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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-1)601
FILE NUMBER
21-010051
C'i5UNNcoor -YEAR- - - iAAi8ER--
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DECEDENrs NAME (lAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
2 0 7 - 2 4 - 6 2 5 5
THIS RETURN MUST BE FilED IN OUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
207-246255
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HERMAN MYRTLE E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD- Year)
o 3. Remainder Retum (daleofdeathpriorID12-1J..82)
o 5. Fed..., Estate Tax Retum Required
Q.. 8, Total Number of Safe DeposrtBoxes
o 11. Election to tax under Sec. 9113(A) -. 50h 01
12/20/2000 04/15/1918
(IF APPUCABLEj SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!Xl 1. Onglnal Retum
o 4.limrted Estate
o 6. Decedent DieclTestate (Altach copy of WIll)
o 9. litigation Proceeds Rece,ed
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dalll ofdealh aIB 12.12-32)
o 7. Decedent Maintained a Living Trust (Atlach cllfIyofTrust)
o 10. Spousal Poverty Credit (date ofdMh bfItween 12.31.91 and 1-1-95)
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 Ap~k:able)
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TELEPHONE NUMBER
717-582-7313
NEW BLOOMFIELD
PA 17068
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Morlgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billin9 Requested
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
40,898,69 i
7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total G.... A..... (total Lines 1-7)
9. Funeral Expl!f1ses & Administrative Cosm (Schedule H) (9)
10. Debts of Decedl!f1t Morlgage liabilities, & liens (Schedule I) (10)
11. Total Deduction. (total lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charrtable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made(~J)
14. Net Value SUbject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
91,533.80
19,596.14
15. Amount of Line 14 taxable at the spousal tax
rate, ortransfe", under Sec. 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. AmountofUne 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
------...- --... ---- -- -----
STREET ADDRESS
P.O. BOX 2015
CITY I STATE I ZJP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pnor Payments
C. Discount
(1)
6,356.14
4.000.00
200.00
Total Credits (A +B +C)
(2)
4,200.00
3. InteresUPenalty it applicable
D. Interest
E. Penalty
T otallnteresUPenaity ( 0 + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE, (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
2,156.14
2,156.14
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 1RI
b. retain the nght to designate who shall use the property transferred or its inceme; ........................................ 0 1RI
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1RI
2. If death occurred afier December 12, 1982, did decedent transfer property within one year of death
without receiving adequate censideration?.. ........... .................. ........................ ........ ............................... 0 1RI
3. Did decedent own an 'in trust fo~ or payable upen death bank acccunt or secunty at his or her death? ................. 0 1RI
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
centains a beneficiary designation? ....................................................................................................... 0 1RI
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 penaties of perjury, I decIcr"e thai I have exanined this return, includ1~ a::cornpalying schedules ood statements, ood Ie the best of my knowledge ood belief, it is true, correct
ald complete.
Declcnion ofprepnrolherthm the personal. representatlY9 is based on a1llnfom1at1on ofwhich preparer has any knowledge.
SIGNATURE 0 PERSON RESPONS BlE FOR FiLING RETURN DATE
J I
ADD
PA 17090
DATE
'1-/9-11/
PA 17068
For dates of death on or afier July 1, 1994 and before January 1, 1995, the tax rate impesed on the net value of transfers to or for the use of the surviving speuse is 3%
[72 P.S. ~9116 (al (1.1) (i)).
For dates of death on or afier January 1,1995, the tax rate impcsed on the net value of transfers to or for the use of the surviving speuse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exernot a transfer to a surviving speuse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even ~
the surviving speuse is the only beneficiary.
For dates of death on or afier Juiy 1, 2000:
The tax rate impesed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a naturai parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(I.2)].
The tax rate impcsed on the net value of transfers to or for the use of the decedenfs lineal beneficianes is 4.5%, except as noted in 72 P.S. ~116(1.2) [72 P.S. ~9116(al(I)).
The tax rate imoosed on the net value of transfers to or for the use of the decedent's siblinos is 12% 172 P.S. 69116Ia\ll.3\1. A siblino is defined. under Section 9102. as an
LAST WJ[LL AND TESTAMENT
OF
MYRTLE E. HERMAN
I, MYRTLE E. HERMAN, presently residing at 505 Princeton Avenue, Palmerton,
Carbon County, Pennsylvania 18071, being of sound and disposing mind, memory and
underst,mding, 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
AJl 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 DA VlD R. WILLIAMS, and to my stepdaughter, JANE MAE
DONCHEZ, to have and to hold the same absolutely, per stirpes and not per capita.
