HomeMy WebLinkAbout01-0024
R~V-1500EX:(6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
LEED LOIS A.
DATE OF DEATH (MM-OO-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
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12/01/2000 11/11/1936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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FILE NUMBER
21-0100024
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SOCIAL SECURITY NUMBER
1 8 4-2 6-4 6 5 5
THIS RETURN MUST BE FILED IN DUPLICATE WrrH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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00 1. Original Return
o 4. Limited Estate
[K] 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise [date 01 death after 12-12-82)
o 7, Decedent Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (dateofdealh between 12-.31.S1 and 1.1-S5)
o 3. Remainder Retum {da!e of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
00 8. Total Number of Safe o.posit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sell 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIOENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
JOHN H. BROUJOS ESQUIRE 4 N. HANOVER STREET
FIRM NAME (If Applicable)
BROUJOS & GILROY P.C.
TELEPHONE NUMBER
717-243-4574 OR 717-766-1690 CARLISLE P 17013
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1. Real Estata (Schedule A)
2. Stocks and Bands (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Recei..bIe (Schedule Dj
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. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Totallle<luctions (total Lines 9& 10)
12. Net Value of Estate (Unea minus Line 11)
13. Charitable and Govemmental8equests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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19,328.54. l>-
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(8)
19,449.80
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13}
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
X _(15)
12,415.91 X .045 (16)
X .12 (17)
X .15 (18)
(19)
2,137.00
4,896.89
(11)
(12)
(13)
7,033.89
12,415.91
(14)
12,415.91
16. Amount of line 14 taxable at lineal rate
558.72
558.72
17. Amount of Line 14 taxable atsibting rate
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Line 14 taxable at collateral rate
Decedent's ComDlete Address:
STREET ADDRESS
6280 CARLISLE PIKE, LOT 100
CITY I STATE I ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
558.72
500.00
25.00
Total Credits (A + 8 + C)
(2)
525.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (0 + E) (3)
4. 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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
33.72
33.72
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ......................,.................................."........................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?................. ............................................................................. 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................. .......................... 0 00
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 have examined this return, includinQ accompanying schedules and statements, and to the best of my k.nowledge and belief, it is true, correct
and complete,
Declaration of preparer other than the personal representative IS based on all mformation of whIch preparer has any knowledge.
SIGNATURE OF ERSON RESPONSI8 E FOR FILING RET RN DATE
) d-; ;;)..0
PA 17050
DATE
'2. -z.o.O\
ADDRESS
4 N. HAN VER STREET
CARLISLE
PA 17013
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 value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
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 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 fhe nef value of transfers from a deceased chiid 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 beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2} [72 P.S. 99116(a)(I)].
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.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE I NTD C DENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
LEED LOIS A
AU property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 01
00024
ITEM
NUMBER
1.
DESCRIPTION
Series EE US Savings Bond, Serial No. L524963638EE, issued 10/95, matures 10/2025
VALUE AT DATE
OF DEATH
31.20
2.
Series EE US Savings Bond, Seriai No. L545222850EE, issued 2/96, matures 212026
30.42
3.
Series EE US Savings Bond, Serial No. C585765111EE, issued 11/96, matures 11/2026
59.64
TOTAL (Also enter on line 2, Recapituiation) $
(If more space is needed, insert additional sheets of the same size)
121.26
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
LEED. LOIS A
FILE NUMBER
21 01
00024
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.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DESCRIPTION
Susquehanna Valley Federal Credit Union checking accl/member # 8251
VALUE AT DATE
OF DEATH
473.85
Susquehanna Valley Federal Credit Union savings accl/member # 8251
2,938.76
1987 Skyline Mobile Home 14'x66'. VIN: 1A111062W
6280 Carlisle Pike, Lot 100, Mechanicsburg, PA (copy of check attached)
14,500.00
Household Furnishings (auctioneer's settlement sheet attached)
900.75
Veterans Life Insurance Company - refund of premium
23.82
Cumberland Valley School District - OCC refund
85.26
Federal income tax refund
244.95
Tax refu nd
28.00
12.6.00 deposit unidentified
105.28
Interest - checking/savings account
27.87
TOTAL (Also enler on line 5, Recapitulation) $
(ff more space is needed, insert addilionai sheels of Ihe same size)
19328.54
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9/25/2001
DOLLAR'
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CONSIGNOR'S NAME
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~c..".\:c1> t'O-tte1fer ,~,/J1...c '~\I"-S,
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ADDRESS
PHONE
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ZIP CODE
QUANTITY \ DESCRIPTION OF CONSIGNED ITEMS OU"11ITY DESCRIPTION OF CONSIGNED ITEMS
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SHEET #
OF_TOTAL SHEETS
Dale
I (consignor) hereby commission you to sell the items listed above & on
the attached sheets to the highest bidder by public auction. I certify that
I am the owner of the above listed items and have good title and the right
to sell them. I certify that the items listed are free fro.m all incumbrances.
