The URL can be used to link to this page

Home My WebLink About01-0586 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY (!;. .-ll~-- ~_~<iL __5_ FILE NUMBER 2 - 0 o 0 5 8 6 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) t- Z W C w ~ C CROTHERS JAMES M. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) ""COuNTYCci1iE' -YEA~ - - NuMBER- - SOCIAL SECURITY NUMBER 5 4 6 - 5 2 - 7 383 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3 03/22/2001 10/18/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ~ ~:!!:II) ult:~ wo..u J: 00 UIt:...J 0.. III 0.. <( CROTHERS JULIA E. BILLINGS 00 1. Original Return o 4. Limited Estate 00 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required L 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ~ z w o z o 0.. II) W It: It: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN H. BROUJOS ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY P.C. TELEPHONE NUMBER 717-243-4574 CARLISLE PA 17013 z o i= ~ ::) Q. :! o o >< < t- z o i= < ...J ::) t- ii: < o w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) :",,",\r ;:...1 ~ ' . _. - -- OFFICIAL USE ONLY 2 ::! ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19. Tax Due X _(15) 91 ,988.27 X .045 (16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 1,890.45 : , 95,532.00 ItS 97,422.45 3,323.94 2,110.24 (11) (12) (13) 5,434.18 91,988.27 (14) 91 ,988.27 4,139.47 4,139.47 Decedent's Complete Address: STREET ADDRESS 86 PLUM TREE CIRCLE CITY I STATE I ZIP NEWVILLE PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,139.47 4.000.00 200.00 Total Credits (A + B + C) (2) 4,200.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 60.53 0.00 0.00 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. Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration ohlneparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNA TUREOF PER~ON R~PONSIB~ FP~ ~ILI~G RETURN . DATE _ y: /~ L. 1';2vt~~ [r-^<-1) ~ 2- C&-- b '<: ADDRqS$ 86 PLUM TREE CI E / \ .. - \, WVI LLE SIGNATURE OF P RER ER PA 17241 DATE ,g-o "L ADDRESS PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P,S. ~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 0% [72 P,S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~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 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)j, The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P.S, ~9116(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. . ,~'~'"":'" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CROTHERS JAMES M. FILE NUMBER 21 01 00586 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Refund on medical claims from Presbyterian Board of Pensions VALUE AT DATE OF DEATH 665.45 2. Prepaid funeral account (Cremation Society of PA) 1,225.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 890.45 . .""'~":':'" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CROTHERS. JAMES M. FILE NUMBER 21 01 00586 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. John H. Crothers 6788 Armour Drive Oakland, CA 94611 son B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 12/98 Vanguard High Yield Corporate Fund, 5334.612 shares 36,382.00 50. 18,191.00 Acct. 9872489834, Fund 29 1.a. A 12/98 Vanguard High Yield - accrued dividends 200.00 50. 100.00 2. A 1 0/94 Vanguard Wellington Fund Inv., 1492.472 shares 40,759.00 50. 20,379.50 Accl. 9872489834, Fund 21 3. A 1994 Merrill Lynch Money Fund 29,390.00 50. 14,695.00 Accl. 897-20241 4. A 1994 Merrill Lynch - Bonds 5,140.00 50. 2,570.00 AT&T Capital Corp. ,200 shares 5. A 1994 Merrill Lynch - Mutual Funds 22,767.00 50. 11,383.50 Duff&Phelps UTL&CPTE, 1742 shares 6. A 1994 Merrill Lynch - Mutual Funds 109.00 50. 54.50 Govl. Securities Inc. Fund, 3831 shares 7. A 1994 Merrill Lynch - Mutual Funds 123.00 50. 61.50 Govt. Securities Inc. Fund, 4867 shares 8. A 1994 Merrill Lynch - Mutual Funds 39,298.00 50. 19,649.00 ML BD FD High Inc., 7210.799 shares 9. A 1994 Merrill Lynch - Mutual Funds 16,896.00 50. 