HomeMy WebLinkAbout02-0652
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT Of REVENl,JE
OEPT.280601
HARRISBURG. PA 171211-0601
,_.,~, ~..
REV-1500 I 1--lltt(P
INHERITANCE TAX RETURN FILE NUMBER .
RESIDENT DECEDENT I 21 02
L COUNTY CODE YEAR NUMBER
- .-....---.--..-..-
SOCIAL SECURITYNUMBER-- ----
o X 4a. Future Interest Comprom"lse (dale 01 death
after 12-1Nl2)
o X6. Decedent Died Testate (Attach copy 0 X 7. Decedent Maintained a Uving Trust (Attach
~W~ ~~~)
OX 9. Litigation Proceeds Received 0 x 10. Spousal poverty Credit (dale of death between 0 X11.Election to tax under$ec. 9113(A) (Attach Sch 0)
'!1~!if~!!I!!$OOli"~i~l./..tl~~~;l!iC!'IIl'I~~.llf~liii!lC~~IIt~~~.~~n~Umrn\i
AME COMPLe.TE MAIUNG ADDRESS
Hamilton C. Davis
I DECEDENT'S NAME (LAst, FIRST, AND MIDDLE-fNI~
. Holtry, Helen M.
~A I E OFUEATR1MM-lJIl'YEJ\Rl -oATE1lF BIIlTfllM!'.OO"I'EARJ'
04/28/2002 05/05/1926
{IF APPUCABLE) SUWNlNG SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
N/A,
~aj x 1. Original Ret~ ---. 0 X 2. - Supplemental Return --
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o X 4. limited Estate
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IRM NAME (Ifapplicable)
Zullinger - Davis, PC
OFFICIAL USE ONLY
0652
--+
--1
182-22-9787
TELEPHONE NUMBER
i717/532-5713
1 Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or So'e~Proprietorship
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4. Mortgages & Notes Receivable (Schedule OJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o '$eparate Billing Requested
7. Inter~Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
THIS RETURN MUST BE FILeD IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NuM~-
-------crx3. Remainder RBIuiTilC81eOTcleiill'. prior 10 '2-f3~-
CJ x5.
8.
Federal Estate Tax Return Required
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
Total Number of Safe Deposit Boxes
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, P A 17257
I
(1) 43,500.00
.-- .---'..-
(2) None
--
(3) None
(4) None
(5) 5,288.85
._-
(6) None
(7) None
(9) 15,884.33
-- -
(10) 9,952.26
OFFICIAL USE ONLY
(8) 48,788.85
(11)
25,836.59
22,952.26
(12)
(13)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J)
I' 14. Net Value Subject to Tax (Line 12 minus Line 13)
__.__ ..____. ,___.. ____ .__m ._' ..__
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
22,952.26
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2) -- --_....-
'" 16.Amount of Line 14 taxable at lineal rate 22,952.26 x .045 (16) 1,032.85
0
" --.-..-- ----
~
=> 17.Amount of Line 14 taxable at sibling rate .12 (17)
~ x
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0 -.-.----
u
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) 1,032.85
-- -
20. CJ
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
. .. ",!.Ile;iIIlmll';1"OAlil~ilIU"(l!l&S1'lQ1II.ClIIfIl!\IIl!$Il1l~"NI>"ECI-!I!qI(MATH- ..[. '-if- . . .... .
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
43 Spring Street
CITY ..
STATE PA
I
Shippensburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3. InteresUPenaity if applicabie
O. Interest
E. Penalty
TotallnteresUPenalty (0 + E)
4. ItUne 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
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.
[-------
ZIP 17257
(1)
1,032.85
(2)
0.00
(3)
(4)
0.00
(5)
(5A)
(5B)
1,032.85
1,032.85
Make Check Payable to: REGISTER OF WILLS, AGENT
__._.11 Ill' ~-',.J III .
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............... ................... ....................... ............... 0 a
b. retain the right to designate who shall use the property transferred or its income;... 0 ~
c. retain a reversionary interest: or............ .................. .................. ................. ..................... 0 ~
d. receive the promise for life of either payments, benefits or care?.................... .................. ................ 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.. ................ .................. .................... ....................... 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?...... 0 IBl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.................. .............. ................ ................ .................. ............... 0 IBl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of p8fj~, IdEiCiare that I have examined thIs return, irIe\Ud\r.tl accomi)anylng schedules ana s\a\emen\s~- end to the besl of my knowledge and bellet, ills true, cOrrect
and cOmplete. -"
Declaration of preparer other than the personal representative is based on all mformallon of whIch preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETUR~ ADDRESS -- ----- -- ---------~- D~ -
:::~"i;olJ!p~f/~;iNG R~ _~DREs~yp~gJ~~U~g~epXe 17257_ - - ~cy0~
RpTRERTRANREPRESENTA~- .------p;()DRES~O East BurdStreet, Su.i~
,- P.O. Box 40
I -- Shippensburg, PA 17257
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--'--D~
II
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are stm applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)).
The tax rate imposed on the net value of transfers to odor the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)). A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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SCHEDULE A
REAL ESTATE
I
-~
FILE NUMBER
~ 21-02-0652
COMMONVVEAl TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-~
ESTATE OF
Holtry, Helen M.
- - ---
Ail 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 and a willing seller,_ neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned witn right of survivorship must lie disclosed on
schedule F.
ITEM
NUMBER
~
VALUE AT DATE
OF DEATH
- 43,500.00
DESCRIPTION
43 Spring Street, Shippensburg, P A
17257 (See attached Settlement Sheet)
TOTAL (Also enter on Line 1, Recapitulation)
43,500.00
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
_~ __~__ _ ~____~__ _~~~__n~
7iLENUMBER--
I 21-02-0652
ESTATE OF ----
Holtry, Helen M.
