HomeMy WebLinkAbout01-0902
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Patricia M. Hart
also known as
No.
21-01-902
, Deceased
Social Security No. 174 - 20 - 3968
Valerie A. Carrolus and Kevin J. Hart
Petitioner{s), who is/are 18 years of age or older, applyOes) for:
(COMPLETE 'A' or 'B' BELOW:)
[]] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors
the Decedent, dated 03/16/1998 and codicil(s) dated None
none
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
none
D 8. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at 3408 Hawthorne Drive, Boro of Camp Hill, PA 17011
(ljst street, number, and municipality)
Decedent, then ~years of age, died 09/21/2001 at 3408 Hawthorne Dr., Camp Hill, PA
(Location)
Decedent 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
35,000.00
$
$
$
$
130,000.00
situated as follows:
3408 Hawthorne Dr., Boro of Carnp Hill, PA
'-
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a riate form to the undersi ned:
Si nature T ed or rinted name and residence
Valerie A. Carrolus
17 Citadel Dr., Carn Hill, PA 17011
Kevin J. Hart
35 Mt. Zion Rd., York, PA 17402
/7-//~
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and slIbscribed
before me this~ day of
OCTOBER 2001
No. 21-01-902
Estate of Patricia M. Hart
Deceased
Social Security No: 174 - 20 - 3968
Date of Death: 09/21/2001
AND NOW,
OCTOBER 2, 2001
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary D Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Valerie A. Carrolus and Kevin J. Hart
in the above estate and that the instrument(s} dated
03/16/1998
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
~r!f#I:Oi./Uh/ /lIlY J:J~1'l
Re ster of Wills
Letters. . . . . . .
$ 235.00
Short Certificate(s).
$ 30.00
Attorney:
Robert C. Saidi:s
Renunciation.
$
Affidavits (
$
1.0. No:
21458
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Extra Pages (
) .
$
9.00
Address:
Camp Hill, PA 17011
Codicil. .
$
JCP Fee.
$
5.00
Telephone:
717/737-3405
Inventory.
$
Other . .
$
TOTAL.
$
279.00
Form RW-1 (1991)
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc.
_T'f'I~.C'f'I~ ":'':'\~ f'I,'01'.,
This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as
I~ocal ~~gistrar. The original certific.ate will be forwarded to the State Vital Records Office for permanent hling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7691124
No.
21-01-902
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Local Re istrar
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Date
Hl05.143 Aev 2187
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRINT
IN
PERMANENT
BUCK INK
2311.
TIME OF DEATH
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WERE AUlOf'SY FlHOINGS
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COMI'l.ETIOH OF CAUSI:
OF DEATH1
HomIC>de
MANNER OF DEATH
DATE OF INJURY
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SOCIAl SECURITY NUMBER
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INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED
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.PAONOUNClNG AND CERTifYING ..HYSIQAN tPt:tSICtant'Olh PlOflOuJlC.1\Q ue.uh dltdcert"VIOQIOCdUsa 01 dedit!)
To 11M beeto' my knowteclge, dealhocc"',ed at the tllM. ute. andplaca, and due to ""ecauae(a) and manne,.. .'.Ied... .. . ..
'MEDICAL EllAUlHERlCORONEA
On Ihe bal'e o. ..aminatlon andlOllnvesUgaUon, in my opinion, d.ath occurr.d allhe lime. date, and place, and due to the cau.eCa) and
mAlnn.,.. atated.. . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . _. . . . . . . . . . . . . . . .. . . . . . .. .
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LICENSE DATE SIGNED 1_. Day. _I
o 31 . M '0 0 'jO 5 7 J i= I'll. 1 - J ( , [,
NAME AHDADDRESSOF PEA5<>>AWHO COMPLETED CAUSE OF DEATH
Cl1em27IT~OfP"nt Il. )JI(, j- Cl-\.. + k-". .
D 3'1 I.L -"....f.~.! I ~ R c~
:12. ~ ". '" I J; Ii p'" I '7 '- ,I
DATE FILED 1M."., Day _I
:14. .s~ [;z #J be.e ..2..~ :).(X) ~
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle, PA
~1-01-902
LAST WILL AND TESTAMENT
OF
PATRICIA M. HART
I, PATRICIA M. HART, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my last
illness and funeral from my estate as soon after my death as
conveniently may be done.
