HomeMy WebLinkAbout03-06-06
REV-1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 -05 068
COUNTYC'ODE ~A~ - - "N'U'MBER--
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Kline, Ethel M.
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
2 03- 1 0 - 1 816
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
11/15/2005 OS/21/1910
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach 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 ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
!L 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION. MUST BE. COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Carl G. Wass, Es uire 3631 North Front Street
FIRM NAME (If Applicable)
CALDWELL & KEARNS
TELEPHONE NUMBER
717 232-7661 Harrisbur PA 17110
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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76,146.57
(8)
76,146.57
9,318.22
3,472.96
(11 )
(12)
(13)
12,791.18
63,355.39
47,516.00
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
19. Tax Due
(14)
15,839.39
0.00 X _ (15) 0.00
0.00 X _ (16) 0.00
0.00 X .12 (17) 0.00
15,839.39 X .15 (18) 2,375.91
(19) 2,375.91
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QOESTIONS ON REVERSE SIDE AND RECHECK MATH < <
REV-15G8 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kline. Ethel M.
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
1068
ITEM
NUMBER
1.
DESCRIPTION
Wachovia Bank N.A. - checking account #1010059090160
(Exhibit #1 )
VALUE AT DATE
OF DEATH
9,447.43
2.
Wachovia Bank N.A. - savings account #3014130023597
(Exhibit #1 )
3,842.77
3.
Wachovia Securities, LLC - account No. 4876-3365
(Exhibit #2)
56,715.44
4.
M & T Bank - checking account #51769018
(Exhibit #3)
5,864.18
5.
Highmark - refund, health insurance premium
276.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
76,146.57
REV-1511 EX + (12-99)
,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Kline. Ethel M.
FILE NUMBER
21
05
1068
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Neill Funeral Home, Inc. - Balance due upon otherwise pre-paid funeral expenses
549.50
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) William F. Shultz
Social Security Number(s)/EIN Number of Personal Representative(s) 178-22-4845
Street Address 7697 Manor Drive
City HarrisburQ State PA Zip 17112
Year(s) Commission Paid: 2006
Attorney Fees Caldwell & Kearns, P.C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
3,807.00
B.
2.
3.
4,557.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees Register of Wills, Cumberland County
178.00
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7.
8.
9.
The Patriot News - Legal advertising
Cumberland Law Journal - Legal advertising
William F. Shultz - Postage stamps
143.92
75.00
7.80
TOTAL (Also enter on line 9. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9,318.22
REV-1~12 EX + (6;98)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kline. Ethel M.
FILE NUMBER
21
05
1068
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Mobile X-Ray Imaging, Inc. - Medical service
248.00
2. Messiah Village - Nursing home expense
3,062.50
3. Alert Pharmacy Service, Inc. - Prescription expense
162.46
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,472.96
REV-151.3 EX + ("*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kline Ethel M
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 05
1068
RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. William Shultz Collateral 3,167.87
7697 Manor Drive
Harrisburg, PA 17112
2. Carl Smith Collateral 3,167.87
103 Pleasant View Drive
Goode, VA 24556-2201
3. Margaret Neibert Collateral 9,503.65
5 Pine Hill Avenue
Mechanicsburg, PA 17050
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Humane Society of Harrisburg 3,167.73
7790 Grayson Road
Harrisburg, PA 17111
2. Zion Lutheran Church 3,167.73
265 N. Enola Drive
Enola, PA 17025
3. Tressler Lutheran Services (Diakon Lutheran Social Ministries) 3,167.73
960 Century Drive
Mechanicsburg, PA 17055
TOT AL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 47,516.00
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Kline, Ethel M.
Decedent's Name
Page 1
21 05 1068
File Number
Schedule J - Beneficiaries - 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
4. Bethesda Mission
611 Reilly Street
Harrisburg, PA 17102
5. Lawnton Fire Company
52 S. 46th Street
Harrisburg, PA 17111
6. Messiah Village Endowment Fund
100 Mount Allen Drive
Mechanicsburg, PA 17055
7. Association for Retarded Citizens
102 S. 2nd Street
Harrisburg, PA 17101
8. Visiting Nurses Association of Harrisburg
3315 Derry Street
Harrisburg, PA 17111
6,335.47
6,335.4 7
6,335.4 7
9,503.20
9,503.20
SUBTOTAL SCHEDULE J-2B
38,012.81
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LAST WILL AND TESTAMENT
OF
ETHEL M. KLINE
I, ETHEL M. KLINE, of Upper Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory, and
understanding, do make, publish and declare this to be my Last will I
and Testament, hereby revoking all Wills and Codicils by me at any
time heretofore made.
