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Home My WebLink About01-0929 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~})IJIPIJ ~A~ G SI-;;[~ 1_ also known as I No. To: OlI-OI-qZC( Register of Wills for the County of in the Commonwealth of Pennsylvania Deceased. Social Security No. .I 9 g, (J 1-- 3/39' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl I E.~ for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in h eP./ last family or principal residence at D<;fendent, then . q t years of age, died at t 1~lJ1f Ii I LL- e _ e (, e tJfeih County, Pennsylvania with sIt-veI!..- I (~J~ /11 . I . C'. =-1 ~^flAJ9 za~ (list strtet, number and municipality) c.Jf" P/~/a/ ~-, Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $~/9. :22 $ $ $ Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name SU-NE ;rEN5~ THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. - Ii qv~~~ -00 ~.O C':$"O 3~ <lJ '- 50 <is <= OJ) Vi {l,/Z'JY OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF OlAJY\ 13E::KLAi'LI) } ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. t?~/ --- '" '-' CI) ..... ;::3 ...... ro ::: OIl Ci5 Estate of No. ~/-DI-,qlq D 0 ~ 0 r/1 '/ q. ~ -rA I-t L , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW Oc'T. to .K Z..o(::\h consideration of the petition on the reverse side hereof, satisfactory .Eroof~~n~ be~n. presented before me, lT IS DECREED that ....:ru.-N E;. ....J e:N~t::N is! aHl' entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ..:rUJJE ~E:1\J in the estate of \)0 ROT H- 'l ~. eTA- r(L FEES . Letters of Administration ..... $~' 00 Short Certificates(2.) . . . . . . . . .. $ . 0 R ., $ 10 0 enun""tlon ......;;rtr... $~ Filed .lO: q. . . . ~~~.~~. ~.~. ~ Dl ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE IY@llD -ro fMnlNlsrMTDK l{'f1<::QI\<:: or" '.1,I~'< This is to certify that the infotmation here given is correctly copied from an otiginal certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~jR,9~~ Fee for rhis cerrificare, $2.00 p 7733006 <::: ~;l~/ . t'/ Dare r-110~ 4J As.. U87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 'EJPAtNl IN 'IiIAHEN T lCKINK elT". SEx STAlE I=1lJ: ~UM8EA Sl..."CIAL SECUAtT'l' NUMBER ~ ~ ~ c ~ . ~ ( z 1. AGE IlaSl 6oftt\dav1 S If/HI- UNDER 1 OAr ...... ...... 2. t."",,'M~ 3. 1i'!:5 - OJ B&RTHPLACE:C.r,M1O ~EOFDEATHll:"ec:II01I""""~'- ...'>il,....:hu"tor'lQtf'el MJctI 3~.Cl'iCl*'Qf1COUnfl....1 HOSPITAL. ( . '1 D. 1...'_ 0 'RIC'uo>'".''' ::= 7. V.... Al,),,"'" ~ L-r ... FACIlITV NAME it! nol of1s",\...11Of' 1.)l..e Sft'HI'.ano nombfilrl r ~.;-. 2~"", qtf 5. ""* ~ \Specll'y,U .... [' DECEDENT'S ACTUAL RESIDENCE ISee on&lNChON cnoltlelSlOeJ 17.. Slat. pc, MARITAl STATUS. Married N...., ....",Iltd. Widow<<!. 0N0ru41~1 ,.. "v.k..", \7C.OO ......o.c.ctenl:lftleclift 5.L "i.IL St./A'VlVINQ SPOuSE ,d...... ;pvern.a.oetll\Mnet 17b. Caun Did --'" I......". etA MPJE~~..;,.....i:") township? 17d.O ~~.'::of MOTHER'S NAME IF"s1. 'ot.a0le. -Iola.oeo 5<Ir.....,r., 11. )11/;;: LIIJ ),;/?,."J:;.I'/ INFORMANT'S MAlUHO AOQRESS ISlr_. C,tyl"".own. SIal., ZipCodel 200. 'i S,,,.-.i D;::..,.: (VIE'-IIWI($I3"~ f.4 \ ,,:,'3'; PlACE OF OISPOsmoH - N."... of Cemetery, Crem,lloty LOCAT}()N. Cir,JTown. SI.II., Z"IP COdlt OI'~Pt.ae. ..... ""-.. I I c . . , . ( ~ Removilll,om SIal. 0 2fc. eA) I p.., 11/0, rll.\(, )'1. 2",,', 9!' PER~ ACTING AS SUCH lICENSE NUMBER .;~ 22.. CI.)./,~). L. 10 ,,. bnl: of my~. lJealh OCCUlred oI11r'le l,me. ~I' ~ p('~ Sl.ted ~f.andTillel 230. TIME OF OERH DATE PRONOVNCED DEAD IMonrt\. Day, Yean 2'. 