HomeMy WebLinkAbout01-0996
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of . No. 21-01-QQ6
also known as To:
Register of Wills for the
Deceased. County of CUMBERLAND in the
Social Security No. Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ies 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 Cumberland County, Pennsylvania, with
h er last family or principal residence at 3003 Columbia Avenue, Porough of Camp. Hill
(list street, nllcIl1ber and municipality)
Decendent, then 80 years of age, died October 3 , , 2001
,
at 3003 Columbia Avenue, Camp Hill, PA
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 185,250.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 115,000.00
situated as follows:
3003 Columbia Avenue, Borouqh of Camp Hill
Cumberland County, PA
Petitioner_ after a proper search hILL.. ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Donna J. Deltz Daughter 1024 Swarthnore Rd.
New Cumberland, PA 17070
George W. Irvin, Jr. Son 26 Center Dr., Camp Hill, PA 17011
Charles Lerov Irvin Son 5279 E. Trindle Rd. Mechanicsburg
PA 17050
William C. Irvin Son 782 Valley St., Enola, PA 17025
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersIgned. ,
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DOROTHY M IRVIN
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
} ss
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 ell and
truly administer the estate according to law.
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en
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Sworn to or affirmed and. subscribed I
before me this 29th day of
~BER ~ 2001
Y;!#-<'~.4 ~'t
Register
No. 21-01-996
Estate of
DOROTHY M. IRVIN
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW OCTOBER 31 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Georqe W. Irvin, Jr.
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
Georqe W. Irvin, Jr.
are hereby granted to
Dorothy M. Irvin
in the estate of
FEES
Letters of Administration $ 305.00
Short Certificates( ).......... $ 9.00
Renunciation ................ $ 5 . 00
JCP $ 5.00
TOTAL _ $ 324.00
Filed.. .10:-.29-:-2.001. . . . .. A.D. :ll9vvvvxxxx
~,yt7 -ji~"" /'1',,,./$, Ab~
'7 R ster of Wills oCL..~ - !
Edmund G. Myers (20558)
Johnson, Duffie, Stewart & Weidner
ATTORNEY (Sup. Ct. I.D. No.)
301 Market St., P. O. Box 109
ADDRESS Lemoyne, PA 17043-0109
(717) 761-4540
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This is to cettity that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original cettificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7743192
No.
21-01-996
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Local Registrar.tV
(j
OCI U 4 2001
Date
5.143A.....2187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
STArE FIlE NUMBER
SOCIAL SECURITY NUMBER
DATe OF DEATH ,Moo"'. Day. .....,
NAME OF DECeDENT (FI'.. Mickle. laa)
SEX
..
AGEIl.. -vl
Doroth M.
_. YEAR
- llayo
8IIlTHl'I.AC.E (QIy ....
Slate Of FOfe.gn Counky)
Irvin
UNDER . DIll'
-!-
80
Yra.
..female .. 204 - 01 - 9949
Pl.ACE OF DEATH (Check onty one ... instrllCtlOnS on ~ Sld8t
HOSPITAL: OTHER:
o 0 Nuralng 0
20 7.Harrisburg, PA::-- EAI~ Home
~tt.JTY NAME (If nee 1N8iIUIiotI. Qlve str"' and number,
3003 Columbia Avenue
=..vI 0
COUNlYOF DERH
Cumberland
Camp Hill, PA
... Ill.
KIND OF BUSlNESS/lNOUSTRY
DECEOEHrS USUAL 0CCIlPRI0N
I~~~,,=::~:'r
. II Homemaker ..-. Domestic
DECEDENTS MAlLING AIlDAESS (SU... QyITown. SIIIo. ZlC>Codo\ DECEDENTS
ACTUAl
RESIDENCE
(800_
on_-,
...
E-.ryts--y
... 1().12) 12
17e. State
PA
.. Oct. 3, 2001
CoIIogo
(1.4015...)
lotAAITA1.SWUS._
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llMItwd ~)
... widowed
.70.0....__..
SUAYlVING SPOUSE
(If WIle. gNe ma.d8n name)
3003 Columbia Avenue
II. Camp Hill, PA 17011
FIlI'HEA'S NAME (Fir.. _. l")
.. Charles L. Holsber er
INFOAMAHT'S NAME (T-"""l
. Geor e W. Irvin Jr.
METHOD OF D1Sl'OS1T1OH
O _00 c_O -..komSl...O
Donation 00lI0I' ~
.
SlGNATUAE OF
DId
-
live...
Cumberland ...........1 .7d.K1 :"',,"=,,=01
MOTHeR'S NAME (Filst. MIddle. Ma.d<<I Surname)
II. Ethel Hiatt
1NF000000'S _UNO ADDAESS (SIr... CiIy/Town. SlaIo. 2;p Codel
. 26 Center Drive Cam Hill PA 1 011
PlACE OFDlSPOSITlON. Name 0I~ Cr_ lOCRlON .CiIyI1Own. _. 2;pCodo
orOlhor _
2'0~olling Green Mem. Park 2td?wer Allen Twp.,
NAME ANOADDAESSOFFIoCIUTY Par t hemore
22c.
.n..
..
[ :
d.
WERE AUlOPSV RNOINGS
-...ae PAIOAlO
COUPt.ETlOH OF CAUSE
OF DERH?
M_R OF DEATH
DATE OF INJURY
(hAonll.DaV. ......
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Camp Hill
.-.
Cumb.Co.PA
MATn: OIhor,,-__COl1OriI>llIIngIO_.bu1
not..wtinQ..... ~..... given" PART I.
TIMe Of INJURY
INJURY ~ WORK?
DESCRIBE HOW INJURY OCCURflED.
P.-.g InwMigaIlon
D
D
o PlACE OF INJURY. At hom..'..... .,....factory, _ M.
builclng, .... (Spoayl
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.........
Homicide
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Could noc be dMennIned
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CERTIfiER (C"- only eno)
-CERTyrylHQ PHYSICIAN (Physc.an ce1ifying cause at death whef1 anochef ph'fSICian has pronouncecl dealh and campktted nem 231
TD.....O.""knowIedge...thoc:c:urNd.....lOthecauM(.)andlnllnner..-................_...... ........ .........................
...
-PRONOUNCING AND CERTIFYING PHYSICIAN (Phy$lC1iU"i tIoCh pronouncing c:Ieath and c8ltifylng 10 ca.Jse of dftath)
To the bMt of my knowledge, datlt occurred" the...... dlle. end place, and due to the C&UM(a) and manner.. a.a-.ct.. . . . . . . . . . . . . . . . . . . . . . . . .
