HomeMy WebLinkAbout01-1144
PETITION FOR PROBATE and GRANT OF LETTERS
. Estate of Mildred G. Kohler No. 2] -01-1144
also known as To:
, Deceased.
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
in the
Social Security No. 197 -03-8137
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut or
in the last will of the above decedent, dated Februarv 26. 1996
and codicil(s) dated None
Executor Kenneth E. Robinson died on June 15, 1998
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 17 East Burd Street. Aoartment 5. Shiooensburg. Pa. 172
(list street, number and municipality)
Decedent, then 80 years of age, died 12/8/01
at Shiooensburcl. Cumberland County, Pennsvlvania
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never ajudicated
incompetent: none
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(Ifnot domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
8.000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
thereon. (testamentary; administration c.ta.; administration db.ncta)
V>
"
u
"
<U
.",
"Vi-
<U V>
0::'1:::
<U
.", "
" 0
~:~
-tr~
~4-
Z 0
co
"
OJ)
Vi
Scott J. Robin SC'11
~. Robinson /Y. J '.
c~l.Ct 1/1 tJ..h'>>() 07
949 Baltimore Road
Shiooensburq
Pa 17257
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA } ss
COUNTY OF .Cumber:land
j
The pctitionp-r(:s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above dec~dent petitioner(s) will well anA administer the ~stat~ according to law.
Sworn to or affirmed and subscribed { C,Mt I j(~N~.7
before me this 18th day of
>;ecember J~~
~"Y :X,dv~7
'-":
1
'"
~
'< 'J)
as a::
a::
'-0
~
CX)
c::'C
00
..-
c...J
Cl
'.....~
D
.0
";": s::
(,) =
aU
p
No.
Estate of Mildred G. Kohler
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW December 19 .2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 2/27/96
described then:in be admitted to probate and filed of record as the last will of Mildred G. Kohler
and Letters Testamentary
are hereby granted to
Scott J. Robinson
~"yeitfr'b_~<') /Le-J ~y
Reg crofWills
FEES
H. Anthony Adams
40.00
9.00
6.00
5.00
60.00
Probate, Letters, Etc. .
Short Certificates (
x-pag~s.
RenunciatIOn.
JCP
. . . $
).......$
....... $
$
TOTAL _ $
.~Eq;]~~E~. ~8... 200.1. . . .
ATTORNEY (Sup. Ct. I.D. No)
128 East King Street
Shippensburg
Pa. 17257
ADDRESS
717 -532-3270
Filed.
PHONE
. <:
I'hl~. is to certifv that the information here given is correctly copied from aruJrlginal certificate of death duly filed with me as
l.ned Registrar. The original certificate will be forwarded to the State Vital tzecords Office for permanent filing.
W ARNI~G: It is illegal to duplicate this copy by photostat or pho
.~
Fee for this certificate, $2.00
,.
p
7 7 8 3 3.9 7
J2.'L-. /1/ #'6('
Date
No.
2] -01-1144
':;
-~
~ 2/81
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
Mildred G. Kohler
"or UII" fllflM_vl u~~:-y.~_A!!._
80 v,.. MonttIe i. 0.,.
S.
COUNT't 0* DUl'H
...
5T.cT1E ~1~fNlJMIII!A
SOCIAL SEcuRlrv NUMBER
DATE OF OL'.TH ,Mr.ntf!. n,.... ""''I
NAME Of DECEOENllr"", M'drilfIl,1_'
--~~~ ~~_.
...". 1 Mlnut..
'.Female .. 197 - 03
--iiRTHiii:ACoo;.~- PlACf- cY Of-AfHlr.'-"-;;~Y rll~----';' ~;;;-,-,~,i~~~;.j';,,~Ulr;.,~~- --.---
outl'iJinPCoK' 1WP~ , HOSPI,Ai .-- H - - - ---, - . -. ---
.,ctilrb. Co., PA :-,,"",0
FACILITY NAME In not ll'IIfoM1CI'I. 01\4,"", ancl numMI'I
.. 12~B-() 1
- - .... . - . .
