HomeMy WebLinkAbout01-0472
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of .lkk~/Il.6oo./,MA,.J No. ~l- 0\ - 4.-"1;U
also known as To:
Register of Wills for the
JJ.eceased. County of CUMBERLAND in the
Social Security No. I u>.3 - I ~ - ts. / 32. Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or oJder an the execut .o~
in the last will of the above decedent, dated CJ:!Y Jut /9 j>e
and codicil(s) dated '
named
, 19_
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in tJwrr16~,If!/A-,J/ RQunty, Pennsylvania, with
h e,<.. last family or I:ipcip residence at ~'1/2.. /f'cJ$S e II a
L'. ,.11 'A /761/ ' VI'? ,// cnC .
(list street, number and muncipality)
Decenge~, the 8S"" ,;rears ot.-age, d~d .3 d' , ~ ,{co(
at ~ /~,.~ H.",::. ,1-,1/ C~ ,.// ~ .
Except a foll ws, decedent did not marry, was not divorcecr'and did not have a child born or adopted
~fter execution o~th; wi,!Loffere.d. for probate; was not the victim of a killing and was never adjudicated
Incompetent: ,.../-H~ .'
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: (
./
;C ~ ,0-0
/or;,.
$
$
$
$
~ C,T~~
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
t e probate;.- of the last will and codicil(s)
A1 /7f ..e ,.-" -r,4-.
(testamentary; administrati n c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1- ss
COUNTY OF CUMBERLAND J
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No. 21 - 01- 472
Estate of
HELEN M GOODMAN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MA Y 14, x19 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 OCTOBER 22, 1998
described therein be admitted to probate and filed of record as the last will of
HELEN M GOODMAN
TESTAMENTARY
DAVID M GOODMAN
and Letters
are hereby granted to
~ (! !f!::: J.::' Q,,-(b
MARY CLEWIS
FEES
Probate, Letters, Etc. .........
Short Certificates( 3) . . 0 . . . . . . .
Renunciation ................
X-PAGES
JCP
$ 200.00
$ goOO
$
$ ?4.00
5.00
TOTAL - $ 238.00
. . . . . ~~.Y. .1 ~ .'. .~ q9} . . . 0 . . . . . . . . . . . .
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
Filed
PHONE
MAILED LETTERS TO EXECUTOR ON 5-14-01
H] 05.805 REV 9/86
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~~~A~
Local Registrat
Fee for this certificate, $2.00
p
7298037
MAY 0 8 200'
Date
105,i43Aev.2J87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
AGE (last a_vI
UNDER . YEAR
-- Days
sex
zf ema1.e
STAlE FilE NUMBER
SOCIAL SECURITY NUMBER
s.163 -14 -6932
aoel
NAME OF DECEDENT tflfSl. MIdcIe. laslJ
.. Helen M. Goodman
85 Y..
UNIlER 1 DAY
-1-
8/flTHPlACf IC.......
SIaIe Of fcte.gn CounIryJ
g::"Y10
.. Cumbvr.land
DECEDENT'S USUAl OCCUMrIOH I<lNO 01' BUSlNESS/lHDUSTRV
(Give Iund 01_ <lone....~__
Han~rt~g~b~ld.ta Petvr.-6on SIj-6tem
11.. 111t.
DECEDENT'S MAILING All\1flI'SS (51<.... l=oIyIbon. _.lip ~l DECEDENT'S
2 912 RLL6~e.{.{ Roaa ~=-NCE 11.. Stale
Camp Hill, PA 17011 ~::::-
... Ilb. County
fRHEA'S NAME (Fifst Middle. laSl)
1..Ha/lold W. Ma/l-6hall
1NF00000000'S NAME (T ypoIPnnq
~. Vavid M. Goodman
01' DISPOSITION
_ 0 CremoIJon f]
00h0I (SpocoIy1
l.lARITAl.SWUS._
Never Married. WidDwed.
~(SpecoIy)
,.. Widow
RACE . ArMncan 1ncNn. 8IKk. Whit.. etc;.
I_I
,V!hite
SURVIVING SPOUSE
," WIle. QMt ma.aen name)
COUNTY 01' DEATH
1.../
PA
I);d
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Min.