'MEDlCAL EllAIllHEAlCORONER
On the baaIa of eumlnetlon end/or Inv.stlgatlon, in my opinion. d..th occurred .. the "me. dille, and place, and du. to the cau..(a) end
"'.nneruatated..................................... ..... ............. .... .......,............. ................ ..,
31..
REGI
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21-01-996
RENUNCIATION
In Re Estate of
t\{.
DOROTHY) IRVIN
deceased.
To the Register of Wills of
Cumber1and
County, Pennsylvania.
The undersigned
Children and heirs-at-law
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
George W. Irvin. Jr.
WITNESS
our
. .7L
hand this / r day of October
2001
-'
Sworn to and Subscribed
/ If JZ.,
lJlr>">1-iL2 jt b5
( Ignature)
Donna J. Deitz
before me this
day of October. 2001.
1024 Swarthmore Road
New Cumberland, PA 17070
(Address)
~{fYl
Notar~ic
Notarial Seal
Kristee K. Myers. Notary Public
Lemoyne Bora, cun.merland County
My Commission Expires Dec. 2. 2002 .
Member, pennsylVania Association ot Notanes
~~ /k~
(Signature)
Charles Leroy Irvin
5279 East Trindle Road
Mechanicsburg, PA 17050
(Address)
v~ c. ~
(Signature)
William C. Irvin
782 Valley Street
Enola, PA 17025
(Address)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
-------- fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN:
FILE NUMBER: 21-2001- 0996
DECEDENT NAME: IRVIN DOROTHY M
DATE OF PAYMENT: 1 2/1 9/2001
POSTMARK DATE: 12/18/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 10/03/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: GEORGE W IRVIN JR
C/O EDMUND G MYERS ESQUIRE
CHECK# 96
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 000659
AMOUNT
--------
I $11,000.00
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$11,000.00
MARY C. LEWIS
REGISTER OF WILLS
r
TO Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
SUBJECT: Estate of Dorothy M. Irvin
No. 21-01-00996
000: October 3,2001
FROM
JOHNSON, DUFFIE, STEWART & WEIDNER
Attorneys at Law
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
DATE: December 18, 2001
Enclosed is a check in the amount of $11,000.00 as a payment on account of Inheritance
Tax for the above-captioned Estate, being made within the 90 days to allow for the 5% discount.
SIGNED: Edmund G. Myers
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: DOROTHY M. IRVIN
Date of Death: October 3,2001
Will No.:
Admin. No.: 2001-00996
To the Register:
I certify that notice of beneficial interest 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 C(( 6 7./
Name
Address
1024 Swarthmore Road
New Cumberland, PA 17070
26 Center Drive, Camp Hill, PA 17011
5279 East Trindle Road
Mechanicsburg, PA 17050
782 Valley Street, Enola, PA 17025
Donna J. Deitz
George W. Irvin, Jr.
Charles Leroy Irvin
William C. Irvin
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None.
Date: (!r.r()2/
w~
Signature
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Name Edmund G. Myers, Esq.
Johnson, Duffie, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
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Capacity: Personal Representative
X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 01-0996
ACN 02103165
DATE 01-30-2002
REV-1545 EX AFP 109-GOI
Re(;()l '"
Re~n
EST. OF DOROTHY M IRVIN
S.S. NO. 204-01-9949
DATE OF DEATH 10-03-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
~ CERTIF.
'02 "JAR -6 .\11 ',1 0
hi i
GEORGE WDRIRVIN ~.fl8r!<
~~M~E~I~~ PA~lirfli!}l'
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REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
AllFIRST FINANCIAL SERVICE has provided the Depert.ant with the infor.etion listed below which has been used in
calculeting the potential tax due. Their records indicate that at the death of the above decedent. yoU were a joint owner/beneficiary of
this account. If you feel this infor.ation is incorrect. please obtain written correction fro. the financial institution. attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.~nwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 87009140027538 Date 07-09-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
387.99
50.000
194.00
.15
29.10
TAXPAYER RESPONSE
To insure proper credit to your account. two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills. Agent".
x
NOTE: If tax pay.ents are .ade within three
(3) Bonths of the decedent.s date of death.
you .ay deduct a 57. discount of the tax due.
Any inheritance tax due will becoBe dalinquent
nine (9) Bonths after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
c=J The above inforBation and tax due is correct.
1. You Bay choose to reBit paYBent to the Register of Wills with two copies of this notice to obtain
a discount Dr avoid interest. Dr you Bay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue.
c=J The above asset has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
c=J The above inforBation is incorrect and/or debts and deductions were paid by you.
You BUst co.plete PART ~ and/or PART ~ below.
x
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1.6,73
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
lINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX
ON JOINT/TRUST ACCOUNTS
)-1 -17
J h7. 11
..w
PART
[!]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax Computation)
I
$
clare that the facts I
and belief.
have reported above are true, correct
HOME (7/1 ) 73 7-1~1
WORK (7/7) 78/J - 2333
TEL PHON NUMBER
and
2 -2.~ -i' 2-
DATE
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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
APPRAISEIIENTl. ALLOIlANCE ,.OR DISALLOIIANCE
OF DEDUCTION~, AND ASSESSIIENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-154' EX AFP I Dl-D21
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
04-01-2002
IRVIN
10-03-2001
21 01-0996
CUMBERLAND
204-01-9949
02103165
Allount Rellitted
M
GEORGE W IRVIN JR
26 CENTER DR
CAMP HILL
'02
APf< -1
fYj I :1\ 8
PA 17lUn
GlIITlLc
DOROTHY
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 ~
Rifv:i5~i-E)f-AFP--foi-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-01-2002
ESTATE OF IRVIN
DOROTHY
M DATE OF DEATH 10-03-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0996
TAX RETURN WAS:
S.S/D.C. NO. 204-01-9949
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACN
02103165
ACCOUNT NO.
