J37
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
/AWd c --rh~tnAS
.w J)hl/ -a~5 JL.
. .
~/3 C!JBh.4M?),(JIIL. Jf.1!1/~/(s'l1h Ale 2?2t<i
/ /
IRtf~1 L//-/;tJtl I'r>v~f / 6JJIFLSJiJIj / II 179-6
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
/tJ~/~-tJ2
~~~)
Signature
Name "y; Jcj/'J ~m.,.(S' JL.
/
Address /;tjf~ k^l,,~h ~d
E4s1 '-k~jp~) It- IYs'20
f-::" !,
,
Telephone (1/lJ 5~'1- 7'1~ 1
,
Capacity: /~ersonal Representative
_Counsel for personal representative
/"'/- ~6-- 6
"'..
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIDUAL TAXES
IHHERIT~MCE TAX DIVISION
DEPT. Z80601
HARRISBURG~ PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
W JOHN THOMAS JR
6494 LINCOLN CT
E PETERSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-11-2002
THOMAS
05-28-2002
21 02-0637
CUMBERLAND
101
'*
REY-15UEKlFP<U-!Rl
CHARLOTTE A
Allount Remitted
PA 17.520
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=istii-EX-AFP--fiiFozY-NCificE--OF-.rNHERiTANCE-Y,iX-A'pjiRA'IsEMEN:r-,--ALrOWANcE-oli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THOMAS CHARLOTTE A FILE NO. 21 02-0637 ACN 101 DATE 11-11-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. AMount of Line 14 at Spousal rate (15)
16. Allaunt of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rat. (17)
18. Allount of Line 14 taxable at Coll.teral/Class 8 rate (18J
19. Principal Tax DUB
X ED TS:
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. Hortgages/Notes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule El
6. Jointly Owned Property (Schedule fl
7. Transfers (Schedule Gl
8. Total Assets
(1)
(2)
(3)
(4)
IS)
(6)
(7)
107.500.00
.00
.00
.00
20.205.97
.00
28.956.22
(S)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deduct.ions
12. Net Velue of Tax Return
13. Charit.able/Governmentel Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Est.ete Subject to Tax
(9)
(10)
16,744.40
14.166.97
(11)
(12)
(13)
(14)
NOTE:
.00
125,750.82
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
+
AMOUNT PAID
5,658.79
DATE
09-25-2002
INTEREST/PEN PAlO (-)
.00
NUMBER
CD001670
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account~
submit the upper portion
of t.his for. with your
tax payment.
156,662.19
30.911 37
125,750.82
.00
125,750.82
(19)=
.00
5,658.79
.00
.00
5,658.79
5,658.79
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIREO.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY SE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transfe~~ed
in possession or enjoY~ent to Class B (collateral) baneficiaries of the decedent after the expiration of any estate for
life or for years~ the COllmonwealth hereby '"'Pressly rsserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOnCE:
To fulfill the requirellents 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 subllit with your payment to the Register of Wills Printed on the reverse side.
-~Make check or 1lI0ney 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 b~ completing an -Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are aVQllabh at the Office
of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-8DD-36Z-2D5D; 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 appra!ssmant, 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 deter.inad at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS:
Factual errors discovered an this assessment should be $ddressed in writing to: PA Department of Revenue,
Bureau of Individual TB~es, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg~ PA 17128-0601
Phone (117) 187-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) fo~ an explanation of administratively correctable errors.
DISCOUNT:
If any tax dUe is paid within three (3) calendar .onths after the decedent.s death, a five percent (57.) discount of
the tax paid is allowed.
PENALTY:
The 157. tax amnesty non-participation penalty is computud 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 .anne~ and in the the sa.e 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 dalinquuncy, or nine (9) .onths and one (1) day fro. the date of
death, to the date of payment. Ta~es which beca.e delinquent before January I, 1982 bear interest at the rate of
six (67.) percent per annu. calculated at a daily nlte of .00<<164. All taxes which becBfle delinquent on and after
Janua~y I, 1982 will bear interest at a rate which will vary fro. calendar year to calendar year with that rate
announced by the PA Depart.ent of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Fl;lctor Year Interest Rate Daily Interest Factor
1982 207- .000548 1992 9% .000241
1983 167- .000438 1993-1994 n .000192
1984 117- .000301 1995-1998 9% .000247
1985 137. .000356 1999 n .000192
1986 107- .000274 2000 8;: .000219
1987 97- .000247 2001 9;: .000247
1988-1991 117- .000301 2002 6% .000164
--Interest is calculated o. follows:
INTEREST = BALANCE OF TAX UNPAID X NUlIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax beco.es delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If pay.ent is .ade after the interest computation date shown on the
Notice, additionl;ll interest must be calculated.
