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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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NUMBER
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FILE NUMBER
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COUNTY CODE YEAR
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OECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Sutton, Mary E.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
02-11-2001 01-05-1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIALI
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURI1Y NUMBER
SOCIAL SECURI1Y NUMBER
207 07
7951
o 1. Original Return
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 (dat@ofdeall1after12-12..fl2)
o 7. Dece~f'lt Maintained a Living T rusl (Attach copy 01 Trust)
o 10. Spousai Poverty Credit (dateolda9th retween 12-31-91 arld 1-1-95)
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
D 11. Election to tax I..lnder Sec. 9113(A) {Attach Sch 0)
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E DIRECTED TO:
'~~~qjfltfli~'t
NAME
Harr L. Bricker
FIRM NAME III Applicable)
TELEPHONE NUMBER
(717) 233-2555
,'Pli~,i;:Q.:,l\lt~$I'Q/'loe!l!~ANQ .,,' -I ,~FQ~Al"IdJilsHQuUl'
COMPLETE MAILING ADDRESS
Harry L. Brlcker, Jr.
Attorney at Law
407 North Front Street
Harrisburg, PA 17101
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivabie (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Properly
(Schedule E)
(1) I OFFICIAL USE ONLY
(2) I I
(3) i
I
(4) I
I
(5) $ 182,320.42 I
(6) $ 1,566.72
(7) J
(B) $ 183,887.14
(9) $ 23,770.34
(10)
6. Joinlfy Owned Property (Schedule F)
o Separate Billing Requested
1. 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)
1 Q. Debts of Decedent, Mortgage liabilities, & li€:ns {Schedule I}
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(11) $
$
23,770.34
160,116.80
(12)
(13)
(14) $ 160,116.80
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.o_ (15)
x.o~ (16) $
x .12 (17)
x .15 (18)
(19) $
7,205.26
$ 160,116.80
7,205.26
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
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>>>> SE SURE TO ANSWER AU. Q.UES'110ns ON ReveRSE SIDEAAD RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS Cumberland Crossings
1 Longsdorf Way
Carlsi1e
Retirement Community
I STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
.
I liP
17013
Total Credits (A + B + C ) (2)
3. InteresUPenafly if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 215 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. (5)
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1.
Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.. ................ ..................................... 0
b. retain the right 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 death
without receiving adequate consideration? .........mm..'" ........................................ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .. ................,.... .
No
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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, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and beliel, if is true, correct
and complete.
Declaration olpreparer other than the personal representative is based on all information of which preparerhas any knowledge.
SIGNATURE OF PERSON RESPONSiBLE FOR FILING RETURN
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ADDRESS
963 W. Old York Road, Carlisle,
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
PA 17013
DATE
,f -r-Q I
ADDRESS
407 North
DATE
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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 (8) (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 (al (1.1) (ii)J.
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 stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The fax rate imposed on the net value of transfers 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. 99116(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. ~9116(a)(1.3)J. 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.
REV.'~':X'I'.97I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlQEN1 OECEOEN1
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Mary E. Sutton
Include the proceeds of lmgation 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.
FILE NUMBER
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
DESCRIPTION
First Union National Bank - Certificate of Deposit
Account No. 2474102041269011
VALUE AT DATE
OF DEATH
$ 20,643.71
First Union National Bank - IRA
Account No. 257410060293120
9,799.18
First Union National Bank - Savings Account
Account No. 3082645417015
46,697.27
Baltimore Life Companies - Single Premium Retirement
Annuity
Policy No. 01052021615
20,915.88
Transamerica Life Insurance and Annuity Company
Annuity No. 26858057
55,644.88
Metropolitian Life Insurance Company
Group Annuity Contract 1032A and
Certificate No. 174050597
28,619.50
TOTAL (Also enter on line 5, Recapitulation) $ 182, 320 . 42
(If more space is needed, insert additional sheets of the same size)
REV'",,:'.I1,".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Mary E. Sutton
FilE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G,
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELAIIONSHIP TO DECEDENT
A. Marsha E. Thrush
963 W. Old York Road
Carlisle, PA 17013
Daughter
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERT'f %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank a::counl number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deedforjoinlly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 10/12 1989 First Union Bank - Checking $3,133.44 50% $1,566.72
Account
Account No. 1000324243092
--,--
. TOTAl (Also enter on line 6, Recapituiation) $1,566.72
(If more space is needed, insert additionai sheets of the same size)
REV.151iEX+{1-97)_~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT ECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mary E. Sutton
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral HOlfle $ 7,038.70
2. Luncheon following funeral (Church) 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Representative (s)
Sodal Secunty Numbe~s) I EIN Number 01 Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Harry L. Bricker, Jr. 9,200.00
3. Family Exempnon: (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 Register of Wills, Cumberland County 90.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 60.00
7. Income Tax 544.00
8. Carlisle Sentinel - Advertise Estate 87.35
9. Cumberland Law Journal - Advertise Estate 75.00
10. Alert Pharmacy Services, Inc. 253.09
II. Cumberland Crossings Retirement Community 6,238.25
12. BMC Internal Med. 83.95
.' TOTAL (Also enter on line 9, Recapilulation) $23,770.34
(If more space IS needed, Insert additional sheets of the same size)
REV-,S'3EX+('.97j
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESJDENT DECEDENT
ESTATE OF
Mary E. Sutton
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1.
