HomeMy WebLinkAbout01-0050
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
PETITION FOR GRANT OF LETTERS
Estate of MYRTLE E. HERMAN
No.
21-01-51
also known as
, Deceased
Social Security No 207-24-6255
Hew', r\l V\/illiams
Pelij';;;,er(s~~ho isal~ 18 years; of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
[J
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut.9..!:.-_ named in the Last Will of the
Decedent, dated 4/22/94 and codicil(s) dated
Renunciation of Co-Executors M. Elizabeth Babinchak and David R. Williams
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:
o
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(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 Messiah Village, !Jpper Allen Township
Decedent, then 82
(list street, number and municipality)
years of age, died December 20 ,2000, at Messiah Village, Upper Allen Township, Cumberland Co
(Location)
Decedent 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 ...............
Total............ ................... ................
157,000.00
$
$
$
$
$
157,000.00
Real Estate situated as follows:
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:
Typed or printed name and residence
Hen N. Williams
1029 Fox Hollow Road, Shermans Dale, PA 17090
/6 - .;2 C) / - / J
Oath of Personal Representative
Commonwealth of Pennsylvania
County of
The Petitioner(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 estate according to law.
./;)/ h C /' .-
Sworn to and affirmed and subscr:bed /Y>(l7C\'J.-JA,/' ( LIA_,L,,/./~A/r-Y?-Q _/
before me this 10 . day of
JANUARY 2001
,
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DECREE OF REGISTER
Estate of MYRTLE E. HERMAN
Deceased
No.
2101-51
also known as
Social Security No:207-24-6255 Date of Death: 12-20-2000
AND NOW, JANUARY 10 2001 ,in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that LettersB Testamentary 0 of Administration
((c.I.a.. d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
are hereby granted to
HENRY N WILLIAMS
in the above estate and that the instrument(s), if any, dater! APRIL 22. 1994
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters ..... ......... ...... ........... ..... $
235.00
>;:VLLL/ (:. J~~';' //}//J~;r / k2/v d Y
.~/ Regis~ef of Wills .
Short Certificates(s) ...............
$
Renunciation .......................... $
$
$
$'
$
$
$
30.00
5.00
Extra Pages (
) ...............
12.00
I.T.R.......................................
Signature
JCP Fee .................................
5.00
Inventory .. ...... ....... .................
Other ..... ....................... ..... .....
17068
TOTAL..................... .......$
287.00
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
4755828
12-21-2000
21-01-51
Myrtle
E .
Herman
Female
207...24-6255
12-20-2000
April 15, 1918
Palmerton, PA
Messiah Village Cumberland
Upper Allen Twp.
White Teller
No
Widow
P.O. Box 2015
Mechanicsburg PA 17055
Henry N. Williams
James F. Nickel
Nickel Funeral Home, Loysville, PA 17047
CAD
CHF
xx
L. Zimmerman
M . D .
Lemoyne, PA 17043
12-21-2000
tl~?zo tJ. dn-e_~ 50-455
101 Barnett St., New Bloomfield, PA 17068
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RENUNCIA TION
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Estate of ivtyrtle E. Hel1l1an
-r~TO"-'''''-_.-'---- -.---,..--...---.---.......---
N 21-01-51
O. _____~.________
also known as
_......- I Deceased
II
The undersigned, M. Elizabeth Babinchak and David R. WiHiwllS, children
(Relatlonshlp) (Capacity)
. of
the above Decendentl hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters Testamentary ._________ be Issued to H\'fU)' N, williams _..._.___.___
. -fh
hand thiS 1 '7 day of December ,2000.
,~fL~(drcA B~'LQL ~_~_
{ i) (SIgnature)
253 WiM Road
Etters, PA 17319
Witness our
(Address)
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Cjl:t:11. cL. ~/~-./"''''~
(Signatu(8)
809 Parsonage Hill
Somerville. NJ 08876
(Address)
(Signature)
(AddTe.$s)
Sworn to or affirmed and subscribed
-:'\ l -+ /)
before me this 0\ day of
~ \ _ \ 2rvY\
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l_ (/~.~VJ'/i/;;;#ZffQ._
/Nbtary Public
My Commission Expires Notarial Seal
Joanne R. Nemeth, Notary Public
LowerTowamensing Twp.. Carbon County
My Commission Expires Oct. 11. 2004
Member, Pennsylvania AssOCiation. atNotaries . .
(Signature and &Gal of Notary or other NUTt::u. ttenunciations executed outside the Office of Register of Wilts are
OffiCial qualified to Bdmini$ter ~tI15. Show required In some counties to be notarized.
date of expIration of Notary', oommi5$iol1.)
RW-'3
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21-01-51
LAST WIl,l, AND TESTAMENT
OF
MYRTlLE Eo HERMAN
I, MYRTLE E. HERMAN, presently residing at 505 Princeton Avenue, Palmerton,
Carbon County, Pennsylvania 18071, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and
Testament, hereby revoking any and all wills and other documents of a testamentary nature
heretofore made by me.
ARTICLE I
Payment of Debts
I direct that all of my just debts and expenses of my last illness and funeral be paid
from my estate as soon as practicable after my decease.
ARTICLE II
Gift of Residue
All the rest, residue and remainder of my estate, of whatsoever kind or nature and
wheresoever situated, of which I may die seized, possessed or entitled to, I give, devise and
bequeath in equal shares, share and share alike, to my children, HENRY N. WILLIAMS, M.
ELIZABETH BABINCHAK and DAVID R. WILLIAMS, and to my stepdaughter, JANE MAE
DONCHEZ, to have and to hold the same absolutely, per stirpes and not per capita.
ARTICLE III
Appointment of Fiduciaries
I nominate, constitute and appoint my children, HENRY N. WILLIAMS, M.
ELIZABETH BABINCHAK and DAVID. R. WILLIAMS, as Co-Executors of this my Last Will
and Testament and also as Trustee of all trusts created hereunder. In the event that any of
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them shall fail to qualify or cease to act, then I direct that the survivors shall continue to act
without the necessity of appointment of a substitute.
