HomeMy WebLinkAbout01-0130
PETITION FOR PROBATE and GRANT OF LETTERS
,;;'1-01- /30
JEFFREY A SNYDER
No.
To:
Estate of
also known as
Register of Wills for the
, Deceased. County of CUMBERLAND in the
Social Security No. 176-34-8801 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 execut rix
in the last will of the above decedent, dated December 1,
and codicil(s) dated
named
,19~
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in CUMBERLAND
h is last family or principal residence at 504 Wes t Keller.
County, Pennsylvania, with
Mechanicsburg Borongh
(list street, number and muncipality)
Decendent, then 57 years of age, died January 26, ,Jq~ 2001
~ 504 West Keller St, Mechanicsburg
Except as follows, 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 $ 1300.00
(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:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Tes tamentary
theron.
(testamentary; administration c. La.; administration d. b.n.c. La.)
on
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nka Barbara Jean Snyder
504 West Keller Street
Mechanicsburg, PA 17055
OATH OF PERSONAL REPRESENTATIVE
COMMON'''EALTH OF PENNSYLVANIA l ss
COUNTY OF CUMBERLAND 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 th{' 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.
REGIS
/G-.207-S
affirmed and
1
lJ;:~AN BLOMBAC)! .U'
.. ~M?,~~IJ/K/J
~ J~AN S~
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N 21-2001-130
o.
Estate of
Jeffrey A. Snyder
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW February 1st Uk2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that the instrument(s) dated December 1st, 1999
described therein be admitted to probate and filed of record as the last will of
Jeffrey A. Snyder
Testamentary
Barbara Jean Blombach, n/k/a Barbara Jean Snyder
and Letters
are hereby granted to
FEES
J~_
MARY C LEWIS ~ 'l/r /
REGISTER OF WILLS
$ 25.00
$ 9 .00
$
$ 6.00
TOTAL _ $ 5.00
Filed It'el::m..EFY' -1081::;2001... .$45...()Q....
Probate, Letters, Etc. .........
Short Certificates(3 ) . . . . . . . . . .
Renunciation ................
ATTORNEY (Sup. Ct. I.D. No.)
x-Pages (2)
JCP
ADDRESS
PHONE
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EXECUTRIX WILL PICK UP LETTERS
MAILED LETTERS AND ORDER TO EXECUTRIX
;__",:"",.o;:-r,,, 'c'-:y
This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as
Local~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~"",,,~>~Af)17
. Local Registrar
Fee for this certificate, $2.00
p
7121088
~~ 3,,' ;2()ol
{} f Date/
21-2001-130
Hl05.143Rev_ 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRINT
IN
PERMANENT
BLACK INK
..
COUNTY OF DEATH
57
Y<s.
UNDER 1 DAY
Hours i Minut..
SEX
2. Male
STATE FILE NUMBER
~AL SECUAtTY NUMBER
176 - 34
DATE OF DEATH (MonIh, Day, Year)
.January 26, 2001
NAME OF DECEDENT (Firs.. Middle. Last)
1. Jeffrey A. Snyder
AGE {laSS Bitlhday)
UNDER 1 YEAR
MonthI Da)'l
BIRTHPlACE (City and
Mec'1rah'l"c!'S'lJmlg,
7. P
FACIUTY NAME (II nollnslilutlon, give street and number)
="10
lb.
Cumberland
10. Mechailicsburg
KINO OF BUSINESSIINDUSTRY
MARITAL SWUS - ....,t~
HItWI' Married. WIdowed,
Dlvotc:ed(SpeciIy)
1.. Married
DECEDENT'S USUAl OCCUPRtON
{~:':~IiI~~~r:~~
. 11.. Electrician "0. Railroad
DECeDENT'S MAILING ADDRESS (Street. Cllyllown, Slate, lip Code) DECEDENT'S
504 W. Keller street ~~~NCE
Mechanicsburg, PA 17055 ~~':::'"
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17a. State
11.
FATHER'S NAME (First, Middle, Last)
Unknown
1lb. Coon
Mechanicsburg
c 11>0<0
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Removal from 51al80
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I Approximate
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DUE 10 (OA AS A CONSEQUENCE Of)'
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WERE AUlOPSY ANOINGS
oIM'dLABlE PRIOR m
COMPlETtON OF CAUSE
OF DEATH?