ITEM
I.
I direct my Executrix, hereinafter named,
to pay all my just debts, including funeral expenses, expenses of
my last illness and costs of administration,
as soon as
conveniently may be done after my decease.
ITEM
II.
This Will is subject to the disposition I
have made of my furniture and personal effects by a form dated
January 20 I 1997 entitled, "DISPOSITION OF PERSONAL PROPERTY AND
EFFECTS" (attached hereto) I in favor of William Shultz, Carl Smith
and Margaret R. Neibert.
I
All the rest! residue and remainder of my!
estate of whatever nature and wheresoever situate, I give, devise I
ITEM
III.
and bequeath to the following:
(a) A one-twentieth (1/20th) share to the Humane Society of
Harrisburg;
(b) A one-twentieth (1/20th) share to William Shultz;
(c) A one-twentieth (1/20th) share to Carl Smith;
11
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(d) A one-twentieth (1/20th) share to the Zion Lutheran Church
of Enola Cemetery Fund;
(e) A two-twentieth (2/20th) share to Bethesda Mission;
(f) A two-twentieth (2/20th) share to Lawnton Fire Company;
(g) A three-twentieth (3/20th) share to the Association for
Retarded Citizens, Pennsylvania;
(h) A three-twentieth (3/20th) share to the Visiting Nurses
Association of Harrisburg;
(i) A two-twentieth (2/20th) share to the Messiah Village
Endowment Fund; and
(j) A three-twentieth (3/20th) share to Margaret Neibert.
(k) A One/twentieth (l/20th) share to Tressler Lutheran
Services.
If any of the above institutions are not in existence at the
time of my death, or if any of the above individuals should
predecease me, I direct that the share that they would have
received be divided equally among the surviving institutions and
people.
ITEM IV. I name Margaret R. Neibert, as Executrix
of this my Last Will and Testament. If for some reason Margaret R.
Neibert is unable to serve, I appoint William F. Shul tz, of
Harrisburg, to b2 the Executor of this my Last Will and Testament.
My Executrix and/or Executor lS relieved from the duty or
II obligation of filing a bond or other security.
II
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~/1 t1day of
9n;t
, 1997.
f-fiAJ 1n, kJ~
Ethel M. Kline
(SEAL)
We, the undersigned, hereby certify that the foregoing Will was
signed, sealed, published and declared by the above-named
Testatrix, as and for her Last Will and Testament, in the presence
of us, who at her request, in her presence and in the presence of
each other, have hereunto set our hands and seals the day and year
above written, and we certify that at the time of the execution
thereof, the said Te~tatrix was of sound and disposing mind and
memory.
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"W"ACHOVIA
Reference ID: 1450885
Wachovia Bank N .A.
Balance Confirmation Services
POBox 40028
Roanoke, VA 24022-7313
December 22, 2005
CALDWELL & KEARNS
ATTORNEYS AT LAW
3631 NORTH FRONT STREET
HARRISBURG, PA 17110-1533
SUBJECT: Verification / Confrrmation of Account and Balance Information provided for:
Customer: ETHEL M KLINE (SSN# 203-10-1816)
Date of Death: November 15,2005
Deposit Account Information
Account
Type
Account
Number
Date of Death
Balance
Average
Balance.
Date
Opened
Maturity Interest Accrued YTD Date
Date Rate Interest Interest Paid Closed
CHECKING
LEGAL TITLE: ETHEL M KLINE
WILLIAM F SHULTZ - POA
1010059090160
$9,445.46
12/12/2002
$1.97
$291.84
SAVINGS 3014130023597
LEGAL TITLE: ETHEL M KLINE
WILLIAM F SHULTZ - POA
$3,842.53
6/1/1996
$0.24
$4.79
· Due to system limitations, we can only provide a twelve month average balance on depository accounts.
