Loading...
HomeMy WebLinkAbout01-0441 WillRW 21-1 Howard C. Sankey Estate of......................................................................................... Howard Charles Sankey also known as .......... ............... .... ......... ................................... ....... PETITION FOR PROBATE and GRANT OF LETTERS No. ....dJ::-:..Q.~.:..4~ \ To: RONALD HOLT ......................................................................................................... Register of Wills for the County of Montgomery in the Commonwealth of Pennsylvania ............................................................................ ........ , Deceased. Social Security No. ....... ~.? ~:~. 9.1 .:J.~}? ......... ................. ..... ...... The petition of the undersigned respectfully represents that: Your petitioner(s) is/are 18 years of age or older and the execut ....?!...........named in the last will of the above decedent, dated ....... ..~.p.!.~.~..}.g.!... .~.~?.?............................ ....... and codicil( s) dated ...................................... .r-: ......................................................................................................................................................................................... ......................................................................................................................................................................................... .............................................................................................................................................................................................................. (State relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Montgomery County, Pennsylvania, with h J..~.... last family or principal residence at ............. 5.Q.Q 8.. .Ky.1Q.~ k.. EQ 9. ~:L...J:1~$;.h9.n.i. ~.~ J:;m~K....................................... ............................... ....................................................................................................................................................................................................................... (List street, number and municipality) Decedent, then .....~.?........ years of age, died .............................................!.\P.E~~...??....................... 20 ...~.~. at .......................... gg.1y...? P."! !'.~.t. ..~fl.~ P. ~.t:: ~~.................................. .................... ................................................ 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: ........................................................................................................................................................................................................................... Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property $ .........!.?9.....9.g.9..:.Q.9.......... (If not domiciled in P A) Personal property in Pennsylvania $ ............................................ (If not domiciled in P A) Personal property in County $ ............................................ f I . $ -0- Value 0 real estate in Pennsy vama ............................................ situated as follows: .. ..................................... ............................................ .............................................................. ....... ................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................... WHEREFOR, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented . testamentary hereWIth and the nt of letters ............................................. ......... ...... .............................. ....... ................. ..... thereon. (Testamentary: administration c.la.: administration d.b.n.c.t.a.) - ...................................... ..................................................................................................... ......................................................................................................... .................................................................................................... illow Grove PA 19090 ........ ............................ .1........................................ ........................................................................................................... .......................................................................................................... ............................................................................................................ II... _ ~::::> f2' - '1 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA} SS COUNTY OF>MOO'J~x CUMBERLAND The petitioner(s) above-named swear(s) or affinn(s) that the statements in the foregoing petition are true and correct to the best of my knowledge and belief of petitioner( s) and that as personal representative( s) of the above decedent petitioner( s) will well and truly administer the es te a cord' g to Sworn to or affinned and subscribed. before me this ,..........~~.~......... day 01"- ~................. ;11)............. 20 .%:. . ........~.~AJrn Deputy Register MA CLEWIS . It..................................................... ......................... rn QQ' ::l ~ ::; ~ ~ No. ..........l J.. .::.. .9. J...::.. ~ .4. J................... - Estate 6f ..?~~~"E.~...g.:....~~p.}f~y....E?:!.~l!'!-..JI9.~~.!g....9.h.~E1.~~....$.~g~~ ,)Deceased -~. t'-!. -~DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, .................t1~.Y..},......................................... 20 ..9J.... , 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 ................ .~P.."E .~~...~ 9?... ..12.~.?.......................................................................................................................... , <.... described therein be admitted to probate and filed of record as the last will of .............................................~.............. ............................ H. Q~ ~ f. ~t. .g.:....? .~m~~.y.. ...9-itl.9,. ..~.9.W ~ ~ r. .9.. Ih 9 r..1.~.?. j .~. D. K ~y.................................................. ; Testamentary and Letters ................................................................................................................................................... .................. are hereby granted to ... ........... ... ............. ............ ............. ............~j..c;.h~.r.g.....J..~...gwJ?~.r.y...... ....... ............ ..... ......... ........................................................................................................................................................................................ FEES Probate, Letters, Etc. .............. $ ...A:4.?:.QQ........... Short Certificates ( 10 ) ....... $ .....).9.:.9.9............ Renunciation .......................... $ ............................ lnv. & Tax Fonns ................... $ ............................ , Cxo~~bs:ion ........................... $ ........j':.OO........... J C P TOTAL ............... $ ........5...0.a........... Filed ... .t1~ Y...;~.~...? Q 9.~......................~? ~.: 9.9............ Mailed letters to attorney on 5-4-01. ~. . .. ...@~.L..~.a&.m' . Register olwil/s MARY CLEWIS Richard J. Embery, Esq. #56267 .............................................................................................................. ATTORNEY (Sup. Ct. I.D. No.) ..J.Q.O'.J:hJntJngg9.D...J.)J.~!?L..Bg.~.~J..~gg,~..!. P A ADDRESS 19046 ....~.?~.?). ...?~.~....?.9.9..?............ ............. ............ ..... .... ......... PHONE HI05.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded ro the State Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~:::I~ Fee for this certiflcate, $2.00 p 7296246 APR 11 2001 Date 5.143 R..... 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH I<lAME Of DECEDENT (F... """.l.all) I. HOWlVld C. Sanke AGE (L..1lil1I>dayj UNOeIIl YEAR _ o.lW SEX STR&: FILE. NUMBER SOCIAL SECURfl'f NUMBER 89 Vro COUNl'f OF OERH Cumbvr..ea.n.d UNOeIIll111r -1- DATE Of IIIIITH IM"""'.~. _I DECEDENTS ACTUAL RESIDENCE (See""""""'" on QCh. SKi.) 17.. Stale =..vI 0 RACE '_Indian. _ WIll.. 00:. (SpGy) WhUe IlL MARITAL STATUS. Mamed SUA'JIVlNG SPOUSE Nevet ~6ed~. 'U """e. gMI mald8n name) ". W-idowed 17'.0 ....__In LoWVt Allen. Iwp. KINO Of 8USlNESS/lNOUSTRV l1b. Cumbvr..ea.n.d DHI - /Min. -1Wlip? 2211. lb the b.- 01 my knowledge. death occurred at 1he bme. dal. and place 51ated. (SignBMe and Titlel ciIy-.,. 