HomeMy WebLinkAbout02-0643
R.~ ~ ~ .J. >>-DA',..
REV-346 EX(S-92) \ ' - -l) Ci~_
PA DEPARTMENT OF REVENUE 'f2!IJifS'
ESTATE INFORMATION SHEET
ell' a_ .. 0\.. eu-u
FOR REGI ER'S OFFICE USE NlY
County Code Year File Number
o 0
DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
Name (Last) Glessner (First) Tim (Middle) Eugene
Decedent's Social Security Number Date of Death Date of Birth
203 I 48 , 7395 March 13, 2001 January 9, 1962
TYPE FILING: Enter check (..-) mark to Indicate the nature of the return to be flied with the department.
[] Probate Return
DJoint Assets Only
o Estate Tax Only
o Litigation Purposes (No Other Assets)
Enter check (..-) mark to Indicate the nature of the proceedings at the Register of Wills
Office. (..::tach act.;a:ur.a; sh;;~i." ;, '!;{planatlo~_i~nell!ssary.)
LETTERS GRANTED:
OTestamentary
ua Administration
o No te<<ers
OOther (Please Explain)
ATTORNEY/CORRESPONDENT
INFORMATION:
Enter all data concerning the attorney or other Individual to receive all
tax information and correspondence.
Name (Last) (First) (Middle) Supreme COurt 1.0. #
Kopecky Johnna J. 53147
Street Address
26 West High Street
City State Zip Code Telephone Number
Carlisle PA 17013 717-243-6222
PERSONAL REPRESENTATIVE
INFORMATION:
Enter all data concerning the personal representative(s) of the estate
authorized by the Register of Wills
Executor/AdministratoD
Name (Last) (First) (Middle) Social Security Number
Glessner Robin L. d). J I CoO ,CoCj(;'f
,
Street Address
41 Mill Street
City ~'pringS - -."."....,~..." , State ,..~ .-_.. . Zip Code. Telephone Number
"r;fE. Holly cPA -- "-, ,"::"17065..... -717-486-4047
\
Co-Executor/ Admil'llstrator
Name (Last) (First) (Middle) Social Security Number
I I
Street Address
City State Zip Code Telephone Number
Co-Executor/Administrator
Name (Last) {First} (Middle) Social Security Number
I I
Street Address
City State Zip Code Telephone Number
I Prepared By ~YJ:f~
I Date
c:''';;I-O~
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Tim Euqene Glessner
also known as
No.
To:
citl-,O~ .. "l/ ~
Social Security No. 203-48-7395
Deceased.
Register of Wills for the
County of rl1mnQr] .::Ipn in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who islare 18 years of age or older, applies
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in
his last family or principal residence at
Cumberland County, Pennsylvania, with
41 Mill Street :^t. Hollv Sorinas PA 170,,5 (BoyotJ5J.,
(list street, number and mUnLctpahty) o~ M+ rlDl\lr )
at
Decendent, then 39
41 Mill Street
years of age, died March 13
Mt. Holly Sprinqs PA 17065
,JIll ?om
Decendent at death owned property with estimated values as folllows:
(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:
$
$
$
$ %.000 00
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Robin L. Glessner Spouse 41 Mill St-. Mt- l-l~ll c,
Vanessa Glessner Minor child same
Krlstin Glessner Minor child same
Cassandra Glessner Minor child same
prings PA
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
I&-: ","00""'
41 Mill Street
Mt. Holly Sprinas PA ]7065
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF cumberland
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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
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
subscribed
da~ 2
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Register
No.
21-2002-643
Estate of
Tim Euqene Glessner
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW July 17th, 19> 200~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Tims Euqene Glessner
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
Robin L. Glessner
Tlffi Eugene Glessner
in the estate of
$ 200.00
$ 6.00
$
$
TOTAL _ $ 211.00
Filed . ~.~J,r. P1:J:1rlQQ?.. ~
<
FEES
Letters of Administration
Short Certificates( 2) . . . . . . . . . .
Renunciation ................
JCP
5.00
Jo\"'nM -.J. k'op-ec.1c.j '531'+ T
ATIORNEY (Sup. Ct. I.D. No.)