ARTICLE ill
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
them shall fail to qualify or cease to act, then I direct that the sUIvivors 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 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 delivera1l 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 undistnlJUted 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 l7ilvislons
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 offour (4) typewritten pages, this R~~/day of April, 1994.
7nrHi. G. )iA~'~/ (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 oresence 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 .< tR..( day of April, 1994. .
~
C~/LLV-U.:6~lL~
Nor~r.'\L SEA.l
lEN:SE t\. A~)ILL, r'~!Jtary Public
Patmtnton BGiO, ':arbolt County, "'A-
My Commi"io" Expire< March a ,. I
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CARBON
We, Steven J. Hartz and Joyce Ricciardi, the witnesses whose
names are subscnbed 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?:<"/day of April, 1994.
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c/C~J:7LtH- hu~
NOTAAlAl SEAL
DENISE B. AMilL. Notary Puollc
PalmaTIon Bo,", Carbon Countv, PA
My Camm;,"ia" Exp:, eo March 2i'., 1!19ll
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DE DENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
HERMAN MYRTLE E
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 01
0051
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
17,460.00
P.P.&L.-400 Shares @43.65
2
Philadelphia Electric-100 Shares @21.75
2,175.00
3.
Lucent Technologies-140 Shares @ 15.5
2,170.00
4.
A. T. & T. 165 shares @ 18.9375
3,124.69
5.
Bell Atlantic (Verizon)-248 Shares @ 50.125
12,431.00
6.
Savings Bond-Series EE-V4700570EE
3,538.00
TOTAL (Also enteron line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
40 898.69
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX 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 jointly-owned _ the right of .uIYivolShip must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC BANK-C.D.-#31100153110 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. OF REVENUE 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
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
HERMAN MYRTLE E
tf an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
FILE NUMBER
21 01
0051
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. HENRY N. WilLIAMS
B BETTY BABINCHAK
c DAVID R. WilLIAMS
1029 Fox Hollow Road,
Shermans Dale, PA 17090
253 Willis Road
Ephrata, PA 17319
809 Parsonage Hill
Somerville, NJ 08876
SON
DAUGHTER
SON
JOINTLY-OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF OEA TH
ITEM FOR JOINT MADE Include name of financial institution CW'ld balk account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deedforjointly-held realestale. VALUE OF ASSET INTEREST DECEDENrs INTEREST
1. A. 4/9/99 PNC BANK-G.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-G.D. #480013821 5,318.19 50. 2,659.10
6. C '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
(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
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 OECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real eslate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
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 $ 19,596.1 ~
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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
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of P""""al Representative (s)
Sociai Security Numbel(s)I EIN Number of P....nal Representative(s)
Street Address
City State Zip
Year(s) 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 Preparers 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) $ 8882.04
(If more space is needed, insert additional sheets of the same size)
,.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERMAN MYRTLE E.
FILE NUMBER
21 01
0051
'nclud. u"reimbursed medical expenses.
ITEM
NUMBER
OESCRIPTION
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 enteron line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 898.99
.REV-f5f~EJ('(.
COMftllONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
~~., ...'''..........1=1=:_ 71 01 nn"1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not L10t Truotee(o) OF ESTATE
I. TAXABLE DISTRIBUTIONS Undude outright spousal distributions. and transfers under
See. 9116 (a)(1.2))
1. Henry N. Williams son 25%
1029 Fox Hollow Road
Shermans Dale, PA 17090
2. Betty Babinchak daughter 25%
253 Willis Road
Ephrata, PA 17319
3. David R. Williams 25%
809 Parsonage Hill son
Somerville, NJ 08876
4. Jane Mae Donchez step-daughter 25%
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. 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 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
flf mOM ~n;:vop i~ n~Arl in~prt ::virlition:ll o::.hPAt,:: of thA ';::::lmp o::i7A)
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
Henr',' N V\lilliams
~~;ier(s).~tlO is"ar~'18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut.9l.-_ 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.t.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, Upper 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 P A All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in P A Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
T ota I ..................................................................................................................... $
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"-c20/- //
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.