8,448.00 ML US High Yield FD CLB, 2448.735 shares ( if I{ Ow r TOTAL (Also enter on line 6, Recapitulation) $ 95 532.00 . . (If more space IS needed, Insert additional sheets of the same size) REV-1511EX"(1;97) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CROTHERS. JAMES M. FILE NUMBER 21 01 00586 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Clergyman's Fee 200.00 2. Musician 50.00 3. Flowers 38.69 4. Reception and luncheon 105.00 5. Housing for family at funeral 434.00 6. Additional expenses (newspaper notification, county coroner, death certificates) 56.25 7. Cremation Society of Pennsylvania 1,225.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) 0.00 Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Broujos & Gilroy, P.C.; EIN 23-2267691 1,200.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Retum Prepare~s Fees 7. Register of Wills - Inheritance Tax Return filing fee 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 3 323.94 .. (If more space IS needed, Insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent . CROTHERS, JAMES M. 21 01 00586 Paqe 1 Schedule I - Debts or Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 1, Medical Expenses (net of Medicare) 91.80 Link to Life - 1/2/01, 1/6/01, 3/2/01 (dates of service) 2. Graham Medical Clinic-1/3/01, 1/7/01, 1/30/01,3/2/01,3/7/01,3/12/01 297.19 3. Cosmetics & Plastic Surgery Center - 1/6/01 46.55 4. Howard Burket, MD - 1/13/01 6.56 5. Family Home Health Care Products - 1/17/01 19.99 6. Central PA Oncology Assoc. - 1/23/01,2/27/01 313.16 Central PA Hematology Assoc. - 2/9/01 7. Lab work - 1/26/01 30.00 8. Carlisle Hospital - 1/29/01 853.00 9. Carlisle Hospital, Dr. Sola - 1/29/01 16.25 10. Carlisle Pathology Associates - 1/29/01 and 3/8/01 17.12 11. Dr. Winer, ER - 2/5/01 17.75 12. Dr. Hartzell - 2/15/01 15.00 13. Stoken Opthalmology - 2/20/01 22.18 14. Dr. Dagen - 3/14/01 170.86 15. Blue Mountain Anesthesia - 3/8/01 16.25 SUBTOTAL SCHEDULE I 1,933.66 .. Continuation of REV-1500 Inheritance Tax Return Resident Decedent CROTHERS, JAMES M. 21 01 00586 Page 2 Schedule I - Debts or Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Friendship Hose Co. - ambulance 2/5/01 30.08 17. Jay A. Townsend, MD - 1/30 to 2/14/01 46.50 18. Merrill Lynch Annual Service Fee 100.00 SUBTOTAL SCHEDULE I 176.58 GRAND TOTAL SCHEDULE I $ 2,110.24 '""."''''':'''' . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER r.ROTHFRS JAMES M. 21 01 on"RR RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Julia E. Billings spouse personal property aka Julia Crothers in common 86 Plum Tree Circle, Newville, PA 17241 residence 2. John H. Crothers son Remainder of 6788 Armour Drive estate Oakland, CA 94611 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. none B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. none TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) /6-o?3P-0>-- ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '02 DATE ESTATE OF DATE OF DEATH FILE NUMBER :$~NTY ACN 04-15-2002 CROTHERS 03-22-2001 21 01-0586 CUMBERLAND 101 f\PI~ 19 JOHN H BROUJOS ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE '* REV-1547 EX AFP 100-Dll JAMES M Anount Renitted l~.~i P A 17 0 13Cnn:; 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 = iS4-j-Ex--AFP--foY=02Y-Ncii'YcE--oF-YNHEiiifAi.fcrY'\"SC-A-PPRA-isEMENT-:--ALrOWAifcE-ifR'----------- --- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CROTHERS JAMES M FILE NO. 21 01-0586 ACN 101 DATE 04-15-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15) 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 17. Anount of Line 14 at Sibling rate (17) 18. Anount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 91,988.27 X 045 = 4,139.47 .00 X 12 = .00 .00 X 15 = .00 (19)= 4,138.47 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 (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 1,890.45 95,532.00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 3,323.94 2 . 11 0 . 