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Home My WebLink About04-0269REV- 1500 EX + (6-00} D E C E D E N T R E C A P I T U L A T I O N C 0 M T I O N COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-04- o zg? COUNTYCODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Powell D 185-38-4844 DATE OF DEATH (MM -OD-YEAR) DATE OF BIRTH (MM-DO-YEAR) IF APPLICABLE) SURVIVING SPOUSE'S NAME LAST, FIRST, REGISTER OF WILLS SOCIAL SECURtTY NUMBER 1. Original Return ~J 2 Supplemental Return 4 Limited Estate ~4; Futurelnterest Compromise(date of death after 12-12-82) r~9 LltigatlonProceedsRecelvod r--IlO spousalPovertyCredlt Remain- - r (dateof death aer Hetu n prior to 1Z- 13-82) Federal Estate Tax Return Required Total Number of Safe Deposd Boxes ] Election to tax under Sec 9113(A) 11 (Attach Sch O) ~THIS~SECTIONIMUST~BE COMPLETE~ALC~CORRESPONDENCE~&~CONFIDENTIAL%TAX~INFORMATION SHOULD BE~DIRECTED ~TO.~~ NAME RoRer B. Irwin Esq. IRWIN & McKNIGHT TELEPHONE NUMBER 717/2/,9-2353 COMPLETE MNLING ADCRESS 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 I Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Propnetorshlp 4 Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposes & Mmcellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate B~lhn§ Requested 7 Inter-Vivos Transfers & M~scel[aneous Non-Probate Property (7) (Schedule G or L) 8 Total Gross Assets (total L~nes 1-7) 9 Funeral Expenses & Admlnmtratlve Costs (Schedule H) (9} 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule ~) (10) 11 Total Deducbons (total L~nes 9 & 10) 12 Net Valueof Estate(L~ne 8 minus Line 11) 13 (1) None (2) (3) (4) 184.~5. 12,558.50 None OFFICIAL USE ONLY (8) 861.51 (11) 12,558.50 (12) (11 ~696 99) (13) Chantable and Governmental Bequests/Sec 9113 Trusts for which an elecbon to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 rr~nus Line 13) (14) (11,696.99) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of L~ne 14 taxable at the spousal tax rate, or transfers under Sec 9116(aX 1 2) x 0 0 (15) 0.00 16 Amount of Line 14 taxable at hneal rate (11,696.99) X 0 45 (16) 0.00 17 Amount of Lone 14taxable at mbhng rate X 12 (17) 0.00 18 Amountof Line 14 taxable at collateralrate X 15 (18) 0.00 19 Tax Due (19) 0. O0 20 ~.~ ~.~.~:~,~ ~ ~ BE SURE,TO,ANSWER AI~I:~QUEST OtIS ON~REVERSE,S DE AND TO RECHECK MATH~ Copyright (c) 2COO form software only T he Lackner Group I r~ Form REV-1500 EX (Rev 6-o0) Decedent's Complete Address' STREET ADDRESS 1850 Wa~oners Cap Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1 Tax Due (Page 1 Lie 19) 2 Credits/Payments A Spousal Poverty Credit B Pnor Payments C Discount (~) Total Credos ( A + B + C ) (2) Interest/Penalty if apphcable D Interest E Penalty Total Interest/Penalty ( D + E ) (3) If Lie 2 ~s greater than Line 1 + Line 3, enter the d*fference This is the OVERPAYMENT Check box on Page 1 Lie Z0 to request a refund (4) If Line 1 + Line 3 IS greater than Line 2, enter the difference This is the TAX DUE. (5) A Enter the mterest on the tax due (SA) B Enter the total of Line 5 + 5A Thru Is the BALANCE DUE (SB) Make Check Payable to REGISTER OF WILLS, AGENT PLE'ASE ANSWER THE FO IN UES S PLAC'II~'~ AN "X" IN PRIATE BLOCKS Did decedent make a transfer and Yes No a retain the use or income of the property transferred, [-~ ~-~ b retam the right to destgnate who shall use the property transferred or its income, c. retain a reversionary mterest, or d receive the promise for life of either payments, benefits or care~ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? [] Did decedent own an "mn trust for" or payable upon death bank account or security at or her death? [] [] D~d decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary des~gnabon? [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 0.00 0 O0 0.00 O. O0 0 O0 Under penalties of perjury, I declare that I have examined thru return, Includ~r~j accompeny*ng schedules and statements, and to the best of my knowledge/and belief, it m true, correct and complete Declarahon