~(/
Of')
NlIIlle uf Decedcill :
Dule uf Denlll ;
Eslnte Numbcl" :
ch4~ /".Jk. /1, -rJJom4~
~-7~ --71'lt")2-
2/ OZ--0637
l'ursUllllllu Rulc 6.12 01" thc SUllrcllle Courl Ol'lJlmus' CUIII'! Rules, II-ellol'llhe
fullowing wilh n-esllccllu cOIIIJllclion oflbc ndmillislml.ioll of Ihe IIllOve-cuJllillllCd eslu!e:
1. Sllllc whelhcl' udmiuisll'lllioll of tbe cstnle is collllllde;
Yes X No_
2. If Ihe nllswei' is No, slule whellllne !ICl'SOiBlli rel'l'escululivc l'ellsollllllRy IIclieves
tllal the .IIJmlllisIK'lI(!CW will be cOIBIIIRcle :
J; .If tlnc ,U!SWCI' 10 No. I is Yes, slllle lhe rollowing:
A, Did line ilcn"somnl rel'l'esenlulivc file II fon-muD fimli nceu"lIl willn lhe cUIDrl?
Ycs No)(
1lJ. Did the licn'somlll'e!ln-esclIllllivc slnte 1I11 :nccoIHnt ilDfummlly 10 thc IUlI'ties
ini illlcl'csl? Ycs X Nil
C. Did Iile pea'somll relll'CSeullllivc iile lillllrllvllls.of Ihe .ICCIlIOIII, n-ccC;lllS,
joimJei"S mad n'clc:nscs wilh the Clcl'l, orOrl'h:ms' Court?
Ycs No 'X
.
D. Did Ihe IIcl'sllllllH J'elll'esellllllive comlllete I1mnH disll'ilmlionn?
Ycs X No
JI):ntc : '7---LI- Zoll3.
,.~, ,
~/t4H1 -kJhl'J IkJH~.I.f.
N:nanlc (D'!cJISC I)'pe on' !Idnnl) /
1;'19'1 j.p../ft/ (gtJt-t
Adllnss E~f tkiC5 ",It<j, PA 175J.O
C:n!IlDdly : L D'cR"Somni D{CDln"CSCHlIUlivc
\-- COUJIIHSC! foa' D'cn!lml~
,..,1 .
,,: Hcnnn"cseRiI:nllvc
~
N
---'
='0
-,
I '1/'7) S~? - '-:7'11;> I
'Jl'cic!liR!l!l\: N mnnilJcJ'
~-
,')
c.:
C'"\
?
"
..1
- ',,, ~
,,,,;.'-"
/"')- 76--:' 6"
"'-..
BUREAU OF INDIVIDUAL TAXES
I~~P~TAMCE TA~ DIVISIQM
Dt:PT ~8D601
HAR~iSBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
1 ~:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
,I COUNTY
ACN
W JOHN THOMAS JR
6494 LINCOLN CT
E PETERSBURG
11-11-2002
THOMAS
05-28-2002
21 02-0637
CUMBERLAND
101
'*
REV-I547 EXAFP I Dl-D2l
CHARLOTTE A
PA 17:5?0
Allount Re..itted
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-Y-=i54"j-EX--AFP-fiiFo2rtiiii"IcnWi-tiHEifITAi"-cn:'A'irAPPRAISEi.rEtiT~--Ai:.LowANcE-DR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THOMAS CHARLOTTE A FILE NO. 21 02-0637 ACN 101 DATE 11-11-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l Estate (Schedule AJ
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C>
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Trensfers (Schedule Gl
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
\7>
107.500.00
.00
.00
.00
20.205.97
.00
28.956.22
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/"isc. Expenses (Schedule H)
10. Debts/Hortgaue Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net V.lue of Tax Return
13. Charit8ble/Gov8rn~ntB1 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A.aunt of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 .t Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
(9)
llO)
NOTE:
16,744.40
14.166.97
(11)
(12)
ll3)
(14)
.00
125,750.82
.00
.00
X 00 =
X 045 =
X 12 =
X IS =
NOTE: To insure proper
credit to your account,
submit the upper portion
of this fo~ with your
tax paymmt.
156,662.19
30.91] 37
125,750.82
.00
125,750.82
ll9)=
.00
5,658.79
.00
.00
5,658.79
TAlC C~EDIT!l:
,+, AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-25-2002 CDOO1670 .00 5,658.79
TOTAL TAX CREDIT 5,658.79
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" ICR), YOU MAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIDNS.)