DUE TO (OA AS A CONSEQUENCE Of):
DUE 10 (OR AS ACONSEQUENCE OF)'
MANNER OF DEATH
DATE OF INJURY
(Month, Day, Year)
TIME OF INJURY
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED
Suicic:le
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Pending Invesligalion
.MEDiCAL EXAMINER/CORONER
On the baala o' eumlnallon andlor Inve"iglltlon, In my opInkm. .eth occurred.t the 11m.. date, end pl.ce, .nd due to the ceuHCa) end
m8ftttefe. ltaltel...................,........,.................................,......,.........'........'.........
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CERTiFIER (Check only one)
.CERTlF'tlNO PHYSICIAN (pny5lCl/lIl ceftilylOg cause of oeath when anolhar phy~1afi 'las pronounced (jealll and compleltld llelTl 23)
To.... best of my kno...... du1h DCcunecl ctu. to.... cauM(a) and manner.. atated. . . . . . . .
...
.PROHOUHC1NG AND CERTaFYINQ PHYSICIAN (Phy$icl/lll both pronouncIng dealtl and ceflllYlng 10 ca..~ ot dealn)
To the blNt of lilY kMWledge, dNth 0CCUtNd.. the I"", date, and ptace. and due 10 the cllUMCa) end fMnnet a. atllted..
.
,
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.
&
1Last Will
of
3/ effrep a. &npber
21.::.2001-130
I, Jeffrey A. Snyder, of Mechanics burg, Cumberland County,
Pennsylvania, hereby declare this to be my last Will and revoke all
Wills which I have previously made.
Item I. I give and bequeath all my tangible personal property,
owned by me at my death, to my friend, Barbara Jean Blombach,
provided she survives me for sixty (60) days.
Item II. I give, devise and bequeath all the residue of my estate,
real and personal, owned by me at my death, to my friend, Barbara
Jean Blombach, provided she survives me for sixty (60) days.
Should my said friend not survive me, but leave issue me
surviving, said issue shall take in equal parts per stirpes the share
which my said friend, Barbara Jean Blombach, who did not survive
me would have taken should my said friend, Barbara Jean
Blombach, had survived me. Provided further that any share or part
distributable to anyone who is a minor, but, instead, I give, devise
and bequeath the same to my Trustee, IN TRUST, to apply to the
use of said minor's, Barbara Lee Arnold, and David Michael
Arnold, at any time and from time to time, so much or all of the
income ( accumulating the balance, if any), so much or all of any
accumulated income and so much or all of the principal as my
Trustee, in it's discretion, deems advisable for the support,
education and welfare of said minors, my Trustee may, in it's
discretion, consider or disregard, to such extent as it deems
advisable, said minor's other income or property or the duty of
,
..
anyone to support said minor's (but it shall disregard the interests
of subsequent beneficiaries) and make any such application, among
other methods, by payments to said minor's, a guardian of said
minor's, or the person with whom said minor's resides, without
bond or security, and my Trustee shall not be bound to see to the
application or use of payments so made; my Trustee shall pay over
any then remaining principal and accumulated income to said
minor's upon attaining the age of 21 years, and should said minor's
die before attaining said age, then upon said minor's death, to said
minor's then living issue in equal shares, per stirpes.
Item III. I appoint my friend, Barbara Jean Blombach, Executor
under this Will, and as a substitute Executor, I appoint PNC Bank,
Mechanicsburg, Pennsylvania.
Item IV. I appoint my friend, Barbara Jean Blombach, as Trustee
of any trusts created hereunder, and as a substitute Trustee, I
appoint PNC Bank, Mechanicsburg, Pennsylvania.
IN WITNESS HEREOF, I have hereunto set my hand this 1st.
day of December, 1999.
Ji6 /( 41
SIGNED, SEALED, PUBLISHED, AND DECLAIRED by the
above-named Jeffrey A. Snyder, as and for his last Will in the
presence of us, who, at his request, in his presence and in the
presence of each other have hereunto subscribed our names as
witnesses.
i?.M.~ 5u.J~5
Name
5"1]30 Un tOn Ot2j;())tf- R.d. ( I.Jb CJ III- f? / J I
Residence I
/~~
Name
;90; [/.led.! 2~r/t ?Cd ~IJO/k'-;;;f.~/M/ 7057
Residence
..