ARTICLE IV
Management Powers
My Executors and Trustees and their successors shall have the following powers in
addition to those vested in them by law, without the necessity of judicial authorization or
approval, and effective until distribution of all property:
(a) To retain any and all assets of my estate, real or personal;
(b) To invest in such securities (including common and preferred stocks), common
trust funds, real estate, and other property as they may deem prudent, without restriction
to so-called legal investments.
(c) To vote in person or by proxy all stocks or other securities, and in connection
therewith, to delegate discretionary powers; to participate in any reorganization,
consolidation, or merger of any corporation; to deposit securities under protective
agreements or with protective committees; and to receive securities issued as a result of such
proceedings;
(d) To compromise claims by or against me or my estate;
( e) To sell real and personal property at public or private sale, for cash or credit or
both and to lease or mortgage such property for any period of time;
(f) To distribute in cash or in kind, or partly in each;
(g) To borrow money and to mortgage or pledge any real or personal property for
any purpose;
(h) To exercise any law-given option to treat administrative expenses either as income
tax or as estate tax deductions, without regard to whether the expenses were paid from
principal or income, and without requiring reimbursement among beneficiaries affected,
provided, however, that no decisions under this paragraph shall be made by any executor
having any direct or indirect beneficial interest in the allocation of such expenses as income
tax or as estate tax deductions.
(i) To execute and deliver all instruments of writing necessary or appropriate for the
exercise of any of their powers and to do all other acts in their judgment necessary or
desirable for the proper management, investment and distribution of my estate, including
the retention and compensation of consultants, advisers, accountants and attorneys.
2
'..
ARTICLE V
Trust Provisions for Beneficiaries Under Twenty-One
In the event that any property, real or personal, shall vest in absolute ownership in any
beneficiary before such beneficiary has attained the age of twenty-one (21) years, I direct
that my Trustee shall hold such property in trust in a separate fund, and invest and reinvest
the same and distnbute the principal and income therefrom, as follows:
1. As much of such income or principal, or both, as my Trustee may from time to
time think necessary for the maintenance, support and education of such beneficiary, or to
enable such beneficiary to purchase a home or become established in a business, trade or
profession. Such payments Inay be Inade to the beneficiary, his or her duly appointed
guardian, or to any person or organization caring for such beneficiary.
2. All remaining principal and undistributed income shall be paid to such beneficiary
upon his or her attaining the age of twenty-one (21) years.
3. If any beneficiary should die without issue before attaining the age of entitlement,
then such share shall be divided amongst my surviving beneficiaries in equal shares.
4. My hereinafter named Trustee, in full discharge of her duties hereunder, may
nevertheless pay such fund to the parent, person or organization charged with the care of
such beneficiary, and the receipt to my Trustee for such payment shall be the complete
release therefor.
5. Notwithstanding the foregoing, however, my hereinafter named Trustee shall have
the power to retain in trust the share of any beneficiary who, in her absolute opinion, is
incapable of managing suqh share by reason of age, illness, mental infirmity, drug or alcohol
dependence or other cause.
ARTICLE VI
Spendthrift Prvvisions
I direct that all legacies and all shares and interests in my estate, whether principal
or income, while in the hands of my Executors or Trustees, shall not be subject to any debt,
contract, obligation or liability of any beneficiary and shall not be subject to pledge,
assignment, conveyance or anticipation.
ARTICLE VII
Waiver of Security
I direct that my fiduciaries shall not be required to furnish bond or enter surety for
3
....
the faithful performance of their duties in any jurisdiction in which they may act or in any
capacity in which they may act.
ARTICLE VIII
Tax Clause
All federal, state and other taxes payable because of my death with respect to the
property forming my gross estate for tax purposes, including any interest or penalty imposed
in connection with such tax, shall be considered a part of the expense of the administration
of my estate and shall be paid out" of the residue thereof without contnbution by or
apportionment among my beneficiaries.
IN WITNESS WHEREOF, I have hereunto set my hand and seal" to this my Last Will
and Testament, which consists of four (4) typewritten pages, this R'?II/day of April, 1994.
7Jt~ &0, 2l~~ (SEAL)
Myrtle E. Herman
The writing contained in this and the preceding three (3) pages
was signed and sealed by the above named MYRTLE E.
HERMAN, Testatrix named therein, and by her published and
declared as and for her Last Will and Testament, in the
presence of us who have hereunto subscnbed our names as
witnesses at her request and in her presence and in the
presence of each other.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CARBON
I, MYRTLE E. HERMAN, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I have signed and
executed the instrument as my Last Will and Testament; that I signed same willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
SWORN TO and acknowledged before me by MYRTLE E. HERMAN, the above-named
.Testatrix, this o<?;?tt/day of April, 1994.
r~Xb_ ~ ;JeA~
/ yrtle E. Herman .
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DfNlSF l<. ,~;;;.i:LL. t.;ntary Public
Palmf!!tofi Bora, ;:arl:Jon County, PA
My Commis')ion Expjre<.; March ~. 1.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CARBON
We, Steven J. Hartz and Joyce Ricciardi , the witnesses whose
'names are subscribed to the foregoing instrument, being duly sworn according to law, do
depose and say that they were present and saw the Testatrix, MYRTLE E. HERMAN, sign and
execute the instrument as her Last Will and Testament; that she signed same willingly and
that she 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 that time eighteen (18) years of age or more,
of sound mind and under no constraint or undue influence.
SWORN TO and subscribed before me this ~C:<l1lday of April, 1994.
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My Comml~:;lon c:.~!~:~~~~~~~, 1998 i
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CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Myrtle E. Herman
Date of Death: December 20, 2000
File No. 2001-00051
PA File No. 21-01-0051
To the Register:
I certify that notice of beneficial interest 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
January 30, 2001.