'palBlnolao aq lsn_ lsa~8luT IBuoTlTPPB '80TlON
S4l ua UM04s Blap uaTleqnd~oo lSe~elU! B4l ~slle spe. 5T lU8W~Bd II 'lU8RSS8ssa 84l 10 8lap e4l pUO~8q
s~ep (51) uaallII Ol UO!lBlnOIBO l5B~BluT ue loalle~ III" luenbullep 5emooBq Xal a4l ~alla pans5T aOTloN ~UW--
HO~~Vd ~SaHa~NI X1IVO X ~N3RbNI1aa sxva dO HaSHRN X aIVdNR XV~ dO a~NV1VS = ~SaHa~NI
: SMOIIOI SB pelalnoIao 51 l5B~aluI__
MIOOO' ;":9 ZOOZ to!t:ooo' ;":ll 1661-9961
l~ZOOO' ." 100Z l~ZOOO' ." 1961
61Z000' .. OOOZ ~LZOOO' 1.01 9961
Z61000' "' 6661 9S!t:000' X!t:1 5961
l~ZOOO' ." 9661-5661 lD!t:OOO' XII ~96I
Z61000' "' ~661-!t:661 9!t:~OOO' 1.91 !t:961
l~ZOOO' ." Z661 9~SOOO' 1.0Z Z961
~OlOB.:I l5e~BluI "UaD 8leH lse~eluI ~Ba^ ~OlOB.:I l5B~8luI "nBD BlBH lSB.JeluI ~ae,l,
:a.J8 ZOOZ 46no.J4l Z961 ~ol s8le~ lSB.JBlUI BIQaoIldda B41 osnuBABH 10 lUBWl~BdBO Yd B4l "q pBounouuB
sle~ lB4l 4lTM .J8B~ .JBpU8IBO Ol ~88" .Japu8lBo _O.JI ~.JaA III'" 40!4" BlB~ B la lS8.J8lUT ~88q III" Z961 'I ~.JBnuBr
.JellB pUB UO lUBnbuJlep eeaoaq 40T4M 58XRl IIY '~910DD' 10 8lB.J "IIRP 8 l8 pBlBlnOIRO gnUUB ~ad luao.Jad (1.9l xTs
10 8lB.J B4l l8 lsa~BluI ~BBq Z961 'I "~enuBr a~0I8q luenbullep B8eoBq 4014" S8XB! 'lUBg~Bd 10 BlRP B4l Ol '4l8Bp
fO alBP 84l .O.JI "BP (Il euo PUB S4lUO~ (6l eUJu ~o '~ouenbUIIBp fa "ap lS.JII 4ll'" 6UJUUJ6eq pe6~a4o sJ l5B.JBlUI
'BOIlOU sl4l UO PBl80IPUI sa pessBssa UB8q s84 l84l
lsa.JBluT pUB XBl BLQ. leeddB PIneM no" se POI.JBd B~Jl SUBS e4l B4l UI pUB .JBuuee sees B4l UJ eIQBI8eddB SJ "lIBUBd
UOIlBdIOIl~8d-uou S14! 'pol.J8d "lSeUB8 xal a4l 10 PU8 84l .JBlIR ~8p lS~!1 B4l '9661 '91 ~BnuBr B~oleq Pled
lau pue 'pBsseS58 lsa~BluT PU8 XBl S4l 10 IRlol a4l uo pBlndeoo 51 ~leUad uOIlBdloTl.JBd_uou "lsBuwa xal 1.51 841
'peMOlla 51 PIBd xq I14l
10 lunOOSJP (1.S) lUBo~ed e^'!J B '4lBap S.lUBpBoep B4l .JeUB S4lUOII .JRpU8leo (!t:l eB~4l UI4lT'" PTBd SJ Bnp XRl ~UR II
'S~O.J~B 8IqBloB~~OO ~IBAIlR~lSIUI.pB 10 UDTl8UBldx8 U8 ~OI (IOSI-^3Hl uluepBoeO
lUBP!SBH R ~Ol U~"lBH XB! 80URlI.J84UI .JOJ suoTlon.JlsuIu l81~oq 84l 10 5 aBed aas 'S059-l9l (llll BUD4d
1090-9Z1l1 Yd 'a~nqs!~.JeH '10909Z oldBO 'lTun MalA8H lU88SSBSSY lSOd :NLlY 'saxe! IRnpJAIPuI 10 nRB~nB
'BnUI!IABH 10 lualll.JBd80 Yd :Ol aunT~'" uI pBSSB~ppB eq Plnolp: lUBIISSBSSB SI4l uo pe~BAOOS!P S~0.J~8 IR"l:Mil.:l
'l.JnOJ ,5uQ4d.J0 B4l ol IBBddR__
10 '8AnRlUeS8~dB~ lBUos.Jad I14l 10 lunOOOB BLQ. 10 HpnR lB peuIIII~8lBp ~8llBll e4l BA84 ol UOnOBIB-_
10 'IZOI-9Z111 Wd 'a.JnqsT~~8H 'IZ01iZ 'ldeO 'SI88ddy 10 p~eo&: 'enu8ABlj ;1-0 lU81lq.~lideO Yd 8LQ. ol lSBlo~d ueHT.JM--
:~q BOHoN sT4l
10 ldl8oB~ 10 S"BP (09) "lxTs ul4llM loerqo lsnm BOTloN sl4l uo UM045 SB (lse.JBlu! .JO lunooslP 6UTpnlouIl XBl fO
