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Home My WebLink About01-0159 PETITION FOR PROBATE and GRANT OF LETTERS No. To: 21-01-159 Estate of GEORGE W _ KASSEN also known as Register of Wills for the Deceased. County of CUMBERLAND in the Social Security No. 195-07-9449 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 or in the last will of the above decedent, dated Apr i 1 19, and codicil(s) dated named , 1922- (state relevant circllmstanc~s, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in h ; ~ last family or principal residence at CUMBERLAND County, Pennsylvania, with 1 en ~ rhnthnm nrivp C?r(Y\.~ \"Ull Lower ~l]en TOWQ5hip (list street, number and muncipality) Decendent, then 96 years of age, died January 30, 2001 at 1913 Chatham~Drive 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 (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: $ 640,000.00 $ $ $ 103,000.00 1913 Chatham Drive, Lower Allen Township Cumberland County. PA WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentarv theron. (testamentary; administration c.La.; administration d.b.n.c.t.a.) VI Il.I U c::: 1J ~- .C;;~ Il.I ... ~1J c::: ~.g cu'::; _1J ~c.. Il.I '- ~o C; c::: OIl en . g.. h/o~) ?l.~ ~a1ter L. Mehaf ie 3818 CenterfieJd Road H;::\rric::hllrlJ, pn 1710Q OATH OF PERSONAL REPRESENTATIVE COMMON~EALT.H OF PENNSYLVANIA 1- ss COUNTY OF CUMBRRL.AND 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. pctitioner(s) will well a ~ruly admi ister ee'ftate according to law. 7/ . Mehaffie Sworn to or affirmed and subscribed { before me this 8th day of Wa \ );~~,r,(tJf"m." ~.A'i~"'< ",,/ /.)' j ./ I / Register . . I ~ ;]c-j(l- I ~o. 21-01-159 Estate of GEORGE W. KASSEN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW February q 2001, 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 AI;> r ill 9, 19 9 9 described therein be admitted to probate and filed of record as the last will of George W. Kassen and Letters Testamentary are hereby granted to Wa1 ter L Mpnrl ff; p Probate, Letters, Etc. ......... Short Certificates( ).......... .1{-paRe s KenUn~lation ................ JCP $ $ $ $ TOTAL _ $ 471.00 . .r:~l?.. . '~" . f.qq ~ . . . . . . . . . . . . . . . . . . . 445.00 12.00 ~.OO ~' La /) ;;x,;;;/wk't',/41' /*lzj/ , gister 0 f ills / Edmund G. Myers (20558) Johnson, Duffie, Scev~_rt & Weidner FEES 5.00 3 0 1 AkTfORNEY (Sup. Ct. I.D. No.) Mar et St., P. O. Box 109 Lemoyne, PA 17043-0109 ADDRESS (717) 761-4540 Filed 7J)9 e_ ~~'/ 6, / PHONE /Jr /,.,/" .7 _ ,~/ V"C ~ ( //'-__ -;;,- LyY -' -.' - /! Ii i", t"l) l.'L'rrl!\ ~h~l{ R'T!\LLll. l hl' till" ll1hlllJi.ll,"!1 hen." ll'i:.I'".-\ft \\i!i \ i ( ,1 n ,i (, 'Jl I il! 11. d ,.c Ii Ji 'c',( t ,-' ,) I l \1",'1-, '"LI-l"ll.'\.'. 1"~.(I' '.ktll];llhtlt \ J ; fl" '" 1. l( '; 'J I, , \NARNING: It is illegal 10 dup!icate this copy by photostat or photoqraph. : i' ,', ;-;/-/;/i,f/;", '-::".~.. .~~ '1':' t-,\ \ \1 OFI'F,'~-: {1~~;lt ~f; 5~. ~'i \~dh'"""'i ", <~.~~~~;,:! ~~/..~',tN \J.,w,/ ;:_"~:'.::~~,/!-~~()_~' '.! I ,"'- ~Jj / '-'\ , \ ~ -~_......\ "~' '-- !'Y !,,:".',l: / fl'l,' fur \lil', ,_,-.rr\1h([,' ..,,20i\ ,r P 7284253 0/ - 3/ - 01________ --~_.._.---- -~- 1 ~ i: ,: '...;, 21-01-159 HIQS.:QR.. 2117 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT Of HEALTH · VITAL RECORDS CERTIFICATE OF DEATH lIrlllHT ... '~T _CIt INK Vra, UttOEA 1 00Ilr -! ......... STATH'l1 !oUt.IIIVl SOGIAl. SECURITY NUM8ER NAMEOFDECIDENTIF..,Mod...~----'-'-"----------- SEll t. George W. Kassen AGE (laor-'" utlOEA 1 ~ - o.y. 3.195 -07 ~ January 30, 2001 96 8IRT~:C.., ...-<1 3Wearf"'...".Counor", 4 Harrisburg, ~o " I "/' / I 5. COUNTY OF OEAl'H Cumberland RACE ._-.~ -.. olC. cSilecl'rI .. Ie. White DECEDENT'S USUAL CX:CUMlON ~.:=:.:..,::.::~::i' American Can Co. tt Utilit -Parts Uk. OECEOEHT'S MAIlING AOOAESS(Slr_~. _. ZII>Cooel 1913 Chatham Road l~amp Hill, PA 17011 FRHEII'S NAME IFirtL _. lUll tL Geor e W. Kassen ~SNAME (1-"'"1 Walter L. Mehaffie WETHOOOF OlSPOSITlON .... (]I 1:<_ 0 ,,--_s.-O Olfw (SpecIyt I~. Did - ... ... Cumberland ......7 17...0 ::w.-==-=", MOTHER'S NAYf! ,f.... _, ..-.s..."'-l I.. Mar Nolan 1Hf'00000TS lolM.lNG ADOAESS IS..... C4y1'bwn. s... Zip Cooel .3818 Centerfield Road, Hb , Pa. 17109 PlACf OF 0lSI'0S/Tl0H. ~"'~ I:<--.y lOCRlOH.~ sa-. r...Coda 01 ou... PIaclI ... ITef] -.__.. 1MAllAl. SWUS. ~ ---.-. o.--t~ W. SUfNMNG SPOUSE (._,~-- DECEDENT'S ACTUAl. AESIOEHCE cs....