Sworn to and affirmed and subscrIbed ~.nd..::/ 'l-[ "-u~--/;~.-9.-/
before me this 1 0 . day of
JANUARY
,
DECREE OF REGISTER
Estate of MYRTLE E. HERMAN
Deceased
No.
2101-51
also known as
AND NOW,
reverse side hereon, satisfactory proof having been presented before me,
Social Security No: 207 -24-6255
JANUARY 10
Date of Death:
12-20-2000
2001
I in consideration of the Petition on the
IT IS DECREED that LettersEl Testamentary 0 of Administration
((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
are hereby granted to
HENRY N WILLIAMS
in the above estate and that the instrument(s), if any, dated APRIL 22 'I 1994
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters.................... ................. $
235.00
~7/ (J '7;/~;1 ~~/< /Mt'" / ~n/:/
Reg:st I of Wills ,
Short Certificates(s) ...n..........
$
Renunciation .......................... $
$
$
30.00
5.00
Extra Pages (
) ..... ~:.. . .. .. ..
12.00
" -'
.... ,. ~
I. T. Roo.................................... .'""$"
JCP Fee ................................. $
Inventory ................................ $
Other ...................................... $
Signature
5.00
Attorney: KATHY A MORROW
1.0. No: 54709
TOTAL ............................$.
287.00
Address: POBOX 250
NEW BLOOMFIELD. FA 17068
Telephone: 717-582-7111
DATE FILED:
JAN 10, 2001
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 4 7 5 5 8 2 8
~ ~';-;I; i ,-Iii;; ;/.-,;:;-
'liiiitt\1" OF p"'';:;:,;;>
/.\\11 ~ \~- --" --.-- 'f ~f.-:~
f?\~"'/ "".<'~.(.~
!~ ~/ .~.~_. \,./..~
/$ ~~.. 'J~'" ".?-~\
:~~, '~ ~~'\
1~t:::), ,..-,;, ..-~
I~ (.....> L, .;-1. , . .:r:., ~/r
\..... . . ' ~'S:
'~.', *' "-' ~,,' 'r '. *9'
\'\:. .;'}" .....,.,--.---'. .'. ,
\'%\. . ~/
'-:'-~" ~,'\\\I
\~~ --,' t9 i--.- t~\. ~;,\~/
::~~ f MEN"! \\T ,..,..
"X'(::-(~~,~}..~)~,~:'J~-~:../
12-21-2000
Datf' at Issue of This Certification
21-01-51
Narne of Decedent
_. _ rvty_!'.t1_~--_.---
r
erman
Sex
Female
SO';lal Secunty No,
207-24-6255
Date of Death
12-20-2000
Date of Birth
_~~_!,__i I 15 Lm~_~ 1 ~__ Birthplace _____~_a l"!.~!:t a ~__L~~_________________________________________u____
Place of Death Me s s i a h _Y~~_~~_R~__________~____________C u m b ~ I a!1 d____u Up per A ~!-~~__.!~E-~__ __nP~_!2~'y_~\:,~QJ?__
COUllt',
C:l'; 8oru\~r~Jfl ":'U\\,'--:.;111C'
Race_ White Occupation __________I~__!~_~_~_______________________.___ Armed Forces? (Yes or No)_____!i_~_______________
Decedent's
MantEll Status Wid a w _________ Matling Address P . O. B a x 2015
I ntolTnant Hen ~y._._ N. lrJ_~~1:_~__~!l:1~_u_________ Funeral Director
Name and Address of
Funeral Estahlis~-mlent N i c k elF u n era I Ham e
James F. Nickel
La
ville
PA 17047
F'ail i.
I nli"!lecllat\~: Ca.l.lSH
Interval Between
Onset and Death
id)
CAD
(b)
CHF
____. .___._......____ _._ ___.______~____._~______u_____,_.__~"___..____~__.________._____._______..__'___ ___.____-L_.___...__..____~~_.__,_____.._______
Par1li:
dl
Other
I
I
I
-.----r ----------.--------------- -- ---
Conditions
_________._______.___-._________________________________________L_____________________ .- - -
Manner of DE:ath
Describe how injury occurred:
Natural
xx
H0r11iCICie
Accident
Investigation
SUicide
Could not be Determined
Name and 1 itle of Certtier
L. Zimmerman M.D.
...--"~_._._-,_.._-_._-_.----------~_._._------~-_._--"._._------------~._---------- -'--- ---"
(M.D., D.O., Coroner, M.E.)