21ct. 21<1. PERSON ACTING AS SUCH EANO_SSOf 2Zc. 4100 JONEG'i'OWN ROAD LICENSE NUMBER (MonOI\. Dov. -I liME Of DERH .. RI2r1el re'!VoF'e ~ CASE REFERRED lO~ItoIEAICOIlOHI!Il? NeD 21. :==- PART": ~~~~ I 0rlMt ana death : (".v PI) S'f)4T l: DuE 10 (OR AS A CONSEOUENCE Of): WERE AU1OP$Y FINO/NGS AIlIlIl.ABLE PAlOfIlO COMPlETIOH OF CAUSE Of OERH? MANNER Of DEATIi DATE OF INJUAV (Montn. Day, 'fttaf) TIME OF INJURY INJURY R WORK? DESCRIBE HOlN INJURV OCCURRED. ......... .2S o o Iiomicide p""""", In_lgalion Could noI be detennined o o o PlACE OF INJURY. AI home. farm, It...... factory. otfk:e M. building. etC'. (Sp60tyl 300. ... 0 NoD ...0 NoX Accident s..;clcle 3Oc. o ~ _. CIEIlT1I'1EA IC-" only one) -ClRTIFYING PHYSICIAN (PhySlClCln cerlltyinQ cause of dee1tl When anoth8( phY$ICl8Il has prQ(\()l.,lnced dea1h ana compelEKJ Item 231 To.........oemyknowlilclge...1hoccurrllddUtlIoIheCllUl4J(.).ndm.nner..N'-d..,..............,.................................. . ~. .PItOHOUNCING AND CERTIFYING PHYSICIAN (Physicsan bOIh plooouncltl9 oeath and certtfytng to cause of death) To the bMt of my kno...... dH1h 0CC\IfNd .tthe Urfta;. .... and plate.. and due to me caUM(a) and me"'*'.. .uNd.. . . . . . . . . . . . . . . . . . . . . . . . . ._AL EllAMlNERlCORONEIl On the beM of ..aMIna1lon and/or Inv..UgaUon. In my opinion. de.th occurred .t the tlm.. date. .nd place. and due.o the cauM(a) and m.,.,..,....,.................................................................................................. . :n.. REGIST o ~ . NATURE ANIjI!IJ!aIpE!,~ '41'~'" /'1' r"'''''*CI~ -e....- I a:? /.,,,( V < I 34. // .J.ao / BE IT REMEMBERED, that I, HOWARD C. SANKEY, of Ambler, Montgomery County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my last Will and Testament, hereby revoking and making void all former wills by me at any time made. FIRST: I order and direct that all my just debts and funeral expenses shall be paid as soon as conveniently may be after my decease. SECOND: I give and bequeath the sum of FIFTEEN THOUSAND ($15,000.00) DOLLARS to my friend, ROBERT IRVINE. THIRD: I give and bequeath the sum of FIFTEEN THOUSAND ($15,000.00) DOLLARS to my nephew, LLOYD E. MATTHEWS. FOURTH: I give and bequeath the sum of FIFTEEN THOUSAND ($15,000.00) DOLLARS to my nephew, ROBERT T. MATTHEWS. FIFTH: All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and wheresoever situate, I give, devise and bequeath to my grandnephew, WILLIAM KYLE WHITLOCK, JR., my grandnephew, ROBERT HOWARD WHITLOCK, and my grandnephew, JOHN BRADLEY WHITLOCK, equally, share and share alike, or to the survivors or survivor thereof and not to their Issue. SIXTH: All Federal Estate, State Inheritance Tax and other death taxes payable because of my death, with respect to the property forming my gross estate passing under this will, including any interest or penalty imposed in connection with such tax, shall be paid from my residuary estate, before its division into shares, in the same manner as an administrative expense. SEVENTH: I nominate, constitute and appoint RICHARD J. EMBERY, Executor of this my last Will and Testament. In the event RICHARD J. EMBERY shall predecease me, is unable to act or dies during the administration of the estate, then I nominate, constitute and appoint CHRISTINE EMBER Y W AL TZ, Executrix in his place and stead. I order and direct that my Executor or his successor shall not be required to file bond to qualify or serve as Executor in any jurisdiction. IN WITNESS WHEREOF I have hereunto set my hand and seal this - jh ~ .~ day of u- , A.D. 1997. t#~.~i~kl HOWARD C. SAN . Y /,'7 /,/ V (SEAL) Signed, Sealed, Published and declared by the above named Testator as and for his last Will and Testament in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~,?f d7-~tt- ?7(LL. ----... /""'j LJ" A-/'y'..--v-J-~ I E PA O.C. Rule 5 (b) Form of Certification of Notice. CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent Howard C. Sankey Date of Death April 9, 2001 Will Number 00441 of 2001 Administration Number To the Register: I certify that notice of estate administmtion 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 May 14, 200l: NAME William Kyle Whitlock, Jr. Robert Howard Whitlock ADDRESS Sterretts Gap Ave. Carlisle, PA 17013 5017 Wood Box Lane Mechanicsbur PA 17055 409 S. BaltimQre Ave. Mt. Holly Sprlngs, PA 17065 Lakeland - 22 Simmons Cove Ruther Glen, VA 22546 2417 parkhave Dr. PIano TX 75075 1 Jeffron Drive Ambler PA 19002 John Bradley Whitlock Lloyd E. Matthews Robert T. Matthews Robert Irvine Notice has now been given to all persons entitled thereto under Rule 5.6(a) except No exceptions. Signature Date !