-- ""-- tT.. sa- Low~r - ~ J DATE PRONOUNCED DEAD 1_, o.y. _I 2~ 13.14 FM lot 2$. January :l), AD1 17. HIlT l: e........ -.. ......... ~_........ cauMCll/le C1e11ll, 00 noc .....1IIe _ 01 cIVtnO. SUCIlIS CltClilc Of ,_It..... ..,.... _ Of "-.."..... lJal 0I'#t _ CIIMI on __ _ ~91ling Green Memorial Park 2101. Camp Hill, PA IWolE AMlJ A/JOAESS OF FACIlITY Z2c~1CO LinglestcM1 Read, Hbg, Pd. 17110 lICENSE NUloI8ER DATE SIGHED (MOrWI. ~ _I Ia. Dc. 'M'.S CASE REFERRED TO MEOICAI. ElWoUHERoCOAOHEJl1 .....0 MQ@ ~ I AppfouNI. '-- : _1nCl..... I ~ PAIlT I: Olfw ~ -.........dMlII.... 1IlII--.g..... -.._.....inrwn I. C 't4 .r l:M; lOtoR AS A CONSEQUENCE ~ urn I: DUE 10 toR AS A CONSEQUENCE ~ l:M; 10 toR AS A CONSEOUENCE ~ MAE AU1tlI'SY FlNOlNOS ~~1O COWlETlON (7 CAUSE OF 0ERK1 lotANHER Of' DEATH DATE OF INJURY ,_.0.." -. TIUE OF IHJUAV INJURY III WOflI(7 DESCRlIIE HOW IKJURY 0CCUflAE0. .....0 NoD - - Sulctda iJ o o Homil:ida o o o I'UlCE (7INJURV .AI_........ _. '1dDry._ M. -. eoc, c5pacoM _. ..... 0 NoD "-'II "-igaIioft CouIcInoc ..._ .... ~oO>ec:k_ ..... .c:&nI'YWOI'ttYSlCIANI""_~"-d___pnvsc...._lJf__"""c_._n) -..._oc...,--........-occ......._.....e...Ni.,__'.._.........,............., . a. o 31k. ~ lICENSE NU_R DI 3tc. IV"- D 0 \ '\" SS,Q 21 Jan. 31, 2001 =2~~=..:.(7j'4:~~J?eu-n~M(. l 10'l:3 <..0.......(1-......... L.k ~ '1 'V It. ~ ~ lfC)'1") 32. DATE FILED 1_ Oay, _, "PIlOMOuNCINO AHO aIlTlf'YlNG ,,"'SICLUI (~""'" "''''''''''''''''9 _ _ cOflOly<nQ 10.,.,.. "'_I 10... _ oc ..., 1uIowla<IQ.. ..... occ....... ..... _, 010,-. ..... pe.c.. ..... _..... CIUM(.'- "'.__. .. ...,..., , -..oec:.u. EXAIIIHEAlCORONER On'" __ oIe.-..1oft MdJo. "'-.1'-. In my opinjon. ...h occun... "'Ilellme. dele, and place, and _10.... .....M(.I and ;)tL - .. ltal".. . . . . .. . . ' . . ' .. , . . . . .. .. . . . . . . . .. . .. .. .. . . . . . . . .. .. . . . .. , . . . . . . . . . . . .. . . . . . " ' .. . .. . .. . . .. .. . .. .. AEGlSTRAA'S SlGNATUAE AHO NU_R o ~~I~ ;w, C)/- ::>)-&:'t 01 0944-00001/4. 14.99/EGM/DLM/1 02073.1 , , . , 21-01-159 mast mill an~ westament OF GEORGE W. KASSEN I, GEORGE W. KASSEN, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the paYment of my legally enforceable debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II I give and bequeath my motor vehicle(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my nephew, CLYDE J. PEFFER, provided he survives me. ARTICLE III I devise my real estate known as 1913 Chatham Drive, Camp Hill (Lower Allen Township), Cumberland County, Pennsylvania, unto my nephew, CLYDE J. PEFFER or his then-living issue, per stirpes, should he predecease me. If, at the time of my death, I no longer own the real estate known as 1913 Chatham Drive, Camp Hill, Pennsylvania, I give and bequeath the sum of ONE HUNDRED THOUSAND DOLLARS ($100,000.00) unto my nephew, CLYDE J. PEFFER or his then-living issue, per stirpes, should he predecease me. ARTICLE IV I give, devise, bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate as follows: A. Thirty (30%) percent thereof unto my nephew, CLYDE J. PEFFER, or his then- living issue, per stirpes, should he predecease me; and B. Seventy (700/0) percent thereof unto my nephew, WALTER L. MEHAFFIE, and his wife, BETTY J. MEHAFFIE, or the survivor of them. If neither survives me, I give, devise and bequeath the same unto their then-living issue, per stirpes. ARTICLE V I name, constitute and appoint my nephew, WALTER L. MEHAFFIE, Executor of this my Last Will and Testament. Should WALTER L. MEHAFFIE fail to qualify or cease to so act, I name, constitute and appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, Alternate Executor to con1plete the administration of my estate. No fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. 2 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 17~ay of /Id'~(j , 1999 /.k~ y tv /(~~ GEORGE W. KASSEN (SEAL) Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, 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. IhWC/)); }~ ~A/~. 3 '. ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEAL TH OF PENNSYL VANIA SSe COUNTY OF CUMBERLAND We, GEORGE W. KASSEN, . .(s::~} {'v"~'~- ,~ '-("(, -~''-'.J and <<. ~\.;", '-'" Ow ,,, ~ o'!3 ' the Testator and the witnesses, respectively, whose names are signed to the a ached or foreg01ng Instrument, beIng first duly swum, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of hislher knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. p~ UJ -If ~A-- GE GE W. SSEN ~/~d fJ~ WItness /~p4 Subscribed, sworn to and acknowledged before me by GEORGE W. KASSEN, Testator, and is::, x,,""'-~ \~~ _,~'" I and ....