87009140027538
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 07-09-1997
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
387.99
0.500
194.00
.00
194.00
.45
8.73
x
x
TAX CREDITS:
PAYMENT
DATE
03-04-2002
RECEIPT
NUMBER
CD000927
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
8.73
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER THIS DATE, 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 "CREDlr. ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
8.73
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
IRVIN GEORGE W JR
26 CENTER STREET
CAMP HILL, PA 17011
______n fold
ESTATE INFORMATION: SSN: 204-01-9949
FILE NUMBER: 2101-0996
DECEDENT NAME: IRVIN DOROTHY M
DATE OF PAYMENT: 03/06/2002
POSTMARK DATE: 03/04/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 10/03/2001
REMARKS: GEORGE W IRVIN JR
CHECK# 1341
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
02103165
TOTAL AMOUNT PAID:
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 000927
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$8.73
$8.73
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
NO. CD 001361
MYERS EDMUND G
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
-------- fold
101
$862.35
ESTATE INFORMATION: SSN: 204-01-9949
FILE NUMBER: 2101-0996
DECEDENT NAME: IRVIN DOROTHY M
DATE OF PAYMENT: 07/02/2002
POSTMARK DATE: 07/01/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 10/03/2001
TOTAL AMOUNT PAID:
$862.35
REMARKS: GEORGE W IRVIN JR
C/O EDMUND G MYERS ESQUIRE
CHECK# 106
SEAL
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
55:
GEORGE W. IRVIN, JR.
according to law, deposes and says that he is Administri'lTnr
of the Estate of Dorothy M. T rv; n
late of _____~_cH!ll2_1L:ll,l.J3oroy.gh ' ,Cumberland County, Pa., deceased and that the
within is an inventory made by (;pnrgp W Trv; n. Tr ., the said Administrator
of the entire estate of said decedent, consisting of all the personal propl!rty and real. estate, except real estate outside
the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value
a' o;~:::at::1 decodent', death" .,.,~ I , \ ~" ." ~ I
and subscribed before me, , :J.( W ~
~.
19 2 0 0 2
being duly
sworn
George W.
xeeutor . Ac:lministr
Irvin, Jr.,
or .
Administrator
NOTARIAU L
DIANNE LENIG, No ary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21, 2005
26 Center Drive
Camp Hill, PA 17011
Addr.ss
Date of Death
3rd
October
Month,
2001
Day
Y..r
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional a~h.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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TO Register of Wills Office FROM
Cumberland County Courthouse JOHNSON, DUFFIE, STEWART & WEIDNER
1 Courthouse Square Attorneys at Law
Carlisle, PA 17013-3387 P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
SUBJECT: Estate of Dorothy M. Irvin DATE: July 1,2002
No. 21-01-00996
Enclosed for filing in the above-captioned Estate are the following:
1. Original Inventory.
2. Original and copy of Inheritance Tax Return.
3. Check in the amount of $25.00, filing charges. ..-'~, ..,-...
'- -'.
4. Check in the amount of $862.35, Inheritance Tax .- d
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SIGNED: Edmund G. Myers csh r--:J
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~ BUR~U OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
:JEPT. Z80601
. HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-19-2002
IRVIN
10-03-2001
21 01-0996
CUMBERLAND
101
EDMUND G MYERS
JOHNSON ETAL
PO BOX 109
LEMOYNE
'O"?
ESQ
PA 17043
; I
Allount Rellitted
'*
REY-1547 EX AFP [01-021
DOROTHY
M
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:isirj-E3f-AFP-foY:02Y-NoYicE--oF-YNHEifiTANcE-YA'x-APPRAisEifENT~--ALi-oWANCE-O-i-------------- --- !
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF IRVIN DOROTHY M FILE NO. 21 01-0996 ACN 101 DATE 08-19-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. 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)
115,000.00
65,181. 02
.00
.00
131,991. 75
.00
6,428.75
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ~
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
DATE
12-18-2001
07-01-2002
l+J
INTEREST/PEN PAID (-)
578.95
.00
NUHBER
CD000659
CD001361
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
llO)
33,938.43
8,577.72
(8)
(11)
ll2)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
318,601. 52
42.516 15
276,085.37
.00
276,085.37
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
.00
12,423.84
.00
.00
12,423.84
12,441.30
17.46CR
.00
17 .46CR
( 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.)
.00 X 00 =
276,085.37 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
AHOUNT PAID
11,000.00
862.35
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
REV.1470 EX (K8)
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INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
FILE NUMBER
IRVIN,DOROTHY M
REVIEWED BY
ACN
2101-0996
101
Deborah Washington
ITEM
SCHEDULE NO.
E 9
EXPLANATION OF CHANGES
The value of the jointly held assets is being stricken from the assessment of this return
since they were previously assessed on 4-1-2002 under ACN 02103165.
ROW
Page 1
I~- /?- /1
'\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1U7 EX AFP [01-021
EDMUND G MYERS
JOHNSON ETAL
PO BOX 109
LEMOYNE
EsJ!- -I it
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-09-2002
IRVIN
10-03-2001
21 01-0996
CUMBERLAND
101
DOROTHY
M
Allount Rellitted
.-'fA 17043
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 =ii,ifj-ix--AFP-foY:02Y------...--iNHERITANCE-YAX--SYjrfEMENY-cfF'-AC-coUi.ff--...---------------- -- ---
ESTATE OF IRVIN DOROTHY M FILE NO. 21 01-0996 ACN 101 DATE 09-09-2002
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-19-2002
P R I N C I PAL T A X DUE: ____________________________________________________________________________________________________________________________________________________________________0______________0________0___________0___0______________
12,423.84
PAYMENTS (TAX CREDITS):
PAYMENT
DATE
12-18-2001
07-01-2002
08-26-2002
RECEIPT
NUMBER
CD000659
CD001361
REFUND
DISCOUNT (+)
INTEREST/PEN PAID (-)
578.95
.00
.00
AMOUNT PAID
11,000.00
862.35
17 .46-
TOTAL TAX CREDIT
12,423.84
.00
BALANCE OF TAX DUE
INTEREST AND PEN.
· IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL DUE
.00
.00
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
~~
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM
YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: DOROTHY M. IRVIN
Date of Death: October 3.2001
Will No.:
Admin No.: 2001-00996
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:.
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a final account with the Court?
Yes No ~
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 accounts may be filed with the Clerk of the Orphans'
Court and may be attached to this report.
/i;G/OY ~~
Signature
Date:
Edmund G. Mvers
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemovne. PA 17043-0109
Address
(717) 761-4540
Telephone No.
Capacity:
Personal Representative
~ Counsel for Personal Representative
REV-1500F.X(s.oo1 ·
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*< ~ . COMMONWEALTH OF
. PENNSYLVANIA
. DEPARTMENT OF REVENUE
. DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE QNL Y
- /7- n- 1/
FILE NUMBER
2 1 _ 0 1
c.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
o 0 9 9 6
-- -- ------
COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
IRVIN, DOROTHY M.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
October 3, 2001 November 9, 1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!KJ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy 01 Will)
o 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death after 12.12-ll2)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trusl)
o 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-a2)
D 5. Federal Estate Tax Return Required
B. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Myers,
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FIRM NAME (II Applicable)
TELEPHONE NUMBER
(717) 761-4540
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
(Schedule G or L)
B. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
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)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
115,000.00
65.181.02
-0-
-0-
132,379.74
i
I' "
"'.'