of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATUREOFPERSONRESPONSIBLEFORFILINGRETURN Dwaln E. Powell DATE 1850 Waggoners Gap Road SIGNATUREOFPREPAREROTHERTHANREPRESENTATIVE IRWIN & HcY-_NIGHT DATE ./~,. ~ ~ 60 West Pomfret Street ' ', ........................... For dates of d 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 surwwng spouse is 3%I72 P S 9116 (a) (1 1) (I)] For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surwwng spouse IS 0% [72 P S 9116 (a) (1 1) 0D1 The statute does not exempt a transfer to a surwwng spouse from tax, and the statutory requirements for disclosure of assets and fllmg a tax return are st~ll apphcable even ¢ the surviving spouse Is the only beneficiary For dates of death on or after July 1 2000 The tax rate ~mposea 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 ~s 0% [72 P S 9116 (a) (1 2)] The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneflc~anes ~s 4.5%, except as noted In '/2 P S 9116(1 2) [72 P S 9116(a)(1)] The tax rate Imposed on the net value of transfers to or for the use of the decedent s s*bhngs is 12% I72 P S 9116(aX 1 3)] A s~bhng is defined, under Section 9102 as an ~nd~wdual who has at least one parent m common with the decedent, whether by blood or adoption Copyr~ght(c) 2OOO form software on~ The Lackner Group Inc Form REV-1500 EX (Rev 6-00) REV-t503 EX + (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE B STOCKS & BONOS FILE NUMBER Gary D. Powell SS~/ 185-38-4844 12/09/2003 All property jointly-owned w~th right of surv~vorshtp must be disclosed on Schedule F 21-04- ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 $25 U.S Savings Bond issued 05/1973 129.89 2 $50 EE U S. Savings Bond issued 12/1984 74.60 TOTAL (Also enter on hne 2, Recapitulation) 204.49 (If more space ~s needed, ~nsert additional sheets of the same s~ze) Copyright(c) 1996 form softwareonly CPSystems, lnc Form REV-1503 EX (Rev 1-97) REV- %508 EX + (1-97) COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER Gary D. Powell SS{/ 185-38-4844 12/09/2003 21-04- Include the proceeds of htlgatlon and the date the proceeds were received by the estate All I~rope~'ty jointly-owned wrth the right of surwvorship must be disclosed on Schedule F iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T Bank, checking account 472,87 TOTAL (Also enter on hne 5, Recapitulation) $ 472.87 (If more space Is needed, insert additional sheets of the same size) Copyright(c) 1996 formsoftware only CPSystems, lnc Form REV-1508 EX (Rev 1-97) REV- ~509 EX + (1-97) SCHEDULE F COMMO.WE^LTH OF PENNSYLV^.~^ JOINTLY-OWNED PROPERTY iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gary D. Powell SS~ 185-38-4844 12/09/2003 if an asset was made jmnt w~thln one year of the decedenfs date of death, ~t must be reported on Schedule G FILE NUMBER 21-04- SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Dwain E. Powell Father B C 1850 Waggoners Gap Road Carlisle, PA 17013 JOINTLY-OWNED PROPERTY LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINl MADE Ir~l~lertameoff[~ar~lallnstltutlonandbank DATE OF DEATH DECD'S VALUE OF account number or similar Identifying number ',lUMBER TENANT JOINT Attachdeedforjointly-heldrealestate VALUE OF ASSET INTEREST )ECEDENT'SINTERES 1 A 03/21/94 Members First Federal 368.29 50.007, 184.15 Credit Union - regular savings account TOTAL (Also enter on bne 6, Recapitulation) $ 184.1.5 (if more space is needed ~nsert additional sheets of the same s~ze) Copyright (c) 1996 form software only CPSystems, Inc Form REV-I$09 EX (Rev 1-97) .EV-~0 EX~(f-ST~ SCHEDULE G INTER-VIVOS TR.II~ISFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Gary D. Powell SS~ 185-38-4844 12/09/2003 21-04- Thru schedule must be completed and filed If the answer to any of questions I through 4 on page 2 is yes DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND TH E DATE OI~ TRANSFER NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST 0F APPLICABLE) 1 M&T IRA - not subject to 0.00 0.00 tax, under age 59 1/2 TOTAL (Also enter on line 7, Recapitulation) $ 0.00 (If more space ~s needed, ~nsert additional sheets of the same s~ze) Copyright (c) 1996 form software only CPSystems Inc Form REV-1510 EX (Rev 1-97) REV-tS. EX +0-971 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Gary D. Powell SS~ 185-38-4844 12/09/2003 FILE NUMBER 21-04- Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A 1 2 3 B 1. 