\ ~....j..", ~ \r~,~ ~ ,-') . h' \~~~ f . ~ ,~ . wItnesses, t IS.-...y . 'uay 0 c:..'J",",--v_':L , 1999. 1 ~ ~ ~ ~\ ..~". N~t~ryip~blic ~'S"~ " My Commission Expires: NOTARIAL SEAL I DIANNE LENIG, Notary Public I Lemoyne Borough Cumberland Co. I My Commission Expires Dec. 21, 2001 I .J 4 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Emily J. Group Date of Death: January 16, 2002 Will No. 21-02-159 To the Register: I certify that notice of 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 June 25, 2001: Name Address Ronald A. Group RRl, Box 117-2 Loysville, Pennsylvania 17047 Gerald M. Group RR1, Box 70 Elliottsburg, Pennsylvania 17024 Randall A. Group RR2, Box 15A Green Park, Pennsylvania 17024 Yvonne D. Kuhn RD 1, Box 1014 Landisburg, Pennsylvania 17040. Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: rYlI12/<-?z )/L~ t.cCr\)~ --1Signature) Name: Shaun E. O'Toole, Esq. Address: 2813 North Second Street Harrisburg, Pennsylvania 17110 Telephone: (717) 213-6653 Capacity: _ Personal Representative -2L Counsel for Personal Representative -- r.: ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: George W. Kassen Date of Death: January 30, 2001 Will No.: 2001-00159 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Ruies was served on or mailed to the following beneficiaries of the above-captioned estate on March 8, 2001. Name Address 3309 Market St., Camp Hill, PA 17011 Clyde J. Peffer Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: :s/Jl ~ ( -j/ i:~~ Signature Name Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative REV.1500EX (5-00J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL llSE ONLY o w ,., ::s:::$cn ,,"'''' wOo" :3:09 ug:lQ Oo " / (;- dtJq- I INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2 1 0 1 00159 COUNTY CODE YEAR NUMBER I- Z W C W U w c DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) KASSEN, GEORGE W. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) January 30, 2001 July 28, 1904 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 195 - 07 9449 ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (A~ad'lcopyofWill) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12.12-82) 07. Decedent Maintained a Living Trust (AttathcopyOrTrIlSI) o 10. Spousal Poverty Credit (datB of death belween 12.31.91 and 1.1.95) o 3. Remainder Return (dale of death prior to 12-13-82) ~ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AllachSeh0) I- Z W " Z o Oo '" W '" '" o " !:l!$\~iocJlq),ii:rAl1:st;l;lioi~Q"'If,[!:tI;!P:;A4(;;coRREs.~QNPEN~E;i~Nl1;C!iiNF'pE!lfiA!\~ri.\.X'I!'lF.Q~M".rl&>I"I'$'I:1Q\JtD'l!iopiREC;;J'ioPito: NAME COMPLETE MAILING ADDRESS Edmund G. M ers, Es 301 Market St. FIRM NAME l'Appl....1 P.O. Box 109 Johnson Duffie Stewart & Weidner TELEPHONE NUMBER Lemoyne, PA 17043-0109 (717) 761-4540 (1) (2) (3) (4) (5) 103,440.00 485,148.80 OFFICIAL USE ONLY " z o !;;c ..J ~ I- D: < u w 0:: 1. Real Estate (Schedule A) 2. Slocks and Bonds (Schedule B) 3. Closely Held Corporation, PartnershIp or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule O) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. InterNivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) 35,138.36 (12) 722.969.03 (13) n_ (14) 722,969.03 x.O_ (15) -0- x.O_ (16) -O- x .12 (17) -O- x .15 (18) 108,445.35 (19) 169,518.59 (6) (7) (8) 758,107.39 (9) (10) 33,077.52 2,060.84 14. Net Value Subject to Tax (line 12 minus line 13) z o ~ I-' ~ a.. :i: o U ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate. or transfers under Sec. 9118 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 722,969.03 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ':ii:::;:II!:; ':,.:.,,:"',::.';, ~"i,;,_,:l;;,';~;"!,,:;;":;~:"- ,!i~~:':l'",$'. ~>BE_SW1:Elcj MilSViER ALDQu:ESTioNS 6f:I RE\lER~E'SIDE >!'-ND, ~ECHECKMATH",,~ <: l',' ,'::: '<"l':",,; ,'i,.'..'.;..:W,;j;;i:;,i,'" Decedent's Complete Address: STREET ADDRESS 1913 Chatham Road . CITY Camp Hill I STATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 95,000.00 5,000.00 Total Credits ( A + 8 + C ) (2) 100.000.00 3. InteresVPenally if applicable D. Interest E. Penally -0- TotallnteresVPenally ( D + E ) (3) 4. If Line 2 is 9reater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 108,445.35 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8.445.35 -0- 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) 8 , 44 5 . 