=~,D
RACE .Amencan'ndilI".~", Wtl.... Me
'''-''VI
.. Cumberland
DE.CEDEHl'S USUAL OCCUPlGK)N
1~~::O~:::zl,;}
n. School Bus Driver ".~
DECEDENT'S MAlUNQ ADDAI!5S(St'.... Cllyfblln. s...lrpt:oo.l
to.
White
MAAtTAt. stRUS. MamM
N'\4f"'rr~.W\dl:)wed.
0Iv0rc<<t (Specify)
,.. Widowed
SURVIVlHO SPOUSE
clt""'.(JI_"""'IfW'''",,1\tl1
t".
DId
-
...~.
Cumberland - 17l1.Qg ::;;,.,"'::'.::'.. Shippensburg
MOTHEA'S NAME (Fit". Md:IIe. MaJden Surntmel
Bella N. Smith
INF~'S """""ss,..... Cily/bon.""'. \>~I
~49 Baltimore Road, Shlppensburg, PA 17257
at'oos ,,,"",,,"~.c_ lOCAl'lON.C_.......ZipCodo
"'..... -
.... Spring Hill Cemetery . .... Shippensburg. PA
~:\WE AND ADDRESS Of' FACILITY
.... Fogelsanger-Bricker Funeral !lane
lICENSE NUMBER
.....
17 East Burd Street
~Shippensburg. PA 17251
,.....".. NAME (firll. ~. lilt)
~ John E. Varner
1Nf"""Sc;~tt J>:R6 bin s on
METHOD OF OISPOS1Ttqt!
_0 =..~~....O
....
~~AAl.SE
CompIIt. ..... 2>>c onty wfWl C*f
""'**' .MtIl'4llltl6e.. tlfM of dNfh to
cnf>t ~ of lIHth.
__ 24-2'1 mull bII ~by
.,....,whO~...".
-
-..--
If ...,. ...... .. ..........
..... ~..........,..
CAU8I! (0... c.-....",.
. ,...........,.
r-*'alftOllllhILAll
u a
27.NJIITI: Ent.'m.dIM.....jl'ltUl'...ortomp.u'.,....~cauudlhede..h Do I~'
l*onttonecaUHonHCIIIlne 11nt__~
r lonMtand~
. VR.4-1-.k,'~ k&L~.Ala}~~...-l___.
, DUElO~Jt;~OF) r ,
.~~ II:.
l . DUE 10 "'" AS' C()N"OU~kE "?J -'" - - - ~ '" j
c. I7r~1..I2.-_ V.e-v~' : 'j:"
OUI!1O""'OS'CONSEOUENt.~' r I
. V)RA<.. S'1",vOe'OMt:; I
... AN AU10PSV WERE AUlOPSV ,fNOtNOS MANNER OF DEATH DATE OF INJURY T1~E OF INJURY
rrAfOAMt:D? ~t6:~'iUSE""""" 0 (Man"'_ ~"'l
OF DeRH1 ..leU.. L.:P HomICIdI ,..
IIftllM'" 0 Pendlng InYMUoaUon 0
_ 0 No lA- _ 0 No [J... __ 0 CouId........._..... [J
17257
172',7
MRTI:
Other IlQl"lfteanl condlliONcontnbutln9lO dHm. but
1'lOl........lncJinthl~caUHO-inPA.RT1
....uJIATI CAUeIIFINIl
'~Ofr:Qndlhntl
'..-nQondltlllhl-
",1
INJURV Kr'M)At(1
DESCRIBE HOW INJURY OCCVARE.D.
,i!J
\'
_ 0 NoD
... 28b. H.
conlPlER cCNck ony one!
"C&lTWYWD PHYSICIAN (Pt't,.., cenrtyr.o eaused dnIh.... MlOItler ph'fllCoan has pronounced daalh and cc:mpleted nern 231
TII....... Of "" 1lnDwtedga, de_ eocUf'Nd......... cauM(I...... m.nner -........ . . . . . , . . . . . . , - .