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
DESCRIPTION
VALUE AT DATE
OF DEATH
-f,986.6Sn
~ Miscellarieous HousehOidGoods and Furnishings-and j>ersonafEffects~
2
1993 Ceverolet Cavalier (with damage)
1,500.00
3
Refund from Erie Insurance Group
154.00
4
Refund from Sprint
36.94
5
Rebate from IRS for Low Inrome Home Energy Assistance Program
65.00
6
Orrstown Bank Checking Account
156.27
7
Pro-Rated Real Estate Taxes from Sale of House
389.99
TOTAL (Also enter on Line 5, Recapitulation)
5,288.85
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
CQMMONlMOALTH OF PENNSYlVANIA '
INHERITANCE TAX RETURN.. I
RESIDENT DECEDENT . ~
I
L
'FILE NUMB~ ~
I 21-02-0652
ESTATEOF HI HIM
o try, een .
Debts of decedent must be reported on Schedule I.
_~::::" ~""'''''' ...:.." .. ... OE"~""O'
1 Fogelsanger-Bricker Funeral Home, Inc.
!AMOUNT
I
6,538.90
2
Eby Granite Works
2,092.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) I EIN Number of Personal Representative(s}:
Street Address
City State
Year(s) Commission paid
Attorney's Fees Hamilton C. Davis, Esquire
Zip
2,500.00
2.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Zip
City
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills
State
66.00
4.
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
I
Other Administrative Costs
Legal Advertising - News Chronicle
69.86
2
Legal Advertising - Cumberland County Legal Journal
75.00
Total of Continuation Schedule(s)
4,542.57
TOTAL (Also enter on line 9, Recapitulation)
15,884.33
.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Holtry, Helen M.
3
In Reserve for Contingencies
4
I FILE NUMBER
21-02-0652
I_-
1,000.00
Schedule H
Funeral Expenses &
Administrative Costs continued
Real estate settlement expenses. It was necessary to liquidate this asset for the benefit of
settling the estate (not for the benefit of the beneficaries).
I
~
3,542.57
Page 2 of Schedule H
SCHEDULE I I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, &_ LIENS __L
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Holtry, Helen M.
I FILE NUMBER
21-02-0652
------.-
Include un reimbursed medical expenses.
ITEM
NUMBER
j
-----.._-----
DESCRIPTION
CRS Medical Oncology
AMOUNT
- - -- 20.00
2
Roy Humelfarb, DDS, Inc.
6.70
3
Borough of Chambersburg Medic Transport
71.91
4
Penelec
36.32
5
Pinker & Associates, Podiatric Medicine
13.74
6
Chambersburg Hospital
341.07
7
Yogindra Balhara, M.D.
83.00
8
Sprint
54.55
9
10
Chambers burg ALS
Oralscan Laboratories
341.07
11.85
II
Drs. Drawbaugh, Saylor and Wathne
210.05
12 Summit Health Dialysis Center and Chambersburg Hospital (ultimate lein amount undetermined may be
$800.00 and $14,269.62)
13
Redevelopment authority of Cumberland County Lein (See attached agreement)
8,762.00
TOTAL (Also enter on Line 10, Recapitulation)
9,952.26
HUD.l UNIFOl\M SETfLEMENT STATEMENT
(I EASY SOFT, Inc.
A- U.S. DEPARTMENT Of HOUSING AND uaaAN .[)EVl!LOPMENT SITfLEMENTSTATEMENT
B. TYPE OF LOAN 6. File Number: 7. Loan Number:
1. FHA 1. 'mIlA
3. Conv.UniM. 4. VA ,. Omv.lns. 8. Mortgage Insurance Case Numbc:r
C NOTE: This form is fiunisbed to give you a statement ofacrual settlement costS. Amounts paid to and by the sett:lemcntagetltuesbGwn. I\c:nl$ mJUked .(p.o.c.)~
were paid ouuide the closing; they are shown here fur iIlfonnational purposes and are DOt included in the totals.
NOTE: TIN '= Taxpayds ldemifiar.tion Number
0 NAME AND ADDRESS OF BORROWER: E NAME, ADDRESS AND TIN Of SELLER: f NAME AND ADDRESS OF LENDER:
Russel Albert Barry W. Ho1 try, Admin c.t.a.
Hannah Albert Estate of Helen M. Holtry
5025 Sunset Drive 43 N. Spring Street
Harrisburg, FA 11112 Shippensburg, FA 17257
G. PROPERTY LOCATION. H. SETTLEMENT AGENT NAME, ADDRESS AND TIN
43 N. Spring Street TURD LAW OFFICES 25-1616109
Shippensburg, PA 11257 28 SOUTH PITT S'l'REET, CARLISLE PA 17013
PLACE OF SETrLEMENT 1. SEITLEMENT DATE
34-34-2417-023 Turo LoW Offices 08/29/2002
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACfl0N
100. GR.OSS AMOUNT DUE FROM BORROWE~ 400. GROSS AMOUNT DUE TO SELLER:
lOl.Contnctsales~ 43,500.00 401. CODtJact sales price 43,500.00
10Z.Petsonalpropcrty 402. Pmonal property
103. Scrtlcmcnt char2eS to borrower (Linll 1400) 801. 73 403.
]04. 404.
105. 405. -C-
Adjustments for items paid by sell<< in advance ADjusunc:ntslOTitemspllidbysellllflnadvan/;C
106. Cityl\own taXe$ 406. City/lown ta~
107. County taxes 08/29/2002-12/31/2002 59.82 407. COWllytaXllS 08/29/2002-12/31/2002 59.82
lOB. Assessments 408..~nts
]09. 409.
