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REV-rl500 EX + (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA REV-1500 J{O 1 llo - I (
-
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FilE NZ1ER nl 2-7 (
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT
COUNTY CODe YEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MrLE INITIAL) SOCIAL SECURITY NUMBER
FOR-b I ])ON A: . . 379-20-3448
BSlff>. r !'6ntl
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
01-07-2001 05-06-1916 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
3. Remainder Return
CHECK r ""~ '~m ~> &..-~- B (date of death prior to 12-13-82)
APPRO- 4. Umited Estate 4a. Futurlllnterest Compromise 5. Federal Estate Tax Return Required
(datil of death after 12-12-82)
PRIATE 6. OecedentOilld Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) Attach acopy of Trust)
BLOCKS 9. Utigation Proceeds Received 10. ~pousal Poverty Credit(date of death between 011. EltlctiontotaxundlilfSec.g113(A)
12-31-91 and 1-1-95) (Attach 5ch 0)
nus ,SECTION 'MUST BE COMPlET,ED.J\l.I;COFlRESPONDENCE;&,CPNI'IDEtfrIAL l"AXINFORMATIOJ'l,SHOULDBE OIRECTEDl"O'
NAME COMPLETE MAILING ADDRESS
COR- JOYCE F BOOK
RE- FIRM NAME (If Applicable) JOYCE F BOOK
SPON
DENT N/A 707 CHARLES ST
TELEPHONE NUMBER MECHANICSBURG, PA 17055
717-766-7937
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) >. -
3. CI051i11y Held Corporation, Partnership or Solll-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 3,023.
6. Joinijy Owned Property (Schedule F)
o Separate Billing Requested (6)
RECA-
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7)
8. Total Gross Assets (total Unes 1-7) (8) 3,023.
9. Funeral Expenses & Administrative Costs (Schedule H)(9) 68.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Unes 9 & 10) (11) 68.
12. Net Value 01 Estate (Une 8 minus Une 11) (12) 2,955.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13)
has not been made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Line 13) (14) 2 955.
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of linll14 taxable at the spousal tax
rate, or transf.rs under Sec. 9118 (a)(1.2) X .0 (15)
TAX 16. Amount of Linll14 taxable at lineal rat. X.O .06(16) 177.
COMPU- 17. Amount of Line 14 taxable at sibling ratll X .12 (17) o.
TATION 18. Amount of Line 14 taxable at collateral rate x.15 (18) o .
19. Tax Due (19) 177.
20. 0 I CIIECK IIEREI!;,\,ouAflEREQQESTitlGAflEI;lINOOF ANOVERP)l,YM!ONt'1
"v.'
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, >>B!;SURETO'ANSWERAL~QUESTIONS'ONPAGE2AND RECHECKMATH<<?'.' ':T ,"
'iL.l;;:;>::j::r';.'
o PA 1500t
NTF 29755
EL
PA REV-1500 EX (6-00)
Decedent's Complete Address:
Page 2
STREET ADDRESS
CHAPEL POINTE AT CARLISLE
770 S HANOVER ST
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
177.
9.
Total Credits (A + 8 + C)
(2)
9.
3. Interest/Penalty if applicable
O. Interest
E. Penalty
TotallnterestlPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3; enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WilLS, AGENT
':Y!;;i0:;ijij::i,:;;>> "''i\:;> 'tUWi '\~1:\_? ,i~"':i:i !ji~l~mmllr~llmmillmmm~mm(:;i ~;~ gmfmmmm~mnmmmlm~~Jjj;;:;:;!:;l;li;H::~;,;' "'iJ~;:0;;:k;~m!liwJ: ,;j:';:;h ,i:l:m:lii,l';imH'Ei)i:
<iF: ,,>i::_CC';cc,
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; ....................................... ~ i
:.. ~::~ :;e~~~;i:,:sii~:::t~:; ~~~.I ~.s~.t~~.~r~~~~.~~~~~r~~.~r.~. i~~~~~;. : : : : : : : : : : : : : : : : :
d. receive the promise for life of either payments, benefits or care? .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . .. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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.
Under penalties of perjUlY, I declare that I have examined this return including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete. Declaration oi preparer other than the personal representative Is based on information of
which preparer has any knowledge.
