HomeMy WebLinkAbout01-0315
PETITION FOR PROBATE and GRANT OF LETTERS
~
Estate of~' H-. Prno..Q.-'f'SQ/'\ No. c:i/ -0 J -3 )5
also known as ~. 1-\. '9ndQrsoY'\ To:
Register of Wills for the
Deceased. County of Cum ~ 10 'flO\ in the
Social Security No. \ Sq - 0 q - 04 f 6 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/aile 18 years of age or older ~ the execut r IX
in the last will of the above decedent, dated Y'llo. Y'c.h q, \ q 01 <0
and codicil(s) dated
named
,19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
hlS
Decendent, then 8co years of age, died lIIarcXl \(Q , ~ 2a) I ,
at 441 Brook. C\ y cle.. I rY\.Q ch(lY) I t.s: to V(',\, p...,. 1/05S- (at- ho rI'\.{.. '~ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: n I (A
I
$ ttL{IOOO
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~ men -to. V' j
((testamentarY,)dministration c.t.a.; administration d.b.n.c.t.a.)
theron.
~
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~~ ~l\'\.Q.JL~v
~~ -nmmee Svhr
].g Bf<1lcOY'l COUrT
0;1'= YnDchO-\f\\t.s'ourq \ PA \ 10tJ5
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OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA l.. ss
COUNTY OF CufY\~(, (a.n.ck J
Sworn to or affirm~1 and subscribed {
before me this st day of
March ' 1~2001
'--rr)7 C. . ;;1 H~/P:t -
. ~ B. ~egister
}t,-~/9-7
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.
--ri'mme.e..- Sv,,",r ~(~
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No. 21-01-315
Estate of E.H. ANDERSON a/k/a ED H. ANDERSON
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW March 23 ~~~, 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 March 9, 1996
described therein be admitted to probate and filed of record as the last will of
E.H. ANDERSON a/k/a ED. H. ANDERSON
and Letters TESTAMENTARY
are hereby granted to TIMMEE SUHR
m~ c.. ~ .lb- fJBIJ,D'-\'
Register of W(lIs I '\
FEES
Probate, Letters, Etc. .........
Short Certificates( 3) . . . . . . . . . .
Renunciation ................
JCP
$ 80.00
$ 9.00
$
$ 9~'88
TOTAL _ $
MARCH 23,2001
AITORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
c.-)
H105.805 REV 9/8(,
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.
ITEM # I
SHOULD READ AS FOLLOWS:
~r.v cU. ~
d-.v~~
No.
~?{?~ ~
Local Registr~
Fee for this certificate, $2.00
p
7294701
MAR 2 0 200t
Date
105.143 Aev _ 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
Cumberland
DECEDENT'S USUAl. OCCUlWlON
(~"'=:~":::'.::~:or
ltLCorrections Officer lt~. Prison S stem
DECEDENT'S MAlt.ING _58(50.... c~. _. Z",C_I
461 Brook Circle
Mechanicsburg, PA 17055
...
SEX
2. Male
STAll FilE NUMBER
SOCIAL SECUR1TV NUMBER
DAl E OF DEATH IMCNtl. Oa.,. '''881'
NAME OF DECEDENT (FIrst. Middle, L.asl
..
AGE (la.. -Yl UNDER 1 YEAR
-.. Ooyo
Ed H. Anderson
UNDER 1 OM
HouN Minul"
2. 189 - 09
0478
.. March 16, 2001
86 Y.,..
COUNTY Of' DEAl'H
BIRTHPLACE (C~ and PtACE OF DeATH lCl'>ea ~ /)f'8 ~- -see 'nslruct.ons on OCher ...)
Stare Of Fcreqn CounlrYI HOSPITAL:
InpaI_ 0
1. Palmetta, FL ...
FACILITY N4ME Itt notlnstofu!:lOIl. g.ve stleel and numberl
:::;""10
10.
White
SURVIVING SPOuSE
I" ..... QlYe ma.cJen NI'I1tII
17.. Stale
MARITAl. STATUS.........
N.-..r Manied. WidawecI.
~(S_
Q Divorced a
[l;d I1C.o ......-.._"'-- Hampden
-..
..in.
Cumberland ......... I1d.D =-..-===..
MOTHER'S NAME (F... Middle. MaJden Surname)
.....
...
FRHER'S NAME (First. Middle. lastl
1~.
_.
Clarence Anderson
METHOD OF llISPOSlTlON
_0 Cr_~ __Sl...o
0Ih0r -...
Edward J. Anderson
DATE Of' DISPOSlT1ON
_.lloy._1
o
21~. March 21, 2001
NSEE OR PERSON ACTING AS SUCH lICENSE NUMBER
~
DUE 10 COR AS A CONSEOUENCE Of):
H.
i AppIoximale
'~bMwMn
: onMI and death
I
:
PAATH: OUlorsigniflcorO_~.._.,,",
noI NIUftInQ in 1M underfying CMIM gMtn in FINn' t.
[ :
d.
DUE 10 lOR AS A CONSEQUENCE Of):
DUE 10 (OR AS A CONSEOUENCE Of):
WERE AUlOPSY FINDINGS WANNER Of DEATH
AWLA8LE PRIOA 10
COMPt.ET1OH OF CAUSE ~ 0
Of' DEAl'H7 ...."'.. Homicide
Accadent 0 Pend*ng InYe:sligalion 0
YeoO No 0 SWcide 0 Couad noc be decemuned 0
DATE OF INJURV
(Month. Day, ~atl
TlME OF INJURY
INJURY IJ YiOAK? DESCRI8E HON tNJUAY OCCURRED,
..... 0 NoD
M.
:lID.
CERT._ (Check orJy one)
.currliPYtNQ PHYSICIAN (PhySIC~ c8l1ltytng QuM ~ death wh8f'l.ilnothef phvs.c.an has pronounceo de.1h iU"IO completed Item 23)
To........ 01 my kno........ dea'" occurred due.. IN CauH(I) and manne, .. alii... . . . . . . . . . . . . . . .
29.
PlACE OF INJURY. AI home, farm, street. taclOfy, oMe.
buitding. etc. ISpec~vl
_.
34.