I aQree to accept aU responsibility for providing good title and for delivery
of tllle to the purchaser. II is agreed that the consignee is not responsible
for the loss of any item due to fire, theft, damage, etc. I understand that
a % commission will be deducted from the gross sales
of my items. "No Bid" items Will be disposed of at the discretion of the
Auctioneer/Auction House. Payment will be made to the consignor within
__ days from date of sale.
Consignor Signature
Date
Auctioneer/Auction Staff Signature
CONSIGNOR'S SETTLEMENT COPY
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
LEED LOIS A
FilE NUMBER
21
01
00024
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
Myers Funeral Home, Mechanicsburg - paid by insurance
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Kim I. GillauQh 1,000.00
Social Security Numbe~s) f ErN Number of Personal Representative(s)
SlreelAddress 28 Cumberland Drive
City MechanicsburQ Stale PA Zip 17050
Yea~s) Commission Paid: 2001
2. Attorney Fees Broujos & Gilroy, P.C.; EIN 23-2267691 1,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probale Fees & Short Certificates - Register of Wills 95.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Inventory - Register of Wills 10.00
8. inheritance Tax Retum - Register of Wills 15.00
9. Family Settlement Agreement - Register of Wills 17.00
TOTAL (Also enler on line 9, Recapitulation) $ 2 137.00
(If more space IS needed, Insert additional sheels of the same size)
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COMMONWEALTH OF PENNSYLVANIA
lNHERlT ANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
LEED LOIS A
FILE NUMBER
21
01
00024
Include unreimbursed medical expenses.
ITEM
NUMBER
t
2.
3"
4"
5"
6"
7"
R
9"
10"
11"
DESCRIPTION
AMOUNT
467.00
Amerigas - propane
Comcast - cable
45A9
Verizon - phone
42.61
AT&T - phone
109"04
Foremost - fire insurance
115"80
Salem Acres - lot rent until mobile home was sold
2,925"00
Wachovia - credit card
140"00
Chase - payment on mobile home
787 "05
P P & L - electricity
131"05
Lowe's - credit card
110"00
Prudential - life insurance premium
23B5
TOTAL (Also enter on line 10, Recapitulation) $
(If more space IS needed, Insert additional sheets of the same size)
4896"89
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
I FFn I liS A. ?1 01 OOO?A
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS (Include outright spousal distributions)
1. Carl R Leed, Jr. son 1/4
4015 Rawlelgh Street
Harrisburg, PA 17109
2. AI an V. Leed son 1/4
c/o Grants Mini-Mart, 517 Bush Street
San Francisco, CA
3. Thomas R Leed son 1/4
2101 Hill Road, Apt. E-21
Sellersville, PA 18960
4. Kim I. Gillaugh daughter 1/4
28 Cumberland Drive
Mechanicsburg, PA 17050
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 I1- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space IS needed, insert additional sheets at the same size)
Estate of Lor.s A. L ~~
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
.:1./- 0 I... ::J-V
No.
