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HomeMy WebLinkAbout01-0065 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAl. USE ONLY ~ C'/ I r;r ;{Oc?l, - /0 w .... ::.:::'!If} u"'''' w"u ,,00 u"'... ..'" .. '" FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT L2a6--5-- NUMBER ':<L-L2L COUNTY CODE YEAR I- Z W C W (,) W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Tz..f W'~nf) DATE OF DEATH (MM-DD-YEAR) /1- i\;" ,^OoC!. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, ANO MIDOLE INITIAL) /<f.?f;/Tz.ea oaor/f r? SOCIAL SECURITY NUMBER J.O'!- - 03 /6$"7 DATE OF BIRTH (MM.DD-YEAR) I - i3 - AO. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER . ~ 1. Original Relurn o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after 12-12-82) 07. Decedent Maintained a Living Trust (AllachcopyofTrust) 010. Spousal PovertyCredit(da\e.o{(\ealhbe~1\12'31-91 aI1ll1-1-%} o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11, Election to tax under Sec. 9113(A) {AttacnSch0) .... z w C Z o .. Ul W '" '" o u NAME /lfi IT2..E-f(. COMPLETE MAILING ADDRESS "ao3 5 1IC//YlRn 5T {:/VC'-11 f'/J 170).S".~q9-/- FIRM NAME (If Applicable) TELEPHONE NUMBER 717' 73,{ -9"7 1S 1. Real Estate (Schedule A) 2. Slocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY 7. ;'66. '6 f z o < ...J ::l l- ii: cs: (,) w 0:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) '7. $''::'1. O<"C (6) (7) (6) '7. ..t "16 '?<i_ 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) 7. S'5'7'- C1C"'_ (12) -c (13) -c - (14) -C' - -0 x.O_ (15) x.O_ (16) x .12 (17) x .15 (16) (19) -C' 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;t I-' ::l ll. :liE o (,) ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) -0 - 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable al sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 0 ,3 r CITY STATE ~11 :"/VC'C.-/) Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Disrount (1) -C' Totai Credits ( A + 8 + C ) (2) ...c- - 3. InteresVPenalty if applicable D.lnterest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) -C"' o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q A. Enter the interest on the tax due. (SA) C' 8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT o PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ~ ff ~ ff cv- ~ 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;....... ....................... b. retain the right to designate who shall use the property transferred or its income;.. C. retain a reversionary interest; or....................... ......................"m <Um........................ d. receive the promise for life of either payments, benefits or care?. ................................ ...................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....... ..................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?... 4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation? .. ..................................... ................. .................. Under penalties of pe~liry, I dedare that I have examined !n;s return, including accompanying schedules and statements, and to the best 01 my knowledge and belief, it is true. correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT DATE .01 ADDRESS frJ 3 -d ~ /U .~L. ~ t'j 'fJ1) _ / TCJ ::'J...L:}- .:2<f'~/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (il)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparenl of the child is 0% [72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or forthe use of the decedent's lineal benefiCiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A siblin9 is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. "'. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERHANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edward H. Kreitzer FILE NUMBER 2001-00065 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cemetery lot $ 100.00 2. Richardson Funeral Home 2,889.00 3. Cemetery Vault 800.00 4. Opening and Closing of Ground 713.00 5. Casket 2,430.00 6. Head Stone Marker 495.00 :7 i l B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commiss\o!ls Name of Personal Representative (s) Social Securily Numbe~s) I EIN Number of Personal Representative!s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 20.00 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 57.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 55.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 7559.00 (It more space is needed, insert addijional sheets of the same size) REV.,00"'.[,.". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Edward H. Kreitzer All property jointly-owned with right 01 survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Metropolitian Stock FILE NUMBER 2001-00065 VALUE AT DATE OF DEATH $ 1,286.88 2. John Hancock Stock $ 6,000.00 TOTAL (Also enteron line 2, Recapitulation) $ 7,ltib.n-. (If more space Is needed, Insert additional sheets of the same size) PETITION FOR PROBATE and GRANT OF LETTERS Estate of E ri(O a. rrl/ft rY?~'/ t ze r No. ~ - 0 1- OO~5 also known as To: Register of Wills for the . /' Deceased. County of CUJYI B E-R L-PrN D in the Social Security No. ~ 0 '/ ()"3 / V; s- 7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrl' Y. in the last will of the above decedent, dated and codicil(s) dated fV"\ n \Ie y,\ \ S , cQOOC) named ,19_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) , Decendent was d?miciled. at .death i~ .f? ~'G7 Cum B.. County, Penn~lvania, with hIS last famIly or pnncIpal resIdence at /S (1?' ~. H L--l m eor ,51' c 11 () 1(1" rAil 09-..'5 I C__,l.-tJY1 he r {Q nd Co iA (\ + L.J , E C( s +- P ~ n n~ be (0 l(;j (). I , I (list street, number and muncipality) 0' /~ i..-YJ /} /) .-~ J --+ C (./ years of age, died / ~~ 6\ {)... '. ~ u (J l/ , ~ at ' /l.s . NNc)N '~ {) Except as follow, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ L,}uOC,OO $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.La.; administration d.b.n.c.La.) VJ '-' v u I:: v ~3 v I-; ~v I:: -00 1::'0 C'j.;: 3~ v 4- ~ 0 ~ I:: OJ) Ci3 Db;--.0 fA V R,Kr~1 17- e ~ ?D9 Si I H U /Yl t::;- Sf t- €-cf E /J(j /4. PJ ,/?t? 9..5'-(}.. qq/ ,~.u d^ ,/?, /f'-1 j',( ~LJV OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I s~ COUNTY OF c'ClmBERLJ\Nt) J ~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. A~Jr/ ;f ~~ 1t) llo- ~CiL-IO ~ ~. :::s t:l ...... ~ ~ ~ N fJl-O(-LrD{y~ o. O't Estate of E:f>vv A1\ D ~-L K RE (7 ll2R , Deceased DECREE OF PROBATE AND GRANT OF LETTERS 2- 00 t AND NOW JA-N LtAR~ , to .%_, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated m A l=(c.J-f j G I ~ 060 described therein be admitted to probate and filed of record as the last will of E D V\J A R D H. KRE ( TZ f:'R and Letters TE~ r A III EN r AR Y are hereby granted to DC RC TH 'I R. KREI TZE'~ FEES 4DOO Probate, Letters, Etc. ......... $ . , Sh t C . f' t (1) $ 3 - 00 or ffuca es . . . . . . . . . . .- R('Hl~iat1ott ................ $ q. 00 sep $ 5.00 TOTAL _ $ 51.0-0 Filed .. L-.I.~:-Q .t........................ ~~{}'~~'PUtXn1'~~{j. 'U.. Reg'istert5f Wills ' bf~ J ( _ i ATTORNEY (Sup. Ct. LD. No.) ADDRESS PHONE LE rTG:R~ rY) Pn LB1) 'TO E:X-&-LL-LT DR, Hl05.RO'i REV'J!Pl, This is to certify that the information here given is correctly copied from an original certificate of death dul~ tIled with me as Local Registrar. The original certificate will be forwarded to the State Vital Records ()ffice for permanent filIng. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 6920702 No. a //~ f~ 1f....It/ ;/ ( ~ 1'2A4 ~,IL-- Local Registrar if NOV 2 Z 2000 Date 5.143 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA e DEPARTMENT OF HEALTH e VITAL RECORDS CERTIFICATE OF DEATH DECEDENT'S EDUCRION MARITAL STRUS - Married S if on h est com eled Never Married. Widowed. ElemllfllarylSecondary College Divorced (Specify) 13. (Of~ (1.4orS+) 1.. Ma r r i e d 15.Do rot h y Did 17C.~ Yes, decedent lived in E a s t Pen n s b 0 r 0 decedent live in a Cum b e r 1 and township? 17d.D :h::'-:~i~': 01 MOTHER'S NAME (First. Middle, Maiden Surname) 1.. Lottie Kerns INFORMANT'S MAILING ADDRESS (Street. CltylTown. Slale, Zip Code) .803 S. Humer St. Enola, Pa. 17025 PLACE OF DISPOSITION. Name 01 Cemetery, Crematory LOCRION . CltyfTown, Stat.. Z~ Code or Olher Place Woodlawn Mem. Gardens 21C. NAME OF DECEDENT (First, Middle. Last) 1. Ed war d H. K rei t z e r SEX 2. Mal e AGE (Last Birthday) UNDER 1 YEAR Months Days 5. 80 COUNTY OF DERH UNDER 1 DAY Hours ! Minutes I BIRTHPLACE (City and State or Foreign Country) Yrs. lb. Perry DECEDENT'S USUAL OCCUPATION (~,V:~~~'lih,~r~d:~u~r~~r~gr . 11.. For em a n 11b. Con r ail DECEDENT'S MAILING ADDRESS (Slleel, CltylTown, State, Zip Code) DECEDENT'S 8 0 3 S" Hum e r S t " ~~~~~NCE Enola, Pa. 17025 ~~~:I:~)ns 1.. FATHER'S NAME (First, M.Odle. Lasl) 1.. E d war d K rei t z e r INFORMANT'S NAME (Type/Print) Do rot h yR. K rei t z e r METHOD OF DISPOSITION BurialU Cram.lion 0 Ramoval Irom State 0 Olher (Specify' Ie. Dun can non KIND OF BUSINESs/INDUSTRY 8d. Kin cor a P y t h i an WAS DECEDENT EVER IN U.S. ARMED FORCES? Yes4J No 0 Home 12. 