;:;LG ()}e.d Itl5h sJorvi' C'cvJ.;sk
ADDRESS
("'f1i) )..'{S -(DZ?<-'-
PHONE
MAILED LETTERS AND ORDER 10 ALMINISTRATRIX ON JULY 17TH, 2002.
1<i;.~IJ;
IiIY'.'/,'"
T'lIS is [0 certi/\' that the lnl(Hmariol1 ht'fC given is correerl)'
l.()(al RL'e:istrar 'I'lll' origin;l! ccnifiCltl' will hL' forvvardcd [0
-"
copit;'d from an original certitlcate of dearh duly flIed with
the Slare Viral Records OHlce for permanent filing_
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar -......:
Fe,,: f()( this Cc'rtItIClll', SLOO
P 7247754
MAR 1 6 2001
Date
Hl05.14~R&\I, 1191
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
'PIlUfT
.
..WENT
~K INK
UNOER 1 YEAR
Monll1' 04yS
UtmER101l1
HOurs Minut..
Glessner
,
2. Male
sr,t;1EFILENu",aEA
SClCIAlSECUFlITYNUMBEFl
.. 203-48-7395
D.lJEOFDfATH{Monlh,Day,Yearj
4. March 13, 2001
E
Pv.cEOFDEATH(Ch9CkO",YO,," '''''".ttUC\<M~M~~
HOSPITAl-
Sanerset r PA In!W~ 0
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~AClllTY NAME (II "01 ;n'Mu~"". \Ii.~ oIi<<>e\...m ",mt.er)
BlflTHPlACflCilyand
SI.laorForeiQ1'CooJntt~l
OTHER
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CEOEJ\I.T'S USUAl OCCUPATl N
(G<",jr>dol_kO"""<lu<"',,~
olwor'illQlilI;<lOn01use'et"ed.!
TruCK UrJ.. ver
KINOO~BUSINESSJINOUSTFlY
WASDECEOENTE'lEI'H~
U.S,ARMEOFORCES?
Yui&! 1'100
MARfTAlSTAlUS.M."ied
N.ve, M.m..d, w-.."
Di.....",d(Spec.ly)
, . Married
RACE.A"'.fio.nlndio.nll~W~,...
{Spec<fyj .,
III. White
S!)fWIVINGSPOUSE
(II-.ile.gi...me_n""me;
k.
3525 Old Gettysburg Road
41 Mill Str.
II.Mt. Holly Springs, PA 17065
FATHER'SNAMEIFi'st, Mi<lOf$.l.t$lj
Marvin R. Glessner
"
INFOAMANT"S NAME (Typ&lP"nl)
Robin L. Glessner
ME1\-ICD 01' DISPOSITION
O B....I.tO. C'_lon~ R_.fY"allromsl.I.D
Oonolio<l Olhef(Spec:;tyl
2,..
SIGNATUflEOF N ALSEFWICEL
,,~hipley Energy Co. ".
DECEOENT'S
ACTUAL
FlESIDENCE
(Seein"'l'Olion'
onolrHi,.idej
Shellenber
17.. Stat.
PA
1l0.0'"'..~IIOfI~ltil'.dln
-,
17b.Coun
,.
<Me.oMnl
~". in .
Cum1::>erland ",wnonip? 17d.~ ~;,=nI~<>l Mt. Hollv Sprinqs
MOTHEFl'SNAME(F.~.~ioOlo.M.i(lens...marna)
". Amella J" wng
INFORMANT'SMAllINGADOFlfSS(Slroe\,Clly(fuwn,S\Me.lipC""a)
2Gb 41 Mill Str. Mt. Holl S rin s, PA 17065
PlACE OF OlSPOSITION. Name 01 Camltlary. Crematory L AllON . Cityrlbwn. Stale. Zip Co<le
OfOlrHi'Plae.
Gitylboro
DATE OF DtSPOSiTlON
(Monlh,Day,"".')
0",3/16/2001
NACTINGASSUCH lIC~seNWBER
, 22b.FD 012633 L
olmr~ncr,oIO<lge.d.atn<l<;C~".d.lmell",..da".odpl.e.el.led
an<lTIIIe)
21f.ast Harrisburg Can/Crem. ~.