To:
Register of Wills for the
, Deceased. County of Cu",- b e: ,( a. Ntl in the
Social Security No. 18'-( - '2. c.o - '-f l.o S- s;-- Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
y our petitioner~, who isf$e 18 years of age or older an the execut.- i)(
in the last will of the above decedent, dated r'-<. 1'1 I,f"
and codicil(s) dated
named
-f9: .;uy~
,-
(state relevant circumstances, e.g. renunciation, death of execUtor, etc.)
c ~ ~ "'" <Lr I a. ~ County, Pennsylvania, with
Co 2...'l?C L<.\....\'s;(e p,'kJL l-..ot loe
)
I\\.~ L i-.a. ",l <:...$ licl s-o
Decendent, then <:0 t.f years of age, died D €. ~ . , +9 ~ ,
at lc'1..-8'O C.o r I," P,' Lei I t9-0 "'^- Ci!..: -' ~ "A
Except as follows, decedent did not marry, was not divorced and did not have a child born 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
situated as follows:
$ .J i.f. $-Oc,. (p
,
$
$
$
WHEREFORE, petitioner~ respectfully request(s) the probate of the last will -f.tnti-redi~ilW
presented herewith and the grant of letters + -EO 'So +<.\ '^" .e ,,-\ ... .-~
(testamentary; admi IstratlOn c.La.; admInIstratIOn d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA Is'"
COUNTY OF C:L.~~ ~.e... (Cl '" ~ J ~
The petitioner~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 belie of petitioner(sf"and that as personal represen-
tative.(.s1Y of the above decedent petitionerw-wiIl well a d truly administer the estate according to law.
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Sworn to or affirma and subscri d
befOC~~ thiS~ ~~ day
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/9 q - /3 Register
;10-
No.
21-01-24
Estate of
L cJJ's;. 4. Le -eeL
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
Zoo;
AND NOW :Jd-'llM-Q..r-y 5th ~~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument~' dated ..r;.d..., {~ 2.&e--c
described therein be admitted to probate and filed of record as the last will of i.. () ,<r IJ. Leetl
and Letters -,- e s+tl ~""'-A +a I' r
are hereby granted to ;(, ~ :r, c:;'./I au 7 '-
7m(j e
ATTORNEY (Sup, Ct. LD, No.)
H. 'B r~ '-'-~ 05
AI. H"'......ove. ,")t. C"'-r{'-J(~
ADDRESS p/f 170)3
"7f,' 2-'fJ- '-I)'" 7'f
PHONE
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FEES
Probate, Letters, Etc. ......... $ 60. 00
Short Certificates(5) . . . . . . . . .. $ 24.00
~ ~~'IJ~..t\. :P.GS. ~. .. $ 6.00
JCP $ 5.00
TOTAL _ $ 95.00
Filed . J ~ll~X .? ,. .~ Q9 ~. . . . . . . . . . . . . . . .
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CALLED ATTORNEY JANUARY 5, 2001
1110':;)W'i l{FV 'J/H(,
21-01-24
Th is is to certif) that the information here given is correctly copied from an original certitlcate of death duly filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Oftlce for permanent filing.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
No.
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t1105 143 Rev 2187
COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT Of HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRINT
'N
PERWANENT
BLACK INK
,.
AGE (l ast Bortnaay) UNDER 1 YEAR
Monaha Oa,..
December 1, 2000
NAME OF DECEDENT If'fSl t.ttdOle, Las,
OA1 E Of OEATH ,Mcrnh. Oa." '''&atl
BIRTHPlACE le".,..v.d
5lBle 01 fCfe'9f1 Count/vI
.
COUNTY OF DEATH
64 v"
Harrisburg, Pa.
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RA.CE ,Al'l'I.ncan India", 8taCk, Whit..~.
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SUflVIVfNG SPOUSE
(II....... ~mMl<<loamel
OECEOENl'S USUAL OCCUPATION:
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Secretary
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FATHER'S NAME (Fif$!. MllJdllt, LaSl)
6280 Carlisle Pike Lot 100
Mechanicsburg, Pa 17050
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Mina
Cumberland _,,1 17..0 ~=.:::..
MOTHER'S NAME jh:;e. WIdale. MalCjen SurflilfT18)
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'fWfOAMANT'S NAME (T ypeo'Prinl)
Harry A. Roat
Kim I Gillaugh
~~"omSlal.O
Conolite Crematory
NAME AND ADDRESSOF FACilITY
Schaefferstown, Pa. 17088
22c.
liCENSE NUMBER
....
TIME OF DEATH
DATE PRONouNCED DEADlMO{J{fJ, Day. Yea1J
DATE SKiNEO
~.Day.'lNI1
2lb. 23c:,
Wt.S CASE REFERRED TO MeOfCAl EXAMINERlCQRONER?
