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Home My WebLink About96-00853 Estate of \~aIL"r II. lIur~lu, No. also known as Walter II. lIurdu, Sr.. aka To: W.II. lIur~11I aka Walter II. lIurgln. Sr., 1m Register of Wills for the Drcc~cd. County of f'lImlwrl'1IHI Sucial Security Nuo I H )- '16-7125 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petilioner(s), who is/are 18 years of age or older al,llhe execur or in the lasl will of the above d~cedent. dated September 20. and codicil(s) dated N I A PETITION FOR PROBATE and GRANT OF LETTERS ~(-crc, -lfS3 in the named .19-2L (SCIIC relevant circumstances. e.g. renunciation, death or executor, de.) Decendent was domiciled at death in Cllmh"r l.,n,I County. Pennsylvania. with l1 is last family or principal residence at 1\,. t-It'lny U~ 11 ~g'~ 'm.m,. ^ 11 un T. 'P . \'IVJ~nrlnnd Cn.. M(1('h:1"f('~hllrr' PA (Ii>! "'eet. number and muncipaJilY) Decendent. then _-2,~_ years of age, died Octohcr 2. ,19 % at Bethany Vil1!!J~ Lower Allen TWD.. Nechnnlrohllre. PA . Eo"ept as foliows, deccdcr,t did not marry, was not divorced and did not have a child born or adopled after execuliDn olthe will off:red for probate; was not the viclim of a killing and was never adjudicated incompetent: .., Decendent at death owned property with estimated values as follows: (If domiciled in Pa.i All personal propeny (If not domiciled in Pa.) Personal propeny in Pennsylvania (If nOl domiciled in Pa 0) Personal property in County Value of real estale in Pennsylvania situated as follows: $ 609.000,00 $ $ $ WHEREFORE. petitioner(s) respectfully request(s) the probate of the lasl will and codicil(s) presented herewith and the grant of lellers t"otnmpntnrv therono (testamentary; administration C.t.L; administration d.b.n.c.t.a.) ~ 1;' u C U ""- 0- ~ ~':: o:U c ",,0 co= r#': ':::i~ 1;'~ ;0 ;; c .. in \ ----- .. Walter II. lIur~in, Jr. )00 E. Seminary St. Nercersbllre. PA I 7236 ^1p.~ B. Bllrl!in OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } 88 COUNTY Of' (O'.'JII\ERI.ANIl The petitioncris) uoove o!1amrt: swear(s) or affirm(s) that the statements in the foregoing petition are true and co,rect to the best uf the knowledge and belief of petitioner(s) and that as personal represen' tative(s) of th,; above dccedcm petidoner(s) will well an~trulY administer. the estate according to lawo Sworn to or affirmed and subscribed { \_____dU - '" before me this 1", th day of ~o ll~ t:oh.'! r 19 ~}{i !:! 'i}iO.~~ ('. ~.(:fl't.. ~ l-L iJ l'> 0 I'~"I' :\ '-\ Register ~ No. 21-96-853 Wa1tur II. Burgin, aka Wa1tur II. Burgin, Sr., aka Estate of W.II. Ilurgin, aka Waltur II. BlIr~jn. Sr.. Mil ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW O~tober 24 19..2..!i-. 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 Septembur 20. 1966 described therein be admiued to probate and tiled ofrecord as the last will of lJo 1 "n ~" """Il inn ka Wa1tur H. Burgin. Sr., aka W.II. Burgin, aka Wa1tur II. Bur in. Sr.. MD. and Leuers Testamuntary are hereby grallled to Wa1tur II. Burnin. Jr. and A1u" R. Bur!!in ---. ~, ~Il~ t/~fJ8 ~T;-~ R-.iuOl" WUIJ I FEES Probate. Lelters. Etc. .. 0... 0 o. $480.00 Shorr Certificates(lq 0........0 $ 30.00 Renunciation 0............. 0 0 $ ~r~ages $--l:.aL TOTAL _ $518.00 Filed 0...... .QroW~P'R .?~.d,.90~!i....... Jon F. LaFavur AITORNEY (Sup. Cr. I. Do NDo) 1'0 r.l1Tnl ~,.,."Pt- ~PIJ r.ttmhPTlnnd. PA ADDRESS 17070 (717) 774-7753 PHONE on C"' ;-.. \ ~'. .:" 2:J ~ ': ~ ~ '.II ,. . hJ ';"-",.'., ',.< ra:.l1J.IU1'j rUK l'I<UUAlt. anu \:dUU'll VJ;' LJl,11~1\.~ Eslate of Walter II. Illlrr,ln. No. C ((. also known as Walter II. Illlrr,ln. Sr.. aka To: W.II. 1I11rr,in aka Walter II. 1I11rr,ln. Sr... MD Register of Wills for the Deceased. County of (~lImh,.rl '10;,1 Social Secumy No. 183-36-712S Commonwealth of Pennsylvania The pelition of the undersigned respectfullY represents that: Your petitioner(s). who is/are 18 years of age or older an the exeCUl or in the last will of lhe above decedent. daled Se(ltembe r 20. and codicil(s) daled N I A r;-'(" '.l . , in the named . 19.-i!.fL- (Sllle relevant circumstances. e.g. renunciation, dwh of executor, dC.) Decendent was domiciled at death in Cllmhpr1."n~ County, Pennsylvania. wilh I> I" lasl family or principal residence at ~p'honl' \Ii 11 OS" 1 n<JPr ^ 11"n TnI' 0 ""mharland Co.. M,..rh!1ni("~hllrg. PA (lilt m<C!o number and muncip.lily) Decendent. then 94 years of age. died Octoher 2. . 