Marsha E. Thrush
963 W. Old York Road
Carlisle, PA 17013
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
AMOUNT OR SHARE
OF ESTATE
100%
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)
ft)i~N'
Reference 10: 1435] 5
First Union National Bank
Attn: Account Verifications
POBox 40028
Roanoke VA 24022-7313
February 27, 2001
HARRY L BRlCKER JR
ATTORNEY AT LAW
407 NORTH FRONT STREET
HARRISBURG, PA 17101-1296
SUBJECT: Verification J Confirmation of Account and Balance Infonnatiol1 provided for:
MARY E SUTTON (SSN# 207-07-7951)
Date of Death: February 11, 2001
Deposit Account Information
Account Account Date of Death Average Date Maturity Interest Accrued YTD Date
Type Number Balance Balance* Opened Date Rate Interest lnterest Paid Closed
CERT1FICA TE OF DEPOSIT 247412041269011 $20,643.71/ 7/2012000 4120/2001 $82.11 $110.04
LEGAL TITLE. MARY E SUTTON
MARSHA E. THRUSH, POA
CHECKING 1000324243092 $3,133.44, 10/12/1%9 $2.08 $2.87
LEGAL TlTLE. MARY E SUTTON
MARSHA E. THRUSH
IRA 257410060293120
LEGAL TiTLE MARY SUTTON
$9,799.18 ,-
1/18/2000
$71.36
$0.00
For Beneficiary Claim Form infonnatioll, please call 1(800)669-2136.
SA VINGS 3082645417015
LEGAL TITLE. MARY E. SUTTON
MARSHA THRUSH, POA
$46,697.27
1/1/1992
$80.78
$5797
>I< Due to system 1imitations, we can only provide a twelve monlh avera.~e balance on depository accounts.
Other Account Information
Account
Type
Account
Number
Date of Death
Balance
Date
Opened
Date
Closed
Title(s)
ANNUlTY
T AFS 126858057
10/20/]999
MARY E. SUTTON
CONTACT TRANS AMERICA AT 1-800-258-4260 FOR INFORMATION.
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Reference JD: ]435]5
No Safe Deposit Box found for customer.
'" Date of death balance does not include accrued interest.
.. If date of death occurrs on a weekend or a holiday, date of death balance does not include any transact10ns that were
made during that time period.
,c()
ature of Depository Representative
February 27, 200 J
Date
Julia Sorrells
Depository Representative
Se"rvicenter Associate
Title
(540)563-7323
Phone Number
abs; at
00102;;
Form 712
(Rev..August 1994)
Department of the Treasury
Internal RewntJll SeMoe
Dececlent-lnsured (To Be, Filed by the Executor With United States Estate Tax Return, Form 706 or Form 706-NA)
1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security 'number 4 Date of death
~, E: TTO (II known) .0107 {! 5
5 Name and address of insurance company
8/1t-rl #?~ /L/S ~I r'/.!! Co 1"1 ;1AfVI J.!...$
/CP7 "Ai i3LI//J. OWilv&5
6 , Type of policy
.5INGrl.-t~ ~~, 14.., ~t5TIfLe",a-vl fr",.;t.1IT
8 Owne(s name. If decedent Is not owner, 9 Date Issued
attach copy of eppllcation.
Life Insurance Statement
'J11/I.-L.:5 NO .>L1I17
7 Policy number
OMS: .s-
10 Assignor's name. Attach copy of
assignment.
12. Value ot the policy at the
time of assignment
05 -1.2.-11
13 Amount of premium (see instructions)
#;.f') 7 (po, 7"(' .sr>
14 Name of beneficiaries
I'llfte5H/4 E rH'fuSW
15
16
17
18
19
20
21
22
23
24
25
26
Face amount of policy .
Inqernnity benefits .
Additional Insurance
Other. benefits. . .
Principal of any Indebtedness to the company that is deductible in determining net proceeds .
Interest on Indebtedness Qine .19) accrued to date of death
Amount of accumulated dividends.
Amount of post-mortem dividends. . . .
Amounl of retumed premium . . . . .
Amount of proceeds if payabie in one sum .
Value of proceeds as of date of d~ath (if not payable in one sum)
POlicy provisions concerning deferred payments or installments.
Note: If other than lump-sum settiement is authorizea for a surviving spouse, attach a copy of the
insurance poiicy.
'.