(!Jjv I Telephone Number Address City State 215 663 9005 Zip Code 300 Huntingdon Pike, Rockledge, PA 19046 Capacity: X Personal Representative Counsel for personal Representative [Originally part of Rule 5.6, which was adopted April 30, 1992, effictivefor decedents dying on or after July 1. 1992, Amended and renumbered as Rule 5.7 on December 23, 1998,29 Pa. B. 327. effectivefor descendents dying on or after January 1, 1999.] 10-134 (Page 2 of 2) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT EMBERY RICHARD J ESQ 300 HUNTINGDON PIKE ROCKLEDGE, PA 19046 u______ fold ESTATE INFORMATION: SSN: 159-01-1639 FILE NUMBER: 21 - 200 1 - 0441 DECEDENT NAME: SANKEY HOWARD C DATE OF PAYMENT: 07/11/2001 POSTMARK DATE: 07/09/2001 COUNTY: CUMBERLAND DATE OF DEATH: 04/09/2001 NO. CD 000039 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $115,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RICHARD J EMBERY ESQUIRE CHECK#1008 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $115,000.00 MARY C. LEWIS REGISTER OF WILLS * COMMONWEAITHOF , PENNSYLVANIA DEPARTMENT OF REVENUE ,. DEPT 280601 . , HARRISBURG, PA 17128.00<11 REV..1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W Q W o W Q I!! "'~!:! [;l"g %~... u.... .. " DECEDENT'S NAME (LAST, FIRST, AND MIIlOlE INITIAL) Sankey, Howard C. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 04/09/2001 07/28/1911 (IF APPLICABl.E\ SURVIVING SPOUSE'S NIIME (LAST, FIRST, AND MIDDLE INITiAl) G]Ulrlglnal ReIlJm o 4. Umllod EsIaIe o 6. Decedenlllied Testate <-".py"WI} 09. lIIigaliooProceeds_ o 2. SU(l(lIemenlal ReIlJm o 48. Future Interest CompromIse (dale of dealh afIer 12-12-82) 07. OecedenlMalntained elMngTrusli_..."'T""l o 10. Spousal Poverty Credk (dOo '" ...._12~'.... '4851 OFFiCIAL USE ('NLY -,Jk_,=2" 'A'il=.Z.__.. FILE NUMBER .2. ..1. - 0 1 COUNTY COOE yoo o 4 4 1 ----- tlJIIBER SOCiAl SECURITY NUMBER 159 _ 01 _ 1639 llIIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCiAl SECURITY NUMBER o 3. Remainder ReIlJm i...."'........b12-'><2' o 5. Fedellll Estate Tax Retum Required ~ 8. Total N_mber of Safe Deposit Boxes o 11.ElecIioo 10 tax_ndel'Sec. 9113{A) (AIbo<OSd>O' z o ~ :J t: Il. < o w 0:: NAME Richard J. Embery, Esq. FIRM~I!!~'outterson & Fuges TELEPHONE NUMBER (215) 663 9005 COMPLETE MAlUNG ADDRESS 300 Huntingdon pike Rock1edge, PA 19046 x.o_ (15) LO_ (16) x .12 (17) x .15 (18) $118,869.63 (19) $118,869.63 1. Real Estate (Sche<Ue A) 2. SIocks and Boods (Schad_Ie B) 3. Closely Held ColpornIion, Pal1ne!slliJ or SoIe-Proprielorship 4. Mortgages & Notes Receivable (SchedtJla D) 5. Cash, Bank DeposIIs & t.IisceIanooos Personal Property (SdleduIa E) 6. JoInay OWned Prq>elly (ScIlecUo F) o Separate Biling Requested 7. Inter-Vivos Transfers & ~ Nola'robate Property (SdloduIe G or L) 8. Total Gross As.... (Iotal Uoes 1-7) (I) (2) (3) (4) (5) 713,011.43 ....-",.-. ..j'\... ~ ;:1- d N $124,000.00 (6) (7) (9) (10) $23,913.46 20,633.78. '. OFFI IAL USE ONLY ~"'- ' ", UI t...j ;".,j (S) $837,011.43 9. FllI1OI'lII Expenses & Adninislralive Cosls (SchedoIe H) 10. Debls 01 00eed0nt.1lortgage Uablllles, & liens (Sche<Ue Q 11. Total Jleduotlons (loIaIlInes 9 & 10) 12. Net Val.. olEstobl (tile 8niJVJsUne II) 13. ChaIItable and Govemmental ~9113 Trusts for wt1Ich an eIeoIion to tax has not been made (SchedoIe J) z o ~ I"" :J Il. ::!!: o o ~ 14. Net Value Subject to T.. (Lilo 12""""" line 13) SEE INSTRUCl\CINS OK REVERSE SIDE FOR APPlICABLE RATES 15. Amoonl of Uno 14 taxobIe et Ihe spoosaI tax rate, orlransienl ooderSec. 9116 (aXl.2) 16. Amount of Lilo 14 taxobIe al ineaI rate 17. Amomt of Lilo 14 taxable aI slllIinQ IllIe 18. Amomtofllne 14 taxobIe aI_rato (11) (12) (13) 44,547.24 $792,464_19 $792,464.19 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYIl'lEONT (14) $792,464.19 '; )< :l<\ ::ft!i~~. I q \n~ll'I~I~l ,\1 t l,ltl;,~~n tq~f., ~PI ~'~Y~~~t.~*~ ;1(:)::-1 '~?IC~ ~~!'t, i~(:11~~'\ !I~ \! ~t ,.' " _ _" _ _.