110 School Tax 330.17 410. School Tax 330.17
111. 411.
H2. 412.
120. GROSS AMOUNT DUE FROM BORROWER 44,691.72 420. GROSS AMOUNT DUE TO SELLER 43,889.99
200. AMOUNTS PAID BY OR IN BEHALF OFBORR.OWE~ 500. REDUCfIONS IN AMOUNT DUE TO SELLER:
201. nem..itoreamcsl 1,000.00 50LE:<<;cssdeposi.t
202. Princi....lamountofncwloan(s) S02. ScttIement cblIrgcs 10 seller (Line 1400) 3,542.57
2M.E~0IlII(5)lalr.:IlnSUbiectto 503. Existing loan<)) takCII sub.cctto
204. S04.Pa ffoffirstmllrt21lgeloan
205. 505. PayoffofsocoDd ,,]"'"
206. 5%. Payoff Redev. Auth, of C.C. 8,762.00
207. 507.
208. SOB.
109 S09.
Adjustments fOl" ittrrl$ unpam by seller Adjustments for items unpaidh... seUIlC
ZI0.City/towntaxeS SIO.Cityltownmxes
21 I. Coun """ 511. CoUIltV taxes
212.Assessmef1ts 512.~t5
213. m
114 514.
2.15. 51S.
216. 516.
217. 517.
218. 51&.
219. 519.
220. TOTAL PAlO BYiFOR BORROWER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 12,304.51
300. CASU ATSETTLEME!'lT fllOMffO IM>RROWER
301. Gross amount due from bortower(Line 120)
302. Less llITIOIlnt id by/for borToWeI" (Line 220)
303. CASH FROM BORROWER
44,691.72
1,000.00
43,691.72
600. CASH AT SETTLEMENT FROMffO SELLER
601. Gross amount due to selJllf (Line 420)
602. Less reduction in anlOUllt due seller (Line 520)
6OJ.CASH TO SELLER
43,889.99
12,304.57
31,585.42
SUBSnnJrE FORM 1099 SELLER STATEMENT
The infurmationcontaincd in BIOI;.\r,:;E, G. H, and I and on line4DI (or, ifline401 is astcrisked.liDe403 aDd 404) is imporuntw. information a.od is being fumishedto the
lnlemlli Revenue Service. If you are rcquirtd to file a rdum,aoq,ligeo;:epeoalty or olhcr SIlnCtiod will be imposed on you if this item isrc:quired to be reported and the IRS
determines that it bas not been teported. If this real estate is your principal residence. file Form 2119. Sale or E~0rPrintjpal Residence. for any gain. with yOlll" income
~~; for other tnmsactions, complete the applicable parts of Form 4791. Form 6252lU1dJor Scbedule D(Fonn 1040). You are rcquircd to provkk the SetUanc:nt Agent
(namc:d above) with your coma tuplycr jQP.m;fu.t.1inn number. If you do not provide rhe Settleme:ot Agcm with yaw c.orrect taxpByeZ" identification number, you.may be
S1ibject: to civil or criminal penallies impJscd by law. Under penaltiesofpajUl"J, I certif; that the number shown on dtis.statement is my corn:ct laxplIyer identification number.
,
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'c, to..." '-( . .I~lt
Barr:yh;!. "Holt'ty,S:-;dmin
c.t.a.
i7/.~{,~/-
(SelJ,rsSignature) fEstate
of Helen M. Holtry
I . - --
....{SetIer's..Slgnature)
L SETfLEMENT CRARGf..S
iO EASY SOFT, Inc.
700.TOTALSALESlBROKER',COMMISSIONbuedoll .ce$43,500.00 @ 6.000%
Division of Commission (line 7(0) as full~:
701.$ 1,305.00 to Gear e L. Ebener Assoc.
m2.S1,305.00 to Remax Realt
703. Commission pa.id at Settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITII LOA....
80L Loan Origination Fee $
S02. LOlIII Discount $
803. Appraisal Fee to
S04.C~ to
80S. Lendcr's (nspection Fee
806. Mort lmurance Application Fee to
1107. A5sumption Fee
1108.
809.
8\0
SII.
900. ITEMS REQ1.JIRED BY LENDER TO BE PAlD IN Al)V ANCE
901. lnterest lrom
902. Mortgage Insurance Premium for
903. Hamrd insuranct Premium fur
PAID FROM
BORROWER'S
FUNDS AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
2,610.00
904.
90S.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insuraoce
1002. Mortgage insurancc
100J. Ci PrnpertyTues
l004.CountyPropcrt)rTaxes
1005. Annual assessmentS
1006.
1007.
lOOS. ~te Acoowtting Adju$tmem
1100. TITLE CHARGES
1101.Setdementorclosin tbtto
1102. Abstratt or title scan:h to Ianni Abstract Co.
1103. Title Examination to
1104. Title insurance trindcrto
1105. Documern prepan.tion to
ll06. Notaryfecslo
1l07.Attornty'sfecstoTuro Law Off. I Hamilton Davis, Es . P.O.C.
(im:ludeslincnumbcrs: 1101 1107
lIOll. Title Insurancc to
(includcslincnumbcrs:
1109. Lalder'scovenge $
1110. Owner'scovcragc:$
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. RcconI.ingfces: DeedS 28.50 Mortgagt:$
1202.Ci fcntytaxfstamps: DecdS MoltpgeS
1203. Statctaxf DeedS Molt S
12~.Realt Transfer Tax
120j.
1300. ADDmONAL SETILEMENT CHARGES
IJ01.SurveytD
1302. Pcst inspcctionro
1303. Water, Sewer, Refuse, etc. to Borou h of Shi ensbur
13~. 2002 Z003 School Tax to Lisa Helm, Tax Collector
1305.
