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HomeMy WebLinkAbout12-20-06 , I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-06-0901 ESTATE OF GRACE M. GRIFFITH DECREE AND NOW, this -z If' day of ~A~ DEe 1 5 2DD6~ i , 2006, upon consideration of the attached Petition, the Court authorizes Joan M. Miller to have distribution of the personalty of the estate, and directs any commercial bank to negotiate any checks payable to Grace M. Griffith and to , close any account and distribute the balance to Joan M. Miller upon her signature in accordance with the , Last Will and Testament attached to the Petition. BY THE COURT, /tL ~ J. (") So ~~~3 25 .-, -- (") _: J- .-- ,,.: ::t;:. i-r1 2;::0 Cf) -;?'. OC) ...~)O-n ,'-)C :.. ~ :e. f"o-) <=.':) c;::':) CT'" o f'T1 (""') N o -0 :at: "1:J """"lfn .;;:;~, ,.-,') C)Q (r; ._U .:10 ,nm .:.00 (:10 :d33 ...~- ( ') ~~= ("'Tl (.I') C) ,~ - .. Coii) In Re: GRACE M. GRIFFITH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-06-0901 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 12-20-06 JUDGE'S INITIALS: KAH TIME STAMP DATE: 12-20-06 IN RE: DECREE , , " , , , , , , , , , , , , , , , , , , , , , , " , , " , , , , , , , , , , , , , , , , , , , , , , , , , , " , , , , , , , , , , '" , , , , , " , , , " , " , , " , , , , , , " , , " , , , , , , , , , , , , , , , , , , , , , SERVICE TO: DA VID A BARIC ESO METHOD OF MAILING: ENVELOPES PROVIDED BY: ~ USPS DRRR D HAND DELIVERED D OTHER_ ~ PETITIONER D JUDGE D CLERK OF ORPHANS COURT MAILED: 12/21/06 """"""""""".."""""......""""",..,.."""......,........,..,........"""..,....""""""...."......""",..".."""""", SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: D USPS DRRR D HAND DELIVERED D OTHER_ D PETITIONER D JUDGE D CLERK OF ORPHANS COURT MAILED: ~D~ Dpty CI. of Orphans' Court IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION NO. 21-06-0901 ESTATE OF GRACE M. GRIFFITH PETITION UNDER SECTION 3102 OF THE PROBATE. ESTATES AND FIDUCIARIES CODE FOR THE SETTLEMENT OF A SMALL ESTATE TO THE HONORABLE JUDGES OF SAID COURT: 1. Your Petitioner, Joan M. Miller, 503 Gettysburg Pike, Mechanicsburg, (") ~9 ~':g ='~ 0 -;J;r: I ,- J:;; rn :;I.: ~0 3? .;J C") 0 "jOll ;-)C .- :D ..-\ ~ ):... Cumberland County, Pennsylvania, 17055, is an adult individual and the one (1) and only surviving child of Grace M. Griffith, deceased on September 4, 2006, Social Security Number 139-12-0701. 2. The Decedent, Grace M. Griffith, was born on October 20, 1913 and was ninety- two (92) years of age at the time of her death. Her residence was Claremont Nursing Home, 1000 Claremont Road, Carlisle, Cumberland County, Pennsylvania, 17013. She was a single woman at the time of her death. 3. Her sole heir as set forth in her Last Will and Testament, a true and correct copy ,....., ~ c::::I c:T' o r1"1 n + -0 :x c.;.? w N of which is attached hereto and incorporated as Exhibit "A", is her daughter, who has signed this Petition. She is identified as follows: Joan M. Miller 4. Joan M. Miller was nominated in Decedent's Last Will and Testament as executrix. --0 fr-l c-:> c::> :-:-:0 C) rn CJ C") -n -n C) en ';r; ~ 5. The Decedent's sole assets are as follows: A. Stocks and Bonds: 119 SHS Common, CenterPoint Energy, Inc. @$14.59 per share, $1,736.00; B. Fulton Bank Classic Checking Account No. 3622-32677, $4,565.00; C. Resident Account at Claremont Nursing Home, $547.00; 6. Decedent had been receiving medical assistance from the Department of Public Welfare in connection with her residing at a skilled nursing facility prior to her death. The Department has agreed to accept the sum of $4,568.00 as payment in full. A letter of acceptance from the Department of Public Welfare is attached hereto as Exhibit "B" and is incorporated by reference. 