2 3 4 5 6 7, FUNERALEXPENSES Cumberland Valley Memorial Gardens - plot, vault & internment Gravemarker Hoffman-Roth Funeral Home ADMINISTRATIVE COSTS Personal Representative's Commlssioi3s Name of Personal Representative(s) Social Securffy Number(s)/EIN Number of Personal Representahve(s) Street Address C,ty State Z~p Year(s) Commission Paid Attorney's Fees IRWIN & McKNIGHT Family Exemption (If decedent's address m not the same as claimant's, attach explanation) Clmmant Dwain E Powell Street Address 1850 Wa~oners Gap Road C,~/ Carlisle Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Register of Wills - filin§ £ee father State PA Z~p17013 TOTAL (Also enter on line 9, Recap~ulation) 1,693.00 1,014.00 5,966.50 375.00 3,500.00 10.00 12,558.50 (If more space is needed, insert add~bonal sheets of the same raze) Copyright (c) 1996 form software onh/CPSystems, I nc Form REV-1511 EX {Rev 1-97) REV-3533 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF Gary D. Powell SS# 185-38-4844 NUMBER 2 SCHEDULE J BENEFICIARIES 12/09/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spo~al distributions, a~ t~nsfers under Sec 911~a)(1 Dwain E. Powell 1850 Waggoners Gap Road Carlisle, PA 17013 Ruby B. Powell 1850 Waggoners Gap Read Carlisle, PA 17013 II RELATIONSHIP TO DECEDENT Do Not L~st Trustee(s) Father FILE NUMBER 21-04- Mother AMOUNT OR SHARE OF ESTATE 1/2 remainder 1/2 remainder ENTER DOLLAR AMTS FOR DISTRIBUTIONS SHOWN ABOVE ON LN 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SEC 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 $ 0.00 (If more space IS needed, insert addlbonal sheets of the same size) Copyright (c) 2000 form software only The Lackner Group Inc Form REV- 1513 EX (Rev 9-00) LAST Vi/ILL AND TESTAMENT I, GARY D. POWELL, of North Mlddleton Township, Cumberland County, Permsylvama, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me 1 I direct my Executors to pay all of my debts, funeral and admlmstrat~ve expenses as soon as may be done convemently after my decease 2 I authorize and empower my Executors to sell any realty owned by me at my death, and not specifically demsed herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee s~mple, as I could do lfhwng. 3. I devise and bequeath all of my estate of every nature and wherever situate to my parents, DWAIN E. POWELL and RUBY B POWELL, or the surmvor thereof 4. Should the gift in Paragraph No 3 not take effect, I de~se and bequeath all of my estate of every nature and wherever situate to REBECCA A MYERS and DEBBIE R GOSSERT, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living. 5 I nominate and appolnt DWAIN E POWELL and RUBY B POWELL to be the Co- Executors of this my Last Will and Testament; they are to serve as such without bond Should they die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadmmlstered, I nominate and appoint REBECCA A MYERS and DEBBIE R GOSSERT as subsumte Co-Executrices, also to serve as such without bond, with the same powers as are g~ven herein to my Co-Executors. IN WITNESS WHEREOF, I have hereunto set my hand and seal tNs __ July, 2003 day of Signed, sealed, published and declared by GARY D. POWELL, the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscribed our names as w~tnesses hereto ACKNOWLEDGEMENT AND AFFIDAVIT WE, GARY D. POWELL, SHARON L. SCHWALM and KAMELA S. CORNMAN, the testator and wxtnesses respectxvely, whose names are sxgned to the foregoing xnstrument, being first duly sworn, do hereby declare to the undersigned authority that the testator s~gned and executed the xnstrument as his Last Will and that he had s~gned wflhngly, and that he executed xt as his free and voluntary act for the purpose hereto expressed, and that each of the