17.. State Pa. 17b. Coun 27,2000 LICENSE NUMBER Db. 0 1 2 7 7 4 - L To the 01 my knowledge, death occurred at the time, date and place stated ure and T.tle) .. hems 24-26 must be completed by DATE PRONOUNCED DEAD (Monlh. Day. Year) ~ perllOn who pronounces death =-- 24. 6 . 3 5 P M. 25. No V em b e r 2 2 2 0 0 0 27. PART I: Enta, the diseases, injuries or complications which c.used tha death. 00 not enter the mode 01 dying, such as cardiac or respiratory arrest. shock or hurt lailure. List only one cause on aach line. IMMEDIATE CAUSE (F.nal disease or condition resulllng .n death)_ Asp ,'(< A -i,'D)1J fJlf) EtA 11-10'" /A . DUE TO (OR AS A CONSEQUENCE OF): MCAlf( if CfRf~*AL tJAS('l..t/,.~ ~CC"t1Et1-1S DUE TO (OR AS A CONSEQUENCE OF): Sequentially list con4itions il any. leading 10 immediate cause Entef UNDERLYING CAUSE jDisease or Inlury . " that Initiated events resulting In death) LAST b. DUE TO (OR AS A CONSEOUENCE OF): d WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? MANNER OF DEATH DATE OF INJURY (Month, Day. Year) ~ o o STATE FILE NUMBER SOCIAL SECURITY NUMBER 3. 2 04 - 03 - I 6 5 7 DATE OF DERH (Month, Day, Year) ~November 22,2000 ERlOutpatient 0 ~::IY) 0 RACE. American Indian, Black, White, etc. (Specily) 10. Wh i t e SURVIVING SPOUSE (II wile, give maiden name) Ritter lWp. citylboro Lower 21d. Paxton Twp. Pa. NAME AND ADDRESS OF FACilITY 22c. R i c h a r d son F " H " 2 9 S " E n 0 1 a Dr. E n 0 1 a , P a . 1 7 0 2 5 LICENSE NUMBER ORE SIGNED (Month. Day. Year) 2~. 2k. WAS CASE REFERRED TO MEDICAL EXAMINERlCORONER? Yes D Nn 2.. I Approximate I interval between onset and death PART II: Other signifICant conditions contributing '0 death. but not resuhing in the undellying cause given in PART I. "" ~ L.'+ l^'s " TIME OF INJ RY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Pending Investigation Could not be detefmined D o D PLACE OF INJURY - At home, larm~~eet. lactory. off'lCe M. building, etc. (Spec,ly) 30e. Natural Homicide Accident Yes D No IKI Yes 0 No 0 Suicide .21a. 28b. CERTIFIER (Check only one) "CERTIFYING PHYSICIAN (PhySIC,an celtoly.ng cause 0' death when another phYSIClCln has pronounced death and completed lIem 23) To the tlnl 01 my knowledge, dealt! occurr.ct due to the caUM(a) and m.nner.. .wted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. ~... :-:: . :~ ~ 'PRONOUNCING AND CERTIFYtNG PHYSICIAN (PhYSIC.an both pronounc,ng death and certifYing 10 cause 01 death) To the tlnl of my knowledge, .alt! occuned al the lime, data, end p*e. and due 10 the cauaeta) and manner.. atated.. . . . . . . . . . . . . . . . . . . . . . . . . "MEDICAL EXAMINER/CORONER On the b.... of .xamlnatlon .nd/or Inv.atlgatlon,ln my opinIon, d.ath occ;urrecl.t the tlm., dat., and pbIc" and due to the c.uM(a) and mann.r .. "ated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.. REG~ATUR~N~ 33. ~' '" C ~~'"\'-1liC--~ .- I ~1/1..l1 / ( I I. Yes 0 NoD lOCATION (Street, City!Town. Stale) o D 32. DATE FILED (Month. Day, Year) (/ 1M LAST WILL AND TEST AMENT OF EDWARD H. KREITZER I, EDWARD H. KREITZER, of 803 South Humer Street, Enola, East Pennsboro Township, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: PAYMENT OF EXPENSES - I direct that all my just debts and any funeral expenses not prepaid, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. SECOND: RESIDUE OF EST ATE - I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal, or mixed, of whatsoever kind and wheresoever situate, unto my wife, DOROTHY R. KREITZER, provided she shall survive me by thirty (30) days. In the event my wife fails to survive me by thirty (30) days, I then give, devise and bequeath my estate as follows. A. To each of my children, the respective items that were given to me by that child; and B. My children shall choose any other items that they desire, as they can agree. The rest, residue and remainder of my estate shall be sold, and the proceeds therefrom be distributed so that each child receives an equal value of all assets received pursuant to this Subparagraph B. P AGE ONE OF FOUR .' 