13~.
1307.
1308.
1400. TOTAL SETl"LEMENT CHARGES {CIIter ou lIu" IOJ.Sec:tlOII.had501.~OD K) 801.73 3, 5.4Z-. 57
CJ:.:RTIFlCATION ,/ /'
r have c:areWlly reviewed the HtJD..1 Settlem:ttt Stfrtemcn! alld to tbI: bat of my knowItd,c: and belie(. it . true and. IlCC\II"8.te statement of all receipts and disbUrsements
onmy~_"!,,byrneintbistranSaCtiou.rfu,rther~fYthatlrecei~aoopyoftheHUD-ISettI temcnt. j 'L ('. .
\~~" -.. .1/1' ,>-/ - /ir;:~J ,~ 4'~!yl,.- :., '-Y l~. /tf
"1I~ __~ j' > ~arr.\I. W). ~Hf5.'rtry I Borr:; I Russel Albert
s'n~1~~'0:~s;t~. HOltr~j Bo=~ann~
TothebcSf<ii-~ HUD-I cineol Statement which I have prepared isa true and accuratt: Iccoumofthe funds wtic1t werercoeivod4l:1d IzavtbccnorwiU
be disbursed by igntd as oftbe ement of this ttansaction.
105.00
200.00
~~-i, "i-:"'J::;\'''ij;~:_;,-\i-i',ll;;,,< '.--.E:';0+(~J~';t<i
0.00
43500.00
Rell:llSCS
34.00
28.50
34.00
435.00
435.00
33.23
68.45
395.12
08/29/2002
LAW OFFICES Date
. gly make &Ise Siatements to the Unitcd States on this or anyot:hersimilarfumt PcnaftiCSl1polt ClJnrictioncan includea fine and
Title III U.S. Code Section 1001 andScction 1010.
OCT-28-2002 12: :';6P FPOI'I: THE HOLTR! FHI'IILLE' 717
~-::--,
_....Je:.
7807
TO: 5305222
p: 1/1
---'....
~
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=
=
=
=
-
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=
001
FUND
"-:," "
'';~:../iN0569
533305 ~>. ;:':;,~
WARRANT 10 \;._. ~r,',:~\!
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"PO 5 I ~ I V ~tA v',,~ PRO T ;'C'T ED C"~~~f?;,j":~~~:~;'-;:.';::
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coe
021
DEPT
\01002
PREP QATE
&85
41523678
,
".. 'CH.EC~ NUMBf~ '~",F'
...", " '. ' .
>.-FULTON-'BANK'
. LANCASTER.i PA
'VERIFICATI'ON ,AVAIlABli'-
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\,
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""-..
10;.16/2002
DJ\,"
PAY,~ ~OO
ONlY"-a/~CTSCTS
'~;:. ..
VOID AFrER 180 DAYS
TO THE ORDER OF
$ ****.~.~~~~ ~ ~**65. 00
HOLTRY HELEN
43 SPRING STREET
SHIPPENSBURG PA 17257
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ORIG!NAL. F. F. D. OF A. 1994
DUPLICATE. CUENT
TRIPLICATE - FUNERAL HOME
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Eby Granite Works
P.O. Box 187, Newville, Pa. 17241-0187
Phone: (717) 776-5118
Name
Address
Phone
Monument
Slant
Base -,
Bevel ~
Grass Marker
Design
Corner Post 0
Flower Vases 0
I.. S~t
Date
Zip
Kind of Granite
Cemetery -,.
Name on back
IYesl IINol-
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FOUNDATION
WARRANTY
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I ..::~.;:;~~,:.):1;:. ' ,;:. ............ take full responsibility for the accuracy
01 the above spellings and dates.
0 Check How to Letter I Letter this way - opposite
Unit Price $ c".-
-$
Flower Vase $
Total $"""
Corner Post $
Deposit $" ,.
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ORD,
P.O. #
pas
GRA
VAS
POSTS
GARS
COM
B&J
Misc, $
Balance $ "
I agree thai said memorial. with litle thereto and right of possession thereof, shall remain your personal property unti! I have paid fa
full. In default of any payment hereunder, 1 license you to repossess and remove the said memorial, without guill or trespass or other w
and authorize and empower you, in my name and on my behall, to apply to the management of said cemetery or other premises for a p
for its removal and to take any other steps you may deem roecessary or expedient and further agree to save you harmless from any €
repossession and removal; you may retain said memorial or dispose of it at your own discretion without being answerable to me 101 it 0
proceeds therefrom.
Orders sL:bject to cancellation. All contracts contingent upon slrikes, accidents, and other causes beyond our control.
I understand that30 days after placement af the memorial a FINANCE CHARGE will be enter~d on the billing dale. It is compuled by a per
rate of 1 'Yo! % permont/1 which is an annual percentage rate of 18 % applied to the previOUS balance before deducting credits, payments or ae
purchases appearing on this statement. To avoid FINANCE CHARGE pay the "New balance" before the bllling date next month.
I AGREe THAT ALL LEiTERING AND DATES GIVEN ON ABOVE ORDER ARE CORRECT.
I ALSO HAVE BEEN INFORMED AND UNDERSTAND THATTHERE WILL BE A CHARGE FOR ANY LETTERING DONE AFTER
MEMORIAL HAS BEEN ERECTED IN THE CEMETERY,
I ALSO ACKNOWLEDGE THAT I HAVE BEEN GIVEN MY FOUNDATION GUARANTEE, IF APPLICABLE.
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Customer's Signature:)
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Grave Marked
# of Grave
Cremation
AUG-27-2002 .
