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Home My WebLink About03-20-08 --.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 5 File Number 5 9 Date of Birth 009109811 o 1 0 8 2 0 0 5 04121922 Decedent's Last Name Suffix Decedent's First Name Claire MI R e t t b erg Ann (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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 00 1. Original Return o 4. Limited Estate o o 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes Way n e F Firm Name (If Applicable) Shade 71724 3 022 0 - - REGISTER OF WILLS USE ONLY ------------- ------ -, First line of address 5 3 W est Pomfret S t r e e t :....:," Second line of address ;;:u f',) '---' City or Post Office State ZIP Code , . DM'~ FILED=~~ Car 1 i s 1 e PA 17013 C,..) Correspondent's e-mail address:waynefshade(ti}comcast.net Under penalties of peljury, I declare that I have examined this return, induding 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 infonnation of which preparer has any knowledge. SIGNA TU OF PERS N ESP IB E FOR FILING RETURN DATE ~ ~ --lcY8 ADDRESS 19 Mine Run Road ER THAN REPRESENTATIVE Schwenksville PA 19473 ADDRESS 53 West Pomfret Street 3 Carlisle PLEASE USE ORIGINAL FORM ONLY PA 17013 Side 1 L 15056041125 15056041125 --.J -I 15056042126 REV-1500 EX Decedent's Social Security Number ~ Decedent's Name: Claire Ann Rettberg RECAPITULATION 009109811 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 103049.85 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. 2 0 4 2 6. 8 9 ...... . 6. Jointly Owned Properly (Schedule F) D Separate Billing Requested . . . . . . . 6. 9 5 7 1 . 9 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) . 0 Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets (total Lines 1-7) 8. 1 3 3 0 4 8 . 7 3 .......................... . 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 3 8 8 1 . 4 0 ............... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 9 . 9 0 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 3 8 9 1 . 3 0 12. Net Value of Estate (Line 8 minus Line 11) .........................12. 1 1 9 1 5 7 . 4 3 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. 119157.43 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 _ 16. Amount of Line 14 taxable at lineal rate X .O~. 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 o . 0 0 18. O. 0 0 5362.08 O. 0 0 O. 0 0 5362.08 o . 0 0 15. 119157.40 16. o . 0 0 17. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 ---1 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Claire Ann Rettberg STREET ADDRESS 620 Letort Spring Road File Number 21 05 59 CITY Carlisle - - -- - . _..~_.._---._------------....- I-STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 5,362.08 4,300.00 226.31 Total Credits (A + 8 + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty 147.99 4,526.31 4. T otallnteresUPenalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) (4) (5) (5A) (58) 147.99 0.00 983.76 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 983.76 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 IKl b. retain the right to designate who shall use the property transferred or its income; ............................... 0 IKl c. retain a reversionary interest; or ................................................................................................ 0 IKl d. receive the promise for life of either payments, benefits or care? ....................................................... 0 IKl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 IKl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 IKl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 IKl 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-{me 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. REV-1502i:X + (6-98) '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Claire Ann Rettber 21 05 59 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real ro e which is' in .owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM NUMBER 1. TOTAL (Also enter on line 1, Recapitulation) $ (If mnrp. ~n"'r.p. i~ nP.P.rlp.n inAArt ",nnilinn",' ~hp.p.'" nf thp. AAmp. ~i7P.l 103,049.85 REV-15ml EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Claire Ann Rettberg ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. FILE NUMBER 21 05 59 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. M&TB VALUE AT DATE OF DEATH 1,21 . Household contents 235.00 854.820 shares ofGNMA Fund-Class AARP Account #00705322458 at $15.16 per share 12,957.07 Cash 3,955.73 Wachovia Bank., N.A., Certificate of Deposit #247022041118070 1,130.12 Shipley Energy Co., monthly budget fuel oil credit 137.77 Ralph M. Rettberg, fuel oil reimbursement 162.47 Catholic Digest, subscription refund 21.00 Prudential Financial, dividend 79.50 The Patriot-News, subscription refund 8.10 Commonwealth of Pennsylvania, property tax rebate 500.00 1 st Advantage Settlement Services, Inc., refund of overpayment of water and sewer 29.25 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 20,426.89 !1 M&TBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 February 10, 2005 Wayne F Shade Attorney At Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 Re: Estate of Claire Ann Rettberg Social Security: 009-10-9811 Date of Death: Januarv 08. 