_? 17d.D ::"'''':':''':::01 Camp Hill Bolto
:rHEc~~rt~fm~o;l
IN'ORMANT'S!WJNIl AIXlflESS~_ CoIylTown.~. ZopS;-1
1_.313 WOOC1vlU.e lJJt.<.ve, cnamovr.-6bwr.g, PA 17201
PUlCE 01' llISPOSIT1ON. _oIc-OIy. ~""Y LOCRION. ~ SloIo. z;p~
OtOlho<"'-CltemaUon Soc..{.ety 06
2". PA Cltematoltlj 2'd.Ha/llti-6bwr.9, PA
HAIlE AND AllORESS 01' FAClUTY('lte.maUan ~<::'oc.ie
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lICENSE NUMBER ORE SIGNED
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DUE 1OtoRASAC~OUENCE OF):
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DUE 10 toR AS A CONSEOUENCE OF):
DUE 10 toR AS ACQNSEOUENCE OF):
WERE AUlOPSY FINDINGS MANNER OF OEATH
AIWLABLE PRIOR 10 16
COMPLETION 01 CAUSE 0
OFIlEJQ'H? Hal..... Homicide
-..... 0 Pending Investtgation 0
No~ Y.. 0 No}d" Suicide 0 Coukt not be delermlned 0
DATE OF INJURY
(Monlh. Day, 'Marl
TIME OF INJURY
INJURY fiJ WORK? DESCRIBE HOW lNJURYOccURRED.
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lICENSE NUMBER DiltESIG~D llAonel. Day. _,
"PlIDHDUNCING AND CERTIFYING PHVSICIAN IPh_""'" ",,,,,,,,,nc"'9 ""a'" andc,"",yong 10 cause 01 "".,." 0 31...0. ."":.0. '. c.. ').."14 L . ... 3'd.. 51'3 JG (
To1he beet of my knowledge, de.thoccUf'...a......1Ime..... andpfac.. anddu.10 thecauae(a)andmann.r".'alad.. .......... ............. ... _. .._ ... ... . . __ . .
NAME AND ADDRESS OF ~RSON WHO~PLETE\l'huAUSE 01' DEfiJH
(Il.m 27) Type Of Prin' beO'<.ae l.IZK.. Cd\
.MEDICAL EXAMINER/CORONER I L h
On the b..i. of eumtn.Uon .nd/or Inve.lig"lion. in my opinion, death oc:curred at the Ume, date, and place, and due to Ihe c.uae(.) and 0 0 Ol,J..J f ~ l~ ,5' r
3..-.nn........ed............. .............. ......................... ........................... 12. Le /Yl 0 fl(' f' ~ /70(/3
TRAA'SStG~URE A~R ~OATEFlleO(Monlh.oav. "au
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LAST WILL AND TEST AMENT
I HELEN M. GOODMAN, of Cumberland County, Pa., declare this to be my last Will
and Testament, hereby revoking all wills and codicils at any time heretofore made by me.
SECTION FIRST
Payment of Debts and Expenses
I direct my Executor to pay my debts, the expenses of my last illness and my
funeral expenses as soon as may be convenient after my death.
SECTION SECOND
Bequest of Tan2ible Personal Property
A. I give and bequeath all my personal and household effects, jewelry, automobiles,
and all other tangible personal property, to my son, David M. Goodman, ifhe survives me for a
period ofthirty (30) days after my death; or, ifhe does not so survive me then to his wife, Linda
Goodman. Any cost of packing and shipping shall be paid by my Executor as a general
administration expense.
B. If any beneficiary in the opinion of my Executor is under a disability as defined in
Section FIFTH hereof, my Executor shall represent such beneficiary in any division of such
property among the beneficiaries entitled thereto. Any or all of the items distributable to any
such beneficiary may, in the discretion of my Executor, be delivered to the beneficiary, to the
guardian of the beneficiary or to the person having custody of or caring for the beneficiary (and a
receipt signed by such person shall fully discharge my Executor); or may be sold and the
proceeds retained for such beneficiary's benefit under the provisions of Section FIFTH hereof.