NAMEANOADORESSO~FACILITY
22~ing Brothers Funeral
lICENSENUMQEP.
Harrisburg, PA
17109
Heme, Carlisle, PA 17013
M 25.
n.PARTI, Enl...tM di....... Inju"-.o' ""mpliear"ne""'"neau..o tn.de.lh. Oo'lOl.nle'lh.m odeol<lyjn9,..,on.._eOl'~<><Y'''..It,aIIo<kO'''''.~t.ilu..
Lmotlt\'.....ea.... on..on tine
..
TIMEOFOEAlK Aprx.
14 1:00 P.
o EPRONOUNCfDOCAD(Monlh,Day,'r"eerj
March 14, 2001
231>.
WAS CASE FIEF FIRE
QATESIGNED
(Moolh,O.y.'l'ear)
'k
TOMEQK:M.El:A!J,INEPJCOFlONEFl?
~'JIiI. ..0
In estion of Corrosive Alkalies
OUETO(OI"ASACONSEQUENCEOFj:
..
,Appr-wlm.t.
!lrtl.",.lbetwHn
10nMlanddll.th
,
PAR711: Ottl.,~gnll~nt""nOjtlo...""n1r;l>ul'....todU.It\.l>ul
1"I01".ull)nglnln.undertylngCll~.'g"""lnl>A.FlTl.
OUETO(OFlASACONSEOUENCEOFl
OUETO(OAASACONSEQUENCEOF\:
.
~P.E;\I,\JTOPSYFINOINGS
AIl'ctLA8U:-PRIOflTO
CO~lET\ONOI' C;\I,U$E
oFoenH?
MANNER OF DEATH
tWmltlde
OATEOFtNJURY TIM(.OI'lN.l\.JRY
IMoo.... 04y, "'.,) Aprx.
o Mar. 13,2001
o 30 1:00 P'M.
o Pl.ACfOFINJUI'IY.Alr\om.,flfm.IlrH1.I.OIOfy,otr",.
~,~.\~~iJ Parking Lot
SIGNATUFlEANDT
INJUAYATWOFlK?
N.Mel
o
o
~
v.. KJ NoD
OESCRIBEHOININ,JURYOCCLlRREO
Ingested Sodium
Hydroxide (liquid drain
. opener)
eel,CityflOwn,Slat.)
burg Rd,Camp Hill,PA
...~
..0
ACOdenl
P.ndlngln".II~.I"'n
Coroner
2... 2.b.
CER?lfll.J11ICne::k","yoM)
.CERT1FYlNOPffYSIClAN(Phy$iCillne"'tlfyirlgCll~!!eolo..>:l\_n~ph'y!Oc'l.nNl.p.-on""""e<l040Ih.nocompleledlt""'23)
r<>llw_ O1"'Y~""wIHg.. _th<><CU....r_1aIlwCll..H/.).rId ",.n"......,.I.o..
Su""",
>>.
