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Home My WebLink About02-0003PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of'~Lf~ ~- ~-~/~ No. ~ { -- O t .-O~ ~ also known as To: Deceased. Social Security Register of Wills for the. County o f~r~ ~ ~ r't/~ ~t ~ in.the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/_~t~ 18 years of age or older, appl )~'~ 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 ~49/90 ~)~C-~kJi~> Ciuntyl Pennsylvania with hi~5 last family or principal residence at IL~L~---~'7-v(~ (list street, number and m/unicipality) De.cendent, then * ~. years of age, died Decendent at death owned property with estir~ated values as folllows: (If domiciled in Pa.) All personal property $ /~/ (If not domiciled in Pa.) Personal· property in Pennsylvania $ (If not d67_mi_cjled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner after a proper search ha the following spouse (if any) and heirs: Name ascertained that decedent left no will and was survived by Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of' letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF 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 r~presentative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed,'a.a, a4~ subscribed before pge this '~ C:3. i_ day of ~ , - ~:~ R/egisfeer7 , Deceased -~ 'G~NT OF LETTERS OF ADMINISTRATION AND NOW JANUARY 3, 7tl)2002 , in consideration of' the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED 'that LINDA LARSON is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to LINDA LARSON in the estate of CHARLES W. L/LRSON ('/ Register of Wills FEES Letters of Administration ..... $ /40.00 Short Certificates(/4) .......... $ 12.00 Renunciation ................ $ 5.00 JCP $ 5.00 · TOTAL $ 62.00 ..................... Xl~ 2002 Filed JANUARY 3 A.D. ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE LETTERS GIVEN TO ADMINISTRATRIX JANUARY 3, 2002 21-02-0003 RENUNCIATION In Re Estate of deceased. To the Register of Wills of County, Pennsylvania. The undersigned ~ 0/~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to ,~oo/L, WITNESS. hand this ~ day of ~ ,~,140/~ , ~ (Signature) (Address) (Signature) (Address) (Signature) (Addr~s) '7000 0600 002.5 15'95 o~ o~ 90. :t~ MAY 1 6 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ~ NO. REQUEST TO CONDUCT A RULE 5.6(e), SUPREME COURT COURT RULE Clerk, lJary 3, 200_p i3, 2002 , Register of Wills, in accordanc6 with Rule 5.6, :reby nohfies the Orphans Court D~ws~on, Court of ! · · .hat neither the above named personal repreSentative nor >resentative have filed with the Register of Wills or :s certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on 4- q .3,20 0 ~ , and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and:the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the'delinquent personal representative or counsel for the delinquent personal representative. Date: MAY Distribution: Mary,. Lewi;, Register oTWills - '~t/ ~' Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for 2///~ ~,~Lat ~,'~dg~t?/~ Courtroom No 3 if the Certification of Notice is filed prior t~ the h/earing date, the hearing will automaticaily'be ' cancelled. ~ Geor{ge .t~'of~er, 1g.J. ' ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: C H A R L E S W. L A R S 0 N Date of Death: December 29, 2001 Will No. Admin. No. 2 0 0 2 - 0 0 0 0 3 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 · Name Address · ~d:ofi' C. Larson 2339 Tenth St. "B" Berkeley CA 94710 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Linda E. Larson Address 310 S. Market Street Mechanicsburg PA 17055 Telephone ~ 1 7) 7 9 O- 0 7 5 1 Capacity:__X Personal Representative Adm i n i stratr i x __Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent:' CHARLES W. LARS0N Date of Death: December 29, 2001 Will No. Admin. No. 2002 - 00003 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: State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonablY believes that the administration will be~ complete: August 15, 2002 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 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 d. Copies ~f receipts, releases, joinders and approvals of formal.or informal aCcounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. v Signature Linda £. Larson Name (Please type or print) 310 S. Market St., Mechanicsburg PA ~7055 Address (717) 790-0751 Tel. No. Capacity: X Personal Representative ( MAH: rmf/AM3 ) Counsel for. personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 '/128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001 649 LARSON LINDA PO BOX 493 UWCHLAND, PA 19480 ........ fold ESTATE INFORMATION: SSN: 146-10-7747 FILE NUMBER: 21 02-0003 DECEDENT NAME: LARSON CHARLES W DATE OF PAYMENT: 09/25/2002 POSTMARK DATE: 09/24/2002 COUNTY: CUMBERLAND DATE OF DEATH: 12/29/2001 ACN . ASSESSMENT CONTROL NUMBER AMOUNT 101 $290.65 TOTAL AMOUNT PAID: $290.65 REMARKS: LINDA E LARSON SEAL CHECK#265 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ':~anda Larso~ . - 13~0 ~,,~.f.-,~drket Street i~-' ~ech~n~csburg PA 17055 REGISTER OF WILLS OF CUMBERLAND COUNTY Cumberland County Courthouse Carlisle PA 17013 REV-1500 EX (6-00) / , COM ONW A HO I ~ . PENNSYLVANIA ' ~~~ ~EPARTMENT OF REVENUE INHERITANCE TAX RETURN ms.060 RESIDENT DECEDENT Z UJ LU DECEDENT'S NAME (~ST, FIRST, AND MIDDLE INITIAL) CHARLES N. LARSON D~E OF DE~H (MM-DD-YEAR) D~E OF BIRTH (MM-DD-YEAR) · $2/29/01 01/2M09 OFFICIAL USE ONLY FILE NUMBER / NUMBER SOCIAL SECURITY NUMBER. -/o - 7 7-/7 III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER W THIS RETURN MUST BE FILED IN DUPI'ICATE WITH THE REGISTER OF WILLS ~]1. Original Return E~4. Limited Estate [~6. Decedent Died Testate (Attach copy of Wifl) [~9. Litigation Proceeds Received [~2. Supplemental Return .[~ 4a. Future Interest Compromise (date of death after 12-12-82) []7. Decedent Maintained a Living Trust (Attach copy of TnJst) [~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 3. Remaihde~ Reidrn (date of death pdor to 12-13-82) E~]5. Federal Estate Tax Return Required 8. Total Number 0f Safe Deposit Boxes ~'~ 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Linda E. La'rson FIRM NAME (If Applicable) 717-790-0751 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) -']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. 14. (1) None (8) 22,531.82 None (3) None (4) None x .o45 x .,12 x .15 i5) .22,531..82 None (6) (11) · (12) (13) (14) 16,072.92 6,458.90 (7) (9) None .8,913.93 (lO) 7, 158.99 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax(Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 6,458.90 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 19. Tax Due 20. i15) (16) (17) (!8) (19) 6,458.90 2,90,. 65 290.65 OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SbHEDULi A REAL ESTATE ESTATE OF . FILE NUMBER CHARLES ~l. LARSON 2002 - 00003 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 property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION NONE TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE - OF DEATH COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARLES W. LARSON scHEDULE B STOCKS & BONDS FILE NUMBER 2002 - 00003 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. NONE TOTAL (Also enter on line 2, Recapitulation) (if more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-1504 EX+ (1-97) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARLES W. LARSON SCHEDULE C' CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER 2002 - 00003 ITEM NUMBER NUMBER 1. Schedule C-1 or C-2 (including all supporting information) must he attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorsh ~s. NONE DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (1-97) COMM6NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF CHARLES W. LARSON FILE NUMBER 2002 - 00003 All property iointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE DESCRIPTION OF DEATH ITEM NUMBER NONE TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) P. EV.15~*(I-9~ .,~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEisO$i'~, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER CHARLES W. LARSON 2002 - 00003 Include the proceeds of litigauon 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 e 3. 