Further, I direct that my body be interred at my cemetery
plot in Holy Cross Cemetery, Harrisburg, Pennsylvania.
My personal representative may expend funds from my estate,
in such amount as my personal representative shall consider
necessary and desirable for the purchase, erection and inscription
of a suitable marker for my grave and a contract for perpetual
care.
SECOND
I give, devise and bequeath all the rest, residue and
remainder of my estate in equal shares unto my children, VALERIE
A. CARROLUS, JUDITH K. HART, DIANE M. ROCEK, SUSAN R. HART AND
KEVIN J. HART, per stirpes.
SAIDIS, GUIDO,
SHUFF &
MAS LAND
26 W. High Street
Carlisle, PA
THIRD
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will or otherwise
shall be paid out of the principal of my residuary estate.
FOURTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument, in his or
her absolute discretion:
A. To retain in the form received, or to sell either at
public or private sale any real or personal property;
B. To exercise any options to subscribe for stocks,
bonds, or other investments;
c.
To join in any plan of lease,
mortgage,
consolidation, exchange, reorganization or foreclosure of any
corporation in which my estate or any trust may hold stocks,
bonds or other securities;
D. To sell, transfer, convey, mortgage, pledge, lease
or exchange any property, real or personal, which at any time
may form part of my estate, for the payment of debts or
taxes, or for any purpose of administration or distribution,
for such prices and upon such terms as my personal
representative, in his or her sole discretion, may deem wise,
and to execute and deliver deeds of conveyance or transfer
thereof;
E. To make settlements and compromises on such terms as
my personal representative in his or her sole discretion may
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 w. High Street
Carlisle, PA
deem wise without the necessity of obtaining
any
court
approval thereof;
F. To make distribution hereunder either in cash or
kind, as my personal representative in his or her discretion
may deem wise.
FIFTH
I do hereby nominate, constitute and appoint VALERIE A.
CARROLUS AND KEVIN J. HART, to act as Co-Executors of this my Last
Will and Testament.
Provided, however, that if either is
unwilling or unable to act, the other shall act as sole Executor
of this my Last will and Testament.
SIXTH
I direct that no personal representative, guardian, trustee
or other fiduciary appointed under this instrument shall be
required to give bond for the faithful performance of their duties
in any jurisdiction.
IN WITNESS WHEREOF, I, PATRICIA M. HART , have hereunto set
my hand and seal to this my Last Will and Testament, consisting of
three (3) typewritten pages, the first two (2) of which bear my
signature in the margin for identification, this ~day of
m~~
, 1998.
o~~.k
patricia M. Hart
Signed, sealed, published and declared by the above-named
PATRICIA M. HART, the Testatrix, as and for his Last Will and
Testament in the presence of us, who have hereunto subscribed our
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle, PA
names at her request as witnesses thereto, in the presence of said
Testatrix and of each other.
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ADDRESS
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ADDRESS
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COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
We, PATRICIA M. HART, :fwl/e. ~. SbWf/t.5 and Kbl ).(. J.ed-eJ",
, the Testatrix and witnesses, respectively whose names are
signed to the foregoing or attached instrument, being first duly
sworn, do hereby declare to the undersigned authority that the
Testatrix signed and executed the instrument as her Last Will and
Testament and that she signed willingly and that she executed 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 witnesses and that to the best of
their knowledge the Testatrix was at the time eighteen (IS) or
more years of age, of sound mind and under no constraint or undue
influence.
~--=~~ }h.~
Patr cia M. Hart, Testatrix
~ t.\Jzif~
) / . W~S8
lit! J#AjJ;'~88
Subscribed, sworn to and acknowledged before me by PATRICIA
M. HART, the Testatrix, and subscribed to and sworn or affirmed to
before me by J!J.j;-e. t.
jI,(, !. etf.e6oAh0
, 199 P.
, witnesses, this
€
---
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Patricia M. Hart
Date of Death: September 21, 2001
Will No.
21-01-0902
Admin. No.
To the Register:
I certify that notice of 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 October il ,2001.
