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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
/to -~ Ii - J f
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF B1RTH (MM-OD-Year)
01/27/2001 06/19/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[X] 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 (date of death after 12-12-82)
o 7. Decedent Mainlained a Living Trusl(AttadlCO\lyofTrust)
o 10. Spousal Poverty Credit (date of death tlelWeen 12-31-91 and 1-1-95)
(
OFFICIAL USE ONLY
FILE NUMBER
21 -0 1 00
COON"rYC06E --VEAR- -
2 0 1
NUMBER
SOCIAL SECURITY NUMBER
2 04- 4 0 306 1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
_ B. Total Number of Safe Deposit Boxes
o 11. Election 10 tax under Sec. 9113(A} (AllachScl\Oj
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE A.ND CONFIDENTlALTAX INF.ORMA'IlONSHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
H. Anthon Adams 128 East King Street
FIRM NAME (If A,~.ab1e1
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1. Real Eslale (Schedule A)
2. Stocks and Bonds (Schedule B)
3, Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscel1aneous Non-Probate Property
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7)
g, Funeral Expenses & Administrative Costs (Schedule H)
10, Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I)
11. lotal Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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TELEPHONE NUMBER
717-532-3270
Suite A
Shi
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subjeet to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a){1.2)
16. Amount of Une 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
Pa 17257
I
1 ,544.24\
i
17,310.10 I
I
30,735.98
I
119,000.00 L-__
1
OFFICIAL USE ONLY
(8)
168,59032
1 ,984.64
(11)
(12)
(13)
1 ,984.64
166,605.68
500.00
(14)
166,105.68
0.00 X _(15)
163,094.97 X .045 (16) 7,339.27
X .12 (17)
3,010.71 X .15 (18) 451.61
(19) 7,790.88
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
625 Brad Street
CITY I STATE TZ'P
Shippensburg Pa 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
7,790.88
Total Credits (A + B +C) (2)
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty (0 +E) (3)
4. If Line 2 is greatert~an Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a relund (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. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
7,790.88
7,790.88
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ..... ................. .............. .............. ..... 0 0
b. retain the right to designate who shall use the property transferred or its income; ............... ................ 0 0
c. retain areverslonary interest; or .......,..... ..... 0 0
d. receive the promise for life of either payments, benefits or care? .......""'''''''''''' ................... ............' 0 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?...... ........... ......................................... .... ... .........m.... 0 0
3. Did decedent own an 'in trustfo~ or payable upon death bank account or security at his or her death? ........ .... 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......"....................... ............... ...................... ......,....... ..... 0 D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
this relurn, including accornpanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete
tive IS based on all information of which preparer has any knowledge.
FILING RETURN DATE
9'1J.~ to I
Underpenaltiesofpe~ury, I declare that I haveexamin
Declaration of preparer other than the personal represe
SI URE OF PERSON R~NSI8LE F
0-n ,/Ll r--
ADDRESS
DATE
.9
of transfers to or for the use of the surviving spouse is 3%
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the ne
[72 PS ~9116 (aJ (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value aftransfers to or forth. use ofthe surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
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. ~9116(a)(1.2)J.
The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted In 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)].
The tax rate imposed on the net vaiue 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 parenlln common with the decedent, whether by blood or adoption.
':'.'~m'I'.9'1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE. lDENT DECEO NT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Van Scyoc Beryl A.
All property jointly-owned with Tight of survivorship must be disclosed on Schedule F.
FILE NUMBER
21 01
00201
ITEM
NUMBER
1.
DESCRIPTION
CV Cooperative 56 shares of common stock
VALUE AT DATE
OF DEATH
560.00
2
York Farm Credit 123 shares of common stock class c
984.24
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is nee<led, Insert addllional sheets of the same size)
1 544.24
.,,,,.,",,,,1';"'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Van Scyoc Beryl A
FILE NUMBER
21 01
00201
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
8,973.52
Mellon Bank Checking Account
2
Safeco Annuity AN 0880121
3,336.58
3.