19 96 at Bethan Villa e Lower Allen Tw . Except as follows. decedent did not marry. was not divorced and did not have a child born or adopted afler execuliDn of the will offered for probate; wa~ not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal propeny (If not domiciled in Pa.) Personal propeny in Pennsylvania (If not domiciled in Pa.) Personal propeny in County Value of real estate in Pennsylvania siluated as follows: S eQQ.QQO 00 S S S WHEREFORE, petitioner(s) lespectfull)' request(s) the probate of the last will and codicil(s) pre.ented herewith and the grant of leller' tP~tnmpntnrv (testamentarY: admininnuon c.f.L; administration d.b.n.c.t.a.) theron. ~ t c U .,,- 'C~ o:U c .,,0 c': 1'1': E~ U~ ; O' ;; C .. Vi ~ ~.~r~~~"'r N(lrcer~hl1rg Academv l ~tprcl'rshllrl!. PA 17236 Walter H. Burgin. Jr. 300 E. Seminary St. Mercersburl!. PA 17236 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } 8S COUNTY OF __....r.ilMUEJU,AND The petili:met(s) above.namd swear(s) or affinn(s) that the SlatemenlS in the foregoing petition are true and correct III lhe best cf ; h~ knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedem pe:il::mer(s) will well anl},truly administer the estate according to lawo Swornt .0 or affirmed. unrl subscribed { ~Q.. r ~ I 0 L 7~ ~ before me this 21 s L 0 _ day of : ~o Or, ':00"'( 19 96 !: 't ) I "r :::: . 1110"0 " .,' " .. ..- ~ ') 'J (', . ~ f, ., f!.,.- t' " L~ Register ~ '!- - ,.., I.' !!l R .....~ ..;::( Ct) 'OM c:: N 0- "-> "" j '; 1~': '" ri::..J... >1, "- ;~ :J, uu '1'111'" I'" 10 U I I il\ 111.11 tilt IllhllltUllll1l IH'lt ~!\l"ll I., \ "Ill t 11\ I "I"t ,I j,,,nl ,Ill lIllI'BCd \ I lid.. ,11( I d ,k,llh dlllv llll'.! \\ Ilh lilt ,I'" I.IILlIl(q':I"'II',1I Tilt '1I1.~1I1.11 ten 111\ ,lit' \~ dlllt 1"1 W,ll,lt ,11" Illl "l,dl \'Il,d Hll !I"]... C 1111' l' Ifll 1'\ 1111.1111 III IdOll: WARNING: It Is Illegal to duplicate this copy by photostat or phologrnpho No 21-%-853 1..'........-........, /o'\,~WI OL!'i,t'\ j '~"$"-" '~\" 00~:f~~\~ (i~{" .. ',~ \'-' - .'. y,... \~~ l"."I:'_.f,.~':I. ~."i'/ /7 /. . /::--- {,'?':-J,.>?...I /r:J%'/I~~'l'2~'Z;ZfL- 1"\.'~(',~"",,, d hl' jlll till... (1'!lIlIl,IIt. ~.) (Ill 3783889 ocr tl{ 199B I>,lll' COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 94 'III Sr. MD UNOlfltD>W ORIC6..nH HcuI I __ ,Ma.. o.-r __I I October 17, ... I, male tLllt'UItUUl&.ll socw. stC\lfllT'Y JtUVlJI" Walter II. fur in UHOl"ll'INI - .... '.183 - 36 - 7125 UlftftACllC.., _ S1N.:.fo..,.c.u.1'I "-"CIC6[W:RH,o..un..c.>I__........k......._.... """'.... _ 0 .""'- 0 Cumberland Lower Allen Twp. ~'airfie1d, vr .. , Pennsylvania .- PO" aC=r., MoUWWIWUS........ --- -- tt widwed ,,..m _,........... J.GJer Allen """"'""""".. "...lP"t___.......... OICIOllft USUA&. 1014 __........oa.ro;!_ .....,........-..,....., Phvslcian Medical CICIDlHt..YAlJGAOOfIl..~_"""'-'....l~CalIIl OIaDlHT. """" ,,,..,,"" ...- -- _n,.." "..... ... ... - ..... CUmberland .....,.., ".D~~'::.. WO,..1t1 NoUC ~.... YdJiI. .....lIuIfWI..e o. Bertha ."OAMAHt.IIUoILHlAOOAlUlSna~~_lllICcnII 300 E. Semina St., Mercersbur f'\ACIO#CISPOIItO\l,"""_c-.rr.c.-. LOCAlIOl4. .....- Greenwood Cemetery ... Bethany Village .. Mechanicsburg, PA 17055 HnCIt.,..,..,..~UlfI George fur in WONWfTI~f1~ Walter H. Burgin, Jr. .... .... ag c-- 0 ............0 ....- - , PA 1723& _..eo. 1996 ar Indiana, PA , errore era nc. MSCASI NlINllO ltIYlOlCAl.I ...0 .......... :1f'Ji:GCI',;l I' ',(; ...1lY /~ ""'" It: cww.............. -............ tIUI ...,..,.,...............-......"""' ~,L. ,...Ue- /L/ L, _ fl' , . ~ -1/i; OUIlOjOl'l o\SAWCSlOUlHCI 01) 1-- .:::.:: I: OUItOlOIIo\SACoPalOJllPaOf) OUIltIIO"IM.-coPc5lWlIc:lOl) MN AUtOrt'Y 'WClHGI ........1~JO CXJW'\n1ON C6 CAUIl Of OIR"' 16NH"0#0UI1t ONIOlNAtlll' ,.......0.'...' 11W((lfI'~l' ...........'#lWOM' 0l$CNDI tOl'IlUJfIl' OCC\IANO ...0 ...0 -. - - jI) o o -- ......-- eo..w......_-*I o o O "'-- ,.. Y. P'LJoUOII'UUA'.......... """,..... ''''''''0lIU -.... - &-.1" ... ... 0 ...0 - - CU1NJ11O"".......... .cunlf'YMl""IlQ.AII.......-~~_~........,..,.___..,....._P\MPuru.n.ed_..IQ~....lJt ..........,--........-___........~t1....__...... ...., ... -,...., ....., ,.. .,.....,.,...."........... ". .. SlGKoVLiNAHOfI1L&OIC o ": UClkSlNt.lU(l(fI lWtJlOMOl...... Uro_1 ~. !1rl{)d!o'HrF I,.. Oc-+ 3 I",~ MMllIKJ .IoOClMnOl....~11HO~"0CA&.lll 0# OlRH '.....lrlfl'P".,. I(~...... ~ (j '-'rf..4'-""0 ill 1 "uJ.., ;'Iv.. C.. 1/, II ~ 0, " '~.l ~ UfOCUI'.".liIQl'ttl&1CLU1,...-bAl...~_..-d...",..~.......dONl'>l ,. .........,..,......., ...~_~.. ..........,................... ....1.....1.,.._......... o n o.vl'UO~o.,_1 I,.?ot.x... .II .. /t? ..y / 7't'. I 0 :z; ~ ~ 0 ~ ~ ffi ~ t !: 13 ~ ~ ~ ~ f-< I . \1. ~ ... li :r: ~ j Ul Z ~ C3 ~ ~ ~ ~ J tLz-~ I ~ J: w :i o ... lD ,- Z ~ ~ I /, f-< o ( OJ j !