~ Decedent's Complete Address: STREET ADDRESS 5008 Kvlock Road " CITY Mechanicsburrr Cumberland County I STATE I ZIP 17055 PA Tax Payments and Credits: 1. Tax 0Ue (Page 1 Una 19) 2. CreditsIPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $118,869.63 $115,000.00 5,943.48 ToIalCredits(A+B+C) (2) 120,943.48 3. lnIeresllPenally hpplicable D. Intaresl E. Penally ToIallnterastJPenally ( D + E ) (3) 4. II Una 2isgrealerlhan Una 1 +lile 3, enter1he dilleranCe. This is 1he OVERPAYMENT. Check box on Page 1 line 20 10 request a refund (4) 5. K Une 1 + Una 31s graallir than lile 2, enter 1he difference. ThIs is 1he TAX DUE. (5) $2,073.85 A. Enter 1he Inllirest on the tax due. (SA) . B. Enllir 1hetolaJ 01 line 5 + 5A This Is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X. IN THE APPROPRIATE BLOCKS 1. Did decedent make a lJansler and: Yes No a. ratain 1he use or income 011he property transferred;.......................................................................................... 0 !2l ~. ratain 1he right 10 deslgnalli who shall use 1he property lJanslerred or its Income; ............................................ 0 U!I 0. ratain a reversionaly interest; or.......................................................................................................................... 0 U!I d. receive 1he promise lo< life 01 eithef payments, benefits or care? ...................................................................... 0 U!I 2. K death occurred after Decembel' 12, 1982, did decedentlransler property lMthin one year 01 death wilhoul reoeMng adequa\e c:onsideration? .............................................................................................................. 0 !2l 3. Did decedent own an "in trust for" or payallle upon death bank aa:ount or secuity at hts or her death? .............. 0 Q:<I 4. Did decedent own an Individual Retirement Accoun~ annuity, or o1her non-prollllle property which contains a beneficiaJy designation? ........................................................................................................................ 0 [B IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. lblorpenalllesdpeojwy,ldedaI8l1al .. ~_ard_andlolhebesldmyknooiedgeandbeliel,l~bue,""""ardcomplelo. _d__1han "'''nbmalioa has"'Ykn<MIedge. SIGNATURE OF PA 19046 4445 DATE ADDRESS . For dalliS 01 death on or after July I, 1994 and belore Janulll}' I, 1995,the tax rate Imposad on the naI value ollransflll1l to or lo< 1he usa 01 the SlIVIvIng spouse ls 3% [12 P.S. ~9116 (a) (1.1) (i)}. For dalliS ol death on or after Janulll}' I, 1995, the tax mle imposed on the naI value ollransfers to or lo< 1he usa 01 the SUIViving spouse is 0% [72 P.S. ~9116 (a) (1.1) (.)]. The statute does not exemDt a lJansler 10 a surviving spousa from tax, end the statutory requirements lor disclosure 01 assals and filing a tax return are still applicable even II the SlI'Vivlng spouse Is 1he only benelicl8l}'. For dallis 01 death on or after ~ I, 2000: The tax mla i11posad on the ne\ value ollransfers from a deceased child lwenly-one yearn of age or younger at death 10 or lo< 1he usa 01 a natural parent, an adoptive parent, or a stepparant 0I1he child ls 0% [72 P.S. fi9116(a)(1.2)). The tax mte Imposad on the net value of lransfernlo or lo< the use 0I1he decedenfs lineal beneficiaries Is 4.5%, except as noted In 72 P.S. ~9116(1.2) [72 P.S. fi9116(a)(I)). The tax I8le imposed on the net velue ollranslernlo or lor the usa olthe dec:edenfs siblings Is 12% [72 P.S. ~9116(a)(1.3)}." sibling Is defined, under Section 9102, as an Individual YAw has at least one parent In common with the decedent, \\11ether by blood or adoption. . REV-1503 EX+ (1-97) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HOWARD C. SANKEY SCHEDULE B STOCKS & BONDS FILE NUMBER 2l Ol 044l All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. 