27 Amount of installments . . . . . . . . . . . . . .. . . . . . . . .
28 Date of birth, sex, and name of any person Ilie duration of whose life may measure the number of pa}lll)ents.
~--_. -0" -. -..-..' -.-._--.- -~. ~ ~.~~. -~ --. - -~ -.. -. ~-. --. --.~ -. -. ~_. _ .__. _~ .__ ~_.... _.. ~.. ~ _. __ ~~. ~ ___ _ ___. _ _ _~_ _~~_..__
29 Amount applied by the insurance company as a single premium, representing the purchase of
Installment benefits. '. . . . . . . . . . . . . . . . . . . . . . . . . . .
30 Basis (mortality table and rate of Interest) used by Insurer in valuing Installment benefits.
'QMB No. 1545-0022
11 Data assigned
$
$
$
$
$
$
$
,$ ,;zo '?/5-:' r
$
. -. --.-.. -. .-~.. ~-- ~. - ~ ~. - ~ -~ ~~ -~. - ~ ~-. - -~ -~. - ------~ -. -- -- -- -_..-. .-. ~-.- -- -- ~- -~. -- - --. - .-- ~_.~ -' --'. - -. --~-_.... -~.. .-... - - -- -. --
-_.~.__..~._~
31 Was the ,insured the annuitant or beneficiary of any annuity contract issued' by the company? . . . . 0 Yes D No
, 32 Names of companies with which decedent carried other policies and amount of such policies If this information is disclosed by your records.
... __._ _. _ .._____. __~ _ _~ ~ _ _ __ ~_.... _~ _ ~ _. _ _ __.. __. ~_..._. _ __ ___ _. ~_ ___~ __~. ~ _ _~ __ __. __ _~ __ __ .__._ _ __ _. ~ _ __ _ _. __~.._. _'~ __~.. _~.. _ _.
_~ .__ _ n ~_....__
- _... _. _. n _ _ _m .__. _ _. _.. _. _ _. __... _ _. _..... .tI'~/[I!'!!'-'1~!Y.__... __.... _. _ _. _ _....n n n _ _. _.._ _. _ _. _. _ _ _.. __ 'n' n" _ _. _ _... __. __ _ __.__.
_.. _ _.
InstnJc ons
fa Reduction A Notice.-We ask for the Information on this
fonn to carry out the Internal Revenue laws of the United States. You are
requlred to give us the information. We need it to ensure that you ar&
oomplylng with these taws and to allow US to figure and collect the right
amount of tax.
The time needed to complete and flIe 'this form will vary depending on
Individual circumstances. The estimated average time 1$:
Form Recordkeeping Preparing 'the form
712 18 hrs.. 25 min. 18 mln.
If you have comments concerning the accuracy of these time
estimates or suggestions for making this fonn more simple. we would be
happy to hear from you. You can write to both the IRS and the OffIce of
Cat. No. '0170V
)
'T11le ~ <!:. .Date of QMfficatlon ~ 7--7'" C'/
Management and Budget at the ad_ listed in the Instructions of the
lax retum with which this form Is fiied. DO NOT send the tax foml 10
either of 'these offices. lnstead, return It to the executor or representative
who requested It.
Statement of insurer.-This statement must be made, on behalf of the
Insurance company that Issued the policy, by an officer of the company
having access, to the records of the company. For purposes of this.
statement. a fac:s1mlle signature may be used In "80 of a manual signature
and if used. shall be binding as a manual signature.
Separate statements.-l'11e a seperale Form 712 for each policy.
Une 13..-Report on line 13 the annual premium, not the cumulative '
premium to date of death. If death occurred after the end of the premium
period, report the last annual premium.
Form 712 (Rev.8-84)
Ponll 712 (Rev. 8-94)
IDID Uving Insured ..
(File WIth United ~tates Gift Tax Return, Form 709. May Be Filed WIth United States Estate Tax
Return, Form 706 or Form 706-NA, Where Decedent Owned Insurance on Ute of Another) .
SECTION A-Generallnfol'!11ation
Page 2
33 First name and middle initial of donor (or decedent)
34 last name
35 Social rCUf number
36
37
Date of gift for which valuation data submitted. .. . . . .
Date of decedent's death for which valuation data submitted. . . .
SECTIOf~ B--i>oiicy Information
38 Name of insured
/39 Sex.
140 Date of birth
4' Name and address of insurance company
42 Type of policy 143 Policy number. 44 Face amount 45 . Issue date
.. .
46 Gross premium 47 Frequency of payment
48 Assignee's name 49 Date assigned
. .
50 If irrevocable designation of beneficiary made, name of 51 Sex 52 Date of birth, 53 Date
beneficiary If known designated
54 If other than simple designation, quote in full. (Attach additional sheets if necessary.)
55 If policy is not paid up:
a Interpolated terminal reserve on date of death, assignment, or irrevocable designation
. of beneficiary. . . . . . . . '.' . . . . . . . : . . . . . . .
b Add proportion of gross premium paid beyond date of death, assignment, or Irrevocable
designation of beneficiary. . . . . . . . . . . .