.-
Commonwealth of Pennsylvania
County of Cumberland
On this, the 1st. day of December, 1999, before me,
.::2/4,//,/) L~ 6hE~.iJ u:~
the undersigned officer, personally appeared, Jeffrey A. Snyder
and witnesses, known to me (or satisfactorily proven) to be the
person's whose name's are subscribed to the within instrument, and
acknowledged that they executed the same for the purposes therein
contained.
In witness whereof, I set my hand and official seals.
~,~~,
Notary Public
NOTARIAL SEAL
DAVID t COFIELD JR., NOTARY PUBLIC
fAST PENNSBORO TWP. CUMBERLAND 00.
MY COMMISSION EXPIRES MARCH 31, 2003
-
s
--
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
0"E:PFIZ01 A. 6NYD~
l-~lc-OJ
Name of Decedent:
Will No. ~ -C) 1- 130
Admin. No.
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 () ~ - 01 - ~OD I
Address
Name
~fYvy<sef i) B~(8A~A ~~~b~YDen
S"D L( w\ /(~II-e fL 'S J; (}t 'e.-oAIA,v/co sh IVU /
(JA J ") P ~ ~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
tJ/fJ
,
Date:
;:;-3-0/
l?uj~f'/~ /I~;Y,-I~
Signature
BAt 81l L tJ J e iq N 'S Vi t:> (-Ie...
Name ~~ ~~
Address S-04 W. I~.u-
~ko 4 . fA l/()::;-~
,/
Telephone (7/06 C; 7'" :5: J S I
Capacity: ~ersonal Representative
_Counsel for personal representative
~e~I'Ie.~ A. S;n~
De ased:
1- d.{q - ;).001
CLAIM AGAINST DECEDENT'S ESTATE
Date
d-.I 01 13{)
Ol - / - ~OO I
In the Estate of:
Estate No.
The claimant certifies that there is due and owing by the decedent in accordance
with the attached statement of account or other basis for the claim the sum of
$ j~36-'6. 75". ;t9ee't~ *
I solemnly affirm under the penalties of perjury that the contents of the foregoing
claim are true to the best of my knowledge, information, and belief.
People's Bank
Name of Claimant
ture of claimant or p son authorized to make
verifications on behaJf of claimant
Roanne Imbimbo I Repavment Information Clerk
Name and Title of Person Signing Claim
People's Bank
1000 Lafavette Blvd. RC 6-271
Address
Bridaeport CT 06604
(203) 338-2474
Telephone Number
FILED:
RECORDED:
Claims Docket Liber
Folio
Instructions:
1. This form may be filed with Register of Wills upon payment of the filing fee provided by law. A
copy must also be sent to the personal representative by the claimant.
2. If a claim is not yet due, indicate the date when it will become due. If a claim Is contingent, indicate
the nature of the contingency. If a claim is secured, describe the security.
-
-
- .
peoplefl bonk
PROOF OF CLAIM
People's Bank
Bridgeport Center, 850 Main Street
Bridgeport, Connecticut 06604-4913
800.345.0207, ext. 2474
203338.7171
RE: Account #5466747006032223
To: The Estate of Jeffrey A. Snyder, late of 504 W. Keller Street, Mechanicsburg P A
17055.
Deceased: January 26,2001
The subscriber represents that:
1. The above-named deceased was at the time of his death, his estate is still, justly and
truly indebted to the subscriber in the sum of$ 1,356.75.
2. The nature and consideration of said debt is as follows: Purchase of commodities
and/or services made under People's Bank: Credit Card.
3. The subscriber has not nor has any person by its order, for its use, had or received any
manner of security for said debt.
WHEREFORE, the subscriber presents a claim to you as Retail Lending Officer of
People's Bank:, a Connecticut corporation.
PEOPLE'S BANK
BY:~~
Repayment Information Clerk
Subscribed alld sworn to this 7 day of May, 2001, before me.
rk4ti14 a c!iJ.