35 Make Check Payable to: REGISTER OF WILLS, AGENT r"l'a~~~ll\\l'lWji~~~~;L'@.!Il!I'$.~>!j;lMW~~$;WJii,,!of~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the nght to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or................................,......................................".."'....."................................."... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12. 1982, did decedent transfer property within one year of dealh without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuily, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 No J[] J[] o o J[] o o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, 1 declare /hat' have examined this leturn, JncJudJng BCCDmpBnyi11g schedules and statements, and 10 the best of my knowledge and belief, it is true, cortee! and complete. Declaralion of preparer other than the personal representative is based on all information of which preparer has any kno'NIedge. SIGNATURE OF ER ON R 0 IB LING RETURN ADDRESS Walter L. Me affie, Executor 3813 Centerfield Road, Harrisburg, PA 17109 SIGNATURE OF PR ARER OTHER THAN REPRESENTATIVE ADDRESS mun . Myers, Esq. 301 Market st., P. O. Box 109, Lemoyne, PA 17043 ~~4ft!~;;~~~~~:f~T~~~~~!4'i!tif,g,"~r~l!~fJ:W~~~1il~~~_i!1~~l@..~d:~G.i~~~~~~:~ Far dates of death an or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers 10 or for Ihe use of Ihe sUNiving spouse is 3% [72 P.S. ~9118 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, the tax rate imposed an the net value of trensfers to or for the use of the SUrviving spouse is 0% [72 P.S. ~9116 (aJ (1.1) (ii)). The stafute 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 sUNiving spouse is the only beneficiery. Far dates of death on or after Juiy 1, 2000: The tax rate imposed on the nel 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, ora stepparenlofthe child is 0% [72 RS. s9'16(a)(1.2)). The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneflcianes is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 99116(e)(1)]. The tax rate imposed an the net value of transfers to or lor the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is denned, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV'~EX'I'.n,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF KASSEN, GEORGE W. FILE NUMBER 21-01-00159 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 at which property would be exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of sUlVfvorshlD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Real Estate - No. 1913 Chatham Drive, Lower Allen Township, Cumberland County, Pennsylvania. (Deed Book E, Volume 17, Page 437) Assessed Value based on 2000 County-wide reassessment to 100% of fair market value. 103,440.00 . TOTAL (Also enteron line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 103,440.00 THIS IS NOT A TAX BILL ~(()J!Plf .....1 " ...... ~LING DATE: July I, 2000 District: 13 - LOWER ALLEN TOWNSHIP School..: WEST SHORE sn Parcel Identifier: 13-23-0547-184. Location: 1913 CHATHAM DRIVE HIGHLAND ESTATES LOT 7 Land Buildings TOTAL 2000 Market Value 14,980 88,460 103,440 Assessed Value (2000 Market x 100%) , 14,980 88,460 103,440 Old Assessed Value (1974 Market x 25%) 920 4,880 5,800 TAXABLE Land Size....: .17 acres I Land . NOT Buildings APPLICABLE TOTAL 2000 Clean and Green Values ~T/LOT ID..: L-0007 NOT NOT APPLICABLE APPLICABLE Property Type: R Residential With Buildings Clean and Green values apply to some farm and forest land. Such values become effective only upon application and approval. All applications must be received by the Assessment OffIce by 4:30 p.m. on October 15, 2000. Those previously approved for Clean and Green do not need to re-apply. Control No: 13000880 CUHVLNIG Pennsylvania law requires that all real estate be valued as of the most recent county-wide reassessment. The lest reassessment, or tax base year, was 1974. Since the last reassessment in 1974, properties have been assessed at 25% of the 1974 value (the "Pre-Determined Ratio"). The new tax base year will be the Year 2000, with the new assessed values becoming effective for the 2001 tax year. The Pre-Determined Ratio has been changed to 100%. Your new assessed value equals your Year 2000 market value. It Is very fmportant for you to know that