CotJtdn<>lboodll~ln"<l
o
-PIlOHOUNCtHO AND CEIITtFYIHO PHYSICIAN (l'fIySician botn po-<>nounonQ OMln an<! certily.ng '0 """'!!eo! ""\1>\
T<>u,.l>ftlO1",~~nowIlOdQoI. d..th ...,....<nd.IIMI_, d-,.,.fHI,,1~.,.nd"u.1Dthlc....e(.) .ndn'l.nn.',,".~.,
OATESIGNEDI"'on..., DaY,"""<l
o 10. !d. March 16, 2001
NAME AND ADDFlESS OF PEFlSO/Il WHO COMPleTED CAUSE OF OEATH
(Itam271TYpap'Prt<\1 Michael L. Norris, Coroner
M 6375 Basehore Road, Suite It1
~ ~2. Mechanicsburg, Pa. 17050
'MEDICAL EXAMlNI!AlCORONER
On I~ b....oI...."'ln.IIoII...dJorlrtV..Ull.1I0ll, III mYO(llnlOn,<!\l.thl>Ccun"ot .tth.tlml, d.'.,''''' pl.c., .IIddUIllllh. c....e(.) I""
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RmIS'fRor.R'SSIG"'1\TUREANDN
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1;;tc\,,;c,I,OI
j)llfl:FIlEO(Monlh,
JOHN E. SllKE
RDBERTC. SAIDlS
GEOFFREY S. SHUFF
JAMJ!S D. FLOWER,JR
CAROL]. LlNDSA Y
JOHNNAJ. KOI'ECKY
KAJU.,L LEDEBO!JM
1HOMAS E.l'LOWER
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
A PlIOPESSIONAL COlU'O!li\ TION
26 WEST fUGH SlREET
CARllSLE, PENNSYLVANIA 170B
Tdq>honc (717) 243.6222
F~ (717)243,(,510
E-MAlLo "'omey@>Sfl-i=.com
OF COONS&.,
ALBERT H.MA51./\ND
WIST SflORf,Orea;,
2109 Madret_
c.mpHili,PA 17011
Telephon. (717) 7,7-340,\
FoaUmlo (717) 737-3407
REPLY TO CARLISLll
FACSIMILE TRANSMITIAL MEMORANDUM
5<:nl by; Adele Group
Time sent:
tla:tvxx,SGIt1 >>tD C:01G':tl>E'N'nAL information intended only for the uSe of the addressee (sl
named below. If the readQr of this mese~ge is not the intended recipient (s} or the
employee or age.nt r$sponsible for delivering the message to the int.ended recipient (s) ,
pleas0 note that any dissemination. distribution or copying of ~his communication is
strictly prohibited. Anyone who receives this communication in error Shol,l1d notify UB
immediately by telephone and return the original message to us at the address above via
the U. S. Mail.
TO:
DolUla, Register of Wills (fax: 240.7797)
FROM:
Adele Group
DATE:
09-04-02
SUBJECT:
Estate of Tim Eugene Glessner
.**..~**.******.*.****w***w************..**********************...~****************.**ww**********
We are transmitting a total of 3 pages to you, including !his one,
Please advise if your copy quality is nol adequ<lte.
~d W~~S:~~ c00c v0 'ddS
mS9E1'c
'ON X~j
^~saNII+~3MOlj'jJnHS'SlaI~S WO~j
'\
'"\
JOHN E. SUKE
ROBERT C. SAlOIS
GEOFFREY S. SHUFF
JAMES D. FLOWER, jR.
CAROLj.l1NDSAY
jOHNNA j. KOPECKY
KARL M. LEDEBOHM
JOSEPH L. HlTOflNGS
THOMAS E. FLOWER
LAW omas
SAlDIS, SHUFF, FLOWER &; LINDSAY
A PROFBSSlONAL CORPORATION F Il t r UP V
26 WEST mGli STREET U
CARLISLE, PENN5YT..V ANIA 1701~
TELEPHONE: (717) 243.{;222. FACSIMILE: (717) 243-6486
EMAII.:attomey@SSfl-law.com
www....f1.law.com WEST SHOREOl'FICE:
2109 MARKET STREET
CAMP I-llLI. P A 17011
TELEPHONE: (717)737-3405
FACSIM1I.E: (717)737-3407
REPLy TO CARLISLE
July 31, 2002
Register of Wills
Cumberland County Courthouse
One Courthouse Square
CarlislePA 17013
RE: ESTATE OF TIM EUGENE GLESSNER
To Whom It May Concern:
We have taken out Letters of Administration for the purposes of Mrs. Glessner, widow of
Tim Eugene Glessner, to be the administratrix of the Estate of Tim Glessner. This was to
execute a deed for the fonner marital residence at 41 Mill Street, Mount Holly Springs,
Pennsylvania, and for no other purpose.
Should you have any questions or any additional information, please do not hesitate to
contact me.
Very truly yours,
SAlOIS, S~OWER & LINDSAY
JO~ecky -.