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2.. 7:30 P.M. .. 25. December 1,2000
27. PART I: Enl""'" diMUtlS. IOIUties Of compItcallOftS, which caused the death 00 not llol.' lhe mol:MI 01 dying, such is cardia.:: or 'Upifalory a".sl. Shoc;:kOf tMlart la.....
1I1l ontt ON Cill.ISII on .acf'lIfMl
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OUElOtOAAS CONSEOUENCEOf)
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PART': Ocher ligltilJcMf ~ CGnfI"OUhng 10 ONlh. buI
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WERE AUTOPSY FINDINGS
AVAIl..A8lE PRtOA TO
COM~ETION OE CAUSE
OF DEATH1
MANNER OF DEATH
DATE Of INJURY
iMonlfl, Day. _all
TIME OF INJUAV
IHJUAV JJ WOrRK1 DESCIU8f HOW INJURY OCCURRED
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Pell<J'ng Inw:5-f'9allOn
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Could noI ~ dehHmlned
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lOCAJION (SIJ_. CItylTo\lllffl StalIilI
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CERTifiER (Ct'eck onl. onel
'CERTlF'tJHG PHYSJClAN IPflySlC....n c...'oIV'''') CdUStl of lk<lU' ...he" .I'''-''I\e, .,IIV""'-"U1 h.ls ~o.-.o"nu~.J ,1~41h ,ll~ cOm~~lOl.,{j 11""" IJt
To ~ beat 01 Ifty know'-du-. dealh o<:cuued dU4110 the caualth) and m.nn.,.. at.tecl.
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. PRONOUNCING AND CERTifYING PHYSICIAN tPhy!.tC1d11 tJOlt1 ;.lICll1o"'->Cln'l <.Ie.!I" .JOld,-e,IlIV,nq IO<';",u~ otde<1/tl1
To the bont 01 mr k.nowte4QfI, d..lh OCC:Ufled ilIl the Urn., 'hlle, .lInd pia!;., and due to the ,auH(a).OO manne,.. "'lIed
'MEDICAl EXAMINER/CORONER
On the b..is ot ..aminaUon andJar in'VesUg<ition, in my OpinIOn, de.lh occurred ill the time, aale, and place. and due to the causeta) and
man"er a. slaleU. .
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21-01-0024
mill
3J Lois A. Leed of 6280 Carlisle Pike, Lot 100, Mechanicsburg, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
3Jtem ~: I direct that all my debts and funeral expenses including my gravemarker shall be
paid from my residuary estate as soon as practicable after my decease as a part ofthe expense of
the administration of my estate.
3Jtem m:wo: I give, devise, and bequeath my entire estate to my children, equally, share and
share alike, per stirpes.
3Jtem m:btte: I appoint my daughter Kim 1. Gillaugh Executrix of this my last will. Should she
fail to qualify or cease to act as Executrix, I appoint my son Carl R. Leed, Jr. of Harrisburg,
Pennsylvania to act as Executor with the same rights, powers, and duties
3Jtem ..four: I appoint my daughter Kim 1. Gillaugh guardian of any property which passes to
any person under the age of 18 years and with respect to which I am authorized to appoint a
guardian and have not otherwise specifically done so. Should she fail or cease to act as
guardian/trustee, I appoint my son Carl R. Leed, Jr. to act with the same rights, powers, and
duties. Guardian shall establish separate guardianship accounts and shall have the power to use
income from time to time for the beneficiary's education, including technical and vocational
training and graduate school, travel, support, and welfare without regard to his or her parent's
ability to provide for such education, travel, support, and welfare, or to make payment for these
purposes, without further responsibility, to the beneficiary or to the beneficiary's parents or to
any person taking care ofthe beneficiary. Guardian shall administer the account until he or she
becomes 18 years of age, at which time the guardian shall transfer the principal and income
remaining in the separate guardianship account to my trustee, being the same person as my
designated guardian, who shall then administer a trust account, of both principal and income and
any other funds transferred to the accounts designated, for the beneficiary's education, including
technical and vocational training and graduate school, travel, support, health, and welfare. When
the guardianship or trust account is less than $5,000.00 or the beneficiary of the separate trust
becomes 21 years of age, the share of the beneficiary remaining in the account shall be paid to
the beneficiary in full and the guardianship or trust terminated. In the event of the death of any
beneficiary after my decease and prior to reaching the age 01'21 years, his or her share shall be
distributed equally among his or her children, equally; otherwise to my surviving children or
child to be administered in accordance with the guardianship and/or trust provisions. No interest
under this instrument shall be transferable or assignable by any beneficiary, or be subject during
its life to the claims of creditors. Guardian and trustee shall not be required to file accountings
with any court. In the event that any provision of this will shall be interpreted to violate the Rule
against Perpetuities, then the remaining provisions ofthis will shall not be invalid. Trustee shall
administer the trust and dispose of assets so as not to violate the rule, making distribution as
required to a life or lives in being plus 21 years.