/l ' U ;S ~ Z 21-9(, 1l'J3 REGISTER OF WILLS OF CIINJlEHI.ANIl COUNTY OATH OF SUBSCRIBING WITNESS Jon F, LaFnvl!r ~i1 ~eh:) a subscribing witness to the will presented herewith. (each) being duly qualified according 10 law, depose(s) and say(s) Ihat Ill' waH present and saw Walter II. Bur'in. aka Walter II. Burgin, Sr.. aka \0111. Burgin nka Wnlter II. Burgin. Sr.. NO the testat or , sign the same and that he request of testat~ in h is presence and (in the presynce of ea ----- other subscribing witness(es)). '---- signed as a witness at the other (in the presence of the Sworn 10 or affirmEd and subscribed before me Ihis I ,'j fA. day of f-)e.t-l'-k~ 19~ )T'(\'\,,~ C. ;t., ,~. ( ;) ') (\ 1 I~ l~ '0'1" 1, ... < (Name) Register 120 Carol Street New Cumberland. (~Rdr~~b70 (Name) (A ddress) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Walter II. Burgin. Jr. (elIcit) a subscriber hereto, (each) being duly qualified according to law, deposc(s) and say(s) that hn i~ familiar with the signature of Walter II. Burgin eodit:i1 will lestat 0 r of (one of the subscribing witnesses to) the presented herewith and codicil believes the signatare on Ihe will is in the handwriting of that he Walter II. Burgin, aka Walter II. Burgin, Sr. aka W. II. Burgin aka Walter II. Burgin, Sr.. MO to the best of ___ knowledge and belief~ ~ Sworn to or affirmed and subs~'ribed before I me this IS ll., day of (Jc(AA.u.. 19~ })"lO, '::I t'. .i.r<< 0" o I) ,) U (\ \ ,~l 1). "''''f.~l!-~ Register . ~ Walter II. tlUrglll, ~r. (Name) 100 r ~flmfnnry St. Mercersburg. PA(AUJk1f) (Name) (Address) / : i' 1 ('., , RECEIVEDBY 1/,.(''':''/,' .'.,ooj,O,;;'.::.... .f SIGNATURE. .'. ' MARV C. LEW1 S /</ " ,l, f/. 1,;' REGISTER OF WILLS D 185007 COMMONWEALTH OF PENNSYLVANIA NO. AA DIPARTMENT 0' REVINUI OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX '*' 1"'M211 1"'&1 ACN ASSESSMENT r:'I CONTROL ... NUMBER AMOUNT 1 I I I I t t I I I I I I I t L '010 Hill t t I I I I I I I . , . . I RECEIVED FROM: D JON F LA FAVER ESQUIRE 101 .4",000.00 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ESTATE INFORMATION, ~ FILE NUMBER ~ 21-1996-0853 t=t NAME OF DECEDENT (LAST) ~ BURGIN WALTER H ~ DATE OF PAYMENT Iii 7/9 EJ POSTMARK DATE COUNTY 5SN 183-36-7125 (FIRST) (Mil CUMBERLAND DATE OF DEATH 10/02/96 REMARKS WAL TER H BURGIN JR C/O JON F LA FAVER ESQ fa TOTAL AMOUNT PAID $47,000.00 DO SEAL CHECKtI 11 REGISTER OF WILLS ___ _._~ ..__0 _.__ ." .-- - .-. --.- - - >-.-- -. ~ .-_.1 -.,.".,.,..- , ---.-- -.~.JlI" _ 4li~ '1:. .- '010 HUI ., ! j i< ,'L' 1"" ../;;,'.)-- ~ IllY, "',or>' I""" " INHERITANCE TAX RETURN ~~~~:m~~jFDRVJ~mR 1:zJ311l11 ,4 RESIDENT DECEDENT POVERTY CR~DIT IS CLAIMED CO""O"W[ALIIIO' Pl ""'1 VA"A (TO BE FILED IN DUPLICATE FILE NUMaER O[PA"I"[",O'"","U' 21 1996 "Alln"~~::~.~~~~~~"''''OI WITH REGISTER OF WILLS) COUNTY CODE YEAR DECEDENrs NAME (LAST, FIRUT, AND MIDDLE INITIAL) DECEDENrs COMPLETE ADDRESS Bur in a/k/a Dur in Sr. Waltl!r II. lI/k/a W.II. Dothlll1Y village SOCIAL SECURITY NUMBER DATE OF DEATIi DATE OF UlRW I-b::hanicoburg, PA 17044 DECEDENT 183-36-7125 10/02/96 10/02/1996 Coun CUrrber1and II A II A L UI VIVI ". u. ".. ."A', SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ","ST AND MID l[ INITlALI 0853 NUMBER 1. OnglnaJ AolU111 3, Romwndor ROlurn llof datuo' dulh pflor It 12.1]-1121 o 40, Futuro Intorost COmplOrnso (ror delo. 01 doalh anal 12-12-02) ~ 0, Docodonl Died Testato ~ 70 Docodont MoInlelnod a Uvlng Tru.t (Anach copy 01 Will) (Anacl1 copy 01 Tru.t) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT1ON SHOU\.D BE DIRECTED TO: NAME COMPLETE MAIUNG ADDRESS Jon F. LaFaver 414 Bridge Street TELEPHONE NUMBER New CUrrberland, PA 717-774-7435 1, RooJ Entalo (Schodule A) 2, Stock. and Bond. (Schodulo B) 30 CIa.oly Hold Stock/Ponno15hip InTOlO.t (Sch, C) 4, Mortgego. and NOI09 RocolVablo (Schedule D) 50 Casho Benk DopoSlts & Mlscellaneou. PorsonoJ Proporty (Schedulo E) 0, JoinUy Ownod Property (Scl1odulo F) 70 Tran.rol9 (Schedulo G) (Scl1odulo l) 0, TotoJ Gro.. Assots (toloJ Un091-7) 90 FunoroJ Expon909o Adminl.uabYo Co.ts, Mlscolleneous Expen.e. (Schodulo H) 100 Debts, Mortgago UabiliUos, Uon. (Schodule I) "0 TotoJ Doducbon. (tatoJ Un.. 9 & 10) 12, Not VoJuo 01 Enlalo (Uno B minus Uno 11) 130 Charitablo and GovornmontoJ Boquo.ts (Schodulo J) 14, Not VoJua Sub oct to Tox (Uno 12 ""nus Uno 13) 15. SPOUJI. T,ans'". tlor dAtil 0' duth .It., e.30-941. 5.. InsUuctlons 'or Appll"tll' p.ttlnuge on PIli' 2. (Include vIl"lI from SChllll.tll Ko, SChldul1 M.) 10, Amount of Une 14'oxablo at 0"10 lato (Includo VoJU09 from Schodulo K or Schedulo M,) 17. Amounl 01 Uno 1418Xablo a115% 1010 (Includo YoJU05 from Schodulo K or Schodulo M,) PrlnclpoJ tox duo (Add tox from Un09 150 10 and 17,) CrodilS SPOUIAI Pa'llrty Cttdll Prior Payments Discount . 