lUSUSSSSSB .JO 'suoTlonp8p ;1-0 8oUBMoIIBSTP ~o '80uaMoIIB 'lU8.esJB~ddB eLQ. 4'!" PBlfsJ,BS lOU lSB.JBlUI uJ ~l~Bd liUy
'(~IUO .L.Ll OZo5:-l~~-009-1 :Sp8BU 6UI)llil8ds
~o I pUR 6uI~Re~ leloads lIlIM S~8"Bdxal .JOj S80!A~BS fOSOZ-Z95:-009-1 :6UI.JBP.J0 S.~Of ~of BOTA~es 6uT.J8MSUB
~n04-~Z IBloeds 8l1l aUTlleo ~q ~o 'sBoJl;l-O lOI~lS!O enUBABH 52 B~ 10 ~UB 'SIIJM fa ~BlSIDBlj 84l 10
80JHO B4l l8 8lqlillTIilAB B~R suoHaonddW '(5:15:I-^3Kl uXB! BlBlS3 pUB 8oUBll~s4UI BluBAI"suued 10 punfBH ~ol
UOJlaollddyu UB 6ull8ldmoo ~q pe,sBnbB~ eq ~B. 'UUOlBH XB1 8~ uo pelssnbe~ ,DU SBM 40J4" 'lIP8~0 xel B 10 punle~ Y
J.N3f)' I n1IM .::10 33J.SID33 :0' 8tqB~Bd ~Bp.JO I08UO. ~o )loe40 B)laN--
'BPJS BS~.AB.J a4l uo pe,uI~d SIll" ;1-0 .Je,sJ68H B4l Ol lU8m"ed ~no~ lIlI" lTmqns pUB BOIlON sI4l 10 uOTl.JOd dOl 84l 40Rl80
'(0~16 UOHoes
'S'd Zll 'OOOZ 10 !t:Z lOY 'lOW XB1 8lBlS3 pus aOURlT~84UI 84l fO O~IZ uOIl~BS 10 sluB8B~lnbe.J a4l II!fthf 01
'lSB.J&:j.UJ 8~nlnl 40n5 "UR uo 8lIU (l1i~8lBtlOO) &: SSBtJ In:J.MRI 8lA lB
SBXB! BOUBl!~84UI ~8fSUB~l SSBSSB PUIi BSlli.Jdde ol l461~ 84l S8A.Jase.J ~lsse~dx8 "qe~e4 4lIBBMUO..OJ B4l 'S.JBB" ~ol ~o BIll
~ol BlBlsB "ua 10 uOTl~Jdxe 84l ~B'fB ,u8peo8p B4l ;1-0 s81~BJOJIBuBq (t~8lBltOO) B SSBIJ ol ,u8~orue ~o uoIssassod uI
p8.J.J8ISUB~l sI 8lRlS8 e4l uT lSBJB,UI 8~"lnf "UB fJ -- Zi61 'Zt .JBq880BO 8~OJ8q ~o uo aUJ"P sluBpeoep :J.o s8lals3
-'-
"r ...
:lS3H31NI
:,l,11YN3d
:LNnO:JSIO
: SNOIl:J3m:10J
3^IlYHJ,SI
-MINDY
: SHOIlJ3f&:O
: (tl:)l ONn.:l3H
:1N3W,l,Yd
: 3:JIlON
.:10 3S0dHnd
lNOIlW^H3S3H
July 21,2003
TO: Mary C. Lewis
Register of Wills & Clerk of the Orphans Court
Courthouse
Carlisle, P A 17013
FROM: W. John Thomas, Jr.
6494 Lincoln Court
East Petersburg, P A 17520
CC: David C. Thomas
Dear Ms. Lewis,
Attached is form 6.12 stating closure of my mother's estate, Charlotte A. Thomas (Estate No. 2102-0637).
The distribution of my late mother's estate was between myself and my brother, David C. Thomas of 613
Chesharn Drive, Kemersville, North Carolina 27284 (phone: 336-993-3602) - as per the wishes described
in her Will which was to be a 50/50 split of all remaining assets, was comnleted.
Attached is "Notice ofInheritance Tax Appraisement" which summarizes valuation and payment to the
Commonwealth of Pennsylvania Department of Revenue of the appropriate monies to satisfY the current
6% estate tax rate.
To my knowledge, this should conclude any and all responsibilities that I need to complete as personal
representative for the estate of Charlotte A. Thomas. If there is anything that I have not satisfied as part of
my responsibilities as executor, please contact me at (717)569-7461.
~~J