.~andra A. Sobocienski
NOTARY PUBLIC
My Commission Expires: June 30, 2002
/6 -0)07--.3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060l
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
~NTY
ACN
BARBARA JEAN SNYDER
504 W KELLER ST
MECHANICSBURG PA 17055
08-06-2001
SNYDER
01-26-2001
21 01-0130
CUMBERLAND
101
'*
REY-1547 EX AFP U2-DDl
JEFFREY
A
Allount Rellitted
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
) CHANGED
112,700.00
2,132.11
.00
.00
15,032.29
28.30
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdB. Costs/Misc. ExPenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Gover~ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate SUbject to Tax
8.685.10
107.699.17
13.508.43 X 00 =
.00 X 045 =
.00 X 12 =
.00x 15 =
(19)=
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4j-E'X-AFP-('li=oI>>r-NOYiCE--oF-YtiHEiiiTANCE-YAX-APPRAisEMENT~--Ar.LOWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SNYDER JEFFREY A FILE NO. 21 01-0130 ACN 101 DATE 08-06-2001
NOTE: To insure proper
credit to your account.
sub_it the upper portion
of this forll with your
tax paYllent.
129.892.70
(11)
(12)
(13)
(14)
116.~84 27
13.508.43
.00
13.508.43
TAX RETURN WAS: (X) ACCEPTED AS FILED
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
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. A.aunt of Line 14 at Spousal rata (15)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. A_ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
X C DIT
A ENT C (+
DATE INTEREST/PEN PAID (-)
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
.00
.00
.00
.00
.00
.00
.00
.00
.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.)
-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~e--f~az~ '-/ A. ~fVVDelL
, /
Date of Death: J~ fJ 9. 4>, ;;) CJO I
,
Will No. /) {- 0/- /30 Admin. No.
.
pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 'j... 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.
Date: <2:;'-30 - 0 (
/26A~(b~ ~~
Signature C7
g 14 f{ /Sri IlIJ J e IJ N <;;, tv YD ~ 1Z-
Name (Please type or print)
S'OLj LV, J( e//-e /L $ 'j, /JJ.e(1 f/ ~t<lI)OS)
Address
(1/7) b17-5)3/
Te 1. No.
Capacity: )( Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
REV-1500 EX (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
/({;-d07-3
REV-1500
OFFICIAL USE ONLY
S/J/
L-/
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
Cey-kE - 4A-I-
--Lao
NUMBER
I-
Z
W
C
w
o
w
c
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
31J D f-12. Je HI 4,
DATE OF DEATH (MM- D-YEAR) DATE OF BIRTH (MM-DD-YEAR)
0/ -;../ -I<j/f~
e -~ -' ()of
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
'j PY f} fl. I!>IUI3IU..!4
~.OriginaIReturn
o 4. Limiled Estate
~. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
J?b - 3'/ --8f{l>/
:r
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12.13-82)
D 5. Federal Estate Tax Return Required
L 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
I-
Z
W
C
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W
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NAMEI3~IlI5~U Je-Afl} S~
FIRM NAME (If Applicable)
TELEPHONE NUMBl'R ..-
717 - (,"11 -~/3 /
Efl-
COMPLETE MAILING ADDRESS
SOL{ W. l<.e/lelL S,
)?1ea-H/JAJ1l!.S 6.<-Jt..~ 1".-1. /7.050
(1)
(2)
(3)
(4)
(5)
11"),..~tJl -
~/'3~. II
PJ~
MI/
/ s;-o3,L ~tt
~ff;30
OFFICIAL USE ONLY
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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 Properly
(Schedule G or L)
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w
c:::
(6)
(7)
(8)
J:;.r fr?;), 70
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(9) 'iJ~'Il6', 10
(10)_i0'7~,q, L7
(11)
(12)
(13)
J/iPSgJ./,'J.?
.
135"0 ~I '13
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
-
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
/ 3S0~ 11-J-3
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
13S0g.J/3
utA
N/1J
AlIA
~oo
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19)
-0-
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 0'-1 j) . K'I/ -sf, ,
L .
crT} II t, ;' I STATE"" .<J I ZIP/7,,;;:;:,'..
ItEee' ...... "" /. f
Tax Payments and Credits:
t. Tax Due (Page I line 19)
2. Credits/Payments
A Sfl<Jusai Poverty Credit
B. Prior Payments
C. Discount
(1)
o
Total Credits (A+ B+ C) (2)
3. InleresVPenal1y if appucable
D. Interest
E Penally
,/)
TotallnteresVPenal1y ( 0 + E ) (3)
4. If line 2 is greater than line 1 + line 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5)
(5A)
B. Enter the total at line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
-0-
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transter 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; 0(. ....................... ..................
d. receive the promise for life of either payments, benefits or care? ................. ........................ .........................