".DleM. DAUINEAJCOAONER
On the lMal. of ...m,n.,1on and/Dt Inv..Uoa.6on. In my opinion, "...h occurred .. the 11m.. d.'.. .nd pIK.. ....d due to lhe cau..(.).nd "
mllftn., .. .t.IM
,~_._----------,..------,-,-_.
HtGISTAAR 5 SIONA'UA~ AND NUM8ER
1..(/ ~II Sf
'P,
LtCEN$! NUN DATE SIOjD ..1..MonIh. Day, 'tUr1
o .1\.ttJO}'1'109-L- t. ;L -/0- 0/
NAIro4I!ANDAODRl!880tFPI!RSONWHOCOMPlI!Tf:DCAUSECWDf,uH /? A
{110m ':ITYPO" '"n, y 0 ~. 1/11 D;e, ..4- So /k'Yl< J 17'/ .. rr
nil.. ' ?;f/- 1j['!7"~ 4t-C
.. . ell ~f1rf ~ r\u -.4 _..I,.} /"} 1 C.J
:" """'M~{i( e ~, /~ 7rL/O I
MO-
"~AHOC1!fnIflVINQ ....vSlCIAH~., boIt1 ~onoutlCll'IO dNltl.ndClIf'llfy,1'\Q IOCauMof ~l
TIItMbeetafmy.II'lOwWQa,de.thooeUfrM........, .ate, InclptH...ndduelolheclUM(I'lndmanMl'...'.led..."..,.....
..
'"t.
d:
(J ....,
<::' .....".
UQ
CJ a:
a:
\,Q
s:?
co
00
c..J
o
tv
r' .0
t:s::
~J) :::
-- :-(
Ow
p
..
1I
LAST WILL AND TESTAMENT
21-01-1144
I, MILDRED G. KOHLER, being of sound mind, memory and
understanding, do make, publish and declare this my Last will and
Testament, hereby revoking all prior wills and codicils made at
any time before by me.
FIRST: I direct that all my funeral expenses be paid as
soon as practical after my death.
SECOND: I give and bequeath all my property, be it real,
mixed or personal of whatever nature or kind to my son, Kenneth
E. Robinson.
THIRD: If my son should predecease me or if we should die
in a common disaster, then in either of those said events, I give
and bequeath all my property, be it real, mixed or personal, to
Scott J. RObinson, per stirpes.
FOUR~rH: I nominate and appoint my son, Kenneth E. Robinson,
as the Executor of this my Last will and Testament. If he should
fail to serve or be unable to serve, then in either of those said
events, I nominate and appoint, Scott J. Robinson, Executor of
this my Last will and Testament.
IN WITNESS WHEREOF, I, Mildred G. Kohler, to this my Last
will and 'restament, set my hand and official seal, this JJh
day of
\=~ .
, 1996.
7li~.>I/: /MJiv
Mildred G. Kohler
(SEAL)
~.
..
Sworn to and subscribed, declared and
published by Mildred G. Kohler, as
her Last will and Testament, and so
done in the presence of we the
witnesses, who sign at her request,
and in her presence, and in the
presence c)f each other.
-h1(X" C'~
/'. ~ ~ '
( Zi;:~tr~~
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, Mildred G. Kohler, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do
hereby acknowledge that I signed it willingly; and that I signed
it as my free and voluntary act for the purpose therein
expressed.
'7J~.~ ~
Sworn to and acknowledged, before me,
by Mi~~~~ G. Kohler he Testatrix,
this ( 7+'_ day of.:..-e..) , 1996.
rJW1A~~laAJ1ci~
Notary Publl.c
NOTARIAL SEAL
DAWN MARte SHOOP. NOTARY PUBLIC
Shippensburg. Cumberland County, PA
My Commission Expires February 5. 2000.