3Jtem.11tbe: All estate, inheritance, succession, and other taxes, imposed or payable by reason
of my death, and interest and penalties thereon, with respect to all property comprising my gross
estate for tax purposes, whether or not such property passes under this will, shall be paid out of
the principal of my residuary estate, without apportionment or right of reimbursement.
3Jttm ~ix: I direct that my personal representative or guardian shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
3Jtem ~eben: In addition to the rights and powers given to the fiduciaries by law or elsewhere in
this will, I give to my Executrix during the full time necessary and for the administration of my
estate the following rights and powers to be exercised in her sole discretion.
A. To retain any real or personal property which may at any time form a part of my estate so
long as she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
C. To repair, alter, improve or lease for any period of time any real or personal property and
to give options for leases.
D. To sell at public or private sale, for cash or credit, with or without security, to exchange
or to partition, to mortgage or pledge real or personal property, and to give options for
leases.
E. To make distribution in kind.
F. To compromise claims.
IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of July, 2000.
..i!l1ltb ~ ~ A. ~.cL
Lois A. Leed
The preceding instrument, consisting of this and two other typewritten pages each identified by the
signature of the Testatrix was on the day and date thereof signed, published and declared by the
Testatrix therein named as and for her last will, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed ~..n. am. . es.
..^..~~
'-I ry ~
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We John H. Broujos and J 0 yS'f e -f'-fy , witnesses whose names are signed to the
attached or foregoing instrument being duly qualified according to law, do depose and say that we
were present and saw the Testatrix sign and execute the instrument as her last will; that she signed
willingly and executed it as her free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our
knowledge, the Testatrix was at the time 18 or more years of age, sound mind and under no
constraint or undue influence.
S worn and subscribed to before
me t is 18th day of July, 2000.
~
uu- CA..AA-
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Bore, Cumberland County
My Commission Expires June 10, 2002
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I Lois A. Leed whose name is signed to the attached document, having been duly qualified
according to law, do hereby acknowledge that I signed and executed the instrument as my last will;
that I signed it as my free and voluntary act for the purposes therein expressed.
qo-t-:O II. ~R-~~
Lois A. Leed, Testatrix
Sworn and affirmed to and
acknowledged before me
this 18th day of July, 2000.
i.A~ ~O~~ ~ & CA-rCv.JJ
NCYfARYPUBLlC
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10, 2002
, IN THE CmCUlT COURT OF
CUMBERLAND COUNTY
PROBATE DMSION
21-01-24
FILE NO.
INRE: ESTATE OF:
LOIS A LEED
12/1/00
DECEASED
STATEMENT OF CLAIM
The undersigned hereby presents for filing against the above estate this statement of
claim and alleges:
1. The basis of the claim is VISA Account #
~astercard # 4118-1603-0651-4335
2. The name and address of claimant is: The First National Bank of Atlanta
dba Wachovia Bank Card Services
fka First Atlanta, NA
POBox 14009
Atlanta, GA 30324
And the name and address ofthe claimant's agent or attorney, if any, are set forth
below.
3. The amount of the claim is $ 1 ,838.57
which is now due and owing, or, if not due, will become due on NOW
4. The Claim D..n..oi contingent.
5. The Claim D..n..oi secured.
Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged
are true, to the best of my knowledge and belief.