HA01/65035.1
1
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SECTION THIRD
Specific Bequest
A. I give and bequeath to Paxton Presbyterian Church, Dauphin County,
Pennsylvania, the sum of five thousand dollars ($5,000.00)
B. I give and bequeath to Penn Cumberland Garden Club, Cumberland County,
Pennsylvania, the sum of one thousand ~ollars ($1,000.00)
SECTION FOURTH
Residuary Estate
I give, devise and bequeath my residuary estate as follows:
A. To my son, David M. Goodman, ifhe survives me for a period of thirty (30) days
after my death; or ifhe does not so survive me, and both my son's wife, Linda Goodman, and my
granddaughter, Nicole Goodman, or her issue survives me,
B. To my son's wife, Linda Goodman, in the amount of50% of my residuary estate
and to my granddaughter, Nicole Goodman, per sterpes, in the amount of 50% of my residuary
estate; or ifmy son, David M. Goodman does not survive me and either my son's wife Linda
Goodman, or my granddaughter Nicole Goodman, or her issue, do not survive me,
C. To my son's wife, Linda Goodman, or my granddaughter, Nicole Goodman, or
her issue, whichever survives me; or if neither my son David M. Goodman, his wife Linda
Goodman, nor my granddaughter Nicole Goodman or her issue survive me,
D. To the person or persons who would have been entitled to inherit such property
from me under the Pennsylvania intestate law if I had died intestate, unmarried and possessed of
such property.
HA01/65035.1
2
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E. As used in this Will, "child", "children" and "issue" shall include persons related
by adoption as well as by blood, provided in each instance that the adoptee is under the age of
eighteen (18) years at the time of adoption.
SECTION FIFTH
Retention of Property Distributable
to Beneficiaries under a Disability
Any property (whether income or principal) distributable to a beneficiary under a
disability may be retained by my Executor, acting as Trustee, in a separate trust and may be
invested and applied (together with any income earned by it) from time to time for the
beneficiary's benefit in any way which my Executor may deem appropriate.
Such property shall be distributed to the beneficiary when he or she is free of disability,
or, in case of death during disability, shall be paid to his or her estate.
Ifthe continued retention of property under this Section should be impracticable because
of the small size of the fund, my Executor may distribute it for the beneficiary's benefit. Any
property held for a minor may be deposited in a savings account made payable to the minor at
majority at a savings institution selected by my Executor.
For the purposes of this Section a beneficiary shall be considered to be under a disability
while under the age of twenty-one (21) years or at any time when such beneficiary shall in the
opinion of my Executor be unable by reason of advanced age, illness or other condition to
properly manage his or her affairs.
Payments made for the benefit of a beneficiary may be made directly to the beneficiary,
to his or her parent or guardian or to the persons caring for or having custody of the beneficiary,
or may be applied for such beneficiary's benefit by payment to such other persons, organizations
HAOl/65035.1
3
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or institutions as my Executor may select, and the receipt of any such payee shall be a full release
therefor.
SECTION SIXTH
Protective Provision
I direct that the principal of my estate and the income therefrom, so long as the same are
held by my Executor, shall be free from the control, debts, liabilities and assignments of any
beneficiary interested therein, and shall not be subject to execution or process for the
enforcement of judgments or claims of any sort against such beneficiary.
SECTION SEVENTH
Tax Clause
I direct that all inheritance, estate, transfer, succession and death taxes, (including any
interest and penalties thereon), which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of the principal of my residuary
estate.
SECTION EIGHTH
General Powers
In addition to any authority otherwise given, I expressly grant to my Executor the
following powers, to be exercised in the discretion of my Executor and on such terms as my
Executor may deem best with respect to my estate, including property retained under Section
FOURTH hereof, without need for court approval and effective until final distribution of all
assets:
HA01l65035.1
4
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A. To retain any property owned by me at my death and to invest and reinvest,
without being confined to "legal investments", and without responsibility for diversification, in
any form of property.
B. To sell, exchange or lease for any period of time any property, real or personal; to
maintain, repair, alter, improve, restrict, subdivide, develop, partition, dedicate or abandon real
estate; to grant easements concerning and to otherwise encumber real estate; and to give options
and execute option agreements for the sale or lease of assets held, without obligation to repudiate
the same in favor of better offers.
C. To subscribe for stocks, bonds or other investments; to join in any plan of lease,
mortgage, merger, consolidation, reorganization, foreclosure or voting trust and deposit securities
thereunder; to exercise options to purchase stock and other property; and generally to exercise all
the rights of security holders of any corporation.
D. To retain reasonable amounts of cash uninvested, in the commercial or trust
department of any bank or trust company, including any corporate fiduciary hereunder, for such
periods oftime as are deemed reasonable for the efficient administration ofthe estate.