7. It is requested that the assets of the Decedent be turned over to the Petitioner to pay the administration expenses and make distribution as follows: administrative expenses and balance to the Department Of Public Welfare 8. The Petitioner has filed a Pennsylvania Inheritance Tax Return and has received acceptance of the return. A copy of the return and the response from the Department Of Revenue are attached hereto Exhibits "e" and "D." WHEREFORE, Your Petitioner prays that an Order be made authorizing distribution of the accounts as set forth in the foregoing to Petitioner for him to apply against the expenses of administration and debts. O~2HE David A. Baric, Esquire LD.# 44853 19 West South Street Carlisle, P A 17103 (717) 249-6873 Attorney for Petitioner da b.dir/esta tes/griffith/smallestate. pet VERIFICATION I verify that the statements made in the foregoing Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. ~ -,-,"Yd. '7mJ b A. -/ Joan M. Miller CONSENT The undersigned acknowledge, pursuant to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities, that she is the sole heir of Grace M. Griffith; that she is an adult; that the statements made in the Petition filed by David A. Baric, Esquire are true and correct to the best of their knowledge, information and belief; that she concurs and consents to the proposed distribution to herself. WITNESS: /.1-- (5-(16 r ~JIuu DATE Joan . Miller .. ~ f~~ ~ ~ - Jradf ~ aun (ttJinmenf 01 GRACE . M. GRIFFITH . ..~ ~-~'t.-. .-....""'...~ I, GRACE M. GRIFFITH, residing in the Township of Hamilton, County of Mercer and state of New Jersey, being of sound and disposing mind, memory and understanding do hereby MAKE, PUBLISH and DECLARE this to be my Last Will and Testament, hereby revoking any and all former Wills, Codicils and testamentary dispositions whatsoever hereto by me made. FIRST: I direct that all my just debts and funeral expenses be paid as soon after my decease as conveniently may be. SECOND: I give, devise and bequeath all the rest, residue '. and remainder of my property, real, personal or mixed, of whatever nature and wheresoever situate, including any property over which I may have a power of appointment, to my daugh:ter, JOAN M. MILLER, to have and to hold same for her own use absolutely and forever. ~~~~~-~.'-----_.._--~_._"-~- .~--~.-- .... " .. direct that no bond or undertaking shall be required of my said Executrix in this or any other jurisdiction for the faithful performance of her duties. FIFTH: If my said daughter, JOAN M. MILLER, predeceases me or shall for any reason fail to qualify as such Executrix, then and in that event, I nominate, constitute and appoint my grandson, MARK RICK, Executor of this, my Last will and Testament to serve without.. .. ..i~;";; bond and with the same rights, privileges and powers given to JOAN M. MILLER. SIXTH: I direct that my Executrix pay all Federal and State Transfer Inhe~itance or Succession taxes levied upon the transfer or the succession of the interests passing under this, my Last will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ l,j day of ?t Cf7.P in the year of our Lord, Nineteen Hundred and Ninety-Six 00 ~' . I ~--t(V/~oSol 'GRACE M. GRIFFITH THE FOREGOING WILL, consisting of three pages, inclusive . . of this page and the following pages, was SIGNED, SEALED, PUBLT~HF.n _ A.wn nli'f"T.?.'D'Vn 'h.... ............. m~L'"mu'l"l'l"\l"'U' .&.-- 'L - .. - - - ""..iL:. ".......-.I:-.- ' STATE OF NEW JERSEY ) ) ) SS. COUNTY OF MERCER I, GRACE M. GRIFFITH, the Testatrix sign my name to this instrument this ( 3 day of ~...(...A.. ,1996, and being duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and ,._.......,......