NAME
ADDRESS
Henry N. Williams
1029 Fox Hollow Road
Shermans Dale, PA 17090
M. Elizabeth Babinchak
253 Willis Road
Etters, PA 17319
David R. Williams
809 Parsonage Hill
Somerville, NJ 08876
Jane Mae Donchez
42 Sierra Trails
East Stroudsburg, PA 18301
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except,
N/A
DATE: '/30/DI
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P.O. ox 250
217 S. Carlisle Street
New Bloomfield, PA 17068
Telephone: 717-582-7313
Capacity:
Personal Representative
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Counsel for Personal Representative
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 280601
HARRISBURG, PA 17128-0601
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FILE NUMBER
2 1 -0 1 0 0 5 1
'"'C'OUNTYCOOE --YEAr- - - NuMiiER--
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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HERMAN MYRTLE E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
12/20/2000 04/15/1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
2 07- 2 4 - 6 2 5 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
2 07- 2 4 - 6 255
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IX] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AttachcopyofW~I)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death aller 12.12-82)
o 7. Decedent Maintained a Living Trust (AttachcOllyofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1.95)
o 3. Remainder Return (dateofdeatllpriorto12-13-82)
o 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113{A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
KATHY A. MORROW ESQ, P.O. BOX 250
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717-582-7313
NEW BLOOMFIELD
OFFICIAL USE ONLY
(1 )
(2)
(3)
(4)
(5)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
PA 17068
40,898.69
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Sche,<fuieJ]
91,533.80
19,596.14
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 See. 9116 (a)(1.2)
19. Tax Due
X _(15)
141,247.60 X .045 (16)
X .12 (17)
X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(8)
'152,028.63
8,882.04
1,898.99
(11 )
(12)
(13)
10,781.03
141,247.60
(14)
141 ,247.60
6,356.14
6,356.14
u~s~r ~wl~LL AJID TESTAMENT
OF
.fo/fYR TLE Eo JHDERMAN
I, MYRTLE E. HERIYIAN~ presently residing at 505 Princeton Avenue, Palmerton,
Carbon County, Pennsylvania 18071, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and
Testament, hereby revoking an)' ,md all wills and other documents of a testamentary nature
heretofore made by me.
ARTICLE I
Payment of Debts
I direct that all of my just debts and expenses of my last illness and funeral be paid
from nlY estate as soon as practicabk after my decease.
ARTICLE II
Gift of Residue
All the rest, residue and r~mainder of my estate, of whatsoever kind or nature and
wheresoever situated, of whjch r may die seized, possessed or entitled to, I give, devise and
bequeath in equal shares, share and share alike, to my children, HENRY N. WILLIAMS, M.
ELIZABETH BABINCHAK and DAVID R. WILLIAMS, and to my stepdaughter, JANE MAE
DONCHEZ, to have and to hold the same absolutely, per stirpes and not per capita.
ARTICLE III
Appointment of Fiduciaries
I nominate, constitute and appoint my children, HENRY N. WILLIAMS, M.
ELIZABETH BABINCHAK and DAVID. R. WILLIAMS, as Co-Executors of this my Last Will
and Testament and c~lso as Trustee of all trusts created hereunder. In the event that any of
them shall fail to qualify or cease to act, then I direct that the survivors shall continue to act
without the necessity of appointment of a substitute.
ARTICLE IV
Management Powers
My Executors and Trustees anod their successors shall have the following powers in
addition to those vested in them by law, without the necessity of judicial authorizati~n or
approval, and effective until distnbution of all property:
(a) To retain any and all assets of my estate, real or personal;
(b) To invest in such securities (including common and preferred stocks), common
trust funds, real estate, and other property as they may deem prudent, without restriction
to so-called legal investments.
(c) To vote in person or by proxy all stocks or other securities, and in connection
therewith, to delegate discretionary powers; to participate in any reorganization,
consolidation, or merger of any corporation; to deposit securities under protective
agreements or with protective committees; and to receive securities issued as a result of such
proceedings;
(d) To compromise claims by or against me or my estate;
(e) To sell real and personal property at public or private sale, for cash or credit or
both and to lease or mortgage such property for any period of time;
(f) To distnbute in cash or in kind, or partly in each;
(g) To borrow money and to mortgage or pledge any real or personal property for
any purpose;
(h) To exercise any law-given option to treat administrative expenses either as income
tax or as estate tax deductions, without regard to whether the expenses were paid from
principal or income, and without requiring reimbursement among beneficiaries affected,
provided, however, that no decisions under this paragraph shall be made by any executor
having any direct or indirect beneficial interest in the allocation of such expenses as income
tax or as estate tax deductions.
(i) To execute and deliver all instruments of writing necessary or appropriate for the
exercise of any of their powers and to do all other acts in their judgment necessary or
desirable for the proper management, investment and distnbution of my estate, including
the retention and compensation of consultants, advisers, accountants and attorneys.
2
ARTICLE V
Trust Provisions for Beneficiaries Under Twenty-One
In the event that any property, real or personal, shall vest in absolute ownership in any
beneficiary before such beneficiary has attained the age of twenty-one (21) years, I direct
that my Trustee shall hold such property in trust in a separate fund, and invest and reinvest
the same and distnbute the principal and income therefrom, as follows:
1. As much of such income or principal, or both, as my Trustee may from time to
time think necessary for the maintenance, support and education of such beneficiary, or to
enable such beneficiary to purchase a: home or become established in a business, trade or
profession. Such payments may be made to the beneficiary, his or her duly appointed
guardian, or to any person or organization caring for such beneficiary.
2. All remaining principal and undistnbuted income shall be paid to such beneficiary
upon his or her attaining the age of twenty-one (21) years.
3. If any beneficiary should die without issue before attaining the age of entitlement,
then such share shall be divided amongst my surviving beneficiaries in equal shares.
4. My hereinafter named Trustee, in full discharge of her duties hereunder, may
nevertheless pay such fund to the parent, person or organization charged with the care of
such beneficiary, and the receipt to my Trustee for such payment shall be the complete
release therefor.
5. Notwithstanding the foregoing, however, my hereinafter named Trustee shall have
the power to retain in trust the share of any beneficiary who, in her absolute opinion, is
incapable of managing sUGh share by reason of age, illness, mental infirmity, drug or alcohol
dependence or other cause.
ARTICLE VI
Spendthrift Provisions
I direct that all legacies and all shares and interests in my estate, whether principal
or income, while in the hands of my Executors or Trustees, shall not be subject to any debt,
contract, obligation or liability of any beneficiary and shall not be subject to pledge,
assignment, conveyance or anticipation.
ARTICLE VII
Waiver of Security
I direct that my fiduciaries shall not be required to furnish bond or enter surety for
3
the faithful performance of their duties in any jurisdiction in which they may act or in any
capacity in which they may act.
