HomeMy WebLinkAbout09-12-05 (2)
REV-150t eX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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(IF APPLlCA LE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND
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~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
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D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
~L-6S-
COVNTY CODE YEAR
SOCIAL SECURITY NUMBER
06/5-
NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
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NAME
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FIRM NAME (If Applicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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)
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)
COMPLETE MAILING ADDRESS
(1)
(2)
(3)
(4)
(5)
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(10)
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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
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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
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x .12 (17)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
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CITY
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A Spousal Poverty Credit
B, Prior Payments
C, Discount
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D, Interest
E, Penalty
Total Credits (A + B + C )
(2)
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TotallnteresUPenalty ( 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)
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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)
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B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................,......................................................................................... D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..........,..................................................................,.......................................... D
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge.
ADDRESS
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
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. S9116 (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. S9116 (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. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(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-150t eX (6-00)
REV-1500
'*" , COMMONWEALTH OF
PENNSYLVANIA
.' .~, . DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
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OFFICIAL USE ONLY
FILE NUMBER
~L-(J5-
COUNTY CODE YEAR
06/!J-
NUMBER
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior 10 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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(IF APPLlCA LE) SURVIVIN'G SPOUSE'S NAME (LAST, FIRST, AND
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DLE INITIAL)
iszJ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attam copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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NAME
COMPLETE MAILING ADDRESS
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FIRM NAME (If Applicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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3. Closely Held Corporation, Partnership or Sole.Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
(6)
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7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
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8. Total Gross Assets (total Lines 1-7)
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9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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x .12 (17)
16. Amount of Line 14 taxable at lineal rate
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17. Amount of Line 14 taxable at sibling rate
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18. Amount of Line 14 taxable at collateral rate
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x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(14)
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Decedent's Complete Address:
STREET ADDRESS
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CITY
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
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+
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Total Credits ( A + B + C )
(2)
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3.
InteresVPenalty if applicable
D. Interest
E. Penalty
4.
TotallnteresUPenalty ( D + E )
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
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5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
(5)
(5A)
(5B)
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A. Enter the interest on the tax due.
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B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [J
b. retain the right to designate who shall use the property transferred or its income; ............................................ D D
c. retain a reversionary interest; or.......................................................................................................................... D D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D G
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
D [}.../
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.
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 pre parer other than the personal representative is based on all information of which pre parer has any knowledge.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not 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. 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 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
. .
RtV-15U3 Ex + (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
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All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 2, Recapitulation) $ / r( /
(If more space is needed, insert additional sheets of the same size)
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REV-1512 EX" (1-97)
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
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Include unreimbursed medical expenses.
ITEM
NUMBER
1,
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DESCRIPTION
AMOUNT
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TOTAL (Also enter on line 10, Recapitulation) $ /-.5-4> 4/ 3 -::-
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"REV-1513,EXt- (9-00)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
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FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
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AMOUNT OR SHARE
OF ESTATE
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NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
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B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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TOTAL OF PART II - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
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REV-1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
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Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 5, Recapitulation) $ t':l ~ Z?:. '/.1
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'l=1EV-1511 EX+ (12-99) .
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1
ESTATE OF
FILE NUMBER
ITEM
NUMBER
A.
B.
1.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
1.
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ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) /,.
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Social Security Number(s)/EIN Number of Personal Representative(s) . I I
Street Address
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City
State ==- Zip
2. Attorney Fees
Year(s) Commission Paid:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City
State ~ Zip
Relationship of Claimant to Decedent
Probate Fees
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5. Accountant's Fees
6.
Tax Return Preparer's Fees ?12.~P#/ZIIr 77.'." I !fI
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TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
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/67f21
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CEJRTlI][m:::.ATKON OF NonCE UNDER RULE S.Ma)
Name of Decedent:
Date or Death:
_-5-
Will No.
d tJo.5- tJtJt/.5-
Admin. No.
To the Register:
I certify that notice of (benelIicilllf in1l:eres1l:) estate administJrattion required by Rule 5.6(a) of the Or,phans' Court Rules was
served on or ~ to the following beneficiaries of the above-captioned estate on C Z. ~ :
Name
Address
7;!.2.c.? <-
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
9) /l?-- / ~
J /
Signature
;.L.
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Telephone (7; Y'
,:;-
0.1
Capacity: 0ersonal Representative
u
_Counsel for personal represerltative
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