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HomeMy WebLinkAbout99-0001 --.J 15056041125 REV -1 500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '* C C y , , oun ode ear Bureau of Individual Taxes INHERITANCE TAX RETURN ty PO BOX 280601 I'll na Harrisburg, PA 17128-0601"""'" --=- RESIDENT DECEDENT .f;;;:J-I -, I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death File Number trot Date of Birth 207221471 062 3 1 9 9 7 07221931 Decedent's Last Name Suffix Decedent's First Name FISHER JACOB MI K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FILL IN APPROPRIATE OVALS BELOW [XJ 1. Original Return o 4. Limited Estate o o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required p DAN I E L ALTLAND E S Q 717 232 766 1 Firm Name (If Applicable) C A L D W ELL & REGIS "'-3 ~WILLS U NL Y -1:] ;:u I " . :II: rn'J CD 0 G),:':::> ~m:EQ -= ~/~ (~ 3;'fn - frl rr1 oo~ ~ :..n C:J 6~~ -0 ~.~ ~ 8 ::It;.;.; ~ ~ ~ r:: n1 :0 C/' c) ~ATE FILED c.n ." 1 KEARNS First line of address 3 6 3 1 NORTH FRO N T S T R E E T Second line of address City or Post Office State ZIP Code H A R R I S BUR G P A 17110 Correspondent's e-mail address:daltlandlO2caldwellkearns.com Under penalties of pe~ury, 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 preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNAT E OF PERSON RESPONSIBL FOR FILING RETURN $" tr-;E $"", 0 7(/0 Side 1 L 15056041125 15056041125 --.J .-I 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: JACOB K. FI SHER RECAPITULATION 207221471 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) ... ................ .,. . .. ...... .,. 2. 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. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . ., 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . ., 7. 18928.50 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 18928.50 415.00 8. Total Gross Assets (total Lines 1-7) ..................... ...... 8. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4 1 5.0 0 18513.50 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 1 8 5 1 3 . 5 0 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) X.O _ 15. 16. Amount of Line 14 taxable 1 8 5 1 3 . 5 0 1 1 1 o . 8 at lineal rate X .0lL- 16. 1 17. Amount of Line 14 taxable at sibling rate X. 12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 1 o . 8 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 L 15056042126 15056042126 .-I REV~1~OO EX Pag,e 3 Decedent's Complete Address: File Number o 0 DECEDENT'S NAME JACOB K. FISHER STREET ADDRESS 19 LANCASTER AVENUE CITY I STATE I ZIP ENOLA PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,110.81 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 721.90 Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. (4) A. Enter the interest on the tax due. 721.90 0.00 1,832.71 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 1,832.71 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. 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 zero (0) percent [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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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. RE\Y-1509 EX.. (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JACOB K. FISHER FILE NUMBER o 0 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Susan A. Garman 19 Lancaster Avenue Enola, PA 17025 Daughter B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 4/29/94 Real estate and improvements at 19 Lancaster Avenue, 37,857.00 50. 18,928.50 Enola, PA 17025 (Copy of Deed attached) Date of death value determined by dividing assessed value of $2,650 by CLR of .070. TOTAL (Also enter on line 6, Recapitulation) $ 18 928.50 T (If more space is needed, insert additional sheets of the same size) ","-1,511 EX' (1. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOB K. FISHER FILE NUMBER o 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Caldwell & Kearns 400.