7:';-:; ,., M 2.. rllo/6 t<;,2..........., 27. PIUfT I: Ent., tht' otM&H'. InlUf,"Ofcompllcacl()f'lll.hichc:aUUCIlhe l3ealh 00 nee ..,....IM modtI 01 dyll'lg. SUCh as c:arCkaC: at relpHatory lIuest snock or heen lellul' LISt onfy ane ~ on ..ch hne. C),/I ...0 Medullary Failure 21. '~XlIYIat. :=== I : PART II: Othef S9"tftcanl conditIoN c:oncreutinQ 10 0Nln. Dul I'llX rnuft~ In the ~ c:auM 'iJI'*l1l\ PART I Fracture-Right Hip DuE TO (OR AS A CONSEOUENCE OF): Res iratorv Failure Due 10 lOA AS A CONSEOUENCE OF): l : WERE AUTOPSV FtNDtNGS .uJLABLE PRtQR 10 COMPLETtON OF CAUse OFOERH1 DUE TO tOA AS A CONSEOUENCE OF}: ...~ _0 MANNER Of DEATH ...... t'!( -... 0 - 0 P~ng InYUli;allon 0 -... 0 Could nor be det.muned 0 DATE OF INJURY (Monll'l.~'1."'arl TIUE OF INJURY INJURY IfS WORK? DESCRIBE HOW INJURY OCCURRED. Y.. 0 ...0 ...0 ... 'PAONOUNCING AND CERTIFYING PHYSICIAN (PtI~'iIC~ boIrI ;.lIOIlOunc....g oe.'" d'ldc~tl....1OQ lO';du$8 of ded:f\, To the ~ of my kno_..ov.. death occurred al IN ItIne. date. and pl.U. "net due to lhe cauM(.) 11M mlllme,.. staled. lJ D. O. HARRISBURG PA 17111 2". 2.. CERTlf'IEA ICneck or1Iy 'Yle~ .CEftTIFY1NG PttYStClAN IPhysclafl Celh'ylOQ CilU_ 01 de.il1tI 'o\IIher'>dflOCtl8f of!Y5IC,ant'l;jlspfClnOl.nced tJe.dl" <lna comOletea '!efT'I .?Jl To the beet 0' my kno..~. dealh occurNd due 10 Ihe ~sJ and manner... sut". . . ... PlACE OF INJURy - AI hOme larm. SlfHf. l~orv. "me. but6dInQ. !IlC.ISpec,M _. "MEDICAL EXAMINER/CORONER On the be.i. 01 ...mlnellon .nd/or Inv.stigahon. in my opinion. d..th occurred at the Iim.. date. ,Jnd place. ,Jnd due 10 'he cause(a) and menn.r a. ......... .. .... .. . .. . ... .. ...... . . . . . . .. ......... .... ... . . . .. .. ., .. . . )111. REGISTRARS SIGNATuRE AND NUMSER c:: IJYdJ1,pl J4 '(.~I '"" . r-.. f" '""' ""- ~- j - '......- I - 1 Clot -T - . 5.0D RENUNCIATION In Re Estate of DOROnt'-l q. STAHL o lAJYlB ~LA1"D deceased. To the Register of Wills of County, Pennsylvania. The undersigned DDN A'll) :;; TA H L (\SUN) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters A DrYlJ N 16 TRA TJ ON JUNE ..JEN0EN be issued to ---- WITNESS hand this / day of / / ,19_. xolJ (Signature) 353 t€luee w~d ;fad ><mM&vIUe N~ ;(Y//7 (Address) (Signature) (Address) (Signature) (Address) /"). r::.r-- ~1 eX J - 0 I - I 0(_ : !5{JD RENUNCIATION In Re Estate of DOR-UTH ~I G,. 6TA Ii L Cutm BERl-A1J D deceased. To the Register of Wills of County, Pennsylvania. The undersigned PlZED 6Zl C:.K... 0 fA J.I L L.5() N ') of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters A 1>YV11 N ISTIZA T\ ON JC,lNE -JEN~EN be issued to WITNESS .~/ /" hand this day of /' ----. ,19_. <<~(7:ytJ;O (Signature) -f--,j. ~~ ~ ~fJA (Address) (Signature) (Address) (Signature) (Address) DEX55 (9-93) '* COMMONWEALTH OF PENNSYlVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE Dear Register of Wills: Enclosed you will find: ~check(s) Ddocuments(s) which were received by the Department of Revenue in error. These may be proces'd~ccording to normal procedures. REMINDER: The POST MARK DATE on envelope attached to any checks enclosed must appear on your Official Receipt. Thank you. Sincerely, John Murphy, Chief Inheritance Tax Division (717) 787-6201 Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes Dept. 280601 Harrisburg, PA 17128-0601 fiRST It.A.W r. . , ~"'lQ_ ~;-c~ MU'12 'if: ~~ relis56Lu.s. ~o_ - .... ~A .....V..~I:~~ ..-..... .... /"" ,....;:M '" '-..'-..--"'- .--.- MS MARY C LEWI3 REGISTER OF WILLS CUMBERLAND CO COURTHOUSE 1 COURTHOUSE SQ CARLISLE PA 1.7013 ~2/-ol-f?~ c; 1f:G \!o.\~-~~~2. 0.'2. 111111111I 11111111111" II" ,1111111111111" 1,11,111111111 J 1111 C H R'rs T M A ~ Ms. June Jensen 9 _y Dr. Mechanlcsburg. P^ 17050-1535 - /~}.;J R 'J ,il i ~J:...:...C-.) . P i/l. \:", cc '--.J , ;',... " r. .