~IG TURE OF ~R~NlESPONSI8lE FOR FILING RETURN DATE
--1fl4~ 5--~/h'?/
ADD S
707 CHARLES ST MECHANICSBURG, PA 17055
SIGNA E OF PR~RE THER THAN REPRESENTATIVE
~/4A
ADDRESS
711 STATE ST LEMOYNE, PA
(3)
(4)
(5)
(SA)
(58)
168.
168.
~
DATE
3 zr 01
17043
'"
172 .
For dates of duth on or after January 1, 199~, the tax rate is impo.sed on the net value of transfers to orforthe use of the surviving spouse is OG/o 172 P,S, I 91 HI (a)(1. 1) (li)].
The .statute does not elfllmot a transfer to a surviving spouse from tax, and the statutory requirements for disclO$ure of assets and filing a tax return are still applicable even if
thesurvivingspousa istheonly beneficiary.
For dates of duth on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% (72 P.S, 191 18(a)(1.2)],
The tax rate imposed on the net value of transfers to orfor the usa of the decedent's lineal beneficiaries is 4.50/., axceptas noted in 72,P.S. i 9118(1.2) (72 P.S. i 9118(a)(1)].
The tax rate impo$ed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S, I 9118(a)(1.3)]. A sibling is defined, under Section 9102, as an individual
who has at least one parent in common with the decedent, whether by blood or adoption,
o PA15002
NTF 29756
EL
REV-)508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONA P FORD
Include proceeds of litigation & date proceeds were received by the 8$tate. All prop. Jointly-owned with right of survivorship must be disclosed on Sch. F.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ITEM
NO.
1. ~ommunity
DESCRIPTION
State Bank of Orbisonia - Bank Account
VALUE AT
DATE OF DEATH
3,023.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3.023.
o PA15081
NTF33305
EL
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONA P FORD
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NO. DESCRIPTION
A FUNERAL EXPENSES:
1.
AMOUNT
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4.
Probate Fees
53.
5. Accou ntant's Fees
6. Tax Return Preparer's Fees
7. Fi.H.nq Fee
15.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
68.
o PA15111
NTF 33308
EL
21-01-271
LAST WILL AND TESTAMENT
OF
DONA P. FORD
I, DONA P. FORD, of Satillo Borough, County of Huntingdon, and State
of Pennsylvania, being of sound mind, memory and understanding, do hereby
make and publish this my Last Will and Testament, hereby revoking and
making void all former Wills at any time by me heretofore made, together
with all Codicils thereto.
I
If there is no cemetery lot available for my interment by me at the
time of my death, I hereby direct that my hereinafter named personal
representatives shall purchase such a lot together with a marker suitable
to my station in life, to be inscribed and erected thereon, using and
expending therefor such funds from my estate as shall in the sole
discretion of the said personal representatives be deemed appropriate.
II
I direct the payment of all my just debts, together with the expenses
of my last illness and funeral and the expenses of administration of my
estate from my estate as soon after my death as may be practicable.
Viffl a
Dona
\) ~N" nO
P. Ford -
(SEAL)
. __-___~,._.-......,.,.,__,.<<____c..~___ __..,
_h___-.
-.....,.,-'",--<,.,--.,,,- - --
III
I direct the payment of all taxes payable as a result of my death out
of my estate before distribution to the end that all bequests made herein
shall pass to the beneficiaries without the requirement that tax be paid
on the same after distribution.
IV
I give, devise and bequeath all my estate, whet.her real, personal
or mixed, and wherever si~uate, unto my son and daughter, in equal shares,
'N &7IJ (/) 0:p(Jr of-
Dona P. Ford
(SEAL)
viz:
James O. Ford
One-half (ls)
Joyce F. Book
One-half (ls)
V
Should either of my aforenamed beneficiaries fail to survive my death,
then I direct that his/her share shall pass to his/her issue, if any, per
stirpes.
VI
My hereinafter named personal representatives shall have all powers
necessary to act in such capacity without limitation, including the power
to sell real estate or personal property at a public or private sale, to
make distribution in cash or in kind and to compromise controversies and
settle disputes.
-2-
_._""'''"'' __.........-----n......---...-
~kliIIIiAf-~...:';;..:..__":~,.,,
VII
My hereinafter named personal representatives shall be excused from
the necessity of posting bond in connection with their duties as such in
any jurisdiction in which they may be called upon to act insofar as I am
able to do so by law.