Other Account Information
Account
Type
Account
Number
Date of Balance
Date
Opened
Date
Closed
Ledger
Collected
BROKERAGE
48763365
CAP, Brokerage and Self-Directed IRA accounts have been converted to Wachovia Securties. Your request has been forwarded for processing and will be mailed under
separate cover. For questions regarding these accounts, please call 1-800-733-8812.
EXHIBIT #1
0000 000614
II!
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........~----......-
"W"ACHOVIA
Reference 10: 1450885
No Safe Deposit Box found for customer.
0000 000614
* Date of death balance does not include accrued interest.
* If t of.de t~c~u tin.. a :::rek:nd or a liday, date of death balance does not include any transactions that were
ad (i rm t e pen
. J1
y Gr ill
Service er Associate
Phone: (540)563-7323
Il;ag
__ Wachovia Securities, LLC
Retail Investment Group
~ ~4 NC1164
~~.. 401 South Tryon Street
Charlotte,NC 28288
W"ACHOVIA
January 18, 2006
Caldwell & Kearns
Attorneys At Law
Attn: Carl G. Wass
3631 North Front Street
Harrisburg, PAl 711 0
~: Ethel~.~ine
Dear Carl W ass:
Thank you for contacting Wachovia Securities, LLC regarding the account( s) of Ethel M. Kline.
Attached is the information regarding the date of death valuation requested.
If you have any questions regarding this matter or if you need further assistance, our Estate
Processing Specialists are available 8 a.m. to 6 p.m. Monday through Friday at 1-866-874-2717.
Sincerely,
OiJ. / eh.
'-../?u::/{; J/U/i11/
Rick Shinn
Estate Processing Specialist
Wachovia Securities
Securities and Insurance Products:
Not Insured By FDIC Or Any MAY LOSE VALUE Not A Deposit Of Or Guaranteed By
Federal Government A enc A Bank Or An Bank Affiliate
Brokerage services offered through Wachovia Securities, LLC, a registered broker-dealer and a separate, non-bank
affiliate ofWachovia Corporation. Member NYSE and SIPC.
EXHIBIT #2
BKDQA.rtf 857552130 6220706 48763365
Estate Valuation
Ethel M. Kline
Date of Death: 11/15/2005
Valuation Date: 11/15/2005
Processing Date: 01/18/2006
Estate of: Ethel M. Kline
Account: 4876-3365
Report Type: Date of Death
Number of Securities: 2
File ID: 48763365
Shares
or Par
Security
Description
High/Ask
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
1)
2026.968 VAN KAMPEN TAX FREE HIGH INCM (921128302}
STRATG MUN C
Mutual Fund (as quoted by NASDAQ)
11/15/2005
13 .18000 Mkt
13.180000
26,715.44
30,000.00
2 )
30000 Cash (CASH)
Total Value:
Total Accrual:
Total: $56,715.44
S56,715.44
SO.OO
Portfolio Endnotes
Title:
ETHEL M KLINE
7697 MANOR DRIVE
HARRISBURG PA 17112-4207
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
. m M&fBank
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
February 6, 2006
Caldwell & Kearns
Attorneys At Law
3631 North Front Street
Harrisburg, Pennsylvania 17110-1533
Re: Estate or Ethel M Kline
Social Securitv: 203-10-1816
Date of Death: November 15. 2005
Dear Sir or Madam:
Per your inquiry dated January 30, 2006, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
51769018
Ownership (Names of)
Ethel M Kline *
Margaret R Neibert, POA *
William F Shultz, POA *
Opening Date
08/28/64
Balance on Date of Death
$5,864.05
Accrued Interest
$ 0.13
Total
$5,864.18
Interest Paid YTD
$ 9.18 (Accrued interest is not included)
Please be advised, there was no safe deposit box found for the above decedent.
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the Harrisburg Main Office # 717-255-2070.
Sincerely,
'~uy<<~
Nancy Clagett
Records Management
EXHIBIT #3
CALDWELL & KEARNS
A PROFESSIONAL CORPORATION
JAMES R. CLIPPINGER
CHARLES J. DEHART. "'
JAMES D. CAMPBELL. JR.