ARTICLE VIII
Tax Clause
All federal, state and other taxes payable because of my death with respect to the
property forming my gross estate for tax purposes, including any interest or penalty imposed
in connection with such tax, shall be considered a part of the expense of the administration
of my estate and shall be paid out" of the residue thereof without contnbution by or
apportionment among my beneficiaries.
IN WITNESS WHEREOF, I have hereunto set my hand and seal" to this my Last Will
and Testament, which consists of four (4) typewritten pages, this R.?/I/day of April, 1994.
7tT+l,~ G. )L/YV'fi/'v'./ (SEAL)
Myrtle E. Herman
The writing contained in this and the preceding three (3) pages
was signed and sealed by the above named MYRTLE E.
HERMAN, Testatrix named therein, and by her published and
declared as and for her Last Will and Testament, in the
presence of us who have hereunto subscnbed our names as
witnesses at her request and in her presence and in the
presence of each other.
~~~r--J~
PJ~, 1/1- /crcJ7/
I
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4
COMMONWEALTH OF PENNSYLVANIA:
COUN1Y OF CARBON
1, MYRTLE E. HERMAN, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I have signed and
executed the instrument as my Last Will and Testament; that I signed same willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
SWORN TO and acknowledged before me by MYRTLE E. HERMAN, the above-named
Testatrix, this ,;' ~ J{ /day of April, 1994. .
)JJ~
C~tL(V-L6-.t;~II.(~
~
r~er:~r.'~~ S~^l 1
rEN:SE t\ ;'.;;w':iLL, :.;ntary Public I
Palmerton ~'Qi~.: :arbon County, PA
My COmml!')lon t:XP!~es March a 1_ }
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CARBON
We, Steven J. Hartz and Joyce Ricciardi, the witnesses whose
names are subscribed to the foregoing instrument, being duly sworn according to law, do
depose and say that they were present and saw the Testatrix, MYRTLE E. HERMAN, sign and
execute the instrument as her Last Will and Testament; that she signed same willingly and
that she 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 that time eighteen (18) years of age or more,
of sound mind and under no constraint or undue influence.
SWORN TO and subscnbed before me this o?".<~jday of April, 1994.
(' ~~~:--;;I---j-2:
~,/ q .", ....;. "...0,_-
/\
c;4}~(.1AH. \./)O~
NOTARIAL SEAl
DENISE B. AM;U... ~!crary PuOlic
Palm6rton BonJ, Carton Count" PA
My Commi!:::;jon bpi.:1s March ~, 1998
~
COMMONWEALTH OF PENNSYLVANIA
INHERIT ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERMAN MYRTLE E
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE 8
STOCKS & BONDS
FILE NUMBER
21 01
0051
DESCRIPTION
ITEM
NUMBER
1.
P.P.&L.-400 Shares @ 43.65
2
Philadelphia Electric-100 Shares @ 21.75
3.
Lucent Technologies-140 Shares @ 15.5
4.
A.T. & T. 165 shares @ 18.9375
5.
Bell Atlantic (Verizon)-248 Shares @ 50.125
6.
Savings Bond-Series EE-V4700570EE
VALUE AT DATE
OF DEATH
17,460.00
2,175.00
2,170.00
3,124.69
12,431.00
3,538.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
40,898.69
~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T M RETURN
RESIDENT DECEDENT
ESTATE OF
HERMAN MYRTLE E
FILE NUMBER
21 01
0051
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointJy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC BANK-C.D.-#311 0015311 0 5,487.23
2. PNC BANK-C.D. #31000175749 10,559.06
3. PNC BANK-C.D. #31500182859 10,995.36
4. PNC BANK-C.D. #31000195942 18,051.65
5. PNC BANK-C.D. #31600197859 12,256.72
6. PNC BANK-CHECKING ACCT. #5000001612 4,501.27
7. PNC BANK-I.R.A. ACCT. #75500014188 16,396.22
8. KEYSTONE SAVINGS BANK-C.D. #480005266 13,105.09
9. BLUE CROSS/BLUE SHIELD REFUND 81.20
10. PA.DEPT.OFREVENUE 100.00
2001 TAX REFUND
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
91 533.80
erh
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
HERMAN MYRTLE E
FILE NUMBER
21 01
0051
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. HENRY N. WILLIAMS
B BETTY BABINCHAK
c DAVID R. WILLIAMS
1029 Fox Hollow Road,
Shermans Dale, P A 17090
SON
253 Willis Road
Ephrata, P A 17319
DAUGHTER
809 Parsonage Hill
Somerville, NJ 08876
SON
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTSINTERES
1. A. 4/9/99 PNC BANK-C.D. #31900152896 6,035.96 50. 3,017.98
2. B. 5/3/96 ALLFIRST-MONEY MARKET ACCT. #8874085471 2,186.52 50. 1,093.26
3. A. 6/19/95 KEYSTONE SAVINGS BANK-C.D. #480013805 5,318.19 50. 2,659.10
4. B. 6/19/95 KEYSTONE SAVINGS BANK-C.D. #480013813 5,318.19 50. 2,659.10
5. C. 6/19/95 KEYSTONE SAVINGS BANK-C.D. #480013821 5,318.19 50. 2,659.10
6. e '84-'98 VERIZON STOCK-48 Shares @ 50.125 2,406.00 50. 1,203.00
7. A. 2/1995 U.S. SAVINGS BOND 661.20 50. 330.60
M64878598EE
8. A. 2/1995 U.S. SAVINGS BOND 3,306.00 50. 1,653.00
V4636081EE
9. B. 2/1995 U.S. SAVINGS BOND 661.20 50. 330.60
M64878597EE
10. B. 2/1995 U.S. SAVINGS BOND 3,306.00 50. 1,653.00
V4636080EE
TOTAL (Also enter on line 6, Recapitulation) $ 19596.14
T
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
HERMAN, MYRTLE E.