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Filing Fee for Inheritance Tax Return 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 415.00 (If more space is needed, insert additional sheets of the same size) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Discount: 0.00 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throuah 1991 1992 1993 throuah 1994 1995 through 1998 1999 2000 2001 2002 2003 0.00 2004 2005 0.00 2006 ":1/").11/1 QQQ t-hn' 11 1/1 .I11?nn7 721.90 -. ~ .. . ~ .....",1.... ., TOTALS 0 721.90 Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: Pr(!ctitioner Portal Page 1 of I Penalty and Interest Calculations CALCULATION DATES- 3/24/1998 TO 11/14/2007 TAX DEFICIENCY $ 1,110.81 CALCULATED INTEREST $ 721.90 BALANCE AS OF 11/14/2007 $ 1,832.71 [ Start Over J https:/ /www.doreservices.state.pa.us/pi tservices/Defaul t.aspx 11/5/2007 H10",.R(}'; REV C)/R(' . This is. to certifY that the information here given is correctly copied from an original certificate of death dul~ filed with me as . Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fillOg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. 4395935 JUN 2 3 1991 < Date -:cl._._ COMllOHWEAl.TH 0............. . DlEMII'rMENT OF HI!ALTtf. Yn'Al IItECORDS CERTIFICATE OF DEATH 65 v,., COUNTYOf'_ 1Wl!0f'_ IRlHPLACalClv_ 1-.010(._, -or~CGunovtpA J.fechanicsbur _(lnoI_.givo...._~ (0-'2\ 7 _STRlJI._ -lIontod.-. ~CSIJodlol I. Widowed 1741.o....__1ro F."'~~ White ~IPOUII! 11__,,__ Cumberland UIUAl. ';"=::~~:::.I:.T Driver , Tr ~I--_..--~.-.z-.c_ 19 Lancaster Avenue Enola,PA 17025 ,. PA I"" IlIII - ...... Cumberland......... 17..0 ~"="=.. 1IIllTHEII'I_lFinl.__~ PAnn~hnrn 6-24-97 - ["" DUllOlOIlAl A NoD MRT.. 0IIlIr..- -........10_. ilia noIlaU1Jng....~_gioaoI..FMTI. I : DUllOlOIl AlACONSIQuENCE Of): - DUllOlOIl AI Aco.EOUENCE Of): -1llIl'DI'IY"-S _0fI DEAI'H ____10 ~ CClMPUTION OfICAUIlI - - Of'DlEAlH7 - 0 ........~ _0 NoD - 0 CouId...ba_ DII1E 0fI1NJURY ~.llay. - TlUE 0fI WJUIIY INJURY R WOIIK7 DEICIlIllE HOW INJURY ClCCIRWll. -. -""10-*...,,,,,,, '--I'HY_{Ph-~_o/____ian"'''""""",*,_ana_'''231 ......-.."".............---.....-.,----.................................................... . ZI. o o o PlACEOI'lNJUIlv.Al_....m._.~_ lot. IlI-.g. Me. lSpac:jy\ ... ... 0 NoD ~I/~J/'" I ~.4 '---Y<<lCEllTlP't_-~_"__ond~lO_o/_1 ......-.."".............--.....-.-.--.--.....-.,----......................... :M. lj' ii c ,.__________-.......-.................,""-.<M...."-....-'...'... .1.. HI05H05 REV 9-H6 This is to certify that the information here given is correctly copied from an original. certificate of death duly filed with me as .Local Rl:!gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ",':'," .:..:....,.-'.:. ....-::.......'.....,-.:.......:. ;.........,..:...:.......... . '., .' ,... , .' . . ' . - . " '... .. - . .. ," ... '- .--- -.... .."'" -, ."".. '... ...' .. - - . . . .. ' "', , .... . . .- /.":".,'-"':"""'. . - ::......::........ '.. ..... "...... . ""'-..., .. . :':'-':".':-::"", '.....'.,........:,;.:. . -...... - -,", ,-, ..,............-. ...,..,......... .....-'.' .'."- ,-....,.........,-........ . .. -- -, ...... ..,.:..:......:.::.:....:: .::.-:",-:;::.-';,..; . -, .... . ...... .... ::.........-......:::.............:;..':.:.:: ....:::.'...:::.::.....................;:..: Fee for thiscet~iticate~-$-z;60 No. ...2187 -", Date COMMONWEALTH OF PENNSVLVAN'A · DEPARTJ,fl!NT OF HEALTH. VITAL ReCORDS CERTIFICATE OF DEATH h~,:,j kI"W'i '." '- ~'~(d trRE'FlLEN........'" ","":,,'>:~_.'4W f".J~,'r~' 1/ _O#DECEllE (f".-.LMI) I. AOE(lU~ UNIlEIlI YEAR MonII1o llayo Marsha J. 'isher HounI 8lR1'Ill't.ACl \CiIy '-P' 'i>" HiP'Erl&~'i, ^ 7. Fa FACIl.tI'Y NAIoIE Of ""'........ gI,. "'Ind"""'l*l 19 Lanca,sterAve,~,Enola, - .. 52vlS. ._COUNtY .. DEAfH 1II -.. Cumberlan:i NT' USUAl. ClCCUMl'1Oii - ~"'=:~~=:r -Ita. Clerical . 1lICIOENT., MAIUNQ ADOAUs lSIrMI. Cllvnown. SlaID. ZIp Co>>) : 19 Lancaster Ave Enola, pa 17025 II. _ FArHEIl'S -IF". Modele. LMI) II. . Morris P. Kautz 1lNF<lflMAHT's - (T\'WPrinIl ~ ' Jacob K. Fisher . &unoC~O .---__0 ~ DanalIonO 0IIlw~ "'I.. _lM4e_"'~by =---- -...uac:AUM (FinoI _.. c:ondition _-.gin_l_ .-:....' :~...- "" any,1aIlcIng 10 1m-. =-.