Name
Address
Valerie A. Carrolus
Kevin J. Hart
Diane M. Rocek
Judith K. Hart
Susan R. Hart
17 Citadel Drive, Camp Hill, PA 17011
35 Mt. Zion Road, York, P A 17402
61 7 Ducktown Road, York, P A 17406
2001 Sewel Street, Lincoln, NE 68501
9 Welling Ave., Warwick, NY 10990
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date: ())l~ 1(, rhJa I
Robe C. Saidis, Esquire
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
_ Personal Representative
--.2L Counsel for Personal
Representative
\
/?-//-~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT, 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ROBERT C SAIDIS
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
'O:,~
-,,2
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-29-2002
HART
09-21-2001
21 01-0902
CUMBERLAND
101
::~u
*
REY-1547 EX AFP COl-O!)
PATRICIA
M
AIIount Rellitted
PA ~~'iU.
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 ~
RE-Y=is'irj-Ex--AFP--fol-:02'r-No;--icE--oF-'rNHERiTANcE-TAi-AiipRA-isEifENT~--ALi-oWAiicE-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HART PATRICIA M FILE NO. 21 01-0902 ACN 101 DATE 07-29-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (lS)
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
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. JointlY Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
3,278.62
.00
.00
.00
.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/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
219.28
67.14
(1)
(2)
(3)
(4)
NOTE:
.00 X 00 =
271,967.22 X 045=
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
3,278.62
286 42
2,992.20
.00
271,967.22
(9)=
.00
12,,238.53
.00
.00
12,,238.53
TAX CREDITS:
,""'nenl l'(el.e~,"1 II (+ J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
12-20-2001 CDOO0678 605.26 11,,500.00
04-08-2002 REFUND .00 1.31-
06-05-2002 CDOO1259 .00 134.65
TOTAL TAX CREDIT 12,,238.60
BALANCE OF TAX DUE .07CR
INTEREST AND PEN. .00
TOTAL DUE .07CR
. 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.)
\, 1/)- / 1- ~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1n7 EX AFP C01-021
ROBERT C 5AIDI5
5AIDI5 ETAL
2109 MARKET 5T
CAMP HILL
'02 ['l/W 1 7 P I~ :!~ 1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-22-2002
HART
09-21-2001
21 01-0902
CUMBERLAND
101
Allount Rellitted
PATRICIA
M
PA (lrJDll
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-\i=i6oj-ix--AFP-col-:oz.r------....--iNHEliITANc'E-YAX--STATEM'Etif-oF'-ACCOUNY--...---------------------
ESTATE OF HART PATRICIA M FILE NO. 21 01-0902 ACN 101 DATE 04-22-2002
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: 04-15-2002
PR I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
12,103.88
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-20-2001 CDOO0678 605.19 11,500.00
04-08-2002 REFUND .00 1.31-
TOTAL TAX CREDIT 12,103.88
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" (CRl,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l
17-/1-~
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
'02 /\PR 19
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
:':12 :1eoUNTY
ACN
04-15-2002
HART
09-21-2001
21 01-0902
CUMBERLAND
101
ROBERT C SAIDIS
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
*'
REY-1547 EX iFP COl-aZ)
PATRICIA
M
C,c'l i
PA 1701Cumb.,'
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is'4j-ix-AFP--coi-:ozi--Nor-icE--OF-'rtiHEifiiANci-i'AX-APPRA-isEiiENT~--Ai:.i-oWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HART PATRICIA M FILE NO. 21 01-0902 ACN 101 DATE 04-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
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 DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
124..000.00
79..997.00
.00
.00
51..843.66
.00
30..329.15
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule 1)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
14,878.37
2.316.42
(1lJ
(12)
(13)
(14)
NOTE:
.00 X 00 =
268,975.02 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
286,169.81
17.194 79
268,975.02
.00
268,975.02
(19)=
.00
12,103.88
.00
.00
12,103.88
TAX CREDITS:
. ... ....... , "..-..... . (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-20-2001 CDOO0678 605.19 11,500.00
04-08-2002 REFUND .00 1.31-
TOTAL TAX CREDIT 12,103.88
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
~
~
. 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,)
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
SAlOIS ROBERT C
26 W HIGH STREET
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 174-20-3968
FILE NUMBER: 21-2001- 0902
DECEDENT NAME: HART PATRICIA M
DA TE OF PAYMENT: 12/21/2001
POSTMARK DATE: 1 2/20/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 09/21/2001
NO. CD 000678
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$11,500.00
REMARKS: SAlOIS ET AL
CHECK#1010
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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
SAlOIS ROBERT C
26 W HIGH STREET
CARLlSLE( PA 17013
-.----.- fold
ESTATE INFORMATION: SSN: 174-20-3968
FILE NUMBER: 2101-0902
DECEDENT NAME: HART PATRICIA M
DATE OF PAYMENT: 06/06/2002
POSTMARK DATE: 06/05/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 09/21/2001
NO. CD 001259
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $134.65
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$134.65
REMARKS: VALERIE A CARROLUS
C/O ROBERT C SAlOIS ESQUIRE
CHECK#1019
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
V
,/
v
1-'
Name of Decedent: Patricia M. Hart
Date of Death: September 21, 2001
Will No.