_ . 04.01P FF'OI'I'THE
. . , HOLTRY Fr'iI'IILLE'
717
5-32
7::::07
TO: 53rjC:.;:O.....2
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P:2/2
THIS ADDENDUM m,d< ond ~",,,, in" <h" J '" d,yo[ O,W,,, , J 998 b,L_,n "o!"
Ho"'" of 43 Sp'"'''' Shipp'~ ,,,' ' p"""I'''''' ",,,,,,,.,, "" ,,' "own'," on' m'
Bo,", of Co,",,,",'",,' of Cwnb"\~' Co,"~, , ",lit''''' ..bd""'o, of Lb' Co,"","w,,"b
of Pennsylvania, hereinafter called "County".
CUMBERLAND COUNTY HOME PROGR.AM.
ADDENDUM TO DEFERRED LOAN AGREEMENT
WHEREAS, m' ,""" ""dO "" ",,,iOU,ly ~"", i,to , Dd,",d Lo,", A>"",,'nl ,,,,d tho
J '" ',y of },"" J 998 fo< ho~'ng ""'bilil,,'on inil.'ng """, from Ib' HOME 1",''"'''"'
partnership Program;
~S."",",do"", CoM .""m,'" ,,",i'''..' ooon onmol,tioo 0"" ""'b'liuti'"
A owner s ~roperty, that the parties would execute an Addend~ to the Deferred Loan - "-
greement setting forth th t tal
e 0 amount ofthe deferred loan for said rehabilitation.
NOW, THEREFORE' . .
, m consideratIOn of mutual covenants herein, the parties agree as f 11 .
L DEFERRED LOAN ,0 OWS.
Agreement shall be ame~~OUNT: The parties agree that th .
for the rehabilitation of O'~:eS? as to provide that the deferre~ ~foresald Deferred Loan
2. BINDING NA T . " ,ro,,,,>, " io tho =mmt (, ~,;;;~;-')'re'It"h' 0"",,,
Loan A ORE. In all oth '. .
greement shall . er respects th
Addendum. remaIn as previously agre~~errns and conditions of the 1< .
upon and shall not b 'I a oresald Deferred
e a tered by this
IN WITNESS WHE
above. REOF, the parties h
ereto set thejr hand
s and seals the date and
year written
WITNESS
OWNER(S)
sdm-9ch
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wrL'-'_"M R. MARK
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-
LAST WILL AND TESTh~NT
I, HELEN M. HOLTRY, of 33 Spring Street, Shippensburg, Cumberland County,
Pennsylvania, being of sound mind, memory and disposition, do hereby make,
?ublish and deelaxe this my Last Will and Testament, hereby revoking and
making void all wills by me at any time heretofore made.
FIRST. I order and direet the payment of all my just debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I authorize and direct and empower my hereinafter-named Executors to
sell all of my estate, real, personal and mixed, whatsoever and wheresoever
situate, at either a public or private sale, and after payment of all debts,
to distribute the proceeds of such sale to my beloved children, BARRY W.
HOLTRY, JIMtIT L. HOLTRY, NANCY A. WILLIAMS, and GERALD L. HOLTRY, in equal
shares, per stirpes.
THIRD. In the event that any beneficiary of this my Last Will and Testament
is under the age of twenty-one (21) years, I then give and bequeath said bene-
ficiary's share to GERALD L. HOLTRY, AS GUARDIAN, NEVERTHELESS, to invest and
re-invest the same until the said beneficiary reaches the age of twenty-one
(21) years, with the following powers in addition to those presently given by
law:
A. The power to expend the income towards the health, support and
maintenance, and education, including a college, trade, business
or technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the
said Guardian, if the income is insufficient, towards the health,
support and maintenance, and education, including a college, trade,
business or technical school education, of the said beneficiary;
I::
C. The power to sell any and all real estate within the discr.etion of
the said Guardian;
D. The power to distribute the balance of principal and interest, if
any remaining, when the said beneficiary reaches the age of twenty-
one (21) years, without the necessity of a formal adjudication of
the Guardian's Account in the Court of Common Pleas of Cumberland
County, upon the receipt of a good and valid release;
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''-'-'AM F'I_ "'AFIlI'<
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E. The principal of the Guardianship and the income therefrom shall
be free from the debts, liabilities and engagements of those
beneficially interested therein, and shall not be subject to
assignment by him or her, nor to attachment or execution under
any legal, equitable or other process for the enforcement of
judgments or claims of any sort against them, either individually
or collectively;
F. In the event the above mentioned Guardian is unable to accept the
Guardianship, I then name, constitute and appoint JIMMY L. HOLTRY,
as Guardian, with the same powers hereinbefore stated.
FOURTH. I nominate, constitute and appoint GERALD L. EOLTRY as the Guardian
of the persons of my child or children, if such is convenient to him, both
financially and physically; and if he be unable to perform the duties of the
Guardian of the persons, I then request RUTH HOLTRY to be the said Guardian of
the persons of my child or children.
FIFTH. I nominate, constitute and appoint GERALD L. HOLTRY and JlWofY L.
HOLTRY to be the Co-Executors of this my Last Will and Testament.
SIXTH. I direct that neither my personal representative nor Guardian shall
be required to post bond for the faithful performance of their obligations in
any jurisdiction.
IN WITNESS t4HEREOF, I, HELE~ M. liOLTRY, have hereunto set my hand and
seal to this my Last Will and Testament, written on
two sheets of paper, the
S .J1 day of [n7(v1.'v~
first signed for identification purposes only. this
1975.
,
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,
,
Signed, sealed, published and
declared by HELEN M. HOLTRY,
the Testatrix, as and for her
Last Will and Testament, in the
presence of us who have at her
request signed our names as
Witnesses hereto in the presence
of tne~said Testatrix and of each
othe~.i / /.