-c :\1 r-c \1 · '- 200,\ / -~._~ --------_.r ! --"'---. ~~- ,..-p.-"""----.,---. =--:: .,..,....""~",....,.L...:,~~~.,.._ ~ ~<~~--- ---... " .....-........,-~-.."--;.- ~na Pb~ph.iaM\IIIOUmofA. E-143 EX (3-99) PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 0\ /q ~ ~ /), \J Zip Code Attention: TIC 340 \ '~'l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' / '1-/~ - /'-1 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0929 ACN 01156510 DATE 11-21-2001 .~ REV-15~5 EX AFP (09-001 ReGo B8(:,\EsT. OF DOROTHY G STAHL S.S. NO. 198-01-3139 DATE OF DEATH 08-25-2001 .02 JAM -4 P1~otiiTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. JUNE I JENSEN 9 SMILEY DR RR 4 MECHANICSBURG PA 17050 Cleri', Cumben,: i f)/\ RE"IT PAY"ENT AND FOR"S TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICE has provided the Departllent with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this inforllation is incorrect, please obtain written correction from the financial institution, attach a COpy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllmonwealth of Pennsylvania. Questions lIay be answered by calling (117) i87-8~l7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 80000002186350 Date 10-14-1999 Established x 6,924.33 50.000 3,462.17 .15 519.33 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must aCCOllpany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax paYllents are made within three (3) lIonths of the decedent.s date of death, you lIay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You lIay choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. ~ The above information is incorrect and/or debts and deductions were paid by you. You IIUSt cOllplete PART ~ and/or PART ~ below. DEBTS AND DEDUCTIONS CLAIMED PART If you indicate a different tax r~~le~ state your @] relationship to decedent: -n A.I.Itf e - TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I my knowledge and belief. ~a;~Erep~1ii a~o~v~a~re'E~? irrect and WORK ("717 )c:!)..J '~3CJ() I?!rW/J/ TE EPHONE NU BE D GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. LINE 1. Enter NOTE: TAX RETURN - PART 2 - TAX COMPUTATION the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.77. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 507. (TAXABLE FOR EACH SURVIVDR) . . .' 4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount SUbject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. ' MThe 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 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descllnd~l!It9. "Children" includes natural children whether or not they have been adopted by others, adopted children and step ~~dren. "~fteal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopte~f~~' adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at leas~~e'~afent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Oat. 0-1' Death Spouse Lineal SiblIng Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X '.' .~X 15X 07/01/00 to present OX 4,5XII 12X 15X CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JENSEN JUNE I 9 SMILEY DRIVE RR 4 MECHANICSBURG, PA 17050 _n_n__ fold ESTATE INFORMATION: SSN: 198-01-3139 FILE NUMBER: 2 1 - 2001 - 0929 DECEDENT NAME: ST AHL DOROTHY G DATE OF PAYMENT: 01/04/2002 POSTMARK DATE: 12/31/2001 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2001 NO. CD 000717 ACN ASSESSMENT CONTROL NUMBER AMOUNT 01156510 I $23.33 \ \ I I I I I I TOTAL AMOUNT PAID: $23.33 REMARKS: JUNE I JENSEN CHECK# 4202 INITIALS: SK RECEIVED BY: SEAL MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS , , 1\ ~~ J j (V"~ .;i~>l .: : . 