VIII
I do hereby make, constitute and appoint my son and daught.er, James
O. Ford and Joyce F. Book, to be Co-Executors of this my Last will and
Testament.
.~m~
Dona
-3-
Q~cJ
P. Ford
(SEAL)
IN WITNESS WHEREOF, I, DONA P. FORD, the Testatrix above named, have
subscribed my name and affixed my seal to this, my Last Will and Testatment,
consisting of four (4) sheets, having affixed my name and seal to each
of the preceding sheets separately this
16:1i day of ~
, 1984.
~cm a Q ~ord
Dona P. Ford
(SEAL)
Signed, sealed, published and declared by the above named Testatrix,
Dona P. Ford, as and for her Last Will and Testatment, in the presence
of us, we having witnessed her signature to this sheet and the preceding
three (3) sheets hereof and have hereunto subscribed our names at her
request as witnesses thereto in the presence of the said Testatrix and
of each other.
~./} /cnJL
ness
~tf~"~ y'J ~
ness
-4-
.-~. --~. ----- ...-----"., -_'''...,--,-,--,~- --,,--,
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i
COMMONWEALTH Of' PENNSYLVANIA
:
55.
COUNTY OF HUNTINGDON
:
I, DONA P. FORD, Tes~a~rix, whose name is signed ~o the attached
foregoing instrumen~, having been duly qualified according to law, do
hereby acknowledge that I signed and execu~ed ~he foregoing instrument
as my Las~ Will; that I signed it as my free and voluntary act for the
purposes herein expressed.
)\Jm711 Q ~~I?~
Dona P. Ford
Sworn to or affirmed to and acknowledged
before me by Dona P. Ford, Tes~a~rix, ~his
/eo#.
A-pr; J
, 1984, A.D.
day of
G/v,_' TWo (loJ
Notary Public
(SEAL)
~
Commission 91Jiret Jan. 6. 1995
-5-
,
(SEAL)
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
SS.
COUNTY OF HUNTINGDON
:
We, R411/111..JJ :r MekE
and /(1h\flEfl.I..Y L. 1110)10...
,
the witnesses whose names are signed to the attached foregoing instrument,
being duly qualified according to law, do depose and say that we were
present and saw the. Testatrix sign and execute the instrument as her Last
Will; that she signed it 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 Testatrix signed the Will as witnesses;
and that to the best of our knowledge the Testatrix was at the time 18
or llOre years of age, of sound mind and under no constraint or undue
influence.
Sworn to or affirmed to and
~lafh
tness
~&"&.$~Y
subscribed before
me by H""c..lcl. J. LoCI:'" and J!,"'b<rl'-( L. fl{"'IQlV
wi tnesses, this
I (o-tJ.. day of
apJ
1984, A.D.
QL t,. TlAJ/J Ii.. /
Notary Public
PROTHONOTARY
Commission Expires Jan. 6, 1mYt
(SEAL)
-6-
PETITION FOR PROBATE and GRANT OF LETTERS
Estate ofU" AI ,1 ~p hrrJ, No. ~, - 0 I - ~ 7 (
also known as To:
Register of Wjlls for the
. Deceased. County of ('J(rnhIr/Jl.NIL in the
Social Security No. "37 9- 20-- =? 'Ill J? Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or ol.der an t~~ execun-, K
in the last will of the above decedent, dated Ii Df' I I l b -
and codicil(s) dated '
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was do m i ci led at death in C!u",kwr l ~ III tL ~ .. nO un ~y , ,Penns ylvania, with
h I' -r I'llit f '\lII ily or prin9ip,al resi de~ce at l~" .v .)0 I nd- '" rtJ (.'\ r I , s 1-<-
17'7 td. Effvuu~n"';:!i; n~rJ i ~I..v) _~__
(list street, number and muncipality)
Dcccn,dcnt, tfw1 ~ ~ears of ,age, died .J" '" 'I ,t h i~ {j i ,
at (\v."p~j \{)/~I_~_ @ (v:rrl;sJ-.....<L .
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
incom peten t:
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:
LJI.
$ 3J oe0, --
$
$
$
WHEREFORE, petitioner(s) respectfully req.ues~(s) the. probate of the last will and codicil(s)
presented herewith and the grant of letters -t es t,1 'v'Y\ e Y'i Tcif\4
(testamentary; adm'ilOlstratlOn c. La.; admInistration d. b.n.c. La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA l ss
COUNTY OF CUMBERLAND J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of 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.