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Register of Wills of Cumberland County, Pennsylvania
Estate of Helen M. Holtry
also known as
PETITION FOR GRANT OF LETTERS
No. .;2/-~ -66-.;1/
, Deceased
Social Security No. 182-22-9787
Barry W. Holtry
Petitioner{s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
of Administration C.T.A.
A. Probate and Grant of Letters
[i)
and avers that the last Will of the Decedent,
dated March 5, 1975, nominated two of Decedent's children as Executors (Gerald L. Holtry and Jimmy L. Holtry) with no substitutes,
and both Gerald L. Holtry and Jinuny L. Holtry have renounced in favor of Petitioner.
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
GJ
B. Grant of Letters of Administration C. T.A.
(c.t.a., d.b.n.c.t.a.: pendente Iiteadurante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left iXKWill and was survived by the followin~
(if any) and heirs: Executors named in the Will have renounced, see attached renunciation.
Name Relationship Residence
Ba W.Hol Son Shi ensbur PA
Gerald L. Holt Son Shi ensbur PA
Jimm L. Hol Son Shi ensbur PA
Nanc A. Williams Dau hter St. Louis MO
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 43 Spring Street, Shippensburg, P A 17257 (Shippensburg Borough)
(list street, number and municipality)
Decedent, then 75 years of age, died April 28 ,2002 ,at Shippensburg Health Care Center
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PAl 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 .....................,..................,...................,.....................,..... $
Total................. ..................... ..................... ..................... ......................... ....... $
0.00
Real Estate situated as follows:
43 Spring Street, Shippensburg, PA 17257
Wherefore, Petitioner(s) respectfUlly request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature
Typed or printed name and residence
w.
B
W.Hol
226 Hollar Avenue Shi ensbur P A 17257
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petilioner(s) above-named swear(s) and 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 representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estat~~1tg to ~
Sworn to and affirmed and subscribed /21)
~ BarryW. oltry
befo me this / day of
Estate of Helen M Holtrv
DECREE OF REGISTER
Deceased
No. r::::.>/-O'::;-A.5..:2J
also known as
Date of Death: 4/28/2002
AND NOW, ,"- ~ , in consideration of the Petition
on the reverse side hereo ,satisfa ory proof having been presented before me,
IT IS DECREED that Letters Cl Testamentary IiiI of Administration C.T.A.
('C.t.a., d.b.n.c.\.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Barrv W. Holtry
in the above estate and that the instrument(s), if any, dated March 5.1975
described in the Petition be admitted to probate and filed of record as the iast Will of Decedent.
FEES
Letters .................................... $ ~.o;'7" /?/?
$
$
$
$
$
$
Inventory & Tax Forms............. $
$
Short Certificate(s) ...............
Renunciation ..........................
Affidavit (
) .......................
)..............
Extra Pages (
Codicil.................................
JCP Fee .................................
Other ......................................
TOTAL .............................$
RW-7A
~//l/Il~(//h-;;.,u2;hJ $f..JEj...,,'l
Regist of Wills
IX'. /"JI'?
/..... ~~I"Y"J
..~ ,..."...,
6:0CJ
Attorney: HAMILTON C. DAVIS
I.D. No: 10264
Address: P.O. BOX 40
SHIPPENSBURG
PA 17257
66. a:>
Telephone: 532-5713
DATE FILED:
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Barry W. Holtry and Hamilton C. Davis
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he
~ familiar with the signature of Helen M. Holtry, testatrix of (one of the subscribing witnesses to)
the will presented herewith and that he believes the signature on the will is in the handwriting pf
- Iy\o\J ~,<\ W~;'1I' lft,D
Helen M. Holtry to the best of his knowledge and belief; Mary E. SeaveA, the subsct'ibing
witnesses to the said will, r~aVailable.
,20_
&w1fI2/J~
Barry W. Holtry
226 Hollar Avenue
Shippensburg, P A 17257
( Address)
/7/ ~h(! t ~
- ~ (Name
Hamilton C. Davis
P.O. Box 40
Shippensburg, P A 17257
(Address)
Sworn to or affirmed and sub-
scribed before me this day of
For the Register
u,:lIe 01 ~"'IJl[dUUrl UI l"UldIY:::> \..Vlllllll;::':>'UI '.J
RW-3
",.,,,,1.'"
This IS ro certifv rhar rhe inf(xmarion here given is canccrly copied J1.0111 an original cerriflcarc of dcarh duly filed' wi~h me as
Local Registrar.' The original certificate will bi.:' forwarded \0 the State Vital Records Office for permanent tIling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No,
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COMMONWEALTH OF PENNSylVANIA. DEPARTMENT OF HEALTH. VITAL RECOAOS
CERTIFICATE OF DEATH
NAM[Qf'l'll;:CEOENT\f"....._.C_
.. Helen M. Holtry
~.
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SOCIAlSECIJArN''''Uu&A
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LAST WILL AND TESTAMENT
I, HELEN M. HOLTRY, of 33 Spring Street, Shippensburg, Cumberland County,
Pennsylvania, being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and
making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my just debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I authorize and direct and empower my hereinafter-named Executors to
sell all of my estate, real, personal and mixed, whatsoever and wheresoever
situate, at either a public or private sale, and after payment of all debts,
to distribute the proceeds of such sale to my beloved children, BARRY W.
HOLTRY, JIMMY 1. HOLTRY, NANCY A. WILLIAMS, and GERALD L. HOLTRY, in equal
shares, per stirpes.