47 ,000.00. 2r473.68- 20, II Uno 19 i. roetar Ihan Uno 18, onter Iho dinoronco on Uno 20. Thi.I.lho OVERPAYMENT. A.; Chock hare" au ara re uaoIln a rotund 01 ur ova om. 210 II Uno 10 I. groater then Uno 190 enlor the dilloronco on Uno 21, Thi. is Iho TAX DUE. A. Entor Iho Intarost on tl10 boJanco due on Uno 21Ao B, Enter tho totoJ 01 Uno 21 end 2lA on Uno 21B, Thi.l. the BALANCE DUE. Mako Chock Pa able 10: Ra taler 01 Wills. Agenl I' ,'.. ." . " . . '...... BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ... ... ' Undor ponalUo9 01 porJury, I doclaro Ihall havo oxammod thiS roturn, including accompanYing schedulos and slalomonls, and 10 Iho basi of my knowledgo snd bo1101, it i. , corroct and complete, I doclare thai oJl rooJ ostate 11.. boOn roportod et truo marko' voJuo. DocIaraUon 01 prapBIor othor than Iho pal50noJ fO re.ontaUvo i. .od on oJl informaUon of which pro aror ha. on knowlod a, SIGNATURE OF PERS N RESPONSlOlE FOR FlllNG RETURN ADDRESS See Schedule attached CHECK APPRO- PRIATE aLOCKS o 4, Umitod Eslalo CORRES- PON.JENT RECAPIT- ULATION TAX lBo COMPUTA- 190 T10N 15001 ADDRESS 414 Brid e Street New CWnberland, PA 17070 DATE I Ii ,3JC,7 OAT~ 'j I ~ 1.1 (~'7 I SIQNATURE OF PREPA , , ./ /'I";:. NTF eel0 COPV11Qhl Forml Saf1wAtt Only, 11194 NIlco,lnc. Ng4PAOOl ~5, FodoroJ EslelO Tox Roturn Roqullod ..Q. 0, TotoJ Numbor 01 Se'e Dopas" Boxe. 17070 (1) ( 2) (3 ) ( 4) ( 5) None 174,368.00 None None 660,539.10 ( 6) ( 7) None 89,780.53 924,687.63 (0) (9) 58,689.42 (10) 27,153.28 85,842.70 838,844.93 None (11) (12) (13) 14) 838 844.93 (15) x 0 . (16) 838,844.93 x 50,330.70 ,DB . (17) 0.00 x 015 . 0.00 (10) 50,330.70 Inlorosl (19) (20) 49,473.68 (21) (21A) (21 B) 857.02 0.00 857.02 , Burgin - u.s. Savings Bonds inventory SERIES EE BONDS: Denomination Serial Number Issue Date DatevRlugeath $1,000 M4J866501 EE February 1992 $ 645.60 1,000 M4JB66502 EE " " I 1,000 M4J86650J EE " " 1,000 M4JB66504 EE " " 1,000 M4J866505 EE " " 1,000 M4J866506 EE " " 1,000 M4JB66507 EE " " 1,000 M4JB66508 EE " " 1,000 M4JB66509 EE " " 1,000 M4J866510 EE " " 5,000 V2J516 7J EE August " 3,106.00 5,000 V2J516 74 EE " " II 5,000 V2J516 75 EE " " II 5,000 V2J516 76 EE " " II 5,000 V25J7027 EE January 199J 2,998.00 5,000 V25J7028 EE " " II 5,000 V25J7029 EE " " II 5,000 V25J7DJO EEo " " II 5,000 V25J70J1 EE " " II 5,000 V25J70J2 EE " " n " ESTATE OF WALTER H. BURGIN UNITED STATES SAVINGS BOND INVENTORY SERIES H BONDS: Denomination Serial Number Issue Date $ 50D 09 365 525 H December 1971 500 D9 366 951 H II II 1,00D M11 773 436 H II II 1,DOD M11 773 437 H II II 5,00D V3 184 210 H December 1972 5,000 V3 184 211 H II II 5,000 V3 184 212 H II II 1,000 M15 108 956 H II II 1,DDO M15 108 957 H II II 1,000 M15 108 906 H II II 10,ODO X3 042 952 H December 1973 10,000 X3 066 602 H December 1974 10,ODO X3 068 378 H December 1975 5,000 V5 145 066 H II II 500 011 102 056 H II II 500 011 103 165 H II II 10,000 X3 070 152 H December 1976 1,ODO M16 848 064 H II II 5DO 011 404 329 H II II 10,000 X3 070 926'H December 1977 1,000 M17 251 963 H II II 1,000 M17 251 964 H II II 1,000 M17 251 965 H II II 10,DOO X3 072 105 H December 1978 SERIES HH BONDS 5,ODO V24 243 HH December 198D 1,000 M103 998 HH II II 1,ODO M103 999 HH II II 1,000 M104 DOO HH II II 500 D941 184 HH II II 10,000 X230 855 HH December 1985 10,000 X230 856 HH II 10,000 X230 857 HH II 5,000 V 404 489 HH II 1,000 M1 697 133 HH II 1,00D M1 697 135 HH II 500 01 414 148 HH II 1 .....,~ ~ .C w ;:. 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'" " "- ..., '" 00 -0 .., oC r. 0 .... ('. co (0. =1": -.... W - " .' .., :;i:., .... oC <: '" c: -. r. :> ~ "- i!: oC '" '- <: " -: '- 5 u E l- e: <, ... - "- (oJ i:'lf. - '" '- '" " r - " l- e " '0 -:: r c ... t.~ u.r ::: - r L:.'I: '" t,..., .., ,. '" ~ - r - '" (oJ .- 0 1:', ... "- E ;: - .....1..'; W <: c: :> :. .., ., -' J: 1: .J::: ~ .... ., ~ c - c: :> ,. , c; <- .. ..: ;: W -w c ;:, t": , t.,;r ;: i: r. ; ::=' ". t.. '. - -t.: ... " c: ., "'::: c: G '- u <- - 0 <. ., .. , o. C ;: " t.. ... '" 'ic. c..c. - ,,- .. ,. to: ... ,. Oo.. ..JCl: -: .,. WC -r .. '" co .., '" '" l.o.!W ,., ,., -r - tlO " .,. 1: ~. -:: e 0 -- ,., ,., " W C' - e e - e e C :: >< 0 0 W e 0 - r c '" c:> c ,., - e c ... ." co -w ,. r. .., 0 ~::; .,. ..,. -<> W :.:.