Address
Lema ne PA 17043
T n IS; 0 e r t if Y H' a t the I for rn at ion her e 9 i v e n i S c 0 rr e c t lye 0 pie d fro man 0 rig i n a Ice r t if i cat e
o cieath cJuly filed \tJith me as Local Registrar. The original certificate will be forwarded to the
State Vita' Reco,-ds Office for permanent fllin-0~~-!,<R~-.~---6,:,:,;~;~n-04-55
12-21-2000 101 Barnett ~ New Blaamfi.alcL.--.PA--.11068
Str80t Address ell\! F3nr\;iJ:Jt,. fC,c,'Jlhr1,[
71 '7--;3313-6'312 E:F~ I t":"l~;EF"~:~. L.JF~13t"lER-
T52 t-'l:1d
-LJt:."":-ZO "~.::JIQ l. 0 .;"J::' ~-
RENUNCIA liON
"
No.
21-01-51
Estate of tvtYrtle Eo Henuan
also known as
____ I Deceased
JU. IT n:r
The undersigned, M. Elizabeth Babinchak and David R. WilliwllS, children
(R.elatlonshlp) (CapacJty)
of
the above Decendent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters Testamentary. be Issued to He~ N. WUl!ams .--..
Witness our
hand this
day of Decetuber ,aQillL..
a~~~
(Signature) -
(A(Jdress)
Cj~cL~~
(Signatut8)
809 Parsonage Hill
Somerville, NJ 08876
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
-th
before n1e this ~ 1 day of
V e e e \'\(\ 'h € L- 2CXXJ
2~(1~w/2! ;;if)}
~ary Public
// "" My Commission Expires Notarial Seal
/ /" Joanne R. Nemeth, Notary Public
v LowerTowamensingTwp., Carbon County
My Commission Expires Oct. 11, 2004
Member, Pennsylvania AssOCiation. af..bJotaries .. . .'
(Signature and eeal of Notary or other ..-NOTtr:.--.~.nunClatlOns executed outsIde the Office of RegIster of Wills ate
offtCial qualified to sdminiater ~th5, Show required In sorne counties to be notarized.
date of expiratIon of Notary', c;:ommiuiQn")
RW-3
\.. -
'/~-(~/,--II
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1U7 EX AFP (01-02>
.02 11Al~ 1 8
P 2 :1 6
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-19-2002
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
MYRTLE
E
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIElD PA ~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 ~
RE-lj=i6oj-iY-AFP--((fi.:o2-r------...-iNHERITANc'E--YAX--STA-fEM'E-tiT-'(fF-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 PAYHENTS~ 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 DU E : ...........................................................................................................................................................................................................................
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 $l~
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. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS.I AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEAL TH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit~ which was not requested on the Tax Return~ may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax"" (REV-1313). Applications are available at
the Office of the Register of Wills~ any of the 23 Revenue District Offices or from the Department"s 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue~ Bureau
of Individual Taxes~ ATTN: Post Assessment Review Unit~ Dept. 280601~ Harrisburg~ PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent"s death, a five percent (5~) discount
of the tax paid is allowed.
PENALTY:
The 15~ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6~) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year
Interest Rate
Daily Interest Factor
Year
Interest Rate
Daily Interest Factor
1982 20~ .000548 1992 9~ .000247
1983 16~ .000438 1993-1994 n .000192
1984 ll~ .000301 1995-1998 9~ .000247
1985 13~ .000356 1999 n .000192
1986 10~ .000274 2000 8~ .000219
1987 9~ .000247 2001 9~ .000247
1988-1991 ll~ .000301 2002 6~ .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice~ additional interest must be calculated.
.01
BETTY BABINCHAK
253 WILLIS RD
ETTERS
/6 -020/- / /
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESS KENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
Recoroed. of
Regtster or Vvins ~~~~TE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
REV-15fi8 EX UP (12-00)
tIlV 26 At1:49
11-26-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
207-24-6255
01123459
MYRTLE E
.,. r-i<oC" s (;ourt
PA t!fn~;i~f\d Co., PI>.
Allount Rellitted
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 ~
i-E-Y=is4-i-ix--AFP--liz-:ooj------------------------------------------------------------------------------------
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
CUMBERLAND
FILE NO. 21 01-0051
TAX RETURN WAS:
COUNTY
S.S/D.C. NO. 207-24-6255
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
01123459
ACN
ACCOUNT NO.