I'
-PRONOUNCING AND CERTIfYING PHYStclAN (Physc&an boIh >JfOOOUflCJ/'\Q oealh and ctf'llfyulg 10 cause of dealh)
To u.. beet oC my knowledge. dealtl occur,'" al "lime, dale, and pfKe, and due to the cau..(.' and manne, a. Itatlld
'MEDlCAL EXAMINER/CORONER
On lhe be. ot examination ancllcw Inve.Ugation, in my opinion, death occurred at the lime, date, IInd place, and duelo the CaUM(a) and
manner.. statect.. .. .... . . . ,. ... .. . . ... , .. . . .. ... , .. . .. .. .. . ... .... , . . . , . . . , , ,... .. ,.., . . . ,....... ...
31.,
,REGISTRAR'S StGNATURE AND NUMBER
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21-01-315
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNE~
,/
/
". codicil /
(each) a subscribing witness to the"~1 presented herewith, ~e~ch) being duly qualified according to
law, depose(s) and say(s) that '"", /' present and saw
~ /"
signed as a witness at the
e presence of each other) (in the presence of the
the testat , sign the same and that
request of testat_ in h presence and;i
other subscribing witness(es)). //
Sworn to or affirmed and subscribed be ~~
me this Clay of
/ 19_
./
Register
~" (Name)
~dreSS)
',,-
(Nam~
(Address)
/,,->
"'" !
REGISTER OF WILLS OF CUMBERLAND COUNTY
. OATH OF NON-SUBSCRIBING WITNESS
-- '
_-.J \ YY\ ff\e ~ S U hY'
,
Q(\cL
EdWQY'd 0'. AY\MV'S<.lY\
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
\.kX.. Q'<'€. - familiar with the signature of '2.. ' +\ An dJ1 (' ~~ (JY\, ,
co~
testat~ ~ of the ~ubscribing witnes~es.1G) 4.he ~'presented herewith and
~icil
that \A.R. ~ believ~ the signature on the ~s in the handwriting of
8, K~ r-S-<fl\ a"lld.
to the best of ctvr knowledge and belief.
D
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-nmYYULS0X\r
(Name) -5
B Fo..\ CClJ) CO Uf+l Yl\tc\t\(ln,C:Sbvr11 f?i ((Db
t:~~~
(Name)
J.7 /'1(;.V(l(e.. u.oct $ M-~ fit) I'7C!YO
)
(Address)
Sworn to or affirmed and subscribed before
me this 21S'r - day of
MARCH NK2001
/Y1a~( C" ~~J>. +.
JL P. B . ~ Register
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: 6.d. H. And..eV'SlTYI
Date of Death: rY'O. ('c\.-) I CD f 2..00 \
Will No.
0:// - C) I -3/5
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 l JO \ ~ :l. J 2...00 I
Namej'.\\Ynm-ee. K. Svhr (S-Clf-\
Address 8 'fo. \ cO">". Ct-. ,f'ne cIA a Yl\C S b v.r1}oA- \ '1 OSS
2-. :to\Jn E. ~ rc1 eY'San
<;'3 \"2.. c~'\te('f..t e \d Uiru",-/ VY\uc.ha\"\1 ts-buf'C) \ p.q.. 11055
3, f::.dwCM"l), S. Affie r-5di'J
'31~ Chc1s"le("ft~.Id Lnr\!l) (Y'c:rhlr\Icsbvr9/ Ptt 11055
4-, J'a.mes m. Anderton
(pq 'Z. J)~ v e~ J>a YY\ R O<1d, Ea.$;'\- B-ev- ne I f\J V I 20SC(
:3. YY\Cll+1 Y, A. A rO.er5cJn
rY\\c\1o.e\ e. t\no..ersOY'\
Notice has now been given to all persons enht e
Date:
:JW2M~ 200\
I
<::)
T~K.S\lh'"
Signature
Name 1Y\r-<; ,l\'mmee i(. SV\',.. (m~~:,~en01))
Address 8 'Fctlcon Court
mec\tlaVl 'csbu r~ I (Pit 11055
Telephone (711 14> 6 - l q 3 5'
Capacity: ~ Personal Representative / t..')(ec\J1t \ y.
_Counsel for personal representative
/6-oz/7'- 7
'v 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 OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
TIMMEE K SUHR
8 FALCON CT
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-23-2001
ANDERSON
03-16-2001
21 01-0315
CUMBERLAND
101
Allount Reali tted
PA 170.55-7558
*'
REY-1547 EX AFP 1l2-DDl
E
H
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=is4-j-E3CAFP-fi'2-:o0Y-NOTicE--OF-YNHEififAifcE-TAX-A-PPRjrisEifENT~--A[rOWANCE-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ANDERSON E H FILE NO. 21 01-0315 ACN 101 DATE 07-23-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
Cl)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
57.346.59
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
ClO)
677 . 00
415.88
(11)
(12)
(13)
Cl4)
NOTE:
.00
56,253.71
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
Cl9)=
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
57,346.59
1.092 88
56,253.71
.00
56,253.71
.00
2,531.42
.00
.00
2,531. 42
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-15-2001 AA496731 126.57 2,531.42
TOTAL TAX CREDIT 2,657.99
BALANCE OF TAX DUE 126.57CR
INTEREST AND PEN. .00
TOTAL DUE 126.57CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
"'/ b -02/9-- 7
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1607 EX AFP (12-00)
TIMMEE K SUHR
8 FALCON CT
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-10-2001
ANDERSON
03-16-2001
21 01-0315
CUMBERLAND
101
E
H
Amount Rellitted
, PA 17055
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, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6"ifi-Ex--AFP-fi'2-=ooy------...--iNHERIy-ANCE--TAX--sTAfEHE-NT-oF'-Ac-couiif--.-..---------------------
ESTATE OF ANDERSON E H FILE NO. 21 01-0315 ACN 101 DATE 09-10-2001
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: 07-23-2001
PR I NCI PAL TAX DUE: ...................................................................._..........._............._.........._......_....._.........................................._..................................................