4. 5. DESCRIPTION Allfirst Bank, Checking Account #28821025 Allfirst Bank, Money Fund #00982-8028-7 Waypoint Bank, Savings Account #202126536 Oppenheimer Fund #3003005523518 Misc. Persona! Effects TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 2,862.95 7.;~347.43' 6,100.97 6,195.47 25.00 $ 22,531.82 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F. JOINTLY-OWNED PROPERTY FILE NUMBER CHARLES W. LARSON 2002 - 00003 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. NONE JOINTLY-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 identifying number. Att. ach DATE OF DEATH DECD'S VALUE OF ~IUMBER. TENANT JOINT deed for jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES' 1. A. : TOTAL (Also enter on line 6, Recapitulation)$ (If more space is needed, insert additional sheets of the same size) RE"V-1510 EX * (I-97) ~ COMMONWEALTH OF PENNSYLV^NI^ INHIFRIT^NCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE 'PROPERTY ESTATE OF FILE NUMBER CHARLES W. LARSON 2002 - 00003 This schedule must be completed and filed if the answer toany of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET m es. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NNdE OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT N~ID THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE AT T,*~:. A COPY OF THE DEED FOR ~ ESTATE. NUMBER VALUE OF ASSET INTEREST (IF APPLIC. ABLE) 1. NONE TOTAL (Also enter on line 7, Recapitulation) $ (If mom space is needed, insert additional sheets of the same size) REVo1511 EX+ (12-99) COMk;IONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSEs & ADMINISTRATIVE COSTS ESTATE OF CHARLES W. LARSON FILE NUMBER 2002 - 00003 ITEM NUMBER 2. 3. 4. 5: 6. 8. 9. 10 B. 1. Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERALEXPENSES: Parthemore Funera! Home & Cremation Services, Inc.. Parthemore Funera! Home --Cemetery charge Dillsburg Cemetery Association -Vault for Ashes Baughman Memorial Works, Inc.- Grave Marker Funera! Flowers - Royer's Honorari. ums ~..Minister,~nd*'Organ~st Progress Immanual. Women's Assn. - Service Luncheon Memorial Packets & Tapes for out of town elderly relatives Messiah Village Memorial Servt~e - Ministers, etc. Cost of change of flight for son & wife' ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ~ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Death Certificates Administratrix Expense Moving personal files, Larsons apt. at -- Postage, Telephone, Supp!ies papers, etc.and cleaning Char!es W. Messiah Village AMOUNT 5,981.26 250.00 100.80 415.00 204.31 200.00 300.00 108.92 350.00 200.00 62.00 9.00 67.64 665.00 TOTAL (Also enter on line 9, Recapitulation) $ 8, 913.93 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARLES W. LARSON SCHEDUL~ i DEBTS OF DECEDENT, MOETGAGE LIABILITIES, & LIENS FILE NUMBER 2002 - 00003 Include unreimbursed medical expenses. ITEM NUMBER o 5. 6. 7. DESCRIPTION Messiah Village Nursing Home Special Care Dr. John M. Sullivan. Dr. Pau! D. DaIbey A!ert Pharmacy Progres~ Immanuel Presbyterian, ChuPch PA Dept. of Revenue - balance due, PA Income Tax TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 2,642.72 2,772. O0 "422.00 30.00 33.53 1,000.00 258.74 $ 7,158.99 REV-l$13EX*(1-97) * ~ COMMONWEALTH OF PENNSYLVAN A INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIAJ i s ESTATE OF FILE NUMBER CHARLES N. LARSON 2002 - 00003 RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS (include outdght spousal distributions) II. 1. Jon C. Larson (Son) 2339 Tenth St., ~"B" Berkeley CA 94710 Linda E. Larson 310 S. Market St. Mechanicsburg PA 17055 ENTER DOELAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINEI Son Daughter AMOUNT OR SHARE OF ESTATE 3,229.45 3,229.45 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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) ~ 'BUREAU,OF TNDTVTDUAL TAXES :~NHERZTANCE TAX DzVZSTON (~EPT. 18060! HARRISBURG, PA [7128-0601 LINDA E LARSON $10 S MARKET ST MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF /NHERZTANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 11-11-2002 ~,!ESTATE OF LARSON DATE OF DEATH 12-29-2001 FILE NUMBER 21 OZ-O00$ ~GQq,"~UNTY CUMBERLAND ACN 101 Amount: RemA~:~:ed REV-IS4? EX AFP (01-02) CHARLES MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ - ................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LARSON CHARLES WFZLE NO. 21 02-0005 ACN 101 DATE 11-11-2002 TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e {Schedule A) (1) 2. S~ocks and Bonds (Schedule B} $. Closely Held S~:ock/Par~cnershAp In*eras* (Schedule C) ($) q. Mortgages/No,es ReceAvable (Schedule D) (q) 5. Cash/Bank DeposA~s/MAsc. Personal Proper~y (Schedule E) (5) 6. Jointly Owned Propar~:y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~:s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Cos~s/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage LAabAli~ies/Liens (Schedule T) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn .ZZ~5~1.BZ .00 .00 NOTE: To Ansure proper .00 credi~ ~o your account, .00 submA~ ~he upper portion .00 of ~hAs form wASh your ~ax payment. .0O (8) 8,713.93 15. lq. NOTE: 22,551.82 7~158.99 (zz) ]5.872.g2 (12) 6,658.90 CharA~able/Governmen~al Bequests; Non-eZec*ed 911:5 Trus~:s (Schedule J) (15) Ne~ Value of EState Sub.~ec~: ~o Tax (1fi) If an assessment ~as lssued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 6,658.90 18 and 19 w111 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE INTEREST IS CHARGED THROUGH 11-26-2002 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 290.65 9.00 .09 9.09 ( TF TOTAL DUE TS LESS THAN ~1, NO PAYMENT TS RE~)UTRED. TF TOTAL DUE TS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS.) ASSESSMENT OF TAX: 16. Amoun~ of LAne lq a~ Spousal re~e 16. Amoun~ of LAne lq *axable a~ Lineal/Class A ra~e 17. Amoun~ of LAne lq a~ Sibling ra~e 18. Aaoun~ of L/ne lq *axable a~ Collateral/Class B ra~e 19. PrAncApel Tax Due TAX CREDITS: PAYMENT RECE/PT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 09-Zq-ZOOZ CDOO16q9 .00 Z90.65 AMOUNT PAID (IS) .00 X O0 = .00 (X6) 6,658.90 X Oq5= 299.65 (17) . O0 X 12 = . O0 (ia) .00 x 15 = .00 (~9)= 299.65 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: D[SCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any futu're 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 Commonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafuI Class i (collatmrat) rate on any such future interest. To RJlfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, mhich 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 Hills, any of the 13 Revenue District Offices, or by calling the specia! Z~-hour answering service for forms ordering: 1-800-362-ZO50;'services for taxpayers with special hearing and / or speaking needs: 1-800-4~7-3010 (TT only). , Any party in interest not satisfied with the appraisement, allowance, or dis~llowance 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 tm the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PADepartment of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, Dept. Z80601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) far an explanation of administratively correctable errors. ; If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty nan-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, tho 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 is charged beginning aJth 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, 1981 bear interest at'the rate of six (61) percent par annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year eith 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 1982 202 . O005~.8 1992 97. 1985 16Z .000~38 1993-199~ 72 . 198q 112 .000301 1995-1998 92 1985 131 .000356 1999 7X 1986 IOZ · 00027~ 2000 81 1987 92 · 0001~7 2001 92 1988-1991 117. .O003Ol 200Z 62 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Rate Daily Interest Factor X NUNBER OF DAYS DELINI~UENT o0002~7 .000192 .0002~7 .000192 .000219 .0002q7 .00016~ X DAILY INTEREST FACTOR --Any'N&ticm 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 calculatmd. REV-1470 EX (6-88) ~ ,~ ~1 INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA CHANGES ' DEPARTMENT OF REVENUE OF . .: BUREAU OF INDIVIDUAL TAXES ' ' ' - ' . - DEPT. 280601 .:. , HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER Charles W Larson · ' 2102-0003 REVIEWED BY . ACN Deborah Washington . " ' .' ,:'-'.' .'