480013821
FINANCIAL INSTITUTION: KEYSTONE SAVINGS BANK
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 06-19-1995
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
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."
x
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" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
,. ~-
j,
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Actl Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLSI AGENT.
A refund of a tax creditl which was not requested on the tax returnl may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of
the Register of Willsl any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisementl allowancel or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenuel Board of Appealsl Dept. 2810211 Harrisburgl PA 17128-10211 OR
--electing to have the matter determined at the audit of the account of the personal representative I OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenuel
Bureau of Individual Taxesl ATTN: Post Assessment Review Unitl DEPT. 2806011 Harrisburgl PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT:
PENALTY:
INTEREST:
If any tax due is paid within three (3) calendar months after the decedent's deathl a five percent (57-)
discount of the tax paid is allowed.
The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed I and not
paid before January 181 19961 the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquencYI or nine (9) months and one (I) day
from the date of deathl to the date of payment. Taxes which became delinquent before January II 1982
bear interest at the rate of six (67-) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January II 1982 will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2001 are:
Year Interest Rate Daily Interest Factor Year Interest Rate DailY Interest Factor
1982 207- .000548 1992 97- .000247
1983 167- .000438 1993-1994 77- .000192
1984 117- .000301 1995-1998 97- .000247
1985 137- .000356 1999 77- .000192
1986 107- .000274 2000 87- .000219
1987 97- .000247 2001 97- .000247
1988-1991 117- .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Noticel additional interest must be calculated.
~/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
APPRAISEHENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT 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
*'
REV-1547 EX AFP (12-00)
MYRTLE
E
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=is'4-j-EX-AFP--fi'2-:ooi--Noi"-icE--OF-.rNHEifiTAifcE-TAX-A-PPRA-isEMENT~--Ail-oWAifcE-oi-------------- ---
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. Hortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. 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/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental 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:
IS. Allount of Line 14 at Spousal rate (IS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount 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~
subllit the upper portion
of this forll with your
tax paYllent.
152~028.63
10.781 03
141~247.60
.00
141~247.60
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER 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 $l~ NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A IIICREDITIII (CR)~ YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF lULLS I AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-150l) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent.s death, a five percent (5%) discount of
the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 7% .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 7% .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
'\, /6 --cQLJl-i /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENTL ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 Ell 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
Allount Rellli tted
MYRTLE
E
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=is4-i-i)f-AFit-fi1f=ooi------------------------------------------------------------------------------------
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 (~ TIME CERTIFICATE
DATE ESTABLISHED 06-19-1995
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."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDJ:TS:
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. )
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Actl Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLSI AGENT.
A refund of a tax creditl which was not requested on the tax returnl may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of
the Register of Willsl any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisementl allowancel or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenuel Board of Appealsl Dept. 2810211 Harrisburgl PA 17128-10211 OR
--electing to have the matter determined at the audit of the account of the personal representativel OR
--appeal to the Orphans" Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenuel
Bureau of Individual Taxesl ATTN: Post Assessment Review Unitl DEPT. 2806011 Harrisburgl PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT:
PENALTY:
INTEREST:
If any tax due is paid within three (3) calendar months after the decedent"s deathl a five percent (5X)
discount of the tax paid is allowed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessedl and not
paid before January 181 19961 the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquencYI or nine (9) months and one (1) day
from the date of deathl to the date of payment. Taxes which became delinquent before January 11 1982
bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January 11 1982 will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2001 are:
Year Interest Rate DailY Interest Factor Year Interest Rate Daily Interest Factor
1982 20X .000548 1992 9X .000247
1983 16X .000438 1993-1994 7X .000192
1984 llX .000301 1995-1998 9X .000247
1985 13X .000356 1999 7X .000192
1986 lOX .000274 2000 8X .000219
1987 9X .000247 2001 9X .000247
1988-1991 llX .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date$hown on the
Noticel additional interest must be calculated.
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
n__nn 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, 1 56.14
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2, 1 56.14
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
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.. Z80601.