21
01
0051
Paqe 2
Schedule F-2 - Jointly-Owned Property
LEDER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTSINTERES
11 . C. 2/1995 U.S. SAVINGS BOND 661.20 50. 330.6C
M64878596EE
12. C. 2/1995 U.S. SAVINGS BOND 3,306.00 50. 1,653.0C
V4636079EE
13. A. 7/1993 U.S. SAVINGS BOND 707.60 50. 353.8C
M55294615EE
SUBTOTAL SCHEDULE F.2 2,337.4C
GRAND TOTAL SCHEDULE F.2 $ 19,596.14
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HERMAN MYRTLE E
FILE NUMBER
21
01
0051
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Nickel Funeral Home 3,490.81
8. ADMINISTRA TIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number1s) f E1N Number of Personal Representative(s)
Street Address
City State Zip
Year1s) Commission Paid:
2. Attorney Fees Kathy A. Morrow, Esq. 4,000.00
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. Probate Fees
5. Accountanfs Fees
6. Tax Return Prepare(s Fees
7. Brinser, Wagner, Zimmerman (Renunciation) 50.00
8. Henry N. Williams-Reimb. for Expenses 1,068.80
9. The Sentinel-Estate Notice 87.35
10. Cumberland Law Journal 75.00
11. Reimbursement to pay tax accountant 80.00
12. Verizon-Statement 30.08
TOTAL (Also enter on line 9. Recapitulation) $ 8 882.04
(If more space is needed, insert additional sheets of the same size)
,.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEAr-H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERMAN. MYRTLE E.
FILE NUMBER
21
01
0051
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1,173.00
1. Messiah Village
2. Alert Pharmacy Services
3. Messiah Village-West Shore EMS
4. Holy Spirit Hospital
5. Eye Care
6. U.S. Treasury
7. AARP Pharmacy
8.63
74.55
44.52
5.00
519.00
74.29
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,898.99
."~V_151>?'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
H A
NUMBER
I.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnctude outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1.
Henry N. Williams
1029 Fox Hollow Road
Shermans Dale, P A 17090
Betty Babinchak
253 Willis Road
Ephrata, PA 17319
David R. Williams
809 Parsonage Hill
Somerville, NJ 08876
Jane Mae Donchez
step-daughter
AMOUNT OR SHARE
OF ESTATE
25%
25%
25%
25%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
son
2.
daughter
3.
son
4.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If mnrA Cm::lr.p ic;: nPPliM inc;:prt ::lrlrlitinn::ll c;:hpptc;: nf thp C:::lmp c:i7P)
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
MORROW KATHY A ESQ
217 S CARLISLE ST
POBOX 250
NEW BLOOMFIELD, PA 17068
_uuu_ fold
ESTATE INFORMATION: SSN: 207-24-6255
FILE NUMBER: 21 - 2001 - 0051
DECEDENT NAME: HERMAN MYRTLE E
DATE OF PAYMENT: 09/21/2001
POSTMARK DATE: 09/20/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 12/20/2000
NO. CD 000293
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,156.14
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,156.14
REMARKS: HARRY N WILLIAMS
C/O KETHY MORROW ESQUIRE
CHECK#18
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
'\.
/(: -,:2<:) /--- 1/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-I'D? EX AFP (01-02)
'I e
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-19-2002
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
MYRTLE
E
'02
:1 G
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIELD PA ~10_68
~ ,t d ,,; .
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iffv: 16rfj-Ex-AFP--((fi: o 21-------...--iNifERITANc'E--TA3f-sTAfEMENT-ifF"-Ac-coUiff--.-..--------------- - - - - --
ESTATE OF HERMAN MYRTLE E FILE NO.21 01-0051 ACN 101 DATE 02-19-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-20-2001
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
6,356.14
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-19-2001 AA478173 210.53 4,000.00
05-23-2001 AA496644 .00 121.39
09-20-2001 CDOO0293 .00 2,156.14
01-29-2002 REFUND .00 131.92-
TOTAL TAX CREDIT 6,356.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
., IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
/tb -c:2C)/- /' /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
of
REV-1548 EX UP (12-00)
Recor'''''''-'
~ l..A".i-="~ ~,."
RegsI8:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-26-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
207-24-6255
01123459
MYRTLE E
"01
BETTY BABINCHAK
253 WILLIS RD
ETTERS
t{lV 26 An:4 9
m.~\ . U. ~", . -"
PAn t ..~ ~
iU.n enai ie
~_;ourt
. PA
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Rifv=is4-s-E3f-AFP--f12-:oo1------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-26-2001
ESTATE OF HERMAN
MYRTLE
E DATE OF DEATH 12-20-2000
COUNTY
CUMBERLAND
FILE NO. 21 01-0051
TAX RETURN WAS:
S.S/D.C. NO. 207-24-6255
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01123459
FINANCIAL INSTITUTION: KEYSTONE SAVINGS BANK
ACCOUNT NO.
480013821
TYPE OF ACCOUNT:
DATE ESTABLISHED
( ) SAVINGS ( ) CHECKING ( ) TRUST (>0 TIME CERTIFICATE
06-19-1995
x
.00
0.500
.00
.00
.00
.45
.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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-24-2001 AA496640 .00 119.66
TOTAL TAX CREDIT 119.66
BALANCE OF TAX DUE 119.66CR
INTEREST AND PEN. .00
TOTAL DUE 119.66CR
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 "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
\,/ b -c:2CJ/- //
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIELD PA 17068
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-05-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
*
REY-1547 EX AFP U2-00)
MYRTLE
E
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iffy: ls4j-Ex--AFP--fr2"=offf-Noi"-icE--oF--fNHEifiTAN-cE-i"-Ax-A-PPRA-isEi.rENT~--Ai:i-oWAN-CE-ifR----------- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HERMAN MYRTLE E FILE NO. 21 01-0051 ACN 101 DATE 11-05-2001
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)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
.00
40.898.69
.00
.00
91.533.80
19.596.14
.00
(8)
8,882.04
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. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
141~247.60 X 045 = 6,356.14
.00 X 12 = .00
.00 X 15 = .00
(19)= 6~356.14
1.898.99
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account~
submit the upper portion
of this form with your
tax payment.