E. To borrow money and to mortgage or pledge assets held hereunder as security;
and to lend money upon such security as may be deemed sufficient.
F. To make all reasonable compromises.
G. To make distribution in cash or in kind or partly in cash and partly in kind and,
except as otherwise specifically directed, to allocate specific assets to or among the beneficiaries,
in such manner or proportion as my Executor may deem advisable; provided, however, that this
clause shall not be construed to permit my Executor to affect the value of the distribution to
which any such beneficiary may be entitled hereunder.
HA01l650J5.l
5
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done so outside of my Will, I appoint my Executor serving hereunder from time to time. Such
Guardian shall not be required to post bond or enter security in any jurisdiction and shall have all
of the responsibility, authority and discretion herein granted to my Executor as to property held
for minors.
SECTION ELEVENTH
Appointment of Executor
A. I appoint my son DAVID M. GOODMAN as Executor of this Will. In case of his
renunciation, resignation, disability or death, I appoint MICHAEL W. GANG, to serve as
substitute Executor.
B. Any successor Executor shall have the same powers, duties and authorities as
though named hereunder as an initial Executor. No Executor serving hereunder at any time shall
be required to post bond or enter security in any jurisdiction.
HAD 1/65035. 1
7
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IN WITNESS WHEREOF, I have set my hand and seal to this my last Will and
~ (,,~
Testament this 2-2 day of Q:{o~(-, 1998.
/1d~fV Ilt,Ii-~IIF;a IT/
HELEN M. GOODMAN
(SEAL)
Signed, sealed, published and declared by HELEN M. GOODMAN, the above-named
testatrix, as and for her last Will and Testament, in the presence of us, who, at her request, in her
presence, and in the presence of each other, all being present at the same time, have hereunto
subscribed our names as witnesses.
NAME
/;03 {g~k, Club/2J ftunf!ltll~
ADDRESS
!k't~' ~-d ,~. #-If 111'7 1'19
DRESS (
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"1 NAME 7
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NAMEc-:/
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ADDRESS
HA01l65035.1
8
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF
We, HELEN M. GOODMAN, ~ \ {\~h a (' I tJJ I (d(JJ\t.j
,j
(Y1rl i l t A 'Sf! L <' I er I and ---1:l Ii.! tV ()'L-1,OAt~h f , the
testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her Will and that she had signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to
the best of his or her knowledge the testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
, WITNESS
, I
--1/ jJ ),_ y ~:I- dt ~-!' 1',d',; /> j,
( WITNES / /
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':jw~ '/1 71 !;itsl
Subscribed, sworn to and acknowledged before me by lief f n (VI - aX'{~ vHq~ '
the testator, and subscribed and sworn to before me by _t1'1 I (Lit-a e ( W.. ~ 6.tu:y
Jllalj A .Sfl'~l~' and AlvA! m.(1.JJllfl
witnesses, this ,:;0!/lo( day ofrOc.kper, 1998.
HA01l65035.1
Notarial Seal
Gail J. Mahoney, Notary Public
Harrisburg, Dauphin County
My CommIssion Expires Feb. 19, 2002
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DAVID M GOODMAN
815 MIDDLE STREET
CHAMBERSBURG, PA 17201
-------- fold
ESTATE INFORMATION: SSN: 163-14-6932
FILE NUMBER: 21-2001- 0472
DECEDENT NAME: GOODMAN HELEN M
DATE OF PAYMENT: 08/06/2001
POSTMARK DATE: 08/03/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 05/03/2001
NO. CD 000119
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $22,601.00
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TOTAL AMOUNT PAID:
$22,601.00
REMARKS: DAVID M GOODMAN
CHECK# 116
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
.REV-I5XIEX~
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
/6-~-c?