"
.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, H. Anthony Adams and Sharon Coleman Adams, the
witnesses whose names are signed to the foregoing instrument,
being duly qualified according to law, do depose and say that we
saw the Testatrix sign and execute the instrument as her Last
will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of
the Testatrix signed the will as witnesses, and that to the best
of our knowledge and the Testatrix was at the time at least
eighteen (18) or more years of age and of sound mind and under no
constrain1: or undue influence.
, 1996.
NOTARIAL SEAL
DAWN MARIE SHOOP. NOTARY PUBLIC
Shippensburg, Cumberland County, PA
My Commission Expires February 5, 2000
r~
"--
~; .
.....'. /,:,;
.....,.,.
"(\ .. ~~
r) Cl
U J./
a>cc
a:
~ ~
3: ~ ~
H
L' \rt trt
~ a
S- Ei ~
0 -=--'
G ~ t:Y ~ ~
. a
6
~ ~
= l -
~
~
\.0
9
co
.:...t:
"':.;J
co
..-
u
CJ
..:g
5:)=
0u
p
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent Mildred G. Kohler
Date of Death: 12/8/01
WillNo 2001-01144
Admin. No. 2001-01144
To the Register
I certify that notice 01' (beneficial interest) estate administration required by Rule 56(a) of the Orphan's Court Ru!es \'.''1''
served on or mailed to the following beneficiaries of the above-captioned estate on 3/17/02
Name
Address
Scott J Robinson
949 Baltimore Road
Shippensburq,
Pa 172Q7
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
None
Date 3/17/02
.L ~--C)~
Signature
Name H. Anthony Adams
Address: 49 West Oranqe Street. SUite 3
ShlPDensburg Pa. 17257
~""""I
Telephone(717) - 532- 327
Capacity
C:i\
.,..-
x
Personal Representative
Counsel for Personal
Representative
[-.;::
.~:r::
('''-J
p
. ~'-
,-II ~
. --
~ .... r~.
..,i ......
(;)
\
'r,
(-
~7
(
~
;0
~
r,
_..7
--
I
()
~
t .
{
y
T
~,
n
c
!
(
(~.
(
tV
(:)
r)
~
(
~
~
('
r
c/
~
~
i
C>
-'
()
r,
';'J
~
?
~7
(:)
r
("
t
~
~7
h
~
"(
?-'
n
i$l
2
(
oJ.
I '
'r\-
1
J-
.....(.
r
, "
"
tIl
t'"
~ ~
x :I:
,...,0
'-l Z
~ tIl
'-' ,...,
VI '-l
w ....
tv '-l
, '-'
0\ VI
0\ w
'-l tv
W ,
W
tv
'-l
o
m
:I:+ ::r:
.... 'D
~ ~
m m
Zm ')-,..
m" ."
2 0 z
~ ~ ~ t'"
,0 Z ::r: ~
~~ 0 0
Z m Z ~
Z" J n
m ~ ....... m
-< tIl
~m >
;1>." 0
~ s ~
...." ~
'-l m (/.l
~ w
'-l
..
~
.
'.":.
.,
COMMONWEALTH OF PENNSYlVIlNIA
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
H ANTHONY ADAMS ESQUIRE
128 E KING STREET
SHIPPENSBURG, PA 17257
___nn_ fold
ESTATE INFORMATION: SSN: 197-03-8137
FILE NUMBER: 2101-1144
DECEDENT NAME: KOHLER MILDRED G
DATE OF PAYMENT: 06/13/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/08/2001
NO. CD 001289
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,441.50
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$ 1 ,441 .50
REMARKS: SCOTT J ROBINSON C/O H ANTHONY
ADAMS-WAS MAILED NO POSTMARK
CHECK# 108
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
~
REV.1500EX + (6.00;
REV -.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.w
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
t-
Z
W
C
w
<..>
w
c
Mildred G. Kohler
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
12/08/2001 03/12/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
OFFICIAL USE ONLY
L--
I 7- '2. 7 - 1/
FILE NUMBER
~L-ll-L_iL If Y-
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
197--0-3
8 13'7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
0-
x:~U)
u"""
wt5u
::I:a:g
u"-al
"-
<:
(KIt Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate lAltach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7, Decedent Maintained a Living Trust (Attach copy of Trusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death priorto 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSchO)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
H. Anthon Adams 49 West Orange Street, Suite 3
FIRM NAME (If Applicable)
0-
Z
W
C
Z
o
"-
'"
w
0:
0:
o
U
TELEPHONE NUMBER
717-532-3270
Shi ensbur
c..~
,',.'
