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..~ COMMONWEALTH OF
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.'ilIai.'. DEPARTMENT DF REVENUE
DEP1280601
. HARRiSBURG, PA 17123-0601
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FILE NUMBER
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COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
JJ/12..1D-
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HESTER JAMES J.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
December 8 2001 December 13
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1913
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
172 - 12
- 2687
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[Z] 1. Original Return
o 4. limited Estate
5{1 B. D~Cedent Died Testate (AU. achooPJ~wln)
Not Probated)
o g, Lllgation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of de<J!h afler 12-12-82)
o 7. Decedenl Maintained a Living Trust {Attach copy of Trust)
o 10. Spousal Poverty Credit (date 01 death be.\ween1Z-3HI' BM 1-1-95)
o 3. Remainder Return (date. ofde.ath prior to 12.13.82\
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
i.Tt-lIS"SECTll)N' l!SJ',;!l
NAME
:,COMPlI;1'ED:(;lI.C1.!iCORREsPQNDl:NCEAND:CONF.lDeNTIJl,I:., .AA:INFQRMJI,TIONSHQULl>.BE;.DIREC.TED,;rO::1
COMPLETE MAILING ADDRESS
10 West Pomfret Street
Carlisle PA 17013
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Patricia R. Brown
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-249-3024
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
OFFICIAL USE ON LY'-
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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 orL)
7,378.33
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Ur.es9 & 1Q)
46,976.02
(39,597.69)
(11)
(12)
(13)
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)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 tClxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
,,0_ (15)
,,0_ (16)
,,12 (17)
16. Amount of line 14 taxable at lineal rate
17. Amount of line 14 t(lx<lble at siblina rale
,,15 (18)
18. Amount of Line 14 tilxable at collatera~ rate
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(19)
19. Tax Due
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
''Ji1,~;, {'}:;'~~::~>/:,;';;"~;"::;:f\~:\,' t>.', !;>~>',.BE::,SURE':TO;:o.NSWERALl: QU.ESrtON$'.:'ON',Rev:ERSE;.SIDE;AND.'RECHECK:M'ATH<:o,<i!~{.};,':, i :ij;Y;,\:' ;';"';:'(':':~;~\':,
Decedent's Complete Address:
STREET ADDRess 121 Walnut Bottom Road
CITY Shippensburg I STATE PA I ZIP 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credils/Payments
A. Spousal Poverty Credil
B. Prior Paymenls
C. Discounl
(1)
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. Tolal Credils (A + B + C) (2)
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3. InteresVPenalty if applicable
D. Inleresl
E. Penalty
TolallnteresVPenalty ( D + E) (3)
4. If Une 2 is grealer Ihan Une 1 + Une 3, enter Ihe difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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5. If Une 1 + Line 3 is grealer Ihan Une 2, enler Ihe difference. This is the TAX DUE. (5)
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A. Enler Ihe inlerest on Ihe lax due.
(5A)
(5B)
B. Enter the tolal of Une 5 + 5A. This is Ihe BALANCE DUE.
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Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a Iransfer and: Yes No
a. retain Ihe use or income of the property lransferred:.................... ...................................... 0 lliI
b. relain Ihe right to designale who shall use Ihe property Iransferred or ils income; .................................... ....... 0 lliI
c. retain a reversionary interest; Of........ ................."..... ........................................................ .......... 0 ll9
d. receive Ihe promise for life of eilher payments, benefils or care? .................................................... ....... 0 lliI
2. If dealh occurred after December 12, 1982, did decedent Iransfer property within one year of dealh
without receiving adequate consideration? ............................. ............................................................... '''m. 0 CRl
3. Did decedent own an "in Irust for" or payable upon dealh bank account or security al his or her dealh? ............. 0 GJ
4. Did decedenl own an Individual Retirement Account, annuity, or other non-probate property which
conlains a beneficiary designation? ..... ..................................................... ......................... 0 lliI
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 perjury, I declare that I hal/e examined this return, inclu<:!i~ accompanying scheoules ana statements, and to the best 01 my knowledge and belief, it is true, correct
and complete.