152~028.63
10.781 03
141~247.60
.00
141,247.60
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-19-2001 AA478173 210.53 4,000.00
05-23-2001 AA496644 .00 121.39
INTEREST IS CHARGED THROUGH 11-20-2001 TOTAL TAX CREDIT 4,331.92
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 2,024.22
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 30.50
TOTAL DUE 2,054.72
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
\, /6 --cQLJl-1 /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENTL ALLOMANCE OR DISALLOMANCE
OF DEDUCTION~, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (12-00>
DAVID R WILLIAMS
809 PARSONAGE HILL RD
SOMERVILLE NJ 08876
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
08-27-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
207-24-6255
01123460
MYRTLE
E
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REfv=is4-i-Ex--AFi>>-fi2-:oo1------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-27-2001
ESTATE OF HERMAN
MYRTLE
E DATE OF DEATH 12-20-2000
COUNTY
CUMBERLAND
FILE NO. 21 01-0051
TAX RETURN WAS:
S.S/D.C. NO. 207-24-6255
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01123460
FINANCIAL INSTITUTION: KEYSTONE SAVINGS BANK
ACCOUNT NO.
480013805
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (X'> TIME CERTIFICATE
DATE ESTABLISHED 06-19-1995
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
5,318.19
0.500
2,659.10
.00
2,659.10
.45
119.66
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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-23-2001 AA496644 .00 121.39
TOTAL TAX CREDIT 121.39
BALANCE OF TAX DUE 1.73CR
INTEREST AND PEN. .00
TOTAL DUE 1.73CR
* 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 "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P 3 OO\INTY
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT ~ L'f10601..
HARRISBURG, PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
Reeo'
R-,r
'02 JF\N 11
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIELD
C:E;j
PA 17068 CUfnb:,~
1 ~ _.Ji) / -II
12-21-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
*5!
REV-1595 EX AFP <12-DDI
MYRTLE
E
Amount Remitted
ESTATE OF HERMAN
MYRTLE
E FILE NO. 21 01-0051
ll)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
llO)
ACN 1 0 1
.00
40,898.69
.00
.00
91,533.80
19,596.14
.00
(8)
8,882.04
1,898.99
ll5)
ll6)
ll7)
ll8)
ll1)
ll2)
ll3)
ll4)
.00Xoo =
141.247.60X 045=
.00X12 =
.00 X 15 =
ll9)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v:i5~j-Ex--AFP--fi2-:o0)------.-.-IN-HERI-fANc-E-TA-i-RE-CORif-ADj-usTM-ENT--..-----------------------------
DATE
12-21-2001
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
PROTEST BOARD DECISION
10.
11.
12.
13.
14.
TAX:
15. 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 B rate
19. Principal Tax Due
TAX CREDITS:
152,028.63
10,781.03
141,247.60
.00
141,247.60
.00
6.356.14
.00
.00
6.356.14
" ",......, 1'(~"'~.Ltl (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-19-2001 AA478173 210.53 4,000.00
05-23-2001 AA496644 .00 121.39
09-20-2001 CDOO0293 .00 2,156.14
TOTAL TAX CREDIT 6,488.06
BALANCE OF TAX DUE 131.92CR
INTEREST AND PEN. .00
TOTAL DUE 131.92CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
! ( . ! 2 (' / --- /1
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*5[
REV-l'07 EX AFP el2-00l
Re,";( .
.02
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIELD
JAN -4 P12 :04
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-24-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
MYRTLE
E
1. ".
~~tl'1068
Clunbc t.. .
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
rffv = i 6o-j-E3f-AFP--fi"2-:ooY------...--iNifERi'i"-ANc"E--i A3f-STA-fEMENi-'fF-AC-Couiff--.-..--------------- - - - - --
ESTATE OF HERMAN MYRTLE E FILE NO.21 01-0051 ACN 101 DATE 12-24-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-20-2001
PRINCIPAL TAX DUE: ........................................................................................................................
6,356.14
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-19-2001 AA478173 210.53 4,000.00
05-23-2001 AA496644 .00 121.39
09-20-2001 CDOO0293 .00 2,156.14
TOTAL TAX CREDIT 6,488.06
BALANCE OF TAX DUE 131.92CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 131.92CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS lESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
.I [J .::>20/ - / /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
'02
Jf,N 25
DATE"
ESTATE OF
DATE OF DEATH
FILE NUMBER
CHJdNtrV
ACN
BETTY BABINCHAK
253 WILLIS RD
ETTERS PA 17319
*Ji
'-"
REV-IU7 EX AFP (12-00)
12-24-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
01123459
MYRTLE
E
C~s'r~;
Amount Remitted
GUlnbc
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iffy =i6Cfj-E3f-AFP--fi'2-':oo:f-- ----...--iNifERIY-ANc'E--TAx--sTA-fEH'E-tiT-ifF'-Ac-coui-ff--.-i.--------------- - -- - --
ESTATE OF HERMAN
MYRTLE
E FILE NO.21 01-0051
ACN 01123459 DATE 12-24-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYMENTS I THE CURRENT BALANCEI ANDI IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-19-2001
P R I N C I PAL TAX DUE: .............................................................................................................................................................................................................h............
PAYMENTS (TAX CREDITS):
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-24-2001 AA496640 .00 119.66
12-06-2001 REFUND .00 119.66-
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
II! IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJI
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
CONHoNWEALTH JF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01- 0051
ACN 01123459
DATE 05-09-2001
REY-1545 EX AFP (09-00>
EST. OF MYRTLE E HERMAN
S.S. NO. 207-24-6255
DATE OF DEATH 12-20-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[Xl CERTIF.
BETTY BABINCHAK
253 WILLIS RD
ETTERS PA 17319
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KEYSTONE SAVINGS BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions mav be answered ~y ~~lli~g (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 480013821 Date 06-19-1995
Established
Tax
5,318.19
50.000
2,659.10
.045
119.66
TAXPAYER RESPONSE
....:,l)i~~~~mi:~ITt]ml:~~m:gm:.~~~~~lml~~m!:~:.:::::.,.::::. ....
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!] :i::l,~~i~~.ii:i:~QmC'
":::iiil'ASID)'::OH:mTHxS::))ilmtxclii)i)i
...-.-...-...............................-....,..........................-...-...............................-.-.
.........................-.-.-..........................-...-.....-.-.-.-...-.......-.........-...-.-.-.-.-........
............. .-.-.-.-.-.-.-.-.-.-.-.-------.-. .-.. . .-.-.-.-.-.---.---.-----. ...................
[ C~~~K ]
BLOCK
ONLY
e above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
~discount or avoid interest, or you may check box "A" and return this notice to the Register of
ills and an official assessment will be issued by the PA Department of Revenue.