HARRISBURG1 PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE 1 C, 'dO l - /1
INHERITANCE TAX
;;~,~~ATE
i!i;'-ESTATE OF
DATE OF DEATH
FILE NUMBER
P 3 ~NTY
ACN
RECORD ADJUSTMENT
Reco~ rtli-;';
."'_ ~ .,_._c ~- '1._";
Reqbtc
.02
JAN 11
KATHY A MORROW ESQ
PO BOX 250
NEW BLOOMFIELD
ClerK-
PA 17068 Cu,nbEf'
12-21-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
101
*51:
REV-1S9S EX AFP 02-00)
MYRTLE E
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iifi=is9-j-E)f-AFP--fiz-:ool------.-.-iiiHERi-fANc:i-Tiri-RE-CORD--ADj-USTM-iNT--..-----------------------------
ESTATE OF HERMAN
MYRTLE
E FILE NO. 21 01- 0051
ACN 101
DATE
12-21-2001
9113 Trusts (Schedule J)
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
PROTEST BOARD DECISION
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/Adllinistrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governllental Bequests; Non-elected
Net Value of Estate Subject to Tax
10.
11.
12.
13.
14.
TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
(15)
(16)
(17)
(18)
.00
40,898.69
.00
.00
91,533.80
19,596.14
.00
(8)
81882.04
11898.99
(11)
(12)
(13)
(14)
.oox 00 =
1411247.60X 045=
.oox 12 =
.oox 15 =
(19)
1521028.63
10,781.03
1411247.60
.00
141,247.60
.00
61356.14
.00
.00
61356.14
. ". I-'~I'I' IU;~I;...r I {+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-19-2001 AA478173 210.53 41000.00
05-23-2001 AA496644 .00 121.39
09-20-2001 CDOO0293 .00 21156.14
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 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit~ which was not requested on the Tax Return~ may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wi11s~ any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
REPLY
TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue~ Bureau
of Individual Taxes~ ATTN: Post Assessment Review Unit~ Dept. 280601~ Harrisburg~ PA 17128-0601~ Phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death~ a five percent (5%) discount
of the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed~ and not
paid before January 18~ 1996~ the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day from the date of
death to the date of payment. Taxes which became delinquent before January 1~ 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1~ 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year
Interest Rate
Daily Interest Factor
Year
Interest Rate
Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 n .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 n .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice~ additional interest must be calculated.
BOARD OF APPEALS
DEPT. 281021
HA~ISBU~, PA 17128-1021
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.....~~....................~...'...................'...._.....~.,....
..> = .
...:....:. =- .
"::.::::: S. ~ . .
...., =. .'.
;...... ===-
December 7, 2001
PHONE: 717-783-3664
FAX: 717-787-7270
DEe 1 02001
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 DISABILITES 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)
Ifv~;Zo/ .--/1
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG~ PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*5t
REY-U07 EX AFP (12-00>
ReGor"~,, 01
Re~3;Ei,<' r
.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
Allount Rellitted
"". ,. .."
tltJef'068
'Clun"'Berl<::,,' i.;
P!-\
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 ~
RE-V =i 60j-i:x--AFP-(i2-:ooi-------...--iNiiEii'~..-ANCE--yAX--STAiEME-Ny-ifF'-Accouiii--.....---------------- - - - --
ESTATE OF HERMAN
MYRTLE
E FILE NO.21 01-0051
ACN 101
DATE 12-24-2001
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-20-2001
P R I N C I PAL TAX DUE: ..u..m..........................................uu..........u..u...............................................m...............u..m...........................................................u.u............
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 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 PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS... AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department"s 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent"s death, a five percent (5%) discount
of the tax paid is allowed.
PENALTY:
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of
death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year
Interest Rate
Daily Interest Factor
Year
Interest Rate
Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 n .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 n .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
/h --020/ - / /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*;f
L,.;
REY-IU7 EX AFP (12-00)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
DA Ttt
.SSfATE OF
DATE OF DEATH
FILE NUMBER
.02 JAN 25 COiiN'V
ACN
12-24-2001
HERMAN
12-20-2000
21 01-0051
CUMBERLAND
01123459
MYRTLE
E
BETTY BABINCHAK
253 WILLIS RD
ETTERS PA 17319
CiE..rh.
lAJlnber;:.",
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 ~
RE-V =i60-j-Ex--AFP-(i2:0(jr------...--iNirERi~..-ANCE-fAX--STAfEHE-tif-o-F'-AC-couiff--.-..--------------- - - - - --
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 DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-19-2001
P R I NC I PAL TAX DUE: ......................................................................m.............................................................m...............m................................................................
