HomeMy WebLinkAbout01-0560
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of 'TlloM#j J: tr'/U)~/~ No. :ll-{) I -5 t,O
also known as To:
, Deceased.
Social Security No. -'!i3 - /? - 49''7?
Register of \'ijlls for the
County of (!i(~,i1("7Z-L',/"I';) in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or olde,[ an the executll't
in the last will of the above decedent, dated O/:(! ~
and codicil(s) dated
named
,19~
(state relevant circumstances, e.g. renunciation, death of executor, etc,)
Decendent was domiciled at death in (jp",,4i..7lUl/tv County, Pennsylvania, with
hlJ last family or principal residence at J~ ~:~ .../7'. . f ~ . )
"vt?w ('ifp,__"~' :;q 17(J"10 tf tA/~
(list street, number and muncipaiity)' .
Decendent, then 79. years of age, died /71/17 Ol? , ~ .:2tml ,
at Wet'r J'f/tJ,1..t' #dYi'-l'r{ #"y ,) IZ~J.l48
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:
$ ..=:.-rA~ ~
Iii l.i v,..
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentarv
(testamentary; administration c, t. a.; administration d, b, n. c. t. a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I SM
COUNTY OF Cumberland J :s
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 admin' e estate according to law.
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Esta te of
THCMAS J. PETROSKIE
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JUNE 14TH ~ 200~ 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 DECEMBER !:}'lli, 1986
described therein be admitted to probate and filed of record as the last will of
'lliCMAS J. PETROSKIE
and Letters TESTAMENTARY
are hereby granted to MICHAEL T. PETROSKIE
FEES
Probate, Letters, Etc. .........
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
x-paqes (2)
JCP
$ 25.00
$ 3. 00
$
$ 6. 00
TOTAL _ $ 5.00
JUNE. ~4TH, 20.01. .. . . .. $39.00. J.Q\SH)
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
Filed
PHONE
MAILED LETTERS AND ORDER 'TO EXECUTOR
r-){o .L/flcL ;aZcZ~ I" . _ '
Ie 2<'-~/ &.- /~) .c) /(~h-c:1 cilaYi)
21-2001-560
.~ ,LvntL .da"7
tL.-'J.p4 6 -13 -0/ ~ I~~k'l of.~4
JAMES M. BACH
ATTORNEY AND
COUNSELOR AT LAW
352 s. SPORTING HILL RD.
MECHANICSBURG,
PENNA. 17055
TEL (717J 737-2033
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LAST WILL OF THOMAS J. PETROSKIE
I, THOMAS J. PETROSKIE, of the Borough of Lemoyne,
County of Cumberland and State of Pennsylvania, being in good
bodily health and of sound and disposing mind and memory, and
not acting under duress, menace, fraud, or undue influence of any
person whomsoever, merely calling to mind the frailty of human
life, and being desirous of disposing of my worldly goods while
I have the strength and capacity so to do, I do make, publish and
declare this my LAST WILL AND TESTAMENT.
I hereby revoke, cancel
and annul all my former Wills and Testaments, including codicils
thereto, by me at any time made, and declare this alone to be my
LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME
WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1.
I direct that my executors hereinafter named
pay and discharge all of my just debts, funeral and testamentary
expenses.
ITEM 2.
All the rest, residue and remainder of my
entire estate, wheresoever situate, and whatsoever it may consist
of, I give devise and bequeath, absolutely, and in fee, to my
dearly beloved children, share and share alike, per stirpes.
ITEM 3.
I nominate and appoint MICHAEL T. PETROSKIE
as Executor of this my Last Will.
ITEM 3.
I direct that my personal representatives, as
well as their successors, shall not be required to give bond for
the faithful performance of their duties in any jurisdiction.
ITEM 4.
I grant to my personal representatives herein
named, In addition to, but not in limitation of those powers
vested by law, to be exercised without prior application to or
approval of any court, the power and authority to retain indefin-
itely any property, to invest and reinvest any assets or the
proceeds derived from the sale of assets, although said invest-
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THOMAS J./PETROSKIE
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JAMES M. BACH
ATTORNEY AND
COUNSELOR AT LAW
352 S. SPORTING HILL RD
MECHANICSBURG,
PENNA. 17055
TEL (717) 737~2033
ments may not be of the character prescribed by law, to sell,
convey, assign, transfer and encumber any property, to pay, set-
tle or compromise all claims, to make distribution or divisions
in cash or In kind, and in general to exercise all powers in the
management of any property hereunder which any individual could
exercise in the management of similar property owned in his own
right, and to execute and deliver any and all instruments and to
do all acts which may be deemed necessary and proper.