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C-
FilE NUMBER
~L-aL
COONTY COOE YEAR
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NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
'",,,,d a.... Helen m
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
r-1-oj /0-"31- IS-
(IF APFlICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
I~J - /'1 -&,932-
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCiAl SECURITY NUMBER
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B't Original Return
o 4. Limited Estate
o 6. Decedenl Dted Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
043. Future Interest Compromise (dale of death afIer 12.12-82j
D 7. Decedent Maintained a Living Trust (AIradt copy ofTI\ISI)
o 10. Spousal Poverty Credit (dais ofd8a!tl be'-' 12-J1-91 ancIt-1-95j
D 3. Remainder Return (dale or cleam prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Depos, Boxes
o 11. Election to tax under Sec. 9113(A) (AIlBctIScflO)
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THIS SECTION MUST BE COMPlETED. All CORRESPONDENCE AND CONFJDENTW. TAXINFORMAT1OM SfJOUlDElE DlRI;C'I'ED TO:
NAMEOa"iJ CO" ""Q~ COMFlET(}:~~ADOR~uJ....~.....
FIRMNAME{If~e) AI/
,II 313 W"'colv61le O....I~<:
26'1-'1131 C}...~...bc"$!'.r {JII 17...."1
TELEPHONE NUMBER
17
(1)
(2)
(3)
(4)
(5)
15'9.900
2.7(., "J .,
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or SoIe-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Sched~e E)
6, Jo~ Owned Properly (Schedule F)
o Separate SiRing Requested
7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property
(Sched~e G or L)
8, Tolal Grass Assets (1otalLiles 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule Q
11. Tolallleduc:tlans (total lines 9 & 10)
12. Net Value of Estate (li1e 8 minus Una 11)
13. Charitable and Governmental BequesmlSec 9113 Trusts for which an election to tax has not been
made (Sch_ J)
o
(8)
,ns 71..\
,
(6)
o
(7)
(9)
1077
o
(10)
14, Net Value SubjecllIl TOll (line 12 minus Lile 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
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15. Amount of Line 14 taxable at the spousal tax ()
rate. or transfers under Sec. 9116 (a)(1.2) x.O_ (15)
16. Amoonl of Line 14 taxable at Hneal rate ~-Z9, "8 'I x .0 j2.. (16)
17. Amount of Line 14 taxable at sibling rate 0 x .12 (17)
18. Amount of line 14 taxable at collateral rate 0 x .15 (18)
19. Tax Due (19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER' ALL QUESl10NS ON REVERSl; SIDl!AND RECHECf( MATH < <
(11) / ,077
(12) SJY,G.84
(13) ~,Oco.
(14) 5 ze, ~ [; ~
'23.7'1\
2 ~,/91
. Decedent's Complete Address:
STREET ADDRESS'2 t \ I
I 'L ,,;l~<:
~,,"'-c/
CITY
Cq.....
dt
STA1E
PA
ZIP
,-,6'
Tax Payments and Credits:
1. Tax Due (Page lUne 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Z "3, '7 '1 /
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/.1 "to
Tolal Credits (A+ B + C)
(2)
tl 9 (>
3. InterestJPenalty if applicable
O. Interes\
E. Penalty
Total InleresUPenalty ( D + E )
4. ~ Line 215 greater than Une 1 + Une 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 \0 request a refund
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B. Enter the total of Une 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
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o
2.~/""C)'
5. If Line 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transfeRred;'HHH" HHHH.HH'H'HHH" HHHHHH'H'H'H..H.. H"HH 0 S-
b. retain the right 10 designate who shall use the property transferred or ils income; H..H..HH....H..HH......HHHH..HH 0 ~
C. retain a reversionary interest; or... . ... ............. 0 G--
d. receive the promise for life of either paymenls. benefils or care? .H.H..H..HH..H..H.HH.H...H.HH.HHHHH....H.HHH.H. 0 G-'
2. If death occuRred after December 12. 1982, did decedent transfer property within one year of death
withoulreceiving adequaleconsidOlalion1 HH'H'" H"HHHH'H"'HHH H"HHH"HHH'H "'HH"H"'H'HH"HH. 0 W
3. Did decedent own an 'n trust for or payable upon death bank account or secunty at his or her death? ...H....H.H 0 B--
4. Did decedent own an lndividuat Retirement Acoount. annuity, or other f\OOi)robate property which
contains a beneficiary designation? ...........m.......m.................m.........H..........m................................mm.............. 0 13""
o ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
llI8lhat I haYe examined this Allum, i'duding ~ sc:hedlies and statements, and 10 tIIB best of my knowledge and belief, it is but, COmlC! and COf'llplete.
thantlepersonalre basedonallnfonnationofwhlchprepererhasf1('('fknowledge.