2. If death occurred affer 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? . ... .............. ..................... ................... ................... ..................
Yes
.u 0
o
o
o
o
..0
....0 >Q
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
m
xO
)'.0
)1.0
XJ
)<,.0
Under penalties of perjury, I declare thaI I have examined Ihis relum, includio9 accompanyin9 schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other Ihan the personal representative is based on all inforrnation of which preparerhas any knowledge.
~I(;NATURE OF PERSqN RESPONSIBLE FOR FILlN(; RETURN
~~;o"__//"': Z,.'__
',(;;'1 (.0<(. II ( r 1/,
SI(;NATURE OF PREPARER OTHER THAN REPRESENTATIVE
i F~ .I i
, .
;,....,- \
,.',;
_l j
"
DATE
(.- j )--;J
DATE
'J I
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. 99116 (a) 11.1) (i)].
For dates ot death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the sUlViving spouse is the only beneficiary.
For dates of death on or affer 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 stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value oftranslers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116Ia)11)].
The tax rate Imposed on the net value of transters to or tor the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined. under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
'''''"''''',''''''W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
J.
FILE NUMBER
;';' ." i ,;
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price atwhich property would be exchanged
between a wlmng buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
sUlVivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
(i f
I
Ii
/" ~ '
'I
I'
.' f..:j ij
il
,(Y,' ;' iJ 7
TOTAL (Also enteron line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
11/ I, 7,/0, -
R~"OO3EX'(1''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DE EOENT
ESTATESlF
J co C, .q I' 'i 14-:' l"/ /) r/(.
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
;; 1-..11:"0/ -/ _':'Ci
All property jointly-owned with right ol.u",ivorship must be dioc\o$ed on Schedule F,
ITEM
NUMBER
Q
.J'
Ii, (i I !
.
I; ,
I" ;.,)"""4 0:::
[JI._ _,.
~
'" /
VALUE AT DATE
OF DEATH
(p/'/J.
f, {) '/)-
d- 01) ::;;'. () 7
DESCRIPTION
1.
r
-:JPv,
\;1,.,
I:;
J
'h'
i -dL
)iJl:J1
~.--'-
TOTAL (Also enter on line 2, Recapitulation) $
(II more space is needed, insert additionai sheets of the same size)
. -
'1-1 ;;) ,/ /
~'''EX'''.~ '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Je tS,R"'1
FILE NUMBER
;)/-;)()tJ/- 1<'0
.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
J
A
S/vY DFic
DESCRIPTION
C I'htf ON /11I,v!;>
9.3 fc//J2f."-
~.
-
,-"
c,,-~<. Jj} iJ dt'ff'"(. 'Al,,)N@.IDarV fJil^- 'T~(I/,-
,/1-1
,'j (. r~/."'I'~'f'
'1,
j).. C'\ ~<.I,,,,-, 'LlJGl."'-
0-"'0 :>7J~'!..'e.JAT,,J"',J~ If) (
GOf\ T ~f 7 P (i I I ~ r:~
./
..:J.
C. Iv !/I("
L.
TtJr/ 1$
7,
j---f)...-i;t;' .I,,, fie
7
/.! ~..". PV 7- II'~lD
.J ~ ALl, /1)/ Co /")'::;' . I'" I.: Q. .
1_'lre/C/NG 1..;J ,~
fNe p,I'1NI~. -, 'J,','-
-= 57 (\ J A. (1(' r _P- !J uv oJ. ! ,,/ "" I :/ j
Cj
,jj\.J _ SAV,U':,>'':'
/.j 1'4 C. Q ii, PI', c\ "f A L C. Ie E<j ,1 LA /J'
VALUE AT DATE
OF DEATH
fl,=..