JJK/ahg
Cc: Robin Glessner
Enclosure
~d W~~S:ll ~00~ v0 'd~S
01S'3~v~ : 'ON XtlJ
^tlSaNIl+~3MOnJ'JJnHS'SIaI~S WO~J
u
CERTIFICATION OF NOTICE UNDER RULE 5.6(a\
Name of Decedent:--rT {Y\
f~. b k~f1Qr
3JJ-S{u}
I '
C) J ~()~ ~& f.( -:?
Admin. No.
Date of Death:
Will No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of t'j; Orp~ns' Court Rules was
served on or mailed to the following beneficiaries of the above-captloned estate on ~ / <f ~ c.Jd.- :
Name
Address
~k; \^ C=,:(p<;:<;rur-
y,) ~r, GK:. \ Ia-rJ ~~
y
~((S()'LL1 (\ I 0'1 I 6lt, d:)~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature~
Name .__~
I
Address"/Lfd 6,(( 1;:;/c1
&w}:(V;fl C1 tJL,:J31
Telephone 6:10) 7 71 ~ Ud-<s'D
~io I ~ C<J-f.eBSYvr-
R~J
Capacity: _ Personal Representative
_Counsel for personal representative
STATUS REPORT UNDER RULE 6.12
C/
i5~
..;.
,
Name of Decedent:
Tim Eugene Glessner
Date of Death: 03/13/2001
21-02-0643
Admin. No.:
2002-00643
Will No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion ofthe administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: N/A
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: N/A
c. Did the personal representative state an account informally to the parties
in interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
0", "hl)- 0 3 md m.y b, """hed " 1hi: ~~ j.A . 'irr:\:JL
Si at.~
Jaclyn M. Smith, Esq.
Name
26 West High Street, Carlisle PA
Address
(717) 243.6222
Telephone No.
Capacity: 0 Personal Representative
!i1 Counsel for personal representative
.. . 'J
.
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
FEe I I 2003
Date: 2/07/2003
KOPECKY JOHNNA J
26 W HIGH STREET
CARLISLE, PA 17013
RE: Estate of GLESSNER TIM EUGENE
File Number: 2002-00643
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 3/13/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
L~ J;1&&ld~ft0
DONNA M. OTTO ~ ~
DEPUTY REGISTER OF WILLS~
cc: File
~Personal Representative(s)
Judge
NOTICE OF~;INHE~RITANCE TAX pennsylvania ~
s LOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES ( i_y+,,.. rp
INHERITANCE TAX DIVISION r :'~~I-~CD~, !• AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
PO BOX 280601 ~';, ~ ~,~~_t~
HARRISBURG PA 17128-0601 _
DATE 03-05-2012
•'.~"IL 1'lAR 12 ~'1'~# I~' Ot ESTATE OF GLESSNER TIM E
DATE OF DEATH 03-13-2001
CLERK ~~ FILE NUMBER 21 02-0643
ORP~~,~'~ ~;~L~T COUNTY CUMBERLAND
JOHNNA J KOPECKY Ctf~,,~~~-a ~,lr,~s,; ~ ~~, Pa ACN 101
26 W HIGH ST APPEAL DATE: 05-04-2012
CA R L I S L E PA 17 013 ( See reverse side under Objections )
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YDUR RECORDS ~
-------------------------------------------------------------------------------------------
REV-1547 EX AFP C12-11? NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: GLESSNER TIM EFILE N0.:21 02-0643 ACN: 101 DATE: 03-05-2012
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
.0 0 credit to your account,
2. Stocks and Bonds (Schedule B) C2)
.00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets C8) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) .00
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .0 0
11. Total Deductions C11) .00
12. Net Value of Tax Return (12) .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) .00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) •00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .00 x 04 5 = .0 0
17. Amount of Line 14 at Sibling rate C17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCDUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. /L
REV-1470 EX (01-10)
enns Lvania '"
P Y INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280601
DECEDENT'S NAME FILE NUMBER
Tim Eugene Glessner 2102-0643
REVIEWED BY ACN
Joan M. Peters 101
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
Efforts to file an Inheritance Tax return have been exhausted in the above referenced
estate. Therefore, the filing requirements have been waived. The Department however,
reserves the right to assess any assets that may be recovered at a future time.
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