S L ILlNG ~TURN
.,..o~~
ADDRESS /? /) . L L .
3d lJuQdv4/. , <..:-fi,4rl1/XA!.SOVIZ1, '-J /77.. 0/
SIGNAZ~:P"'~EROTli~ATIVE
ADDRESS ~
'-( :> l{ S'j."""/e7 Il..e
DATE
8-/-01
CJ,~...J,c,", J,~~)
/1/
112.<:1\
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.s. !i9116 (a) (1.1) (i)).
For dates of death on or after January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !i9116 (a) (1.1) (ii)).
The statute does not exernot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the suMving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child tw"enty-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% 172 P.S. !i9116(a)(12)].
The tax rate imposed on the net value of transfers 10 or for the use of the decedent's lineal benefidanes is 4.5%. except as noted in 72 P.S. !i9116(1.2) [72 P.S. !i9116(a)(I)].
The lax rate Imposed on \he nel value of translers 10 or for the use 01 the decedent's siblings is 12% [72 P.S. !i9116(a)(1.3)]. A sibling is defined. under Sect"" 9102. as an
individual who has at least one parent in common with the decedent, whether by blood Of adoption.
""~''''''t.,,~,",".
COfRJJONWEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
He{~.... In 6-~od'",..;..,
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a w~ling buyer and a willing seBer, neither being compeDed 10 buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jolnUy-owned with right
of
survivorshln must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
/louse oJ
fch" s"/I",,,,,: <<.
2 'ltZ--
/l v 5 ~c::Il
;e",..d
c,,_1' ;-/,1/
I ~ 't, 7' Cl::?
17" I'
TOTAL (Also enteron line 1, Recap~ulation) $ I S- '1 '700
(If more space is needed, insert additional sheets of the same size)
""""''''f'''"''.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
He/"'.... In
FILE NUMBER
Cc...d no c...
All property joinUy4M1ed with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
3Vf.:,LG Sh
Lfl" ~j....
ys{" 51.
~c:,,> SI-
3J'l 51-.
5D'" 5h
2..7) 5\..
:>50 Sh
Zl..,&c.. Si-
405\
\0
Sh
51..
5
51.-
400 ~l..
4oC> 51..
'foo Sh
'foe.
5'1..
~tJ 0 5i-.
"" L K.,.. I<..'-:.s Ad......... k) t:-
A.....e.,. 'T~LL.......ol')1 SelLe/;
Atn,z" T"-LL",..I<>}7 ~""\,,d
(Jet', c<-j,..<-
5cd...- SfcJ.- C<>h S;->oR S SUP/-
S~<k~ <5f.1...
S~L~~- Sfd""
~ <: <-!._ <; pel >-
eQ"5.- rs
hnQ~ c.:~ l
5"f"1'L.
VAlUE AT DATE
OF DEATH
3Yfc L<l
I
82-11
I
I ~ 110'
2.3'~~S-
I
8~83
I
) Z-,U,6
,<:;'11-
I
'1.73'(
~6, >$.s
L{)''-/97
I
ID 1)4 r
zs-el
I
10 z z C
I
982 e
{
/<:10'-'(
/
9- 'tc 8
, d 13 L
I
h\oo.~"'<::c.\
WlL ~v..ol.._c~t..1 G""'-<-4-L 0
fYlL &1../...11<:.<.1, fd c l l3
m.:r-....II .:r....~...~d
(Yt r",
I~"
:t..t,.~".,cd;<l. h:
~C""""'"
TOTAL (Also enter on line 2, Recapitulation) $ 2 7 (" (, J ')
(If more space IS needed, Insert addnional sheets of the same s",e)
Ill.t<1 /V'At,Q'..J PLc S'c>- A
A61'1 /1/>'116 ('.,p h-;.-cI TC 11
1111 s j." k F:... .....e.i.':J -'-
B~k"", c....~....
C,4~ III
pr:O 0'11''' Tie V
m~......,11 L'Ir.
""~''''''''~'''('' '*'
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF
/.Ie/~... ,?'7
&Cao/hoC,'"
Include the proceeds of Dligalion and the date the proceeds were received by the estate. All property jointly-owned with the right of slXYtvonhip must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Ch",,-\<.I~J /fc C<>~... t (YI c: II en .t] "'" 1<
.-
s...v.:..)5 I7cc~u...-t
cc...t,r.c'~/<:. oS? (Jcf<>~:/;
c::u\.. \'. ,_~c o~' OC(4S,.J.