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
Pa. 17257
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole-Proprietorship
~
t....)
4, Mortgages & Notes Receivable (Schedule D)
z
o
i=
<C
...J
=>
!::
a.
<C
<..>
w
0:::
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)
8. Total Gross Assets (total lines 1-7)
(7)
(6)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10,150.61
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10)
11. Total Deductions (tolallines 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
i=
<C
t-
=>
a.
:!!
o
<..>
><
<C
t-
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
X _(15)
32,035.61 X .045 (16)
X .12 (17)
X .15 (18)
(19)
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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
37,882.25
4,303.97
(8)
42,186.22
(11)
(12)
(13)
10,150.61
32,035.61
(14)
32,03561
1,441.60
1,441.60
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
17 East Surd Street
CITY
I STATE
Pa
I ZIP
17257
Shippensburg
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C, Discount
(1)
Total Credits ( A + B + C ) (2)
1,441.60
3. Interest/Penalty if applicabie
D, Interest
E. Penaity
TotallnteresUPenaity ( 0 + E) (3)
4 it 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. (5A)
B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,441.60
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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?. .................
Yes
o
o
o
o
o
o
IKJ
1,441.60
No
IKJ
IKJ
IKJ
IKJ
IKJ
IKJ
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.
Urlder perlalties of perJllry, 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA TUR F PERSON RESPO~E FOR FILING RETURN
'tf.-lZ '/J d-4/14 ;",
ADDRESS 949 Itimore Road
Shippensburq
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ce,-;;-Cb(
PA 17257
DATE
ADDRESS
49 West Orange Street, Suite 3
Shippensburq
PA 17257
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 PS 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P,S, 99116 (a) (11) (ii)]
The statute does not exempt a transfer to a surviving spouse from lax, 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 99116(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. 99116(1.2) [72 PS 99116(a)(1)]
The tax rate imposed on the net value oftransfers to or for the use ofthe decedent's sibiin9s IS 12% [72 PS 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at leas! one parent in common with the decedent, whether by blood or adoption
."",om,.,,",,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred G Kohler
SCHEDULE J
BENEFICIARIES
FILE NUMBER
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)
1. Scott J. Robinson grandson 100%
949 Baltimore Road
Shippensburg, Pa 17257
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)
"c."em.,,'"".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Mildred G. Kohler
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Transamerica Annuity Contract #27302220 36,418.94
2. Refund from Sprint 3746
3, Household and Personal Property sold at Auction 1,32150
4. Refund from Nationwide 77.90
5. Refund from Mutual of Omaha 18,39
6. Refund from Comcast 8.06
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, Insert additional sheets of the same size)
37 882.25
e"'~m..'''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Mildred G. Kohler
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Scott Robinson
949 Baltimore Road
Shippensburg, Pa 17257
grandson
B
c
JOINTLY-OWNED PROPERTY
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name 01 finarlcial institution and bank account number or similar identifying number Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed lor jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 3/29/80 Checking Account Citizens (previously Mellon) Bank 8,607.94 50 4,303.97
Account # 412-267-5525
TOTAL (Also enter on line 6, Recapitulation) $ 4303.97
(If more space is needed, insert additional sheets of the same size)
R~V.I~lltX.II-9ii ~_
".~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mildred G. Kohler
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES.