21-01-0902
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
complete:
1 .
Yes
State
X ;
whether
No
administration
of
the
estate
is
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes ; No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes~; No
d. Copies of receipts, releases, joinders and
approvals of formal or informal acco may be filed with the
Clerk of the Orphans' Court and may e att ched to this report.
c.:::.
Signature
Name: Robert C. Saidis, Esquire
1.0. No. 21458
SAlOIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
Date: 7 -/3 - ()::L
Capacity:
Personal Representative
X Counsel for Personal
Representative
~ .
REV-1500 EX +(6-00)
CAPB
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
c.
OFFICIAL USE ONLY
'7- '/~ ~
FILE NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hart Patricia M.
DATE OF DEATH (MM-DD-YEAR)
COUNTY CODE
SOCIAL SECURITY NUMBER
21-01-0902
YEAR
NUMBER
DATE OF BIRTH (MM-DD-YEAR)
174-20-3968
THIS RETURN MUST BE FilED IN DUPUCATEWlTH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 6. Decedent Died Testate
X 2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust 0
3. (date of death
. Remamder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
1?HI$$~~1?I(:)NMU$1?EI~.~(:)MP~~~I;P..Atteoaae$p()NPE;NeE.'&.e(:)NFIQ~N'I1IAI.1?AX..INr:()FlMA.TIQN$H()UI.P.ijI;QI8e~.p"t<>;
NAME COMPLETE MAILING ADDRESS
Robert C. Saidis
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsa
TELEPHONE NUMBER
2109 Market Street
Camp Hill, PA 17011
R
E
C
A
P
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717 737-3405
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(1 )
(2)
(3)
None
3,278.62
None
(4)
(5)
None
None
(6)
None
None
219.28
67.14
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
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
2,992.20
x
X
X
X
.0 0
.0 45
.12
.15
OFFICIAL USE ONLY
c
(8) 3,278.62
(11 ) 286.42
(12) 2,992.20
(13)
(14) 2,992.20
(15)
(16)
(17)
(18)
(19)
0.00
134.65
0.00
0.00
134.65
1f::xqVARI;,R.i;q\.l~s1?II'f~AReFUNb OF AN. OVI;RPAiYMi;N"t
RE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
3408 Hawthorne Drive
CITY 1 STATE I ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
134.65
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
134.65
0.00
134.65
'.:I!i:mm~t~~~~i~~~!~i~iiiYA&i~i~tt~~~~~~~~:~YIBi~i~m~Y:~L~2\1\~~ii~~ :,\,i~"
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or .
d. receive the promise for life of either payments, benefits or care? .
2. If death occurred after December 12, 1982. did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
:~~:~Ag:'~~~~:~~~:I~Y:~~~~'2:~~:m:'ii:
Yes No
~~
o
o
IT]
IT]
o
[]]
Under penalties of perjury. 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 reparer other thar the personal representative is based on all information of which preparer has any knowledge.
Valerie A. Carrolus and Kevin J. Hart
17 Citadel Drive
--- ----- - - - -- - -- - -------- - -- --- --- - -- ---------- --- --
am Hill, PA 17011
Saidis, Shuff, Flower & Lindsay
2109 Market Street
DATE
~/ I/OU
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. 9116 (a) (1.1) (ill
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. 9116 (a) (1.1) (ii)). The statute does not exempt 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 twenty-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% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2)
[72 PS 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. 9116(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.
Copyright (c) 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00)
R!Y-1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Patricia M. Hart
SSif 174-20-3968
09/21/2001
21-01-0902
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
UNIT VALUE
NUMBER OF DEATH
1 Merrill Lynch, investment acct. if872-45291 :
Ready Asset cash account 3,278.62
(see attached copy of statement )
TOTAL (Also enter on line 2, Recapitulation) 3,278.62
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
REY-1511 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Patricia M. Hart
SS# 174-20-3968
09/21/2001
FILE NUMBER
21-01-0902
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
B.