(6)
-0-
(7)
6,428.75
r.o., ,
(8)
318,989.51
(9)
(10)
33,938.43
8,577.72
(11) 42,516.15
(12) 276,473.36
(13) -0-
(14) 276,473.36
X.O_ (15) -O-
x .0 45 (16) 12,441.30
x .12 (17) -O-
x .15 (1B) -0-
(19) 12.441.30
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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
19. Tax Due
20.0
276.473.36
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
i....i;;:.l:,: ,:;'..;),:'i,:;\:)::';S";~"', .',:J~~f~~Ii,iir;~i:::'::i::;:::,':~(:~?;~.E:$;Q~t;i;rQ:::~t:l~~g,B;'~~tq9:~$](~~'~:l~~,'1iE;~E~~!t(~I,Q'~~~~'O;;f{'~CHEc;j(:'I\!!AT.Ij..~i,:;:::";I;I':::
:';:;':~;;r:'i);:;~~t:~;;:;i:i~':},~::!;;:'n;M:;i;!l1~~:jt;.
Decedent's Comp'lete Address:
· STR5E! ADDRESS
3003 Columbia Avenue
CITY
STATE
Cam Hill
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount.
(1)
11,000.00
578.95
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
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 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
~
ZIP
17011
12,441.30
11,578.95
-0-
862.35
-0-
862.35
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J~ (i,:-!f,~l(~~~;i:/~~~~l\?{~:;~~2~~=~.~~!~~~" ~
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;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
~ retain a reversionary interest; or........................................................................................................................... 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 non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
00
[XJ
~
[XJ
[XJ
[Xl
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Center Drive, Camp Hill, PA 17011
301 Market st., P. O. Box 109, Lemoyne, PA 17043-0109
DATE
'/7&/--""'/
G-/ l8/0 "-
DATE
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) (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. ~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 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. ~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.
.
REV-l502fX. (1-91)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
IRVIN, DOROTHY M. 21-01-00996
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with
right of
survlvorshlc must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Real Estate - No. 3003 Columbia Avenue, Borough
of Camp Hill, Cumberland County, Pennsylvania
(Deed Book A, Volume 20, Page 1)
Sale Price 115,000.00 .
(Copy of Settlement Sheet attached)
TOTAL (Also enter on line 1, Recapitulation) $ 115, 000 . 00
(If more space is needed, insert additional sheets of the same size)
JUN 26 '02 01:23PM TWRNER &. Q'CONNELL
r.c.
.J
. Sert'emBnt~tatemel1t
U.S. oepw\11lent of HOUlinlL
end Urban Developmlnt ,.,..,.
,r
OMB NO. 25D2-0266
TypB of Loan
1. 0 FHA 2. 0 FIl1HA
4. 0 VA S. 0 Conv. InG.
. NOTE:Thls form Is furnished to glvll you a GtatGmllnlof ac!ualsaltlllmenl COSII. Amounls paid to and by the GGtUemenlllllent I\I'e shown.
Ilems marked 'p.b.c" were paid outaide of 01081ng: tl18)' ara shown 118", for Infonnatillnal putpOaea and are no! Included In the totala.
. NAME AND ADDRESS OF BORROWER~ J""a" M. EII."IY JennIfer L. 'lUIey
4238 Du,", SfrlJllt, Enalll, PA 11025 4238 DUke street. Enola, PA 17025
Estllte of Dorothy M, Itvln
3"03 Columbia Avenue, Camp Hill, PA 17011
Nat/anal City Mortgage Company
3;l32 NGwmark Drive, MlamWlurg, OH 411342
i. PROPERTY 3D03 ColumbIa Avenue
LOCATION: Camp Hili, PA 17011
I. sElTLEMENT AGENT:
PLACE OF sETTlEMENT:
TIN:
3. 0 COnY. Unins File Number
baney
loan Number
oooJ.3105R6
Mortgage InaUrance Case Number
~~ \8rr, n r,.~~~) \~ifv/;'
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. NAME AND ADDRESS OF SELLER:
. NAME AND ADDRESS OF LENDER:
SEmEMENT PATE; OBl28/2002 REsCISSION DATE:
I, SUMMARY OF BORROWER'S TRANSACTION K. 8~R'lOF SiLLER'S TRANSACTION
DO. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
D1. Contn\Ol BBles price .u ''''^ "0 401. Contract SII9 Prloo ~~5 000.00
D2. POIllOl1al PfOpl!1!V 402. PlIlsonal .ro.1llIv
D3. Salllllmanls cl1;uge& to borrOWer. "D3.
(110m IInl 104(0) ',S33.~5
04. 404.
06. 0405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
108. Ci\y1laW1\ _. \0 408. C1lyl1cwn Taxea to
107. County Texes tJlt/28/2.002 to 12/31/.200Jl aU.1t1l 407. Count:fTlIXlIll 06/28/2002 to 12/31/2002 .235. 62
108. As_lmenla rJS/IlII/1l00/l to 06/30/2002 9.71l "08. AAaeUl1llInlll 06/IlI/BOO/l to 06/30/2002 9.72
f09. Sewer 06/28/03 to 06130102 0.66 'DB. SQ'tlGJ: 06/28/02 1:0 06/30/D2 0.66
,10. , 410.
111. 411.
112- 412.
120. GROSS AMOUN'I' DUE FROM BORROWER: 119,8'19.15 420. GROSS AMOUNT DUE TO SELLER; 3.15,246.00
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWeR: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Oepolll Of earnul monll'J 1,000.00 5DI. Elale)1 deaolit (sIIIIInClNcII_1
202. Princtpat amounl Of new 1oIln(.) :109,250.00 502. SoWelllenl Chargee 10 HIler line 14ClOI S,SIS.SO
l03. edcdng loan(l) taken IUbjllcllO 503. EldIUn~ loa~(a) laIIen aublecl to
2ll". 504. PIIYDII 0' ftrcl mort...... loan
205. 506. Payoff or Illoond mOlidxoe loan
208. Bel~er aSId,5t: 3,450.00 506. se~ler lISB1st 3,'50.00
207. 507.
208. 508.
209. 509.
ADJUSTMENTS i='OR ITEMS UNPAID BY seu.ER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. Oily/lown teX11 '" 61 D. Cilvllowtl laxel to
211. CouOl)'lexa& to 511. Cpunl\llalClll to
212. MIll&smenla to 512. AS4ee,menl8 10
213. 613.
214. 514.
215- 515.