Cc....~. r, c ~~" or O'r"-/:;
Ccv ~ . r, "- -Ie c-~ O<:I-~6 t:
p9Z-
LI:"'C:(2),...
Tot..o.J.J- Co........
(U,/Yl', tv....."'(.
t CI",J-l-,;..)
TOTAL (Also enter on line 5, Recapitulation) $
(If more space ~ needed, insert add~ional sheets of the same size)
VALUE AT DATE
OF DEATH
7'5 'i I, 7~
.
/ Z-)2.- ,,(l., LIZ-
2~/c,o(), c<>
s. ~co, c>C
.
<> <.0
l-!:,GQ. ,
( CJ, 'l'..~ 0 . ce
'7.000, CJ ()
5' 5 S If. d "
)
792Z'L<{/
I
""""""""""10*
COMMON'NEAl TH OF PENNSYL V ANlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FilE NUMBER
fleI e..
/Y'l
(}ooJ.... en
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Sl.,~t (O<~~. h." ~o< Z'>
1Z~').~i<- '.l~ Lv ,'115 1-)8
L.':"ol. ~...l<lc - (: 1<:1..00',,,","$ "2.1-
c.~_...,,- ......... $...o;c~", c..)"'"cz..~-....Q.\-Ict- 2-IS
-
fl~-k'J(~ He.o.l.(.,i~+O"e.- I L 7
-
P~vl St..\ik:nj "Ritv<:.>rQ....cl lC Q.
-
T..-..... ~,........,.;. - $nl":5l 25
J "~,,, Hc:.~'''c.''''~''- - A.:.oco.:._,.,.....y.;"- 7S
B. ADMINIST~Afl~ECbsTS - F.....~d 7-:5 o'
1. Personal Representative 5 Commissions
Name of Personal Representative (5} 6
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 0
3. Fam~y Exemption: (If decedent 5 address is not the same as claimant 5, attach explanation)
Claimant 0
Street Address
City State Z~
Relatio!'\Sh~ of Claimant to Decedent
4. Probate Fees 0
5. Accountant s Fees 0
6. Tax Return Preparers fees {)
7.
TOTAL (Also enter on line 9, Recapnulation) $ /<n7
(If more space IS needed, Insert additional sheets of \he same size)
RE~-'513 EX+ 19-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
sa ....i:'J
BENEFICIARIES
ESTATE OF
FILE NUMBER
HC(Ch
f>1
~' I
l?'"cco("..... 0.._
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
RELATlONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ListT..stee(.)
TAXABLE DISTRIBUTIONS [include ouvight spousal distributions, ana transfers under
Sec. 91'6 (0) (1.2)]
,.
OAV1'J
Goot:J.dn-..Q-"'I
San
i <:) 0 "/0
~)3 WOad,,", Ie O~'~G
Q)..,~_.b"~,; boY) PA 1,2C\
ENTER DOlLAR AMOUNTS FOR DISTRIBUTlONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l5OQ COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTiON TO TAX IS NOT BEING MADE
,.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
,.
pO"'X,j.-e,,,
C h'-vd.