~~ Testament and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of sound mind, and under no constraint or undue influence. ~~r..s.) GRACE M. GRIFFITH weWl~~~~Lo~ , the witnesses, sign our names to this instrument, and being duly sworn, do hereby declare to the undersigned authority that the Testatrix signs and executes this instrument as her Last will and that she signs it willingly, and that each of us, in the presence and hearing of the Testatrix hereby signs this will as witness to ___-.L~_,~, - -~, -,- -,- *' COMMONWEAlTH OF PENNSYlVANIA DEPARTMENT OF PUBlIC WELFARE BUREAU OF FINANCIAL OPERATIONS DMSION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG. PA 17105-8486 October 4, 2006 O'BRIEN BARIC & SCHERER DAVID A BARIC ESQUIRE 19 W SOUTH ST CARLISLE PA 17013 Re: GRACE M. GRIFFITH CIS #: 590164269 .SSN: 139-12 -0701 Date of Death: 09/04/2006 Dear Attorney Baric: This letter is to advise you that according to the information you provided to our office regarding the assets of the above-referenced estate, the Department of Public Welfare will accept the balance, namely $4,568.00 remaining in the estate for payment of our existing claim. Please have the check made payable to the Department of Public Welfare and forwarded to my attention at the above address. Your cooperation in resolving this matter is appreciated. Sincerely, .. m~ A ~.-.. Marie A. Trayer Claims Investigation Agent 717-772-6723 717-772-6553 FAX EXHIBIT IIBII e ~ ~1~~r4!~ ' .--.J 15056051058 REV.1500 EX (06-05) PA 0epIrtment ~f Revenue . a.n.u of InchIUI Taxes PO BOX 280601 HarrisIug, PA 17128-0601 ENTER DECEDENT INFORMAnON BELOW Social ~rity N':Imber ~~~~_of_~~!,,_. OFFICIAL USE ONLY Ccutty Code Year INHERITANCE TAX RETURN -~ : RESIDENT DECEDENT I fie NIInber Decedent's Last Name Suffix Date of Birth ~ 1 : 10120/1913 I ~.___________.__._____---1 Decedent's First Name 139-12-0701 09/04/2006 MI I M __.J Griffith : Grace (If Applicable) Enter Surviving Spou.e'. Information Below Spo~se's L~s~ Nar:ne _ __ _ __ . ___ Suffix ~~u~'~_~~t_ ~_am~ MI .. .__....__~_..___n_._. __'___.__, Spouse's S~al S~rity Nu~t?!r _____ L__ _m_ ._.______..m ------.------____.___-1 THIS RETURN MUST BE FILED IN DUPUCA TE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ce) 1. OrIginal Retum c::> 2. Supplemental Retum c::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::> 4. Limited Estate c::> 48. Future Interest Compromise (date of death after 12-12-82) c::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECllON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Nam.e _ _______________.d_ ._' __. _ .._________________________ ,Da~,!,e Telephone Number c::> c::::> 6. Decedent Died Testate (Attach Copy of Will) c::::> 9. litigation Proceeds Received 8. Total Number of Safe Deposit Boxes David A. Baric, Esquire '(717) 249-6~ r-..;) i c=> ! g;-----=-! ?~ REGISTEri~~LLS USE LV ;:~~ ;::-~; ;~~~ : :J~ ~~3~ ~ >~~ 3J ~~~ ~ ~;~ .. ;"1 Firm Name (If Applicable) _ ~__ Y_. .on._ "_un.," ,._ ._.. ." : O'Brien Baric & Scherer First line of address ...- -_.__...._~._....., 19 West South Street I .._ .___..._...._.......i Second line of addre$$ '---1 i ...J DATE FILED OJ , Carlisle City or Post Office --'--' ... _.-._-.__... --.-------.---------- ---.....-------, i I State ZIP Code iPA I l_17013 ___________ Correspondent's e-mail address: Under penalties of perjury, I deda,. 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 pntparer other than the personal representative Is based on a1llnfonnation of which prepsrer has any knowledge. SIG URE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 19 West South Street, Carlisle. Pennsylvania 17013 PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -I EXHIBIT "e" ....J 15056052059 REV-1500 EX Decedent's SocIal Security Number Decedent's Name: RECAPO'ULAnON Grace M Griffith 139-12-0701 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) ......... '" ..... .. ........ ...... ...... 2. 1,736.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 5,112.00 36,385.00 i 6. Jointly Owned Property (Schedule F) <::) Separate BIlling Requested . . . . . .. 6. i 7. Inter-VIvos Transfers & MlsceUaneous Non-Probate Property (Schedule G) <::) Separate Billing Requested.. . . . . .. 