when the new 2000 tax base Is determined after thfs reassessment, all taxing districts are required by law to fower the mil/age rate by the same proportion that the tax base went up. The law provides that in the first year after reassessment (2001),.the county and all townships and boroughs may not increase overall revenue by more than five percent (5%) and school districts may not Increase overall revenue by more than ten percent (10%). The county and the other taxing bodies will make these decisions next year, and may choose not to Increase overall revenue. Of course, some individual's taxes will go up or down by more than those percentages. The essential point Is that an Increase In market values does not necessarily mean a corresponding Increase in taxes. Individual changes In taxes will depend upon a specific property's change as compared to the overall change for the taxing district. The ESTIMATED impact statement printed below is our best estimate of change, based on 2000 COUNTY tax figures. This estimate does not include any borough, township, or school district impact. ESTIMATED COUNTY TAX IMPACT: Current 2000 County mills = Adjusted 2000 County mills = 27.500 1.858 $ $ 160 192 2000 County Tax BEFORE Reassessment. 2000 County Tax AFTER Reassessment. ,m.... ........ REV,m".".o,. COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF KASSEN, GEORGE W. FILE NUMBER 21-01-00159 All property jolntly-owned with right of sUNivorshlp must be disclosed on Schedule F, ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 250 Shares - PP&L Resources, Inc. Common @ $42.02 per share 10,505.00 2 . 8,472 Shares - Citigroup, Inc. Common @ $56.025 per share 474,643.80 TOTAL (Also enter on line 2, Recapitulation) $ 485.148.80 (If more space is needed, insert additional sheets of the same size) ",,,,,,,,.,'..nw COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY KASSEN, GEORGE W. FILE NUMBER 21-01-00159 Include the proceeds 01 litigation and the data the proceeds were received by the ..tata, All property jointiy-owned with the right 01 survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Household Goods - date of death value 2. 1999 Pontiac Grand Am - Blue Book value 5,831.50 13,260.00 200.00 100.00 85.00 15.00 100.00 11. 54 15.94 113.00 244.00 23,846.45 12,003.34 20,016.77 10,019.60 36,807.83 10,018.41 6,795.30 10,011.78 10,013.44 10,009.69 -0- 3. Jewelry: Appraised value Lady's 17 Jewel Swiss Gubelin wrist watch in 18K Yellow Gold Case Lady's 18k yellow gold filigree-style ring containing seven 1.5 rrm rubies (one missing) 14K yellow gold bar pendant Lady's 18 inch 14K yellow gold link chain 14K white gold lOrrm wide wedding band Comcast Cable - refund Verizon - refund - telephone service AllState - premium refund - automobile insurance AllState - premium refund - homeowner's insurance Allfirst Bank - Checking Account No. 00502-1169-2 Allfirst Bank - Certificate Allfirst Bank - Certificate Allfirst Bank - Certificate Allfirst Bank - Certificate Allfirst Bank - Certificate No. 8100546231 No. 2027466 No. 2027599 No. 2027662 No. 8-700-814-1013815 Waypoint Bank - Savings Account No. 0100000464 Waypoint Bank - Certificate No. 04~63-316842 PNC Bank - Certificate No. 31000095015 M&T Bank - Certificate No. 3780915975 Miscellaneous Jewelry - No value TOTAL (Also enteron lineS, Recapitulation) $ 169.518: 59 (II more space is needed, Insert additional sheets 01 the same size) CG BUSER & SON 875 Market Street, Second Floor Lemoyne, PA 17043 (717) 972-1230 t())~)f Diamond Mounting A Specialty Prompt Attention To Mail Orders February 17, 2001 Estate of George Kassen c/o Walter Mchaffe Lady's 17 Jewel Swiss Gubelin wrist watch in 18k yellow gold case. Fair truttket value, approximately $200 Lady's 18K yellow gold filigree-style ring containing seven 1.5 rom ruhies (one missing). The ring weighs approximately 4.65 dwt. Total fair truttket value, approximately $100. 14K yellow gold bar pendent that weighs approximately 5.70 dwt Total fair truttket value, approximately $85. Lady's 18 inch 14K yellow gold link chain that weighs approximately .90 dwt. Total fair truttket value, approximately $15. 