~J
, ~Je< lip~~Ji
THOMAS J. TRO KIE
END
2
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUHBERLAND
I, THOMAS J. PETROSKIE ' Testator, whose name is signed
to the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purpose there~
in expressed.
Sworn or affirmed to and acknowledged before me, by THOMAS J.
PETROSKIE
, Testator, this
9th day .of December , 1 98 6 ~
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,-2 ~~;4-TJitff ~ /L-_
My Commission Expires: 9/11/89
The preceding instrument consisting of this and two (2) other
typewritten page, identified by the signature of the Testatcr, was
on the date thereof signed, published and declared by THOMAS J.
PETROSKIE , the Testator therein named as and for his Last
will and Testament, in our presence of each other, have hereunto
subscribed our names as witness.
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Residing at 352 S. Sporting Hill Rd.
Mechanicsburg, PA
17055
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Residing
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352 S. Sporting Hill Rd.
Mechanicsburg, PA
17055
A F F I D A V I T
COMMONWEALTH OF PENNSYVLANIA
ss
COUNTY OF CUMBERLAND
WE, James M. Bach and R. Edward Kitchen , the
witnesses whose names are signed to the attached or foregoing in-
I strument, being duly qualified according to law, do depose and say
II that we were present and saw Testator sign and execute the instru- ,
I ment as his Last Will; that he signed willingly and that he execute~
~ it as his free and voluntary act for the purpose therein expressed;
i that each of us in the hearing and sight of the Testator signed thel
will as witnesses; and that to the best of our knowledge the Testator
was at that time 18 or more years of age, of sound mind and under nb
constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
James M. Bach and --R. Edward Kitchen , witnesses, t.his
9th day of December ",19 86. _-0 . /. ,
~W-;i('- / /ac0~
C::::.../ NOTAR'f PUBLIC'
My Commission Expires: 9/11/8q
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HIOS.90S REV. (09/00)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~/I~
C\~5.~-,~.
Robert S. cZinJnerman, Jr., MPH
Secretary of Health
Charles Hardester
State Registrar
1826843
JUl 0 2 2001
Date
CORRECTED ITEMS:3
Hl05.,43.0..,,07 PER: FD DATE: 6_27_01basCOMMONWEAlTH OF PEN~ISYlVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
050418
TYPE/PRINT
IN
PERMANENT
BLACK INK
NTh~~~C~DENT (f"st. Middle.lU)
..
AGE (lase Birtt>dayt UNDER 1 YEAR
79 ....... Do,.
J.
Petroskie
SEX
male
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STAlE ~'LE mJMeEA
SOCIAL SECuRITY NUM8ER 78
,193 _18 _49
DAlE OF DEATH ,Mcnf1. Oa". '.....,
.. May 27,2001
v...
BlRTHPlACE lC.ry ~
5taleOl' Fcre.gnCOlJI'\fI'V1
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5.
COUNTY OF OERH
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Cumberland
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MARITAL STATUS - ManiIId
N...MarriIId. W~.
"-cod (Speay\
..!Vidowed
SURVlVtNG spouSE
I"..... QIWI maoen rtarne)
DECEDENT'S USUAl OCCUPG'ION
(~~':~:O~::=:f
.... office clerk ....state
DECEDENT'S MAIl.WG ADDRESS lSb'-. c..,nowo. s...~ Z"Ip Code\
1708 Charles Street
New Cumberland, PA 17070
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FRHE'it~~tWhMiddIe.Lasr)
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METHOD OF DlSPOSIT1Q!t
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DorwtiOn 0Uwr (SpecIy\
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SlGNMURE
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.7b.CounIyCumber land
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1IJwnShip1 l1d.~ ~iINn~=of
MOTHER'S N....ME (First Middle. Malden Sul'name)
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INFOR""f'7W~m':g",.~t":'"'1f~'Cumberland, PA 17070
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PlACE OF OlSPOsrrlON. Neme of Cemetery. CremalDrf
"&'it:'e""of Heaven
RemovaIIrom sellle 0
DATE OF DISPOSITION
o~r'~b, 2001
21b.