7. f--- 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. i 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . " 9.: 43,233.00 2.280.00 , 140.256.00 142,536.00 , 0.00 : 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I). . . . . . . . . . . . .. . . 10. i i 11. Total Deductions (total Lines 9 & 10).... .. .. .... . . .... . .. ... ........ ... 11. : , 12. Net Value of Estate (Line 8 minus Une 11) . . . . . .. . . . . . . . . . . . . . . . . . . . .. .. 12. ! 13. Charitable and Govemmental Bequests/See 9113 Trusts for which , an election to tax has not been made (Schedule J) ... . . . . . . . . . . . . . .. . . . .. . 13. i 14. Net Value Subject to Tax (Line 12 minus Line 13) .. . . . . . . . . . . . . . . . . . . . . . . 14. ! TAX COMPUTAnON - SEE INSTRUCnONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spous8t-tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 : ---.---------; I ! ! i i I ----- -----, I , l~.__.- 15. i I 16. L--._______________ ! 17. i I I 18. i 19. TAX DUE................ ......................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:::> L 15056052059 Side 2 15056052059 ---I REV-1500 EX Page 3 Decedent's Complete Address: I ID i~mJttr_---J -- - -. ~._-.-------- S NAME DECEDENl'S SOCIAl. SECURITY NUMBER Grace M Griffith 139-12-0701 STREET ADDRESS 137 Banicklo Street CITY I STATE I ZIP Trenton NJ 08610 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D.lnterest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2, Line 20 to request a refund. (4) 5. If Une 1 + Une 3 is greater than Une 2. enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT _f:fi:~t!~m~~~:5k~~,. ..-.~?..;,. "~~"-~. ~ ;>\': ')~~;:"l;/':\!'''';..:-:.l~~ ...f.!!:t-;.....,~.)':;;~t,i......~\'~~.. rr.:""..,;;"~"''5'r~''~''.~\i/:,,''f'~,!:{:?<,f~..t.: ~'~:-':..J",'" ~~::. :.:'"~ PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain thause or income of the property transferred:.......................................................................................... 0 [i] b. retain th~ right to designate who shall use the property transferred or its income; ............................................ D [i] c. retain a reversionary interest; or .......................................................................................................................... D liJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receMng adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an rill trust for" or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an IndMdual Retirement Accoun~ annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. li~ii~\lit~:t:~~~,~~-~:1su:?:!:;)l~\:,;i~~~~P;::t~$!~~;;f~ltmi;~:ga~~f~~~~:$B ~ ;,.;...J.' ~..... ?r~t', :-y.:.. .:...)'~~t:,f'\,,\;l>';Jt, ,.!.~~ .. - 'l't. _ . <; .... ~'>:.. 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 survMng spouse is three (3) percent [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 zero (0) percent [72 P.S. 59116 (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 zero (0) percent [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 four and one-half (4.5) percen~ except as noted In 72 P.S. 19116(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 twelve (12) percent [72 P.S. ~9116(a)(1.3)].Asibling Is defined, under Section 9102, as an indMdual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX> _ . COMMONWEALTH OF PEN'4SYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULE . STOCKS & BONDS ESTATE OF Grace M. Griffith FILE NUMBER All proI*tJ joIntIy-owntd with right of lurvlvorshlp mUlt be cllCIoItd on Schedule F. ITEM NUMBER 1. DESCRIPTION 119 SHS Common, CenterPoint Energy, Inc.