Declaralion of preparer other lhan lhe personal represen!auve is based on all informatiollofwhich preparerhas any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
ADDRESS
SI~NAJJJI3E OF PRE PARER OTHER THAN REPRESENTATIVE
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ADDRESS
DATE / )
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10 West Pomfret Street, Carlisle PA 17013
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For dates of death on or after July 1, 1994 and before January 1 t 1995, the lax rale imposed on the net value of transfers 10 or for the use of the surviving spouse is 3%
[72 P.S. s9116 (al (1.11 (i)].
For dales of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)J.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dales 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 slepparenl of Ihe child is 0% [72 P.S. s9116(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(12) [72 P.S. ~9116{a}(1)J.
The lax rale imposed on Ihe nel value of Iransfers 10 or for Ihe use of Ihe decedenl's siblings is 12% [72 P.S. s9116(a)(1.3)). A sibling is defined, under Seclion 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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LAST WILL AND TESTAMENT
I, Jl\MESJ. HESTER, ofR.D.ff!I, Slippery Rock, Butler
County, Pennsylvania, being of sound mind, memory and
I understanding, do make, publish and declare this to be my
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Last Will and Testament, hereby revoking all Hills, Codicils and
Writings in the nature thereof heretofore made by me.
FIRST:
I direct my Executor to pay my lawful debts
and the expenses of my last illness and funeral as soon as may
be conveniently possible after my death.
SECOND:
I give, devise and bequeath all the rest,
residue and remainder of my estate of whatsoever kind and
nature and wheresoever situate to my wife, VIOLET A. HESTER,
if she survives me for a period of sixty (60) days.
THIRD:
If my wife, VIOLET A. HESTER, fails to so
survive me, then I hereby give, devise and bequeath all the
rest, residue and remainder of my estate of whatsoever kind and
nature and wheresoever situate to my children, HELEN ANN SCOTT,
PATRICIA MARY TEIERLE, and JANES WILLIAN HESTER, in equal shares,
share and share alike. If any of my said children should fail
to survive me, then I give, devise and bequeath the share of such
deceased child to his or her issue, per stirpes. I further
direct that if any issue of mine be a minor at the time of my
death, then the share of such minor issue shall be given in Trust
to the person having custody of him or her until such issue
Ii reaches the age of twenty-one (21) years, at which time such
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share, together with accrued interest, shall be distributed
outright.
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FOURTH: For the purposes of this Will, adopted children
shall be considered the natural children of the adopting parents
regardless of the date of adoption.
FIfTH: The interest of any beneficiary hereunder,
including a remainderman, in income or principal, shall not be
subject to assignment, alienation, pledge, attachment or claims
of creditors until after payment has actually been made by the
fiduciary as herein provided.
SIXTH: My fiduciaries hereunder shall have the
following powers, in addition to and not in limitation of those
granted by law; to accept assets in kind in distribution from my
estate, to collect proceeds of insurance on my life, and to use
such proceeds to purchase assets from my estate; to retain
assets in kind or to sell the same and to invest and reinvest
the proceeds in any kind of property, real or personal, or part
interest therein, without being restricted to investments which
are listed as legal for trust funds; to pledge, exchange or
mortgage real or personal property and to lease the same for
terms exceeding five (5) years; to give options for sales,
leases and exchanges; to borrow money; to compromise claims; to
vote shares or corporate stock, in person or by proxy, in favor 0
or against management proposals; to carry securities in the
name of a nominee; to make division or distribution hereunder
either in cash or in kind; and to allot different kinds of or
interest in property to different shares.
SEVENTH: My fiduciaries may resign at any time without
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stating cause, by petitioning a court of competent jurisdiction
to designate a successor fiduciary, if none is named in this
Will.