14K white gold 10 rom wide wedding band. The band weighs approximately 6.65 dwt Total fair truttketvalue, approximately $100. ~fi~zzr- Charles G. Buser ill G.G., I.S.A. Fair Market Value: The price in the truttket place in which the item would change hands between willing buyer and willing seller, neither under any compulsion to buy or sell and each having reasonable knowledge of the relevant facts ~e: the price in the truttketplace in which the item is most commonly sold to the public). Also taken into consideration was a reasonable and realistic time frame for willing buyers and willing sellers to reach an "arms-length" agreement within the truttket. ManufacturingJewelers & Diamond Setters ~.""~:'1m '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS KASSEN, GEORGE W. FILE NUMBER 21-01-00159 EST ATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Jessie H. Geigle Funeral Home - additional death certificates 15.00 B. ADMINISTRATIVE COSTS: 1. PelSOl1al Representative's CommIssions Name of PelSOnsl Representative (s) Walter L. Mehaffie Social Security Numbe<<s) I EIN Number of PelSonal Representative(s) 3818 Centerfield Road Street Address City Harrisbu'ca Stale PA Zip 1710Q 20,000.00 Vea<<s) CommIssion Peid: 2001 2. Attorney Feea - Johnson, Duffie, Stewart & Weidner 11.500.00 3. Family Exemption: (If decedenfs address ~ not the same as clalmanfs, attach explenetlon) Claimant Street Address City Slete Zip Relationship of Claimant to Decedent 4. Probate Feea - Register of Wills - Cumberland County 471. 00 5. Accountanfs Fees 6. Tax Retum Prepare's Fees 7. C. G. Buser - Jewelry Appraisal 50.00 8. Cumberland Law Journal - advertise letters 75.00 9. The Patriot-News - advertise letters 93.81 10. Register of Wills - short certificates 9.00 11. Register of Wills - file Inventory & Inh. Tax Return 25.00 12. Recorder of Deeds - record Deed 26.50 13. Comcast Cable - final charges 29.01 14. Bob Strohm - plumbing leak 63.52 15. Hershock's - 50.00 16. Reserve for close-out costs 175.00 Total .from additional sheet 494.68 TOTAL (Also enteron line 9, Recapitulation) $ 33.071.52 .. (If more space IS needed, Insert additional sheets of the same size) ESTATE OF: KASSEN, GEORGE W. SCHEDULE H - CONTINUED 16. PP&L - final charges 17. Verizon - final telephone charges 18. PA American Water Company - final charges 19. UGI - monthly budget amount - February 20. UGI - final charges based on final reading 21. County real estate taxes - 1/1/01 - 3/8/01 Total 21-01-00159 47.32 26.57 29.72 112.00 212.83 66.24 $494.68 REV'''';'''.''.".. COMMONWEAl.TH OF PENNSYLVANIA INHERITANCE TAX RETURN RES'DENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF KASSEN, GEORGE W. FILE NUMBER 21-01-00159 Include unrelmbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION AMOUNT Holy Spirit Hospital - decedent's account balance not covered by insurance United States Treasury - decedent's 2000 income tax PA Department of Revenue - decedent's 2000 income tax Kunkle Surgical Group - decedent's account balance not covered by insurance PA Water Company - decedent's account PP&L - decedent's account Comcast Cable - decedent's account 641. 96 564.00 325.00 308.38 17.23 36.77 29.01 112.00 26.49 UGI - gas service - decedent's account Verizon - telephone service - decedent's account TOTAL (Also enteron line 10, Recapitulation) $ 2,060.84 (If more space is needed, insert additional sheets of the same size) REV.151JEX+{1-97) o. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT KASSEN, GEORGE W. FILE NUMBER 21-01-00159 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do NotLIstTrustee(s) OF ESTATE EST ATE OF t NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outnght spousal distributions) Clyde J. Peffer 3309 Market st. Camp Hill, PA 17011 Nephew Automobiles; Household and personal effects: real estate; 30% residue NUMBER I. 2. Walter L. Mehaffie and his wife, Betty J. Mehaffie 3818 Centerfield Road Harrisburg, PA 17109 Nephew & wife 70% residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 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) 'COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J ss: WALTER L. MEHAFFIE being duly sworn according to law, deposes and says that he of the Estate of George W. Kas s en is Executor late of Lower Allen Township , I Cumberland County. Pa., deceased and that the within is an inventory made by Wal ter:. L. Mehaffie I the said Executor of the e~tire estate of said decedentl consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. c/.. f 19 2001 'I~ ({J . 