-.: ... ..,. ., 0 "'C . :> -: ,,:> - ." c: '" r - rI :: "- r- ." -<> .., rI "- - c .... -, rI = ... .. :- w '" - C' ;: " :J e 0 g >- c e .. :: " c: e c CO " c: '" r 0 c: '" c ,., "- 0 C> ... ." r t: ::I.L' " .. '" 0 = -: .,. .,. .., >-oJ .,. " ., 0 "' Cl:C "':> "" '" .: - rI ~. '" "" .., ~ - "- c.' .. ,. "' " " .: l", - - r - " ~ w <' ~ >- ll": '-" " ~ "' to ,., U " C r- ... - :- L1 W ;: ;: oJ C C'o ~ 0: ~o " :: '- - '- ;: ~. E E oJ C REV-l~10 EX. (2-07) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G TRANSFERS PLEASE PRINT OR TYPE FfLE NUMBER Walter H. a/k/a w.n. Burqin a/k/a Burgin, Sr. 21-1996-0853 THIS SCHo MUST aE COMPLETED & FILED IF THE ANSWER TO ANY OF THE OUESTIONS ON THE REVERSE SIDE OF COVER SHEET IS YESo DESCRIPTION OF PROPERTY DECO, DOLLAR VALUE ITEM Include narno 01 tho Uensrorooo IhOlr EXCLUSION TOTAL VALUE % OF DECEDENTS NOo rolellonshlo 10 docedonto d.lo of U.n.IOI. OF ASSET INT, INTEREST 1 Walter B. Burgin, Jr.-gift of 3,000.00 10,000.00 100% 7,000.00 $10,000 made on 09-28-96 aon of deceased 2 Alex B. Burgin-gift of $10,000 made 3,000.00 10,000.00 100% 7,000.00 on 09-28-96 son of deceased 3 Alex B. Burgin, Jr.-gift of $10,000 3,000.00 10,000.00 100% 7,000.00 made on 09-28-96 grandson of deceased 4 Debbie B1=k-giftof $10,000 made or 3,000.00 10,000.00 100% 7,000.00 09-28-96 granddaughter of deceased 5 Lisa Burgin-gift $10,000 made on 3,000.00 10,000.00 100% 7,000.00 09-28-96 granddaughter of deceased 6 Mickey Burgin-gift of $10,000 made 3,000.00 10,000.00 100% 7,000.00 on 09-28-96 grandson of deceased 7 Jennifer Cogliano-gift of $10,000 3,000.00 10,000.00 100% 7,000.00 made on 09-28-96 granddaughter of deceased 8 Equitable Life Assurance S=iety of 0.00 35,681. 62 100% 35,681. 62 the U.S.-Annuity No. 32011869, Walter H. Burgin, Jr. and Alex Burgin, benef., Prine. $35,342.31, Interest $339.31 9 Penn Mutual Life Insurance 0.00 5,098.91 100% 5,098.91 Co.-Annuity No. RPS1984102, Walter H. Burgin, Jr. and Alex Burgin benf., Prine. $5,017.27, Interest $81.64 TOTAL (AI.o onler on II no 70 Roc.pllur.Uonl $ 89.780.53 (II moro .paco I. noodedo In.en eddiUonol.hools ol.arno .Izo,) PA15101 NTF ""A CopyrlghlForml SollwI'. Only, 1994 Nelco,lnt. NV4PA101 REV"I~tO EX . (2-07) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETlJRN RESIDENT DECEDENT ESTATE OF SCHEDULE G TRANSFERS PLEASE PRINT OR TYPE FfLE NUMBER Walter II. a/k/a W.II. Burqin a/k/a Burqin, Sr. 21-1996-0853 TllIS SCHo MUST BE COMPLETED & FILED IF THE ANSWER TO ANY OF TllE DUESTIDNS ON THE REVERSE SIDE OF COVER SHEET IS YESo DESCRIPTION OF PROPERTY DECO, DOLLAR VALUE ITEM Includo nama 01 tho uansloroo, Iholr EXCLUSION TOTAL VALUE % OF DECEDENrS NO, rolallonship 10 docodonl. dalo 01 1ranutor. OF ASSET INT, INTEREST 1 Walter B. Burgin, Jr.-gift of 3,000.00 10,000.00 100% 7,000.00 $10,000 made on 09-28-96 Bon of deceased 2 Alex B. Burgin-gift of $10,000 made 3,000.00 10,000.00 100% 7,000.00 on 09-28-96 Bon of deceased 3 Alex B. Burgin, Jr.-gift of $10,000 3,000.00 10,000.00 100% 7,000.00 made on 09-28-96 grandson of deceased 4 Debbie Block-giftof $10,000 made on 3,000.00 10,000.00 100% 7,000.00 09-28-96 granddaughter of deceased 5 Lisa Burgin-gift $10,000 made on 3,000.00 10,000.00 100% 7,000.00 09-28-96 granddaughter of deceased 6 Mickey Burgin-gift of $10,000 made 3,000.00 10,000.00 100% 7,000.00 on 09-28-96 grandson of deceased 7 Jennifer Cogliano-gift of $10,000 3,000.00 10,000.00 100% 7,000.00 made on 09-28-96 granddaughter of deceased 8 Equitable Life Assurance Society of 0.00 35,681.62 100% 35,681.62 the U.S.-Annuity No. 32011869, Walter H. Burgin, Jr. and Alex Burgin, benef., Prine. $35,342.31, Interest $339.31 9 Penn Mutual Life Insurance 0.00 5,098.91 100% 5,098.91 Co.-Annuity No. RPS1984102, Walter H. Burgin, Jr. and Alex Burgin benf., Prine. $5,017.27, Interest $81.64 TOTAL (Also ontor on lino 70 Recapitulation) $ 89.780.53 (II maIO spaco 19 noodedo insen addillonal shoots at sarno SilO,) PA151Dl NTF ""A COPyftghl Form. SOl1w.r.Onty. 1994 Nltco,lnc. N9"PA10l f .' ..... COMMONWE,\LTH or PENNSYLVANI,\ ) )SS: COUNTY or CUMI3ERLAND ) (Lf..(I\ ~ /OCII I On lhis the rL day of ~ A ,I Lu... , ~. before I me a Notary Public. lhe unuersigned officer. personal I y apl'eareu JV\a r i Q _f.) 10 01 p- k.i ,1 S , who acknowledged ~~elf to be lhe Jrll st C{-heel"'- , of PNC BANK, National Association. a corporalion. anu lhat"lle as such I? Ll S + 0 r: f, c.t! r I being authorized 10 UO so. execuleu the foregoing instrument for lhe purpose therein conl.1ined by signing lhe name of lhe corporalion by ~self as .Y u S~ () (: Flc... e y- IN WITNESS WHEREOF, 1 have hereunto set my hand and official seal. DO/1(l Cr I. ~l,tJ- Notary Public NoIa/lill ,~a1 0elJaA.~:~~~", I~T"'9."u",~--""'''' My~e.;;res~e. 1996 .pOllI"$j........_"""'.INo\81\89 5 .