State
Zip
City
Year(s) Commission Paid:
2. Attorney's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
Merrill Lynch, costs incurred in sale of stock and bond funds
219.28
TOTAL (Also enter on line 9, Recapitulation) $ 219.28
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
F;lEV'-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Patricia M. Hart
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSif 174-20-3968
09/21/2001
FILE NUMBER
21-01-0902
Include unreimbursed medical expenses.
ITEM
NUMBER
1 PPL, final utility bill
DESCRIPTION
AMOUNT
67.14
TOTAL (Also enter on line 10, Recapitulation) $ 67.14
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1512 EX (Rev. 1-97)
f3EV'-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIAR IES
ESTATE OF
Patricia M. Hart
SS1ft 174-20-3968
09/21/2001
FILE NUMBER
21-01-0902
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)]
1 Valerie A. Carro1us daughter 1/5 of residue
17 Citadel Dr.
Camp Hill, PA 17011
2 Kevin J. Hart son 1/5 of residue
35 Mt. Zion Rd.
York, PA 17402
3 Diane M. Rocek daughter 1/5 of residue
617 Ducktown Rd.
York, PA 17406
4 Judith K. Hart daughter 1/5 of residue
2001 Sewell St.
Lincoln, NE 68501
5 Susan R. Hart daughter 1/5 of residue
9 Welling Ave.
Warwick, NY 10990
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1513 EX (Rev. 9-00)
:Jt': ~'. ~~'~~}'l,\~~~~~?;t ~'~ ~!:,t:i.-i'.fj~;t~~.'
MerrH; Ly.,ch,
.Pierce, Fenner & Smith Inc.
. Member, Securities Investor Protection Corporation (SIPC)
r
ACCOUNT #
872 45291
STATEMENT PERIOD
10/27/01 TO 11/30/01
FINANCIAL ADVISOR
BRENNER MADDEN TEAM
Individual
Investor Account
________.__mm-"d~~~'ililii~~~
PAGE # TELEPHONE #
1 717-975-4600
PATRICIA M HART DCSD
3408 HAWTHORNE DR
CAMP HILL PA 17011-2718
SS OR 10
174-20-3968
INVESTOR
CREDIT LINE
OFFICE SERVING YOUR ACCOUNT TYPE
214 SENATE AVE, STE 501
CAMP HILL PA 17011 CASH
*****
ACCOUNT SUMMARY
OPENING BALANCE CLOSING BALANCE
$.00 $.00
*****
DESCRIPTION
REPORTABLE DIVIDENDS
*****
MONEY ACCOUNT
MERR I LL LYNCH READY ASsE'TS..
*****
DATE
TRANSACTION
" 15
Journal Entry
" 15
Journal Entry
" 15
Journal Entry
" 15
Journal Entry
" 15
Journal Entry
11 15
Journal Entry
INVESTMENTS
$0
MONEY ACCOUNTS PRICED PORTFOLIO
$.73 $.73
TAX INFORMATION SUMMARY
THIS STATEMENT
$.00
MONEY ACCOUNTS SUMMARY
OPENING
BALANCE
CLOSING
BALANCE
*****
*****
YEAR TO DATE
I
$3,282.73
DA TLYACCOV~T ACT I V I TV
DESCRIPTION
TR TO 87254676
N/O VALERIE A CARROLUS E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-5899 ALLIANCE GROWTH AND
INCOME FUND CLASS C
TR TO 87254676
N/O VALERIE A CARROL US E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-627 ALLIANCE GROWTH FUND
CLASS C
TR TO 87254676
N/O VALERIE A CARROLUS E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-378 FIDELITY ADV EQUITY
GROWTH FD CL A
TR TO 87254676
N/O VALERIE A CARROLUS E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-346 FIDELITY ADV GROWTH OPPS
FD CL A
TR TO 87254676
N/O VALERIE A CARROLUS E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-414 FID ADV EQ INC FD CL A
TR TO 87254676
NIO VALERIE A CARROLUS E
VS 87254676 UNIT 41W
BATCH # = 00030325518
-000021417
$423.03CR
*****
$.73
$4.11 $278.32
***** t
PRICE AMOUNT i
~
$3282.00
DIVIDEND/I~iERESJ/
THIS STMT. Y~ DATE
r--
-11 ,'~ ~J 1.