216. 516.
217. S17.
218. 518.
218, 519.
220. TOTAL PAID BYIFOR 113,100.00 520. TOTAL REDUOTIONS :12,345.80
BORROWER: IN AMOUNT DUE TO SELLER:
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/F-ROM SELLER
301. Gran amounl dlle from borrower (IIna 120) 11.9,879.15 601. GroGG amaunl due to aeller lIine 420) ~15,246.00
3D2. Less amaunl paid by/for borrower (line 22D) ""3,700.00 602. LaGS reducllan& In lIm!. due aeller Oine 520) 12,315.90
303. CASH ( ~FROM) ( DTO) BORROWER: fi,179.1!J 603. CASH ( o FROM) ( ~TO) SELLER: S.02,900..20
Tumer and O'Connall
4415 North Front Street, H,lITl1;burg, flA 17110
23.U72S07
HUD-1 (3-86). RESPA, HB 4305.2
PAGE 1
JUN 26 '02
01:23PM TURNER & O'CONNELL
. .
t-'..::l
10-1 (Row<f8G1
OMS No. 250200265
SETTL!;MI:!NT CHARGES
lO. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM
1lA8~D Otll'RIOE 115,000.00 CIl 'II- 6,693,00 BORROWER'S SeLLER'S
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: FUNDS FUNDS
AT AT
1. 3 321.50 kI R.,JoWr Real br illlllloc:l.atn SETTLEMENT
2. 3.371.50 10 JIllQ-J/JIil' r1>l:. SETTLEMENT
a. 0,00 '0
4. 0.00 I.
6. ccmmIa.1on pold III $0\11_ 6,693.00
iG. W::amract1on :Fee eo D/I-AAf, r.ao. 100.00
~ ITEMS PAYABLE IN CONNE:CTION wrfH LOAN:
II. LllaI\orloInsllonr.. % 10 Nat.1=aJ. C.1t.y *"egaga ~
12. LmsrI di1lCClUtl1 II 10 1/'"U""1l1 cic:v .M'OrtCr....' CallpAml'
)3, /IppraIIol 100 Ill' Nat.iol1Al ci t:V Ho::tll'''l1'' CadIIoaJU' ( 335.00 1'.0.0.)
!4.0redlllOllOl1lo: Nat:.t=1l1 ciCY Hozf:as/N CcmlPAAV
15. Londef.ln$pOl:tion ree Natl.o....l CJ.ty Ho::ea~ a""""s""y
18.MOIIgagolm\lllnCupplieolJanrooIoNlIuona1 cil:'V Nortaaae CClIll)/lI1V
)7.AcalJl'4lUo.r.. NlIUcna.l city llodgage CC\1IIiPoUIY
)8. Ra,U htat. !rax Be::viC<l Too to HOC 77,00
DII. AdldJli.se::at:.ton .Fe" = NCHC' 410. 00
10. T100d Ce2:t:.t:f1catl.ol1 ~"e 17.00
II. Ibtpren MaJ.l I'tle (liCK) 15.00
00. ITEMS REQUIReD BY LENOeR ro BE PAID IN ADVANGE:
01.lnI<fUlIrom 06/28/2002. 10 07/01/2.002. 9 :l0.5B/""Y 61.74
02. MorlG'1lO insurance premIUm ror ""'$, 10
I03.liwrd lnIutlll1CO pteI7'lum rill 1. OO)'!!.!. 8tate r= 291. 00
G<I. Flood rn.....nce promiuln ror \'1'1.'"
IOS. H01:~age Src>ke:: Eae %::llIII JiOH to can011 Hong"g. qnnS..!Il 11'00
000. RESHRVIiiS OEP ITH leNDER:
;001. HOIurd snlLnnc:e 3.00 lIIMIh. @I .114.:lSporlllCllll/l 7R.7S
1002. Moo\QOgOlft!lU11lnce /IlO/IlhaO 61.QQpor/llCllllll
ICOB. City p(OpOIly Ia.... m1lI\lhS @ 1'0,1\10111/\
10001. CcnInIY_otlV- S.OOmonlll@ 37,67P11'- 16B.35
1005. ,....,1I__No -g p.rtt1Onlh
IOQS. l'1aod IlllNl'8MO m_CIl ....1I\Ol1\h
lOOT. .""'001 baxa.. 1.2. 00 manlh'llI 97.13 pormun'" 1,165.56
1008. monlh8Q per month
111ll1. Ayy~egate ACQo~ting ~scrQW Adjustment -:02.00
1100. nTI.Fi HARGE3: .
110l.llI\lI_ardllOlnglocltll :l'U::nor oII1Jd o'oonnol1
1102. Aba1l1lcl or UUo lUrch Iu
110a.liUo 1UClIII1""'~'n '0
1104. TIUelf\AUl'M.. blndetlo
11OS.0_ntprep_lon1u
1108. tl""''l' ,...to cssa 1.0.00 S.OO
I 107 .IolklrM)"o 10"'"
(InelUdO' .bov.llems tl1llllNlnll I
l1oe. TI\Ie IllS\PIl'" '" !'W:Ile.l:' .....d o'c0I1I181.1 933.751
prdudo. ebovo nOm! Numb.... )
1109. LondefO"""""'" ( 109,:lSO.00 )
1\ 10. awn.... COII""",e ( 3.15,000.00 )
1111. 1rnd:J. lOa 300, gOO 1.50.00 I
1112. cJ.O/JiDg llarr.!.COll LettGJ:' to Ole:! RaDubl.iCl .!Is. 00 I
ilIa. I
12llll~ C30VEKNME/IIT REGORDING AND'TRANSFI:R GHAKC3ES:
1:m. RlICIlIdinO leu, Deod JIB. 50 ; MorIlIlIOe 5f.:JQ : _.... B.!I.ao
1202. ClIylcounly \0lfI.14mpG: 00011 1,150. 00: MorIg... 1,150.00
12D3. 8la1a l&lrIoIamp" Coed 1,lSO.00:Mlr1gegv 1,150.00
1204.
1205.
1300: ADD1l10NAL SE:TTLEMENT CHARGES:
1101. BuN8y \0
1302. pullnsp_n III SUddaJ1 ~..f:h 561..BO
1303. ove::n.ite package 10$.00
1304. ;.JJQ war::.../;]>' to JllL\-JIR!l', .Inc. 385.00
ls05. tsx racd"b <<:0 JlMe R=sav 1.00
1-' "ower "11. be> 12131 60.00
1307.