.. ,,. " 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES h A-10 The deduction for travel expenses has been disallowed. The executor or administrator of the estate is the only person entitled to claim these expenses in. conjunction with the administration of the estate. '. .. .. ROW . Page 1 BU~E'~U OF INDIVIDUAL TAXES TNHERITANCE TAX DTVISION DEPT. Z80601 HARRISBURg, PA 171Z8-0601 COHMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ~ '.~.~.': I1':1'1~2002 ESTATE :IS~, ~:A~ DATE OF DEATH 12-29-2001 COUNTYU~ I~LH/ Z~UM.B~R~/~ND ACN 101 REV-15~? EX AFP (01-02) CHARLES MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMgERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LONER PORTION FOR YOUR RECORDS BL~E'~,U OF TNDTVZDUAL TAXES ]'NHERZTANCE TAX DZVI'SI'ON DEPT. 280601 HARR][SBURG, PA 171Z8-0601 LTNDA E LARSON 310 S HARKET ST' HECHANI'CSBURG PA 17055 COHNONtqEALTH OF PENNSYLVAN'rA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT,, ALLO#ANCE OR DZSALLOgANCE OF DEDUCTZONS AND ASSESSHENT OF TAX DATE r~ i': ' J.~,,',,:'I1:~'I1'-'2002 ESTATE OF ..... :£ ARS'OH CHAR ES DATE OF DEATH 12-29-2001 COUNTYU~ I~UV Z~CUH.BdR~]/t~iD ACN 101 HAKE CHECK PAYABLE AND REHIT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THTS LZNE ~ RETA.ZN_~LOgER PORTZON FOR YOUR RECORDS REV-15~7 EX AFP Name of Decedent: Date of Death: Will No.: STATUS REPORT UNDER RULE 6.12 Admin. No.: 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 D 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 - 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 i~ No [-~']. ' ...... Date: Co 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. Capacity: Nanle Address 717- OZ- fo Telephone No. [~ersonal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD, 001 870 LARSON LINDA PO BOX 493 UWCHLAND, PA 19480. ........ fold ESTATE INFORMATION: SSN: 146-10-7747 FILE NUMBER: 2102-0003 DECEDENT NAME: LARSON CHARLES W DATE OF PAYMENT: 11/21/2002 POSTMARK DATE: 11/19/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/29/2001 ACN ASSESSMENT .. CONTROL NUMBER AMOUNT 101 ¢9.09 TOTAL AMOUNT PAID: 99.09 REMARKS: CHECK# 272 INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~~-~ ~ .3 COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISIDN DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REY-1607 E% AFP (01-02~ DATE 12-09-2002 ESTATE OF CARSON CHARLES W DATE OF DEATH 12-29-2001 FILE NUMBER 21 02-0003 ?COUNTY CUMBERLAND LINDA E CARSON ACN 101 310 S MARKET ST Amount Remitted MECHANICSBURG PA 170'55 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP t01-02) *~* INHERITANCE TAX STATEMENT OF ACCOUNT **~ ESTATE OF CARSON CHARLES W FILE N0. 21 02-0003 ACN 101 DATE 12-09-2002 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: 11-11-2002 PRINCIPAL TAX DUE: PAYMENTS tTAX CREDITS): 299.65 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID t-) AMOUNT PAID 09-24-2002 CD001649 .00 290.65 11-19-2002 CD001870 .08- 9.09 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, 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. ) 299.66 .O1CR .00 .O1CR PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and aaaress printed on the reverse side. -- If RESIDENT DECEDENT make check ar money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make 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 far 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 Dffices ar from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TD: 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 L717) 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 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 C9) 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 (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% .OOD548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .OOD192 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 NUMBER 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.