.00
PAYMENTS (TAX CREDITS):
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
. 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" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS" AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEAL TH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit~ which was not requested on the Tax Return~ may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wil1s~ any of the Z3 Revenue District Offices or from the Department's Z4-hour
answering service for forms ordering: 1-8oo-36Z-Zo5o; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-30ZO (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue~ Bureau
of Individual Taxes~ ATTN: Post Assessment Review Unit~ Dept. Z80601~ Harrisburg~ PA 171Z8-0601~ phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death~ a five percent (5X) discount
of the tax paid is allowed.
PENALTY:
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed~ and not
paid before January 18~ 1996~ the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency~ or nine (9) months and one (1) day from the date of
death~ to the date of payment. Taxes which became delinquent before January 1~ 198Z bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1~ 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are:
Year
Interest Rate
Daily Interest Factor
Year
Interest Rate
Daily Interest Factor
198Z ZoX .000548 199Z 9X .000Z47
1983 16X .000438 1993-1994 ]X .00019Z
1984 llX .000301 1995-1998 9X .000Z47
1985 13X .000356 1999 ]X .00019Z
1986 lOX .000Z74 ZOOO 8X .000Z19
1987 9X .000Z47 Zool 9X .000Z47
1988-1991 llX .000301 ZOOZ 6X .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice~ additional interest must be calculated.
f
--
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: Ij3oj9:J
~~i:r~~
P.O. ox 250
217 S. Carlisle Street
New Bloomfield, PA 17068
Telephone: 717-582-7313
Capacity:
Personal Representative
x
Counsel for Personal Representative
.
(\
l/l./"
...
STATUS REPORT UNDER RULE 6.12
Name of Decedent: lhy,.erLL--
/Z/J..%o
I I
C:<oo { - 000 ~J
E:. II Gf /1},/I ~
Date of Death:
(,~
w-H:-r No.
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~ estata"i~ 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;< .
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.
Da te: J;Z/ / gl()~
/ '.,
s~rf 7~
kf/771Y 4. /J]of,{'tJJ
Name (Please type or print)
-p, o. '13c-:k ~S'O
Ne <J73Loo/YI flf LLJ ?A / '(0&'1
Address J
(7/;7) S'F:2. -- /f313
Tel. No.
Capacity: Personal Representative
X Counsel for personal
representative
(MAH:rmf/AM3)
,
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
COMMoNwEALTH ~F 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-154! 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.
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 may be answered bY e~!ling (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
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
Tax
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
[!] ljlllll~!~~.!i!jl~l!ll::;;;:"';"
...........::;:i::::::;;;;:;;;;;;::;,;;;:i.;i1i!!!MI[::;:,:,:,::""",,::::;:::jl!!Il~lijij,;::.................;;;;;;;;;;;;;;
[CHECK ]
ONE
BLOCK
ONLY
e above information and tax due is correct.
I. 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.
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
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
S
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line S of Tax Computation)
perjury, I declare that the facts I
knowledge and belief. HOME
I
$
an~
~ tJ/
I
DATE
~ n_~~_ __~ ft_~._~~___
I;:;!;;;;;;;;;;;;;;;;;;;;;;;;;;;';';';;;;;;;;;;;;;;;;;';:;;;;;;;';;;;;;;;;;;;,=':""""';"'"'';''''';';''''';"",;,;,;,;,;",;",;,;,;,;,;,','""".,;,.,.,...".'"
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent"s date of death.
3. A joint account is taxable even though the decedent"s name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A - If the information and cOllPUtation in the notice are correct and deductions are not being claimed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
To"," DrIo+. ......." &.; 1 ftorl ........ +h.... .,.a___...__.... _ ________..._~: ....._ _, ___ __ nun : _ ..... 'I __II "aft
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent"s date of death.
3. A joint account is taxable even though the decedent"s name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointlY between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent"s representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account inCluding interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent"s death:
DIVIDED BV TOTAL NUMBER OF DIVIDED BV TOTAL NUMBER OF X 100 PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100
16.7Z (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent"s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BV TOTAL NUMBER OF SURVIVING ~OINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: ~oint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BV 2 (SURVIVORS) = .50 X 100 50Z (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%* 12% 15%
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