ORPERSONACTINGASSUCH CFSP LIC']\CffNtl'1~~40-L
22b.
10" but of my knowledge. ~ath QCC\Jl'red Allhe time. dale and place slated
(SionlIlureandTitIel
21c.
....., ~6'f'1rr'!dg~TY S
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LICENSE NUMBER
17070
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PART II: Other siQnilicant condiIions contrIIuIlng 10 death, blJt
not I'MUIl:Ing in 1M undertyIngca.-giwnin A\RT I.
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WERE AUlOPSY FINDINGS
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COMP\.ETlOH (y: CAUSE
OF DERH1
DUE 10(00 AS A CQNSEOUENCE Of):
MANNER Of OEATH
'DATE OF INJURY
lMornh. Day. '\laarl
TIMe OF INJURY
INJURY' 1J WORK?
DESCRIBE HON INJURY OCCURRED.
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CERTIFIER ,Check or"v ooe}
-CERTIFYING ptfVStCIAN (PtI'fSIC1af' c~ cause d death wtletl another phYSIC.aR haS pronounced deam ana completed Ilern 231
To...... 01 my k~. de_ occurNd due III 11M cauH(s) and m.n....... staled. . . . . . . . . . . .
21.
"PRONOUNCING AND CERTIFYING PttY$tCIAN (Physoclan boIh ;.lfonouncll'\Q aealh and ce(!lfy.ng IQCause of dealhl
Tothe boNt at my kno~.. deathoccurNd .,the date, de'., and place, and due to theeau"CI) and maroner a. ,taled..
-UEDICAl EXAMINER/CORONER
On the be.. of ..amin.t1on and/or Inv.stlgation. in my opinion, death OCCUlTed at the lime, dat.. and place. and due 10 (he cluse(.) and
MafIner a.stated.............................. .,.......,............,....,
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REGISTRAR'SSIGNATURE AND NUMBER
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CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: !AOn,q.S v: a.ff05k/e
Date of Death: /ilay ;/7, ~O()I
Will No.: ';1-~{)()I".5hO 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 'I- 1'1 ~t> I
Name
Address
-'l1/c.h~el -r Pe.J.y.D~kt'~ - l'lbj ellar/~c. 5~ AJew ~fJ1herJanl, 121 /7IJ7tJ
Befnadefde GI.Z\t"I)~J /~ I Cal1/er-bi.,f,'j R~ 111* Lau~~ MT I)J'IJS'I
Ja-l-hJeen Wa1Yler-, "llO M(;lY'aJ14J1 Wa't fJUY1~ ~r('L~'-1 fL 339d'd
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 1::J!1"0 I
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Si ature
mJc.hae/ -r fJefrosk,-e
Name
J?()~ ~4ar/e5 6f/ ;tIeuJ~l11berl,,~ fJ/l
Address 11 () 7 ()
1/7.. 77'1"O~D"3
Telephone
Capacity: 5Personal Repre?entativ~.
D Counsel for personal representative
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. .~ u.s. POSTAGE
;::, PAW
AMOUNT NEW CUMBERLAND.PA
' 17070
UNIT~DsrMFS $4 30 APR 11.' 03
' ~ 00027025_01
f 17013
0000
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DELlllER, CONFlRlfA17oN1If
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HOW TO USE:
1. Place pre_addressed enVE.
. Make sure the address
. Any postage placed on
. Any postage applied tc
2. Affix (appropriate) priority
3. seal flap on priority Mail I
\
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
PETROSKIE MICHAEL T
1708 CHARLES STREET
NEW CUMBERLAND, PA 17070
n_u_n fold
ESTATE INFORMATION: SSN: 193-18-4978
FILE NUMBER: 2101-0560
DECEDENT NAME: PETROSKIE THOMAS J
DA TE OF PAYMENT: 04/14/2003
POSTMARK DATE: 04/11/2003
COUNTY: CUMBERLAND
DATE OF DEATH: OS/27/2001
NO. CD 002435
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $157.93
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TOTAL AMOUNT PAID:
$157.93
REMARKS: MICHAEL PETROSKIE
CHECK# 3862
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WillS
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STATUS REPORT UNDER RULE 6.12
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Name of Decedent:
Date of Death:
Will No.:
Admin. No.:
;;"(1 (J I - 0 6 5 - C ()
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:
Date:
~~L;
a::
1. State ~ther administration of the estate is complete:
Yes E1 No 0
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 r~r7>entative file a final account with the Court?