C Add adjustment on account of dividends to credit of policy.
d .Total (add Jines a, b, and c) .... . 00 " . . . . . . ...
e Outstanding indebtedness against policy. . . . . . .
f Net total value of the policy (for gift or estate tax purposes) (subtract line e from line d)
56 if policy Is either paid up or a single premium:
a Total cost, on date of death, assignment, or irrevocable designation of beneficiary, of a
single-premium policy on life of insured at attained age, for original face amount plus
any additional paid-up insurance (additional face amount $ . )
(if a single-premium policy for the toia! face amount would not have been issued on
the life of the insured as of the date specified, nevertheless, assume that such a policy
could then have been purchased by the insured and state the. cost thereof, using for
such purpose the same formula and basis employed, on the date specified, by the
company in calculating single premiums.)' .
b Adjustment on account of dividends to credit of policy .
C Total (add lines S6a and S6b). .'. . . . .... .
d Outstanding indebtedness against policy. . . . .. .......
e Netteta! value of poli (lor gift or estate tax purposes) (subtract line S6d from line S6c)
The undersigmd ,officer of h aboYHwned Insurance' company hereby certif.. that this statement sets forth true and correct ,lnfotmatlon.
Signature ... TItle ... .
@ Printadon ~ paper
0010 of
Cert\ficatlcm ~
~u.s. GOWImment Prlnting Office; 1994 - 301.62810024&
~J"~1:l~2~~J6I:lVl~ ~I J.\JOJ r\LE COP1:
CIO H'v'I;I;^ r BI;ICKEI:l, II; l ..
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b'O' BOX I....'
.Lll'VVl2'VVIIEllIC'V rilE IVl2nll'VVlCE 'VVlD 'VVlVlnI.LA COVllb'VVlA
DATE: 04/11/2001
RE: 'l'RANSAMERICA LIFE INSURANCE AND ANNUITY COMPANY
Deferred Annuity Number:
Tax Qualification:
Annuitant Name:
Policyowner(s):
26858057
NON-QUALIFED
MARY E SUTTON
Payee Name:
Soci~1 Sel;;.Urity Number:
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ESTATE OF MARY E SUTTON
207-07-7951
Please accegt our company's sincere condolences on your recent loss. Your request for a
distribution from your tax deferred annuity has been processed. Your check is attached. Following
is information regarding any deductions taken from and the taxable amount of this distribvtion.
Gross distribution:
Less Federal Income Tax Withheld:
Less State Income Tax Withheld:
Less delivery fee:
Net check.amovnt:
55,644.88
.00
.00
.00
55,644.88
Taxable ;amovnt:
';:, '
5,644.88
, .' .
If any portion oftnis qistribution is t"".bJe, inis.qistribution Will bsrsported to the IRS and to You on a Form
t 099~R Unqer the above listed !;oci.liSeCUr~y Number.
Please be-advised that the 'release' of PQIiQV values may affect the ',guaranteed elements, non-guaranteed elements, face
amount or surrender value of ~he - pOlicy<from which the values are released.
, .; j. .,".'.....,.~.,
For your information, state regulati'ons require insurers to monitor unreported replacements of ex.isting annuity contracts
and lite:insuranee policies by QUr comp~nY. I'f this distribution is intended to be used to purchase a new annuity
c'ontract or Jife'insurance policy with OUf' company. please contact us at the number below.
We reccmmendyou seek the advice of 'your tax consultant concerning the proper reporting of this distribution. Unless
we have been notified of a community Of' m~rital' property interest in this policy, we wlll rely on our good' faith belief
that no such interest exists; the pol;cyowneragrees to indemnify and hold the Company harmles$from the
consequences of accepting this transaction.
Please contact your local representative. or the Annuity DIstribution Service Team at 1-800-553-5957, if you have
any questions.
22510 120Q
CHECK NO.
00567760
DATE~
04/11/2001
VENDOR NO.
AAIT031804
PAYEE NAME
ESTATE OF MARY E SUTTON
CHECK AMOUNT
55,644.88
t
To Remove Document Fold and Tear Along This Perforation
t
~i,!~lR*~~~.m'~
PAYFIFTYFl.vETHOUSlUID l>lXHI1NDRE~ FORTY FOUR .
"'ACT'Y DOLLARSAN.~ El~HTJE1~lITGENTS 04/11/2001 ****'55;644.88 .1
VOID AFTER SIX MONTHS
I
ESTATE OF MARY E SUTTON
C/O MARSHA SUTTON THRUSH, EXEC
C/O HARRY L BRICKER, JR
407 N FRONT ST
HARRISBURG FA 17101
I
TRAHSAMERlCA LIFE INSURANCE AND ANNUITY COMPaNY
TO
THE
ORDER
OF
BY:
I
-.1
BY~
AUTHORIZED REPRESENTATIVE
~.~A~
11'00 Sb? ?bOIl' ':0 j l.l.OO j 5 ~I:
o :I 0 0 '1 ? b 2 5 511'
.._~~
Metropolitan Ufe Insurance Company
PO Box 74027B, Atlanta, GA 30374.027B
MetLife
Harry Bricker, Jr., Attorney
Law Offices of Harry L. Bricker, Jr.