JAMES L. GOLDSMITH
P. DANIEL ALTLAND
JEFFREY T. McGUIRE-
STANLEY J. A. LASKOWSKI
DOUGLAS K. MARSICO
BRETT M. WOODBURN
RAY J. MICHALOWSKI
DOUGLAS L. CASSEL
ATTORNEYS AT LAW
OF COUNSEL
RICHARD L. KEARNS
CARL G. WASS
3631 NORTH FRONT STREET
HARRISBURG. PENNSYLVANIA 17110-1533
THOMAS D. CALDWELL. JR.
11928-2001l
February 24,2006
-BOARD CERTIFIED CIVIL TRIAL ADVOCATE
Glenda Farner Strasbaugh
Register of Wills, Cumberland County
Cumberland County Court House
1 Court House Square
Carlisle, PA 17013
717-232-7661
FAX: 717-232-2766
thefirm@caldwellkearns.com
RE: Estate of Ethel M. Kline
Docket No. 2005-01068
Dear Register Of Wills Strasbaugh:
Enclosed herewith for filling, you will find the original and two copies of the inheritance tax
return with regard to the above - captioned estate. A check in the amount of the computed
inheritance tax, in the sum of $2,375.91, is also enclosed.
We respectfully request that you accept for filling the check and two copies of the enclosed
inheritance tax return. bhrequest that a time stamped copy of the inheritance tax return, together
with the receipt for payment of the taxes, to be returned to the undersigned in the enclosed self-
addressed, stamped envelope. Thank you for your cooperation.
Very truly yours,
~
Carl G. Wass
CALDWELL & KEARNS
CGW:ajr
Enclosure
98822
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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
WASS CARL G
3631 NORTH FRONT ST.
HARRISBURG, PA 17110
____n__ fold
ESTATE INFORMATION: SSN: 203-10-1 81 6
FILE NUMBER: 2105-1068
DECEDENT NAME: KLINE ETHEL M
DATE OF PAYMENT: 03/01/2006
POSTMARK DATE: 02/27/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 11/15/2005
NO. CD 006385
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,375.91
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TOTAL AMOUNT PAID:
$2,375.91
REMARKS:
CALDWELL & KEARNS
CHECK#1005
SEAL
INITIALS: RSK
RECEIVED BY:
TAXPAYER
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
CAl.DWELL & KEARNS
A PROFESSIONAL. CORPORATION
JAMES R. CLIPPINGER
CHARLES J. DEHART. III
JAMES D. CAMPBELL, JR.
JAMES L. GOLDSMITH
P. DANIEL ALTLAND
JEFFREY T. McGUIRE-
STANLEY J. A. LASKOWSKI
DOUGLAS K. MARSICO
BRETT M. WOODBURN
RAY J. MICHALOWSKI
DOUGLAS L. CASSEL
ATTORNEYS AT LAW
OF COUNSEL
RICHARD L. KEARNS
CARL G. WASS
3631 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17110-1533
THOMAS D. CALDWELL. JR.
11928-20011
March 3, 2006
Glenda Farner Strasbaugh
Register of Wills/Clerk of Orphans Court
Cumberland County Courthouse
1 Courthouse Square
Carlisle~ PA 17013
717 - 232 -7661
FAX; 717-232-2766
thefirm@caldwellkearns.com
-SOARD CERTIFIED CIVIL TRIAL ADVOCATE
RE: Estate of Ethel M. Kline, No. 2005-01068
Dear Ms. Strasbaugh:
Your office called my office to inform that we had recently forwarded the Inheritance Tax
Return and did so without having forwarded a check for the filing fee. My sincerest apologies.
I am accustomed to Dauphin County which charges the filing fee for the Inheritance Tax Return
at the time Letters are issued.
Enclosed herewith please find our check in the sum of $15.00 representing payment of
the filing fee for the Inheritance Tax Return.
Enclosed also is an additional check in the sum of $4.00 in the same Estate. We
respectfully request that you produce and forward to the undersigned a Short Certificate in this
Estate. We previously provided you with a self-addressed, stamped mailing envelope and
request that you send the Short Certificate in that envelope along with the time-stamped
Inheritance Tax Return and the receipt for the payment of the inheritance tax.
Thank you for your cooperation.
~
Carl G. Wass
CALDWELL & KEARNS
CGW:se
Enc.
99087
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