Yes _ No LJ{"
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal ~~entative state an account informally to the parties
in interest? Yes lJJ' No 0
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c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk ofthe Orphans' Court
and may be attached to this report~, I
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Signature J)
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Name /
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Telephone No.
Capacity: ~rsonal 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
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Date: 4/09/2003
PETROSKIE MICHAEL T
1708 CHARLES STREET
NEW CUMBERLAND, PA 17070
RE: Estate of PETROSKIE THOMAS J
File Number: 2001-00560
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: 5/27/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
OF WILLS
cc: 'File
Counsel
Judge
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~, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
Reccr,
C:IDATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
A11 :4iUNTY
ACN
06-03-2003
PETROSKIE
05-27-2001
21 01-0560
CUMBERLAND
101
'03 JUN-6
MICHAEL T PETROSKIE
1708 CHARLES ST
NEW CUMBERLAND
*
REV-1547 EX AFP 101-031
THOMAS
J
Amount Remitted
PA 1707~~,C;rh
Cum02,,,:
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4j-EX--AFP--foY:JJjY-NoricE--oF-YNHEifiTANCrrAx-A"PPRA-isEMENT~--AiroWAi"-crOR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF PETROSKIE THOMAS J FILE NO. 21 01-0560 ACN 101 DATE 06-03-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. 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
698.58
.00
.00
16,223.80
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
8,283.15
5.129.58
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
16,922.38
13.412 73
3,509.65
.00
3,509.65
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount 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:
.00 X 00 =
3,509.65 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
.00
157.93
.00
.00
157.93
~ ..,~ -~, . l+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
04-11-2003 CD002435 .00 157.93
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-12-2003 TOTAL TAX CREDIT 157.93
BALANCE OF TAX DUE .00
INTEREST AND PEN. 10.14
TOTAL DUE 10.14
. IF PAID AFTER DATE INDICATED, SEE REVERSE
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), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
REFUND (CR):
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS:
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount of
the tax paid is allowed.
PENALTY:
The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (67-) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest
Rate Factor Year Rate Factor Year Rate
Daily
Factor
Year
1982 207- .000548 1987 97- .000247 1999 n .000192
1983 167- .000438 1988-1991 117- .000301 2000 87- .000219
1984 117- .000301 1992 97- .000247 2001 97- .000247
1985 137- .000356 1993-1994 n .000192 2002 67- .000164
1986 107- .000274 1995-1998 97- .000247 2003 57- .000137
-- Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
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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
PETROSKIE MICHAEL T
1708 CHARLES STREET
NEW CUMBERLAND, PA 17070
-------- fold
ESTATE INFORMATION: SSN: 193-18-4978
FILE NUMBER: 2101-0560
DECEDENT NAME: PETROSKIE THOMAS J
DATE OF PAYMENT: 06/11/2003
POSTMARK DATE: 06/10/2003
COUNTY: CUMBERLAND
DATE OF DEATH: OS/27/2001
NO. CD 002665
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $10.14
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: MICHAEL T PETROSKIE
CHECK# 3892
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$10.14
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
/1 ~./ c:' C
\.- BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-liD7 EX AFP 101-03)
MICHAEL T PETROSK~ JUL 11
1708 CHARLES ST
NEW CUMBERLAND cPf' 17070
!Jl :29
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-30-2003
PETROSKIE
05-27-2001
21 01-0560
CUMBERLAND
101
THOMAS
J
Allount Rellitted
C~t r
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: i6o-j-Ex-AFP-{oY:03Y------...--iNifERiYANcE--TAX--STA-fEME-NT-'(fF'-Ac-couiff--.-..---------------- -----
ESTATE OF PETROSKIE THOMAS J FILE NO.21 01-0560 ACN 101 DATE 06-30-2003
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: 06-03-2003
P R I NC I PAL TAX DUE: ..........................................................................................................................................................................................................................
157.93
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-11-2003 CD002435 .00 157.93
06-10-2003 CD002665 10.14- 10.14
TOTAL TAX CREDIT 157.93
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEAL TH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount
of the tax paid is allowed.