1400. TOTAL SErn.EMENT CHARGES 1,633.15 B,B9S.80
, nave care1U11y rav'Jellle<l Ina HUD.1 GelIIamanl Slalemanl end t. ttte IlIl!lt of my knOWledge and beller, II iA a IrUI and aCCII1'8111 statement or 111\ lIIoalpls and diAbun:mnenlllll1llde
en my accounl or by me In tI1lo tranlactlon. I further oetIIri hI I have recelYed a COIll' DI tile HUD-l SeWamenl SlalemenL
Seller or
Agent
Ilorrower.
Dltl:
Dele:
Jason M. Stlnsy
George W. Irvin, Jr., Administrator
Sellar or
Agent:
Dele:
BorlwIer.
Dale:
Jennifsr L. Baney
TIIa IiUD.1 Salllemenl Slalament which IIUlI/Q prepared la a ll'Ua and aCCII1'8la account of1ll1& trslllaction. 11laI/Q caused or....1I eaUla tho funds III be disbul'&ed In accordance
w11h IhI.eI8lMlanL
Dal8:
Sa\llemenl Allene
Dale:
Jamll5 H. Turner
WARNING: It Is a ctlnle \0 knowingly makll raise slatemanta to the Uoiled Stalas en 1/li, or any other IIIrnHat fOrm. Penalties upon cDnvictlon CWl iM]uda a fine and ImariaD/lo
mllnl For dll:llls tee: TIIIa 18 U.S. Coda SllG1lan 1001 and IllCflOn 1010.
RE\I.l503 EX + (1-S1)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IRVIN, DOROTHY M.
FILE NUMBER
21-01-00996
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
68 Shares - Conrail, Inc. @ $115.00 per share
7,820.00
2 .
96 Series E Bonds - Date of death value
(See attached for Face amount, issue date
and date of death value)
33,953.90
3.
62 Series EE Bonds - Date of death value
(See attached for Face amount, issue date
and date of death value)
23,407.12
TOTAL (Also enter on line 2, Recapitulation) $ 6 5 , 18 1 . 02
(If more space is needed, insert additional sheets of the same size)
-,
]!state of DJrothy M.' IIVin SERIES E BONDS
D:Ite
of
D:eth
Serial Number Issue Series Denom Issue Price Interest Value
Date
L 1084285151 E Jan-75 E 50 37.50 191.58 229.08
L 1 084285187E Feb-75 E 50 37.50 191.58 229.08
L 1 084285260E Mar-75 E 50 37.50 191.58 229.08
L 1 084285290E Apr-75 E 50 37.50 191.58 229.08
L1084285381E May-75 E 50 37.50 189.24 226.74
L2002624043E Jun-75 E 50 37.50 189.78 227.28
L2002624124E Jul-75 E 50 37.50 189.78 227.28
L2002624210E Aug-75 E 50 37.50 189.78 227.28
L2002624238E Sep-75 E 50 37.50 189.78 227.28
L 1 084285509E Oct-75 E 50 37.50 189.78 227.28
L2002624542E Nov-75 E 50 37.50 187.52 225.02
L2012034681 E Dec-75 E 50 37.50 188.00 225.50
L2012034693E Jan-76 E 50 37.50 188.02 225.52
L2014305091E Feb-76 E 50 37.50 188.02 225.52
L2014305110E Mar-76 E 50 37.50 188.02 225.52
L2013895821E Apr-76 E 50 37.50 188.02 225.52
L2005437477E May-76 E 50 37.50 185.70 223.20
L2032271056E Jun-76 E 50 37.50 186.20 223.70
L2032271070E Jul-76 E 50 37.50 186.16 223.66
L2045288804E Aug-76 E 50 37.50 186.16 223.66
L2002042145E Sep-76 E 50 37.50 186.16 223.66
L2002042152E Oct-76 E 50 37.50 186.16 223.66
L2045288858E Nov-76 E 50 37.50 181.76 219.26
L2045288901E Dec.76 E 50 37.50 182.38 219.88
L2045288914E Jan-77 E 50 37.50 182.38 219.88
L2045288922E Feb-77 E 50 37.50 182.38 219.88
L2038998538E Mar-77 E 50 37.50 182.38 219.88
L2067613550E Apr-77 E 50 37.50 182.38 219.88
L2056438321E MaY-77 E 50 37.50 178.10 215.60
L2056438342E Jun-77 E 50 37.50 178.54 216.04
L2060929486E Jul-77 E 50 37.50 178.50 216.00
L2084195381E Aug-77 E 50 37.50 178.50 216.00
L2067250251E Sep-77 E 50 37.50 178.50 216.00
L2060923325E Oct-77 E 50 37.50 178.50 216.00
L2081383251E Nov-77 E 50 37.50 154.82 192.32
L2087286417E DeC-77 E 50 37.50 155.36 192.86
L2093988437E Jan-78 E 50 37.50 155.36 192.86
L2097527737E Jan-78 E 50 37.50 155.36 192.86
L2083934001E Mar-78 E 50 37.50 136.50 174.00
L2104892411E Apr-78 E 50 37.50 136.50 174.00
L2104892424E May-78 E 50 37.50 124.18 161.68
L2104892432E Jun-78 E 50 37.50 124.60 162.10
L2101633802E Jul-78 E 50 37.50 124.62 162:12
L2101633812E Aug-78 E 50 37.50 124.62 162.12
L2101633821E Sep-78 E 50 37.50 124.62 162.12
L2101633825E Oct-78 E 50 37.50 124.62 162.12
L2116353910E Nov-78 E 50 37.50 122.96 160.46
L2123207900E Dec-78 E 50 37.50 123.38 160.88
C2057035738E Jan-79 E 100 75.00 246.84 321.84
C2057035739E Jan-79 E 100 75.00 246.84 321.84
C2057035740E Jan-79 E 100 75.00 246.84 321.84
C2057035741E Jan-79 E 100 75.00 246.84 321.84
~l
Esta.ze of Ibrothy M. IrVin,
. Ser:i.e3 E B::rI:E . D:rte
. .