1. Fogelsanger-Bricker Funeral Home 7,21140
B. ADMINISTRATIVE COSTS
1 Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid
2 Attorney Fees H. Anthony Adams 2,100.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State lip
Relationship of Claimant to Decedent
4. Probate Fees 75.00
5. Accountant's Fees
6. Tax Return Prepare~s Fees
7 Sprint Telephone 74.93
8. GPU Energy 22.38
9. Cumberland Valley EMS (last illness) 204.37
10. Kenny's Auction House 462.53
TOTAL (Also enter on line 9, Recapitulation) $ 10150.61
(If more space IS needed, insert additional sheets of the same size)
/~-c:Q?- //
\ BUREAU OF INDIVIDUAL TAXES
\, INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-22-2002
KOHLER
12-08-2001
21 01-1144
CUMBERLAND
101
H ANTHONY ADAMS
STE 3
49 W ORANGE ST
SHIPPENSBURG
'__;iJ:.-
7
p~\ 17257
'*
REY-1547 EX AFP (01-02)
MILDRED
G
Allount Rellitted
) CHANGED
ll)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
37,882.25
4.303.97
.00
(8)
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-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KOHLER MILDRED G FILE NO. 21 01-1144 ACN 101 DATE 07-22-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H)
10. Debts/"ortgage 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
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. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(9)
1l0)
10,150.61
.00
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
42,186.22
(11)
(12)
(13)
(14)
10.150 61
32,035.61
.00
32,035.61
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. 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. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
32,035.61 X 045 = 1,441.60
.00 X 12 = .00
.00 X 15 = .00
(19)= 1,441.60
l+J A"OUNT PAID
DATE NU"BER INTEREST/PEN PAID (-)
06-13-2002 CDoo1289 .00 1,441.50
TOTAL TAX CREDIT 1,441.50
BALANCE OF TAX DUE .10
INTEREST AND PEN. .00
TOTAL DUE .10
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the eKpiration of any estate for
life or for years, the Commonwealth hereby eKpressly reserves the right to appraise and assess transfer Inheritance TaKes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section Zl40 of the Inheritance and Estate TaK Act, Act Z3 of ZOOO. (7Z P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS. AGENT
REFUND (CR): A refund of a taK credit, which was not requested on the TaK Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate TaK" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-36Z-Z050; services for taKpayers with special hearing and I or
speaking needs: 1-800-447-30Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of taK (including discount or interest) as shown on this Notice must object within siKty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual TaKes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance TaK Return for a Resident
Decedent" (REV-1501) for an eKplanation of administratively correctable errors.
DISCOUNT:
If any taK due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount of
the taK paid is allowed.
PENALTY:
The 157- taK amnesty non-participation penalty is computed on the total of the taK and interest assessed, and not
paid before January 18, 1996, the first day after the end of the taK amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the taK and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. TaKes which became delinquent before January 1, 198Z bear interest at the rate of
siK (67-) percent per annum calculated at a daily rate of .000164. All taKes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
198Z Z07- .000548 199Z 97- .000Z47
1983 167- .000438 1993-1994 n .00019Z
1984 117- .000301 1995-1998 97- .000Z47
1985 137- .000356 1999 n .00019Z
1986 107- .000Z74 ZOOO 87- .000Z19
1987 97- .000Z47 ZOOI 97- .000Z47
1988-1991 117- .000301 ZOOZ 67- .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the taK becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
G~~
Oh
STATUS REPORT UNDER RULE 6.12
\\\\ \& rei) G. VO~\e-r
Date of Death: De c e 'N'--\o'~ <0 I g CXJ ~
Name of Decedent:
Will No.:
Admin. No.: dC>O ~ - 6t / LfY
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~ether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
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 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal wesentative state an account informally to the parties
in interest? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: ~I a3 Signa~ ~ (\00
N=' 1\", ~""'~ ~ \MS, .
\tq ~ o-{'~e sfr~J-
~u l ~ .s
AddressS~, ~ ~"'..) ~; \0 "rc~; ?9.' 172J 5. ?
7 J 7 -.$3 cd- --- 3d 77)
Telephone No.
Capacity: 0 Personal Representative
ACounsel for personal representative