2,531.42
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-15-2001 AA496731 126.57 2,531.42
08-22-2001 REFUND .00 126.57-
TOTAL TAX CREDIT 2,531.42
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 nCREDI~' (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TIMMEE SUHR
8 FALCON COURT
MECHANICSBURG, PA 17055
un____ fold
ESTATE INFORMATION: SSN: 189-09-0478
FILE NUMBER: 21-2001- 0315
DECEDENT NAME: ANDERSON E H
DA TE OF PAYMENT: 12/03/2001
POSTMARK DATE: 11/30/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 03/16/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: TIMMEE K SUHR
CHECK# 1025
SEAL
INITIALS: SK
RECEIVED BY:
REV-1162 EX(11-961
NO. CD 000585
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
AMOUNT
$13.50
$13.50
Ih~2/9- 7
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Recore ,;
Re~Jjc;tc
d DATE
ESTATE OF
DATE OF DEATH
...fILE NUMBER
P 2 :O:COUNTY
ACN
01-21-2002
ANDERSON
03-16-2001
21 01-0315
CUMBERLAND
101
TIMMEE K SUHR
8 FALCON CT
MECHANICSBURG
.02 JAN 25
,;-f;~ I
Allount Rellitted
PA 17o~lerh
Cumberla, .
*5~
REV-1547 EX AFP '12-001
E
H
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 = [S4-j-E3f-AFP--fi'2":ooY-NoTicE--OF-iNHEifiTAifcE-TAirA -PPRA-isEi"-ENT~--AiroWAiicE-ifR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ANDERSON E H FILE NO. 21 01-0315 ACN 101 DATE 01-21-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
.00
.00
.00
300.00
.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 Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
.00
Ul)
(2)
(3)
(14)
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
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
AX C ITS:
PAY T
DATE
06-15-2001
08-22-2001
11-30-2001
NOTE:
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
300.00
on
300.00
.00
56,553.71
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
56,553.71 X 045 =
.00 X 12 =
.00 X 15 =
(9)=
RECEIpT
NUMBER
AA496731
REFUND
CDoo0585
DISCOUNT (+)
INTEREST/PEN PAID (-)
127.25
.00
.00
AMOUNT PAID
2,531.42
126.57-
13.50
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
2,544.92
.00
.00
2,544.92
2,545.60
.68CR
.00
.68CR
( 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.)
..
STATUS REPORT UNDER RULE 6.12
Name of Decedent: 'E. H.-Andev-s.on
oj ~/ a. Ed. \4. A no.. er san
Date of Death:
1Y)0Jl m t Co J 200 \
Will No.: ,;)00 \ - 00"3> \ 5 fA No. :<'1-01-03 \ 5
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 t;(l No D
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 X NoD
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: no Y\ e
c. Did the personal representative state an account informally to the parties
in interest? Yes l&l No D
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: ~&\ I' ) 2-fXJ::'
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Signature
IT YY\l'Y\e e... K., <\ u \) Y'
Name
8 RA-~(OY\ CoUY \-.
mec\t\QX\\'CSOV('), PA ",055
Address
(, 1l)I~Co - \ q 3')
Telephone No.
Capacity: RJ Personal Representative
o Counsel for personal representative
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Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
.. .
Date: 2/07/2003
TIMMEE SUHR
8 FALCON COURT
MECHANICSBURG, PA 17055
RE: Estate of ANDERSON E H
File Number: 2001-00315
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: 3/16/2003
Your prompt attention to this matter will be appreciated.
Thank You.
If:~~Zf%~
DEPUTY REGISTER OF WILLS~
cc: / File
Counsel
Judge
REV.150QEX(S.OOI
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DATE OF DEATH (MM-DD-YEAR)
03- 1(,,-0 \
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held CoqmratiOr., Partnership tlr Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly
(Schedule G or L)
8. Total Gross Assels (total lines 1-7)
COMMONWEALTH Of
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITiAl)
E
~ 1. Original Return
04. Limit&d Estate
~ 6. Decedent Died Testate {Attach copy of Will)
o 9. litigation Proceeds Received
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FIRM NAME (I!Applicatl\e\
TElEPHONE NUMBER
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
G
'");::FjC1?'L l.JSF ;'*(~
FILE NUMBER
~ I - O(
_J...... __
COUNTY CODE YEAR
0&
NUMBER
SOCIAL SECURI1'f NUMBER
lEA -oq -04/8
DATE OF BIRTH (MM-DD-YEARI
0::1-04 - \ 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. future Interest Compromise (date of death after 12-12.82)
o 7. Decedent Maintained a Living Trust (Allach copy of Trust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13--82)
o 5. Federal Estate Tax Return Required
o 8, Total Number 01 Sate Deposit Boll.as
o 11 Election to tax under Sec. 9113(A) (Attact1 SchO
r
COMPLETE MAILING ADDRESS
81=a.\COVl (0\)(+
VY't~cho.Y\lc.s bur')> PA l'1055t
5
(1) -0-
(2) -0-
13} -0-
(4) -c-
(5) ~7, 34(q- SCi
(6) -0-
(7) -0-
(B)
(9) CtJi1.()O
(10) 415-8B
OFFICIAL USE- 6iiLY
l
9, Funeral Expenses & Administrative Costs (Schedule H)
5" 3L\c". sq
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (Iotal Lines S& 10)
12. Net Value of Eslate (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)
14. Nel Value Subject to Tax (line 12 minus Line 13)
(11) I)Co.;U3B
(12) SCp. 253. '1 I
.
(13) -0-
(14) Sf.>, ;253./ \
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal talC
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rale
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
"5(;,) 1.5:2, ,I \
x.O_ (15)
x.O~ (16)
x .12 (17)
x ,15 (16)
(19)
(;l,531.4:::L
;/)53\.4";;l.
')ii:,'
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS
~\b...oo~ l'Y\a.na~ A(-'o.v+ ynIH"lT:>")
CITY
STATE
PA
ZIP
1105 5"
roecnanl C'i> bu
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A, Spousal Poverty Credit -o-
s' Prior Payments -0 -
C, Discount - S<T1.