~_. 2001
WACHOVIA BANK CARD SVCS
CLAIMANT
THE FmST NATIONAL BANK OF ATLANTA
dba W ACHOVIA BANK CARD SERVICES
fka FIRST ATLANTA, NA
POBox 14009
Atlanta, GA 30324
1-888-222-4886 Ext. 3492
COPY MAILED TO PERSONAL
REPRESENTATIVE ON
19_
CLERK OF THE CmCUlT COURT
BY
7~
otary P IC
4/13/01
'"
Date
Wft-CHOVIA
Wachovia Bank Card Services
Post Offiee Box 14009
Atlanta, Georgia ;~0324
QB01 QBPT01M
CORP: 01 ACCT: 411816
CYC: 00 GRP: CRD1:
M/R: B/R: B6 CRD2:
NAME: LOIS A LEED
STM1: 6280 CARLISLE PIKE
STM2:
CITY: MECHANICSBURG
ST..: PA ZIP: 17055
CD-----REFERENCE NBR------
STATEMENT INQUIRY SCREEN 09:57:25 04/16/01 ASF:
0306514335 PRODUCT: CXX XXX NO CURR ITEMS FOR ACCT
5467 1003 0651 4335 CRED LMT: 6400 CLOSE: BILL 14
INSRT: DUE: 041701
BBAL: 1838 . 57 F / CHG. : 20 . 17
PUR.: 0.00 LATE..: 0.00
CASH: 0.00 CL INS: 0.00
PMTS: 0.00 BALANC: 1838.57
CRED: 0.00 MIN PY: 72.00
POST TRAN -------DESCRIPTION------- -----AMOUNT-----
Family Settlement Agreement
THIS is an Agreement entered into this ~3 ,-.:!day of August, 2002, by and between Kim 1.
Gillaugh, Executrix and Beneficiary under the estate of Lois A. Leed, of28 Cumberland Drive,
Mechanicsburg, P A 17050, (Executrix), and the following Beneficiaries: Carl R. Leed, Jr., of
4015 Rawleigh Street, Harrisburg, PA 17109, Alan V. Leed (noaddress) c/o Kim 1. Gillaugh, 28
Cumberland Drive, Mechanicsburg, P A 17050, Thomas R. Leed, 2101 Hill Road, Apt. E-21,
Sellersville, P A 18960, whose names are set forth as signatories at the end of this Agreement.
WHEREAS:
A. Lois A. Leed, of 6280 Carlisle Pike, Lot 100, Mechanicsburg, P A 17050, died on
December 1,2000.
B. On January 5, 2001, Letters Testamentary were granted to Kim 1. Gillaugh at File No. 21-
01-0024 in the Register of Wills Office for Cumberland County, Pennsylvania.
C. Executrix has administered the Estate of Lois A. Leed, up until the present time and has
paid all debts of the estate, including Inheritance Tax owed.
D. Lois A. Leed died testate, thereby vesting all rights and interest in her personal and real
property to her children whose names are set forth as signatories at the end of this Agreement.
E. The Estate of Lois A. Leed has received assets as set forth in Exhibit A attached hereto
and made a part hereof; has paid debts and expenses as set forth in Exhibit B attached hereto and
made a part hereof; and has made distributions as set forth in Exhibit C attached hereto and made
a part hereof.
F. There remains to be distributed to beneficiaries the assets as set forth in the Schedule of
Distribution in Exhibit C.
G. Executrix and Beneficiaries desire to forego a formal accounting and schedule of
distribution and desire to conclude the estate by virtue of the filing of this document.
NOW, THEREFORE, Executrix and Beneficiaries intending to be legally bound, state as
follows:
1. The Executrix and Beneficiaries agree that the Executrix of the Estate of Lois A. Leed
need not file a formal accounting or schedule of distribution.
2. Executrix states that all costs of the estate are paid.
3. Beneficiaries agree that the final distribution of all estate assets remaining after payment
of debts and expenses shall be made to the Beneficiaries.
4. The parties acknowledge that any distribution made by Executrix pursuant to this
Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release
Executrix with respect to acts or omissions in the administration and distribution of the estate
and hereby agree to return such funds as were distributed under the administration of the estate
as may be required for the payment of any proper claims not discharged prior to this distribution.
5. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
6. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Lois A. Leed, subject to the provisions hereof.