wxtnesses, xn the presence and heanng of the testator, sxgned the Will as a witness and that to the best of their knowledge the testator was, at that t~me, e~ghteen years of age or older, of sound mind and under no constraint or undue influence GARY D. POX~ELL ] KAMELA S. CORNMAN COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by GARY D. POWELL, the testator, and subscribed and sworn to before me by SHARON L. SCH~VALM and KAMELA S. CORNMAN, w~messes, this ~ day of July, 2003 /~Not~ry Public Roger B trOiln, Nota~/ Public ,?a~isle ,Bo~, Cumberland County Inventory Report Active Inventory Bonds NO Series Denom Serial Number I 2 I E I 25105095075208E Issue Date 12/1984 05/1973 Price Interest $25 00 $49 60 18 75 111 14 Print Date 02/02/2004 Fde Pnc~ng Date 12/2003 I t fext Interes~nal Maturl~ I Va ue [ Rate I Y eld/ Date / Date NoteI $7460 400%I564[ / 06/2004 ~ 12/2014 ~ I 12989 656Yo/ J 05/2003 ! ME I Totals Price Interest $43 75 $160 74 Value$204 49 · cz- bond was Cashed n · EX - bond was EXchanged for an HH bond · ME - bond ~s Matured and Exchangeable for an HH bond · MN - bond ~s Matured and NOt exchangeable for an HH bond · NE - bond ~s Not yet Ehglble for payment 0t's < 6 months old) · NI - bond has Not yet been ~ssued · PS - bond is a Series I or EE, was ~ssued in or after May 1997 and includes a 3-month-interest Penalty unbl the bond is 5 years old · * bond is a Series I or EE, was issued m or after January 1990 and may be tax exempt if used for post-secondary education · ( ) bond was Cashed In or EXchanged for an HH bond, but ~s being pnced on a date prior to the cashed or exchanged date C \My Documents\Gary D Powell Estate sbw Page 1 of 1 499 Mitchell Road, Millsboro, DE 19966 Mall Code DE-MB-12 Irwin & McKnight Attorneys At Law 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Gary D Powell Soctal Securay 185-38-4844 Date o[ Death December g, 2003 Phone (302) 934-2909 F ax (302) 934-2955 January 12, 2004 deposit with thts bank the followmg Type of Account Account Number Ownership (Names od') Opemng Date Balance on Date of Death Accrued lnterest Total 2 Type of. qccount Account Number Ownershtp (Names o99 Openmg Date Balance on Date of Death Accrued lntere~t Total Checking Account 773212 Gary D Powell l 1/01/71 $472 87 $ 000 $472 87 IRA 35004201743752 Gary D Powell Dwame E Powe#, Father, Benefictary 03/25/83 $7,383 28 $ 135 32 $7,518 60 For further account mformat~on, closures and/or retrnbursement of funds please call the H~gh Street-Carhsle Office at #71%2404536 Please be ad,nsed, there was no safe deposa box found for the abm e decedent Records Management Dear Str or Madam Per your mqmry dated December 18, 2003, please be advised that at the time of death, the above-named decedent had on MEMBERS 1" FEDERAL CREDIT UNION DEC 30 2003 IRWrN & McKNIGitT REGULAR SAVINGS ACCOUNT' Account Number/Suffix Date Account Estabhshed Pnnc~pal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/03 to Date of Death Name of Joint Owner Date Joint Ownership Established i 38691 -00 03/21/1994 $368 21 $ 08 $368 29 $6 81 Dwa~n E Powell 03/21/1994 e~n~s~BE~S lSTEEDERAL CREDIT UNION Insurance Supervisor December 29, 2003 Estate of. GARY D. POWELL Date of Death 12/09/2003 Social Security Number: 185-38-4844 500(t Louise Drive * PO Box40 ° Mechamcsburg, Pennsylvanl,t 17{)55 · (717) 697-1161 · wwwmemberslstorg STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: No. 21-04-0269 GARY D. POWELL DECEMBER 9, 2003 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: X Yes __ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No do Date: 05/03/2004 Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Signature IRWIN & MS~I~IGHT Roger B. Irwin, Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle, PA 17013 City, State, Zip (717) 249-2353 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISTON DEPT. HARRISBURG, PA 171Z8-0601 COHMON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ROGER B IRWIN IRWIN 8 MCKNIGHT 60 W POMFRET ST CARLISLE PA 17015 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-O$-ZOOq