EIGHTH: I direct that all estate, inheritance and
other taxes in nature thereof, together with any interest or
penalties thereon, becoming payable because of my death with
respect to the property constituting my gross estate for death
tax purposes, whether or not such property passes under this
Will, shall be paid from the principal of my residuary estate,
and no person receiving or having a beneficial interest in any
such property, whether under this Will or otherwise, shall at
any time be required to contribute to or refund any part thereof.
NINTH: The interest of any beneficiary hereunder,
including a remainderman, in income or principal, shall not be
subject to assignment, alienation, pledge, attachment or claims
of creditors until after payment has actually been made.
TENTH: I do hereby make, constitute and appoint my
wife, VIOLET A. HESTER, to be Executrix of this my Last Will
and Testament. Should she for any reason fail to qualify or
cease to act as such w~ring the administration of my estate,
I appoi.nt JANES HILLIAM HESTER, to be Executor of this Will,
with the same duties, power and discretion as if originally
appointed. Should he for any reason fail to qualify or
cease to act as such during the administration of my estate,
I appoint HELEN ANN SCOTT, to be Executrix of this Will,
with the same duties, power and discretion as if originally
appointed.
ELEVENTH: My fiduciaries shall not be required to
furnish bond or other security in any jurisdiction in which
they shall serve.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this ,-] I '
day of
VDLY
./
. 1984.
, , '9Pr-':~ ' ~ ;;JJd-.-
&mes J. ~ter '
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
JamesJ. Hester, as and for his Last Will and Testamer..t.
in the presence of us, who have hereunto subs cribed our names
at his request as ~~tnesses thereto in the presence of the said
Testator and of each other.
( SEAL
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F I L E
FIRST CODICIL
TO
LAST WILL AND TESTAMENT
OF
JAMES J. HESTER
I, JAMES J. HESTER, a resident of Shippel').sburg, Pennsylvania, declare this to
be the first Codicil to my Will dated July 31, 1984.
I
I hereby revoke the Tenth paragraph of my Will in its entirety dated July 31, 1984,
and substitute the following:
TENTH
I do hereby make, constitute and appoint my daughter, PATRICIA M. TEIERLE,
to be Executrix of this my Last Will and Testament. Should she for any reason fail to
qualifY or cease to act as such during the administration of my estate, I hereby appoint
my son, JAMES WILLIAM HESTER, to be Executor of this Will, with the same duties,
power and discretion as if originally appointed.
II
In all other respects, I do hereby ratifY and confirm my Will dated July 3 I, 1984.
UlQl,~~p
Witness
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Witness
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,JAMES j. HESTER - Testator
Page 1 of 2
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COMMONWEALTH OF PENNSYLVANIA
SS.
COUNlY OF CUMBERLAND
We,JAMESJ. HESTER, VICKIEJ. GROUPandPATRICIAR. BROWN, the Testator
and the witnesses, respectively, whose names are signed to the foregoing instrument,
being first duly swom, do hereby declare to the undersigned authority that the Testator
signed and executed the instrument as his first Codicil to his Last Will and that he
signed willingly, and that he executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of the
Testator, signed the Will as witnesses and that to the best of each witness' knowledge
and belief the Testator was at that time eighteen years of age or older, of sound mind
and under no undue constraint or influence.
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Witness
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Testator ~
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Address
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Witness
Subscribed, swom to and acknowledged before me by JAMES J. HESTER, the
Testator, and subscribed and swom to before me by VICKIE J. GROUP and PATRICIA
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NOTARIAL SEAL
DENISE PINAMONTI. Notary Public
Carlisle Borough, Cumberlend Coun
M Commission ~x ires Nov. 20. 2000 ...
day of J.ttly" 2000. ( "-
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Notary/Public
R. BROWN , witnesses, this
Page 2 of 2
'''''''''',P971..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
HESTER, JAMES J.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
DESCRIPTION
Commerce Bank - Checking Account No. 513174912
First National Bank of Slippery Rock
VALUE AT DATE
OF DEATH
3,614.19
3,764.14
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7,378.33
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REV-1511 EX+ (12-99) .