407 North Front Street'
Harrisburg, PA 17101
Re: Group Annuity Contract 1032A Certificate No. 174050597
Marshall Sutton (Deceased) Mary E. Sutton (Deceased)
Dear Mr. Bricker
A review of our files indicates that Marshall Sutton owned two annuities which
became effective on July I, 1984. He was entitled to receive monthly payments in
the respective amounts of $197.68 and $583.42. These benefits were to be
guaranteed until June I, 2004 and then for his lifetime thereafter.
Upon his demise, Mary E. Sutton became eligible to receive the remainder of the
guaranteed payments and at that time she designated Marsha E. Sutton Thrush as
her beneficiary. Marsha now has the right to receive the remainder of these
payments, retroactive to April 1, 2001, and I have enclosed the forms needed to get
this process started. Please also provide us with a copy of the death certificate for
Mary E. Sutton.
For these respective annuities we have determined the replacement cost (estate
valuation) to be $28,619.50 effective February 11, 2001. Whether the replacement
cost is the appropriate measure of valuation of this contract for estate tax purposes
is a matter to be decided by a qualified tax advisor.
It should be noted that all of the proceeds received on behalf of Mr. Sutton were
contributed by his employer so that any and all payments are fully taxable as
ordinary income. There is no cost-basis to be applied in this instance.
I hope this information is helpful and line with your request. This file will be held
on callup pending receipt of Mrs. Thrush's response.
ve~v:JC2~
wi1f:am Haskins
Retirement & Savings
July 28, 2001
Estate of \H.....~~.... ~
,
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
;;"/~ - J'i J
'~o..o'- ~<>",-
No.
To:
Register of Wills for ,the l \ .
, Deceased. County o~ ""-- ~ ~ ~~~he
Social Security No':?-. c> "l. 0-, ---, ~;:;;.- \ 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"'-- '\ r:
in the last will of the abovr decedent, dated fA......... -\. l ,~ \ G. '\. "\
and codicil(s) dated ~ 0'- C!---
named
,19_
'^'" ....)- '> '" ~ ~ ~ l..t..:.>
~ .......~ ' ""-'
~\..~~
~-""2-D
~~
Decendent, t \... , ~ ~ o~.:. \
at
Except as follows, decedent did not marry, was dived 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:
$ ~
$ A.- is> IS> C;> CJ -
$
$
WHEREFORE, petitioner(s) respect~ request(s) the probate of the ~t will and codicil(s)
presented herewith and the grant of lette \,~~~~~ .........."'-~~~ <;;-
"
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
~
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C\... <:0 ~ t .A~'\ ("I) ,-" ...\ "..... \.<..~ u<"'<..~
~ -..1'1..' \,\, ~1.. Co'> .... C\? Cot. \ I. 0 \ """'t....
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF'PENNSYLVANIA ~ 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 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.
affinr6~h and
P7~c'?~~~ ~
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~o. 21-2001-191
Estate of MARY E. SUTION
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW FEBRUARY 20TH. 32001 , 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 MAY 15TH.1997
described therein be admitted to probate and filed of record as the last will of
MARY E. SUTION
and Letters TESTAMENTARY
are hereby granted to MARSHA E. SUTION THRUSH
Register f Wills MARY E. LEWIS ~
REGISTER OFW WILLS'-/ ~
v-lc.>-~~""~ ~ ,~~'.. <:-\<'<..\:'- , ~~
D~.., C> ~ "'-
ATTORNEY (Sup. Ct. 1.0. No.)
4- c.;) \. ~'-l ~ 'f- c) --..-\:- c:::s.~
ADDRESS
'--\.~"l- -; -::.\c.~ ~"-- ,....... L 2>,
PH E
'-t. \ ""1 'L ~ ~ "2.... ~ ~ ~
FEES
Probate, Letters, Etc. .........
Short Certificates( ~ . . . . . . . . . .
Renunciation ................
x-Pages (2)
JCP
$ 70.00
$ q .00
$
$ 6 . 00
5.00
TOTAL _ $
.WFJJAE'i..2.QWI.2.QQJ.. .$. . 90...QQ. . .
Filed
Ci,
.,=~ c:
MAILED LETTERS AND ORDER 'IO ATTORNEY
HI05.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. 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.
11:-~. ~b>.-~~
Local Registrar
Fee for this certificate, $2.00
p
6948276
FEB 1 4 2001
Date
21-2001-191
H105.143 Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA" DEPARTMENT OF HEALTH" VITAL RECORDS
CERTIFICATE OF DEATH
YPElPRINT
IN
-::RMANENT
LACK INK
82 v".