Melion Bank Certificate of Deposit # 00876458
5,000.00
TOTAL (Also enter on line 5, Recapitulation) $
Ilf more space is needed, insert additional sheets of the same size)
17310.10
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Van Scyoc Bervl A
If an asset was made joint within one year Of the decedent's date of death, It must be reported on Schedule G.
FILE NUMBER
21 01
00201
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. B. Joyce Rosenberry
3 Longview Street
Shippensburg, Pa. 17257
daughter
B Robert M VanScyoc
620 Brad Street
Shippensburg, Pa. 17257
son
c Earl D. Rosenberry
3 Longview Sreet
Shippensburg, Pa. 17257
son in law
JOINTLY -OWNED PROPERTY:
LETTER DATE OESCRIPTION OF PROPERTY %0' DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Allach DATE OF DEATH DECO'S VALUE OF
NUM8ER TENANT JOINT deedforjoinUy-held realestale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 4/21/94 Mellon Bank C.D. #0-B22141_-C 5,018.08 50. 2,509.04
2. C 5/05/97 Mellon Bank Certificate of Deposit #00512133 5,019.30 50. 2,509.65
3. D 10/2/92 Mellon Bank C.D. 42-A46596 5,021.94 50. 2,510.97
4. E 10/2/92 Mellon Bank C.D 42-A46597 5,021.94 50. 2,510.97
5. A,B 6/12/92 Orrstown Bank Trust Fund 34,329.11 34. 11,67190
6. B 4/21/94 Mellon Bank CD. #0-b22143-C 5,017.19 50. 2,508.60
7. F. 6/24/96 Mellon Bank CD. 00339638 1,000.38 50. 500.19
8. G 10/2/92 Mellon Bank C.D. 42-A46599-C 5,021.94 50. 2,510.97
9. H 4/03/95 Mellon Bank Certificate of Deposit #00135811 1,002.11 50. 501.06
10 I 10/2/92 Mellon Bank Certificate of Deposit #42-a46598 5,005.25 50. 2,502.63
TOTAL (Also enler on line 6, Recapitulation) $ 30735.98
(It more space is needed, insert addilional sheels of Ihe same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Van Scyoc Beryl A.
21
01
00201
PaQe 1
Schedule F-1 . Jointly Owned Property
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
D. Randy E. VanScyoc
3046 Orrstown Road
Shippensburg, Pa. 17257
grandchild
E. Steven B. VanScyoc
1401 Memory Lane
Chambersburg, Pa. 17201
grandchild
F. Benjamin E. VanScyoc
Apartment 607
527 Vine Street
Johnstown, Pan 15901
17612 West Washington Street
Hagerstown, MD 21740
grandchild
G. Angela R. Rosenberry
grandchild
H. F.G. Hershey
386 Strohm Road
Shippensburg, Pa 17257
friend
I. Lisa A. Morrow
3 Summit Drive
Shlppensburg, Pa. 17257
grandchiid
J. Oakville United Methodist Church
519 Oakville Road
Shippensburg, Pa. 17257
religious institution
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Van Scyoc Beryl A.
21
01
00201
PaQe 2
Schedule F-2 - Jointly-Owned Property
LETTER DATE OESCRlPTION Of PROPER1Y %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial inslilution and bank account number or sim ilaridentifyingnumber.Attach DATE OF DEATH DEWS VALUE OF
NUMBER TENANT JOINT deedforjoirlUy-held real estate. VALUE OF ASSET INTEREST DECEDENrSINTEREST
11 J 5/02/99 Oakville United Methodist Church 1,000.00 50. 500.00
SUBTOTAL SCHEDULE f.2 500.00
GRAND TOTAL SCHEDULE f.2 $ 30,735.98
''''''00'''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Van Scvoc Beryl A.
FILE NUMBER
21 01
00201
This schedule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OFTHE TAAN$FEREE,THEIR FlELATIONSHIPTO DECEDENT AN OTHEOATEOFTAANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE OEEO FOR REAL ESTATE VALUE OF ASSET INTEREST
(IFAPPUCABLE)
1. Land and residential dwelling erected thereon lying and being 119,000.00 100. 119,000.00
situate in Shippensburg Borough, Cumberland County,
Pa as per deed book "K" vol. 36 at page 367
.