1".' 4~' 4 II' . t , . ) II II) (ill!(\ ~ , 'F\ \ \ 'S' ~ \ '- ~ \ -- """"',\ "\ <3 I I Ql 8 c. N '" .., 5 ~ 6 '" III ~ = ~ ~ ~ G.I ~ ~ .S ~ = d~ ..,~ iii ~'5 ~ :E OIl .. i I li ~ ~ ! w cr: j~ wtn ::;)W Z><Z W~O >...IC;; Wc(_ a:::;)~ &Lee o>~ 1-- ze,. w~w,.." ~&L(,)Qa: itOZ!::;) !C::;)~cotD Q;c(-Ntn wwa:,.:<< ea:!!!a.a: !C::;)-wc( Q;tD~ex: - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - - - -= - - -= - - - C)) \ (~-, ) ------' Il@ c 0 z S no c: If) :x:z m ~!:( -4 ~ ~c en o~ m ~ ~-1 6 OJ:x: 5- 000 "V m "m :;; OJZ -< ~< g . m -u5 > >"'0 :II :\m m ,,'," !: .. - > "T1 25 ... -< z % 0 C) ~ c > "V ,:: ~ -< !: 0 m C ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* /1--/~- If INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0929 01151754 11-08-2001 \~J \J V REV-1545 EX iFP 109-001 Recor~) ." Rep\;) EST. OF DOROTHY G STAHL S.S. NO. 198-01-3139 DATE OF DEATH 08-25-2001 ~2:OQbUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. .02 JAN-4 JUNE I JENSEN 9 SMILEY DR MECHANICSBURG CierK... PA 1705SC'Aunbe: 00.' pL, REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MELLON BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Penns3'lvi:iniCl. .uestioil3 itiay b-. anslJierSid b::t calling {717} 787-832:7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 100-008-2535 Date 10-02-1996 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 376.22 50.000 188.11 .15 28.22 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART If you indicate a differen~t~,r~~~~ase state your ~ relationship to decedent: :J2~~ TAX RETURN - COMPUTATION OF TAX ON JOINThlRUST ACCOUNTS LINE 1. Date Established I / f)' tJ~, tq Lffp,. 2. Account Balance 2 -:371LJ. a,~ 3. Percent Taxable 3 , () 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I have reported above are true, correct end ledge and belief. HOME TAXPAYER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C _ If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIOED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe 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%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sib1,ing Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4,5XIE 12X 15X CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JENSEN JUNE 9 SMILEY DRIVE MECHANICSBURG, PA 17050-1535 u______ fold ESTATE INFORMATION: SSN: 198-01-3139 FILE NUMBER: 21-2001- 0929 DECEDENT NAME: STAHL DOROTHY G DATE OF PAYMENT: 01/04/2002 POSTMARK DATE: 12/31/2001 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2001 NO. CD 000718 ACN ASSESSMENT CONTROL NUMBER AMOUNT 01151754 I $8.47 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JUNE I JENSEN CHECK# 4201 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $8.4 7 MARY C. LEWIS REGISTER OF WILLS ~. ,. II Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) JJtgePMy a &/-aiJL tfbs h / , Date of Death: Will No. Admin~(' d~O 1- tJ()tj;L 9 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on /cJ '~5.CJ I Name Address '))(}I)a.-Ld tv ~izAL L:J5-3 Rvee ~ I?d /IItJ4&tltLLe M c:2f//l lterlet:IJ( F 3la.AL ~ ;rJdAJOJ'! f!; Liflcsfrcd,V fflL7~ Jtwe .L 0 Pfils,o--u q 2indey JJe ~ 1C!5 ~ ~~ ~~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except AIM , (I) a: N P .,.:;i ..2:g 'J) == ..,..,. .." DU Q::t---cOf~ ~j SI ature Name ~L//IJe- '-C. JeVSe/lJ Add"" q ~ iey ))E Neda~/tC-$6rLilf IA J1ILS{) TelephoneQrl 166-~31/ Capacity: /personal Representative Date: I /f~~;l I / \0 1.[:' r-- ..- z -::::: J _Counsel for personal representative /?