-..... COMMOrJWEAlflt OF PEUNSYlVAWA OLPARTMENT or IIEVENUE BUREAU OF INDIVIDUAL TAXES OErT 280601 ttARHtSUURG, PA 1712B.OOOl PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ti.~~ f:'; :'> . .", . NO. AA 211480 "LVII.mll"" RECEIVED FROM: I ACN ASSESSMENT CONTROL NUMDER AMOUNT JON LA FAVER ESQUIRE 101 .Sl"i7.(l2 414 BRIDGE STREET NEW CUMBERLAND. PA 17070 fOlDttER( fOlDttERE ESTATE INFORMATION: FILE NUMBER 21-1006-0B53 NAME OF DECEDENT ILAST! <; <; 'lie 3 -=.31o.=7-l~ IFlIISTI IMII OATE OF PAYMENT 6L3(}/07 POSTMARK DATE O'OCUOO COUNTY TOTAL AMOUNT PAID $857.02 BERl...t\Nn OATE OF DEATH SEALCHECKIl 19 i/96 REMARKS JON F LA FAVER ESQUIRe 'I ':.!! Lt.) .. ! .. " . . . --..-. __t -.....,......- .. -.'""'7'~ _ g-.~ T ..,:~ I:> . /.3.i - ~; BUREAU OF INOIVIDUAL TA~lS IHltlJUUHCI: 'All nll/ISION 01111. :801001 IlAwwlSI\UIlG, JlA 11I.~ft ohOI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE ~~. -j'l'~fl .(,Y.~l~~"v\ '~~ r. ."J~;":;'.l....l' '4~rJ.\'~1~t~~ NDTlCE OF INItERITANCE TA~ APrRAISEMENT. AllDWANCE OR DISAlLDWANCE OF DEDUCTIDNS AND ASSESSMENT OF TA~ 110 ~hl " ,If II' t/, JON F LAFAVER 414 BRIDGE ST NEW CUMBERLAtlD DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-01-97 BURG IN 10-02-96 21 96-0853 CUMBERLAND 101 WAL TER H PA 17070 ~ Artount Rellll Uad 1'....::=--,==~:7-""~.=_--=-:-.;- , 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 ~ iiEV:is'4j-Eif""Fji-ni9-:9:fj-iiii'ficEuoi'-YNHERiTANCE-TAX-APPRAisEHEiir;-,'ii.i.-OWANCE-iili"-m-u--m---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BURGIN WALTER H FILE NO. 21 96-0853 ACN 101 DATE 12-01-97 TA~ RETURN WAS: I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Estate (Schedule A) 2. Stocks and Bonds ISchedule OJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortg.ges/Notes Raceivable (Schedule OJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assats CHANGED NOTE: To insure proper credit to your account, submit the upper portion of this form with your !ex paylftent. ,00 174,368.00 .00 .00 660.539.10 ,00 89.78D.53 IBI III 121 (! . 141 151 Ib) 17) 924.687.63 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H. 10. Debts/Hortg.ga Liabilitias/Liens (Schadule I. 11. Total Deductions 12. Nat Value of Tax Return 13. Charitable/Governlftental Bequests; Non-elected 9113 Trusts (Schedule JI 14. Net Value of Estate Subject to Tax Iq) 110) 58.689.42 27,153.28 1111 1121 113) 114) R~.R4? 70 838.844.93 .00 838,844.93 If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18 will reflect figures that include the total of abh returns assessed to date. ASSESSMENT OF TAX: 15. Alftount of Line 14 at Spousal rate 16. Alftount of line 14 taxable at Lineal/Class A rate 17. Alftount of Line 14 taxable at Collateral/Class 8 rat. 18. Principal Tax Due NOTE: 115) I1b) 1171 .00 ~ .00: 838.844.93 X .06: .00 ~ .15: I1BI .00 50.330.70 .00 50.330.70 TAX CREDITS: PAYMENT DATE 12-27-96 06-30-97 DISCOUNT I') INTEREST'PEN PAID 1-) 2.473.68 .00 RECEIPT NUMBER AA185007 AA211480 AHDUNT PAID 47.000.00 857.02 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL'DUE 50.330.70 .00 .00 .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION DF ADDITIDNAL INTEREST. IF TOTAL DUE IS LESS THAN II, ND PAYMENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIDNS.) RESERVATION; Eltatu of dlcldlnts dyIng on or b.forl alCub.r 12, 1982 -- 11 My fulur. Inlerl.1 In the ..Ial. Is Iran.f.rred In po...ulon or .nJoy..nt to Clau B (collat.ral) ben.Uclerl.. of the deCld.nt aft.r Ih. ,.pIntlon of IIny e.tat. for Ilf. or for Ylftr., the Co.~nw.alth her.by ..pr...ly re..rve. the rlahl to appr.I.. .nd ...... transf.r Inherltanc. Ta..s al Ih. lawful Clau a Ccallel.raU ral. on any .uch future Inler.st. PURPOSE Of NOTICE; fa fulfill Ihe r.qulre..nts of S.ctlon 2Jt.0 of Ih. Inh.rltanc. and Estal. Tu Acl. Act 21 of 1995. In P.S. S.ctlon 9It,O}. PAVKENTr D.tach Ih. top portion of Ihls Nolin and .ub.1t with your pay..nt to Ih. Reglsl.r of Wills prlnlad on the rlv.r.. sid.. .-"ak. ch.ck or .on.y ord.r payabl. 101 REGISTER or HILLS, AGENT REFUND (CA): A r.fund of a tu cr'dlt, which was nol r.qu....d on Ih. Ta. R.turn, .ay b. r.quul.d by caapleUng an "APPlication for R.fund or P.M,ylvanla Inh.rllance .nd E.lat. TalC" (REV-U13l. Applications ar. avaUabl. at Ih. Offlc. of the R.aht.r of Willi, any of the 21 R.v.nu. Dhtrlct Offlc.., or by caUlng Ih. splclal Zt,-hour .n.w.rlng s.rvlc. nu.b.r. for foras ordlrlngl In P.nnsylvanla 1-800-162-2050, oulsld. Plnnsylvanla and wllhln 10c.1 Harrisburg .r.. (717) 787-8091" TOOl (717) 772-225Z (H.arlng I.palr.d Only). DIJECTIOHS; Any p.rty In Inl.rut not utlsfled with the apprals..lnt, .110w8Oc. or dlsallowanc. of d.ductlons, or ........nt of tIle (InclUding dhcount or Int.ruu .. .hown on this Nollc. BU.t objlct within .htv (60) dayt of rec.lpl of this Hotlc. by; AD"IH ISTAUIVE CCRRf:CnOHS; .