11 Ex cu or - AdministrAtor Walter L. Mehaffie, Executor Sworn to and subscribed before me, NOTAru SEAL DIANNE LENIG, Notary puOTrc Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21, 2001 3818 Centerfield Road Harrisburg, PA .17109 Address Day January Month 2001 Date of Death 30th Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of dis<;overy of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV. Fiduciaries Act of 1949. M o:::r 0 [' ...-t ~ ~ 'M ..c: O-l Cf.l >- C -c 0'1 I- W ~ ~ (1) .... c L.() ~ 0::: I- 0 ra .-t W -< E-I cu 0 a.. I- Z u 0 0 V1 11l. G) E 0 0 w 0::: w !:il C 0 C\ >- I :c U) (1) 10 ~ (1) J0- e.. u. U) rl ~ 0.. ill c: H .-t I- ...J ... 0 Z ...J < 0 ~ rl 0.. H 0 0 w u. < w ~ ~ (1)' :t: .. 0 >.. \'oJ > Z 0::: - ~ <. 0'1 Z 0 . H c: ~ 0 0 ~ (1) ::I ...-t V) Z 0 0 0:::: ~ U . Z l..U < !:il 0 ~ l? X a. c.9 ~ -c 0 p::; c: '0 o:l ItS 0 - -;: C !:il 0 I1l ;:j . l? ..0 ~ E 0 I1l E -c '0 0+- ~ 0 ra ::I 0 !:il -J U u: a:1 O-l 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 MYERS EDMUND G 301 MARKET STREET P 0 BO X 1 09 LEMOYNE, PA 17043 n__un fold ESTATE INFORMATION: SSN: 195-07-9449 FILE NUMBER: 21 - 2001 - 01 59 DECEDENT NAME: KASSEN GEORGE W DATE OF PAYMENT: 08/13/2001 POSTMARK DATE: 08/10/2001 COUNTY: CUMBERLAND DATE OF DEATH: 01/30/2001 NO. CD 000147 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8,445.35 I I I I I I I I TOTAL AMOUNT PAID: $8,445.35 REMARKS: WALTER L MEHAFFIE CHECK# 119 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS /0 -;(t)t!--/ 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 RE~(':C:; HfL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-14-2002 KASSEN 01-30-2001 21 01-0159 CUMBERLAND 101 .02 JAN 1 8 p 3 :1 4 EDMUND G MYERS ESQ JOHNSON ETAL PO BOX 109 LEMOYNE . v 1/ 'I- REV-1547 EX AFP el2-00l GEORGE W Amount Remitted C;,:: C1\ PA 1 }cJ.lJ31L~ 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 ~ if{v: iS4-j-E3f-AFP--C 12-:0 i.-r-NCfficE--oF-YNHEififAifcE-TAX -APPRA-isEMENT-,--ALi-oWAifcE-Cri----------- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KASSEN GEORGE W FILE NO. 21 01-0159 ACN 101 DATE 01-14-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 722,969.03 X 15 = 108,445.35 ll9)= 108,445.35 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 ll) (2) (3) (4) (5) (6) (7) 103.440.00 485.148.80 .00 .00 169.518.59 .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 (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) 33,077.52 2.060.84 (11) ll2) ll3) ll4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 758,107.39 31) . 138 36 722,969.03 .00 722,969.03 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-23-2001 AA496507 5,000.00 95,000.00 08-10-2001 CDOOO147 .00 8,445.35 TOTAL TAX CREDIT 108,445.35 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 MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ / b -L;)L:)9 - / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN REV-485 EX AFP 02-00) .02 (QATE :,~ESTATE OF DATE OF DEATH FILE NUMBER P 3 !iPfJNTY ACN 01-14-2002 KASSEN 01-30-2001 21 01-0159 CUMBERLAND 201 GEORGE W ReCL: Rt,. EDMUND G MYERS ESQ JOHNSON ETAL PO BOX 109 LEMOYNE JAN 11 Amount Remitted CiSfh PA 17043 Gurnbe;l( MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ Rifv=483--EX--AFP--{i2~-oo)-----.-i-Ncrficif-oF--DETE-iMIN-ATIO-N-AN-D-As-sESS-MENy----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF KASSEN GEORGE W FILE NO.21 01-0159 ACN 201 DATE 01-14-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 16,624.00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 103.445.35 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 103,445.35 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: 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 THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) / / --, /- -' 7 " /r.- c.:xl( '~/- . \/ , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 EDMUND G MYERS ESQ JOHNSON ETAL PO BOX 109 LEMOYNE ~A;,17043 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-75' EX AFP (01-02) 05-20-2002 KASSEN 01-30-2001 21 01-0159 CUMBERLAND 202 GEORGE W Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV = 7 36 -EX--AFP-To'i---o2"r----.-.