(1)
QI53\.4~
Total Credits (A + S + C ) (2)
1'2..C.,'57
3, InteresVPenalty if applicable
D, Inferest
E, Penalty
-0-
-0-
TotallnteresVPenalty (D + E)
4, If Line 2 is greater lt1an Line 1 + Line 3, enter the difference, This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
A. Enter the interest on the tax due.
(3) -0-
(4)
(5) J.)401..\.85
(SA) -0-
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is lt1e TAX DUE.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) ;0 I '-tOLl, '3'5
Make Check Payable to: REGISTER OF WILLS, AGENT
-__,mlllllllll rilL _ 1iI11l_ll.ll~"lf:lftf;llil;tif'~ii\,'i;i~i~~~'R~nl.~:i:I"Jil\f;,,\',;f,,!"."'~""
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. relain the use or income of the property transferred;...... ..,..................................... ................................ 0 Gr
b. relain the righllo designate who shaH use the property transferred or its income;. ........................... 0 0
c. relain a reversionary interest; or................................... ...................... ...."..... ........................................., 0 0'
d. receive the promise for life of eilher psymenls, benefits or care? ...................................................................... 0 ~
2. If death occurred after December 12, 1982. did decedenl transfer property within one year of death
wilt10ut receiving adequate consideration? ............................., ................ ........................... 0 B"
3. Did decedent own an "in trust for" or psyable upon death bank account or security at his or her death? .............. 0 B"
4. Did decedent own an Individual Retirement Account, annuity, or olt1er non-probete property which
contains a beneficiary designation? ................................................................ ........................................... .........., 0 [3'"
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 peljury, I declare thai I have examined this relum, inclUding accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct
and complete
Declaration of preparer other than the personar representative is based on aN inform800n 01 which preparer has an}! knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
<>
\\rY\m.OQ. S\lhr
ADDRESS
'e ~a.kcY\ (CUlT J me.cha.~lcs;6v ('q J fA 1,055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE \
DATE
3u.Int 15, ~oo i
DATE
ADDRESS
_ 1 __..:,......,;k,,,,,,,,,.., __._. _......,...<lI'...,....",."'...'J.~I,'I'':f.~'Ji'',;'"
For dales 01 death on or after July 1, 1994 and before Januery 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, ~9118 (a) (1.1) (i)],
For dates of dealt1 on or after January 1, 1995, the /ax rale imposed on the net value 01 translers to or for the use of the surviving spouse is 0% [72 P,S, ~9116 (a) (1.1) (ii)]
The statute does not exemDt 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 ;s the only beneficiaIy.
For dales of death on or after July 1, 2000:
The /ax rate imposed on the net velue of transfers from a deceesed child twenty-one years of age or younger al death to or for the use of e natural psrent, an adoptive psrenl,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on lt1e 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, ~9116(1.2) [72 P,S, ~9116(a)(1lJ.
The lax rate imposed on the net value of transfers 10 or for the use of the decedent's s;blings 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 psrent in common with the decedent, whether by blood or edoption,
-
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At'{ 'SA /J
/ e.- H" ./te.:. ._...ct_Jad'III y:J'41 ~
Y/4 Y'J tb.._.;4._A.1tt611".$dlk
. i!j!e $~~~..~ Q II
9'II1UB_./. E!.1 .
1{),l-ltteJ-fe:1 bJ'....j--~.Ji~. ~~-'
-aolf 'I14ral, Si- 737-11.7"
C?c.." P (I,ll I /'7':"1
jV,fi1tE$SeJ i~k.j~~
ItJ f- ;.Ii:Ifk~f- R..I 137- 97'11
---...c ""f!I7S"N,U. ITe II
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESID NT DE EDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
EST ATE OF
Ed. 1-1:. And.e~s~
FILE NUMBER
Indude the proceeds of litigation end the date the prooaeds wara received by the estate All proparty jolnl/y.owned with therlght o!survivorship must be disclowl on SoMdule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
,;l..
~.
I.\.
5.
(0.
1.
8.
(\10 cash an ho.y\ck
w~p3\n+ 0~Y1K ,600 ca.mp +h II YYUI\,Chmpl-\-I'11. PA
mV'. E.l~\'\e...I'Y\Orr(s, Cusmn.Q..I'" SQ.l.Qs RQp. no \ I
~\n.~s -t- CD closeou+ (.:see a+b.chW.')
PNC "bo-n\<...,Co..Y'Y\P H-ill mo..ll. Cavnplfill, (JA no \ I
'('{\s. ~e\~l n STu bbs , Esta.k. PIC\.0Y'l110, i'Y1l1Y\a.je r
CY\Q.a.l\n~ Qeeo\,) V"\ +-t C D CIOSe.001- (see Q. tidch.o.d ')
U 5 i~o..5V('1 . TO. \( T-ef-v YlC~ fay- C.oco
CDl)Yl'T~ of- Cum bey [anGl. !Jur-(aQ 0..11 Q1..\j(\"Y"\ClL
so,u..of- CIJ0,:tomoblliL~ llqqo Buick. Skylavk..)
tD -Ha.rn youn S. (SlX o.:tlu.cVv(\ ')
Lt-s Tre.a.SUf'j" VA Compensa.1-'nl (l'Y'Q.("ch. 2.00 I)
Del broo'K t/'o-no-r Afur+vYIeV\ts Co-wru.d b"l
Prope~ vy\a.na~meV1.+- Jnc. . -See:.uid"')
dtfos l q.- r-efVV1d.
al \ m.on~ d9.0'fG$ (>kd l Y'"\ am es+a..k. QCQlun+
a:\- Al\~ r~ fun\(, 5.;2\ C\ Sltl"lpScJr\ ~rY\ R.OQ<C
YlteQ"\o..\,,\tcsw,"},fA \'1655 ,
~\ ino.o.. J La.wreV\CR-- I H"nOJY\C:.taQ Se'(\J\ce,s Yap.
-0-
3(0)2..0\, '1"
Ie.) I foe{. (03
38(0.00
100,00
<>2.)IQ5.00
I Q4.00
100.00
TOTAL (Also enter on line 5, Recapitulation) $ 51, 34-1:4 . 59
(If more space IS needed, insen additional sheets of the same size)
"",.,,,,ex'I,.,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SOEN E EDE T
SCHEDULE E 2r::tr2-
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
fd. \-t. MM'('S'm
FILE NUMBER
Include the proceed. of Illiga~on and the date tha prooaod. wera racaived by tha e.lata. All property jointly-owned wIttllt1e right ofsuNivonhlp must be disclosed on Scbadule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
0.; app\ I 'aY\as w:rtL~d 10,\ La. v-d La rcL (SU #'0) -0-
10' ~n dad. \'Y'\O uc.ck. I irdo his ~- bJLd.x'mrm u-ru' II I ...t-
\ h 10.0.0) -fC1 nil \ '\ VY\Q.AI)'\ bells ~d..a.d h.e Vn wt~ -0-
.fonU.~) ru:~Sr \::l..Vl'\f'5, clC.. (naw ~VV-.d.,)
,
II. '})Jrtn,\ 'rUs waY"\(.IY\.,\ <'Xl...Y'<=er, dad Wore VV"lt~Yn'1S,
~'oro-lt\.Uls c:1A& <?piMOV~h oo.d.'~ dCl~ fmr -0-
~ lYl..O.JY"\ '\6.s-C \Otru.S -'\1:> l.AJe'Q '(' pro-UO~ ~+
.
rem\ V"\d. -+ho.JYY\ of- h ( VY\ .