-wrltt.n prot..t to the PA D.part..nt of R'venuI. loard of ApP.als, a.pl. 2810Z1, Harrisburg, PA ...llctlon to h.v. the .atter d.t.ralnld at audit of t". account of the p.rsone. repre..ntltlv., "'PPlaI to the Orph'ns' Court. 17128-1021, DR DR rlctuel .rrort dltcov.r.d on thlt a.......nt .hould b. addr""d In wrJtlng 10: PA D.parl..nt of R.V.nul, Bur.au of Individual reu., ATTN: Po.t .........nl Rlvlew Unit, D.PI. 280601, H.rrlsburg, PI. 17128.0601 Phon. (717) 787-6505. S.. pilla' 5 of the bookl.t "Instruction. for Inh.rltancl Ta. R.turn for a R..ld.nt D.c.d.nt.. (REV-ISOI) for IlIn .leplanatlon of adelnlstratlv.1Y corr.ctabl. .rror.. DISCOUNT I If IlIny tu due Is paId wlthJn thr.. (1) eelenclar .onth. ""r the daced.nt"s death, a IIv. p.rc.nt (5~) dlscOWlt of the t.. Plld J. allow'd. PENALTY I Th. 15~ tn a.nUb non-pa,.tlclpatlon p.nal tv Is co.puhd on the total of the tax IlInd Jnt.re.. .......d, end not paid b.fare January IS, 1996, the 'Jrst day art.,. Ihl end of the tall aan..ty period. Thls nan-p.rtlcJpatlon p.nalty J. app.al.bl. In the sa.. a.nn.r and In the the .... II.. periOd as you would apPlal thl tale and Int.rut that has b..n .......d a. Indlc.t.d on thl. notlc.. IHTERESfl Int.r.st I. chargld b.glnnlng with first day of dlllnqu.ncy, or nJn. C91 ~onth. and an. (I) d.y fro. the date of d.ath, to the dati of pay..nt. T.... which b.ca.. d.lInqu.nt blfor. January 1, 1982 blar Int.r..t at the rat. of .Ix (6;() p.rc.nt pI,. annUl calcuht.d at III d.lly rat. of .000161,. All ta.n ..hlch blc.., d.llnqulnt on .nd art.r January I, 1982 will b.ar Intlr..t at a rat. which will vary fro. cal.ndar yler to callnda,. year with thai rat. aMounc.d by thl PA D.part..nt of R.v.nuI. Th. appllcabl. Int.r..t rat.. for 1982 through 1997 ar.; "!!.!! Int.ra.t Rat. Dally Intarut Fllctor !!!.r Int.r..t Rft" Dally Inllr..t r..ctol'" 1982 20il: .0ODSt,S 1987 .~ .OOD2~7 1981 16i1: .ODOU8 1988-1991 It:1:: .000301 1981, Il~ .000301 1992 .~ .OODZt,1 1985 UiI: .000.556 1993-1994 1~ .000192 1986 lOX .ODOZ7t, 1995-1997 'X .000247 --Int.r..t Is cllllcuhtld .. followt: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR .-Any Hotlc. Is'ued after the talC blco." delinquent wIll rlfl.ct an inhr..t calculation to flftll" US) dlys b.yand the date of the ........nt. If pay..nt II .ad. aflar the Int.rllt coaputatlon data .hown on the HatJcI, addItional Int.r..t au.t bl calculatad. \ " . .. -. .- ..... ~ . LAW orncr::!lo JON F.LAFAVEH )It lll,no ~TJ1tr: I Sr.w CU'-IUp.ul.A.sn,11r.sNSYI.VANIA. 17070 'tLr ""0'" ". ''''~l /;j' F(' __~:'U ;- {_i'./~' '" (// (I I / , ,/ " / , , , I .- , :. " , ! L / /; i \ I; 'I;: I / " I ..:: ( i , ' , I . r/ /~' ! , ,.. ii,' I / " - ( '( ;' " .~.~ I I . I ,/i" I 'J ) 2Q 3~ C'" .. r. <.' , (' "0<- );J~ / I \Ci Cl' <=> C":I ~ -u \.AI UI J>oo , , .,/-, ") ~ ) . \ ''',I. ., . ) " . -! .', f' If. c t t \"j " j. .I ). r r ....'. J ~~ . . ___ a"""" r~--~~--:"~ r.. - 1- ~'~- , :nil? wO " ,9 l") ,., ., '. ~~ ~~ Ui 2. /' -- 1~/13:J-J BUREAU OF INDIVIDUAL TAXES INlllIl11ANC[ 1&X DIVISION DlPt. :S06111 tIAAAISBUAC. PA l"I'S-ObOI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN .9fr,~~l Ws' \.~ "'.HI II 1"111"" 05-04-98 BURGIN 10.02-96 21 96-0853 CUMBERLAND 201 WALTER JON F LAFAVER 414 BRIDGE ST NEW CUMBERLAND Anount R.nltt.d PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your eccount, subnlt the upper portion of this forn with your tex p.yn.nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES .... Rifv:4si.-Ex--AFp.-{Oj:-97i-----.-.-NCificif-oF--DETifRHiN.ATio-N.Aiin-As-sES!iHENif-------------._------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN MM ESTATE OF BURGIN WALTER H FILE NO.21 96-0853 ACN 201 DATE 05-04-9B ESTATE TAX DETERMINATION 1. Credit For Stete Death Taxes as Verified 28.602.00 2. Pennsylvania Inheritance Tax Assessad (Excluding Discount and/or Interest) 47.857.02 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Intarest) .00 4. Total Inheritance Tax Assessed 47.857.02 5. Pennsylvania Estate Tax Due TAX CREDITS: PAVMENT DATE DISCOUNT (+) INTEREST/PEN PAID (-) RECEIPT NUMBER AMOUNT PAID o'!? <;:? r.j Go ~(t ~ 0"';. U Ii.) ClIO: 0: IX ~ ~ n ~'-= ~5 Uc.; TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 _IF PAID AFTER THIS DATE. SEE REVERSE SIDE IIF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I H .00 ,';:'135 ,..5 c:. - COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERHINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN BUREAU OF INDIVIDUAL TAXES IHIIERIUHCE tAIl DIVISION PEP'. 