1. DESCRIPTION VALUE AT DATE OF DEATH l24,OOO Par U. S. Treasury - HH Bonds l24,OOO.OO TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) l24,OOO.OO 9 PA15031 NTF 10872 Copyrighl1999 Greatland/Nelco LP - Forms Software Only RE~,150BEX+ (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HOWARD C. SANKEY FILE NUMBER 21 01 0441 ITEM NO. 1. Arnica Mutual Ins. Co. DESCRIPTION Include proceeds of litigation & date proceeds were received by the estate. All prop. jointly-owned with right of survivorship must be disclosed on 5ch F. 2. Blue Cross Return Premium 3. First Union - Cert. #247042050922286 Interest accrued to 04/09/2001 4. First Union - Cert. #247042051155296 Interest accrued to 04/09/2001 5. First Union - Cert. #247492055778382 Interest accrued to 04/09/2001 6. First union - Cert. #247042050999145 Interest accrued to 04/09/2001 7. First Union - Checking Acct. #1000163165632 Interest accrued to 04/09/2001 8. First Union - Sav. Acct. #3000452665757 Interest accrued to 04/09/2001 9. John Herr Trust U/Agreement Accrued income to D/O/D 10. Mellon Bank - Acct. #100-019-1419 Interest accrued to 04/09/2001 Total from continuation pages 9 PA15081 NTF 10875 Copyrighl1999 Grealland/NeJco LP - Forms Software Only TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE Of DEATH 220.46 391.73 43,462.72 14.54 60,008.23 3,849.80 50,000.00 192.13 40,008.06 153.74 73,723.59 31. 10 35,574.47 124.40 88.95 20,419.13 112.45 384,635.93 713,011.43 Schedule E (Page 2) '. Estate of: HOWARD C. SANKEY Item No. Description Value at Date of Death 11. Mellon Bank - Cert. #01121728 109,450.63 Interest accrued to 04/09/2001 182.75 12. Mellon Bank - Cert. #01144766 110,000.00 Interest accrued to 04/09/2001 164.56 13. Mellon Bank - Cert. #01172827 50,000.00 Interest accrued to 04/09/2001 14. Plymouth Breeze Sedan - 1996 15. PNC Bank - Cert. #21000697213 Interest accrued to 04/09/2001 16. PNC Bank - Cert. #31800204338 39.93 3,800.00 70,000.00 2,861.88 35,000.00 Interest accrued to 04/09/2001 110.05 17. PNC Bank - Checking Acct. #5003502252 676.87 18. Trust U/W of John Herr 168.26 Accrued Income to D/O/D 19. U.S. Treasury - 2000 1040 Income Tax Refund 2,181.00 Total (Carry forward to main schedule) 384,635.93 REV-1511EX + (1-97) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HOWARD C SANKEY SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 01 0441 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Whitemarsh Memorial Park Bronze Marker 1,567.00 2 William Whitlock Reimbursement for: Cremation $1194 Grave opening $345 1,539.00 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 Embery, OUtterson & Fuges 20,000.00 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 551.78 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. First Union Checkbook charge 19.00 8 William Mansfield-Legal Advertising 236.68 TOTAL (Also enter on line 9, Recapitulation) $ 23,913 .46 (If more space is needed, insert additional sheets of the same size) 9 PA15111 NTF 10878 Copyright 1999 Greatland/Neleo LP - Forms Software Only HEY -1512 EX + (1-97) COMMONWEALTH CF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HOWARD C SANKEY Include unreimbursed med~al expenses. ITEM NO. 1. Conner-Rich-Kearney-Torchia Assoc. 2 First Union-Ck. Acct. #1000163165632 Checks outstanding as of D/O/D 3 Holy Spirit Hospital Balance due 4 FA Dept. of Revenue 2001 PA40 Income Tax 5 united States Treasury 2001 1040 Income Tax 6 HCR ManorCare Balance due SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FI LE NUMBER 21 01 0441 DESCRIPTION AMOUNT 51.78 1,322.00 1,568.00 555.00 15,751.00 1,386.00 9 PA15121 N1F 10B74 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 20,633.78 Copyrlghl1999 GreallandlNeloo LP - Forms Software Only R~\I-1513 ~X + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER HOWARD C SANKEY 21 01 0441 AMOUNT OR SHARE OF ESTATE No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Robert Irvine 510 Belfry Drive Blue Bell, PA 19422 RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) General Bequests: 15000 None 15,000.00 Lloyd E. Matthews Lakeland 22 Simmons Cove Ruther Glen, VA 22546 General Bequests: 15000 Nephew 15,000.00 Robert T. Matthews 2417 Parkhaven Drive Plano, TX 75075 General Bequests: 15000 Nephew 15,000.00 Total from continuation pages 747,464.19 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 9 PA 15131 NTF 10880 (If more space is needed, insert additional sheets of the same size) Copyrighl1999 Grealland/Nelco LP - Forms Software Only Schedule J part 1 (Page 2) ., Estate of: HOWARD C SANKEY Item No. Description Relation Amount John B. Whitlock 409 S. Baltimore Avenue Mount Holly Springs, PA 17065 Nephew $249,154.73 Robert H. Whitlock 5017 Wood Box Lane Mechanicsburg, PA 17055 Nephew $249,154.73 William K. Whitlock 1935 Sterretta Gap Avenue Carlisle, PA 17013 Nephew $249,154.73 Total (Carry forward to main schedule) 0.00 SUPREME COURT ORPHANS' COURT RULE 6.12 STATUS REPORT BY PERSONAL