PENALTY:
The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (67-) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 207- .000548 1987 97- .000247 1999 77. .000192
1983 167- .000438 1988-1991 117- .000301 2000 87- .000219
1984 117- .000301 1992 97- .000247 2001 97- .000247
1985 137- .000356 1993-1994 77. .000192 2002 67- .000164
1986 107- .000274 1995-1998 97- .000247 2003 57- .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
/7 - :<3&- 'is
REV-1500
INHERITANCE TAX RETURN
. RESIDENT DECEDENT
'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
'1" fUlJ /r Ie. 177<1/14 /If
DATE OF DEATH (MIA-DD-YEAR)
6~
7:
DATE OF BIRTH (MM-DD-YEAR)
- c51b7J/ 1.;1 ---,;2I.-t,
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
.t8] 1. Onginal Return
o 4. Limited Estate
o 6. Decedent Died Testate (AllachcopyofWiII)
o 9. Litigation Proceeds Received
o 2. Supp\ementa\ Return
o 4a. Future Interest Compromise (date of death after 12.12-82)
o 7. Decedent Maintained a Living Trust (Attach copyofTrust)
o 10. Spousal Poverty Credit (dale oideath iletween 12-31-81 and 1_1_95)
l/
{JFFICIAl1JSEG~\JL Y
FILE NUMBER
~.l-llL
COUNTY CODE YEAR
_Q5<OO
NUMBER
SOCIAL SECURITY NUMBER
/9$ f
'/7 ~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dale of death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach SchO)
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FIRM NAME (If Applicable)
TELEPHONE NUMBER 7
. 71
?'7tf OUJ3 vJ 7/7
COMPLETE MAILING ADDRESS 1.-
17tlf' {!AlfUd (//.
;1!t!"t.I (2"1'>1/1 a>L/P;J#,
(1)
(2)
(3)
(4)
(5)
t t9J'. g
.
j~. ,}J3. 9
.
/3;
i 7070
_ OFFICIAL USE ONLY
(B)
It" tf~:l..$1
,
1. Real Estate (Schedule /I.)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule OJ
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 Property
(Schedule G or l)
8. Total Gross Assets (lotallines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedenl, Mortgage liabilities, & liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(6)
(7)
(9)
(10)
I(
~ d?J.5~
~, iOlt;. ~
12. Net Value of Estate (line 8 minus line 11:)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(II)
(12)
(13)
?J
13; "11.;1, YO_
. (
'3,5(Yj. b l
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 {a}(1.2} 6('
35'01,
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x.o_ (15)
/
x .o<t.L (16)
x .12 (17)
x .15 (IB)
(191
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(14)
Ji, J'o'l. " ('
''''7, U
(~ .
9.:1
IS?" ~
> > BE SURE TO ANSWER ALL QUESTIONS ONREVERSElllDEAND RECHECK MATH < <.
.!
"'.1
Decedent's Complete Address:
STREET ADDRESS
CITY
i-'7t-L4,,/;J
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + 8 + C) (2)
3. tnteresUPenalty if applicabie
D. Interest
E. Penalty
Totai InteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
~
ZiP '070
/..5''7. 93
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
/~71 'l!.
A. Enter the interest on the tax due.
(5)
(5A)
8. Enter the total of Une 5 + 5A. This is the 8ALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
93
/.5' 7.
.
~D'i&~!1i1l11ilU~.l~~~"...~.,=l~"",,,,~~1iI=E!lI' ._tl -,e,"
,~.
_.,,___.iIlWlIft1.rnL__.._._il1I:tll!OllliM~ lmIlI!IlJI~ljt~~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;............ ................... .......................... .............................. D
p. retain the right to designate who shall use the property transferred or its income; ........................................... 0
G. retain a reversionary interest; ?r... ...................... ..................... .................... 0
d. receive the promise for life of either payments, benefits or care? ................................... ........................... ...... 0
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................ ................ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .... ......... 0
4. Did decedent own an Individual Retirement Account, annuity, or other nonMprobate property which
contains a beneficiary designation? ................... ................... .................. ..................... .............................. ..... 0
No
I.)(]
~
~
~
~
I)il
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 pe~ury, I declare that I have examined this return. including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representalive is based on all informalion of which n knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ·
ADDRESS
DATE
'1"-/'- /a dln3
~eJ,J l1t?1fil.~4 ( .p. /7 () )0
DATE
{!};~ #,
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
/701
ADDRESS
:'T.i1/E;17lliill1:r':;,i2fHi':7;~:g;:;i~li~-:::t\~"'Ef~r{f;:L~;&~J,~;:{!11:ht~;.j}f:'7J:"1!(}'iMX~\f~'i;.i~5!~~~W~~~t~~f,~~~~~~~i~~i~7f;;;;;l}~;:':kEE:.:';
For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (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. 99116 (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 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 twentyMone years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99115(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decsdent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
';;'>/-1003 EX* 16-98-*,
COMMONWeALTH OF PENNSYLVANIA.