SEX
SOCIAL seCURITY NUMBER
NAME OF oeCEOENT(Firlt. MiOcIle. Lutl
I. Mar E.
AGE (Lnt BirNey)
2. Female 2. 207 _ 07 _ 7951
PLACE OF OEAT1-(ChfICk only one .... inatructionI on 0CMr Ilde)
HOSPiTAl:
'.-0
...
F ACILlTY NAME (If not institution, give strMt .nd number)
11 2001
. 5.
. COUNTY OF DeATH
BIRTHPlACE (City ~
S_Ol'F~COUntryI
Harrisburg
'.FA
:"10
:l
-"
"
:l
"
~
'"
J. Longsdorf Way
".Carlisle, PA 17013
FATHER'S NAME IFnt Middle, Last)
". Herbert Coo er
INFORMANT'S NAME (TypelPrintJ
.... Mar sha Thrush
METHOD OF OlSPOSl:1xJ 0
Done"'" 000::"'_1 C..- ............- 0
. 211.
SIGH
Home
DECEDENTS
ACT\JAl
RESIDENCE
(SHinttNctions
on other SIde)
MARITAL STATUs.M.rried
~~~'
Widowed
RACE-American lneli.n, BllIck, White. etc
I_I
10. Whi te
SURVIVING SPOUSE
(If wife. givoe maiden r\llme)
~i
~ lb. Cumberland
DECeDENTS USUAl OCCUP,6,TION
(GlYe kind Of woftl; done during mosI
ot-"ana"'; do notUMretirwd.)
. ,,,.Homemaker ".Own
DECEDENT'S MAILING ADDRESS (SttMt. CitylTown, Statti, Zip Code)
k. Carlisle
KIND OF BUSlNES5nNDU$TRY
17_, Slate
FA
l>d
-
1iYe1,,.
-'
South Middleton Twp.
<wp
ll'b.Counly
Cumberland
17d.D ~~~~of
cityfboro
MOTHER'S NAME (Fnt, Middle, MaiDen Sum.me)
11. Alice Rorabau h
INFORMANTS MAILING ADDRESS (StrMt, CllylTown, Stq;, Zip Code)
....963 W. Old York Rd., Carlisle, PA 17013
~~SPOSITlON - Nameofc.m.ry, Cremettwy lOCATION -ClfylTown, Stn, Zip Code.
14, 2001 "..Letort Cemetery "d. Carlisle, PA 17013
N....eANcAOO.E..OFFACIUTY Ho man-Roth Funera Home, Inc.
u..219 North Hanover Street, Carlisle, PA 17013
T best of my knowledge, dHth occurred lit the time, date ancI place ataItd.
ISignMln and Tille)
230.
TIME OF DEATH
2:9:.> 11, 2001
lICENSE NUMBER DATE SIGNED
(Month, Day, Y....)
23b. 23c.
WAS CASE REFERRED TO MEOl'1&,EXAMINERlCORONER?
Yes U No IXl
21.
Approxim.. PART It: Other significant conditions contributing 10 dHltI, but
l=-':= not resulling in the under!ylngClluse given In PART I
I t PJ,.r'i>
IA.{ c...//1$O"'S /'';),/<;(:>4 <:; f'
DUE TO lOR AS A CONSEOUENCE OF)
\ :
d.
WERE AUTOPSY FINDINGS
AVAIlABlE PRIOR TO
COMPlETION OF CAUSE
OF OEATH?
DUE TO (OR AS A CONSEQUENCE OF)
DUE TO (OR AS A CONSEQUENCE OF):
MAN~OFDEA~
DATE OF INJURY
(Month, o.y, YH!')
TIME OF INJURY
INJURY AT WORK' DeSCRIBE HOW INJURY OCCURRED
.........
o
o
o .... ....
=~N~~harM, farm, snet. fadoty,orrice
....
v.. 0 No 0
,..0 No lliI
,.. 0
NolZl
-
o
o
Ptnding Irwestiption
........
CouicInotlledetllrmined
M, SOc.
tlJ \ L).J I ()l
, Yeer)
211. 2It),
CERTIFIER(Ched< only one)
~c;E~~~~:Y:=~~:=.n::.~r::C:::'=:=::~:g~~~.~8~_.~.~~te~~~~_2~). _ _.._
'''PRONOUNCING AND CERllFYING PHYSICIAN (Physieiln both pronouncing death and certifying to cause of death)
...
'"MEDICAL EXAMINERlCORONER
On the basis of examination and/or Inv..Ogatlon. In my opinion. death occurred .t the tI...... daN. and place, .nd due to the cauae{a) and
manner...tIIted. _ . _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ . _ _. _ _ _ _ . _ . _ _ _. _ . _ _ _ _ _ _ + _ _ _ _ _ _ _ _ __
o
r-
r
LAST WILL AND TESTAMENT
OF
MARY E. SUTTON
I, MARY E. SUTTON, an adult individual. of Carlisle, County of Cumberland,
and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and dec!are this to be my Last Will and Testament,
hereby revoking and making void any and all Wills or testamentary writings by me at any
time heretofore made.