7. Beneficiary Alan V. Leed cannot be located. Attempts have been made to get an address
to request signing ofthe Family Settlement Agreement and to receive distribution. The
Agreement has been signed by all parties except Alan. His distribution is being placed in an
account in the name of Kim I. Gillaugh for Alan V. Leed, for convenience of control and
accounting.
IN WITNESS WHEREOF, Kim I. Gillaugh, Executrix, and Beneficiaries, intending to be legally
bound hereby set their hands and seals the day and year first above written.
~~c->-o~
~
WITNESS:
Kim I. Gillaugh, Executrix and Benefici
Carl R. Leed, Jr., Beneficiary
Thomas R. Leed, Beneficiary
1J. ~ d
( (U/l If €P(0)?# 'fl1
Alan V. Leed, Beneficiary
.Y~
4. The parties acknowledge that any distribution made by Executrix pursuant to this
Agreement is an "at risk" distribution pursuant to 20 P .S. 3532. Beneficiaries hereby release
Executrix with respect to acts or omissions in the administration and distribution of the estate
and hereby agree to return such funds as were distributed under the administration of the estate
as may be required for the payment of any proper claims not discharged prior to this distribution.
. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and
direct the Clerk of Orphans' Court to make satisfied of record any award which may
subsequently be made by the Court with respect to the distribution made to the distributees in
this Agreement.
6. The parties agree that this Family Settlement Agreement shall be filed with the Clerk of
Orphans' Court in final settlement of the Estate of Lois A. Leed, subject to the provisions hereof.
7. Beneficiary Alan V. Leed cannot be located. Attempts have been made to get an address
to request signing of the Family Settlement Agreement and to receive distribution. The
Agreement has been signed by all parties except Alan. His distribution is being placed in an
account in the name of Kim I. Gillaugh for Alan V. Leed, for convenience of control and
accounting.
IN WITNESS WHEREOF, Kim 1. Gillaugh, Executrix, and Beneficiaries, intending to be legally
bound hereby set their hands and seals the day and year first above written.
WITNESS:
Kim I. Gillaugh, Executrix and Beneficiary
W R LQ~
Carl R. Leed, Jr., Beneficiary
Thomas R. Leed, Beneficiary
Alan V. Leed, Beneficiary
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Exhibit A
ASSETS
Series EE US Savings Bonds:
Serial No. L524963638EE,issued 10/95, matures 10/2025
Serial No. L545222850EE, issued 2/96, matures 2/2026
Serial No. C585765111 EE, issued 11/96, matures 11/2026
$ 31.20
30.42
59.64
Susquehanna Valley FCU checking acct/member #8251
473.85
Susquehanna Valley FCU savings acct/member #8251
2,938.76
1987 Skyline Mobile Home 14' x 66'. VIN 1A111062W
14,500.00
900.75
Household Furnishings
Veterans Life Insurance Company - refund of premium
23.82
Cumberland Valley School District - OCC refund
85.26
Federal income tax refund
244.95
Tax refund
28.00
12.6.00 deposit unidentified
105.28
11.
Interest - checking/savings account
27.87
$ 19,449.80
. TOTAL
INCOME
1.
Checking account dividends
43.97
2.
Dividend on 3 savings bonds
4.04
TOTAL ASSETS AND INCOME
$ 19,497.81
Exhibit B
EXPENSES
A. FUNERAL EXPENSES - paid by insurance
B.
C.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ADMINISTRATIVE COSTS:
1. Personal Representative Commissions - Kim I. Gillaugh
2. Attorney Fees - Broujos & Gilroy, P.C.
3. Probate Fees - Register of Wills, Cumberland County
$ 1,000.00
1,000.00
95.00
MISCELLANEOUS EXPENSES:
1. Register of Wills - Inheritance Tax Return
2. Register of Wills - Inventory
3. Register of Wills - Family Settlement Agreement 17.00
15.00
10.00
Amerigas - propane
Com cast - cable
Verizon - phone
AT&T - phone
Foremost - fire insurance
467.00
45.49
42.61
109.04
115.80
Salem Acres - lot rent until mobile home was sold
Wachovia - credit card
Chase - payment on mobile home
PP&L - electricity
Lowe's - credit card
Prudential - life insurance premium
2,925.00
140.00
787.05
131.05
110.00
23.85
7,033.89
533.72
Inheritance Tax ($558.72 less $25 discount)
$ 7,567.61
TOTAL EXPENSES
Exhibit C
DISTRIBUTION
ASSETS AND INCOME
$ 19,497.81
EXPENSES
- 7567.61
BALANCE
$ 11,930.20
ADVANCE DISTRIBUTION ON 12120/01
Carl R. Leed, Jr.