INHERITANCE TAX RETURN
RESlOE~ DECEDENT
SCHEDULE B
STOCKS & 80NDS
FilE NUMBER
PErr'-d..r;e;ecP/o /.- O~~ 0 /':<003 ,-03
All property joIlilly>.owned with riglJt of .wvivorslli!> must be __ en S<:l1e<1ule F. '
ESTATE OF
r;JOMN ;;;
ITEM
NUMBER
t
/% JJ;4/ltf,j- cJ?
(!uwlffm Jhd ~
(!, 1I.f' /1' II-
)lISt!' S''lm[So t.-
DESCRIPTION
..J i-/4NCOCK ;:/;"./1-
4'I1J/tJCm /.f?ti/,t t'h 5):1-/11
r $Jl,F/
VAlUE AT DATE
OF DEATH
6 W:6J"
JtI?
TOTAL (Also enler on line 2, Recapilulalion) $
(If more space is needed. IOSM ad.dltlQnat &heaw Qf tM samEt SilQ}
t Pi. ?J'-
RliV.l506 EX. (1.97j
..
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
(h"I114'f :;r:
'Er/dj'~/c
FILE NUMBER
'/0/- tJ.J'6o :;{OOJ ~(}3
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly..owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.,
DESCRIPTION
eheL'K/N4 ~(,COi/N'- - 4('('OI/"'''-;#OOI3J>-/6ol-2
;1U F;/tJ', 61N):
10 /5tJ'X /s''l{'
4-1L 7? /i1ML' ;?1 ') ell.;? () 3
VALUE AT DATE
OF DEATH
'f 6L.j/,;? J7iJ
7M.J>r ;;;( ~N?X~
1:l01l1~.rrCJ'rj)t!7/..J' LIT~ a",fP'7
~/l// )Jte4,t'; ArlQllvf
f? 0, /.fO'>. 17 n..
/Je../' /1l~/,terl :Z;4/1t 5qSok,
t 7'1 I/' .!!.
$/6;23. .f!.
TOTAL (Also enteron line 5, Recapitulation)
(If more space is needed, Insert additional sheets of the same size)
. REV-1511 EX+ (12-99) _
..... *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
rllt;l11.1.J' v:
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts 01 decedent must be reported on Schedule I.
FILE NUMBER
Y'tl/-OJ60 ;;?tJt13 -().9
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES: !erYI<-tT.J'
1. PIA./'61 r ~rI- iOZn'D 11, v>t Fl/tJedlH ., 7ff/ if
(!;J'.KEr
GfllJYJ"CJ(CN""'" - CI.-()I'/dt,-
#1'7 ofl/l ~ trn./'
;jffaL r!c)l../,//<,r j)/"'/"'cll-
<..'1't- 'f' '50Z, /4
P tau or-/'
B. ADMINISTRATIVE COSTS:
1. Pe'rsonal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _ Zip
Year(s) Commission Paid: .
2. Attorney Fees
3. Family Exemption: (JI 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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
.-
TOTAL (Also enter on line 9, Recapitulation) $ 1;(,f..J. Ij
(If more space is needed, insert additional sheets of the same size)
- .,
REV.1S12 EX. {1-97j
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMmiWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
o?IOI-O~6a ~oo3-03
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER
1. Wt5'1 .,f,1I0fl,f(
DESCRIPTION
efl'll!"rt9~cl f11euIC~(
4mt1l1lpnlCC .j-pz.vreE
AMOUNT
,. /6;:J.,3()
2,
fAtf/VI701-14J - /IuoC/Zy-T7(0 )~"'~
tJlFfi j'#d/l./r ;1/lVn<-?,? ;J1f.n-J'INt- ;/;J/HC
#U3;NJ Mtt- 4r CoV/!.r t/OVnr
'71';%
3.
'IfS'J. .5'7--
'I.
1O,0lI
TOTAL (Also enter on line 10, Recapitulation)
(If more space IS needed, insert additional sheets of the same size)
$.5 1:<9. ~;r