-_INO ~~=in;My ~r_.gin_)LUT E DUE 10\011 AS ACONSEOuENCE OF): -*lANAUlOPSV WEllE AUlOPSV~s MANNE" O#DEArH ~fIEIIFOAMED7 _LA8l.E PllIOR 10 ~ COMPlETION OF CAUSE - OF IIEA7H7 -.. . ~ 0 - 0 No _0 No 0 - 0 PAn! Of' ''WRV I (MonIh. D.v. llMI) Homlcld. "-ndIng ',--ion Could nol"'-"'_ o o OM. PlACE 0# IN.IURY ..-._.1....._ ~..... ~ ....lSl*Iy) 31M. ... -. ~(Chacll onIyor1ll) , .QIl1VlYINOIIHYIlClAN~~_..___ p/1yIiciInhu____.....23) ,", ;,.,), Tv...-..""~.___IO...~__.._..................................................~ ....-_ANDc:eIrnP'tINOlIHYIlClAN~bcJit,Ilf<l'l<>UIlC:i__oe<1iIyinglO_cl_1 ,.,. .c'; Tv..._..""...........__....._. -.-........__lOlh..8IIM(..__..--.... ",..:.,............... a 'IIIDICAL IlCAMINEIlICOIIONIR Onu.._ oI----..~.-....-n.In..,........__"...atu..It_.4ate._P...... _......IIllI......_ .......,......6.. ..6. .6... .... .6. 6... '..6. 6.................... ......... ........ ..... .... .... ......., ..... ....f ." 11.. " RE 'lIl1101U1rullE AND bL/.tJ /1/ I Olhar - lSPoCM 0 .....' pa - L.." ~j ~.~~~l~":::~~'_~.~' '.1; I===- I.... -...... I I I ... q .' V'"j",' ~?\;, HoB"'" """"., ........~ID-.llul . ; lllIl ...~_......IWITI. ~"-,:".' 4 Ii,.,.I"....".. '~"1 ~ ,</ lHJUAY 111 V<<lJIII<t _0".';;'0 M. IqZbl-t .l2UI2 THIS DEED is made the ~ day of April, 1994, BET WEE N PNC BANK, NATIONAL ASSOCIATION, successor by merger to CCNB Bank, N.A., formerly known as Cumberland County National Bank and Trust Company, a national banking corporation ("Grantor"), AND JACOB K. FISHER and MARSHA J. FISHER, husband and wife as tenants by the entirety (as to an undivided one-half interest) and 6USAN M. GARMAN (as to an undivided one-half interest) as joint tenants with the right of survivorship ("Grantee"): WIT N E SSE T H That the Grantor in consideration of Eight Thousand six Hundred Fifty and No/lOO Dollars ($6,650.00) paid by the Grantee to the { Grantor, the receipt whereof is hereby acknowledged, does hereby grant and convey unto the Grantee: ALL THA~ CERTAIN tract of land with the building and improvements thereon erected, situate in East Pennsboro Township, Cumberland county, Pennsylvania, bounded and described, as follo~s: BEGINNING at a point on the westerly line of Lancaster Avenue, which point is 276 teet North of the northwesterly corner of Huntington and Lancaster Avenues; thence in a line at right angles to Lancaster Avenue, North 83 degrees 30 minutes West 167.5 feet to a point on the easterly line of the 15 feet wide unopened alley; thence along same, North 06 degrees 30 minutes East 50 teet to a point; thence in a line at right angles to Lancaster Avenue, South 83 degrees 30 minutes East and through the center at a partition wall 167.5 teet to a point on the westerly line of Lancaster COOk 104 'lCf1157 Avenue aforesaid; thence along same, South 06 degrees 30 minutes West 50 feet to a point, the place of BEGINNING. BEING improved with a two and one-half story frame dwelling known as Lancaster Avenue. BEING the southerly ong-half throughout of Lot No. 9 and the northerly one-half throughout of Lot No. 10, Block B, in Plan of Lots of West Enola, recorded in the office of the Recorder of Deeds for Cumberland County, pennsylvania in Plan Book No.1, Page 29. BEING Parcel No.2 of a Blanket Deed, Group IV, which J. S. Gleason, Jr., Administrator of Veterans' Affairs, by deed dated July 22, 1964 and recorded with the cumberland County Recorder of Deeds Office in Deed Book L, Volume 21, Page 241, granted and conveyed unto Cumberland county National Bank and Trust Company, whose name changed to CCNB Bank, N.A., now known as PNC Bank, National Association, successor by merger, the Grantor herein. } UNDER AND SUBJECT, nevertheless, to all easements, restrictions, encumbrances and other matters of record or that a physical inspection or survey of the premises would reveal. Grantor hereby covenants and agrees that Grantor will warrant SPECIALLY the property hereby conveyed. IN WITNESS WHEREOF, the GrEmtor has caused this Deed to be duly executed as of the day and year first written above. ATTEST: GRANTOR: PNC BANK, NATIONAL ASSOCIATION, successor by merger to CCNB Bank, N.A., formerly known as Cumberland County National Bank & Trust Company BY_~ Name: R. A. Babula Ti tl e: Vice President eOOK 104 pmH~ . COMMONWEALTH OF PENNSYLVANIA 55: COUNTY OF CUMBERLAND On this, the 4th day of Kay , 1994, before me, A Notary Public, the undersigned officer, personally appeared R. A. Uuouln who acknowledgedl~s.lf to be the of PNC Bank National Association, a banking Vice Preaident association, and that ~ as such officer, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the banking association by Her sel r as such of ricer. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~1V~ Nqtary Publ it: - _.. SoB _"-So/Io. N<QyPWc :"r1.';>,'"~f-=~,~ ........ ~....,.,iV"""""""ot My Commission Expires: (SEAL) . .....::: S;1.I '.' ~ PI ~v ~ ~n~ -c ~! ~ I.~~ UI ~ ~:::l ~.., ;)1 ." ::D 0 C) ,...., ::3 c>"" ,-;) r=:. l..' f.... (3) ::. ~~ :-:;, 4:J. -;: ~ ."0.1 rv " p. ~oox 104 rUEU69 . CERTIfICATION Of ADDRESS I hereby certify that the precise residence of the Grantee herein is: 19 Lancaster Avenue Enola, PA 17025 ~ Attorney or Agent for Grantee R. A~ Babula, Vice Pres1denr PNC Bank, M,A. CO~ONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: } RECORDED in the Office of the Recorder of Deeds in and for said County in Record Book~. page7~. WITNESS my hand and official seal this ~ _____ day of ~\} . 1994. ~;?~ Recorder of eeds 0'<799 ga~a ~L..,II.A V.I !!.~~a ? r".."~FilFil~ '1~!;lt;;:ig li?~~~ ~i::'i=l_ ~~i1.'1 ~ 1'1 ili' =' ~- .-. n ., ~ i = ~ ~ n 7.' " ~ ;? ~ ., g '" ~ 1 ". C" "'- i:i ~ ~ ~ ~ " ~ '" ." = :f ~ tit -, ~. = i ~OOK 104 fAtEUftQ ~ ~, ~ I' t: to ~. :::: 8~~g t~Dl~g:~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B060 1 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SUSAN M GARMAN 19 LANCASTER AVENUE ENOLA, PA 17025 -.-----~ fold ESTATE INFORMATION: SSN: 207-22-1471 FILE NUMBER: 2199-0001 DECEDENT NAME: FISHER JACOB K DATE OF PAYMENT: 11/14/2007 POSTMARK DATE: 11/14/2007 COUNTY: CUMBERLAND DATE OF DEATH: 06/23/1997 NO. CD 008971 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,826.39 I I I I I I I I TOTAL AMOUNT PAID: $1,826.39 REMARKS: RECEIPT GIVEN TO ATTY CHECK# 18274 INITIALS: JA RECEIVED BY: SEAL REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 1712B-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SUSAN M GARMAN 19 LANCASTER AVENUE ENOLA, PA 17025 ____nn fold ESTATE INFORMATION: SSN: 207-22-1471 FILE NUMBER: 2199-0001 DECEDENT NAME: FISHER JACOB K DATE OF PAYMENT: 11/14/2007 POSTMARK DATE: 11/14/2007 COUNTY: CUMBERLAND DATE OF DEATH: 06/23/1997 NO. CD 008972 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $6.32 I I I I I I I I TOTAL AMOUNT PAID: $6.32 REMARKS: RECEIPT GIVEN TO A TTY CHECK# 71408 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX * DATE 02-18-2008 ESTATE OF FISHER JACOB K DATE OF DEATH 06-23-1997 FILE NUMBER 21 99-0001 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 04-18-2008 ( See reverse side under Objections) Amount Remittedl ~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FISHER JACOB K FILE NO. 21 99-0001 ACN 101 DATE 02-18-2008 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 -..... '1 'J {. {- !"'::: 11: '~:, i (-~ '~ P DANIEL ALTLANDBSQ CALDWELL & KEARNS 3631 N FRONT ST HBG PA 17110 REV-15~7 EX AFP (06-05) TAX RETURN WAS: (X) ACCEPTED AS F I LED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. 13. 14. Net Value of Tax Return ( ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 18,928.50 .00 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. (8) 18,928.50 (9) (10) 415.00 .00 (11 ) (12) (13) 411;.00 18,513.50 .00 18,513.50 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (14) If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !hh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYMENT DATE 11-14-2007 11-14-2007 02-11-2008 Net Value of Estate Subject to Tax NOTE: RECEIPT NUMBER CD008972 CD008971 SBADJUST DISCOUNT (+) INTEREST/PEN PAID (-) .00 721.90- .00 (15) (16) .00 X 00 = 18,513.50 X 06 = .00 X 00 = .00 X 15 = (19)= .00 1,110.81 .00 .00 1,110.81 AMOUNT PAID 6.32 1,826.39 .28 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,110.81 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ..- . ( IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED. ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)