FIRST:
I direct that all my debts, funeral expenses and inheritance
taxes be paid by my personal representative, hereinafter named, as soon after my death
as may be practicable.
SECOND: I give, devise and bequeath all the rest, residue and remainder
of my Estate, be it real, personal and mixed, of whatever nature and wheresoever the
same may be situate to my husband, Marshall W. Sutton, providing he shall survive me
by a period of thirty (30) days.
THIRD:
Should my husband, Marshall W. Sutton, predecease me or
die on or before the 30th day following my death, I give, devise and bequeath all the rest,
residue and remainder of my estate, be it real, personal or mixed of whatever nature and
wheresoever the same may be situate to my daughter, Marsha E. Sutton Thrush also
known as Mrs. Donald Thrush, per stirpes..
FOURTH: I hereby nominate, constitute and appoint my husband,
Marshall W. Sutton, as Executor of this my Last Will and Testament. Should my
husband, Marshall W. Sutton, fail to qualify or cease to act as Executor of this my Last
Will and Testament, I hereby nominate, constitute and appoint my daughter, Marsha E.
Sutton Thrush, as Executrix of this my Last Will and Testament.
FIFTH:
I hereby direct that my personal representative shall serve
without bond. Said personal representative shall have the power to discharge all the
debts, liens and encumbrances upon my estate, as well as any taxes thereon, to pay for
the cost of the final disposition of my remains and final illness, if any, to receive any and
all commissions and other compensation for services rendered by me during my lifetime
18
F
j
and to perform any and all fiduciary duties authorize by statute. Further, I direct my
personal representative to preserve my estate and any instructions pertaining to the
distribution of the same from any attachment or anticipation while in the hands of my
personal representative, it being my express intent that all legacies shall be free from any
attachment or anticipation while in the hands of the accountant for my estate.
IN WITNESS WHEREOF, I, MARY E. SUTTON, have signed, sealed,
published and declared this to be my Last Will and Testament, consisting of this and two
(2) additional pages in the margin of each of which I have also set my hand for greater
security and better identification this \ "'" day of ~~997.
".~
~..jiL (SEAL)
Mary E. Sutton
The preceding instrument, consisting of this and two other typewritten
pages, each identified by the signature of the testator, was on the day and date hereof
signed, sealed, published and declared by MARY E. SUTTON, Testator herein named
as and for her Last Will, in the presence of us, who at her request, in her presence and
in the presence of each other have hereunto subscribed our names as witnesses hereto.
We further certify that at the time of the execution hereof, the said MARY E. SUTTON
was of sound and disposing mind, memory and understanding.
"-~~ ~n
<"~ ;",.~. . of ~./)"\,~"~ - ~ ~~
~~~--,,~~_. \.\.\b
'-'4v/ .-----12 -1'//./ ... l~
/It~ C. ~ of _ q~3 ld (I/-dL . [:. ,:~-<
t7
(laA'L;/J4. r}<J /7c.//3
I .
~ '''-..., ~ ..r-.J ~~.. /
.i-) c:~.' 7 )J, ;.;2 tj t .Lt /{
J.... . -
rJ ,e/U'wAJ!u-0'1 i? i? ! 7/ /h7
~~Wif
-'
(/I ') ,.~. .
-:1 . . ..
i V. Z,(~{/.-(_/
of
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
I, MARY E. SUTTON, Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me by MARY E. SUTTON, the
Testator, this 1,,-tE,day of "-i/-(\ Q..-t1;"T997.
(SEAL)
1
COMMONWEALTH OF PENNSYLVANIA
Not8rial Seal
Agnes G. Nicll:CI. Notarv Public
Harrisburg, Dauphin County
My Commission Expires June 19, 1998
Member, Pennsylvania Association of Notaries
SS:
COUNTY OF CUMBERLAND
W~ and ,W~Z~~~ ,
the witnesse os s are signed the attached or foregoing instrument, being
duly qualifie according to law, do depose and say that we were present and saw MARY
E. SUTTON, Testator, sign and execute the instrument as her Last Will and Testament;
that MARY E. SUTTON signed willingly, and that she executed it as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight
of the Testator signed the Will as witnesses; and that to the best of our knowledge, the
Testator was at that time 18 or more years of age, of sound mind, and under no
constraint or undue influence.
~~~
~
w~ 'CJIh'<'Cd~
Sworn to and subscribed before me
~' this -----L-!::,-fj.( day of ")/Yl C;,(A_/ /'-
~ 1~97.