18D6001 HARRISBURG, Pi 1I1:a.DbOl 111.116 II "' 111."1 05-11-98 BURGIN 10-02-96 21 96-0853 CUMBERLAND 202 WALTER H JON F LAFAVER 414 BRIDGE ST NEW CUMBERLAND Anount Rani tt.d PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To in sur. proper credit to your account, subnit the upper portion of this forn with your tex pay.ant. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES ~ R-EV:73j;-EX--AFP--(03~-97i-----.-.-Niificif-oF--nETifRHIiiATIo-N-Aiin-As-sEsSlHENif---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF BURGIN WAL TER H FILE NO.2l 96-0853 ACN 202 DATE 05-11-98 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 28,602.00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 47,857.02 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 47.857.02 5. Pennsylvania Estate Tax Due 6. Amount of Pennsylvania Estate Tax Previously Assessed Besed on Federel Estete Tax Return 7. Additional Pennsylvania Estate Tax Due TAX CREDITS: PAYMENT DATE DISCOUNT (+) INTEREST/PEN PAID (-) RECEIPT NUMBER AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE IIF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU MAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS.! .00 .00 .00 ~C"J tB :D -~ :o~, OJ r.> Q c- ;:x =< - N ;::~ ;\?~ D (j,- (.j Q. PURPOSE OF NOTICE I To fulfill thl requlr...nts of Section Zl~5 (b) of thl Inhlrltance and Eltatl YaK Act. Act 21 of 1995. 112 P.S. Slctlon 914S). PAVHENT I D.tach the top portion of thl. Hotlcl and lub.lt with your pay..nt to thl Rlgllt,r of will. printed on the tlv.r.1 sid., u Hllk. chIck or lonlY order ply'bl, tOI REGISTER OF MILLS, AGENT. REFUND (CR): A r.fund Qf . tax credit .ay bl r.quIsted by co.platlng an "Application for R,fund of Pannsylvanla Inherltancl and E.tat, Ta." (REV-Ill)), APplication. at. avallabl, at thl OffiCI of thl Rlgl,t.r of Willi, any of thl 23 RevenuI District OffiCI' or fro. thl Dlpart'ont', Zit-hour an,wlring .otvlel nueber. for forI' orderlnal In Pennsylvania 1.aOD-36Z-ZaSa, out.lda Pann.ylvanla and within local Harrl.burg .raa (717) 7a7~a09~, TOD. (717) 77ZaZZSZ (Haarlng r.palr.d Only). OBJECTIONS I Any party In Intara.t not .atl.flad with the ........nt of taK .. shown on thl. notice ..y obj.ct within .IKty (60) d.y. 0' rac.lpt of thl. Notice by; uwrltt.n prot..t to tha PA O.part.ent of Revanue, Board 0' Appeals, Oapt. ZalaZl. Il.rrlsburg, PA 171za-lOZ1, OR ual.ctlna to h.v. the .atter d.ter.ln.d at audit of the p.r.onal r.pr.sentatlv., OR a-app.al to the Orphan.' Court AOHINa ISfRATlVE CORRECTIONS I Factual arror. dl.cov.r.d on thl. ........nt .hould b. addr....d In writing tal PA O.p.rt..nt of Rev.nue, Bur.au of Individual Ta..., ATTNI Po.t A......ent R.vl.w Unit. C.pt. la0601, Harrl.burg, PA 171Za-0601, Phon. (717) 787-6505. Se. page 5 of tha bookl.t -In.tructlon. for Inh.rltanc. TaK Raturn 'or. R..ldant O.c.d.nt- (REV~IS01) 'or an e.planatlon of ad.lnl.tr.tlvely corractabl. .rror.. PEHAl TV r Tha IS~ ta~ ..n..ty non-p.rtlclp.tlon p.nalty I. co.put.d on the total of the taK and Int.r..t a".'led, and not paid b.'ore January 18, 1996, the 'Ir.t d.y aft.r the end of the ta~ a.n..ty p.rlod. Thl. non~p.rtlclp.tlon p.n.lty I. app.al.ble In the .... .ann.r and In the the .... tl.. p.rlOd a. you would app.al the t.. and Int.ra.t th.t h.. baan a".,.ad .. Indica tad on thl. not Ie.. IHTEREST: Addltlon.1 P.nn.ylv.nl. E.t.t. T.~ .......d .. a ra.ult of a chang. on tha r.daral E.tat. Ta. clo.lng latt.r b.co... dallnqu.nt at the ..plratlon of on. (I) .onth fro. the date the final notlc. of the Incr.... In F.deral E.tat. Ta. I. r.c.lv.d. f..at which beca.. d.llnqu.nt b.fore January 1, 1982 b..r Inter..t at the r.t. 0' ,I. (6~) p.rcent par annu. calcul.t.d at a dally rat. of .000164. All t.... which b.ca.. d.llnqu.nt on or after January I, 198: will b.ar Int.r..t at a rat. which will vary fro. c.l.ndar y..r to c.l.ndar y..r with th.t r.t. .nnounc.d by the PA O.part..nt of Rev.nu.. 1h. .ppllcabl. Int.r..t rat., for 1982 through 1998 ar.1 !!!! Inter..t Rat. Oalh Interest F.ctor V.ar Int.r..t Rata D.lly Int.r..t ractor 1981 lOX .aoaS4a 1987 .~ .aDOl~7 19as 16~ .000~38 1988-1991 11" .00D301 198~ It:( .000301 1992 .~ .000l47 1985 13% .000156 1993-199~ ,~ .00019l 1986 10% .00aU4 1995al998 .. .000247 uInt.rut ls c.lcul.t.d .. follow.: INTEREST = BALANCE OF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Hotlc. I.tu.d .ft.r the ta. b.co.a. d.llnqu.nt will reflect an Int.r..t calculation to flft..n (15) d.y. b.yond the date of the ........nt. If p.y..nt I. ..d. .ft.r tha Int.r..t coaputatlon data .hown on the Notlc., addltlon.l Int.r..t .u.t b. calcul.ted.