REPRESENTATIVE G t/" NAME OF DECEDEN~ Howard C. Sankey DATE OF DEATH: April 9, 2001 WILL NUMBER: ADMINISTRATION NUMBER: 21 01 0441 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 D 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? DYes Q9 No b) The separate Orphans' Court No. (if any) for the personal representative account is: c) Did the personal representative state an account informally to the parties in interest? ~Yes D No d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. I certifY under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief Date October 7, 20 01 Capacity: or x 300 Huntingdon Pike, Rock1edge, PA 19046 ADDRESS Personal Representative Counsel-I.D. # 215 663 9005 TELEPHONE 10-135 (Reverse) LAW OFFICES EMBERY, OUTTERSON & FUGES A PROFESSIONAL CORPORATION ..JOSEPH R. EMBERYj Dr RICHARD ._1. EMBERY CH~ISTINE EMBERY WALTZ 300 HUNTINGDON PIKE ROCKLEDGE, PENNSYLVANIA 19046-4445 (215) 663-9005 .JOSEPH R. EMBERY 1893-1938 CLA~ENCE E. OUTTERSON 1915-1927 FREOERICK C. FUGES 1917-1943 ..JOSEPH R. EMBERY, .JR. 1924-1970 FAX (215) 663-8283 March 25, 2002 Register of Wills of Cumberland County Court House - Room 102 Hanover and High Streets Carlisle, P A 17013 Attention: Cheryl Re: Estate of Howard C. Sankey, Deceased File No. 2001-00441 D/OID April 9, 2001 SS #15901-1639 Dear Cheryl: Enclosed is a check to the Register of Wills in the amount of$63 for the filing fees for the above estate as you requested. Enc. RJE:jm FILE IN DUPLICATE Will AWn. No. 0441 20~ Filed REGISTER OF WILLS COMMONWEAL. TH OF PENNSYLVANIA} COUNTY OF OUMBERLAND ss INVENTORY Richard J. Embery Personal of the Estate of Howard C. Sankey Representative( s) deceased, being duly sworn according to law, depose:;; and say s that the items appearing in the following inventory include all of the personal assets wherever situate and all ofthe real estate in the Commonwealth of Pennsylvania of said decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which ars in a memorandum at the end of this inventory. I verify that the statements made in this Inven-} tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Attorney - (Name) Richard J. Embery, Esq. #56267 (Address) (Sup. Ct. I.D. No.) 300 Huntingdon pike, Rockledge, PA 19046 DATE OF DEATH April 9, 2001 LAST RESIDENCE 5008 Kylock Road, Mechanicsburg DECEDENrs SOCIAl SECURITY NUMBER 159 01 1639 1. Arnica Mutual Ins. Co. 2. Blue Cross Return Premium 3. First Union - Cert. #247042050922286 Interest accrued to 04/09/2001 4. First Union - Cert. #247042051155296 Interest accrued to 04/09/2001 5. First Union - Cert. #247492055778382 Interest accrued to 04/09/2001 6. First Union - Cert. #247042050999145 Interest accrued to 04/09/2001 220.46 391.73 43,462.72 14.54 60,008.23 "LtE)~) , :,~) 3,849.80 7C' L,_e SZ (JV~l ZOo 50,000.00 192.13 40,008.06 153.74 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the petsonal representative include the value' of each item, but such figures should not be extended into the total of the Inventory. (See Section 3301 (b) or PEF Code of 1972.) This form to be used only in estates of persons dying on or after Fcbruary 23, 1956. Estate of Howard C. Sankey, Dec'd File No. 21-01-0441 Inventory - Page 2 7. First Union - Checking Acct. #1000163165632 73,723.59 Interest accrued to 04/09/2001 31.10 8. First Union - Sav. Acct. #3000452665757 35,574.47 Interest accrued to 04/09/2001 9. John Herr Trust U/Agreement Accrued income to 0/0/0 10. Mellon Bank - Acct. #100-019-1419 Interest accrued to 04/09/2001 1l. Mellon Bank - Cert. #01121728 Interest accrued to 04/09/2001 12. Mellon Bank - Cert. #01144766 Interest accrued to 04/09/2001 13. Mellon Bank - Cert. #01172827 124.40 88.95 ~0,419.13 112.45 109,450.63 182.75 110,000.00 164.56 50,000.00 Interest accrued to 04/09/2001 39.93 14. Plymouth Breeze Sedan - 1996 3,800.00 15. PNC Bank - Cert. #21000697213 70,000.00 Interest accrued to 04/09/2001 2,861. 88 16. PNC Bank - Cert. #31800204338 35,000.00 Interest accrued to 04/09/2001 110.05 17. PNC Bank - Checking Acct. #5003502252 676.87 18. Trust U/W of John Herr 168.26 Accrued Income to n/% 19. U.S. Treasury - 2000 1040 Income Tax Refund 2,181.00 20. U. S. Series HH Bonds - Par $124,000 124,000.00 $837,011. 43 ---------- ---------- \, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN '* REy-qU EX AFP 101-021 '02 !'i!