PeY'~
c....... bey 1_,..,1
G....,..d.c.~
(.."..6
5', ()GO, co
\ GC0, 00
I
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
G" GO 0
f;
------
Date of Death:
CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
4/~/J //1. Goclm/ld
3 /l1/Jy ~~O /
Will No.: at'oj- 00 0/'77-
Admin No.:
A'/-o/- O~7~
Name of Decedent:
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 .Jut /2.) 1. it" &> (
Name
Address
Sh#,.tQU ~/. ~~~/..5bu-L'i;P
~/J1#jJl/ A. '
, ./
4rrON Ae~klijl9l/ mu~~
I1NN emi<,.L!;;pc! ~,trb @6
0/11/1;; t11 Ccod.;4#p 3/3 IUP<<IY/lk ~ ag/H~/t'Sbu~ 4 6j"'~1
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~/
~Od~~
Name
.3/3 /Vp.o4yn/c' OL ~,.rrn/;<,~shuA-p 12
Address
'7/ 1.. l. ~ 0/1 t./333
Telephone
Capacity: 0' Personal Representative
D Counsel for personal representative
/6 - oJS6-8
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-08-2001
GOODMAN
05-03-2001
21 01-0472
CUMBERLAND
101
\_,
DAVID GOODMAN
313 WOODVALE DR
CHAMBERSBURG
PA 11201
*'
REV-1547 EX AFP (12-DD)
HELEN
M
Allount Rellitted
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
(8)
500.913.84
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 11013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV :is4j-Ex-AFP--fi'2=ooY-NOYiCE--oF-YtiHERiTANCE-YAX-APPRAiSEiiiNT~--AL1-oWANCE-OR----------- --- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GOODMAN HELEN M FILE NO. 21 01-0472 ACN 101 DATE 10-08-2001
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(1)
(2)
(3)
(4)
(5)
(6)
(7)
159.900.00
216.639.00
.00
.00
64.434.84
.00
.00
(11)
(12)
(13)
(14)
1.071 no
499.896.84
6.000.00
493.896.84
(9)
(10)
L011.00
.00
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (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
.00 X 00 = .00
493.896.84 X 045 = 22.225.36
.00 X 12 = .00
.00 X 15 = .00
(19)= 22.225.36
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO119 1.111.21 22.601. 00
TOTAL TAX CREDIT 23.112.21
BALANCE OF TAX DUE 1.486.91CR
INTEREST AND PEN. .00
TOTAL DUE 1.486.91CR
. 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.)
'\. /6-~o ~~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1607 EX AFP 112-001
RecordedOftlce of
Register ot Wiils
DAVID GOODMAN
313 WOODVALE DR
CHAMBERSBURG
.01
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
All :34 COUNTY
ACN
11-19-2001
GOODMAN
05-03-2001
21 01-0472
CUMBERLAND
101
HElEN
M
Ole - 7
Allount Rellitted
PA 17OQrk-O;.. Court
ClHnberland Co., PA
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=i61fj-E3f-AFP-n'2-=OoY------...-iNHERITANcE-TA3f-sTA"TEME-NT-OF-Ac-couifT--.-..---------------- -----
ESTATE OF GOODMAN HElEN M FILE NO.21 01-0472 ACN 101 DATE 11-19-2001
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: 10-08-2001
PR I NC I PAL T AX DUE: ...........................................................................................................................................................................................................................
22,225.36
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO119 1,111.27 22,601.00
10-29-2001 REFUND .00 1. 486 .91-
TOTAL TAX CREDIT 22,225.36
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
IE
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
~v
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
/~/~,v
~c::>d~;4~
Date of Death: S/03/0/
, ,
Will No. adO! - Ot!> L./7 L
Admin. No. c.R/ - 01- a --/72.
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 yhether administration of the estate is complete:
Yes V 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 rep~esentative file a final
account with the Court? Yes No v .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is: IV/~
c. Did the personal representative sta~e an
account informally to the parties in interest? Yes vr 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 a ached to this report.
~
Date:
~3/ol
.
~.~
;;-'
-~
,)C
S'gnature
0;4 v' /;/ &~ d/J1,A-.J
Name (Please type or print)
3/3 4..)oo~{VAle f)A,V€
Address aIi/l /J4i; e-<: ~ b ~d.7 /J",
(717) ~0cf- ~3 33
Tel. No.
/7-z..-
','"
<::::;-
C'J
Capacity:
/
Personal Representative
Counsel for personal
representative
(HAH:rmf/AM3)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-ln7 EX AFP lIZ-DOl
DAVID GOODMAN
313 WOODVALE DR
CHAMBERSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-19-2001
GOODMAN
05-03-2001
21 01-0472
CUMBERLAND
101
HELEN
M
Allount Rellitted
PA 17201
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 for. with your tax paYMent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=ii;o-j-ix-AFP-fi'2-:oirr------...--xNirERITANc'E-;:AX--STATEMEii;:-OF-ACCouiii--....---------------------
ESTATE OF GOODMAN HELEN M FILE NO. 21 01-0472 ACN 101 DATE 11-19-2001
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 PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-01-2001
PRINCIPAL TAX DUE:. 22.225.36
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO1l9 1.111.27 22.601.00
10-29-2001 REFUND .00 1.486.91-
TOTAL TAX CREDIT 22.225.36
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" (CR).
I
.._a_ ._..... __ -..- . -------- --- --~----- -