of
IE3th
Vahe
L2119060243E Jan-79 E 50 37.50 123.42 160.92
R208283037E Jan-79 E 200 150.00 493.68 643.68
R208283038E Jan-79 E 200 150.00 493.68 643.68
R208283041E Jan-79 E 200 150.00 493.68 643.68
L2119060254E Feb-79 E 50 37.50 123.42 160.92
R208283044E Feb-79 E 200 150.00 493.68 643.68
L2146800138E Mar-79 E 50 37.50 123.42 160.92
R208283047E Mar-79 E 200 150.00 493.68 643.68
R208283048E Mar-79 E 200 150.00 493.68 643.68
C2060799785E Apr-79 E 100 75.00 246.84 321.84
C2060799786E Apr-79 E 100 75.00 246.84 321.84
L2152594300E Apr-79 E 50 37.50 123.42 160.92
R208283051E Apr-79 E 200 150.00 493.68 643.68
R208283054E Apr-79 E 200 150.00 493.68 643.68
L2128168901E May-79 E 50 37.50 121.78 159.28
R208283057E May-79 E 200 150.00 487.12 637.12
R208283058E May-79 E 200 150.00 487.12 637.12
R208283059E May-79 E 200 150.00 487.12 637.12
R208283063E May-79 E 200 150.00 487.12 637.12
R208283070E May-79 E 200 150.00 487.12 637.12
R208283071 E May-79 E 200 150.00 487.12 637.12
L2128168907E Jun-79 E 50 37.50 122.16 159.66
R208283079E Jun-79 E 200 150.00 488.64 638.64
L2128168926E Jul-79 E 50 37.50 122.16 159.66
R208283083E Jul-79 E 200 150.00 488.64 638.64
R208283084E Jul-79 E 200 150.00 488.64 638.64
R208283085E Jul-79 E 200 150.00 488.64 638.64
R208283086E Jul-79 E 200 150.00 488.64 638.64
R208283087E Jul-79 E 200 150.00 488.64 638.64
L2128168939E Aug-79 E 50 37.50 122.16 159.66
R208283090E Aug-79 E 200 150.00 488.64 638.64
L2128168948E Sep-79 E 50 37.50 122.16 159.66
R208283095E Sep-79 E 200 150.00 488.64 638.64
R208283096E Sep-79 E 200 150.00 488.64 638.64
L2176753080E Oct-79 E 50 37.50 122.16 159.66
R208283101E Oct-79 E 200 150.00 488.64 638.64
R208283106E Oct-79 E 200 150.00 488.64 638.64
L2176753114E Nov-79 E 50 37.50 120.50 158.00
R208283109E Nov-79 E 200 150.00 482.00 632.00
L2176753116E Dec-79 E 50 37.50 120.50 158.00
R208283113E Dec-79 E 200 150.00 482.00 632.00
R209034265E Dec-79 E 500 375.00 1,205.00 1,580.00
R210296854E Dec-79 E 200 150.00 482.00 632.00
R210296867E Dec-79 E 200 150.00 482.00 632.00
Total - Page 1 and Page 2
$33.953.90
~2
Estate of Cbrothy M. Irvin SERIES EE BONDS
.or"
Date
of
Death
Serial Number Issue Series Denam Issue Price Interest Value
Date
C 1154365EE Jan-80 EE 100 50.00 186.76 236.76
R599477EE Jan-80 EE 200 100.00 373.52 473.52
R599478EE Jan-80 EE 200 100.00 373.52 473.52
R599480EE Jan-80 EE 200 100.00 373.52 473.52
R599481 EE Jan-80 EE 200 100.00 373.52 473.52
R599483EE Jan-80 EE 200 100.00 373.52 473.52
R599489EE Jan-80 EE 200 100.00 373.52 473.52
C 1154378EE Feb-80 EE 100 50.00 186.76 236.76
R2200610EE Feb-80 EE 200 100.00 373.52 473.52
R599494EE Feb-80 EE 200 100.00 373.52 473.52
R599497EE Feb-80 EE 200 100.00 373.52 473.52
L 1792839EE Mar-BO EE 50 25.00 93.38 118.38
L 1792840EE Mar-BO EE 50 25.00 93.38 118.38
R2200612EE Mar-SO EE 200 100.00 373.52 473.52
R2200613EE Mar-BO EE 200 100.00 373.52 473.52
R2200614EE Mar-SO EE 200 100.00 373.52 473.52
R2200621 EE Mar-SO EE 200 100.00 373.52 473.52
C1154385EE Apr-SO EE 100 50.00 1S6.76 236.76
R2200622EE Apr-BO EE 200 100.00 373.52 473.52
R2200625EE Apr-SO EE 200 100.00 373.52 473.52
R2200626EE Apr-SO EE 200 100.00 373.52 473.52
R2200627EE Apr-SO EE 200 100.00 373.52 473.52
R2200636EE Apr-SO EE 200. 100.00 373.52 473.52
C1154397EE May-SO EE 100 50.00 184.40 234.40
R2200638EE May-BO EE 200 100.00 368.80 46B.BO
R2200640EE May-BO EE 200 100.00 36B.80 468.80
R2200648EE May-80 EE 200 100.00 36B.80 468.80
L 1792903EE Jun-80 EE 50 25.00 92.20 117.20
L 1792904EE Jun-80 EE 50 25.00 92.20 117.20
R2200649EE Jun-80 EE 200 100.00 36B.80 468.BO
R2200650EE Jun-80 EE 200 100.00 368.80 46B.80
R2200651 EE Jun-80 EE 200 100.00 36B.BO 468.BO
R4682594EE Jun-BO EE 200 100.00 36B.BO 46B.80
C1154401 EE Jul-80 EE 100 50.00 184.40 234.40
R4682595EE Jul-80 EE 200 100.00 36B.80 468.80
R4682600EE Jul-80 EE 200 100.00 368.80 468.80
R4682602EE Jul-80 EE 200 100.00 36B.80 468.80
C1154420EE Aug-80 EE 100 50.00 184.40 234.40
R4682608EE Aug-80 EE 200 100.00 368.80 46B.80
R4682609EE Aug-80 EE 200 100.00 36B.80 468.80
R4682614EE Aug-BO EE 200 100.00 36B.80 468.80
C 1154424EE Sep-80 EE 100 50.00 184.40 234.40
C1154427EE Oct-80 EE 100 50.00 184.40 234.40
R4682620EE Oct-BO EE 200 100.00 368.80 468.80
R4682622EE Oct-80 EE 200 100.00 368.80 46B.80
R4682622EE Oct-80 EE 200 100.00 368.80 468.80
C1154430EE Nov-80 EE 100 50.00 160.64 210.64
C1154434EE Dec-80 EE 100 50.00 160.64 210.64
C1154450EE Jan-81 EE 100 50.00 160.64 210.64
C12857497EE Feb-81 EE 100 50.00 160.64 210.64
R5366803EE Feb-81 EE 200 100.00 321.28 421.28
R5366804EE Feb-81 EE 200 100.00 321.28 421.28
Page 1
ESTATE. OF OOROI'HY M" iRViN.