I :l. 5:>YY'\L tbYY\.S w€JLIl.- M\~d +0 ~sdR. mJ,:~iO" h -0-
\ irJ +b.."(''('lS bY,') b,-\ mOJr1\ VI 'B. AY'dll,MaYI .
-. TOTAL (Also enter on line 5, Recapitulation) $
--=-
"_.---.----------"- ------
PLEASE RETAIN THIS VOUCHER FOR YOUR RECORDS
946805156
3/28/01
000000000400713
SAVINGS & CD CLOSEOUT
$**0**36.201. 96
CHECK MADE PAYABLE TO:
E.H. ANDERSON ESTATE
t"WayRRipJ
PO BOX 1711 . HARRISBURG. PENNSYLVANIA 17105.1711
235 N. SECOND STREET' HARRISBURG. PENNSYLVANIA 17101 . 717/236-4041
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t1)6
ESTATE Of ED HAMllE:~**".**_*** $ r::"'18.i6~~~ ]
QPNCBAN<
PNC llw, National AMociatlon
SoulhcenlBl PA
No. 1100984
80-12731313
FORM103'_
Date IWlI::M lllA
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Pay 10 the
Order of
***.......*********............1 S. 169 _ .~......_....____*...
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I"Vn""lVU.f,,"U'sr~ ..- .,,- -~.'. '. -"1'''". .~..
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AMOUNT $
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Account Number .~
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~ \ . -A.{\~ ~^
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Customer's Advice Of Charge
(TYPE OR PAINT) CertifIcate of TIt1e must I;)e 6ubmlned within 20 days, unless the purchaser Is a regllStered CI8alef t\otdlng 1he v8l".ic\e tt>> resale
.'F~FlE':
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T1Tf,./NG FEES $
REV.1511 EX+ (12-99) .
~.j 'Ja. ., ,9
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
EO., H. And.p ", OY'\
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. ~ 'I'e pre f'C\. ~d.
Hmevu\ pre _a"ro..n,\e men:\-.s
'"Z..lYnl'Y'lel"man -Auer- I==unevu\ t't::rrN.. l twx ((Sbv"-", ! ~A. \" 31,,00
"1a\o.Y'\C(.. ':l>WL ( Est-a. t CN..C~ "it l 006 )
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Representative(s)
Social Se{;ufity Number(s)fEIN Number at Personal Representative(sl
Street Address
City _______ Slale __ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attacn explanation)
Claimant
Street Address
City ____ Slale __Zip
RelationshIp of Claimant 10 Decedent
4. Probate Fees $ 103.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Adm \" \strct'i-tVG (OS't$ " ,q..,. GO
TOTAL (Also enter on line 9, Recapitulation) $(.'11.00
Debts of decedent must be reported on Schedule I.
(t)
(0.;)
(1;
(If more space IS needed, Insert additional sheets of the same slle)
ESTATE OF ED. H. ANDERSON
Timmee Suhr, Executrix I Allfirst Bank
SCHEDULE H attachment
FUNERAL EXPENSES
Administrative Costs (see below)
Zimmerman-Aucr Funcral Home
Total
300.00
377.00
$677.00
Dad was awarded a Bronze Star during WWII -0-
and now proud to receivc a military
marker at his grave sitc.
We arc not listing food and refrcshmcnts -0-
during funeral period becausc of lack of
receipts.
ADMINISTRA TIVE COSTS
(receipts on ncxt pagc)
Petition for Probate
Short Certificate
JP Fec
3 more Short Ccrtificates
PLoQatc_Fces
--,.-'.-----.. ,.-.---
Officc Max copies
Br s Phone Card for NY calls to sibling
(March 200 I to present)
Franklin Printing: copies
Post Masters mailing to Jim Anderson (NY),
a certified letter & stamps
Rite Aid: 3 photo albums
Franklin Printing: Armitage Plaquc photocopies
Post Masters: Armitage thank you mailing
Post Masters: return Apr 200] check to Pep!.
of Treasury by ccrtificd mail
A TT long distance calls (to Anderson siblings)
by Executrix (Jan-Mar 2001)
Manila Envelopes
AdmjJ)j~tr.i!tiYe.E~~~
TOTAL ADMINISTRATIVE COSTS
$80.00
9.00
5.00
9.00
$23.50
20.00
13.46
62.94
15.24
11.54
10.79
4.75
19.67
15.11
Estatc check # 100 I
Estate chcck # 1006
$103.00
$19700
$300.00
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Streee
Carlisle, PA 17013
Receipt Date
Receipt Time
Receipt No.
3/23/
11: 1-
1025.
ANDERSON E H
File Number
Remarks
2001-00315
TIMMEE K. SUHR
PB
------------------------
Distribution of Receipt ------------------
Payment Amount Payee Name
80.00 CUMBERLAND COUNTY GENERAL
9.00 CUMBERLAND COUNTY GENERAL
5.00 BUREAU OF RECEIPTS & CNTR
Transaction Description
PETITION FOR PROBA
SHORT CERTIFICATE
JCP FEE
Check# 7783
Total Received.........
$94.00
$94.00
~
1&l.,-lQ35
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Receipt Date
Receipt Time
Receipt No.
4/16/2001
13:28:29
1025335
ANDERSON E H
File Number 2001-00315
Remarks
AC
------------------------ Distribution Of Receipt ------------------------
Transaction Description Payment Amount Payee Name
SHORT CERTIFICATE
9.00
CUMBERLAND COUNTY GENERAL FUN
Cash
Total Received..... ....
$9.00
$9.00
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, V'\~G DATE IN TIME IN DAlE/TIME DUE
~ AM PM
o CALI WHEN DONE
o QUOTE
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COMPANY:
721117 91 GatMay Drivl! ".
.~.kA~lC5bu.r3' Pa l7055 (717) oYl-3,",
Order Nurnrrsr*R BY PIIDHf HlllO-?8fl-8Gllll
DODD
0039 00001 19180
62&275
PROPUCED BY
FINISHED BY
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p,oducedlDl/II * 72111~
(Source It)
ACCI#
PHONE: ( )
ALTlFAX: ( )
4005000OO232 Full Ser~ice c~
400500001673 Full Color Copi
. $Tot'l!-, (CO'
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SUBTOTAL
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TQ;fA\.