C}flrJ ,-1 fJ~
s.worn to.. or affi.rm. ed_ and . Sllbscrib.ed J
before me this J 9U day of
'<(/~i.-dJ , :r~
7):tly(~ ~ _~.h JaIl (',C{. ..2A~.,), ~ . .
_ ~ / . I Register i
. d/~-//
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No. 21-01-271
Estate of
DONA P. FORD
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 12 ~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 APRIL 16, 1984
described therein be admitted to probate and filed of record as the last will of
DONA P. FORD
and Letters TESTAMENTARY
are hereby granted to JOYCE F. BOOK
'm()Jtf'c!' X;~J) (l-'A:.. t~/? JI/~ll~Ld;tr
I '
Register of Wills
FEES
Probate, Letters, Etc. ......... $ 25.00
~~IWAC'i>~[~te5( 1) . . . . . " . .. S 1 ~ : 88
RenuncIatIon ................ $ .
JCP $ 5.00
TOTAL_$ 53.00
Filed . .~~~~ . ~? ? .~ q9 ~ . . . . . . . . . . . . . . . . .
A TIORNEY (Sup. Ct. 1.D. No.)
ADDRESS
PHONE
LETTERS AND ORDERS SENT TO EXECUTRIX MARCH 12, 2001
21-01-271
RENUNCIATION
In Re Estate of
~J)()~d y~rL
HurrflNfdn tV
.~
---') A.H~S
deceased.
To the Register of Wills of
County, Pennsylvania.
The undersigned
('.
C_-;,
,~
\-- a~~~
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
WITNESS
'- J () ~ ('.P ~F. fir1() J(
4~f t 1fj;;;;;.~hand this
SHIRLEY A MATRISCINO
Notary Public. State of New York
Ontario County No. 469657!
My Commlsalon expires /2.(3 ~/o I
? I.//) ~.A ..?'
0- day of /ll'r~t::/n
t'r. ..2 oCJ /
, -.
be issued to
0\.-
~
5<1
(Signature)
~~ C o..",v~ () ~t~s 1:>v,~
,-=-~ ~v VD l--~' (j '-( I '-f Y s'-a
I (Address)
(Signature)
(Address)
(Signature)
(Address)
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
r"'"''''
"
E C; 1ST A F! ':, (; E H T ! Fie 1\ 0 N 0 FOE ,0. T '1
r 4637750
i . ~ ",'t' ,'c', ,.... -._,
(l~^\:~~~l
,* ~L. *'
\t.;~'~I~~ ,\~;}Y
...; "'.; '. ., _,!.~'.C .
January 10, 2001
if
Dona
P,
Ford
female
379-20-)448
Date
January 7, 2001
C)"
May 6, 1916
Pa,
Chapel Pointe at Carlisle,
Cumberland,
Carlisle,
whl te
divorced
school nurse. no
Arrned FOl'ce:3)7..u.(S.ori~over-St.'-,
);-?ceC1ET1Is lU
!c(Jdressg~pe!_Polnte at ~~~!!~~.! _ 9.~11s1e, Pal 1701)
Joyce B.ook
F~Jnc~( ell Director
Douglas R, James
Martin R, Brown Funeral Home, Orblsonla, Pal 1724)
ASlID
unknown
PI
DFscnhe how
xx
Ne'
G~_o_;-~_~ .!!:r:~~tJ~~!_ M ,D.
l\C "
!M [)
850 Walnut Bottom Rd" Carlisle, Pal 1701)
Cur:.:me (, ('1 C
a t i (H1 her ( (1 i \! e t'l i S C () rr e c t ! 'I cop I U (j tor n 3
;3 UJ;'1 iRe ~r ~) t i a The c r J g ! n a e r t I f! cat Plv i i :
u
I)'
t f
f,( anent tiling
MRS. QORoTHy N orr
o ~;d~ley Street
rbi~~~.--l-1243-...
, J~-g~ZH'
January 10, 2001
E-
.--
-='=-~='"
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
1JNG 47~d~
JttN
'I. J- tJ 0 I
/
Name of Decedent:
Will No.
2.~/J/-' tJ02 7/
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
JariW ?