24 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent. 97,422.45 5.434 18 91,988.27 .00 91,988.27 ""'''''''.Lr. [+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-21-2001 AA496753 206.92 4,000.00 04-08-2002 REFUND .00 68.45- TOTAL TAX CREDIT 4,138.47 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF KILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRA TIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount of the tax paid is allowed. PENALTY: The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (67-) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Da ily Interest Factor 1982 207- .000548 1992 97- .000247 1983 167- .000438 1993-1994 n .000192 1984 117- .000301 1995-1998 97- .000247 1985 137- .000356 1999 n .000192 1986 107- .000274 2000 87- .000219 1987 97- .000247 2001 97- .000247 1988-1991 117- .000301 2002 67- .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. \:1;; -0 3J?~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-U07 EX AFP 101-02) '02 did DATE ESTATE OF DATE OF DEATH 1'( r; 'IF:IL:E NUMBER COUNTY ACN 04-22-2002 CROTHERS 03-22-2001 21 01-0586 CUMBERLAND 101 JAMES M JOHN H BROUJOS ESQ BROUJOS 8 GILROY 4 N HANOVER ST CARLISLE PA 17013 '.' {." \ , ~ Il ; Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'EV=i6"ifi-E3f-AFP--foY:02Y------..i:--fNiiERITANc'E--TAx--STA-fE;:ii-tiT-OF'-AC-couiff--i:..---------------- ----- ESTATE OF CROTHERS JAMES M FILE NO.21 01-0586 ACN 101 DATE 04-22-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-15-2002 P R I NC I PAL TAX DUE: ....................................................................................................................................................................................................................... 4,138.47 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-21-2001 AA496753 206.92 4,000.00 04-08-2002 REFUND .00 68.45- TOTAL TAX CREDIT 4,138.47 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. I f NON-RESIDENT DECEDENT lIake check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices or froll the Department's Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone (717J 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is cOllputed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 198Z ZOZ .000548 199Z 9Z .000Z47 1983 16Z .000438 1993-1994 7Z .00019Z 1984 11Z .000301 1995-1998 9Z .000Z47 1985 13Z .000356 1999 7Z .00019Z 1986 10Z .000Z74 ZOOO 8Z .000Z19 1987 9Z .000Z47 ZOO 1 9Z .000Z47 1988-1991 11;C .000301 ZOOZ 6Z .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Q;/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: James M. Crothers Date of Death: 3-21-01 Will No. Admin. No. 21-01-0586 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account/statement with the Court? Yes No X - ONLY INHERITANCE TAX PAID b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an/account informally to the parties in interest? Yes No V d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk an' 0 d may be attached to this report. hn H. Broujos 4 N. Hanover St., Carlisle, PA 17013 717-243-4574 Date: 5-24-02 Capacity: Personal Representative X Counsel for Personal Representative C-..:j ~-- .-- ~- -~-------------------~--- ----.,.y---~ -------'-~~----- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT No.AA 496753 REV-1162 EX (11-96) RECEIVED FROM: I ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4.000.00 BPOUJOS JOHN ESQ (.. f\l H{if'JDV[F~ ~;T CARLISL.E. ~:)A 1'7013 . __ FOLD HERE FOLD HERE - ESTATE INFORMATION: 1 FILE NUMBER i? 1 E2 (> () 1 'O~)Et6 ~3 ~; f\} ~:.i'-+ 6 -' :J c> 7:3 Ei :3 NAME OF DECEDENT (LAST) (FIRST) (MI) Cn(}THEP~::' JAME~j f'1 DATE OF PAYMENT 6 / i:-2 1 / L~ (H) 1 POSTMARK DATE 0 /00 /(lO(}(' COUNTY C:Ul"BEnLAr"jD DATE OF DEATH ., / ~~ Z~ / Z::(JCi 1 ...j JUHN f-~ L~<U I Ht.:.l'.;j '. "" . , , , )l''''''~ . -.:p :~t. .. .)()(l . (.11)..('. TOTAL AMOUNT PAID- REMARKS RECEIVED BY ~'_k../ C/O JCjH!\i i'j m<OUJOS F.sO\.JI~:-.tE l":AR t;/tt ('_ ,c"-"'# ,n"" '"'''[]''''''T!:''' /, r. j . ;f1.4.I--U ,J1L~.1'. . ., ...J t<t:. 1 ::) ~;.t-y -,,' ,4--- ;/ SEAL (/ -' ;(;,"'I";!-:. REGISTER OF WILLS /'Yr',:/' ____--~---~---------~-~-~-------~-------L----- '..1"