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
HESTER, JAMES J.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,. Smith Funeral Home 5,291.00
.
Flowers 232.13
Clothing 36.48
Hotel 55.00
Long Distance Phone Charges and Mail 88.90
Food & Gas 160.03
Mileage and Tolls (502 miles @ 34.5 and $14.00) 187.19
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Representative(s) Patricia M. Teierle 450.00
Social Security Number(s)/EIN Number 01 Personal Representative(s}
Street Address 139 Rustic Drive
City .Sh~ens~~ '__ State ~~ Zip 17257
Year(s} Commission Paid: 2002
2. Atlorney Fees Patricia R. Brown, Esquire 1,000.00
3 Family Exemption: (If decedent's address is nol the same as claimant's, attach explanation)
Claimant
Street Address
City State ~_ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. File PA Inheritance Tax 10.00
TOTAL (Also enler on line 9, Recapitulation) $7,510.73
Debts of decedent must be reported on Schedule I.
(1I more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R.ESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
HESTER, JAMES J.
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
Department of Public Welfare
(See Attached Letter)
AMOUNT
39,465.29
TOT AL (Also enter on line 10, Recapitulation) S 39,465. 29
(If more spaCE is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINA.NCIAl OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8485
HARRISBURG, PA 17105.8485
April 24, 2002
PATRICIA R BROWN ESQUIRE
4 E LIBERTY AVE 3RD FL
CARLISLE PA 17013
. .
Re, JAMES HESTER
CIS #: 380151101
SSN, 172-12-2687
Date of Death: 12/08/2001
Dear Mr. Brown:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $39,465.29 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $19,585.07, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $19,880.22, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
~6..,{L. Jrd
Debra A. Wiest
TPL Program Investigator
717-772-6713
717-772-6553 FAX
Enclosure
REV-1513 EX+ (1-97J
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES1DENT OECEDEN1
ESTATE OF
HESTER, JAMES J.
FILE NUMBER
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include oulright spousal distributions)
RELATiONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1. No Beneficiaries will receive .
property due to insolvency of Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
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(If more space is needed, insert additional sheets of the same size}
l ~- ~~- ~ ~ COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-obol NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX ~fP (01-027
DATE 09-30-2002
ESTATE OF NESTER JAMES J
DATE OF DEATH 12-08-2001
FILE NUMBER 21 02-0730
COUNTY CUMBERLAND
PATRICIA R BROWN ACN 101
10 W POMFRET ST Anount Remitted
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT H OUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~
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REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF NESTER JAMES J FILE N0. 21 02-0730 ACN 101 DATE 09-30-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .0 0 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 7,378.33 tax payment.
b. Jointly Owned Property (Schedule F) (6) .DO
7. Transfers (Schedule G) (7) .00
8. Total Assets (g) 7,378.33
APPROVED DEDUCTIONS AND EXEMPTIONS: 7,510.73
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) [10) 39,465.29
11. Total Deductions (11) 46 .976 . D2
12. Net Value of Tax Return (12) 39,597.69-
13. Charitable/Governmental Bequests; Nonelected 9113 Trus ts (Schedule J) (13) .00
14 Net Value of Estate Subject to Tax (14) 39,597.69-
.
NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (151 •00 X 0 0 = .00
16. Anount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 . .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00
18. Amount of Line 14 taxable at Collateral/Class B rate (181 •00 X 1 5 .00
19. Principal Tax Due (19)= .00
rwv roenrTC.