TOTAL (Also enter on line 7, Recapitulation) $ 11900000
Ilf more space IS needed, insert additional sheets of the same size)
"""""""'~I.
COMMONWEALTH OF PENNSYLVANIA
INHER\l ANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATNE COSTS
EST ATE OF
Van Scvoc Bervl A
FilE NUMBER
21
01
00201
Debts of decedent must be reporled on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1.
<-:,
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I ErN Number of Personal Representative(s)
Street Address
City State Zip
Year{s) Commission Paid:
2. Attorney Fees H. Anthony Adams 850 00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfS, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 72.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal (advertising of letters) 75.00
8. News Chronicle (advertising of letters) 73.04
9. Sprint Telephone 174.17
10. GPU Energy 272.15
11. Borough of Shippensburg 130.73
12. Ausherman Brothers (appraisal) 225.00
13. Eye Specialist of Central Pa, 112.55
TOTAL (Also enter on line 9, Recapitulation) $ 1 984.64
(It more space is needed, insert additionai sheets of the same size)
'''''.'''''''''.''W
COMMONWEALTH OF P~NNSYLVANIA
lNHERITANCE lAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Van SCVI C Bervl A ?1 n1 nmn1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trust..(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. B. Joyce Rosenberry child one-half
3 Longview Street
Shippensburg, Pa. 17257
2. Robert M. VanScyoc child one-half
620 Brad Street
Shippei1sburg, Pa. 17257
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. Oakville United Methodist Church (see joint property schedule) 500.00
519 Oakville Road
Shippensburg, Pa. 17257
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 500 00
(If more space is needed, insert additional sheets of the same size)
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY-PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Estate of Beryl A. VanScyoc
No.
21-01-201
also known as
, Deceased
Social Security No. 204403061
B. Joyce Rosenberry and Robert M. VanScyoc
Petitioner(s), who islare 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
o
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
GJ
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Relationship
Dau hter
Son
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 625 Brad Street, Shippensburg, Cumberland County, Pennsylvania
(list street, number and municipality)
Decedent, then 86 years of age, died January 27 , 2001 , at Manorcare Health Services, Chambersburg, PA
(Location)
Decedent 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 ........................................................................................ $
Total........... ............. ................... .... ........... ...... ....... ........ ....... ..... ........ ........... ...... $
8,000.00
8,000.00
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Typed or printed name and residence
3 Lon view Street Shi
620 Brad Street Shi
PA 17257
PA 17257
RW-1
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Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer th est according aw.
Sworn to and affirmed and subscribed
before me this
20th
February 2001
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Estate of Beryl A VanScyoc
DECREE OF REGISTER
Deceased
No. 21-01-201
also known as
Social Security No: 204403061 Date of Death: 1/27/01
AND NOW, FEBRUARY 21 2001 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary !XI of Administration
are hereby granted to B. Joyce Rosenberry and Robert M. VanScyoc
((c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
in the above estate and that the instrument(s), if any, dated none
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters................................... .
Short Certificates( s) ...............
Renunciation......................... .
Extra Pages (
) ...............
!.T.R.......................................
JCP Fee .................................
Inventory..,......... ....................
Other........,............................ .
TOTAL............................ .$
$
40.00
,
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$
$
$
$
$
$
$
$
12.00
r\\~~\
Si~
5.00
Attorney: H. Anthony Adams, Esquire
I.D. No: 25502
Address: 128 E. King Street
Shippensburg,
Telephone: (717)-532-3270
DATE FILED: ~ -c.;:u-:; --c) /
~'-/p~~/ Lt:> aZ,z/1,:'c'/'"",,/"'"
PA 17257
57.00
This is to .certifY that t~e. inform~tion he~e given is correctly copied from an original certificate of death duly filed with
Local Registrar. The ongmal certIficate will be forwarded to the State Vital Records Office for permanent filing.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
y
706GB77
No.