THIRD. In the event that any beneficiary of this my Last Will and Testament
is under the age of twenty-one (21) years, I then give and bequeath said bene-
ficiary's share to GERALD L. HOLTRY, AS GUARDIAN, NEVERTHELESS, to invest and
re-invest the same until the said beneficiary reaches the age of twenty-one
(21) years, with the following powers in addition to those presently given by
law:
A. The power to expend the income towards the health, support and
maintenance, and education, including a college, trade, business
or technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the
said Guardian, if the income is insufficient, towards the health,
support and maintenance, and education, including a college, trade,
business or technical school education, of the said beneficiary;
C. The power to sell any and all real estate within the discretion of
the said Guardian;
D. The power to distribute the balance of principal and interest, if
any remaining, when the said beneficiary reaches the age of twenty-
one (21) years, without the necessity of a formal adjudication of
the Guardian's Account in the Court of Common Pleas of Cumberland
County, upon the receipt of a good and valid release;
, .A.:
'7 '/ .,' ' ,
'J l.t(
",/1
///
/ /;'
, ~'!7~; '.
, t .~-' " / ,,-
)(/t.. .,/Z{.ISEAL)
,,/j
-'
WILLIAM R. MARK
ATTORNEY AT L.AW
SH''''''E''SSURG, PA
- 1 -
a-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Helen M. Holtry
Date of Death: April 28. 2002
Will No.: 21-02-0652
To the Register:
I certif'y 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 August 8. 2002 :
Name
Address
Nancv A. Williams 1425 Gettsburg Landing:
St. Charles. MO 63303
Jimmv L. Holtry 400 North Morris Street
Shippensburg. PA 17257
Gerald L. Holtry 2376 Lindsay Lot Road
Shippensburg. P A 17257
Barry W. Holtry 226 Holtry Avenue
Shippensburg. P A 17257
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
.~~ t 1.-
Signature
None
Date:
08/08/2002
-"
Hamilton C. Davis. Esq.
P.O. Box 40
Shiooensburg. P A 17257
Telephone: 717-532-5713
Capacity: _ personal representative
~ counsel for personal
representative
Name:
Address:
/'?-?h-b
JEAN HILL
104 MARYANN ST
SCRANTON
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
*'
.
, BUREAU OF INDIVIDUAL TAXES
~NHERITANCE TAX DIVISION
DEPT. Z8D601
HARRISBURG~ PA 17128-0601
REV-l'O~ EX AFP lIZ-DOl
09-10-2002
SAPORITO
02-13-1999
35 02-0652
LACKAWANNA
178-22-2440
99120503
ANGELO J
Amount Remitted
PA 18504-0000
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
LACKAWANNA CO COURT HOUSE
SCRANTON, PA 18503
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (12-00l
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 09-10-2002
ESTATE OF SAPORITO
ANGELO
J DATE OF DEATH 02-13-1999
COUNTY
LACKAWANNA
FILE NO. 35 02-0652
ADJUSTMENT BASED ON:
S.S/D.C. NO. 178-22-2440
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
99120503
FINANCIAL INSTITUTION: PNC BANK
ACCOUNT NO.
92003644627
TYPE OF ACCOUNT: () SAVINGS (Xl CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 04-05-1983
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE nn
. IF PAID AFTER THIS DATE, 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 .'CREDIP' (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
PAYMENT:
Detach the top portion of this Notice and submit with your pay.ent made payable to the name and address
printed on the reverse side.
-- Make check or money order peyable to: REGISTER OF WILLS J AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, .ay ba requasted by co.plating an
RApplicatlon for Refund of Pennsylvania Inheritanca and Estate Taxft (REV-1313). Applications ara available at
the Office of tha Register of WillS, any of the 23 Revanue District Offices or from tha Department.s 24-hour
answering service for forms ordering: 1-800-362-2050; servicas for taxpayers with special haaring
and / or speaking neads: 1-800-447-3020 CTT only).
REPLY TO:
Quast ions ragarding arrors contained on this notica should be addressad to: PA Dapartmant of Revenue, Buraau
of Individual Taxas. ATTN: Post Assassmant Raview Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decadent's daath, a five percent (5%) discount
of tha tax paid is allowed.
PENALTY:
The 15X tax amnasty non-participation panalty is computed on tha total of the tax and intarast assessed, and not
paid befora January 18, 1996, the first day after the end of tha tax amnesty period.
INTEREST:
Intarest is charged beginning with first day of delinquency or nine (9) months and one (1) day from tha date of
death to the date of payment. Taxes which became dalinquent before January 1, 1982 bear interest at the rate of
six (6X) percant per annum calculated at a daily rate of .000164. All taxes which became delinquant on and aftar
January 1, 1982 will bear interest at a rate which will vary fro. calendar yaar to calendar year with that rate
announced by the PA Depart.ent of Revanua. Tha applicable interest rates for 1982 through 2001 are:
Daily Interest Factor
~
Interest Rata
Daily Interest Factor
!!:r
Intarest Rate
1982 20Z .000548 1992 9Z .000247
1983 16Z .000438 1993-1994 n .000192
1984 llZ .000301 1995-1998 9% .000l47
1985 13Z .000356 1999 n .000192
1986 lOX .000l74 lOOO 8% .000l19
1987 9X .000247 2001 9% .000l47
1988-1991 11% .000301
--Interest is calculatad ., follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fiftaen CI5) days
beyond the date of the assassrnent. If pay.ant is made aftar the interast computation date shown on tha
Notice. additional interest must be calculated.
REV_1470 EX (';-88)
'*' INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
ANGELO J. SAPORITO 3502-0652
REVIEWED BY ACN
Phyllis Hoch 99120503
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
ADJUSTED ABOVE ACN TO ZERO. REPORTED ON PROBATE RETURN.