..>,,'(J..,J~
_ it': 1,/ ;tl^-r 1-,
.~ ~ 7 r~' 'j" / t/J
~~ v' ~~ ~ .
/
i
tj, ~ 07(1 ,)-
/ l
~., .-....
NOVEMBER 2001
FOR AN EXPlANA nON OF SYMBOLS, PLEASE SEE REVERSE SIDE
PLEAse ADVISE YOUR FINANCIAL ADVISOR IMMEDIATELY OF ANY DISCREPANCIES ON YOUR STATEMENT OR IF YOU CONTEMPLATE CHANGING YOUR ADDRESS.
WHEN MAKING INaUlA!~S. PL~ASE MENTION YOUR ACCOUNT NUMBER AND ADDRESS ALl. CORRESPONDENCE TO THE OFFICE SeRVIC!NG YOUR ACCOUNT
WE URGE YOU TO PqESERVE THIS STATEMENT FOR USE IN PREPARING INCOME TAX FiETljRNS
CODE 5035 R (R6-01)
~MerrUILpch
,; /~.:"'~"'?'~':~'::!t~Y~'.':"'" /~^"'~ ,:'T:~riffl~'l~:7~:r~ :7^~,~::~':i~'.;:,~'~" i.....:~~~;:'~
Me'r,UJ Lyrrch,
Pierce, Fenner & Smith Inc.
. Member. Securities Investor Protection Corporation (SIPC)
Individual
Investor Account
..._..__.___._~~1!.ili~':'{.1
ACCOUNT 1/
872 45291
TELEPHONE 1/
717-975-4600
PATRICIA M HART DCS~
3408 HAWTHORNE DR
***** DAILY ACCOUNT ACTIVITY *****
DATE TRANSACTION DESCRIPTION PRICE AMOUNT
11 16 Transferred .TFR TO 872-54676 $3282.00CR
11 16 Transferred 3282 ML READY ASSETS TRUST
11 16 Sale 3282 ML READY ASSETS TRUST $3282.00CR
1/ REDMP EFFECTIVE 11/15
11 19 Journal Entry TFR TO 872-54616 $3282.00
11 19 Transferred 3282 ML READY ASSETS TRUST
TFR TO 872-54676
1 1 19 Journal Entry ALLIANCE GROWTH AND
INCOME FUND CLASS C
TRANSFER TO 812-54676
FRAC SHARE QTY TR .1460
11 19 Journal Entry ALLIANCE GROWTH FUND
CLASS C
TRANSFER TO 812-54616
FRAC SHARE QTY TR .1850
11 19 Journal Entry FIDELITY ADV EQUITY
GROWTH FD CL A
TRANSFER TO 812-54616
FRAC SHARE QTY TR .7140
11 19 Journal Entry FIDELITY ADV GROWTH OPPS
FD CL A
TRANSFER TO 812-54616
FRAC SHARE QTY TR .2810
11 19 Journal Entry FID ADV EQ INC FD CL A
TRANSFER TO 872-54676
FRAC SHARE QTY TR .8740
11 30 Check MONTHLY AMT ISSUED ~4. 1 1
11 30 Dividend ML READY ASSETS TRUST 4.11CR
11 30 CLOSING BALANCE $.00
ENROLL IN MERRILL LYNCH ONLINE(SM) AT WWW.MLOL.ML.COM.
-000021418
END OF STATEMENT
NOVEMBER 2001
~.enUI Lynch
FOR AN EXPLANA nON OFSYMBOLS, PLEASE SEE REVERSE SlOE
PLEA.SE ;"O\lISE '(OU~ FINA.NCIAl ADVISOR IMM~D',foTELY OF ANY DISCREPANCIES ON YOUR STATEMENT OR IF YOU CONTEMPLATE CHANGING YOUR ADDRESS.
WHEN MAKING INQUIRIES. PLEAse MENTION YOU~ ACCOUNT NUM8ER AND AODR':SS A,LL CORRESPONDENCE TO THE OFFICE seRVICING YOUR ACCOUNT.
WE URGe YOU TO PReSERVe: THIS STATEMEN"ir FOFl use IN PREPARING INCOME TAX RETURNS.
CODE 5035 R (R6-01)