B. The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
TAX
LINE
RETURN - COMPUTATION OF
1- Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
......- ..-..-,..- ........................... -.-.....-.................... .....
...-.-...-.-.-...................................-.....-.-.-............................ .
...... .;:;::;::::~:;:::;:~:;:;::OIffiFI:C;lA1lli::;;:USE:: "::'-;AF::
:.:.:.ili:l:i!::I!iii!!:!liil~ij!jlii~~ii~M~i~i.m~~iiii'REVENUE):~imiii.:!jj
ill:~Abiiil:mi:::)ii:i::i::::i:i':':i::ji:)j:::'i":mmmmm:m::jim:::)i:m::m:'i':ji!:)::ij::::mj:mm:m:::i:m::!m:ii:):::::i):T
-.: :.: :.:;:;: ;:;: ;;:;:;:;:;:;:;:;~~~;~~:;:::::;:;~~~;~;~~: ~:;~;:;~;~;~~:;~;~~~;ggi;:;:;;;: ;:;~;~;~;~;~;:~:~~;:;~;:;~;:;:;~;~;~;i;:;:;:;:;g;;~;:i:;:;:;:;:;i;;;:;:;::
If you indicate a different tax rate, please state your
relationship to decedent:
.---. . --..-.---.-- .....
....-.-.-.-. .........-...-... ............
::::m:il':'j':iii~m::::i:i'l:j:!:!'i:j'i'!:!:!:!:j:;':1:'::;'::m:m:,11:1:1:!:j:!:::!:1'!::::'j'j'j'j'j:i:i1j!mii!j!j:m::::1i!1::i:i:!i1:mmim:::m:
mmmimi!'!::~j:i:j'::!:!ij:ji!::i::m:im!i:i!:!:::::!i:mii!:!:!:j:j:jj::j:!:!'j'!'!iji!i!i:i:i:i::!i':!i!i;i!'ji1:':::!i!i!:!i!'!:!:!:!'!i!i!i!i:j!j:m:
... ~~!~~j~~~j~j~;;!;;;;;!;!::~;;;;::;~;:~~~:~:~:~:;:;;;:;: ;:;:;:;~;;1;;;' .:. ::::::::;~;:::::~~~~;~i~;~i~~~~~~~~~~~~:~:::~~~:~~i:;~;~;~~:;~;~:'.
..... ii.:liil!:i:::::!i!i!:!ii:::::::!:!:!i!:i:!:!"j.!m:::.j'j':!:!j!:!:!:!:!:!:iii::i!:i:i:!m::i:i:::':':1;;;;;;i': :::... .:::::::::::::::...
. . .:;;;;::'::i~:im:'::i'::":""mm:':'.';::'.':::::::::':'::::<:!:::::::::!'::::::::.. ............
,n::H:;:;:;:;::Hi::;:;:;:;H;H;:;:;:;:;:;:;Hn:: ... .."....'.'.'....::.:.,,:.:....'>:.:.:::::. ...'.",,,,.,,.,,,,,,,,,..,,,,.,.,,,..
~;;~ ;;:;;;: ;~;~;~~~:...: j1j1;:;!;;IiI: ~;;i;;~;i;i::::;:'.'.' :.:: r:. :::: .:: :::;;;;;;;:;; ;;;;;;;;;;; ::;:.. ..... .. .......:::.. . ......... ....... _...
x
x
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I
my knowledge and belief.
"7
I
$
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01- 0051
ACN 01123460
DATE 05-09-2001
REV-1545 EX AFP (09-00)
EST. OF MYRTLE E HERMAN
S.S. NO. 207-24-6255
DATE OF DEATH 12-20-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[X] CERTIF .
DAVID R WILLIAMS
809 PARSONAGE HILL RD
SOMERVILLE NJ 08876
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KEYSTONE SAVINGS BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Penns~lvanj~. Qu~~tion5 ~~~ ~~ ~n~~~~~~ b~ c~!ling ~?!?) ?g7-~!27.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 4800138.9'5' Date 06-19-1995
2-1 Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
53'S". 31
X '
S-,318.19
50.000
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
2,6S~.18
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!] '::;';f,~;~~.J;!m!~!im~..
.045
/0>./.3' 119.~~
TAXPAYER RESPONSE
.....,..'.'.'.!:!:!~~~~:!:!,!_~"m!i!i~~:m~li!i:.~~i~~~i!!!!~~~i!;:i~~:::'::'."
" ;':';iu&i:iiiOH;i;i1TKXS;:;ii.TJXCE::ii\:.
.............-.-.-.-,-...-.................-.-.-....,....................-.......................-.-...-..............
.-.-.-.-.-.-...-..............-.-...-.-....-.............. .-.-...........'..........
.-.-.-. ................-.-....
The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[ C~~~K ]
BLOCK
ONLY
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
X
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX PET~RN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
8
X
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
'Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
~rz.uJ~
TAXPAYER SIGNATURE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0051
ACN 01123459
DATE 05-09-2001
REY-15~3 EX AFP (09-00)
EST. OF MYRTLE E HERMAN
5.5. NO. 207-24-6255
DATE OF DEATH 12-20-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[KI CERTIF.
BETTY BABINCHAK
253 WILLIS RD
ETTERS PA 17319
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KEYSTONE SAVINGS BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. QUQ!':tj"ns m",y be ans..,ered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 480013821 Date 06-19-1995
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
5,318.19
50.000
2,659.10
.045
119.66
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent"..
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
yOU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
~~ TAXPAYER RESPONSE
m:::'i:~~:IL~~!li::~~mii.!~_ii!:!~~~:i:i:!~~li:ii~!i:i1~'iii:~:'.;:::"...""",,,,,,,:;:i:!:!~I:ii:i!~_:iii~.il::~il!ig~~i:i:i.~~:ilili
B.
e above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a iscount or avoid interest, or you may check box "A" and return this notice to the Register of
ills and an official assessment will be issued by the PA Department of Revenue.
A.