-/~ -If BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *,0 NOTICE OF INHERITANCE TAX APPRAISE"ENT~ ALLOHANCE OR DISALLOHANCE OF DEDUCTION~, AND ASSESS"ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS .02 I'JAR 1 8 f) 2 :! 4 JUNE I JENSEN 9 SMILEY DR MECHANICSBURG (:~PA17055 Lurm.J. REY-1548 EX AFP '01-021 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-18-2002 STAHL 08-25-2001 21 01-0929 CUMBERLAND 198-01-3139 01151754 Allount Rellitted DOROTHY G 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 ~ REli=isiri-Ex--AFP--foi-=o21------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-18-2002 ESTATE OF STAHL DOROTHY COUNTY CUMBERLAND G DATE OF DEATH 08-25-2001 FILE NO. 21 01-0929 TAX RETURN WAS: S.S/D.C. NO. 198-01-3139 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MELLON BANK ACN 01151754 ACCOUNT NO. 100-008-2535 TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-02-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due 376.22 0.500 188.11 .00 188.11 .45 8.46 X X TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-31-2001 CDOOO718 .00 8.47 TOTAL TAX CREDIT 8.47 BALANCE OF TAX DUE .01CR INTEREST AND PEN. .00 TOTAL DUE .01CR · IF PAID AFTER THIS DATE, 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" ( CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PURPOSE OF NOTICE: TD fulfill the requirements Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S. SectiDn 9140). PAYMENT: Detach the tDP pDrtiDn reverse side. -- Make check Dr mDney Df this NDtice and submit with YDur payment tD the Register Df Wills printed Dn the Drder payable tD: REGISTER OF WILLS, AGENT. REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the tax return, may be requested by cDmpleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the 23 Revenue District Offices Dr by calling the special 24-hDur answering service fDr fDrms Drdering: 1-800-362-2050; services fDr taxpayers with special hearing and Dr speaking needs: 1-800-447-3020 (TT Dnly). OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice may Dbject within sixty (60) days Df receipt Df this NDtice by: --written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing tD have the matter determined at the audit Df the accDunt Df the persDnal representative, OR --appeal tD the Orphans' CDurt ADMIN- ISTRATIVE CORRECTIONS: Factual errDrs discDvered Dn this assessment ShDUld be addressed in writing tD: PA Department Df Revenue, Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 PhDne (717) 787-6505. See page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs. DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df the tax paid is allDwed. PENALTY: The 15% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn penalty is appealable in the same manner and in the the same time periDd as YDU wDuld appeal the tax and interest that has been assessed as indicated Dn this nDtice. INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDm the date Df death, tD the date Df payment. Taxes which became delinquent befDre January 1, 1982 bear interest at the rate Df six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn Dr after January 1, 1982 will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 1982 thrDugh 200Z are: Year Interest Rate Daily Interest FactDr Year futm~d Rate Daily Interest FactDr 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as fDIIDws: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated. r-~---. -.- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *,C NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOHANCE OR DISALLONANCE OF DEDUCTION~, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-15~8 EX AFP (Ol-m L l , ii~l DATE - <j ESTATE OF DATE OF DEATH FILE NUMBER ZOo COUNTY SSN/DC ACN 03-18-2002 STAHL 08-25-2001 21 01-0929 CUMBERLAND 198-01-3139 01156510 Allount Rellitted DOROTHY G JUNE I JENSEN 9 SMILEY DR RR 4 MECHANICSBURG PA 17050 P / J;l. '11 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Ms. June Jensen ~:t,~~~rg. P^ 17050-1535 /' I- t" .- -- \ - . '\ ~..,.,~, ~~....-.'Wc"""...<,":>_. -.1 ~/ "---""""" """'........""'.,B.. ~""'.,', "><'",~"""",,,,,,,,_,_,,, ,.' r. I \ r~ V . d JddIaJ ! ~L-~~~ ,:. ~ I;J~ /1()/3 -""':._--'/ ~f>~.n-_~ .....-....-. ~ -.., .. ....... " '~ r .... .J ....~ i {;:; i :3./::::::03:'2. L II Hilllliilllluli! ,Hili H I! J /ill! i nl! i ,Illl Hi " -, ~ .' , STATUS REPORT UNDER RULE 6.12 NameofDecedent: ~,&f4 G S-(/lAL. Date of Death: 9/rl2~tJ / t\~ Will No.: Admin. No.: <X 00/" Jf4.:z1 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No 0 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 with the Court? Yes -/ No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal ~}esentative state an account informally to the parties in interest? Yes M No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~~erA-- ~h~ Jttllu ,~ J~JJS~tJ Name if .i:huky ])A fib/; d /1t15tJ Address 2(7 ,7(/1, ,f'? 7/ elephone No. Capacity: ~rsonal Representative o Counsel for personal representative //-/~-/~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1U7 EX AFP IDl-OZl JUNE .02 I ['J~Na~ .5 9 SMILEY DR RR 4 ..... MECHA~~~~RG PA 17050 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-06-2002 STAHL 08-25-2001 21 01-0929 CUMBERLAND 01156510 DOROTHY G 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =i61fj-Ex-AFP-foY:02Y------...-fNHERITANc'E--TAx--sTAfiH'E-NT-cfF'-Accouiff--.-..------------------ - -- ESTATE OF STAHL DOROTHY G FILE NO.21 01-0929 ACN 01156510 DATE 05-06-2002 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: 03-18-2002 P R I N C I PAL TAX DUE: .__m.m...mmmmm_m.mm...mm_m__m...mmmm_m.mmmmmm.m_...m_m..._._m.mm_m.._._._....m_...._........... 155.80 PAYMENTS (TAX CREDITS): PAY PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-31-2001 CDOOO717 .00 23.33 MENT MUST BE MADE BY 05-26-2002*. TOTAL TAX CREDIT 23.33 BALANCE OF TAX DUE 132.47 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 132.47 . 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 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. If NON-RESIDENT DECEDENT make check or money order payable to: C0l1110NWEAL TH OF PENNSYLVANIA. REFUND (CRl: 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-13l3l. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 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 eTT onlyl. REPLY TD: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Ass~ssment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (7171 787-6505. DISCOUNT: If any tax due is paid within three (3l calendar months after the decedent's death, a five percent (57-l 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9l months and one (ll 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-l 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 Daily 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 NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15l 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. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JENSEN JUNE 9 SMILEY DRIVE MECHANICSBURG, PA 17050-1535 _____n_ fold ESTATE INFORMATION: SSN: 198-01-3139 FILE NUMBER: 2101-0929 DECEDENT NAME: ST AHL DOROTHY G DATE OF PAYMENT: 05/17/2002 POSTMARK DATE: 05/15/2002 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2001 NO. CD 001190 ACN ASSESSMENT CONTROL NUMBER AMOUNT 01156510 I $132.47 I I I I I I I I TOTAL AMOUNT PAID: $132.47 REMARKS: JUNE JENSEN CHECK# 4228 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS / ?-I.:z-/~ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-U01 EX AFP 101-021 JUNE I JENSEN 9 SMILEY DR RR 4 MECHANICSBURG rill! 31 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-28-2002 STAHL 08-25-2001 21 01-0929 CUMBERLAND 01156510 DOROTHY G '02 :r:., 1 Allount Rellitted t...... PA 17fJ'~"; 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i6oj-Ex-AFP-[oY:o'2Y------...-iNHERI'TANc'E--fAx-sTA-fEMEtif-'ifF'-ACCOLitff--...--------------- - -- --- ESTATE OF STAHL DOROTHY G FILE NO.21 01-0929 ACN 01156510 DATE 05-28-2002 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: 03-18-2002 P R I NC I PAL TAX DUE: .mmm........m.............mmm........................m.........mmmmmmmm......mmm......m......m......mmmmmmmm..m.............mmm..mmm............... 155.80 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-31-2001 CDOOO717 .00 23.33 05-15-2002 CDOO1190 .00 132.47 TOTAL TAX CREDIT 155.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . 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 sub.it with your pay.ent made payable to the na.e and address printed on the reverse side. If RESIDENT DECEDENT make check or .oney order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or .oney 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 23 Revenue District Offices or fro. the Depart.ent's 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). 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. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax a.nesty 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 a.nesty 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 pay.ent. Taxes which beca.e delinquent before January 1, 1982 bear interest at the rate of six (6%) 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 Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .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. . -,. _~ ,~ R f NOTICE OF INHERITANCE TAX pennsylvan~a :`. ~ ~;~; ,~$~rT~t ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE ~ r BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION ~ IL~.~~ti;a~ h~~D~~~~T~ONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-09? PO BOX 280601 HARRISBURG PA 17128-0601 ZO ~ U ~~C ~ Q Qil ~ ~ ~ ~ ~ DAT E 12 - 0 6 - 2 010 ESTATE OF STAHL DOROTHY G ~~E~~ ~~ DATE OF DEATH 08-25-2001 QRPH~1~,~,~ ~~U~T F I L E N UMBER 21 O 1- 0 9 2 9 ~r~ h ~ ~''~~~~~~-~~''"~ ~~~• ~~ ACNNTY ~~MBERLAND JUNE I JENSEN 9 SMILEY DR APPEAL DATE: 02-04-2011 M E C H A N I C S B U R G P A 17 0 5 0 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE _ --~ --RETA_IN LOWER POR_TION_ FOR YOUR RECORDS F-'- _ ___ ______ _ REV-1547 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR - + DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: STAHL DOROTHY GFILE N0.:21 01-0929 ACN: 101 DATE: 12-06-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED 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) cl) .00 c2) .00 c3) .00 c4) .00 c5) .00 C6) .00 v) .00 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. ~$) .00 C9) .00 Clo) .00 11 Total Deductions C11) .0 0 . 12. Net Value of Tax Return C12) .0 0 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to lax C14) .0 0 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 0 4 5 = .0 0 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .00 19. Principal Tax Due C19)= .0 0 TAY f`R~TITTC PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~