2005 Dear Sir or Madam: Per your inquiry dated January 24, 2005, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 71399283 Ownership (Names oj) Claire Ann Rettberg * Ralph M Rettberg, POA Opening Date 10/28/75 Balance on Date of Death $1,210.88 $ 0.00 Accrued Interest Total Ho..... ......_......... ......._...._ ..._.................._.......~....___,_.............._.. .._....................._........................._...._........_........................ $1,210.88 Please be advised, there was no safe deposit box found for the above decedent. Our records also indicate two closed accounts. Savings Account 02100oo01191361 fonnerly Allfirst # 87004906704565 which was closed 7/23/04 and a CD account # 87008000088800 which was opened 10/22/1992 and closed 9/28/2000. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call the Spring Garden Office # 717-240-4525. Sincerely, Nancy Clagett Records Management ABBOTTS ANTIQUES 1700 Main St Collegeville Pa 610-489-0667 John Godillot - Proprietor Jan 27, 2005 INVENTORY AND APPRAISEMENT OF PERSONAL PROPERTY - ESTATE OF CLAIRE ANN RETTBERG - DECEASED 19 MINE IDLL RD SCHWENKSVILLE P A 19473 Undersigned states that he has been in the business of buying selling and appraising Antiques and Household goods for the past 30 years and is familiar with the value of the items inventoried hereunder. The values affixed represent the fair market value to the best of his information knowledge and belief. 4 Piece Maple Bed Room Set by Chatauqua $200.00 Lamp Table 5.00 Tier Table 5.00 Lot Costume Jewelry 25.00 Appraisal Fee $25.00 -- receipt of which is hereby acknowledged ~0j~~ John Godillot Appraiser . -....~ .~~~ WACHOVIA Reference ill: 1128297 Wachovia Bank N.A. Balance Confirmation Services POBox 40028 Roanoke, VA 24022-73 I3 February 2, 2005 WAYNE F SHADE ATTORNEY AT LAW 53 WEST POMFRET ST CARLISLE, P A 17013 SUBJECT: Verification / ConfIrmation of AccOImt and Balance Information provided for: Customer: CLAIRE ANN RETTBERG (SSN# 009-10-9811) Date of Death: January 8, 2005 Deoosit Account Information Account Account Date of Death Average Date Maturity Interest Accrued YTD Date Type Number Balance Balance. Opened Date Rate Interest Interest Paid Closed CERTIFICATE OF DEPOSIT 247022041118070 $1,130.12 3/27/2000 6/27/2005 1.09 $0.47 $0.00 LEGAL TITLE: CLAIRE ANN RETTBERG RALPH M RETTBERG POA CHECKING 1010083586792 $3,456.05 10/24/2003 .10 $0.26 $0.00 LEGAL TITLE: CLAIRE ANN RETTBERG RALPH M RETTBERG CHECKING 1010083586802 $15,676.33 10/24/2003 1.0 $11.58 $0.00 LEGAL TITLE: CLAIRE ANN RETTBERG RALPH M RETTBERG · Due to system limitations, we can only provide a twelve month average balance on depository accounts. Revolvint! Credit Information Account Type Account Number Date of Death Balance Credit Limit Date Opened Date Closed Times Legal Title Late VISA 4264298388317094 MBNA - Revolving credit accounts are no longer serviced by Wachovia Bank. Please contact MBNA at 800-477-9131. VISA 4264298388658265 MBNA - Revolving credit accounts are no longer serviced by Wachovia Bank. Please contact MBNA at 800-477-9131. Other Account Information Account Type SAFE DEPOSIT BOX Account Number Date of Balance Date Opened Date Closed Ledger Collected 0758551600161 3/1 7/1983 0000000614 . ~~..~ WACHOVIA Reference ID: 1128297 LEGAL TITLE: CLAIRE ANN RETTBERG LOCATION: CARLISLE FINANCIAL CENTER 604 E HIGH ST CARLISLE PA 17013 * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. (j))lnLJ iL S-hC1U)) \_ knnifer straub Servicenter Associates Phone: (540)563-7323 ll;js 0000000614 REV-15Q9 EX + (6-98) '* SCHEDULE F JOINTL Y -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire Ann Rettberg FILE NUMBER 21 05 59 If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Son 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 DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2/2/00 Wachovia Bank, N.A., Checking Account 3,456.05 50. 1,728.03 #1010083586792 2. A 2/2/00 Wachovia Bank, N.A., Money Market Account 15,687.91 50. 