.Seriep.EE Bonds Date
, - " .. . of
Death
Value
R5366805EE Feb-81 EE 200 100.00 321.28 421.28
R5366806EE Feb-81 EE 200 100.00 321.28 421.28
C12857500EE Mar-81 EE 100 50.00 160.64 21 0.64
R5366808EE Mar-81 EE 200 100.00 321.28 421.28
R5366809EE Mar-81 EE 200 100.00 321.28 421.28
C12857503EE Apr-81 EE 100 50.00 160.64 210.64
R5366818EE Apr-81 EE 200 100.00 321.28 421.28
R5366819EE Apr-81 EE 200 100.00 321.28 421.28
C12857511 EE May-81 EE 100 50.00 147.72 197.72
C12857514EE Jun-81 EE 100 50.00 147.72 197.72
Total - Page 1 and Page 2
$23,407.12
Page 2
REV.151l8 EX:(1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21-01-00996
IRVIN, DOROTHY M.
ITEM
NUMBER
1.
lndude 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.
VALUE AT DATE
OF DEATH
2 .
3.
4.
5.
6.
7.
8.
9
10.
11.
12.
DESCRIPTION
Automobile - 1988 Cadillac Sedan - Sale price
Household Goods - appraised value
3,000.00
1,210.00
Allfirst Bank - Checking Account No. 0048210242
Date of death balance, plus interest
Allfirst Bank - Money Market Checking Account
No. 0094325499 - Balance, plus interest
Allfirst Bank - Passbook Savings Account
No. 87004914102811 - Balance, plus interest
Allfirst Bank - Certificate of Deposit - Account
No. 87008000164183 - Balance, plus interest
17,628.03
48,799.90
340.76
10,027.18
Allfirst Bank - Certificate of Deposit - Account
No. 87008000164191 - Balance, plus interest
Allfirst Bank - Certificate of Deposit - Account
No. 87008000169142 - Balance, plus interest
Allfirst Bank - Certificate of Deposit - Account
No. 87009140027538 - Balance, plus interest
united HealthCare - refund
Comcast Cable - refund
25,067.95
25,003.53
387.99
428.28
1.12
485.00
Erie Insurance - refund automobile insurance
TOTAL (Also enter on line 5, Recapitulation) $ 132, 379 . 74
(If more space is needed, insert additional sheets of the same size)
.
REV.ISIO EX. (1-97)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IRVIN, DOROTHY M.
FILE NUMBER
21-01-00996
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INClUDE lHE NAME OF THE TRANSFEREE. THeR RElAlIOHSHlP TO DECEOEIIT AND THE DATE OF 1RAIiSFER.
AT1ACH A CDPVOF THE DeED FOR REAl. ESTATE .
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
EXCLUSION
'IF APPlICABLE\
TAXABLE VALUE
Allfirst Bank - Individual
Retirement Account
No. 87000199322001
Beneficiaries: George W. Irvin, Jr.,
Son
Donna J. (Bender)
Dietz, Daughter
6,428.75 100%
6,428.75
TOTAL (Also enter on line 7, Recapitulation) $
6,428.75
(if more space is neededj Insert additional sheets of the same size)
REV-1511EX "1-97)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IRVIN, DOROTHY M.
FILE NUMBER
21-01-00996
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2.
3.
B.
7.
8.
9.
10.
ll.
12.
13.
14.
DESCRIPTION
FUNERAL EXPENSES:
Parthemore Funeral Home
Clergy Honorarium - funeral service
Rolling Green Cemetery - cenetery charges
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
City
State
Zip
2.
3.
Year(s) Commission Paid:
AltomeyFees - Johnson, Duffie, Stewart & Weidner
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
- Register of Wills - Cumberland County
5.
Accountant's Fees
6.
Tax Retum Prepare(s Fees
Cumberland Law Journal - legal advertisement
The Patriot-News - legal advertisement
Register of Wills - Short certificate
Register of Wills - file Inv. & Inh. Tax Return
Chuck Bricker - household goods appraisal
Allfirst Bank - charge for estate checks
Equiserve Trust - bond premium - replace lost
Conrail shares
Reserve for close-out costs
Total from additional sheet
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
8,225.00
200.00
760.00
6,750.00
324.00
75.00
96.81
3.00
25.00
60.00
7.00
156.40
100.00
17,156.22
33,938.43
, .
ESTATE OF: IRVIN, DOROTHY M.
21-01-00996
SCHEDULE H - CONTINUED
13. PP&L - electricity charges - Oct/June
14. PA Water Company - water service - Oct/June
15. Verizon - final telephone charges
16. Erie Insurance - home/automobile insurance
17. Orendorf's - lawn maintenance
18. Borough of Camp Hill - sewer charges
19. Michael Nester - snow removal
20. Michael Nester - lawn maintenance
197.67
103.94
14.44
645.00
159.00
60.00
25.00
150.00
Sale of real estate - 3003 Columbia Avenue:
21. Gaughen/ReMax - commission on sale
22. Recorder of Deeds - 1 % Transfer Tax
23. Seller to Buyer Closing Costs Assist
24. Kitzmiller Brothers - painting
25. Transaction Fee
26. AHS Home Warranty
27. Notary fees
28. County/Borough real estate taxes
29. Termite Inspection
30. Roger E. Lauck - replace roof shingles - settlement
inspection requirement
6,693.00
1,150.00
3,450.00
1,380.00
100.00
385.00
5.00
256.37
561.80
1.820.00
Sub-Total
$17.156.22
REV.\SI2 EX' (1.91)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
IRVIN, DOROTHY M.
FILE NUMBER
21-01-00996
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
Checks that cleared after death - Allfirst Bank
Account No. 00482-1024-2
2.
York Waste - trash
Keystone Oil - service contract
United Healthcare - premium payment
Comcast - cable service
Erie Insurance - premium
United states Treasury - tax due on decedent's
2001 Federal Form 1040.
25.92
145.00
225.00
33.80
94.00
8,054.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,577.72
. .
REV.~5'3 ex -(ViI7)
SCHEDULE J
BENEFICIARIES
'"""
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IRVIN, DOROTHY M.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Donna J. Deitz
1024 Swarthmore Road
New Cumberland, PA 17070
2. George W. Irvin, Jr.
26 Center Drive
Camp Hill, PA 17011
3. Charles Leroy Irvin
5279 East Trindle Road
Mechanicsburg, PA 17050
4. William C. Irvin
782 Valley Street
Enola, PA 17025
FILE NUMBER
21-01-00996
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Son
Son
Son
AMOUNT OR SHARE
OF ESTATE
(PEF 2103-1)
One-fourth
Residue
One-fourth
Residue
One-fourth
Residue
One-fourth
Residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)