.Jt?lfl<.
ffJ. Fd d
r~~k
,5 q me.. (!"tJr) U.JMd:3 ?JrJue.,
7/) 7 dJr IeJ? S!I.
hI/' /I,1T~ IV j/
/ ,
/ij~~
/Jt"J If tJ4 !?tH5
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: &/12/1)1
Signature
Name Cf&f~ J /J~
Address 7 tJ 7 all' b (J 2ked-
jI);,J, 'ft, 1l1!
Telephone (7/'1) 7~6-748l
Capacity: _ Personal Representative
_Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 4 78224 REV-1162 EX (11-96)
RECEIVED FROM:
I
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
f[J\/CC :-:
DOOr',
1 <) ~
1, .1 6E: . 00
-? 0 '7' C !"h'.) (~ :.. E ~~, ~; T F~ [ E T
f"1FC:l"!A\1 1 C:~EiUPCI to P(:i 170f55"'b6::3::::
- FOLD HERE FOLD HERE
ESTATE INFORMATION:
FILE NUMBER
t..~ 1 ~-, :?C'>Cf-l ."(}2~7 1
:.) ~:1 N :3 -7 '7 c.:~ (\ ... J it i,~ E3
NAME OF DECEDENT (LAST)
C; Fi~ I:. f) l.~~ :\}{i F)
(FIRST)
(MI)
DATE OF PAYMENT
~:.i __/:~ i.) i.;~ () (, 1
POSTMARK DATE
i_) .f (}() ..' ('()(.I(>
COUNTY
'l~ '~ i;.~ (3 w C:J ()
__~ t.J ;:"1 [) r= rt t .... {:. ('.,i L)
TOTAL AMOUNT PAID
DATE OF DEATH
\).?
: / I~~~i~? .f E? t) (~ !
REMARKS \.J {L L. ~
j,'. Ul.:l'
RECEIV:~\~,~, {/(J;t~l
r';L (1 I S TE, F: ()r:/' H
/
/'
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REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-U07 EX AFP Cl2-00>
JOYCE F BOOK
707 CHARLES ST
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-09-2001
FORD
01-07-2001
21 01-0271
CUMBERLAND
101
DONA
P
Amount Remitted
PA l7055
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 RECORDS ~
RE-V: i6'ifj-i:x--AFP--fi"2=oo..r------...--iNHERI,.-ANc"E--YAX-ST'A-fEM"E-NY-ifF'-AC-couiff--.-i.--------------- - --- --
ESTATE OF FORD
DONA
P FILE NO. 21 01-0271
ACN 1 01
DATE 07- 09-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-07-2001
P R I NC I PAL TAX DUE: ..............................._............................._...........................................................................................................................................................
132.98
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-30-2001 AA478224 6.65 168.00
06-25-2001 REFUND .00 41.67-
TOTAL TAX CREDIT 132.98
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
\/b-o;/6-//
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
5t
t./'
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
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JOYCE F BOOK
707 CHARLES ST
MECHANICSBURG
PA 17055
05-14-2001
FORD
01-07-2001
21 01-0271
CUMBERLAND
101
Allount Rellitted
*'
REY-1547 EX AFP Cl2-DDJ
DONA
P
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4j-E3f-AFP--fi"2-:oo1--NoTicE--oF-.rNHEifiTANci-y-AX-APPRA-isEi'-ENT~--Aii-oWANCE-O-i-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FORD DONA P FILE NO. 21 01-0271 ACN 101 DATE 05-14-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
3.023.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
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
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (lS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount 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:
68.00
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
3,023.00
68 00
2,955.00
.00
2,955.00
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 x 00 =
2,955.00 x 045=
.00 x 12 =
.00 x 15 =
(19)=
.00
132.98
.00
.00
132.98
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-30-2001 AA478224 6.65 168.00
TOTAL TAX CREDIT 174.65
BALANCE OF TAX DUE 41.67CR
INTEREST AND PEN. .00
TOTAL DUE 41.67CR
~ 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.)
C-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: /f)DN ffJ ~. r~J
Date of Death: JiiN 7crfJ dUJ () j
Will No. !lPJ D j - O():J 1 / 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 1/ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No ~.
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes ~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: ~/;)2j OJ
I /
~a .d~
Si n ture
Jf)W'L r: .~Cl2)(
Name Please type or print)
707 &/ilY .5!kuf, JkJ~ II
Address /7~~
(1/*7) 7l:;b-7f31
Tel. No.
Capacity:
Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)