424&5398017537S0 VISA
cARCtHO\.!lEft= !I1llIEE KElLY SUltR
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22.20PA
AI" !.!"op Oll Lille tit
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#ofFt
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#of Pads:
o Legal 0 11 x 17 0 I. D. Card 0 lug. Tag Pod SIze;
x
=$
Signature
Cost Center
Dept.
Enlrg,fRed. Charge
Total
CUSTOMER PROOF APPROVAL
l'hQve!ecel\'EIdandfel'ltwedorop!edtowal"oproa'lllflil{OldQfft:ll~<J!\d<xll\'o?\9R_.\
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F:~anhlin1$ Printing M,ai1io9 GOpIJ1l"r9
S217 Si~p~on F~rry Roa~
M~chanic$bvrg, fA 17055
Phone 717-691-6880
Fax 117-691-6928
Systam
:i,48:08 PM
6/3/~1
------'~..-..~.~--.., _.._-----_.._-~._.~-~._".,~--.."----
02 11 '( 0.99 Color 10.89
Paym~nt.. VISA (r~f ~l2"m :ll.S4
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=::;====:~::=:::=::=:::::.==::::::;====::::
Sub-Te,tal: 10.89
Ta(;~ 0.65
Total: H.Sf.;
Tendered: 11. Sq.
Chan'le: 0. 00
----.". ---------_..".-..._-----_..._----~.__._----
Th,~nf: you I
------.-.......---
RITE AID g
It's not just 0 store. It's a so!ution..
Visil au/'online (/h"."!'I;uC' at
~dnlgstore.<~on1 "
Store #01074
1137 MARKET STREET
LEMOVNE.?' 17043
(71?) 7.i" ,>59
Register #4 Transaction #274006
Cashier #10741206 4/28/01 2:44PM
RITE REWARD SAVINGS
>
14.37 T
M NETIC ALBUM 100 PAG
egu. ar y .
Tot Employee Disc 3.60-
3 Items Subtotal 14.37
Tax .87
Total 15.24
.. GIFT CERTIF PAVMNT" 15.24
Gift Card Value $14.76
Tendered 15.24
Cash Change .00
Your EMPLOVEE DISC Savings: 3.60
Visit our onl ine pharmac'c .at
drugstore.com
1-800-RITEAID for c'" . "er sar'll ce
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CERTIFIED MAIL RECEIPT
(Domc<;tlc Mall Only, No /nsUI.Jf7CC Covcr,lge Provided)
Postage $
Certified Fee -2.90
Postmark
Return Receipt Fee ,g). Here
(Endorsement Flequifad}
Restricted Delivery Fee
(Endorsement Required)
Total PO$UVe & FINs $ !.f 7<;'
NLb~~ Print Clearly) (to bfo',r:!!!Pleted by milller) {Jf\n
'st~;l;,~.;.tJl".(},\~-~.-/!Jf'J:-..s:"c~_~_,fll":~
-1iiY.-S('i--ii~~~-~_tt!~!1-i4:-?~bb-------_h_-----_h---------__oj
Customer Service: 1 800 222-0300
Text Phone errY)~ 1.800833-3232
Jan 15-Apr 14, 2001
Customer # 717 766-1936
Page 3 at 3
\iSI dirut <li-ti,,1 <<db
Domestic calls
Oa.. Number called Where Time Rate Type Mln Amount
1 Jan 19 215674.5540 Hatboro,PA 11'.30am day direct 1 .30
~--
2 Jan 23 518872-0662 East Sorno,NY 9:23pm ovo direct 24 5.40
3 Mar 17 518872-0662 East Berne,NY 9:40pm nighl direct 24 3.48
4 Mar 21 518 872-0662 East Sorno,NY 11:12am day direct 18 5.31
5 Mar 28 518872-0662 East Berno,NY 9:55pm ava direct 23 5.18
90 $19.87
Orl)( I ~ h,u......t..., .~lld.. fcdit"
-Date -~ ---~--e.:30(),~lkl~- ,
6 Uni'lersat connectivity charge
For an explanation of this charge,
plaas. callI 800532-2021.
Amount ---:.
$1.92
1,1 '\.( <.,; ,t.io.; '~Ill-.. b.1I ~('.
Oesoriptlon
Federal tax
State tax
PA Gross Receipts Tax
Amount
.65
1.30
.02
$1.97
In!I'''H'i.l'n ;nt~ll.'ILl !,nl lh".., \0111 ((I"pholl( ...cr' it'.
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you may want to know more about. We've set up a special web site to
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1.92
''';''''''"9'1,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Ed, H, Amev-soY\
FilE NUMBER
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTIO'~
I,
AMOUW
Cl.
3,
1-\-,
5.
Comro.s+ fubto.) -6sta.-k.. d'\Qcl~* 1003
PP~L- LClQ.CttlC)- Esta'iG CN..C~# \OOL{
Pfi-l-J' 00,,\- <:l(.:STa(\CQ.... CUllS - Esta.:K.. c.lN.d::. ilo 1001
Vei('l'''Z..oy\ (PhClYU!.) - Esto.:+<_dl.Q.c~# 10013'
lm l'e\m 'ov ("s-ed. yY\.u:lA.:CC..Q.... el'-pens e-s - w.~St-~
~hl6Y' B\LUL dJY\d rr\QdlCafe. are s-hl\ dl.Sc..u.d(n~
. c
'it! lS I S'S LLQ.J ,
QO,51
384-. J::l.
8.\3
3 ' o,J,
2,
TOT AL (Also enler on line 10. RecapltutaliOn) 5 4\5, 8 '3
{If mere spacE. is needed, insen a(1di1;onal shee!s of the same size}
'~.""""'.~.
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES.
FILE NUMBER
81. H. An<:J..R.. rs <OY'\
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do No! Us! Trusteeisl OF ESiATE
I. TAXABLE DISTRIBUTIONS (Include outnght spousal distributions) ta)'l"'L.\:~\
do.>..Lq h WV
1, -r\mme.e. j(.., Suhr , ant. -51 y. ~
8fu\ccm Courh \Y\e&\O.'(\\tsbuftJ,~ \,055 exe.G\.:>+Y\'f.