ROW
PaQe 1
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
DAVIS HAMILTON C
POBOX 040
SHIPPENSBURG, PA 17257-0040
------.-Iold
ESTATE INFORMATION: SSN: , 82-22-9787
FILE NUMBER: 2102-0652
DECEDENT NAME: HOLTRY HELEN M
DATE OF PAYMENT: 01/23/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/28/2002
NO. CD 002076
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,032.85
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,032.85
REMARKS: HAMILTON C DAVIS ESQ
CHECK# 117
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
/-?_-?.;- t,
'\. BUREAU OF INDIVIDUAL TAXES
INHERITANcg TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
HAMILTON C DAVIS
ZULLINGER DAVIS
PO BOX 40
SHIPPENSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-17-2003
HOLTRY
04-28-2002
21 02-0652
CUMBERLAND
101
*'
REV-1547 EX AFP (Gl-U5l
HELEN
M
Amount Remitted
PA 11257
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 ~
iiE"y=Ei'4-j-E1Dif:iQoFo3Y-NoYicn:iF-iiiHEifii'ANCE-YAin'PPRAiSEMEN:r,--li:LUiwANCE-OR:-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOLTRY HELEN M FILE NO. 21 02-0652 ACN 101 DATE 03-17-2003
TAX RETURN WAS: (X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds {Schedule 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
(11
(21
(31
(41
(51
(61
(71
43,500.00
.00
.00
.00
5.288.85
.00
.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 911~ Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(91
UOI
15,884.33
9.952.26
1111
U21
U31
U41
NOTE: To insure proper
credit to your account)
submit the upper portion
of this for. with your
tax payment.
48,788.85
2~.R36 ~q
22,952.26
.00
22,952.26
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class Brat.
19. Principal Tax Due
NOTE:
U51
U61
U71
U81
.00
22,952.26
.00
.00
x 00 = .00
X 045 = 1,032.85
X 12 = .00
X 15 = .00
U91= 1,032.85
TAY "RI"DITS:
'RT"""' ,., ANOUNT PAID
DATE NUN8ER INTEREST/PEN PAID (-I
01-23-2003 CD002076 .00 1, 032 .85
TOTAL TAX CREDIT 1,032.85
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 PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expreSSly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 2:3 of 2000. (72 P.S.
Section 914D).
PAVMENT:
Detach the top portion of this Notice and submit with your pay.ent to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS ~ AGENT
REFUND (CR):
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ftApplication
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13I3). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, Qr by calling the special 24-hour
answering se~vice for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-302:0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to thl;l PA Department of Revenua, Board of Appeals, Dept. 281021. Harrisburg, PA 17128-1021, OR
--election to have the qatter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS:
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue.
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, HarriSburg, PA 17128~0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) far an explanation of ad~inistratively correctable errors.
DISCOUNT:
If any tax due is paid within threg (3) calendar ~onths after the decedent's death. a five percent (57.) discol,Snt of
the tax paid is allowed.
PENALTV:
The 15X tax amnesty non~participation penalty is computed on the total of the tax and interest assessed. and not
paid before January 18, 1996. the first day after the end of the tax amnesty periOd. This non-participation
penalty is appealable in the sa.e manner and in the the same time period as YOU would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of
death. to the date of payment. Taxes which beca.e delinquent before January 1, 1982 bear interest at the rate of
six (67.) percent per annum calculated at a daily rate of .000164. All taxes Which became delinquent on and after
January 1. 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest lJaily Interest
~ ~ Year ~ Factor Year Rah
Daily
Factor
Year
1982 20X .000548 1987 9. .000247 1999 7X .DOO19Z
1983 16X .000438 1988-1991 11X .000301 2000 8X .000219
1984 117. .DDD3D1 1992 9. .000247 2001 9X .000247
1985 13X .000356 1993-1994 n .000192 2:002 .. .000164
1986 lOX .000274 1995-1998 9X .000247 2003 5X .000137
--Interlast is calculated as fallows:
INTEREST = BALANCE OF TAK UNPAID K NUnBER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
--Any Hotice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of the assessment. If payment is .ads after the interest computation date shown on the
Notice. additional interest must be calculated.
'"/,('\0 :
v
/
o~
REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12 pr;
(For Resident Decedents Dying After July 1, 1992) ~;
'"
8
:I:J
::c (1)
;": '''''':
Name of Decedent:
Arthur G. Hunt
'-
c::
z
\
:>.
Date of Death:
June 21, 2001
FileNo.:
21-02-0652
ill
01
-.J
Social Security No.:
233-26-7454
Pursuant to Rule 6. I 2 ofthe Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration ofthe above-captioned estate:
I. State whether administration of the estate is complete:
Yes X 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. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes X 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 Clerk of the Orphans' Court and may be attached to this report.
Date: June 4, 2003
Signature:
Name:
Address:
~.~~
Ivo V. Otto III, Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
Ten East High Street
Carlisle, PAl 70 13
(717) 243-3341
Counsel for personal representative
F IFlLES\DA T AFILE\EST A TES\6939-2srep
L
, f
:' ,......
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Helen M. Holtry
Date of Death: 04/22/2002
Estate No. 2002-00652
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 X 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 X
b. The separate Orphans' Court No. (if any) for the personal
representative's account is: N/ A
c. Did the personal representative state an account informally to the
parties in interest? Yes..l'L- No_
d.
Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' court
and may be attached to this report.
'~l (i A~...--,
Hamilton C. Davis, Esquire
P.O. Box 40
Shippensburg, P A 17257
(717) 532-5713
1~/gJ03
{ I
Date:
Capacity: _ Personal Representative
XX Counsel for Personal
Representative