Kim I. Gillaugh for Alan V. Leed (in a CD)
($900 deducted for his expenses paid from estate)
Thomas R. Leed
Kim I. Gillaugh
$3,000
2,100
3,000
3.000
- 11.100.00
ASSETS MINUS EXPENSES AND ADVANCE DISTRIBUTION
$ 830.20
ADJUSTMENT
2.992.45
BALANCE FOR DISTRIBUTION
$ 3,822.65
FINAL DISTRIBUTION:
Carl R. Leed, Jr.
Kim I. Gillaugh for Alan V. Leed (in a CD)
Thomas R. Leed
Kim I. Gillaugh
$ 955.66
955.66
955.66
955.67
-0-
f-
---
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Lois A. Leed
Date of Death: December 1,2000
Will No.:
Admin. No.: 21-01-0024
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) ofthe Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
February 28,2001:
Name
Address
Carl R. Leed, Jr.
Alan V. Leed
Thomas R. Leed
Kim 1. Gillaugh
4015 Raleigh Street, Harrisburg, P A 17109
6280 Carlisle Pike, Lot 100, Mechanicsburg, P A 17050
2010 Hill Road, Apt. E-21 ,Sellersville, P A 18960
28 Cumberland Drive, Mechanicsburg, P A 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: February 28,2001
~ 0>. ~CD
Kim 1. Gillaugh, personal~ative
28 Cumberland Drive
Mechanicsburg, P A 17050
(717) 766-3321
Counsel for Personal Representative:
John H. Broujos, Esquire #06268
Broujos & Gilroy, P.C.
4 North Hanover Street
Carlisle, P A 17013
(717) 243-4574
t
v
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Lois A. Leed
Date of Death: 12-01-00
Will No.
Admin. No.
21-01-0024
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. lfthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account/statement 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 X No
d.
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be
attached to this report.
dJ) ~~
Signature
Date:
%-i:?~Oz-
Kim 1. Gillaugh, Executrix
28 Cumberland Drive
Mechanicsburg, P A 17050
Capacity:
X Personal Representative
Counsel for Personal
Representative
/t,.-/ 99 - /3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
c/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 EX iFP ni-OOl
fiec...
Re;:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
02-04-2002
LEED
12-01-2000
21 01-0024
LOIS
A
'02 FEB 13 :48 COUNTY CUMBERLAND
JOHN H BROUJOS ESQ ACN 101
BROUJOS & GILROY . , I Allount Rellitted I
4 N HANOVER ST lJiSiI.
CARLISLE PA Ct~TI~'3
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=i547-Ex-AFP--fi'2=ooY-NoYicE--oF-INHERiTANci-YAx-APPRAisEMENT-,--ALi-oWANCi-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEED LOIS A FILE NO. 21 01-0024 ACN 101 DATE 02-04-2002
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) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 121.26 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your
S. Cash/Bank Deposits/Misc. Personal Property [Schedule E) (5) 19,328.54 tax paYllent.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 19,449.80
APPROVED DEDUCTIONS AND EXEMPTIONS: 2,137.00
9. Funeral Expenses/Adll. Costs/Misc. Expenses [Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 4.896.89
U. Total Deductions (11) 7.033 89
12. Net Value of Tax Return (12) 12,415.91
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 12,415.91
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate US) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (6) 12,415.91 X 045 = 558.72
17. Allount of Line 14 at Sibling rate (17J .00 X 12 = .00
18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 558.72
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-01-2001 AA478094 26.32 500.00
12-20-2001 CDOO0671 .88- 33.72
TOTAL TAX CREDIT 559.16
BALANCE OF TAX DUE .44CR
INTEREST AND PEN. .00
TOTAL DUE .44CR
9( IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, 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.)
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