2. JOhn E.. Ar.o..eX"'soY\ . , PA <7Y\..Q - S \ "x. H-'\
cQo I:) ch.2s\-e.rfte..\6 Lane, rl\ecran\(~~~~ gJY1
3 Ed,wo.'ld. S, A-nd..el("$CY\ crT\R. - s \. ~"WI
<03\-=t cru.s+e~f-I€\d Lo.nlL, n"\ec..Y\aY"\(tll~)';:i- f.\. SDY\
110:,-"
L.\. J"aY"Y\ es Tn . A nd. e <rS'~ Y\ 0'"'n9- -5 ,'v."'\"n
G1~~ver Da.V"Y'\ Road) Eos+- 1X>('Y\ey ny SOl')
\2<)5'1
5. f'llQ.r+,'y) A. A-\r\d.e(S'<m . -\on t>A \1012... sOY) O'T\.Q. -.5 I Y- r'rt
P.Q.Bo)<. 1\3-I"'O,Nc:'W ~\nqS ,
G 0\ tc.Y'\o..e\ ~. And. 'E'V'suYI . pA sOY") (JTIQ. - S I it. ttJ
004 "l=\~s\d..e 'O('\\.;e m.cch(U/'\lc5Wf'\h055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SI-ET
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 $ -0-
. -""'-.-
(If more space is needed, insert addiMnal sheets olloe same size)
J"~~'~'
14: iE'
REGISTER OF WILLS ~ 7177961522
Gl01
'"
,-
"'iil'~
~..u
!<:lO
Qa::...1
,.al
~
..
COMMONWEA.TH OF
~ENNSYLVANIA
OEPAR TMENT OF REVENUE
DEPl 280601
HARRISBURG, PA 1712B.0601
NO. 571
/ (,..;J.iq_ 7
REV-1500
INHERITANCE TAX RETlJRN
RESIDENT DECEDEN,T
~
FILE NUMB'
~ Q.... - ;lQ. 1-
CO\JN'l'1 CODE YEAR.
SOCIAL SECU TV NUMBER
I 8 k 0'\
00=3 IS
- tUiB€!i- - -
.....
z
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o
w
(,.)
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DECEDENT'S NAME (tAST FIRS~ AND MIDOlE INITIA,)
AY\ckevsOll ~. \-\-.
DATE OF DEATH (MM.DQ.yeAR)
03-1" - 01
(IF APPLICABLE) SURVIVING SPOUSE'S NAMe (lAST, FIRST, AND MIDDLE INITIAL)
Oy...,g>
J, Glos.el~ Held Corporation, Pal'tnarsllip or S<lle-Pro~rietorshlp
t, Morlgages &. NotO)l:l Receivable (Schedule 0)
5. CUh, !3Dnk Deposits & MIsceUal'leQus Personal F'ropGrty
{~C"8dUle E}
6_ Jolnriy Owned Property (SC:n&dule F)
o S",parate B!lIIng Requesled
7. Il'I~r.Vivtl6 Transhm; & MISC&llal'lelJUS Non.probete Property
(Schedule G or LJ
e. Totat Croiii At;&tIB (total Lln8:s '-1)
9. Funert:ll Etpanses & AcImlnistl'ative Costs (Schedule H)
10. DeblS of D&:edenl. Morr:gage UlblUUes. & Liens (Schedule I)
11. lolal OBductiON (total Lines 9 &. 10)
rJ '. Original Return
o 4. Limiled Estate
[] S. Oecedanl O:e<:l Testale (All;Id" ctItry IJf will)
o 9. L1t1gaUon Proceeds ReceIVed
>-
~
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.,
..
Ii
o
u
NAME'Timmee .j(. Svhr
FIRM NAME (If Apaltgbl~l
DATE OF BIRTH (MM-DD-YEAR)
oa-OLj-15
THIS RETURN UST BE FILED IN DUPUCATe WITH THE
R GISTER OF WILLS
SOCIAL S.CU~ITY NUMBER
L _
1. Reel Estate (Schedule A)
2. Stocks aM BoNte; {Schedule Bl
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~ 2. Supplemental Relvm
o 4a. Future Interest Compromise (al. af(lo~lh sf\er 12:~12..a2J
07, Decedent MainlEllneCl a l..iving TrUSllAnal:h<;l1pfJ~TI'Il.\l
o 10. Spousal POWlrtyCredit 1dl!l&oI~&illM batwaen1Z-1/-91.w11-1--9:iJ
o 3./te alnder~elu", (clel&ol'dNitlpri:rrlc lZ-13-Uj
o 5. F rei Estate Ta.I Rewm ReQuired
I
8. T~l Number af Safe Deposh Boxes
011.01
5
COMPLETE ,,!AI(lNG ADDRESS ,I
g fa\CO"Y\ Covvt :1
\'Y\eC\tt(1'Y\\C5bvrl~ p.4 \ 7055
,
(1) n0 ,I
(2) ;; <t' II
~ 7' -
(3) IT, II
~,F' II <:::l
(4) pi n ('" "
I, C~.
?:OO,oO ~:,' ;1" I ""',
(5) II W
II 31
(61 'I N
"""J c; II Ui L'
--
i." I,
(7) 0\
l
!I
(6) u 300,00
(9)
(10)
I
if
(11) ~
(12) ~
(13) ~
(14) 300,00
~ I
, 0_ 1'5J~
IxO~ (16)~ 13, ':Yo
i. ,12 (17)~
!. .15 (161 1
(19) 1?,5D
1L Ne1 V~ue of blata (L1na a minus line '1)
13. Cheritable and GgvammenlfllBequestslSec 9,,3 TruStS for which SI"o IJlection latall1as 1'101 b&er.
malle tSl;/1edUla 1)
',4, Net Value Subject lo l"u (Line 12 rnlr'lUS line 13)
SEE INSTRUCTlo,~S ON RI!Vl!RSe SIDE FOR APP,ICABLE RATES
"'2,00.00
z
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19. Tn OLIO
CI-tECK H~Rr= IF yOU A~t RFOUESTING A REFuNU OF AN OveRPAYMENT
15. AJr.olJnt of L1n~ 14 b,w,able at the SL)ousal laJll
rate. ortflinsfers uMer S~. '3116 (a){1.2)
16. Amount of Unit '14 taJstlle at lineal ralG
17. Amount of Llr'le 14 la"'E1~e at ~lIbllng rate
lB. AmOllntQfllM 14 talable at collalera! rate
10/04/01
14: 18
REGISTER OF WILLS? 7177961522
NO. 571
Gl02
Of. ed~,t's Complete Address:
STIlEET ADDRESS 1..\ f. e .... C
VI \ roo...... \yc.