-Ncffic"E-oF--DETE-RMIifATIcfti-AifD-AS-SESSMENT----------------------- - - - - -- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF KASSEN GEORGE W FILE NO.21 01-0159 ACN 202 DATE 05-20-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 16~624.00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 103~445.35 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 103,445.35 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: 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 THIS DATE~ SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ 0 ~ 0 0 -0 0 m :JJ :D m m )> 0 0 )> (J) I I 0 m 0 0 -i C (J) -i -I :0 J> m C m 0 ~ m z -j m )> m JJ 1J :0 -0 ?: )> 0 -i ~ 0 -I ,.".. n JJ -i m J> ~ en :D 11 [;-< )> 11 m ..,,~. m (jj rv )> JJ 0 m ^ ~ JJ r U - <: CD CO c: -I Z )> (f) t-"O - ^ )> ,,"- c 0 0 ~ m Z m OJ m ~ r --.., )> ...::, 0 '. -< r--'} 0 JJ S ." Z m n h) -i G:; )> r')~ 11 .~? . ,_.~ Q Z -i J> \') I r;: ,-i ;m 0 ' ' "'Tl r X m z JJ - ~"-1 :0 u 0 0 -i f!1 , -,., -i '" ~ rr~ 0 )> <: il I ",,' S '.. n ru $ a JJ 0 )> t'~~ j c m 11 ~:"'"\ ;5 ..t." " -I :3 ~-) )> < m -u # 1-.- (5 co r m 0 Z :.". '. Z OJ -j C Z S )> m z 1-> ...; X fJJ ..... m -< en r C'- (.J-1 < )> z 5> ,", ,. JJ m G) (f) -I m JJ o " ~ r r (f) ~ :D m o m <: JJ 3 m fTiDO Q ~~ """'-<' m " -..-in,. m; ,,,,-.: :t1 m )~ ~,,{ ~,.(. , '~.~ ~'t \ ". ,~r~ "~) ('. " , ~ r c -I o -I )> r )> ~ o c Z -I "'t }>. ci )> zo~ cOm)> ~zC/)o OJ-1C/)z m::Ds: :DOm rz -1 .+1- ,f;. Ll1 )> s: o c Z -1 \:.,\ \~- j ~ o ::r: m CD m o " " - o - )> r JJ m o m - -C -t Z :J: m :0 =i )>'1J zm ('")Z mZ )>cn z-< c!< m)> cn2 -1- )>)> -I m -I )> >< Z 9 )> )> ~ <.D 0> U1 o ~ JJ m ;t.' 1 .~ (J) I\) m x <D 2:' J',j.' - .- cu :E f/) f/) cu - () ~ CJ) ~ o :r: E-i r-.... 0::; co ~ 1'1 o 1'1 U~I 0::;1'1 Cf):>i~..-l ....:lE-i~O ~ Z Or-.... H~en..-l ~O U~~ ~ en~ OO~ Z 0 ... o:;~:r:~ ~...:l~....:l E..d~:: 0::; en en~~H HCQO....:l t9~Uo:; ~~ ~ O:::Ur-lU ~ .~ - , ..... f/) '- .- LL rI" J PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: GEORGE W. KASSEN Date of Death: January 30 2001 Will No.: 2001-00159 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 X 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 X B. The separate Orphans' Court No. (if any) for the personal representative's account is:. C. Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: (9/1-{ ( 0 \,./ ~ {&ftm{ J; J?ftp- Signature Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 1 09 Lemoyne. PA 17043-0109 Address (717) 761-4540 Telephone No. "'1 I Capacity: Personal Representative X Counsel for Personal Representative ...;....;. 'fr.J-c2t)(/-/ ~J-OI--IS'1 .. .-0 ~<i\l Internal Revenue Service WII 201 W Rivercenter Blvd. Covington, KY 41019 WALTER L MEHAFFIE 0/0 EDMUND G MYERS ESQ 301 MARKET ST PO BOX 109 LEMOYNE PA 17043-0109 Department of Trearf* 'U' fB) ~ E~~~ ~~~ UC GEORGE W KASSEN Decedent's Social Security Number: 195-07 -9449 Date of Death: 01/30/2001 Person to Contact: STEVE FEHRING Contact Telephone Number: (859)669-5283 Date: APR 1 0 2002 Estate Tax Closing Letter (This is not a bill for tax due) Our computation of the Federal tax liability for the above estate is shown at the bottom of this letter. It does not include any interest that may be charged. If you have made a request for discharge of personal liability under Section 2204 of the Internal Revenue Code, proof of request and payment of tax will discharge you from personal liability for the tax and any deficiency that may later be found due. This letter and proof of payment, such as canceled checks or receipts, will establish that your personal liability for the tax has been settled. This letter is evidence that the Federal tax return for the estate has either been accepted as filed or has been accepted after an adjustment to which you have agreed. You should keep this letter as a permanent record. Your attorney may need it to close probate proceedings for the estate. This is not a formal closing agreement under Section 7121 of the Internal Revenue Code. We will not reopen this case, however, unless Revenue Procedure 94-68 reproduced on the following page of this letter applies. ~ ~- ':' ,I 0\ Sincerely yours, ~<<lt!A- ~ Field Director Cincinnati Compliance Service Center II c:::: _:'~l _:.: 5= I _ . -' r ... .. ,,~ TENTATIVE TAX...... ......... .., ...::-:.::-:......... ............... ......... ...... ............. .... LESS: TOTAL GIFT TAXES PAYABLE (FOR GIFTS MADE AFTER 12/31/1976) $ UNIFIED CREDIT $ CREDIT FOR STATE DEATH TAXES $ CREDIT FOR FEDERAL GIFT TAXES $ CREDIT FOR FOREIGN DEATH TAXES $ CREDIT FOR TAX ON PRIOR TRANSFERS $ TOTAL SUBTRACTIONS..................... ......... ...... .................. ............ ...... NET ESTATE TAX GENERATION SKIPPING TRANSFER TAXES ,~ p $ 237,174.00 0.00 220,550.00 16,624.00 0.00 0.00 0.00 $ $ 237,174.00 0.00 0.00 TOTAL ESTATE TAXES $ 0.00