~_~ 2.? :?&'~/
Date
21-01-201
.2117
COMMONWEALTH 01' PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
HAW( OF DECEDENT (f.,,,,. MlddMl. L_'
....
to Female
SWI'ILf~A
SOCt"l SECUAITV NUM8EA
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DECEDENT'S USUAl OCCUAVlON
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17257
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CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Beryl A. VanScyoc
Date of Death:
January 27, 2001
Will No: 2001-00201
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the
Orphan's Court Rules were served on or mailed to the following beneficiaries of
the above captioned estate on: June 4, 2001
Name
Address
B. Joyce Rosenberry
3 Longview Street
Shippensburg, PA 17257
Robert M. VanScyoc
620 Brad Street
Shippensburg, PA 17257
Notice has now been given to all persons entitled thereto under Rule 5.6
(a) except: None.
Date: 6/4/01
~~~
H. Anthony Adams, Esquire
128 E. King Street
Shippensburg, PA 17257
Telephone: (717)-532-3270
Counsel for Personal Representatives
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ADAMS H ANTHONY
128 EKING ST
SHIPPENSBURG, PA 17257
_____n_ fold
ESTATE INFORMATION: SSN: 204-40-3061
FILE NUMBER: 21-2001- 0201
DECEDENT NAME: V ANSCYOC BERYL A
DATE OF PAYMENT: 10/01/2001
POSTMARK DATE: 09/28/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 01/27/2001
NO. CD 000333
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $7,790.88
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$7,790.88
REMARKS: B JOYCE ROSENBERRY & ROBERT M
VANSCYOC C/O H ANTHONY ADAMS
CHECK# 1021
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-lSQl EX AFP 112-001
Recoroed Offyce.of
Register of Wills
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-20-2001
VANSCYOC
01-27-2001
21 01-0201
CUMBERLAND
101
BERYL
A
'01 NaV 26 All :51
H ANTHONY ADAMS
STE A
128 EKING ST
SHIPPENSBURG
Allount Rellitted
Clerk-Or s Court
PA 17@amberiand Co.. PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i5"4-j-EX--AFP-fi'2-:o0Y-NOYicE--OF-INHEififANCE-YA"X-jrpPRA-isEifENT~--ALlowAifcE-oR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VANSCYOC BERYL A FILE NO. 21 01-0201 ACN 101 DATE 11-20-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
) CHANGED
.00
1.544.24
.00
.00
17,310.10
30.735.98
119.000.00
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
168.590.32
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/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
1.984.64
.00
(11)
(12)
(13)
(14)
(9)
(10)
] .984 64
166.605.68
500.00
166.105.68
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 (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE:
.00 X
163.094.97 X
.00 X
3.010.71 X
00 =
045 =
12 =
15 =
.00
7.339.27
.00
451. 61
7.790.88
(19)=
PAyMENT Rt:CuPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-28-2001 CDOO0333 .00 7.790.88
TOTAL TAX CREDIT 7.790.88
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 RFFlJND c:.~J:' DC"CD~E: CTnle' ....r- ..u__ ___u --- ------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/06/2002
ADAMS H ANTHONY
128 EKING ST
SHIPPENSBURG, PA 17257
RE: Estate of VANSCYOC BERYL A
File Number: 2001-00201
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. I, for decedents dying on or after
July I, 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: 1/27/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~.lJl.~jd~~
MARY c. LEWIS~~
REGISTER OF WILLS
cc: File
vPersonal Representative(s)
Judge
0.V
vd~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: .~ ~. ,J C>.. t-.J ~ (') C ~
\
Date of Death:
I ~ 0
Will No. Admin. No. JDa 1- 6DdO I
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:
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:
1.
3. If the answer to No.1 is Yes, state the following:
a. Did the personal r~fesentative file a final
account with the Court? Yes No~.
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~
Name (Please typ r print)
Yl:\ \)0, 0 \(X~ ~~, S. '<-\\~ ""~~
Address ' t I o-~ (
DIl) 53;)-- ~~lb
Tel. No.
Date: 1 3
Capacity: Personal Representative
~counsel for personal
representative
(MAH:rmf/AM3)