(~ \ 1::J"oo I<.
CITY
ZIP 11055
Tax Payments and Credits;
,. Ta. Due (Page 1 Une 19)
2. CredilllPayments
A. Spousal POverly Credit
B. Prior PaymenlS
c. Discount
(1) J
13.50
(2) ,
(3) J
(4) ~
(sd
(SAd
i (58d
Make Check Payable to: REGISTER OF WILLS, AGENT
i
1
ToIalCrellilS (A> 8 + C)
I
3.
Inter.stlPen.lly ff applicable
D. Inlerest
E. P.nally
TolallnterastlP.naIly ( 0 . E )
II Line 2 is grealer lIIan line 1 . lIn. 3, onter ilia difla<ence. TlIis io ilia Ovt:Rl'AYMENT. I
Clle._ box ... Page 1 Uno 20 to request, refund
4.
s.
" line 1 . line 315 greatar th.n line 2, .nlO' !he dlll,ren... This is the TAX DUE.
A. Enter the in1erest on the tax due.
B. EnlOr !he IDlai 01 line 5 . 5A This 'ollie BAlANCE DUE-
\7>,50
, '
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X. IN THE APP OPRlATE BLOCKS
1 Old decedenl make. tlansf.r and: i I Ves No
a. roteln ilia use 0' Incom. 01111. PIQll.rly transferred; ...... .. ......"1' ....,.................. . ....... 0 0
b. "'lOin !he nght to d.Slgnate ""'" shall use tho properly u.nslo".d or.1S ,"come; I......................................... 0 0
c. r.lain a "ve"lonary inlelest 0'.............................................................................,:.........................................1. 0 0
d. 'ooaive U1e promiselorllle of.l!he, payn"mts, Denollls or ca,e? ..........................).........."" ".........................j. 0 0
Z :: ==: :::~=~~:~::~i~.~~~nl~~~sf~r~~.~~~~.~1~~'~I~~~.....u......... 0 0
3. Did d.cadent own an .i~ !ruSI for" or PlIyafll. upon dea\h ban. eccount or securily at his or her death? ........... . 0 0
4. ::n7:":::;~I::~:;:.~nt~.~t...~".n~ly.~o~~::~':~~r.':::~~....................~. 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE'SCHEDULE G AND FU IT AS PART OF THE RETURN.
,
Under EI&naI\Ies ofl*iUry, Idldn lhall hBV8 8llIUnineO lib MtUm, incIwCllnQ BCCCIOllll'ttyIflg 1CheduI" 8nIIl mll)/Mtlbl. al'd ~ lie b8sl~mv ~ andOe.'Ief, if Is M, 0ln'Id n~.
otclaratla" D' P!'IparerOlAerflift lie petIIani!Illeple"'..enl8li~ i& tle$ed0Jl itIllnlOmlMan Clf~ prlIpnrhM all)' knlJlll'ledge. I
SIGNATURE OF PERSON RESPONSIBLE FOR FilING RfT1JRN I ?ATE
I~ <;\J'^(' III~O\OI
ADDRESS ,., I I
B Fa.\c0l\ COVvt-. YYltrv,(U',ICsh"(,, ell 170A>G
SIGNATURE OF PFlEPARER OTHEIl THAN REPRESENTATIVE I
DATE
ADDRESS
For dates of death on or after July " 1994 and before Januo'Y " 1995. INllal role Imposed on IIIe nel val", 0I1I1nSf.1S" or fo, IIIe Ja 01 INlsuMvinlll90USW i. 3%
172 P.S. ~91161') (1.1)(111 1 J
I I
For d.... of d.ath on or .lIar JonuafY ,. 1995. I~e lal oale Impowl on the ne' yaluo of transf." 10 or for \he use 01 the SUMvl spouse is 0% (72 P.S. ~9116 (al (1.1 I (iill.
The sfatU'te doas nat 81'.!mnt a tTansler to a sIJT\lJ~fl~ spOUSe from tal, and the statulOry requirements for I1isdosure of assets aFld ling a tax K!tum are stillapplieable even Jf
the SUN'lvtog spouSQ Is the only beneficiary. i
for dates o( O&ath on or aftsr July 1. 2000~ j
The lB_ rate imposed on the net vAlue of tr!Insfers from a deceasQd,child rwanty-one "years of age or younQet at death 10 or For th8 se of a natural paren~ an adoptive parent.
Of 8Sleppafent 0' ilia cIIilrJ is 0% [72 P,S. S9116(aj(1.21J. .
. I
The w:( rate Imposed on the net value or [ransfers lO or fO( the use Of the dececlenl's ~ne81 benefICIaries is ~.5%, except as noted In
Th. t.. "Ie imposed on IIIe nel yalue of tlinstars 10 or for the use 01 \he de<:adanl'. ~blin9s Is 12% (72 P.S. S9"6(.)(1.3)1. A
individual who has at )easl one parent in common with the decedent whether by blood or adoption. !
,
1
,
P.S, ~9116(1.2) (72 PS. 59116(0)(1)).
,ling Is defined. unde' Section 9102, as an
I
I,
10/04/01
14: 18
REGISTER OF WILLS ~ 7177961522
NO. 571
Gl03
Rill,t:d.lf .Q7J
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY ,
COMMONWe.AL TH OF peNNSYLVANIA
INHE~TANCE TAX ~~TURN
RESIOIiNT OECEOr..NT
ESTATE OF
AYlCkey-SOYl
~.
-\-\.
, FILE NUMBER
ZOO \ - 003\'5
I
Indudslhe p""",,dS of lltigolion and !he 40telhe pmceeds we.. f8Ci\wd by lhe osmte. All p..perly jOln~""eO _ the righlolo.",IYO" Ip muollle dls_ell on Schedule F.
,
ITEM DESCRIPTION: VALUED~~ DATE
NUM6ER OF OATH
,.
iCt',C ~wV\d fOCi' '2-000
$ 300 .60
I
TOTAL(AlSOenleranlinoS.R..",.,l la.ion) S 300.00
I
(If mora space is needed. inSer\ additional sI1eots of ',he same size)