@$14.59 per share VAlUE AT DATE OF DEATH 1,736.00 0' ! . .. TOTAL (Also enter on line 2, Recapitulation) $ (If more space Is needed, Insert additional sheets of the same size) 1,736.00 REv-'5Il8 ex+ (6-98) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ICHIDUU I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Grace M. Griffith FILE NUMBER Include the proceeds of ltigatlon and !he date !he proceeds were received by the ellate. All property jolntly-owned with right of survivorship mutt be dJlCloHCI on Schtdul. F. 2. Resident Account at Claremont Nursing Home VAlUE AT DATE OF DEAlH 4.565.00 547.00 ITEM NUMBER DESCRwnON 1. Fulton Bank Classic Checking Account No. 3622-326n 0' 01 . .. ..... . .. TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 5.112.00 REv-1509 ex. (. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leMIDULI . JOINTLy-oWNED PROPERTY ESTATE OF Grace M. Griffith FILE NUMBER If In ....t wu ..... joint within onl ,.... of the dtctellnt'1 Ute of eIIath, It mUlt be reported on Schtdult G. SURVMNG JOINT TENANT(S) NAME A. Joan M. Miller ADDRESS RELATIONSHIP TO OeCEDENT 503 Gettysburg Pike, Mechanlcsburg, Pennsylvania, 17055 Daughter B. c. JOINTLY-OWNED PROPERTY: \.ETTER DAlE DESCRIPTION OF PROPERTY ~OF DATE OF DEATH ITEM FOR JOINT MADE INClUDE NAME OF FINANCIAl INSTITUTION AND IlANKACCOUNT NUMBER OR SIMIlAR DAlE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTFYING NUMBER ATTACH DEED FOR JOlNTLY-HELO REAL ESTATE. VAlUE OF ASSET INTEREST DECEDENrS MEREST . 1. A. OW Scudder Balanced Fund-A, No. 2-55535939 15,788.00 50 7,894.00 1999 2. A. 1999 OW Scudder High Income Fund, No. 8-3211732 56,983.00 50 28,491.00 .- .' .. : . TOTAL (Also enter on line 6, Recapitulation) $' 36,385.00 (If more space Is needed, insert additional sheets of the same size) : REV-15" EX+ 112-01). COMMONWEAL11-f OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT ICHIDUU H FUNERAL EXPENSES & . ADMINISTRATIVE COSTS ESTATE OF Grace M. Griffith FILE NUMBER Debts of dtctdtnt mull be reportId on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. 1. ADMINISTRATIVE COSTS: Personal RepresentaliYe's Commissions Name of Personal Representative(s) Joan M. Miller SocIal Security Number(s)lEIN Number of Personal Representalive(s) Street Address 500.00 City Year(s) Commission Paid: . State Zip 2. AttomeyFees 0 I Brien, Baric & Scherer 1,750.00 3. Family Ex8.ll'lption: (If decedenfs address is not the same as claimant's, attach explanation) . Cla~nt None Street Address City Relationship of Clainant 10 Decedent State . Zip 4. Probate Fees 30.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,280.00 : REV-1500 EX Page 3 Decedent's Complete Address: EJIe Number DO' ~ .--~ .__. - DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Grace M Griffith 139-12-0701 STREET ADDRESS 137 Barricklo Street CITY I STATE I ZIP Trenton NJ 08610 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Un. 20 to request a refund. (4) 5. If Line 1 + Une 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 Une 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT t:-.;t::,.;:;1,~(~~~W .~;~'2cl ..._ 'rr= ':~~1': '" "rd" (.:\1.,:.... __....<. .'" .'J"~~ ~Jj:."~1'"'{'f.. -..<,.,,,,,..,,.. ........;.....--~;.-:\.... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain th~ use or income of the property transferred;.......................................................................................... 0 [il b. retain th8 right to designate who shan use the property transferred or its income; ............................................ 0 (iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments. benefits or care? ...................................................................... 0 lil 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 lil 3. Did decedent own an -in trust for" or payable upon death bank account or security at his or her death? .............. 0 (iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. {~~.. :" !.fI~ :t~~:~ -~ ~~"i>! :~E~I~.~";ii:.'~.!~.r~.~it~r~t;~~~..;~~.~~.