(p '"/5'(), -
J;;{5V, -
'3 (,1 tJ, -::-
;;ou, -
J./IJIJ, -
'iOO, -
&/~~
9(;1, -
TOTAL (Also enter on line 5, Recapitulation) S / ~
(If more space is needed, insert additional sheets of the same size)
~~'''~''':71 '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
5IJY DEi?,
-
JPf,.h::p'-j
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
,:],
FILE NUMBER
J. /-:)OO/-/3/)
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A,
B,
c,
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account flumber or similar idenbfying number. AttGl:h
deedforjoinlly-held realeslale.
DATE OF DEATH
VAlUE OF ASSET
%0'
DECO'S
INTEREST
DATE OF DEATH
VALUEQF
DECEDENT'S INTEREST
1.
A
'O-)(JdJ me t'I\ b E'~ ~ I
1'f(p<6(,3
5/P,
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
~~,30
~"""."9:'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ES!t..U~ {) € e, J e 5- 5-R. ~y
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
It
FILE NUMBER ;< 1- ;JOt) 1- /30
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
DESCRIPTION
FUNERAL EXPENSES: F..... "I(? (U;. L.. 1'/0 "" E-
I'rI f\' PE;2.l. (
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (5)
Social Secunty Numbe~s) I EIN Number of Personal Represenlative(s)
Street Address
City
Slate
Year(s) Commission Paid;
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant 8 A ~ 8 A .e .q \ie-~ IJ S AI Y () EJl
Streetliddress ..) 0 ':I w . J( e II IE:' /l- $ I
City T'Iee.-t1I1V1C51!>v../l' Slate fli
Relationship of Claimant to Decedent VJ I tC.
Probate Fees
Accountanfs Fees
Tax Return Preparer's Fees
AMOUNT
f/fI;oli:,J.IU
Zip
. '70~--S
Zip
{,J,-
TOTAL (Also enter on line 9. Recapitulation) $ CJ Iofl,!.~/O
(It more space is needed, insert additional sheets of the same size)
.REV""""I:"".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT
,
MORTGAGE LIABILITIES. & LIENS
FILE NUMBER
~/-.jOOI-130
ESTATE OF
J'<.5H."1 A. SNY/)E-~
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
j.,
:3
~/
j
0-'
DESCRIPTION
fl.JC. f3,4,fIJ/< I {Y'V,,-, {gilt€. ~/V" V'O 'J"t:I ~u.,.
fN~ /3111/1( tltHHEtt<.d/ /.{OP3o'lffO /]0(, 3'>-~'I
AMOUNT
" 7,
'il '1~/-
f!1d:a fIIIwKeJ.-lIflf/ 5('1//'(""-S '-I Q 0.'-1 ~'1?y (p 7'-150 '86 't
Jlh/,r 'J3o'i.Jl;--J.
1/:>;),31;'
~..pofl"'::, t3/1iIJ/( i:'if.(P 7'170 0(,0"3 ~;;/J.5
I .5 ;;l. ;).. JpL/
Ve Ii, LtI/U 7f;; -(77- 5-13/
W A (( 0::' II 3 -</3'1 -) 'if 3
'/1,</6
I 79,/7
I 7,;/. ;) 7
1.
(!r/fJ'l!,s SI-IR.'2I1()[~ fl"""b...VJr
'if.
/loly 5/'"". T ffpsf, 74L
I:>.. -
'1.
:;j-O :>/, :3 b
l3/ue.. (!li' f Fe u.
IS-; -
/iJ. At' 1)(2('00, '1 /A7EL
/I, f/tl/y S/:;d.! Hf/S/",7/1c
I~, FI e ""r ~-'i '1/ (J()ol t).9()(" &i73l(
13 c'dU.t.<.T ClfY 15J3-0D3/-1o'f3fo-6176
d.J..:;B
'? ~-;,9, J 7
13~-t. . {O
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
107 !:?Y7../?
1~:'6911-j7
,'-. J-- 11-- ,~
I _., i
'~""".(':').
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE :/ T I' j (. \ .
I
NUMBER
I.
SCHEDULE J
BENEFICIARIES
i
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1.
t?Ailt'.lilli
. ( / V., <
FILE HUM E
RELATIONSHIP TO DECEDENT
Do Hot List Trustee(s)
J(f
AMOUNT OR SHARE
OF ESTATE
1,;>1;)
/~6
" ,: {'/
J I \ l i
./ ,I !
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
if;
I "i!.};
l :.1 f (
I
I "
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)