[ C~~~K ]
BLOCK
ONLY
The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
m:m!:mmmmmmmmml::mIIQI.m~~i~~~ti\l\iQ$.~ii:\:~~~~ml:L :;::;::;:iAF":
ii:'.i.I!!i::!!i.!,lil.!!!i:i~~!I:i!!~~~~I~~~~:'II.~~!i!i!~~~~,:,:,,,:,:,:,,,,,,::::::;:.:,,,
;~!~~~~mI1m~;:;:;;;~:i:~~~I:;:1;;~;:;;;:~~;;;;;~::;;;~;;~!;~;~;:;:;;~~~:;:;~;~;~;~;:;:;~:~:~;~;~;~;~:;:~~~;~;~;~;~;~~~~~;~;~;~~~;~;~;~~;;~;~~~;~:~;::::
::i:iiiiii!iiliiii!~iii:;:::::!:;:;:;:!:!:::::::ii;:!i;:i':.;:;:::;:;i::::;:i:;:;:;:;:;:;ii:j:j:i:i:;iii;:;:;:i:;i;:ii;i;:;:::;:::;:;:::;:;:;i;:;!::;i;i;::::!:::i:i'
~1j1~1~1~!~~i!i!lI~~1l~~~i~~:~~m~;~~~~~j;m~;~~~~~l~i~;~;~1~;~;~;m;~!~;~!~i~i;:~;:!~!~;~!~;~;:;~!;!~:m;;!:!~;1m;!:!~~1!;i;!;!;!;i:~!l~~:~~~;~;!:~:~!~:~~~:~:
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
Tax Due
OF
1
2
3
4
5
6
7
8
x
.....-.-.-............ ................................... .
,.,.......................,.,......................................................".........-.-.....-.........-.-.-.-.-.-.....-.-.-.....-.....-.-.....................
1imWmim~m~m;~;;:~;~;n:~;~;;;:;:~~;~~~;~~j;~~:mm;i;~;~~~m~:;~m~;;;;;:~~;~~!:;~;;;;~~;:i:;;:;~;:;;;;~~;;;~;!;:;:::~!;;;;;;;~~:~;i:~::;~;~;~;~:~;.
m:m:mi;i;::i:~!m::::::::::::::':'::!::::::::: ,. ";.:.:.::::::::;:;::;;;;;;:;;;;;:;;;;;:;:::::;:;:::;:;:::;:;:;:;;;::;;:;::::::,:;:.:;:,;:::::::.
::'::::m:::::::!:~m:::::!'::m::i:::ii:::i:i::!:::(:.::':::i':'::::::;:;:;:CU:i:;:;:;:;:;:;'i'j:.':,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..
LINE
1. Date Established
2.
3.
4.
5.
6.
7.
8.
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Amount Taxable
Tax Rate
...........-.........-.........-.
:::!::::mm6.!:!::::;:-:::m:>m:m:m:
.....-...-...-.........-.-...-.....-.-.-.-.-.-.-.
.-.....-.-.-.-.-...-...-.....-..............,...
,-..,..-,.,-.-.-.......-.........-,..............
..........-...--.....-...-.-.-.-...-.-.-.-...-.-.
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,.,.,...................,...................................,....
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DEBTS AND DEDUCTIONS CLAIMED
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I
my knowledge and belief.
.~~_/
I
$
DATE
COMMONWE.A L TH OF PENNSYLVANIA
DEPARTMENT OF HEVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
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Ct ('1 \/ T L:'. F~: lrJ J L_ L_. I ,.,~ j"'l :'~'.,.,
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ESTATE INFORMATION:
FILE NUMBER
NAME OF DECEDENT (LASi)
DATE OF PAYMENT
POSTMARK DATE
SEA.L
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
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No.AA 4 C' 6644 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 4 78173 REV-1162 EX (11-96)
RECEIVED FROM:
I
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
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ESTATE INFORMATION:
FILE NUMBER
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TOTAL AMOUNT PAID
DA TE OF DEATH
.,
REMARKS
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SEAL
REGISTER OF WILLS
~------~-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
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NAME OF DECEDENT (LAST)
DATE OF PAYMENT
POSTMARK DATE
I COUNTY
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REMARKS
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
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No.AA 496640 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
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.281021
:ISBU~, PA 17128-1021
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
- "'~"'I"'f.~~'.
=- ~.J~;,r.l..UI"''iI~...l
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December 7, 2001
PHONE: 717-783-36
FAX: 717-787-72
DEe 1 0 2001
KATHY A MORROW ESQ
217 S CARLISLE ST
PO BOX 250
NEW BLOOMFIELD PA 17068
ESTATE OF MYRTLE E HERMAN
FILE NO. 2101-0051
DOCKET NO. 0124778
Dear Ms. Morrow:
Please be advised that the Bureau of Individual Taxes has adjusted its records to
reflect credit for the estate's September 20,2001 remittance of $2,156.14. Since there
is no longer any reason for proceeding with a formal appeal, your case will be marked
"closed."
Please contact this office if you have any questions regarding this matter.
Very truly yours,
p~lC. ~
Joseph R. Sleek
Board Member
IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATIVE FORMAT UNDER THE
PROVISIONS OF THE AMERICANS WITH DISABILlTES ACT OF 1990, PLEASE
CALL (717) 783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL
HEARING AND SPEAKING NEEDS: 1-800-447-3020(TT ONLY)
.'
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/05/2002
HENRY N WILLIAMS
1029 FOX HOLLOW ROAD
SHERMANSDALE, PA 17090
RE: Estate of HERMAN MYRTLE E
File Number: 2001-00051
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 12/20/2002
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
MARY C. LEWIS
REGISTER OF WILLS
cc: J File
Counsel
Judge
f\
L// ..
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Ihytf rL[~
/ 2../ ~o/ Go
/ I
- 000 ~J
c~.
lief /11/l ~
Date of Death:
(ILrL
WriT No. ;(00 I
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 th~ estat~ ~s complete;
Yes)( 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;K
b. The separate Orphans' Court No. (if any) for
the personal representative/s account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes )( No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: /2/ /!/6J.-
I !
s~rf 7~
k/117{Y II. /JJ6frfo G.)
Name (Please type or print)
?, c.I3c.-::k c:2Sa
AI F J d L<."l (; /Yl Ff f L Ll ? A I '70 G't
Address J
(7/'7) ~F2- - /fa/~
Tel. No.
(MAH:rmf/AM3)
Capacity: Personal Representative
)( Counsel for personal
representative