1 However, if a child does not survive me and leaves children who so survive me, such children shall receive, per stirpes (by representation), the share my child would have received had he or she so survived me. THIRD: TAXES RESULTING FROM MY DEATH - All federal, estate and other death taxes that may be assessed as a consequence of my death, whether or not the assets pass under this Will, shall be paid from the residuary estate of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary or joint owner. FOURTH: EXECUTRIX - I appoint my wife, DOROTHY R. KREITZER, Executrix of my Will. In the event that she predeceases me or is unwilling or unable to serve as Executrix, I then appoint my son, JAMES E. KREITZER, Executor of my Will. Neither my Executrix nor any successor shall be required to give bond for the performance of their duties. I grant to my Executrix and successors the power to compromise claims without court approval and without the consent of any beneficiary. FIFTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual payment to a beneficiary or to his or her account, no interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary. P AGE TWO OF FOUR J . IN WITNESS WHEREOF, I hereunto have signed my name to this, my Last Will and IlL.. Testament, consisting ofa total of FOUR (4) typewritten pages, this ~day of ~t,{ ~ 2000. / 8>t~ ~I-!-/tf--'l~~ 5 ~. EDWARD H. KREITZER, Testato In our presence, the above-named Testator signed this and declared it to be his Will, and now, at his request and in his presence and in the presence of each other, we sign as witnesses: ~/~~ ~.U~ ST A TE OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND I, EDWARD H. KREITZER, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will and that I signed it as my free and voluntary act for the purposes therein expressed. 8o&d'J~J /{~~ EDWARD H. KREITZER, Testa r .r PAGE THREE OF FOUR I . We, having been duly qualified according to law, depose and say that we were present and saw EDWARD H. KREITZER sign the foregoing instrument as his Will; that he signed it as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing and at his request signed the Will as witnesses; and that to the best of our knowledge he was at the time 18 or more years of age, of sound mind and under no constraint or undue infl uence. 4J~/~ ~~. /) JtJku Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testator and by the witnesses whose names ePpear opposite on this J S"-f day of rt.r c ~ , 2000. W/lf~~ Notary Public '\ NOTARIAL SEAL RlCMARO l WEBBER, JR., NOTARY PUBlC IEWVILLE BORO., CUMBERLAND COUNtY MY COMMISSION EXPtRES MAY 6 P AGE FOUR OF FOUR y :l6'-~C)Q-/D 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 DOROTHY R KREITZER 803 S HOMEN ST ENOLA PA 17025 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-23-2001 KREITZER 11-22-2000 21 01-0065 CUMBERLAND 101 Sl (/ ~ REY-1547 EX AFP el2-00) EDWARD H 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 ~ ifE-,,=is4-j-EX-AFP--fi"2:0(ir-NO,.-icE--OF--rNHEifiTAifcE-"AX-]rpPRjrisEiiENT~--ALiowAircE-o-R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KREITZER EDWARD H FILE NO. 21 01-0065 ACN 101 DATE 04-23-2001 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) .00 7,286.88 .00 .00 .00 .00 .00 (8) 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 14. Net Value of Estate Subject to Tax (9) (10) 7,559.00 .00 (11) (12) (13) (14) (Schedule J) NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL 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: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 7,286.88 7.559 00 272.12- .00 272.12- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045= .00 X 12 = .00 x 15 = (19)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * 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 HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Edward H. Kreitzer Date of Death: November 22, 2000 Will NcROO l-OOOh C) (2001-00065) Admin. No. 21-01-0065 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Dorothy R. Kreitzer Address 803 S. Humer St., Enola, PA 17025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name ~~tu;-7(.~~ Address 7 () :3 J. ~L4nL--t.-- c-<tt; .u..:C ~(J--ll1 ~ r'--fJf), 17.1J<S-;J-.<t t.j / ( Telephone (/1 'J 7 g ~ ' '9'7 1 :;- Capacity: _ Personal Representative _Counsel for personal representative G ,~ ,.. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Edward H. Krp;r7.pr Date of Death: November 22, 2000 Will No. 2001-00065 Admin. No. 21-01-0065 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ 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 . 9~~ _~ .r 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 I 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:~.f1.p.~ q ~Oo J )}~~- -;f~2P Signature Do ro/IJ //l( Kre//~er Name (P leas/e type or print) :1C3 .cJ, f/v/J1~ r Sf. ~N6lt.lP/J. Address /7 d ;;;J-S- (7/1) 7S~ - <77CfS Tel. No. Capacity: Personal Representative Counsel for personal representative (MAH: rmf / AM3) ( ~~ ~ ~ ',t C) , ~ ~ '-. 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