7,843.96 #1010083586802 TOTAL (Also enter on line 6, Recapitulation) $ 9,571.99 (If more soace is needed. insert additional sheets of the same sizel REV-1510 EX + (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire Ann Rettberg FilE NUMBER 21 05 59 Isse uemus compee an e answer 0 any 0 ques ons mug on e reverse SI e 0 e - IS yes, DESCRIPTION OF PROPERTY ITEM INClUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1, There IS no mdIcatIOn that the M&T savmgs account that was closed on 7/23/04 was closed for the benefit of anyone other than Decedent. TOTAL (Also enter on line 7 Recapitulation) $ Th' hed I too It d dfiledifth ti 1th h4 th 'd f th REV 1500 COVER SHEET' {If mnl'P ~n:lr.A i~ np.Mp.rf inAArt :lrfrfilinn:ll ~hp.p.f!:: nf thp. AAmp. ~i7P.\ r!M&TBank Manufacturers and Traders Trust Company, 100 SoUth Spring Garden Street, Carlisle, PA 17013 717240 4525 F/\X 717240 4526 Apri15,2005 Wayne F. Shade Attorney at Law 53 W Pomfret Street Carlisle Pa 17013 Attention Connie: Here is the infonnation that I have in regards to the closed Passbook Savings Account # 21000001191361. Account Titled: Claire Ann Rettberg 620 Letort Spring Rd Carlisle Pa 17013 Balance as of 7/23/2004 $ 1681.73 This Passbook Savings and the CD would have had no statements issued. Therefore with the CD since it was closed in 2000 and the bank was Allfirs~ I was unable to retrieve any records with balances or account titles. I hope you find this information helpful and if you have finther questions please do not hesitate to contact me. rrbd~ ~Fraker ~ .d o S ~ .ON ~VOS: II SOO~.S .~d\f REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Claire Ann Rettberg FILE NUMBER 21 05 59 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Holcombe Funeral Home, Inc., funeral expenses 1,712.90 2. The Lakeside Inn, funeral luncheon 955.08 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. Attorney Fees Wayne F. Shade, Esquire 9,000.00 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 Register of Wills of Cumberland County, P A 302.00 5. Accountanfs Fees 6. Tax Retum Prepare~s Fees 7. Cumberland Law Journal, advertise Letters Testamentary 75.00 8. Abbotts Antiques, personal property appraisal 25.00 9. Rose N. Warren, reimbursement for travel and food expense 58.81 10. Borough of Carlisle, water service 107.69 II. PP&L, electric service 133.56 12. The Sentinel, advertise Letters Testamentary 137.03 13. Borough of Carlisle, water and sewer 18.86 14. Diversified Appraisal Services, real estate appraisal 300.00 15. PPL, electric service 9.63 16. State Farm, homeowner's insurance 267.00 17. Borough of Carlisle, water and sewer 30.36 18. PPL, electric service 8.21 TOTAL (Also enter on line 9, Recapitulation) $ 13,881.40 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) I - Continuation of REV-1500 Inheritance Tax Return Resident Decedent Claire Ann Rettberg Decedent's Name Page 1 21 05 59 File Number Schedule H - Funeral Expenses & Administrative Costs _ B7. ITEM NUMBER DESCRIPTION AMOUNT 19. Borough of Carlisle, water and sewer 18.86 20. All Mechanical Contractors, Inc., winterize house 96.08 21. PPL, electric service 115.72 22. Borough of Carlisle, water and sewer 18.86 I 23. Borough of Carlisle, water and sewer 20.75 24. Rose N. Warren, reimbursement for notary expense 5.00 25. Register of Wills, filing Pennsylvania inheritance tax return 15.00 26. Register of Wills, reserve for filing Account, etc. 450.00 I SUBTOTAL SCHEDULE H.B7 740.27 r - .REV-1512 EX + (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire Ann Rettberg FILE NUMBER 21 05 59 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Darlene L. Moyer, per capita tax 9.90 TOTAL (Also enter on line 10, Recapitulation) $ 9.90 (If more space is needed, insert additional sheets of the same size) .'"'''''''' '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire Ann Rettberg NUMBER I. 1. 2. 3. 4. 5. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Richard S. Rettberg 7 Edgemere Road Middleton, MA 01949 Rose N . Warren 19 Mine Run Road Schwenksville, P A 19473 Patricia A. McGough 139 Lin Brook Drive Newport News, VA 23602 Ivan W. Rettberg 548 Miller Fork Road LaFollette, TN 37766 Ralph M. Rettberg 99 Regency Woods North Carlisle, PAl 7015 I FILE NUMBER 21 05 59 RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal 0.20 Lineal 0.20 Lineal 0.20 Lineal 0.20 Lineal 0.20 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) $ --T . REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation irotal Amount Paid within three calendar months of the decedent's date of death: ~ 4,300.00 iscount: 226.31 nterest Table Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 i 2005 2006 2007 2008 i 184 - fm 365 365 81 ~~t:~i~: [_ ~~~;c;~rue _ _[- t~~re;__ -- ~_n ----___ ___ _____ .___u_ ---I~~------ . -~~-- . - -t--~~--t;=--~~~~ -r- . - - =-t= - --=-- = -- r-- -- -~ --=+~--~- -. -- .- .L~. ~..~~.:H:#j~-~--=-~~!,~~i I 835.771 12.99 i - -::: -j - -~t -- - -=~- -- -=~ ~-~f--- n ------ I i _ -______1___ ____ ~_ nn L4 7. 99! Year TOTALS 530 ,Penalty Calculation 1f the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: rally