-\'( 1 0 RICHARD J EMBERY ESQ EMBERY ET AL . 300 HUNTINGDON 'fK- ROCKLEDGE t ;V~A"1'1046 :':5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-13-2002 SANKEY 04-09-2001 21 01-0441 CUMBERLAND 201 HOWARD C Allount R_i Hed 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 paYMent. CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR FILES ~ RE-V=483--EX-~FP--foi:;02)-----j(i-NOificif-OF-iDETEiiMiN~Tio..-AN-U-AS-SESsiiENT----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF SANKEY HOWARD C FILE NO.21 01-0441 ACN 201 DATE 05-13-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 23.325.51 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 112.926.15 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 112.926.15 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND_ SFF RI=UI=DC>J: c>Tn., ..... ?..~- ___u --- ---- /b-c:2,;)~-1 '\~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RICHARD J EMBERY ESQ EMBERV ETAL 300 HUNTINGDON PK ROCK LEDGE PA 19046 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-13-2002 SANKEY 04-09-2001 21 01-0441 CUMBERLAND 101 '* REV-1547 EX AFP 101-02l HOWARD C Allount Rellitted 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=i5'4-j-ix-AFP--C:OY:OZY-NOYici-OF-iNHiifiTANCE-YAX-A"PPRAYsiHENT~--Ai.ioWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SANKEV HOWARD C FILE NO. 21 01-0441 ACN 101 DATE 05-13-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect ~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. AlIOunt 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 (1) (2) (3) (4) (5) (6) (7) .00 124.000.00 .00 .00 713.011.43 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 23,913.46 20.633.78 (11) (12) (13) (14) NOTE: .00 .00 .00 792,464.19 X 00 = X 045 = X 12 = X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 837,011.43 44.547 24 792,464.19 .00 792,464.19 (19)= .00 .00 .00 118,869.63 118,869.63 , .... ..... . n_v_.. . l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-09-2001 CDOOO039 5,943.48 115,000.00 TOTAL TAX CREDIT 120,943.48 BALANCE OF TAX DUE 2,073.85CR INTEREST AND PEN. .00 TOTAL DUE 2,073.85CR . 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 srDl' OF TWT<:. s:n_ s::nD T..........._...._.._ . , / .-. _, 0 .-A/ /~... o,L/""-,,. <5 ~ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '02 JUL -'1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN RICHARD J EMBERY ESQ EMBERY ETAL 300 HUNTINGDON PK '... ROCKLEDGE PA 19ijlt6i '* REY-UD7 EX AFP COl-DZl 05-28-2002 SANKEY 04-09-2001 21 01-0441 CUMBERLAND 101 HOWARD C Allount Rellitted 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 ~ RE\i=i60-j-E)f-AFP--(Oi-=02)-------...--iNiiiRiT~Nc:E--TA)f-srirfEME-NT-O-F-AC-Couiif--.ii.--------------------- ESTATE OF SANKEY HOWARD C FILE NO. 21 01-0441 ACN 101 DATE 05-28-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-06-2002 PR I NC I PAL TAX DUE: .............................................................................................................................................................................._....................................... PAYMENTS (TAX CREDITS): 118,869.63 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-09-2001 CDOOO039 5,943.48 115,000.00 05-07-2002 REFUND .00 2,073.85- TOTAL TAX CREDIT 118,869.63 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTTnN~ 1 """ /6-~p- 7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 RICHARD J EMBERY ESQ EMBERY ETAL 300 HUNTINGDON PK ROCKLEDGE PA 19046 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '* REV-73' EX AFP <01-02) 02-25-2003 SANKEY 04-09-2001 21 01-0441 CUMBERLAND 202 HOWARD C Allount Rellitted 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 FILES .... REV =736-EX--AFP-Toi::-o2j-----..-Nofic'E-oi=-uETERHINATION-ANjj-A'SSESS-tiEN'f---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF SANKEY HOWARD C FILE NO.2l 01-0441 ACN 202 DATE 02-25-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 23.325.51 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 112.926.15 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 112.926.15 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 *IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. .IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REUFR!':.F c:.T"I' "I' TUT., ~n"" ~~~ ~..---.._--_.--