DATE ~ ,NUMBER ~ INTEREST/PEN PAID (-) I AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE 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 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) rata on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or manev order payable to: REGISTER OF WILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-SOD-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, ar assessment
of tax (including discount or interest) as shown on this Notice must abject within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (7177 787-6505. See page 5 of the hoaklet ^Instructions far Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%7 discount of
the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%l percent par 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 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 7% .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 7% .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
5042709
D~~~.,„bz~ ~ 1. Zno ~
Jame:: .1. Hester
Nlale ~ 172 - 12 - 2657 Decemt~er ~, 2001
flecem(;er 13; ! ~; > Pittsburgh, 1ennsylvania
Shippensl~ur~; Nealt;~ Care, Center; Cu~t~beriand Cour.t_y, Shippensburg,
White Packer /Child's Equipment No
~`idc}wer 121 ~~'al~tut ~3otto~n Road; Sl~ipper~sbur~, Pennsylvania 172i7
It~1rs. Patricia NI. Teierle F~radley :~. Smit'r~
Sntitlt >uneral Home, 421 New Castle, Street, Slippery hock. Pennsylvania 16057
Femur Fracture
ParkinsoT~'s /Dementia
X
H. D. ~E%z,limon. D.C?.
127 t~'ainlrt Bottom h'.oac(; ~+hippensh~ar~, f'enns~~tvania 17257
~~ c, . .
~- , ~T~,
~ C2U"I'H N. ~ f1S'i'Y ft
I)ecembe~r 12, 201)1 54, 6 ~i~~est Prairie Street, ~rrisville, Pa. 1.6057
~J,/
FAMILY SETTLEMENT AND FINAL RELEASE
IN
ESTATE OF JAMES J. HESTER
(File No. 21-02-0730)
hNOW' ALL MEN BY THESE PRESENTS, that WHEREAS, James J. Hester, late of Shippensburg,
Cumberland County, Pennsylvania, deceased, died testate on December 8, 2001, having first made his Last ~~'ill
and Testament and Codicil, which were duly executed on July 31, 1984 and July 14, 2002 and which are duly
recorded at the Register of Wills in Cumberland County, Pennsylvania.
WHEREAS, the said James J. Hester, by the aforesaid Last Will and Testament, .yarned Patricia M.
Teierle, as Executrixr of said Last Will and Testament;
WHEREAS, letters testamentary on the estate of the said decedent were duly issued by the Register of
Fills of Cumberland County, Pennsylvania, to the said Executrix hereinafter called personal representative;
~~'HEREAS, the said personal representative has gathered the assets of the estate of the said decedent
and the assets consist of only personal property; to a total value of $7,378.33 as set forth in Exhibit A, which
is a statement of account of the said personal representative, and which is attached hereto and made a part
hereof, andmarked Exhibit A;
~~'HEREAS, the debts and deductions, including the payment of inheritance tas in the said estate,
amount to $46,976.02, leaving no balance for distribution also as set forth in the statement of the said personal
representative, which is attached hereto and marked Exhibit A;
WHEREAS, the following is a list of all known unpaid creditors, said creditors having been informed
by letter of the insolvency of the estate and the amount of their claim, which will not be paid due to said
insolvency:
PA Dept. of P ublic Welfare
(Estate Recovery Program)
$ 39,465.29
NOW, THEREFORE, KNOW YE, that we, PATRICIA M. TEIERLE, CHARLENE SCOTT,
D ARYL SCOTT, JAMES SCOTT and JAMES WILLIAhI HESTER, being the children and grandchildren of
Page 1 of 8
said decedent, do hereby acknowledge that because of the insolvency of the estate there are no funds for
distribution;
AND, We hereby stipulate that in order to avoid the expense and time involved in the filing of a formal
account and schedule of distribution, we agree that no account is necessary.
THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said personal
representative, Patricia M. Teierle, her heirs, executors, acid administrators and assigns, of and from the said
estate and from all actions, suits, payments, accounts, reclconings, claims, and demands whatsoever for or by
reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the estate of the said
decedent.
Page 2 of 8
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
200.