POWELL 1Z-O9-ZO0$ Z! 0q-0269 CUMBERLAND 101 Amount Ram/'l:'l:ed GARY O MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~> RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF POWELL GARY D FILE NO. 21 0q-0269 ACN 101 DATE 05-05-200q 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. Ram1 Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B} (2) $. Closely Held S~ock/Par:knership Zn~eres~ (Schedule C) (5) q. More:gages/No'cas Race/vable (Schedule D) (q) 5. Cash/Bank Dapos/~s/M/sc. Personal Proper~y (Schedule E) (E) 6. Jo/n~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To'al Asse~cs APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Cos~s/M/sc. Expenses (Schedule H) (9). 10. Debts/Mortgage L/ab/1/~/es/L/ens (Schedule I) (10) 11. To,al Daduc~/ons 12. Ne~ Value of Tax Re~urn ZOq.q9 472.87 .00 NOTE: To /nsura proper cred/~ ~o your account, .00 sube/~ ~he upper por~/on .00 of ~his form wi~h your ~ax payeen~. 184.15 .00 (8) 9,755.86 .00 15. lq. NOTE: 861.51 (11) 9 (la) 8,874.55- Charitable/Governmental Bequests; Non-eZec~ed 9115 Trus~cs (Schedule J) (15) . O0 Net Value of Estate Sub~ect to Tax (lq) 8,874.55- If an assesseent was lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. D/SCUUNT INTEREST/PEN PAID (-) b~"x o~= i)Ox o~ :00 x 1Z~= '.00 x 1~-~= AMOUNT PAID ASSESSMENT OF TAX: 15. Amoun~ of L/ne 1~ e~ Spousal ra~e 16. Amoun~ of L/ne lq ~axable a~ L/naal/Class A ra~e 17. Aeoun~ of L/ne lq a~ Sibling ra~a 18. Aeoun~ of Line lq ~axabla a~ Collateral/Class B ra~e 19. Princ/pal Tax Due TAX CREDITS: PAYMENT RECE/PT DATE NUMBER .00 .00 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .O0 .00 .00 .00 (15) (16) (17) (18) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REIIUZRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 19DZ -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after tho expiration of any estate fcc lifo or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rata on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act) Act 15 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES) AGENT A refund of a tax credit, ehich was not requested an the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of tho Register of Hills, any of the 25 Revenue District Offices) or by calling tho special Z4-hour answering service far forms ordering: 1-800-56Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied with the appraisement) allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue) Board of Appeals) Dept. Z81021, Harrisburg, PA 171lB-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes) ATTN: Post Assessment Review Unit, Dept. 180601) Harrisburg) PA 1711B-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (~) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the totml of the tax and interest assessed) and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest Js charged beginning with first day of delinquency) or nine (9) months and one (l) day from the date of death) to the date of payment. Taxes which became delinquent before January l) 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, [982 will bear interest at a rate mhich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .000548 1988-1991 IZZ .000501 2001 9Z .OOOZ4? 1985 162 .000438 199Z 9Z .000Z47 ZOOZ 62 .000164 1984 llZ .000501 1995-1994 7X .000192 ZOO5 5Z .000157 1985 15Z .000556 1995-1998 9X .000247 ZOO4 41 .000110 1986 IOZ .000274 1999 71 .OOO19Z 1987 lOZ .000274 ZODO 7Z .00019Z --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DEL'rNt~UENT X DA:ELY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Tf payment is made after the interest computation date shown on the Notice) additional interest must be calculated. REV-1470 EX {6-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURGI PA 17128-0601 DECEDENTS NAME FILE NUMBER GARY D. POWELL 2104-0269 REVIEWED BY ACN CHARLES WRIGHT 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H b-3 Reduced to $677.36. Family exemption can only be claimed against assets subject to will or intestacy. ROW Page 1