"'-
/'
'.~i~/l~~.{'--{ ~
& /7/Y:;/
i ~,' ,./
,-t~L
Notary I
My co
(SEAL)
A Notarial Seal
gnes G. Nichici, Notary Public
Harnsburg, Dauphin Count
My Commission Expires June 1 r.l. 1998
Member, Pennsylvania Association of Notaiies
E
-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mary E. Sutton
Date of Death:
02/11/01
No. 2001-00191
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiary of the above-captioned
estate on May 23, 2001:
Name
Address
Mrs. Marsha E. Sutton Thrush
963 W. Old York Road. Carlisle. PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
No Exceptions
Date:'~ - 1- "3. - 0 '-
~ \--~
('""':::5'-'- '", ~
~.- <::::::::::--., "
..- '~
Harry L. Br~
407 North Front Street .. ,
Harrisburg, PA 17101
(717) 233-2555
Capacity: _ Personal representative
X Counsel for personal
representative
""~~;C"" ,_.~
C v,/
tJL,
STATUS REPORT UNDER RULE 6.12
Name of Decendent: Marv E. Sutton
Date of Death: Februarv 11. 2001
Will No. 2001-00191
Admin. No. 21-01-0191
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
b.
representative's account is:
The separate Orphans' Court No. (if any) for the personal
c.
parties in interest? Yes
Did the personal represenatative state an account informally to the
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: Januarv 13. 2003
.,,;:.._-~)\.l.- _..<~.,...~///
--s -,~.,c<' ..,,~:~:~=
Signatllr~ . ....~~>~
("
Harrv L. Bricker, Jr.
Name (Please type or print)
\.
'\
\
'\
407 North Front Street, Hba, PA 17101
Address
( 717) 233-2555
Tel. No.
Capacity: Personal Representative
X Counsel for personal
representative
(MAH:rmf/AM3)
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/06/2003
MARSHA E SUTTON THRUSH
963 W OLD YORK ROAD
CARLISLE, PA 17013
RE: Estate of SUTTON MARY E
File Number: 2001-00191
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/11/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: ./File
Counsel
Judge
/&-;21/- Lf
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRY L BRICKER JR ATTY
407 N FRONT ST
HBG PA 17101-1102
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-24-2001
SUTTON
02-11-2001
21 01-0191
CUMBERLAND
101
)~*
REY-1547 EX AFP 1l2-00l
MARY
E
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i54-j-EX-AFP-li2"=oOY-NOYicE--OF-YNHEifiTANCE-YAX-APPRAisEMENT-,--ALI"OWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SUTTON MARY E FILE NO. 21 01-0191 ACN 101 DATE 09-24-2001
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 80nds (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
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
182,320.42
1,566.72
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
23,770.34
.00
(11)
(2)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax payment.
183,887.14
23.170.34
160,116.80
.00
160,116.80
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
US) .00 X 00 = .00
(6) 160,116.80 X 045 = 7,205.26
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(19)= 7,205.26
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-10-2001 CDOOO142 .00 7,205.26
TOTAL TAX CREDIT 7,205.26
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 RFFlIND_ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
l
)
55:
I, Marsha E. Sutton Thrush
being duly sworn according to law, deposes and says that ~ she is the
Executrix of the Estate of Mary E. Sutton
late of _~o~_th _~_iA~~~1::2!l__~own~~~ , Cumberland County, Pa., deceased and that the
within is an inventory made by Harry L. Bricker, Jr. __ _/ the said attorney
of the entire estate of said decedent. consisting of all the personal propc}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. v..
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and subscribed before me,
Marsha E. Sutton Thrush
Executor. Administretor
19
963 W. Old York Road
Carlisle, FA 17103
Address
Date of Death
11
February
2001
Day
Month
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 discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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Inventory of the real and personal estate of
Mary E. Sutton
deceased
First Union Bank - Certificate of Deposit
Account No. 2474102041269011
20,643 71
First Union Bank - IRA
Account No. 257410060293120
9,799 18
First Union Bank - Savings Account
Account No. 3082645417015
46,697 27
Baltimore Life Companies - 20 year Pay Life
Policy No. 103289351
757 00
Baltimore Life Companies - Single Premium Retirement Annuity
Policy No. 01052021615
20,915 88
Transamerica Life Insurance and Annuity Company
Annuity No. 26858057
55,644 88
Metropolitian Life Insurance Company
Group Annuity Contract 1032A and Certificate No. 174050597
28,619 50
183.077 4:;>
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
BRICKER HARRY L JR
407 NORTH FRONT STREET
HARRISBURG, PA 17101
-------- fold
ESTATE INFORMATION: SSN: 207-07-7951
FILE NUMBER: 21-2001- 0191
DECEDENT NAME: SUTTON MARY E
DATE OF PAYMENT: 08/13/2001
POSTMARK DATE: 08/10/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 02/11/2001
NO. CD 000142
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $7,205.26
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TOTAL AMOUNT PAID:
$7,205.26
REMARKS: HARRY L BRICKER, ESQ.
CHECK# 51 22
SEAL
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: Mary E. Sutton
Date of Death:
February 11. 2001
No. 2001-00191
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 X
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: Hopefully within one year
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 Clerk of the Orphans' Court and may be attached to this
report.
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Harry L.~--j~e "".,,~
407 North Front SU.eer-----. .
Harrisburg, PA 17101
(717) 233-2555
Capacity:
Personal Representative
X
Counsel for Personal
Representative