Witness:
r~._-._
--~ ~ ~ ~ ~ (SEAL)
PATRICIA ICI. TEIERL
CO~NION~'EALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
/ ~ /
On this, the ~_ day of , 200, before me, a notary public, the undersigned
officer, personally appeared Patricia M. T rle (known to me or satisfactorily proven) to be the person whose
name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN `FITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public
~1M !, ~ fUllllC
CARLISLE 60R0, CUMBERLAND COUNTY
SI001~1 IX MAY 13~4~^'
Page 3 of 8
IN FITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of -a 4-~
?00~.
STATE OF FLORIDA
COUNTY OF
~-
~~`~ (SEAL)
JAMES SCOTT
SS.
On this, the ~ day of ~..u , 20Q,~, before me, a notary public, the undersigned
officer, personally appeared)ames' cott (known t me or satisfactorily proven) to be the person whose name
is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
i
UUACI
~
~
8SY
~
E
E
P,RY p~ 'Notary Public '
O1
MI
GE
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* COMMISSION NUMBER
~
`~ 00115649
MY COMMISSION EXPIRES
9r~O
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MAY 6,2006
Page 6 of 8
IN `FITNESS WHEREOF, I have hereunto set my hand and seal this s~U
200.
CO~II~IONVv'EALTH OF PENNSYLVANIA
COUNTY OF ~ D
Y
v ~~ (SEAL)
MES WILLIAM HESTER
SS.
On this, the ~ day of ~-~-~~'~" rJL~ , 2002, before me, a notary public, the undersigned
officer, personally appeared James illiam Hester (known to me or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that he executed the same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand
Notarial Seal
SlipPeiY Rock Boro, Buter Counttyy
My ommission Expires Oct. 30, 2U03
fUember, pennsyNerMfaAseoctattonotNotaries
Page 7 of 8
official seal.
~~. ~ ~
Notary Public
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
200
(SEAL)
CHARLENE SCOTT
STATE OF FLORIDA
COUi~TTY OF
SS.
On this, the day of , 2002, before me, a notary public, the undersigned
officer, personally- appeared Charlene Scott (known tome or satisfactorily proven) to be the person whose name
is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein
contained.
IN ~YIITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public
Page 4 of 8
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
200
STATE OF FLORIDA
COUNTY OF
DARYL SCOTT
SS.
(SEAL)
On this, the day of , 2002, before me, a notary public, the undersigned
officer, personally appeared Daryl Scott (known to me or satisfactorily proven) to be the person whose name
is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public
Page 5 of 8
EXHIBIT "A"
STATEMENT OF ACCOUNT
OF
Patricia M. Teierle, Executrix
Assets:
1. Personal Property:
Checking Account (Commerce Bank) $ 3,614.19
First National Bank of Slippery Rock $ 3,764.14
Debts & Deductions:
1) Funeral Expenses
2) Administrative Costs
3) 1~liscellaneous (medical, nursing home)
Balance for Distribution to Heirs:
TOTAL $ 7,378.33
$ 6,050.73
$ 1,460.00
$ 39,465.29
TOTAL $ 46,976.02
NONE ($39,597.69)
Heirs: Patricia M. Teierle, daughter
James `~l'lilliam Hester, son
Charlene Scott, granddaughter
Daryl Scott, grandson
James Scott, grandson
NOTE: Under Debts & Deductions Paragraph 3 the sum of $_5,000 was paid to Dept.
of Public Welfare on account of the Estate Recovery's Program claim.
Also heirs Charlene and Daryl Scott failed to respond to repeated requests to
complete Family Agreement.
Page 8 of 8
(~,
~,..
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
James J. Hester
Date of Death: December 8, 2001
Will No. 21-02-0730
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 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 Filed Family Settlement
Agreement
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 X No
d. Copies of receipts, releases, joinders and
approti•als of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: ` 2 ~3
Signature
Patricia R. Brown
Name (Please type or print)
10 W Pomfret Street,
Address Carlisle, PA 17013
717) 249-3024
Tel. No.
Capacity: Personal Representative
X Counsel for personal
representative