~!p"~~:s.c~~:.~ :,~~~i" "':~f ~.;JIT~~:~,..~:~~:~:~'tD,~ : ~rr ~'f'. ~... r.i;:t~' ,~~. '~....... ' ~, ..,......~~.' il.",..to:..., ./'~-:'~::...':'- :~,' 01; ~~;fI~ IS 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 three (3) percent [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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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 chUd 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 zero (0) percent [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 four and onf~..half (4.5) percen~ 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 twelve (12) percent [72 P.S. ~9116(a)(1.3)].Asibling 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-1512 EX+ (12.03) *' SCHIDULI I DEBTS OF DECEDENT, MORTGAGE UABILmES, & UENS COMMONWEALTH OF PEJMYL.VAHIA NtERITANCE TAX REIURH RESIDENT DECEDENT ESTATE OF Grace M. Griffith Report debb Incumd by the dec:tdtnt prior to dtath which .......In" unpaid u of the date of death, Including unrtlmbuned medlClIIIpIIIIII. VAlUE AT DATE OF DEATH FILE NUMBER ITEM NUMBER 1. DESCRIPTION Commonwealth of Pennsylvania 140,256.00 Department of Public Welfare .J ! TOTAL (Also enter on line 10. Recapitulation) $ (If more space Is needed. Insert additional sheets of the same size) 140,256.00 12-04-2006 GRIFFITH 09-04-2006 21 06-0901 CUMBERLAND 101 APPEAL DATE: 02-02-2007 ( See reverse side under Objections) AIIount R_:I. tted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE .... RETAIN LaMER PORTION FOR YOUR RECORDS +- itE": i547 - Ei - AF; - i oi:osi - NOTicE- OF-iNHERiTANCE - TAit APPRAiiEMENT: - ALLOWANCE-OR - - - - - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX GRACE M FILE NO. 21 06-0901 ACN 101 . ; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE"ENTI ALLONANCE OR DISALLOWANCE Of DEDUCTIONS AND ASSESSttENT Of TAX BUREAU OF INDIVIDUAL TAXES IllERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 171Z8-0601 DAVID A BARIC ESQ OBRIEN ETAL 19 W SOUTH ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17013 ESTATE OF GRIFFITH . REV-I547 EX AFP (06-05) GRACE M ( ) CHANGED DATE 12-04-2006 APPROVED DEDUCTIONS AND EXEMPTIONS: 21280.00 9. Funeral Expenses/A.. Costs/"isc. Expenses (Schedule H) (9) 10. Debts/~rtpge U8bil1Ues/Uens (Schedule I) UO) 140.256.00 11. Total Deductions (11) 12. Net Value of Tax Return (12) 13. Charitable/Govern.ental Bequestsi Non-elected 9113 Trusts (Schedule J) (13) 1~. Net Value of Est.te SUbject to Tax (l~) NOTE: I~ an asses...nt was issued previouslY. lines 14. 15 and'or 16, 17, 18 and r~lect ~igur.s that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. AItowIt of Une 1~ at Spousel r.t. US) 16. Aaount of Line I~ t.xabl. .t Lineal/Class A r.te (16) 17. AItowIt of Line I~ .t Sibling r.ta (17) 18. Aaount of Line I~ tax8ble .t Coll.teral/Class 8 rat. (18) 19. Principal Tax Due TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estate (Schedule A) 2. Stocks and Bonds (Schedule 8) 3. Closely Held Stock/Partnership Inter.st (Schedule C) 4. Mortgages/Not.s Recelvabl. (Schedul. D) S. C.shI8.... Deposlts,"lsc. Personal Property (Schedul. E) 6. Jointly Owned Property (Schedul. F) 7. Transf.rs (Schedule S) 8. Tot.l Assets (1) (2) (3) (~) (S) (6) (7) .00 1.736.00 .00 .00 5.112.00 36.385.00 .00 (8) .00 X .00 X .00 X .00 X AMOUNT PAID DATE NUtlBER INTERESl/PEN PAID (-) ~~(elve~ a. - o1-i)/o TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE EXHIBIT "D" . IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To in.... proper cradl t to your ~ountl ....1 t the upper portion of this f~ with your tax ~t. 431233.00 167.1i3lt 00 991303.00- .00 991303.00- 19 will 00 = 045 = 12 = IS = (19)= .00 .00 .00 .00 .00 .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $11 NO PAYM~NT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAY 8E DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)